Conhecimento dos profissionais da saúde de um hospital público em relação à afasia / Knowledge on aphasia held by health professionals of a public hospital / Conocimiento de los profesionales sanitarios de un hospital público sobre la afasia

Introdução: A compreensão da afasia é fundamental para os profissionais de saúde que prestam assistência a pacientes com AVC. No entanto, a informação disponível sobre a afasia ainda é limitada e insuficiente para uma abordagem eficaz. É de suma importância identificar o conhecimento dos profissionais de saúde a respeito da afasia, a fim de planejar o atendimento aos pacientes e suas famílias.Objetivo: Avaliar o nível de conhecimento dos profissionais de saúde de um hospital público em relação à afasia e analisar como eles lidam com pacientes com afasia durante o período de hospitalização. Método: Realizamos uma pesquisa com profissionais de saúde por meio de um questionário online para avaliar seu conhecimento sobre a afasia e suas estratégias de atendimento. Resultados: Os resultados indicam que profissionais de saúde com níveis de educação mais elevados tendem a possuir um entendimento mais sólido da afasia. No entanto, persistem lacunas de conhecimento em diversos aspectos da afasia. Embora a maioria dos profissionais se sinta adequadamente preparado para lidar com pacientes com afasia, eles reconhecem os desafios envolvidos e expressam o desejo de receber orientações para aprimorar suas habilidades de comunicação. Conclusão: Este estudo ressalta a necessidade de uma formação mais abrangente para os profissionais de saúde no que diz respeito à afasia e suas estratégias de comunicação. É fundamental o desenvolvimento de programas de treinamento e a elaboração de diretrizes específicas para os profissionais que atuam com esses pacientes, visando proporcionar um atendimento de alta qualidade. (AU)

Introduction: Understanding aphasia is crucial for healthcare professionals providing care to stroke patients. However, there is a need to enhance and refine the information available about aphasia for practical application. It is imperative to assess the knowledge of healthcare professionals regarding aphasia to facilitate effective care planning for patients and their families. Objective: This study aims to evaluate the level of knowledge among healthcare professionals in a public hospital concerning aphasia and their approach to patients with aphasia during their hospitalization. Method: An online questionnaire was administered to healthcare professionals to assess their understanding of aphasia and their caregiving strategies. Results: The findings indicate that healthcare professionals with higher education levels tend to have a better understanding of aphasia. Nevertheless, knowledge gaps persist in various aspects of aphasia. While most professionals feel adequately prepared to interact with patients experiencing aphasia, they acknowledge the challenges involved and express a desire for guidance to enhance their communication skills. Conclusion: This study underscores the necessity for comprehensive training of healthcare professionals in the realm of aphasia and effective communication strategies. The development of training programs and guidelines is crucial to better serve patients with aphasia, ensuring the provision of high-quality care. (AU)

Introducción: La comprensión de la afasia es importante para los profesionales de la salud que atienden a pacientes con ACV. Sin embargo, la información sobre la afasia sigue siendo limitada e insuficiente para un enfoque efectivo. Es importante identificar el conocimiento de los profesionales de la salud sobre la afasia para planificar la atención a los pacientes y sus familias. Objetivo: Evaluar el conocimiento de los profesionales de la salud de un hospital público sobre la afasia y cómo manejan a los pacientes con afasia durante el período de hospitalización. Método: Se realizó una encuesta a profesionales de la salud a través de un cuestionario en línea para evaluar su conocimiento sobre la afasia y sus tácticas de atención. Resultados: Se señala un mayor conocimiento sobre la afasia entre los profesionales de nivel superior, pero aún existen lagunas de conocimiento en varios aspectos de la afasia. La mayoría de los profesionales se sienten preparados para manejar a pacientes con afasia, pero reconocen que la atención es desafiante y les gustaría recibir orientación para mejorar sus habilidades de comunicación. Conclusión:Este estudio destaca la necesidad de una formación más amplia y completa para los profesionales de la salud sobre la afasia y su comunicación. Es fundamental desarrollar programas de capacitación y guías para atender mejor a estos pacientes y garantizar una atención de calidad. (AU)

Evolución de la afasia en adolescentes con secuela de ACV: serie de casos / Post-stroke aphasia in adolescents' progress: case series

La afasia como secuela de un accidente cerebrovascular es un trastorno del lenguaje poco estudiado en adolescentes, tanto en Latinoamérica como a nivel mundial. Independientemente del hecho de que un número significativo de afasias mejora espontáneamente, la necesidad del inicio oportuno del tratamiento es imprescindible. En esta serie de casos se describe la presentación clínica y evolución de la afasia en 3 adolescentes con secuelas de accidente cerebrovascular que ingresaron a un instituto de neurorehabilitación. Fueron dos mujeres y un varón, de entre 15 y 17 años, que recibieron rehabilitación integral intensiva desde las áreas de fisioterapia, terapia ocupacional, neuropsicología, psicopedagogía, musicoterapia y fonoaudiología. Fueron evaluados con la versión chilena de la herramienta Western Aphasia Battery (WAB). A los 3 meses todos mejoraron y evolucionaron a un tipo de afasia más leve. Este estudio expone la importancia del tratamiento precoz e intensivo en esta población de adolescentes en plena etapa de construcción social como personas, en donde la alteración del lenguaje impacta en sus vínculos, grupo de pertenencia, estado anímico y a nivel académico. Se considera fundamental la evaluación y seguimiento sistemático con el objetivo de identificar los cambios y avances alcanzados durante la rehabilitación.

Aphasia as a sequela of stroke is an understudied language disorder in adolescents, both in Latin America and worldwide. Although a significant number of aphasia cases improve spontaneously, it is necessary to initiate treatment as soon as possible. This cases series describes the clinical presentation and evolution of aphasia in 3 adolescents with stroke sequelae who were admitted to a neurorehabilitation facility. Two females and one male, aged between 15 and 17 years, received intensive comprehensive rehabilitation from the areas of physiotherapy, occupational therapy, neuropsychology, psychopedagogy, music therapy and speech therapy. They were evaluated with the Chilean version of the Western Aphasia Battery (WAB). After 3 months, all of them improved and evolved to a milder type of aphasia. This study shows the importance of early, intensive treatment in adolescents who are in the height of their social development, where language alteration impacts on their bonds, their groups of belonging, their mood and their academic process. Systematicassessment and follow-up are considered essential to identify the changes and progress achieved during rehabilitation.

Afasias e construção de sentido: estudo com foco em história em quadrinhos / Aphasia and construction of meaning: study focused on comic strips

RESUMO Objetivo observar, na linguagem em afasia de sujeitos adultos, a constituição de sentidos, considerando a (re)organização enunciativa na leitura e na escrita. Métodos pesquisa qualitativa com método aplicado e exploratório e perspectiva de análise enunciativa sobre a linguagem, tendo as noções de forma e sentido como base analítica. Foi realizada uma atividade com três sujeitos com afasia (Bir, Cr e Aul), integrantes do Grupo Interdisciplinar de Convivência (GIC), formado por participantes com e sem afasia. Tal atividade consistiu em (re)organizar quadrinhos de uma história, visando constituir sentido, uma vez que a leitura/escrita de textos são habilidades comumente comprometidas nas afasias. Resultados a categoria de tempo crônico mostra-se fundante para elaboração das narrativas dos sujeitos com afasia. Entretanto, eles encontraram formas distintas de sustentação de sentidos, mas sempre atrelados a experiências provenientes da relação entre homem e mundo. Conclusão as narrativas foram organizadas/construídas pelos participantes, tendo por base as imagens (base formal) - uma vez comprometida a habilidade de leitura de textos verbais. Bir, Cr e Aul usaram o tempo crônico como eixo organizacional de suas narrativas e suas histórias em quadrinhos, demonstrando que promovem leitura e escrita ao se considerar o viés enunciativo de análise da linguagem.

ABSTRACT Purpose to observe , in the language of aphasic adult subjects, the constitution of meanings, considering the enunciative (re)organization in reading and writing. Methods qualitative research with applied and exploratory methods and a perspective of enunciative analysis on language, using the notions of form and meaning as analytical base. From an activity performed by three subjects with aphasia (Bir, Cr and Aul), members of the Interdisciplinary Coexistence Group (GIC), formed by participants with and without aphasia, which constituted of (re)organizing the panels (frames) of a comic strip, in order to constitute meaning - since the reading/writing of texts are skills that are commonly affected in aphasia. Results the chronic time category shows itself to be fundamental for the elaboration of the narratives of the subjects with aphasia, however they found different ways of sustaining meanings, but always linked to experiences arising from the relationship between man and world. Conclusion the narratives were organized/constructed by the participants, having the images as a base (formal base) - since the ability to read verbal texts is impaired. Bir, Cr and Aul used chronic time as an organizational axis of their narratives and their comic strips show that these subjects with aphasia promote reading and writing when considering enunciative bias of language analysis.

Do ouvido ao narrado: interlocução terapeuta-sujeito com afasia em atividade com história em quadrinhos / From heard to narrated: therapist-subject with aphasia interlocution in an activity with comic books

RESUMO Objetivo Analisar a interlocução terapeuta-sujeito com afasia no processo de interpretação e organização de história em quadrinhos. Métodos Estudo transversal, de natureza qualitativa. Os dados coletados foram de situações enunciativas audiogravadas e apresentadas descritivamente por quadros de interlocução (A1-T1) e (A2-T2), registrando atividade com Histórias em Quadrinhos (HQ), realizada em encontro do Grupo Interdisciplinar de Convivência da instituição, do qual participaram sujeitos com e sem afasia. Analisou-se a interlocução entre duas terapeutas em formação (T1 e T2) e dois sujeitos com afasia (A1 e A2). Resultados As interlocuções entre A1-T1 e A2-T2, ocorridas durante o processo de organização das HQ, evidenciaram posicionamentos diferentes das terapeutas, no que tange ao ouvido e ao narrado. A1 foi reconhecida por T1 como sujeito de linguagem, à medida que a terapeuta promoveu a disjunção, ou seja, encaminhou A1 à condição de locutor; o mesmo fato não ocorreu com A2 e T2, pois o primeiro não foi reconhecido como sujeito de linguagem, já que T2 manteve-se em conjunção, não conferindo lugar de fala a A2. Conclusão A enunciação benvenistiana configura-se como recurso teórico-metodológico para análise e intervenção clínica junto a sujeitos com afasia. O contexto de convivência grupal impõe-se como lócus de cuidado e formativo para as diferentes áreas de atenção às pessoas com afasia, articulando, interdisciplinarmente, aspectos da enunciação à prática terapêutica.

ABSTRACT Purpose To analyze the therapist-subject with aphasia interlocution in the process of interpretation and organization of comics. Methods Cross-sectional study of a qualitative nature. The data are from audio-recorded enunciative situations and presented descriptively by interlocution charts (A1-T1) and (A2-T2), registering activity with Comics, held at a meeting of the Interdisciplinary Group of Coexistence (GIC) in which subjects with and without aphasia participate. The interlocution between two therapists in training (T1 and T2) and two subjects with aphasia (A1 and A2) is analyzed. Results: The interlocutions between A1-T1 and A2-T2, which occurred during the process of organization of the comic, show different positions of the therapists regarding the ear and the narrated. A1 is recognized by T1 as a subject of language as the therapist promotes disjunction, that is, it directs A1 to the condition of speaker; the same does not occur with A2 and T2, because the former is not recognized as a subject of language, since T2 remains in conjunction, not giving A2 speaking space. Conclusion Benvenistian enunciation is configured as a theoretical and methodological resource for analysis and clinical intervention with subjects with aphasia; the context of group coexistence imposes itself as a locus of care and training for the different areas of attention to people with aphasia, articulating, interdisciplinary, aspects of enunciation to therapeutic practice.

Alterações de linguagem em pacientes pós lesão encefálica adquirida na fase aguda / Language changes in patients after brain injury acquired in the acute phase

Caracterizar as alterações de linguagem encontradas em pacientes com lesão encefálica adquirida em fase aguda Métodos: Trata-se de uma pesquisa observacional, descritiva do tipo transversal. A avaliação foi realizada nas enfermarias de um hospital de urgências, com pacientes de idade superior a 18 anos, diagnóstico de lesão encefálica adquirida e tempo de internação de até 60 dias. O protocolo utilizado incluiu avaliação das praxias orais, expressão, compreensão da linguagem oral e leitura. Ao final, foi possível apresentar as hipóteses diagnósticas de afasias fluentes e não fluentes, disartria e sem alteração de linguagem. A análise dos dados foi realizada por meio de estatística descritiva através da distribuição de frequência absoluta e frequência relativa Resultados: A amostra foi composta por 24 pacientes sendo a maioria do gênero masculino, com média de idade de 51 anos. O diagnóstico de maior frequência foi Acidente Vascular Cerebral. Dos pacientes avaliados, 79% tiveram alterações de fala/linguagem. As hipóteses diagnósticas fonoaudiológicas encontradas foram: afasia global, afasia de broca, afasia transcortical mista, afasia de condução, afasia transcortical motora, afasia transcortical sensorial e disartria. Conclusão: A afasia global foi o transtorno de linguagem de maior ocorrência entre os indivíduos, bem como o gênero masculino e o acidente vascular cerebral. A avaliação da linguagem de pacientes com lesões encefálicas adquiridas na fase aguda é pertinente, pois promove o levantamento de alterações desde as perceptíveis até as mais discretas

To characterize the language disorders found in patients with brain injury acquired in the acute phase Methods: This is an observational, descriptive cross-sectional study. The evaluation was carried out in the wards of an emergency hospital, with patients aged over 18 years, diagnosed with acquired brain injury and hospitalization time of up to 60 days. The protocol used included assessment of oral praxis, expression, comprehension of oral language and reading. In the end, it was possible to present the diagnostic hypotheses of fluent and non-fluent aphasias, dysarthria and without language alteration. Data analysis was performed using descriptive statistics through the distribution of absolute frequency and relative frequency. Results: The sample consisted of 24 patients, most of whom were male, with a mean age of 51 years. The most frequent diagnosis was Cerebral Vascular Accident. Of the evaluated patients, 79% had speech/language disorders. The speech-language diagnostic hypotheses found were: global aphasia, drill aphasia, mixed transcortical aphasia, conduction aphasia, motor transcortical aphasia, sensory transcortical aphasia and dysarthria. Conclusion: Global aphasia was the most frequent language disorder among individuals, as well as males and stroke. The evaluation of the language of patients with brain injuries acquired in the acute phase is relevant, as it promotes the survey of changes from the perceptible to the most discreet

The rules of acupoint selection of acupuncture and moxibustion for aphasia based on data mining / 中国针灸

OBJECTIVE@#To explore the rules of acupoint selection for aphasia treated with acupuncture and moxibustion using data mining technology.@*METHODS@#From January 1, 2000 to April 1, 2022, the articles for clinical researches of acupuncture and moxibustion for aphasia published in CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase were searched. Using Microsoft Excel 2021, the database was set up to analyze the use frequency of acupoint, meridian tropism, acupoint distribution and the use of specific points. SPSS26.0 was adopted for factor analysis, SPSS Modeler 18.0 was for association rule analysis of prescriptions, and Gephi 0.9.5 was to plot the co-occurrence network diagrams of acupoints and meridians.@*RESULTS@#A total of 140 articles were collated, including 146 acupuncture and moxibustion prescriptions and 189 acupoints. The total use frequency of these acupoints was 1 211. Lianquan (CV 23), Jinjin (EX-HN 12), Yuye (EX-HN 13), Baihui (GV 20) and Yamen (GV 15) were the top 5 acupoints of the high use frequency for aphasia treated with acupuncture and moxibustion. Among 189 acupoints collected, the extra points and empirical points were mostly selected. The top 3 involved meridians were the governor vessel, the gallbladder meridian of foot-shaoyang and the conception vessel. These acupoints were mostly distributed on the head, face and neck region. The use frequency of five-shu points was the highest among the specific points. The acupoint combinations of high frequency referred to Yuye (EX-HN 13)-Jinjin (EX-HN 12), Yuye (EX-HN 13)-Lianquan (CV 23)-Jinjin (EX-HN 12), and Fengchi (GB 20)-Yuye (EX-HN 13)-Jinjin (EX-HN 12). Factor analysis extracted 10 common factors for acupoint compatibility in treatment of aphasia with acupuncture and moxibustion.@*CONCLUSION@#In clinical treatment of aphasia with acupuncture and moxibustion, the local acupoints are preferred. The core acupoints include Lianquan (CV 23), Jinjin (EX-HN 12), Yuye (EX-HN 13), Baihui (GV 20) and Yamen (GV 15). The acupoint prescription is modified flexibly according to syndrome differentiation to enhance the therapeutic effect.

Kaiqiao Jieyin acupuncture combined with repetitive transcranial magnetic stimulation for post-stroke aphasia: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of Kaiqiao Jieyin acupuncture (acupuncture for opening orifices and relieving aphasia) combined with repetitive transcranial magnetic stimulation (rTMS) on language ability and daily life communication ability in patients with post-stroke aphasia (PSA).@*METHODS@#Fifty-six patients with PSA were randomly divided into an observation group and a control group, 28 cases in each group. Both groups received routine symptomatic treatment. The control group was treated with speech rehabilitation training and rTMS. On the basis of the treatment in the control group, the observation group was treated with Kaiqiao Jieyin acupuncture at the speech area Ⅰ, Fengchi (GB 20), Tongli (HT 5), Lianquan (CV 23), Panglianquan (Extra), etc. Panglianquan (Extra) on both sides were connected to electroacupuncture, with intermittent wave, 2 Hz in frequency. The above treatment was performed once a day for 5 consecutive days, followed by 2 days of rest for 2 weeks. The scores of western aphasia battery (WAB, including scores of spontaneous speech, auditory comprehension, repetition, naming and score of aphasia quotient [AQ]) and communication abilities in daily living (CADL) in the two groups were compared before and after treatment.@*RESULTS@#After treatment, the spontaneous speech, auditory comprehension, repetition, naming scores and AQ scores in both groups were higher than those before treatment (P<0.05), and the increase in the observation group was greater than the control group (P<0.05). The CADL scores of the two groups were higher than those before treatment (P<0.05).@*CONCLUSION@#Kaiqiao Jieyin acupuncture combined with rTMS can improve the language ability and daily life communication ability of PSA patients.

Formal language assessment in low-educated persons with aphasia: can the lesion effect be distinguished from the education effect? / Avaliação da linguagem em pacientes afásicos com baixa escolaridade: o impacto da lesão neurológica pode ser discriminado da baixa escolaridade?

ABSTRACT Background: Language tests are important in the assessment and follow up of people with aphasia (PWA). However, language assessment in the low literacy population is still a challenge. Objective: To investigate whether a formal evaluation of aphasia is able to distinguish the neurological effect from the effect of low educational level in people with post-stroke aphasia. Methods: The sample consisted of a group of 30 aphasic subjects (AG) and a control group (CG) of 36 individuals, both with an educational level of 1-4 years. The Brazilian Montreal-Toulouse Language Assessment battery was applied to all subjects. Results: There were statistically significant differences between the groups in 19 out of the 20 tasks analyzed. Conclusions: These results suggest that formal evaluation procedures are able to detect language disorders resulting from stroke, even in subjects with low educational level.

RESUMO Antecedentes: Os testes de linguagem são importantes para a avaliação e o acompanhamento de pacientes afásicos. Apesar disso, a avaliação de linguagem em indivíduos com baixa escolaridade ainda é um desafio. Objetivo: Investigar se a avaliação formal da afasia é capaz de diferenciar o efeito da lesão neurológica versus o efeito da baixa escolaridade em pacientes afásicos, acometidos por acidente vascular cerebral (AVC). Métodos: A amostra foi composta de um grupo de 30 sujeitos afásicos (AG) e um grupo controle (CG) de 36 indivíduos, todos com um a quatro anos de escolaridade. A Bateria Montreal-Toulouse de Avaliação da Linguagem foi administrada a todos os participantes. Resultados: Das 20 tarefas analisadas, 19 apresentaram diferenças significativas entre os grupos. Conclusões: Os resultados sugerem que procedimentos formais de avaliação são capazes de identificar as alterações linguísticas ocasionadas por um AVC, também em pacientes com baixa escolaridade.

Profil clinique de la surdité de l'enfant à Yaoundé / Clinical profile of child deafness in Yaounde

In Cameroon, the prevalence of deafness in children is 3.6%. The aim of this study was to describe the clinical profile of these hearing impaired children at the time of diagnosis. Patients and methods.This was a descriptive cross-sectional study that took place between November 2020 and June 2021 and involved 127 hearing impaired children. Results.The mean age of these children was 9.2 ± 3.9 years, with extreme values of 1 and 15 years. The sex ratio was 1.3. The average number of children in the siblings was 3.5 ± 1.8 children and 30.7% occupied the 1st rank in their siblings. The average birth weight was 3269 ± 0.685g. The neonatal history was found in 11.81% of the cases while the postnatal history related to 32.28% of the cases. Maternal alcoholism and parental genital infections were found during pregnancy. Familial deafness was found in one of the mothers (0.4%) and in the siblings in 3.1% (n=4). At the time of diagnosis, the median age was between 0 and 24 months, the mode of onset was old and 96.9% of children had bilateral deafness. The absence of reaction to noise and the delay of language were the most found modes of revelation. Moderate and severe deafness were the most represented and were mostly sensory or mixed. Among these deaf children, 4%presented a handicap or an associated pathology. Conclusion.The causes of child deafness in Yaoundé are acquired in perinatal period. This deafness is diagnosed in the perilingual period and remains dominated by bilateral deafness, whether severe or profound

Combining electroacupuncture and transcranial direct current stimulation as an adjuvant therapy enhances spontaneous conversation and naming in subacute vascular aphasia: A retrospective analysis / 中西医结合学报

OBJECTIVE@#Emerging evidence shows the effectiveness of speech and language therapy (SLT); however, precise therapeutic parameters remain unclear. Evidence for the use of adjunctive transcranial direct current stimulation (tDCS) to treat post-stroke aphasia (PSA) is promising; however, the utility of combining tDCS and electroacupuncture (EA) has not yet been analyzed. This study assessed the therapeutic consequences of EA and tDCS coupled with SLT in subacute PSA patients who were also undergoing hyperbaric oxygen therapy (HBOT).@*METHODS@#A retrospective analysis was conducted on subacute (< 6 months) PSA patients who were divided into three groups: patients who received EA plus tDCS (acupuncture group), patients who underwent tDCS (tDCS group), and patients who experienced conventional therapy (HBOT + SLT). All subjects underwent 21 days of treatment and also received conventional treatment. The aphasia battery of Chinese (ABC) was used to score pre- and post-intervention status.@*RESULTS@#The analysis comprised 238 patients. Cerebral infarction was the most frequent stroke type (137 [57.6%]), while motor (66 [27.7%]) and global aphasia (60 [25.2%]) were the most common types of aphasia. After 21 days of intervention, the ABC scores of all patients were improved. The acupuncture group had the highest ABC scores, but only repetition, naming, and spontaneous speech were statistically improved (P < 0.01). Post-hoc tests revealed significant improvement in word retrieval in the acupuncture and tDCS groups (P < 0.01, P = 0.037), while the acupuncture group had additional significant improvement in spontaneous conversation (P < 0.01).@*CONCLUSION@#Combining acupuncture and tDCS as an adjuvant therapy for subacute PSA led to significant spontaneous speech and word retrieval improvements. Future prospective, multi-ethnic, multi-center trials are warranted.

Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia: A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials / 中国结合医学杂志

OBJECTIVE@#To evaluate the existing randomized controlled trials (RCTs) for evidence of the efficacy and safety of head acupuncture (HA) plus Schuell's language rehabilitation (SLR) in post-stroke aphasia.@*METHODS@#Seven databases including Embase, PubMed, Cochrane Library, Technology Periodical Database, the China National Knowledge Infrastructure, SinoMed and Wanfang Data Information Site were searched for RCTs published from database inception until November 14, 2021. RCTs that compared HA plus SLR with sham (or blank) control, acupuncture therapy alone, certain language rehabilitation therapy alone or other therapies for post-stroke aphasia were included. Data were extracted and assessed, and the quality of RCTs was evaluated. Fixed-effects model was used, with meta-inflfluence analysis, meta-regression, and regression-based sub-group analyses applied for exploration of heterogeneity. Publication bias was estimated by funnel plots and Egger's tests.@*RESULTS@#A total of 32 RCTs with 1,968 patients were included and 51 comparisons were conducted classified as types of strokes and aphasia. (1) For patients with aphasia after ischemic stroke, HA plus PSA showed significantly higher accumulative markedly effective rate [relative risk (RR)=1.55, 95% confidence interval (CI): 1.19-2.02, I2=0%] and accumulative effective rate (RR=1.22, 95% CI: 1.09-1.36, I2=0%). (2) For patients with comprehensive types of stroke, HA plus PSA was more effective in increasing recovery rate (RR=1.89, 95% CI: 1.39-2.56, I2=0%), accumulative markedly effective rate (RR=1.53, 95% CI: 1.36-1.72, I2=9%) and accumulative effective rate (RR=1.14, 95% CI: 1.09-1.19, I2=34%). (3) For patients with aphasia after stroke, HA plus PSA was superior to PSA alone with statistical significance in increasing recovery rate (RR=2.08, 95% CI: 1.24-3.46, I2=0%), accumulative markedly effective rate (RR=1.49, 95% CI: 1.24-1.78, I2=0%) and accumulative effective rate (RR=1.15, 95% CI: 1.06-1.24, I2=39%). (4) For patients with multiple types of aphasia, HA plus PSA also demonstrated significantly higher recovery rate (RR=1.86, 95% CI: 1.28-2.72, I2=0%), accumulative markedly effective rate (RR=1.55, 95% CI: 1.35-1.78, I2=22%), and accumulative effective rate (RR=1.17, 95% CI: 1.11-1.23, I2=41%). (5) For patients with motor aphasia after ischemic stroke, compared with PSA alone, HA plus PSA showed significantly higher accumulative markedly effective rate (RR=1.38, 95% CI: 1.06-1.79, I2=0%) and accumulative effective rate (RR=1.20, 95% CI: 1.05-1.37, I2=0%). Meta-regression analyses were performed without significant difference, and publication bias was found in some comparisons.@*CONCLUSION@#HA plus SLR was significantly associated with better language ability and higher effective rate for patients with post-stroke aphasia, and HA should be operated cautiously especially during acupuncture at eye and neck. (Registration No. CRD42020154475).

Associação entre o número de deglutições, resíduo faríngeo e broncoaspiração na esclerose múltipla / Association between the number of swallowing, pharyngeal residue and bronchopulmonary aspiration in multiple sclerosis

RESUMO Objetivo verificar a associação entre o número de deglutições e presença de resíduo faríngeo e broncoaspiração em pessoas com esclerose múltipla. Métodos estudo transversal observacional de exames de videofluoroscopia de 231 deglutições de indivíduos com esclerose múltipla. Três fonoaudiólogas avaliaram as deglutições de IDDSI 1 (International Dysphagia Diet Standardisation Initiative) (5 ml e 10 ml) e IDDSI 4 (8 ml) quanto à presença de resíduo faríngeo e de penetração/aspiração. Deglutições que não apresentaram resíduo faríngeo foram classificadas como deglutições sem resíduos faríngeos (DSR) e as que apresentaram, como deglutições com resíduos faríngeos (DCR), sendo estas últimas subdivididas em resíduos faríngeos em todas as ofertas ou eventuais (DCR1 e DCR2). O número de deglutições foi analisado por um avaliador cego e comparado com os dados demográficos e clínicos. Resultados das 231 deglutições, 73 (31,6%) apresentaram resíduos faríngeos. O número médio de deglutições foi semelhante nas deglutições sem e com resíduos faríngeos em cada consistência e volume e nas variáveis idade, gênero, tipo de esclerose múltipla e incapacidade funcional. Houve associação entre a média do número de deglutições e a ausência de penetração/aspiração, quando comparada às deglutições sem e com resíduos faríngeos, nas DCR2 e em indivíduos acima de 50 anos. Ao analisar intragrupo, observou-se associação nas DCR, sendo maior na ausência de penetração/aspiração e nas DCR2. Conclusão não houve correlação entre o número de deglutições e a presença de resíduos em recessos faríngeos na esclerose múltipla. Todavia, o número de deglutições foi maior quando houve resíduo e ausência de disfagia e de penetração/aspiração, em indivíduos mais velhos.

ABSTRACT Purpose To verify the association between the number of swallows and the presence of pharyngeal residue and bronchoaspiration in people with Multiple Sclerosis. Methods An observational cross-sectional study of videofluoroscopic examinations of 231 swallows from individuals with Multiple Sclerosis. Three speech therapists evaluated IDDSI 1 (International Dysphagia Diet Standardisation Initiative) (5ml and 10ml) and IDDSI 4 (8ml) deglutitions for pharyngeal residue and penetration/ aspiration. Swallows with no pharyngeal residue were classified as swallows without pharyngeal residue (SWTR) and those with pharyngeal residue (SWR), the latter subdivided into pharyngeal residue in all or occasional offerings (SWR1 e SWR2). The number of swallows was analyzed by a blind evaluator and compared with demographic and clinical data. Results Of the 231 swallows, 73 (31.6%) showed pharyngeal residues. The mean number of swallows was similar in the deglutitions with and without pharyngeal residues in each consistency and volume and in the variables age, gender, type of Multiple Sclerosis and functional disability. There was an association between the mean number of swallows and the absence of penetration/aspiration when comparing deglutitions with and without pharyngeal residues, in SWR2 and in individuals over 50 years of age. When analyzing intragroup, an association was observed in SWR, being higher in the absence of penetration/aspiration and in SWR2. Conclusion There was no correlation between the number of swallows and the presence of residues in pharyngeal recesses in multiple sclerosis. However, the number of swallows was higher when there was residue and absence of dysphagia and penetration/aspiration, and in older individuals.

Desfechos de deglutição e alimentação associados à intubação orotraqueal e à traqueostomia em pediatria / Swallowing and feeding outcomes associated with orotracheal intubation and tracheostomy in pediatrics

RESUMO Objetivo verificar os desfechos de deglutição e alimentação de pacientes pediátricos submetidos à intubação orotraqueal (IOT) prolongada, considerando aqueles que evoluíram para traqueostomia após. Métodos estudo de coorte retrospectivo, realizado por meio da análise de prontuários de pacientes admitidos em Unidade de Terapia Intensiva Pediátrica e acompanhados até a alta hospitalar, entre março de 2017 e dezembro de 2018. Resultados dos 51 pacientes incluídos, 64,7% eram do gênero masculino e a mediana de idade foi de 6,7 meses. Pacientes submetidos à IOT por mediana de sete dias apresentaram disfagia orofaríngea (DOF) leve e, quando submetidos a mais de 14 dias, apresentaram DOF moderada/grave, distúrbio alimentar pediátrico (DAP) com características de recusa alimentar e contraindicação de alimentação por via oral na alta hospitalar. Dentre os pacientes, 74,5% foram submetidos apenas à IOT e 25,5% evoluíram para traqueostomia, após. Pacientes traqueostomizados apresentaram maior ocorrência de alta hospitalar com DOF moderada/grave, DAP com características de recusa alimentar e uso de via alternativa de alimentação, em comparação a pacientes sem traqueostomia (p=0,001). Comparado ao diagnóstico inicial, pacientes não traqueostomizados tiveram diagnóstico final com graus mais leves de disfagia (p<0,001). Conclusão o tempo de IOT e a presença de traqueostomia são fatores associados ao diagnóstico fonoaudiológico de DOF moderada/grave, à presença de sinais de DAP com características de recusa alimentar e à necessidade de via alternativa de alimentação, persistentes até a alta hospitalar, sendo achados fonoaudiológicos frequentes entre os desfechos de deglutição/alimentação em pediatria.

ABSTRACT Purpose To verify the swallowing and feeding outcomes of pediatric patients undergoing prolonged OTI, considering those who progressed to tracheostomy afterward. Methods Retrospective cohort study, carried out by analyzing the medical records of patients admitted to the Pediatric ICU and followed up until hospital discharge, between 03/2017 and 12/2018. Results Of the 51 patients included, 64.7% were male and the median age 6.7 months. Patients undergoing OTI for a median of 7 days had mild dysphagia and when submitted for more than 14 days had moderate/severe dysphagia and PFD with characteristics of food refusal, with contraindication to oral feeding at hospital discharge. 74.5% of the patients underwent OTI only and 25.5% progressed to tracheostomy afterward. Tracheostomized patients had a higher occurrence of hospital discharge with moderate/ severe oropharyngeal dysphagia, pediatric feeding disorder (PFD) with characteristics of food refusal and alternative method of feeding compared to patients without tracheostomy (p=0.001). Non-tracheostomized patients had a final diagnosis with milder degrees of dysphagia when compared to the initial diagnosis (p<0.001). Conclusion The time of OTI and the presence of tracheostomy are factors associated with the speech-language pathology diagnosis of moderate/severe oropharyngeal dysphagia, presence of signs of PFD with characteristics of food refusal and the need for an alternative method of feeding that persists until hospital discharge, being frequent findings among the swallowing/feeding outcomes in pediatrics.

Afasia global. Documentación de 3 años tratamiento desde la fase aguda a crónica / Global aphasia. Documentation of 3 years of treatment from acute to chronic phase

Aphasia as a sequel to stroke is present between 14-28% worldwide and in 20% in the Chilean population. The most serious form is called global aphasia, with a severe alteration of the comprehensive and expressive language, with a poor communicative prognosis and quality of life for the patient and families. The objective of this case is to describe the evolution of a person with global aphasia from the acute phase to 3 years of speech therapy treatment, who achieved a successful evolution of their language, communication and quality of life. This paper presented anamnestic data of the case, initial and systematic evaluation of linguistic functions and impact on quality of life, and the results that document its progress in 3 years. Also, this case is described dynamic person-centered treatment and methodology to start in the acute phase with severe compromise (aphasic cocient 6/100 Cutoff 93.8) and after 3 years improve to mild-moderate aphasia (76/100 points). Progress in vitality, communication, physical and psychosocial aspects and the mean quality of life score are described quantitatively. (AU)

Aphasia assessment: impact of material on naming performance / Avaliação da afasia: impacto do material no desempenho da nomeação

ABSTRACT Background: Naming and lexical retrieval difficulties are common symptoms of aphasia. Naming abilities are usually evaluated by means of real objects or pictures or line drawings that are printed. Objective: The aim of this study was to investigate whether the ability to name objects among individuals with aphasia is influenced by the dimensions of the visual stimuli and to understand whether the order of presentation of the stimuli, number of years of education and length of time post-onset are involved in the success of naming. Methods: The naming abilities of healthy controls and patients with acute or chronic aphasia due to stroke were assessed through presentation of two sets of 24 stimuli consisting of real objects and color photographs of the same objects presented on a screen. The results obtained under these two conditions were compared by means of within-subject paired ANOVA, controlling for presentation order. Results: 40 patients (62.4 ± 17.3 years old; 70% females; mean education level of 8.5 ± 5.3 years; and 60% evaluated within the first eight days after stroke) and 50 controls that were age, gender and education-matched were included. Object naming was significantly better than naming color photographs among the patients (p = 0.001), but no differences were observed among the controls. Age, education, length of time post-onset and presentation sequence did not have any impact on naming performance. Conclusion: These results suggest that use of digital color photographs for naming objects in assessment of aphasia may be associated with lower naming performance, compared with use of real objects. This needs to be taken into account when different forms of stimuli are presented in sequential aphasia evaluations.

RESUMO Antecedentes: As dificuldades de nomeação e de evocação lexical são sintomas comuns de afasia. A nomeação é geralmente avaliada por objetos reais, imagens ou desenhos de contorno, impressos. Objetivo: Este estudo visa investigar se a capacidade de nomear objetos em pessoas com afasia é influenciada pelas dimensões dos estímulos visuais e compreender se a ordem de apresentação dos estímulos, os anos de escolaridade e o tempo de evolução estão envolvidos no sucesso da nomeação. Métodos: A nomeação de pessoas saudáveis e pessoas com afasia, em fase aguda ou crónica, por AVC foi avaliada com dois conjuntos de 24 estímulos, objetos reais e fotografias a cores, dos mesmos objetos, apresentadas num ecrã. Os resultados obtidos nas duas condições foram comparados por uma ANOVA para amostras emparelhadas, controlando para a ordem de apresentação. Resultados: Foram incluídos 40 sujeitos com afasia (62,4±17,3 anos de idade, 70% mulheres, com uma escolaridade média de 8,5±5,3 anos, 60% avaliados nos primeiros 8 dias após o acidente vascular cerebral) e um grupo de controlo de 50 pessoas saudáveis, emparelhadas para a idade, sexo e escolaridade. A nomeação de objetos foi significativamente melhor do que a nomeação de fotografias a cores (p=.001), mas isso não se verificou nos controles. A idade, a escolaridade, o tempo de evolução e a sequência de apresentação não tiveram impacto na nomeação dos dois tipos de estímulos. Conclusão: Estes resultados sugerem que a utilização de fotografias digitais a cores para avaliar a nomeação de objetos na afasia pode ser associada a um pior desempenho quando comparada com objetos reais. Isto deve ser tido em conta quando são apresentadas diferentes formas de estímulos nas reavaliações.

Afasia e inclusão social: panorama brasileiro na Fonoaudiologia / Aphasia and social inclusion: a Brazilian Speech-Therapy overview / Afasia y inclusión social: un panorama brasileño en Fonoaudiología

Introdução: Os impactos da afasia vão além de alterações de linguagem ou comunicação, afetando a qualidade de vida e a participação social. Faz-se necessário, portanto, que o fonoaudiólogo atue de forma interdisciplinar e amplie seu escopo de atuação na terapia das afasias, indo além de uma perspectiva que foca majoritariamente na correção de déficits linguísticos. Esta comunicação discute a importância de metas de incentivo à inclusão social e aponta caminhos para melhor atender às demandas dessa população. Objetivo: Discutir o trabalho do fonoaudiólogo no que tange a metas de enfrentamento dos impactos sociais da afasia. Método: Revisão não sistemática de literatura. São discutidos temas ligados à inclusão social e apresentadas iniciativas nacionais que promovem a participação social da pessoa com afasia. Resultados: Apesar das lacunas ainda existentes, as ações crescentes de diversos grupos de convivência, a criação de associações e as campanhas de conscientização da população apontam para importantes sinais de  mudança no escopo de atuação do fonoaudiólogo junto a essa população. Conclusão: Há um crescimento das intervenções em grupo e valorização de atividades artísticas oferecidas junto a pessoas que vivem com afasia. Os estudos sobre tais intervenções demonstram impactos positivos na qualidade de vida, participação social e funcionalidade da comunicação dessa população. São necessários esforços no sentido de trabalhar com a família e com a sociedade, bem como ampliar políticas públicas e oferecer serviços que promovam a inclusão social da pessoa com afasia.

Introduction: The impacts of aphasia are not restricted to changes in language or communication, and affect both quality of life and social participation. Therefore, it is essential that speech-language pathologists work within an interdisciplinary approach and their scope of action in aphasia therapy should not be restricted to correct language deficits. This study discusses the importance of social inclusion goals in aphasia therapy, suggesting ways to better meet the demands of this population. Objective: To discuss the role of speech-language pathologists in tackling the social impacts of aphasia. Method: This is a non-systematic literature review that addresses topics related to social inclusion, as well as current Brazilian initiatives that promote social participation for people with aphasia. Results: Despite remaining gaps, there are important signs of a change in perspective and scope of action of speech-language pathologists, such as increasing actions involving peer groups, the development of associations, as well as nation-wide awareness campaigns. Conclusion: There has been an increase in group interventions, as well as greater promotion of artistic activities for people with aphasia. Studies on these interventions report positive impacts on quality of life, social participation and functional communication for this population. Further combined efforts with family members and society as a whole are needed, as well as the promotion of policies and services that promote social inclusion for people with aphasia.

Introducción: los impactos de la afasia van más allá que las alteraciones de lenguaje o de comunicación, afectando la calidad de vida y la participación social. Sin embargo, es necesario que el logopeda trabaje de forma interdisciplinar y amplíe su alcance de atención a la terapia de afasia, más allá de una perspectiva centrada en la corrección de déficits lingüísticos. Esta comunicación analiza la importancia de metas de incentivo y de medidas de inclusión social para satisfacer mejor las demandas de esta población. Objetivo: Discutir el trabajo del logopeda en relación con las metas de enfrentamiento del impacto social de la afasia. Métodos: revisión no sistemática de literatura. Son discutidos temas relacionados con la inclusión social y la presentación de iniciativas brasileñas que promueven la participación social de la persona con afasia. Resultados: aún que existan faltas, las iniciativas crecientes de variados grupos de convivencia y la creación de asociaciones y de campañas de concientización indican haber cambios importantes en el ámbito de actuación del logopeda junto a esta población. Conclusión: Ha habido un aumento en las intervenciones en grupo y en las actividades artísticas ofrecidas a las personas que viven con afasia. Los estudios sobre estas intervenciones demuestran impactos positivos en la calidad de vida, la participación social y la funcionalidad de esta población. Son necesarios esfuerzos en el sentido de trabajar junto a familia y la sociedad, así como expandir las políticas públicas y el ofrecimiento de servicios que promuevan la inclusión social de la persona con afasia.

Post-stroke aphasia in famous writers: when Neurology left geniuses speechless / Afasia pós-AVC em escritores famosos: quando a Neurologia deixou gênios sem palavras

ABSTRACT Aphasia is a frequent and devastating stroke complication that does not spare even great writers. In these cases, not only one of the highest cognitive functions is suddenly lost but also the act of bringing beauty into the world. Herein, we discuss the case of three writers who had to abandon their art compulsorily due to a cerebrovascular disease: Charles Baudelaire, Ralph Waldo Emerson, and Stendhal. They were magnificent writers, united by excellence in literature and an inevitable destiny that restricted their art to just a few words. They are also examples of the proximity of Neurology to Art, History, and Literature.

RESUMO A afasia é uma complicação frequente e devastadora do acidente vascular cerebral (AVC), que não poupa nem mesmo os grandes escritores. Nesses casos, de repente, perde-se não apenas uma das funções cognitivas mais importantes, mas o ato de colocar a beleza no mundo. Discutimos o caso de três escritores que precisaram abandonar sua arte compulsoriamente devido a uma doença cerebrovascular: Charles Baudelaire, Ralph Waldo Emerson e Stendhal. Todos eles foram escritores magníficos, unidos pela excelência em literatura e por um destino inevitável que restringia sua arte a apenas algumas palavras. Eles também são exemplos da proximidade da Neurologia com a Arte, a História e a Literatura.

Corpo e linguagem: repercussões em um caso de disfagia / Body and language: repercussions on a dysphasia case

RESUMO Preenchido por tecidos e órgãos, o corpo é referenciado pela biologia e pela medicina a partir de sua arquitetura anatômica e biomecânica. Sabe-se, contudo, que há diferentes modos de compreender o corpo humano. Partindo do pressuposto de que se trata do corpo do ser que fala, a teoria e clínica psicanalítica nos mostra que o corpo é enlaçado pelo sujeito, atravessado pela linguagem e afetado pela palavra. No campo dos distúrbios de deglutição, mesmo que se aponte para as repercussões da ruptura no prazer alimentar e da privação de emoções gustativas, discussões teórico-clínicas que impliquem a relação entre corpo e linguagem são ainda incipientes. Esse trabalho objetivou discutir as consequências clínicas para o cuidado do sujeito disfágico de se levar em consideração a relação entre corpo e linguagem. A exposição do caso clínico revelou que marcas do acometimento neurológico colocaram em relevo a vulnerabilidade imposta pelo confronto radical com os efeitos da perda da condição corporal anterior, colocando o sujeito frente a um mal-estar que avançou na medida em que a perda do corpo implicou na perda de sua posição na linguagem e no enlace social que envolve o ato de comer. Diante desse cenário, foi fundamental para a eficácia do cuidado a abertura para o diálogo e para a escuta como ações clínicas norteadoras da aplicação de tecnologias dirigidas ao funcionamento orgânico. Esse passo só foi possível porque houve o reconhecimento de que o corpo humano ultrapassa a concepção de biomáquina já que é corpo falante.

ABSTRACT The human body is made of tissues and organs, and the body is mentioned by biology and medicine based on its anatomical and biomechanical architecture. However, there are different ways of understanding the human body. Based on the assumption that the body is the consistency of the speaker´s body-being, the psychoanalytic theory us that the body is crossed by language and affected by the word. In the field of swallowing disorders, even if it points to the repercussions of the rupture in eating pleasure and the deprivation of gustatory emotions, theoretical-clinical discussions that imply the relationship between body and language are still incipient. This work aimed to discuss the clinical consequences for the care of the dysphagic patient of taking into account the relationship between body and language. The presentation of the clinical case revealed that marks of neurological involvement highlighted the vulnerability imposed by the radical confrontation with the effects of the loss of the previous body condition, placing the subject in front of a malaise that advanced as the loss of the body implied in the loss of their position in language and in the social connection that involves the act of eating. Owing to this scenario, it was essential for evaluating the effectiveness of care to open up a dialogue and pay attention to clinical actions which guide the application of technologies aimed at organic functioning. This step was only possible because there was a recognition that the human body goes beyond the concept of a machine since it is identified with a speaking body.

Trastornos de la comunicación en personas con esclerosis múltiple e instrumentos de evaluación / Communication disorders in people with multiple sclerosis and evaluations instruments

Communication is an essential part of our social participation and the need to know how to evaluate and deal with its alterations is essential when working with people with neurological pathologies such as Multiple Sclerosis (MS). Purpose: to carry out a bibliographic review and group information related to communication problems, describing useful instruments for timely evaluation in the different areas involved. Material and method: bibliographic review related to the subject. Results: People with MS can face differents communication problems (aphasia, dysarthria or cognitive communicative disorder), it is important to have the characterization of these disorders and with tools that specifically carry out a pertinent evaluation with common language among experts. Conclusions: considering the importance of communication, its disorders as a consequence of MS and the forms of evaluation are a priority when intervening with this population. (AU)

Investigação da gravidade da Afasia em um hospital de urgência e emergência: estudo de caso / Investigating the gravity of Aphasia in an urgengy and emergency hospital: case study

Objetivo: Investigar a gravidade da afasia em uma paciente com Acidente Vascular Encefálico (AVE), a partir da aplicação de um teste considerado simples e rápido: o Aphasia Rapid Test (ART). Metodologia: a paciente de 63 anos foi admitida no pronto socorro de um hospital de urgência e emergência com hipótese diagnóstica de AVE, consciente e fora de qualquer procedimento invasivo que comprometesse sua comunicação. Resultados: na primeira avaliação, não apresentou alteração de linguagem. Na segunda, apresentou dificuldade na execução das provas de ordens simples e complexas, repetição de palavras e frases, na tarefa verbal de fluência semântica e na avaliação de disartria. Considerações finais: observou-se durante a pesquisa que no início da internação a paciente não apresentava gravidade para afasia, porém com o decorrer da internação evidenciou-se dificuldades na linguagem mostrando gravidade para o quadro de afasia, além disso, dificuldades motoras as quais comprometeram a realização das atividades de vida diária

Objective: Investigate the severity of aphasia in a patient with stroke, by applying a test considered simple and fast: the Aphasia Rapid Test (ART). Methodology: the 63-year-old patient was admitted to the emergency room of an urgent and emergency hospital with a diagnostic hypothesis of stroke, conscious and out of any invasive procedure that compromised her communication. Results: in the first evaluation, there was no change in language. In the second, he presented difficulty in carrying out the tests of simple and complex orders, repetition of words and phrases, in the verbal task of semantic fluency and in the evaluation of dysarthria. Final considerations: it was observed during the research that at the beginning of the hospitalization, the patient did not present severity for aphasia, however, with the course of hospitalization, language difficulties were evident, showing severity for the condition of aphasia, in addition, motor difficulties which compromised carrying out activities of daily living