title: The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study.
abstract: OBJECTIVE
  To examine the effects of the Intensive Dysphagia Rehabilitation approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia.
  
  
  METHODS
  Intervention study; before-after trial with 4-week follow-up through an online survey.
  
  
  METHODS
  Outpatient university clinics.
  
  
  METHODS
  A consecutive sample of subjects (N=10) recruited from outpatient university clinics. All subjects were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subjects withdrew from the study.
  
  
  METHODS
  Participants completed the 4-week Intensive Dysphagia Rehabilitation protocol, including 2 oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice per week and home practice for approximately 45 min/d.
  
  
  METHODS
  Outcome measures assessed pre- and posttreatment included airway safety using an 8-point Penetration Aspiration Scale, lingual isometric pressures, self-reported swallowing-related quality of life (QOL), and level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey).
  
  
  RESULTS
  The Intensive Dysphagia Rehabilitation approach was effective in improving maximum and mean Penetration Aspiration Scale scores (P<.05, η(2)=.8146 and P<.05, η(2)=.799708, respectively) and level of oral intake (P<.005, Cohen d=-1.387). Of the 5 patients who were feeding tube dependent initially, 2 progressed to total oral nutrition, and 2 progressed to partial oral nutrition. One patient remained tube dependent. QOL was significantly improved at the 4-week follow-up (95% confidence interval, 6.38-14.5; P<.00), but not at the posttreatment. No adverse effects were observed/reported.
  
  
  CONCLUSIONS
  The Intensive Dysphagia Rehabilitation approach was safe and improved physiological and some functional swallowing outcomes in our sample; however, further investigation is needed before it can be widely applied.
authors.affiliation: Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, IN; Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY; Dysphagia Clinic, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece. Electronic address: malandraki@purdue.edu.
authors.forename: Georgia A
authors.initials: GA
authors.lastname: Malandraki
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY.
authors.forename: Akila
authors.initials: A
authors.lastname: Rajappa
authors.affiliation: Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, IN; Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY.
authors.forename: Cagla
authors.initials: C
authors.lastname: Kantarcigil
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY.
authors.forename: Elise
authors.initials: E
authors.lastname: Wagner
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Columbia University, New York, NY.
authors.forename: Chandra
authors.initials: C
authors.lastname: Ivey
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Youse
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D026241:Exercise Movement Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000503:physiopathology; D011788:Quality of Life; D012107:Research Design; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Deglutition; Deglutition disorders; Exercise; Rehabilitation