Arquivo da categoria: Screening and Evaluation

Instrumentos de rastreio para disfagia orofaríngea no acidente vascular encefálico

Almeida, Tatiana Magalhães de;  Cola, Paula Cristina;  Pernambuco, Leandro de Araújo;  Magalhães Junior, Hipólito Virgílio;  Silva, Roberta Gonçalves da.

Audiology – Communication Research, Dez 2015, Volume 20  4 Páginas 361 – 370
esteto

 

ABSTRACT:

Objetivo:

Identificar os parâmetros presentes nos instrumentos de rastreio para a disfagia orofaríngea no acidente vascular encefálico, publicados na literatura.

Estratégia de pesquisa:

Para a seleção dos estudos, foram utilizados os descritores: transtornos de deglutição, acidente vascular cerebral, rastreio, screening, avaliação e disfagia. Foram consultadas as bases de dados MEDLINE, Embase, LILACS, SciELO e biblioteca Cochrane.

Critérios de seleção:

Foram selecionados artigos em inglês, português e espanhol, publicados até dezembro de 2014, cuja abordagem metodológica referisse instrumentos de rastreio para a disfagia orofaríngea, elaborados para indivíduos adultos com acidente vascular encefálico. Os parâmetros utilizados nos diferentes instrumentos de rastreio foram agrupados por igualdade e/ou semelhança. Foi realizada análise descritiva e calculada a frequência dos parâmetros encontrados.

Resultados:

Foram encontrados 688 artigos e, após consideração dos critérios de inclusão e exclusão, 23 artigos foram efetivamente analisados. Dos 20 instrumentos encontrados, 90% utilizaram algum tipo de oferta via oral no rastreio para a disfagia, sendo a maioria, a água. Foram encontrados 19 parâmetros distintos, não relacionados à oferta de alimento e 12 parâmetros relacionados à oferta de alimento.

Conclusão:

Não há consenso, entre os estudos, sobre os parâmetros mais sensíveis e específicos para compor o método de rastreio para disfagia orofaríngea na população com acidente vascular encefálico.

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Anúncios

Usefulness of the Simplified Cough Test in Evaluating Cough Reflex Sensitivity as a Screening Test for Silent Aspiration

Lee JY, Kim DK, Seo KM, Kang SH.

Ann Rehabil Med. 2014 Aug;38(4):476-84

Abstract

Objective

To assess cough reflex sensitivity using the simplified cough test (SCT) and to evaluate the usefulness of SCT to screen for silent aspiration.

Methods

The healthy control group was divided into two subgroups: the young (n=29, 33.44±9.99 years) and the elderly (n=30, 63.66±4.37 years). The dysphagic elderly group (n=101, 72.95±9.19 years) consisted of patients with dysphagia, who suffered from a disease involving central nervous system (ischemic stroke 47, intracerebral hemorrhage 27, traumatic brain injury 11, encephalitis 5, hypoxic brain damage 3, and Parkinson disease 8). The SCT was performed using the mist of a 1% citric acid from a portable nebulizer. The time from the start of the inhalation to the first cough was measured as the cough latency. All the dysphagic patients underwent the videofluoroscopic swallowing study.

Results

The cough latency was more significantly prolonged in the healthy elderly group than in the healthy young group (p<0.001), and in the dysphagic elderly group than in the healthy elderly group (p<0.001). The sensitivity and specificity of SCT were 73.8% and 72.5% for detecting aspiration in the dysphagic patients, and 87.1% and 66.7% for detecting silent aspiration in the aspirated patients.

Conclusion

Cough latency measured with the SCT reflects the impairment of cough reflex in healthy elderly and dysphasic subjects. The results of this study show that the SCT test can be a valuable method of screening aspiration with or without cough in dysphasic patients.

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Spontaneous Swallowing Frequency Has Potential to Identify Dysphagia in Acute Stroke

Michael A. Crary, Giselle D. Carnaby, Isaac Sia, Anna KhannaMichael F. Waters

Stroke.2013; 44: 3452-3457

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Background and Purpose—Spontaneous swallowing frequency has been described as an index of dysphagia in various health conditions. This study evaluated the potential of spontaneous swallow frequency analysis as a screening protocol for dysphagia in acute stroke.

Methods—In a cohort of 63 acute stroke cases, swallow frequency rates (swallows per minute [SPM]) were compared with stroke and swallow severity indices, age, time from stroke to assessment, and consciousness level. Mean differences in SPM were compared between patients with versus without clinically significant dysphagia. Receiver operating characteristic curve analysis was used to identify the optimal threshold in SPM, which was compared with a validated clinical dysphagia examination for identification of dysphagia cases. Time series analysis was used to identify the minimally adequate time period to complete spontaneous swallow frequency analysis.

Results—SPM correlated significantly with stroke and swallow severity indices but not with age, time from stroke onset, or consciousness level. Patients with dysphagia demonstrated significantly lower SPM rates. SPM differed by dysphagia severity. Receiver operating characteristic curve analysis yielded a threshold of SPM≤0.40 that identified dysphagia (per the criterion referent) with 0.96 sensitivity, 0.68 specificity, and 0.96 negative predictive value. Time series analysis indicated that a 5- to 10-minute sampling window was sufficient to calculate spontaneous swallow frequency to identify dysphagia cases in acute stroke.

Conclusions—Spontaneous swallowing frequency presents high potential to screen for dysphagia in acute stroke without the need for trained, available personnel.

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Swallowing screens after acute stroke: a systematic review

Schepp SK; Tirschwell DL; Miller RM; Longstreth WT
Stroke; 43(3): 869-71, 2012 Mar.
ABSTRACT

Background and Purpose—Swallowing screens after acute stroke identify those patients who do not need a formal swallowing evaluation and who can safely take food and medications by mouth. We conducted a systematic review to identify swallowing screening protocols that met basic requirements for reliability, validity, and feasibility.

Methods—We searched MEDLINE and supplemented results with references identified through other databases, journal tables of contents, and bibliographies. All relevant references were reviewed and evaluated with specific criteria.

Results—Of 35 protocols identified, 4 met basic quality criteria. These 4 had high sensitivities of ≥87% and high negative predictive values of ≥91% when a formal swallowing evaluation was used as the gold standard. Two protocols had greater sample sizes and more extensive reliability testing than the others.

Conclusions—We identified only 4 swallowing screening protocols for patients with acute stroke that met basic criteria. Cost-effectiveness of screening, including costs associated with false-positive results and impact of screening on morbidity, mortality, and length of hospital stay, requires elucidation.

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A Swallowing Clinical Assessment Score (SCAS) to evaluate outpatients with Parkinson’s disease

Fernanda Loureiro, Ana Caline Nóbrega, Marília Sampaio, Natalie Argolo, André Dalbem,
Ailton Melo, Irenio Gomes

Aims: This study proposes a standardized Swallowing Clinical Assessment Score (SCAS)
in PD.
Methods: 174 idiopathic PD patients and 22 controls were evaluated in a transversal study.
The SCAS comprised of twelve items that identify the occurrence of specific alterations in
the oral and pharyngeal phases. Each alteration was given a weight in accordance to its
relevance in compromising the act of swallowing.
Results: The SCAS follows a theoretical scoring system ranging from 0 to 354 points,
where zero corresponds to the ability to swallow without alteration. Scores ≤2 points
indicate normal swallowing; functional swallowing ranges from ≥2 and ≤15 points;
mildly altered ranges from ≥15 and ≤35 points; moderately altered ranges from ≥35
and ≤60 points. Scores in excess of 60 points indicate severe alteration.
Conclusions: The SCAS proposed here is only part of the global assessment of dysphagia.
Its main applications are: to screen swallowing difficulties in PD, even with no complaints,
thus facilitating early diagnosis; to monitor the development of alterations in swallowing
in an objective manner; and to assess the effectiveness of strategies for swallowing
rehabilitation.

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Diagnostic evaluation of dysphagia

Nature Clinical Practice Gastroenterology & Hepatology (2008) 5, 393-403
doi:10.1038/ncpgasthep1153  
Received 4 December 2007 | Accepted 28 March 2008 | Published online: 10 June 2008

Ian J Cook  

Taking a careful history is vital for the evaluation of dysphagia. The history will yield the likely underlying pathophysiologic process and anatomic site of the problem in most patients, and is crucial for determining whether subsequently detected radiographic or endoscopic ‘anomalies’ are relevant or incidental. Although the symptoms of pharyngeal dysphagia can be multiple and varied, the typical features of neurogenic pharyngeal dysphagia are highly specific, and can accurately distinguish pharyngeal from esophageal disorders. The history will also dictate whether the next diagnostic procedure should be endoscopy, a barium swallow or esophageal manometry. In some difficult cases, all three diagnostic techniques may need to be performed to establish an accurate diagnosis. Stroke is the most common cause of pharyngeal dysphagia. A videoradiographic swallow study is vital in such cases to determine the extent and timing of aspiration and the severity and mechanics of dysfunction as a prelude to therapy.

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Which cortical area is related to the development of dysphagia after stroke? A single photon emission computed tomography study using novel analytic methods

Momosaki R; Abo M; Kakuda W; Uruma G

Eur Neurol;67(2):74-80, 2012.

PURPOSE: The purpose of this study is to clarify cortical areas related to the development of dysphagia in poststroke patients using novel analytic methods for single photon emission computed tomography (SPECT) imaging. SUBJECTS AND METHODS: Twenty poststroke patients (age: 66.1 ± 5.1 years) with a left hemispheric lesion were studied. According to clinical evaluation, patients were divided into a dysphagia group (n = 10) and a control group (n = 10). In each patient, measurement of regional cerebral blood flow (rCBF) was performed by SPECT imaging with a 99mTc-ethylcysteinate dimer. For the analysis, an easy Z-score imaging system and voxel-based stereotactic extraction estimation were applied, with placing regions of interest segmented into the Brodmann area level. We compared rCBF in each area between the two groups, and receiver operating characteristic analysis to calculate the area under the curve was also performed. RESULTS: The rCBF in Brodmann areas 4 and 24 was significantly lower in the dysphagia group. The highest area under the curve was found in Brodmann area 4. In this area, 80% sensitivity and 60% specificity for discriminating dysphagia were achieved with an optimal cutoff value. CONCLUSIONS: When analyzed with novel methods, SPECT imaging can be useful for predicting the risk of dysphagia and subsequent aspiration in poststroke patients.

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