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Gu H, Ren D. Prevalence and Risk Factors of Poststroke Dysphagia: A Meta-Analysis. Cerebrovasc Dis 2024:1-24. [PMID: 38643757 DOI: 10.1159/000538218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/29/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION In patients with stroke, poststroke dysphagia (PSD) is a common complication that plays an important role in morbidity and mortality. The aim of this paper was to assess the prevalence and risk factors of PSD using a systemic review and meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for potentially eligible studies published until September 2023. Further, the pooled incidence and risk factors for PSD were determined using a random-effects model. Overall, 58 studies involving 37,404 patients with acute stroke were selected for the meta-analysis. RESULTS The pooled incidence of PSD in patients with acute stroke was 42% (95% confidence interval [CI]: 36-48%), which is the highest in South America (47%) and lowest in Asia (37%). Notably, older age (odds ratio [OR]: 2.13; 95% CI: 1.53-2.97; p < 0.001), hypertension (OR: 1.23; 95% CI: 1.06-1.44; p = 0.007), diabetes mellitus (OR: 1.22; 95% CI: 1.04-1.44; p = 0.014), stroke history (OR: 1.26; 95% CI: 1.04-1.53; p = 0.019), and atrial fibrillation (OR: 1.58; 95% CI: 1.02-2.44; p = 0.039) were found to be associated with an increased risk of PSD. Conversely, sex differences, smoking, alcoholism, obesity, hyperlipidemia, ischemic heart disease, stroke type, and the hemisphere affected were not associated with the risk of PSD. CONCLUSION The abstract reports the prevalence of PSD in patients with acute stroke and identified potential risk factors for PSD, including older age, hypertension, diabetes mellitus, stroke history, and atrial fibrillation.
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Affiliation(s)
- Haiyan Gu
- Intensive Care Rehabilitation Department, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Dan Ren
- Intensive Care Rehabilitation Department, Ningbo Rehabilitation Hospital, Ningbo, China
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2
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Banda KJ, Chu H, Kang XL, Liu D, Pien LC, Jen HJ, Hsiao STS, Chou KR. Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis. BMC Geriatr 2022; 22:420. [PMID: 35562660 PMCID: PMC9103417 DOI: 10.1186/s12877-022-02960-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 03/04/2022] [Indexed: 12/30/2022] Open
Abstract
Background Post-stroke dysphagia (PSD) has been associated with high risk of aspiration pneumonia and mortality. However, limited evidence on pooled prevalence of post-stroke dysphagia and influence of individual, disease and methodological factors reveals knowledge gap. Therefore, to extend previous evidence from systematic reviews, we performed the first meta-analysis to examine the pooled prevalence, risk of pneumonia and mortality and influence of prognostic factors for PSD in acute stroke. Methods Our search was conducted in CINAHL, Cochrane Library, EMBASE, Ovid-Medline, PubMed, and Web of Science an initial search in October 2020 and a follow-up search in May 2021. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and the DerSimonian-Lard random-effects model for prognostic factors and outcomes of PSD. Results The pooled prevalence of PSD was 42% in 42 studies with 26,366 participants. PSD was associated with higher pooled odds ratio (OR) for risk of pneumonia 4.08 (95% CI, 2.13–7.79) and mortality 4.07 (95% CI, 2.17–7.63). Haemorrhagic stroke 1.52 (95% CI, 1.13–2.07), previous stroke 1.40 (95% CI, 1.18–1.67), severe stroke 1.38 (95% CI, 1.17–1.61), females 1.25 (95% CI, 1.09–1.43), and diabetes mellitus 1.24 (95% CI, 1.02–1.51) were associated with higher risk of PSD. Males 0.82 (95% CI, 0.70–0.95) and ischaemic stroke 0.54 (95% CI, 0.46–0.65) were associated with lower risk of PSD. Haemorrhagic stroke, use of instrumental assessment method, and high quality studies demonstrated to have higher prevalence of PSD in the moderator analysis. Conclusions Assessment of PSD in acute stroke with standardized valid and reliable instruments should take into account stroke type, previous stroke, severe stroke, diabetes mellitus and gender to aid in prevention and management of pneumonia and thereby, reduce the mortality rate. Trial registration https://osf.io/58bjk/?view_only=26c7c8df8b55418d9a414f6d6df68bdb. Supplementary information The online version contains supplementary material available at 10.1186/s12877-022-02960-5.
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Affiliation(s)
- Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Shu-Tai Shen Hsiao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan. .,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. .,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan. .,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. .,Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
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3
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Electrical, taste, and temperature stimulation in patients with chronic dysphagia after stroke: a randomized controlled pilot trial. Acta Neurol Belg 2021; 121:1157-1164. [PMID: 33586087 DOI: 10.1007/s13760-021-01624-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
The objective of present study was compare a traditional swallowing therapy program with a new combined swallowing therapy program including neuromuscular electrical stimulation in patients with oropharyngeal dysphagia after stroke. This pilot study included eight patients with chronic oropharyngeal dysphagia after stroke. These patients underwent traditional therapy with gustative-thermic-tactile stimulation (group A), or a new combined program adding neuromuscular electrical stimulation (group B). Study participants were evaluated before and after the intervention using fiberoptic endoscopic evaluation of swallowing with temporal measures of posterior oral spillage and whiteout time, functional oral intake scale and a visual analog scale classifies an individual's swallowing ability. The two groups did not differ in terms of posterior oral spillage time, whiteout time and functional oral intake scale. Subjects in group B exhibited significant increases in visual analog scale scores. However, both groups demonstrated improvement with decreases in posterior oral spillage time, increased whiteout time, and increased functional oral intake scale and visual analog scale scores. There was no difference in the parameters studied in both therapeutic programs in individuals with chronic oropharyngeal dysphagia after stroke.
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4
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Meng PP, Zhang SC, Han C, Wang Q, Bai GT, Yue SW. The Occurrence Rate of Swallowing Disorders After Stroke Patients in Asia: A PRISMA-Compliant Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2020; 29:105113. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/07/2023] Open
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Dysphagia and tube feeding after stroke are associated with poorer functional and mortality outcomes. Clin Nutr 2020; 39:2786-2792. [DOI: 10.1016/j.clnu.2019.11.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 10/24/2019] [Accepted: 11/27/2019] [Indexed: 01/24/2023]
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Pacheco-Castilho AC, de Martini Vanin G, Reichardt B, Miranda RPC, Norberto AMQ, Braga MC, Bueno TBC, Weber KT, Santos TEG, Leite JP, Dantas RO, Pontes-Neto OM, Martino R. Translation and Validation of the TOR-BSST © into Brazilian Portuguese for Adults with Stroke. Dysphagia 2020; 36:533-540. [PMID: 32766936 DOI: 10.1007/s00455-020-10167-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
Brazil has a higher rate of dysphagia in stroke patients compared to developed countries, but does not have a fully validated method for early identification of dysphagia in this population. The aim of this study is to translate the TOR-BSST© into Brazilian Portuguese and assess the newly translated version for reliability and validity with Brazilian adult patients with stroke. The translation of the TOR-BSST© followed a multi-step process, according to the International Quality of Life Assessment project. For validation, we included patients with age ≥ 18 years and stroke diagnosis confirmed by neuroimaging and tolerance for videofluoroscopic swallowing assessment. The BR-PTfinal TOR-BSST© was administered by two trained screeners within two hours of videofluoroscopy. All assessors were independent and blinded. Estimates for reliability used the intraclass correlation coefficient (ICC) and for accuracy both sensitivity (SN) and negative predictive (NP) values were used, along with 95% confidence intervals (CI). Sixty patients were enrolled and tested for a mean (SD) of 14.4 (6.9) days from last seen normal. Of all the patients, 41 (68.3%) failed the BR-PTfinal TOR-BSST© and 21 (35%) were scored to have dysphagia on videofluoroscopy, of which 11 (52.4%) had mild dysphagia. The overall reliability between screeners was satisfactory (ICC = 0.59; 95% CI 0.32 to 0.76). The SN and NP values for the BR-PTfinal TOR-BSST© were 85.7% (95% CI 0.62-0.96) and 84.2% (95% CI 0.72-0.95), respectively. The TOR-BSST© was successfully translated to Brazilian Portuguese with the BR-PTfinal TOR-BSST© proven to have high sensitivity and negative predictive values when compared to gold standard videofluoroscopy.
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Affiliation(s)
- Aline Cristina Pacheco-Castilho
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | | | - Beatrix Reichardt
- Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Rubia Poliana Crisóstomo Miranda
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Monica Carvalho Braga
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Thatiana Barboza Carnevalli Bueno
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Karina Tavares Weber
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Taiza Elaine Grespan Santos
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - João Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Rosemary Martino
- Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Swallowing Lab, University of Toronto, Toronto, ON, Canada
- Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
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7
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Almeida TMD, Gomes LMS, Afonso D, Magnoni D, Mota ICP, França JÍD, Silva RGD. Risk factors for oropharyngeal dysphagia in cardiovascular diseases. J Appl Oral Sci 2020; 28:e20190489. [PMID: 32401939 PMCID: PMC7213782 DOI: 10.1590/1678-7757-2019-0489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/02/2020] [Indexed: 11/21/2022] Open
Abstract
Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases.
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Affiliation(s)
| | - Lívia Maria Silva Gomes
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista, Marilia, SP, Brasil
| | - Débora Afonso
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista, Marilia, SP, Brasil
| | - Daniel Magnoni
- Instituto de Cardiologia, Nutrologia, Instituto Dante Pazzanese, São Paulo, SP, Brasil
| | | | - João Ítalo Dias França
- Seção de Estatística, Instituto de Cardiologia, Instituto Dante Pazzanese, São Paulo, SP, Brasil
| | - Roberta Gonçalves da Silva
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista, Marilia, SP, Brasil
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8
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Mourão AM, Vicente LCC, Abreu MNS, Tatiana Simões C, Romeu Vale S, De Souza LC, Teixeira AL. Swallowing progression during the acute phase of cortical and subcortical ischemic stroke and its association with the extension of brain damage and cognitive impairment. Top Stroke Rehabil 2019; 26:523-527. [PMID: 31287384 DOI: 10.1080/10749357.2019.1628464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess swallowing progression and its association with the extension of brain damage and cognitive impairment during the acute phase of ischemic stroke. Methods: Cross-sectional, observational study with 50 patients, who were admitted to a Stroke Unit with cerebral ischemia, with a maximum stroke time of 24 h. The following clinical tools were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Frontal Battery Assessment, and the Alberta Stroke Program Early CT Score for neuroimaging. The Gugging Swallowing Screen and the Functional Oral Intake Scale were used to assess swallowing. The patients were assessed at three different time-points: at hospital admission, after 72 h of hospitalization, and at hospital discharge. Results: The mean age of patients was 65.5 years. The frequency of dysphagic patients was 50.0%, 18.0%, and 12.0% at admission, after 72 h of hospitalization, and at discharge, respectively. Scores on the Frontal Battery Assessment and the Alberta Stroke Program Early CT Score were associated with dysphagia progression. Conclusion: Dysphagia is a common complication in the acute phase of stroke, and is associated with the extension of brain damage and cognitive impairment.
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Affiliation(s)
- Aline Mansueto Mourão
- Department of Speech Therapy, Federal University of Minas Gerais , Belo Horizonte , Brazil.,Sector of the Stroke Unit of the Risoleta Tolentino Neves Hospital , Belo Horizonte , Brazil
| | | | | | - Chaves Tatiana Simões
- Sector of the Stroke Unit of the Risoleta Tolentino Neves Hospital , Belo Horizonte , Brazil
| | - Sant'Anna Romeu Vale
- Sector of the Stroke Unit of the Risoleta Tolentino Neves Hospital , Belo Horizonte , Brazil
| | - Leonardo Cruz De Souza
- Interdisciplinary Laboratory of Medical Investigation, School of Medicine, University of Minas Gerais (UFMG) , Belo Horizonte , Brazil
| | - Antônio Lucio Teixeira
- Interdisciplinary Laboratory of Medical Investigation, School of Medicine, University of Minas Gerais (UFMG) , Belo Horizonte , Brazil
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9
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Pacheco-Castilho AC, Vanin GDM, Dantas RO, Pontes-Neto OM, Martino R. Dysphagia and Associated Pneumonia in Stroke Patients from Brazil: A Systematic Review. Dysphagia 2019; 34:499-520. [PMID: 31111249 DOI: 10.1007/s00455-019-10021-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/15/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023]
Abstract
Dysphagia and its associated complications are expected to be relatively more frequent in stroke patients in Brazil than in similar patients treated in developed countries due to the suboptimal stroke care in many Brazilians medical services. However, there is no estimate of dysphagia and pneumonia incidence for the overall stroke population in Brazil. We conducted a systematic review of the recent literature to address this knowledge gap, first screening citations for relevance and then rating full articles of accepted citations. At both levels, judgements were made by two independent raters according to a priori criteria. Fourteen accepted articles underwent critical appraisal and data extraction. The frequency of dysphagia in stroke patients was high (59% to 76%). Few studies assessed pneumonia and only one study stratified patients by both dysphagia and pneumonia, with an increased Relative Risk for pneumonia in patients with stroke and dysphagia of 8.4 (95% CI 2.1, 34.4). Across all articles, we identified bias related to: heterogeneity in number and type of stroke; no rater blinding; and, assessments that were not reproducible, reliable or validated. Despite the high frequency of dysphagia and associated pneumonia in stroke patients in Brazil, the quality of the available literature is low and that there is little research focused on these epidemiologic data. Future rigorously designed studies are in dire need to accurately determine dysphagia incidence and its impact on stroke patients in Brazil. These data will be critical to properly allocate limited national resources that maximize the quality of stroke care.
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Affiliation(s)
- Aline Cristina Pacheco-Castilho
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, Zip Code: 14049-900, Brazil.
| | - Gabriela de Martini Vanin
- Department of Speech Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, Zip Code: 14049-900, Brazil
| | - Rosemary Martino
- Department of Speech Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
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Avelino MR, Montibeller CG, Luchesi KF, Mituuti CT, Ribeiro PW, Fagundes DA, Furkim AM. Oral dietary intake level in thrombolysed and non-thrombolysed patients after ischemic stroke. NeuroRehabilitation 2017; 40:49-55. [DOI: 10.3233/nre-161389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marcella Rachadel Avelino
- Department of Speech-Language Pathology, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Karen Fontes Luchesi
- Department of Speech-Language Pathology, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Cláudia Tiemi Mituuti
- Department of Speech-Language Pathology, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | | | - Ana Maria Furkim
- Department of Speech-Language Pathology, Federal University of Santa Catarina, Florianópolis, Brazil
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11
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Pinto AR, Silva RGD, Pinato L. Oropharyngeal swallowing in chronic renal failure. Codas 2016; 28:71-6. [PMID: 27074193 DOI: 10.1590/2317-1782/20162015041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/16/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterize the oropharyngeal swallowing profile of patients with chronic renal failure. METHODS A cross-sectional clinical study involving 20 adults diagnosed with chronic renal failure in hospital stay was conducted. The evaluation of swallowing was performed by videofluoroscopy, and characterization of findings was based on effectiveness and safety parameters. Functional Oral Intake Scale (FOIS) was also applied. RESULTS On videofluoroscopy, 16 patients presented changes in oral and pharyngeal patterns, three individuals presented impairment at the pharyngeal phase, and only one individual presented changes only at the oral phase of swallowing. Furthermore, videofluoroscopy showed penetration and tracheal aspiration in 30% of the sample. Before the videofluoroscopy, four individuals (20%) were at level 5 of FOIS scale, whereas 16 individuals (80%) were at level 7. After adjustments of the oral diet consistency because of safety and swallowing effectiveness, FOIS classification was six individuals at level 1, seven at level 4, four at level 5, and three at level 6. CONCLUSION The characterization of oropharyngeal swallowing profile in chronic renal patients showed abnormalities at oral and pharyngeal phase, including penetration and tracheal aspiration, which requires oral intake changes.
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Affiliation(s)
| | | | - Luciana Pinato
- Universidade Estadual Paulista Júlio de Mesquita Filho, Marília, SP, Brazil
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Mourão AM, Lemos SMA, Almeida EO, Vicente LCC, Teixeira AL. Frequency and factors associated with dysphagia in stroke. Codas 2016; 28:66-70. [PMID: 27074192 DOI: 10.1590/2317-1782/20162015072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/15/2015] [Indexed: 05/29/2023] Open
Abstract
PURPOSE To investigate the frequency of dysphagia in acute stroke and the possible associated clinical and sociodemographic features. METHOD A cross-sectional study was performed including 100 stroke patients who were admitted to the Minas Gerais Regional Public Hospital. Sociodemographic and clinical data were collected, and the patients underwent clinical evaluation through the Gugging Swallowing Screen (GUSS). RESULTS The frequency of dysphagia was 50%, and most patients had severe swallowing disorders. Only a previous history of stroke was associated with dysphagia (p=0.02). Other sociodemographic and clinical variables were not associated with dysphagia, suggesting that the location and the pathophysiology of stroke did not influence its occurrence and severity. CONCLUSION The frequency of dysphagia after stroke is high, being a previous stroke an important risk factor for subsequent stroke.
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13
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Mourão AM, Almeida EO, Lemos SMA, Vicente LCC, Teixeira AL. Evolução da deglutição no pós-AVC agudo: estudo descritivo. REVISTA CEFAC 2016. [DOI: 10.1590/1982-0216201618212315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: analisar a evolução da deglutição de pacientes após acidente vascular cerebral. Métodos: trata-se de estudo exploratório descritivo com amostra não probabilística em que foram acompanhados 100 pacientes admitidos com o diagnóstico de acidente vascular cerebral no Hospital Público Regional de Betim. Os pacientes foram submetidos à avaliação fonoaudiológica estruturada em dois momentos: nas primeiras 48 horas após acidente vascular cerebral e no momento da alta hospitalar. Utilizou-se a escala Gugging Swallowing Screen que é um instrumento padronizado e validado para ser utilizado na beira do leito. Resultados: na avaliação fonoaudiológica inicial, a frequência da disfagia foi de 52%, sendo que 28% dos pacientes foram classificados como disfagia grave com alto risco de aspiração. A média de tempo entre a avaliação inicial da deglutição e a do momento da alta hospitalar foi de 22,1 dias. Na alta, apenas 2,1% dos pacientes ainda apresentavam disfagia grave. Observou-se mudança do perfil de deglutição do paciente de acordo com a gravidade da disfagia e da consistência da dieta oral. Conclusão: a frequência de disfagia após acidente vascular cerebral é alta, mas há progressiva mudança no perfil de deglutição do paciente durante o período de internação.
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14
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Gaspar MDRDF, Pinto GDS, Gomes RHS, Santos RS, Leonor VD. Avaliação da qualidade de vida em pacientes com disfagia neurogênica. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517619114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Objetivo: avaliar a qualidade de vida de pacientes com Acidente Vascular Encefálico e disfagia neurogênica. Métodos: estudo quantitativo, do tipo transversal, descritivo, realizado no Setor de Neurologia de um Hospital de Ensino, em Curitiba- Paraná. A amostra foi constituída de 35 indivíduos com Acidente Vascular Encefálico e queixa de disfagia. Os dados foram coletados por meio de questionário para avaliação da qualidade de vida em disfagia. Resultados: nas variáveis sociodemográficas houve predomínio de homens, idosos, brancos, casados e primeiro grau incompleto. A avaliação de qualidade de vida demonstrou que os domínios que apresentaram alterações foram os que investigam como a alteração da deglutição tem afetado o aspecto social dos participantes. A correlação de Mann-Whitney evidenciou significância estatística (p < 5) quando relacionou a deglutição como um fardo com o tempo de se alimentar (p 0,002), frequência dos sintomas (p <0,001), saúde mental (p <0,001) e fadiga (p <0,001). Conclusão: o levantamento estatístico comprovou o impacto causado pela disfagia neurogênica na qualidade de vida dos pacientes acometidos por Acidente Vascular Encefálico, representado pelas alterações encontradas nos resultados de avalição da qualidade de vida. Na correlação de Mann-Whitney, ao se realizar os cruzamentos entre os domínios do instrumento, os dados evidenciaram significância estatística quanto ao tempo de alimentação, medo de se alimentar, saúde mental, social e fadiga, que causam prejuízo na qualidade de vida dos pacientes com disfagia neurogênica.
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Resende PDD, Dobelin JB, Oliveira IBD, Luchesi KF. Disfagia orofaríngea neurogênica: análise de protocolos de videofluoroscopia brasileiros e norte-americanos. REVISTA CEFAC 2015. [DOI: 10.1590/1982-021620151754315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo: Este artigo tem por objetivo analisar e comparar o uso de protocolos brasileiros e norte-americanos para videofluoroscopia da deglutição em pacientes com histórico de acidente vascular encefálico. Trata-se de uma revisão bibliográfica de artigos brasileiros e norte-americanos. Foram selecionados artigos com descrição de procedimentos para videofluoroscopia da deglutição em sujeitos que sofreram acidente vascular encefálico, publicados entre 2003 e 2013. Os procedimentos descritos para realização de videofluoroscopias foram analisados de forma quantitativa e qualitativa. Consideraram-se as variáveis: posicionamento para o exame, consistências e quantidades de oferta de bolo, tipos de utensílios e utilização de protocolos Foram encontrados 16 artigos que atenderam aos critérios supracitados, sendo nove (56,25%) norte-americanos e sete (43,75%) brasileiros. Observou-se que quatro dos estudos nacionais (57,14%) não relatam as quantidades oferecidas, enquanto todos os artigos norte-americanos detalharam as quantidades, que variaram entre 2 e 15 mL; os tipos de alimento e suas consistências foram detalhadas em todos os estudos nacionais e norte-americanos, porém os nacionais o fizeram de forma genérica, sem identificação dos alimentos. Quanto à posição do paciente durante o exame, 57,14% dos artigos nacionais não relataram e todos os artigos norte-americanos o fizeram. Os utensílios para oferta do bolo são citados em 55,55% dos artigos norte-americanos e em apenas 14,28 % dos nacionais. Quanto à utilização de protocolos para avaliação 33% dos estudos norte-americanos não os citam, comparados aos 71,42% dos nacionais. Observou-se a necessidade de padronização dos procedimentos e terminologias utilizadas na videofluoroscopia da deglutição, de modo a facilitar a intercompreensão e reprodutibilidade dos estudos.
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Furmann N, Costa FM. Critérios clínicos utilizados por profissionais para liberação de dieta via oral em pacientes adultos hospitalizados. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517413614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo:OBJETIVO:identificar critérios clínicos utilizados por profissionais para liberação de alimentação via oral em pacientes hospitalizados que apresentam risco para disfagia.MÉTODOS:participaram do estudo 48 profissionais que atuam em dois hospitais gerais de uma cidade do interior do Paraná. Os dados foram coletados por meio da aplicação de um questionário.RESULTADOS:100% dos profissionais consideram o nível de consciência importante para a deglutição, apenas 52,2% vê a importância da presença de deglutição salivar antes que se inicie via oral. Destes, 95,8% elencam Acidente vascular cerebral e Traumatismo cranioencefálico como principais doenças relacionadas a disfagia, porém nenhum apontou a Doença Pulmonar Obstrutiva Crônica. Além disso, somente 47,9% reconhecem a importância da avaliação fonoaudiológica após extubação orotraqueal independente do motivo da intubação ou patologia de base. E, 45,8% considera necessária oclusão do orifício da traqueostomia no momento da oferta alimentar, mostrando que não fazem a relação entre fisiologia da deglutição e uso da traqueostomia. Sobre alimentar um paciente com cânula plástica e balonete insuflado, 52,1% dos profissionais consideram ser possível e 47,9% dizem que não. Observa-se que 77,1% dos profissionais considera que a retirada da traqueostomia melhora e facilita o processo de deglutição, sendo este um percentual estatisticamente significante.CONCLUSÃO:há um conhecimento regular dos profissionais sobre o manejo das disfagias em âmbito hospitalar. Verifica-se a necessidade de um programa de formação continuada a equipe para melhoria do atendimento de pacientes disfágicos.
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Ribeiro PW, Cola PC, Gatto AR, da Silva RG, Luvizutto GJ, Braga GP, Schelp AO, de Arruda Henry MAC, Bazan R. Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke. J Stroke Cerebrovasc Dis 2015; 24:2088-94. [PMID: 26187787 DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/23/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The present study aimed to evaluate the relation between the National Institutes of Health Stroke Scale (NIHSS) score and the presence of laryngeal penetration and/or laryngotracheal aspiration in ischemic stroke patients and to verify what factors are predictors of the occurrence of pneumonia in the evaluated patients. METHODS This was an observational study of ischemic stroke in the acute or subacute phases. Neurologic examination included anamnesis, Bamford classification, and application of the NIHSS. Speech therapy evaluation was carried out after clinical stabilization of the patient, and all individuals who were considered dysphagic were sent for examination by means of videofluoroscopic recordings. The parameters observed in the objective examination were the presence of laryngeal penetration and/or laryngotracheal aspiration. The pneumonia data were obtained in accordance with local protocols, which were based on international guidelines. The relation of laryngeal penetration and laryngotracheal aspiration with the NIHSS score was assessed by the Mann-Whitney U test, and predictors for the occurrence of pneumonia were analyzed by multiple logistic regression using semiautomatic backward selection. Significance was set at P less than .05. RESULTS The relations between laryngeal penetration and the NIHSS score and between laryngotracheal aspiration and the NIHSS score were not statistically significant. The predictors for pneumonia occurrence in the ischemic stroke patients with a clinical diagnosis of dysphagia were age (P = .002; odds ratio [OR], 1.12) and NIHSS score (P = .04; OR, 1.17), whereas laryngeal penetration of liquid (P = .065; OR, 3.70) tended to correlate with pneumonia but not significantly. CONCLUSIONS There was no relation between the NIHSS score and laryngeal penetration or laryngotracheal aspiration, and the principal predictors of pneumonia in dysphagic patients after ischemic stroke were advanced age and neurologic severity.
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Affiliation(s)
- Priscila W Ribeiro
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
| | - Paula C Cola
- Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil
| | - Ana R Gatto
- Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil
| | - Roberta G da Silva
- Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil
| | - Gustavo J Luvizutto
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Gabriel P Braga
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Arthur O Schelp
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Maria A C de Arruda Henry
- Department of Surgery, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Rodrigo Bazan
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
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Almeida TMD, Cola PC, Magnoni D, França JÍD, Germini MFCA, Silva RGD. Impacto da intubação orotraqueal na deglutição do indivíduo pós-acidente vascular encefálico após cirurgia cardíaca. REVISTA CEFAC 2015. [DOI: 10.1590/1982-021620156414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO:associar o grau de disfagia orofaríngea e o tempo de intubação orotraqueal no indivíduo pós-acidente vascular encefálico após cirurgia cardíaca.MÉTODOS:estudo clínico transversal descritivo, retrospectivo, realizado por meio da coleta de dados de protocolos e registros de prontuário, durante seis meses, em Hospital Público de Referência em Cardiologia. Foram analisados 25 protocolos e prontuários de indivíduos submetidos à cirurgia cardíaca, que evoluíram com acidente vascular encefálico e foram assistidos pela equipe de Fonoaudiologia. Os indivíduos foram divididos em dois grupos. O Grupo I (GI) constou de 10 indivíduos com intubação orotraqueal menor que 24 horas e o Grupo II (GII) de 15 indivíduos com intubação orotraqueal maior que 24 horas. Realizada avaliação clínica da deglutição e analisada a associação entre a classificação clínica do grau de comprometimento para disfagia e o tempo de intubação orotraqueal.RESULTADOS:verificou-se que no GI 40% apresentaram disfagia leve, 30% moderada e 20% grave. No GII 13,3% apresentaram disfagia leve, 33,3% moderada e 53,33% grave. Verificou-se associação linear significante entre o grau de disfagia e o tempo de IOT (p= 0,031), indicando que o número de indivíduos com disfagia moderada e grave foi maior no grupo com mais tempo de intubaçao.CONCLUSÕES:constatou-se que o tempo de intubação orotraqueal maior que 24 horas aumentou o grau da disfagia orofaríngea nesta população.
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SCHMIDT H, OLIVEIRA VRD. Avaliação reológica e sensorial de espessantes domésticos em diferentes líquidos como alternativa na disfagia. BRAZILIAN JOURNAL OF FOOD TECHNOLOGY 2015. [DOI: 10.1590/1981-6723.3714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O objetivo desse estudo foi analisar as propriedades reológicas e a aceitabilidade de espessantes domésticos em diferentes líquidos, além de comparar os custos e o valor energético desses espessantes. Avaliaram-se no viscosímetro de Brookfield amostras à base de farinha de fécula de batata, de amido de milho, de polvilho doce e de farinha de arroz, além de dois espessantes comerciais, diluídos em líquidos. Foi realizada, com a participação de 30 avaliadores, a investigação de aceitabilidade dos espessantes em água, leite e suco para os atributos: aparência, consistência, odor, sabor e aceitação global. A viscosidade em água dos espessantes comerciais, do amido de milho e da farinha de arroz não teve diferença estatística significativa entre si. Um dos espessantes comerciais atingiu a consistência “rala”. Os resultados de leites e sucos foram semelhantes quando classificados por consistência. Na aceitabilidade dos atributos odor e sabor para água, o espessante comercial, a fécula de batata, o polvilho doce e a farinha de arroz não apresentaram diferença significativa entre si. No leite, para os atributos odor e sabor as amostras não tiveram diferença significativa entre si e para sucos, o espessante comercial, a fécula de batata e o polvilho doce não apresentaram diferença significativa. A viscosidade de um dos espessantes comerciais não estava adequada para o consumo por pacientes com disfagia, obtendo consistência “rala”. O espessante comercial E.C1F e o amido de milho (AM) apresentaram consistência “mel”, sendo apropriado para o consumo em líquidos. As amostras com leites foram as que apresentaram maiores viscosidades, a maioria obteve consistência “pudim”. A aceitabilidade da E.C1F e da fécula de batata (FB) em leite foram as que mais se destacaram promissoras.
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Mancopes R, Gonçalves BFDT, Costa CC, Favero TC, Drozdz DRC, Bilheri DFD, Schumacher SF. Correlation between the reason for referral, clinical, and objective assessment of the risk for dysphagia. Codas 2015; 26:471-5. [PMID: 25590909 DOI: 10.1590/2317-1782/20142014065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/28/2014] [Indexed: 08/30/2023] Open
Abstract
PURPOSE To correlate the reason for referral to speech therapy service at a university hospital with the results of clinical and objective assessment of risk for dysphagia. METHODS This is a cross-sectional, observational, retrospective analytical and quantitative study. The data were gathered from the database, and the information used was the reason for referral to speech therapy service, results of clinical assessment of the risk for dysphagia, and also from swallowing videofluoroscopy. RESULTS There was a mean difference between the variables of the reason for the referral, results of the clinical and objective swallowing assessments, and scale of penetration/aspiration, although the values were not statistically significant. Statistically significant correlation was observed between clinical and objective assessments and the penetration scale, with the largest occurring between the results of objective assessment and penetration scale. CONCLUSION There was a correlation between clinical and objective assessments of swallowing and mean difference between the variables of the reason for the referral with their respective assessment. This shows the importance of the association between the data of patient's history and results of clinical evaluation and complementary tests, such as videofluoroscopy, for correct identification of the swallowing disorders, being important to combine the use of severity scales of penetration/aspiration for diagnosis.
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Affiliation(s)
- Renata Mancopes
- Curso de Graduação em Fonoaudiologia, Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria - UFSM, Santa Maria, RS, Brazil
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Santos RRDD, Sales AVMN, Cola PC, Ribeiro PW, Jorge AG, Peres FM, Dantas RO, Silva RGD. Association between pharyngeal residue and posterior oral spillage with penetration and aspiration in stroke. Codas 2014; 26:231-4. [PMID: 25118920 DOI: 10.1590/2317-1782/201420140476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/21/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study aimed at showing association between the posterior oral spillage and pharyngeal residue with tracheal aspiration and/or laryngeal penetration in stroke. METHODS Clinical cross-sectional retrospective multicenter study. The study included 63 videofluoroscopic tests of post-ischemic stroke individuals and oropharyngeal dysphagia data of the three reference centers providing care for patients with dysphagia (43 men and 20 women; age range: from 40 to 90 years). These individuals were divided into two groups. Group I consisted of 35 participants with the presence of penetration and/or laryngotracheal aspiration, and Group II consisted of 28 individuals with no penetration and/or aspiration. Videofluoroscopic swallowing test results were analyzed to divide the groups, and the presence of posterior oral spillage and pharyngeal residue was observed. RESULTS No association was found between the groups with posterior oral spillage (χ²=1.65; p=0.30; φ²=0.02), but there was statistical difference for the association between pharyngeal residue (χ²=12.86; p=0.003; φ²=0.20) and the groups. CONCLUSION There is an association between pharyngeal residue and penetration with tracheal aspiration in post-stroke individuals.
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Affiliation(s)
| | | | | | - Priscila Watson Ribeiro
- School of Medicine of Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil
| | | | | | | | - Roberta Gonçalves da Silva
- Speech Language Pathology and Audiology Department, Universidade Estadual Paulista Júlio de Mesquita Filho, Marília, SP, Brazil
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Pinto G, Zétola V, Lange M, Gomes G, Nunes MC, Hirata G, Lagos-Guimarães HN. Program to diagnose probability of aspiration pneumonia in patients with ischemic stroke. Int Arch Otorhinolaryngol 2014; 18:244-8. [PMID: 25992100 PMCID: PMC4297022 DOI: 10.1055/s-0034-1374646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/11/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Stroke is a major cause of death and disability worldwide, with a strong economic and social impact. Approximately 40% of patients show motor, language, and swallowing disorders after stroke. Objective To evaluate the use of software to infer the probability of pneumonia in patients with ischemic stroke. Methods Prospective and cross-sectional study conducted in a university hospital from March 2010 to August 2012. After confirmation of ischemic stroke by computed axial tomography, a clinical and flexible endoscopic evaluation of swallowing was performed within 72 hours of onset of symptoms. All patients received speech therapy poststroke, and the data were subsequently analyzed by the software. The patients were given medical treatment and speech therapy for 3 months. Results The study examined 52 patients with a mean age of 62.05 ± 13.88 years, with 23 (44.2%) women. Of the 52 patients, only 3 (5.7%) had a probability of pneumonia between 80 and 100% as identified by the software. Of all patients, 32 (61.7%) had pneumonia probability between 0 and 19%, 5 (9.5%) between 20 and 49%, 3 (5.8%) between 50 and 79%, and 12 (23.0%) between 80 and 100%. Conclusion The computer program indicates the probability of patient having aspiration pneumonia after ischemic stroke.
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Affiliation(s)
- Gisele Pinto
- Department of Internal Medicine, Universidade Federal do Paraná (HC-UFPR), Curitiba, Brazil
| | - Viviane Zétola
- Department of Internal Medicine, Universidade Federal de São Paulo (USP), São Paulo, Brazil
| | - Marcos Lange
- Department of Internal Medicine, Universidade Federal do Paraná (HC-UFPR), Curitiba, Brazil
| | - Guilherme Gomes
- Department of Gastroenterology and Endoscopy, Universidade Federal do Paraná (HC-UFPR), Curitiba, Brazil
| | - Maria Cristina Nunes
- Department of Internal Medicine, Universidade Federal do Paraná (HC-UFPR), Curitiba, Brazil
| | - Gisela Hirata
- Department of Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Brazil
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Ribeiro PW, Cola PC, Gatto AR, da Silva RG, Luvizutto GJ, Braga GP, Schelp AO, Henry MACDA, Bazan R. The Incidence of Dysphagia in Patients Receiving Cerebral Reperfusion Therapy Poststroke. J Stroke Cerebrovasc Dis 2014; 23:1524-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022] Open
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Inaoka C, Albuquerque C. Efetividade da intervenção fonoaudiológica na progressão da alimentação via oral em pacientes com disfagia orofaríngea pós AVE. REVISTA CEFAC 2014. [DOI: 10.1590/1982-0216201413112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objetivo : analisar a efetividade na progressão da alimentação via oral de pacientes com sintomas de disfagia, que sofreram acidente vascular encefálico prévio ou atual, internados em um hospital federal do Rio de Janeiro.Métodos : foi feito estudo retrospectivo do prontuário de 20 pacientes com acidente vascular encefálico, para os quais foi solicitada fonoterapia para disfagia. Para comparação do nível de ingestão oral de cada paciente, antes e depois da terapia, foi utilizada uma escala funcional. Foram estudados os possíveis fatores de interferência na progressão na escala como: idade, intercorrências clínicas, tempo e incidência prévia do AVE. Os seguintes indicadores de resultado foram analisados: tempo para retirada de via alternativa de alimentação e tempo para reintrodução de alimentação via oral.Resultados : dos 20 pacientes, 15 apresentaram melhora na escala de ingestão oral após a fonoterapia. As intercorrências clínicas foram consideradas estatisticamente significantes para a não evolução da alimentação via oral. Os outros fatores analisados não demonstraram significância estatística, sugerindo não interferir na melhora ou piora do paciente. Foi possível reintroduzir alimentação via oral e retirar via alternativa de alimentação antes de 10 dias.Conclusão : a fonoterapia é efetiva para melhorar a ingestão de alimentos por via oral nos pacientes com AVE e disfagia neurogênica, atendidos em ambiente hospitalar, salvo se apresentarem intercorrências clínicas e rebaixamento do nível de consciência durante o processo.
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Affiliation(s)
- Clarissa Inaoka
- Centro de Especialização em Fonoaudiologia Clínica CEFAC ? Saúde e Educação, Brasil
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Onofri SMM, Cola PC, Berti LC, da Silva RG, Dantas RO. Correlation between laryngeal sensitivity and penetration/aspiration after stroke. Dysphagia 2014; 29:256-61. [PMID: 24442645 DOI: 10.1007/s00455-013-9504-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 12/12/2013] [Indexed: 11/24/2022]
Abstract
Stroke is the most common neurological disease in adults that is associated with deglutition disorders. The presence of laryngeal sensitivity is very important in developing safe swallowing without risk of pulmonary complications. The aim of this study was to correlate laryngeal sensitivity with laryngeal penetration and tracheal aspiration after swallows of three food consistencies (puree, thickened liquid, and liquid) in poststroke individuals in the late phase. A cross-sectional clinical study was performed with 91 post-ischemic stroke individuals, with oropharyngeal dysphagia, who were in rehabilitation center treatment from 2009 to 2011. They had a mean age of 68.1 years and average time since injury was 22.6 months; 39 had injury to the right hemisphere and 52 had injury to the left hemisphere. All underwent fiberoptic endoscopic evaluation of swallowing and evaluation of laryngeal sensitivity by touching the tip of the endoscope to the arytenoids and aryepiglottic folds. The linear correlation coefficient of Spearman was applied to evaluate the correlation between laryngeal penetration and tracheal aspiration and the presence/absence of laryngeal sensitivity. There was a negative correlation between the observation of penetration and tracheal aspiration and laryngeal sensitivity, with all bolus consistencies (p < 0.001 for aspiration and p ≤ 0.01 for penetration). The absence of laryngeal sensitivity determines the more frequent findings of penetration and tracheal aspiration. This sensory stimulus in the mucosa of the pharynx and larynx is an essential element for safe swallowing and its deficiency associated with altered motor activity can cause laryngeal penetration and aspiration in poststroke individuals regardless of food consistency.
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Affiliation(s)
- Suely Mayumi Motonaga Onofri
- Department of Speech and Language Therapy, São Paulo State University - UNESP, Av. Hygino Muzzi Filho, 737, Campus Universitário, Marília, São Paulo, 17525-900, Brazil,
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Martins AS, Rezende NAD, Torres HODG. Occurrence of complications and survival rates in elderly with neurological disorders undergoing enteral nutrition therapy. Rev Assoc Med Bras (1992) 2013; 58:691-7. [PMID: 23250098 DOI: 10.1590/s0104-42302012000600014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 07/10/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the occurrence of complications, as well as the survival rates, in elderly people having neurological diseases and undergoing enteral nutrition therapy (ENT). METHODS Patients aged over 60 years, assisted by a home medical service from a healthcare plan in the city of Belo Horizonte, MG, Brazil, were thoroughly evaluated. The mentioned evaluation occurred at their homes after hospital discharge with enteral nutrition (EN) after a three-month period, a six-month period, and at the end of the study. A nutritional assessment was performed along with data collection performed on the patients' electronic medical records, and interviews performed with patients' family members and caregivers. RESULTS Seventy-nine patients aged 82.9 ± 10.4 years old were evaluated; of these, 49.4% presented dementia, and 50.6% presented other neurological diagnoses. 100% of patients presented a high dependence level, assessed by the Katz index. The majority of patients (91.2%) presented some complications such as: pneumonia, catheter loss, diarrhea, constipation, vomiting, fluid leakage, periostotomy, tube obstruction, reflux, and myiasis. Pneumonia was the most frequent complication, occurring in 55.9% of cases. The mortality rates were 15.2% at a three-month period, 22.8% at a six-month period, and 43% at the end of study. The median survival after starting EN was 364 days. Differences among the mortality rate and neurological diagnosis, EN routes of access, and complications were not observed. The survival rate was lower in patients having inadequate nutritional status and albumin levels < 3.5 mg/dL. CONCLUSION The population followed presented a high rate of complications and death at the end of the study. Diagnosis of dementia, EN routes of access, as well as complications, did not influence the survival rates. However, inadequate nutritional status according to the clinical assessment and albumin levels lower than 3.5 mg/dL significantly influenced the survival rates.
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Gatto AR, Cola PC, Silva RGD, Spadotto AA, Ribeiro PW, Schelp AO, Carvalho LRD, Henry MACDA. Sour taste and cold temperature in the oral phase of swallowing in patients after stroke. Codas 2013; 25:164-8. [DOI: 10.1590/s2317-17822013000200012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 09/13/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To determine the effect of sour flavor and cold temperature on oral transit time during swallowing. METHODS: Participants were 52 subjects (28 male and 24 female) with ages between 50 and 80 years (median=66 years), after ischemic stroke involving right or left side damage and mild to moderate oropharyngeal dysphagia. Videofluoroscopy was performed to analyze the swallowing times. Each subject was assessed during swallowing of a paste consistency bolus offered in 5 ml spoons, with a total of four different stimuli (natural, cold, sour and sour-cold). After the exam, the oral transit time was measured using specific software. The oral transit time (starting at the beginning of the bolus movement in the mouth) and the total oral transit time (starting at the moment that the bolus is placed in the mouth) were measured. RESULTS: The association between sour and cold stimuli caused a significant decrease of oral transit time and total oral transit time. CONCLUSION: Sour flavor and cold temperature reduced oral transit time in stroke patients.
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Zart P, Levy DS, Bolzan GDP, Mancopes R, da Silva AMT. Cryostimulation improves recovery from oropharyngeal dysphagia after stroke. Int Arch Otorhinolaryngol 2013; 17:31-40. [PMID: 25991991 PMCID: PMC4423318 DOI: 10.7162/s1809-97772013000100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 10/07/2012] [Indexed: 11/23/2022] Open
Abstract
Introduction: Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia. Aim: To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. Methods: Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue) 3 times a day (for a total of 30 daily applications per structure) for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Student's t-test and Fisher's exact test. Results: Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects. Conclusion: Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation.
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Affiliation(s)
- Patrícia Zart
- Assistant Professor, Speech Department, Passo Fundo University, Passo Fundo/RS, Brazil
| | - Deborah Salle Levy
- Ph.D. in Health Science, Institute of Cardiology of Rio Grande do Sul, Adjunct Professor, Department of Psychology and Personality Development, Rio Grande do Sul Federal University, Porto Alegre/RS, Brazil
| | - Geovana de Paula Bolzan
- Postgraduate Student in Human Communication Disorders, Santa Maria Federal University, Santa Maria/RS, Brazil
| | - Renata Mancopes
- Ph.D. in Linguistics, Santa Catarina Federal University, Adjunct Professor, Speech Department, Santa Maria Federal University, Santa Maria, RS, Brazil
| | - Ana Maria Toniolo da Silva
- Ph.D. in Human Communication Disorders, Sao Paulo Federal University. Associate Professor, Speech Department, Santa Maria Federal University, Santa Maria/RS, Brazil
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Sobrevida e complicações em idosos com doenças neurológicas em nutrição enteral. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70273-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nogueira SCJ, Carvalho APCD, Melo CBD, Morais EPGD, Chiari BM, Gonçalves MIR. Perfil de pacientes em uso de via alternativa de alimentação internados em um hospital geral. REVISTA CEFAC 2012. [DOI: 10.1590/s1516-18462012005000079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: caracterizar a população em uso de via alternativa de alimentação internada em um hospital geral de referência. MÉTODO: estudo transversal prospectivo, tendo-se realizado coleta de dados em 229 prontuários de pacientes em uso de via alternativa de alimentação internados em enfermarias adultas de um hospital geral, identificando-se dados referentes à via alternativa de alimentação em uso, justificativas clínicas, doença(s) de base e demais aspectos clínicos relacionados aos distúrbios de deglutição. RESULTADOS: houve predomínio do sexo masculino (55,02%); 70,3% dos pacientes apresentaram diagnóstico de alguma doença neurológica e a via de alimentação mais utilizada foi a sonda nasoenteral (82,53%). Embora a pneumonia e a desnutrição tenham sido diagnosticadas na minoria dos casos (35,08% e 10,04%), houve associação entre as variáveis pneumonia e disfagia (p=0,0098), não ocorrendo o mesmo entre desnutrição e disfagia (p=0,0759). A disfagia foi citada em apenas em 6,55% dos casos. Observou-se, ainda, alta frequência de ausência de dados referente aos sinais e sintomas de dificuldade de alimentação e de justificativas para indicação da via alternativa de alimentação prescrita. CONCLUSÃO: embora a população estudada tenha apresentado fatores de risco para desenvolvimento de distúrbios da deglutição, como doenças de base com alta ocorrência de disfagia e alteração do nível de consciência e/ou sonolência, a baixa frequência do diagnóstico da disfagia e a constante falta de dados relacionados ao contexto alimentar revelaram a pouca importância dada às manifestações funcionais pela unidade hospitalar estudada.
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Santos JN, Gomes LBP, Souza LDMD, Souza NRMD. Aspectos da assistência fonoaudiológica segundo a pesquisa por amostra de domicílios de Minas Gerais. REVISTA CEFAC 2012. [DOI: 10.1590/s1516-18462012005000075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: descrever o perfil das pessoas entrevistadas pela Pesquisa por Amostra de Domicílios de Minas Gerais (PAD-MG) que receberam atendimento fonoaudiológico em Minas Gerais em maio de 2009. MÉTODO: análise dos pacientes assistidos por fonoaudiólogos e entrevistados pela PAD-MG. Foram investigadas as variáveis: escolaridade, renda, idade, gênero, percepção do estado de saúde, natureza jurídica da fonte prestadora de serviço. RESULTADOS: 15 pessoas entrevistadas pela pesquisa referiram ter sido assistidas por fonoaudiólogos em maio de 2009, o que corresponde a 0,2% da população mineira (com utilização do peso amostral). Destes, 60% são do sexo masculino com idade entre 1 e 82 anos e 75% relataram bom estado de saúde. CONCLUSÃO: dos entrevistados assistidos por fonoaudiólogos, a maioria recebeu atendimento pelo SUS em consultórios da rede. Houve grande variação da faixa etária sendo que dos jovens e adultos atendidos 66% são alfabetizados. Foi possível perceber uma necessidade de expansão das ações de assistência fonoaudiológica no território estadual de modo a atender todas as parcelas da população, buscando o alcance da universalidade, integralidade e equidade, princípios doutrinários do SUS e norteados da rede de assistência à saúde no estado.
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Nunes MCDA, Jurkiewicz AL, Santos RS, Furkim AM, Massi G, Pinto GSA, Lange MC. Correlation between brain injury and dysphagia in adult patients with stroke. Int Arch Otorhinolaryngol 2012; 16:313-21. [PMID: 25991951 PMCID: PMC4399643 DOI: 10.7162/s1809-97772012000300003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 05/08/2012] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In the literature, the incidence of oropharyngeal dysphagia in patients with cerebrovascular accident (AVE) ranges 20-90%. Some studies correlate the location of a stroke with dysphagia, while others do not. OBJECTIVE To correlate brain injury with dysphagia in patients with stroke in relation to the type and location of stroke. METHOD A prospective study conducted at the Hospital de Clinicas with 30 stroke patients: 18 women and 12 men. All patients underwent clinical evaluation and swallowing nasolaryngofibroscopy (FEES(®)), and were divided based on the location of the injury: cerebral cortex, cerebellar cortex, subcortical areas, and type: hemorrhagic or transient ischemic. RESULTS Of the 30 patients, 18 had ischemic stroke, 10 had hemorrhagic stroke, and 2 had transient stroke. Regarding the location, 10 lesions were in the cerebral cortex, 3 were in the cerebral and cerebellar cortices, 3 were in the cerebral cortex and subcortical areas, and 3 were in the cerebral and cerebellar cortices and subcortical areas. Cerebral cortex and subcortical area ischemic strokes predominated in the clinical evaluation of dysphagia. In FEES(®), decreased laryngeal sensitivity persisted following cerebral cortex and ischemic strokes. Waste in the pharyngeal recesses associated with epiglottic valleculae predominated in the piriform cortex in all lesion areas and in ischemic stroke. A patient with damage to the cerebral and cerebellar cortices from an ischemic stroke exhibited laryngeal penetration and tracheal aspiration of liquid and honey. CONCLUSION Dysphagia was prevalent when a lesion was located in the cerebral cortex and was of the ischemic type.
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Affiliation(s)
- Maria Cristina de Alencar Nunes
- Speech Therapist. Student Doctorate in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR). Professor of the Specialization Course on Dysphagia and Voice of the University Tuiuti do Paraná – Curitiba/PR.
| | - Ari Leon Jurkiewicz
- Geriatrician. Doctor of Sciences from the UNIFESP / EPM. Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.
| | - Rosane Sampaio Santos
- Speech Therapist. Student Doctorate in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR). Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.
| | - Ana Maria Furkim
- Speech Therapist. Doctor in Human Communication Disorders from the Federal University of Sao Paulo. Professor of Speech Pathology, Federal University of Santa Catarina/SC.
| | - Giselle Massi
- Speech Therapist. Doctor in Linguistics from the Universidade Federal do Paraná (UFPR). Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.
| | - Gisele Sant Ana Pinto
- Speech Therapist. Student Master in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR) - Curitiba/PR.
| | - Marcos Christiano Lange
- Neurologist. Doctor in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR) - Curitiba/PR.
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Baroni AFFB, Fábio SRC, Dantas RO. Risk factors for swallowing dysfunction in stroke patients. ARQUIVOS DE GASTROENTEROLOGIA 2012; 49:118-24. [DOI: 10.1590/s0004-28032012000200005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 01/20/2012] [Indexed: 01/25/2023]
Abstract
CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.
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Remesso GC, Fukujima MM, Chiappetta ALDML, Oda AL, Aguiar AS, Oliveira ADSB, do Prado GF. Swallowing disorders after ischemic stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 69:785-9. [PMID: 22042182 DOI: 10.1590/s0004-282x2011000600012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 06/28/2011] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate occurrences of swallowing disorders after ischemic stroke. METHOD This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. RESULTS 50.5% were men and 49.5% women; mean age 65.3 years (SD= ± 11.7) (p ≤ 0.001). Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p ≤ 0.001) and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p ≤ 0.001). CONCLUSION Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.
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Affiliation(s)
- Gabriela Camargo Remesso
- Department of Emergency Medicine and Evidence-Based Medicine, Federal University of São Paulo (UNIFESP), São Paulo SP, Brazil.
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Silvério CC, Hernandez AM, Gonçalves MIR. Ingesta oral do paciente hospitalizado com disfagia orofaríngea neurogênica. REVISTA CEFAC 2010. [DOI: 10.1590/s1516-18462010005000090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: verificar a evolução na ingesta oral e a ocorrência de broncopneumonias (BCP) em pacientes hospitalizados com disfagia orofaríngea neurogênica, após atuação fonoaudiológica. MÉTODOS: 50 pacientes adultos, divididos em grupos: I: 31 pacientes pós-acidente vascular encefálico; II: sete pacientes pós-traumatismo crânio-encefálico; III: 12 pacientes com demência. Foram levantadas as informações antes e após a atuação fonoaudiológica: nível da Functional Oral Intake Scale (FOIS), ocorrência de BCP; número de atendimentos fonoaudiológicos e motivo de interrupção destes. RESULTADOS: houve aumento significativo dos níveis da escala FOIS e redução do percentual de ocorrência de BCP nos três grupos estudados. Nos grupos pós-AVE e demência a interrupção da fonoterapia ocorreu devido à alta hospitalar, enquanto que no grupo pós-TCE devido à alta fonoaudiológica. CONCLUSÃO: os pacientes deste estudo demonstraram avançar das consistências alimentares na ingesta oral, e redução da ocorrência de BCP, após a intervenção fonoaudiológica com relação à disfagia.
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Paixão CT, Silva LDD. Características de pacientes disfágicos em serviço de atendimento domiciliar público. Rev Gaucha Enferm 2010; 31:262-9. [DOI: 10.1590/s1983-14472010000200009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este artigo teve como objetivo identificar as características dos pacientes portadores de disfagia decorrente de um acidente cerebrovascular em relação à idade, fatores de risco, episódios de acidente vascular cerebral (AVC) e grau de dificuldade para deglutir em função da consistência dos alimentos. Estudo transversal com 30 pacientes através da técnica da entrevista. Os resultados mostraram média de idade de 73,6 (± 9,55) anos, sendo 76,47% de mulheres, todos hipertensos e a metade diabéticos (58,82%). Todos tiveram acidente vascular isquêmico. Não se encontrou associação entre disfagia e idade nem com a frequência de episódios de AVC. Pacientes com hipertensão e diabetes apresentam maior chance para a disfagia. Constatou-se que a dificuldade de deglutição para líquidos é maior que os pacientes com disfagia são idosos com vários fatores de risco diante do que o enfermeiro deve orientar para uma alimentação segura diminuindo complicações como a pneumonia e a desnutrição.
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Silva RGD, Jorge AG, Peres FM, Cola PC, Gatto AR, Spadotto AA. Protocolo para controle de eficácia terapêutica em disfagia orofaríngea neurogênica (PROCEDON). REVISTA CEFAC 2010. [DOI: 10.1590/s1516-18462010000100010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJETIVO: apresentar uma proposta para o controle de eficácia terapêutica em disfagia orofaríngea neurogênica. MÉTODOS: o protocolo foi proposto em concordância com a literatura atual e aplicado em um indivíduo pós-acidente vascular encefálico (AVE) isquêmico à direita, comprovado por tomografia computadorizada, com disfagia orofaríngea grave crônica, gênero masculino, 66 anos, apresentando aspiração laringotraqueal e em uso de sonda nasoentérica exclusiva pré-fonoterapia. Para controle da eficácia terapêutica do programa de reabilitação fonoaudiológica foi aplicado, pré e pós-fonoterapia, a classificação do grau de comprometimento da disfagia orofaríngea, Functional Oral Intake Scale (FOIS), a avaliação videofluoroscópica da deglutição com medida do tempo de trânsito faríngeo (TTF) da deglutição por meio de software e da percepção do indivíduo. RESULTADOS: na pré-fonoterapia verificou-se disfagia orofaríngea grave, FOIS nível 1, presença de aspiração laringotraqueal para mais de uma consistência e tempo de trânsito faríngeo de 13 segundos. Após fonoterapia verificou-se disfagia orofaríngea moderada, FOIS nível 5, ausência de aspiração laringotraqueal e TTF de 4 segundos. CONCLUSÃO: o protocolo proposto foi capaz de avaliar a eficácia da reabilitação na disfagia orofaríngea neurogênica neste indivíduo pós-acidente vascular encefálico, tanto para mensurar as mudanças ocorridas na fisiopatologia da deglutição quanto na ingestão oral e na percepção do indivíduo. Outros estudos com populações distintas são necessários, sendo que novas propostas devem ainda refletir a inclusão da condição nutricional e pulmonar do indivíduo no controle de eficácia em disfagia orofaríngea.
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Dziewas R, Warnecke T, Hamacher C, Oelenberg S, Teismann I, Kraemer C, Ritter M, Ringelstein EB, Schaebitz WR. Do nasogastric tubes worsen dysphagia in patients with acute stroke? BMC Neurol 2008; 8:28. [PMID: 18651972 PMCID: PMC2507716 DOI: 10.1186/1471-2377-8-28] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 07/23/2008] [Indexed: 02/08/2023] Open
Abstract
Background Early feeding via a nasogastric tube (NGT) is recommended as safe way of supplying nutrition in patients with acute dysphagic stroke. However, preliminary evidence suggests that NGTs themselves may interfere with swallowing physiology. In the present study we therefore investigated the impact of NGTs on swallowing function in acute stroke patients. Methods In the first part of the study the incidence and consequences of pharyngeal misplacement of NGTs were examined in 100 stroke patients by fiberoptic endoscopic evaluation of swallowing (FEES). In the second part, the effect of correctly placed NGTs on swallowing function was evaluated by serially examining 25 individual patients with and without a NGT in place. Results A correctly placed NGT did not cause a worsening of stroke-related dysphagia. Except for two cases, in which swallowing material got stuck to the NGT and penetrated into the laryngeal vestibule after the swallow, no changes of the amount of penetration and aspiration were noted with the NGT in place as compared to the no-tube condition. Pharyngeal misplacement of the NGT was identified in 5 of 100 patients. All these patients showed worsening of dysphagia caused by the malpositioned NGT with an increase of pre-, intra-, and postdeglutitive penetration. Conclusion Based on these findings, there are no principle obstacles to start limited and supervised oral feeding in stroke patients with a NGT in place.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany.
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Cola PC, Gatto AR, Silva RGD, Schelp AO, Henry MACDA. Reabilitação em disfagia orofaríngea neurogênica: sabor azedo e temperatura fria. REVISTA CEFAC 2008. [DOI: 10.1590/s1516-18462008000200009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
TEMA: reabilitação em disfagia orofaríngea neurogênica OBJETIVO: apresentar revisão de literatura sobre os controles neurofisiológicos da deglutição orofaríngea e a influência do sabor azedo e da temperatura fria no mecanismo da deglutição. CONCLUSÃO: quanto à questão do controle central da deglutição, ainda existem controvérsias em relação ao sabor azedo e a temperatura fria. Esses dois parâmetros provocam mudanças na dinâmica da deglutição, podendo trazer benefícios aos indivíduos acometidos por disfagia orofaríngea neurogênica. Porém, tais achados sugerem a necessidade de investigações futuras com populações randomizadas.
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Affiliation(s)
| | - Ana Rita Gatto
- Universidade Estadual Paulista; da Universidade Estadual Paulista de Botucatu
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Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36:2756-63. [PMID: 16269630 DOI: 10.1161/01.str.0000190056.76543.eb] [Citation(s) in RCA: 1180] [Impact Index Per Article: 62.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the incidence of dysphagia and associated pulmonary compromise in stroke patients through a systematic review of the published literature. METHODS Databases were searched (1966 through May 2005) using terms "cerebrovascular disorders," "deglutition disorders," and limited to "humans" for original articles addressing the frequency of dysphagia or pneumonia. Data sources included Medline, Embase, Pascal, relevant Internet addresses, and extensive hand searching of bibliographies of identified articles. Selected articles were reviewed for quality, diagnostic methods, and patient characteristics. Comparisons were made of reported dysphagia and pneumonia frequencies. The relative risks (RRs) of developing pneumonia were calculated in patients with dysphagia and confirmed aspiration. RESULTS Of the 277 sources identified, 104 were original, peer-reviewed articles that focused on adult stroke patients with dysphagia. Of these, 24 articles met inclusion criteria and were evaluated. The reported incidence of dysphagia was lowest using cursory screening techniques (37% to 45%), higher using clinical testing (51% to 55%), and highest using instrumental testing (64% to 78%). Dysphagia tends to be lower after hemispheric stroke and remains prominent in the rehabilitation brain stem stroke. There is increased risk for pneumonia in patients with dysphagia (RR, 3.17; 95% CI, 2.07, 4.87) and an even greater risk in patients with aspiration (RR, 11.56; 95% CI, 3.36, 39.77). CONCLUSIONS The high incidence for dysphagia and pneumonia is a consistent finding with stroke patients. The pneumonia risk is greatest in stroke patients with aspiration. These findings will be valuable in the design of future dysphagia research.
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Affiliation(s)
- Rosemary Martino
- Graduate Department of Speech Language Pathology, University of Toronto, Ontario, Canada.
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