Ana Rita Gatto

Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência

Cerebrovascular disease is recognized as to be associated with the highest mortality rate in Brazil. Dysphagia, speech and language disturbances are common consequences of the high incidence of stroke. Dysphagia is known to occur in at least 50% of the patients with acute stroke. The study is designed to stablish the incidence of stroke in a reference hospital. One hundred and two consecutive patients admitted between January 2001 and January 2002 underwent a neurological examination with dysphagia specific analysis, performed by speech/dysphagia professionals as soon as they have clinical conditions. The localization of the lesions are determined by computer tomography or magnetic resonance image of the brain. Sixty one patients underwent videofluorscopic evaluation of swallowing. There was detected oropharyngeal dysphagia in 78 patients (76.5%) if the examination was limited to the clinical evaluation. Neverthless, if complemented by videofluorscopic evaluation, the incidence grows to 90%. The explanation for the high incidence observed in this study could be pointed to the fact that dysphagia was registered on different times of the convalescence period. The data reinforces the importance of repeated evaluations made by different professionals of the sttaff involved in acute stroke attendance.

The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke

CONTEXT The effect of sour taste and food temperature variations in dysphagic patients has not been entirely clarified. OBJECTIVE To determine the effect of sour and cold food in the pharyngeal transit times of patients with stroke. METHODS Patients participating in this study were 30 right-handed adults, 16 of which were male and 14 were female, aged 41 to 88 (average age 62.3 years) with ictus varying from 1 to 30 days (median of 6 days). To analyze the pharyngeal transit time a videofluoroscopy swallow test was performed. Each patient was observed during swallow of a 5 mL paste bolus given by spoon, totaling four different stimuli (natural, cold, sour and cold sour), one at a time, room temperature (22 degrees C) and cold (8 degrees C) were used. Later, the tests were analyzed using specific software to measure bolus transit time during the pharyngeal phase. RESULTS The results showed that the pharyngeal transit time was significantly shorter during swallow of cold sour bolus when compared with other stimuli. CONCLUSION Sour taste stimuli associated to cold temperature cause significant change in swallowing patterns, by shortening the pharyngeal transit time, which may lead to positive effects in patients with oropharyngeal dysphagia.

Software para análise quantitativa da deglutição

OBJECTIVE: The present paper is aimed at introducing a software to allow a detailed analysis of the swallowing dynamics. MATERIALS AND METHODS: The sample included ten (six male and four female) stroke patients, with mean age of 57.6 years. Swallowing videofluoroscopy was performed and images were digitized for posterior analysis of the pharyngeal transit time with the aid of a chronometer and the software. RESULTS: Differences were observed in the average pharyngeal swallowing transit time as a result of measurements with chronometer and software. CONCLUSION: This software is a useful tool for the analysis of parameters such as swallowing time and speed, allowing a better understanding of the swallowing dynamics, both in the clinical approach of patients with oropharyngeal dysphagia and for scientific research purposes.

Protocolo para controle de eficácia terapêutica em disfagia orofaríngea neurogênica (PROCEDON)

PURPOSE: to submit a proposal for efficacy control in neurogenic oropharyngeal dysphagia. METHODS: the protocol was proposed in accordance with other researches and applied in one post-stroke individual, with right-hemispheric lesion confirmed by computed tomography, with oropharyngeal dysphagia, male gender, 66-year old, with laringotraqueal aspiration and using nasogastric feeding tube before swallowing therapy. In order to control the therapy effectiveness in pre- and post-swallowing therapy, the following procedures were applied: classification of severity degree for oropharyngeal dysphagia, functional oral intake scale (FOIS), videofluoroscopic evaluation of swallowing with additional swallowing pharyngeal transit time evaluation using a specific software and individual perception. RESULTS: before swallowing therapy, severe oropharyngeal dysphagia, FOIS level 1, presence of laryngotracheal aspiration, and 13 seconds of pharyngeal transit time were found. After swallowing therapy, moderate oropharyngeal dysphagia, FOIS level 5, absence of laryngotracheal aspiration, and 4 seconds of pharyngeal transit time were found. CONCLUSION: the proposed protocol could measure changes, both for pathophysiology of swallowing as well as for oral ingestion of the individual. We believe that it is still necessary to include nutritional and lung status of the individual in efficacy control of oropharyngeal dysphagia.

Sour taste and cold temperature in the oral phase of swallowing in patients after stroke

PURPOSE To determine the effect of sour flavor and cold temperature on oral transit time during swallowing. METHODS Participants were 52 subjects (28 male and 24 female) with ages between 50 and 80 years (median=66 years), after ischemic stroke involving right or left side damage and mild to moderate oropharyngeal dysphagia. Videofluoroscopy was performed to analyze the swallowing times. Each subject was assessed during swallowing of a paste consistency bolus offered in 5 ml spoons, with a total of four different stimuli (natural, cold, sour and sour-cold). After the exam, the oral transit time was measured using specific software. The oral transit time (starting at the beginning of the bolus movement in the mouth) and the total oral transit time (starting at the moment that the bolus is placed in the mouth) were measured. RESULTS The association between sour and cold stimuli caused a significant decrease of oral transit time and total oral transit time. CONCLUSION Sour flavor and cold temperature reduced oral transit time in stroke patients.

Classification of normal swallowing and oropharyngeal dysphagia using wavelet

Oropharyngeal dysphagia is characterized by any alteration in swallowing dynamics which may lead to malnutrition and aspiration pneumonia. Early diagnosis is crucial for the prognosis of patients with dysphagia, and the best method for swallowing dynamics assessment is swallowing videofluoroscopy, an exam performed with X-rays. Because it exposes patients to radiation, videofluoroscopy should not be performed frequently nor should it be prolonged. This study presents a non-invasive method for the pre-diagnosis of dysphagia based on the analysis of the swallowing acoustics, where the discrete wavelet transform plays an important role to increase sensitivity and specificity in the identification of dysphagic patients.

Reabilitação em disfagia orofaríngea neurogênica: sabor azedo e temperatura fria

BACKGROUND: rehabilitation in neurogenic oropharyngeal dysphagia PURPOSE: to submit an overview of the related literature about neurophisiological control of oropharingeal dysphagia and the role of temperature and sour taste on swallowing mechanisms. CONCLUSIONS: as for the neurophysiologic swallowing control, there are still controversies when it comes to sour taste and cold temperature. These two standards can change the swallowing dynamics, and they may bring out benefits to the individuals with neurogenic oropharyngeal dysphagia. Therefore, the findings suggest the need for further investigations with randomized studies.

Componentes do sinal acústico da deglutição: estudo preliminar

PURPOSE To analyze the components of the acoustic signal of swallowing using a specific software. METHODS Fourteen healthy subjects ranging in age from 20 to 50 years (mean age 31 ± 10 years), were evaluated. Data collection consisted on the simultaneous capture of the swallowing audio with a microphone and of the swallowing videofluoroscopic image. The bursts of the swallowing acoustic signal were identified and their duration and the interval between them were later analyzed using a specific software, which allowed the simultaneous analyses between the acoustic wave and the videofluoroscopic image. RESULTS Three burst components were identified in most of the swallows evaluated. The first burst presented mean time of 87.3 milliseconds (ms) for water and 78.2 for the substance. The second burst presented mean time of 112.9 ms for water and 85.5 for the pasty substance. The mean interval between first and second burst was 82.1 ms for water and 95.3 ms for the pasty consistency, and between second and third burst was 339.8 ms for water and 322.0 ms for the pasty consistency. CONCLUSION The software allowed the visualization of three bursts during the swallowing of healthy individuals, and showed that the swallowing signal in normal subjects is highly variable.

Adaptação para a língua Portuguesa e aplicação de protocolo de avaliação das disartrias de origem central em pacientes com Doença de Parkinson

OBJETIVO: traduzir e adaptar protocolo desenvolvido por pesquisadores alemaes, adequando-o as caracteristicas foneticas e linguisticas do portugues falado no Brasil. Caracterizar os componentes de fala mais alterados na populacao com doenca de Parkinson, comparando-os com grupo de sujeitos normais na mesma faixa etaria. METODOS: realizou-se a traducao e adaptacao do protocolo. Posteriormente foram avaliados 21 pacientes com diagnostico neurologico de Doenca de Parkinson nos estagios Hoehn &Yarh, entre 2 e 3, e 10 sujeitos normais. O protocolo incluia avaliacao da respiracao, fonacao, ressonância, articulacao, prosodia e a analise acustica dos parâmetros vocais. RESULTADOS: o protocolo mostrou-se de facil aplicacao clinica. Nos sujeitos com doenca de Parkinson foram observadas alteracoes predominantes na fonacao (85,9%) e articulacao (42,9%). CONCLUSAO: o estudo demonstrou ser o protocolo uma ferramenta eficiente para a avaliacao da disartria em pacientes com doenca de Parkinson.

Tempo de trânsito oral e lateralidade da lesão cerebral no acidente vascular encefálico

Introduction: The oropharyngeal transit time changes according to several variables. Purpose: To compare the total oral transit time (TOTT) and laterality of brain lesion in the individual after stroke with oropharyngeal dysphagia. Methods: Analyzed 61 videofluoroscopic swallowing studies of individuals after unilateral cortical ischemic stroke. Participants were divided into two groups. Group 1 (G1) consisted of 30 individuals with right-side cortical lesion and group 2 (G2) of 31 individuals with left-side cortical lesion. Quantitative analysis of the TOTT was performed by two judges trained in the procedure by means of specific software and an analysis of the reliability between judges was performed. The Mann-Whitney test was used for the data analysis. Results: It was found TTOT longer than 2000 ms in 50% of the G1 and in 94% of the individuals of G2 with a significant statistical difference between the groups (p<0.01). In the comparison between G1 and G2 regarding TOTT, it was verified that there was significant statistical difference (p=0.001). However, there was no significant statistical difference in the comparison between G1 and G2 for both TOTT shorter than 2000 ms (p=1.000) and TOTT longer than 2000 ms (p=0.603). However, it was found that in G2 the TOTT average is longer than 2000 ms and was greater than in G1. Conclusion: There were TOTT shorter and longer than 2000 ms in both hemispheric cortical lesion. The frequency of individuals with TTOT are longer than 2000 ms and the average are greater in the left-side cortical lesion in stroke.