Aspiration Pneumonia in Children with Cerebral Palsy after Videofluoroscopic Swallowing Study

Abstract Introduction Dysphagia is a common symptom in children with cerebral palsy, either in oral or pharyngeal phases. Children who face such difficulties tend to show health problems such as food aspiration, malnutrition and respiratory infections. Videofluoroscopic swallowing study is the most recommended for these cases, as it reveals the real situation during swallowing. Objective The study aimed to verify the occurrence of aspiration pneumonia in children with cerebral palsy after videofluoroscopy. Methods The population for this prospective cross-sectional study involved 103 children with cerebral palsy, referred for videofluoroscopic who had returned for medical examination after a week to search for signs and symptoms of pneumonia. Results The study involved 46 girls (44.66%) and 57 boys (55.34%), aged between 0 and 14 years of age. Of the total, 84 (81.5%) had dysphagia, of which 24 (23.3%) were severe, 8 (7.7%) were moderate and 52 (50.4%) were mild dysphagia. None of the children presented aspiration pneumonia or infectious complications during the course of videofluoroscopy or after the procedure. Conclusion In the population studied, the authors found no cases of aspiration pneumonia, even with tracheal aspiration present in 32 (31.07%) cases.

Aspiration Pneumonia in Children with Cerebral Palsy after Videofluoroscopic Swallowing Study.

Introduction Dysphagia is a common symptom in children with cerebral palsy, either in oral or pharyngeal phases. Children who face such difficulties tend to show health problems such as food aspiration, malnutrition and respiratory infections. Videofluoroscopic swallowing study is the most recommended for these cases, as it reveals the real situation during swallowing. Objective The study aimed to verify the occurrence of aspiration pneumonia in children with cerebral palsy after videofluoroscopy. Methods The population for this prospective cross-sectional study involved 103 children with cerebral palsy, referred for videofluoroscopic who had returned for medical examination after a week to search for signs and symptoms of pneumonia. Results The study involved 46 girls (44.66%) and 57 boys (55.34%), aged between 0 and 14 years of age. Of the total, 84 (81.5%) had dysphagia, of which 24 (23.3%) were severe, 8 (7.7%) were moderate and 52 (50.4%) were mild dysphagia. None of the children presented aspiration pneumonia or infectious complications during the course of videofluoroscopy or after the procedure. Conclusion In the population studied, the authors found no cases of aspiration pneumonia, even with tracheal aspiration present in 32 (31.07%) cases.

Ataxia espinocerebelar tipo 6: relato de caso / Spinocerebellar ataxia type 6: a case report

O objetivo deste estudo foi verificar as alterações vestibulococleares observadas em um caso de ataxia espinocerebelar tipo 6. O caso foi encaminhado do Hospital de Clínicas para o Laboratório de Otoneurologia de uma Instituição de Ensino e foi submetido aos seguintes procedimentos: anamnese, inspeção otológica, avaliações audiológica e vestibular. O caso retrata uma paciente com diagnóstico genético de ataxia espinocerebelar tipo 6, do sexo feminino, com 57 anos de idade, que referiu desequilíbrio à marcha com tendência a queda para a esquerda, disartria e disfonia. Na avaliação audiológica apresentou configuração audiométrica descendente a partir da frequência de 4kHz e curva timpanométrica do tipo "A" com presença dos reflexos estapedianos bilateralmente. No exame vestibular observou-se na pesquisa da vertigem posicional presença de nistagmo vertical inferior e oblíquo, espontâneo e semiespontâneo múltiplo com características centrais (ausência de latência, paroxismo, fatigabilidade e vertigem), nistagmooptocinético abolido e hiporreflexia à prova calórica. Constataram-se alterações labirínticas que indicaram afecção do sistema vestibular central evidenciando-se a importância dessa avaliação. A existência da possível relação entre os achados com os sintomas vestibulares apresentados pela paciente apontou a relevância do exame labiríntico neste tipo de ataxia uma vez que a presença do nistagmo vertical inferior demonstrou ser frequente neste tipo de patologia.

The aim of this study was to investigate the vestibulocochlear alterations observed in a case of spinocerebellar ataxia type 6. The case was referred from the Hospital das Clinicas to the Otoneurology Laboratory of an educational institution and was subjected to the following procedures: anamnesis, otologic examination, as well as audiological and vestibular assessments. The case shows a 57-year-old female patient with a genetic diagnosis of spinocerebellar ataxia type 6 who presented unsteadiness of gait with tendency to fall to the left, dysarthria, and dysphonia. The audiological assessment presented sloping audiometric configuration from 4.0 kHz and tympanogram type “A” with the presence of acoustic reflexes bilaterally. Observed during the survey of positional vertigo in the vestibular assessment were the presence of oblique and vertical downbeat nystagmus, spontaneous and semispontaneous with multiple core features (absence of latency, paroxysm, fatigue and vertigo), abolished optokineticnystagmus and hyporeflexia in the caloric test. We found labyrinthic alterations that indicate central vestibular system disorders and lend credence to the importance of this evaluation. The existence of a possible relationship between the findings and vestibular symptoms displayed by the patient indicated the relevance of the labyrinthine evaluation for this type of ataxia once the presence of vertical downbeat nystagmus proved to be frequent in this type of pathology.

The evaluation of swallowing in patients with spinocerebellar ataxia and oropharyngeal dysphagia: A comparison study of videofluoroscopic and sonar doppler

Introduction: Spinocerebellar ataxia (SCA) is a degenerative disease that can cause loss of coordination of voluntary muscle movement such as that required for swallowing. Aims: The purposes of this cross-sectional and comparative case study were: (1) to assess the severity of dysphagia through a videofluoroscopic swallow study, and (2) to compare differences in frequency, intensity, and duration of sound waves produced during swallowing in normal and SCA patients by using sonar Doppler. Method: During swallow evaluation using videofluoroscopy, a sonar Doppler transducer was placed on the right side of the neck, at the lateral edge of the trachea, just below the cricoid cartilage to capture the sounds of swallowing in 30 SCA patients and 30 controls. Result: The prevalence in the dynamic evaluation of swallowing videofluoroscopy was by changes in the oral phase of swallowing. The analysis of variance of the averages found in each variable - frequency, intensity and duration of swallowing - shows there was a significant correlation when compared to the healthy individual curve. Conclusion: The study demonstrates the prevalence of oral dysphagia observed in dynamic videofluoroscopic swallow evaluation. In patients with SCA, the mean initial frequency (IF), initial intensity (II), and final intensity (FI) were higher and the time (T) and peak frequency (PF) were lower, demonstrating a pattern of cricopharyngeal opening very close to that found in normal populations...

Characterization of swallowing sounds with the use of sonar Doppler in full-term and preterm newborns.

Introduction Technological advances have provided a large variety of instruments to view the swallowing event, aiding in the evaluation, diagnosis, and monitoring of disturbances. These advances include electromyography of the surface, dynamic video fluoroscopy, and most recently sonar Doppler. Objective To characterize swallowing sounds in typical children through the use of sonar Doppler. Method Thirty newborns participated in this prospective study. All newborns received breast milk through either their mother's breasts or bottles during data collection. The newborns were placed in either right lateral or left lateral positions when given breast milk through their mother's breasts and in a sitting position when given a bottle. There were five variables measured: initial frequency of sound wave (FoI), frequency of the first peak of the sound wave (FoP1), frequency of the second peak of the sound wave (FoP2), initial intensity and final sound wave (II and IF), and swallowing length (T), the time elapsed from the beginning until the end of the analyzed acoustic signal measured by the audio signal, in seconds. Results The values obtained in the initial frequency of the babies had a mean of 850 Hz. In terms of frequency of first peak, only three presented with a subtle peak, which was due to the elevated larynx position. Conclusion The use of sonar Doppler as a complementary exam for clinical evaluations is of upmost importance because it is nonintrusive and painless, and it is not necessary to place patients in a special room or expose them to radiation.

The evaluation of swallowing in patients with spinocerebellar ataxia and oropharyngeal dysphagia: A comparison study of videofluoroscopic and sonar doppler.

INTRODUCTION: Spinocerebellar ataxia (SCA) is a degenerative disease that can cause loss of coordination of voluntary muscle movement such as that required for swallowing. AIMS: The purposes of this cross-sectional and comparative case study were: (1) to assess the severity of dysphagia through a videofluoroscopic swallow study, and (2) to compare differences in frequency, intensity, and duration of sound waves produced during swallowing in normal and SCA patients by using sonar Doppler. METHOD: During swallow evaluation using videofluoroscopy, a sonar Doppler transducer was placed on the right side of the neck, at the lateral edge of the trachea, just below the cricoid cartilage to capture the sounds of swallowing in 30 SCA patients and 30 controls. RESULT: The prevalence in the dynamic evaluation of swallowing videofluoroscopy was by changes in the oral phase of swallowing. The analysis of variance of the averages found in each variable - frequency, intensity and duration of swallowing - shows there was a significant correlation when compared to the healthy individual curve. CONCLUSION: The study demonstrates the prevalence of oral dysphagia observed in dynamic videofluoroscopic swallow evaluation. In patients with SCA, the mean initial frequency (IF), initial intensity (II), and final intensity (FI) were higher and the time (T) and peak frequency (PF) were lower, demonstrating a pattern of cricopharyngeal opening very close to that found in normal populations.

Vestibular findings in autosomal recessive ataxia.

OBJECTIVE: This study aims to examine vestibular disorders in patients with recessive spinocerebellar ataxia. DESIGN: A retrospective cross-sectional study was conducted. The patients underwent the following procedures: case history, ENT and vestibular evaluations. STUDY SAMPLE: The tests were performed in 19 patients ranging from 6 to 63 years of age (mean age of 36.7). RESULTS: Clinically, the patients commonly had symptoms of dizziness (57.8%), lack of coordination of movement with imbalance when walking (52.6%), and headaches (42.1%). In vestibular testing, alterations were predominantly evident under caloric testing (73.5%), rotational chair testing, and testing for gaze and optokinetic nystagmus (36.8%). The presence of alterations occurred under examination in 89.5% of these patients, 100% occurred in subjects with Friedreich's ataxia and 84.6% for subjects with indeterminate recessive spinocerebellar ataxia, with the majority occurring in those with central vestibular dysfunction, 57.9% of the examinations. CONCLUSION: The most evident neurotological symptoms were dizziness, lack of coordination of movement, and imbalance when walking. Alterations in vestibular examinations occurred in 89.5% of patients, mostly in the caloric test, with a predominance of deficient central vestibular system dysfunction. This underscores the importance of the contribution of topodiagnostic labyrinthine evaluations for neurodegenerative diseases.

Characterization of Swallowing Sounds with the Use of Sonar Doppler in Full-Term and Preterm Newborns

Technological advances have provided a large variety of instruments to view the swallowing event, aiding in the evaluation, diagnosis, and monitoring of disturbances. These advances include electromyography of the surface, dynamic video fluoroscopy, and most recently sonar Doppler. Objective  To characterize swallowing sounds in typical children through the use of sonar Doppler. Method: Thirty newborns participated in this prospective study. All newborns received breast milk through either their mother's breasts or bottles during data collection. The newborns were placed in either right lateral or left lateral positions when given breast milk through their mother's breasts and in a sitting position when given a bottle. There were five variables measured: initial frequency of sound wave (FoI), frequency of the first peak of the sound wave (FoP1), frequency of the second peak of the sound wave (FoP2), initial intensity and final sound wave (II and IF), and swallowing length (T), the time elapsed from the beginning until the end of the analyzed acoustic signal measured by the audio signal, in seconds. Results: The values obtained in the initial frequency of the babies had a mean of 850 Hz. In terms of frequency of first peak, only three presented with a subtle peak, which was due to the elevated larynx position. Conclusion: The use of sonar Doppler as a complementary exam for clinical evaluations is of upmost importance because it is nonintrusive and painless, and it is not necessary to place patients in a special room or expose them to radiation...

Evolução de pacientes com disfagia orofaríngea em ambiente hospitalar / Evolution of patients with oropharyngeal dysphasia in hospital environment

Introdução: A disfagia orofaríngea de etiologia neurogênica pode causar risco clínico nutricional e comprometimento laringo traqueal por aspiração, podendo culminar em broncopneumonia aspirativa. Esta condição está presente na rotina das avaliações do fonoaudiólogo que atua em ambiente hospitalar junto a pacientes pós acidente vascular encefálico (AVE). Objetivo: O objetivo deste estudo foi avaliar a evolução de pacientes portadores de disfagia orofaríngea neurogênica pós AVE, durante o período de internação até o momento da alta hospitalar, analisando grau da disfagia no pré-tratamento; diagnóstico instrumental; condutas fonoaudiológicas; condições do paciente na alta hospitalar. Método: Foram estudados 39 pacientes no período de dezembro de 2003 a junho de 2004, com queixa de dificuldade de deglutição sugestiva de disfagia. Foi elaborado um protocolo padronizado para a coleta dos dados clínicos. Conclusão: Os resultados permitiram concluir que: houve prevalência da disfagia de grau moderado, seguida pelos graus leve e severo; no diagnóstico instrumental ocorreu à prevalência de aspiração laríngea, seguida de alteração na fase orofaríngea, penetração laríngea, alteração na fase oral da deglutição; nas condutas fonoaudiológicas a manipulação de alimentos apresentou excelente resultado seguida das manobras posturais e das manobras protetivas; na alta hospitalar a prevalência foi de sujeitos que apresentaram estado clínico de nível bom, alimentando-se por via oral, com algumas modificações posturais e/ou da consistência alimentar sem o uso de sonda, seguido pelos que apresentaram nível regular, iniciando com dieta via oral fazendo uso de sonda, mas com possibilidade de retirada entre 30 a 60 dias do período hospitalar.

Introduction: Neurogenic etiology oropharyngeal dysphagia may lead to clinical malnutrition, laryngotracheal damage, and result in aspirative bronchopneumonia. This condition is present in the evaluations routine of the phonoaudiologist who works in hospitals with post CVA (cerebral vascular accident) patients. Objective: The objective of this study is to evaluate the evolution of neurogenic oropharyngeal dysphagia patients after CVA, during interment period until hospital discharge, and to analyze the dysphagia degree before treatment; diagnostic tools; phonoaudiologic routines; state o the patients upon discharge. Method: Thirty-nine (39) patients were studied from December 2003 through June 2004 complaining of deglutition disorder, that indicates dysphagia. A standardized protocol was prepared for collection of clinical data. Conclusion: The results allowed to conclude that there was moderate degree dysphagia, followed of light and severe degrees; in the instrumental diagnosis there was a prevalence of laryngeal aspiration, followed of a change in the oropharyngeal phase, laryngeal penetration, change in the deglutition oral phase; in the phonoaudiological procedures, the food manipulation presented excellent results followed of postural and protective maneuvers; upon hospital discharge there was a prevalence of individuals who had a good level clinical state and were eating orally with some postural and/or food consistency modifications without the use of probe, followed by those who presented a regular level beginning the oral diet with the use of probe, but able to be discharged between 30 to 60 days after the hospital period.