Rozprawy doktorskie: „Deglutition”

1

Nilsson, Håkan. "Quantitative aspects of swallowing with particular reference to disturbances of swallowing in neurological disorders /". Malmö : Dept. of Neurology, Malmö University Hospital, 1998. http://books.google.com/books?id=5ORqAAAAMAAJ.

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Briche, Denis. "Evaluation objective de la deglutition par la scintigraphie". Université Louis Pasteur (Strasbourg) (1971-2008), 1991. http://www.theses.fr/1991STR1M163.

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Leung, Wing-yan Vivian. "A comparison of cost-effectiveness of dysphagia management via community and out-patient speech therapy service". Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31971969.

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Woisard, Virginie. "Etude de la deglutition apres chirurgie partielle horizontale sus-glottique". Toulouse 3, 1992. http://www.theses.fr/1992TOU31506.

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Rosendall, Brigette Marie. "Mathematical modeling of the pharyngeal phase of swallowing /". Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/9888.

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6

Ciucci, Michelle Renee. "The Effects of Deep Brain Stimulation on Deglutition in Parkinson Disease". Diss., Tucson, Ariz. : University of Arizona, 2006. http://etd.library.arizona.edu/etd/GetFileServlet?file=file:///data1/pdf/etd/azu%5Fetd%5F1505%5F1%5Fm.pdf&type=application/pdf.

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Germain, Isabelle. "The evaluation of the nutritional outcomes of advanced nutritional care for the treatment of dysphagia in the elderly /". Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=30819.

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

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Ngan, Yuk-hing Candy. "Diet and fluid tolerance of dysphagic stroke patients in predicting swallowing outcomes at 3 months post-stroke". Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B3197210X.

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Lansiaux, Vincent. "Troubles de deglutition et troubles respiratoires apres laryngectomie reconstructrice avec crico-hyoido-pexie". Lille 2, 1993. http://www.theses.fr/1993LIL2M200.

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Barbosa, Lisiane de Rosa. "Sinais clínicos de disfagia em lactentes com bronquiolite viral aguda". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/165717.

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

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11

Ma, Pingping. "Quantitative manofluorography for the evaluation of normal pharyngeal swallowing". Thesis, Georgia Institute of Technology, 1989. http://hdl.handle.net/1853/16106.

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Lai, King-lok, i 黎敬樂. "Associations of cognitive function with feeding performance and swallowing function in elderly with dementia". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206598.

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Introduction: Feeding difficulty and dysphagia are common problems in elderly patients with dementia. Malnutrition and aspiration pneumonia may result from feeding problem and swallowing dysfunction. There were limited previous reports on the course of cognitive functional decline and the relationship among cognitive function, feeding performance and swallowing function in dementia patients. Objectives: The objectives of the present study were to investigate the association between cognitive function and feeding performance in elderly with dementia, and to investigate the association between cognitive function and severity of dysphagia in elderly with dementia. Method: In this cross-sectional study, we recruited 215 Chinese participants from hospital clinics and old aged homes from March 2014 to July 2014. The participants were over 65-year-old, with diagnosis of dementia and without history of other neurological diseases. Sociodemographic information of the participant was interviewed. Medical records were reviewed for the diagnoses of dementia and associated medical conditions. The Abbreviated Mental Test (AMT) was adopted to assess participants’ cognitive function. The feeding performance was evaluated by the Chinese version of Edinburgh Feeding Evaluation in Dementia (EdFED) Scale. The swallowing function was assessed by the Gugging Swallowing Screen (GUSS) test and Therapy Outcome Measure (TOM) impairment scale. Results: Significant negative correlation was demonstrated between AMT score with EdFED score (rho= -0.571, p<0.001). After adjustment of confounders, AMT score was an independent predictor of EdFED score (p=0.034), with age (p=0.016) and functional status (p=0.001) being two additional independent factors. The AMT score manifested significant associations with the measures of severity of dysphagia from the bivariate analysis of results from GUSS (p<0.001) and TOM (p<0.001). After adjustment of confounders, the AMT score was not a significant independent predictor when the swallowing function was assessed by GUSS, but it was an independent predictor when the former was assessed by TOM (p=0.004). Age, functional status, male gender, living in old aged homes, caregivers being children/family members and maids were also independent factors of dysphagia. Conclusion: In this pilot study, we found the cognitive function of elderly with dementia was related to feeding performances. Those with the poorest cognitive function had the worst feeding performance. We also found poor cognitive function was related to poor swallowing function in elderly with dementia. Furthermore, age and functional status were also predictors of feeding performance in dementia. Future prospective studies are recommended to examine the effects of other possible confounding factors including co-morbid neurological diseases, medications and behavioral symptoms, on the association between cognitive function and feeding performance and swallowing function. Early assessment, education and intervention on feeding problem and dysphagia to elderly with dementia and their caregivers are recommended in daily clinical practice.
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Medicine
Master
Master of Medical Sciences

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Ricci, Gabriela Lima. "Queixa de deglutição em indivíduos com Diabetes Melito tipos 1 e 2". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17151/tde-12042018-115816/.

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

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Kift, Russell J. "Orthodontic and biological considerations of deglutition, oro-linguo-facial muscle function, and tongue thrust : diagnosis". Thesis, The University of Sydney, 1985. http://hdl.handle.net/2123/4644.

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

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15

Kift, Russell J. "Orthodontic and biological considerations of deglutition, oro-linguo-facial muscle function, and tongue thrust : diagnosis". University of Sydney, 1985. http://hdl.handle.net/2123/4644.

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

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16

Shune, Samantha Eve. "The effects of age and sensation on the anticipatory motor patterns activated during deglutition". Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/4752.

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Swallowing problems, and the often-associated sequelae including pneumonia, malnutrition, and dehydration are common, potentially life-threatening conditions suffered by many elderly individuals. The combination of cognitive, physical, and sensory impairments commonly seen in individuals with dementia and following stroke often results in eating needs going unmet, leading to increased morbidity and premature mortality. The functional limitations of many of these individuals frequently result in decreased mealtime independence and necessitate extensive or total assistance (i.e., dependence) with consuming food and liquids. Despite the implication of increased safety associated with feeding assistance, the influence and potential risk of absent pre-oral cues are unclear, especially in an already taxed system. This study investigated the cooperative relationships between the sequential sensorimotor acts involved in eating and swallowing, focusing on the anticipatory stage, under various sensory-loss conditions. Kinematic data from the lips, jaw, and hand were obtained from 24 healthy younger adults (ages 18-30) and 24 healthy older adults (ages 70-85) under four different conditions: typical self-feeding, typical assisted feeding (i.e., loss of proprioceptive cues), sensory loss self-feeding (i.e., loss of visual cues and degradation of auditory cues), and sensory loss assisted feeding (i.e., loss/degradation of auditory, proprioceptive, and visual cues). During typical self-feeding, all participants began the mouth opening gesture shortly after the onset of hand movement toward the mouth and prior to the onset of oral sensation. However, differences in the timing of anticipatory onset and offset lip movements were observed between older and younger adults and also on the basis of the presence/absence of feeding dependency and sensory loss. Older adults initiated lowering movement earlier than younger adults given the availability of proprioceptive and/or visual cues. In addition to demonstrating earlier lip lowering, during both self-feeding conditions older adults more consistently attended to the timing between lip lowering onset and hand movement onset as compared to both the younger adults and other relative timing pairs. Given the absence of proprioceptive cues (i.e., during assisted feeding), the onset of anticipatory lip movement was delayed. Sensory loss (i.e., loss of visual cues, reduction in auditory cues) alone did not negatively impact the onset of lip movement for either group as compared to typical self-feeding. Conversely, the presence of sensory loss more negatively impacted the offset of lip movement as compared to the absence of proprioception (e.g., the offset of lip movement was later given only visual/auditory loss as compared to assisted feeding). The presence of both feeding dependence and sensory loss had the greatest negative impact on the timing of both the onset and offset of anticipatory lip movement. These findings suggest that deglutition should be considered as beginning prior to the onset of oral sensation and highlight the necessity of better understanding the role that pre-oral, or anticipatory, sensorimotor information may play in the overall eating and deglutitory process. As older adults consistently demonstrated a "compensatory advantage" via earlier and less variable movement onset given the availability of proprioceptive and/or visual cues, continued investigation into these age-related differences is important. This study provides a first step in clarifying the relationship between these pre-oral cues and anticipatory oral posturing during eating and swallowing, allowing for a better understanding of the potential for increased risk assisted feeding recommendations may elicit. However, the differences observed between older and younger adults, particularly under conditions of sensory loss, may be further exacerbated in a taxed system, potentially increasing risk for various patient populations.

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Wenger, Urs. "Esophageal stenting in the palliation of malignant strictures /". Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-625-5/.

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Budhan, Jamie A. "The Impact of a Novel Gaming Reinforcement System on Oral Intake Outcomes in Pediatric Dysphagia Therapy: A Pilot Study". Miami University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=miami1525427023914417.

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Wong, Wai-ming. "The swallowing compliance of post-discharge geriatric patients with dysphagia in Hong Kong". Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31972329.

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20

Tindall, Andrew Paul. "An analysis of tongue position using electropalatography /". Title page, contents and summary only, 1998. http://web4.library.adelaide.edu.au/theses/09DM/09dmt588.pdf.

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21

Fong, Raymond, i 方思行. "Effects of different radiation therapy techniques on swallowing function in individuals with nasopharyngeal cancer". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/196497.

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Nasopharyngeal cancer (NPC) is more common in the Southern China region than the rest of the world. Radiation therapy (RT) is the contemporary and standard treatment for nasopharyngeal cancer. Chronic complications arise from RT including hearing loss, xerostomia, trismus and dysphagia. Previous research has shown that dysphagia is prevalent in irradiated NPC patients. Radiation therapy techniques have improved in the last decade with the emergence of Intensity Modulated Radiation Therapy (IMRT), which allows more precise radiation beams directed at the tumor. In turn, it should also allow greater sparing of surrounding structures that are vital for preservation of swallowing function. This study was designed to investigate the difference in the degree of swallowing function preservation in two groups of irradiated NPC patients: the conventional RT and the IMRT group. Thirty patients with NPC who received RT from 1998 to 2006 in Queen Mary Hospital, Hong Kong were randomly recruited during the period from January to December 2011. Participant’s swallowing competence and its effect on the quality of life was assessed by videofluoroscopic swallowing study (VFSS) and by the MD Anderson Dysphagia Inventory, respectively. In comparison of swallowing performance with VFSS between the two groups, only one measure (Duration of Laryngeal Elevation) out of 13 showed significant difference on thin liquid and congee diet. Results from the MDADI did not show significant difference between the two groups. From the results, it was concluded that IMRT only resulted in subtle improvement in preserving the swallowing function as compared to conventional RT. One possibility is the subject self-compensation of their swallowing impairments that led to functionally similar performance despite their differences in the anatomy and physiology. Swallowing is a highly complex body function and no single parameter can be used to accurately quantify and characterize one’s swallowing function. The interaction between the anatomical and physiological impairments resulted from radiation therapy and the compensatory mechanism could not be clearly explained with this study. Future research could adopt a longitudinal approach such that the changes in NPC patients who received radiation therapy can be better understood.
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Speech and Hearing Sciences
Master
Master of Philosophy

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22

Darmont, Araya Francis Mosheh. "Investigating the Design and Manufacture of PneuNet Actuators as a Prosthetic Tongue for Mimicking Human Deglutition". Digital WPI, 2019. https://digitalcommons.wpi.edu/etd-theses/1300.

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The number of Total Glossectomy cases in the United States is seeing an increasing trend as per the Nationwide Inpatient Sample Database. Patients, who have undergone such aggressive surgical procedures, have extensive limitations performing basic oral functions such as swallowing (deglutition), eating and speaking. Current rehabilitation prostheses do little in restoring the functionality of the original tongue. This is true especially in deglutition, which is necessary to transfer a bolus to the esophagus. Such patients need advanced prosthetic devices and through this research, investigations into potential solutions for prosthetic tongues to aid in deglutition were carried out. The process began with an extensive literature review that provided tongue position, motion, and pressure data during the swallowing stages. Several potential designs were considered such as using linkages and pneumatic networks (PneuNets). Based on a decision matrix, PneuNets were adopted as the foundational basis for generating prosthetic designs. Several prototypes were fabricated using Fused Filament Disposition for mold development and silicone Eco-flex 00-30 for actuator development. Each iteration involved tackling several design and manufacturing challenges especially when scaling these actuators from an initial experiment to an anatomical shape and size of a human tongue. A tongue of dimensions 1.8 inches wide, 2.4 inches long and 0.24 inches thick was developed. The PneuNet actuator was powered by a pneumatic system and kinematic data was collected using a tracking software. The data gathered provided validation comparisons between position trends exhibited in the literature. Theoretical deflection models were generated for analyzing the deflection of the front, middle and back sections of the tongue prototype. Details from literature review, design iterations, simulations, validation processes, research challenges and conclusions will be discussed in depth.

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23

Francis, Charmine 1978. "The discriminative validity of the McGill Ingestive Skills Assessment (MISA) /". Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=111570.

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Introduction: Stroke is associated with a high prevalence of dysphagia in the elderly population. Hence, dysphagia evaluation and management are key issues in stroke rehabilitation. The McGill Ingestive Skills Assessment (MISA) is a recently developed mealtime observational tool aimed at evaluating the functional aspects of the oral phase of ingestion. Objective: To determine the discriminative validity of the MISA by assessing known/extreme groups of elderly individuals presenting with stroke, who have been admitted to an acute-care-hospital or a rehabilitation center. Participants were allocated to one of two groups: 1) individuals with stroke and no dysphagia, who are on a regular diet and 2) individuals with stroke and dysphagia, who are permitted only purees. Methods: Participants were evaluated with the MISA and a comprehensive chart review was conducted. Analysis: Groups were compared on socio-demographic and clinical characteristics. Univariate tests were performed to test the significance of between-group differences. Conclusion and significance: The results of the study are satisfactory, and enhance the clinical usefulness of the tool for dysphagia management. These results also support future studies addressing the responsiveness of the MISA.

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24

Silva, Paulo César Lopes. "Cuidados de enfermagem de reabilitação em doentes com deglutição comprometida: resultados de um programa de intervenção". Master's thesis, Universidade de Évora, 2018. http://hdl.handle.net/10174/23326.

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O presente relatório pretende descrever o processo de aquisição de competências, as ativi-dades desenvolvidas no Estágio Final e evidenciar os resultados de um programa de enfermagem de reabilitação. A literatura foca a importância de uma abordagem sistemática, multidisciplinar e deta-lhada nos doentes com deglutição comprometida. Partindo da identificação de tal compromisso, aplicou-se um programa de enfermagem de reabilitação em cinco doentes vítimas de Acidente Vas-cular Cerebral, visando a promoção da deglutição segura e fomentando a sua independência. A me-todologia de estudo de caso e a análise reflexiva sobre o processo de desenvolvimento de compe-tências permitiram ajuizar sobre os resultados obtidos. Os doentes que integraram o programa não desenvolveram complicações e alguns reverteram o compromisso na deglutição, concorrendo para aumentar a sua autonomia e independência. Os dados obtidos e a reflexão realizada permitem afir-mar que o processo de aquisição de competências de enfermeiro especialista e de mestre também se concretizou; Abstract: Rehabilitation Nursing Care in patients with compromised swallowing: Outcomes of an intervention program. This report aims to describe the process of acquiring competencies, the activities developed in the Final Stage and evidence the results of a rehabilitation nursing program. The literature focuses on the importance of a systematic, multidisciplinary and detailed approach in patients with compromised swallowing. Based on the identification of this commitment, a rehabilitation nursing program was applied to five stroke patients in order to promote safe swallowing and fostering their independence. The case study methodology and the reflexive analysis about the competencies development process allowed the judgement of the obtained results. The patients involved in the program did not develop any complications and some reversed their commitment on swallowing, thereby increasing their autonomy and independence. The obtained data and the realized reflection allow to affirm that the process of acquisition of competences of specialist nurse and master also materialized.

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25

Leow, Li Pyn. "Mechanisms of airway protection in ageing and Parkinson's disease". Thesis, University of Canterbury. Communication Disorders, 2007. http://hdl.handle.net/10092/1461.

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Safe and efficient swallowing requires integrity of both motor and sensory systems. Prior studies have established that motor impairment in individuals with PD frequently manifests as abnormalities in swallowing biomechanics. In contrast, very few studies have investigated the contribution of sensory impairment towards pharyngeal biomechanics and airway protection in this patient cohort. This area should be addressed in light of evidence that the severity of limb motor dysfunction in PD does not reliably predict severity of dysphagia. Emerging data suggests that dysphagia in PD cannot be solely attributed to motor impairment, but may also be influenced by deficits in sensory aspects of airway protection. As an example, silent aspiration in up to 100% has been reported in individuals with PD due to laryngopharyngeal sensory deficits have. Even so, current research lacks information on the integration of both motor and sensory components that make up the swallowing process. The aim of this study was to document changes in airway protection with age, in PD and across severity levels of PD. The project was comprised of two parts. In part one, three parallel studies were conducted to assess a series of both motor and sensory airway mechanism (Chapters 4 to 9). In the first study, 16 young (8 males, age range 21.3 - 32.4) and 16 elder adults (8 males, age range 61.5 - 84.7), were assessed to investigate changes in airway protection that accompany ageing. In the second study, data from individuals diagnosed with PD across severity levels (Hoehn-Yahr 1 - 4, age range 64.2 - 84.5) were age and gender-matched to 16 healthy elders in order to examine the effects of PD on airway protection. In the third, the impact of disease severity was studied with data from 16 individuals in the earlier stages (Hoehn-Yahr ≤ 2, 13 males, age range 51.3 - 82.5, ) compared to 16 individuals in the later stages (Hoehn-Yahr ≥ 2.5, 10 males, age range 61.5 - 78.9). In part two of this project, two smaller, pilot studies were completed to probe the influence of pharmacologic and behavioural treatments on airway protection mechanisms. In the first pilot study, the effect of pharmacotherapy on airway protection was investigated in 10 patients 'on' and 'off' levodopa (Chapter 10). In the second study, 5 patients were assessed before and after completing the Lee Silverman Voice Treatment (LSVT) to document effects of speech rehabilitation on airway protection (Chapter 11). Multimodality assessment elicited data from all participants on both motor and sensory components of airway protection (Chapter 3). Specifically, breathing-swallowing coordination (BSC) and swallowing apnoea (SA) were captured using simultaneous directional nasal airflow and surface electromyography (sEMG). Standard, closed-loop spirometry was used to assess pulmonary function. Swallowing biomechanics were screened using a validated timed test of swallowing efficiency and further evaluated using fibreoptic endoscopic evaluation of swallowing (FEES). Finally, chemo-sensation of the laryngopharynx was determined with the administration of the inhalation cough challenge while mechanosensation was examined using FEES. Results suggest that motor control for airway protection is reasonably robust in PD, although sensory response is impaired. The predominant pattern for swallowing respiratory coordination was mid-expiration for all participants regardless of age and disease severity (Chapter 4). Individuals with PD demonstrated a reduction in average time and volume per swallow, leading to an overall decrease in swallowing capacity (Chapter 5). No difference was found for swallowing efficiency between those in early and later stages of PD. Pulmonary function measures were not significantly different as a function of age, PD or PD severity (Chapter 6). In summary, results from motor assessments contributing to airway protection support the robustness of breathing-swallowing coordination (BSC) and pulmonary function across research groups, but identify a reduction in overall swallowing efficiency in PD. Results from sensory assessments contributing to airway protection revealed that chemosensation was not different between age groups but base of tongue mechano-sensation was diminished in individuals with PD. Natural cough thresholds did not differ between young adults and elders but when asked to stifle coughing, elders were less able to do so compared to young adults (Chapter 7). For the first time, a reduction in mechano-reception at the base of tongue was recorded in individuals with PD (Chapter 8). These patients also demonstrated increased post swallow residual (Chapter 5), which offers an explanation for the complaint of globus in this population. These assessments highlight some compromise to sensory aspects of airway protection in PD. Overall, dysphagia had a negative impact on the quality of life of individuals with PD and even more as disease severity progresses (Chapter 9). Results from part two of the study looking at the effects of therapeutic interventions on airway protection revealed some unexpected findings. In chapter 10, results showed a reduction in pulmonary function when 'on' levodopa, but no differences in swallowing efficiency, BSC, or laryngopharyngeal chemo- and mechano-reception were observed. These results suggested a reduction in pulmonary function with levodopa without any increase in risk of airway protection compromise1. Unexpectedly and documented for the first time, the percentage of post swallow inspiration increased after LSVT (Chapter 11) but as with the levodopa study, this was also not accompanied by any apparent increase in aspiration risk. An increase in submental surface electromyography (sEMG) amplitude across all 5 participants may serve as a proxy measure of improvement in hyolaryngeal excursion. Finally, participants reported an overall improvement in social functioning and communication after LSVT. In conclusion, this study provided evidence that mechano-sensory aspect of airway protection is diminished in individuals with PD, possibly compromising airway protection. Patients not only demonstrated increased residue but the lack of sensation may prevent clearing or spontaneous multiple swallows. Overall, airway protection is maintained in ageing but swallowing efficiency declines in the presence of PD. This study contributes significantly to current research efforts in PD by expanding on existing reports regarding motor aspects of airway protection. Specifically, BSC, swallowing efficiency and evaluation of biomechanics using FEES research have never before been investigated exclusively in the PD population. Finally, the chemo- and mechano-sensation evaluated in this study are an important addition to the limited evidence that sensory impairment in individuals with PD potentially compromises airway protection. Results of the present study will serve as a platform upon which future studies may compare and expand.

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Neves, Danielle Akemi 1981. "Fatores de risco aos sintomas de deglutição em idosos da comunidade = Risk factors to swallowing symptoms in community elderly". [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312416.

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Orientador: Lucia Figueiredo Mourão
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: O processo de envelhecimento ou senescência, tem como evento concomitante o risco aumentado para o aparecimento de doenças crônicas (DC); no entanto, poucos estudos analisam a influência das DC no envelhecimento natural do processo da deglutição. Objetivo: Descrever e investigar os fatores de risco sociodemográficos, doenças crônicas, sintomas depressivos, saúde bucal e fatores nutricionais sobre os sintomas de deglutição em idosos da comunidade. Método: Estudo transversal realizado a partir dos dados do Estudo sobre Fragilidade em Idosos Brasileiros. Dentre os 900 idosos recrutados (65 anos ou mais) sem alterações neurológicas limitantes, que integravam amostra representativa de Campinas, SP, foram excluídos os idosos com déficit cognitivo sugestivo de demência e os idosos que autorrelataram história de acidente vascular cerebral ou câncer. Foram levantadas as variáveis sobre gênero, idade, renda familiar e colhidos o autorrelato de doenças crônicas, saúde bucal e sintomas de deglutição. Foram feitas as medidas de peso e altura para cálculo do índice de massa corporal (IMC) e investigada a presença de sintomas depressivos através da Escala de Depressão Geriátrica. O tratamento estatístico consistiu em análises descritivas e de regressão logística multivariada. Resultados: A amostra constituiu de 507 idosos, sendo a maioria mulheres (69,2%), com média de idade de 71,9 anos. A prevalência dos sintomas em fase oral foi de 39,1% e em fase faríngea de 35,9%, sendo os mais referidos: dificuldade ou dor para mastigar e sensação de alimento parado. Número de doenças e grau de depressão apareceram como fatores de risco aos sintomas em fase oral tendo OR=1,33 (IC=1,15-1,55) e OR=2,13 (IC=1,44-3,15) respectivamente. Sensação de boca seca (OR=0,50; IC=0,34-0,74), número de doenças (OR=1,53;IC=1,30-1,81) e renda familiar (OR=0,71;IC=0,55-0,92) foram fatores de risco aos sintomas em fase faríngea. Idade foi fator de risco apenas para a ocorrência de pigarro tendo OR=1,05 (IC=1,00-1,11). Conclusão: As DC como doenças do coração, doença pulmonar, depressão e osteoporose, bem como o maior número de DC, a maior idade, a menor renda familiar, o menor IMC e a sensação de boca seca, são fatores de risco aos sintomas de deglutição em idosos da comunidade
Abstract: Introduction: Aging is a natural process which leads to changes in swallowing process, however there are few studies which analyze the interference of chronic diseases (CD) in the natural aging of swallowing process. Objective: Describing and Investigating the socio-demographic risk factors, chronic diseases, depressive symptoms, oral health and nutritional status on swallowing symptoms in elderly. Method: Cross-sectional study performed based on data from the Study of Brazilian Elderly Frailty. Among 900 elderly recruited (65 or older) with no limiting neurological dysfunctions who integrated representative samples from Campinas, SP, elderly who presented suggestive dementia cognitive deficit who self-reported stroke and cancer were excluded. Data on gender, age, family yields, CDs, oral health and swallowing symptoms were collected. Weight and height were measured to calculate body mass index, and the depresssive symptoms were investigated by using geriatric depression scale. The statistical analysis were based on the multivariate logistic regression analysis Results: Samples were built out of 507 elderly, and mostly formed from women (69.2%), whereas the mean age was 71.9 years. The swallowing oral phase symptoms prevalence was at 39.1% and pharynx phase was at 35.9%, difficulty in chewing and the feeling of food stuck in throat is mostly reported. The multivariate logistic regression analysis showed that the number of diseases (OR=1,33; IC=1,15-1,55) and depression (OR=2,13;IC=1,44-3,15) were risk factors to oral phase. Dry mouth self-report (OR=0,50; IC=0,34-0,74), number of diseases (OR=1,53;IC=1,30-1,81) and family yields (OR=0,71;IC=0,55-0,92) were risk factors to the gathered pharynx phase symptoms. The age (OR=1,05; IC=1,00-1,11) was a risk factor solely to throat clearing occurrence. Conclusion: Chronic diseases such as heart disease, pulmonary disease, depression and osteoporosis, as well as higher number of diseases, older age, shorter family yields, shorter body mass index and dry mouth self-report are risk factors to swallowing symptoms in community elderly
Mestrado
Gerontologia
Mestra em Gerontologia

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Moraes, Danielle Pedroni. "Indicadores de prognósticos clínicos de deglutição funcional em pacientes de um hospital público de grande porte". Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5162/tde-14012013-155556/.

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INTRODUÇÃO: A presença da disfagia pós-extubação é bem documentada na literatura, com alta prevalência na maior parte dos estudos. No entanto, há relativamente poucos estudos que apresentam indicadores específicos referentes ao acompanhamento destes pacientes até o momento da alta hospitalar. O objetivo desta tese é determinar os indicadores de prognósticos da deglutição funcional em paciente submetidos à intubação orotraqueal prolongada (IOTp). MÉTODOS: Os fatores prognósticos analisados em 148 pacientes submetidos à IOTp incluíram a gravidade da disfagia no momento da avaliação fonoaudiológica inicial e no momento da resolução da disfagia/alta hospitalar; o tempo para iniciar a alimentação por via oral; a quantidade de tratamento individual; o número de intubações orotraqueais; o tempo de intubação e o tempo de permanência no hospital. Os pacientes foram divididos em dois grupos de acordo com a idade: GI - 18 a 54 anos e GII >= 55 anos. As análises de correlação, regressão linear e estatística descritiva foram usadas para verificar estas variáveis. RESULTADOS: A variável que obteve valor prognóstico nos dois grupos e influenciou os resultados da deglutição funcional no momento da alta hospitalar foi a gravidade da disfagia na avaliação inicial. Os resultados do estudo indicam também uma tendência à significância para o indicador tempo para iniciar a alimentação por via oral, sugerindo que o grupo mais jovem inicia a alimentação por via oral mais cedo que o grupo mais velho. CONCLUSÃO: Os estudos a respeito de indicadores de prognósticos em diferentes populações de pacientes disfágicos podem contribuir para o estabelecimento de procedimentos mais efetivos de avaliação, tratamento e gerenciamento da disfagia. Além disso, este estudo ressalta a importância da avaliação/classificação inicial da deglutição para a população de indivíduos submetidos à intubação orotraqueal prolongada.
INTRODUCTION: The development of post-extubation swallowing dysfunction is well documented in the literature with high prevalence in most studies. However, there are relatively few studies with specific outcomes that focus on the follow-up of these patients until hospital discharge. This thesis aims to determine prognostic indicators of swallowing functional outcomes in patients submitted to prolonged orotracheal intubation (OTIp). METHODS: The prognostic factors analyzed for 148 patients submitted to OTIp included dysphagia severity rate at the initial swallowing assessment and at dysphagia resolution/hospital discharge, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubation, intubation time and length of hospital stay. Patients were divided in two groups according to age: GI - 18 to 54 years and GII >= 55 years. Correlation analysis, linear regression and descriptive statistics were used to analyze these variables. RESULTS: The variable that had prognostic value and had an influence on the swallowing functional outcome at hospital discharge was the classification of dysphagia severity rate at the first swallowing assessment for both age groups. The results of the study also indicated a trend to significance regarding the time to initiate oral feeding, suggesting that younger adults initiated oral feeding earlier. CONCLUSION: Studies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder. Additionally, this study stresses the importance of the initial assessment ratings.

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Mituuti, Cláudia Tiemi. "Saúde oral e deglutição em idosos acometidos por Acidente Vascular Encefálico". Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/25/25143/tde-05122011-170111/.

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As condições dentárias e o uso de próteses mal adaptadas podem contribuir com as dificuldades decorrentes da velhice, as quais podem ser potencializadas por alterações neurológicas, resultando em quadros de disfagia, importante causa de morbidade e mortalidade nessa população. O objetivo do presente trabalho foi verificar se o acometimento cerebral crônico acarreta implicações na função da deglutição em idosos, como também se a condição de saúde oral apresenta relação com o grau de disfunção da deglutição orofaríngea, em idosos acometidos por Acidente Vascular Encefálico (AVE). Foram avaliados 30 idosos com idades entre 61 e 90 anos (mediana 73,5 anos), acometidos por AVE, sendo 15 homens e 15 mulheres. Os pacientes foram submetidos à avaliação odontológica quanto ao número de dentes cariados, perdidos e obturados, uso e condição das próteses, além de índices periodontal e de perda de inserção. Além diso foi aplicada a escala funcional de ingestão oral (FOIS) e realizada avaliação videoendoscópica da deglutição de alimentos de diferentes consistências. A partir dos resultados foram aplicados os testes de correlação de Spearman, para as associações, e o Kruskal Wallis para as comparações. Os indivíduos idosos pós-AVE desta pesquisa foram comparados a um grupo controle de 15 idosos saudáveis, tendo-se encontrado maior gravidade da disfagia para o grupo AVE para a consistência líquida (p=0,01). Especificamente para o grupo AVE houve correlação estatisticamente significante entre a classificação da escala FOIS e a necessidade de troca das próteses (p=0,02) e diferença entre grupos considerando diferentes tipos de prótese na deglutição de sólido (p=0,04). Devido à heterogeneidade da amostra, foram excluídos os dentados totais, desdentados totais sem reabilitação e indivíduos com mais de um episódio de AVE. Além disso, os mesmos foram divididos de acordo com o lado do corpo comprometido (direito e esquerdo) após o acometimento cerebral, resultando em 19 indivíduos. Não foram encontradas diferenças no desempenho da deglutição entre os grupos de indivíduos com hemicorpo direito e esquerdo comprometidos. Houve correlação entre a necessidade de troca das próteses e a classificação na escala FOIS (p=0,01) para os indivíduos com hemicorpo direito comprometido, enquanto para os indivíduos com comprometimento em hemicorpo esquerdo, foi observada correlação entre a deglutição de líquido e o número de dentes presentes (p=0,05) e ausentes (p=0,05). Além disso, para os 19 indivíduos, como também para os com hemicorpo esquerdo comprometido, verificou-se que aqueles com prótese parcial no arco superior tiveram melhores classificações na escala FOIS em relação aos indivíduos com prótese total (p=0,01). Já para os indivíduos com o hemicorpo direito comprometido, essa diferença foi verificada em relação às próteses utilizadas no arco inferior (p=0,04). O acometimento cerebral crônico influenciou a gravidade da disfagia para a consistência líquida, não tendo sido encontrada implicações sobre o nível da ingestão oral, como também para o grau da disfagia orofaríngea para alimentos pastoso e sólido. Houve influência do número de dentes, tipo e necessidade de uso ou troca das próteses dentárias sobre a deglutição em indivíduos acometidos por AVE, principalmente quando houve melhor delineamento dos grupos de acordo com o hemicorpo comprometido.
Dental conditions and the use of poorly fitted prostheses may contribute to difficulties deriving from aging, which may be potentiated by neurologic alterations, resulting in dysphagia, an important cause of morbidity and mortality in this population. This work aimed at verifying whether chronic cerebral involvement compromises the swallowing function in the elderly, as well as if the oral health condition is related to the degree of oropharyngeal swallowing dysfunction, in elderly people who had a stroke (CVA). Thirty elderly people, i.e., 15 men and 15 women, in the age range 61- 90 yrs (mean 73.5 yrs), presented with CVA, were assessed. The patients underwent dental assessment as to the number of decayed, missing and filled teeth, use and conditions of their prostheses, besides periodontal indexes and insertion loss. In addition, the functional oral intake scale (FOIS) was applied and video endoscopy to evaluate the swallowing of food of different consistency, performed. From the results, correlation tests, Spearman for associations, and Kruskal Wallis for comparisons, were applied. The post CVA elderly individuals of this research were compared to a control group of 15 healthy elderly subjects, with more dysphalgia severity in the CVA group, for liquid consistency (p=0.01). Specifically, for the CVA group, a statistically significant correlation was seen between FOIS scale rating and the need to replace the prostheses (p=0.02) and the difference between the groups, taking into account the types of prosthesis in the swallowing of solid foods (p=0.04). Owing to the heterogeneity of the sample, total dentulous, total edentulous patients with no rehabilitation and individuals with more than one episode of CVA, were excluded. Furthermore, they were divided according to the side of the body affected (right and left), following cerebral involvement, resulting in 19 individuals. No differences were found in the swallowing performance between the groups of subjects with compromised right and left hemi-body. There was a correlation between the need to replace the prostheses and the FOIS scale rating (p=0.01) for subjects with compromised right hemi-body, while for subjects with left hemi-body involvement, a correlation was observed between liquid swallowing and the number of teeth present (p=0.05) and absent (p=0.05). Furthermore, for these 19 individuals, as well as for those with compromised left hemi-body, it was verified that those with a partial prostheses in the upper arch scored better on the FOIS scale, as compared to those with total prostheses (p=0.01). Now, for individuals with a compromised right hemi-body, this difference was not verified in relation to the prostheses utilized in the lower arch (p=0.04). Chronic cerebral involvement influenced the severity of dysphalgia for liquid consistency, with no implications on the level of oral intake, as well as for the degree of oropharyngeal dysphagia for doughy and solid foods. The number of teeth, type and need to use or replace the dental prostheses influenced the swallowing of individuals presented with CVA, mainly when there was a better outlining of the groups, according to the hemi-body affected.

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Leung, Wing-yan Vivian, i 梁詠茵. "A comparison of cost-effectiveness of dysphagia management via community and out-patient speech therapy service". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31971969.

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Silvério, Carolina Castelli [UNIFESP]. "Deglutição de parkinsonianos pré e pós riboflavina: queixa, aspectos funcionais e impacto na vida diária". Universidade Federal de São Paulo (UNIFESP), 2009. http://repositorio.unifesp.br/handle/11600/9297.

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Objetivo: verificar a relação entre queixa, aspectos funcionais da deglutição e impacto na qualidade de vida referente à voz e à deglutição, em pacientes portadores da doença de Parkinson, submetidos à administração de riboflavina, no período de um ano. Métodos: participaram do estudo 16 pacientes portadores da Doença de Parkinson, com média de idade de 67,25 anos, média do nível de severidade da doença de II para III e média de tempo de diagnóstico da doença de Parkinson de 3,5 anos. As avaliações videofluoroscópicas da deglutição foram realizadas antes e após um ano da administração de riboflavina e restrição de carne vermelha e de aves. Foram realizadas a análise qualitativa da deglutição, a verificação da presença de queixa com relação à deglutição e aplicação de dois protocolos de qualidade de vida sendo relacionados um com o impacto da alteração vocal, e outro com o impacto da alteração na deglutição. A análise quantitativa compreendeu a realização de medidas de deslocamento do osso hióide, de abertura do esfíncter esofágico superior e de constrição da faringe. Resultados: foram observadas redução da queixa e discreta piora na qualidade de vida relacionada à voz e à deglutição, maior freqüência de ocorrência de deglutição normal, no momento pós-riboflavina. Não foram observadas diferenças significativas entre as medidas quantitativas. Conclusões: Conclui-se neste estudo que: houve melhora, apesar de não significativa, da queixa relacionada à deglutição; não ocorreram pioras significativas na dinâmica da deglutição, com exceção do deslocamento da cartilagem cricóidea na consistência de líquido fino após um ano de estudo; não houve piora com relação ao impacto na qualidade de vida, tanto relacionado à deglutição, quanto ao aspecto vocal; os pacientes que não apresentavam queixas de deglutição no momento pré apresentaram melhora na dinâmica da deglutição, com exceção da constrição da faringe; os pacientes com queixa de deglutição no momento pré apresentaram melhora nos índices de qualidade de vida e na auto-avaliação vocal segundo o QVV, no momento pós.
Objective: to verify the relation between clinical complaint, swallowing functional aspects and the impact on quality of life related to voice and swallowing in patients with Parkinson´s disease submitted to treatment with riboflavin during one year period. Method: sixteen patients with Parkinson´s disease participated in the study; mean age was 67.25 years old, mean degree of disease severity was II to III and mean time of disease diagnosis was 3.5 years. Videofluoroscopic evaluations were performed before and after one year of treatment with riboflavin and restriction diet of read meat and chicken. It were analyzed: qualitative analysis of swallowing, presence of complaints related to swallowing, application of questionnaires related to the impact of voice and swallowing alterations and quantitative analyses of swallowing, which included computerized measurements of hyoid bone and cricoid cartilage displacement, opening of the superior esophageal sphincter and pharyngeal constriction. Results: it were observed: decrease of complaints and slight worsening in quality of life impact regarding voice and swallowing and more frequent normal swallowing post riboflavin; there were no significant changes regarding quantitative measurements. Conclusions: there was a non significant improvement regarding swallowing complaints; it were not observed significant impairments of the swallowing dynamics, except for cricoid cartilage displacement during thin liquid ingestion at the end of the treatment; there was no impairment of quality of life regarding swallowing or voice; patients without swallowing complaints at the beginning of the treatment showed improvement in swallowing dynamics, except for pharyngeal constriction; patients with swallowing complaints at the beginning of the treatment showed improvement regarding quality of life and vocal selfevaluation after treatment.
TEDE
BV UNIFESP: Teses e dissertações

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Ching, K. Y. "Validating a quantified clinical screening tool in detecting aspiration /". View the Table of Contents & Abstract, 2005. http://sunzi.lib.hku.hk/hkuto/record/B3168368X.

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Crary, Michael A. "Dysphagia and nutritional status following stroke". [Gainesville, Fla.] : University of Florida, 2004. http://purl.fcla.edu/fcla/etd/UFE0008951.

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Thesis (M.S.)--University of Florida, 2004.
Typescript. Title from title page of source document. Document formatted into pages; contains 44 pages. Includes Vita. Includes bibliographical references.

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Kennedy, Daniel Lloyd, i n/a. "Measurement of intraoral pressure during normal swallowing". University of Otago. School of Dentistry, 2008. http://adt.otago.ac.nz./public/adt-NZDU20081211.160044.

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Aim: The aim of this research was to measure functional intraoral pressures using a newly developed method; specifically, three areas were examined. Firstly, this new approach to measurement allowed the equilibrium theory of tooth position to be re-addressed. Secondly, it allowed investigation the patterns of pressure change in the palatal midline during water swallowing. Lastly, this approach allowed a preliminary investigation of the affect of the viscosity of the food ingested on the pressures generated in the mouth. Methods: The participants were 6 healthy volunteers (4 males, 2 females) recruited from the post-graduate students at the University of Otago, School of Dentistry. The age range was 25 to 35 years. All had full permanent dentitions, Angle Class I occlusions (normal) with acceptable overbite and overjet relationship, and none of them had a history of previous orthodontic treatment. For each of the subjects a cast chrome-cobalt baseplate was constructed to house 8 miniature strain gauge pressure transducers (Precision Measurement Co. Michigan). The location of the sensors were standardised as follows: Three sensors were paired on the buccal and lingual surfaces of the central, canine and first molar. Two palatal vault sensors were placed in the midline of the palate, one at level of the distal of the first premolar, and the second slightly anterior to the junction of the hard and soft palate. Simultaneous recordings were taken during a set of tasks including water swallows, saliva swallows and food ingestion. Results: The results showed that swallowing was a highly complex wellcoordinated event, and that each individual had their own unique signature pattern of swallowing, characterised by pressure changes of high frequency, in excess of �1000 kPa/s. Conclusions: The analysis of the pressure acting on the teeth showed that although the pattern and magnitude of pressure generated varied among the group, the observation of waveforms would suggest a tendency for no inherent balance between the buccal and the palatal pressures on the teeth during swallowing for any of the individuals tested. This investigation of the pressure in the midline revealed an aspect previously not fully explored; these experiments showed that there were large and persistent negative pressures generated during swallowing, that preceded the positive pressures and which appear important in bolus propulsion The patterns of swallowing and the magnitudes of pressure generated, changed with the different consistency of the various substances ingested. There was a general trend for increased pressures during swallowing of substrates that are more viscous; water showed the lowest pressures, followed by saliva and finally jelly. Keywords: Tongue pressure, Intraoral pressures, Tongue dynamics, Swallowing.

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He, Weijia, i 何維佳. "Use of proxy method for assessing swallowing-related quality of life in frail elderly". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/202377.

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

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Clayton, Nicola. "The effect of COPD on laryngopharyngeal sensitivity and swallow function". Connect to full text, 2007. http://hdl.handle.net/2123/2236.

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Thesis (M. Sc. Med.)--University of Sydney, 2008.
Title from title screen (viewed 29 July 2008). Submitted in fulfilment of the requirements for the degree of Master of Science in Medicine to the Discipline of Medicine, Faculty of Medicine. Degree awarded 2008; thesis submitted 2007. Includes bibliographical references. Also available in print form.

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Padovani, Aline Rodrigues. "Protocolo fonoaudiológico de introdução e transição da alimentação por via oral para pacientes com risco para disfagia (PITA)". Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5162/tde-19042010-110604/.

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A disfagia orofaríngea é um déficit frequentemente relacionado à consequências graves, como a desidratação, desnutrição, aspiração, pneumonia e morte. A avaliação fonoaudiológica a beira do leito é indicada para a detecção precoce deste distúrbio, no ambiente hospitalar. Geralmente inclui a coleta de informações acerca da dificuldade de deglutição; revisão da história médica; observação do estado clínico atual; avaliação da fala, voz e estruturas orofaciais e; observação do paciente durante os testes de deglutição com diferentes consistências de alimentos. Neste estudo, foi proposta a elaboração e validação de conteúdo do Protocolo Fonoaudiológico de Introdução e Transição da Alimentação por Via Oral para pacientes com risco para disfagia orofaríngea (PITA). Este protocolo visa auxiliar o fonoaudiólogo no gerenciamento clínico da disfagia, durante a fase de introdução e transição da alimentação por via oral na internação. O processo de elaboração e validação de conteúdo do PITA foi conduzido em três fases. A primeira fase baseou-se na fundamentação teórica e avaliação do protocolo-piloto. A segunda fase teve como objetivo a elaboração do PITA, sendo determinadas as definições constitutivas e operacionais de cada variável eleita. A terceira fase, a validação de aparência e conteúdo foi conduzida por meio da análise de treze juízes com expertise na área de estudo. Durante a terceira fase, os juízes foram convidados a avaliar o PITA, por meio de um questionário de validação de aparência e conteúdo. Para a análise das respostas dos juízes foram aceitos os índices de 0,78 para validação de conteúdo dos itens individualmente (IVC-I) e 0,90 para o índice de validação total do protocolo (IVC-T). Como resultado, o PITA foi constituído por vinte e um itens, com suas respectivas definições constitutivas e operacionais. Os resultados da terceira fase foram divididos em duas etapas. Na primeira, após a avaliação dos juízes, houve necessidade de modificar, incluir e excluir algumas variáveis. Na segunda, após repetição da avaliação dos juízes, os índices calculados apresentaram-se adequados, conforme a proposta do estudo, sendo definida a aparência e conteúdo do protocolo final. Assim, o PITA apresenta-se como um protocolo teórico, elaborado com base na literatura científica disponível. Por meio da avaliação de juízes experientes na área de estudo foi possível aperfeiçoar o instrumento e validá-lo em sua aparência e conteúdo. Outras pesquisas são essenciais para a aplicação experimental em larga escala, abrangendo diferentes fonoaudiólogos, pacientes, doenças de base e instituições. Apesar de ser um instrumento de baixo custo e fácil utilização, há ressalvas quanto à sua subjetividade e adverte-se a necessidade de treinamento prévio do examinador para a correta aplicação do instrumento.
Dysphagia is a deficit often related to serious consequences such as dehydration, malnutrition, aspiration, pneumonia, and death. Speech evaluation at bedside is indicated for early detection of this disorder in the hospital. It usually includes collecting information about dysphagia; medical review; current clinical status; assessment of speech, voice, and orofacial structures and; clinical tests with intake of different food textures. In this study, the development and validation of content of the \"Oral Feeding Transition Protocol (OFTP) was proposed. This protocol aims to assist speech pathologists in the clinical management of dysphagia, during the introduction and the transition to oral feeding at hospitals. The process of developing and validating the content of OFTP was conducted in three phases. The first phase provided theoretical background and evaluation of the pilot protocol. The OFTP was elaborated in the second phase, when the constitutive and operational definitions of each chosen variable were determined. The third phase was carried out in order to validate the protocol content. This validation was performed through the analysis of thirteen judges with expertise in dysphagia. During the third phase, the judges were asked to assess the OFTP, through a questionnaire of content validation. For this analysis the following validation indexes were accepted: 0.78 for individual items (IVC-I), and 0.90 for the overall scale (CVI-T). As a result, the OFTP was composed of 21 items, with their respective constitutive and operational definitions. The results of third phase were divided in two stages. In the first stage, after the judges evaluations, it was necessary to modify, add and delete some variables. In the second stage, after a new evaluation of the judges, the calculated indexes demonstrated to be adequate, as proposed by the study, and the final version of the protocol was determined. The OFTP is a theoretical protocol based on the available scientific literature. The evaluation of expert judges improved the tool and validated appearance and content of the protocol. Further research is essential for the experimental application with a large scale, different speech therapists, patients, underlying diseases, and institutions. The OFTP is a low cost instrument, with simple procedures for application. Despite this, there are concerns about its subjectivity; specific training is needed prior to the correct application of the instrument.

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Ercolin, Beatriz. "Caracterização da deglutição em portadores de distrofia miotônica de Steinert". Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5162/tde-22012013-165844/.

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INTRODUÇÃO: A disfagia orofaríngea e os distúrbios de motilidade esofágica são considerados as mais importantes causas de pneumonia aspirativa em pacientes com distrofia miotônica. O objetivo deste estudo foi avaliar as características clínicas da motricidade orofacial e a deglutição de indivíduos com distrofia miotônica (DM1), utilizando um protocolo clínico padronizado e eletromiografia de superfície (EMGs). MÉTODO: Os participantes foram divididos em dois grupos: G1-composto por 20 adultos com DM1; G2-composto por 20 voluntários saudáveis, os participantes foram pareados por idade e gênero com G1 para a análise estatística. Foi realizada a avaliação das estruturas e funções orofaciais, utilizando um protocolo clínico padronizado, e mensurada a atividade mioelétrica da deglutição por meio da EMGs, com eletrodos localizados em quatro grupos musculares: (1) orbicular da boca, (2) masseter, (3) musculatura suprahioidea e (4) extrínseca da laringe. A atividade mioelétrica foi medida durante o repouso muscular e durante a deglutição de saliva e de 16,5ml e 20ml de água. Os traçados da EMGs foram avaliados durante o inicio (onset), pico e o término (offset), dos evento da deglutição. A análise estatística incluiu a ANOVA de duplo fator para intragrupos e intergrupos e o teste de Bonferroni para correções de comparações múltiplas. RESULTADOS: Pacientes com DM1 apresentaram déficits em posição, postura e mobilidade dos órgãos miofuncionais orofaciais, e nas funções de mastigação e deglutição. Além disso, os resultados da EMGs para diferentes tarefas de deglutição indicaram maior atividade muscular do orbicular da boca e maior duração da ativação muscular para os músculos: orbicular da boca, masseter e extrínseco de laringe. Não foi observado aumento significativo na amplitude da EMGs, nos pacientes com DM1, quando comparado aos resultados obtidos no teste de deglutição normal com o teste de estresse. CONCLUSÕES: A maior duração da deglutição na EMGs no grupo DM1, possivelmente está relacionada a miotonia e/ou incoordenação dos músculos envolvidos no processo da deglutição ou pode estar relacionado a uma adaptação fisiológica para uma deglutição segura. A identificação precoce dos distúrbios da deglutição permite reabilitação precoce oral, o que poderia diminuir o risco de pneumonia por aspiração nesta população.
INTRODUCTION: Oropharyngeal dysphagia and oesophageal motility disorders were found to be the most important reasons causing aspiration pneumonia in patients with myotonic dystrophy. The purpose of this report was to evaluate clinical characteristics of the oral motor movements and swallowing of individuals with myotonic dystrophy type 1 (DM1), using a standardized clinical protocol and surface electromyography (sEMG). METHOD: Participants were 40 individuals divided in two groups: G1- composed by 20 adults with DM1; G2- composed by 20 healthy volunteers paired by age and gender to individuals in G1. Participants of all groups underwent clinical assessment of the orofacial structures and functions using a standardized clinical protocol. The myoelectric activity of swallowing was measured using sEMG. Four muscle groups were examined: (1) the orbicularis oris superior and inferior; (2) the masseter; (3) the submental muscle group; and (4) the laryngeal strap muscles. Muscle activity was measured during rest, during dry swallows and during the swallowing of 16.5ml and 20ml of water. Surface EMG traces were evaluated for onset, peak and offset of activity during swallow events. The statistical analysis included the one-way ANOVA with two factors for within and between group comparisons and the Bonferroni correction for multiple comparisons. RESULTS: Patients with DM1 presented deficits in posture, position and mobility of the oral motor organs, as well as compromised mastication and deglutition. Moreover, sEMG results for different swallowing tasks indicated higher muscle activity for the orbicularis oris and longer durations of muscle activation for the orbicularis oris, masseter and laryngeal strap muscles. When considering within group comparisons, DM1 patients did not present a significant increase of sEMG amplitude during the stress test in comparison with the normal swallow test. CONCLUSION: Compared to healthy individuals, patients with DM1 presented longer times to pass a bolus from the oral cavity to the esophagus. The larger duration of sEMG in the DM1 group is possibly related to myotonia and/or incoordination of the muscles involved in the swallowing process or could reflect a physiological adaptation for safe swallowing. Early identification of swallowing disorders enables early oral rehabilitation, which in turn could decrease the risk of aspiration pneumonia in this population.

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Bergquist, Henrik. "Aspects on the management of patients with esophageal cancer /". Göteborg : Dept. of Otorhinolaryngology, Head and Neck Surgery, the Sahlgrenska Academy, Göteborg University, 2007. http://hdl.handle.net/2077/4422.

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Ngan, Yuk-hing Candy, i 顏玉卿. "Diet and fluid tolerance of dysphagic stroke patients in predicting swallowing outcomes at 3 months post-stroke". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B3197210X.

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Fioravanti, Marisa Portes [UNESP]. "Caracterização e classificação da deglutição orofaríngea do idoso institucionalizado: avaliaçao clínica fonoaudiológica". Universidade Estadual Paulista (UNESP), 2007. http://hdl.handle.net/11449/86334.

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Fundação para o Desenvolvimento Médico e Hospitalar (Famesp)
O aumento da expectativa de vida preocupa os profissionais de saúde quanto à qualidade da mesma em idosos. Entre os problemas que surgem com o envelhecimento estão aqueles relacionados com as condições orais e os distúrbios da deglutição. Os distúrbios da deglutição orofaríngea em idosos, particularmente naqueles institucionalizados, causam desnutrição, desidratação e disfagia, aspiração e pneumonia. A dificuldade para deglutir pode ser avaliada inicialmente por testes clínicos fonoaudiológicos da deglutição, os quais apresentam grande heterogeneidade quanto aos sinais clínicos observados e às consistências e volume de alimentos usados. Objetivo: Caracterizar e classificar a deglutição orofaríngea do idoso institucionalizado. Pacientes e Métodos: Foram estudados 47 moradores de uma casa de repouso que ingeriram 4 consistências de alimentos e foram observados quanto à presença de 7 sinais clínicos sugestivos risco de disfagia e de aspiração. As condições oral e nutricional foram determinadas, foram estabelecidas correlações entre consistências e presença de alterações clínicas e foi criada classificação das alterações segundo grau de severidade. Resultados: Foram encontrados 43 indivíduos desdentados, 40% deles com prótese dentária, 38 dos quais com alteração à mastigação para sólido entre 78 alterações nas 4 consistências. Dos 47 indivíduos, cerca de 69% apresentaram alterações à mastigação de sólidos, enquanto que alteração na elevação da laringe e alteração na qualidade vocal foram apresentados, cada uma, por 15,6% deles. Na consistência pastoso grosso cerca de 19% dos idosos apresentavam deglutições múltiplas, enquanto que alteração na elevação da laringe e da qualidade vocal estiveram presentes, cada uma, em 13%. Foram classificados como portadores de alteração de grau leve a moderado...
The increase in life expectancy concerns health care professionals with regard to the quality of life of the elderly population. Problems arising from ageing include those related to oral condition and deglutition disorders. Oropharyngeal swallowing disorders particularly in institutionalized elderly individuals, cause malnutrition, dehydration, aspiration and pneumonia. Swallowing impairment can be initially evaluated by clinical tests, which present great heterogeneity regarding the clinical signs observed and the consistency and volume of the food used. Objective: To characterize and classify oropharyngeal deglutition in institutionalized elderly individuals by means the bedside clinical evaluation. Patients and methods: Forty-seven nursing home residents were evaluated during ingestion of foods of four consistencies. They were assessed for the presence of 7 clinical signs suggestive of risk dysphagia. Oral and nutritional conditions were determined; correlations between the consistencies and the presence of clinical changes were established and a classification of the alterations according to levels of severity was done. Forty-three toothless individuals were found, of whom 40% had dental prostheses and 38 presented alteration in mastication for solid food among the 78 alterations found for the 4 consistencies. Of the 47 individuals, approximately 69% showed alteration for solid food and impairment of larynx elevation and of vocal quality were each found in 15.6% of the subjects. In thick consistency 19% of the elderly showed repetitive swallowing and alteration in larynx elevation and vocal quality were each present in 13% of the elderly. Seventy-four percent of the individuals were classified as presenting mild to moderate alteration, and 38% of them were malnourished, without differences between age ranges. Discussion: The presence... (Complete abstract click electronic access below)

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BENAMAR, DJELLAL NADJIA. "Etude de la sensibilite tactile de la langue chez les enfants presentant des anomalies des praxies buccales". PARIS 6, DENTAIRE, 1988. http://www.theses.fr/1988PA06H007.

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Conardeau, Jean-Christophe. "Tachycardies supra-ventriculaires induites par la déglutition : à propos de trois cas". Bordeaux 2, 1994. http://www.theses.fr/1994BOR2M115.

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Berglund, Viktoria, i Carin Engström. "Att lyssna på sväljning : En studie om användning av cervikal auskultation vid bedömning av dysfagi i Sverige". Thesis, Uppsala universitet, Logopedi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-193064.

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Syftet med denna studie var att undersöka hur användningen av bedömningsmetoden cervikal auskultation (CA) ser ut hos dysfagilogopeder i Sverige. Våra frågeställningar var: Hur utspridd är metoden inom logopedkåren? Hur utspridd är metoden i landet? Vilka åsikter finns kring metoden bland logopeder i Sverige? Vilka undersökningsmetoder vid dysfagi används mest bland logopeder i Sverige? Totalt deltog 82 personer i studien. Data samlades in genom en webbenkät. Frågorna i enkäten var blandat öppna och slutna. Resultaten visade att 18 % av de svarande använde CA. Det fanns ett signifikant samband mellan hur ofta man använde metoden och hur säker man kände sig i bedömningen. Signifikans hittades också mellan hur ofta man använde CA och hur stor vikt man lade vid det man kom fram till med metoden när man gjorde sin totala bedömning. Större vikt tillskrevs även CA:s resultat av dem som kände sig säkra i att bedöma med CA. Resultaten visade också att ju fler år man hade använt metoden desto säkrare kände man sig i att göra bedömningar med den. Majoriteten av de som använde CA var självlärda eller hade lärt sig metoden genom kollegor. En tanke som uppkom var om logopeder i Sverige eventuellt tror att CA är menat att användas som enskild bedömningsmetod och därmed ersätta icke-instrumentell bedömning. CA tycks inte användas så frekvent i Sverige främst på grund av brister i evidens och tillförlitlighet men många ser fördelar som skulle motivera användning av CA som en del i icke-instrumentell bedömning.
The purpose of this study was to investigate the use of the assessment method cervical auscultation (CA) amongst speech and language pathologists (SLPs) in Sweden working with dysphagia. We wanted to find out: How widespread is the method in the SLP profession? How widespread is the method in the country? What opinions are there about the method amongst SLP´s in Sweden? What assessment methods within dysphagia are mostly used among SLP´s in Sweden? A total of 82 SLPs participated in the study. Data were collected through an online survey. The survey questions were of both quantitative and qualitative nature. The results showed that 18% of the respondents used CA. There was a significant correlation between the frequency of use of the method and how confident SLPs felt in the assessment. Significance was also found between the frequency of use of CA and how much importance SLPs assigned to what was discovered with the method when making the overall assessment. More importance was also ascribed to the results of CA from those who felt confident in assessing with the method. The results also showed that the longer SLPs had used the method, the more confident they felt in assessing with it. The majority of those who used CA were self-taught or had learned the method through colleagues. A thought that arose was whether the SLPs in Sweden possibly believe that CA is meant to be used as the sole method of assessment, replacing non-instrumental assessment. CA does not seem to be used frequently in Sweden, mainly because of lack of evidence and reliability but many see benefits that would justify the use of CA as part of the clinical assessment.

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Mendes, Amanda Elias. "Indicação da gastrostomia em pacientes com esclerose lateral amiotrófica: critérios fonoaudiológicos". Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-12082015-153452/.

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Introdução: A esclerose lateral amiotrófica (ELA) é uma doença neurodegenerativa progressiva, de etiologia desconhecida, que envolve os neurônios motores do córtex cerebral, do tronco encefálico e da medula espinhal. O comprometimento dos neurônios motores inferiores causa disfagia, distúrbios de fala e outros sintomas, como fraqueza muscular global e sintomas respiratórios. A dificuldade de deglutição ou disfagia pode causar complicações, como pneumonia aspirativa, má nutrição e desidratação, e afeta a qualidade de vida destes pacientes, sendo necessária a indicação de via alternativa de nutrição. Atualmente, esta indicação é dada subjetivamente pelo exame clínico e funcional realizado pela equipe multidisciplinar, de acordo com a deterioração dos parâmetros da função respiratória, do estado nutricional e de comprometimentos na deglutição. Objetivos: objetivo geral: verificar se a redução de pressão de língua pode ser indicadora de necessidade de gastrostomia (GEP) como via alternativa de nutrição em pacientes com diagnóstico de ELA. Objetivos específicos: verificar se há redução significativa nas medidas funcionais e de pressão de lábio, de língua e de bochecha entre o momento da primeira avaliação e da indicação da GEP; avaliar o tempo desde o primeiro sintoma da doença até a indicação da GEP; verificar se o tempo de indicação da GEP foi influenciado por variáveis demográficas, manifestação clínica inicial (espinhal ou bulbar), condições clínicas, medidas funcionais globais e de deglutição, com destaque para pressão de língua, de lábios e de bochechas. Métodos: Foram estudados longitudinalmente 63 pacientes, avaliados do ponto de vista fonoaudiológico com os instrumentos: escala ASHA, escala ALSFRS, avaliação funcional, medida de pressão dos órgãos fonoarticulatórios com o aparelho IOPI, encaminhamento para videoendoscopia da deglutição (VED) e capacidade vital forçada (CVF) no momento da indicação da GEP. Resultados: Os pacientes tinham faixa etária entre 28 e 79 anos (média de 58 anos de idade), com média de 7,04 anos de escolaridade, tempo médio de doença no momento da avaliação inicial de 34,96 meses, 32% manifestação clínica inicial da forma bulbar, 39,5% espinhal membros superiores e 28,5% espinhal membros inferiores, porém, na avaliação fonoaudiológica inicial, todos apresentavam alguma queixa de acometimento bulbar. Cinquenta pacientes foram encaminhados à GEP, 1 foi a óbito e 12 mantiveram dieta via oral exclusiva até o término do estudo. Medidas funcionais e de pressão de língua, lábio e bochecha apresentaram redução significativa no agravamento da ELA (p < 0,001). Dificuldades com líquido espessado: de contenção (p=0,001), de transporte (p=0,005) e de proteção de vias aéreas inferiores (p =0,003), e com a consistência pastosa: contenção na cavidade oral, (p < 0,001) observadas em avaliações clínicas fonoaudiológicas, e a idade (p =0,014) influenciam na indicação de GEP. Conclusão: A medida de pressão de língua pode, portanto, servir como um indicador adicional, objetivo e prático para o exame do prognóstico da funcionalidade da deglutição, e, em particular, da possibilidade ou não de manutenção de vias tradicionais em pacientes com diagnóstico de ELA
Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of unknown etiology that involves motor neurons from the cerebral cortex, from the brainstem and from the spinal cord. The damage on the lower motor neurons causes dysphagia, speech disorders and other symptoms such as overall muscle weakness and respiratory symptoms. The difficulty in swallowing, or dysphasia, may cause complications such as aspiration pneumonia, malnutrition and dehydration and affects the quality of live of these patients. Thus, it is necessary to indicate and alternative form of nutrition. This indication is currently given subjectively by the clinical and functional evaluation performed by the multidisciplinary team, according to deterioration of respiratory function parameters, nutritional status and swallowing impairments. Objectives: general objective: verify if reduced tongue pressure could indicate the need for gastrostomy (PEG) as an alternative form of nutrition for patients who have been diagnosed with ALS. Specific objectives: verify if there is significant reduction on tongue, lips, and cheeks pressure as well as functional measures between the moment of the first evaluation and the indication of PEG; evaluate the time between the first symptom of the disease and the indication of PEG; verify if the time of the indication of PEG was influenced by demographic variables, initial clinical manifestation (spinal or bulbar forms), clinical conditions, global and swallowing functional measures, highlighting tongue, lips and cheeks pressure. Methods: 63 patients have been longitudinally studied. They have been assessed from the speech-language therapy point of view with the following instruments: ASHA, ALSFRS, functional evaluation, pressure measurement of the phono-articulatory organs with the IOPI, referral to videoendoscopy of swallowing and FVC at the moment of the indication of PEG. Results: The patients, whose ages ranged from 28 to 79 years old (average of 58 years old), had, on average, 7.04 years of education. They had been suffering from the disease for an average of 34.96 months at the time of the first evaluation. 32% showed initial clinical manifestation of the bulbar form, 39.5% upper limbs spinal form and 28.5% lower limbs spinal form. At the initial speech-language therapy assessment, however, all of them showed some sort of complaint regarding bulbar impairment. 50 patients were sent to PEG, 1 died and 12 continued with an oral exclusive diet until the end of this study. Tongue, lips and cheeks as well as functional measures showed significant decrease with the aggravation of ALS (p < 0,001). Difficulties with thickened liquid: with containment (p=0,001), with transport (p=0,005) and with protection of lower airways (p =0,003) and with pasty consistencies: containment in the oral cavity, (p < 0,001) observed in speech-language therapy clinical assessments, as well as age (p =0,014) have influence on the indication of PEG. Conclusion: The measure of the tongue pressure can, therefore, serve as an additional, objective and practical indicator for the evaluation of the prognosis of swallowing functionality, particularly of the possibility or not of maintenance of traditional forms in patients who have been diagnosed with ALS

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Brasil, Rita de Cássia Escobar de Arruda [UNESP]. "Disfagia orofaríngea e estado de saúde bucal em pessoas com paralisia cerebral". Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/154377.

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Introdução: Pessoas com Paralisia Cerebral (PC) apresentam prognóstico e comorbidades diversificadas e suas manifestações estão relacionadas com limitações funcionais, tanto motoras globais como de controle neuromotor das funções orais, desencadeando dificuldades na comunicação, deglutição e saúde bucal. Objetivo: Este estudo teve por objetivo relacionar o risco de disfagia orofaríngea (DO) com o estado de saúde bucal na pessoa com Paralisia Cerebral. Método: Foram selecionados todos os prontuários com diagnóstico neurológico conforme CID 10, dentro da classificação de Paralisia Cerebral de distintos subtipos, do período de janeiro de 2011 a junho de 2017, do Centro de Assistência Odontológica à Pessoa com Deficiência (CAOE) da Universidade Estadual Paulista – Unesp - Campus de Araçatuba, perfazendo 1868 indivíduos. Foram incluídos nesse estudo 345 prontuários, 194 do gênero masculino e 151 do gênero feminino, faixa etária de 1 a 60 anos, com média de 13,9 anos, e função motora grossa (GMFCS) que variou de I a V. Elaborado e aplicado instrumento de rastreio para disfagia orofaríngea na PC e para a classificação da saúde bucal nessa população. Resultados: Das 345 (100%) pessoas com PC, 197 (57,1%) apresentaram risco para DO e 148 (42,9%) não apresentaram. A associação entre risco de DO e subtipo de PC foi significante na PC quadriplégica espástica e com maior razão de chance que nos demais subtipos. Houve associação entre disfagia orofaríngea e saúde bucal na PC considerando o desempenho motor (p: 0,0485). Conclusão: O risco de disfagia orofaríngea foi mais frequente na PC quadriplégica espástica e apresentou relação com o estado de saúde bucal na PC quando associado ao desempenho motor e não por subtipo.
Introduction: People with Cerebral Palsy (CP) have different prognoses and comorbidities and their manifestations are related to functional limitations, both global motor and neuromotor control of oral functions, with impairment in communication, swallowing and oral health. Purpose: This study aimed to relate the risk of oropharyngeal dysphagia (OD) with oral health status in people with CP. Methods: All neurological records according within the classification of CP of different subtypes, from January 2011 to June 2017, were selected from the Center for the Assistance to the Individuals with Disabilities (CAOE) of the Paulista State University- Unesp - Campus of Araçatuba, comprising 1868 individuals. The study included 345 medical records, 194 males and 151 females, ranging from 1 to 60 years old, mean age of 13.9 years, and gross motor function (GMFCS), ranging from I to V. Screening for oropharyngeal dysphagia on CP and the classification of oral health in this population were proposed and applied. Results: Of the 345 (100%) people with CP, 197 (57.1%) presented risk for OD and 148 (42.9%) did not present. The association between OD risk and PC subtype was significant in spastic quadriplegic CP and with a higher odds ratio than in the other subtypes. There was an association between oropharyngeal dysphagia and oral health in CP considering motor performance (p: 0.0485). Conclusion: The risk of oropharyngeal dysphagia was more frequent in spastic quadriplegic CP and presented a relationship with oral health in CP when associated with motor performance and not by subtype.

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46

JABRE, MARIE-HELENE. "Les troubles de la deglutition d'origine centrale chez le jeune enfant : prise en charge dans le cadre d'un centre d'action medico-sociale precoce". Aix-Marseille 2, 1988. http://www.theses.fr/1988AIX20052.

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47

Erne, Claudia. "Monitoring natural progression of dysphagic symptoms in stroke". Thesis, University of Canterbury. Department of Communication Disorders, 2008. http://hdl.handle.net/10092/2141.

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Swallowing difficulties after acute stroke are common. Clinical bedside assessments are used frequently to detect acute dysphagia. Published studies which have assessed the natural history of swallowing using bedside assessments have only observed swallowing for a short period of time. The purpose of this investigation was to monitor the natural progression of dysphagic symptoms in stroke over three month using a clinical assessment. 26 patients consecutively admitted to the regional public hospital were assessed using a clinical assessment consisting of cranial nerve exam, observation of oral intake, water swallow test and inhalation cough challenge. The assessment was implemented within 72 hours post admission and then after one week, three weeks and three months. For this exploratory study, descriptive statistics were used to explore the data set. The results confirm that dysphagia after stroke is common and that there are improvements within three months.

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48

Campos, Camila Heitor 1985. "Influência da prótese parcial removível implanto-retida sobre a mastigação e ingestão de nutrientes". [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/288650.

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Orientador: Renata Cunha Matheus Rodrigues Garcia
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: A reabilitação de arcos parcialmente dentados por meio de próteses parciais removíveis (PPR), sobretudo aqueles com ausência de dentes posteriores, apresentam limitações relativas ao suporte da prótese, que nestes casos é dividido entre dentes e mucosa, estruturas com diferentes resiliências. A associação de implantes osseointegrados à base da PPR tem como proposta atenuar estas limitações e trazer benefícios para o paciente, porém, a literatura sobre este assunto é escassa. Desta forma, este estudo se propôs a avaliar o efeito da associação de implantes osseointegrados pela adição de encaixe posterior implanto-retido à base de PPR mandibulares sobre o limiar de deglutição e ingestão de nutrientes. Oito voluntários (idade média = 60,1 ± 6,6 anos) apresentando edentulismo total maxilar e parcial mandibular (Classe I de Kennedy) foram selecionados e reabilitados com próteses totais (PT) maxilares e PPR mandibulares. Após dois meses de uso das novas próteses, as variáveis acima citadas foram mensuradas. Em uma segunda etapa, os mesmos voluntários receberam dois implantes osseointegrados bilaterais na região de molares inferiores. Após o período de osseointegração, foram adicionados encaixes do tipo bola aos implantes e à base da PPR, e após dois meses de uso das PPR implanto-retidas as variáveis foram novamente mensuradas. O limiar de deglutição foi avaliado por meio da contagem do número de ciclos mastigatórios realizados para a mastigação de uma porção de amendoim até o paciente sentir que está na iminência de deglutir. Foi ainda realizado o cálculo do tamanho mediano de partículas trituradas (X50), utilizando o material teste mastigável Optocal, pelo método de fracionamento de peneiras. O estado nutricional foi avaliado por meio de diário alimentar de três dias, e posteriormente foi traduzido em valores nutricionais por meio da utilização da Tabela Brasileira de Composição de Alimentos. Foram realizadas análises comparativas pareadas, sendo utilizados os testes T de Student e Wilcoxon para nível de significância de 5%. Embora não tenha ocorrido mudança no número de ciclos mastigatórios necessários à deglutição após a inserção do encaixe implanto-retido (P>0,05), houve redução significativa do X50 (P<0,05). Observou-se, ainda, aumento na ingestão de calorias (P=0,008) e no consumo diário de carboidratos (P=0,003), proteína (P=0,023), cálcio (P=0,006), fibras (P=0,040) e ferro (P=0,038). Não foram detectadas alterações na ingestão de gordura e no IMC (P>0,05). Pode-se concluir que a associação de implantes às PPR por meio encaixe do tipo bola apresenta efeito positivo sobre a mastigação e ingestão de nutrientes em pacientes com arcos Classe I de Kennedy
Abstract: The rehabilitation of partially dentate arches with removable partial dentures (RPD), especially those with absence of posterior teeth, have limitations regarding RPD support, divided between teeth and mucosa, with different structures resilience. The association of dental implants beneath RPD base proposal is to reduce these limitations and bring benefits to patients; however, the literature on this is scarce. Therefore, this study aimed to assess the impact of the use of a posterior implant retainer for free-end RPD on the swallowing threshold and nutrient intake. For this purpose, eight volunteers (mean age = 60.1 ± 6.6 years) presenting maxillary edentulism and mandibular partially dentate arch (Kennedy Class I) were selected and rehabilitated with maxillary complete dentures (PT) and mandibular RPD. After two months of use of the new prosthesis, the variables were measured. In a second step, the same volunteers received two osseointegrated implants, bilaterally in the region of mandibular first molars. After healing time, ball attachments were added to the implants and fitted on the RPD base, providing retention, and after two months of using, the variables were again measured. The swallowing threshold was assessed by counting the number of masticatory cycles and by calculating the median particle size reduction (X50). The number of masticatory cycles performed for chewing a portion of peanuts until the patient felt need to swallow was registered by the researcher. The X50 value was determined by sieve fractioning method using the chewable test material Optocal. Nutritional state was assessed by three-day food diary and further compared to the Brazilian Food Composition Table. Comparative analyzes were made by using the Paired Student's t-test and Wilcoxon Rank-test, depending on the normality distribution of data, and for 5% of significance level. Although there was no change in the number of chewing cycles needed to swallow after implant insertion (P>0.05), there was a significant reduction in the average size of the particle to be swallowed (P<0.05). There was also an increase in energy intake (P=0.008) and daily consumption of carbohydrates (P=0.003), protein (P=0.023), calcium (P=0.006), fiber (P=0.040) and iron (P=0.038). No changes were detected in fat intake and BMI (P>0.05). It can be concluded that the association of implants to RPD by ball attachment insertion may have positive effect on chewing and nutrient intake in patients with Class I Kennedy arches
Mestrado
Protese Dental
Mestra em Clínica Odontológica

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Carvalho, Eloisa Muller de 1969. "Prevenção e tratamento da mucosite oral induzida pelo tratamento do câncer em crianças e adolescentes : revisão sistemática". [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/290133.

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Orientador: Antonio Carlos Pereira
Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Este estudo é composto por um artigo, cujo objetivo principal foi investigar a eficácia dos métodos de prevenção e tratamento da mucosite oral induzida pela terapia do câncer em crianças e adolescentes. Trata-se de uma revisão sistemática de literatura (RSL) realizada por meio da análise retrospectiva de estudos primários que focalizaram a prevenção e o tratamento da mucosite oral. Os procedimentos metodológicos foram baseados nas recomendações da Cochrane Collaboration (Clarke, 2001), caracterizada pela análise criteriosa dos estudos selecionados, conforme o nível de evidência e relevância na área, síntese e interpretação dos dados. Capitulo 1: Um total de 1.394 registros potencialmente relevantes foram encontrados em seis bases de dados. Do total de registros, 254 estavam duplicados. Assim, os resumos de 1.140 estudos foram lidos, dos quais 1.038 referências foram excluídas com base nos resumos, e 102 foram selecionados para análise de texto completo, dos quais 4 foram elegidos para a inclusão da revisão sistemática. Embora a busca tenha sido realizada com a finalidade de encontrar estudos tanto de prevenção quanto de tratamento de mucosite oral, nenhum estudo de prevenção mostrou-se eficaz. As evidências de eficácia desta revisão sistemática foram atribuídas somente a vitamina "E" e laserterapia, ambas modalidades de tratamento para mucosite oral
Abstract: This study consists of an article whose main objective was to identify the effectiveness of the methods of prevention and treatment of oral mucositis induced by cancer therapy in children and adolescents. It is a systematic literature review (SLR) performed by retrospective analysis of primary studies that focused on the prevention and treatment of oral mucositis. The methodological procedures based on the recommendations of the Cochrane Collaboration (Clark, 2001), characterized by careful analysis of the selected studies, as the level of evidence and relevance in the area; synthesis and interpretation of data. Chapter 1): A total of 1,394 entries were found in the potentially relevant six data bases, of which 254 were duplicated. Thus, abstracts of 1,140 studies were read, of which 1,038 references were excluded on the basis of the abstracts, and 102 were selected for full-text analysis, from which 4 were selected for inclusion in the systematic review. Although the search has been performed with the aim of finding studies both as preventive treatment of oral mucositis, none prevention study was effective. The evidence of efficacy of this systematic review were assigned only to vitamin "E" and laser therapy, both treatment modalities for oral mucositis
Mestrado
Odontologia em Saude Coletiva
Mestra em Odontologia em Saúde Coletiva

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Oliveira, Ana Railka de Souza. "ValidaÃÃo dos resultados de enfermagem estado de deglutiÃÃo e prevenÃÃo da aspiraÃÃo em pacientes apÃs acidente vascular cerebral". Universidade Federal do CearÃ, 2013. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=11334.

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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
Teve-se como proposta construir e validar as definiÃÃes conceituais e os referentes empÃricos dos Resultados de Enfermagem (RE) relacionados ao Estado da deglutiÃÃo e Ã PrevenÃÃo da aspiraÃÃo em pacientes apÃs acidente vascular cerebral (AVC). Estudo metodolÃgico, realizado em trÃs etapas: anÃlise de conceito, validaÃÃo por especialistas e validaÃÃo clÃnica. Para a AnÃlise de Conceito, realizou-se RevisÃo Integrativa, com acesso on-line a seis bases de dados: Pubmed, Cinahl, Scopus, EMBASE, Web of science e Lilacs, bem como dissertaÃÃes e teses disponibilizadas no site da CAPES e na BDTD. Na busca utilizaram-se os descritores: Deglutition, Deglutition Disorders e Stroke e sua sinonÃmia em portuguÃs. ApÃs leitura crÃtica e aplicaÃÃo dos critÃrios de inclusÃo e exclusÃo, foram obtidos 29 artigos, cinco dissertaÃÃes e uma tese. O conceito em estudo inicialmente foi a âDeglutiÃÃoâ, e os atributos crÃticos: conteÃdo oral (alimento, lÃquido ou saliva); estÃmulos motor e sensitivo; fase oral, farÃngea e esofÃgica; e transporte da boca atÃ o estÃmago. Foi elaborado um caso modelo e um caso contrÃrio e identificados antecedentes e consequentes para DeglutiÃÃo no contexto de pacientes com AVC. Ao final da etapa, foram identificados 14 indicadores para o Estado da deglutiÃÃo e revisada a sua definiÃÃo. O conceito de aspiraÃÃo jÃ havia sido estudado, e nÃo foi ressubmetido Ã AnÃlise de Conceito. Assim, para o RE PrevenÃÃo da aspiraÃÃo foram identificados seis indicadores e revisados o tÃtulo e a definiÃÃo. Ao final da AnÃlise de Conceito, construiu-se um instrumento de avaliaÃÃo dos dois RE com seus indicadores, definiÃÃes conceituais e referentes empÃricos. ApÃs avaliaÃÃo por ComitÃ de Ãtica em pesquisa, o instrumento foi submetido Ã apreciaÃÃo de 14 profissionais. Os dados da apreciaÃÃo foram compilados no programa Excel e analisados pelo SPSS versÃo 20.0. A maioria dos juÃzes era do sexo feminino (85,71%), enfermeiros (92,86%), com tempo de formaÃÃo de 6,64 anos (Â6,72), trabalhavam no CearÃ (92,86%). Os especialistas propuseram revisÃo em todos os indicadores e definiÃÃes para melhor atender aos critÃrios da psicometria; agrupamento dos indicadores ProduÃÃo de saliva e ManutenÃÃo do conteÃdo oral na boca; exclusÃo dos indicadores FormaÃÃo do bolo alimentar, NÃmero de deglutiÃÃes e MudanÃa na qualidade da voz, por considerarem que eram possÃveis de serem avaliados por outros indicadores, e a elaboraÃÃo do indicador Utiliza sondas gÃstricas e enterais de forma adequada. Exceto o Ãltimo indicador, os demais foram validados clinicamente em 81 pacientes com AVC, os quais eram avaliados por duas duplas de enfermeiros, uma com instrumento com as definiÃÃes construÃdas e a outra com instrumento sem definiÃÃes. As avaliaÃÃes foram comparadas pelo Coeficiente de CorrelaÃÃo Intraclasse, teste de Friedman e pela DiferenÃa MÃnima Significante. A dupla com definiÃÃes apresentou concordÃncia total na avaliaÃÃo dos resultados. Apenas o indicador Refluxo nasal foi avaliado de forma similar pelos dois grupos. A anÃlise de cluster demonstrou agrupamento preferencial dos indicadores do RE PrevenÃÃo da aspiraÃÃo respiratÃria. Diante desses achados, recomenda-se a continuaÃÃo do processo de validaÃÃo destes resultados para confirmar o agrupamento dos seus indicadores, bem como sua validaÃÃo para condiÃÃes clÃnicas diferentes do AVC.
The study aimed to build and validate the conceptual definitions and empirical referents of nursing outcomes (NO) related to the State of swallowing and the Prevention of aspiration in patients after stroke. This is a methodological study carried out in three stages: concept analysis, validation by experts and clinical validation. The concept analysis was performed by integrative literature review through online access to six databases: PubMed , CINAHL , Scopus , EMBASE , Web of science and Lilacs, and dissertations and theses available on the website of CAPES and BDTD. The following descriptors were used: deglutition , deglutition disorders and stroke and their synonyms in Portuguese. After a critical reading and the application of inclusion and exclusion criteria, 29 articles, five dissertations and one thesis were obtained. Initially the concept of study was âSwallowingâ and its critical attributes: oral content (food, liquid or saliva), motor and sensory stimulation; oral, pharyngeal and esophageal phases; and transport from the mouth to the stomach. A case model and a opposite case were elaborated and antecedents and consequential for swallowing in the context of stroke patients. At the end, 14 indicators were identified for the swallowing state and its definition was reviewed. The concept of aspiration has already been studied and it was not submitted again to the analysis concept. Thus, for the NO Prevention of aspiration, six indicators were identified and their titles and definitions were revised. After the concept analysis, a tool was built with the concepts and empirical references of both NO. After evaluation by the Research Ethics Committee, the tool was submitted to 14 professionals. The date were compiled in the Excel software and analyzed by the SPSS software version 20.0. According to the sample profile: most experts were female (85.71%), nurses (92.86%), graduated in an average of 6.64 years ago (Â 6.72), working in CearÃ (92.86%). The experts proposed revision for all the indicators and definitions in order to fit the psychometrics criteria, clustering the indicators Saliva production and Maintains food in mouth; exclusion of the indicators Bolus formation, Number of swallows and Changes in voice quality. The changes happened because the experts considered the possibility to evaluated those indicators by other indicators; and the development of the indicator Uses gastric and enteral tube properly. With the exception of the last indicator, the others were clinically validated in 81 patients with stroke, who were evaluated by two pairs of nurses, one with the tool with the definitions built and the other without the definitions. The evaluations were compared by intraclass correlation coefficient, Friedman test and Minimum Significant Difference. The pair of nurses with the definitions presented total agreement on the evaluation of the results. Only the indicator Nasal reflux was evaluated similarly by both groups. The cluster analysis showed preferential grouping of indicators to the NO Prevention of aspiration. Then, it is recommended the continuation of the validation process of these results in order to confirm the grouping of its indicators, as well as its validation for clinical conditions other than stroke.

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