Arquivo do autor:Natalie Argolo Ponte

Sobre Natalie Argolo Ponte

PhD, Speech Therapist

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.

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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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Effects of neck exercises on swallowing function of patients with stroke.

J Phys Ther Sci. 2015 Apr;27(4):1005-8. doi: 10.1589/jpts.27.1005. Epub 2015 Apr 30.

Abstract

[Purpose] This study examined the effects of neck exercises using PNF on the swallowing function of stroke patients with dysphasia. [Subjects and Methods] A total of 26 study subjects were selected and randomly divided into an experimental group of 13 subjects, who received the PNF-based short neck flexion exercises, and a control group of 13 subjects, who received the Shaker exercise. [Results] The experimental group showed statistically significant improvements in premature bolus loss, residue in the valleculae, laryngeal elevation, epiglottic closure, residue in the pyriform sinuses, and coating of the pharyngeal wall after swallowing, and improvements in pharyngeal transit time, and aspiration on both the new VFSS scale and the ASHA NOMS scale. [Conclusion] PNF-based short neck flexion exercises appear to be effective at improving swallowing function of stroke patients with dysphagia.

Swallowing disorders in Parkinson’s disease: impact of lingual pumping

Int J Lang Commun Disord. 2015 Feb 4. doi: 10.1111/1460-6984.12158. [Epub ahead of print]

Abstract

BACKGROUND:

Lingual pumping (LP) is a repetitive, involuntary, anteroposterior movement of the tongue on the soft palate that is executed prior to transferring the food bolus to the pharynx, but we also observed LP when multiple swallows were taken. LP may be associated with rigidity and bradykinesia in patients with Parkinson’s disease (PD). This phenomenon tends to be more prevalent in dysphagic PD patients, and its impact on swallowing dynamics remains poorly understood.

OBJECTIVE:

To evaluate how LP interferes with the oral and pharyngeal phases of the swallowing of foods of different consistencies and volumes.

METHODS:

We used videofluoroscopy to study the swallowing of 69 PD patients performing 10 swallows of barium mixed with foods of different consistencies and volumes.

RESULTS:

LP was associated with the unstable intra-oral organization of the bolus, the loss of bolus control, the pharyngeal retention of food and food entering the airway. This abnormal movement was also associated with a shorter oral transit time and was found to be more prevalent with food of thicker consistencies.

CONCLUSIONS:

LP is associated with swallowing incoordination and with food entering the airway. Preventive measures to minimise the pulmonary or nutritional consequences of this behaviour are necessary.

© 2015 Royal College of Speech and Language Therapists.

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A simple bedside stroke dysphagia screen, validated against video-fluoroscopy, detects dysphagia and aspiration with high sensitivity

congresso AVC

Jeff Edmiaston, M.S. CCC-SLP,1 Lisa Tabor Connor, PhD,2,3 Karen Steger-May, MA,4 and Andria L. Ford, MD, MSCI3

Background

Early identification of dysphagia is associated with lower rates of pneumonia after acute stroke. The Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) was previously developed as a simple bedside screen performed by nurses for sensitive detection of dysphagia and was previously validated against the speech pathologist’s clinical assessment for dysphagia. In this study, acute stroke patients were prospectively enrolled to assess the accuracy of the BJH-SDS when tested against the gold-standard test for dysphagia, the video-fluoroscopic swallow study (VFSS).

Methods

Acute stroke patients were prospectively enrolled at a large tertiary care inpatient stroke unit. The nurse performed the BJH-SDS at the bedside. After providing consent, patients then underwent VFSS for determination of dysphagia and aspiration. The VFSS was performed by a speech pathologist who was blinded to the results of the BJH-SDS. Sensitivity and specificity were calculated. Pneumonia rates were assessed across the five year period over which the BJH-SDS was introduced into the Stroke Unit.

Results

A total of 225 acute stroke patients were enrolled. Sensitivity and specificity of the screen to detect dysphagia were 94% and 66%, respectively. Sensitivity and specificity of the screen to detect aspiration were 95% and 50%, respectively. No increase in pneumonia was identified during implementation of the screen (p=0.33).

Conclusion

The BJH-SDS, validated against video-fluoroscopy, is a simple bedside screen for sensitive identification of dysphagia and aspiration in the stroke population.

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Sabor azedo e temperatura fria na fase oral da deglutição no acidente vascular encefálico

CoDAS vol.25 no.2 São Paulo  2013

http://dx.doi.org/10.1590/S2317-17822013000200012

Ana Rita GattoI; Paula Cristina ColaII; Roberta Gonçalves da SilvaIII; André Augusto SpadottoIV; Priscila Watson RibeiroV; Arthur Oscar SchelpV; Lidia Raquel de CarvalhoVI; Maria Aparecida Coelho de Arruda HenryII

RESUMO

OBJETIVO: Verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito oral da deglutição.
MÉTODOS:
Participaram deste estudo 52 indivíduos (28 do gênero masculino e 24 do gênero feminino) após acidente vascular encefálico isquêmico, com lesão à direita ou à esquerda e disfagia orofaríngea de grau leve a moderado, com idades variando de 50 a 80 anos (mediana=66 anos). Foi realizada a videofluoroscopia da deglutição para a análise dos tempos de deglutição. Cada indivíduo foi avaliado durante a deglutição de bolo na consistência pastosa, oferecido em colher com 5 ml, com quatro estímulos diferentes (natural, frio, azedo e azedo-frio). Após o exame foram realizadas as medidas de tempo de trânsito oral utilizando software específico. Foram mensurados o tempo de trânsito oral (a partir do início do movimento do bolo alimentar na boca) e o tempo de trânsito oral total (a partir do momento em que o bolo é colocado na boca).
RESULTADOS: A associação entre o estímulo azedo e a temperatura fria provocou mudanças significavas no tempo de trânsito oral total e no tempo de trânsito oral, com redução nestes tempos.
CONCLUSÃO: O sabor azedo e a temperatura fria associados apresentaram redução do tempo de trânsito oral em pacientes pós acidente vascular encefálico.

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Complicações laringeas por intubação orotraqueal: revisão da literatura

Int. Arch. Otorhinolaryngol. vol.16 no.2 São Paulo Apr./June 2012

http://dx.doi.org/10.7162/S1809-97772012000200014

Luiz Alberto Alves MotaI; Glauber Barbosa de CavalhoII; Valeska Almeida BritoII

RESUMOINTRODUÇÃO: As lesões causadas pela intubação orotraqueal são comuns no nosso meio e amplamente relatadas pela literatura. Geralmente são causadas por acidentes na colocação do tubo ou consequência de sua permanência nas vias aéreas do paciente. Há diversos tipos de lesões laríngeas, causadas por múltiplos mecanismos.
OBJETIVO: Verificar, na literatura, as principais causas de complicações laríngeas pós-intubação orotraqueal e seus mecanismos de lesão.
REVISÃO DE LITERATURA: As bases de dados pesquisadas foram LILACS, BIREME e SCIELO. Foram utilizados artigos, livros e teses, delimitando-se o período entre 1953 a 2009. As palavras-chaves utilizadas para a busca dos artigos foram: complicações, lesões, laringe, intubação, entubação, endotraqueal, orotraqueal, granulomas, estenose. Foram selecionadas 59 referências. Os critérios de inclusão utilizados para a escolha dos artigos foram os que mostraram os diversos tipos de lesões ocasionadas pela intubação orotraqueal e suas fisiopatologias.
CONSIDERAÇÕES FINAIS: Esta revisão de literatura foi motivada pela observação na prática clínica de um grande número de sequelas laríngeas em pacientes submetidos à intubação orotraqueal. Diante disto é importante o conhecimento, pelos profissionais da área de saúde, dos tipos de complicações e de suas causas, com o intuito de evitá-las, adotando medidas de prevenção dessas lesões.

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