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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:
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:
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
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.
Around the Journals
Jane Watts
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.
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.
MULTICULTURALISM AND DYSPHAGIA
ACQuiring knowledge in sp eech, language and hearing, Volume 11, Number 1 2009 57