Neurogenic Oropharyngeal Dysphagia Research Articles

Features of nutritional support for dysphagia. The role of a speech therapist

Neurogenic oropharyngeal dysphagia remains a widespread complication of neurological diseases. Its prevalence in stroke patients reaches 50%, among patients with multiple sclerosis — 44%, with amyotrophic lateral sclerosis — 60%, after brain injury — 50%, with Parkinson’s disease — 84%. Neurogenic oropharyngeal dysphagia can lead to a decrease in food intake, development of malnutrition and dehydration, and can also be complicated by the development of aspiration pneumonia, followed by death. Currently, the detection of dysphagia in hospitalized patients is often carried out late or outside the algorithm, which significantly increases the risk of nutritional deficiency, decreased quality of life, and other complications when eating. A clinical study of the swallowing function at the earliest possible time of hospitalization avoids delays in diagnosis and timely determines the feeding tactics of a patient with neurogenic dysphagia. The assessment of the swallowing function should be carried out in the first hours of the patient’s hospitalization, and the main conclusion to be drawn from the results of a clinical study of the swallowing function is whether the patient can receive food through the mouth to satisfy nutritional needs. Despite the urgency of the problem of the development of nutritional deficiency in patients with dysphagia, there are few specific recommendations in the Russian literature on the stages of diagnosis, medical rehabilitation and nutritional support for this category of patients. This review is devoted to the analysis of the need for correct diagnosis and rehabilitation of patients with dysphagia and the impact of dysphagia on the quality of life and nutritional status of the patients.

Temporal perception of dysphagia symptoms in a cohort of patients with neurogenic oropharyngeal dysphagia

Introducción: la disfagia resulta de varios mecanismos fisiopatológicos donde sus síntomas no son estáticos ni homogéneos en las personas, especialmente cuando existe disfagia orofaríngea neurogénica. Objetivo: conocer la percepción y comportamiento en el tiempo de síntomas de disfagia mediante el instrumento Eating Assessment Tool-10 (EAT-10) en pacientes con disfagia orofaríngea neurogénica, con el fin de visualizar la dinámica clínica de esta forma de disfagia. Metodología: estudio observacional tipo cohorte en pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares, con seguimiento a tres y seis meses y diligenciamiento del EAT-10 al momento basal, tercer y sexto mes. Resultados: un total de 90 personas con evaluación basal, de las cuales el 56,7 % (51/90) lograron seguimiento al tercer mes y 25,6 % (23/90) al sexto mes. Los síntomas de disfagia con mayor autopercepción en los tres momentos fueron la dificultad para tragar sólidos, sensación de comida pegada en garganta y tos al comer. La odinofagia no fue un síntoma habitualmente percibido. La puntuación total del EAT-10 estuvo entre 16,61 ± 9 y 18,1 ± 9,5 puntos en general. En pacientes con seguimiento completo se observó variación en la autopercepción para tragar líquidos y pastillas. Se observó variación del puntaje al ajustarlo por recepción de terapias. Discusión: las enfermedades neurológicas y neuromusculares impactan directamente la deglución con gravedad entre leve a profunda, donde la autopercepción de síntomas deglutorios es dinámica, pero con síntomas cardinales de disfagia orofaríngea en el tiempo. Conclusiones: el reconocimiento y seguimiento de síntomas de disfagia deben ser aspectos usuales en la atención de pacientes con enfermedades neurológicas y neuromusculares.

Neurogenic oropharyngeal dysphagia: clinical characterization and perception of symptoms in Antioquia, Colombia between the years 2019 to 2021

Introducción: la disfagia es un trastorno de la deglución, el cual es habitualmente desatendido por profesionales de la salud, en especial la disfagia orofaríngea neurogénica, que es capaz de producir varios síntomas, signos y complicaciones secundarias en los pacientes. Objetivo: realizar una caracterización clínica incluyendo percepción de síntomas de disfagia en pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares en Antioquia, Colombia entre los años 2019 y 2021. Metodología: estudio transversal realizado en 80 pacientes con disfagia orofaríngea neurogénica confirmada a través de la herramienta Eating Assessment Tool-10, evaluación clínica y/o resultados de video fluoroscopia de la deglución. Resultados: 71 pacientes presentaron causas neurológicas centrales. La enfermedad cerebrovascular y la enfermedad de Parkinson fueron las etiologías más frecuentes. Solo 18% de los pacientes con causas neurológicas y 33% con causas neuromusculares reportaron tolerancia a todas las consistencias de alimentos. Mediana de 16 puntos en cuanto a autopercepción de síntomas de disfagia mediante el instrumento Eating Assessment Tool-10, con puntuaciones más altas en pacientes con presencia de gastrostomía, antecedente de neumonía, odinofagia y alteración en la oclusión mandibular al examen físico. En los pacientes con causas neurológicas hubo mayor presencia de signos motores linguales y apraxias orofaciales. Conclusión: existen características clínicas como sensación de comida pegada, dificultad para tragar alimentos sólidos, tos y ahogo al tragar, que son útiles en el reconocimiento de casos de disfagia orofaríngea, y apoyan que esta genera más síntomas que signos al examen físico en pacientes con condiciones neurológicas y neuromusculares.

ПЕРКУТАННАЯ ЭНДОСКОПИЧЕСКАЯ ГАСТРОСТОМИЯ (ОБЗОР ЛИТЕРАТУРЫ)

Percutaneous endoscopic gastrostomy is the most common method for long-term enteral nutrition in patients with organic and functional diseases of the esophagus, with severe neurogenic oropharyngeal dysphagia as a result of acute cerebral circulatory disorders, oropharyngeal cancer, severe facial injuries, etc.
 The advantages of endoscopic surgery are the minimally invasive nature and speed of the intervention, an insignificant percentage of postoperative complications. 
 The review article analyzes data on the relevance of the problem, indications and contraindications, technique of execution, complications of percutaneous endoscopic gastrostomy. 
 Measures aimed at minimizing risks during this operation, including correction of the general condition and concomitant somatic diseases in patients, a thorough assessment of the risk of surgery, which have the greatest impact on the immediate results of the operation, are identified.

Hospital speech-language pathology approach in oropharyngeal dysphagia and its motor and etiological associations

Objective: To identify the profile of speech-language pathology in patients with oropharyngeal dysphagia at a University Hospital and the associations between health conditions and the etiology of swallowing disorders. Methods: A cross-sectional and descriptive study, with analysis of medical records of patients with oropharyngeal dysphagia treated at a University Hospital, of both sexes, attended from February to December 2018. A descriptive and association analysis of the evaluated variables was carried out, with a significance level of 0.05. Results: It was identified in the sample, consisting of 26 (51%) females and 25 (49%) males, with a mean of 57.1 years (± 18.6), presence of progressive neurogenic oropharyngeal dysphagia (39.2 %), idiopathic (31.4%) and non-progressive (29.4%), in which the most performed speech-language pathology procedures were assessment (100%), giving support to observational issues during the fiberoptic endoscopic evaluation of swallowing (96.1%), management of dysphagia (92.2%) and return and discharge conducts (49% and 25.5%, respectively). The multi-professional participation has conducted better decision-making for an adequate diagnosis and speech therapy approach that had aimed at the management of oropharyngeal dysphagia, as well the intervention approaches with techniques aimed at maneuvers, and neuromuscular conditioning in relation to disorders of the biomechanics of swallowing. There was a significant association between the presence of motor and balance changes with neurogenic oropharyngeal dysphagia and difficulty in swallowing and choking symptoms as a sign of oropharyngeal dysphagia.

A systematic review and meta-analysis of the effects of intraoral treatments for neurogenic oropharyngeal dysphagia.

Rehabilitative treatments for oropharyngeal dysphagia, including oromotor exercises and sensory stimulation, have been widely adopted into clinical practice. However, the effects of these treatments are mainly supported by exploratory studies. As such, their clinical efficacy remains uncertain. Our systematic review and meta-analysis aimed to evaluate the efficacy of intraoral treatments for neurogenic oropharyngeal dysphagia based on evidence from randomised controlled trials (RCTs). Six electronic databases were systematically searched between January 1970 and July 2021. Data were extracted and analysed by two independent reviewers. The outcome measure was changes in (any) relevant clinical swallowing-related characteristics. Data from 285 dysphagic patients were collected from 8 RCT studies across a range of intraoral dysphagia treatments. The pooled effect size of all intraoral dysphagia treatments was non-significant compared to control comparators (SMD [95%CI]=0.23 [-0.22, 0.69], p=.31; I2 =73%). Subgroup analysis revealed that the pooled effect sizes were also non-significant for oromotor exercises (device-facilitated lip resistance exercises and tongue exercises) (SMD [95%CI]=0.11 [-0.76, 0.97]; p=.81; I2 =88%) and sensory stimulation (thermal-tactile, thermo-chemical and electrical stimulation) (SMD [95%CI]=0.35 [-0.03, 0.72]; p=.07; I2 =0%). Our results showed that overall, intraoral dysphagia treatments, including oromotor exercises and sensory stimulation, do not show beneficial effects for neurogenic oropharyngeal dysphagia. The evidence for these treatments remains weak and currently inadequate to support clinical use. Large-scale, multi-centre RCTs are warranted to fully explore their clinical efficacy.

Effects of pharmacological agents for neurogenic oropharyngeal dysphagia: A systematic review and meta-analysis.

BackgroundThis systematic review and meta‐analysis aimed to evaluate the effects of pharmacological agents for neurogenic oropharyngeal dysphagia based on evidence from randomized controlled trials (RCTs).MethodsElectronic databases were systematically searched between January 1970 and March 2021. Two reviewers independently extracted and synthesized the data. The outcome measure was changed in (any) relevant clinical swallowing‐related characteristics.Key resultsData from 2186 dysphagic patients were collected from 14 RCT studies across a range of pharmacotherapies. The pooled effect size of transient receptor potential (TRP) channel agonists was large compared to placebo interventions (SMD[95%CI] =1.27[0.74,1.80], p < 0.001; I 2 = 79%). Data were limited for other pharmacological agents and the overall pooled effect size of these agents was non‐significant (SMD [95% CI] =0.25 [−0.24, 0.73]; p = 0.31; I 2 = 85%). When analyzed separately, large effect sizes were observed with Nifedipine (SMD[95%CI] =1.13[0.09,2.18]; p = 0.03) and Metoclopramide (SMD[95%CI] =1.68[1.08,2.27]; p < 0.001). By contrast, the effects of angiotensin‐converting enzyme (ACE) inhibitors (SMD[95%CI] = −0.67[−2.32,0.99]; p = 0.43; I 2 = 61%), Physostigmine (SMD[95%CI] = −0.05[−1.03,0.93]; p = 0.92) and Glyceryl Trinitrate (GTN) (SMD [95% CI] = −0.01 [−0.11, 0.08]; p = 0.78) were non‐significant. Within stroke patients, subgroup analysis showed that TRP channel agonists had a moderate pooled effect size (SMD[95%CI] =0.74[0.10,1.39]; p = 0.02; I 2 = 82%) whereas the effects of other agents were non‐significant (SMD[95%CI] =0.40[−0.04,0.84]; p = 0.07; I 2 = 87%).Conclusions & InferencesOur results showed that TRP channel agonists, Nifedipine and Metoclopromide may be beneficial for neurogenic dysphagic patients. Large scale, multicenter clinical trials are warranted to fully explore their therapeutic effects on swallowing.

Detection of poststroke oropharyngeal dysphagia with swallowing screening by ultrasonography.

There are currently no standard evaluation tools for poststroke neurogenic oropharyngeal dysphagia. We previously suggested calculating the relative movements of the hyoid bone and larynx by ultrasonography to evaluate swallowing movement. Swallowing movement is altered in neurogenic oropharyngeal dysphagia. Therefore, the present study aimed to verify whether an ultrasonographic evaluation of swallowing movement facilitates the detection of neurogenic oropharyngeal dysphagia. Eighteen healthy male elderly participants (the healthy group) and 18 male stroke patients diagnosed with neurogenic oropharyngeal dysphagia (the dysphagia group) were enrolled. Participants swallowed 5 mL of liquid and water with an adjusted viscosity and the movements of the hyoid bone and larynx were visualized by ultrasonography. The results obtained revealed significant differences in laryngeal duration (static phase), laryngeal displacement (elevation phase), and the hyoid bone–laryngeal motion ratio (HL motion ratio) between the two groups. A multiple regression analysis was performed to adjust for confounding factors, and laryngeal duration (static phase) and the HL motion ratios were identified as factors affecting dysphagia. In the receiver operation characteristic curve of the two variations, the area under the curve for laryngeal duration (static phase) was 0.744 and the cut-off was 0.26 sec with 72.2% sensitivity and 88.9% specificity; the area under the curve for the HL motion ratio was 0.951 and the cut-off was 0.56 with 88.9% sensitivity and 88.9% specificity. Therefore, the objective evaluation of hyoid bone and larynx movements during swallowing by ultrasonography facilitated the detection of neurogenic oropharyngeal dysphagia.

Effects of effortful swallowing on cardiac autonomic control in individuals with neurogenic dysphagia: a prospective observational analytical study

Considering that neurogenic oropharyngeal dysphagia is a prevalent condition with or without cardiac disease we should contemplate issues surrounding cardiovascular difficulties during rehabilitation. This study aims to evaluate the effects of effortful swallowing maneuver (ESM) on heart rate variability (HRV) in subjects with neurogenic oropharyngeal dysphagia. We studied 22 individuals [8 Stroke and 14 Parkinson Disease (PD) subjects aged between 41 and 75 years old] with neurogenic oropharyngeal dysphagia regardless of gender. HRV was assessed under two circumstances: spontaneous swallowing versus ESM. Surface electromyography of the suprahyoid muscles was undertaken to measure the swallowing muscle excitation, which then confirmed higher muscle activity during ESM. We attained no changes in HRV between the two swallowing events [HR: spontaneous swallowing 78.68 ± 13.91 bpm vs. ESM 102.57 ± 107.81 bpm, p = 0.201; RMSSD (root-mean square of differences between adjacent normal RR intervals in a time interval): spontaneous swallowing 16.99 ± 15.65 ms vs. ESM 44.74 ± 138.85 ms, p = 0.312; HF (high frequency): spontaneous swallowing 119.35 ± 273 ms2 vs. ESM 99.83 ± 194.58 ms2, p = 0.301; SD1 (standard deviation of the instantaneous variability of the beat-to-beat heart rate): spontaneous swallowing 12.02 ± 1.07 ms vs. ESM 31.66 ± 98.25 ms, p = 0.301]. The effortful swallowing maneuver did not cause clinically significant changes in autonomic control of HR in this group of subjects with oropharyngeal dysphagia.

Severity degree neurogenic oropharyngeal dysphagia in the patient of intermediate care unit

Objetivo: Indagar el grado de severidad de la disfagia orofaríngea neurogénica en los pacientes de la unidad de cuidado intermedio, por medio de la escala de severidad de la disfagia de Horacio Cámpora que considera habilidades alimentarias a través de consistencias que puede manejar el paciente realizadas con el Método de Exploración Clínica Volumen – Viscosidad (MECV-V). Metodología: El estudio es de tipo exploratorio, no experimental, con un grupo de 32 pacientes con desórdenes neurológicos. Resultado: Se detecta que el grado de severidad de la disfagia orofaríngea neurogénica en los pacientes de la unidad de cuidados intermedios es moderada – severa, en la cual la ingesta oral no es exitosa y requiere supervisión constante y asistencia por el fonoaudiólogo. Conclusión: La investigación aporta elocuentemente al abordaje fonoestomatognatico y/o motricidad orofacial, en cuanto a la labor asistencial del fonoaudiólogo en las unidades de cuidados intermedios.

Validation of the Dutch Version of the M.D. Anderson Dysphagia Inventory for Neurogenic Patients

Background/Aim: The aim of this study was to validate the Dutch-language version of the M.D. Anderson Dysphagia Inventory (MDADI) for patients with neurogenic oropharyngeal dysphagia (OD). Methods: One hundred and seventy-eight patients with neurogenic OD and 92 healthy control subjects completed the MDADI and the Dutch version of the Swallowing Quality-of-Life Questionnaire (SWAL-QOL-NL). Exclusion criteria were: suffering from a concurrent head-and-neck oncological disease, scoring below 23 on a Mini Mental State Examination, being older than 85 years, and being illiterate or blind. None of the patients was in a palliative state of disease. Floor and ceiling effects, known-groups validity, internal consistency, construct validity, and criterion validity were assessed. Results: The MDADI total score showed no floor or ceiling effects for the patient group. Known-groups validity was confirmed by group differences in score distributions between patients and healthy control subjects. The internal consistency showed Cronbach’s α-values ranging from 0.77 to 0.92. Correlations between the MDADI subscales and SWAL-QOL-NL domains were moderate to strong: 0.71, 0.70, and 0.62 (convergent construct validity). Correlations between the MDADI scores and the SWAL-QOL-NL domains general burden, food selection, eating duration, communication, mental health, social functioning, and frequency of symptoms were moderate to strong, ranging from 0.41 to 0.75. Weak correlations (<0.4) were found between the MDADI scores and the SWAL-QOL-NL domains eating desire, sleep, and fatigue. Conclusion: The results of this study show that the Dutch translation of the MDADI is a psychometrically validated and suitable dysphagia-specific quality-of-life questionnaire for patients with neurogenic OD.

The relevance of the early terms of the formation of percutaneous endoscopic gastrostomy after a stroke complicated by severe neurogenic oropharyngeal dysphagia (review of the literature)

Neurogenic oropharyngeal dysphagia (NOD) was a frequent complication after a stroke, determining the further prognosis and quality of life, causing a number of serious complications. Patients with severe NOD was recommended enteral feeding through the nasogastric tube (NGT) with the subsequent formation of a percutaneous endoscopic gastrostomy (PEG). Prolonged use of NGT had its own complications – sinusitis, gastroesophageal reflux, aspiration pneumonia, etc., and therefore it should be limited in time. In various recommendations, the length of terms before the formation of the PEG remained controversial. The analysis of modern tactics of PEG in patients after severely developed NOD was performed on the basis of literature data.

Consistencies and terminologies - the use of the International Dysphagia Diet Standardization Initiative.

Introduction: this study aimed to verify the ability of speech therapists to identify, sort and name the different consistencies used in neurogenic oropharyngeal dysphagia (NOD) management, and to compare the results with the terms proposed by the International Dysphagia Diet Standardization Initiative (IDDSI). Methods: this research was approved by the ethics committee. Sixty speech therapists who work with NOD patients sorted 5 commercial foods from thinnest to thickest to match IDDSI levels 0 to 4, and then used a term to designate each consistency. Results: most subjects (76.66%) sorted the foods properly. Terminologies were divergent at all levels. For level 0, practitioners assigned 3 different terms. For level 1, 24 different terms were reported; for level 2 there were 25 terms, 23 terms for level 3, and 18 terms for level 4. Level 0 (IDDSI - thin) was designated by most participants as liquid; level 1 (IDDSI - slightly thick) was referred to as semi-thickened liquid; level 2 (IDDSI - mildly thick) as thickened liquid; level 3 (IDDSI - moderately thick) as honey; and level 4 (IDDSI - extremely thick) as pasty by most subjects. A reduced number of participants used terms in accordance with IDDSI. Level 0 was appropriately named by 5 subjects (8.33%); levels 1, 2 and 4 by 2 practitioners each (3.33%); and level 3 by 1 professional (1.66%). None of the subjects named all 5 IDDSI levels correctly. Conclusion: most practitioners progressed consistencies properly. There was a diversity of terminologies used for the same consistency at all levels, with no standardization.

Management of the risk of bronchoaspiration in patients with oropharyngeal dysphagia

ABSTRACT Objective: to manage the risk of bronchoaspiration in patients with oropharyngeal dysphagia through signalizing plates in the hospital bed. Methods: a descriptive, quantitative study, developed in the medical clinic I (diagnostic investigation), medical clinic II (infectology / pneumology), surgical clinics and intensive care unit of the University Hospital of the Federal University of Sergipe, from February to August 2017. It was composed of patients in the age group ≥ 18 years of age, of both sexes, diagnosed with oropharyngeal dysphagia, based on the application of the adapted protocol of clinical evaluation in the hospital bed and instrumental examination of swallowing, when pertinent. Following the clinical evaluation and identification of the risk of bronchoaspiration due to oropharyngeal dysphagia, the signs were inserted at the hospital bed by the speech therapist. Results: the study included 43 patients at risk of bronchoaspiration due to oropharyngeal dysphagia, average age of 53.7 ± 3.53 years old, with 51.1% (n = 22) females and 48.9% (n = 21) males. A predominance of neuropathies (53.4%) and severe neurogenic oropharyngeal dysphagia (37.2%) was observed. The intensive care unit stood out with 44.18% (n = 19) of the application of signs of risk of bronchoaspiration. Conclusion: the management of bronchoaspiration risk has been shown to be a promising measure to reduce adverse events, which affect the patient's safety and consequently the quality of care in the hospital environment, as well as a possible strategy for measuring respiratory complications triggered by aspiration of oropharyngeal contents.

Abstract WP359: Enteral Tube Feeding Propensity Score for Acute Stroke Patients

Background: Stroke is the most frequent cause of neurogenic oropharyngeal dysphagia. Its frequency is greater than 50% in the acute phase. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. The aim of this study was to identify predictive clinical factors associated with enteral tube feeding (ETF) in acute stroke patients to develop an ETF predictive score. Methods: The medical records of 1104 acute ischemic stroke patients from our prospective stroke database were reviewed. Clinical factors as age, sex, blood pressure, glycemia, NIHSS score, Glasgow coma scale, previous Rankin, localization, and classification of acute stroke, and comorbidity index were analyzed. Logistic multivariate regression was used to identify perfect predictors of early ETF placement. The sample was randomly divided into two samples (30 and 70% of the sample) to proceed the internal score validation. Results: 1104 patients were enrolled. Mean age was 65.9 years old (SD 13), male patients were 51.7%, mean Glasgow score was 13.9 (SD 1.9), NIHSS at admission was 7.2 (SD 5.7), mean ASPECT score was 9.3 (1.6). Multivariate logistic regression disclosed age (odds ratio [OR] 1.02; CI 95% 1.00-1.03, p=0.005), initial NIHSS (OR 1.15; CI 95% 1.11-1.19, p&lt;0.001) and NIHSS dysarthria subitem (OR 1.76; CI 95% 1.36-2.37, p&lt;0.001) as independent predictive variables. The EFT propensity score was constructed based on these variable. A score equal or above four correctly classified 75% of patients (sensitivity = 67%, specificity = 79%). A ROC curve (AUC = 0.78, CI 0.75 - 0.81; p = 0.015) was constructed taking the formal phonoaudiological evaluation as gold-standard. Discussion: The ETF score allows us to quickly identify and indicate the use of ETF in acute stroke patients avoiding delay in starting enteral feeding and reducing the risk of bronchoaspiration, morbidity, and mortality due to pneumonia. Besides, the ETF score might optimize the patient care in hospitals where the speech therapist is not always available. Conclusion: Combining data from age, NIHSS at admission and the dysarthria subitem could be a strong and useful predictor to evaluate and decide about ETF in acute stroke patients.

Dificuldades na introdução de alimentos complementares ao aleitamento materno em bebês não disfágicos: efeitos da atuação fonoaudiológica

Introdução: No período de transição do aleitamento materno para alimento pastoso e/ou sólido, tal modificação pode não ser bem aceita pela mãe e/ou pelo bebê e ocasionar problemas de alimentação e/ou de linguagem subsequentes. Objetivo: descrever os efeitos da atuação fonoaudiológica diante das dificuldades na introdução de alimentos complementares ao aleitamento materno em bebês não disfágicos numa abordagem biopsíquica. Método: Estudo realizado em instituição de saúde filantrópica, de acordo com critérios éticos estabelecidos para pesquisas com seres humanos. Casuística: Cinco díades mãe/bebê, bebês de ambos os gêneros, na faixa etária entre 5 e 8 meses, com dificuldades no desmame e sem diagnóstico de disfagia orofaríngea neurogênica ou mecânica. A amostragem foi obtida por conveniência. Procedimento: Foram realizados quatro encontros, sendo três visitas domiciliares, nos quais foram aplicados três instrumentos de avaliação, adaptados a partir da literatura. Após a ação fonoaudiológica foi reaplicado o último, para efeitos de comparação pré e pós. Resultados: Após a atuação fonoaudiológica, houve eliminação de episódios de engasgos, as refeições se tornaram mais prazerosas para a díade mãe/bebê e os bebês passaram a aceitar melhor os alimentos. Os resultados revelaram diferença estatisticamente significativa entre os obtidos pré e pós atuação fonoaudiológica: média inicial era de 16,0 pontos (dp=1,0) e final 21,2 pontos (dp=0,8/ p= 0,001), (p=0,001). Conclusão: A atuação fonoaudiológica numa abordagem biopsíquica promoveu benefícios nos casos estudados.

Efficacy of Myofunctional Therapy Associated with Voice Therapy in the Rehabilitation of Neurogenic Oropharyngeal Dysphagia: a pilot study.

Introduction Dysphagia causes changes in the laryngeal and stomatognathic structures; however, the use of vocal exercises is poorly described. Objective To verify whether the therapy consisting of myofunctional exercises associated with vocal exercises is more effective in rehabilitating deglutition in stroke patients. Methods This is a pilot study made up of two distinct groups: a control group, which performed only myofunctional exercises, and an experimental group, which performed myofunctional and vocal exercises. The assessment used for oral intake was the functional oral intake scale (FOIS). Results The FOIS levels reveal that the pre-therapy median of the experimental group was 4, and increased to 7 after therapy, while in the control group the values were 5 and 6 respectively. Thus, the experimental group had a statistically significant difference between the pre- and post-therapy assessments ( p = 0.039), which indicates that the combination of myofunctional and vocal exercises was more effective in improving the oral intake levels than the myofunctional exercises alone ( p = 0.059). On the other hand, the control group also improved, albeit at a lower rate compared with the experimental group; hence, there was no statistically significant difference between the groups post-therapy ( p = 0.126). Conclusion This pilot study showed indications that using vocal exercises in swallowing rehabilitation in stroke patients was able to yield a greater increase in the oral intake levels. Nevertheless, further controlled blind clinical trials with larger samples are required to confirm such evidence, as this study points to the feasibility of conducting this type of research.

Abstract TP317: Enteral Tube Feeding in Acute Ischemic Stroke Patients: a Multivariate Predictive Analysis

Introduction: Stroke is the most frequent cause of neurogenic oropharyngeal dysphagia. In the acute phase of stroke, the frequency of dysphagia is greater than 50%. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. Hypothesis: The aim of this study was to identify predictive clinical factors associated with enteral tube feeding in acute ischemic stroke patients. Methods: The medical records of 326 acute ischemic stroke patients from our prospective stroke database were reviewed. Clinical factors as age, sex, comorbidities, blood pressure, glycemia, National Institutes of Health Stroke Scale (NIHSS) score and subscores, Glasgow Come Scale (GCS), previous Rankin, Alberta Stroke Program Early CT score (ASPECTS) and localization of acute stroke were analyzed. Logistic regression was used to develop a risk score by weighting predictors of enteral tube feeding placement based on strength of association. Results: Of the 326 patients, 84 used enteral feeding tubes (25.8%). The mean age (70.2 years - SD 13.1), mean GCS (12.7 - SD 2.1), mean NIHSS (12.6 - SD 5.6), and Aspect score (8.8 - SD 1.8) were significantly higher in the tube group. Logistic regression showed that only age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.6. P=0,025), NIHSS score (OR, 1.15; 95% CI, 1.05-1.25, P= 0,001) and NIHSS 10 (dysarthria) subscore (OR, 2.2; 95% CI, 1.2-4.05, P=0,011) were independent predictors of enteral tube feeding. A 3-item risk score was developed based on the regression model in order to identify those patients needing enteral feeding. A score ≥ 4 predicted tube feeding in 75% of cases. Conclusions: In conclusion, combining information about age, NIHSS, NIHSS 10 subscore, may be a useful predictor tool for clinical decision for enteral tube feeding in acute ischemic stroke patients.

Management of oropharyngeal neurogenic dysphagia in adults.

This article reviews recent literature in the management of neurogenic oropharyngeal dysphagia (OPD) including assessment processes and treatments, with a specific focus on OPD as a result of stroke and Parkinson's disease. A large number of high-quality systematic reviews were published that provide an excellent summary of current evidence across assessment and treatment of swallowing disorders. There is building interest and knowledge in technology in both the understanding and treatment of OPD including functional MRI, manometry, and noninvasive brain stimulation. Neurologic disorders demonstrate a high prevalence of OPD resulting in significant decrement to health and healthcare costs. Novel technologies were reported in assessment and tracking of dysphagia as well as emerging innovative therapeutic options.

Effectiveness of Chin-tuck Maneuver to Facilitate Swallowing in Neurologic Dysphagia.

Introduction The chin-tuck maneuver is the most frequently employed postural maneuver in the treatment of neurogenic oropharyngeal dysphagia caused by encephalic vascular strokes and degenerative diseases. Objective The purpose of this study was to investigate the effectiveness of this maneuver in patients with neurogenic dysphagia and factors that could interfere in it. Methods In this retrospective cohort, we analyzed the medical files and videofluoroscopy exams of 35 patients (19 male – 54% and 16 female – 46%; age range between 20 and 89 years old; mean = 69 years). Results The results suggest that the effectiveness of chin-tuck maneuver is related to the overall degree of dysphagia: the more severe the dysphagia, the less effective the maneuver. Conclusion Chin-tuck maneuver should benefit dysphagic patients with delay in the swallowing trigger, reduced laryngeal elevation, and difficulties to swallow liquids, but is not the best compensatory strategy for patients with severe dysphagia.