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1.
J Oral Sci ; 62(2): 156-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224568

RESUMO

Swallowing has a vital function in airway protection and is the next step after mastication. Swallowing impairment, which is known as dysphagia, is frequently accompanied by pain. Previous clinical studies have shown that orofacial pain affects swallowing function. Thus, it was hypothesized that orofacial noxious inputs may modulate swallowing function. Previous studies using anesthetized animals has proposed that the facial skin-nucleus tractus solitarii (NTS), masseter muscle-NTS, lingual muscle-NTS, and lingual muscle-paratrigeminal nucleus-NTS pathways may be involved in the inhibition of swallowing caused by facial, masseter, and lingual pain. Moreover, the activation of gamma-aminobutyric acidergic NTS neurons is involved in the inhibition of the swallowing reflex following trigeminal noxious inputs. This review focused on the recent management of dysphagia, neural mechanisms of swallowing, and relationship between orofacial pain and swallowing function. This and other future studies in this field can provide a better understanding of both normal and impaired swallowing and can help develop a new approach to treat patients with dysphagia and orofacial pain.


Assuntos
Transtornos de Deglutição , Animais , Deglutição , Dor Facial , Humanos , Músculo Masseter , Núcleo Solitário
2.
J Laryngol Otol ; 134(3): 252-255, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32138804

RESUMO

BACKGROUND: Velopharyngeal insufficiency is the inability to close the velopharyngeal port during speech and swallowing, leading to hypernasal speech and food regurgitation. OBJECTIVE: This study aimed to explore the aetiological factors contributing to the development of velopharyngeal insufficiency in a non-cleft paediatric population, especially following adenoidectomy. METHODS: A retrospective case review was conducted of all children without a known cleft palate, born between 2000 and 2013, who were referred to a tertiary cleft centre with possible velopharyngeal insufficiency. RESULTS: The data for 139 children diagnosed with velopharyngeal insufficiency following referral to the cleft centre were analysed. Thirteen patients developed the condition following adenoidectomy; only 3 of these 13 had a contributing aetiological factor. CONCLUSION: Velopharyngeal insufficiency is a rare but significant complication of adenoidectomy. The majority of patients who developed velopharyngeal insufficiency following adenoidectomy did not have an identifiable predisposing factor. This has important implications for the consent process and when planning adenoidectomy.


Assuntos
Adenoidectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Insuficiência Velofaríngea/etiologia , Criança , Pré-Escolar , Deglutição , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Fala , Insuficiência Velofaríngea/fisiopatologia
3.
Eur J Paediatr Dent ; 21(1): 46-52, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32183528

RESUMO

AIM: It has been suggested that atypical swallowing (AS) may negatively influence the skeletal and alveolar development, but its specific effects are still unclear. The aim of this work is to compare the cephalometric characteristics of children and adolescents with and without AS. MATERIALS AND METHODS: Study design: Case-control retrospective cross-sectional study. One hundred patients with (AS group) and 100 patients without AS (control group, C) were retrospectively selected. Their cephalometric data before orthodontic treatment were compared using a 3-way ANOVA variance test to detect any differences between groups considering: the type of swallowing (AS vs C); whether or not the second dentition was completed (SDC vs SDNC); and the gender (males-M and females-F). In addition, a Student-t test for unpaired data was carried out to detect differences between M and F within the AS and C groups. RESULTS: When compared to the controls, AS patients showed a significantly decreased SNB angle (p<.01), increased ANB and SN^Go. Me angles (p<.0001), increased overjet and lower facial height (p<.01), decreased overbite (p<.0001), and increased proclination of the upper incisors. AS-SDC patients also showed significantly increased alveolar length. Within the AS and C groups, skeletal and alveolar measurements were larger in males, with higher significance in the C group, suggesting a different trend of growth in AS patients. CONCLUSION: AS seems to affect the skeletal growth causing mandibular clockwise rotation, skeletal Class II, open bite and incisor proclination. To compensate for these effects, an increase in alveolar growth together with molar eruption seems to be induced.


Assuntos
Deglutição , Má Oclusão de Angle Classe II , Adolescente , Cefalometria , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Mandíbula , Maxila , Estudos Retrospectivos
4.
Zhongguo Zhen Jiu ; 40(2): 115-8, 2020 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-32100493

RESUMO

OBJECTIVE: To compare the clinical effect of acupuncture at the affected side and both sides of the pharyngeal acupoints for true bulbar paralysis after cerebral infarction. METHODS: A total of 66 patients with true bulbar paralysis after cerebral infarction were randomly divided into an unilateral group and a bilateral group, 33 cases in each group, 1 case dropped off in each group at last. On the basis of conventional drugs and electro-nape-acupuncture treatment, the patients in the unilateral group were treated with acupuncture at the affected side's Tunyan, Fayin and Zhifanliu (Extra), while patients in the bilateral group were treated with acupuncture at the both sides' Tunyan, Fayin and Zhifanliu. The treatment was performed once a day, 6 days a week, and the clinical effect was assessed after 21-day therapy. The swallowing and vocalization of the two groups were evaluated by dysphagia grading scale, Kubota water swallowing test and GRBAS grading scale before and after treatment. RESULTS: After 21 days of treatment, the scores of the dysphagia grading scale in the two groups were both improved (P<0.01), and the unilateral group was superior to the bilateral group (P<0.01). The GRBAS grading scale and Kubota water swallowing test grading after treatment were improved in both groups (P<0.01), and the unilateral group was superior to the bilateral group (P<0.05, P<0.01). CONCLUSION: Acupuncture at the pharyngeal acupoints of the affected side achieves much better therapeutic effect on true bulbar paralysis as compared with the acupoints of the bilateral sides.


Assuntos
Terapia por Acupuntura , Paralisia Bulbar Progressiva/terapia , Infarto Cerebral/complicações , Pontos de Acupuntura , Paralisia Bulbar Progressiva/etiologia , Deglutição , Humanos , Faringe , Resultado do Tratamento
5.
Artigo em Chinês | MEDLINE | ID: mdl-32086923

RESUMO

Objective:The aim of this study is to investigate the effect of fibreoptic endoscopic of sallowing (FEES) in the assessment of pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma. Method:Fifty-three NPC patients with post-irradiated underwent FEES and video fluoroscopy(VF).The results were analyzed using the Bolus Residue Scale and Rosenbek's penetration aspiration scale. Result:The agreement in the detection of penetration and aspiration between FEES and VF of liquid(κ=0.56, 95%CI 0.38-0.73) and porridge(κ=0.64, 95%CI 0.43-0.81) was "fair". The detection rates of penetration on FEES with liquid and porridge were 60% and 51%, the detection rates of aspiration on VF with liquid and porridge were 70% and 53%. There were no statistical differences. The agreement in the detection of pharyngeal residue between FEES and VF of liquid (κ=0.38, 95%CI0.12-0.62) and porridge (κ=0.66, 95%CI 0.44-0.86) was "fair". The detection rates of pharyngeal residue on FEES and VF with porridge were 43% and 45%, the difference was not statistically significant. The detection rates of pharyngeal residue on FEES and VF with liquid were 44% and 24%, and the difference was statistically significant. Conclusion:FEES is an effective and valuable tool for evaluating pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Endoscópios , Carcinoma Nasofaríngeo/complicações , Neoplasias Nasofaríngeas/complicações , Deglutição , Transtornos de Deglutição/etiologia , Tecnologia de Fibra Óptica , Humanos , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia
6.
J Oral Sci ; 62(1): 18-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31996517

RESUMO

This study used 320-row area detector computed tomography (320-ADCT) to determine whether kinematic swallowing events and bolus movement through the oropharynx are affected by bolus consistency and angle of recline. Fourteen healthy adults (4 men, 10 women; age, 22-90 years) underwent 320-ADCT assessment during three 10-mL barium swallow tests, with honey-thick liquid at 60° recline (60°thick), thin liquid at 60° recline (60°thin), and thin liquid at 45° recline (45°thin). The times of swallowing events were measured and compared among the different tests. Bolus propulsion, onset time of true vocal cord (TVC) closure, and upper esophageal sphincter opening were significantly earlier for 60°thin than for 60°thick. Onset time did not significantly differ between 60°thin and 45°thin; however, greater variability was noted for onset of TVC closure with 45°thin, as the TVC started to close before onset of swallowing in 30% of participants. Modulation of TVC closure depends on bolus transport in different reclining positions. The 45° reclining position elicited pre-swallow TVC closure in some participants, which suggests that excessive recline can increase perceived risk of airway invasion during swallowing.


Assuntos
Deglutição , Tomografia Computadorizada por Raios X , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Movimento
7.
J Oral Rehabil ; 47(4): 523-527, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31925969

RESUMO

Gustatory function is closely related to chewing and swallowing; however, there are currently no reports regarding gustatory function in persons with cerebral palsy (CP). The aim of this study was to compare the gustatory function between persons with CP and healthy controls. We investigated sweet, salty, sour and bitter tastes using the whole-mouth method and measured the electrogustometric thresholds in the chorda tympani nerve area. Twelve participants with CP (6 women and 6 men) for whom gustatory testing was possible at our facilities, and 17 age-matched controls (9 women and 8 men) were included. The mean age ± standard deviation was 58.6 ± 8.1 years and 58.5 ± 8.7 years in subjects with CP and controls, respectively. Taste detection and identification were significantly worse in persons with CP compared with the controls. Taste identification was more impaired than taste detection. At the highest concentration, taste identification was impossible 11 times out of 48 (12 persons × 4 kinds of tastes) in persons with CP but such a deficit was not observed in 68 attempts (17 persons × 4 kinds of tastes) involving controls. The electrogustometric thresholds were not significantly different between the groups. Gustatory function associated with chewing and swallowing is worse in persons with CP compared to the controls.


Assuntos
Paralisia Cerebral , Paladar , Idoso , Deglutição , Feminino , Humanos , Masculino , Mastigação , Pessoa de Meia-Idade , Boca
8.
Codas ; 32(1): e20180216, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31721923

RESUMO

PURPOSE: This study aimed to compare the fiberoptic endoscopic findings of oropharyngeal swallowing of distinct food consistencies in Amyotrophic Lateral Sclerosis (ALS). METHODS: This was a retrospective clinical study of a convenience sample of 20 individuals (13 males and seven females aged 34 to 78 years old) with a diagnosis of ALS and oropharyngeal dysphagia confirmed by clinical and objective evaluation of swallowing, regardless of the bulbar or skeletal type and of the time of neurological diagnosis. The fiberoptic endoscopic evaluation of swallowing (FEES) of the liquid (N = 18), thickened liquid (N = 19) and pureed samples (N = 20) in a volume of 5 ml were analyzed. Data related to posterior oral spillage, pharyngeal residues, laryngeal penetration and/or aspiration after swallowing the three food consistencies were analyzed statistically by the Friedman ANOVA test. RESULTS: No impairment of laryngeal sensitivity was found in this population. There was no statistically significant difference in posterior oral spillage, penetration and/or aspiration between food consistencies. There was a statistically significant difference only related to pharyngeal residues of the thickened liquid and pureed consistency. CONCLUSION: Among the fiberoptic endoscopic findings of swallowing in ALS, only pharyngeal residues had a higher frequency depending on the consistency of food.


Assuntos
Esclerose Amiotrófica Lateral/complicações , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Laringoscopia/métodos , Adulto , Idoso , Deglutição , Endoscopia do Sistema Digestório , Feminino , Alimentos/classificação , Humanos , Laringe , Masculino , Pessoa de Meia-Idade , Orofaringe , Estudos Retrospectivos
9.
J Stroke Cerebrovasc Dis ; 29(2): 104508, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31759914

RESUMO

BACKGROUND: It is recommended that enteral feeding should be offered to patients with dysphagia estimated to be unable to take adequate diet orally within 7 days of admission after acute stroke, but there is no clear criterion for initiation of enteral feeding. Recent studies have reported that the frequency of spontaneous swallowing is useful in screening for dysphagia in acute stroke. The present study was aimed to investigate whether measurement of frequency of spontaneous swallowing for 2 minutes could predict independence on enteral feeding 1 week after admission in patients with acute stroke. METHODS: Patients with acute stroke were subjected. Within 72 hours of stroke onset, the number of swallows for 2 minutes was measured by auscultation. Subsequently, 1-hour frequency of spontaneous swallowing was measured using a laryngeal microphone. Functional Oral Intake Scale (FOIS) was evaluated 1 week after admission. RESULTS: Twenty-six out of 40 patients were independent on enteral feeding 1 week after admission based on FOIS. The presence of spontaneous swallowing for 2 minutes had .89 sensitivity, .54 specificity to predict independence on enteral feeding 1 week after admission, whereas the 1-hour frequency of spontaneous swallowing had 1.00 sensitivity, .46 specificity. Logistic regression analysis demonstrated that the presence of spontaneous swallowing for 2 minutes was independent predictor for independence on enteral feeding 1 week after admission, independently of age, sex, and NIHSS. CONCLUSIONS: The 2-minute spontaneous swallowing screening predicts independence on enteral feeding 1 week after admission in patients with acute stroke.


Assuntos
Acústica , Transtornos de Deglutição/diagnóstico , Deglutição , Nutrição Enteral , Acidente Vascular Cerebral/complicações , Acústica/instrumentação , Idoso , Tomada de Decisão Clínica , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo
10.
J Oral Rehabil ; 47(2): 196-203, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31442312

RESUMO

During mastication, some portion of the food bolus is gradually transported to the oropharynx before deglutition, which is known as stage II transport (STII). Although the importance of STII in mastication and deglutition has been widely acknowledged, food particle properties that are transported into the oropharynx by STII have not yet been fully specified. To reveal the food particle properties that are transported into the oropharynx by STII and to assess the usefulness of new food bolus sampling methods for the evaluation of masticatory efficiency. Twenty-two healthy volunteers participated in this study. Four different bolus sampling conditions were adopted: (a) the whole food particles were expectorated when the subject was aware of the first deglutition, (b) the last bolus to be swallowed at the end of unrestrained food intake was expectorated (aftermost bolus sample), (3) the whole food particles were expectorated when the subject felt ready to swallow after swallow-inhibited mastication (swallow-inhibited sample), (4) the particles were regurgitated from the oropharynx after the first STII (stage II-transported sample). Food particles were analysed using the homogeneity index and particle size index. There was no significant difference between food particles in the aftermost bolus sample and swallow-inhibited sample. The particles in the stage II-transported sample showed significantly more homogeneous and smaller sizes than other sampling conditions (P < .05). The food particles transferred to the oropharynx in the stage II-transported sample were smaller than those broken down by natural mastication.


Assuntos
Deglutição , Mastigação , Alimentos , Humanos , Orofaringe , Tamanho da Partícula
11.
J Oral Rehabil ; 47(3): 339-345, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31705814

RESUMO

BACKGROUND: Movement of the hyoid and laryngeal complex is critical for preventing aspiration, as well as smooth bolus passage through the pharynx. We have developed a non-invasive system for measuring laryngeal movement during swallowing with a bend sensor and have already reported the time coordination between the signal waveform from the sensor and hyoid movement. OBJECTIVE: The aim of this study was to clarify the quantitative association between the output value of the sensor and hyoid movement during swallowing. METHODS: A small bend sensor was fixed on the skin surface along the midline of the neck of 13 healthy men (mean age, 30.8 ± 4.5 years). Laryngeal and hyoid movements during swallowing of 5 mL of water were recorded synchronously by the bend sensor and videofluorography. The relationship between the bend sensor output value (LM value) and hyoid position (x- and y-axis displacements) by videofluorography from the onset to the offset of the signal waveform was analysed for all tasks and for each task using Pearson's correlation coefficients. RESULTS: There was a positive correlation between the LM value and hyoid position for all tasks (x-axis displacement: r = .647, y-axis displacement: r = .233). In particular, there was a moderate to high correlation between the LM value and x-axis displacement for each task (.453 ≤ r ≤ .934). CONCLUSION: The LM value can be a quantitative parameter of anterior hyoid movement during swallowing that might be associated with bolus flow and upper oesophageal sphincter opening.


Assuntos
Deglutição , Laringe , Adulto , Esfíncter Esofágico Superior , Humanos , Osso Hioide , Masculino , Movimento
12.
Odontology ; 108(1): 117-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31037446

RESUMO

Dysphagia prevalence has increased with increasing elderly population worldwide. Therefore, early detection of dysphagia has become increasingly important. Repetitive saliva swallowing test (RSST), modified water swallowing test (MWST), and cervical auscultation, which are convenient for non-experts to assess eating and swallowing and have been frequently used in Japan since 20 years. Using aspiration and pharyngeal residues, the objective of this study was to elucidate the efficacy of the three screening tests performed by non-experts in patients who had swallowing disorders. In total, 102 patients with cerebrovascular diseases who were suspected of having dysphagia were assessed. A swallowing team assessed their swallowing capabilities; videofluoroscopy and screening tests were performed. RSST, MWST, and cervical auscultation were performed by junior dentists who were non-experts in dysphagia. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio in each examination were evaluated using results of aspiration in videofluoroscopy and pharyngeal residues. For aspiration, the highest sensitivity with cervical auscultation (VES) was 93.7%. For pharyngeal residue, the highest sensitivity with cervical auscultation (VES) was 84.3%. For piriform sinus residue, the highest sensitivity with cervical auscultation (VES) was 86.4%. Despite being evaluated by a non-expert, the sensitivity of cervical auscultation (VES) and MWST was ≥ 80%, suggesting their effectiveness as prescreening tests, although the range of specificity was 25.5-68.4% in all examinations. These tests are easy to perform and useful to screen for aspiration or pharyngeal residues before precision tests.


Assuntos
Transtornos Cerebrovasculares , Transtornos de Deglutição , Idoso , Deglutição , Humanos , Japão , Sensibilidade e Especificidade
13.
J Oral Rehabil ; 47(1): 53-60, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31299094

RESUMO

BACKGROUND: Food boluses in the pharynx without enough bolus formation sometimes cause aspiration among older adults; however, the relationship between food bolus-forming ability and incidence of aspiration pneumonia is unclear. OBJECTIVE: To investigate the relationship between food bolus-forming ability and incidence of aspiration pneumonia by evaluating the condition of chew-swallow managing food transported into the pharynx. METHODS: A prospective observational study conducted in a nursing home for the elderly between April 2016 and February 2018. Seventy-three residents who swallowed thickened liquids and consistent boluses without aspiration were included. Food boluses were graded into three categories in the pharynx using videoendoscopic evaluation. Boluses that retained their original shape were defined as Grade 1. A mixture of large and small boluses was defined as Grade 2. Boluses that had completely transformed into a paste were defined as Grade 3. The relationship between the bolus formation grade and incidence of aspiration pneumonia over 6-month follow-up was investigated. RESULTS: Seventeen residents developed aspiration pneumonia. The incidence rate of aspiration pneumonia was highest among residents with Grade 1 boluses, at an incidence rate of .187 cases per person-month (95% confidence interval (CI): 0.097-0.359). Cox regression showed residents with Grade 1 boluses had a hazard ratio of 4.548 (1.393-14.85) for incidence of aspiration pneumonia compared with residents who had Grade 2 or 3 boluses. CONCLUSION: Insufficient food bolus-forming ability predicted high incidence of aspiration pneumonia. Healthcare professionals should evaluate the food bolus-forming ability, as well as swallowing function, to prevent aspiration pneumonia.


Assuntos
Transtornos de Deglutição , Pneumonia Aspirativa , Idoso , Deglutição , Humanos , Incidência , Casas de Saúde , Estudos Prospectivos
14.
Arch Oral Biol ; 111: 104631, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31869725

RESUMO

OBJECTIVE: The aim of this study was to evaluate tongue movement and its biomechanical effects during squeezing, one of the oral strategies for processing soft foods, by tongue pressure sensors, videofluorography, and surface electromyography. DESIGN: Fifteen healthy men (mean age, 31.0 ± 4.1 years) without dysphagia were recruited. A 0.1-mm-thick pressure sensor sheet with five measuring points, videofluorography, and surface electromyography were used for synchronous measurements of tongue pressure, hyoid movement, and suprahyoid muscles activity, respectively, while squeezing 5 mL of gels. Amplitude, duration, area, and their sequential order during initial squeezing were analyzed. Differences in hyoid position at the onset, peak, and offset of hyoid movement were also analyzed. RESULTS: At the beginning of initial squeezing, tongue pressure at the middle area of the hard palate, hyoid movement, and suprahyoid muscle activity appeared simultaneously, followed by tongue pressure at the anterior area and then at the posterior area. When the hyoid was in an elevated position, the amplitude of suprahyoid muscle activity and tongue pressure peaked. At the end of initial squeezing, the hyoid position at the offset of hyoid excursion was superior to that at the onset. All evaluation items of tongue pressure, hyoid movement, and suprahyoid muscle activity were modulated according to the texture of gels. CONCLUSIONS: During initial squeezing, tongue pressure, hyoid movement, and suprahyoid muscle activity were coordinated while being modulated by the food texture. At the end of initial squeezing, the hyoid was maintained in an elevated position, which might be beneficial for subsequent squeezing.


Assuntos
Língua , Adulto , Deglutição , Eletromiografia , Géis , Humanos , Osso Hioide , Masculino , Movimento , Pressão
15.
Arch Oral Biol ; 111: 104636, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31869726

RESUMO

OBJECTIVES: To compare three different exercises for dysphagia to see if they had effects on tongue strength. DESIGN: Thirty-one healthy volunteers were randomly divided into three groups. One group (G1, n = 10) performed 24 sets of five repetitions with 30 s rest with the target level set at 80 % of one repetition maximum using Iowa Oral Performance Instrument (IOPI) per day. Another group (G2, n = 10) performed exercise which was consisted of forceful swallow of 5 mL of water in a neutral posture every 10 s for 20 min per day. The other group (G3, n = 11) performed 5 mL of water swallowing exercise in chin-down posture every 10 s for 20 min per day. A total of 12 sessions in four weeks were performed in all groups. Blinded lingual strength measures (maximal isometric pressure) were obtained using IOPI before training and at four weeks after training for the three groups. RESULTS: After four weeks of training, measures of tongue strength were increased significantly in all groups. However, there was no significant difference in strength increment among groups [average increase in strength ± standard deviation (% of initial value): G1, 10.3 ± 10.4 %; G2, 8.7 ± 9.45 %; G3, 9.9 ± 12.6 %, p = 0.825]. CONCLUSIONS: Regardless of the type, tongue strengthening exercises had good effects in improving the swallowing function with equal superiority.


Assuntos
Exercício , Força Muscular , Deglutição , Transtornos de Deglutição , Terapia por Exercício , Humanos , Língua , Adulto Jovem
16.
J Oral Rehabil ; 47(4): 501-510, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31880338

RESUMO

BACKGROUND: Dysphagia following stroke is prevalent; however, dysphagia treatment is often applied haphazardly and outcomes unclear. Neuromuscular electrical stimulation (NMES) has received increased attention as a treatment for post-stroke dysphagia; but application data remain conflicted. OBJECTIVE: This study investigated effectiveness and safety of an exercise-based swallowing therapy (McNeill Dysphagia Therapy: MDTP) +NMES for dysphagia rehabilitation following stroke. METHODS: Stroke patients (n = 53, x̅ age: 66 [13.2], 47.2% male) with dysphagia admitted to sub-acute rehabilitation hospital were randomised to MDTP + NMES [NMES], MDTP + sham NMES [MDTP] or usual care [UC] swallowing therapy groups. Patients were treated for 1 hour per day for 3 weeks and monitored to 3 months by a blinded evaluator. Outcomes included clinical swallowing ability, oral intake, weight, patient perception of swallow and occurrence of dysphagia-related complications. RESULTS: Post-treatment dysphagia severity and treatment response were significantly different between groups (P ≤ .0001). MDTP demonstrated greater positive change than either NMES or UC arms, including increase in oral intake (χ2  = 5, P ≤ .022) and improved functional outcome by 3 months post-stroke (RR = 1.72, 1.04-2.84). Exploratory Cox regression revealed the MDTP group conferred the greatest benefit in time to "return to pre-stroke diet" of 4.317 [95% CI: 1.08- 17.2, P< .03]. CONCLUSION: Greater benefit (eg reduction in dysphagia severity, improved oral intake and earlier return to pre-stroke diet) resulted from a programme of MDTP alone vs NMES or UC.


Assuntos
Transtornos de Deglutição , Terapia por Estimulação Elétrica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Idoso , Deglutição , Método Duplo-Cego , Feminino , Humanos , Masculino , Resultado do Tratamento
17.
Arq Gastroenterol ; 56(4): 386-389, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800734

RESUMO

BACKGROUND: The perception of bolus transit through the thoracic esophagus may be caused by altered esophageal anatomy and function. OBJECTIVE: To evaluate the hypothesis that, in healthy volunteers, swallows followed by perception of esophageal bolus transit are associated with changes in esophageal motility. METHODS: Simultaneous evaluation of motility and perception of esophageal bolus transit was performed in 22 healthy volunteers. Esophageal motility was evaluated by high-resolution manometry with a 32-channel solid state catheter. Each volunteer performed, in the sitting position, 10 swallows of a 5 mL bolus of saline and 10 swallows of pieces of 1 cm3 of bread, with an interval of at least 30 seconds between swallows. After each swallow the volunteers were asked about the perception of bolus transit through the esophagus. RESULTS: Perception of bolus transit occurred in 11.7% of liquid swallows and in 48.1% of solid swallows. In liquid swallows the perception was associated with higher distal contractile integral and shorter proximal contraction length. Perception of solid bolus transit was associated with a longer distal latency, longer proximal contraction length, lower proximal contractile integral and shorter proximal contraction duration. CONCLUSION: The perception of swallowed bolus transit through the esophagus in healthy individuals is more frequent with solid than liquid swallows and is associated with changes in proximal esophageal contractions.


Assuntos
Deglutição/fisiologia , Esôfago/fisiologia , Sensação/fisiologia , Adulto , Esôfago/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Valores de Referência , Adulto Jovem
18.
J Assoc Physicians India ; 67(12): 44-49, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31801331

RESUMO

Background: This study evaluated the adherence and swallowing experience with novel oval-shaped, compact-sized metformin (500 mg/1000 mg)-glimepiride (1mg/2mg) combination, sustained-release tablet (Gluformin G1/Gluformin G2 SR; GM-new-SR) in Indian patients with T2DM, previously treated with conventional metformin-glimepiride combination tablet. Methods: Patients' adherence, swallowing experience, and satisfaction were assessed at baseline and month-3 by Adherence to Refills and Medication Scale (ARMS12; adherent: ARMS12 score=12; nonadherent: ARMS12 score >12) and questionnaire based 5-point Likert scale, respectively. Safety was also assessed. Results: Of 1550 patients enrolled, 1547 (99.8%) completed the study. After 3 months of switching to GM-new-SR tablets, adherence rate increased from 4.38% to 91.1%, with concurrent reduction in mean ARMS-12 score by 6.3±4.36 (p<0.0001). Compared to baseline, all glycemic indices, HbA1c, PPG, and FPG, significantly improved (p<0.0001) in the overall population. Reduction in HbA1c levels was significant only in patients who were adherent to therapy as opposed to nonadherent patients (7.8±1.74 to 7.1±0.85, p<0.0001 vs. 7.7±1.39 to 6.7±0.77, p=0.4276). Most patients attributed ease of swallowing of GM-new-SR tablets to its modified shape (95.5%) and size (94.9%). Most patients (90.4%) were satisfied with the new tablet formulation. Size of the tablet was the most common reason for patients' nonadherence with conventional tablets, which was reported to be less frequent with GM-new-SR tablets (2.5% vs 53.4%). Conclusion: Treatment with GM-new-SR tablets significantly increased adherence and was associated with improvement in glycemic indices, which could be attributed to the compact shape and size of the new tablet formulation.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Compostos de Sulfonilureia/uso terapêutico , Glicemia , Deglutição , Quimioterapia Combinada , Hemoglobina A Glicada , Humanos , Adesão à Medicação , Comprimidos
19.
NeuroRehabilitation ; 45(4): 525-536, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868691

RESUMO

BACKGROUND: There is little high-level evidence for the effect of the nonverbal facilitation of swallowing on swallowing ability in the subacute stage of rehabilitation following severe acquired brain injury (ABI). OBJECTIVE: To pilot test a randomised controlled trial to determine the effect of an intensification of the nonverbal facilitation of swallowing on dysphagia. METHODS: Ten patients with severe ABI and dysphagia were randomised into two groups at a highly specialised neurorehabilitation clinic.The intervention group received an intensification of the nonverbal facilitation of swallowing and the control group received basic care of the face and mouth in addition to treatment as usual for two sessions of 20 minutes per day for three weeks.Outcomes were Functional Oral Intake Scale (FOIS), Penetration Aspiration Scale (PAS), and electrophysiological swallowing specific parameters (EMBI). RESULTS: The intensified intervention was feasible. PAS and FOIS scores improved in both groups, with no differences between groups. The swallowing specific parameters reflected clinically observed changes in swallowing. CONCLUSIONS: PAS and FOIS are feasible instruments to measure dysphagia. It is possible and valid to measure swallowing frequency and kinematics using electromyography and bioimpedance. The definitive study should have widened inclusion criteria and optimise intervention timing to maintain patient arousal.


Assuntos
Lesões Encefálicas/reabilitação , Transtornos de Deglutição/reabilitação , Deglutição , Reabilitação Neurológica/métodos , Adulto , Lesões Encefálicas/complicações , Transtornos de Deglutição/etiologia , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
20.
NeuroRehabilitation ; 45(4): 463-469, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868693

RESUMO

BACKGROUND: Dysphagia and dysarthria tend to coexist in stroke patients. Dysphagia can reduce patients' quality of life, cause aspiration pneumonia and increased mortality. OBJECTIVE: To evaluate correlations among swallowing function parameters and acoustic vowel space values in patients with stroke. METHODS: Data from stroke patients with dysarthria and dysphagia were collected. The formant parameter representing the resonance frequency of the vocal tract as a two-dimensional coordinate point was measured for the /a/, /ae/, /i/, and /u/vowels, and the quadrilateral vowel space area (VSA) and formant centralization ratio (FCR) were measured. Swallowing function was evaluated by a videofluoroscopic swallowing study (VFSS) using the videofluoroscopic dysphagia scale (VDS) and penetration aspiration scale (PAS). Pearson's correlation and linear regression analyses were used to assess the correlation of VSA and FCR to VDS and PAS scores. RESULTS: Thirty-one stroke patients with dysphagia and dysarthria were analyzed. VSA showed a negative correlation to VDS and PAS scores, while FCR showed a positive correlation to VDS score, but not to PAS score. VSA and FCR were significant factors for assessing dysphagia severity. CONCLUSIONS: VSA and FCR values were correlated with swallowing function and may be helpful in predicting dysphagia severity associated with stroke.


Assuntos
Transtornos de Deglutição/fisiopatologia , Deglutição , Disartria/fisiopatologia , Acústica da Fala , Acidente Vascular Cerebral/complicações , Transtornos de Deglutição/epidemiologia , Disartria/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia
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