Ludimila Labanca

Validade da prova calórica monotermal em comparação à estimulação bitermal

BACKGROUND the use of monothermal caloric testing as a screening tool for vestibular asymmetry has been considered as an alternative to bithermal caloric testing. AIM to evaluate the effectiveness of monothermal stimulation when compared to bithermal stimulation in the diagnosis of labyrinth asymmetry. METHOD the results of 389 vectoelectronystagmography, performed between 1998 and 2007, were analyzed. Monothermal stimulation at 30°C and 44°C with unilateral weakness (UW) cut-off at 20% and 25% was compared to bithermal stimulation with cut-off at 25% (gold standard). The analysis was aimed at finding which kind of monothermal caloric test (30°C or 44°C) and which kind of cut-off (20% or 25%) presented the highest specificity and sensitivity values in comparison with bithermal caloric testing. RESULTS sensitivity and specificity of monothermal caloric tests were: 84% and 80%, at 30°C with UW at 20%; 78% and 90%, at 30°C with UW at 25%; 81% and 78%, at 44°C with UW at 20%; 76% and 85%, at 44°C with UW at 25%. CONCLUSION monothermal caloric testing with 30°C stimulus presented the highest sensibility and specificity values in comparison to the results obtained with bithermal stimulation. However, no significant difference was observed between such values and those obtained with 44°C stimulus. In all of the analyses, monothermal testing presented low sensitivity. Thus, the abnormal result of bithermal caloric testing might be seen as normal in monothermal stimulation. The use of monothermal testing as a screening tool is better recommended for individuals whose medical history suggests a low probability of vestibular disease.

Contribution of Galvanic Vestibular Stimulation for the Diagnosis of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis.

Background and Purpose Galvanic vestibular stimulation (GVS) is a low-cost and safe examination for testing the vestibulospinal pathway. Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive disease that affects the vestibulospinal tract early in its course. This study compared the electromyographic (EMG) responses triggered by GVS of asymptomatic HTLV-1-infected subjects and subjects with HAM/TSP. Methods Bipolar galvanic stimuli (400 ms and 2 mA) were applied to the mastoid processes of 39 subjects (n=120 stimulations per subject, with 60 from each lower limb). Both the short latency (SL) and medium latency (ML) components of the EMG response were recorded from the soleus muscles of 13 healthy, HTLV-1-negative adults (56±5 years, mean±SD), and 26 individuals infected with HTLV-1, of whom 13 were asymptomatic (56±8 years) and 13 had HAM/TSP (60±6 years). Results The SL and ML EMG components were 55±4 and 112±10 ms, respectively, in the group of healthy subjects, 61±6 and 112±10 ms and in the HTLV-1-asymptomatic group, and 67±8 and 130±3 ms in the HAM/TSP group (p=0.001). The SL component was delayed in 4/13 (31%) of the examinations in the HTLV-1-asymptomatic group, while the ML component was normal in all of them. In the HAM/TSP group, the most common alteration was the absence of waves. Conclusions A pattern of abnormal vestibular-evoked EMG responses was found in HTLV-1-neurological disease, ranging from delayed latency among asymptomatic carriers to the absence of a response in HAM/TSP. GVS may contribute to the early diagnosis and monitoring of nontraumatic myelopathies.

Identificação dos distúrbios da linguagem na escola

OBJETIVO: verificar se os educadores infantis sao capazes de identificar as criancas com alteracao no desenvolvimento de linguagem. METODOS: tratou-se de um estudo observacional transversal comparativo realizado em escolas carentes de educacao infantil. A amostra do estudo foi composta por 14 educadores e 91 alunos regularmente matriculados nas instituicoes de ensino selecionadas, nas faixas etarias de dois a quatro anos e 11 meses. Os educadores responderam um questionario sobre o desenvolvimento das criancas e aplicou-se a avaliacao fonoaudiologica em todas elas. Realizou-se analise da concordância entre a avaliacao fonoaudiologica e a do educador por meio do coeficiente Kappa e calculos de sensibilidade e especificidade, considerando a avaliacao fonoaudiologica como referencia. RESULTADOS: segundo avaliacao fonoaudiologica, o desenvolvimento da linguagem das criancas estava comprometido da seguinte forma: 22% possuiam alteracao na recepcao, 34,1% na emissao, 35,2% nos aspectos cognitivos e 6,6% nos aspectos motores. Identificou-se baixa concordância entre a avaliacao fonoaudiologica e do educador. A avaliacao do educador teve sensibilidade que variou entre 0,3 e 0,4 e especificidade que variou entre 0,6 e 0,9. CONCLUSAO: os educadores apresentaram dificuldades em identificar as criancas com riscos para alteracoes de linguagem.

Vestibular Evoked Myogenic Potential (VEMP) Triggered by Galvanic Vestibular Stimulation (GVS): A Promising Tool to Assess Spinal Cord Function in Schistosomal Myeloradiculopathy.

Background Schistosomal myeloradiculopathy (SMR), the most severe and disabling ectopic form of Schistosoma mansoni infection, is caused by embolized ova eliciting local inflammation in the spinal cord and nerve roots. The treatment involves the use of praziquantel and long-term corticotherapy. The assessment of therapeutic response relies on neurological examination. Supplementary electrophysiological exams may improve prediction and monitoring of functional outcome. Vestibular evoked myogenic potential (VEMP) triggered by galvanic vestibular stimulation (GVS) is a simple, safe, low-cost and noninvasive electrophysiological technique that has been used to test the vestibulospinal tract in motor myelopathies. This paper reports the results of VEMP with GVS in patients with SMR. Methods A cross-sectional comparative study enrolled 22 patients with definite SMR and 22 healthy controls that were submitted to clinical, neurological examination and GVS. Galvanic stimulus was applied in the mastoid bones in a transcranial configuration for testing VEMP, which was recorded by electromyography (EMG) in the gastrocnemii muscles. The VEMP variables of interest were blindly measured by two independent examiners. They were the short-latency (SL) and the medium-latency (ML) components of the biphasic EMG wave. Results VEMP showed the components SL (p = 0.001) and ML (p<0.001) delayed in SMR compared to controls. The delay of SL (p = 0.010) and of ML (p = 0.020) was associated with gait dysfunction. Conclusion VEMP triggered by GVS identified alterations in patients with SMR and provided additional functional information that justifies its use as a supplementary test in motor myelopathies.

A avaliação do desenvolvimento infantil: um desafio interdisciplinar

OBJECTIVE: The aim of this study was to evaluate early childhood development, from two months to two years of age, based on Integrated Management of Childhood Illness, IMCI (or AIDPI in Portuguese) in the context of the Educational Program for Health Work (PET-Saude). METHODS: A cross-sectional study was conducted with 122 children two months to two years of age from the coverage area of the Sao Bernardo Health Center in Belo Horizonte, Minas Gerais State, in 2009. Data on the children´s development were obtained using two questionnaires: IMCI and the Childrens Health Booklet (CSC in Portuguese). Early childhood development according to the IMCI classification was compared to the results with CSC. The authors also investigated potential associations between independent variables and developmental delay. RESULTS: The most frequent characteristics in the study population were low maternal schooling (62.1%), followed by relatives with mental disability (71.3%), and problems during the pregnancy (71.3%). Based on the IMCI classification, 61.5% of the study population was normal with some risk factor, 16.4% normal without any risk factor, 11.5% with possible delay, and 10.7% with probable childhood developmental delay. Agreement between the IMCI and CSC classifications was 0.34, kappa index - 0.12 (p = 0.98). There was no statistically significant association between the variables (daycare attendance; contact with emotional problems; maternal schooling; gestational age; and birth weight) and possible or probable early childhood developmental delay according to the IMCI classification. CONCLUSION: PET-Saude, as a proposal for integration between education and work, provided an opportunity for contact and exchange of experiences between students and health professionals from various fields, working in a common project.

Triagem auditiva em idosos: avaliação da acurácia e reprodutibilidade do teste do sussurro

Resumo Devido a alta prevalencia da presbiacusia e as suas consequencias, metodos de triagem auditiva sao necessarios no âmbito da atencao primaria. Diante disso, o objetivo do estudo foi verificar a reprodutibilidade e acuracia do teste do sussurro como metodologia de triagem auditiva em idosos. Trata-se de estudo transversal com medidas de acuracia que incluiu 210 idosos, entre 60 e 97 anos, submetidos ao teste do sussurro com dez expressoes diferentes e ao exame de referencia audiometria tonal limiar. Calculou-se a sensibilidade, a especificidade, o valor preditivo positivo, o valor preditivo negativo e a acuracia do teste, avaliada por meio da area sob a curva Receiver Operating Characteristic (ROC). O teste foi repetido em 20% das orelhas por um segundo examinador com a finalidade de avaliar a reprodutibilidade interexaminador (RIE). As expressoes que apresentaram melhor area sob a curva ROC (AUC) e RIE foram: “sapato” (AUC = 0,918; RIE = 0,877), “janela” (AUC = 0,917; RIE = 0,869), “parece que vai chover” (AUC = 0,911; RIE = 0,810) e o “onibus esta atrasado” (AUC = 0,900; RIE = 0,810). Estas sao, pois, as expressoes propostas para fazerem parte do protocolo do teste do sussurro que mostrou-se como uma ferramenta util para triagem auditiva em idosos.

Achados da avaliação comportamental e eletrofisiológica do processamento auditivo

Objetivo Realizar uma analise descritiva do desempenho de pacientes encaminhados a um hospital de uma instituicao de ensino publico, para avaliacao do processamento auditivo, e correlacionar os achados desta avaliacao a idade, queixas, resultados e as avaliacoes auditivas comportamental e eletrofisiologica.Metodos O estudo incluiu 159 individuos encaminhados pelo sistema publico de saude para avaliacao do processamento auditivo. Todos os participantes realizaram audiometria tonal liminar, medidas de imitância acustica, testes comportamentais do processamento auditivo e avaliacao eletrofisiologica da audicao.Resultados A principal queixa referida foi a de dificuldade de aprendizagem e os testes que avaliam processamento temporal e escuta dicotica foram os que apresentaram maior prevalencia de alteracao. Em todos os testes eletrofisiologicos, o numero de resultados normais foi superior aos alterados. A proporcao de individuos normais e alterados, nos testes comportamentais e eletrofisiologicos, nao diferiu em relacao ao genero. Houve correlacao fraca entre fechamento auditivo e potencial evocado auditivo de media latencia da orelha direita; potencial evocado auditivo de media latencia da orelha esquerda e potencial evocado auditivo de media latencia total; ordenacao temporal e efeito eletrodo direito e P300; processamento temporal e potencial evocado auditivo de media latencia da orelha direita; escuta dicotica e P300 e entre interacao binaural e reflexo acustico das orelhas direita e esquerda.Conclusao A dificuldade de aprendizagem prevaleceu sobre as queixas dos participantes e as habilidades de processamento temporal e escuta dicotica apresentaram maior prevalencia de alteracao. A maioria dos participantes foi encaminhada para a avaliacao do processamento auditivo pelo fonoaudiologo. Os testes eletrofisiologicos apresentaram correlacao fraca com os testes comportamentais.

Vestibular evoked myogenic potential (VEMP) with galvanic stimulation in normal subjects

INTRODUCTION The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. AIM To describe VEMP generated by GVS. METHODS In this cross-sectional clinical study, VEMP was generated by 2 mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. RESULTS SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. CONCLUSION The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.Introduction: The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. Aim: To describe VEMP generated by GVS. Methods: In this cross-sectional clinical study, VEMP was generated by 2mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. Results: SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. Conclusion: The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.

Potencial evocado miogênico vestibular (VEMP) com estímulo galvânico em indivíduos normais

INTRODUCTION The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. AIM To describe VEMP generated by GVS. METHODS In this cross-sectional clinical study, VEMP was generated by 2 mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. RESULTS SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. CONCLUSION The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.Introduction: The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. Aim: To describe VEMP generated by GVS. Methods: In this cross-sectional clinical study, VEMP was generated by 2mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. Results: SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. Conclusion: The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.

Contribution of galvanic vestibular stimulation for the diagnosis of HAM/TSP

Galvanic vestibular stimulation (GVS) is a low-cost and safe exam that tests the vestibulospinal pathway. HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive disease that precociously affects the vestibulospinal tract. This study compared electromyographic (EMG) responses triggered by GVS between asymptomatic individuals infected with HTLV-1 and those with HAM/TSP.