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1.
Arq. neuropsiquiatr ; 80(1): 84-96, Jan. 2022. tab, graf
Article in English | LILACS | ID: biblio-1360127

ABSTRACT

ABSTRACT Background: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. Objective: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. Methods: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. Results: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. Conclusions: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.


RESUMO Antecedentes: A disfagia é caracterizada como uma dificuldade no padrão de deglutição em qualquer fase desse processo neuromuscular. É um sintoma frequente após o Acidente Vascular Cerebral. Objetivos: O objetivo deste estudo foi investigar as intervenções fonoaudiológicas mais utilizadas como terapia para o tratamento dos distúrbios da deglutição em pacientes com disfagia pós AVC. Métodos: Realizamos uma revisão dos estudos indexados no MEDLINE-PubMed, LILACS, Cochrane e Clinical trials.gov com foco nas intervenções fonoaudiológicas em pacientes adultos e disfágicos após AVC entre janeiro de 2008 e janeiro de 2021. Resultados: Foram selecionados trinta e seis artigos de ensaios clínicos e estudados onze tipos de terapia. Os estudos sobre a eficácia de intervenções terapêuticas para a reabilitação destes pacientes adultos ainda são restritos. A maioria das técnicas é aplicada em combinação com a terapia convencional, tornando inconclusiva a medição da eficácia de outras técnicas isoladamente. Conclusões: As intervenções terapêuticas devem ser escolhidas de acordo com as possibilidades e limitações dos pacientes e, principalmente, com os achados da avaliação clínica e seu objetivo.


Subject(s)
Humans , Adult , Deglutition Disorders/etiology , Deglutition Disorders/rehabilitation , Stroke/complications , Stroke Rehabilitation , Deglutition
2.
Article in Portuguese | LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1354790

ABSTRACT

Objetivo: verificar a percepção do fonoaudiólogo sobre o atendimento de usuários diagnosticados com COVID-19, no Brasil. Resultados: dos fonoaudiólogos que atuaram de forma direta ao enfrentamento à COVID-19, a maioria (45,83%) exerceu atividade em Unidade de Terapia Intensiva (UTI). A maior parte dos entrevistados relatou ter atendido 10 ou mais indivíduos (45,83%) submetidos à intubação orotraqueal. A avaliação fonoaudiológica foi realizada principalmente após os indivíduos apresentarem sinais e sintomas de disfagia. Conclusão: de acordo com relatos dos fonoaudiólogos entrevistados, a disfagia foi o distúrbio mais prevalente entre os usuários com COVID-19, e a conduta mais frequente foi a indicação de uma via alternativa de alimentação. A maioria realizou terapia tradicional. O desfecho mais encontrado foi a alta hospitalar após 8-14 dias.


Objective: to verify the perception of the speech therapist on the care of users diagnosed with COVID-19, in Brazil. Results: of the speech therapists who acted directly in the face of COVID-19, the majority (45.83%) worked in the Intensive Care Unit (ICU). Most respondents reported having seen 10 or more individuals (45.83%) undergoing orotracheal intubation. Speech-language pathology assessment was performed mainly after individuals presented signs and symptoms of dysphagia. Conclusion: according to the speech therapists interviewed, dysphagia was the most prevalent disorder among users with COVID-19, and the most frequent conduct was the indication of an alternative feeding route. Most underwent traditional therapy. The most common outcome was hospital discharge after 8-14 days.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Deglutition Disorders/rehabilitation , COVID-19/rehabilitation , Speech, Language and Hearing Sciences
3.
Article in Portuguese | LILACS | ID: biblio-1284362

ABSTRACT

Introdução: O trauma decorrente de causas externas é um problema de saúde em várias regiões do mundo. Além de altos índices de mortalidade e morbidade, os traumas de face resultam em impactos estéticos, estruturais e psicológicos na vida do indivíduo e na sociedade, gerando, também, um alto custo com gastos hospitalares. Objetivo: Relatar o caso de um paciente com trauma de face por acidente ciclístico, com alterações na funcionalidade do sistema estomatognático. Metodologia: Foi realizada avaliação fonoaudiológica por meio do Protocolo de Avaliação Preliminar (PAP), para observação do aspecto das estruturas orais, funções do sistema estomatognático, voz e reflexos protetivos de vias aéreas superiores. Na sequência, foi aplicado o Protocolo de Avaliação do Risco para Disfagia (PARD), para avaliação direta da deglutição. Resultados: Na avaliação dos órgãos fonoarticulatórios foi observado alterações de sensibilidade, mobilidade e redução significativa de força. Na avaliação direta da deglutição foi observada dificuldade na captação do alimento, escape anterior de alimento, elevação laríngea reduzida e múltiplas deglutições. Conclusão: O paciente foi classificado com Disfagia Orofaríngea leve a moderada, mantendo dieta via oral com consistência adaptada e orientação para continuidade de terapia fonoaudiológica. Devido ao alto número de casos semelhantes ao relatado nos hospitais de urgência e emergência, constata-se a necessidade de avaliação do sistema estomatognático para promover a melhor abordagem aos pacientes com trauma de face


Introduction: Trauma due to external causes is a health problem in several regions of the world. In addition to high rates of mortality and morbidity, facial traumas result in aesthetic, structural and psychological impacts on the individual's life and on society, also generating a high cost of hospital expenses. Objective: Report the case of a patient with facial trauma due to a cycling accident, with changes in the functionality of the stomatognathic system. Methodology: Speech therapy evaluation was carried out through the Preliminary Evaluation Protocol, to observe the appearance of oral structures, functions of the stomatognathic system, voice and protective reflexes of the upper airways. Then, the Risk Assessment Protocol for Dysphagia was applied, for direct swallowing assessment. Results: In the evaluation of Organs phonoarticulatory organs, changes in sensitivity, mobility and significant reduction in strength were observed. In the direct evaluation of swallowing, difficulty in capturing food, previous escape of food, reduced laryngeal elevation and multiple swallowing were observed. Conclusion: The patient was classified with Mild to Moderate Oropharyngeal Dysphagia, maintaining an oral diet with consistency adapted and guidance for continuing speech therapy. Due to the high number of cases similar to that reported in urgent and emergency hospitals, there is a need to evaluate the stomatognathic system to promote the best approach to patients with facial trauma.


Subject(s)
Humans , Adult , Young Adult , Stomatognathic System/injuries , Deglutition Disorders , Facial Injuries , Deglutition Disorders/rehabilitation , Glasgow Coma Scale , Emergency Service, Hospital/statistics & numerical data , Mandibular Fractures
4.
Rev. CEFAC ; 23(1): e1720, 2021. tab, graf
Article in English | LILACS | ID: biblio-1143681

ABSTRACT

ABSTRACT Objective: to describe the profile of patients treated by Speech-Language therapists in a Critical Patient Unit. Methods: an ex post facto, observational and descriptive study was carried out. Monthly statistical data of patients hospitalized in the period January-December 2018 were analyzed, in the Intensive Care Unit at a public hospital. Data were described from the analysis of frequency and measures of central tendency. The distribution of the variables was determined through the skewness-kurtosis test, considering a significance level of p<0.05. Results: 217 individuals got 868 speech-language therapy services. Men (57.26%), older than 65 years old, required a more frequent intervention. The main medical diagnosis of admission to the unit corresponded to non-specific pathologies (57.14%), respiratory disease (15.21%) and cerebrovascular disease (12.79%). The speech-language therapy functions were related to the evaluation of swallowing (54.31%) and voice (32.4%). In relation to the intervention, the treatment of dysphagia (25.82%) and oral motor functions (25.04%) was predominant in the duties. Functions associated with language, speech and cognition were secondary. Conclusion: the profile of the critical patient and the speech-language therapy work in this field represent a first step to characterize the role of the speech-language therapist in Intensive Medicine teams.


RESUMEN Objetivo: describir el perfil de usuarios atendidos por fonoaudiólogos en una unidad de paciente crítico. Métodos: se realizó un estudio observacional descriptivo con temporalidad ex post facto. Se analizaron los resúmenes estadísticos mensuales de usuarios internados durante los meses de enero a diciembre de 2018, en la unidad de cuidados intensivos de un hospital público. Se describieron los datos a partir de análisis de frecuencia y medidas de tendencia central. La distribución de las variables se determinó mediante skewness-kurtosis test, considerando un nivel de significancia p<0,05. Resultados: 217 sujetos recibieron 868 atenciones fonoaudiológicas. Los hombres (57,26%) mayores de 65 años requirieron una intervención más frecuente. Los principales diagnósticos médicos de ingreso a la unidad correspondieron a patologías inespecíficas (57,14%), enfermedades respiratorias (15,21%) y cerebrovasculares (12,79%). Las funciones de fonoaudiología se relacionaron con la evaluación de la deglución (54,31%) y de la voz (32,4%). En cuanto a la intervención, el tratamiento de la disfagia (25,82%) y las funciones motoras orales (25,04%) dominaron la carga laboral. Las funciones asociadas con el lenguaje, el habla y la cognición fueron secundarias. Conclusión: el perfil del paciente crítico y las labores fonoaudiológicas en este ámbito representan un primer paso para caracterizar el rol profesional del fonoaudiólogo en el contexto de los equipos de medicina intensiva.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Speech Disorders/rehabilitation , Speech Therapy/statistics & numerical data , Deglutition Disorders/rehabilitation , Voice Disorders/rehabilitation , Intensive Care Units/statistics & numerical data , Critical Care
5.
Audiol., Commun. res ; 26: e2542, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1345349

ABSTRACT

RESUMO Objetivo Este estudo piloto teve como objetivo verificar a influência do uso do biofeedback EMG como método coadjuvante para auxiliar na manutenção dos resultados a longo prazo da terapia da deglutição em idosos com doença de Parkinson em uma abordagem profilática. Métodos Os sujeitos foram avaliados quanto ao nível de ingestão oral (Functional Oral Intake Scale - FOIS), qualidade de vida (questionário SWAL-QOL) e videofluoroscopia da deglutição das consistências sólida, pudim e líquida. A gravidade da disfagia foi avaliada por meio do Dysphagia Outcome and Severity Scale (DOSS). Todos os procedimentos foram realizados antes, após três meses e após seis meses do tratamento fonoaudiológico para disfagia orofaríngea. Resultados Três sujeitos foram tratados com terapia fonoaudiológica profilática e três com terapia convencional fonoaudiológica profilática utilizando biofeedback EMG coadjuvante em um total de 18 sessões. Seis pacientes apresentaram melhora nos níveis de ingestão oral, gravidade da disfagia e qualidade de vida após o programa de reabilitação. O nível de ingestão oral foi mantido seis meses após a terapia convencional para dois pacientes e todos os participantes tratados com biofeedback EMG. Conclusão Ambas as modalidades de terapia profilática mostraram melhora na qualidade de vida, nível de ingestão oral e gravidade da disfagia, mas os benefícios foram mantidos ao longo do tempo apenas para os participantes do grupo experimental.


ABSTRACT Purpose This pilot study aimed to verify the influence of using EMG biofeedback as an assisting method to maintain long-term results for swallowing therapy in older adults with Parkinson's disease in a prophylactic approach. Methods: Subjects were evaluated as to the oral intake level (Functional Oral Intake Scale - FOIS), quality of life (SWAL-QOL questionnaire), and videofluoroscopy of swallowing of solid, pudding and liquid consistencies. The severity of dysphagia was assessed using the Dysphagia Outcome and Severity Scale (DOSS). All procedures were performed before, after three months, and after six months of speech-language therapy treatment for oropharyngeal dysphagia. Results: Three subjects were treated with prophylactic speech-language therapy, and three with prophylactic speech-language conventional therapy using adjunctive EMG biofeedback in a total of 18 sessions. Six patients experienced a reduction of the severity of the dysphagia, improved oral intake levels and quality of life after the rehabilitation program. The oral intake level was maintained six months after conventional therapy for two patients and for all participants treated with EMG biofeedback. Conclusion Both therapy modalities with PSLT showed improved quality of life, oral intake level, and reduction of the severity of dysphagia, but the benefits were maintained over time only for participants in the experimental group.


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Parkinson Disease , Biofeedback, Psychology/methods , Deglutition Disorders/prevention & control , Deglutition Disorders/rehabilitation , Speech Therapy
6.
Article in Spanish | LILACS | ID: biblio-1148365

ABSTRACT

A la fecha de redacción de este artículo, más de 500 mil personas han sido afectadas por el virus SARS-CoV-2 en Chile, manifestando diferentes grados de la enfermedad COVID-19. Aquellas que sobrellevan condiciones más severas generan una condición que requiere soporte ventilatorio invasivo y tratamiento en unidades de cuidados intensivos, que de prolongarse en el tiempo deriva en la necesidad de una traqueostomía. A pesar de los beneficios que posee esta en la recuperación de personas con dificultades respiratorias, su implementación se asocia a alteraciones deglutorias que se suman a las generadas por COVID-19. Condición que supone un desafío para los/as fonoaudiólogos/as, quienes están expuestos/as al virus debido a su proceder en estructuras del tracto aerodigestivo y la realización de procedimientos potencialmente generadores de aerosol. El objetivo de este artículo es entregar orientaciones y herramientas clínicas para la intervención en la deglución de personas con traqueostomía y COVID-19. Estas emanan de un análisis pragmático de la evidencia disponible a la fecha, interpretadas bajo nuestra experiencia de atender a más de 561 personas con dicha condición. Se espera contribuir a la rehabilitación de la deglución en personas con COVID-19 y traqueostomía. Para ello se expone sobre las características de la deglución en esta población, su tratamiento, consideraciones para el uso de técnicas específicas, y orientaciones para la mejora de la calidad de vida mediante la mantención y/o recuperación de la funcionalidad deglutoria. Siempre bajo un esquema centrado en el cuidado y protección de las personas hospitalizadas y el equipo de salud.


At the time of writing this article, more than a million people have been affected by the SARS-CoV-2 virus in Chile, displaying different degrees of COVID-19 disease. Severe infections generate a condition that requires invasive ventilatory support and treatment in intensive care units, which, when extended in time, makes necessary conducting a tracheostomy. Despite its benefits for the recovery of patients with respiratory difficulties, it is linked to swallowing disorders that add to the problems generated by COVID-19. This represents a challenge for speech pathologists, who are potentially exposed to the virus because they work on structures of the aerodigestive tract and becuase they conduct procedures that may be aerosol-generating. The aim of this article is to provide guidance and clinical tools for swallowing-intervention in people with tracheostomies and COVID-19. Thees tools spring from a pragmatic analysis of the currently available evidence , interpreted based on our experience of caring more than561 infected patients. We hope to contribute to the rehabilitation of swallowing of patients with COVID-19 and a tracheostomy. The characteristics of swallowing in this population, its treatment, considerations for the use of specific techniques, and guidelines for improving the quality of life through the maintenance and/or recovery of swallowing functionality are discussed, focused caring and protecting hospitalized patients and the health team.


Subject(s)
Humans , Pneumonia, Viral/surgery , Tracheostomy/adverse effects , Deglutition Disorders/etiology , Coronavirus Infections/surgery , Speech, Language and Hearing Sciences/standards , Pneumonia, Viral/complications , Pneumonia, Viral/rehabilitation , Quality of Life , Deglutition Disorders/rehabilitation , Coronavirus Infections/complications , Coronavirus Infections/rehabilitation , Critical Care , Speech, Language and Hearing Sciences/methods , Pandemics , Betacoronavirus
7.
Rev. chil. fonoaudiol. (En línea) ; 19: 1-7, nov. 2020. tab
Article in Spanish | LILACS | ID: biblio-1148408

ABSTRACT

Los actuales protocolos de intervención en deglución no especifican parámetros de los ejercicios tales como la cantidad de series, duración, tiempos de repetición, entre otros. Lo anterior, es un desafío para la intervención fonoaudiológica en los trastornos de la deglución. El objetivo de este trabajo es acercar al profesional fonoaudiólogo al conocimiento de las fibras musculares, ya que es un conocimiento que se debe considerar antes de indicar ejercicios musculares cráneo-cérvico-orales. Por ello, se describen las principales fibras musculares con sus respectivas características fundamentales, como lo son: la resistencia a la fatiga y la velocidad de contracción. Se revisa la literatura sobre la dispersión de las fibras musculares, de algunos de los principales músculos que participan en el proceso deglutorio. También, se analizan diversas particularidades de los músculos de la zona cráneo-cérvico-oral. Se describen además las diferentes dificultades para evaluar esta musculatura. Finalmente, se expone la relevancia práctica de conocer estos tipos de fibras musculares y las perspectivas futuras de este enfoque basado en parámetros del ejercicio y la medición de variables objetivas.


Swallowing intervention protocols in dysphagia do not specify the parameters of the exercises, namely the duration, frequencyand number of series, all of which present a challenge in speech therapy intervention in swallowing disorders. The purpose of this review is to provide Speech and Language Pathologists with background information concerning crucial muscle fibres used in swallowing therapy and to subsequently indicate appropriate skull-cervical-oral muscle exercises. We describe the primary muscle and its characteristics such as fatigue resistance and contraction speed, review the types of fibres of some of the main muscles that participate in the swallowing process, and present the particularities of the muscles of the cranio-cervical-oral area in comparison with the rest of the skeletal muscles. We also provide information regarding the difficulties in evaluating the musculature involvedin the swallowing process before finally highlighting the relevance of understanding the roles and characteristics of these muscles for clinical practice


Subject(s)
Humans , Deglutition Disorders/rehabilitation , Muscle Fibers, Skeletal/physiology , Exercise Therapy , Muscle Fibers, Skeletal/classification , Speech, Language and Hearing Sciences
8.
Audiol., Commun. res ; 25: e2262, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1098092

ABSTRACT

RESUMO Objetivo Caracterizar as alterações relacionadas à deglutição e as principais intervenções e condutas fonoaudiológicas em pacientes em cuidados paliativos, com disfagia orofaríngea. Métodos Estudo observacional, prospectivo, descritivo, realizado com 20 pacientes em cuidados paliativos, em internação hospitalar no Hospital Universitário da Universidade Federal de Santa Catarina. Foram coletados dados do histórico de saúde, dieta prescrita, tempo de internação, avaliação e intervenção fonoaudiológica. Também foi realizada avaliação funcional da deglutição no leito hospitalar, classificação na Functional Oral Intake Scale (FOIS) e aplicado um questionário sobre a satisfação do paciente quanto à alimentação. Resultados A maioria dos participantes era homem, com média de idade de 75 anos, que se encontrava sob cuidados paliativos por diversos tipos de doenças e agravos à saúde. O tempo médio de internação foi de 15 dias e a maioria evoluiu a óbito durante a internação. As consistências mais utilizadas para avaliação foram líquida e mel. O sinal de penetração e/ou aspiração laringotraqueal mais frequente foi voz "molhada" após a deglutição. Quanto à FOIS, metade da amostra encontrava-se no nível 5 e pequena parte no nível 1. As intervenções mais utilizadas foram modificação de consistência, manobras de múltiplas deglutições e deglutição com esforço. A partir do questionário, verificou-se que a maioria estava satisfeita com a dieta servida pelo hospital. Conclusão As alterações mais encontradas, relacionadas à deglutição, foram sinais clínicos de penetração e/ou aspiração laringotraqueal. As principais intervenções foram ajuste nas consistências das dietas e manobras compensatórias. A maioria seguiu durante a internação com alimentação por via oral, respeitando o desejo dos pacientes e seus familiares.


ABSTRACT Purpose To characterize the changes related to swallowing and the main interventions and management of speech therapy in patients with oropharyngeal dysphagia in palliative care. Methods Observational prospective descriptive study conducted with 20 patients in palliative care at the University Hospital of the Federal University of Santa Catarina. Data were collected regarding the patients health history, prescribed diet, time of hospitalization and speech therapy evaluation and intervention. Clinical evaluation of swallowing was also performed on bedside, using the Functional Oral Intake Scale (FOIS). A semi-structured questionnaire was applied with questions about patient's satisfaction related to feeding. Results Most of the sample was composed of men with 75 years of age on average, all under palliative care due to different diseases and health problems. The average time of hospital stay was 15 days and most patients died during hospitalization. The most common food consistencies used for evaluation were liquid and honey. The most common sign of penetration and/or laringo-tracheal aspiration was the "wet" voice after swallowing. As to FOIS, half the sample was at level 5 and part at level 1. The most common interventions used were consistency modification, multiple swallowing maneuvers and swallowing with effort. From the survey, it was found that most patients were satisfied with the diet served by the hospital. Conclusion The most frequently encountered changes related to swallowing were clinical signs of penetration and/or laringo-tracheal aspiration. The main interventions were adjustments of the prescribed diets consistency and compensatory maneuvers. Most patients continued during hospitalization with oral feeding, respecting the desire of the patients and their family members.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Palliative Care , Deglutition Disorders/rehabilitation , Diet Therapy , Speech, Language and Hearing Sciences , Patient Care Team , Quality of Life
9.
CoDAS ; 32(1): e20180229, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1055895

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Deglutition Disorders/rehabilitation , Thrombolytic Therapy/methods , Stroke/complications , Severity of Illness Index , Deglutition Disorders/diagnosis , Chi-Square Distribution , Retrospective Studies , Risk Factors , Stroke/therapy
10.
CoDAS ; 32(1): e20170097, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1055890

ABSTRACT

RESUMO Objetivo Verificar o acesso à reabilitação fonoaudiológica e a continuidade do cuidado pela Atenção Primária à Saúde (APS) em vítimas de acidente de motocicleta. Método Trata-se de estudo realizado em um hospital de grande porte localizado em Recife-Pernambuco, recrutado entre o período de junho e julho de 2014. Após a alta hospitalar todos foram contatados para investigação do processo de reabilitação fonoaudiológica. Para o estudo na Atenção Primária à Saúde, foram utilizadas medidas de frequência absoluta e relativa. Já os casos em reabilitação foram descritos através de quadros. Resultados Foi verificado que 99 indivíduos foram vítimas de acidentes por motocicletas no período estudado. Desses, 30 entrevistados referiram ter essas queixas de alteração no sistema estomatognático, dos quais 8 estavam em reabilitação e 18 referiram residir em área adstrita a Unidade de Saúde da Família. Os principais obstáculos para o acesso à fonoterapia apontados foram a distância aos serviços de Fonoaudiologia e o tempo de espera para início do tratamento. Um dos aspectos relacionados à continuidade do cuidado pela Atenção Primária à Saúde, como a busca e obtenção de insumos, foi visto como frequente. Ao contrário da visita domiciliar, menos frequente. Conclusão Foram identificados obstáculos que dificultaram o acesso à fonoterapia, assim como fragilidades nos cuidados dispensados pela Atenção Primária, como a visita domiciliar, contribuindo para a fragmentação do cuidado contínuo e integral às vítimas.


ABSTRACT Purpose To verify the access to speech-language pathology (SLP) therapy and continuity of assistance in Primary Health Care (PHC) for victims of motorcycle accidents. Methods A quantitative and qualitative study was conducted at a large hospital in the city of Recife, Pernanbuco state, Brazil. Among the 99 victims recruited between June and July 2014, 30 had SLP complaints as a result of the accidents. After hospital discharge, all victims were contacted for investigation of the SLP rehabilitation process. Absolute and relative frequencies were used for the analysis in PHC, and data were displayed in tables for the therapy cases. Results Among the 30 individuals who reported having alterations of the stomatognathic system, eight were undergoing rehabilitation and 18 reported residing in an area covered by the Family Health Strategy (primary care modality). Seeking and obtaining continuity of treatment (medication and bandaging) in primary care were frequent; in contrast, home visits were less frequent. The main obstacles to access SLP therapy were distance to the service and waiting time to begin treatment. Conclusion This study identified obstacles that hamper access to SLP therapy in PHC, such as the low frequency of home visits, contributing to the fragmentation of continuous and complete care for victims.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Primary Health Care , Motorcycles , Accidents, Traffic , Deglutition Disorders/rehabilitation , Health Services Accessibility/statistics & numerical data , Language Disorders/rehabilitation , Brazil , Deglutition Disorders/etiology , Deglutition Disorders/epidemiology , Cross-Sectional Studies , Language Disorders/etiology , Language Disorders/epidemiology , Middle Aged
12.
Arq. neuropsiquiatr ; 77(7): 501-508, July 2019. tab
Article in English | LILACS | ID: biblio-1011364

ABSTRACT

ABSTRACT A swallowing disorder is present in more than 50% of patients with acute stroke. Objective To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. Methods Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) and the verification of demographic and clinical variables. Results The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 - ASHA1 (n = 51); levels 3, 4 and 5 - ASHA2 (n = 96); levels 6 and 7 - ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age ≥ 70 years); had anterior circulation infarct; had lower scores on the Glasgow Coma Scale (GCS ≤ 14 points); took longer to initiate swallowing rehabilitation; had longer hospital stays; made more use of alternative feeding methods; needed more sessions of swallowing rehabilitation to remove alternate feeding methods; took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). Conclusion Patients with acute ischemic stroke, admitted to the emergency room, aged ≥ 70 years, score on the GCS ≤ 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.


RESUMO Alterações da deglutição são observadas em mais de 50% dos pacientes com acidente vascular cerebral isquêmico (AVCI) agudo. Objetivo Identificar os indicadores de prognóstico clínico da funcionalidade da deglutição na população com AVCI em fase aguda, visando o estabelecimento de indicadores de priorização de atendimento fonoaudiológico. Métodos Participaram do estudo adultos admitidos em Pronto Socorro (PS) com AVCI. As etapas de coleta de dados envolveram avaliação fonoaudiológica para determinação do nível funcional da deglutição (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) e a coleta de variáveis demográficas e clínicas. Resultados A amostra do estudo incluiu 295 pacientes agrupados de acordo com os níveis ASHA NOMS: níveis 1 e 2 - ASHA1 (n = 51); níveis 3, 4 e 5 - ASHA2 (n = 96); níveis 6 e 7 - ASHA3 (n = 148). As análises indicaram os seguintes resultados significantes: pacientes com pior funcionalidade da deglutição (ASHA1) apresentaram média de idade superior a 70 anos, maior comprometimento da circulação cerebral anterior pós-AVCI, pior pontuação na Escala de Coma de Glasgow (ECG ≤ 14 pontos), demoraram mais tempo para iniciar o atendimento fonoaudiológico, permaneceram mais tempo internados no hospital, fizeram mais uso de via alternativa de alimentação, necessitaram de mais sessões fonoaudiológicas para retirada da via alternativa de alimentação, demoraram mais tempo para retornar para alimentação por via oral e apresentaram pior desfecho (um número menor de indivíduos recebeu alta fonoaudiológica e apresentaram mortalidade aumentada). Conclusão Pacientes com AVCI agudo, admitidos em PS, que apresentem idade ≥ 70 anos, pontuação na ECG ≤ 14, com comprometimento do sistema circulatório cerebral anterior e demência, devem ser priorizados no atendimento fonoaudiológico.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Deglutition Disorders/diagnosis , Brain Ischemia/physiopathology , Stroke/physiopathology , Prognosis , Deglutition Disorders/etiology , Deglutition Disorders/rehabilitation , Comorbidity , Glasgow Coma Scale , Cross-Sectional Studies
13.
Int. arch. otorhinolaryngol. (Impr.) ; 22(3): 225-230, July-Sept. 2018. tab
Article in English | LILACS | ID: biblio-975593

ABSTRACT

Abstract Introduction Dysphagia causes changes in the laryngeal and stomatognathic structures; however, the use of vocal exercises is poorly described. Objective To verify whether the therapy consisting of myofunctional exercises associated with vocal exercises is more effective in rehabilitating deglutition in stroke patients. Methods This is a pilot study made up of two distinct groups: a control group, which performed onlymyofunctional exercises, and an experimental group, which performed myofunctional and vocal exercises. The assessment used for oral intake was the functional oral intake scale (FOIS). Results The FOIS levels reveal that the pre-therapymedian of the experimental group was 4, and increased to 7 after therapy, while in the control group the values were 5 and 6 respectively. Thus, the experimental group had a statistically significant difference between the pre- and post-therapy assessments (p = 0.039), which indicates that the combination of myofunctional and vocal exercises was more effective in improving the oral intake levels than the myofunctional exercises alone (p = 0.059). On the other hand, the control group also improved, albeit at a lower rate compared with the experimental group; hence, there was no statistically significant difference between the groups post-therapy (p = 0.126). Conclusion This pilot study showed indications that using vocal exercises in swallowing rehabilitation in stroke patients was able to yield a greater increase in the oral intake levels. Nevertheless, further controlled blind clinical trials with larger samples are required to confirm such evidence, as this study points to the feasibility of conducting this type of research.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Voice Training , Deglutition Disorders/rehabilitation , Myofunctional Therapy , Voice Quality , Deglutition Disorders/diagnosis , Pilot Projects , Stroke/diagnosis , Eating
14.
Bol. méd. Hosp. Infant. Méx ; 75(1): 15-22, ene.-feb. 2018.
Article in Spanish | LILACS | ID: biblio-951287

ABSTRACT

Resumen En 20 años se han atendido 640 recién nacidos prematuros (RNP) y recién nacidos a término con alteraciones en la coordinación de la succión-deglución en la unidad de cuidados intensivos neonatales del Hospital Infantil de México Federico Gómez, empleado técnicas de tratamiento para pacientes con inmadurez, patologías de tipo neurológico, gastrointestinal, cardiológico y respiratorio. El presente trabajo describe el tratamiento empleado principalmente en RNP durante este periodo. La coordinación de la succión-deglución-respiración es una de las habilidades más complejas a las que se enfrenta el RNP, debido a que presenta inmadurez anatomofuncional y una incorrecta integración sensoriomotriz para los altos requerimientos energéticos a los que debe someterse. La succión y la deglución son procesos voluntarios e involuntarios que garantizan el paso seguro de alimentos de la boca al estómago, y requieren la coordinación de algunos pares craneales, del tronco y la corteza cerebral, y de los músculos de la boca, la faringe y el esófago. El tratamiento de rehabilitación consiste en el posicionamiento del niño y el cuidador al momento de la alimentación, la regulación de la sensibilidad y el tono muscular perioral e intraoral, la coordinación lingual, el cierre labial, la regulación del flujo de leche, el control de la velocidad de las salvas y la adaptación de tetinas tanto para biberón como para seno materno. El procesamiento de la alimentación con el tratamiento se logró reducir a semana y media, mientras que en los RNP sin tratamiento este proceso llegó a tomar hasta 3 semanas.


Abstract Over the last 20 years, 640 premature newborns with alterations in suction-deglution have been taken care of in the neonatal intensive care unit at the Hospital Infantil de México Federico Gómez, using techniques for patients with immaturity, and neurological, gastrointestinal, cardiologic and respiratory pathologies. This descriptive study includes the treatment employed mainly in premature newborns during this period. Suction, swallowing and breathing coordination are some of the most complex abilities that premature newborns face, due to their anatomofunctional immaturity and improper sensoriomotor integration for the high energy requirements they must meet. Sucking and swallowing are voluntary and involuntary processes that guarantee the safe passage of food from mouth to stomach, and require the coordination of the cranial nerves, the brain stem and cerebral cortex and muscles of the mouth, pharynx and esophagus. The rehabilitation treatment consists in the positioning of the newborn and caretaker, adaptation of teat, regulation of muscle tone and progressive intake of milk. The feeding processing was reduced to 1.5 weeks in newborns submitted to treatment, whereas in those who did not receive the treatment, the proccess took up to 3 weeks.


Subject(s)
Humans , Infant, Newborn , Sucking Behavior/physiology , Deglutition Disorders/rehabilitation , Deglutition/physiology , Infant, Premature , Intensive Care Units, Neonatal , Mexico
15.
Audiol., Commun. res ; 23: e1933, 2018. tab
Article in Portuguese | LILACS | ID: biblio-950653

ABSTRACT

RESUMO Objetivo Descrever o conhecimento das equipes assistenciais sobre a disfagia e prescrição e administração de medicamentos orais em pacientes disfágicos adultos. Métodos Estudo transversal, realizado com médicos, enfermeiros e técnicos de enfermagem das unidades de internação e terapia intensiva em hospital universitário do Sul do Brasil. Participaram 102 profissionais, que responderam questionários adaptados e previamente testados para a pesquisa. As variáveis exploratórias foram: dados sociodemográficos; orientação acadêmica e profissional sobre disfagia; conhecimento sobre disfagia; fases da deglutição; sinais, sintomas e comorbidades associados à disfagia; manejo, prescrição e administração de medicações no paciente disfágico. Resultados Dos entrevistados, 93,5% dos médicos, 100% dos enfermeiros e 97,8% dos técnicos de enfermagem sabiam o que é disfagia. A maioria reconheceu o fonoaudiólogo como responsável pela reabilitação da deglutição, mas não identificou os sinais e sintomas da disfagia, sendo o engasgo na deglutição o mais reconhecido. Ao prescrever medicamentos, 58,1% dos médicos responderam que não cogitam vias alternativas (enteral ou endovenosa) para administração medicamentosa e 22,5%, que orientam a equipe de enfermagem sobre como administrar em pacientes disfágicos. A maioria dos enfermeiros e técnicos - 50,0% e 68,9% respectivamente -, informou que tritura o medicamento, misturando com água, e 65,4% e 46,7%, respectivamente, mencionaram que se sentem pouco preparados para administrar medicamentos em pacientes disfágicos. Conclusão O conhecimento das equipes assistenciais ainda é incipiente, quando relacionado ao cuidado do paciente adulto disfágico hospitalizado e ao uso de medicações por via oral. O compartilhamento de saberes, o investimento em educação permanente e a qualificação durante a formação destes profissionais é fundamental para melhorar o atendimento integral ao paciente.


ABSTRACT Purpose To describe the knowledge of healthcare teams about dysphagia, prescription, and administration of oral medications in dysphagic adult patients. Methods Cross-sectional study that included physicians, nurses, and nursing technicians from Hospitalization and Intensive Therapy Units of a university hospital in southern Brazil. A total of 102 professionals participated and answered an adapted and previously tested survey for this research. Exploratory variables were: sociodemographic data; academic and professional guidance on dysphagia; knowledge about dysphagia; phases of swallowing; signs, symptoms, and comorbidities associated with dysphagia; management, prescription, and administration of medications in the dysphagic patient. Results 93.5% of the physicians, 100% of the nurses, and 97.8% of the nursing technicians know what dysphagia is. Most recognize the speech therapist as being responsible for swallowing rehabilitation; however they do not identify the signs and symptoms of dysphagia; choking during swallow was the most recognized symptom. For prescription drugs, 58% of the physicians do not consider alternative routes (enteral or intravenous) for administration, and 22.5% advise the nursing staff on how to manage patients with dysphagia. Most nurses and nursing technicians, 50,0% and 68,9% respectively, crush the medicine and mix it with water; and 65,4% and 46,7%, respectively, feel unprepared to administer medications in patients with dysphagia. Conclusion The knowledge of healthcare teams is still incipient when it comes to the care of the hospitalized adult dysphagic patients and the use of oral medications. Knowledge sharing, investment in permanent education, and qualification during the education of these professionals is fundamental to improve the integral care to the patient.


Subject(s)
Humans , Adult , Drug Prescriptions , Deglutition Disorders/drug therapy , Administration, Oral , Deglutition , Deglutition Disorders/rehabilitation , Medication Therapy Management , Patient Safety , Intensive Care Units , Medication Errors
16.
Rev. Assoc. Med. Bras. (1992) ; 63(12): 1076-1081, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-896330

ABSTRACT

Summary Objective: Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia. Method: Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention. Results: Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01). Conclusion: Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Outpatient Clinics, Hospital/organization & administration , Parkinson Disease/rehabilitation , Deglutition Disorders/rehabilitation , Exercise Therapy/methods , Parkinson Disease/complications , Quality of Life , Tongue/physiopathology , Deglutition Disorders/etiology , Feasibility Studies , Patient Education as Topic , Multimedia , Middle Aged
17.
Article in English | LILACS | ID: biblio-900299

ABSTRACT

ABSTRACT: Therapy of malignant neoplasms of the tongue or oropharynx may cause dysphagia. Dysphagia in patients has negative significant social and psychological consequences. The six cases reports describe the effect of palatal augmentation prosthesis (PAP) on the management of dysphagia in patients with oral-pharyngeal cancer and as consequence of its treatment. The study also assesses PAP's effects on the quality of life of such patients.


Subject(s)
Humans , Male , Middle Aged , Aged , Palate , Tongue Neoplasms/complications , Deglutition Disorders/rehabilitation , Maxillofacial Prosthesis , Quality of Life , Tongue Neoplasms/psychology , Tongue Neoplasms/rehabilitation , Deglutition Disorders/etiology , Surveys and Questionnaires
18.
Rev. AMRIGS ; 61(1): 51-55, jan.-mar. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-849239

ABSTRACT

Introdução: Durante a internação hospitalar, os pacientes podem sofrer alterações funcionais, como limitações na ingestão de alimentos por via oral, por isso faz-se necessário o uso de via alternativa de alimentação. O fonoaudiólogo ingressa no atendimento hospitalar em uma equipe multidisciplinar, com a finalidade de prevenir e reduzir complicações, gerenciar a deglutição de maneira segura e eficaz. O objetivo deste estudo foi verificar os benefícios do tratamento fonoaudiológico aos pacientes em uso de via alternativa de alimentação. Métodos: Estudo desenvolvido em um hospital com pacientes internados nas enfermarias e Centro de Tratamento Intensivo. Analisaram-se prontuários de pacientes entre dezoito e noventa anos, em uso de via alternativa de alimentação, e classificou-se quanto ao tempo de internação, patologia de base, justificativa para o uso de via alternativa, ocorrência de pneumonia, evolução e via de alimentação na alta. A amostra dividiu-se em dois grupos, Com Acompanhamento Fonoaudiológico (CAF) e Sem Acompanhamento Fonoaudiológico (SAF). Resultados: A amostra foi composta por 288 prontuários, 32,5% com acompanhamento fonoaudiológico e 67,5% sem acompanhamento. A média de internação do grupo CAF foi maior que do grupo SAF. No CAF, 21,3% evoluíram a óbito e 78,7% tiveram alta hospitalar. No SAF, 47,4% evoluíram a óbito e 52,6% tiveram alta. No CAF, 45,7% receberam alta com via oral exclusiva, enquanto 18,6% do SAF tiveram alta com via oral exclusiva. Conclusão: O acompanhamento fonoaudiológico aumentou o tempo de internação hospitalar quando comparados os grupos, porém evidenciou uma diminuição do percentual de óbitos e aumentou a alta hospitalar com via oral exclusiva (AU)


Introduction: During hospitalization, patients may suffer functional changes, such as limitations in oral food intake, which demand the use of an alternative feeding route. The speech therapist enters the hospital's care in a multidisciplinary team, in order to prevent and reduce complications, to manage swallowing safely and effectively. The aim of this study was to determine the benefits of speech therapy for patients using an alternative feeding route. Methods: A study developed in a hospital with inpatients in the wards and Intensive Care Unit. Medical charts of patients between 18 and 90 years old using alternative feeding route were analyzed and classified as for time of hospitalization, baseline pathology, justification for the use of alternative route, pneumonia, evolution, and feeding route at discharge. The sample was divided in two groups, one with speech therapy (WST) and the other with no speech therapy (NST) follow up. Results: The sample consisted of 288 charts, 32.5% with speech therapy and 67.5% without it. The mean hospitalization rate in the WST group was higher than in the NST group. In the WST, 21.3% patients died and 78.7% were discharged from hospital. In the NST, 47.4% patients died and 52.6% were discharged. In the WST, 45.7% were discharged with exclusive oral route, while 18.6% of the NST were discharged with exclusive oral route. Conclusion: Speech therapy increased hospitalization time when the groups were compared, but it evidenced a decrease in the percentage of deaths and increased hospital discharge with exclusive oral route (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Deglutition Disorders/rehabilitation , Enteral Nutrition/adverse effects , Speech Therapy , Cross-Sectional Studies , Treatment Outcome
19.
CoDAS ; 29(3): e20160088, 2017. tab
Article in Portuguese | LILACS | ID: biblio-840138

ABSTRACT

RESUMO Objetivo O objetivo desta pesquisa foi verificar se há melhora funcional do padrão de deglutição em indivíduos identificados com risco para disfagia orofaríngea após quatro semanas da realização de exercícios orofaríngeos específicos com intensidade e duração pré-determinados. Método Esta pesquisa é de caráter longitudinal de efeito funcional, determinado por medidas comparativas inicial e final. A população-alvo foi constituída de indivíduos adultos e idosos selecionados por 24 meses. Foi incluído para esta pesquisa um total de 68 indivíduos. Foi realizada avalição clínica da deglutição e observados sinais clínicos para disfagia. Os indivíduos foram divididos em dois grupos de acordo com o nivelamento inicial na escala ASHA NOMS. No Grupo 1 (G1) – ASHA NOMS, inicial de níveis 1 e 2; Grupo 2 (G2) – ASHA NOMS, inicial de níveis 3, 4 e 5. Todos os indivíduos realizaram um protocolo de exercícios por quatro semanas. O protocolo conta com sessões presenciais e continuidade das atividades em ambiente domiciliar. Ao final, foi realizada nova mensuração do desempenho de deglutição. Resultados Para o grupo G2 houve melhora estatisticamente significante. Para o G1, a relação não foi significante, apesar de mudança intensa na escala ASHA NOMS, porém, neste grupo, temos um número reduzido de indivíduos devido à gravidade do perfil. Conclusão O programa se mostrou efetivo, pois, após as quatro sessões de exercícios, houve melhora importante no padrão de deglutição, demonstrada pela escala funcional.


ABSTRACT Purpose The objective was to determine if there was functional improvement of swallowing pattern in subjects identified with risk of oropharyngeal dysphagia after four weeks of specific oropharyngeal exercises. These exercises have pre-determined intensity and duration. Methods It is a longitudinal study of functional effect, determined by initial and final comparative measures. Participants were adults and elderly, selected in a period of 24 months. A total of 68 participants were included. All subjects had a clinical evaluation of swallowing, and an initial measure in a functional scale. The individuals were split into two groups, according to the initial levelling of ASHA NOMS scale. In Group 1 (G1) - ASHA NOMS, initial of levels 1 and 2; Group 2 (G2) - ASHA NOMS, initial of levels 3, 4 and 5. All subjects executed an exercise protocol performed for four weeks. The protocol includes sessions with a speech therapist, and continuity of activities in home environment. Finally, new measurement of swallowing performance was held. Results For G2 group there was statistically significant improvement. For G1, the relation was insignificant, despite the intense change in ASHA NOMS scale, however, in this group there was a reduced number of individuals due to the profile severity. Conclusion The program was effective because after four exercise sessions, there was significant improvement in swallowing pattern, demonstrated by functional scale.


Subject(s)
Humans , Adult , Deglutition Disorders/rehabilitation , Deglutition , Exercise Therapy/methods , Severity of Illness Index , Brazil , Deglutition Disorders/diagnosis , Risk Factors , Longitudinal Studies , Middle Aged
20.
Rev. chil. fonoaudiol. (En línea) ; 15: 1-10, nov. 2016. tab
Article in Spanish | LILACS | ID: biblio-869722

ABSTRACT

El fonoaudiólogo es el principal profesional en la rehabilitación no farmacológica y no quirúrgica del usuario con disfagia. Su participación es fundamental tanto para el aminoramiento del riesgo de aspiración o penetración laríngea, como para mejorar o restaurar la función deglutoria. Para este fin, posee opciones terapéuticas directas e indirectas, cuya elección y aplicación dependerá de la patología que curse el usuario, las redes que posea para su recuperación y la motivación intrínseca del mismo. Entre las estrategias de intervención indirecta se encuentra el Tratamiento Sensorio-Motor Oral (OSMT, por sus siglas en inglés), el cual pretende producir una aceleración en el desencadenamiento del proceso deglutorio mediante la ejercitación de los músculos orofaciales en conjunto con diferentes estímulos sensoriales (específicamente la temperatura fría y el sabor ácido). La presente revisión tiene por objetivo dilucidar si la utilización de la temperatura fría y el sabor ácido son útiles como mecanismo de intervención indirecta de la disfagia. Se concluye que las acciones propuestas son efectivas simplemente como mecanismos compensatorios en el proceso deglutorio, puesto que modifican las características del bolo alimenticio e incrementan momentáneamente las sensaciones intraorales.


The speech-language pathologist (SLP) is the main professional in the nonpharmacological and non-surgical rehabilitation of patients with dysphagia. Their role is essential for both reducing the risk of aspiration or laryngeal penetration and improving or restoring the swallowing function. To this end, the SLP has direct and indirect therapeutic options, whose choice and application will depend on the patient’s condition, support networks, and their intrinsic motivation. As part of the indirect intervention strategies, the oral sensorymotor treatment (OSMT) aims to exercise the orofacial muscles, and introduce sensory input by the application of cold temperature and sour taste to increase the triggering speed of the swallowing reflex. This review seeks to determine whether the use of cold temperature and sour taste are effective indirect mechanisms for treating patients with dysphagia. It is concluded that the proposed actions in this review are useful simply as compensatory mechanisms in the swallowing process, as they modify the bolus properties and increase, temporarily, the intra-oral sensations.


Subject(s)
Humans , Cold Temperature , Speech, Language and Hearing Sciences/methods , Taste/physiology , Deglutition Disorders/rehabilitation , Acids , Deglutition/physiology , Pharynx/physiopathology , Stimulation, Chemical , Deglutition Disorders/therapy
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