Eletrodiagnóstico e perfil energético com o Ryodoraku em medicina tradicional chinesa: revisão integrativa / Eletrodiagnostic and energy profile with Ryodoraku in chinese traditional medicine: integrative review / Eletrodiagnóstico y perfil energético con el Ryodoraku en medicina tradicional china: revisión integrativa

Objective: To synthesize the evidence in the literature on the applicability of the Ryodoraku system in the energy diagnosis based on the precepts of Traditional Chinese Medicine. Method: integrative review, carried out by independent reviewers in databases. Results: we found 324 studies. After exclusion, eight were analyzed, with a predominance of descriptive studies. There was agreement about the 24 points selected for the application of Ryodoraku; however, there is disagreement as to their location. Conclusions: Ryodoraku still does not present consistent evidence on its use, limiting the evaluation of its applicability

Objetivo: Sintetizar as evidências disponíveis na literatura sobre a aplicabilidade do sistema Ryodoraku no diagnóstico energético baseado nos preceitos da Medicina Tradicional Chinesa. Método: revisão integrativa, realizada por revisores independentes em bases de dados. Resultados: encontrou-se 324 estudos. Após exclusões, oito foram analisados, com predomínio de estudos descritivos. Houve concordância acerca dos 24 pontos selecionados para a aplicação do Ryodoraku; entretanto, há divergência quanto à localização dos mesmos. Conclusões: o Ryodoraku ainda não apresenta evidências consistentes sobre sua utilização, limitando a avaliação de sua aplicabilidade.

Objetivo: Sintetizar las evidencias de la literatura sobre la aplicabilidad del sistema Ryodoraku en el diagnóstico energético basado en los preceptos de la Medicina Tradicional China. Método: revisión integrativa, realizada por revisores independientes en bases de datos. Resultados: se han encontrado 324 estudios. Después de exclusiones, ocho fueron analizados, con predominio de estudios descriptivos. Hubo concordancia sobre los 24 puntos seleccionados para la aplicación del Ryodoraku; sin embargo, hay divergencia en cuanto a la localización de los mismos. Conclusión: el Ryodoraku todavía no presenta evidencias consistentes sobre su utilización, limitando la evaluación de su aplicabilidad

Aplicação da técnica de eletrodiagnóstico em pacientes críticos: uma revisão sistemática / Application of electrodiagnostic technique in critically ill patients: a systematic review

O ambiente de terapia intensiva está evoluindo em tecnologias para avaliação e tratamento sendo uma das técnicas mais atuais aplicadas neste ambiente o eletrodiagnóstico. Esta é uma revisão sistemática desenvolvida com base nos resultados de pesquisa das principais bases de dados, seguindo o PRISMA. Neste foram incluídos somente artigos observacionais que utilizaram a técnica de eletrodiagnóstico em pacientes críticos, para os mais diferentes objetivos e desfechos. As bases de dados consultadas foram: MEDLINE (acessado via PubMed), Fisioterapia Evidence banco de dados (Pedro), Registro de Ensaios Controlados (CENTRAL Cochrane) e EMBASE além de uma busca manual de referências adicionais. Um total de 10 artigos foram encontrados, sendo que dois apresentaram-se repetidos e outros seis foram excluídos por não contemplarem os critérios de inclusão obtendo-se ao final um total de dois artigos totalizando 33 pacientes. Um dos artigos apresentou resultados seguros, sem lesão muscular e o protocolo foi viável para ser aplicado em terapia intensiva. O outro artigo que após lesão cerebral traumática os pacientes podem apresentar distúrbios eletrofisiológicos, além de atrofia muscular generalizada sendo evidenciados pela técnica de eletrodiagnóstico. (AU)

The intensive care environment is evolving in technologies for evaluation and treatment, and these include a recent technique named electrodiagnosis. This systematic review was based on search results from major databases, following PRISMA guidelines. Only observational studies using the electrodiagnostic technique in critically patients for different objectives and outcomes were included. The following databases were searched: MEDLINE (accessed via PubMed), Physiotherapy Evidence database (Pedro), Controlled Trials Registry (CENTRAL Cochrane) and EMBASE, in addition to a manual search for additional references. Ten articles were found, two of which were repeated and six were excluded because they did not meet the inclusion criteria; thus, two articles were selected, with a total of 33 patients. One of the articles showed safe results, without any muscle injury, and the protocol was applicable in intensive care. The other article demonstrated that, after traumatic brain injury, patients may present with electrophysiological disorders and generalized muscle atrophy, which can be revealed by the electrodiagnostic technique. (AU)

Acometimento de nervos cranianos na granulomatose com poliangeíte (GPA) C-ANCA negativo / Cranial nerve impairment in granulomatosis with polyangeitis (GPA) C-ANCA negative

RESUMO O presente relato tem o objetivo de mostrar um caso incomum de Granulomatose com Poliangeíte (GPA), que previamente era denominada Granulomatose de Wegener. Trata-se de é uma doença multissistêmica, caracterizada por inflamação granulomatosa necrotizante e vasculite que envolve principalmente o trato respiratório superior e inferior, embora não raramente, exista comprometimento neurológico.

ABSTRACT This report aims to show an unusual case of granulomatosis with polyangeitis (GPA), previously known as Wegener's granulomatosis. It is a multisystemic disease characterized by necrotizing granulomatous inflammation and vasculitis involving mainly the upper and lower respiratory tract, although not infrequently, there is neurological impairment.

Obtención, interpretación y usos del electrorretinograma multifocal / Obtaining, interpreting and using the multifocal electroretinogram

Las pruebas electrofisiológicas oculares constituyen un variado grupo de herramientas diagnósticas de extremada relevancia, sobre todo por su objetividad. El electrorretinograma multifocal se encuentra entre los más novedosos y promisorios de este selecto grupo y, a la vez, entre las de mayor complejidad de obtención. Se realiza una revisión bibliográfica de los aspectos relacionados con la obtención, representación y aplicaciones clínicas del electrorretinograma multifocal(AU)

The ocular electrophysiological tests are a varied group of extremely relevant diagnostic tools that stand out because of their objectivity. The multifocal electroretinogram is among the most novel and promising in this selected group, but at the same time, it is one of the most complex to be obtained. A literature review of the aspects related to obtaining, representation and clinical applications of the multifocal electroretinogram was made and presented in this paper(AU)

Neurological disorders associated with glutamic acid decarboxylase antibodies: a Brazilian series / Distúrbios neurológicos associadas a anticorpos anti-GAD (descarboxilase do ácido glutâmico): uma série de casos brasileira

Neurological disorders associated with glutamic acid decarboxylase (GAD) antibodies are rare pleomorphic diseases of uncertain cause, of which stiff-person syndrome (SPS) is the best-known. Here, we described nine consecutive cases of neurological disorders associated with anti-GAD, including nine patients with SPS and three cases with cerebellar ataxia. Additionally, four had hypothyroidism, three epilepsy, two diabetes mellitus and two axial myoclonus.

Distúrbios neurológicos associados com anticorpos anti-GAD são doenças pleomórficas, raras, de causa incerta, das quais a rigidez muscular espasmódica (SPR) é a mais conhecida. Neste estudo, descrevemos nove casos consecutivos de distúrbios neurológicos associados com a presença de anticorpos anti-GAD, incluindo nove pacientes com SPR e três casos com ataxia cerebelar. Adicionalmente, foram encontrados quatro casos com hipotireoidismo, três com epilepsia, dois com diabetes mellitus e dois casos com mioclonia axial.

Combined nerve conduction index in diabetic polyneuropathy / Índice combinado de condução nervosa na polineuropatia diabética

Diabetic polyneuropathy can be confirmed by nerve conduction studies. The data can be analyzed in the form of a combined index instead of individual parameters. METHODS: The combined index included five parameters of nerve conduction studies commonly used for evaluation of polyneuropathies. We evaluated sensitivity in 100 diabetic patients with suspected polyneuropathy, and specificity in 200 non-diabetic patients with suspected lumbosacral radiculopathy. All results were expressed in number of standard deviations (SD). RESULTS: The sensitivity of the combined index was 81 or 74%, and specificity was 97 or 98%, using respectively -2.0 or -2.5 SD as cutoff. The range of sensitivity of the other parameters was 57-65% or 48-56%, and specificity range was 96-98% or 98-100%, using the same criteria. DISCUSSION: The combined index had higher sensitivity and equivalent specificity compared to isolated parameters.

A polineuropatia diabética pode ser confirmada por estudos de condução nervosa. Os dados podem ser analisados por um índice combinado ao invés de parâmetros isolados. MÉTODOS: O índice combinado incluiu cinco parâmetros usados rotineiramente na avaliação de polineuropatias. Avaliamos a sensibilidade em 100 pacientes diabéticos com suspeita de polineuropatia e a especificidade em 200 pacientes não diabéticos com suspeita de radiculopatia lombossacral. Todos os resultados foram expressos em número de desvios-padrão (DP). RESULTADOS: A sensibilidade do índice combinado foi 81 ou 74%, e a especificidade foi 97 ou 98%, usando respectivamente -2,0 ou -2,5 DP como ponto de corte. A sensibilidade dos parâmetros isolados oscilou entre 57-65% ou 48-56%, e a especificidade foi 96-98% ou 98-100%, usando os mesmos critérios. DISCUSSÃO: O índice combinado apresentou melhor sensibilidade e especificidade equivalente aos parâmetros isolados.

Comparisons among different reference values of nerve conduction velocity in forensic appraisal / 法医学杂志

OBJECTIVE@#To provide the evidences for the choice of normal reference value of nerve conduction velocity (NCV) in clinical forensic appraisal.@*METHODS@#One hundred and fourteen cases with normal peripheral nerve and 155 cases with injured peripheral nerve were collected. The NCV of homonymous nerves in two limbs were detected. In the normal cases, the NCV of the left limbs were used as the normal reference values. The NCV of the right limbs were compared with that of left limbs, the commendatory normal reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital. In the injured cases, the results of NCV in injuried limbs were compared with the results of healthy limbs and the reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital.@*RESULTS@#In the normal group, there was no statistical difference between the left and right limbs in NCV results of homonymous nerve (P > 0.05). The false positive rates (FPR) were 0, 11.4% and 5.2% for three choices normal reference respectively. The false negative rates (FNR) were 0, 9.7% and 12.3% for three choices normal reference in injuried group. Thee false negative cases were all slight nerve injury.@*CONCLUSION@#The reference value of self-control method could decrease the FPR of normal cases and FNR of injured cases. In clinical forensic appraisal of peripheral nerve, the nerve condition study results from healthy homonymous nerve should be regarded as the reference value at first, supplemented by reference values from clinical labs.

Avaliação da sensibilidade cutânea em pacientes com síndrome do túnel do carpo relacionada à hemodiálise / Cutaneous sensibility assesment in hemodialysis- related carpal tunnel syndrome

OBJETIVO: Descrever a utilização do PSSD (Pressure specified sensory device) para a realização do diagnóstico de Síndrome do Túnel do Carpo. MÉTODOS: O PSSD consiste de aparelho que incorpora um transdutor de pressão com duas extremidades rombas e com regulagem de distância entre elas, acoplado a um computador capaz de determinar os limiares cutâneos de pressão. Para tanto, os pacientes foram divididos em três grupos: Grupo 1- grupo controle, pacientes sem neuropatia no membro superior ou insuficiência renal. Grupo 2- pacientes com síndrome do túnel do carpo relacionada à hemodiálise. Grupo 3 - pacientes com síndrome do túnel do carpo sem insuficiência renal. RESULTADOS: Os resultados demonstraram haver um maior benefício do uso do PSSD para o diagnóstico da síndrome para os pacientes do grupo dois em dois dos quatro parâmetros avaliados quando comparados com os pacientes do grupo 3. CONCLUSÃO: O PSSD é útil para o diagnóstico da síndrome do túnel do carpo em pacientes hemodialíticos. Nível de Evidência II. Estudos diagnósticos.

OBJECTIVE: The aim of this study is to describe the use of the PSSD (Pressure specified sensory Device) for the diagnosis of carpal tunnel syndrome.METHODS: The PSSD is a tool that incorporates a pressure transducer with two prongs, linked to a computer capable of measuring the cutaneous pressure thresholds. The patients were divided in two groups: Group 1- patients neither with superior limb neuropathy nor renal insufficiency. Group 2- patients with carpal tunnel syndrome related to hemodialysis. Group 2 - patients with carpal tunnel syndrome but no renal insufficiency.RESULTS: The results showed, for two of the four parameters measured, that the group 2 had more benefits for the diagnosis of carpal tunnel syndrome than group 3.CONCLUSION: The PSSD is useful as a diagnostic tool in hemodialysis-related carpal tunnel syndrome Level of Evidence: Level II, development of diagnostic.

Mielopatia cervical por instabilidade atlanto-axial em portadora de trissomia do 21: diagnóstico neurofisiológico / Cervical myelopathy by atlantoaxial instability in a patiente with trisomy 21

Os autores apresentam o caso de uma mulher portadora da síndrome de Down com um quadro de paraparesia assimétrica de maior gravidade no lado esquerdo há sete meses, sem sintomas sensitivos ou autonômicos. Foi encaminhada para realização de investigação neurofisiológica especificamente a eletroneuromiografia. Os autores descrevem a estratégia da investigação neurofisiológica para evidenciar a mielopatia e demonstram a presença de subluxação atlanto-axial por Raio X e Tomografia computadorizada.

The authors present a clinical case of a woman with Down syndrome and an asymmetric paraparesis, more severe on the left side, for seven months, without sensory or autonomic symptoms. She was sent for neurophysiological evaluation, specifically electromyography. The authors describe a neurophysiological strategy in order to evidence the involvement of cervical medulla and conluded to be a cases of atlanto-axial subluxation by X-ray and Computed Tomography.

Comparação entre o método clássico de Gibson e Cooke e o teste da condutividade no suor em pacientes com e sem fibrose cística / Comparison between classic Gibson and Cooke technique and sweat conductivity test in patients with and without cystic fibrosis

OBJETIVO: Comparar os valores de cloro no suor obtidos pelo teste quantitativo da iontoforese pela pilocarpina (teste clássico) com os valores de condutividade no suor obtidos pelo sistema de coleta por Macroduct® em pacientes com e sem fibrose cística (FC). O custo e tempo despendidos na execução de cada teste foram também analisados. MÉTODOS: O teste do suor pelas duas técnicas foi realizado simultaneamente, em pacientes com e sem FC. Os pontos de corte para a condutividade para excluir ou diagnosticar FC foram < 75 e > 90 mmol/L, respectivamente, e, para o teste clássico, cloro < 60 e > 60 mmol/L. RESULTADOS: Cinquenta e dois pacientes com FC (29 do sexo masculino e 23 do sexo feminino; de 1,5 a 18,2 anos) realizaram o teste do suor pelas duas técnicas, apresentando valores medianos de cloro e condutividade no suor de 114 e 122 mmol/L, respectivamente. Em todos eles, a condutividade foi > 95 mmol/L, o que conferiu ao teste 100 por cento de sensibilidade (IC95 por cento 93,1-100). Cinquenta pacientes sem FC (24 do sexo masculino e 26 do sexo feminino; de 0,5 a 12,5 anos) apresentaram valores medianos de cloro e condutividade no suor de 15,5 e 30 mmol/L, respectivamente. Em todos os casos, a condutividade foi < 70 mmol/L, o que conferiu ao teste 100 por cento de especificidade (IC95 por cento 92,9-100). O tempo despendido na execução dos testes foi significativamente menor com o teste da condutividade, e o seu custo também foi inferior. CONCLUSÕES: O teste da condutividade apresentou alta sensibilidade e especificidade, e houve boa correspondência entre os testes. O tempo de execução foi mais rápido e o custo inferior na aplicação do teste da condutividade em relação ao teste clássico.

OBJECTIVE: To compare sweat chloride values obtained by quantitative pilocarpine iontophoresis (classic test) with the sweat conductivity values obtained using Macroduct® collection system in patients with and without cystic fibrosis (CF). The cost and time spent to carry out each test were also analyzed. METHODS: The sweat test using both techniques was performed at the same time in patients with and without CF. Conductivity cutoff values to rule out or diagnose CF were < 75 and > 90 mmol/L, respectively, and for the classic test the chloride values were < 60 and > 60 mmol/L. RESULTS: Fifty-two patients with CF (29 males and 23 females; aged from 1.5 to 18.2 years) underwent the sweat test using both techniques, showing median sweat chloride and conductivity values of 114 and 122 mmol/L, respectively. In all of them, conductivity was > 95 mmol/L, which provided the test with 100 percent sensitivity (95 percentCI 93.1-100). Fifty patients without CF (24 males and 26 females; aged from 0.5 to 12.5 years) had median sweat chloride and conductivity values of 15.5 and 30 mmol/L, respectively. In all cases, conductivity was < 70 mmol/L, which provided the test with 100 percent specificity (95 percentCI 92.9-100). Time spent to perform the tests was significantly shorter for the conductivity test, and its cost was also lower. CONCLUSIONS: The conductivity test showed high sensitivity and specificity, and there was good correspondence between the tests. The time spent to carry out the conductivity test was shorter and the cost was lower in comparison with the classic test.

Guillain- barre syndrome in children; clinicolaboratory features, electrodiagnosis and prongnosis

Guillain - barre syndrome [GBS] is an acute post- infectious immune mediated peripheral neuropathy with a highly variable clinical course and outcome[1]. There are several factors claimed to affect the outcome as age, electrophysiologic type, levels of proinflammatory cytokines, and previous diarrhea[2]. This study was performed to evaluate the effect of these previous factors on the outcome of GBS. Fifty patients with GBS were prospectively studied and the following factors were evaluated; age of onset of the disease, days from onset of the disease to nadir level, days required to improve GBS Score from nadir level by one, severity of the disease at nadir, prior diarrhea, bulbar affection, autonomic dysfunction, parasthesia, respiratory failure, need for mechanical ventilation, electrophysiologic classification, Tumour necrosis factor [TNF] alpha in serum on admission and one week after IVIG therapy. Outcome was evaluated using the functional grading scale [FGS] of Hughes[3]. Prognosis of GBS in children is generally good with complete recovery of all patients after one year from the onset of the disease without residual neurologic deficit; however severity of the disease at nadir was increased by older age of onset, axonal type on electrophysiology, prior diarrhea, and higher levels of TNF alpha in serum. Guillan barre syndrome in children carry good prognosis as regard the long term outcome, however there is some risk of mortality and morbidity during the short term outcome. Both long and short term outcomes are improved by younger age of onset, demyelinating nature, and use of IVIG therapy

Anatomical and Electrophysiological Myotomes Corresponding to the Flexor Carpi Ulnaris Muscle

This study was designed to investigate the incidence of lateral root of the ulnar nerve through cadaveric dissection and to analyze its impact on myotomes corresponding to the flexor carpi ulnaris (FCU) assessed by electrodiagnostic study. Dissection of the brachial plexus (BP) was performed in 38 arms from 19 cadavers, and the connecting branches between the lateral cord and medial cord (or between lateral cord and ulnar nerve) were investigated. We also reviewed electrodiagnostic reports from January 2006 to May 2008 and selected 106 cases of single-level radiculopathy at C6, C7, and C8. The proportion of abnormal needle electromyographic findings in the FCU was analyzed in these patients. In the cadaver study, branches from the lateral cord to the ulnar nerve or to the medial cord were observed in 5 (13.1%) of 38 arms. The incidences of abnormal electromyographic findings in the FCU were 46.2% (36/78) in C7 radiculopathy, 76.5% (13/17) in C8 radiculopathy and 0% (0/11) in C6 radiculopathy. In conclusion, the lateral root of the ulnar nerve is not an uncommon anatomical variation of the BP and the FCU commonly has the C7 myotome. Needle EMG of the FCU may provide more information for the electrodiagnosis of cervical radiculopathy and brachial plexopathy.

Detection of patients with functional dyspepsia using wavelet transform applied to their electrogastrogram

The aim of the present study was to develop a classifier able to discriminate between healthy controls and dyspeptic patients by analysis of their electrogastrograms. Fifty-six electrogastrograms were analyzed, corresponding to 42 dyspeptic patients and 14 healthy controls. The original signals were subsampled, filtered and divided into the pre-, post-, and prandial stages. A time-frequency transformation based on wavelets was used to extract the signal characteristics, and a special selection procedure based on correlation was used to reduce their number. The analysis was carried out by evaluating different neural network structures to classify the wavelet coefficients into two groups (healthy subjects and dyspeptic patients). The optimization process of the classifier led to a linear model. A dimension reduction that resulted in only 25 percent of uncorrelated electrogastrogram characteristics gave 24 inputs for the classifier. The prandial stage gave the most significant results. Under these conditions, the classifier achieved 78.6 percent sensitivity, 92.9 percent specificity, and an error of 17.9 ± 6 percent (with a 95 percent confidence level). These data show that it is possible to establish significant differences between patients and normal controls when time-frequency characteristics are extracted from an electrogastrogram, with an adequate component reduction, outperforming the results obtained with classical Fourier analysis. These findings can contribute to increasing our understanding of the pathophysiological mechanisms involved in functional dyspepsia and perhaps to improving the pharmacological treatment of functional dyspeptic patients.

Acute inflammatory demyelinating polyneuropathy in children; clinical and electrophysiologic findings

The aim of this study was to evaluate the electrophysiologic findings of Guillain Barre Syndrome [GBS] in children and their relation with clinical progress of the disease. Twenty-three children with GBS were evaluated between 2005 and 2007. Electrophysiologic evaluations were performed at admission and one month later. Five patients needed respirator, 15 were bedridden, 1 developed recurrence 6 months later, and 2 experienced chronic GBS. The most common findings included: decreased amplitude of muscle action potential [CMAP] [96%], increased distal latency [74%], increased F wave latency [69%], and decreased nerve conduction velocity [NCV] [61%]. Sensory nerve conduction [evaluating sural nerve] was normal in 78% of the cases. These measures did not significantly change after 1 month. Electrodiagnostic evaluations are helpful at the primary stages of GBS for diagnosis. Fibrillation potentials and positive sharp waves showing denervation and axonal injury are presentative of longer duration of the disease and a worse prognosis

Electrophysiological examination of peripheral nerve injury and its significance in forensic medicine / 法医学杂志

Assessment of peripheral nerve injury is a common task in forensic practice. As an objective assistance of inspection, electrophysiological examination is significant in the evaluation of peripheral nerve function after injury. There are currently several methods of electrophysiological examination, including I-T curve, EMG, NCV and SEP. Because electrophysiological examination can assess the injury and regeneration of peripheral nerve injury at different times, it is valuable to estimate prognosis of peripheral nerve injury in forensic medicine. Besides the electrophysiological examination, evaluation of the peripheral nerve injury needs to combine other clinical manifestations to provide an accurate appraisal.

Mandible protrusion and decrease of TMJ sounds: an electrovibratographic examination

This study quantified by, electrovibratography, the amount of mandible protrusion required to decrease significantly temporomandibular joint (TMJ) vibratory energy as an aid in the diagnosis of the recapture of anteriorly displaced disk. Eighteen patients diagnosed as having anterior disk displacement with reduction and TMJ clicking were submitted to electrovibratographic examination at the first appointment and treated with a stabilizing appliance and anterior positioning appliance with 1 to 5 mm protrusion. Vibratory energy was checked in each of these positions. Baseline data were used as control. At the first appointment, the patients had vibrations with more elevated intensities at the middle and late phases of the mouth opening cycle. At only one clinical step, mandible protrusion was obtained with the anterior repositioning appliance, ranging from 1 to 5 mm protusion. At each new position, a new electrovibratographic exam was made. After the 5-mm mandibular projection, only 2 patients presented vibration, with means between 0.6 and 2.8 Hz. Data were analyzed statistically by ANOVA and Tukey's test (alpha=0.05). The outcomes of this study indicate that 3 mm is the minimum amount of mandible protrusion to significantly decrease the TMJ vibratory energy and to recapture the displaced articular disk.

Este trabalho teve por finalidade quantificar a protrusão mandibular necessária para diminuir significativamente a energia vibratória da articulação temporomandibular (ATM), verificada por meio da eletrovibratografia, como um meio auxiliar de diagnóstico da recaptura do disco articular deslocado anteriormente. Dezoito pacientes com diagnóstico de deslocamento anterior do disco com redução e estalos na ATM foram submetidos ao exame eletrovibratográfico na consulta inicial e tratados com placa oclusal estabilizadora e placa reposicionadora anterior com protrusão variando de 1 a 5 mm, checando-se a energia vibratória em cada uma destas posições. Os dados obtidos na consulta inicial foram usados como grupo controle. Na consulta inicial, os pacientes apresentaram vibrações com intensidades mais elevadas no meio e final da abertura bucal. Em uma única sessão, a protrusão era realizada a partir de 1 mm por meio de placa reposicionadora anterior e realizado novo exame de imediato, até atingir 5 mm. Após a mandíbula ser protruída 5 mm, apenas 2 pacientes apresentavam alguma vibração, com uma média de 0,6 a 2,8 Hz. A análise estatística foi realizada por análise de variância e teste de Tukey (a=0,05). Os resultados indicaram que 3 mm seria a protrusão mínima necessária para reduzir significantemente a energia vibratória e recapturar o disco articular.

Electrognathographic evaluations of rehabilitated edentulous patients

This study investigated, through computerized electrognathographic evaluations (K6-I Diagnostic System, Myotronics-Noromed Inc., Tukwila, USA), the mandibular movement pattern of 16 patients rehabilitated with complete dentures presenting no symptoms of stomatognathic functional alterations. The patients were instructed to wear an intra-oral appliance for occlusal plane coverage over their usual superior denture and were then rehabilitated with new dentures preserving a free-way space of 3 mm. After sixty days, the occlusal vertical dimension was increased and the modified inferior dentures were used for another 60 days. The obtained results were submitted to the Tukey Test and to the Friedman test, depending on which variable was under consideration, both at a significance level of 5 percent. The data revealed a significant decrease in free-way space when the first and the last evaluations were compared. No significant differences were found during opening and closing. It was concluded that the presence of a free-way space at the end of the treatment confirms the importance of its existence for maintaining the balance of the masticatory system, assuming the occurrence of a postural repositioning.

O objetivo deste estudo foi avaliar por meio de eletrognatografia computadorizada (K6-I Diagnostic System, Myotronics-Noromed Inc., Tukwila, EUA) o padrão dos movimentos mandibulares de 16 pacientes reabilitados com dentaduras completas, livres de alterações funcionais do sistema estomatognático. Os pacientes foram instruídos a utilizar um aparelho intra-oral de cobertura oclusal plana adaptado na prótese usual superior e então reabilitados com novas próteses preservando a existência de um espaço funcional livre de 3 mm. Após 60 dias promoveu-se um aumento da dimensão vertical de oclusão e as próteses inferiores assim modificadas foram utilizadas por mais 60 dias. Os resultados foram submetidos ao Teste de Tukey e ao Teste de Friedman, dependendo da variável em estudo, ambos com 5 por cento de significância. Constatou-se decréscimo significante do espaço funcional livre quando compararam-se a primeira e a última avaliações. Não foram encontradas diferenças durante abertura e fechamento. Concluiu-se que a presença de um espaço funcional livre ao final do tratamento vem comprovar a importância de sua existência na manutenção do equilíbrio do sistema mastigatório, admitindo-se que ocorre o reposicionamento postural.