Translation and Validation of the TOR-BSST© into Brazilian Portuguese for Adults with Stroke.

Brazil has a higher rate of dysphagia in stroke patients compared to developed countries, but does not have a fully validated method for early identification of dysphagia in this population. The aim of this study is to translate the TOR-BSST© into Brazilian Portuguese and assess the newly translated version for reliability and validity with Brazilian adult patients with stroke. The translation of the TOR-BSST© followed a multi-step process, according to the International Quality of Life Assessment project. For validation, we included patients with age ≥ 18 years and stroke diagnosis confirmed by neuroimaging and tolerance for videofluoroscopic swallowing assessment. The BR-PTfinal TOR-BSST© was administered by two trained screeners within two hours of videofluoroscopy. All assessors were independent and blinded. Estimates for reliability used the intraclass correlation coefficient (ICC) and for accuracy both sensitivity (SN) and negative predictive (NP) values were used, along with 95% confidence intervals (CI). Sixty patients were enrolled and tested for a mean (SD) of 14.4 (6.9) days from last seen normal. Of all the patients, 41 (68.3%) failed the BR-PTfinal TOR-BSST© and 21 (35%) were scored to have dysphagia on videofluoroscopy, of which 11 (52.4%) had mild dysphagia. The overall reliability between screeners was satisfactory (ICC = 0.59; 95% CI 0.32 to 0.76). The SN and NP values for the BR-PTfinal TOR-BSST© were 85.7% (95% CI 0.62-0.96) and 84.2% (95% CI 0.72-0.95), respectively. The TOR-BSST© was successfully translated to Brazilian Portuguese with the BR-PTfinal TOR-BSST© proven to have high sensitivity and negative predictive values when compared to gold standard videofluoroscopy.

Dysphagia and Associated Pneumonia in Stroke Patients from Brazil: A Systematic Review.

Dysphagia and its associated complications are expected to be relatively more frequent in stroke patients in Brazil than in similar patients treated in developed countries due to the suboptimal stroke care in many Brazilians medical services. However, there is no estimate of dysphagia and pneumonia incidence for the overall stroke population in Brazil. We conducted a systematic review of the recent literature to address this knowledge gap, first screening citations for relevance and then rating full articles of accepted citations. At both levels, judgements were made by two independent raters according to a priori criteria. Fourteen accepted articles underwent critical appraisal and data extraction. The frequency of dysphagia in stroke patients was high (59% to 76%). Few studies assessed pneumonia and only one study stratified patients by both dysphagia and pneumonia, with an increased Relative Risk for pneumonia in patients with stroke and dysphagia of 8.4 (95% CI 2.1, 34.4). Across all articles, we identified bias related to: heterogeneity in number and type of stroke; no rater blinding; and, assessments that were not reproducible, reliable or validated. Despite the high frequency of dysphagia and associated pneumonia in stroke patients in Brazil, the quality of the available literature is low and that there is little research focused on these epidemiologic data. Future rigorously designed studies are in dire need to accurately determine dysphagia incidence and its impact on stroke patients in Brazil. These data will be critical to properly allocate limited national resources that maximize the quality of stroke care.

Reduced incidence of aspiration with spoon-thick consistency in stroke patients.

BACKGROUND: Dysphagia and aspiration occur frequently in stroke patients. The aim of the present study was to evaluate 2 consistencies (liquid and spoon-thick/pudding-like) regarding the risk of aspiration and to determine the usefulness of a bedside speech therapy assessment to predict risk of aspiration. METHODS: This randomized, crossover clinical trial was carried out April to August 2001 at a university hospital. Sixty-one inpatients diagnosed with acute phase or prior stroke received liquid and spoon-thick (pudding-like) feeds during nasoendoscopy and bedside clinical assessment. RESULTS: Aspiration occurred in only 3 patients with the spoon-thick consistency vs 21 with the liquid consistency (relative risk=0.13; 95% confidence interval=0.04-0.39; P<.001). The bedside assessment had a sensitivity of 81% and a specificity of 70.8% to detect risk of aspiration. CONCLUSIONS: The use of a spoon-thick consistency reduced the risk of aspiration compared with the liquid consistency. Clinical assessment was useful to predict aspiration, although the probability of dysphagia in the presence of a negative clinical assessment (29%) is a reason for concern.

The association between temporal measures of swallowing with penetration and aspiration in patients with dysphagia: A meta-analysis.

INTRODUCTION: Temporal features of swallowing physiology vary with age in healthy normals and have the potential to impact swallow safety and efficiency in patients with dysphagia. We conducted a meta-analysis to assess the relation between temporal features of swallowing with penetration, aspiration and residue in adult patients with dysphagia regardless of etiology. METHODS: Operational definitions of relevant terms were defined a priori. A search of 5 databases was conducted to November 2016 without restriction to language. Two independent raters reviewed abstracts and full articles, with discrepancies resolved by consensus. All accepted articles advanced to data extraction and critical appraisal according to Cochrane standards. Analysis of pooled data compared measures between groups. RESULTS: Of the 11 articles accepted, the temporal measures used in three or more studies were grouped into morphofunctional categories: bolus transit time; pharyngeal response time; laryngeal closure time; and upper esophageal opening time. Across all selected articles, definitions varied for abnormal swallow and only 4 articles reported rater blinding and reliability for measures related to timing. Pooled data identified two main findings: a. longer pharyngeal response time was associated with penetration and/or aspiration (MD = 0.40 95% CI 0.59 - 0.22), and longer upper esophageal opening duration was associated with only aspiration (PAS ≥ 6) (MD = 0.09 95% CI 0.16 - 0,02). No studies were found that related temporal measures and residue. CONCLUSION: Our pooled findings identified an association of two temporal measures with penetration and/or aspiration but none with residue. The current evidence remains limited due to the heterogeneity across studies in how swallow measures were operationalized. Future work with a standardized and reproducible approach is direly needed.

O perfil fonoaudiológico do paciente portador de queimaduras de cabeça e pescoço internado no Hospital de Pronto Socorro de Porto Alegre/RS / The speech-language pathology profile of patients with burning of head and neck hospitalized at Emergency Hospital of Porto Alegre/RS

Objetivo: Traçar o perfil fonoaudiológico dos pacientes com queimaduras de cabeça e pescoço internados no Hospital de Pronto Socorro de Porto Alegre. Método: Foram avaliados pacientes com queimaduras entre 2º e 3º grau, acima de 18 anos, internados na Unidade de Terapia Intensiva do Hospital de Pronto Socorro de Porto Alegre e que estivessem próximos da sua alta hospitalar. Foram submetidos à avaliação por meio de um protocolo adaptado, validado nacionalmente, que investigou dados sociodemográficos e perfil fonoaudiológico dos pacientes referidos. Resultados: A amostra foi constituída de 10 pacientes, com etiologia predominante de queimadura por álcool, elétrica e chama, totalizando 6 (60%) casos. Todos os pacientes apresentaram dificuldade de deglutição; 70%, esforço ventilatório; 90%, abertura de boca reduzida. A alteração no tempo máximo de emissão teve maior prevalência no sexo masculino, com média de 10,67 segundos; alterações vocais foram encontradas em 7 (70%) pacientes e 9 (90%) apresentaram alterações articulatórias. A dor esteve presente em 3 (30%) pacientes. Conclusão: O perfil fonoaudiológico foi alterado na amostra investigada, conforme o esperado.

Objective: To describe the speech-language pathology profile of patients with burns of head and neck who were hospitalized at the Emergency Hospital of Porto Alegre. Methods: Assessed patients with burns between 2nd and 3rd degree over 18 years-old at the Intensive-Care Unit of Emergency Hospital of Porto Alegre and they were close to their discharge, underwent an evaluation by a protocol adapted nationally validated that investigated socio-demographic data and speech-language pathology of the referred patients. Results: The sample consisted of 10 patients with predominant etiology of alcohol-burning, electrical and flame, totaling 6 (60%) cases. All patients had difficulty swallowing, 70%, difficulty breathing, mouth opening reduced in 9 (90%) cases, changes in the maximum emission time was most prevalent in males with an average of 10.67 seconds, vocal changes were found in 7 (70%) patients and 9 (90%) showed articulation changes. The pain was present in 3 (30%) patients. Conclusion: As expected, the speech-language pathology profile was changed in the investigated sample.

Pressäo negativa do ouvido médio em escolares / Negative middle ear pressure in school children

Pressäo negativa no ouvido médio é um achado frequente. O seu significado clínico, entretanto, näo está ainda perfeitamente conhecido quanto à associaçäo com perda auditiva e prevalência em crianças assintomáticas. Uma mostra de setenta e três escolares assintomáticos foi submetida a timpanometria, screening audiométrico e otoscopia. Encontramos pressäo negativa no ouvido médio (maior que -110mmH2O) em 16,4 por cento das crianças. Deste grupo com pressäo negativa, apenas 25 por cento apresentaram perda auditiva. A pressäo do ar do ouvido médio pode estar negativa e passar despercebida em grande número de crianças em idade escolar. Caso näo leve a uma otite média secretora, esta alteraçäo só raramente poderá ser suficiente para prejudicar a aprendizagem, visto que a maioria das crianças com pressäo negativa apresentou audiçäo normal no presente estudo