The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series.

Objective: We evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70%WPI:30%MS), on nutritional and functional parameters of patients with ALS. Method: A prospective randomized double-blind study was performed with 16 ALS patients, divided in two groups, the treatment group received (70%WPI:30%MS) and the control group received (maltodextrin). They underwent prospective nutritional and functional assessment for 4 months. Results: Patients in the treatment group presented weight gain, increased body mass index (BMI), increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical parameters did not change, but weight and BMI declined. Conclusion: Our results indicate that the agglomerate 70%WPI:30%MS may be useful in the nutritional therapy of patients with ALS. Key words: amyotrophic lateral sclerosis, nutrition status, anthropometry.Efeito da suplementação nutricional com proteínas do soro de leite em pacientes com esclerose lateral amiotrófica RESUMO Objetivo: Avaliar a eficácia da suplementação nutricional oral com proteínas do soro do leite e amido modificado (70%WPI:30%MS), nos parâmetros nutricionais e funcionais de pacientes com esclerose lateral amiotrófica (ELA). Método: Foi realizado estudo randomizado duplo-cego, com 16 pacientes com ELA, divididos em dois grupos, um que recebeu 70%WPI:30%MS e um controle que recebeu maltodextrina. Os pacientes foram submetidos a avaliação nutricional e funcional durante quatro meses. Resultados: Nos pacientes que receberam o suplemento 70%WPI:30%MS, foi observado ganho de peso, aumento na contagem de linfócitos e redução de creatina kinase, aspartato aminotransferase and alanina aminotransferase. No grupo controle, os parâmetros bioquímicos não sofreram modificações; no entanto, peso e índice de massa corporal diminuíram. Conclusão: Nossos resultados indicam que o aglomerado 70%WPI:30%MS pode ser útil na terapia de pacientes com ALS. Palavras-chave: esclerose lateral amiotrófica, estado nutricional, antropometria.

The purpose of this study is to determine the relationship between the structural integrity of the corpus callosum (CC) and clinical feeding/swallowing performance in children with unilateral spastic cerebral palsy (USCP). Twenty children with USCP, (11 males, 5.11-17.6 yoa) were assessed via the Dysphagia Disorder Survey (DDS) and diffusion tensor imaging. Children were grouped into left hemisphere lesion (LHL; n = 13) and right hemisphere lesion (RHL; n = 7) groups. DTI variables analyzed for three CC regions (anterior, middle, posterior) were: fractional anisotropy (FA), radial diffusivity (RD), mean diffusivity (MD), and fibers count. Children with RHL presented with higher clinical dysphagia severity (p = 0.03). Six of seven children with RHL had lesions affecting periventricular/subcortical areas, and 8/13 children with LHL had lesions affecting the sensorimotor cortex. In the LHL group, as FA and fiber count of the anterior CC decreased and RD increased (all indicating reduced CC structural integrity), signs of dysphagia increased (r = -0.667, p = 0.013; r = -0.829, p ≤ 0.001; r = 0.594, p = 0.032, respectively). Reduced fiber count in the middle and posterior CC was also significantly associated with increased DDS scores (r = -0.762, p = 0.002; r = -0.739, p = 0.004, respectively). For the RHL group no significant correlations were observed. We provide preliminary evidence that corpus callosum integrity correlates with feeding/swallowing performance in children with USCP, especially when cortical sensorimotor areas of the left hemisphere are impacted. In this sample, CC integrity appeared to enable interhemispheric cortical plasticity for swallowing, but was not as critical when intrahemispheric connections were disrupted, as seen in the RHL group.

Purpose Speech-language pathologists are playing a crucial role in the assessment and management of patients infected with severe acute respiratory syndrome coronavirus 2. Our goal was to synthesize peer-reviewed literature and association guidelines from around the world regarding dysphagia assessment and management for this specific population. Method A review of publications available in the PubMed database and official guidelines of international groups was performed on May 23, 2020. The information was synthesized and categorized into three content areas for swallowing: clinical evaluation, instrumental assessment, and rehabilitation. Results Five publications were identified in the PubMed database. Following title, abstract, and full-text review, only three publications met inclusion criteria: two reviews and one narrative report. Additionally, 19 international guidelines were reviewed. To assess swallowing, a modified clinical evaluation was recommended and only following a risk assessment. Instrumental assessments were often considered aerosol generating, especially transnasal procedures such as endoscopy and manometry. For this reason, many associations recommended that these examinations be performed only when essential and with appropriate personal protective equipment. Guidelines recommended that intervention should focus on compensatory strategies, including bolus modification, maneuvers/postural changes, and therapeutic exercises that can be conducted with physical distancing. Respiratory training devices were not recommended during rehabilitation. Conclusions International associations have provided extensive guidance regarding the level of risk related to the management of dysphagia in this population. To date, there are no scientific papers offering disease and/or recovery profiling for patients with dysphagia and coronavirus disease 2019. As a result, research in this area is urgently needed.

ResumoDentre os trabalhadores, a categoria mais numerosa que faz uso profissional da voz é a dos professores. Este artigo teve por objetivo discutir, sob a óptica do professor, o uso da voz na prática docente e a prevenção de problemas vocais. Trata-se de um estudo de caso qualitativo-descritivo com 25 professores. Com base num roteiro semiestruturado foram realizadas entrevistas a fim de conhecer a relação dos sujeitos com suas vozes, a relação dos sujeitos com o trabalho docente e obter sugestões de ações preventivas. Os resultados indicaram que a alteração vocal era percebida, mas geralmente atribuída maior importância ao fato de fazer-se compreender e de exercer controle sobre os alunos em sala de aula. Os professores que ainda não tinham problemas vocais conheciam colegas que tinham, reconheciam o risco ao qual estavam expostos e, aparentemente, consideravam-no uma consequência natural e esperada da prática docente. Acreditavam que as intervenções com os alunos, o apoio da entidade empregadora, a presença de especialistas na escola e o trabalho com as necessidades específicas que enfrentam em sala de aula, poderiam ajudar a preservar suas vozes. Palavras-chave: Docentes; Saúde do Trabalhador; Condições de Trabalho; Prevenção de Doenças; Distúrbios da Voz.

RESUMOObjetivo: analisar parâmetros fonoarticulatórios de professores, pré e pós-programa de aprimoramento vocal. Método: um programa de aprimoramento vocal foi oferecido numa escola estadual do município de Campinas, São Paulo, Brasil. Treze professores aceitaram participar do programa. Devido ao critério de exclusão, apenas cinco foram selecionados para as análises. Os sujeitos foram previamente submetidos à avaliação laringológica. Foram realizados 12 encontros semanais de 1 hora e 30 minutos na própria escola. No primeiro e no último encontro os sujeitos gravaram três "frases-veículo". As gravações foram submetidas à análise perceptivo-auditiva (para avaliação do pitch, da modulação e da articulação) e acústica (para avaliação da freqüência fundamental, da extensão de freqüência e dos dois primeiros formantes). Os dados foram submetidos à análise estatística. Resultados: mesmo com o pequeno número de sujeitos, os resultados do presente estudo, revelaram ampliação significante da extensão de freqüência, indicando maior uso deste recurso expressivo pós-aprimoramento, além do aumento estatisticamente significante de F 1 nas vogais /i/ e /u/ pós-intervenção, sugerindo melhora no ajuste articulatório. Conclusões: não foram observadas modificações no pitch, modulação e articulação avaliados por meio da análise perceptivo-auditiva, bem como da freqüência fundamental pós-intervenção.

Compensatory and sensorial maneuvers are more recommended to rehabilitee program in both diseases. The physiopathology of the diseases determined the choice of therapeutic approaches. The disease duration of the patients did not interfere directly in the therapeutic approaches.

Persistent smell and taste disorders have been reported as some of the most common symptoms after COVID-19 (coronavirus disease 2019). Sensory, olfactory, and gustatory functions perform an important role in the initiation and modulation of oropharyngeal swallow biomechanics and salivation as well as in mealtime enjoyment and appetite. Yet, the details of this interaction remain relatively unknown in patients who are infected with and recovering from COVID-19. In this commentary, we discuss the possible impacts of SARS-CoV-2 on the central and peripheral nervous system and consider the pathophysiology of olfactory, gustatory, and pharyngolaryngeal sensory deficits and its influence on deglutition, describing hypotheses and offering guidance for future research.