Investigation on the complaint of dysphagia in aphasic patients
Investigação da queixa de disfagia em pacientes afásicos
Karin Zazo Ortiz; Milena Ribeiro Marinelli
Abstract
Purposes: to assess the presence and evolution of swallowing complaints in post-stroke aphasic patients and, based on reports by family members on symptom improvements, to determine the influence of aphasia on the prognosis of dysphagia.
Methods: 30 post-stroke aphasic patients at the chronic phase were interviewed and, together with family members, answered a questionnaire on the presence and persistence of post-stroke swallowing complaints and related aspects, including improvements in dysphagia and aphasia. Kaplan-Meier curves of dysphagia complainers and non-complainers were compared to verify the influence of swallowing complaints on the prognosis of aphasia.
Results: 48% of patients reported swallowing problems after the stroke. Out of them, 93% showed positive changes (partial or total resolution of dysphagia symptoms). The average time for patient improvement (spontaneous or otherwise) was 76 days. 60% of the subjects reported total resolution of dysphagia symptoms, 47% of underwent speech therapy. Regarding aphasia, 87% of patients reported some improvement, although no patient reported full resolution of the symptoms. A total of 57% had undergone speech therapy to treat aphasia. The average time reported for positive change in patients was 183 days. No significant difference in aphasia improvement was observed between dysphagia complainers and non-complainers.
Conclusions: out of the aphasic patients assessed in this study, 48% reported swallowing complaints. Based on reports by family members, aphasia had no impact on the prognosis of dysphagia.
Keywords
Resumo
Objetivos: verificar a presença e evolução da queixa de deglutição em pacientes afásicos pós- AVE e, a partir do relato dos familiares em relação à melhora das manifestações, analisar se a ocorrência da afasia interferiu no prognóstico da disfagia.
Métodos: 30 pacientes afásicos pós-AVE na fase crônica foram entrevistados e, juntamente com seus familiares, responderam a um questionário sobre a presença e a permanência de queixas de deglutição pós-AVE e aspectos relacionados, bem como melhoras ocorridas em relação aos quadros de disfagia e afasia. Para verificar se a disfagia parece ter interferido no prognóstico da afasia, comparou-se as curvas de Kaplan-Meier dos pacientes que referiram queixas de disfagia com os que não referiram.
Resultados: 48% dos pacientes tiveram queixas de dificuldades de deglutição pós-AVE. Destes, 93% apresentaram mudanças positivas (melhora parcial ou total do quadro). O tempo médio para que o paciente apresentasse qualquer tipo de mudança (espontânea ou não) foi de 76 dias. 60% referiu melhora total da disfagia, sendo que 47% foram submetidos à terapia fonoaudiológica. Em relação à afasia, 87% dos pacientes referiram melhora, apesar de nenhum paciente ter referido melhora total. 57% haviam sido expostos à terapia fonoaudiológica para a afasia. O tempo médio referido para que o paciente apresentasse qualquer tipo de mudança positiva nas manifestações foi de 183 dias. Não houve diferença significante na melhora da afasia entre o grupo com e sem queixa de deglutição.
Conclusões: dos pacientes afásicos avaliados neste estudo, 48% apresentou queixa de disfagia. Verificou-se, a partir do relato dos familiares, que a ocorrência da afasia parece não ter interferido no prognóstico da disfagia.
Palavras-chave
Referências
1. Soler EP, Ruiz VC. Epidemiology and risk factors of cerebral ischemia and ischemic heart diseases: similarities and differences. Curr Cardiol Rev. 2010;6(3):138-49.
2. Fernadez JR. Acidente Cerebrovasculares (AVE) en Cuidad de Concepicion y Áreas de Influencia. Revista Medica de Tucumán. 2000;6(2):61-78.
3. Pedersen PM, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Aphasia in acute stroke: incidence, determinants, and recovery. Ann Neurol. 1995;38:659-66.
4. Paolucci S, Antonucci G, Pratesi L, Traballesi M, Lubich S, Grasso MG. Functional outcome in stroke inpatient rehabilitation: predicting no, low and high response patients. Cerebrovasc Dis. 1998;8:228-34.
5. Tilling K, Sterne JA, Rudd AG. A new method for predicting recovery after stroke. Stroke. 2001;32:2867-73.
6. Hier DB, Yoon WB, Mohr JP. Gender and aphasia in the Stroke Data Bank. Brain Lang. 1994;47:155-67.
7. Madalozzo D, Tognola WA. –Afasias: correlações clínico-topográficas. Revista Brasileira de Neurologia. 2006;42(2):5-13.
8. Ickenstein GW, Höhlig C, Prosiegel M, Koch H, Dziewas R, Bodechtel U, Muller R, Reichmann H, Riecker A. Prediction of Outcome in Neurogenic Oropharyngeal Dysphagia Within 72 Hours of Acute Stroke. J Stroke Cerebrovasc Dis. 2011 Jun 15. [Epub ahead of print].
9. Teismann IK, Suntrup S, Warnecke T, Steinsträter O, Fischer M, Flöel A et al. Cortical swallowing processing in early subacute stroke. BMC Neurol. 2011;11(11):34.
10. Tippett DC. Clinical challenges in the evaluation and treatment of individuals with poststroke dysphagia. Top Stroke Rehabil. 2011 Mar-Apr;18(2):120-33.
11. Menezes FT, Gonçalvez MIR, Chiari B.M. – Adaptações alimentares em adultos pós AVEi sem queixa de disfagia. Fono Atual. 2005;(34):14-21.
12. Luiz MR. – Atuação Fonoaudiológica em UTI. [levantamento parcial de dados para divulgação da atuação fonoaudiológica em UTI no Hospital das Clínicas da Faculdade de Medicina da USP, realizado em julho de 1999]. www.ufpe.br/utihc/fono.htm, acesso em maio de 2008.
13. Crawford H, Leslie P, Drinnan MJ. Compliance with dysphagia recommendations by carers of adults with intellectual impairment. Dysphagia. 2007 Oct;22(4):326-34.
14. Tippett DC. Clinical challenges in the evaluation and treatment of individuals with poststroke Dysphagia. Top StrokeRehabil. 2011;18(2):120-33.
15. Dulli D, Samaniego EA. Inpatient and community ischemic strokes in a university hospital. Neuroepidemiology. 2007;28(2):86-92.
16. Crinion JT, Leff AP. Recovery and treatment of aphasia after stroke: functional imaging studies. Curr Opin Neurol. 2007;20(6):667-73.
17. Berthier ML. Postsroke aphasia: epidemiology, pathophysiology and treatment. Drugs Aging. 2005;22(2):163-82.
18. Groher ME, Bukation R. The prevalence of swallowing disorders in two teaching hospitals. Dysphagia. 1986;1:3-6.
19. Langdon C, Blacker D. Dysphagia in stroke: a new solution. Stroke Res Treat. 2010;30: 570-3.
20. Barritt AW, Smithard DG. Role of cerebral cortex plasticity in the recovery of swallowing function following dysphagic stroke. Dysphagia. 2009;24(1):83-90.
21. Fujishima I. Evaluation and management of dysphagia after stroke. Nippon Ronen Igakkai. 2003;40(2):130-4.
22. Meng NH, Wang TG, Lien IN. Dysphagia in patients with brainstem stroke: incidence and outcome. American Journal of Physical and Medicine Rehabilitation. Mar-April 2000;79(2):170-5.
23. Bravata DM, Daggett VS, Woodward-Hagg H, Damush T, Plue L, Russell S, Allen G, Williams LS, Harezlak J, Chumbler NR. Comparison of two approaches to screen for dysphagia among acute ischemic stroke patients: nursing admission screening tool versus National Institutes of Health stroke scale. Rehabil Res Dev. 2009;46(9):1127-34.
24. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, Diamant NE. The Toronto Bedside Swallowing Screening Test (TOR-BSST): development and validation of a dysphagia screening tool for patients with stroke. Stroke. 2009 Feb;40(2):555-61.
25. Elia M, StrattonRJ, Holden C, Meadows N, Micklewright A, Russell C et al. Home enteral tube feeding following cerebrovascular accident. Committee of the British Artificial Nutrition Survey (BANS). 2001;20(1):27-30.
26. Han M, Ohnishi H, Nonaka M, Yamauchi R, Hozuki T, Hayashi T et al. Relationship between dysphagia and depressive states in patients with Parkinson's disease. Parkinsonism Relat Disord. 2011 Jul;17(6):437-9.
27. Guyomard V, Fulcher RA, Redmayne O, Metcalf AK, Potter JF, Myint PK. Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study. J. Am Geriatr Soc. 2009 Nov;57(11):2101-6.
28. Schrock JW, Bernstein J, Glasenapp M, Drogell K, Hanna J. A novel emergency department dysphagia screen for patients presenting with acute stroke. Acad Emerg Med. 2011 Jun;18(6):584-9.
29. Smith-Tamaray M, Wilson L, McAllister L. Factors affecting dysphagia management and compliance with recommendations in non-metropolitan healthcare settings. Int J Speech Lang Pathol. 2011 Jun;13(3):268-79.
30. Byrne A, Pettigrew CM. Knowledge and attitudes of allied health professional students regarding the stroke rehabilitation team and the role of the Speech and Language Therapist. Int J Lang Commun Disord. 2010 Jul-Aug;45(4):510-21.
31. Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009 Sep-Oct;18(5):329-35.
Submetido em:
21/10/2011
Aceito em:
09/06/2012
Facebook
Twitter
LinkedIn
Mendeley
Email