ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

reassuring to have a quick reference sheet to know that you are correctly identifying the likely underlying neurological process related to the bedside symptoms you observe. In times of increasing medico-legal accountability, this type of revision is valuable and helps to reinforce your knowledge. 8 The whole brain atlas At: http://www.med.harvard.edu/AANLIB/home. html Produced by Keith Johnson, MD, and J. Alex Becker, PhD, of Harvard, this is a great resource of neuroimaging. It contains examples from normal brain images, and from those with cerebrovascular disease, neoplastic disease and degenerative disease. The atlas can be used to gain familiarity with normal brain

structures and how these are affected in various etiologies. 9 Animation for facial muscle innervations At: http://library.med.utah.edu/kw/animations/ hyperbrain/facial_muscles/facial_muscles.html Never be confused about upper motor neuron versus lower motor neuron facial muscle innervations again! Need I say more? 10 www.dysphagia.com An incredibly extensive website including latest news from the world of dysphagia research, tutorials and articles, blogs with other professionals, case studies, reference materials, links to organisations and foundations, the list goes on.

A round the J ournals

Jane Watts

The principles of strength training including: intensity, specificity and transference are explained and their relevance to dysphagia treatment presented. Repetition and volume of practice are also considered important factors impacting on treatment. These important principles dictate what kind of changes will take place in muscle training and, therefore, research to help develop structured dysphagia exercise programs based on these principles will help enhance treatment effectiveness. There is an argument for more research to explore the way in which normal systems respond to specific exercises and levels of intensity. Management of oropharyngeal dysphagia in acute care settings Schindler, A., Vincon, E., Grosso, E., Miletto, A.,Di Rosa, R., & Schindler, O., 2008. Rehabilitative management of oropharyngeal dysphagia in acute care settings: Data from a large Italian teaching hospital. Dysphagia 23 : 230–236. This study reported on the management of oropharyngeal dysphagia by collecting information from inpatients admitted to San Giovanni Battista Hospital during 2004. Of the 35,590 patients admitted, 222 were referred for swallowing assessment and management. Almost half of these 222 patients also had a communication disorder. This article looked at the rehabilitative management of these patients by collection of data prospectively. The hospital is a large teaching institution with over 30 differ­ ent inpatient departments including: neurology, neurosurgery, intensive care, general medicine, head and neck surgery and geriatrics. The inpatients with dysphagia mainly had neurologic disease, though only 36% had suffered a stroke. The need for acute hospitals to assess, manage and rehabilitate dysphagia of different origins was emphasised and it was argued that early identification and management of dysphagia needs to occur across the full spectrum of etiologies related to dysphagia. The data collected did support swallowing rehabilitation in the acute care phase as a means of helping patients achieve independent feeding and preventing respiratory and nutritional complications.

Variant thyroid cartilage anatomy Lin, D., Fischbein, N., & Eisele, D., 2005. Odynophagia secondary to variant thyroid cartilage anatomy. Dysphagia , 20: 232–234. This article describes a case of displaced cornu of thyroid cartilage. A review of possible developmental and acquired etiologies is presented and also a review of treatment options. Neck trauma and traumatic endotracheal intubation have been associated with painful swallowing (odynophagia) and a globus sensation. It is suggested that patients with no history of these may have a displaced superior cornu of thyroid as a congenital condition, but it is unclear why this becomes symptomatic with age. The superior cornu or horn of the thyroid cartilage is one of the pair of upward pro­ jections of the thyroid cartilage to which the lateral hyothyroid ligament attaches. Ways in which abnormal thyroid cartilage anatomy can comprise normal swallowing are outlined and the article highlights that endoscopic laser resection can assist in resolving symptoms. A case is discussed to assist in differential diagnosis of pain on swallowing or globus sensation, when no abnormality, or a non-specific bulging of the pharyngeal wall, is seen on physical examination or radiographic imaging. Strength training exercises in dysphagia rehabilitation Burkhead, L., Sapienza, C., & Rosenbek, J., 2007. Strength training exercises in dysphagia rehabilitation: Principles, procedures and directions for future research. Dysphagia , 22: 251–265. An overview of muscle structure and function, including the difference between type I, type II, type IIa and IIb fibres is given, and the unique fibre types of muscles involved in swallowing are highlighted. Adaptations of muscle strength training and de-training are discussed and the effects of training and de-training of muscles in ageing are also presented as well as possible implications on maintenance programs for prolonging training effects with older individuals with dysphagia. The authors suggest there is a need for more research in this area.

ACQ uiring knowledge in sp eech , language and hearing , Volume 11, Number 1 2009

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