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      Adolescents with HIV and facial lipoatrophy: response to facial stimulation

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          Abstract

          OBJECTIVES:

          This study evaluated the effects of facial stimulation over the superficial muscles of the face in individuals with facial lipoatrophy associated with human immunodeficiency virus (HIV) and with no indication for treatment with polymethyl methacrylate.

          METHOD:

          The study sample comprised four adolescents of both genders ranging from 13 to 17 years in age. To participate in the study, the participants had to score six or less points on the Facial Lipoatrophy Index. The facial stimulation program used in our study consisted of 12 weekly 30-minute sessions during which individuals received therapy. The therapy consisted of intra- and extra-oral muscle contraction and stretching maneuvers of the zygomaticus major and minor and the masseter muscles. Pre- and post-treatment results were obtained using anthropometric static measurements of the face and the Facial Lipoatrophy Index.

          RESULTS:

          The results suggest that the therapeutic program effectively improved the volume of the buccinators. No significant differences were observed for the measurements of the medial portion of the face, the lateral portion of the face, the volume of the masseter muscle, or Facial Lipoatrophy Index scores.

          CONCLUSION:

          The results of our study suggest that facial maneuvers applied to the superficial muscles of the face of adolescents with facial lipoatrophy associated with HIV improved the facial area volume related to the buccinators muscles. We believe that our results will encourage future research with HIV patients, especially for patients who do not have the possibility of receiving an alternative aesthetic treatment.

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          Most cited references64

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          Anthropometry of the head and face

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            Self-perception of body changes in persons living with HIV/AIDS: prevalence and associated factors.

            Highly active antiretroviral therapy has brought about a substantial improvement in the prognosis of HIV/AIDS. In this context, therapy-related body changes (lipodystrophy) gain in importance, in light of the psychological distress they cause and of their association with adherence to treatment. This study analyses patients' self-perception of central fat gain (CFG) and peripheral fat loss (PFL). A total of 457 patients were interviewed in a university outpatient facility for the treatment of adults and adolescents with HIV/AIDS in the city of São Paulo, Brazil, between September and December 2001. Two-thirds of subjects (64.3%) perceived body changes. The self-perception of CFG and PFL was associated with greater schooling. The self-perception of CFG was more frequent among women and in patients who used protease inhibitors for longer periods. The self-perception of PFL was more frequent among older patients, patients who used stavudine for longer periods, and patients who reported a lack of adherence to antiretroviral agents. The quality of affective/social relationships with friends and family was inversely associated with the self-perception of PFL. The evaluation of self-perceived body changes and their determinants in individuals living with HIV/AIDS may help improve provided care. Listening to what patients have to say concerning antiretroviral therapy-related body changes and how they perceive them, as well as including the patient in therapeutic decisions in this regard will contribute towards greater adherence to proposed interventions and towards an improvement in the quality of life.
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              Central pattern generation and the motor infrastructure for suck, respiration, and speech.

              The objective of the current report is to review experimental findings on centrally patterned movements and sensory and descending modulation of central pattern generators (CPGs) in a variety of animal and human models. Special emphasis is directed toward speech production muscle systems, including the chest wall and orofacial complex during patterned motor output. Experimental results indicate that CPGs subserving orofacial motor behavior can be modulated via descending and sensory inputs. This feature of control may also operate in the control of other centrally patterned motor behaviors including speech breathing, suck, mastication, and the recombination of CPG processes for the development and production of speech. Readers will be able to: (1) define the salient characteristics of CPGs, (2) list five factors which influence the development and operation of a CPG over the lifespan, (3) define sensorimotor entrainment of CPGs, and (4) describe one new application for therapeutic training of the non-nutritive suck in premature infants.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics (Sao Paulo)
                Clinics
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                August 2014
                : 69
                : 8
                : 574-578
                Affiliations
                [I ]Fundação de Proteção Especial do Rio Grande do Sul, Porto Alegre/RS, Brazil.
                [II ]Faculdade de Medicina da Universidade de Sao Paulo, Physiotherapy, Speech-Language and Hearing Sciences, and Occupational Therapy, Sao Paulo/SP, Brazil.
                [III ]Universidade Estadual do Rio de Janeiro, Microbiology, Immunology and Parasitology, Rio de Janeiro/RJ, Brazil.
                Author notes

                Gabana-Silveira JC was involved in data collection and analysis, interpretation of the results, and manuscript writing. Mangilli LD participated in organizing and conducting the statistical analyses, interpretation of the results, and writing a major portion of the paper. Sassi FC was responsible for gathering and analyzing data, and conducting the statistical analyses. Braga AF was responsible for the medical criteria adopted in the experimental design and contributed to data analysis and manuscript preparation. Andrade CR was responsible for the research and experimental design and contributed to data analysis and manuscript preparation.

                E-mail: clauan@ 123456usp.br Tel.: 55 11 3091-8406
                Article
                cln_69p574
                10.6061/clinics/2014(08)12
                4129557
                c8e81aea-2027-4aed-ba01-68fea4f4c4e7
                Copyright © 2014 Hospital das Clínicas da FMUSP

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 December 2013
                : 14 January 2014
                : 21 February 2014
                Page count
                Pages: 5
                Categories
                Rapid Communication

                Medicine
                speech,language and hearing sciences,hiv,associated lipodystrophy syndrome,therapeutics
                Medicine
                speech, language and hearing sciences, hiv, associated lipodystrophy syndrome, therapeutics

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