Arquivo da tag: disfagia orofaríngea

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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Risperidone-induced bulbar palsy-like syndrome

Sico JJ; Patwa H

Dysphagia;26(3):340-3, 2011 Sep.

There have been several case reports of risperidone-associated dysphagia. Risperidone-induced bulbar palsy-like syndrome has not been previously described. We report on a 58-year-old gentleman with prior history of schizophrenia and remote chlorpromazine use with no history of extrapyramidal symptoms who experienced acute onset of dysphagia and facial diplegia with hyperprolactinemia while being treated with risperidone. To date there have been five reported cases of dysphagia associated with risperidone, occurring by such mechanisms as isolated pharyngeal dysfunction from pharyngeal constrictor palsy and dystonia, drug-induced parkinsonism, and acute dystonic reaction. These cases were associated either with initiation or up-titration of risperidone, with complete resolution of dysphagia after medication discontinuation or dose change. Our patient developed dysphagia within 2 weeks of taking risperidone and completely resolved 1 month after the medication was stopped. Unlike other reported cases, our patient also experienced symptomatic hyperprolactinemia, another known side effect of risperidone. Physicians should also be aware that risperidone can be associated with oropharyngeal dysphagia secondary to an acute bulbar palsy-like syndrome that places patients at increased risk of aspiration events and its associated morbidity and mortality.

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Measuring elderly dysphagic patients’ performance in eating–a review

Hansen T; Kjaersgaard A; Faber J

Disabil Rehabil;33(21-22):1931-40, 2011.

PURPOSE: This review aims to identify psychometrically robust assessment tools suitable for measuring elderly dysphagic patients’ performance in eating for use in clinical practice and research. METHOD: Electronic databases, related citations and references were searched to identify assessment tools integrating the complexity of the eating process. Papers were selected according to criteria defined a priori. Data were extracted regarding characteristics of the assessment tools and the evidence of reliability, validity and responsiveness. Quality appraisal was undertaken using developed criteria concerning the study design, the statistics used for the psychometric evaluation and the reported values. RESULTS: Eight of fourteen identified assessment tools met the inclusion criteria. Three assessment tools were specific to dementia, two were specific to stroke and three targeted a range of neurological and geriatric conditions. The rigor of the assessment tools’ psychometric properties varied from no evidence available to excellent evidence. Only two assessment tools were rated adequate to excellent. CONCLUSION: ‘The Minimal Eating Observation Form-Version II’ to be used for screening and ‘The McGill Ingestive Skills Assessment’ to be used for treatment planning and monitoring appeared to be psychometrically robust for clinical practice and research. However, further research on their psychometric properties is needed.

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Is swallowing of all mixed consistencies dangerous for penetration-aspiration?

Lee KL; Kim WH; Kim EJ; Lee JK’

Am J Phys Med Rehabil;91(3):187-92, 2012 Mar

OBJECTIVE: The aim of this study was to determine whether the risk and severity of penetration-aspiration with mixed consistency (MIX), which consists of cooked rice and thin liquid barium (LIQUID), are different from the risks and severities with each single consistency (cooked rice or LIQUID) in dysphagic patients. DESIGN: Dysphagic patients (N = 29) performed a videofluoroscopic swallowing study with the following foods: cooked rice, LIQUID, and MIX. Several components were analyzed using recorded videotapes. RESULTS: The Penetration-Aspiration Scale score for MIX was significantly lower than that for LIQUID (P < 0.016). The location of the leading edge at the onset of a pharyngeal swallow between MIX and LIQUID was not different (P = 0.705). The pharyngeal delay time of LIQUID was delayed significantly compared with that of MIX (0.142 ± 0.267 and -0.149 ± 0.096 sec, respectively, P < 0.016). The severity of pharyngeal residue among the foods was different according to the location. CONCLUSIONS: Swallowing of MIX is not dangerous, and it is safer for not inducing penetration-aspiration as compared with the swallowing of LIQUID. The risk of penetration-aspiration may be judged depending on not only a food’s consistency but also on various factors that affect airway protection, including the texture of food.

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Awareness of dysphagia in Parkinson’s disease

Bayés-Rusiñol À; Forjaz MJ; Ayala A; Crespo Mde L; Prats A; Valles E; Petit C; Casanovas M; Garolera-Freixa M

Rev Neurol;53(11):664-72, 2011 Dec 1.

INTRODUCTION AND AIM: In order to be able to assess the level of awareness of swallowing disorders in Parkinson’s disease (PD), a specific questionnaire was designed and validated: the Dysphapark questionnaire. PATIENTS AND METHODS: A total of 470 persons with PD were asked whether they believe they have problems swallowing or not, and then they filled in a self-administered questionnaire that evaluates the effectiveness and safety of swallowing. The Dysphapark questionnaire was validated by means of Rasch analysis and classical psychometric methods. RESULTS: The safety and effectiveness dimensions of the Dysphapark fit the Rasch model well. The efficacy dimension showed significant differences for gender, length of the illness, awareness of dysphagia and length of meals. Significant differences were also found in the safety dimension for length and severity of illness, awareness of dysphagia, speech therapy and knowledge of thickening agents. Despite the fact that 90% of patients had problems concerning effectiveness and safety in swallowing, 79.45% were not aware that they suffered from dysphagia. CONCLUSIONS: The Dysphapark questionnaire is a suitable measure of dysphagia in PD, according to the Rasch analysis. A high proportion of patients with PD have dysphagia, although it has been observed that they have a low level of awareness of the condition, of the consequences it may have and of the possibility of using thickening agents. Given that some of the swallowing disorders in PD are asymptomatic and that the level of awareness of the disorder is low, we recommend including specific questionnaires as well as clinical and instrumental evaluation of dysphagia in clinical practice.

 

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