摘要:

Safe and adequate nutrition, vital to the recovery from a traumatic brain injury, can be severely compromised by the presence of dysphagia. This study identified injury severity and swallowing factors that were associated with impaired oral intake in patients with severe brain injury. An admitting Glasgow Coma Scale (GSC) 3–5; a Rancho Los Amigos Scale of Cognitive Functioning (RLA) Level II; a computed tomography (CT) scan exhibiting midline shift, brainstem involvement, or brain pathology requiring emergent operative procedures; or ventilation time ≥15 days identified patients at highest risk for abnormal swallowing, aspiration, and delay in initiation of oral feeding and achievement of total oral feeding. When combined in multivariate models, RLA Level, CT scan, ventilation time and aspiration emerged as significant independent predictors of impaired oral intake.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Dysphagia and aspiration in intensive care unit patients with acute traumatic brain injury (TBI) is a frequent and potentially life-threatening problem. Any diagnostic technique used with this population, therefore, must be able to be performed in a timely and efficient manner while providing objective information on the nature of the swallowing problem. The purpose of the present study was to investigate the utility of using the fiberoptic endoscopic evaluation of swallowing (FEES) technique to diagnosis pharyngeal stage dysphagia and determine aspiration status in patients who presented with acute TBI. A total of 47 subjects were assessed with FEES. Thirty of 47 (64%) subjects swallowed successfully and were able to take an oral diet: 2 of 30 (7%) thickened liquids and puree consistencies, 8 of 30 (27%) a soft diet, and 20 of 30 (67%) a regular diet. Seventeen of 47 (36%) subjects exhibited pharyngeal stage dysphagia with aspiration and were not permitted an oral diet based on objective results provided by FEES. Of the 17 subjects who aspirated, 9 of 17 (53%) exhibited silent aspiration. Younger subjects (mean age 34 years, 3 months) aspirated significantly less often than older subjects (mean age 51 years, 8 months). No significant age difference was observed for gender or between overt and silent aspirators. It was concluded that FEES is an objective and sensitive tool that can be used successfully to diagnose pharyngeal stage dysphagia, determine aspiration status, and make recommendations for oral or nonoral feeding in patients with acute TBI.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A major complication commonly seen in persons with severe brain injury is swallowing dysfunction. The neuropathology leading to impaired swallowing is discussed. In addition, Other risk factors associated with dysfunctional swallowing, such as tracheostomy and the need for prolonged ventilatory support, are discussed. Within the intensive care environment, the consequences of impaired swallowing leading to aspiration—a major cause of pneumonia—are discussed.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

An overview of the metabolic response to acute traumatic brain injury is presented. The consequences of hypermetabolism, hypercatabolism, and an altered immune function are discussed. Once a person with acute traumatic brain injury develops this hyperdynamic state, the resultant excessive protein breakdown ensues. This can lead to malnutrition. The feeding methods used to prevent malnutrition are discussed, along with the proper alimentation to provide to diminish the hyperdynamic state and improve immune function.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The clinical bedside swallow evaluation and videofluoroscopy routinely have been used for dysphagia management. This article explores clinical issues for dysphagia management in the population with brain injury in the acute rehabilitation setting. Citing the dysphagia, cognitive, and other relevant issues present in the population with brain injury, the use of fiberoptic endoscopy to address dysphagia assessment and intervention is presented. Factors for decision making, a retrospective review of recent studies, and relevant cases are discussed.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This article discusses the impact of cognitive-communicative and behavior problems on oral intake. Data on the swallowing outcomes of a group of patients in an acute rehabilitation facility are presented. These data illustrate the relationships among severity of dysphagia, admission and discharge Functional Independence Measure (FIM™) scores, admission and discharge cognitive FIM™ scores and length of stay. Two case studies that describe the effect of cognitive-communicative disorders on dysphagia are provided.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The course of pediatric traumatic brain injury is not homogeneous because the underlying neuropathology can be so variable. Assessment, intervention, and recovery are examined among five individuals whose neuroradiologic imaging differed grossly on initial and early presentations after head trauma. Knowledge of the neuropathology in an overarching sense can be informative to a clinician's management of different swallowing problems after brain injury.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID