Sequential swallowing of liquid in elderly adults: cup or straw?

This article describes the study of the characteristics of sequential swallowing of 100 ml of liquid (dyed water) in two swallowing trials, directly from a cup and through a straw, in healthy elderly individuals. The aim of the study was to determine whether differences in the swallowing pattern are influenced by the type of utensil used. The subjects were subjected to clinical assessment and fiberoptic endoscopic evaluation of swallowing. The research found that intake from the cup showed a significantly lower median as regards time to drink the total volume. The final intake volume was significantly larger from the cup. A statistically significant difference was found in the oral spillage of liquid, which was notably higher in the cup trial. Despite the presence of residue in the valleculae and pyriform sinuses, in neither trial was there penetration or aspiration of liquid. The straw has a favorable influence on the quality of the sequential swallowing of liquid in regard to bolus containment within the oral cavity, which was better with that utensil. The cup provides a higher final volume in a shorter time for intake but there is more fluid spillage.

Muscular activity in class III dentofacial deformity.

Individuals with Class III dentofacial deformities exhibit morphological changes and myofunctional adaptations, and an accurate diagnosis is essential for treatment planning. The purpose of this study was to evaluate the electrical activity of the masseter, temporal, and suprahyoid muscles in subjects with Class III dentofacial deformities, assessing electromyographic characteristics using functional tests. The research group consisted of 20 subjects with Class III dentofacial deformities and indications for surgical-orthodontic treatment. The control group consisted of 10 individuals presenting a good maxilla and mandible relationship. Electrical activities of the masseter and temporal were recorded during isometric contraction and maximal isometric contraction. The suprahyoid and masseter were assessed during maximal mouth opening and swallowing of saliva. Isometric contraction and maximal isometric contraction analysis showed less potential in the research group, with a significant difference regarding the masseter muscle in isometric contraction. In maximal isometric contraction, an increase in electrical activity in both groups was observed; it remained lower for the research group, but with no significant difference. With regard to symmetry, significant differences among the groups were observed only for the left masseter in the research group, as well as during isometric contraction. There was no significant difference found regarding maximal mouth opening. During swallowing of saliva, there was a high percentage of abnormal electromyographic tracings for both groups. This finding was not expected for the control group. The study found some changes in muscular activity in Class III dentofacial deformities, characterized by lower potential in the masseter muscle during isometric contractions. No other peculiarities were found that could contrast either group.

Brazilian Consensus on Sleep-Focused Speech-Language-Hearing Sciences - 2023 Brazilian Sleep Association.

Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach. Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when ⅔ (66.6%) of valid responses were on a same on a same answer (either "agree" or "disagree"). Results Participants voted on 102 items. The mean consensus rate was 89.9% ± 10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services. Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.

Obstructive Sleep Apnea: characterization of the obstructive site and type of collapse. / Apneia Obstrutiva do Sono: caracterização do sítio obstrutivo e tipo de colapso.

Obstructive Sleep Apnea is characterized by recurrent episodes of partial or complete collapse of the pharynx, followed by decreased oxyhemoglobin saturation and frequent arousals. It is regarded as a public health issue with important night and day symptoms that impact life quality. Its effects are associated with the areas of competence of Speech and Language Pathologists. To establish efficient diagnosis and treatment methods, professionals must know the pathogenesis of upper airway obstruction during sleep. This study seeks to enlarge the understanding of obstructive sleep apnea pathophysiology, eligibility of individualized therapeutic procedures and guidance for orofacial myofunctional therapy by describing and illustrating the locations and types of upper airway collapse during sleep. We analyzed original records of Drug Induced Sleep Endoscopy exams of a series of cases with polysomnographic diagnosis of obstructive sleep apnea following the proper ethical processes. The images of the exam recordings were analyzed by five professionals with expertise in the sleep area. Obstructive sites and types of collapse were presented according to the current classification. The videos were divided into screenshots, originating figures from each anatomical site: without collapse and collapsed. The results are visualized in the images of the cases showing a predominance of velopharyngeal collapse: anteroposterior, lateral, or concentric; oropharyngeal lateral collapse; tongue anteroposterior collapse and anteroposterior collapse of the epiglottis. Understanding the obstruction sites and types of collapse illustrated in this study may help to predict therapeutic responses and learn the limitations or direct individual proposals patient.

A Apneia Obstrutiva do Sono caracteriza-se por episódios recorrentes de colapso parcial ou completo da faringe, seguidos de diminuição da saturação de oxihemoglobina e despertares frequentes. É considerada problema de saúde pública com importantes sintomas noturnos e diurnos, impactando qualidade de vida. Seus efeitos associam-se as áreas de competência da Fonoaudiologia. Para estabelecer diagnóstico e métodos de tratamento eficientes, profissionais devem conhecer a patogênese da obstrução da via aérea superior durante o sono. Visando contribuir para a compreensão da fisiopatologia da apneia obstrutiva do sono, elegibilidade de procedimentos terapêuticos individualizados e direcionamento para terapêutica miofuncional orofacial, o presente estudo tem como objetivo descrever e ilustrar os locais e tipos de colapso da via aérea superior durante o sono. Após processos éticos, foram analisados registros originais das sonoendoscopias de uma série de casos com diagnóstico polissonográfico de apneia obstrutiva do sono. As imagens das gravações dos exames foram analisadas por cinco profissionais com expertise na área do sono. Os locais obstrutivos e tipos de colapso foram apresentados conforme classificação vigente. Os vídeos foram divididos em capturas de tela, originando figuras de cada sítio anatômico: sem colapso e com colapso. Os resultados foram apresentados por imagens dos casos, que ilustram cada colapso, predominando colapso velofaríngeo: anteroposterior, lateral ou concêntrico; seguido por colapso orofaríngeo lateral; colapso anteroposterior na hipofaringe e colapso anteroposterior da epiglote. O entendimento dos locais de obstrução e tipos de colapso ilustrados nesse estudo pode ser um preditor de respostas terapêuticas, auxiliando a compreensão das limitações ou direcionando propostas para cada paciente.

Myofunctional assessment for obstructive sleep apnea and the association with patterns of upper airway collapse: a preliminary study.

Objectives: To organize an assessment instrument with questionnaires and myofunctional orofacial/oropharyngeal assessment for OSA patients and correlate it with the upper airway obstructive site detected during drug-induced sleep endoscopy (DISE). Material and Methods: 29 OSA patients aged 22-65 years with an indication to undergo DISE to evaluate an alternative treatment to PAP and signed the consent form. Patients over 65 years old with maxillofacial deficiency and BMI>30 were excluded. The subjects answered the Pittsburgh, Berlin (snore), and Epworth questionnaires. The myofunctional orofacial/oropharyngeal assessment comprised soft palate, palatine pillars, and uvula (structure and mobility), tonsils (size), mandible (bony bases), hard palate (depth and width), tongue (posture, volume, width, and height), floor of mouth (mylohyoid), tongue suction and sustaining (mobility), "lowering of the back of the tongue" (stimulus), which were scored by three speech-language pathologists with expertise. DISE was scored according to VOTE classification. The statistical analysis (t-test) compared groups without and with obstruction in VOTE with questionnaires and myofunctional orofacial/oropharyngeal assessment. Results: The following were significantly different: snoring frequency (p=0.03) with VOTE/velopharynx; intensity (p=0.02) and frequency of snoring (p=0.03) with VOTE/lateral wall of oropharynx; suction the tongue and sustain (p=0.02) with VOTE/velopharynx; hard palate depth (p=0.02) and width (p=0.05) with obstruction VOTE/epiglottis; tonsils volume (p=0.05) with VOTE/epiglottis; tongue posture (p=0.00) with obstruction VOTE/epiglottis; floor of the mouth (p=0.02) with VOTE/epiglottis. Conclusion: Higher snoring frequency and intensity was observed in patients with obstruction at the velopharynx and oropharyngeal lateral wall. Obstruction at the velopharynx was associated with poor tongue ability to suck the tongue against the hard palate. Obstruction at the epiglottis had structural and functional associations, including the oropharyngeal lateral wall, affected by the palatine tonsils size, depth and width of the hard palate, tongue position, and flaccidity of the floor of mouth. Considering that this is a preliminary study, the data should be carefully verified and not generalized.

Swallowing Analyses of Neonates and Infants in Breastfeeding and Bottle-feeding: Impact on Videofluoroscopy Swallow Studies.

Introduction Dysphagia, when left untreated, can result in an increase in morbidity and mortality rates, especially among infants with history of life-threatening neonatal diseases. The videofluoroscopy swallowing study (VFSS) is considered the gold standard for the diagnosis of dysphagia. There are few imaging studies of infant swallowing based on videofluoroscopy, none of which were performed during breast-feeding. Objective To analyze the similarities and differences in infant swallowing function -regarding the feeding method - breast or bottle - and the impact on videofluoroscopy findings. Methods A retrospective study of 25 VFSSs of breastfeeding and bottle-feeding infants was performed. The studied variables were: oral capture and control; tongue versus mandible movement coordination; sucking pattern; mandible excursion; liquid flow; bolus retention; laryngeal penetration; tracheal aspiration; clearing of material collected in the pharynx; and gastroesophageal reflux (GER). Results The study showed a statistically significant association between nipple/areole capture; oral control; sucking pattern; mandibular excursion; liquid flow and feeding method. The velar sealing deficit, the place that trigger the pharyngeal swallow, food retention in the pharyngeal recesses, laryngeal penetration and GER were also factors associated with the feeding method. Conclusion The analysis of the swallowing characteristics of both feeding methods revealed significant differences between them, with an impact on the diagnosis in the VFSSs, especially regarding velar function.

Oxygen saturation and heart rate in premature: comparison between cup and finger feeding techniques. / Saturação de oxigênio e frequência cardíaca em prematuros: comparação entre as técnicas de copo e sonda-dedo.

PURPOSE: To evaluate the oxygen saturation, heart rate, length of hospital stay and weight preterm infants or preterm newborns (PTNBs) (in the Neonatal Intensive Care Unit in the diet supply by cup and finger feeding techniques, simultaneously with breastfeeding. METHODS: Simultaneous randomized clinical trial. Twenty-five preterm infants admitted to the Neonatal Intensive Care Unit of the Public Hospital from October 2011 to February 2012 were selected. The sample was divided into two groups: Eight preterm infants who received the diet in the cup probe group (CPG) who were born on the same day, and 17 by finger probe group (FPG) who were born on the odd day. In the diet offer, the minimum and maximum values of oxygen saturation (O2 Sat) and heart rate (HR) were recorded: before offering the diet, during and after the offer. RESULTS: Regarding the variables O2 Sat and HR, no statistically significant differences were observed between the groups, but in the group vs time factor, the groups showed differences, not continuous in the O2 Sat variable. Regarding weight, a statistically significant gain was observed for both groups, and in CPG the highest weight gain was due to the longer hospitalization time. It was verified that FPG presented shorter hospitalization time. CONCLUSION: There were no differences regarding O2 Sat and HR. However, when analyzing the time factor, the groups presented some differences, not continuous, indicating the need for other studies for a better understanding of the effect. The FPG presented shorter hospitalization time and the CPG infants had greater weight gain due to longer hospitalization time.

OBJETIVO: Avaliar a saturação de oxigênio (SatO2), a frequência cardíaca (FC), o tempo de internação e o peso dos recém-nascidos pré-termos (RNPTs) em Unidade de Terapia Intensiva Neonatal, na oferta de dieta pelas técnicas de alimentação via copo e sonda-dedo, simultaneamente ao aleitamento materno. MÉTODO: Ensaio clínico randomizado simultâneo. Foram selecionados 25 prematuros internados na Unidade de Terapia Intensiva Neonatal de hospital público, no período de outubro de 2011 a fevereiro de 2012. A amostra foi dividida em dois grupos: 8 prematuros nascidos em dia par, que receberam a dieta no copo (GCP) e 17 prematuros, nascidos em dia ímpar, que receberam a dieta pela sonda-dedo (GSD). Na oferta da dieta foram anotados os valores mínimos e máximos da SatO2 e FC, antes de oferecer a dieta, durante e após a oferta. RESULTADOS: Quanto às variáveis SatO2 e FC, não foram observadas diferenças estatisticamente significativas entre os grupos, mas, no fator grupo versus tempo, os grupos apresentaram diferenças, não contínuas na variável SatO2. Em relação ao peso, foi constatado ganho estatisticamente significativo para ambos os grupos, sendo que, no GCP, o maior ganho de peso foi por causa do maior tempo de internação. Foi verificado que o GSD apresentou menor tempo de internação. CONCLUSÃO: Não houve diferenças quanto à SatO2 e FC. Contudo, ao se analisar o fator tempo, os grupos apresentaram algumas diferenças, não contínuas, o que indica a necessidade de outros estudos para melhor compreensão do efeito. O GSD apresentou menos tempo de internação e os RNPTs do GCP tiveram maior ganho de peso em razão do maior tempo de internação.

Scientific production of Brazilian speech language pathologists in sleep medicine.

INTRODUCTION: Previous diagnosis and intervention in patients with sleep-disordered breathing involves several health professionals. Speech-Language and Hearing Sciences (SLHS) performance has been solidified through scientific production. OBJECTIVE: To describe the inclusion of Brazilian Speech-Language Pathologists (SLP) in the field of sleep disorders, through the description of studies, scientific publications and participation in scientific events. DATA SYNTHESIS: A search and an analysis of the Brazilian SLP publications in the field of sleep disorders were carried out, including articles, monographs, dissertations, thesis and abstracts published in annals of events. The databases Lilacs, SciELO, Pubmed, Google Scholar tool and Lattes platform were accessed, with final search in January 2018. The analysis consisted of a description of the year of publication, type of publication, area of the SLHS, place of publication and/or event. 40 articles were found in national and international journals, from 1999 to 2017. In relation to publications in books, one book about the subject was published in 2009 and eight chapters of books were published. In the monograph format, 21 studies were carried out, there are 13 dissertations and eight thesis. A total of 151 abstracts were published in annals of scientific events, from 2001 to 2017 and 63 lectures were conducted by SLP. CONCLUSION: The inclusion of Brazilian SLP in the area of sleep disorders has been supported by scientific publications in the format of articles in national and international journals, monographs, thesis, dissertations, books and publications in event annals.

Emotional aspects of parents of children with dysphagia / Aspectos emocionais dos pais de crianças com disfagia

Dysphagia is a common swallowing disorder in the pediatric population, which may influence the quality of life and well-being of the family. The literature points to stress, guilt, and social isolation of family members. However, the management of psychosocial aspects involved in the treatment of pediatric dysphagia is rarely discussed. This study aimed to carry out an integrative review of the literature regarding the emotional aspects of parents of children with dysphagia. Therefore a search in the databases SciELO and PubMed was made, from January 2013 to June 2020, using the descriptors in Health Sciences (DeCs): "deglutition disorders" and "child". The search was performed with English and Portuguese language limiters using associated descriptors. The selection of the studies was performed by reading the title, abstract and, if necessary, full text, applying the inclusion and exclusion criteria. There were 2,169 publications, and 8 met the inclusion criteria. The included studies were examined according to the author, type of study, goals, emotional aspects involved in the treatment of swallowing disorders, and conclusions. The analysis was performed according to the presence of certain variables of the emotional aspects presented in the face of swallowing disorders, namely, parental stress, negative impact on parent/child interaction, guilt and frustration, and social isolation. The literature points out that pediatric dysphagia causes an emotional impact on the parents; indicating that it is necessary to offer emotional support and to adapt the clinical management to the different demands present in the clinic.

A disfagia é um distúrbio de deglutição comum na população pediátrica, podendo influenciar na qualidade de vida e no bem-estar da família. A literatura aponta estresse, culpa e isolamento social dos familiares. Entretanto, o manejo dos aspectos psicossociais envolvidos no tratamento da disfagia pediátrica raramente é discutido. Este estudo teve como objetivo realizar uma revisão integrativa da literatura sobre os aspectos emocionais de pais de crianças com disfagia. Para tanto, foi realizada uma busca nas bases de dados SciELO e PubMed, no período de janeiro de 2013 a junho de 2020, utilizando os descritores em Ciências da Saúde (DeCs): "distúrbios da deglutição" e "criança". A busca foi realizada com limitadores dos idiomas inglês e português usando descritores associados. A seleção dos estudos foi realizada por meio da leitura do título, resumo e, se necessário, texto completo, aplicando-se os critérios de inclusão e exclusão. Houve 2.169 publicações e 8 preencheram os critérios de inclusão. Os estudos incluídos foram examinados quanto ao autor, tipo de estudo, objetivos, aspectos emocionais envolvidos no tratamento dos distúrbios da deglutição e conclusões. A análise foi realizada de acordo com a presença de algumas variáveis ​​dos aspectos emocionais apresentados diante dos distúrbios da deglutição, a saber, estresse parental, impacto negativo na interação pais/filhos, culpa e frustração e isolamento social. A literatura aponta que a disfagia pediátrica causa impacto emocional nos pais; indicando que é necessário oferecer suporte emocional e adequar o manejo clínico às diferentes demandas presentes na clínica.

Apneia Obstrutiva do Sono: caracterização do sítio obstrutivo e tipo de colapso / Obstructive Sleep Apnea: characterization of the obstructive site and type of collapse

RESUMO A Apneia Obstrutiva do Sono caracteriza-se por episódios recorrentes de colapso parcial ou completo da faringe, seguidos de diminuição da saturação de oxihemoglobina e despertares frequentes. É considerada problema de saúde pública com importantes sintomas noturnos e diurnos, impactando qualidade de vida. Seus efeitos associam-se as áreas de competência da Fonoaudiologia. Para estabelecer diagnóstico e métodos de tratamento eficientes, profissionais devem conhecer a patogênese da obstrução da via aérea superior durante o sono. Visando contribuir para a compreensão da fisiopatologia da apneia obstrutiva do sono, elegibilidade de procedimentos terapêuticos individualizados e direcionamento para terapêutica miofuncional orofacial, o presente estudo tem como objetivo descrever e ilustrar os locais e tipos de colapso da via aérea superior durante o sono. Após processos éticos, foram analisados registros originais das sonoendoscopias de uma série de casos com diagnóstico polissonográfico de apneia obstrutiva do sono. As imagens das gravações dos exames foram analisadas por cinco profissionais com expertise na área do sono. Os locais obstrutivos e tipos de colapso foram apresentados conforme classificação vigente. Os vídeos foram divididos em capturas de tela, originando figuras de cada sítio anatômico: sem colapso e com colapso. Os resultados foram apresentados por imagens dos casos, que ilustram cada colapso, predominando colapso velofaríngeo: anteroposterior, lateral ou concêntrico; seguido por colapso orofaríngeo lateral; colapso anteroposterior na hipofaringe e colapso anteroposterior da epiglote. O entendimento dos locais de obstrução e tipos de colapso ilustrados nesse estudo pode ser um preditor de respostas terapêuticas, auxiliando a compreensão das limitações ou direcionando propostas para cada paciente.

ABSTRACT Obstructive Sleep Apnea is characterized by recurrent episodes of partial or complete collapse of the pharynx, followed by decreased oxyhemoglobin saturation and frequent arousals. It is regarded as a public health issue with important night and day symptoms that impact life quality. Its effects are associated with the areas of competence of Speech and Language Pathologists. To establish efficient diagnosis and treatment methods, professionals must know the pathogenesis of upper airway obstruction during sleep. This study seeks to enlarge the understanding of obstructive sleep apnea pathophysiology, eligibility of individualized therapeutic procedures and guidance for orofacial myofunctional therapy by describing and illustrating the locations and types of upper airway collapse during sleep. We analyzed original records of Drug Induced Sleep Endoscopy exams of a series of cases with polysomnographic diagnosis of obstructive sleep apnea following the proper ethical processes. The images of the exam recordings were analyzed by five professionals with expertise in the sleep area. Obstructive sites and types of collapse were presented according to the current classification. The videos were divided into screenshots, originating figures from each anatomical site: without collapse and collapsed. The results are visualized in the images of the cases showing a predominance of velopharyngeal collapse: anteroposterior, lateral, or concentric; oropharyngeal lateral collapse; tongue anteroposterior collapse and anteroposterior collapse of the epiglottis. Understanding the obstruction sites and types of collapse illustrated in this study may help to predict therapeutic responses and learn the limitations or direct individual proposals patient.

[Anthropometrical measurements of the height of the upper lip and length of the philtrum]. / Medidas antropométricas de comprimento de lábio superior e filtro.

BACKGROUND: indirect anthropometrical measurements of the height of the upper lip and length of the philtrum. AIM: to describe the measurements of the height of the upper lip and length of the philtrum, extracted from video x-rays, in children with mixed dentition, relating these measurements to facial typology--medium and long-, to occlusion--Angle's class I and II--and to the rest position of the lips--with and without lip seal. METHOD: verification of 123 x-rays, in lateral norm, of children with ages between 7:7 and 11:10 years, 56 male and 67 female, extracted from archives of orthodontical documentation prior to treatment. RESULTS: the T-Student test, with a significance level of 5%, was used for the statistical analyses and the obtained results were: for the height of the upper lip no statistical difference was found considering the variables of face typology, occlusion and gender; there was no statistical difference for the measurements of the philtrum considering the variables of face typology and occlusion, but a statistically significant difference was found for the variable gender: a statistically significant difference was found for the height of the upper lip and length of the philtrum considering the variable rest position of the lips--with and without lip seal--being this a determinant factor for the measurements. This finding suggests that a direction of structural modifications may exist. CONCLUSION: the mean value for the height of the upper lip was established at 21mm; the mean value for the length of the philtrum was established at 12mm. It is important to consider the rest posture of the lips, during assessment and therapy, when taking the measurements of the height of the upper lip and length of the philtrum.

Relationship between electrical activity of the temporal and masseter muscles, bite force, and morphological facial index. / Relações entre potenciais elétricos dos músculos temporais e masseteres, força de mordida e índice morfológico da face.

PURPOSE: To analyze possible correlations between the electrical activity of masseter and temporal muscles, Bite Force (BF), and Morphological Facial Indices (MFI). METHODS: The study involved 43 young adults, both genders, 18 to 37 years old. The individuals were submitted to: face measurement to calculate MFI; Masseter and Temporal Surface Electromyography (sEMG) and BF measurements on right and left premolars and incisors. The following electromyographic tests were conducted: at rest position; Maximal Voluntary Isometrical Contraction (MVIC) and usual chewing of raisins. Statistical analysis was conducted using the coefficient of Spearman correlation with significance level of 5%. RESULTS: The values at rest in the temporal muscles were significantly higher than those in the masseter muscles. A meaningful correlation was found between MFI and sEMG in the MVIC test for the Left Temporal (rs=36, p=0.017). A significant correlation was observed between FMI and sEMG during BF in incisors for temporal muscles and the Right Masseter. During the force tests, it was possible to observe a meaningful correlation between BF in right premolars and the sEMG of the Left Temporal and Masseters. CONCLUSION: No correlation was found between the sEMG of temporal and masseter muscles, BF, and FMI in adult individuals based on the tests performed. The SEMG of temporal and masseter muscles seems to be associated only with BF. As a datum of habitual postural characteristic, the electrical activity of temporal muscles is higher than the activity of masseters, also regardless of MFI.

Speech-language-hearing instruments to assess peripheral facial palsy: an integrative literature review / Instrumentos de avaliação fonoaudiológica da paralisia facial periférica: revisão integrativa de literatura

ABSTRACT Purpose: to describe and analyze the clinical instruments that assess peripheral facial palsy through an integrative literature review. Methods: the precepts for this type of review were followed: research question, identification, selection of studies, and critical analysis. The Virtual Health Library (VHL), Scientific Electronic Library Online (SciELO), Google Scholar, and PubMed databases were accessed to search for fully available articles published in national journals between January 2008 and July 2018. The terms used in the search were "Speech, Language and Hearing Sciences", "Evaluation", and "Facial Paralysis", in both English and Portuguese. The data obtained were organized per author, title, objective, instruments used, description of the instruments, and application procedures used in the articles. Results: out of the total 992 articles found, only 18 met the inclusion criteria of the research. In most of them, there was only the citation of the assessment instruments or considerations about them, without fully describing the application procedures. Conclusion: the study identified publications that indicate the use of clinical and speech-language-hearing assessment instruments. However, further detailing is necessary regarding the assessment procedures to help develop and refine the speech-language-hearing methodologies and techniques.

RESUMO Objetivo: descrever e analisar os instrumentos clínicos de avaliação de paralisia facial periférica por meio da revisão integrativa de literatura. Métodos: foram seguidos os preceitos deste tipo de revisão: questão norteadora, identificação, seleção de estudos e análise crítica. As bases utilizadas foram: "Biblioteca Virtual em Saúde (BVS)", "Scientific Electronic Library (SCIELO)", "Google Acadêmico" e "Pubmed", na busca de artigos publicados em periódicos nacionais, no período entre janeiro de 2008 e julho de 2018, disponíveis na íntegra, sendo utilizados os termos: "Fonoaudiologia", "Avaliação" e "Paralisia Facial" e na língua inglesa: "Speech, Language and Hearing Sciences", "Evaluation" e "Facial Paralysis. Os dados obtidos foram organizados por autor, título, objetivo, instrumentos utilizados, descrição dos instrumentos e procedimentos de aplicação utilizados nos artigos. Resultados: de um total de 992 artigos encontrados, apenas 18 se encaixaram nos critérios de inclusão da pesquisa. Na maioria dos artigos encontrados, havia apenas citações ou considerações sobre instrumentos de avaliação, sem a plena descrição e procedimentos para aplicação. Conclusão: o estudo permitiu identificar publicações que indicam uso de instrumento de avaliação clínica e fonoaudiológica. No entanto, seria necessário detalhamento quanto a apresentação dos procedimentos de avaliação, visando cooperar na elaboração e no refinamento de metodologias e técnicas fonoaudiológicas.

Análise fonoaudiológica na cirurgia ortognática: estudo de caso uma década após procedimento / Speech-Language and Hearing Sciences Analysis in orthognathic surgery: a case study with a ten-year follow up / Análisis fonoaudiológica en la cirugía ortognática: estudio de caso una década de evolución posquirúrgica

Introdução: desproporções esqueléticas são consideradas casos extremos de variação da tipologia facial, caracterizadas por grandes alterações da oclusão associadas a modificações funcionais. O tratamento é orto-cirúrgico, com reconstrução das bases ósseas por meio de cirurgia ortognática. Após essa cirurgia, o acompanhamento fonoaudiológico auxilia o paciente no reconhecimento da nova face e nas readaptações das funcões de respiração, fala, mastigação e deglutição. Objetivo: apresentar relato de caso clínico de cirurgia ortognática, em seguimento longitudinal de 10 anos, por meio de análise das avaliações fonoaudiológicas. Relato do caso: mulher, 26 anos, portadora de deformidade craniofacial do tipo Classe III, prognata, com queixa estética e de mastigação, com indicação de cirurgia ortognática. Foram realizadas cinco avaliações fonoaudiológicas, sendo: a primeira na fase pré-operatória, segunda no 19º dia de pós-operatório, terceira após três meses de reabilitação fonoaudiológica, quarta após quatro meses de manutenção dos resultados obtidos e a quinta após 10 anos da intervenção cirúrgica. Em avaliação pré-cirúrgica foi registrada alteração no padrão miofuncional relacionado às funções de mastigação, deglutição, fala e respiração. Após terapia fonoaudiológica observou-se melhora da musculatura de lábios, bochecha, masseter e postura de língua, bem como na amplitude dos movimentos mandibulares. Em 10 anos observa-se estabilidade nos padrões funcionais de respiração, posicionamento de língua em repouso, organização do padrão da fala, articulação, deglutição, assim como na autoestima da paciente. Considerações finais: o tratamento fonoaudiológico associado à cirurgia ortognática e à ortodontia mostrou evoluções e eficácia, para nesse caso, atingir satisfação da paciente aos novos ajustes do padrão miofuncional.

Introduction: dentofacial deformities are seen as extreme cases of facial typology variation, characterized by major changes in occlusion associated with functional modifications. It requires an ortho-surgical treatment, in which the bone bases are reconstructed through orthognathic surgery. Treatment and monitoring are required after surgery with a Speech-language Pathologist (SLP) in order to assist patients in the recognition of their new faces and in the adjustments of orofacial functional patterns, avoiding negative interferences. Purpose: to report an orthognathic surgery clinical case in a 10-year longitudinal follow-up through the analysis of the SLP assessments. Case report: a prognathous 26-year-old woman with Class III craniofacial deformity, presenting aesthetic and chewing complaints with indication for orthognathic surgery. Five SLP ́s assessments were conducted, as follows: the first one, in the preoperative stage; the second, 19 days after the surgery; the third, after three months of SLP rehabilitation; the fourth, after four months of follow-up as maintenance of the results obtained; and the fifth, ten years after the surgical intervention. In the preoperative assessment, changes were recorded in the myofunctional pattern related to chewing, swallowing, speech and breathing functions. Improvements in the lip, cheek and masseter muscles were reported after SLP therapy, as well as in tongue posture and mandibular range of motion. After 10 years, favorable changes were observed in breathing pattern and tongue posture at rest, organization and stability of speech, articulation, and swallowing patterns, as well as in the patient's self-esteem. Final considerations: the SLP approach associated with orthognathic surgery and orthodontics procedure achieved evolutions and proved to be effective, leading this patient to satisfactory new adjustments of the myofunctional pattern.

Introducción: Desproporciones esqueléticas son consideradas casos extremos de variaciones de la tipología facial, caracterizadas por grandes alteraciones de la oclusión asociadas a las modificaciones funcionales. El tratamiento es echo con ortodoncia y cirugía ortognática, con reconstrucción de las bases óseas y estabilización oclusal. Después de esa cirugía, acompañamiento fonoaudiólogo auxilia el paciente en el reconocimiento facial y en las readaptaciones de las funciones estomatognáticas. Objetivo: Presentar relato de caso clínico de cirugía ortognática, en seguimiento longitudinal de 10 años, por medio de análisis de las evaluaciones fonoaudiológicas. Relato del caso: Mujer, 26 años portadora de deformidad cráneo facial del tipo clase III, prognata, con queja estética y de masticación, con indicación de cirugía ortognática. Fueron realizadas cinco evaluaciones fonoaudiológicas, siendo: la primera en la fase pre-operatorio, segunda en el 19º día de post operatorio, tercera después de tres meses de rehabilitación fonoaudiológica, cuarta después de cuatro meses de manutención de los resultados obtenidos y la quinta después de 10 años de la intervención de cirugía. En la evaluación preoperatorio fue registrada alteración en el patrón miofuncional relacionado a las funciones de masticación, deglución, habla y respiración. Después terapia fonoaudiológica se observó mejora en la musculatura de labios, mejillas, masseter (musculo masetero) y postura de la lengua, bien como en el patrón de oclusión. En 10 años se observa el cambio favorable en el patrón de respiración y posicionamiento de la lengua en reposo, organización y estabilidad del patrón de habla, articulación, deglución, así como en el auto estima de la paciente. Consideraciones Finales:El tratamiento fonoaudiológico asociado a la cirugía ortognática y la ortodoncia mostro evoluciones y eficacia, para en ese caso, alcanzar satisfacción de la paciente a los nuevos ajustes del patrón miofuncional.

Swallowing Analyses of Neonates and Infants in Breastfeeding and Bottle-feeding: Impact on Videofluoroscopy Swallow Studies

Abstract Introduction Dysphagia, when left untreated, can result in an increase in morbidity and mortality rates, especially among infants with history of life-threatening neonatal diseases. The videofluoroscopy swallowing study (VFSS) is considered the gold standard for the diagnosis of dysphagia. There are few imaging studies of infant swallowing based on videofluoroscopy, none of which were performed during breast-feeding. Objective To analyze the similarities and differences in infant swallowing function -regarding the feeding method - breast or bottle - and the impact on videofluoroscopy findings. Methods A retrospective study of 25 VFSSs of breastfeeding and bottle-feeding infants was performed. The studied variables were: oral capture and control; tongue versus mandible movement coordination; sucking pattern; mandible excursion; liquid flow; bolus retention; laryngeal penetration; tracheal aspiration; clearing of material collected in the pharynx; and gastroesophageal reflux (GER). Results The study showed a statistically significant association between nipple/areole capture; oral control; sucking pattern; mandibular excursion; liquid flow and feeding method. The velar sealing deficit, the place that trigger the pharyngeal swallow, food retention in the pharyngeal recesses, laryngeal penetration and GER were also factors associated with the feeding method. Conclusion The analysis of the swallowing characteristics of both feeding methods revealed significant differences between them, with an impact on the diagnosis in the VFSSs, especially regarding velar function.

Myofunctional orofacial examination: comparative analysis in young adults with and without complaints.

PURPOSE: To verify myofunctional orofacial characteristics in young adults and to compare data on individuals with and without myofunctional complaints, aiming to identify the main myofunctional problems and differentiating them from characteristics that are common for this population, as well as to list items for myofunctional evaluation in this population. METHODS: Cross-sectional study with 85 adult participants, aged between 19 and 39 years, selected through consecutive sampling at the Department of Speech, Language and Hearing Sciences of Universidade Veiga de Almeida. The participants were divided into two groups: G1 (comprising 50 individuals referred for orofacial myofunctional disorders) and G2 (comprising 35 volunteers without complaints). Descriptive evaluation of craniofacial structures of hard and soft tissues, kinesiology and mandible range of motion and functional patterns of breathing, chewing, and swallowing was applied. Three expert Speech-Language pathologists assessed all participants. Statistical analysis was done using χ2-test, Student's t-test, or Mann-Whitney test. The reliability level was 99%. RESULTS: A predominance of Angle Class I pattern of occlusions for G2 (p<0.0001) was found. G1 showed (p<0.0001) mandible movements with deviations and joint noises, amplitude reduction in lateral and protrusive movements, unilateral chewing, nonexpected muscle contraction, temporomandibular joint noises, swallowing with excessive contraction of the orbicularis oris muscle, loud noise, and residues (p=0.006). CONCLUSION: The main myofunctional orofacial alterations in young adults with complaints refer to changes of the mandibular movements and patterns of chewing or of swallowing, reflecting the main items of the clinical evaluation. Many items of assessment and characterization do not differ between the groups, and these should be analyzed regarding their relevance.

Interference of dentofacial deformities in the acoustic characteristics of speech sounds / Interferência das deformidades dentofaciais nas características acústicas dos sons da fala

ABSTRACT Purpose: to verify speech characteristics regarding the production of fricative sounds in people with dentofacial deformities (DFD), through acoustic analysis, evaluating possible interferences of the variation of the osseous bases in the articulation of speech. Methods: fifteen adults of both genders, aged between 17 and 42, participated in the study. They were distributed in three groups: GII (n = 5) Skeletal Class II, GIII (n = 5) Skeletal Class III, and CG (n = 5) without DFD. All of them had their voices recorded, with key words containing the fricative sounds of Brazilian Portuguese (BP), and acoustically analyzed; the parameters: duration, intensity, and formants F1, F2. The Mann-Whitney test was used to compare the groups. Results: there were differences (p <0.05) when comparing GII and GIII with CG. For the variable duration GIII obtained higher value in the fricative sound /z/ (r = 0.016, p <0.05). The variable intensity was higher for GII in /z/ (r = 0.028, p <0.05), and higher for GIII in /f/ (r = 0.028, p <0.05), /v/ (r = 0.028, p<0.05) and /ʃ/ (r = 0.036, p <0.05). For the variable F1, GII obtained a higher value for the syllable /za/ (r = 0.047, p <0.05). In the variable F2, GII obtained the lowest value in the syllable /ʒa/ (r = 0.047, p <0.05). Conclusion: the disharmony of the maxillomandibular osseous bases results in interference in speech acoustic characteristics regarding fricative sounds.

RESUMO Objetivo: verificar as características da fala quanto a produção dos sons fricativos em indivíduos com deformidades dentofaciais (DDF), por meio da análise acústica, analisando possíveis interferências da variação das bases ósseas na articulação da fala. Métodos: participaram 15 indivíduos adultos, ambos os sexos, com idade entre 17 a 42 anos. Distribuídos em 3 grupos: GII (n=5) Classe II esquelética, GIII (n=5) Classe III esquelética e GC (n=5) sem (DDF). Todos tiveram suas vozes gravadas, com "palavras-chave" contendo os sons fricativos do português brasileiro (PB), e analisadas acusticamente, os parâmetros: duração, intensidade, e formantes F1, F2. Para a comparação entre os grupos foi utilizado o Teste de Mann-Whitney. Resultados: houve diferenças (p<0,05) ao comparar GII e GIII com GC. Para a variável duração GIII obteve valor maior no som fricativo /z/ (r=0,016; p<0,05). A variável intensidade foi maior para o GII em /z/ (r=0,028; p<0,05), e maior para o GIII em /f/ (r=0,028; p<0,05), /v/ (r=0,028; p<0,05) e /ʃ/ (r=0,036; p<0,05). Para a variável F1, GII obteve valor maior para a sílaba /za/ (r=0,047; p<0,05). Na variável F2 o GII obteve valor mais baixo na sílaba /ʒa/ (r=0,047; p<0,05). Conclusão: a desarmonia das bases ósseas maxilomandibulares resulta em interferência nas características acústicas da fala quanto aos sons fricativos.

Morfofisiologia dos exercícios orofaríngeos: revisão integrativa / Oropharyngeal exercises morphophisiology: an integrative review / Morfofisiología de los ejercicios orofaríngeos: revisión integrativa

Introdução: Dentre as possíveis abordagens terapêuticas fonoaudiológicas para as regiões orofacial e orofaríngea, a utilização de exercícios constitui-se em proposta frequente para trazer mudanças na musculatura envolvida e na funcionalidade dessas regiões. Entretanto, pouco se busca em relação à compreensão de como os exercícios funcionam para essa musculatura e principalmente quais as possíveis mudanças que podem ser observadas a partir de um programa de treinamento com exercícios. Objetivo: Realizar revisão integrativa da literatura científica referente à morfofisiologia dos exercícios orofaríngeos empregados na terapêutica fonoaudiológica. Método: Realizada busca nas bases de dados eletrônicas: Pubmed, Medline e Scielo, pela combinação dos seguintes Descritores em Ciências da Saúde (DeCs): "fisiologia", "exercício"; "terapia miofuncional"; "disfagia" e "Fonoaudiologia" nas línguas portuguesa e inglesa, por descritores associados (e/and). A seleção dos estudos foi realizada por meio da leitura do título, resumo, para aplicação dos critérios de inclusão e exclusão. Resultados: No total, foram encontrados 890 estudos nas bases de dados. A partir dos critérios de inclusão e exclusão foram selecionados 12 artigos, os quais foram analisados criteriosamente. Os artigos selecionados apresentaram quais músculos são ativados durante a prática dos exercícios, qual efetividade individual do exercício proposto e os casos em que essas terapêuticas são indicadas. Embora esses estudos tenham contribuído para a base de conhecimento atual, os mesmos possuem diferentes desenhos metodológicos. Conclusão: Parece existir reduzido número de estudos que abordem os efeitos promovidos pela terapia miofuncional orofacial nos músculos e funções orofaríngeas, sendo a maioria deles relacionados aos estudos da disfagia orofaríngea.

Introduction: Among the possible speech-language therapy approaches for the orofacial and oropharyngeal regions, the use of exercises constitutes a frequent proposal to bring about changes in the musculature involved and the functionality of these regions. However, little is sought in relation to the understanding of how the exercises work for this musculature and especially what the possible changes that can be observed from the exercise training program. Objective: To carry out an integrative review of the scientific literature referring to the morphophysiology of the exercises oropharyngeal used speech therapy. Method: the bibliographic survey was carried out in the electronic databases: Pubmed, MEDLINE and Scielo, using the Descriptors in Health Sciences (DeCs): "exercise"; "physiology"; "myofunctional therapy"; "dysphagia" and "Speech, Language and Hearing Sciences" in Portuguese and English. Inclusion and exclusion criteria were applied based on the title and the abstracts. Results: In total, 890 studies were found in the databases. Based on the inclusion and exclusion criteria, 12 articles were analyzed carefully. The selected articles presented which muscles are activated during exercise, which individual effectiveness of the proposed exercise and the cases in which these therapies are indicated. Although these studies have contributed to the current knowledge base, they have different methodological designs. Conclusion: There seems to be a small number of studies addressing the effects promoted by orofacial myofunctional therapy in muscles and oropharyngeal functions. Most of them are related to the studies of oropharyngeal dysphagia.

Introducción: Entre los posibles abordajes terapéuticos fonoaudiológicos para regiones orofacial y orofaríngea, la utilización de ejercicios se constituye en propuesta frecuente para traer cambios en la musculatura involucrada y en la funcionalidad de esas regiones. Poco se busca en relación con la comprensión de cómo los ejercicios funcionan para esa musculatura y principalmente cuáles son los posibles cambios que pueden ser observados a partir de un programa de entrenamiento con ejercicios. Objetivo: Realizar revisión integrativa de la literatura científica referente a la morfofisiología de los ejercicios orofaríngeos empleados en la terapia del habla. Método: el levantamiento bibliográfico fue realizado en las bases de datos electrónicos: Pubmed, MEDLINE y Scielo, mediante la combinación de los siguientes Descriptores en Ciencias de la Salud (DeCs): "fisiología", "ejercicio"; "terapia miofuncional"; "disfagia" y "fonoaudiología", en los idiomas portugués y inglés. Resultados: En total, se encontraron 890 estudios en las bases de datos. Criterios de inclusión y exclusión se aplicaron en el título y en los resúmenes, siendo seleccionados 12 artículos, los cuales fueron analizados. Los artículos seleccionados presentaron qué músculos se activan durante la práctica de los ejercicios, cuál es la efectividad individual del ejercicio propuesto y los casos en que esas terapias son indicadas. Aunque estos estudios han contribuido a la base de conocimiento actual, poseen diferentes diseños metodológicos. Conclusión: Parece existir un número reducido de estudios que abordan los efectos promovidos por la TMO en los músculos y funciones orofaríngeas, siendo la mayoría de ellos relacionados con los estudios de la disfagia orofaríngea.

Characteristics of sequential swallowing of liquids in young and elderly adults: an integrative review.

PURPOSE: To perform an integrative review of studies on liquid sequential swallowing, by characterizing the methodology of the studies and the most important findings in young and elderly adults. RESEARCH STRATEGY: Review of the literature written in English and Portuguese on PubMed, LILACS, SciELO and MEDLINE databases, within the past twenty years, available fully, using the following uniterms: sequential swallowing, swallowing, dysphagia, cup, straw, in various combinations. SELECTION CRITERIA: Research articles with a methodological approach on the characterization of liquid sequential swallowing by young and/or elderly adults, regardless of health condition, excluding studies involving only the esophageal phase. DATA ANALYSIS: The following research indicators were applied: objectives, number and gender of participants; age group; amount of liquid offered; intake instruction; utensil used, methods and main findings. RESULTS: 18 studies met the established criteria. The articles were categorized according to the sample characterization and the methodology on volume intake, utensil used and types of exams. Most studies investigated only healthy individuals, with no swallowing complaints. Subjects were given different instructions as to the intake of all the volume: usual manner, continually, as rapidly as possible. The findings about the characterization of sequential swallowing were varied and described in accordance with the objectives of each study. CONCLUSION: It found great variability in the methodology employed to characterize the sequential swallowing. Some findings are not comparable, and sequential swallowing is not studied in most swallowing protocols, without consensus on the influence of the utensil.

Effects of orofacial myofunctional therapy on the symptoms and physiological parameters of sleep breathing disorders in adults: a systematic review / Efeitos da terapia miofuncional orofacial em adultos quanto aos sintomas e parâmetros fisiológicos dos distúrbios respiratórios do sono: revisão sistemática

ABSTRACT Recently, the orofacial myofunctional therapy (OMT) has appeared as a possible alternative treatment for obstructive sleep apnea (OSA). Systematic reviews are required to achieve scientific evidence, seeking to direct the decision on therapeutic issues. The aim of this study was to systematically review the literature about the OMT proposals in adults with OSA related to symptoms and physiological parameters. Data sources were Lilacs, MEDLINE, Pubmed, Cochrane and Scielo using the descriptors: obstructive sleep apnea; myofunctional therapy; oropharyngeal exercises; breathing exercises; upper airway exercises; speech therapy. Studies published from 2000 to 2017 that evaluated the treatment with isolated OMT in subjects with OSA were included, obligatorily with polysomnographic data, pre and post therapy. Eight studies, out of 124 articles, were eligible according to the criteria adopted. Two systematic reviews, one clinical trial, three randomized clinical trials, and two case reports were included. Six studies showed a decrease in the Apnea and Hypopnea Index (AHI), five studies showed improvement in the minimum SpO2, decrease in the Epworth Sleepiness Scale (ESS) and in snoring. OMT proposals refer to a three-month program changing the parameters related to partial reduction of AHI, ESS index, snoring, and partial increase of SpO2. There are few randomized studies.

RESUMO Recentemente a terapia miofuncional orofacial (TMO) aparece como tratamento alternativo para a apneia obstrutiva do sono (AOS). Revisões sistemáticas são necessárias para apontar evidência científica buscando direcionar sua indicação. O objetivo foi analisar sistematicamente a literatura científica quanto às propostas de TMO em adultos com AOS e sintomas e parâmetros fisiológicos. As buscas ocorreram: Lilacs, MEDLINE, Pubmed, Cochrane e Scielo usando-se os descritores: apneia obstrutiva do sono; terapia miofuncional; exercícios orofaríngeos; exercícios respiratórios; exercícios da via aérea; Fonoaudiologia. Estudos publicados de 2000 a 2017 que avaliaram TMO isolada em sujeitos com AOS foram selecionados. Obrigatoriamente com dados de polissonografia pré e pós terapia. A partir de 124 artigos, oito estudos foram elegíveis de acordo com os critérios adotados. Duas revisões sistemáticas, um ensaio clínico, três ensaios clínicos randomizados e dois estudos de casos foram incluídos. Seis estudos mostraram diminuição do índice de apneia e hipopneia (IAH), cinco estudos mostraram melhora da saturação mínima SpO2, pontuação da escala de sonolência e do ronco. A TMO refere-se à programas de três meses com modificação dos parâmetros referentes à redução parcial do IAH, aumento parcial da saturação mínima SpO2, redução da sonolência diurna e do ronco. Ainda há poucos estudos randomizados.