A framework for understanding shared substrates of airway protection

Deficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough28 (2009) by Hegland, et al.42 (2012). It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits

Deglutição e consistências alimentares pastosas e sólidas: revisão crítica de literatura Deglutition of pasty and solid food: a critical review of the literature

OBJETIVO: Levantar artigos científicos internacionais sobre a fisiologia da deglutição de alimentos nas consistências néctar, mel, pudim, pastosa heterogênea, semissólida e sólida, nas fases oral e faríngea. MÉTODOS: Trata-se de estudo de revisão qualitativa da literatura. Para a seleção dos artigos, foi utilizada a base de dados PubMed com emprego dos descritores "Swallowing and consistency", "Swallowing and solid" e "Swallowing and pasty", limitando-se a pesquisas publicadas no idioma inglês, entre os anos de 2005 e 2010, realizadas com seres humanos maiores de 18 anos. A metodologia empregada envolveu formulação da pergunta, localização e seleção dos estudos, e avaliação crítica dos artigos, conforme os preceitos do Cochrane Handbook. RESULTADOS: Foram identificados 211 estudos, dos quais 18 foram analisados, pois permitiam acesso ao texto completo e eram diretamente relacionados ao tema. CONCLUSÃO: Os estudos apresentam metodologia pouco uniforme, não havendo padronização, principalmente quanto aos métodos de avaliação. Em geral, as pesquisas foram realizadas com sujeitos saudáveis ou remeteram a um tipo de patologia, sem utilização de casos-controle. A heterogeneidade dos estudos possibilita que diferentes grupos de patologias sejam avaliados, porém, a variabilidade metodológica dificulta a definição e generalização dos padrões encontrados. Sendo assim, não é possível evidenciar dados que embasem a prática clínica fonoaudiológica no que diz respeito à fisiologia normal ou alterada da deglutição de diferentes consistências alimentares, tanto para sujeitos normais quanto para os acometidos por alguma desordem.<br>PURPOSE: To analyze published international scientific papers on the physiology of deglutition in oral and pharyngeal phases, considering different food consistencies: nectar, honey, pudding, pasty heterogeneous, semi-solid, and solid. METHODS: This is a qualitative literature reviews. The studies considered were selected on PubMed, using the keywords "Swallowing and consistency", "Swallowing and solid", and "Swallowing and pasty", limiting the search to manuscripts published in English in the period between 2005 and 2010, and conducted with human beings over 18 years old. The methodology involved question formulation, location and selection of studies, and critical analyses of the manuscripts, according to the concepts of the Cochrane Handbook. RESULTS: Two hundred and eleven studies were identified, out of which only 18 allowed access to the full text and were directly related to the theme. CONCLUSION: The studies presented very few similarities between the applied methodologies, especially when considering assessment methods. Overall, the studies were conducted with healthy individuals or with a specific pathology, without presenting the comparison with control cases. The heterogeneity of studies allows the investigation of different swallowing disorders. However, methodological variability makes it difficult to define and generalize the identified swallowing patterns. For this reason, it is not possible to identify parameters on which to base the clinical practice of speech-language therapists, especially when considering the normal or altered physiology of swallowing different food consistencies