Safety Protocol for Nasolaringoscopic Evaluation of Swallowing: cultural and linguistic validation and adaption for European Portuguese language

Abstract

Background: In practice, a Speech Therapist works with several neurological diseases that present changes in swallowing, especially after acute stroke. These changes, called dysphagia, can lead the patient to death by leading to malnutrition, dehydration, tracheal aspiration and recurrent pneumonia [1]. Since most of these cases are diagnosed in a hospital setting, it becomes increasingly important to create working tools that help health professionals to perform more rigorous therapeutic evaluations and interventions. Objective: The present study aims to contribute to the cultural and linguistic validation and adaptation of the Protocol of Security of a Nasolaryngoscopy Evaluation of Swallowing (PSAND). Methods: The study comprises two parts: a qualitative part, that corresponds to the translation and adaptation of the protocol to European Portuguese Language, and a quantitative part, where the psychometric characteristics of the protocol were studied. Further details about translation and adaptation of the protocol can be found in [2], specially the content validity procedures and its application in a pilot study. A severity assessment scale [3] was used for the functional evaluation of the swallowing safety by classifying the swallow of the subjects as normal, penetration or aspiration. For data collection, it was used the Portuguese adaptation of the PSAND and the nasolaryngoscope as evaluation tools. The content validity index (CVI) was calculated for the qualitative part, and t-student or qui-squared tests were used for comparison between severity groups. Results: The sample consisted of twenty subjects, where all of them have an acute stroke as clinical diagnosis whether or not having dysphagia. The age of the inquired ranged from 31 to 85 years old, being 16 males. The results obtained by the panel of experts allowed us to conclude that all the parameters are relevant to the evaluation of swallowing and important to determinate a safe feeding for each case (CVI>0.80). Thus, by applying the PSAND, it was possible to study two groups: “Penetration” (13 patients) and “Aspiration” (5 patients). There were statistically significant differences (p < 0.05) between the two groups for the variables: dependent or independent feeding; poor oral control; lot of residues; reduction of laryngeal sensitivity; leaking of the bolus and difficulty in cleaning pharyngeal residues. Conclusions: In summary, we can say that the application of this protocol is an asset to diagnose the presence of dysphagia in any clinical diagnosis, evaluate the swallowing function, verifying the risk of penetration and aspiration and classifying the Dysphagia Severity.