Degree of swallowing impairment in the elderly: clinical and instrumental assessment.

OBJECTIVE: To classifying the degree of swallowing impairment in the elderly, comparing clinical and instrumental assessment. METHODS: This is a cross-sectional study with quantitative and qualitative analysis of clinical and instrumental assessment of 37 elderly, aged 60-82 years, of both genders without neurological, oncological or systemic diseases, participated in this study. All participants were submitted to clinical evaluation and their results compared through fiberoptic endoscopic evaluation of swallowing considering liquid, pudding and solid food consistencies. Data were analyzed descriptively and statistically using the analysis of variance test (two-way ANOVA) and Tukey's post hoc test (p <  0.05). RESULTS: In the clinical evaluation there was a higher occurrence of moderate swallowing impairment, followed by functional swallowing, while in fiberoptic endoscopic evaluation of swallowing the severity of the impairment was greater for moderate and mild degrees. There was no statistical difference between the clinical and instrumental evaluation methods. However, there was a significant interaction between the variables, with a difference for liquid consistency in the instrumental evaluation method. CONCLUSION: Healthy elderly have different degree of swallowing impairment according to food consistency. The clinical assessment using a scale that considers the physiological changes of the elderly, presented results similar to those found in the instrumental examination.

Intervenções da Fonoaudiologia nas áreas de respiração, mastigação, deglutição e fala: uma revisão de escopo / Speech Language Pathology interventions in the areas of breathing, chewing, swallowing and speaking: a scoping review

RESUMO Há diversas abordagens que podem ser utilizadas para atingir os objetivos terapêuticos nos distúrbios relacionados às funções de mastigação, deglutição, fala e respiração. Entretanto, a literatura necessita de evidências que fundamentem o uso na prática clínica fonoaudiológica. O objetivo desta revisão foi mapear as sínteses de evidências sobre intervenção fonoaudiológica nas áreas de respiração, mastigação, deglutição e fala em adultos e idosos.‬ Foram incluídos apenas estudos classificados por seus autores como revisão sistemática, que abordaram terapia para disfunções orofaciais em indivíduos maiores de 18 anos. Os procedimentos realizados foram: busca eletrônica e manual; seleção dos estudos; extração dos dados; avaliação da qualidade dos estudos e análise de dados. Foi possível observar diversos tipos de intervenções principalmente voltadas à função de deglutição, abarcando desde a terapia tradicional até a utilização de dispositivos. Contudo, devido às limitações dos estudos, os dados devem ser interpretados com cautela.

ABSTRACT There are several types of approaches that can be used to achieve therapeutic goals in disorders related to the functions of mastication, swallowing, speech, and breathing. However, the literature lacks evidence to support their use in speech-language clinical practice. The objective of this review was to map the syntheses of evidence on speech-language pathology intervention in the areas of breathing, mastication, swallowing and speech in adults and the elderly. Only studies classified by their authors as a systematic review, studies that addressed therapy for orofacial disorders in individuals over 18 years of age were included. The procedures performed included: electronic and manual search; selection of studies; data extraction; evaluation of the quality of studies and data analysis. It was possible to observe different types of interventions mainly aimed at the swallowing function, ranging from traditional therapy to the use of devices. However, due to the limitations of the studies, the data must be interpreted with caution.

Translation and cross-cultural adaptation of the "Protocolo de Avaliação Miofuncional Orofacial MBGR" from Brazilian Portuguese into English.

In health-related research, an increasing number of clinical assessment tools are translated and cross-culturally adapted for cross-national and cross-cultural studies and comparisons. However, when translating and cross-culturally adapting clinical assessment tools for use across new countries, cultures, or languages, we must follow a thorough method to reach semantic, idiomatic, experiential, and conceptual equivalences between translated and original versions. Therefore, in this study, we translated and cross-culturally adapted the Protocolo MBGR (Marchesan, Berretin-Felix, Genaro, and Rehder) from Brazilian Portuguese into English, following international guidelines, and named it "MBGR Protocol." To verify its content validity, we used the Content Validity Index. Results indicated excellent content validity: a Scale-Content Validity Index of 0.96 and 97% of all translation units with an Item-Content Validity Index of 1.00. Also, to prove its face validity and confirm whether it worked in the target population's linguistic-cultural setting, we used it with 35 subjects. Again, results demonstrated excellent face validity: in the pretest, 91% of all translation units were considered comprehensible and clear; in the pilot test, 98% of all translation units were considered comprehensible and clear. Thus, we concluded that the MBGR Protocol is promising to enhance the uptake of studies in Orofacial Myology worldwide and support researchers and health professionals in assessing and diagnosing orofacial myofunctional disorders in children, adolescents, adults, and the elderly. Also, it may support evidence-based practice and assist in standardizing assessment and diagnostic criteria. The MBGR Protocol should have its psychometric properties tested before being used in clinical practice or scientific research. Therefore, future studies are needed, and collaborations among researchers from South and North American countries are encouraged to create an international network and advance with knowledge and skills in the Orofacial Myology discipline.

Symptoms of oropharyngeal dysphagia, efficiency, and safety of swallowing in patients after treatment for head and neck cancer.

PURPOSE: The aim of this study is to investigate the relation between symptoms and signs of oropharyngeal dysphagia after treatment for head and neck cancer. METHODS: An observational analytical study with retrospective and prospective components was carried out including 25 adult and elderly patients with head and neck cancer who had completed the treatment at least 3 months before data collection. Data from the Eating Assessment Tool (EAT-10) protocol were analyzed, as well as from the videofluoroscopic swallowing exams. Based on videofluoroscopy, the degree of oropharyngeal dysphagia was classified, as well as the safety and efficiency grade using the DIGEST (Dynamic Imaging Grade of Swallowing Toxicity) scale. Pearson's correlation test was applied, adopting a significance level of 5%. RESULTS: There was a significant correlation between question 4 of the EAT-10 (swallowing solids takes extra effort) and the efficiency profile (p = 0.004), as well as between question 4 and the DIGEST score (p = 0.002). No significant relation was found between the DIGEST score and EAT-10 total score (p = 0.180) and not even between EAT-10 total score and efficiency (p = 0.129) or safety grade (p = 0.878). CONCLUSION: In conclusion, no relation was found between most of the dysphagia signs and symptoms investigated, demonstrating that the individual's perception of the swallowing function may not be consistent with the findings of the instrumental evaluation after long-term treatment for head and neck cancer.

Speech Language Pathology interventions in the areas of breathing, chewing, swallowing and speaking: a scoping review. / Intervenções da Fonoaudiologia nas áreas de respiração, mastigação, deglutição e fala: uma revisão de escopo.

There are several types of approaches that can be used to achieve therapeutic goals in disorders related to the functions of mastication, swallowing, speech, and breathing. However, the literature lacks evidence to support their use in speech-language clinical practice. The objective of this review was to map the syntheses of evidence on speech-language pathology intervention in the areas of breathing, mastication, swallowing and speech in adults and the elderly. Only studies classified by their authors as a systematic review, studies that addressed therapy for orofacial disorders in individuals over 18 years of age were included. The procedures performed included: electronic and manual search; selection of studies; data extraction; evaluation of the quality of studies and data analysis. It was possible to observe different types of interventions mainly aimed at the swallowing function, ranging from traditional therapy to the use of devices. However, due to the limitations of the studies, the data must be interpreted with caution.

Há diversas abordagens que podem ser utilizadas para atingir os objetivos terapêuticos nos distúrbios relacionados às funções de mastigação, deglutição, fala e respiração. Entretanto, a literatura necessita de evidências que fundamentem o uso na prática clínica fonoaudiológica. O objetivo desta revisão foi mapear as sínteses de evidências sobre intervenção fonoaudiológica nas áreas de respiração, mastigação, deglutição e fala em adultos e idosos.‬ Foram incluídos apenas estudos classificados por seus autores como revisão sistemática, que abordaram terapia para disfunções orofaciais em indivíduos maiores de 18 anos. Os procedimentos realizados foram: busca eletrônica e manual; seleção dos estudos; extração dos dados; avaliação da qualidade dos estudos e análise de dados. Foi possível observar diversos tipos de intervenções principalmente voltadas à função de deglutição, abarcando desde a terapia tradicional até a utilização de dispositivos. Contudo, devido às limitações dos estudos, os dados devem ser interpretados com cautela.

Orofacial Myofunctional Aspects of Nursing Infants and Preschoolers.

Introduction Clinical assessment in orofacial motricity is required for the speech therapist to diagnose and treat disorders involving the stomatognathic system. Validated tools can help establish a prognosis and outline intervention methods connected to human development. Objective The goal of the present study was to examine the domains of the oromyofunctional assessment of nursing infants and preschoolers according to sex and age group, as well as the application of the MMBGR Protocol - Nursing Infants and Preschool Children. Methods A quantitative technique was used to conduct an analytical and cross-sectional investigation. The present study included a total of 214 healthy breastfeeding infants and preschoolers of both sexes. The Mann-Whitney test was used to compare the medians. The Spearman correlation of each test domain was determined. R Core Team 2021 (R Foundation, Vienna, Austria) was used, and the significance threshold was set at 5%. Results In intraoral and extraoral examinations, there was a difference between sexes for tongue scores in nursing infants (d = - 0.428; p = 0.045), worse in males. When the orofacial functions were considered in nursing infants, there were differences between the sexes for the liquid/solid/semisolid deglutition scores (d = 0.479; p = 0.031), with females performing worse. There were sex differences in solid/semisolid deglutition (d = - 0.335; p = 0.043), and speech in preschoolers (d = - 0.478; p = 0.034), including the production of phones/phonemes (d = - 0.599; p = 0.007), which were always worse in males. Conclusion The research revealed sex disparities and related the domains of oromyofunctional assessment, according to scores, of the domains of myofunctional assessment, as recorded in a standardized oromyofunctional assessment protocol by age group.

Utilization of electromyographic biofeedback in speech therapy to attenuate the signs of facial aging: a case report. / Utilização do biofeedback eletromiográfico na terapia fonoaudiológica para atenuar sinais de envelhecimento facial: relato de caso.

Myotherapy intervention in facial aesthetics aims to attenuate wrinkles and signs of facial aging. The relationship between accentuated muscle contraction during chewing, swallowing and speaking and the appearance of facial wrinkles has been suggested by speech-language pathology literature. This study aimed to report the effect of electromyographic biofeedback associated with training of chewing, swallowing, and smiling patterns, during speech therapy intervention aimed at reducing the signs of facial wrinkles and furrows, in a 55-year-old woman. The therapy also included isotonic and isometric exercises and clinical procedures to decrease the contraction of facial mimicry muscles, which were not associated with training using electromyographic biofeedback. Signal collection and training were performed using the Biotrainer software on the New Miotool Face by Miotec, over nine weekly sessions. Two assessments were performed (before and after the nine sessions), using the MBGR Protocol (assessment of chewing, swallowing, and smiling) and validated scales described in the literature (assessment of signs of facial aging). In the reported case, the usefulness of electromyographic biofeedback was verified for learning trained orofacial myofunctional patterns, as well as to improve chewing and swallowing functions and decrease signs of facial aging. However, further research is needed to demonstrate the positive effects of electromyographic biofeedback associated with myofunctional therapy aimed at attenuating the signs of facial aging.

A intervenção mioterápica em estética facial tem como meta atenuar rugas e sinais de envelhecimento facial. A relação entre contração exagerada dos músculos durante a mastigação, deglutição e comunicação oral e aparecimento de rugas faciais é preconizada na literatura fonoaudiológica neste campo de atuação. Este estudo teve por objetivo relatar o efeito da utilização do biofeedback eletromiográfico associado ao treinamento dos padrões de mastigação, deglutição e sorriso, durante intervenção fonoaudiológica direcionada à atenuação de rugas e sulcos faciais, em mulher de 55 anos de idade. O programa terapêutico incluiu exercícios isotônicos, isométricos e procedimentos clínicos para diminuir a contração dos músculos mímicos faciais, que não foram associados ao treinamento com biofeedback eletromiográfico. A coleta de sinais e o treinamento com o software Biotrainer foram realizados com o aparelho New Miotool Face (Miotec) em nove sessões realizadas semanalmente. Foram realizadas duas avaliações (antes e após as nove sessões), por meio do Protocolo MBGR (avaliação da mastigação, deglutição e sorriso) e de escalas validadas descritas na literatura (avaliação dos sinais de envelhecimento facial). No caso descrito, constatou-se o efeito adjuvante do biofeedback eletromiográfico no aprendizado dos padrões miofuncionais orofaciais treinados, como também, a melhoria das funções mastigação e deglutição e a diminuição dos sinais de envelhecimento facial. Porém, são necessárias pesquisas mais robustas que comprovem efeitos positivos do biofeedback eletromiográfico associado à terapia miofuncional direcionada a atenuar os sinais de envelhecimento facial.

Utilização do biofeedback eletromiográfico na terapia fonoaudiológica para atenuar sinais de envelhecimento facial: relato de caso / Utilization of electromyographic biofeedback in speech therapy to attenuate the signs of facial aging: a case report

RESUMO A intervenção mioterápica em estética facial tem como meta atenuar rugas e sinais de envelhecimento facial. A relação entre contração exagerada dos músculos durante a mastigação, deglutição e comunicação oral e aparecimento de rugas faciais é preconizada na literatura fonoaudiológica neste campo de atuação. Este estudo teve por objetivo relatar o efeito da utilização do biofeedback eletromiográfico associado ao treinamento dos padrões de mastigação, deglutição e sorriso, durante intervenção fonoaudiológica direcionada à atenuação de rugas e sulcos faciais, em mulher de 55 anos de idade. O programa terapêutico incluiu exercícios isotônicos, isométricos e procedimentos clínicos para diminuir a contração dos músculos mímicos faciais, que não foram associados ao treinamento com biofeedback eletromiográfico. A coleta de sinais e o treinamento com o software Biotrainer foram realizados com o aparelho New Miotool Face (Miotec) em nove sessões realizadas semanalmente. Foram realizadas duas avaliações (antes e após as nove sessões), por meio do Protocolo MBGR (avaliação da mastigação, deglutição e sorriso) e de escalas validadas descritas na literatura (avaliação dos sinais de envelhecimento facial). No caso descrito, constatou-se o efeito adjuvante do biofeedback eletromiográfico no aprendizado dos padrões miofuncionais orofaciais treinados, como também, a melhoria das funções mastigação e deglutição e a diminuição dos sinais de envelhecimento facial. Porém, são necessárias pesquisas mais robustas que comprovem efeitos positivos do biofeedback eletromiográfico associado à terapia miofuncional direcionada a atenuar os sinais de envelhecimento facial.

ABSTRACT Myotherapy intervention in facial aesthetics aims to attenuate wrinkles and signs of facial aging. The relationship between accentuated muscle contraction during chewing, swallowing and speaking and the appearance of facial wrinkles has been suggested by speech-language pathology literature. This study aimed to report the effect of electromyographic biofeedback associated with training of chewing, swallowing, and smiling patterns, during speech therapy intervention aimed at reducing the signs of facial wrinkles and furrows, in a 55-year-old woman. The therapy also included isotonic and isometric exercises and clinical procedures to decrease the contraction of facial mimicry muscles, which were not associated with training using electromyographic biofeedback. Signal collection and training were performed using the Biotrainer software on the New Miotool Face by Miotec, over nine weekly sessions. Two assessments were performed (before and after the nine sessions), using the MBGR Protocol (assessment of chewing, swallowing, and smiling) and validated scales described in the literature (assessment of signs of facial aging). In the reported case, the usefulness of electromyographic biofeedback was verified for learning trained orofacial myofunctional patterns, as well as to improve chewing and swallowing functions and decrease signs of facial aging. However, further research is needed to demonstrate the positive effects of electromyographic biofeedback associated with myofunctional therapy aimed at attenuating the signs of facial aging.

Orofacial Myofunctional Aspects of Nursing Infants and Preschoolers

Abstract Introduction Clinical assessment in orofacial motricity is required for the speech therapist to diagnose and treat disorders involving the stomatognathic system. Validated tools can help establish a prognosis and outline intervention methods connected to human development. Objective The goal of the present study was to examine the domains of the oromyofunctional assessment of nursing infants and preschoolers according to sex and age group, as well as the application of the MMBGR Protocol - Nursing Infants and Preschool Children. Methods A quantitative technique was used to conduct an analytical and cross-sectional investigation. The present study included a total of 214 healthy breastfeeding infants and preschoolers of both sexes. The Mann-Whitney test was used to compare the medians. The Spearman correlation of each test domain was determined. R Core Team 2021 (R Foundation, Vienna, Austria) was used, and the significance threshold was set at 5%. Results In intraoral and extraoral examinations, there was a difference between sexes for tongue scores in nursing infants(d =-0.428; p = 0.045), worse in males. When the orofacial functions were considered in nursing infants, there were differences between the sexes for the liquid/solid/semisolid deglutition scores (d = 0.479; p = 0.031), with females performing worse. There were sex differences in solid/semisolid deglutition (d = -0.335; p = 0.043), and speech in preschoolers (d = - 0.478; p = 0.034), including the production of phones/phonemes (d = - 0.599; p = 0.007), which were always worse in males. Conclusion The research revealed sex disparities and related the domains of oromyofunctional assessment, according to scores, of the domains of myofunctional assessment, as recorded in a standardized oromyofunctional assessment protocol by age group.

Oropharyngeal dysphagia and quality of life in elderly people in the late phase after stroke / Disfagia orofaríngea e qualidade de vida em idosos após a fase tardia do acidente vascular encefálico

ABSTRACT Purpose: to verify the correlation between oropharyngeal dysphagia and quality of life in elderly people in the late phase after stroke. Methods: a retrospective cross-sectional study, whose data were obtained by analyzing a database composed of 30 elderly people in the late phase after stroke. All participants underwent clinical and instrumental evaluation of swallowing through the fiberoptic endoscopic evaluation of swallowing. The quality of life related to swallowing was analyzed using the Quality of Life in Swallowing Disorders protocol. Data were submitted to descriptive statistical analysis and Spearman's correlation test (p ≤ 0.05). Results: the clinical evaluation showed that most individuals had mild oropharyngeal dysphagia, while the protocol applied in the instrumental evaluation showed swallowing with functional limitations. There was a positive correlation between burden, eating desire, eating duration, and mental health with the severity of oropharyngeal dysphagia, both by clinical and instrumental evaluation; and between the symptom's frequency and the severity of dysphagia by clinical evaluation. Conclusion: there was a correlation between the severity of oropharyngeal dysphagia and the quality of life of elderly people in the late phase after stroke.

RESUMO Objetivo: verificar a correlação entre disfagia orofaríngea e qualidade de vida em idosos após a fase tardia do Acidente Vascular Encefálico. Métodos: estudo transversal retrospectivo, cujos dados foram obtidos pela análise de um banco de dados, composto por 30 idosos acometidos por Acidente Vascular Encefálico, em fase tardia. Todos os participantes foram submetidos a avaliação clínica e instrumental da deglutição, por meio da videoendoscopia da deglutição. A qualidade de vida relacionada à deglutição foi analisada pelo protocolo Quality of Life in Swallowing Disorders. Os dados foram submetidos à análise estatística descritiva e ao teste de correlação de Spearman (p ≤ 0,05). Resultados: a avaliação clínica evidenciou que a maioria dos indivíduos apresentou disfagia orofaríngea leve, enquanto a escala aplicada na avaliação instrumental demonstrou deglutição com limitações funcionais. Houve correlação positiva entre fardo, desejo de se alimentar, duração da alimentação e estado mental com a gravidade da disfagia orofaríngea, tanto pela avaliação clínica quanto instrumental; e entre a frequência dos sintomas e a gravidade da disfagia pela avaliação clínica. Conclusão: houve correlação entre a gravidade da disfagia orofaríngea e a qualidade de vida de idosos após a fase tardia do Acidente Vascular Encefálico.

Effects of Resonance Tube Voice Therapy on Parkinson's Disease: Clinical Trial.

PURPOSE: To verify the effect of resonance tube voice therapy on the vocal aspects of patients with Parkinson's Disease (PD). METHOD: Intra-subject comparative controlled clinical trial with a single group assignment. Fourteen individuals with PD (10 men, mean age 66.1 years; four women, mean age 73.75 years) received eight 45-minute sessions of voice therapy, twice a week for 4 weeks. The therapy consisted of semi-occluded vocal tract exercises - phonation method in a resonance tube (glass, 27 cm x 9 mm) in water. Tube depth in water ranged from 2 cm to 9 cm, as the difficulty in carrying out the exercises increased (usual pitch, high pitch, low pitch, ascending/descending glissandos), followed by sentence production. The assessments were made three times: at baseline (Time0), after 30 days without intervention (Time1), and 1 day after eight intervention sessions (Time2). The following aspects were assessed: vocal intensity; acoustic parameters (Smoothed Cepstral Peak Prominence - CPPs, alpha ratio, and L1-L0 difference); auditory-perceptual analysis of the overall degree of vocal quality deviation; voice symptoms (Voice Symptom Scale protocol - VoiSS) and voice-related quality of life (Voice-Related Quality of Life Protocol - V-RQOL). The results were compared at the three times of assessment Time0/Time1/Time2 using one-way repeated measures ANOVA test and Tukey test (5% significance). RESULTS: intervention significantly increased: vocal intensity, L1-L0 value of vowel /a/ and counting, CPP value in counting, and decreased: the overall degree of vocal quality deviation in 78% of participants, the total score of VoiSS protocol, the limitation, and emotional subscales. In addition, the intervention increased the score of all the domains of V-RQOL protocol - physical, socio-emotional, and total. CONCLUSION: Resonance tube phonation in voice therapy was effective in increasing vocal intensity and long-term acoustic parameters, the improved overall degree of vocal quality, reducing voice symptoms, and increasing voice-related quality of life in individuals with PD.

MMBRG Protocol - Infants and Preschoolers: Myofunctional Orofacial Clinic Examination. / Protocolo MMBRG ­ Lactentes e Pré-Escolares: Exame Clínico Miofuncional Orofacial.

PURPOSE: To present the Myofunctional Orofacial Clinical Examination Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including its validation. METHODS: Initially, test content-based validity was evaluated from the MBGR Protocol to be used with the age group between 6 and 71 months based on the bibliography and experience between the authors (original and current). For the content and appearance analysis, 10 speech therapists specialized in Orofacial Motricity attended and filled out an electronic form with dichotic and Likert scale questions in two moments. We used the Content Validity Index and the Exact Binomial Test. Then there was a validity based on the response processes analysis followed by a reliability of the Clinical Examination with 155 participants by 7 experienced and calibrated speech therapists, and the examiners between and within agreement was verified by the Intraclass Correlation Coefficient. RESULTS: There were additions, modifications, and exclusions of items according to the age group, resulting in the Myofunctional Orofacial Clinical Examination Protocol for Infants and Preschoolers, which obtained 90.5% agreement; and 100% of the appropriate scores by at least 90% of the specialists. In reliability, most items of the Extraoral and Intraoral Examination and Chewing obtained a reasonable to good, or even excellent, agreement. CONCLUSION: The "Clinical Myofunctional Clinical Examination" was validated based on the test content, response process, and reliability and, along with the "Instructional" and the "Clinical History" is part of the "MMBGR Protocol - Infants and Preschoolers" for speech therapy activities in the age group between 6 and 71 months of age.

OBJETIVO: Apresentar Exame Clínico Miofuncional Orofacial pertencente ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo sua validação. MÉTODO: Inicialmente foi realizada a validade do conteúdo do teste adaptado do Protocolo MBGR, para faixa etária entre 6 e 71 meses, fundamentada na bibliografia e experiência entre autores (originais e atuais). Para análise de conteúdo e aparência participaram 10 fonoaudiólogos especialistas em Motricidade Orofacial, que preencheram formulário eletrônico com questões dicóticas e escala de Likert, em dois momentos. Foi calculado Índice de Validade de Conteúdo e Teste Binomial Exato. Na sequência houve análise da validade baseada nos processos de resposta, seguida da análise da confiabilidade do Exame Clínico, com 155 participantes, por 7 fonoaudiólogos experientes e calibrados, sendo verificada a concordância entre e intra examinadores pelo Coeficiente de Correlação Intraclasse. RESULTADOS: Houve acréscimos, modificações e exclusão de itens conforme faixa etária, concluindo-se o Protocolo Exame Clínico Miofuncional Orofacial para lactentes e pré-escolares, que obteve 90,5% com concordância; e 100% dos escores adequados por pelo menos 90% dos especialistas. Quanto à confiabilidade, a maioria dos itens dos Exames Extraoral e Intraoral e Mastigação obtiveram concordância razoável a boa, ou, até mesmo, excelente. CONCLUSÃO: O "Exame Clínico Miofuncional Orofacial" teve validação baseada no conteúdo do teste, nos processos de resposta e confiabilidade concluída, e junto ao "Instrutivo" e à "História Clínica" integra o "Protocolo MMBGR - Lactentes e Pré-escolares", para atuação fonoaudiológica na faixa etária entre 6 e 71 meses de idade.

Effect of Lingual Frenotomy on Tongue and Lip Rest Position: A Nonrandomized Clinical Trial

Abstract Introduction The tongue plays an important role in the development of craniofacial structures. At rest, the light and constant pressure of the tongue against the hard palate, counterbalanced by the pressure provided by proper lip sealing, serves as a guide for maxillary growth. Ankyloglossia makes tongue coupling against the hard palate difficult, impacting maxillary development, which may lead to breathing disorders. Objective To verify the effect of lingual frenotomy on the resting position of the tongue and lips in infants with ankyloglossia. Methods The sample consisted of 334 infants aged between 1 and 60 days old diagnosed with ankyloglossia. The groups were divided in: a) experimental group (EG), which consisted of infants whose mothers agreed with lingual frenotomy; b) control group (CG), which consisted of infants whose mothers either refused lingual frenotomy or were waiting for surgery. Both the position of the lips and of the tongue at rest were assessed while the infants were sleeping during the quiet sleep phase. For mothers who refused their infants to undergo the surgical procedure, a follow-up of the infants was proposed to verify possible interference of the frenulum with the resting position of the tongue and lips. Infants whose mothers agreed with surgery were referred for lingual frenotomy. Results Regarding the position of the tongue and lips at rest at the initial and final assessments, the statistical analysis demonstrated significant differences between both groups. Conclusion Lingual frenotomy enabled infants diagnosed with ankyloglossia to maintain both tongue coupling against the hard palate and closed lips at rest.

MMBGR Protocol - infants and preschoolers: Instructive and Orofacial Myofunctional Clinical History. / Protocolo MMBRG ­ Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial.

PURPOSE: To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. METHODS: Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. RESULTS: We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. CONCLUSION: "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.

OBJETIVO: Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. MÉTODO: Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. RESULTADOS: Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. CONCLUSÃO: "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.

Effect of Lingual Frenotomy on Tongue and Lip Rest Position: A Nonrandomized Clinical Trial.

Introduction The tongue plays an important role in the development of craniofacial structures. At rest, the light and constant pressure of the tongue against the hard palate, counterbalanced by the pressure provided by proper lip sealing, serves as a guide for maxillary growth. Ankyloglossia makes tongue coupling against the hard palate difficult, impacting maxillary development, which may lead to breathing disorders. Objective To verify the effect of lingual frenotomy on the resting position of the tongue and lips in infants with ankyloglossia. Methods The sample consisted of 334 infants aged between 1 and 60 days old diagnosed with ankyloglossia. The groups were divided in: a) experimental group (EG), which consisted of infants whose mothers agreed with lingual frenotomy; b) control group (CG), which consisted of infants whose mothers either refused lingual frenotomy or were waiting for surgery. Both the position of the lips and of the tongue at rest were assessed while the infants were sleeping during the quiet sleep phase. For mothers who refused their infants to undergo the surgical procedure, a follow-up of the infants was proposed to verify possible interference of the frenulum with the resting position of the tongue and lips. Infants whose mothers agreed with surgery were referred for lingual frenotomy. Results Regarding the position of the tongue and lips at rest at the initial and final assessments, the statistical analysis demonstrated significant differences between both groups. Conclusion Lingual frenotomy enabled infants diagnosed with ankyloglossia to maintain both tongue coupling against the hard palate and closed lips at rest.

Protocolo MMBRG - Lactentes e Pré-Escolares: Exame Clínico Miofuncional Orofacial / MMBRG Protocol - Infants and Preschoolers: Myofunctional Orofacial Clinic Examination

RESUMO Objetivo Apresentar Exame Clínico Miofuncional Orofacial pertencente ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo sua validação. Método Inicialmente foi realizada a validade do conteúdo do teste adaptado do Protocolo MBGR, para faixa etária entre 6 e 71 meses, fundamentada na bibliografia e experiência entre autores (originais e atuais). Para análise de conteúdo e aparência participaram 10 fonoaudiólogos especialistas em Motricidade Orofacial, que preencheram formulário eletrônico com questões dicóticas e escala de Likert, em dois momentos. Foi calculado Índice de Validade de Conteúdo e Teste Binomial Exato. Na sequência houve análise da validade baseada nos processos de resposta, seguida da análise da confiabilidade do Exame Clínico, com 155 participantes, por 7 fonoaudiólogos experientes e calibrados, sendo verificada a concordância entre e intra examinadores pelo Coeficiente de Correlação Intraclasse. Resultados Houve acréscimos, modificações e exclusão de itens conforme faixa etária, concluindo-se o Protocolo Exame Clínico Miofuncional Orofacial para lactentes e pré-escolares, que obteve 90,5% com concordância; e 100% dos escores adequados por pelo menos 90% dos especialistas. Quanto à confiabilidade, a maioria dos itens dos Exames Extraoral e Intraoral e Mastigação obtiveram concordância razoável a boa, ou, até mesmo, excelente. Conclusão O "Exame Clínico Miofuncional Orofacial" teve validação baseada no conteúdo do teste, nos processos de resposta e confiabilidade concluída, e junto ao "Instrutivo" e à "História Clínica" integra o "Protocolo MMBGR - Lactentes e Pré-escolares", para atuação fonoaudiológica na faixa etária entre 6 e 71 meses de idade.

ABSTRACT Purpose To present the Myofunctional Orofacial Clinical Examination Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including its validation. Methods Initially, test content-based validity was evaluated from the MBGR Protocol to be used with the age group between 6 and 71 months based on the bibliography and experience between the authors (original and current). For the content and appearance analysis, 10 speech therapists specialized in Orofacial Motricity attended and filled out an electronic form with dichotic and Likert scale questions in two moments. We used the Content Validity Index and the Exact Binomial Test. Then there was a validity based on the response processes analysis followed by a reliability of the Clinical Examination with 155 participants by 7 experienced and calibrated speech therapists, and the examiners between and within agreement was verified by the Intraclass Correlation Coefficient. Results There were additions, modifications, and exclusions of items according to the age group, resulting in the Myofunctional Orofacial Clinical Examination Protocol for Infants and Preschoolers, which obtained 90.5% agreement; and 100% of the appropriate scores by at least 90% of the specialists. In reliability, most items of the Extraoral and Intraoral Examination and Chewing obtained a reasonable to good, or even excellent, agreement. Conclusion The "Clinical Myofunctional Clinical Examination" was validated based on the test content, response process, and reliability and, along with the "Instructional" and the "Clinical History" is part of the "MMBGR Protocol - Infants and Preschoolers" for speech therapy activities in the age group between 6 and 71 months of age.

Breathing pattern, orthognathic surgery and head posture in dentofacial deformity / Padrão respiratório, cirurgia ortognática e postura de cabeça na deformidade dentofacial

Abstract Introduction: Dentofacial deformity (DFD) and the breathing mode can change the head posture. However, head posture changes after orthognathic surgery are controversial, and no studies were found on the relationship between the head posture and breathing mode in adults with DFD. Objective: To identify the main head posture changes in young adults affected by DFD, to verify if orthognathic surgery modifies the breathing mode and head posture, and if the breathing mode is associated with the head posture. Methods: Twenty-five young adults were assessed and divided in dentofacial deformity group (DFD; n = 15; x̅ = 28 years) and control group with dentofacial harmony (CG; n = 10; balanced by gender and age with the study group). Breathing mode was evaluated according to the orofacial myofunctional evaluation protocol, and biophotogrammetry was used in the head posture analyses. For the DFD group, the evaluations were performed pre and post the orthognathic surgery (pre- and post-DFD). Results: For the DFD group, the breathing mode modified after orthognathic surgery (p = 0.003), but with difference from GC (p = 0.027). No changes were found in head posture after orthognathic surgery, but significant difference was seen between post-DFD and GC for head inclination (p = 0.017). No relationship was observed between breathing mode and head posture (p > 0.05). Conclusion: After orthognathic surgery, a spontaneous improvement of breathing was seen in the sample. It was not possible to verify changes in head posture and association with breathing mode and head posture.

Resumo Introdução: A deformidade dentofacial (DDF) e o modo respiratório podem alterar a postura de cabeça. Entretanto as modificações da postura de cabeça após a cirurgia ortognática são controversas e não foram encontrados estudos que apontassem relação entre a postura de cabeça e o modo respiratório em adultos com DDF. Objetivo: Identificar as principais alterações na postura de cabeça em adultos jovens com DDF, verificar se a cirurgia ortognática altera o modo respiratório e a postura de cabeça e se o modo respiratório está associado com a postura de cabeça. Métodos: Foram avaliados 25 jovens adultos, os quais foram divididos no grupo deformidade dentofacial (DDF; n = 15; x̅ = 28 anos) e grupo controle com harmonia dentofacial (GC; n = 10; equilibrados por gênero e idade com o grupo de estudo). O modo respiratório foi analisado de acordo com o protocolo de avaliação miofuncional orofacial e a postura de cabeça foi avaliada por meio da biofotogrametria. Para o grupo DDF, as avaliações foram realizadas antes e após a cirurgia ortognática (pré e pós-DDF). Resultados: Para o grupo DDF, o modo respiratório se modificou após a cirurgia ortognática (p = 0,003), porém com diferença em relação ao GC (p = 0,027). Não houve modificação na postura de cabeça após a cirurgia ortognática, porém observou-se diferença significativa entre os grupos pós-DDF e GC para a inclinação de cabeça (p = 0,017). Não observou-se relação entre o modo respiratório e a postura de cabeça (p > 0,05). Conclusão: Após a cirurgia ortognática, notou-se melhora espontânea da respiração na amostra estudada. Não foi possível verificar modificações na postura de cabeça e associação entre modo respiratório e postura de cabeça.

Protocolo MMBRG - Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial / MMBGR Protocol - infants and preschoolers: Instructive and Orofacial Myofunctional Clinical History

RESUMO Objetivo Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. Método Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. Resultados Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. Conclusão "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.

ABSTRACT Purpose To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. Methods Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. Results We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. Conclusion "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.

Duration of mastication and oral phase of swallowing in the elderly with different dental conditions: a clinical analysis / Duração da mastigação e da fase oral da deglutição em idosos com diferentes condições dentárias: análise clínica

ABSTRACT Purpose: to measure the total time of mastication and oral phase of swallowing in healthy elderly people, considering different food consistency, the presence of natural teeth, and the type of prosthetic oral rehabilitation, as well to compare dental conditions and consistencies. Methods: a cross-sectional study with 57 healthy elderly people, aged between 60 and 82 years, divided into: dentate group (D) (n=15); and rehabilitated groups; PD: fixed or removable partial dentures in one or both arches (n=15); CRD: maxillary and mandibular complete removable dentures (n=15); ISCD: complete dentures - maxillary removable denture and mandibular implant-supported dentures (n=12). The duration time (seconds) of chewing and of the oral phase of swallowing was measured in the consistencies: solid (a roll slice), pudding (10 ml) and liquid (10 ml). Results: healthy dentate elderly subjects had the following intervals: liquid=1.07±0.35 s; pudding=3.48±1.76 s; and solid=27.88±7.11 s. Statistically significant differences were observed between the D and ISCD groups (p=0.0056) and between D and CRD (p=0.0056) for liquid. For all groups, there was a statistically significant increase between liquid and solid consistencies and between pasty and solid ones (p<0.001). Conclusions: the dentate elderly had shorter oral phase time of swallowing for liquids than the rehabilitated edentulous elderly, but not different from the elderly with partial dentures. Chewing and swallowing time for solid food was longer than that for the other consistencies, regardless of dental condition.

RESUMO Objetivo: mensurar o tempo total da mastigação e da fase oral da deglutição em idosos saudáveis, considerando diferentes consistências alimentares, a presença de dentes naturais e o tipo de reabilitação oral protética, bem como realizar comparação entre as condições dentárias e as consistências. Métodos: estudo transversal com 57 idosos saudáveis, entre 60 e 82 anos, distribuídos em grupo dentado (D) (n=15) e grupos reabilitados: próteses parciais fixas ou removíveis em uma ou ambas as arcadas (PP) (n=15); prótese total removível maxilar e mandibular (PTR) (n=15); prótese total - prótese removível superior e prótese implanto-suportada inferior (PTIS) (n=12). O tempo de duração (segundos) da mastigação e da fase oral da deglutição foi medido nas consistências: sólida (pão francês), pudim (10 ml) e líquida (10 ml). Resultados: idosos dentados saudáveis apresentaram os intervalos: líquido=1,07±0,35 s; pudim=3,48±1,76 s; e sólido=27,88±7,11 s. Foram observadas diferenças estatisticamente significativas entre os grupos D e PTIS (p=0,0056) e entre D e PTR (p=0,0056) para líquido. Para todos os grupos, houve aumento estatisticamente significante entre as consistências líquida e sólida e entre pastosa e sólida (p<0,001). Conclusões: idosos dentados apresentaram menor tempo de fase oral da deglutição para líquidos do que idosos edêntulos totais reabilitados, mas não diferente dos idosos com prótese parcial. O tempo de mastigação e deglutição do alimento sólido foi maior que o das demais consistências, independente da condição dentária.