Sinais, sintomas e função vocal em indivíduos com disfagia tratados de câncer de cabeça e pescoço

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Felipe Moreti;

Bruna Morasco-Geraldini;

Simone Aparecida Claudino-Lopes;

Elisabete Carrara-de

Audiol., Commun. Res. vol.23  São Paulo  2018  Epub 18-Out-2018

http://dx.doi.org/10.1590/2317-6431-2017-1873 

Imagem retirada da internet

RESUMO

Objetivos

Avaliar a presença de sinais e sintomas vocais e função vocal em indivíduos com disfagia, tratados de câncer de cabeça e pescoço – CCP e identificar os valores de corte dos respectivos instrumentos. 

Métodos

Estudo prospectivo com 96 indivíduos (68 homens e 28 mulheres), divididos em grupo experimental – GE (pacientes tratados de CCP com disfagia, independente de queixa vocal) e grupo controle – GC (sem queixas autorrelatadas de voz e deglutição, pareados em média de idade e sexo com GE), que responderam a um questionário com dados de identificação e caracterização da amostra, Lista de Sinais e Sintomas Vocais – LSS, e dois protocolos de avaliação vocal (Índice de Função Glótica – IFG e Escala de Sintomas Vocais – ESV). Por fim, as notas de corte dos protocolos foram identificadas por meio da curva ROC (Receiver Operating Characteristic). 

Resultados

Indivíduos do GE apresentaram mais sinais e sintomas vocais e maiores escores no IFG e ESV que os indivíduos do GC, além de pior autoavaliação vocal. Os três instrumentos apresentaram máxima área sob a curva ROC, com valores de corte ESV=17, IFG=4 e LSS=6 pontos. 

Conclusão

Indivíduos tratados de CCP com disfagia apresentam mais sinais e sintomas vocais, pior autopercepção da disfunção vocal e maior prejuízo nos aspectos de limitação, emocional e físico da voz, que indivíduos vocalmente saudáveis. Os três instrumentos evidenciaram sensibilidade e especificidade máximas, podendo ser utilizados como ferramentas de triagem. 

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Augmentation of Deglutitive Thyrohyoid Muscle Shortening by the Shaker Exercise

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Rachel Mepani, Stephen Antonik, Benson Massey, Mark Kern, Jerilyn Logemann, Barbara Pauloski, Alfred Rademaker, Caryn Easterling, Reza Shaker

Dysphagia. Author manuscript; available in PMC 2010 Jun 28.

Published in final edited form as: Dysphagia. 2009 Mar; 24(1): 26–31. Published online 2008 Aug 7.

doi: 10.1007/s00455-008-9167-y

Abstract

Earlier studies of the effect of 6 weeks of the Shaker Exercise have shown significant increase in UES opening and anterior excursion of larynx and hyoid during swallowing in patients with upper esophageal sphincter (UES) dysfunction, resulting in elimination of aspiration and resumption of oral intake. This effect is attributed to strengthening of the suprahyoid muscles, as evidenced by comparison of electromyographic changes in muscle fatigue before and after completion of the exercise regime. The effect of this exercise on thyrohyoid muscle shortening is unknown. Therefore the aim of this study was to determine the effect of the exercise on thyrohyoid muscle shortening. We studied 11 dysphagic patients with UES dysfunction. Six were randomized to traditional swallowing therapy and five to the Shaker Exercise. Videofluoroscopy was used to measure deglutitive thyrohyoid shortening before and after completion of assigned therapy regimen. Maximum thyrohyoid muscle shortening occurred at close temporal proximity to the time of maximal thyroid cartilage excursion. The percent change in thyrohyoid distance from initiation of deglutition to maximal anterior/superior hyoid excursion showed no statistically significant difference between the two groups prior to either therapy (p = 0.54). In contrast, after completion of therapy, the percent change in thyrohyoid distance in the Shaker Exercise group was significantly greater compared to the traditional therapy (p = 0.034). The Shaker Exercise augments the thyrohyoid muscle shortening in addition to strengthening the suprahyoid muscles. The combination of increased thyrohyoid shortening and suprahyoid strengthening contributes to the Shaker Exercise outcome of deglutitive UES opening augmentation.

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Efficacy of Myofunctional Therapy Associated with Voice Therapy in the Rehabilitation of Neurogenic Oropharyngeal Dysphagia: a pilot study

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Bruno Francisco de Fraga; Sheila Tamanini de Almeida; Márcia Grassi Santana; Mauriceia Cassol

Int Arch Otorhinolaryngol 2018;22:225–230.

Fonte: Speechspark

ABSTRACT

Introduction Dysphagia causes changes in the laryngeal and stomatognathic struc- tures; however, the use of vocal exercises is poorly described.

Objective To verify whether the therapy consisting of myofunctional exercises associated with vocal exercises is more effective in rehabilitating deglutition in stroke patients.

Methods This is a pilot study made up of two distinct groups: a control group, which performed only myofunctional exercises, and an experimental group, which performed myofunctional and vocal exercises. The assessment used for oral intake was the functional oral intake scale (FOIS).

Results The FOIS levels reveal that the pre-therapy median of the experimental group was 4, and increased to 7 after therapy, while in the control group the values were 5 and 6 respectively. Thus, the experimental group had a statistically significant difference between the pre- and post-therapy assessments (p 1⁄4 0.039), which indicates that the combination of myofunctional and vocal exercises was more effective in improving the oral intake levels than the myofunctional exercises alone (p 1⁄4 0.059). On the other hand, the control group also improved, albeit at a lower rate compared with the experimental group; hence, there was no statistically significant difference between the groups post-therapy (p 1⁄4 0.126).

Conclusion This pilot study showed indications that using vocal exercises in swallow- ing rehabilitation in stroke patients was able to yield a greater increase in the oral intake levels. Nevertheless, further controlled blind clinical trials with larger samples are required to confirm such evidence, as this study points to the feasibility of conducting this type of research.

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Dysphagia in Parkinson’s Disease Improves with Vocal Augmentation

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Howell, R.J., Webster, H., Kissela, E. et al.
Dysphagia (2019)
https://doi.org/10.1007/s00455-019-09982-z

dysphagia PARK

Imagem retirada da internet

Abstract

While voice-related disorders in Parkinson’s disease (PD) are commonly discussed in the literature, dysphagia in PD is less widely published. Vocal fold augmentation, including injection laryngoplasty (IL), is a well-established treatment for glottal insufficiency (Cates et al. in Otolaryngol Head Neck Surg 155(3):454–457, 2016). This study aimed to observe the effects of IL in PD patients with vocal bowing, with or without therapy, on glottic closure and patient-reported dysphagia outcomes. The study design was based on retrospectively collected database and cohort–case series. PD patients selected for retrospective review over a 2-year period were referred and evaluated in the Voice, Swallowing, and Airway multidisciplinary clinic by speech language pathologist and laryngologist, and were undergoing IL. Charts were reviewed for age, gender, Body Mass Index (BMI), onset of PD, and Movement Disorders Society-Unified Parkinson’s Disease Rating Scale Part 3 (MDS-UPDRS) scoring. We compared pre/postoperatively (> 1 < 3 months) using validated patient-reported outcome tools: Reflux Symptom Index (RSI), Glottal Function Index (GFI), Eating Assessment Tool-10 (EAT), and stroboscopic examinations. The study included 14 patients undergoing 22 IL or 1.6 IL/patient: mean age 70 years (63–80), 100% male, and BMI 25.9 ± 4.3 (mean ± SD). MDS-UPDRS scoring 33 ± 20 (moderate severity), with time between PD diagnosis and IL 8 ± 10 years. All patients had pre- and post-stroboscopic examinations; however, only 4:14 underwent formal swallowing evaluation. Overall, 14 IL patients improved on patient-reported measures (ΔRSI = 4; ΔGFI = 3; ΔEAT = 4). Based on the findings of the study, we conclude that PD is a progressive neurodegenerative condition with dysphagia. The presented pilot data suggest that IL may be considered as a beneficial adjunct for PD patients with glottal insufficiency.

Level of Evidence: 4

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Tongue Shape Dynamics in Swallowing Using Sagittal Ultrasound

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Ohkubo, M. & Scobbie, J.M.
Dysphagia (2019) 34: 112.
https://doi.org/10.1007/s00455-018-9921-8

US Lingua                                                                                                                              Fonte: Researchgate

Abstract

Ultrasound imaging is simple, repeatable, gives real-time feedback, and its dynamic soft tissue imaging may make it superior to other modalities for swallowing research. We tested this hypothesis and measured certain spatial and dynamic aspects of the swallowing to investigate its efficacy. Eleven healthy adults wearing a headset to stabilize the probe participated in the study. Both thickened and thin liquids were used, and liquid bolus volumes of 10 and 25 ml were administered to the subjects by using a cup. The tongue’s surface was traced as a spline superimposed on a fan-shaped measurement space for every image from the time at which the tongue blade started moving up toward the palate at the start of swallowing to the time when the entire tongue was in contact with the palate. To measure depression depth, the distance (in mm) was measured along each radial fan line from the location at which the tongue’s surface spline intersected the fan line to the point where the hard palate intersected the fan line at each timepoint. There were differences between individual participants in the imageability of the swallow, and so we defined quantitatively “measureable” and “unmeasurable” types. The most common type was measureable, in which we could find a clear bolus depression in the cupped tongue’s surface. Indeed, with 10 ml of thin liquids, we were able to find and measure the depression depth for all participants. The average maximum radial distance from the palate to the tongue’s surface was 20.9 mm (median) (IQR: 4.3 mm) for swallowing 10 ml of thin liquid compared to 24.6 mm (IQR: 3.3 mm) for 25 ml of thin liquid swallow (p < 0.001). We conclude that it is possible to use ultrasound imaging of the tongue to capture spatial aspects of swallowing.

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Curso Teórico-prático: Fotobiomodulação Aplicada à Fonoaudiologia

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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.

✔️ Ministrantes:

Ftp. Alexandre Cavallieri Gomes/Portugal

Fgª Vanessa Mouffron/MG

Fgª Tatiana Chaves/MG

✔Datas:

– 29 e 30/03: Alexandre Cavallieri

– 26 e 27/04: Vanessa Mouffron

– 24 e 25/05: Tatiana Chaves

Sextas: 18:00/22:00

Sábados: 08:00/17:00

✔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 n

Safety and efficacy of inspiratory muscle training for preventing adverse outcomes in patients at risk of prolonged hospitalisation

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  • Balbino Rivail Ventura NepomucenoJr
  • Mayana de Sá Barreto, 
  • Naniane Cidreira Almeida, 
  • Caroline Ferreira Guerreiro, 
  • Eveline Xavier-Souza and 
  • Mansueto Gomes Neto
Trials201718:626

https://doi.org/10.1186/s13063-017-2372-y

Fonte Imagem: my.moxymonitor.com

Background

The early institution of inspiratory muscle training on hospitalised patients with no established respiratory deficits could prevent in-hospital adverse outcomes that are directly or indirectly associated to the loss of respiratory muscle mass inherent to a prolonged hospital stay. The objective of the clinical trial is to assess the impact of inspiratory muscle training on hospital inpatient complications.

Methods

This is a double-blind randomised controlled trial. Subjects in the intervention group underwent an inspiratory muscle training loaded with 50% maximum inspiratory pressure twice daily for 4 weeks from study enrolment. Patients were randomly assigned to an inspiratory muscle training group or a sham inspiratory muscle training group. All patients received conventional physiotherapy interventions. Baseline and post-intervention respiratory and peripheral muscle strength, functionality (performance of activities of daily living), length of hospital stay, and death were evaluated. Clinical outcomes were assessed until hospital discharge. This study was approved by the Institutional Hospital Ethics Committee (03/2014).

Results

Thirty-one patients assigned to the inspiratory muscle training group and 34 to the sham inspiratory muscle training group were analysed. Patients in the inspiratory muscle training group had a shorter mean length of hospital stay (35.3 ± 2.7 vs. 41.8 ± 3.5 days, p< 0.01) and a lower risk of endotracheal intubation (relative risk (RR) = 0.36; 95% confidence interval (CI) 0.27–0.97; p= 0.03) as well as muscle weakness (RR = 0.36; 95% CI 0.19–0.98; p= 0.02) and mortality (RR = 0.23; 95% CI 0.2–0.94; p= 0.04). The risk of adverse events did not differ significantly between groups.

Conclusion

Inspiratory muscle training was a protective factor against endotracheal intubation, muscle weakness, and mortality.

Trial registration

ClinicalTrials.gov, ID: NCT02459444. Registered on 19 May 2015.

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Clinical Importance of Peak Cough Flow in Dysphagia Evaluation of Patients Diagnosed With Ischemic Stroke.

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Min SW, Oh SH, Kim GC, Sim YJ, Kim , Jeong

Ann Rehabil Med. 2018 Dec;42(6):798-803. doi: 10.5535/arm.2018.42.6.798. Epub 2018 Dec 28.

Abstract

OBJECTIVE: To investigate the relationship between peak cough flow (PCF), pulmonary function tests (PFT), and severity of dysphagia in patients with ischemic stroke.

METHODS: This study included patients diagnosed with ischemic stroke, who underwent videofluoroscopic swallowing study (VFSS), PCF and PFT from March 2016 to February 2017. The dysphagia severity was assessed using the videofluoroscopic dysphagia scale (VDS). Correlation analysis of VDS, PFT and PCF was performed. Patients were divided into three groups based on VDS score. One-way ANOVA of VDS was performed to analyze PCF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and age among the different groups.

RESULTS: The correlation coefficients of VDS and PCF, VDS and FVC, and VDS and FEV1 were -0.836, -0.508, and -0.430, respectively, all of which were statistically significant at the level of p<0.001. The one-way ANOVA indicated statistically significant differences in PCF, FVC, FEV1, and age among the VDS groups. Statistically significant differences in VDS and age were observed between aspiration pneumoia and non-aspiration pneumonia groups.

CONCLUSION: Coughing is a useful factor in evaluating the risk of aspiration in dysphagia patients. Evaluation of respiratory and coughing function should be conducted during the swallowing assessment of patients with ischemic stroke.

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Influência do modelo da seringa nos resultados do teste de fluxo para líquidos proposto pela International Dysphagia Diet Standardisation Initiative

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Roberto Oliveira Dantas; Luciana Oliveira

Rev. CEFAC. 2018 Maio-Jun; 20(3):382-387

ABSTRACT:

Objetivo: investigar se duas seringas diferentes provocam resultados diferentes do teste de avaliação da consistência de líquidos proposto pela International Dysphagia Diet Standardisation Initiative (IDDSI flowtest).

Métodos: foram comparadas duas seringas de 10 ml (Bencton e Dickinson, fabricada nos Estados Unidos, e Saldanha Rodrigues, fabricada no Brasil). Foi medido, imediatamente após o preparo, eapós 8 horas e 24 horas, o fluxo de água com espessante alimentar (maltodextrin, goma xantana e cloreto de potássio) em três concentrações, e sulfato de bário em três concentrações.

Resultados: o fluxo foi maior com a seringa Bencton e Dickinson, para a água e sulfato de bário, com discordâncias na classificação descritas pela International Dysphagia Diet Standardisation Initiative.

Conclusão: na avaliação da consistência de líquidos pelo método descrito pela International Dysphagia Diet Standardisation Initiative deve ser seguida a orientação preconizada pelo grupo, tendo como instru- mento a seringa Bencton e Dickinson.

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Photobiomodulation improves the frontal cognitive function of older adults. Review article

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Chan AS, et al. Int J Geriatr Psychiatry. 2018.

Fonte: Google Images

Abstract

OBJECTIVES: The frontal lobe hypothesis of age-related cognitive decline suggests that the deterioration of the prefrontal cortical regions that occurs with aging leads to executive function deficits. Photobiomodulation (PBM) is a newly developed, noninvasive technique for enhancing brain function, which has shown promising effects on cognitive function in both animals and humans. This randomized, sham-controlled study sought to examine the effects of PBM on the frontal brain function of older adults.

METHODS/DESIGNS: Thirty older adults without a neuropsychiatric history performed cognitive tests of frontal function (ie, the Eriksen flanker and category fluency tests) before and after a single 7.5-minute session of real or sham PBM. The PBM device consisted of three separate light-emitting diode cluster heads (633 and 870 nm), which were applied to both sides of the forehead and posterior midline, and delivered a total energy of 1349 J.

RESULTS: Significant group (experimental, control) × time (pre-PBM, post-PBM) interactions were found for the flanker and category fluency test scores. Specifically, only the older adults who received real PBM exhibited significant improvements in their action selection, inhibition ability, and mental flexibility after vs before PBM.

CONCLUSIONS: Our findings support that PBM may enhance the frontal brain functions of older adults in a safe and cost-effective manner.

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