Arquivo do autor:Tatiana Simões Chaves

Sobre Tatiana Simões Chaves

Coordenadora do Serviço de Fonoaudiologia do Hospital Risoleta Tolentino Neves/ Belo Horizonte - MG Especialista em Motricidade Orofacial pelo CEFAC/2006 MBA em Gestão Hospitalar/2012

The Long-Term Effects of COVID-19 on Dysphagia Evaluation and Treatment

Martin B. Brodsky, PhD, ScM and Richard J. Gilbert, MD

Arch Phys Med Rehabil. 2020 Sep; 101(9): 1662–1664. Published online 2020 Jun 10. doi: 10.1016/j.apmr.2020.05.006

Imagem retirada da internet

Fear of the viral syndrome severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) termed COVID-19 (ie, coronavirus disease 2019)1 is real. Government mandates intended to reduce the rate of transmission, such as social distancing (read as physical distancing), community lock-downs, and public masking, are the only options available for containment.234This new normal, amid the constant threat of COVID-19, has led to an upheaval in rehabilitation care, forcing us to rethink the manner in which we deliver it.

Aerosol generating procedures + vulnerabilities = opportunities

The virus is with us and will likely remain so, even when the more stringent methods of disease mitigation have been lifted. Rehabilitation professionals work physically close with patients, caregivers too. Health care professionals who make a living assessing and treating the oropharynx, nasopharynx, larynx, and upper and lower airways, the anatomical epicenters of the SARS-CoV-2 virus, share the responsibility for constructive clinical engagement. Specific to dysphagia assessment, highly affected geographical regions have limited use of the gold standards—videofluoroscopic swallow study (VFSS) and flexible endoscopic evaluation of swallowing (FEES). Less affected regions have adjusted practice to address safety concerns. Under the current regime, guided by professional societies down to departments of clinicians, VFSS and FEES are considered: (1) aerosol generating procedures567 and (2) electiveprocedures (defined as neither emergent nor urgent for medical care789). The irony is that patients with COVID-19, especially those postextubation from mechanical ventilation in intensive care units, may be among those who need these procedures most.10 , 11 Moreover, if we take the perspective that all patients with a potentially compromised (ie, vulnerable) airway may be carriers of SARS-CoV-2 (ie, person under investigation12), determining a safe swallow of foods and liquids may be less relevant than quantifying the degree of airway risk. In this light, VFSS and FEES are both insufficient and unsafe. We are caught in a clinical time warp, assessing patients with little more than clinical examinations. How do we resume evaluations of swallowing and airway protection in this post-COVID-19 world?

We could consider risk stratification of airway vulnerability with noninvasive imaging and noninvasive metrics. Assessments could include such swallowing characteristics as laryngeal structure and dynamics, lingual deformation during swallowing, airway compromise during swallowing, and efficiency of swallowing physiology. Among the methods that address these characteristics are noninvasive imaging,13 ,14 strength or somatosensory testing,1516171819patient-reported symptoms,2021222324accelerometry,2526272829 cervical auscultation,30313233 and swallowing frequency.34353637 Still largely being developed and what many might consider not ready for prime time, none of these methods have been substantively tested in the clinical setting. Characterizing pathology across the spectrum of diseases, distinguishing macroscale from microscale aspiration, and quantitative assessment of airway vulnerability and its risk of pneumonia using tools with translatable and reproducible metrics to clinical outcomes are needed—now more than ever.

We must embrace noninvasive testing of swallowing and airway safety. Combining a detailed medical history, validated patient-reported symptoms inventory, and cranial nerve examination are a good start, but with variable reliability,38 but this cannot be all there is. We need to work constructively with industry and regulatory bodies to develop and test inventions for routine, value-based care. Health care, especially rehabilitation, is dynamic. This necessitates continued engagement with third-party payors, including state and federal governments, to welcome and respond to these changes. Skepticism and reluctance need to be quelled when innovation and onboarding must be the ever-present themes. “We’ve always done it that way” never was an acceptable ideology.

LEIA O ARTIGO NA ÍNTEGRAhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286637/

Moving Forward With Dysphagia Care: Implementing Strategies During the COVID-19 Pandemic and Beyond


Mark A Fritz et al.

Dysphagia. 2020.

Abstract

Growing numbers of SARS-CoV-2 cases coupled with limited understanding of transmissibility and virulence, have challenged the current workflow and clinical care pathways for the dysphagia provider. At the same time, the need for non-COVID-19-related dysphagia care persists. Increased awareness of asymptomatic virus carriers and variable expression of the disease have also focused attention to appropriate patient care in the context of protection for the healthcare workforce. The objective of this review was to create a clinical algorithm and reference for dysphagia clinicians across clinical settings to minimize spread of COVID-19 cases while providing optimal care to patients suffering from swallowing disorders. Every practitioner and healthcare system will likely have different constraints or preferences leading to the utilization of one technique over another. Knowledge about this pandemic increases every day, but the algorithms provided here will help in considering the best options for proceeding with safe and effective dysphagia care in this new era.

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Moving Forward With Dysphagia Care: Implementing Strategies During the COVID-19 Pandemic and Beyond





Virtual Dysphagia Evaluation: Practical Guidelines for Dysphagia Management in the Context of the COVID-19 Pandemic

, MD, , MS, CCC-SLP, , MD, …First Published May 26, 2020

https://doi.org/10.1177%2F0194599820931791

journals.sagepub.com

Abstract

With encouraging signs of pandemic containment nationwide, the promise of return to a full range of clinical practice is on the horizon. Clinicians are starting to prepare for a transition from limited evaluation of emergent and urgent complaints to resumption of elective surgical procedures and routine office visits within the next few weeks to months. Otolaryngology as a specialty faces unique challenges when it comes to the COVID-19 pandemic due to the fact that a comprehensive head and neck examination requires aerosol-generating endoscopic procedures. Since the COVID-19 pandemic is far from being over and the future may hold other highly communicable infectious threats that may require similar precautions, standard approaches to the clinical evaluation of common otolaryngology complaints will have to be modified. In this communication, we present practical recommendations for dysphagia evaluation with modifications to allow a safe and comprehensive assessment.

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Framework for open tracheostomy in COVID-19 patients

This guidance is aimed at outlining the steps that can be taken by ENT / Head & Neck Surgeons to best protect themselves and minimise aerosol generation when called on to perform open tracheostomies on COVID patients

ACESSE NA ÍNTEGRA

Tony Jacob MSc., FRCS, FRCS, Abigail Walker, ENT ST7; Angelos Mantelakis, ENT FY2; and Oliver Keane

Department of ENT & Head and Neck Surgery, University Hospital Lewisham

Curso sobre Ronco e Apnéia do Sono com Yasmin Frazão

Curso sobre Ronco e Apnéia do sono com a Dra. Yasmin Frazão/SP. Docente certificada pela ABS em Fonoaudiologia na Medicina do Sono. Um diferencial na sua formação e que conta pontos para sua certificação! Curso Inédito em MG!

❗️Curso Inédito!

📍Local:

Belo Horizonte/MG

✔ Palestrante:

*Fga Yasmin Frazão/SP*

CRFa 2 3933

– Graduada e Mestre em Fonoaudiologia pela PUC/SP.

– Doutoranda no Programa de Pós-Graduação em Fonoaudiologia na FOB/USP.

– Especialista em Motricidade Orofacial pelo CFFa.

– Certificada em Fonoaudiologia do Sono pela Associação Brasileira do Sono/ABS.

✔Data e horário:

20/03 – 18 às 22h

21/03 – 08 às 17h

✔Programação:
1. Anatomo fisiologia da respiração

2. Inter-relação complexo oro-crânio-cervical

3. Etiologia dos distúrbios da respiração

4. Consequências funcionais da respiração oral

5. Equipe de intervenção na Respiração Oral

6. Metodologias, abordagens e técnicas de intervenção na respiração Oral

7. Classificação dos distúrbios do sono

8.Etiologia dos Distúrbios Respiratórios do Sono

9. Causas multifatoriais–tratamento com equipe multiprofissional

10.Tratamento interdisciplinar x multidisciplinar

11.Avaliação Fonoaudiológica – protocolos de avaliação

12.Critérios para eleição do paciente para o tratamento fonoaudiológico – possibilidades e limites da intervenção

13.Terapia Miofuncional Orofacial – recursos terapêuticos

14.Discussão de casos clínicos: diagnóstico e planejamento terapêutico.

⚠️ VAGAS LIMITADAS!

The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review

Smaoui, S., Langridge, A. & Steele, C.M.

Dysphagia (2019).

https://doi.org/10.1007/s00455-019-10066-1

Imagem retirada da Internet

Abstract

Lingual resistance training has been proposed as an intervention to improve decreased tongue pressure strength and endurance in patients with dysphagia. However, little is known about the impact of lingual resistance training on swallow physiology. This systematic review scrutinizes the available evidence regarding the effects of lingual resistance training on swallowing function in studies using Videofluoroscopic Swallowing Studies (VFSS) with adults. Seven articles met the inclusion criteria and underwent detailed review for study quality, data extraction, and planned meta-analysis. Included studies applied this intervention to a stroke and brain injury patient populations or to healthy participants, applied different training protocols, and used a number of outcome measures, making it difficult to generalize results. Lingual resistance training protocols included anterior and posterior tongue strengthening, accuracy training, and effortful press against hard palate with varying treatment durations. VFSS protocols typically included a thin barium stimulus along with one other consistency to evaluate the effects of the intervention. Swallowing measures included swallow safety, efficiency, and temporal measures. Temporal measures significantly improved in one study, while safety improvements showed mixed results across studies. Reported improvements in swallowing efficiency were limited to reductions in thin liquid barium residue in two studies. Overall, the evidence regarding the impact of lingual resistance training for dysphagia is mixed. Meta-analysis was not possible due to differences in methods and outcome measurements across studies. Reporting all aspects of training and details regarding VFSS protocols is crucial for the reproducibility of these interventions.

Future investigations should focus on completing robust analyses of swallowing kinematics and function following tongue pressure training to determine efficacy for swallowing function.

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Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention: a review and summary of an international expert meeting

Rainer Wirth, Rainer Dziewas, Anne Marie Beck, Pere Clavé, Shaheen Hamdy, Hans Juergen Heppner, Susan Langmore,9 Andreas Herbert Leischker, Rosemary Martino, Petra Pluschinski, Alexander Rösler, Reza Shaker, Tobias Warnecke, Cornel Christian Sieber and Dorothee Volkert

Clin Interv Aging. 2016; 11: 189–208. 
Published online 2016 Feb 23. doi: 10.2147/CIA.S97481
PMCID: PMC4770066
PMID: 26966356

Imagem retirada da internet

Abstract

Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.

Keywords: aspiration, dehydration, dysphagia, geriatric, malnutrition, older

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Three‐dimensional analysis of the human pharyngoesophageal sphincter

Derrick R. Randall, MD, MSc ; Daniel J. Cates, MD ; E. Brandon Strong; Peter C. Belafsky, MD, PhD, MPH

Laryngoscope

© 2019 The American Laryngological, Rhinological and Otological Society

First published: 14 December 2019

Abstract

Objectives: Dysfunction of the pharyngoesophageal segment (PES) is a common cause of oropharyngeal dysphagia. Surgi- cal dilation of the PES uses cylindrical dilators that expand radially in a circular shape. Animal studies, however, suggest that the PES is kidney-shaped. The purpose of this investigation was to evaluate the 3D shape of the human PES with a novel cast- ing method.

Methods: A platinum-cured liquid silicone polymer was infused under pressure into the upper aerodigestive tract of nine fresh human cadavers to construct 3D casts of the maximally distended PES. Cross-sectional and volumetric analysis were per- formed using computed tomography and serial sectioning of the models. Canonical variate analysis was used to identify the shape features that best distinguishes the PES from the cervical esophagus.

Results: The mean age of the cadavers was 77.9 (SD 10.6) years, with 67% women. Analysis of the casts confirms that the human PES possesses a kidney-shaped structure at maximal distention, which is discretely different from the adjacent esophagus (P < 0.001). The posterior body of the cricoid cartilage formed the anterior wall of the PES, which provided a rigid structure responsible for preservation of the kidney shape during distention. The diameter of the maximally distended PES at the cricopharyngeus was highly variable (range = 0.86–4.68 cm2; SD = 1.33 cm2).

Conclusion: The data suggest that the human PES is not round and that targeted expansion at the level of the cricopharyngeus with an eccentrically shaped dilator may provide improved distention.

Key Words: Dysphagia, laryngology, pharynx.

Level of Evidence: 4

ACESSE O PERIÓDICO

Aula Solidária: Disfagia Neonatal e Pediátrica

*5ª Aula Solidária Núcleo Reabilite/BH*.

Venha aprender e fazer o Natal de uma criança mais feliz 🎄 🎅🏻 🎁❤️

💫Tema: Disfagia Neonatal e Pediátrica

💫Palestrante:

Fga. Mariah Batalha Ribeiro

💫Data: 18/12

💫Horário: 18:30/21:30

💫Local: Associação Médica de Minas Gerais (Avenida João Pinheiro, 161 – Centro). Belo Horizonte/MG

🎁 O Valor de R$20,00 deve ser pago no dia, em dinheiro e o brinquedo para doação deverá ser novo.

Fotobiomodulação Aplicada à Fonoaudiologia

Cidade: Belo Horizonte/ MG

 O curso visa desenvolver o raciocínio clínico para adequação da dosimetria laser baseada em evidências; detalhar os diferentes tipos de laser e as estruturas que os absorvem; apresentar e discutir os efeitos fisiológicos e terapêuticos da laserterapia baseados evidências nas diversas áreas da Fonoaudiologia.

Professores:

Ftp. Alexandre Cavallieri Gomes/Portugal

Fgª Vanessa Mouffron/MG

Fgª Tatiana Chaves/MG

Programação:

Curso teórico e prático!

1. Laserterapia como facilitadora do exercício e redutor da fadiga muscular;

2. Interação da FBM com os tecidos;

3. lesões nervosas periféricas (paralisias faciais e parestesias);

5. tratamento de fraturas;

6. prevenção e tratamento de mucosites (oncologia);

7. cicatrização de feridas e incisões;

8. como agente analgésico e modulador da inflamação;

9. Laserterapia na amamentação;

10. Disfunções neurológicas;

11. Voz;

12. Estética Facial;

13. Disfagias;

14. Fonoaudiologia Hospitalar;

15. Fotobiomodulação e o cérebro: perspectivas futuras e evidências científicas (AVC, TCE, Alzheimer, Parkinson, demências).

Local:

Associação Médica de Minas Gerais: Avenida João Pinheiro, 161 – Centro

Informações:

(31)992783239 – Tatiana Chaves

(31)986927256 – Graziela Bougo