Arquivo do autor:Natalie Argolo Ponte

Sobre Natalie Argolo Ponte

PhD, Speech Therapist

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

Effects of Repetitive Transcranial Magnetic Stimulation in the Rehabilitation of Communication and Deglutition Disorders: Systematic Review of Randomized Controlled Trials

Folia Phoniatr Logop 2015;67:97-105
(DOI:10.1159/000439128)

Gadenz C.D. · Moreira T.d.C. · Capobianco D.M. · Cassol M.

Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil

Objective: To systematically review randomized controlled trials that evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on rehabilitation aspects related to communication and swallowing functions. Methods: A search was conducted on PubMed, Clinical Trials, Cochrane Library, and ASHA electronic databases. Studies were judged according to the eligibility criteria and analyzed by 2 independent and blinded researchers. Results: We analyzed 9 studies: 4 about aphasia, 3 about dysphagia, 1 about dysarthria in Parkinson’s disease and 1 about linguistic deficits in Alzheimer’s disease. All aphasia studies used low-frequency rTMS to stimulate Broca’s homologous area. High-frequency rTMS was applied over the pharyngoesophageal cortex from the left and/or right hemisphere in the dysphagia studies and over the left dorsolateral prefrontal cortex in the Parkinson’s and Alzheimer’s studies. Two aphasia and all dysphagia studies showed a significant improvement of the disorder, compared to the sham group. The other 2 studies related to aphasia found a benefit restricted to subgroups with a severe case or injury on the anterior portion of the language cortical area, respectively, whereas the Alzheimer’s study demonstrated positive effects specific to auditory comprehension. There were no changes for vocal function in the Parkinson’s study. Conclusion: The benefits of the technique and its applicability in neurogenic disorders related to communication and deglutition are still uncertain. Therefore, other randomized controlled trials are needed to clarify the optimal stimulation protocol for each disorder studied and its real effects.ARTIGO FREE

A Pilot Study of the Tongue Pull-Back Exercise for Improving Tongue-Base Retraction and Two Novel Methods to Add Resistance to the Tongue Pull-Back.

Dysphagia. 2016 Feb 9. [Epub ahead of print]

Abstract

This pilot study investigated the tongue pull-back (TPB) exercise to improve tongue-base retraction as well as two methods to add resistance to the TPB. Surface electromyography (sEMG) to the submental triangle was used as an indication of tongue-base activity on 13 healthy adults during: (1) saliva swallow, (2) 15 mL water swallow, (3) effortful swallow, (4) unassisted TPB, (5) TPB with added resistance by holding the tongue with gauze (finger-resisted TPB), and (6) TPB with the tongue clipped to a spring-loaded tension resistance device (device-resisted TPB). Order of the exercises was randomized. The exercises fell into two groups-weak and intense. Weak exercises included saliva swallow, water swallow, and unassisted TPB (mean sEMG = 19.07 μV, p = .593). Intense exercises included effortful swallow, finger-resisted TPB, and device-resisted TPB (mean sEMG = 36.44 μV, p = .315). Each intense exercise resulted in significantly higher mean sEMG peak amplitude than each weak exercise (p < .05), with one exception; the effortful swallow was not significantly different than the unassisted TPB (p = .171). This study provides preliminary evidence that the unassisted TPB may not be any more helpful for improving tongue-base retraction than normal swallowing. Adding resistance to the TPB by holding the tongue with gauze may be an effective alternative. This study also demonstrates proof-of-concept for creating a device to attach to the tongue and provide tension resistance during the TPB exercise. Further research with a more sophisticated design is needed before such a device can be fully developed and implemented clinically.

ACESSE O PERIÓDICO

Bolus Residue Scale: An Easy-to-Use and Reliable Videofluoroscopic Analysis Tool to Score Bolus Residue in Patients with Dysphagia.

Este estudo apresenta uma ótima ferramenta para conferir maior precisão à videofluoroscopia de deglutição. De modo fácil e rápido, este artigo (free para download) descreve como utilizar esta ferramenta para auxílio na prática clínica e realização de pesquisas.

Segue o resumo:

Background. We aimed to validate an easy-to-use videofluoroscopic analysis tool, the bolus residue scale (BRS), for detection and classification of pharyngeal retention in the valleculae, piriform sinuses, and/or the posterior pharyngeal wall. Methods. 50 randomly selected videofluoroscopic images of 10 mL swallows (recorded in 18 dysphagia patients and 8 controls) were analyzed by 4 experts and 6 nonexpert observers. A score from 1 to 6 was assigned according to the number of structures affected by residue. Inter- and intrarater reliabilities were assessed by calculation of intraclass correlation coefficients (ICCs) for expert and nonexpert observers. Sensitivity, specificity, and interrater agreement were analyzed for different BRS levels. Results. Intrarater reproducibility was almost perfect for experts (mean ICC 0.972) and ranged from substantial to almost perfect for nonexperts (mean ICC 0.835). Interjudge agreement of the experts ranged from substantial to almost perfect (mean ICC 0.780), but interrater reliability of nonexperts ranged from substantial to good (mean 0.719). BRS shows for experts a high specificity and sensitivity and for nonexperts a low sensitivity and high specificity. Conclusions. The BRS is a simple, easy-to-carry-out, and accessible rating scale to locate pharyngeal retention on videofluoroscopic images with a good specificity and reproducibility for observers of different expertise levels.

Int J Otolaryngol. 2015;2015:780197. doi: 10.1155/2015/780197. Epub 2015 Nov 12.

 

2016 – O ano do recomeço!

Sol-2A pesquisa na área de disfagia ao longo do mundo se mantém em ritmo crescente! Mas sempre em nossa prática clínica estamos diante de perguntas sem respostas, questões sobre qual melhor diagnóstico ou método terapêutico, quando intervir, ou, o mais difícil, quando deixar de intervir.

Muitas vezes, esperamos que estas respostas estejam no próximo volume de alguma revista científica e apenas aguardamos a resolução do problema por algum grupo de pesquisa do mundo.

A nossa dica é que os leitores, pesquisadores ou clínicos (ou ambos), possam em 2016 abraçar suas perguntas, encontrar pessoas que estejam dispostas a estudar junto e tentar respondê-las. Que o DisfagiaBrasil possa, neste ano, fomentar mais discussões e suscitar mais perguntas nos fonoaudiólogos brasileiros, e que 2016 seja um ano rico para a produção científica em nosso país (apesar do pouco investimento)!

Vamos construir uma área de atuação cada vez mais sólida e baseada em evidências! Contamos com vocês em 2016! Podem contar conosco!

Crédito da imagem: http://www.vocesabia.net/wp-content/uploads/2012/07/Sol-2.jpg

Correlation between Location of Brain Lesion and Cognitive Function and Findings of Videofluoroscopic Swallowing Study.

Ann Rehabil Med. 2012 Jun;36(3):347-55. doi: 10.5535/arm.2012.36.3.347. Epub 2012 Jun 30.

Abstract

OBJECTIVE:

To investigate whether patterns of swallowing difficulties were associated with the location of the brain lesion, cognitive function, and severity of stroke in stroke patients.

METHOD:

Seventy-six patients with first-time acute stroke were included in the present investigation. Swallowing-related parameters, which were assessed videofluoroscopically, included impairment of lip closure, decreased tongue movement, amount of oral remnant, premature loss of food material, delay in oral transit time, laryngeal elevation, delay in pharyngeal triggering time, presence of penetration or aspiration, and the amount of vallecular and pyriform sinus remnants. The locations of brain lesions were classified into the frontal, parietotemporal, subcortical, medulla, pons, and cerebellum. The degree of cognitive impairment and the severity of stroke were assessed by the Mini Mental Status Examination (MMSE) and the National Institute of Health Stroke Scale (NIHSS), respectively.

RESULTS:

An insufficient laryngeal elevation, the amount of pyriform sinus, and vallecular space remnant in addition to the incidence of aspiration were correlated with medullary infarction. Other swallowing parameters were not related to lesion topology. Lip closure dysfunction, decreased tongue movement, increased oral remnant and premature loss were associated with low MMSE scores. A delayed oral transit time were associated with NIHSS scores.

CONCLUSION:

In-coordination of the lip, the tongue, and the oropharynx were associated with the degree of cognitive impairment and the stroke severity rather than with the location of the lesion, whereas incomplete laryngeal elevation and aspiration were predominant in medullary lesions.

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