Laélia Cristina Caseiro Vicente

Envelhecimento vocal em idosos instucionalizados

PURPOSES: to investigate vocal aspects related to healthy aging in the institutionalized elderly people, and to identify if these aspects interfer with communication and correlate vocal changes with motor oral system evaluation and speech patterns. METHODS: transversal clinic research in which the methods used were interview and phonoaudiological examination of a randomized sample of 48 aged patients, resident in Casa do Anciao Francisco Azevedo - Belo Horizonte/MG, who did not show neurological disabilities. Specific protocols were used, developed by the authors, according to aspects related to the purposes of this study RESULTS: vocal parameters were analyzed and the following conditions were observed: hoarse voice (70,8%), in moderate degree (33,3%), reduced loudness (56,2%), bass pitch (62,5%) and short maximum phonation periods (81,2%). About 41 (85,4%) patients reported that vocal problems do not interfer with their communication process. Normal aging did not result directly in alterations in speech patterns, but changes in motor oral system due to health aging showed different associations with those patterns. CONCLUSIONS: this study showed the presence of alterations in the aspects related to voice but they do not interfer with the communication process. There were not alterations in speech patterns due to health aging but changes in motor oral system showed different association with those patterns. This study has contributed to improve knowledge about voice and elderly that suffer changes due to health aging and live in old peoples homes.

Medidas de biossegurança em audiologia

BACKGROUND: biosafety precautions for audiologic practice. PURPOSE: to review the biosafety precautions suggested in the literature for infection control in audiology. The biosafety precautions suggested for many health professionals were adapted for the inherent activities of audiologic practice in Audiology Service at Hospital das Clinicas of UFMG. CONCLUSION: the submitted biosafety precautions can be used by any institution, hospital or clinic where the audiologic performance is becoming more widespread and, consequently, demanding specific precautions for audiologic practice.

Conhecimento dos profissionais da enfermagem que assistem pacientes com alterações da deglutição em um Hospital Universitário de Belo Horizonte

ABSTRACT Purpose: To describe the performance of nursing professionals with patients with swallowing disorders. Methods: Cross-sectional, comparative study of stratified sampling, where 130 nursing professionals of a university hospital were interviewed. The mean age of the groups was 29.16 years, with a standard deviation of 11.81. From the professionals interviewed, 64% were female, and 23% were male. Data were statistically analyzed using the Exact Fischer’s test, with a significance level of 5%. Results: From the inter-viewed professionals, 92.33% reported that the speech therapist is the professional responsible for the rehabilitation of patients with swallowing disorders; 87% showed appropriate knowledge about the diseases that might cause swallowing disorders, and 94.66% declared to know how to identify patients with signs or symptoms of swallowing disorders. The present study allowed demonstra-ting that nurses are more prepared than technicians, who are more prepared than nursing assistants, in some related items regarding swallowing disorders.

Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation

INTRODUCTION Lesions in the oral cavity, pharynx and larynx due to endotracheal intubation can cause reduction in the local motility and sensitivity, impairing the swallowing process, resulting in oropharyngeal dysphagia. OBJECTIVE To verify the predictive factors for the development of oropharyngeal dysphagia and the risk of aspiration in patients with prolonged orotracheal intubation admitted to an intensive care unit. METHODS This is an observational, analytical, cross-sectional and retrospective data collection study of 181 electronic medical records of patients submitted to prolonged orotracheal intubation. Data on age; gender; underlying disease; associated comorbidities; time and reason for orotracheal intubation; Glasgow scale on the day of the Speech Therapist assessment; comprehension; vocal quality; presence and severity of dysphagia; risk of bronchoaspiration; and the suggested oral route were collected. The data were analyzed through logistic regression. The level of significance was set at 5%, with a 95% Confidence Interval. RESULTS The prevalence of dysphagia in this study was 35.9% and the risk of aspiration was 24.9%. As the age increased, the altered vocal quality and the degree of voice impairment increased the risk of the presence of dysphagia by 5-; 45.4- and 6.7-fold, respectively, and of aspiration by 6-; 36.4- and 4.8-fold. The increase in the time of orotracheal intubation increased the risk of aspiration by 5.5-fold. CONCLUSION Patients submitted to prolonged intubation who have risk factors associated with dysphagia and aspiration should be submitted to an early speech-language/audiology assessment and receive appropriate and timely treatment. The recognition of these predictive factors by the entire multidisciplinary team can minimize the possibility of clinical complications inherent to the risk of dysphagia and aspiration in extubated patients.

Frequência e fatores associado à disfagia após acidente vascular cerebral

PURPOSE To investigate the frequency of dysphagia in acute stroke and the possible associated clinical and sociodemographic features. METHOD A cross-sectional study was performed including 100 stroke patients who were admitted to the Minas Gerais Regional Public Hospital. Sociodemographic and clinical data were collected, and the patients underwent clinical evaluation through the Gugging Swallowing Screen (GUSS). RESULTS The frequency of dysphagia was 50%, and most patients had severe swallowing disorders. Only a previous history of stroke was associated with dysphagia (p=0.02). Other sociodemographic and clinical variables were not associated with dysphagia, suggesting that the location and the pathophysiology of stroke did not influence its occurrence and severity. CONCLUSION The frequency of dysphagia after stroke is high, being a previous stroke an important risk factor for subsequent stroke.

Tempo de trânsito oral na demência de Alzheimer

Objetivo: Avaliar o tempo de trânsito oral de alimento na consistência pudim, nos diferentes estágios da demência de Alzheimer. Métodos: Estudo de caráter descritivo e observacional do tipo transversal, com uma amostra de 34 idosos com idade entre 65 e 98 anos, com demência de Alzheimer em diferentes estágios. Os participantes foram observados por avaliação de videofluoroscopia da deglutição, enquanto ingeriam alimento na consistência pudim, usando o programa de cronometragem Kinovea. Os dados foram analisados estatisticamente, em nível de significância de 5%. Resultados: Os participantes com o Clinical Dementia Rating CDR 3 apresentaram maior tempo de trânsito oral, quando comparados àqueles com CDR 1, média de 3,09s (desvio padrão = 0,91) e 1,17s (desvio padrão = 1,10), respectivamente. Participantes na faixa etária de 90a 100 anos apresentaram maior tempo de trânsito oral do que os mais jovens, entre 60 e 79 anos, média de 3,90s e 1,28s. Conclusão: Indivíduos com demência e idade avançadas apresentam tempo de trânsito oral aumentado para alimento na consistência pudim, devendo ser alvo de atenção de familiares e cuidadores.

Association between executive and food functions in the acute phase after stroke

Purpose To investigate potential associations among executive, physical and food functions in the acute phase after stroke. Methods This is a cross-sectional study that evaluated 63 patients admitted to the stroke unit of a public hospital. The exclusion criteria were other neurological and/or psychiatric diagnoses. The tools for evaluation were: Mini-Mental State Examination and Frontal Assessment Battery for cognitive functions; Alberta Stroke Program Early CT Score for quantification of brain injury; National Institutes of Health Stroke Scale for neurological impairment; Modified Rankin Scale for functionality, and the Functional Oral Intake Scale for food function. Results The sample comprised 34 men (54%) and 29 women with a mean age of 63.6 years. The Frontal Assessment Battery was significantly associated with the other scales. In multivariate analysis, executive function was independently associated with the Functional Oral Intake Scale. Conclusion Most patients exhibited executive dysfunction that significantly compromised oral intake.

Fatores associados à pressão de língua em pacientes pós-acidente vascular cerebral

Introdução: A prática clínica fonoaudiológica no ambiente hospitalar mostra que existe alta prevalência de disfagia em pacientes pós-acidente vascular cerebral. Objetivo: Verificar se o tempo de ocorrência e o tipo do acidente vascular cerebral, o hemicorpo acometido por hemiplegia, a gravidade do deficit neurológico, a presença e o grau de disfagia interferem na pressão de língua de pacientes internados pós-acidente vascular cerebral. Métodos: Estudo realizado com 31 pacientes. Foi aplicado protocolo da avaliação da disfagia, prova de mobilidade lingual e mediu-se a pressão de língua com o Iowa Oral Performance Instrument (IOPI). Foram realizadas três medidas da pressão anterior e três da pressão posterior. Os dados foram analisados por meio de estatística apropriada, com nível de significância de 5%. Resultados: Apenas a presença de disfagia se mostrou associada estatisticamente à pressão de língua, sendo que os pacientes pós-acidente vascular cerebral disfágicos apresentaram pressão anterior e posterior média e máxima da língua menor que aqueles sem a presença de disfagia. O tempo de ocorrência do acidente vascular cerebral, o tipo e o hemicorpo acometido e a gravidade do deficit neurológico não apresentaram associação com a pressão lingual. Dentre os 15 participantes que apresentaram a dificuldade de deglutição, 14 (93,3%) foram classificados com disfagia leve e um (6,7%) com disfagia moderada. Conclusão: Verificou-se que a disfagia, ainda que de grau leve, foi o fator preponderante para diminuição da pressão de língua em pacientes que sofreram acidente vascular cerebral.

Evolução da deglutição no pós-AVC agudo: estudo descritivo

Purpose: to analyze the evolution of swallowing after acute stroke. Methods: this is a descriptive exploratory study with a non-probabilistic sample where 100 stroke patients were followed in the Regional Public Hospital of Betim. The patients were subjected to a structured speech evaluation in two different times: in the first 48 hours after stroke and at the time of hospital discharge. The Gugging Swallowing Screen scale was used. It is a standardized and valid tool to be used at the bedside. Results: in the initial speech evaluation, the frequency of dysphagia among patients was of 52%, being that 28% of them were diagnosed with severe dysphagia with high risk of aspiration. The average time between the initial swallowing assessment and the assessment at the hospital discharge was 22.1 days. At the hospital discharge, only 2.1% of patients still presented severe dysphagia. A change of the swallowing profile with the severity of dysphagia and texture of the oral feeding was observed. Conclusion: the frequency of post-stroke dysphagia is high, but there are progressive changes in the swallowing profile of the patients during their hospital stay.