Avaliação foniatrica de crianças com disturbios globais do desenvolvimento e com compromentimento do tronco cerebral

Orientador : Raul Renato Guedes de MeloTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: A pesquisa tem por objetivos estudar as características foniátricas das crianças com distúrbios globais do desenvolvimento, que apresentam potenciais auditivos evocados do tronco cerebral desorganizados, e formular modelos teóricos neuropsicológicos explicativos. Para tanto, foram estudados dois grupos de crianças, A e B, com 32 e 35 crianças respectivamente, genericamente classificadas como portadoras de distúrbios globais do desenvolvimento (DSM-III-R).Os grupos guardaram distribuição homogênea nos sub-tipos da classificação e foram pareados quanto à idade, sexo e fatores causais. Os grupos foram diferenciados pelas respostas apresentadas no estudo dos potenciais auditivos evocados do tronco cerebral (PEA-TC, BERA). O grupo A mostrou desorganização no padrão de respostas, por tanto com distúrbio da arquitetura troncular, enquanto o grupo B esteve normal. Os estudos foniátricos, como o da modulação senso-perceptiva, do desenvolvimento psicomotor, da cognição e da linguagem, mostraram rendimento significativamente pior no grupo A. O estudo permite concluir que, para a população do grupo A, a desorganização da arquitetura troncular é, também, responsável pelo quadro clínico. As crianças apresentam sintomas que indicam distúrbios nas funções do primeiro organizador cerebral de Luria. E, conseqüentemente, desestruturação do sistema funcional formado pelos organizadores cerebraisAbstract: The research studies the developmental characteristies of children with Pervasive Disturb Development and desorganization in the evocated potential auditive of the brain stream. Two groups of children, A and B, were studied, with 32 and 35 children respectively. They had general charactheristics that permitted classify them as bearer of Pervasive Disturb Development (by DSH-III-R), and carry equal distribution on its sub-typer. The groups were distributed in pairs concerning age, sex, causal factors and social behaviors. The groups were differenciated by the answers showed in the auditive potencial studies, evocated from the brain stream (PEA-TC BERA). Group A, showed desorganization on the stream answers, and groups B showed normal answers.The clinical studies, like senso-perceptive modulaticn, psyco-motor developmental, cognitive and language tests showed significative worse average in the group A. The study concludes that, for this populatioti, the strearn disturb detected by BERA desorganization, is related with the clinical aspects.The childrens show disturb in the first cerebral organizator of Luria, and its correlativesDoutoradoMedicina InternaDoutor em Ciências Médica

[characteristics Of The Communication In Individuals With Fragile X Syndrome].

The aim of this study was to make a characterization of the communication in a group with fragile X syndrome (FXS), based on normal development scale. The sample has 10 boys, between 6 and 13 years and with FXS. All of them were submitted to language evaluation. The most part of them had the communication in linguistic form (80%), until 3 years old. It was considered that the data confirmed the significant delay in the acquisition and development of the communication, being necessary an early and specialized intervention.60981-

Characteristics of the communication in individuals with fragile X syndrome

The aim of this study was to make a characterization of the communication in a group with fragile X syndrome (FXS), based on normal development scale. The sample has 10 boys, between 6 and 13 years and with FXS. All of them were submitted to language evaluation. The most part of them had the communication in linguistic form (80%), until 3 years old. It was considered that the data confirmed the significant delay in the acquisition and development of the communication, being necessary an early and specialized intervention.O objetivo deste estudo foi, a partir da avaliação de linguagem de um grupo de 10 meninos com idades variando entre 6 e 13 anos e com a síndrome do cromossomo X frágil (SXF), caracterizar o nível de comunicação desses indivíduos a partir de escalas de desenvolvimento normal. Constatou-se que dentro desta amostra, os indivíduos apresentaram predominantemente forma de comunicação linguística (80%), atingindo o nível máximo de até 3 anos de idade. Concluiu-se que os dados obtidos confirmam o significativo atraso na aquisição e desenvolvimento da comunicação, necessitando, portanto, de intervenção precoce e especializada.98198

[the Functional Evaluation Of Dysphagia In The Neonatal Intensive Care Unit].

The objectives of this study were: 1) to detect clinical criteria on the evaluation of dysphagy in preterm newborns; 2) to analyze the association between the functional and the videoendoscopy findings and 3) to show the relevance of the joint work of the Speech Therapist and the Otolaryngologist criteria on the evaluation of dysphagy in preterm syndromic and pathologic newborns. The sample comprised fifteen infants born in Maternity Campinas Hospital, Campinas-SP, to whom was requested a Speech Therapist evaluation by the Neonatologist. All the infants were evaluated once by the same Speech Therapist and the Otolaryngologist. The functional evaluation of swallowing considered: a) the extra oral tactile sensibility, b) the intra oral tactile sensibility, c) the nauseous reflex and d) the buccinator movement. The evaluation of the videoendoscopy swallowing analyzed a) the sensibility in the arytenoid cartilage, b) the crying, c) the aspiration, d) desaturation and e) the penetration. The exact test of Fisher was applied for small samples and each hypothesis was tested with significance level of 0.05. At the end of the study, a statistically dependence relation between the variants was noticed: 1) aspiration after pharyngeal phase and penetration (high and low) and 2) extra oral sensibility on the cheeks and the sensibility on the arytenoid cartilage. This last result shows the association between a functional finding obtained by the Speech Therapist and a videoendoscopy finding achieved by the Otolaryngologist, that shows clearly the relevance of the team work among these two health professionals.49278-8

Interdisciplinary evaluation of dysphagia: clinical swallowing evaluation and videoendoscopy of swallowing

Patients with dysphagia have impairments in many aspects, and an interdisciplinary approach is fundamental to define diagnosis and treatment. A joint approach in the clinical and videoendoscopy evaluation is paramount. AIM: To study the correlation between the clinical assessment (ACD) and the videoendoscopic (VED) assessment of swallowing by classifying the degree of severity and the qualitative/descriptive analyses of the procedures. STUDY DESIGN: cross-sectional, descriptive and comparative. MATERIALS AND METHODS: held from March to December of 2006, at the Otolaryngology/Dysphagia ward of a hospital in the country side of São Paulo. 30 dysphagic patients with different disorders were assessed by ACD and VED. The data was classified by means of severity scales and qualitative/ descriptive analysis. RESULTS: the correlation between severity ACD and VED scales pointed to a statistically significant low agreement (KAPA = 0.4) (p=0,006). The correlation between the qualitative/descriptive analysis pointed to an excellent and statistically significant agreement (KAPA=0.962) (p<0.001) concerning the entire sample. CONCLUSION: the low agreement between the severity scales point to a need to perform both procedures, reinforcing VED as a doable procedure. The descriptive qualitative analysis pointed to an excellent agreement, and such data reinforces our need to understand swallowing as a process.Opaciente disfágico apresenta prejuízos em diversos aspectos, sendo a atuação interdisciplinar fundamental para definição do diagnóstico e da conduta. A atuação em conjunto na avaliação clínica e videoendoscópica é de extrema importância. OBJETIVO: Estudar a correlação entre a avaliação clínica (ACD) e videoendoscópica da deglutição (VED) por meio da classificação do grau de severidade e a análise qualitativo/descritiva dos procedimentos. FORMA DE ESTUDO: Estudo transversal, descritivo, comparativo. MATERIAL E MÉTODO: Realizado no março a dezembro de 2006 no ambulatório de Otorrinolaringologia/Disfagia de um hospital do interior de São Paulo. Foram avaliados pela ACD e VED 30 pacientes disfágicos com diferentes doenças. Os dados foram classificados por meio de escalas de severidade e análise qualitativa/descritiva. RESULTADOS: A correlação entre as escalas de severidade de ACD e VED apontou concordância baixa (KAPA = 0,4) de modo estatisticamente significante (p=0,006). A correlação entre a análise qualitativa/descritiva apontou concordância excelente (KAPA=0.962) estatisticamente significante (p<0.001) para a amostra total. CONCLUSÃO: A concordância baixa entre as escalas de severidade aponta a necessidade da realização de ambos os procedimentos, reforçando a VED como procedimento factível. A análise qualitativa descritiva apontou concordância excelente, dado que reforça a necessidade da compreensão da deglutição como um processo.77678

Environmental stress and temporoman-dibular disorder (TMD) among members of a public university in Brazil

mandibular disorder (TMD) is one of several somatic manifestations of stress. Several studies have shown that some patients with TMD suffer more anxiety than individuals without this condition. The aim of this study was to identify individuals with TMD and correlate with environmental stress among members of a public university. A proportional stratified probabilistic procedure was used to select 455 subjects age 17-63 yrs consisted of students, staff and professors. The subjects were enlisted after lunch. TMD were diagnosed using a screening questionnaire based on the American Academy of Orofacial Pain (AAOP). Presence of TMD was defined based on pain in chewing or speaking, tired maxillae and pain in the head, neck and/or teeth. Environmental stress was diagnosed by using the Social Readjustment Rating Scale (SRRS).Gender distribution was similar among undergraduate and graduate students, but there were significant differences in the sex ratio of university staff (66.7% were females) and professors (81.8% were males). Prevalence of TMD influenced by stress among women was significantly greater than in men of the same age group (p=0.0001), and almost all individuals (90.9%) with TMD had a high level of stress (p=0.0082). These findings suggest that there is positive association between TMD and environmental stres

Effect of nutritional supplementation with milk whey proteins in amyotrophic lateral sclerosis patients Efeito da suplementação nutricional com proteínas do soro de leite em pacientes com esclerose lateral amiotrófica

OBJECTIVE: We evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70%WPI:30%MS), on nutritional and functional parameters of patients with ALS. METHOD: A prospective randomized double-blind study was performed with 16 ALS patients, divided in two groups, the treatment group received (70%WPI:30%MS) and the control group received (maltodextrin). They underwent prospective nutritional and functional assessment for 4 months. RESULTS: Patients in the treatment group presented weight gain, increased body mass index (BMI), increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical parameters did not change, but weight and BMI declined. CONCLUSION: Our results indicate that the agglomerate 70%WPI:30%MS may be useful in the nutritional therapy of patients with ALS.OBJETIVO: Avaliar a eficácia da suplementação nutricional oral com proteínas do soro do leite e amido modificado (70%WPI:30%MS), nos parâmetros nutricionais e funcionais de pacientes com esclerose lateral amiotrófica (ELA). MÉTODO: Foi realizado estudo randomizado duplo-cego, com 16 pacientes com ELA, divididos em dois grupos, um que recebeu 70%WPI:30%MS e um controle que recebeu maltodextrina. Os pacientes foram submetidos a avaliação nutricional e funcional durante quatro meses. RESULTADOS: Nos pacientes que receberam o suplemento 70%WPI:30%MS, foi observado ganho de peso, aumento na contagem de linfócitos e redução de creatina kinase, aspartato aminotransferase and alanina aminotransferase. No grupo controle, os parâmetros bioquímicos não sofreram modificações; no entanto, peso e índice de massa corporal diminuíram. CONCLUSÃO: Nossos resultados indicam que o aglomerado 70%WPI:30%MS pode ser útil na terapia de pacientes com ALS

Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment Esclerose lateral amiotrófica: correlações dos indicadores da avaliação nutricional, funcional e respiratória

OBJECTIVE: To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). METHOD: Twenty patients (13 appendicular - GA and 7 bulbar - GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. RESULTS: Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r= -0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss (%WL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with %WL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat (%), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm²). CONCLUSION: It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.OBJETIVO: Correlacionar os indicadores utilizados na avaliação nutricional, funcional e respiratória de indivíduos com esclerose lateral amiotrófica (ELA). MÉTODO: Vinte pacientes (13 apendiculares - GA e 7 bulbares - GB) foram incluídos no estudo usando parâmetros nutricionais, respiratórios e escala funcional (ALSFRS-R). RESULTADOS: Entre os pacientes do GA, as correlações observadas foram: pressão inspiratória máxima (PImax) e expiratória máxima (PEmax) (r= -0,76); PEmax e oximetria de pulso (r=0,58); PImax e porcentagem de perda de peso (%PP) (r=0,59); e entre PImax, escore ALSFRS-R com %PP. No GB, houve correlação entre MEP e índice de massa corporal (IMC) (r=0,97). Em GA e GB, observaram-se correlação entre IMC e as variáveis: massa, gordura (%), circunferência braquial e punho, pregas cutâneas tricipital, subescapular e supra-ilíaca, circunferência muscular do braço (cm), área muscular gordurosa do braço (mm²). CONCLUSÃO: Sugere-se a aplicação deste conjunto de medidas durante a evolução clínica de indivíduos com ELA

Efeito da suplementação nutricional com proteínas do soro de leite em pacientes com esclerose lateral amiotrófica

OBJECTIVE: We evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70%WPI:30%MS), on nutritional and functional parameters of patients with ALS. METHOD: A prospective randomized double-blind study was performed with 16 ALS patients, divided in two groups, the treatment group received (70%WPI:30%MS) and the control group received (maltodextrin). They underwent prospective nutritional and functional assessment for 4 months. RESULTS: Patients in the treatment group presented weight gain, increased body mass index (BMI), increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical parameters did not change, but weight and BMI declined. CONCLUSION: Our results indicate that the agglomerate 70%WPI:30%MS may be useful in the nutritional therapy of patients with ALS.OBJETIVO: Avaliar a eficácia da suplementação nutricional oral com proteínas do soro do leite e amido modificado (70%WPI:30%MS), nos parâmetros nutricionais e funcionais de pacientes com esclerose lateral amiotrófica (ELA). MÉTODO: Foi realizado estudo randomizado duplo-cego, com 16 pacientes com ELA, divididos em dois grupos, um que recebeu 70%WPI:30%MS e um controle que recebeu maltodextrina. Os pacientes foram submetidos a avaliação nutricional e funcional durante quatro meses. RESULTADOS: Nos pacientes que receberam o suplemento 70%WPI:30%MS, foi observado ganho de peso, aumento na contagem de linfócitos e redução de creatina kinase, aspartato aminotransferase and alanina aminotransferase. No grupo controle, os parâmetros bioquímicos não sofreram modificações; no entanto, peso e índice de massa corporal diminuíram. CONCLUSÃO: Nossos resultados indicam que o aglomerado 70%WPI:30%MS pode ser útil na terapia de pacientes com ALS