Postextubation Dysphagia in Children: The Role of Speech-Language Pathologists.

OBJECTIVES: Postextubation dysphagia is common and associated with worse outcomes in the PICU. Although there has been an increased participation of speech-language pathologists in its treatment, there is limited evidence to support speech-language pathologists as core PICU team member. We aimed to assess the impact of speech-language pathologists interventions on the treatment of postextubation dysphagia. DESIGN: A quasi-experimental prospective study. In the historical group (controls), patients received a standard care management for dysphagia whereas the intervention group was routinely treated by speech-language pathologists. SETTING: PICU of a tertiary hospital. PATIENTS: Children who were endotracheally intubated for a period greater than 24 hours with greater oral intake limitation as defined by a Functional Oral Intake Scale less than or equal to 3. INTERVENTION: Routine speech-language pathologist assessment. MEASUREMENTS AND MAIN RESULTS: A total of 74 patients were enrolled to receive intervention (January 2015 to December 2016) and 41 patients to the historical group (January 2014 to December 2014). There were no differences in the demographic and clinical characteristics. The historical group had both longer time to initiate oral intake (7 vs 4 d; p = 0.0002; hazard ratio, 2.33) and to reach full oral intake compared with intervention group (9 vs 13 d; p < 0.001; hazard ratio, 2.51). A total of 32 controls (78%) and 74 intervention patients (100%) were on total oral intake at discharge (p ≤ 0.001). Three of nine control patients were feeding tube dependent at hospital discharge. Also, controls had a longer length of hospital stay (25 vs 20 d) and a higher rate of reintubation when compared with those patients of intervention group (10% vs 2%). CONCLUSIONS: Incorporating speech-language pathologists in the routine management of postextubation dysphagia can result in faster functional improvement and favorable patient outcomes. Yet, further and larger studies in pediatric dysphagia are required to support the related interventions and strategies to guide clinical practice.

Analysis of figure recognition on the modified MT Beta-86 test for adaptation: description and discussion of methodological aspects.

PURPOSE: The purpose of this study was to analyze the recognition of figures from the modified MT Beta-86 test for subsequent refinement and adaptation of this language assessment instrument. METHODS: This study was organized into two parts. The first part of the study involved 61 subjects with educational level higher than nine years. Naming of 266 visual stimuli was elicited and concordance among participants on figure naming was also determined. Concordance of responses was assessed using Cochrane's test at a 5% level of significance. Some visual stimuli were subsequently re-designed and images were replaced. The second part of this study involved the re-testing of the new images among 110 individuals ranging in age from 18 to 75 years of both genders, stratified into four educational bands (A: 1-4 years; B: 5-8 years; C: 9-11 years; and D: more than 12 years). Stimuli with concordance level of 70% or higher were considered adequate. RESULTS: In part A of the study, from the index of agreement of naming, the figures considered suitable for inclusion in the adapted version were selected. In part B, all the figures had a response concordance level over 70%. CONCLUSION: Figures in the Modified MT Beta-86 test suitable for retention in the new version of the instrument were identified. Analysis of low sample recognition was used to identify boards for replacement, and those for retention, in the new version of the test.

Análise do reconhecimento das figuras do Teste MT Beta-86 modificado para uma adaptação: descrição e discussão de aspectos metodológicos / Analysis of figure recognition on the modified MT Beta-86 Test for adaptation: description and discussion of methodological aspects

OBJETIVO: Analisar o reconhecimento das figuras do Teste MT Beta-86 modificado, descrever e discutir aspectos metodológicos da adaptação desse instrumento de avaliação da linguagem. MÉTODOS: O estudo foi dividido em duas partes. Na primeira, participaram 61 indivíduos com escolaridade superior a 9 anos. Solicitou-se nomeação de 266 estímulos visuais e verificou-se a concordância da nomeação das figuras entre os participantes. Para a concordância de respostas, utilizou-se o teste de Cochran, com nível de significância de 5%. Em seguida, alguns estímulos visuais foram redesenhados, e as imagens foram substituídas. As imagens passaram pela segunda parte do estudo, da qual participaram 110 indivíduos divididos em 4 faixas de escolaridade (A: 1 a 4 anos; B: 5 a 8 anos; C: 9 a 11 anos e D: acima de 12 anos), de ambos os sexos e idades entre 18 e 75 anos. Foram considerados adequados para serem utilizados na avaliação de linguagem os estímulos com índice de concordância de, no mínimo, 70%. RESULTADOS: Na parte A do estudo, a partir do índice de concordância de nomeação das figuras, foram escolhidas as consideradas apropriadas para fazer parte do teste em sua versão em adaptação. A segunda parte demonstrou que todas as figuras selecionadas apresentaram concordância de resposta acima de 70%. CONCLUSÃO: Identificaram-se quais figuras do Teste MT Beta-86 modificado poderão continuar presentes na próxima versão do instrumento e, por meio da análise do baixo reconhecimento populacional, verificaram-se quais pranchas deverão ser substituídas e quais poderão compor a nova versão do teste.

PURPOSE: The purpose of this study was to analyze the recognition of figures from the modified MT Beta-86 test for subsequent refinement and adaptation of this language assessment instrument. METHODS: This study was organized into two parts. The first part of the study involved 61 subjects with educational level higher than nine years. Naming of 266 visual stimuli was elicited and concordance among participants on figure naming was also determined. Concordance of responses was assessed using Cochrane's test at a 5% level of significance. Some visual stimuli were subsequently re-designed and images were replaced. The second part of this study involved the re-testing of the new images among 110 individuals ranging in age from 18 to 75 years of both genders, stratified into four educational bands (A: 1 - 4 years; B: 5 - 8 years; C: 9 - 11 years; and D: more than 12 years). Stimuli with concordance level of 70% or higher were considered adequate. RESULTS: In part A of the study, from the index of agreement of naming, the figures considered suitable for inclusion in the adapted version were selected. In part B, all the figures had a response concordance level over 70%. CONCLUSION: Figures in the Modified MT Beta-86 test suitable for retention in the new version of the instrument were identified. Analysis of low sample recognition was used to identify boards for replacement, and those for retention, in the new version of the test.