A web-based survey to map the electromyography practice in Brazil / Uma enquete via internet para mapear a prática de eletromiografia no Brasil

Abstract Background Detailed information about the electromyography practice in Brazil is largely unavailable. Objective To evaluate where and how electromyography is performed in Brazil, as well as regional disparities and the professional and academic credentials of electromyographers. Methods We conducted an internet-based survey of active Brazilian electromyographers. The websites of health insurance companies, professional academies, medical cooperatives, online search engines, and social networks in each Brazilian state were screened and we evaluated the credentials of each electromyographer listed in the Brazilian Federal Medical Board (BFMB) registration website and their online curricula vitae in the Brazilian National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq, in Portuguese). We also evaluated the same parameters in a control group of non-electromyographer neurologists randomly matched by geographical distribution and gender. Results We found 469 electromyographers (384 neurologists and 85 non-neurologists), with a male predominance. In total, 81.9% were BFMB-certified neurologists, 49.9%, BFMB-certified clinical neurophysiologists, and 10.4%, BFMB-certified physiatrists. Among the non-neurologists, 48.2% were physiatrists. Most electromyographers practiced in states on the Southern and Southeastern regions of Brazil. When adjusted by population, the Federal District and the states of Mato Grosso do Sul and Goiás presented the highest of eletromyographers density. Electromyographers were not more likely to have current/past academic affiliations. Conclusion In Brazil, electromyography is performed predominantly by neurologists, and half of them are BFMB-certified clinical neurophysiologists. The present study highlights regional disparities and may guide government-based initiatives, for instance, to improve the diagnosis of leprosy and the management of neuromuscular disorders within the Brazilian territory.

Resumo Antecedentes Informações detalhadas sobre a prática de eletromiografia no Brasil são em grande parte indisponíveis. Objetivo Avaliar onde e como a eletromiografia é realizada no Brasil, as disparidades regionais, e as credenciais profissionais e acadêmicas dos eletromiografistas. Métodos Realizamos uma enquete via internet de eletromiografistas brasileiros ativos. Foram rastreados sites de operadoras de planos de saúde, academias profissionais médicas, cooperativas médicas, ferramentas de busca online e redes sociais em cada estado brasileiro. Em seguida, avaliamos as credenciais de cada eletromiografista listado no site de registro do Conselho Federal de Medicina (CFM) e seus curricula vitae online no Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Também avaliamos os mesmos parâmetros em um grupo controle de neurologistas não eletromiografistas pareados aleatoriamente por distribuição geográfica e gênero. Resultados Encontramos 469 eletromiografistas (384 neurologistas e 85 não neurologistas), com predominância do sexo masculino. Ao todo, 81,9% eram neurologistas com certificação confirmada pelo site do CFM, 49,9%, neurofisiologistas clínicos com certificação confirmada pelo site do CFM, e 10,4%, fisiatras com certificação confirmada pelo mesmo site. Entre os não neurologistas, 48,2% eram fisiatras. A maioria dos eletromiografistas atuava nos estados do Sul e do Sudeste. Quando ajustados pela população, o Distrito Federal e os estados de Mato Grosso do Sul e Goiás apresentaram a maior densidade de eletromiografistas. Os eletromiografistas não eram mais propensos a ter vínculos acadêmicos atuais/passados. Conclusão No Brasil, a eletromiografia é realizada predominantemente por neurologistas, e metade deles são neurofisiologistas clínicos com certificação confirmada pelo site do CFM. Este estudo destacou as disparidades regionais, e pode orientar ações governamentais para, por exemplo, melhorar o diagnóstico da hanseníase e o manejo das doenças neuromusculares no território brasileiro.

Neurophysiology in between the interests of Dom Pedro II of Brazil, and Charles Brown-Séquard (Historical Note) / Neurofisiologia entre os interesses de Dom Pedro II do Brasil e Charles Brown-Séquard (Nota Histórica)

This article presents our historical research regarding Charles Brown-Séquard, a famous scientist with important contributions to the medical field, in particular for neurology, and endocrinology, and his relationship with Dom Pedro II, the second and last Brazilian Emperor, and an enlightened ruler. The Emperor contacted several illustrious personages in support of State policy, such as for the development of experimental physiology at the Imperial Museum of Natural History, but also for personal purposes given his health problems and those of the Empress. Charles Brown-Séquard and his pilgrimage between different worlds as a physician and physiologist are presented until his definitive establishment in Paris, where he replaces Claude Bernard in the chair of experimental medicine at the Collège de France. Jacques-Arsene d'Arsonval took over after this chair, and together with Brown-Séquard, he electrophysiologically examined the Emperor's diabetic peripheral neuropathy. In this article, the Emperor´s relationship with Brown-Séquard was studied mainly from the correspondence sent to Dom Pedro II and retrieved from the Imperial Museum in Petrópolis, Brazil, and from the accounts of his meetings that included scientific sessions and clinical consultations. This article can be used to understand the progress of knowledge in the field of neurology/clinical neurophysiology, the tracking of emerging ideas in the field of science in the past and the threat to the credibility of researchers.

Este artigo apresenta nossa pesquisa histórica a respeito de Charles Brown-Séquard, famoso cientista com importantes contribuições para a área médica, em especial para a neurologia e endocrinologia, e sua relação com Dom Pedro II, segundo e último Imperador brasileiro, e governante esclarecido. O Imperador contactou várias personalidades ilustres no apoio à política de Estado, como para o desenvolvimento da fisiologia experimental no Museu Imperial de História Natural, mas também para fins pessoais dados os seus problemas de saúde e os da Imperatriz. Charles Brown-Séquard e sua peregrinação entre diferentes mundos como médico e fisiologista são apresentados até seu estabelecimento definitivo em Paris, onde substitui Claude Bernard na cadeira de medicina experimental no Collège de France. Jacques-Arsene d'Arsonval assumiu após esta cadeira e, juntamente com Brown-Séquard, examinou eletrofisiologicamente a neuropatia periférica diabética do imperador. Neste artigo, a relação do Imperador com BrownSéquard foi estudada principalmente a partir da correspondência enviada a Dom Pedro II e recuperada no Museu Imperial de Petrópolis, Brasil, e dos relatos de seus encontros que incluíam sessões científicas e consultas clínicas . Este artigo pode ser usado para entender o progresso do conhecimento no campo da neurologia/neurofisiologia clínica, o rastreamento de ideias emergentes no campo da ciência no passado e a ameaça à credibilidade dos pesquisadores.

Assessment of knowledge about the neurophysiology of pain and self-perception of skills to assist individuals with pain among undergraduate physiotherapy students in Brazil: cross-sectional study / Avaliação do conhecimento sobre neurofisiologia da dor e autopercepção de habilidades para atender indivíduos com dor em graduandos e graduados em fisioterapia no Brasil: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Approaches to coping with pain, such as patient education, are directly related to the professionals' skill level. The identification of possible learning gaps in the different stages of training can contribute to the development of new teaching strategies and methods. This study aimed to evaluate and compare the level of knowledge about the neurophysiology of pain and the self-perception of abilities to care for individuals with pain in undergraduate and graduate students in physiotherapy in Brazil. METHODS: This is a cross-sectional analytical observational study, in which the Neurophysiological Pain Questionnaire (QND) was applied to assess the level of knowledge about the neurophysiology of pain. A self-administered questionnaire was also used to collect sociodemographic data from the sample and to assess self-perception of abilities to care for individuals with pain. The characteristics of the study population were defined by descriptive statistics. For the analysis of QND score distribution and self-perception of abilities to care for individuals with pain, the Shapiro-Wilk test was used. In the bivariate analysis to compare the distribution of the QND score and self-perception of abilities to care for individuals with pain between the stages of undergraduates and schooling after graduation, the Kruskal-Wallis test was used, with a significance level of 5% and 95% confidence interval. The statement Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used as a guide for reporting the results of the study. RESULTS: A total of 306 volunteers participated in the study, 208 undergraduate students (22.3 ± 3.2 years) and 98 physiotherapists (31.7± 8.7 years). The average QND score for undergraduate students was 6.17 and 8.56 for physiotherapists, considering a total of 12 points. There was a significantly higher difference in the scores obtained on the QND by undergraduates in the intermediate phase and in the last year (p<0.05), as well as in the self-perception of abilities to care for individuals with pain and perform a biopsychosocial approach to the patient, between the different phases of the course. However, among physiotherapists, no significant difference was observed in the total QND score, and in the self-perception of abilities to care for individuals with pain. CONCLUSION: The findings of this study suggest that the level of knowledge about the neurophysiology of pain and self-perception of skills to care for individuals with pain differs between academics and physiotherapy professionals. However, the low QND score of physiotherapy undergraduates, as well as the absence of significant differences in the QND between the different levels of physiotherapist training, suggest that curricular implementation and specific training on pain may be indispensable to increase the level of knowledge and skills of physiotherapists in the treatment of individuals with pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Abordagens para o enfrentamento da dor, como educação do paciente, estão diretamente relacionadas ao nível de habilidades dos profissionais. A identificação de possíveis lacunas do aprendizado nas diferentes fases de formação pode contribuir para o desenvolvimento de novas estratégias e métodos de ensino. O objetivo deste estudo foi avaliar e comparar o nível de conhecimento sobre neurofisiologia da dor e a autopercepção de habilidades para atender indivíduos com dor em alunos de graduação e graduados em fisioterapia no Brasil. MÉTODOS: Trata-se de um estudo observacional analítico do tipo transversal, em que foi aplicado o Questionário Neurofisiológico de Dor (QND) para avaliar o nível de conhecimento sobre neurofisiologia da dor. Também foi utilizado um questionário autoaplicado para coletar os dados sociodemográficos da amostra e avaliar a autopercepção de habilidades para atender indivíduos com dor. As características da população do estudo foram definidas pela estatística descritiva. Para a análise da distribuição do escore QND e da autopercepção de habilidades para atender indivíduos com dor foi utilizado o teste Shapiro-Wilk. Na análise bivariada para a comparação de distribuição do escore QND e da autopercepção de habilidades para atender indivíduos com dor entre as fases dos graduandos e a escolaridade após a formação foi utilizado o teste de Kruskal-Wallis, nível de significância de 5% e intervalo de confiança de 95%. A declaração Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) foi utilizada como guia para relatar os resultados do estudo. RESULTADOS: Um total de 306 voluntários participaram do estudo, sendo 208 alunos de graduação (22,3 ± 3,2 anos) e 98 fisioterapeutas (31,7± 8,7 anos). A pontuação média do QND para os alunos de graduação foi 6,17 e de 8,56 para os fisioterapeutas, considerando um total de 12 pontos. Observou-se uma diferença significativamente superior na pontuação obtida no QND pelos graduandos da fase intermediária e do último ano (p<0,05), bem como na autopercepção de habilidades para atender indivíduos com dor e realizar uma abordagem biopsicossocial do paciente entre as diferentes fases do curso. Contudo, entre os fisioterapeutas, não foi observada diferença significativa na pontuação total do QND e na autopercepção de habilidades para atender indivíduos com dor. CONCLUSÃO: Por meio dos achados deste estudo, foi possível observar que o nível de conhecimento sobre neurofisiologia da dor e autopercepção de habilidades para atender indivíduos com dor difere entre acadêmicos e profissionais de fisioterapia. Entretanto, a pontuação baixa do QND dos graduandos de fisioterapia, bem como a ausência de diferenças significativas do QND entre os diferentes níveis de formação dos fisioterapeutas, sugere que a implementação curricular e capacitações específicas sobre dor são indispensáveis para ampliar o nível de conhecimento e habilidades dos fisioterapeutas no tratamento de indivíduos com dor.

Diagnostic utility of transcranial magnetic stimulation for neurodegenerative disease: a critical review / Utilidade diagnóstica da estimulação magnética transcraniana para doenças neurodegenerativas: uma revisão crítica

ABSTRACT. Neurodegenerative diseases pose significant challenges due to their impact on brain structure, function, and cognition. As life expectancy rises, the prevalence of these disorders is rapidly increasing, resulting in substantial personal, familial, and societal burdens. Efforts have been made to optimize the diagnostic and therapeutic processes, primarily focusing on clinical, cognitive, and imaging characterization. However, the emergence of non-invasive brain stimulation techniques, specifically transcranial magnetic stimulation (TMS), offers unique functional insights and diagnostic potential. TMS allows direct evaluation of brain function, providing valuable information inaccessible through other methods. This review aims to summarize the current and potential diagnostic utility of TMS in investigating neurodegenerative diseases, highlighting its relevance to the field of cognitive neuroscience. The findings presented herein contribute to the growing body of research focused on improving our understanding and management of these debilitating conditions, particularly in regions with limited resources and a pressing need for innovative approaches.

RESUMO. As doenças neurodegenerativas representam desafio significativo por seu impacto na estrutura cerebral, função e cognição. À medida que a expectativa de vida aumenta, a prevalência dessas doenças cresce rapidamente, resultando em substanciais encargos pessoais, familiares e sociais. Esforços têm sido feitos para otimizar os processos diagnósticos e terapêuticos, com foco principal na caracterização clínica, cognitiva e de imagem. No entanto, o surgimento de técnicas de estimulação cerebral não invasivas, especificamente a estimulação magnética transcraniana (EMT), oferece compreensão funcional e potencial diagnóstico únicos. A TMS permite a avaliação direta da função cerebral, fornecendo informações valiosas inacessíveis por outros métodos. Esta revisão teve como objetivo resumir a utilidade diagnóstica atual e potencial da EMT na investigação de doenças neurodegenerativas, destacando sua relevância para o campo da neurociência cognitiva. As conclusões aqui apresentadas contribuem para o crescente corpo de investigação centrado na melhoria da nossa compreensão e gestão dessas condições debilitantes, particularmente em regiões com recursos limitados e necessidade premente de abordagens inovadoras.

A influência da dopamina nos transtornos de depressão: revisão de literatura / The influence of dopamine on depression disorders: review of literature / La influencia de la dopamina en los transportes de la depresión: revisión de la literatura

A depressão é definida como um distúrbio que provoca alterações de ordem social, psicológica, fisiológica e biológica. Pessoas diagnosticadas como depressivas apresentam impactos no funcionamento psicossocial, saúde física, mortalidade e qualidade de vida. Por esta razão, este estudo teve como objetivo demonstrar os mecanismos fisiológicos envolvidos nos transtornos de depressão e sua relação com o neurotransmissor dopamina. Trata-se de uma revisão bibliográfica narrativa realizada no período de março a maio de 2023, através de pesquisas nas bases de dados Scientific Electronic Library Online (SciELO), PubMed via Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Google Scholar. Através desta revisão foi possível evidenciar a importância no conhecimento acerca dos mecanismos fisiopatológicos envolvidos nos transtornos de depressão, sendo essencial para o entendimento e aplicação em tratamentos de pacientes diagnosticados com este transtorno.

Depression is defined as a disorder that causes social, psychological, physiological and biological changes. People diagnosed as depressive have an impact on psychosocial functioning, physical health, mortality, and quality of life. For this reason, this study aimed to demonstrate the physiological mechanisms involved in depression disorders and their relationship with the neurotransmitter dopamine. It is a narrative bibliographic review conducted in the period from March to May 2023, through searches in the databases Scientific Electronic Library Online (SciELO), PubMed via Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS) and Google Scholar. Through this review it was possible to highlight the importance in the knowledge about the physiopathological mechanisms involved in depression disorders, being essential for the understanding and application in treatments of patients diagnosed with this disorder.

La depresión se define como un trastorno que causa cambios sociales, psicológicos, fisiológicos y biológicos. Las personas diagnosticadas como depresivas tienen un impacto en el funcionamiento psicosocial, la salud física, la mortalidad y la calidad de vida. Por esta razón, este estudio tuvo como objetivo demostrar los mecanismos fisiológicos involucrados en los trastornos de la depresión y su relación con el neurotransmisor dopamina. Esta es una revisión bibliográfica narrativa realizada entre marzo y mayo de 2023, a través de la investigación en las bases de datos Scientific Electronic Library Online (SciELO), PubMed via Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS) y Google Scholar. A través de esta revisión, se pudo destacar la importancia en el conocimiento de los mecanismos fisiopatológicos involucrados en los trastornos de la depresión, y es esencial para entenderlos y aplicarlos al tratamiento de pacientes diagnosticados con este trastorno.

Application of preoperative and intraoperative electroneurophysiological examination for persons with hemifacial spasm / 中华物理医学与康复杂志

Objective:To analyze the diagnostic value of preoperative electromyography and spasticity assessment for patients with hemifacial spasm, and to define a relationship between intraoperative electrophysiological examination and prognosis in order to provide help for clinical diagnosis and treatment.Methods:Thirty-one patients with hemifacial spasm were selected for the clinical spasticity scoring and divided into a general spasm group ( n=27) and a severe spasm group ( n=4). All received preoperative neurophysiological examination to record their twitch discharge, facial nerve conduction velocity (MCV), lateral spread (LSR) of the spasm, brainstem auditory evoked potential (BAEP), and blink reflex. Electrophysiological monitoring then recorded intraoperative LSR. According to whether the LSR disappeared or not, the patients were divided into the LSR disappearance group (of 15) and the LSR residual group (of 16), and facial muscle activity was recorded again one, three and six months after the operation. Results:Preoperative EMG examination of both groups showed positive LSR and that facial nerve MCV was within the normal range. There were, though, significant differences between the two groups in the twitching discharge by needle electromyography, blink reflex and preoperative BAEP. One week after the operation, one member of the residual group and 3 from the disappearance patients of the former and latter group had recovered in terms of LSR, with 3 and 7 cases significantly relieved, respectively. Two months later, the corresponding figures were 5 and 7, 3 and 6, respectively. Half of a year after the surgery, 5 from the residual group and 12 from the disappearance group had fully recovered in terms of LSR, while 9 and 2 cases were significantly relieved. Altogether, there were significant differences within the two groups in terms of recovery among all the time points, with significantly better recovery in the LSR disappearance group than the LSR residual group at 1 week after operation, while there were no significant differences between the two groups in recovery 3 and 6 months after their operation.Conclusions:Preoperative electromyography can provide objective assessments of the scope, severity, and facial nerve excitability of patients with hemifacial spasm. Real-time intraoperative electrophysiology monitoring can help surgeons to objectively assess the effect of decompression and to find and avoid nerve traction injury in surrounding areas quickly.

Strengthen the training and application of electromyography and clinical neurophysiological examination in the diagnosis, treatment and research of neuromuscular diseases / 中华神经科杂志

Electromyography and neurophysiological examination are not only a clinical examination technique, but also play a more and more important role in the interpretation and solution of clinical problems of neuromuscular diseases by emphasizing the correlation between clinical and neurophysiology. In order to accurately locate the lesion site, further provide pathophysiological information, and assess the severity and course of the disease, it is necessary to develop a personalized examination program according to the symptoms and signs of patients, and it is also necessary to conduct systematic standardized training for clinicians and electrophysiological practitioners.

Curso optativo sobre ataxia espinocerebelosa tipo 2 en la Universidad de Ciencias Médicas de Holguín

Introducción: Recientemente inició la formación de profesionales en una nueva modalidad de Programas Técnico Superior de Ciclo Corto en la especialidad Neurofisiología Clínica, en la Universidad de Ciencias Médicas de Holguín, atendiendo a la alta incidencia de enfermedades neurológicas, como la ataxia espinocerebelosa tipo 2, que constituye un serio problema de salud en Cuba. Un programa de curso optativo que aborde esta temática, contribuye al conocimiento de esta enfermedad para su investigación y posibles tratamientos. Objetivo: Diseñar un programa de curso optativo sobre diagnóstico e intervención físico-terapéutica en la fase prodrómica de la ataxia espinocerebelosa tipo 2 para estudiantes de Neurofisiología Clínica Primer Año en la Facultad de Enfermería ¨Arides Estévez Sánchez¨ de Holguín. Método: Se realizó una investigación didáctica metodológica utilizando los métodos empíricos: observación; teóricos: histórico-lógico, estudio documental, dialéctico; análisis-síntesis e inducción-deducción. Resultados: Se propuso un programa para curso optativo basado en la búsqueda de información científica y métodos empíricos, el cual fue estructurado en cuatro temas, con carácter presencial y duración de 24 horas. Se presentaron los contenidos por temas, objetivos, conocimientos esenciales a adquirir, habilidades principales a dominar y sistema de evaluación. Conclusiones: La aplicación de este programa contribuye a desarrollar habilidades en los profesionales en formación, en el conocimiento de la fase prodrómica de esta enfermedad.

Introduction: It recently began the training of professionals in a new modality of Programas Técnico Superior de Ciclo Corto (Short Cycle Superior Technical Programs) in the Clinical Neurophysiology specialty, at the Universidad de Ciencias Médicas de Holguín, attending to the high incidence of neurological diseases, such as spinocerebellar ataxia type 2, which constitutes a serious health problem in Cuba. This is an elective course program that addresses this topic and contributes to the knowledge of this disease, in order to improve research and possible treatments. Objective: To design an elective course program on diagnosis and physical-therapeutic intervention in the prodromal phase of spinocerebellar ataxia type 2 for first year Clinical Neurophysiology students at the ¨Arides Estévez Sánchez¨ School of Nursing in Holguín. Method: A methodological didactic research was carried out using the empirical methods: observation; theoretical: historical-logical, documentary study, dialectical; analysis-synthesis and induction-deduction. Results: A program was proposed for an optional course, based on the search for scientific information and empirical methods, which was structured in four themes, in face-to-face modality and with a duration of 24 hours. The contents were presented by themes, objectives, essential knowledge to acquire, main skills to master and evaluation system. Conclusions: The application of this program contributes to developing skills in training professionals, in the knowledge of the prodromal phase of this disease.

Introdução: Iniciou-se recentemente a formação de profissionais em uma nova modalidade de Programas Técnicos Superiores de Ciclo Curto na especialidade de Neurofisiologia Clínica, na Universidad de Ciencias Médicas de Holguín, atendendo à alta incidência de doenças neurológicas, como a ataxia espinocerebelar tipo 2, que constitui um grave problema de saúde em Cuba. Um programa de disciplina eletiva que aborde esse tema contribui para o conhecimento dessa doença para sua investigação e possíveis tratamentos. Objetivo: Elaborar um programa de disciplina eletiva sobre diagnóstico e intervenção fisioterapêutica na fase prodrômica da ataxia espinocerebelar tipo 2 para alunos do primeiro ano de Neurofisiologia Clínica da Escola de Enfermagem ¨Arides Estévez Sánchez¨ de Holguín. Método: Foi realizada uma pesquisa didática metodológica utilizando os métodos empíricos: observação; teórico: histórico-lógico, estudo documental, dialético; análise-síntese e indução-dedução. Resultados: Foi proposto um programa para um curso opcional baseado na busca de informações científicas e métodos empíricos, o qual foi estruturado em quatro temas, com caráter presencial e duração de 24 horas. Os conteúdos foram apresentados por temas, objetivos, conhecimentos essenciais a adquirir, principais competências a dominar e sistema de avaliação. Conclusões: A aplicação deste programa contribui para o desenvolvimento de competências nos profissionais em formação, no conhecimento da fase prodrómica desta doença.

A systematic review of observational, naturalistic, and neurophysiological outcome measures of nonpharmacological interventions for autism

Objective: Naturalistic and neurophysiological assessments are relevant as outcome measures in autism intervention trials because they provide, respectively, ecologically valid information about functioning and underlying neurocognitive mechanisms. We conducted a systematic review to highlight which specific neurophysiological techniques, experimental tasks, and naturalistic protocols have been used to assess neural and behavioral functioning in autism intervention studies. Methods: Studies were collected from four electronic databases between October 2019 and February 2020: MEDLINE (via PubMed), PsycINFO, LILACS, and Web of Science, and were included if they used structured observational, naturalistic, or neurophysiological measures to assess the efficacy of a nonpharmacological intervention for ASD. Results: Fourteen different measures were used by 64 studies, with the Autism Diagnostic Observation Schedule the most frequently used instrument. Thirty-seven different coding systems of naturalistic measures were used across 51 studies, most of which used different protocols. Twenty-four neurophysiological measures were used in 16 studies, with different experimental paradigms and neurophysiological components used across studies. Conclusions: Cross-study variability in assessing the outcomes of autism interventions may obscure comparisons and conclusions about how different behavioral interventions affect autistic social communication and underlying neurophysiological mechanisms.

Triphasic waves and brain atrophy in patients with acute encephalopathy / Ondas trifásicas y atrofia cerebral en pacientes con encefalopatía aguda

Abstract Introduction: Triphasic waves (TW) constitute an electroencephalographic pattern associated with certain kinds of encephalopathy. Brain atrophy may be a predisposing factor linked with TW. Objective: To compare the degree of brain atrophy and white matter disease between patients with acute encephalopathy with and without TW. Methods: A retrospective observational study including adult patients with encephalopathy, with and without TW, hospitalized between 2016 and 2017. The degree of brain atrophy and white matter lesion were defined using the Global Cortical Atrophy and Age Related White Matter Changes (ARWMC) scales, respectively. Scores were compared between groups. Mortality rates were registered. Results: Sixteen patients with TW were identified matched by age and sex with 30 patients without TW. The mean age was 80 years in the TW group. Women represented 87.5%. Multifactorial encephalopathy was the most frequent diagnosis followed by metabolic encephalopathy. Patients with TW had more brain atrophy (10.43 vs 6.9, p= 0.03). Mean ARWMC was 9.43±6.5 and 8.5 ±7.89 in patients with and without TW respectively (p= 0.5). Mortality rate was higher in the TW group (31.25 vs 6.66% p= 0.02). Conclusions: Patients with acute encephalopathy and TW had higher degree of cerebral atrophy. It is possible that this structural alteration predisposes to the appearance of TW. There was no significant difference in white matter lesion degree. The mortality of the TW group was high, so future studies are necessary to determine their prognostic value.

Resumen Introducción: Las ondas trifásicas (OT) constituyen un patrón electroencefalográfico asociado con diversas encefalopatías. La atrofia cerebral podría predisponer a su aparición. Objetivo: Comparar el grado de atrofia cerebral y de lesión de sustancia blanca en pacientes con encefalopatía aguda con y sin OT. Métodos: Estudio observacional retrospectivo, incluyó pacientes adultos con encefalopatía aguda con y sin OT internados entre 2016 y 2019. El grado de atrofia cerebral y de lesión de sustancia blanca se definieron según las escalas Global Cortical Atrophy y Age Related White Matter Changes (ARWMC), respectivamente. Se compararon los puntajes entre grupos. Se registró la mortalidad. Resultados: Se identificaron 16 pacientes con OT y 30 sin OT pareados según edad y sexo. La edad promedio del grupo con OT fue 80 años. El 87.5% fueron mujeres. La encefalopatía multifactorial fue el diagnóstico más frecuente seguido de la encefalopatía metabólica. El grado de atrofia fue mayor en pacientes con OT (10.43 vs 6.9, p= 0.03). El puntaje ARWMC fue 9.43 ±6.5 y 8.5 ±7.89 en pacientes con y sin OT respectivamente (p= 0.5). La mortalidad fue mayor en el grupo con OT (31.25 vs 6.66% p= 0.02). Conclusiones: Pacientes con encefalopatía aguda y OT tuvieron mayor grado de atrofia cerebral. Dicha alteración estructural podría relacionarse con la aparición de OT. No hubo diferencias significativas en el grado de lesión de sustancia blanca. La mortalidad del grupo con OT fue elevada. Son necesarios estudios para determinar su valor pronóstico.

Magnetoencephalography in clinical practice / Magnetoencefalografia na prática clínica

ABSTRACT Magnetoencephalography (MEG) is a neurophysiological technique that measures the magnetic fields associated with neuronal activity in the brain. It is closely related but distinct from its counterpart electroencephalography (EEG). The first MEG was recorded more than 50 years ago and has technologically evolved over this time. It is now well established in clinical practice particularly in the field of epilepsy surgery and functional brain mapping. However, underutilization and misunderstanding of the clinical applications of MEG is a challenge to more widespread use of this technology. A fundamental understanding of the neurophysiology and physics of MEG is discussed in this article as well as practical issues related to implementation, analysis, and clinical applications. The future of MEG and some potential clinical applications are briefly reviewed.

RESUMO A magnetoencefalografia (MEG) é uma técnica neurofisiológica que mede os campos magnéticos associados à atividade neuronal no cérebro. A técnica é distinta da eletroencefalografia (EEG), porém está intimamente relacionada a ela. A primeira foi registrada há mais de 50 anos e evoluiu tecnologicamente ao longo do tempo. Está agora bem estabelecida na prática clínica, particularmente nos campos da cirurgia de epilepsia e mapeamento cerebral funcional. No entanto, a subutilização e a incompreensão das aplicações clínicas da MEG são um desafio para o uso mais amplo dessa tecnologia. Suas bases neurofisiológica e física são discutidas neste artigo, bem como questões práticas relacionadas à sua implementação, análise e aplicações clínicas. O futuro da MEG e algumas aplicações clínicas potenciais são brevemente revistos.

Seventy years since the invention of the averaging technique in Neurophysiology: Tribute to George Duncan Dawson / 70 anos da invenção da técnica de promediação na Neurofisiologia: Tributo a George Duncan Dawson

ABSTRACT In 1951, the physiologist George Duncan Dawson presented his work with the averaging of the signal in the evoked potentials (EPs), opening a new stage in the development of clinical neurophysiology. The authors present aspects of Professor Dawson's biography and a review of his work on the EPs and, mainly, the article reveals the new technique in detail that would allow the growth of the clinical application of the visual, auditory, and somatosensory EPs.

RESUMO Em 1951 o fisiologista George Duncan Dawson apresentou seu trabalho com a promediação de sinal nos potenciais evocados, abrindo uma nova etapa no desenvolvimento da neurofisiologia clínica. Os autores apresentam aspectos da biografia do professor Dawson e uma revisão de seus trabalhos sobre os potenciais evocados, principalmente do artigo que mostrava a nova técnica, que viria a permitir o crescimento da aplicação clínica dos potenciais evocados visual, auditivo e somatossensitivo.

Neuroauriculotherapy: Framework and Remarks for a possible use in Voice Medicine / Neuroauriculoterapia: marco y observaciones para un posible uso en medicina de la voz

Aim. Neuroauriculotherapy (NAT) is a branch of medicine, which, thanks to its diagnostic and therapeutic value, is a powerful tool at the service of both physician and patient. In our experience, as it is discussed in this article, neuroauriculotherapy can have successful applications in voice science and in phoniatrics. The aim of this article is to open a discussion about possible applications of neuroauriculotherapy in voice medicine. Introduction. From the diagnostic point of view, it is possible to explore, with a palpeur (i.e., a tool that provides a constant pressure) or a "spot-hunter", the presence of a perturbation into a particular organ or area, and its return to normal during treatment. Indeed, at the level of the ear auricle, representations of an organ, its in-nervation, its muscular components, etc., are fixed. These spots or voxels correspond absolutely to the respective sensory, motor, visceral, among other spots. Therefore, if any abnormal potential comes from the periphery, it will illuminate the spots both at the cortical level and in the pavilion ­a real display with a constantly active touch screen. The spot can be treated with needles in the context of a neurophysiological strategy to send a message to the brain.Reflection. NAT appears to be a good method to improve the treatment of voice problems, enhancing the results of other therapies based on drugs or rehab and in-ducing relaxation. In neuroauriculotherapy, the ear is used to give the brain orders in a process which has a logical basis in neurophysiology.Conclusion. Diseases of the vocal tract can be dysfunctional or organic. According to our clinical experience, we can say that neuroauriculotherapy can be used in both cases. Neuroauriculotherapy is also extremely effective in voice therapy, both alone and in combination with other therapies, as there is no conflict among them

Objetivo. La neuroauriculoterapia (NAT) es una rama de la medicina que, gracias a su valor diagnóstico y terapéutico, constituye una poderosa herramienta al servicio del médico y del paciente. En nuestra experiencia, como se comenta en este artículo, la neuroauriculoterapia puede tener aplicaciones exitosas en la ciencia de la voz y en foniatría. El objetivo de este artículo es abrir una discusión sobre las posibles aplica-ciones de la neuroauriculoterapia en la medicina de la voz.Introducción. Desde el punto de vista del diagnóstico, es posible explorar, con un palpeur (i.e., una herramienta que proporciona una presión constante) o un "spot-hunter", la presencia de una perturbación en un órgano o área en particular, y su retorno a la normalidad durante el tratamiento. En efecto, a nivel del pabellón auricular se fijan representaciones de un órgano, su inervación, sus componentes musculares, etc. Estos puntos o vóxeles corresponden absolutamente a los respectivos puntos sensoriales, motores, viscerales, entre otros. Por lo tanto, si algún potencial anormal proviene de la periferia, iluminará los puntos tanto a nivel cortical como en el pabellón ­una pantalla real con una pantalla táctil constantemente activa. El punto se puede tratar con agujas en el contexto de una estrategia neurofisiológica para enviar un mensaje al cerebro.Reflexión. NAT parece ser un buen método para mejorar el tratamiento de los problemas de voz, potenciando los resultados de otras terapias basadas en fármacos o rehabilitación e induciendo a la relajación. En neuroauriculoterapia se utiliza el oído para dar órdenes al cerebro en un proceso que tiene una base lógica en la neurofisiología.Conclusión. Las enfermedades del tracto vocal pueden ser disfuncionales u orgáni-cas. Según nuestra experiencia clínica, podemos decir que la neuroauriculoterapia se puede utilizar en ambos casos. La neuroauriculoterapia también es extremadamente eficaz en la terapia de la voz, tanto sola como en combinación con otras terapias, ya que no existe conflicto entre ellas

Fasciculaciones y calambres: bases fisiológicas y enfrentamiento clínico de un fenómeno complejo

Fasciculations and cramps originate in the motor unit, a functional unit that includes the lower motor neuron and their innervated muscle fibres. Both are common complaints in outpatient practice. These symptoms can be secondary to neurological or medical pathology, presenting a broad differential diagnosis and a complex approach. Recent neurophysiological studies have increased the knowledge of their origin mainly in amyotrophic lateral sclerosis. The symptomatic management of fasciculations and cramps depends on their etiology and includes pharmacological and non-pharmacological treatments. This article aims to present an updated review of the most relevant aspects of physiopathology, clinical approach, and differential diagnosis of both phenomena.

Evaluación del desarrollo de la asignatura virtual Fisiología II en la especialidad Neurofisiología Clínica / Assessment of developing Physiology II as a virtual subject in the specialty of Clinical Neurophysiology

Introducción: La enseñanza mediante la modalidad virtual se adoptó como medida preventiva ante la propagación de la COVID-19. Para la educación médica cubana ha implicado un reto en cuanto a la reorganización de los programas de estudio. Con este propósito, se rediseño e implementó la asignatura Fisiología II en modalidad virtual, para garantizar la continuidad en la formación de residentes en Neurofisiología Clínica. Objetivo: Evaluar el desarrollo de la asignatura Fisiología II en su modalidad virtual desde la perspectiva de los estudiantes de la especialidad Neurofisiología Clínica. Métodos: Estudio exploratorio, no experimental y transversal. Mediante un cuestionario de preguntas cerradas y una abierta (aspectos positivos y negativos), se evaluó el desarrollo de la asignatura en modalidad virtual en relación con las variables: programa de la asignatura, desempeño de los profesores, escenario de las plataformas y soporte tecnológico. Resultados: La asignatura Fisiología II en modalidad virtual tuvo una alta aceptación por parte de los estudiantes. Los aspectos identificados como positivos fueron los relacionados con la gestión personal del tiempo, y la aplicabilidad y estructura de la asignatura; mientras que los negativos se orientaron hacia problemas de conectividad de internet y el entorno de estudio. Conclusiones: Las exitosas experiencias obtenidas en el desarrollo de la asignatura virtual Fisiología II sientan las bases para el empleo de este tipo de diseño en la especialidad de Neurofisiología Clínica y la posibilidad de extenderlo a otras asignaturas del plan de estudio(AU)

Introduction: Teaching through virtual modality was adopted as a preventive measure against the COVID-19 spread. For Cuban medical education, it has implied a challenge regarding the reorganization of study programs. For this purpose, the subject Physiology II was redesigned and implemented in virtual modality, in order to guarantee continuity in the training of Clinical Neurophysiology residents. Objective: To assess the development of the subject Physiology II in its virtual modality from the perspective of the students of the Clinical Neurophysiology specialty. Methods: Exploratory, nonexperimental and cross-sectional study. Through a questionnaire made up of closed questions and one open question (positive and negative aspects), the development of the subject in virtual modality was assessed in relation to the variables subject syllabus, professors' performance, platform scenario, and technological support. Results: The subject Physiology II in virtual modality had a high acceptance by the students. The aspects identified as positive were those related to individual time management, as well as the subject's applicability and structure; while the negative ones were oriented towards internet connectivity problems and the study environment. Conclusions: The successful experiences obtained in the development of Physiology II as a virtual subject lay the foundations for using this type of design in the specialty of Clinical Neurophysiology and the possibility of extending it to other subjects of the study plan(AU)

Epidemiological and clinical aspects of Guillain-Barré syndrome and its variants / Aspectos epidemiológicos e clínicos da síndrome de Guillain-Barré e suas variantes

Abstract Background: Guillain-Barré syndrome (GBS), an acute polyradiculoneuropathy that occurs because of an abnormal inflammatory response in the peripheral nervous system, is clinically characterized by acute flaccid paresis and areflexia with or without sensory symptoms. This syndrome can lead to disabling or even life-threatening sequelae. Objective: This study aimed to present the clinical and epidemiological aspects of GBS in patients admitted to a tertiary-level hospital in the Federal District between January 2013 and June 2019. Methods: In this observational, cross-sectional and retrospective study, medical records of patients diagnosed with acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy or acute axonal motor-sensitive neuropathy based on electromyographic findings were included, and clinical data were collected retrospectively. Results: A total of 100 patients (63 males and 37 females; ratio, 1.7:1) aged 2-86 years (mean, 36.4 years) were included. The mean annual incidence rate of GBS was 0.54 cases/100,000 inhabitants, with 52 and 49% of the cases occurring between October and March (rainy season) and between April and September (dry season), respectively. The proportions of patients showing each GBS variant were as follows: demyelinating forms, 57%; axonal forms, 39%; and undetermined, 4%. The mean duration of hospitalization was 8-15 days for most patients (38%). During hospitalization, 14% of the patients required mechanical ventilation and 20% experienced infectious complications. Conclusion: The findings indicate that there was an increase in the incidence of GBS during the rainy season. Moreover, we did not observe the typical bimodal distribution regarding age at onset.

RESUMO Introdução: Síndrome de Guillain-Barré (SGB), uma polirradiculoneuropatia aguda que ocorre devido a uma resposta inflamatória anormal no sistema nervoso periférico, é caracterizada clinicamente por paralisia flácida aguda e arreflexia, com ou sem sintomas sensitivos. Essa síndrome pode deixar sequelas incapacitantes ou até ameaçar a vida. Objetivo: Apresentar os aspectos clínicos e epidemiológicos da SGB em pacientes internados em um hospital terciário do Distrito Federal, no período de janeiro/2013 a junho/2019. Métodos: Estudo observacional, transversal e retrospectivo, no qual pacientes com diagnóstico de polirradiculoneuropatia desmielinizante inflamatória aguda, neuropatia axonal motora aguda ou neuropatia axonal sensitivo motora aguda a partir dos achados eletroneuromiográficos foram selecionados e seus dados clínicos coletados retrospectivamente em seus prontuários. Resultados: Um total de 100 pacientes (63 homens e 37 mulheres; proporção de 1,7:1), com idades entre 2-86 anos (média, 36,4 anos), foram incluídos. A taxa média anual de incidência de SGB foi de 0,54 casos/100.000 habitantes, com 52 e 49% dos casos ocorrendo entre outubro e março (período chuvoso) e entre abril e setembro (período seco), respectivamente. A proporção de pacientes que apresentaram cada variante de SGB foi a seguinte: formas desmielinizantes, 57%; formas axonais, 39%; e indeterminado, 4%. A duração média da hospitalização foi de 8‒15 dias para a maioria dos pacientes (38%). Durante a hospitalização, 14% dos pacientes necessitaram de ventilação mecânica e 20% apresentaram complicações infecciosas. Conclusão: Os resultados indicam aumento na incidência de GBS durante a estação chuvosa. Além disso, não observamos a distribuição bimodal típica em relação à idade de início.

La neuroanatomía y neurofisiología en la comprensión de los trastornos del espectro autista / Neuroanatomy and neurophysiology in the study of autism spectrum disorders

Introducción: Los trastornos de espectro autista se caracterizan por presentar un déficit en la interacción y comunicación social con presencia de patrones repetitivos y restrictivos de comportamiento, intereses y actividades. En ellos estarían implicadas causas genéticas, ambientales y del desarrollo del sistema nervioso central. Un mayor conocimiento de la neuroanatomía y la neurofisiología ayudaría a comprender mejor este trastorno del neurodesarrollo. Objetivo: Profundizar en el conocimiento neuroanatómico y neurofisiológico de los trastornos del espectro autista. Métodos: Se realizó una búsqueda bibliográfica acerca del tema en las bases de datos LILACS, Scopus, SciELO, Pubmed, Medigraphic. Se escogieron 13 documentos, todos correspondientes a artículos originales que abordan el tema desde diferentes aristas. De los documentos, dos fueron localizados en Scopus, uno en Pubmed, cuatro en Medigrafhic, dos en LILACS y cuatro en SciELO. Resultados: Los trastornos de espectro autista se producen por una alteración estructural y funcional de la corteza cerebral. Los estudios de neuroimágenes han demostrado las alteraciones estructurales, fundamentalmente en la corteza prefrontal y sus conexiones, principal región encefálica implicada en la regulación de la conducta social. Las técnicas de secuenciación genómica de nueva generación muestran el origen genético en casos donde los estudios previamente señalados han resultado ser normales. Conclusiones: La profundización del conocimiento neuroanatómico y neurofisiológico de los trastornos de espectro autista permiten comprenderlos mejor(AU)

Introduction: Autism spectrum disorders are characterized by social deficits and communication difficulties, as well as restrictive, repetitive behavior patterns, interests and activities. Their causes may be genetic, environmental or related to the development of the central nervous system. Broader knowledge about neuroanatomy and neurophysiology could lead to a better understanding of this neurodevelopmental disorder. Objective: Gain insight into the neuroanatomy and neurophysiology of autism spectrum disorders. Methods: A bibliographic search about the topic was conducted in the databases LILACS, Scopus, SciELO, Pubmed and Medigraphic. A total 13 documents were selected, all of which were original papers approaching the topic from different perspectives. Two of the documents were obtained from Scopus, one from Pubmed, four from Medigraphic, two from LILACS and four from SciELO. Results: Autism spectrum disorders are caused by a structural and functional alteration of the cerebral cortex. Neuroimaging studies have shown the structural alterations, which mainly occur in the prefrontal cortex and its connections, the principal encephalic region involved in social behavior regulation. New generation genomic sequencing techniques reveal a genetic origin in cases where previous studies have been normal. Conclusions: Broader knowledge about the neuroanatomy and neurophysiology of autism spectrum disorders lead to their better understanding(AU)

Neurophysiological aspects of isotonic exercises in temporomandibular joint dysfunction syndrome / Efeito de exercícios isotônicos para redução da dor da musculatura orofacial em indivíduos com disfunção temporomandibular: aspectos neurofisiológicos

ABSTRACT Purpose The aim of the study was to investigate the electroneurophysiological aspects of volunteers with temporomandibular disorders before and after performing isotonic exercises for pain relief and self-care guidelines. Methods The study was a parallel controlled randomized controlled trial under protocol 1,680,920. The inclusion criteria were age between 18 and 60 years, muscle temporomandibular dysfunction with or without limitation of mouth opening and self-reported pain with scores between 4 and 10. The individuals were randomized into experimental group and control. Twenty-three volunteers participated in the study, most of then were female. Control group had 11 and experimental group 12 individuals. Dropouts occurred in both groups, two in the experimental group and three in the control group. Since there were an intergroup imbalance the power density was analysed just in experimental group. Electroencephalographic recording was performed before and after the interventions, using the 32-channel apparatus, with sample frequency of 600 Hz and impedance of 5 kΩ. The data were processed through the MATLAB computer program. The individual records filtered off-line, using bandpass between 0.5 and 50 Hz. Epochs of 1,710 ms were created and the calculation of the absolute power density calculated by means of the fast Fourier transform. The statistical approach was inferential and quantitative. Results The alpha power density analyzed presented a difference, but not significant, when compared in the two moments. Conclusion According to this study, isotonic exercises performed to reduce pain provided a small increase in alpha power density in the left temporal, parietal and occipital regions.

RESUMO Objetivo O objetivo do estudo foi investigar os aspectos eletroneurofisiológicos de voluntários com disfunção temporomandibular antes e após realização de exercícios para redução de dor e orientações de autocuidado. Método Foi realizado ensaio clínico randomizado controlado paralelo, aprovado por um Comitê de Ética. Os critérios de inclusão foram idade de 18 a 60 anos, disfunção temporomandibular muscular, com ou sem limitação de abertura de boca, e dor autorreferida com escores entre 4 e 10. Os indivíduos foram distribuídos, por sorteio, em grupo experimental ou controle. Participaram do estudo 23 voluntários,11 controles e 12 do grupo experimental sendo a maioria do sexo feminino. Desistências ocorreram, sendo duas no grupo experimental e três no controle. Houve desbalanceamento entre grupos e apenas o experimental foi analisado. Foi realizado registro eletroencefalográfico antes e depois das intervenções, por meio de aparelho com 32 canais, frequência amostral de 600 Hz e impedância de 5 kΩ. Os dados foram processados por meio do programa computacional MATLAB. Os registros individuais filtrados off-line, utilizando passa banda entre 0,5 e 50 Hz. Épocas de 1,710 ms foram criadas e o cálculo da densidade de potência absoluta calculada por meio da transformada rápida de Fourier. A abordagem estatística foi inferencial e quantitativa. Resultados A densidade de potência alfa analisada apresentou diferença, porém não significativa, quando comparada nos dois momentos. Conclusão Pode-se concluir que, com base nesse estudo, os exercícios isotônicos realizados para redução de dor proporcionaram pequeno aumento na densidade de potência alfa nas regiões temporal, parietal e occipital esquerdas.

Presbifagia Una mirada a los procesos de alimentación y deglución en los adultos mayores / Presbyphagia A look at feeding and swallowing processes in older adults

Introducción: El proceso de envejecimiento, al igual que en todo el organismo, genera una serie de cambios en las estructuras estomatognáticas, y estos cambios morfológicos, característicos en el mecanismo de la deglución en sujetos sanos de edad avanzada caracterizan a la Presbifagia. Objetivo: Realizar un análisis crítico-reflexivo en torno a la conceptualización desde las diversas ópticas de los autores que exponen el fenómeno, con el fin de abrir la discusión dirigida a establecer un lenguaje unificado en pro de dirigir las acciones fonoaudiológicas hacia las áreas de promoción de la salud de la función deglutoria y prevención de la disfagia esta población. Metodología: Se seleccionaron, por conveniencia, artículos y capítulos de libros de especialidad publicados en la última década, que abordan las alteraciones deglutorias en adultos mayores, para comparar similitudes y diferencias en la forma de abordar el fenómeno. Resultados: Se evidencia que, pese al exponencial progreso de la disciplina, no existe consenso conceptual entre los especialistas al momento de hacer referencia a los cambios anatomofuncionales de la biomecánica deglutoria y la transición de la presbifagia a la disfagia en los adultos mayores. Discusión: Una interesante discusión se genera en torno a la presbifagia y los parámetros de seguridad, efectividad, competencia y confortabilidad, dado que los cambios neurológicos-estructurales son frecuentes en la tercera edad, los cuales acarrean diversas consecuencias, desde grados leves a severos, que impactan de forma diferenciada en los indicadores que habitualmente se describen en la clínica. Sin embargo, la conceptualización utilizada no es clara al realizar una distinción entre un estado transicional o de afección. Conclusión: Los cambios en el envejecimiento deben seguir siendo estudiados desde las diferentes concepciones para comprender mejor los fenómenos neurofisiológicos y anatómicos que se originan entorno a la Presbifagia.

Introduction: The aging process, as in the whole organism, generates a series of changes in the stomatognathic structures, and these morphological changes, characteristic of the swallowing mechanism in healthy elderly subjects, characterize Presbyphagia. Objective: To carry out a critical-reflective analysis around the conceptualization from the different perspectives of the authors who expose the phenomenon, in order to open the discussion aimed at establishing a unified language in favor of directing speech therapy actions towards the areas of promotion of the health of the swallowing function and prevention of dysphagia in this population. Methodology: Articles and chapters of specialty books published in the last decade, which address swallowing disorders in older adults, were selected for convenience in order to compare similarities and differences in the way of approaching the phenomenon. Results: It is evident that, despite the exponential progress of the discipline, there is no conceptual consensus among specialists when referring to anatomical and functional changes in swallowing biomechanics and the transition from presbyophagia to dysphagia in older adults. Discussion: An interesting discussion is generated around presbyphagia and the parameters of safety, effectiveness, competence and comfort, given that neurological-structural changes are frequent in the elderly, which carry various consequences, from mild to severe degrees. that have a differentiated impact on the indicators that are usually described in the clinic. However, the conceptualization used is not clear when making a distinction between a transitional state or a state of affection. Conclusion: Changes in aging must continue to be studied from different conceptions to better understand the neurophysiological and anatomical phenomena that originate around Presbyphagia.