Arquivo da tag: Swallowing disorders

Swallowing impairment and pulmonary dysfunction in Parkinson’s disease: the silent threats.

J Neurol Sci. 2014 Apr 15;339(1-2):149-52. doi: 10.1016/j.jns.2014.02.004. Epub 2014 Feb 14.



Swallowing disorders and respiratory impairment are frequent in Parkinson‘s disease (PD) patients, and aspiration pneumonia remains the leading cause of death among these subjects.


The objective of this study was to investigate whether there is an association between pulmonary impairment and swallowing dysfunction in PD patients.


A cross-sectional study with a comparison group was conducted with PD patients. Subjects were submitted to demographic questionnaires and underwent spirometric and videofluorographic assessments. Significance level was considered at 95% (p<0.05).


Among 35 PD patients, 40% presented with swallowing complaints. However, 22% of the clinically asymptomatic patients presented airway food penetration when submitted to videofluoroscopy. In 20% of PD patients material entered the airways and there was contact with the vocal folds in 7%. However, there was an efficient cleaning with residue deglutition in almost all patients. No penetration/aspiration was detected among the controls. Respiratory parameters were below the normal predicted values in PD patients when compared to the healthy controls.


These data suggest an association between pulmonary dysfunction and swallowing impairment in PD patients; even in patients without swallowing complaints, impaired pulmonary function can be detected.


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.


Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial

Middleton S; McElduff P; Ward J; Grimshaw JM; Dale S; D’Este C; Drury P; Griffiths R; Cheung NW; Quinn C; Evans M; Cadilhac D; Levi C; QASC Trialists Group

Lancet;378(9804):1699-706, 2011 Nov 12.

BACKGROUND: We assessed patient outcomes 90 days after hospital admission for stroke following a multidisciplinary intervention targeting evidence-based management of fever, hyperglycaemia, and swallowing dysfunction in acute stroke units (ASUs). METHODS: In the Quality in Acute Stroke Care (QASC) study, a single-blind cluster randomised controlled trial, we randomised ASUs (clusters) in New South Wales, Australia, with immediate access to CT and on-site high dependency units, to intervention or control group. Patients were eligible if they spoke English, were aged 18 years or older, had had an ischaemic stroke or intracerebral haemorrhage, and presented within 48 h of onset of symptoms. Intervention ASUs received treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction with multidisciplinary team building workshops to address implementation barriers. Control ASUs received only an abridged version of existing guidelines. We recruited pre-intervention and post-intervention patient cohorts to compare 90-day death or dependency (modified Rankin scale [mRS] ≥2), functional dependency (Barthel index), and SF-36 physical and mental component summary scores. Research assistants, the statistician, and patients were masked to trial groups. All analyses were done by intention to treat. This trial is registered at the Australia New Zealand Clinical Trial Registry (ANZCTR), number ACTRN12608000563369. FINDINGS: 19 ASUs were randomly assigned to intervention (n=10) or control (n=9). Of 6564 assessed for eligibility, 1696 patients’ data were obtained (687 pre-intervention; 1009 post-intervention). Results showed that, irrespective of stroke severity, intervention ASU patients were significantly less likely to be dead or dependent (mRS ≥2) at 90 days than control ASU patients (236 [42%] of 558 patients in the intervention group vs 259 [58%] of 449 in the control group, p=0·002; number needed to treat 6·4; adjusted absolute difference 15·7% [95% CI 5·8-25·4]). They also had a better SF-36 mean physical component summary score (45·6 [SD 10·2] in the intervention group vs 42·5 [10·5] in the control group, p=0·002; adjusted absolute difference 3·4 [95% CI 1·2-5·5]) but no improvement was recorded in mortality (21 [4%] of 558 in intervention group and 24 [5%] of 451 in the control group, p=0·36), SF-36 mean mental component summary score (49·5 [10·9] in the intervention group vs 49·4 [10·6] in the control group, p=0·69) or functional dependency (Barthel Index ≥60: 487 [92%] of 532 patients vs 380 [90%] of 423 patients; p=0·44). INTERPRETATION: Implementation of multidisciplinary supported evidence-based protocols initiated by nurses for the management of fever, hyperglycaemia, and swallowing dysfunction delivers better patient outcomes after discharge from stroke units. Our findings show the possibility to augment stroke unit care. FUNDING: National Health & Medical Research Council ID 353803, St Vincent’s Clinic Foundation, the Curran Foundation, Australian Diabetes Society-Servier, the College of Nursing, and Australian Catholic University.


Electrical activity of the masseter during swallowing after total laryngectomy

Pernambuco, Leandro de Araújo; Silva, Hilton Justino da; Nascimento, Gerlane Karla Bezerra Oliveira; Silva, Elthon Gomes Fernandes da; Balata, Patrícia Maria Mendes; Santos, Veridiana da Silva; Leão, Jair Carneir

Braz J Otorhinolaryngol; 77(5): 645-650, Sept.-Oct. 2011. tab.


Total laryngectomy is a surgical procedure that can change swallowing biomechanics, including muscle activity of the masseter; this muscle stabilizes the mandible.

AIM: To characterize the electrical activity of the masseter muscle during swallowing after total laryngectomy. Series study.

MATERIAL AND METHODS: An electromyographic evaluation of swallowing was carried out; three different volumes of water (14.5ml, 20ml and 100ml) were swallowed, and there was a rest condition. The electromyographic signal was normalized by Maximum Resisted Voluntary Activity – considered as 100 percent of electrical activity of muscles. All other values were calculated as a percentage of this parameter.

RESULTS: There is moderate electrical activity of the masseter during swallowing with higher averages on the left. There was no difference between swallowing 14.5ml or 20ml. Natural swallowing of 100ml had the lowest average. Electromyographic signals were recorded at rest on both sides, indicating the existence of electric activity in this situation.

CONCLUSION: Patients submitted to total laryngectomy present electrical activity of the masseter muscles during swallowing and at rest. This activity is influenced by the volume of swallowed liquid, and showed significant differences among the tasks.



Andrea Santamato, Francesco Panza, Vincenzo Solfrizzi, Anna Russo, Vincenza Frisardi, Marisa Megna, Maurizio Ranieri, Pietro Fiore

J Rehabil Med 2009; 41: 639–645

Objective: To perform acoustic analysis of swallowing sounds, using a microphone and a notebook computer system, in healthy subjects and patients with dysphagia affected by neurological diseases, testing the positive/negative predictive value of a pathological pattern of swallowing sounds for penetration/aspiration.

Design: Diagnostic test study, prospective, not blinded, with the penetration/aspiration evaluated by fibreoptic endoscopy of swallowing as criterion standard.

Subjects: Data from a previously recorded database of normal swallowing sounds for 60 healthy subjects according to gender, age, and bolus consistency was compared with those of 15 patients with dysphagia from a university hospital referral centre who were affected by various neurological diseases.

Methods: Mean duration of the swallowing sounds and post-swallowing apnoea were recorded. Penetration/aspiration was verified by fibreoptic endoscopy of swallowing in all patients with dysphagia.

Results: The mean duration of swallowing sounds for a liquid bolus of 10 ml water was significantly different between patients with dysphagia and healthy patients. We also described patterns of swallowing sounds and tested the negative/positive predictive values of post-swallowing apnoea for penetration/aspiration verified by fibreoptic endoscopy of swallowing (sensitivity 0.67 (95% confidence interval 0.24–0.94); specificity 1.00 (95% confidence interval 0.56–1.00)).

Conclusion: The proposed technique for recording and measuring swallowing sounds could be incorporated into the bedside evaluation, but it should not replace the use of more diagnostic and valuable measures.


Diagnosis and treatment of post-extubation dysphagia: Results from a national survey


Macht M, Wimbish T, Clark BJ, Benson AB, Burnham EL, Williams A, Moss M.

J Crit Care. 2012 Oct 17. pii: S0883-9441(12)00235-3. doi: 10.1016/j.jcrc.2012.07.016. [Epub ahead of print]



This study sought to determine the utilization of speech-language pathologist (SLPs) for the diagnosis and treatment of post-extubation dysphagia in survivors of mechanical ventilation.


We designed, validated, and mailed a survey to 1,966 inpatient SLPs who routinely evaluate patients for post-extubation dysphagia.


Most SLP diagnostic evaluations (60%; 95% CI, 59%-62%) were performed using clinical techniques with uncertain accuracy. Instrumental diagnostic tests (such as fluoroscopy and endoscopy) are more likely to be available at university than community hospitals. After adjusting for hospital size and academic affiliation, instrumental test use varied significantly by geographical region. Treatments for post-extubation dysphagia usually involved dietary adjustment (76%; 95% CI, 73-79%) and postural changes/compensatory maneuvers (86%; 95% CI, 84-88%), rather than on interventions aimed to improve swallowing function (24%; 95% CI, 21-27%).


SLPs frequently evaluate acute respiratory failure survivors. However, diagnostic evaluations rely mainly upon bedside techniques with uncertain accuracy. The use of instrumental tests varies by geographic location and university affiliation. Current diagnostic practices and feeding decisions for critically ill patients should be viewed with caution until further studies determine the accuracy of bedside detection methods.