Fundamentação: Pacientes após o Acidente Vascular Encefálico (AVE) em fase aguda apresentam disfagia orofaríngea com risco de aspiração traqueal. Objetivos: Verificar a prevalência de sinais ou sintomas sugestivos de disfagia orofaríngea medidos através de avaliação clínica da deglutição em pacientes adultos, após o Acidente Vascular Encefálico, internados na Enfermaria de Neurologia do Hospital de Pronto Socorro de Porto Alegre. Métodos: Foram incluídos neste estudo os pacientes internados na Enfermaria de Neurologia de um Hospital Público, entre maio de 2009 e novembro de 2010, com diagnóstico de AVE isquêmico ou hemorrágico, que tiveram sua dieta via oral liberada pela equipe médica. Foram avaliados 101 pacientes (56 homens), até 72 horas após o evento, à beira do leito. Através de um protocolo da deglutição foram testadas consistências líquidas e pastosas para observar a presença de preditores clínicos que, seguramente, podem indicar risco de aspiração. Resultados: A média de idade dos pacientes avaliados foi de 64 anos. Trinta e seis destes tinham idade abaixo de 60 anos. Foram avaliadas 45 mulheres e 56 homens. Observou-se uma prevalência de 448,5% (49/101; IC 95%:3:8,9,% a 5,24%) de disfagia orofaríngea nestes pacientes. A predominância de gênero foi masculina e o tipo de AVE predominante foi o isquêmico. Observou-se uma correlação entre mulheres com disfagia (57,1%) e AVE hemorrágico neste grupo. Conclusão: Sinais clínicos de disfagia orofaríngea e risco para aspiração pós AVE podem ser identificados na avaliação clínica da deglutição através de um protocolo de deglutição com preditores clínicos validados na literatura. / Background: Patients after stroke in acute phase present oropharyngeal dysphagia having risk of tracheal aspiration. Objectives: To verify the prevalence of signs or symptoms suggesting oropharyngeal dysphagia with risk of tracheal aspiration with clinical evaluation of swallowing in adult patients after stroke interned in the Neurology Ward of the Hospital de Pronto Socorro de Porto Alegre. Methods: In this study patients interned in a Neurology Ward of a Public Hospital, between May 2009 and November 2010, diagnosed with ischemic or hemorrhagic stroke, having their oral diet released by the medical team. It was evaluated 101 patients (56 men), within the first 72 hours after being admitted to hospital, at bedside. Using a swallowing protocol, liquid and pudding consistencies were tested in order to observe the presence of clinical predictors which can indicate aspiration risk. Results: The mean age of the evaluated patients was 64 years old. Thirty six of these patients were under 60 years old. Forty five women and 56 men were evaluated. It was observed a prevalence of 48.5% (CI (49/101;IC 95%:38,9,% to 58,2%) of oropharingeal swallowing in those patients. The predominance was the male gender and the prevailing kind of stroke was the ischemic. In this group, it was observed a correlation among women with dysphagia (57.1%) and hemorrhagic stroke. Conclusion: Clinical signs of Oropharingeal dysphagia and aspiration risk after stroke can be identified in the clinical evaluation of swallowing through a swallowing protocol with clinical predictors validated in the literature.

Made available in DSpace on 2015-07-22T20:50:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-26 / Objetivos: Descrever os parâmetros acústicos do som da deglutição de indivíduos sem queixa e relacionar os parâmetros acústicos da deglutição (pico de frequência, pico de intensidade e duração) com sexo, volume e consistência dos alimentos. Material e Método: A amostra foi composta por 118 indivíduos (58 homens e 60 mulheres) com idades entre 18 a 39 anos (média 27,29 anos), sem queixas com relação à deglutição e ausência de história pregressa ou atual de disfagia mecânica ou neurogênica, doenças neurológicas, traumas e/ou cirurgias em região de cabeça e pescoço e/ou alterações anatômicas da cavidade oral que influenciassem nas funções de fala e deglutição, além de alteração de pele na região cervical. Foi utilizado um microfone de ausculta cardíaca adaptado para captação dos sons da deglutição, posicionado na região cervical conectado a micro computador. Foram gravadas três deglutições de saliva, líquido (água) e pastoso (iogurte), sendo os dois últimos nos volumes de 1, 3, 5 e 10ml, no total de 27 deglutições por indivíduo. Os sons foram gravados e analisados pelo software de análise acústica Adobe Audition versão 15.0. Resultados: Os valores médios do pico de frequência, pico de intensidade e duração do som da deglutição nos homens foram respectivamente: 509,8191(Hz), -10,1211(dB) e 0,3976(s); os valores médios do pico de frequência, pico de intensidade e duração do som da deglutição nas mulheres foram respectivamente: 468,4373(Hz), -14,0142(dB) e 0,4150(s). Houve diferença estatística significante no parâmetro pico de intensidade do som da deglutição que foi maior nos homens que nas mulheres; e quando comparadas as consistências, a duração do som da deglutição do líquido foi maior que no pastoso para os volumes de 3, 5 e 10ml. Não houve diferença estatística na correlação da duração do som da deglutição com os volumes testados. Conclusões: Não houve diferença entre os picos de frequência e duração do som das deglutições de homens e mulheres. Houve aumento no pico de intensidade dos homens comparado às mulheres. Considerando o total da amostra, a duração do som da deglutição do líquido foi maior que o pastoso para os volumes de 3, 5 e 10ml. Houve aumento da duração do som da deglutição com o aumento dos volumes para consistência líquida, exceto com 10ml. / Objectives: To describe the acoustic parameters of the sound of the swallow of individuals without complaint and to relate to the acoustic parameters of the swallow (peak of frequency, peak of intensity and duration) with sex, volume and consistency of food. Material and Method: The sample was composed by 118 individuals (58 men and 60 women) with ages between 18 and 39 years (27,29 means age), without complaints with regard to the swallow and absence of former or current history of mechanic or neurological dysphagia, illnesses, traumas and/or surgeries in head and neck area and/or anatomical alterations of the verbal socket that could influence in the functions of speaking and swallowing, besides alteration of skin in the cervical region. It was used a cardiologic auscultation microphone adapted for capitation of the sounds of the swallow, located in the cervical region hardwired to the micron computer. Three swallows of saliva, liquid (water) and paste had been recorded (yoghurt), being the two last ones in the volumes of 1, 3, 5 and 10ml, in the total of 27 swallows for individual. The sounds recorded were analyzed by the software acoustics Audition analysis Adobe version 15.0. Results: The average values of the peak of frequency, peak of intensity and duration of the sound of the swallow in the men were respectively: 509,8191(Hz), -10,1211(dB) and 0,3976(s); the average values of the peak of frequency, peak of intensity and duration of the sound of the swallow in the women were respectively: 468,4373,4373(Hz), -14,0142(dB) and 0,4150(s). There was a significant statistics difference in the parameters peak of intensity of the sound of the swallow that was bigger in the men than in the women; when compared to the consistence, the duration of the sound of the swallow of the liquid was greater that in the paste for the volumes of 3, 5 and 10ml. Sound of the swallow with the tested volumes did not have statistics difference in the correlation of duration. Conclusions: There as not difference between the peaks of frequency and duration of the sound of the swallows of men and women. There was an increase in the peak of intensity of the men compared to the women. Considering the total of the sample, the duration of the sound of the swallow of the liquid was greater that the paste for the volumes of 3, 5 and 10ml. Correlation was not established between the duration of the sound of the swallow and volumes. There was an increase in duration of the sound of swallow with increasing volumes to liquid consistency, except with 10ml. / TEDE

Fundamentação: Pacientes após o Acidente Vascular Encefálico (AVE) em fase aguda apresentam disfagia orofaríngea com risco de aspiração traqueal. Objetivos: Verificar a prevalência de sinais ou sintomas sugestivos de disfagia orofaríngea medidos através de avaliação clínica da deglutição em pacientes adultos, após o Acidente Vascular Encefálico, internados na Enfermaria de Neurologia do Hospital de Pronto Socorro de Porto Alegre. Métodos: Foram incluídos neste estudo os pacientes internados na Enfermaria de Neurologia de um Hospital Público, entre maio de 2009 e novembro de 2010, com diagnóstico de AVE isquêmico ou hemorrágico, que tiveram sua dieta via oral liberada pela equipe médica. Foram avaliados 101 pacientes (56 homens), até 72 horas após o evento, à beira do leito. Através de um protocolo da deglutição foram testadas consistências líquidas e pastosas para observar a presença de preditores clínicos que, seguramente, podem indicar risco de aspiração. Resultados: A média de idade dos pacientes avaliados foi de 64 anos. Trinta e seis destes tinham idade abaixo de 60 anos. Foram avaliadas 45 mulheres e 56 homens. Observou-se uma prevalência de 448,5% (49/101; IC 95%:3:8,9,% a 5,24%) de disfagia orofaríngea nestes pacientes. A predominância de gênero foi masculina e o tipo de AVE predominante foi o isquêmico. Observou-se uma correlação entre mulheres com disfagia (57,1%) e AVE hemorrágico neste grupo. Conclusão: Sinais clínicos de disfagia orofaríngea e risco para aspiração pós AVE podem ser identificados na avaliação clínica da deglutição através de um protocolo de deglutição com preditores clínicos validados na literatura. / Background: Patients after stroke in acute phase present oropharyngeal dysphagia having risk of tracheal aspiration. Objectives: To verify the prevalence of signs or symptoms suggesting oropharyngeal dysphagia with risk of tracheal aspiration with clinical evaluation of swallowing in adult patients after stroke interned in the Neurology Ward of the Hospital de Pronto Socorro de Porto Alegre. Methods: In this study patients interned in a Neurology Ward of a Public Hospital, between May 2009 and November 2010, diagnosed with ischemic or hemorrhagic stroke, having their oral diet released by the medical team. It was evaluated 101 patients (56 men), within the first 72 hours after being admitted to hospital, at bedside. Using a swallowing protocol, liquid and pudding consistencies were tested in order to observe the presence of clinical predictors which can indicate aspiration risk. Results: The mean age of the evaluated patients was 64 years old. Thirty six of these patients were under 60 years old. Forty five women and 56 men were evaluated. It was observed a prevalence of 48.5% (CI (49/101;IC 95%:38,9,% to 58,2%) of oropharingeal swallowing in those patients. The predominance was the male gender and the prevailing kind of stroke was the ischemic. In this group, it was observed a correlation among women with dysphagia (57.1%) and hemorrhagic stroke. Conclusion: Clinical signs of Oropharingeal dysphagia and aspiration risk after stroke can be identified in the clinical evaluation of swallowing through a swallowing protocol with clinical predictors validated in the literature.

Os mecanismos fisiológicos sofrem mudanças durante o processo de envelhecimento. Dentre as alterações que ocorrem naturalmente durante esse processo, existem os problemas de deglutição. A integridade da deglutição não só garante a manutenção do estado nutricional do paciente mas também protege o trato respiratório contra acidentes como aspiração de conteúdo da orofaringe; por outro lado, suas alterações, muitas vezes somadas a processos patológicos, levam a complicações nutricionais e infecciosas, favorecendo a ocorrência de outras doenças e podendo, até mesmo, levar a quadros irreversíveis. O presente estudo teve por objetivo avaliar a fase orofaríngea da deglutição de pacientes idosos internados na enfermaria da Divisão de Clínica Médica Geral e Geriatria do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, com ou sem queixas de dificuldade de deglutição, através da avaliação clínica fonoaudiológica e do estudo cintilográfico da deglutição, correlacionando-os. Para tanto, foram avaliados 30 pacientes idosos internados, com idades entre 66 e 94 anos, idade média de 80 anos, selecionados aleatoriamente, sem se considerar suas doenças e a presença ou não de queixas de disfagia, sendo excluídos os pacientes gravemente comprometidos, cujo estado impossibilitava a avaliação clínica e objetiva da deglutição. Além disso, obteve-se dois grupos controle, sendo um constituído por jovens, com idades variando de 21 a 30 anos, idade média de 25 anos e o outro foi constituído por idosos, com idades variando de 60 a 80 anos, idade média de 70 anos. Os voluntários dos grupos controle foram cuidadosamente triados antes da participação no estudo para assegurar que eles não apresentassem histórias de dificuldades para a deglutição e/ou condições médicas que pudessem influenciar a deglutição ou performance motora orofacial e/ou que usassem medicamentos depressores do sistema nervoso central. Para a avaliação funcional da deglutição, os participantes do estudo deglutiram dois bolos de alimentos de 5 ml cada, nas consistências líquida e pastosa. No estudo cintilográfico foram adicionados aos dois bolos, um marcador de radioatividade de fitato coloidal ligado ao tecnécio (99mTc). Os dados da avaliação foram analisados no computador através do protocolo de aquisição da gama-câmara (vision DST) quanto ao trânsito e resíduo oral, trânsito, clearance e resíduo faríngeo e entrada no esôfago proximal. O estudo permitiu concluir que idosos doentes sem queixa de dificuldade de deglutição e sem a presença de doenças que cursam com a disfagia, não apresentam diferença significativa dos parâmetros observados quando comparados com idosos saudáveis; pessoas idosas deglutem mais lentamente quando comparadas com pessoas mais jovens, entretanto essa lentificação permite que idosos deglutam mais seguramente. As mudanças no hábito alimentar de idosos devem ser questionadas por profissionais que trabalham com a população geriátrica e a avaliação fonoaudiológica clínica da deglutição deve fazer parte da definição do diagnóstico diferencial em quadros que sugiram dificuldades de deglutição e, principalmente deve ser imprescindível naqueles que apresentem patologias que cursam com a disfagia; a técnica cintilográfica é sensível a sutis mudanças relacionadas ao trânsito, clearance e resíduo alimentar. / Physiological mechanisms change during the aging process. Among the changes that occur naturally during this process, there are the problems of swallowing. Swallowing integrity not only warrants the maintenance of the patient’s nutritional status, but also protects the respiratory system against accidents like the aspiration of oropharyngeal contents. On the other hand, changes in the swallowing process, often added by other diseases, induces nutritional and infectious complications, favoring the occurrence of other diseases and, even, irreversible clinical pictures. The present study aimed to assess the oropharyngeal phase of swallowing of older persons admitted to the wards of the Division of General Internal Medicine and Geriatric Medicine of the Internal Medicine Department of the School of Medicine of Ribeirão Preto – University of São Paulo, independently of the presence or absence of swallowing complaints, through phonoaudiological clinical evaluation and cintilographic study of swallowing. Thirty elderly patients were studied, with age ranging from 66 to 94 years old, mean age 80 years, randomly selected, without being taken into consideration specific diseases and the presence or absence of swallowing complaints. Severely compromised Patients, whose health status made impossible adequate evaluation, were excluded. Two control groups were composed, one of young volunteers, aged from 21 to 30 years, mean age 25 years and one of elderly volunteers, with age ranging from 60 to 80 years old, mean age 70 years. Volunteers of the control groups were carefully evaluated before participation, to make sure that they did not have swallowing difficulties and/or clinical conditions that could influence swallowing and oral and facial motor performance and did not take medications with central nervous system actions. For functional assessment of swallowing, the study participants swallowed two boluses of 5 ml each, in liquid and syrup consistence. In the cintilographic study, a radioactive tracer (99mTc colloidal phytate) was added to the boluses. Data were analyzed through the gamma-camera acquisition protocol (vision DST) for oral transit and residual, pharyngeal transit, clearance time and residual and time for proximal esophagus entrance. The study allowed us to conclude that older patients without swallowing complaints and without diseases that cause dysphagia, do not show significant differences of the observed parameters when compared to healthy older persons. Older persons swallow slower when compared to younger persons, however this delay allows them to swallow safer. Changes in dietary habits of older persons should be questioned by professionals that work with geriatric populations and clinical phonoaudiological assessment of swallowing must be part of the assessment process of situations where difficulties for swallowing appeared, being absolutely necessary for those that present diseases that courses with dysphagia. The cintilographic technique is sensitive to subtle changes in transit, clearance and food residuals.

INTRODUÇÃO: A deglutição é um processo complexo que requer a coordenação precisa de mais de 25 músculos, seis pares de nervos cranianos e os lobos frontais. O comprometimento neste processo, denominado de disfagia, pode aumentar a taxa de morbidade dos pacientes e também o risco para a aspiração, retardando a administração de uma nutrição adequada por via oral. A intubação orotraqueal prolongada, definida na literatura como período superior a 48 horas de intubação, poderá causar alterações na deglutição e ocasionar a disfagia após a extubação. O objetivo deste estudo foi verificar as variáveis independentes da avaliação fonoaudiológica da deglutição que são preditoras do risco de disfagia após intubação orotraqueal prolongada nas Unidades de Terapia Intensiva. MÉTODOS: Foi realizado um estudo transversal observacional. Participaram deste estudo 148 pacientes submetidos à avaliação em beira de leito da deglutição, no período entre setembro de 2009 e setembro de 2011. Todos os pacientes apresentavam histórico de intubação orotraqueal prolongada e foram admitidos em uma das Unidades de Terapia Intensiva de um grande hospital escola brasileiro. Os critérios de inclusão adotados foram: estabilidade clínica e respiratória; pontuação na Escala de Coma Glasgow acima de 14 pontos; idade acima de 18 anos; ausência de traqueostomia; ausência de doenças neurológicas; ausência de disfagia esofágica; ausência de procedimentos cirúrgicos envolvendo a área de cabeça e pescoço. Além disso, os pacientes deveriam ser submetidos à avaliação em beira de leito da deglutição no prazo de 48 horas após a extubação. A análise estatística incluiu a correlação entre os resultados obtidos no teste de deglutição de água e a pontuação do nível da deglutição. RESULTADOS: Os resultados indicaram que a presença de tosse e alteração da ausculta cervical durante a deglutição de água são variáveis preditoras independentes do risco de disfagia para o grupo testado. CONCLUSÃO: O estudo apontou as variáveis preditoras do risco de disfagia em pacientes submetidos à intubação orotraqueal prolongada. / INTRODUCTION: Swallowing is a complex process, that require the precise timing and coordination of more than 25 muscles, six cranial nerves and frontal lobes. Compromise of this process, or dysphagia, can result in profund morbidity, increasing the changes of aspiration and delaying the admistration of proper oral nutrition. It is know that an orotracheal tube might disturb these intricately choreographed events and cause post-extubation dysphagia. Prolonged intubation, typically defined as longer than 48 hours in the literature, is thought to contribute to swallowing dysfunction. The objective of this study is to elucidated independent factors that predict the risk of dysphagia after prolonged orotraqueal intubation in Intensive Care Units patients. METHODS: A cross-sectional, observational study design was used. Participants were 148 consecutive patients who underwent clinical bedside swallowing assessment, from September 2009 to September 2011. All patients presented a history of prolonged orotraqueal intubation and were admitted in one of the several Intensive Care Units of a large Brazilian school hospital. The adopted inclusion criteria were: to present clinical and respiratory stability, to present more than 14 points on the Glasgow Coma Scale; age above 18 years; absence of tracheostomy; absence of neurologic diseases, absence of esophageal dysphagia; absence of surgical procedures involving the head and neck. Also, to be included in the study, patients had to undergo a clinical swallowing assessment within 48 hours after extubation. The statistical analysis included the correlation of the results obtained on a water swallow test and the risk level for dysphagia. RESULTS: Results indicated that altered cervical auscultation and presence of cough during water swallow tests increase the likelihood of dysphagia in patients who underwent prolonged orotracheal intubation. CONCLUSION: The results of the study indicate factors that predict the risk of dysphagia after prolonged orotraqueal intubation.

Fundamentação: Pacientes após o Acidente Vascular Encefálico (AVE) em fase aguda apresentam disfagia orofaríngea com risco de aspiração traqueal. Objetivos: Verificar a prevalência de sinais ou sintomas sugestivos de disfagia orofaríngea medidos através de avaliação clínica da deglutição em pacientes adultos, após o Acidente Vascular Encefálico, internados na Enfermaria de Neurologia do Hospital de Pronto Socorro de Porto Alegre. Métodos: Foram incluídos neste estudo os pacientes internados na Enfermaria de Neurologia de um Hospital Público, entre maio de 2009 e novembro de 2010, com diagnóstico de AVE isquêmico ou hemorrágico, que tiveram sua dieta via oral liberada pela equipe médica. Foram avaliados 101 pacientes (56 homens), até 72 horas após o evento, à beira do leito. Através de um protocolo da deglutição foram testadas consistências líquidas e pastosas para observar a presença de preditores clínicos que, seguramente, podem indicar risco de aspiração. Resultados: A média de idade dos pacientes avaliados foi de 64 anos. Trinta e seis destes tinham idade abaixo de 60 anos. Foram avaliadas 45 mulheres e 56 homens. Observou-se uma prevalência de 448,5% (49/101; IC 95%:3:8,9,% a 5,24%) de disfagia orofaríngea nestes pacientes. A predominância de gênero foi masculina e o tipo de AVE predominante foi o isquêmico. Observou-se uma correlação entre mulheres com disfagia (57,1%) e AVE hemorrágico neste grupo. Conclusão: Sinais clínicos de disfagia orofaríngea e risco para aspiração pós AVE podem ser identificados na avaliação clínica da deglutição através de um protocolo de deglutição com preditores clínicos validados na literatura. / Background: Patients after stroke in acute phase present oropharyngeal dysphagia having risk of tracheal aspiration. Objectives: To verify the prevalence of signs or symptoms suggesting oropharyngeal dysphagia with risk of tracheal aspiration with clinical evaluation of swallowing in adult patients after stroke interned in the Neurology Ward of the Hospital de Pronto Socorro de Porto Alegre. Methods: In this study patients interned in a Neurology Ward of a Public Hospital, between May 2009 and November 2010, diagnosed with ischemic or hemorrhagic stroke, having their oral diet released by the medical team. It was evaluated 101 patients (56 men), within the first 72 hours after being admitted to hospital, at bedside. Using a swallowing protocol, liquid and pudding consistencies were tested in order to observe the presence of clinical predictors which can indicate aspiration risk. Results: The mean age of the evaluated patients was 64 years old. Thirty six of these patients were under 60 years old. Forty five women and 56 men were evaluated. It was observed a prevalence of 48.5% (CI (49/101;IC 95%:38,9,% to 58,2%) of oropharingeal swallowing in those patients. The predominance was the male gender and the prevailing kind of stroke was the ischemic. In this group, it was observed a correlation among women with dysphagia (57.1%) and hemorrhagic stroke. Conclusion: Clinical signs of Oropharingeal dysphagia and aspiration risk after stroke can be identified in the clinical evaluation of swallowing through a swallowing protocol with clinical predictors validated in the literature.

Introdução: A desnutrição é um problema de saúde frequente, especialmente em pacientes com AVC, que atinge cerca de 16% da população podendo aumentar para 50% em até 3 meses. A Disfagia orofaríngea é considerada um distúrbio de deglutição, com sinais e sintomas específicos, que se caracteriza por alterações em qualquer etapa e/ou entre as etapas da dinâmica da deglutição, podendo ocorrer em 45 a 65% dos casos de AVC. Desnutrição e problemas de deglutição são comuns após acidente vascular encefálico e frequentemente ocorrem juntos. A falha em reconhecer a sua presença resultará em um aumento da morbidade e mortalidade. Pacientes internados em hospital como consequência de um AVC podem já estar desnutridos ou em risco de desnutrição, e muitas vezes estes se tornam mais desnutridos enquanto estão hospitalizados, mantendo este quadro meses depois. Entretanto, apesar da alta taxa de morbidade e mortalidade, estudos que investigam a evolução da desnutrição e disfagia e suas consequências clínicas após a o AVC ainda são escassos. Objetivos: Este estudo tem como objetivos identificar a frequência do estado nutricional e as dificuldades de deglutição em pacientes com AVC além de identificar os fatores preditivos para o estado nutricional e verificar se há associação entre o estado nutricional e os desfechos clínicos nesta população após três meses do ictus. Casuística e Métodos Foram avaliados 102 pacientes com AVC que deram entrada na Unidade de Emergência e que compareceram para consulta no Ambulatório de Doenças Neurovasculares (ADNV) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRPUSP) após três meses do ictus. Os seguintes procedimentos foram realizados com todos os pacientes selecionados para o estudo: aplicação da NIHSS para avaliação da gravidade do AVC; escala de Rankin modificada, para avaliação da capacidade funcional; aplicação do Eating Assessment Tool (EAT-10) que avalia sintomas de disfagia; aplicação da Mini-Avaliação Nutricional (MNA®) para avaliação do estado Nutricional e avaliação da cognição com o Mini Exame do Estado Mental (MEEM) Resultados: De acordo com a Análise multivariada (Correlação de Pearson) entre os instrumentos de avaliação é possível determinar que o estado nutricional associou-se com a gravidade do AVC na admissão (r=-0,38; p=0,001) e ambos se correlacionaram com incapacidade funcional aos 3 meses (r=-0,5; p=0,001), (r=0,45; p=0,001). A gravidade do AVC na admissão associou-se significativamente com maior número de noites no hospital. (r=0,41 p=0,001). E que a presença de alteração cognitiva associou-se significativamente com a incapacidade funcional aos 3 meses (rankin de 3 meses) (r=-0,51; p=0,001). Na análise de regressão logística, utilizando o método Backward a gravidade do AVC na admissão hospitalar foi fator preditivo independente de desnutrição nesta população (p=0,001) Portanto, os pacientes com pior estado nutricional possuíam maior gravidade do AVC na admissão, tiveram maior tempo de internação, (noites no hospital) e possuíam pior capacidade funcional e pior cognição aos 3 meses. / Introduction: Malnutrition is a frequent health problem, especially in patients with stroke, which affects about 16% of the population and can increase to 50% within 3 months. Oropharyngeal dysphagia is considered a swallowing disorder, with specific signs and symptoms, which is characterized by changes at any stage and / or between the stages of swallowing dynamics which can occur in 45 to 65% of stroke cases. Malnutrition and swallowing problems are common after a stroke and often occur together. Failure to recognize their presence will result in increased morbidity and mortality. Patients hospitalized as a consequence of a stroke may already be malnourished or at risk of malnutrition and often become more malnourished while hospitalized, maintaining this condition months later. However, despite the high rate of morbidity and mortality studies that investigate the evolution of malnutrition and dysphagia and its clinical consequences after stroke are still scarce. Objectives: This study aims to identify the frequency of nutritional status and swallowing difficulties in stroke patients in addition to identifying the predictive factors for nutritional status and to verify if there is an association between nutritional status and clinical outcomes in this population after three months of the stroke. Casuistry and Methods: We evaluated 102 stroke patients admitted to the Emergency Unit and attending the Neurovascular Diseases Outpatient Clinic (ADNV) at the Hospital das Clínicas of the Medical School of Ribeirão Preto at the University of São Paulo (HCFMRP-USP) After three months of the stroke. The following procedures were performed with all patients selected for the study: application of the NIHSS to evaluate the severity of stroke; Modified Rankin scale for functional capacity assessment; Application of the Eating Assessment Tool (EAT-10) evaluating symptoms of dysphagia; Application of the Nutritional Mini-Assessment (MNA®) to evaluate the nutritional status and evaluation of cognition with the Mini Mental State Examination (MMSE). Results: According to the Multivariate Analysis (Pearson\'s Correlation) among the evaluation instruments it was possible to determine that the nutritional status was associated with the severity of stroke on admission (r = - 0.38, p = 0.001) and both Correlated with functional disability at 3 months (r = -0.5, p = 0.001), (r = 0.45, p = 0.001). The severity of stroke on admission was significantly associated with greater number of nights in the hospital. (R = 0.41 p = 0.001). And that the presence of cognitive alteration was significantly associated with functional disability at 3 months (Rankin of 3 months) (r = -0.51; p = 0.001). In the logistic regression analysis using the Backward method the severity of stroke at hospital admission was an independent predictor of malnutrition in this population (p = 0.001). Therefore, patients with worse nutritional status had a greater severity of stroke on admission, had a longer (Nights in the hospital) and had worse functional capacity and worse cognition at 3 months.

There has been a worldwide increase in the number of tracheostomies performed on the paediatric population, particularly during the first year of life, which has also been evident at Red Cross Children’s Hospital in South Africa. Infants and toddlers with tracheostomies present with multiple risk factors for having or developing dysphagia and/or communication difficulties, due to the effects of the tracheostomy on the development of feeding, speech and communication, as well as the underlying medical conditions that necessitated the tracheostomy, and associated medical, social and environmental factors. There is, however, a dearth of literature in the area of paediatric tracheostomies in the South African context, particularly with regard to feeding and communication. The purpose of this study was to determine the incidence and describe the nature of dysphagia and communication difficulties in infants and toddlers with tracheostomies in the South African context, and detail the need for speech-language therapy intervention. It also attempted to determine whether there was an association between the underlying medical condition and the incidence of dysphagia and/or communication difficulties. A retrospective, descriptive survey of the folders of infants and toddlers with tracheostomies within the age range of 0 – 3 years from 2002 – 2004 at Red Cross Children’s Hospital was conducted. A checklist for dysphagia and communication difficulties in infants and toddlers with tracheostomies was developed and used to collect data from participants’ medical records. Results indicated that 80% of the study population presented with dysphagia. Oral phase difficulties were documented in 81.25%, pharyngeal phase difficulties in 60.9% and oesophageal phase difficulties in 79.7% of the dysphagic sample. Communication difficulties were recorded in 94% of the sample population. Speech production difficulties were documented in 78%, receptive language delays in 87% and expressive language delays in 96% of the sample population with communication difficulties. No statistically significant association was established between the underlying medical condition and the incidence of either dysphagia or communication difficulties. The results in the present study support the limited available literature, and the need for early speech-language therapy intervention for infants and toddlers with tracheostomies. / Dissertation (M (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / M (Communication Pathology) / unrestricted

<div>The aim of this study was to compare a newly developed ultrathin wearable surface electromyography (sEMG) sensors patch (patent pending, inventors: Lee & Malandraki) (i.e., experimental sensors) to commercially available and widely-used sEMG sensors (i.e., conventional sensors) in monitoring submental muscle activity during swallowing in healthy older adults. A randomized crossover design was employed to compare the performance of the experimental sensors with the performance of conventional snap-on sensors. Forty healthy older adults participated (24F; age range 53-85). Participants completed the same experimental protocol with both sensor types in a counterbalanced order. Swallow trials completed with both types of sensors included 5 trials of 5ml and 10ml water swallows. Comparisons were made on: a) signal related factors (i.e., signal-to-noise ratio, baseline amplitude, normalized amplitude of the swallow trials, and duration of sEMG burst during swallow trials); and b) safety and preclinical factors (safety/adverse effects, efficiency, and satisfaction/comfort).</div><div><br></div><div><div>In terms of signal related factors (Aim 1), we hypothesized that the signal-to-noise ratio and baseline amplitude values acquired using the experimental sensors will not be inferior to the ones acquired using the conventional sensors. These hypotheses were tested using non-inferiority tests. Moreover, we hypothesized that the normalized amplitude values and the sEMG burst duration during swallow trials will be comparable/equivalent between the two sensor types. These hypotheses were tested using equivalency tests. In terms of safety and pre-clinical factors</div><div>(Aim 2), we predicted that no adverse effects will be reported after using either type of sensors. We also hypothesized that sensor placement will be more efficient, and satisfaction/comfort level will be higher with the experimental sensors. These hypotheses were tested using paired t-tests.</div></div><div><br></div><div><div>Overall, the findings supported our hypotheses for Aim 1. Results showed that the experimental sensors did not perform inferiorly to the conventional sensors based on signal-tonoise ratio (left sensors: t(39) = 3.95, p <0.0002; right sensors: t(39) = 2.66, <i>p <0.0056</i>) and baseline amplitude values (left sensors: t(39) = -7.72, p <<i>0.0001</i>; right sensors: t(39) = -7.43, <i>p</i><<i>0.0001</i>). The normalized amplitude values were deemed equivalent for all swallow trials (5ml left: t_u = 4.25, t_l = -6.22; overall <i>p-value <0.0001</i>; 5ml right: t_u = 2.07, t_l = -4.06; overall <i>p-value <0.0224</i>; 10ml left: t_u = 5.49, t_l = -7.20; overall <i>p-value <0.0001</i>; 10ml right: t_u = 3.36 t_l = -5.28; overall <i>p-value <0.0012</i>).The duration of sEMG burst was also deemed equivalent for all variables (5ml left: t_u = 9.48, t_l = -7.25; overall <i>p-value <0.0001</i>; 5ml right: t_u = 9.03, t_l = -6.35; overall <i>p-value <0.0001</i>; 10ml left: t_u = 6.75, t_l = -6.11; <i>p-value <0.0001</i>; 10ml right: t_u = 6.58, t_l = -6.23; overall <i>p-value < 0.0001</i>).</div></div><div><br></div><div><div>In terms of safety and adverse effects (Aim 2, hypothesis #1), mild redness and itchiness occurred with the conventional sensors in six participants, whereas only one participant reported itchiness with the experimental sensors. No redness or skin irritation was observed or reported by any of the participants after the removal of the experimental sensors. In terms of time efficiency of electrode placement (Aim 2, hypothesis #2), our hypothesis was not proven, as there were no statistically significant differences in the time it took to place both sensor types; (t(39) = 1.87, <i>p= 0.9657</i>). However, as hypothesized (Aim 2, hypothesis #3) satisfaction/comfort level was significantly higher with the experimental sensors than the conventional ones, albeit with a relatively small effect size, t(39) = 1.71, <i>p = 0.0476</i>, <i>d = 0.226</i>.</div></div><div><br></div><div><div>Taken together, these findings indicate that the newly developed ultrathin wearable sEMG sensors obtain comparable signal quality and signal parameters to conventional and widely used sEMG snap-on electrodes; have fewer adverse effects associated with them compared to the conventional sensors, and healthy older adults are highly satisfied and comfortable using them. Future research is warranted to optimize the wearable sEMG sensors, before clinical trials examining the effectiveness of these sensors in the treatment of dysphagia can be initiated.</div></div>

Background: Feeding and swallowing difficulties (FSD) have been found in typically developing children as well as in children with complex medical conditions and developmental disabilities. These difficulties cause negative health consequences such as aspiration pneumonia, chronic lung disease, failure to thrive, prolonged hospital stay and even death. The early identification and management of feeding and swallowing difficulties is important as it prevents the negative effects on health and quality of life. Hence, there is a need for a validated screening tool to use in the general hospitalized paediatric population. Research Aims: The aim of this study was to validate the Feeding and Swallowing Questionnaire as a screening tool, in the paediatric population aged 0 – 2 years admitted to general medical wards. The secondary aim was to describe the FSD presenting in the paediatric population aged 0 - 2 years who are hospitalized in the general medical wards. Methodology: A prospective, descriptive, clinimetric design was utilized. A sample of 107 participants admitted to the general medical wards at Steve Biko Academic Hospital were included in the study. Participants’ feeding and swallowing was screened by a research assistant using the Feeding and Swallowing Questionnaire. After the screening, a clinical feeding and swallowing assessment was conducted for comparison, the assessment was conducted by the student researcher using the Clinical Feeding and Swallowing Assessment Tool. Results: There was a 27% FSD prevalence, with the majority of cases (92%) occurring in children under one year of age. One hundred and three children (63% male; median (IQR) age 5.2 (2.1 – 12.8) months) underwent screening and clinical assessment for feeding and swallowing disorders. The criterion validity of the Feeding and swallowing Questionnaire was established with a sensitivity of 88% and a specificity of 32%. Internal consistency was achieved with an acceptable Cronbach’s alpha of 0.79, and good inter-rater reliability (80%). Participants presented with feeding difficulties in all the phases of swallowing, while some participants had behavioural feeding difficulties. Those who had FSD had the following medical conditions: cardiorespiratory, neurological and gastrointestinal disorders namely acute gastroenteritis and liver disease. Feeding and swallowing difficulties were associated with increased mealtime duration (p=0.005) and supplementary oxygen support (p=0.03). Conclusion: The results confirm that the Feeding and Swallowing Questionnaire shows promising findings as a reliable and valid tool for the identification of FSD in the general hospitalized paediatric population. However, further research in other setting with general paediatric medical wards is required to increase the robustness of the screening tool.