Case report: the management of a patient with severe malnutrition and swallowing disorder with the involvement of nutrition support nurses / 中华临床营养杂志

Nutrition support nurse specialists play an important role in clinical management of patients with malnutrition and swallowing disorders. Here is the case report where nutrition support nurses were engaged in the whole course management of an elderly patient with severe malnutrition and swallowing disorder, including the early assessment, the multidisciplinary team intervention, and rehabilitation. With this case as well as related literature, the practice of the early intervention, dynamic whole course management, and the role of nutrition support nurses were discussed.

Alterations in deglutition in children with congenital Zika virus syndrome / Alterações na deglutição em crianças com síndrome congênita do vírus Zika

ABSTRACT Purpose To characterize swallowing in children with congenital Zika virus syndrome in comparison to typical children. Methods This cross-sectional study enrolled 45 children diagnosed with congenital Zika virus syndrome and 45 others with typical development. Swallowing was evaluated through clinical feeding evaluations Protocolo de Avaliação Clínica da Disfagia Pediátrica and using acoustic swallowing parameters (Doppler sonar). Results The mean age of children with congenital Zika virus syndrome was 26.69 ± 4.46 months and the mean head circumference was 29.20 ± 1.98 cm. Moderate/severe oropharyngeal dysphagia was found in 32(71.1%) of the children with congenital Zika virus syndrome. Significant differences were found between the groups on clinical evaluation: Children with congenital Zika virus syndrome presented insufficient lip closure 42(93.3%) and altered tonus of the tongue 35(77.8%) and cheeks 34(75.6%). In the children in the comparison group, only 6(13.3%) presented insufficient lip closure and 1(2.2%) had inadequate tongue posture. Changes during swallowing with liquid and spoonable food were not observed in the comparison group. When liquid/food was offered, affected children presented difficulties in sipping movements 14(77.8%) and lip/spoon contact 35(75%). The presence of residual food in the oral cavity after swallowing 38(86.4%) and clinical signs indicative of laryngotracheal penetration/aspiration, such as coughing, gagging and/or labored breathing, were also notable. No differences were found between the groups with regard to the acoustic parameters evaluated instrumentally. Conclusion Children with congenital Zika virus syndrome present alterations in the oral phase of swallowing, as well as clinical signs indicative of pharyngeal phase impairment.

RESUMO Objetivo Caracterizar a deglutição das crianças com síndrome congênita do Zika vírus e comparar com crianças típicas. Método Estudo de delineamento transversal, com 45 crianças diagnosticadas com síndrome congênita do Zika vírus e 45 típicas. A deglutição foi avaliada por meio de avaliações clínicas da alimentação através do Protocolo de Avaliação Clínica da Disfagia Pediátrica e dos parâmetros acústicos da deglutição (sonar Doppler). Resultados A idade média das crianças com síndrome congênita do vírus Zika foi de 26,69 ± 4,46 meses e o perímetro cefálico médio foi de 29,20 ± 1,98 cm. Disfagia orofaríngea de moderada a grave foi observada em 32(71,1%) das crianças com síndrome congênita do Zika vírus, ao contrário do grupo comparação que não revelou alterações na deglutição. Nas crianças com síndrome congênita do Zika vírus foram verificados lábios entreabertos 42(93,3%) e tônus alterado em língua 35(77,8%) e bochechas 34(75,6%). Nas crianças do grupo comparação apenas 6(13,3%) apresentaram fechamento labial insuficiente e 1(2,2%) postura de língua inadequada. Alterações durante a deglutição com líquido e alimento pastoso não foram observadas no grupo comparação. Durante a oferta do alimento ocorreram dificuldades no movimento de sorver 14(77,8%), na captação da colher 35(75%), resíduo em cavidade oral 38(86,4%) e sinais clínicos indicativos de penetração/aspiração laringotraqueal como tosse, engasgo e respiração com esforço. Não foram encontradas diferenças nos parâmetros acústicos da avaliação instrumental. Conclusão as crianças com síndrome congênita do Zika vírus têm alterações nas fases oral e faríngea da deglutição, com sinais clínicos indicativos de penetração/aspiração laringotraqueal quando comparadas a crianças típicas.

Oropharyngeal Dysphagia in Mucopolysaccharidoses: Evidence from Videofluoroscopic Swallowing Study

Abstract Mucopolysaccharidoses (MPS) are rare inborn errors of metabolism, leading to the accumulation of glycosaminoglycans (GAG) in distinct tissues. We investigated oropharyngeal dysphagia using the videofluoroscopic swallowing study (VFSS) in patients with different MPS types. Since there is a lack of studies systematically evaluating this disorder in this population, the use of a standard technique should contribute to better evaluate individuals with MPS. A cross-sectional and observational study enrolling patients followed by an outpatient service for lysosomal diseases at the Genetics Service of the Hospital de Clínicas de Porto Alegre (SGM/HCPA) was conducted. Patients underwent semi-structured interviews, clinical evaluation and VFSS. Nineteen patients were evaluated, including patients with MPS types I (16%), II (42%), IIIb (10%) and IVa (32%). Nearly all patients (95%) presented with oropharyngeal dysphagia in the VFSS. The most frequent findings were impaired chewing during oral phase (94%) and reduced laryngeal elevation in the pharyngeal phase (72%). Oropharyngeal dysphagia constituted a prevalent symptom in the studied cohort regardless of MPS type. Our data reinforces the notion that this disorder should be objectively assessed since it can significantly compromise the nutrition and the hydration of these patients as well as lead to tracheobronchial aspiration, thus resulting in aspiration pneumonia and even death eventually.

Análise da mastigação e deglutição na paralisia cerebral com deficiência visual: estudo de caso / Analysis of chewing and swallowing in cerebral palsy with a visual impairment: study of case / Análisis de la masticación y la deglución en la parálisis cerebral con discapacidad visual: un estudio de caso

Introdução: A Paralisia Cerebral pode acarretar alterações em qualquer uma das fases da deglutição, causando uma disfagia neurogênica. No entanto, desordem neurológica e deficiência visual associada é um tema pouco estudado. A criança com a ausência do canal visual, geralmente tem pouca noção na estrutura do espaço e até mesmo em relação à sua estrutura corporal e organizacional. É sabido que a Paralisia Cerebral discorre atrasos no padrão mastigatório e da deglutição, mas questiona-se se a deficiência visual pode interferir ou não neste desempenho. Objetivo: O propósito deste estudo foi analisar as funções de mastigação e o tempo de deglutição em criança com paralisia cerebral e deficiência visual associada. Método: Esta pesquisa é de natureza exploratória e descritiva, desenvolvida por meio de um estudo de caso clínico de uma criança com paralisia cerebral e deficiência visual associada. Três consistências de alimento foram examinadas: líquido (suco), pastosa (iogurte) e sólido (pão), sendo cronometrado o tempo gasto para deglutir cada uma delas, durante o horário normal de alimentação. Resultados: os resultados mostraram que a criança com Paralisia Cerebral e Deficiência Visual apresenta dificuldades na função de mastigação e leva mais tempo para deglutir nas consistências sólida e líquida. Conclusão: A deficiência visual associada à paralisia cerebral pode acentuar na dificuldade das funções de mastigação e deglutição.

Introduction: Cerebral Palsy can cause changes in any of the phases of swallowing, causing neurogenic dysphagia. However, neurological disorder and associated visual impairment is a poorly studied topic. The child with the absence of the visual channel, generally has little idea of the structure of the space and even of its body and organizational structure. It is known that Cerebral Palsy has delays in chewing and swallowing patterns, but it is questioned whether visual impairment can interfere or not in this performance. Objective: The purpose of this study was to analyze chewing functions and swallowing time in children with cerebral palsy and associated visual impairment. Method: This research is exploratory and descriptive in nature, developed through a clinical case study of a child with cerebral palsy and associated visual impairment. Three food consistencies were examined: liquid (juice), pasty (yogurt) and solid (bread), with the time spent swallowing each of them during the normal feeding time being timed. Results: the results showed that the child with Cerebral Palsy and Visually Impaired presents difficulties in chewing function and takes more time to swallow in solid and liquid consistencies. Conclusion: Visual impairment associated with cerebral palsy may accentuate the difficulty in chewing and swallowing functions.

Introducción: La parálisis cerebral puede provocar cambios en cualquiera de las fases de la deglución, provocando disfagia neurogénica. Sin embargo, el trastorno neurológico y la discapacidad visual asociada es un tema poco estudiado. El niño con ausencia del canal visual, generalmente tiene poca idea de la estructura del espacio e incluso de su cuerpo y estructura organizativa. Se sabe que la parálisis cerebral tiene retrasos en los patrones de masticación y deglución, pero se cuestiona si la discapacidad visual puede interferir o no en este desempeño. Objetivo: El propósito de este estudio fue analizar las funciones de masticación y el tiempo de deglución en niños con parálisis cerebral y discapacidad visual asociada. Método: Esta investigación es de naturaleza exploratoria y descriptiva, desarrollada a través de un estudio de caso clínico de un niño con parálisis cerebral y discapacidad visual asociada. Se examinaron tres consistencias de alimentos: líquido (jugo), pastoso (yogur) y sólido (pan), y se pasó el tiempo de deglución de cada uno de ellos durante el tiempo normal de alimentación. Resultados: los resultados mostraron que el niño con parálisis cerebral y deficiencia visual tiene dificultades en la función de masticación y toma más tiempo para tragar en forma sólida y líquida. Conclusión: la discapacidad visual asociada con la parálisis cerebral puede acentuar la dificultad en las funciones de masticación y deglución.

Miositis por cuerpos de inclusión esporádica / Sporadic inclusion body myositis

A pesar de ser la miopatía primaria más frecuente en hombres mayores de 50 años de edad, la miositis por cuerpos de inclusión (MCI) esporádica es una enfermedad rara. En muchas ocasiones su diagnóstico es retrasado por lo que se refuerza la importancia de una adecuada valoración clínica e indicación oportuna de estudios complementarios. En el presente artículo se presenta un caso que tiene la distinción de presentarse en un paciente mestizo, sin afectación demostrada en flexores profundos de las manos y con elementos de gravedad, determinadas por la presencia de disfagia alta funcional y disnea a la posición de decúbito supino. En la revisión realizada no se recogen hasta el presente reportes en publicaciones de esta enfermedad en Cuba. Clínicamente, la afección se caracteriza por debilidad muscular combinada distal y proximal, electromiografía (EMG) con alteración mixta neuropática y miopática, y escasa respuesta a la terapia inmunosupresora. La biopsia de músculo ayuda a establecer el diagnóstico definitivo al demostrar la presencia de inclusiones distintivas en las fibras musculares. El pronóstico es sombrío al mostrar un comportamiento progresivo con afectación de la calidad de vida y llevar a una discapacidad física avanzada(AU)

Despite being the most common primary myopathy in men over 50 years of age, sporadic inclusion body myositis (ICM) is a rare disease. On many occasions its diagnosis is delayed, which is why the importance of an adequate clinical assessment and timely indication of complementary studies is reinforced. This article reports a case that has the peculiarity of affecting a mestizo patient, with no established involvement in the deep flexors of his hands and with elements of severity, determined by the presence of high functional dysphagia and dyspnea in the supine position. There have not been publication reports on this disease in Cuba. Clinically, the condition is characterized by combined distal and proximal muscle weakness, electromyography (EMG) with mixed neuropathic and myopathic impairment, and poor response to immunosuppressive therapy. Muscle biopsy helps establish the definitive diagnosis by demonstrating the presence of distinctive inclusions in the muscle fibers. The prognosis is bleak, showing progressive behavior affecting quality of life and leading to advanced physical disability(AU)

Rol del fonoaudiólogo en el tratamiento de la disfagia en usuarios con alta clínica por Covid-19: una revisión de literatura / Role of the speech therapist in the treatment of dysphagia in users with clinical discharge for COVID-19: a literature review

La enfermedad conocida como Covid-19fue declarada pandemia a principios del año 2020, atacando de manera sustancial el aparato respiratorio de los contagiados. La insuficiencia respiratoria progresiva generada por la enfermedad genera incluso, la muerte en los estados más graves de la enfermedad. Debido a esta alteración algunos pacientes pueden requerir ventilación mecánica. Muchas investigaciones relacionan la intubación con las disfagias. El fonoaudiólogo es quien ayuda en la rehabilitación de las alteraciones deglutorias, por lo que el objetivo de esta investigación fue revisar literatura especializada para recabar información sobre el papel del fonoaudiólogo en el tratamiento de la disfagia en pacientes con alta clínica por Covid-19.La metodología usada, definió una búsqueda específica en las bases de datos PubMed, Sciencedirect y en la Biblioteca Virtual de Salud (BSV). Se utilizó el término clave MeSH "Covid-19" luego el booleano de intersección "AND" y el término clave MeSH "Dysphagia" en seguida el booleano de intersección "OR" y el termino clave MeSH "Swallowing Disorder". Se encontraron un total de 42 artículos en distribuidos de la siguiente manera: PubMed (14), ScienceDirect (7), BSV (21). En la presente investigación solo fueron incluidos artículos correspondientes a estudios experimentales, cuasi experiméntales, estudios de casos, revisiones bibliográficas y ensayos clínicos donde se observa el papel del fonoaudiólogo en el trabajo de la disfagia en pacientes con alta clínica después de haber tenido Covid-19.Los resultados obtenidos relacionan la intubación prolongada a la disfagia, aunque los artículos hallados no son suficientes para realizar una generalización, sumado a que la calidad de los artículos encontrados no tienen el nivel de evidencia esperada, a pesar de eso, los resultados encontrados confirman al fonoaudiólogos especialistas en motricidad orofacial como un actor relevante tanto en la evaluación como en la intervención de pacientes que poseen disfagia debido a la intubación prolongada por Covid-19.

The disease known as Covid-19 was declared a pandemic at the beginning of 2020, substantially attacking the respiratory system of those infected. The progressive respiratory failure generated by the disease even leads to death in severe stages of the disease. Due to this alteration some users may require mechanical ventilation. Much research links intubation to dysphagia. The Speech Therapist is the one who helps in the rehabilitation of swallowing disorders, the objective of this research was to review specialized literature to gather information on the Role of the Speech Pathologist in the Treatment of Dysphagia in High Clinic Users due to (Covid-19).A specific search was carried out in the databases PubMed, Science direct and in the Virtual Health Library (BSV). The key term Mesh "Covid-19" was used then the intersection boolean "AND" and the key term Mesh "Dysphagia" then the intersection boolean "OR" and the key term Mesh "Swallowing Disorder". A total of 42 articles in distributed as follows: PubMed (14), ScienceDirect (7), BSV (21). In the present investigation only articles corresponding to experimental studies, quasi-experimental studies, case studies, bibliographic reviews were included, clinical trials, where the role of the speech therapist in the work of dysphagia in patients with clinical discharge after having had Covid-19 is observed.The results obtained relate prolonged intubation to dysphagia, although the articles found are not enough to make a generalization, added to the fact that the quality of the articles found does not have the expected level of evidence, despite that, the results found confirm the speech pathologist specializing in orofacial motor skills as a relevant actor both in the evaluation and in the intervention of users who have dysphagia due to prolonged intubation by Covid-19.

Pacientes pós-AVC com e sem trombólise: análise da deglutição na fase aguda da doença / Post-stroke patients with and without thrombolysis: analysis of deglutition in the acute phase of the disease

RESUMO Objetivo Verificar a frequência e a gravidade de disfagia pós-acidente vascular cerebral isquêmico na fase aguda com e sem trombólise e a associação entre a disfagia e as características demográficas, comprometimentos neurológico e funcional e a realização da trombólise. Método Estudo retrospectivo de análise de prontuário de 94 pacientes pós-acidente vascular cerebral isquêmico na fase aguda, destes, 52 pacientes realizaram trombólise e 42 não receberam o tratamento. Os dados coletados foram: idade, sexo, comorbidades, janela terapêutica para realização da trombólise, nível de consciência, grau de comprometimento neurológico, nível de dependência funcional, avaliação clínica da deglutição. Foram realizadas análise descritiva das variáveis categóricas e contínuas e análise de associação pelo teste Quiquadrado de Pearson, sendo consideradas como associações estatisticamente significantes as que apresentaram valor de p ≤ 0,05. Resultados A frequência de disfagia nos pacientes trombolizados foi de 67,3%. Os pacientes trombolizados apresentaram 4,6 vezes mais chance de apresentarem disfagia do que os pacientes não trombolizados. A gravidade da disfagia não apresentou associação com a realização da trombólise. Houve associação entre a presença de disfagia e a dependência funcional. As características demográficas e o comprometimento neurológico não apresentaram associação com o transtorno da deglutição. Conclusão Os pacientes trombolizados apresentaram maior tendência de desenvolverem disfagia do que os não trombolizados na fase aguda do acidente vascular cerebral, estando a disfagia associada à dependência funcional.

ABSTRACT Purpose To verify the frequency and severity of dysphagia after ischemic stroke with or without thrombolysis in the acute phase; and the association among dysphagia, demographic characteristics, neurological and functional impairments and thrombolysis. Methods A retrospective study of the medical records of 94 patients who suffered from ischemic stroke during the acute phase of the disease. From these, 52 patients received thrombolytic therapy and 42 patients did not receive such therapy. We collected data on age, sex, comorbidities, therapeutic time window of thrombolytic therapy, level of consciousness, degree of neurological impairment, level of functional dependency and clinical swallowing examination. A descriptive analysis included categorical and continuous variables, and an analysis of the association using the Pearson's Chi-Square Test, in which the value of p ≤ 0.05 was considered as a statistically significant association. Results The frequency of dysphagia in the thrombolytic patients was 67.3%, the odds ratio was 4.6 higher than the non-thrombolysed patients. The severity of dysphagia was not associated with thrombolysis. There was an association between the presence of dysphagia and functional dependence. Demographic characteristics and neurological impairment were not associated with dysphagia. Conclusion Thrombolytic patients were more likely to develop dysphagia than non-thrombolysed patients in the acute phase of stroke, with dysphagia associated to functional dependence.

Desidratação, acidente vascular cerebral e disfagia: revisão sistemática da literatura / Dehydration, stroke and dysphagia: systematic review

RESUMO Objetivos trata-se de revisão sistemática da literatura científica sobre a associação entre o acidente vascular cerebral, desidratação e disfagia orofaríngea. Estratégia de pesquisa o levantamento bibliográfico foi realizado nas bases de dados científicos: MEDLINE, LILACS, SciELO, Web of Science e Cochrane. Critérios de seleção foram incluídos os estudos que preencheram os seguintes critérios de inclusão: ser artigo original, com resumo disponível; ter sido publicado entre os anos de 2001 e 2018 e nos idiomas português, inglês ou espanhol; abordar o tema desidratação em indivíduos após acidente vascular cerebral. A triagem e análise dos estudos foram realizadas por dois avaliadores independentes. Resultados dentre os 484 artigos localizados para a triagem, 43 foram selecionados para leitura completa e 18 foram incluídos na análise final. Foram descritos diferentes métodos de avaliação do estado de hidratação nos indivíduos após acidente vascular cerebral, tais como: análise da relação BUN /creatinina, osmolaridade plasmática, relação ureia/creatinina, gravidade específica da urina, coloração da urina, ingestão hídrica, balanço hídrico, bioimpedância elétrica, avaliação clínica, análise de eletrólitos isolados. A prevalência de desidratação em pacientes após acidente vascular cerebral, durante a internação, variou de 11% a 66% e está associada à gravidade e piora na evolução clínica. Conclusão foi possível compreender a complexidade do processo de mensuração do estado de hidratação em indivíduos após acidente vascular cerebral e sua associação com a disfagia. Estudos enfocando essa temática são de extrema relevância, visto a sua influência sobre a taxa de mortalidade e morbidade nesta população.

ABSTRACT Purpose this is a systematic review of scientific literature associated with stroke, dehydration and oropharyngeal dysphagia (OD). Research Strategy bibliographic survey was conducted in scientific databases: MEDLINE, LILACS, SciELO, Web of Science and Cochrane. Selection criteria studies that met the following inclusion criteria were included: being original article with summary available; have been published in the last seventeen years (2001-2018) and in Portuguese, English or Spanish languages; and addressing dehydration in individuals after stroke Screening and analysis of the studies were performed by two independent evaluators. Results among the 484 articles found for screening, 43 were selected for full reading and 18 articles were included in the final analysis. Different methods of assessing hydration status have been described in individuals post-stroke, such as ratio analysis blood urea nitrogen (BUN)/creatinine, plasma osmolality, urea / creatinine, urine specific gravity, urine color, water intake, water balance, bioelectrical impedance analysis (BIA), clinical evaluation and analysis of electrolytes. The prevalence of dehydration in post-stroke during hospitalization varied from 11% to 66% and is associated with severity and deterioration in the clinical evolution. Conclusion It was possible to understand the complexity of the measurement of hydration status in individuals after stroke and its association with dysphagia. Studies focusing on the association between dehydration and stroke are very important, due to its influence on mortality and morbidity in this population.

Tratamiento endoscópico de una hendidura laríngea posterior: reporte de un caso y revisión de la literatura / Endoscopic treatment of a laryngeal cleft: case report and literature review

RESUMEN Las hendiduras laríngeas posteriores son anomalías congénitas de la laringe de baja incidencia que comprometen la región interaritenoidea o la lámina cricoidea. En caso de extenderse hasta la tráquea son denominados clefts laringo-tráqueo-esofágicos. Su clínica es inespecífica y debe sospecharse en todo niño con trastorno de deglución y neumonía aspirativa a repetición. A continuación, presentamos un caso de un cleft laríngeo tipo 2 tratado endoscópicamente.

ABSTRACT The posterior laryngeal clefts are congenital anomalies of the larynx of low incidence that comprise the interaritenoid region or the cricoid lamina. In case of extending to the trachea they are called laryngo-tracheo-esophagic clefts. Its clinic is non-specific and should be suspected in any child with swallowing disorder and aspiration pneumonia. We present a case of an endoscopically treated laryngeal cleft type 2.

Tempo de trânsito oral na demência de Alzheimer / Oral transit time in Alzheimer's disease

RESUMO Objetivo Avaliar o tempo de trânsito oral de alimento na consistência pudim, nos diferentes estágios da demência de Alzheimer. Métodos Estudo de caráter descritivo e observacional do tipo transversal, com uma amostra de 34 idosos com idade entre 65 e 98 anos, com demência de Alzheimer em diferentes estágios. Os participantes foram observados por avaliação de videofluoroscopia da deglutição, enquanto ingeriam alimento na consistência pudim, usando o programa de cronometragem Kinovea. Os dados foram analisados estatisticamente, em nível de significância de 5%. Resultados Os participantes com o Clinical Dementia Rating CDR 3 apresentaram maior tempo de trânsito oral, quando comparados àqueles com CDR 1, média de 3,09s (desvio padrão = 0,91) e 1,17s (desvio padrão = 1,10), respectivamente. Participantes na faixa etária de 90a 100 anos apresentaram maior tempo de trânsito oral do que os mais jovens, entre 60 e 79 anos, média de 3,90s e 1,28s. Conclusão Indivíduos com demência e idade avançadas apresentam tempo de trânsito oral aumentado para alimento na consistência pudim, devendo ser alvo de atenção de familiares e cuidadores.

ABSTRACT Purpose Evaluate oral transit time (OTT) with pudding consistency at the different stages of Alzheimer's disease (AD). Methods Descriptive, cross-sectional, observational study conducted with a sample of 34 elderly aged 65-98 years, with AD at different stages. Participants were observed using videofluoroscopy of swallowing while ingesting pudding consistency, using the Kinovea timing program. Data were statistically analyzed at 5% significance level. Results Participants with Clinical Dementia Rating - CDR 3 presented longer OTT compared with those with CDR 1, with means of 3.09 s (SD = 0.91) and 1.17 s (SD = 1.10), respectively. Individuals aged 90-100 years presented longer OTT than those aged 60-79 years, means of 3.90 s and 1.28 s, respectively. Conclusion Individuals with dementia and advanced aged present longer OTT for pudding consistency and should receive special attention from family members and caregivers.

Case of making maxillary palatal augmentation complete denture for patient with dysphagia after partial glossectomy

If complication arises after glossectomy which leads to trouble in forming food bolus or transfer of the food, it is possible that either food bolus may block the airway or dysphagia may occur as the food bolus goes down into the airway. To solve the issue, palatal augmentation prosthesis could be used. In this case, the patient with an oral cancer is having difficulties swallowing food after glossectomy. Through taking impressions of polishing surface of his denture referring his tongue movement, the complete denture for the upper jaw was created using the concept of palatal augmentation prosthesis. This new upper denture increases the palatal-tongue contact pressure, allowing the patient to perform better swallowing and better pronunciation.

Application of nursing-coordination-led multidisciplinary collaboration model in treatment of patients with post-stroke swallowing disorder / 现代临床护理

Objective To study the effect of nursing-coordination-led multidisciplinary collaboration model in the treatment of patients with post-stroke swallowing disorder. Methods About 120 patients who suffered from post-stroke swallowing disorder were randomly divided into two groups:60 patients in the multidisciplinary collaboration group and 60 patients in the control group. In the latter, the patients were treated with conventional deglutition treatment and rehabilitation care, and those in the former were treated on the multidisciplinary collaboration model. The two groups were compared in terms of swallow function, nutrition and physiologicalsituations before and one month after their treatment. Result The swallow function, nutrition and physiological situation in the collaboration group were significantly better than those of the control group (P<0.05). Conclusion The treatment on the nursing-coordination-led multidisciplinary collaboration can effectively improve the patients' swallow function and their nutrition conditions and alleviate the physiological pressure, which is good for their recovery.

Application of standard swallowing function assessment scale on extubation time for patients with nasal feeding / 现代临床护理

Objective To explore the effect of the standardized swallowing assessment (SSA) on extubation time for patients with nasal feeding. Methods One hundred patients with nasal feeding in our department from January 2013 to December 2014 were divided into the observation group and control group randomly with 50 in each group. The control group was treated with education on aspiratioin prevention and the right time for extubation was decided following doctor′s order. SSA was used in the observation group with weekly SSA and swallowing function, then the patients took pertinent functional exercises till a right time for extubation was decided. The two groups were compared in terms of incidences of re-intubation and aspiration pneumonia. Result The observation group had significantly lower incidences of re-intubation and aspiration pneumonia than the control one (P<0.01). Conclusions SSA is used to assess the swallowing function as well as the aspiration risks , which helps patients to take functional exercise and helps nurses to decide the right time for extubation. It can effectively lower the incidences of re-intubation and aspiration pneumonia and improve patients′prognosis.

Observation of Iced Rhizoma Coptidis Decoction Stimulation for Intervention of Post-stroke Swallowing Disorder / 广州中医药大学学报

Objective To observe the therapeutic effect of iced Rhizoma Coptidis decoction stimulation for post-stroke swallowing disorder. Methods Sixty-two post-stroke swallowing disorder patients admitted from June of 2012 to June of 2014 in Sanya Hospital of Traditional Chinese Medicine were enrolled into the study. The patients were evenly randomized into intervention group and control group. The control group was given conventional intervention and stomatological nursing with ice, and the intervention group was given conventional intervention and stomatological nursing with iced Rhizoma Coptidis decoction, once a day for 4 continuous weeks. After treatment, the therapeutic effect on swallowing disorder was evaluated, and the changes of scores of swallowing disorder before and after treatment were compared in the two groups. Results (1) The total effective rate of intervention group was 87.09%, and that of the control group was 67.74%, the difference being significant (P<0.05) . (2) After treatment, scores of swallowing disorder were increased in both groups (P<0.05 compared with those before treatment) , and the increase in the intervention group was superior to that in the control group ( P<0.05) . Conclusion Iced Rhizoma Coptidis decoction stimulation is effective on improving swallowing function of post-stroke swallowing disorder patients.

Clinical effect of sEMG-BFB training combined with swallowing training for dysphagic patients with cerebral infarction / 中国基层医药

Objective To investigate clinical effect of sEMG-BFB training combined with swallowing training for dysphagic patients with cerebral infarction,to provide a reference for life quality improvement of dysphagic patients.Methods 48 patients with cerebral infarction combined swallowing disorder were selected.According to the digital table,patients were divided into the control group and observation group,24 cases in each group.Patients in the control group were given training such as routine training and behavioral swallowing training,while patients in the observation group were given sEMG-BFB training based on training of the control group.FOIS score,Kubota's water drinking test grade,SSA score and SWAL-QOL score were compared between two groups.Results After treatment,FOIS score,SSA score and SWAL-QOL score of the observation group were (3.82 ± 1.04),(19.97 ± 8.17),(158.23 ± 10.27),which were significantly higher than those of the control group [(2.82 ± 1.21),(24.21 ± 6.31),(139.23±7.32),t =4.394,4.115,5.642,all P ＜ 0.05] ; Kubota's water drinking test grade of the observation group was better than the control group,the difference was statistically significant (U =283.43,P ＜ 0.05).Conclusion sEMG-BFB training combined with swallowing training is helpful for dysphagic patients with cerebral infarction to improve swallowing ability and life quality.

Development and Evaluation of an Enteral Nutrition Protocol for Dysphagia in Patients with Acute Stroke

PURPOSE: The study was done to develop an evidence-based enteral nutrition (EN) protocol for effective nutritional support for dysphagia in patients with acute stroke, and to evaluate effects of this protocol on clinical outcomes. METHODS: A methodological study was used to develop the EN protocol and a quasi-experimental study to verify the effectiveness of the protocol. The preliminary EN protocol was drawn by selecting recommendations from previous well-designed EN guidelines, and then developing additional recommendations based on high-quality evidence. Content validation was assessed by an expert group, and clinical applicability by care providers and patients. The scale-level content validity index of the final EN protocol was 0.99. Assessment was done of differences in percentage of caloric goals achieved and presence of undernutrition, aspiration pneumonia, and gastrointestinal (GI) complications after application of the EN protocol. RESULTS: In the EN protocol group, the percentage of caloric goals achieved (R2=.24, p=.001) and the reduction of GI complications (p=.045) were significantly improved, but the presence of undernutrition (p=.296) and aspiration pneumonia (p=.601) did not differ from the usual care group. CONCLUSION: Results indicate that the new EN protocol for dysphagia in patients with acute stroke significantly increased their nutritional intake and reduced GI complications.

Effectiveness of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Swallowing Disorders -A Systematic Review-

OBJECTIVE: The objective of this systematic review is to evaluate the safety and effectiveness of fiberoptic endoscopic evaluation of swallowing (FEES) for dysphagia patients. METHOD: We performed a systematic review of the literature. We searched Ovid-Medline(R), EMBASE(R) and Cochrane library(R) and Eight domestic databases including KoreaMed up to 19 April 2010. In addition, we added hand search. Searches were conducted without language restriction. We identified ten studies that met our eligibility criteria. Two reviewers independently extracted prespecified data from each study. Also reviewers assessed quality of each study. The qualities of these studies were assessed according to Scottish Intercollegiate Guidelines Network (SIGN) tool. RESULTS: Ten studies (nine diagnostic evaluation studies and one case series) were identified. The complication rate of FEES was 6% which was reported only one study as nose bleeding that did not need further treatment. The effectiveness of FEES was evaluated based on diagnostic accuracy, agreement rate with videofluoroscopy as a reference test. The sensitivities of FEES were 0.87~1.0 (penetration), 0.22~0.96 (aspiration), 0.68~0.91 (pharyngeal residue), and 0.75 (premature spillage) respectively. Specificities of FEES were 0.75~1.0 (penetration), 0.88~1.0 (aspiration), 0.86~1.0 (pharyngeal residue), and 0.56 (premature spillage) respectively. Agreement rate with VFFS were 85~100% (penetration), 82.3~100% (aspiration), 80~89.3% (pharyngeal residues), and 60.7% (premature spillage) respectively. There was no evidence of statistical heterogeneity. The body of evidence as a whole suggests a grade C for FEES. CONCLUSION: FEES is considered as a safe and effective test in patients with dyspahgia and grade C evidence based on existing studies.

Análise das manifestações clínicas da esofagite eosinofílica com a atopia / Analysis of clinical manifestations of eosinophilic esophagitis and atopy

A Esofagite Eosinofílica é um distúrbio clínico patológicoprimário do esôfago com sinais e sintomas relacionadosà esofagite, confirmado por biópsia da mucosa cominfiltrado eosinofílico e ausência da doença do refluxogastroesofágico. O objetivo deste estudo foi analisar asmanifestações clínicas da esofagite eosinofilica, associadascom atopia nos pacientes atendidos em Centro deGastroenterologia de Florianópolis. Foi realizado estudotipo caso-controle, analisados 72 pacientes com diagnósticode esofagite eosinofilica (grupo Caso) e 72 pacientesobtidos por sorteio aleatório (grupo Controle). Os dadosforam coletados nos prontuários e analisados e descritossob a forma de medidas de tendência central para variáveisquantitativas, e proporção para as variáveis qualitativas.O teste do qui-quadrado (?2) ou prova exata deFisher foram utilizados para testar a homogeneidade deproporções da amostra. O projeto foi aprovado pelo Comitêde Ética em Pesquisa da Universidade do Sul de SantaCatarina. O sexo masculino foi 6,5 vezes mais acometidoe a idade variou de 13 a 84 anos (média de 32 anos emediana de 38). A atopia foi estatisticamente significantee mais frequente (16 vezes) quando associada à esofagiteeosinofilica, sendo a asma a manifestação mais frequenteseguida pela rinite. No quadro clínico, os sintomasmais encontrados foram a disfagia (81,9%), regurgitação(16,7%) e pirose (16,7%). Como conclusão este estudodemonstrou que o sexo masculino foi o mais frequenteassociado à atopia em 48,6% dos Casos e a disfagia foi osintoma mais achado, ambos com significância estatística.

Eosinophilic esophagitis is a clinical disorder of theesophagus with primary pathological signs and symptomsof esophagitis, confirmed by biopsy of the mucosato have an eosinophilic infiltrate in absence of gastroesophageal reflux disease. The aim of this study was toanalyze the clinical manifestations of eosinophilic esophagitis,associated withatopy in patients treated atthe-Gastroenterology Center of Florianopolis. We conducteda case-control study, analyzed 72 patients diagnosed witheosinophilic esophagitis (Case group) and 72 patientsobtained by random selection (Control group). Data wascollectedfrom medical records and analyzed then describedinthe format of measures of central tendency forquantitative variables and proportions for qualitative variables.The chi-square (?2) or Fisher?sexacttestwas usedto test the homogeneity of the sample proportions. TheEthics Committee of the University of the South of SantaCatarina under Opinion No 10.818.4.01.III approved theproject. Men were 6.5 times more affectedand ages rangedfrom13 to 84 years (mean age 32 years and median38). Atopywas statistically significant and more frequent(16times) when associated withe osinophilic esophagitis,asthmabeingthe most common manifestation followedby rhinitis.Inthe clinical condition, the symptoms foundwere dysphagia (81.9%), regurgitation (16.7%) and heartburn(16.7%). In conclusion this study showed thatthe male was the most frequently associated with atopyin 48.6% of cases and dysphagia was the most commonsymptom found, both with statistical significance.

Responsiveness of 3 Scale for Swallowing Disorder on Elderly Dysphagic Patients / 中国康复理论与实践

@#ObjectiveTo determine the responsiveness of 3 assessment for swallowing disorder on elderly people. Methods40 elderly cases with were assessed with drinking test, classification of swallowing disorder, and swallowing ability evaluation before and 3 weeks after treatment. ResultsThe effect size was 1.04 for drinking test, 1.74 for classification of swallowing disorder and 2.06 for swallowing ability evaluation. The standardized response mean was 2.49 for drinking test, 2.35 for classification of swallowing disorder and 2.78 for swallowing ability evaluation. There was very significant difference before and after treatment in the score of all the scales (P<0.001). ConclusionDrinking test, classification of swallowing disorder, and swallowing ability evaluation are responsive for swallowing disorder in elderly people receiving rehabilitation.

Importância da interdisciplinaridade na avaliação das disfagias: avaliação clínica e videofluoroscópica da deglutição / Interdisciplinary evaluation of dysphagia: clinical swallowing evaluation and videoendoscopy of swallowing

O paciente disfágico apresenta prejuízos em diversos aspectos, sendo a atuação interdisciplinar fundamental para definição do diagnóstico e da conduta. A atuação em conjunto na avaliação clínica e videoendoscópica é de extrema importância. Objetivo: Estudar a correlação entre a avaliação clínica (ACD) e videoendoscópica da deglutição (VED) por meio da classificação do grau de severidade e a análise qualitativo/descritiva dos procedimentos. Forma de estudo: Estudo transversal, descritivo, comparativo. Material e método: Realizado no março a dezembro de 2006 no ambulatório de Otorrinolaringologia/Disfagia de um hospital do interior de São Paulo. Foram avaliados pela ACD e VED 30 pacientes disfágicos com diferentes doenças. Os dados foram classificados por meio de escalas de severidade e análise qualitativa/descritiva. Resultados: A correlação entre as escalas de severidade de ACD e VED apontou concordância baixa (KAPA = 0,4) de modo estatisticamente significante (p=0,006). A correlação entre a análise qualitativa/descritiva apontou concordância excelente (KAPA=0.962) estatisticamente significante (p<0.001) para a amostra total. Conclusão: A concordância baixa entre as escalas de severidade aponta a necessidade da realização de ambos os procedimentos, reforçando a VED como procedimento factível. A análise qualitativa descritiva apontou concordância excelente, dado que reforça a necessidade da compreensão da deglutição como um processo.

Patients with dysphagia have impairments in many aspects, and an interdisciplinary approach is fundamental to define diagnosis and treatment. A joint approach in the clinical and videoendoscopy evaluation is paramount. AIM: To study the correlation between the clinical assessment (ACD) and the videoendoscopic (VED) assessment of swallowing by classifying the degree of severity and the qualitative/descriptive analyses of the procedures. Study design: cross-sectional, descriptive and comparative. Materials and methods: held from March to December of 2006, at the Otolaryngology/Dysphagia ward of a hospital in the country side of São Paulo. 30 dysphagic patients with different disorders were assessed by ACD and VED. The data was classified by means of severity scales and qualitative/ descriptive analysis. Results: the correlation between severity ACD and VED scales pointed to a statistically significant low agreement (KAPA = 0.4) (p=0,006). The correlation between the qualitative/descriptive analysis pointed to an excellent and statistically significant agreement (KAPA=0.962) (p<0.001) concerning the entire sample. Conclusion: the low agreement between the severity scales point to a need to perform both procedures, reinforcing VED as a doable procedure. The descriptive qualitative analysis pointed to an excellent agreement, and such data reinforces our need to understand swallowing as a process.