Symptoms of oropharyngeal dysphagia, efficiency, and safety of swallowing in patients after treatment for head and neck cancer.

PURPOSE: The aim of this study is to investigate the relation between symptoms and signs of oropharyngeal dysphagia after treatment for head and neck cancer. METHODS: An observational analytical study with retrospective and prospective components was carried out including 25 adult and elderly patients with head and neck cancer who had completed the treatment at least 3 months before data collection. Data from the Eating Assessment Tool (EAT-10) protocol were analyzed, as well as from the videofluoroscopic swallowing exams. Based on videofluoroscopy, the degree of oropharyngeal dysphagia was classified, as well as the safety and efficiency grade using the DIGEST (Dynamic Imaging Grade of Swallowing Toxicity) scale. Pearson's correlation test was applied, adopting a significance level of 5%. RESULTS: There was a significant correlation between question 4 of the EAT-10 (swallowing solids takes extra effort) and the efficiency profile (p = 0.004), as well as between question 4 and the DIGEST score (p = 0.002). No significant relation was found between the DIGEST score and EAT-10 total score (p = 0.180) and not even between EAT-10 total score and efficiency (p = 0.129) or safety grade (p = 0.878). CONCLUSION: In conclusion, no relation was found between most of the dysphagia signs and symptoms investigated, demonstrating that the individual's perception of the swallowing function may not be consistent with the findings of the instrumental evaluation after long-term treatment for head and neck cancer.

Effect of transcutaneous electrical stimulation amplitude on timing of swallow pressure peaks between healthy young and older adults.

OBJECTIVES: This study compared the effect of transcutaneous electrical stimulation (TES) amplitude on timing of lingual-palatal and pharyngeal peak pressures during swallowing in healthy younger and older adults. BACKGROUND: Transcutaneous electrical stimulation amplitude is one parameter that may have different impacts on the neuromotor system and swallowing physiology. One aspect of swallowing physiology influenced by age is the timing of swallowing events. However, the effect of varying TES amplitudes on timing of swallowing physiology is poorly understood, especially in older adults. MATERIALS AND METHODS: Thirty-four adults (20 younger and 14 older) swallowed 10 ml of nectar-thick liquid under three TES conditions: no stimulation, low-amplitude stimulation and high-amplitude stimulation. TES was delivered by surface electrodes on the anterior neck. Timing of pressure peaks for lingual-palatal contacts and pharyngeal pressures were measured under each condition. RESULTS: A significant age × stimulation amplitude interaction was identified for the base of tongue (BOT) [F(2,62) = 5.087, p < 0.009] and the hypopharynx (HYPO) [F(2,62) = 3.277, p < 0.044]. At the BOT, low-amplitude TES resulted in slower swallows in the younger adults compared with no TES. In older adults, low-amplitude TES resulted in faster swallows compared with high-amplitude TES. At the HYPO, no significant differences were identified in pressure timing across the three TES amplitudes in both age groups. In each case, low-amplitude TES resulted in faster swallows in older adults compared with younger adults. CONCLUSIONS: Transcutaneous electrical stimulation influences pharyngeal pressure timing differently in young and old people, which questions the appropriateness of using a 'one-size-fits-all' TES amplitude for rehabilitating people with dysphagia.

Immediate effects of transcutaneous electrical stimulation on physiological swallowing effort in older versus young adults.

OBJECTIVE: This study compared the immediate impact of different transcutaneous electrical stimulation (TES) amplitudes on physiological swallowing effort in healthy older adults versus young adults. BACKGROUND: Swallowing physiology changes with age. Reduced physiological swallowing effort in older adults including lower lingua-palatal and pharyngeal pressures may increase risk for swallowing dysfunction (i.e. dysphagia). Transcutaneous electrical stimulation (TES) has been advocated as an adjunctive modality to enhance outcomes in exercise-based therapy for individuals with dysphagia. However, significant variation in how TES is applied during therapy remains and the physiological swallowing response to TES is poorly studied, especially in older adults. MATERIALS AND METHODS: Physiological change in swallowing associated with no stimulation, sensory stimulation and motor stimulation was compared in 20 young adults versus 14 older adults. Lingua-palatal and pharyngeal manometric pressures assessed physiological swallowing effort. RESULTS: Multivariate analyses identified interactions between age and stimulation amplitude on lingual and pharyngeal functions. Motor stimulation reduced anterior tongue pressure in both age groups but selectively reduced posterior lingua-palatal pressures in young adults only. Sensory stimulation increased base of tongue (BOT) pressures in older adults but decreased BOT pressures in young adults. Motor stimulation increased hypopharyngeal pressures in both groups. CONCLUSION: Age and TES level interact in determining immediate physiological responses on swallow performance. A one-size-fit-all approach to TES in dysphagia rehabilitation may be misdirected.

Speech Articulatory Characteristics of Individuals With Dentofacial Deformity.

PURPOSE: To analyze the speech articulatory characteristics of individuals with dentofacial deformities (DFD) and assess differences compared to individuals with dentofacial balance. METHODS: Sixty individuals participated, being 30 presenting DFD (19 with class III and 11 class II skeletal malocclusion, 18 women and 12 men, age group 18-40 years) and 30 individuals from a control group matched for gender and age. The assessment of the diadochokinesis (DDK) was evaluated using the emissions /pa/, /ta/, /ka/, /pataka/, and /i/. RESULTS: The individuals with DFD produced fewer emissions per second: at syllable "ka" and sequence "pataka" for the total of individuals; syllable "pa" and sequence "pataka" for women, individuals with class II and class III malocclusion. The parameters related to the irregularity of the cycles were higher for the group with DFD than for the control, as well as emission of the syllable "pa" for the total of individuals, group of class III malocclusion and women, during production of the syllables "ta" and "ka" for all individuals and group of class III and during emission of the vowel "ï" for women. CONCLUSIONS: Differences regarding speed and stability of oral and laryngeal DDK were found among individuals with DFD compared with the control group.

Degree of swallowing impairment in the elderly: clinical and instrumental assessment.

OBJECTIVE: To classifying the degree of swallowing impairment in the elderly, comparing clinical and instrumental assessment. METHODS: This is a cross-sectional study with quantitative and qualitative analysis of clinical and instrumental assessment of 37 elderly, aged 60-82 years, of both genders without neurological, oncological or systemic diseases, participated in this study. All participants were submitted to clinical evaluation and their results compared through fiberoptic endoscopic evaluation of swallowing considering liquid, pudding and solid food consistencies. Data were analyzed descriptively and statistically using the analysis of variance test (two-way ANOVA) and Tukey's post hoc test (p <  0.05). RESULTS: In the clinical evaluation there was a higher occurrence of moderate swallowing impairment, followed by functional swallowing, while in fiberoptic endoscopic evaluation of swallowing the severity of the impairment was greater for moderate and mild degrees. There was no statistical difference between the clinical and instrumental evaluation methods. However, there was a significant interaction between the variables, with a difference for liquid consistency in the instrumental evaluation method. CONCLUSION: Healthy elderly have different degree of swallowing impairment according to food consistency. The clinical assessment using a scale that considers the physiological changes of the elderly, presented results similar to those found in the instrumental examination.

Validity based on the response processes of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofuncional Clinical History. / Validade baseada nos processos de respostas - Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial.

PURPOSE: Present the step of evidence of validity based on the responses to procedures of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History. METHODS: Study developed according to phonoaudiologic tests validations recommendations. Validity analysis performed based on the process of instrument response. Ten speech therapists, that work on phonoaudiology clinic and/or orofacial myofunctional research on the population with age between 6 to 71 months, participated and applied the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History with those responsible for the children. The speech therapists appraised the instrument applicability via Google®ï¸ electronic forms, containing dichotic and/or multiple-choice questions, and likert scale with space to justify negative answers. The data was tabulated on Microsoft Excel 2016®ï¸ worksheets and analyzed by the content validity index (CVI). The software R Core Team 2022 (Versão 4.2.2) was used. RESULTS: All items from the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History were valid when applied to real contexts. Orofacial Myofunctional Clinic history protocol- IVC 100% in terms of ease of application and filling and usage in professional practice; IVC 90% in terms of usefulness for phonoaudiology clinic. The instructional got IVC 80% in terms of clinic usefulness and 70% regarding to the prior reading necessity to fill the MMBGR Protocol Infants and Preschoolers. CONCLUSION: The Instrucional and Orofacial Myofunctional Clinical History, in the MMBGR Protocol Infants and Preschoolers had its validity proven based on the processes of responses to the usage on phonoaudiology clinic.

OBJETIVO: Apresentar a etapa da evidência de validade baseada nos processos de respostas do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial. MÉTODO: Estudo desenvolvido conforme recomendações para validação de testes em Fonoaudiologia. Realizada análise da validade baseada nos processos de resposta do instrumento. Participaram dez fonoaudiólogos, que atuam em clínica e/ou pesquisa da Motricidade Orofacial com população entre 6 e 71 meses de idade, que aplicaram o Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial junto aos responsáveis pelas crianças. Os fonoaudiólogos emitiram apreciação sobre aplicabilidade do instrumento via formulário eletrônico do Google®, contendo questões dicóticas e/ou múltipla escolha, e escala likert com espaço para justificar respostas negativas. Os dados foram tabulados em planilhas Microsoft Excel 2016® e analisados pelo Índice de Validade de Conteúdo (IVC). Utilizado software R Core Team 2022 (Versão 4.2.2). RESULTADOS: Todos os itens do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial foram válidos na aplicação em contexto real. Protocolo de História Clínica Miofuncional Orofacial - IVC 100% quanto à facilidade de aplicação e preenchimento, e uso na prática profissional; e IVC 90% quanto à utilidade para clínica fonoaudiológica. O Instrutivo obteve IVC 80% quanto à utilidade e 70% referente à necessidade de leitura prévia para preenchimento do Protocolo MMBGR Lactentes e Pré-escolares. CONCLUSÃO: O Instrutivo e o Protocolo História Clínica Miofuncional Orofacial, pertencentes ao protocolo MMBGR ­ Lactentes e Pré-escolares tiveram comprovada validade baseada nos processos de resposta, para uso na clínica fonoaudiológica.

Utilization of electromyographic biofeedback in speech therapy to attenuate the signs of facial aging: a case report. / Utilização do biofeedback eletromiográfico na terapia fonoaudiológica para atenuar sinais de envelhecimento facial: relato de caso.

Myotherapy intervention in facial aesthetics aims to attenuate wrinkles and signs of facial aging. The relationship between accentuated muscle contraction during chewing, swallowing and speaking and the appearance of facial wrinkles has been suggested by speech-language pathology literature. This study aimed to report the effect of electromyographic biofeedback associated with training of chewing, swallowing, and smiling patterns, during speech therapy intervention aimed at reducing the signs of facial wrinkles and furrows, in a 55-year-old woman. The therapy also included isotonic and isometric exercises and clinical procedures to decrease the contraction of facial mimicry muscles, which were not associated with training using electromyographic biofeedback. Signal collection and training were performed using the Biotrainer software on the New Miotool Face by Miotec, over nine weekly sessions. Two assessments were performed (before and after the nine sessions), using the MBGR Protocol (assessment of chewing, swallowing, and smiling) and validated scales described in the literature (assessment of signs of facial aging). In the reported case, the usefulness of electromyographic biofeedback was verified for learning trained orofacial myofunctional patterns, as well as to improve chewing and swallowing functions and decrease signs of facial aging. However, further research is needed to demonstrate the positive effects of electromyographic biofeedback associated with myofunctional therapy aimed at attenuating the signs of facial aging.

A intervenção mioterápica em estética facial tem como meta atenuar rugas e sinais de envelhecimento facial. A relação entre contração exagerada dos músculos durante a mastigação, deglutição e comunicação oral e aparecimento de rugas faciais é preconizada na literatura fonoaudiológica neste campo de atuação. Este estudo teve por objetivo relatar o efeito da utilização do biofeedback eletromiográfico associado ao treinamento dos padrões de mastigação, deglutição e sorriso, durante intervenção fonoaudiológica direcionada à atenuação de rugas e sulcos faciais, em mulher de 55 anos de idade. O programa terapêutico incluiu exercícios isotônicos, isométricos e procedimentos clínicos para diminuir a contração dos músculos mímicos faciais, que não foram associados ao treinamento com biofeedback eletromiográfico. A coleta de sinais e o treinamento com o software Biotrainer foram realizados com o aparelho New Miotool Face (Miotec) em nove sessões realizadas semanalmente. Foram realizadas duas avaliações (antes e após as nove sessões), por meio do Protocolo MBGR (avaliação da mastigação, deglutição e sorriso) e de escalas validadas descritas na literatura (avaliação dos sinais de envelhecimento facial). No caso descrito, constatou-se o efeito adjuvante do biofeedback eletromiográfico no aprendizado dos padrões miofuncionais orofaciais treinados, como também, a melhoria das funções mastigação e deglutição e a diminuição dos sinais de envelhecimento facial. Porém, são necessárias pesquisas mais robustas que comprovem efeitos positivos do biofeedback eletromiográfico associado à terapia miofuncional direcionada a atenuar os sinais de envelhecimento facial.

Translation and cross-cultural adaptation of the "Protocolo de Avaliação Miofuncional Orofacial MBGR" from Brazilian Portuguese into English.

In health-related research, an increasing number of clinical assessment tools are translated and cross-culturally adapted for cross-national and cross-cultural studies and comparisons. However, when translating and cross-culturally adapting clinical assessment tools for use across new countries, cultures, or languages, we must follow a thorough method to reach semantic, idiomatic, experiential, and conceptual equivalences between translated and original versions. Therefore, in this study, we translated and cross-culturally adapted the Protocolo MBGR (Marchesan, Berretin-Felix, Genaro, and Rehder) from Brazilian Portuguese into English, following international guidelines, and named it "MBGR Protocol." To verify its content validity, we used the Content Validity Index. Results indicated excellent content validity: a Scale-Content Validity Index of 0.96 and 97% of all translation units with an Item-Content Validity Index of 1.00. Also, to prove its face validity and confirm whether it worked in the target population's linguistic-cultural setting, we used it with 35 subjects. Again, results demonstrated excellent face validity: in the pretest, 91% of all translation units were considered comprehensible and clear; in the pilot test, 98% of all translation units were considered comprehensible and clear. Thus, we concluded that the MBGR Protocol is promising to enhance the uptake of studies in Orofacial Myology worldwide and support researchers and health professionals in assessing and diagnosing orofacial myofunctional disorders in children, adolescents, adults, and the elderly. Also, it may support evidence-based practice and assist in standardizing assessment and diagnostic criteria. The MBGR Protocol should have its psychometric properties tested before being used in clinical practice or scientific research. Therefore, future studies are needed, and collaborations among researchers from South and North American countries are encouraged to create an international network and advance with knowledge and skills in the Orofacial Myology discipline.

Speech Language Pathology interventions in the areas of breathing, chewing, swallowing and speaking: a scoping review. / Intervenções da Fonoaudiologia nas áreas de respiração, mastigação, deglutição e fala: uma revisão de escopo.

There are several types of approaches that can be used to achieve therapeutic goals in disorders related to the functions of mastication, swallowing, speech, and breathing. However, the literature lacks evidence to support their use in speech-language clinical practice. The objective of this review was to map the syntheses of evidence on speech-language pathology intervention in the areas of breathing, mastication, swallowing and speech in adults and the elderly. Only studies classified by their authors as a systematic review, studies that addressed therapy for orofacial disorders in individuals over 18 years of age were included. The procedures performed included: electronic and manual search; selection of studies; data extraction; evaluation of the quality of studies and data analysis. It was possible to observe different types of interventions mainly aimed at the swallowing function, ranging from traditional therapy to the use of devices. However, due to the limitations of the studies, the data must be interpreted with caution.

Há diversas abordagens que podem ser utilizadas para atingir os objetivos terapêuticos nos distúrbios relacionados às funções de mastigação, deglutição, fala e respiração. Entretanto, a literatura necessita de evidências que fundamentem o uso na prática clínica fonoaudiológica. O objetivo desta revisão foi mapear as sínteses de evidências sobre intervenção fonoaudiológica nas áreas de respiração, mastigação, deglutição e fala em adultos e idosos.‬ Foram incluídos apenas estudos classificados por seus autores como revisão sistemática, que abordaram terapia para disfunções orofaciais em indivíduos maiores de 18 anos. Os procedimentos realizados foram: busca eletrônica e manual; seleção dos estudos; extração dos dados; avaliação da qualidade dos estudos e análise de dados. Foi possível observar diversos tipos de intervenções principalmente voltadas à função de deglutição, abarcando desde a terapia tradicional até a utilização de dispositivos. Contudo, devido às limitações dos estudos, os dados devem ser interpretados com cautela.

Orofacial Myofunctional Aspects of Nursing Infants and Preschoolers.

Introduction Clinical assessment in orofacial motricity is required for the speech therapist to diagnose and treat disorders involving the stomatognathic system. Validated tools can help establish a prognosis and outline intervention methods connected to human development. Objective The goal of the present study was to examine the domains of the oromyofunctional assessment of nursing infants and preschoolers according to sex and age group, as well as the application of the MMBGR Protocol - Nursing Infants and Preschool Children. Methods A quantitative technique was used to conduct an analytical and cross-sectional investigation. The present study included a total of 214 healthy breastfeeding infants and preschoolers of both sexes. The Mann-Whitney test was used to compare the medians. The Spearman correlation of each test domain was determined. R Core Team 2021 (R Foundation, Vienna, Austria) was used, and the significance threshold was set at 5%. Results In intraoral and extraoral examinations, there was a difference between sexes for tongue scores in nursing infants (d = - 0.428; p = 0.045), worse in males. When the orofacial functions were considered in nursing infants, there were differences between the sexes for the liquid/solid/semisolid deglutition scores (d = 0.479; p = 0.031), with females performing worse. There were sex differences in solid/semisolid deglutition (d = - 0.335; p = 0.043), and speech in preschoolers (d = - 0.478; p = 0.034), including the production of phones/phonemes (d = - 0.599; p = 0.007), which were always worse in males. Conclusion The research revealed sex disparities and related the domains of oromyofunctional assessment, according to scores, of the domains of myofunctional assessment, as recorded in a standardized oromyofunctional assessment protocol by age group.

Normalization of temporal aspects of swallowing physiology after the McNeill dysphagia therapy program.

OBJECTIVES: We examined the timing of physiological swallowing events in patients before and after completion of an exercise-based dysphagia intervention (McNeill Dysphagia Therapy Program; MDTP) and compared their performance to that of healthy volunteers. METHODS: Eight adults (mean age, 57.5 years) with chronic dysphagia (mean, 45 months) completed 3 weeks of the MDTP. Before and after the MDTP we measured lingual-palatal and pharyngeal manometric pressures during swallows of thin liquid, thick liquid, and pudding material in 5-mL volumes. Using the pressure peak of the pharyngoesophageal segment clearing wave as the anchor point, we measured the relative timing of pressure peaks from the anterior, middle, and posterior parts of the tongue and the manometric peaks from the base of the tongue, the hypopharynx, and the nadir of the pharyngoesophageal segment. We compared these results to identical measures obtained from 34 healthy adults (mean age, 44.0 years). RESULTS: The timing of physiological events before the MDTP was significantly slower than that of the group of healthy volunteers. The timing data from after the MDTP were not significantly different from those of the healthy group. The magnitude change was greatest for thin liquid. CONCLUSIONS: Dysphagia therapy with the MDTP improves the timing of physiological events during swallowing. Temporal coordination of swallowing components after therapy approximates that of healthy adults, suggesting a normalization of swallow timing after the MDTP.

MBGR protocol of orofacial myofunctional evaluation with scores.

The MBGR Protocol with scores was first published in 2009. This protocol was widely administered by speech-language pathologists experienced in orofacial myology in different states from Brazil for four months. From the comments and suggestions of these professionals, the protocol was reviewed and modified. A consistent visual training materials program was prepared, and speech-language pathologists, experienced in orofacial myology from different states of Brazil, Venezuela, Peru, and Colombia were trained with the provided materials. These speech-language pathologists administered the protocol for two years. From the data collected by the speech-language pathologists, modifications were made, and a final version was designed. This final version was administered for two-months by the same speech-language pathologists from Brazil, Venezuela, Peru, and Colombia in order to re-test the final version of MBGR protocol. The aim of this study was to demonstrate the efficiency and effectiveness of the protocol to assess orofacial myofunctional alterations. The final version of the MBGR protocol with scores has proven to be efficient and effective in the identification of individuals experiencing orofacial myofunctional disorders.

Lingual frenulum protocol with scores for infants.

An experimental protocol model for frenulum evaluation was first designed, and administered to ten infants in 2010. After obtaining the data and statistical analysis, the protocol was re-designed and administered to 100 infants. The aim of this study is to present an efficient and effective lingual frenulum protocol with scores for infants. From the experimental protocol model, a new protocol was designed. One speech-language pathologist, and specialist in orofacial myology, administered the new protocol to 100 full-term infants. All steps of the protocol were recorded and photographed. The data collected was sent to two specialists in the area, who evaluated the cases based on the recordings and photographs. The data from the three evaluations were compared. A two-part protocol was designed to evaluate the lingual frenulum in infants. The first part consists of clinical history with specific questions about family history and breastfeeding. The second part consists of clinical examination: anatomo-functional, non-nutritive and nutritive sucking evaluations. A new lingual frenulum protocol with scores for infants was designed, and has proved to be an effective tool for health professionals to assess and diagnose anatomical alterations of the lingual frenulum, and its possible interference with breastfeeding.

Effect of Lingual Frenotomy on Tongue and Lip Rest Position: A Nonrandomized Clinical Trial.

Introduction The tongue plays an important role in the development of craniofacial structures. At rest, the light and constant pressure of the tongue against the hard palate, counterbalanced by the pressure provided by proper lip sealing, serves as a guide for maxillary growth. Ankyloglossia makes tongue coupling against the hard palate difficult, impacting maxillary development, which may lead to breathing disorders. Objective To verify the effect of lingual frenotomy on the resting position of the tongue and lips in infants with ankyloglossia. Methods The sample consisted of 334 infants aged between 1 and 60 days old diagnosed with ankyloglossia. The groups were divided in: a) experimental group (EG), which consisted of infants whose mothers agreed with lingual frenotomy; b) control group (CG), which consisted of infants whose mothers either refused lingual frenotomy or were waiting for surgery. Both the position of the lips and of the tongue at rest were assessed while the infants were sleeping during the quiet sleep phase. For mothers who refused their infants to undergo the surgical procedure, a follow-up of the infants was proposed to verify possible interference of the frenulum with the resting position of the tongue and lips. Infants whose mothers agreed with surgery were referred for lingual frenotomy. Results Regarding the position of the tongue and lips at rest at the initial and final assessments, the statistical analysis demonstrated significant differences between both groups. Conclusion Lingual frenotomy enabled infants diagnosed with ankyloglossia to maintain both tongue coupling against the hard palate and closed lips at rest.

Effects of Resonance Tube Voice Therapy on Parkinson's Disease: Clinical Trial.

PURPOSE: To verify the effect of resonance tube voice therapy on the vocal aspects of patients with Parkinson's Disease (PD). METHOD: Intra-subject comparative controlled clinical trial with a single group assignment. Fourteen individuals with PD (10 men, mean age 66.1 years; four women, mean age 73.75 years) received eight 45-minute sessions of voice therapy, twice a week for 4 weeks. The therapy consisted of semi-occluded vocal tract exercises - phonation method in a resonance tube (glass, 27 cm x 9 mm) in water. Tube depth in water ranged from 2 cm to 9 cm, as the difficulty in carrying out the exercises increased (usual pitch, high pitch, low pitch, ascending/descending glissandos), followed by sentence production. The assessments were made three times: at baseline (Time0), after 30 days without intervention (Time1), and 1 day after eight intervention sessions (Time2). The following aspects were assessed: vocal intensity; acoustic parameters (Smoothed Cepstral Peak Prominence - CPPs, alpha ratio, and L1-L0 difference); auditory-perceptual analysis of the overall degree of vocal quality deviation; voice symptoms (Voice Symptom Scale protocol - VoiSS) and voice-related quality of life (Voice-Related Quality of Life Protocol - V-RQOL). The results were compared at the three times of assessment Time0/Time1/Time2 using one-way repeated measures ANOVA test and Tukey test (5% significance). RESULTS: intervention significantly increased: vocal intensity, L1-L0 value of vowel /a/ and counting, CPP value in counting, and decreased: the overall degree of vocal quality deviation in 78% of participants, the total score of VoiSS protocol, the limitation, and emotional subscales. In addition, the intervention increased the score of all the domains of V-RQOL protocol - physical, socio-emotional, and total. CONCLUSION: Resonance tube phonation in voice therapy was effective in increasing vocal intensity and long-term acoustic parameters, the improved overall degree of vocal quality, reducing voice symptoms, and increasing voice-related quality of life in individuals with PD.

MMBRG Protocol - Infants and Preschoolers: Myofunctional Orofacial Clinic Examination. / Protocolo MMBRG ­ Lactentes e Pré-Escolares: Exame Clínico Miofuncional Orofacial.

PURPOSE: To present the Myofunctional Orofacial Clinical Examination Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including its validation. METHODS: Initially, test content-based validity was evaluated from the MBGR Protocol to be used with the age group between 6 and 71 months based on the bibliography and experience between the authors (original and current). For the content and appearance analysis, 10 speech therapists specialized in Orofacial Motricity attended and filled out an electronic form with dichotic and Likert scale questions in two moments. We used the Content Validity Index and the Exact Binomial Test. Then there was a validity based on the response processes analysis followed by a reliability of the Clinical Examination with 155 participants by 7 experienced and calibrated speech therapists, and the examiners between and within agreement was verified by the Intraclass Correlation Coefficient. RESULTS: There were additions, modifications, and exclusions of items according to the age group, resulting in the Myofunctional Orofacial Clinical Examination Protocol for Infants and Preschoolers, which obtained 90.5% agreement; and 100% of the appropriate scores by at least 90% of the specialists. In reliability, most items of the Extraoral and Intraoral Examination and Chewing obtained a reasonable to good, or even excellent, agreement. CONCLUSION: The "Clinical Myofunctional Clinical Examination" was validated based on the test content, response process, and reliability and, along with the "Instructional" and the "Clinical History" is part of the "MMBGR Protocol - Infants and Preschoolers" for speech therapy activities in the age group between 6 and 71 months of age.

OBJETIVO: Apresentar Exame Clínico Miofuncional Orofacial pertencente ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo sua validação. MÉTODO: Inicialmente foi realizada a validade do conteúdo do teste adaptado do Protocolo MBGR, para faixa etária entre 6 e 71 meses, fundamentada na bibliografia e experiência entre autores (originais e atuais). Para análise de conteúdo e aparência participaram 10 fonoaudiólogos especialistas em Motricidade Orofacial, que preencheram formulário eletrônico com questões dicóticas e escala de Likert, em dois momentos. Foi calculado Índice de Validade de Conteúdo e Teste Binomial Exato. Na sequência houve análise da validade baseada nos processos de resposta, seguida da análise da confiabilidade do Exame Clínico, com 155 participantes, por 7 fonoaudiólogos experientes e calibrados, sendo verificada a concordância entre e intra examinadores pelo Coeficiente de Correlação Intraclasse. RESULTADOS: Houve acréscimos, modificações e exclusão de itens conforme faixa etária, concluindo-se o Protocolo Exame Clínico Miofuncional Orofacial para lactentes e pré-escolares, que obteve 90,5% com concordância; e 100% dos escores adequados por pelo menos 90% dos especialistas. Quanto à confiabilidade, a maioria dos itens dos Exames Extraoral e Intraoral e Mastigação obtiveram concordância razoável a boa, ou, até mesmo, excelente. CONCLUSÃO: O "Exame Clínico Miofuncional Orofacial" teve validação baseada no conteúdo do teste, nos processos de resposta e confiabilidade concluída, e junto ao "Instrutivo" e à "História Clínica" integra o "Protocolo MMBGR - Lactentes e Pré-escolares", para atuação fonoaudiológica na faixa etária entre 6 e 71 meses de idade.

MMBGR Protocol - infants and preschoolers: Instructive and Orofacial Myofunctional Clinical History. / Protocolo MMBRG ­ Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial.

PURPOSE: To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. METHODS: Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. RESULTS: We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. CONCLUSION: "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.

OBJETIVO: Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. MÉTODO: Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. RESULTADOS: Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. CONCLUSÃO: "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.

Oral and vocal fold diadochokinesis in children.

AIM: To establish reference values concerning the results of oral and vocal fold diadochokinesis (DDK) assessment, as well as to analyze the differences among gender and age. METHODS: One hundred and fifty Brazilian-Portuguese-speaking children from 8 to 10 years old were assessed. The DDK was assessed through the repetition of 'pa', 'ta', 'ka', 'pataka', 'a' and 'i'. RESULTS: As age increased there was a rise in the average DDK rate, a rise in the coefficient of variation of period for syllable 'ka' and a rise in the coefficient of variation of the peak intensity for the syllable 'ta'. The number of utterances per second of 'ta' was higher for girls than for boys. In trisyllables, 8-year-old girls presented a lower number of utterances than the other subgroups. As age increased, there was a rise in the average DDK rate of the vowel 'i' for girls; there was also a smaller standard deviation and perturbations of the period for this same vowel. CONCLUSION: Oral and vocal fold DDK reference values were established and differences as to gender and age were observed.

Swallowing disorders in patients with obstructive sleep apnea: a critical literature review.

Patients with obstructive sleep apnea (OSA) may show signs and symptoms of altered swallowing function since repetitive episodes of OSA may cause hypoxia (decreased oxygen concentration in the blood) and hypercapnia (increased carbon dioxide concentration in the blood), as well as neuromuscular changes in the tissues involved, including the pharynx. This study aims to analyze whether patients with OSA show signs and symptoms of altered swallowing function. A literature search was performed in the PubMed, LILACS, Medline, Scopus, and SciELO databases by using the following search strategy: ("dysphagia") or ("deglutition disorders") and ("obstructive sleep apnea") or ("obstructive sleep apnea syndrome"). The included articles were sorted by authors, year, country, journal of publication, and type of study, as well as analyzed according to the objectives, case series, OSA and swallowing assessment methods, results and conclusions. After applying the inclusion and exclusion criteria, ten articles published in medicine, dentistry and physiology journals between 1999 and 2018 were selected. The analysis of the selected articles showed that the number of participants and group structuring vary according to the study and instrumental and objective exams are used to assess swallowing and sleep in most articles. Also, the results show that groups of patients with OSA can present altered swallowing reflex, altered latency time and inspiratory suppression time, and presence of premature posterior escape, residues, penetration and aspiration. Premature posterior escape was the most frequent sign found. In conclusion, patients with OSA may show signs and symptoms of altered swallowing function.