RESUMO
Seven institutions participated in this small clinical trial that included 19 patients who exhibited oropharyngeal dysphagia on videofluorography (VFG) involving the upper esophageal sphincter (UES) and who had a 3-month history of aspiration. All patients were randomized to either traditional swallowing therapy or the Shaker exercise for 6 weeks. Each patient received a modified barium swallow pre- and post-therapy, including two swallows each of 3 ml and 5 ml liquid barium and 3 ml barium pudding. Each videofluorographic study was sent to a central laboratory and digitized in order to measure hyoid and larynx movement as well as UES opening. Fourteen patients received both pre-and post-therapy VFG studies. There was significantly less aspiration post-therapy in patients in the Shaker group. Residue in the various oral and pharyngeal locations did not differ between the groups. With traditional therapy, there were several significant increases from pre- to post-therapy, including superior laryngeal movement and superior hyoid movement on 3-ml pudding swallows and anterior laryngeal movement on 3-ml liquid boluses, indicating significant improvement in swallowing physiology. After both types of therapy there is a significant increase in UES opening width on 3-ml paste swallows.
Assuntos
Transtornos de Deglutição/terapia , Terapia por Exercício , Adulto , Idoso , Idoso de 80 Anos ou mais , Deglutição/fisiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Fluoroscopia , Humanos , Músculos Laríngeos/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Força Muscular/fisiologia , Projetos Piloto , Resultado do TratamentoRESUMO
BACKGROUND: Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing. METHODS: Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment. Oral mucosa was rated with the Oral Mucositis Assessment Scale. Stimulated whole-mouth saliva, oral pain rating, percent of oral intake, and 2 subscales of the Performance Status Scale for Head and Neck (PSS-HN) cancer were also collected. RESULTS: Mucositis scores and pain ratings decreased over time while functional measures of eating improved over time. Reduction in chronic mucositis was correlated with improved oral intake and diet. CONCLUSION: Lack of association with pain was attributed to the absence of ulcerations. Continued impairment of oral intake during the first year posttreatment may be related to oral mucosal changes and other factors.
Assuntos
Ingestão de Alimentos , Neoplasias de Cabeça e Pescoço/terapia , Mucosite/fisiopatologia , Dor/fisiopatologia , Adulto , Assistência ao Convalescente , Idoso , Quimioterapia Adjuvante/efeitos adversos , Estudos de Coortes , Terapia Combinada , Deglutição/fisiologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Dieta , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Mucosite/etiologia , Esvaziamento Cervical/efeitos adversos , Esvaziamento Cervical/métodos , Estadiamento de Neoplasias , Dor/etiologia , Medição da Dor , Radioterapia Adjuvante/efeitos adversos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
There is little evidence regarding the type(s) of information clinicians use to make the recommendation for oral or nonoral feeding in patients with oropharyngeal dysphagia. This study represents a first step toward identifying data used by clinicians to make this recommendation and how clinical experience may affect the recommendation. Thirteen variables were considered critical in making the oral vs. nonoral decision by the 23 clinicians working in dysphagia. These variables were then used by the clinicians to independently recommend oral vs. nonoral feeding or partial oral with nonoral feeding for the 20 anonymous patients whose modified barium swallows were sent on a videotape to each clinician. Clinicians also received data on the 13 variables for each patient. Results of clinician agreement on the recommendation of full oral and nonoral only were quite high, as measured by Kappa statistics. In an analysis of which of the 13 criteria clinicians used in making their recommendations, amount of aspiration was the criterion with the highest frequency. Recommendations for use of postures and maneuvers and the effect of clinician experience on these choices were also analyzed.