Training to Analyze Functional Parameters with Fiberoptic Endoscopic Evaluation of Swallowing: A Scoping Review.

Analyzing fiberoptic endoscopic evaluation of swallowing (FEES) is challenging and requires training to ensure the proficiency of health professionals and improve reliability. This scoping review aims to identify and map the available evidence on training health professionals to analyze FEES functional parameters. The method proposed by the Joanna Briggs Institute and the PRISMA-ScR guidelines were followed. The search was performed in MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL databases, and in the gray literature. Two blinded independent reviewers screened articles by title and abstract. Then, they read the full text of the included reports, considering the eligibility criteria. Data were extracted using a standardized form. Six studies met the established eligibility criteria, published between 2009 and 2022, with few participants. All these studies addressed training as part of the process to validate a rating scale. No standardized criteria were observed regarding the selection of experts and participants, training structure, and outcome measures to assess participants' competence. The reviewed literature indicates that training must be developed to equip students and health professionals who treat dysphagia, enabling them to analyze the functional parameters of the FEES, considering variables that may influence the participants' performance.

Interrater reliability in the temporal quantitative analysis of oropharyngeal swallowing using a specific software / Confiabilidade entre avaliadores na análise quantitativa temporal da deglutição orofaríngea por meio de software específico

ABSTRACT Purpose This study aims to analyze inter-judge reliability by measuring a few temporal parameters of swallowing using a specific software. Methods Six databases that include the results of reliability tests performed in prior studies by the present research group were employed. The datasets were obtained using the same measurement method and include data obtained based on puree (level 3) consistency and liquid (level 0) consistency according to the International Dysphagia Diet Standardization Initiative. In this study, the reliabilities corresponding to the total oral transit time (TOTT), initiation of the pharyngeal response time (PRT), and the pharyngeal transit time (PTT) were measured using the same software; the evaluations performed by a single rater for all datasets were used as the benchmark, and evaluations performed by new raters for each dataset were also included. The intra-class correlation coefficient (ICC) with a 95% confidence interval was employed. Results A total of 244 videofluoroscopic swallowing study images were analyzed. In all analyses, the ICCs were >0,75 and showed excellent agreement between the senior and junior raters. The TOTT for level 3 showed ICCs from 0.936 to 1.000 and that for level 0 showed ICCs from 0.997 to 1.000. Further, the PRT showed ICCs from 0.916 to 1.000 for level 3 and from 0.978 to 1.000 for level 0. The PTT showed ICCs from 0.848 to 1.000 for level 3 and from 0.984 to 1.000 for level 0. Conclusion The reliabilities obtained using this specific software for the TOTT, PRT, and PTT showed excellent agreement.

RESUMO Objetivo analisar a confiabilidade inter-juízes por meio da mensuração de alguns parâmetros temporais da deglutição por meio de um software específico. Método Foram utilizados seis bancos de dados que incluem os resultados dos testes de confiabilidade realizados em estudos anteriores do presente grupo de pesquisa. Os bancos de dados foram obtidos usando o mesmo método de medição e incluem dados obtidos na consistência purê (nível 3) e líquida (nível 0). Neste estudo, as confiabilidades correspondentes ao tempo de trânsito oral total (TTOT), tempo de início de resposta faríngea (IRF) e tempo de trânsito faríngeo (TTF) mensuradas no mesmo software; as avaliações realizadas por um único avaliador para todos os bancos de dados foram usadas como referência, e as avaliações realizadas por novos avaliadores para cada banco de dados também foram incluídas. Foi utilizado o coeficiente de correlação intraclasse (ICC) com intervalo de confiança de 95%. Resultados Foram analisadas 244 imagens de estudos videofluoroscópicos da deglutição. Em todas as análises, os ICCs foram >0,75, mostrando excelente concordância entre avaliadores. O TTOT do nível 3 apresentou ICCs de 0,936 a 1.000 e o do nível 0 apresentou ICCs de 0,997 a 1,000. Além disso, o IRF mostrou ICCs de 0,916 a 1,000 para o nível 3 e de 0,978 a 1,000 para o nível 0. O TTF mostrou ICCs de 0,848 a 1,000 para o nível 3 e de 0,984 a 1,000 para o nível 0. Conclusão As confiabilidades obtidas com este software específico para o TTOT, IRF e TTF mostraram excelente concordância.

Training for fiberoptic endoscopic evaluation of swallowing parameter analysis: a scoping review protocol / Treinamento para análise de parâmetros da videoendoscopia da deglutição: um protocolo de revisão de escopo

ABSTRACT Purpose: to present a scoping review protocol to identify and map available evidence on training for fiberoptic endoscopic evaluation of swallowing parameter analysis. Methods: the protocol follows the method proposed by the Joanna Briggs Institute and the PRISMA-P guidelines for review protocol reports. The survey will be made in MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL, and grey literature. A search strategy has been developed for MEDLINE, which will be adapted for each database. Two independent reviewers will screen the articles by title and abstract. Then, they will read the full text of the included articles, considering the eligibility criteria. The data will be extracted with a standardized form. The results will be presented in a flowchart and narrative summary, following the PRISMA-ScR guidelines. Literature Review: there is a scarcity of research describing visual-perceptual training methods to analyze FEES parameters and inconsistent data to guide clinical decision-making. This review will provide comprehensive information on developing training for this type of analysis. Conclusion: this scoping review protocol will present the overall state of research on the topic and identify existing gaps in the base of evidence.

RESUMO Objetivo: apresentar um protocolo de revisão de escopo para identificar e mapear as evidências disponíveis sobre treinamento para a análise de parâmetros da videoendoscopia da deglutição. Métodos: o protocolo seguirá o método proposto pelo Joanna Briggs Institute e as diretrizes PRISMA-P para relato de protocolos de revisão. A busca será feita na MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL e literatura cinzenta. Uma estratégia de busca foi desenvolvida para a MEDLINE, que será adaptada para cada base de dados. Dois revisores independentes rastrearão os artigos pelo título e resumo. Em seguida, farão a leitura do texto completo dos artigos incluídos, considerando os critérios de elegibilidade. Os dados serão extraídos com um formulário padronizado. Os resultados serão apresentados em fluxograma e resumo narrativo, seguindo as diretrizes do PRISMA-ScR. Revisão da literatura: há escassez de pesquisas que descrevam métodos de treinamento perceptivo-visual para analisar parâmetros da VED e dados inconsistentes para orientar a tomada de decisão clínica. Esta revisão fornecerá informações abrangentes sobre o desenvolvimento de treinamento para esse tipo de análise. Conclusão: este protocolo de revisão de escopo apresentará o estado geral das pesquisas sobre o tema e identificará as lacunas existentes na base de evidências.

Maternal complaints about feeding problems and anthropometric parameters of children with a diagnosis of pediatric feeding disorder

ABSTRACT Purpose: to describe the anthropometric parameters of children diagnosed with pediatric feeding disorder by a multiprofessional team. Methods: a retrospective clinical study conducted on 196 children on maternal complaints of feeding difficulties and a diagnosis of pediatric feeding disorder. Children with neurological diseases or having no pediatric feeding disorder diagnosis were excluded from the study. Weight and height data were obtained and parameters such as weight-for-age, length/height-for-age and body mass index for-age were analyzed, according to the recommendations of the World Health Organization. The two-proportion equality test was used and the level of significance was set at 0.05 (5%) in all analyses. Results: results showed mean (±Standard Deviation) values of 13.09±5.1 for weight (kg), 0.61±15.53 for height (cm) and 15.37±1.56 for body mass index (kg/m²). The results also showed that 87.2% of the children were within the adequate z-score for weight-for-age, 93.4% were within the adequate z-score for length/height-for-age, and that 88.8% had a normal z-score for-age for body mass index. Conclusion: the sample of children diagnosed with pediatric feeding disorder exhibited adequate anthropometric parameters for their age range.

Interrater reliability in the temporal quantitative analysis of oropharyngeal swallowing using a specific software.

PURPOSE: This study aims to analyze inter-judge reliability by measuring a few temporal parameters of swallowing using a specific software. METHODS: Six databases that include the results of reliability tests performed in prior studies by the present research group were employed. The datasets were obtained using the same measurement method and include data obtained based on puree (level 3) consistency and liquid (level 0) consistency according to the International Dysphagia Diet Standardization Initiative. In this study, the reliabilities corresponding to the total oral transit time (TOTT), initiation of the pharyngeal response time (PRT), and the pharyngeal transit time (PTT) were measured using the same software; the evaluations performed by a single rater for all datasets were used as the benchmark, and evaluations performed by new raters for each dataset were also included. The intra-class correlation coefficient (ICC) with a 95% confidence interval was employed. RESULTS: A total of 244 videofluoroscopic swallowing study images were analyzed. In all analyses, the ICCs were >0,75 and showed excellent agreement between the senior and junior raters. The TOTT for level 3 showed ICCs from 0.936 to 1.000 and that for level 0 showed ICCs from 0.997 to 1.000. Further, the PRT showed ICCs from 0.916 to 1.000 for level 3 and from 0.978 to 1.000 for level 0. The PTT showed ICCs from 0.848 to 1.000 for level 3 and from 0.984 to 1.000 for level 0. CONCLUSION: The reliabilities obtained using this specific software for the TOTT, PRT, and PTT showed excellent agreement.

Relationship between Anthropometric Parameters and Sensory Processing in Typically Developing Brazilian Children with a Pediatric Feeding Disorder.

In this study, we aimed to relate anthropometric parameters and sensory processing in typically developing Brazilian children diagnosed with a pediatric feeding disorder (PFD). This was a retrospective study of typically developing children with a PFD. Anthropometric data were collected and indices of weight-for-age, length/height-for-age, and body mass index-for-age (BMI-for-age) were analyzed as z-scores. Sensory profile data were collected for auditory, visual, tactile, vestibular, and oral sensory processing. We included 79 medical records of children with a PFD. There were no statistically significant (p > 0.05) relationships between the anthropometric variables (weight-, length/height-, or BMI-for-age) and the sensory variables (auditory, visual, tactile, vestibular, or oral sensory processing). In conclusion, we found no relationship between anthropometric parameters and sensory processing in the sample of typically developing Brazilian children diagnosed with a PFD under study.

Relationship between pharyngeal response time and lateralized brain lesion in stroke.

Objectives: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions. Methods: A Cross-sectional study. 73 videofluoroscopic swallow studies (VFSS)were conducted on patients after stroke The study subjects were divided into : group 1 (G1) consisting of 39 individuals with left cortical lesion and group 2 (G2) consisting of 34 individuals with right cortical lesions. The VFSS of G1 and G2 subjects were analyzed using puree (A) and liquid (B) consistencies, and  were also subdivided into young adults and older persons. . The mean PRT was divided into times shorter and longer than 250 ms. Results: No statistically significant difference was observed between G1 and G2 for the A and B consistencies, being obtained : G1 (A mean: 56.6 ms; B mean: 99.5 ms; A mean: 3627 ms; B mean: 1712 ms) and G2 (A mean: 79.6 ms; B mean: 110.7 ms; A mean: 2040 ms, B mean: 1529 ms), for PRT shorter (A:p = .673; B: p = 1.000) and longer (A: p = .435; B: p = .847) than 250 ms, respectively. No statistically significant difference was found regarding the variable age in the comparison between young and old adults for mean PRT according to the A and B consistencies in G1 (A: p = .260; B: p = .732) and G2 (A: p = .586; B: p = .104). Conclusion: No relationship between PRT and lateralization of brain lesion was observed with respect to subject age and to the swallowing of different food consistencies.

Tempo de trânsito oral e lateralidade da lesão cerebral no acidente vascular encefálico / Oral transit time and brain lesion laterality in stroke

RESUMO Introdução O tempo de trânsito orofaríngeo se modifica de acordo com inúmeras variáveis. Objetivo Comparar o tempo de trânsito oral total (TTOT) e a lateralidade da lesão cerebral no indivíduo após acidente vascular encefálico (AVE), com disfagia orofaríngea. Métodos Foram analisados 61 exames de videofluoroscopia da deglutição de indivíduos pós-AVE hemisférico unilateral e isquêmico. Os participantes foram divididos em dois grupos: O Grupo 1 (G1) foi composto de 30 indivíduos com lesão cortical direita e o Grupo 2 (G2), de 31 indivíduos com lesão cortical esquerda. A análise quantitativa do TTOT foi feita por dois juízes treinados no procedimento, por meio de software específico e foi realizada a análise da confiabilidade entre julgadores. Para a análise dos resultados, utilizou-se o teste Mann-Whitney. Resultados Verificou-se que, no G1, o TTOT foi maior que 2000 ms em 50% dos indivíduos e, no G2, em 94% dos indivíduos, ocorrendo diferença estatística significativa entre os grupos (p<0,01). Na comparação entre G1 e G2, para o TTOT, observou-se diferença estatística significativa (p=0,001). Entretanto, não houve diferença estatística significativa na comparação do G1 e G2, tanto para o TTOT menor que 2000 ms (p=1,000), como para o TTOT maior que 2000 ms (p=0,603). Contudo, verificou-se que, no G2, a média do TTOT maior que 2000 ms foi superior, quando comparada ao G1. Conclusão Houve tempo de trânsito oral total maior e menor que 2000 ms, em ambos os hemisférios corticais lesionados. A frequência de indivíduos com tempo de trânsito oral total maior que 2000 ms, bem como a média desse tempo, foram maiores na lesão cortical à esquerda no AVE.

ABSTRACT Introduction The oropharyngeal transit time changes according to several variables. Purpose To compare the total oral transit time (TOTT) and laterality of brain lesion in the individual after stroke with oropharyngeal dysphagia. Methods Analyzed 61 videofluoroscopic swallowing studies of individuals after unilateral cortical ischemic stroke. Participants were divided into two groups. Group 1 (G1) consisted of 30 individuals with right-side cortical lesion and group 2 (G2) of 31 individuals with left-side cortical lesion. Quantitative analysis of the TOTT was performed by two judges trained in the procedure by means of specific software and an analysis of the reliability between judges was performed. The Mann-Whitney test was used for the data analysis. Results It was found TTOT longer than 2000 ms in 50% of the G1 and in 94% of the individuals of G2 with a significant statistical difference between the groups (p<0.01). In the comparison between G1 and G2 regarding TOTT, it was verified that there was significant statistical difference (p=0.001). However, there was no significant statistical difference in the comparison between G1 and G2 for both TOTT shorter than 2000 ms (p=1.000) and TOTT longer than 2000 ms (p=0.603). However, it was found that in G2 the TOTT average is longer than 2000 ms and was greater than in G1. Conclusion There were TOTT shorter and longer than 2000 ms in both hemispheric cortical lesion. The frequency of individuals with TTOT are longer than 2000 ms and the average are greater in the left-side cortical lesion in stroke.

Swallowing endoscopy findings in Huntington's disease: a case report

ABSTRACT Huntington's disease (HD) is a degenerative genetic disorder with autosomal-dominant transmission. The triad of symptoms of this disease consists of psychiatric disorders, jerky movements, and dementia. Oropharyngeal dysphagia, which is more evident with disease progression, is also present. Few studies have addressed the swallowing characteristics using objective analysis in this population. The purpose of this research was to describe the swallowing endoscopic findings of the pharyngeal phase in HD. This is a cross-sectional study addressing a clinical case which included two individuals of the same family, male, 32 and 63 years old, designated as individual A and individual B, with progression of the disease for five and 13 years, respectively. Consistent liquid, nectar, and puree were offered during the evaluation. There was presence of posterior oral spillage in liquid and nectar, small amount of pharyngeal residues, and no laryngeal penetration or aspiration in the individuals with HD in this study.

Swallowing endoscopy findings in Huntington's disease: a case report.

Huntington's disease (HD) is a degenerative genetic disorder with autosomal-dominant transmission. The triad of symptoms of this disease consists of psychiatric disorders, jerky movements, and dementia. Oropharyngeal dysphagia, which is more evident with disease progression, is also present. Few studies have addressed the swallowing characteristics using objective analysis in this population. The purpose of this research was to describe the swallowing endoscopic findings of the pharyngeal phase in HD. This is a cross-sectional study addressing a clinical case which included two individuals of the same family, male, 32 and 63 years old, designated as individual A and individual B, with progression of the disease for five and 13 years, respectively. Consistent liquid, nectar, and puree were offered during the evaluation. There was presence of posterior oral spillage in liquid and nectar, small amount of pharyngeal residues, and no laryngeal penetration or aspiration in the individuals with HD in this study.