Dysphagia in Duchenne muscular dystrophy: practical recommendations to guide management

被引:51
作者
Toussaint, Michel [1 ,2 ]
Davidson, Zoe [3 ,4 ]
Bouvoie, Veronique [1 ,2 ]
Evenepoel, Nathalie [1 ,2 ]
Haan, Jurn [1 ,2 ]
Soudon, Philippe [1 ,2 ]
机构
[1] Vrije Univ Brussel, Inkendaal Rehabil Hosp, Neuromuscular Excellency Ctr, Acute Neuroresp Rehabil Unit, Brussels, Belgium
[2] Vrije Univ Brussel, Inkendaal Rehabil Hosp, Ctr Home Mech Ventilat, Brussels, Belgium
[3] Monash Univ, Dept Nutr & Dietet, Melbourne, Vic, Australia
[4] Murdoch Childrens Res Inst, Melbourne, Vic, Australia
关键词
Duchenne; dysphagia; swallowing; NONINVASIVE VENTILATION; FEEDING PROBLEMS; INSUFFLATION-EXSUFFLATION; SWALLOWING DIFFICULTIES; CHILDREN; MALNUTRITION; SURVIVAL; TUBE;
D O I
10.3109/09638288.2015.1111434
中图分类号
R49 [康复医学];
学科分类号
100215 ;
摘要
Purpose: Duchenne muscular dystrophy (DMD) is a rapidly progressive neuromuscular disorder causing weakness of the skeletal, respiratory, cardiac and oropharyngeal muscles with up to one third of young men reporting difficulty swallowing (dysphagia). Recent studies on dysphagia in DMD clarify the pathophysiology of swallowing disorders and offer new tools for its assessment but little guidance is available for its management. This paper aims to provide a step-by-step algorithm to facilitate clinical decisions regarding dysphagia management in this patient population. Methods: This algorithm is based on 30 years of clinical experience with DMD in a specialised Centre for Neuromuscular Disorders (Inkendaal Rehabilitation Hospital, Belgium) and is supported by literature where available. Results: Dysphagia can worsen the condition of ageing patients with DMD. Apart from the difficulties of chewing and oral fragmentation of the food bolus, dysphagia is rather a consequence of an impairment in the pharyngeal phase of swallowing. By contrast with central neurologic disorders, dysphagia in DMD accompanies solid rather than liquid intake. Symptoms of dysphagia may not be clinically evident; however laryngeal food penetration, accumulation of food residue in the pharynx and/or true laryngeal food aspiration may occur. The prevalence of these issues in DMD is likely underestimated. Conclusions: There is little guidance available for clinicians to manage dysphagia and improve feeding for young men with DMD. This report aims to provide a clinical algorithm to facilitate the diagnosis of dysphagia, to identify the symptoms and to propose practical recommendations to treat dysphagia in the adult DMD population.
引用
收藏
页码:2052 / 2062
页数:11
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