Dysphagie oropharyngée : contribution des méthodes d’exploration fonctionnelle dans la pratique orthophonique

Abstract : Oropharyngeal dysphagia is a difficulty to swallow that affects the first two phases of swallowing. The identification of pathophysiological mechanisms is essential to guarantee a precise assessment of this disorder. This study aims at determining, in speech and language therapy, the importance to complete medical examination with the following functional exploration methods: fiberoptic endoscopic evaluation of swallowing, videofluoroscopy, and Cine-MRI. We gave 20 speech therapists a questionnaire to fill in so as to be able to research the limits of clinical evaluation and of potential palliatives. In parallel, we have studied the results of twelve dysphagic patients (all etiologies included) to the three functional examinations above-mentioned in order to establish the specificities of each examination and their impact on decisions concerning speech therapy. These experiments allowed us to objectify the fault in identifying pathophysiological mechanisms of the pharyngeal stage as one of the main limits of clinical evaluation. Objective exams, which compensate this flaw by the individual exploration of the different modes of deglutition --time, texture, posture, etc. -- allow the speech therapist to validate or invalidate his clinical hypotheses and, as such, to establish a more precise diagnosis. Depending on the patient and his trouble, targeted adaptation strategies are precociously implemented, avoiding the appearance of aspecific symptoms. Moreover, this research also shows that pluri-disciplinary work optimizes the results for all exams (clinical or functional). To conclude, clinical examination paired withfiberoptic endoscopic evaluation of swallowing, videofluoroscopy, and Cine-MRI plays a role improving and accelerating speech therapy management. However, the focus of this study on clinical and functional complementarity should not let us forget that beyond his trouble, the patient is first and foremost an individual who must be considered in his entirety.
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Master thesis
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Marion Kessler. Dysphagie oropharyngée : contribution des méthodes d’exploration fonctionnelle dans la pratique orthophonique. Médecine humaine et pathologie. 2015. ⟨hal-01828909⟩

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