Effects of Tongue-Hold Swallows on Suprahyoid Muscle Activation According to the Relative Tongue Protrusion Length in the Elderly Individuals

  • Jong-Chi Oh

Dysphagia (2018). https://doi.org/10.1007/s00455-018-9948-x

Imagem: Google


This study investigated differences in suprahyoid muscle activity in elderly adults during tongue-hold swallowing (THS) according to tongue protrusion length to determine the most effective tongue protrusion length during THS. A total of 52 healthy participants (34 females and 18 males) aged 69–92 years were included. Changes in suprahyoid muscle activation during normal swallowing and THS with 1/3rd and 2/3rd tongue protrusions using surface electromyography were observed. Suprahyoid muscle activation significantly increased with the increasing tongue protrusion length (p< 0.05). Depending on the responses of the participants based on tongue protrusion length, participants were categorized into the increase group [increased suprahyoid muscle activity with tongue protrusion, n= 36 (1/3rd THS compared to normal swallowing) or 38 (2/3rd THS compared to normal swallowing)] or decrease group [decreased suprahyoid muscle activity with tongue protrusion, n= 16 (1/3rd THS compared to normal swallowing) or 14 (2/3rd THS compared to normal swallowing)]. The functional reserve of the increase group was significantly higher than that of the decrease group (p< 0.05). Many elderly people were found to have increased activation of the suprahyoid muscle during THS; however, others showed the opposite. Therefore, it is necessary to confirm the degree of suprahyoid muscle activation during THS so that the patient can perform the exercise at the tongue protrusion length that can maximize the effect of the exercise. For individuals who cannot overcome even a small amount of tongue protrusion (e.g., 1/3rd MTPL), replacing THS with another exercise may be considered.



Curso: Práticas Respiratórias e estratégias ventilatórias no paciente disfágico neurogênico

✔ Palestrantes:

Dra. Ana Lucia Chiappetta

Ms. Celiana Figueiredo

✔Data e horário:

26/10- 14 às 21h

27/10 – 08 às 17h

✏ O curso visa favorecer conhecimento e estratégias ventilatórias utilizadas no paciente disfágico neurogênico com abordagem interdisciplinar para a avaliação e tratamento miofuncional.


➖ Conceitos de neuroanatomia e neurofisiologia do sistema respiratório e da deglutição

➖ Avaliação do paciente disfágico neurogênico

➖ Prescrição e Discussão de exercícios fonoterápicos e respiratórios para pacientes disfágicos neurogênicos

➖ Uso de Ambu e suas diferentes técnicas

➖ Uso de cough assist

➖ Uso de INCENTIVADORES RESPIRATÓRIOS threshold, respiron (diferentes níveis) Shaker, EMST, VUP e voldayne

➖ Válvula de fala

➖ Disfagia X Prevenção de Complicações pulmonares

➖ Atuação em equipe interdisciplinar

➖ Discussão de casos

✔ Carga horária: 20 h/aula


– *590,00 para grupos de 5 alunos (dividido de 2x 295,00)*

– R$640,00 à vista *

– R$690,00 em 4x (4x 172,50)

* Valor à vista em 3x para alunos Núcleo Reabilite (3x 213,00)

**10% para estudantes no último período, residentes e recém formados mediante comprovação.

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Tatiana Chaves

CPos BH/ Núcleo Reabilite


International consensus (ICON) on assessment of oropharyngeal dysphagia.

Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Feb;135(1S):S17-S21. doi: 10.1016/j.anorl.2017.12.009. Epub 2018 Feb 1.

Espitalier F1, Fanous A2, Aviv J3, Bassiouny S4, Desuter G5, Nerurkar N6, Postma G7, Crevier-Buchman L8.


OBJECTIVE: To present international recommendations regarding the proper evaluation of oropharyngeal dysphagia (OD), both objectively and subjectively (self-evaluation).

METHODS: Following a thorough review of the literature, 5 experts in the field from 4 different continents answered separately a questionnaire regarding the work-up of OD. Individual answers were presented and discussed during the world ENT conference that was held in Paris in June 2017. This article will present the recommendations issued from that meeting.

RESULTS: For the initial objective assessment of OD, it is recommended to perform either a functional endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallowing study (VFSS). FEES is the more popular investigation given its increased ease of use and accessibility. When evaluating for the presence of aspiration during the objective evaluation of OD, it is recommended to perform either a FEES or a VFSS. In this case, FEES is the favored investigation given its likely increased sensitivity. In order to highlight the presence of oropharyngeal food residue following the deglutition process, it is recommended to perform either a FEES or a VFSS; FEES likely being the more sensitive investigation while VFSS allows a better quantification of the amount of pharyngeal residue. Is it also recommended to objectify the quality of the deglutition process by means of a score during the objective evaluation of OD. Finally, it is recommended to utilize a self-evaluation questionnaire during research studies exploring the deglutition process.

Copyright © 2018 Elsevier Masson SAS. All rights reserved.


Home-Based Orolingual Exercise Improves the Coordination of Swallowing and Respiration in Early Parkinson Disease: A Quasi-Experimental Before-and-After Exercise Program Study

Front Neurol. 2018 Jul 30;9:624. doi: 10.3389/fneur.2018.00624. eCollection 2018.


Introduction: The coordination of swallowing and respiration is important for safety swallowing without aspiration. This coordination was affected in Parkinson disease (PD). A noninvasive assessment tool was used to investigate the effect of an easy-to-perform and device-free home-based orolingual exercise (OLE) program on swallowing and respiration coordination in patients with early-stage PD. Materials and Methods: This study had a quasi-experimental before-and-after exercise program design. Twenty six patients with early-stage PD who were aged 62.12 ± 8.52 years completed a 12-week home-based OLE program. A noninvasive assessment tool was used to evaluate swallowing and respiration. For each patient, we recorded and analyzed 15 swallows (3 repeats of 5 water boluses: 1, 3, 5, 10, and 20 mL) before and after the home-based OLE program. Oropharyngeal swallowing and its coordination with respiration were the outcome measures. The frequency of piecemeal deglutition, pre- and post-swallowing respiratory phase patterns, and parameters of oropharyngeal swallowing and respiratory signals (swallowing respiratory pause [SRP], onset latency [OL], total excursion time [TET], excursion time [ET], second deflexion, amplitude, and duration of submental sEMG activity, and amplitude of laryngeal excursion) were examined. Results: The rate of piecemeal deglutition decreased significantly when swallowing 10- and 20-mL water boluses after the program. In the 1-mL water bolus swallowing trial, the rate of protective pre- and post-swallowing respiratory phase patterns was significantly higher after the program. For the parameters of oropharyngeal swallowing and respiratory signals, only the amplitude of laryngeal excursion was significantly lower after the program. Moreover, the volume of the water bolus significantly affected the SRP and duration of submental sEMG when patients swallowed three small water bolus volumes (1, 3, and 5 mL). Conclusion: The home-based OLE program improved swallowing and its coordination with respiration in patients with early-stage PD, as revealed using a noninvasive method. This OLE program can serve as a home-based program to improve swallowing and respiration coordination in patients with early-stage PD.

Post-extubation Dysphagia: Does Timing of Evaluation Matter?

Marvin S1, Thibeault S2, Ehlenbach WJ3.

Dysphagia. 2018 Jul 24. doi: 10.1007/s00455-018-9926-3. [Epub ahead of print]


Swallowing evaluations are often delayed at least 24 h following extubation with the assumption that swallow function improves over time. The purpose of this prospective cohort study was to determine if dysphagia, as measured by aspiration and need for diet modification, declines over the first 24-h post-extubation, whereby providing evidence-based evaluation guidelines for this population. Forty-nine patients completed FEES at 2-4 h post-extubation and 24-26 h post-extubation. We compared Penetration-Aspiration Scale scores and diet recommendation between time points. Multivariable logistic regression models were created to investigate associations between age, reason for admission, reason for intubation, and a history of COPD and outcomes of aspiration or silent aspiration at either FEES exam. Sixty-nine percent of participants safely swallowed at least one texture without aspiration at 2-4 h post-extubation. Within participants, there was a significant decrease in penetration/aspiration at 24 h and 79% showed improvement in airway protection on at least one bolus type, suggesting an improvement in swallow function over the first day following extubation. These findings suggest that although patients may be safe to begin a modified diet soon after extubation, delaying evaluation until 24-h post-extubation may allow for a less restricted diet.


The role of speech-language pathologists in adult palliative care.

Chahda L1, Mathisen BA2, Carey LB1.

Int J Speech Lang Pathol. 2017 Feb;19(1):58-68. doi: 10.1080/17549507.2016.1241301.

Créditos Imagem: http://www.indusage.com.au/after-hours-helpline-for-palliative-care-patients-and-carers/


PURPOSE: Given minimal studies describing the role and practice of speech-language pathologists (SLPs) in adult palliative care, the aim of this review was to compile a database of research literature, examine the potential research gaps and to consider material that specifically discussed the need for and/or use of procedures and protocols for SLPs working in palliative care that would support the development of SLP palliative care guidelines.

METHOD: A scoping review was conducted utilising Arksey and O’Malley’s framework with the goal of exploring any key concepts and approaches utilised by SLPs in adult palliative care, plus any literature and/or recommendations regarding SLP practice in adult palliative care settings.

RESULT: Over 1200 articles were initially identified. Of the 1200 articles, 13 academic papers were considered relevant as they recommended, or at least suggested, the need for speech-language pathology therapy guidelines to be implemented within adult palliative care settings.

CONCLUSION: The main focus of these articles was on ethical considerations and clinical recommendations for SLPs. Recommendations arising from this scoping review include providing goals to support current practising SLP clinicians and developing clinical guidelines to manage swallowing and/or communication needs of people receiving palliative care.

Getting comfortable with “comfort feeding”: An exploration of legal and ethical aspects of the Australian speech-language pathologist’s role in palliative dysphagia care.

Kelly K1,2, Cumming S2, Kenny B2, Smith-Merry J2, Bogaardt H2.

Int J Speech Lang Pathol. 2018 Mar 28:1-9. doi: 10.1080/17549507.2018.1448895. [Epub ahead of print]


PURPOSE: With an ageing population, speech-language pathologists (SLPs) can expect to encounter legal and ethical challenges associated with palliative and end-of-life care more frequently. An awareness of the medico-legal and ethical framework for palliative dysphagia management will better equip SLPs to work effectively in this area.

METHOD: This narrative review examines a range of legislation, legal, ethical and SLP literature that is currently available to orient SLPs to legal and ethical palliative dysphagia management in the Australian context.

RESULT: Relevant legal and ethical considerations in palliative and end-of-life care are described.

CONCLUSION: SLPs have a role in palliative dysphagia management, however, this can involve unique legal and ethical challenges. The legal position on provision and cessation of nutrition and hydration differs between Australian States and Territories. Decisions by the courts have established a body of relevant case law. This article introduces SLPs to some of the important considerations for legal and ethical palliative care, but is not intended to be directive. SLPs are encouraged to explore their local options for ethical and medico-legal guidance. It is hoped that increasing SLPs awareness of many of the concepts discussed in this article enhances the provision of high-quality patient-centred care.