| 1. |
- Gonzalez Lindh, Margareta, 1965-, et al.
(författare)
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Swallowing dysfunction in patients hospitalised due to a COPD exacerbation
- 2021
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Ingår i: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 7:2, s. 00173-2021-
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This cross-sectional study aimed to investigate the prevalence of self-reported and clinically screened swallowing dysfunction (dysphagia) in COPD patients with severe exacerbations and to identify any associated factors. Findings were then compared to a control group.Methods: Participants included 30 patients hospitalised due to a COPD exacerbation. The control group consisted of 30 adults hospitalised with acute cardiac symptoms. Data were derived from spirometry, the 150 mL timed water swallow test, a cookie swallow test and a dyspnoea questionnaire (modified Medical Research Council (mMRC)). Scores from the 10-item Eating Assessment Tool (EAT-10) were calculated to assess patient perception of swallowing dysfunction.Results: Self-reported swallowing dysfunction and clinical signs thereof were more common in COPD patients than in the control group (67% versus 23% and 80% versus 37%, respectively; p <= 0.001). Clinical signs of swallowing dysfunction in the group with acute exacerbation of COPD were associated with self-reported swallowing dysfunction (p=0.02) and xerostomia (p=0.04). Dyspnoea (mMRC >= 2) was more common among the COPD patients (90% versus 47%, p<0.001). There was a significant negative correlation between lung function and self-reported dysphagia (r=-0.39, p=0.03), but not between lung function and clinically screened dysphagia (r=-0.23, p=0.21).Conclusion: COPD patients hospitalised with an acute exacerbation experienced significantly more self-reported and clinically screened swallowing dysfunction compared to a control group of patients with cardiac symptoms. Both patient groups experienced dyspnoea, but it was twice as common in the group with acute exacerbation of COPD. Both groups also experienced xerostomia.
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| 2. |
- Gonzalez Lindh, Margareta, 1965-
(författare)
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Swallowing Dysfunction in Respiratory Diseases : Prevalence and risk factors in COPD and COVID-19
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Swallowing dysfunction, dysphagia, is a common, sometimes dangerous, and often neglected problem that affects many people. The prevalence is estimated to be approximately 8% in the general population which makes it as common as e.g. diabetes or asthma. Dysphagia can cause serious complications like malnutrition, aspiration pneumonia and even death. The aims of this thesis were to gain further knowledge and a broader understanding of the prevalence, characteristics and risk factors of swallowing dysfunction in patients with respiratory diseases. Specifically Chronic Obstructive Pulmonary Disease, COPD, and COVID-19 after invasive mechanical ventilation.Study I is a prospective explorative study of 51 COPD patients in stable phase. Swallowing function was evaluated through a questionnaire and through two swallowing tests (water and a cookie) and lung function was measured through a spirometry. The prevalence of self- reported swallowing dysfunction was 65% and the screened prevalence was 49%. There was a negative correlation between lung function and both measurements of swallowing function, i.e. the poorer the lung function the more dysphagia symptoms.Study II is a cross-sectional multi-centre study where we examined the prevalence of self-reported swallowing dysfunction in 571 COPD patients. Additional tests were: spirometry, physical capacity, mMRC and CAT. Subjective swallowing symptoms were found in 33% of the patients. More prevalent in symptomatic patients and patients with lower physical capacity. A high score on the mMRC or CAT and a classification in GOLD groups B and D may be predictive of a swallowing dysfunction and should be addressed by the COPD nurse or physician.Study III is a cross-sectional study of 30 COPD patients hospitalized with a severe exacerbation. Their swallowing function was compared to a control group. The main results of this study were that the prevalence of swallowing dysfunction, both patient-reported and screened in patients hospitalised with a COPD exacerbation, was high. In addition, the AECOPD group was almost three times more likely to suffer from self-reported dysphagia compared to the control group.Study IV is a longitudinal cohort study of swallowing function in 28 COVID-19 patients post invasive mechanical ventilation. Dysphagia was found in 71% of the patients at baseline and it was associated with number of days in the hospital and in the ICU. At discharge from the hospital swallowing function and tolerance of oral intake had improved significantly.Conclusion: Swallowing dysfunction is prevalent both in COPD and in COVID-19 patients post invasive mechanical ventilation.
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| 3. |
- Gonzalez Lindh, Margareta, 1965-, et al.
(författare)
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Swallowing function in COVID-19 patients after invasive mechanical ventilation
- 2022
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Ingår i: Archives of Rehabilitation Research and Clinical Translation. - : Elsevier. - 2590-1095. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore swallowing function and risk factors associated with delayed recovery of swallowing in patients with COVID-19 post–invasive mechanical ventilation using the Functional Oral Intake Scale (FOIS).Design: Longitudinal cohort study.Setting: Three secondary-level hospitals.Participants: Invasively ventilated patients (N=28) who were hospitalized with severe COVID-19 and referred to the hospitals’ speech and language pathology (SLP) departments after mechanical ventilation between March 5 and July 5, 2020 for an evaluation of swallowing function before commencing oral diet.Interventions: SLP assessment, advice, and therapy for dysphagia.Main Outcome Measures: Oral intake levels at baseline and hospital discharge according to the FOIS. Patients were stratified according to FOIS (1-5, dysphagia; 6-7, functional oral intake). Data regarding comorbidities, frailty, intubation and tracheostomy, proning, and SLP evaluation were collected.Results: Dysphagia was found in 71% of the patients at baseline (79% men; age, 61±12y; body mass index, 30±8 kg/m2). The median FOIS score at baseline was 2 (interquartile range [IQR], 1) vs 5 (IQR, 2.5) at hospital discharge. Patients with dysphagia were older (64±8.5y vs 53±16y; P=.019), had a higher incidence of hypertension (70% vs 12%; P=.006), and were ventilated invasively longer (16±7d vs 10±2d; P=.017) or had a tracheostomy (9±9d vs 1±2d; P=.03) longer. A negative association was found between swallowing dysfunction at bedside and days hospitalized (r=–0.471, P=.01), and number of days in the intensive care unit (ICU) (r=–0.48, P=.01).Conclusion: Dysphagia is prevalent in COVID-19 patients after invasive mechanical ventilation and is associated with number of days in hospital and number of days in the ICU. Swallowing function and tolerance of oral diet improved at discharge (P<.001).
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| 4. |
- Okhiria, Åsa, et al.
(författare)
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Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair.
- 2022
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Ingår i: The Cleft Palate-Craniofacial Journal. - : Sage. - 1055-6656 .- 1545-1569. ; 59:8, s. 1030-1037
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective.DESIGN: Retrospective, longitudinal study.SETTING: A single multidisciplinary craniofacial team at a university hospital.PATIENTS: Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included.MAIN OUTCOME MEASURES: The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings.RESULTS: Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable.CONCLUSIONS: Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age.
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| 5. |
- Okhiria, Åsa, et al.
(författare)
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Longitudinal data on speech outcomes in internationally adopted children compared with non-adopted children with cleft lip and palate
- 2023
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Ingår i: International journal of language and communication disorders. - : Wiley. - 1368-2822 .- 1460-6984. ; 58:5, s. 1440-1453
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAt the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7-8 years, but later development remains unstudied. AimsTo investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non-adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups. Methods & ProceduresIn a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow-ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC-Sum) for single words and rated on a three-point scale (VPC-Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in-depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s-errors. Information on secondary palatal surgery and number of visits to an SLP was collected. Outcomes & ResultsVPF differed significantly between the groups at both ages when assessed with VPC-Sum, but not with VPC-Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s-errors at age 5 years, and CSCs and s-errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits. Conclusions & ImplicationsCSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre-school years. WHAT THIS PAPER ADDSWhat is already known on this subjectAt the beginning of the 21st century, IA children with cleft lip and/or palate arrived in Sweden partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. Studies up to age 7-8 years show that adopted children, compared with NA peers, have poorer articulation skills, demonstrate both cleft-related and developmental articulation errors, and are more likely to have velopharyngeal incompetence. Several studies also report that adopted children more often require secondary palatal surgery due to fistulas, dehiscence or velopharyngeal incompetence compared with NA peers. What this paper adds to existing knowledgeThis longitudinal study provides additional knowledge based on longer follow-ups than previous studies. It shows that the proportion of children assessed to have incompetent VPF was similar among IA and NA children. It was no significant difference between the groups regarding the proportion that received secondary palatal surgery. However, fewer IA children were assessed to have a competent VPF. Developmental articulation errors have ceased in most IA and all NA children at age 10 years, but significantly more adopted children than NA children still have cleft-related articulation errors. What are the potential or actual clinical implications of this work?Speech and language therapy should target both cleft-related and developmental articulation errors. When needed, treatment must be initiated early, comprehensive, and continued past the pre-school years, not least for adopted children.
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| 6. |
- Ali, M, et al.
(författare)
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Protocol for the development of the international population registry for aphasia after stroke (I-PRAISE)
- 2022
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Ingår i: Aphasiology. - : Informa UK Limited. - 0268-7038 .- 1464-5041. ; 36:4, s. 534-554
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Tidskriftsartikel (refereegranskat)abstract
- Background: We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia.Aim: To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia.Methods & Procedures: Multi-centre, prospective, non-randomised, open study, employing blinded outcome assessment, where appropriate, including people with post-stroke aphasia, able to attend for 30 minutes during the initial language assessment, at first contact with a speech and language therapist for assessment of aphasia at participating sites. There is no study-mandated intervention. Assessments will occur at baseline (first contact with a speech and language therapist for aphasia assessment), discharge from Speech and Language Therapy (SLT), 6 and 12-months post-stroke. Our primary outcome is changed from baseline in the Amsterdam Nijmegen Everyday Language Test (ANELT/Scenario Test for participants with severe verbal impairments) at 12-months post-stroke. Secondary outcomes at 6 and 12 months include the Therapy Outcome Measure (TOMS), Subjective Index of Physical and Social Outcome (SIPSO), Aphasia Severity Rating Scale (ASRS), Western Aphasia Battery Aphasia Quotient (WAB-AQ), stroke and aphasia quality of life scale (SAQoL-39), European Quality of Life Scale (EQ-5D), lesion description, General Health Questionnaire (GHQ-12), resource use, and satisfaction with therapy provision and success. We will collect demography, clinical data, and therapy content. Routine neuroimaging and medication administration records will be accessed where possible; imaging will be pseudonymised and transferred to a central reading centre. Data will be collected in a central registry. We will describe demography, stroke and aphasia profiles and therapies available. International individual participant data (IPD) meta-analyses will examine treatment responder rates based on minimal detectable change & clinically important changes from baseline for primary and secondary outcomes at 6 and 12 months. Multivariable meta-analyses will examine associations between demography, therapy, medication use and outcomes, considering service characteristics. Where feasible, costs associated with treatment will be reported. Where available, we will detail brain lesion size and site, and examine correlations with SLT and language outcome at 12 months.Conclusion: International differences in care, resource utilisation and outcomes will highlight avenues for further aphasia research, promote knowledge sharing and optimise aphasia rehabilitation delivery. IPD meta-analyses will enhance and expand understanding, identifying cost-effective and promising approaches to optimise rehabilitation to benefit people with aphasia.
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| 7. |
- Blom Johansson, Monica, 1965-
(författare)
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Experiences and need of support to significant others of persons with aphasia
- 2023
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Konferensbidrag (refereegranskat)abstract
- Background and aims: Significant others (SOs) of people with aphasia (PWA) can affect the individual’s social participation, conversational ability, and rehabilitation outcome [1]. SOs have been called the most valuable but also the most vulnerable resource of a patient [2]. To be a supportive SO and to remain healthy in a challenging situation SOs may need support themselves. The aim of this study was to investigate what support SOs of PWA have received, how they experienced the support, and their need for further support. Methods: 173 SOs responded to a study-specific questionnaire (response rate: 67.8%). Quantitative data were analysed with descriptive and comparative statistics and answers to open-ended questions were analysed with qualitative content analysis. Results and main contribution: The SOs appreciated knowledge, devotion, helpfulness, and empathy of health care staff and community services. Community services were perceived as being characterised by long processing times, lack of continuity of staff and insufficient understanding of the needs of the PWA and the SO. Most respondents were satisfied with the informal support provided by disability organizations, family, and relatives. There was however still a pronounced need of a more understanding environment (family, friends, health-care services). The strongest need expressed by the SOs was having time of their own. Despite an acknowledged burdensome situation and low emotional well-being among SOs of PWA [3], the need for counselling was the least perceived need (expressed by 16%).Conclusions: Feeling seen and acknowledged as well as having time of their own are important but perhaps underestimated needs of SOs of PWA. Implications: This study highlights the importance to include the SOs in the rehabilitation of PWA but also to provide separate support to them.
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| 8. |
- Blom Johansson, Monica, 1965-
(författare)
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Psykisk ohälsa vanligt bland anhöriga
- 2022
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Ingår i: Tidningen Afasi. - : Afasiförbundet i Sverige. - 2001-9564. ; :4, s. 23-25
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Det är välkänt att anhöriga till personer med afasi kan må dåligt på olika sätt. Men hur vanligt är det med psykisk ohälsa? En ny forskningsstudie har tittat på det.
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| 9. |
- Blom Johansson, Monica, 1965-, et al.
(författare)
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Self-reported changes in everyday life and health of significant others of people with aphasia : a quantitative approach
- 2022
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Ingår i: Aphasiology. - : Taylor & Francis. - 0268-7038 .- 1464-5041. ; 36:1, s. 76-94
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Tidskriftsartikel (refereegranskat)abstract
- Background: Changes in the everyday life and health of the significant others (SOs) of people living with stroke sequalae have been widely investigated. However, information regarding the frequency of the changes in daily life and the variables most associated with these perceived life changes is limited. Aims: To examine the extent to which SOs of persons with aphasia (PWAs) experience changes in everyday life and health after the stroke event and how they evaluate these changes and to identify which variables are associated with these perceived life changes. Methods & Procedures: A study-specific questionnaire about perceived changes in everyday life and health was completed by 173 SOs of PWAs living in Sweden (response rate 67.8%). The items concerned the SO’s working and financial situation, leisure time and social life, relationship with the PWA, household work and responsibility, and health and quality of life. Outcomes & Results: The everyday life and health of the SOs were greatly affected by the stroke event. The changes the SOs experienced were mainly appraised negatively. The relationships with the PWA and immediate family were least affected by the stroke. The perceived existence and severity of physical, cognitive, and language impairments of the PWA were the variables most strongly associated with the everyday life situation of the participants. The sex and age of the participants and the nature of the relationship with the PWA were only marginally associated with the experience of the situation. Conclusions: SOs’ perceptions of the PWA’s stroke-related disabilities and need for assistance may be a key factor in identifying SOs who may require support and guidance to help them cope with their new life situation.
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| 10. |
- Blom Johansson, Monica, 1965-, et al.
(författare)
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Why do significant others of people with aphasia accept or decline participation in communication partner training? : A pilot study
- 2023
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Konferensbidrag (refereegranskat)abstract
- Why do significant others of people with aphasia accept or decline participation in communication partner training? A pilot studyBackground and aims: Communication partner training (CPT) is an evidence-based aphasia intervention that is strongly recommended in Swedish clinical guidelines for stroke care [1]. However, clinicians report that many significant others (SOs) decline participation [2]. There is limited research on the SOs’ perspectives and experiences of CPT, especially regarding the factors that could make them decline the training. This study aims to explore why SOs accept or decline CPT in Sweden, and what factors influence the decision to participate or not.Methods: Interviews with four SOs who had been offered CPT, two of which had completed CPT and two that had declined participation. The interviews were analysed using qualitative content analysis.Results and main contribution: Reasons for not taking part were Practical barriers (long distances, training during work hours, own health problems) and Doubtful to effect of CPT (communication is already working well, too severe aphasia). Factors which could affect the decision were Time when CPT was offered (time post-onset of aphasia, recurring offers during rehabilitation), Experiences of earlier aphasia therapy, Perception of the speech-language pathologist (SLP), and How CPT was introduced.Conclusions: The decision to accept or decline CPT is affected by several factors, not only practical issues. However, to better understand the SOs’ perspectives and experiences of CPT, future studies with larger samples are needed.Implications: Although being a pilot study with few participants, the result contributes with insights of the importance of a good relationship with the SLP and trust in his/her competence in addition to how CPT is presented.References:1. National Board of Health and Welfare. (2020). Nationella riktlinjer för vård vid stroke: stöd för styrning och ledning. Socialstyrelsens publikationsservice. https://www.socialstyrelsen. se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2020-1-6545.pdf2. Persson, K. J. et al. (2022). Do best practice recommendations align with current aphasia practices in the Swedish care context: a national survey. Aphasiology, 36(8), 903–920. doi:10.1080/02687038.2021.1917504
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