Quality of life in dysphagia and functional performance of cancer patients in palliative care. / Qualidade de vida em disfagia e performance funcional de pacientes oncológicos em cuidados paliativos.

PURPOSE: To correlate the functional performance and impact of dysphagia on the quality of life of cancer patients in palliative care. METHODS: This cross-sectional, quantitative study was conducted at the outpatient clinic and oncology ward of a university hospital. Inclusion criteria required patients to respond positively to the question: "Do you have difficulty or problems swallowing?". Patients were excluded if they had been diagnosed with head and neck cancer, were unable to answer questionnaires due to actively dying status, were in a state of drowsiness, experienced extreme pain and systemic instability, or if data collection instruments were incomplete. Two instruments were used in their Brazilian Portuguese versions: the Palliative Performance Scale (PPS) and the M. D. Anderson Dysphagia Inventory (MDADI). The variables were analyzed using descriptive and inferential statistics, with Pearson's correlation used at a 5% significance level. RESULTS: The sample consisted of 39 participants, with an average age of 65.3 years, of whom 24 (61.5%) were women. The most frequent neoplasm sites were the pancreas and stomach. The results of the PPS indicated that the average patient had reduced ambulation and inability to work, but maintained independence in self-care, with a complete level of swallowing and consciousness. The MDADI showed an average degree of limitation. Outpatients exhibited a moderate correlation between the MDADI result and the level of functionality according to the PPS. CONCLUSION: Cancer patients at the palliative care outpatient clinic demonstrated a correlation between functional performance and the impact of dysphagia on quality of life.

OBJETIVO: Correlacionar a performance funcional e impacto da disfagia na qualidade de vida de pacientes oncológicos em cuidados paliativos. MÉTODO: Estudo transversal e quantitativo realizado no ambulatório e enfermaria de oncologia de um hospital universitário. Os critérios de inclusão exigiram que os pacientes respondessem positivamente à pergunta: "você tem dificuldade ou problema para engolir?". Foram excluídos os pacientes que tivessem diagnóstico de câncer de cabeça e pescoço, incapacidade de responder questionários devido a estarem em processo ativo de morte, estado de sonolência, dor extrema e instabilidade sistêmica, bem como os instrumentos de coleta que não foram concluídos. Foram aplicados dois instrumentos em suas versões para o português brasileiro: a Palliative Performance Scale (PPS) e M. D. Anderson Dysphagia Inventory (MDADI). A análise das variáveis foi realizada com base na estatística descritiva e inferencial, por meio da correlação de Pearson, em nível de significância de 5%. RESULTADOS: A amostra foi composta por 39 participantes, com média de 65,3 anos, dos quais 24 (61,5%) eram mulheres. As localizações mais frequentes de neoplasia foram: pâncreas e estômago. O resultado da PPS indicou que a média dos pacientes apresentou deambulação reduzida, incapacidade para trabalhar, porém com independência no autocuidado, nível de ingesta e consciência completos e o MDADI obteve grau médio de limitação. Pacientes ambulatoriais apresentaram correlação moderada entre o resultado do MDADI e nível de funcionalidade pela PPS. CONCLUSÃO: Pacientes oncológicos do ambulatório de cuidados paliativos apresentaram correlação entre performance funcional e o impacto da disfagia na qualidade de vida.

Methodological Procedures to Acquire and Analyze Ultrasound Images of Swallowing: A Scoping Review.

This scoping review aimed to identify methodological procedures for acquiring and analyzing ultrasound images related to swallowing in adults and older adults. The inclusion criteria were based on the PCC strategy (participants, concept, and context), as follows: population (adults and older adults), concept (ultrasound assessment), and context (swallowing assessment). The review included observational, experimental, descriptive, and analytical studies and excluded those that were not available in full, animal studies, in vitro studies, letters to the editor, errata, study protocols, and those that used ultrasound for purposes other than swallowing. There were no language and time restrictions. Two independent blinded professionals selected 81 articles that met the inclusion criteria from different databases. The most evaluated parameters included tongue morphology and movements, hyoid bone displacement, swallowing muscle area, and pharyngeal residue detection, such as pharyngeal wall mobility. They used convex and linear transducers (3 MHz to 8 MHz) positioned in the submental, laryngeal, and lateral regions of the neck. The subjects were seated and instructed to eat different food volumes and consistencies. The literature mapping showed that ultrasound is a promising diagnostic tool, helping clinicians understand swallowing disorders, as it provides static and dynamic images in different modes and positions. Also, patients receive real-time biofeedback of changes related to dysphagia.

Olfactory and taste disorders in COVID-19: a cross-sectional study in primary health care.

OBJECTIVE: The objective of this study was to describe the occurrence of self-reported olfactory and taste disorders in non-hospitalized Brazilian adults who presented severe acute respiratory syndrome-related coronavirus 2 infection symptoms and attended primary health care. METHODS: This cross-sectional study was based on a routine standardized diagnostic screening questionnaire applied in a Brazilian primary care facility. The olfactory and taste disorder occurrence was compared between severe acute respiratory syndrome-related coronavirus 2-positive and severe acute respiratory syndrome-related coronavirus 2-negative cases and described by age and sex. RESULTS: Severe acute respiratory syndrome-related coronavirus 2-positive patients had a higher proportion of self-reported olfactory and taste disorders, as compared with severe acute respiratory syndrome-negative (50.7%, vs. 20.6%, p<0.0001). Of all individuals with self-reported olfactory and taste disorder cases, 69% presented both olfactory and taste impairments, 13% olfactory only, and 17% taste only. In severe acute respiratory syndrome-related coronavirus 2-positive cases, the frequency of olfactory and taste disorders was significantly higher among females as compared with males (71% vs. 34%). Additionally, people with olfactory and taste disorders were significantly younger in the severe acute respiratory syndrome-related coronavirus 2-positive group. CONCLUSION: Self-reported olfactory and taste disorders are highly common among non-hospitalized severe acute respiratory syndrome-related coronavirus 2-positive Brazilian people who attended the Family Health Care Unit. The co-occurrence of both self-reported olfactory and taste disorders was more frequent than self-reported olfactory or taste disorders alone.

Olfactory and taste disorders in COVID-19: a cross-sectional study in primary health care

SUMMARY OBJECTIVE: The objective of this study was to describe the occurrence of self-reported olfactory and taste disorders in non-hospitalized Brazilian adults who presented severe acute respiratory syndrome-related coronavirus 2 infection symptoms and attended primary health care. METHODS: This cross-sectional study was based on a routine standardized diagnostic screening questionnaire applied in a Brazilian primary care facility. The olfactory and taste disorder occurrence was compared between severe acute respiratory syndrome-related coronavirus 2-positive and severe acute respiratory syndrome-related coronavirus 2-negative cases and described by age and sex. RESULTS: Severe acute respiratory syndrome-related coronavirus 2-positive patients had a higher proportion of self-reported olfactory and taste disorders, as compared with severe acute respiratory syndrome-negative (50.7%, vs. 20.6%, p<0.0001). Of all individuals with self-reported olfactory and taste disorder cases, 69% presented both olfactory and taste impairments, 13% olfactory only, and 17% taste only. In severe acute respiratory syndrome-related coronavirus 2-positive cases, the frequency of olfactory and taste disorders was significantly higher among females as compared with males (71% vs. 34%). Additionally, people with olfactory and taste disorders were significantly younger in the severe acute respiratory syndrome-related coronavirus 2-positive group. CONCLUSION: Self-reported olfactory and taste disorders are highly common among non-hospitalized severe acute respiratory syndrome-related coronavirus 2-positive Brazilian people who attended the Family Health Care Unit. The co-occurrence of both self-reported olfactory and taste disorders was more frequent than self-reported olfactory or taste disorders alone.

Ultrasound assessment of swallowing: a scoping review protocol / Avaliação ultrassonográfica da deglutição: um protocolo de revisão de escopo

ABSTRACT Purpose: to conduct a scoping review to identify procedures to obtain and analyze ultrasound images related to swallowing in adults and older adults. Methods: the strategy (participants, concept, and context) was employed to determine inclusion criteria - population (adults and older adults), concept (ultrasound assessment), and context (assessment of swallowing). The review will analyze observational, experimental and/or quasi-experimental, descriptive, analytical, and qualitative studies, and opinion texts and articles. It will exclude studies unavailable in full text, in animals, or in vitro, letters to the editor, errata, study protocols, and studies using ultrasound with purposes other than swallowing. There will be no restriction on the language. Two independent professionals will select the studies in the databases (MEDLINE, EMBASE, LILACS, Web of Science, and Scopus). The review will analyze the year of publication, study design, sample, age, and procedures to assess swallowing with ultrasound. Data will be presented in diagrams, tables, and narrative. Final Considerations: the literature has described ultrasound as an assessment instrument to analyze biomechanical swallowing movements. This scoping review will describe methods to acquire ultrasound images to assess swallowing.

RESUMO Objetivo: realizar uma revisão de escopo para identificar os procedimentos de obtenção e análise de imagens ultrassonográficas relacionadas à deglutição de adultos e idosos. Métodos: a estratégia (participantes, conceito e contexto) foi empregada para determinar os critérios de inclusão - população (adultos e idosos), conceito (avaliação ultrassonográfica) e contexto (avaliação da deglutição). Serão analisados os estudos observacionais, experimentais e/ou quase experimentais, descritivos, analíticos, qualitativos, textos e artigos de opinião; e eliminados os que não estiverem disponíveis na íntegra, estudos em animais, in vitro, cartas ao editor, errata, protocolos de estudo e os que usaram a ultrassonografia para fins que não contemplam a deglutição. Não haverá restrições a idiomas. Os estudos serão escolhidos por dois profissionais, independentemente, a partir das bases de dados (MEDLINE, EMBASE, LILACS, Web of Science e Scopus). Serão analisados o ano do estudo, delineamento, amostra, idade e os procedimentos para avaliação ultrassonográfica da deglutição. Os dados serão expostos por meio de diagramas, narrativas e tabelas. Considerações Finais: a ultrassonografia vem sendo descrita na literatura como um instrumento de avaliação que permite a análise dos movimentos biomecânicos da deglutição. Esta revisão de escopo irá permitir a descrição dos métodos de aquisição da ultrassonografia na avaliação da deglutição.

Speech-language-hearing therapists' perception of orofacial myofunctional changes in subjects with congenital Zika syndrome / Percepção dos fonoaudiólogos sobre alterações miofuncionais orofaciais em sujeitos com Síndrome Congênita pelo Zika Vírus

ABSTRACT Purpose: to investigate the profile of speech-language-hearing therapists from Northeastern Brazil assisting children presented with congenital Zika syndrome and their perception of these children's orofacial myofunctional aspects and speech-language-hearing intervention procedures. Methods: a cross-sectional observational study with quantitative/qualitative analysis. The data collection instrument was an online questionnaire with 34 items on the speech-language-hearing therapists' sociodemographic information and perception of the study topic. The sample comprised 23 speech-language-hearing therapists from the nine Northeastern states. Results: altogether, 96% of the sample were females. Most professionals had more than 3 years of experience with congenital Zika syndrome. Concerning stomatognathic system characterization, the professionals described a greater degree of change in aspects of orofacial muscle posture and mobility. Regarding oral functions, they perceived greater changes in speech and swallowing liquids and solid foods. There was a greater degree of change in masticating solids than in swallowing liquids. Conclusion: most speech-language-hearing therapists in the research had a specialization degree, especially in dysphagia and oral-motor control. Most of them had more than 3 years of experience following up with children with congenital Zika syndrome, which indicates a satisfactory time working with this population to help identify orofacial myofunctional changes in them. The professionals stated that orofacial muscle posture and mobility, speech, and swallowing liquids and solid foods were the most changed aspects.

RESUMO Objetivo: investigar o perfil e a percepção de fonoaudiólogos do Nordeste do Brasil, que atuam com crianças com Síndrome Congênita pelo Zika vírus, quanto aos aspectos miofuncionais orofaciais e aos procedimentos de intervenção fonoaudiológica. Métodos: trata-se de estudo transversal, observacional, com análise quanti-qualitativa. O instrumento de coleta de dados tratou-se de um questionárioon-line, que continha 34 questões abrangendo: dados sociodemográficos e questões voltadas para a percepção de fonoaudiólogos no que se refere ao assunto estudado. A amostra foi composta por 23 fonoaudiólogos dos nove estados do Nordeste. Resultados: da amostra, 96% foram mulheres. A maioria dos profissionais apresentava mais de 3 anos de experiência com a Síndrome Congênita pelo Zika Vírus. Na caracterização do sistema estomatognático, os profissionais descreveram maior grau de alteração nos aspectos de postura e mobilidade da musculatura orofacial. Em relação às funções, observou-se maior percepção de alteração na fala e deglutição para líquido e sólido. Conclusão: a maioria dos fonoaudiólogos da pesquisa possuem especialização, com destaque nas áreas de Disfagia e Motricidade Orofacial. Os profissionais afirmaram que a postura e mobilidade da musculatura orofacial são os aspectos mais alterados, assim como as funções de fala e deglutição de sólido e líquido.

Effects of photobiomodulation combined with orofacial myofunctional therapy on the quality of life of individuals with temporomandibular disorder. / Efeitos da fotobiomodulação associada a terapia miofuncional orofacial na qualidade de vida de indivíduos com disfunção temporomandibular.

PURPOSE: To analyze the impact of photobiomodulation combined with orofacial myofunctional therapy (OMT) on the oral health quality of life (OHQOL) of individuals with temporomandibular disorder, before and after the treatment. METHODS: Blind, controlled, randomized clinical trial with 34 volunteers randomly distributed into two groups: G1, who received OMT combined with photobiomodulation, and G2, treated with OMT combined with inactive laser. The subjects were first assessed with a visual analog scale (VAS) to classify them according to the degree of orofacial pain and with the Oral Health Impact Profile - Short Form (OHIP-14) regarding the impact on the OHQOL. The resulting data were statistically analyzed. The significance level was set at 0.05 (95%). RESULTS: "Physical pain", "psychological discomfort", "physical disability", and "psychological disability" were the aspects with the greatest impact on the OHQOL. The G1 subjects responded positively to their treatment, as well as G2 to theirs. There was a strong positive correlation between VAS and total OHIP-14 score in both groups after the treatment. However, the functional recovery in the control group individuals (G2) was the most perceived positive change in the OHQOL in comparison with the experimental group (G1). CONCLUSION: The people who received photobiomodulation combined with OMT perceived an improvement in the OHQOL, as well as those treated with placebo laser. There was a strong positive correlation in both groups in the improvement of the degree of pain and self-perception of the OHQOL.

OBJETIVO: Analisar o impacto na qualidade de vida relacionada à saúde oral de indivíduos com disfunção temporomandibular, antes e após o tratamento de fotobiomodulação associada a terapia miofuncional orofacial. MÉTODO: Estudo do tipo ensaio clínico randomizado, controlado e cego, com 34 voluntários distribuídos aleatoriamente em dois grupos: G1, que recebeu a Terapia Miofuncional Orofacial (TMO) associada a fotobiomodulação e o G2, tratado pela TMO associada ao laser inativo. Os indivíduos foram submetidos, primeiramente, à avaliação para serem classificados de acordo com o grau da dor orofacial pela Escala Visual Analógica (EVA) e também quanto ao impacto da qualidade de vida relacionada a saúde oral (QVRSO) pelo questionário Oral Health Impact Profile ­ Short form (OHIP-14). Os dados obtidos foram analisados estatisticamente. Foi adotado o nível de significância de 0,05 (95%). RESULTADOS: "Dor física", "desconforto psicológico", "limitação física" e "limitação psicológica" foram os aspectos mais impactantes na QVRSO. O G1 apresentou respostas positivas para o respectivo tratamento, assim como o G2. Observou-se correlação positiva e de grau forte para EVA e escore total do OHIP-14 em ambos os grupos após tratamento. Porém, os indivíduos do grupo controle (G2) evidenciaram que a recuperação funcional foi o aspecto que mais se percebeu de mudança positiva na QVRSO em comparação ao grupo experimental (G1). CONCLUSÃO: As pessoas que receberam fotobiomodulação associada a TMO-perceberam melhora da QVRSO, assim como as tratadas com o laser placebo. Houve correlação positiva e forte em ambos os grupos na melhora do grau da dor e autopercepção da QVRSO.

Accuracy of an epidemiological oropharyngeal dysphagia screening for older adults.

OBJECTIVE: The aim of this study was to determine the accuracy of an epidemiological screening questionnaire for oropharyngeal dysphagia in older people. BACKGROUND: Determining the cut-off point and the accuracy of the self-reported epidemiological questionnaire for screening oropharyngeal dysphagia in older adults is important for mass screening, which may estimate the prevalence of oropharyngeal dysphagia. MATERIALS AND METHODS: This was a cross-sectional diagnostic study with a convenience sample of 70 older adults over 60 years of age of both sexes, aged between 60 and 90 years (mean age 69.2; SD, 7.6). It used a screening questionnaire with nine ordered items response options resulted in a score ranging from 0 to 18. The criterion test was the fiberoptic endoscopic evaluation of swallowing, with analysis of the receiver operating characteristic (ROC), with a 5% significance level. RESULTS: Oropharyngeal dysphagia frequency by the criterion test was 73%, with no significant difference between age and sex. The area under the ROC curve was 0.88 (95% confidence interval: 0.79-0.98) above the cut-off point 3. This screening questionnaire showed good parameters of sensitivity (80%), specificity (89%), positive predictive value (95%), negative predictive value (63%), positive likelihood ratio (7.64), negative likelihood ratio (0.22) and accuracy (83%). CONCLUSIONS: This questionnaire may be a satisfactory screening tool for estimating the prevalence of oropharyngeal dysphagia in older adults.

Variability in quantitative parameters of instrumental swallowing assessments: a scoping review protocol / Variabilidade de parâmetros quantitativos das avaliações instrumentais da deglutição: protocolo de revisão de escopo

ABSTRACT Purpose: to present a scoping review protocol mapping scientific evidence on the level of variability in quantitative parameters or outcomes extracted with instrumental swallowing examinations. Methods: a protocol following the methodological approach designed by the Joanna Briggs Institute and the scoping review recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). The search will be made in PubMed/MEDLINE, LILACS, Cochrane Library, EMBASE, Web of Science, Scopus, and CINAHL and the grey literature (Google Scholar and ProQuest) with a search strategy developed for PubMed/MEDLINE, adapted for each database. Two independent reviewers will initially select articles by title and abstract, and the full text of the selected ones will be read and analyzed according to the eligibility criteria. Data will be extracted from the selected articles in a standardized form, and the results will be presented in a flowchart and narrative summary, following PRISMA-ScR guidelines. Final considerations: the scoping review resulting from this protocol is expected to present the overall state of the scientific evidence and identify gaps in the topic that need to be addressed in studies.

RESUMO Objetivo: apresentar um protocolo de revisão de escopo, o qual pretenderá mapear as evidências científicas sobre o nível de variabilidade dos parâmetros ou desfechos quantitativos extraídos por exames instrumentais da deglutição. Métodos: o protocolo seguirá a proposta metodológica designada pelo Joanna Briggs Institute (JBI) e as recomendações para elaboração de revisões de escopo do Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). Serão pesquisadas as bases de dados eletrônicas Pubmed/Medline, Lilacs, Cochrane Library, Embase, Web of Science, Scopus e CINAHL, assim como a literatura cinzenta pelo Google Scholar e ProQuest. Desenvolveu-se uma estratégia de busca para a Pubmed/Medline, que será adaptada para cada base de dados. Os artigos serão inicialmente selecionados pelo título e resumo por dois revisores independentes. Os textos completos dos artigos incluídos serão lidos e analisados conforme os critérios de elegibilidade. Os dados serão extraídos dos artigos selecionados por meio de formulário padronizado. Os resultados serão apresentados em fluxograma e resumo narrativo, seguindo as diretrizes do PRISMA-ScR. Considerações Finais: Espera-se que a revisão de escopo a ser gerada por meio deste protocolo apresente o estado geral das evidências científicas e identifique as lacunas que precisam ser estudadas sobre o tema investigado.

Translation and transcultural adaptation of the Modified Swallowing Assessment (MSA) to Brazilian Portuguese. / Tradução e adaptação transcultural do Modified Swallowing Assessment (MSA) para o português brasileiro.

PURPOSE: To translate and adapt the Modified Swallowing Assessment (MSA) protocol for post-stroke patients into Brazilian Portuguese. METHODS: This is an initial stage of the Brazilian Portuguese Modified Swallowing Assessment validation process. Translation was performed by two bilingual speech therapists and the translations synthesis evaluations by two external dysphagia experts. The synthesis version in the target language (Portuguese) was back-translated into the source language (English). After the synthesis of the translated versions, the instrument was applied to 22 post-stroke individuals. RESULTS: Health professionals discussed all the results of the study stages considering the instrument concept and the target population. The semantic, linguistic and conceptual equivalences found in the translation and adaptation process were adequate, not requiring modifications since the items were consistent with the Brazilian culture. CONCLUSION: MSA was translated and adapted to Brazilian Portuguese (MSA-BR). The translation and cross-cultural adaptation process included all the items of the original protocol and maintained the standards and characteristics of the instrument.

OBJETIVO: Traduzir e adaptar para o português brasileiro o protocolo Modified Swallowing Assessment (MSA) para pacientes pós-acidente vascular cerebral. MÉTODO: Trata-se de uma etapa inicial do processo de validação do Modified Swallowing Assessment para o português brasileiro. Foi realizada a tradução por dois fonoaudiólogos bilíngues e a síntese das traduções por dois avaliadores externos, especialistas em disfagia. A versão síntese no idioma alvo (português) foi retrotraduzida para o idioma fonte (inglês). Após a síntese das versões traduzidas, o instrumento foi aplicado em 22 indivíduos com acidente vascular cerebral. RESULTADOS: Os avaliadores debateram sobre todos os resultados das etapas do estudo considerando o conceito do teste e o público alvo. As discrepâncias semânticas, linguísticas e conceituais encontradas no processo de tradução e adaptação foram adequadas, para que os itens fossem compatíveis com a cultura brasileira. CONCLUSÃO: O MSA foi traduzido e adaptado para o português brasileiro (MSA-BR). O processo de tradução e adaptação transcultural manteve todos os itens do protocolo original, preservando-se os padrões e as características do instrumento original.

Tradução e adaptação transcultural do Modified Swallowing Assessment (MSA) para o português brasileiro / Translation and transcultural adaptation of the Modified Swallowing Assessment (MSA) to Brazilian Portuguese

RESUMO Objetivo Traduzir e adaptar para o português brasileiro o protocolo Modified Swallowing Assessment (MSA) para pacientes pós-acidente vascular cerebral. Método Trata-se de uma etapa inicial do processo de validação do Modified Swallowing Assessment para o português brasileiro. Foi realizada a tradução por dois fonoaudiólogos bilíngues e a síntese das traduções por dois avaliadores externos, especialistas em disfagia. A versão síntese no idioma alvo (português) foi retrotraduzida para o idioma fonte (inglês). Após a síntese das versões traduzidas, o instrumento foi aplicado em 22 indivíduos com acidente vascular cerebral. Resultados Os avaliadores debateram sobre todos os resultados das etapas do estudo considerando o conceito do teste e o público alvo. As discrepâncias semânticas, linguísticas e conceituais encontradas no processo de tradução e adaptação foram adequadas, para que os itens fossem compatíveis com a cultura brasileira. Conclusão O MSA foi traduzido e adaptado para o português brasileiro (MSA-BR). O processo de tradução e adaptação transcultural manteve todos os itens do protocolo original, preservando-se os padrões e as características do instrumento original.

ABSTRACT Purpose To translate and adapt the Modified Swallowing Assessment (MSA) protocol for post-stroke patients into Brazilian Portuguese. Methods This is an initial stage of the Brazilian Portuguese Modified Swallowing Assessment validation process. Translation was performed by two bilingual speech therapists and the translations synthesis evaluations by two external dysphagia experts. The synthesis version in the target language (Portuguese) was back-translated into the source language (English). After the synthesis of the translated versions, the instrument was applied to 22 post-stroke individuals. Results Health professionals discussed all the results of the study stages considering the instrument concept and the target population. The semantic, linguistic and conceptual equivalences found in the translation and adaptation process were adequate, not requiring modifications since the items were consistent with the Brazilian culture. Conclusion MSA was translated and adapted to Brazilian Portuguese (MSA-BR). The translation and cross-cultural adaptation process included all the items of the original protocol and maintained the standards and characteristics of the instrument.

Photobiomodulation in speech-language-hearing therapy: a profile of professional practice and the level of information of Brazilian speech-language-hearing therapists / Fotobiomodulação em fonoaudiologia: o perfil da prática profissional e o nível de informação dos fonoaudiólogos brasileiros

ABSTRACT Purpose: to know the profile of Brazilian speech-language-hearing (SLH) therapists and their level of information on the use of low-level laser photobiomodulation. Methods: an observational, cross-sectional, quantitative study conducted with a self-administered online questionnaire related to the professional education, work, and knowledge of SLH therapists on low-level laser photobiomodulation. Two hundred sixty-one speech-language-hearing therapists of both sexes participated in the research. The data were analyzed with descriptive and inferential statistics. Results: the speech-language-hearing therapists had graduated predominantly 10 to 20 years before, their highest degree was mainly specialization, and most of them worked in the fields of oral-motor functions, dysphagia, voice, language, and audiology. Most of them knew photobiomodulation and its use in SLH therapists; also, they agreed on using a low-level laser as a therapeutic resource. Even so, most did not use it in clinical practice, although those who did, reported greater patient adherence. Statistical significance was verified for the association between laser use and access to resolution number 541 of the Federal Speech-Language-Hearing Council, time in the profession, main specialization, and required qualification. Conclusion: the participating speech-language-hearing therapists showed knowledge on low-level laser photobiomodulation and its applicability. However, most of these professionals did not use the resource yet.

RESUMO Objetivo: conhecer o perfil dos fonoaudiólogos brasileiros e o seu nível de informação quanto ao uso da Fotobiomodulação com o Laser de Baixa Potência (LBP). Métodos: estudo observacional, transversal e quantitativo, realizado por meio de um questionário virtual autoaplicado, composto por questões relacionadas à formação, atuação profissional e conhecimentos sobre fotobiomodulação com LBP. Participaram 261 fonoaudiólogos, de ambos os sexos. Os dados foram analisados utilizando estatística descritiva e inferencial. Resultados: os fonoaudiólogos possuíam, predominantemente, 10 a 20 anos de formação, especialização concluída como maior titulação e atuavam principalmente nas áreas de Motricidade Orofacial, Disfagia, Voz, Linguagem e Audiologia. A ampla maioria conhece a fotobiomodulação e a sua aplicação na Fonoaudiologia, bem como concorda com a utilização do LBP como recurso terapêutico. Ainda assim, a maioria não utiliza o recurso na prática clínica, mas os que utilizam relatam melhor adesão do paciente. Verificou-se significância estatística para a associação do uso do laser ao acesso à resolução de nº 541 do Conselho Federal de Fonoaudiologia, ao tempo de profissão, à principal especialização e à capacitação exigida. Conclusão:os fonoaudiólogos participantes do estudo demonstraram apresentar informações sobre a fotobiomodulação com LBP e suas aplicabilidades, entretanto, o recurso ainda não é utilizado pela maioria dos profissionais.

Fotobiomodulação com laser de baixa potência na área de motricidade orofacial: uma análise comparativa a partir do conhecimento dos especialistas / Photobiomodulation with low-level laser therapy in the area of orofacial motricity: comparative analysis from the knowledge of specialists

RESUMO Objetivo comparar os conhecimentos e interesses dos fonoaudiólogos especialistas em motricidade orofacial quanto ao uso do laser de baixa potência antes e após a aprovação da Resolução nº 541 do Conselho Federal de Fonoaudiologia. Métodos trata-se de um estudo observacional, transversal e quantitativo, de caráter comparativo. Foi composto por dois momentos distintos: uma primeira coleta de dados, realizada em 2016, antes da aprovação da resolução e a segunda coleta, realizada em 2020, após a publicação das normativas. A primeira amostra foi constituída por 25 participantes e a segunda por 49, todos especialistas em motricidade orofacial. O instrumento de coleta consistiu em um formulário online elaborado no Google Forms, composto por questões do perfil do fonoaudiólogo, conhecimentos, interesses e aplicabilidades da fotobiomodulação com o laser de baixa potência. Os dados foram analisados utilizando estatística descritiva e inferencial. Resultados nos dois momentos, a expressiva maioria dos profissionais indicou saber o que é fotobiomodulação e concordou que o especialista em motricidade orofacial pode atuar com a técnica. Além disso, os profissionais apontaram a disfunção temporomandibular e a paralisia facial como principais casos para aplicações. Foram encontradas diferenças estatisticamente significativas entre os resultados obtidos antes e após a publicação da resolução, verificando-se aumento expressivo no acesso à bibliografia, capacitação, conhecimento das normas de biossegurança, acesso ao aparelho de laser e utilização na prática clínica. Conclusão constatou-se mudança no perfil profissional em relação ao uso da fotobiomodulação, com aumento dos conhecimentos, interesses e aplicabilidades pelos especialistas em motricidade orofacial, após a publicação da resolução normativa.

ABSTRACT Purpose To compare knowledge and interest of speech therapists specialized in Orofacial Motricity regarding the use of low-level laser before and after approval of resolution No. 541 by the Brazilian Federal Speech Language Pathology and Audiology Council (CFFa). Methods Cross-sectional observational and quantitative study of comparative character consisting of two distinct moments: first data collection performed in 2016, before approval of the resolution; and second, collection performed in 2020, after publication of the regulation. The first sample consisted of 25 participants and the second of 49, with the entire sample consisting of specialists in Orofacial Motricity. The collection instrument was an online Google Form consisting of questions on the profile of the speech therapist, knowledge, interests, and applicability of photobiomodulation with low-level laser. Data were analyzed using descriptive and inferential statistics. Results In both moments, the significant majority of professionals indicated knowing what is photobiomodulation, agreed that the Orofacial Motricity specialist can act with the technique and indicated temporomandibular dysfunction and facial paralysis as main applications. Statistically significant differences were found between the results obtained before and after the publication of the resolution, with a significant increase in access to bibliography, training, knowledge of biosafety standards, access to the low-level laser apparatus and use in clinical practice. Conclusion Change in the professional profile regarding the use of photobiomodulation was verified, with increased knowledge, interest, and applicability by Orofacial Motricity specialists after publication of the normative resolution.

Orofacial myofunctional changes and electromyographic activity of the orbicularis oris muscle in trombonists / Alterações miofuncionais orofaciais e atividade eletromiográfica do músculo orbicular da boca em trombonistas

ABSTRACT Objective: to analyze whether trombonists present orofacial myofunctional changes and compare the electrical activity of the orbicularis oris muscle before and after playing their instrument. Methods: an observational, descriptive, and cross-sectional study. The sample consisted of 20 university trombonists. Data collection involved three steps: application of a questionnaire investigating some peculiarities of trombonists (Orofacial Myofunctional Evaluation with Expanded Scores - OMES-E), and electromyographic analysis of the orbicularis oris muscle before and after performing a piece with the trombone. The mean, standard deviation, frequency, and percentage were calculated, and the paired Student's t test was used to compare the means of the electromyographic records before and after playing the trombone, at a 5% significance. Results: seventy per cent of trombonists reported some symptom of orofacial myofunctional alteration, namely, muscle compensations, tension, and pain. The myofunctional evaluation showed a mild change in cheek volume (90%) and labial commissure asymmetry (60%). The electrical activity of the lower orbicularis oris muscle decreased significantly after the trombone practice (p = 0.04), while that of the superior orbicularis oris muscle remained unchanged. Conclusion:trombonists show clinical and self-reported oromyofunctional changes as well as decreased electrical activity of the lower orbicularis oris muscle, after playing the trombone.

RESUMO Objetivos: analisar se existem alterações miofuncionais orofaciais clínicas e autorreferidas em trombonistas, assim como comparar a atividade elétrica do músculo orbicular da boca antes e após o uso do trombone. Métodos: estudo transversal e observacional, cuja amostra foi composta por 20 universitários trombonistas. Foi utilizado um questionário que investiga algumas particularidades sobre o instrumentista, da Avaliação Miofuncional Orofacial Com Escores Ampliados - AMIOFE-A e análise eletromiográfica do músculo orbicular da boca antes e após execução de uma tarefa com o trombone. Foram calculadas: média, desvio padrão, frequência e porcentagem e utilizou-se o teste t-Student pareado na comparação das médias dos registros eletromiográficos pré e pós-execução do trombone, significância=5%. Resultados: setenta por centro dos trombonistas relataram algum sintoma de alteração miofuncional orofacial, sendo compensações musculares, tensão e dor. Na avaliação miofuncional encontrou-se alteração leve no volume de bochechas (90%) e comissuras labiais com assimetria (60%). Houve redução significante da atividade elétrica do músculo orbicular inferior após a execução de tarefa com trombone (p=0,04), enquanto a do superior permaneceu inalterada. Conclusão: trombonistas apresentam alterações oromiofuncionais clínicas e autorreferidas e diminuição da atividade elétrica do músculo orbicular inferior da boca após uso do trombone.

Validity Evidence of an Epidemiological Oropharyngeal Dysphagia Screening Questionnaire for Older Adults.

OBJECTIVE: This research aimed to identify evidence of validity of a self-reported Oropharyngeal Dysphagia screening questionnaire for older adults based on test content, response processes, internal structure, relations to other variables, and reliability. METHOD: This is a nonrandomized, cross-sectional study employing the concepts and principles of the Standards for Educational and Psychological Testing. Data were collected from 644 community-dwelling older adults (both genders, age: ≥60 years) who agreed to participate in some steps of the validation process. Statistical methods obtained the content representation of the construct, internal structure validation, discriminant and convergent evidence, and reliability, using a 5% significance level. RESULTS: The screening tool was re-specified in nine questions that provided the best fit and robust reliability, with proper discriminant and convergent evidence. CONCLUSIONS: The screening questionnaire presented valid and reliable results to identify oropharyngeal dysphagia symptoms in older adults, highlighting the importance of the validation process based on the standards to construct an epidemiological instrument.

Validity evidence of an epidemiological Oropharyngeal dysphagia screening questionnaire for older adults

OBJECTIVE: This research aimed to identify evidence of validity of a self-reported Oropharyngeal Dysphagia screening questionnaire for older adults based on test content, response processes, internal structure, relations to other variables, and reliability. METHOD: This is a nonrandomized, cross-sectional study employing the concepts and principles of the Standards for Educational and Psychological Testing. Data were collected from 644 community-dwelling older adults (both genders, age: ≥60 years) who agreed to participate in some steps of the validation process. Statistical methods obtained the content representation of the construct, internal structure validation, discriminant and convergent evidence, and reliability, using a 5% significance level. RESULTS: The screening tool was re-specified in nine questions that provided the best fit and robust reliability, with proper discriminant and convergent evidence. CONCLUSIONS: The screening questionnaire presented valid and reliable results to identify oropharyngeal dysphagia symptoms in older adults, highlighting the importance of the validation process based on the standards to construct an epidemiological instrument.

Accuracy of traditional and formant acoustic measurements in the evaluation of vocal quality. / Acurácia das medidas acústicas tradicionais e formânticas na avaliação da qualidade vocal.

PURPOSE: Investigate the accuracy of isolated and combined acoustic measurements in the discrimination of voice deviation intensity (GD) and predominant voice quality (PVQ) in patients with dysphonia. METHODS: A total of 302 female patients with voice complaints participated in the study. The sustained /ɛ/ vowel was used to extract the following acoustic measures: mean and standard deviation (SD) of fundamental frequency (F0), jitter, shimmer, glottal to noise excitation (GNE) ratio and the mean of the first three formants (F1, F2, and F3). Auditory-perceptual evaluation of GD and PVQ was conducted by three speech-language pathologists who were voice specialists. RESULTS: In isolation, only GNE provided satisfactory performance when discriminating between GD and PVQ. Improvement in the classification of GD and PVQ was observed when the acoustic measures were combined. Mean F0, F2, and GNE (healthy × mild-to-moderate deviation), the SDs of F0, F1, and F3 (mild-to-moderate × moderate deviation), and mean jitter and GNE (moderate × intense deviation) were the best combinations for discriminating GD. The best combinations for discriminating PVQ were mean F0, shimmer, and GNE (healthy × rough), F3 and GNE (healthy × breathy), mean F 0, F3, and GNE (rough × tense), and mean F0 , F1, and GNE (breathy × tense). CONCLUSION: In isolation, GNE proved to be the only acoustic parameter capable of discriminating between GG and PVQ. There was a gain in classification performance for discrimination of both GD and PVQ when traditional and formant acoustic measurements were combined.

OBJETIVO: Investigar a acurácia das medidas acústicas, isoladas e combinadas, na discriminação da intensidade do desvio vocal (GG) e da qualidade vocal predominante (QVP) em pacientes disfônicos. MÉTODO: Participaram 302 pacientes do gênero feminino, com queixa vocal. A partir da vogal /ɛ/ sustentada, foram extraídas as medidas acústicas de média e desvio padrão (DP) da frequência fundamental (F0), o jitter, o shimmer e o Glottal to noise excitation (GNE) e a média dos três primeiros formantes (F1, F2, F3). A avaliação perceptivo-auditiva do GG e QVP foi realizada por três fonoaudiólogos especialistas em voz. RESULTADOS: Isoladamente, apenas o GNE obteve desempenho satisfatório na discriminação do GG e da QVP. Houve uma melhora na classificação do GG e QVP com a combinação das medidas acústicas. A média de F0, F2 e GNE (saudável × desvio leve a moderado), DP de F0, F1 e F3 (leve a moderado × desvio moderado), Jitter e GNE (moderado × desvio intenso) foram as melhores combinações para discriminar o GG. As melhores combinações para discriminação da QVP foram média de F0, Shimmer e GNE (saudável × rugosa), F3 e GNE (saudável × soprosa), média de F0, F3 e GNE (rugosa × tensa), média de F0, F1 e GNE (soprosa × tensa). CONCLUSÃO: De forma isolada, o GNE mostrou-se o único parâmetro acústico capaz de discriminar o GG e a QVP. Houve um ganho no desempenho da classificação com a combinação das medidas acústicas tradicionais e formânticas, tanto para a discriminação do GG como da QVP.

Factors associated with voice disorders among the elderly: a systematic review / Fatores associados a alterações vocais em idosos: uma revisão sistemática

Abstract Introduction During the aging process, natural modifications occur in the larynx and the structures involved in phonation which explain the specific characteristics found in the voices of elderly persons. When, at any moment, a voice fails and there is interference with communication, a voice disorder has occurred. This can generate disadvantages in communicative efficiency and have a negative impact on quality of life, compromising mechanisms of socialization, the maintenance of autonomy, and the sense of well-being. Nevertheless, there appears to be little clarity about which factors are associated with voice disorders in this population, especially from an epidemiological perspective. Objective The present study is a literature review to identify factors associated with voice disorders among the elderly described in population-based studies. Methods A systematic review of electronic databases was carried out. The methodological quality of the studies was analyzed with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The research was conducted independently by two researchers. Results Although two articles met the eligibility criteria, none fulfilled all the criteria for the evaluation of methodological quality. According to the two studies selected for this review, factors associated with voice disorders among the elderly included both physical and psychosocial aspects. However, the methodological discrepancies between the studies, particularly in relation to sample selection and the instruments used indicate great variability and compromise the reliability of the results. Conclusion Further prevalence studies and investigations of factors associated with voice disorders in the elderly from an epidemiological perspective, and which involve different cultures, should be carried out.

Resumo Introdução Durante o processo de envelhecimento, modificações naturais ocorrem na laringe e nas estruturas envolvidas na fonação que explicam as características específicas encontradas nas vozes de pessoas idosas. Quando, a qualquer momento, a voz falha e há interferência com a comunicação, ocorre um distúrbio de voz. Isso pode gerar desvantagens na eficiência de comunicação e um impacto negativo sobre a qualidade de vida, comprometendo os mecanismos de socialização, a manutenção da autonomia e o sentido de bem-estar. Entretanto, ainda não estão claros quais os fatores associados aos distúrbios de voz nessa população, especialmente considerando-se uma perspectiva epidemiológica. Objetivo O presente estudo é uma revisão da literatura para identificar fatores associados a distúrbios de voz em idosos descritos em estudos de base populacional. Método Foi realizada uma revisão sistemática das bases de dados eletrônicas. A qualidade metodológica dos estudos foi analisada utilizando-se as diretrizes Strengthening the Reporting of Observational Studies in Epidemiology. A pesquisa foi realizada de forma independente por dois pesquisadores. Resultados Embora dois artigos tenham preenchido os critérios de elegibilidade, nenhum deles preencheu todos os critérios para a avaliação da qualidade metodológica. De acordo com os dois estudos selecionados para esta revisão, os fatores associados aos distúrbios de voz em idosos incluíram aspectos físicos e psicossociais. Entretanto, as discrepâncias metodológicas entre os estudos, particularmente em relação à seleção da amostra e aos instrumentos utilizados, indicam grande variabilidade e comprometem a confiabilidade dos resultados. Conclusão Devem ser realizados estudos de prevalência e investigações de fatores associados a distúrbios de voz em idosos a partir de uma perspectiva epidemiológica e que levem em consideração diferentes culturas.

Screening for oropharyngeal dysphagia in older adults: A systematic review of self-reported questionnaires.

BACKGROUND: Oropharyngeal dysphagia is a swallowing disorder with signs and symptoms which may be present in older adults, but they are rarely noticed as a health concern by older people. The earliest possible identification of this clinical condition is needed by self-reported population-based screening questionnaire, which are valid and reliable for preventing risks to nutritional status, increased morbidity and mortality. OBJECTIVE: The aim of this systematic review was to identify self-reported screening questionnaires for oropharyngeal dysphagia in older adults to evaluate their methodological quality for population-based studies. METHODS: An extensive search of electronic databases (PubMed (MEDLINE), Ovid MEDLINE(R), Scopus, Cochrane Library, CINAHL, Web of Science (WOS), PsycINFO (APA), Lilacs and Scielo) was conducted in the period from April to May 2017 using previously established search strategies by the two evaluators. The methodological quality and the psychometric properties of the included studies were evaluated by the COSMIN (Consensus based Standards for the selection of health Measurement Instruments) checklist and the quality criteria of Terwee and colleagues, respectively. RESULTS: The analysed information was extracted from three articles which had conducted studies on the prevalence of oropharyngeal dysphagia by self-reported screening questionnaires, showing poor methodological quality and flaws in the methodological description to demonstrate its psychometric properties. CONCLUSION: This study did not find any self-reported screening questionnaires for oropharyngeal dysphagia with suitable methodological quality and appropriate evidence in its psychometric properties for elders. Therefore, the self-reported questionnaires within the diagnostic proposal require greater details in its process for obtaining valid and reliable evidence.

Masseter muscle surface electromyography in college students with a high degree of anxiety and temporomandibular disorder / Eletromiografia de superfície do músculo masseter em universitários com alto grau de ansiedade e disfunção temporomandibular

ABSTRACT Objective: to compare the electrical activity of masseter muscles, bilaterally, according to the presence or absence of Temporomandibular Disorder (TMD) in college students with a high degree of anxiety. Methods: the study was conducted with a randomized sample of 31 Speech Therapy students aged between 17 and 32 years; 61.3% (n = 19) were females and 38.7% (n = 12) were males. They were divided into two groups, Group 1 (G1), comprising 11 students with TMD, and Group 2 (G2), composed of 20 students without TMD. The college students answered the State-Trait Anxiety Inventory (STAI) for anxiety investigation, and were evaluated by the protocol Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for TMD diagnosis. The evaluation of muscular electrical activity took into account the records in the conditions of rest, Sustained Maximum Voluntary Activity (SMVA) and habitual chewing (HC). The data were analyzed using the version 22 IBM Statistical Package for Social Sciences (SPSS) software. The statistical analysis was performed using Student t test to compare means between groups, considering < 0,05 as the significant p-value. Results: college students, of both groups, presented high levels of anxiety traits. Significant statistical differences were observed on the percentage of electrical activity of right masseter muscle in chewing function, as well as muscle fibers recruitment during chewing, which were higher on the group without TMD. Conclusion: college students with TMD and a high degree of anxiety presented lower means of masseter muscle electromyografic activity during chewing, in most conditions assessed, as compared to volunteers without TMD, except for the left masseter muscle in rest and chewing.

RESUMO Objetivo: comparar a atividade elétrica dos músculos masseteres bilateralmente de acordo com a presença ou ausência de Disfunção Temporomandibular (TMD) em estudantes universitários com alto grau de ansiedade. Métodos: o estudo foi realizado com 31 acadêmicos de Fonoaudiologia, selecionados aleatoriamente, com idades entre 17 e 32 anos, sendo 61,3% (n=19) do sexo feminino e 38,7% (n=12) do sexo masculino, divididos em dois grupos, sendo o Grupo 1 (G1) composto por 11 estudantes com DTM e o Grupo 2 (G2) formado por 20 estudantes sem DTM. Para investigação da ansiedade os estudantes universitários responderam o Inventário de Ansiedade Traço-Estado (IDATE), e para o diagnóstico de DTM, foram avaliados por meio do protocolo Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). A avaliação da atividade elétrica muscular considerou os registros nas condições de repouso, Máxima Atividade Voluntária Sustentada (MAVS) e mastigação habitual (MH). Os dados foram analisados por meio do software IBM Statistical Package for Social Sciences (SPSS), versão 22. A estatística analítica foi realizada por meio do teste T de Student para comparação das médias entre os grupos. Os dados foram considerados significantes, quando o p-valor fosse inferior a 5%. Resultados: os graduandos, de ambos os grupos, apresentaram alto nível de ansiedade traço. Foram verificadas diferenças estatisticamente significantes para a porcentagem da atividade elétrica do músculo masseter direito na mastigação, bem como no recrutamento de fibras musculares na mastigação, as quais foram superiores no grupo sem DTM. Conclusões: universitários com DTM e alto grau de ansiedade apresentaram médias de atividade eletromiográfica do músculo masseter inferiores as do grupo sem DTM, na maioria das condições avaliadas, exceto para o masseter esquerdo em repouso e na mastigação.