A percepção da qualidade de vida do idoso disfágico após intervenção fonoaudiológica / Perceived quality of life of the dysphagic elderly after swallowing therapy intervention

Este trabalho teve o objetivo de identificar a percepção de qualidade de vida do idoso disfágico após intervenção fonoaudiológica. Trata-se de um estudo de caso longitudinal prospectivo de análise quantitativa, realizado com 4 pacientes encaminhados ao serviço ambulatorial de Fonoaudiologia de um hospital referência em saúde do idoso de Curitiba, os quais apresentavam queixa de disfagia e responderam ao protocolo SWAL-QOL antes e após programa de reabilitação. Foi calculado a média dos scores nos 11 domínios do protocolo nos dois momentos da pesquisa e analisado os resultados. Dos domínios avaliados no protocolo, 9 apresentaram aumento da média do score após terapia. Portanto, o estudo identificou mudança da percepção da qualidade de vida destes idosos, o que pode ser atribuído ao programa de reabilitação fonoaudiológica proposto aos participantes. No entanto, sugere-se mais pesquisas na área e com maior número de indivíduos. (AU)

This objective of this study was to identify in the percevedi quality of life of dysphagic elderly after swallowing therapy intervention. This is a prospective longitudinal case study of quantitative analysis, carried out whith 4 patients referred to a SpeechTherapy service in a reference hospital for elderly health in the city of Curitiba, who complained of dysphagia, and answered the SWAL-QOL protocol before and after a rehabilitation program. The mean scores were calculated in the 11 domains of the protocol in the two moments of the study, and the results were analyzed. Of the 11 domains evaluated by the protocol, 9 showed an increase in the mean score after therapy. Therefore, it was found that deglutition rehabilitation for dysphagic elderly patients may contribute to change the perception of the quality of life related to dysphagia. However, more research is needed in the area, and with a greater number of individuals. (AU)

A frequência de disfagia em idosos em um hospital da cidade de Curitiba-PR / The frequency of dysphagia in the elderly in a hospital of the city of Curitiba ­ state of Paraná

O trabalho consistiu em analisar o perfil epidemiológico dos pacientes internados em um hospital na cidade de Curitiba - PR, durante um período de seis meses e identificar a frequência de disfagia nesta população. Trata-se de uma pesquisa epidemiológica retrospectiva, descritiva a partir de análise de prontuário eletrônico. Os dados foram submetidos à análise descritiva. Sendo identificados 216 pacientes atendidos pelo serviço de fonoaudiologia da instituição, a amostra se configurou com média de idade igual a 83 anos e composta por 131 pacientes do sexo feminino e 85 do sexo masculino. A Hipertensão Arterial Sistêmica foi a doença com maior frequência nos idosos pesquisados e par a comorbidade a Desnutrição. O trabalho constatou que em relação as dificuldades de deglutição a disfagia de grau leve ocorreram com maior frequência e que há grande frequência de distúrbios de deglutição em idosos hospitalizados acometidos por doenças crônicas relacionadas ao envelhecimento. (AU)

The objective of the study was to analyze the epidemiological profile of patients admitted in a hospital in the city of Curitiba, state of Paraná, Brazil, for six months, and to identify the frequency of dysphagia among this population. It is a retrospective, descriptive epidemiological survey made with the electronic medical record analysis. Data were submitted to descriptive analysis. Among 216 patients being treated by the speech therapy service of the institution, the sample was configured with a mean age of 83 years, and consisted of 131 female patients and 85 male patients. Systemic Arterial Hypertension was the disease with the highest frequency in the elderly studied, and the comorbidity was Malnutrition. The study found that regarding swallowing difficulties, mild dysphagia occurred more frequently and there is a high frequency of swallowing disorders in hospitalized elderly patients with chronic aging-related diseases. (AU)

Speech-language pathology assessment for tracheal decannulation in patients suffering from traumatic brain injury. / Avaliação fonoaudiológica para decanulação traqueal em pacientes acometidos por traumatismo cranioencefálico.

PURPOSE: To describe the effect of Speech-Language Pathology (SLP) management on the tracheal decannulation process in patients with traumatic brain injury (TBI). METHODS: Prospective controlled clinical study. Two groups of patients with TBI confirmed by computed axial tomography were included in the study group (G1) and control group (G2) composed of 30 individuals each, with 25 (83.3%) male and 5 (16.7%) female individuals in both groups. Patients' age ranged from 18 to 53 years old - mean age was 32 years. A SPL assessment tool was developed for tracheostomized patients with TBI, composed of investigation of awareness level, cognition and swallowing (annex 1) and conduct. G1 underwent the assessment proposed by the study, and G2 was assessed by retrospective analysis of medical records without SLP evaluation. In this population, the variables time with tracheostomy and total days of hospitalization were the measurement markers for the effect of SLP conduct with this instrument. RESULTS: It was verified that G1 presented mean reduction of 4.2 days with tracheostomy and of 4.4 days in length of hospital stay when compared to G2. However, these figures are not statistically significant (p = 0.2031). CONCLUSION: The group that was evaluated and received the SLP conduct proposed in the instrument presented a reduction in the time of permanence with tracheostomy, as well as in hospital stay.

Avaliação fonoaudiológica para decanulação traqueal em pacientes acometidos por traumatismo cranioencefálico / Speech-language pathology assessment for tracheal decannulation in patients suffering from traumatic brain injury

RESUMO Objetivo Descrever o efeito da conduta fonoaudiológica no processo de decanulação traqueal em indivíduos com traumatismo cranioencefálico (TCE). Método Estudo clínico transversal prospectivo controlado. Participaram deste estudo dois grupos de indivíduos com TCE confirmado por tomografia axial computadorizada, sendo o grupo de estudo (G1) e o grupo controle (G2) compostos por 30 indivíduos cada, com 25 (83,3%) indivíduos do gênero masculino e 5 (16,7%) do gênero feminino em cada grupo. A faixa etária variou de 18 a 53 anos, com média de 32 anos. Foi elaborado um instrumento de avaliação fonoaudiológica para indivíduos com TCE traqueostomizados composto por investigação do nível de consciência, cognição e deglutição (anexo 1) e conduta. O G1 recebeu a avaliação proposta pelo estudo e o G2, análise retrospectiva de prontuário sem avaliação fonoaudiológica. As variáveis, tempo de permanência com a traqueostomia e total de dias de internamento foram os marcadores de mensuração do efeito da conduta fonoaudiológica com esse instrumento nessa população. Resultados Verificou-se que o G1 obteve uma redução média de 4,2 dias de permanência com a traqueostomia e de 4,4 dias no tempo de internamento hospitalar quando comparado com G2, porém sem significância estatística (p = 0,2031). Conclusão O grupo que foi avaliado e recebeu a conduta fonoaudiológica proposta no instrumento obteve diminuição do tempo de permanência com a traqueostomia bem como redução do tempo de internamento hospitalar.

ABSTRACT Purpose To describe the effect of Speech-Language Pathology (SLP) management on the tracheal decannulation process in patients with traumatic brain injury (TBI). Methods Prospective controlled clinical study. Two groups of patients with TBI confirmed by computed axial tomography were included in the study group (G1) and control group (G2) composed of 30 individuals each, with 25 (83.3%) male and 5 (16.7%) female individuals in both groups. Patients’ age ranged from 18 to 53 years old – mean age was 32 years. A SPL assessment tool was developed for tracheostomized patients with TBI, composed of investigation of awareness level, cognition and swallowing (annex 1) and conduct. G1 underwent the assessment proposed by the study, and G2 was assessed by retrospective analysis of medical records without SLP evaluation. In this population, the variables time with tracheostomy and total days of hospitalization were the measurement markers for the effect of SLP conduct with this instrument. Results It was verified that G1 presented mean reduction of 4.2 days with tracheostomy and of 4.4 days in length of hospital stay when compared to G2. However, these figures are not statistically significant (p = 0.2031). Conclusion The group that was evaluated and received the SLP conduct proposed in the instrument presented a reduction in the time of permanence with tracheostomy, as well as in hospital stay.

Tracheal Decannulation Protocol in Patients Affected by Traumatic Brain Injury

Introduction: The frequency of tracheostomy in patients with traumatic brain injury (TBI) contrasts with the lack of objective criteria for its management. The study arose from the need for a protocol in the decision to remove the tracheal tube. Objective: To evaluate the applicability of a protocol for tracheal decannulation. Methods: A prospective study with 20 patients, ranging between 21 and 85 years of age (average 33.55), 4 of whom were women (20%) and 16 were men (80%). All patients had been diagnosed by a neurologist as having TBI, and the anatomical region of the lesion was known. Patients were evaluated following criteria for tracheal decannulation through a clinical evaluation protocol developed by the authors. Results: Decannulation was performed in 12 (60%) patients. Fourteen (70%) had a score greater than 8 on the Glasgow Coma Scale and only 2 (14%) of these were not able to undergo decannulation. Twelve (60%) patients maintained the breathing pattern with occlusion of the tube and were successfully decannulated. Of the 20 patients evaluated, 11 (55%) showed no signs suggestive of tracheal aspiration, and of these, 9 (82%) began training on occlusion of the cannula. The protocol was relevant to establish the beginning of the decannulation process. The clinical assessment should focus on the patient's condition to achieve early tracheal decannulation. Conclusion: This study allowed, with the protocol, to establish six criteria for tracheal decannulation: level of consciousness, respiration, tracheal secretion, phonation, swallowing, and coughing...

Tracheal decannulation protocol in patients affected by traumatic brain injury.

Introduction The frequency of tracheostomy in patients with traumatic brain injury (TBI) contrasts with the lack of objective criteria for its management. The study arose from the need for a protocol in the decision to remove the tracheal tube. Objective To evaluate the applicability of a protocol for tracheal decannulation. Methods A prospective study with 20 patients, ranging between 21 and 85 years of age (average 33.55), 4 of whom were women (20%) and 16 were men (80%). All patients had been diagnosed by a neurologist as having TBI, and the anatomical region of the lesion was known. Patients were evaluated following criteria for tracheal decannulation through a clinical evaluation protocol developed by the authors. Results Decannulation was performed in 12 (60%) patients. Fourteen (70%) had a score greater than 8 on the Glasgow Coma Scale and only 2 (14%) of these were not able to undergo decannulation. Twelve (60%) patients maintained the breathing pattern with occlusion of the tube and were successfully decannulated. Of the 20 patients evaluated, 11 (55%) showed no signs suggestive of tracheal aspiration, and of these, 9 (82%) began training on occlusion of the cannula. The protocol was relevant to establish the beginning of the decannulation process. The clinical assessment should focus on the patient's condition to achieve early tracheal decannulation. Conclusion This study allowed, with the protocol, to establish six criteria for tracheal decannulation: level of consciousness, respiration, tracheal secretion, phonation, swallowing, and coughing.