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Objective: The aim of this study was to determine if external subglottic air flow (ESAF) influences swallowing frequency in severely dysphagic tracheotomized patients with brain injury. Methods: Ten patients were recruited at the neurological intensive care unit. The ESAF intervention was provided through the standard cuffed suction aid tracheotomy tube, which primarily is used to suction residual secretion volume from the subglottic area. Sessions were 150 minutes, and ESAF was provided at 60-65, 90-95, and 120-125 minutes at 3 L/min. Outcome measures included swallowing frequency (swallows/5 min) at 0-5 minutes (pre-baseline), 25-30 and 55-60 minutes (baseline/control), and 85-90, 115-120, and 145-150 minutes (postintervention). The residual secretion volume (ml) from the subglottic area was collected using a syringe at 0 minutes (pre-baseline), 30 and 60 minutes (baseline/control), and at 90, 120, and 150 minutes (postintervention). Results: The mean (±SEM) swallowing frequency (swallows/5 min) increased from 0.60 ± 0.30 to 2.10 ± 0.70 during the ESAF intervention (P < .001). The mean (±SEM) residual secretion volume reduced from 3.10 ± 0.31 ml to 0.50 ± 0.30 ml after the ESAF intervention (P < .001). Conclusion: The increase in swallowing frequency and reduction in residual secretion volume may indicate that ESAF influences swallowing parameters in patients with tracheotomy tubes. [ABSTRACT FROM AUTHOR]

Introduction: The relation between motor and cognitive function and autonomic nervous system (ANS) function during neurorehabilitation following acquired brain injury (ABI) has only been investigated sporadically. In the present study, it was hypothesized that clinical measures in severely injured patients would relate to heart rate variability (HRV), a measure of autonomic function. Methods: HRV measurements were initially performed on 49 patients (enrolled in a previous study) and follow-up (> 28 days) HRV measurements were performed. Standard deviation of normal-to-normal intervals (SDNN) and low frequency (LF) were extracted and these HRV variables were related to the clinical measures, Early Functional Ability (EFA) and Functional Independence Measure (FIM). Associations between HRV and clinical measures were analysed on admission data (only EFA), at follow-up and for the longitudinal change in measures. Results: Follow-up HRV was extracted from 19 patients. SDNN and LF were significantly correlated ( p < 0.05) to the EFA and FIM at follow-up, but not at admission. SDNN and LF changes were significantly correlated to EFA changes, but not FIM changes. Admission SDNN and LF were unable to provide prognostic information for the EFA and FIM at follow-up. Conclusion: HRV and its change during neurorehabilitation were associated to EFA and EFA changes over time. Further studies are required to clarify a number of limitations arising from this observational study. [ABSTRACT FROM AUTHOR]

Introduction: Acquired brain injury (ABI) cause neural deficits. In addition to motor and cognitive deficits, the autonomic nervous system may be affected. This has been shown for neurorehabilitation patients with traumatic brain injury (TBI) by means of reduced heart rate variability (HRV). It was hypothesized that patient groups with other ABI aetiology (mainly stroke, subarachnoid haemorrhage and anoxia) would also present reduced HRV. Methods: Patients consecutively admitted and severely ABI injured were considered for HRV measurements. HRV was extracted as a mean of four 5-minute ECG recordings at 6 pm, 10 pm, 2 am and 6 am the following day (scheduled resting periods). One 5-minute HRV recording from a sex- and age-matched group of healthy volunteers constituted control data. Standard deviation of normal-to-normal intervals (SDNN) and low frequency (LF) were primary HRV variables. Results: Of 71 admitted patients, HRV was extracted from 49 patients. Patient SDNN and LF were reduced compared to controls (SDNN: 13 ms (CI = [10.8; 15.3]) vs 40.3 ms (CI = [36.6; 44.2]), p < 0.0001; LF: 29.4 ms2 (CI = [19.8; 43.7]) vs 518 ms2 (CI = [419; 639]), p < 0.0001). HRV appeared identical across ABI aetiology. Conclusion: It was found that HRV was considerably reduced in an heterogenic ABI patient group admitted for neurorehabilitation. [ABSTRACT FROM AUTHOR]