RESUMO
INTRODUCTION: Children diagnosed with attention deficit disorder (ADD) can present with different abnormalities in electrophysiological studies. OBJECTIVE: The purpose of this paper is to compare brainstem auditory (short latency) evoked responses (BSAER) and long latency auditory evoked responses (LLAER) in school children with and without ADD. MATERIALS AND METHODS: A normative study was carried out, 20 normal subjects were studied. All these patients underwent a study protocol including BSAER and LLAER. Eighteen school children diagnosed as ADD were included in the active group. Eighteen school children were selected as controls. All children from both groups underwent BSAER and LLAER. BSAER and LLAER results from both groups of patients were compared. RESULTS: Brainstem transmission was significantly longer in children with ADD. The latency of P300 was significantly longer in children with ADD. Also, mean amplitude of P300 was significantly decreased in children with ADD. CONCLUSION: The results of this study indicates that school children with ADD show significant abnormalities in BSAER and LLAER. These electrophysiological procedures involving the auditory system can be useful for the diagnosis of children with ADD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Potenciais Evocados Auditivos do Tronco Encefálico , Adulto , Estudos de Casos e Controles , Criança , Método Duplo-Cego , Eletroencefalografia , Potenciais Evocados Auditivos , Feminino , Humanos , Masculino , Probabilidade , Tempo de Reação , Valores de Referência , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Natural learning must include language learning relationships that provide natural support for communication and language learning. OBJECTIVE: To find out if including the mother as an active participant during speech therapy sessions would improve the communicative style and mode of the interaction of the mothers with their cleft palate children. MATERIALS AND METHODS: Fifty-nine children with cleft palate and their mothers were included in the study group. The patients were divided into two groups randomly. Patients received the same treatment. Twenty-eight of the children were included in the control group. They participated in small working groups comprising the speech pathologist and two children. Thirty-one of the children were included in the experimental group. In this case, the mothers of the children were also included as active participants. The mothers of the patients from the two groups were assessed at the beginning and end of the speech therapy period to find out their style and mode of interaction. Pre- and post-data of the mothers from both groups were compared. RESULTS: Eighty-nine per cent of the mothers of the experimental group modified their patterns of interaction. In contrast, only 19% of the mothers of the control group modified their style and mode of interaction. A Fisher exact test demonstrated that the frequency of mothers from the experimental group that modified their style and mode of interaction was significantly greater as compared to the number of mothers from the control group that were able to modify their style and mode of interaction. CONCLUSIONS: Mothers of children with cleft palate and accompanying language delay modify their communicative style and mode of interaction through active participation in speech therapy.
Assuntos
Fissura Palatina/reabilitação , Comunicação , Relações Mãe-Filho , Fonoterapia , Adulto , Pré-Escolar , Fissura Palatina/cirurgia , Feminino , Humanos , Comportamento MaternoRESUMO
Submucous cleft palate is a congenital malformation with specific clinical and anatomical features. It can be present with or without velopharyngeal insufficiency. Surgical treatment of this malformation is indicated only when velopharyngeal insufficiency has been demonstrated. This article compares two modalities of surgical treatment for submucous cleft palate. The first includes a minimal incision palatopharyngoplasty, as described in a previous report. The second combines the first technique with additional individualized velopharyngeal surgery (individualized pharyngeal flap or sphincter pharyngoplasty) performed simultaneously. The individualized part of the procedure was selected and performed according to the findings of videonasopharyngoscopy and multiview videofluoroscopy, as reported previously. Two hundred and three patients with submucous cleft palate were studied from 1990 to 1999. Videonasopharyngoscopy and multiview videofluoroscopy demonstrated velopharyngeal insufficiency in 72 patients, who were randomly divided into two groups. Those in group 1 (n = 37) underwent a minimal incision palatopharyngoplasty. Patients in group 2 (n = 35) also underwent that procedure but simultaneously received individualized pharyngeal flap or sphincter pharyngoplasty, according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. The median age of the patients from both groups was not significantly different (p > 0.5). The frequency of residual velopharyngeal insufficiency after palatal closure was not significantly different in both groups of patients (14 percent versus 11 percent; p > 0.5). The mean size of the gap at the velopharyngeal sphincter during speech was not significantly different in both groups of patients before surgery (23 percent versus 22 percent; p > 0.5). After the surgical procedures, there was a nonsignificant difference between both groups of patients in mean residual size of the gap in cases of velopharyngeal insufficiency (7 percent versus 8 percent; p > 0.5). It seems that minimal incision palatopharyngoplasty is a safe and reliable procedure for palatal closure in patients with submucous cleft palate. The use of additional individualized velopharyngeal surgery performed simultaneously did not seem to decrease the frequency of residual velopharyngeal insufficiency. Moreover, the residual size of the gap at the velopharyngeal sphincter was not significantly reduced when an additional surgical procedure was performed simultaneously with palatal closure.
Assuntos
Fissura Palatina/cirurgia , Palato/cirurgia , Transtornos da Articulação/etiologia , Transtornos da Articulação/reabilitação , Criança , Pré-Escolar , Fissura Palatina/complicações , Fissura Palatina/patologia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Faringe/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Fonoterapia , Resultado do Tratamento , Insuficiência Velofaríngea/diagnóstico , Insuficiência Velofaríngea/etiologia , Insuficiência Velofaríngea/cirurgiaRESUMO
BACKGROUND: A method is needed to measure parameters of vertigo and disequilibrium. Our objective was to ascertain whether the vestibular autorotation test (VAT) gives numerical data on the vestibular oculomotor reflex (VOR) that are useful for clinical research. METHODS: A VAT was carried out on 17 healthy young volunteers twice, with an interval of 7 days (group A), and on a single occasion on another 17 volunteers of similar age and health (group B). The parameters studied were vertical and horizontal gains and phases and horizontal eye velocity symmetry. The resulting values were paired inter-session in the same individuals of group A, and between the first test of group A with the test in group B, chosen at random. Variances for the sets of numbers in each parameter as a whole and for each frequency of stimulation were calculated and statistical validity was determined. RESULTS: No significant differences were found between the inter-session and inter-individual results. Variances of gain (horizontal and vertical) were small, but variances of phase and symmetry were large. An analysis of frequencies of stimulation revealed that variances increased with the elevation of frequency. CONCLUSIONS: For clinical research and evaluation, the VAT affords sufficiently consistent figures for vertical and horizontal gain in the entire spectrum of frequencies tested (2-5.9 Hz) and for horizontal phases between 2-3.9 Hz. Vertical phases and horizontal asymmetry vary too greatly for our stated purpose.
Assuntos
Reflexo Vestíbulo-Ocular/fisiologia , Testes de Função Vestibular/estatística & dados numéricos , Adulto , Análise de Variância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa , Testes de Função Vestibular/métodosRESUMO
The experience with free flaps and conventional reconstructive procedures for 118 patients with Rombergapos;s disease and hemifacial microsomia over a 10-year period is presented. The groin free flap was used most frequently for patients with Rombergapos;s disease, whereas the scapular free flap was used for patients with hemifacial microsomia. The rectus abdominis or the latissimus dorsi free flap was chosen only when additional volume was required. To achieve better contour, secondary procedures, such as defatting the flap, pedicled temporal fascial flaps, cartilage and bone grafts, orthognathic surgery, and bone distraction were performed in severe cases. For patients with Rombergapos;s disease, excellent results were achieved in 35% (n = 28) of mild cases, in 72% (n = 27) out of 38 moderately and in 41% (n = 5) out of 12 severely affected patients. In hemifacial microsomia group (n = 40) excellent results were obtained in 66% of cases.
Assuntos
Assimetria Facial/cirurgia , Hemiatrofia Facial/cirurgia , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Adulto , Transplante Ósseo , Criança , Feminino , Humanos , Masculino , Microcirurgia , Escápula/transplanteRESUMO
Two hundred free flaps for reconstructing the head and neck regions in 192 patients with non-oncological pathology were studied. Pathological entities included Romberg's disease, hemifacial microsomia, acquired facial palsy, trauma, and burn sequelae. Indications for selecting a specific free flap for reconstructing each case, details of anastomoses, reexploration, flap success, operative time, length of hospitalization, and complications were studied. The long-term results of cosmetic and function were also obtained. Patient age ranged from 6 to 40 years. The most common diagnosis was Romberg's disease 39% (n = 75), followed by hemifacial microsomia 20% (n = 40). The free flap most frequently used was the scapular 32% (n = 64), followed by the groin free flap 21% (n = 42). A total of 190 flaps (95%) were successful, whereas only 10 (5%) were lost. The mean operative time was 5:30 h and the average hospital stay was only 6 days. There were no major complications and no deaths in the study group. The patients were followed for at least 1 year in all cases. It is concluded that free flaps are safe and reliable procedures for reconstructing complex head and neck non-oncological defects.
Assuntos
Queimaduras/cirurgia , Assimetria Facial/cirurgia , Hemiatrofia Facial/cirurgia , Traumatismos Faciais/cirurgia , Lesões do Pescoço/cirurgia , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Adolescente , Adulto , Queimaduras/complicações , Criança , Contratura/cirurgia , Humanos , Lipodistrofia/cirurgia , Estudos RetrospectivosRESUMO
INTRODUCTION: Cleft palate patients frequently show compensatory articulation disorder (CAD). CAD severely affects speech intelligibility and requires a prolonged period of speech intervention. CAD has been considered a phonologic disorder. Thus, it seems necessary to explore the relationship between CAD and language development. OBJECTIVE: To study the relationship between language development and the presence of CAD in cleft palate patients. MATERIALS AND METHODS: Cleft palate children with residual velopharyngeal insufficiency (VPI) after palatal closure, with and without CAD were studied. Only patients with an age ranging from 3 to 8 years were included in the study group. Twenty-nine cleft palate patients with residual VPI and CAD were included in the first group (active). The second group was assembled with 29 cleft palate patients with residual VPI without CAD, matched by age and sex (control). For evaluating language development, all patients were analyzed using the Situational-Discourse-Semantic (SDS) Model [13]. This Model is a valuable tool for conducting naturalistic observation and descriptive assessment of language development. The SDS Model provides a detailed description of three contexts (situational, discourse, and semantic) in ten levels of cognitive and linguistic organization. RESULTS: In all contexts considered by the model of cognitive and linguistic organization used for this study, i.e. SDS, a Fischer exact test demonstrated that patients with CAD showed a significantly higher frequency of language delay as compared with patients without CAD. None of the patients present with CAD showed an adequate level of language development. The degree of language delay was greater in the situational context as compared to the semantic and discourse contexts. CONCLUSIONS: Cleft palate patients present with CAD, demonstrated a significantly higher frequency of delay in language development as compared with cleft palate patients present with VPI without CAD. From the results of this paper, it seems that a detailed evaluation of all aspects of cognitive and linguistic organization should be performed in cleft palate patients, especially in patients present with CAD. Moreover, it seems that speech intervention in cleft palate patients with CAD should address not only the articulation process, but also specific aspects of language development.
Assuntos
Transtornos da Articulação/diagnóstico , Fissura Palatina/complicações , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Patologia da Fala e Linguagem/métodos , Adaptação Fisiológica , Transtornos da Articulação/etiologia , Criança , Pré-Escolar , Fissura Palatina/fisiopatologia , Feminino , Seguimentos , Humanos , Desenvolvimento da Linguagem , Transtornos do Desenvolvimento da Linguagem/etiologia , Masculino , Monitorização Fisiológica , Probabilidade , Medição de Risco , Testes de Articulação da FalaRESUMO
To compare two modalities of speech intervention (SI) in cleft palate children with compensatory articulation disorder (CAD). The first modality was a phonologic based intervention, the second modality was an articulatory or phonetic intervention. The main purpose is to study whether a phonologic intervention may reduce the total time of speech therapy necessary for correcting CAD in cleft palate children as compared to an articulatory intervention. A prospective, comparative, and randomized trial was carried out. Cleft palate children with velopharyngeal insufficiency and CAD were included in the study group. Only patients with an age ranging from 3 to 7 years were included. A total of 29 patients were selected and were divided randomly into two groups. Fifteen patients were included in the first group (control) and received articulatory SI. Fourteen patients were included in the second group (active) and received phonologic SI. The speech pathologist in charge of the SI was the same in all cases. A blind procedure was utilized whereby each patient was evaluated independently by two speech pathologist every three months until both examiners were convinced that CAD had been completely corrected. The mean total time of SI required for the normalization of speech in the two groups of patients was compared. Median age in the control group was 54 months, and 55.50 months in the active group (P > 0.05). The mean total time of SI in the control group was 30.07, and 14.50 in the active group. A Student's t-test demonstrated that the total time of SI was significantly reduced (P < 0.001) when a phonological intervention was utilized. Phonologic based SI significantly reduced the time necessary for correcting CAD in cleft palate children.
Assuntos
Transtornos da Articulação/etiologia , Transtornos da Articulação/terapia , Fissura Palatina/complicações , Fonoterapia/métodos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Fonética , Distribuição Aleatória , Medida da Produção da Fala , Fatores de TempoRESUMO
The frontotemporal fasciocutaneous island flap is a useful source of tissue for correcting aesthetic units of the face. The quality of the tissue may be enhanced, and a successful color and texture match may be achieved. This flap is based on the temporal vessel system and its own fascia. Its provides excellent venous drainage and its pedicle length and arc of rotation may be increased. The donor scar is hidden under the hair-bearing area. The frontotemporal fasciocutaneous island flap was used in patients with inferior eyelid defects, for cheek reconstruction, for providing coverage of superior and inferior lip defects, for restoring the normal anatomy of columellar defects, and for reestablishing the contour of menton defects. The frontotemporal fasciocutaneous island flap was employed successfully in 9 patients at the Hospital Gea Gonzalez. The wide treatment possibilities for the reconstruction of aesthetic units in the face with the frontotemporal fasciocutaneous island flap are illustrated.
Assuntos
Face/cirurgia , Traumatismos Faciais/cirurgia , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Adolescente , Adulto , Bochecha/cirurgia , Procedimentos Cirúrgicos Dermatológicos , Pálpebras/cirurgia , Neoplasias Faciais/cirurgia , Fasciotomia , Feminino , Humanos , Lábio/cirurgia , Masculino , Pessoa de Meia-Idade , Transplante Autólogo , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Sphincter pharyngoplasty is a surgical procedure for managing velopharyngeal insufficiency after palatal closure. This procedure is intended to create an active diaphragm for velopharyngeal closure. The purpose of this study was to evaluate velopharyngeal motion after sphincter pharyngoplasty, by using selective electromyography and simultaneous videonasopharyngoscopy. Twenty-five patients who were subjected to sphincter pharyngoplasty from 1985 to 1996 were reviewed. All conditions were evaluated by using electromyography with simultaneous videonasopharyngoscopy. The following velopharyngeal muscles were examined: superior constrictor pharyngeus, palatopharyngeus, and levator veli palatini. The palatopharyngeus was included in the superiorly based surgical flaps inserted at the posterior pharyngeal wall. Twenty-three patients (92 percent) showed complete velopharyngeal closure. The two patients with residual velopharyngeal insufficiency showed a defect size of 20 and 25 percent. None of the patients showed electromyographic activity at the superiorly based flaps, indicating absence of activity of the palatopharyngeus muscles. However, all patients showed normal electromyographic activity at the superior constrictor pharyngeus and the levator veli palatini. Videonasopharyngoscopy demonstrated that lateral pharyngeal wall movements, which ranged from 25 to 40 percent, were related to strong electromyographic activity at the superior constrictor pharyngeus. It is concluded that the superiorly based pharyngeal flaps of the sphincter pharyngoplasty do not seem to create an active diaphragm for velopharyngeal closure. Moreover, the observed sphinctering seems to be passive, caused by the contraction of the superior constrictor pharyngeus.