Search for compensation postures with videofluoromanometric investigation in dysphagic patients affected by amyotrophic lateral sclerosis

Abstract

This study was undertaken to verify the effectiveness of compensatory postures, suggested on the basis of the type of dysphagia identified at videofluoromanometric (VFM) investigation to ensure safe oropharyngeal transit. Eighty-one patients with amyotrophic lateral sclerosis (ALS) underwent speech therapy assessment and VFM investigation of the swallowing process. In the event of altered transit, penetration or aspiration of contrast material into the airways, compensation postures for correction of the swallowing disorder were suggested and verified during VFM examination. In 37 patients, contrast agent transport was preserved and safe; in 19, we observed penetration of the contrast agent into the laryngeal inlet without aspiration; in 24, there was aspiration (four preswallowing, eight intraswallowing, nine postswallowing, three mixed), whereas in one patient no transit was seen. Penetration without aspiration was resolved by coughing or throat clearing; aspiration was resolved in 13 patients by assuming the chin-tuck posture and in six by rotating the head; in five patients, it was not resolved. A hyperextended head posture proved to be effective to resolve lack of transit. By correlating morphological with functional data, VFM enables one not only to precisely characterise the dysphagic disorder but also to identify the most appropriate compensation posture for each patient and verify its effectiveness. Scopo del nostro lavoro è stato verificare l’efficacia delle posture di compenso, ipotizzate in base alle caratteristiche del disturbo disfagico individuato con videofluoromanometria (VFM), per garantire il transito orofaringeo in sicurezza. Sono stati inclusi 81 pazienti affetti da sclerosi laterale amiotrofica (SLA) e sottoposti ad un protocollo di valutazione logopedia ed esame VFM della deglutizione. In caso di transito alterato, penetrazione o aspirazione del mezzo di contrasto (MdC) nelle vie aeree, sono state ipotizzate e verificate durante l’esame VFM posture di compenso per la correzione del disturbo deglutitorio. In 37 pazienti il transito del MdC era conservato e sicuro, in 19 abbiamo osservato penetrazione del MdC in aditus laringeo senza aspirazione, in 24 aspirazione (4 pre-deglutitoria, 8 intra-deglutitoria, 9 post-deglutitoria, 3 mista), in 1 non era presente transito. La penetrazione senza aspirazione è stata risolta con un colpo di tosse o col raclage sostenuto; l’aspirazione è stata risolta in 13 pazienti con la postura a capo flesso, in 6 col capo ruotato, in 5 non è stata risolta. Per l’assenza di transito è risultata efficace la postura a capo iperesteso. La VFM, correlando il dato morfologico a quello funzionale, permette di caratterizzare con precisione il disturbo disfagico ed ipotizzare le posture di compenso più idonee al singolo caso e verificarne l’efficacia.

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