Objetivo: Determinar a ocorrência de sinais clínicos de disfagia em lactentes com bronquiolite viral aguda. Métodos: Estudo transversal, com 42 lactentes, entre 0 e 12 meses, previamente hígidos, recebendo dieta via oral e internados com bronquiolite viral aguda. A avaliação clínica da deglutição foi acompanhada das medidas da frequência respiratória e oximetria de pulso. Foi elaborado escore de alterações de deglutição para estabelecer associações com demais variáveis do estudo. Realizada a concordância intra e entre examinadores. Os cuidadores responderam um questionário sobre comportamento de alimentação. O nível de significância utilizado foi p<0,05. Resultados: Foram encontradas alterações na fase oral (pausas prolongadas) e faríngea (respiração ruidosa, tosse e engasgos) da deglutição. Houve aumento significativo da frequência respiratória entre o momento pré e pós alimentação e quase metade dos lactentes apresentaram taquipnéia. Observou-se associação entre o escore de alterações de deglutição e a queda de saturação de oxigênio. Apesar da associação do número de alterações de deglutição com o aumento da frequência respiratória não ter sido significativa, as crianças com maior número de alterações de deglutição tenderam a apresentar frequência respiratória mais elevada. Não houve diferença significativa entre as duas avaliações do mesmo observador (p>0,05), entretanto na concordância entre examinadores houve diferença significativa entre os dois avaliadores quanto à cinco itens da avaliação. Os lactentes cujos cuidadores relataram dificuldades de alimentação durante a internação tiveram um número significativamente maior de alterações de deglutição na avaliação. Conclusão: Lactentes com bronquiolite viral aguda apresentaram alterações da deglutição, acrescidas de mudanças na frequência respiratória e nas medidas das taxas de saturação de oxigênio. Sugere-se, assim, risco para a disfagia. / Objective: To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis. Methods: Cross-sectional study of 42 infants between 0 and 12 months, previously healthy, receiving oral diet and hospitalized with acute viral bronchiolitis. Clinical evaluation of swallowing was accompanied by measurements of respiratory rate and pulse oximetry. Score of swallowing dysfunction was developed to establish associations with other study variables. An agreement among the examiners was reached. Caregivers answered a questionnaire on feeding behavior. The level of significance was p <0.05. Results: Alterations in the oral phase (prolonged pauses) and pharyngeal phase (wheezing, coughing and gagging) of swallowing were found in the study. There was a significant increase in respiratory rate between the time before and after feeding and nearly half of the infants had tachypnea. It was observed a relation between the score of swallowing dysfunction and fall of oxygen saturation. Although the association of the number of swallowing disorders with the increase of respiratory rate was not significant, children with larger changes in swallowing tended to have higher respiratory rate. There was no significant difference between the two evaluations of the same observer (p> 0.05), however in the agreement between examiners there was significant difference between the two raters on the five items of the assessment. Infants whose caregivers reported feeding difficulties during hospitalization had a significantly greater number of changes in the evaluation of swallowing. Conclusion: Infants with acute viral bronchiolitis showed abnormal swallowing, plus changes in respiratory frequency and measures the rate of oxygen saturation. It is suggested, therefore, risk for dysphagia.

Chan, Sze Ling. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 145-156). / Abstracts in English and Chinese; some appendixes in Chinese. / Declaration of Originality --- p.i / Acknowledgements --- p.ii / Abstract --- p.iv / 摘要(Abstract in Traditional Chinese) --- p.vii / Table of Contents --- p.ix / Abbreviations --- p.xvi / List of Figures --- p.xviii / List of Tables --- p.xix / Chapter Chapter 1 --- Literature Review --- p.1 / Chapter 1.1 --- What is neurogenic dysphagia? --- p.2 / Chapter 1.2 --- Prevalence of neurogenic dysphagia --- p.3 / Chapter 1.2.1 --- The prevalence of dysphagia in stroke --- p.3 / Chapter 1.2.2 --- The prevalence of dysphagia in dementias --- p.4 / Chapter 1.2.3 --- The prevalence of dysphagia in PD --- p.5 / Chapter 1.2.4 --- The prevalence of dysphagia in progressive supranuclear palsy (PSP) --- p.5 / Chapter 1.2.5 --- The prevalence of dysphagia in age-related changes --- p.5 / Chapter 1.3 --- Characteristics of neurogenic dysphagia --- p.6 / Chapter 1.3.1 --- Characteristics of dysphagia in stroke --- p.7 / Chapter 1.3.2 --- Characteristics of dysphagia in PD --- p.8 / Chapter 1.3.3 --- Characteristics of dysphagia in dementias --- p.9 / Chapter 1.3.4 --- Characteristics of dysphagia in age-related changes --- p.9 / Chapter 1. 4 --- Complications and prognosis of neurogenic dysphagia --- p.10 / Chapter 1.4.1 --- Complications --- p.10 / Chapter 1.4.2 --- Prognosis --- p.11 / Chapter 1.5 --- Managements of dysphagia --- p.13 / Chapter 1.5.1 --- Treating the underlying diseases --- p.13 / Chapter 1.5.2 --- Non-oral feeding --- p.13 / Chapter 1.5.3 --- Swallowing therapies --- p.14 / Chapter 1.5.3.1. --- Compensatory strategies --- p.14 / Chapter 1.5.3.2 --- Direct strategies --- p.16 / Chapter 1.5.3.3 --- Indirect strategies --- p.17 / Chapter 1.5.4 --- Medications --- p.19 / Chapter 1.5.5 --- Surgical interventions --- p.19 / Chapter 1.6 --- Management of dysphagia in Chinese medicine --- p.20 / Chapter 1.6.1 --- "Diagnosis, mechanisms and locations of dysphagia in Traditional Chinese medicine (TCM)" --- p.20 / Chapter 1.6.2 --- Use of acupoints in treating dysphagia in ancient Chinese medicine liteatures --- p.21 / Chapter 1.6.3 --- Use of acupuncture in treating dysphagia in recent Chinese medicine liteatures --- p.22 / Chapter 1.6.4 --- Reviews on the use of acupuncture in treating dysphagia --- p.25 / Chapter 1.7 --- Conslusion --- p.30 / Chapter Chapter 2 --- Methodology --- p.31 / Chapter 2.1 --- Study design --- p.32 / Chapter 2.2 --- Hypotheses of this study --- p.32 / Chapter 2.3 --- Objectives of this study --- p.32 / Chapter 2.4 --- Ethics approval --- p.32 / Chapter 2.5 --- Qualification & experience of the acupuncturists --- p.33 / Chapter 2.6 --- Subjects --- p.33 / Chapter 2.6.1 --- Setting --- p.33 / Chapter 2.6.2 --- Inclusion criteria --- p.33 / Chapter 2.6.3 --- Exclusion criteria --- p.34 / Chapter 2.7 --- Method of randomization and blinding --- p.35 / Chapter 2.7.1 --- Experimental group and control group1 --- p.35 / Chapter 2.7.2 --- Control group2 --- p.36 / Chapter 2.8 --- Sample size --- p.36 / Chapter 2.9 --- Procedures --- p.37 / Chapter 2.9.1 --- Screening and recruitment of subjects --- p.37 / Chapter 2.9.2 --- Baseline --- p.37 / Chapter 2.9.2.1 --- Chinese medicine diagnoses --- p.37 / Chapter 2.9.2.2 --- Western medicine diagnoses --- p.40 / Chapter 2.9.2.3 --- Clinical bedside assessment --- p.40 / Chapter 2.9.2.4 --- Procedure of fiberoptic endoscopic evaluation of swallowing --- p.41 / Chapter 2.9.3 --- Interventions --- p.43 / Chapter 2.9.3.1 --- Experimental group --- p.44 / Chapter 2.9.3.2 --- Control group1 --- p.53 / Chapter 2.9.3.3 --- Control group2 --- p.53 / Chapter 2.9.4 --- On completion of acupuncture treatments --- p.54 / Chapter 2.9.5 --- Follow-up assessment --- p.54 / Chapter 2.10 --- Adverse effects --- p.55 / Chapter 2.11 --- Outcome measures --- p.56 / Chapter 2.11.1 --- Primary outcome --- p.56 / Chapter 2.11.2 --- Secondary outcome --- p.58 / Chapter 2.11.3 --- Data collection --- p.59 / Chapter 2.12 --- Treatment compliance --- p.60 / Chapter 2.13 --- Statistical analysis --- p.60 / Chapter Chapter 3 --- Results --- p.62 / Chapter 3.1 --- Baseline data --- p.63 / Chapter 3.2 --- Diagnoses --- p.67 / Chapter 3.2.1 --- Western medicine diagnoses --- p.67 / Chapter 3.2.2 --- Chinese medicine diagnoses --- p.71 / Chapter 3.3 --- Data of acupuncture treatments --- p.72 / Chapter 3.3.1 --- Days of onset to the day of acupuncture treatment --- p.72 / Chapter 3.3.2 --- Sessions of acupuncture completed by experimental group and control group1 --- p.73 / Chapter 3.3.3 --- Follow-up compliance --- p.75 / Chapter 3.4 --- Primary outcome measures --- p.75 / Chapter 3.4.1 --- The Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS) --- p.75 / Chapter 3.4.1.1 --- Correlations of diagnoses and RBHOMS --- p.80 / Chapter 3.4.2 --- The Penetration-Aspiration Scale (PAS) --- p.81 / Chapter 3.5 --- Secondary outcome measures --- p.83 / Chapter 3.5.1 --- The food and fluid consistencies --- p.83 / Chapter 3.5.2 --- The body mass index (BMI) --- p.90 / Chapter 3.5.3 --- Aspiration pneumonia --- p.92 / Chapter 3.5.4 --- Mortality rate --- p.93 / Chapter 3.6 --- Other outcomes --- p.94 / Chapter 3.6.1 --- Nasogastric tube feeding --- p.94 / Chapter 3.7 --- Adverse effects --- p.95 / Chapter Chapter 4 --- Discussion --- p.99 / Chapter 4.1 --- The therapeutic effect and appropriate course of treatment of acupuncture on neurogenic dysphagia --- p.101 / Chapter 4.1.1 --- The therapeutic effect and long-term efficacy of acupuncture on neurogenic dysphagia --- p.101 / Chapter 4.1.2 --- The suggested course of acupuncture treatment --- p.117 / Chapter 4.2 --- The implications of the study --- p.119 / Chapter 4.3 --- The limitations of the study --- p.123 / Chapter 4.4 --- Conclusion and prospective for further study --- p.127 / Appendices --- p.128 / References --- p.145

Undernutrition and dysphagia in the institutionalized elderly are well documented in the literature. However, the clinical efficacy of diets to treat dysphagia have not been established. To offer a better understanding of the textural characteristics of the new Sainte-Anne's Hospital (SAH) modified texture reformed foods, rheological evaluations were performed. Apparent viscosity, consistency coefficient, flow behavior index and yield stress values were calculated for the thickened beverages. Texture profile analyses were performed on the reformed foods. Secondly, to evaluate the impact of SAH's reformed foods on nutritional intake and weight, a 12-week clinical trial was undertaken. Dysphagic frail elderly subjects (n = 17) of a long-term care facility of Montreal were randomly assigned to receive SAH reformed foods or traditional care. The experimental group demonstrated a significant increase in nutritional intake resulting in significant weight gain. These findings suggest that dysphagic frail elderly could reach healthy weight when adequately fed.

Thesis (M.S.)--Missouri State University, 2008. / "May 2008." Includes bibliographical references (leaves 41-45). Also available online.

Objetivo: Determinar a ocorrência de sinais clínicos de disfagia em lactentes com bronquiolite viral aguda. Métodos: Estudo transversal, com 42 lactentes, entre 0 e 12 meses, previamente hígidos, recebendo dieta via oral e internados com bronquiolite viral aguda. A avaliação clínica da deglutição foi acompanhada das medidas da frequência respiratória e oximetria de pulso. Foi elaborado escore de alterações de deglutição para estabelecer associações com demais variáveis do estudo. Realizada a concordância intra e entre examinadores. Os cuidadores responderam um questionário sobre comportamento de alimentação. O nível de significância utilizado foi p<0,05. Resultados: Foram encontradas alterações na fase oral (pausas prolongadas) e faríngea (respiração ruidosa, tosse e engasgos) da deglutição. Houve aumento significativo da frequência respiratória entre o momento pré e pós alimentação e quase metade dos lactentes apresentaram taquipnéia. Observou-se associação entre o escore de alterações de deglutição e a queda de saturação de oxigênio. Apesar da associação do número de alterações de deglutição com o aumento da frequência respiratória não ter sido significativa, as crianças com maior número de alterações de deglutição tenderam a apresentar frequência respiratória mais elevada. Não houve diferença significativa entre as duas avaliações do mesmo observador (p>0,05), entretanto na concordância entre examinadores houve diferença significativa entre os dois avaliadores quanto à cinco itens da avaliação. Os lactentes cujos cuidadores relataram dificuldades de alimentação durante a internação tiveram um número significativamente maior de alterações de deglutição na avaliação. Conclusão: Lactentes com bronquiolite viral aguda apresentaram alterações da deglutição, acrescidas de mudanças na frequência respiratória e nas medidas das taxas de saturação de oxigênio. Sugere-se, assim, risco para a disfagia. / Objective: To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis. Methods: Cross-sectional study of 42 infants between 0 and 12 months, previously healthy, receiving oral diet and hospitalized with acute viral bronchiolitis. Clinical evaluation of swallowing was accompanied by measurements of respiratory rate and pulse oximetry. Score of swallowing dysfunction was developed to establish associations with other study variables. An agreement among the examiners was reached. Caregivers answered a questionnaire on feeding behavior. The level of significance was p <0.05. Results: Alterations in the oral phase (prolonged pauses) and pharyngeal phase (wheezing, coughing and gagging) of swallowing were found in the study. There was a significant increase in respiratory rate between the time before and after feeding and nearly half of the infants had tachypnea. It was observed a relation between the score of swallowing dysfunction and fall of oxygen saturation. Although the association of the number of swallowing disorders with the increase of respiratory rate was not significant, children with larger changes in swallowing tended to have higher respiratory rate. There was no significant difference between the two evaluations of the same observer (p> 0.05), however in the agreement between examiners there was significant difference between the two raters on the five items of the assessment. Infants whose caregivers reported feeding difficulties during hospitalization had a significantly greater number of changes in the evaluation of swallowing. Conclusion: Infants with acute viral bronchiolitis showed abnormal swallowing, plus changes in respiratory frequency and measures the rate of oxygen saturation. It is suggested, therefore, risk for dysphagia.

Objetivo: Determinar a ocorrência de sinais clínicos de disfagia em lactentes com bronquiolite viral aguda. Métodos: Estudo transversal, com 42 lactentes, entre 0 e 12 meses, previamente hígidos, recebendo dieta via oral e internados com bronquiolite viral aguda. A avaliação clínica da deglutição foi acompanhada das medidas da frequência respiratória e oximetria de pulso. Foi elaborado escore de alterações de deglutição para estabelecer associações com demais variáveis do estudo. Realizada a concordância intra e entre examinadores. Os cuidadores responderam um questionário sobre comportamento de alimentação. O nível de significância utilizado foi p<0,05. Resultados: Foram encontradas alterações na fase oral (pausas prolongadas) e faríngea (respiração ruidosa, tosse e engasgos) da deglutição. Houve aumento significativo da frequência respiratória entre o momento pré e pós alimentação e quase metade dos lactentes apresentaram taquipnéia. Observou-se associação entre o escore de alterações de deglutição e a queda de saturação de oxigênio. Apesar da associação do número de alterações de deglutição com o aumento da frequência respiratória não ter sido significativa, as crianças com maior número de alterações de deglutição tenderam a apresentar frequência respiratória mais elevada. Não houve diferença significativa entre as duas avaliações do mesmo observador (p>0,05), entretanto na concordância entre examinadores houve diferença significativa entre os dois avaliadores quanto à cinco itens da avaliação. Os lactentes cujos cuidadores relataram dificuldades de alimentação durante a internação tiveram um número significativamente maior de alterações de deglutição na avaliação. Conclusão: Lactentes com bronquiolite viral aguda apresentaram alterações da deglutição, acrescidas de mudanças na frequência respiratória e nas medidas das taxas de saturação de oxigênio. Sugere-se, assim, risco para a disfagia. / Objective: To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis. Methods: Cross-sectional study of 42 infants between 0 and 12 months, previously healthy, receiving oral diet and hospitalized with acute viral bronchiolitis. Clinical evaluation of swallowing was accompanied by measurements of respiratory rate and pulse oximetry. Score of swallowing dysfunction was developed to establish associations with other study variables. An agreement among the examiners was reached. Caregivers answered a questionnaire on feeding behavior. The level of significance was p <0.05. Results: Alterations in the oral phase (prolonged pauses) and pharyngeal phase (wheezing, coughing and gagging) of swallowing were found in the study. There was a significant increase in respiratory rate between the time before and after feeding and nearly half of the infants had tachypnea. It was observed a relation between the score of swallowing dysfunction and fall of oxygen saturation. Although the association of the number of swallowing disorders with the increase of respiratory rate was not significant, children with larger changes in swallowing tended to have higher respiratory rate. There was no significant difference between the two evaluations of the same observer (p> 0.05), however in the agreement between examiners there was significant difference between the two raters on the five items of the assessment. Infants whose caregivers reported feeding difficulties during hospitalization had a significantly greater number of changes in the evaluation of swallowing. Conclusion: Infants with acute viral bronchiolitis showed abnormal swallowing, plus changes in respiratory frequency and measures the rate of oxygen saturation. It is suggested, therefore, risk for dysphagia.

Introdução: O Diabetes Melito afeta o sistema digestório ao longo dos anos. Embora seja grande o relato da ocorrência de disfagia nesta população, não existem na literatura descrições da frequência de dificuldade na deglutição destes pacientes. Objetivo: Esta pesquisa teve como objetivo caracterizar a presença de sintomas autorreferidos de dificuldade de deglutição nos pacientes portadores de Diabetes Melito e relacioná-los com idade, sexo, índice de massa corporal, controle glicêmico, tratamento medicamentoso, tempo de diagnóstico do diabetes e suas complicações. Materiais e Métodos: Foram selecionados 221 indivíduos adultos portadores de Diabetes Melito para compor os grupos Diabetes Melito tipo 1 (GDM1) e Diabetes Melito tipo 2 (GDM2). O GDM1 consistiu de 112 indivíduos, 36 homens e 76 mulheres, média de 36 anos e o GDM2 de 109 indivíduos, sendo 39 homens e 70 mulheres com idade média de 57 anos. Foram selecionados ainda 217 adultos para compor o Grupo Controle (GC), divididos em Grupo Controle Diabetes Melito tipo 1 (GC1) e Grupo Controle Diabetes Melito tipo 2 (GC2) selecionados de acordo com a idade e sexo do grupo estudo. Tais participantes responderam ao questionário de autoavaliação alimentar Eating Assessment Tool (EAT-10), a fim de mensurar suas dificuldades de deglutição para identificação do risco de disfagia. A possibilidade de disfagia no EAT-10 foi definida quando os resultados foram >=3. Resultados: Os indivíduos com Diabetes Melito tipo 2 apresentaram maior frequência de disfagia, uma vez que a comparação entre os grupos de estudo GDM1 e GDM2 evidenciou que os indivíduos do grupo GDM2 pontuaram mais no protocolo EAT-10 do que os do GDM1, com uma diferença de 1,38 pontos (p 0,003). Os resultados do EAT-10 para os indivíduos com Diabetes Melito sofreram influência da idade, sexo, tempo de diagnóstico, dosagem de hemoglobina glicada, presença de neuropatia diabética, nefropatia e retinopatia, bem como medicamentos anti-hipertensivos e antiaglutinantes plaquetários. Conclusão: Os Dissertação de Mestrado 8 indivíduos com Diabetes Melito tipo 2 que apresentam maior tempo de diagnóstico da doença e com controle glicêmico alterado apresentaram maiores frequências de sintomas de disfagia em relação aos indivíduos com Diabetes Melito tipo 1. Estudos futuros são necessários para caracterizar a biodinâmica da deglutição nesses indivíduos. / Introduction: Diabetes mellitus affects the digestive system over the years. Although the occurrence of dysphagia in this population is large, there are no descriptions in the literature of the frequency of dysphagia in these patients. Objective: This study aimed to characterize the presence of self-reported symptoms of swallowing difficulty in diabetic patients and to relate them to age, sex, body mass index, glycemic control, drug treatment, time of diagnosis and others complications. Materials and Methods: Twentyone adult individuals with Diabetes mellitus were selected to form the groups Diabetes mellitus type 1 (GDM1) and Diabetes mellitus type 2 (GDM2). GDM1 consisted of 112 individuals, 36 men and 76 women, mean age of 36 years, and GDM2 of 109 individuals, 39 men and 70 women and 117 adults to be part of the Control Group (CG), selected according to age and sex of the study group. These participants answered a self-assessment questionnaire regarding their swallowing difficulties, in order to identify the risk of dysphagia. The possibility of dysphagia in EAT-10 was defined when the results were >=3. Results: Individuals with type 2 diabetes mellitus presented greater symptoms of dysphagia. The results of the EAT-10 for individuals with Diabetes were influenced by age, sex, time of diagnosis, glycated hemoglobin levels, presence of diabetic neuropathy, nephropathy and retinopathy, as well as antihypertensive drugs and platelet anti-caking agents. Conclusion: Individuals with type 2 diabetes mellitus who present a longer diagnosis and with altered glycemic control presented greater symptoms of dysphagia. Future studies are needed to characterize the biodynamics of swallowing in these individuals.

No description available.

Master of Dental Surgery / This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

Dysphagia, which refers to difficulties in swallowing, is a common clinical dysfunction with high morbidity in the ageing population. At least four validated questionnaires are available for assessing swallowing-related quality of life. These include the M. D. Anderson Dysphagia Inventory (MDADI), the Swallow Quality-of-Life Questionnaire (SWAL-QOL), the Sydney Swallowing Questionnaire (SSQ) and the Dysphagia Handicap Index (DHI). However, these questionnaires are either designed for some specific dysphagic populations or only focused on the impact of swallowing disorders at the impairment level. The Swallowing Activity and Participation Profile (SAPP) has been developed and validated as a self-reported tool for dysphagic population to assess the effects of swallowing problems on the physical, functional and social aspects of quality of life. It is common to find the elderly population exhibiting cognitive impairment. Elderly people with cognitive impairment may have difficulties completing the questionnaire by themselves. In such cases, family members or caregivers are often asked to judge how the dysphagic individuals are affected by the swallowing dysfunction. There are, however, most of the previous studies failed to investigate the validity and reliability of such proxy method. Thus, the objective of this study was to verify the reliability of proxy method in assessing swallowing-related quality of life for frail elderly people who are not able to finish the self-reported questionnaire because of their cognitive impairment. Forty-six elderly individuals (24 males and 22 females) and their respective caregivers (six males and 36 females) participated in this study. All the elderly received a clinical swallowing assessment to confirm the existence and the severity of dysphagia. They were assigned into the dysphagic group and the non-dysphagic group according to the results of swallowing assessment, and then asked to complete a quality of life questionnaire (SAPP) and a swallowing function scale, called Eating Assessment Tool (EAT-10). Their caregivers were invited to complete the same assessment tasks from the perspective of the elderly and to report how they perceived the elderly persons’ swallowing–related quality of life as the proxies. The scores obtained from the questionnaires filled out by the elderly participants and their caregivers were compared. The findings showed that there was no statistically significant agreement between the elderly and the caregivers. The association between the responses of the elderly and the caregivers on quality of life was not as strong as what was hypothesized at the beginning of this study. However, the test-retest reliability of the instrument of this study was good, as shown by the intra-class correlation coefficient in the elderly group. The current study found that dysphagia had a negative impact on the dysphagic elderly’s emotional well-being, but was not clear if the proxy method could be used as a valid and reliable method for assessing the elderly’s swallowing-related quality of life. Further studies with a larger sample size and a wider range of dysphagia severity are needed. / published_or_final_version / Speech and Hearing Sciences / Master / Master of Philosophy