No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Comparative analysis of method effectiveness for relieving masticatory muscle hypertonicity in children with cerebral palsy
Abstract
Relevance . Relevance. Cerebral palsy is a persistent lesion of the nervous system. Though it is stable, the consequences of the lesion are progressing. Muscle hypertonicity is one of the principal complications which may progress. The spasticity of chewing muscles limits mouth opening, which prevents the children from practising good oral hygiene and results in multiple dental diseases. Such patients need dental care with a specific approach. The relief of masticatory muscle hypertonicity should be a priority. Nowadays, there is a large variety of methods for treating spasticity.The study aimed to comparatively analyse the effectiveness of methods for relieving masticatory muscle hypertonicity in children with cerebral palsy. Materials and methods . The patients formed two groups: the first group used kinesio taping to reduce spasticity, and the second group was prescribed adaptive chewing muscles exercises combined with the gnathic device. The study evaluated the clinical results using the developed screening diagnosis and functional results by electromyographic examination after 14 days and three months. Results . Both groups showed positive treatment routcomes. Children demonstrated significant improvement clinically and electromyographically. However, the short-term observation discovered a faster effect of kinesio taping, though the differences were not statistically significant. Adaptive chewing muscles exercises combined with the gnathic device are more effective in the long run, which statistical analysis of data reliably ref lects. Conclusion . The study reliably proved the need to include both kinesio taping and adaptive myofunctional exercises in the treatment to relieve muscle hypertonicity. There were no side effects or complications. Treatment planning requires an individual approach based on the clinical situation .
To understand the processes occurring during the development of temporomandibular myofascial pain syndrome, a clear description of the anatomical components is necessary. In the literature, the term «stomatognathic system» is used for this, the elements of which are the temporomandibular joint, masticatory muscles and the dental periodontal complex. Each component of the system is influenced by a number of factors, primarily psychological, which causes the subjectivization of clinical manifestations from headaches to pathological tooth cutting and the development of temporomandibular joint dysfunction. One of the methods of treating this pathology is to inject botulinum toxin type A into the chewing muscles. However, the question of the choice of methods of administration of botulinum toxin and its dosage remains relevant.
Materials and methods. Botulinum toxin injections were performed outside and intraoral in 30 patients with temporomandibular myofascial pain syndrome. The effectiveness of the therapy was evaluated on the basis of clinical examination data, analysis of the degree of mouth opening before the start of treatment, after 14 days, 6 and 12 months.
Results. The high efficiency of botulinum toxin type A injections in the treatment of the above pathology has been proven.
Conclusion. It is important to evaluate the effectiveness of treatment based on the developed clinical examination methods, if necessary, correct it in a timely manner at all stages of treatment and follow-up of patients with temporomandibular myofascial pain syndrome.
Relevance. Myofascial pain syndrome (MPS) often progresses to a chronic form that is challenging to treat with established methods. This issue is well known to dentists and frequently leads to frustration despite significant efforts to advance knowledge in the fields of etiopathogenesis, diagnosis, and therapy. Most treatment protocols focus on normalizing physiological parameters, such as restoring masticatory function, achieving stable occlusal relationships, alleviating pain, and enhancing the psychological well-being of these patients. Therefore, the need for non-invasive diagnostics to assess functional activity and monitor the condition of masticatory muscles during treatment is crucial. This study aims to address this need.
Materials and methods. The examination and treatment of 64 patients with myofascial pain syndrome were conducted in two stages—clinical and electromyographic. During the clinical examination, tenderness of the masticatory muscles during palpation and the degree of mouth opening were assessed. The electromyographic research was also conducted in two stages. The first stage assessed the average amplitude and total biopotential of the masticatory and temporal muscles on both the right and left sides. The second stage evaluated the symmetry index of the masticatory muscles, as well as torsion and masseter indices. The first group received conventional treatment combined with laser therapy, while the second group received ozone therapy and kinesiology taping in addition to the conventional therapy.
Results . In the short-term observations over 14 days, both groups achieved positive results. However, patients undergoing ozone therapy and kinesiology taping showed statistically significant improvements in their parameters by the third day of observation compared to their baseline values.
Conclusion. For diagnosing this pathology, it is advisable to incorporate electromyography into the examination protocol to allow non-invasive evaluation of the functional activity of the masticatory muscles. For treating myofascial pain syndrome, minimally invasive methods with anti-inflammatory, analgesic, and muscle relaxant effects are recommended. While all treatment methods yielded favorable results, ozone therapy combined with kinesiology taping effectively eliminated both subjective and objective symptoms in this patient category.
Relevance . Dental care for children diagnosed with cerebral palsy (CP) presents substantial challenges to dental practitioners. These children not only necessitate individualized care strategies but also face challenges in mouth opening due to masticatory muscle spasticity, which limits operational access during treatments. This study introduces a phased approach to debridement that is integrated with interventions aimed at alleviating hypertonia in the masticatory muscles through adaptive myogymnastics and the use of a pneumatic mouth expander.
Materials and methods . A clinical and functional assessment of the orofacial region was conducted on 34 compliant CP patients aged 6-12 years, with the mean age being 9.6 ± 0.3 years. These assessments considered the extent of motor activity and movement limitations in daily activities. Follow-up evaluations were performed six months post-intervention.
Results . The phased debridement plan demonstrated significant effectiveness, integrating diagnostic and therapeutic strategies with tailored visitation schedules based on the clinical conditions of the patients.
Conclusion . Uniform diagnostic and therapeutic protocols are recommended to enhance dental health and restrain the prevalence of dental diseases among children with spastic cerebral palsy.
INTRODUCTION . The relevance of the study is related to the increased uncontrolled consumption of chewing gum by children.AIM. The aim is to study the functional state of masticatory muscles in patients with changeable dentition using chewing gum in different modes. MATERIALS AND METHODS . The study was carried out on 31 children, the average age of whom was 8.5 ± 1.2 years. It is at this age there is an active formation of facial morphology, which is directly related to the activity of the masticatory muscles. Therefore, it is very important to assess the condition of the masticatory musculature in order to timely identify imbalance in muscle activity, hypo and hypertonus of the musculature and to start therapy. Electromyographic study was performed on the Synapsis apparatus. RESULTS . There is a violation of coordination in the work of masticatory muscles with predominance in the work in the right temporal muscle and left proper masticatory muscle. This is due to the fact that additional chewing was present in this group. CONCLUSION . The provided analysis of masticatory function showed that children who frequently use chewing gum have a pronounced discoordination and imbalance in the work of masticatory muscles.
Relevance. In children, muscle hypertonia, including sustained stiffness of the chewing muscles, accompanies the spastic form of cerebral palsy. Considering hypertonia severity is necessary to develop treatment tactics and schemes. This paper proposes a reasonable criterion-based assessment of the above pathology severity based on clinical and functional examination data. Material and methods. To develop grading of muscle hypertonia severity, we examined 30 children with spastic cerebral palsy and 30 healthy children of the same age to obtain normalized parameters. Based on the questionnaire data, the study analyzed the functions of chewing, swallowing, and speech formation, assessed the condition of the hard dental tissues by clinical examination, and obtained active and passive mouth-opening data. Electromyography calculated the average amplitude of the right and left temporal and masticatory muscles and the total biopotential. Results . Clinical and functional evaluation data showed a direct correlation. The more complex the situation in the oral cavity was, the higher the amplitude of the chewing muscles was. Conclusion . The correlation allowed the development of the criterion-based assessment of moderate and significant masticatory muscle hypertonia severity, which management of this patient type should consider.
Relevance. The modern development of practical dentistry and the emergence of new techniques and methods of diagnosis and treatment determine the necessity and expediency of studying the anatomical features of the head, skull, structure of dental arches, and dental segments in general. Knowledge of the patterns and characteristics of the skull structure and their relationship with morphometric, clinical and functional parameters will allow the diagnosis of various forms of maxillofacial disorders based on comorbidity.
Materials and methods. The study examined 30 children aged 6 to 12 y.o. to determine the relationship between the type of face and the state of the chewing muscles in children with cerebral palsy. Maxillofacial anthropometric measurements were made, e.g., the bitragional length (t-t) and the distance between the tragion and subnasale landmarks (t-sn); the gnathic index of the face was calculated, and the mouth opening range was measured. The surface electromyography determined the mean biopotential amplitude of the right and left proper masticatory and temporal muscles using the "bruxism" test.
Results. The anthropometric measurement data indicate the prevalence of a brachygnathic facial type in children with cerebral palsy. The electromyographic study data evidence spasticity of the masticatory muscles.
Conclusion. The obtained data indicate functional overload of the chewing muscles. Masticatory muscles' hypertonicity determined the brachygnathic facial type in children with cerebral palsy.
Objectives
The purpose of the present study was to analyze treatment outcome with a full-occlusion biofeedback (BFB) splint on sleep bruxism (SB) and TMD pain compared with treatment with an adjusted occlusal splint (AOS).Materials and methodsForty-one patients were randomly allocated to a test (BFB) or a control (AOS) group and monitored over a 3-month period. Output variables were frequency and duration of bruxing events (bursts) and various pain symptoms.ResultsThe BFB group showed a statistically significant reduction in the frequency and duration of bursts and a statistically significant improvement in the patients’ global well-being and the facial muscle pain parameter. After the treatment was stopped, the BFB group showed a statistically significant reduction in the average and maximum duration but no statistically significant change in the frequency of bursts.Conclusions
The tested BFB splint is highly effective in reducing SB at the subconscious level, i.e., without waking the patient, and in achieving improvements in global pain perception. The results suggest that the BFB splint also provides a better treatment option for bruxism-related pain than an AOS. However, further research is needed, and specifically studies with a larger patient population displaying higher levels of pain at baseline.Clinical relevanceBy reducing burst duration and therefore the pathological load on the masticatory apparatus, the BFB splint reduces TMD and bruxism-related symptoms and improves patients’ physical well-being. In the long term, this could prevent damage to the TMJ. This study confirms the effectiveness and safety of this splint.The universal trial numberU1111-1239-2450DRKS-ID registrationDRKS00018092
The aim of this study was to identify correlations between sleep bruxism (SB) and temporomandibular disorders (TMD) as diagnosed by means of the research diagnostic criteria for temporomandibular disorders (RDC/TMD). Sleep bruxism was diagnosed on the basis of I) validated questionnaires, II) clinical symptoms, and III) electromyographic/electrocardiographic data. A total of 110 subjects were included in the study. Fifty-eight patients were identified as bruxers and 52 as nonbruxers. A psychosocial assessment was also performed. An RDC/TMD group-I diagnosis (myofascial pain) was made for 10 out of 58 bruxers, whereas none of the nonbruxers received a diagnosis of this type. No significant differences were found between bruxers and nonbruxers with regard to RDC/TMD group-II (disc displacement) and group-III (arthralgia, arthritis, arthrosis) diagnoses. Somatization was significantly more common among bruxers than nonbruxers. Multivariate logistic regression analysis revealed that somatization was the only factor significantly correlated with the diagnosis of myofascial pain. The results of this study indicate a correlation between myofascial pain, as diagnosed using the RDC/TMD, and somatization. It seems that somatization is a stronger predictor of an RDC/TMD diagnosis of myofascial pain than sleep bruxism is.
Purpose of review:
Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019.
Recent findings:
Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.
The origin of contractures in spastic forms of cerebral palsy (CP) is unclear. Tomorrow the early appearance and persistence of spasticity are not qualified as the main reason of growths disturbances, musculo-skeletal system deformations and secondary orthopedic complications. The latest investigations have shown prominent changes in the spastic muscles on the different structural levels and stages of muscle development. This study describes the histological, morphological, and biomechanical changes in the spastic muscles that play a pathophysiological role in the formation of CP contractions. The authors discuss the changes in the muscle fiber size, differentiation and elastic properties, degrees of the lengthening resistance in the bundles of muscle fibers, extracellular matrix proliferation, structural and mechanical changes, disturbances in gene expression and regulation in the tendons and muscle tissue, changes in the length and number of sarcomers, as well as the length and cross-section of the whole muscle.
Therefore, the movement limitations and contractions in CP do not depend on one universal mechanism. It is a combination of different structural changes in the muscles and the failure of the central movement and postural control.
Cerebral palsy (CP) is a common chronic motor disorder with associated cognitive, communicative, and seizure disorders. Children with CP have a higher risk of dental problems creating signi cant morbidity that can further a ect their wellbeing and negatively impact their quality of life. Screening for dental disease should be part of the initial assessment of any child with CP. e objective of this article is to present an updated overview of dental health issues in children with CP and outline important preventative and practical strategies to the management of this common comorbidity. Providing adequate oral care requires adaptation of special dental skills to help families manage the ongoing health issues that may arise. As oral health is increasingly recognized as a foundation for general wellbeing, caregivers for CP patients should be considered an important component of the oral health team and must become knowledgeable and competent in home oral health practices.
We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified Ashworth scale. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. We agreed on 86.7% of our ratings. The Kendall's tau correlation between our grades was .847 (p less than .001). Thus, the relationship between the raters' judgments was significant and the reliability was good. Although the results were limited to the elbow flexor muscle group, we believe them to be positive enough to encourage further trials of the modified Ashworth scale for grading spasticity.
Pediatric cerebral palsy is a non-progressive neurological disorder. It is one of the most common causes of disability among children. Numerous physical therapy techniques are currently used for treatment, and kinesio taping is one of them. The main objective of this study was to review the outcomes of using kinesio taping in published scientific studies conducted in pediatric patients with cerebral palsy and determine their methodological quality. The main scientific databases and the studies published in the official site of the Asociación Española de Vendaje Neuromuscular (Spanish Association for Neuromuscular Taping) were reviewed. Nine studies were included, which provided important outcomes. These studies show the effectiveness of recovering upper limb and motor function and solving dysphagia, which could be present in these patients, although scientific evidence may expand due to improvements in methodology.
The article covers the problems of diagnosis and treatment of mental impairment in children with cerebral palsy. Mental disorders in cerebral palsy include cognitive impairment (disorders of perception, memory, attention, motor-visual coordination, intelligence and speech), border disorders (cerebral/asthenic, neurosis-like, psychopathic-like syndromes) and personality disorders (accentuation of character, mental infantilism). Diagnosis of mental disorders in patients with cerebral palsy is a challenging task, due to various combinations of them with physical, speech and sensory disorders, which requires a differentiated approach. Current trends in comprehensive system of rehabilitation, including medical and social, and psychological-pedagogical correction of cognitive, emotional and behavioral disorders, in cerebral palsy are reviewed. Experience of using cortexin, which compensates for cognitive impairment and improves social adaptation, is discussed.
The present investigation was performed in a population of patients with temporomandibular disorders (TMD), and it was designed to assess the correlation between self-reported questionnaire-based bruxism diagnosis and a diagnosis based on history taking plus clinical examination. One-hundred-fifty-nine patients with TMD underwent an assessment including a questionnaire investigating five bruxism-related items (i.e. sleep grinding, sleep grinding referral by bed partner, sleep clenching, awake clenching, awake grinding) and an interview (i.e. oral history taking with specific focus on bruxism habits) plus a clinical examination to evaluate bruxism signs and symptoms. The correlation between findings of the questionnaire, viz., patients' report, and findings of the interview/oral history taking plus clinical examination, viz., clinicians' diagnosis, was assessed by means of φ coefficient. The highest correlations were achieved for the sleep grinding referral item (φ = 0·932) and for the awake clenching item (φ = 0·811), whilst lower correlation values were found for the other items (φ values ranging from 0·363 to 0·641). The percentage of disagreement between the two diagnostic approaches ranged between 1·8% and 18·2%. Within the limits of the present investigation, it can be suggested that a strong positive correlation between a self-reported and a clinically based approach to bruxism diagnosis can be achieved as for awake clenching, whilst lower levels of correlation were detected for sleep-time activities.
Agreement of the International Classification of Sleep Disorders Criteria with polysomnography for sleep bruxism diagnosis: A preliminary study. The Journal of prosthetic dentistry
- J Stuginski-Barbosa
- A L Porporatti
- Y M Costa
- P Svensson
- Pcr Conti
11. Stuginski-Barbosa J, Porporatti AL, Costa YM, Svensson P, Conti PCR. Agreement of the International Classification of Sleep Disorders Criteria with polysomnography
for sleep bruxism diagnosis: A preliminary study. The Journal of prosthetic dentistry. 2017;117(1):61-66.
doi: 10.1016/j.prosdent.2016.01.035
12. Nemkova SA. Mental impairment in children with
cerebral palsy: diagnosis and treatment. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2018;118(2):105-113
(In Russ.).
doi:10.17116/jnevro201811821105-113
Cerebral palsy: the state of knowledge of the problem (review)
- E S Tkachenko
- O P Goleva
- D V Sherbakov
- A R Khalikova
Tkachenko ES, Goleva OP, Sherbakov DV, Khalikova AR. Cerebral palsy: the state of knowledge of the problem (review). Mother and baby in Kuzbass. 2019;2(77):4-9
(In Russ.). Available from:
https://mednauki.ru/index.php/MD/article/view/338/612
Effect of botulinum toxin injection on nocturnal bruxism: a randomized controlled trial. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists
- S J Lee
- Wdmc Jr
- Y K Kim
- S C Chung
- J W Chung
Детский церебральный паралич: состояние изученности проблемы (обзор)
- Е С Ткаченко
- О П Голева
- Д В Щербаков
- А Р Халикова
Ткаченко ЕС, Голева ОП, Щербаков ДВ, Халикова АР. Детский церебральный паралич: состояние
изученности проблемы (обзор). Мать и дитя в Кузбассе. 2019;2(77):4-9. Режим доступа:
https://mednauki.ru/index.php/MD/article/view/338/612
Формирование контрактур при спастических формах детского церебрального паралича: вопросы патогенеза. Ортопедия, травматология и восстановительная хирургия детского возраста
- О А Клочкова
- А Л Куренков
- В М Кенис
Клочкова ОА, Куренков АЛ, Кенис ВМ. Формирование контрактур при спастических формах детского церебрального паралича: вопросы патогенеза.
Ортопедия, травматология и восстановительная хирургия детского возраста. 2018;6(1):58-66.
doi: 10.17816/PTORS6158-66
State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Current neurology and neuroscience reports
- I Novak
- C Morgan
- M Fahey
- M Finch-Edmondson
- C Galea
- A Hines
Novak I, Morgan C, Fahey M, Finch-Edmondson M,
Galea C, Hines A, et al. State of the Evidence Traffic Lights
2019: Systematic Review of Interventions for Preventing
and Treating Children with Cerebral Palsy. Current neurology and neuroscience reports. 2020;20(2):3.
doi: 10.1007/s11910-020-1022-z
14. The Union of Pediatricians of Russia. Clinical recomendations. Cerebral palsy in children [e-book].