OBJETIVO: Correlacionar, em pacientes portadores de acidente vascular encefálico (AVE) na fase subaguda, as alterações clínicas da deglutição com as observadas na videofluoroscopia. MATERIAIS E MÉTODOS: De 37 portadores de AVE subagudo confirmado por exame de imagem, 26 pacientes de ambos os sexos, com idade média de 59,69 anos, foram avaliados clínica e videofluoroscopicamente. Consideramos como variáveis para pareamento estatístico os parâmetros clínicos indicativos de penetração/aspiração e sua confirmação na videofluoroscopia. RESULTADOS: Identificamos disfagia em 19 (73%) dos 26 pacientes que fizeram videofluoroscopia; dez (38,46%) apresentaram penetração/aspiração de líquidos. Os dados resultantes mostraram não existir correlação (p < 0,05) entre a presença de disfagia e/ou disartria e a presença de penetração/aspiração de líquidos na videofluoroscopia. Houve correlação entre a presença de penetração/aspiração de líquidos observados na videofluoroscopia com os seguintes parâmetros clínicos: estado dos dentes (p = 0,047), mobilidade (p = 0,019) e sensibilidade da face (p = 0,039) e mobilidade da língua (p = 0,012). CONCLUSÃO: Não foi possível definir a presença de penetração/aspiração de líquidos nas vias aéreas por dados epidemiológicos do AVE. A existência de mau estado de preservação dos dentes, alterações na mobilidade da face e da língua e na sensibilidade da face mostrou risco aumentado de penetração/aspiração para líquidos. Permanece importante a indicação da videofluoroscopia para melhor avaliação dos quadros de disfagia após AVE.

Objective: To analyze the different methods of Neuromuscular Electrical Stimulation (NMES) in the intervention of oropharyngeal dysphagia. Methods: Review using the descriptors: “deglutition disorders” and “electrical stimulation” in PubMed, BVS, SciELO, and MedLine, from 1997 to 2015. Classified according to the CAPES Integrated System (SiCAPES), PEDro, and Jadad scales. Results: There were 165 articles found, from which 25 were selected according to the theme. Between 2009-2012 there were more publications (60%, n = 15). Case-control was the most reported type of study (28%, n = 7). Most individuals were investigated after a stroke (44%, n = 11). The most popular type of therapy considered NMES at rest and traditional therapy (TT) (28%, n = 8), NMES during swallowing and TT (28%, n = 7), and NMES at rest (24%, n = 3). Vital Stim® was the most cited electrical stimulation device (32%, n = 8). Transcutaneous electrical nerve stimulation was the most reported (76%, n = 19). As to location, electrodes placed on the neck (48%, n = 12) and submental (44%, n = 11) stood out. Electric current commonly used: FES (40%, n = 10) and TENS (24%, n = 6). Fluoroscopy was the prevailing evaluation method (52%, n = 13). For SiCAPES distribution, the greatest number of materials was classified as B2 (36%, n = 9) and A1 (16%, n = 4). On the PEDro scale, the studies mostly scored 11 (24%, n = 6) and 10 (16%, n = 4). Considering the Jadad scale, (24%, n = 6) the studies scored 3 points. Conclusion: A higher prevalence of therapeutic effect on hyolaryngeal complex elevation, an important airway defense mechanism during swallowing, and the use of FES current and electrodes placed on the submental region or neck. Further research is needed, with defined etiological groups, to prove the therapeutic effect in the medium and long term

A pneumonia é uma inflamação do parênquima pulmonar resultante do processo infeccioso ou inflamatório, responsável por 5% do total das mortes notificadas no mundo, instalando-se geralmente em indivíduos cujos mecanismos de defesa encontram-se comprometidos. A relação estreita entre as alterações da deglutição e a predisposição para pneumonias bacterianas de repetição e sua associação com desordens neuromusculares tem sido objeto constante de pesquisas. Objetivo: propor um protocolo clínico para detecção de broncoaspiração entre pacientes com pneumonia sem realização de videofluoroscopia. Metodologia: 70 pacientes com média de idade de 67,5±16,3 anos, foram submetidos a 2 protocolos de avaliação da deglutição validados na literatura: Tohara (2003) e Xerez (2002). Resultados: Foram considerados aspiradores pelo exame clínico 62,9% (44/70). Ser classificado aspirador pelo exame clínico mostrou correlação estatística significativa com a presença de doença neurológica e redução do estado de alerta (p<0,001). Conclusão: o exame clínico foi capaz de detectar os pacientes em risco para pneumonia aspirativa. A presença da associação de fatores deve levar a equipe a adotar cautela maior no manuseio da alimentação do paciente com pneumonia que pode ser de origem aspirativa.

Objective: To describe the profile of patients undergoing a gastrostomy, the recommendations and outcome of this insertion in a Pediatric Teaching Hospital. Method: This was a retrospective, quantitative, and descriptive study that researched the records of patients who underwent a gastrostomy between January 2010 and December 2012. Results: The diseases and conditions most frequent were chronic infantile encephalopathy (77.5%), pneumonia (67.5%), seizures (57.5%), and malnutrition (42.5%). Although most patients presented a history of dysphagia (62.5%), oral feeding was observed most frequently as the most common form of nutrition, before the gastrostomy insertion (42.5%), followed by nasoenteric tube (40%). The introduction of nutrition by gastrostomy was successful and occurred an average of 2.82 (± 1.19) days after insertion. Six months after their gastrostomy, 80% of patients continued feeding only through this access tube and only 2.5% had removed the gastrostomy; 45% of the participants had gastrostomy complications, with extravasation of gastric material (15%) and local inflammation (15%) being the most frequent. Conclusion: The profile of patients undergoing gastrostomy is mostly of individuals with neurological and respiratory diseases, without respiratory support, of the male gender, and feeding by oral cavity or nasoenteric tube for a prolonged period. The main recommendation criteria were dysphagia and neurological diseases. Regarding the outcome, the introduction of nutrition by gastrostomy was successful; most individuals remained with this long-term nutritional support and the most common complications were gastric material extravasation and local inflammations. Acta Fisiatr. 2015;22(3):123-129 Soutinho LAR, Fontes DA, Carvalho YSV, Brendim MP, Marques CHD Profile, recommendation criteria, and outcome of gastrostomy tube insertions in a pediatric teaching hospital Acta Fisiatr. 2015;22(3):123-129 Soutinho LAR, Fontes DA, Carvalho YSV, Brendim MP, Marques CHD Profile, recommendation criteria, and outcome of gastrostomy tube insertions in a pediatric teaching hospital Acta Fisiatr. 2015;22(3):123-129 Soutinho LAR, Fontes DA, Carvalho YSV, Brendim MP, Marques CHD Profile, recommendation criteria, and outcome of gastrostomy tube insertions in a pediatric teaching hospital Acta Fisiatr. 2015;22(3):123-129 Soutinho LAR, Fontes DA, Carvalho YSV, Brendim MP, Marques CHD Profile, recommendation criteria, and outcome of gastrostomy tube insertions in a pediatric teaching hospital 129

Objective: To describe the profile of patients undergoing a gastrostomy, the recommendations and outcome of this insertion in a Pediatric Teaching Hospital. Method: This was a retrospective, quantitative, and descriptive study that researched the records of patients who underwent a gastrostomy between January 2010 and December 2012. Results: The diseases and conditions most frequent were chronic infantile encephalopathy (77.5%), pneumonia (67.5%), seizures (57.5%), and malnutrition (42.5%). Although most patients presented a history of dysphagia (62.5%), oral feeding was observed most frequently as the most common form of nutrition, before the gastrostomy insertion (42.5%), followed by nasoenteric tube (40%). The introduction of nutrition by gastrostomy was successful and occurred an average of 2.82 (± 1.19) days after insertion. Six months after their gastrostomy, 80% of patients continued feeding only through this access tube and only 2.5% had removed the gastrostomy; 45% of the participants had gastrostomy complications, with extravasation of gastric material (15%) and local inflammation (15%) being the most frequent. Conclusion: The profile of patients undergoing gastrostomy is mostly of individuals with neurological and respiratory diseases, without respiratory support, of the male gender, and feeding by oral cavity or nasoenteric tube for a prolonged period. The main recommendation criteria were dysphagia and neurological diseases. Regarding the outcome, the introduction of nutrition by gastrostomy was successful; most individuals remained with this long-term nutritional support and the most common complications were gastric material extravasation and local inflammations