Browsing by Subject "dysphagia"

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    Clinical Outcomes Associated with Speech, Language and Swallowing Difficulties Post-Stroke – A Prospective Cohort Study
    (2022) Kaylor, Stephanie Anne; Singh, Shajila
    Background: Due to a lack of prospective research in South Africa's Speech-Language Therapy (SLT) private healthcare sector, this prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), risk factors, and outcomes post-stroke (i.e. length of hospital stay, degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). Methods: Adults with a new incident of stroke without pre-existing speech, language or swallowing difficulties (N=68) were recruited. Convenience sampling was used to select participants. A prospective design was used to determine the incidence of speech, language, and swallowing conditions poststroke and association with outcomes from admission to discharge. Results: Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to SLT greater than 24 hours post-admission (52.94%) stayed in hospital for a median of three days longer than those who were referred within 24 hours (p=.042). Dysphagia was significantly associated with moderate to severe physical disability. Dysphagia with aspiration was significantly associated with poor functional level of oral intake (i.e. altered consistency diets and enteral nutrition), at admission and at discharge (p<. 01). Dysphagia had a higher likelihood of mortality (OR=2.86) (p=.319). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p< .01, r=0.70). Risk factors; poor oral hygiene (p=1.00), low level of consciousness (p=1.00), dependent for oral intake (p=.040), and enteral nutrition (p=.257); were not associated with aspiration pneumonia. Conclusion: In South Africa's private sector, cooccurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed SLT referrals.
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    Feeding and swallowing in neonates with Hypoxic Ischemic Encephalopathy (HIE): a descriptive study
    (2024) Branfield, Samantha; Norman, Vivienne; Rhoda, Natasha; Joemat, Janine
    Background: Intrapartum-related complications, including intrapartum hypoxia and subsequent hypoxic ischemic encephalopathy (HIE), are the second highest cause of neonatal deaths in South Africa. For survivors, such complications may be associated with a substantial burden of impairment, including the inability to feed well and swallow safely, thus representing a possible neurological cause of oropharyngeal dysphagia (OPD). HIE may result in disturbances of physiological stability, state regulation, neuromuscular integration, coordinated oral movements, and/or feeding endurance. However, feeding and swallowing characteristics in this population of neonates are not well described in the literature. Research Aims: To describe the feeding and swallowing profile of neonates with HIE in a neonatal unit in Cape Town, South Africa, including characteristics of oral feeding readiness, oromotor skill, oropharyngeal swallowing and clinical signs and symptoms of OPD, time taken to reach full oral feeds, and feeding method at discharge from the neonatal unit. Method: A descriptive, exploratory, longitudinal design consisting of both prospective and retrospective data collection methods was used to examine the feeding and swallowing characteristics in a sample of 52 participants with HIE of varying severities. Clinical feeding and swallowing assessments were conducted for 13 participants using the Neonatal Feeding Assessment Scale (NFAS), and medical folder reviews were conducted for 39 participants. The medical and feeding information was documented using data collection forms, including the feeding management received from the on-site speech-language therapist. Data from both data collection methods were amalgamated onto Excel spreadsheets, and information from medically similar participants was identified and grouped together for descriptive and statistical analysis. Statistical analysis comprised the nonparametric Kruskal-Wallis test and the Mann-Whitney U test. Results: A main effect of oral feeding readiness was indicated with a median of 4 days (p = 0.036), and an interquartile range of 4 – 5 days (standard deviation = 3.7 days). The median number of days to full oral feeds for the sample was 5 days (p = 0.016) with an interquartile range of 4 – 6.8 days (standard deviation = 4.3 days). Participants with a severely abnormal initial aEEG and who did not receive cooling treatment demonstrated the longest average time to oral feeding readiness and,subsequently, to full oral feeds. Participants of all severities presented with feeding and swallowing difficulties primarily in the oral phase of swallowing. Few pharyngeal signs and symptoms of OPD were identified. Most participants (96.2%; n = 50) were discharged on full oral feeds, while the remaining 3.8% (n = 2) were discharged on nasogastric tube feeds (NGT) while awaiting gastrostomy placement. ii | P a g e Conclusion: Regardless of severity, neonates with HIE face an increased risk of feeding and swallowing difficulties. The findings highlight that neonates with HIE should be screened by a speech-language therapist for feeding and swallowing difficulties before discharge from hospital. This study contributes to the small body of research on feeding and swallowing difficulties in neonates with HIE, and may guide future research.
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    Incidence of traumatic brain injury, prevalence of dysphagia, and factors predicting health outcomes following traumatic brain injury in adults
    (2015) Rossouw, Joanne Courtney; Singh, Shajila
    South Africa has a high incidence of injury-related disorders, such as traumatic brain injury (TBI) as a result of motor vehicle accidents and assault. Dysphagia is a common sequela of TBI, which may result in malnutrition or aspiration pneumonia. There is limited epidemiological data available for TBI and dysphagia in South Africa which is important for health care planning. There is also inadequate literature reporting predictive factors for dysphagia and health outcomes of patients with TBI and swallowing disorders for the South African context, which would provide management guidelines for Speech-Language Pathologists (SLPs) for patients with TBI and dysphagia. This study aims to begin to provide up-to-date information regarding the incidence of TBI and the prevalence of dysphagia in the population with TBI in Bloemfontein, South Africa. Predictive factors for dysphagia and health outcomes were also investigated in order to provide management guidelines for TBI-related dysphagia for SLPs. A prospective cohort study followed 77 participants aged 18 to 68 years (M = 33.1) with mild to severe traumatic brain injury, admitted to 2 state and 2 private hospitals in the Bloemfontein metropole, South Africa, to investigate the incidence of TBI and the prevalence of TBI-related dysphagia in the adult population in 2013. Participants were tracked from admission to hospital to discharge. Demographic and medical data was collected for each participant, including: gender, age, TBI aetiology, means of nutritional intake, respiratory status, length of hospital stay, and number of speech therapy sessions. Glasgow Coma Scale (GCS) scores at time of admission, swallowing evaluation, and discharge were noted as an indicator of TBI severity and each participant was assessed with the Mann Assessment of Swallowing Ability on admission and prior to discharge to assess the presence of dysphagia. The incidence of TBI for the Bloemfontein metropole was 353 per 100,000 people and was greater in the male than in the female population (11.83:1). The main mechanism for TBI in Bloemfontein was interpersonal violence (67.53%), followed by road traffic accidents (motor and pedestrian vehicle accidents; 23.38%). The prevalence rate for dysphagia was 32%. Twenty-eight percent of those who presented with dysphagia also aspirated. Severe TBI (GCS ≤ 8) was identified as a predictive factor for dysphagia. Participants with dysphagia had longer hospital stays (days; M = 22.04, SD = 17.67) than those with normal swallowing (M = 6.23, SD = 4.28), t(75) = 6.13, p < .001, and took significantly more days to achieve oral intake (M = 6.23, SD = 10.32) than those without dysphagia (M = .31, SD = 1.41), t(75) = 4.08, p < .001. Ventilation was associated with longer hospital stays, rs(25) = -.47, p = .02 and longer duration until achievement of oral intake, rs(22) = -.80, p < .001. Tracheotomised participants also had significantly longer hospital stays, rs(25) = -.67, p < .001, and took longer to achieve oral intake, rs(22) = -.52, p = .01. An increased period of time with a tracheostomy was also significantly associated with mortality, χ2(2, n = 11) = 6.52, p = .04. Participants with dysphagia (M = 3.84, SD = 5.44) required significantly more therapy sessions with an SLP than those without dysphagia (M = .15, SD = .64), t(75) = 4.85, p < .001, and those with low GCS scores were significantly less likely to achieve oral intake prior to discharge, rs(25) = -.45, p = .02, and had longer hospital stays than participants with mild head injuries, rs(25) = -.49, p = .01. All participants who received nutrition via nasogastric tubes returned to oral intake; however, individuals who had percutaneous endoscopic gastrostomies did not achieve oral intake prior to discharge. It is recommended that objective swallowing evaluations be conducted for patients admitted with severe TBIs, and patients with mild and moderate TBIs be screened to determine the presence of dysphagia. TBI prevention initiatives should be developed to reduce the incidence of TBI, specifically in the young adult male population.
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    Indications medical conditions and services related to gastrostomy placements in infants and children at a tertiary hospital in South Africa
    (Health and Medical Publishing Group, 2011) Norman, V; Singh, S A; Hittler, T; Jones, N; Kenny, N; Mann, R; McFarlane, S; Moeng, A
    Objectives: To describe South African infants and children requiring gastrostomies in a tertiary hospital, including the indications, medical conditions and health services, during a 5-year period (2005 - 2009). Design. The research design was a retrospective descriptive survey of medical records. Setting: A tertiary paediatric state hospital in South Africa. Subjects. One hundred and forty-two patients between the ages of 0 and 17 years. Results: Dysphagia (N=80, 56%), aspiration (N=70, 49%) and need for nutritional support (N=63, 44%) were the most common indicators for gastrostomy placement. Most participants (N=85, 75% of the subset of 114 with feeding and swallowing difficulties) presented with multiple medical conditions, and neurological impairment (N=94, 82%) and gastro-intestinal problems (N=96, 84%) were the most prominent. Services were required from a variety of health care professionals for a period ranging from 6 to 103 months (mean 18 months). The speech-language therapist was consulted most frequently before gastrostomy placement (85%), while the stoma sister (97%) and dietician (97%) were consulted after placement. Conclusions: South African infants and children requiring gastrostomies frequently present with multiple medical conditions and dysphagia. These children are likely to benefit from extended services provided by a specialised team of health care professionals.
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    Interventions used by health care professionals to transition preterm infants and neonates from enteral feeds to full-oral feeds: A Scoping review
    (2021) Rabbipal, Yajna; Norman, Vivienne; Pascoe, Michelle
    Background: Preterm infants and neonates may present with dysphagia due to immaturity or the presence of medical conditions. Enteral feeds are used to ensure optimal nutrition is achieved while the neonates are developing appropriate oral feeding skills. Varied interventions may be used to transition neonates to full oral feeds as oral feeding is often a prerequisite for discharge from hospital. Aims: The main aim of this study was to summarize, interpret and analyse the literature on the different interventions used for the transition to full oral feeds in preterm infants and neonates to identify research gaps and to inform clinical practice on the best intervention options. A secondary aim was to validate the findings of the scoping review for the South African context. Methods: A scoping review was conducted. Relevant studies were identified by searching six databases, Google and Google scholar. Inclusion criteria included studies written in English, peer reviewed and published between 1998–2018, that described the interventions used to transition preterm infants and neonates to full oral feeds. Data were extracted from the articles using a data charting form and analysed descriptively and thematically. The findings were shared with health care professionals who work with premature infants and neonates who then participated in a semi-structured interview to provide feedback relevant to the South African context. Results: Forty-seven articles were included. Six broad intervention categories were identified: oral-motor, oral-sensory, other senses, timing, cue-based and utensils. Non-nutritive sucking (NNS) interventions were reported most frequently across single and combined interventions. Outcome measures reported included: time taken to full oral feeds, earlier hospital discharge, long-term feeding outcomes, weight and sucking proficiency. Improved outcomes were associated with NNS and NNS with oral stimulation. Nine health care professionals were interviewed. They confirmed using a number of the interventions, with NNS reported the most. Health care professionals also provided insight into the challenges of implementing some interventions due to limited resources and staffing in the South African context. Conclusions: There are a range of interventions reported in the literature and many of them are used in South Africa. Positive outcomes such as earlier transition to full oral feeds; earlier hospital discharge; improved weight gain and improved sucking proficiency have been reported with NNS and combined NNS and Oral Stimulation interventions, however further studies are needed.