Carolina Castelli Silvério

Ingesta oral do paciente hospitalizado com disfagia orofaríngea neurogênica

OBJETIVO: verificar a evolucao na ingesta oral e a ocorrencia de broncopneumonias (BCP) em pacientes hospitalizados com disfagia orofaringea neurogenica, apos atuacao fonoaudiologica. METODOS: 50 pacientes adultos, divididos em grupos: I: 31 pacientes pos-acidente vascular encefalico; II: sete pacientes pos-traumatismo crânio-encefalico; III: 12 pacientes com demencia. Foram levantadas as informacoes antes e apos a atuacao fonoaudiologica: nivel da Functional Oral Intake Scale (FOIS), ocorrencia de BCP; numero de atendimentos fonoaudiologicos e motivo de interrupcao destes. RESULTADOS: houve aumento significativo dos niveis da escala FOIS e reducao do percentual de ocorrencia de BCP nos tres grupos estudados. Nos grupos pos-AVE e demencia a interrupcao da fonoterapia ocorreu devido a alta hospitalar, enquanto que no grupo pos-TCE devido a alta fonoaudiologica. CONCLUSAO: os pacientes deste estudo demonstraram avancar das consistencias alimentares na ingesta oral, e reducao da ocorrencia de BCP, apos a intervencao fonoaudiologica com relacao a disfagia.

Indicadores da evolução do paciente com paralisia cerebral e disfagia orofaríngea após intervenção terapêutica

PURPOSE: To verify the evolution in nutrition and clinical stability of children with spastic tetraparetic cerebral palsy, after therapeutic intervention. METHODS: Data from before and after the therapeutic process were raised from the medical records of 36 children with spastic cerebral palsy, regarding classification of functional oral intake (FOIS scale) and degree of dysphagia, food consistency, and suggestive signs of penetration and/or tracheal aspiration. RESULTS: Most subjects were fed with special preparation, before and after intervention, with restrictions to solid and liquid foods in the second instance. It was observed decrease of the severity of dysphagia, reduction of the incidence of bronchopneumonia and pulmonary hypersecretion, weight increase, and reduction of suggestive signs of penetration and/or tracheal aspiration, except for refusal of food and cyanosis. CONCLUSION: Speech-language intervention in dysphagia, along with the work of a multidisciplinary team, promotes better functionality of swallowing and reduction of suggestive signs of penetration and/or tracheal aspiration, as well as improved clinical stability.PURPOSE: To verify the evolution in nutrition and clinical stability of children with spastic tetraparetic cerebral palsy, after therapeutic intervention. METHODS: Data from before and after the therapeutic process were raised from the medical records of 36 children with spastic cerebral palsy, regarding classification of functional oral intake (FOIS scale) and degree of dysphagia, food consistency, and suggestive signs of penetration and/or tracheal aspiration. RESULTS: Most subjects were fed with special preparation, before and after intervention, with restrictions to solid and liquid foods in the second instance. It was observed decrease of the severity of dysphagia, reduction of the incidence of bronchopneumonia and pulmonary hypersecretion, weight increase, and reduction of suggestive signs of penetration and/or tracheal aspiration, except for refusal of food and cyanosis. CONCLUSION: Speech-language intervention in dysphagia, along with the work of a multidisciplinary team, promotes better functionality of swallowing and reduction of suggestive signs of penetration and/or tracheal aspiration, as well as improved clinical stability.

Incidência de disfagia orofaríngea em pacientes com paralisia cerebral do tipo tetraparéticos espásticos institucionalizados

PURPOSE: To verify the incidence of oropharyngeal dysphagia in institutionalized patients with spastic tetraparetic cerebral palsy, correlating the findings with food consistency and type of hydration. METHODS: A total of 140 patients, with an average of 28 years old, participated in the study. The following data were gathered from their medical records: swallowing impairment, as classified according to the ROGS protocol; feeding type and food consistencies; hydration type. RESULTS: It was observed the presence of different degrees of oropharyngeal dysphagia, and most of the patients (40%) had functional deglutition. From the patients with functional deglutition and mild dysphagia, the majority, 65% and 50% respectively, were put on a doughy-consistency-based diet. From the patients with moderate dysphagia, 66.7% were put on a semi-liquid-consistency-based diet, and 94.7% of the patients with severe dysphagia used alternative feeding means. From the total number of patients, 63.6% had a liquid diet, and 10.7% received gelatin as hydration. CONCLUSION: The incidence of oropharyngeal dysphagia, adding its different impairment degrees, was high among patients with spastic tetraparetic cerebral palsy, although functional deglutition was the most often found. Doughy consistency food was more common among patients diagnosed with functional deglutition and mild dysphagia. Most patients with severe dysphagia used alternative feeding means. Fine liquid was more often found as the hydration type for most patients, and it was frequently substituted by gelatin depending on the severity of the swallowing impairment.

Análise quantitativa da deglutição de parkinsonianos pré e pós-riboflavina

Purpose to verify the quantitative changes in the swallowing dynamics in patients with Parkinson´s disease submitted to treatment with riboflavin, red meat and poultry removed during one year period. Methods sixteen patients with Parkinson´s disease participated in the study; the mean age was 67.25 years, the mean degree of disease severity was II to III, and the mean time since the diagnosis of the disease was 3.5 years. Videofluoroscopic evaluations were performed before and one year after treatment with riboflavin and diet with restriction of read meat and poultry. Analyzed were presence of complaints related to swallowing and quantitative analyses of swallowing includind computerized measurements of hyoid bone and cricoid cartilage displacement, opening of the superior esophageal sphincter and pharyngeal constriction. Results decrease of complaints was observed after administration of riboflavin. About the quantitative measures after riboflavin, there were a increase in the opening of the superior esophageal sphincter for all consistencies offered, an increase in the pharyngeal constriction for the thickened liquid, a reduction in the hyoide bone displacement, and an increase or a reduction in the cricoid cartilage displacement for each consistency, with significant reduction for the liquid. Conclusion quantitative measurements made in the movement of organs associated with swallowing showed no significant differences between pre-and post-riboflavin, and red meat and poultry removed.

Paciente com paralisa cerebral coreoatetoide: evolução clínica pós-intervenção

OBJETIVO: verificar a eficacia da intervencao terapeutica na funcao de degluticao e na estabilidade clinica de criancas portadoras de paralisia cerebral (PC) coreoatetoide com disfagia orofaringea. METODOS: 11 criancas portadoras de PC do tipo coreoatetoide, com media de idade de tres anos e tres meses, que frequentaram terapia fonoaudiologica. Foram levantados os seguintes dados: escala de avaliacao funcional da alimentacao (Functional Oral Intake Scale - FOIS); grau de severidade da disfagia; broncopneumonias (BCP), hipersecretividade pulmonar e peso; consistencia alimentar; sinais de penetracao e/ou aspiracao laringotraqueal. Os dados foram levantados no relatorio de avaliacao antes da intervencao terapeutica e no relatorio final de evolucao, no momento da alta. RESULTADOS: com relacao a aplicacao da escala FOIS, obteve-se que, tanto antes, quanto apos a intervencao, a maioria dos pacientes encontrou-se no nivel V da escala, com diminuicao no segundo momento. Aumento dos pacientes nos niveis III e IV. Apos intervencao terapeutica, houve diminuicao de pacientes que ingeriam liquidos, aumento do uso do liquido espesso e do pastoso homogeneo. Houve diminuicao da severidade da disfagia, reducao dos episodios de BCP e de hipersecretividade pulmonar, aumento de peso e reducao dos sinais de penetracao e/ou aspiracao laringotraqueal. CONCLUSAO: a intervencao fonoaudiologica, dentro de uma equipe multidisciplinar em disfagia, em criancas portadoras de PC coreoatetoide promove degluticao mais segura e eficaz, com reducao dos sinais sugestivos de penetracao e/ou aspiracao laringotraqueal, dos episodios de BCP e de hipersecretividade pulmonar, e aumento do peso.

O efeito da eletroestimulação neuromuscular na contração da musculatura supra-hióidea durante a deglutição de indivíduos com disfagia

Objetivo: verificar o efeito da Eletroestimulacao Neuromuscular na contracao da musculatura supra-hioidea durante a degluticao em individuos pos-Acidente Vascular Cerebral com disfagia orofaringea. Metodos: participaram da pesquisa oito individuos pos-Acidente Vascular Cerebral com disfagia, de ambos os sexos, encaminhados para terapia fonoaudiologica com objetivo de trabalhar a funcao da degluticao, em inicio de processo terapeutico. Anteriormente ao inicio da primeira sessao, foi realizada a mensuracao do tempo e amplitude da atividade eletrica muscular atraves da Eletromiografia de Superficie de Biofeedback. Os pacientes foram divididos aleatoriamente em dois grupos: Grupo Experimental (n=4): pacientes que receberam a fonoterapia tradicional e aplicacao da Eletroestimulacao Neuromuscular; Grupo Controle (n=4): pacientes que receberam a fonoterapia tradicional. Apos oito sessoes, todos os pacientes passaram novamente pela Eletromiografia de Superficie de Biofeedback para verificar a atividade eletrica da musculatura supra-hioidea. Os registros dos exames pre e pos intervencao foram comparados nos dois grupos. Resultados: comparando-se as medias das variaveis de amplitude e tempo da atividade eletrica muscular durante a degluticao de saliva e nas duas degluticoes de pastoso, nao foram observadas diferencas estatisticamente significantes entre os grupos estudados, na comparacao dos valores pre e pos intervencao. Conclusoes: o uso da Eletroestimulacao Neuromuscular nos parâmetros e na metodologia empregada nao mostrou-se eficiente em promover maior contracao da musculatura supra-hioidea durante a degluticao em individuos pos-Acidente Vascular Cerebral com disfagia orofaringea. Os dados encontrados podem ser decorrentes da metodologia utilizada nesta pesquisa com relacao ao protocolo de aplicacao da tecnica e a forma de mensuracao dos resultados.