Evaluación y tratamiento de las alteraciones de la deglución

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Los trastornos en la deglución se han extendido a lo largo del tiempo debido al incremento en la esperanza de vida mundial y a los avances de las ciencias médicas que han reducido la mortalidad de algunas patologías. La deglución es definida como la actividad de transportar sustancias sólidas, líquidas y saliva desde la boca hacia el estómago. Este mecanismo se logra gracias a fuerzas, movimientos y presiones dentro del complejo orofaringolaríngeo. Cuando se pierde la coordinación, el sincronismo y la eficacia se presenta la disfagia. La disfagia no es una enfermedad, sino una sintomatología que puede encontrarse en diversas patologías. La causa de la misma puede hallarse en enfermedades neurogénicas, estructurales y/o enfermedades respiratorias. El objetivo de esta guía es lograr que el profesional de la salud pueda reconocer en los pacientes la disfagia como una sintomatología, para realizar una correcta derivación al equipo interdisciplinario para su evaluación y tratamiento. El equipo de reeducadores tendrá en esta guía la correcta aplicación de las técnicas terapéuticas, sus recomendaciones y su funcionalidad. Las mismas serán aplicadas según la etapa deglutoria afectada, para disponer de un nuevo patrón deglutorio eficaz y seguro.

Translated abstract

The alterations of deglutition have become more frequent over time, owing to the increase in life expectancy in the world and the progress of medical sciences that reduced the mortality from some pathologies. Deglutition is the act of swallowing solid and liquid substances, including saliva, from the mouth to the stomach. This act is the result of a complex mechanism of forces, movements and pressures within the oropharynx and the larynx. The failure of the coordination, syncronization and efficacy of this mechanism is called dysphagia. Dysphagia is not a disease; it is a symptom of several pathologies related to neurologic, structural and respiratory causes. The objective of this paper is to provide guidance to health professionals on how to identify the presence of dysphagia in order to refer the patient to the correct specialized team for evaluation and treatment. This guide also includes recommendations on therapeutic techniques for functional therapists. Guidance is given on the correct application of therapeutic techniques depending on the stage of the deglutition that is affected in order to educate the patient in recovering an effective and safe deglutitive function

Related collections

Most cited references 74

Record: found
Abstract: found
Article: not found

The effect of bolus viscosity on swallowing function in neurogenic dysphagia.

M Girvent, W Vos, Père Clavé … (2006)

To assess the pathophysiology and treatment of neurogenic dysphagia. 46 patients with brain damage, 46 with neurodegenerative diseases and eight healthy volunteers were studied by videofluoroscopy while swallowing 3-20 mL liquid (20.4 mPa s), nectar (274.4 mPa s) and pudding (3931.2 mPa s) boluses. Volunteers presented a safe and efficacious swallow, short swallow response ( or =0.33 mJ). Brain damage patients presented: (i) 21.6% aspiration of liquids, reduced by nectar (10.5%) and pudding (5.3%) viscosity (P or =806 ms) with a delay in laryngeal closure (> or =245 ms), and weak bolus propulsion forces (< or =0.20 mJ). Increasing viscosity did not affect timing of swallow response or bolus kinetic energy. Patients with neurogenic dysphagia presented high prevalence of videofluoroscopic signs of impaired safety and efficacy of swallow, and were at high risk of respiratory and nutritional complications. Impaired safety is associated with slow oropharyngeal reconfiguration and impaired efficacy with low bolus propulsion. Increasing bolus viscosity greatly improves swallowing function in neurological patients.

0 comments Cited 124 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia.

Rachel Lazarus, L Colangelo, M Fujiu … (1995)

This study examines the effects of a sour bolus (50% lemon juice, 50% barium liquid) on pharyngeal swallow measures in two groups of patients with neurogenic dysphagia. Group 1 consisted of 19 patients who had suffered at least one stroke. Group 2 consisted of 8 patients with dysphagia related to other neurogenic etiologies. All patients were selected because they exhibited delays in the onset of the oral swallow and delays in triggering the pharyngeal swallow on boluses of 1 ml and 3 ml liquid barium during videofluoroscopy. Results showed significant improvement in oral onset of the swallow in both groups of patients and a significant reduction in pharyngeal swallow delay in Group 1 patients and in frequency of aspiration in Group 2 patients with the sour as compared to the non-sour boluses. Other selected swallow measures in both subject groups also improved with the sour bolus. Volume effects were present but not as consistently as in prior studies. Implications for swallow therapy are discussed.

0 comments Cited 64 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal Dysphagia.

Lisa Crujido, K Saxon, Ianessa Humbert … (2006)

We tested two hypotheses using surface electrical stimulation in chronic pharyngeal dysphagia: that stimulation (1) lowered the hyoid bone and/or larynx when applied at rest, and (2) increased aspiration, penetration, or pharyngeal pooling during swallowing. Bipolar surface electrodes were placed on the skin overlying the submandibular and laryngeal regions. Maximum tolerated levels of stimulation were applied while patients held their mouth closed at rest. Videofluoroscopic recordings were used to measure hyoid movements in the superior-inferior and anterior-posterior dimensions and the subglottic air column position while stimulation was on or off. Patients swallowed 5 ml liquid when stimulation was off, at low sensory stimulation levels, and at maximum tolerated levels (motor). Speech pathologists, blinded to condition, tallied the frequency of aspiration, penetration, pooling, and esophageal entry from videofluorographic recordings of swallows. Only significant (p = 0.0175) hyoid depression occurred during stimulation at rest. Aspiration and pooling were significantly reduced only with low sensory threshold levels of stimulation (p = 0.025) and not during maximum levels of surface electrical stimulation. Those patients who had reduced aspiration and penetration during swallowing with stimulation had greater hyoid depression during stimulation at rest (p = 0.006). Stimulation may have acted to resist patients' hyoid elevation during swallowing.