Purpose to verify the efficacy of speech therapy in the early return of oral intake in patients with post-orotracheal intubation dysphagia. Methods It was a double-blinded randomized controlled trial for two years with patients of intensive care units of a hospital. Study inclusion criteria were orotracheal intubation>48hours, age≥18 years old, clinical stability, and dysphagia. Exclusion criteria were tracheotomy, score 4 to 7 in the Functional Oral Intake Scale (FOIS), neurological disorders. Patients were randomized into speech treatment or control group (ten days of follow-up). The treated group (TG) received guidance, therapeutic techniques, airway protection and maneuvers, orofacial myofunctional and vocal exercises, diet introduction; the control group (CG) received SHAM treatment. Primary outcomes were oral intake progression, dysphagia severity, and tube feeding permanence. Results In the initial period of study, 240 patients were assessed and 40 (16.6%) had dysphagia. Of this, 32 patients met the inclusion criteria, and 17 (53%) received speech therapy. Tube feeding permanence was shorter in TG (median of 3 days) compared to CG (median of 10 days) (p=0.004). The size effect of the intervention on tube feeding permanence was statistically significant between groups (Cohen's d=1.21). TG showed progress on FOIS scores compared to CG (p=0.005). TG also had a progression in severity levels of Dysphagia protocol (from moderate to mild dysphagia) (p<0.001). Conclusion Speech therapy favors an early progression of oral intake in post-intubation patients with dysphagia. Clinical Trial Registration: RBR-9829jk.
Hepatic glycogen storage diseases (GSDs) are inborn errors of metabolism whose dietary treatment involves uncooked cornstarch administration and restriction of simple carbohydrate intake. The prevalence of feeding difficulties (FDs) and orofacial myofunctional disorders (OMDs) in these patients is unknown. Objective: To ascertain the prevalence of FDs and OMDs in GSD. Methods: This was a cross-sectional, prospective study of 36 patients (19 males; median age, 12.0 years; range, 8.0-18.7 years) with confirmed diagnoses of GSD (type Ia ¼ 22; Ib ¼ 8; III ¼ 2; IXa ¼ 3; IXc ¼ 1). All patients were being treated by medical geneticists and dietitians. Evaluation included a questionnaire for evaluation of feeding behavior, the orofacial myofunctional evaluation (AMIOFE), olfactory and taste performance (Sniffin' Sticks and Taste Strips tests), and facial anthropometry. Results: Nine (25%) patients had decreased olfactory perception, and four (11%) had decreased taste perception for all flavours. Eight patients (22.2%) had decreased perception for sour taste. Twenty-six patients (72.2%) had FD, and 18 (50%) had OMD. OMD was significantly associated with FD, tube feeding, selective intake, preference for fluid and semisolid foods, and mealtime stress (p < 0.05). Thirteen patients (36.1%) exhibited mouth or oronasal breathing, which was significantly associated with selective intake (p ¼ 0.011) and not eating together with the rest of the family (p ¼ 0.041). Lower swallowing and chewing scores were associated with FD and with specific issues related to eating behavior (p < 0.05). Conclusion: There is a high prevalence of FDs and OMDs in patients with GSD. Eating behavior, decreased taste and smell perception, and orofacial myofunctional issues are associated with GSD.
Background: In phenylketonuria (PKU), only a limited range of natural foods, such as fruits, vegetables, oils and sugars, can be consumed without restrictions. The present study aimed to study if food neophobia (i.e. an unwillingness to eat novel food) occurs in patients with PKU and to compare in non-PKU healthy controls and to identify any associated factors. Methods: This cross-sectional case-control study used a convenience sampling strategy to recruit patients diagnosed with PKU and healthy controls matched by gender and age. Patients and controls were invited to complete the food neophobia scale (FNS) questionnaire, and clinical and treatment data were collected through a review of medical records. Results: Twenty-five patients (mean age 19.3 ± 4.7 years, 13 women) with PKU and 25 controls (mean age 19.9 ± 4.9 years; P = 0.676, 13 women) were evaluated. The mean age of treatment onset in patients with PKU was 52.8 ± 29.7 days. The mean phenylalanine (Phe) level in the 12-month preceding neophobia study was 710.5 ± 346 µmol/L. The mean FNS score of patients with PKU was significantly higher (47.2 ± 9.7) than controls (29.4 ± 12.5, P < 0.001). Food neophobia was associated more with male gender (P = 0.039). Conclusions: Food neophobia is frequent in patients with PKU. It does not appear to be associated with female gender, with Phe levels and not just in children.
RESUMO Objetivo identificar sinais e sintomas de DTM, bem como analisar os resultados de parâmetros vocais, do exame clínico físico de palpação muscular, da autopercepção de sintomas vocais, dor e fadiga vocal de mulheres com DTM e comparar com mulheres vocalmente saudáveis. Métodos estudo transversal com 45 mulheres (23 com DTM e 22 controles), mediana de idade similar entre os grupos. A avaliação fonoaudiológica e otorrinolaringológica determinaram o diagnóstico de DTM. Todas as participantes responderam aos protocolos Escala de Sintomas Vocais (ESV), Índice de Fadiga Vocal (IFV) e Questionário Nórdico de Sintomas Osteomusculares (QNSO). Elas também foram avaliadas pelo exame de palpação da musculatura perilaríngea, avaliação perceptivo-auditiva e análise acústica da voz da frequência fundamental. A amostra de fala incluiu vogais “a”, “i” e “é” sustentadas e fala encadeada, gravada em ambiente silente, e submetida à avaliação perceptivo-auditiva por três juízes. Na análise acústica, a frequência fundamental e tempos máximos de fonação foram extraídos. Resultados O grupo DTM apresentou piores resultados na ESV, na IFV e no QNSO, além de maior resistência à palpação e posição vertical de laringe alta. Os parâmetros vocais também apresentaram maior desvio na DTM, exceto para a frequência fundamental. Não houve relação entre sintomas vocais, fadiga ou dor com o grau geral da disfonia no grupo DTM, indicando sintomas importantes em desvios vocais leves ou moderados. Conclusão mulheres com DTM apresentaram sintomas vocais, fadiga vocal, dor muscular, resistência à palpação e parâmetros vocais desviados quando comparadas às mulheres vocalmente saudáveis.
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