ABSTRACT
The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.
Subject(s)
Stroke Rehabilitation , Stroke , Humans , Brazil , COVID-19 , Stroke/complications , Stroke/drug therapy , Stroke Rehabilitation/methods , Randomized Controlled Trials as Topic , Meta-Analysis as Topic , Systematic Reviews as TopicABSTRACT
Abstract The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
Resumo As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderênciaao usode medicamentos, cuidados paliativos,ofuturodareabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.
ABSTRACT
BACKGROUND: Right-hemisphere lesions (RHL) may impair inference comprehension. However, comparative studies between left-hemisphere lesions (LHL) and RHL are rare, especially regarding reading comprehension. Moreover, further knowledge of the influence of cognition on inferential processing in this task is needed. OBJECTIVES: To compare the performance of patients with RHL and LHL on an inference reading comprehension task. We also aimed to analyze the effects of lesion site and to verify correlations between cognitive functions and performance on the task. METHODS: Seventy-five subjects were equally divided into the groups RHL, LHL, and control group (CG). The Implicit Management Test was used to evaluate inference comprehension. In this test, subjects read short written passages and subsequently answer five types of questions (explicit, logical, distractor, pragmatic, and other), which require different types of inferential reasoning. The cognitive functional domains of attention, memory, executive functions, language, and visuospatial abilities were assessed using the Cognitive Linguistic Quick Test (CLQT). RESULTS: The LHL and RHL groups presented difficulties in inferential comprehension in comparison with the CG. However, the RHL group presented lower scores than the LHL group on logical, pragmatic and other questions. A covariance analysis did not show any effect of lesion site within the hemispheres. Overall, all cognitive domains were correlated with all the types of questions from the inference test (especially logical, pragmatic, and other). Attention and visuospatial abilities affected the scores of both the RHL and LHL groups, and only memory influenced the performance of the RHL group. CONCLUSIONS: Lesions in either hemisphere may cause difficulties in making inferences during reading. However, processing more complex inferences was more difficult for patients with RHL than for those with LHL, which suggests that the right hemisphere plays an important role in tasks with higher comprehension demands. Cognition influences inferential processing during reading in brain-injured subjects.
Subject(s)
Brain Injuries/rehabilitation , Cerebrum/physiopathology , Cognition/physiology , Comprehension/physiology , Functional Laterality , Reading , Adult , Aged , Attention/physiology , Brain Injuries/diagnostic imaging , Brain Injuries/physiopathology , Case-Control Studies , Cerebrum/diagnostic imaging , Executive Function/physiology , Female , Humans , Language , Male , Memory, Short-Term/physiology , Middle Aged , Neuroimaging , Neuropsychological Tests , Orientation, Spatial/physiology , Visual Perception/physiologyABSTRACT
Transcranial brain stimulation (TS) techniques have been investigated for use in the rehabilitation of post-stroke aphasia. According to previous reports, functional recovery by the left hemisphere improves recoveryfrom aphasia, when compared with right hemisphere participation. TS has been applied to stimulate the activity of the left hemisphere or to inhibit homotopic areas in the right hemisphere. Various factors can interfere withthe brain?s response to TS, including the size and location of the lesion, the time elapsed since the causal event, and individual differences in the hemispheric language dominance pattern. The following questions arediscussed in the present article: [a] Is inhibition of the right hemisphere truly beneficial?; [b] Is the transference of the language network to the left hemisphere truly desirable in all patients?; [c] Is the use of TS during the poststroke subacute phase truly appropriate? Different patterns of neuroplasticity must occur in post-stroke aphasia.
As técnicas de estimulação cerebral transcraniana (ET) têm sido estudadas como recurso na reabilitação da afasia resultante de acidente vascular cerebral. Tem sido apontado que melhor recuperação da afasia ocorre quando o hemisfério esquerdo reassume a função da linguagem, quando comparado à participação do hemisfério direito. A ET pode estimular a atividade do hemisfério esquerdo ou inibir a atividade de áreas homotópicas do hemisfério direito. Vários fatores podem interferir na resposta à ET, como o tamanho e local da lesão, o tempo decorrido do evento causal e diferenças individuais no padrão de dominância hemisférica para a linguagem. Este artigo discute as seguintes questões: [a] Realmente é benéfico inibir o hemisfério direito? [b] Realmente é desejável a transferência para a esquerda da função da linguagem em todos os casos? [c] Realmente é adequada a aplicação da TS na fase subaguda pós AVC? Diferentes padrões de reorganização cerebral devem ocorrer frente à presença de afasia decorrente de AVC.
Subject(s)
Humans , Aphasia , Rehabilitation , Transcranial Magnetic StimulationABSTRACT
Agrammatism is characterized by morphosyntactic deficits in production of sentences. Studies dealing with the treatment of these deficits are scarce and their results controversial. The present study describes the rehabilitation of a case diagnosed as chronic Broca?s aphasia, with agrammatism, using a method directed to sentence structural deficits. The method aims to expand the grammatical repertoire by training production of sentences with support from contexts that stimulate actions and dialogues. The patient showed positive results on all types of sentences trained and generalized the gains to spontaneous speech. However, these benefits were not sustained in the long term.
O agramatismo é marcado por déficits morfossintáticos na produção das sentenças. Estudos que abordam o tratamento destas dificuldades são escassos e controversos. O presente estudo descreveu a reabilitação de uma paciente com agramatismo associado à afasia de Broca em fase crônica, por meio de programa de estruturação de sentenças. Trata-se de método que visa à expansão do repertório gramatical através do treino com apoio de contextos que estimulam ações e diálogos. A paciente obteve resultados positivos em todos os tipos de frases treinadas, com ganhos generalizados para contextos de fala espontânea. No entanto, os benefícios não se mantiveram em longo termo.
Subject(s)
Humans , Aphasia , Aphasia, Broca , RehabilitationABSTRACT
Transcranial brain stimulation (TS) techniques have been investigated for use in the rehabilitation of post-stroke aphasia. According to previous reports, functional recovery by the left hemisphere improves recovery from aphasia, when compared with right hemisphere participation. TS has been applied to stimulate the activity of the left hemisphere or to inhibit homotopic areas in the right hemisphere. Various factors can interfere with the brain's response to TS, including the size and location of the lesion, the time elapsed since the causal event, and individual differences in the hemispheric language dominance pattern. The following questions are discussed in the present article: [a] Is inhibition of the right hemisphere truly beneficial?;[b] Is the transference of the language network to the left hemisphere truly desirable in all patients?;[c] Is the use of TS during the post-stroke subacute phase truly appropriate? Different patterns of neuroplasticity must occur in post-stroke aphasia.
As técnicas de estimulação cerebral transcraniana (ET) têm sido estudadas como recurso na reabilitação da afasia resultante de acidente vascular cerebral. Tem sido apontado que melhor recuperação da afasia ocorre quando o hemisfério esquerdo reassume a função da linguagem, quando comparado à participação do hemisfério direito. A ET pode estimular a atividade do hemisfério esquerdo ou inibir a atividade de áreas homotópicas do hemisfério direito. Vários fatores podem interferir na resposta à ET, como o tamanho e local da lesão, o tempo decorrido do evento causal e diferenças individuais no padrão de dominância hemisférica para a linguagem. Este artigo discute as seguintes questões:[a] Realmente é benéfico inibir o hemisfério direito?[b] Realmente é desejável a transferência para a esquerda da função da linguagem em todos os casos?[c] Realmente é adequada a aplicação da TS na fase subaguda pós AVC? Diferentes padrões de reorganização cerebral devem ocorrer frente à presença de afasia decorrente de AVC.
ABSTRACT
Agrammatism is characterized by morphosyntactic deficits in production of sentences. Studies dealing with the treatment of these deficits are scarce and their results controversial. The present study describes the rehabilitation of a case diagnosed as chronic Broca's aphasia, with agrammatism, using a method directed to sentence structural deficits. The method aims to expand the grammatical repertoire by training production of sentences with support from contexts that stimulate actions and dialogues. The patient showed positive results on all types of sentences trained and generalized the gains to spontaneous speech. However, these benefits were not sustained in the long term.
O agramatismo é marcado por déficits morfossintáticos na produção das sentenças. Estudos que abordam o tratamento destas dificuldades são escassos e controversos. O presente estudo descreveu a reabilitação de uma paciente com agramatismo associado à afasia de Broca em fase crônica, por meio de programa de estruturação de sentenças. Trata-se de método que visa à expansão do repertório gramatical através do treino com apoio de contextos que estimulam ações e diálogos. A paciente obteve resultados positivos em todos os tipos de frases treinadas, com ganhos generalizados para contextos de fala espontânea. No entanto, os benefícios não se mantiveram em longo termo.
ABSTRACT
Oropharyngeal dysphagia and esophageal motility disorders were found to be the most important causes of aspiration pneumonia in patients with myotonic dystrophy. The purpose of this report was to evaluate clinical characteristics of the oral motor movements and swallowing of individuals with myotonic dystrophy type 1 (DM1) using a standardized clinical protocol and surface electromyography (sEMG). Participants were 40 individuals divided in two groups: G1 composed of 20 adults with DM1 and G2 composed of 20 healthy volunteers paired by age and gender to the individuals in G1. Statistical analysis included one-way ANOVA with two factors for within- and between-group comparisons and Bonferroni correction for multiple comparisons. Patients with DM1 presented deficits in posture, position, and mobility of the oral motor structures, as well as compromised mastication and deglutition. The sEMG data indicated that these patients had longer muscle activations during swallowing events. The longer duration of sEMG in the group of patients with DM1 is possibly related to myotonia and/or incoordination of the muscles involved in the swallowing process or could reflect a physiological adaptation for safe swallowing.
Subject(s)
Deglutition/physiology , Myotonic Dystrophy/physiopathology , Adult , Case-Control Studies , Cheek/physiopathology , Cross-Sectional Studies , Electromyography , Female , Humans , Jaw/physiopathology , Lip/physiopathology , Male , Mastication/physiology , Movement , Myotonic Dystrophy/complications , Tongue/physiopathologyABSTRACT
UNLABELLED: Positron emission tomography studies during speech have indicated a failure to show the normal activation of auditory cortical areas in stuttering individuals. In the present study, P300 event-related potentials were used to investigate possible effects of behavioral treatment on the pattern of signal amplitude and latency between waves. In order to compare variations in P300 measurements, a control group paired by age and gender to the group of stutterers, was included in the study. Findings suggest that the group of stutterers presented a significant decrease in stuttering severity after the fluency treatment program. Regarding P300 measurements, stutterers and their controls presented results within normal limits in all testing situations and no significant statistical variations between pre and post treatment testing. When comparing individual results between the testing situations, stutterers presented a higher average decrease in wave latency for the right ear following treatment. The results are discussed in light of previous P300 event-related potentials and functional imaging studies with stuttering adults. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe the: (1) use of P300 event-related potentials in the study of stuttering; (2) differences between stuttering and non-stuttering adults; and (3) effects of behavioral fluency treatment on cerebral activity in stuttering speakers.
ABSTRACT
UNLABELLED: Positron emission tomography studies during speech have indicated a failure to show the normal activation of auditory cortical areas in stuttering individuals. In the present study, P300 event-related potentials were used to investigate possible effects of behavioral treatment on the pattern of signal amplitude and latency between waves. In order to compare variations in P300 measurements, a control group paired by age and gender to the group of stutterers, was included in the study. Findings suggest that the group of stutterers presented a significant decrease in stuttering severity after the fluency treatment program. Regarding P300 measurements, stutterers and their controls presented results within normal limits in all testing situations and no significant statistical variations between pre and post treatment testing. When comparing individual results between the testing situations, stutterers presented a higher average decrease in wave latency for the right ear following treatment. The results are discussed in light of previous P300 event-related potentials and functional imaging studies with stuttering adults. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe the: (1) use of P300 event-related potentials in the study of stuttering; (2) differences between stuttering and non-stuttering adults; and (3) effects of behavioral fluency treatment on cerebral activity in stuttering speakers.
Subject(s)
Event-Related Potentials, P300/physiology , Stuttering/physiopathology , Electromyography , Evoked Potentials, Auditory/physiology , Humans , Male , Speech/physiology , Speech Therapy , Stuttering/therapy , Young AdultABSTRACT
BACKGROUND: One contemporary view of stuttering posits that speech disfluencies arise from anomalous speech motor control. PURPOSE: To verify the rest muscle tension and speech reaction time of fluent and stuttering adults. METHOD: 22 adults, divided in two groups: G1--11 fluent individuals; G2--11 stutterers. Electromyography recordings (inferior orbicularis oris) were collected in two different situations: during rest and in a reaction time activity. RESULTS: The groups were significantly different considering rest muscle tension (G2 higher recordings) and did not differ when considering speech reaction time and muscle activity during speech. There was a strong positive correlation between speech reaction time and speech muscle activity for G2--the longer the speech reaction time, the higher the muscle activity during speech. CONCLUSION: In addition to perceptible episodes of speech disfluency, stutterers exhibit anomalies in speech motor output during fluent speech. Correlations with a possible cortical-subcortical disorder are discussed.
Subject(s)
Cerebral Cortex/physiopathology , Facial Muscles/physiopathology , Stuttering/physiopathology , Adult , Electromyography , Female , Humans , Male , Reaction Time , Rest/physiologyABSTRACT
BACKGROUND: One contemporary view of stuttering posits that speech disfluencies arise from anomalous speech motor control. PURPOSE: To verify the rest muscle tension and speech reaction time of fluent and stuttering adults. METHOD: 22 adults, divided in two groups: G1 - 11 fluent individuals; G2 - 11 stutterers. Electromyography recordings (inferior orbicularis oris) were collected in two different situations: during rest and in a reaction time activity. RESULTS: The groups were significantly different considering rest muscle tension (G2 higher recordings) and did not differ when considering speech reaction time and muscle activity during speech. There was a strong positive correlation between speech reaction time and speech muscle activity for G2 - the longer the speech reaction time, the higher the muscle activity during speech. CONCLUSION: In addition to perceptible episodes of speech disfluency, stutterers exhibit anomalies in speech motor output during fluent speech. Correlations with a possible cortical-subcortical disorder are discussed.
INTRODUÇÃO: Atualmente considera-se que as disfluências da fala na gagueira sejam decorrentes de controle motor anormal. OBJETIVO: Verificar o repouso e tempo de reação para fala em adultos fluentes e gagos. MÉTODO: 22 adultos, divididos em dois grupos: G1 - 11 fluentes; G2 - 11 gagos. Os dados eletromiográficos (orbicular dos lábios inferior) foram obtidos em duas situações: repouso e atividade de tempo de reação. RESULTADOS: Os grupos apresentaram diferenças significantes para a tensão muscular de repouso (G2 valores maiores) e não se diferenciaram quanto ao tempo de reação e atividade muscular de fala. Houve correlação positiva entre o tempo de reação e a atividade muscular de fala para G2 - quanto maior o tempo de reação maior a atividade muscular de fala. CONCLUSÃO: Além dos episódios perceptíveis de disfluência, gagos apresentam alterações no output motor de fala durante a produção da fala fluente. Correlações com possível distúrbio cortico-subcortical são discutidas.
Subject(s)
Adult , Female , Humans , Male , Cerebral Cortex/physiopathology , Facial Muscles/physiopathology , Stuttering/physiopathology , Electromyography , Reaction Time , Rest/physiologyABSTRACT
CONTEXT: Aphasia is a very disabling condition caused by neurological diseases. In Brazil, we have little data on the profile of aphasics treated in rehabilitation centers. OBJECTIVE: To present a descriptive study of 192 patients, providing a reference sample of speech and language disturbances among Brazilians. DESIGN: Retrospective study. SETTING: Speech Pathology Unit linked to the Neurology Division of the Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo. SAMPLE: All patients (192) referred to our Speech Pathology service from 1995 to 2000. PROCEDURES: We collected data relating to demographic variables, etiology, language evaluation (functional evaluation, Boston Diagnostic Aphasia Examination, Boston Naming and Token Test), and neuroimaging studies. MAIN MEASUREMENTS: The results obtained in language tests and the clinical and neuroimaging data were organized and classified. Seventy aphasics were chosen for constructing a profile. Fourteen subjects with left single-lobe dysfunction were analyzed in detail. Seventeen aphasics were compared with 17 normal subjects, all performing the Token Test. RESULTS: One hundred subjects (52 percent) were men and 92 (48 percent) women. Their education varied from 0 to 16 years (average: 6.5; standard deviation: 4.53). We identified the lesion sites in 104 patients: 89 percent in the left hemisphere and 58 percent due to stroke. The incidence of aphasia was 70 percent; dysarthria and apraxia, 6 percent; functional alterations in communication, 17 percent; and 7 percent were normal. Statistically significant differences appeared when comparing the subgroup to controls in the Token Test. CONCLUSIONS: We believe that this sample contributes to a better understanding of neurological patients with speech and language disturbances and may be useful as a reference for health professionals involved in the rehabilitation of such disorders
