Hyoid Bone Movement During Swallowing in Female Thyroidectomy Patients: A Kinematic Ultrasound Study.

The aim of this study was to investigate the measures of displacement, time and velocity of hyoid bone movement in female thyroidectomy patients. Fifty-eight ultrasound videos of 29 women during swallowing were analyzed. The sample was divided into experimental group (EG), composed of 12 women following total or partial thyroidectomy; and control group (CG) of 17 healthy women. The kinematic measures of displacement, time and velocity of hyoid bone displacement were tracked during swallowing of 10 ml of liquid (water) and 10 ml of thickened liquid (honey) in both groups for comparisons. Additional analysis included bolus consistency effect and relationship with clinical characteristics. Ultrasound videos were analyzed according to a standardized protocol using ImageJ software. Displacement, time and velocity of hyoid movement during swallowing of 10 ml of liquid or thickened liquid were not statistically different between female thyroidectomy patients and healthy women. There is no bolus consistency effect on kinematic measures in both groups, but among thyroidectomy patients, velocity of hyoid bone movement is significantly faster in those with swallowing complaints.

Swallowing disorders and associated factors in older adults living in nursing homes.

PURPOSE: The aim of this study was to identify the frequency of swallowing disorders and the associated factors in older adults living in nursing homes. METHODS: This is a cross-sectional study with a sample of 73 older adults (≥ 60 years; mean age = 80 ± 7.49 years; female = 82.2%) living in five non-profit Brazilian nursing homes. Demographic and clinical data were collected. The frequency of swallowing disorders was determined by the Volume-Viscosity Swallow Test (VVS-T). Covariables with a p-value less than 0.20 according to Pearson's chi-square test or Fisher's exact test were included in the multiple logistic regression analysis model. The level of significance was 5%. RESULTS: The frequency of swallowing disorders was 63%. The multiple logistic regression model revealed that the chance of an older adult living in a nursing home presenting with swallowing disorders increased by 8% with each 1-year increase in age. Decreases in oral intake level improved the chance of a negative result in the VVS-T by approximately four times, and an individual with a FOIS level below seven was almost 11 times more likely to have a swallowing disorder. CONCLUSION: The frequency of swallowing disorders in older adults living in nursing homes is high and is associated with age and oral intake. The management care team should be aware of the early detection of these conditions to prevent complications of oropharyngeal dysphagia.

Instrumento de rastreio para disfagia orofaríngea no Acidente Vascular Encefálico - Parte I: evidências de validade baseadas no conteúdo e nos processos de resposta / Screening tool for oropharyngeal dysphagia in stroke - Part I: evidence of validity based on the content and response processes

RESUMO Objetivo Este estudo tem o objetivo de identificar as evidências de validade baseadas no conteúdo e nos processos de resposta de um instrumento de Rastreamento para disfagia orofaríngea no Acidente Vascular Encefálico (RADAVE). Método Os critérios para elaborar os itens do instrumento foram baseados na revisão de literatura. Um grupo de juízes com 19 profissionais distintos e da área da saúde avaliaram a relevância e representatividade das questões e o resultado foi analisado por meio do índice de validade de conteúdo (IVC). Para evidência de validade baseada nos processos de resposta, 23 profissionais da saúde aplicaram o instrumento e analisaram as questões por meio de escala estruturada e entrevista cognitiva. Resultados O RADAVE foi estruturado para ser aplicado em duas etapas. A primeira versão foi constituída por 18 questões na etapa I e 11 questões na etapa II. Oito questões da etapa I e quatro questões da etapa II não atingiram o IVC mínimo, sendo realizadas reformulações pelos autores. A entrevista cognitiva demonstrou a necessidade de novos ajustes que resultaram na versão final com 12 questões na Etapa I e seis questões na Etapa II. Conclusão Foi possível desenvolver um instrumento de rastreamento para a disfagia no Acidente Vascular Encefálico com adequadas evidências de validade baseadas no conteúdo e nos processos de resposta. As duas evidências de validade obtidas até o momento permitiram ajustar o instrumento em relação ao seu constructo. Os próximos estudos irão analisar as demais evidências de validade e as medidas de acurácia.

ABSTRACT Purpose The aim of the present study was to identify the evidence of validity based on the content and response process of the Rastreamento de Disfagia Orofaríngea no Acidente Vascular Encefálico (RADAVE; "Screening Tool for Oropharyngeal Dysphagia in Stroke"). Methods The criteria used to elaborate the questions were based on a literature review. A group of judges consisting of 19 different health professionals evaluated the relevance and representativeness of the questions, and the results were analyzed using the Content Validity Index. In order to evidence validity based on the response processes, 23 health professionals administered the screening tool and analyzed the questions using a structured scale and cognitive interview. Results The RADAVE structured to be applied in two stages. The first version consisted of 18 questions in stage I and 11 questions in stage II. Eight questions in stage I and four in stage II did not reach the minimum Content Validity Index, requiring reformulation by the authors. The cognitive interview demonstrated some misconceptions. New adjustments were made and the final version was produced with 12 questions in stage I and six questions in stage II. Conclusion It was possible to develop a screening tool for dysphagia in stroke with adequate evidence of validity based on content and response processes. Both validity evidences obtained so far allowed to adjust the screening tool in relation to its construct. The next studies will analyze the other evidences of validity and the measures of accuracy.

Procedimentos fonoaudiológicos em recém-nascidos de alto risco / Speech therapy procedures in high-risk newborns

Objetivo: Investigar os procedimentos fonoaudiológicos realizados em uma UTI neonatal. Métodos: Pesquisa documental baseada em registro de prontuários, composta por um total de 34 recém-nascidos que necessitaram de estimulação precoce pelo serviço de Fonoaudiologia na UTI neonatal de um hospital, com nível terciário de atendimento. O estudo ocorreu entre agosto de 2005 a janeiro de 2006. Da amostra, 14 crianças eram do sexo feminino (41,2%) e 20 eram do sexo masculino (58,8%). A idade dos recém-nascidos variou de 3 a 57 dias de vida. As variáveis estudadas compreenderam: condições de risco do neonato, procedimentos de avaliação fonoaudiológica, intervenção realizada e resultados obtidos do ponto de vista ponderal. Resultados: A condição de risco do recém-nascido prétermo (RNPT) associada à síndrome do desconforto respiratório (SDR) apresentou-se em25 (73,5%) das crianças estudadas. O peso inicial de 15 (44,11%) crianças variou de 1170 a 1742 gramas. Os procedimentos fonoaudiológicos mais abordados foram a avaliação das funções orais com identificação de alterações na sucção/deglutição em 25(73,5%) recém nascidos e a intervenção por meio da sucção não nutritiva em 18(53%) crianças. Ao final do atendimento fonoaudiológico, 19 (55,9%) crianças pesavam entre 1742 a 2314 gramas. Conclusões: Os benefícios da atuação fonoaudiológica foram relacionados à identificação das crianças de risco que precisaram da intervenção nas funções orais e na organização do bebê para a alimentação. Pressupõe-se que a introdução da via oral o mais rápido e seguro possível favoreceu a melhora do estado nutricional da criança e a evolução de seu quadro clínico.

Objective: To investigate the speech therapy procedures performed in a neonatal ICU. Methods: A documental research based on registration records, comprised by a total of 34newborns that required early stimulation by the speech therapy service in a neonatal ICU of a hospital with tertiary level of care. The study was held in the period between August, 2005 and January, 2006. From the sample, 14 children were female (41.2%) and 20 were male (58.8%). The age of the newborns ranged from 3 to 57 life days. The studied variables included: risk conditions of the newborn, clinical assessment procedures, the intervention performed and the results obtained regarding weight. Results: The risk condition of preterm newborn (PTNB) associated with respiratory distress syndrome (RDS) was present in 25 (73.5%) children. The initial weight of 15 (44.11%) children ranged from 1170 to 1742 grams. The most widely discussed speech therapy procedures were the assessment of oral functions with identification of changes in sucking and swallowing in 25 (73.5%) newborns and intervention by means of non-nutritive sucking in 18 (53%) children. At the end of speech therapy, 19 (55.9%) children weighed between 1742 to 2314 grams. Conclusions: The benefits of speech therapy performance were related to the identification of high-risk children who required intervention in oral functions and organization of the baby for feeding. It is assumed that the introduction of oral administration as quickly and safely as possible favored the improvement of the nutritional status of children and their clinical evolution.