Risk factors independently associated with the maintenance of severe restriction of oral intake and alternative feeding method indication at hospital outcome in patients after acute ischemic stroke.

BACKGROUND AND AIMS: From a clinical point of view, post-stroke patients present difficulties in swallowing management. The purpose of this research was to identify risk factors that were independently related to the maintenance of a severe restriction of oral intake in patients affected by acute ischemic stroke. METHODS: The authors conducted a prospective observational cohort study of patients with dysphagia post-acute ischemic stroke who were admitted to an Emergency Room (ER). Demographic and clinical data were collected at ER admission. Swallowing data was based on The Functional Oral Intake Scale (FOIS) and was collected at two distinct moments: initial swallowing assessment and at the patient outcome. Patients were divided into two groups according to their FOIS level assigned on the last swallowing assessment (at hospital outcome): G1 with severe restriction of oral intake and indication of feeding tube - patients with FOIS levels 1 to 4; G2 without restriction of food consistencies in oral intake - patients with FOIS levels 5 to 7. RESULTS: One hundred and six patients were included in our study. Results of the multivariate logistic regression model for the prediction of maintenance of a severe restriction of oral intake at hospital outcome in patients post-acute ischemic stroke indicated that increasing age (p = 0.006), and dysarthria (p = 0.003) were associated with higher chances of presenting severe restriction of oral intake at hospital outcome. CONCLUSIONS: Patients with acute ischemic stroke in an Emergency Room may experience non-resolved severe dysphagia, indicating the need to prepare for the care/rehabilitation of these patients.

Orofacial rehabilitation after severe orofacial and neck burn: Experience in a Brazilian burn reference centre.

OBJECTIVE: To quantify the benefits of a functional oral rehabilitation program for impairment caused by full thickness orofacial and neck burns, comparing the effects of early and late intervention. METHODS: An observational cross-sectional study was conducted in a burn reference center over a two-year period. Patients with full thickness orofacial and neck burns were divided in two groups: Group 1 was composed by 14 patients who began the rehabilitation program 3-12 months after the burn injury; Group 2 was composed by 15 patients who began the rehabilitation program more than 12 months after the burn injury. Treatment was based on current strategies of non-surgical exercises for orofacial contracture management. Outcome measurements included an oral motor clinical evaluation and the assessment of the mandibular range of movement. RESULTS: The functional rehabilitation program was effective in reestablishing the oral motor functions (i.e deficits reduced to approximately 15% when compared to the optimal possible scores) and in restoring horizontal mouth opening dimensions, with more than 70% of the patients presenting measurements within the expected normal limits at the end of treatment. Our results did not indicate differences in performance between the group of patients in neither set of assessments, i.e. pre and post treatment (p > 0.05). CONCLUSION: The results of this study indicate that non-invasive orofacial contracture management is effective for patients with orofacial and neck burns, including those with long term sequelae.

Swallowing transit times and valleculae residue in stable chronic obstructive pulmonary disease.

BACKGROUND: Breathing and swallowing are physiologically linked to ensure effortless gas exchange during oronasal breathing and to prevent aspiration during swallowing. Studies have indicated consistent aspiration in chronic obstructive pulmonary disease, mainly related to delayed swallowing reflex and problems with lingual propulsion and pharyngeal peristalsis as a result of bilateral weakness and incoordination of the related muscles. The purpose of the present study was to evaluate swallowing transit times and valleculae residue characteristics of stable COPD patients who have no swallowing complaints. METHODS: Our study population included 20 stable patients with COPD and no swallowing complaints and 20 healthy controls. Swallowing was assessed through videofluoroscopic examination and involved the analysis of the following parameters: (1) pharyngeal stages of deglutition; (2) the duration of bolus movement through the oral cavity and pharynx (i.e. transit times); (3) valleculae residue ratio; (4) penetration/aspiration. RESULTS: Participants of the study did not present any signs of penetration-aspiration for any of the tested consistencies. Patients with COPD presented longer pharyngeal transit times during the ingestion of the liquid consistency and during the ingestion of the paste consistency. Regarding the duration of tongue base contact with the posterior pharyngeal wall, COPD patients also presented longer durations for the liquid and paste consistencies. No significant difference was observed for the distribution of individuals among the different valleculae residue severity levels. CONCLUSIONS: Our study suggests that stable COPD patients may present physiological adaptations as a protective swallowing maneuver to avoid aspiration/penetration of pharyngeal contents. Moreover, valleculae residue cannot be seen as an isolated factor when trying to explain swallowing alterations in this population.

Computer game-based and traditional learning method: a comparison regarding students' knowledge retention.

BACKGROUND: Educational computer games are examples of computer-assisted learning objects, representing an educational strategy of growing interest. Given the changes in the digital world over the last decades, students of the current generation expect technology to be used in advancing their learning requiring a need to change traditional passive learning methodologies to an active multisensory experimental learning methodology. The objective of this study was to compare a computer game-based learning method with a traditional learning method, regarding learning gains and knowledge retention, as means of teaching head and neck Anatomy and Physiology to Speech-Language and Hearing pathology undergraduate students. METHODS: Students were randomized to participate to one of the learning methods and the data analyst was blinded to which method of learning the students had received. Students' prior knowledge (i.e. before undergoing the learning method), short-term knowledge retention and long-term knowledge retention (i.e. six months after undergoing the learning method) were assessed with a multiple choice questionnaire. Students' performance was compared considering the three moments of assessment for both for the mean total score and for separated mean scores for Anatomy questions and for Physiology questions. RESULTS: Students that received the game-based method performed better in the pos-test assessment only when considering the Anatomy questions section. Students that received the traditional lecture performed better in both post-test and long-term post-test when considering the Anatomy and Physiology questions. CONCLUSIONS: The game-based learning method is comparable to the traditional learning method in general and in short-term gains, while the traditional lecture still seems to be more effective to improve students' short and long-term knowledge retention.

Influencia del sexo y el nivel educativo en la fluidez del habla en personas adultas / Influence of gender and educational status on fluent adults' speech fluency

El objetivo de este estudio fue comprobar la influencia del sexo y el nivel educativo en la fluidez del habla en personas adultas. La muestra final estuvo compuesta por 136 adultos brasileños de ambos sexos que hablaban portugués con fluidez, cuyas edades oscilaban entre 18 y < 60 años, distribuidos en los siguientes grupos, según su nivel educativo: educación primaria, educación secundaria y educación superior. Se analizaron sus muestras de habla considerando las variables propuestas en el perfil de la fluidez del habla, a saber: la tipología de las interrupciones (disfluencias normales y tartamudez), velocidad del habla (tanto en palabras como en sílabas por minuto) y la frecuencia de interrupciones (porcentaje de discontinuidad del habla). Teniendo en cuenta las variables analizadas, no se han encontrado diferencias estadísticamente significativas entre los sexos. Para comprobar la influencia del nivel educativo se consideró una diferencia estadísticamente significativa en la ocurrencia de las interjecciones, las revisiones y los prolongamientos. Los participantes con educación superior produjeron menos interjecciones y revisiones que los participantes con estudios de educación primaria, pero más prolongamientos que aquellos con estudios de educación secundaria. Los resultados indicaron que el sexo y el nivel educativo no pueden ser considerados como factores decisivos en la fluidez del habla en los adultos. Con todo, las conclusiones señalan que el nivel educativo influye en el uso de las estructuras semánticas, sintácticas y léxicas, así como en las estrategias utilizadas para superar estas dificultades (AU)

The aim of the study was to verify the influence of gender and educational status on fluent adults' speech fluency. The sample comprised 136 fluent adult Brazilian Portuguese speakers of both genders, whose ages ranged between 18 and < 60, distributed in the following groups, according to the educational status: elementary school, high school and higher education. A 200-fluent-syllable sample, elicited by visual stimulus was collected from each subject. The speech samples were analyzed considering the variables proposed in the Speech Fluency Profile, namely, typology of disruptions (stuttering-like disfluencies and other disfluencies), speech rate (in words / syllables per minute) and frequency of disruptions (percentage of speech discontinuity). Considering the variables analyzed, a lack of statistically significant difference between genders was found. Concerning the influence of educational status, a statistically significant difference in occurrence of interjections, revisions and prolongations was observed. Participants with higher education produced less interjections and revisions than participants with elementary school, but more prolongations than those with high school. Gender and educational status may not be regarded as decisive factors in fluent adults' speech fluency. It seems that the educational status determines the presence of difficulties in leading with semantic-lexical and syntactical structures, as well as the strategies used for overcoming these dificultéis (AU)

Speech disfluency types of fluent and stuttering individuals: age effects. IALP Student Award.

OBJECTIVE: The purpose of the present study was to quantify and compare the typology of speech disruptions presented by stuttering and fluent Brazilian Portuguese-speaking children, adolescents and adults. SUBJECTS AND METHODS: Participants were 150 individuals, with ages between 4.0 and 49.11 years, who were divided into six groups: children who stutter (n = 25), children who do not stutter (n = 25), adolescents who stutter (n = 25), adolescents who do not stutter (n = 25), adults who stutter (n = 25) and adults who do not stutter (n = 25). For each participant, the frequency of stuttering-like disfluencies (SLD) and other disfluencies was calculated based on the video recordings of spontaneous speech samples. RESULTS: The results obtained for SLD were significant when comparing stuttering and fluent individuals. In children who stutter, adolescents who stutter, and adults who stutter, a higher frequency of SLD was found. Other disfluencies did not differentiate the groups. CONCLUSION: The age factor did not qualify quantitatively any of the groups, but indicated qualitative differences (in terms of the type of speech disfluencies) between groups. The results revealed similarities when compared with studies carried out in different languages.

[Fluency shaping with surface electromyography: a pilot study]. / Modelamento da fluência com o uso da eletromiografia de superfície: estudo piloto.

BACKGROUND: the use of a technological resource in fluency promotion. AIM: to verify the effectiveness of a stuttering treatment based on the use of surface electromyography (SEMG) exclusively. METHOD: participants were four stuttering adults of both genders. Assessment, pre and post-treatment, consisted of a speech gathering session and the analyses of the rest tension and of the reaction time for speech. Treatment consisted of twelve twenty minute training sessions monitored by SEMG. RESULTS: there was a statistically significant reduction in the number of stuttering-like disfluencies (p = 0.094) and in the number of other disfluencies (p = 0.014). The other parameters, as well as differences in the electromyographic measurements, did not present significant variation. CONCLUSION: SEMG proved to be effective in the reduction of stuttering, with no need of association to other techniques.

Fluency variation in adolescents.

The Speech Fluency Profile of fluent adolescent speakers of Brazilian Portuguese, were examined with respect to gender and neurolinguistic variations. Speech samples of 130 male and female adolescents, aged between 12;0 and 17;11 years were gathered. They were analysed according to type of speech disruption; speech rate; and frequency of speech disruptions. Statistical analysis did not find significant differences between genders for the variables studied. However, regarding the phases of adolescence (early: 12;0-14;11 years; late: 15;0-17;11 years), statistical differences were observed for all of the variables. As for neurolinguistic maturation, a decrease in the number of speech disruptions and an increase in speech rate occurred during the final phase of adolescence, indicating that the maturation of the motor and linguistic processes exerted an influence over the fluency profile of speech.