ABSTRACT
Purpose
Translate into Brazilian Portuguese and culturally adapt the component scores definition from the Modified Barium Swallow Impairment Profile – MBSImP videofluoroscopy protocol.
Methods
This study was conducted based on international guidelines for creation, translation and transcultural adaptation according to domestic publications for the validation of international speech-language pathology tests. A specialist committee was convened with two otorhinolaryngologists and three speech-language pathologists familiar with videofluoroscopy examinations. Translation into Brazilian Portuguese was carried out by two otorhinolaryngologists with subsequent back translation performed independently by two U.S.-born translators. The final Brazilian Portuguese version was written by speech-language pathologists after revision of translations and back translations resolved semantic, idiomatic, conceptual, linguistic and contextual inconsistencies. This version was tested by committee members, who assessed subjects with no disease, with head and neck cancer and with mild cognitive impairment.
Results
Translation of the component scores definition from MBSImP was performed independently and translators agreed on a final version. The MBSImP protocol was renamed “Martin-Harris scale for swallowing videofluoroscopy”. Some terms were adapted for the final Brazilian Portuguese version. Use of the translated protocol did not reveal any deviations from the original.
Conclusion
Translation of the MBSImP fragment into Brazilian Portuguese was consistent with the original version. Approval from specialist committee members refined the protocol adaptation, allowing precise concepts to be accurately translated.
Keywords
Clinical Protocols; Translation; Swallowing Disorders; Fluoroscopy; Speech-Language Pathology
RESUMO
Objetivo
Traduzir para o português brasileiro e adaptar culturalmente a definição dos componentes e pontuação (Component Scores Definition) pertencentes ao protocolo para videofluoroscopia Modified Barium Swallow Impairment – MBSImPTM.
Método
Esse estudo foi desenvolvido com base nas recomendações internacionais para elaboração, tradução e adaptação transcultural em consonância com publicações nacionais para validação de testes internacionais em Fonoaudiologia. Foi formado um comitê de especialistas, composto por dois médicos otorrinolaringologistas e três fonoaudiólogas conhecedoras do exame de videofluoroscopia. A tradução para o português brasileiro foi realizada por dois otorrinolaringologistas com retrotradução de forma independente por dois nativos norte-americanos. A versão final em português brasileiro foi elaborada pelas fonoaudiólogas certificadas após a revisão das traduções e das retrotraduções com resolução de discrepâncias semânticas, idiomáticas, conceituais, linguísticas e contextuais. Essa versão foi testada pelas fonoaudiólogas membros do Comitê, que avaliaram indivíduos saudáveis, com Câncer de Cabeça e Pescoço e Comprometimento Cognitivo Leve.
Resultados
A tradução da definição dos componentes e pontuação do MBSImP foi realizada de forma independente e os tradutores chegaram a um consenso para a versão final. O protocolo original Modified Barium Swallow Impairment, foi traduzido para “Escala Martin-Harris para videofluoroscopia da deglutição”. Na versão final em português brasileiro alguns termos foram adaptados. A aplicação do protocolo traduzido não apresentou discrepâncias em relação ao protocolo original.
Conclusão
A tradução do excerto do protocolo MBSImP para o português brasileiro foi compatível com a versão original. A certificação de membros do comitê favoreceu a adaptação do material, permitindo a adaptação conceitual.
Descritores
Protocolos Clínicos; Tradução; Transtornos de Deglutição; Fluoroscopia; Fonoaudiologia
INTRODUCTION
Videofluoroscopy of the swallowing function (VFS) is an instrumental assessment tool to visualize deglutition physiology, dynamically capturing food passage through the oral cavity, pharynx and esophagus. VFS is regarded as the gold standard in assessing the swallowing function(11 Swan K, Cordier R, Brown T, Speyer R. Psychometric properties of visuoperceptual measures of videofluoroscopic and fibre-endoscopic evaluations of swallowing: a systematic review. Dysphagia. 2019;34(1):2-33. http://dx.doi.org/10.1007/s00455-018-9918-3. PMid:30019178.
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). However, the use of standardized protocols for performing the assessment and interpreting the results is not widespread in clinical and academic practices.
Assessing the swallowing function is done by analyzing images generated by the fluoroscope, a device capable of x-ray video recording at least at 30 frames per second. When less than 30 fps is used, some events cannot be captured during swallowing of barium sulfate contrast medium. These images can be recorded for further analysis and reviewed without subjecting patients to new assessments, while also reducing their exposure to radiation(22 Logemann JA. Manual for videofluorographic study of swallowing. 2nd ed. Austin: ProEd; 1993.,33 Costa MMB. Videofluoroscopy: a radiological method indispensable for medical practice. Radiol Bras. 2010;43(2):VII-VIII.). VFS can provide information about structures and biomechanics of deglutition, besides pinpoint instances of stasis, penetration and/or aspiration in different places, degrees and times. Apart from diagnosing possible alterations in swallowing physiology, the examination allows testing of varied therapeutic approaches (seeking more adequate consistencies, utensils and postural maneuvers) and management of oropharyngeal dysphagia during rehabilitation(44 ASHA: American Speech and Hearing Association. Knowledge and skills needed by speech-language pathologist providing services to individuals with swallowing and/or feeding disorders. Rockville: ASHA; 2004. p. 81-88. (ASHA Supplements; 22).). The Brazilian Federal Council of Speech Pathology, through Law No. 6 965/81, decree No. 87 218/82 and its bylaws, recommends that speech pathologists performing VFS be capable of “(…) executing suitable instrumental evaluations according to currently employed protocols”(55 Brasil. Conselho Federal de Fonoaudiologia. Recomendação CFFa nº 17, de 18 de fevereiro de 2016 [Internet]. Diário Oficial da União; Brasília; 18 fev. 2016 [citado em 2020 Ago 23]. Disponível em: https://www.sbfa.org.br/portal2017/themes/2017/departamentos/artigos/resolucoes_28.pdf
https://www.sbfa.org.br/portal2017/theme...
).
One of the first VFS protocols was proposed by Logemann in 1993, and many assessments continue to follow its guidelines regarding consistencies, volume, administration procedures and patient positioning(66 Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008;19(4):769-85, viii. http://dx.doi.org/10.1016/j.pmr.2008.06.004. PMid:18940640.
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). Today, however, there are many diverse methodologies used by investigators concerning the interpretation of physiological aspects, with modifications introduced by radiology services or even academic research. Because of this, the selection of components and interpretation of VFS results do not follow a common terminology amongst professionals. A study in Brazil that intended to analyze and compare the use of Brazilian and American VFS protocols in patients with a history of cerebrovascular accidents concluded that most local papers do not sufficiently describe the employed methodology, while the same is not true in foreign studies. Nonetheless, no adequate standardization for the fluoroscopic assessment was found in any of them(77 Resende PD, Dobelin JB, Oliveira IB, Luchesi KF. Disfagia orofaríngea neurogênica: análise de protocolos de videofluoroscopia brasileiros e norte-americanos. Rev CEFAC. 2015;17(5):1610-9. http://dx.doi.org/10.1590/1982-021620151754315.
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).
Even though VFS is an instrumental examination, in order to interpret its results, the speech-language pathologist must subjectively judge the visuoperceptive features of resulting images based on defined deglutition components to establish an analysis framework(11 Swan K, Cordier R, Brown T, Speyer R. Psychometric properties of visuoperceptual measures of videofluoroscopic and fibre-endoscopic evaluations of swallowing: a systematic review. Dysphagia. 2019;34(1):2-33. http://dx.doi.org/10.1007/s00455-018-9918-3. PMid:30019178.
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).
When VFS protocols are standardized, validated and interpreted by trained personnel, strategies for rehabilitation may be put in place and communicated more consistently among different specialists, positively impacting the therapeutic process. Furthermore, the use of a standardized protocol in academic research supports reproducibility(66 Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008;19(4):769-85, viii. http://dx.doi.org/10.1016/j.pmr.2008.06.004. PMid:18940640.
http://dx.doi.org/10.1016/j.pmr.2008.06....
). Therefore, several initiatives were created to systematize VFS assessments.
A few examples of these tools are the “Functional Dysphagia Scale (FDS)”, conceived in 2001 by Korean researchers to analyze 11 swallowing components(88 Han TR, Paik NJ, Park JW. Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil. 2001;82(5):677-82. http://dx.doi.org/10.1053/apmr.2001.21939. PMid:11346847.
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); “A Videofluoroscopic Dysphagia Scale (VDS)”, devised in 2008 by the same investigators and expanded to 14 components(99 Han TR, Paik N, Park J, Kwon BS. The prediction of persistent dysphagia beyond six months after stroke. Dysphagia. 2008;23(1):59-64. http://dx.doi.org/10.1007/s00455-007-9097-0. PMid:17602263.
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); “Modified Barium Swallow Impairment Profile (MBSImP)”, published in 2008 by United States researchers to evaluate 17 components(1010 Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, et al. MBS measurement tool for swallow impairment - MBSImp: establishing a standard. Dysphagia. 2008;23(4):392-405. http://dx.doi.org/10.1007/s00455-008-9185-9. PMid:18855050.
http://dx.doi.org/10.1007/s00455-008-918...
) and “Dynamic Imaging Grade of Swallowing Toxicity (DIGEST)”, presented in 2017, also by American scientists, analyzing two components(1111 Hutcheson KA, Barrow MP, Barringer DA, Knott JK, Lin HY, Weber RS, et al. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): scale development and validation. Cancer. 2017;123(1):62-70. http://dx.doi.org/10.1002/cncr.30283. PMid:27564246.
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). While FDS and VDS protocols were initially conceived to be used in post-stroke patients and DIGEST was directed to head and neck cancer subjects, MBSImP was tested in adult inpatients and outpatients with diverse medical and surgical backgrounds(1212 Martin-Harris B, Humphries K, Garand KL. The modified barium swallow impairment profile (MBSImP™©): innovation, dissemination and implementation. Perspectives. 2017;2(13):129-38.).
Although the use of each protocol presents challenges regarding their psychometric properties and there hasn’t been a consensus as to how to interpret VFS results(11 Swan K, Cordier R, Brown T, Speyer R. Psychometric properties of visuoperceptual measures of videofluoroscopic and fibre-endoscopic evaluations of swallowing: a systematic review. Dysphagia. 2019;34(1):2-33. http://dx.doi.org/10.1007/s00455-018-9918-3. PMid:30019178.
http://dx.doi.org/10.1007/s00455-018-991...
), MBSImP is currently acknowledged as a protocol that favors standardized swallowing assessments, and is widely employed by speech pathologists and radiologists since 2008 in several countries(1212 Martin-Harris B, Humphries K, Garand KL. The modified barium swallow impairment profile (MBSImP™©): innovation, dissemination and implementation. Perspectives. 2017;2(13):129-38.,1313 Martin-Harris B, Steele CM, Peterson J. Stand up for standardization: Collaborative clarification for clinicians performing Modified Barium Swallowing Studies (MBSS) [Internet]. Dysphagia Café’s; 16 jan. 2020 [citado em 2020 Ago 23]. Disponível em: https://dysphagiacafe.com/2020/01/16/stand-up-for-standardization-collaborative-clarification-for-clinicians-performing-modified-barium-swallowing-studies-mbss/
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). MBSImP was originally developed by a NIH-funded study and field tested for 13 years(1313 Martin-Harris B, Steele CM, Peterson J. Stand up for standardization: Collaborative clarification for clinicians performing Modified Barium Swallowing Studies (MBSS) [Internet]. Dysphagia Café’s; 16 jan. 2020 [citado em 2020 Ago 23]. Disponível em: https://dysphagiacafe.com/2020/01/16/stand-up-for-standardization-collaborative-clarification-for-clinicians-performing-modified-barium-swallowing-studies-mbss/
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), presenting, in its validation report, 80% for both inter- and intra-examiner reliabilities(1414 NSS: Northern Speech Services [Internet]. Modified barium swallowing impairment: MBSImP on-line course. Gaylord: NSS; 2020 [citado em 2020 Ago 23]. Disponível em: https://www.northernspeech.com/dysphagia-assessment-adult/introduction-to-mbsimp-a-standardized-protocol-for-assessment-of-swallowing-impairment
https://www.northernspeech.com/dysphagia...
).
According to MBSImP authors, the use of a standardized protocol allows to determine the presence, type and severity of swallowing impairment, establishes the efficiency of oral ingestion and safety of airways and aids observation of intervention outcomes such as postural and airway protection maneuvers, assisting further therapeutic planning(1212 Martin-Harris B, Humphries K, Garand KL. The modified barium swallow impairment profile (MBSImP™©): innovation, dissemination and implementation. Perspectives. 2017;2(13):129-38.,1313 Martin-Harris B, Steele CM, Peterson J. Stand up for standardization: Collaborative clarification for clinicians performing Modified Barium Swallowing Studies (MBSS) [Internet]. Dysphagia Café’s; 16 jan. 2020 [citado em 2020 Ago 23]. Disponível em: https://dysphagiacafe.com/2020/01/16/stand-up-for-standardization-collaborative-clarification-for-clinicians-performing-modified-barium-swallowing-studies-mbss/
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).
MBSImP evaluates 17 physiological components of swallowing: six regarding the oral phase, ten related to the pharyngeal phase and one corresponding to the esophageal phase. For each component, there are increasing degrees of alteration, representing higher impairment levels observed during swallowing tasks listed in the protocol. These degrees are added to obtain a final score for each swallowing phase, without attributing a general, global score. Totals for the oral phase range from 0 (normal) to 22 (severe impairment); pharyngeal phase ranges from 0 (normal) to 29 (severe impairment) and esophageal phase ranges from 0 (normal) to 4 (severe impairment)(1414 NSS: Northern Speech Services [Internet]. Modified barium swallowing impairment: MBSImP on-line course. Gaylord: NSS; 2020 [citado em 2020 Ago 23]. Disponível em: https://www.northernspeech.com/dysphagia-assessment-adult/introduction-to-mbsimp-a-standardized-protocol-for-assessment-of-swallowing-impairment
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).
The 12 swallowing tasks patients must perform are defined in the protocol guide. The authors detail the consistencies and the order they should be offered to patients. Instructions to the patient, ways of presenting the medium and patient positioning are also discussed. Additionally, there are detailed descriptions to enable the speech pathologist to attribute degrees following established criteria related to physiological swallowing events. Authors also provide, in the aforementioned guide, directions to specific situations, such as patients without some anatomical structures or making use of an alternative feeding method, adoption of compensatory techniques, consistencies best avoided for safety reasons and problems in image capturing, among others(1414 NSS: Northern Speech Services [Internet]. Modified barium swallowing impairment: MBSImP on-line course. Gaylord: NSS; 2020 [citado em 2020 Ago 23]. Disponível em: https://www.northernspeech.com/dysphagia-assessment-adult/introduction-to-mbsimp-a-standardized-protocol-for-assessment-of-swallowing-impairment
https://www.northernspeech.com/dysphagia...
).
Aiming to diagnose the incidence of penetration and aspiration during examinations, MBSImP considers the use of a scale developed by Rosenbek and collaborators(1515 Rosenbek JC, Robbins J, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-8. http://dx.doi.org/10.1007/BF00417897. PMid:8721066.
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) jointly with the protocol. This scale has eight levels, with the first two considered as normal(1616 Robbins J, Coyle J, Rosenbek J, Roecker E, Wood J. Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia. 1999;14(4):228-32. http://dx.doi.org/10.1007/PL00009610.
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). Levels 3 to 5 indicate laryngeal penetration due to residue in the airways and contact with vocal folds. Levels 6 to 8 refer to laryngotracheal aspiration corresponding to the cough physiological response to this aspiration(1515 Rosenbek JC, Robbins J, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-8. http://dx.doi.org/10.1007/BF00417897. PMid:8721066.
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,1616 Robbins J, Coyle J, Rosenbek J, Roecker E, Wood J. Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia. 1999;14(4):228-32. http://dx.doi.org/10.1007/PL00009610.
http://dx.doi.org/10.1007/PL00009610...
).
In order to effectively use MBSImP, one has to be registered as an “MBSImP clinician”, which can only be done after completion and approval in a course offered by the protocol authors. Training provides audiovisual resources with activities to guide score assignment for each component(1414 NSS: Northern Speech Services [Internet]. Modified barium swallowing impairment: MBSImP on-line course. Gaylord: NSS; 2020 [citado em 2020 Ago 23]. Disponível em: https://www.northernspeech.com/dysphagia-assessment-adult/introduction-to-mbsimp-a-standardized-protocol-for-assessment-of-swallowing-impairment
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). There are over 9,000 currently in training and 5, 809 registered speech pathologists in 25 countries. In Brazil, there are only four certified speech pathologists so far, and two of them contributed to this report.
METHODS
The purpose of this study was to translate into Brazilian Portuguese and culturally adapt the component scores definition for the MBSImP videofluoroscopy protocol. It was developed based on international guidelines for creation, translation and transcultural adaptation(1717 Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186-91. http://dx.doi.org/10.1097/00007632-200012150-00014. PMid:11124735.
http://dx.doi.org/10.1097/00007632-20001...
) according to domestic publications for the validation of international speech-language pathology tests(1818 Pernambuco L, Espelt A, Magalhães HVJ, Lima KC. Recommendations for elaboration, transcultural adaptation and validation process of tests in Speech, Hearing and Language Pathology. CoDAS. 2017;29(3):e20160217. http://dx.doi.org/10.1590/2317-1782. PMid:28614460.
http://dx.doi.org/10.1590/2317-1782...
).
Pre-testing of the final Brazilian Portuguese version (FBPV) was conducted in two doctoral studies from the Medical Sciences Faculty of the University of Campinas (UNICAMP). The “Complaint and dysphagia risk assessment versus physiological swallowing results in head and neck cancer” study was run in the Department of Otorhinolaryngology – Head and Neck Cancer and approved by the ethics committee under No. 58313016.6.000.5404. The second study, “Correlations between swallowing components, structural and functional connectivities” is underway in the Department of Human Development and Rehabilitation, and was approved by the ethics committee under No. 72644417.8.0000.5404. All patients read and signed a free and clarified consent term.
Step 1: translation
After obtaining written permission from the original protocol authors, a specialist committee was convened to compose the Brazilian Portuguese version. It was constituted by two otorhinolaryngologists and three speech-language pathologists familiar with VFS and the purpose of this work. Both otorhinolaryngologists, bilingual in Brazilian Portuguese and English and native in the target language and culture, independently translated the protocol (TP1, TP2) taking into account conceptual equivalences and avoiding literal conversions. As advocated by international guidelines(1717 Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186-91. http://dx.doi.org/10.1097/00007632-200012150-00014. PMid:11124735.
http://dx.doi.org/10.1097/00007632-20001...
), one of the physicians had greater fluency with the protocol as a consequence of his academic duties next to speech-language pathologists who regularly employ it.
Step 2: synthesis of translations
Based on TP1 and TP2, speech-language pathologist members of the specialist committee reached a consensus and combined the previous translations to create the Brazilian Portuguese synthesized version (BPSV), addressing semantic, idiomatic, conceptual, linguistic and contextual discrepancies.
Step 3: back translation
To ensure the Brazilian Portuguese version consistently reflected the original protocol(1818 Pernambuco L, Espelt A, Magalhães HVJ, Lima KC. Recommendations for elaboration, transcultural adaptation and validation process of tests in Speech, Hearing and Language Pathology. CoDAS. 2017;29(3):e20160217. http://dx.doi.org/10.1590/2317-1782. PMid:28614460.
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), BPSV was back translated into English. It was performed by two independent native translators without any knowledge of the original protocol and unfamiliar with its contents and concepts.
Step 4: analysis by the specialist committee and back translated version
Speech-language pathologists from the committee compared both back translated versions (BT1, BT2) with the original protocol, assessing semantic, idiomatic, conceptual, linguistic and contextual discrepancies. After a consensus was reached, a back translated version (BTV) was provided to the original authors.
Step 5: final Brazilian Portuguese version
The speech-language pathologist committee members reviewed all translated (TP1, TP2, BPSV) and back translated (BT1, BT2, BTV) versions to develop the definitive form of the translated protocol. After addressing any remaining inconsistencies, they created the final Brazilian Portuguese version (FBPV).
Step 6: testing of the final Brazilian Portuguese version
The last step of the adaptation process was pre-testing the translated protocol(1717 Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186-91. http://dx.doi.org/10.1097/00007632-200012150-00014. PMid:11124735.
http://dx.doi.org/10.1097/00007632-20001...
). It was performed by using the FBPV in two doctoral studies approved by a research ethics committee and conducted by MBSImP certified speech-language pathologists who were members of the specialist committee. Both studies were carried out in the Medical Sciences Faculty of the University of Campinas. The translated protocol was used to evaluate VFS from three subject groups: without neurological disease (n = 28), with mild cognitive impairment (n = 15) and patients treated for head and neck cancer (n = 58).
RESULTS
Both independent translations into Brazilian Portuguese and the synthesized version described in steps 1 and 2 are presented in Chart 1 (TP1, TP2, BPSV), followed by the final Brazilian Portuguese version (FBPV), detailed in step 5.
Translation into Brazilian Portuguese (TP1, TP2), Brazilian Portuguese synthesized version (BPSV) and final Brazilian Portuguese version (FBPV)
Independent back translations (BT1, BT2) and the final back translated version (BTV) described in steps 3 and 4 are presented in Chart 2 together with the original MBSImP protocol.
Back translations (BT1, BT2), original MBSImP protocol and final back translated version (BTV)
DISCUSSION
By analyzing national and international studies that used VFS as part of swallowing assessments, it is possible to detect great disparities in evaluation procedures(77 Resende PD, Dobelin JB, Oliveira IB, Luchesi KF. Disfagia orofaríngea neurogênica: análise de protocolos de videofluoroscopia brasileiros e norte-americanos. Rev CEFAC. 2015;17(5):1610-9. http://dx.doi.org/10.1590/1982-021620151754315.
http://dx.doi.org/10.1590/1982-021620151...
). As previously mentioned, professionals from either Brazil or the USA perform the examination with markedly distinct approaches regarding patient positioning, volume, consistencies and utensils. The same is true when analyzing investigation results: 71.42% of Brazilian reports do not employ the laryngotracheal penetration and aspiration scale, and there is no description of swallowing physiology evaluation parameters(77 Resende PD, Dobelin JB, Oliveira IB, Luchesi KF. Disfagia orofaríngea neurogênica: análise de protocolos de videofluoroscopia brasileiros e norte-americanos. Rev CEFAC. 2015;17(5):1610-9. http://dx.doi.org/10.1590/1982-021620151754315.
http://dx.doi.org/10.1590/1982-021620151...
). Even though this matter is not recent and some domestic authors have proposed elements that should be monitored during examination(77 Resende PD, Dobelin JB, Oliveira IB, Luchesi KF. Disfagia orofaríngea neurogênica: análise de protocolos de videofluoroscopia brasileiros e norte-americanos. Rev CEFAC. 2015;17(5):1610-9. http://dx.doi.org/10.1590/1982-021620151754315.
http://dx.doi.org/10.1590/1982-021620151...
), there are no known instruments that allow categorization of physiological findings into impairment degrees based on well-established parameters in order to differentiate them.
This backdrop, associated with the importance of propagating a standardized protocol for performing and interpreting VFS results(77 Resende PD, Dobelin JB, Oliveira IB, Luchesi KF. Disfagia orofaríngea neurogênica: análise de protocolos de videofluoroscopia brasileiros e norte-americanos. Rev CEFAC. 2015;17(5):1610-9. http://dx.doi.org/10.1590/1982-021620151754315.
http://dx.doi.org/10.1590/1982-021620151...
), inspired the translation of component scores from MBSImP. Even though the effective application of the protocol in clinical practice requires professionals to be certified(1414 NSS: Northern Speech Services [Internet]. Modified barium swallowing impairment: MBSImP on-line course. Gaylord: NSS; 2020 [citado em 2020 Ago 23]. Disponível em: https://www.northernspeech.com/dysphagia-assessment-adult/introduction-to-mbsimp-a-standardized-protocol-for-assessment-of-swallowing-impairment
https://www.northernspeech.com/dysphagia...
), the project of translating and culturally adapting this excerpt of MBSImP encourages standardized VFS practices among Brazilian speech-language pathologists. Therefore, this study does not intend to replace therapists training backgrounds so they can employ the MBSImP protocol, but instead to illustrate possibilities for improvement of their practices.
Although original authors named the protocol Modified Barium Swallow Impairment Profile, the specialist committee chose, for the Brazilian Portuguese version, the name “Escala Martin-Harris para videofluoroscopia da deglutição” (“Martin-Harris Scale for swallowing videofluoroscopy”). This adaptation was suggested as a way to emphasize, standardize and facilitate its application in Brazil, specifying the principal author’s name to differentiate the protocol from other instruments with generic names in domestic publications(1919 Bilton TL, Lederman HM. Descrição da padronização normal da videofluoroscopia da deglutição. Distúrb Comun. 1998;10(1):111-6.). This modification was approved by original protocol authors.
First versions translated into Brazilian Portuguese (TP1 and TP2) displayed some differences between them. While a few were subtle, without any further significance, others required editing. Differences that gave rise to deliberations among committee members when creating the synthesized version (BPSV) will be discussed, omitting details that were not related to possible semantic, idiomatic, conceptual and/or contextual issues.
While in TP1 terms “Oral Impairment”, “Pharyngeal Impairment” and “Esophageal Impairment” were translated into “Deficiência Oral”, “Deficiência Faríngea” and “Deficiência Esofágica”, in TP2 the same terms were “Alteração Oral”, “Alteração Faríngea” e “Alteração Esofágica”. Considering multiple meanings of the word “Deficiência” in Brazilian Portuguese, specialists agreed upon the term “Alteração” for BPSV.
For each component, authors of the original protocol provide brief directions for therapists concerning the moment of score attribution or what aspect must be considered when doing so (example for component 1: “Judge at any point during the swallow”). While in TP1 the word chosen for “Judge” was “Julgue”, in TP2 the word was “Avalie”. The committee considered the term “Julgue” to be closer to the implication of value attribution inherent to the original English word. Given that effective use of the protocol requires prior certification, it was decided that the term “Julgue” semantically assumes and stresses the existence of qualified arbitration.
Translation of score 1 (“Slow prolonged chewing/mashing with complete re-collection”) from component 3 (“Bolus Preparation/Mastication”) in TP1 was “1 = Mastigação/trituração lenta prolongada com re-coleção completa”. In TP2, it was “1 = Mastigação/trituração lenta, prolongada com organização completa do bolo”. The term “re-coleção” was regarded as a literal translation and semantically inappropriate, as in Brazilian Portuguese it means “austere life”. A deep knowledge of the protocol allowed speech-language pathologists from the committee to realize that this score, besides chewing, includes tongue functionality in collecting the mashed bolus in the oral cavity. Accordingly, the Brazilian Portuguese version was adapted to “1 = Mastigação/trituração lenta e prolongada, com reunião completa do bolo”.
Knowledge of the protocol also improved the Brazilian Portuguese version of components 12 (“Pharyngeal Stripping Wave”) and 17 (“Esophageal Clearance Upright Position”). In TP1, component 12 was translated as “Onda Faríngea Uniforme”, while in TP2 the translator opted for “Onda de decapagem faríngea”. As reported by the original authors, this component allows to evaluate the sequence of pharyngeal contractions extending from the nasopharynx to the pharyngo-esophageal segment that aid in bolus clearance. In Brazilian Portuguese, the terms “onda de contração faríngea”(2020 Luchesi KF, Campos BM, Mituuti CT. Identificação das alterações de deglutição: percepção de pacientes com doenças neurodegenerativas. CoDAS. 2018;30(6):e20180027. http://dx.doi.org/10.1590/2317-1782/20182018027. PMid:30517269.
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) and “onda de pressão faríngea”(2121 Lemos EM. Tempo de fechamento faríngeo correlacionado com consistências, volumes, gênero e idade em videoendoscopia da deglutição [tese]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2011.) have been used. Since the authors intent was to assess pharyngeal contraction functionality in lateral view, this component was converted to “Onda de limpeza faríngea”. It is separate from component 13 (“Pharyngeal Contraction”), which represents the combination of pharyngeal contraction and bolus clearance functionalities in anteroposterior view. The term “decapagem” was regarded as a literal translation, culturally and semantically inadequate.
In the case of score 0 (“Complete clearance; esophageal coating”) from component 17, the term “revestimento esofágico” was selected in both TP1 and TP2 corresponding to “esophageal coating”. The specialist committee discussed the need for a cultural adaptation in this context, given the usual interpretation of “revestimento esofágico” among Brazilian speech-language pathologists. Even though, in isolation, the term refers to the esophagus inner wall, its mention in score 0 complements the qualitative observation of bolus transit. According to the original protocol, score 0 indicates complete clearance of esophageal contents, even if there is some remaining residue coating the esophagus wall, which allows its observation.
The instruction (“Judge after first swallow or after the last swallow of the sequential swallow tasks”) from component 5 (“Oral Residue”) also required adjustments for the Brazilian Portuguese version. In TP1, the translator opted for “Avalie após a primeira deglutição ou depois da última deglutição numa sequência de tentativas de deglutição”. TP2, however, was written as “Julgue após primeira tentativa de deglutição ou após última tentativa de deglutição na sequência de exercícios de deglutição”. Based on the training course for MBSImP, committee therapists agreed on “Julgue após a primeira deglutição ou após a última deglutição nas tarefas de deglutições sequenciais”, because the protocol recommends 12 predefined swallowing tasks (not attempts), with each swallow performed in a single sip and sequential sips (only for liquid boluses). The term “exercícios de deglutição” was disregarded because it promotes an interpretation related to rehabilitation instead of an evaluation procedure.
There were technical terms in TP2 (“região mentoniana”, in component 1 and “vestíbulo nasal” and “rinorreia”, in component 7) which may be frequent in otorhinolaryngology, but are not, however, common in speech-language pathology clinical practices in dysphagia. In the translated version, the committee decided to use the terms “queixo”, “narina” and “saída alimentar”, respectively. Lastly, translation of component 6 (“Initiation of Pharyngeal Swallow”) from both translators was “iniciação da deglutição”. Although the term “iniciação” can be found in Brazilian speech-language pathology scientific literature, the term “início da deglutição faríngea” was preferred, as it has also been used by other investigators(2222 Zancan M, Luchesi KF, Mituuti CT, Furkim AM. Locais de início da fase faríngea da deglutição: meta-análise. CoDAS. 2017;29(2):e20160067. http://dx.doi.org/10.1590/2317-1782/20172016067. PMid:28327783.
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).
Back translated versions (RT1 and RT2) suggested that, despite differences between translators, translation into Brazilian Portuguese complied with the original version content as intended by the protocol authors, with no conceptual issues that required further revisions. This compliance was verified when the final Brazilian Portuguese version was employed in clinical practice (step 6), since there were no disparities between the use of translated and original versions in any of the three subject groups.
CONCLUSION
Translation from an excerpt of the protocol Modified Barium Swallow Impairment Profile (MBSImP) into Brazilian Portuguese was compatible with the original version. Certification of committee members promoted appropriate adaptation of protocol contents, allowing conceptual and cultural adjustments to be made.
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Study conducted at Universidade Estadual de Campinas – UNICAMP - Campinas (SP), Brasil.
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Financial support: nothing to declare.
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» http://dx.doi.org/10.1590/2317-1782/20182018027 -
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» http://dx.doi.org/10.1590/2317-1782/20172016067
Publication Dates
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Publication in this collection
30 Aug 2021 -
Date of issue
2021
History
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Received
23 Aug 2020 -
Accepted
02 Oct 2020