Differences between the activity of the masticatory muscles of adults with cerebral palsy and healthy individuals while at rest and in function.

OBJECTIVE: The aim of the present study was to compare the electromyographic activity of masticatory muscles of adult patients with different degrees of oral motor impairment (cerebral palsy) with the electromyographic activity of healthy individuals in a control group. Electromyographic activity was compared when the masticatory muscles were at rest and in motion. DESIGN: Thirty adult patients with cerebral palsy and 30 subjects without neuromotor disorders were enrolled in the present study. Oral motor function impairment was classified for each subject according to the Orofacial Motor Function Assessment Scale. Surface electromyography was bilaterally recorded in the masseter and anterior temporalis muscles at rest, during maximal voluntary clench and mouth opening. Comparisons between the groups were statistically assessed using Mann-Whitney test. RESULTS: At rest and mouth opening, electromyographic values were higher among patients with cerebral palsy than control group. During maximal voluntary clench, the opposite occurred. The degree of oral motor impairment affected mouth opening. CONCLUSION: There are significant differences in masticatory muscle activity between adult patients with CP and healthy individuals, and the degree of oral motor impairment is important. SIGNIFICANCE: To improve the masticatory function of these patients, muscle therapy should approach rest, mouth opening and clenching differently.

Effects of Neuromuscular Electrical Stimulation on the Masticatory Muscles and Physiologic Sleep Variables in Adults with Cerebral Palsy: A Novel Therapeutic Approach.

Cerebral palsy (CP) is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair orapharygeal muscle tone, leading to a compromised chewing function and to sleep disorders (such as obstructive sleep apnea). Thirteen adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES) therapy. The effects on the masticatory muscles and sleep variables were evaluated using electromyography (EMG) and polysomnography (PSG), respectively, prior and after 2 months of NMES. EMG consisted of 3 tests in different positions: rest, mouth opening and maximum clenching effort (MCE). EMG values in the rest position were 100% higher than values recorded prior to therapy for all muscles analyzed (p < 0.05); mean mouth opening increased from 38.0 ± 8.0 to 44.0 ± 10.0 cm (p = 0.03). A significant difference in MCE was found only for the right masseter. PSG revealed an improved in the AHI from 7.2±7.0/h to 2.3±1.5/h (p < 0.05); total sleep time improved from 185 min to 250 min (p = 0.04) and minimun SaO2 improved from 83.6 ± 3.0 to 86.4 ± 4.0 (p = 0.04). NMES performed over a two-month period led to improvements in the electrical activity of the masticatory muscles at rest, mouth opening, isometric contraction and sleep variables, including the elimination of obstructive sleep apnea events in patients with CP. Trial registration: ReBEC RBR994XFS http://www.ensaiosclinicos.gov.br.

Test-retest reliability of electromyographic variables of masseter and temporal muscles in patients with cerebral palsy.

INTRODUCTION: The aim of this study was to evaluate the reliability of surface electromyography of the masticatory muscles in patients with cerebral palsy. METHODS: Surface electromyography was performed over the masseter and temporal muscles in 15 patients with cerebral palsy with the mandible at rest and during maximum clenching effort in two sessions. The data were analyzed using the root mean square amplitude, mean frequency, median frequency, zero crossings and approximate entropy. RESULTS: In the within-day evaluations, intraclass correlation coefficients were higher (0.80-0.98) for the all electromyography variables and muscles during maximum clenching effort. In the resting position, the coefficients revealed good to excellent reliability (0.61-0.95) for root mean square, mean frequency, median frequency and zero crossings and fair to good reliability (0.53-0.74) for approximate entropy. In the between-day evaluations, the coefficients revealed good to excellent reliability (0.60-0.86) for mean frequency, median frequency, zero crossings and approximate entropy. In the resting position, the coefficients revealed poor to fair reliability (0.23-0.57) for all electromyography variables studied. The root mean square had the highest standard errors during maximum clenching effort (2.37-5.91) and at rest (1.47-6.86). CONCLUSION: Mean frequency, median frequency and approximate entropy are the most reliable variables of surface electromyography signals of the masseter and temporal muscles during maximum clenching effort in individuals with cerebral palsy. These measures can be used to evaluate the function and behaviour of the masticatory muscles in this population following oral rehabilitation and surgical oral procedures as well as for the study the physiology of these muscles.

Effect of a hyperbolide mastication apparatus for the treatment of severe sleep bruxism in a child with cerebral palsy: long-term follow-up.

PURPOSE: Sleep bruxism is common among the various oromotor alterations found in individuals with cerebral palsy (CP). Few studies have investigated the use of the mastication device denominated "hyperbola" (HB) and none was found describing the use of such a device for the treatment of bruxism in children with CP. The aim of the present study was to evaluate the effect of the HB on electromyographic (EMG) activity in the jaw-closing muscles and the reduction in sleep bruxism in a child with CP using surface EMG analysis before and after nine months of treatment. METHODS: A seven-year-old boy with severe spastic CP and sleep bruxism was enrolled in this study. The HB was chosen as the treatment option for sleep bruxism in this case because the child did not accept an occlusal splint. The HB has a hyperbolic shape and is made of soft, non-toxic, odorless, tasteless silicone. There are five different sizes of HB manufactured based on the diversity of tooth sizes. This device produces proprioceptive excitation in the dentoalveolar nerve, spindles and Golgi tendon organs. HB has been employed for the treatment of temporomandibular disorder, abnormal oro-dental development, abnormal occlusion, xerostomy, halitosis and bruxism. HB therapy was performed for 5 min six times a day over a nine-week period. Surface EMG of the mandible at rest and during maximum contraction was performed on the masseter and temporalis muscles bilaterally to evaluate electromyographic activity before and after nine months of HB usage. RESULTS: HB usage led to a visible tendency toward the reorganization of mastication dynamics, achieving a marked balance in electromyographic activity of the jaw-closing muscles and improving the child's quality of life. CONCLUSION: Based on the findings of the present study, this noninvasive therapy may be useful for individuals with cerebral palsy due to its positive effects and low cost, which allows its use in the public health realm. Further clinical studies with a larger sample size are needed to validate these results and allow the development of a new treatment protocol for patients with spastic cerebral palsy.

Anatomical evaluation of the cervical vertebrae of Wistar rats by means of digital radiographs and its correlation with the maturation stages of human cervical vertebrae.

INTRODUCTION: Biological age is an important parameter for growth and development assessment. It can be evaluated through the observation of radiographic changes in skeletal maturation of cervical vertebrae. OBJECTIVE: This study aims to: a) verify if there is correlation between growth curve and the stages of bone age of animals used in laboratories, by evaluating radiographs of the cervical vertebrae; b) correlate these stages with their correspondents in humans. METHODS: 35 Wistar rats were evaluated for a period of 160 days, starting at day 22nd (weaning), with cross sections for periodic weighing, length measurement and digital radiography. Radiographs of the cervical vertebrae (C2 and C3) were measured by means of a computer program (Radio IMP). Data were submitted to statistical analysis (ANOVA) and Pearson correlation. RESULTS: Growth spurt was characterized by fast increasing in weight and length. Through ANOVA, differences were observed in the cervical measurements between days 22, 97, 127, 157, 187 and 217 (p <0.001). A high correlation was found between increasing in body length and weight, as well as in cervical vertebrae height (r = 0.86). Increments in concavities of vertebrae were also observed, similar to humans. CONCLUSIONS: There is correlation between body growth and maturation of cervical vertebrae in rats. Despite the continuous development of concavities, it was not possible to clearly identify the 5/6 stages as in studies of cervical vertebrae maturation in humans.

Anatomical evaluation of the cervical vertebrae of Wistar rats by means of digital radiographs and its correlation with the maturation stages of human cervical vertebrae

INTRODUCTION: Biological age is an important parameter for growth and development assessment. It can be evaluated through the observation of radiographic changes in skeletal maturation of cervical vertebrae. OBJECTIVE: This study aims to: a) verify if there is correlation between growth curve and the stages of bone age of animals used in laboratories, by evaluating radiographs of the cervical vertebrae; b) correlate these stages with their correspondents in humans. METHODS: 35 Wistar rats were evaluated for a period of 160 days, starting at day 22nd (weaning), with cross sections for periodic weighing, length measurement and digital radiography. Radiographs of the cervical vertebrae (C2 and C3) were measured by means of a computer program (Radio IMP). Data were submitted to statistical analysis (ANOVA) and Pearson correlation. RESULTS: Growth spurt was characterized by fast increasing in weight and length. Through ANOVA, differences were observed in the cervical measurements between days 22, 97, 127, 157, 187 and 217 (p <0.001). A high correlation was found between increasing in body length and weight, as well as in cervical vertebrae height (r = 0.86). Increments in concavities of vertebrae were also observed, similar to humans. CONCLUSIONS: There is correlation between body growth and maturation of cervical vertebrae in rats. Despite the continuous development of concavities, it was not possible to clearly identify the 5/6 stages as in studies of cervical vertebrae maturation in humans.

INTRODUÇÃO: a idade biológica é um parâmetro importante na avaliação do crescimento e desenvolvimento, podendo ser avaliada por meio da observação de alterações na maturação óssea das vértebras. OBJETIVO: o presente estudo visa descrever e relacionar a curva de crescimento de ratos utilizados em pesquisas laboratoriais com os estágios de idade óssea, avaliados por radiografias de vértebras cervicais, e correlacionar esses estágios com estudos correspondentes em humanos. MÉTODOS: foram avaliados 35 ratos Wistar em um período de 160 dias, iniciando no 22º dia de vida (desmame), com cortes transversais periódicos para pesagem, medição do comprimento e radiografias digitais. As radiografias das vértebras cervicais (C2 e C3) foram mensuradas por meio de um programa de computador (Radio IMP). Os dados foram submetidos à análise estatística de variância (ANOVA). RESULTADOS: o surto de crescimento caracterizou-se por aumento rápido de peso e comprimento, seguido por um período de crescimento lento e de estabilidade. Uma alta correlação (r = 0,86) foi verificada entre o aumento de peso e o comprimento do corpo, bem como o comprimento das vértebras cervicais. Incrementos nas concavidades das vértebras dos ratos foram observados, semelhantemente aos resultados obtidos em estudos em humanos. CONCLUSÕES: existe correlação entre o crescimento corporal de ratos e a maturação das vértebras cervicais. Apesar da detecção de desenvolvimento contínuo de concavidades das vértebras, não foi possível identificar claramente os 5 ou 6 estágios de maturação óssea descritos em seres humanos.

Effects of neuromuscular electrical stimulation, laser therapy and LED therapy on the masticatory system and the impact on sleep variables in cerebral palsy patients: a randomized, five arms clinical trial.

BACKGROUND: Few studies demonstrate effectiveness of therapies for oral rehabilitation of patients with cerebral palsy (CP), given the difficulties in chewing, swallowing and speech, besides the intellectual, sensory and social limitations. Due to upper airway obstruction, they are also vulnerable to sleep disorders. This study aims to assess the sleep variables, through polysomnography, and masticatory dynamics, using electromiography, before and after neuromuscular electrical stimulation, associated or not with low power laser (Gallium Arsenide- Aluminun, =780 nm) and LED (= 660 nm) irradiation in CP patients. METHODS/DESIGN: 50 patients with CP, both gender, aged between 19 and 60 years will be enrolled in this study. The inclusion criteria are: voluntary participation, patient with hemiparesis, quadriparesis or diparetic CP, with ability to understand and respond to verbal commands. The exclusion criteria are: patients undergoing/underwent orthodontic, functional maxillary orthopedic or botulinum toxin treatment. Polysomnographic and surface electromyographic exams on masseter, temporalis and suprahyoid will be carry out in all sample. Questionnaire assessing oral characteristics will be applied. The sample will be divided into 5 treatment groups: Group 1: neuromuscular electrical stimulation; Group 2: laser therapy; Group 3: LED therapy; Group 4: neuromuscular electrical stimulation and laser therapy and Group 5: neuromuscular electrical stimulation and LED therapy. All patients will be treated during 8 consecutive weeks. After treatment, polysomnographic and electromiographic exams will be collected again. DISCUSSION: This paper describes a five arm clinical trial assessing the examination of sleep quality and masticatory function in patients with CP under non-invasive therapies. TRIAL REGISTRATION: The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC RBR-994XFS.

Estudo clínico e eletromiográfico da dinâmica do sistema mastigatório em pacientes adultos com paralisia cerebral / Clinical and electromyographical study of the dynamics of the masticatory system in adult patients with cerebral palsy

Pacientes com paralisia cerebral se deparam com limitações funcionais motoras na mastigação, deglutição e fonação. É imprescindível compreender o comportamento da musculatura mastigatória para direcionar o diagnóstico e reabilitação oral desses pacientes. A eletromiografia de superfície é uma técnica diagnóstica empregada para a avaliação clínica da atividade muscular. O objetivo deste estudo foi avaliara função motora oral de pacientes adultos com paralisia cerebral,mediante analises clínica e eletromiográfica. Foram selecionados 30 adultos com paralisia cerebral, de ambos os sexos, entre 20 e 59 anos,com capacidade de compreender e responder a comandos verbais. Após anamnese e exame clínico, a função motora da mandíbula, língua, lábios,palato mole e laringe, bem como expressões da mímica facial foram avaliados. De acordo com o escore alcançado por cada paciente ao realizar os movimentos orais, o comprometimento motor oral foi classificado nas intensidades leve, moderado e severo. O exame eletromiográfico da musculatura mastigatória foi realizado, bilateralmente, nos músculos masseter, temporal e supra-hióideos nas posições de repouso, isometria e abertura. Um transdutor de força e um goniômetro foram utilizados para a medição de força e abertura bucal máxima, respectivamente. A correlação entre os resultados clínicos e eletromiográficos foi avaliada pelo Teste de Friedman, Mann-Whitney e Wilcoxon. O grau de comprometimento motor oral foi moderado em 60%dos pacientes, severo em 36,66% e leve em 3,33%. As atividades elétromiográficas dos músculos estudados nas posições de repouso,isometria e abertura apresentaram respostas individuais, não se estabelecendo relação com os diferentes graus de comprometimento motor oral. A alta prevalência e o caráter individual dos problemas motores orais em pacientes adultos com paralisia cerebral sugerem que aatuação transdisciplinar deve ser contínua e individualizada durante a vidado paciente

Patients with cerebral palsy are faced with motor limitations in chewing,swallowing and speech. It is essential to understand their oral motorf unction to guide the diagnosis and treatment. Surface electromyographyis a diagnostic tool for clinical evaluation of muscle activity. This studyaimed to evaluate the clinical and electromyographic behavior of oral motor function in adult patients with cerebral palsy. 30 patients withcerebral palsy, both gender, aged between 19 and 59 years were enrolledin this study. After anamnesis and clinical examination, oral motor function was assessed through a scale that evaluated: jaw, tongue, lips, soft palate and larynx mobility, as well as facial expressions. The score achieved byeach patient according to her/his performance in accomplishing oral movements classified her/his impairment of oral motor function in mild,moderate and severe. Surface electromyography was recorded bilaterally from masseter, anterior temporalis and suprahyoid muscles at rest,isometry and openness position. A force transducer and a goniometer were used to measure, respectively, maximum bite force and opening.Finally, the compatibility between the clinical and electromyographice valuation was statistically assessed by means of Friedman, Mann-Whitney and Wilcoxon test. The degree of oral motor impairment was mildin 60% of the patients, severe in 36.66% and mild in 3.33%. The electromyographic activity in rest, isometry and openness position,showed individual responses and were not related to the degree of oral motor impairment. The high prevalence of oral motor problems and itsindividual character in adult patients with cerebral palsy suggest that transdisciplinary therapy should be continuous and individualized for these patients

Caries experience associated to social and preventive factors in children of a pastoral community from Limeira-SP

To evaluate caries experience and prevalence associated to social and preventive factors in 3-6-year-old children of a Pastoral Community from Limeira, Brazil. Methods: A cross-sectional study was carried out through an epidemiologic research about the oral conditions of 110 children registered at the Children’s Pastoral Community from the city of Limeira, SP, Brazil. Intraoral examination was performed by a trained dentist and the parents/caregivers filled out a questionnaire in order to outline the children’s profile with respect to gender, parental education and oral health. Results: Differences related to gender were not detected (p= 0.3404). The most frequent periods of breastfeeding were 0 to 2 months (36.36%) and 2 to 6 months (35.45%), corresponding to 71.81% of the cases. The time bottle feeding pointed to two most frequent categories: 1) more than 12 months (35.45%) and 2) between 2 and 6 months (22.63%). Regarding parental education, the majority of the sample has not completed primary school (38.32%). It was observed a larger number of decayed teeth in male children (63.39%). Caries experience was significantly higher in children who were breastfed for only 2 months of life (41.96%). Children that did not use baby bottle or did not use a baby bottle for more than 1 year presented a smaller dmft, corresponding to 29.17% and 28.33%, respectively. Time of use of bottle and pacifier presented a significant association (p<0.05). Conclusions: The implementation of adequate strategies and actions is needed to reinforce oral health conditions in risk groups.

Comparative study between conventional and digital radiography in cephalometric analysis / Estudo comparativo entre radiografia convencional e digital na análise cefalométrica

Objective - Technological improvement is usually followed by comparisons between conventional and new. Those who work with radiographic assessment, such as cephalometric analysis for orthodontic diagnosis, have been living a new challenging and learning phase since the introduction of digital images. It is possible to obtain reproducible and clear images with digital radiography, but radiography printing is still a necessity for teaching purposes. The aim of this study was to compare cephalometric analysis performed on conventional radiography and on digitized and printed radiography. Methods - Eleven lateral cephalometric radiographies were taken from different patients, digitized by scanner and printed on transparent proper paper. Ricketts cephalometric analysis was performed on conventional radiographies and on digitized-and-printed radiographies. Results - After statistical analysis, it was found that there were no significant differences between printed and conventional radiography. High correlation between the techniques was found for LAFH, EF, PF and PM; while moderate correlation was found for MA. Conclusion - Digital radiography acquired with indirect method, when properly printed, presents satisfactory results for cephalometric analysis.

Objetivo - Com o desenvolvimento tecnológico, são inevitáveis as comparações entre o novo e o convencional. Aqueles que trabalham com estudos radiográficos, incluindo análises cefalométricas para o diagnóstico em ortodontia, têm vivido uma fase de adaptação e aprendizado com a introdução das imagens digitais. Tornou-se, com elas, possível a obtenção de imagens mais nítidas e reprodutíveis, embora sua impressão ainda seja necessária para propósitos de ensino. Este trabalho tem por objetivo comparar radiografias convencionais e digitais impressas com finalidade de se realizar análises cefalométricas. Métodos - Onze teleradiografias laterais foram realizadas em diferentes pacientes. As imagens foram digitalizadas e impressas em papel apropriado transparente. A análise cefalométrica de Ricketts foi realizada nas radiografias convencionais e digitalizadas. Resultados - De acordo com a análise estatística, não houve diferenças entre as radiografias convencionais e digitalizadas. Grande correlação foi encontrada para ângulo da altura facial anterior, eixo facial, profundidade facial e plano mandibular; enquanto correlação moderada foi encontrada para arco mandibular. Conclusão - A radiografia digital adquirida pelo método indireto quando adequadamente impressa, serve satisfatoriamente aos anseios da análise cefalométrica.

Alterações sialoquímicas e sialométricas de pacientes com paralisia cerebral: uma revisão de literatura / Sialochemical and sialometric alterations in patients with cerebral palsy: a literature review

TEMA: paralisia cerebral e alterações salivares. O paciente com paralisia cerebral é acometido por diversas desordens no Sistema Estomatognático, sendo muitas delas expressas sob a forma de alterações no fluxo e composição salivar. A variação da concentração de constituintes da saliva está diretamente relacionada com sua capacidade tampão, antioxidante, imunológica, digestiva e lubrificante, além de sofrer variações em função da velocidade do fluxo salivar, o qual está intimamente relacionado à eficiência dos estímulos mecânicos e neurais do trato salivar. Alterações na deglutição, da percepção gustativa, do processo de mineralização dos dentes e da propriedade protetora da saliva contra lesões cariosas, infecções e inflamações, freqüentemente observadas em pacientes com paralisia cerebral, podem ser avaliadas pelo exame da saliva. OBJETIVO: realizar uma revisão de literatura relacionando as principais alterações sialométrica e sialoquímica de pacientes com paralisia cerebral e seus efeitos na saúde bucal. CONCLUSÃO: a análise sialométrica e sialoquímica oferece informações extremamente úteis no diagnóstico e no direcionamento do tratamento desses pacientes, e pode ser considerada uma indicadora prática e objetiva dos processos de doença e disfunções.

BACKGROUND: cerebral palsy and salivary alterations. Patients with cerebral palsy frequently suffer from several disorders in the Stomatognathic System, many of them being expressed as alterations in the salivary flow and composition. Variations in the concentration of salivary components are directly related to their buffering, antioxidant, immunological, digestive and lubricant capacity, and vary according to the velocity of salivary flow, which is deeply related to the efficiency mechanical and neural stimuli on salivary tracts. Alterations in the swallowing function, gustative perception, mineralization of teeth process, as well as salivary protection function against caries lesions, infection and inflammation, which are frequently found in patients with cerebral palsy, can be analyzed through salivary exams. PURPOSE: this study aimed to perform a literature review related to the main sialometric and sialochemical alterations observed in patients with cerebral palsy and their effects on oral health. CONCLUSION: sialometric and sialochemical analyses are an objective and practical indicator of disease and dysfunction process and offer extremely useful information on the diagnosis and treatment referral for these patients.