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1.
Internist (Berl) ; 61(4): 411-415, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32170331

RESUMO

Pneumonia and in particular aspiration pneumonia, is a common disease in geriatrics. These aspirations are often due to dysphagia, which is frequently first noticed in the context of a geriatric assessment. The reasons for dysphagia are manifold. In this geriatric department several patients have been detected in recent months in whom a Zenker diverticulum was the cause of recurrent aspiration pneumonia. The swallowing disorder was already apparent during the logopedic examination on admission to hospital. A supplementary fiber optic endoscopic evaluation of swallowing (FEES) revealed a postswallow hypopharyngeal reflux (PSHR), which is typical for a Zenker diverticulum. A supplementary contrast esophagography confirmed the findings. In the present case the treatment of choice was a myotomy with a flexible endoscope performed by gastroenterologists. After successful treatment, swallowing was again possible with no indications of penetration or aspiration in the FEES control. The case highlights the importance of logopedic diagnostics and treatment in geriatric patients with recurrent pneumonia. With the aid of early diagnostics it was possible to quickly recognize the finding of a PSHR that is typical for a Zenker diverticulum. The findings in this case could be clearly demonstrated based on the images of the FEES and contrast esophagography.


Assuntos
Transtornos de Deglutição/fisiopatologia , Delírio , Divertículo/diagnóstico por imagem , Esofagoscopia/métodos , Pneumonia Aspirativa/fisiopatologia , Patologia da Fala e Linguagem/métodos , Divertículo de Zenker/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/complicações , Transtornos de Deglutição/terapia , Tecnologia de Fibra Óptica , Humanos , Masculino , Miotomia , Pneumonia Aspirativa/etiologia , Resultado do Tratamento , Divertículo de Zenker/fisiopatologia , Divertículo de Zenker/cirurgia
2.
Cir. pediátr ; 33(1): 51-54, ene. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-186139

RESUMO

Introducción: El tratamiento de la tiroides lingual es controvertido y debe individualizarse. Las opciones incluyen el reemplazo hormonal, cirugía en presencia de hemorragia y obstrucción de la vía aérea o digestiva, y la terapia con radioisótopos. Caso clínico: Niña de 8 años de edad, con molestias a la deglución. Se observa masa rosada, muy vascularizada, no dolorosa ni ulcerada, que protruye desde la base de la lengua y cierra prácticamente toda la orofaringe. Ecografía informa ausencia de tejido tiroideo en su posición normal. Tomografía axial computarizada cervical comprueba el diagnóstico y la obstrucción faríngea. Se indicó tratamiento sustitutivo de las hormonas tiroideas. Ante la progresión de los síntomas de disfagia, se indicó cirugía. Se describe la exéresis tiroidea por vía cervical, suprahioidea, con reimplante de láminas de tejido tiroideo. Evolucionó sin complicaciones y se mantiene tratamiento sustitutivo, con excelente estado clínico después de cuatro años


Introduction: The treatment of lingual thyroid is controversial and should be individualized. Options include hormonal replacement, surgery in the presence of bleeding and obstruction of the airway and the digestive tract, and radioisotope therapy. Clinical case: 8-year-old girl presenting with discomfort when swallowing. A pink, well-vascularized mass, not painful or ulcerated, protruding from the base of the tongue and virtually closing the whole oropharynx, was observed. Absence of thyroid tissue in its normal posi-tion was reported by the ultrasound department. Cervical computed axial tomography confirmed the diagnosis and the presence of pharyngeal ob-struction. Thyroid hormone replacement was established. As a result of dysphagia symptom progression, surgery was indicated. Thyroid removal was performed by means of a cervicotomy, with re-implantation of thyroid tissue laminas. The postoperative course was uneventful and replacement treatment was maintained, with an excellent clinical status four years later


Assuntos
Humanos , Feminino , Criança , Tireoide Lingual/diagnóstico por imagem , Tireoide Lingual/cirurgia , Obstrução das Vias Respiratórias/complicações , Radioisótopos/uso terapêutico , Tireoide Lingual/tratamento farmacológico , Transtornos de Deglutição/complicações , Tomografia Computadorizada de Emissão , Laringe/diagnóstico por imagem , Laringe/patologia , Cintilografia
4.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31996405

RESUMO

OBJECTIVES: Oropharyngeal dysphagia and aspiration may occur in infants and children. Currently, there is wide practice variation regarding when to feed children orally or place more permanent gastrostomy tube placement. Through implementation of an evidence-based guideline (EBG), we aimed to standardize the approach to these patients and reduce the rates of gastrostomy tube placement. METHODS: Between January 2014 and December 2018, we designed and implemented a quality improvement intervention creating an EBG to be used by gastroenterologists evaluating patients ≤2 years of age with respiratory symptoms who were found to aspirate on videofluoroscopic swallow study (VFSS). Our primary aim was to encourage oral feeding and decrease the use of gastrostomy tube placement by 10% within 1 year of EBG initiation; balancing measures included total hospital readmissions or emergency department (ED) visits within 6 months of the abnormal VFSS. RESULTS: A total of 1668 patients (27.2%) were found to have aspiration or penetration noted on an initial VFSS during our initiative. Mean gastrostomy tube placement in these patients was 10.9% at the start of our EBG implementation and fell to 5.2% approximately 1 year after EBG initiation; this improvement was sustained throughout the next 3 years. Our balancing measures of ED visits and hospital readmissions also did not change during this time period. CONCLUSIONS: Through implementation of this EBG, we reduced gastrostomy tube placement by 50% in patients presenting with oropharyngeal dysphagia and aspiration, without increasing subsequent hospital admissions or ED visits.


Assuntos
Medicina Baseada em Evidências , Gastrostomia/instrumentação , Melhoria de Qualidade , Aspiração Respiratória de Conteúdos Gástricos/terapia , Transtornos de Deglutição/complicações , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Gastrostomia/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Aspiração Respiratória de Conteúdos Gástricos/diagnóstico por imagem , Fatores de Tempo
5.
Einstein (Sao Paulo) ; 18: eAO4952, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31939524

RESUMO

OBJECTIVE: To define physician´s behavior in the face of a mentally capable elderly dysphagic patients at risk of pulmonary aspiration, who do not accept oral restriction. METHODS: Observational, cross-sectional study, presenting a clinical case of an independent elderly with clinical complaints of dysphagia and laryngotracheal aspiration by flexible endoscopic evaluation of swallowing who rejected the proposal to restrict oral diet. A questionnaire about the patient's decision-making process was used to assess whether the physician was sympathetic and justify their answer, and if they are aware of hierarchy of ethical principles (recognition of the person´s value, autonomy, beneficence, nonmaleficence and justice), in the decision-making process, and which was the main principle that guided their decision. RESULTS: One hundred participants were classified by time since graduation as Group I (less than 10 years) and Group II (more than 10 years). Of them, 60% agreed with the patient's decision, with no difference between the groups. The main reason was autonomy of patients, in both groups. Among those who were not sympathetic, the main argument was beneficence and nonmaleficence, considering the risk between benefit and harm. As to awareness about the hierarchy of principles, we did not find differences between the groups. Autonomy was the principle that guided those who were sympathetic with the patient's decision, and justice among those who didnot agree. CONCLUSION: Physicians were sympathetic with the patient's decision regarding autonomy, despite the balance between risks of beneficence and nonmaleficence, including death. We propose to formalize a non-compliance term.


Assuntos
Transtornos de Deglutição/complicações , Padrões de Prática Médica/estatística & dados numéricos , Aspiração Respiratória/etiologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Estudos Transversais , Transtornos de Deglutição/prevenção & controle , Gastroscopia/métodos , Gastrostomia/métodos , Humanos , Intubação Gastrointestinal/métodos , Masculino , Autonomia Pessoal , Relações Médico-Paciente , Aspiração Respiratória/prevenção & controle , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo
7.
Medicine (Baltimore) ; 98(46): e18013, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725674

RESUMO

INTRODUCTION: Severe temporomandibular joint disorder (TMD) could induce dysphagia, which could lead to aspiration pneumonia. However, no clinical study has reported that TMD-related dysphagia could result in aspiration pneumonia. Integrative Korean medicine (KM) is suggested to be an effective treatment for patients with severe TMD. PATIENT CONCERNS: A 76-year-old female could not open her mouth because of TMD and subsequently experienced dysphagia. To clearly identify the cause of dysphagia and to treat the symptoms, she was admitted to the neurology department. However, she eventually developed aspiration pneumonia. Despite the inpatient treatment and even after pneumonia was cured, TMD symptoms and dysphagia persisted. DIAGNOSIS: Based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the magnetic resonance imaging findings, the patient was diagnosed as having severe TMD with disc displacement without reduction and with limited opening. INTERVENTIONS: Integrative KM treatment, including acupuncture, herbal acupuncture, cupping therapy, Chuna manual therapy, and herbal medicine, was performed during the admission period (23 days). OUTCOMES: The following clinical improvements were detected: maximal unassisted opening from 8 to 28 mm, right lateral movement from 3 to 11 mm, left lateral movement from 10 to 15 mm, and protrusion movement from 5 to 7 mm. Dysphagia disappeared when the TMD symptoms improved. CONCLUSION: Patients with severe TMD might experience dysphagia, which could lead to aspiration pneumonia. Symptoms of severe TMD could be treated with integrative KM treatment.


Assuntos
Transtornos de Deglutição/complicações , Pneumonia Aspirativa/etiologia , Transtornos da Articulação Temporomandibular/complicações , Idoso , Transtornos de Deglutição/diagnóstico , Feminino , Humanos , Amplitude de Movimento Articular , República da Coreia , Transtornos da Articulação Temporomandibular/terapia
8.
AAPS PharmSciTech ; 21(1): 3, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31713006

RESUMO

Suspension of microparticles in an easy-to-swallow liquid is one approach to develop sustained-release formulations for children and patients with swallowing difficulties. However, to date production of sustained-release microparticles at the industrial scale has proven to be challenging. The aim of this investigation was to develop an innovative concept in coating sustained-release microparticles using industrial scalable Wurster fluidised bed to produce oral liquid suspensions. Microcrystalline cellulose cores (particle size <150 µm) were coated with Eudragit® NM 30 D and Eudragit® RS/RL 30 D aqueous dispersions using a fluidised bed coater. A novel approach of periodic addition of a small quantity (0.1% w/w) of dry powder glidant, magnesium stearate, to the coating chamber via an external port was applied throughout the coating process. This method significantly increased coating production yield from less than 50% to up to 99% compared to conventional coating process without the dry powder glidant. Powder rheology tests showed that dry powder glidants increased the tapped density and decreased the cohesive index of coated microparticles. Reproducible microencapsulation of a highly water-soluble drug, metoprolol succinate, was achieved, yielding coated microparticles less than 200 µm in size with 20-h sustained drug release, suitable for use in liquid suspensions. The robust, scalable technology presented in this study offers an important solution to the long-standing challenges of formulating sustained-release dosage forms suitable for children and older people with swallowing difficulties.


Assuntos
Administração Oral , Transtornos de Deglutição/complicações , Preparações de Ação Retardada/química , Composição de Medicamentos/métodos , Nanopartículas , Idoso , Celulose , Criança , Excipientes , Humanos , Metoprolol/administração & dosagem , Tamanho da Partícula , Ácidos Polimetacrílicos , Pós , Reologia , Ácidos Esteáricos
9.
Rev. neurol. (Ed. impr.) ; 69(9): 353-362, 1 nov., 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187097

RESUMO

Introducción: La sialorrea es un signo importante en los niños con patologías del sistema nervioso central que afecta gravemente a la salud y a la calidad de vida. El kinesiotaping se presenta como una alternativa no invasiva útil para el control de la deglución de la saliva. Objetivo: Examinar la eficacia del kinesiotaping como recurso terapéutico en el control de la sialorrea. Pacientes y métodos: Se realizo una búsqueda bibliográfica en las bases de datos Scopus, PubMed, Web of Science, Cochrane Library, Science Direct y Google Académico, usando los términos «bandages», «tape», «kinesiotaping», «sialorrea», «deglutition», «drooling» y «swallowing difficulty», y se valoró la calidad metodológica con la Critical Review Form-Quantitative Studies y la escala de Oxford. Resultados: Se seleccionaron diez estudios para la revisión: seis aplicaron kinesiotaping en la zona suprahioidea y cuatro en la zona del músculo orbicular de los labios. Todos los estudios muestran diferencias significativas con el uso de las diferentes técnicas de tratamiento, sin establecer diferencias significativas entre otras técnicas y el kinesiotaping. Conclusiones: Los estudios de alta calidad metodológica son escasos; sin embargo, se describen mejoras significativas en los resultados y sin efectos adversos, lo que puede influir positivamente en la clínica y en la terapia cotidiana


Introduction: Sialorrhoea is an important sign in children with central nervous system conditions that seriously affects health and quality of life. Kinesiotaping is presented as a non-invasive alternative that is useful in controlling the swallowing of saliva. Aim: To examine the efficacy of kinesiotaping as a therapeutic resource in the control of sialorrhoea. Patients and methods: A bibliographic search was carried out in the databases Scopus, PubMed, Web of Science, Cochrane library, Science Direct and Google Scholar, using the terms 'bandages', 'tape', 'kinesiotaping', 'sialorrea', 'deglutition', 'drooling' and 'swallowing difficulty', and the methodological quality was evaluated with Form-Quantitative Studies and the Oxford scale. Results: Ten studies were selected for review: six of which applied kinesiotaping in the suprahyoid area and four in the area of the orbicularis muscle of the lips. All studies show significant differences in the use of different treatment techniques, but without any significant differences between kinesiotaping and other techniques. Conclusions: Studies of high methodological quality are scarce; however, significant improvements in outcomes and no adverse effects are reported, which may have a positive influence on the clinical features and on day-to-day therapy


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Sialorreia/terapia , Resultado do Tratamento , Transtornos de Deglutição/complicações , Sistema Nervoso Central/patologia , Sialorreia/etiologia , Sialorreia/prevenção & controle , Transtornos de Deglutição/terapia
10.
J Neuromuscul Dis ; 6(3): 361-368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476167

RESUMO

BACKGROUND: Spinal muscular atrophy (SMA) is hereditary motor neuron disorder, characterised by the degeneration of motor neurons and progressive muscle weakness. It is caused by the homozygous loss of function of the survival motor neuron (SMN) 1 gene. SMA shows a wide variability of disease severity. OBJECTIVE: To investigate self-reported bulbar problems in patients with SMA, and their relationship to age, functional motor scores and active maximum mouth opening. METHODS: We used the Diagnostic List of Dysphagia and Dysarthria in (pediatric) patients and relevant recent clinical data from the national SMA database. RESULTS: The 118 included patients with SMA frequently reported jaw problems (34%), fatigue associated with mastication (44%), choking (56%) and intelligibility problems (27%). Jaw, mastication and swallowing problems frequently occurred in combination with each other. There was an increase of reported bulbar problems in patients with SMA type 3a, older than 30 years of age, compared to younger patients of this SMA type.The Hammersmith Functional Motor Scale Expanded scores showed a negligible correlation with jaw and mastication problems, a low negative correlation with swallowing problems and a moderate negative correlation with intelligibility problems. Reduced mouth opening showed a significant, but low correlation with bulbar complaints in patients with SMA type 2. CONCLUSIONS: Fatigue associated with mastication and swallowing problems were frequently reported complaints. Patients 30 years and older with milder forms of SMA showed an increase of self-reported bulbar problems.


Assuntos
Atrofia Muscular Espinal/complicações , Adulto , Idoso , Obstrução das Vias Respiratórias/complicações , Obstrução das Vias Respiratórias/epidemiologia , Transtornos de Deglutição/complicações , Transtornos de Deglutição/epidemiologia , Fadiga/complicações , Fadiga/epidemiologia , Feminino , Humanos , Doenças Maxilomandibulares/complicações , Doenças Maxilomandibulares/epidemiologia , Masculino , Pessoa de Meia-Idade , Atrofia Muscular Espinal/epidemiologia , Autorrelato , Inteligibilidade da Fala/fisiologia , Inquéritos e Questionários , Adulto Jovem
11.
Int J Pediatr Otorhinolaryngol ; 127: 109667, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31499263

RESUMO

OBJECTIVE: To compare the frequency and type of diagnoses associated with pharyngeal dysfunction (PD) in children presenting with early versus late onset sleep disordered breathing (SDB). METHODS: This was a retrospective, cross-sectional study. A consecutive series of children ≤3 years old who underwent management for SDB were retrospectively identified from a prospectively kept surgical database. The early onset group was compared with two separate late onset (≥4years old) groups. Diagnoses associated with PD included gastroesophageal reflux disease (GERD), swallowing dysfunction, prematurity, asthma, and obesity. Distribution of PD diagnoses, airway lesions, syndromic conditions, pulse oximetry scores, and endoscopic pattern of airway obstruction were compared. RESULTS: 73 patients with early onset SDB were identified (51 boys, mean age 2.25 ±â€¯0.64 years, range 1.75-3 years) and compared with two groups of later onset SDB consisting of 75 and 72 patients with mean ages of 7.58 ±â€¯2.40 years and 8.04 ±â€¯3.34 years respectively (range 4-16 years). The early onset SDB group had a higher prevalence of PD diagnoses compared to the later onset group with 35 of 73 patients being diagnosed compared to 41 of 147 children (p = 0.01). Early onset SDB patients were more likely to have GERD or swallowing dysfunction (p < 0.01) while later onset patients more commonly presented with associated asthma or obesity (p < 0.01). There was no statistically significant difference in airway lesions between groups. CONCLUSION: Early-onset SDB is associated with conditions causing PD more often than later-onset SDB. Identifying these conditions and optimizing their management may impact outcomes in treating pediatric SDB.


Assuntos
Doenças Faríngeas/complicações , Faringe/fisiopatologia , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/fisiopatologia , Adolescente , Idade de Início , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Asma/complicações , Criança , Pré-Escolar , Estudos Transversais , Transtornos de Deglutição/complicações , Endoscopia , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Lactente , Masculino , Obesidade/complicações , Oximetria , Doenças Faríngeas/fisiopatologia , Nascimento Prematuro/fisiopatologia , Estudos Retrospectivos , Síndromes da Apneia do Sono/diagnóstico
13.
Otolaryngol Head Neck Surg ; 161(5): 829-834, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31476971

RESUMO

OBJECTIVES: Little is known about esophageal transit times (ETT) in relation to underlying comorbid disease or aspiration risk. Our study evaluated liquid ETT in patients relative to underlying comorbid disease and compared this with ETT in healthy adults. We examined whether prolonged ETT was associated with swallow risk. STUDY DESIGN: Prospective observational study. SETTING: Radiology department. SUBJECTS: Patients included those referred to speech pathology for a videofluoroscopic study of swallowing (VFSS) within a tertiary hospital. METHODS: A total of 617 patients (49% female; mean ± SD age, 77 ± 15 years) and 139 healthy adults (56% female; age, 59 ± 22 years) were included. All patients underwent a standardized VFSS with esophageal screening. Patients were categorized by chief underlying disorder: previous stroke (n = 207), other neurologic condition (n = 188), respiratory conditions (n = 91), or gastroenterology conditions (n = 131). All VFSSs were analyzed with objective measures. ETT and penetration-aspiration scores were compared between groups. RESULTS: Advancing age was significantly associated with increased ETT (P < .05). When controlling for age, mean 20-mL ETT remained significantly different across groups: healthy adults, 11 seconds; stroke, 17 seconds; other neurologic condition, 15 seconds; gastroenterology, 14 seconds; and respiratory, 9 seconds (P < .001). One-third of patients aspirated; no healthy adults aspirated. Increasing ETT was associated with aspiration events (P < .001). CONCLUSIONS: Liquid ETTs differ among patients with different underlying primary diagnoses. Patients following stroke show significantly prolonged ETT and increased risk of aspiration. Prolonged ETT may influence symptom complaint and warrants consideration.


Assuntos
Transtornos de Deglutição/complicações , Transtornos de Deglutição/fisiopatologia , Esôfago/fisiopatologia , Trânsito Gastrointestinal/fisiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Transtornos de Deglutição/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/etiologia , Aspiração Respiratória/fisiopatologia
14.
Otolaryngol Head Neck Surg ; 161(5): 862-869, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31426703

RESUMO

OBJECTIVE: To assess the reliability and construct validity of the Penetration-Aspiration Scale in children. STUDY DESIGN: This was a retrospective cohort study of pre- and postoperative video modified barium swallow studies from children who underwent interarytenoid injection augmentation for unexplained persistent pharyngeal dysphagia. Two pediatric speech and language pathologists reviewed each study twice in a blinded and randomized fashion. SETTING: Tertiary academic pediatric hospital. SUBJECTS AND METHODS: Thirty children were identified with adequate pre- and postoperative modified barium swallow studies within 4 weeks of intervention. Children were separated into clinical outcome groups based on ability to advance to thinner diet consistencies postoperatively. Construct validity was assessed with a mixed linear model to test the hypothesis that only the clinically improved group would receive better Penetration-Aspiration Scale scores after surgery. Reliability was assessed by calculating chance-corrected agreement between raters (interrater) and raters' repeat evaluations (intrarater). RESULTS: Inter- and intrarater reliabilities (Cohen's κ) were both excellent. Results of the mixed model revealed a significant interaction between outcome group and pre- and postoperative time interval. As hypothesized, this involved a significant improvement in Penetration-Aspiration Scale score only in the improved group. CONCLUSIONS: These findings suggest that the Penetration-Aspiration Scale is a reliable and valid measure of clinical response to interarytenoid injection augmentation in children.


Assuntos
Cartilagem Aritenoide/cirurgia , Transtornos de Deglutição/complicações , Transtornos de Deglutição/cirurgia , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/prevenção & controle , Cartilagem Aritenoide/fisiopatologia , Criança , Pré-Escolar , Transtornos de Deglutição/diagnóstico , Feminino , Humanos , Lactente , Masculino , Avaliação de Resultados da Assistência ao Paciente , Reprodutibilidade dos Testes , Aspiração Respiratória/etiologia , Estudos Retrospectivos
15.
Int J Pediatr Otorhinolaryngol ; 127: 109646, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31450168

RESUMO

OBJECTIVES: Neuromuscular electrical stimulation (NMES) therapy in the head and neck has been effectively used to rehabilitate swallowing in adult patients with acquired dysphagia. Limited data is available for the effectiveness of NMES in medically complex children with dysphagia and aspiration. This study intends to determine the efficacy of NMES as a therapeutic adjunct to improve aspiration and feeding status in medically complex children with severe dysphagia undergoing comprehensive speech and swallow therapy. STUDY DESIGN: Case series. SETTING: Tertiary children's hospital. SUBJECTS: and Methods: Medically complex children undergoing treatment for dysphagia using NMES during a three year period were included. Duration of treatment routinely ranged from 20 to 26 weeks. Demographic information, pre and post-NMES treatment aspiration status via modified barium swallow (MBS), and pre and post-NMES treatment feeding status were examined. RESULTS: 15 medically complex children underwent NMES as a component of their feeding therapy. The mean age was 2.51 ±â€¯3.20 years. Mean pre-treatment Functional Oral Intake Scale(FOIS) was 3.07 ±â€¯1.94. Following NMES, FOIS improved to 4.47 ±â€¯2.26 (p < 0.0001). Fourteen patients were evaluated with MBS prior to NMES. Pre-treatment aspiration and penetration were noted in 10 and 2 patients respectively. Two patients did not aspirate on pre-treatment MBS. Improvement was noted in 9 of 11 children with post-treatment MBS. CONCLUSION: NMES was safely completed in all children without complication. Improvement in aspiration status was seen in 83.3% of patients with pre- and post-treatment MBS. Feeding status as measured by textures was advanced in all patients with a significant improvement in FOIS. Future prospective studies are required to investigate the specific role in children with acquired and congenital dysphagia.


Assuntos
Transtornos de Deglutição/terapia , Terapia por Estimulação Elétrica , Nutrição Enteral , Aspiração Respiratória/terapia , Sulfato de Bário , Criança , Pré-Escolar , Meios de Contraste , Deglutição , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Radiografia , Aspiração Respiratória/diagnóstico por imagem , Aspiração Respiratória/etiologia , Resultado do Tratamento
17.
Dev Med Child Neurol ; 61(11): 1249-1258, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31328797

RESUMO

AIM: To determine the prevalence of drooling, swallowing, and feeding problems in persons with cerebral palsy (CP) across the lifespan. METHOD: A systematic review was conducted using five different databases (AMED, CINAHL, Embase, MEDLINE, and PubMed). The selection process was completed by two independent researchers and the methodological quality of included studies was assessed using the STROBE and AXIS guidelines. Meta-analyses were conducted to determine pooled prevalence estimates of drooling, swallowing, and feeding problems with stratified group analyses by type of assessment and Gross Motor Function Classification System level. RESULTS: A total of 42 studies were included. Substantial variations in selected outcome measures and variables were observed, and data on adults were limited. Pooled prevalence estimates determined by meta-analyses were as high as 44.0% (95% confidence interval [CI] 35.6-52.7) for drooling, 50.4% (95% CI 36.0-64.8) for swallowing problems, and 53.5% (95% CI 40.7-65.9) for feeding problems. Group analyses for type of assessments were non-significant; however, more severely impaired functioning in CP was associated with concomitant problems of increased drooling, swallowing, and feeding. INTERPRETATION: Drooling, swallowing, and feeding problems are very common in people with CP. Consequently, they experience increased risks of malnutrition and dehydration, aspiration pneumonia, and poor quality of life. WHAT THIS PAPER ADDS: Drooling, swallowing, and feeding problems are very common in persons with cerebral palsy (CP). The prevalence of drooling, swallowing, and feeding problems is 44.0%, 50.4%, and 53.5% respectively. There are limited data on the prevalence of drooling, swallowing, and feeding problems in adults. Higher Gross Motor Function Classification System levels are associated with higher prevalence of drooling, swallowing, and feeding problems. There is increased risk for malnutrition, dehydration, aspiration pneumonia, and poor quality of life in CP.


Assuntos
Paralisia Cerebral/epidemiologia , Transtornos de Deglutição/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Sialorreia/epidemiologia , Paralisia Cerebral/complicações , Transtornos de Deglutição/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Humanos , Longevidade , Prevalência , Qualidade de Vida , Sialorreia/complicações
18.
Br J Community Nurs ; 24(7): 323-327, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265346

RESUMO

There is an increase in the demand for community services to provide care closer to home, and care teams are placing a growing emphasis on admission avoidance and early discharge. Community and district nurses are key professionals in this care delivery and are required to be alert to the risk factors for clinical deterioration, such as dysphagia (swallowing problems). Especially in older adults and those with frailty, dysphagia can cause a wide range of problems, from dehydration and malnutrition to respiratory tract infections that warrant antibiotic use and even hospitalisation. This article describes how dysphagia can be identified and managed in the community setting and explains the benefits and impact of speech and language therapy and wider multidisciplinary team intervention.


Assuntos
Enfermagem em Saúde Comunitária , Serviços de Saúde Comunitária , Transtornos de Deglutição/enfermagem , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico , Desidratação/etiologia , Desidratação/prevenção & controle , Dietoterapia , Fragilidade , Humanos , Desnutrição/etiologia , Desnutrição/prevenção & controle , Equipe de Assistência ao Paciente , Encaminhamento e Consulta , Infecções Respiratórias/etiologia , Infecções Respiratórias/prevenção & controle , Medição de Risco , Patologia da Fala e Linguagem , Medicina Estatal , Reino Unido
19.
PLoS One ; 14(7): e0214352, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31344030

RESUMO

BACKGROUND: The underlying pathophysiology of dysphagia is multifactorial and evidence clarifying the precise mechanisms are scarce. Dysfunction in dopamine-related and non-dopamine-related pathways, changes in cortical networks related with swallowing and peripheral mechanisms have been implicated in the pathogenesis of dysphagia. We aimed at investigating whether dysphagia is associated with presynaptic dopaminergic deficits, faster motor symptom progression and cognitive decline in a population of early drug-naïve patients with Parkinson's disease. METHODS: By exploring the database of Parkinson's Progression Markers Initiative we identified forty-nine early drug-naïve Parkinson's disease patients with dysphagia. Dysphagia was identified with SCOPA-AUT question 1 (answer regularly) and was assessed with MDS-UPDRS Part-II, Item 2.3 (Chewing and Swallowing). We compared Parkinson's disease patients with dysphagia to Parkinson's disease patients without dysphagia, and investigated differences in striatal [123I]FP-CIT single photon emission computed tomography levels. Using Cox proportional hazards analyses, we also evaluated whether dysphagia can predict motor deterioration and cognitive dysfunction. RESULTS: Parkinson's disease patients with dysphagia, harbored a greater deterioration regarding motor and non-motor symptoms and decreased [123I]FP-CIT binding when compared with patients without dysphagia. Higher burden of dysphagia (MDS-UPDRS-II, item 2.3) was correlated with lower [123I]FP-CIT uptakes within the striatum (rs = -0.157; P = 0.002) and the caudate (rs = -0.156; P = 0.002). The presence of dysphagia was not a predictor of motor progression (Hazard ratio [HR]: 1.143, 95% confidence interval [CI]: 0.848-1.541; P = 0.379) or cognitive decline (HR: 1.294, 95% CI: 0.616-2.719; P = 0.496). CONCLUSIONS: Dysphagia is associated with decreased presynaptic dopaminergic integrity within caudate and greater motor and non-motor symptoms burden in early drug-naïve PD.


Assuntos
Transtornos de Deglutição/complicações , Doença de Parkinson/complicações , Idoso , Disfunção Cognitiva/complicações , Disfunção Cognitiva/fisiopatologia , Corpo Estriado/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Neurônios Dopaminérgicos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Terminações Pré-Sinápticas/patologia
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