Comparação da função ventilatória e da atividade elétrica dos músculos inspiratórios acessórios entre adultos jovens com respiração nasal e oral / Comparison of ventilatory function and electrical activity of the accessory inspiratory muscles in young adults with nasal and mouth breathing

Objetivo: Avaliar a função ventilatória, o pico de fluxo inspiratório nasal, as pressões respiratórias máximas, a atividade elétrica dos músculos inspiratórios acessórios e a relação entre as variáveis, em adultos com respiração oral (RO), comparando-os com adultos com respiração nasal (RN). Métodos: Estudo transversal, controlado com 77 participantes, entre 18 e 30 anos, ambos os sexos, distribuídos em Grupo RO (n = 38) e RN (n = 39). Foram avaliados por espirometria, manovacuometria, para obtenção da Pressão Inspiratória Máxima (PImáx) e Pressão Expiratória Máxima (PEmáx); medida do pico de fluxo inspiratório nasal (PFIN) e eletromiografia de superfície (EMG) dos músculos esternocleidomastoideo (ECM) e trapézio superior durante testes de PImáx e PFIN. Resultados: O grupo RO apresentou valores significativamente menores de PImáx (91 versus 100%), PEmáx (91,6 versus 102,6%) e PFIN (121,4 versus 147,7 l/min). Houve diferença (p < 0,01) na atividade EMG do ECM, com valores menores no grupo RO. A PImáx se correlacionou com o PFIN (r = 0,48, p < 0,01). Conclusão: Os RO apresentaram menores valores de PFIN, PImáx, PEmáx e de amplitude da atividade EMG dos músculos inspiratórios acessórios durante inspirações rápidas, quando comparados aos RN. Traz como contribuição para a prática clínica, a importância de uma investigação global do modo respiratório, não envolvendo apenas intervenções médicas, ortodônticas e miofuncionais, mas também os aspectos ventilatórios e musculares, sobre os quais se identificou a influência da RO. (AU)

Objective: To evaluate the ventilatory function, peak nasal inspiratory flow, respiratory muscle strength, electrical activity of the accessory inspiratory muscles and the relationship between the variables comparing mouth (MB) and nasal-breathing (NB) adults. Methods: Consisted in a cross-sectional, controlled study with 77 participants, between 18 and 30 years old, both sexes, distributed into MB (n=38) and NB (n=39) group. They were assessed by manovacuometry, for acquisition of the Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) measures; peak nasal inspiratory flow meter (PNIF) and, surface electromyography (sEMG) of the of the sternocleidomastoid (ECM) and upper trapezius muscles, during MIP and PNIF. Results: The MB group presented values significantly lower on the MIP (91 versus 100%), MEP (91.6 versus 102.6%) and PNIF (121.4 versus 147.7 l/min). There was difference (p<0.01) in the ECM muscle activity, with lower values in the MB group. The MIP measure correlated to the PNIF (r=0.48, p<0.01). Conclusion: The adults MB presented smaller values of PNIF, MIP, MEP, and EMG amplitude of accessory inspiratory muscles during fast inspiration when compared to the NB. As a contribution to clinical practice, the importance of a global investigation of the respiratory mode, involving not only medical, orthodontic and myofunctional interventions, but also the ventilatory and muscular aspects, on which the influence of RO was identified. (AU)

Multimodal physiotherapeutic approach: effects on the temporomandibular disorder diagnosis and severity / Abordagem fisioterapêutica multimodal: efeitos sobre o diagnóstico e a gravidade da disfunção temporomandibular

Introduction The temporomandibular disorder (TMD) consists of a set of signs and symptoms that affect the masticatory structures, which may cause joint and/or muscular pain. The physiotherapy approach aims at the pain relief and the functional recovery by means of several modalities.Objective To investigate the effects, short and medium-term, of a multimodal physiotherapeutic approach on TMD diagnosis and severity.Methodology Individuals with diagnosis of TMD, confirmed by the Axis I of the RDC/TMD, took part in the study. From this evaluation, the Temporomandibular Index (TMI) and its sub-indices were calculated. The participants were treated during ten sessions of physiotherapy, which included therapeutic ultrasound, thermotherapy, manual therapy, stretching and neuromuscular exercises, as well as self-care and home exercises instructions. Assessments were carried out before treatment (AV1), immediately after treatment (AV2) and two months after the end of the treatment (AV3). The values of indices and the diagnosis prevalence were compared between the different periods by the t paired test (p < 0.05).Results The number of diagnoses reduced in all the subgroups and 41.7% of the 24 participants presented no diagnosis after the treatment. A significant decrease in the TMI was observed between AV1 and AV2 (p = 0.000). There was no difference between AV2 and AV3 (p = 0.204) in 13 participants assessed two months after the end of the treatment.Conclusion The multimodal physiotherapeutic approach resulted in positive effects, short and medium-term, on the symptoms and clinical signs, with deletion of the dysfunction or reduction of its severity in treated patients.

Introdução A disfunção temporomandibular (DTM) envolve um conjunto de sinais e sintomas que afetam as estruturas mastigatórias, podendo causar dor articular e/ou muscular. A abordagem da fisioterapia visa o alívio da dor e a recuperação funcional por meio de diversas modalidades.Objetivo Verificar os efeitos, em curto e médio prazo, de uma abordagem fisioterapêutica multimodal sobre o diagnóstico e a gravidade da DTM.Metodologia Participaram do estudo, indivíduos com diagnóstico DTM, obtido pelo eixo I do instrumento RDC/TMD. A partir desta avaliação foram calculados o Índice Temporomandibular e seus sub-índices. Os participantes foram tratados durante dez sessões de fisioterapia que incluiu ultrassom terapêutico, termoterapia, terapia manual, exercícios de alongamento e neuromusculares, além de orientações de autocuidado e de exercícios domiciliares. Foram realizadas avaliações antes do tratamento (AV1), imediatamente após o tratamento (AV2) e 2 meses após o seu término (AV3). Os valores dos índices e prevalência de diagnósticos de DTM foram comparados entre os diferentes momentos pelo teste t pareado (p < 0,05).Resultados Houve redução do número de diagnósticos em todos os subgrupos e ausência de diagnóstico em 41,7% dos 24 participantes após o tratamento. Obteve-se, ainda, significante redução do ITM na comparação entre AV1 e AV2 (p = 0,000). Não houve diferença entre AV2 e AV3 (p = 0,204) em 13 participantes avaliados dois meses após o término do tratamento.Conclusão A abordagem fisioterapêutica multimodal produziu efeitos positivos, em curto e médio prazo, sobre os sintomas e sinais clínicos, com supressão da disfunção ou redução da sua gravidade nos pacientes tratados.

Electromyographic evaluation of the effect of ultrasound with muscle stretching in temporomandibular disorder: a clinical trial

AIM: To investigate the electromyographic activity of masticatory muscles in women with myogenic or mixed TMD treated with ultrasound and ultrasound associated with stretching. METHODS: Sixteen women with myogenic or mixed TMD, according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD), participated in the study. The patients were evaluated using surface electromyography (sEMG) of the masseter and anterior temporalis muscles, during maximum intercuspation, before and immediately after application of therapeutic resources. All patients were treated by ultrasound (US), ultrasound associated with stretching and placebo ultrasound, by turns, once a week with a one-week minimum interval between them. RESULTS: There was greater symmetry of the masseter muscle electrical activity after ultrasound associated with stretching (p=0.03). The electromyographic values for the maximum intercuspation as well as the symmetry of anterior temporal muscle (p=0.47, p=0.84, p=0.84) and anteroposterior coefficient (p=0.07, p=0.84, p=0.57) showed no statistically significant difference after the intervention, placebo, ultrasound and ultrasound with stretching. CONCLUSIONS: These results indicate that a single application of ultrasound and ultrasound associated with stretching were not able to modify the activity pattern of the masticatory muscles during maximum intercuspation, except the symmetry of the masseter muscle that increased with the last, in women with myogenic or mixed temporomandibular disorder...