ObjectiveThe aim of the present study was to assess the feasibility of the early
implementation of a swallowing rehabilitation program in tracheostomized patients
under mechanical ventilation with dysphagia.MethodsThis prospective study was conducted in the intensive care units of a university
hospital. We included hemodynamically stable patients under mechanical ventilation
for at least 48 hours following 48 hours of tracheostomy and with an appropriate
level of consciousness. The exclusion criteria were previous surgery in the oral
cavity, pharynx, larynx and/or esophagus, the presence of degenerative diseases or
a past history of oropharyngeal dysphagia. All patients were submitted to a
swallowing rehabilitation program. An oropharyngeal structural score, a swallowing
functional score and an otorhinolaryngological structural and functional score
were determined before and after swallowing therapy.ResultsWe included 14 patients. The mean duration of the rehabilitation program was 12.4
± 9.4 days, with 5.0 ± 5.2 days under mechanical ventilation. Eleven
patients could receive oral feeding while still in the intensive care unit after 4
(2 - 13) days of therapy. All scores significantly improved after therapy.ConclusionIn this small group of patients, we demonstrated that the early implementation of
a swallowing rehabilitation program is feasible even in patients under mechanical
ventilation.
Dyst onias are organic central motor processing disorders characterized by involuntary muscular contractions or incontrollable spasms induced by task-specific movements. Adduction laryngeal dystonias present with important speech impairments, with inappropriate spasms and abrupt voice breaks. The diagnosis is based on clinical features, evaluation by a speech therapist and transnasal fiber optic laryngoscopy. Aim: Our objective is to propose and evaluate a task-oriented transnasal fiber optic laryngoscopy protocol, which shows the spasms, and propose maneuvers that reduce or make them disappear, in order to facilitate the diagnosis. Methods: transversal study. Analysis of the transnasal fiber optic laryngoscopy records of 15 patients with adductor laryngeal dystonia using the proposed protocol. Results: most of the speech and non-vocal tasks allowed us to identify the spasms and reduce or make them disappear. We propose the exclusion of two of the maneuvers that don't bring new data to the evaluation. Conclusion: the protocol was useful for the evaluation of the patients, showing changes in muscle behavior in the structure under investigation.
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