Efeitos imediatos da eletroestimulação neuromuscular na deglutição de idosos com demência do tipo Alzheimer

• Ano de defesa: 2015
• Autor(a) principal: Eliene Giovanna Ribeiro
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Demência; Fonoaudiologia; Transtornos de deglutição; Doença de Alzheimer; Protocolos clínicos; Estimulação elétrica; Disturbios da deglutição; Transtornos de deglutição/reabilitação
• Link de acesso: http://hdl.handle.net/1843/BUOS-AJLMBS

Introduction: oropharyngeal dysphagia is an advanced stage marker of dementia. When present, dysphagia predisposes individuals to dehydration, malnutrition, weight loss and laryngotracheal aspiration. Usually the treatment of dysphagia in Alzheimer-type dementia patients consists in making thermal-gustatory stimuli, the change in posture while eating and food consistencies, besides using therapeutic maneuvers. It is believed that the neuromuscular electrical stimulation (NMES) can offer new prospects for the treatment of oropharyngeal dysphagia this population. Objective: To identify, through literature review, the main neuromuscular electrical stimulation models for the treatment of oropharyngeal dysphagia and meet the immediate effects of neuromuscular electrical stimulation in the pharyngeal phase of swallowing in elderly patients with Alzheimer type dementia. Method: it was conducted systematic literature review through Medline, Lilacs and Scielo and Cochrane Library and used the following terms: "Neuromuscular electrical stimulation and dysphagia", "Neuromuscular electrical stimulation and deglutition disorders" and "Neuromuscular electrical stimulation and dysphagia and treatment ". Articles went through descriptive analysis. To evaluate the immediate effects of neuromuscular electrical stimulation, it was conducted clinical trial using non-probabilistic sample of 30 patients evaluated at the Hospital for the Elderly Reference Center - UFMG. These patients underwent clinical evaluation and then the videofluoroscopy during which neuromuscular electrical stimulation were applied through non-invasive portable system VitalStim® therapy of two channels in sensory and motor stimulation levels. The parameters applied were 3 mA in sensory level and 9 mA in motor level. All participants received food in solid, pudding and liquid consistencies. Linear marginal models were used for data analysis in which was adopted the significance level of 5%. Results: Among the 18 articles included in the systematic review, the most used 80 Hz frequency and 700 s pulse duration, using the same equipment (VitalStim®) with a horizontal positioning predominance of electrodes; the stimulation sessions lasted 60 minutes and were applied five days a week. Selected studies for this review indicated application of neuromuscular electrical stimulation in motor levels for oropharyngeal dysphagia treatment, using sensory level only to determine the minimum intensity perceived. When evaluating the immediate effects of neuromuscular electrical stimulation there was no significant impact on penetration and aspiration scale, hyolaryngeal displacement and pharyngeal transit time. However, when the food consistencies were set at the linear marginal model, it was verified when 10 ml liquid swallowing a reduction on larynx displacement in motor stimulation level compared to no electrical stimulation at all. Very close value to the significance level was observed when pudding swallowing, also in the laryngeal displacement when comparing the motor level to the absence of electrical stimulation. According to multivariate analysis the mean value of the hyolaryngeal displacement decreased significantly when comparing puddingconsistency to the other classifications; in males, the mean value of displacement increased when compared to females. There was no significant difference when comparing sensory and motor levels, even considering the consistencies as well penetration and aspiration scale as hyolaryngeal displacement and pharyngeal transit time. Conclusion: neuromuscular electrostimulation has been employed for oropharyngeal dysphagia treatment in individuals afflicted by stroke, with 80 Hz frequency and 700 s pulse duration for 45 to 60 minutes, five times a week, although other parameters and electrode positioning have been cited in literature. In elderly patients with Alzheimer-type dementia, it was not verified effect of electrical stimulation on the penetration and aspiration scale, hyolaryngeal displacement and pharyngeal transit time. However, when the food consistencies are considered, under effect of motor stimulation, there is smaller hyolaryngeal displacement when 10 ml liquid and pudding swallowing.