Clinical And Videofluoroscopic Evaluation Of Swallowing In Patients With Spastic Tetraparetic Cerebral Palsy And Athetosic Cerebral Palsy [evaluación Clínica Y Videofluoroscópica De La Deglución En Pacientes Con Parálisis Cerebral Tetraparésica Espástica Y Atetósica]

Aim. To evaluate and to compare the findings of oral and pharyngeal phases of swallowing in children with both spastic tetraparetic cerebral palsy (STCP) and with athetosic cerebral palsy (ACP). Patients and methods. 11 children were evaluated, with their ages ranging from 10 months to 8 years old, through both clinical assessment and videofluoroscopic evaluation. Results. The children with STCP were more involved at the neurologic, clinical and speech-language and hearing aspects. At the oral phases all the children had presented some involvement. At the pharyngeal phases the clinical signs of aspiration were identified in 10 children. It was observed aspirations in 80% of children with STCP and in 67% with ACP. The changes on swallowing were similar in both cerebral palsy groups, but the performance of the children with STCP was inferior. Conclusion. The videofluoroscopy was an important method which makes possible the verification of aspirations, helping the professionals at the therapeutical program for these children. © 2006, Revista de Neurología.428462465Chen, M.Y.M., Peele, V.N., Donati, D., Ott, D.J., Donofrio, P.D., Gelfand, D.W., Clinical and fluoroscopic evaluation of swallowing in 41 patients with neurologic disease (1992) Gastrointest Radiol, 17, pp. 95-98Logemann, J.A., Swallowing physiology and pathophysiology (1988) Otolaryngol Clin North Am, 21, pp. 613-623Furkim, A.M., (1999) Deglutição de crianças com paralisia cerebral do tipo tetraparética espástica: Avaliação clínica fonoaudiológica e análise videofluoroscó pica, , São Paulo: Universidade Federal de São Paulo;Furkim AM, Silva RG. Conceitos e implicações para a prática clínica e para a classificação da disfagia orofaríngea neurogênica. In Furkim AM, Silva RG. Programas de reabilitação em disfagia neurogênica. São Paulo: Frôntis1999. p. 1-20Logemann, J.A., (1983) Evaluation and treatment of disorders, , San Diego: College Hill;Pino-Quera R, Caffri-Defilippi C. Disfagia orofaríngea. Acta Gastroenterol Latinoam 200112: 26-35Perlman, A.L., Lu, C., Jones, B., Radiographic contrast examination of the mouth, pharynx and esophagus (1997) Deglutition and its disorders: Anatomy, phisiology, clinical diagnosis, and management, pp. 153-199. , Perlman AL, Schulze-Delrieu K, eds, San Diego: Singular;Rogers, B., Arvedson, J., Buck, G., Smart, P., Msall, M., Characteristics of dysphagia in children with cerebral palsy (1994) Dysphagia, 9, pp. 69-73Grunert-Paolinelli, P., Bontes-Lukoviek, A., Videofluoroscopía VFC em el estúdio de los transtornos de la deglución (2000) Revista Chilena de Radiología, 6, pp. 5-7Furkim, A.M., Behlau, M.S., Weckx, L.L.M., Avaliação clínica e videofluoroscópica da deglutição em crianças com paralisia cerebral tetraparética espástica (2003) Arq Neuropsiquiatr, 61, pp. 611-616Kramer, S.S., Eicher, P.S., Swallowing in children (2003) Normal and abnormal swallowing: Imaging in diagnosis and therapy, pp. 205-226. , Jones B, ed, 2 ed. New York: Springer;Morton, R.E., Bonas, R., Fourie, B., Minford, J., Videofluoroscopy in the assessment of feeding disorders of children with neurological problems (1993) Dev Med Child Neurol, 35, pp. 388-395Helfrich-Miller, K.R., Rector, K.L., Straka, J.A., Dysphagia: Its treatment in the profoundly retarded pacient with cerebral palsy (1986) Arch Phys Med Rehabil, 67, pp. 520-525Plant, R.L., Anatomy and physiology of swallowing in adults and geriatrics (1998) Otolaryngol Clin North Am, 31, pp. 477-488Griggs, C.A., Jones, P.M., Lee, R.E., Videofluoroscopic investigation of feeding disorders of children with multiple handicap (1989) Dev Med Child Neurol, 31, pp. 303-308Buchholz, D.W., Neurogenic dysphagia: What is the cause when the cause is not obvious? (1994) Dysphagia, 9, pp. 245-255Arvedson, J., Rogers, B., Buck, G., Smart, P., Msall, M., Silent aspiration prominent in children with dysphagia (1994) Int J Pediatr Otorhinolaryngol, 28, pp. 173-181Dantas, R.O., Kern, M.K., Massey, B.T., Dodds, W.J., Kahrilas, P.J., Brasseur, J.G., Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing (1990) Am J Physiol, 258, pp. 675-681Lazarus, C.L., Logemann, J.A., Rademaker, A.W., Kahrilas, P.J., Pajak, T., Lazar, R., Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients (1993) Arch Phys Med Rehabil, 74, pp. 1066-1070Costa, M.M.B., Moscovici, M., Pereira, A.A., Koch, A., A avaliação videofluoroscópica da transição faringoesofágica (esfíncter superior do esôfago) (1993) Radiologia Brasileira, 23, pp. 71-80Perlman, A.L., Booth, B.M., Grayhack, J.P., Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia (1994) Dysphagia, 9, pp. 90-95Logemann, J.A., Swallowing physiology and pathophysiology (1988) Otolaryngol Clin North Am, 21, pp. 613-623Kandel ER. Linguagem. In Kandel ER, Schwartz JH, Jessel TM. Fundamentos da neurociência e do comportamento. Rio de Janeiro: Guanabara Koogan2000. p. 505-1

Computerized Manometry Use To Evaluate Spasm In Pharyngoesophageal Segment In Patients With Poor Tracheoesophageal Speech Before And After Treatment With Botulinum Toxin

Tracheoesophageal voice (TEV) with voice prosthesis (VP) is an efficient and reproducible method used in vocal rehabilitation after total laryngectomy (TL), prevented by spasms in the pharyngoesophageal segment (PES). Computerized Manometry (CM) is a new, direct and objective method used to assess the PES. Aim: to carry out an objective analysis of the PES, with CM, before and after the injection of botulinum toxin (BT). Study design: clinical-prospective. Materials and Methods: analysis of eight patients consecutively submitted to TL with TEV and VP, without vocal emission, with PES spasms seen through videofluoroscopy, considered the gold standard for spasm detection. All had their spasms treated with the injection of 100 units of BT in the PES. The assessment was based on PES videofluoroscopy and CM, before and after BT injection. Results: There was a PES pressure reduction according to the CM after BT injection in all patients. The average pressure in the PES seen through the CM in eight patients before BT injection was 25.36 mmHg, and afterwards it dropped to 14.31 mmHg (p=0.004). There was vocal emission without stress and PES spasm improvement seen through the videolaryngoscopy after BT injection. Conclusion: We observed a reduction in PES pressure after BT injection, seen through CM in all the patients, with spasms improvement seen through videofluoroscopy.752182187Lavertu, P., Guay, M.E., Meeker, S.S., Kmiecik, J.R., Secic, M., Wanamaker, J.R., Eliachar, I., Wood, B.G., Secondary tracheoesophageal puncture: Factors predictive of voice quality and prosthesis use (1996) Head and Neck, 18 (5), pp. 393-398Blom, E.D., Pauloski, B.R., Hamaker, R.C., Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part I: Speech characteristics (1995) Laryngoscope, 105, pp. 1093-1103Blom, E.D., Pauloski, B.R., Hamaker, R.C., Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part I: Speech characteristics (1995) Laryngoscope, 105, pp. 1093-1103Sloane, P.M., Griffin, J.M., O'Dwyer, T.P., Esophageal insufflation and videofluoroscopy for evaluation of esophageal speech in laryngectomy patients: Clinical implications (1993) Radiology, 181, pp. 433-437Singer, M.I., Blom, E.D., An endoscopic technique for restoration of voice after laryngectomy (1980) Ann Otol Rhinol Laryngol, 89, pp. 529-533Blom, E.D., Singer, M.I., Hamaker, R.C., An improved esophageal insufflation test (1985) Archives of Otolaryngology, 111 (4), pp. 211-212Blom, E.D., Singer, M.I., Hamaker, R.C., A prospective study of tracheoesophageal speech (1986) Archives of Otolaryngology - Head and Neck Surgery, 112 (4), pp. 440-447Singer, M.I., Blom, E.D., Selective myotomy for voice restoration after total laryngectomy (1981) Arch Otolaryngol, 107, pp. 670-673Singer, M.I., Blom, E.D., Hamaker, R.C., Pharyngeal plexus neurectomy for alaryngeal speech rehabilitation (1986) Laryngoscope, 96 (1), pp. 50-54Callaway, E., Truelson, J.M., Wolf, G.T., Kincaid, L.T., Cannon, S., Predictive value of objective esophageal insufflation testing for acquisition of tracheoesophageal speech (1992) Laryngoscope, 102, pp. 704-708Hamaker, R.C., Singer, M.I., Blom, E.D., Daniels, H.A., Primary voice restoration at laryngectomy (1985) Arch. Otolaryngol., 111, pp. 182-186Yoshida, G.Y., Hamaker, R.C., Singer, M.I., Blom, E.D., Charles, G.A., Primary voice restoration at laryngectomy:1989 update (1989) Laryngoscope, 99, pp. 1093-1095Lau, W.F., Wei, W.I., Ho, C.M., Lam, K.H., Immediate tracheoesophageal puncture for voice restoration in laryngopharyngeal resection (1988) American Journal of Surgery, 156 (4), pp. 269-272. , DOI 10.1016/S0002-9610(88)80289-7Stiernberg, C.M., Bailey, B.J., Calhoun, K.H., Perez, D.G., Primary tracheoesophageal fistula procedure for voice restoration: The University of Texas Medical Branch experience (1987) Laryngoscope, 97 (7 I), pp. 820-824Baugh, R.F., Lewin, J.S., Baker, S.R., Vocal rehabilitation of tracheoesophageal speech failures (1990) Head and Neck, 12 (1), pp. 69-73Blitzer, R., Komisar, A., Baredes, S., Brin, M.F., Stewart, C., Voice failure after tracheoesophageal puncture: Management with botulinum toxin (1995) Otolaryngology - Head and Neck Surgery, 113 (6), pp. 668-670. , DOI 10.1016/S0194-5998(95)70002-1Crary, M.A., Glowasky, A.L., Using botulinum toxin a to improve speech and swallowing function following total laryngectomy (1996) Archives of Otolaryngology - Head and Neck Surgery, 122 (7), pp. 760-763Hoffman, H.T., Fischer, H., Vandenmark, D., Peterson, K.L., McCulloch, T.M., Karnell, L.H., Funk, G.F., Botulinum neurotoxin injection after total laryngectomy (1997) Head and Neck, 19 (2), pp. 92-97Mahieu, H.F., Annyas, A.A., Schutte, H.K., Van Der Jagt, E.J., Pharyngoesophageal myotomy for vocal rehabilitation of laryngectomees (1987) Laryngoscope, 97 (4), pp. 451-457Terrell, J.E., Lewin, J.S., Esclamado, R., Botulinum toxin injection for postlaryngectomy tracheoesophageal speech failure (1995) Otolaryngology - Head and Neck Surgery, 113 (6), pp. 788-791. , DOI 10.1016/S0194-5998(95)70023-4Zormeier, M.M., Meleca, R.J., Simpson, M.L., Dworkin, J.P., Klein, R., Gross, M., Mathog, R.H., Botulinum toxin injection to improve tracheoesophageal speech after total laryngectomy (1999) Otolaryngology - Head and Neck Surgery, 120 (3), pp. 314-319. , DOI 10.1016/S0194-5998(99)70268-8Hamaker, R.C., Blom, E.D., Botulinum neurotoxin for pharyngeal constrictor muscle spasm in tracheoesophageal voice restoration (2003) Laryngoscope, 113, pp. 1479-1482Chone, C.T., Spina, A.L., Crespo, A.N., Gripp, F.M., Speech rehabilitation after total laryngectomy: Long-term results with indwelling voice prosthesis Blom-Singer (2005) Rev Bras Otorrinolaringol. (Engl Ed), 71, pp. 504-509Chone, C.T., Gripp, F.M., Spina, A.L., Crespo, A.N., Primary versus secondary tracheoesophageal puncture for speech rehabilitation in total laryngectomy: Long-term results with indwelling voice prosthesis (2005) Otolaryngology - Head and Neck Surgery, 133 (1), pp. 89-93. , DOI 10.1016/j.otohns.2005.02.014, PII S0194599805002433McIvor, J., Evans, P.F., Perry, A., Cheesman, A.D., Radiological assessment of post laryngectomy speech (1990) Clinical Radiology, 41 (5), pp. 312-316. , DOI 10.1016/S0009-9260(05)81691-5Schneider, I., Pototschnig, C., Thumfart, W.F., Eckel, H.E., Treatment of dysfunction of the cricopharyngeal muscle with botulinum a toxin: Introduction of a new, noninvasive method (1994) Annals of Otology, Rhinology and Laryngology, 103 (1), pp. 31-35Blom, E.D., Hamaker, R.C., Tracheoesophageal voice restoration following total laryngectomy (1996) Cancer of the Head and Neck. Third Ed., pp. 839-852. , Myers EN, Suen JY. Philadelphia: W.B. Saunders CoChoi, E.C., Hong, W.P., Kim, C.B., Yoon, H.C., Nam, J.I., Son, E.J., Kim, K.M., Kim, S.-H., Changes of esophageal motility after total laryngectomy (2003) Otolaryngology - Head and Neck Surgery, 128 (5), pp. 691-699. , DOI 10.1016/S0194-5998(03)00093-7Koybasioglu, A., Oz, O., Uslu, S., Ileri, F., Inal, E., Unal, S., Comparison of pharyngoesophageal segment pressure in total laryngectomy patients with and without pharyngeal neurectomy (2003) Head and Neck, 25 (8), pp. 617-623. , DOI 10.1002/hed.1026