Ana Maria Furkim

AVALIAÇÃO CLÍNICA E VIDEOFLUOROSCÓPICA DA DEGLUTIÇÃO EM CRIANÇAS COM PARALISIA CEREBRAL TETRAPARÉTICA ESPÁSTICA

Cerebral palsy is a condition that may be associated with swallowing disorders, that is, oropharingeal dysphagia. The aim of this study was to characterize and compare the swallowing processes of 32 children with this condition, by clinical and videofluoroscopic evaluation, with special focus on tracheal aspiration detectability. Results show an important compromise of oral phase. The most important findings during the pharyngeal phase were velopharingeal incompetence and residuals on the pharyngeal recesses. Aspiration was more common with liquids, before and after deglutition. On clinical and videofluoroscopic evaluation, cervical hyperextension was the commonest postural abnormality. Videofluoroscopy confirmed the occurrence of aspiration on most of the cases that presented suggestive signs of aspiration during clinical evaluation. We conclude that clinical and videofluoroscopic evaluations are complementary on deglutition evaluation and together may point to the most specific rehabilitation procedure.

Correlação entre os achados clínicos da deglutição e os achados da tomografia computadorizada de crânio em pacientes com acidente vascular cerebral isquêmico na fase aguda da doença

Stroke is one of the main causes of permanent lesions in adults and can provoke global motor sequels, speech and language alterations, and swallowing. During the acute phase, the detection of aspiration risks is essential to prevent lung complications and to allow appropriate therapeutic interventions, making possible precocious oral feeding. In the literature, the correlations between the disturbance of the deglutition and the location of the lesion in patients with stroke are not specific. This way, the objective of the present study was to determine if correlation exists between the location of the vascular lesion and dysphagia in acute ischemic stroke patients. Bedside clinical evaluation of deglutition was made in 27 patients with acute ischemic stroke and the results were compared with the computed tomography findings. In the clinical evaluation, 48% patients were dysphagic and 52% had functional deglutition. In dysphagic patients, 84% had lesion in carotid territory, with 76% in the middle cerebral artery. In patients with functional deglutition, 57% had lesion in the middle cerebral artery and 22% in the posterior cerebral artery. In 50% of the patients with functional deglutition and in 46% of the dysphagics the lesion was in the left hemisphere. In conclusion, the hemispherical location is not associated with the presence or not of dysphagia, however most of the dysphagic patients presented alterations in the carotid territory, especially in the middle cerebral artery.

O uso da ausculta cervical na inferência de aspiração traqueal em crianças com paralisia cerebral

OBJETIVO: comparar a detectabilidade da ausculta cervical na avaliacao clinica com a comprovacao da aspiracao na videofluoroscopia da degluticao em criancas com paralisia cerebral tetraparetica espastica com disfagia orofaringea. METODOS: estudo retrospectivo com analise de 101 prontuarios de criancas, na faixa etaria de 1 a 12 anos, pertencentes a uma instituicao, com diagnostico de paralisia cerebral tetraparetica espastica e que foram encaminhadas e avaliadas por equipe interdisciplinar. Foi realizada anamnese com avaliacao clinica da alimentacao com ausculta cervical e videofluoroscopia da degluticao. RESULTADOS: os resultados estatisticos mostraram que ha relacao significante entre a ausculta cervical positiva e a penetracao ou aspiracao laringea constatada na videofluoroscopia da degluticao e que a ausculta cervical negativa esta mais associada a nao penetracao/aspiracao. CONCLUSAO: concluiu-se que a ausculta cervical pode ser utilizada para inferencia do risco de aspiracao e, portanto, como alerta para atuacao precoce nessa populacao, alem da vantagem de ser um metodo nao invasivo.

INCIDENCE OF TRACHEAL ASPIRATION IN TRACHEOTOMIZED PATIENTS IN USE OF MECHANICAL VENTILATION

CONTEXT Many patients in use of mechanical ventilation show clinical complications due to tracheal aspiration. Assessment and early methods are necessary, so that preventive and safety measures apply to this patients. OBJECTIVE To study the incidence of tracheal aspiration of saliva in tracheotomized patients treated in intensive care unit using two modes of mechanical ventilation and with different sedation levels. METHOD Prospective study with 14 tracheotomized non-neurological patients using mechanical ventilation. The sample was divided into two groups based on ventilation mode: pressure support ventilation and pressure controlled ventilation. Those two groups were subdivided into two others according to sedation level. The speech pathology evaluation was completed via the blue dye test in order to analyze the incidence of tracheal aspiration of saliva. RESULTS Sedation levels and mechanical ventilation time related to tracheal aspiration were not statistically significant in this study. On the other hand, ventilation mode and tracheal aspiration showed statistical significance, and there was a higher incidence of tracheal aspiration in the pressure controlled ventilation mode. CONCLUSION It was possible to observe a significant relationship between tracheal aspiration incidence and pressure controlled ventilation mode, which means the inclusion of those patients in the risk group for oropharyngeal dysphagia and their insertion in prevention protocols. The relationship between tracheal aspiration and sedation level, as well as tracheal aspiration and mechanical ventilation, were not statistically significant in this sample, needing further research.

Clinical and fiberoptic endoscopic assessment of swallowing in patients with chronic obstructive pulmonary disease

Summary Introduction: Chronic obstructive pulmonary disease is characterized by progressive and partially reversible obstruction of pulmonary airflow. Aim: To characterize swallowing in patients with chronic obstructive pulmonary disease and correlate the findings with the degree chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, and smoking. Method: We conducted a prospective cohort study of 19 patients (12 men and 7 women; age range, 50–85 years) with confirmed medical diagnosis of chronic obstructive pulmonary disease. This study was performed in 2 stages (clinical evaluation and functional assessment using nasolaryngofibroscopy) on the same day. During both stages, vital signs were checked by medical personnel. Results: Clinical evaluation of swallowing in all patients showed the clinical signs of cough. The findings of nasolaryngofibroscopy highlighted subsequent intraoral escape in 5 patients (26.5%). No patient had tracheal aspiration. There was no association of subsequent intraoral escape with degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking. Conclusion: In patients with chronic obstructive pulmonary disease, there was a prevalence of oral dysphagia upon swallowing and nasolaryngofibroscopy highlighted the finding of subsequent intraoral escape. There was no correlation between intraoral escape and the degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking.

A instituição asilar como fator potencializador da disfagia

PURPOSE: to check if the conditions related to general structure, human resources and daily routine of feeding in asylums can increase the chances for an alteration in the deglutition process of the elderlies. METHODS: a questionnaire was elaborated to be applied to the directors of five institutions in the city of Rio de Janeiro. RESULTS: it can be observed that the sole factor related to the structure of the place that had relevance in the obtained results was the nature of the institution, as the private system was the only one that was considered near the ideal conditions. Regarding the existing human resources, none of the institutions had all the professionals demanded by the Ordinance no810/89. In relation to the daily feeding routines, in one of the investigated institutions, where the majority of the residents did not use denture, there was no restriction as for the offered food consistency. Another significant factor was the carelessness in terms of oral hygiene, favoring the settling of bacteria in the mouth, which can cause serious consequences in case of microaspirations. In three of the investigated institutions, it was observed that the elderlies lay down to sleep soon after the meals, fact that also had great importance, as this favors the incidence of gastroesophageal reflux episodes that can lead to gradual dysphagia. CONCLUSION: despite the fact that the asylum directors did not mention any referring problem in the process of deglutition of the elderlies, they show proper characteristics that can increase the possibilities for occurrence of alterations in the deglutition of these elderlies.

A miotomia do cricofaríngeo: artigo de revisão

Cricopharyngeal myotomy is a surgical procedure that might be indicated to patients with oropharyngeal dysphagia that, in general, are characterized by a motor impairment limited to the pharyngeal phase of swallowing, cricopharyngeal incoordination or incomplete relaxation of the Upper Esophageal Sphincter (UES). Indication of the myotomy, however, have been discussed and applied in many cases, with no effect on the improvement of deglutition dynamics. The aim of this study was to verify the criteria of indication and efficacy of cricopharingeal myotomy, based on studies of deglutition physiology in patients with oropharyngeal dysphagia. A literature review about this procedure and the description of its results on deglutition dynamics was carried out. Results showed that the best indicators of a well-succeeded myotomy are: efficient oral phase and good laryngeal elevation during deglutition. Therefore, an adequate indication of cricopharyngeal myotomy must consider not only the pharyngeal phase and the isolated functioning of the UES, but also the coordination and the relationship between the oral and the pharyngeal phases of deglutition.

Análise acústica do tempo de deglutição através do Sonar Doppler

Mailing address: Franciele Savaris Soria Rua das Papoulas, 70 CXP: 349 Toledo /PR Brasil E-mail: francisoria@hotmail.com ABSTRACT Objective: to compare the acoustic oropharyngeal swallowing time parameter in adult and elderly subjects, in different consistencies and volumes, using Doppler Sonar. Methods: the study was conducted in two stages. Firstly, the Screening Protocol of Swallowing Risk was applied. In the second stage, the individuals were submitted to a swallowing assessment with Doppler Sonar. The subjects received the following food consistencies during the assessment: dry swallowing (saliva), liquid, nectar, honey and pudding, in the volumes of 5 ml, 10 ml and free swallowing. The acoustic parameter analyzed in this study was Acoustic Swallowing Time (T). Results: objective and measurable outcomes were obtained; the difference in swallowing time between the adult and elderly subjects in relation to the consistency and the volume was mostly significant. Conclusion: a change in swallowing time was observed both in relation to the consistency and the volume of the food bolus when the elderly and adult subjects were compared.