Disfagia na doença de Carcot-Marie-Tooth: relato de caso / Dysphagia in Charcot-Marie-Tooth disease: a case report

A doença de Charcot-Marie-Tooth (CMT) é uma polineuropatia motora, sensitiva, hereditária e de predomínio distal. Os membros inferiores são os mais afetados e, ocasionalmente, há comprometimento dos membros superiores. Este estudo descreve a presença de disfagia orofaríngea e a intervenção fonoaudiológica em uma paciente de 58 anos com diagnóstico de CMT, encaminhada à avaliação fonoaudiológica devido a queixas na deglutição. Na avaliação inicial identificaram-se alterações, tanto de caráter estrutural quanto funcional, que resultaram em uma disfagia orofaríngea leve. Também se utilizou o Questionário de Qualidade de Vida na Disfagia para identificar o impacto na qualidade de vida da paciente. Após um mês de acompanhamento observou-se melhora dos sintomas e aumento do conforto e segurança ao deglutir. (AU)

Charcot-Marie-Tooth (CMT) disease is a motor and sensory, hereditary, distally predominant polyneuropathy. The lower limbs are most affected and, occasionally, there is upper limb impairment; however, presence of oropharyngeal dysphagia has been identified. The present study describes the findings and speech therapy intervention in a 58-year-old patient, with CMT diagnosis, referred to speech therapy evaluation due to swallowing complaints. In an initial evaluation, presence of structural and functional alterations, resulting in mild oropharyngeal dysphagia, was identified. The Swallowing Quality of Life questionnaire was also used to identify the impact of dysphagia in the patient's quality of life. After a month of follow-up, an improvement was observed in the presenting symptoms, as well as an increase in comfort and safety during swallowing. (AU)

Clinical findings of speech therapy swallowing assessments in patients with oropharyngeal dysphagia following orotracheal intubation

Introduction: Endotracheal intubation has been associated with oropharyngeal dysphagia. The aim of this study was to identify the prevalence of oropharyngeal dysphagia among patients in an intensive care unit (ICU) by comparing patients requiring orotracheal intubation with those who did not undergo this procedure. Methods: This is a cross-sectional study that analyzed the medical records of 681 patients admitted to the ICU of Hospital de Clínicas de Porto Alegre between 2014 and 2017; inclusion criteria were patients aged 18 years and older who had been assessed by the hospital's Speech Therapy Service. Patients who had undergone tracheostomy, who had incomplete medical records or multiple speech-language assessments were excluded. Results: A total of 380 patients were included in the statistical analysis: 97 (25.5%) had not undergone orotracheal intubation (Group 1), 229 (60.3%) had undergone orotracheal intubation once (Group 2), and 54 (14.2%) had undergone orotracheal intubation on 2 or more occasions (Group 3). Regarding the Functional Oral Intake Scale (FOIS), 61.1% of patients in Group 3 received a FOIS I classification (p = 0.020), whereas 16.5% of patients from Group 1 received a FOIS V. Concerning their outcomes, 40.7% of patients in Group 3 died (p = 0.006), and 82.5% of patients in Group 1 were discharged from the ICU. Considering the severity of oropharyngeal dysphagia according to the Dysphagia Risk Evaluation Protocol (PARD), no statistically significant association was observed between groups (p = 0.261). Conclusions: In this study, the prevalence of oropharyngeal dysphagia was higherin patients who had undergone orotracheal intubation in the ICU. (AU)

Profile of patients using nasoenteric probe at the adult emergency service in a public hospital

Introduction: Part of the prognosis of hospitalized patient depends on nutritional status and the safety and efficacy of the feeding administration route. Therefore, the aim of this study was to identify data on the indication of nasoenteric tube (NET) prescription to analyze the profile of these patients. Methods: A retrospective cross-sectional study was carried out with data collection in medical records of patients over 18 years of age, of both sexes, treated at the Emergency Adult Service (EAS), using NET. Results: there was a predominance of females (51.9%); neurological disease was the most prevalent underlying disease, and 57.8% had more than one diagnosed disease. Malnutrition, bronchopneumonia, and dysphagia were present in 23.6%, 27% and 40% of the cases, respectively. There was a request for speech-language evaluation in only 8.7% of the patients. And 80.7% did not use NET prior to emergency care. Regarding the indications for the use of NET by group of underlying disease, low food intake was the most prevalent clinical reason described in the medical records, followed by dysphagia, with a higher prevalence of patients taking NET for nutritional reasons. There was no justification for prescription in 15.2% of the sample. There was an association between the variables bronchopneumonia and dysphagia (p = 0.01). Conclusion: It was verified that in the studied population there are risk factors for dysphagia. The analysis of the population profile in the present study contributed to increased knowledge and information about this population regarding the criteria for indication of the use of the alternative route. (AU)

Qualidade de vida em pacientes com doença de Machado-Joseph sob acompanhamento fonoaudiológico para disfagia / Therapy speech impact in quality of life in patients with Machado-Joseph disease

RESUMO A doença de Machado-Joseph é uma doença degenerativa e atualmente considerada a ataxia espinocerebelar mais frequente. O processo degenerativo da doença afeta diferentes regiões e funções do sistema nervoso central e/ou periférico. A disfagia é um dos sintomas presentes na doença de Machado-Joseph, sendo responsável pelas complicações clínicas e pela pneumonia aspirativa, sua principal causa de morte. O objetivo deste trabalho é verificar o impacto da terapia fonoaudiológica na qualidade de vida em pacientes com doença de Machado-Joseph. Participaram da pesquisa quatro pacientes diagnosticados com a doença, três do sexo feminino e um do sexo masculino, com média de idade de 46,5 anos (±18) e queixa de disfagia. Na primeira sessão, todos os pacientes responderam ao questionário de Avaliação da Qualidade de Vida em Disfagia, SWAL-QOL, foram avaliados quanto aos aspectos estruturais e funcionais da deglutição e classificados de acordo com a Escala Funcional de Ingestão por Via Oral (FOIS). Após seis sessões de tratamento fonoaudiológico, realizaram nova avaliação clínica da deglutição, novamente classificados de acordo com a escala FOIS e responderam o SWAL-QOL. Conclusões: Após a intervenção fonoaudiológica, todos os pacientes apresentaram melhor conceito nos domínios medo de alimentar-se, alimentação como um fardo e fadiga, podendo-se inferir que houve uma melhora na satisfação com o processo alimentar e, consequentemente, qualidade de vida dos sujeitos acompanhados.

ABSTRACT The Machado-Joseph disease is a degenerative disease, currently considered the most frequent spinocerebellar ataxia. The degenerative process of the disease affects several regions and functions of the central and/or peripheral nervous system. The dysphagia is one of the symptoms of Machado-Joseph disease, being responsible for the clinical complications and for the aspiration pneumonia, its main cause of death. The goal of this paper is to verify the impact of the speech-language therapy in the quality of life of the Machado-Joseph disease patients. Four patients diagnosed with Machado-Joseph disease attended to the research, three female and one male, with age average in 46,5 years-old (± 18), and complaining about dysphagia. In the first session, all patients answered the protocol of quality of life in dysphagia assessment of Quality of Life in Dysphagia, SWAL -QOL were assessed for structural and functional aspects of swallowing and classified according to Functional Intake Scale for Oral (FOIS). After six speech therapy sessions conducted a new clinical evaluation of swallowing, again classified according to FOIS and answered the SWAL -QOL. Conclusions: After speech therapy, all patients showed better concept in the field fear of eating, food as a burden and fatigue, which can be inferred that there was an improvement in satisfaction with food processes and hence the quality of life accompanied subjects.