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Picard D, Hervochon R, Lannadere E, Cabos C, Gourves L, Tankere F, Gatignol P. Normal Facial Function in the Sunnybrook Facial Grading System: Is the 100% Score too Restrictive? Clin Otolaryngol 2024. [PMID: 39215610 DOI: 10.1111/coa.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/09/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES The primary objective of this study was to describe the distribution of the Sunnybrook Facial Grading System scores in the general population. Secondary objectives included analyzing the effects of age, gender and facial side on these scores. DESIGN Two speech therapists specializing in facial motor skill assessment evaluated the healthy participants using the Sunnybrook Facial Grading System, first with the right hemiface as a reference and then with the left hemiface as a reference. SETTING The study was conducted in our ENT department from September 2022 to June 2023. PARTICIPANTS One hundred eleven healthy participants were included (57 women and 54 men), aged 18 to 79 years. MAIN OUTCOME MEASURES SFGS composite scores (SFGS-Total) and sub-scores at rest (SFGS-Rest) and in movement (SFGS-Movement) were studied according to three age categories (18-39 years) (40-59 years) and (60-79 years) and gender. Inter-rater reliability was collected between the two evaluators with Cronbach's alpha. RESULTS Taking the right hemiface as a reference, SFGS-Total scores ranged from 65% to 100% (median = 96, IQR [91-100]). When the left hemiface was considered as the reference, scores ranged from 78% to 100% (median = 95; IQR [90-100]). Right and left SFGS-Total scores showed high inter-rater reliability (respectively α = 0.953 and α = 0.926). There was a slight negative correlation between age and SFGS-Total scores. CONCLUSIONS By embracing a more realistic approach that acknowledges natural variations and asymmetry in facial movements, we can enhance patient care and promote a more holistic understanding of facial rehabilitation outcomes.
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Affiliation(s)
- Diane Picard
- AP-HP, ENT Department, Pitié-Salpêtrière University Hospital, Paris, France
| | - Remi Hervochon
- AP-HP, ENT Department, Pitié-Salpêtrière University Hospital, Paris, France
| | - Elodie Lannadere
- AP-HP, ENT Department, Pitié-Salpêtrière University Hospital, Paris, France
| | - Cloe Cabos
- AP-HP, ENT Department, Pitié-Salpêtrière University Hospital, Paris, France
| | - Loeiza Gourves
- AP-HP, ENT Department, Pitié-Salpêtrière University Hospital, Paris, France
| | - Frederic Tankere
- AP-HP, ENT Department, Pitié-Salpêtrière University Hospital, Paris, France
| | - Peggy Gatignol
- AP-HP, ENT Department, Pitié-Salpêtrière University Hospital, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Attali V, Weber M, Rivals I, Similowski T, Arnulf I, Gatignol P. Moderate-to-severe obstructive sleep apnea syndrome is associated with altered tongue motion during wakefulness. Eur Arch Otorhinolaryngol 2023; 280:2551-2560. [PMID: 36707431 DOI: 10.1007/s00405-023-07854-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/18/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Impairment of genioglossus control is a frequent "non-anatomical" cause of obstructive sleep apnea syndrome (OSAS) in non- or mildly obese patients. Although wake-related compensatory mechanisms prevent the occurrence of obstructive events, the genioglossus control is often impaired during wakefulness. We hypothesized that the lingual motion would be altered during wakefulness in this population in patients with moderate-to-severe OSAS. METHODS We included non- or mildly obese participants with suspected OSAS. They underwent a Bucco-Linguo-Facial Motor Skills assessment using the MBLF ("Motricité Bucco-Linguo-Faciale"), which includes an evaluation of 13 movements of the tongue. This was followed by a night-attended polysomnography. We compared patients with moderate-to-severe OSAS (apnea-hypopnea index (AHI) ≥ 15/h; n = 15) to patients without or with mild OSAS (AHI < 15/h; n = 24). RESULTS MBLF total and "tongue" sub-scores were lower in patients with moderate-to-severe OSAS: total z-score - 0.78 [- 1.31; 0.103] versus 0.20 [- 0.26; 0.31], p = 0.0011; "tongue" z-sub-score (- 0.63 [- 1.83; 0.41] versus 0.35 [0.26; 0.48], p = 0.014). There was a significant age-adjusted correlation between the "tongue" sub-score and AHI. The logistic regression model for the prediction of moderate-to-severe OSAS gave area under the curve ratio of 88.2% for MBLF score plus age. CONCLUSIONS Myofunctional activity of the tongue is impaired during wakefulness in non- or mildly obese patients with moderate-to-severe OSAS. This study supports the lingual myofunctional assessment using the MBLF in screening of moderate-to-severe OSAS. This simple tool could help clinicians to select patients with suspected moderate-to-severe OSAS for polysomnography.
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Affiliation(s)
- Valérie Attali
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France. .,Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
| | - Mathilde Weber
- Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France
| | - Isabelle Rivals
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département R3S, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Isabelle Arnulf
- Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institut du Cerveau, Paris Brain Institute-ICM, INSERM, CNRS, Sorbonne Université, 75013, Paris, France
| | - Peggy Gatignol
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.,Département d'Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France.,Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
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Renom-Guiteras M, Najas-Sales V, Ramirez-Mirabal E, Nadal-Castells MJ, Pintor-Ojeda A, Bascuñana-Ambrós H. [Holistic semi-presential evaluation of oropharygeal dysphagia with the framework of International Classification of Functioning, Disability and Health: Optimizing evaluation to improve rehabilitation treatment]. Rehabilitacion (Madr) 2023; 57:100735. [PMID: 35570031 DOI: 10.1016/j.rh.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/21/2021] [Accepted: 03/01/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Oropharyngeal dysphagia can lead to medical complications and decreased quality of life. Although there is a wide diversity of instrumental and clinical procedures to assess it, consensus for its holistic evaluation is scarce and poorly defined. The objective of this article is to present the design of a model for the holistic examination of oropharyngeal dysphagia that takes into account the components of the International Classification of Functioning, Disability and Health (ICF) and that can be carried out both face to face and semi-presentially using Information and Communication Technology (ICT) tools. MATERIAL AND METHODS A non-systematic review of the literature is carried out in order to select validated oropharyngeal dysphagia assessment tools with the highest degree of recommendation. These tools are analyzed by a group of experts in oropharyngeal dysphagia from the Hospital de la Santa Creu i Sant Pau in Barcelona to design a holistic exploration model. RESULTS This evaluation model includes an assessment at the beginning and at the end of the treatment, as well as continuous monitoring during the rehabilitation process. It is implemented in a semi-presential and multidisciplinary way, and its purpose is to understand oropharyngeal dysphagia holistically to design and monitor an individualized therapeutic plan. CONCLUSIONS The evaluation of oropharyngeal dysphagia should be within the biopsychosocial framework proposed by the ICF. The application of ICT in blended interventions facilitates this.
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Affiliation(s)
- M Renom-Guiteras
- Servicio de Medicina Física y Rehabilitación (MFRHB), Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - V Najas-Sales
- Facultad de Psicología, Ciencias de la Educación y del Deporte, Blanquerna, Universidad Ramón Llull, Barcelona, España
| | - E Ramirez-Mirabal
- Servicio de MFRHB, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, España
| | - M J Nadal-Castells
- Servicio de MFRHB, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, España
| | - A Pintor-Ojeda
- Servicio de MFRHB, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, España
| | - H Bascuñana-Ambrós
- Servicio de MFRHB, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, España.
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