Arquivo do autor:Graziela Chamarelli Bougo

Sobre Graziela Chamarelli Bougo

Fonoaudióloga do Hospital Risoleta Tolentino Neves Graduada em Fonoaudiologia pela Universidade Estadual do Centro-Oeste-PR Aprimoramento em Fonoaudiologia Hospitalar pelo Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP/SP) Residência em Fonoaudiologia na área de ênfase de Urgência, Emergência e Terapia Intensiva do Hospital Municipal Odilon Behrens de Belo Horizonte (BH/MG)

Respiratory-swallowing coordination and swallowing safety in patients with Parkinson’s disease

Troche MS; Huebner I; Rosenbek JC; Okun MS; Sapienza CM

Dysphagia;26(3):218-24, 2011 Sep.

The purpose of this study was to determine if individuals with Parkinson’s disease (PD) demonstrate abnormal respiratory events when swallowing thin liquids. In addition, this study sought to define associations between respiratory events, swallowing apnea duration, and penetration-aspiration (P-A) scale scores. Thirty-nine individuals with PD were administered ten trials of a 5-ml thin liquid bolus. P-A scale score quantified the presence of penetration and aspiration during the swallowing of a 3-oz sequential bolus. Participants were divided into two groups based on swallowing safety judged during the 3-oz sequential swallowing: Group 1 = P-A â‰¤ 2; Group 2 = P-A â‰¥ 3. Swallows were examined using videofluoroscopy coupled with a nasal cannula to record respiratory signals during the event(s). Findings indicated that expiration was the predominant respiratory event before and after swallowing apnea. The data revealed no differences in our cohort versus the percentages of post-swallowing events reported in the literature for healthy adults. In addition, individuals with decreased swallowing safety, as measured by the P-A scale, were more likely to inspire after swallows and to have shorter swallowing apnea duration. Individuals who inspired before swallow also had longer swallowing apnea duration. The occurrence of inspiratory events after a swallow and the occurrence of shorter swallowing apnea durations may serve as important indicators during clinical swallowing assessments in patients at risk for penetration or aspiration with PD.


Impaired food transportation in Parkinson’s disease related to lingual bradykinesia

Umemoto G; Tsuboi Y; Kitashima A; Furuya H; Kikuta T

Dysphagia;26(3):250-5, 2011 Sep.

This study aimed to analyze quantitatively videofluoroscopic (VF) images of patients with Parkinson’s disease (PD), to evaluate if the predicted factors of the oral phase of swallowing deteriorated with PD progression, and to demonstrate a relationship between the abnormal movements of the tongue and food transportation. Thirty PD patients were recruited and divided into mild/moderate (Hoehn & Yahr stages II and III) and advanced (stages IV and V) groups. They underwent measurement of tongue strength and VF using 5 ml of barium gelatin jelly as a test food. We measured the speed of bolus movement and the range of tongue and mandible movements during oropharyngeal transit time. The maximum tongue pressure of the mild/moderate group was significantly larger than that of advanced group (p = 0.047). The oropharyngeal transit time of the mild/moderate group was significantly shorter than that of the advanced group (p = 0.045). There was a significant negative correlation between the speed of tongue movement and the oropharyngeal transit time (p = 0.003, R = -0.527). Prolonged mealtimes and the ejection of insufficiently masticated food from the oral cavity into oropharynx were associated with PD progression. These results indicate the importance of the oral phase of swallowing in PD patients.


Risperidone-induced bulbar palsy-like syndrome

Sico JJ; Patwa H

Dysphagia;26(3):340-3, 2011 Sep.

There have been several case reports of risperidone-associated dysphagia. Risperidone-induced bulbar palsy-like syndrome has not been previously described. We report on a 58-year-old gentleman with prior history of schizophrenia and remote chlorpromazine use with no history of extrapyramidal symptoms who experienced acute onset of dysphagia and facial diplegia with hyperprolactinemia while being treated with risperidone. To date there have been five reported cases of dysphagia associated with risperidone, occurring by such mechanisms as isolated pharyngeal dysfunction from pharyngeal constrictor palsy and dystonia, drug-induced parkinsonism, and acute dystonic reaction. These cases were associated either with initiation or up-titration of risperidone, with complete resolution of dysphagia after medication discontinuation or dose change. Our patient developed dysphagia within 2 weeks of taking risperidone and completely resolved 1 month after the medication was stopped. Unlike other reported cases, our patient also experienced symptomatic hyperprolactinemia, another known side effect of risperidone. Physicians should also be aware that risperidone can be associated with oropharyngeal dysphagia secondary to an acute bulbar palsy-like syndrome that places patients at increased risk of aspiration events and its associated morbidity and mortality.


Measuring elderly dysphagic patients’ performance in eating–a review

Hansen T; Kjaersgaard A; Faber J

Disabil Rehabil;33(21-22):1931-40, 2011.

PURPOSE: This review aims to identify psychometrically robust assessment tools suitable for measuring elderly dysphagic patients’ performance in eating for use in clinical practice and research. METHOD: Electronic databases, related citations and references were searched to identify assessment tools integrating the complexity of the eating process. Papers were selected according to criteria defined a priori. Data were extracted regarding characteristics of the assessment tools and the evidence of reliability, validity and responsiveness. Quality appraisal was undertaken using developed criteria concerning the study design, the statistics used for the psychometric evaluation and the reported values. RESULTS: Eight of fourteen identified assessment tools met the inclusion criteria. Three assessment tools were specific to dementia, two were specific to stroke and three targeted a range of neurological and geriatric conditions. The rigor of the assessment tools’ psychometric properties varied from no evidence available to excellent evidence. Only two assessment tools were rated adequate to excellent. CONCLUSION: ‘The Minimal Eating Observation Form-Version II’ to be used for screening and ‘The McGill Ingestive Skills Assessment’ to be used for treatment planning and monitoring appeared to be psychometrically robust for clinical practice and research. However, further research on their psychometric properties is needed.


A clinical audit of the management of patients with a tracheostomy in an Australian tertiary hospital intensive care unit: Focus on speech-language pathology

Freeman-Sanderson A; Togher L; Phipps P; Elkins M

Int J Speech Lang Pathol;13(6):518-25, 2011 Dec.

Speech-language pathologists manage communication and swallowing disorders, both of which can occur in patients after tracheostomy insertion. An audit on the incidence and timing of speech-language pathology intervention for adults with tracheostomies has not previously been published. Data were retrospectively extracted from the medical records of all patients who were tracheostomized at Royal Prince Alfred Hospital, NSW, Australia, from October 2007 for 1 year. Extracted data included diagnosis, date and type of tracheostomy, time to speech-language pathologist involvement, time to phonation, and time to oral intake. Among the 140 patients (mean age 58 years, range 16-85), diagnoses were neurological (32%), head and neck (25%), cardiothoracic (24%), respiratory (6%), and other (13%). Speech-language pathology was involved with 78% of patients, with initial assessment on average 14 days after tracheostomy insertion (14 days to 166 days). Median time from tracheostomy insertion to phonation was 12 days (range 1-103). Median time from tracheostomy insertion to oral intake was 15 days (range 1-142). Only 20% of patients returned to verbal communication within 1 week after tracheostomy insertion. Further research into access to and timing of speech-language pathology intervention in the critical care setting is warranted.


Community-Acquired Pneumonia Guidelines

Michael S. Niederman, M.D., Carlos M. Luna, M.D., Ph.D.

Semin Respir Crit Care Med. 2012;33(3):298-310.


Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality worldwide, and since 1993, guidelines for management have been available. The process, which first began in the United States and Canada, has now been implemented in numerous countries throughout the world, and often each geographic region or country develops locally specific recommendations. It is interesting to realize that guidelines from different regions often interpret the same evidence base differently, and guidelines differ from one country to another, even though the bacteriology of CAP is often more similar than different from one region to another. One of the unique contributions of the 2007 US guidelines is the inclusion of quality and performance measures. In addition, US guidelines emphasize management principles that differ from some of the principles in European guidelines because of unique epidemiological considerations. In addition, certain therapy principles apply in the United States that differ from those in other regions, including the need for all patients to receive routine therapy for atypical pathogens, the emergence of community-acquired methicillin-resistant Staphylococcus aureus in some patients following influenza, and the need for all patients admitted to the intensive care unit to receive at least two antimicrobial agents. In the future, as guidelines evolve, there will be an important place for regional guidelines, particularly if these guidelines can recommend locally specific strategies to implement guidelines, which if successful, can lead to improved patient outcomes.


Is swallowing of all mixed consistencies dangerous for penetration-aspiration?

Lee KL; Kim WH; Kim EJ; Lee JK’

Am J Phys Med Rehabil;91(3):187-92, 2012 Mar

OBJECTIVE: The aim of this study was to determine whether the risk and severity of penetration-aspiration with mixed consistency (MIX), which consists of cooked rice and thin liquid barium (LIQUID), are different from the risks and severities with each single consistency (cooked rice or LIQUID) in dysphagic patients. DESIGN: Dysphagic patients (N = 29) performed a videofluoroscopic swallowing study with the following foods: cooked rice, LIQUID, and MIX. Several components were analyzed using recorded videotapes. RESULTS: The Penetration-Aspiration Scale score for MIX was significantly lower than that for LIQUID (P < 0.016). The location of the leading edge at the onset of a pharyngeal swallow between MIX and LIQUID was not different (P = 0.705). The pharyngeal delay time of LIQUID was delayed significantly compared with that of MIX (0.142 ± 0.267 and -0.149 ± 0.096 sec, respectively, P < 0.016). The severity of pharyngeal residue among the foods was different according to the location. CONCLUSIONS: Swallowing of MIX is not dangerous, and it is safer for not inducing penetration-aspiration as compared with the swallowing of LIQUID. The risk of penetration-aspiration may be judged depending on not only a food’s consistency but also on various factors that affect airway protection, including the texture of food.


Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: effect on survival

Spataro R; Ficano L; Piccoli F; La Bella V

J Neurol Sci;304(1-2):44-8, 2011 May 15.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is offered to amyotrophic lateral sclerosis (ALS) patients with severe dysphagia. Immediate benefits of PEG are adequate food intake and weight stabilization. However, the impact of PEG on survival is still uncertain. In this work we retrospectively evaluated the effect of PEG on survival in a cohort of ALS patients followed in a tertiary referral centre. METHODS: Between 2000 and 2007, 150 dysphagic ALS patients were followed until death or tracheostomy. PEG was placed in 76 patients who accepted the procedure and survival was analysed using the Kaplan-Meier life-table method. RESULTS: In ALS patients submitted to PEG, no major complications were observed. Total median survival time from symptom onset was 38 months for PEG users as compared to 32 months for the remaining dysphagic patients who declined the procedure (p=0.05). Among bulbar-onset patients, PEG users showed a median survival time longer than those with no PEG (28 months vs. 25 months), even though the difference was not significant. Conversely, dysphagic spinal-onset patients with PEG lived significantly longer than those who refused this palliative care (44 months vs. 36 months, p=0.046). Survival in patients with PEG was not affected by the severity of the respiratory impairment, as measured by forced vital capacity. CONCLUSIONS: This study demonstrates that PEG improves survival in dysphagic ALS patients, with few side effects. The procedure is safe and applicable even to patients with impaired respiratory function. PEG remains a milestone in palliative care in dysphagic ALS patients.