Silvia Dornelles

Avaliação da deglutição em lactentes com cardiopatia congênita e síndrome de Down: estudo de casos

This study had the aim to perform clinical swallowing evaluation in infants diagnosed with Down syndrome and congenital heart disease (complete atrioventricular canal) suspected to have swallowing disorders hospitalized in unit 2A and Pediatric ICU of instituition.It is a descriptive and qualitative study in which was possible to assess two infants during the proposed period. It was used a sample profile protocol to collect data about clinical history and diagnoses from patients records and the Instrumento de avaliacao para prontidao do prematuro para alimentacao oral by Fujinaga (2002) for clinical swallowing evaluation. The pacients presented results of oropharyngeal dysphagia and low scores invalidating exclusively oral feed. The treatment was oral stimulation and oral feeding volume controlled. The findings contribute to the literature regarding the correlation between dysphagia, congenital heart defects, genetic syndromes and myofunctional disorders. It is concluded that dysphagia was presented as a difficulty symptom to safe and effective oral feed for all infants studied. Prospective larger researches are needed to contribute with this clinical cases study and thus identify other risk factors for dysphagia and specific treatment for children with Down syndrome and swallowing disorders associated.

Velopharyngeal dysfunction: a systematic review of major instrumental and auditory-perceptual assessments

Summary Introduction: Velopharyngeal dysfunction may cause impaired verbal communication skills in individuals with cleft lip and palate; thus, patients with this disorder need to undergo both instrumental and auditory-perceptual assessments. Objective: To investigate the main methods used to evaluate velopharyngeal function in individuals with cleft lip and palate and to determine whether there is an association between videonasoendoscopy results and auditory-perceptual assessments. Method: We conducted a systematic review of the literature on instrumental and auditory-perceptual assessments. We searched the PubMed, Medline, Lilacs, Cochrane, and SciELO databases from October to November 2012. Summary of findings: We found 1,300 studies about the topic of interest published between 1990 and 2012. Of these, 56 studies focused on velopharyngeal physiology; 29 studies presented data on velopharyngeal physiology using at least 1 instrumental assessment and/or 1 auditory-perceptual assessment, and 12 studies associated the results of both types of assessments. Only 3 studies described in detail the analysis of both methods of evaluating velopharyngeal function; however, associations between these findings were not analyzed. Conclusion: We found few studies clearly addressing the criteria chosen to investigate velopharyngeal dysfunction and associations between videonasoendoscopy results and auditory-perceptual assessments.

Evaluation of Swallowing in Infants with Congenital Heart Defect

Introduction Surgical repair of congenital heart disease in the first years of life compromises the coordination of the suction, breathing, and swallowing functions. Objective To describe the alterations in swallowing found in infants with congenital heart defect during their hospitalization. Methods Prospective, cross-sectional study in a reference hospital for heart disease. The sample consisted of 19 postsurgical patients who underwent an evaluation of swallowing. The infants included were younger than 7 months and had a diagnosis of congenital heart defect and suspected swallowing difficulties. Results Of the 19 infants with congenital heart defect, the median age was 3.2 months. A significant association was found between suction rhythm and dysphagia (p = 0.036) and between oral-motor oral feeding readiness and dysphagia (p = 0.014). Conclusions The data suggest that dysphagia often occurs after surgery in infants with congenital heart defect. Infants with congenital heart defect had very similar behavior to preterm infants in terms of oral feeding readiness.

Associação entre perda auditiva e sintomatologia depressiva em idosos

* Doutora em Gerontologia Biomedica (PUCRS). Professora Adjunta da UFRGS Departamento de Psicologia do Desenvolvimento e da Personalidade Curso de Fonoaudiologia. ** Doutora em Psicologia Social (USP). Professora Adjunta da UFRGS Escola de Educacao Fisica (ESEF). *** Doutora em Ciencias do Movimento Humano (UFRGS). Professora Adjunta da UFSC. **** Doutoranda em Gerontologia Biomedica (PUCRS). Professora da UFCSPA Departamento de Fonoaudiologia. ***** PhD em Medicina pela Tokay University, School of Medicine, Japao. Professor Adjunto da PUCRS Programa de Pos-Graduacao em Gerontologia Biomedica. ****** Doutora em Fitotecnia (UFRGS). Professora Adjunta do Curso de Educacao Fisica da ULBRA Canoas. ****** Doutora em Saude da Crianca e do Adolescente UFRGS. Professora Adjunta da UFRGS Departamento de Psicologia do Desenvolvimento e da Personalidade.

Comparison of videonasoendoscopy and auditory-perceptual evaluation of speech in individuals with cleft lip/palate

Summary Introduction: The velopharyngeal sphincter (VPS) is a muscle belt located between the oropharynx and the nasopharynx. Investigations of velopharyngeal function should include an auditory-perceptual evaluation and at least 1 instrument-based evaluation such as videonasoendoscopy. Aim: To compare the findings of auditory-perceptual evaluation (hypernasality) and videonasoendoscopy (gap size) in individuals with cleft lip/palate. Method: This was a retrospective, cross-sectional study assessing 49 subjects, of both sexes, with cleft lip/palate followed up at the Otorhinolaryngology Service and the Speech Therapy outpatient clinic of Hospital de Clínicas de Porto Alegre (HCPA). The results from the auditory-perceptual evaluation and the videonasoendoscopy test were compared with respect to the VPS gap size. Results: Subjects with moderate/severe hypernasality had more severe velopharyngeal closure impairment than those with a less severe condition. The interaction between hypernasality severity and the presence of other speech disorders (p = 0.035), whether compensatory and/or obligatory, increased the likelihood of having a moderate-to-large gap in the velopharyngeal closure. Conclusions: We observed an association between the findings of these 2 evaluation methods.

Correlation of Vocal Intensity with Velopharyngeal Closing Mechanism in Individuals with and without Complaint of Velopharyngeal Dysfunction

Introduction Velopharyngeal sphincter is a portion of the muscle of the palatopharyngeal arch that is capable of separating the oral cavity from the nasal cavity. It has not been determined yet whether voice intensity has an influence on this capacity. Velopharyngeal sphincter closure is accomplished by elevating and retracting the soft palate at the same time as the nasopharyngeal walls are constricted. Objective This study aims to correlate voice intensity with velopharyngeal sphincter closure in individuals without velopharyngeal dysfunction and patients with cleft lip and palate. Methods We conducted a cross-sectional, comparative, and contemporary study. The sample consisted of 16 individuals in the control group and 16 individuals in the study group. Patients underwent instrumental assessment, which we subsequently analyzed using a computer program, and a brief medical history review. The mean age of the control group was 27.6 years, whereas the mean age of the case group was 15.6 years. Results Cases showed higher voice intensity in regular and weak fricative sentences when compared with controls. There was no agreement on the analysis of the instrumental assessment between the assessors and the computer program. Regardless of voice intensity, the computer program demonstrated a similar closure pattern. Conclusion The computer program showed similar closure pattern for the three levels of intensity. There was no agreement between the three assessors and the closure pattern determined by the computer program. There was no statistically significant correlation between voice intensity and degree of velopharyngeal sphincter closure.

Avaliação do efeito imediato de exercício de trato vocal semiocluído no mecanismo velofaríngeo em cinco portadores de fissura labiopalatina: estudo piloto

Introducao: As fissuras labiopalatinas nao sindromicas estao incluidas entre as malformacoes craniofaciais severas mais frequentes na populacao humana. O individuo acometido pode apresentar alteracoes no mecanismo velofaringeo e assim, comprometendo a inteligibilidade da fala. Objetivo: Analisar o efeito imediato do exercicio de trato vocal semiocluido no mecanismo velofaringeo de pacientes com fissura labiopalatina. Metodos: A amostra foi composta por 05 sujeitos com fissura labiopalatina reparada cirurgicamente submetidos a avaliacao multidimensional, de videonasofibroscopia, analise das imagens dinâmicas por meio de software especializado, analise de fala por meio da avaliacao perceptivo- auditiva e parecer auto referido. Resultados: Todos os pacientes apresentaram fala encadeada melhor apos o exercicio, melhora acentuada na impressao geral da emissao e projecao vocal, maior fechamento velofaringeo e efeito positivo na autoavaliacao. Conclusao: Observou-se efeito positivo do exercicio de trato vocal semiocluido quando aplicado nessa amostra. Palavras-chave: Esfincter velofaringeo; fissura labial; fissura palatina; reabilitacao, trato vocal semiocluido

Tinnitus in Elderly Individuals: Discomfort and Impact in the Quality of Life

Introduction Tinnitus is a symptom that affects mainly the elderly and can negatively influence their quality of life. Objective The objective of our study is to evaluate the existence of a relationship between the quality of life and the impact caused by tinnitus in elderly individuals, considering the age and gender variables. Method We conducted a cross-sectional study in elderly people of both genders who participate in the extension activities at the university. The evaluation was composed of anamnesis and WHOQOL-OLD instruments, to evaluate the quality of life, and Tinnitus Handicap Inventory (THI) for the evaluation of the tinnitus impact. Result We evaluated 36 elderly individuals with an average age of 68.6 ± 6.8 years old, 72.2 % of them were women. We verified that most of the subjects classified their tinnitus as weak (44.4%) or medium (36.1%). The score average in the THI was 20 points, with predominant classification of tinnitus impact as negligible (41.7%) or mild (30.6%). In the WHOQOL-OLD, the average score was 15.6 ± 1.6 points (total score). The negative correlation between the THI score and the WHOQOL-OLD score was found in the sensory domain operation and total score. Conclusion The results obtained in the study prove that the quality of life of the elderly individuals evaluated is related to a discomfort caused by the tinnitus.

Aspectos de comunicação oral em pacientes com doença de Parkinson submetidos à Estimulação Cerebral Profunda

INTRODUCTION Deep Brain Stimulation (DBS) has been satisfactorily used to control the cardinal motor symptoms of Parkinsons disease (PD), but little is known about its impact on communication. PURPOSE This study aimed to characterize the aspects of cognition, language, speech, voice, and self-perception in two patients with PD, pre- and post- DBS implant surgery. METHODS The patients were assessed using a cognitive screening test, a brief language evaluation, a self-declared protocol, and an analysis of the aspects of voice and speech, which was conducted by a specialized Speech-language Therapist who was blinded for the study. RESULTS At the pre-surgery assessment, Case I showed impairment regarding the aspects of cognition, language and voice, whereas Case II showed impairment only with respect to the voice aspect. The post-surgery evaluation of the cases showed an opposite pattern of the effect of DBS after analysis of the communication data: Case I, who presented greater impairment before the surgery, showed improvement in some aspects; Case II, who presented lower communicative impairment before the surgery, showed worsening in other aspects. CONCLUSION This study shows that DBS may influence different communication aspects both positively and negatively. Factors associated with the different effects caused by DBS on the communication of patients with PD need to be further investigated.Introduction Deep Brain Stimulation (DBS) has been satisfactorily used to control the cardinal motor symptoms of Parkinson’s disease (PD), but little is known about its impact on communication. Purpose This study aimed to characterize the aspects of cognition, language, speech, voice, and self-perception in two patients with PD, pre- and post- DBS implant surgery. Methods The patients were assessed using a cognitive screening test, a brief language evaluation, a self-declared protocol, and an analysis of the aspects of voice and speech, which was conducted by a specialized Speech-language Therapist who was blinded for the study. Results At the pre-surgery assessment, Case I showed impairment regarding the aspects of cognition, language and voice, whereas Case II showed impairment only with respect to the voice aspect. The post-surgery evaluation of the cases showed an opposite pattern of the effect of DBS after analysis of the communication data: Case I, who presented greater impairment before the surgery, showed improvement in some aspects; Case II, who presented lower communicative impairment before the surgery, showed worsening in other aspects. Conclusion This study shows that DBS may influence different communication aspects both positively and negatively. Factors associated with the different effects caused by DBS on the communication of patients with PD need to be further investigated.

Ressonância magnética funcional e deglutição: revisão sistemática

Objetivo Avaliar a viabilidade e seguranca da ressonância magnetica funcional para a avaliacao de areas corticais envolvidas na degluticao. Estrategia de pesquisa Conduziu-se uma busca entre abril de 2003 e abril de 2013, usando as palavras chave “functional magnetic resonance imaging” or“fMRI” and “dysphagia” e“functional magnetic resonance imaging” or“fMRI” and “swallowing” na base de dados PubMed. Criterios de selecao Os estudos foram revisados por analise de seus titulos eabstracts e os criterios de inclusao utilizados foram: pesquisas envolvendo seres humanos, utilizacao de exames neurofuncionais, referencia a funcao de degluticao, analise de populacao adulta e/ou idosa, relacao com patologias neurologicas. Resultados A estrategia de busca resultou em 1167 citacoes, das quais apenas 35 preencheram os criterios de elegibilidade. Conclusao A ressonância magnetica funcional foi considerada segura e viavel para a avaliacao de areas corticais envolvidas na degluticao. Entretanto, os relatos de utilizacao de ressonâcia magnetica funcional diferiram entre os estudos revisados e houve variabilidade na metodologia utilizada, dificultando as comparacoes.