Submitted by Daniella Santos (daniella.santos@ufma.br) on 2017-12-05T15:45:11Z No. of bitstreams: 1 AnaCarolineCaldas.pdf: 1130324 bytes, checksum: 51d08077b7aeaa3043da20a4be379d4a (MD5) / Made available in DSpace on 2017-12-05T15:45:11Z (GMT). No. of bitstreams: 1 AnaCarolineCaldas.pdf: 1130324 bytes, checksum: 51d08077b7aeaa3043da20a4be379d4a (MD5) Previous issue date: 2017-08-17 / The making of gastrostomy leads many families to experience conflicting moments characterized by uncertainty, stress and disagreements between parents. In addition to the feelings of anguish and fear unveiled by caregivers, families are required to have innumerable knowledge and practices that are unusual for the daily care of children. Families need to receive professional support and have the social support network to deal with adversities that permeate family life. This research seeks to develop educational-care technology to support the care of the gastrostomy child based on the Model of Interpersonal Relations of Peplau and conception of Autonomy of Paulo Freire. Qualitative descriptive research utilized the Sensitive Creative Method (MSC) and Body Knowledge dynamics. Participants were 10 families living the gastrostomy preparation process, from the preoperative to the home care. For data collection, we used semi-structured interview recorded in audio, systematic observation and field notes. The data were coded / recoded and the situations-problems revealed were substrate for construction of the educational-care technology. The situation-problems encountered were: lack of knowledge of the families about the hospitalization process of the child, difficulty in the families' perception on gastrostomy, disruption of the parents' ideal of a perfect child, insufficient health education to attend to the demands of family care for the children with gastrostomy, resignation to the new family situation, having a child dependent on technologies, loss of the physiological feeding route. It is concluded that families with knowledge about gastrostomy will be empowered with their rights and thus may transform their reality. The technology can help families better understand what a gastrostomy is and how to handle it so that the care safely provided to the child helps in adapting to the situation of chronicity experienced. / A confecção da gastrostomia em crianças leva muitas famílias a vivenciar momentos conflituosos caracterizados por incertezas, estresse e desavenças. Além dos sentimentos de angústia e medo desvelados pelos cuidadores, é exigido das famílias inúmeros saberes e práticas incomuns para o cuidado cotidiano das crianças. As famílias precisam receber suporte profissional e dispor da rede de apoio social para enfretamento das adversidades que permeiam a vida familiar. Nesta investigação procura-se desenvolver tecnologia cuidativo-educacional para apoiar o cuidado à criança gastrostomizada a partir do Modelo das Relações Interpessoais de Peplau e Concepção da Autonomia de Paulo Freire. A pesquisa descritiva qualitativa utilizou o Método Criativo Sensível com a dinâmica Corpo Saber. Foram sujeitos de participação 10 famílias que vivenciavam o processo de confecção da gastrostomia, desde o pré-operatório até o cuidado domiciliar. Para coleta de dados utilizou-se entrevista semiestruturada gravada em áudio, observação sistemática e anotações de campo. Os dados foram codificados/recodificados e as situações-problemas reveladas constituíram substrato para construção da tecnologia cuidativoeducacional. As situações-problemas estabelecidas foram: desconhecimento das famílias sobre o processo de hospitalização da criança, dificuldade na percepção das famílias sobre a gastrostomia, desestruturação do imaginário dos pais sobre a criança perfeita, educação em saúde insuficiente para atender demandas de cuidado das famílias às crianças com gastrostomia, resignação diante da nova situação familiar, ter um filho dependente de tecnologias, perda da via de alimentação fisiológica. Conclui-se que as famílias com o conhecimento sobre gastrostomia serão empoderadas dos seus direitos e assim poderão transformar sua realidade. A tecnologia poderá ajudar famílias a conhecer melhor o que é uma gastrostomia e como manuseá-la para que o cuidado fornecido com segurança à criança auxilie na adaptação à situação de cronicidade vivenciada.

Orientador: Magda Cristina Queiroz Dell'Acqua / Coorientador: Silvia Justina Papini / Banca: Cleide Carolina da Silva Demoro Mondini / Banca: Janete Pessuto / Resumo: Pacientes com desnutrição e paralisia cerebral atendidos no ambulatório AIPEG (Ambulatório Interdisciplinar para Paciente Infantil Portador de Encefalopatia e Gastrostomia) do HEB (Hospital Estadual Bauru), necessitam de gastrostomia para auxiliar na alimentação pela disfagia e são acompanhados por uma equipe multiprofissional e interdisciplinar. Neste estudo quantitativo, transversal, descritivo e exploratório, verificou-se o perfil dos cuidadores e pacientes deste ambulatório e descreveu-se as dificuldades encontradas por esses familiares/cuidadores em domicílio. Após aprovação do comitê de ética em pesquisa e a assinatura do termo de consentimento livre e esclarecido os familiares/cuidadores dos pacientes do AIPEG (Ambulatório Interdisciplinar para Paciente Infantil Portador de Encefalopatia e Gastrostomia) foram abordados com um questionário e responderam questões abertas e fechadas. Utilizou-se também, como fonte de dados, a análise dos prontuários dos pacientes. Os dados foram coletados no período de janeiro a junho de 2012. A amostra foi composta de 50 pacientes e seus respectivos familiares/cuidadores, sendo 60,00% dos pacientes eram do sexo feminino, 70,00% etnia branca e com média de idade de 11,43 anos. O diagnóstico médico de todos os pacientes (100,00%) era de paralisia cerebral e 91,17% apresentava desnutrição. A maioria dos pacientes, em 92,00%, realizou gastrostomia cirúrgica. Com relação aos cuidadores, 98,00% eram do sexo feminino, com média de idade em 40,82 anos de idade, 70,00% de etnia branca, 86,00% dos familiares/cuidadores são as próprias mães dos pacientes e a renda com média de 2,32 salários mínimos. Quanto às dificuldades mais relatadas, pelos familiares/cuidadores, verificou-se o relato da saída da sonda de ostomia com prevalência de 84,00% e 68,00% dos familiares/cuidadores relatou a ocorrência de lesão na pele. A gastrostomia é um procedimento ... / Abstract: Patients with malnutrition and cerebral palsy attended in the ambulatory AIPEG (Interdisciplinary Ambulatory for Child Patient with encephalopathy and gastrostomy) of BSH (Bauru State Hospital), need of gastrostomy for help feeding by dysphagia and are accompanied by a multidisciplinary team and interdisciplinary. In this quantitative, transversal, descriptive and exploratory study, it was verified a profile of caregivers and patients in this ambulatory and described the difficulties found by these families / caregivers at home. After approval of the research ethics committee and signing the free and informed consent families/carers of patients AIPEG (Interdisciplinary Ambulatory for Child Patient with encephalopathy and gastrostomy) were approached with a questionnaire and answered open and closed questions. We used also, as a source of data, analysis of the patients' records. Data were collected from January to June 2012. The sample was composed of 50 patients and their family/caregivers, 60,00% of patients were female, 70,00% Caucasian, with a mean age of 11.43 years. The medical diagnostic of all patients (100,00%) was cerebral palsy and 91,17% presented malnutrition. Most patients, 92,00% made surgical gastrostomy. With respect to caregivers 98,00% were female, with mean age of 40.82 years old, 70,00% were Caucasian, 86,00% of families / caregivers are mothers themselves and the patients income with mean of 2.32 minimum salaries. About the difficulties most reported, by family / caregivers, there was the account of output of the tube ostomy with prevalence of 84,00% and 68,00% of family / caregivers told the occurrence of skin lesion. A gastrostomy is a procedure that assists in the patient's condition, helping the family care in homes, which has a preference for silicone tube at skin level (button). Becomes evident that although the service offers an appropriate structure, with a multidisciplinary team and ... / Mestre

A retrospective chart review was conducted on pediatric patients at the Intermountain Cystic Fibrosis Center who had a percutaneous endoscopic gastrostomy (PEG) placed between 1993 and 1999. Height velocity improved significantly in the group of patients with a PEG placed; however, pulmonary function declined more significantly over time. Questionnaires regarding attitude toward PEG placement were sent to patients enrolled in accredited cystic fibrosis centers in the mountain west region and to their parents. The overall response rate was 54.25% for the PEG questionnaire and 24% for the non-PEG questionnaire. Ninety-six percent of the patients with a PEG reported that weight was a problem at time of placement, and 91% reported weight gain after PEG ill placement. Sixty-four percent of the patients with a PEG reported that they would have a PEG placed if they made the decision again. Of the patients without a PEG, 60.7% thought a PEG looked bad, and 59.2% would be embarrassed to have a PEG. Forty-nine percent of patients without a PEG expressed a lack of knowledge of the pros and cons of PEG placement and 35.4% had no opinion about their knowledge of PEGs. PEG placement can be beneficial in improving nutritional status. Optimal time for PEG placement may be earlier rather than after pulmonary function has declined. People with a PEG have felt positive toward placement, and those without a PEG seem to lack knowledge about the pros and cons of PEG placement.

Syfte. Syftet med detta arbete var att undersöka förekomsten och behandling av granulom vid gastrostomier hos barn och ungdomar under 18 år i Sverige. Syftet var även att undersöka sjuksköterskors kunskaper om granulombehandling hos barn och ungdomar under 18 år med gastrostomi i Sverige. Metod. Den forskningsdesign som valdes var av kvantitativ metod genom enkätundersökning. Enkäterna skickades ut till sjuksköterskor som arbetar i Sverige och finns med i något av följande nätverk: Nätverket för habiliteringssjuksköterskor, Nätverket för habiliteringssjuksköterskor inom nutrition och/eller Nätverket för nutritionssjuksköterskor. Resultat. Det upplevdes att granulombesvären var varierande och berodde på barnets övriga hälsa. 52% uppskattade att barnen utvecklade granulom inom två månader efter inläggning av gastrostomin. 34% av deltagarna uppskattade att ca 25% av barn och ungdomar med gastrostomier utvecklar granulom. 46% använde en kombination av lapis och kortisonsalva som behandlingsmetod vid granulom. Slutsats. De behandlingar som idag används för granulom är lapis och kortisonsalva, dessa används av många i kombination med varandra och verkar ha ett gott resultat. Sjuksköterskors kunskap inom området är brett och många har en gemensam åsikt om att granulombildning ofta har ett samband med patientens övriga hälsa. / Aim. The aim of the study was to investigate the occurrence and treatment of granulomas in children and adolescents under the age of 18 with gastrostomy in Sweden. The aim was also to investigate nurses knowledge of granulomatreatment in children and adolescents under the age of 18 with gastrostomy in Sweden. Methods. The design was of quantitative method by questionnaire. A questionnaire was sent to nurses who work in Sweden and are included in one of the following networks: Network for rehabilitation nurses, Network for rehabilitation nurses in nutrition and / or Network for nutrition nurses. Results. The severity of granuloma varied, depending on the child's general health. 52% estimated that the children developed granulomas within two months after insertion of the gastrostomy. 34% of respondents estimated that about 25% of children and adolescents with gastrostomier develop granulomas.46% used a combination of lapis and cortisone ointment as a treatment for granuloma. Conclusion.The treatments currently used for granulomas is lapis and cortisone ointment, these are used by many in combination with each other and seem to have a good result. Nurses' knowledge in the field is extensive and many have a common view that granuloma formation is often linked to the patients general health.

Made available in DSpace on 2014-08-13T14:50:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-13Bitstream added on 2014-08-13T18:00:33Z : No. of bitstreams: 1 000758247.pdf: 803751 bytes, checksum: e1f05fe406f54075654a530d95ef3b1f (MD5) / Pacientes com desnutrição e paralisia cerebral atendidos no ambulatório AIPEG (Ambulatório Interdisciplinar para Paciente Infantil Portador de Encefalopatia e Gastrostomia) do HEB (Hospital Estadual Bauru), necessitam de gastrostomia para auxiliar na alimentação pela disfagia e são acompanhados por uma equipe multiprofissional e interdisciplinar. Neste estudo quantitativo, transversal, descritivo e exploratório, verificou-se o perfil dos cuidadores e pacientes deste ambulatório e descreveu-se as dificuldades encontradas por esses familiares/cuidadores em domicílio. Após aprovação do comitê de ética em pesquisa e a assinatura do termo de consentimento livre e esclarecido os familiares/cuidadores dos pacientes do AIPEG (Ambulatório Interdisciplinar para Paciente Infantil Portador de Encefalopatia e Gastrostomia) foram abordados com um questionário e responderam questões abertas e fechadas. Utilizou-se também, como fonte de dados, a análise dos prontuários dos pacientes. Os dados foram coletados no período de janeiro a junho de 2012. A amostra foi composta de 50 pacientes e seus respectivos familiares/cuidadores, sendo 60,00% dos pacientes eram do sexo feminino, 70,00% etnia branca e com média de idade de 11,43 anos. O diagnóstico médico de todos os pacientes (100,00%) era de paralisia cerebral e 91,17% apresentava desnutrição. A maioria dos pacientes, em 92,00%, realizou gastrostomia cirúrgica. Com relação aos cuidadores, 98,00% eram do sexo feminino, com média de idade em 40,82 anos de idade, 70,00% de etnia branca, 86,00% dos familiares/cuidadores são as próprias mães dos pacientes e a renda com média de 2,32 salários mínimos. Quanto às dificuldades mais relatadas, pelos familiares/cuidadores, verificou-se o relato da saída da sonda de ostomia com prevalência de 84,00% e 68,00% dos familiares/cuidadores relatou a ocorrência de lesão na pele. A gastrostomia é um procedimento ... / Patients with malnutrition and cerebral palsy attended in the ambulatory AIPEG (Interdisciplinary Ambulatory for Child Patient with encephalopathy and gastrostomy) of BSH (Bauru State Hospital), need of gastrostomy for help feeding by dysphagia and are accompanied by a multidisciplinary team and interdisciplinary. In this quantitative, transversal, descriptive and exploratory study, it was verified a profile of caregivers and patients in this ambulatory and described the difficulties found by these families / caregivers at home. After approval of the research ethics committee and signing the free and informed consent families/carers of patients AIPEG (Interdisciplinary Ambulatory for Child Patient with encephalopathy and gastrostomy) were approached with a questionnaire and answered open and closed questions. We used also, as a source of data, analysis of the patients' records. Data were collected from January to June 2012. The sample was composed of 50 patients and their family/caregivers, 60,00% of patients were female, 70,00% Caucasian, with a mean age of 11.43 years. The medical diagnostic of all patients (100,00%) was cerebral palsy and 91,17% presented malnutrition. Most patients, 92,00% made surgical gastrostomy. With respect to caregivers 98,00% were female, with mean age of 40.82 years old, 70,00% were Caucasian, 86,00% of families / caregivers are mothers themselves and the patients income with mean of 2.32 minimum salaries. About the difficulties most reported, by family / caregivers, there was the account of output of the tube ostomy with prevalence of 84,00% and 68,00% of family / caregivers told the occurrence of skin lesion. A gastrostomy is a procedure that assists in the patient's condition, helping the family care in homes, which has a preference for silicone tube at skin level (button). Becomes evident that although the service offers an appropriate structure, with a multidisciplinary team and ...

Gastrostomy is one of the access routes enabling enteral nutrition support to children with eating disorders. It is a method of choice in situations where real assumption of enteral feeding by a nasogastric probe longer than six weeks exists and with undamaged functional digestive system. The possibility to perform enteral feeding outside health care facilities is the most advantageous aspect of gastrostomy for children and their parents. Optimum nursing care is one of the main preconditions of long term functional gastrostomy. This why suitable education of parents and their children in the nutrition support method is necessary. The aim of the work was to map awareness of the issues of gastrostomy in children patients among parents and to propose a unified educational programme aimed at easier insight into the issues. Qualitative research method was applied to the problems. The techniques of study of healthcare documentation and semi standardized interviews with respondents in their home environment were used for data collection. The results of the healthcare documentation studies, which defined the sample of the children with applied gastrostomy, were processed into graphic form for better transparency. The interviews with the respondents in the form of audio recording were transposed into written form and quantified by means of tables enabling the research conclusion to be drawn. The research results showed that practical training of gastrostomy treatment and awareness of possible complications and their solution was the weak point of the education. The above results have confirmed the necessity to elaborate a unique educational programme related to the issues of feeding tube insertion, the care for gastrostomy, support of food, medicines, and possible related complications in terms of learning the ability to prevent complications, identify and solve them.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-02-02T17:09:12Z No. of bitstreams: 1 Vera Lúcia de Castro Perissé.pdf: 1392085 bytes, checksum: 380573b24e79527cc95f2004623f6cf0 (MD5) / Made available in DSpace on 2016-02-02T17:09:12Z (GMT). No. of bitstreams: 1 Vera Lúcia de Castro Perissé.pdf: 1392085 bytes, checksum: 380573b24e79527cc95f2004623f6cf0 (MD5) Previous issue date: 2007 / Clínica Vídeo-Endo / Mestrado Profissional em Enfermagem Assistencial / O cliente gastrostomizado requer o acompanhamento contínuo do enfermeiro estomaterapeuta, até que este e sua família readquiram a independência diante desta nova condição de vida. Este apoio inicia-se durante a hospitalização, a partir da instalação do cateter, estendendo-se para o dia-a-dia, no cenário domiciliar, quando este estoma assume o caráter permanente, havendo a necessidade de incentivo à família a participar no cuidado desse cliente, dando suporte às suas ações, ensinando-lhes os cuidados com o cateter, seu manuseio durante a administração da dieta, os cuidados em relação aos aspectos físicos e emocionais. Tais cuidados devem ser avaliados não só no sentido de prevenir complicações advindas do manuseio incorreto do cateter, mas também para garantir a reabilitação e a manutenção da saúde desse cliente no ambiente domiciliar, independente de sua condição sócio-econômica. Assim, o presente estudo teve por objetivos caracterizar o ambiente do cliente gastrostomizado e sua família, analisar as necessidades do familiar no cuidado do cliente gastrostomizado no cenário domiciliar e elaborar um programa de ensino ao familiar que cuida do cliente gastrostomizado no domicílio. Os sujeitos do estudo foram dez familiares que cuidavam de clientes gastrostomizados no domicílio. A coleta de informações foi desenvolvida através de visita domiciliar que possibilitou a aplicação das técnicas de observação participante, para caracterização do contexto domiciliar e entrevistas semi-estruturadas com os familiares desses clientes. Tais informações serviram de base para o documento que se encontra no final do estudo e que após testes e aprovação da equipe de médicos diretores da Clínica Vídeo-Endo, será enfim implantado / The client that suffered a gastrostomy needs the full attention of a stomach therapist nurse. This support starts with the probe installation and should be followed in homecare attention by motivating the family to take part of this process, giving them the necessary support, teaching how to manage the probe, how to handle it in the process of feeding the client and also the physical and emotional care required in order to prevent difficulties and contributing effectively to the health promotion, maintenance and rehabilitation of the client in home scene. The purpose of this work is to know the new possibilities of innovation in the nurse‟s practice and teaching with the family of the gastrostomized patient, identifying the needs of the family in this kind of care in home scene and elaborating a homecare program to the family of a gastrostostomized client. The subjects of this case study were ten members of the family who took care of gastrostomized patients in their homes. The information gathered was based on visitations to the homes, which enabled the use of techniques of participating observation, for the characterization of the home care context, as well as on semi structured interviews with family members of these patients. Such information is the basis of the document at the end of this study, which after trials and approval from the team of doctors - directors of the Clinic Video-Endo - will be then, implemented

Percutaneous endoscopic placement of feeding gastrostomies (PEG) was pioneered by Gauderer et. al, in 1980. Since then, it has become the preferred method of providing enteral nutritional support in children and adults because of advantages in morbidity and cost. Pneumonia is a known sequel of this procedure, occurring at different rates, depending on the length of follow-up. Some series have shown an incidence of 10% at 30 days and others 56% at 11 months. It does not appear that PEG feeding offers an advantage over the more traditional naso-enteric tube feeding methods in this respect. To study the prevalence of gastroesophageal reflux (GER) in PEG-fed patients, we quantitated GER by 24-hour intraesophageal pH monitoring in a group of patients who developed post-PEG pneumonia and compared it with a control group. Our study demonstrates an increased prevalence of GER in the pneumonia group compared with the control group. However, the exact contribution of this observed increased GER to the development of pneumonia needs to be determined.

INTRODUÇÃO: O diabetes mellitus tipo 2 (DM2) é uma doença correlacionada com a obesidade mórbida. O paciente obeso apresenta efeito incretínico suprimido e consequente desbalanço da homeostase glicêmica. Diversos estudos evidenciam a melhora do DM2 após a confecção da Gastroplastia com derivação intestinal em Y de Roux (GDYR). Os mecanismos de controle da glicemia podem ser de longo e curto prazo. Os mecanismos de ação precoce estão ligados à restrição calorica, melhora da resistência insulínica, da função da célula beta pancreática e retorno do efeito incretínico pelo aumento do GLP1 e GIP, porém os dados são conflitantes. MÉTODOS: Onze pacientes obesos graves diabéticos foram submetidos à GDYR com confecção de gastrostomia no remanescente gástrico após perda de peso inicial de 10%. Os pacientes foram submetidos à coleta de entero-hormônios, perfil glicêmico e Teste de Tolerância Oral à glicose (TTOG) no pré-operatório em curva temporal que foi comparado ao pós-operatório por Via Oral e por Via da Gastrostomia em até 7 dias após o procedimento. RESULTADOS: A média da idade foi 46,09±7,08 anos. No pré-operatorio, o peso médio foi 120,97±17,02 quilogramas, altura 1,67±0,11 metros, IMC médio 44,06±6,59 kg/m2, glicemia de jejum média 194,55±62,45 mg/dl e hemoglobina glicada 8,74±1,64%. Em 77,7% dos pacientes, houve remissão precoce do DM2 no pós-operatório avaliado pelo TTOG. Também foi observada queda significante da glicemia, insulinemia e do HOMA-IR independente da via administrada. Ocorreu aumento significativo do GLP1 e redução do GIP pela Via Oral pós-operatória. A Grelina não apresentou alterações. CONCLUSÃO: Evidenciou-se redução da glicemia e da resistência periférica nos primeiros dias de pós-operatório da GDYR, independente da via de passagem do alimento. A alteração no efeito incretínico (aumento do GLP1 e redução do GIP) só foi observada na Via Oral pós-operatória / INTRODUCTION: Type 2 diabetes mellitus (DM2) is a disease correlated with morbidly obesity. The obese patient has a suppressed incretin effect and consequent inbalance of glycemic homeostasis. Several studies have shown an improvement in DM2 after Gastroplasty with Roux-en-Y gastric bypass (RYGB). The mechanisms of glycemic control may be long-term and shortterm. The mechanisms of early action are linked to caloric restriction, improvement of insulin resistance, pancreatic beta cell function and return of the incretin effect through the increase of GLP1 and GIP, but the data are conflicting. METHODS: Eleven diabetic obese patients underwent RYGB with gastrostomy in gastric remnant after initial 10% weight loss. Patients were submitted to assessment of enterohormones, glycemic profile and Oral Glucose Tolerance Test (OGTT) in the preoperative period in a time curve that was compared to the postoperative period by Oral Via and Gastrostomy Via up to 7 days after the procedure .RESULTS: The mean age of the group was 46.09 ± 7.08 years. In the preoperative the mean weight was 120.97 ± 17.02 kilograms, height of 1.67 ± 0.11 meters, mean BMI of 44.06 ± 6, 59 kg/m2, mean fasting blood glucose of 194.55 ± 62.45 mg/dl and glycated hemoglobin 8.74 ± 1.64%. In 77.7% of the patients there was remission of DM2 in postoperative evaluated by the OGTT. Significant decrease in glycemia, insulinemia and HOMA-IR was also observed, regardless of the route of administration. There was a significant increase in GLP1 and reduction of GIP by the postoperative oral route. Ghrelin did not change. CONCLUSION: A reduction in glycemia and peripheral insulinal resistance was observed in early postoperative days of RYGB, independent of the food route. The change in incretin effect (increase of GLP1 and reduction of GIP) was only observed in the postoperative oral route

Introdução: A esclerose lateral amiotrófica (ELA) é uma doença neurodegenerativa progressiva, de etiologia desconhecida, que envolve os neurônios motores do córtex cerebral, do tronco encefálico e da medula espinhal. O comprometimento dos neurônios motores inferiores causa disfagia, distúrbios de fala e outros sintomas, como fraqueza muscular global e sintomas respiratórios. A dificuldade de deglutição ou disfagia pode causar complicações, como pneumonia aspirativa, má nutrição e desidratação, e afeta a qualidade de vida destes pacientes, sendo necessária a indicação de via alternativa de nutrição. Atualmente, esta indicação é dada subjetivamente pelo exame clínico e funcional realizado pela equipe multidisciplinar, de acordo com a deterioração dos parâmetros da função respiratória, do estado nutricional e de comprometimentos na deglutição. Objetivos: objetivo geral: verificar se a redução de pressão de língua pode ser indicadora de necessidade de gastrostomia (GEP) como via alternativa de nutrição em pacientes com diagnóstico de ELA. Objetivos específicos: verificar se há redução significativa nas medidas funcionais e de pressão de lábio, de língua e de bochecha entre o momento da primeira avaliação e da indicação da GEP; avaliar o tempo desde o primeiro sintoma da doença até a indicação da GEP; verificar se o tempo de indicação da GEP foi influenciado por variáveis demográficas, manifestação clínica inicial (espinhal ou bulbar), condições clínicas, medidas funcionais globais e de deglutição, com destaque para pressão de língua, de lábios e de bochechas. Métodos: Foram estudados longitudinalmente 63 pacientes, avaliados do ponto de vista fonoaudiológico com os instrumentos: escala ASHA, escala ALSFRS, avaliação funcional, medida de pressão dos órgãos fonoarticulatórios com o aparelho IOPI, encaminhamento para videoendoscopia da deglutição (VED) e capacidade vital forçada (CVF) no momento da indicação da GEP. Resultados: Os pacientes tinham faixa etária entre 28 e 79 anos (média de 58 anos de idade), com média de 7,04 anos de escolaridade, tempo médio de doença no momento da avaliação inicial de 34,96 meses, 32% manifestação clínica inicial da forma bulbar, 39,5% espinhal membros superiores e 28,5% espinhal membros inferiores, porém, na avaliação fonoaudiológica inicial, todos apresentavam alguma queixa de acometimento bulbar. Cinquenta pacientes foram encaminhados à GEP, 1 foi a óbito e 12 mantiveram dieta via oral exclusiva até o término do estudo. Medidas funcionais e de pressão de língua, lábio e bochecha apresentaram redução significativa no agravamento da ELA (p < 0,001). Dificuldades com líquido espessado: de contenção (p=0,001), de transporte (p=0,005) e de proteção de vias aéreas inferiores (p =0,003), e com a consistência pastosa: contenção na cavidade oral, (p < 0,001) observadas em avaliações clínicas fonoaudiológicas, e a idade (p =0,014) influenciam na indicação de GEP. Conclusão: A medida de pressão de língua pode, portanto, servir como um indicador adicional, objetivo e prático para o exame do prognóstico da funcionalidade da deglutição, e, em particular, da possibilidade ou não de manutenção de vias tradicionais em pacientes com diagnóstico de ELA / Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of unknown etiology that involves motor neurons from the cerebral cortex, from the brainstem and from the spinal cord. The damage on the lower motor neurons causes dysphagia, speech disorders and other symptoms such as overall muscle weakness and respiratory symptoms. The difficulty in swallowing, or dysphasia, may cause complications such as aspiration pneumonia, malnutrition and dehydration and affects the quality of live of these patients. Thus, it is necessary to indicate and alternative form of nutrition. This indication is currently given subjectively by the clinical and functional evaluation performed by the multidisciplinary team, according to deterioration of respiratory function parameters, nutritional status and swallowing impairments. Objectives: general objective: verify if reduced tongue pressure could indicate the need for gastrostomy (PEG) as an alternative form of nutrition for patients who have been diagnosed with ALS. Specific objectives: verify if there is significant reduction on tongue, lips, and cheeks pressure as well as functional measures between the moment of the first evaluation and the indication of PEG; evaluate the time between the first symptom of the disease and the indication of PEG; verify if the time of the indication of PEG was influenced by demographic variables, initial clinical manifestation (spinal or bulbar forms), clinical conditions, global and swallowing functional measures, highlighting tongue, lips and cheeks pressure. Methods: 63 patients have been longitudinally studied. They have been assessed from the speech-language therapy point of view with the following instruments: ASHA, ALSFRS, functional evaluation, pressure measurement of the phono-articulatory organs with the IOPI, referral to videoendoscopy of swallowing and FVC at the moment of the indication of PEG. Results: The patients, whose ages ranged from 28 to 79 years old (average of 58 years old), had, on average, 7.04 years of education. They had been suffering from the disease for an average of 34.96 months at the time of the first evaluation. 32% showed initial clinical manifestation of the bulbar form, 39.5% upper limbs spinal form and 28.5% lower limbs spinal form. At the initial speech-language therapy assessment, however, all of them showed some sort of complaint regarding bulbar impairment. 50 patients were sent to PEG, 1 died and 12 continued with an oral exclusive diet until the end of this study. Tongue, lips and cheeks as well as functional measures showed significant decrease with the aggravation of ALS (p < 0,001). Difficulties with thickened liquid: with containment (p=0,001), with transport (p=0,005) and with protection of lower airways (p =0,003) and with pasty consistencies: containment in the oral cavity, (p < 0,001) observed in speech-language therapy clinical assessments, as well as age (p =0,014) have influence on the indication of PEG. Conclusion: The measure of the tongue pressure can, therefore, serve as an additional, objective and practical indicator for the evaluation of the prognosis of swallowing functionality, particularly of the possibility or not of maintenance of traditional forms in patients who have been diagnosed with ALS