Marcadores clínicos fonoaudiológicos como modelo prognóstico nas funções orofaringolaringeais em pacientes com doença do neurônio motor

• Ano de defesa: 2016
• Autor(a) principal: Oda, Adriana Leico [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Amyotrophic lateral sclerosis; Deglutition disorders; Clinical diagnosis; Prognosis; Speech; Language and hearing sciences; Rehabilitation; Esclerose amiotrófica lateral; Transtornos de deglutição; Diagnóstico clínico; Prognóstico; Fonoaudiologia; Reabilitação
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4255728; http://repositorio.unifesp.br/handle/11600/46215

Purpose: To identify clinical markers of bulbar alterations during progressive dysfunction of the oropharyngolaryngeal musculature in patients with Amyotrophic Lateral Sclerosis (ALS) and to compare the patients with Progressive Bulbar Paralysis (PBP). Methods: 89 (74.17%) patients with ALS, with a mean age of 58.19 years (51.68% male and 48.32% female), and patients with PBP, mean age 62.71 years (32.26% male and 67.74% female). The evaluation instruments were: speech-language clinical evaluation, peak cough flow, speech intelligibility scale, FOIS food consistency scale, ALSFRS-R and EGELA functional scales, and quality of life scale. Results: Patients with PBP differed from patients with ALS in the bulbar domains of the functional scales (p <0.01) and quality of life (p <0.01). The fatigue index is a clinical marker that showed a significant correlation (p <0.01) with the bulbar domains (r = 0.843) and the sum of the functional (r = 0.423) and quality of life scales (r = 0.493) (R = 0.741), speech intelligibility (r = 0.866) and peak cough flow (r = 0.581). 38.2% of patients with appendicular onset had a need for changes in food consistency or in the alimentary route, in contrast to 71% of patients with bulbar onset. Patients with ALS had median values of: 7.0 in the Speech Intelligibility Scale, 190 liters / minute in the Peak Cough Flow and Fatigue Index of 9.0 movements, for almost all muscle groups evaluated. Patients with bulbar onset had a median of: 4.0 on the Speech Intelligibility scale, 170 liters / minute on the Peak Cough Flow and Fatigue Index of 4.0 movements for most of the muscle groups evaluated. Orofacial muscles severity, Fatigue Index, besides diagnosis and age, are factors related to survival. Conclusion: Changes in the orofacial musculature and dysphagia were predictors of the outcomes analyzed, increasing the risk of death in patients with Motor Neuron Disease. Fatigability proved to be a consistent marker of clinical severity and prognosis.