Mohit Kothari

Background: Individuals with dysphagia exhibit impaired oral clearance and reduced airway protection, increasing oral biofilm accumulation and inflammatory burden. Objective: To evaluate whether a structured, individualized oral care approach (MOHIT) was associated with changes in oral inflammatory and biofilm‐related markers in dysphagic, care‐dependent individuals with acquired brain injury (ABI) during inpatient neurorehabilitation. Methods: Adults with ABI, who screened positive for dysphagia at week 1 ( n = 44) were followed for 3 weeks in an exploratory predefined subgroup analysis of a cluster nonrandomized controlled trial. Three wards implemented a structured, individualized oral care protocol (MOHIT: n = 12), consisting of structured oral assessment and individualized nurse‐delivered oral care including suction‐assisted electric toothbrushing, while three wards continued standard oral care (EOCP: n = 32). Outcomes included behavioural indicators (brushing frequency and toothbrush type), modified Bedside Oral Examination (mBOE), and clinical parameters (plaque, bleeding on probing, tongue coating, and odour) assessed at baseline and week 4. Direction‐of‐change indicators were compared using the Mann–Whitney U test. Results: Toothbrushing frequency did not differ between groups ( p = 0.347). The MOHIT group showed more favourable exploratory changes in overall mBOE score (3.1 ± 2.2 vs. 0.8 ± 2.8; p = 0.007), bleeding on probing (22.7 ± 22.3 vs. −4.0 ± 20.2; p = 0.001), plaque (20.1 ± 14.0 vs. 2.7 ± 17.4; p = 0.009), and odour score (1.6 ± 1.7 vs. 0.3 ± 1.4; p = 0.019). Tongue‐coating score showed a favourable but non‐significant exploratory pattern (6.2 ± 5.5 vs. 1.4 ± 6.6; p = 0.057). Conclusion: Structured, individualized oral care delivered by trained nursing staff was associated with improvements in screening and clinical inflammatory markers among dysphagic, care‐dependent ABI individuals. Given the cluster‐level implementation, small sample size, and nonrandomized allocation, findings indicate feasibility and support hypothesis‐generating evidence of potential clinical benefit but do not establish causal efficacy.

Background: Community awareness of swallowing and dysphagia plays a significant role in improving early‐referral behavior. Literature reports that community awareness of swallowing and dysphagia in the Western countries to be low. Conversely, India has a diverse cultural, linguistic and healthcare‐related factors which may influence the health‐seeking behavior and early‐referral of dysphagia. Hence, it becomes difficult to generalize the findings of existing literature. Aim: The primary objective of this study was to analyze the knowledge, attitudes and practices (KAP) related to swallowing and dysphagia among the community dwelling adults of South India. The secondary objective was to evaluate if age, sex and education levels were associated with these factors. Methods and Procedures: Community dwelling adults were recruited from Mangalore city, India for a cross‐sectional survey using a convenience sampling design. A purposive built content validated 27‐item questionnaire was distributed using Google Form and/or hard copies to the participants for data collection. Participant's responses were independently analyzed by two Speech Language Pathologists using open content analysis. The responses were summarized as percentages and categories and chi square test was administered to examine the association between age, sex and education levels and KAP enquiries at 0.05 level. Outcomes and Results: A total of 372 participants aged 20–79 years (mean age = 46.26; SD = 15.63) participated in the study. Participants demonstrated limited knowledge of signs, causes, complications and professional management of dysphagia. Aspiration was widely recognized as unsafe, yet only one‐tenth correctly identified pneumonia as a complication of dysphagia. Less than one‐fifth knew the treatment options for dysphagia. Attitudes reflected fear of choking, discomfort towards nasogastric‐tube feeding and moderate willingness to seek help from healthcare professionals. Practices suggested low awareness of Heimlich maneuver, inconsistent food‐texture modification and reliance on water to manage dry mouth. Age, sex and education levels were significantly associated with knowledge (saliva is important for chewing, avoid eating in public space to overcome stigma, early intervention helps regain swallowing abilities, age range frequently associated with dysphagia), attitude (fear of choking, preference to non‐oral feeds), practices (using internet to find solutions for dysphagia, drinking water before meals or moistening food using water, changing food consistencies, using straw over cup) at p > 0.05 level. Conclusions and Implications: Community dwellers demonstrated insufficient knowledge, predominantly negative attitudes and unsafe self‐management practices related to swallowing and dysphagia. Strengthened public education, early‐referral pathways and inclusion of basic life‐support skills are highly warranted to improve community awareness on swallowing and dysphagia. WHAT THIS PAPER ADDS: What is already known on this subject Community awareness of dysphagia is low in Western countries. Cultural beliefs, literacy, superstition and access to healthcare influence what people know, how they respond and when they seek help. Understanding knowledge, attitude and practices (KAP) of swallowing and dysphagia in India is critical for reducing self‐management risks and improving early‐referral behavior. What this study adds to existing knowledge The study provides the first structured KAP analysis on swallowing and dysphagia in an Indian community . Participants recognized aspiration as dangerous, yet lacked awareness of critical signs, causes, treatment options and responsible team members. Fear of choking was high, and most were uncomfortable with tube‐based feeding. The public seldom employed safe compensatory strategies and very few were familiar with Heimlich maneuver or food‐texture modification. Age, sex and education levels were significantly associated with multiple KAP variables. What are the clinical implications of this work? There is an urgent need to conduct more public awareness programs on prevention, early identification and intervention of dysphagia by healthcare professionals involved in dysphagia care. Efforts must be scaled to provide basic life support (BLS) skills training programs, including training in Heimlich maneuver, to the public.

Oral candidiasis (OC) is an infection of the oral cavity by the fungus Candida albicans. It has a prevalence of 35%–39% in debilitating conditions. OC can present as white and erythematous lesions that affect the oral cavity and larynx; it may invade the oesophagus in extreme cases. The most common risk factors for the development of OC include immunosuppression, wearing of dentures, pharmacotherapeutics, smoking, endocrine dysfunction, and decreased salivation. OC can cause burning mouth sensation and dysphagia, leading to nutritional deficiency and impaired quality of life. The presence of OC is associated with dysphagia, particularly in individuals with head and neck carcinoma, brain injury, and in the ageing population. However, the causal pathway is complex and influenced by multiple shared risk factors. The diagnosis of OC is based on clinical examination, assessment of risk factors, and mycological examination. A wide range of management options is available, ranging from prevention (oral care) to treatment that includes antifungal drugs. The prognosis of OC is good, although on rare occasions it may be life-threatening in individuals with unmanageable diseases.

Objective: Oral health care (OHC), despite its essential role in overall health, remains underprioritized in medical practice. The study investigated the effectiveness of an individualised, item‐specific, Mouth and Oral Health Individualised Treatment (MOHIT) plan compared to the existing oral care plan (EOCP) in individuals with acquired brain injury (ABI). Methods: A cluster nonrandomized controlled trial was conducted across six wards at a neurorehabilitation center. Wards were pragmatically assigned to deliver either MOHIT or routine EOCP for 3 weeks. Based on stepwise oral assessment, the MOHIT plan provided individualised protocols tailored to each patient's dependency level and oral condition. Oral care was performed daily by trained nurses under dental supervision. The primary outcome was change in bleeding on probing (BOP) from baseline to Week 4. Secondary outcomes included plaque index, tongue coating, oral malodor, salivary flow rate, and modified Bedside Oral Examination (mBOE) total and sub‐scores. Linear mixed‐effects models (for continuous outcomes) and cumulative link mixed models (for ordinal outcomes) were applied to assess Week‐4 versus baseline changes between groups, adjusting for ward clustering, baseline values, age, sex, and feeding status. Results: 86/126 individuals completed the trial (34 MOHIT, 52 EOCP). Compared with EOCP, the MOHIT plan showed greater reductions in BOP (coeff: −19.11; 95% CI: −27.97 to −10.24) and significant improvements in plaque (−13.23; 95% CI: −19.93 to −6.53), tongue coating (−3.01; 95% CI: −5.58 to −0.45), oral malodor (−1.27; 95% CI: −2.15 to −0.40), and suspected oral candidiasis (−3.21; 95% CI: −3.22 to −3.20) compared with EOCP. MOHIT also showed greater improvement in mBOE scores (−1.46; 95% CI: −2.54 to −0.39). Effects remained consistent after sensitivity analyses controlling for baseline imbalance and missing data. Conclusion: An individualised, item‐specific, nurse‐implemented OHC plan guided by structured screening and clinical assessment improved gingival inflammation and oral hygiene compared with routine care in adults with ABI within a multidisciplinary neurorehabilitation setting. Validation and feasibility testing in randomised clinical trials are warranted to facilitate translation into clinical practice.

This study aimed to map swallowing exercise protocols for healthy older adults based on the principles of neural plasticity and motor learning. The search strategy was run in MEDLINE, CINAHL, Cochrane CENTRAL, Embase, and Web of Science from inception to 6 May 2025. Two researchers independently screened for interventional studies involving swallowing exercises targeting the oropharyngeal, upper oesophageal, and respiratory structures relevant to swallowing in healthy older adults. The reviewers then mapped the eligible studies for adherence to the 10 principles of neural plasticity and principles of motor learning using validated operational definitions. Twenty studies were included for mapping. Studies showed good adherence to principles of neural plasticity like 'use it or lose it', 'repetition matters', and 'salience matters'. However, no study addressed the interference and gaps identified in the application of 'intensity', 'specificity', and 'transference' concepts. Furthermore, gaps were also observed for recommended guidelines across five practice conditions of principles of motor learning, except 'target complexity'. Lastly, gaps were also noted for all the four feedback conditions of principles of motor learning. This mapping review identified common trends and gaps in how principles of neural plasticity and principles of motor learning are integrated into swallowing exercise protocols of healthy older adults, offering valuable insights into concepts that meet or fall short of established guidelines.

To develop a pneumonia risk score for patients with severe acquired brain injury (sABI) hospitalized for post-acute rehabilitation. A prognostic model with data from 1,625 patients with sABI who were pneumonia-free at admission for rehabilitation. Candidate predictors were gathered within 72 hours following admission. Prognostic risk scores were calculated based on hazard ratios and combined in an overall pneumonia risk score ranging 0-10. Predictors were age >50 years hazard ratio (HR) 1,83 (95% CI: 1.33; 2.53), male sex HR 2.43 (95% CI: 1.70; 3.46), diagnosis (stroke, traumatic or anoxic brain injury) HR 1.69 (95% CI: 1.12; 2.55), tube feeding HR 4.46 (95% CI: 2.59; 7.70), and functional independence measure score of 18 HR 2.06 (95% CI: 1.10; 3.85). A score of 8-10 encompassed those being at high-risk of pneumonia with a positive predictive value (PPV) of 35% (95% CI: 32-37), a score of 5-7 encompassed those being at medium risk with a PPV of 16% (95% CI: 14-17), and a score of 0-4 encompassed those being at low risk with a PPV of 4% (95%CI: 3-5). A prognostic score was developed to raise awareness of patients in post-acute rehabilitation who are at high risk of pneumonia. The prognostic score should be externally validated before being used outside the development setting.

Objectives: To evaluate the presence, severity and progression of temporomandibular disorders (TMD) in acquired brain injury (ABI) population and determine the diagnostic accuracy of 3Q/TMD and Fonseca Anamnestic Index (FAI) against the gold standard, Diagnostic Criteria for TMD (DC/TMD).Methods: ABI individuals were assessed using 3Q/TMD and FAI at admission (n = 73) and Week 4 (n = 52), while DC/TMD was conducted only at Week 4. Diagnostic accuracy, sensitivity and specificity of 3Q/TMD and FAI were calculated against DC/TMD.Results: TMD was detected in 66.0% (3Q/TMD) and 27.8% (FAI) at admission, with mild (75%) to moderate (25%) severity which was mostly pain‐related. TMD frequency decreased to 11.3% (3Q/TMD) and 17.3% (FAI) by Week 4. Accuracy rates were 0.82 for 3Q/TMD and 0.83 for FAI. Sensitivity was 0.33 (3Q/TMD) and 0.50 (FAI), while specificity was high at 0.93 (3Q/TMD) and 0.90 (FAI).Conclusions: TMD presence was higher in an ABI population compared to the general population however the frequency decreased over time. The high specificity and accuracy of 3Q/TMD and FAI indicate their potentials as screening tools but their low sensitivity limits their effectiveness in identifying all TMD cases. Patients with ABI should be assessed for TMD as part of their comprehensive care.

Background: Neuroplasticity induced by mandibular advancement appliance (MAD) in patients with obstructive sleep apnoea (OSA) is poorly documented.Objective: This randomised placebo‐controlled crossover mechanistic study assessed the effects of short‐term use of a MAD on corticomotor excitability of the masseter and tongue in patients with OSA.Methods: Adults (n = 28) with mild or moderate OSA were randomly allocated to sleep with a MAD for 2‐weeks with 40% of the maximal protrusion (MAD active position) and without any jaw protrusion (MAD placebo position). The outcomes were assessed at baseline, and after 2 and 6 weeks, with a 2‐week washout period. The primary outcome was the amplitude of motor evoked potential (MEP) assessed on the right masseter, right side of tongue and right first dorsal interosseous with transcranial magnetic stimulation. Corticomotor map volume of the same muscles was also assessed. Repeated‐measures ANOVAs followed by Tukey test were applied to the data (p < .050).Results: There was a significant increase in the MEP amplitude of the masseter and tongue following the MAD active position compared with the baseline and MAD placebo (Tukey: p < .001). There were no significant MEP amplitude differences between the baseline and placebo positions (p > .050). Moreover, there was a significant increase in corticomotor map volume for the masseter and tongue muscles following the MAD active position compared with baseline and MAD placebo (Tukey: p < .003).Conclusion: Excitability of the masseter and tongue motor pathways is, at least transiently, increased in patients with OSA following a short‐term use of MAD. This novel finding of MAD‐induced neuroplasticity in corticomotor pathways may contribute to a further understanding of the mechanisms of oral appliances for treating OSA.

Background: The Test of Mastication and Swallowing Solids (TOMASS) is a reliable tool for assessing chewing and swallowing in healthy adults, using commercially available crackers. TOMASS‐Children (TOMASS‐C) is the paediatric version of TOMASS.Objective: The present study aimed to establish normative data for TOMASS‐C using a validated regional commercial cracker among healthy individuals aged between 6–20 years of India.Methods: 327 healthy individuals between 6–20 years were recruited in a cross‐sectional study design following a convenient sampling procedure. Participants consumed one validated regional cracker and the procedure was video recorded. Data were stratified according to age groups (6–7, 8–9, 10–13, 14–17 and 18–20 years) and sex (boys and girls). Two Speech Language Pathologists independently analysed the video recordings to derive discrete bites, masticatory cycles, swallows and total swallow time indices. Using them, time/swallow, masticatory cycles/bite, swallows/bite and time/bite were calculated.Results: All parameters of TOMASS‐C had moderate to good (0.6–0.85) test–retest reliability and moderate to excellent (0.69–0.99) inter‐rater reliability at p > .000. Younger participants took more bites, chewed more times and swallowed more frequently with longer chewing and swallowing time. Boys exhibited a lower number of swallows, shorter swallow time and reduced total masticatory time at p > .05. Additionally, girls demonstrated fewer bites and chewing cycles compared to boys at p > .05.Conclusion: TOMASS‐C using a validated regional cracker was feasible and reliable. Normative data established for healthy boys and girls between 6–20 years offers much‐needed quantitative data to objectively delineate individuals with and without chewing and swallowing solid food difficulties.