ABSTRACT This case report aimed to evaluate the swallowing capacity and the severity of the risk of laryngotracheal aspiration of a 52-year-old female patient with atypical and rare stroke, with major injury in the cerebellar pathway. In order to measure swallowing capacity and risk of aspiration a routine clinical assessment used in the speech therapy clinic was performed and two valid clinical tests were used: Massey Bedside Swallowing Screen (MBSS) and Gugging Swallowing Screen (GUSS). After evaluation with the clinical tests, it was observed that the patient had reduced swallowing capacity, performance characterized as pathological, 100% dysfunction in the water swallowing test (MBSS), presence of choking, coughing, change in vocal quality and anterior escape. In the assessment of risk of aspiration with the GUSS, the patient presented moderate dysphagia and risk of laryngotracheal aspiration.This case report demonstrated that moderate dysphagia is found in a stroke patient with lesions that affect the cerebellum. Standardized and validated clinical tests such as GUSS and MBSS should also be used to assess the risk of dysphagia after stroke at ambulatory care.

RESUMO Esse relato de caso teve o objetivo de avaliar a capacidade de deglutição e a gravidade do risco de aspiração laringotraqueal de uma paciente, 52 anos, com Acidente Vascular Encefálico (AVE) atípico, com comprometimento na via cerebelar. Para mensurar a capacidade de deglutição e do risco de aspiração foram utilizados a avaliação de rotina na clínica de fonoaudiologia e dois testes clínicos validados: o Massey Bedside Swallowing Screen (MBSS) e o Gugging Swallowing Screen (GUSS). Após a avaliação com os testes clínicos, foi observado que a paciente apresentou capacidade de deglutição diminuída, desempenho caracterizado como patológico e de risco, com 100% de alteração no teste de deglutição de água pelo MBSS, presença de engasgo, tosse, alteração na qualidade vocal e escape anterior de alimento. Já na avaliação do risco de aspiração com o GUSS, a paciente apresentou disfagia moderada e com risco de aspiração laringotraqueal. A disfagia pode estar presente em casos de AVE com lesão anatômica comprometendo o cerebelo e suas vias, o que sugere a importância de avaliação específica da deglutição nesses casos. Os testes GUSS e o MBSS podem ser utilizados para avaliação de casos atípicos de AVE em fase ambulatorial, com objetivos de avaliar o risco de aspiração e a capacidade de deglutição.

RESUMO Objetivo Identificar a prevalência da Síndrome da Fragilidade em idosos e suas relações com o risco para quedas. Método Estudo clínico descritivo, transversal e analítico. Cento e um voluntários com mais de 60 anos, foram submetidos à avaliação audiológica, Dynamic Gait Index – Brazilian brief (DGI), Timed Up and Go(TUG) e Escala de Fragilidade de Edmonton (EFE) que determinaram, respectivamente, os limiares auditivos, síndrome da fragilidade, equilíbrio funcional e dinâmico e risco para quedas. Utilizou-se a distribuição percentual simples, o teste de Wilcoxon e de Correlação Bivariada com coeficiente de Pearson para a análise estatística. Foram adotados limites iguais inferiores a 1,0 e 5,0%. Resultados A EFE identificou 22,8% dos voluntários como frágeis e 22,8% como vulneráveis. O DGI e o TUG classificaram 34,6 e 84,1% de riscos para quedas. Ocorreu correlação significativa entre a EFE e o DGI (p<0,01), a EFE e o TUG (p<0,01) e o DGI e TUG (p<0,01). O coeficiente de Pearson entre EFE e o DGI, entre o EFE e o TUG e DGI e TUG foram -0,26, -0,41 e 0,46 respectivamente. Ocorreu associação entre DGI e TUG e idade (p<0,01). Não houve correlação entre a EFE com sexo e idade. Conclusão A fragilidade e pré-fragilidade foi identificada em uma parcela expressiva dos voluntários, sobretudo nos mais longevos. O equilíbrio funcional e o dinâmico se correlacionaram moderamente com fragilidade, o que demonstrou que a Síndrome da fragilidade aumenta o risco para quedas.

ABSTRACT Purpose To identify the prevalence of Frailty Syndrome in the elderly and the relationship with risk of falling. Methods Descriptive, cross-sectional, and analytical clinical study. One hundred and one volunteers over 60 years old were submitted to audiological evaluation, Dynamic Gait Index - Brazilian brief (DGI), Timed Up and Go (TUG) and Edmonton Fragility Scale (EFE) that verified, respectively, hearing thresholds, frailty syndrome, functional and dynamic balance, and risk of falling. The simple percentual distribution, the Wilcoxon´s test and the Bivariate Correlation with Pearson's coefficient were used for statistical analysis. Limits equal to or less than 1.0 and 5.0% were adopted. Results EFE identified 22.8% of volunteers as fragile and 22.8% as vulnerable. DGI and TUG found 34.6% and 84.1% of at risk for falls, respectively. Significant correlations between EFE and DGI (p <0.01), EFE and TUG (p <0.01), and DGI and TUG (p <0.01) were observed. Pearson's coefficient between EFE and DGI, EFE and TUG, and DGI and TUG were -0.26, -0.41, and 0.46, respectively. An association between DGI and TUG and age (p <0.01) was identified. No correlation between EFE and sex or age was found. Conclusion Frailty and pre-frailty were identified in a significant segment of the volunteers, especially in the oldest subjects. Functional and dynamic balance were moderately correlated with frailty, which demonstrated that frailty syndrome increases the risk of falls.

Abstract: Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2–17 years. Information on DOH was obtained from the verbal report of the children’s parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13–1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00–1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.

SUMMARY We performed an integrative review on the scientific literature about the use of telehealth in audiology care. Through high criteria search of published studies on the “Biblioteca Virtual em Saúde” – Virtual Health Library, PubMed, and Scientific Electronic Library Online databases, nine articles were selected. It was possible to verify that the use of telehealth in audiology is feasible and efficient, because it could promote audiological care for patients from away places. This process reaches more patients and communities by breaking down geographic barriers, and it offers a specific service not available with less cost and more quickly when compared with traditional speech therapy care.

RESUMO Objetivo Verificar a eficácia de uma intervenção fonoaudiológica para diminuição do risco de quedas. Método Estudo exploratório e de intervenção em que 148 voluntários socialmente ativos, de ambos os sexos, com média de 68,6(±6,5) anos foram avaliados pelo Dynamic Gait Index (DGI)–Brazilian brief e o Timed Up and Go (TUG). Todos os voluntários, com e sem risco para quedas, foram convidados para o programa de intervenção realizado em cinco semanas consecutivas, com duração de 50 minutos baseados nos exercícios de Cawthorne e Cooksey. Destes, 72 com 68,1(±6,5) anos, com e sem riscos para quedas, que participaram de, pelos menos, três encontros foram reavaliados. Foram utilizados o teste de Wilcoxon, Qui-quadrado, Spearman e Matriz de Correlação, com p≤5,0%. Resultados Inicialmente, 37(25,0%) e 106(71,6%) dos voluntários apresentaram, respectivamente, riscos para quedas no DGI–Brazilian brief e no TUG. Verificou-se correlação negativa do DGI-Brazilian brief (p=0,034) e positiva com o TUG (p=0,0071) com a idade e entre os dois instrumentos (p=0,00000016). Na comparação dos dados iniciais e finais de 72 voluntários averiguou-se correlação positiva no DGI-Brazilian brief e TUG no teste do Qui-quadrado e de Wilkoxon. Foi observado melhor desempenho nestes testes após a intervenção. Conclusão A intervenção foi eficaz, uma vez que diminuiu o risco para quedas e melhorou o desempenho da marcha e equilíbrio funcional e dinâmico.

ABSTRACT Purpose to verify the effectiveness of a Speech Therapy intervention program to decrease the risk of falls in elderly people. Methods Exploratory and intervention study where upon 148 volunteers from community, both genders, with an average of 68.6(± 6.5) years were submitted to the Dynamic Gait Index (DGI)- Brazilian brief and the Timed Up and Go (TUG). Volunteers with or without potential risk for falling were invited to participate in a 50-minutes long intervention program carried out for five consecutive weeks, based on Cawthorne and Cooksey exercises. Seventy-two volunteers 68.1(±6.5) years presented in at least three meeting, were reassessed. The results were analyzed by Wilcoxon, Chi-square, Spearman and Correlation Matrix tests, with p≤5.0%. Results Thirty-seven (25.0%) and 106 (71.6%) participants presented, respectively, risks for falls in the DGI–Brazilian brief and TUG. There was negative correlation between the DGI-Brazilian brief (p=0.034) and positive with the TUG (p=0.0071) with age and both instruments (p=0.00000016). Through the comparison the initial and final data a positive correlation was found for the DGI-Brazilian brief and for TUG in the Chi-square test and by Wilcoxon’s. Better performance was observed in both tests after the intervention. Conclusion The intervention was effective in decreasing the risk for falls and improving gait performance, and functional and dynamic balance.

RESUMO A pandemia da COVID-19 é associada com o novo tipo do coronavírus, o SARS-Cov-2, que causa síndrome respiratória aguda grave. Esse vírus afeta o trato respiratório superior e é transmitido, principalmente, por gotículas, espirros e aerossóis e, por isso, há um alto risco de transmissão durante os procedimentos do fonoaudiólogo que atua no ambiente hospitalar. O objetivo deste artigo foi descrever as iniciativas que podem ser adotadas pelo fonoaudiólogo que atende pacientes à beira do leito, com disfagia, visando diminuir o risco de contaminação cruzada na prática clínica durante a pandemia do SARS-CoV-2.

ABSTRACT The COVID-19 pandemic is associated with a new strain of coronavirus, SARS-Cov-2, which causes severe acute respiratory syndrome. This virus affects the upper respiratory tract and is transmitted mainly by droplets, sneezes and aerosols, so there is a high risk of transmission during the procedures of the speech therapist who works in the hospital environment. This article aims to describe the steps that can be taken by the speech therapist who attends bedside patients with dysphagia, to reduce the risk of cross-contamination in clinical practice during the COVID-19 pandemic.

RESUMO Objetivo: realizar uma revisão integrativa sobre estratégias de comunicação suplementar e/ou alternativa utilizadas com adultos e idosos no ambiente hospitalar e a repercussão na comunicação. Métodos: foi realizada uma revisão integrativa com descritores em inglês e português: ‘communication’ ‘hospitals’ ‘communication aids for disabled’, nas bases de dados: LILACS, PubMed, Cinahl, Cochrane Library, SciELO, Scopus, Web of Science e incluídos artigos em inglês e português, dos últimos 14 anos, que abordassem a comunicação alternativa em adultos e idosos hospitalizados. Estudos com crianças, duplicados, revisão e que abordassem outros métodos de comunicação foram excluídos. Resultados: 13 artigos caracterizaram estratégias de comunicação alternativa utilizadas com adultos e idosos. A prevalência foi de pacientes intubados, traqueostomizados, profissionais de saúde, sendo o enfermeiro com maior citação e, pesquisas com abordagem qualitativa. Seis estudos utilizaram alta e baixa tecnologia, no entanto, a maioria evidenciou maior uso das ferramentas de baixa tecnologia. Conclusão: identificou-se uma variedade de estratégias de alta e baixa tecnologia, sendo observada redução das dificuldades de comunicação, melhora da qualidade de vida e comunicação com profissionais. A prancha de comunicação foi a mais utilizada, devido a disponibilidade nos hospitais e facilidade no uso. Sugere-se estudos sobre avaliação e eficácia das ferramentas de comunicação em diferentes setores e perfis clínicos.

ABSTRACT Objective: to carry out an integrative review about the augmentative and alternative communication strategies used with adults and the elderly in the hospital environment and their impact on communication. Methods: this research study used the integrative review methodology with descriptors in English and Portuguese: 'communication', 'hospitals', 'communication aids for the disabled', in the following databases: LILACS, PubMed, Cinahl, Cochrane Library, SciELO, Scopus, Web of Science. Several articles in English and Portuguese, from the last 14 years, which addressed alternative communication strategies used with hospitalized adults and the elderly, were included. Studies on children, as well as duplicates, reviews, and those that addressed other methods of communication were excluded. Results: 13 articles characterized the alternative communication strategies used with adults and the elderly. There was a prevalence of intubated or tracheostomized patients, and health professionals, nurses being the ones with the highest citation, and researches on a qualitative approach. Six studies have used high and low technologies; however, most have shown a greater use of low-tech tools. Conclusion: a variety of high and low-tech strategies were identified, a reduction in communication difficulties being noted, as well as improvements in the quality of life and communication with professionals. The most used tool was the communication board, due to its hospitals' availability and its simple use. The evaluation and the effectiveness of communication tools in distinct clinical settings and profiles should be studied.

ABSTRACT Purpose: to identify associated factors and preventive measures for aspiration pneumonia in hospitalized elderly patients. Methods: the PPOT (population, predictor, outcome, and type of study) was the strategy used to define the eligibility criteria: (1) Population: people over 60 years of age; (2) predictor: hospitalized patients (3) Outcomes: associated factors and measures to prevent aspiration pneumonia; (4) Type of study: Observational Studies (transversal and case-control). We performed the data collection in the PubMed, Lilacs, Scielo, Google Scholar, Science Direct, and Web of Science databases. Observational studies on factors associated with aspiration pneumonia and preventive measures in the elderly, without language restriction and available in full, were included. Data on authors/year/country, objective, methodology, sample, and results, were collected. The risk of bias was assessed, according to the JBI Critical Appraisal Checklist. Results: a case-control and two cross-sectional studies were analyzed. One paper presented a smaller sample with 86 patients, and another presented a larger sample comprising 443 patients. The median age was 77 years old. Conclusion: factors such as severe stroke, dysphagia, advanced age, male gender, coronary heart disease, lower Glasgow coma scale score, use of mechanical ventilation for more than 48 hours, and aspiration of colonized gastric juice were associated with aspiration pneumonia.

RESUMO A doença de coronavírus (COVID-19) é causada pela síndrome respiratória aguda grave coronavírus 2 (SARS-CoV-2). O vírus é transmitido, principalmente, por gotículas, espirros e aerossóis e pode ser transmitido mesmo entre pacientes assintomáticos, havendo risco de contágio durante os procedimentos do audiologista, que utiliza e reutiliza equipamentos clínicos em uma ampla variedade de pacientes. Este artigo teve como objetivo descrever as etapas que podem ser adotadas pelos audiologistas para diminuir o risco de contaminação cruzada na prática clínica, durante a pandemia de SARS-CoV-2. Recomenda-se, portanto, a esses profissionais, o uso de equipamentos de proteção individual, incluindo respiradores N95, luvas de procedimento, protetores para calçados descartáveis, protetores faciais ou óculos de segurança, gorros e aventais descartáveis, além de seguir, rigorosamente, os protocolos de biossegurança durante os cuidados audiológicos.

ABSTRACT Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV2). This virus is transmitted mainly by droplets, sneezes and aerosols and can be transmitted even among asymptomatic patients, so there is a risk of transmission during the audiologist's procedures which, in addition, use and reuse clinical equipment in a wide variety of patients. This article aims to describe the steps that can be taken by the audiologist in order to decrease the risk of cross-contamination in clinical practice during the SARS-CoV-2 pandemic in Brazil. During the COVID-19 pandemic, audiologists are recommended to use personal protective equipment including N95 respirators, clinical gloves, disposable shoe covers, face shields or safety glasses, hair covers and disposable aprons, in addition to strictly following biosafety protocols during audiological care.

ABSTRACT Purpose to evaluate the efficacy of orofacial myofunctional therapy in improving orofacial function and nasal breathing in patients with asthma and rhinitis and, consequently, achieve clinical control of these conditions. Research strategies We used the elements of the PICOT method (study population, intervention, comparison, outcomes and type of studies) to define the eligibility criteria: (1) Population: patients with asthma and rhinitis; (2) Intervention: orofacial myofunctional therapy to improve chewing, swallowing, and breathing; (3) Comparison: control group without orofacial myofunctional therapy; (4) Predefined outcomes: clinical control of asthma and improvement of orofacial functions and nasal breathing; (5) Study type: clinical trials. The data were collected from PubMed, SCOPUS, Web of Science, Science Direct, LILACS, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), OATD, and Open Thesis, in November 2018. Selection criteria Randomized controlled trials published in full-text versions without language restriction, no filter was used. Data analysis Demographic characteristics of study participants, specific diagnosis of asthma and control medication, type, duration, intensity and follow-up of orofacial myofunctional therapy, and outcome data. The risk of bias was assessed according to the Cochrane guidelines for clinical trials. Results One study met the eligibility criteria: although the study has shown an improvement of functional control and clinical scores of asthma, the evidence is very low. Conclusion There is no scientific evidence on the efficacy of orofacial myofunctional therapy in improving clinical control, orofacial function, and nasal breathing in patients with asthma and rhinitis.

RESUMO Objetivo avaliar a eficácia da terapia miofuncional orofacial na melhora das funções orofaciais, na respiração nasal em pacientes com asma e rinite e, consequentemente, alcançar o controle clínico das doenças. Estratégia de pesquisa Utilizamos a estratégia PICOT (população, intervenção, comparação, resultado e tipo de estudo) para definir os critérios de elegibilidade: (1) População: pacientes com asma e rinite; (2) Intervenção: terapia miofuncional orofacial, para melhora da mastigação, deglutição e respiração; (3) Comparação: grupo controle sem terapia miofuncional orofacial; (4) Desfechos pré-definidos: controle clínico da asma e melhora das funções orofaciais e respiração nasal; (5) Tipo de estudo: ensaios clínicos. Os dados foram coletados no PubMed, SCOPUS, Web of Science, Science Direct, LILACS, Google Scholar, Cochrane Central Register de Ensaios Controlados (CENTRAL), OATD, Open thesis, Novembro de 2018. Critérios de seleção Ensaios controlados randomizados publicados em versões de texto completo, sem restrição de idioma, nenhum filtro foi utilizado. Análise dos dados Foram avaliadas as características demográficas dos participantes do estudo, diagnóstico específico de asma e medicação de controle, tipo, duração, intensidade, acompanhamento da terapia miofuncional orofacial e dados do desfecho. O risco de viés foi avaliado de acordo com as diretrizes da Cochrane para ensaios clínicos. Resultados Um estudo atendeu aos critérios de elegibilidade. Embora o estudo tenha mostrado melhora do controle funcional e escores clínicos da asma, as evidências são baixas. Conclusão Não há evidências científicas sobre a eficácia da terapia miofuncional orofacial na melhora do controle clínico, funções orofaciais e respiração nasal em pacientes com asma e rinite.

RESUMO Objetivo: gerenciar o risco de broncoaspiração em pacientes com disfagia orofaríngea por meio de placas sinalizadoras no leito. Métodos: estudo descritivo, transversal, de caráter quantitativo, desenvolvido na clínica médica I, clínica médica II, clínica cirúrgica e unidade de terapia intensiva do Hospital Universitário da Universidade Federal de Sergipe, de fevereiro a agosto de 2017. Composto por pacientes na faixa etária ≥ 18 anos de idade, ambos os sexos, com disfagia orofaríngea, baseada na aplicação do Protocolo Adaptado de Avaliação Clínica no Leito e exame instrumental da deglutição. Subsequente à avaliação clínica e identificação do risco de broncoaspiração por disfagia orofaríngea, o profissional fonoaudiólogo realizou a inserção da placa sinalizadora junto ao leito. Resultados: abrangeu 43 pacientes com risco de broncoaspiração por disfagia orofaríngea, média de idade 53,7± 3,53 anos, sendo 51,1% (n=22) do sexo feminino e 48,9% (n=21) do sexo masculino. Observou-se predomínio de neuropatias (53,4%) e de disfagia orofaríngea neurogênica grave (37,2%). A unidade de terapia intensiva destacou-se com 44,18% (n= 19) de aplicação das placas sinalizadoras. Conclusão: o gerenciamento do risco de broncoaspiração demonstrou ser uma medida promissora para redução de eventos adversos, os quais afetam a segurança do paciente e a qualidade do cuidado no ambiente hospitalar.

ABSTRACT Objective: to manage the risk of bronchoaspiration in patients with oropharyngeal dysphagia through signalizing plates in the hospital bed. Methods: a descriptive, quantitative study, developed in the medical clinic I (diagnostic investigation), medical clinic II (infectology / pneumology), surgical clinics and intensive care unit of the University Hospital of the Federal University of Sergipe, from February to August 2017. It was composed of patients in the age group ≥ 18 years of age, of both sexes, diagnosed with oropharyngeal dysphagia, based on the application of the adapted protocol of clinical evaluation in the hospital bed and instrumental examination of swallowing, when pertinent. Following the clinical evaluation and identification of the risk of bronchoaspiration due to oropharyngeal dysphagia, the signs were inserted at the hospital bed by the speech therapist. Results: the study included 43 patients at risk of bronchoaspiration due to oropharyngeal dysphagia, average age of 53.7 ± 3.53 years old, with 51.1% (n = 22) females and 48.9% (n = 21) males. A predominance of neuropathies (53.4%) and severe neurogenic oropharyngeal dysphagia (37.2%) was observed. The intensive care unit stood out with 44.18% (n = 19) of the application of signs of risk of bronchoaspiration. Conclusion: the management of bronchoaspiration risk has been shown to be a promising measure to reduce adverse events, which affect the patient's safety and consequently the quality of care in the hospital environment, as well as a possible strategy for measuring respiratory complications triggered by aspiration of oropharyngeal contents.

Objetivo Avaliar se o diagnóstico clínico da disfagia foi potencializado pelo método videofluoroscópico na encefalopatia crônica da infância. Materiais e Métodos A amostra foi constituída por 93 crianças com diagnóstico de encefalopatia crônica da infância, com idade entre dois e cinco anos, selecionadas por conveniência, de encaminhamentos vindos de fonoaudiólogos, neuropediatras e gastrenterologistas no período de março de 2010 a setembro de 2011. A coleta se deu em dois momentos distintos, com pesquisadores diferentes e cegos entre si. Resultados Foi observada baixa sensibilidade para detectar a aspiração na consistência pastosa (p = 0,04). Os valores de especificidade e valor preditivo negativo foram altos para diagnóstico clínico da disfagia na consistência pastosa. Conclusão Neste estudo, o valor da sensibilidade do diagnóstico clínico da disfagia demonstra que este procedimento de diagnóstico pode não detectar comportamentos alterados no processo de deglutição, independente da consistência utilizada durante a investigação. Desta forma, o diagnóstico clínico da disfagia foi potencializado pelo método videofluoroscópico.

Objective To evaluate the contribution of deglutition videofluoroscopy in the clinical diagnosis of dysphagia in chronic encephalopathy of childhood. Materials and Methods The study sample consisted of 93 children diagnosed with chronic encephalopathy, in the age range between two and five years, selected by convenience among patients referred to the authors' institution by speech therapists, neurologists and gastroenterologists in the period from March 2010 to September 2011. The data collection was made at two different moments, by different investigators who were blind to each other. Results The method presented low sensitivity for detecting aspiration with puree consistency (p = 0.04). Specificity and negative predictive value were high for clinical diagnosis of dysphagia with puree consistency. Conclusion In the present study, the value for sensitivity in the clinical diagnosis of dysphagia demonstrates that this diagnostic procedure may not detect any change in the swallowing process regardless of the food consistency used during the investigation. Thus, the addition of the videofluoroscopic method can significantly contribute to the diagnosis of dysphagia.