Alterações de deglutição, motricidade orofacial e linguagem nas fases aguda e subaguda após Acidente Vascular Cerebral

Abstract

Stroke is one of the leading causes of permanent injuries in adults being dysphagia one of the most frequent complications and speech disorders one of the most common sequelae. Studies concerning the epidemiological aspects of acute phase dysphagia point to a prevalence of this symptom on 41% to 90% of post stroke individuals. A study that researched the incidence and co-occurrence of dysphagia, dysarthria an aphasia in post first stroke patients identified the prevalence of dysphagia in 44%, dysarthria in 42% and aphasia in 30%; 10% of the patients had all three disorders at once. Speech Therapy knowledge on the prevalence and predictive factors of swallowing, speech and language disorders that occur in these patients is still incipient. Thus, identifying swallowing and communication disorders as well as related factors in post stroke patients is an eminent need. The main purposes of this study are: 1- To identify the prevalence and co-occurrence of dysphagia, dysarthria, aphasia, buccofacial apraxia and facial paralysis on patients admitted to UFMG’s Hospital das Clínicas who were diagnosed with ischemic stroke; 2- To investigate predictive factors that in an independent or correlated way indicate the presence of speech, language and/or swallowing disorders; 3- To analyze the degree of commitment of dysphagia, oral intake capacity and prognostic factors to the rehabilitation of swallowing. The study was conducted through an analytic observational prospective cohort method. The sample was constituted of patients admitted on UFMG’s Hospital das Clínicas, attended by the Speech Therapy Service that had a diagnose of ischemic stroke. They were submitted to speech therapy clinic evaluation which consisted in bedside evaluation of speech, language, swallowing and the stomatognathic system. Patients included were submitted to daily speech therapy and reclassified every seven days after the ictus according to their capacity of oral intake, degree of dysphagia, comprehensibility of speech, National Institute of Health Stroke Scale, Modified Rankin Scale, Modified Barthel Index and BEST-2 test grades. To the statistical analysis of data were used central tendency measures, categorical variables dispersion and categorical variables frequency distribution. To categorical variables the Pearson’s Chi-Square, Fisher’s Exact and Tendencies Test were used as measures of association. To verify modification on evaluated parameters the T Test was used to compare medians, as well as ANOVA and non-parametric tests. To evaluate the association between response and explanatory variables were used multivariate analysis of both logistic and linear regression models in which were included all 9 variables with value p≤0.20 in the univariate analysis. The results are presented as two articles to be published in scientific journals, including the discussion. The first article addresses the issue of prevalence and co-occurrence of dysphasia, aphasia, dysarthria, buccofacial apraxia and facial paralysis and their risk factors in patients admitted to UFMG’s Hospital das Clínicas. The second article investigates and characterizes dysphagia’s occurrence at admittance and its evolution through hospital dismissal. This way, in the first article it was observed a prevalence of facial paralysis of 52.9%, 33.8% of aphasia, 32.4% of dysarthria and 28.8% of buccofacial apraxia. Regarding co-occurrence of disorders 10.29% of individuals presented all five evaluated disorders, 10.29% presented four disorders, 13.24% presented three disorders and 17.65% presented two disorders. As to the predictive factors, NIHSS grade was related to the occurrence of dysphagia, aphasia, buccofacial apraxia and facial paralysis; Barthel Index to the occurrence of dysphagia, left hemisphere injury with the presence of aphasia and buccofacial apraxia and Rankin Scale grade with dysarthria. As to dysphagia (article 2), moderate degree was the most common, followed by mild degree; 30% of dysphagic patients used alternative infeed methods after the speech therapist assessment; there was statistical relation among the degree of dysphagia, NIHSS score and the presence of buccofacial apraxia. Given the results presented we conclude that full evaluation of the patient is extremely important due to the great co-occurrence of disorders as well as the prompt evaluation of the patient by the speech therapist as soon as he presents conditions to it in order to diagnose disorders, especially dysphasia, and begin the swift promotion of rehabilitation.