Ventilatory, phonatory and swallowing impairments in advanced neuromuscular disease patients | Revista de Logopedia, Foniatría y Audiología

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Patients with neuromuscular diseases develop during the clinical course of their pathology different symptoms such as spasticity, fasciculation, muscle stiffness and muscle pain (<a class="elsevierStyleCrossRef" href="#bib0140">Mancuso & Navarro, 2015</a>). However, there is a main and common symptom in all NMD, the muscular weakness. The progressive course of this symptom produces a decrease in the global functional capacity and in the independence of the activities of daily life (<a class="elsevierStyleCrossRef" href="#bib0080">Fowler, 2002</a>). As a consequence of this progressive muscle weakness, the patients use to report disturbances related to the ventilatory system (<a class="elsevierStyleCrossRef" href="#bib0090">Gauld & Boynton, 2005</a>), phonatory disorders (<a class="elsevierStyleCrossRef" href="#bib0110">Hanson, 1991</a>) and swallowing difficulty (<a class="elsevierStyleCrossRef" href="#bib0215">Willig, Paulus, Saint, Beon, & Navarro, 1994</a>).Different research has explored the development of ventilatory, phonatory and swallowing impairments related to the progressive course of NMD diseases in children and adults (<a class="elsevierStyleCrossRef" href="#bib0035">Bourke, 2014</a>). These impairments play an important role in the activities of daily living impacting the level of disability in NMD patients (<a class="elsevierStyleCrossRef" href="#bib0145">McDonald, 2002</a>).Concretely, upper airway muscles malfunction may increase the resistance to airflow, precipitating ventilatory failure or lead to aspiration pneumonia, both frequent causes of morbidity and mortality in NMD.Similarly, weakness on the upper airway muscles affect to the tone, strength, and stiffness of structures involved in the phonation and speech (<a class="elsevierStyleCrossRef" href="#bib0105">Hartley & Ascott, 1994</a>).Other authors, such as <a class="elsevierStyleCrossRef" href="#bib0165">Nuñez-Batalla, Méndez, and Pastrana (2011)</a> have reported variables of dysphonia in these patients related to abnormalities like excessive glottal closure, nonperiodic vibrations of vocal folds, occasional laryngeal spasms, an abnormal adduction of false folds and impaired glottal closure.Further, studies carried out by <a class="elsevierStyleCrossRef" href="#bib0100">Hanson (2011)</a>, and <a class="elsevierStyleCrossRef" href="#bib0135">Makkonen, Ruottinen, Puhto, Helminen, and Palmio (2018)</a> have shown the presence of rates of dysarthria, related to a decreased strength and movement of the velopharynx, larynx, lips, tongue and jaw, or orofacial myofunctional disorders.The development of difficulties in chewing and swallowing could cause dysphagia in these patients. Which leads to serious problems such as malnutrition, dehydration, aspiration and pneumonia (<a class="elsevierStyleCrossRef" href="#bib0040">Britton, Karam, & Schindler, 2018</a>).Different studies, such as <a class="elsevierStyleCrossRef" href="#bib0085">Furuta et al. (2013)</a> and <a class="elsevierStyleCrossRef" href="#bib0130">Kito et al. (2019)</a> have explored the relationship between physical status and different impaired functions in numerous clinical profiles but this relationship need to be deeply explored in NMD.Physical status is defined as the person's psycho-physical performance capacity at any given time (<a class="elsevierStyleCrossRef" href="#bib0220">WHO, 1995</a>). This status can reflect the different progression of the clinical features in any pathology impacting the ability to perform any function. In the case of NMD patients, the physical status level can be related to the functional impairment, concretely ventilatory, phonatory and swallowing function.Thus, the main objective in this study is to analyze the ventilatory, phonatory and swallowing and their relationship with physical status in a group of advanced NMD.MethodThis research was an observational study with a cross-sectional design performed between July and September 2020. The investigation was approved by the Association of NMD of Granada (Granada, España) and the Ethics Committee of the University of Granada (Granada, España). It was registered in clinicaltrials.gov with identifier number: <a href="ctgov:NCT04473612">NCT04473612</a>. The design was conducted following the ethical guidelines of the Declaration of Helsinki reviewed in 2013 (<a class="elsevierStyleCrossRef" href="#bib0150">Millum, Wendler, & Emanuel, 2013</a>) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guideline (<a class="elsevierStyleCrossRef" href="#bib0210">Von Elm et al., 2014</a>).ParticipantsA total of 48 individuals participated in this study: 24 participants diagnosed with NMD and 24 healthy controls. Participants with NMD were recruited from Association of NMD of Granada (Granada, España). Inclusion criteria were diagnosis of advanced NMD, and patients being aged 18–65 years.Patients who met the inclusion criteria were informed of the study purposes and signed an informed consent form.All patients were free to withdraw from the present study at any time without negative outcomes.ProcedureNMD Patients were divided in two groups according to the level of their overall physical status (NMD higher physical status group or NMD lower physical status group). To determine the physical status muscle strength was measured, using hand grip dynamometry (<a class="elsevierStyleCrossRef" href="#bib0025">Bohannon, 2008</a>).Additionally, we recruited a control group with healthy controls sex-matched and age-matched.Testing took place in patient's house in a quiet place. Evaluations were systematic and standardized for all patients.All measurements were collected in an interview, which lasted between 1 and 2h depending on the physical condition of the patient.MaterialsAnthropometric and sociodemographic variables such as age, gender, body mass index (BMI) and disability (World Health Organization (WHO) Disability Assessment Scale, WHODAS 2.0 (WD2)) (<a class="elsevierStyleCrossRef" href="#bib0230">Xenouli, Xenoulis, Sarafis, Niakas, & Alexopoulos, 2016</a>) were collected accompanied by the pathology characteristics (diagnosis and time since diagnosis). Additionally, physical status, ventilatory, phonatory and swallowing function were measured.Physical status assessmentPhysical status was evaluated by handgrip strength with a pressure dynamometer Jamar Plus+Digital Hand Dynamometer, 200Ib (Sammons Preston Rolyan, Bolingbrook, IL, USA) according to the protocol. The results were expressed in Newtons. Patients were classified with lower level of physical status when they had low muscle strength. Low muscle strength was defined as lower than 10kg (<a class="elsevierStyleCrossRef" href="#bib0160">Norman, Stobäus, Gonzalez, Schulzke, & Pirlich, 2011</a>).Functionality of the upper airway was assessed including ventilatory, phonatory and swallowing functions.The ventilatory assessmentVentilatory function was evaluated using the spirometry, the peak expiratory flow measurement and the perception of dyspnea.Spirometry was performed using Spirobank II (MIR, Italy). Collected variables were Forced Expiratory Volume in the First Second (FEV1), Forced Vital Capacity (FVC), Maximal Voluntary Ventilation (MVV), Peak Expiratory Flow (PEF) and Maximum Expiratory Flow (MEF). All measures were made following the standardized technical statement of the American Thoracic Society and European Respiratory Society (<a class="elsevierStyleCrossRef" href="#bib0095">Graham et al., 2019</a>).Peak expiratory flow (PEF) measurement and the peak cough flow (PCF) were evaluated using the wright peak flow meter. PEF and PFC were performed following the protocol previously used in NMD patients (<a class="elsevierStyleCrossRef" href="#bib0090">Gauld & Boynton, 2005</a>).The perception of dyspnea was evaluated with the modified Borg scale (<a class="elsevierStyleCrossRef" href="#bib0030">Borg, 1982</a>).The phonatory assessmentPhonatory function was evaluated through the analysis of aerodynamic measures of the voice, acoustic analysis of the voice and perception of dysphonia.Analysis of aerodynamic measures of the voice allows us to know the values of the maximum phonation time (MPT) and the maximum expiration time (MET), measured in seconds (sc) (<a class="elsevierStyleCrossRef" href="#bib0155">Neiman & Edeson, 1981</a>). The MET allows us to access to a parameter of the relationship between phonation and expiration. The relationship between MPT and MET is reflected in the so-called s/z ratio. It is interpreted as an indicator of glottic closure efficiency.The acoustic voice analysis allows objectifying the evaluation of the voice with numerical parameters.The acoustic signal was recorded using the PRAAT application for mac, version 6.0.33. The PRAAT program is a tool for phonetic analysis of voice, for which the evaluator previously trained (<a class="elsevierStyleCrossRef" href="#bib0020">Boersma, 2001</a>). The computer used was a MacBook Air PC with 8 Gigabytes (Gb) RAM that works at a speed of 2133 Megahertz (MHz). The microphone was unidirectional dynamic with a noise level equivalent to 22dB (decibels) (A). The sampling frequency was 44,100 Herzios (Hz) and a high frequency resolution microphone was used, which was placed 10cm from the patient's mouth while phoning a vowel / a / at intensity and comfortable tones in a quiet and empty room. 3 sc were captured from the computer emission. The recommendations of the National Center for Voice and Speech were followed (<a class="elsevierStyleCrossRef" href="#bib0200">Titze, 1994</a>).The recordings of the controls were made in their homes, an the way that was done for the recordings of the patients. Following the same protocol.Regarding the signal-to-noise ratio (SNR), it was carried out with a ratio above 30dB to have voice measurements with an accuracy above 95%, proposed by <a class="elsevierStyleCrossRef" href="#bib0075">Deliyski, Shaw, and Evans (2005)</a>.Acoustic voice analyzes were completed with the Dysphonia Severity Index (DSI) (<a class="elsevierStyleCrossRef" href="#bib0225">Wuyts et al., 2000</a>). It collects the MPT, the highest fundamental frequency (F0) measured in herzios (Hz) and the lowest sound pressure level (SPL) intensity in decibels (dB) and jitter (dB). We used the PRAAT software to evaluated F0, SPL, jitter, shimmer an harmonics-to-noise ratio (HNR). Its weighting is expressed in the following formula: DSI=0.13×MPT+0.0053×F0 max.−0.26×SPL Min.−1.18×jitter+12.4.The phonatory function and it's repercussion on daily life was evaluated by the Voice handicap index (VHI-10) (<a class="elsevierStyleCrossRef" href="#bib0120">Jacobson et al., 1997</a>). This scale consists of 10 items, where the patient indicates the presence of symptoms of dysphonia with a Likert type score of 5 points, in which 0 indicates never and 4 indicates always. A version adapted to children of these questionnaire were used for the child population, the Children's Voice Handicap Index-10 (CVHI-10). This scale has the same items and score than VHI-10.The swallowing assessmentSwallowing function evaluation included the clinical examination of dysphagia, presence and severity of dysphagia, and swallowing quality of life. Additionally, we evaluated the orofacial myofunctional condition.The clinical examination of dysphagia was performed using the Volume-Viscosity Swallow test (V-VST) (<a class="elsevierStyleCrossRef" href="#bib0060">Clavé et al., 2008</a>). The aim of the V-VST is to identify clinical signs of impaired efficacy of swallow during swallowing of three viscosities (Nectar, Liquid and Pudding); and clinical signs of impaired safety during swallow.The presence of dysphagia was evaluated with the Eating Assessment Tool-10 (EAT-10) (<a class="elsevierStyleCrossRef" href="#bib0015">Belafsky et al., 2008</a>). The EAT-10 is a self-administered instrument that evaluate specific symptoms of dysphagia with 10 items and each item have a range from 0 (no problem to swallow) to 4 (a serious problem for life). A version adapted to children of these questionnaire were used for the child population, the Pediatric Eating Assessment Tool (PEDI-EAT-10). This scale has the same items and score than EAT-10.The severity of swallowing was assessed using the Functional Oral Intake Scale (FOIS) questionnaire (<a class="elsevierStyleCrossRef" href="#bib0065">Crary et al., 2005</a>). This scale consists of 7 levels, with 1 being the most severe and 7 being the least severe, the patient has to select the level with which he/she is.Swallowing quality of life questionnaire (SWAL-QOL) measures the possible swallowing problems in daily life, it contains 44 items and each item is scored from 0 (the worst state) to 5 (the best state) (<a class="elsevierStyleCrossRef" href="#bib0213">Zaldibar-Barinaga et al., 2013</a>).The clinical evaluation of the orofacial myofunctional condition was assessed by the Orofacial Myofunctional Evaluation with Scores (OMES). It consists of 4 subscales: appearance and posture, mobility and functions. The examiner attributed scores on a 3 point scale: 3=normal, 2=insufficient ability; and 1=absence of ability or being unable to perform the task (<a class="elsevierStyleCrossRef" href="#bib0070">De Felicio & Pimenta-Ferreira, 2008</a>).Statistical analysisStatistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) program, version 20.0 (International Business Machines, Armonk, NY). Normal distribution of the data was tested by Kolmogorov–Smirnov test (with Lilliefors’ correction). The homogeneity of variances was approached with Fisher's F-test.If both conditions were satisfied, parametric tests were used. If any of the conditions was not satisfied, a nonparametric test was used instead. A 95% confidence interval and a p value of 0.05 were considered to be significant.ResultsThe results are discussed below for the 48 participants. The final sample consisted of 24 patients with NMD and 24 healthy controls. Flow diagram describing the number of participants screened, and included in the study are reported in <a class="elsevierStyleCrossRef" href="#fig1">Fig. 1</a>. NMD patients were divided into two groups depending on their level of physical status: 11 patients were included in the NMD with lower physical status group and 13 patients were included in the NMD with higher physical status group.<elsevierMultimedia ident="fig1"></elsevierMultimedia>Participant's characteristicsWe will provide an overview of the characteristics of participant's in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. There were no differences among groups in age, gender and anthropometric characteristics. As regards to time since diagnosis, significant differences (p<.05) were found when NMD with higher physical status group and NMD lower physical status group are compared. The NMD lower physical status group comprised patients for whom the time since diagnosis was 1485±1515 years on average, whereas for the patients in the NMD higher physical status group it was of 7.66±11.90 years. Significant differences (p<.05) were found in the handgrip force between the three groups. On the same scale, for the subscales Cognition, Mobility, Self-care, Life activities, Participation and WHODAS-total, there were significant differences (p<.05) when comparing NMD higher physical status group and NMD lower physical status group (p<.05), finally there were significant differences (p<.05) in all subscales of WHODAS scale, when comparing NMD lower physical status group and control group (p<.05).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Ventilatory characteristics of the participantsThe scores for ventilatory measures are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Significant differences (p<.05) were found in spirometry for FVC% and FEV1% measures, between the three groups.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Phonatory characteristics of the participantsPhonatory measures are reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. Significant differences (p<.05) were found for MET and MPT measures, between the three groups. Also, in this last outcome NMD lower physical status group had the worse time, a MPT lower than 10 secons (sc) is considered pathological and in this group was 8.50sc. (<a class="elsevierStyleCrossRef" href="#bib0005">Adrian & Casado, 2002</a>). Significant differences (p<.05) were found in SPL and DSI when comparing NMD lower physical status, with a control group and higher physical status group and when comparing lower and higher physical status. While in acoustics measurements Jitter exceeds the limit of normality for both NMD groups, higher and lower. For the variable Jitter both groups got 1.89%, Jitter higher than 0.45% is considered pathological.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Swallowing characteristics of the participantsThe different swallowing and orofacial characteristics detected in our patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. Significant differences (p<.001) were found in the Clinical examination of dysphagia, for all subscales, between the three groups with higher impairments in the NMD group with lower physical status, except for recommended viscosity (p<.05).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>When orofacial characteristics were analyzed between groups, significant differences were found in (OMES test) or (OMES-Mobility, OMES-Function Breathing, OMES-Functions; deglutition: lips behavior, OMES-Functions; Deglutition: other behavior and changes signals, OMES-Functions; deglutition efficiency, OMES-Functions; mastication, and OMES-Functions; mastication: others behaviors and changes) when comparing NMD lower physical status, with a control group and higher physical status group.DiscussionThe goal of this study was to investigate the ventilatory, phonatory and swallowing functions and their relation with physical status in a group of advanced NMD. Upper airway functionality and issues related to a lower level of physical status were identified among the patients with NMD as compared to the control group in this study.When patients with NMD with a lower level of physical status are compared with NMD with higher level of physical status, the former exhibit significantly higher ventilatory, phonatory and swallowing functions. Our findings as expected show that both groups of NMD have worse ventilatory, phonatory and swallowing outcomes than healthy controls.The sociodemographic and clinical characteristics of the population included in this study, as well as the sample size, were similar to other studies such as <a class="elsevierStyleCrossRef" href="#bib0170">Pellegrini et al. (2004)</a> and <a class="elsevierStyleCrossRef" href="#bib0185">Shapiro et al. (2014)</a>.Numerous studies, such as that of <a class="elsevierStyleCrossRef" href="#bib0055">Clark and Manini (2010)</a>, affirm that functional deterioration is associated with physical deterioration, however the impact that this deterioration has on the functionality of the upper airway and their ventilatory, phonatory and swallowing in advanced NMD has not been studied previously.In this study, patients with less than 10kg in the hand grip strength test were the ones who showed the worst results in the evaluations, like it was predicted by a previously study by <a class="elsevierStyleCrossRef" href="#bib0160">Norman et al. (2011)</a>. We used this test specifically, since the use of self-perceived scales to assess physical state is sometimes not objective enough. This could be due to the fact that patients who have a worse physical condition have a different perception of pain and the degree of disability. Since, they are used to enduring a higher level of discomfort and difficulties.Other studies, for example that of <a class="elsevierStyleCrossRef" href="#bib0195">Suarez et al. (2002)</a>, have observed that the general weakness in NMD cause debilitation of the ventilatory function. Data from our study show that the ventilatory variables seem to be significantly worsen in advanced NMD with lower physical status patients.In the same line the literature highlights the fact that the phonatory capacities become more impaired as disability increases in NMD (<a class="elsevierStyleCrossRef" href="#bib0205">Tomik et al., 2015</a>). <a class="elsevierStyleCrossRef" href="#bib0050">Carpenter, McDonald, and Howard (1978)</a>, found the occurrence of phonatory difficulties in about 25% of their ALS patients. In our study the higher phonatory dysfunction was shown in both groups of NMD, however NMD lower physical status group shown the worse result. This can be observed by the results of dysphonia severity, and acoustic analysis of voice data.Acoustic analysis of the voice was introduced as a means for more objective description of phonatory disturbances. Our study utilized the four most important and commonly used parameters F0, jitter, shimmer and HNR. The patients were characterized with increased values of jitter, shimmer, HNR, while no impact on mean F0 was noted. Similar findings related to acoustic examination of voice were reported by <a class="elsevierStyleCrossRef" href="#bib0205">Tomik et al. (2015)</a>. In the evaluation of perception of dysphonia and dysphagia, has been discovered that NMD higher physical status group have a worse result than NMD lower physical status group, which would go against expectations. These it happens on the other occasions, in NMD patients, when we compare the results of self-perceived questionnaires, patients with a lower level of physical status have a better result than those with a higher level of physical status (<a class="elsevierStyleCrossRef" href="#bib0190">Simmons, 2015</a>).The early evaluation of swallowing function in NMD patients can make possible the prevention of complications that may develop later like aspiration and choking. Studies such as <a class="elsevierStyleCrossRef" href="#bib0060">Clavé et al. (2008)</a> used V-VST to diagnose oropharyngeal dysphagia, these studies found that most of their patients at risk of complications were quickly safely and accurately recognized using V-VST. They refer dysphagia as a highly prevalent condition among vulnerable patients with neurodegenerative diseases. Our results about the prevalence of V-VST dysphagia signs and impaired swallow response agree with previous studies in neurological and neurodegenerative patients (<a class="elsevierStyleCrossRef" href="#bib0175">Power et al., 2007</a>).Despite the existence of evidence about the relationship between affectation of upper airway and NMD, there is little research focused on advanced NMD patients whose have different level of physical status.LimitationsFirstly, the cross-sectional design of this study precludes the possibility of being able to make causal inferences. We do not know in which cases age or functional mobility was the cause or the consequence of the assessed physical status. It is necessary to conduct longitudinal studies that explore the causality between these outcome measurements.A second limitation of this study is that we only assessed strength using hand grip strength measure. However, the hand grip strength has proven to be reliable and adequate to assess the strength.Thirdly, the participants were not recruited in clinical settings; nevertheless, in Spain most patients with NMD belong to patients’ associations.Finally, the present study has a small sample size, which is explained by the low prevalence rate of NMD. Therefore, the interpretation of the findings should be done with caution.In conclusion, ventilatory, phonatory and swallowing difficulties were observed in the of participants with NMD in this study compared to a control group. Patients with lower physical status have higher risk of ventilatory, phonatory and swallowing impaired after diagnosis of NMD (<a class="elsevierStyleCrossRef" href="#bib0115">Hull et al., 2012</a>). Evaluation of these disorders and physical status should be taken into account for the design of the therapeutic approach in NMD patients. A refined intervention should be tested in a randomized clinical trial with an adequately powered sample size. That therapeutic approach to those patients should incorporate an integrated process including global physical status and ventilatory, phonatory and swallowing training.FundingNo author reported sources of funding.Conflict of interestThe authors report no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1962672" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1689332" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1962671" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Propósito" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1689333" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedure" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Materials" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Physical status assessment" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "The ventilatory assessment" ] 5 => array:3 [ "identificador" => "sec0040" "titulo" => "The phonatory assessment" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "The swallowing assessment" ] ] ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0055" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Participant's characteristics" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Ventilatory characteristics of the participants" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Phonatory characteristics of the participants" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Swallowing characteristics of the participants" ] ] ] 7 => array:3 [ "identificador" => "sec0080" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0100" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-05-17" "fechaAceptado" => "2022-11-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1689332" "palabras" => array:5 [ 0 => "Neuromuscular disease" 1 => "Ventilatory impairment" 2 => "Phonatory impairment" 3 => "Swallowing impairment" 4 => "Hand grip strength" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1689333" "palabras" => array:5 [ 0 => "Enfermedad neuromuscular" 1 => "Alteración ventilatoria" 2 => "Alteración fonatoria" 3 => "Alteración deglutoria" 4 => "Fuerza de prensión manual" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "PurposeTo analyze the ventilatory, phonatory and swallowing impairments and their relation with physical status in a group of advanced Neuromuscular Disease (NMD). MethodsA cross-sectional observational study was utilized 48 participants from the Association of NMD of Granada (Granada, España), university clinical research, University of Granada. A total of 24 advanced NMD patients and 24 healthy controls matched for age and sex were recruited. Advanced NMD patients were divided in two groups according to the level of their overall physical status (NMD higher physical status group or NMD lower physical status group). Hand grip strength, ventilatory, phonatory and swallowing features were analyzed. ResultsThere were significant differences (p<.05) among NMDs groups in ventilatory function. There were significant differences (p<.05) between NMDs groups in ventilatory, phonatory and swallowing function. Finally, there were significant differences (p<.05) among advanced NMDs groups in swallowing function and orofacial evaluation. ConclusionPatients with lower physical status have higher risk of suffer ventilatory, phonatory and swallowing complications after diagnosis of NMD.Registered in the Clinical Trials reference: NCT04473612." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "PropósitoAnalizar las alteraciones ventilatorias, fonatorias y deglutorias y su relación con el estado físico en un grupo de Enfermos Neuromusculares (ENM) avanzados. MétodosSe realizó un estudio observacional transversal con 48 participantes de la Asociación de ENM de Granada (Granada, España), y de la facultad de ciencias de la salud de la Universidad de Granada. Se reclutaron un total de 24 pacientes con ENM avanzada y 24 controles sanos emparejados por edad y sexo. Los pacientes con ENM avanzada se dividieron en dos grupos según el nivel de su estado físico general (grupo de ENM de mayor estado físico o grupo de ENM de menor estado físico). Se analizó la fuerza de agarre de las manos y las características ventilatorias, fonatorias y deglutorias. ResultadosSe encontraron diferencias significativas (p<0,05) entre los grupos de ENM en la función ventilatoria. También, se observaron diferencias significativas (p<0,05) entre los grupos de ENM en la función fonatoria y deglutoria. Por último, existieron diferencias significativas (p<0,05) entre los grupos de ENM avanzados respecto a la condición miofuncional orofacial. ConclusionesLos pacientes con menor estado físico tienen mayor riesgo de sufrir complicaciones ventilatorias, fonatorias y deglutorias tras el diagnóstico de ENM." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Propósito" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1966 "Ancho" => 3341 "Tamanyo" => 282483 ] ] "descripcion" => array:1 [ "en" => "Flow diagram describing the number of participants screened, and included in the study." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "NMD: neuromuscular disease; ALS: amyotrophic lateral sclerosis; BMD: Becker muscular dystrophy; BMI: body mass index; DMD: Duchenne muscular dystrophy; N: Newtons; WHODAS: WHO Disability Assessment Scale; yr: years." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Outcome measure \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Control group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">NMD higher physical status group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">NMD lower physical status group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Chi squared/F value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">(n=24) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">(n=13) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">(n=11) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender n (% men) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (76.58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.961 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (yr) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.51±11.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.35±10.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.81±15.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.592 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.19±4.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.46±3.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.98±4.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.403 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis n (%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DMD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (33.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mitochondrial myopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (16.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Myasthenia Gravis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (33.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Steinert's myotonic dystrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (16.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time since diagnosis (yr) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.66±11.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.85±15.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.012<a class="elsevierStyleCrossRef" href="#tblfn0065">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disability</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WHODAS – cognition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.55±1.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.10±2.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.36±6.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.560<a class="elsevierStyleCrossRefs" href="#tblfn0010">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WHODAS – mobility \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.33±1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.65±2.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.90±5.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.691<a class="elsevierStyleCrossRefs" href="#tblfn0010">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WHODAS – self-care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.05±0.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.81±2.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.679<a class="elsevierStyleCrossRefs" href="#tblfn0010">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WHODAS – getting along \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.66±2.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.65±1.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.18±6.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.987<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WHODAS – life activities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.88±0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.40±0.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.90±3.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.900<a class="elsevierStyleCrossRefs" href="#tblfn0010">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WHODAS – participation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.14±1.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.55±2.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.63±5.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.425<a class="elsevierStyleCrossRefs" href="#tblfn0005">a,b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WHODAS – total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.88±2.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.60±5.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.36±15.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">132.376<a class="elsevierStyleCrossRefs" href="#tblfn0005">a,b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physical status</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand grip strength (N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">211.02±29.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">146.63±48.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.87±31.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.52<a class="elsevierStyleCrossRefs" href="#tblfn0005">a,b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3267040.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Significant differences when comparing NMD higher physical status group and control group (p<.05)." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Significant differences when comparing NMD lower physical status group and control group (p<.05)." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Significant differences when comparing NMD higher physical status group and NMD lower physical status group (p<.05)." ] 3 => array:3 [ "identificador" => "tblfn0065" "etiqueta" => "*" "nota" => "p<.05." ] ] ] "descripcion" => array:1 [ "en" => "Participants characteristics." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "NMD: neuromuscular disease; FVC: forced vital capacity; FEV1: forced expiratory volume in the first second; FET: forced expiratory time; MVV: maximal voluntary ventilation and maximum expiratory flow." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome measure \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control group(n=24) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NMD higher physical status group(n=13) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NMD lower physical status group(n=11) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">F value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spirometry</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FVC% predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.14±18.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.25±16.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.50±18.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30,102<a class="elsevierStyleCrossRefs" href="#tblfn0020">a,b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV1% predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.85±9.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.00±23.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.00±20.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26,102<a class="elsevierStyleCrossRefs" href="#tblfn0020">a,b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEF% predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.14±34.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.75±24.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.50±32.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7185<a class="elsevierStyleCrossRefs" href="#tblfn0020">a,b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FET% predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.83±34.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.00±42.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1257<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MVV% predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.83±28.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.66±11.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10,090<a class="elsevierStyleCrossRefs" href="#tblfn0020">a,b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peak expiratory flow measurement</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peak expiratory flow l/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">375.00±122.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">161.66±90.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">144.16±68.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15,765<a class="elsevierStyleCrossRefs" href="#tblfn0020">a,b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peak cough flow l/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">390±97.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">225.00±130.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">168.33±86.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26,149<a class="elsevierStyleCrossRefs" href="#tblfn0020">a,b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perception of dyspnea</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Modified Borg scale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">00.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.50±2.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.28±1.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33,325<a class="elsevierStyleCrossRefs" href="#tblfn0025">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3267039.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "Significant differences when comparing NMD higher physical status group and control group (p<.05)." ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "Significant differences when comparing NMD lower physical status group and control group (p<.05)." ] 2 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "c" "nota" => "Significant differences when comparing NMD higher physical status group and NMD lower physical status group (p<.05)." ] ] ] "descripcion" => array:1 [ "en" => "Ventilatory characteristics of the participants." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "NMD: neuromuscular disease; MPT: maximum phonation time; MET: maximum expiratory time; PQ: phonation quotient s/z; SPL min: sound pressure level minimum intensity; F0 máx: maximum fundamental frequency; HNR: harmonics-to-noise ratio; DSI: dysphonia severity index; VHI-10: voice handicap index; CVHI-10: children's voice handicap index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome measure \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control group(n=24) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NMD higher physical status group(n=13) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NMD lower physical status group(n=11) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">F value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aerodynamic measures of the voice</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MPT (s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.50±4.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.83±5.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.50±1.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24,814<a class="elsevierStyleCrossRefs" href="#tblfn0035">a,b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MET (s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.00±9.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.16±7.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.66±0.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25,828<a class="elsevierStyleCrossRefs" href="#tblfn0035">a,b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PQ s/z \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92±0.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01±0.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.70±0.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31,637<a class="elsevierStyleCrossRefs" href="#tblfn0040">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acoustic analysis of the voice</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SPL min (dB) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.50±5.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.50±8.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.83±4.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12,768<a class="elsevierStyleCrossRefs" href="#tblfn0040">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F0 máx (Hz) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">183.16±57.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">227.03±72.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">215.58±33.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2204 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jitter (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.35±0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.89±2.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.89±0.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6064<a class="elsevierStyleCrossRefs" href="#tblfn0035">a,b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Shimmer (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.42±0.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.73±0.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.33±0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15,955<a class="elsevierStyleCrossRefs" href="#tblfn0040">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HNR (dB) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.03±1.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.79±6.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.73±3.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11,841<a class="elsevierStyleCrossRefs" href="#tblfn0035">a,b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dysphonia severity</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DSI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.91±0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.24±3.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−1.06±1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19,047<a class="elsevierStyleCrossRefs" href="#tblfn0040">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perception of dysphonia</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VHI-10 | CVHI-10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.71±3.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.00±15.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.00±9.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3023<a class="elsevierStyleCrossRef" href="#tblfn0035">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3267041.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "a" "nota" => "Significant differences when comparing NMD higher physical status group and control group (p<.05)." ] 1 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "b" "nota" => "Significant differences when comparing NMD lower physical status group and control group (p<.05)." ] 2 => array:3 [ "identificador" => "tblfn0045" "etiqueta" => "c" "nota" => "Significant differences when comparing NMD higher physical status group and NMD lower physical status group (p<.05)." ] ] ] "descripcion" => array:1 [ "en" => "Phonatory characteristics of the participants." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "NMD: neuromuscular disease; V-VST: Volume-Viscosity Swallow test; EAT-10: Eating Assessment Tool-10; PEDI-EAT-10: pediatric eating assessment tool; FOIS: Functional Oral Intake Scale; SWAL-QOL: swallowing quality of life questionnaire; OMES: Orofacial Myofunctional Evaluation with Scores." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome measure \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control group(n=24) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NMD higher physical status group(n=13) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NMD lower physical status group(n=11) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Chi-squared/F value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical examination of dysphagia</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V-VST Impaired safety n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0075">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V-VST Impaired efficacy n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (33.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0075">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V-VST Mixed alteration n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0075">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V-VST Recommended volume n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0075">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (16.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0075">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (66.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (83.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0075">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V-VST Recommended viscosity n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nectar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009<a class="elsevierStyleCrossRef" href="#tblfn0070">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liquid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009<a class="elsevierStyleCrossRef" href="#tblfn0070">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pudding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009<a class="elsevierStyleCrossRef" href="#tblfn0070">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V-VST pathologic n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009<a class="elsevierStyleCrossRef" href="#tblfn0070">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptoms of dysphagia</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EAT-10 | PEDI-EAT-10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.75±16.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.00±12.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.561<a class="elsevierStyleCrossRef" href="#tblfn0050">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dysphagia severity</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FOIS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.00±1.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.33±1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.333<a class="elsevierStyleCrossRef" href="#tblfn0050">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Swallowing quality of life</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SWAL-QOL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">220.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">170.00±57.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">175.00±67.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.664<a class="elsevierStyleCrossRefs" href="#tblfn0050">a,b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evaluation of the orofacial myofunctional condition</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Appearance and posture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.16±3.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.66±2.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.398 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Mobility \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.50±10.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.50±5.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.371<a class="elsevierStyleCrossRefs" href="#tblfn0055">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Functions; Breathing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.20±0.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.000<a class="elsevierStyleCrossRefs" href="#tblfn0055">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Functions; Deglutition: lips behavior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.67±0.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.60±1.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.297<a class="elsevierStyleCrossRefs" href="#tblfn0055">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Functions; Deglutition: others behavior and changes signals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00±1.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.315<a class="elsevierStyleCrossRefs" href="#tblfn0055">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Functions; Deglutition efficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.33±0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.60±1.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.909<a class="elsevierStyleCrossRefs" href="#tblfn0055">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Functions; Mastication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.87±0.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.66±0.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.20±1.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.367<a class="elsevierStyleCrossRefs" href="#tblfn0055">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Functions; Mastication: others behavior and changes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.80±1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.000<a class="elsevierStyleCrossRefs" href="#tblfn0055">b,c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Functions; Mastication; Chewing time (s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.25±15.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.33±30.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.60±40.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.048 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OMES-Evaluation of the functional occlusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00±0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3267042.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0050" "etiqueta" => "a" "nota" => "Significant differences when comparing NMD higher physical status group and control group (p<.05)." ] 1 => array:3 [ "identificador" => "tblfn0055" "etiqueta" => "b" "nota" => "Significant differences when comparing NMD lower physical status group and control group (p<.05)." ] 2 => array:3 [ "identificador" => "tblfn0060" "etiqueta" => "c" "nota" => "Significant differences when comparing NMD higher physical status group and NMD lower physical status group (p<.05)." ] 3 => array:3 [ "identificador" => "tblfn0070" "etiqueta" => "*" "nota" => "p<.05." ] 4 => array:3 [ "identificador" => "tblfn0075" "etiqueta" => "**" "nota" => "p<.001." ] ] ] "descripcion" => array:1 [ "en" => "Swallowing and orofacial characteristics of the participants." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "Adrián and Casado, 2002" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La evaluación clínica de la voz: Fundamentos médicos y logopédicos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. 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Ventilatory, phonatory and swallowing impairments in advanced neuromuscular disease patients

Alteraciones ventilatorias, fonatorias y deglutorias en pacientes con enfermedad neuromuscular avanzada

Natalia Muñoz-Vigueras, Irene Torres-Sánchez

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irenetorres@ugr.es

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, Paula Obeso-Benitez, Esther Prados-Román, María Granados-Santiago, Irene Cabrera-Martos, Marie Carmen Valenza

Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Granada, Spain

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    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Ventilatory&#44; phonatory and swallowing impairments in advanced neuromuscular disease patients"
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        "autoresLista" => "Natalia Mu&#241;oz-Vigueras, Irene Torres-S&#225;nchez, Paula Obeso-Benitez, Esther Prados-Rom&#225;n, Mar&#237;a Granados-Santiago, Irene Cabrera-Martos, Marie Carmen Valenza"
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            "nombre" => "Marie Carmen"
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            "entidad" => "Departamento de Fisioterapia&#44; Facultad de Ciencias de la Salud&#44; Universidad de Granada&#44; Spain"
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      "es" => array:1 [
        "titulo" => "Alteraciones ventilatorias&#44; fonatorias y deglutorias en pacientes con enfermedad neuromuscular avanzada"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow diagram describing the number of participants screened&#44; and included in the study&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The neuromuscular diseases &#40;NMD&#41; are a highly heterogeneous group of around 600 infrequent neurological diseases&#44; resulting from an abnormality in the anterior horn motor cells&#44; peripheral nerves&#44; neuromuscular muscles&#44; or junctions &#40;<a class="elsevierStyleCrossRef" href="#bib0145">McDonald&#44; 2002</a>&#41;&#46; Patients with neuromuscular diseases develop during the clinical course of their pathology different symptoms such as spasticity&#44; fasciculation&#44; muscle stiffness and muscle pain &#40;<a class="elsevierStyleCrossRef" href="#bib0140">Mancuso &#38; Navarro&#44; 2015</a>&#41;&#46; However&#44; there is a main and common symptom in all NMD&#44; the muscular weakness&#46; The progressive course of this symptom produces a decrease in the global functional capacity and in the independence of the activities of daily life &#40;<a class="elsevierStyleCrossRef" href="#bib0080">Fowler&#44; 2002</a>&#41;&#46; As a consequence of this progressive muscle weakness&#44; the patients use to report disturbances related to the ventilatory system &#40;<a class="elsevierStyleCrossRef" href="#bib0090">Gauld &#38; Boynton&#44; 2005</a>&#41;&#44; phonatory disorders &#40;<a class="elsevierStyleCrossRef" href="#bib0110">Hanson&#44; 1991</a>&#41; and swallowing difficulty &#40;<a class="elsevierStyleCrossRef" href="#bib0215">Willig&#44; Paulus&#44; Saint&#44; Beon&#44; &#38; Navarro&#44; 1994</a>&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Different research has explored the development of ventilatory&#44; phonatory and swallowing impairments related to the progressive course of NMD diseases in children and adults &#40;<a class="elsevierStyleCrossRef" href="#bib0035">Bourke&#44; 2014</a>&#41;&#46; These impairments play an important role in the activities of daily living impacting the level of disability in NMD patients &#40;<a class="elsevierStyleCrossRef" href="#bib0145">McDonald&#44; 2002</a>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Concretely&#44; upper airway muscles malfunction may increase the resistance to airflow&#44; precipitating ventilatory failure or lead to aspiration pneumonia&#44; both frequent causes of morbidity and mortality in NMD&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Similarly&#44; weakness on the upper airway muscles affect to the tone&#44; strength&#44; and stiffness of structures involved in the phonation and speech &#40;<a class="elsevierStyleCrossRef" href="#bib0105">Hartley &#38; Ascott&#44; 1994</a>&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Other authors&#44; such as <a class="elsevierStyleCrossRef" href="#bib0165">Nu&#241;ez-Batalla&#44; M&#233;ndez&#44; and Pastrana &#40;2011&#41;</a> have reported variables of dysphonia in these patients related to abnormalities like excessive glottal closure&#44; nonperiodic vibrations of vocal folds&#44; occasional laryngeal spasms&#44; an abnormal adduction of false folds and impaired glottal closure&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Further&#44; studies carried out by <a class="elsevierStyleCrossRef" href="#bib0100">Hanson &#40;2011&#41;</a>&#44; and <a class="elsevierStyleCrossRef" href="#bib0135">Makkonen&#44; Ruottinen&#44; Puhto&#44; Helminen&#44; and Palmio &#40;2018&#41;</a> have shown the presence of rates of dysarthria&#44; related to a decreased strength and movement of the velopharynx&#44; larynx&#44; lips&#44; tongue and jaw&#44; or orofacial myofunctional disorders&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The development of difficulties in chewing and swallowing could cause dysphagia in these patients&#46; Which leads to serious problems such as malnutrition&#44; dehydration&#44; aspiration and pneumonia &#40;<a class="elsevierStyleCrossRef" href="#bib0040">Britton&#44; Karam&#44; &#38; Schindler&#44; 2018</a>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Different studies&#44; such as <a class="elsevierStyleCrossRef" href="#bib0085">Furuta et al&#46; &#40;2013&#41;</a> and <a class="elsevierStyleCrossRef" href="#bib0130">Kito et al&#46; &#40;2019&#41;</a> have explored the relationship between physical status and different impaired functions in numerous clinical profiles but this relationship need to be deeply explored in NMD&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Physical status is defined as the person&#39;s psycho-physical performance capacity at any given time &#40;<a class="elsevierStyleCrossRef" href="#bib0220">WHO&#44; 1995</a>&#41;&#46; This status can reflect the different progression of the clinical features in any pathology impacting the ability to perform any function&#46; In the case of NMD patients&#44; the physical status level can be related to the functional impairment&#44; concretely ventilatory&#44; phonatory and swallowing function&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Thus&#44; the main objective in this study is to analyze the ventilatory&#44; phonatory and swallowing and their relationship with physical status in a group of advanced NMD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><p id="par0055" class="elsevierStylePara elsevierViewall">This research was an observational study with a cross-sectional design performed between July and September 2020&#46; The investigation was approved by the Association of NMD of Granada &#40;Granada&#44; Espa&#241;a&#41; and the Ethics Committee of the University of Granada &#40;Granada&#44; Espa&#241;a&#41;&#46; It was registered in clinicaltrials&#46;gov with identifier number&#58; <a href="ctgov:NCT04473612">NCT04473612</a>&#46; The design was conducted following the ethical guidelines of the Declaration of Helsinki reviewed in 2013 &#40;<a class="elsevierStyleCrossRef" href="#bib0150">Millum&#44; Wendler&#44; &#38; Emanuel&#44; 2013</a>&#41; and Strengthening the Reporting of Observational studies in Epidemiology &#40;STROBE&#41; guideline &#40;<a class="elsevierStyleCrossRef" href="#bib0210">Von Elm et al&#46;&#44; 2014</a>&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants</span><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 48 individuals participated in this study&#58; 24 participants diagnosed with NMD and 24 healthy controls&#46; Participants with NMD were recruited from Association of NMD of Granada &#40;Granada&#44; Espa&#241;a&#41;&#46; Inclusion criteria were diagnosis of advanced NMD&#44; and patients being aged 18&#8211;65 years&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patients who met the inclusion criteria were informed of the study purposes and signed an informed consent form&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All patients were free to withdraw from the present study at any time without negative outcomes&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure</span><p id="par0075" class="elsevierStylePara elsevierViewall">NMD Patients were divided in two groups according to the level of their overall physical status &#40;NMD higher physical status group or NMD lower physical status group&#41;&#46; To determine the physical status muscle strength was measured&#44; using hand grip dynamometry &#40;<a class="elsevierStyleCrossRef" href="#bib0025">Bohannon&#44; 2008</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Additionally&#44; we recruited a control group with healthy controls sex-matched and age-matched&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Testing took place in patient&#39;s house in a quiet place&#46; Evaluations were systematic and standardized for all patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">All measurements were collected in an interview&#44; which lasted between 1 and 2<span class="elsevierStyleHsp" style=""></span>h depending on the physical condition of the patient&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Materials</span><p id="par0095" class="elsevierStylePara elsevierViewall">Anthropometric and sociodemographic variables such as age&#44; gender&#44; body mass index &#40;BMI&#41; and disability &#40;World Health Organization &#40;WHO&#41; Disability Assessment Scale&#44; WHODAS 2&#46;0 &#40;WD2&#41;&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0230">Xenouli&#44; Xenoulis&#44; Sarafis&#44; Niakas&#44; &#38; Alexopoulos&#44; 2016</a>&#41; were collected accompanied by the pathology characteristics &#40;diagnosis and time since diagnosis&#41;&#46; Additionally&#44; physical status&#44; ventilatory&#44; phonatory and swallowing function were measured&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Physical status assessment</span><p id="par0100" class="elsevierStylePara elsevierViewall">Physical status was evaluated by handgrip strength with a pressure dynamometer Jamar Plus<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Digital Hand Dynamometer&#44; 200Ib &#40;Sammons Preston Rolyan&#44; Bolingbrook&#44; IL&#44; USA&#41; according to the protocol&#46; The results were expressed in Newtons&#46; Patients were classified with lower level of physical status when they had low muscle strength&#46; Low muscle strength was defined as lower than 10<span class="elsevierStyleHsp" style=""></span>kg &#40;<a class="elsevierStyleCrossRef" href="#bib0160">Norman&#44; Stob&#228;us&#44; Gonzalez&#44; Schulzke&#44; &#38; Pirlich&#44; 2011</a>&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Functionality of the upper airway was assessed including ventilatory&#44; phonatory and swallowing functions&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">The ventilatory assessment</span><p id="par0110" class="elsevierStylePara elsevierViewall">Ventilatory function was evaluated using the spirometry&#44; the peak expiratory flow measurement and the perception of dyspnea&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Spirometry was performed using Spirobank II &#40;MIR&#44; Italy&#41;&#46; Collected variables were Forced Expiratory Volume in the First Second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; Forced Vital Capacity &#40;FVC&#41;&#44; Maximal Voluntary Ventilation &#40;MVV&#41;&#44; Peak Expiratory Flow &#40;PEF&#41; and Maximum Expiratory Flow &#40;MEF&#41;&#46; All measures were made following the standardized technical statement of the American Thoracic Society and European Respiratory Society &#40;<a class="elsevierStyleCrossRef" href="#bib0095">Graham et al&#46;&#44; 2019</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Peak expiratory flow &#40;PEF&#41; measurement and the peak cough flow &#40;PCF&#41; were evaluated using the wright peak flow meter&#46; PEF and PFC were performed following the protocol previously used in NMD patients &#40;<a class="elsevierStyleCrossRef" href="#bib0090">Gauld &#38; Boynton&#44; 2005</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The perception of dyspnea was evaluated with the modified Borg scale &#40;<a class="elsevierStyleCrossRef" href="#bib0030">Borg&#44; 1982</a>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">The phonatory assessment</span><p id="par0130" class="elsevierStylePara elsevierViewall">Phonatory function was evaluated through the analysis of aerodynamic measures of the voice&#44; acoustic analysis of the voice and perception of dysphonia&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Analysis of aerodynamic measures of the voice allows us to know the values of the maximum phonation time &#40;MPT&#41; and the maximum expiration time &#40;MET&#41;&#44; measured in seconds &#40;sc&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0155">Neiman &#38; Edeson&#44; 1981</a>&#41;&#46; The MET allows us to access to a parameter of the relationship between phonation and expiration&#46; The relationship between MPT and MET is reflected in the so-called <span class="elsevierStyleItalic">s</span>&#47;<span class="elsevierStyleItalic">z</span> ratio&#46; It is interpreted as an indicator of glottic closure efficiency&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The acoustic voice analysis allows objectifying the evaluation of the voice with numerical parameters&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The acoustic signal was recorded using the PRAAT application for mac&#44; version 6&#46;0&#46;33&#46; The PRAAT program is a tool for phonetic analysis of voice&#44; for which the evaluator previously trained &#40;<a class="elsevierStyleCrossRef" href="#bib0020">Boersma&#44; 2001</a>&#41;&#46; The computer used was a MacBook Air PC with 8 Gigabytes &#40;Gb&#41; RAM that works at a speed of 2133 Megahertz &#40;MHz&#41;&#46; The microphone was unidirectional dynamic with a noise level equivalent to 22<span class="elsevierStyleHsp" style=""></span>dB &#40;decibels&#41; &#40;A&#41;&#46; The sampling frequency was 44&#44;100 Herzios &#40;Hz&#41; and a high frequency resolution microphone was used&#44; which was placed 10<span class="elsevierStyleHsp" style=""></span>cm from the patient&#39;s mouth while phoning a vowel &#47; a &#47; at intensity and comfortable tones in a quiet and empty room&#46; 3 sc were captured from the computer emission&#46; The recommendations of the National Center for Voice and Speech were followed &#40;<a class="elsevierStyleCrossRef" href="#bib0200">Titze&#44; 1994</a>&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The recordings of the controls were made in their homes&#44; an the way that was done for the recordings of the patients&#46; Following the same protocol&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Regarding the signal-to-noise ratio &#40;SNR&#41;&#44; it was carried out with a ratio above 30<span class="elsevierStyleHsp" style=""></span>dB to have voice measurements with an accuracy above 95&#37;&#44; proposed by <a class="elsevierStyleCrossRef" href="#bib0075">Deliyski&#44; Shaw&#44; and Evans &#40;2005&#41;</a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Acoustic voice analyzes were completed with the Dysphonia Severity Index &#40;DSI&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0225">Wuyts et al&#46;&#44; 2000</a>&#41;&#46; It collects the MPT&#44; the highest fundamental frequency &#40;F0&#41; measured in herzios &#40;Hz&#41; and the lowest sound pressure level &#40;SPL&#41; intensity in decibels &#40;dB&#41; and jitter &#40;dB&#41;&#46; We used the PRAAT software to evaluated F0&#44; SPL&#44; jitter&#44; shimmer an harmonics-to-noise ratio &#40;HNR&#41;&#46; Its weighting is expressed in the following formula&#58; DSI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;13<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>MPT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;0053<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>F0 max&#46;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#46;26<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>SPL Min&#46;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>1&#46;18<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>jitter<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>12&#46;4&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The phonatory function and it&#39;s repercussion on daily life was evaluated by the Voice handicap index &#40;VHI-10&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0120">Jacobson et al&#46;&#44; 1997</a>&#41;&#46; This scale consists of 10 items&#44; where the patient indicates the presence of symptoms of dysphonia with a Likert type score of 5 points&#44; in which 0 indicates never and 4 indicates always&#46; A version adapted to children of these questionnaire were used for the child population&#44; the Children&#39;s Voice Handicap Index-10 &#40;CVHI-10&#41;&#46; This scale has the same items and score than VHI-10&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">The swallowing assessment</span><p id="par0170" class="elsevierStylePara elsevierViewall">Swallowing function evaluation included the clinical examination of dysphagia&#44; presence and severity of dysphagia&#44; and swallowing quality of life&#46; Additionally&#44; we evaluated the orofacial myofunctional condition&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The clinical examination of dysphagia was performed using the Volume-Viscosity Swallow test &#40;V-VST&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0060">Clav&#233; et al&#46;&#44; 2008</a>&#41;&#46; The aim of the V-VST is to identify clinical signs of impaired efficacy of swallow during swallowing of three viscosities &#40;Nectar&#44; Liquid and Pudding&#41;&#59; and clinical signs of impaired safety during swallow&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The presence of dysphagia was evaluated with the Eating Assessment Tool-10 &#40;EAT-10&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0015">Belafsky et al&#46;&#44; 2008</a>&#41;&#46; The EAT-10 is a self-administered instrument that evaluate specific symptoms of dysphagia with 10 items and each item have a range from 0 &#40;no problem to swallow&#41; to 4 &#40;a serious problem for life&#41;&#46; A version adapted to children of these questionnaire were used for the child population&#44; the Pediatric Eating Assessment Tool &#40;PEDI-EAT-10&#41;&#46; This scale has the same items and score than EAT-10&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The severity of swallowing was assessed using the Functional Oral Intake Scale &#40;FOIS&#41; questionnaire &#40;<a class="elsevierStyleCrossRef" href="#bib0065">Crary et al&#46;&#44; 2005</a>&#41;&#46; This scale consists of 7 levels&#44; with 1 being the most severe and 7 being the least severe&#44; the patient has to select the level with which he&#47;she is&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Swallowing quality of life questionnaire &#40;SWAL-QOL&#41; measures the possible swallowing problems in daily life&#44; it contains 44 items and each item is scored from 0 &#40;the worst state&#41; to 5 &#40;the best state&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0213">Zaldibar-Barinaga et al&#46;&#44; 2013</a>&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The clinical evaluation of the orofacial myofunctional condition was assessed by the Orofacial Myofunctional Evaluation with Scores &#40;OMES&#41;&#46; It consists of 4 subscales&#58; appearance and posture&#44; mobility and functions&#46; The examiner attributed scores on a 3 point scale&#58; 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>normal&#44; 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>insufficient ability&#59; and 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>absence of ability or being unable to perform the task &#40;<a class="elsevierStyleCrossRef" href="#bib0070">De Felicio &#38; Pimenta-Ferreira&#44; 2008</a>&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0200" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with the Statistical Package for the Social Sciences &#40;SPSS&#41; program&#44; version 20&#46;0 &#40;International Business Machines&#44; Armonk&#44; NY&#41;&#46; Normal distribution of the data was tested by Kolmogorov&#8211;Smirnov test &#40;with Lilliefors&#8217; correction&#41;&#46; The homogeneity of variances was approached with Fisher&#39;s <span class="elsevierStyleItalic">F</span>-test&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">If both conditions were satisfied&#44; parametric tests were used&#46; If any of the conditions was not satisfied&#44; a nonparametric test was used instead&#46; A 95&#37; confidence interval and a p value of 0&#46;05 were considered to be significant&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0210" class="elsevierStylePara elsevierViewall">The results are discussed below for the 48 participants&#46; The final sample consisted of 24 patients with NMD and 24 healthy controls&#46; Flow diagram describing the number of participants screened&#44; and included in the study are reported in <a class="elsevierStyleCrossRef" href="#fig1">Fig&#46; 1</a>&#46; NMD patients were divided into two groups depending on their level of physical status&#58; 11 patients were included in the NMD with lower physical status group and 13 patients were included in the NMD with higher physical status group&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Participant&#39;s characteristics</span><p id="par0215" class="elsevierStylePara elsevierViewall">We will provide an overview of the characteristics of participant&#39;s in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; There were no differences among groups in age&#44; gender and anthropometric characteristics&#46; As regards to time since diagnosis&#44; significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; were found when NMD with higher physical status group and NMD lower physical status group are compared&#46; The NMD lower physical status group comprised patients for whom the time since diagnosis was 1485<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1515 years on average&#44; whereas for the patients in the NMD higher physical status group it was of 7&#46;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;90 years&#46; Significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; were found in the handgrip force between the three groups&#46; On the same scale&#44; for the subscales Cognition&#44; Mobility&#44; Self-care&#44; Life activities&#44; Participation and WHODAS-total&#44; there were significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; when comparing NMD higher physical status group and NMD lower physical status group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; finally there were significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; in all subscales of WHODAS scale&#44; when comparing NMD lower physical status group and control group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Ventilatory characteristics of the participants</span><p id="par0220" class="elsevierStylePara elsevierViewall">The scores for ventilatory measures are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; were found in spirometry for FVC&#37; and FEV1&#37; measures&#44; between the three groups&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Phonatory characteristics of the participants</span><p id="par0225" class="elsevierStylePara elsevierViewall">Phonatory measures are reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; were found for MET and MPT measures&#44; between the three groups&#46; Also&#44; in this last outcome NMD lower physical status group had the worse time&#44; a MPT lower than 10 secons &#40;sc&#41; is considered pathological and in this group was 8&#46;50<span class="elsevierStyleHsp" style=""></span>sc&#46; &#40;<a class="elsevierStyleCrossRef" href="#bib0005">Adrian &#38; Casado&#44; 2002</a>&#41;&#46; Significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; were found in SPL and DSI when comparing NMD lower physical status&#44; with a control group and higher physical status group and when comparing lower and higher physical status&#46; While in acoustics measurements Jitter exceeds the limit of normality for both NMD groups&#44; higher and lower&#46; For the variable Jitter both groups got 1&#46;89&#37;&#44; Jitter higher than 0&#46;45&#37; is considered pathological&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Swallowing characteristics of the participants</span><p id="par0230" class="elsevierStylePara elsevierViewall">The different swallowing and orofacial characteristics detected in our patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; Significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; were found in the Clinical examination of dysphagia&#44; for all subscales&#44; between the three groups with higher impairments in the NMD group with lower physical status&#44; except for recommended viscosity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0235" class="elsevierStylePara elsevierViewall">When orofacial characteristics were analyzed between groups&#44; significant differences were found in &#40;OMES test&#41; or &#40;OMES-Mobility&#44; OMES-Function Breathing&#44; OMES-Functions&#59; deglutition&#58; lips behavior&#44; OMES-Functions&#59; Deglutition&#58; other behavior and changes signals&#44; OMES-Functions&#59; deglutition efficiency&#44; OMES-Functions&#59; mastication&#44; and OMES-Functions&#59; mastication&#58; others behaviors and changes&#41; when comparing NMD lower physical status&#44; with a control group and higher physical status group&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0240" class="elsevierStylePara elsevierViewall">The goal of this study was to investigate the ventilatory&#44; phonatory and swallowing functions and their relation with physical status in a group of advanced NMD&#46; Upper airway functionality and issues related to a lower level of physical status were identified among the patients with NMD as compared to the control group in this study&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">When patients with NMD with a lower level of physical status are compared with NMD with higher level of physical status&#44; the former exhibit significantly higher ventilatory&#44; phonatory and swallowing functions&#46; Our findings as expected show that both groups of NMD have worse ventilatory&#44; phonatory and swallowing outcomes than healthy controls&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The sociodemographic and clinical characteristics of the population included in this study&#44; as well as the sample size&#44; were similar to other studies such as <a class="elsevierStyleCrossRef" href="#bib0170">Pellegrini et al&#46; &#40;2004&#41;</a> and <a class="elsevierStyleCrossRef" href="#bib0185">Shapiro et al&#46; &#40;2014&#41;</a>&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Numerous studies&#44; such as that of <a class="elsevierStyleCrossRef" href="#bib0055">Clark and Manini &#40;2010&#41;</a>&#44; affirm that functional deterioration is associated with physical deterioration&#44; however the impact that this deterioration has on the functionality of the upper airway and their ventilatory&#44; phonatory and swallowing in advanced NMD has not been studied previously&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">In this study&#44; patients with less than 10<span class="elsevierStyleHsp" style=""></span>kg in the hand grip strength test were the ones who showed the worst results in the evaluations&#44; like it was predicted by a previously study by <a class="elsevierStyleCrossRef" href="#bib0160">Norman et al&#46; &#40;2011&#41;</a>&#46; We used this test specifically&#44; since the use of self-perceived scales to assess physical state is sometimes not objective enough&#46; This could be due to the fact that patients who have a worse physical condition have a different perception of pain and the degree of disability&#46; Since&#44; they are used to enduring a higher level of discomfort and difficulties&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Other studies&#44; for example that of <a class="elsevierStyleCrossRef" href="#bib0195">Suarez et al&#46; &#40;2002&#41;</a>&#44; have observed that the general weakness in NMD cause debilitation of the ventilatory function&#46; Data from our study show that the ventilatory variables seem to be significantly worsen in advanced NMD with lower physical status patients&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">In the same line the literature highlights the fact that the phonatory capacities become more impaired as disability increases in NMD &#40;<a class="elsevierStyleCrossRef" href="#bib0205">Tomik et al&#46;&#44; 2015</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#bib0050">Carpenter&#44; McDonald&#44; and Howard &#40;1978&#41;</a>&#44; found the occurrence of phonatory difficulties in about 25&#37; of their ALS patients&#46; In our study the higher phonatory dysfunction was shown in both groups of NMD&#44; however NMD lower physical status group shown the worse result&#46; This can be observed by the results of dysphonia severity&#44; and acoustic analysis of voice data&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Acoustic analysis of the voice was introduced as a means for more objective description of phonatory disturbances&#46; Our study utilized the four most important and commonly used parameters F0&#44; jitter&#44; shimmer and HNR&#46; The patients were characterized with increased values of jitter&#44; shimmer&#44; HNR&#44; while no impact on mean F0 was noted&#46; Similar findings related to acoustic examination of voice were reported by <a class="elsevierStyleCrossRef" href="#bib0205">Tomik et al&#46; &#40;2015&#41;</a>&#46; In the evaluation of perception of dysphonia and dysphagia&#44; has been discovered that NMD higher physical status group have a worse result than NMD lower physical status group&#44; which would go against expectations&#46; These it happens on the other occasions&#44; in NMD patients&#44; when we compare the results of self-perceived questionnaires&#44; patients with a lower level of physical status have a better result than those with a higher level of physical status &#40;<a class="elsevierStyleCrossRef" href="#bib0190">Simmons&#44; 2015</a>&#41;&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">The early evaluation of swallowing function in NMD patients can make possible the prevention of complications that may develop later like aspiration and choking&#46; Studies such as <a class="elsevierStyleCrossRef" href="#bib0060">Clav&#233; et al&#46; &#40;2008&#41;</a> used V-VST to diagnose oropharyngeal dysphagia&#44; these studies found that most of their patients at risk of complications were quickly safely and accurately recognized using V-VST&#46; They refer dysphagia as a highly prevalent condition among vulnerable patients with neurodegenerative diseases&#46; Our results about the prevalence of V-VST dysphagia signs and impaired swallow response agree with previous studies in neurological and neurodegenerative patients &#40;<a class="elsevierStyleCrossRef" href="#bib0175">Power et al&#46;&#44; 2007</a>&#41;&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Despite the existence of evidence about the relationship between affectation of upper airway and NMD&#44; there is little research focused on advanced NMD patients whose have different level of physical status&#46;</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Limitations</span><p id="par0290" class="elsevierStylePara elsevierViewall">Firstly&#44; the cross-sectional design of this study precludes the possibility of being able to make causal inferences&#46; We do not know in which cases age or functional mobility was the cause or the consequence of the assessed physical status&#46; It is necessary to conduct longitudinal studies that explore the causality between these outcome measurements&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">A second limitation of this study is that we only assessed strength using hand grip strength measure&#46; However&#44; the hand grip strength has proven to be reliable and adequate to assess the strength&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Thirdly&#44; the participants were not recruited in clinical settings&#59; nevertheless&#44; in Spain most patients with NMD belong to patients&#8217; associations&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Finally&#44; the present study has a small sample size&#44; which is explained by the low prevalence rate of NMD&#46; Therefore&#44; the interpretation of the findings should be done with caution&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">In conclusion&#44; ventilatory&#44; phonatory and swallowing difficulties were observed in the of participants with NMD in this study compared to a control group&#46; Patients with lower physical status have higher risk of ventilatory&#44; phonatory and swallowing impaired after diagnosis of NMD &#40;<a class="elsevierStyleCrossRef" href="#bib0115">Hull et al&#46;&#44; 2012</a>&#41;&#46; Evaluation of these disorders and physical status should be taken into account for the design of the therapeutic approach in NMD patients&#46; A refined intervention should be tested in a randomized clinical trial with an adequately powered sample size&#46; That therapeutic approach to those patients should incorporate an integrated process including global physical status and ventilatory&#44; phonatory and swallowing training&#46;</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Funding</span><p id="par0330" class="elsevierStylePara elsevierViewall">No author reported sources of funding&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interest</span><p id="par0320" class="elsevierStylePara elsevierViewall">The authors report no conflicts of interest&#46;</p></span></span>"
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            0 => "Neuromuscular disease"
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            0 => "Enfermedad neuromuscular"
            1 => "Alteraci&#243;n ventilatoria"
            2 => "Alteraci&#243;n fonatoria"
            3 => "Alteraci&#243;n deglutoria"
            4 => "Fuerza de prensi&#243;n manual"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the ventilatory&#44; phonatory and swallowing impairments and their relation with physical status in a group of advanced Neuromuscular Disease &#40;NMD&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional observational study was utilized 48 participants from the Association of NMD of Granada &#40;Granada&#44; Espa&#241;a&#41;&#44; university clinical research&#44; University of Granada&#46; A total of 24 advanced NMD patients and 24 healthy controls matched for age and sex were recruited&#46; Advanced NMD patients were divided in two groups according to the level of their overall physical status &#40;NMD higher physical status group or NMD lower physical status group&#41;&#46; Hand grip strength&#44; ventilatory&#44; phonatory and swallowing features were analyzed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; among NMDs groups in ventilatory function&#46; There were significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; between NMDs groups in ventilatory&#44; phonatory and swallowing function&#46; Finally&#44; there were significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; among advanced NMDs groups in swallowing function and orofacial evaluation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients with lower physical status have higher risk of suffer ventilatory&#44; phonatory and swallowing complications after diagnosis of NMD&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Registered in the Clinical Trials reference&#58; <span class="elsevierStyleInterRef" id="intr0005" href="ctgov:NCT04473612">NCT04473612</span>&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Prop&#243;sito</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar las alteraciones ventilatorias&#44; fonatorias y deglutorias y su relaci&#243;n con el estado f&#237;sico en un grupo de Enfermos Neuromusculares &#40;ENM&#41; avanzados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio observacional transversal con 48 participantes de la Asociaci&#243;n de ENM de Granada &#40;Granada&#44; Espa&#241;a&#41;&#44; y de la facultad de ciencias de la salud de la Universidad de Granada&#46; Se reclutaron un total de 24 pacientes con ENM avanzada y 24 controles sanos emparejados por edad y sexo&#46; Los pacientes con ENM avanzada se dividieron en dos grupos seg&#250;n el nivel de su estado f&#237;sico general &#40;grupo de ENM de mayor estado f&#237;sico o grupo de ENM de menor estado f&#237;sico&#41;&#46; Se analiz&#243; la fuerza de agarre de las manos y las caracter&#237;sticas ventilatorias&#44; fonatorias y deglutorias&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se encontraron diferencias significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; entre los grupos de ENM en la funci&#243;n ventilatoria&#46; Tambi&#233;n&#44; se observaron diferencias significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; entre los grupos de ENM en la funci&#243;n fonatoria y deglutoria&#46; Por &#250;ltimo&#44; existieron diferencias significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; entre los grupos de ENM avanzados respecto a la condici&#243;n miofuncional orofacial&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con menor estado f&#237;sico tienen mayor riesgo de sufrir complicaciones ventilatorias&#44; fonatorias y deglutorias tras el diagn&#243;stico de ENM&#46;</p></span>"
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                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DMD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mitochondrial myopathy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Myasthenia Gravis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;987<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">97&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V-VST Mixed alteration <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 02144603
Original language: English

DOI:10.1016/j.rlfa.2022.11.002

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