@article{SchlickeweiNienstedtFranketal.2021, author = {Schlickewei, Ole and Nienstedt, Julie Cl{\"a}re and Frank, Ulrike and Fr{\"u}ndt, Odette and P{\"o}tter-Nerger, Monika and Gerloff, Christian and Buhmann, Carsten and M{\"u}ller, Frank and Lezius, Susanne and Koseki, Jana-Christiane and Pflug, Christina}, title = {The ability of the eating assessment tool‑10 to detect penetration and aspiration in Parkinson's disease}, series = {European archives of oto-rhino-laryngology and head \& neck}, volume = {278}, journal = {European archives of oto-rhino-laryngology and head \& neck}, number = {5}, publisher = {Springer}, address = {Berlin}, issn = {0937-4477}, doi = {10.1007/s00405-020-06377-x}, pages = {1661 -- 1668}, year = {2021}, abstract = {Purpose: Dysphagia is common in patients with Parkinson's disease (PD) and often leads to pneumonia, malnutrition, and reduced quality of life. This study investigates the ability of the Eating Assessment Tool-10 (EAT-10), an established, easy self-administered screening tool, to detect aspiration in PD patients. This study aims to validate the ability of the EAT-10 to detect FEES-proven aspiration in patients with PD. Methods: In a controlled prospective cross-sectional study, a total of 50 PD patients completed the EAT-10 and, subsequently, were examined by Flexible Endoscopic Evaluation of Swallowing (FEES) to determine the swallowing status. The results were rated through the Penetration-Aspiration Scale (PAS) and data were analyzed retrospectively. Results: PAS and EAT-10 did not correlate significantly. Selected items of the EAT-10 could not predict aspiration or residues. 19 (38\%) out of 50 patients with either penetration or aspiration were not detected by the EAT-10. The diagnostic accuracy was established at only a sufficient level (AUC 0.65). An optimal cut-off value of >= 6 presented a sensitivity of 58\% and specificity of 82\%. Conclusions: The EAT-10 is not suited for the detection of penetration and aspiration in PD patients. Therefore, it cannot be used as a screening method in this patient population. There is still a need for a valid, simple, and efficient screening tool to assist physicians in their daily diagnostics and to avoid clinical complications.}, language = {en} } @article{FrankRadtkeNienstedtetal.2021, author = {Frank, Ulrike and Radtke, Julia and Nienstedt, Julie Cl{\"a}re and P{\"o}tter-Nerger, Monika and Sch{\"o}nwald, Beate and Buhmann, Carsten and Gerloff, Christian and Niessen, Almut and Fl{\"u}gel, Till and Koseki, Jana-Christiane and Pflug, Christina}, title = {Dysphagia screening in Parkinson's Disease.}, series = {Neurogastroenterology and motility}, volume = {33}, journal = {Neurogastroenterology and motility}, number = {5}, publisher = {Wiley}, address = {Hoboken}, issn = {1350-1925}, doi = {10.1111/nmo.14034}, pages = {8}, year = {2021}, abstract = {Background Simple water-swallowing screening tools are not predictive of aspiration and dysphagia in patients with Parkinson's Disease (PD). We investigated the diagnostic accuracy of a multi-texture screening tool, the Gugging Swallowing Screen (GUSS) to identify aspiration and dysphagia/penetration in PD patients compared to flexible endoscopic evaluation of swallowing (FEES).
Methods Swallowing function was evaluated in 51 PD participants in clinical 'on-medication' state with the GUSS and a FEES examination according to standardized protocols. Inter-rater reliability and convergent validity were determined and GUSS- and FEES-based diet recommendations were compared.
Key Results Inter-rater reliability of GUSS ratings was high (r(s) = 0.8; p < 0.001). Aspiration was identified by the GUSS with a sensitivity of 50\%, and specificity of 51.35\% (PPV 28\%, NPV 73\%, LR+ 1.03, LR- 0.97), dysphagia/penetration was identified with 72.97\% sensitivity and 35.71\% specificity (PPV 75\%, NPV 33.33\%, LR+ 1.14, LR- 0.76). Agreement between GUSS- and FEES-based diet recommendations was low (r(s) = 0.12, p = 0.42) with consistent NPO (Nil per Os) allocation by GUSS and FEES in only one participant.
Conclusions and Inferences The multi-texture screening tool GUSS in its current form, although applicable with good inter-rater reliability, does not detect aspiration in PD patients with acceptable accuracy. Modifications of the GUSS parameters "coughing," "voice change" and "delayed swallowing" might enhance validity. The GUSS' diet recommendations overestimate the need for oral intake restriction in PD patients and should be verified by instrumental swallowing examination.}, language = {en} } @article{HuckabeeMcIntoshFulleretal.2018, author = {Huckabee, Maggie-Lee and McIntosh, Theresa and Fuller, Laura and Curry, Morgan and Thomas, Paige and Walshe, Margaret and McCague, Ellen and Battel, Irene and Nogueira, Dalia and Frank, Ulrike and van den Engel-Hoek, Lenie and Sella-Weiss, Oshrat}, title = {The test of masticating and swallowing solids (TOMASS)}, series = {International Journal of language \& communicaton disorders}, volume = {53}, journal = {International Journal of language \& communicaton disorders}, number = {1}, publisher = {Wiley}, address = {Hoboken}, issn = {1368-2822}, doi = {10.1111/1460-6984.12332}, pages = {144 -- 156}, year = {2018}, abstract = {BackgroundClinical swallowing assessment is largely limited to qualitative assessment of behavioural observations. There are limited quantitative data that can be compared with a healthy population for identification of impairment. The Test of Masticating and Swallowing Solids (TOMASS) was developed as a quantitative assessment of solid bolus ingestion. AimsThis research programme investigated test development indices and established normative data for the TOMASS to support translation to clinical dysphagia assessment. Conclusions \& ImplicationsThe TOMASS is presented as a valid, reliable and broadly normed clinical assessment of solid bolus ingestion. Clinical application may help identify dysphagic patients at bedside and provide a non-invasive, but sensitive, measure of functional change in swallowing.}, language = {en} } @article{FrankvandenEngelHoekNogueiraetal.2018, author = {Frank, Ulrike and van den Engel-Hoek, Lenie and Nogueira, Dalia and Schindler, Antonio and Adams, Sasha and Curry, Morgan and Huckabee, Maggie-Lee}, title = {International standardisation of the test of masticating and swallowing solids in children}, series = {Journal of oral rehabilitation}, volume = {46}, journal = {Journal of oral rehabilitation}, number = {2}, publisher = {Wiley}, address = {Hoboken}, issn = {0305-182X}, doi = {10.1111/joor.12728}, pages = {161 -- 169}, year = {2018}, abstract = {The Test of Masticating and Swallowing Solids (TOMASS) is a validated assessment tool measuring the efficiency of solid bolus intake by four quantitative parameters: discrete bites, masticatory cycles, swallows and time to ingest a single cracker. A normative database for adults (20-80+ years) has previously been established. The objective of this study was to investigate the applicability and reliability of the TOMASS in children and adolescents (TOMASS-C) and to establish the normative database for this younger population. We collected data from 638 participants (male: 311, female: 327) in five age groups (4-18 years) with five different but very similar test crackers in four countries. Significant effects of bolus type (cracker), age group and gender on the TOMASS parameters were identified, requiring stratification of the TOMASS-C database by these variables. Intra-rater reliability was excellent (ICC > 0.94) for all parameters; inter-rater reliability was moderate for "number of swallows" (ICC = 0.54), good for "bites" (ICC = 0.78) and "time" (ICC = 0.82), and excellent for "masticatory cycles" (ICC = 0.96). The "Test of Masticating and Swallowing Solids in Children (TOMASS-C)" was identified to be a reliable diagnostic tool for the comprehensive measurement of discrete oral stage components of solid bolus ingestion, standardised by a large normative database that covers age groups from preschoolers to young adults. While differences between gender groups were less pronounced than in the adult population, previous results relating to changes in masticatory and swallowing as a function of age are confirmed by our data.}, language = {en} } @article{GaeckleDomahsKartmannetal.2019, author = {Gaeckle, Maren and Domahs, Frank and Kartmann, Angelika and Tomandl, Bernd and Frank, Ulrike}, title = {Predictors of Penetration-Aspiration in Parkinson's Disease Patients With Dysphagia}, series = {Annals of Otology, Rhinology and Laryngology}, volume = {128}, journal = {Annals of Otology, Rhinology and Laryngology}, number = {8}, publisher = {Sage Publ.}, address = {Thousand Oaks}, issn = {0003-4894}, doi = {10.1177/0003489419841398}, pages = {728 -- 735}, year = {2019}, abstract = {Methods: The data of 89 PD patients with dysphagia who underwent routinely conducted videofluoroscopic studies of swallowing (VFSS) were included in this retrospective study. The occurrence of penetration-aspiration was defined as scores >= 3 on the Penetration-Aspiration Scale (PAS). Four commonly reported signs of dysphagia in PD patients were evaluated as possible predictors. Furthermore, the relationships between the occurrence of penetration-aspiration and liquid bolus volume as well as clinical severity of PD (modified Hoehn and Yahr scale) were examined. Results: Logistic regression showed that a delayed initiation of the pharyngeal swallow (odds ratio [OR] = 7.47, P = .008) and a reduced hyolaryngeal excursion (OR = 5.13, P = .012) were predictors of penetration-aspiration. Moreover, there was a strong, positive correlation between increasing liquid bolus volume and penetration-aspiration (gamma = 0.71, P < .001). No correlation was found between severity of PD and penetration-aspiration (gamma = 0.077, P = .783). Conclusion: Results of the present study allow for a better understanding of penetration-aspiration risk in PD patients. They are useful for treatment planning in order to improve safe oral intake and adequate nutrition.}, language = {en} } @article{FrankFrankZimmermann2015, author = {Frank, Ulrike and Frank, Katrin and Zimmermann, Heinrich}, title = {Effects of Respiratory Therapy (bagging) on Respiratory Function, Swallowing Frequency and Vigilance in Tracheotomized Patients in Early Neurorehabilitation}, series = {Pneumologie : Zeitschrift f{\"u}r Pneumologie und Beatmungsmedizin}, volume = {69}, journal = {Pneumologie : Zeitschrift f{\"u}r Pneumologie und Beatmungsmedizin}, number = {7}, publisher = {Thieme}, address = {Stuttgart}, issn = {0934-8387}, doi = {10.1055/s-0034-1392359}, pages = {394 -- 399}, year = {2015}, abstract = {Objective: Tracheotomized patients often suffer from impairments in mucociliary clearance and limited capacities for active expectoration of secretions. We investigated the effects of a specific respiratory intervention method (bagging) for tracheotomized patients on respiratory parameters (pO(2), pCO(2), SpO(2), respiratory rates), swallowing frequency, vigilance and secretion viscosity. Methods: The bagging method supports enforced mobilization and expectoration of secretions by application of a series of manual hyperinflations with a resuscitation bag during active inspiration and manual cough support on the chest. 30 tracheotomized neurological patients participated in a multiple-baseline study including a three-weeks intervention period and a follow-up measurement three weeks after termination of the treatment. Results: Most outcome parameters improved significantly during the intervention period: pO(2) (p<.01), SpO(2) (p<.01), respiratory rates (p<.01), swallowing rates (p<.01), and vigilance scores (p<.01). The quality of bronchial secretions improved in all participants. All effects were sustained up to the follow-up measurements. Conclusion: This preliminary data indicates positive effects for a respiratory intervention method (bagging) on respiratory function and additional respiration-related functions in tracheotomized neurological patients. This easy-to-learn and inexpensive method might expand the range of treatment options for tracheotomized and non-responsive patients.}, language = {en} }