Influence of craniofacial morphology on hyoid movement: a preliminary correlational study.

There has been little attention given to the relationship between variations in normal craniofacial morphology and swallowing physiology. This preliminary investigation evaluated the relationship between the Frankfort-mandibular plane angle (FMA) and hyoid displacement during swallowing. Hyoid movement was evaluated during 12-ml and 24-ml swallows of liquid barium in 12 healthy subjects (age = 20-29 years, median = 23 years).

Racial disparities in the development of dysphagia after stroke: analysis of the California (MIRCal) and New York (SPARCS) inpatient databases.

Objectives: To determine whether the proportion of patients with stroke experiencing dysphagia differs among racial groups and whether this relation can be explained by stroke type or severity.

Design: Case-control study using California's Medical Information Reporting and New York's Statewide Planning and Research Cooperative System databases for 2002. Cases had primary diagnosis of cerebrovascular disease (International Classification of Disease, 9th Revision [ICD-9] codes 430-438.

Do racial disparities exist in access to inpatient stroke rehabilitation in the state of Maryland?

Objective: Black patients tend to have a greater number and severity of stroke cases. The literature on access to rehabilitative services shows mixed results ranging from no disparities to limited access among minority populations. This study evaluated the association of race and acute discharge to inpatient stroke rehabilitation in Maryland, a diagnostic related group-and postacute care prospective payment system-exempt state.

[Dysphagia severity scale].

A simple, broadly applicable, standardized dysphagia severity scale would be useful to standardize dysphagia evaluations, to monitor recovery and efficacy of treatment and to study the consequences of dysphagia. We developed a global Dysphagia Severity Scale (DSS) from videofluorographic swallowing studies which included subjective clinical ratings of functional swallowing. We rated laryngeal penetration/aspiration (P/A) and pharyngeal retention (PR), and then assessed methods for scoring severity of P/A and PR and for combining them in a global scale.

Three tests for predicting aspiration without videofluorography.

The videofluorographic swallowing study (VFSS) is the definitive test to identify aspiration and other abnormalities of swallowing. When a VFSS is not feasible, nonvideofluorographic (non-VFG) clinical assessment of swallowing is essential. We studied the accuracy of three non-VFG tests for assessing risk of aspiration: (1) the water swallowing test (3 ml of water are placed under the tongue and the patient is asked to swallow); (2) the food test (4 g of pudding are placed on the dorsum of the tongue and the patient asked to swallow); and (3) the X-ray test (static radiographs of the pharynx are taken before and after swallowing liquid barium).

Prevalence of venous thromboembolism in acute hemorrhagic and thromboembolic stroke.

Objective: Deep venous thromboembolism (DVT) is an important health issue in the hospitalized geriatric population that leads to increased length of stay, morbidity, and mortality. Patients with hemorrhagic strokes are usually not placed on prophylactic therapy because of the risk of hemorrhagic extension of the stroke. The purpose of this study was to evaluate the prevalence of DVTs in hospitalized patients with hemorrhagic vs.

Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients.

There is no empirically derived consensus as to what food consistency types and method of food delivery (spoon, cup, straw) should be included in the videofluoroscopic swallowing (VFSS) studies. In the present study, we examine the rates of aspiration and pharyngeal retention in 190 dysphagic patients given thin (apple juice) and thick (apricot nectar) liquids delivered by teaspoon and cup and ultrathick (pudding-like) liquid delivered by teaspoon. Each patient was tested with each of the bolus/delivery method combinations.

How do skilled nursing rehabilitation managers track efficiency and costs?

Financial and efficiency indicators have not been used extensively by skilled nursing (SNF) rehabilitation managers, but may prove useful in the prospective payment system (PPS)-dominated long-term care (LTC) environment. The purpose of this pilot study was to demonstrate a method for measuring the extent of SNF rehabilitation managers' use of volume, revenue, cost, and manpower indicators; and whether usages differ among occupational, physical, and speech therapy managers. The subjects were 74 occupational, 75 physical, and 72 speech therapy managers employed by a multinational health care corporation.

Intra- and interrater variation in the evaluation of videofluorographic swallowing studies.

The objective of this study was to determine the inter- and intrarater reliability in evaluating videofluoroscopic swallowing studies (VFSS). Participants included 4 physicians (3 physiatrists and 1 internist) and 5 speech-language pathologists with at least 5 years experience in evaluating VFSS. The main outcomes of the study were reliability ratios of positive and negative tests in inter- and intrarater evaluations.

Cervical pain: a comparison of three pillows.

Objective: To compare three pillows with regard to pain intensity, pain relief, quality of sleep, disability, and overall satisfaction in subjects with benign cervical pain. The three pillows evaluated were the subjects' usual pillow, a roll pillow, and a water-based pillow.

Study Design: Subjects used their usual pillows for the first week of this 5-week randomized crossover design study.

Racial disparities in severity of cerebrovascular events.

Background And Purpose: This study was conducted to determine if blacks hospitalized for cerebrovascular events had more severe cerebrovascular events than whites similarly hospitalized.

Methods: Data from the Maryland Health Services Cost Review Commission were used to determine incidence of coma, death rates, age at death of those who died, and length of stay for acute hemorrhagic and occlusive stroke in hospitalized blacks and whites after adjusting for sex and, if appropriate, age.

Results: With a single exception (number of patients with hemorrhagic stroke who died during short-term hospitalization), all indices indicated that blacks incurred more severe cerebrovascular events than whites (P < .

Epidemiology and dysphagia.

With few exceptions, epidemiology of dysphagia is unexplored, particularly with regard to risk and protective factors, and underutilized. The range of incidence of dysphagia in selected primary diagnoses often associated with dysphagia is summarized.

A protocol for the videofluorographic swallowing study.

This paper presents a detailed protocol for performing the videofluorographic swallowing study (VFSS), and describes how it evolved from its antecedents. The objectives of the VFSS are both diagnostic and therapeutic. Preparing for the VFSS is described, including the equipment, food preparation, and a brief discussion of the clinical evaluation.

The probability of correctly predicting subglottic penetration from clinical observations.

It is difficult to predict from clinical signs and symptoms which patients suffer from subglottic penetration of foods. Most investigators attempting to predict aspiration have used small numbers of patients and relatively unsophisticated statistical techniques. In this study, we utilized 249 patients to examine the predictive value of several clinical factors thought to be suggestive of subglottic penetration with discriminant analysis.

Impact of the journal Plastic and Reconstructive Surgery.

The "impact" of Plastic and Reconstructive Surgery was evaluated by bibliometric analysis. This technique considers the average frequency with which journal authors refer to articles published in Plastic and Reconstructive Surgery. The impact of Plastic and Reconstructive Surgery was compared with that of journals most commonly referred to within Plastic and Reconstructive Surgery as well as with that of journals read most commonly by Plastic and Reconstructive Surgery subscribers, such as the Annals of Plastic Surgery and the Journal of Hand Surgery (both American and British editions).

A bibliometric analysis of the Archives of Physical Medicine and Rehabilitation.

A bibliometric analysis based on the Journal Citation Reports distributed by the Institute of Scientific Information was made of the Archives of Physical Medicine and Rehabilitation and related journals to determine the relative ranking of the Archives in several bibliometric categories. It was hoped that this process would yield objective evidence for the strengths and weaknesses of the Archives. Bibliometric indices that were compared included the impact factor (a reflection of how often a journal's articles are cited) and the cited half-life and immediacy (both of which deal with the timeliness of a journal's articles).

Scintigraphy for the detection and quantification of subglottic aspiration: preliminary observations.

Eleven patients with previously documented aspiration underwent a radioisotopic swallowing study to detect and quantify airway penetration. In those subjects able to complete a rapid-acquisition phase during swallowing, no laryngotracheal penetration was seen despite previous evidence of aspiration. However, sequential static pulmonary imaging showed significant aspiration in three individuals.

Nutritional status during the acute stage of spinal cord injury.

This study was designed to help clinicians establish objective guidelines for meeting the nutritional requirements of spinal cord injury (SCI) patients during their initial hospitalizations. The nutritional status of 51 SCI patients treated between 1983 and 1986 was assessed at two, four, and eight weeks after injury. Nutrient deficiencies such as albumin (100% of patients), carotene (62%), transferrin (37%), ascorbate (25%), thiamine (24%), folate (20%), and copper (11%) were documented most frequently at two weeks postinjury.

Prediction of pyelocaliectasis in follow-up of patients with spinal cord injury.

Two hundred and fifty spinal cord injury patients were studied on each of two occasions, 12 to 24 months apart, to determine which urological findings could be used to predict the subsequent development of clinically significant pyelocaliectasis. An equation was developed which correctly classified 90% of the patients who remained free of clinically significant pyelocaliectasis and 82% of the patients who subsequently developed clinically significant pyelocaliectasis. The statistically significant risk factors were renal calculi, bladder diverticula and a decrease in effective renal plasma flow.

Year-to-year changes in effective renal plasma flow in asymptomatic spinal cord injury patients.

Year-to-year variations in effective renal plasma flow (ERPF) measurements were determined in 78 patients with spinal cord injury who had no urologic complications or surgery or bouts of chills and fever between consecutive annual follow-up examinations. The effects of age, gender, level and degree of lesion, and time since injury on the degree of variability were also determined. None of the factors considered had a statistically significant effect (P greater than 0.

Clinical significance of minimal changes on intravenous urography after spinal cord injury.

Evidence is given to support the thesis that minimal pyelocaliectasis and ureterectasis are of little clinical significance in spinal cord injured patients. Such renal changes almost always improve or remain stable on sequential examinations. Since moderate or severe pyelocaliectasis is usually detected by renal scintillation procedures, these findings support its use as a urinary tract screening examination along with an abdominal radiograph to detect calculi.

Initial bladder management in spinal cord injury: does it make a difference?

We classified 204 patients with acute spinal cord injury into 1 of 5 groups according to the initial form of urological management. Group A patients were placed on an intermittent catheterization program within 36 hours of injury, group B received a suprapubic trocar within 36 hours of injury, group C had urethral catheters in place for more than 36 hours before intermittent catheterization was begun, group D was on indwelling urethral catheter drainage throughout the hospitalization and discharged from the hospital with indwelling catheters, and group E was placed on intermittent catheterization in a community hospital. There were no statistically significant differences among the groups in the incidence of chills and fever, rate of urinary infections (excluding group D), incidence of upper tract changes, genitourinary complications or frequency of urological procedures at 1 year after injury.