Silvana Bommarito

Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea

BACKGROUND Patients with obstructive sleep apnea (OSA) exhibit reduced quality of life (QoL) due to their daytime symptoms that restricted their social activities. The available data for QoL after treatment with continuous positive airway pressure (CPAP) are inconclusive, and few studies have assessed QoL after treatment with speech therapy or other methods that increase the tonus of the upper airway muscles or with a combination of these therapies. The aim of our study was to assess the effect of speech therapy alone or combined with CPAP on QoL in patients with OSA using three different questionnaires. METHODS Men with OSA were randomly allocated to four treatment groups: placebo, 24 patients had sham speech therapy; speech therapy, 27 patients had speech therapy; CPAP, 27 patients had treatment with CPAP; and combination, 22 patients had treatment with CPAP and speech therapy. All patients were treated for 3 months. Participants were assessed before and after treatment and after 3 weeks of a washout period using QoL questionnaires (Functional Outcomes of Sleep Questionnaire [FOSQ], World Health Organization Quality of Life [WHOQoL-Bref], and Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]). Additional testing measures included an excessive sleepiness scale (Epworth sleepiness scale [ESS]), polysomnography (PSG), and speech therapy assessment. RESULTS A total of 100 men aged 48.1±11.2 (mean±standard deviation) years had a body mass index (BMI) of 27.4±4.9 kg/m(2), an ESS score of 12.7±3.0, and apnea-hypopnea index (AHI) of 30.9±20.6. After treatment, speech therapy and combination groups showed improvement in the physical domain score of the WHOQoL-Bref and in the functional capacity domain score of the SF-36. CONCLUSIONS Our results suggest that speech therapy alone as well as in association with CPAP might be an alternative treatment for the improvement of QoL in patients with OSA.

Impacto vocal de professores

RESUMO Objetivo: analisar o impacto vocal nas atividades diarias em professores do ensino medio. Correlacionar os achado da auto-percepcao do problema vocal com os aspectos: efeitos no traba-lho, na comunicacao diaria, na comunicacao social e na sua emocao. Metodo: a amostra foi cons-tituida por 107 professores, sendo 86 com queixa e 21 sem queixa, selecionados em escolas da rede particular de ensino de Maceio-AL. Cada professor respondeu individualmente o protocolo Perfil Participacao em Atividades Vocais na presenca da pesquisadora, assinalando suas respostas em uma escala visual que varia de 0 a 10. O protocolo e composto por 28 questoes com a presenca inte-grada em cinco aspectos englobados para avaliar a qualidade de vida e o resultado de tratamentos vocais. O protocolo oferece, ainda, dois escores adicionais: pontuacao de limitacao nas atividades (PLA) e de restricao de participacao (PRP). Resultados: na comparacao dos grupos com e sem queixa vocal foram verificados que todos os resultados foram estatisticamente significantes (p<0,001) e, em todos os aspectos os maiores escores foram do grupo com queixa vocal. A PLA foi de 33,27, em um total de 100 pontos e a PRP foi de 20,46, em um total de 100 pontos e a pontuacao da media dos aspectos foi de 79,50, em um total de 280 pontos. Conclusao: a media dos aspectos analisados foi de 79,50 pontos verificando-se que os professores se sentem limitados no exercicio da sua profis-sao, porem nao restritos a exerce-la. Quanto a correlacao dos aspectos todos foram estatisticamente significantes, demonstrando fidedignidade. Os escores adicionais PLA e PRP apresentaram valores que reforcam a limitacao em exercer a docencia.DESCRITORES: Voz; Qualidade de Vida; Docentes; Atividades Cotidianas

Avaliação do processamento auditivo de sons não-verbais em indivíduos com doença de Parkinson

Auditory processing, as we understand, refers to how the individual handles with auditory information. The importance of auditory perception of sound sequences and temporal patterns in acquiring and comprehending symbolic components of language is well recognized. Acoustic properties of speech may be limited to the basic components of duration and frequency analysis. Speech signals are the most important events we receive through hearing and, as we know, speech patterns may be compromised in Parkinsons disease. AIM: To evaluate the performance of subjects diagnosed with Parkinsons disease in Duration and Frequency Pattern Tests. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Nonverbal stimuli identification was evaluated in three different modes of response: humming, verbal labeling and indicating. Stimuli were characterized by sequences of three or four elements, varying in duration and frequency. RESULTS: No significant difference was observed considering mode of response; better results were obtained for three-element sequences than four-element sequences and for duration patterns in comparison to frequency patterns. Subjects with Parkinsonss disease demonstrated poorer performance than normal subjects. CONCLUSION: Temporal ordering is a very important function of the central auditory nervous system. This ability enables the listener to discriminate sound patterns based on auditory ordering or sequencing. Therefore, our findings are important since they stimulate further studies concerning analysis and interpretation processes in patients with Parkinsons disease.

Maximum Bite Force Analysis in Different Age Groups

Introduction Maximum bite force (MBF) is the maximum force performed by the subject on the fragmentation of food, directly related with the mastication and determined by many factors. Objective Analyze the MBF of subjects according to age groups. Methods One hundred individuals from the city of São Paulo were equally divided according to age groups and gender. Each individual submitted to a myotherapy evaluation composed of anthropometric measurements of height and weight to obtain body mass index (BMI), using a tape and a digital scale (Magna, G-life, São Paulo), and a dental condition and maximum bite force evaluation, using a digital dynamometer model DDK/M (Kratos, São Paulo, Brazil), on Newton scale. The dental and bite force evaluations were monitored by a professional from the area. Analysis of variance was used with MBF as a dependent variable, age group and gender as random factors, and BMI as a control variable. Results Till the end of adolescence, it was possible to observe a decrease in MBF in both sexes, with the male force greater than the female force. In young adults, the female force became greater the males, then decreased in adulthood. There was no correlation between MBF and BMI. Conclusion There are MBF variations that characterizes the human development stages, according to age groups.

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.

Avaliação da prevalência das seis chaves de oclusão de Andrews, em jovens brasileiros com oclusão normal natural

AIM: due to the large use of Andrewss six keys to normal occlusion concept as a tool for diagnosis and treatment planning, we carried out this study with the purpose to evaluate the prevalence of such characteristics in a brazilian sample. METHODS: 61 cast models of untreated subjects with normal occlusion were evaluated. The frequency that the six keys were found in each subject, as well as which were the most or least frequent keys, was observed. The results showed that most of the subjects presented one to three keys and none presented all the six keys. RESULTS AND CONCLUSIONS: the characteristics more frequently observed were: flat curve of Spee (100%), tight interproximal contacts (42,6%) and correct tippings (34.4%). The low prevalence of untreated normal occlusion that achieves Andrewss requirements lead us to reflect on the search for such rigid patterns.OBJETIVOS: diante da larga utilizacao e difusao dos conceitos das seis chaves de oclusao de Andrews como instrumento de diagnostico e planificacao de tratamento, realizamos este trabalho com o objetivo de avaliar a prevalencia destas caracteristicas numa amostra de oclusao normal brasileira. METODOLOGIA: 61 modelos de estudo de individuos brasileiros, leucodermas e com oclusao normal natural foram estudados. Foi observada a frequencia com que as seis chaves foram encontradas em cada individuo, bem como quais as chaves de maior e menor frequencia. RESULTADOS E CONCLUSOES: os resultados demonstraram que a grande maioria dos individuos apresentou de uma a tres chaves de oclusao e nenhum dos modelos apresentou as seis chaves de oclusao. As caracteristicas observadas com maior frequencia foram a presenca da curva de Spee suave (100%), contatos interproximais justos (42,6%) e inclinacoes corretas (34,4%). A baixa prevalencia de oclusoes normais naturais na populacao, que preencham os requisitos propostos por Andrews, leva-nos a refletir sobre a busca desenfreada por padroes tao rigidos.

Avaliação da profundidade do palato e das dimensões do arco dentário superior em indivíduos com má oclusão e diferentes tipos faciais

AIM: The aim of this study was to evaluate palatine depth and dimensions of the upper dental arch in patients with malocclusion and different facial types. METHODS: The sample was constituted of profile cephalograms and dental casts of 135 individuals, 67 females and 68 males, with age between 12 to 21 years and malocclusions: Class I (n = 45), Class II (n = 45) and Class III (n = 45), Angle. The sample was divided in three groups, according to the facial type: brachyfacial (n = 45), mesofacial (n = 45) and dolichofacial (n = 45). The transversal dimensions (intercuspids and inter-first molars distances) and upper dental arch length were obtained with auxiliary of digital caliper. In order, to obtain palatine depth measurement was used a special equipment developed and adapted to the digital caliper. RESULTS AND CONCLUSION: Based on our results, we concluded that: (1) no statistically significant differences between these measurements were found considering the facial types, except for the palatine depth, that was smaller in brachyfacial group (18.18mm) than dolichofacial group (19.52mm); (2) according to sex, only two variables, the depth palatine and inter-first molar distance, demonstrated statistically significant differences, that appeared to be bigger in males than females; (3) according to the malocclusion, statistically significant differences between these measurements were found only to the upper dental arch length, that was bigger in Class II group (31.23mm) than Class III group (29.64mm).

Peak nasal inspiratory flow: uma possível ferramenta para a motricidade orofacial?

ABSTRACT The speech-language pathologists that work in the Orofacial Myology field frequently have patients with nasal obstruction; however, the access to the professional responsible for the diagnosis can be difficult at times. The Peak Nasal Inspiratory Flow is a cheap and easy to handle instrument, broadly cited in the international literature, that has the aim to evaluate nasal patency. The aim of this study was to review the current literature regarding the Peak Nasal Inspiratory Flow, enabling considerations about its use in cervical and orofacial myology disorders. The literature review consulted Medline, Cochrane Library, LILACS and SciELO databases, using the keywords: peak, inspiratory, nasal and flow. The results showed that Peak Nasal Inspiratory Flow is a simple, cheap, validated technique with good reproducibility. Thus, it seems to be an useful instrument to be used in nasal patency evaluation, despite some limitations, providing complementary data to orofacial myofunctional diagnosis. However clinical trials are needed to prove this

A confiabilidade da informação fornecida pelo indivíduo a respeito de seu posicionamento habitual de língua

OBJETIVO: verificar a confiabilidade da informacao fornecida por adultos e criancas a respeito do posicionamento habitual de lingua. METODOS: foram investigadas 30 criancas e 30 adultos em dois momentos, com diferenca minima de sete e maxima de vinte e um dias. Inicialmente foi realizada a observacao do posicionamento habitual de lingua. Em seguida, o participante foi questionado a respeito de seu posicionamento habitual. Apos a resposta, a lingua foi estimulada com uma espatula de madeira, a fim de aumentar a percepcao. Posteriormente, questionou-se, novamente, o individuo. Em seguida, orientou-se o participante a observar onde sua lingua permanece habitualmente na cavidade oral, ate o segundo momento da avaliacao. Nesta oportunidade, o participante foi questionado a respeito de seu posicionamento habitual de lingua. Os dados foram analisados por meio da estatistica Kappa. RESULTADOS: nao foi possivel visualizar o posicionamento habitual de lingua em 100% da amostra. Quanto a confiabilidade geral das respostas verificou-se classificacao entre discreta e regular. As criancas apresentaram respostas pouco consistentes e bastante diversificadas, ja em relacao aos adultos, parte apresentou respostas corretas logo no primeiro questionamento e parte somente apresentou respostas confiaveis apos estimulacao de percepcao intra-oral. CONCLUSOES: a confiabilidade da informacao fornecida pelos individuos da amostra a respeito de seu posicionamento habitual de lingua varia entre discreta e regular, sendo, portanto, baixa, tanto em criancas quanto em adultos. Uma possivel estrategia a ser utilizada na pratica clinica fonoaudiologica e questionar o paciente quanto ao seu posicionamento lingual apos determinado periodo de observacao.

Model of oronasal rehabilitation in children with obstructive sleep apnea syndrome undergoing rapid maxillary expansion: Research review

Rapid maxillary expansion (RME) is a widely used practice in orthodontics. Scientific evidence shows that RME can be helpful in modifying the breathing pattern in mouth-breathing patients. In order to promote the restoration of physiological breathing we have developed a rehabilitation program associated with RME in children. The aim of the study was a literature review and a model of orofacial rehabilitation in children with obstructive sleep apnea undergoing treatment with rapid maxillary expansion. Muscular training (local exercises and general ones) is the key factor of the program. It also includes hygienic and behavior instructions as well as other therapeutic procedures such as rhinosinusal washes, a postural re-education (Alexander technique) and, if necessary, a pharmacological treatment aimed to improve nasal obstruction. The program should be customized for each patient. If RME is supported by an adequate functional rehabilitation, the possibility to change the breathing pattern is considerably amplified. Awareness, motivation and collaboration of the child and their parents, as well as the cooperation among specialists, such as orthodontist, speech therapist, pediatrician and otolaryngologist, are necessary conditions to achieve the goal.