Videofluoroscopic measures of swallowing in people with stable COPD compared to healthy aging

ABSTRACT Purpose Swallowing impairment is a serious extra-pulmonary manifestation of Chronic Obstructive Pulmonary Disease (COPD). Previous studies suggest that individuals with stable COPD show atypical values for several videofluoroscopy measures of swallowing, compared to healthy adults under age 60. However, it is unclear to what degree these changes are attributable to healthy aging. In this study, we aimed to clarify how swallowing in people with stable COPD differs from age-matched healthy controls. Methods We performed a retrospective analysis of videofluoroscopy data from two previously-collected datasets: a) a sample of 28 adults with stable COPD (18 male); b) a sample of 76 healthy adults, from which 28 adults were selected, matched for sex and age to participants in the COPD cohort. In both prior studies, participants swallowed 20% w/v liquid barium prepared in different consistencies (thin; mildly, moderately, and extremely thick). Blinded duplicate ratings were performed according to a standard procedure, yielding measures of laryngeal vestibule closure (LVC) integrity and timing, swallow timing, upper esophageal sphincter (UES) opening, pharyngeal constriction and pharyngeal residue. Mann-Whitney U tests and odds ratios were performed to determine significant group differences (p<.05). Results Across the consistencies tested, participants with COPD showed significantly shorter durations of LVC, earlier onsets and shorter durations of UES opening, and reduced pharyngeal constriction. No significant differences were seen in other measures. Conclusion These results point to features of swallowing in people with stable COPD that differ from changes seen with healthy aging, and which represent risks for potential aspiration.

Instrumento multiprofissional de rastreio para risco de broncoaspiração em ambiente hospitalar à população idosa: evidências de validade baseada nos processos de resposta / Multi-professional screening instrument for risk of broncho-aspiration in a hospital environment for the elderly population: validity evidence based on response processes

RESUMO Objetivo O objetivo deste estudo foi validar, com base nos processos de resposta, o Instrumento Multiprofissional de Rastreio para o Risco de Broncoaspiração em Ambiente Hospitalar, direcionado à população idosa. Método O instrumento foi aplicado por juízes em pacientes distintos e selecionados de forma aleatória. Após a aplicação, os juízes foram entrevistados para que fosse possível verificar a impressão deles quanto à relevância dos itens e quanto a interpretação sobre o conteúdo escrito, bem como a questões gramaticais e semânticas. Foram consideradas sugestões de acréscimo de alternativas de perguntas e de respostas, além de propostas de adequação de questões que compunham o instrumento. As reações não verbais, tais como expressões faciais que sugeriram dúvidas ou hesitações, por parte dos juízes, em relação ao instrumento, também foram analisadas. Resultados A concordância dos juízes em relação a cada item do dispositivo foi calculada pelo Índice de Validade de Conteúdo (IVC), e pelo Coeficiente de Correlação Intraclasse (CCI), sendo que seus resultados demonstraram alto nível de concordância. Através das sugestões dos juízes, elaborou-se uma nova versão do Instrumento Multiprofissional de Rastreio para o Risco de Broncoaspiração em Ambiente Hospitalar à população idosa. Conclusão Os resultados obtidos demonstraram que a validade do Instrumento Multiprofissional para Rastreio do Risco de Broncoaspiração em Ambiente Hospitalar junto à população idosa, baseada nos processos de respostas, foi alcançada.

ABSTRACT Purpose The objective of this study was to validate the Multiprofessional Screening Instrument for Broncho-aspiration Risk in Hospital Environment, which is aimed at the elderly population, based on response processes. Methods Judges applied the instrument to different patients and randomly selected. After the application, the judges were interviewed so that it was possible to verify their impression regarding the relevance of the items about their interpretation of the written content, as well as grammatical and semantic issues. Suggestions for adding alternative questions and answers were considered, as well as proposals for adapting the questions that made up the instrument. Non-verbal reactions, such as facial expressions that suggested doubts or hesitations, by the judges concerning the instrument were also analyzed. Results The agreement of the judges concerning each item of the device was calculated by the Content Validity Index (CVI) and by the Intraclass Correlation Coefficient (ICC), and their results showed a high level of agreement. Through the suggestions of the judges, a new version of the Multi-professional Screening Instrument for the Risk of Broncho-aspiration in a Hospital Environment in the Elderly was elaborated. Conclusion The results obtained showed that the validity of the Multi-professional Instrument for Screening the Risk of Broncho-aspiration in the Hospital Environment with the elderly population, based on the response processes, was achieved and makes it a promising device to assist professionals in hospital care for the elderly.

Intervenções da Fonoaudiologia nas áreas de respiração, mastigação, deglutição e fala: uma revisão de escopo / Speech Language Pathology interventions in the areas of breathing, chewing, swallowing and speaking: a scoping review

RESUMO Há diversas abordagens que podem ser utilizadas para atingir os objetivos terapêuticos nos distúrbios relacionados às funções de mastigação, deglutição, fala e respiração. Entretanto, a literatura necessita de evidências que fundamentem o uso na prática clínica fonoaudiológica. O objetivo desta revisão foi mapear as sínteses de evidências sobre intervenção fonoaudiológica nas áreas de respiração, mastigação, deglutição e fala em adultos e idosos.‬ Foram incluídos apenas estudos classificados por seus autores como revisão sistemática, que abordaram terapia para disfunções orofaciais em indivíduos maiores de 18 anos. Os procedimentos realizados foram: busca eletrônica e manual; seleção dos estudos; extração dos dados; avaliação da qualidade dos estudos e análise de dados. Foi possível observar diversos tipos de intervenções principalmente voltadas à função de deglutição, abarcando desde a terapia tradicional até a utilização de dispositivos. Contudo, devido às limitações dos estudos, os dados devem ser interpretados com cautela.

ABSTRACT There are several types of approaches that can be used to achieve therapeutic goals in disorders related to the functions of mastication, swallowing, speech, and breathing. However, the literature lacks evidence to support their use in speech-language clinical practice. The objective of this review was to map the syntheses of evidence on speech-language pathology intervention in the areas of breathing, mastication, swallowing and speech in adults and the elderly. Only studies classified by their authors as a systematic review, studies that addressed therapy for orofacial disorders in individuals over 18 years of age were included. The procedures performed included: electronic and manual search; selection of studies; data extraction; evaluation of the quality of studies and data analysis. It was possible to observe different types of interventions mainly aimed at the swallowing function, ranging from traditional therapy to the use of devices. However, due to the limitations of the studies, the data must be interpreted with caution.

The use of photobiomodulation in swallowing difficulties in individuals who developed the severe form of COVID-19 / O uso da fotobiomodulação na dificuldade de deglutição em indivíduos que desenvolveram a forma grave da COVID-19

ABSTRACT This study aimed to verify the use of photobiomodulation in swallowing difficulties in individuals who had a severe form of COVID-19. This case report was based on a quasi-experimental, quantitative study, with primary data collected from a non-probabilistic sample of 13 adults (aged ≥ 19 to < 60 years) of both sexes, who had the severe form of COVID-19. Swallowing was assessed with the Dysphagia Risk Assessment Protocol, and the intervention used photobiomodulation. Descriptive statistics were used. It was found that all research participants' risk for dysphagia in water and pudding swallowing tests improved from before to after the intervention. It can be concluded that photobiomodulation had positive results in speech-language-hearing practice to treat swallowing difficulties in adults who were affected by the severe form of COVID-19, intubated, tracheostomized, and needed an alternative feeding route, as the swallowing difficulties improved.

RESUMO O objetivo foi verificar o uso da fotobiomodulação na dificuldade de deglutição em indivíduos que desenvolveram a forma grave da COVID-19. Trata-se de um relato de casos, a partir de um estudo quase experimental, quantitativo, com coleta de dados primários e com amostra não probabilística, realizado com 13 indivíduos adultos (idade ≥ 19 a < 60 anos) de ambos os sexos, que tiveram a forma grave da COVID-19. Foi realizada a avaliação da deglutição pelo Protocolo de Avaliação para o Risco de Disfagia (PARD) e a intervenção com fotobiomodulação. Foi utilizada a estatística descritiva. Verificou-se que todos os participantes da pesquisa apresentaram melhora no risco para disfagia no teste de deglutição de água e de alimento pastoso do momento pré para o pós-intervenção. Pode-se concluir que a utilização da fotobiomodulação na prática fonoaudiológica para tratar a dificuldade de deglutição dos adultos que foram acometidos pela forma grave da COVID-19, intubados, traqueostomizados e necessitaram fazer uso de via alternativa de alimentação, trouxe resultados positivos, com melhora da dificuldade de deglutição.

Sensitivity and specificity of the EAT-10 and SDQ-DP in identifying the risk of dysphagia in Parkinson's disease / Sensibilidade e especificidade do EAT-10 e SDQ-DP na identificação do risco de disfagia na doença de Parkinson

Abstract Background The early identification of risk for dysphagia in patients with Parkinson's disease (PD) is essential for the prevention of nutritional and pulmonary complications. Objective To analyze the sensitivity and specificity of the Swallowing Disturbance Questionnaire (SDQ-PD) and the Eating Assessment Tool (EAT-10) in identifying dysphagia risk in patients with early and intermediate stages of PD. Methods Twenty-nine patients with PD participated in the study. EAT-10 and SDQ-PD questionnaires were applied, and a videofluoroscopic swallowing study. Dysphagia Outcome and Severity Scale (DOSS) was used to classify the presence and severity of dysphagia, and the Penetration-Aspiration Scale (PAS) was used to identify the presence of penetration/aspiration. In the statistical analysis, the sensitivity and specificity of the risk questionnaires were calculated, as well as positive predictive value, negative predictive value, and accuracy. Results EAT-10 to identify the risk of penetration/aspiration revealed a sensitivity of 71.42% and specificity of 45.45%; in the identification of the presence of dysphagia, the sensitivity was 47.61%, and the specificity was 12.5%. The SDQ-PD questionnaire for risk of penetration/aspiration demonstrated a sensitivity of 28.57%, and a specificity of 68.18%. In terms of identifying the presence of dysphagia, the sensitivity was 20%, while the specificity was 44.44%. Conclusion The SDQ-PD revealed low sensitivity and low specificity to identify the presence of dysphagia and/or penetration/aspiration in patients with early and intermediate stages of PD in this sample. Despite its low specificity, the EAT-10 exhibited good sensitivity in indicating the risk of penetration/aspiration.

Resumo Antecedentes A identificação precoce de risco para disfagia nos pacientes com doença de Parkinson (DP) é fundamental para a prevenção de complicações nutricionais e pulmonares. Objetivo Analisar a sensibilidade e especificidade dos questionários Swallowing Disturbance Questionnaire (SDQ-PD) e Eating Assessment Tool (EAT-10) para a identificação do risco de disfagia em pacientes com DP nos estágios iniciais e intermediários da doença. Métodos Participaram 29 pacientes com DP. Foi realizado a aplicação dos questionários EAT-10 e SDQ-PD e o exame de videofluoroscopia da deglutição. Para a classificação da presença e gravidade da disfagia foi utilizada a escala Dysphagia Outcome and Severity Scale e, para identificação da presença de penetração/aspiração, a escala Penetration-Aspiration Scale (PAS). Na análise estatística, calcularam-se a sensibilidade e a especificidade dos questionários de risco EAT-10 e SDQ-DP e o valor preditivo positivo, o valor preditivo negativo e a acurácia. Resultados A análise do EAT-10 para identificar o risco de penetração/aspiração revelou sensibilidade de 71.42% e especificidade de 45.45%; para identificar a presença de disfagia, a sensibilidade foi de 47,61% e a especificidade de 12.5%. Em relação ao questionário SDQ-PD, para identificar risco de penetração/aspiração, a sensibilidade foi de 28.57% e a especificidade de 68.18% e, para identificar a presença de disfagia, a sensibilidade foi de 20% e a especificidade de 44.44%. Conclusão O questionário SDQ-PD revelou baixa sensibilidade e baixa especificidade para identificar presença de disfagia e/ou penetração/aspiração em pacientes com DP em estágios iniciais e intermediários para essa amostra. O EAT-10 revelou boa sensibilidade na indicação de risco de penetração/aspiração, apesar de baixa especificidade.

Clinical outcomes before and after videofluoroscopic swallow study in children 24 months of age or younger / Desfechos clínicos antes e depois da videofluoroscopia da deglutição em crianças com 24 meses de idade ou menos

ABSTRACT Objective: To evaluate the combined impact of videofluoroscopic swallow study (VFSS) and therapeutic feeding and swallowing interventions on clinical outcomes in children with oropharyngeal dysphagia (OPD). Methods: This was an uncontrolled longitudinal analytical study in which OPD patients were evaluated before and after VFSS. Children ≤ 24 months of age diagnosed with OPD in a clinical setting and undergoing VFSS for investigation and management of OPD were included in the study. The study participants received therapeutic feeding and swallowing interventions after having undergone VFSS, being followed at an outpatient clinic for pediatric dysphagia in order to monitor feeding and swallowing difficulties. Respiratory and feeding outcomes were compared before and after VFSS. Results: Penetration/aspiration events were observed in 61% of the VFSSs (n = 72), and therapeutic feeding and swallowing interventions were recommended for 97% of the study participants. After the VFSS, there was a reduction in the odds of receiving antibiotic therapy (OR = 0.007) and in the duration of antibiotic therapy (p = 0.014), as well as in the odds of being admitted to hospital (p = 0.024) and in the length of hospital stay (p = 0.025). A combination of oral and enteral feeding became more common than oral or enteral feeding alone (p = 0.002). Conclusions: A high proportion of participants exhibited penetration/aspiration on VFSS. Therapeutic feeding and swallowing interventions following a VFSS appear to be associated with reduced respiratory morbidity in this population.

RESUMO Objetivo: Avaliar o impacto conjunto da videofluoroscopia da deglutição (VFD) e intervenções terapêuticas de alimentação e deglutição nos desfechos clínicos em crianças com disfagia orofaríngea (DOF). Métodos: Trata-se de um estudo analítico longitudinal não controlado em que pacientes com DOF foram avaliados antes e depois da VFD. Foram incluídas no estudo crianças com idade ≤ 24 meses e diagnóstico clínico de DOF, submetidas à VFD para a investigação e manejo da DOF. Os participantes do estudo receberam intervenções terapêuticas de alimentação e deglutição após terem sido submetidos à VFD, sendo então acompanhados em um ambulatório de disfagia pediátrica para o monitoramento das dificuldades de alimentação e deglutição. Os desfechos respiratórios e alimentares foram comparados antes e depois da VFD. Resultados: Eventos de penetração/aspiração foram observados em 61% das VFD (n = 72), e intervenções terapêuticas de alimentação e deglutição foram recomendadas a 97% dos participantes do estudo. Após a VFD, houve uma redução das chances de receber antibioticoterapia (OR = 0,007) e da duração da antibioticoterapia (p = 0,014), bem como das chances de internação hospitalar (p = 0,024) e do tempo de internação (p = 0,025). A alimentação por via oral e enteral em conjunto tornou-se mais comum do que a alimentação exclusivamente por via oral ou enteral (p = 0,002). Conclusões: Houve alta proporção de crianças que apresentaram penetração/aspiração na VFD. As intervenções terapêuticas de alimentação e deglutição após a VFD parecem estar associadas à redução da morbidade respiratória nessa população.

Percepción temporal de síntomas de disfagia en una cohorte de pacientes con disfagia orofaríngea neurogénica

Introducción: La disfagia resulta de varios mecanismos fisiopatológicos donde sus síntomas no son estáticos ni homogéneos en las personas, especialmente cuando existe disfagia orofaríngea neurogénica. Objetivo: Conocer la percepción y comportamiento en el tiempo de síntomas de disfagia mediante el instrumento Eating Assessment Tool-10 (EAT-10) en pacientes con disfagia orofaríngea neurogénica, con el fin de visualizar la dinámica clínica de esta forma de disfagia. Metodología: Estudio observacional tipo cohorte en pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares, con seguimiento a tres y seis meses y diligenciamiento del EAT-10 al momento basal, tercer y sexto mes. Resultados: Un total de 90 personas con evaluación basal, de las cuales el 56,7 % (51/90) lograron seguimiento al tercer mes y 25,6 % (23/90) al sexto mes. Los síntomas de disfagia con mayor autopercepción en los tres momentos fueron la dificultad para tragar sólidos, sensación de comida pegada en garganta y tos al comer. La odinofagia no fue un síntoma habitualmente percibido. La puntuación total del EAT-10 estuvo entre 16,61 ± 9 y 18,1 ± 9,5 puntos en general. En pacientes con seguimiento completo se observó variación en la autopercepción para tragar líquidos y pastillas. Se observó variación del puntaje al ajustarlo por recepción de terapias. Discusión: Las enfermedades neurológicas y neuromusculares impactan directamente la deglución con gravedad entre leve a profunda, donde la autopercepción de síntomas deglutorios es dinámica, pero con síntomas cardinales de disfagia orofaríngea en el tiempo. Conclusiones: El reconocimiento y seguimiento de síntomas de disfagia deben ser aspectos usuales en la atención de pacientes con enfermedades neurológicas y neuromusculares.

Introduction: Dysphagia results from several pathophysiological mechanisms where its symptoms are not static or homogeneous in people, especially when there is neurogenic oropharyngeal dysphagia. Objective: To know the perception and behavior over time of symptoms of dysphagia using the Eating Assessment Tool-10 (EAT-10) in patients with neurogenic oropharyngeal dysphagia to visualize the clinical dynamics of this form of dysphagia. Methodology: Observational cohort study in patients with neurogenic oropharyngeal dysphagia of neurological and neuromuscular causes with, follow-up at three and six months, and completion of the EAT-10 at baseline, third and sixth month. Results: A total of 90 people with baseline evaluation were included, of whom 56.7% (51/90) achieved follow-up at the third month and 25.6% (23/90) at the sixth month. Symptoms of dysphagia with greater self-perception at all three moments were difficulty swallowing solids, sensation of food stuck in the throat and coughing when eating. Odynophagia was not a commonly perceived symptom. The total score of the EAT-10 was between 16.61±9 and 18.1±9.5 points in general. In patients with complete follow-up, variation in self-perception of swallowing liquids and pills was observed. Variation of the score when adjusting for the reception of therapies. Discussion: Neurological and neuromuscular diseases directly impact swallowing with mild to profound severity, where self-perception of swallowing symptoms is dynamic, but with cardinal symptoms of oropharyngeal dysphagia over time. Conclusions: The recognition and monitoring of dysphagia symptoms should be usual aspects in the care of patients with neurological and neuromuscular diseases.

Inicio de nutrición enteral luego de una gastrostomía endoscópica, ¿es necesario esperar?

Tradicionalmente, el inicio de nutrición enteral, luego de una gastrostomía endoscópica percutánea (GEP) se realiza entre 12 a 24 horas. Diferentes investigaciones sugieren que iniciarla más temprano podría ser una opción segura. El objetivo es determinar si el inicio de nutrición enteral a las 4 horas después de realizar GEP es una conducta segura en cuanto al riesgo de intolerancia, complicaciones o muerte, comparado con iniciarla a las 12 horas. Realizamos un estudio prospectivo, aleatorizado, multicéntrico en instituciones de tercer y cuarto nivel de Bogotá y Cundinamarca, entre junio de 2020 y mayo de 2022, se incluyeron 117 pacientes que fueron aleatorizados en 2 grupos, el grupo A de inicio temprano de nutrición (4 horas), y el grupo B de inicio estándar (12 horas). El mecanismo más frecuente de disfagia fue la enfermedad cerebrovascular (43%), seguido por complicaciones de infección por COVID-19 (26%). No hubo diferencias estadísticamente significativas entre los grupos evaluados respecto al porcentaje de intolerancia a la nutrición, RR = 0,93 (IC 0,30-2,90), tampoco hubo diferencias en términos de complicaciones posoperatorias, (RR) = 0,34 (IC 0,09-1,16), y no se encontraron diferencias en la mortalidad entre los grupos evaluados, (RR) = 1,12 (IC 0,59 - 2,15). En conclusión, el inicio de nutrición a través de la gastrostomía de forma temprana, 4 horas después de la realización de la GEP es una conducta segura que no se relaciona con una mayor intolerancia a la nutrición, complicaciones o muerte, en comparación con un inicio más tardío.

Traditionally, the initiation of enteral nutrition after a percutaneous endoscopic gastrostomy (PEG) is performed between 12 and 24 hours. Different research suggests that early initiation might be a safe option. Our aim was to determine whether starting enteral nutrition 4 hours after performing PEG is a safe practice in terms of risk of intolerance, complications, or death, compared to starting it at 12 hours. We carried out a prospective, randomized, multicenter study in third and fourth level institutions in Bogotá and Cundinamarca, between June 2020 and May 2022, 117 patients were included who were randomized into 2 groups, group A with early nutrition initiation (4 hours), and standard group B (12 hours). The most frequent mechanism of dysphagia was cerebrovascular disease (43%), followed by complications of COVID19 infection (26%). There were no statistically significant differences between the groups evaluated regarding the percentage of intolerance to nutrition, RR = 0.93 (CI 0.30-2.90), there were also no differences in terms of postoperative complications, (RR) = 0.34 (CI 0.09-1.16), and no differences were found in mortality between the evaluated groups, (RR) = 1.12 (CI 0.59-2.15). In conclusion, early initiation of nutrition through the gastrostomy, 4 hours after performing the PEG, is a safe behavior that is not related to greater intolerance to nutrition, complications, or death, compared to later initiation.

Manifestaciones laríngeas de COVID-19 / Laryngeal manifestations of COVID-19

Introducción: la infección por COVID-19 afecta el tracto aerodigestivo superior a través de la enzima convertidora de angiotensina 2 (ECA2) y/o la proteasa transmembrana serina 2 (TMPRSS2). Sus manifestaciones agudas y secuelas han sido muy variadas y no todas están relacionadas con la intubación orotraqueal. El objetivo es describir las características sociodemográficas, clínicas y los hallazgos endoscópicos de los pacientes con síntomas laringofaríngeos posteriores a una infección por SARS-CoV-2 evaluados en el Hospital Militar Central y Hospital Universitario Clínica San Rafael entre marzo de 2020 y marzo de 2022. Materiales y métodos: estudio observacional de corte transversal con datos sociodemográficos, comorbilidades, necesidad de intubación orotraqueal, variedad de síntomas y sus hallazgos endoscópicos. Resultados: se recolectaron datos de 118 pacientes; la edad media fue de 51 años ± 14,4. El síntoma más frecuente fue la disfonía (69,5 %), seguido de la disnea (39,8 %). El 58,9 % requirió intubación orotraqueal y, de estos, la manifestación más frecuente fue disfonía por tensión muscular (DTM) y estenosis subglótica-traqueal. En el 41,1 % restante su hallazgo más frecuente fue la laringitis irritativa. Conclusiones: la COVID-19 tiene múltiples manifestaciones laringofaríngeas en relación con su mecanismo de infección e invasión en los tejidos de esta zona, de tipo inflamatorio y estructural, y no todos están relacionados con la intubación.

Introduction: COVID 19 infection affects the upper aerodigestive tract through angiotensin-converting enzyme 2 (ACE2) and/or Transmembrane serine protease 2 (TMPRSS2). Its acute manifestations and sequelae have been very varied, and not all of them are related to orotracheal intubation. The objective is to describe the sociodemographic and clinical characteristics and the endoscopic findings of patients with laryngopharyngeal symptoms after SARS-CoV-2 infection evaluated at the Hospital Militar Central and Hospital Universitario Clínica San Rafael between March 2020 and March 2022. Methods: Cross-sectional observational study, obtaining sociodemographic data, comorbidities, need for orotracheal intubation, variety of symptoms and their endoscopic findings. Results: 118 patients were collected; the mean age was 51 years ± 14.4. The most frequent symptom was dysphonia (69.5%), followed by dyspnea (39.8%). 58.9% required orotracheal intubation and of these the most frequent manifestation was muscular tension dysphonia (MTD) and subglottictracheal stenosis. In the remaining 41.1%, the most frequent finding was irritative laryngitis. Conclusions: COVID-19 has multiple laryngopharyngeal manifestations in relation to its mechanism of infection and invasion in the tissues of this area, as an inflammatory and structural type, and not all of them are related to intubation.

Dificuldades de deglutição nas diferentes formas de oferta de alimentação em lactentes cardiopatas congênitos: uma revisão sistemática / Swallowing difficulties in the different forms of food supply in congenital heart disease infants: a systematic review / Dificultades para tragar em las diferentes formas de su ministro de alimentos em lactantes com cardiopatias congénitas: una revisión sistemática

Introdução: A forma de alimentação mais segura nos bebês cardiopatas pode ser um desafio para escolha da equipe multiprofissional. Objetivo: Identificar as principais dificuldades de deglutição nas diferentes formas de oferta de alimentação em lactentes cardiopatas congênitos. Métodos: A questão norteadora foi: "Quais as principais dificuldades de deglutição nas diferentes formas de oferta de alimentação em lactentes cardiopatas congênitos?". A população foi delimitada como lactentes cardiopatas, considerando amamentação como exposição de interesse e alimentação em mamadeira considerado grupo comparação. Dificuldades de deglutição foram consideradas desfecho. Foram selecionados artigos sem restrição de idioma, independentemente do ano de publicação até abril de 2019, que apresentassem no título, resumo ou corpo do artigo relação com o objetivo da pesquisa e os critérios de elegibilidade, com delineamento observacional. Após a extração dos dados, as medidas foram transformadas em percentagem, e descritas em uma síntese qualitativa. Resultados: Foram encontrados 828 artigos ao total, sendo que após análises, foram incluídos 11 artigos ao total. As principais dificuldades apresentadas pelos lactentes cardiopatas em seio materno foram: tosse, engasgo, cianose, queda da saturação periférica de oxigênio e incoordenação entre sucção, respiração e deglutição. As dificuldades de deglutição mais encontradas na oferta de seio materno foram: tosse, engasgo, cianose, queda de saturação, incoordenação entre sucção-respiração-deglutição, fadiga, escape oral, tempo prolongado de alimentação, vedamento-labial inadequado, preensão inadequada do bico, e ausculta cervical alterada. Conclusão: Os lactentes cardiopatas apresentam dificuldades de deglutição tanto em seio materno quanto em mamadeira, sendo observada maior frequência de apresentações das dificuldades, com mamadeira. (AU)

Introduction: The safest way of feeding babies with heart disease can be a challenge for the multidisciplinary team to choose. Objective: To identify the main swallowing difficulties in the different forms of feeding in infants with congenital heart disease. Methods: The guiding question was: "What are the main swallowing difficulties in the different forms of feeding in infants with congenital heart disease?". The population was defined as infants with heart disease, considering breastfeeding as exposure of interest and bottle feeding considered a comparison group. Swallowing difficulties were considered the outcome. Articles without language restriction were selected, regardless of the year of publication until April 2019, which presented in the title, abstract or body of the article a relationship with the objective of the research and the eligibility criteria, with an observational design. After data extraction, the measurements were transformed into percentages and described in a qualitative synthesis. Results: A total of 828 articles were found, and after analysis, 11 articles were included in total. The main difficulties presented by infants with heart disease at the mother's breast were coughing, choking, cyanosis, drop in peripheral oxygen saturation and incoordination between sucking, breathing and swallowing. The swallowing difficulties most found in the offer of the mother's breast were: cough, choking, cyanosis, drop in saturation, incoordination between sucking-breathing-swallowing, fatigue, oral leakage, prolonged feeding time, inadequate lip sealing, inadequate nipple grip, and altered cervical auscultation. Conclusion: Infants with heart disease have swallowing difficulties both in the mother's breast and in the bottle, with a higher frequency of presentations of difficulties being observed with the bottle. (AU)

Introducción: La forma más segura de alimentación en bebés com enfermidades del corazón puede ser um desafío para el equipo multidisciplinario para elegir. Objetivo: Identificar las principales dificultades deglutorias em las diferentes formas de alimentación en lactantes com cardiopatías congénitas. Métodos: La pregunta orientadora fue: "¿Cuáles son las principales dificultades deglutorias em las diferentes formas de alimentación en lactantes com cardiopatías congénitas?" La población se definió como lactantes com cardiopatías, considerando la lactancia materna como exposición de interés y la alimentación com biberón considerada una grupo de comparación. Las dificultades para tragar se consideraron el desenlace. Se seleccionaron artículos sin restricción de idioma, independentemente del año de publicación hasta abril de 2019, que presentaran em el título, resumen o cuerpo del artículo relación com el objetivo de la investigación y los criterios de elegibilidad, com um diseño observacional. Después de la extracción de datos, las medidas se transformaron em porcentajes y se describieron en una sínteses cualitativa. Resultados: Se encontraron un total de 828 artículos, y después del análisis, se incluyeron 11 artículos en total. Las principales dificultades que presentaron los lactantes com cardiopatia em el pecho materno fueron: tos, ahogo, cianosis, caída de la saturación periférica de oxígeno y falta de coordinación entre la succión, la respiración y la deglución. Las dificultades de deglución más encontradas em la oferta del pecho de la madre fueron: tos, ahogo, cianosis, descenso de la saturación, descoordinación entre succión-respiración-deglución, fatiga, escape oral, tiempo de alimentación prolongado, sellado labial inadecuado, agarre inadecuado del pezón y auscultación cervical alterada. Conclusión: Los lactantes com cardiopatia presentan dificultades para la deglución tanto em el pecho materno como em el biberón, observándose una mayor frecuencia de presentaciones de dificultades con el biberón. (AU)

Relação entre estado nutricional, disfagia, e nível funcional de alimentação em pacientes adultos com paralisia cerebral em instituição de longa permanência / Relationship between nutritional status, dysphagia, and functional eating level in adult patients with cerebral palsy in long institutional stays

ABSTRACT Background: Diets with modified consistencies for patients with dysphagia in long term care health institutions may be associated with malnutrition. Objective : To assess the nutritional status of adult patients with cerebral palsy and dysphagia hospitalized in a health institution for more than 10 years. Methods : This prospective investigation was performed in 56 patients with cerebral palsy (ages 25 to 71 years, mean: 44±12 years) and no other neurological diagnosis in hospital stay for more than 10 years had their nutritional status, dysphagia, and food ingestion capacity assessed in two moments with a 12-month interval in between them, respectively using the body mass index, the dysphagia risk assessment protocol (PARD), and the functional oral ingestion scale (FOIS). Results : There were no differences between December 2015 and December 2016 in the patients' weight, nutritional status, diet consistency classification, PARD, and FOIS. The limits of prescribed diet consistency (IDDSI-FDS) and the assessments of dysphagia and functional eating level influenced the nutritional status. More intense dysphagia and greater eating restrictions were associated with a worse nutritional status. Conclusion : The nutritional status of adult patients with cerebral palsy hospitalized in a health long term institution who had modified diets according to their swallowing and mastication capacity did not worsen between assessments with a 12-month interval in between them. The severity of dysphagia and diet restrictions interfere with the patients' nutritional status: dysphagia and more intense eating restrictions are associated with a worse nutritional status.

RESUMO Contexto: Dieta com consistência modificada para pacientes com disfagia internados em instituições por longa permanência pode causar desnutrição. Objetivo : Avaliar o estado nutricional de pacientes adultos com paralisia cerebral (PC) e disfagia internados em instituição de saúde por mais de dez anos. Métodos : É um estudo prospectivo realizado em 56 pacientes com PC com idades entre 25 e 71 anos, média: 44±12 anos. O estado nutricional, a disfagia e a capacidade de ingestão alimentar foram avaliados em dois momentos, separados por 12 meses, respectivamente pelo índice de massa corporal (IMC), protocolo de avaliação do risco de disfagia (PARD) e pela escala funcional de ingestão por via oral (FOIS), em 56 pacientes com PC internados em instituição hospitalar por mais de 10 anos, sem outro diagnóstico neurológico. Resultados : Não houve diferenças, entre dezembro de 2015 e dezembro de 2016, nas avaliações do peso, do estado nutricional, na classificação da consistência da dieta ingerida, na escala PARD para disfagia e na escala FOIS de avaliação de ingestão por via oral. Houve influência dos limites da consistência da dieta prescrita (IDDSI-FDS), da avaliação da disfagia e do nível funcional da alimentação no estado nutricional. Disfagia mais intensa e maior restrição alimentar foram associadas com pior estado nutricional. Conclusão : Em pacientes adultos com PC, avaliados com intervalo de 12 meses, não houve piora do estado nutricional. A intensidade da disfagia e as restrições alimentares são fatores que interferem no estado nutricional dos pacientes, disfagia e restrições alimentares mais intensas associadas com pior estado nutricional.

HIGLIGHTS •Diets with modified consistencies may cause malnutrition. •Patients with dysphagia in long term health institutions should ingest the prescribed amount of food to avoid malnutrition. •In patients with cerebral palsy with more intense dysphagia and greater eat restrictions are associated with the worse nutritional status. •The nutritional status of patients with cerebral palsy and dysphagia do not always worsen between assessments with 12-month interval.

Disfagia orofaríngea neurogénica: caracterización clínica y percepción de síntomas en Antioquia, Colombia entre los años 2019 a 2021

Introducción: la disfagia es un trastorno de la deglución, el cual es habitualmente desatendido por profesionales de la salud, en especial la disfagia orofaríngea neurogénica, que es capaz de producir varios síntomas, signos y complicaciones secundarias en los pacientes. Objetivo: realizar una caracterización clínica incluyendo percepción de síntomas de disfagia en pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares en Antioquia, Colombia entre los años 2019 y 2021. Metodología: estudio transversal realizado en 80 pacientes con disfagia orofaríngea neurogénica confirmada a través de la herramienta Eating Assessment Tool-10, evaluación clínica y/o resultados de video fluoroscopia de la deglución. Resultados: 71 pacientes presentaron causas neurológicas centrales. La enfermedad cerebrovascular y la enfermedad de Parkinson fueron las etiologías más frecuentes. Solo 18% de los pacientes con causas neurológicas y 33% con causas neuromusculares reportaron tolerancia a todas las consistencias de alimentos. Mediana de 16 puntos en cuanto a autopercepción de síntomas de disfagia mediante el instrumento Eating Assessment Tool-10, con puntuaciones más altas en pacientes con presencia de gastrostomía, antecedente de neumonía, odinofagia y alteración en la oclusión mandibular al examen físico. En los pacientes con causas neurológicas hubo mayor presencia de signos motores linguales y apraxias orofaciales. Conclusión: existen características clínicas como sensación de comida pegada, dificultad para tragar alimentos sólidos, tos y ahogo al tragar, que son útiles en el reconocimiento de casos de disfagia orofaríngea, y apoyan que esta genera más síntomas que signos al examen físico en pacientes con condiciones neurológicas y neuromusculares.

Introduction: dysphagia is a swallowing disorder that is usually neglected by health professionals, especially neurogenic oropharyngeal dysphagia, which can produce various symptoms, signs and secondary complications in patients. Objective: to perform a clinical characterization, including perception of dysphagia symptoms, in patients with neurogenic oropharyngeal dysphagia of neurological and neuromuscular causes in Antioquia, Colombia between 2019 and 2021. Methodology: cross-sectional study conducted in 80 patients with neurogenic oropharyngeal dysphagia confirmed through the Eating Assessment Tool-10, clinical assessment and/ or video fluoroscopy results of swallowing. Results: 71 patients presented central neurological causes. Cerebrovascular disease and Parkinson's disease were the most frequent etiologies. Only 18% of patients with neurological causes and 33% with neuromuscular causes reported tolerance to all food consistencies. Median of 16 points in terms of self-perception of dysphagia symptoms using the Eating Assessment Tool-10, with higher scores in patients with gastrostomy, a history of pneumonia, odynophagia, and abnormal mandibular occlusion on physical examination. In patients with neurological causes, there was a greater presence of lingual motor signs and orofacial apraxia. Conclusion: there are clinical characteristics such as a sensation of stuck food, difficulty swallowing solid foods, coughing, and choking when swallowing, which are useful in recognizing cases of oropharyngeal dysphagia, and support that this generates more symptoms than signs on physical examination in patients with neurological and neuromuscular conditions.

Influence of handgrip strength on pharyngeal transit time in individuals with chronic obstructive pulmonary disease

Abstract Objective: To investigate the relationship between Handgrip Strength (HGS), dysphagia classification, nutritional aspects, and Pharyngeal Transit Time (PTT) in subjects with Chronic Obstructive Pulmonary Disease (COPD). Methods: Study based on the analysis of secondary data from a database. The sample comprised 15 COPD patients of both sexes and a mean age of 65.7 years. We collected information on HGS, videofluoroscopic swallowing study, Volume-Viscosity Swallow Test (V-VST), and Body Mass Index (BMI). We applied correlation, effect size, and logistic regression tests at the 5% significance level. Results: Most individuals had severe COPD (66.7%), mean dominant HGS of 28.2, and non-dominant HGS of 25.3. Five subjects were malnourished, five were well-nourished, and five were obese. Most of them had normal swallowing (40%), normal V-VST results (60%), and PTT of 0.89 s (liquid) and 0.81 s (pudding-thick). There was no significant correlation between the swallowing classification and the other variables. We obtained a significant correlation (p = 0.015), though weak (r = -0.611), between non-dominant HGS and PTT. Regarding the binary logistic regression, HGS variables and HGS asymmetry were not enough to be considered a risk to clinically abnormal swallowing (V-VST). Conclusion: Subjects with COPD in this study had a longer PTT than reported in the literature for normal subjects and a weak correlation between PTT and non-dominant HGS. The variables related to muscle condition were not considered predictors for abnormal swallowing. Level of evidence: 3.

Emotional aspects of parents of children with dysphagia / Aspectos emocionais dos pais de crianças com disfagia

Dysphagia is a common swallowing disorder in the pediatric population, which may influence the quality of life and well-being of the family. The literature points to stress, guilt, and social isolation of family members. However, the management of psychosocial aspects involved in the treatment of pediatric dysphagia is rarely discussed. This study aimed to carry out an integrative review of the literature regarding the emotional aspects of parents of children with dysphagia. Therefore a search in the databases SciELO and PubMed was made, from January 2013 to June 2020, using the descriptors in Health Sciences (DeCs): "deglutition disorders" and "child". The search was performed with English and Portuguese language limiters using associated descriptors. The selection of the studies was performed by reading the title, abstract and, if necessary, full text, applying the inclusion and exclusion criteria. There were 2,169 publications, and 8 met the inclusion criteria. The included studies were examined according to the author, type of study, goals, emotional aspects involved in the treatment of swallowing disorders, and conclusions. The analysis was performed according to the presence of certain variables of the emotional aspects presented in the face of swallowing disorders, namely, parental stress, negative impact on parent/child interaction, guilt and frustration, and social isolation. The literature points out that pediatric dysphagia causes an emotional impact on the parents; indicating that it is necessary to offer emotional support and to adapt the clinical management to the different demands present in the clinic.

A disfagia é um distúrbio de deglutição comum na população pediátrica, podendo influenciar na qualidade de vida e no bem-estar da família. A literatura aponta estresse, culpa e isolamento social dos familiares. Entretanto, o manejo dos aspectos psicossociais envolvidos no tratamento da disfagia pediátrica raramente é discutido. Este estudo teve como objetivo realizar uma revisão integrativa da literatura sobre os aspectos emocionais de pais de crianças com disfagia. Para tanto, foi realizada uma busca nas bases de dados SciELO e PubMed, no período de janeiro de 2013 a junho de 2020, utilizando os descritores em Ciências da Saúde (DeCs): "distúrbios da deglutição" e "criança". A busca foi realizada com limitadores dos idiomas inglês e português usando descritores associados. A seleção dos estudos foi realizada por meio da leitura do título, resumo e, se necessário, texto completo, aplicando-se os critérios de inclusão e exclusão. Houve 2.169 publicações e 8 preencheram os critérios de inclusão. Os estudos incluídos foram examinados quanto ao autor, tipo de estudo, objetivos, aspectos emocionais envolvidos no tratamento dos distúrbios da deglutição e conclusões. A análise foi realizada de acordo com a presença de algumas variáveis ​​dos aspectos emocionais apresentados diante dos distúrbios da deglutição, a saber, estresse parental, impacto negativo na interação pais/filhos, culpa e frustração e isolamento social. A literatura aponta que a disfagia pediátrica causa impacto emocional nos pais; indicando que é necessário oferecer suporte emocional e adequar o manejo clínico às diferentes demandas presentes na clínica.

Correlação entre achados da avaliação clínica miofuncional orofacial, a pressão e a atividade eletromiográfica da língua na deglutição em indivíduos com diferentes alterações da motricidade orofacial / Correlation between findings of the oral myofunctional clinical assessment, pressure and electromyographic activity of the tongue during swallowing in individuals with different orofacial myofunctional disorders

RESUMO Objetivo correlacionar os achados da avaliação clínica miofuncional orofacial, pressão de língua e da eletromiografia de superfície (EMGs) da deglutição de grupos de pacientes com diferentes alterações da motricidade orofacial. Método 44 pacientes (20 homens e 24 mulheres com idades entre 17 e 63 anos), com diferentes alterações miofuncionais orofaciais foram avaliados por meio da Avaliação Miofuncional Orofacial com Escores Expandido (AMIOFE-E), avaliação da amplitude mandibular e antropometria facial, mensuração da pressão de língua (ponta e dorso) e exame de Eletromiografia de Superfície (EMGs) em região supra hioidea na tarefa de deglutição de saliva e diferentes volumes de água. Resultados a análise estatística encontrou algumas correlações fracas que envolvem a pressão do dorso de língua e sugerem que quanto maior for a medida do terço inferior, menor será a pressão do dorso da língua; quanto maior for a medida dos trespasses (vertical e horizontal) maior será a pressão do dorso da língua; quanto maior for a pontuação da avaliação de postura e funções orofaciais, maior será a pressão do dorso de língua e quanto maior for a pressão do dorso de língua, maior será a pressão da ponta da língua. Conclusão os resultados sugerem que as alterações miofuncionais orofaciais encontradas nos diferentes grupos de pacientes estão mais relacionadas às discrepâncias maxilomandibulares do que às patologias pesquisadas no presente estudo.

ABSTRACT Purpose To correlate the findings regarding the myofunctional orofacial examination, tongue pressure and surface electromyography (sEMG) of deglutition in individuals with different orofacial myofunctional disorders. Methods 44 patients (20 males and 24 females, aged between 17 and 63 years old) with different orofacial myofunctional changes were clinically assessed using the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-E). In addition, the range of mandibular movements and facial anthropometry were measured, along with the assessment of the tongue pressure (tip and dorsum) and of the electrical activity of the suprahyoid muscles during deglutition, using surface electromyography (sEMG). Results The statistical analysis found weak correlations between tongue dorsum pressure values, suggesting that the greater the measurement of the lower third of the face, the lower the pressure of the tongue dorsum; the greater the measurement of the overlaps (vertical and horizontal), the higher the pressure of the tongue dorsum; the higher the score from the orofacial evaluation and orofacial functions assessment, the higher the pressure of the tongue dorsum; and the higher the pressure of the tongue dorsum, the higher the pressure of the tongue tip. Conclusion The present study results indicate that the orofacial myofunctional changes found in different groups of patients are more related to the maxillomandibular discrepancies than to the pathologies investigated herein.

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.

Ultrasound assessment of swallowing: a scoping review protocol / Avaliação ultrassonográfica da deglutição: um protocolo de revisão de escopo

ABSTRACT Purpose: to conduct a scoping review to identify procedures to obtain and analyze ultrasound images related to swallowing in adults and older adults. Methods: the strategy (participants, concept, and context) was employed to determine inclusion criteria - population (adults and older adults), concept (ultrasound assessment), and context (assessment of swallowing). The review will analyze observational, experimental and/or quasi-experimental, descriptive, analytical, and qualitative studies, and opinion texts and articles. It will exclude studies unavailable in full text, in animals, or in vitro, letters to the editor, errata, study protocols, and studies using ultrasound with purposes other than swallowing. There will be no restriction on the language. Two independent professionals will select the studies in the databases (MEDLINE, EMBASE, LILACS, Web of Science, and Scopus). The review will analyze the year of publication, study design, sample, age, and procedures to assess swallowing with ultrasound. Data will be presented in diagrams, tables, and narrative. Final Considerations: the literature has described ultrasound as an assessment instrument to analyze biomechanical swallowing movements. This scoping review will describe methods to acquire ultrasound images to assess swallowing.

RESUMO Objetivo: realizar uma revisão de escopo para identificar os procedimentos de obtenção e análise de imagens ultrassonográficas relacionadas à deglutição de adultos e idosos. Métodos: a estratégia (participantes, conceito e contexto) foi empregada para determinar os critérios de inclusão - população (adultos e idosos), conceito (avaliação ultrassonográfica) e contexto (avaliação da deglutição). Serão analisados os estudos observacionais, experimentais e/ou quase experimentais, descritivos, analíticos, qualitativos, textos e artigos de opinião; e eliminados os que não estiverem disponíveis na íntegra, estudos em animais, in vitro, cartas ao editor, errata, protocolos de estudo e os que usaram a ultrassonografia para fins que não contemplam a deglutição. Não haverá restrições a idiomas. Os estudos serão escolhidos por dois profissionais, independentemente, a partir das bases de dados (MEDLINE, EMBASE, LILACS, Web of Science e Scopus). Serão analisados o ano do estudo, delineamento, amostra, idade e os procedimentos para avaliação ultrassonográfica da deglutição. Os dados serão expostos por meio de diagramas, narrativas e tabelas. Considerações Finais: a ultrassonografia vem sendo descrita na literatura como um instrumento de avaliação que permite a análise dos movimentos biomecânicos da deglutição. Esta revisão de escopo irá permitir a descrição dos métodos de aquisição da ultrassonografia na avaliação da deglutição.

Taste perception in complete denture wearers / Percepção do sabor em usuários de prótese dentária total

ABSTRACT Purpose: to assess the recognition of salty, sweet, and citrus tastes in complete denture wearers. Methods: the study included toothless individuals (experimental group) who had been using, for at least 3 months and at the most 5 years, acrylic resin removable bimaxillary complete dentures in good condition and with adequate maxillo-mandibular relationship. The same assessment was performed in the control group, which had 26 toothed individuals. Volunteers had no difficulties ingesting any type of food. Salty, sweet, and citrus tastes were assessed with filter paper strips soaked in such solutions and placed on the tongue dorsum. Assessments were performed in duplicate and in random order. Results: the percentage rate of errors was similar between the control (9.6±13.5%) and experimental groups (10.5±15.5%) (p=0.80). There was no difference in the frequency of correct perception of tastes between denture wearers and toothed individuals. Conclusion: individuals who wore acrylic resin removable bimaxillary complete dentures perceived salty, sweet, and citrus tastes like toothed individuals did.

RESUMO Objetivo: avaliar o reconhecimento dos sabores salgado, doce e cítrico em usuários de prótese dentária total. Métodos: foram incluídos indivíduos desdentados (grupo experimental) usuários de prótese total removível bimaxilar confeccionada em resina acrílica, com tempo mínimo de uso de três meses e máximo de cinco anos, em bom estado de conservação e com adequada relação maxilo-mandibular. Como grupo controle, a mesma avaliação foi realizada em 26 indivíduos dentados. Os voluntários não tinham dificuldade na ingestão de nenhum tipo de alimento. Os sabores salgado, doce e cítrico foram testados com fitas de papel filtro embebidas nas soluções e colocadas na parte dorsal da língua. As avaliações foram realizadas em duplicata e em ordem ao acaso. Resultados: a taxa percentual de erros foi igual entre os grupos controle (9,6±13,5%) e experimental (10,5±15,5%) (p=0,80). Não houve diferenças na frequência de percepção correta dos sabores entre indivíduos usuários de prótese e indivíduos dentados. Conclusão: usuários de prótese total removível bimaxilar confeccionada em resina acrílica têm a mesma percepção dos sabores salgado, doce e cítrico que indivíduos dentados.

Risk factors independently associated with the maintenance of severe restriction of oral intake and alternative feeding method indication at hospital outcome in patients after acute ischemic stroke

Abstract Background and aims From a clinical point of view, post-stroke patients present difficulties in swallowing management. The purpose of this research was to identify risk factors that were independently related to the maintenance of a severe restriction of oral intake in patients affected by acute ischemic stroke. Methods The authors conducted a prospective observational cohort study of patients with dysphagia post-acute ischemic stroke who were admitted to an Emergency Room (ER). Demographic and clinical data were collected at ER admission. Swallowing data was based on The Functional Oral Intake Scale (FOIS) and was collected at two distinct moments: initial swallowing assessment and at the patient outcome. Patients were divided into two groups according to their FOIS level assigned on the last swallowing assessment (at hospital outcome): G1 with severe restriction of oral intake and indication of feeding tube - patients with FOIS levels 1 to 4; G2 without restriction of food consistencies in oral intake - patients with FOIS levels 5 to 7. Results One hundred and six patients were included in our study. Results of the multivariate logistic regression model for the prediction of maintenance of a severe restriction of oral intake at hospital outcome in patients post-acute ischemic stroke indicated that increasing age (p = 0.006), and dysarthria (p = 0.003) were associated with higher chances of presenting severe restriction of oral intake at hospital outcome. Conclusions Patients with acute ischemic stroke in an Emergency Room may experience non-resolved severe dysphagia, indicating the need to prepare for the care/rehabilitation of these patients.

Capacidade de deglutição e gravidade do risco de aspiração laringotraqueal no Acidente Vascular Encefálico atípico em via cerebelar: relato de caso / Swallowing capacity and gravity of the laryngotracheal aspiration risk in atypical cerebellar stroke: case report

RESUMO Esse relato de caso teve o objetivo de avaliar a capacidade de deglutição e a gravidade do risco de aspiração laringotraqueal de uma paciente, 52 anos, com Acidente Vascular Encefálico (AVE) atípico, com comprometimento na via cerebelar. Para mensurar a capacidade de deglutição e do risco de aspiração foram utilizados a avaliação de rotina na clínica de fonoaudiologia e dois testes clínicos validados: o Massey Bedside Swallowing Screen (MBSS) e o Gugging Swallowing Screen (GUSS). Após a avaliação com os testes clínicos, foi observado que a paciente apresentou capacidade de deglutição diminuída, desempenho caracterizado como patológico e de risco, com 100% de alteração no teste de deglutição de água pelo MBSS, presença de engasgo, tosse, alteração na qualidade vocal e escape anterior de alimento. Já na avaliação do risco de aspiração com o GUSS, a paciente apresentou disfagia moderada e com risco de aspiração laringotraqueal. A disfagia pode estar presente em casos de AVE com lesão anatômica comprometendo o cerebelo e suas vias, o que sugere a importância de avaliação específica da deglutição nesses casos. Os testes GUSS e o MBSS podem ser utilizados para avaliação de casos atípicos de AVE em fase ambulatorial, com objetivos de avaliar o risco de aspiração e a capacidade de deglutição.

ABSTRACT This case report aimed to evaluate the swallowing capacity and the severity of the risk of laryngotracheal aspiration of a 52-year-old female patient with atypical and rare stroke, with major injury in the cerebellar pathway. In order to measure swallowing capacity and risk of aspiration a routine clinical assessment used in the speech therapy clinic was performed and two valid clinical tests were used: Massey Bedside Swallowing Screen (MBSS) and Gugging Swallowing Screen (GUSS). After evaluation with the clinical tests, it was observed that the patient had reduced swallowing capacity, performance characterized as pathological, 100% dysfunction in the water swallowing test (MBSS), presence of choking, coughing, change in vocal quality and anterior escape. In the assessment of risk of aspiration with the GUSS, the patient presented moderate dysphagia and risk of laryngotracheal aspiration.This case report demonstrated that moderate dysphagia is found in a stroke patient with lesions that affect the cerebellum. Standardized and validated clinical tests such as GUSS and MBSS should also be used to assess the risk of dysphagia after stroke at ambulatory care.