Evaluating Anterior and Posterior Oral Tongue Contributions to Pressure Generation: A Comparison Between Regular and Effortful Saliva Swallows.

PURPOSE: This study determined the contributions of the anterior and posterior tongue regions in tongue pressure generation during regular saliva swallows (SSs) and effortful swallows (ESs) completed under two different instructions. The association between tongue pressure and perceived effort to swallow was also examined. METHOD: Forty healthy adults without swallowing disorders participated in this study, divided into two age groups: 20 younger (Mage = 21.95 years, SD = 4.43) and 20 older (Mage = 70.10 years, SD = 4.30). Simultaneous data acquisition involved submental surface electromyography, tongue manometry, and a visual analog scale across swallowing conditions (SS, ES with tongue emphasis, and ES with pharyngeal squeezing). The main outcome measures were tongue pressure during swallowing and perceived effort to swallow. RESULTS: Overall tongue pressure during ESs with tongue emphasis and with pharyngeal squeezing was greater than that during SSs (R2 = .78, p < .001). Moreover, tongue pressure during the ES with tongue emphasis was greater than that during the ES with pharyngeal squeezing (t = 25.63, p < .001). The posterior tongue region generated more pressure during SSs (R2 = .64, p < .001) and the ES with tongue emphasis (R2 = .55, p < .001) than the anterior tongue. Finally, a positive correlation was found between perceived effort and tongue pressure during swallowing (r = .75, 95% CI [0.72, 0.77]). CONCLUSIONS: Tongue pressure generation was affected by the type of instruction used to elicit ESs, and the posterior tongue showed relatively greater pressure contributions than the anterior tongue for ESs with tongue emphasis and SSs. Furthermore, age-related declines in pressure generation during swallowing were not evidenced in this study, underscoring the ability of healthy older individuals to appropriately modulate lingual pressure during ESs. Last, our results showed that the visual analog scale is a simple tool for rating swallowing effort during ESs, supporting its potential clinical use to train ESs.

Surface Electromyographic Activity of the Masseter Muscle During Regular and Effortful Saliva Swallows: A Preliminary Study.

Biofeedback is a critical component in motor learning of new, complex behaviors such as modifications to swallowing. Surface electromyography (sEMG) is a commonly employed biofeedback tool in swallowing management to assess muscle activity patterns, determine amplitude and duration of swallowing, and train swallowing strategies such as the effortful swallow (EFS) maneuver. The EFS can potentially change multiple physiological components of the swallowing process such as pressure generation and movement of biomechanical structures. The purposes of this study were to determine whether the masseter muscle could differentiate a normal swallow (NS) from an EFS and whether there was a relationship between perceived muscle effort used to swallow and objective measures of muscle activity. Twenty healthy young adults participated in this study. Masseter sEMG peak amplitude and duration were measured across five regular saliva swallows and five effortful saliva swallows. Additionally, participants rated their perceived swallowing effort using a visual analog scale (VAS). Two swallowing conditions, NSs and EFSs were compared with hierarchical models, and repeated measures correlation was used to determine the relationships between the VAS and sEMG peak amplitude. Participants produced swallows with greater masseter sEMG peak amplitude and duration during the EFS. Moreover, a positive correlation was identified between perceived swallowing effort and masseter sEMG peak amplitude. These findings support the potential use of the masseter muscle to differentiate NSs from EFSs and implement the VAS during therapy for tracking patients' performance, particularly in settings with limited access to sEMG.

Hyolaryngeal Movement During Normal and Effortful Swallows Determined During Ultrasonography.

PURPOSE: This study investigated (a) the effects of the effortful swallow under two different instructions (tongue emphasis vs. pharyngeal squeezing) on hyoid displacement and hyoid-larynx approximation, (b) the association between tongue pressure and hyolaryngeal movement during normal swallowing and the effortful swallow produced with tongue emphasis, and (c) age-related differences in hyolaryngeal movement during normal and effortful swallows (tongue emphasis vs. pharyngeal squeezing) in healthy individuals. METHOD: Forty healthy adults (20 younger and 20 older) swallowed their saliva as they normally do (normal swallow) and performed the effortful swallow with tongue emphasis and pharyngeal squeezing. Tongue-to-palate pressure during swallowing was measured using the Iowa Oral Performance Instrument, hyolaryngeal movement was measured using ultrasonography, and submental surface electromyography was used to track swallows. RESULTS: Results revealed differences in hyolaryngeal movement across swallowing types. Both types of effortful swallows showed greater hyolaryngeal movement than normal swallows. Additionally, hyolaryngeal movement was greater during the effortful swallow with tongue emphasis than the effortful swallow with pharyngeal squeezing. Age-related differences were found only in hyoid-larynx approximation during the effortful swallow with tongue emphasis (younger > older adults). Furthermore, moderate positive correlations were identified between tongue pressure and hyolaryngeal movement during normal swallows and the effortful swallow with tongue emphasis. CONCLUSIONS: The findings show that varying instructions of the effortful swallow affect hyolaryngeal movement differently, suggesting that clinicians may need to individualize the effortful swallow instruction according to the physiological impairments of each patient. Additionally, natural age-related changes in swallowing physiology do not seem to affect an individual's ability to perform the effortful swallow or to impact hyolaryngeal movement. Finally, the association between tongue pressure and hyolaryngeal movement during normal swallows and the effortful swallow with tongue emphasis suggests that the tongue plays a critical role in swallowing, priming subsequent swallowing events.

Brazilian Portuguese Adaptation and Validation of the Language Screening Test for Poststroke Patients.

BACKGROUND: There is a lack of standardized assessment tools for poststroke aphasia in Brazil, particularly bedside screenings for early identification of patients with suspected language disorders. The Language Screening Test (LAST) is a valid and reliable method for screening hospitalized patients following a stroke. This tool was first developed in French and then translated and validated in other languages. PURPOSE: This study aimed to translate, culturally adapt, and validate the LAST into Brazilian Portuguese. METHOD: Following a systematic, multistep approach to translation and cultural adaptation of language instruments, this study developed the two parallel versions of the Brazilian Portuguese LAST (pLAST) Versions A and B. The final versions were applied to 70 healthy and 30 poststroke adults across age and educational levels. Subtests of the Boston Diagnostic Aphasia Examination (BDAE) were used to assess the external validity of the pLAST. RESULTS: Findings showed that the two versions (A and B) of the pLAST were equivalent (intraclass correlation coefficient = .91; p < .001). No floor or ceiling effects were observed, and internal validity was excellent (Cronbach's α = .85). Moreover, its external validity against the BDAE was moderate to strong. Test sensitivity and specificity were 0.88 and 1, respectively, and accuracy was 0.96. CONCLUSION: The Brazilian Portuguese version of the LAST is a valid, simple, easy, and rapid test to screen poststroke aphasia in hospital settings. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23548911.

Effectiveness of Intense Accent Modification Training With Refugees From Burma.

PURPOSE: This pilot research project sought to determine if an intensive accent modification training program that included See the Sound-Visual Phonics and prosodic gestures improved articulation, prosody, and intelligibility measures in refugees from Burma. PARTICIPANTS: Four individuals (two men, two women) aged 20-67 participated in this study, and they were recruited from a state organization supporting refugees who have resettled in the United States. METHOD: All participants completed the Proficiency in Oral English Communication (POEC) and Assessment of Intelligibility of Dysarthric Speech (AIDS) to measure pre- and posttraining changes. The duration of this study was 6 weeks and consisted of 1 week of pretesting, 4 weeks of accent modification training, and 1 week of posttesting. Participants attended a total of twelve 50-min accent modification training sessions, including eight individual sessions (twice per week) and four group sessions (once per week), which provided a functional way to practice newly acquired skills in a scripted conversational-type format. Trained and untrained articulation and prosody probes were used to establish baselines and measure change. RESULTS: All four participants showed gains across articulation and prosody (in untrained and trained items). On pre- and posttest measures, three of the four participants also made gains on the broad measures of the AIDS and the POEC. CONCLUSION: Findings support that a brief and intensive multimodality accent modification program can be beneficial.

Stroke Communication Scale based on the International Classification of Functioning, Disability and Health (ICF - SCS).

INTRODUCTION: The International Classification of Functioning, Disability, and Health encompasses activities, participation, and contextual factors in health care, helping in the evaluation, planning, and management of patients. AIM: To develop an instrument to evaluate and classify speech-language needs, participation, and functioning in post-stroke based on the International Classification of Functioning, Disability, and Health. MATERIALS AND METHODS: This is a methodological research to develop an instrument. We adopted the following steps: a) selection of the International Classification of Functioning, Disability, and Health domains related to speech-language; b) development of guiding questions and qualification criteria; c) content validity; d) development of instructions; d) pilot test; e) inter-observer reliability. RESULTS: The Stroke Communication Scale is a clinical assessment in the Brazilian Portuguese language with 35 questions, integrating language, environmental, and personal aspects. This instrument showed good validity and reliability, demonstrating its applicability. Additionally, the possibility of using different sources of information (patient, caregiver, and health professional observations) and time of application of the protocol constitute positive factors for its use in different clinical settings. CONCLUSION: The Stroke Communication Scale allows a comprehensive clinical evaluation helping in the development of individualized treatment programs in post-stroke in a biopsychosocial approach centered on the patient.IMPLICATIONS FOR REHABILITATIONCommunication disorders post-stroke can be an important social barrier.An assessment based on the International Classification of Functioning, Disability, and Health offers an integral view of different perspectives of health.The Stroke Communication Scale is a holistic instrument to assess communication, participation, and functioning.The Stroke Communication Scale allows an evaluation of functional communication beyond the disorder.Interview-format encourages the participation of individuals with communication impairment, which is essential for their rehabilitation process and participation in social activities.

A Systematic Review of the Physiological Effects of the Effortful Swallow Maneuver in Adults With Normal and Disordered Swallowing.

Purpose This systematic review summarizes the biomechanical and functional effects of the effortful swallow in adults with and without dysphagia, highlighting clinical implications and future research needs. Specifically, the effects of the effortful swallow on swallowing physiology, safety, and efficiency were identified, as well as the strengths and limitations of current research. Method Recommendations specified by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. A literature search of three databases and relevant articles cited in the searched studies was performed. Two evaluators independently analyzed the studies for eligibility criteria, and final inclusion of studies was decided by consensus. Evaluators also assessed each study for quality of evidence. Results Twenty-three studies were included in this systematic review. Main findings indicated that the effortful swallow generated greater pressures in the tongue-to-palate, pharynx, upper esophageal sphincter, and esophageal regions. Inconsistent results for hyolaryngeal excursion were reported, as well as for swallowing function. Instructions of the effortful swallow varied greatly across studies. Two of the 23 studies were judged to be of high quality, and the remaining studies were of medium quality based on the quality indicators of this review. Conclusions Biomechanical effects of the effortful swallow included increased pressures in the oral, pharyngeal, and esophageal regions. Future investigations should address the effects of the effortful swallow in individuals with dysphagia and its potential role as a rehabilitative maneuver. Moreover, standardization of the effortful swallow instructions based on its physiological and functional effects is essential.

Functionally navigated transcranial magnetic stimulation to evoke lingual pressure in stroke survivors with dysphagia and healthy adults: a proof of concept trial.

Background: Post-stroke dysphagia is characterized by reduced corticolingual excitability and lingual pressure; however, it remains unknown if transcranial magnetic stimulation (TMS) directly facilitates lingual pressure generation.Objectives: To explore optimal procedures for single pulse TMS using neuronavigation to evoke lingual pressure in intact and disrupted neural networks.Methods: Using co-registered functional magnetic resonance imaging, stimulation sites were determined for five healthy adults (Mage = 67) and four stroke survivors with dysphagia and reduced tongue strength (Mage = 66). Evoked lingual pressures were sampled across 45-65% of maximum stimulator output. Healthy participants repeated TMS with a bite block to isolate lingual pressure from off-target stimulation of mandibular elevators.Results: Only one functionally-guided stimulation site fell within previously reported optimal lateral (8-11cm) and anterior (2-4.25cm) coordinates. Lingual pressure was stable prior to pulse and increased linearly with intensity for both groups (p = .005). Post-stroke active motor thresholds were elevated compared to healthy adults (p = .025). Lingual pressure latency remained stable across intensities (p > .05). Jaw stabilization via bite block reduced the mean magnitude of evoked lingual pressure by approximately 16%.Conclusions: Single pulse TMS directly evokes higher lingual pressure and can define motor thresholds in intact and disordered corticolingual pathways. Stimulation sites using neuronavigation in healthy adults and stroke survivors largely differed from external coordinates in the literature that were predominantly established in young adults. Procedures to investigate motor thresholds for lingual pressure generation are proposed. The therapeutic role of TMS to address post-stroke deficits in lingual pressure and corticolingual excitability warrants continued investigation.

Dysarthria as a predictor of dysphagia following stroke.

BACKGROUND: Stroke is the leading cause of mortality and disability worldwide. Important sequels are frequent, including dysphagia and communication disorders. OBJECTIVE: to determine the prevalence of dysphagia and communication disorders following stroke, and to identify if communication disorders can predict dysphagia. METHODS: Thirty-one prospective and consecutive patients were admitted to the Otolaryngology-Dysphagia Outpatient Clinic with diagnosis of ischemic or hemorrhagic stroke. Stroke was confirmed by computed tomography or magnetic resonance imaging, and medical evaluation. All patients had a swallowing and communication evaluation. We compared patients with and without dysphagia, and established the co-occurrence among dysphagia and communication disorders. RESULTS: Twenty-five patients presented dysphagia. Aphasia occurred in 32.3% of the patients; dysarthria in 45.2%. Dysphagia and aphasia co-occurred in 29% of the population; dysphagia and dysarthria in 45.2%; the three conditions co-occurred in 22.6%. Dysarthria was a predictor of dysphagia, and it was associated with the presence of oral stage problems. CONCLUSIONS: A comprehensive evaluation of dysphagia, aphasia, and dysarthria are important to improve clinical outcome following stroke. The identification of dysarthria as a predictor of dysphagia can help identify risk for dysphagia in stroke and assist in the therapeutic process of swallowing problems.

Predictors of pneumonia in acute stroke in patients in an emergency unit.

OBJECTIVE: To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. METHOD: Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. RESULTS: 159 patients (18-90 years) were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001), higher National Institute of Health Stroke Scale (NIHSS) (p = 0.047) and, lower Glasgow Coma Score (GCS) (p < 0.0001). Patients with pneumonia had longer hospitalization (p < 0.0001). Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002). CONCLUSION: Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

Predictors of pneumonia in acute stroke in patients in an emergency unit / Preditores de pneumonia em pacientes com AVC isquêmico numa unidade de emergência

Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years) were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001), higher National Institute of Health Stroke Scale (NIHSS) (p = 0.047) and, lower Glasgow Coma Score (GCS) (p < 0.0001). Patients with pneumonia had longer hospitalization (p < 0.0001). Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002). Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients. .

Objetivo Avaliar os fatores de risco e as comorbidades associadas ao desenvolvimento de pneumonia em pacientes com acidente vascular cerebral (AVC) agudo. Determinar os preditores independentes de pneumonia. Método Estudo retrospectivo, realizado entre julho e dezembro de 2011. Foi revisado todos os prontuários dos pacientes com diagnóstico de AVC. Resultados 159 pacientes (18-90 anos) foram admitidos. A incidência de pneumonia foi de 32%. A incidência de pneumonia foi maior em pacientes com AVC hemorrágico (OR: 4,36; IC95%: 1,9-10,01, p < 0,001) e em pessoas com escore alto National Institute of Health Stroke Scale (NIHSS) (p = 0,047) e escores mais baixos da Escala de Coma de Glasgow (ECG) (p < 0,0001). Os pacientes com pneumonia tiveram maior tempo de internação (p < 0,0001). A análise de regressão logística identificou apenas o NIHSS como um preditor independente de pneumonia (IC95%: 1,049-1,246, p = 0,002). Conclusão O diagnóstico de pneumonia foi associado a tipo e gravidade do AVC e com tempo de hospitalização. A gravidade do déficit, avaliada pela escala NIHSS mostrou ser o único fator de risco independente para pneumonia em pacientes com AVC agudo. .

Quality of life in aphasia: differences between fluent and non-fluent aphasic Augmentative and Alternative Communication users / Qualidade de vida na afasia: diferenças entre afásicos fluentes e não fluentes usuários de Comunicação Suplementar e/ou Alternativa

Purpose To investigate and to compare quality of life (QOL) in fluent and non-fluent aphasics. Methods This is a prospective, quantitative, and transversal study. We included 11 stroke patients with aphasia (five non-fluent aphasics augmentative and alternative communication users and six fluent aphasics). Data was gathered from the Stroke Specific Quality of Life Scale (SS-QOL), a structure interview, and The Modified Rankin Scale. Results The non-fluent aphasics presented poorer Rankin and quality of life than the fluent aphasics. The major difference occurred in the fields of language and upper extremity function. The three most affected domains in non-fluent aphasics were language, social roles, and thinking, whereas in the fluent aphasics were personality, social roles, and thinking. All the subjects referred a worse quality of life after stroke. The domains of language and self-care were identified as the most affected after stroke. Conclusion This study demonstrated that, in general, non-fluent aphasics have lower quality of life than fluent aphasics. However, this difference is not homogeneous among the several quality of life domains. Additionally, this research evidences a relationship between aphasia severity and individual functionality, implying impairment in quality of life, especially for non-fluent aphasics. .

Objetivo Investigar e comparar a qualidade de vida de afásicos fluentes e não fluentes. Métodos Trata-se de pesquisa prospectiva, quantitativa, transversal, cuja amostra se constituiu de 11 sujeitos afásicos (5 não fluentes, usuários de comunicação suplementar e/ou alternativa e 6 fluentes, não usuários de comunicação suplementar e/ou alternativa. A coleta de dados foi realizada por meio da aplicação de um questionário específico de qualidade de vida, entrevista estruturada e aplicação da escala de Rankin modificada. Resultados Na comparação dos grupos estudados, os afásicos não fluentes apresentaram escores de Rankin e de qualidade de vida menores do que os fluentes e as maiores diferenças referiram-se aos domínios de linguagem e função do membro superior. Os domínios mais prejudicados pelo acidente vascular cerebral foram linguagem, relações sociais e modo de pensar, para os afásicos não fluentes, e comportamento, relações sociais e modo de pensar, para os fluentes. Todos os sujeitos relataram que sua qualidade de vida piorou após o acidente vascular cerebral, sendo que linguagem e cuidados pessoais foram apontados como os aspectos que mais mudaram, após o episódio lesional. Conclusão Os achados mostram relação entre gravidade da afasia e funcionalidade do indivíduo, indicando que, no geral, os afásicos não fluentes apresentam qualidade de vida pior do que os fluentes. As diferenças não são homogêneas nos diversos domínios de qualidade de vida. .

Repercussão da comunicação suplementar e/ou alternativa na afasia não fluente / Augmentative and alternative communication repercussion on non-fluent aphasia

Objetivos : verificar as formas de comunicação e desempenho linguístico-cognitivo de afásicos a partir da Comunicação Suplementar e/ou Alternativa (CSA) e conhecer sua percepção.Métodos : pesquisa de abordagem qualitativa de corte longitudinal, aprovada pelo CEP, com amostra de 5 sujeitos afásicos não fluentes. A coleta de dados ocorreu por meio dos prontuários dos sujeitos, registros em vídeo do acompanhamento fonoaudiológico com a CSA e dos seus depoimentos acerca da utilização da CSA.Resultados : os sujeitos utilizam diversas formas de comunicação para se expressar além de fazerem maior uso da CSA, necessitando menor apoio de gestos próprios ao longo do estudo, o que facilitou a comunicação com o outro e diminuiu o uso de adivinhações e tentativas frustradas de conversas. O uso da CSA repercutiu no aumento da produção oral. Os sujeitos referem gostar de utilizar os recursos da CSA e que estes contribuem de alguma forma na sua comunicação.Conclusão: os resultados evidenciam que o apoio da CSA contribui para que os sujeitos estudados pudessem assumir seus lugares como falantes, superando suas dificuldades de linguagem. Deste modo, favoreceu que eles se colocassem como sujeitos linguísticos e sociais. As atividades dialógicas e contextualizadas, bem como a mediação do interlocutor, favoreceram o processo de (re)significação de seus enunciados. Portanto, a CSA, nesse contexto, mostra-se como importante recurso mediador e facilitador do processo linguístico nas afasias não fluentes com repercussão na produção oral.

Purpose : verify the communication forms and linguistic-cognitive performance of aphasics from an Augmentative and Alternative Communication (AAC) perspective and to evaluate their perception.Methods : this is a longitudinal research with qualitative approach, approved by the Ethic and Research Committee. The sample includes 5 non-fluent subjects with aphasia. Data was collected analyzing the subjects’ files, video records of speech and language therapy focused on AAC, and the subjects opinions about it.Results : subjects used several ways of communication to express themselves as well as increased their use of AAC. In doing so, they demanded less gestures support during the study, which facilitated their communication and diminished guessing and frustrated conversation attempts. The use of AAC resulted in the increase of oral production. Subjects referred that they enjoyed using AAC and that it contributed to their communication in some way.Conclusion : results showed that AAC support contributed to subjects so they could assume their position as speakers, overcoming their language difficulties. Therefore it has facilitated them to assume themselves as linguistic and social subjects. Dialogic and contextualized activities, as well as the interlocutor mediation, facilitated the process of (re)signification of their enunciations. Therefore, regarding this context, AAC is an important support that mediates and facilitates the linguistic process on non-fluent aphasias with repercussions on oral production.

Mudanças na formação em Saúde: o portfólio como prática inovadora na Graduação em Fonoaudiologia / Changes in health education: the portfolio as an innovative practice in undergraduate speech therapy

Este artigo aborda o portfólio como instrumento reflexivo de ensino-aprendizagem, tendo em vista o incremento de metodologias ativas e a implementação de práticas processuais/qualitativas na formação em saúde voltada ao Sistema Único de Saúde - SUS. Tal prática foi implantada em uma das disciplinas do Curso de Fonoaudiologia por quatro anos consecutivos. Trata-se de proposta inovadora nesse curso e no cenário nacional. Foram analisados os portfólios da primeira turma em que a proposta foi introduzida e colhidos depoimentos desses alunos (n= 24) acerca desse processo. Os resultados mostram a contribuição do portfólio na formação como uma metodologia que propicia uma participação mais ativa dos sujeitos. A maioria pontuou impressões positivas do mesmo como instrumento reflexivo e de expressão de idéias. O portfólio se evidencia como relevante ferramenta nas práticas educativas para uma formação integral e humanizada em Saúde.

This paper aims to study the portfolio as a reflexive instrument of teaching-learning, regarding the increment of active methodologies and the implementation of procedural/qualitative practices, in health professional education focused on Unified Health System-SUS. Such practice was introduced in the Speech-Language Pathology course for four consecutive years. It is an innovative approach both on the level of the present course and on national level. The portfolios from the first group of students in which the portfolio was introduced were analyzed, and 24 written reports about this process were collected. The results show the contribution of the portfolio as a methodology that provides a more active participation of the subjects. Most students indicated positive impressions of the portfolio as a reflexive instrument that enabled them to express their ideas. The portfolio is shown to be a relevant tool in educational practices for health and humanized professional development.

Este artículo aborda el portafolio como instrumento reflexivo de enseñanza-aprendizaje, teniendo en vista el incremento de metodologías activas y la implementación de prácticas procesuales/cualitativas en la formación en salud dirigida al Sistema Único de Salud-SUS. Esa práctica fue implementada en una disciplina del Curso de Fonoaudiología durante cuatro años consecutivos. Se trata de propuesta innovadora en ese curso y en el escenario nacional. Fueron analizados los portafolios del primer grupo de alumnos en que esa propuesta fue introducida y se tomaron testimonios de eses alumnos (n= 24) sobre ese proceso. Los resultados muestran la contribución del portafolio para la formación como una metodología que permite una participación más activa de los alumnos. La mayoría expresó impresiones positivas del portafolio como instrumento reflexivo y de expresión de ideas. El portafolio se muestra una herramienta relevante en las prácticas educativas para una formación integral y humanizada en la salud.

O uso do portfólio na formação em fonoaudiologia sob o eixo da integralidade / The use of portfolio in Speech and Language Pathology undergraduate education from the perspective of comprehensive training

OBJETIVOS: investigar o portfólio como instrumento de avaliação e aprendizagem em um Curso de Fonoaudiologia e verificar as expectativas e conhecimento acerca da Fonoaudiologia. MÉTODOS: pesquisa retrospectiva de abordagem qualitativa e quantitativa, aprovada pelo Comitê de Ética em Pesquisa, corpus de 24 sujeitos, do 1º ano do curso de graduação em Fonoaudiologia que cursaram a disciplina História da Fonoaudiologia. A coleta de dados ocorreu por meio de portfólios e depoimentos escritos dos sujeitos. Foram aceitas mais de uma resposta nas categorias de análise. Para análise estatística foram utilizados os Testes Exato de Fischer e Qui-Quadrado. RESULTADOS: os portfólios evidenciam quanto à visão inicial da Fonoaudiologia que 53 por cento dos sujeitos (n=15) indicaram conhecer a profissão por contato anterior e 40 por cento referiram pouco conhecimento da profissão ao ingressar no Curso. 71 por cento dos sujeitos (n=24) apontaram o ajudar/lidar com as pessoas como uma das principais razões da escolha da Fonoaudiologia. Quanto aos depoimentos escritos, 71 por cento (n=24) dos sujeitos referiram que o portfólio possibilitou reflexão e 50 por cento que foi um meio de aquisição de conhecimento quanto à contribuição do portfólio. CONCLUSÃO: os achados mostram que o portfólio se constitui como importante instrumento processual e reflexivo. Verificam-se mudanças no decorrer da disciplina, em relação às expectativas iniciais e ao conhecimento dos sujeitos acerca da Fonoaudiologia. Contribui para a definição da escolha da profissão, em alguns casos, e favorece a percepção acerca do papel das demais disciplinas, angústias comuns entre os alunos, nessa época da graduação.

PURPOSE: to study the portfolio as a reflective tool for assessment and learning in a Speech and Language Pathology Course (SLP) and to investigate what the students expect and know about SPL field. METHODS: a retrospective study that is both qualitative and quantitative and approved by the Ethics in Research Commission. There were 24 participants who were first year students of a university level (SLP) and who were enrolled in a SLP History course. Data were collected using portfolios and reports written by the participants. More than one answer per category of analysis was acceptable. Statistical analysis was done with the Fischer's Exact Test and Chi-Square. RESULTS: as for the initial views of the SLP field, the portfolios show that 53 percent of the subjects (n=15) reported that they knew about the profession from earlier contact, while 40 percent reported little knowledge of the profession before registration. Due to the written reports, 71 percent of the subjects (n=24) indicated that the portfolios promote reflections and 50 percent indicate the contribution of the portfolio as a mean of acquisition of knowledge. CONCLUSION: the findings demonstrate the portfolio as an important tool in an ongoing reflective evaluation. There were changes about the initial impressions the undergraduates brought with them, as to their expectations and knowledge on SLP. This instrument contributes for defining the choice of profession, in some cases, and encourages the perception about the role of other disciplines, common doubts among students at this graduation period.

[Impact of sleep hygiene on patients with obstructive sleep apnoea syndrome].

The purpose of this study was to evaluate the impact of a Sleep Hygiene brochure on a population of 36 patients recently diagnosed with Obstructive Sleep Apnoea Syndrome and beginning treatment. One expects that: 1) the information about Sleep Hygiene offered in the brochure would change some of the patients' habits toward sleep; and that, 2) this intervention in the form of a free informative brochure would have an echo in terms of a better subjective evaluation of sleep complaints. The sleep habits and the sleep complaints were evaluated in the pre-test. Those variables were re-evaluated in the post-test and at that time the patients filled in a scale of satisfaction with the information about Sleep Hygiene, in terms of its contribution to improving their sleep complaints. There were no significant differences in the level of compliance to Sleep Hygiene between the two periods, although the majority of the patients considered that Sleep Hygiene did improve their sleep difficulties. The low level of compliance may be due to the fact that patients already had reasonable Sleep Hygiene habits, and also to the fact that the scale was not sufficiently discriminative. In addition, the self-discipline that Sleep Hygiene involves may have collided with other demands such as the adaptation to treatment with CPAP (Continuous Positive Air Pressure). In a following study, it would be interesting to find if the levels of sleep hygiene compliance would change if they were implemented after the initial adaptation to CPAP, which would imply a longitudinal study. It would be helpful to keep reminding the patients of Sleep Hygiene importance, offering new and update brochures to the patients during consultations.