Skip to main content
Top
Published in: Dysphagia 5/2021

01-10-2021 | Multiple Sclerosis | Original Article

Depression, Anxiety, and Stress Relative to Swallowing Impairment in Persons with Multiple Sclerosis

Authors: Zahra Sadeghi, Zahra Sadat Ghoreishi, Heather Flowers, Parvaneh Mohammadkhani, Fereshteh Ashtari, Mehdi Noroozi

Published in: Dysphagia | Issue 5/2021

Login to get access

Abstract

Dysphagia and symptoms of depression, anxiety and stress are common in persons with multiple sclerosis (MS). We posited a relationship between dysphagia and increased frequency of psychological symptoms. Therefore, the aim of the present study was to examine associations between symptoms of psychological difficulties, use of emotional suppression and cognitive reappraisal strategies, and dysphagia status in persons with MS. One hundred persons with MS were prospectively assessed in multiple domains of functioning: cognitive, psychological, and dysphagia-related. Participants underwent cognitive screening with the Mini Mental State Examination and completed two psychological inventories: The depression, anxiety and stress scale (DASS)-21 and the Emotion Regulation Questionnaire. Further, they completed the dysphagia in Multiple Sclerosis questionnaire. A speech-language pathologist evaluated persons suspected of having dysphagia with the Mann Assessment of Swallowing Ability. Dysphagia was present in 29 persons with MS, and the sample was split accordingly. The two groups differed at baseline with respect to Expanded Disability Status Scale scores. There were significant between-group differences for mental health symptoms and for use of emotional regulation strategies. Accordingly, multivariate logistic regressions showed that increased symptoms of psychological stress, decreased use of cognitive reappraisal strategies, and increased indicators of emotional suppression independently predicted the presence of dysphagia. There was a clear pattern towards poorer psychological well-being in persons with dysphagia compared to those without. Psychological difficulties may contribute to the manifestation or worsening of dysphagia and should be addressed in treatment planning and future investigations. Therapeutic interventions that promote improvement in mental state alongside swallowing function may be highly beneficial.
Literature
1.
go back to reference World Health Organization. Atlas: multiple sclerosis resources in the world 2008. Geneva: World Health Organization; 2008. World Health Organization. Atlas: multiple sclerosis resources in the world 2008. Geneva: World Health Organization; 2008.
2.
go back to reference Guan X-L, Wang H, Huang H-S, Meng L. Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci. 2015;36(5):671–81.PubMedCrossRef Guan X-L, Wang H, Huang H-S, Meng L. Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci. 2015;36(5):671–81.PubMedCrossRef
3.
go back to reference Marchese-Ragona R, Restivo D, Marioni G, Ottaviano G, Masiero S, Staffieri A. Evaluation of swallowing disorders in multiple sclerosis. Neurol Sci. 2006;27(4):s335–7.CrossRef Marchese-Ragona R, Restivo D, Marioni G, Ottaviano G, Masiero S, Staffieri A. Evaluation of swallowing disorders in multiple sclerosis. Neurol Sci. 2006;27(4):s335–7.CrossRef
4.
go back to reference Calcagno P, Ruoppolo G, Grasso M, De Vincentiis M, Paolucci S. Dysphagia in multiple sclerosis–prevalence and prognostic factors. Acta Neurol Scand. 2002;105(1):40–3.PubMedCrossRef Calcagno P, Ruoppolo G, Grasso M, De Vincentiis M, Paolucci S. Dysphagia in multiple sclerosis–prevalence and prognostic factors. Acta Neurol Scand. 2002;105(1):40–3.PubMedCrossRef
5.
go back to reference Tassorelli C, Bergamaschi R, Buscone S, Bartolo M, Furnari A, Crivelli P, et al. Dysphagia in multiple sclerosis: from pathogenesis to diagnosis. Neurol Sci. 2008;29(4):360–3.CrossRef Tassorelli C, Bergamaschi R, Buscone S, Bartolo M, Furnari A, Crivelli P, et al. Dysphagia in multiple sclerosis: from pathogenesis to diagnosis. Neurol Sci. 2008;29(4):360–3.CrossRef
6.
go back to reference Prosiegel M, Schelling A, Wagner-Sonntag E. Dysphagia and multiple sclerosis. Int MS J. 2004;11:22–31.PubMed Prosiegel M, Schelling A, Wagner-Sonntag E. Dysphagia and multiple sclerosis. Int MS J. 2004;11:22–31.PubMed
7.
go back to reference Abraham SS, Yun PT. Laryngopharyngeal dysmotility in multiple sclerosis. Dysphagia. 2002;17(1):69–74.PubMedCrossRef Abraham SS, Yun PT. Laryngopharyngeal dysmotility in multiple sclerosis. Dysphagia. 2002;17(1):69–74.PubMedCrossRef
8.
go back to reference Boeschoten RE, Braamse AM, Beekman AT, Cuijpers P, van Oppen P, Dekker J, et al. Prevalence of depression and anxiety in multiple sclerosis: a systematic review and meta-analysis. J Neurol Sci. 2017;372:331–41.PubMedCrossRef Boeschoten RE, Braamse AM, Beekman AT, Cuijpers P, van Oppen P, Dekker J, et al. Prevalence of depression and anxiety in multiple sclerosis: a systematic review and meta-analysis. J Neurol Sci. 2017;372:331–41.PubMedCrossRef
9.
go back to reference Gold SM, Irwin MR. Depression and immunity: inflammation and depressive symptoms in multiple sclerosis. Immunol Allergy Clin N Am. 2009;29(2):309–20.CrossRef Gold SM, Irwin MR. Depression and immunity: inflammation and depressive symptoms in multiple sclerosis. Immunol Allergy Clin N Am. 2009;29(2):309–20.CrossRef
10.
go back to reference Feinstein A, Roy P, Lobaugh N, Feinstein K, O’connor P, Black S. Structural brain abnormalities in multiple sclerosis patients with major depression. Neurology. 2004;62(4):586–90.PubMedCrossRef Feinstein A, Roy P, Lobaugh N, Feinstein K, O’connor P, Black S. Structural brain abnormalities in multiple sclerosis patients with major depression. Neurology. 2004;62(4):586–90.PubMedCrossRef
11.
go back to reference Group GC. The Goldman Consensus statement on depression in multiple sclerosis. Mult Scler J. 2005;11(3):328–37.CrossRef Group GC. The Goldman Consensus statement on depression in multiple sclerosis. Mult Scler J. 2005;11(3):328–37.CrossRef
12.
go back to reference Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev. 2010;30(2):217–37.PubMedCrossRef Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev. 2010;30(2):217–37.PubMedCrossRef
13.
go back to reference Gross JJ. Handbook of emotion regulation. New York: Guilford Publications; 2013. Gross JJ. Handbook of emotion regulation. New York: Guilford Publications; 2013.
14.
go back to reference Fernandes AM, Duprat Ade C, Eckley CA, Silva L, Ferreira RB, Tilbery CP. Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity? Braz J Otorhinolaryngol. 2013;79(4):460–5.PubMedCrossRef Fernandes AM, Duprat Ade C, Eckley CA, Silva L, Ferreira RB, Tilbery CP. Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity? Braz J Otorhinolaryngol. 2013;79(4):460–5.PubMedCrossRef
15.
go back to reference Folks DG, Kinney FC. The role of psychological factors in gastrointestinal conditions: a review pertinent to DSM-IV. Psychosomatics. 1992;33(3):257–70.PubMedCrossRef Folks DG, Kinney FC. The role of psychological factors in gastrointestinal conditions: a review pertinent to DSM-IV. Psychosomatics. 1992;33(3):257–70.PubMedCrossRef
16.
go back to reference Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–46.PubMedCrossRef Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–46.PubMedCrossRef
17.
go back to reference Baijens LW, Koetsenruijter K, Pilz W. Diagnosis and treatment of phagophobia: a review. Dysphagia. 2013;28(2):260–70.PubMedCrossRef Baijens LW, Koetsenruijter K, Pilz W. Diagnosis and treatment of phagophobia: a review. Dysphagia. 2013;28(2):260–70.PubMedCrossRef
18.
go back to reference Verdonschot RJ, Baijens LW, Serroyen JL, Leue C, Kremer B. Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia. J Psychosom Res. 2013;75(5):451–5.PubMedCrossRef Verdonschot RJ, Baijens LW, Serroyen JL, Leue C, Kremer B. Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia. J Psychosom Res. 2013;75(5):451–5.PubMedCrossRef
19.
go back to reference Verdonschot RJ, Baijens LW, Vanbelle S, van de Kolk I, Kremer B, Leue C. Affective symptoms in patients with oropharyngeal dysphagia: a systematic review. J Psychosom Res. 2017;97:102–10.PubMedCrossRef Verdonschot RJ, Baijens LW, Vanbelle S, van de Kolk I, Kremer B, Leue C. Affective symptoms in patients with oropharyngeal dysphagia: a systematic review. J Psychosom Res. 2017;97:102–10.PubMedCrossRef
20.
go back to reference Tarameshlu M, Azimi AR, Ghelichi L, Ansari NN. Prevalence and predictors of dysphagia in Iranian patients with multiple sclerosis. Med J Islam Repub Iran. 2017;31:133.PubMedPubMedCentralCrossRef Tarameshlu M, Azimi AR, Ghelichi L, Ansari NN. Prevalence and predictors of dysphagia in Iranian patients with multiple sclerosis. Med J Islam Repub Iran. 2017;31:133.PubMedPubMedCentralCrossRef
21.
go back to reference Poorjavad M, Derakhshandeh F, Etemadifar M, Soleymani B. Associated factors with swallowing disorders in patients with multiple sclerosis. J Isfahan Med School. 2010;28(104):40–6. Poorjavad M, Derakhshandeh F, Etemadifar M, Soleymani B. Associated factors with swallowing disorders in patients with multiple sclerosis. J Isfahan Med School. 2010;28(104):40–6.
22.
go back to reference Solaro C, Rezzani C, Trabucco E, Amato M, Zipoli V, Portaccio E, et al. Prevalence of patient-reported dysphagia in multiple sclerosis patients: an Italian multicenter study (using the DYMUS questionnaire). J Neurol Sci. 2013;331(1–2):94–7.PubMedCrossRef Solaro C, Rezzani C, Trabucco E, Amato M, Zipoli V, Portaccio E, et al. Prevalence of patient-reported dysphagia in multiple sclerosis patients: an Italian multicenter study (using the DYMUS questionnaire). J Neurol Sci. 2013;331(1–2):94–7.PubMedCrossRef
23.
go back to reference De Pauw A, Dejaeger E, D’hooghe B, Carton H. Dysphagia in multiple sclerosis. Clin Neurol Neurosurg. 2002;104(4):345–51.PubMedCrossRef De Pauw A, Dejaeger E, D’hooghe B, Carton H. Dysphagia in multiple sclerosis. Clin Neurol Neurosurg. 2002;104(4):345–51.PubMedCrossRef
24.
go back to reference Thomas FJ, Wiles C. Dysphagia and nutritional status in multiple sclerosis. J Neurol. 1999;246(8):677–82.PubMedCrossRef Thomas FJ, Wiles C. Dysphagia and nutritional status in multiple sclerosis. J Neurol. 1999;246(8):677–82.PubMedCrossRef
25.
go back to reference Manor Y, Balas M, Giladi N, Mootanah R, Cohen JT. Anxiety, depression and swallowing disorders in patients with Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(6):453–6.PubMedCrossRef Manor Y, Balas M, Giladi N, Mootanah R, Cohen JT. Anxiety, depression and swallowing disorders in patients with Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(6):453–6.PubMedCrossRef
26.
go back to reference Han M, Ohnishi H, Nonaka M, Yamauchi R, Hozuki T, Hayashi T, et al. Relationship between dysphagia and depressive states in patients with Parkinson’s disease. Parkinsonism Relat Disord. 2011;17(6):437–9.PubMedCrossRef Han M, Ohnishi H, Nonaka M, Yamauchi R, Hozuki T, Hayashi T, et al. Relationship between dysphagia and depressive states in patients with Parkinson’s disease. Parkinsonism Relat Disord. 2011;17(6):437–9.PubMedCrossRef
27.
go back to reference Lin BM, Starmer HM, Gourin CG. The relationship between depressive symptoms, quality of life, and swallowing function in head and neck cancer patients 1 year after definitive therapy. Laryngoscope. 2012;122(7):1518–25.PubMedCrossRef Lin BM, Starmer HM, Gourin CG. The relationship between depressive symptoms, quality of life, and swallowing function in head and neck cancer patients 1 year after definitive therapy. Laryngoscope. 2012;122(7):1518–25.PubMedCrossRef
28.
go back to reference Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;24(7):476–80.PubMedCrossRef Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;24(7):476–80.PubMedCrossRef
29.
go back to reference Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.PubMedCrossRef Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.PubMedCrossRef
30.
go back to reference Ansari NN, Naghdi S, Hasson S, Valizadeh L, Jalaie S. Validation of a Mini-Mental State Examination (MMSE) for the Persian population: a pilot study. Appl Neuropsychol. 2010;17(3):190–5.PubMedCrossRef Ansari NN, Naghdi S, Hasson S, Valizadeh L, Jalaie S. Validation of a Mini-Mental State Examination (MMSE) for the Persian population: a pilot study. Appl Neuropsychol. 2010;17(3):190–5.PubMedCrossRef
31.
go back to reference Brown TA, Chorpita BF, Korotitsch W, Barlow DH. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Ther. 1997;35(1):79–89.PubMedCrossRef Brown TA, Chorpita BF, Korotitsch W, Barlow DH. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Ther. 1997;35(1):79–89.PubMedCrossRef
32.
go back to reference Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176.CrossRef Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176.CrossRef
33.
go back to reference Asghari A, Saed F, Dibajnia P. Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. Int J psychol. 2008;2(2):82–102. Asghari A, Saed F, Dibajnia P. Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. Int J psychol. 2008;2(2):82–102.
34.
go back to reference Gloster AT, Rhoades HM, Novy D, Klotsche J, Senior A, Kunik M, et al. Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. J Affect Disord. 2008;110(3):248–59.PubMedPubMedCentralCrossRef Gloster AT, Rhoades HM, Novy D, Klotsche J, Senior A, Kunik M, et al. Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. J Affect Disord. 2008;110(3):248–59.PubMedPubMedCentralCrossRef
35.
go back to reference Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(2):227–39.PubMedCrossRef Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(2):227–39.PubMedCrossRef
36.
go back to reference Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2003;42(Pt 2):111–31.PubMedCrossRef Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2003;42(Pt 2):111–31.PubMedCrossRef
37.
go back to reference Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. Iran Psychol. 2005;4(1):299–313. Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. Iran Psychol. 2005;4(1):299–313.
38.
go back to reference Samani S, Joukar B. A study on the reliability and validity of the short form of the depression anxiety stress scale (DASS-21). 2007. Samani S, Joukar B. A study on the reliability and validity of the short form of the depression anxiety stress scale (DASS-21). 2007.
39.
go back to reference Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Person Soc Psychol. 2003;85(2):348.CrossRef Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Person Soc Psychol. 2003;85(2):348.CrossRef
40.
go back to reference Hasani J. Persian version of the emotion regulation questionnaire: factor structure, reliability and validity. Int J Behav Sci. 2016;10(3):156–61. Hasani J. Persian version of the emotion regulation questionnaire: factor structure, reliability and validity. Int J Behav Sci. 2016;10(3):156–61.
41.
go back to reference Bergamaschi R, Crivelli P, Rezzani C, Patti F, Solaro C, Rossi P, et al. The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. J Neurol Sci. 2008;269(1–2):49–53.PubMedCrossRef Bergamaschi R, Crivelli P, Rezzani C, Patti F, Solaro C, Rossi P, et al. The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. J Neurol Sci. 2008;269(1–2):49–53.PubMedCrossRef
42.
go back to reference Jafari Z, Shahbodaghi MR, Maroufizadeh S, Moghadasi AN. Validation of the Persian version of dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis. Iran J Neurol. 2018;17(3):99.PubMedPubMedCentral Jafari Z, Shahbodaghi MR, Maroufizadeh S, Moghadasi AN. Validation of the Persian version of dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis. Iran J Neurol. 2018;17(3):99.PubMedPubMedCentral
43.
go back to reference Asadollahpour F, Mehri A, Khatoonabadi A, Mohammadzaheri F, Ebadi A. Validation of the Persian version of the dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis. J Res Med Sci J Isfahan Univ Med Sci. 2019;24:52. Asadollahpour F, Mehri A, Khatoonabadi A, Mohammadzaheri F, Ebadi A. Validation of the Persian version of the dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis. J Res Med Sci J Isfahan Univ Med Sci. 2019;24:52.
44.
go back to reference Mann G. MASA: the Mann assessment of swallowing ability. Boston: Cengage Learning; 2002. Mann G. MASA: the Mann assessment of swallowing ability. Boston: Cengage Learning; 2002.
45.
go back to reference González-Fernández M, Sein MT, Palmer JB. Clinical experience using the Mann assessment of swallowing ability for identification of patients at risk for aspiration in a mixed-disease population. Am J Speech-Lang Pathol. 2011;20:331.PubMedCrossRef González-Fernández M, Sein MT, Palmer JB. Clinical experience using the Mann assessment of swallowing ability for identification of patients at risk for aspiration in a mixed-disease population. Am J Speech-Lang Pathol. 2011;20:331.PubMedCrossRef
46.
go back to reference Mennin DS, Holaway RM, Fresco DM, Moore MT, Heimberg RG. Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behav Ther. 2007;38(3):284–302.PubMedCrossRef Mennin DS, Holaway RM, Fresco DM, Moore MT, Heimberg RG. Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behav Ther. 2007;38(3):284–302.PubMedCrossRef
47.
go back to reference Campbell-Sills L, Barlow DH. Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In: Gross JJ, editor. Handbook of emotion regulation. New York: Guilford Press; 2007. p. 2. Campbell-Sills L, Barlow DH. Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In: Gross JJ, editor. Handbook of emotion regulation. New York: Guilford Press; 2007. p. 2.
48.
go back to reference Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. Dialog Clin Neurosci. 2011;13(1):7.CrossRef Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. Dialog Clin Neurosci. 2011;13(1):7.CrossRef
49.
go back to reference Kisely S, Smith M, Lawrence D, Maaten S. Mortality in individuals who have had psychiatric treatment: population-based study in Nova Scotia. Br J Psychiatry. 2005;187(6):552–8.PubMedCrossRef Kisely S, Smith M, Lawrence D, Maaten S. Mortality in individuals who have had psychiatric treatment: population-based study in Nova Scotia. Br J Psychiatry. 2005;187(6):552–8.PubMedCrossRef
50.
go back to reference Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665–73.PubMedPubMedCentralCrossRef Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665–73.PubMedPubMedCentralCrossRef
51.
go back to reference Naragon-Gainey K, McMahon TP, Chacko TP. The structure of common emotion regulation strategies: a meta-analytic examination. Psychol Bull. 2017;143(4):384.PubMedCrossRef Naragon-Gainey K, McMahon TP, Chacko TP. The structure of common emotion regulation strategies: a meta-analytic examination. Psychol Bull. 2017;143(4):384.PubMedCrossRef
Metadata
Title
Depression, Anxiety, and Stress Relative to Swallowing Impairment in Persons with Multiple Sclerosis
Authors
Zahra Sadeghi
Zahra Sadat Ghoreishi
Heather Flowers
Parvaneh Mohammadkhani
Fereshteh Ashtari
Mehdi Noroozi
Publication date
01-10-2021
Publisher
Springer US
Published in
Dysphagia / Issue 5/2021
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-020-10207-x

Other articles of this Issue 5/2021

Dysphagia 5/2021 Go to the issue