Conocimiento y adaptación de válvulas de habla a traqueostomía por parte de fonoaudiólogos colombianos / Knowledge of colombian speech- language pathologists and adaptation of tracheostomy speaking valves

El propósito de este estudio fue describir el conocimiento que poseen los fonoaudiólogos colombianos acerca de las válvulas de habla y determinar si las emplean como parte del manejo de usuarios con traqueostomía así como las variables que puedan influir en su uso. Para ello, se distribuyó un formulario digital a fonoaudiólogos egresados en Colombia. Las preguntas se agruparon en cinco secciones a partir de las cuales se ajustaron varios modelos lineales generalizados para determinar la influencia de variables como la ciudad, la experiencia profesional, los posgrados, la población, el escenario de atención y la presencia de equipos de traqueostomía en la adaptación de las válvulas. Las preguntas abiertas se analizaron a partir de tendencias temáticas en las respuestas de los participantes. El cuestionario fue respondido por 27 fonoaudiólogos de distintas latitudes con variedad en el nivel posgradual. La totalidad de los encuestados conoce el insumo; de estos, el 66.66% manifestó haber adaptado válvulas y ratifica su beneficio fisiológico. Solo un 33.33% indica que el proceso administrativo para ordenar el insumo fue sencillo. Ninguna de las variables predictoras fue significativa para explicar la adaptación de válvulas de habla (p>0.05). Este estudio plantea que los fonoaudiólogos conocen las válvulas de habla y sus beneficios. Adicionalmente, advierte que las variables estudiadas no tienen influencia significativa en la adaptación del dispositivo. Por último, ratifica que los procesos administrativos relacionados con órdenes médicas y autorizaciones pueden tener un rol desfavorable para lograr acceder a estos insumos

The purpose of this study was to describe the knowledge that Colombian speech-language pathologist have about sepaking valves and to determine whether they use them as part of the management of tracheostomized clients, as well as the variables that may influence their use. To do this, a digital form was distributed to graduated speech therapists in Colombia. The questions were grouped into five sections from which several generalized linear models were adjusted to determine the influence of variables such as city, professional experience, postgraduate degrees, population, setting of care and the presence of tracheostomy teams in the adaptation of the valves. Open questions were analyzed based on thematic trends in the participants' responses. The questionnaire was answered by 27 speech- language pathologists from different latitudes with a variety at the postgraduate level. All of the respondents know the device; of these, 66.66% stated that they had adapted valves and confirmed their physiological benefit. Only 33.33% indicated that the administrative process to order the device was simple. None of the predictor variables was significant to explain the adaptation of speaking valves (p> 0.05). This study suggests that speech- language pathologists are aware of speaking valves and their benefits. Additionally, it warns that the variables studied have no significant influence on the adaptation of the device. Finally, it confirms that the administrative processes related to medical orders and authorizations may play an unfavorable role in gaining access to these supplies.

Planificación de la rehabilitación de la vía aérea superior y la función de la deglución en el paciente con cánula de traqueostomía / Plan for the Rehabilitation of the Upper Airway and Deglutition Function in Patients with a Tracheostomy Cannula

Los sistemas respiratorio, fonatorio y deglutorio actúan de manera coordinada y sincrónica permitiendo el accionar independiente de cada uno de ellos; la cánula de traqueostomía interrumpe la coordinación de este proceso. El motivo por el cual el paciente fue traqueostomizado, las patologías previas del mismo y los diferentes tipos de cánula de traqueostomía hace que no todos los pacientes traqueostomizados se comporten de la misma manera, lo que nos lleva a organizar la rehabilitación desde diferentes puntos de vista: el estructural (cánula de traqueostomía) y el clínico (disfunción en la encrucijada aerodigestiva). Se realizó una revisión narrativa, con el objetivo de conocer la evidencia disponible de las complicaciones por el uso prolongado de la cánula de traqueostomía sobre la función de la vía aérea superior y su posterior rehabilitación. Es considerado de importancia comenzar la rehabilitación de la deglución de manera precoz, siempre que sea posible, para no perder la función deglutoria.

The respiratory, phonatory and deglutitive systems function in a coordinated and synchronized manner, allowing each one of them to operate independently. The tracheostomy cannula interrupts the coordination of this process. Not all tracheostomized patients behave in the same way, it depends on the reason for which they were tracheostomized, their previous diseases and the different types of tracheostomy cannulas, that is why we have to plan their rehabilitation according to different points of view: the structural (tracheostomy cannula) and the clinical (aerodigestive junction dysfunction). A narrative review was carried out for the purpose of studying available evidence about complications in the upper airway caused by prolonged use of tracheostomy cannula, and subsequent rehabilitation. It is important to begin the rehabilitation of deglutition as soon as possible so as not to lose the deglutitive function.

Effect of One-way Tracheostomy Speaking Valve on Aspiration of Dysphagia Patients after Tracheotomy for Cerebral Hemorrhage / 中国康复理论与实践

Objective:To investigate the effects of a one-way tracheostomy speaking valve based on neuromuscular electrical stimulation on aspiration in patients with dysphagia after tracheotomy for cerebral hemorrhage. Methods:From January to December, 2018, 37 patients with dysphagia after tracheotomy for cerebral hemorrhage were randomly divided into control group (n = 21) and experimental group (n = 16). Both groups accepted neuromuscular electrical stimulation, while the experimental group was trained to use one-way tracheostomy speaking valve additionally, for three weeks. They were assessed with Functional Oral Food Intake Scale (FOIS) and Penetration-Aspiration Scale (PAS) before and after treatment. Results:The scores of FOIS and PAS improved in both groups after treatment (|Z| > 3.544, P < 0.001), and was better in the experimental group than in the control group (|Z| > 2.094, P < 0.05). Conclusion:One-way tracheostomy speaking valve training based on neuromuscular electrical stimulation could improve swallowing and reduce aspiration of patients with dysphagia after tracheotomy.

Effects of the Passy-Muir speaking valve on tracheotomized patients′ swallowing function after brain damage / 中华物理医学与康复杂志

Objective@#To investigate the effect of a Passy-Muir speaking valve (PMV) on the biomechanics of swallowing and on aspiration among persons tracheotomized after brain damage.@*Methods@#Twenty tracheotomized patients with aspiration after brain injury were selected and randomly divided into a non-PMV intervention group and a PMV intervention group, each of 10. Both groups were given routine swallowing training, while the PMV intervention group was additionally provided with a PMV and trained to use it. The treatment ended when the tracheal tube was removed or after 2 weeks. High-resolution manometry and videofluoroscopy were used to evaluate the maximum pressure in the velopharynx (VP-Max), the maximum post-deglutitive upper esophageal sphincter (UES) pressure (UES-Max) and Rosenbek penetration aspiration (PAS) scores for both groups before and after the treatment.@*Results@#Before the treatment there was no significant difference between the two groups in terms of average VP-Max, UES-Max or PAS score. After the treatment, the average VP-Max and UES-Max had increased significantly in both groups, and the average PAS score of the PMV intervention group had decreased significantly. There was a significant positive correlation between the increases in VP-Max and the decrease in PAS scores.@*Conclusion@#Inserting a PMV can improve velopharynx contraction and post-deglutitive UES among persons tracheotomized after a brain injury. The increase in maximum velopharynx pressure is positively correlated with decreases in aspiration.

Effects of remodeling pressure in upper airway on swallowing function of patients with tracheostomy after acquired brain damage / 中华物理医学与康复杂志

Objective To monitor the immediate effect of Passi-Muir speaking valve (PMV) on patients with tracheostomy after acquired brain damage.Methods Twelve patients with tracheostomy after acquired brain damage were recruited.All of them underwent the high resolution manometry to measure the pressure in pharynx and upper esophagus during swallowing before and immediately after wearing PMV.The parameters including the pharyngeal peak pressure,increasing rate of the pharyngeal pressure,pharyngeal pressure duration,upper esophageal sphincter (UES) residual pressure and UES relaxation duration were recorded.Results No significant differences were found in all the measurements before and immediately after wearing PMV (P＞0.05).Conclusion PMV has no instant impact on the swallowing function of patients with tracheostomy after acquired brain damage.

Velopharyngeal Incompetence in Dysarthria：Pathogenesis, Evaluation and Treatment (review) / 中国康复理论与实践

Dysarthric patients often present velopharyngeal incompetence (VPI), characterized nasalization articulation for hypernasali-ty, which seriously impaired their communication. Research of evaluation of VPI is mainly about cleft palate and postoperative, few about the dysarthria. Some approaches, such as physiologic approach to rehabilitation, have been used to correct hypernasality, and prosthesis, such as palatal lift prosthesis (PLP) and nasal speaking valve (NSV), are also proved effectively. PLP has been widely used for hypernasality oversea, but fewer in China.

Valores de presión espiratoria mantenida en la vía aérea como indicador de tolerancia al uso de válvula de fonación en pacientes traqueostomizados / Maintained expiratory airway pressure values as an indicator of tolerance of speaking valve in tracheostomized patients

Introduction: Speaking valve (SV) is an unidirectional flow device installed over the tracheostomy tube allowing phonation. Tolerance to this device depends on the permeability of the upper airway (UA), which may be indirectly assessed by measuring UA maintained expiratory pressure (PEMant). Objective: To evaluate the usefulness of the maintained expiratory pressure as a clinical indicator of tolerance to the SV. Method: Twenty three tracheostomized patients (median age 22 months-old) were evaluated with an aneroid manometer during 15 minutes, recording PEMant, arterial oxygen saturation (SaO2), heart rate, respiratory rate, accessory muscle use and wheezing as signs of respiratory distress Results: PEMant values less than 10 cmH2O are associated with tolerance of the SV and values over 20 cmH2O are associated with intolerance. Conclusion: Values under 10 cmH2O of PEMant can be used as an indicator of tolerance to VF.

Introducción: La válvula de fonación (VF), es un dispositivo de flujo unidireccional instalado sobre la cánula de traqueostomía posibilitando la fonación. La tolerancia a este dispositivo depende de la permeabilidad de la vía aérea superior (VAS), pudiendo ser valorada indirectamente a través de la medición de la presión espiratoria mantenida (PEMant) en vía aérea. Objetivo: Estudiar esta técnica como indicador clínico de tolerancia a la VF. Método: Se evaluaron 23 pacientes traqueostomizados (mediana de edad 22 meses) con un manómetro aneroide durante 15 minutos, registrando PEMant, saturación arterial de oxígeno (SaO2), frecuencia cardiaca, frecuencia respiratoria, uso de musculatura accesoria y sibilancias para valorar la dificultad respiratoria. Resultados: Valores de PEMant menores a 10 cmH2O se asocian con tolerancia a la VFy valores sobre 20 cmH2O a intolerancia a ésta. Conclusión: Valores bajo 10cmH2O de PEMant pueden ser indicadores de tolerancia al uso de VF.

The application of dysphagia ventilation swallowing and speaking valve in children with swallowing disorder after tracheostomy / 中华物理医学与康复杂志

Objective To observe the application of dysphagia ventilation swallowing and speaking valve inchildren with swallowing disorder after tracheostomy.Methods Four children with tracheostomy done and swallowing disorders(3 with brainstem encephalitis caused by hand,foot and mouth disease and 1 post-surgery case of cerebellar astrocytoma)were observed.Videofluoroscopic swallowing studies(VFSS)showed cricopharyngeal achalasia and silent aspiration.After VFSS assessments,ventilation swallowing and speaking valves(Passy-Muir,USA,PMVs)were applied to the 4 children.After that they received comprehensive swallowing trainings including balloon dilatation,breathing exercises,sensory stimulation and electrical stimulation.Results Four children could pronounce with PMVs immediately.After(36.50 ± 35.63)d of comprehensive intervention,all of them could live without tracheostomy tube or nasal feeding tube,their swallowing function improved obviously and could take food per os.Conclusions The application of PMVs combining with swallowing training is effective for children with swallowing disorder and dysphonia after tracheostomy.It is helpful to decrease the risk of aspiration,to open the cricopharyngeus muscle and to restore pronunciation.