RESUMO
Abstract Introduction Neurological alterations can generate swallowing disorders and fiberoptic endoscopic evaluation of swallowing is one of the tests performed for its diagnosis, as well as assistance in dysphagia management. Objective To identify and describe a fiberoptic endoscopic evaluation of swallowing standardized protocol for the neurological adult population and its stages. Methods Systematic review registered on the PROSPERO platform (CRD42018069428), carried out on the websites: MEDLINE, Cochrane Library and Scielo; published between 2009 and 2020. Randomized clinical trials, cross-sectional, and longitudinal studies were included. Two independent judges evaluated the study design and extracted the data from the selected studies. Doubts regarding inclusion or not of the studies were evaluated by a third judge. Scientific articles included were those with adult neurological remained patients with outcomes: (1) diagnosis of swallowing disorder (2) change in sensitivity in laryngeal region (3) penetration of food offered (4) aspiration of food offered. Results 3724 articles were initially selected, after personalized search for patients with neurological alterations 101 studies remained. In the end, 21 qualitative studies from 2009 to 2020 remained in the systematic review and they were described in detail and compared. Seven articles used protocols of the institutions in which the research took place and four mentioned using the same protocol. The reliable reproducibility of the protocols is feasible only in three of the articles, even presenting different protocols. Conclusion There is no standard or validated protocol to assess the swallowing function of adults with neurological diseases.
Resumo Introdução As alterações neurológicas podem gerar distúrbios deglutitórios e a videoendoscopia da deglutição é um dos exames feitos para o seu diagnóstico e auxílio no manejo da disfagia. Objetivo Identificar e descrever o protocolo para videoendoscopia da deglutição padronizado para a população adulta com transtornos neurológicos e suas etapas. Método Revisão sistemática registrada na plataforma Prospero (CRD42018069428), realizada nos sites: Medline, Cochrane Library e Scielo; publicados entre 2009 e 2020. Foram incluídos ensaios clínicos randomizados, estudos transversais e longitudinais. Dois avaliadores independentes analisaram o delineamento do estudo e extrairam os dados dos estudos selecionados. As dúvidas de inclusão ou não dos estudos foram avaliadas por um terceiro avaliador. Artigos científicos incluídos englobam pacientes adultos neurológicos. Os desfechos avaliados: 1) diagnóstico de distúrbio deglutitório ou disfagia; (2) alteração de sensibilidade em região laríngea; (3) penetração laríngea do bolo alimentar ofertado; (4) aspiração traqueal do bolo alimentar ofertado. Resultados Foram selecionados inicialmente 3.724 artigos, após busca personalizada para pacientes com alterações neurológicas permaneceram 101 estudos. Ao final, 21 estudos qualitativos de 2009 a 2020 permaneceram na revisão sistemática e foram descritos detalhadamente e comparados. Sete estudos usaram protocolos das instituições promotoras e quatro citaram usar o mesmo protocolo. A reprodutibilidade fidedigna dos protocolos é viável apenas em três dos artigos, mesmo com protocolos diferentes. Conclusões Não há protocolo padronizado ou validado para avaliar a deglutição da população adulta neurológica.
RESUMO
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.