doctoralThesis
Efeitos agudos das cargas inspiratórias nos volumes da parede torácica e atividade elétrica dos músculos respiratórios em adultos saudáveis e crianças respiradores orais
Fecha
2019-09-26Registro en:
FONSECA, Jéssica Danielle Medeiros da. Efeitos agudos das cargas inspiratórias nos volumes da parede torácica e atividade elétrica dos músculos respiratórios em adultos saudáveis e crianças respiradores orais. 2019. 117f. Tese (Doutorado em Fisioterapia) - Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, 2019.
Autor
Fonseca, Jéssica Danielle Medeiros da
Resumen
Introduction: Mouth breathing (MB) most commonly found in children is a respiratory
disorder in which the subject adopts an oral mode to supplement or totally replace the
normal nasal breathing. This disorder results in an imbalance of the stomatognathic
system, which leads to structural changes in the jaws and changes in posture, speech,
swallowing, sleep and breathing. Nasal breathing is the physiologic pattern and has
advantages when compared to oral breathing. However, the respiratory resistance devices
available in the market use mouthpieces (oral airway). The use of inspiratory overloads
aims to improve endurance and muscle strength to improve lung function, for this,
different modalities of respiratory muscle training have been reported in the literature.
Based on what has been described this thesis presents two studies resulting from its
research line: 1) a study of the use of inspiratory overloads with different interfaces in
healthy adult subjects and 2) a second study of the use of inspiratory overloads via nasal
airway with different inspiratory resistance devices in mouth breathing children. Aims:
The aim of this thesis was to evaluate the acute effects of different inspiratory overloads
intensities, different interfaces and different inspiratory resistance devices on the
breathing pattern and respiratory muscle activity of healthy adult subjects and mouth
breathing children. Methods: 1) Twenty healthy adults were recruited and assigned to
two groups based on inspiratory load intensity (20 and 40% of the Maximal Inspiratory
Pressure) by way of randomized crossover allocation. Subjects were evaluated during
quiet breathing, breathing against inspiratory load, and recovery. The measurements were
repeated using two different interfaces (nasal and oral). 2) Thirty-nine children with
mouth breathing syndrome (MBS) were randomized into two groups based on inspiratory
load intensity (20% and 40% of the Maximal Inspiratory Pressure). These children were
assessed during quiet breathing, breathing against inspiratory load via nasal airway and
recovery. The measurements were repeated using two different devices (pressure
threshold and flow resistance). In both studies during the intervention protocol, chest wall
volumes and respiratory muscles activity were evaluated by optoelectronic
plethysmography and surface electromyography, respectively. Results: 1) During the
application of inspiratory load, significant changes were observed in the respiratory rate
(p < 0.04), inspiratory time (p < 0.02), minute ventilation (p < 0.04), tidal volume (p <
0.01), end-inspiratory volume (p < 0.04), end-expiratory volume (p < 0.03), and in the
activity of the scalene, sternocleiomastoid, and parasternal portion of the intercostal muscles (RMS values, p < 0.01) when compared to quiet breathing, regardless of the load
level or the interface applied. Inspiratory load application generated an increase in the
tidal volume (p < 0.01), end-inspiratory volume (p < 0.01), and electrical activity of the
scalene and sternocleiomastoid muscles (p < 0.01) with the use of nasal interface when
compared to oral. 2) During the application of inspiratory load, significant changes
occurred in respiratory rate (p<0.04), inspiratory time (p<0.02), total time of respiratory
cycle (p<0.02), minute volume (p<0.03), tidal volume (p<0.01) and scalene and
sternocleidomastoid muscles activity (RMS values, p<0.01) when compared to quiet
spontaneous breathing and recovery, regardless of load level or device applied. The
application of inspiratory load using the flow resistance device showed an more increase
in the tidal volume (p<0.02) and end-inspiratory volume (p<0.02) when compared to
pressure threshold. Conclusion: Both studies open new physiological and therapeutic
perspectives. These are precursor studies regarding the assessment of chest wall volumes
and compartments, as well as the analysis of the electrical activity of respiratory muscles.
Study 1 shows that the addition of inspiratory loading has a significant effect on the
breathing pattern and electrical activity of respiratory muscles, and these effects are
greater when the nasal interface is applied. Study 2 shows that the addition of inspiratory
loading using a nasal interface has a positive effect on the breathing pattern and electrical
activity of inspiratory muscles, and the FR device was more effective for lung volume
generation.