Tube feeding predictors after ischemic hemispheric stroke during hospitalization.

PURPOSE: To verify the factors associated with the need of tube feeding (TF) during patients post-ischemic stroke hospitalization. METHOD: This is a retrospective study with 70 adult post-ischemic hemispheric stroke adult patients hospitalized in the Neurology department at a tertiary public hospital in Santa Catarina, Brazil. We investigated associations between the need of a feeding tube during hospitalization and the variables age, gender, admission and discharge NIHSS and FOIS, length of hospital stay in days, presence of thrombolytic therapy, extensive stroke, hemisphere affected, prior stroke, pneumonia during hospitalization, presence of signs of laryngeal penetration and laryngotracheal aspiration and dysphagia in the first and last swallowing clinical evaluation. RESULTS: A total of 33 participants used tube feeding. There was a significant relationship among tube feeding and the following parameters: NIHSS (p value .001), FOIS (p value .001), extensive stroke (p value .034), left hemisphere involvement (p value .035), pneumonia during hospitalization (p value .001), length of hospital stay in days (p value .001), signs of laryngotracheal penetration/aspiration (p value .001) and dysphagia in speech-language assessment (p value .001). CONCLUSION: Tube feeding during patients hospitalization after ischemic hemispheric stroke was predicted by the severity of stroke and signs of airway permeation.Key pointsSwallowing difficulty is one of the most common post-stroke consequences.There are few studies on the characterization of post-stroke patients with tube feeding.Tube feeding after ischemic stroke predictors were severity of stroke and signs of airway permeation.

Translation and transcultural adaptation of the Modified Swallowing Assessment (MSA) to Brazilian Portuguese. / Tradução e adaptação transcultural do Modified Swallowing Assessment (MSA) para o português brasileiro.

PURPOSE: To translate and adapt the Modified Swallowing Assessment (MSA) protocol for post-stroke patients into Brazilian Portuguese. METHODS: This is an initial stage of the Brazilian Portuguese Modified Swallowing Assessment validation process. Translation was performed by two bilingual speech therapists and the translations synthesis evaluations by two external dysphagia experts. The synthesis version in the target language (Portuguese) was back-translated into the source language (English). After the synthesis of the translated versions, the instrument was applied to 22 post-stroke individuals. RESULTS: Health professionals discussed all the results of the study stages considering the instrument concept and the target population. The semantic, linguistic and conceptual equivalences found in the translation and adaptation process were adequate, not requiring modifications since the items were consistent with the Brazilian culture. CONCLUSION: MSA was translated and adapted to Brazilian Portuguese (MSA-BR). The translation and cross-cultural adaptation process included all the items of the original protocol and maintained the standards and characteristics of the instrument.

OBJETIVO: Traduzir e adaptar para o português brasileiro o protocolo Modified Swallowing Assessment (MSA) para pacientes pós-acidente vascular cerebral. MÉTODO: Trata-se de uma etapa inicial do processo de validação do Modified Swallowing Assessment para o português brasileiro. Foi realizada a tradução por dois fonoaudiólogos bilíngues e a síntese das traduções por dois avaliadores externos, especialistas em disfagia. A versão síntese no idioma alvo (português) foi retrotraduzida para o idioma fonte (inglês). Após a síntese das versões traduzidas, o instrumento foi aplicado em 22 indivíduos com acidente vascular cerebral. RESULTADOS: Os avaliadores debateram sobre todos os resultados das etapas do estudo considerando o conceito do teste e o público alvo. As discrepâncias semânticas, linguísticas e conceituais encontradas no processo de tradução e adaptação foram adequadas, para que os itens fossem compatíveis com a cultura brasileira. CONCLUSÃO: O MSA foi traduzido e adaptado para o português brasileiro (MSA-BR). O processo de tradução e adaptação transcultural manteve todos os itens do protocolo original, preservando-se os padrões e as características do instrumento original.

Tradução e adaptação transcultural do Modified Swallowing Assessment (MSA) para o português brasileiro / Translation and transcultural adaptation of the Modified Swallowing Assessment (MSA) to Brazilian Portuguese

RESUMO Objetivo Traduzir e adaptar para o português brasileiro o protocolo Modified Swallowing Assessment (MSA) para pacientes pós-acidente vascular cerebral. Método Trata-se de uma etapa inicial do processo de validação do Modified Swallowing Assessment para o português brasileiro. Foi realizada a tradução por dois fonoaudiólogos bilíngues e a síntese das traduções por dois avaliadores externos, especialistas em disfagia. A versão síntese no idioma alvo (português) foi retrotraduzida para o idioma fonte (inglês). Após a síntese das versões traduzidas, o instrumento foi aplicado em 22 indivíduos com acidente vascular cerebral. Resultados Os avaliadores debateram sobre todos os resultados das etapas do estudo considerando o conceito do teste e o público alvo. As discrepâncias semânticas, linguísticas e conceituais encontradas no processo de tradução e adaptação foram adequadas, para que os itens fossem compatíveis com a cultura brasileira. Conclusão O MSA foi traduzido e adaptado para o português brasileiro (MSA-BR). O processo de tradução e adaptação transcultural manteve todos os itens do protocolo original, preservando-se os padrões e as características do instrumento original.

ABSTRACT Purpose To translate and adapt the Modified Swallowing Assessment (MSA) protocol for post-stroke patients into Brazilian Portuguese. Methods This is an initial stage of the Brazilian Portuguese Modified Swallowing Assessment validation process. Translation was performed by two bilingual speech therapists and the translations synthesis evaluations by two external dysphagia experts. The synthesis version in the target language (Portuguese) was back-translated into the source language (English). After the synthesis of the translated versions, the instrument was applied to 22 post-stroke individuals. Results Health professionals discussed all the results of the study stages considering the instrument concept and the target population. The semantic, linguistic and conceptual equivalences found in the translation and adaptation process were adequate, not requiring modifications since the items were consistent with the Brazilian culture. Conclusion MSA was translated and adapted to Brazilian Portuguese (MSA-BR). The translation and cross-cultural adaptation process included all the items of the original protocol and maintained the standards and characteristics of the instrument.

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.

Introdução e desenvolvimento do uso da comunicação alternativa na Síndrome de Angelman: estudo de caso / Introduction and developing alternative communication in Syndrome of Angelman: case study

TEMA: Síndrome de Angelman (SA) e comunicação alternativa. PROCEDIMENTOS: com o objetivo de descrever o processo de introdução e desenvolvimento do uso do Sistema Alternativo de Comunicação (SAC) na SA. Foi utilizado um estudo de caso, realizado na Clínica de Fonoaudiologia da Faculdade Estácio de Sá de Santa Catarina. E., diagnosticada com SA, 17 anos, sem linguagem oral. A coleta de dados foi realizada com 8 trechos de terapias filmadas durante o primeiro semestre de 2007 e anotações no diário de campo. RESULTADOS: o programa de comunicação escolhido foi o Picture Communication Symbols System (PCS). Para seleção dos símbolos, foi utilizado centros de interesse da paciente. O processo de inserção de símbolos aconteceu de maneira lenta e gradativa. A terapeuta realizava a apresentação do objeto concreto, em seguida, correlacionava o símbolo com o objeto. Os dois eram postos em cima da mesa, correlacionandoos várias vezes. Para introdução da paciente ao uso do sistema a terapeuta pegava a mão da paciente e colocava sobre o símbolo e simultaneamente entregava o objeto. Com o passar das sessões foram introduzidos novos símbolos. E. mostrou-se "perdida" negando categorias apresentadas, direcionando sua escolha para os símbolos que já lhe eram familiar. Dos 15 símbolos trabalhados, adquiriu funcionalidade para 5 símbolos. CONCLUSÃO: o SAC torna-se um meio viável de comunicação para SA. O processo de introdução e desenvolvimento de uso de SAC foi composto pela: apresentação, correlação e introdução da paciente ao uso do sistema. Salienta-se que é um trabalho lento que exige participação da família.

BACKGROUND: Syndrome of Angelman (SA) and alternative communication. PURPOSE: with the objective to describe the process for introducing and developing the use of an Alternative Communication System(SAC) in the SA, we used a case study, carried through in the Clinic of Speech Therapy of Faculdade Estácio de Sá of Santa Catarina. E., diagnosed with SA, 17year old, without verbal language. Collection of data carried through with 8 stretches of therapies recorded during the first half of 2007 and notations in the field daily record. RESULTS: the program of communication chosen was the Picture Communication Symbols System (PCS). For electing the symbols, we used interest centers of the patient. The process for inserting symbols happened in a slow and gradual manner. The therapist carried through the presentation of the concrete object, after that, she correlated the symbol with the object. Both were placed on top of the table correlating them several times. For introducing the patient to the use of the system, the therapist took the hand of the patient and placed it on the symbol and simultaneously delivered the object. With the passing of the sessions, new symbols were introduced. E. revealed being "lost" denying the presented categories, directing its choice for the symbols that already were familiar. Of the 15 worked symbols, 5 symbols acquired functionality. CONCLUSION: SAC becomes a feasible communication mode for SA. The process of introducing and developing SAC use was made up by: presentation, correlation and introduction of the patient to the use of the system. We stress out that this is a slow work that demands participation of the family.