Arquivo da tag: Deglutition disorders

Cough reflex testing in Dysphagia following stroke: a randomized controlled trial

 

Miles A, Zeng IS, McLauchlan H, Huckabee ML.

J Clin Med Res. 2013 Jun;5(3):222-33. doi: 10.4021/jocmr1340w. Epub 2013 Apr 23.

Abstract

BACKGROUND:

Significant health issues and service delivery costs are associated with post-stroke pneumonia related to dysphagia. Silent aspiration is known to increase pneumonia and mortality in this population. The utility of cough reflex testing (CRT) for reducing pneumonia in acute stroke patients was the subject of this randomised, controlled trial.

METHODS:

Patients referred for swallowing evaluation (N = 311) were assigned to either 1) a control group receiving standard evaluation or 2) an experimental group receiving standard evaluation with CRT. Participants in the experimental group were administered nebulised citric acid with test results contributing to clinical decisions. Outcomes for both groups were measured by pneumonia rates at 3 months post evaluation and other clinical indices of swallowing management.

RESULTS:

Analysis of the data identified no significant differences between groups in pneumonia rate (P = 0.38) or mortality (P = 0.15). Results of CRT were shown to influence diet recommendations (P < 0.0001) and referrals for instrumental assessment (P < 0.0001).

CONCLUSIONS:

Despite differences in clinical management between groups, the end goal of reducing pneumonia in post stroke dysphagia was not achieved.

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Correlation between brain injury and dysphagia in adult patients with stroke

Nunes, Maria Cristina Alencar; Jurkiewicz, Ari Leon; Santos, Rosane Sampaio; Furkim, Ana Maria; Massi, Giselle; Pinto, Gisele Sant´Ana; Lange, Marcos Christiano
Int. Arch. Otorhinolaryngol. 16(3): 313-321, TAB. 2012 Sep.

SUMMARY

INTRODUCTION: In the literature, the incidence of oropharyngeal dysphagia in patients with cerebrovascular accident (AVE) ranges 20–90%. Some studies correlate the location of a stroke with dysphagia, while others do not.
OBJECTIVE: To correlate brain injury with dysphagia in patients with stroke in relation to the type and location of stroke.
METHOD: A prospective study conducted at the Hospital de Clinicas with 30 stroke patients: 18 women and 12 men. All patients underwent clinical evaluation and swallowing nasolaryngofibroscopy (FEES®), and were divided based on the location of the injury: cerebral cortex, cerebellar cortex, subcortical areas, and type: hemorrhagic or transient ischemic.
RESULTS: Of the 30 patients, 18 had ischemic stroke, 10 had hemorrhagic stroke, and 2 had transient stroke. Regarding the location, 10 lesions were in the cerebral cortex, 3 were in the cerebral and cerebellar cortices, 3 were in the cerebral cortex and subcortical areas, and 3 were in the cerebral and cerebellar cortices and subcortical areas. Cerebral cortex and subcortical area ischemic strokes predominated in the clinical evaluation of dysphagia. In FEES®, decreased laryngeal sensitivity persisted following cerebral cortex and ischemic strokes. Waste in the pharyngeal recesses associated with epiglottic valleculae predominated in the piriform cortex in all lesion areas and in ischemic stroke. A patient with damage to the cerebral and cerebellar cortices from an ischemic stroke exhibited laryngeal penetration and tracheal aspiration of liquid and honey.
CONCLUSION: Dysphagia was prevalent when a lesion was located in the cerebral cortex and was of the ischemic type.

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Swallowing disorders in nursing home residents: how can the problem be explained?

Nogueira D, Reis E.

Clin Interv Aging. 2013;8:221-7. doi: 10.2147/CIA.S39452. Epub 2013 Feb 19.

Abstract

BACKGROUND:

The swallowing mechanism changes significantly as people age, even in the absence of chronic diseases. Presbyphagia, a term that refers to aging-related changes in the swallowing mechanism, may be linked to many health conditions and presents itself in distinct ways. Swallowing disorders are also identified as a major problem amongst the elderly population living in nursing homes.

METHODS:

The study sought to determine the prevalence of swallowing disorders in nursing home residents, to identify the relationship between self-perceived swallowing disorders, cognitive functions, autonomy, and depression, and also to analyze which variables explain the score of the Dysphagia Self-Test (DST). For this purpose, the researchers chose to apply a survey conveying questions on demographic aspects, general health, eating and feeding, as well as instruments to assess functional performance and the 3 ounce Water Swallow Test.

RESULTS:

The sample consisted of 272 elderly people living in eight nursing homes in Portugal. Six did not sign the informed consent form. Of the total, 29% were totally dependent, 33% were depressed, 45% had cognitive impairment, and 38% needed help with feeding. About 43% of the individuals reported having problems related to eating. Regarding the DST, 40% showed signs of dysphagia. With respect to the 3 ounce Water Swallow Test, 38% revealed at least one of the symptoms, wet voice being the most prevalent. Correlation measures showed that age had no linear association with the DST score although correlation with the Barthel Index and Mini Mental State Examination was found to be significant. A linear regression model was estimated with the DST score as the dependent variable and the MMSE and BI scores, gender, age, education, the Geriatric Depression Scale score, 3 ounce Water Swallow Test, and diagnosed conditions (such as neurological disorder, dementia, and cardiorespiratory problems) as explaining variables.

CONCLUSION:

Results showed a high prevalence of dysphagia signs amongst a nursing home population. For the purpose of the present study, both a subjective and an objective assessment were applied. Results pointed to a significant statistical relation between objective and subjective measures, thus indicating that a self-perception test should be included in the assessment of swallowing disorders in a nursing home population. Notwithstanding, it should not be used as a single or principal measure as it is influenced by the individuals’ cognitive condition.

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Evolution of swallowing in lateral pharyngoplasty with stylopharyngeal muscle preservation

Mesti, Jayson Junior; Cahali, Michel Burihan
Braz. j. otorhinolaryngol. 78(6): 51-55, ILUS, GRA. 2012 Dec.

ABSTRACT

Lateral pharyngoplasty manages obstructive sleep apnea through the myotomy and repositioning of the muscles of the lateral pharyngeal wall. Dysphagia after any pharyngeal surgery is influenced by pain, discomfort from the sutures, the healing process and by the adaptation to the changes in pharyngeal structures. Experience with lateral pharyngoplasty has shown that the superior pharyngeal constrictor muscle plays a minor role in swallowing. One of them, the stylopharyngeus muscle, seems to play an important role during swallowing.
OBJECTIVE: The aim of this study is to provide a daily analysis of the follow-up of the swallowing function.
METHOD: We have prospectively evaluated the swallowing function in 20 patients, through the daily application of a visual analogue scale from the first post-op until the complete disappearance of dysphagia.
RESULTS: Patients have returned to their normal feeding habits in a mean of 10.9 days after the procedures and they presented a completely normal swallowing, on average, 21.6 days after the surgeries. All patients recover normal swallowing after the procedures, with a maximum recovery time of 33 days.
CONCLUSION: In this study, all patients who underwent lateral pharyngoplasty with total preservation of the stylopharyngeus muscle reported complete normalization of swallowing with a recovery time up to 33 days.

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Food in liquid consistency and deglutition: a critical review of the literature

Elaine Cristina Pires; Fernanda Chiarion Sassi; Laura Davison Mangilli; Suelly Cecília Olivan Limongi; Claudia Regina Furquim de Andrade

Rev. soc. bras. fonoaudiol. vol.17 no.4 São Paulo dez. 2012

ABSTRACT

The purpose of this literature review was to analyze international scientific papers published on the physiology of swallowing fluids in the oral and pharyngeal phases. The employed methodology involved the formulation of a question, the location and selection of studies, and a critical assessment of the manuscripts according to the concepts of the Cochrane Handbook. We identified 185 articles, of which 141 were excluded for not being directly related to the theme. Twenty-nine studies were analyzed. The researchers were strongly focused on ways to identify dysphagia and not on the features offered by swallowing various consistencies. Regarding the methodology employed in the reviewed articles, it was observed that there were no control groups in most studies. The studied groups were heterogeneous, especially when considering individuals with neurological disorders. In addition, the subjects were not paired by age. Thus, the findings of this review indicate that clinicians face great difficulty in applying these scientific findings in their daily practices, which, in turn, limits the use of evidence-based practice.

Keywords: Deglutition; Food; Drinking behavior; Deglutition disorders; Speech, language and hearing sciences

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Alimentos na consistência líquida e deglutição: uma revisão crítica da literatura

Elaine Cristina Pires; Fernanda Chiarion Sassi; Laura Davison Mangilli; Suelly Cecília Olivan Limongi; Claudia Regina Furquim de Andrade

Rev. soc. bras. fonoaudiol. vol.17 no.4 São Paulo dez. 2012

RESUMO

O objetivo da presente revisão de literatura foi analisar artigos científicos internacionais publicados sobre a fisiologia da deglutição de alimentos líquidos nas fases oral e faríngea. A metodologia empregada envolveu a formulação da pergunta; localização e seleção dos estudos; avaliação crítica dos artigos; conforme os preceitos do Cochrane Handbook. Foram identificados 185 artigos, dos quais se excluiu 141 por não relacionarem-se diretamente ao tema e analisou-se 29 estudos. As pesquisas estão fortemente relacionadas às formas de identificação de disfagia e não as características proporcionadas pela deglutição de diferentes consistências. Quanto à metodologia empregada nos artigos analisados observa-se que na maioria dos estudos não há grupo-controle. Os grupos estudados são heterogêneos, principalmente quando considerando indivíduos com alterações neurológicas, além disso, não há pareamento de idade na maioria dos estudos. Dessa forma, os achados desta revisão demonstram que há dificuldade na aplicabilidade clínica dos achados científicos, dificultando a prática baseada evidências.

Descritores: Deglutição; Alimentos; Comportamento de ingestão de líquido; Transtornos de deglutição; Fonoaudiologia

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Impaired food transportation in Parkinson’s disease related to lingual bradykinesia

Umemoto G; Tsuboi Y; Kitashima A; Furuya H; Kikuta T

Dysphagia;26(3):250-5, 2011 Sep.

This study aimed to analyze quantitatively videofluoroscopic (VF) images of patients with Parkinson’s disease (PD), to evaluate if the predicted factors of the oral phase of swallowing deteriorated with PD progression, and to demonstrate a relationship between the abnormal movements of the tongue and food transportation. Thirty PD patients were recruited and divided into mild/moderate (Hoehn & Yahr stages II and III) and advanced (stages IV and V) groups. They underwent measurement of tongue strength and VF using 5 ml of barium gelatin jelly as a test food. We measured the speed of bolus movement and the range of tongue and mandible movements during oropharyngeal transit time. The maximum tongue pressure of the mild/moderate group was significantly larger than that of advanced group (p = 0.047). The oropharyngeal transit time of the mild/moderate group was significantly shorter than that of the advanced group (p = 0.045). There was a significant negative correlation between the speed of tongue movement and the oropharyngeal transit time (p = 0.003, R = -0.527). Prolonged mealtimes and the ejection of insufficiently masticated food from the oral cavity into oropharynx were associated with PD progression. These results indicate the importance of the oral phase of swallowing in PD patients.

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