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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2019.tde-24102018-123211
Document
Author
Full name
Luciana de Oliveira
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2018
Supervisor
Committee
Dantas, Roberto Oliveira (President)
Felicio, Claudia Maria de
Hamad, Ana Paula Andrade
Mourão, Lucia Figueiredo
Title in Portuguese
Relação entre a lesão cerebral e alterações da deglutição em crianças com paralisia cerebral
Keywords in Portuguese
Crianças
Distúrbios de deglutição
Lesão cerebral
Paralisia cerebral
Abstract in Portuguese
Estudamos a relação entre local e tipo da lesão cerebral com a gravidade da disfagia, e a relação entre o grau de comprometimento motor com a gravidade da disfagia em crianças com paralisia cerebral. Foi um estudo retrospectivo de exames de videofluoroscopia da deglutição e ressonância magnética cerebral de crianças com diagnóstico de paralisia cerebral e disfagia, atendidas do Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP), Universidade de São PauloBrasil, de 2008 a 2016. Foi realizada analise descritiva dos dados e utilizado o teste exato de Fisher para verificar a relação entre as variáveis estudadas. Foram incluídos na pesquisa exames de 20 crianças com idades ao exame de ressonância magnética entre 2 anos e 1 mês de vida a 10 anos e 2 meses, e ao exame de videofluoroscopia da deglutição entre 9 meses a 16 anos e 2 meses. Quanto ao gênero, seis crianças eram do sexo feminino, e 14 do sexo masculino. Com relação à classificação da função motora grossa, duas crianças eram do nível III, cinco do nível IV e 13 do nível V. Quanto a gravidade da disfagia, sete crianças apresentaram disfagia leve/moderada, três com disfagia moderada e 10 crianças com disfagia moderada/grave. As principais alterações evidenciadas na ressonância magnética, quanto à localização da lesão, foram em corpo caloso (60%), ventrículos cerebrais (60%), substancia branca (55%), tronco encefálico (35%) e cerebelo (15%). Os tipos de lesões cerebrais mais freqüentes foram encefalopatia hipóxico-isquêmica (35%), leucomalacia periventricular (25%) e encefalomalacia multicistica (15%). Não houve relação entre o local da lesão cerebral e gravidade da disfagia, entretanto houve relação entre o tipo de lesão cerebral e a gravidade do distúrbio de deglutição (p=0,02). Além disso, houve relação entre a gravidade da disfagia e o grau de comprometimento da função motora grossa. Deste modo, a gravidade da disfagia foi relacionada com encefalomalacia multicística e com o comprometimento da função motora grossa, e nossos resultados mostram a importância da avaliação de deglutição tão logo, nestes pacientes, seja realizado o diagnóstico médico. Além disso, ressaltamos a importância da avaliação da deglutição em todos graus de lesão, devido à presença de disfagia leve a intensa.
Title in English
Relationship between brain injury and changes in swallowing in children with cerebral palsy
Keywords in English
Brain injury
Cerebral palsy
Children
Swallowing disorder
Abstract in English
We studied the relationship between site and type of brain injury with the severity of dysphagia, and the relationship between the degree of motor impairment and the severity of dysphagia in children with cerebral palsy. It was a retrospective study of videofluoroscopy examinations of swallowing and magnetic resonance imaging of children diagnosed with cerebral palsy and dysphagia, attended at Hospital das Clinicas of the Ribeirão Preto Medical School (HCFMRP), University of São Paulo-Brazil, from 2008 to 2016. A descriptive analysis of the data was performed and Fisher's exact test was used to verify the relationship between the variables studied. Included in the study were examinations of 20 children aged between 2 years and 1 month of life to 10 years and 2 months, and videofluoroscopy of swallowing between 9 months and 16 years and 2 months. Six children were female, and 14 were male. Regarding the classification of gross motor function, two children were of level III, five of level IV and 13 of level V. Regarding the severity of dysphagia, seven children presented mild/moderate dysphagia, three with moderate dysphagia and 10 children with moderate/severe dysphagia. The most freqeunt lesions seen in magnetic ressonance imaging (MRI) were in the corpus callosum (60%), cerebral ventricles (60%), white matter (55%), brainstem (35%) and cerebellum (15%). The most frequent types of brain lesions were hypoxicischemic encephalopathy (35%), periventricular leukomalacia (25%) and multicystic encephalomalacia (15%). There was no relationship between the site of the brain lesion and the severity of dysphagia, however, there was a relationship between the type of brain injury and the severity of the swallowing disorder (p = 0.02). In addition, there was a relationship between the severity of dysphagia and the degree of impairment of gross motor function. Thus, the severity of dysphagia was related to multicystic encephalomalacia and the involvement of gross motor function, and our results show the importance of swallowing assessment as soon as the medical diagnosis is made in these patients. In addition, we emphasize the importance of evaluating swallowing in all degrees of injury, due to the presence of mild to severe dysphagia
 
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LUCIANADEOLIVEIRA.pdf (1.11 Mbytes)
Publishing Date
2019-08-15
 
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