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Dysphagia Research Society

Fim do ano chegando e já começamos a nos planejar para 2015! E dentre os planos, a atualização científica deve ser um item com lugar no topo da nossa lista. Nós da disfagia sabemos como é uma área complexa e que requer troca constante. Por isso, hoje a dica é do congresso do Dysphagia Research Society que será realizado em Chicago,em março de 2015! Mas não se preocupem porque muita coisa boa vai acontecer aqui no Brasil também, e nos próximos posts vamos divulgar os eventos da disfagia brasileira, que, por sinal, é super forte e tem se destacado internacionalmente! Um abraço da equipe disfagiabrasil!
Segue o link para o site do DRS – Dysphagia Research Society


Acoustic Study of Pharyngeal Swallowing as a Function of the Volume and Consistency of the Bolus

Karim Hammoudi, Michèle Boiron, Nadia Hernandez, Clément Bobillier, Sylvain Morinière


August 2014Volume 29, Issue 4, pp 468-474


Cervical auscultation is a noninvasive technique for the exploration of swallowing and has been used since the 1960s. The aim of our study was to describe how the volume and consistency of the bolus affect swallowing acoustic sound characteristics in healthy subjects. Twenty-three subjects aged from 20 to 59 years were included (13 women and 10 men). A microphone mounted on a stethoscope chest piece, positioned on the skin on the right side in front of the posteroinferior border of the cricoid cartilage, was used; it was connected to a computer for acoustic recordings. Each subject swallowed 2-, 5-, and 10-ml aliquots of water, yogurt, and mashed potato. Each bolus was administered once, with a period of at least 30 s between each swallow. For each recorded sound, the total duration of the sound and the duration of each sound component (SC) (SC1, SC2, and SC3) and interval (IT1 and IT2) between the SCs were measured. For all records, the average duration of acoustic measures was calculated. Differences according to the volume and the consistency of the swallowed bolus were assessed using Student’s t test for paired data. We calculated the percentage of recordings that included each SC. We also compared results between men and women using Student’s t test. We successfully interpreted 540 of the 621 (87 %) records. The results indicated that the average total duration of the sound, and especially the average duration of SC2, increased with increasing volume and was greater for mashed potato than for the boluses of other consistencies. SC2 was present in all of the records.


Effect of Low-Frequency rTMS and NMES on Subacute Unilateral Hemispheric Stroke With Dysphagia

Lim KB, Lee HJ, Yoo J, Kwon YG.

Ann Rehabil Med. 2014 Oct;38(5):592-602


To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on post-stroke dysphagia.


Subacute (<3 months), unilateral hemispheric stroke patients with dysphagia were randomly assigned to the conventional dysphagiatherapy (CDT), rTMS, or NMES groups. In rTMS group, rTMS was performed at 100% resting motor threshold with 1 Hz frequency for 20 minutes per session (5 days per week for 2 weeks). In NMES group, electrical stimulation was applied to the anterior neck for 30 minutes per session (5 days per week for 2 weeks). All three groups were given conventional dysphagia therapy for 4 weeks. We evaluated the functional dysphagia scale (FDS), pharyngeal transit time (PTT), the penetration-aspiration scale (PAS), and the American Speech-Language Hearing Association National Outcomes Measurement System (ASHA NOMS) swallowing scale at baseline, after 2 weeks, and after 4 weeks.


Forty-seven patients completed the study; 15 in the CDT group, 14 in the rTMS group, and 18 in the NMES group. Mean changes in FDS and PAS for liquid during first 2 weeks in the rTMS and NMES groups were significantly higher than those in the CDT group, but no significant differences were found between the rTMS and NMES group. No significant difference in mean changes of FDS and PAS for semi-solid, PTT, and ASHA NOMS was observed among the three groups.


These results indicated that both low-frequency rTMS and NMES could induce early recovery from dysphagia; therefore, they both could be useful therapeutic options for dysphagic stroke patients.


Chin tuck for prevention of aspiration: effectiveness and appropriate posture

Ra JY, Hyun JK, Ko KR, Lee SJ.

Dysphagia. 2014 Oct;29(5):603-9.


Chin tuck has been has been widely used to prevent aspiration in the patients with dysphagia. This study was performed to investigate the effectiveness and the degree of optimal neck flexion of chin tuck. Ninety-seven patients who showed aspiration in the videofluoroscopic swallow study (VFSS). Participants were grouped into the effective (patients who showed effect with chin tuck) and ineffective group (those who did not show effect with chin tuck). VFSS was performed in neutral and chin tuck position and findings were compared between the groups. Severity of aspiration was assessed by the point penetration-aspiration scale. Duration of dysphagic symptoms, history of tracheostomy, and other possible contributing factors were also compared. Neck flexion angle was measured to find appropriate posture in which aspiration was prevented with chin tuck. Aspiration was reduced or eliminated in only 19 patients (19.6 %) with chin tuck. Oral transit time, pharyngeal delayed time and pharyngeal transit time were significantly shortened in both groups (p < 0.05), but the difference between the groups was not significant. Female sex and absence of residue in pyriform sinus favored the effect of chin tuck (p < 0.05). At least 17.5° of neck flexion was required to achieve an effect with chin tuck. The effectiveness of chin tuck was less than anticipated. Patients without residue in pyriform sinus were more likely to benefit from chin tuck. Sufficient neck flexion was important in chin tuck to prevent aspiration.


Chin tuck

Differences in Videofluoroscopic Swallowing Study (VFSS) Findings According to the Vascular Territory Involved in Stroke

Kim SY, Kim TU, Hyun JK, Lee SJ.

Dysphagia. 2014 Aug;29(4):444-9.


Dysphagia affects up to half of stroke patients and increases the risk of pneumonia and fatal outcomes. In order to assess swallowing difficulty, videofluoroscopic swallowing study (VFSS) has traditionally been the gold standard. The purpose of this study was to compare the patterns of post-stroke swallowing difficulties according to the vascular territories involved in the stroke. One hundred and three patients who were diagnosed with first ischemic stroke by brain magnetic resonance imaging and had swallowing difficulty were included in this study. Location of the stroke was classified into three groups: territorial anterior infarcts (TAI) (n = 62), territorial posterior infarcts (TPI) (n = 19) and white matter disease (WMD) (n = 22). Oral cavity residue existed significantly in the TAI group more than in any other groups (P = 0.017). The WMD group showed more residue in the valleculae (P = 0.002) and the TPI group showed more residue in the pyriform sinuses (P = 0.001). The oral transit time, pharyngeal delay time and pharyngeal transit time did not show significant differences among the groups with swallowing of both thick and thin liquids. Penetration and aspiration were more frequent in the TPI group (P < 0.05) with swallowing of both thick and thin liquids. The results suggest that TAI is more related to oral phase dysfunction and TPI is more related to pharyngeal dysfunction. In ischemic stroke, patterns of swallowing difficulty may differ according to the vascular territory involved and this should be considered in the management of post-stroke dysphagia.



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