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Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence.

J Speech Lang Hear Res. 2008 Feb;51(1):S276-300. doi: 10.1044/1092-4388(2008/021).
Robbins J1, Butler SG, Daniels SK, Diez Gross R, Langmore S, Lazarus CL, Martin-Harris B, McCabe D, Musson N, Rosenbek J.

Abstract

PURPOSE:

This review presents the state of swallowing rehabilitation science as it relates to evidence for neural plastic changes in the brain. The case is made for essential collaboration between clinical and basic scientists to expand the positive influences of dysphagia rehabilitation in synergy with growth in technology and knowledge. The intent is to stimulate thought and propose potential research directions.

METHOD:

A working group of experts in swallowing and dysphagia reviews 10 principles of neural plasticity and integrates these advancing neural plastic concepts with swallowing and clinical dysphagia literature for translation into treatment paradigms. In this context, dysphagia refers to disordered swallowing associated with central and peripheral sensorimotor deficits associated with stroke, neurodegenerative disease, tumors of the head and neck, infection, or trauma.

RESULTS AND CONCLUSIONS:

The optimal treatment parameters emerging from increased understanding of neural plastic principles and concepts will contribute to evidence-based practice. Integrating these principles will improve dysphagia rehabilitation directions, strategies, and outcomes. A strategic plan is discussed, including several experimental paradigms for the translation of these principles and concepts of neural plasticity into the clinical science of rehabilitation for oropharyngeal swallowing disorders, ultimately providing the evidence to substantiate their translation into clinical practice.

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Ainda sobre a Jeri Logemann…

Ainda falando dessa super pesquisadora na área da disfagia, trago uma revisão muito instrutiva escrita pela J. Logemann e publicado numa sessão especial da Nature. Ela aborda desde a fisiologia da deglutição até métodos e técnicas reabilitadoras. Vale a pena! Boa leitura! Segue o link abaixo:

http://www.nature.com/gimo/contents/pt1/full/gimo50.html

Effects on facial dysfunction and swallowing capacity of intraoral stimulation early and late after stroke

NeuroRehabilitation. 2015 Jan 1;36(1):101-6. doi: 10.3233/NRE-141197.
Hägg MK, Tibbling LI.
BACKGROUND: Most patients with post-stroke dysphagia are also affected by facial dysfunction in all four facial quadrants. Intraoral stimulation can successfully treat post-stroke dysphagia, but its effect on post-stroke facial dysfunction remains unknown. OBJECTIVE: This study aimed to investigate whether intraoral stimulation after stroke has simultaneous effects on facial dysfunction in the contralateral lower facial quadrant and in the other three facial quadrants, on lip force, and on dysphagia. METHODS: Thirty-one stroke patients were treated with intraoral stimulation and assessed with a facial activity test, lip force test, and swallowing capacity test at three time-points: before treatment, at the end of treatment, and at late follow-up (over one year after the end of treatment). RESULTS: Facial activity, lip force, and swallowing capacity scores were all improved between baseline and the end of treatment (P < 0.001 for each), with these improvements remaining at late follow-up. Baseline and treatment data did not significantly differ between patients treated short and late after stroke. CONCLUSIONS: Treatment with intraoral stimulation significantly improved post-stroke dysfunction in all four facial quadrants, swallowing capacity, and lip force even in cases of long-standing post-stroke dysfunction. Furthermore, such improvement remained for over one year after the end of treatment.

Jeri Logemann – O estudo sobre a disfagia no mundo

Quem é fonoaudiólogo e trabalha com disfagia com certeza já leu algum texto da Dra Jeri Logemann. O site http://www.swallowstudy.com/?p=653 traz uma análise do percurso desta pesquisadora na fonoaudiologia e, ao longo do texto, encontramos uma série de links para artigos clássicos na nossa área. Ótima leitura e grande homenagem!

Jeri A. Logemann, PhD, CCC-SLP, BCS-S (from http://www.swallowstudy.com/?p=653)

Dysphagia after Occipitothoracic Fusion is Caused by Direct Compression of Oropharyngeal Space Due to Anterior Protrusion of Mid-cervical Spine.

J Spinal Disord Tech. 2014 Oct 28. [Epub ahead of print]
Abstract

STUDY DESIGN::

A retrospective study.

OBJECTIVE::

To investigate the relationship among the craniocervical alignment, the oropharyngeal space and the incidence of dysphagia after occipitothoracic fusion (OTF).

SUMMARY OF BACKGROUND DATA::

Craniocervical malalignment after occipitothoracic fusion is one of a trigger of dysphagia. However, there has been no logical explanation for the etiology yet.

METHODS::

A total of 32 patients who underwent OTF (5 male, 27 female) were reviewed. Following four parameters on the lateral cervical radiogram, pharyngeal tilt angle (PTA); the angle between the McGregor’s line and the line that links the center of C2 pedicle and the center of vertebral body at the apex of cervical sagittal curvature, diameter of oropharyngeal airway space (dPS), O-C2 angle and C2-C7 angle were measured at follow-up and then the relationship of these parameters and their influence to the incidence of dysphagia were analyzed.

RESULTS::

Six of 32 cases (18.8%) exhibited postoperative dysphagia. ROC curves showed that PTA and dPS had moderate accuracy for the predictor of the dysphagia after OTF with the area under the curve (AUC) of 0.76 and 0.86 respectively, whereas O-C2 angle had low accuracy with AUC of 0.69 and C2-C7 angle was almost useless for prediction of postoperative dysphagia with AUC of 0.51. A multiple linear regression analysis showed that only PTA was significantly correlated with dPS (β=0.822, P=0.014), whereas the O-C2 angle (β=0.101, P=0.779) and C2-C7 angle (β=0.352, P=0.157) had negligibly small influence on dPS.

CONCLUSIONS::

Our results demonstrated strong relationships between PTA and the value of dPS, and the incidence of dysphagia. Since PTA reflects anterior protrusion of mid-cervical spine, these results indicated that dysphagia after OTF is caused by narrowing of oropharyngeal space due to direct compression from anteirorly protruded mid-cervical spine.

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TOR-BSST©

PARA INICIARMOS AS LEITURAS PREPARATÓRIAS PARA OS EVENTOS DESTE ANO NA NOSSA ÁREA, SEGUE BREVE DESCRIÇÃO DO TOR-BSST QUE SERÁ APRESENTADO EM JUNHO/2015 NO CONGRESSO BRASILEIRO DE DISFAGIA PELA DR MARTINO. SEGUE ABAIXO BREVE DESCRIÇÃO EXTRAÍDA DO SITE DA AUTORA E LINK PARA O ARTIGO.

“A primary focus of the lab over the last decade has been the development, validation and implementation of the Toronto Bedside Swallowing Screening Test (TOR-BSST©). Dr. Martino developed the TOR-BSST© to be a tool by which patients can be screened for the presence of swallowing difficulties early in the course of their disease.

The premise of the TOR-BSST© is that earlier identification will initiate earlier intervention, and thereby reduce the incidence of preventable medical complications such as pneumonia, malnutrition and even death while at the same time promote earlier overall recovery. The TOR-BSST© was first validated among stroke patients across the continuum of care and has been distributed to speech language pathologists worldwide. It is currently being translated into several languages and is also undergoing validation among critically ill cardiac patients who have undergone prolonged intubation, thereby ensuring that many more people will benefit from early detection of swallowing problems.”

Congresso Brasileiro de Disfagia

CONGRESSO DISFAGIA
Mais um evento para discutirmos e aprofundarmos os conhecimentos nessa área! O Congresso Brasileiro de Disfagia será realizado em Ribeirão Preto-SP entre os dias 12 e 13 de junho de 2015. Uma série de convidados nacionais e a convidada internacional Dra Rosemary Martino, da Universidade de Toronto, discutirão aspectos relacionados à avaliação da disfagia (como o TOR-BSST), disfagia infantil, mecânica e neurogênica e à pesquisa na área de disfagia. Segue o link:
http://www.oxfordeventos.com.br/disfagia/

II Simpósio Nacional IGD de Disfagia

Simpósio IGDComo eu disse no início do ano, 2015 será um convite ao aprimoramento científico, com muitos eventos na nossa área. Este Simpósio será realizado em Porto Alegre-RS, entre os dias 20 e 21 de março de 2015 e está cheio de palestras interessantes e palestrantes com grande expertise na área. Segue o link abaixo para maiores informações (e ainda dá tempo de submeter trabalhos científicos!).
http://www.igddisfagia.com.br