Arquivo do autor:Natalie Argolo Ponte

Sobre Natalie Argolo Ponte

PhD, Speech Therapist

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.

Abstract

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.

Anúncios

Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines

Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The disease itself and the treatment can have far reaching effects on speech and swallow function, which are consistently prioritised by survivors as an area of concern. This paper provides recommendations on the assessments and interventions for speech and swallow rehabilitation in this patient group.

Recommendations

• All multidisciplinary teams should have rehabilitation patient pathways covering all stages of the patient’s journey including multidisciplinary and pre-treatment clinics. (G)

• Clinicians treating head and neck cancer patients should consult the National Cancer Rehabilitation Pathway for head and neck cancers. (G)

• All head and neck cancer patients should have a pre-treatment assessment of speech and swallowing. (G)

• A programme of prophylactic exercises and the teaching of swallowing manoeuvres can reduce impairments, maintain function and enable a speedier recovery. (R)

• Continued speech and language therapist input is important in maintaining voice and safe and effective swallow function following head and neck cancer treatment. (R)

• Disease recurrence must be ruled out in the management of stricture and/or stenosis. (R)

• Continuous radial expansion balloons offer a safe, effective dilation method with advantages over gum elastic bougies. (R)

• Site, length and completeness of strictures as well as whether they are in the presence of the larynx or not, need to be assessed when establishing the likelihood of surgically improved outcome. (G)

• Primary surgical voice restoration should be offered to all patients undergoing laryngectomy. (R)

• Attention to surgical detail and long-term speech and language therapist input is required to optimise speech and swallowing after laryngectomy. (G)

• Patients should commence wearing heat and moisture exchange devices as soon as possible after laryngectomy. (R)

 

BAIXE AQUI O PDF!

Terapia da disfagia na doença de Parkinson 

Expert Rev Neurother. 2010 Jun;10(6):875-8. doi: 10.1586/ern.10.60.

Dysphagia in Parkinson’s disease: a therapeutic challenge?

Michou E1Hamdy S.

Abstract

This article focuses on the current status and research directions on swallowing disorders (dysphagia) in patients with Parkinson’s disease (PD). Although epidemiological data are scarce, increased incidence of dysphagia in patients with PD leads to increased risk of mortality, secondary to aspiration pneumonia. Although studies show that aspiration pneumonia is a common cause of death in this group of patients, clinical practice lacks an evidence base and there is an increased need for randomized clinical trials. Importantly, the underlying mechanisms accounting for the progression of dysphagia in PD are still unclear. Furthermore, evidence shows that dopaminergic medication does not affect swallowing performance. Future research in the field is urgently needed and may result in improved management of dysphagia in patients with PD.

https://www.ncbi.nlm.nih.gov/pubmed/20518603

Edição comemorativa 25 anos do Dysphagia Journal

Em comemoração aos 25 anos de uma das revistas mais importantes no campo da disfagia mundial, foi lançada uma edição comemorativa neste mês de fevereiro de 2017.

Esta edição conta com importantes textos de ponto de vista e revisões em áreas como avaliação por FEES (Langmore), reabilitação (Easterling), estratégias compensatórias (Lazarus) além de avaliação videofluoroscópica, biofeedback, estudos em modelos animais, dentre outros. Vale a pena dar uma olhada.

Segue o link abaixo e a maioria dos artigos podem ser baixados a partir de uma conexão universitária. Bom carnaval! 😉

ACESSE O DYSPHAGIA JOURNAL

Failed Deglutitive Upper Esophageal Sphincter Relaxation Is a Risk Factor for Aspiration in Stroke Patients with Oropharyngeal Dysphagia.

J Neurogastroenterol Motil. 2016 Aug 10. doi: 10.5056/jnm16028. [Epub ahead of print]

Abstract

Background/Aims:

We attempted to examine the relationship between abnormal findings on high-resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) of the pharynx and upper esophageal sphincter (UES) and to identify the risk factors for aspiration.

Methods:

We performed VFSS and HRM on the same day in 36 ischemic stroke patients (mean age, 67.5 years) with dysphagia. Pressure (basal, median intra bolus, nadir), relaxation time interval of the UES, and mesopharyngeal and hypopharyngeal contractility (as a contractile integral) were examined using HRM. The parameters of VFSS were vallecular residue, pyriform sinus residue, vallecular overflow, penetration, and aspiration. The association between the parameters of VFSS and HRM was analyzed by the Student’s t test.

Results:

Three (8.3 %) and 4 (11.1 %) stroke patients with dysphagia had pyriform sinus residue and vallecular sinus residue, respectively, and 5 (13.8%) patients showed aspiration. Mesopharyngeal and hypopharyngeal contractile integrals in patients with residue in pyriform sinus were significantly lower than those in patients without residue in pyriform sinus (P < 0.05, respectively). Relaxation time intervals in patients with aspiration were significantly shorter than those in patients without aspiration (P < 0.05), and multivariate regression analysis revealed a shorter relaxation time interval as the main risk factor for aspiration (odds ratio, 0.025; 95% confidence interval, 0.001-0.652).

Conclusions:

Manometric measurements of the pharynx and UES were well correlated with abnormal findings in the VFSS and a shorter relaxation time interval of the UES during deglutition is an important parameter for the development of aspiration.

ARTIGO NA ÍNTEGRA!

Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial.

J Oral Rehabil. 2016 Jun;43(6):426-34. doi: 10.1111/joor.12390. Epub 2016 Mar 9.
Park JS1, Oh DH2, Hwang NK3, Lee JH4.

Abstract

Neuromuscular electrical stimulation (NMES) has been used as a therapeutic intervention for dysphagia. However, the therapeutic effects of NMES lack supporting evidence. In recent years, NMES combined with traditional swallowing therapy has been used to improve functional recovery in patients with post-stroke dysphagia. This study aimed to investigate the effects of effortful swallowing combined with neuromuscular electrical stimulation on hyoid bone movement and swallowing function in stroke patients. Fifty stroke patients with mild dysphagia who were able to swallow against the resistance applied by using NMES and cooperate actively in training were included. This study was designed as a 6-week single-blind, randomised, controlled study. In the experimental group, two pairs of electrodes were placed horizontally in the infrahyoid region to depress the hyoid bone. The NMES intensity was increased gradually until the participants felt a grabbing sensation in their neck and performed an effortful swallow during the stimulation. In the placebo group, the same procedure was followed except for the intensity, which was increased gradually until the participants felt an electrical sensation. All participants underwent this intervention for 30 min per session, 5 sessions per week, for 6 weeks. Videofluoroscopic swallowing studies (VFSS) were carried out before and after the intervention and kinematics of the hyoid bone and swallowing function were analysed based on the VFSS. The experimental group revealed a significant increase in anterior and superior hyoid bone movement and the pharyngeal phase of the swallowing function. This intervention can be used as a novel remedial approach in dysphagic stroke patients.

LINK PARA O PERIÓDICO

Effect of the Masako maneuver and neuromuscular electrical stimulation on the improvement of swallowing function in patients with dysphagia caused by stroke.

J Phys Ther Sci. 2016 Jul;28(7):2069-71. doi: 10.1589/jpts.28.2069. Epub 2016 Jul 29.

Abstract

[Purpose] The aim of this study was to compare improvements in swallowing function by the intervention of the Masako maneuver and neuromuscular electrical stimulation in patients with dysphagia caused by stroke. [Subjects and Methods] The Masako maneuver (n=23) and neuromuscular electrical stimulation (n=24) were conducted in 47 patients with dysphagia caused by stroke over a period of 4 weeks. Swallowing recovery was recorded using the functional dysphagia scale based on videofluoroscopic studies. [Results] Mean functional dysphagia scale values for the Masako maneuver and neuromuscular electrical stimulation groups decreased after the treatments. However, the pre-post functional dysphagia scale values showed no statistically significant differences between the groups. [Conclusion] The Masako maneuver and neuromuscular electrical stimulation each showed significant effects on the improvement of swallowing function for the patients with dysphagia caused by stroke, but no significant difference was observed between the two treatment methods.

ARTIGO NA ÍNTEGRA