Influence of Thermal and Gustatory Stimulus in the Initiation of the Pharyngeal Swallow and Bolus Location Instroke.

INTRODUCTION/OBJECTIVE: The aim of this study is to analyze the influence of sour taste and cold temperature in the initiation of the pharyngeal swallow (IPS) and bolus location at pharyngeal swallow onset in individuals after stroke. METHODS: Cross-sectional prospective study. The study included 52 individuals with unilateral ischemic stroke. Each individual was assessed by videofluoroscopic swallowing study with 5ml of paste bolus offering four different stimuli (natural, cold, sour, and sour-cold). The individuals were divided into two groups according to the offer sequence. Group 1 (G1) - received a randomized sequence of stimuli (24 individuals), and Group 2 (G2) -the stimuli were offered in the following order: natural, cold, sour, and sour-cold(28 individuals). The IPS time and bolus location at pharyngeal swallow onset were analyzed. The bolus location at pharyngeal swallow onset was defined using six different levels. RESULTS: Individuals in G1 did not show a significant difference in IPS time between stimuli. However, individuals in G2 presented a significantly shorter IPS time with the sour and sour-cold stimuli than with natural or cold stimuli. The bolus location at pharyngeal swallow onset did not show significant difference between stimuli in both groups. On the other hand, in the G2 it was observed higher frequency of swallowing with sour-cold stimulus at level 1 (the bolus head was located in any region between the fauces pillar and the point where the tongue crosses the inferior border of the mandible). CONCLUSION: The sour and sour-cold stimuli influenced the IPS time when they were offered in a sequential order. Moreover, both the IPS time and bolus location at pharyngeal swallow onset were not influenced by the sour and sour cold-bolus when offered in a random sequence.

Interrater reliability in the temporal quantitative analysis of oropharyngeal swallowing using a specific software.

PURPOSE: This study aims to analyze inter-judge reliability by measuring a few temporal parameters of swallowing using a specific software. METHODS: Six databases that include the results of reliability tests performed in prior studies by the present research group were employed. The datasets were obtained using the same measurement method and include data obtained based on puree (level 3) consistency and liquid (level 0) consistency according to the International Dysphagia Diet Standardization Initiative. In this study, the reliabilities corresponding to the total oral transit time (TOTT), initiation of the pharyngeal response time (PRT), and the pharyngeal transit time (PTT) were measured using the same software; the evaluations performed by a single rater for all datasets were used as the benchmark, and evaluations performed by new raters for each dataset were also included. The intra-class correlation coefficient (ICC) with a 95% confidence interval was employed. RESULTS: A total of 244 videofluoroscopic swallowing study images were analyzed. In all analyses, the ICCs were >0,75 and showed excellent agreement between the senior and junior raters. The TOTT for level 3 showed ICCs from 0.936 to 1.000 and that for level 0 showed ICCs from 0.997 to 1.000. Further, the PRT showed ICCs from 0.916 to 1.000 for level 3 and from 0.978 to 1.000 for level 0. The PTT showed ICCs from 0.848 to 1.000 for level 3 and from 0.984 to 1.000 for level 0. CONCLUSION: The reliabilities obtained using this specific software for the TOTT, PRT, and PTT showed excellent agreement.

Relationship between pharyngeal response time and lateralized brain lesion in stroke.

Objectives: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions. Methods: A Cross-sectional study. 73 videofluoroscopic swallow studies (VFSS)were conducted on patients after stroke The study subjects were divided into : group 1 (G1) consisting of 39 individuals with left cortical lesion and group 2 (G2) consisting of 34 individuals with right cortical lesions. The VFSS of G1 and G2 subjects were analyzed using puree (A) and liquid (B) consistencies, and  were also subdivided into young adults and older persons. . The mean PRT was divided into times shorter and longer than 250 ms. Results: No statistically significant difference was observed between G1 and G2 for the A and B consistencies, being obtained : G1 (A mean: 56.6 ms; B mean: 99.5 ms; A mean: 3627 ms; B mean: 1712 ms) and G2 (A mean: 79.6 ms; B mean: 110.7 ms; A mean: 2040 ms, B mean: 1529 ms), for PRT shorter (A:p = .673; B: p = 1.000) and longer (A: p = .435; B: p = .847) than 250 ms, respectively. No statistically significant difference was found regarding the variable age in the comparison between young and old adults for mean PRT according to the A and B consistencies in G1 (A: p = .260; B: p = .732) and G2 (A: p = .586; B: p = .104). Conclusion: No relationship between PRT and lateralization of brain lesion was observed with respect to subject age and to the swallowing of different food consistencies.

Interrater reliability in the temporal quantitative analysis of oropharyngeal swallowing using a specific software / Confiabilidade entre avaliadores na análise quantitativa temporal da deglutição orofaríngea por meio de software específico

ABSTRACT Purpose This study aims to analyze inter-judge reliability by measuring a few temporal parameters of swallowing using a specific software. Methods Six databases that include the results of reliability tests performed in prior studies by the present research group were employed. The datasets were obtained using the same measurement method and include data obtained based on puree (level 3) consistency and liquid (level 0) consistency according to the International Dysphagia Diet Standardization Initiative. In this study, the reliabilities corresponding to the total oral transit time (TOTT), initiation of the pharyngeal response time (PRT), and the pharyngeal transit time (PTT) were measured using the same software; the evaluations performed by a single rater for all datasets were used as the benchmark, and evaluations performed by new raters for each dataset were also included. The intra-class correlation coefficient (ICC) with a 95% confidence interval was employed. Results A total of 244 videofluoroscopic swallowing study images were analyzed. In all analyses, the ICCs were >0,75 and showed excellent agreement between the senior and junior raters. The TOTT for level 3 showed ICCs from 0.936 to 1.000 and that for level 0 showed ICCs from 0.997 to 1.000. Further, the PRT showed ICCs from 0.916 to 1.000 for level 3 and from 0.978 to 1.000 for level 0. The PTT showed ICCs from 0.848 to 1.000 for level 3 and from 0.984 to 1.000 for level 0. Conclusion The reliabilities obtained using this specific software for the TOTT, PRT, and PTT showed excellent agreement.

RESUMO Objetivo analisar a confiabilidade inter-juízes por meio da mensuração de alguns parâmetros temporais da deglutição por meio de um software específico. Método Foram utilizados seis bancos de dados que incluem os resultados dos testes de confiabilidade realizados em estudos anteriores do presente grupo de pesquisa. Os bancos de dados foram obtidos usando o mesmo método de medição e incluem dados obtidos na consistência purê (nível 3) e líquida (nível 0). Neste estudo, as confiabilidades correspondentes ao tempo de trânsito oral total (TTOT), tempo de início de resposta faríngea (IRF) e tempo de trânsito faríngeo (TTF) mensuradas no mesmo software; as avaliações realizadas por um único avaliador para todos os bancos de dados foram usadas como referência, e as avaliações realizadas por novos avaliadores para cada banco de dados também foram incluídas. Foi utilizado o coeficiente de correlação intraclasse (ICC) com intervalo de confiança de 95%. Resultados Foram analisadas 244 imagens de estudos videofluoroscópicos da deglutição. Em todas as análises, os ICCs foram >0,75, mostrando excelente concordância entre avaliadores. O TTOT do nível 3 apresentou ICCs de 0,936 a 1.000 e o do nível 0 apresentou ICCs de 0,997 a 1,000. Além disso, o IRF mostrou ICCs de 0,916 a 1,000 para o nível 3 e de 0,978 a 1,000 para o nível 0. O TTF mostrou ICCs de 0,848 a 1,000 para o nível 3 e de 0,984 a 1,000 para o nível 0. Conclusão As confiabilidades obtidas com este software específico para o TTOT, IRF e TTF mostraram excelente concordância.

Residual signal auto-correlation to evaluate speech in Parkinson's disease patients.

OBJECTIVE: To evaluate the maximum residual signal auto-correlation also known as pitch amplitude (PA) values in patients with Parkinson's disease (PD) patients. METHOD: The signals of 21 Parkinson's patients were compared with 15 healthy individuals, divided according age and gender. RESULTS: Statistical difference was seen between groups for PA, 0.39 for controls and 0.25 for PD. Normal value threshold was set as 0.3; (p<0.001). In the Parkinson's group 80.77%, and in the control group only 12.28%, had a PA<0.3 demonstrating an association between these variables. The dispersion diagram for age and PA for PD individuals showed p=0.01 and r=0.54. There was no significant difference in relation to gender and PA between groups. CONCLUSION: The significant differences in pitchs amplitude between PD patients and healthy individuals demonstrate the methods specificity. The results showed the need of prospective controlled studies to improve the use and indications of residual signal auto-correlation to evaluate speech in PD patients.

[Incidence of oropharyngeal dysphagia associated with stroke in a regional hospital in São Paulo State - Brazil]. / Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência.

Cerebrovascular disease is recognized as to be associated with the highest mortality rate in Brazil. Dysphagia, speech and language disturbances are common consequences of the high incidence of stroke. Dysphagia is known to occur in at least 50% of the patients with acute stroke. The study is designed to establish the incidence of stroke in a reference hospital. One hundred and two consecutive patients admitted between January 2001 and January 2002 underwent a neurological examination with dysphagia specific analysis, performed by speech/dysphagia professionals as soon as they have clinical conditions. The localization of the lesions are determined by computer tomography or magnetic resonance image of the brain. Sixty one patients underwent videofluorscopic evaluation of swallowing. There was detected oropharyngeal dysphagia in 78 patients (76.5%) if the examination was limited to the clinical evaluation. Nevertheless, if complemented by videofluorscopic evaluation, the incidence grows to 90%. The explanation for the high incidence observed in this study could be pointed to the fact that dysphagia was registered on different times of the convalescence period. The data reinforces the importance of repeated evaluations made by different professionals of the staff involved in acute stroke attendance.

Sour taste and cold temperature in the oral phase of swallowing in patients after stroke.

PURPOSE: To determine the effect of sour flavor and cold temperature on oral transit time during swallowing. METHODS: Participants were 52 subjects (28 male and 24 female) with ages between 50 and 80 years (median=66 years), after ischemic stroke involving right or left side damage and mild to moderate oropharyngeal dysphagia. Videofluoroscopy was performed to analyze the swallowing times. Each subject was assessed during swallowing of a paste consistency bolus offered in 5 ml spoons, with a total of four different stimuli (natural, cold, sour and sour-cold). After the exam, the oral transit time was measured using specific software. The oral transit time (starting at the beginning of the bolus movement in the mouth) and the total oral transit time (starting at the moment that the bolus is placed in the mouth) were measured. RESULTS: The association between sour and cold stimuli caused a significant decrease of oral transit time and total oral transit time. CONCLUSION: Sour flavor and cold temperature reduced oral transit time in stroke patients.

Components of the acoustic swallowing signal: preliminary study.

PURPOSE: To analyze the components of the acoustic signal of swallowing using a specific software. METHODS: Fourteen healthy subjects ranging in age from 20 to 50 years (mean age 31 ± 10 years), were evaluated. Data collection consisted on the simultaneous capture of the swallowing audio with a microphone and of the swallowing videofluoroscopic image. The bursts of the swallowing acoustic signal were identified and their duration and the interval between them were later analyzed using a specific software, which allowed the simultaneous analyses between the acoustic wave and the videofluoroscopic image. RESULTS: Three burst components were identified in most of the swallows evaluated. The first burst presented mean time of 87.3 milliseconds (ms) for water and 78.2 for the substance. The second burst presented mean time of 112.9 ms for water and 85.5 for the pasty substance. The mean interval between first and second burst was 82.1 ms for water and 95.3 ms for the pasty consistency, and between second and third burst was 339.8 ms for water and 322.0 ms for the pasty consistency. CONCLUSION: The software allowed the visualization of three bursts during the swallowing of healthy individuals, and showed that the swallowing signal in normal subjects is highly variable.

Tempo de trânsito oral e lateralidade da lesão cerebral no acidente vascular encefálico / Oral transit time and brain lesion laterality in stroke

RESUMO Introdução O tempo de trânsito orofaríngeo se modifica de acordo com inúmeras variáveis. Objetivo Comparar o tempo de trânsito oral total (TTOT) e a lateralidade da lesão cerebral no indivíduo após acidente vascular encefálico (AVE), com disfagia orofaríngea. Métodos Foram analisados 61 exames de videofluoroscopia da deglutição de indivíduos pós-AVE hemisférico unilateral e isquêmico. Os participantes foram divididos em dois grupos: O Grupo 1 (G1) foi composto de 30 indivíduos com lesão cortical direita e o Grupo 2 (G2), de 31 indivíduos com lesão cortical esquerda. A análise quantitativa do TTOT foi feita por dois juízes treinados no procedimento, por meio de software específico e foi realizada a análise da confiabilidade entre julgadores. Para a análise dos resultados, utilizou-se o teste Mann-Whitney. Resultados Verificou-se que, no G1, o TTOT foi maior que 2000 ms em 50% dos indivíduos e, no G2, em 94% dos indivíduos, ocorrendo diferença estatística significativa entre os grupos (p<0,01). Na comparação entre G1 e G2, para o TTOT, observou-se diferença estatística significativa (p=0,001). Entretanto, não houve diferença estatística significativa na comparação do G1 e G2, tanto para o TTOT menor que 2000 ms (p=1,000), como para o TTOT maior que 2000 ms (p=0,603). Contudo, verificou-se que, no G2, a média do TTOT maior que 2000 ms foi superior, quando comparada ao G1. Conclusão Houve tempo de trânsito oral total maior e menor que 2000 ms, em ambos os hemisférios corticais lesionados. A frequência de indivíduos com tempo de trânsito oral total maior que 2000 ms, bem como a média desse tempo, foram maiores na lesão cortical à esquerda no AVE.

ABSTRACT Introduction The oropharyngeal transit time changes according to several variables. Purpose To compare the total oral transit time (TOTT) and laterality of brain lesion in the individual after stroke with oropharyngeal dysphagia. Methods Analyzed 61 videofluoroscopic swallowing studies of individuals after unilateral cortical ischemic stroke. Participants were divided into two groups. Group 1 (G1) consisted of 30 individuals with right-side cortical lesion and group 2 (G2) of 31 individuals with left-side cortical lesion. Quantitative analysis of the TOTT was performed by two judges trained in the procedure by means of specific software and an analysis of the reliability between judges was performed. The Mann-Whitney test was used for the data analysis. Results It was found TTOT longer than 2000 ms in 50% of the G1 and in 94% of the individuals of G2 with a significant statistical difference between the groups (p<0.01). In the comparison between G1 and G2 regarding TOTT, it was verified that there was significant statistical difference (p=0.001). However, there was no significant statistical difference in the comparison between G1 and G2 for both TOTT shorter than 2000 ms (p=1.000) and TOTT longer than 2000 ms (p=0.603). However, it was found that in G2 the TOTT average is longer than 2000 ms and was greater than in G1. Conclusion There were TOTT shorter and longer than 2000 ms in both hemispheric cortical lesion. The frequency of individuals with TTOT are longer than 2000 ms and the average are greater in the left-side cortical lesion in stroke.

The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke.

CONTEXT: The effect of sour taste and food temperature variations in dysphagic patients has not been entirely clarified. OBJECTIVE: To determine the effect of sour and cold food in the pharyngeal transit times of patients with stroke. METHODS: Patients participating in this study were 30 right-handed adults, 16 of which were male and 14 were female, aged 41 to 88 (average age 62.3 years) with ictus varying from 1 to 30 days (median of 6 days). To analyze the pharyngeal transit time a videofluoroscopy swallow test was performed. Each patient was observed during swallow of a 5 mL paste bolus given by spoon, totaling four different stimuli (natural, cold, sour and cold sour), one at a time, room temperature (22 degrees C) and cold (8 degrees C) were used. Later, the tests were analyzed using specific software to measure bolus transit time during the pharyngeal phase. RESULTS: The results showed that the pharyngeal transit time was significantly shorter during swallow of cold sour bolus when compared with other stimuli. CONCLUSION: Sour taste stimuli associated to cold temperature cause significant change in swallowing patterns, by shortening the pharyngeal transit time, which may lead to positive effects in patients with oropharyngeal dysphagia.

Sour taste and cold temperature in the oral phase of swallowing in patients after stroke / Sabor azedo e temperatura fria na fase oral da deglutição no acidente vascular encefálico

PURPOSE: To determine the effect of sour flavor and cold temperature on oral transit time during swallowing. METHODS: Participants were 52 subjects (28 male and 24 female) with ages between 50 and 80 years (median=66 years), after ischemic stroke involving right or left side damage and mild to moderate oropharyngeal dysphagia. Videofluoroscopy was performed to analyze the swallowing times. Each subject was assessed during swallowing of a paste consistency bolus offered in 5 ml spoons, with a total of four different stimuli (natural, cold, sour and sour-cold). After the exam, the oral transit time was measured using specific software. The oral transit time (starting at the beginning of the bolus movement in the mouth) and the total oral transit time (starting at the moment that the bolus is placed in the mouth) were measured. RESULTS: The association between sour and cold stimuli caused a significant decrease of oral transit time and total oral transit time. CONCLUSION: Sour flavor and cold temperature reduced oral transit time in stroke patients.

OBJETIVO: Verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito oral da deglutição. MÉTODOS: Participaram deste estudo 52 indivíduos (28 do gênero masculino e 24 do gênero feminino) após acidente vascular encefálico isquêmico, com lesão à direita ou à esquerda e disfagia orofaríngea de grau leve a moderado, com idades variando de 50 a 80 anos (mediana=66 anos). Foi realizada a videofluoroscopia da deglutição para a análise dos tempos de deglutição. Cada indivíduo foi avaliado durante a deglutição de bolo na consistência pastosa, oferecido em colher com 5 ml, com quatro estímulos diferentes (natural, frio, azedo e azedo-frio). Após o exame foram realizadas as medidas de tempo de trânsito oral utilizando software específico. Foram mensurados o tempo de trânsito oral (a partir do início do movimento do bolo alimentar na boca) e o tempo de trânsito oral total (a partir do momento em que o bolo é colocado na boca). RESULTADOS: A associação entre o estímulo azedo e a temperatura fria provocou mudanças significavas no tempo de trânsito oral total e no tempo de trânsito oral, com redução nestes tempos. CONCLUSÃO: O sabor azedo e a temperatura fria associados apresentaram redução do tempo de trânsito oral em pacientes pós acidente vascular encefálico.

Componentes do sinal acústico da deglutição: estudo preliminar / Components of the acoustic swallowing signal: preliminary study

OBJETIVO: Analisar os componentes do sinal acústico da deglutição com o auxílio de software específico. MÉTODOS: Foram avaliados 14 indivíduos saudáveis com idades variando entre 20 e 50 anos (média de 31±10 anos). A coleta de dados consistiu da captura simultânea do áudio da deglutição, por meio de um microfone, associado ao registro da imagem videofluoroscópica da deglutição. A identificação dos componentes de som e a quantificação dos tempos foram analisados posteriormente com o auxílio de software específico que possibilitou a análise simultânea entre a onda acústica e a imagem videofluoroscópica. RESULTADOS: Foram identificados três componentes de som (burst) na maioria das deglutições avaliadas. O primeiro burst apresentou tempo médio de 87,3 milissegundos (ms) para água e 78,2 para substância pastosa. O segundo burst retornou um tempo médio de 112,9 ms para água e 85,5 para consistência pastosa. O intervalo médio entre o primeiro e segundo burst foi 82,1 ms (água) e 95,3 ms (consistência pastosa), e entre o segundo e terceiro foi 339,8 ms e 322,0 ms, respectivamente para água e consistência pastosa. CONCLUSÃO: O software permitiu a visualização de três componentes do som durante a deglutição de indivíduos saudáveis e mostrou que o sinal da deglutição em indivíduos normais é altamente variável.

PURPOSE: To analyze the components of the acoustic signal of swallowing using a specific software. METHODS: Fourteen healthy subjects ranging in age from 20 to 50 years (mean age 31±10 years), were evaluated. Data collection consisted on the simultaneous capture of the swallowing audio with a microphone and of the swallowing videofluoroscopic image. The bursts of the swallowing acoustic signal were identified and their duration and the interval between them were later analyzed using a specific software, which allowed the simultaneous analyses between the acoustic wave and the videofluoroscopic image. RESULTS: Three burst components were identified in most of the swallows evaluated. The first burst presented mean time of 87.3 milliseconds (ms) for water and 78.2 for the substance. The second burst presented mean time of 112.9 ms for water and 85.5 for the pasty substance. The mean interval between first and second burst was 82.1 ms for water and 95.3 ms for the pasty consistency, and between second and third burst was 339.8 ms for water and 322.0 ms for the pasty consistency. CONCLUSION: The software allowed the visualization of three bursts during the swallowing of healthy individuals, and showed that the swallowing signal in normal subjects is highly variable.

Estudo multicêntrico sobre escalas para grau de comprometimento em disfagia orofaríngea neurogênica / Multicenter study about severity scales of neurogenic oropharyngeal dysphagia

OBJETIVO: Analisar a concordância entre distintas escalas para grau de comprometimento em disfagia orofaríngea neurogênica. MÉTODOS: Foi realizado estudo clínico transversal. Participaram 200 indivíduos com disfagia orofaríngea neurogênica, 108 do gênero masculino e 92 do gênero feminino, com idades de 3 meses a 91 anos. Foram aplicadas quatro escalas para classificar o grau de comprometimento da disfagia orofaríngea, sendo duas escalas clínicas e duas videofluoroscópicas. Análises estatísticas foram realizadas para verificar a concordância entre as escalas clínicas e objetivas. RESULTADOS: Os resultados mostraram concordância muito boa entre as escalas clínicas estudadas (Kappa=0,92) e concordância moderada entre as escalas objetivas (Kappa=0,52). CONCLUSÃO: Embora a concordância entre as escalas clínicas tenha sido muito boa e entre as escalas objetivas tenha sido moderada, ainda é necessária ampla discussão e possível revisão dos parâmetros que definem o grau de comprometimento da disfagia orofaríngea em pacientes neurológicos.

PURPOSE: To analyze the agreement among different severity scales for neurogenic oropharyngeal dysphagia. METHODS: A clinical cross-sectional study was conducted. Participants were 200 individuals (108 male, 92 female) with neurogenic oropharyngeal dysphagia, aged between three months and 91 years. Four severity scales were applied to classify the oropharyngeal dysphagia: two clinical scales and two videofluoroscopic scales. Statistical analysis were conducted to verify the agreement between clinical and objective scales. RESULTS: Results showed very good agreement between the clinical scales (kappa=0.92) and moderate agreement between the objective scales (kappa=0.52). CONCLUSION: Although the agreement between the clinical scales was very good and between the objective scales was moderate, further discussion and possible revision of the parameters that define the severity of oropharyngeal dysphagia in neurological patients are required.

Adaptação para a língua Portuguesa e aplicação de protocolo de avaliação das disartrias de origem central em pacientes com Doença de Parkinson / Adjustment to the Portuguese and application to patients with Parkinson's disease of protocol within central origin dysarthrias' assessment

OBJETIVO: traduzir e adaptar protocolo desenvolvido por pesquisadores alemães, adequando-o às características fonéticas e linguísticas do português falado no Brasil. Caracterizar os componentes de fala mais alterados na população com doença de Parkinson, comparando-os com grupo de sujeitos normais na mesma faixa etária. MÉTODOS: realizou-se a tradução e adaptação do protocolo. Posteriormente foram avaliados 21 pacientes com diagnóstico neurológico de Doença de Parkinson nos estágios Hoehn &Yarh, entre 2 e 3, e 10 sujeitos normais. O protocolo incluía avaliação da respiração, fonação, ressonância, articulação, prosódia e a análise acústica dos parâmetros vocais. RESULTADOS: o protocolo mostrou-se de fácil aplicação clínica. Nos sujeitos com doença de Parkinson foram observadas alterações predominantes na fonação (85,9 por cento) e articulação (42,9 por cento). CONCLUSÃO: o estudo demonstrou ser o protocolo uma ferramenta eficiente para a avaliação da disartria em pacientes com doença de Parkinson.

PURPOSE: to translate and adapt the protocol developed by German researchers, adjusting it to the phonetic and linguistic characteristics of Brazilian Portuguese. Observe the amended speech components in a group of patients with Parkinson's disease, and comparing them with normal subjects in the same age. METHOD: twenty one patients with neurological diagnosis of Parkinson's disease in the Hoehn & Yarh stages (2-3), and 10 control subjects were assessed. The protocol was translated, adjusted and applied to the subjects of both control and Parkinson's disease group, assessing the breathing, phonation, resonance, articulation, prosody and acoustic analysis. RESULTS: in the dysarthria evaluation, the protocol showed to be simple and it presented a fast clinical application. In the subjects with Parkinson's disease, we observed alterations in both phonation (85.9 percent) and articulation (42.9 percent). CONCLUSION: the study demonstrated that the protocol is an efficient tool for dysarthria assessment in patients with Parkinson's disease.

Protocolo para controle de eficácia terapêutica em disfagia orofaríngea neurogênica (PROCEDON) / Efficacy control protocol in oropharyngeal dysphagia

OBJETIVO: apresentar uma proposta para o controle de eficácia terapêutica em disfagia orofaríngea neurogênica. MÉTODOS: o protocolo foi proposto em concordância com a literatura atual e aplicado em um indivíduo pós-acidente vascular encefálico (AVE) isquêmico à direita, comprovado por tomografia computadorizada, com disfagia orofaríngea grave crônica, gênero masculino, 66 anos, apresentando aspiração laringotraqueal e em uso de sonda nasoentérica exclusiva pré-fonoterapia. Para controle da eficácia terapêutica do programa de reabilitação fonoaudiológica foi aplicado, pré e pós-fonoterapia, a classificação do grau de comprometimento da disfagia orofaríngea, Functional Oral Intake Scale (FOIS), a avaliação videofluoroscópica da deglutição com medida do tempo de trânsito faríngeo (TTF) da deglutição por meio de software e da percepção do indivíduo. RESULTADOS: na pré-fonoterapia verificou-se disfagia orofaríngea grave, FOIS nível 1, presença de aspiração laringotraqueal para mais de uma consistência e tempo de trânsito faríngeo de 13 segundos. Após fonoterapia verificou-se disfagia orofaríngea moderada, FOIS nível 5, ausência de aspiração laringotraqueal e TTF de 4 segundos. CONCLUSÃO: o protocolo proposto foi capaz de avaliar a eficácia da reabilitação na disfagia orofaríngea neurogênica neste indivíduo pós-acidente vascular encefálico, tanto para mensurar as mudanças ocorridas na fisiopatologia da deglutição quanto na ingestão oral e na percepção do indivíduo. Outros estudos com populações distintas são necessários, sendo que novas propostas devem ainda refletir a inclusão da condição nutricional e pulmonar do indivíduo no controle de eficácia em disfagia orofaríngea.

PURPOSE: to submit a proposal for efficacy control in neurogenic oropharyngeal dysphagia. METHODS: the protocol was proposed in accordance with other researches and applied in one post-stroke individual, with right-hemispheric lesion confirmed by computed tomography, with oropharyngeal dysphagia, male gender, 66-year old, with laringotraqueal aspiration and using nasogastric feeding tube before swallowing therapy. In order to control the therapy effectiveness in pre- and post-swallowing therapy, the following procedures were applied: classification of severity degree for oropharyngeal dysphagia, functional oral intake scale (FOIS), videofluoroscopic evaluation of swallowing with additional swallowing pharyngeal transit time evaluation using a specific software and individual perception. RESULTS: before swallowing therapy, severe oropharyngeal dysphagia, FOIS level 1, presence of laryngotracheal aspiration, and 13 seconds of pharyngeal transit time were found. After swallowing therapy, moderate oropharyngeal dysphagia, FOIS level 5, absence of laryngotracheal aspiration, and 4 seconds of pharyngeal transit time were found. CONCLUSION: the proposed protocol could measure changes, both for pathophysiology of swallowing as well as for oral ingestion of the individual. We believe that it is still necessary to include nutritional and lung status of the individual in efficacy control of oropharyngeal dysphagia.

The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke

CONTEXT: The effect of sour taste and food temperature variations in dysphagic patients has not been entirely clarified. OBJECTIVE: To determine the effect of sour and cold food in the pharyngeal transit times of patients with stroke. METHODS: Patients participating in this study were 30 right-handed adults, 16 of which were male and 14 were female, aged 41 to 88 (average age 62.3 years) with ictus varying from 1 to 30 days (median of 6 days). To analyze the pharyngeal transit time a videofluoroscopy swallow test was performed. Each patient was observed during swallow of a 5 mL paste bolus given by spoon, totaling four different stimuli (natural, cold, sour and cold sour), one at a time, room temperature (22ºC) and cold (8ºC) were used. Later, the tests were analyzed using specific software to measure bolus transit time during the pharyngeal phase. RESULTS: The results showed that the pharyngeal transit time was significantly shorter during swallow of cold sour bolus when compared with other stimuli. Conclusion - Sour taste stimuli associated to cold temperature cause significant change in swallowing patterns, by shortening the pharyngeal transit time, which may lead to positive effects in patients with oropharyngeal dysphagia.

CONTEXTO: O efeito do sabor azedo e as variações da temperatura dos alimentos em indivíduos disfágicos, ainda não foi totalmente esclarecidos. OBJETIVO: Verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito faríngeo da deglutição em indivíduos após acidente vascular encefálico hemisférico isquêmico. MÉTODOS: Participaram deste estudo 30 indivíduos adultos, sendo 16 do gênero masculino e 14 do feminino, destros, com faixa etária variando de 41 a 88 anos (média de 62,3 anos) e ictus que variou de 1 a 30 dias (mediana de 6 dias). Para analisar o tempo de trânsito faríngeo da deglutição foi realizado o exame de videofluoroscopia da deglutição. Cada indivíduo foi observado durante a deglutição de bolo na consistência pastosa, oferecido em colher, com 5 mL cada, sendo ao todo quatro estímulos diferentes, um por vez. Posteriormente os exames foram analisados com auxílio de um software específico para medição do tempo de deslocamento do bolo pela fase faríngea. RESULTADOS: Os resultados mostraram que o tempo de trânsito faríngeo da deglutição foi significantemente menor durante a deglutição de bolo azedo gelado quando comparado aos outros estímulos. CONCLUSÃO: Constatou-se que estímulos com sabor azedo associado à temperatura fria provocam significativa mudança na dinâmica da deglutição, diminuindo o tempo de trânsito faríngeo, podendo assim proporcionar efeitos positivos em indivíduos com disfagia orofaríngea.

Reabilitação em disfagia orofaríngea neurogênica: sabor azedo e temperatura fria / Rehabilitation in neurogenic oropharyngeal dysphagia: sour taste and cold temperature

TEMA: reabilitação em disfagia orofaríngea neurogênica OBJETIVO: apresentar revisão de literatura sobre os controles neurofisiológicos da deglutição orofaríngea e a influência do sabor azedo e da temperatura fria no mecanismo da deglutição. CONCLUSÃO: quanto à questão do controle central da deglutição, ainda existem controvérsias em relação ao sabor azedo e a temperatura fria. Esses dois parâmetros provocam mudanças na dinâmica da deglutição, podendo trazer benefícios aos indivíduos acometidos por disfagia orofaríngea neurogênica. Porém, tais achados sugerem a necessidade de investigações futuras com populações randomizadas.

BACKGROUND: rehabilitation in neurogenic oropharyngeal dysphagia PURPOSE: to submit an overview of the related literature about neurophisiological control of oropharingeal dysphagia and the role of temperature and sour taste on swallowing mechanisms. CONCLUSIONS: as for the neurophysiologic swallowing control, there are still controversies when it comes to sour taste and cold temperature. These two standards can change the swallowing dynamics, and they may bring out benefits to the individuals with neurogenic oropharyngeal dysphagia. Therefore, the findings suggest the need for further investigations with randomized studies.

Swallowing quantitative analysis software / Software para análise quantitativa da deglutição

OBJETIVO: Apresentar um software que permita uma análise detalhada da dinâmica da deglutição. MATERIAIS E MÉTODOS: Participaram deste estudo dez indivíduos após acidente vascular encefálico, sendo seis do gênero masculino, com idade média de 57,6 anos. Foi realizada videofluoroscopia da deglutição e as imagens foram digitalizadas em microcomputador, com posterior análise do tempo do trânsito faríngeo da deglutição, por meio de um cronômetro e do software. RESULTADOS: O tempo médio do trânsito faríngeo da deglutição apresentou-se diferente quando comparados os métodos utilizados (cronômetro e software). CONCLUSÃO: Este software é um instrumento de análise dos parâmetros tempo e velocidade da deglutição, propiciando melhor compreensão da dinâmica da deglutição, com reflexos tanto na abordagem clínica dos pacientes com disfagia como para fins de pesquisa científica.

OBJECTIVE: The present paper is aimed at introducing a software to allow a detailed analysis of the swallowing dynamics. MATERIALS AND METHODS: The sample included ten (six male and four female) stroke patients, with mean age of 57.6 years. Swallowing videofluoroscopy was performed and images were digitized for posterior analysis of the pharyngeal transit time with the aid of a chronometer and the software. RESULTS: Differences were observed in the average pharyngeal swallowing transit time as a result of measurements with chronometer and software. CONCLUSION: This software is a useful tool for the analysis of parameters such as swallowing time and speed, allowing a better understanding of the swallowing dynamics, both in the clinical approach of patients with oropharyngeal dysphagia and for scientific research purposes.

Residual signal auto-correlation to evaluate speech in Parkinsons disease patients / Auto-correlação do sinal residual para avaliação da fala em pacientes com doença de Parkinson

OBJECTIVE: To evaluate the maximum residual signal auto-correlation also known as pitch amplitude (PA) values in patients with ParkinsonÆs disease (PD) patients. METHOD: The signals of 21 ParkinsonÆs patients were compared with 15 healthy individuals, divided according age and gender. RESULTS: Statistical difference was seen between groups for PA, 0.39 for controls and 0.25 for PD. Normal value threshold was set as 0.3; (p<0.001). In the ParkinsonÆs group 80.77 percent, and in the control group only 12.28 percent, had a PA<0.3 demonstrating an association between these variables. The dispersion diagram for age and PA for PD individuals showed p=0.01 and r=0.54. There was no significant difference in relation to gender and PA between groups. CONCLUSION: The significant differences in pitchÆs amplitude between PD patients and healthy individuals demonstrate the methods specificity. The results showed the need of prospective controlled studies to improve the use and indications of residual signal auto-correlation to evaluate speech in PD patients.

OBJETIVO: Avaliar autocorrelação do sinal residual também denominado como amplitude do pitch (PA) em pacientes com doença de Parkinson (PD). MÉTODO: Os valores de PA, estratificados de acordo com idade e sexo, em 21 pacientes com doença de Parkinson foram analisados e comparados aos dados obtidos em 15 indivíduos sadios. RESULTADOS: Foi determinada diferença estatística para a PA entre os dois grupos (p<0,001; 0,39 para os controles e 0,25 para PD), considerando os valores normais como >0,3. Nos pacientes com PD 80,77 por cento dos pacientes tinham a PA <0,3, enquanto que entre os controles somente 12,28 por cento apresentavam valores abaixo de 0,3. O diagrama de dispersão para idade e sexo para os doentes com PD mostraram um p=0,001 e r=0,54. Não houve diferença em relação a sexo e idade entre os grupos. CONCLUSÃO: A significativa diferença da PA entre pacientes com PD e controles demonstra a especificidade da análise. Os resultados apontam para a necessidade de estudos controlados, prospectivos, para implementar o uso e indicações da determinação da amplitude do pitch na avaliação da fala em pacientes com doença de Parkinson.

Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência / Incidence of oropharyngeal dysphagia associated with stroke in a regional hospital in São Paulo State - Brazil

A doença vascular encefálica (AVE) é a principal causa de morte no Brasil. As seqüelas em indivíduos pós-acidente vascular encefálico incluem distúrbios motores, distúrbios de fala ou de linguagem e distúrbios de deglutição. A disfagia orofaríngea ocorre em cerca de 50 por cento dos pacientes com AVE. Este estudo teve por objetivo determinar a incidência da disfagia após AVE. Foram avaliados todos os pacientes que deram entrada em hospital universitário de referência no período de um ano, tão logo apresentassem condições para avaliação clínica, fonoaudiológica e neurológica (102 pacientes), com análise objetiva da deglutição (61 pacientes). Foi observada incidência de disfagia em 76,5 por cento dos pacientes avaliados clinicamente, este percentual elevando-se a 91 por cento com avaliação videofluoroscópica. A alta incidência de disfagia observada neste estudo que avaliou pacientes com amplo espectro de gravidade, em diferentes fases de recuperação, ressalta a importância de equipe multidisciplinar, incluindo fonoaudiólogos capacitados, para avaliar os distúrbios da deglutição nos diversos momentos de recuperação dos AVEs.