Arquivo da tag: swallowing disorder

Swallowing in disorders of consciousness

Bicego A, Lejoly K, Maudoux A, Lefebvre P, Laureys S, Schweizer V, Diserens K, Faymonville ME, Vanhaudenhuyse A.

Rev Neurol (Paris). 2014 Jun 18.

 

Abstract

INTRODUCTION:

Interest in studying swallowing disorders in patients with altered consciousness has increased over the past decade. Swallowing deficit is frequently encountered in severe brain-injured patients.

STATE OF ART:

Results of studies have highlighted different factors such as the delay between the injury and the treatment and the level of consciousness of these patients, as well as the presence or not of tracheotomy, which will determine the feasibility of resuming oral feeding. Nowadays, very few valid and sensitive scales can be used to assess swallowing deficit in patients with disorders of consciousness. The Facial Oral Tract Therapy (FOTT) scale is an inter-professional multidisciplinary approach offering a structured way to evaluate and treat patients with swallowing disorders. In contrast with other scales, patients do not have to follow verbal instructions for the FOTT.

PERSPECTIVES:

This paper presents a review of existing literature on the assessment and management of swallowing disorders in patients with altered state of consciousness, and a description of the FOTT method.

CONCLUSION:

The FOTT seems to be an interesting assessment and rehabilitation tool for patients with disorders of consciousness. However, clinical studies are needed to confirm the validity and sensitivity of this technique.

LEIA O ARTIGO NA ÍNTEGRA

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The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration.

Dysphagia. 1996 Spring;11(2):99-103.

This study retrospectively investigated the value of both endoscopically visible oropharyngeal secretions in the hypopharynx and swallowing frequency in the prediction of aspiration of food and liquid. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed on a total of 69 individuals that included hospitalized elderly, nonhospitalized elderly, and young normal subjects. A four-level rating scale for determining the severity of accumulated oropharyngeal secretions was developed and employed to rate subjects prior to the presentation of food or liquid during the FEES. Spontaneous dry swallows were also counted during the observation period of the FEES. It was found that the accumulation of endoscopically visible oropharyngeal secretions located within the laryngeal vestibule was highly predictive of aspiration of food or liquid. There were significantly fewer spontaneous swallows in hospitalized subjects when compared with nonhospitalized subjects. There was also a significant decrease in the frequency of spontaneous swallows in aspirating hospitalized subjects when compared with nonaspirating hospitalized subjects. Results are discussed in terms of integrating this information with clinical bedside examination techniques.

Acesse o periódico

Interdisciplinary evaluation of dysphagia: clinical swallowing evaluation and videoendoscopy of swallowing

 

Sordi M, Mourão LF, Silva AA, Flosi LC.

Braz J Otorhinolaryngol. 2009 Nov-Dec;75(6):776-87.

 

Abstract

Patients with dysphagia have impairments in many aspects, and an interdisciplinary approach is fundamental to define diagnosis and treatment. A joint approach in the clinical and videoendoscopy evaluation is paramount.

AIM:

To study the correlation between the clinical assessment (ACD) and the videoendoscopic (VED) assessment of swallowing by classifying the degree of severity and the qualitative/descriptive analyses of the procedures.

STUDY DESIGN:

cross-sectional, descriptive and comparative.

MATERIALS AND METHODS:

held from March to December of 2006, at the Otolaryngology/Dysphagia ward of a hospital in the country side of São Paulo. 30 dysphagic patients with different disorders were assessed by ACD and VED. The data was classified by means of severity scales and qualitative/ descriptive analysis.

RESULTS:

the correlation between severity ACD and VED scales pointed to a statistically significant low agreement (KAPA = 0.4) (p=0,006). The correlation between the qualitative/descriptive analysis pointed to an excellent and statistically significant agreement (KAPA=0.962) (p<0.001) concerning the entire sample.

CONCLUSION:

the low agreement between the severity scales point to a need to perform both procedures, reinforcing VED as a doable procedure. The descriptive qualitative analysis pointed to an excellent agreement, and such data reinforces our need to understand swallowing as a process.