Wheezing trajectories from childhood to adulthood in a population-based cohort.

BACKGROUND: Wheezing may lead to asthma and reduced pulmonary function in later life. The study aims to identify wheezing trajectories and investigate their relation with pulmonary function and asthma-related outcomes at 22 years of age. METHODS: Individuals from a population-based cohort in Brazil (1993 Pelotas Birth Cohort) with post-bronchodilator pulmonary function data at 22 years (3350) were included in the study. From parentally reported (4 and 11 years) and self-reported (15, 18 and 22 years) history of wheezing in the last 12 months, we used a group-based trajectory modelling approach to derive wheezing trajectories. RESULTS: Four trajectories were identified: never/infrequent, transient-early, late-onset and persistent wheeze. After adjustments, wheezing trajectories remained associated with lower post-bronchodilator values of pulmonary function. Individuals in the persistent wheeze trajectory had a markedly poorer pulmonary function and also showed greater odds of asthma-related outcomes compared to other trajectories groups. Those following this trajectory had on average -109 ml (95% CI: -188; -35), -1.80 percentage points (95% CI: -2.73; -0.87) and -316 ml/s (95% CI: -482; -150) lower FEV1, FEV1/FVC ratio and FEF25-75% respectively; higher odds of self-reported medical diagnosis of allergy (OR 6.18; 95% CI: 3.59; 10.61) and asthma (OR 12.88; 95% CI: 8.91; 18.61) and asthma medication use (OR 9.42; 95% CI: 5.27; 16.87) compared to the never/infrequent group. CONCLUSIONS: Wheezing trajectories, especially the persistent wheeze trajectory, were related to lower pulmonary function values and increased risk of asthma and allergy diagnosis in early adulthood.

Short and long sleep duration and associated factors in pre-adolescence and early adulthood: evidence from the 1993 Pelotas birth cohort study.

OBJECTIVE: The objective of the present study was to investigate the associated factors with short and long sleep duration at ages 11 (pre-adolescence) and 22 years old (early adulthood). METHODS: Participants of the 1993 Pelotas birth cohort with self-reported sleep records at 11 (n = 4442) and 22 (n = 3800) years were included. The total sleep time duration was categorised as short (<9 h for 11 years and <7 h for 22 years), long (>11 for 11 years and >9 for 22 years) and recommended according to the National Sleep Foundation criteria. Multinomial regression analyses were applied according to a hierarchical approach in order to investigate the associated factors with sleep duration patterns. All analyses were stratified by sex. RESULTS: Higher income was associated with higher odds of short sleep duration in 11-year-old boys [OR = 1.54 (CI95%: 1.08; 2.19)] and girls [OR = 1.45 (CI95%: 1.03; 2.06)] and also with lower odds of long sleep duration in both ages. At 22 years, common mental health disorders were associated with higher odds of short sleep duration in both men [OR = 1.56 (CI95%: 1.18; 2.06)] and women [OR = 1.48 (CI95%: 1.11; 1.99)]. Sleep duration was also related to screen time and physical activity showing different association patterns according to sex and age. CONCLUSIONS: Different factors may be associated with sleep duration patterns in pre-adolescence and early adulthood. Our results emphasise the importance of considering stratification analyses to identify associated factors with sleep duration since they may vary according to age and sex.

Characterisation of pulmonary function trajectories: results from a Brazilian cohort.

BACKGROUND: Pulmonary function (PF) trajectories are determined by different exposures throughout the life course. The aim of this study was to investigate characteristics related to PF trajectories from 15 to 22 years in a Brazilian cohort. METHODS: A birth cohort study (1993 Pelotas Birth Cohort) was conducted with spirometry at 15, 18 and 22 years. PF trajectories were built based on z-score of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and their ratio using a group-based trajectory model. Associations with exposures reported from perinatal to 22 years were described. RESULTS: Three trajectories, low (LT), average (AT) and high (HT) were identified in 2917 individuals. Wealthiest individuals belonged to the HT of FEV1 (p=0.023). Lower maternal pregestational body mass index (BMI) (22.4±0.2; p<0.001 and 22.1±0.14; p<0.001) and lower birth weight (3164.8±25.4; p=0.029 and 3132.3±19.4; p=0.005) were related to the LT of FEV1 and FVC. Mother's smoking exposure during pregnancy (37.7%; p=0.002), active smoking at ages 18 and 22 years (20.1% and 25.8%; p<0.001) and family history of asthma (44.8%; p<0.001) were related to the LT of FEV1/FVC. Wheezing, asthma and hospitalisations due to respiratory diseases in childhood were related to the LT of both FEV1 and FEV1/FVC. Higher BMIs were related to the HT of FEV1 and FVC at all ages. CONCLUSIONS: PF trajectories were mainly related to income, pregestational BMI, birth weight, hospitalisation due to respiratory diseases in childhood, participant's BMI, report of wheezing, medical diagnosis and family history of asthma, gestational exposure to tobacco and current smoking status in adolescence and young adult age.

Childhood mouth-breathing consequences at adult age: ventilatory function and quality of life / Consequências da respiração oral em adultos: função ventilatória e qualidade de vida

Introduction Mouth breathing can affect the functions of the respiratory systems and quality of life. For this reason, children who grow up with this stimulus may have implications on physical and psychological aspects at adult age.Objective To evaluate childhood mouth-breathing consequences for the ventilatory function and quality of life at adult age.Materials and methods Prospective, observational and cross-sectional study with 24 adults, between 18 and 30 years old, mouth breathers during childhood, comprised the childhood mouth-breathing group (CMB). The childhood nasal-breathing (CNB) group was composed of 20 adults of the same age, without history of respiratory disease during all their lives. Measurements of maximal respiratory pressures, peak expiratory flow and 6-minute walk test were assessed. In addition, all the volunteers answered the Short Form-36 questionnaire (SF-36).Results The maximal inspiratory (p = 0.001) and expiratory (p = 0.000) pressures as well as the distance in the walk test (p = 0.003) were lower in the COB. The COB also presented lower score in the General Health domain of the SF-36 Questionnaire (p = 0.002).Conclusion Childhood mouth-breathing yields consequences for the ventilatory function at adult age, with lower respiratory muscle strength and functional exercise capacity. Conversely, the quality of life was little affected by the mouth breathing in this study.

Introdução A respiração oral pode afetar o sistema respiratório e a qualidade de vida e, crianças que crescem com este estímulo podem trazer implicações em aspectos físicos e psicológicos na idade adulta.Objetivo Avaliar as consequências da respiração oral na infância na função ventilatória e qualidade de vida de adultos.Materiais e métodos Estudo prospectivo, observacional e transversal com 24 adultos, entre 18 e 30 anos, respiradores orais na infância (ROI). O grupo respiradores nasais na infância (RNI) foi composto por 20 adultos da mesma idade, sem história de doença respiratória até o momento. Foram avaliadas as medidas das pressões respiratórias máximas, pico de fluxo expiratório e teste de caminhada de 6 minutos (TC6). Todos os voluntários responderam o questionário de qualidade de vida Short Form-36 (SF-36).Resultados As pressões inspiratória (p = 0,001) e expiratória (p = 0,000) máximas e a distância percorrida no TC6’ (p = 0,003) foram menores no grupo ROI. O grupo ROI também apresentou um escore menor no domínio Estado Geral de Saúde do questionário SF-36 (p = 0,002).Conclusão A respiração oral na infância provoca consequências na função ventilatória na idade adulta, com diminuição na força muscular respiratória e na capacidade funcional ao exercício. Porém, esta trouxe pequena implicação na qualidade de vida dos sujeitos desta pesquisa.

Relação da atividade elétrica dos músculos supra e infra-hióideos durante a deglutição e cefalometria / Relationship between the electrical activity of suprahyoid and infrahyoid muscles during swallowing and cephalometry

OBJETIVO: investigar a influência da postura habitual da cabeça, da posição mandibular e do osso hióide na atividade dos músculos supra e infra-hióideos durante deglutição de diferentes consistências de alimentos. MÉTODO: estudo observacional, transversal, com mulheres entre 19 e 35 anos, sem alterações miofuncionais de deglutição. A postura craniocervical, posição da mandíbula e osso hióide foram avaliados pela cefalometria. A atividade eletromiográfica dos músculos supra e infra-hióideos foi coletada durante a deglutição de água, gelatina e biscoito. RESULTADOS: amostra com 16 mulheres, média de idade 24,19±2,66 anos. No repouso, observaram-se correlações negativas/moderadas entre a atividade elétrica dos músculos supra-hióideos com as variáveis posturais NSL/CVT (posição da cabeça em relação às vértebras cervicais) e NSL/OPT (posição da cabeça em relação à coluna cervical) e positiva/moderada com o ângulo CVA (posição de flexão/extensão da cabeça). Durante a deglutição do biscoito, a atividade dos músculos infra-hióideos apresentou correlação negativa/moderada com o ângulo NSL/OPT. Constatou-se maior atividade elétrica dos músculos supra-hióideos durante a deglutição de todos os alimentos testados e, dos músculos infra-hióideos, no repouso. Os supra-hióideos foram mais ativos que os infra-hióideos durante a deglutição, entretanto, houve aumento da atividade eletromiográfica em ambos os grupos musculares durante a deglutição do biscoito, comparado com a deglutição de água e gelatina. CONCLUSÃO: a hiperextensão da cabeça repercutiu na menor atividade dos músculos supra-hióideos no repouso e, dos músculos infra-hióideos, na deglutição. A consistência do alimento influenciou na atividade elétrica dos músculos supra e infra-hióideos, havendo maior recrutamento muscular na deglutição de alimento sólido.

PURPOSE: to investigate the influence of the habitual head posture, jaw and hyoid bone position on the supra and infrahyoid muscles activity of the muscles during swallowing of different food textures. METHOD: an observational, cross-sectional study, with women between 19 and 35 years, without myofunctional swallowing disorders. The craniocervical posture, position of the mandible and hyoid bone were evaluated by cephalometry. The electromyographic activity of the supra and infrahyoid muscles was collected during swallowing water, gelatin and cookie. RESULTS: sample of 16 women, mean age 24.19 ± 2.66 years. At rest, there were negative/moderate correlations between the electrical activity of the suprahyoid muscles with NSL/CVT (head position in relation to the cervical vertebrae) and NSL/OPT (head position in relation to the cervical spine) postural variables, and positive/moderate with the CVA angle (position of flexion/extension of the head). During swallowing the cookie, the activity of infrahyoid muscles showed a negative/moderate correlation with NSL/OPT angle. It was found higher electrical activity of the suprahyoid muscles during swallowing of all foods tested, and of the infrahyoid muscles at rest. There was difference on the muscle activity during swallowing of foods with different consistencies, which was higher with cookie compared to water and gelatin. CONCLUSION: the head hyperextension reflected in lower activity of the suprahyoid muscles at rest and of the infrahyoid muscles during swallowing. The consistency of food influenced the electrical activity of the suprahyoid and infrahyoid muscles, with greater muscle recruitment in swallowing solid food.

Influência da dor no controle postural de mulheres com dor cervical / Influence of pain on postural control in women with neck pain

O objetivo foi verificar a influência da dor no controle postural de mulheres com dor cervical e a relação com as possíveis alterações nos sistemas sensoriais e postura corporal. O grupo dor cervical foi composto por mulheres, entre 20 e 50 anos, com dor cervical por mais de três meses e o grupo controle por 20 mulheres sem dor cervical. Para caracterização, utilizaram-se anamnese, índice de incapacidade cervical e Escala Visual Analógica. O equilíbrio postural foi avaliado por uma plataforma de força. O equilíbrio com manipulação dos sistemas sensoriais foi avaliado pela posturografia dinâmica Foam-laser, expondo o indivíduo a seis testes de organização sensorial. A postura foi avaliada pelo Software de Avaliação Postural. Normalidade das variáveis verificada pelo teste de Shapiro Wilk e testes t de student e Mann Whitney para comparação entre grupos, nível de significância de 5%. Os grupos apresentaram homogeneidade nas variáveis demográficas. No equilíbrio postural, observou-se maior amplitude e velocidade de deslocamento do centro de pressão no grupo dor cervical, demonstrando maior oscilação postural. Houve diferença significativa no ângulo crâniovertebral, mostrando anteriorização da cabeça nas mulheres sintomáticas. Na posturografia dinâmica, observou-se diferença entre os grupos sendo que o escore obtido nas seis condições sensoriais demonstrou que o grupo dor cervical apresentou maior comprometimento do equilíbrio. Dor cervical e postura anteriorizada da cabeça têm efeito deletério no controle postural de mulheres sintomáticas, tanto na postura estática quanto na postura dinâmica.

The objective of this study was to investigate the influence of pain on postural control in women with neck pain and the relationship with possible changes in sensory systems and posture. The neck pain group was composed of women, aged between 20 and 50 years, complaining of neck pain for more than three months; the control group was composed of women without complaints of neck pain. For the characterization of the groups, we used anamnesis, neck disability index and Visual Analogue Scale. Postural balance was assessed on force platform. Postural balance with manipulation of the sensory systems was measured by Foam Laser Dynamic Posturography, exposing the individual to six sensory organization tests. Posture was assessed by the Postural Assessment Software. The normality of the variables were verified using Shapiro-Wilk test, Student's t-test and Mann-Whitney test for comparison between groups, with a significance level of 5%. Groups were homogeneous in demographic variables. We observed higher amplitude and displacement velocity of the center of pressure in the neck pain group, showing greater postural balance. There were significant differences in craniovertebral angle, showing forward head posture in symptomatic women. In dynamic posturography, we observed a difference between the groups: the score obtained in the six sensory conditions showed that neck pain group presented greater balance impairment. Neck pain and forward head posture have a deleterious effect on postural control in symptomatic women, both in the static posture and dynamic posture.

Severidade da desordem temporomandibular e sua relação com medidas cefalométricas craniocervicais / Severity of the temporomandibular disorder and its relationship with craniocervical cephalometric measures

INTRODUÇÃO: Sabe-se que existe uma relação entre a Desordem Temporomandibular (DTM) e a postura craniocervical, porém, além de os estudos apresentarem resultados inconclusivos, a severidade dos sinais e sintomas de DTM não é considerada. OBJETIVO: Correlacionar índices de severidade da DTM com medidas cefalométricas craniocervicais. MATERIAIS E MÉTODOS: Participaram da pesquisa 32 mulheres entre 19 e 35 anos com diagnóstico de DTM (RDC/TMD). A severidade dos sinais e sintomas da DTM foi avaliada pelo Índice Temoromandibular proposto por Pehling, calculado com base nos achados do exame físico do RDC/TMD (eixo I). A postura craniocervical foi avaliada por cefalometria, por meio de 11 medidas referentes à posição da cabeça, coluna cervical, mandíbula e osso hioide. A normalidade dos dados foi testada pelo teste de Lilliefors e as correlações foram realizadas pelo coeficiente de Spearman. RESULTADOS: Foram encontradas correlações negativas e moderadas entre o ângulo CVT/Hor e os Índices Muscular (p = 0,0288) e Temporomandibular (p = 0,0394); entre o ângulo CPL/Hor (anteriorização) quando correlacionado aos Índices Funcional (p = 0,0482) e Muscular (p = 0,0086) e entre distância do hioide à terceira vértebra cervical (Hy/C3) e o Índice Funcional (p = 0,0155). CONCLUSÕES: Constatou-se associação entre a maior severidade do quadro clínico da DTM e a projeção anterior da cabeça, a flexão da coluna cervical baixa e a menor distância do osso hioide à terceira vértebra cervical. Essa relação sugere que as alterações posturais craniocervicais podem contribuir para a maior intensidade dos sinais e sintomas e perpetuação da DTM.

INTRODUCTION: It is known that there is a relationship between the Temporomandibular Disorder (TMD) and craniocervical posture, but, besides the studies showed inconclusive results, the severity of signs and symptoms of TMD is not considered. OBJECTIVE: To correlate the severity of TMD index to craniocervical cephalometric measurements. MATERIALS AND METHODS: Thirty-two women, from 19 to 35 years old with a diagnosis of TMD (RDC/TMD), took part in the study. The severity of signs and symptoms of TMD was assessed by the Temoromandibular Index proposed by Pehling and calculated according to the physical examination findings of the RDC/TMD (Axis I). The craniocervical posture was evaluated by cephalometry through 11 measures related to the head, cervical spine, jaw and the hyoid bone position. Data normality was tested by Lilliefors test and correlations were performed by Spearman coefficient. RESULTS: Moderate negative correlation was found between the CVT/Hor angle and Muscular (p = 0.0288) and Temporomandibular (p = 0.0394) Indices; between the CPL/Hor angle (anterior) when correlated with Functional (p = 0.0482) and Muscle indices (p = 0.0086) and between distance from the hyoid to the third cervical vertebra (Hy/C3) and Functional Index (p = 0.0155). CONCLUSIONS: There was an association between greater severity of clinical symptoms of TMD and a more forward head posture, the lower cervical spine flexion and a smaller distance from hyoid bone to the third cervical vertebra. This relationship suggests that the craniocervical postural changes may contribute to a greater intensity of signs and symptoms and the perpetuation of TMD.

Chewing and swallowing in young women with temporomandibular disorder.

PURPOSE: To evaluate chewing and swallowing functions in women with and without temporomandibular disorder (TMD) and investigate the position of the mandible and the hyoid bone as they are important structures in the development of these functions. METHODS: Seventy women were evaluated in relation to TMD diagnosis according to the Research Diagnostic Criteria, among them, 34 composed the study group (SG) with TMD and 36 took part in the control group (CG). Evaluation of the masticatory and swallowing functions was performed according to the Protocol of Orofacial Myofunctional Evaluation with Scores. Mandibular and hyoid bone position variables were measured by cephalometric analysis. RESULTS: TMD subjects showed a significant difference on tongue (p=0.03) and lip (p=0.04) posture during swallowing function, and a more frequent adoption of a chronic unilateral chewing pattern as well (p=0.03). Moreover, they presented a lower position of the hyoid bone in relation to the mandible (p=0,00). CONCLUSION: TMD presence resulted on a higher frequency of myofunctional alterations during masticatory and swallowing functions. A greater distance from hyoid bone to the mandible in addition with the presence of painful symptom can justify, partly, the atypical behaviors of the tongue and lips observed on TMD group. The TMD repercussion on alimentaires functions in a young age group justifies the importance of an earlier diagnosis and therapeutic intervention in these individuals.

Mastigação e deglutição em mulheres jovens com desordem temporomandibular / Chewing and swallowing in young women with temporomandibular disorder

OBJETIVO: Avaliar a mastigação e a deglutição em mulheres com e sem desordem temporomandibular (DTM) e investigar a posição da mandíbula e do osso hioide, por serem estruturas importantes para a realização destas funções. MÉTODOS: Setenta mulheres foram avaliadas quanto à presença de DTM segundo o instrumento Critérios de Diagnóstico para Pesquisa de Desordem Temporomandibular, sendo que 34 delas, com DTM, constituíram o grupo de estudo (GE) e 36 participaram do grupo controle (GC). A avaliação da mastigação e deglutição foi baseada no Protocolo de Avaliação Miofuncional Orofacial com Escores (AMIOFE). As variáveis referentes à posição da mandíbula e osso hioide aferidas pela análise cefalométrica. RESULTADOS: Os indivíduos com DTM apresentaram diferença significativa quanto à postura de língua (p=0,03) e lábios (p=0,04) durante a função de deglutição, bem como a adoção mais frequente de um padrão mastigatório unilateral crônico (p=0,03). Além disso, apresentaram posição mais baixa do osso hioide em relação à mandíbula (p=0,00). CONCLUSÃO: A presença de DTM promoveu maior frequência de alterações miofuncionais orofaciais durante as funções de mastigação e deglutição. A maior distância entre o osso hioide e a mandíbula, bem como a presença da sintomatologia álgica, podem justificar, em parte, os comportamentos atípicos da língua e dos lábios observados no grupo com DTM. A repercussão da DTM sobre as funções alimentares em uma faixa etária jovem explica a importância do diagnóstico e da intervenção terapêutica precoce nestes indivíduos.

PURPOSE: To evaluate chewing and swallowing functions in women with and without temporomandibular disorder (TMD) and investigate the position of the mandible and the hyoid bone as they are important structures in the development of these functions. METHODS: Seventy women were evaluated in relation to TMD diagnosis according to the Research Diagnostic Criteria, among them, 34 composed the study group (SG) with TMD and 36 took part in the control group (CG). Evaluation of the masticatory and swallowing functions was performed according to the Protocol of Orofacial Myofunctional Evaluation with Scores. Mandibular and hyoid bone position variables were measured by cephalometric analysis. RESULTS: TMD subjects showed a significant difference on tongue (p=0.03) and lip (p=0.04) posture during swallowing function, and a more frequent adoption of a chronic unilateral chewing pattern as well (p=0.03). Moreover, they presented a lower position of the hyoid bone in relation to the mandible (p=0,00). Conclusion: TMD presence resulted on a higher frequency of myofunctional alterations during masticatory and swallowing functions. A greater distance from hyoid bone to the mandible in addition with the presence of painful symptom can justify, partly, the atypical behaviors of the tongue and lips observed on TMD group. The TMD repercussion on alimentaires functions in a young age group justifies the importance of an earlier diagnosis and therapeutic intervention in these individuals.

Craniocervical posture: cephalometric and biophotogrammetric analysis

Aim: To investigate the correlation between the craniocervical posture measurements obtained by the biophotogrammetric and cephalometric analysis. Methods: 80 women aged between 19 and 35 years were evaluated by the cephalometric and biophotogrammetric methods. The cephalometric variables were: CVA (position of flexion/extension of the head) CPL (forward head posture) CVT/EVT ratio (cervical column curvature). For the biophotogrammetric analysis, photography were analyzed in right profile being two angles related to the head forward posture (A1 and A2) and one related to flexion-extension head position (FE). It was also measured the curvature of the cervical spine by the cervical distance. The correlation between the craniocervical posture variables, as measured by the two methods of assessment, was analyzed by the Pearson’s correlation with a significance level of 5%. Results: It was observed a moderate and significant agreement (p=0.00) between the postural craniocervical variables that analyzed the flexionextension head position (FE and CVA) and the forward head (CPL and A1). The evaluation of the cervical curvature by the DC measure showed no correlation with the cephalometric variable CVT/EVT. Conclusions: The biophotogrammetric analysis can be preferably chosen for assessing the head posture. However, the cephalometric analysis appears to be the most indicated for the cervical curvature measurement, since it enables a more objective view of the bone structures without the influence of the soft tissues.

Cervical spine dysfunction signs and symptoms in individuals with temporomandibular disorder.

PURPOSE: To study the frequency of cervical spine dysfunction (CCD) signs and symptoms in subjects with and without temporomandibular disorder (TMD) and to assess the craniocervical posture influence on TMD and CCD coexistence. METHODS: Participants were 71 women (19 to 35 years), assessed about TMD presence; 34 constituted the TMD group (G1) and 37 comprised the group without TMD (G2). The CCD was evaluated through the Craniocervical Dysfunction Index and the Cervical Mobility Index. Subjects were also questioned about cervical pain. Craniocervical posture was assessed by cephalometric analysis. RESULTS: There was no difference in the craniocervical posture between groups. G2 presented more mild CCD frequency and less moderate and severe CCD frequency (p=0.01). G1 presented higher percentage of pain during movements (p=0.03) and pain during cervical muscles palpation (p=0.01) compared to G2. Most of the TMD patients (88.24%) related cervical pain with significant difference when compared to G2 (p=0.00). CONCLUSION: Craniocervical posture assessment showed no difference between groups, suggesting that postural alterations could be more related to the CCD. Presence of TMD resulted in higher frequency of cervical pain symptom. Thus the coexistence of CCD and TMD signs and symptoms appear to be more related to the common innervations of the trigeminocervical complex and hyperalgesia of the TMD patients than to craniocervical posture deviations.

Relationship between craniocervical posture, mandible and hyoid bone and influence on alimentary functions

Aim: To evaluate the anatomical relationship between craniocervical posture and mandibularand hyoid bone position and the influence on the masticatory and swallowing functions. Methods:Thirty-six women aged 19 to 35 years without temporomandibular disorder diagnosis wereevaluated. Variables related to the craniocervical posture and mandibular and hyoid boneposition were obtained by cephalometric measurements. Masticatory and swallowing functionevaluations were performed according to a protocol of orofacial myofunctional evaluation withscores. Results: Significant correlations were observed between craniovertebral angle and thelinear distance from the hyoid bone to the mentum (p=0.02) and to the mandible (p=0.03). Theangle that measured the forward head position also demonstrated a significant correlation with thelinear distance between hyoid bone and jaw (p=0.00). The cervical curvature degree showed asignificant correlation with the linear distance from hyoid bone to the third cervical vertebra(p=0.01). Modifications of the cranium base inclination in relation to the cervical column at the twolevels (NSL/CVT and NSL/OPT) were the only variables, which showed a significant correlationwith the mandible position. Important craniocervical postural changes were observed in thesubjects, although there was no association between them and a higher frequency of atypicalbehaviors evaluated during masticatory and swallowing functions. Conclusions: Cephalometricfindings confirm the anatomical relationship between craniocervical posture, mandible and hyoidbone. However, association between craniocervical posture alterations and masticatory and swallowingfunction impairments was not detected. Such findings suggest that, in the presence of a musculoskeletalimbalance, the body readapts itself ensuring that alimentary functions will not be affected.

Análise da postura craniocervical de crianças respiradoras bucais após tratamento postural em bola suíça / Craniocervical posture analysis of mouth breathing children after postural treatment on swiss ball

O estudo teve como objetivo avaliar a postura craniocervical de crianças respiradoras bucais após tratamento postural em bola suíça. Doze crianças respiradoras bucais foram submetidas a um protocolo de reeducação postural constituído por exercícios de alongamento e fortalecimento muscular sobre a bola suíça, estimulação diafragmática e alongamento dos músculos acessórios da inspiração. A postura craniocervical foi avaliada através da análise biofotogramétrica. A posição da anteriorização da cabeça foi aferida por meio do ângulo formado pelos pontos localizados no tragus direito e no processo espinhoso da sétima vértebra cervical com a linha horizontal. A curvatura cervical foi avaliada pela distância horizontal de uma linha vertical tangenciando o ápice da cifose torácica e o ponto de maior concavidade da curvatura cervical. As fotografias foram obtidas antes e após dez atendimentos. A normalidade das variáveis foi verificada a partir do teste Shapiro-Wilk. Para as comparações entre as médias foi utilizado o teste t de Student para amostras dependentes admitindo-se nível de significância de 5% (p<0,05). Verificou-se uma melhora na postura craniocervical, através da diminuição da anteriorização da cabeça (p=0,00) e do restabelecimento da curvatura fisiológica da coluna cervical (p=0,01). O tratamento postural em bola suíça proporcionou um melhor alinhamento da postura craniocervical, provavelmente pelo equilíbrio dos músculos cervicais e maior ação diafragmática.

The study aimed to evaluate the craniocervical posture of mouth breathing children after postural treatment on swiss ball. Twelve mouth breathing children were undergone to a postural reeducation protocol through stretching and strengthening exercises on swiss ball, diaphragmatic stimulation and stretching of the inspiratory accessory muscles. Craniocervical posture was evaluated through biophotogrammetry analysis. Forward head position was measured through an angle formed by the points in the tragus and in the spinous process of the seventh cervical vertebra with a horizontal line. Cervical column curvature was taken by the horizontal distance from a vertical line passing through the thoracic kyphosis apex to the point of the greatest cervical curvature concavity. Pictures were taken before and after ten treatment sessions. The normality of the variables was tested by Shapiro-Wilk test and the Student's t -test was used to determine differences in variables between assessments. It was considered a significance level of 5% (p<0.05). It was verified a significant improvement on craniocervical posture with reduction of the forward head position (p=0.00) and restoration of cervical column physiological curvature (p=0.01). The postural reeducation protocol on swiss ball reflected on craniocervical posture alignment probably by cervical muscles equilibrium and diaphragmatic action improvement.

Efeito da fisioterapia sobre os parâmetros ventilatórios e a dinâmica tóraco-abdominal de crianças respiradoras bucais / Effects of the physical therapy on ventilatory parameters and thoracoabdominal dynamics of mouth breathing children

Este estudo objetivou avaliar o efeito da fisioterapia nos parâmetros ventilatórios e na dinâmica tóraco-abdominal de crianças respiradoras bucais. Dez crianças respiradoras bucais foram submetidas a um programa de reeducação respiratória e correção postural durante 20 sessões de exercícios de alongamento e fortalecimento muscular sobre a bola suíça, estimulação diafragmática e alongamento dos músculos acessórios da inspiração. Os dados coletados foram as medidas de pressões inspiratórias e expiratórias máximas (PIM e PEM), capacidade inspiratória (CI), pico de fluxo expiratório (PFE), mobilidade torácica por meio do coeficiente respiratório (Cr) nos níveis axilar (CrA), xifoide (CrX) e umbilical (CrU) e análise biofotogramétrica do ângulo de Charpy. Estes foram verificados antes e após 10 e 20 atendimentos. Os dados foram submetidos a uma análise de variância (ANOVA) e, nas diferenças encontradas entre as médias, aplicou-se o Teste de Tukey com nível de significância de 5% (p<0,05). Houve melhora para as medidas referentes ao ângulo de Charpy (p=0,048), CI (p=0,037), PFE (0,002), PIM (0,007), CrA (p=0,008) e CrX (p=0,041). A PEM e o CrU, apesar da melhora nos valores absolutos, não apresentaram resultados estatisticamente significativos. O programa de fisioterapia respiratória e postural produziu efeitos positivos sobre a função ventilatória de crianças respiradoras bucais.

This study aimed to evaluate the effects of the physiotherapy on the ventilatory parameters and thoracoabdominal dynamics of mouth breathing children. Ten mouth breathing children were undergone to 20 sessions of respiratory reeducation and postural correction through stretching and strengthening exercises on Swiss ball, diaphragmatic stimulation and stretching of the inspiratory accessory muscles. The data collected were measurements of the maximum inspiratory and expiratory pressures (MIP and MEP), inspiratory capacity (IC), peak expiratory flow (PEF), the chest wall mobility measured by the respiratory coefficient (Rc) at the levels of the axillary (RcA), xiphosternal (RcX) and umbilical (RcU) regions and biophotogrametry analysis of the Charpy angle. These were measured before and after 10 and 20 sessions. A 1-way repeated measures analysis of variance (ANOVA) was used to determine differences in variables among the three evaluations. Post-hoc comparisons were conducted with the Tukey's Test. It was considered a significance level of 5% (p<0.05). There were improvements on Charpy angle (p=0.048), IC (p=0.037), PEF (0.002), MIP (p=0.007), RcA (p=0.008) and RcX (p=0.041) measures. Although MEP and RcU improved their absolute values, the results were not statistically significant. The program of respiratory physiotherapy and postural correction produced positive effects on the ventilatory function of mouth breathing children.

Correlação entre postura da cabeça, intensidade da dor e índice de incapacidade cervical em mulheres com queixa de dor cervical / Correlation between head posture, pain and disability index neck in women with complaints of neck pain

A dor cervical é o sintoma mais comum das disfunções cervicais, frequentemente relacionado à manutenção de posturas inadequadas. As alterações posturais da cabeça estão associadas à ocorrência de dor cervical, sendo a anteriorização a alteração mais comum. O objetivo foi investigar a correlação entre postura da cabeça, intensidade da dor e índice de incapacidade cervical - neck disability index (NDI). O grupo estudo (GE) foi composto por mulheres na faixa entre 20 e 50 anos com queixas de dor cervical por mais de três meses, e o grupo controle (GC), por mulheres assintomáticas. A intensidade da dor foi avaliada pela escala visual analógica (EVA), a incapacidade pelo NDI e a postura da cabeça pelo ângulo craniovertebral (CV). A normalidade dos dados foi verificada pelo teste de Lilliefors, e a comparação entre os grupos pelo teste t de Student para amostras independentes e a associação entre as variáveis pela correlação de Spearman. O nível de significância foi de 5%. O GE apresentou médias menores para o ângulo CV (p=0,02). O ângulo CV demonstrou correlação negativa com a EVA (r=-0,48) e o NDI (r=-0,15), sugerindo que quanto menor o ângulo, maior a intensidade da dor e a incapacidade cervical. O NDI e a EVA apresentaram correlação positiva (r=0,59). O ângulo CV em indivíduos com dor cervical foi significativamente menor que em assintomáticos, apresentando correlação moderada com o NDI e a dor.

Neck pain is the most common symptom of cervical dysfunctions often being related to the maintenance of postures. Postural changes of the head are often associated with the occurrence of neck pain with an anterior approach was the most frequent. The purpose was to investigate the correlation between head posture, pain intensity and neck disability index. The study group (SG) was composed of women, aged between 20 and 50 years who complained of neck pain for more than three months, and the control group (CG) for asymptomatic women. Pain intensity was assessed by visual analogue scale (VAS), disability by neck disability index (NDI) and the head posture by the craniovertebral angle (CV). Normality of the data was verified by the Lilliefors test and the comparison between groups by the Student's t-test for independent samples, and the association between variables by Spearman correlation test. Significance level was 5%. The SG had lower average CV for the angle (p=0.02). The CV angle was negatively correlated with the VAS (r=-0.48) and NDI (r=-0.15) suggesting that the smaller the angle, the greater the intensity of neck pain and disability. The NDI and VAS showed a positive correlation (r=0.59). The angle CV in subjects with neck pain was significantly lower than in healthy individuals association with the neck disability index and pain.

Cervical spine dysfunction signs and symptoms in individuals with temporomandibular disorder / Frequência de sinais e sintomas de disfunção cervical em indivíduos com disfunção temporomandibular

PURPOSE: To study the frequency of cervical spine dysfunction (CCD) signs and symptoms in subjects with and without temporomandibular disorder (TMD) and to assess the craniocervical posture influence on TMD and CCD coexistence. METHODS: Participants were 71 women (19 to 35 years), assessed about TMD presence; 34 constituted the TMD group (G1) and 37 comprised the group without TMD (G2). The CCD was evaluated through the Craniocervical Dysfunction Index and the Cervical Mobility Index. Subjects were also questioned about cervical pain. Craniocervical posture was assessed by cephalometric analysis. RESULTS: There was no difference in the craniocervical posture between groups. G2 presented more mild CCD frequency and less moderate and severe CCD frequency (p=0.01). G1 presented higher percentage of pain during movements (p=0.03) and pain during cervical muscles palpation (p=0.01) compared to G2. Most of the TMD patients (88.24%) related cervical pain with significant difference when compared to G2 (p=0.00). CONCLUSION: Craniocervical posture assessment showed no difference between groups, suggesting that postural alterations could be more related to the CCD. Presence of TMD resulted in higher frequency of cervical pain symptom. Thus the coexistence of CCD and TMD signs and symptoms appear to be more related to the common innervations of the trigeminocervical complex and hyperalgesia of the TMD patients than to craniocervical posture deviations.

OBJETIVOS: Investigar a frequência de sinais e sintomas de disfunção da coluna cervical (DCC) em indivíduos com e sem disfunção temporomandibular (DTM) e avaliar a influência da postura craniocervical sobre a coexistência da DTM e da DCC. MÉTODOS: Participaram 71 mulheres, com idades entre 19 e 35 anos, que foram avaliadas quanto à presença de DTM. Destas, 34 constituíram o grupo com DTM (G1) e 37 participaram compuseram o grupo sem DTM (G2). A DCC foi avaliada pelo Índice de Disfunção Clínica Craniocervical e pelo Índice de Mobilidade Cervical. Questionou-se, ainda, a queixa de dor cervical. A postura craniocervical foi aferida por meio do traçado cefalométrico. RESULTADOS: Não houve diferença na entre os grupos quanto à postura craniocervical. O G2 apresentou maior frequência de DCC leve e menor frequência de DCC moderada ou grave (0,01). O G1 apresentou maiores percentuais de frequência de dor durante a execução do movimento e dor à palpação dos músculos cervicais. No G1, a maioria (88,24%) das participantes relatou dor cervical, com diferença em relação ao G2. CONCLUSÃO: Não houve diferença na postura craniocervical entre os grupos, o que sugere que as alterações posturais estejam mais relacionadas à ocorrência de DCC. A presença de DTM resultou em maior frequência de sintomas dolorosos na região cervical. Assim, a coexistência de sinais e sintomas de DCC e DTM parece estar mais relacionada à inervação comum do complexo trigêmino-cervical e à hiperalgesia de indivíduos com DTM do que à alteração postural craniocervical.

Efeito do treinamento de Isostretching sobre a dor lombar crônica: um estudo de casos / Effects of isostretching training in low back pain subjects: case studies

Estratégias de exercício e terapias físicas têm sido propostas para amenizar ou reverter déficits decorrentes da dor lombar. Neste trabalho investigamos a influência do método Isostretching no tratamento da dor lombar. Foram estudadas 10 estudantes universitárias com dor lombar (GE, grupo experimental) e10 estudantes universitárias sem dor lombar (GC, grupo controle). O GE foi submetido a 10 sessões de Isostretching e o GC não sofreu intervenção. Foram coletadas variáveis referentes à intensidade da dor através da escala visual analógica (EVA), força muscular através da goniometria, o grau de encurtamento da cadeia muscular anterior e posterior, e o equilíbrio corporal por uma plataforma de força. Os indivíduos foram avaliados em pré- e pós-treinamento. Os resultados demonstraram uma diminuição da dor lombar em todos os indivíduos e melhoras significativas quanto à força muscular, alongamento das cadeias musculares e equilíbrio. Conclui-se que método foi efetivo para o grupo estudado e é adequado para o tratamento da dor lombar.

Exercise programs and physical therapies have been proposed to minimize or reverse current deficits related to low back pain. Here the influence of Isostretching training on the low back pain was evaluated. Ten university students reporting low back pain (GE, experimental group) and ten university students without low back pain (GC, control group) were evaluated. GE was submitted to 10 sessions of Isostretching; GC remains sedentary. For pre and post- training period, the intensity of pain was evaluated throughout a subjective analogical visual scale (EVA), muscle strength evaluated by goniometry, degree of shortening in anterior and posterior muscle chains evaluated employing functional clinical tests, and body balance was evaluated with a force plate. The results showed decrease in the low back pain for all subjects, significantly improvement of muscle strength, lengthening of muscle chains, and improved postural control. It was concluded that the program applied was effective providing a healthy life and without pain the subjects.