Associação entre risco de disfagia e sinais sugestivos de sarcopenia, estado nutricional e frequência de higiene oral em idosos hospitalizados / Association between risk of dysphagia and signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in hospitalized elderly

RESUMO Objetivo Identificar o risco de disfagia e sua associação com os sinais sugestivos de sarcopenia, estado nutricional e frequência da higiene oral em idosos hospitalizados. Método Trata-se de um estudo transversal analítico com participação de 52 idosos internados em clínica médica de um hospital público no Distrito Federal. Foram aplicados os instrumentos Eating Assessment Tool, Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls + Circunferência da Panturrilha e o Mini Nutritional Assessment shortform além de coleta de dados sociodemográficos e de condições de saúde. Resultados Dos idosos participantes 30,8% apresentaram risco de disfagia autorrelatada. Os fatores associados ao risco de disfagia foram sinais sugestivos sarcopenia (p=0,04), estado nutricional (p<0,001) e frequência da higiene oral (p=0,03). Conclusão Na população geriátrica deste estudo, em sua maioria com Covid-19, o risco de disfagia esteve associado aos sinais sugestivos de sarcopenia, estado nutricional e frequência da higiene oral.

ABSTRACT Purpose To identify the risk of dysphagia and its association with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in the hospitalized elderly. Methods This is an analytical cross-sectional study with the participation of 52 elderly patients admitted to a medical clinic at a public hospital in the Federal District, Brazil. The Eating Assessment Tool, Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls + Calf Circumference and the Mini Nutritional Assessment shortform were applied, in addition to the collection of sociodemographic data and health conditions. Results Among the elderly participants, 30.8% were at risk of self-reported dysphagia. The factors associated with the risk of dysphagia were: signs suggestive of sarcopenia (p=0.04), nutritional status (p<0.001) and oral hygiene frequency (p=0.03). Conclusion In the geriatric population of the present study, with the majority of the participants having tested positive for Covid-19, the risk of dysphagia was associated with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene.

Telehealth and oropharyngeal dysphagia: An integrative review / Telessaúde e disfagia orofaríngea: uma revisão integrativa

ABSTRACT Purpose: to analyze the telehealth speech therapy approach in patients with oropharyngeal dysphagia and determine the applications and effects of this practice. Methods: the following descriptors were used for selection: Telerehabilitation, Telemedicine, "Remote Consultation", "Healthcare Delivery", "Distance Counseling", "Therapy, Computer-Assisted", "Speech-Language Pathology", "Speech Therapy", "Swallowing Disorders", Dysphagia, "Bottle Feeding" and "Enteral Nutrition" in PubMed, MedLine, Scopus and Web of Science databases and in the gray literature, by Google Scholar and ProQuest. Studies were selected without time limits, in Portuguese, English and Spanish, that described the applicability and/or effects of telehealth in speech therapy practice in patients with swallowing disorders/dysphagia, regardless of gender and age. For analysis, the following were considered: level of scientific evidence and recommendation, telehealth modality, objectives, methods and results/conclusion. Literature Review: 490 articles were found and, after exclusion of duplicates, analysis of titles, abstracts and reading of full articles, 22 studies were selected. The articles were classified into telehealth modalities: tele-education, telediagnosis, teleconsulting, teleregulation and telemonitoring. Conclusion: the telehealth modalities described had a great potential to promote significant improvements in patients presented with swallowing disorders/dysphagia, suggesting them as viable for speech therapy services. Among them, teleconsultation was the least addressed.

RESUMO Objetivo: analisar a abordagem fonoaudiológica por meio da telessaúde em pacientes com disfagia e determinar as aplicações e efeitos desta prática. Métodos: para seleção foram utilizados os descritores: Telerehabilitation, Telemedicine, "Remote Consultation", "Delivery of Health Care", "Distance Counseling", "Therapy, Computer-Assisted", "Speech-Language Pathology", "Speech Therapy", "Deglutition Disorders", Dysphagia, "Bottle Feeding" e "Enteral Nutrition" nas bases de dados PubMed, MedLine, Scopus e Web of Science e na literatura cinzenta, por meio do Google Acadêmico e ProQuest. Foram selecionados estudos sem delimitação de tempo, nas línguas português, inglês e espanhol, que descrevessem a aplicabilidade e/ou efeitos da telessaúde na prática fonoaudiológica junto à pacientes com alteração da deglutição/disfagia, sem restrição de sexo e idade. Para análise considerou-se: nível de evidência científica e recomendação, modalidade de telessaúde, objetivos, métodos e resultados/conclusão. Revisão da Literatura: foram encontrados 490 artigos e, após exclusão de duplicatas, análise dos títulos, resumos e leitura completa dos artigos, 22 estudos foram selecionados. Os artigos foram classificados nas modalidades da telessaúde: tele-educação, telediagnóstico, teleconsultoria, telerregulação e telemonitoramento. Conclusão: as modalidades de telessaúde descritas tiveram grande potencial para promover melhoras significativas em pacientes com alteração de deglutição/disfagia, sugerindo-as como viáveis para serviços fonoaudiológicos. Entre elas, a teleconsulta foi a menos explorada.

Exploring the Feasibility of a Comprehensive Screening for Voice and Swallowing Function in Post-Extubation Patients: A Pilot Study

Objectives: This pilot study aimed to identify and test a battery of time-efficient and cost-effective voice and swallowing screening tools for post-extubated patients in Chile. Methods: A panel of four experts selected and rated voice and swallowing screening tools. Seven measures were selected: smoothed cepstral peak prominence (CPPS) and maximum phonation time (MPT) for voice assessment, Volume-Viscosity Swallow Test (V-VST) for swallowing, voluntary and reflex peak cough flow for cough assessment, Eating Assessment Tool-10 (EAT-10), and Vocal Symptom Scale (VoiSS) for patient-reported outcomes. These tools were applied to four post-extubation patients within 48-72 hours post-hospital discharge, alongside the assessment of 17 matched controls. Results: Post-extubation patients showed significantly shorter MPT, lower CPPS values, increased V-VST dysphagia signs, reduced voluntary peak cough flow, and more pronounced symptoms on both the VoiSS and EAT-10 compared to controls. Limitations: The study had a modest sample size and relied solely on clinical screening tools. Value: This pilot study suggests a feasible and cost-effective approach to voice and swallowing screening for post-extubation patients, valuable in resource-constrained settings. Conclusion: While these accessible tools are not gold-standard assessments, they offer valuable insights and can guide future research. This study underscores the potential of selected tools in facilitating early detection of voice and swallowing disorders in post-extubation patients.

Objetivos: Este estudio piloto tuvo como objetivo identificar y probar una batería de herramientas de detección de problemas de voz y deglución que fueran eficientes en cuanto a tiempo y costo para pacientes chilenos postextubados. Métodos: Un panel de cuatro expertos seleccionó y evaluó herramientas de detección de voz y deglución. Se seleccionaron siete medidas: prominencia de pico cepstral suavizado (CPPS) y tiempo máximo de fonación (TMF) para la evaluación de la voz, prueba de volumen-viscosidad (V-VST) para la deglución, flujo máximo voluntario y reflejo de la tos para evaluar la tos, Eating Assessment Tool-10 (EAT-10) y la Escala de Sintomas Vocales (ESV) para los resultados informados por los pacientes. Estas herramientas se aplicaron a cuatro pacientes postextubados (48-72 horas), junto con la evaluación de 17 controles pareados. Resultados: Los pacientes postextubados mostraron un TMF y CPPS significativamente más bajos, aumento de los indicios de disfagia en la V-VST, reducción del flujo máximo de la tos y síntomas más pronunciados tanto en la ESV como en la EAT-10 en comparación con los controles. Limitaciones: El estudio tuvo un tamaño de muestra reducida y se basó únicamente en herramientas de detección clínica. Valor: Este estudio piloto sugiere un enfoque factible y rentable para la detección de problemas de voz y deglución en pacientes postextubados, valioso en entornos con recursos limitados. Conclusión: Aunque ese abordaje no sustituye a las evaluaciones de referencia, ofrece información valiosa y puede guiar futuras investigaciones que busquen facilitar la detección temprana de los trastornos de la voz-deglución en pacientes postextubados.

Evaluating the Efficacy and Safety of Laparoscopic Heller Myotomy in Treating Achalasia

Introduction: Laparoscopic Heller myotomy (LHM) is widely recognized as the standard surgical treatment for esophageal achalasia. However, there is a lack of local data regarding the clinical characteristics of patients and the outcomes of this intervention. Methodology: This retrospective study analyzed patients who underwent LHM over an eight-year period. Demographic, operative, and postoperative variables were assessed. The Eckardt score was used to compare symptoms before and after the intervention. Continuous variables were presented as means. Results: Among the 39 patients assessed, 27 met the inclusion criteria. Of these, 51% were male, with an average age of 48 years. The average lower esophageal sphincter pressure was 36 mmHg. The mean operative time and bleeding were 133 minutes and 34 mL, respectively. The average length of the myotomy was 8.3 cm. Partial fundoplication was performed in all cases, and intraoperative endoscopy was conducted in 88% of the cases. Two intraoperative mucosal perforations occurred. The average length of hospital stay was 2.7 days. There was one medical complication but no mortality. Dysphagia significantly improved by 95%, and the mean Eckardt score decreased from 7.7 to 1.2 after surgery (p < 0.001). The average follow-up period was 24 months. Conclusion: LHM with partial fundoplication proves to be an effective and safe procedure for treating achalasia. It results in the resolution of dysphagia in 95% of cases and carries minimal morbidity. Therefore, LHM should be considered the definitive treatment of choice for achalasia.

Introducción: la miotomía de Heller laparoscópica (MHL) se considera el tratamiento quirúrgico estándar en acalasia esofágica. A nivel local se desconocen las características clínicas de los pacientes y los resultados de la intervención. Metodología: estudio retrospectivo que incluye pacientes llevados a MHL durante un periodo de 8 años. Se analizaron variables demográficas, operatorias y posoperatorias. Mediante el puntaje de Eckardt se compararon síntomas antes y después de la intervención. Las variables continuas se expresan en promedios. Resultados: 27 de 39 pacientes cumplieron los criterios de inclusión. El 51% fueron hombres y el promedio de edad fue de 48 años. La presión promedio del esfínter esofágico inferior fue de 36 mm Hg. El promedio de tiempo operatorio y sangrado fue de 133 minutos y 34 mL, respectivamente. La longitud promedio de la miotomía fue de 8,3 cm. Se adicionó funduplicatura parcial en todos los casos y en el 88% se realizó una endoscopia intraoperatoria. Se presentaron 2 perforaciones intraoperatorias de la mucosa. El promedio de estancia hospitalaria fue 2,7 días. Hubo una complicación médica y ninguna mortalidad. La disfagia mejoró en el 95% y el promedio del puntaje de Eckardt disminuyó de 7,7 a 1,2 luego de cirugía (p < 0,001). El seguimiento fue de 24 meses en promedio. Conclusión: la MHL con funduplicatura parcial es un procedimiento efectivo y seguro para el tratamiento de la acalasia. Se asocia a resolución de la disfagia en el 95% de los casos, su morbilidad es mínima y debe considerarse el tratamiento definitivo de elección.

Z-POEM: ¿Procedimiento ideal para el tratamiento del divertículo de Zenker? / Z-POEM: Ideal procedure for the treatment of Zenker's diverticulum?

Introducción. El divertículo de Zenker es una patología poco frecuente, caracterizada por la presencia de disfagia, halitosis, tos y pérdida de peso, que afectan la calidad de vida de los pacientes. El tratamiento es quirúrgico y las técnicas han evolucionado de forma permanente. El objetivo de este estudio fue evaluar la mejoría de la disfagia en pacientes a quienes se les realizó la técnica de miotomía endoscópica peroral (Z-POEM). Métodos. Estudio descriptivo de una serie de 23 pacientes con divertículo de Zenker diagnosticado por endoscopia y esofagograma, tratados entre mayo de 2018 y noviembre de 2021 en diferentes instituciones de la ciudad de Bogotá, D.C., Colombia, mediante una miotomía endoscópica del cricofaríngeo con la técnica de Z-POEM. Resultados. La mayoría de los pacientes fueron adultos mayores, de sexo masculino. Los síntomas más frecuentes correspondieron a disfagia y regurgitación. El tamaño promedio del divertículo fue de tres centímetros. La estancia hospitalaria fue de un día. Un paciente presentó disfagia postoperatoria en relación con los clips y otro presentó un absceso mediastinal, el cual fue resuelto de manera endoscópica. Actualmente, todos los pacientes se encuentran asintomáticos y no han presentado recurrencia. Conclusiones. El tratamiento endoscópico mínimamente invasivo mediante la miotomía endoscópica peroral (Z-POEM) en el paciente con divertículo de Zenker es una alternativa segura y eficaz, con buenos resultados y poca morbilidad

Introduction. Zenker's diverticulum is a rare pathology characterized by the presence of dysphagia, halitosis, cough, and weight loss, which affect the patients' quality of life. The treatment is surgical and the techniques have evolved permanently. The objective of this study was to evaluate the improvement of dysphagia in patients who underwent peroral endoscopic myotomy technique (Z-POEM). Methods. Descriptive study of a series of 23 patients with Zenker's diverticulum diagnosed by endoscopy and esophagram, treated between May 2018 and November 2021 at different institutions in Bogotá, Colombia, by means of an endoscopic cricopharyngeal myotomy with the Z-POEM technique. Results. Most of patients were older males. The most frequent symptoms corresponded to dysphagia and regurgitation. The average size of the diverticulum was three centimeters. The hospital stay was one day. One patient presented postoperative dysphagia related to the clips and another presented a mediastinal abscess which was resolved endoscopically. Currently, all patients are asymptomatic and have not presented recurrence. Conclusions. Minimally invasive endoscopic treatment by peroral endoscopic myotomy (Z-POEM) in patients with Zenker's diverticulum is a safe and effective alternative, with good results and low morbidity

Diagnóstico y manejo actual de la acalasia / Diagnosis and current management of achalasia

Introducción. La acalasia es un trastorno motor del esófago poco común, de etiología no clara, caracterizado por la pérdida de relajación del esfínter esofágico inferior, pérdida del peristaltismo normal, regurgitación y disfagia. Métodos. Se realizó una revisión narrativa de la literatura en revistas científicas y bases de datos en español e inglés, con el fin de presentar información actualizada en lo referente al diagnóstico y tratamiento de esta patología. Resultado. Se presenta la actualización de los criterios de los trastornos motores esofágicos según la clasificación de Chicago (CCv4.0) para el diagnóstico de acalasia y sus subtipos de acuerdo con los nuevos criterios, así como los tratamientos actuales. Conclusión. La acalasia es un trastorno esofágico multimodal, con manifestaciones de predominio gastrointestinal, por lo que su diagnóstico y abordaje terapéutico oportuno es esencial para mejorar la calidad de vida de los pacientes

Introduction. Achalasia is a rare motor disorder of the esophagus of unclear etiology, characterized by loss of lower esophageal sphincter relaxation, loss of normal peristalsis, regurgitation, and dysphagia. Methods. A narrative review of the literature in scientific journals and databases in Spanish and English was carried out, in order to present updated information regarding the diagnosis and treatment of this pathology. Result. The update of the Chicago esophageal motor disorders criteria (CCv4.0) is presented for the diagnosis of achalasia and its subtypes according to the new criteria, as well as current treatments. Conclusion. Achalasia is a multimodal esophageal disorder, with predominantly gastrointestinal manifestations, so its timely diagnosis and therapeutic approach is essential to improve the quality of life of patients.

A review of patients with dysphagia after anterior cervical discectomy and fusion / 中国实用护理杂志

Anterior cervical discectomy and fusion is one of the classic procedures for the treatment of cervical spondylosis, and dysphagia is a common perioperative complication of this procedure, which affects patients′ recovery to different degrees. This paper summarizes and analyzes the perioperative assessment and interventions in the care of patients with dysphagia after anterior cervical discectomy and fusion, aiming to improve clinical nursing staff′s attention to dysphagia in patients after anterior cervical discectomy and fusion, and provide scientific basis for the prevention and treatment of high-risk groups.

Impacto na deglutição e manejo da mucosite hipofaríngea em pacientes submetidos à quimiorradioterapia na região de cabeça e pescoço: uma revisão integrativa da literatura / Management of hypopharyngeal mucositis in patients undergoing chemoradiotherapy in the head and neck region and its impact on swallowing: an integrative literature review

RESUMO Objetivo Investigar o impacto da mucosite hipofaríngea quimiorradioinduzida na deglutição e o seu manejo, a partir de uma revisão integrativa de literatura. Estratégia de pesquisa A busca e a seleção dos artigos foram realizadas nas seguintes bases de dados: PubMed, Embase, Scopus, ScienceDirect e LILACS. Critérios de seleção Os termos de busca utilizados foram ''Pharyngeal Mucositis", ''Radiotherapy" e ''Esophagitis", com auxílio do operador booleano (AND). A equação de busca utilizada foi: ''Pharyngeal Mucositis" AND "Radiotherapy" AND "Esophagitis". A seguinte questão central orientou o estudo: "Qual a forma de avaliação e manejo da mucosite hipofaríngea induzida pela radiação na região de cabeça e pescoço e seu impacto na deglutição?". Resultados Foram identificados 75 estudos, sendo que 6 foram excluídos devido à duplicidade e 60 foram excluídos por não se encaixarem nos critérios de inclusão; os artigos restantes foram lidos na íntegra e 4 foram selecionados para fazerem parte desta revisão integrativa da literatura. Conclusão Apesar da escassa literatura e das poucas informações sobre os métodos de avaliação da mucosite hipofaríngea, os artigos apontam que, independentemente da dose de radiação, a radioterapia na região cervical causa mucosite hipofaríngea. A mucosite hipofaríngea provoca grande impacto na deglutição, resultando na necessidade de uso de via alternativa de alimentação. Além da ausência de informações quanto à avaliação e graduação da mucosite hipofaríngea, os estudos não discutem o tratamento direto ou a prevenção desse tipo de doença.

ABSTRACT Purpose To investigate the impact of chemoradiation-induced hypopharyngeal mucositis on swallowing and its management, based on an integrative literature review. Research strategy Two researchers were responsible for the search and selection of articles, within the following databases: PubMed, Embase, Scopus, Science Direct, and Lilacs. Selection criteria The search terms used were "Pharyngeal Mucositis", "Radiotherapy" and "Esophagitis", with the aid of the Boolean operator (AND). The search equation used was "Pharyngeal Mucositis" AND Radiotherapy AND Esophagitis. The following central question guided the study: "What is the assessment and management of radiation-induced hypopharyngeal mucositis in the head and neck region and its impact on swallowing?" Results 75 studies were identified, of which 6 were excluded due to duplicity and 60 were excluded for not meeting the inclusion criteria; the remaining articles were read in full and 4 were selected to be part of the integrative literature review. Conclusion Despite the scarce literature and little information on methods for evaluating hypopharyngeal mucositis, the articles point out that, regardless of the radiation dose, radiotherapy in the cervical region causes hypopharyngeal mucositis. Hypopharyngeal mucositis causes a great impact on swallowing, resulting in the need to use an alternative feeding route. In addition to the lack of information regarding the assessment and grading of hypopharyngeal mucositis, the studies do not discussitsdirect treatment or prevention.

Elaboração e validação do questionário de rastreamento de disfagia aplicado aos cuidadores de idosos com demência (RaDID-QC) / Development and validation of the dysphagia screening questionnaire applied to caregivers of elderly people with dementia (RaDID-QC)

O rápido envelhecimento populacional e o aumento da expectativa de vida associam-se ao incremento da população de idosos em todo o mundo, o que contribui significativamente para a maior prevalência das síndromes demenciais. A demência é uma síndrome clínica caracterizada pela deterioração progressiva de múltiplos domínios da cognição, prejuízo da funcionalidade e alterações comportamentais. O cuidador possui relevância fundamental no cuidado do idoso com demência. Em relação à alimentação, os idosos com demência apresentam menor interesse pelos alimentos, maior dificuldade na coordenação do bolo alimentar e redução na ingesta de alimentos, determinando alteração no processo da deglutição. É de suma importância que o cuidador identifique os sinais e sintomas dos transtornos da deglutição, visto que a disfagia é um fator de risco para mortalidade. O presente estudo, tem como objetivo desenvolver e validar o questionário Rastreamento de Disfagia em Idosos com Demência ­ Questionário para cuidadores (RaDID-QC), aplicado ao cuidador de idoso com demência por doença de Alzheimer e/ou demência vascular de gravidade leve, moderada ou avançada. Construímos um questionário para rastreamento de disfagia. Foi realizado um estudo de validação observacional transversal com o objetivo de identificar a disfagia no idoso parcial ou totalmente dependente de cuidado de terceiros. Para evidência de validade baseada no conteúdo, foram realizados levantamento bibliográfico, elaboração da primeira versão do questionário e análise das questões pelo comitê de 23 especialistas em disfagia com experiência em atendimento a idosos. A concordância entre as análises dos especialistas foi aferida por meio do Índice de Validade de Conteúdo por item (IVC-I) e do Coeficiente de Correlação Intraclasse (CCI). Para evidência de validade baseada nos processos de resposta, uma fonoaudióloga aplicou o instrumento, por meio de entrevista, em 30 cuidadores de idosos com demência (binômio cuidador-idoso com demência) provenientes do Instituto Jenny Andrade Faria de atenção à saúde do idoso do Hospital das Clínicas da Universidade Federal de Minas Gerais. Em seguida, os cuidadores realizaram o julgamento das questões quanto à clareza e facilidade de compreensão. Após novo ajuste no questionário, seguiu-se para a obtenção das evidências de validade baseadas na estrutura interna. Nesta etapa participaram 170 cuidadores de idosos com demência que responderam o instrumento. Os dados desta fase foram analisados usando coeficiente Alfa de Cronbach, correlações item-total e análise fatorial exploratória. A primeira versão do RaDID-QC foi constituída de 29 questões. Após duas rodadas de avaliações dos especialistas, a última versão permaneceu com 24 questões. O coeficiente de correlação intraclasse foi de 0,85. Na evidência de validade baseada nos processos de resposta houve adequação semântica de apenas uma questão. Na validade baseada na estrutura interna, após a análise fatorial exploratória, o questionário permaneceu com 14 questões, cinco fatores conseguiram explicar 61,7% da variância total, o coeficiente de correlação item-total apresentou valores iguais ou acima de 0,50 para os fatores e o Alfa de Cronbach padronizado obteve índice de 0,688. O questionário de rastreamento de disfagia aplicado ao cuidador de idoso com demência ­ RaDID-QC apresentou evidências de validade baseadas na análise de conteúdo, processos de resposta e estrutura interna satisfatório, válido e confiáveis.

Rapid population aging and increased life expectancy are associated with the increase in the elderly population worldwide, which significantly contributes to the higher prevalence of dementia syndromes. Dementia is a clinical syndrome characterized by the progressive deterioration of multiple domains of cognition, impairment of functionality and behavioral changes. The caregiver has fundamental relevance in the care of the elderly with dementia. Regarding food, elderly people with dementia have less interest in food, greater difficulty in coordinating the food bolus and reduced food intake, determining changes in the swallowing process. It is extremely important for the caregiver to identify the signs and symptoms of swallowing disorders, as dysphagia is a risk factor for mortality. The present study aims to develop and validate the questionnaire Dysphagia Screening in older adults with Dementia - Questionnaire for caregivers (RaDID-QC), applied to caregivers of older adults with dementia due to Alzheimer's disease and/or mild vascular dementia, moderate or advanced. We built a dysphagia screening questionnaire. A cross-sectional observational validation study was carried out with the aim of identifying dysphagia in the elderly partially or totally dependent on third-party care. For evidence of content-based validity, a bibliographic survey was carried out, the first version of the questionnaire was created, and the questions were analyzed by a committee of 23 experts in dysphagia with experience in caring for the elderly. The agreement between the experts' analyzes was checked using the Content Validity Index per item (IVC-I) and the Intraclass Correlation Coefficient (ICC). For evidence of validity based on the response processes, a speechlanguage applied the instrument, through interviews, to 30 caregivers of older adults with dementia (caregiver-elderly binomial with dementia) from the Jenny Andrade Faria Institute of health care for the elderly in the Clinical Hospital of the Federal University of Minas Gerais. Then, the caregivers judged the questions regarding clarity and ease of understanding. After a new adjustment in the questionnaire, we proceeded to obtain evidence of validity based on the internal structure. In this step, 170 caregivers of elderly people with dementia answered the instrument. Data from this phase were analyzed using Cronbach's alpha coefficient, item-total correlations and exploratory factor analysis. The first version of the RaDID-QC consisted of 29 questions. After two rounds of expert evaluations, the last version remained with 24 questions. The intraclass correlation coefficient was 0.85. In the evidence of validity based on response processes, there was semantic adequacy of only one question. In the validity based on the internal structure, after the exploratory factor analysis, the questionnaire remained with 14 questions, five factors were able to explain 61.7% of the total variance, the item-total correlation coefficient presented values equal to or above 0.50 for the factors and standardized Cronbach's alpha obtained an index of 0.688. The dysphagia screening questionnaire applied to caregivers of elderly people with dementia - RaDID-QC presented evidence of validity based on content analysis, response processes and internal structure that was satisfactory, valid and reliable.

Impacto de la cánula nasal de alto flujo y la ventilación no invasiva en la fisiología deglutoria: revisión de la literatura / Impact of high-flow nasal cannula and non-invasive ventilation on swallowing physiology: a literature review

El proceso deglutorio requiere de una adecuada coordinación entre respiración y deglución. En el contexto clínico, el uso de dispositivos ventilatorios no invasivos, como la cánula nasal de alto flujo (CNAF) o la ventilación no invasiva (VNI), ha cobrado gran relevancia durante los últimos años. Sin embargo, existe escasa información respecto a la interferencia que estos dispositivos podrían ocasionar en la fisiología deglutoria. En este contexto, y con el objetivo de describir el impacto de la CNAF y la VNI en la fisiología deglutoria, se realizó una revisión de la literatura en PubMed, Medline, Embase, Web of Science, Lilacs y Scielo. Se incorporaron estudios que incluyeran población ≥18 años, con uso de CNAF o VNI. Se excluyeron estudios en población con antecedentes de disfagia, necesidad de intubación, presencia de enfermedad neurológica, neuromuscular o respiratoria, entre otros. Los resultados de los estudios muestran que la CNAF podría disminuir el número de degluciones (en flujos ≥ 20 L/min; p<0,05),disminuir el tiempo medio de activación de la respuesta deglutoria proporcional al flujo empleado (p<0,05), incrementar el riesgo aspirativo en flujos altos (>40 L/min, p<0,05) e incrementar en promedio la duración del cierre del vestíbulo laríngeo (p<0,001). La VNI modo BiPAP, por su parte, podría aumentar el riesgo aspirativo debido al incremento en la tasa de inspiración post deglución (SW-I, p<0,01). Si bien la evidencia disponible es limitada, los resultados aportan información relevante a considerar en el abordaje de usuarios que utilicen estos dispositivos ventilatorios. Futuras investigaciones deberían ser desarrolladas para fortalecer la evidencia presentada.

Deglutition requires adequatecoordination between breathing and swallowing. In the clinical context, the use of non-invasive ventilatory devices such as high-flow nasal cannulas(HFNC) or non-invasive ventilation (NIV) has become highlyrelevantin recent years. However, there is little information regarding howthese devices could interferewith the physiologyof deglutition. This study aimedto describe the impact of HFNC and NIV on swallowing physiology. To this end, aliterature review was carried out usingPubMed, Medline, Embase, Web of Science, Lilacs,and Scielo. Studies performed onpopulations≥18 years old where HFNC or NIV were used were included. Studies where thepopulation hada history of dysphagia, need for intubation, and presentedneurological, neuromuscular,or respiratory diseases, among others, were excluded. The results show that HFNC could decrease the swallowing rate(with flows≥ 20 L/min; p<.05), decrease the mean activation time of the swallowing reflex in proportion to the flow (p<.05), increase the risk of aspiration when usinghigherflows (>40 L/min, p<0.05),and increase the average duration of the laryngeal vestibuleclosure(p<.001).NIV, particularly BiPAP, could increase the risk of aspiration due to the higherrate of post-swallowing inspiration (SW-I, p<.01). Although the evidence available on this matter is limited, theseresults offerrelevant information that should beconsideredwhen working with patients who use these ventilatory devices. Furtherresearch should be carriedoutto strengthen the evidence that is provided in this study.

Profile of oropharyngeal dysphagia patients in a teaching hospital in Northern Brazil: a descriptive cross-sectional study

SUMMARY OBJECTIVE: The aim of this study was to describe the profile of patients with oropharyngeal dysphagia in a teaching hospital in the public health system in northern Brazil. METHODS: This is a descriptive cross-sectional study. All procedures of this study were approved by the ethics committee. A convenience sample composed of participants aged >18 years, of both sexes, with any underlying pathology admitted to the medical clinic on exclusive oral feeding, alternatively enteral or gastric tube feeding (Gastrostomy), or associated by both routes, whose swallowing assessment was performed by a Speech-Language Pathologist. Data from the database/medical records were investigated from March 2020 to September 2021. RESULTS: The sample consisted of 44 patients diagnosed with oropharyngeal dysphagia, with a higher frequency of males (63.64%) aged over 60 years (70.45%). Almost half of the evaluated patients were diagnosed with neurological disorders (47.73%) and had dysphagia associated with other underlying diseases (31.82%). Excluding patients with neurological disorders, trauma/polytrauma, and respiratory disorders from the last group, some patients (11.36%) had two concomitant underlying diseases. CONCLUSION: According to the sample of this study, the profile of oropharyngeal dysphagia patients includes pneumonia, respiratory failure, bronchoaspiration, and the consequent need for ventilatory support.

Assessment of the Sensitivity of the Vocal Tract in Parkinson Disease by Nasal Video Endoscopy

Abstract Introduction Sensory deficits of the upper airways are common in people with Parkinson disease. Compounded by considerable deterioration of the swallowing function, these deficits may contribute to the elevated rates of morbidity and mortality among this population. Objective To examine the sensitivity of the vocal tracts of people with Parkinson disease using nasal videoendoscopy and to compare the results with paired controls. Methods The present was a prospective, observational, case-control study. Sensitivity assessments were conducted in a sample of 24 people divided into 2 groups: one group of 12 patients with Parkinson's disease, and a control group with 12 healthy subjects. The study group also underwent a fiberoptic endoscopic evaluation of swallowing and answered the Swallowing Disturbance Questionnaire (SQD) to detect dysphagia. Results There was a significant difference (p < 0.05) in the region of the arytenoid cartilages, showing that sensitivity was better preserved among the control group, and that sensitivity deficits were present in the study group. The qualitative results showed sensorial impairment in the study group than in the control group regarding the base of the tongue, the vestibular folds, and the vocal folds. The study group showed self-awareness regarding the deficits in the swallowing function, but there was no statistically significant association between swallowing function deficits and deterioration of sensorial function among them. Conclusions Sensorial deficits were present in the study group when compared to the healthy subjects, mainly in the qualitative evaluation.

Características de deglutição e ingestão oral pré e pós acompanhamento fonoaudiológico de pacientes traqueostomizados internados em um hospital universitário / Swallowing characteristics and oral intake before and after speech therapy follow-up of tracheostomized patients admitted to a university hospital / Características de deglución e ingesta oral antes y después del seguimiento logopédico de pacientes traqueostomizados ingresados en un hospital universitario

Introdução: A traqueostomia pode impactar na deglutição e gerar alterações neurofisiológicas e mecânicas. Objetivo: Analisar a funcionalidade da deglutição em pacientes traqueostomizados internados em um hospital universitário, pré e pós intervenção fonoaudiológica por meio da análise de protocolos do serviço ­ Protocolo Adaptado (base na escalaFOIS e Protocolo de Avaliação do Risco para Disfagia ­ PARD). Método: Estudo transversal, retrospectivo, analítico observacional, de abordagem quantitativa. Analisados 114 protocolos de avaliação da deglutição, verificou-se o grau de disfagia conforme a classificação de O'Neile escala FOIS em um período de quatro anos. Pesquisa aprovada pelo Comitê de Ética em Pesquisa da Instituição (29894920.5.0000.5349). Resultados: Após analisados os protocolos constataram-se que a maioria era do sexo masculino com média de idade de 54,55 anos. Observou-se a predominância das seguintes comorbidades prévias de saúde: pneumonia, hipertensão arterial sistêmica e acidente vascular encefálico isquêmico. Após o acompanhamento fonoaudiológico houve melhora da biomecânica da deglutição com mais pacientes apresentando deglutição funcional ­ um (0,9%) para 12 (10,5%), redução do número de sujeitos com disfagia grave ­ 32 (28,1%) para 17 (14,9%) e maior ingestão por via oral ­ 79 (69,3%) dos pacientes aumentaram o nível de ingestão oral conforme a escala FOIS. A maior parte da amostra apresentou boa tolerância à oclusão de traqueostomia e 60 (52,6%) progrediram para decanulação. Conclusão: A presença da traqueostomia impactou sobre a funcionalidade da deglutição, pois a maioria dos pacientes possuía algum grau de disfagia. Ressalta-se a importância da atuação fonoaudiológica no processo de reabilitação da deglutição, auxiliando no processo de decanulação.

Introduction: Tracheostomy may impact swallowing and generate neurophysiological and mechanical alterations. Objective: To analyze the swallowing functionality in tracheostomized patients admitted to a university hospital, before and after speech-language therapy intervention through the analysis of the service protocols - Adapted Protocol (based on the FOIS scale and Dysphagia Risk Assessment Protocol - PARD). Method: Cross-sectional, retrospective, analytical observational study, with a quantitative approach. We analyzed 114 swallowing assessment protocols, and checked the degree of dysphagia according to O'Neil's classification and FOISscale over a four-year period. Research approved by the Institution's Research Ethics Committee (29894920.5.0000.5349). Results: After analyzing the protocols it was found that the majority were male with a mean age of 54.55 years. A predominance of the following previous health comorbidities was observed: pneumonia, systemic arterial hypertension and ischemic stroke. After the speech-language therapy follow-up there was an improvement in swallowing biomechanics with more patients presenting functional swallowing - one (0.9%) to 12 (10.5%), reduction in the number of subjects with severe dysphagia - 32 (28.1%) to 17 (14.9%) and greater oral intake - 79 (69.3%) of the patients increased the level of oral intake according to the FOIS scale. Most of the sample showed good tolerance to tracheostomy occlusion and 60 (52.6%) progressed to decannulation. Conclusion: The presence of a tracheostomy had an impact on swallowing functionality, since most patients had some degree of dysphagia. We emphasize the importance of speech therapy in the swallowing rehabilitation process, helping in the decannulation process.

Introducción: La traqueotomía puede afectar la deglución y generar cambios neurofisiológicos y mecánicos. Objetivo: Analizar la funcionalidad de la deglución en pacientes traqueostomizados ingresados en un hospital universitario, antes y después de la intervención logopédica mediante el análisis de protocolos de servicio - Protocolo Adaptado (basado en la escala FOIS y Protocolo de Evaluación de Riesgos para Disfagia - PARD). Método: Estudio observacional analítico, transversal, retrospectivo, con enfoque cuantitativo. Tras analizar 114 protocolos de evaluación de la deglución, se verificó el grado de disfagia según la clasificación de O'Neil y la escala FOIS durante un período de cuatro años. Investigación aprobada por el Comité de Ética en Investigación de la Institución (29894920.5.0000.5349). Resultados: Tras analizar los protocolos, se encontró que la mayoría eran varones con una edad media de 54,55 años. Predominaron las siguientes comorbilidades de salud previas: neumonía, hipertensión arterial sistémica e ictus isquémico. Después del seguimiento de logopedia, hubo una mejora en la biomecánica de la deglución, con más pacientes presentando deglución funcional - uno (0,9%) a 12 (10,5%), una reducción en el número de sujetos con disfagia severa - 32 (28,1%) %) a 17 (14,9%) y mayor ingesta oral - 79 (69,3%) de los pacientes aumentaron el nivel de ingesta oral según la escala FOIS. La mayor parte de la muestra mostró buena tolerancia a la oclusión de la traqueotomía y 60 (52,6%) progresaron a decanulación. Conclusión: La presencia de traqueotomía repercutió en la funcionalidad de la deglución, ya que la mayoría de los pacientes presentaba algún grado de disfagia. Enfatiza la importancia de la logopedia en el proceso de rehabilitación de la deglución, ayudando en el proceso de decanulación.

Protocols and assessment procedures in fiberoptic endoscopic evaluation of swallowing: an updated systematic review / Protocolos e procedimentos de avaliação em endoscopia da deglutição: uma revisão sistemática atualizada

Abstract Introduction Neurological alterations can generate swallowing disorders and fiberoptic endoscopic evaluation of swallowing is one of the tests performed for its diagnosis, as well as assistance in dysphagia management. Objective To identify and describe a fiberoptic endoscopic evaluation of swallowing standardized protocol for the neurological adult population and its stages. Methods Systematic review registered on the PROSPERO platform (CRD42018069428), carried out on the websites: MEDLINE, Cochrane Library and Scielo; published between 2009 and 2020. Randomized clinical trials, cross-sectional, and longitudinal studies were included. Two independent judges evaluated the study design and extracted the data from the selected studies. Doubts regarding inclusion or not of the studies were evaluated by a third judge. Scientific articles included were those with adult neurological remained patients with outcomes: (1) diagnosis of swallowing disorder (2) change in sensitivity in laryngeal region (3) penetration of food offered (4) aspiration of food offered. Results 3724 articles were initially selected, after personalized search for patients with neurological alterations 101 studies remained. In the end, 21 qualitative studies from 2009 to 2020 remained in the systematic review and they were described in detail and compared. Seven articles used protocols of the institutions in which the research took place and four mentioned using the same protocol. The reliable reproducibility of the protocols is feasible only in three of the articles, even presenting different protocols. Conclusion There is no standard or validated protocol to assess the swallowing function of adults with neurological diseases.

Resumo Introdução As alterações neurológicas podem gerar distúrbios deglutitórios e a videoendoscopia da deglutição é um dos exames feitos para o seu diagnóstico e auxílio no manejo da disfagia. Objetivo Identificar e descrever o protocolo para videoendoscopia da deglutição padronizado para a população adulta com transtornos neurológicos e suas etapas. Método Revisão sistemática registrada na plataforma Prospero (CRD42018069428), realizada nos sites: Medline, Cochrane Library e Scielo; publicados entre 2009 e 2020. Foram incluídos ensaios clínicos randomizados, estudos transversais e longitudinais. Dois avaliadores independentes analisaram o delineamento do estudo e extrairam os dados dos estudos selecionados. As dúvidas de inclusão ou não dos estudos foram avaliadas por um terceiro avaliador. Artigos científicos incluídos englobam pacientes adultos neurológicos. Os desfechos avaliados: 1) diagnóstico de distúrbio deglutitório ou disfagia; (2) alteração de sensibilidade em região laríngea; (3) penetração laríngea do bolo alimentar ofertado; (4) aspiração traqueal do bolo alimentar ofertado. Resultados Foram selecionados inicialmente 3.724 artigos, após busca personalizada para pacientes com alterações neurológicas permaneceram 101 estudos. Ao final, 21 estudos qualitativos de 2009 a 2020 permaneceram na revisão sistemática e foram descritos detalhadamente e comparados. Sete estudos usaram protocolos das instituições promotoras e quatro citaram usar o mesmo protocolo. A reprodutibilidade fidedigna dos protocolos é viável apenas em três dos artigos, mesmo com protocolos diferentes. Conclusões Não há protocolo padronizado ou validado para avaliar a deglutição da população adulta neurológica.

Oropharyngeal dysphagia telerehabilitation in the Intensive Care Unit for COVID-19: a case report

ABSTRACT The face-to-face assessment of and training for dysphagia are considered aerosol-generating procedures, and thus are contraindicated for patients who are positive or suspected of having severe acute respiratory syndrome coronavirus 2 infection. Considering the extremely infectious nature of the virus, transmission to other individuals during rehabilitation is possible. Some patients in the intensive care unit and those who are on endotracheal intubation and mechanical ventilation often have dysphagia. Therefore, assessment and training for oropharyngeal dysphagia are provided by rehabilitation professionals to restore normal feeding before patient discharged. Thus, we aimed to explore the advantages of telerehabilitation in dysphagia management during the coronavirus disease 2019 (COVID-19) pandemic. An infected 50-year-old man admitted to the hospital underwent extracorporeal membrane oxygenation rescue therapy and tracheostomy. Upon gradual respiratory status stabilization, extracorporeal membrane oxygenation therapy was discontinued, and he was weaned off the ventilator. He had difficulty swallowing and coughed after attempting to drink fluids. We considered the application of telerehabilitation for managing dysphagia while minimizing the risk of infection and usage of personal protective equipment. A videoconferencing software on a tablet device provided contactless telerehabilitation, thus reducing the risk of infection and preventing personal protective equipment shortage. Moreover, it facilitates discussion on the issues related to the evaluation of oropharyngeal dysphagia telerehabilitation. We highlight important considerations for the application of telerehabilitation in the assessment and treatment of dysphagia during the COVID-19 pandemic.

Kinematic measures of swallowing obtained with ultrasound: a scoping review protocol / Medidas cinemáticas da deglutição obtidas por ultrassonografia: um protocolo de revisão de escopo

ABSTRACT Purpose: to identify and synthesize scientific evidence on kinematic measures of swallowing obtained with ultrasound. Methods: a protocol following the methodology proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). The search will be made in PubMed/MEDLINE, Scopus, Web of Science, LILACS, ScienceDirect, Embase, and Google Scholar, using a search strategy developed for PubMed/MEDLINE, which will be adapted for each database. Articles will be initially screened by title and abstract by two independent reviewers who will read their full text according to the eligibility criteria. Data in included articles will be extracted by means of a standardized form and the results presented in a flowchart and narrative summary. Final Considerations: once carried out, this protocol will present the state-of-the-art on the research topic and help better understand the possibilities to quantitatively analyze swallowing through ultrasound.

RESUMO Objetivo: identificar e sintetizar as evidências científicas sobre medidas cinemáticas da deglutição obtidas por ultrassonografia. Métodos: este protocolo seguiu a metodologia proposta pelo Joanna Briggs Institute (JBI) e as diretrizes para elaboração de revisões de escopo do Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). As bases de dados eletrônicas pesquisadas serão: PubMed/Medline, Scopus, Web of Science, Lilacs, ScienceDirect, Embase e Google Scholar. Uma estratégia de busca foi desenvolvida para PubMed/Medline, que será adaptada para cada base de dados. Inicialmente, os artigos serão rastreados pelo título e resumo por dois revisores independentes. Em seguida, farão a leitura do texto completo dos artigos de acordo com os critérios de elegibilidade. Os dados serão extraídos dos artigos incluídos por meio de formulário padronizado. Os resultados serão apresentados em fluxograma e resumo narrativo. Considerações Finais: a execução deste protocolo apresentará o estado da arte sobre o tema pesquisado e contribuirá para a melhor compreensão das possibilidades de análise quantitativa da deglutição por meio da ultrassonografia.

Fatores associados a fragilidade em pacientes com doenças neurodegenerativas / Factors associated with frailty in patients with neurodegenerative diseases

RESUMO Objetivo Identificar os fatores associados à fragilidade em pacientes com doenças neurodegenerativas. Método Estudo transversal, cuja amostra foi composta por 150 pacientes com diagnóstico de doenças neurodegenerativas atendidos em um ambulatório de Fonoaudiologia de um hospital de referência no sul do Brasil. Foi realizada análise secundária exploratória dos prontuários dos pacientes atendidos neste ambulatório entre o período de abril de 2016 e maio de 2019. As informações coletadas foram: sexo, idade, escolaridade, tipo de doença neurodegenerativa, tempo de doença, fragilidade (Edmonton Frail Scale - EFS), deglutição (Northwestern Dysphagia Patient CheckSheet- NDPCS, Eating Assessment Tool-EAT 10) e cognição (Mini-Mental State Examination-MMSE e Montreal Cognitive Assessment-MoCA). As variáveis quantitativas contínuas foram analisadas a partir de média e desvio padrão e as quantitativas categóricas a partir de frequência absoluta e relativa, assim como analisou-se a associação destas com o desfecho pelo teste Qui-Quadrado. As Razões de Prevalência brutas e ajustadas foram avaliadas a partir da Regressão de Poisson com variância robusta. Todos os testes estatísticos foram considerados significativos a um nível de 5%. Resultados Os fatores significativos associados à fragilidade foram à presença de disfagia orofaríngea e desempenho cognitivo alterado. Indivíduos com a fragilidade apresentam maior prevalência de disfagia orofaríngea (RP=1,772(1,094-2,872)), enquanto a cognição alterada está associada a menor prevalência de fragilidade (RP=0,335(0,128-0,873). Conclusão A disfagia orofaríngea pode ser um importante fator clínico preditivo a ser considerado em casos de fragilidade em pacientes com doenças neurodegenerativas.

ABSTRACT Purpose To identify the factors associated with frailty in patients with neurodegenerative diseases. Methods Cross-sectional study, whose sample consisted of 150 patients diagnosed with neurodegenerative diseases seen at a speech-language therapy clinic in a reference hospital in southern Brazil. A secondary exploratory analysis of the medical records of patients treated at this clinic between April 2016 and May 2019 was performed. The information collected was sex, age, education, type of neurodegenerative disease, time of disease, frailty (Edmonton Frail Scale-EFS), swallowing (Northwestern Dysphagia Patient CheckSheet-NDPCS, Eating Assessment Tool-EAT 10), and cognition (Mini-Mental State Examination-MMSE and Montreal Cognitive Assessment-MoCA). Continuous quantitative variables were analyzed using mean and standard deviation and categorical quantitative variables from absolute and relative frequency, as well as their association with the outcome using the Chi-square test. Crude and adjusted Prevalence Ratios were assessed using Poisson regression with robust variance. All statistical tests were considered significant at a level of 5%. Results The significant factors associated with frailty were the presence of oropharyngeal dysphagia and altered cognitive performance. Individuals with frailty have a higher prevalence of oropharyngeal dysphagia (PR= 1.772(1.094-2.872)), while cognition alteration presented a lower prevalence (PR= 0.335(0.128-0.873). Conclusion Oropharyngeal dysphagia can be an important clinical predictive factor for consideration in cases of frailty in patients with neurodegenerative diseases.

Efeitos dos exercícios vocais no tratamento da disfagia: revisão integrativa / Effects of vocal exercises on the treatment of dysphagia: integrative review

RESUMO Objetivo verificar as evidências disponíveis sobre o efeito dos exercícios vocais no tratamento da disfagia. Estratégia de pesquisa foi realizado levantamento bibliográfico nas bases de dados PubMed, LILACS, SciELO e MEDLINE, sem restrições quanto ao período de publicação. Critérios de seleção artigos originais, estudos de caso e/ou revisões de literatura publicados nos idiomas português e/ou inglês, disponíveis eletronicamente na íntegra e que abordassem o tratamento clínico com exercícios vocais em adultos e idosos com disfagia. Foram excluídas publicações repetidas nas bases de dados, com população de crianças, com indivíduos que não apresentassem o diagnóstico de disfagia, com exercícios vocais sem especificação, com exercícios exclusivos de deglutição, artigos e/ou resumos sem possibilidade de acesso pelas plataformas institucionais e estudos com modelo animal. Resultados foram encontrados 2.356 artigos, dos quais, após aplicados os critérios de elegibilidade, foram selecionados 8 para a amostra final. Para avaliar os efeitos dos exercícios vocais, os estudos utilizaram avaliação clínica, videofluoroscopia, videoendoscopia e eletromiografia. Quanto aos efeitos dos exercícios vocais na deglutição, observou-se que as técnicas de som plosivo, empuxo, trato vocal semiocluído, som basal, modulação vocal, sobrearticulação, o método Lee Silverman Voice Treatment® e o uso de exercícios de treino de força muscular expiratória apresentaram efeitos positivos na reabilitação da disfagia. Conclusão os estudos com treino de força muscular expiratória, o método Lee Silverman e os exercícios vocais tradicionais demonstraram efeitos positivos no tratamento da disfagia. No entanto, ainda não foi possível comprovar o nível de evidências de todos os estudos.

ABSTRACT Purpose To verify the available evidence on the effect of vocal exercises on the treatment of dysphagia. Research strategy A bibliographic survey was carried out in the PubMed, LILACS, SciELO and MEDLINE databases, with no restrictions on the publication period. Selection criteria Original articles, case studies and/or literature reviews published in Portuguese and/or English, available electronically in full and addressing clinical treatment with vocal exercises in adults and elderly with dysphagia. Publications repeated by the databases, with a population of children, individuals who did not present the diagnosis of dysphagia, with vocal exercises without specification, with exclusive swallowing exercises, articles and/or abstracts without the possibility of access by institutional platforms, and studies with animal model were excluded. Results A total of 2,356 articles were found, of which, after the eligibility criteria were applied, 08 were selected for the final sample. To evaluate the effects of vocal exercises, the studies used clinical evaluation, videofluoroscopy, videoendoscopy and electromyography. Regarding the effects of vocal exercises on swallowing, it was observed that the techniques of plosive sound, buoyancy, semi-occluded vocal tract, basal sound, vocal modulation, overarticulation, the Lee Silverman Voice Treatment method® and the use of expiratory muscle strength training exercises showed positive effects in the rehabilitation of dysphagia. Conclusion It was observed that studies with expiratory muscle strength training (EMST), Lee Silverman method (LSVT®) and traditional vocal exercises demonstrated positive effects in the treatment of dysphagia. However, it has not yet been possible to prove the level of evidence in all studies.

Decannulation: a retrospective cohort study of clinical and swallowing indicators of success

Abstract Objective: To investigate the clinical and swallowing indicators related to a successful decannulation process during the hospital stay. Methods: A retrospective cohort clinical study. The study sample comprised a heterogeneous patient population who had submitted to a tracheostomy procedure in a tertiary hospital. Patients were divided into two groups (dec-annulated vs. non-decannulated) and compared not only in terms of demographic and clinical data but also the results of a swallowing assessment and intervention outcome. Results: Sixty-four patients were included in the present study: 25 (39%) who had been successfully decannulated, and 39 (61%) who could not be decannulated. Between-group comparisons indicated that both groups presented similar clinical and demographic characteristics. The groups also presented similar swallowing assessment results prior to intervention. However, significant differences were observed regarding the time to begin swallowing rehabilitation. The decannulated group was assessed nine days earlier than the non-decannulated group. Other significant differences included the removal of the alternate feeding method (72.0% of decannulated patients vs. 5.1% of non-decannulated patients) and the reintroduction of oral feeding (96.0% of decannulated patients vs. 41.0% of non-decannulated patients) and functional swallowing level at patient disclosure. The non-decannulated patient group presented higher death rates at disclosure. Conclusion: The results of the present study indicated that the following parameters were associated with a successful decannulation process: early swallowing assessment, swallowing rehabilitation, and improvement in the swallowing functional level during the hospital stay. The maintenance of low swallowing functional levels was found to be negatively associated with successful decannulation. HIGHLIGHTS Deccanulation indicators were investigated in patients who were submitted to a tracheostomy procedure. Early swallowing evaluation and rehabilitation were associated with a successful decannulation process. Low swallowing functional levels were negatively associated with the success of decannulation.

Citations of Brazilian manuscripts published in the journal Dysphagia from 2001 to 2020 / Citações dos trabalhos brasileiros publicados na revista Dysphagia de 2001 a 2020

ABSTRACT Purpose: to compare the number of citations in papers conducted in Brazil and published in the journal Dysphagia between 2001 and 2020 with that of papers conducted in other countries and published in the same number, volume, and year. Methods: in September 2021, the study assessed the number of citations received by Brazilian papers (n = 34) and reference group papers - which counted two for every Brazilian one (n = 68), published in the same number, volume, and year, between 2001 and 2020. Results: Brazilian papers published in the period had a lower mean number of citations (14.6) than those in the reference group (23.1, p = 0.01). From 2001 to 2010, the mean number of citations in the reference group (31.1) was greater than that of the Brazilian papers (16.7, p = 0.03), though not between 2011 and 2020 (Brazilians: 13.1, reference group: 17.5, p = 0.23). Two Brazilian papers (5.9%) and 18 from other countries (26.5%) received more than 30 citations between 2001 and 2020. Conclusion: the results suggest that the number of citations received by Brazilian papers is not influenced by the time since they have been published, unlike the papers in the reference group.

RESUMO Objetivo: comparar o número de citações de trabalhos realizados no Brasil e publicados na revista Dysphagia entre os anos de 2001 e 2020, com o de trabalhos realizados em outros países e publicados no mesmo número, volume e ano. Métodos: foi avaliado, em setembro de 2021, o número de citações dos trabalhos brasileiros (n=34) e de um grupo de referência com dois trabalhos para cada trabalho brasileiro (n=68), publicados no mesmo número, volume e ano, entre 2001 e 2020. Resultados: os trabalhos brasileiros publicados no período tiveram menor média de citações (14,6) quando comparados com os trabalhos do grupo de referência (23,1, p=0,01). A média de citações do grupo de referência (31,1) foi maior do que a dos brasileiros (16,7) no período 2001 a 2010 (p=0,03), mas não no período 2011 a 2020 (brasileiros: 13,1, grupo de referência: 17,5, p=0,23). Dois trabalhos brasileiros (5,9%) e 18 trabalhos de outros países (26,5%) tiveram mais de 30 citações no período 2001 a 2020. Conclusão: os resultados sugerem que no número de citações dos trabalhos realizados no Brasil não há influência do tempo em que os trabalhos estão publicados, o que foi observado nos trabalhos do grupo de referência.