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      Avaliação da qualidade de vida em pacientes com disfagia neurogênica Translated title: Evaluation of quality of life in patients with neurogenic dysphagia

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          Abstract

          RESUMO: Objetivo: avaliar a qualidade de vida de pacientes com Acidente Vascular Encefálico e disfagia neurogênica. Métodos: estudo quantitativo, do tipo transversal, descritivo, realizado no Setor de Neurologia de um Hospital de Ensino, em Curitiba- Paraná. A amostra foi constituída de 35 indivíduos com Acidente Vascular Encefálico e queixa de disfagia. Os dados foram coletados por meio de questionário para avaliação da qualidade de vida em disfagia. Resultados: nas variáveis sociodemográficas houve predomínio de homens, idosos, brancos, casados e primeiro grau incompleto. A avaliação de qualidade de vida demonstrou que os domínios que apresentaram alterações foram os que investigam como a alteração da deglutição tem afetado o aspecto social dos participantes. A correlação de Mann-Whitney evidenciou significância estatística (p < 5) quando relacionou a deglutição como um fardo com o tempo de se alimentar (p 0,002), frequência dos sintomas (p <0,001), saúde mental (p <0,001) e fadiga (p <0,001). Conclusão: o levantamento estatístico comprovou o impacto causado pela disfagia neurogênica na qualidade de vida dos pacientes acometidos por Acidente Vascular Encefálico, representado pelas alterações encontradas nos resultados de avalição da qualidade de vida. Na correlação de Mann-Whitney, ao se realizar os cruzamentos entre os domínios do instrumento, os dados evidenciaram significância estatística quanto ao tempo de alimentação, medo de se alimentar, saúde mental, social e fadiga, que causam prejuízo na qualidade de vida dos pacientes com disfagia neurogênica.

          Translated abstract

          ABSTRACT: Purpose: to assess quality of life in patients with cerebrovascular accident and neurogenic dysphagia. Methods: a quantitative, descriptive, cross-sectional study carried out by the Division of Neurology of a Teaching Hospital in Curitiba- Paraná State, Brazil. The sample consisted of 35 individuals with cerebrovascular accident and dysphagia. Data were collected through a questionnaire to assess quality of life in dysphagia. Results: as for the socio-demographic variables, predominantly males, elderly, white, married and incomplete primary education. The evaluation of quality of life showed that the domains that presented changes were the ones investigating how swallowing changes have affected participants' social aspect. Mann-Whitney correlation evidenced statistical significance (p <5) when related swallowing as a burden to feeding time (p 0.002), frequency of symptoms (p <0.001), mental health (p<0.001) and fatigue (p <0.001). Conclusion: the statistical survey confirmed the impact of neurogenic dysphagia on quality of life of patients suffering from cerebrovascular accident, represented by the changes found in the instrument used for rating the quality of life. In Mann-Whitney correlation, when performing intersections between the domains of the instrument, data showed statistical significance on feeding time, fear of eating, mental, social health and fatigue, which adversely affect the quality of life of patients with neurogenic dysphagia.

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          Most cited references25

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          Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review.

          This paper is a report of a systematic review conducted to determine the effectiveness and feasibility of bedside screening methods for detecting dysphagia in patients with neurological disorders. Dyspaghia affects 22-65% of patients with neurological conditions. Although there is a large variety of bedside tests to detect dysphagia, it is unknown which have the best psychometric properties and are feasible for nurses to use. An electronic database search was carried out using Medline (PubMed), Embase, CINAHL, and PsychLit, including all hits up to July 2008. The search terms were dysphagia, sensitivity, specificity, diagnosis, and screening. The methodological quality of included studies was assessed. Thirty-five out of 407 studies were included in the review. Eleven studies with sufficient methodological quality revealed that trial swallow tests using water had sensitivities between 27% and 85% and specificities between 63% and 88%. Trial swallow tests with different viscosities led to sensitivities ranging from 41% to 100% and specificities of 57% to 82%. Combining water tests with oxygen desaturation led to sensitivities between 73% and 98% and specificities between 63% and 76%. Single clinical features, such as abnormal gag, generally had low sensitivity and specificity. A water test combined with pulse oximetry using coughing, choking and voice alteration as endpoints is currently the best method to screen patients with neurological disorders for dysphagia. Further research is needed to establish the most effective standardized administration procedure for such a water test, and to assess the value of pulse oximetry, in addition to a trial swallow to detect silent aspiration.
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            Oropharyngeal dysphagia.

            Ian J Cook (2009)
            Although the aging process per se can produce measurable changes in the normal oropharyngeal swallow, these changes alone are rarely sufficient to cause clinically apparent dysphagia. The causes of oropharyngeal dysphagia in the elderly are predominantly neuromyogenic, with the most common cause being stroke. The evaluation of oropharyngeal dysphagia in the elderly involves early exclusion of structural abnormalities, detection of aspiration by videofluoroscopy which might dictate early introduction of nonoral feeding, and exclusion of underlying systemic and neuromyogenic causes that have specific therapies in their own right. Such conditions include Parkinson disease, myositis, myasthenia, and thyrotoxicosis. Management is best delivered by a multidisciplinary team involving physician, speech pathologist, nutritionist and, at times, a surgeon.
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              Novel preventive and therapuetic strategy for post-stroke pneumonia.

              Pneumonia is a significant complication of ischemic stroke that increases mortality. Post-stroke pneumonia is defined as newly developed pneumonia following stroke onset. Clinically and chronologically, post-stroke pneumonia is divided into two types of aspiration pneumonia. First, acute-onset post-stroke pneumonia occurs within 1 month after stroke. Second, insidious or chronic-onset post-stroke pneumonia occurs 1 month after the stroke. The mechanisms of pneumonia are apparent aspiration and dysphagia-associated microaspiration. Stroke and the post-stroke state are the most significant risk factors for aspiration pneumonia. The preventive and therapeutic strategies have been developed thoroughly and appropriate antibiotic use, and both pharmacological and nonpharmacological approaches for the treatment of post-stroke pneumonia have been studied rigorously. Increases in substance P levels, oral care, and swallowing rehabilitation are necessary to improve swallowing function in post-stroke patients, resulting in a reduction in the incidence of post-stroke pneumonia in a chronic stage. The stroke must be a cause of aspiration pneumonia.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcefac
                Revista CEFAC
                Rev. CEFAC
                CEFAC Saúde e Educação (São Paulo )
                1982-0216
                December 2015
                : 17
                : 6
                : 1939-1945
                Affiliations
                [1 ] Universidade Tuiuti do Paraná Brazil
                Article
                S1516-18462015000801939
                10.1590/1982-0216201517619114
                612605aa-da9c-46bd-aacd-513b9f5aa1d0

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1516-1846&lng=en
                Categories
                REHABILITATION

                Physiotherapy
                Quality of Life,Swallowing Disorders,Cerebrovascular Accident,Qualidade de Vida,Transtornos da Deglutição,Acidente Vascular Cerebral

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