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A força muscular respiratória em crianças e adolescentes com Síndrome de Down é comprometida pela hipotonia generalizada que os acometem. Analisar os efeitos da fisioterapia aquática na força muscular respiratória em crianças e adolescentes com síndrome de Down. Estudo de intervenção, quasi-experimental, com amostra constituída de oito crianças e adolescentes diagnosticados com SD e média de idade de 12 anos (± 3,8). Foram realizadas 10 sessões de fisioterapia aquática, com 50 minutos de duração cada, em piscina com água aquecida. A força muscular respiratória foi avaliada a partir da pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx) com auxílio do manuvacuômetro, sendo obtido seus valores antes do primeiro atendimento e após o último. Analisou-se ainda a saturação periférica de oxigênio e frequência cardíaca. Para comparação das médias antes e depois da intervenção foi utilizado o Teste T pareado. Amostra de indivíduos predominantemente do sexo feminino (75,0%), pardos (75,0%) e residentes em zona urbana (87,5%). A comparação da PImáx e PEmáx antes e após as 10 sessões de fisioterapia aquática evidenciou melhora da força muscular inspiratória e expiratória, sendo tais diferenças estatisticamente significantes (valor de p<0,01). Também foram notadas melhorias na frequência cardíaca e saturação de oxigênio (valor de p<0,05) com a intervenção. Destaca-se neste estudo que a fisioterapia aquática parece ser um recurso terapêutico eficiente para o fortalecimento da musculatura respiratória e melhora dos sinais vitais de crianças e adolescentes de com diagnóstico de Síndrome de Down.

Respiratory muscle strength in children and adolescents with Down syndrome is compromised by the generalized hypotonia that affects them. This study aims to analyze the effects of aquatic physical therapy on respiratory muscle strength in children and adolescents with Down syndrome. Material and method: A quasi-experimental study with a sample consisting of eight children and adolescents diagnosed with DS and mean age of 12 years (± 3.8). Ten sessions of aquatic physiotherapy were performed, each with a duration of 50 minutes, in a pool with heated water. Respiratory muscle strength was assessed from maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) using a manuvacuometer, and its values were obtained before the first session and after the last one. Peripheral oxygen saturation and heart rate were also analyzed. The paired T-test was used to compare the means before and after the intervention. Sample of predominantly female (75.0%), brown (75.0%) and urban residents (87.5%). The comparison of MIP and MEP before and after the 10 sessions of aquatic physiotherapy showed an improvement in inspiratory and expiratory muscle strength, and these differences were statistically significant (p <0.01). Improvements in heart rate and oxygen saturation (p value <0.05) were also noted with the intervention. In this study, aquatic physiotherapy seems to be an efficient therapeutic resource for the strengthening of respiratory muscles and improvement of the vital signs of children and adolescents diagnosed with Down's Syndrome.

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El síndrome del niño hipotónico es una entidad bien reconocida por pediatras y neonatólogos. Se refiere a un niño con hipotonía generalizada presente desde el nacimiento o infancia precoz. Es el signo de disfunción neurológica más frecuente en el recién nacido y lactante, resultado de injurias agudas o crónicas a cualquier nivel del sistema nervioso, desde la corteza cerebral al músculo. Por la multiplicidad de causas y condiciones que subyacen a la hipotonía es imprescindible un enfoque ordenado y sistemático en la evaluación del niño hipotónico.

Floppy infant syndrome is a well recognized entity for pediatricians and neonatologists. It refers to a child with decreased muscle tone present at birth or in early infancy. It is the commonest sign of neurological dysfunction in newborns and infants, which can result from acute or chronic injuries at any level of the nervous system from cerebral cortex to muscle. Because of the multiple causes and conditions underlying hypotonia, asystematic assessment is essential in the approach to the floppy infant.

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Hypotonia is understood to refer to a pronounced decrease in muscle tone that affects normal motor development and that may affect the axial muscles as well as those of the limbs and, sometimes, the face. It is a very challenging clinical picture because it consists in a fairly wide range of conditions that affect different areas of the central and peripheral nervous system and may be the expression of pathologies that can be either benign or of an uncertain prognosis. These cover myopathies, metabolic disorders, diseases based on genetic causes, pathologies affecting the endocrine glands and progressive or chronic diseases, among other aetiologies. The important development of medicine today has made a number of tools available to the examiner with which to refine or pronounce a diagnosis. Such instruments include the developments achieved in genetic research, together with studies conducted in imaging and optical and electronic microscopy. However, in spite of having all this material available for use, it is still the clinical features that allow a rational use to be made of these advances to be able to point towards the possible causation, topographic location and developmental control. It is useful, for the diagnostic approach and the use of auxiliary methods, to know the topographic location of the disorder, whether it is situated in the brain, the cerebellum, the stem, the spinal cord, the peripheral nerves, the myoneural junction or the muscle.

TITLE: Sindrome hipotonico del lactante.Entendemos como hipotonia la disminucion acentuada del tono muscular que afecta al desarrollo motor normal y que puede afectar a la musculatura axial y de los miembros y, en ocasiones, a la facial. Es un cuadro que genera un gran desafio ya que, en su universo, comprende una serie bastante amplia de condiciones que afectan a distintas areas del sistema nervioso, tanto central como periferico, y que pueden ser expresion de patologias de corte benigno o de pronostico reservado. Abarcan miopatias, alteraciones metabolicas, enfermedades de corte genetico, endocrinopatias y enfermedades progresivas o cronicas, entre otras causas. El gran desarrollo de la medicina actual ha logrado poner a disposicion del examinador multiples herramientas que permiten afinar o aseverar el diagnostico, entre las que destacan los desarrollos logrados en las investigaciones geneticas, asi como los estudios de imagenes y de microscopia optica y electronica. Sin embargo, pese a toda esta oferta, sigue siendo la clinica la que permite usar racionalmente estos avances y orientar hacia la posible etiologia, localizacion topografica y control evolutivo. Es de utilidad, para el enfoque diagnostico y la utilizacion de metodos auxiliares, que la localizacion topografica de la afectacion ya este esta ubicada en el cerebro, el cerebelo, el tallo, la medula, los nervios perifericos, la union mioneural o el musculo.

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Down's syndrome children shown multiple alterations, among them marked general hypotonic. While this produces some basic difficulties, at the orofacial level it generates a characteristic expression marked by open mouth, hypotonic tongue that rests upon the lower lip, and great salivation. To ameliorate this, an orofacial regulation therapy was initiated, to stimulate this musculature, strengthen it and mold it during development. Objective: To observe the effect of stimulating palate plates, and orofacial exercises in the function and tonicity of children with Down's syndrome. Patients and Methods: Five children, 10 to 21 months old, with Down's syndrome, were treated through orofacial regulation for 20 to 30 minutes, 4 times a day for 2 months (palate plates and orofacial stimulation exercises). Pre and post treatment evaluations were made and a photographic and video evaluation was registered weekly. Results and Conclusions: Therapy decreased lingual protrusion and increased mouth closure. This is not thought as real tonicity change since that statement would require a long term and wider area study to determine effectiveness and applicability.

Introducción: Se sabe que los pacientes con Síndrome de Down presentan múltiples alteraciones, entre ellas marcada hipotonía general lo que dificulta las funciones básicas y a nivel orofacial genera una expresión característica de boca abierta, lengua hipotónica descansando sobre el labio inferior y gran salivación. En respuesta a esto se creó la terapia de regulación orofacial que estimula la musculatura orofacial, para fortalecerla y modelarla durante el desarrollo. Objetivo: Observar los efectos de las placas palatinas estimulantes y de los ejercicios orofaciales, en la función y tonicidad de la musculatura orofacial de niños con Síndrome de Down. Pacientes y Métodos: seleccionamos 5 niños con síndrome de Down, entre 10 y 21 meses de edad, se les aplicó la terapia de regulación orofacial durante 2 meses con uso de 20 a 30 min por 4 veces al día (placas palatinas estimulantes y ejercicios de estimulación orofacial). Se realizaron evaluaciones pre y post tratamiento, y controles semanales con registro fotográfico y video. Resultados y Conclusiones: La terapia aumentó el cierre bucal y disminuyó la protrusión lingual. Sin embargo, no se observaron cambios "reales" en la tonicidad muscular, ya que su evaluación requiere estudios a largo plazo y de un universo mayor, para determinar la efectividad de la técnica y masificar su aplicación.

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OBJECTIVE: To report national variations in diagnostic approaches to apparent life-threatening events (ALTEs) and resource utilization. STUDY DESIGN: Using the Pediatric Health Information System, we studied children who were age 3 days to 5 months at admission and were discharged with an International Classification of Diseases, Ninth Revision (ICD-9) code potentially identifiable as ALTE. Multiple analysis of variance was used to determine whether the variances in adjusted charges, length of stay (LOS), and diagnostic studies were hospital-related after controlling for other covariates. Logistic regression was used to study the association of readmission rates with discharge diagnosis and specific diagnostic studies. RESULTS: The study group comprised 12,067 patients, with a mean LOS of 4.4 days (standard deviation +/- 5.6 days) and mean adjusted charges of $15,567 ($28,510) per admission. The mean in-hospital mortality rate was 0.56% (n = 68), and the rate of 30-day readmission was 2.5%. The most common discharge diagnoses were gastroesophageal reflux 36.9% (48.3%) and lower respiratory tract infection 30.8% (46.2%). Mean LOS, total adjusted charges, and use of diagnostic studies varied considerably across hospitals, and hospital-level differences were a significant contributor to the variance of these outcomes after controlling for covariates (P < .001). There was an increased likelihood of readmission for patients discharged with a diagnosis of cardiovascular disorders (odds ratio [OR] = 1.68; 95% confidence interval [CI] = 1.30 to 2.16) and gastroesophageal reflux (OR = 1.32; 95% CI = 1.03 to 1.69) compared with other discharge diagnoses. CONCLUSIONS: There is considerable hospital-based variation in care for patients hospitalized for conditions potentially identifiable as ALTE, particularly in the evaluation and diagnosis of gastroesophageal reflux, which may contribute to adverse clinical and financial outcomes. An evidence-based national standard of care for ALTE is needed, as are multi-institutional initiatives to study different diagnostic and management strategies and their effect on patient outcomes.

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A rural-area resident male patient deliberately ingested chlorpiriphos, an organophosphate insecticide. Although presented with cholinergic symptoms initially, he suffered general condition deterioration after 4 d characterized by muscular weakness, hypotonia, arreflexia and recumbent dyspnea requiring ventilatory support. These clinical manifestations occur from liposoluble organophosphates or metabolites with long-lasting half time, causeing delayed inhibition of acetylcholinesterase and subsequent burn out of the neuromuscular junction from acetylcholine overstimulation.

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O artigo relata um caso clínico de luxaçäo temporomandibular e hipotonia dos músculos faciais do lado direito, após intervençäo odontológica, tratado através de fisioterapia (exercícios de coordenaçäo muscular) e placa interoclusal

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