OBJECTIVES:To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation.METHODS:The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance.RESULTS:Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk.CONCLUSIONS:Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population.

OBJETIVO: Investigar as contribuições da fonoterapia na voz, na deglutição e na qualidade de vida de pacientes com alteração unilateral de mobilidade de prega vocal. MÉTODOS: Os sujeitos foram 13 pacientes, de ambos os sexos, com alteração unilateral de mobilidade de prega vocal. Foi realizado um levantamento da história clínica, dos dados de avaliação pré e pós-fonoterapia e da qualidade de vida dos mesmos a partir dos prontuários, das fitas de exame e das gravações de exames. RESULTADOS: Após a intervenção fonoaudiológica foi possível observar: nove pacientes apresentaram melhora da qualidade vocal após fonoterapia; todos os pacientes apresentaram melhora em pelo menos um parâmetro da avaliação acústica; dez pacientes apresentaram classificação dentro dos limites de normalidade em relação à escala de severidade da disfagia e nove em relação à escala de penetração/aspiração; seis pacientes referiram menor desvantagem vocal; nove pacientes referiram menor impacto da disfagia na qualidade de vida. CONCLUSÃO: Os resultados apontam melhoras na voz, na deglutição, na limitação vocal e na qualidade de vida relacionada à deglutição após fonoterapia. Pode-se dizer que a fonoterapia parece ser efetiva na melhora da voz, da deglutição, do nível de desvantagem vocal e da qualidade de vida em deglutição de pacientes com alterações na mobilidade das pregas vocais.

IntroductionThe development of postextubation 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. The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI).MethodsWe conducted a retrospective, observational cohort study from 2010 to 2012 of all patients over 18 years of age admitted to a university hospital ICU who were submitted to prolonged OTI and subsequently received a bedside swallow evaluation (BSE) by a speech pathologist. The prognostic factors analyzed included dysphagia severity rate at the initial swallowing assessment and at hospital discharge, age, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubations, intubation time and length of hospital stay.ResultsAfter we excluded patients with neurologic diseases, tracheostomy, esophageal dysphagia and those who were submitted to surgical procedures involving the head and neck, our study sample size was 148 patients. The logistic regression model was used to examine the relationships between independent variables. In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes.ConclusionsStudies 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.

BackgroundBreathing and swallowing are physiologically linked to ensure effortless gas exchange during oronasal breathing and to prevent aspiration during swallowing. Studies have indicated consistent aspiration in chronic obstructive pulmonary disease, mainly related to delayed swallowing reflex and problems with lingual propulsion and pharyngeal peristalsis as a result of bilateral weakness and incoordination of the related muscles. The purpose of the present study was to evaluate swallowing transit times and valleculae residue characteristics of stable COPD patients who have no swallowing complaints.MethodsOur study population included 20 stable patients with COPD and no swallowing complaints and 20 healthy controls. Swallowing was assessed through videofluoroscopic examination and involved the analysis of the following parameters: (1) pharyngeal stages of deglutition; (2) the duration of bolus movement through the oral cavity and pharynx (i.e. transit times); (3) valleculae residue ratio; (4) penetration/aspiration.ResultsParticipants of the study did not present any signs of penetration-aspiration for any of the tested consistencies. Patients with COPD presented longer pharyngeal transit times during the ingestion of the liquid consistency and during the ingestion of the paste consistency. Regarding the duration of tongue base contact with the posterior pharyngeal wall, COPD patients also presented longer durations for the liquid and paste consistencies. No significant difference was observed for the distribution of individuals among the different valleculae residue severity levels.ConclusionsOur study suggests that stable COPD patients may present physiological adaptations as a protective swallowing maneuver to avoid aspiration/penetration of pharyngeal contents. Moreover, valleculae residue cannot be seen as an isolated factor when trying to explain swallowing alterations in this population.

Oropharyngeal dysphagia and esophageal motility disorders were found to be the most important causes of 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). Participants were 40 individuals divided in two groups: G1 composed of 20 adults with DM1 and G2 composed of 20 healthy volunteers paired by age and gender to the individuals in G1. Statistical analysis included one-way ANOVA with two factors for within- and between-group comparisons and Bonferroni correction for multiple comparisons. Patients with DM1 presented deficits in posture, position, and mobility of the oral motor structures, as well as compromised mastication and deglutition. The sEMG data indicated that these patients had longer muscle activations during swallowing events. The longer duration of sEMG in the group of patients with DM1 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.

Background: recent studies have used ultrasonography with the purpose of measuring muscle cuts. Aim: to characterize the motor control and the morphology of the masseter muscle in normal individuals, verifying the compatibility between surface electromyography and ultrasonography. Method: five adult individuals, with no alterations of the stomatognathic system. The adopted assessment procedures for all participants were: 1. Surface Electromyography; 2. Ultrasonography. Results: a high correlation was observed only when comparing both hemifaces in the ultrasonographic assessment (rest 0.95; biting 0.86). Conclusion: the results indicate that there is no correlation between the tested methods, suggesting that both methods are complementary and not mutually excludent. Key Words: Masseter Muscle; Electromyography; Ultrasonics. ResumoTema: estudos recentes utilizaram a ultrassonografia com o objetivo de medir cortes musculares. Objetivo: caracterizar o controle motor e a morfologia do músculo masseter em indivíduos normais, verificando a compatibilidade entre a eletromiografia de superfície e a ultrassonografia. Método: cinco indivíduos adultos, sem alterações no sistema estomatognático. Os procedimentos adotados para a avaliação dos participantes foram: 1. Eletromiografia de Superfície; 2. Ultrassonografia. Resultados: houve alta correlação apenas para a comparação entre hemifaces direita e esquerda no exame de ultrassonografia (repouso 0,95; máxima intercuspidação dentária 0,86). Conclusão: os resultados indicam não haver correlação entre os métodos testados, sugerindo que os exames são complementares e não excludentes. Palavras-Chave: Músculo Masseter; Eletromiografia; Ultra-som.

regardi ng orofacial motor assessment in facial paralysis, quantitative measurements of the face are being used to establish diagnosis, prognosis and treatment planning. Aim:To assess the prevalence of changes in mandibular range of motion in individuals with peripheral facial paralysis.Materials and Methods: prospective study. We had 56 volunteers, divided in two groups: G1 made up of 28 individuals with idiopathic facial paralysis (6 males and 22 females); 14 with manifestations on the right side of the face and 14 on the left side; time of onset varied between 6-12 months; G2 with 28 healthy individuals paired by age and gender to G1. in order to assess mandibular range of motion, a digital caliper was used. The following measurements were made: 1) middle line; 2) maximum oral opening; 3) lateralization to the right; 4) lateralization to the left; 5) protrusion; 6) horizontal overlap.Results: Statistically significant differences between the groups were observed for maximum oral opening, lateralization to the left and protrusion. G1 presented smaller measurement values than G2.Conclusion: patients with facial paralysis present significant reduction of mandibular range of motion. The results support the suggestion of incorporating functional evaluation of the temporomandibular joint to the existing facial paralysis clinical assessment protocols. . The speech and hearing therapist's assessment must encompass instruments which enable functional measuring. These measures will enable treatment and help check for treatment efficacy. ORIgInAL ARTIcLEThe speech and hearing quantitative measures can be obtained through surface electromyography; photogrammetry; digital caliper; cephalometry and, more recently, the facial movement quantification system, in 3-d video [11][12][13][14][15] . The qualitative measures may be obtained through clinical protocols and self-perception questionnaires 16,17 . in speech and hearing therapy practice concerning facial paralysis patients, it is not a routine to completely assess orofacial functions, because the main complaint is associated with facial movements. nonetheless, frequent have been the reports of pain in the temporomandibular joint (TMJ) and a reduction in speech articulatory movements. in the bibliography search, we did not find specific studies on the relationship between facial paralysis and TMJ function. The TMJs are important structures of the stomatognathic system, since they enable mandibular movements and functions such as suction, swallowing, chewing and speech 18 . Literature states that the range of mandibular motion is associated with TMJ integrity and the action of skeletal muscles [19][20][21] . The TMJ needs to support and accommodate occlusal, muscular and neck adaptations. When the demand for functional adaptations exceeds the TMJ functional and structural tolerance, the patient may develop signs and symptoms of temporomandibular disorders (TMd) [22][23][24] , causing changes to mandibular movements and to the stomatognathic functions associated with them 1...

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