Dysphagia and associated clinical markers in neurologically intact children with respiratory disease.

OBJECTIVE: The identification of oropharyngeal aspiration is paramount since it can have negative consequences on a compromised respiratory status. Our hypothesis was that dysphagia in neurologically intact children with respiratory disease is associated to specific clinical markers. STUDY DESIGN: Using the medical files we conducted a retrospective, observational cohort study on children admitted to the pediatric hospital unit due to respiratory disease. We collected data on specific parameters of a clinical swallowing assessment and dysphagia was classified according to the Dysphagia Management Staging Scale. We also included the following clinical markers: age, days of hospitalization, need for orotracheal intubation (OTI), duration of orotracheal intubation (in hours), number of previous hospital admissions due to respiratory disease, number of previous hospital admissions due to other causes, and previous orotracheal intubations. RESULTS: The final study sample consisted of 102 patients (mean age of 5.88 months). For the purposes of statistical analysis, the patients were grouped according to the classification of dysphagia (ie, no dysphagia, mild dysphagia, and moderate-severe dysphagia). Data analysis indicated that the clinical markers of orotracheal intubation (P = 0.042), duration of orotracheal intubation (P = 0.025), and days of hospitalization (P = 0.037) were significant in children with moderate-severe dysphagia. CONCLUSIONS: Our data indicate that neurologically intact children with respiratory disease who were submitted to prolonged OTI (ie, over 48 h) should be prioritized for receiving a detailed swallowing assessment.

Screening protocol for dysphagia in adults: comparison with videofluoroscopic findings

OBJECTIVES: To compare the videofluoroscopic findings of patients with suspected oropharyngeal dysphagia with the results of a clinical screening protocol. METHODS: A retrospective observational cohort study was conducted on all consecutive patients with suspected oropharyngeal dysphagia between March 2015 and February 2016 who were assigned to receive a videofluoroscopic assessment of swallowing. All patients were first submitted to videofluoroscopy and then to the clinical assessment of swallowing. The clinical assessment was performed within the first 24 hours after videofluoroscopy. The videofluoroscopy results were analyzed regarding penetration/aspiration using an 8-point multidimensional perceptual scale. The accuracy of the clinical protocol was analyzed using the sensitivity, specificity, likelihood ratios and predictive values. RESULTS: The selected sample consisted of 50 patients. The clinical protocol presented a sensitivity of 50% and specificity of 95%, with an accuracy of 88%. "Cough" and "wet-hoarse" vocal quality after/during swallowing were clinical indicators that appeared to correctly identify the presence of penetration/aspiration risk. CONCLUSION: The clinical protocol used in the present study is a simple, rapid and reliable clinical assessment. Despite the absence of a completely satisfactory result, especially in terms of the sensitivity and positive predictive values, we suggest that lower rates of pneumonia can be achieved using a formal dysphagia screening method.

Screening protocol for dysphagia in adults: comparison with videofluoroscopic findings.

OBJECTIVES: To compare the videofluoroscopic findings of patients with suspected oropharyngeal dysphagia with the results of a clinical screening protocol. METHODS: A retrospective observational cohort study was conducted on all consecutive patients with suspected oropharyngeal dysphagia between March 2015 and February 2016 who were assigned to receive a videofluoroscopic assessment of swallowing. All patients were first submitted to videofluoroscopy and then to the clinical assessment of swallowing. The clinical assessment was performed within the first 24 hours after videofluoroscopy. The videofluoroscopy results were analyzed regarding penetration/aspiration using an 8-point multidimensional perceptual scale. The accuracy of the clinical protocol was analyzed using the sensitivity, specificity, likelihood ratios and predictive values. RESULTS: The selected sample consisted of 50 patients. The clinical protocol presented a sensitivity of 50% and specificity of 95%, with an accuracy of 88%. "Cough" and "wet-hoarse" vocal quality after/during swallowing were clinical indicators that appeared to correctly identify the presence of penetration/aspiration risk. CONCLUSION: The clinical protocol used in the present study is a simple, rapid and reliable clinical assessment. Despite the absence of a completely satisfactory result, especially in terms of the sensitivity and positive predictive values, we suggest that lower rates of pneumonia can be achieved using a formal dysphagia screening method.

Syntactic structural assignment in Brazilian Portuguese-speaking children with specific language impairment.

PURPOSE: In this study, the authors examined the comprehension of sentences with predicates and reflexives that are linked to a nonadjacent noun as a test of the hierarchical ordering deficit (HOD) hypothesis. That hypothesis and more modern versions posit that children with specific language impairment (SLI) have difficulty in establishing nonadjacent (hierarchical) relations among elements of a sentence. The authors also tested whether additional working memory demands in constructions containing reflexives affected the extent to which children with SLI incorrectly structure sentences as indicated by their picture-pointing comprehension responses. METHOD: Sixteen Brazilian Portuguese-speaking children (8;4-10;6 [years;months]) with SLI and 16 children with typical language development (TLD) matched for age (± 3 months), gender, and socioeconomic status participated in 2 experiments (predicate and reflexive interpretation). In the reflexive experiment, the authors also manipulated working memory demands. Each experiment involved a 4-choice picture selection sentence comprehension task. RESULTS: Children with SLI were significantly less accurate on all conditions. Both groups made more hierarchical syntactic construction errors in the long working memory condition than in the short working memory condition. CONCLUSION: The HOD hypothesis was not confirmed. For both groups, syntactic factors (structural assignment) were more vulnerable than lexical factors (prepositions) to working memory effects in sentence miscomprehension.

Emerging issues concerning the education of speech and language pathologists and audiologists in Brazil and South America.

Diversity is one of the major characteristics of Brazil and all South America. This paper presents an overview of the current situation of the education of speech and language pathologists (SLP) and audiologists in Brazil and in several other countries of South America. This paper also discusses the main challenges shared by these countries. The discussion is focused on the mutual interferences between education and the areas of professional practice, cultural diversity and continued education. There are many emerging issues about the education of SLP and audiologists in South America. The suggested conclusion is that, despite the many differences, the South American SLP and audiologists' education would benefit from joint efforts and collaborative experiences.

Mandibular movement patterns during speech in subjects with temporomandibular disorders and in asymptomatic individuals.

The mandibular movements used during speech modify space to allow different articulation postures proper for each sound. Temporomandibular disorders (TMD) may cause modifications in these movements due to joint and muscular conditions. The aim of this study was to verify the amplitude and the characterization of the mandibular movements during speech, using computerized electrognathography, in individuals with TMD and in asymptomatic individuals, analyzing possible interferences of these dysfunctions. One hundred thirty-five (135) adult subjects were divided into two groups: GI with 90 participants diagnosed with TMD and GIII with 45 asymptomatic participants. Their mandibular movements were observed during the sequential naming of pictures containing all of the word sounds, which occur in the Brazilian Portuguese language. The records were obtained with computerized electrognathography (BioEGN-BioPak system, BioResearch Associates, Inc., Milwaukee, WI). Mean values of the amplitude were described for the two groups. The analysis of such results showed statistically significant differences between the means of the values, obtained for the two groups in the opening and retrusion ranges. Statistically significant differences were not established for the presence and the range of the deviations in laterality, during speech. Prevalence of bilateral deviations was verified in GIII and unilateral deviations in GI. This study describes the 3-dimensional thresholds of mandibular movements in speech for Brazilian Portuguese, for the investigated individuals of both groups. The presence of TMD shows reduction in mandibular opening and retrusion ranges and prevalence of unilateral deviation movements during speech.

A model of mandibular movements during speech: normative pilot study for the Brazilian Portuguese language.

The precision of speech articulation is related to the possibility and freedom of the mandibular movements, modifying the spaces in order to allow the different articulatory positions of each sound. Electrognathography allows the objective delineation and registration of the mandibular movements, determining the level of opening, translations and velocity of these movements. Its use is a resource that can establish quantitative diagnostic parameters. The aim of this study was to verify the amplitude, velocity and characterization of the mandibular movements during speech using computerized electrognathography. Participants were 40 adults, male and female, with no temporomandibular disorders; with no missing teeth; with no dental occlusion alterations or dentofacial deformities; with no dental prostheses; and with no communication, neurological or cognitive deficits. The mandibular movements were observed during the sequential naming of pictures containing all the phonemes of the Brazilian Portuguese language. The registrations were obtained using electrognathography (BioENG-BioPak system), assessing the spatial position, course and velocity of the mandibular movements. The mean values of velocity were: 88.65 mm/sec during opening and 89.90mm/sec during closing. The mean values of amplitude were: sagittal opening: 12.77 mm, frontal opening: 11.21 mm, protrusion: 1.22 mm; retrusion 5.67 mm; translations to the right: 1.49 mm and to the left: 1.59 mm. The velocity of opening is directly related to that of closing. The amplitude of opening demonstrates a direct correlation with the velocity of opening and closing. All participants presented lateral translations during the course of the jaw. The assessment of speech in normal individuals is characterized by: discreet mandibular movements with an anteroposterior component and lateral translations. This study allowed for the delineation of a profile of the mandibular movements during speech in asymptomatic individuals.