Ana Maria Toniolo da Silva

Relação entre grau de severidade de disfunção temporomandibular e a voz

BACKGROUND Temporomandibular dysfunction is one of the most complex disorders of the body, capable of unchaining alterations in the mandibular movements which in turn can cause damage not only to speech articulation but also to the quality of voice. In the literature, the relationship between the symptomatology severity levels of this dysfunction and their influence on vocal production has been scarcely studied. AIM To verify the relationship between the symptomatology severity levels of temporomandibular dysfunction and vocal production. METHOD Participants of this study were 24 females, with ages between 16 and 56 years, who were submitted to an anamnesis index questionnaire (Fonseca et al., 1994), to odontological and otolaryngological examinations and to a hearing evaluation. Later, the participants were submitted to a voice recording, using a digital recorder, for a perceptive-auditive analysis of voice parameters such as: vocal type, resonance, quality of emission, pitch and loudness and for the analysis of the acoustic parameters of the wide and narrow band spectrography and of the Multi Dimensional Voice Program (MDVP) -- Key Elementrics Real Time software. RESULTS Considering the parameters of the perceptive-auditive evaluation, it was observed that only individuals with severe symptomatology presented a statistically significant decrease in loudness (p = 0.013). The hoarse vocal quality was the most frequent type among the participants, with severities classified as mild and severe, followed by the breathy type. In the wide band spectrography, there was a statistically significant difference for the anti-resonance increase (p = 0.013) in individuals with severe temporomandibular dysfunction. CONCLUSION It was verified that the severity level causes a decrease in loudness, an increase of noise and alterations in voice resonance, interfering in the vocal quality of these individuals.

Electrical Activity of the Anterior Temporal and Masseter Muscles in Mouth and

Summary Mouth breathing has been associated with severe impact on the development of the stomatognathic system. Aim This paper aims to analyze the electromyographical findings and patterns of electrical activity of the anterior temporal and masseter muscles in mouth and nasal breathing children. Materials And Method The patients were divided into two groups: mouth breathers (n=17) and nasal breathers (n=12). The children underwent bilateral electromyographic examination of the anterior temporal and masseter muscles at maximal intercuspal position and during usual mastication. A Myosystem Br-1 electromyograph with 12 acquisition channels, amplification with total gain of 5938, rate of acquisition of 4000 Hz, and band-pass filter of 20-1000Hz, was used in the examination. The signal was processed in Root Mean Square(RMS), measured in µV, analyzed and expressed as a normalized percentage. The data set was statistically treated with the T-test (Student). Results The observed level of electrical activity in the mouth breathing (MB) group was lower in all analyzed muscles, with statistical significance found only in the left temporal muscle; during mastication, mouth breathers also presented increased electrical activity on the right side and on the temporal muscle. Conclusion Mouth breathing impacts the electrical activity of the muscles studied at maximal intercuspal position and during usual mastication.

Relação da respiração oral e hábitos de sucção não-nutritiva com alterações do sistema estomatognático

PURPOSE: to investigate the relationship between oral breathing of different etiologies and persisting non-nutritive sucking habits in establishing structural alterations in the stomatognathic system. METHOD: the sample comprised 78 children between 7 and 11 year old, 36 boys and 42 girls, divided in two groups based on non-nutritive sucking habits and breathing mode. All children underwent otolaryngological, speech-language and dentistry evaluations. Data analysis was performed using Chi-square test considering significance level of 5%. RESULTS: there was significant association between breathing mode and lips posture; between breathing mode and hard palate; between nonnutritive sucking habits and cheek posture. In the analysis of the association between breathing mode and nonnutritive sucking habits with the habitual lips posture and hard palate, we also forund a statistical significance. CONCLUSION: it was found that the altered lips posture and hard palate was more frequent in the vicious and obstructive mouth breathers groups. The asymmetrical cheeks posture was more frequent among children with habits. The altered lips posture and hard palate alterations were also more frequent in oral breathers regardless of the presence or absence of any habits.

Acupuntura como recurso terapêutico na dor e na gravidade da desordem temporomandibular

Este estudo avaliou o efeito da acupuntura no nivel de dor e gravidade da Desordem Temporomandibular (DTM). Participaram dele 40 mulheres entre 20 e 40 anos com DTM diagnosticada pelo Research Diagnostic Criteria (RDC/TMD). A dor foi avaliada pela escala visual analogica e a gravidade da desordem pelos Indices de Disfuncao Craniomandibular e de Fonseca. As 20 primeiras participantes foram submetidas a acupuntura duas vezes na semana por cinco semanas ininterruptas e, apos o periodo, foram reavaliadas. Os dados destas participantes constituiram os resultados para o grupo acupuntura. As demais voluntarias receberam o tratamento apos o primeiro grupo e seus dados, coletados no inicio e apos cinco semanas sem tratamento, foram utilizados para controle. Na analise estatistica foram levados em conta os testes de Wilcoxon para o nivel de dor e Indice Craniomandibular e Teste t de Student para o Indice de Fonseca, com nivel de significância de 5%. Houve reducao significante no nivel de dor (p=0,000) e na gravidade da DTM pelos Indices Craniomandibular (p=0,004) e de Fonseca (p=0,000) apos o tratamento. O grupo controle nao apresentou melhora. A efetividade da acupuntura foi demonstrada pela melhora no nivel da dor e na gravidade da DTM.

ESTUDO DA POSTURA CORPORAL EM CRIANÇAS COM RESPIRAÇÃO PREDOMINANTEMENTE ORAL E ESCOLARES EM GERAL

Objetivo: avaliar a postura de respiradores predominantemente orais e comparar com achados, descritos na literatura, de escolares em geral. Metodos: a amostra foi composta por 30 escolares, respiradores orais, que foram submetidos a avaliacao postural subjetiva com analise da simetria e do posicionamento das estruturas, nas vistas anterior, posterior e lateral. Os achados obtidos foram comparados aos descritos na literatura sobre a postura corporal de escolares em geral. Resultados: na vista anterior predominou a elevacao do ombro direito, flexao de cotovelo e dedos. Na vista posterior, observou-se abducao e elevacao das escapulas e rotacao dos joelhos. E, na vista lateral, anteriorizacao da cabeca, protrusao e rotacao interna de ombros. Na literatura revisada predominaram: semiflexao de joelhos, protrusao de ombros, hiperlordose lombar. Conclusao: o modo respiratorio e essencial no equilibrio postural de criancas em idade escolar. Algumas alteracoes sao proprias do desenvolvimento postural normal, pois apareceram em ambos os grupos.

Analysis of the Level of Dysphagia, Anxiety, and Nutritional Status Before and After Speech Therapy in Patients with Stroke

Introduction: The rehabilitation in oropharyngeal dysphagia evidence-based implies the relationship between the interventions and their results. Objective: Analyze level of dysphagia, oral ingestion, anxiety levels and nutritional status of patients with stroke diagnosis, before and after speech therapy. Method: Clinical assessment of dysphagia partially using the Protocol of Risk Assessment for Dysphagia (PARD), applying the scale Functional Oral Intake Scale for Dysphagia in Stroke Patients (FOIS), Beck Anxiety Inventory (BAI) and the Mini Nutritional Assessment MNA®. The sample consisted of 12 patients, mean age of 64.6 years, with a medical diagnosis of hemorrhagic and ischemic stroke and without cognitive disorders. All tests were applied before and after speech therapy (15 sessions). Statistical analysis was performed using the chi-square test or Fishers exact test, McNemars test, Bowkers symmetry test and Wilcoxons test. Results: During the pre-speech therapy assessments, 33.3% of patients had mild to moderate dysphagia, 88.2% did not receive food orally, 47.1% of the patients showed malnutrition and 35.3% of patients had mild anxiety level. After the therapy sessions, it was found that 33.3% of patients had mild dysphagia, 16.7% were malnourished and 50% of patients had minimal level of anxiety. Conclusion:  There were statistically significant evolution of the level of dysphagia (p = 0.017) and oral intake (p = 0.003) post-speech therapy. Although not statistically significant, there was considerable progress in relation to the level of anxiety and nutritional status.

Pulse Oximetry: Instrumental Alternative in the Clinical Evaluation by the Bed for the Dysphagia

Introduction:  The clinical evaluation by the bed is the clinical procedure utilized by the speech therapy as a screening test for established if the individual presents or not a clinical picture of dysphagia. Its achievement count with the use of the pulse oximetry that is the not-invasive measure of the peripheral saturation of O2. When it related to the dysphagia, the saturation can decline in the moment of the swallowing, suggesting a compromise of the respiratory system. Such decline is observed in individuals that aspire with sustenances of liquid and solid consistency, before during and after food, when compared to the individuals that do not aspire. Objective:  To verify the possibility of the utilization of the pulse oximetry as an instrumental alternative in the clinical evaluation for the dysphagia. Method:  Revision of literature, based in articles indexed in the bases Lilacs and Medline having as a reference the descriptors: saturation of oxygen, pulse oximetry and swallowing disorders. Results:  The association of the clinical evaluation to the pulse oximetry shows up with high sensibility in the detection of the penetration and aspiration laringotraqueal and with bass false-positive index, considering it desaturation, the indices that pierced with bigger values than 2%. Some data found are divergent as the aspiration detection possibility. Final Comments:  The studies analyzed confer to oximetria of wrist the character of practically and possibility of use in the actions by the bed, being utilized ally to the clinical evaluation for dysphagia, although certain disagreement between the same is found as regards the utilization of its results as indicator of aspiration laringotraqueal, suggesting need of subsequent researches.

Cryostimulation improves recovery from oropharyngeal dysphagia after stroke

Summary Introduction: Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia. Aim: To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. Methods: Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue) 3 times a day (for a total of 30 daily applications per structure) for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Students t-test and Fishers exact test. Results: Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects. Conclusion: Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation.

ANÁLISE ELETROMIOGRÁFICA DO MÚSCULO MASSETER EM INDIVÍDUOS RESPIRADORES ORAIS

Objetivo: Analisar a funcao mastigatoria, atraves da avaliacao clinica e eletromiografica, em individuos respiradores orais. Metodos: Foram estudados 2 individuos respiradores nasais e 3 respiradores orais, com idades entre 13 e 17 anos, que realizaram avaliacao clinica e avaliacao eletromiografica do musculo masseter. Resultados: em repouso nao foi observada diferenca na atividade eletrica do musculo masseter nos individuos avaliados. Porem, embora nao se tenha encontrado diferenca estatisticamente significante, observou-se atividade eletrica inferior nos respiradores orais no teste de maxima intercuspidacao e, atividade eletrica inferior no masseter direito dos respiradores orais na funcao de isotonia. Na avaliacao clinica, observaram-se alteracoes estruturais e funcionais nos individuos respiradores orais que podem justificar tais achados. Conclusoes: A partir da analise dos resultados, observou-se que, de modo geral, existe uma diminuicao da atividade eletrica dos musculos masseteres nos respiradores orais, evidenciada tambem na avaliacao clinica, o que demonstra, portanto, prejuizo da funcao mastigatoria desses individuos. Descritores: Eletromiografia, Respiracao Bucal, Musculo Masseter, Mastigacao, Musculos Mastigatorios