Maria Inês Rebelo Gonçalves

Cross-cultural adaptation of the Brazilian version of the Eating Assessment Tool - EAT-10

The Eating Assessment Tool (EAT-10) was conceptually developed in the United States from data collected from 482 patients, for use as a self-administered survey regarding risk identification of dysphagia and symptoms related to clinical response to treatment. The purpose of this study is to present the cultural equivalence of the Brazilian version of the EAT-10. The process followed the Scientific Advisory Committee of Medical Outcome Trust (SACMOT). The questionnaire was translated by two Brazilian bilingual speech-language pathologists, aware of the purpose of this study. A back translation was performed by a third Brazilian speech-language pathologist, bilingual and English teacher that had not participated in the previous stage. After comparing both translations, a final version of the questionnaire was produced and called Instrumento de Autoavaliação da Alimentação (EAT-10). It was administered to 107 adult inpatients of the Hospital São Paulo, cwith request for bedside clinical evaluation of swallow. During the process of translation and cultural adaptation, no item was modified and/or suppressed. The EAT-10 maintained the same structure as the original American English version with ten questions, of which three of functional domain, three of emotional domain and four of physical symptoms domain. The cultural equivalence of the Brazilian version of the EAT-10 was demonstrated, being a score of three points or above it the cutoff for dysphagia risk, also for the Brazilian population.

Transfer function of Brazilian Portuguese oral vowels: a comparative acoustic analysis

The vocal tract transfers its characteristics onto the sounds produced at the glottis, depending on its tridimensional configuration. Aim: this study aims to...

Voice Quality in Short Stature With and Without GH Deficiency

OBJECTIVE The aim of this study was to analyze the individual impact of short stature (SS) or untreated isolated growth hormone deficiency (IGHD) on voice quality and the influence of IGHD on voice aging. METHODS A cross-sectional study was carried out on 73 adults: 33 IGHD, 10 SS, and 30 normal controls (CO), by evaluating vocal perception using Voice-Related Quality-of-Life (V-RQOL) scores and fundamental frequency (ƒ0). Analysis of variance with Bonferroni post-test was used to compare groups, and the Student t test was used to verify the influence of aging. RESULTS Stature of the SS and IGHD groups was similarly reduced in comparison to CO. Cephalic perimeter (CP) in SS males was larger than CO (P<0.05), and this was larger than in IGHD (P<0.0001). CP was similar in SS and CO females, and both were larger than in IGHD (P<0.0001). V-RQOL scores were lower in IGHD than in SS and CO. ƒ0 (Hz) was similar in IGHD females and SS and higher than in CO (P<0.05). f0 of IGHD males was higher than in SS (P=0.01) and CO (P=0.001). IGHD abolished the effect of aging on ƒ0 exhibited by CO. CONCLUSIONS Lower vocal perception and higher ƒ0 were found in IGHD in comparison to CO in both genders; in comparison to SS, higher ƒ0 was only found in IGHD males. Because SS males have higher CP than IGHD, this suggests that CP and craniofacial growth can influence voice in IGHD. Finally, IGHD seems to abolish the effects of aging on voice.

Laryngeal and vocal evaluation in untreated growth hormone deficient adults.

OBJECTIVE: To evaluate the consequences of lifetime, severe and untreated isolated growth hormone deficiency (IGHD) on vocal and laryngeal function. STUDY DESIGN: Cross-sectional. SUBJECTS AND METHODS: A total of 23 IGHD adult subjects and 22 controls were administered a questionnaire about vocal complaints and harmful voice habits, and underwent videolaryngostroboscopic examination, voice evaluation by perceptual-auditory analysis with GRBAS scale including grade of dysphonia, roughness, breathiness, asthenia and strain items, objective voice evaluation by maximum phonation time (MPT), and acoustic analysis. RESULTS: There was no difference in vocal complaints between IGHD subjects and controls. Vocal abuse and smoking were more frequent in IGHD subjects. IGHD subjects presented higher values for roughness, breathiness, and strain. Laryngopharyngeal reflux (LPR) signs and laryngeal constriction were more frequent in IGHD individuals. MPT was similar in the two groups. Fundamental frequency was higher in IGHD females and males. Harmonic to noise ratio was higher in IGHD in both genders and shimmer was lower in IGHD females. CONCLUSIONS: IGHD subjects have higher prevalence of signs of LPR and laryngeal constriction, with high pitch in both genders, which suggests a prominent role of IGHD on these parameters.

Speech-language and hearing complaints of children and adolescents with brain tumors.

Central nervous system (CNS) tumors generally leave sequelae that may compromise speech, language, swallowing, hearing, and voice functions. This report describes the incidence of speech‐language and hearing complaints and disorders in children and adolescents with CNS tumor under treatment at one of the most important Brazilian reference center for pediatric cancer. One‐hundred ninety patients were examined for speech‐pathology screening and analysis: forty‐two percent presented with complaints and symptoms. From the remaining patients, 68% presented clinical symptoms and 32% were actually free from any speech‐language and hearing‐related symptoms. The high incidence of complaints and symptoms indicate that these patients might benefit from specific rehabilitation interventions. Pediatr Blood Cancer 2008;50:706–708.

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.

Perfil de pacientes em uso de via alternativa de alimentação internados em um hospital geral

PURPOSE: to characterize the population submitted to administration of alternative feeding route admitted to a general hospital in the state of Alagoas. METHOD: data from medical records of 229 patients admitted to adult infirmary were investigated. Data referring to the administration of alternative feeding route in use and clinical aspects related to swallowing disorders were analyzed. RESULTS: there was a predominance of male participants (55.02%) in the sample. From the total sample, 70.3% of participants were diagnosed with a neurological disease and most of them used the nasogastric tube (82.53%) as feeding route. There was an association between the variables pneumonia and dysphagia (p = 0.0098). However, no association between malnutrition and dysphagia was found (p = 0.0759). There was also a high frequency of absence of data concerning symptoms of feeding difficulty as well as about justification for the use of the alternative feeding route. CONCLUSION: the population studied presented risk factors for development of dysphagia. The shortage of data revealed the little importance given to functional manifestation at the hospital context.

Characteristics and Professional Use of Voice in Street Children in Aracaju, Brazil

The objective of the study was to evaluate voice characteristics of children engaged in street selling, which involves an essentially professional use of voice in this population. A controlled cross-sectional study was carried out. A randomly chosen sample of 200 school children with a history of street selling assisted by public social services and 400 school children without this experience was selected. Seven- to 10-year-old children of both sexes were studied. Both groups were interviewed and given vocal assessment (auditory-perceptual assessment and spectrographic acoustic measures) and otorhinolaryngological evaluation (physical and videonasolaryngoscopic examination). Children with abnormal results in both groups were compared using chi(2) (Chi-squared test). The significance level was established at 5% (P<0.05). Voice problems were detected more frequently in working children (106-53%) than in regular school children (90-22.5%). The control group achieved better school performance as more children in this group attend school regularly than street children, although age-for-grade deficit was similar. The control group had more access to medical visits (80-40%) and treatment with a doctor (34-17%). Language assessment has shown that the control group had more dysphonia (73-37%) and myofunctional orofacial disorders (20-10%). Street children had more normal voice but had more nasal disorders and greater glottal closure than the school control group. Voice disorders were present in both groups, but less frequently in street children. Although subject to inadequate living conditions, street children had better voice quality than the control group. An explanation could be that by adapting their voice professionally for selling goods in the streets, they developed adequate resilience to their difficult living conditions.

Avaliação videofluoroscópica da mastigação e deglutição em indivíduos com disfunção temporomandibular (DTM)

UNLABELLED To study mastication and swallowing disorders in patients with temporomandibular disorders (TMD). OBJECTIVE To investigate mastication and swallowing disorders in patients with severe TMD referred to surgery. MATERIALS AND METHODS Clinical and experimental study involving ten individuals with TMD submitted to deglutition videofluoroscopy. These patients did not have posterior teeth, mastication pain and food replacement in favor of pasty consistence food. The assessment of the oral and pharyngeal phases approached the following aspects: side of onset and preferential side for chewing, premature escape, remains of food residues in the oral cavity or in the pharyngeal recesses, number of necessary swallowing efforts, laryngeal penetration and/or tracheal aspiration. RESULTS During mastication and the oral phase we observed tongue compensatory movements upon chewing (n = 7; 70%), premature escape (n = 4; 40%), food remains in the cavity after swallowing (n = 5; 50%) and an excessive number of deglutition efforts (n = 5; 50%). On the pharyngeal phase we observed food remains in the valleculae (n = 6; 60%), in the pyriform sinuses (n = 4; 40%); laryngeal penetration (n = 1; 10%) and tracheal aspiration (n = 4; 40%). CONCLUSION TMD patients may have alterations in their chewing and swallowing patterns, with laryngeal penetration and/or tracheal aspiration. The study indicates the need for a multidisciplinary assessment because of dysphagia in TMD patients.

Tracheostomized patients care: efficacy of a brief theoretical education program for nursing personnel

IntroductionTracheostomized cancer patients require a special nursing care involving specifically related procedures. The goal of this study was to evaluate the results of a brief theoretical education program on tracheostomized patients care for nursing personnel.Materials and methodsOne hundred and ten professionals have participated in this before and after-intervention one group study, and the program was carried out in a Brazilian hospital, a national reference center in oncology treatment. The questionnaire outcomes were compared to assess the theoretical knowledge level of the participants.Results and discussionStatistical analysis showed that this program was efficient to enhance knowledge skills on specific nursing procedures related to care of the traqueostomized cancer patients. The low costs and simple structure required in the program may encourage the spread of similar practices to improve quality of nursing assistance in the hospital environment.