Rehabilitative management of swallowing and oral-motor movements in patients with tetanus of a public service in Brazil.

When looking at developing countries, the prolonged intensive medical and nursing care required by many patients places extra demands on an already stretched healthcare budget. The purpose of this study was to verify the effectiveness of a systematic rehabilitative program for swallowing and oral-motor movements in intensive care unit patients with the diagnosis of tetanus. Forty-five patients who were clinically diagnosed with tetanus were included in the study. Participants were divided in two groups: GI - consisted of 18 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2002 to December 2005, prior to the existence of a systematic swallowing and oral-motor intervention; GII - consisted of 27 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2006 to December 2009 and were submitted to a specific rehabilitative management of swallowing and of the oral-motor movements. Results indicate that the proposed rehabilitative program reduced by approximately 50% the time patients remained in the ICU. The significant improvement observed in patients with tetanus who were submitted to the rehabilitative program for swallowing and oral-motor movements occurred in conjunction with a reduction in the amount of time necessary to reintroduce oral feeding, to decannulate and to remove the feeding tubes. In conclusion, swallowing/muscle exercise, in patients with severe/very severe tetanus, seem to promote the remission of muscle tension and seem to maximize functional swallowing.

Evaluation of oral-motor movements and speech in patients with tetanus of a public service in Brazil.

The characterisation of oral-motor movements and speech of patients with tetanus were investigated to determine the existence of possible signs that are characteristic of this pathology. Thirteen patients clinically diagnosed with tetanus (10 with severe tetanus and three with very severe tetanus) and admitted to an intensive care unit underwent clinical evaluation of oral-motor movements and speech. Statistical analysis indicated significant between-group differences for speech motor functions, suggesting that individuals with very severe tetanus present rigidity as a characteristic interfering in articulatory precision (P = 0·035) and movement rate (P = 0·038). For lip closure, tongue movement, palatal elevation, gag reflex and voice quality, no between-group differences were identified for the specific abnormal characteristics. The observed abnormal results indicate that muscle strength and functional status of the oral-motor system presented by most of the participants of the study did not ensure the necessary integrity for satisfactory performance. The characterisation of the oral myofunctional aspects of patients with tetanus provides medical teams, patients and families with a wider and better description of the clinical situation, giving support to the diagnosis, prognostics and treatment.

Tratamento de reabilitaçäo: Unidade de Tétano - HCFMUSP / Rehabilitation treatment: Tetanus Unit - HCFMUSP

O tétano é uma doença infecciosa ainda bastante freqüente no nosso meio, com repercussäo severa na área do aparelho locomotor, causando hipertonia muscular acentuada durante a fase aguda e na convalescença. O programa de reabilitaçäo do paciente portador de tétano é iniciado o mais precocemente possível. O objetivo do tratamento é minimizar as complicaçöes osteoarticulares decorrentes do período de imobilizaçäo. A hipertonia generalizada, principalmente dos casos graves, favorece a maior incidência de deformidades. Foram analisados 145 casos, que deram entrada na Unidade de Tétano de JANEIRO DE 1982 à MARÇO DE 1985. Todos esses pacientes receberam tratamento fisiátrico e observou-se que praticamente näo ocorrem complicaçöes decorrentes do período de imobilizaçäo, mesmo nos pacientes mais gravemente acometidos. As complicaçöes osteoarticulares ocorridas foram conseqüentes a dois principais aspectos: 1. Convulsöes tônicas ou espasmos, além é claro, das posturas viciosas mantidas durante períodos prolongados, como o opistótono, que causaram principalmente fraturas dos corpos vertebrais. 2. Complicaçöes decorridas das condiçöes do próprio foco de entrada da doença, levando à infecçöes, tais como osteomielites, pioartrites, infecçöes de tecidos moles, causando assim seqüelas no sistema osteoarticular

Estudio somatométrico y desarrollo psicomotor de los niños recuperados de tetános neonatal / Somatic growth and psychomotor development in children recovered from neonatal tetanos

Con el propósito de conocer el estado del crecimiento físico y la evolución del desarrollo psicomotor de los niños recuperados del tétanos neonatal cuando fueron reintegrados a su medio familiar, se estudiaron 25 niños con edades comprendidas entre 11 meses y 6 años. Los hallazgos somatométricos no evidenciaron deficiencias en su crecimiento. Se observó retraso significativo en el desarrollo psicomotor, siendo más perceptible en el área motor fino adaptativo. Se encontró una relación directa con el grado de severidad del tétanos neonatal

[Neurologic-psychiatric follow-up studies of reanimated tetanus patients (author's transl)]. / Neurologisch-psychiatrische Katamnesen von Reanimierten

During a study of sequela of intensive care therapy eight patients with longterm respirator treatment for severe tetanus infection were studied by neurologic-psychiatric examination two years or more after discharge from the hospital. Two out of four patients with permanent damage suffered from ankylosis of the hip joint caused by myositis ossificans. One patient showed hyperaesthetic-emotional syndrom and IQ-reduction caused by cardiac arrest. Two further patients were resuscitated from cardiac arrest without persisting psycho-physiological injury. A 70 year old man suffered from cardiopulmonary injury, lack of initiative and fatigability. None of the patients complained of depressing memories and all emphazised their pleasure of being alive. The permanent damage fation and not to the tetanus toxin per se. Improved techniques for tetanus patients on curare and artificial respiration may result in better therapeutical results in the future.