Introdução e Objetivos: A intubação orotraqueal (IOT) é utilizada no centro de tratamento intensivo (CTI) em pacientes graves que precisam de auxílio para manter a respiração. Quando prolongada é considerada um dos principais fatores de risco para disfagia orofaríngea (DOF). Nestes casos, o controle neurológico central e nervos periféricos estão intactos, mas as estruturas anatômicas responsáveis pela deglutição podem sofrer prejuízos. O tratamento para a DOF visa proteger as vias aéreas e garantir a nutrição. A terapia de reabilitação da deglutição, através de técnicas e exercícios orofaciais e vocais, parece ser benéfica em pacientes disfágicos. Sendo assim, essa pesquisa apresentou como objetivo avaliar a eficácia da fonoterapia em pacientes com DOF, pós-intubados e sem comorbidades neurológicas. Metodologia: Foram avaliados 240 pacientes, dos quais 40 (16,6%) apresentaram DOF. De acordo com os critérios de inclusão e exclusão, trinta e dois pacientes foram incluídos no estudo realizado de setembro de 2010 a dezembro 2012 no CTI de um hospital universitário. Os pacientes foram randomizados em dois grupos: tratamento fonoaudiológico e controle, sendo que o primeiro (53%) recebeu orientações, técnicas terapêuticas, manobras de proteção de via aérea e de limpeza glótica, exercícios oromiofuncionais e vocais e introdução de dieta; o acompanhamento ocorreu durante 10 dias. Os dados da anamnese foram coletados do prontuário e o local de atendimento de todos os sujeitos foi à beira do leito. Os desfechos primários do estudo foram o tempo de permanência com sonda nasoentereral (SNE) e os níveis da escala FOIS. Resultados e Discussão: O grupo tratado permaneceu por menos tempo com SNE (mediana de 3 dias) em comparação ao grupo controle (mediana de 10 dias) (p< 0,001). No grupo controle houve o dobro de sujeitos com a SNE por ainda apresentarem DOF ao final do tempo de acompanhamento fonoaudiológico. O grupo tratado apresentou evolução significativa nos níveis da escala FOIS (entre 4 e 7) em relação ao controle (p=0,005). O grupo tratado apresentou evolução favorável nos níveis de gravidade pelo protocolo PARD (DOF moderada passou para leve). A consistência alimentar líquida (água) foi a que os pacientes mais apresentaram sinais clínicos de DOF. As doenças respiratórias foram as mais frequentes em ambos os grupos. Conclusões: Os achados desse estudo demonstram que o tratamento fonoaudiológico favorece a progressão mais rápida de alimentação por SNE para via oral em pacientes pós-intubados. Isto sugere que a Fonoaudiologia, na área de DOF, tem um papel importante dentro do plano de tratamento destes indivíduos, hipótese que deve ser confirmada por estudos adicionais. / Introduction: In intensive care units (ICU), orotracheal intubation (OTI) is used in severe patients who need assistance to maintain breathing. When OTI is prolonged, it is considered one of the main risk factors for oropharyngeal dysphagia (OPD). In these cases, the central neurological control and peripheral nerves are intact, but the anatomical structures responsible for swallowing may suffer damages. Treatment of OPD aims to protect the airways and nutrition of individuals. Swallowing rehabilitation therapy, by means of orofacial and vocal techniques and exercises, seems to be beneficial to dysphagic patients. Thus, this research presented as objective to evaluate the efficacy of the speech therapy in patients with OPD, post-intubated and without neurological comorbidities. Material and Methods: The recruitment period of the study was from September 2010 to December 2012 in the ICU of a university hospital. Two hundred and forty patients were assessed, of whom 40 presented OPD (16.6%). According to the inclusion and exclusion criteria, thirty-two patients were included in the study. Patients were randomized in two groups: speech treatment and control, and the first (53%) received daily, for a maximum period of 10 days, assessment, guidance, therapeutic techniques, airway protection and glottal cleaning maneuvers, oromiofunctional and vocal exercises, as well as introduction of diet. Anamnesis data were collected from the patient’s medical records, and all individuals were seen on the hospital bedside. Primary study outcomes were length of stay with nasoenteric tube (NET) and levels on the FOIS scale. Results and Discussion: When compared to the control group (median of 10 days), NET permanence was shorter in the treated group (median of 3 days) (p<0.001). The control group there was twice the number of individuals with NET because they still presented OPD at the end of the speech therapy follow up. The treated group showed a significant evolution in levels on the FOIS scale (between 4 and 7) when compared to the control group (p=0.005). The treated group presented a favorable evolution in severity levels by the PARD (from moderate to mild OPD). Patients showed most clinical signs of OPD with liquid-consistency (water). Respiratory disorders were the most frequent in both groups. During treatment, in some cases it was not possible to complete the length of intervention. In the GT, interruption happened in 2 cases (11.8%) due to death, in 3 cases, (17.6%) due to reintubation, in one patient (5.9%) due to clinical worsening and in one patient (5.9%) due to withdrawal from treatment. In the GC, 4 (26.7%) patients were re-intubated. All these patients remained in the study for an intention-to-treat analysis (ITT). Conclusion: The findings of this study demonstrate that speech therapy favors a faster progression from NET feeding to oral feeding in post-intubated patients. His suggests that Speech Therapy in OPD area, has an important role in the treatment plan of these individuals, this hypothesis should be confirmed by additional studies.

Este estudo foi realizado com os seguintes objetivos: identificar a frequência e os preditores de disfagia em pacientes com Acidente Vascular Cerebral (AVC); avaliar o impacto da disfagia quanto aos desfechos dependência funcional e óbito em três meses após o AVC; e validar o teste de rastreio para disfagia Toronto Bedside Swallowing Screening Test (TOR-BSST©) em pacientes com AVC de um hospital público no Brasil. Participaram do estudo pacientes admitidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) e incluídos no Registro de Acidente Vascular Encefálico (REAVER) no período de abril de 2015 a setembro de 2016, maiores de 18 anos, com diagnóstico de AVC agudo (<10 dias entre o AVC e a admissão hospitalar) confirmado por exames de neuroimagem. Foram excluídos pacientes com ataque isquêmico transitório, hemorragia subaracnóidea, trombose venosa cerebral, ictus antigo, AVC hemorrágico de causa secundária ou aqueles que não concordaram em participar do estudo. As características demográficas e clínicas foram coletadas de forma prospectiva pelos coordenadores de pesquisa do REAVER. A deglutição foi avaliada na primeira semana da admissão hospitalar à beira do leito, por três fonoaudiólogas, com um protocolo de avaliação clínica utilizando as consistências pastosa e líquida. Os pacientes foram avaliados com o teste TORBSST© e com a videofluoroscopia após a alta hospitalar. A escala modificada de Rankin, o Índice de Barthel e a Medida de Independência Funcional (MIF) foram utilizados para avaliar os desfechos funcionais de três meses após o AVC. No período do estudo foram admitidos 831 pacientes com AVC, sendo que 353 pacientes foram excluídos de acordo com os critérios de inclusão e exclusão. Dos pacientes elegíveis, 53 foram removidos das análises por receberem alta antes da avaliação da deglutição, portanto, foram incluídos 425 pacientes. Dentre os pacientes incluídos, 28,2% não apresentaram condições para avaliação clínica da deglutição e foram considerados no grupo de disfagia presumida. Desta forma, foram examinados com avaliação clínica da deglutição 305 pacientes, sendo que 45,2% foram diagnosticados com disfagia. Idade (p=0,017), história médica conhecida de apneia obstrutiva do sono (p=0,003) e gravidade do AVC na admissão hospitalar (p<0,001) se associaram independentemente com disfagia. Os pacientes disfágicos apresentaram maior tempo de internação (p=0,001), maior frequência de reabilitação (p<0,001) e uso de sonda para alimentação (p<0,001) dentro de três meses após o AVC. A presença de disfagia detectada na avaliação clínica da deglutição foi independentemente associada com dependência funcional ou óbito em três meses após o AVC (p<0,001). O teste TORBSST© apresentou sensibilidade de 85% para detectar disfagia comparado a videofluoroscopia, e concordância moderada entre os avaliadores (K=0,44). Portanto, neste estudo, disfagia foi diagnosticada em quase metade dos pacientes (45,2%). Idade, história médica conhecida de apneia obstrutiva do sono e gravidade do AVC foram preditores de disfagia, sendo esta independentemente associada com morte ou dependência funcional em três meses após o AVC. O teste de rastreio para disfagia TOR-BSST© apresentou alta sensibilidade para detectar disfagia em pacientes com AVC comparado ao padrão ouro. / This study was carried out with the following objectives: to identify the frequency and the predictors of dysphagia in stroke patients; to assess the impact of dysphagia on outcomes functional dependence and death at three months post-stroke; and to validate the Toronto Bedside Swallowing Screening Test (TOR-BSST©) screening test in stroke patients from a public hospital in Brazil. All consecutive eligible patients newly admitted to the Emergency Unit of the Hospital Clinics of School of Medicine of Ribeirao Preto - University of São Paulo (HCFMRP-USP) and captured by REAVER (an institution based prospective registry for stroke patients) between April 2015 and September 2016 were approached and consented. Eligible patients were those that met the following criteria: age>18 years and medical diagnosis of acute stroke (<10 days between stroke and hospital admission) confirmed from neuroimage exams. Patients with transient ischemic attack, subarachnoid hemorrhage, cerebral venous thrombosis, not acute stroke, hemorrhagic stroke with secondary cause or those who did not agree to participate in the study were excluded. The demographic and clinical characteristics were prospectively collected by REAVER research coordinators. Swallowing was evaluated by three Speech and Language Pathologists in the first week of hospital admission at the bedside with clinical assessment using paste and liquid consistency. Patients were assessed with TOR-BSST© and with videofluoroscopy after discharge from hospital. Modified Rankin scale, Barthel Index and Functional Independence Measure (FIM) were used to assess functional outcomes three months after stroke. In the period of the study, 831 stroke patients were admitted, 353 patients were excluded according to the inclusion and exclusion criteria. Of the eligible patients, 53 were removed because they were discharged before clinical assessment of swallowing, therefore 425 patients were included in this study. Among the included patients, 28.2% did not present conditions for clinical swallowing assessment and were considered in the presumed dysphagia group. Thus, 305 patients were examined with clinical swallowing assessment and 45.2% of them had dysphagia. Age (p=0.017), known medical history of obstructive sleep apnea (p=0.003) and stroke severity at hospital admission (p<0.001) were independently associated with dysphagia. Dysphagic patients had longer length of stay (p=0.001), higher frequency of rehabilitation (p<0.001) and higher frequency of use of tube feeding (p<0.001) within three months after stroke. The presence of dysphagia detected in clinical swallowing assessment was independently associated with functional dependence or death within three months after stroke (p<0.001). The TORBSST© showed sensitivity of 85% to detect dysphagia compared to videofluoroscopy and moderate agreement among the screeners (K=0.44). Therefore, in this study, dysphagia was diagnosed in almost half of the patients (45.2%). Age, known medical history of obstructive sleep apnea and stroke severity were predictors of dysphagia, which was independently associated with death or functional dependence at three months post-stroke. The TOR-BSST© presented high sensitivity to detect dysphagia in stroke patients compared to the gold standard.

No description available.

Approximately 80% of all patients with ALS suffer from dysphagia sooner or later during the course of the disease. It is important to find patients with dysphagia in an early stage since weight loss and malnutrition, which dysphagia contributes to, are negative prognostic factors. The main purpose of this study was to identify early signs of dysphagia in patients with ALS, by investigating which clinical evaluation tools that discovers dysphagia in an early stage and see how the swallowing difficulties progress over time. Another purpose of the study was to evaluate the participants’ responses in a self-evaluation questionnaire (EAT-10) and how they correlate with findings on fiberoptic endoscopic evaluation of swallowing (FEES). Eleven participants with ALS were examined with FEES and non-instrumental tests one to four times over the course of one year. Only five participants were examined three or more times and because of that it is not possible to draw conclusions about the progression of dysphagia. Nine of 11 participants showed signs of dysphagia at the first examination. Test of lip strength was the clinical evaluation tool that identified most patients with dysphagia, followed by swallow capacity test. In an exploratory analysis, both of these tests showed good correlation with results on FEES. Patient responses on EAT-10 were also strongly correlated with the results on FEES.

Bakgrund: Varje år drabbas 25 000 - 30 000 människor i Sverige av stroke. Två tredjedelar av patienterna i det akuta stadiet av stroke får dysfagi vilket innebär en ökad risk för komplikationer. Nationella riktlinjer rekommenderar att patienter med stroke vårdas på en strokeenhet med kompetent multidisciplinärt stroke-team, vilket ökar patientens chans att återhämta sig och minskar förekomsten av komplikationer. Sjuksköterskor har en central roll i att ge stöd och arbeta förebyggande baserat på bästa tillgängliga evidens för att säkerställa god omvårdnad och säker vård. Trots detta upplever patienter med dysfagi brist på stöd från sjuksköterskor. Syfte: Studien syftar till att beskriva sjuksköterskans kunskap om dysfagi till följd av stroke.  Metod: Studien är genomförd som en litteraturöversikt som grundas på 14 vetenskapliga artiklar med kvantitativ- (n=10) och kvalitativ ansats (n= 2) samt mixed metod-studier (n=2). Datasökning utfördes i databaserna CINAHL och PubMed.  Resultat: Två teman och tre subteman identifierades och presenterades i resultatet som beskriver sjuksköterskans kunskap om dysfagi till följd av stroke. Resultatens två teman är: Kunskap om symtom och tecken samt Kunskap om omvårdnadsåtgärder med subteman - bedömning av sväljningsförmåga, nutrition och munvård. Slutsats: Sjuksköterskor behöver utbildning som intervention för att öka kunskapen om omvårdnad kring dysfagi till följd av stroke. Detta skapar förutsättningar för sjuksköterskan att kunna ge en god och säker vård som grundas på evidens och därmed förebyggs komplikationer samt lidande för personer med dysfagi till följd av stroke. / Background: Every year, 25,000 - 30,000 people in Sweden suffer from stroke. Two-thirds of patients in acute stage of stroke suffer from dysphagia with greater risk of complications. National guidelines recommend patient with stroke are cared for in stroke unit with competent multidisciplinary stroke team, which increases patients’ chance of recovery and reduced incidence of complications. Nurses have a central role in providing support and work preventatively based on the best available evidence in order to ensure good nursing and safe care. Despite this, patients with dysphagia experience a shortage of support from nurses. Aim: The study aims to describe the nurse's knowledge of dysphagia as a result of stroke.  Method: The study is a literature review based on 14 scientific articles with quantitative (n= 10) and qualitative (n= 2) approaches and mixed method studies (n=2). Article search was conducted via CINAHL and PubMed databases.  Results: Two themes and three subthemes were identified and presented in the results that describe the nurse's knowledge of dysphagia as a result of stroke. The two themes of the results are: Knowledge of symptoms and signs and Knowledge of nursing measures with subthemes - assessment of swallowing ability, nutrition and oral care. Conclusion: Nurses need education as an intervention to increase their knowledge of caring about dysphagia as a result to stroke. This creates the conditions for the nurse to be able to provide good and safe care based on evidence and thus prevent complications as well as suffering for people with dysphagia as a result of stroke.

This diploma thesis deals with the topic of nutritional support in patients with neurological diseases (stroke, craniocerebral trauma, critical-illness-polyneuropathy. The aim of this thesis is to find out, how implemented unified system of nutritional support affects the well-being of patients at neuro-rehabilitation clinic Asklepios Schlossberg Klinikum in Bad König. There were observed 58 patients (33 men and 25 women) during 8 weeks. The theoretical part of this thesis describes basic components of nutrition, energy expenditure and needs, selected neurological diseases, dysphagia, malnutrition and nutrition in intensive neurological care. The practical part of the thesis analyses data obtained by the observation. There are observed changes of body weight, BMI and laboratory values of total protein and albumin in serum. These data are divided by sex, age and type of disease. Based on the results, it was found that although patients due to uniform tube feeding do not have sufficient protein intake, serum total protein and albumin levels increased. This can be caused by eating a uniform diet that contains good quality protein in patients, which suffered from hypoalbunemia at the outset of observation, also by reducing the effect of stress reactions with gradual improvement of the state and...

Bakgrund: En stroke kan drabba vem som helst, det kan också komplikationen dysfagi. Med försämrad sväljningsförmåga kan också livskvalitén, hälsan och välbefinnandet hos de drabbade personerna påverkas. Som sjuksköterska är det viktig att ha både kunskap och förståelse för sväljsvårigheter för att kunna ge patienter en god och säker vård. Metod: Studien är en beskrivande litteraturöversikt med kvalitativ ansats som grundar sig på tio kvalitativa artiklar som söktes fram via databasen CINAHL. Syfte: Att belysa drabbade personers upplevelser av dysfagi efter stroke. Resultat: Resultatet delades upp i kategorier utefter upplevelser som berör begränsningar, känsla av rädsla, att ta kontroll, känslan av trygghet och ny anpassning till vardagen. Där framkommer både positiva och negativa upplevelser hos individerna. Konklusion: Dysfagi är ett svårt symtom med både fysiska och psykiska hinder. Dysfagi ger upphov till rädsla, begränsningar, kontrollbehov, anpassning men drabbade personer kan ändå uppleva trygghet i vissa situationer tillsammans med andra förstående individer. Även om dysfagi kan ha en negativ inverkan på livet kan känslan av god av livskvalité, hälsa och välbefinnande upplevas genom att drabbade personer lär sig hantera symtomet. / Background: A stroke can affect anyone, so can the complication dysphagia. With impaired swallowing ability, the quality of life, health and well-being of the person can also be affected. As a nurse, it is important to have both knowledge and understanding of swallowing difficulties in order to provide patients with good and safe care. Method: The study is a descriptive literature review with a qualitative approach that is based on ten qualitative articles that were searched through the CINAHL database. Aim: To elucidate affected people´s experiences of post-stroke dysphagia. Result: The result was divided into categories based on experiences that relate to limitations, feelings of fear, taking control, the feeling of security and new adaptation to everyday life. There are both positive and negative experiences in the individuals. Conclusion: Dysphagia is a serious illness with both physical and mental barriers. Dysphagia gives rise to fear, limitations, control needs, adaptation but affected people can still experience security in certain situations along with other understanding individuals. Although dysphagia can have a negative impact on life, the feeling of goodness of quality of life, health and well-being can be experienced by affected people learning to cope with the symptom.

The aim of this study is to describe hospice caregivers’ perceptions and practices in the management of dysphagia in neurodegenerative disorders. In South Africa, hospices provide support and care for people with neurodegenerative disorders and have been offering palliative care to patients and their families facing life-threatening illnesses since 1989. Detailing the management practices of hospice caregivers may assist in determining whether there is a need for the services of a speech-language therapist in the transdisciplinary model. A non-experimental, descriptive survey research design was selected for the purpose of this study as it allowed the researcher to describe the characteristics of a large number of respondents. Information was gathered by means of mail-distributed, self-administered questionnaires. The collected data was descriptively analysed and graphs and figures were used to summarise and display the frequency distribution and associations within the data. It was evident from the findings that dysphagic patients with neurodegenerative disorders form part of the hospice caregivers’ caseloads. However, there appears to be limited specialist involvement in the management of neurodegenerative dysphagia within the hospice setting. Furthermore, caregivers’ perceptions of the subtle symptoms of dysphagia, the positions that facilitate safe swallowing and the consistencies that are most easily swallowed by people with dysphagia were found to be inadequate. The results obtained have numerous significant clinical and theoretical implications regarding current dysphagia management in the South African hospice setting. Recommendations are made to hospices, speech-language therapists and future researchers. / Dissertation (MCommunication Pathology)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / unrestricted

PURPOSE: Sufficient hyoid excursion plays a critical role in facilitating multiple facets of functional pharyngeal motion, phonation, and nutritional intake; however, objective quantification of hyoid displacement during modified barium swallow studies relies on variable practice protocols. This study sought to compare hyoid displacement methodological differences in the dysphagia literature to establish new clinically feasible references of normative values and measurement strategies. METHOD: The current study incorporated re-analysis of Molfenter and Steele (2011)’s meta- analysis according to measurement strategies (anterior and superior versus hypotenuse (total) displacement as well as rest-to-peak versus frame-by-frame quantification), bolus volume, and participant characteristics (sex and age). Conversion of data was completed using the Pythagorean theorem, and resulting data was then compared within the study itself and externally to Leonard et al. (2000). Two Tailed Independent t-tests and a linear regression were completed to assess the relationship between analysis factors and hyoid displacement. RESULTS: Males were found to have significantly higher hypotenuse hyoid displacement than females. No statistical significance was found between the predetermined age groups (“old” and “young”) or newly determined age groups (“old,” “young,” and “middle age”). A linear relationship between increasing bolus volume and hypotenuse hyoid displacement was established. Rest-to-peak and frame-by-frame internal measurement strategies were statistically identical, but the rest-to-peak strategy incorporates qualitative improvements regarding efficiency. The re-analysis of anterior and superior hyoid displacement norms within Molfenter and Steele (2011) resulted in slightly lower hypotenuse normative values when compared to Leonard et al (2000). CONCLUSION: The current findings suggest that measurement of hyoid hypotenuse displacement is a more efficient measurement strategy and is effective in incorporating the hyoid’s anterior and superior displacement. For clinicians, these findings suggest that normal hyoid excursion may not need to be as large as Leonard et al.’s (2000) norms proposed to be classified as within normal limits for healthy individuals. New references on normative values suggest that as bolus volumes increase, so too does the hyoid displacement, with an expected plateau due to anatomical constraints, to facilitate safe swallows. Furthermore, although rest-to-peak and frame-by-frame internal measurement strategies were statistically identical in quantifying hyoid displacement, the rest-to-peak measurement strategy stood superior when considering the qualitative improvement in a clinician’s time management. Moreover, analysis of participant characteristics identified that hyoid excursion is larger for males than females and that presbyphagia likely results in slightly reduced displacement. Further investigation is warranted and required to better understand hyoid excursion variability and refine best practices.

Background: Preterm infants and neonates may present with dysphagia due to immaturity or the presence of medical conditions. Enteral feeds are used to ensure optimal nutrition is achieved while the neonates are developing appropriate oral feeding skills. Varied interventions may be used to transition neonates to full oral feeds as oral feeding is often a prerequisite for discharge from hospital. Aims: The main aim of this study was to summarize, interpret and analyse the literature on the different interventions used for the transition to full oral feeds in preterm infants and neonates to identify research gaps and to inform clinical practice on the best intervention options. A secondary aim was to validate the findings of the scoping review for the South African context. Methods: A scoping review was conducted. Relevant studies were identified by searching six databases, Google and Google scholar. Inclusion criteria included studies written in English, peer reviewed and published between 1998–2018, that described the interventions used to transition preterm infants and neonates to full oral feeds. Data were extracted from the articles using a data charting form and analysed descriptively and thematically. The findings were shared with health care professionals who work with premature infants and neonates who then participated in a semi-structured interview to provide feedback relevant to the South African context. Results: Forty-seven articles were included. Six broad intervention categories were identified: oral-motor, oral-sensory, other senses, timing, cue-based and utensils. Non-nutritive sucking (NNS) interventions were reported most frequently across single and combined interventions. Outcome measures reported included: time taken to full oral feeds, earlier hospital discharge, long-term feeding outcomes, weight and sucking proficiency. Improved outcomes were associated with NNS and NNS with oral stimulation. Nine health care professionals were interviewed. They confirmed using a number of the interventions, with NNS reported the most. Health care professionals also provided insight into the challenges of implementing some interventions due to limited resources and staffing in the South African context. Conclusions: There are a range of interventions reported in the literature and many of them are used in South Africa. Positive outcomes such as earlier transition to full oral feeds; earlier hospital discharge; improved weight gain and improved sucking proficiency have been reported with NNS and combined NNS and Oral Stimulation interventions, however further studies are needed.