Arquivo da tag: treatment

Patients Treated for Head and Neck Cancer in Brazil

Renata Lígia Vieira Guedes, Elisabete Carrara-de Angelis, Amy Y. Chen, Luiz Paulo Kowalski, José Guilherme Vartanian

Abstract

Analysis of quality of life (QOL) has revealed that preservation of swallowing, speech, and breathing functions has a direct impact on QOL and that these functions are important patient-reported outcomes. The purposes of this study were to adapt and culturally validate the M.D. Anderson Dysphagia Inventory (MDADI) to the Brazilian Portuguese language and to evaluate QOL related to dysphagia in patients treated for head and neck cancer. This was a cross-sectional study that included 72 adult patients with a mean age of 63 years who were treated for head and neck cancer. Construct validity and reliability analyses were performed through the comparison of the MDADI with three other health-related QOL questionnaires administered at the time of enrollment and MDADI application 2 weeks thereafter, respectively. Reliability was established by assuring both internal consistency (Cronbach’s α) and test–retest reliability (intraclass correlation coefficient, ICC). Test–retest reliability for the total score in the MDADI had an ICC greater than 0.795 (p < 0.001). The MDADI had significant statistical correlations with the other questionnaires. Patients treated for head and neck cancer had a mean total score of 83 on the MDADI, which is indicative of minimal limitation in overall QOL. In conclusion, the present study validates the adaptation of the MDADI to the Brazilian Portuguese language and provides another tool to evaluate the impact of dysphagia on the QOL of head and neck cancer patients.

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“Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy

Carnaby-Mann G; Crary MA; Schmalfuss I; Amdur R

Int J Radiat Oncol Biol Phys;83(1):210-9, 2012 May 1.

PURPOSE: Dysphagia after chemoradiotherapy is common. The present randomized clinical trial studied the effectiveness of preventative behavioral intervention for dysphagia compared with the “usual care.” METHODS AND MATERIALS: A total of 58 head-and-neck cancer patients treated with chemoradiotherapy were randomly assigned to usual care, sham swallowing intervention, or active swallowing exercises (pharyngocise). The intervention arms were treated daily during chemoradiotherapy. The primary outcome measure was muscle size and composition (determined by T(2)-weighted magnetic resonance imaging). The secondary outcomes included functional swallowing ability, dietary intake, chemosensory function, salivation, nutritional status, and the occurrence of dysphagia-related complications. RESULTS: The swallowing musculature (genioglossus, hyoglossuss, and mylohyoid) demonstrated less structural deterioration in the active treatment arm. The functional swallowing, mouth opening, chemosensory acuity, and salivation rate deteriorated less in the pharyngocise group. CONCLUSION: Patients completing a program of swallowing exercises during cancer treatment demonstrated superior muscle maintenance and functional swallowing ability.

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Dysphagia–pathophysiology, diagnosis and treatment

Cecconi E; Di Piero V

Front Neurol Neurosci;30:86-9, 2012.

Dysphagia is an extremely common disorder after stroke, affecting as many as half of acute stroke sufferers. It is associated with respiratory complications, increased risk of aspiration pneumonia, nutritional compromise and dehydration, and detracts from quality of life. For this reason, dysphagia significantly affects outcome and is associated with increased morbidity and mortality. Formal dysphagia screening protocols significantly reduce the rate of pneumonia and improve general outcome. Furthermore, early behavioral swallowing interventions are associated with a more favorable outcome in dysphagic stroke patients. This chapter reviews the pathophysiology of swallowing dysfunction, and the diagnosis and treatment of patients with dysphagia after an acute stroke.

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Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part V-Applications for clinicians and researchers

Karen Wheeler-Hegland, PhD; Tobi Frymark, MA; Tracy Schooling, MA; Daniel McCabe, DMA; John Ashford, PhD; Robert Mullen, MPH; Carol Smith Hammond, PhD; Nan Musson, MA

JRRD, Volume 46 Number 2, 2009, Pages 215 — 222

Abstract —

Evidence-based practice (EBP) involves the integration of three essential principles: (1) the current best available research, (2) the clinician’s experience and expertise, and (3) the patient’s values and preferences. This report is the last in a series that presents the culmination of a collaborative effort between the American Speech-Language-Hearing Association and the Department of Veterans Affairs to examine the state of the evidence on seven behavioral swallowing interventions. This article addresses how speech-language pathologists treating individuals with oropharyngeal dysphagia can incorporate EBP into their clinical decision-making process. A fictitious patient scenario is presented and discussed as an example of the clinical application of the findings from the three systematic reviews in this series on evidence for the use of behavioral swallowing interventions. Also, recommendations for researchers studying dysphagia treatment are discussed, with the overall goal of facilitating the generation of a stronger evidence base for clinicians.

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Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part III-Impact of dysphagia treatments on populations with neurological disorders

John Ashford, PhD; Daniel McCabe, DMA; Karen Wheeler-Hegland, PhD; Tobi Frymark, MA; Robert Mullen, MPH; Nan Musson, MA; Tracy Schooling, MA; Carol Smith Hammond, PhD

JRRD, Volume 46 Number 2, 2009, Pages 195 — 204

Abstract —

This evidence-based systematic review (EBSR) is part of a series of reviews examining the state of the research regarding behavioral interventions for dysphagia. This EBSR focuses primarily on dysphagia secondary to neurological disorders (e.g., brain injury, stroke, Parkinson’s disease, and dementia). The seven behavioral treatments investigated were three postural interventions (side lying, chin tuck, and head rotation) and four swallowing maneuvers (effortful swallow, Mendelsohn, supraglottic swallow, and super-supraglottic swallow). We systematically searched the dysphagia literature from March 2007 to April 2008 using 14 electronic databases. Seven studies met the inclusion and exclusion criteria and were evaluated for methodological quality and stage of research. Of the included studies, only two were judged to be efficacy research; the remaining five were considered exploratory. Methodological quality of studies ranged from one to seven out of eight possible quality markers. Five of seven treatment interventions were addressed by at least one study. No studies were found to address the effortful swallow or the super-supraglottic swallow. Currently, limited evidence from seven studies shows the potential effects of dysphagia behavioral interventions for select groups of individuals with neurologically induced dysphagia. Further research is needed to evaluate the effectiveness of these and the remaining interventions with various populations with neurological disorders.

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Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part II-Impact of dysphagia treatment on normal swallow function

Karen Wheeler-Hegland, PhD; John Ashford, PhD; Tobi Frymark, MA; Daniel McCabe, DMA; Robert Mullen, MPH; Nan Musson, MA; Carol Smith Hammond, PhD; Tracy Schooling, MA

JRRD, Volume 46 Number 2, 2009, Pages 185 — 194

Abstract —

This article is the second in a series of evidence-based systematic reviews. Data reported cover the impact of dysphagia behavioral interventions on swallow physiology in healthy adults. The behavioral treatments investigated were three postural interventions-side lying, chin tuck, and head rotation-and four swallowing maneuvers-effortful swallow, the Mendelsohn maneuver, supraglottic swallow, and super-supraglottic swallow. A systematic search of the dysphagia litera-ture was conducted in 14 electronic databases. Seventeen studies meeting the inclusion criteria were evaluated for methodological quality with the American Speech-Language-Hearing Association’s levels-of-evidence scheme and were characterized by research stage (i.e., exploratory, efficacy, effectiveness, cost-benefit/public policy research). Effect sizes were calculated when possible. All studies were exploratory research ranging from two to five of seven possible quality markers. The majority of studies (8 of 17) investigated effortful swallow. Three studies examined the Mendelsohn maneuver, chin tuck, supraglottic swallow, and super-supraglottic swallow and two studies addressed head rotation. No study addressed side lying. For nondisordered populations, the existing evidence demonstrates differential effects of postural changes and maneuvers on swallowing physiology. Some effects reinforced existing recommendations for the applications of the interventions, while others suggested new ways that the treatments may impact swallow function. Avenues for future research are suggested.

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Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part I-Background and methodology

Tobi Frymark, MA; Tracy Schooling, MA; Robert Mullen, MPH; Karen Wheeler-Hegland, PhD; John Ashford, PhD; Daniel McCabe, DMA; Nan Musson, MA; Carol Smith Hammond, PhD

JRRD, Volume 46 Number 2, 2009, Pages 175 — 184

Abstract —

Evidence-based systematic reviews (EBSRs), in conjunction with clinical expertise and client values, are invaluable tools for speech-language pathologists and audiologists. This article provides an overview of the levels-of-evidence scheme used by the American Speech-Language-Hearing Association (ASHA) to conduct systematic reviews. The goal of ASHA reviews is to provide a tool to help clinicians determine the best treatment course for their clients. We present a collaborative project between ASHA’s National Center for Evidence-based Practice in Communication Disorders and the Department of Veterans Affairs (VA) that examined seven behavioral swallowing treatments for disordered and nondisordered populations. The methodology used in a series of reviews conducted by ASHA and the VA will be discussed, including the development of clinical questions, search parameters, inclusion/exclusion criteria, and literature search results. Findings from the series of reviews as well as the practical applications of EBSRs will be reported in subsequent articles in this series.

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