Oromandibular dystonia as a cause of temporomandibular disorder (Case report) / Distonia oromandibular como causa de disfunção temporomandibular (Relato de caso)

Temporomandibular disorders (TMD) can have multiple etiologies, including oromandibular dystonia (OMD). However, in a few cases, the OMD can evolve from cervical dystonia (CD), leading to severe bone degeneration. The purpose of this case report of a 64-year-old woman presenting to the Outpatient Neurology Clinic of the Federal University of Bahia is to illustrate the development of oromandibular dystonia with temporomandibular joint (TMJ) dysfunction after 10 years of cervical dystonia. Clinical examination showed bone degeneration of the mandibular ramus and right TMJ click, a prevalent sound in patients with temporomandibular disorders when they open their mouths or chew. After onabotulinum toxin type A injections in the right lateral pterygoid muscle, the patient improved in swallowing and pain. This case highlights the importance of close follow-up of cervical dystonia patients to identify new dystonic muscles. In our patient, lateral pterygoid muscle involvement was followed by several comorbidities, such as dysphagia and jawbone abnormalities.

Os distúrbios temporomandibulares (DTM) podem ter múltiplas etiologias, incluindo a distonia oromandibular (DO). No entanto, em raros casos, a DO pode evoluir a partir da distonia cervical (DC) e raramente pode levar a degeneração óssea. O objetivo deste relato de caso de uma mulher de 64 anos atendida no Ambulatório de Neurologia da universidade Federal da Bahia é ilustrar o desenvolvimento de distonia oromandibular com disfunção da articulação temporomandibular (ATM) após 10 anos de distonia cervical. O exame clínico mostrou degeneração óssea do ramo mandibular e clique na ATM direita, um som prevalente em pacientes com distúrbios temporomandibulares quando abrem a boca ou mastigam. Após injeções de toxina botulínica tipo A no músculo pterigoideo lateral direito, a paciente apresentou melhora na deglutição e na dor. Este caso destaca a importância do acompanhamento próximo de pacientes com distonia cervical para identificar novos músculos distônicos. Em nossa paciente, o envolvimento do músculo pterigoide lateral foi seguido por várias comorbidades, como disfagia e anormalidades ósseas da mandíbula.

Cervicogenic-Like Headache as the First Symptom of Acromegaly.

Headache is a frequent symptom in patients with acromegaly; however, it has never been described as a cervicogenic-like headache. This paper reports on an 18-year-old Brazilian man with a four-year history of unilateral headaches characterized as a sensation of tightness or pressure in the right nuchal region spreading across the forehead. An MRI of the brain revealed a pituitary tumor and a transsphenoidal surgical resection of the macroadenoma was performed. During follow-up, he reported a complete relief of headaches after one week of surgery, persisting for six months. This paper shows a cervicogenic-like headache as the first symptom of acromegaly and the improvement of symptoms after surgery.

Prevalence of temporomandibular disorders in the Brazilian population: A systematic review and meta-analysis.

This systematic review aimed to assess the prevalence of temporomandibular disorders (TMD) in the Brazilian population, with studies that used the RDC/TMD or DC/TMD as diagnostic tools. A total of 6365 people from 11 studies were included. Sample mean age ranged from 12 to 69.5 years. The pooled prevalence of TMD was 33.6% (95% CI 31.5-35.8; I2 = 37.2). Prevalence of TMD was higher in females (37.0%) than in males (29.3%). Our results indicate that TMD is a prevalent condition across Brazil's territories. The results from this meta-analysis can help calculate more accurate sample sizes for future studies.

Communication disorders in the correctional system: a systematic review.

OBTECTIVES: Good communication is essential for resolving social conflicts, especially in closed communities such as prisons. When communication is interrupted by factors such as hearing loss or difficulties in coordination, voice, language, fluency, or disruption of any of the biological systems required to communicate, Human Communication Disorders can appear. This review aimed to identify the most prevalent communication disorders amongst prison inmates. MATERIAL AND METHOD: Systematic review through databases of studies that analyze individual inmates with communication disorders over the last 38 years. After reading the titles and abstracts and applying the eligibility criteria, 25 articles were selected and included in the final review. RESULTS: A sample of 2,188 individuals was evaluated, two studies were conducted with a female population only, while twelve studied exclusively males, and 11 articles had a mixed population. All the studies included evaluated language and communication disorders in general, with language impairment being more prevalent There are no English language studies evaluating language and communication disorders in incarcerated individuals from African countries, Latin America or Asia. DISCUSSION: Inmates have a high prevalence of language and communication disorders, and thus end up being more vulnerable within the prison system. Speech therapists are important members of the legal workforce and improve the health, well-being and participation of people in contact with or at risk of contact with the judicial system through the prevention, early detection, assessment and treatment of communication disorders.

Relations Between Guardians and Domestic Animals During the Sars-Cov-2 Pandemic in Brazil.

OBJECTIVE: The aim of this study was to evaluate how relationships between guardians and domestic animals were established and their possible effects during the COVID-19 pandemic period in Brazil. METHODS: Data were collected by completing an online questionnaire. Throughout the national territory, 2002 people completed the questionnaire, while respecting social distancing from January 20, 2021, to March 20, 2021. The inclusion and exclusion criteria were 'to own pets' or 'those who had them during the period of quarantine' in Brazil. The data obtained were treated qualitatively through discourse analysis and content analysis, while the quantitative data were tabulated by the questionnaire application platform itself. RESULTS: The results showed that 97% of the participants were affected by the coronavirus pandemic in Brazil and that of these, 95.5% stated that their pet was important to overcome and bear bad feelings during the period of social isolation. It was possible to observe through the participants' reports through the online questionnaire that the relationships with their pets were deepened during the pandemic period, and that these had an important role in overcoming bad emotions caused by social distancing. CONCLUSION: It was concluded that due to these relationships, behaviors such as anxiety and sadness were reduced and the pets themselves also showed an increase in affective behaviors in relation to their guardians.

Discharge outcomes as predictors of social participation in the community after a stroke: a cohort study.

The mapping of possible predictors of restrictions in the social participation of people after stroke in the community can be an essential tool to support the development of rehabilitation strategies even in the hospital environment. This study aimed to identify whether mobility, functional balance and dependence on functionality at hospital discharge can predict restrictions on social participation 1 year after stroke in the community. This is a hospital-based cohort study, with individuals over 18 years old admitted with a diagnosis of acute stroke included. People with dementia, previous functional limitations and cancer patients were omitted. Mobility, balance and functional independence were the predictor variables at hospital discharge, and the outcome of interest was social participation assessed 1 year after a stroke in the community. Forty-eight patients were included after a 1-year follow-up. The degree of functional independence at hospital discharge ( ß = 0.813; P < 0.01) was the independent predictor of social participation, specifically the locomotion ( ß = 0.452; P < 0.001) and social cognition ( ß = 0.462; P < 0.001) related to functional independence. Mobility ( ß = 0.040; P = 0.777) and functional balance ( ß = 0.060; P = 0.652) did not show an independent association. Cognitive functional independence was a predictor of daily activities ( ß = 0.786; P < 0.001), social roles ( ß = 0.390; P = 0.014) and satisfaction ( ß = 0.564; P < 0.001) of social participation. The degree of functional independence of people after a stroke at hospital discharge was able to predict the level of social involvement in the community one year after the stroke.

Right hemisphere and metaphor comprehension: A connectionist perspective.

Metaphor comprehension is a cognitively complex task, with evidence pointing to the engagement of multiple cerebral areas. In addition, the involvement of the right hemisphere appears to vary with cognitive effort. Therefore, the interconnecting pathways of such distributed cortical centers should be taken into account when studying this topic. Despite this, the potential contribution of white matter fasciculi has received very little attention in the literature to date and is not mentioned in most metaphor comprehension studies. To highlight the probable implications of the right inferior fronto-occipital fasciculus, right superior longitudinal system, and callosal radiations, we bring together findings from different research fields. The aim is to describe important insights enabled by the cross-fertilization of functional neuroimaging, clinical findings, and structural connectivity.

Antibacterial activity of medicinal plants against Leptospira spp: a literature review / Actividad antibacteriana de plantas medicinales contra Leptospiraspp: una revisión de la literatura

Leptospirosis is a zoonosis caused by bacteria of the genus Leptospira that affects animals and humans. This disease is usually treated empirically due to its prevalence in precarious areas without basic sanitation. The use of medicinal plants in less industrializedsocieties has been one of the main therapeutic resources available. Considering the need to use these natural resources to combat leptospirosis in areas of socioeconomic vulnerability, this study aimed to review the literature on the use of plants with medicinal potential in the treatment of leptospirosis. The results showed that even though leptospirosis is a common disease in communities lacking basic sanitation and economic development, the number of studies on the use of plants with medicinal potential is scarce. Most of these studies come from India, and all plants investigated between 2012 and 2020 had antileptospiral action.

La leptospirosis es una zoonosis causada por bacterias del género Leptospira que afecta a animales y humanos. Esta enfermedad suele ser tratada empíricamente debido a su prevalencia en zonas precarias sin saneamiento básico. El uso de plantas medicinales en las sociedades menos industrializadas ha sido uno de los principales recursos terapéuticos disponibles. Considerando la necesidad de utilizar estos recursos naturales para combatir la leptospirosis en áreas de vulnerabilidad socioeconómica, este estudio tuvo como objetivo revisar la literatura sobre el uso de plantas con potencial medicinal en el tratamiento de la leptospirosis. Los resultados mostraron que a pesar de que la leptospirosis es una enfermedad común en comunidades que carecen de saneamiento básico y desarrollo económico, el número de estudios sobre el uso de plantas con potencial medicinal es escaso. La mayoría de estos estudios provienen de India, y todas las plantas investigadas entre 2012 y 2020 tuvieron acción antileptospirales.

Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review.

BACKGROUND: Stroke is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet. OBJECTIVE: To identify body structure/function impairments and activity limitations in post-stroke that predict social participation restrictions in the community. METHODS: cohort studies were selected, involving adult post-stroke participants, which investigated body structure and function impairments or activity limitations of post-stroke individuals as predictors of social participation in the community. Studies that included individuals with subarachnoid hemorrhage, other neurological disorders and participants in long-term care facilities were excluded. The Newcastle-Ottawa quality assessment scale was applied to assess the methodological quality. The results were synthesized according to the found exposures, considering the used statistical models. RESULTS: Eleven articles were included, with a total of 2,412 individuals, 58.4% men, 83.7% ischemic stroke. Seven exposures were assessed across studies, in which 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function), and 8 studies assessed activity exposures (daily living activity and walking ability). CONCLUSION: There is some evidence that stroke severity, mental and motor deficits, limitations in activities of daily living and the ability to walk after a stroke can predict social participation in the community. PROSPERO registration CRD42020177591.

Botulinum Toxin Type A in the Spasticity of Cerebral Palsy Related to Congenital Zika Syndrome: An Observational Study.

PURPOSE: Investigate the effect of botulinum toxin type-A (BoNT-A) on spasticity and motor performance in children with Cerebral Palsy (CP) related to Congenital Zika Syndrome (CZS). METHODS: Prospective longitudinal observational study of 34 children with CP referred for BoNT-A treatment. Outcomes were evaluated with a muscle tone assessment scale (Modified Ashworth Scale - MAS) and the Patients' Global Impression of Improvement (PGI-I) scale. RESULTS: Mean age was 32.06 ± 3.07 months and 85% were classified as Gross Motor Function Classification System (GMFCS) V. Primitive reflexes were present in 56% of the sample. The majority of the parents (97.9%) reported improvement in range of motion or reduction in spasticity after treatment with botulinum toxin. No side effects were recorded. When compared to the baseline, median reduction in the MAS was 0.5 (IQR = 0). CONCLUSIONS: The findings of this study suggest that BoNT-A may effectively promote functional improvements and reduce muscle tone, improving the child's and family's quality of life.

Hemisphere stroke: impact on the semantic lexical aspects of language.

OBJECTIVE: To investigate if right hemisphere stroke is associated with decreased lexical-semantic ability. METHODS: We compared subjects with right hemisphere brain damage after stroke with healthy controls using the validated version of the Montreal Evaluation of Communication to assess lexical-semantic domains of language. RESULTS: Sixteen patients and thirty-two controls were included. The post-stroke group with right hemispheric brain lesions showed considerable limitations in metaphor interpretation, fluency, and semantic judgment. CONCLUSION: Individuals with right hemisphere damage after stroke may present with language changes in the lexical-semantic aspects.

Spasticity distribution and severity in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis.

In individuals with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), spasticity is one of the main symptoms. The neurological signs of the disease are well defined, but details of how spasticity appears in these individuals have not been well explored. To describe spasticity location and severity of HAM/TSP individuals. Cross-sectional study with individuals older than 18 years, diagnosed with HAM/TSP and with lower limb spasticity. Pregnant women, individuals with other associated neurological diseases, and those using antispastic drugs were not included. Spasticity was assessed by the Modified Ashworth Scale (MAS), applied to the abductor, adductor, flexor, and extensor muscles of the hips, flexors, and extensors of the knees, dorsiflexors, plantiflexors, evertors, and inverters of the foot. Thirty participants were included. The plantiflexor muscles (90%), knee extensors (80%), knee flexors (63,3%), and adductors (50%) were most frequently affected by spasticity. Twenty-three (76.7%) individuals had mixed spasticity, 5 (16.7%) with distal spasticity and 2 (6.7%) with proximal spasticity. MAS was similar between the lower limbs in at least 6 of the 10 muscle groups of each individual. Spasticity was mostly mixed in the lower limbs, with more frequently mild severity. The individuals were partially symmetrical between the lower limbs. The most affected muscle groups were the plantiflexors, knee extensors and flexors and the hip adductors, consecutively, being predominantly symmetrical.

Eficácia da combinação do Nintendo Wii® e fisioterapia convencional na independência funcional de indivíduos hemiparéticos pós-acidente vascular cerebral: ensaio clínico randomizado / The effectiveness of the combination of Nintendo Wii® and conventional physical therapy in functional independence of post-stroke patients with hemiparesis: a randomized clinical trial

Introdução: Nos últimos anos, nota-se crescente interesse na utilização da realidade virtual não imersiva (RVNI) em pacientes pós-acidente vascular cerebral. Objetivo: O objetivo deste estudo é analisar a eficácia da combinação da realidade virtual não imersiva através do console Nintendo Wii® e cinesioterapia na independência funcional de indivíduos hemiparéticos pósacidente vascular cerebral. Métodos: Trata-se de um ensaio clínico randomizado cego. 48 sujeitos foram randomizados, sendo 57,5 % do sexo masculino com idade média de 55,6 anos, alocados em três grupos de tratamento: grupo Realidade Virtual (GRV), grupo Cinesioterapia (GCT) e grupo Realidade Virtual e Cinesioterapia (GRVCT). Cada grupo com 16 participantes realizaram 16 sessões com duração de 50 minutos cada, duas vezes por semana, durante 8 semanas. A avaliação da independência funcional foi realizada pelo Índice de Barthel Modificado pré e pós-tratamento. Resultados: Não foram encontradas diferenças significativas entre os grupos com relação à idade, gênero, tempo de acidente vascular cerebral e hemicorpo afetado; os grupos foram homogêneos com relação a essas variáveis. Não foram encontradas diferenças estatisticamente significantes entre nenhum dos três grupos (intergrupo) antes do tratamento em comparação com o pós-tratamento nas variáveis do Índice de Barthel Modificado. Na comparação intragrupo, em alguns domínios do Índice de Barthel Modificado foram observadas alterações positivas consideráveis, principalmente no grupo que realizou apenas realidade virtual não imersiva. Conclusão: A realidade virtual não imersiva como terapia para reabilitação não apresentou diferença no grau de independência funcional dos pacientes analisados, porém a RVNI em combinação com a cinesioterapia ou isolada, ou apenas a cinesioterapia, podem ser utilizadas sem prejuízos em pacientes hemiparéticos após AVC. (AU)

Background: In recent years, there has been a growing interest in the use of non-immersive virtual reality (NIVR) treatment in post-stroke patients. Objective: The objective of this study is to analyze the efficacy of the combination of non-immersive virtual reality through the Nitendo Wii® console and kinesiotherapy in the functional independence of post-stroke hemiparetic individuals. Methods: Blind randomized clinical trial; 48 volunteers randomly grouped, being 57.5% male with an average age of 55.6 years. These were allocated into 3 treatment groups: Virtual Reality Group (VRG), Cinesiotherapy Group (CG) and Virtual Reality and Cinesiotherapy Group (VRCG). Each group with 16 participants, held 16 sessions of 50 minutes each, twice a week for 8 weeks. Functional independence was assessed by the Barthel Modified Index (BMI) pre and post treatment. Results: No significant differences were found with respect to age, gender, stroke time and affected hemibody. The groups were homogeneous in relation to these variables. No statistically significant differences were detected between any of the 3 groups (among groups) before treatment compared to the post-treatment in BMI variables. In the intra-group comparison, in some areas of BMI, positive changes were observed, mainly in the groups that used only nonimmersive virtual reality. Conclusion: Non-immersive virtual reality as a rehabilitation therapy showed no difference in the level of functional independence of the patients, but this technique in combination with kinesitherapy or alone, or only kinesitherapy, can be used without damage in post stroke hemiparetic patients. (AU)

Tipos craniofaciais e relação com a síndrome da apneia obstrutiva do sono / Craniofacial types and relation to obstructive sleep apnea syndrome

Introdução: fatores anatômicos, como obesidade e alterações craniofaciais, interagem na etiologia e na expressão da Síndrome da Apneia Obstrutiva do Sono. Dimensões cranianas e faciais são usadas para classificar os diferentes fenótipos mediante duas medidas antropométricas: o índice craniano e o índice facial. Objetivo: avaliar a possível associação dos tipos cranianos e faciais ao risco da Síndrome da Apneia Obstrutiva do Sono, obtido pelo questionário de Berlim. Metodologia: participaram do estudo 34 indivíduos (76,5% mulheres), com mediana de idade = 59,0 (56,8 ­ 65,0) anos, avaliados quanto ao risco da Síndrome da Apneia Obstrutiva do Sono, através do questionário de Berlim e medidas antropométricas: índice de massa corporal, circunferência cervical, circunferência abdominal, índice craniano e índice facial. Resultados: foram encontradas as medidas índice de massa corporal = 30,3 (24,7 ­ 37,4) kg /m², circunferência cervical = 37,6 (33,9 ­ 41,6) cm e circunferência abdominal = 102,0 (91,8 ­ 116,1) cm. No grupo de alto risco para essa Síndrome, houve predominância do tipo craniano braquicefálico = 40,7%, e do tipo facial euriprosópico = 37,0%. Conclusão: através do presente estudo foi possível observar que idade, obesidade, tipo craniano braquicefálico e face euriprosópica associaram-se ao alto risco de Síndrome da Apneia Obstrutiva do Sono.

Introduction: anatomical factors such as obesity and craniofacial alterations interact in the etiology and expression of Obstructive Sleep Apnea Syndrome. Cranial and facial dimensions are used to classify the different phenotypes through two anthropometric measurements: the cranial and facial indexes. Objective: to evaluate the possible association of cranial and facial types with Obstructive Sleep Apnea Syndrome risk obtained by the Berlin questionnaire. Methodology: the study included thirty-four individuals (76,5% women), with a median age = 59,0 (56,8 ­ 65,0) years, who were evaluated for Obstructive Sleep Apnea Syndrome risk through the Berlin questionnaire and anthropometric measurements: body mass index, cervical circumference, abdominal circumference, cranial index and facial index. Results: the following measurements were found: body mass index = 30,3 (24,7 ­ 37,4) kg/m², cervical circumference = 37,6 (33,9 ­ 41,6) cm and abdominal circumference = 102,0 (91,8 ­ 116,1) cm. In the high-risk group for this Syndrome there was a predominance of brachycephalic cranial type = 40,7%, and euryprosopic facial type = 37,0%. Conclusion: through the present study, it was possible to observe that age, obesity, brachycephalic cranial type and euryprosopic face were associated with the high-risk for Obstructive Sleep Apnea Syndrome.

Efficacy of the Nintendo Wii combination with Conventional Exercises in the rehabilitation of individuals with Parkinson's disease: A randomized clinical trial.

BACKGROUND: Studies have demonstrated that the combination of Nintendo Wii (NW) with Conventional Exercises (CE) was effective in the rehabilitation of patients with Parkinson's Disease (PD), but there are no studies comparing the effects of this combination on both techniques isolated. OBJECTIVE: To investigate if the effects of the combination of NW to CE are superior to isolated techniques in the rehabilitation of balance, gait, functional mobility and improvement of the quality of life of individuals with PD. METHODS: 45 patients with PD were divided into three groups, NW alone, CE alone and NW plus EC. The sessions occurred for 50 minutes, twice a week and evaluations administered before and after the 2-month intervention. RESULTS: Significant differences were found in the pre and post intervention analyzes of all the outcomes in the three groups, but there was no difference between the groups. The effect size was evaluated, in which the NW plus CE group had a greater magnitude of the therapeutic effect. CONCLUSION: The NW plus CE was statistically as effective as each intervention alone in the rehabilitation of patients with PD, however, the use of this combination provided a magnitude of the therapeutic effect superior to the other groups.

Efficacy of motor imagery additional to motor-based therapy in the recovery of motor function of the upper limb in post-stroke individuals: a systematic review.

Background. Motor imagery (MI) consists of the mental simulation of repetitive movements with the intention of promoting the learning of a motor skill. It seems to be an additional useful tool for motor-based therapy to potentiate the rehabilitation of the upper limb function of post-stroke individuals. Objective. To investigate whether MI combined with motor-based therapy is effective in recovering motor deficits of upper limbs from post-stroke individuals. Method. A systematic review of the literature was performed in the PEDro, LILACS, Cochrane, SCOPUS, Medline/PubMed and SciELO databases. Randomized controlled trials (RCTs) investigating the efficacy of MI associated with motor-based therapy compared with isolated motor-based therapy were included. The included outcomes were gross motor function and functional activities of the upper limb of post-stroke individuals. The physiotherapy evidence database scale was applied for evaluation of methodological quality. Results. Four RCTs were included, with a total of 104 participants, with methodological quality varying from moderate to high. There was a statistically significant improvement in upper limb motor function in all studies. Gross motor function was higher in MI associated with motor-based therapy compared to controls, but only in one study there was superiority in the results of functional activities of the upper limb. Conclusion. There is evidence showing that MI associated with motor-based therapy is an effective tool in improving the motor function of upper limbs of post-stroke individuals. However, more studies are needed to establish criteria for frequency and duration of intervention, and what better type of MI should be used.

Effects of the Nintendo Wii training on balance rehabilitation and quality of life of patients with Parkinson's disease: A systematic review and meta-analysis.

BACKGROUND: Randomized clinical trials (RCTs) used the Nintendo Wii (NW) in the treatment of Parkinson Disease, however, no meta-analysis was developed to determine the effects in these patients. OBJECTIVE: To analyze RCTs that investigated the effects of NW versus traditional physiotherapy on balance rehabilitation and quality of life of patients with PD. METHODS: Electronic research was conducted between December 2018 and January 2019 in the MEDLINE, PEDro, CENTRAL, LILACS and SciELO databases. The methodological quality was evaluated by the PEDro scale and the completeness of the description of the interventions by the TIDieR checklist. Weighted mean differences (WMD) and 95% confidence interval (CI) were calculated. RESULTS: Five studies were included and presented an average of 5.4 (1.5) on the PEDro scale and 6.7 (1.4) on the TIDieR. Compared to traditional physiotherapy, combined NW and traditional physiotherapy resulted in improvement in balance WMD 1.24 (95% CI: CI: 0.2 to 2.3 N = 72) and quality of life WMD- 8.9 (95% CI: -15.2 to -2.6 N = 56). CONCLUSION: combined NW and traditional physiotherapy was more effective on balance rehabilitation and quality of life of patients with PD, but the values demonstrated a poor methodological quality and a low level of completeness of the intervention descriptions.