Andréa Rodrigues Motta

Avaliação objetiva das forças axiais produzidas pela língua de crianças respiradoras orais

ABSTRACT Purpose: To quantify and to compare the forces produced by the tongues of pre-surgical mouth-breathing children, oral-breathingchildren enrolled in therapy and nasal-breathing children, and also to compare the findings of objective and clinical evaluations. Methods: Transversal study with 15 children of both genders with ages between eight and 12 years: five pre-surgical mouth breathers(Group 1), five mouth breathers enrolled in speech therapy (Group 2) and five nasal-breathing children (Group 3). A clinicalassessment of each child’s tongue characteristics was carried out, followed by the objective evaluation of the axial centre line forceof the tongue using the instrument created at Federal University of Minas Gerais. The results were descriptively analyzed usingmeasures of central tendency and dispersion. Results: The average of the force values found in Groups 1, 2 and 3, respectively,were 5.6, 6.0 and 7.3N. The average values of maximum force were 8.2, 9.2 and 10.4N. The individuals with adequate tonguetension in the clinical evaluation were the ones with highest values of average (7.0N) and maximum force (10.3N). The lowestvalues (3.5N and 2.0N) were obtained by the subjects whose subjective evaluation showed hypotension of the tongue. Statisticalanalysis indicated heterogeneous data in Groups 1 and 2, tending towards homogeneous in Group 1.

Eficácia do emprego do espelho de Glatzel na avaliação da permeabilidade nasal

PURPOSE: To compare the measurement of nasal air escape, carried out using the Glatzel mirror, in children with and without upper respiratory tract obstruction, according to sex and age. METHODS: The sample comprised 43 subjects, with mean age of 6.9 years, divided into four groups: children with surgical indication to clearing of the upper respiratory tract (surgical group), allergic children with upper respiratory tract obstruction (allergic group), allergic children with obstruction and surgical indication (surgical and allergic group), and children without obstruction (control group). Nasal air escape measurement was carried out using the Altmanns Millimetered Nasal Mirror, and data was measured in cm2 by the AutoCAD 2002 software. Data was analyzed using descriptive statistics and hypotheses testing, with a significance level of 5%. RESULTS: The control group presented the highest mean (6.53 cm2) of nasal air escape, while surgical and allergic group presented the lowest mean (3.07 cm2). The means of the allergic group and the surgical group were 4.74 cm2 and 5.91 cm2, respectively. Only the surgical and allergic group presented statistically significant difference compared to the control group. CONCLUSION: The Glatzel mirror demonstrated not to be a trustworthy instrument for the evaluation of nasal permeability in the analyzed sample, except in cases of severe nasal obstruction, that is, allergic patients with surgical indication. No correlations were found with the variables sex and age.

Eficácia de duas técnicas fonoaudiológicas da estética facial no músculo orbicular dos olhos: estudo piloto

PURPOSE: to compare the efficacy of two techniques speech-language pathologists used in the orbicular oculi muscle. METHODS: we conducted a pilot study with four patients, aged between 40 and 51 years. They were submitted to a myofunctional exercise in the left hemiface and to a massage in the right hemiface for a period of 20 days. Data collection was performed followed by historical protocols, then evaluation and review applied by dermatologist and plastic surgeon and by photos evaluation made by 10 speech therapist specializing in orofacial myology. RESULTS: it revealed that there were no differences on the results related to the techniques used during the treatment. In accordance with the dermatologist and plastic surgeon all the patients improved. For the dermatologist the patient 2 had a better improvement while for the plastic surgeon it was the patient 4. According to the speech therapist, all the patients had improved; however, the patient 1 showed the best result in left hemiface and the others maintained the balance between the two hemifaces. CONCLUSION: in accordance with this research, we concluded that in the sample studied there were a significant improvement in the expressions wrinkles of the orbicular oculi muscle without different results between the two techniques studied.

Variabilidade na mensuração das medidas orofaciais

PURPOSE: To verify the degree of variability of orofacial measures, among speech pathologists who are specialists in orofacial myology. METHODS: A prospective study was carried out, where 30 speech pathologists who are specialists in orofacial myology measured, in two different moments, with the use of a digital sliding caliper, ten orofacial measures of a standard subject. Within- and between-examiner data were compared using measures of central trend and dispersion, and hypothesis testing, with the level of significance of 5%. RESULTS: Nine out of the ten parameters investigated were considered as homogeneous in both within- and between-observers analyses. The maximum mouth opening with the tongue in the papilla presented high coefficients of variation, indicating heterogeneous data, although between-observers values were considered similar. In the within-examiner analysis for this parameter, a significant difference was evidenced (p=0.0384). In the data analysis, it was also observed differences next to the cut point established in the study, in the within-observer mensuration of the midfacial height (p= 0.0711) and the maximum mouth opening (p= 0.0677). Among the ten analyzed variables, it was not observed decrease in the coefficient of variation from the first to the second mensuration only for the parameters midfacial height and superior lip. CONCLUSION: It was not observed variability in the orofacial mensuration carried out in this study, except for the parameter maximum mouth opening with the tongue in the incisor papilla, indicating that data produced by different professionals can be considered partially trustworthy.

Atuação fonoaudiológica na síndrome da apnéia e hipopnéia obstrutiva do sono: relato de caso

Purpose: to check the contribution of speech therapy in the treatment of a patient with obstructive sleep apnea-hypopnea syndrome. METHODS: case description of a sixty-year old, female patient with severe obstructive sleep apnea-hypopnea syndrome that underwent speech therapy treatment for improvement of the apnea/ hypopnea condition, snoring, and day fatigue. Clinical evaluation of orofacial myology and a polysomnography were performed before and after speech therapy. Based on the clinical evaluation, a therapeutic plan was elaborated to provide the patient with cervical relaxation and relaxation of the suprahyoid muscles, for improvement in nasal aeration, tongue strength and position, strengthening of the soft palate muscles and their mobility, as well as the mastication muscles. Alternate bilateral mastication training and lowering of the hyoid bone were included. RESULTS: after twelve-forty-minute sessions of speech therapy, a decrease of cervical tension and relaxation of the suprahyoid muscles were observed. The position of the hyoid bone had been adjusted as well as tongue normotension with the dorsal lowered. The soft palate had normal mobility with adequate mastication. The patient reported important improvement in day fatigue. The result of the second polysomnography indicated a decrease from 44 to 3 events per hour of apnea and hypopnea during sleep, lowering the severe level to an index of breathing disturbance which no longer characterized the disease as sleep apnea. CONCLUSION: speech therapy was effective in the treatment for this case of obstructive sleep apnea-hypopnea syndrome.

Desenvolvimento de um sistema protótipo para medição objetiva das forças linguais em humanos

This work presents the development of a system for the measurement of the axial forces produced by the human tongue. A prototype was developed which reproduces the underlying principles of the methods normally adopted in clinical procedures, with the advantage that it allows the phonoaudiologist to obtain objective measurements of these forces. This work also presents an analysis based on the repeatability and the reproducibility of the forces in an attempt to select which of these forces can be employed as parameters for diagnosis and as success indicators of therapies. Preliminary results indicate the mean force as the most reliable parameter.

Prevalência de alteração no frênulo lingual e suas implicações na fala de escolares

OBJETIVOS: verificar a prevalencia do frenulo lingual alterado e suas implicacoes na fala de escolares. METODOS: foram avaliados por tres fonoaudiologas os frenulos de lingua de 260 criancas com idades variando entre 6 e 12 anos. Os frenulos foram classificados por meio de inspecao visual, medidas empregando-se paquimetro e avaliacao da tensao, mobilidade e posicionamento da lingua. Foram consideradas criancas com alteracao de frenulo aquelas que apresentaram alteracao em todas etapas da avaliacao. Nos casos de classificacao de frenulo alterado, a fala foi avaliada. RESULTADOS: os dados encontrados revelaram que das 260 criancas avaliadas 47 (18%), apresentaram alteracao de frenulo, sendo 28 (60%), classificados como curtos; 12 (25%) como anteriorizados e 7 (15%) como curtos e anteriorizados. Nao houve diferenca entre os sexos. Dos individuos com frenulo alterado, 34 (72 %) apresentaram alteracao de fala. A prevalencia de alteracao na fala foi maior no frenulo curto e anteriorizado (85%), seguido pelo curto (75%) e pelo anteriorizado (58%). As implicacoes de fala mais encontradas foram distorcao e articulacao trancada. CONCLUSAO: foi verificada uma prevalencia de 18% de alteracao no frenulo lingual dentre os escolares avaliados, sem diferenca entre os sexos. O frenulo curto predomina sobre os demais tipos, porem o curto e anteriorizado apresenta maiores implicacoes na fala. As caracteristicas de fala mais comuns nestes casos sao distorcao e articulacao trancada.

Mastigação e dietas alimentares para redução de peso

ABSTRACT Purpose: to know the orientations about mastication provided by students from Nutrition course to the patients submitted to a weight reduction diet and to check the masticatory standards of those who have received the orientations. Methods: two methods were used, the first one: 30 forms were applied to the students of Nutrition course in order to know the orientations they provided to the patients; and, the second one: the protocol of evaluation mastication applied in the 30 patients who were under an alimentary diet. Data has been collected in three academic clinics of the metropolitan area of Vitoria, and were analyzed through the accurate Test of Fisher to a 5% significance level. Results: among academics, 83.3% frequently carry through orientations on mastication, being 60% on speed/number of masticatory cycles. All cases are oriented by 63.3% of the students and 93.3% believe in the influence of the mastication in the weight reduction, and 73.3% think that it can be reached by all society. Considering the indication to the speech therapists, 96.7% said they never do that, in this group, 53.3% did not explain why they act so. Considering the patients, the adequate chew was verified, although 50.0% of them had bad dental conservation; 79.7% preferred unilateral mastication and 50.0% use bare hands to handle the meals. In all the cases the patients had received orientation at the beginning of the treatment, and only 46.7% really practice the guidance. No statistics association showed any significant value.

Protrusive tongue strength in people with severely weak tongues

Abstract The purpose of the study was to quantify tongue protrusion force and compare its characteristics between participants with severely weak tongues and those with normal lingual strength. The sample consisted of 11 participants with severe lingual strength deficits and 11 age- and sex-matched participants with normal lingual strength. Tongue force was evaluated quantitatively using the Forling instrument, and the average force, maximum force, average force application rate, and area under the graphic curve were analysed. These parameters were compared between the groups. In the participants with severely weak tongues, the average and the maximum forces in N (Newton) were 2.03 ± 1.17 and 3.56 ± 1.77, respectively. The average force application rate in N/s (Newton per second) was 1.25 and the area under the graphic curve in Ns (Newton times second) was 18.6. The values of the participants with normal lingual strength were, respectively, 13.27 ± 6.15 N, 18.91 ± 7.95 N, 10.46 N/s, and 108.08 Ns. All parameters analysed differed significantly between the groups. The data collected could aid speech-language pathologists in diagnosing problems related to tongue force.

Força axial de língua em diferentes faixas etárias

PURPOSE: To analyze the maximum axial force, the mean axial force, the amount of energy accumulated by the tongue, and the time taken to reach the maximum axial force, in different age ranges. METHODS: The records of 92 individuals - students, staff and visitors at an university -, 29 (32.6%) men and 63 (67.4%) women, with ages between 14 and 53 years old, were analyzed. Subjects were divided into four age groups: 14 to 18 years, 19 to 23 years, 24 to 28 years, and 29 to 53 years. Each subject underwent clinical and instrumental assessment of the tongue. Instrumental assessment used FORLING. Data were statistically analyzed. RESULTS: Regarding the maximum force, the mean force and the tongues accumulated energy, no differences were observed between groups. Regarding the time taken to reach the maximum force, the greatest values were obtained at the age range from 14 to 18 years (4.5 s), and the shortest values, at the age range from 19 to 23 years (3.1 s), with significant difference between the groups (p=0.001). CONCLUSION: Only the time taken to reach the tongues maximum force is influenced by age range, indicating that teenagers are not able to reach the maximum lingual force as fast as young adults.