Maria Elaine Trevisan

Medidas vocais acústicas na doença de Parkinson: estudo de casos

TEMA: caracteristicas vocais acusticas de individuos com Doenca de Parkinson (DP). PROCEDIMENTOS: estudo de casos, estatistica descritiva; cinco pares de parkinsonianos e controle, tres masculinos e dois femininos, entre 36 e 63 anos. Avaliacao otorrinolaringologica, fonoaudiologica, voz analisada pelo Multi-Dimensional Voice Program Advanced Model 5105 da Kay Pentax®. RESULTADOS: a f0 das mulheres adultas de meia-idade com DP ficou na faixa masculina e a f0 dos controles no limite inferior da faixa feminina. Nos demais sujeitos, que eram homens de diferentes idades, a f0 foi normal; houve aumento de todas as medidas acusticas principalmente nos sujeitos com DP de todas as faixas etarias estudadas. CONCLUSAO: o processo de envelhecimento e suas consequencias parecem atuar como fator interferente nas modificacoes acusticas da voz, mas, aparentemente, a DP e a idade precoce de seu aparecimento podem acentuar tais alteracoes, repercutindo de forma negativa na fonacao.

Efeitos de duas técnicas de incentivo respiratório na mobilidade toracoabdominal após cirurgia abdominal alta

Upper abdominal surgery is associated to increased risk of pulmonary complications, which may be lessened by judicious use of therapeutic maneuvers aimed at lung expansion. The purpose here was to compare two respiratory incentive techniques on recovery of thoracic-abdominal dynamics in patients having undergone upper abdominal surgery. Sixteen patients in such condition were randomly divided into group 1 (n=10), who did respiratory training with the Voldyne device, and group 2 (n=6), submitted to a split-inspiration pattern training. Chest wall expansion was rated by measuring thorax circumferences before surgery and on the 1st, 3rd, and 5th post-operative (PO) days. In both groups a significant decrease was found in circumference values on the 1st PO day, which gradually recovered, until on the 5th PO day no significant differences were found as compared to pre-operative measures. Group 1 showed significantly better thoracic-abdominal expansion rates than group 2s, as well as higher recovery time rates all through. Though both breathing techniques used were effective, inspiratory incentive using the Voldyne device showed better results in recovering chest mobility after upper abdominal surgery.

Broncoespasmo induzido pelo exercício em crianças e adolescentes com diagnóstico de asma

INTRODUCTION: In asthmatic children and adolescents a high incidence of temporary bronchospasm is perceived after physical exertion. OBJECTIVE: To investigate incidence and severity of exercise-induced bronchospasm in children and adolescents with a clinical diagnosis of mild, moderate or severe asthma. METHOD: A descriptive, cross-sectional, not controlled study was carried out. The sample encompassed follow-up of 40 asthmatic patients of both genders, between 7 and 18 years of age who were not regularly using anti-inflammatory medication. A standardized exercise provocation test that consisted of steady running on a treadmill with a 10% inclination was administered Pulmonary function was tested with forced spirometry using six expiratory maneuvers repeated at approximately 1, 5 ,10,15, 20 and 30 minutes after the exercise. The highest of six FEV1 readings was used for analysis. The FEV1 was employed to evaluate the presence and to classify the severity of positive exercise induced bronchospasm (EIB). The asthmatic patients presented adequate clinical and spirometric conditions for testing (FEV1 at least 70 % of the predicted value). A drop of > 10% in relation to FEV1 before exercise was adopted as a criterion for (EIB). RESULTS: 26 (65 %) patients developed EIB. The proportion by category was: mild asthma 44%, moderate and severe asthma 100%. There was a significant association between proportion of EIB and severity of asthma (p<0.05), and a significant difference between severity of EIB (confirmed by a recorded decrease in the 1 second forced expiratory volume) and asthma severity (p<0.05). CONCLUSION: The proportion and severity of EIB were clearly related to the clinical severity of asthma.

Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth-breathing adults: A cross-sectional study

The purpose of this study was to evaluate the electromyographic activity of the accessory inspiratory muscles and the diaphragmatic amplitude (DA) in nasal and mouth-breathing adults. The study evaluated 38 mouth-breathing (MB group) and 38 nasal-breathing (NB group) adults, from 18 to 30years old and both sexes. Surface electromyography (sEMG) was used to evaluate the amplitude and symmetry (POC%) of the sternocleidomastoid (SCM) and upper trapezius (UT) muscles at rest, during nasal slow inspiration at Lung Total Capacity (LTC) and, during rapid and abrupt inspiration: Sniff, Peak Nasal Inspiratory Flow (PNIF) and Maximum Inspiratory Pressure (MIP). M-mode ultrasonography assessed the right diaphragm muscle amplitude in three different nasal inspirations: at tidal volume (TV), Sniff and inspiration at LTC. The SCM activity was significantly lower in the MB group during Sniff, PNIF (p<0.01, Mann-Whitney test) and MIP (p<0.01, t-test). The groups did not differ during rest and inspiration at LTC, regarding sEMG amplitude and POC%. DA was significantly lower in the MB group at TV (p<0.01, Mann-Whitney) and TLC (p=0.03, t-test). Mouth breathing reflected on lower recruitment of the accessory inspiratory muscles during fast inspiration and lower diaphragmatic amplitude, compared to nasal breathing.

Força muscular respiratória, postura corporal, intensidade vocal e tempos máximos de fonação na Doença de Parkinson

PURPOSE: To check the findings on respiratory muscular strength (RMS), body posture (BP), vocal intensity (VI) and maximum phonation time (MPT), in patients with Parkinson Disease (PD) and control cases, according to gender, Parkinson Disease stage (PD) and the level of physical activity (PA). METHODS: three men and two women with PD, between 36 and 63 year old (study cases - SC), and five subjects without neurologic diseases, of the same age, gender and PA level (control cases - CC). We evaluated RMS, BP, VI and MPT. RESULTS: men: a more pronounced decrease of MPT, VI, RMS in Parkinson patients, plus postural alterations in the elderly; women: similar postural alterations, positive relation between stages, PA level and the other measures. CONCLUSIONS: We observed in women with PD, impaired VI; in men with PD deficits in MPT, VI, RMS. We suggest further studies under an interdisciplinary bias.

Correlação entre postura da cabeça, intensidade da dor e índice de incapacidade cervical em mulheres com queixa de dor cervical

Neck pain is the most common symptom of cervical dysfunctions often being related to the maintenance of postures. Postural changes of the head are often associated with the occurrence of neck pain with an anterior approach was the most frequent. The purpose was to investigate the correlation between head posture, pain intensity and neck disability index. The study group (SG) was composed of women, aged between 20 and 50 years who complained of neck pain for more than three months, and the control group (CG) for asymptomatic women. Pain intensity was assessed by visual analogue scale (VAS), disability by neck disability index (NDI) and the head posture by the craniovertebral angle (CV). Normality of the data was verified by the Lilliefors test and the comparison between groups by the Students t-test for independent samples, and the association between variables by Spearman correlation test. Significance level was 5%. The SG had lower average CV for the angle (p=0.02). The CV angle was negatively correlated with the VAS (r=-0.48) and NDI (r=-0.15) suggesting that the smaller the angle, the greater the intensity of neck pain and disability. The NDI and VAS showed a positive correlation (r=0.59). The angle CV in subjects with neck pain was significantly lower than in healthy individuals association with the neck disability index and pain.

Influência do treinamento da musculatura respiratória e de membros inferiores no desempenho funcional de indivíduos com DPOC

A doenca pulmonar obstrutiva cronica (DPOC) caracteriza-se pela obstrucao ou limitacao cronica do fluxo aereo, gerando uma desvantagem mecânica, causando fraqueza muscular e recrutamento da musculatura inspiratoria acessoria. A disfuncao muscular esqueletica e uma importante manifestacao extrapulmonar, que leva a diminuicao da capacidade funcional. O objetivo do estudo foi verificar a eficacia de um treinamento da musculatura respiratoria e de quadriceps no desempenho funcional de individuos com DPOC. De nove individuos com idades entre 49 e 76 anos foram avaliadas as pressoes respiratorias maximas (por manovacuometria), forca muscular de membros inferiores (por repeticao maxima), capacidade funcional (pelo teste de caminhada com carga progressiva, shuttle test) e qualidade de vida (pelo questionario de qualidade de vida SF-36), antes e depois da aplicacao de protocolo de fortalecimento da musculatura inspiratoria, dos musculos quadriceps e abdominais. As sessoes de exercicios foram realizadas duas vezes por semana durante dois meses. Foi verificada melhora em todas as variaveis avaliadas, com diferenca significativa na pressao inspiratoria maxima (p<0,05). O treinamento da musculatura respiratoria e de quadriceps proposto mostrou-se benefico ao desempenho funcional de individuos com DPOC, sugerindo a utilizacao do fortalecimento muscular respiratorio e periferico como recurso coadjuvante no tratamento desses individuos.

Respiratory mode, nasal patency and palatine dimensions

PURPOSE To investigate the influence of breathing mode and nasal patency in the dimensions of the hard palate by comparing mouth breathing (MB) and nasal breathing (NB) adults. METHODS Seventy-seven individuals, distributed into the MB group (n=38) and the NB group (n=39), of both genders and aged between 18 and 30 years old, took part in the study. The respiratory mode diagnosis was based on anamnesis, physical characteristics, and otorhinolaryngological examination. The volunteers were evaluated in terms of nasal patency, with a peak nasal inspiratory flow (PNIF) meter, and obstruction symptoms, by a Nasal Obstruction Symptom Evaluation (NOSE) scale, and had their transversal and vertical hard palate dimensions measured with a digital caliper in plaster models. RESULTS Comparing both groups, the MB group presented significantly higher values in the NOSE scale, lower values in the PNIF, lower values in the transversal distance of the palate in the intercanine region, and significantly higher values in the vertical distance in the regions of the first and second premolars and molars. There was a negative correlation between PNIF and NOSE, and a positive correlation between PNIF and transversal distance of the palate in the region of the first premolars. CONCLUSION MB adults presented reduced nasal patency and a higher degree of nasal obstruction symptoms. The hard palate was morphologically narrower and deeper in adults with the MB mode compared to the NB mode. Moreover, it was concluded that the smaller the nasal patency, the greater the obstruction symptoms and the narrower the hard palate.

Capacidade aeróbica em crianças e adolescentes com asma intermitente e persistente leve no período intercrises

OBJECTIVE To assess children and adolescents diagnosed with mild intermittent or mild persistent asthma, in terms of their aerobic capacity between attacks. METHODS We included 33 children and adolescents recently diagnosed with asthma (mild intermittent or mild persistent) and 36 healthy children and adolescents. Those with asthma were evaluated between attacks. All participants underwent clinical evaluation; assessment of baseline physical activity level; pre- and post-bronchodilator spirometry; and a maximal exercise test, including determination of maximal voluntary ventilation, maximal oxygen uptake, respiratory quotient, maximal minute ventilation, ventilatory equivalent, ventilatory reserve, maximal HR, SpO2, and serum lactate. RESULTS No significant differences were found among the groups (intermittent asthma, persistent asthma, and control) regarding anthropometric or spirometric variables. There were no significant differences among the groups regarding the variables studied during the maximal exercise test. CONCLUSIONS A diagnosis of mild intermittent/persistent asthma has no effect on the aerobic capacity of children and adolescents between asthma attacks.

Análise da postura craniocervical de crianças respiradoras bucais após tratamento postural em bola suíça

O estudo teve como objetivo avaliar a postura craniocervical de criancas respiradoras bucais apos tratamento postural em bola suica. Doze criancas respiradoras bucais foram submetidas a um protocolo de reeducacao postural constituido por exercicios de alongamento e fortalecimento muscular sobre a bola suica, estimulacao diafragmatica e alongamento dos musculos acessorios da inspiracao. A postura craniocervical foi avaliada atraves da analise biofotogrametrica. A posicao da anteriorizacao da cabeca foi aferida por meio do ângulo formado pelos pontos localizados no tragus direito e no processo espinhoso da setima vertebra cervical com a linha horizontal. A curvatura cervical foi avaliada pela distância horizontal de uma linha vertical tangenciando o apice da cifose toracica e o ponto de maior concavidade da curvatura cervical. As fotografias foram obtidas antes e apos dez atendimentos. A normalidade das variaveis foi verificada a partir do teste Shapiro-Wilk. Para as comparacoes entre as medias foi utilizado o teste t de Student para amostras dependentes admitindo-se nivel de significância de 5% (p<0,05). Verificou-se uma melhora na postura craniocervical, atraves da diminuicao da anteriorizacao da cabeca (p=0,00) e do restabelecimento da curvatura fisiologica da coluna cervical (p=0,01). O tratamento postural em bola suica proporcionou um melhor alinhamento da postura craniocervical, provavelmente pelo equilibrio dos musculos cervicais e maior acao diafragmatica.