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      Associação da atividade mastigatória com a função motora ampla, espasticidade e classificação topográfica na paralisia cerebral Translated title: Association between masticatory activity and gross motor function, spasticity and topographic classification in cerebral palsy

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          Abstract

          OBJETIVO: verificar a existência de associação entre o grau de espasticidade, o nível de função motora ampla e a classificação topográfica de voluntários com PC com parâmetros de amplitude e tempo da ativação eletromiográfica dos músculos temporal (TA) e masseter (MA). MÉTODOS: a atividade muscular durante a tarefa de mastigação foi avaliada em quinze voluntários com PC. Os instrumentos clínicos utilizados foram: a Escala Modificada de Ashworth para espasticidade, o Sistema de Classificação de Função Motora Ampla (GMFCS) para função motora ampla. Foram analisados os parâmetros de simetria muscular e tempo do período ativo e inativo do ciclo mastigatório. RESULTADOS: durante o ciclo mastigatório observou-se associação entre o nível de função motora ampla e a simetria do MA, entre o maior grau de espasticidade e a diminuição do período inativo e aumento do período ativo e entre a classificação topográfica e a simetria do MA e do TA. CONCLUSÃO: a simetria e o tempo da atividade dos músculos TA e MA devem ser considerados durante a terapia da função motora oral na PC.

          Translated abstract

          PURPOSE: to verify the existence of an association between the degree of spasticity, the level of motor function and wide topographical classification of CP children with amplitude and time parameters of electromyographic activation of temporalis (AT) and masseter (MA) muscles. METHODS: muscle activity during chewing task was evaluated in fifteen children with CP. The clinical instruments used were the Modified Ashworth Scale for spasticity, the Gross Motor Function Classification System (GMFCS) for gross motor function. We analyzed the parameters of muscular symmetry and time of active and inactive period of the masticatory cycle. RESULTS: there was an association between the level of motor function and the symmetry of the MA, between the highest degree of spasticity and decrease in the inactive period and increase in the active period of the masticatory muscles and between the topographical classification and symmetry of the MA and the symmetry of the AT. CONCLUSION: the symmetry and the time of activation of AT and MA should be considered during therapy of oral motor function of CP children.

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          Development of chewing in children from 12 to 48 months: longitudinal study of EMG patterns.

          Developmental changes in the coordinative organization of masticatory muscles were examined longitudinally in four children over 49 experimental sessions spanning the age range of 12-48 mo. Electromyographic (EMG) records were obtained for right and left masseter muscles, right and left temporalis muscles, and the anterior belly of the digastric. Two independent analytic processes were employed, one that relied on identification of onset and offset of muscle activation and a second that used pairwise cross-correlational techniques. The results of these two analyses, which were found to be consistent with each other, demonstrated that the basic chewing pattern of reciprocally activated antagonistic muscle groups is established by 12 mo of age. Nevertheless, chewing efficiency appears to be improved through a variety of changes in the chewing pattern throughout early development. Coupling of activity among the jaw elevator muscles was shown to strengthen with maturation, and the synchrony of onset and offset of these muscles also increased. Coactivation of antagonistic muscles decreased significantly with development. This decrease in antagonistic coactivation and increase in synchrony among jaw elevators, and a parallel decrease in EMG burst duration, were taken as evidence of increased chewing efficiency. No significant differences in the frequency of chewing were found across the ages studied. Additional considerations include the appropriateness of this coordinative infrastructure for other developing oromotor skills, such as speech production. It is suggested that the relatively fixed coordinative framework for chewing exhibited by these children would not be suitable for adaptation to speech movements, which have been shown to rely on a much more variable and adjustable coordinative organization.
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            Detection of onset and termination of muscle activity in surface electromyograms.

            A method of automated detection of onset and termination of rhythmic muscle activity in electromyograms (EMGs) is presented. A threshold level in the EMG is computed, such that amplitudes in the EMG signal exceeding this level indicate muscle activity. The threshold level is determined using a statistical criterion based on the amplitude distribution of the entire EMG signal. The working of the method is illustrated with EMG signals recorded from chewing muscles. EMG signals with a good as well as a worse signal-to-noise ratio are presented. The method can be used for any EMG signal containing cyclic bursts of activity and thus may be applied in studies on rhythmic movements, such as chewing, walking and breathing. An automated method of EMG burst detection has the advantage that large amounts of EMG data can be easily and objectively processed.
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              People With Cerebral Palsy: Effects of and Perspectives for Therapy

              The movement disorder of cerebral palsy (CP) is expressed in a variety of ways and to varying degrees in each individual. The condition has become more complex over the last 20 years with the increasing survival of children born at less than 28 to 30 weeks gestationai age. Impairments present in children with CP as a direct result of the brain injury or occurring indirectly to compensate for underlying problems include abnormal muscle tone; weakness and lack of fitness; limited variety of muscle synergies; contracture and altered biomechanics, the net result being limited functional ability. Other contributors to the motor disorder include sensory, cognitive and perceptual impairments. In recent years understanding of the motor problem has increased, but less is known about effects of therapy. Evidence suggests that therapy can improve functional possibilities for children with cerebral palsy but is inconclusive as to which approach might be most beneficial. The therapist requires an understanding of the interaction of all systems, cognitive/perceptual, motor, musculoskeletal, sensory and behavioral, in the context of the development and plasticity of the CNS. It is necessary to understand the limitations of the damaged immature nervous system, but important to optimize the child's functional possibilities.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcefac
                Revista CEFAC
                Rev. CEFAC
                CEFAC Saúde e Educação (São Paulo )
                1982-0216
                December 2013
                : 15
                : 6
                : 1533-1539
                Affiliations
                [1 ] Universidade do Estado de Santa Catarina Brazil
                Article
                S1516-18462013000600016
                10.1590/S1516-18462013000600016
                2df56089-05bd-43e3-89ac-469a46e8b8ae

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1516-1846&lng=en
                Categories
                REHABILITATION

                Physiotherapy
                Masticatory Muscles,Cerebral Palsy,Electromyography,Músculos Mastigatórios,Paralisia Cerebral,Eletromiografia

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