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Made available in DSpace on 2021-06-25T10:51:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-04-01 Introduction/Objective: The aim of this study is to analyze the influence of sour taste and cold temperature in the initiation of the pharyngeal swallow (IPS) and bolus location at pharyngeal swallow onset in individuals after stroke. Methods: Cross-sectional prospective study. The study included 52 individuals with unilateral ischemic stroke. Each individual was assessed by videofluoroscopic swallowing study with 5ml of paste bolus offering four different stimuli (natural, cold, sour, and sour-cold). The individuals were divided into two groups according to the offer sequence. Group 1 (G1) – received a randomized sequence of stimuli (24 individuals), and Group 2 (G2) –the stimuli were offered in the following order: natural, cold, sour, and sour-cold(28 individuals). The IPS time and bolus location at pharyngeal swallow onset were analyzed. The bolus location at pharyngeal swallow onset was defined using six different levels. Results: Individuals in G1 did not show a significant difference in IPS time between stimuli. However, individuals in G2 presented a significantly shorter IPS time with the sour and sour-cold stimuli than with natural or cold stimuli. The bolus location at pharyngeal swallow onset did not show significant difference between stimuli in both groups. On the other hand, in the G2 it was observed higher frequency of swallowing with sour-cold stimulus at level 1 (the bolus head was located in any region between the fauces pillar and the point where the tongue crosses the inferior border of the mandible). Conclusion: The sour and sour-cold stimuli influenced the IPS time when they were offered in a sequential order. Moreover, both the IPS time and bolus location at pharyngeal swallow onset were not influenced by the sour and sour cold-bolus when offered in a random sequence. Department of Neurology and Psiquiatry Sao Paulo State University-UNESP Department of Medicine Marilia University - UNIMAR Department of Speech and Language Therapy Sao Paulo State University - UNESP Department of Surgery Sao Paulo State University - UNESP Department of Neurology and Psiquiatry Sao Paulo State University-UNESP Department of Speech and Language Therapy Sao Paulo State University - UNESP Department of Surgery Sao Paulo State University - UNESP

Made available in DSpace on 2019-10-06T15:45:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-08-18 Objectives: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions. Methods: A Cross-sectional study. 73 videofluoroscopic swallow studies (VFSS)were conducted on patients after stroke The study subjects were divided into : group 1 (G1) consisting of 39 individuals with left cortical lesion and group 2 (G2) consisting of 34 individuals with right cortical lesions. The VFSS of G1 and G2 subjects were analyzed using puree (A) and liquid (B) consistencies, and were also subdivided into young adults and older persons. The mean PRT was divided into times shorter and longer than 250 ms. Results: No statistically significant difference was observed between G1 and G2 for the A and B consistencies, being obtained : G1 (A mean: 56.6 ms; B mean: 99.5 ms; A mean: 3627 ms; B mean: 1712 ms) and G2 (A mean: 79.6 ms; B mean: 110.7 ms; A mean: 2040 ms, B mean: 1529 ms), for PRT shorter (A:p =.673; B: p = 1.000) and longer (A: p =.435; B: p =.847) than 250 ms, respectively. No statistically significant difference was found regarding the variable age in the comparison between young and old adults for mean PRT according to the A and B consistencies in G1 (A: p =.260; B: p =.732) and G2 (A: p =.586; B: p =.104). Conclusion: No relationship between PRT and lateralization of brain lesion was observed with respect to subject age and to the swallowing of different food consistencies. Dysphagia Research Rehabilitation Center; Graduate of Speech Language and Hearing Sciences Department São Paulo State University-UNESP Medicine Department Marília University–UNIMAR Dysphagia Research Rehabilitation Center São Paulo State University-UNESP Speech Language and Hearing Sciences Department Bauru State Hospital Dysphagia Research Rehabilitation Center; Graduate of Speech Language and Hearing Sciences Department São Paulo State University-UNESP Dysphagia Research Rehabilitation Center São Paulo State University-UNESP

RESUMO Introdução O tempo de trânsito orofaríngeo se modifica de acordo com inúmeras variáveis. Objetivo Comparar o tempo de trânsito oral total (TTOT) e a lateralidade da lesão cerebral no indivíduo após acidente vascular encefálico (AVE), com disfagia orofaríngea. Métodos Foram analisados 61 exames de videofluoroscopia da deglutição de indivíduos pós-AVE hemisférico unilateral e isquêmico. Os participantes foram divididos em dois grupos: O Grupo 1 (G1) foi composto de 30 indivíduos com lesão cortical direita e o Grupo 2 (G2), de 31 indivíduos com lesão cortical esquerda. A análise quantitativa do TTOT foi feita por dois juízes treinados no procedimento, por meio de software específico e foi realizada a análise da confiabilidade entre julgadores. Para a análise dos resultados, utilizou-se o teste Mann-Whitney. Resultados Verificou-se que, no G1, o TTOT foi maior que 2000 ms em 50% dos indivíduos e, no G2, em 94% dos indivíduos, ocorrendo diferença estatística significativa entre os grupos (p

Made available in DSpace on 2015-02-24T13:58:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2012Bitstream added on 2015-02-24T14:07:58Z : No. of bitstreams: 1 ISSN16645456-2012-02-01-45-51.pdf: 723489 bytes, checksum: d2deac0fcac4961fe74c4ad0c97a2dc7 (MD5) Background: Oropharyngeal dysphagia is common in individuals after stroke. Taste and temperature are used in dysphagia rehabilitation. The influence of stimuli, such as taste and temperature, on swallowing biomechanics has been investigated in both healthy individuals and in individuals with neurological disease. However, some questions still remain unanswered, such as how the sequence of offered stimuli influences the pharyngeal response. The goal of the present study was to determine the influence of the sequence of stimuli, sour taste and cold temperature, on pharyngeal transit time during deglutition in individuals after stroke. Methods: The study included 60 individuals with unilateral ischemic stroke, 29 males and 31 females, aged 41–88 years (mean age: 66.2 years) examined 0–50 days after ictus (median: 6 days), with mild to moderate oropharyngeal dysphagia. Exclusion criteria were hemorrhagic stroke patients, patients with decreased level of consciousness, and clinically unstable patients, as confirmed by medical evaluation. The individuals were divided into two groups of 30 individuals each. Group 1 received a nonrandomized sequence of stimuli (i.e. natural, cold, sour, and sour-cold) and group 2 received a randomized sequence of stimuli. A videofluoroscopic swallowing study was performed to analyze the pharyngeal transit time. Four different stimuli (natural, cold, sour, and sour-cold) were offered. The images were digitalized and specific software was used to measure the pharyngeal transit time. Since the values did not present regular distribution and uniform variances, nonparametric tests were performed. Results: Individuals in group 1 presented a significantly shorter pharyngeal transit time with the sour-cold stimulus than with the other stimuli. Individuals in group 2 did not show a significant difference in pharyngeal transit time between stimuli. Conclusions: The results showed that the sequence of offered stimuli influences the pharyngeal transit time in a different way in individuals after stroke and suggest that, when the sour-cold stimulus is offered in a randomized sequence, it can influence the response to the other stimuli in stroke patients. Hence, the sour-cold stimulus could be used as a therapeutic aid in dysphagic stroke patients. Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Filosofia e Ciências, Departamento de Fonoaudiologia, Marília, Av. Hygino Muzzi Filho 737, Vila Universitária, CEP 17005490, SP, Brasil Departments of Surgery, Botucatu Medical School, UNESP, Botucatu Departments of Neurology and Psychiatry, and Biostatistics, Botucatu Medical School, UNESP, Botucatu Departments of Biostatistics, Botucatu Medical School, UNESP, Botucatu Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Filosofia e Ciências, Departamento de Fonoaudiologia, Marília, Av. Hygino Muzzi Filho 737, Vila Universitária, CEP 17005490, SP, Brasil

OBJETIVO: Analisar os componentes do sinal acústico da deglutição com o auxílio de software específico. MÉTODOS: Foram avaliados 14 indivíduos saudáveis com idades variando entre 20 e 50 anos (média de 31±10 anos). A coleta de dados consistiu da captura simultânea do áudio da deglutição, por meio de um microfone, associado ao registro da imagem videofluoroscópica da deglutição. A identificação dos componentes de som e a quantificação dos tempos foram analisados posteriormente com o auxílio de software específico que possibilitou a análise simultânea entre a onda acústica e a imagem videofluoroscópica. RESULTADOS: Foram identificados três componentes de som (burst) na maioria das deglutições avaliadas. O primeiro burst apresentou tempo médio de 87,3 milissegundos (ms) para água e 78,2 para substância pastosa. O segundo burst retornou um tempo médio de 112,9 ms para água e 85,5 para consistência pastosa. O intervalo médio entre o primeiro e segundo burst foi 82,1 ms (água) e 95,3 ms (consistência pastosa), e entre o segundo e terceiro foi 339,8 ms e 322,0 ms, respectivamente para água e consistência pastosa. CONCLUSÃO: O software permitiu a visualização de três componentes do som durante a deglutição de indivíduos saudáveis e mostrou que o sinal da deglutição em indivíduos normais é altamente variável. PURPOSE: To analyze the components of the acoustic signal of swallowing using a specific software. METHODS: Fourteen healthy subjects ranging in age from 20 to 50 years (mean age 31±10 years), were evaluated. Data collection consisted on the simultaneous capture of the swallowing audio with a microphone and of the swallowing videofluoroscopic image. The bursts of the swallowing acoustic signal were identified and their duration and the interval between them were later analyzed using a specific software, which allowed the simultaneous analyses between the acoustic wave and the videofluoroscopic image. RESULTS: Three burst components were identified in most of the swallows evaluated. The first burst presented mean time of 87.3 milliseconds (ms) for water and 78.2 for the substance. The second burst presented mean time of 112.9 ms for water and 85.5 for the pasty substance. The mean interval between first and second burst was 82.1 ms for water and 95.3 ms for the pasty consistency, and between second and third burst was 339.8 ms for water and 322.0 ms for the pasty consistency. CONCLUSION: The software allowed the visualization of three bursts during the swallowing of healthy individuals, and showed that the swallowing signal in normal subjects is highly variable.

OBJETIVO: Apresentar um software que permita uma análise detalhada da dinâmica da deglutição. MATERIAIS E MÉTODOS: Participaram deste estudo dez indivíduos após acidente vascular encefálico, sendo seis do gênero masculino, com idade média de 57,6 anos. Foi realizada videofluoroscopia da deglutição e as imagens foram digitalizadas em microcomputador, com posterior análise do tempo do trânsito faríngeo da deglutição, por meio de um cronômetro e do software. RESULTADOS: O tempo médio do trânsito faríngeo da deglutição apresentou-se diferente quando comparados os métodos utilizados (cronômetro e software). CONCLUSÃO: Este software é um instrumento de análise dos parâmetros tempo e velocidade da deglutição, propiciando melhor compreensão da dinâmica da deglutição, com reflexos tanto na abordagem clínica dos pacientes com disfagia como para fins de pesquisa científica.OBJECTIVE: The present paper is aimed at introducing a software to allow a detailed analysis of the swallowing dynamics. MATERIALS AND METHODS: The sample included ten (six male and four female) stroke patients, with mean age of 57.6 years. Swallowing videofluoroscopy was performed and images were digitized for posterior analysis of the pharyngeal transit time with the aid of a chronometer and the software. RESULTS: Differences were observed in the average pharyngeal swallowing transit time as a result of measurements with chronometer and software. CONCLUSION: This software is a useful tool for the analysis of parameters such as swallowing time and speed, allowing a better understanding of the swallowing dynamics, both in the clinical approach of patients with oropharyngeal dysphagia and for scientific research purposes.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2014-02-26T17:27:37Z No. of bitstreams: 1 WOS000242770500004.pdf: 149267 bytes, checksum: 6eaa680c314c2c84eaab2ef7ed64b994 (MD5) Made available in DSpace on 2014-02-26T17:27:37Z (GMT). No. of bitstreams: 1 WOS000242770500004.pdf: 149267 bytes, checksum: 6eaa680c314c2c84eaab2ef7ed64b994 (MD5) Previous issue date: 2006-12-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:29:53Z No. of bitstreams: 1 WOS000242770500004.pdf: 149267 bytes, checksum: 6eaa680c314c2c84eaab2ef7ed64b994 (MD5) Made available in DSpace on 2014-05-20T15:29:53Z (GMT). No. of bitstreams: 1 WOS000242770500004.pdf: 149267 bytes, checksum: 6eaa680c314c2c84eaab2ef7ed64b994 (MD5) Previous issue date: 2006-12-01 Objective: To evaluate the maximum residual signal auto-correlation also known as pitch amplitude (PA) values in patients with Parkinson's disease (PD) patients. Method. The signals of 21 Parkinson's patients were compared with 15 healthy individuals, divided according age and gender. Results: Statistical difference was seen between groups for PA, 0.39 for controls and 0.25 for PD. Normal value threshold was set as 0.3; (p

Made available in DSpace on 2018-11-26T16:16:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-09-01 Background: The present study aimed to evaluate the relation between the National Institutes of Health Stroke Scale (NIHSS) score and the presence of laryngeal penetration and/or laryngotracheal aspiration in ischemic stroke patients and to verify what factors are predictors of the occurrence of pneumonia in the evaluated patients. Methods: This was an observational study of ischemic stroke in the acute or subacute phases. Neurologic examination included anamnesis, Bamford classification, and application of the NIHSS. Speech therapy evaluation was carried out after clinical stabilization of the patient, and all individuals who were considered dysphagic were sent for examination by means of videofluoroscopic recordings. The parameters observed in the objective examination were the presence of laryngeal penetration and/or laryngotracheal aspiration. The pneumonia data were obtained in accordance with local protocols, which were based on international guidelines. The relation of laryngeal penetration and laryngotracheal aspiration with the NIHSS score was assessed by the Mann-Whitney U test, and predictors for the occurrence of pneumonia were analyzed by multiple logistic regression using semiautomatic backward selection. Significance was set at P less than .05. Results: The relations between laryngeal penetration and the NIHSS score and between laryngotracheal aspiration and the NIHSS score were not statistically significant. The predictors for pneumonia occurrence in the ischemic stroke patients with a clinical diagnosis of dysphagia were age (P = .002; odds ratio [OR], 1.12) and NIHSS score (P = .04; OR, 1.17), whereas laryngeal penetration of liquid (P = .065; OR, 3.70) tended to correlate with pneumonia but not significantly. Conclusions: There was no relation between the NIHSS score and laryngeal penetration or laryngotracheal aspiration, and the principal predictors of pneumonia in dysphagic patients after ischemic stroke were advanced age and neurologic severity. (C) 2015 by National Stroke Association Univ Estadual Paulista, Botucatu Sch Med, Neurol Serv, BR-18618970 Botucatu, SP, Brazil Sch Philosophy & Sci, Dept Phonoaudiol, Marilia, Brazil Univ Estadual Paulista, Botucatu Sch Med, Dept Surg, BR-18618970 Botucatu, SP, Brazil Univ Estadual Paulista, Botucatu Sch Med, Neurol Serv, BR-18618970 Botucatu, SP, Brazil Univ Estadual Paulista, Botucatu Sch Med, Dept Surg, BR-18618970 Botucatu, SP, Brazil

Background The high prevalence of dysphagia after stroke leads to increased mortality, and cerebral reperfusion therapy has been effective in reducing neurologic deficits. The aim of this study was to investigate the severity and evolution of dysphagia and the occurrence of pneumonia in patients submitted to cerebral reperfusion therapy. Methods Seventy ischemic stroke patients were evaluated. Of these, 35 patients (group 1) were submitted to cerebral reperfusion therapy and 35 (group 2) did not receive thrombolytic treatment. The following were evaluated: severity of dysphagia by means of videofluoroscopy, evolution of oral intake rate by means of the Functional Oral Intake Scale, and the occurrence of pneumonia by international protocol. The relation between the severity of dysphagia and the occurrence of pneumonia with the treatment was evaluated through the chi-square test; the daily oral intake rate and its relation to the treatment were assessed by the Mann–Whitney test and considered significant if P is less than .05. Results The moderate and severe degrees of dysphagia were more frequent ( P = .013) among the patients who were not submitted to cerebral reperfusion therapy. The daily oral intake evolved independently of the treatment type, without statistical significance when compared between the groups, whereas pneumonia occurred more frequently in group 2 (28%) in relation to group 1 (11%) and was associated with the worst degrees of dysphagia ( P = .045). Conclusions We can conclude that there is improvement in the oral intake rate in both groups, with lower severity of dysphagia and occurrence of pneumonia in ischemic stroke patients submitted to cerebral reperfusion therapy.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:40:33Z No. of bitstreams: 1 S1516-80342012000200011.pdf: 211686 bytes, checksum: f084c525c5ae97de448e2dd1aed8effb (MD5) Made available in DSpace on 2013-08-22T18:40:33Z (GMT). No. of bitstreams: 1 S1516-80342012000200011.pdf: 211686 bytes, checksum: f084c525c5ae97de448e2dd1aed8effb (MD5) Previous issue date: 2012-06-01 Made available in DSpace on 2013-09-30T19:26:20Z (GMT). No. of bitstreams: 2 S1516-80342012000200011.pdf: 211686 bytes, checksum: f084c525c5ae97de448e2dd1aed8effb (MD5) S1516-80342012000200011.pdf.txt: 19242 bytes, checksum: 838039a8931838c32f6c2ff52bb22cb5 (MD5) Previous issue date: 2012-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:31:29Z No. of bitstreams: 2 S1516-80342012000200011.pdf: 211686 bytes, checksum: f084c525c5ae97de448e2dd1aed8effb (MD5) S1516-80342012000200011.pdf.txt: 19242 bytes, checksum: 838039a8931838c32f6c2ff52bb22cb5 (MD5) Made available in DSpace on 2014-05-20T13:31:29Z (GMT). No. of bitstreams: 2 S1516-80342012000200011.pdf: 211686 bytes, checksum: f084c525c5ae97de448e2dd1aed8effb (MD5) S1516-80342012000200011.pdf.txt: 19242 bytes, checksum: 838039a8931838c32f6c2ff52bb22cb5 (MD5) Previous issue date: 2012-06-01 OBJETIVO: Analisar a concordância entre distintas escalas para grau de comprometimento em disfagia orofaríngea neurogênica. MÉTODOS: Foi realizado estudo clínico transversal. Participaram 200 indivíduos com disfagia orofaríngea neurogênica, 108 do gênero masculino e 92 do gênero feminino, com idades de 3 meses a 91 anos. Foram aplicadas quatro escalas para classificar o grau de comprometimento da disfagia orofaríngea, sendo duas escalas clínicas e duas videofluoroscópicas. Análises estatísticas foram realizadas para verificar a concordância entre as escalas clínicas e objetivas. RESULTADOS: Os resultados mostraram concordância muito boa entre as escalas clínicas estudadas (Kappa=0,92) e concordância moderada entre as escalas objetivas (Kappa=0,52). CONCLUSÃO: Embora a concordância entre as escalas clínicas tenha sido muito boa e entre as escalas objetivas tenha sido moderada, ainda é necessária ampla discussão e possível revisão dos parâmetros que definem o grau de comprometimento da disfagia orofaríngea em pacientes neurológicos. PURPOSE: To analyze the agreement among different severity scales for neurogenic oropharyngeal dysphagia. METHODS: A clinical cross-sectional study was conducted. Participants were 200 individuals (108 male, 92 female) with neurogenic oropharyngeal dysphagia, aged between three months and 91 years. Four severity scales were applied to classify the oropharyngeal dysphagia: two clinical scales and two videofluoroscopic scales. Statistical analysis were conducted to verify the agreement between clinical and objective scales. RESULTS: Results showed very good agreement between the clinical scales (kappa=0.92) and moderate agreement between the objective scales (kappa=0.52). CONCLUSION: Although the agreement between the clinical scales was very good and between the objective scales was moderate, further discussion and possible revision of the parameters that define the severity of oropharyngeal dysphagia in neurological patients are required. Universidade Estadual Paulista Júlio de Mesquita Filho Universidade de São Paulo Universidade Estadual Paulista Júlio de Mesquita Filho

To analyze the components of the acoustic signal of swallowing using a specific software.Fourteen healthy subjects ranging in age from 20 to 50 years (mean age 31 ± 10 years), were evaluated. Data collection consisted on the simultaneous capture of the swallowing audio with a microphone and of the swallowing videofluoroscopic image. The bursts of the swallowing acoustic signal were identified and their duration and the interval between them were later analyzed using a specific software, which allowed the simultaneous analyses between the acoustic wave and the videofluoroscopic image.Three burst components were identified in most of the swallows evaluated. The first burst presented mean time of 87.3 milliseconds (ms) for water and 78.2 for the substance. The second burst presented mean time of 112.9 ms for water and 85.5 for the pasty substance. The mean interval between first and second burst was 82.1 ms for water and 95.3 ms for the pasty consistency, and between second and third burst was 339.8 ms for water and 322.0 ms for the pasty consistency.The software allowed the visualization of three bursts during the swallowing of healthy individuals, and showed that the swallowing signal in normal subjects is highly variable.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:05:50Z No. of bitstreams: 1 S1516-18462011000600011.pdf: 383337 bytes, checksum: de881a8b3e48e73dbb7ce2774c9133a4 (MD5) Made available in DSpace on 2013-08-22T19:05:50Z (GMT). No. of bitstreams: 1 S1516-18462011000600011.pdf: 383337 bytes, checksum: de881a8b3e48e73dbb7ce2774c9133a4 (MD5) Previous issue date: 2011-12-01 Made available in DSpace on 2013-09-30T18:22:15Z (GMT). No. of bitstreams: 2 S1516-18462011000600011.pdf: 383337 bytes, checksum: de881a8b3e48e73dbb7ce2774c9133a4 (MD5) S1516-18462011000600011.pdf.txt: 32297 bytes, checksum: a87e46cf18830c03027ed57ae62a8950 (MD5) Previous issue date: 2011-12-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:36:03Z No. of bitstreams: 2 S1516-18462011000600011.pdf: 383337 bytes, checksum: de881a8b3e48e73dbb7ce2774c9133a4 (MD5) S1516-18462011000600011.pdf.txt: 32297 bytes, checksum: a87e46cf18830c03027ed57ae62a8950 (MD5) Made available in DSpace on 2014-05-20T13:36:03Z (GMT). No. of bitstreams: 2 S1516-18462011000600011.pdf: 383337 bytes, checksum: de881a8b3e48e73dbb7ce2774c9133a4 (MD5) S1516-18462011000600011.pdf.txt: 32297 bytes, checksum: a87e46cf18830c03027ed57ae62a8950 (MD5) Previous issue date: 2011-12-01 OBJETIVO: traduzir e adaptar protocolo desenvolvido por pesquisadores alemães, adequando-o às características fonéticas e linguísticas do português falado no Brasil. Caracterizar os componentes de fala mais alterados na população com doença de Parkinson, comparando-os com grupo de sujeitos normais na mesma faixa etária. MÉTODOS: realizou-se a tradução e adaptação do protocolo. Posteriormente foram avaliados 21 pacientes com diagnóstico neurológico de Doença de Parkinson nos estágios Hoehn &Yarh, entre 2 e 3, e 10 sujeitos normais. O protocolo incluía avaliação da respiração, fonação, ressonância, articulação, prosódia e a análise acústica dos parâmetros vocais. RESULTADOS: o protocolo mostrou-se de fácil aplicação clínica. Nos sujeitos com doença de Parkinson foram observadas alterações predominantes na fonação (85,9%) e articulação (42,9%). CONCLUSÃO: o estudo demonstrou ser o protocolo uma ferramenta eficiente para a avaliação da disartria em pacientes com doença de Parkinson. PURPOSE: to translate and adapt the protocol developed by German researchers, adjusting it to the phonetic and linguistic characteristics of Brazilian Portuguese. Observe the amended speech components in a group of patients with Parkinson's disease, and comparing them with normal subjects in the same age. METHOD: twenty one patients with neurological diagnosis of Parkinson's disease in the Hoehn & Yarh stages (2-3), and 10 control subjects were assessed. The protocol was translated, adjusted and applied to the subjects of both control and Parkinson's disease group, assessing the breathing, phonation, resonance, articulation, prosody and acoustic analysis. RESULTS: in the dysarthria evaluation, the protocol showed to be simple and it presented a fast clinical application. In the subjects with Parkinson's disease, we observed alterations in both phonation (85.9%) and articulation (42.9%). CONCLUSION: the study demonstrated that the protocol is an efficient tool for dysarthria assessment in patients with Parkinson's disease. UNESP Faculdade de Medicina de Botucatu Departamento de Neurologia e Psiquiatria UNESP Faculdade de Medicina de Botucatu Departamento de Oftalmologia e Otorrinolaringologia UNESP Faculdade de Medicina de Botucatu departamento de Neurologia e Psiquiatria UNESP Faculdade de Medicina de Botucatu Departamento de Neurologia e Psiquiatria UNESP Faculdade de Medicina de Botucatu Departamento de Oftalmologia e Otorrinolaringologia UNESP Faculdade de Medicina de Botucatu departamento de Neurologia e Psiquiatria

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:47:19Z No. of bitstreams: 1 S0004-28032010000100004.pdf: 127556 bytes, checksum: 590a8763ed7292aee076b7ad79018cb9 (MD5) Made available in DSpace on 2013-08-22T18:47:19Z (GMT). No. of bitstreams: 1 S0004-28032010000100004.pdf: 127556 bytes, checksum: 590a8763ed7292aee076b7ad79018cb9 (MD5) Previous issue date: 2010-03-01 Made available in DSpace on 2013-09-30T18:15:19Z (GMT). No. of bitstreams: 2 S0004-28032010000100004.pdf: 127556 bytes, checksum: 590a8763ed7292aee076b7ad79018cb9 (MD5) S0004-28032010000100004.pdf.txt: 23508 bytes, checksum: 43fe0ba22569f73b1e0551de254b569b (MD5) Previous issue date: 2010-03-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:31:40Z No. of bitstreams: 2 S0004-28032010000100004.pdf: 127556 bytes, checksum: 590a8763ed7292aee076b7ad79018cb9 (MD5) S0004-28032010000100004.pdf.txt: 23508 bytes, checksum: 43fe0ba22569f73b1e0551de254b569b (MD5) Made available in DSpace on 2014-05-20T13:31:40Z (GMT). No. of bitstreams: 2 S0004-28032010000100004.pdf: 127556 bytes, checksum: 590a8763ed7292aee076b7ad79018cb9 (MD5) S0004-28032010000100004.pdf.txt: 23508 bytes, checksum: 43fe0ba22569f73b1e0551de254b569b (MD5) Previous issue date: 2010-03-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) CONTEXTO: O efeito do sabor azedo e as variações da temperatura dos alimentos em indivíduos disfágicos, ainda não foi totalmente esclarecidos. OBJETIVO: Verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito faríngeo da deglutição em indivíduos após acidente vascular encefálico hemisférico isquêmico. MÉTODOS: Participaram deste estudo 30 indivíduos adultos, sendo 16 do gênero masculino e 14 do feminino, destros, com faixa etária variando de 41 a 88 anos (média de 62,3 anos) e ictus que variou de 1 a 30 dias (mediana de 6 dias). Para analisar o tempo de trânsito faríngeo da deglutição foi realizado o exame de videofluoroscopia da deglutição. Cada indivíduo foi observado durante a deglutição de bolo na consistência pastosa, oferecido em colher, com 5 mL cada, sendo ao todo quatro estímulos diferentes, um por vez. Posteriormente os exames foram analisados com auxílio de um software específico para medição do tempo de deslocamento do bolo pela fase faríngea. RESULTADOS: Os resultados mostraram que o tempo de trânsito faríngeo da deglutição foi significantemente menor durante a deglutição de bolo azedo gelado quando comparado aos outros estímulos. CONCLUSÃO: Constatou-se que estímulos com sabor azedo associado à temperatura fria provocam significativa mudança na dinâmica da deglutição, diminuindo o tempo de trânsito faríngeo, podendo assim proporcionar efeitos positivos em indivíduos com disfagia orofaríngea. CONTEXT: The effect of sour taste and food temperature variations in dysphagic patients has not been entirely clarified. OBJECTIVE: To determine the effect of sour and cold food in the pharyngeal transit times of patients with stroke. METHODS: Patients participating in this study were 30 right-handed adults, 16 of which were male and 14 were female, aged 41 to 88 (average age 62.3 years) with ictus varying from 1 to 30 days (median of 6 days). To analyze the pharyngeal transit time a videofluoroscopy swallow test was performed. Each patient was observed during swallow of a 5 mL paste bolus given by spoon, totaling four different stimuli (natural, cold, sour and cold sour), one at a time, room temperature (22ºC) and cold (8ºC) were used. Later, the tests were analyzed using specific software to measure bolus transit time during the pharyngeal phase. RESULTS: The results showed that the pharyngeal transit time was significantly shorter during swallow of cold sour bolus when compared with other stimuli. Conclusion - Sour taste stimuli associated to cold temperature cause significant change in swallowing patterns, by shortening the pharyngeal transit time, which may lead to positive effects in patients with oropharyngeal dysphagia. São Paulo State University Botucatu Medical School Department of Surgery UNESP Marília College of Philosophy and Sciences Department of Speech-Pathology UNESP Botucatu Medical School Department of Neurology and Psychiatry São Paulo State University Botucatu Medical School Department of Surgery UNESP Marília College of Philosophy and Sciences Department of Speech-Pathology UNESP Botucatu Medical School Department of Neurology and Psychiatry

Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-22Bitstream added on 2014-06-13T20:28:21Z : No. of bitstreams: 1 gatto_ar_me_botfm.pdf: 1016238 bytes, checksum: 8616d5f78187c09a64363d4593887258 (MD5) A dificuldade de deglutição é um déficit comum em pacientes após Acidente Vascular Encefálico (AVE). Estudos com esta população evidenciam atraso no início da resposta faríngea e um aumento do tempo de trânsito oral, quando comparada com indivíduos normais. Verificou-se que a redução destes tempos poderia reduzir o risco de penetração e/ou aspiração laringotraqueal e, consequentemente, diminuir o risco de complicações broncopulmonares. Portanto este estudo tem por objetivo verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito oral da deglutição, no tempo de resposta faríngea e no escape oral posterior. Participaram deste estudo 52 indivíduos após Acidente Vascular Encefálico isquêmico hemisférico, tanto com lesão à direita (D) como à esquerda (E), e disfagia orofaríngea de grau leve a moderado, sendo 28 do gênero masculino e 24 do gênero feminino, de 50 a 80 anos (66 anos). Para a análise dos tempos de deglutição foi realizada a videofluoroscopia da deglutição. Cada indivíduo foi avaliado durante a deglutição de bolo na consistência pastosa, oferecido em colher, com 5 ml cada, sendo ao todo 4 estímulos diferentes (natural, gelado, azedo e azedo-gelado). Os indivíduos foram divididos em dois grupos conforme a seqüência dessa oferta: Grupo 1- estímulos oferecidos aleatoriamente (24 indivíduos), grupo 2 - estímulos oferecidos na seguinte ordem: natural, gelado, azedo e azedogelado (28 indivíduos). Após o exame, através de software específico, foram realizadas as medidas de deslocamento do bolo alimentar. Foram mensurados o tempo de trânsito oral (TTO), o tempo de trânsito oral total (TTOT), o tempo de início da resposta faríngea (IRF) e o escape posterior. Os resultados mostraram que a associação entre os estímulos azedo e gelado provocou mudanças significantes no TTOT e no TTO, no grupo de indivíduos... Dysphagia is a common deficit in patients after stroke. Comparing with normal subjects, studies in this population show both a delay in swallowing initiation and an increase in oral transit time. It is postulated that the remediation of, or reduction of these times could reduce the bronchopulmonary complications risk. Therefore, the goal of this study is to verify the effect of sour taste and cold temperature in the oral phase of swallow, swallow response time, and measure the position of the head of the bolus at the swallowing initiation (posterior oral spillage). Participated in these study 52 patients with hemisphere stroke, as with right lesion as with left lesion, with mild to moderate oropharyngeal dysphagia, being 28 males and 24 females, 50 to 80 years (median 66 years). The stroke ictus ranged from 1 to 30 days (median 6 days). All subjects were assessed by objective examination of swallowing. To measure the swallow times a videofluoroscopic exam was used. During the videofluoroscopic, 4 spoons were offered, with 5 milliliters each of thickened substance (natural, cold, sour and sour-cold). The subjects were divided in two specific groups according to the offering sequence: group 1 – random offer (24 subjects), group 2 – sequential offer: natural, cold, sour and sour-cold (28 subjects). The videofluoroscopic images were digitalized and the measurement of the time of displacement of the bolus in oral phase of swallowing was done by specific software. It was measured the oral transit time (OTT), the total oral transit time (TOTT), the swallow response time (SRT), and the posterior oral spillage. The results showed that, in subjects from group 2, the OTT as well as the TOTT of swallowing were significantly lower during swallowing of the bolus with sour-cold stimulus, than when other stimulus offered separately. Spite of the tendency of reduction in both initial swallow response... (Complete abstract click electronic access below)

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:05:48Z No. of bitstreams: 1 S1516-18462010000100010.pdf: 247237 bytes, checksum: 0e0d84aa4b66936319adfab44a715a7d (MD5) Made available in DSpace on 2013-08-22T19:05:48Z (GMT). No. of bitstreams: 1 S1516-18462010000100010.pdf: 247237 bytes, checksum: 0e0d84aa4b66936319adfab44a715a7d (MD5) Previous issue date: 2010-02-01 Made available in DSpace on 2013-09-30T18:21:36Z (GMT). No. of bitstreams: 2 S1516-18462010000100010.pdf: 247237 bytes, checksum: 0e0d84aa4b66936319adfab44a715a7d (MD5) S1516-18462010000100010.pdf.txt: 31533 bytes, checksum: 5b9c9b75f1f9fe0900211ae803829970 (MD5) Previous issue date: 2010-02-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:36:18Z No. of bitstreams: 2 S1516-18462010000100010.pdf: 247237 bytes, checksum: 0e0d84aa4b66936319adfab44a715a7d (MD5) S1516-18462010000100010.pdf.txt: 31533 bytes, checksum: 5b9c9b75f1f9fe0900211ae803829970 (MD5) Made available in DSpace on 2014-05-20T13:36:18Z (GMT). No. of bitstreams: 2 S1516-18462010000100010.pdf: 247237 bytes, checksum: 0e0d84aa4b66936319adfab44a715a7d (MD5) S1516-18462010000100010.pdf.txt: 31533 bytes, checksum: 5b9c9b75f1f9fe0900211ae803829970 (MD5) Previous issue date: 2010-02-01 OBJETIVO: apresentar uma proposta para o controle de eficácia terapêutica em disfagia orofaríngea neurogênica. MÉTODOS: o protocolo foi proposto em concordância com a literatura atual e aplicado em um indivíduo pós-acidente vascular encefálico (AVE) isquêmico à direita, comprovado por tomografia computadorizada, com disfagia orofaríngea grave crônica, gênero masculino, 66 anos, apresentando aspiração laringotraqueal e em uso de sonda nasoentérica exclusiva pré-fonoterapia. Para controle da eficácia terapêutica do programa de reabilitação fonoaudiológica foi aplicado, pré e pós-fonoterapia, a classificação do grau de comprometimento da disfagia orofaríngea, Functional Oral Intake Scale (FOIS), a avaliação videofluoroscópica da deglutição com medida do tempo de trânsito faríngeo (TTF) da deglutição por meio de software e da percepção do indivíduo. RESULTADOS: na pré-fonoterapia verificou-se disfagia orofaríngea grave, FOIS nível 1, presença de aspiração laringotraqueal para mais de uma consistência e tempo de trânsito faríngeo de 13 segundos. Após fonoterapia verificou-se disfagia orofaríngea moderada, FOIS nível 5, ausência de aspiração laringotraqueal e TTF de 4 segundos. CONCLUSÃO: o protocolo proposto foi capaz de avaliar a eficácia da reabilitação na disfagia orofaríngea neurogênica neste indivíduo pós-acidente vascular encefálico, tanto para mensurar as mudanças ocorridas na fisiopatologia da deglutição quanto na ingestão oral e na percepção do indivíduo. Outros estudos com populações distintas são necessários, sendo que novas propostas devem ainda refletir a inclusão da condição nutricional e pulmonar do indivíduo no controle de eficácia em disfagia orofaríngea. PURPOSE: to submit a proposal for efficacy control in neurogenic oropharyngeal dysphagia. METHODS: the protocol was proposed in accordance with other researches and applied in one post-stroke individual, with right-hemispheric lesion confirmed by computed tomography, with oropharyngeal dysphagia, male gender, 66-year old, with laringotraqueal aspiration and using nasogastric feeding tube before swallowing therapy. In order to control the therapy effectiveness in pre- and post-swallowing therapy, the following procedures were applied: classification of severity degree for oropharyngeal dysphagia, functional oral intake scale (FOIS), videofluoroscopic evaluation of swallowing with additional swallowing pharyngeal transit time evaluation using a specific software and individual perception. RESULTS: before swallowing therapy, severe oropharyngeal dysphagia, FOIS level 1, presence of laryngotracheal aspiration, and 13 seconds of pharyngeal transit time were found. After swallowing therapy, moderate oropharyngeal dysphagia, FOIS level 5, absence of laryngotracheal aspiration, and 4 seconds of pharyngeal transit time were found. CONCLUSION: the proposed protocol could measure changes, both for pathophysiology of swallowing as well as for oral ingestion of the individual. We believe that it is still necessary to include nutritional and lung status of the individual in efficacy control of oropharyngeal dysphagia. Universidade Estadual Paulista Departamento de Fonoaudiologia Hospital Estadual de Bauru Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Neurologia e Neuropsiquiatria Universidade de São Paulo Universidade Estadual Paulista Departamento de Fonoaudiologia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Neurologia e Neuropsiquiatria

The swallowing disturbers are defined as oropharyngeal dysphagia when present specifies signals and symptoms that are characterized for alterations in any phases of swallowing. Early diagnosis is crucial for the prognosis of patients with dysphagia and the potential to diagnose dysphagia in a noninvasive manner by assessing the sounds of swallowing is a highly attractive option for the dysphagia clinician. This study proposes a new framework for oropharyngeal dysphagia identification, having two main contributions: a new set of features extract from swallowing signal by discrete wavelet transform and the dysphagia classification by a novel pattern classifier called OPF. We also employed the well known SVM algorithm in the dysphagia identification task, for comparison purposes. We performed the experiments in two sub-signals: the first was the moment of the maximal peak (MP) of the signal and the second is the swallowing apnea period (SAP). The OPF final accuracy obtained were 85.2% and 80.2% for the analyzed signals MP and SAP, respectively, outperforming the SVM results.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:05:45Z No. of bitstreams: 1 S1516-18462008000200009.pdf: 330177 bytes, checksum: b95be25f762ae41f4d62e2cd394a7b17 (MD5) Made available in DSpace on 2013-08-22T19:05:46Z (GMT). No. of bitstreams: 1 S1516-18462008000200009.pdf: 330177 bytes, checksum: b95be25f762ae41f4d62e2cd394a7b17 (MD5) Previous issue date: 2008-01-01 Made available in DSpace on 2013-09-30T18:15:21Z (GMT). No. of bitstreams: 2 S1516-18462008000200009.pdf: 330177 bytes, checksum: b95be25f762ae41f4d62e2cd394a7b17 (MD5) S1516-18462008000200009.pdf.txt: 27099 bytes, checksum: 99b85ee8380329033a37b9d3c67eab5a (MD5) Previous issue date: 2008-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:40:25Z No. of bitstreams: 2 S1516-18462008000200009.pdf: 330177 bytes, checksum: b95be25f762ae41f4d62e2cd394a7b17 (MD5) S1516-18462008000200009.pdf.txt: 27099 bytes, checksum: 99b85ee8380329033a37b9d3c67eab5a (MD5) Made available in DSpace on 2014-05-20T13:40:25Z (GMT). No. of bitstreams: 2 S1516-18462008000200009.pdf: 330177 bytes, checksum: b95be25f762ae41f4d62e2cd394a7b17 (MD5) S1516-18462008000200009.pdf.txt: 27099 bytes, checksum: 99b85ee8380329033a37b9d3c67eab5a (MD5) Previous issue date: 2008-01-01 TEMA: reabilitação em disfagia orofaríngea neurogênica OBJETIVO: apresentar revisão de literatura sobre os controles neurofisiológicos da deglutição orofaríngea e a influência do sabor azedo e da temperatura fria no mecanismo da deglutição. CONCLUSÃO: quanto à questão do controle central da deglutição, ainda existem controvérsias em relação ao sabor azedo e a temperatura fria. Esses dois parâmetros provocam mudanças na dinâmica da deglutição, podendo trazer benefícios aos indivíduos acometidos por disfagia orofaríngea neurogênica. Porém, tais achados sugerem a necessidade de investigações futuras com populações randomizadas. BACKGROUND: rehabilitation in neurogenic oropharyngeal dysphagia PURPOSE: to submit an overview of the related literature about neurophisiological control of oropharingeal dysphagia and the role of temperature and sour taste on swallowing mechanisms. CONCLUSIONS: as for the neurophysiologic swallowing control, there are still controversies when it comes to sour taste and cold temperature. These two standards can change the swallowing dynamics, and they may bring out benefits to the individuals with neurogenic oropharyngeal dysphagia. Therefore, the findings suggest the need for further investigations with randomized studies. Universidade Estadual Paulista em Marília Ambulatório de Disfagia Universidade Estadual Paulista Faculdade de Medicina de Botucatu da Universidade Estadual Paulista de Botucatu Hospital das Clínicas Universidade Estadual Paulista em Marília Departamento de Fonoaudiologia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Área de Metabolismo e Nutrição Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Neurologia e Psiquiatria Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista em Marília Ambulatório de Disfagia Universidade Estadual Paulista Faculdade de Medicina de Botucatu da Universidade Estadual Paulista de Botucatu Hospital das Clínicas Universidade Estadual Paulista em Marília Departamento de Fonoaudiologia Universidade Estadual Paulista Faculdade de Medicina de Botucatu �?rea de Metabolismo e Nutrição Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Neurologia e Psiquiatria Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia

Cerebrovascular disease is recognized as to be associated with the highest mortality rate in Brazil. Dysphagia, speech and language disturbances are common consequences of the high incidence of stroke. Dysphagia is known to occur in at least 50% of the patients with acute stroke. The study is designed to establish the incidence of stroke in a reference hospital. One hundred and two consecutive patients admitted between January 2001 and January 2002 underwent a neurological examination with dysphagia specific analysis, performed by speech/dysphagia professionals as soon as they have clinical conditions. The localization of the lesions are determined by computer tomography or magnetic resonance image of the brain. Sixty one patients underwent videofluorscopic evaluation of swallowing. There was detected oropharyngeal dysphagia in 78 patients (76.5%) if the examination was limited to the clinical evaluation. Nevertheless, if complemented by videofluorscopic evaluation, the incidence grows to 90%. The explanation for the high incidence observed in this study could be pointed to the fact that dysphagia was registered on different times of the convalescence period. The data reinforces the importance of repeated evaluations made by different professionals of the staff involved in acute stroke attendance.

Made available in DSpace on 2014-10-01T13:08:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2013Bitstream added on 2014-10-01T14:03:03Z : No. of bitstreams: 1 S2317-17822013000200012.pdf: 669964 bytes, checksum: 9978d2221eff239ba8c5c9b674f921d7 (MD5) OBJETIVO: Verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito oral da deglutição. MÉTODOS: Participaram deste estudo 52 indivíduos (28 do gênero masculino e 24 do gênero feminino) após acidente vascular encefálico isquêmico, com lesão à direita ou à esquerda e disfagia orofaríngea de grau leve a moderado, com idades variando de 50 a 80 anos (mediana=66 anos). Foi realizada a videofluoroscopia da deglutição para a análise dos tempos de deglutição. Cada indivíduo foi avaliado durante a deglutição de bolo na consistência pastosa, oferecido em colher com 5 ml, com quatro estímulos diferentes (natural, frio, azedo e azedo-frio). Após o exame foram realizadas as medidas de tempo de trânsito oral utilizando software específico. Foram mensurados o tempo de trânsito oral (a partir do início do movimento do bolo alimentar na boca) e o tempo de trânsito oral total (a partir do momento em que o bolo é colocado na boca). RESULTADOS: A associação entre o estímulo azedo e a temperatura fria provocou mudanças significavas no tempo de trânsito oral total e no tempo de trânsito oral, com redução nestes tempos. CONCLUSÃO: O sabor azedo e a temperatura fria associados apresentaram redução do tempo de trânsito oral em pacientes pós acidente vascular encefálico. PURPOSE: To determine the effect of sour flavor and cold temperature on oral transit time during swallowing. METHODS: Participants were 52 subjects (28 male and 24 female) with ages between 50 and 80 years (median=66 years), after ischemic stroke involving right or left side damage and mild to moderate oropharyngeal dysphagia. Videofluoroscopy was performed to analyze the swallowing times. Each subject was assessed during swallowing of a paste consistency bolus offered in 5 ml spoons, with a total of four different stimuli (natural, cold, sour and sour-cold). After the exam, the oral transit time was measured using specific software. The oral transit time (starting at the beginning of the bolus movement in the mouth) and the total oral transit time (starting at the moment that the bolus is placed in the mouth) were measured. RESULTS: The association between sour and cold stimuli caused a significant decrease of oral transit time and total oral transit time. CONCLUSION: Sour flavor and cold temperature reduced oral transit time in stroke patients. Universidade Estadual Paulista Júlio de Mesquita Filho Botucatu Medical School Department of Neurology and Psychiatry Universidade Estadual Paulista Júlio de Mesquita Filho Botucatu Medical School Department of Surgery Universidade Estadual Paulista Júlio de Mesquita Filho Marília College of Philosophy and Sciences Department of Speech-Language Pathology and Audiology Universidade Estadual Paulista Júlio de Mesquita Filho School of Engineering Department of Electrical Engineering Universidade Estadual Paulista Júlio de Mesquita Filho Botucatu Medical School Department of Bioestatistic Universidade Estadual Paulista Júlio de Mesquita Filho Botucatu Medical School Department of Neurology and Psychiatry Universidade Estadual Paulista Júlio de Mesquita Filho Botucatu Medical School Department of Surgery Universidade Estadual Paulista Júlio de Mesquita Filho Marília College of Philosophy and Sciences Department of Speech-Language Pathology and Audiology Universidade Estadual Paulista Júlio de Mesquita Filho School of Engineering Department of Electrical Engineering Universidade Estadual Paulista Júlio de Mesquita Filho Botucatu Medical School Department of Bioestatistic