Detalhes bibliográficos
| Ano de defesa: |
2014 |
| Autor(a) principal: |
Hausberger, Carmen Silvana Vieira
 |
| Orientador(a): |
Soares, Vânia Muniz Nequer |
| Banca de defesa: |
Santos, Rosane Sampaio,
Abudmaalssih, Edna Marcia da Silva |
| Tipo de documento: |
Dissertação
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| Tipo de acesso: |
Acesso aberto |
| Idioma: |
por |
| Instituição de defesa: |
Universidade Tuiuti do Parana
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| Programa de Pós-Graduação: |
Mestrado em Distúrbios da Comunicação
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| Departamento: |
Distúrbios da Comunicação
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| País: |
Brasil
|
| Palavras-chave em Português: |
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| Palavras-chave em Inglês: |
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| Área do conhecimento CNPq: |
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| Resumo em Inglês: |
INTRODUCTION:The proper diagnosis and management of swallowing disorders and feeding procedures are important because of the high incidence and prevalence of dysphagia and its potential consequences. Establishing the diagnosis and prognosis of dysphagia is crucial to guide the management of this disorder and the reduction of morbidity and mortality associated with it. The presence of the speech therapist in the hospital context contributes to better prognosis, rehabilitation potential sequelae and improved quality of life for patients. The role of speech therapy in hospitals is relatively recent, especially with regard to the monitoring of patients with dysphagia during hospitalization, shows up as a practice expanding in various services in Brazil, with a significant increase in research in this area. OBJECTIVE:To evaluate the impact of speech attention on a Service Diagnosis and Treatment of Dysphagia in patients affected by cerebrovascular accident (CVA). METHODOLOGY:This is a study of quantitative approach , the paired and retrospective case control. The study was conducted in a tertiary referral hospital, linked to the Unified Health System (SUS). The data for the case group were obtained at the Department of Peroral Endoscopy and the control group the records of the Neurology Service. Collected from 60 patients were analyzed in the group cases and 60 matched patients in the control group, data were recorded on the appropriate form prepared for the research. Data on sociodemographic and clinical profile of post-discharge rehabilitation and speech therapy's calculated to measure the impact of this service parameters were investigated. RESULTS:The epidemiological profile of patients with stroke group patients, treated at this hospital revealed a mean age of 63.1 years, 50 %males and 50 % females predominated medium/higher education among cases and controls among elementary school. Risk factors for stroke identified in the two groups were hypertension, smoking, diabetes, dyslipidemia. The patients' clinical data showed that about 70.0 % of patients in the case group had a single event AVE. Both groups underwent Glasgow scale and showed similar mild neurological damage (50%). The indication of thrombolytic medication cases predominated in the group with 53.3 % against 5 % patients in the control group. The main signs and symptoms at admission were dysarthria/aphasia, followed by hemiparesis and unilateral paralysis. The difficulty of swallowing was recorded in the chart of 11 (18.3%) patients in group and 24 cases (40.0%) in the control group. The hospital stay was shorter in the control group, 45.0 % of cases were between 7 to 13 days of hospitalization, and 45.0 % among controls the time was between 14 to 20 days. The frequency of tracheostomy was 1.6 % in the case group and 3.3 % in the control group. The FOIS examination in case subjects allowed to identify more precisely which 21 (35%) patients had swallowing disorders and instrumental evaluation of swallowing through the FEES examination using Severity Scale identified 19 (31.6%) patients had some degree of aspiration, demonstrating swallowing disorders in these patients. A nasogastric tube was prescribed for 17 (28.3%) patients in the case group and 16 (26.6%) in the control group. The time of using this alternative route of supply for 55.5 % of patients in the case group was 10 days, and in the control group to 66.7 % of patients older than 10 days. High with the alternative pathway was indicated for 11 (61.1%) patients in the case group and 14 (77.7%) patients in the control group. The measures for rehabilitation post-discharge, the group cases were referral to physiotherapy (75% of cases), speech therapy (43.3 % of cases) and nutrition (43.3% of cases), while the control group was only 43.3 % cases referred for physical therapy, speech therapy to 8.3% , 11.6% for nutrition. There were continued on therapy for patients in 41.6% cases and 53.3% in control of auditory followed by 31.6% and 5% of patients, respectively. The reasons for discontinuation of treatment in post-discharge rehabilitation were waiting to be allocated SUS, limited mobility and financial difficulty. As to the site to perform the Speech therapy was referred to the Rehabilitation Hospital of the SUS by 21.6% patients in the case group and 1.7% in the control group, there was demand for private clinic for 6.7% patients in the case group and 5.0% of the control group. Reported the persistence of difficulty swallowing after discharge, 35% patients in the case group and 38.3% in the control group. The rate of clinical evaluation of swallowing at this hospital was 28.8%. CONCLUSIONS:The study demonstrated that the speech attention in diagnostic services and treatment of dysphagia in patients with stroke, provided better therapeutic outcomes and fewer complications during hospitalization, however the continued rehabilitation of patients with stroke and dysphagia post-High is still insufficient. The calculated phonoaudiological indicators were similar in both groups due to the small number of cases analyzed and the time of service deployment. The service management of dysphagia and speech attention needs to be deployed more effectively in the hospital under study, as well as in all public hospitals, as recommended by the Ministry of Health with a view to better treatment of dysphagia and its complications. |
| Link de acesso: |
http://tede.utp.br:8080/jspui/handle/tede/1427
|
Resumo: |
INTRODUCTION:The proper diagnosis and management of swallowing disorders and feeding procedures are important because of the high incidence and prevalence of dysphagia and its potential consequences. Establishing the diagnosis and prognosis of dysphagia is crucial to guide the management of this disorder and the reduction of morbidity and mortality associated with it. The presence of the speech therapist in the hospital context contributes to better prognosis, rehabilitation potential sequelae and improved quality of life for patients. The role of speech therapy in hospitals is relatively recent, especially with regard to the monitoring of patients with dysphagia during hospitalization, shows up as a practice expanding in various services in Brazil, with a significant increase in research in this area. OBJECTIVE:To evaluate the impact of speech attention on a Service Diagnosis and Treatment of Dysphagia in patients affected by cerebrovascular accident (CVA). METHODOLOGY:This is a study of quantitative approach , the paired and retrospective case control. The study was conducted in a tertiary referral hospital, linked to the Unified Health System (SUS). The data for the case group were obtained at the Department of Peroral Endoscopy and the control group the records of the Neurology Service. Collected from 60 patients were analyzed in the group cases and 60 matched patients in the control group, data were recorded on the appropriate form prepared for the research. Data on sociodemographic and clinical profile of post-discharge rehabilitation and speech therapy's calculated to measure the impact of this service parameters were investigated. RESULTS:The epidemiological profile of patients with stroke group patients, treated at this hospital revealed a mean age of 63.1 years, 50 %males and 50 % females predominated medium/higher education among cases and controls among elementary school. Risk factors for stroke identified in the two groups were hypertension, smoking, diabetes, dyslipidemia. The patients' clinical data showed that about 70.0 % of patients in the case group had a single event AVE. Both groups underwent Glasgow scale and showed similar mild neurological damage (50%). The indication of thrombolytic medication cases predominated in the group with 53.3 % against 5 % patients in the control group. The main signs and symptoms at admission were dysarthria/aphasia, followed by hemiparesis and unilateral paralysis. The difficulty of swallowing was recorded in the chart of 11 (18.3%) patients in group and 24 cases (40.0%) in the control group. The hospital stay was shorter in the control group, 45.0 % of cases were between 7 to 13 days of hospitalization, and 45.0 % among controls the time was between 14 to 20 days. The frequency of tracheostomy was 1.6 % in the case group and 3.3 % in the control group. The FOIS examination in case subjects allowed to identify more precisely which 21 (35%) patients had swallowing disorders and instrumental evaluation of swallowing through the FEES examination using Severity Scale identified 19 (31.6%) patients had some degree of aspiration, demonstrating swallowing disorders in these patients. A nasogastric tube was prescribed for 17 (28.3%) patients in the case group and 16 (26.6%) in the control group. The time of using this alternative route of supply for 55.5 % of patients in the case group was 10 days, and in the control group to 66.7 % of patients older than 10 days. High with the alternative pathway was indicated for 11 (61.1%) patients in the case group and 14 (77.7%) patients in the control group. The measures for rehabilitation post-discharge, the group cases were referral to physiotherapy (75% of cases), speech therapy (43.3 % of cases) and nutrition (43.3% of cases), while the control group was only 43.3 % cases referred for physical therapy, speech therapy to 8.3% , 11.6% for nutrition. There were continued on therapy for patients in 41.6% cases and 53.3% in control of auditory followed by 31.6% and 5% of patients, respectively. The reasons for discontinuation of treatment in post-discharge rehabilitation were waiting to be allocated SUS, limited mobility and financial difficulty. As to the site to perform the Speech therapy was referred to the Rehabilitation Hospital of the SUS by 21.6% patients in the case group and 1.7% in the control group, there was demand for private clinic for 6.7% patients in the case group and 5.0% of the control group. Reported the persistence of difficulty swallowing after discharge, 35% patients in the case group and 38.3% in the control group. The rate of clinical evaluation of swallowing at this hospital was 28.8%. CONCLUSIONS:The study demonstrated that the speech attention in diagnostic services and treatment of dysphagia in patients with stroke, provided better therapeutic outcomes and fewer complications during hospitalization, however the continued rehabilitation of patients with stroke and dysphagia post-High is still insufficient. The calculated phonoaudiological indicators were similar in both groups due to the small number of cases analyzed and the time of service deployment. The service management of dysphagia and speech attention needs to be deployed more effectively in the hospital under study, as well as in all public hospitals, as recommended by the Ministry of Health with a view to better treatment of dysphagia and its complications. |
