Tatiana Vargas de Castro Perilo

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.

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.

Evaluation of the force applied by the tongue and lip on the maxillary central incisor tooth

PURPOSE To describe the development and testing of a system that measures forces exerted by the tongue and upper lip on a tooth during rest and during swallowing. METHODS Twenty-eight subjects, aged 19-31 years (mean: 23.2 years) were submitted to measurement of forces exerted by the upper lip and tongue on the maxillary right central incisor tooth. Flexiforce resistive sensors were fixed on the labial and lingual surfaces of the tooth. They were connected to an amplifier circuit and a data acquisition board for processing and transmitting information to a computer. RESULTS At rest, the tongue force on the tooth was 0.00±0.00 N and the lip force on tooth was 0.02±0.02 N. The difference between them was significant. During swallowing, the values were 0.31±0.38 N and 0.15±0.14 N, for the tongue and lip, respectively. This difference was not significant. CONCLUSION At rest, the lip exerts a larger force than the tongue on the maxillary right central incisor tooth. During swallowing, there was no difference between lip and tongue force on the tooth.

Avaliação do respirador oral: uso do espelho de Glatzel e do peak nasal inspiratory flow

PURPOSE: To compare the use of the Glatzel mirror and peak nasal inspiratory flow in the evaluation of mouth-breathing participants and to analyze the correlation between these instruments. METHODS: Sixty-four children were evaluated - 32 mouth breathers and 32 nasal breathers; the children were aged 4 to 12 years. The mouth breathers were subdivided according to the cause of obstruction by a multidisciplinary team. The Glatzel mirror and peak nasal inspiratory flow were used in both groups to evaluate patency and nasal airflow. Data were then subjected for statistical analysis. RESULTS: The Glatzel mirror allowed us to differentiate the breathing mode considering gender, age, weight, height, and body mass index, but it did not help in identifying the cause of mouth breathing. The peak nasal inspiratory flow did not allow differentiation of the breathing mode and identification of the cause of mouth breathing. In our sample, there was no correlation between the instruments used. CONCLUSION: The Glatzel mirror was reliable in identifying participants with and without nasal obstruction, although it was not possible to differentiate subgroups of mouth breathers using this instrument. The peak nasal inspiratory flow showed differences only between nasal breathers and surgical mouth breathers. Low correlation was found between these two instruments.

Relationship between perception of tongue position and measures of tongue force on the teeth

Purpose To verify whether there are differences of tongue force on the teeth at rest and during swallowing between individuals who report appropriate tongue position and those who report tongue thrust. Methods Tongue forces on the teeth were evaluated in 28 participants aged 19 to 31 years. To this end, a Flexiforce® resistive sensor was fixed to the palatal surface of the maxillary right central incisor (tooth 8) and was connected to an amplifier circuit, a data acquisition board, and a computer. Measurements were taken at rest and during saliva swallowing. Participants were asked about their habitual tongue position and where the apex of tongue touched when they swallowed. The Mann Whitney test was used for statistical analysis at 5% significance level. Results At habitual position, tongue force on the teeth was 0.00 N both for participants that reported tongue touch and for those who did not. At directed swallowing, tongue force was 0.34 N for the group of individuals whose tongues touch the teeth and 0.08 N for the group of individuals whose tongues do not touch the teeth. This difference was significant. Conclusion No significant difference was found between the tongue forces of participants of both groups at habitual position. However, participants with tongue thrust during directed swallowing presented greater force than those whose tongues do not touch the teeth during this task.

Habilidades cognitivo-linguísticas e sua relação com características respiratórias

PURPOSE: to relate respiratory characteristics with cognitive-linguistic skills performance of children from a public school of the region of Belo Horizonte. METHOD: a cross-sectional, observational and descriptive study. From the 180 enrolled children, 131 met the inclusion and exclusion criteria. We evaluated 66 children in the 4th grade and 65 children in the 3rd grade of the elementary education, from both genders, with ages going between nine and ten year old. We utilized a questionnaire for assessment of respiratory characteristics and a previously published protocol and adapted to the Brazilian population in order to assess the cognitive-linguistic skills. Data were analyzed using the Mann-Whitney and Kruskal Wallis test at a significance level of 1%. RESULTS: there was not observed a p-value <0.01 in comparison between the respiratory characteristics and the cognitive-linguistic skills’ score obtained by each series. We observed that 59.1% of students had scores in a questionnaire for assessment of respiratory characteristics between zero and four points, indicating some impairment in respiratory variables studied. We obtained a significant p value for comparisons between the performance in cognitive-linguistic skills and the presence of respiratory disorders in the studied series. CONCLUSION: no significant relationship was found between the performance of cognitive-linguistic skills and the presence of respiratory characteristics in students from the same public school of Belo Horizonte city, and the children who showed respiratory changes didn´t have performance below those without these changes in the assessed skills.

Development and Clinical Application of Instruments to Measure Orofacial Structures

The muscles which compose the orofacial system are characterized by their small sizes and the ability to generate highly precise and differentiated movements that includes a series of rapid shape changes. This is made possible due to the large amount of innervations and the complex organization of the muscle fibers. These muscles play an essential role in mastication, swallowing, speech, breathing and suction, functions that require fast and complex movements. They also contribute to the orientation of facial bone growth and maintenance of teeth position.

Instrumentation to Evaluate and Train Orofacial Structures

Muscular pressure is the guide for teeth positioning. When balance between tongue, lips and cheeks is broken, there are always consequences for the face bones and teeth. The evaluation of these orofacial structures is then an important and routinely made task in Speech-language Pathology clinical practice. However, this assessment is carried out in a subjective way, according to the experience of the professional, what makes the diagnosis and the follow up harder to be done. Due to the need for precise methods of assessing the strength of orofacial muscles, the Biomechanical Engineering Group from Universidade Federal de Minas Gerais, in an interdisciplinary project, developed some devices with the purposes to measure tongue and lips strength and to rehabilitate tongue strength. Those appliances are currently going through improvements and a device to measure cheek forces is been developed. The use of such devices in clinical practice and research will enable Speech-language Pathologists to make a more reliable orofacial myofunctional evaluation, also improve patients´ follow up observing quantitatively the strength gained.