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Biomedical subjects

M E Groher

Publications and source records attributed to M E Groher.

14 recordsLinked to original sources
PubMed1995

Dysphagia and dietary levels in skilled nursing facilities.

OBJECTIVE: To determine the appropriateness of dietary levels of residents with suspected feeding and/or swallowing disorders. DESIGN: Chart review, evaluation, intervention, observation. SETTING: Two skilled nursing facilities, one in Washington, one in Florida. SUBJECTS: Two hundred twelve residents, mean age 72.9, suspected of having feeding and/or swallowing disorders. MEASUREMENTS: After documentation of dietary level, each resident on a mechanically modified diet was given an evaluation by a speech/language pathologist specific to their feeding and swallowing skills. Changes in the dietary level were made, and the residents were followed for 30 days to evaluate their response. RESULTS: Thirty-one percent of the residents in the two facilities were prescribed a mechanically altered diet. Ninety-one percent were at dietary levels below that which they could tolerate safely; four percent were at dietary levels higher than they could tolerate; five percent were considered to be at the appropriate diet level. CONCLUSIONS: Many nursing home residents may be inappropriately placed or maintained on mechanically altered diets. Regular reevaluation of their dietary level is necessary because most may be able to eat safely at higher levels. Active participation by speech/language pathologists knowledgeable in the assessment of oropharyngeal dysphagia is helpful in this process.

Aged↗
PubMed1994

Methodology for detecting swallowing sounds.

The use of cervical auscultation in the evaluation of the pharyngeal swallow may become a part of the clinical evaluation of dysphagic patients. Though its use is based on subjective evaluation, an acoustic analysis of swallowing sounds might establish more objective criteria in the detection of swallowing disorders. The present study sought to investigate three aspects of the methodology for detecting swallowing sounds: (1) the type of acoustic detector unit suited to an acoustic analysis of the pharyngeal swallow, (2) the type of adhesive suited for the attachment of the detector, and (3) the optimal site for sound detection of the pharyngeal swallow. An accelerometer with double-sided paper tape was selected as the appropriate detector unit because of its wide range of frequency response and small attenuation level. Using this detector unit, swallowing sounds and noise associated with simulated laryngeal elevation and the carotid pulse were acquired at 24 sites on the neck in 14 normal subjects; these signals were acoustically analyzed. The determination of the optimal site for detecting swallowing sounds was based on the signal-to-noise ratio. The site over the lateral border of the trachea immediately inferior to the cricoid cartilage is the optimal site for detection of swallowing sounds because this site showed the greatest signal-to-noise ratio with the smallest variance. The site over the center of the cricoid cartilage and the midpoint between the site over the center of the cricoid cartilage and the site immediately superior to the jugular notch were also considered to be the most appropriate sites.

Acceleration↗
PubMed1994

Determination of the risks and benefits of oral feeding.

The dysphagia team is often faced with the dilemma of whether or not to let patients with known aspiration feed orally. The criteria that assist professionals in their final decisions may be more anecdotal than empirical. Undoubtedly, the decision-making process that is activated in determinations of oral vs. non-oral feeding will vary among institutions and by patient presentation. For some dysphagia teams, the presence of tracheal penetration of swallowed contents is sufficient indication to preclude oral feeding. For others, some amounts of aspiration are acceptable.

Aged↗
PubMed1994

Symmetry and reproducibility of swallowing sounds.

Cervical auscultation is being used more frequently in the clinical assessment of dysphagic patients. The present study was designed to assess symmetry and the reproducibility of swallowing sounds detected simultaneously from bilateral cervical sites. Symmetry of the swallowing sounds acquired using our method was verified because no significant differences were found for any parameters in both time and frequency domain analyses between swallowing sounds detected bilaterally. This result supports the use of a "unilateral" site for the detection of swallowing sounds. The reproducibility of swallowing sounds was assessed by a coefficient of variation. Results of this analysis suggest that one should evaluate the acoustic characteristics of swallowing sounds from repeated swallows rather than from one swallow.

Acoustics↗
PubMed1993

Speech-language pathology and dysphagia: a brief historical perspective.

In the past decade, speech-language pathologists have taken a leading role in the management of services for patients with oropharyngeal dysphagia. This article presents the historical perspective of this role, the rationale for assuming the responsibility, and suggests directions for continued involvement.

Deglutition↗
PubMed1990

Development and dissemination of an aspiration risk reduction diet.

Patients with oropharyngeal swallowing disorders secondary to neurologic impairments benefit from diets that minimize the risk of aspiration. An aspiration risk reduction diet was developed from our hospital's regular menu cycle. Examples of the diet's preparation, dissemination, and use in a 600-bed acute medical/surgical teaching hospital are discussed.

Deglutition Disorders↗
PubMed1990

Ethical dilemmas in providing nutrition.

The decisions involved in the institution of artificial feeding in patients with chronic and/or terminal illness are difficult. They are more complex when one is deciding if nutrition and hydration are to be withdrawn. In both instances the decision must be based on a combination of factors: the patient's right to self-determination; documented medical evidence demonstrating the need for artificial feeding, combined with a risk/benefit analysis if alternative alimentation is recommended; and an appreciation of prior legal decisions as they relate to the implementation of alternative forms of nutrients to sustain life.

Enteral Nutrition↗
PubMed1989

Facilitating training in tracheoesophageal prosthesis placement.

Success in the utilization of a tracheoesophageal voice prosthesis may be limited due to the failure to learn how to insert the prosthesis independently. Reasons that may account for this inadequacy include inadequate preoperative screening tools to assess adequacy of the insertion process and lack of the availability of a model that allows safe practice in the skills necessary for insertion and retention. To avoid these possible complications, a model has been developed that will assist the medical care team in preoperative evaluation and postoperative care.

Humans↗
PubMed1989

Determining normal bolus size for thin liquids.

In order to define a suitable volume of barium to be delivered to patients during the radiographic evaluation of pharyngoesophageal function during swallowing, three different age groups of nondysphagic volunteers were studied. Subjects randomly swallowed boluses of water, barium, and Coca-Cola. The size of a normal thin liquid bolus was 21 ml (SD +/- 5 ml). We intend to include this information to compare different bolus sizes in cineradiographic examination of patients with swallowing complaints.

Cineradiography↗