Cambios en el dolor y el posicionamiento craneocervical en pacientes con trastornos temporomandibulares de origen miofascial tratados con terapia miofuncional / Changes in pain and craniocervical positioning in patients with temporomandibular disorders of myofascial origin treated with myofunctional therapy

Antecedentes: La asociación entre el posicionamiento craneocervical (PCC) y los trastornos temporomandibulares (TTM) ha sido intensamente investigada, pero todavía hay controversias entre clínicos e investigadores. Objetivo: Analizar los cambios en el dolor y el PCC en pacientes con TTM de origen miofascial tratados con terapia miofuncional. Método: Estudio experimental, longitudinal y prospectivo. Se evaluaron 16 pacientes de ambos sexos, edad promedio 31,62±10,61 años, con diagnóstico de TTM de origen miofascial (según los criterios diagnósticos para la investigación de los TTM), que habían recibido 10 sesiones de MAR grado ivde Maitland de la articulación temporomandibular combinadas con el uso de un dispositivo interoclusal de descompresión articular. Antes y después de esa intervención se evaluó: el PCC por fotografía analizada a través del programa SAPO; dolor espontáneo y dolor a la presión. Se analizó la normalidad de las variables mediante la prueba de Shapiro-Wilks. Para las comparaciones antes-después se aplicó la prueba t de Student para muestras pareadas. Se consideró significativo un valor p<0,05. Resultado: Se observó una disminución estadísticamente significativa del dolor espontáneo y a la presión. No se encontraron diferencias en las variables del PCC (p<0,05). Conclusión: Luego del tratamiento con MAR grado iv de Maitland de la articulación temporomandibular y el dispositivo interoclusal de descompresión articular, se observó una disminución estadística y clínicamente significativa del dolor espontáneo y a la presión. No se encontraron diferencias en las variables del PCC.

Background: The association between craniocervical positioning (CCP) and temporomandibular disorders (TMD) has been intensively investigated but there are still controversies between clinicians and researchers. Objective: To analyze the changes in pain and CCP in patients with TMD of myofascial origin treated with myofunctional therapy. Method: Experimental, longitudinal and prospective study. Sixteen patients of both sexes were included, mean age 31.62±10.61 years, with a diagnosis of TMD of myofascial origin (according to diagnostic criteria for investigation of TMD). They received 10 sessions of Maitland grade iv MAR of the temporomandibular joint combined with the use of an interocclusal joint decompression device before and after treatment. The following were evaluated: the PCC by photography analyzed through the SAPO program; spontaneous pain and pain on pressure. The normality of the variables was evaluated using the Shapiro-Wilks Test. For the before-after comparisons, the Student's t test was applied for paired samples. A P<.05 was considered significant. Result: There is a statistically significant decrease in spontaneous pain and pressure. No differences were found in the PCC variables (P<.05). Conclusion: After treatment with Maitland grade iv MAR of the temporomandibular joint and interocclusal joint decompression device, a statistically and clinically significant decrease in spontaneous pain and pressure is shown. No differences were found in the PCC variables.

Immediate effects of rhythmic joint mobilization of the temporomandibular joint on pain, mouth opening and electromyographic activity in patients with temporomandibular disorders.

BACKGROUND: Rhythmic joint mobilizations (RJM) of the temporomandibular joint (TMJ) are employed to relieve pain and improve function in patients with temporomandibular disorders (TMD). However, the evidence on the immediate effects of RJM in patients with TMD is scarce. The aim of this study was to assess the immediate clinical and functional effects of RJM in patients with TMD. MATERIALS AND METHODS: This was a one-group quasi-experimental before and after study. Thirty-eight patients with TMD were assessed by means of pain intensity (visual analogue score, VAS), pressure pain threshold (PPT, measured through pressure algometry on the masseter and temporal muscles), mouth opening (MO, measured with a ruler), and surface electromyographic activity of the masseter and temporal muscles (asymmetry index, AI). Measurements were performed before and after a single, 1-min session of RJM of each TMJ. All statistical analyses were performed using the SPSS version 20.0 statistical package. RESULTS: A statistical significant difference was found in pain intensity, PPT and MO after the intervention (p < 0.05). No difference was found in the AI. A large effect size was observed for pain intensity, PPT of the left and right masseter muscles and MO (d = 0.85-1.13), whereas for the left and right temporal muscles the effect size was moderate (d = 0.62) and small, respectively (d = 0.49). CONCLUSION: In this sample of patients with TMD, a single session of RJM of the TMJ seemed to be effective in reducing pain intensity, increasing PPT and improving MO immediately after the intervention, without differences in the AI.

Evaluación de una estrategia diferente para la enseñanza de la metodología científica en una hospital pediátrico / Evaluation in a new approach to teach the cientific method in a pediatric hospital

Introducción:con el propósito de promover la investigación en el ámbito institucional,se inició en 1994 en el Hospital Garrahan un Programa de Docenica en Metodología de la Investigación para profesionales en formación.Este estudio tiene como objetivos describir las etapas de desarrollo del programa y analizar sus resultados a cuatro años de su implementación.Población:Participaron de esta experiencia educativa,entre junio de 1994 y junio de 1998,residentes y becarios de perfeccionamiento clínico mencionado hospital pediátrico:Material y Métodos:El programa incluyó dos niveles:a)un primer nivel de talleres de Lectura crítica de trabajos científicos evaluados por medio de in pre-postest y b)un segundo nivel de tallleres de elaboración de protocolos de Investigación evaluados mediante el análisis metodológico de los proyectos.Resultados:se realizaron 14 talleres(3 de lectura crítica y 11 de elaboración de Protocolos)en los cuales participaron 304 profesionales,La evaluación del talle de lectura crítica(n=108)mostró entre los puntajes de pretest y postest una diferencia altamente significativa.La comparación de los puntajes de los 36 proyectos diseñados en el taller de elaboración de protocolos y los 43 del grupo control mostro diferencias estadisticamente significativas.Conclusiones:El programa de talleres de metodología de investigación es una estrategia educativa util para fomentar la interpretación critica de la bibliografía y facilita la realización de proyectos de investigación en el ambito hospitalario

Cost and quality of psycho-pedagogic institutional care: the case of 56 establishments in the Swiss canton of Vaud.

We studied 56 boarding institutions caring for 834 children and adolescents with different kinds of difficulties or handicaps in the Swiss Canton of Vaud. In order to weigh the purely qualitative approach we performed two different statistical analyses: 1) a correlation matrix between all qualitative and quantitative variables with the daily individual cost of the institutional care. This cost has been calculated in a standard manner and independently of each institution's accounts. 2) a factor analysis of the collected data led us to the identification of different patterns of institutional functioning. This study stresses the importance of the staff/pupil coefficient, i.e. the richness of the pedago-therapeutic framing--the intervention of specialists such as special teachers, psychologists, and speech and/or motor therapists-, and more particularly the higher ratio of specialist help compared to pure educative staff. The severity of the cases, evaluated by independent specialist observers, was in direct relation to this factor independently of the kind of difficulty or handicap.