Brazilian practice guidelines for stroke rehabilitation: Part II.

The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Brazilian practice guidelines for stroke rehabilitation: part II / Diretrizes brasileiras para reabilitação no acidente vascular cerebral: parte II

Abstract The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

Resumo As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderênciaao usode medicamentos, cuidados paliativos,ofuturodareabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial.

OBJECTIVE: Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal transcranial direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. METHODS: This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to the Behavior Inattention Test-Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 minutes of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity (National Institutes of Health Stroke Scale [NIHSS]), disability (modified Rankin Scale), autonomy (Barthel Index, Functional Independence Measure), and quality of life (EuroQol Group 5-Dimension Self-Report Questionnaire). Outcomes were analyzed using an analysis of covariance model corrected by age, baseline NIHSS, and baseline BIT-C. Pairwise post hoc comparisons were performed using Bonferroni correction. RESULTS: In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (mean difference [MD] = 18.4, 95% confidence interval [CI] = 3.9-32.8, p = 0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD = 13.9, 95% CI = -0.3 to 28.1, p = 0.057), or C-tDCS and sham (MD = 4.5, 95% CI = -9.7 to 18.8, p = 0.99). There were no significant differences between groups in terms of secondary outcomes. INTERPRETATION: A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase 3 trial. ANN NEUROL 2022;92:400-410.

What are the barriers to participation in a neuromodulation pilot trial for aphasia after stroke?

PURPOSE: Aphasia is a common and debilitating manifestation of stroke. Transcranial electrical stimulation uses low-intensity electric currents to induce changes in neuronal activity. Recent evidence suggests that noninvasive techniques can be a valuable rehabilitation tool for patients with aphasia. However, it is difficult to recruit patients with aphasia for trials, and the reasons for this are not well understood. This study aimed to elucidate the main difficulties involved in patient's recruitment and inclusion in a randomized clinical study of neuromodulation in aphasia. METHODS: We evaluated the reasons for the exclusion of patients in a pilot, randomized, double-blinded clinical trial in which patients diagnosed with motor aphasia after stroke were recruited from March to November 2018. A descriptive statistical analysis was performed. RESULTS: Only 12.9% (4) of patients with ischemic stroke were included in the clinical trial. A total of 87.1% (27) of the 31 recruited patients were excluded for various reasons including: sensory aphasia (32.2%), dysarthria (25.8%), spontaneous clinical recovery (16.1%), previous stroke (6.4%), and death or mutism (3.2%). CONCLUSION: The presence of other types of aphasia, dysarthria, spontaneous recovery, deaths, and mutism were barriers to recruiting patients evidenced in this neuromodulation study.

Influence of Thermal and Gustatory Stimulus in the Initiation of the Pharyngeal Swallow and Bolus Location Instroke.

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.

Respiratory Function and Grip Strength in the Acute Phase of Stroke Are Associated with Stroke Severity and Disability at Hospital Discharge.

Introduction. Stroke can lead to musculoskeletal and respiratory dysfunction, chronic deconditioning, and functional limitations, as well as long-term complications. OBJECTIVE: The aim of this study was to evaluate the association between respiratory function and grip strength in the acute phase of stroke and stroke severity, disability, and autonomy in the long term. METHODS: This was a cohort study including 46 patients in the stroke unit. The stroke patients were assessed in the stroke unit at the following moments: at admission by the clinical and haemodynamic stability, demographic and anthropometric data, hand grip strength, stroke severity by National Institutes of Health Stroke Scale (NIHSS) score, and respiratory function using a manovacuometer; during hospitalization by clinical complications and the length of stay; and at hospital discharge and 90 days after discharge by the degrees of functional capacity and dependence using NIHSS, modified Rankin scale (mRs), and Barthel index. Data analysis was performed by multiple linear regression to verify the association between respiratory function and grip strength and the outcomes. RESULTS: The median length of stay in the stroke unit was 7 days. A negative correlation was found between the palmar prehension strength on the unaffected side and mRs at discharge (ß = -0.034, p = 0.049). The NIHSS scores at discharge (ß = -0.034, p = 0.049). The NIHSS scores at discharge (ß = -0.034, p = 0.049). The NIHSS scores at discharge (. CONCLUSION: It was concluded that a loss of grip strength is associated with a loss of ability and autonomy at discharge and poor respiratory function is associated with stroke severity at discharge.

Dysphagia and tube feeding after stroke are associated with poorer functional and mortality outcomes.

BACKGROUND & AIMS: Stroke is the leading cause of disability in adult life. Oropharyngeal dysphagia occurs in 65-90% of patients, and its identification in the acute phase of stroke can prevent complications. The aim of this study was to verify whether oropharyngeal dysphagia during stroke hospitalization is associated with functional capacity, as assessed by the modified Rankin Scale (mRs), and mortality 90 days after stroke. MATERIALS AND METHODS: A prospective cohort study evaluating 201 patients hospitalized in the Stroke Unit was carried out. Dysphagia was evaluated during hospitalization using both a specific protocol to evaluate swallowing biomechanics and the Functional Oral Intake Scale (FOIS), in which FOIS 1-3 reflects tube feeding, 4-5 reflects oral feeding requiring food consistency changes, and 6-7 reflects oral feeding with no changes in food consistency. An mRs≥3 at 90 days after discharge was considered disability. The data were adjusted for the National Institute of Health Stroke Scale score, sex, age, stroke-associated pneumonia, type of stroke, and presence of thrombolysis. The significance level was set at 5%. RESULTS: Of the 201 patients evaluated, 42.8% (86) who had dysphagia were older, had a higher severity of stroke, and pneumonia rate. A FOIS score of 6-7 was a protective factor against disability (mRs≥3) (OR: 0.17; CI: 0.005-0.56; p = 0.004), and tube feeding use at hospital discharge increased the risk of mRs≥3 (OR: 14.97; CI: 2.68-83.65; p = 0.002) and mortality (OR: 9.79; CI: 2.21-43.4; p = 0.003) within 90 days after stroke. Pneumonia was the leading cause of death, however dysphagia and tube feeding at discharge were associated with death from any cause. CONCLUSION: Dysphagia or tube feeding use at discharge are markers of poor prognosis after the first stroke. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke.

Adductor Pollicis Muscle Thickness and Obesity Are Associated with Poor Outcome after Stroke: A Cohort Study.

BACKGROUND: Nutritional status may influence outcome after stroke. It is possible that some obese individuals present reduced fat-free mass. AIMS: We aimed to determine if bedside evaluation of body composition by the body mass index (BMI), adductor pollicis muscle thickness (APMT) and arm muscle area (AMA), and the combination of low APMT or AMA with obesity are associated with disability 90 days after stroke. METHODS: A cohort study evaluating 120 patients hospitalized at the Stroke Unit was carried out. Data were expressed as average ± standard deviation or median and percentiles. Obesity was evaluated by BMI and fat-free mass by the APMT and AMA. Receiver operating characteristic (ROC) curves and multivariate logistic regression analysis were used to measure whether APMT and obesity were associated with modified Rankin Scale (mRS) ≥3 (disability) within 90 days of stroke. The data were adjusted for National Institutes of Health Stroke Scale (NIHSS), sex, age, type of stroke, and thrombolysis. The significance level was 5%. RESULTS: Of 120 patients, we came up with the following demographics: men: 66 (55.0%); mean age: 66.6 ± 13.2 years; ischemic stroke: 109 (90.8%); mean NIHSS: 4 (2-10); thrombolysis: 18 (16.5%). Considering mRS ≥3, ROC curve analysis showed that the value of the cutoff for APMT was <12.5 mm. In multivariate analysis adjusted for the above factors, each 1 mm of increase in APTM reduced the chance of disability by 31%. The intersection of obesity with APMT <12.5 mm increased by 37-fold the risk of disability. AMA was not associated with mRS ≥3. CONCLUSION: Lower APMT alone or in combination with obesity was associated with poor functional status.

Oral dietary intake level in thrombolysed and non-thrombolysed patients after ischemic stroke.

BACKGROUND: Dysphagia can be a stroke sequelae and may impact patient prognosis. Thrombolytic therapy has been used as a treatment of choice which aims to reduce sequelae. OBJECTIVE: Assess the ability of dietary intake orally in subjects undergoing thrombolytic therapy and compare it with non-thrombolytic subjects post-ischemic stroke. METHODS: Documentary cross-sectional study with 87 post-ischemic stroke patients. Subjects were divided as to the type of neurological intervention: group 1 consisted of subjects undergoing brain reperfusion therapy or thrombolysis and group 2 for those undergoing no such therapy or non-thrombolysed. Data was obtained from the subjects relative to age, sex, level of oral dietary intake at the beginning of hospitalization and at discharge, length of hospital stay, comorbidities and site of neurological lesion. RESULTS: Group 1 was composed of 39 patients while 48 patients were in group 2. Both groups consisted of subjects with similar mean age and balanced gender distribution. Both groups presented hypertension as the most frequent comorbidity. The individuals in group 1 demonstrated improvement of oral dietary intake (p = 0.002) and shorter hospital stay (p = 0.007) when compared with group 2. CONCLUSION: There was greater improvement of oral dietary intake and shorter hospital stay for patients undergoing thrombolytic therapy.

Treatment of unilateral spatial neglect after stroke using transcranial direct current stimulation (ELETRON trial): study protocol for a randomized controlled trial.

BACKGROUND: Unilateral spatial neglect (USN) is characterized by the inability to report or respond to people or objects that are presented in the spatial hemisphere that is contralateral to the lesioned hemisphere of the brain. USN has been associated with poor functional outcomes and long stays in hospitals and rehabilitation centers. Noninvasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been used in people who have been affected by USN after stroke. The effects of such treatment could provide new insights for health professionals and policy-makers. The aim of this study will be to evaluate the effectiveness and safety of tDCS for USN after stroke. METHODS: A prospective randomized controlled trial with two parallel groups will be conducted, which will aim to recruit 60 patients with USN after ischemic or hemorrhagic stroke. Participants will be randomly placed into the following four treatment groups: (1) anodal tDCS over the right parietal lobe (n = 15), (2) cathodal tDCS over the left parietal lobe (n = 15), (3) a sham group of anodal tDCS over the right parietal lobe (n = 15), and (4) a sham group of cathodal tDCS over the left parietal lobe (n = 15). Blinded assessors will conduct two baseline assessments and one post-intervention assessment. The primary outcome measure will be the level of USN as assessed by the conventional Behavioral Inattention Tasks and the Catherine Bergego Scale. Secondary measures will include neurological capacity (based on the Scandinavian Stroke Scale), functional capacity (based on the Functional Independence Measure and Modified Rankin Scale), autonomy (based on the Barthel Index), and quality of life (based on the EuroQol-5D). Group allocation will be concealed, and all analyses will be based on an intention-to-treat principle. DISCUSSION: This study will explore the effects of more than 15 sessions of tDCS on the level of USN, functional capacity, autonomy, and quality of life in patients with USN after stroke. This proposed study has the potential to identify a new, evidence-based intervention that can enhance perception and independent living in patients with USN after stroke. TRIAL REGISTRATION: REBEC - RBR-78jvzx , registered on 13 March 2016.

Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital.

[Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, localization, treatment received, ictus onset, hospitalization time, discharge date, and date of first evaluation at the rehabilitation center. The Modified Rankin Scale in 90 days after ictus was utilized to measure functional incapacity with the individuals divided into two groups, before and after acute stroke unit implementation (2010). Functional incapacity was compared between before and after acute stroke unit implementation by the Mann-Whitney test, χ(2) test and Fisher's exact test. [Results] The medical records of 170 patients were evaluated. In the group evaluated after 2010, the patients were significantly older and presented a shorter time between hospitalization and discharge, shorter time until the first evaluation in rehabilitation, and increased percentage of mild incapacity (Modified Rankin Scale = 0 to 2). [Conclusion] After acute stroke unit implementation, the patients treated in the rehabilitation section presented a shorter hospitalization time and rehabilitation delay and less functional incapacity.

Association between pharyngeal residue and posterior oral spillage with penetration and aspiration in stroke.

PURPOSE: This study aimed at showing association between the posterior oral spillage and pharyngeal residue with tracheal aspiration and/or laryngeal penetration in stroke. METHODS: Clinical cross-sectional retrospective multicenter study. The study included 63 videofluoroscopic tests of post-ischemic stroke individuals and oropharyngeal dysphagia data of the three reference centers providing care for patients with dysphagia (43 men and 20 women; age range: from 40 to 90 years). These individuals were divided into two groups. Group I consisted of 35 participants with the presence of penetration and/or laryngotracheal aspiration, and Group II consisted of 28 individuals with no penetration and/or aspiration. Videofluoroscopic swallowing test results were analyzed to divide the groups, and the presence of posterior oral spillage and pharyngeal residue was observed. RESULTS: No association was found between the groups with posterior oral spillage (χ²=1.65; p=0.30; φ²=0.02), but there was statistical difference for the association between pharyngeal residue (χ²=12.86; p=0.003; φ²=0.20) and the groups. CONCLUSION: There is an association between pharyngeal residue and penetration with tracheal aspiration in post-stroke individuals.

Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma.

PURPOSE: To analyze the epidemiological features of patients with esophageal cancer according to the histopathological types: squamous cell carcinoma or adenocarcinoma. METHODS: A total of 100 patients with esophageal cancer, being 50 squamous cell carcinomas and 50 adenocarcinomas were analyzed for demographics, nutritional factors, lifestyle habits, benign pathological conditions associated, like Barrett's esophagus and megaesophagus, tumor stage and survival rates. The nutritional factors evaluated included body mass index, percent weight loss, hemoglobin and albumin serum levels. RESULTS: Esophageal cancer occurred more often in men over 50 years-old in both histological groups. No significant differences on age and gender were found between the histological groups. Squamous cell carcinoma was significantly more frequent in blacks than adenocarcinoma. Alcohol consumption and smoking were significantly associated with squamous cell carcinoma. Higher values of body mass index were seen in patients with adenocarcinoma. Barrett's esophagus was found in nine patients (18%) with adenocarcinoma, and megaesophagus in two patients (4%) with squamous cell carcinoma. The majority of patients were on stages III and IV in both histological groups. The mean survival rates were 7.7 ± 9.5 months for patients with squamous cell carcinoma and 8.0 ± 10.9 months for patients with adenocarcinoma. No significant differences on tumor stage and survival rates were detected between the histological groups. CONCLUSION: Epidemiological features are distinct for the histopathological types of esophageal cancer. Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus.

Association between pharyngeal residue and posterior oral spillage with penetration and aspiration in Stroke / Associação entre presença de resíduos faríngeos e escape oral posterior e a ocorrência de penetração e aspiração no Acidente Vascular Encefálico

PURPOSE: This study aimed at showing association between the posterior oral spillage and pharyngeal residue with tracheal aspiration and/or laryngeal penetration in stroke. METHODS: Clinical cross-sectional retrospective multicenter study. The study included 63 videofluoroscopic tests of post-ischemic stroke individuals and oropharyngeal dysphagia data of the three reference centers providing care for patients with dysphagia (43 men and 20 women; age range: from 40 to 90 years). These individuals were divided into two groups. Group I consisted of 35 participants with the presence of penetration and/or laryngotracheal aspiration, and Group II consisted of 28 individuals with no penetration and/or aspiration. Videofluoroscopic swallowing test results were analyzed to divide the groups, and the presence of posterior oral spillage and pharyngeal residue was observed. RESULTS: No association was found between the groups with posterior oral spillage (χ2=1.65; p=0.30; φ2=0.02), but there was statistical difference for the association between pharyngeal residue (χ2=12.86; p=0.003; φ2=0.20) and the groups. CONCLUSION: There is an association between pharyngeal residue and penetration with tracheal aspiration in post-stroke individuals. .

OBJETIVO: Este estudo teve por objetivo verificar a associação entre a ocorrência de escape oral posterior e a presença de resíduos faríngeos com penetração laríngea e/ou aspiração laringotraqueal no acidente vascular encefálico (AVE). MÉTODOS: Estudo clínico transversal, retrospectivo e multicêntrico. Foram incluídos neste estudo 63 exames videofluoroscópicos de indivíduos pós-AVE isquêmico e disfagia orofaríngea do banco de dados dos serviços de três centros públicos de referência no atendimento do indivíduo disfágico, sendo 43 do gênero masculino e 20 do gênero feminino, faixa etária variando de 40 a 90 anos. Estes foram divididos em dois grupos. O Grupo I foi composto por exames de 35 indivíduos com presença de penetração e/ou aspiração laringotraqueal e o Grupo II, por exames de 28 indivíduos com ausência de penetração e/ou aspiração. Foram analisados exames de videofluoroscopia da deglutição para dividir os grupos e observou-se a presença de escape posterior e resíduos faríngeos. RESULTADOS: Não houve associação entre os grupos com o escape oral posterior (χ2=1,65; p=0,30; φ2=0,02), porém houve associação entre resíduos faríngeos (χ2=12,86; p=0,003; φ2=0,20) e os grupos. CONCLUSÃO: Diante dos resultados obtidos, concluiu-se que há associação entre a presença de resíduos faríngeos com a ocorrência de penetração com aspiração laringotraqueal em indivíduos pós-AVE. .

Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma

PURPOSE: To analyze the epidemiological features of patients with esophageal cancer according to the histopathological types: squamous cell carcinoma or adenocarcinoma. METHODS: A total of 100 patients with esophageal cancer, being 50 squamous cell carcinomas and 50 adenocarcinomas were analyzed for demographics, nutritional factors, lifestyle habits, benign pathological conditions associated, like Barrett's esophagus and megaesophagus, tumor stage and survival rates. The nutritional factors evaluated included body mass index, percent weight loss, hemoglobin and albumin serum levels. RESULTS: Esophageal cancer occurred more often in men over 50 years-old in both histological groups. No significant differences on age and gender were found between the histological groups. Squamous cell carcinoma was significantly more frequent in blacks than adenocarcinoma. Alcohol consumption and smoking were significantly associated with squamous cell carcinoma. Higher values of body mass index were seen in patients with adenocarcinoma. Barrett's esophagus was found in nine patients (18%) with adenocarcinoma, and megaesophagus in two patients (4%) with squamous cell carcinoma. The majority of patients were on stages III and IV in both histological groups. The mean survival rates were 7.7 ± 9.5 months for patients with squamous cell carcinoma and 8.0 ± 10.9 months for patients with adenocarcinoma. No significant differences on tumor stage and survival rates were detected between the histological groups. CONCLUSION: Epidemiological features are distinct for the histopathological types of esophageal cancer. Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus. .

Sour taste and cold temperature in the oral phase of swallowing in patients after stroke.

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.

Sour taste and cold temperature in the oral phase of swallowing in patients after stroke / Sabor azedo e temperatura fria na fase oral da deglutição no 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.

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.

Correlação entre a escala internacional de acidente vascular cerebral do Instituto Nacional de Saúde (NIHSS) e a penetração laríngea e aspiração laringotraqueal no acidente vascular cerebral isquêmico / Correlation between National Institute of Health Stroke Scale (NIHSS) and laryngeal penetration and tracheal aspiration in ischemic stroke

Estudos têm proposto a utilização da Escala Internacional de Acidente Vascular Cerebral do Instituto Nacional de Saúde (NIHSS) como um instrumento de triagem, como preditor clínico da presença de disfagia orofaríngea e indicador de via de alimentação nos indivíduos pós-AVC, mesmo este não pontuando o distúrbio de deglutição. No entanto, a maioria deles preconizou o uso de parâmetros clínicos na avaliação da deglutição, o que dificulta a identificação de alterações específicas que podem direcionar a conduta sobre a via e consistência de alimentação. Sendo assim, este estudo teve como objetivo verificar a correlação entre a pontuação obtida no NIHSS e a presença de penetração laríngea e aspiração laringotraqueal nos indivíduos pós-AVC isquêmico, utilizando o exame de videofluoroscopia da deglutição. Participaram deste estudo 74 indivíduos pós-AVC isquêmico submetidos à avaliação neurológica e aplicação do NIHSS. Os indivíduos foram divididos em quatro grupos conforme a gravidade do AVC na pontuação do NIHSS, sendo G1 (0-4 pontos), G2 (5-10), G3 (11-20) e G4 (≥ 20). Destes indivíduos, dois foram excluídos da avaliação fonoaudiológica da deglutição por apresentarem comprometimento neurológico grave mensurado pelo NIHSS. 72 indivíduos foram submetidos à avaliação fonoaudiológica clinica e ao exame videofluoroscópico da deglutição, realizados no mesmo dia, com o pastoso fino e líquido ralo, observando a presença de penetração laríngea e aspiração laringotraqueal...

The use of the National Institutes of Health Stroke Scale (NIHSS) have been proposed as a screening tool, as clinical predictors of the presence of oropharyngeal dysphagia and an indicator of the safe way of feeding in individuals after stroke, even these not scoring the swallowing disorder. However, most studies recommend the use of clinical parameters in evaluating of swallowing, which hinder identification of specific alterations that could help to decide the way of feeding and the safe consistency. Therefore, this study aimed to determine the correlation between the NIHSS score and the presence of laryngeal penetration and tracheal aspiration in individuals after ischemic stroke, using videofluoroscopic evaluation of swallowing. Seventy-four after ischemic stroke individuals were evaluated; they had been submitted to neurological and NIHSS evaluation. They were divided into four groups according to the severity of stroke in NIHSS score, G1 (0-4 points), G2 (5-10 points), G3 (11-20 points) and G4 (≥ 20 points). Two of these individuals were excluded from the swallowing clinical assessment because they have severe neurological impairment measured by NIHSS. Seventy two subjects were submitted to swallowing clinical evaluation and videofluoroscopy of swallowing, performed on the same day, using thin pasty e liquid consistencies , observing the presence of laryngeal penetration and tracheal aspiration. The absence of a statistically significant correlation between the NIHSS score and the presence of laryngeal penetration with thin pasty (P = 0.3270) and liquid (P= 0.8138) was verified. Likewise, there was no correction between the NIHSS and the presence of tracheal aspiration with thin pastoso (P = 0.3714) and liquid (P=0.6292). The laryngeal penetration occurred in only 06 (8.33%) individuals with thin pasty, distributed in G1 (66.6%) and G2 (33.3%) of the NIHSS...