Proposta de instrumento de avaliação da alimentação para disfagia

Abstract

Introduction: Feeding is a complex functional activity involving motor, sensory, cognitive, behavioral, and contextual components, with swallowing representing only one of its elements. In clinical dysphagia practice, speech-language pathology assessment remains predominantly focused on the safety and efficiency of swallowing, with limited systematization of the other aspects that influence feeding performance throughout the meal. Objective: To propose a structured instrument for the functional assessment of feeding in adult patients at risk of dysphagia. Methods: This is a methodological study developed in two stages. In the first stage, an integrative literature review was conducted through searches in the PubMed, Scopus, Web of Science, Embase, and gray literature databases, including observational and methodological studies addressing feeding assessment instruments for adults with dysphagia. In the second stage, the identified instruments were comparatively analyzed, followed by a literature search, systematization of the assessment criteria, and development of the prototype of the proposed instrument. Results: The integrative review resulted in the inclusion of four validated clinical instruments: Minimal Eating Observation Form (MEOF), Dysphagia Disorder Survey (DDS), Kuchi-Kara Taberu Index (KT Index), and Dysphagia Assessment Package (DAP). The comparative analysis showed that, although these instruments encompass relevant domains of the feeding process, their assessment criteria are distributed in a fragmented and heterogeneous manner, without operational integration aimed at the functional observation of feeding during the meal. Based on this evidence and complementary studies, the prototype of the Feeding Assessment Instrument for Dysphagia (IAAD-Fono) was developed as a comprehensive tool encompassing criteria related to overall functional status, respiratory safety, posture, dietary management, utensil handling, autonomy, feeding behavior, and food intake. Conclusion: The IAAD-Fono prototype represents a proposal aligned with the gaps identified in the literature by systematically organizing the main domains involved in the functional assessment of feeding in patients undergoing the diagnostic process for dysphagia. The instrument has the potential to broaden the speech-language pathology assessment of feeding as a continuous functional activity and to support therapeutic decision-making. Future studies should include content validation, reliability, and clinical applicability of the instrument.