Assessment, Diagnosis, and Treatment of Dysphagia in Patients Infected With SARS-CoV-2: A Review of the Literature and International Guidelines.

Purpose Speech-language pathologists are playing a crucial role in the assessment and management of patients infected with severe acute respiratory syndrome coronavirus 2. Our goal was to synthesize peer-reviewed literature and association guidelines from around the world regarding dysphagia assessment and management for this specific population. Method A review of publications available in the PubMed database and official guidelines of international groups was performed on May 23, 2020. The information was synthesized and categorized into three content areas for swallowing: clinical evaluation, instrumental assessment, and rehabilitation. Results Five publications were identified in the PubMed database. Following title, abstract, and full-text review, only three publications met inclusion criteria: two reviews and one narrative report. Additionally, 19 international guidelines were reviewed. To assess swallowing, a modified clinical evaluation was recommended and only following a risk assessment. Instrumental assessments were often considered aerosol generating, especially transnasal procedures such as endoscopy and manometry. For this reason, many associations recommended that these examinations be performed only when essential and with appropriate personal protective equipment. Guidelines recommended that intervention should focus on compensatory strategies, including bolus modification, maneuvers/postural changes, and therapeutic exercises that can be conducted with physical distancing. Respiratory training devices were not recommended during rehabilitation. Conclusions International associations have provided extensive guidance regarding the level of risk related to the management of dysphagia in this population. To date, there are no scientific papers offering disease and/or recovery profiling for patients with dysphagia and coronavirus disease 2019. As a result, research in this area is urgently needed.

Qualidade de vida em laringectomizados totais: uma análise sobre diferentes instrumentos de avaliação / Quality of life in total laryngectomy patients: an analysis of different assessment tools

OBJETIVO: verificar a contribuição dos diferentes questionários e de entrevista na avaliação de qualidade de vida em sujeitos laringectomizados totais que se comunicam pela voz esofágica. MÉTODOS: estudo quantitativo e qualitativo baseado na realização de entrevista aberta e aplicação de questionários específicos para câncer de cabeça e pescoço - UW-QOL, FACT (H&N) e EORTC QLQ (H&N35) - em quatro pacientes com idade entre 62-68 anos, submetidos à retirada total da laringe e que estão em acompanhamento fonoaudiológico para aquisição de voz esofágica. RESULTADOS: a entrevista possibilitou a melhor 'escuta' do paciente, no entanto, quando se trata de estudos populacionais sua aplicação se torna inviável, sendo os questionários ainda a melhor opção. O EORTC QLQ (H&N) demonstrou ser o questionário mais específico para questões fonoaudiológicas, enquanto o UW-QOL explora mais as questões físicas e o FACT (H&N) aborda melhor o domínio emocional/psicológico. CONCLUSÃO: os questionários e a entrevista avaliados apresentaram especificidades e contribuem para a avaliação da QV de maneira diferente. Por isso, conhecer os domínios prevalentes nos questionários e a temática abordada na entrevista permite a escolha criteriosa do instrumento de avaliação de qualidade de vida mais adequado a ser aplicado ao sujeito laringectomizado total. .

PURPOSE: to verify the contribution of different questionnaires and a semi-structured interview in the assessment of quality of life in individuals with total laryngectomy. METHODS: quantitative and qualitative research with a semi-structured interview and specific questionnaires for head and neck cancer - UW-QOL, FACT (H&N) and EORTC QLQ (H&N35) - in four patients aged 62-68 years who underwent total removal of the larynx and are in speech therapy for the acquisition of the esophageal speech. RESULTS: the semi-structured interview allowed a better listening. However, population studies hinder its application, and interview questionnaires become the better choice. The EORTC QLQ (H&N) proved to be the most specific questionnaire for speech therapist questions, while the UW-QOL explores further physic questions and the FACT (H&N) covers the emotional/psychological domain. CONCLUSION: the questionnaires and the semi-structured interview presented many specifications and their contribution for the assessment of the quality of life are different. The more appropriate choice depends on the goals of the research and the main factor for the assessment of the quality of life. .

Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment.

OBJECTIVE: To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). METHOD: Twenty patients (13 appendicular-GA and 7 bulbar-GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. RESULTS: Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r=-0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss (%WL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with %WL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat (%), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm2). CONCLUSION: It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.

Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment / Esclerose lateral amiotrófica: correlações dos indicadores da avaliação nutricional, funcional e respiratória

OBJECTIVE: To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). METHOD: Twenty patients (13 appendicular - GA and 7 bulbar - GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. RESULTS: Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r= -0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss ( percentWL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with percentWL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat ( percent), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm²). CONCLUSION: It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.

OBJETIVO: Correlacionar os indicadores utilizados na avaliação nutricional, funcional e respiratória de indivíduos com esclerose lateral amiotrófica (ELA). MÉTODO: Vinte pacientes (13 apendiculares - GA e 7 bulbares - GB) foram incluídos no estudo usando parâmetros nutricionais, respiratórios e escala funcional (ALSFRS-R). RESULTADOS: Entre os pacientes do GA, as correlações observadas foram: pressão inspiratória máxima (PImax) e expiratória máxima (PEmax) (r= -0,76); PEmax e oximetria de pulso (r=0,58); PImax e porcentagem de perda de peso ( por centoPP) (r=0,59); e entre PImax, escore ALSFRS-R com por centoPP. No GB, houve correlação entre MEP e índice de massa corporal (IMC) (r=0,97). Em GA e GB, observaram-se correlação entre IMC e as variáveis: massa, gordura ( por cento), circunferência braquial e punho, pregas cutâneas tricipital, subescapular e supra-ilíaca, circunferência muscular do braço (cm), área muscular gordurosa do braço (mm²). CONCLUSÃO: Sugere-se a aplicação deste conjunto de medidas durante a evolução clínica de indivíduos com ELA.

Avaliação da ingestão alimentar de indivíduos com esclerose lateral amiotrófica / Assessment of dietary intake of individuals with amyotrophic lateral sclerosis / Evaluación de la ingesta dietética de las personas con esclerosis lateral amiotrófica

A esclerose lateral amiotrófica (ELA) caracteriza-se por paralisia progressiva, secundária ao comprometimento de neurônios motores inferiores e superiores. Com a evolução da doença observa-se disfunção motora generalizada e insuficiência respiratória, perda progressiva de peso corporal e alterações na ingestão alimentar. O trabalho teve como objetivo avaliar o consumo alimentar, qualitativo e quantitativo, de pacientes com ELA, acompanhados no setor de Doenças Neuromusculares do HC-UNICAMP. Aplicou-se questionário de freqüência de consumo alimentar e o recordatório de 24 horas, em 23 pacientes. Os alimentos mais consumidos diariamente foram óleo (100%), arroz (96%), leite (96%), feijão (91%) e pão francês (74%). Todos os pacientes apresentaram inadequação para energia, fibras, cálcio e vitamina E. Considerando-se a predominância topográfica do comprometimento muscular na doença, foram observadas diferenças significativas entre pacientes predominantemente bulbares e de predomínio apendicular. Nos pacientes com maior envolvimento apendicular houve maior ingestão energética (p=0,02), de gordura saturada (p=0,03), monoinsaturada (p=0,04) e polinsaturada (p=0,001), além de colesterol (p=0,001) e fibras (p=0,001). Os resultados obtidos permitiram conhecer os hábitos alimentares desta população e estimar a ingestão alimentar. Os dados podem ser aplicados no atendimento nutricional, e orientações específicas poderão proporcionar uma alimentação mais adequada.

Amyotrophic lateral sclerosis (ALS) is characterized by progressive paralysis, secondary to the involvement of upper and lower motor neurons. With disease progression there is widespread motor dysfunction and respiratory failure, progressive loss of body weight and changes in food intake. The study aimed to assess food intake, quality and quantity of ALS patients, accompanied in the field of neuromuscular disorders of the HC-UNICAMP. Questionnaire was used for food frequency and recall of 24 hours in 23 patients. The daily food consumption were oil (100%), rice (96%), milk (96%), beans (91%) and French bread (74%). All patients had inadequate energy, fiber, calcium and vitamin E. Considering the prevalence of topographic affected muscle groups, significant differences were found between predominantly bulbar patients and predominantly appendicular. In patients with greater involvement appendicular energy intake was higher (p = 0.02), saturated fat (p = 0.03), monounsaturated (p = 0.04), polyunsaturated fat (p = 0.001), cholesterol (p = 0.001) and fiber (p = 0.001). The results helped to understand the eating habits of this population and to estimate the dietary intake. The data can be applied in the nutritional intervention, and specific guidelines may provide a more appropriate feeding.

La esclerosis lateral amiotrófica (ELA) se caracteriza por parálisis progresiva, secundaria a la implicación de la parte superior e inferior de las neuronas motoras. Con la progresión de la enfermedad existe disfunción motora generalizada e insuficiencia respiratoria, pérdida progresiva de peso corporal y cambios en la ingesta de alimentos. El objetivo del estudio fue evaluar la ingesta de alimentos, la calidad y la cantidad de pacientes de ELA, acompañado en el campo de los trastornos neuromusculares de la HC-UNICAMP. Se utilizó el cuestionario sobre la frecuencia de alimentos y recordatorio de 24 horas en 23 pacientes. El consumo diario de alimentos fueron aceite (100%), arroz (96%), leche (96%), frijol (91%) y pan francés (74%). Todos los pacientes tenían insuficiencia de energía, fibra, calcio y vitamina E. Teniendo en cuenta la prevalencia de la topográfico grupos musculares afectados, se encontraron diferencias significativas entre los pacientes predominantemente bulbar y predominantemente apendicular. En pacientes con afectación apendicular aumento fue mayor ingesta de energía (p = 0,02), grasa saturada (p = 0,03), monoinsaturados (p = 0,04), grasa poliinsaturada (p = 0,001), colesterol (p = 0,001) y fibra (p = 0,001). Los resultados ayudaron a comprender los hábitos alimentarios de esta población y para estimar la ingesta alimentaria. Los datos pueden ser aplicados en la intervención nutricional, y unas directrices específicas pueden proporcionar una alimentación más adecuada.

Acoustic voice assessment in Parkinson's disease patients submitted to posteroventral pallidotomy.

UNLABELLED: Long-term complications in levodopa treated Parkinson's disease (PD) patients caused a resurgence of interest in pallidotomy as an option of treatment. However, postoperative complications such as speech disorders can occur. PURPOSE: The aim of this study is to evaluate the acoustic voice in PD patients, before and after posteroventral pallidotomy. METHOD: Twelve patients with PD were submitted to neurological and voice assessments during the off and on phases, in the pre-operative, 1st and 3rd post-operative months. The patients were evaluated with the UPDRS and the vocal acoustic parameters -- f0, NHR, jitter, PPQ, Shimmer, APQ (using the software MultiSpeech-Kay Elemetrics-3700). RESULTS: The off phase UPDRS scores revealed a tendency to improvement at the 1st month and the off phase worsened. The shimmer and APQ improved. CONCLUSION: This study shows that pallidotomy has little improvement on functional use of communication of PD patients.

Acoustic voice assessment in Parkinson's disease patients submitted to posteroventral pallidotomy

O uso prolongado da levodopa na doença de Parkinson (DP) pode ocasionar alterações em seu rendimento e possibilitou o interesse no ressurgimento da palidotomia. Contudo, complicações pós-operatórias podem ocorrer. OBJETIVO: O presente estudo tem por objetivo avaliar alguns parâmetros acústicos da voz de pacientes com DP pré e pós a realização da palidotomia posteroventral METODO: foram avaliados 12 pacientes com PD submetidos a avaliação neurológica e da voz durante as fases off e on do uso da levodopa, nos momentos pré-operatório, no primeiro e no terceiro mês pós-operatório. Os pacientes foram avaliados com base na escala UPDRS - item motor - e por meio dos parâmetros acústicos da voz - f0, NHR, jitter, PPQ, Shimmer, APQ (usando o software MDVP - Kay Elemetrics - 3700). RESULTADOS: Na fase off o escore UPDRS revelou tendência de melhora no 1º pós-operatório e na fase on piora. Os parâmetros acústicos shimmer e APQ apresentaram melhora. CONCLUSÃO: Este estudo mostrou que a palidotomia resulta em discreta melhora no uso funcional da comunicação dos pacientes com DP.

Avaliação fonoaudiológica e otorrinolaringológica em idosos pré e pós programa vocal / Vocal and laryngological assessment in elderlies pre and post vocal program

Tema: parâmetros laringológicos e vocais em idosos pré e pós programa vocal. Objetivo: avaliar os parâmetros laringológicos e vocais, pré e pós programa vocal, em um grupo de terceira idade com uso de voz profissional. Material e Método: 10 mulheres e 2 homens, entre 54 e 74 anos, foram submetidos à anamnese, análise perceptivo-auditiva da voz, tempo máximo fonatório (TMF) e avaliação laringológica. Os 8 encontros objetivaram o aprimoramento vocal, através de noções da produção e do conhecimento vocal, eficiência respiratória e laríngea, aumento da extensão e projeção vocal. Resultados: o TMF mostrou indícios de aumento pós programa. A avaliação perceptivo-auditiva e laringológica não mostrou alterações significantes. Conclusão: o trabalho revela indícios de melhora do TMF.