A comunicação dos doentes mecanicamente ventilados em unidades de cuidados intensivos

Objective: The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. Methods: This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. Results: Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach’s alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be “quite hard” (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable “number of hours after extubation” (p < 0.05). Conclusion: This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was “quite hard”, and these communication difficulties apparently existed regardless of the presence of other clinical and/or sociodemographic variables.info:eu-repo/semantics/publishedVersio

As especificidades de um consentimento livre e esclarecido para pessoas com afasia

The informed consent of participants is ethically and legally required for most clinical researches. However, standardized models for the informed consent are not appropriate for people with aphasia. This fact justifies why people with aphasia are often excluded from research. This paper aims to discuss the limitations related to obtained informed consent from people with aphasia and suggest strategies and facilitated techniques in order to include this group of people in clinical research. The challenge to include people with aphasia in research should be taken up in order to promote accessibility, while continuing to respect the autonomy and the exercise of decision making for these patients.&nbsp;A obtenção de um consentimento livre e esclarecido é um requisito ético e legal imprescindível para qualquer estudo clínico. Contudo, os modelos tradicionais de obtenção de um consentimento não se adequam a pessoas com afasia, o que se traduz na sua exclusão de diferentes estudos clínicos. O objetivo deste artigo é discutir os apectos ligados às limitações na obtenção de um consentimento livre e esclarecido em pessoas com afasia. Propõe -se um conjunto de estratégias e técnicas que facilitem a obtenção de informação e consequente integração destas pessoas na investigação científica. O desafio de incluir pessoas com afasia nestes estudos deve ser considerado como uma forma de garantir a acessibilidade, o respeito pela autonomia e a tomada de decisão destas pessoas

Dysphagia in Alzheimer’s disease: a systematic review

Dysphagia is described as a highly relevant comorbidity of Alzheimer’s disease (AD). However, there is a scarcity of studies aiming at the characteristics and progression of dysphagia. Objective: The objective of this study was to identify the specific characteristics, progression, and prevalence of dysphagia in AD. Methods: Publications were searched in the PubMed (MEDLINE), EBSCO, ScienceDirect, and BASE databases. Critical appraisal and evidence-level analysis were conducted using the Joanna Briggs Institute and Effective Public Health Practice Project’s (EPHPP) tools. Results: A total of 26 studies were reviewed. Symptoms begin in the early stage of AD, as oral phase impairments, and progress to pharyngeal symptoms and swallowing apraxia in the later stages of AD. Dysphagia progresses, as AD, along a continuum, with severity depending on individual variability. There were no studies found on prevalence. Conclusions: Dysphagia is a complex and important comorbidity in AD that impacts the quality of life. No recent publications on prevalence may imply that is not being coded as a potential cause for pneumonia deaths in AD.info:eu-repo/semantics/publishedVersio

A disfagia na Doença de Alzheimer: uma revisão sistemática

Abstract. Dysphagia is described as a highly relevant comorbidity of Alzheimer’s disease (AD). However, there is a scarcity of studies aiming at the characteristics and progression of dysphagia. Objective: The objective of this study was to identify the specific characteristics, progression, and prevalence of dysphagia in AD. Methods: Publications were searched in the PubMed (MEDLINE), EBSCO, ScienceDirect, and BASE databases. Critical appraisal and evidence-level analysis were conducted using the Joanna Briggs Institute and Effective Public Health Practice Project’s (EPHPP) tools. Results: A total of 26 studies were reviewed. Symptoms begin in the early stage of AD, as oral phase impairments, and progress to pharyngeal symptoms and swallowing apraxia in the later stages of AD. Dysphagia progresses, as AD, along a continuum, with severity depending on individual variability. There were no studies found on prevalence. Conclusions: Dysphagia is a complex and important comorbidity in AD that impacts the quality of life. No recent publications on prevalence may imply that is not being coded as a potential cause for pneumonia deaths in AD.info:eu-repo/semantics/publishedVersio

Rationale and clinical applicably of Transcranial Magnetic Stimulation to aphasia rehabilitation

A recuperação após um Acidente Vascular Cerebral (AVC) é baseada nos mecanismos de plasticidade neuronal e na forma como o sistema nervoso central se reorganiza para compensar a perda das áreas afeta­das. Neste contexto específico, as técnicas de neuromodulação, onde se enquadra a Estimulação Magnética Transcraniana (EMT), têm tido avanços promissores e suscitado grande interesse por parte da comu­nidade científica pelo seu potencial terapêutico, especialmente nas se­quelas pós-AVC. A EMT resulta da produção de campos magnéticos modulados, induzindo a produção de correntes eléctricas no córtex cerebral, modificando a excitabilidade intra-cortical e ativando ou ini­bindo estruturas corticais e subcorticais distantes ao longo de conexões específicas. Neste sentido, a EMT pode promover os mecanismos de neuroplasticidade e está associada à recuperação funcional de pacien­tes que sofreram AVC´s. Pretende-se, com este artigo, apresentar uma atualização da literatura sobre este tema de forma a evidenciar as dife­rentes aplicações clínicas desta técnica especificamente na reabilitação de pessoas com afasia após AVC.Post-stroke recovery is based on neural plastic changes that allow brain reorganization in order to compensate the loss of activity in the affected brain regions. In this line, the neuromodulation techniques, namely Transcranial Magnetic Stimulation (TMS), assists to a growing interest from the scientific community, especially for its therapeutic potential to treat stroke related sequels. TMS results from a magnetic field that induces an electrical current in the cerebral cortex, changing intra-cortical excitability and activating distant cortical and subcortical structures throughout specific connections. Therefore, the application of TMS was recently proposed to promote functional recovery in stroke patients, owing to the induced neuroplasticity. This paper review and discusses the different clinical applications of TMS in patients with post-stroke aphasia.info:eu-repo/semantics/publishedVersio

Lateralization of the visual word form area in patients with alexia after stroke

Background Knowledge of the process by which visual information is integrated into the brain reading system promotes a better understanding of writing and reading models. Objective This study aimed to use functional Magnetic Resonance Imaging (fMRI) to explore whether the Blood-oxygen-level dependent (BOLD) contrast imaging patterns, of putative cortical region of the Visual Word Form Area (VWFA), are distinct in aphasia patients with moder- ate and severe alexia. Methods Twelve chronic stroke patients (5 patients with severe alexia and 7 pa- tients with moderate alexia) were included. A word categorization task was used to examine responses in the VWFA and its right homolog re- gion. Patients performed a semantic decision task in which words were contrasted with non-verbal fonts to assess the lateralization of reading ability in the ventral occipitotemporal region. Results A fixed effects (FFX) general linear model (GLM) multi-study from the contrast of patients with moderate alexia and those with severe alexia (FDR, p = 0.05, corrected for multiples comparisons using a Threshold Estimator plugin (1000 Monte Carlo simulations), was per- formed. Activation of the left VWFA was robust in patients with mod- erate alexia. Aphasia patients with severe reading deficits also activated the right homolog VWFA. Conclusions This bilateral activation pattern only in patients with severe alexia could be interpreted as a result of reduced recruitment of the left VWFA for reading tasks due to the severe reading deficit. This study provides some new insights about reading pathways and possible neuroplasti- city mechanisms in aphasia patients with alexia. Additional reports could explore the predictive value of right VWFA activation for reading recovery and aid language therapy in patients with aphasia.N/

Estimulação magnética transcraniana para a reabilitação das doenças do cérebro

Com o aumento da esperança média de vida, aumenta também a comorbilidade de patologias associadas ao envelhecimento e a consequente busca por novas terapias e abordagens de tratamento das doenças do cérebro. Neste contexto específico, as técnicas de neuromodulação, onde se enquadra a Estimulação Magnética Transcraniana (TMS), têm tido avanços promissores e suscitado grande interesse por parte da comunidade científica pelo seu potencial terapêutico. A TMS resulta da produção de campos magnéticos variáveis no tempo, induzindo a produção de correntes eléctricas no córtex cerebral, modificando a excitabilidade intra-cortical e activando estruturas corticais e subcorticais distantes ao longo de conecções específicas. Pretende-se, com este artigo, apresentar uma breve revisão da literatura sobre este tema de forma a evidenciar as diferentes aplicações clínicas desta técnica na reabilitação de pessoas com doenças neurológicas

“To talk or not to talk”- an rTMS study about naming during stimulation

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A comunicação dos doentes mecanicamente ventilados em unidades de cuidados intensivos

Objective: The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. Methods: This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. Results: Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach's alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be "quite hard" (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable "number of hours after extubation" (p < 0.05). Conclusion: This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was "quite hard", and these communication difficulties apparently existed regardless of the presence of other clinical and/or sociodemographic variables.Objetivo: Traduzir e adaptar cultural e linguisticamente o instrumento Ease of Communication Scale e determinar o nível de dificuldades de comunicação dos doentes submetidos à ventilação mecânica com entubação orotraqueal, relacionando-o a variáveis clínicas e sociodemográficas. Métodos: Este estudo teve três fases: (1) adaptação cultural e linguística da Ease of Communication Scale; (2) avaliação preliminar de suas propriedades psicométricas; e (3) pesquisa observacional, descritivo-correlacional e transversal, realizada entre março e agosto de 2015, com base nas respostas à Ease of Communication Scale - após a extubação, de 31 doentes adultos, extubados e clinicamente estáveis, admitidos em cinco unidades de cuidados intensivos portuguesas, e em suas variáveis clínicas e sociodemográficas. Resultados: A análise dos peritos revelou elevada concordância em relação ao conteúdo (100%) e à pertinência (75%). O pré-teste obteve elevada aceitabilidade ao nível do preenchimento e da sua utilidade. A Ease of Communication Scale apresentou excelente consistência interna (alfa de Cronbach de 0,951). A análise fatorial explicou cerca de 81% da variância total com duas componentes da escala. Em média, os doentes consideraram as experiências de comunicação, durante a entubação, "muito difíceis" (2,99). Não existiu relação estatisticamente significativa entre as dificuldades de comunicação reportadas e as variáveis sociodemográficas e clínicas estudadas, com exceção da variável clínica "número de horas após a extubação" (p < 0,05). Conclusão: Realizou-se a tradução e a adaptação para o português europeu do primeiro instrumento de avaliação das dificuldades de comunicação dos doentes mecanicamente ventilados nas unidades de cuidados intensivos. A validação preliminar da escala sugeriu elevada fiabilidade. Os doentes submetidos à ventilação mecânica consideraram que as experiências de comunicação durante a entubação foram "muito difíceis" e estas dificuldades de comunicação pareceram existir independentemente da presença de outras variáveis clínicas e/ou sociodemográficas.info:eu-repo/semantics/publishedVersio

Exercícios profiláticos de deglutição em pessoas com cancro de cabeça e pescoço: revisão sistemática

Introdução: As alterações de deglutição são comuns após tratamento para cancro de cabeça e pescoço. Os exercícios para a recuperação das funções da deglutição são importantes, mas a sua utilização de forma profilática ainda é pouco estudada. Objetivo: Analisar a utilização de exercícios profiláticos para a deglutição em pessoas com cancro de cabeça e pescoço submetidas a tratamento (neo)adjuvante com radioterapia e/ou quimioterapia. Métodos: Revisão sistemática da literatura cuja seleção dos estudos decorreu em outubro de 2022 envolvendo pesquisas nas bases de dados PubMed central, LILACS, Scielo, CINAHL Complete, Cochrane Collection Plus, Nursing & Allied Health Collection e Medic Latina. A análise do nível de evidência foi realizada através da escala “Quality Assessment Tool for Quantitative Studies”. Resultados: Identificaram-se 1.401 estudos e selecionados apenas oito para análise e extração de dados. Conclusão: A utilização de exercícios profiláticos parece ter algum benefício nas funções da deglutição, mas os resultados não são consistentes. Sugerem-se novas investigações para estudar os seus potenciais benefícios de forma mais específica (i.e. tipo exercício versus tratamento).info:eu-repo/semantics/publishedVersio