Accuracy of an epidemiological oropharyngeal dysphagia screening for older adults.

OBJECTIVE: The aim of this study was to determine the accuracy of an epidemiological screening questionnaire for oropharyngeal dysphagia in older people. BACKGROUND: Determining the cut-off point and the accuracy of the self-reported epidemiological questionnaire for screening oropharyngeal dysphagia in older adults is important for mass screening, which may estimate the prevalence of oropharyngeal dysphagia. MATERIALS AND METHODS: This was a cross-sectional diagnostic study with a convenience sample of 70 older adults over 60 years of age of both sexes, aged between 60 and 90 years (mean age 69.2; SD, 7.6). It used a screening questionnaire with nine ordered items response options resulted in a score ranging from 0 to 18. The criterion test was the fiberoptic endoscopic evaluation of swallowing, with analysis of the receiver operating characteristic (ROC), with a 5% significance level. RESULTS: Oropharyngeal dysphagia frequency by the criterion test was 73%, with no significant difference between age and sex. The area under the ROC curve was 0.88 (95% confidence interval: 0.79-0.98) above the cut-off point 3. This screening questionnaire showed good parameters of sensitivity (80%), specificity (89%), positive predictive value (95%), negative predictive value (63%), positive likelihood ratio (7.64), negative likelihood ratio (0.22) and accuracy (83%). CONCLUSIONS: This questionnaire may be a satisfactory screening tool for estimating the prevalence of oropharyngeal dysphagia in older adults.

Ultrasonographic analysis of the hyoid bone distance in individuals with neurogenic oropharyngeal dysphagia. / Análise ultrassonográfica da distância do osso hioide em indivíduos com disfagia orofaríngea neurogênica.

To compare the ultrasound measurement of distance from the approximation of the hyoid bone during of the maximum deglutition peak between healthy individuals and neurogenic dysphagic individuals and to verify the effect of food consistencies on the displacement of the hyoid bone. Prospective, controlled clinical study. Ultrasound recordings of the oropharyngeal deglutition were conducted in 10 adults diagnosed with oropharyngeal dysphagia and in 10 healthy adults, matched by sex and age group. A portable ultrasound model Micro ultrasound system with a microconvex transducer 5-10 MHz, coupled to a computer as well as the head stabilizer were used. The ultrasound images were recorded using the AAA software (Articulate Assistant Advanced) at a rate of 120 frames/second. Food consistencies level 0 (free volume and 5 mL) and level 4 (5 mL) were used, based on the International Dysphagia Diet Standardisation Initiative (IDSSI). The calculation of the mean and standard deviation was used for the descriptive analysis, while the repeated measures ANOVA test was used for the inferential analysis. Results showed dysphagic individuals had lower elevation of the hyoid bone marked by a longer distance from the approximation of the hyoid bone during of the maximum deglutition peak when compared to healthy individuals, regardless of the food consistency offered. It was concluded that the ultrasound measurement of distance from the approximation of the hyoid bone during of the maximum deglutition peak showed less laryngeal elevation in individuals with neurogenic oropharyngeal dysphagia when compared to healthy individuals for all food consistencies offered.

Comparar a medida ultrassonográfica de distância da aproximação do osso hioide no momento do pico máximo da deglutição entre indivíduos saudáveis e disfágicos neurogênicos e verificar o efeito das consistências do alimento no deslocamento do osso hioide. Estudo clínico prospectivo controlado. Foram realizadas avaliações ultrassonográficas da deglutição orofaríngea em 10 adultos com diagnóstico de disfagia orofaríngea e 10 adultos saudáveis, pareados por sexo e faixa etária. Para tanto, foi utilizado ultrassom portátil com transdutor microconvex 5-10 MHz, além de estabilizador de cabeça. As imagens ultrassonográficas foram gravadas pelo software Articulate Assistant Advanced a uma taxa de 120 quadros/segundo. Foram utilizadas as consistências de alimentos nível 0 (volume livre e 5 mL) e nível 4 (5 mL), conforme as recomendações do International Dysphagia Diet Standardisation Initiative. A distância foi mensurada no momento do pico máximo da deglutição entre a parte inferior do osso hioide e a inserção do músculo milo-hioideo. Cálculos de média e o desvio padrão foram utilizados na análise descritiva, enquanto o teste ANOVA de medidas repetidas foi aplicado na análise inferencial.Resultados evidenciaram que indivíduos disfágicos apresentaram menor elevação do osso hioide, marcada por maior distância da aproximação do osso hioide no momento do pico máximo da deglutição quando comparados aos indivíduos saudáveis, independentemente da consistência alimentar ofertada. Concluiu-se que a medida ultrassonográfica de distância da aproximação do osso hioide no momento do pico máximo da deglutição mostrou menor elevação laríngea em indivíduos com disfagia orofaríngea neurogênica quando comparados aos indivíduos saudáveis para todas as consistências alimentares ofertadas.

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.

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

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

Oral transit time in children with neurological impairment indicated for gastrostomy. / Tempo de trânsito oral na criança com acometimento neurológico indicada à gastrostomia.

PURPOSE: The objective of the present study was to describe the total oral transit time (TOTT) of children with neurological impairment (CNI) and with an indication of gastrostomy. METHOD: A cross-sectional clinical study was conducted on 15 children (10 male and 5 female ranging in age from 1 to 14 years; mean 5.7 years) with CNI and gastrostomy indication. The patients were monitored by a Multidisciplinary Group of Pediatric Gastroenterology of Universidade de Marília - UNIMAR, which 13 of them with previous exclusive oral feeding and 2 fed by a nasogastric tube. Swallowing was analyzed by videofluoroscopy swallowing study and 19 images of TOTT were obtained using specific software, with analysis of pureed food (13 images) and liquid (six images). TTOT was categorized as short or long based on definitions already evidenced in the literature. RESULTS: The mean and standard deviation of TOTT values was 10.75 s and 11.76 s for pureed food and 4.22 s and 1.54 s for liquid food. CONCLUSION: The total oral transit time of pureed or liquid consistency was long in children with neurological involvement and with an indication of gastrostomy.

OBJETIVO: O objetivo deste estudo foi descrever o tempo de trânsito oral total (TTOT) da deglutição em diferentes consistências de alimento na criança com acometimento neurológico (CAN) e com indicação de gastrostomia. MÉTODO: Estudo clínico transversal incluiu 15 indivíduos com CAN e indicação de gastrostomia, sendo 10 do sexo masculino e cinco do sexo feminino, 13 com alimentação via oral exclusiva e dois com sonda nasogástrica, faixa etária de um a 14 anos, média de 5,7 anos, acompanhados no Grupo Multidisciplinar de Gastroenterologia Pediátrica da Universidade de Marília-UNIMAR. A deglutição foi analisada por estudo videofluoroscópico da deglutição. Foram mensuradas 19 imagens do tempo de trânsito oral total (TTOT) da deglutição, por software específico, utilizando alimento pastoso (13 imagens) e alimento líquido (seis imagens). O TTOT foi categorizado em curto ou longo baseado em definições já evidenciadas na literatura. RESULTADOS: A média e o desvio padrão para o TTOT foram, respectivamente, 10,75s e 11,76s para o pastoso e 4,22s e 1,54s para o líquido. CONCLUSÃO: O tempo de trânsito oral total é longo nas consistências pastosa e líquida em crianças com acometimento neurológico e com indicação de gastrostomia.

Fiberoptic endoscopic findings of oropharyngeal swallowing of different food consistencies in Amyotrophic Lateral Sclerosis. / Achados videoendoscópicos da deglutição em diferentes consistências de alimento na Esclerose Lateral Amiotrófica.

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.

OBJETIVO: Este estudo teve por objetivo comparar os achados videoendoscópicos da deglutição orofaríngea em distintas consistências de alimento na Esclerose Lateral Amiotrófica (ELA). MÉTODO: Estudo clínico retrospectivo com amostra de conveniência. Foram incluídos 20 indivíduos com diagnóstico de ELA e disfagia orofaríngea confirmada por avaliação clínica e objetiva de deglutição, independentemente do tipo, bulbar ou esquelética, e tempo de diagnóstico neurológico, 13 do sexo masculino e sete do sexo feminino, faixa etária variando de 34 a 78 anos, média de 57 anos. Foram analisados os achados da videoendoscopia de deglutição (VED) nas consistências líquida (N=18), líquida espessada (N=19) e pastosa (N=20) no volume de cinco ml. Os achados sobre escape oral posterior, resíduos faríngeos, penetração laríngea e/ou aspiração foram comparados nas três consistências de alimento e a análise estatística utilizou o teste ANOVA de Friedman. RESULTADOS: Não foi encontrada alteração na sensibilidade laríngea nessa população. Não houve diferença estatística significativa entre as consistências de alimento na presença de escape oral posterior, penetração e/ou aspiração. Houve diferença estatística significativa somente com resíduos faríngeos na consistência líquida espessada e pastosa na ELA. CONCLUSÃO: Dentre os achados videoendoscópicos da deglutição na ELA, somente o resíduo faríngeo teve maior frequência na dependência da consistência de alimento.

Risk factors for oropharyngeal dysphagia in cardiovascular diseases.

Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases. Objective to correlate predictive risk factors for oropharyngeal dysphagia in individuals with cardiovascular disease admitted at a reference cardiology hospital. Methodology This is a retrospective clinical study. Medical records of 175 individuals hospitalized for clinical and/or surgical treatment at a reference cardiology hospital from January to June 2017, attendants of the Speech-Language Pathology and Nutrition team, were analyzed. Of these, 100 records were included in the study: 41 females and 59 males (mean age 67.56 years). Deaths and individuals from 0 to 18 years were excluded. Stroke, malnutrition, age and prolonged orotracheal intubation were considered predictive risk factors for oropharyngeal dysphagia. Mann-Whitney test and Fisher's test were used for statistical analysis. Results Stroke (OR=2.93 p=0.02), malnutrition (OR=2.89 p=0.02) and prolonged orotracheal intubation (OR=3.94 p=0.02) were statistically significant predictors for oropharyngeal dysphagia within this population. Age below 80 years was not significant (p=0.06), but within octogenarians, significance was found (p=0.033). Conclusion Stroke, malnutrition, prolonged orotracheal intubation and age > 80 years are predictive risk factors for oropharyngeal dysphagia in adult population with cardiovascular diseases.

Análise ultrassonográfica da distância do osso hioide em indivíduos com disfagia orofaríngea neurogênica / Ultrasonographic analysis of the hyoid bone distance in individuals with neurogenic oropharyngeal dysphagia

RESUMO Comparar a medida ultrassonográfica de distância da aproximação do osso hioide no momento do pico máximo da deglutição entre indivíduos saudáveis e disfágicos neurogênicos e verificar o efeito das consistências do alimento no deslocamento do osso hioide. Estudo clínico prospectivo controlado. Foram realizadas avaliações ultrassonográficas da deglutição orofaríngea em 10 adultos com diagnóstico de disfagia orofaríngea e 10 adultos saudáveis, pareados por sexo e faixa etária. Para tanto, foi utilizado ultrassom portátil com transdutor microconvex 5-10 MHz, além de estabilizador de cabeça. As imagens ultrassonográficas foram gravadas pelo software Articulate Assistant Advanced a uma taxa de 120 quadros/segundo. Foram utilizadas as consistências de alimentos nível 0 (volume livre e 5 mL) e nível 4 (5 mL), conforme as recomendações do International Dysphagia Diet Standardisation Initiative. A distância foi mensurada no momento do pico máximo da deglutição entre a parte inferior do osso hioide e a inserção do músculo milo-hioideo. Cálculos de média e o desvio padrão foram utilizados na análise descritiva, enquanto o teste ANOVA de medidas repetidas foi aplicado na análise inferencial.Resultados evidenciaram que indivíduos disfágicos apresentaram menor elevação do osso hioide, marcada por maior distância da aproximação do osso hioide no momento do pico máximo da deglutição quando comparados aos indivíduos saudáveis, independentemente da consistência alimentar ofertada. Concluiu-se que a medida ultrassonográfica de distância da aproximação do osso hioide no momento do pico máximo da deglutição mostrou menor elevação laríngea em indivíduos com disfagia orofaríngea neurogênica quando comparados aos indivíduos saudáveis para todas as consistências alimentares ofertadas.

ABSTRACT To compare the ultrasound measurement of distance from the approximation of the hyoid bone during of the maximum deglutition peak between healthy individuals and neurogenic dysphagic individuals and to verify the effect of food consistencies on the displacement of the hyoid bone. Prospective, controlled clinical study. Ultrasound recordings of the oropharyngeal deglutition were conducted in 10 adults diagnosed with oropharyngeal dysphagia and in 10 healthy adults, matched by sex and age group. A portable ultrasound model Micro ultrasound system with a microconvex transducer 5-10 MHz, coupled to a computer as well as the head stabilizer were used. The ultrasound images were recorded using the AAA software (Articulate Assistant Advanced) at a rate of 120 frames/second. Food consistencies level 0 (free volume and 5 mL) and level 4 (5 mL) were used, based on the International Dysphagia Diet Standardisation Initiative (IDSSI). The calculation of the mean and standard deviation was used for the descriptive analysis, while the repeated measures ANOVA test was used for the inferential analysis. Results showed dysphagic individuals had lower elevation of the hyoid bone marked by a longer distance from the approximation of the hyoid bone during of the maximum deglutition peak when compared to healthy individuals, regardless of the food consistency offered. It was concluded that the ultrasound measurement of distance from the approximation of the hyoid bone during of the maximum deglutition peak showed less laryngeal elevation in individuals with neurogenic oropharyngeal dysphagia when compared to healthy individuals for all food consistencies offered.

Relationship between oral transit time and functional performance in motor neuron disease.

Oral phase swallowing impairment in motor neuron disease (MND) is caused by tongue weakness, fasciculation and atrophy, which may compromise oral transit time and total feeding time. OBJECTIVE To describe and correlate total oral transit time (TOTT) with functional performance in MND using different food consistencies. METHODS The study was conducted on 20 patients with MND, regardless of type or duration of the disease, of whom nine were excluded due to issues on the videofluoroscopic swallowing images. The remaining 11 patients (nine men and two women) ranged from 31 to 87 years of age (mean: 57 years) with scores on the Penetration Aspiration Scale ranging from ≤ 2 to ≤ 4. The Amyotrophic Lateral Sclerosis Functional Rating Scale - revised questionnaire was applied to classify individuals according to global, bulbar and bulbar/respiratory parameters. Videofluoroscopy of swallowing using 5ml of different consistencies was performed and a quantitative temporal analysis of the TOTT was carried out with the aid of specific software. RESULTS There was a wide variation in the TOTT within the same food consistency among MND patients. There was a correlation between the TOTT and overall functional performance for the thickened liquid consistency (r = -0.691) and between the TOTT and bulbar performance for the pureed consistency (r = -0.859). CONCLUSION Total oral transit time in MND varies within the same food consistency and the longer the TOTT, regardless of food consistency, the lower the functional performance in MND.

Pharyngeal residue in neurogenic oropharyngeal dysphagia. / Resíduos faríngeos nas disfagias orofaríngeas neurogênicas.

PURPOSE: To compare pharyngeal residues of different consistencies among groups of individuals with neurogenic oropharyngeal dysphagia. METHODS: In a cross-sectional study, a fiberoptic endoscopic evaluation was performed in 30 swallowing exams of individuals diagnosed with neurological disease and oropharyngeal dysphagia, regardless of the time or stage of the disease. The individuals were divided into three groups according to etiology: group I, 10 post-stroke, 8 male and 2 female, aged 51 to 80 years (average age: 67 years); group II, 10 individuals with amyotrophic lateral sclerosis, 5 male and 5 female, aged 39 to 78 years (average age: 57 years); group III, 10 examinations of individuals with Parkinson's disease, 5 male and 5 female aged 65-88 years (average age: 74 years). The Yale Pharyngeal Residue Severity Rating Scale was applied by two independent raters in a blind manner for the analysis of pharyngeal residues in valleculae and pyriform sinuses based on the first swallowing of 5 mL of pureed and thickened liquid. RESULTS: No statistically significant difference was observed among groups in the degree of pharyngeal residues of puree food or thickened liquid in the valleculae (p = 0.25/p = 0.18) or the pyriform sinuses (p = 1.41/0.49). CONCLUSION: The pharyngeal residue levels of pureed and thickened liquid were similar for the groups studied, with less severe levels being more frequent.

OBJETIVO: Comparar os resíduos faríngeos por consistência de alimento entre indivíduos com disfagia orofaríngea neurogênica. MÉTODO: Estudo clínico transversal. Realizada análise de 30 exames de videoendoscopia de deglutição de indivíduos com diagnóstico de doenças neurológicas e disfagia orofaríngea, independentemente do tempo ou estágio das doenças. Os indivíduos foram divididos em três grupos: o grupo I composto por 10 indivíduos pós-Acidente Vascular Cerebral, 8 homens e 2 mulheres, faixa etária entre 51 e 80 anos (média 67 anos); o grupo II por 10 indivíduos com Esclerose Lateral Amiotrófica, 5 homens e 5 mulheres, faixa etária entre 39 e 78 anos (média 57 anos), e o grupo III por 10 indivíduos com Doença de Parkinson (DP), 5 homens e 5 mulheres, faixa etária entre 65 e 88 anos (média 74 anos). Para análise dos resíduos faríngeos em valéculas e seios piriformes, foi aplicada a Yale Pharyngeal Residue Severity Rating Scale, considerando a primeira deglutição de 5 mL nas consistências pastosa e líquida espessada, por dois juízes independentes e de forma cega. RESULTADOS: Não houve diferença estatística significativa nos resíduos faríngeos, em valéculas (p= 0,25/ p= 0,18) e seios piriformes (p= 1,41/ 0,49), respectivamente nas consistências pastosa e líquida espessada, nas diferentes doenças estudadas. CONCLUSÃO: Os níveis de resíduos faríngeos na consistência pastosa ou líquida espessada na população estudada foram semelhantes e mais frequentes nos níveis menos grave.

Correlation between bulbar functionality and laryngeal penetration and/or laryngotracheal aspiration on motor neuron disease. / Correlação entre funcionalidade bulbar e penetração e/ou aspiração laringotraqueal na doença do neurônio motor.

OBJECTIVE: Describe and correlate bulbar functionality with laryngeal penetration and/or laryngotracheal aspiration for different food consistencies in Motor Neuron Disease (MND). METHODS: Study participants were 18 individuals diagnosed with MND regardless of the type and time of onset of disease. The Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised/BR (ALSFRS-R/BR) was applied, and only the bulbar parameter, which includes speech, salivation and swallowing, was analyzed, with scores raging from 0 (disability) to 12 (normal functionality). Swallowing videofluoroscopy was performed using the Penetration-Aspiration Scale (PAS) described by Rosenbek et al. (1996). The Pearson correlation test was used for data analysis. RESULTS: According to food consistency, the PAS level ranged from 1 to 5 for puree consistency, 1 to 4 for thickened liquid, and 1 to 3 for liquid, and no laryngotracheal aspiration was observed. Negative correlation between bulbar functionality and laryngeal penetration was observed for all food consistencies (pasty: r=-0.487, p=0.041; thickened liquid: r=-0.442, p=0.076; liquid r=0.460, p=0.073), but statistically significant difference was found only for the puree consistency, that is, individuals with poor bulbar functionality presented higher levels of laryngeal penetration. CONCLUSION: Negative correlation was observed between bulbar functionality and laryngeal penetration in MND. The bulbar parameters of the ALSFRS-R/BR are significant for predicting risk of laryngotracheal aspiration for pasty consistency in MND.

OBJETIVO: Descrever e correlacionar a funcionalidade bulbar com penetração e aspiração laringotraqueal em distintas consistências de alimento na Doença do Neurônio Motor (DNM). MÉTODO: Participaram do estudo 18 indivíduos diagnosticados com DNM, independentemente do tipo e tempo da doença. Foi aplicada a escala Amyotrophic Lateral Sclerosis Functional Rating Scale­Revised/BR (ALSFRS-R/BR), sendo analisado apenas o parâmetro bulbar que compreende fala, salivação e deglutição, com pontuação de 0 (incapacidade) a 12 (funcionalidade normal). Realizou-se videofluoroscopia da deglutição com aplicação da Penetration-Aspiration Scale (PAS) descrita por Rosenbek et al. (1996). Realizado Teste de Correlação de Pearson. RESULTADOS: Considerando a consistência do alimento, o nível da PAS variou de 1 a 5 na consistência pastosa, de 1 a 4 na líquida espessada e de 1 a 3 na líquida rala, e não houve aspiração laringotraqueal. Para todas as consistências de alimentos, houve correlação negativa entre funcionalidade bulbar e penetração laríngea (pastoso: r=-0,487, p=0,041; líquido espessado: r=-0,442, p=0,076; líquido ralo: r=-0,460, p=0,073), porém somente na consistência pastosa houve diferença estatística significante, ou seja, indivíduos com baixa funcionalidade bulbar apresentaram maior nível de penetração laríngea. CONCLUSÃO: Houve correlação negativa entre funcionalidade bulbar e penetração laríngea na DNM. Os parâmetros bulbares da escala ALSFRS-R/BR mostraram-se significantes para predizer risco de penetração laringotraqueal na consistência pastosa na DNM.

[Efficacy of rehabilitation in oropharyngeal dysphagia]. / A eficácia da reabilitação em disfagia orofaríngea.

BACKGROUND: efficacy of rehabilitation in oropharyngeal dysphagia. In our country the practice of speech-language pathology in oropharyngeal dysphagia has increased significantly and, at this moment, deserves attention since practice needs to be based on scientific evidence. Therapeutic techniques and the outcome of rehabilitation in oropharyngeal dysphagia have been studied since the 70s, reaching its high point during the 80s and 90s. Few studies have investigated the efficacy of therapy in the rehabilitation of oropharyngeal dysphagia, the vast majority have tried to prove the effects of therapy on the dynamics of swallowing. In Brazil, the studies about oropharyngeal dysphagia have, in great part, investigated assessment procedures, and only a few have worried about rehabilitation. AIM: to present a critical analysis about the efficacy of rehabilitation in oropharyngeal dysphagia. CONCLUSION: this review of the literature indicates that non-randomized studies have compromised the results, once the casuistic of the researches are very heterogeneous--they include neurogenic and mechanical oropharyngeal dyshagia caused by different etiologies. Besides that, therapeutic programs which are used are not sufficiently described, compromising the reproduction of the methodology by other researchers. These results suggest the need for more randomized studies, which can be initially developed as case studies in order to exclude the control variables of therapy efficacy. Another suggestion is, as proposed by present researches, to use scales that can measure the impact of swallowing training in the nutritional and pulmonary condition of dysphagic patients. An important research area, related to the control of therapeutic efficacy and efficiency, are the studies that aim to establish the decrease in hospital and home care costs as a consequence of speech-language intervention with patients with oropharyngeal dyspahgia.

Qualitative and quantitative analysis of oropharyngeal swallowing in Down syndrome. / Análise qualitativa e quantitativa da deglutição orofaríngea na Síndrome de Down.

PURPOSE: To describe the qualitative and quantitative temporal analysis of oropharyngeal swallowing in children diagnosed with Down syndrome (DS) through a case series study of six individuals aged 4 to 17 months (mean age = 11.16 months; median = 12 months). METHODS: Qualitative and quantitative temporal analysis of swallowing using videofluoroscopy and specific software. The following parameters were assessed: presence or absence of oral incoordination, labial sphincter sealing incompetence, oral residue, posterior oral spillage, laryngotracheal penetration and aspiration, pharyngeal and total oral transit time (TOTT). RESULTS: Qualitative analysis identified individuals with disorders in at least four of the swallowing parameters investigated. Only one individual presented total oral transit time (TOTT) different from the others. No difference was observed between the cases regarding pharyngeal transit time. CONCLUSION: Qualitative swallowing disorders are observed in children with DS, with difference in TOTT only in the case report of the youngest infant.

OBJETIVO: Este estudo tem por objetivo descrever a análise qualitativa e quantitativa temporal da deglutição orofaríngea em crianças com diagnóstico de Síndrome de Down (SD). MÉTODO: Estudo de série de seis casos, com idade variando de quatro a 17 meses (Média de 11,16 meses e mediana de 12 meses). Realizada análise qualitativa e quantitativa temporal da deglutição orofaríngea por meio de videofluoroscopia de deglutição e software específico. Foram analisados os parâmetros qualitativos de coordenação oral, resíduos orais, escape oral posterior, penetração, aspiração laringotraqueal e realizada análise do tempo de trânsito oral total (TTOT) e faríngeo. RESULTADOS: Verificou-se alteração em pelo menos quatro dos parâmetros qualitativos investigados. Somente um dos indivíduos apresentou diferença no TTOT quando comparado com os demais e não houve diferença no tempo de trânsito faríngeo entre os casos. CONCLUSÃO: Houve alterações qualitativas na deglutição em crianças com SD e diferença no TTOT somente no caso de menor faixa etária.

Screening tool for oropharyngeal dysphagia in stroke - Part I: evidence of validity based on the content and response processes. / Instrumento de rastreio para disfagia orofaríngea no Acidente Vascular Encefálico - Parte I: evidências de validade baseadas no conteúdo e nos processos de resposta.

PURPOSE: The aim of the present study was to identify the evidence of validity based on the content and response process of the Rastreamento de Disfagia Orofaríngea no Acidente Vascular Encefálico (RADAVE; "Screening Tool for Oropharyngeal Dysphagia in Stroke"). METHODS: The criteria used to elaborate the questions were based on a literature review. A group of judges consisting of 19 different health professionals evaluated the relevance and representativeness of the questions, and the results were analyzed using the Content Validity Index. In order to evidence validity based on the response processes, 23 health professionals administered the screening tool and analyzed the questions using a structured scale and cognitive interview. RESULTS: The RADAVE structured to be applied in two stages. The first version consisted of 18 questions in stage I and 11 questions in stage II. Eight questions in stage I and four in stage II did not reach the minimum Content Validity Index, requiring reformulation by the authors. The cognitive interview demonstrated some misconceptions. New adjustments were made and the final version was produced with 12 questions in stage I and six questions in stage II. CONCLUSION: It was possible to develop a screening tool for dysphagia in stroke with adequate evidence of validity based on content and response processes. Both validity evidences obtained so far allowed to adjust the screening tool in relation to its construct. The next studies will analyze the other evidences of validity and the measures of accuracy.

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

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

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

Oropharyngeal swallowing in chronic renal failure.

OBJECTIVE: To characterize the oropharyngeal swallowing profile of patients with chronic renal failure. METHODS: A cross-sectional clinical study involving 20 adults diagnosed with chronic renal failure in hospital stay was conducted. The evaluation of swallowing was performed by videofluoroscopy, and characterization of findings was based on effectiveness and safety parameters. Functional Oral Intake Scale (FOIS) was also applied. RESULTS: On videofluoroscopy, 16 patients presented changes in oral and pharyngeal patterns, three individuals presented impairment at the pharyngeal phase, and only one individual presented changes only at the oral phase of swallowing. Furthermore, videofluoroscopy showed penetration and tracheal aspiration in 30% of the sample. Before the videofluoroscopy, four individuals (20%) were at level 5 of FOIS scale, whereas 16 individuals (80%) were at level 7. After adjustments of the oral diet consistency because of safety and swallowing effectiveness, FOIS classification was six individuals at level 1, seven at level 4, four at level 5, and three at level 6. CONCLUSION: The characterization of oropharyngeal swallowing profile in chronic renal patients showed abnormalities at oral and pharyngeal phase, including penetration and tracheal aspiration, which requires oral intake changes.

Acoustic analysis of oropharyngeal swallowing using Sonar Doppler.

INTRODUCTION: During the aging process, one of the functions that changes is swallowing. These alterations in oropharyngeal swallowing may be diagnosed by methods that allow both the diagnosis and biofeedback monitoring by the patient. One of the methods recently described in the literature for the evaluation of swallowing is the Sonar Doppler. OBJECTIVE: To compare the acoustic parameters of oropharyngeal swallowing between different age groups. METHODS: This was a field, quantitative, study. Examination with Sonar Doppler was performed in 75 elderly and 72 non-elderly adult subjects. The following acoustic parameters were established: initial frequency, first peak frequency, second peak frequency; initial intensity, final intensity; and time for the swallowing of saliva, liquid, nectar, honey, and pudding, with 5- and 10-mL free drinks. RESULTS: Objective, measurable data were obtained; most acoustic parameters studied between adult and elderly groups with respect to consistency and volume were significant. CONCLUSION: When comparing elderly with non-elderly adult subjects, there is a modification of the acoustic pattern of swallowing, regarding both consistency and food bolus volume.

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

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

Fiberoptic endoscopic evaluation of swallowing in patients with amyothrophic lateral sclerosis: an integrative literature review

ABSTRACT Purpose: to provide an integrative review of the current evidence on the fiberoptic endoscopic evaluation of swallowing performing procedures and analysis parameters in patients with amyotrophic lateral sclerosis. Methods: the study question followed the PECO strategy, and the search was performed in Medline, Cochrane, Scopus, Lilacs, Web of Science, and CINAHL databases, using keywords and specific free terms. Two authors screened eligible articles published from 2013 to October 2021 and extracted data on fiberoptic endoscopic evaluation of swallowing performing procedures and analysis parameters in patients with amyotrophic lateral sclerosis. Literature Review: of the 1,570 articles initially identified, 14 were eligible. There was no consensus on the consistency, volume, and type of food, utensils, sequence, and number of repetitions of each task during the exam. The analysis parameters, when described, were distinct. Although with different classification criteria, the observation of pharyngeal residue, laryngeal penetration, and laryngotracheal aspiration was included in all studies. Conclusion: fiberoptic endoscopic evaluation of swallowing performing procedures and analysis parameters are not standardized in studies with amyotrophic lateral sclerosis patients.

Qualitative and quantitative ultrasound analysis of oropharyngeal swallowing.

UNLABELLED: Purpose To analyze the effect of the age group and food's consistency according to the qualitative and quantitative ultrasonographic parameters in the oropharyngeal swallowing. METHODS: Ultrasonographic evaluations of swallowing were performed in 100 health individuals (divided into four groups, whose age brackets were 20-60 years), using liquid and mashed consistencies. For qualitative analysis, five steps were taken into account during the oropharyngeal swallowing. The following parameters were regarded in the quantitative analysis: duration of the tongue propulsion and maximum displacement of the hyoid bone during swallowing. RESULTS: In the qualitative ultrasonographic analysis, all the participants, independent to age groups, presented the same pattern of the tongue position (1, 2, and 5 phases), whereas in phase 3 there was a great variability within participants of the wavelike movement of the tongue. In phase 4, the displacement of the hyoid bone increased as a consequence of the consistency of the food. In the quantitative ultrasonographic analysis, a significant effect regarding age (p=0.03), consistence (p=0.00), as well as the age*consistency interaction was observed (p=0.03). Overall, the group of individuals between 20 and 30 years (G1) differed from the other groups and pudding consistency increased the measure of duration and displacement. CONCLUSION: The ultrasonography of the movement of the tongue proved itself as a viable instrument to describe the oropharyngeal swallowing. Parameters such as age and food consistency modify the USG images of movement of the tongue in normal subjects should be considered in ultrasound examination of oropharyngeal swallowing.