Arquivo da categoria: Treatment

Treatment of language, motor speech impairments, and Dysphagia

Anderson M, Anzalone J, Holland L, Tracey E.

Continuum (Minneap Minn). 2011 Jun;17(3 Neurorehabilitation):471-93.

Abstract

ABSTRACT: Language, speech, cognitive-associated communication deficits, and dysphagia are common following acquired brain injury (stroke, traumatic brain injury, and others). Treatment of these disorders can be divided into restorative, compensatory, and supportive approaches. Although therapy must be individualized for each person, components of all three approaches are necessary to maximize an individual’s recovery. This article provides a general overview of traditional as well as state-of-the-art treatment for aphasia, cognitive-linguistic impairments, dysarthria, apraxia, and dysphagia.

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Swallowing reflex: analysis of the efficiency of different stimuli on healthy young individuals

Pereira, Nayara A. Vasconcelos, Motta, Andréa Rodrigues and Vicente, Laélia Cristina C

Pró-Fono R. Atual. Cient., Set 2008, vol.20, no.3, p.159-164. ISSN 0104-5687

BACKGROUND: the absence or delay of the swallowing reflex is considered a significant sign of dysphagia. Therefore, the therapy traditionally applied to these cases consists in increasing the intra-oral input through cold touches (0 or 00 larynx mirror) on the inferior portion of the inferior third of the palatoglossus arch. AIM: to identify in healthy young individuals which oropharyngeal regions are more sensitive and which stimulus is more efficient in triggering the swallowing reflex. METHODS: the swallowing reflex was analyzed based on the following stimuli: spatula, cold 00 larynx mirror, gauze embedded in cold water wrapped onto spatula and frozen moist gauze wrapped onto spatula; touching the palatoglossus arch in both its inferior and superior portions, the palatine tonsils, the base of the tongue and the uvula in 65 healthy young individuals. RESULTS: the swallowing reflex was not triggered in most of the participants when touching different oropharyngeal regions with different stimuli. This result was statistically significant. When present, the most efficient stimuli were cold 00 larynx mirror (28.6%) and frozen moist gauze wrapped onto spatula (27.3%). Concerning the oropharynx, the uvula (29.6%), the palatine tonsils (26.7%), the superior (25%) and inferior (21.2%) palatoglossi arches and the base of tongue (25%) were most sensitive to the applied stimuli. CONCLUSION: when the swallowing reflex was present, the uvula, the palatoglossi arches and the palatine tonsils were the most sensitive regions to trigger this reflex, and the most efficient stimuli to trigger swallowing were the cold 00 larynx mirror and the frozen moist gauze wrapped onto spatula.

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Reflexo da deglutição: análise sobre eficiência de diferentes estímulos em jovens sadios

Pereira, Nayara A. Vasconcelos, Motta, Andréa Rodrigues and Vicente, Laélia Cristina C

Pró-Fono R. Atual. Cient., Set 2008, vol.20, no.3, p.159-164. ISSN 0104-5687

RESUMO

TEMA: a ausência ou atraso do reflexo da deglutição é considerado um sinal significativo de disfagia. Assim, a terapia tradicionalmente empregada nesses casos consiste em aumentar o input intra-oral por meio de toques gelados (espelho laríngeo 0 ou 00) no terço inferior do arco palatoglosso, porção inferior.
OBJETIVOS: identificar, em indivíduos jovens e sadios, quais regiões da orofaringe são mais sensíveis para desencadear o reflexo da deglutição e qual estímulo é mais eficiente.
MÉTODO: O reflexo da deglutição foi investigado a partir dos estímulos: espátula, espelho laríngeo 00 gelado, espátula envolta em gaze com água gelada e espátula envolta em gaze umedecida congelada, tocando-se o arco palatoglosso em suas porções inferior e superior, as tonsilas palatinas, a base de língua e a úvula em 65 indivíduos jovens e sadios.
RESULTADOS: o reflexo da deglutição não foi desencadeado na maioria dos participantes quando tocado com diferentes estímulos e locais da orofaringe, sendo esta estatisticamente significante. Quando presente, os estímulos mais eficientes foram o espelho laríngeo 00 (28,6%) e a espátula envolta com gaze congelada (27,3%). Quanto à região da orofaringe, a úvula (29,6%), as tonsilas palatinas (26,7%), os arcos palatoglossos região superior (25%) e inferior (21,2%) e base de língua (25%) foram sensíveis aos estímulos.
CONCLUSÃO: quando presente o reflexo da deglutição, a úvula, os arcos palatoglossos e as tonsilas palatinas foram as regiões mais sensíveis para desencadeá-lo e o estímulo mais eficiente, dentre os selecionados, foram o espelho laríngeo gelado e a espátula envolta em gaze umedecida congelada.

Palavras-Chave: Transtornos da Deglutição; Deglutição; Fisiologia; Reflexo.

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Main taste effects on swallowing apnea duration in healthy adults

Todd JT, Butler SG, Plonk DP, Grace-Martin K, Pelletier CA.

Otolaryngol Head Neck Surg. 2012 Oct;147(4):678-83. Epub 2012 Jun 7.

Abstract

Objective This study examined swallowing apnea duration (SAD) and respiratory phase patterns as a function of taste, tastes combined with barium, age, and genetic taste group. Study Design Prospective group design. Setting University medical center. Subjects and Methods Eighty healthy adult women were identified as nontasters and supertasters and equally comprised 2 age groups: 18 to 35 years (n = 40) and 60+ years (n = 40). The KayPentax Swallowing Signals Lab was used to acquire SAD and respiratory phase patterns via nasal cannula during randomized 5-mL swallows of water, 1.0 M sucrose (sweet), 1.0 M sodium chloride (salty), and 0.032 M caffeine (bitter) alone and mixed with barium. The SAD and respiratory patterns were analyzed in a linear mixed model and a binary logistic regression generalized estimating equation model, respectively. Results A significant main effect of age was found (P = .007). Older women demonstrated longer SAD than younger women. There were no significant effects of taste or genetic taste group on SAD. There was a significant interaction between barium and supertaster status; SAD was shorter in supertasters when barium was included. There were no significant differences in respiratory patterns between age groups, genetic taste groups, or among taste stimuli. Conclusion Advanced age elicited longer SAD, a robust finding in repeated investigations from multiple laboratories. Main tastes did not affect SAD or respiratory phase patterns. Genetic taste group altered SAD when barium was combined with the taste. That is, taste + barium shortened SAD in supertasters. This finding may affect clinical management of dysphagia patients and warrants further investigation.

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Functional outcomes of standard dysphagia treatment in first time documented stroke patients

McMicken BL, Muzzy CL.

Disabil Rehabil. 2009;31(10):806-17.

Abstract

PURPOSE:

This retrospective study investigated whether there were statistically and/or clinically significant changes in functional status for patients between admission and discharge as measured by (1) the assistive/independence levels on the swallowing portion of the functional assessment measure (SFAM), and (2) the food and liquid dietary ratings. Also investigated was the relationship between the assistive/independence levels of the SFAM and the specific dietary ratings.

METHOD:

Treatment was given at Rancho Los Amigos National Rehabilitation Centre in Downey, California. Subjects for this study consisted of 100 first-time documented acute stroke patients with swallowing disorders. Descriptive statistics, the Wilcoxon signed ranks test and Spearman rho were used to investigate the proposed questions in this study.

RESULTS:

There were statistically significant differences in both the dietary ratings and SFAM levels between admission and discharge and a high percentage of these differences were also determined to be clinically significant. In addition, it was found that there was a high level of variability in the dietary ratings at the majority of SFAM levels.

CONCLUSION:

These results demonstrate that separate and specific dietary ratings in addition to the SFAM assistive/ independence levels are necessary to obtain a comprehensive assessment of the stroke patient with dysphagia.

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Effects of olfactory and gustatory stimuli on neural excitability for swallowing

 

Abdul Wahab N, Jones RD, Huckabee ML.

Physiol Behav. 2010 Dec 2;101(5):568-75. Epub 2010 Sep 16.

Abstract

This project evaluated the effects of olfactory and gustatory stimuli on the amplitude and latency of motor-evoked potentials (MEPs) from the submental muscles when evoked by transcranial magnetic stimulation (TMS). Sixteen healthy volunteers (8 males; age range 19-43) participated in the study. Lemon concentrate at 100% and diluted in water to 25% were presented separately as odor and tastant stimuli. Tap water was used as control. 15 trials of TMS-evoked MEPs triggered by volitional contraction of the submental muscles and volitional swallowing were measured at baseline, during control condition, during stimulus presentation, and immediately, 30-, 60-, and 90-min poststimulation for each of the four stimulus presentations. Experiments were repeated using the combined odor and tastant concentrations that most influenced the MEP independently. Differences in MEP amplitude measured during swallowing were seen at 30-, 60-, and 90-min poststimulation for simultaneous olfactory and gustatory stimulation as opposed to no differences seen at any point for stimuli presented separately. This study has shown that combined odor and tastant stimulation (i.e., flavor) can increase MEP amplitude during swallowing and that this enhancement of MEP can persist for at least 90min following stimulation. As increased MEP amplitude has been associated with improved swallowing performance, a follow-up study is underway to determine the biomechanical changes produced by altered MEPs to facilitate translation of these data to clinical dysphagia management.

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Evaluation of the effectiveness of a phonoaudiology program for the rehabilitation of dysphagia in the elderly

 

Santoro P, e Silva IL, Cardoso F, Dias E Jr, Beresford H.

Arch Gerontol Geriatr. 2011 Jul-Aug;53(1):e61-6. Epub 2010 Nov 18.

Abstract

The object of this study was to evaluate the effectiveness of a phonoaudiology rehabilitation program directed towards the degenerative changes of the neurophysiological mechanisms responsible for the upper digestive system compromised by the age between 80 and 90 years, in a regime of internment in a long permanence institution in the city of Rio de Janeiro, which express, bodily, their difficulty in swallowing food of liquid or pasty consistency. To achieve such an object, the current study was developed in an experimental format or design, comprised of a sample group of 23 elderly subjects, of both genders, undergoing evaluation by the phonoaudiology protocol for evaluating the risk of dysphagia (abbreviated from the Portuguese name: Protocolo de Avaliação do Risco para Disfagia=PARD), pre- and post-intervention procedure. The developed program used the indirect therapy approach based on the adaptive myotherapeutic and myofunctional stimulation, contemplating two isometric and isokinetic orofacial active myotherapeutic exercises, two passive myotherapeutic manipulations for the supra-hyoidal musculature, as well as adaptive cephalic postural maneuvres, associated to the intra-oral olfactive and gustative sensory stimulation. The evolution of the individuals was analyzed before and after the therapy by estimating the capacity of swallowing food in the liquid fluid (LF) consistency, by the paired Student t-test, giving a p=0.01, making the difference of 2.31 between the 2 evaluations statistically significant. The changes produced by the PARD program in the capacity of individuals in swallowing food of a pasty consistency were also significant when analyzing the variance of the results on the 2 instances by using the F-test (pre- and post-intervention difference=4.47, p=0.039).

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Lip muscle training in stroke patients with dysphagia

Hägg M, Anniko M.

Acta Otolaryngol. 2008 Sep;128(9):1027-33.

Abstract

CONCLUSION:

Training with an oral screen can improve lip force (LF) and swallowing capacity (SC) in stroke patients with oropharyngeal dysphagia, irrespective of the duration of pretreatment of dysphagia, and irrespective of the presence or absence of central facial paresis. It is more plausible that treatment results are attributable to sensory motor stimulation and the plasticity of the central nervous system than to the training of the lip muscles per se.

OBJECTIVES:

A close relationship has been demonstrated between LF and SC in stroke patients whether or not they are affected by facial paresis. It is not known how training of lip function can improve swallowing capacity. The present study was therefore designed to ascertain: (i) if training with an oral screen can improve the LF and SC of stroke patients with oropharyngeal dysphagia; to establish (ii) if improvement in LF and SC is connected with the presence or absence of central facial palsy, (iii) on the interval between stroke onset and initiation of treatment, (iv) on age, or (v) on sex.

SUBJECTS AND METHODS:

This was a retrospective study of 30 stroke patients, 49-88 years old, who were investigated with a Lip Force Meter, LF100 (LF100) and a swallowing capacity test (SCT) before and after a period of self-training lasting at least 5-8 weeks, using an oral screen. Initial central facial paresis was present in 24 patients.

RESULTS:

The median LF was 7 Newtons (N) (range 0-27) before treatment and 18.5 N (range 7-44) after treatment (p < 0.001). The median SC was 0 ml/s (range 0-9.1) before treatment and 12.1 ml/s (range 0-36.7) at follow-up (p < 0.001). There was no significant difference in swallowing improvement between patients with versus those without facial paresis. The interval between stroke attack and start of treatment, ranging from a few days up to 10 years, had no significant influence on the treatment results, nor did age or sex. The facial paresis was improved or at least ameliorated in all patients after the lip training period.

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Tactile, gustatory, and visual biofeedback stimuli modulate neural substrates of deglutition.

Humbert IA; Joel S

Neuroimage; 59(2): 1485-90, 2012 Jan 16.

It has been well established that swallowing kinematics are modified with different forms of exogenous and endogenous input, however the underlying neural substrates associated with these effects are largely unknown. Our objective was to determine whether the swallowing BOLD response is modulated with heightened sensory modalities (taste, cutaneous electrical stimulation, and visual biofeedback) compared to water ingestion (control) in healthy adults across the age span. Habituation and sensitization were also examined for each sensory condition. Our principal findings are that each sensory swallowing condition activated components of the swallowing cortical network, plus regions associated with the particular sensory modality (i.e. primarily frontal motor planning and integration areas with visual condition). Overall, the insula was most commonly active among the sensory modalities. We also discuss gradual increases and decreases in BOLD signal with repeated exposures for each condition. We conclude that both stimulus- and intention-based inputs have unique cortical swallowing networks relative to their modality. This scientific contribution advances our understanding of the mechanisms of normal swallowing cortical control and has the potential to impact clinical uses of these modalities in treatments for neurogenic dysphagia.

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Clinical challenges in the evaluation and treatment of individuals with poststroke dysphagia

Tippett DC.

Top Stroke Rehabil. 2011 Mar-Apr;18(2):120-33.

Abstract

Although reported frequencies vary due to study design, patient characteristics, and method of ascertainment, dysphagia is a commonly encountered morbidity after stroke. Consequently, speech-language pathologists’ clinical caseloads are heavily populated with individuals with poststroke dysphagia. The body of knowledge about swallowing and swallowing disorders has expanded exponentially over the last 3 decades, and speech-language pathologists are increasingly sophisticated in their evaluation and treatment of this patient population. Nevertheless, clinical quandaries persist regarding the management of these individuals. In this article, clinical challenges are discussed, including early detection of dysphagia and aspiration risk, treatment efficacy, refractory dysphagia, and noncompliance with treatment. Research relevant to these issues is reviewed to aid in formulating sound clinical decisions.

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