Search

Dysphagia often occurs in the most severe cases of Covid-19 infection and has an impact on clinical outcomes and patients’ quality of life. Objective: This study aimed to describe the effects of intensive speech rehabilitation in cases of post-Covid-19 dysphagia in a hospital environment. Methods: This is a series of five patients admitted to a medical ward between May and August 2021. They were dysphagic, underwent orotracheal intubation and were submitted to evaluation and intensive speech therapy for five consecutive days. The intervention involved myofunctional exercises and in three cases electrical stimulation were also associated. The outcomes were: evolution of the Functional Oral Intake Scale (FOIS) and Penetration-Aspiration Scale (PAS) - according to videofluoroscopy - degree of dysphagia according to the Dysphagia Outcome and Severity Scale (DOSS) and improvement in quality of life (SWAL-QOL). Results: After therapy, one patient remained with severe dysphagia, two evolved to mild dysphagia, and two to functional deglutition. In four cases, there was an evolution of the PAS to level 1, showing reduction of aspiration episodes and laryngotracheal penetration, FOIS level 6 and improvement in the quality-of-life questionnaire scores. Conclusion: The therapy promoted an increase in the levels of oral intake, a reduction in the degree of severity of dysphagia and episodes of penetration and laryngotracheal aspiration, in addition to an improvement in the quality of life index in four of the five patients in this series.

Objective: To verify the effectiveness of a Brief and Intensive Dysphagia Therapy programme, in patients with head and neck cancer, during radio-chemotherapy. Study Design: This is a randomized clinical trial - pilot project with a random sample consisting of 11 patients divided into two groups: 7 in the intervention group, who received brief and intensive therapy and 4 in the control group, with weekly therapy. The assessment instruments used were tongue pressure measurement, mouth-opening measures, oral intake scale and quality of life questionnaire. Patients were evaluated before radio-chemotherapy, after 15 days of speech therapy and after radio-chemotherapy. Results: The intervention group presented higher values of lingual apex pressure (p = 0.00), mouth opening maintenance from the second evaluation (35.14 ± 16.82 mm) until the end of the radio-chemotherapy (35.29 p± 5.93 mm), greater oral intake functionality (p = 0.00) and improvement in overall aspects of quality of life questionnaire (p = 0.05) after completion of brief and intensive therapy and radio-chemotherapy. Conclusion: Brief and intensive therapy presented superior results in the maintenance and/or rehabilitation of the swallowing mechanism in patients with head and neck cancer undergoing radio-chemotherapy.

O aleitamento materno é o primeiro alimento do bebê e a primeira forma de contato com a mãe, com a família e com a sociedade. Objetivo: Descrever ações de promoção do aleitamento materno desenvolvidas no atual cenário de distanciamento social. Metodologia: Trata-se de um relato de experiência de ações realizadas por um projeto de extensão no período de distanciamento social provocado pelo Coronavírus. Resultados: Foram produzidas 71 publicações sobre temas relevantes envolvidos com a amamentação e obtido um total de 734 seguidores no perfil do Instagram do projeto com alcance em torno de 1.191 pessoas. Discussão: Ressalta-se a importância de informações seguras sobre a prática de amamentar e acredita-se na importância de profissionais capacitados para incrementar a prevalência do aleitamento materno. Conclusão: Mesmo diante dos desafios frente à pandemia, o projeto conseguiu alcançar a sociedade além dos muros da universidade, bem como atingiu o objetivo de promover e proteger o aleitamento materno baseado em informações científicas.

The World Health Organization recommends exclusive breastfeeding during the first six months of life and supplemented up to 2 years due to the numerous benefits of this practice for both the mother and the baby. This extension project aims to promote and support breastfeeding through the dissemination of knowledge in the area to ensure that pregnant women, puerperal and health professionals are assisted and safely informed about such practice. This study aims to describe how face-to-face actions were developed and how they were remotely adapted, bearing in mind the focus of informing and motivating the target audience regarding breastfeeding and its importance as well as showing that even in times of crisis it is possible to develop new skills. To accomplish that, virtual meetings were carried out and the project was organized and reinvented through posts on Instagram, lives, workshops, campaigns, production of booklets, participation in congresses, participation in online events, and publication of scientific productions. In that period, 38 posts on Instagram were publicized, obtaining 444 followers with an average reach of 229 accounts and 295.7 impressions. Three theoretical-practical workshops and one live were also offered. It was counted on the production and publication of scientific articles, abstracts, campaign and book chapter, winning two awards in the scientific sphere. Given the pandemic situation, the project was able to disseminate knowledge within the target audience, mother-infant and undergraduate students, sharing safe information and, at the same time, promoting breastfeeding.

Introdução: A atuação fonoaudiológica na disfagia decorrente do câncer de esôfago ainda é recente. Não foi encontrado até o momento, estudos que descrevam a atuação fonoaudiológica em pacientes com câncer de esôfago submetidos a radioterapia. Sendo assim, este trabalho teve como objetivo descrever a atuação fonoaudiológica em pacientes com câncer de esôfago, submetidos a tratamento radioterápico com queixa de disfagia. Métodos: Trata-se de uma série de cinco casos, que receberam acompanhamento fonoaudiológico ambulatorial. Os pacientes foram avaliados por meio de avaliação clínica da deglutição, classificação do grau de alteração de deglutição com aplicação de escala visual analógica e protocolos de qualidade de vida utilizados na área da oncologia. Foram submetidos ainda a uma abordagem terapêutica para deglutição. Resultados: Os pacientes obtiveram melhora da deglutição, apresentando, ao término do tratamento, diminuição dos sintomas de disfagia, possibilidade de ingesta de alimentos via oral e melhora da qualidade de vida. Conclusão: A fonoterapia, compreendendo a avaliação clínica da deglutição, seguida de treino da deglutição e exercício miofuncional para abertura do esfíncter esofágico superior (Shaker), auxiliou na reabilitação da disfagia esofágica.

Objetivo: Descrever a atuação fonoaudiológica hospitalar no paciente oncológico disfágico. Métodos: Estudo transversal, retrospectivo, descritivo, quantitativo, desenvolvido em um hospital oncológico. A amostra foi composta por prontuários de pacientes com câncer que realizaram acompanhamento fonoaudiológico para disfagia. Foram aplicados indicadores fonoaudiológicos de disfagia e comparada a escala de ingestão de alimentação por via oral (FOIS) antes e após terapia fonoaudiológica. Resultados: A amostra contou com 400 prontuários, 189 foram incluídos no GA (grupo ambulatório) e 211 no GI (grupo internação). A média geral da idade da amostra corresponde a 60,35±12,63, sendo o predomínio de homens 263 (65,8%). Quanto às neoplasias apresentadas pelos pacientes: 247 cabeça e pescoço e 43 esôfago e estômago. No GA 143 (75,7%) pacientes melhoraram a escala FOIS pós-terapia, 33 pacientes (17,5%) mantiveram o mesmo nível e 13 pacientes (6,9%) apresentaram piora na FOIS após o processo terapêutico. No GI 103 (48,8%) pacientes melhoraram pós-terapia, 81 pacientes (38,4%) mantiveram o mesmo nível na escala, e 27 pacientes (12,8%) apresentaram piora após a terapia fonoaudiológica. Conclusão: O estabelecimento de indicadores na atuação junto ao paciente disfágico permite identificar e quantificar as melhorias dos processos assistenciais, trazendo benefícios diretos aos pacientes, auxiliando na caracterização da população atendida, otimizando e aprimorando os processos e resultados, visando o aprimoramento da qualidade dos serviços prestados, bem como redução do tempo de internação e dos custos hospitalares.

Hyposalivation is a frequent complication after treatment with radiotherapy. To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) on the hyposalivation assessed through stimulated salivary flow (SSF). In this clinical trial, 68 patients (with hyposalivation) were randomly assigned to control (n = 31) or TENS (n = 37) group. Participants in control group received habitual care, while those in TENS group received 8 sessions (20 minutes each) delivered twice a week for four weeks. The electrodes were attached over the skin covering the salivary glands. The electric pulse was adjusted at a frequency of 50 Hz, pulse width of 250 μs and as intense as tolerated. SSF was evaluated through sialometry. Self-perception of salivary flow (SPSF) and quality of life (QL) was evaluated prior to, during and at 1, 3 and 6 months after treatment. Although no changes were observed in the control group for SSF at any timepoints, TENS group showed a progressive increase in SSF from the third session until the end of the treatment. Significant improvements were also found in SPSF, especially when the SSF reached values ≥0.7 mL/minute. The most expressive results were evident at 6 months after treatment so that SSF, SPSF and QL remained significantly higher (F = 9.5, P = 0.0001; H = 143.77, P

The nonfluent/agrammatic variant of primary progressive aphasia is characterized by apraxia of speech and agrammatism. Apraxia of speech limits patients' communication due to slow speaking rate, sound substitutions, articulatory groping, false starts and restarts, segmentation of syllables, and increased difficulty with increasing utterance length. Speech and language therapy is known to benefit individuals with apraxia of speech due to stroke, but little is known about its effects in primary progressive aphasia. This is a case report of a 72-year-old, illiterate housewife, who was diagnosed with nonfluent primary progressive aphasia and received speech and language therapy for apraxia of speech. Rate and rhythm control strategies for apraxia of speech were trained to improve initiation of speech. We discuss the importance of these strategies to alleviate apraxia of speech in this condition and the future perspectives in the area.

EA amamentação é benéfica para o bebê, para a mãe, para a família e para a sociedade. Por conta dos inúmeros benefícios, os órgãos de saúde recomendam aleitamento materno exclusivo até seis meses e complementado até dois anos de vida. No Brasil, as taxas de amamentação ainda se encontram abaixo do recomendado e a falta de conhecimento a respeito de suas vantagens é um dos principais fatores responsáveis pelo desmame. O projeto de extensão “Falando em Amamentação” foi criado com propósito de apoiar e promover o aleitamento materno por meio de orientações no pré-natal e puerpério e ações no ambiente universitário. O objetivo deste artigo é, portanto, relatar as experiências vividas pelos alunos durante as ações realizadas pelo projeto. O projeto realiza orientações semanalmente pela manhã no ambulatório e alojamento conjunto de um hospital em Porto Alegre. No ambulatório, as acadêmicas orientam grupos de gestantes e, no alojamento conjunto, as orientações ocorrem individualmente à beira do leito e são voltadas às dúvidas e às dificuldades do binômio mãe-bebê durante a amamentação. Os resultados são observados por meio do interesse nas informações recebidas, compartilhamento de dúvidas e dificuldades e receptividade para auxílio no manejo da amamentação quando necessário. O projeto considera bem-sucedida sua atuação na promoção e incentivo ao aleitamento materno, visto que a população atendida se mostra satisfeita com a assistência recebida, os serviços estão abertos para as atividades e as alunas participantes têm a oportunidade de aprofundar o conhecimento, colocando em prática habilidades e competências de sua formação curricular.

To analyze the effects of electrical stimulation on the salivary flow of head and neck cancer patients with radiotherapy-induced hyposalivation.Searches were made in the Medline (via Pubmed), Cochrane Library, Scopus and Lilacs databases.Selection included clinical trials that evaluated salivary flow objectively, published in the last 10 years in either Portuguese, English or Spanish.The PEDro scale was used for the methodological evaluation of the studies.The search strategy resulted in 21 publications, 17 of which were excluded, hence there were 4 articles left. The included studies had a total of 212 participants, all of whom had an increase in salivary flow, both through the electroacupuncture method and direct application on the salivary glands. The score obtained through the PEDRo scale was low, evidencing questionable methodological quality and risk of bias.The included studies demonstrate the clinical potential of TENS to increase the salivary flow of head and neck cancer patients treated with RT.Analisar os efeitos da eletroestimulação sobre o fluxo salivar de pacientes com hipossalivação induzida por radioterapia em região de cabeça e pescoço.Utilizaram-se as bases de dados Medline (via Pubmed), Cochrane Library, Scopus e Lilacs.Foram selecionados os ensaios clínicos que avaliaram objetivamente o fluxo salivar, publicados nos últimos 10 anos em português, inglês ou espanhol.Para avaliação metodológica dos estudos, foi utilizada a escala PEDro.A estratégia de busca resultou em 21 publicações, sendo que 17 foram excluídas, selecionando-se assim 4 artigos. Os estudos incluídos contaram com um total de 212 participantes, sendo que todos demonstraram aumento do fluxo salivar, tanto por meio do método de eletroacupuntura quanto pela estimulação aplicada diretamente sobre as glândulas salivares. A pontuação obtida por meio da escala PEDro foi baixa, evidenciando qualidade metodológica baixa e com consideráveis riscos de viés.os estudos incluídos demonstram o potencial clínico da TENS no aumento do fluxo salivar de pacientes com câncer de cabeça e pescoço tratados com RT.

RESUMO Objetivo Verificar o efeito agudo da eletroestimulação sobre o fluxo salivar de pacientes com hipossalivação. Método Ensaio clínico não controlado que avaliou o efeito de uma única aplicação da Transcutaneous Electric Nerve Stimulation (TENS) sobre o fluxo salivar de 15 pacientes com hipossalivação induzida por radioterapia (RT), utilizada no tratamento de câncer de cabeça e pescoço. A média de idade dos pacientes foi de 56,8 ± 6,46 anos e o gênero masculino foi predominante (73%). A TENS foi programada com 50Hz de frequência, 250μs de largura de pulso e a intensidade foi ajustada ao longo dos 20 minutos conforme máxima tolerância. Os eletrodos foram fixados bilateralmente sobre a região das glândulas salivares. A avaliação do fluxo salivar foi realizada por meio de sialometria estimulada, antes e imediatamente após a aplicação da TENS. Resultados Em 80% dos casos, o tratamento oncológico incluiu quimioterapia. A RT foi aplicada em 80% dos casos na região e orofaringe, com intensidade média de 64,6 ± 7,27 Gy. Após a TENS, o fluxo salivar aumentou significativamente (p = 0,0051), passando de 0,05 (0,00; 0,40) mL/min para 0,10 (0,07;0,40) mL/min. A resposta à TENS foi diretamente correlacionada à intensidade da corrente elétrica tolerada (r = 0,553; p = 0,032) e à dose utilizada na RT (r = -0,514; p = 0,050). Conclusão A TENS aumentou significativamente o fluxo salivar de pacientes com hipossalivação induzida pela RT. ABSTRACT Purpose To verify the acute effect of electrostimulation on the salivary flow of patients with hyposalivation. Methods Uncontrolled clinical trial evaluating 15 patients with hyposalivation induced by radiotherapy (RT) used for head and neck cancer treatment. Mean age of the patients was 56.8 ± 6.46 years. Males outnumbered females (73%). Transcutaneous Electrical Nerve Stimulation (TENS) was adjusted with 50Hz of frequency and 250μs of pulse width. Intensity was adjusted over a 20-minute period according to maximum tolerance. The electrodes were attached bilaterally on the region of the salivary glands. Evaluation of the salivary flow was performed through sialometry before and immediately after application of TENS. Results The most prevalent region for RT was the oropharynx (80.0% of cases). The mean dose used in RT was 64.6 ± 7.27 Gy. After TENS, salivary flow increased significantly (p = 0.0051) from 0.05 (0.00; 0.40) mL/min to 0.10 (0.07: 0.40) mL/min. The response to TENS was directly correlated with the intensity of the tolerated electric current (r = 0.553; p = 0.032) and the dose used in RT (r = -0.514; p = 0.050). Conclusion TENS was able to increase the salivary flow rate of patients with RT-induced hyposalivation.

To verify the acute effect of electrostimulation on the salivary flow of patients with hyposalivation.Uncontrolled clinical trial evaluating 15 patients with hyposalivation induced by radiotherapy (RT) used for head and neck cancer treatment. Mean age of the patients was 56.8 ± 6.46 years. Males outnumbered females (73%). Transcutaneous Electrical Nerve Stimulation (TENS) was adjusted with 50Hz of frequency and 250μs of pulse width. Intensity was adjusted over a 20-minute period according to maximum tolerance. The electrodes were attached bilaterally on the region of the salivary glands. Evaluation of the salivary flow was performed through sialometry before and immediately after application of TENS.The most prevalent region for RT was the oropharynx (80.0% of cases). The mean dose used in RT was 64.6 ± 7.27 Gy. After TENS, salivary flow increased significantly (p = 0.0051) from 0.05 (0.00; 0.40) mL/min to 0.10 (0.07: 0.40) mL/min. The response to TENS was directly correlated with the intensity of the tolerated electric current (r = 0.553; p = 0.032) and the dose used in RT (r = -0.514; p = 0.050).TENS was able to increase the salivary flow rate of patients with RT-induced hyposalivation.Verificar o efeito agudo da eletroestimulação sobre o fluxo salivar de pacientes com hipossalivação.Ensaio clínico não controlado que avaliou o efeito de uma única aplicação da Transcutaneous Electric Nerve Stimulation (TENS) sobre o fluxo salivar de 15 pacientes com hipossalivação induzida por radioterapia (RT), utilizada no tratamento de câncer de cabeça e pescoço. A média de idade dos pacientes foi de 56,8 ± 6,46 anos e o gênero masculino foi predominante (73%). A TENS foi programada com 50Hz de frequência, 250μs de largura de pulso e a intensidade foi ajustada ao longo dos 20 minutos conforme máxima tolerância. Os eletrodos foram fixados bilateralmente sobre a região das glândulas salivares. A avaliação do fluxo salivar foi realizada por meio de sialometria estimulada, antes e imediatamente após a aplicação da TENS.Em 80% dos casos, o tratamento oncológico incluiu quimioterapia. A RT foi aplicada em 80% dos casos na região e orofaringe, com intensidade média de 64,6 ± 7,27 Gy. Após a TENS, o fluxo salivar aumentou significativamente (p = 0,0051), passando de 0,05 (0,00; 0,40) mL/min para 0,10 (0,07;0,40) mL/min. A resposta à TENS foi diretamente correlacionada à intensidade da corrente elétrica tolerada (r = 0,553; p = 0,032) e à dose utilizada na RT (r = -0,514; p = 0,050).A TENS aumentou significativamente o fluxo salivar de pacientes com hipossalivação induzida pela RT.

In clinical speech-language pathology practice, tongue force is usually evaluated qualitatively. Perception and practical experience are used to classify this force. The Biomechanical Engineering Group from the Federal University of Minas Gerais developed an instrument to quantify tongue force. The purposes of this study were to quantify maximum tongue protrusion force in Brazilian subjects with normal tongue strength and to compare force values between gender groups. In total, 105 subjects, 43 men and 62 women, aged from 18 to 29 years, with normal tongue strength according to qualitative evaluation, underwent quantitative evaluation by using the instrument. The mean of the maximum tongue force values of all participants was 17.58±7.95 N. There were significant differences in the median values for maximum tongue forces between the genders, with higher values observed for men. In intersubject comparisons, high variation coefficients were evident due to the variability among individuals. However, the study suggested that the instrument could be an interesting tool for intrasubject comparisons, especially during the follow-up.

PURPOSE: To describe the development and testing of a system that measures forces exerted by the tongue and upper lip on a tooth during rest and during swallowing. METHODS: Twenty-eight subjects, aged 19-31 years (mean: 23.2 years) were submitted to measurement of forces exerted by the upper lip and tongue on the maxillary right central incisor tooth. Flexiforce resistive sensors were fixed on the labial and lingual surfaces of the tooth. They were connected to an amplifier circuit and a data acquisition board for processing and transmitting information to a computer. RESULTS: At rest, the tongue force on the tooth was 0.00±0.00 N and the lip force on tooth was 0.02±0.02 N. The difference between them was significant. During swallowing, the values were 0.31±0.38 N and 0.15±0.14 N, for the tongue and lip, respectively. This difference was not significant. CONCLUSION: At rest, the lip exerts a larger force than the tongue on the maxillary right central incisor tooth. During swallowing, there was no difference between lip and tongue force on the tooth.

The muscles which compose the orofacial system are characterized by their small sizes and the ability to generate highly precise and differentiated movements that includes a series of rapid shape changes. This is made possible due to the large amount of innervations and the complex organization of the muscle fibers. These muscles play an essential role in mastication, swallowing, speech, breathing and suction, functions that require fast and complex movements. They also contribute to the orientation of facial bone growth and maintenance of teeth position.

RESUMO Objetivo Analisar os efeitos da eletroestimulação sobre o fluxo salivar de pacientes com hipossalivação induzida por radioterapia em região de cabeça e pescoço. Estratégia de pesquisa Utilizaram-se as bases de dados Medline (via Pubmed), Cochrane Library, Scopus e Lilacs. Critérios de seleção Foram selecionados os ensaios clínicos que avaliaram objetivamente o fluxo salivar, publicados nos últimos 10 anos em português, inglês ou espanhol. Análise dos dados Para avaliação metodológica dos estudos, foi utilizada a escala PEDro. Resultados A estratégia de busca resultou em 21 publicações, sendo que 17 foram excluídas, selecionando-se assim 4 artigos. Os estudos incluídos contaram com um total de 212 participantes, sendo que todos demonstraram aumento do fluxo salivar, tanto por meio do método de eletroacupuntura quanto pela estimulação aplicada diretamente sobre as glândulas salivares. A pontuação obtida por meio da escala PEDro foi baixa, evidenciando qualidade metodológica baixa e com consideráveis riscos de viés. Conclusão os estudos incluídos demonstram o potencial clínico da TENS no aumento do fluxo salivar de pacientes com câncer de cabeça e pescoço tratados com RT. ABSTRACT Purpose To analyze the effects of electrical stimulation on the salivary flow of head and neck cancer patients with radiotherapy-induced hyposalivation. Research strategies Searches were made in the Medline (via Pubmed), Cochrane Library, Scopus and Lilacs databases. Selection criteria Selection included clinical trials that evaluated salivary flow objectively, published in the last 10 years in either Portuguese, English or Spanish. Data analysis The PEDro scale was used for the methodological evaluation of the studies. Results The search strategy resulted in 21 publications, 17 of which were excluded, hence there were 4 articles left. The included studies had a total of 212 participants, all of whom had an increase in salivary flow, both through the electroacupuncture method and direct application on the salivary glands. The score obtained through the PEDRo scale was low, evidencing questionable methodological quality and risk of bias. Conclusion The included studies demonstrate the clinical potential of TENS to increase the salivary flow of head and neck cancer patients treated with RT.