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.

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).

Adesão ao tratamento fonoaudiológico por pessoas com afasia encaminhadas após alta hospitalar: estudo de dois casos / Adherence to speech-language therapy by people with aphasia referred after hospital discharge: study of two cases

RESUMO Diante da percepção do impacto na comunicação e na qualidade de vida ocasionado por um quadro de afasia, compreende-se a relevância da adesão ao tratamento fonoaudiológico. Porém, há casos em que a procura por tal tratamento não ocorre, por motivos que ainda não foram investigados de modo aprofundado. O objetivo deste estudo foi analisar a adesão ao tratamento fonoaudiológico de pessoas com afasia, encaminhadas após alta hospitalar. Foi realizado um estudo qualitativo de dois casos. Participaram deste estudo duas idosas com afasia após acidente vascular cerebral (AVC), acompanhadas em um hospital municipal de referência microrregional. Foi realizada a coleta de dados sociodemográficos e clínicos em prontuário e por meio de entrevista com um familiar de cada participante, durante a internação. Após dois meses, aproximadamente, foi realizada nova entrevista para investigar a procura por atendimento fonoaudiológico. A instalação de sequelas físicas pós-AVC, que afetam membro inferior, sua gravidade e a fase de recuperação contribuem para a não adesão ao tratamento fonoaudiológico público em nível ambulatorial, por pessoas com afasia. A interação entre fatores sociodemográficos, aspectos clínicos e características da rede pública de saúde (como a inexistência de fonoaudiólogo no serviço de atenção domiciliar) pode influenciar a procura por tratamento domiciliar particular nesses casos. É possível afirmar que múltiplos fatores, clínicos e sociodemográficos, influenciam a não procura por tratamento fonoaudiológico por essa população. Além disso, tais fatores indicam a existência de dificuldades no acesso a serviços de saúde públicos, por limitações na rede de atenção à saúde regional.

ABSTRACT Given the perceived impact on communication and quality of life of aphasia, the importance of adherence to speech therapy treatment is clear. However, there are cases in which this treatment is not sought, for reasons that have not been fully investigated. The aim of this study was to analyze adherence to speech therapy by people with aphasia referred after hospital discharge. A qualitative case study of two cases was carried out. Two elderly women with aphasia after stroke treated at a micro-regional public referral hospital participated in this study. Sociodemographic and clinical data were collected from patient medical records and drawn from an interview with a family member during hospitalization. After about two months, a second interview was conducted to investigate whether speech therapy had been sought. The presence of post-stroke physical sequelae affecting lower limbs, its severity, and the post-stroke recovery phase were all factors contributing to non-adherence to public outpatient speech-therapy treatment by these individuals with aphasia. The interaction between sociodemographic factors, clinical aspects and characteristics of the public health network (such as non-availability of speech therapists in the home-care service) can influence the seeking of private home-based treatment in these cases. Results revealed that multiple clinical and sociodemographic factors influence nonadherence to speech therapy in this population. In addition, these factors indicate difficulties accessing public health services as a result of shortcomings in the regional health care network.

Análise do reconhecimento populacional das figuras do sentence production program for aphasia / Analysis of population recognition of pictures from the sentence production program for aphasia

RESUMO Objetivo Analisar o reconhecimento das figuras e a familiaridade dos contextos do Sentence Production Program for Aphasia (SPPA), para obter dados sobre a possibilidade de uso para a língua portuguesa e/ou da necessidade de sua adaptação. Método Inicialmente, foi realizada a tradução dos estímulos por falantes do inglês e, em seguida, a retrotradução para ajustes sem a alteração das estruturas sintáticas das frases. O material foi então submetido para a análise de 39 indivíduos adultos de alta escolaridade. Na primeira fase do estudo, os adultos deveriam criar uma frase de acordo com cada figura apresentada. Na fase seguinte do estudo, os participantes foram expostos às frases originais associadas aos seus respectivos contextos. Os participantes receberam uma folha de registro das respostas com numeração segundo as figuras e julgaram a familiaridade dos contextos a partir de uma escala analógica de 0 a 10. Resultados Observou-se que a média geral de concordância dos estímulos com as respostas para as figuras do SPPA foi de 35,5%. Em relação à familiaridade dos contextos com as figuras, essa foi maior para as cenas relativas às frases com estrutura sintática mais usadas em português. Conclusão Pelo fato de os estímulos terem apresentado baixo grau de reconhecimento, adaptações serão necessárias para que o programa possa vir a ser utilizado na população brasileira. O estudo também permitiu identificar quais as figuras que necessitam de adaptação antes de serem usadas para a reabilitação de pacientes agramáticos no Brasil.

ABSTRACT Purpose To analyze the recognition of the pictures and contexts familiarity from the Sentence Production Program for Aphasia (SPPA) to acquire data determining its potential use in Portuguese and/or need for adaption. Methods The stimuli for English speakers were first translated, back-translated and adjusted without changing the syntactic structures of the phrases. The material was then tested in 39 highly literate individuals. In the first stage of the study, the adults had to produce a phrase corresponding to each picture. In the second stage, participants were exposed to the original phrases associated with their respective contexts. Participants were given an answer sheet containing numbered responses for each picture and rated the familiarity of the contexts on an analogic scale ranging from 0 to 10. Results Based on the sentences produced by the participants, the overall mean agreement of stimuli with responses for the pictures from the SPPA was 35.5%. Familiarity of the contexts with pictures was greater in scenes involving sentences with a syntactic structure similar to that of Portuguese. Conclusion Given most stimuli had a low level of recognition, adaptations are required for use of the program in the Brazilian population. The study allowed identification of those pictures which need adapting before use in the rehabilitation of agrammatic patients in Brazil.

Intervenção fonoaudiológica na afasia expressiva: revisão integrativa / Speech-language intervention in expressive aphasia: integrative review

RESUMO Introdução Por meio da intervenção fonoaudiológica, é possível diminuir os sintomas da afasia. Objetivos Verificar os métodos de intervenção fonoaudiológica na afasia expressiva. Estratégia de pesquisa Trata-se de uma revisão integrativa da literatura. Realizou-se a busca nas bases SciELO, PubMed e PsycINFO, no período de fevereiro a abril de 2018. Para as bases de dados PubMed e PsycINFO foram estabelecidos os descritores em inglês "non-fluent aphasia", OR "broca" OR "transcortical motor aphasia" OR "motor aphasia" OR "amnestic aphasia" OR "semantic aphasia" OR "dymanic aphasia" OR "anomi*" AND "intervention" OR "therapy" OR "rehabilitation" OR "treatment". Para base SciELO, apenas o descritor "aphasia". Critérios de seleção Artigos publicados nos últimos dez anos (de 2009 a 2018) em português, inglês ou espanhol foram incluídos, sendo ou não de periódicos de acesso livre, além de estudos com indivíduos com idade superior a 19 anos. Foram excluídos artigos não relacionados à terapia tradicional, estudos que não apresentassem indivíduos com afasia expressiva e aqueles que tratavam de distúrbios motores de fala, como disartria e apraxia pura. Estudos de revisão de literatura e que envolvessem participantes bilíngues também foram excluídos. Resultados Um total de 174 artigos foram encontrados. Após análise e aplicação dos critérios de seleção estabelecidos, foram selecionados 32 artigos completos. Entre as terapias tradicionais encontradas, observaram-se: terapia de recuperação de palavras, terapia melódica e terapia conversacional. Conclusão A terapia de recuperação de palavras foi o método tradicional mais utilizado.

ABSTRACT Introduction Aphasia symptoms can be improved via speech and language therapy. Purpose To analyze speech-language intervention methods in expressive aphasia. Research strategy An integrative review of the literature was performed using SciELO, PubMed and PsycINFO databases, from February to April 2018. The following search terms: "non-fluent aphasia", OR "broca" OR "transcortical motor aphasia" OR "motor aphasia" OR "amnestic aphasia" OR "semantic aphasia" OR "dymanic aphasia" OR "anomi*" AND "intervention" OR "therapy" OR "rehabilitation" OR "treatment" were used for PubMed and PsycINFO databases. In SciELO database, only the search term "aphasia" was used. Selection criteria Articles published in the last ten years (from 2009 to 2018) in Portuguese, English or Spanish, whether or not they were open access journals. Studies with participants older than 19 years were selected. Articles not related to traditional therapy were excluded, as well as those which did not present participants with expressive aphasia and those which treated speech motor disorders such as pure dysarthria and pure apraxia. Literature review studies and studies involving bilingual participants were also excluded. Results One hundred and seventy-four articles were found. After analysis and application of the established selection criteria, 32 complete articles were selected. Word retrieval therapy, melodic intonation therapy and conversation therapy were the traditional methods found in this study. Conclusion Word retrieval therapy was the method most commonly used.

Reabilitação pós-AVC: identificação de sinais e sintomas fonoaudiológicos por enfermeiros e médicos da Atenção Primária à Saúde / Post-stroke rehabilitation: identification of speech-language disorders signs and symptoms by physicians and nurses in Primary Health Care

RESUMO Objetivo O Acidente Vascular Cerebral (AVC) é um agravo comum para a população e um problema para a saúde pública global em termos de mortalidade, deficiência e demanda de custos. O objetivo deste estudo é verificar quais grupos de comorbidades ligados aos distúrbios fonoaudiológicos são identificados por médicos e enfermeiros das equipes de Estratégia de Saúde da Família (ESF) para encaminhamento à reabilitação fonoaudiológica e continuidade do cuidado de pacientes pós-AVC nas Atenções Primária e Secundária à Saúde (APS). Método Participaram 22 médicos e enfermeiros das equipes de ESF apoiadas pelo Núcleo de Apoio à Saúde da Família, no sul do Brasil. Um questionário desenvolvido para este estudo foi respondido, explorando variáveis sociodemográficas, histórico de formação, atuação profissional e condutas ao paciente com AVC. Análise descritiva dos dados (frequências absoluta e relativa) foi realizada no Software SPSS 22. Resultados Dos entrevistados, 77,3% encaminham pacientes pós-AVC para fisioterapia e 54,5%, para reabilitação fonoaudiológica. Nenhum profissional realiza encaminhamento por sequelas cognitivas de compreensão; 90,0% encaminham por distúrbios de linguagem expressiva na fala. Para alterações do sistema estomatognático, 80,0% dos médicos não encaminham para fonoaudiólogo e 83,3% dos enfermeiros o fazem. Conclusão Os profissionais demonstraram dificuldade em identificar distúrbios fonoaudiológicos ligados à cognição e ao sistema estomatognático, não encaminhando para reabilitação fonoaudiológica nas Atenções Primária e Secundária à Saúde. Os resultados apontam para a necessidade de ações que auxiliem no processo de educação permanente e melhorem o conhecimento das equipes de APS, para que as sequelas fonoaudiológicas sejam devidamente identificadas e encaminhadas para reabilitação.

ABSTRACT Purpose Stroke is a common disease for people and a global public health concern in terms of mortality, disability, and cost demand. This study aims to assess which groups of comorbidities related to speech-language disorders are identified by physicians and nurses of the Family Health Strategy (FHS) as to be referred to post-stroke speech-language rehabilitation at Primary and Secondary Health Care. Methods Twenty-two physicians and nurses, from the FHS supported by the Family Health Support Center in southern Brazil, answered a questionnaire developed for this study, exploring socio-demographic variables, education background, professional performance and conduct to post-stroke patients. A descriptive data analysis (absolute and relative frequencies) was performed in SPSS Software 22. Results Among the participants, 77.3% refer post-stroke patients to physiotherapy and 54.5% to speech-language rehabilitation. None refer to patients to treatment due to cognitive comprehension sequelae; 90.0% refer for significant speech-language disorders. In case of changes in the stomatognathic system, 80.0% of physicians do not refer to speech-language pathologists, and 83.3% of nurses usually do. Conclusion The professionals showed difficulty in identifying speech-language pathological signs and symptoms related to cognition and the stomatognathic system, not referring to speech-language rehabilitation at primary or secondary health care. The results highlight the importance of continuing education and improvement of the knowledge of the primary health care teams, so that speech-language sequelae are properly identified and sent for rehabilitation.

Non-invasive brain stimulation and computational models in post-stroke aphasic patients: single session of transcranial magnetic stimulation and transcranial direct current stimulation. A randomized clinical trial

ABSTRACT CONTEXT AND OBJECTIVE: Patients undergoing the same neuromodulation protocol may present different responses. Computational models may help in understanding such differences. The aims of this study were, firstly, to compare the performance of aphasic patients in naming tasks before and after one session of transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS) and sham, and analyze the results between these neuromodulation techniques; and secondly, through computational model on the cortex and surrounding tissues, to assess current flow distribution and responses among patients who received tDCS and presented different levels of results from naming tasks. DESIGN AND SETTING: Prospective, descriptive, qualitative and quantitative, double blind, randomized and placebo-controlled study conducted at Faculdade de Ciências Médicas da Santa Casa de São Paulo. METHODS: Patients with aphasia received one session of tDCS, TMS or sham stimulation. The time taken to name pictures and the response time were evaluated before and after neuromodulation. Selected patients from the first intervention underwent a computational model stimulation procedure that simulated tDCS. RESULTS: The results did not indicate any statistically significant differences from before to after the stimulation.The computational models showed different current flow distributions. CONCLUSIONS: The present study did not show any statistically significant difference between tDCS, TMS and sham stimulation regarding naming tasks. The patients'responses to the computational model showed different patterns of current distribution.

Afasia: una perspectiva clínica / Aphasia: a clinical perspective

Language is a complex and dynamic system of conventional signs that results from the functioning of different brain areas located mainly in the left hemisphere. Clinical evaluation of aphasia implicates the examination of oral and written language. Aphasia is an acquired language disorders due to a brain damage that affect all modalities: oral expression, auditory comprehension, reading and writing. Various types of aphasias can be induced, each with well defined clinical characteristics that can be correlated with specific areas of the brain. The prognosis depends mainly on the etiology, size of the lesion, type of aphasia and its severity. Treatment objectives include: satisfying the communicational needs of the patient, and achieving psychosocial adaptation of the subject and his family. Both objectives improve the quality of life of our patients...

Recuperación motora y funcional en pacientes con afasia secundaria a un ictus / Motor and functional recovery in patients with aphasia secondary to stroke

Introducción: se realizó un estudio observacional y prospectivo. Objetivo: evaluar la recuperación motora y funcional en pacientes con afasia secundaria a un ictus, incorporados al Programa de Restauración Neurológica del Centro Internacional de Restauración Neurológica. Métodos: se estudiaron 132 pacientes durante los años 2007-2012, en tratamiento durante 4 sem. Se agruparon según la presencia o no de afasia. Se compararon ambos grupos, según la recuperación motora y funcional, mediante la Escala Escandinava del Ictus y el índice de Barthel, respectivamente. Resultados: los grupos estudiados no presentaron diferencias significativas en cuanto a edad, sexo, condición motora y funcional inicial, tiempo de evolución y factores de riesgo vascular. La recuperación motora resultó significativa en ambos grupos (p=0,00), aunque el porcentaje de recuperación motora resultó superior en los pacientes con ictus no afásicos. La recuperación funcional resultó significativa en ambos grupos (p=0,00), existió una recuperación cualitativamente superior en el ictus no afásico donde se identificó una mejora en las habilidades manipulativas (p=0,00), que no resultó significativa en el ictus con afasia. Conclusión: ambos grupos se beneficiaron con el tratamiento aplicado, sin embargo, los pacientes afásicos experimentaron menor recuperación motora y funcional, en comparación con los pacientes no afásicos

Introduction: an observational and prospective study was carried out. Objective: to evaluate motor and functional recovery in patients with aphasia secondary to a stroke, who were included in the Neurological Restoration Program of International Center of Neurological Restoration. Methods: 132 patients were studied from 2007 to 2012; they were in treatment during 4 weeks and they were grouped according to the presence or absence of aphasia. Comparisons between both groups were carried out according to their motor and functional recovery by using Scandinavian Stroke Scale and Barthel Index respectively. Results: significant differences were not found in the studied groups concerning age, sex, motor and functional initial conditions, evolution time and vascular risk factors. Motor recovery was significant in both groups (p=0,00), although motor recovery percent was higher in the patients with non aphasic stroke. Functional recovery was significant in both groups (p=0,00), a higher quality recovery was seen in non aphasic stroke patients, and improvement was identified in hand abilities (p=0,00) which was not significant in stroke with aphasia. Conclusion: both groups were benefitted with the applied treatment, however, the aphasic patients experienced a lower motor and functional recovery, in comparison with the non aphasic patients

Tradução portuguesa e análise de aspectos psicométricos da escala "Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39)" / Portuguese translation and psychometric properties of the Portuguese version of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39)

OBJETIVO: Efetuar a tradução e analisar os aspectos psicométricos da adaptação portuguesa da Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39). Essa escala possui quatro domínios (Físico, Psicossocial, Comunicação e Energia) e foi criada especificamente para pacientes com afasia. MÉTODOS: Foi realizada a tradução e retroversão, a partir da escala original. A versão portuguesa foi aplicada em 33 pacientes com afasia. A avaliação da consistência interna foi obtida através do Alfa de Cronbach e foi efetuado um teste-reteste em 12 pacientes. Foram igualmente utilizados os coeficientes de Pearson e Spearman, para correlacionar os subdomínios da prova e os diferentes dados clínicos e biográficos. RESULTADOS: A versão portuguesa da SAQOL-39 manteve o mesmo formato da versão original, em tamanho e conteúdo semântico. O Alfa de Cronbach da SAQOL-39 foi 0,953 e variou entre 0,882 (domínio psicossocial) e 0,971 (domínio Físico). Os resultados do teste-reteste, referentes à SAQOL-39, foram de 0,927 e variaram de 0,80 a 0,97, entre os diferentes subdomínios. Não se verificou efeito de teto e não houve dados omissos. Não foram encontradas diferenças significativas entre o total da SAQOL-39 e a idade, ou a escolaridade. No entanto, evidenciou-se correlação significativa entre o Quociente de Afasia e o subdomínio Comunicação (r=0,62, p=0,000). CONCLUSÃO: Apesar do tamanho reduzido da amostra, a versão portuguesa da SAQOL-39 apresentou bons valores psicométricos. Este estudo mostra, igualmente, dados preliminares de boa aceitabilidade e confiabilidade dessa adaptação e realça a importância da avaliação da qualidade de vida em pacientes com alterações graves de linguagem.

PURPOSE: The main goals of this study were to translate and assess the psychometric properties and reliability of the Portuguese version of the SAQOL-39 in a group of chronic aphasia patients. METHODS: We used the translation and retroversion method from the original scale to ensure conceptual uniformity. The instrument was administered to 33 aphasia patients. Internal consistency was assessed with Cronbach´s alpha and test-retest reliability was explored (n=12). We also used Pearson´s and Spearman´s correlation coefficients to determine the correlations between the SAQOL-39 domains and other social and clinical variables. RESULTS: The translation process from the original scale was completed without difficulties. Cronbach´s alpha for SAQOL-39 was 0.953 and for each subdomain ranged from 0.882 (Psychosocial) to 0.971 (Physical). The test-retest reliability for total SAQOL-39 was 0.927 and for each subdomain ranged from 0.80 to 0.97. The global scores show neither floor nor ceiling effect and there were no missing data. There was no significant association between the total SAQOL-39 score and either age or years of education. We found a significant correlation between the Communication domain mean score and the Aphasia Quotient outcome (r=0.62, p=0.000). CONCLUSION: Despite the small sample size, the Portuguese version of the SAQOL-39 showed good internal consistency and test-retest reliability. This study also showed preliminary evidence for good acceptability, feasibility and reliability of this adaptation. The importance of communication ability in perceiving the quality of life in patients with aphasia has also been highlighted.

Rehabilitation of oropharyngeal dysphagia in children with cerebral palsy: A systematic review of the speech therapy approach

Introduction: There are an estimated 30,000-40,000 new cases of cerebral palsy per year in Brazil. Motor disorders caused by cerebral palsy can lead to dysphagia as they may alter the preparatory, oral, pharyngeal, and esophageal phases. Aim: To identify existing rehabilitation methods of swallowing disorders in cerebral palsy, with emphasis on the pursuit of research using the Bobath concept, the Castillo Morales concept, oral sensorimotor therapy, and continuing education. Summary of the findings: We performed a systematic review of the medical and speech therapy literature on the rehabilitation of oropharyngeal dysphagia in children with cerebral palsy spanning 1977-2010 and from all languages and nations. Among the 310 articles retrieved, only 22 (7.09%) addressed therapeutic rehabilitation of oropharyngeal dysphagia in children with cerebral palsy. Of the 22 reports, 12 (54.5%) were from Canada, 3 (13.6%) were from Japan, 2 (9%) were from Brazil, 2 (9%) were from Germany, 1 (4.5%) was from the USA, 1 (4.5%) was from the United Kingdom, and 1 (4.5%) was from Poland. Of these reports, 63.6% used oral sensorimotor therapy as a therapeutic method, 36.3% reported continuing education as a therapeutic approach, and only 18.1% and 9% used the Bobath concept and Castillo Morales concept, respectively. Conclusion: Even with a constantly increasing cerebral palsy population, few studies include (re)habilitation in the treatment of oropharyngeal dysphagia in these children...

A reabilitação do sujeito afásico: uma visão sociointeracionista: [revisão] / El sujeto afásico y la rehabilitación: una perspectiva sociointeraccionista: [revisión] / Aphasic subjects rehabilitation: a social-interactionist perspective: [review]

A afasia encontra-se entre as diversas patologias que afetam a linguagem e pode acarretar alterações na vida social, profissional, emocional e pessoal de indivíduos que a possuem. Faz-se necessário pesquisar sobre o impacto gerado pela privação da linguagemna vida desses indivíduos, o que possibilitará ao terapeuta elaborações de estratégias de reabilitação, para que esses sujeitos consigam significar e contextualizar a linguagem participando novamente de diferentes situações interacionais. O presente trabalho teve como objetivo abordar as contribuições da teoria sociointeracionista de aquisição da linguagem na terapia de sujeitos afásicos, pesquisando as implicações das alterações de linguagem no processo interacional e nos aspectos sociais e emocionais desses indivíduos. Para a realização do estudo, foram utilizadas pesquisas em livros didáticos, artigos científicos e leitura on-line.

Aphasia is among the different pathologies that affect language and may cause alterations in social, professional, emotional and personal life of individuals affected by it. It is necessary to investigate the impact generated by language privation in the life of these individuals, something which will allow the therapist to propose rehabilitation strategies, so that these subjects regain the ability for meaning making and to contextualize language, participating on different interaction situations. The present work aimed atapproaching the contributions of the social-interactionist theory of language acquisition in the therapy of aphasic subjects, looking for the implications of language alterations in the interactional process and the social and emotional aspects of these individuals. For the accomplishment of the study, we did on-line searches in manuals, scientific articles and reading.

La afasia está entre las diversas patologías que afectan al lenguaje y pueden causar alteraciones en la vida social, profesional, emocional y personal de los individuos afectados. Es necesario investigar el impacto generado por la privación del lenguaje en la vida de estos individuos, algo que permitirá que el terapeuta proponga estrategias de la rehabilitación, de modo que estos temas recuperen la capacidad para el significado y la contextualización del uso del lenguaje, participando en diversas situaciones de interacción. El trabajo tuvo como objetivo acercar las contribuciones de la teoría sociointeraccionista de la adquisición del lenguaje en la terapia de sujetos afásicos, buscando las implicaciones de las alteraciones del lenguaje en el proceso interaccional y los aspectos sociales y emocionales de estos individuos. Para la realización del estudio, hicimos búsquedas en línea en manuales, artículos científicos y lecturas.

Reflexiones en torno al equipo interdisciplinario: eje y sotén en el abordaje de los trastornos neurolingüistico desde la perspectiva fonoaudiológica / Reflections on the interdisciplinary team

El objetivo de esta presentación es reflexionar acerca del rol del equipo interdisciplinario en el abordaje de los trastornos neurolingüísticas desde la perspectiva fonoaudiológica, a partir de los hallazgos de una investigación que abordó el trabajo en equipo interdisciplinario para la atención temprana del paciente afásico. El propósito perseguido es instalar en los espacios de formación de la disciplina fonoaudiológica, en particular, y en las del campo de la salud, en general, la discusión/inclusión de núcleos temáticos con una visión interdisciplinaria. En este sentido se afirma que la interacción entre los diferentes campos disciplinares debe ser incorporada como una práctica más, que debe ser aprehendida y ejercida desde el inicio de la formación de grado para un futuro beneficio de la salud y la calidad de vida de la población. Se realiza una revisión de los conceptos de disciplina, multidisciplina, interdisciplina y transdisciplina a fin de enmarcar el trabajo de equipo y se profundiza en la labor interdisciplinaria. Se describe los aportes que, desde diferentes disciplinas, confluyen en la rehabilitación del paciente afásico y la necesidad de que el equipo maneje un mismo lenguaje y trabaje de una manera integral e integrada, para lo cual es imprescindible trascender los límites de las disciplinas en aras de lograr un diálogo entre los saberes.

Several professionals, implicated in the treatment of neurolinguistic deficits/aphasia, were surveyed on the subject of the need of a team approach, who were the team members, how the team worked and how did they apply the concepts in their practice. Based on their responses, the authors establish to rigorously reflect on the role of the interdisciplinary team in the approach to the above mentioned pathology.The ultimate goal is to foster the inclusion of the concept of team approach in the institutions where speech pathology and other health care professions are taught; in view of this goal, the authors insist that the interaction between the different disciplines must be incorporated as an essential element to the clinical practice for the benefit of the client’s wellbeing.The concepts of discipline, multidiscipline, interdiscipline and transdiscipline are revised in order to provide a framework for the team, and a special emphasis is made in interdiscipline. The elements brought by each discipline to the treatment and rehabilitation of the client as well as the commonality in language and the intent to work in an integrated and full manner are presented. The most important aspect brought to the fore is the needto transcend the individual professional limits to establish a true exchange of knowledge in view of the client’s wellbeing.

The neurolinguistic statute of perseveration in aphasia / O estatuto neurolinguístico da perseveração na afasia

The aim of this study was to investigate perseveration in two contexts: spontaneous language and linguistic tasks. It points toward perseveration as a theoretical linguistic conception, that is, sociointeractionist. This presupposes language activity produced in an interlocutive space and it does not neglect pragmatic aspects and contextual use of language. Four patients presenting the following types of aphasia were analyzed: motor transcortical, amnestic, semantic and sensory. The results point out different aspects between pathological perseveration and perseveration as a normal expression in the process of language activity. This study might imply another theoretical perspective of language therapy to perseveration in aphasia.

O propósito deste estudo foi investigar a perseveração em dois contextos: linguagem espontânea e tarefas linguísticas. Esta pesquisa aponta para a perseveração como sendo uma concepção teórico-linguística, qual seja, sociointeracionista. Isto abrange atividade linguística produzida em um espaço interlocutivo e não negligencia aspectos pragmáticos e o uso contextual da língua. Quatro pacientes, apresentando os seguintes tipos de afasia, foram analisados: transcortical motora, amnéstica, semântica e sensorial. Os resultados apontam para diferentes aspectos entre perseveração patológica e perseveração, como expressão normal do processo de atividade de linguagem. Este estudo poderá implicar outra perspectiva teórica de terapia de linguagem na afasia.

Introdução da comunicação suplementar e alternativa na terapia com afásicos / Introduction of augmentative and alternative communication in aphasia therapy

Sabe-se que o tratamento fonoaudiológico de pacientes com afasia severa é limitado. A ausência de fala articulada, algumas vezes, impede o diagnóstico da afasia. O paciente grave pode não falar devido à inabilidade de articulação, como ocorre na disartria e/ou apraxia. Essa ausência de fala não permite afirmar se a linguagem está comprometida. O uso da comunicação suplementar e alternativa tem sido um método eficaz na reabilitação desses pacientes. Esse estudo visou descrever o uso da comunicação suplementar e alternativa associada a outras modalidades de linguagem (escrita, gestos), a partir do relato de dois casos de afasia. A análise dos dados foi composta por dois blocos: a introdução da comunicação suplementar e alternativa no diálogo; e o uso da leitura e escrita associado aos símbolos. A comunicação suplementar e alternativa foi um apoio para a oralidade, leitura e escrita dos pacientes.

It is known that the speech-language treatment of patients with severe aphasia is limited. Sometimes the absence of articulated speech is an obstacle to diagnose the aphasia. The patient with severe aphasia might not speak due to articulation inability, as it occurs in dysarthria and/or apraxia, and the absence of speech makes it difficult for speech-language pathologists to determine whether language is also impaired. The use of augmentative and alternative communication techniques has been an effective method for the rehabilitation of these patients. The aim of this study was to describe the use of the augmentative and alternative communication in therapy associated with other modalities of language (written language, gestures), based on the report of two cases of aphasia. Data analysis had two parts: introduction of augmentative and alternative communication in dialogue; and use of reading and writing associated with symbols. The augmentative and alternative communication supported oral language, reading and writing of the patients studied.

Repercussões psicológicas na relação entre o paciente afásico e seu familiar / Psychological repercussions in the relationship between the aphasic patient and his family

Trata-se de um estudo qualitativo com o objetivo de compreender como o familiar vivencia as dificuldades de comunicação com o paciente afásico. Observou-se influência do tipo de vínculo constituído na qualidade da relação com o paciente, podendo ocorrer também estreitamento dos laços afetivos. Percebeu-se que sentimentos de angústia pelo não entendimento de sua falta e luto pelo que ele era são recorrentes no cotidiano dos familiares e que o conhecimento sobre a afasia, somado à empatia pelo paciente, são importantes para sua readaptação.

This is a qualitative study that aims at understanding how the family experiences the communication difficulties with the aphasic patient. It was observed that the type of bond that was formed influenced the quality of the relationship with the patient, and that the strengthening of the affective ties may also occur. It was noticed that feelings of anguish for not understanding the patient’s speech and mourning for what he was are present in the daily life of the family, and that knowledge about aphasia, added to empathy with the patient, are important for his rehabilitation.

Caracterização da linguagem na criança afásica / Characterization of the language in the aphasic child

O presente estudo bibliográfico tem como objetivo abordar as conseqüências geradas pela afasia infantil, com enfoque nos aspectos físicos, lingüísticos, intelectuais e emocionais e também relatar a importância da família na reeducação. A linguagem é o potencial que o ser humano tem para se comunicar, e as crianças com afasia apresentam essa habilidade alterada, pois sofreram um lesão neurológica que ocasiona perda total ou parcial da linguagem. Existem dois tipos de afasia: a de desenvolvimento (ocorre no período pré-lingüístico) e a adquirida (ocorre no período de aquisição). A criança afásica apresenta dificuldade em se integrar com seus irmãos, pais e colegas. Com sua linguagem precária e, às vezes, até impossível de se compreender, poderá ser tida pela sociedade como inferior ou diferente e isso poderá fazê-la evitar a comunicação, tornando-a isolada. O prognóstico de reeducação é mais favorável na infância do que na idade adulta, e a recuperação é mais satisfatória quanto mais precoce for a idade. O tratamento fonoterápico é de grande importância e tem a finalidade de reintegrar a criança afásica no meio social em que vive, melhorando suas condições de comunicação.

Programa de rehabilitación fonoaudiológica para pacientes afásicos / Program of phonoaudiology rehabilitation for aphasic patients

El propósito de este trabajo es presentar un programa de rehabilitación para pacientes afásicos basados en nuestra experiencia. Este programa implica los siguientes componentes: la evaluación los objetivos y el tratamiento. La evaluación proporciona la información necesaria para la planificación del tratamiento. El objetivo fundamental de este programa es lograr que el paciente pueda satisfacer sus necesidades comunicativas de la vida diaria. El tratamiento comprende la intervención, los procedimientos y el programa terapéutico. Se muestra un ejemplo de programa terapéutico. Finalmente, se comenta el programa de rehabilitación y el aporte al quehacer fonoaudiológico

Dysphasia

The aim of this article was to provide a review study for the problem of dysphasia regarding its glossary etiology, the protocol of assessment and the different approaches of its rehabilitation. The investigated and the control groups were evaluated by the same quasiobjective scheme. There was a strong evidence that the rehabilitation program used in this study led to a significant improvement of the scores in the investigated group in comparison with the control. No significant correlation was detected between the age of the patient, the premorbid educational level and the time post onset of dysphasia. On the other hand, the degree of recovery was more noticeable in less severe forms of dysphasia and in posterior lesions than the anterior lesions

O uso de sistemas alternativos e facilitadores de comunicaçäo nas afasias / The use of augmentative and alternative communication techniques in aphasias

Sistemas alternativos e facilitadores de comunicaçäo incluem sinalizaçäo manual em língua de sinais, gestos, mímica e pantomina; ou seleçäo gráfica de desenhos, pictogramas e símbolos em tabuleiros ou computadores. Säo indicados em substituiçäo da comunicaçäo vocal e escrita e em suporte a ela. Para afásicos sua funçäo é mais facilitadora que alternativa: säo indicados para tratamento de reaquisiçäo vocal e escrita e para facilitaçäo dessa comunicaçäo em contextos específicos do dia-adia, mais do que para substituiçäo generalizada da fala. Como coadjuvante terapêutico e recurso de comunicaçäo, sistemas computadorizados baseados em pictogramas e com voz digitalizada säo os mais indicados para afásicos