Navegando por Palavras-chave "Dysphagia"
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- ItemSomente MetadadadosAnálise Da Interface Entre A Disfagia E As Implicações Nutricionais Nos Pacientes Com Doença Do Neurônio Motor(Universidade Federal de São Paulo (UNIFESP), 2017-01-31) Alves, Percilia Cardoso Lopes [UNIFESP]; Oliveira, Acary Souza Bulle [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Amyotriphic Lateral Sclerosis (ALS)is a disease in which there is impairment of the lower and upper motor neurons and the Bulbar Progressive Palsy (BPP) of the lower motor neuron of the brainstem; Both are within the Motor Neuron Disease (MND) group. Muscle weakness is a common sign that can trigger dysphagia. Purpose: To analyze the interaction between dysphagia and nutritional implications in the patient with MND. Method: Through observational, transversal, analytical and prospectiveresearch, 59 patients were evaluated, being 42 (71.18%) with ALS (47.62% male and 52.38%, female) and 17 (28.82%) with BPP (7 (41.17%) male and 17 (58.83%) female. The patients underwent speech therapy and nutritional evaluation; moreover, have been applied: functional range of consistencies (FOIS), scales of functionality (ALSFRS-R and EGELA) and respiratory assessment (peak cough flow).Results: 100% of patients with BPP presented oral and pharyngeal phase changes, while patients with ALS had less changes in oral (66.67%) and pharyngeal phase (73.80%). In nutritional evaluation, malnutrition was observed in 35.71% of patients with ALS and 23.52% of the patients with BPP. 28% (ALS) and 41.17% (BPP) of the patients made use of enteral route.Conclusion: Dysphagia was present in all patients with diagnosis of BPP, relating to increased frequency of malnutrition. Body mass index and Protein Energy Malnutrition score showed correlation with ALSFRS-R functionality. There was correlation between body mass indexes, the scale of food consistency (FOIS) and the peak cough flow.
- ItemSomente MetadadadosAvaliação Da Disfagia Em Pacientes Com Apneia Obstrutiva Do Sono(Universidade Federal de São Paulo (UNIFESP), 2017-07-31) Campanholo, Milena De Almeida Torres [UNIFESP]; Haddad, Fernanda Louise Martinho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: There is evidence that the trauma caused by snoring in the pharynx could cause dysphagia in patients with obstructive sleep apnea (OSA), but the literature is still scarce to define the factors associated with the presence of dysphagia in these patients. Sixty-seven patients with moderate or severe apnea (apnea and hypopnea index - AHI> 15 hours) were enrolled. The patients underwent a sleep questionnaire, a quality of life in dysphagia questionnaire (SWAL-Qol), a questionnaire on symptoms of Laryngopharyngeal Reflux (LRP), a Reflux Symptom Index (RSI), a score based on endolaryngeal videolaryngoscopic findings, a Reflux Finding Score (RFS) and a fiberoptic endoscopic evaluation of swallowing (FEES). Patients with at least one sign of alteration in FEES were considered as having dysphagia and clinical and polysomnographic parameters were compared between the groups. Results: 67 patients were included in the study, 49 men and 18 women, average age 46 ± 11 years. 26.86% of the patients had altered FEES, and the most frequent alteration was the early oral leak with fluid. Comparing the groups with and without dysphagia, men gender was the only clinical parameter that predominant in the group with dysphagia (p = 0.04). This finding was confirmed in the regression analysis (p = 0.01). There was no difference at polysomnographic features, presence of RFL and in the quality of life in the comparison between the groups. Conclusions: The presence of dysphagia in patients with moderate to severe apnea is frequent and subclinical, reinforcing the need to investigate this symptom in this group of patients, and the most frequent finding was the spillage with liquid trials. However, the presence of dysphagia did not impact patients' quality of life, suggesting that, although frequent, its repercussion is mild. There was no relevance in the association of clinical, polysomnographic parameters and the presence of LRP with the presence of dysphagia.
- ItemAcesso aberto (Open Access)Avaliação da motilidade faríngea pela manometria de alta resolução em pacientes submetidos a tireoplastia tipo I(Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Pinna, Bruno de Rezende [UNIFESP]; Biase, Noemi Grigoletto de [UNIFESP]; Fernandes, Fernando Augusto Mardiros Herbella [UNIFESP]; http://lattes.cnpq.br/4035568020554599; http://lattes.cnpq.br/3156326658988323; http://lattes.cnpq.br/9966897407737956; Universidade Federal de São Paulo (UNIFESP)Objectives: This study aims to compare the motility of the pharynx and UES in patients with UVFI before and after thyroplasty type I. Methods: We prospectively studied 15 patients with UVFI that underwent thyroplasty type I. Subjects were divided according to the topography of vagal injury and presence of dysphagia. High resolution manometry (HRM) was performed before and 30 days after surgery. Time and pressure manometric parameters at the topography of the velopharynx, epiglottis and UES were recorded. Results: Dysphagia was present in 67% of patients. 73% had lower vagal injuries. Manometric parameters did not change after thyroplasty for the whole population. The group of dysphagic patients; however, had an increase in residual pressure at the UES after thyroplasty (1.2 vs. 5.2 mmHg - p=0.05). Patients with low vagal injury developed higher peak pressure (100 vs. 108.9 mmHg - p=<0.001); lower rise time (347 vs. 330 ms - p=0.04); and higher up stroke (260 vs. 266.2 mmHg/ms p= 0.04) at the topography of the velopharynx after thyroplasty. Conclusion: Pharyngeal motility is affected by thyroplasty type I in patients with dysphagia and low vagal injury.
- ItemSomente MetadadadosAvaliação de disfagia após aplicação de toxina botulínica em músculo tireoaritenoideo(Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Haidar, Raissa Ferreira Goncalves [UNIFESP]; Biase, Noemi Grigoletto De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To verify the frequency and degree of dysphagia presented by patients submitted to the application of botulinum toxin in thyroarytenoid muscle. Also to identifying the risk factors for the presentation of this swallowing disorder. Methods: 20 patients participated in the study. All participants were submitted to the application of botulinum toxin with the aid of electromyography. For evaluation of dysphagia, fiberoptic endoscopic evaluation of swallowing was used. The examination was performed twice, one before the application of botulinum toxin and other on the 7th day after application. The exam was recorded and later analyzed by 2 otorhinolaryngologists. The data were then computed and sent to the analysis. Results: 90% of the patients were female and the mean age was 62.8 years. 45% had a diagnosis of laryngeal dystonia of adduction, 40% of dystonic tremor, 10% of dysphonia due to musculoskeletal tension and 5% of essential tremor. In the fiberoptic endoscoy evaluation of swallowing before the application of botulinum toxin, 40% of the patients presented some alteration in the examination characterizing the presence of dysphagia (0% aspiration, 15% penetration and 35% presence of residues). When we repeated the test 7 days after the application of botulinum toxin, the frequency of patients with dysphagia in the sample increased to 75% (10% aspiration, 25% penetration and 65% presence of residues).Conclusion: When evaluating dysphagia with fiberoptic endoscopy evaluation of swallowing, we conclude that the application of botulinum toxin increased the frequency of dysphagia in the sample by 35 percentage points. Most of the patients presented, after the botulinum toxin, mild dysphagia, characterized only by the presence of residues. The presence of aspiration occurred only in patients who had previously dysphagic alterations.
- ItemSomente MetadadadosContinuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly(Springer, 2018) de Lima Alvarenga, Eliezia Helena [UNIFESP]; Dall'Oglio, Giovana Piovesan [UNIFESP]; Murano, Emi Zuiki; Abrahao, Marcio [UNIFESP]To investigate whether disclosed symptoms (coughing, choking and throat clearing) can be used as early predictors of swallowing disorders in non-hospitalized elderly population. In addition, to determine the presence of early findings of swallowing disorders through fiber optic endoscopic evaluation of swallowing (FEES). One hundred subjects older than 60 years were recruited from local community social meetings for seniors, they fulfilled inclusion criteria, and were given an oral interview and underwent FEES, with findings classified as: (1) saliva stasis
- ItemSomente MetadadadosHigh-Resolution Manometry Evaluation of Pressures at the Pharyngo-upper Esophageal Area in Patients with Oropharyngeal Dysphagia Due to Vagal Paralysis(Springer, 2017) Pinna, Bruno Rezende [UNIFESP]; Herbella, Fernando A. M. [UNIFESP]; de Biase, Noemi [UNIFESP]; Vaiano, Thays C. G. [UNIFESP]; Patti, Marco G.The motility of the pharynx, upper esophageal sphincter (UES), and proximal esophagus in patients with oropharyngeal dysphagia is still not entirely understood. High-resolution manometry (HRM) was recently added to the armamentarium for the study of this area. This study aims to describe HRM findings in patients with vagal paralysis. Sixteen patients (mean age 54 years, 69% females) with oropharyngeal dysphagia due to unilateral vagal paralysis were prospectively studied. All patients underwent HRM. Motility of the UES and at the topography of the velopharynx and epiglottis were recorded. (1) UES relaxation is compromised in a minority of patients, (2) epiglottis pressure does not follow a specific pattern, (3) vellum is hypotonic in half of the patients, (4) dysphagia is related to a low pharyngeal pressure, not to a flow obstruction at the level of the UES, and (5) aspiration is related to low pressures at the level of the UES and epiglottis and higher pressures at the level of the vellum. Pharyngeal motility is significantly impaired in patients with oropharyngeal dysphagia and unilateral vagal paralysis. In half of the cases, UES resting pressure is preserved due to unilateral innervation and relaxation is normal in most patients. Dysphagia therapy in these patients must be directed toward improvement in the oropharyngeal motility not at the UES.
- ItemSomente MetadadadosImpacto Da Tireoplastia Tipo I Na Qualidade De Vida Relacionada A Disfagia De Pacientes Com Imobilidade De Prega Vocal Unilateral(Universidade Federal de São Paulo (UNIFESP), 2018-03-29) Castro, Thaiana Carneiro De [UNIFESP]; Haddad, Fernanda Louise Martinho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction Dysphagia Can Lead To Functional Limitations And Complications That Compromise An Individual's Quality Of Life. Patients With Laryngeal Immobility May Have Dysphonia And Dysphagia, But Studies Evaluating The Impact Of Surgical Treatment By Thyroplasty On The Improvement Of Dysphagia Are Scarce In The Literature. Objective To Evaluate The Impact Of Type I Thyroplasty On The Improvement Of Dysphagia-Related Quality Of Life In Patients With Unilateral Vocal Fold Immobility. Method This Is An Observational, Prospective And Longitudinal Study. Eleven Patients With Dysphagia, Who Had Type I Thyroplasty Due To Vocal Fold Immobility, Were Evaluated Through The Questionnaire "Quality Of Life In Swallowing Disorders" (Swal Qol). The Findings Were Compared Without Pre And Postoperative. Results The Mean Age Was 46.6 ± 17.1 Years, With Female Predominance (72.7%) And Left Side Immobility 5 (54.5%). An Average Score In All Domains Of Swal Qol Showed Improvement After Surgical Intervention. The Domain With The
- ItemSomente MetadadadosProposta de um programa de terapia fonoaudiológica em pacientes com ataxia espinocerebelar tipo 3(Universidade Federal de São Paulo (UNIFESP), 2020-09-22) Diaferia, Giovana Lucia Azevedo [UNIFESP]; Barsottini, Orlando Graziani Povoas [UNIFESP]; Universidade Federal de São PauloSpinocerebellar ataxia type 3 (SCA3) is a degenerative disease that is inherited in an autosomal dominant pattern. It is caused by a mutation located on the chromosome 14q resulting in abnormal CAG triplet repeats. It affects different population groups with an estimated prevalence of 1:100,000 in Brazil. This disease usually manifests between 30 and 50 years of age and first symptoms include ataxia, gait disturbance and abnormal ocular motricity. The degenerative process underlying SCA3 affects many different regions and/or functions of the central nervous system (CNS) and the peripheral nervous system (PNS) including areas and pathways that are involved in motor speech and swallowing. With progression of the disease, individuals with SCA3 exhibit communication and swallowing deterioration. Speech-language interventions for speech, voice and swallowing problems are important because patients with difficulty swallowing are at risk of repeated aspiration and dysarthria affects normal socialization. Objectives: To evaluate the impact of a speech therapy rehabilitation program on phonoarticulation, voice, swallowing and quality of life (QoL) of patients with SCA3. Methods: All participants were randomly assigned to two groups, an intervention group receiving speech therapy (STG) and a control group (CG). The intervention comprised a 12-session speech therapy rehabilitation program consisting of oral, pharyngeal and laryngeal strengthening exercises—so-called ATAXIA – Myofunctional Orofacial and Vocal Therapy (A-MOVT). All participants underwent pre- and post-intervention clinical evaluations using a phonoarticulation assessment tool developed by the Mayo Clinic; nasofibrolaryngoscopy; videoendoscopic swallowing study; and orofacial motricity assessment based on Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES). They were also assessed by four different QoL instruments: The World Health Organization's Quality of Life (WHOQoL-Bref); Living with Dysarthria, (LwD); Quality of Life in Swallowing Disorders (SWAL-QoL); and EAT-10 Food Assessment Tool. Results: The study sample included 48 patients with SCA3 (STG = 25; CG = 23), 33 (69%) females and 15 (31%) males; mean age 47.1±11.4 years; mean age at symptom onset 36.9±11.3 years; and disease duration 11.9±13.3 years. The International Cooperative Ataxia Rating Scale (ICARS) scores were 32.4±20.2 and the Scale for the Assessment and Rating of Ataxia (SARA) scores were 11.8±8.0. At the end of the three-month intervention, the STG showed significant improvements in dysphagia (0.56±0.87 [pre-] vs. 0.00±0.00 [post-]; p<0.001); dysarthria (1.92±0.27 [pre-] vs. 0.84±0.62 [post-], p<0.001); and orofacial motricity (153.00±16.12 [pre-] vs. 205.44±27.55 [post-], p<0.001). There were significant changes in the QoL in the STG compared to the CG when assessed by the LwD (179.12±62.55 vs. 129.88±51.42, p<0.001), SWAL-QoL (79.04±13.97 vs. 82.87±11.91, p=0.010) and EAT-10 (5.16±7.55 vs. 2.08±3.85, p=0.018). Conclusions: Patients with SCA3 should receive continuous speech therapy as part of the A-MOVT program since rehabilitation therapy improves difficulty swallowing and dysarthria.
- ItemAcesso aberto (Open Access)Tradução, equivalência cultural e validacão do questionário Munich Dysphagia test - Parkinson Disease (MDT-PD) para o português brasileiro(Universidade Federal de São Paulo (UNIFESP), 2019-02-22) Almeida, Luciana Escanoela Zanato [UNIFESP]; Monteiro, Silvana Bommarito [UNIFESP]; http://lattes.cnpq.br/5606969949793059; http://lattes.cnpq.br/1061663287250889; Universidade Federal de São Paulo (UNIFESP)Objective: to translate and validate the Brazilian version of the protocol The MunichDysphagiatest and Parkinson'sDisease (MDT-PD) Methods: A total of 102 individuals with Parkinson's disease and 95 elderly individuals who were the control group were evaluated. The objective of this study was to evaluate the Brazilian version of the Munich Dysphagia test and Parkinson's disease (MDT-PD) protocol. The translation and adaptation were performed according to the criteria of the Scientific Advisory Committee of the Medical Outcomes Trust following the steps: 1- Language and cultural translation and adaptation; 2-Validity of construct and criterion; 3-Reliability; 4- Sensitivity. Results: At the stage of translation and cultural equivalence, there were no intercurrences in the translation process, nor the need to withdraw any question, arriving at the Brazilian Portuguese version titled Dysphagia Test of Munich (TDM-DP), which presents 26 questions, in the same way as the original instrument. Regarding the validation steps, of the psychometric measures, it was possible to validate the construct, since the instrument was able to detect statistically significant differences in the self-assessment. In addition, it was possible to verify by means of regression models that there was a significant positive relation of the TDM-DP test with other instruments already validated for Brazilian Portuguese, confirming the validation of criterion. Regarding the reliability, it was possible to verify that all the questions were positively correlated. The Cronbach's alpha of 0.91 indicated that the assumption of internal consistency of the questionnaire was adequate. It was observed that the value of the intraclass correlation coefficient between the test and retest moments showed a satisfactory agreement for the complete group (r = 0.680), with respect to the sensitivity there was a difference between the pre- and post-intervention moments, with a significant reduction of the score of TDM after the intervention (p = 0.008). Conclusion: The instrument showed to have the psychometric properties necessary for the screening of the risk of dysphagia for patients with Parkinson's disease, being validated for Brazilian Portuguese with the name "Munich Dysphagia Test - Parkinson's Disease (TDM-DP)".