Avaliação da aplicabilidade de um novo método para reabilitação da mobilidade da língua

Abstract

Purpose: to evaluate the performance of children in the use of a new instrument for the tongue mobility rehabilitation associated to computer games. Methods: crosssectional descriptive study. The tests were performed with a control group composed of 16 participants with no alteration in tongue mobility and an experimental group with 16 participants with tongue mobility alteration. Participants were of both sexes, aged between 8 and 12 years (mean of 10,46). Were included individuals attending in the Speech and Hearing Clinic of the Hospital das Clinicas of UFMG, patients from a private clinic and students of a public school, all in the city of Belo Horizonte. Information about the participants was obtained through an interview with the therapists responsible for the treatment, the therapists responsible for the private clinic and the supervisor of the school. The inclusion criteria of the study were: individuals presenting all central and lateral incisor teeth, who did not present cognitive impairments that interfered with the test or invasive developmental disorders, visual impairment, glossectomy and / or pelvectomy or tongue paralysis, and agreed to participate in the research and sign the consent form and whose parents or legal guardians accepted and signed the informed consent form. Participants that did not tolerate the equipment inside the oral cavity were excluded. The tests were carried out at the Speech and Hearing Clinic of the Hospital das Clinicas of UFMG, in the private clinic and at the school, using a new method of tongue mobility rehabilitation. All participants were evaluated by at least two speech therapists with clinical experience in Orofacial Myology. Only those with complete agreement regarding mobility in the clinical evaluation were enrolled in the study. The professionals used for this evaluation the Tongue Evaluation Protocol, which is based on the MBGR Protocol. The evaluation of lingual mobility was divided in: extension and precision (coordination between force, velocity, extension and direction of movement). The lingual tests that evaluated the extension were: bulging and retracting, touching the apex on the incisive papilla and on the right and left cheeks, vibrating the apex, sucking the tongue on the palate and popping the apex. The test to evaluate the accuracy was touching the apex sequentially and rapidly at the right / left commissures and at the upper and lower lips. To be considered as altered, subjects should present at least two alterations in any of these tests. To be considered normal, they should present all such evidence without alteration. During the data collection, the participant received instructions from the speech-language pathologist before performing the game activity and the instrument was presented to him/her. The instrument involves playing with a computer games, inserted in the oral cavity and controlled by the tongue. After being sanitized with 70% alcohol and covered with a plastic film, the instrument was inserted into the oral cavity of the participant, who performed an activity to train the mobility. The activity consisted of a game in which 40 targets (fruit images) appeared on the computer screen and the participant, represented by the image of a hand, was directed to reach the targets by moving the instrument's control pin with the tongue. When moving the control pin with the tongue in a certain direction, the image of the hand moved in the same direction on the computer screen, with a trajectory proportional to the amplitude achieved by the control pin. Upon reaching the target, the individual scored in the game. The activity encompassed the four senses of movement, with ten repetitions for each side. For analysis of the data, the first four targets were excluded (one from each direction), because the performance of the participants could be worse in to the first contact with the game. The total number of analyzed targets was 36, being divided into three groups of 12 targets. After use, the instrument and nozzle were sanitized. The participant was asked about the comfort of the instrument, ease of movement and interest about the game. The computer games that accompany the instrument generate a performance report that includes information about the participant and data on the performance in the game. The variables responses analyzed in the study were total of targets (number of targets in which the participant reached) and total time per target (time spent in seconds for the participant to reach each target). These data were recorded separately by direction (left, right, up and down) and order of appearance of the 36 targets, which were grouped as follows (series 1, first 12 targets; series 2, 12 subsequent targets and series 3, last 12 targets). The descriptive results were obtained using frequencies and percentages for the characteristics of the various categorical variables and for obtaining measures of central tendency, dispersion and position for the continuous variables. To compare the distribution of the categorical variables according to the normal and altered group, the Qui-squared Person test was used. Kruskal Wallis and Mann-Whitney non-parametric tests were used to compare the total of targets and total time of the subjects according to group, sex, age group and speech-language pathology characteristics. To compare the total time and total of the targets according to the direction and order of appearance of the targets, the nonparametric Friedman test was used. The normality assumption was assessed by the Shapiro-Wilk test. A significance level of 5% was considered in all statistical analyzes. Results: a difference was observed between participants with and without alteration in tongue mobility in the variables: extension of the frenulum; fixation of the frenulum on the floor; tongue strength; precision in movements; presence of associated movements and lingual skills of touching the labial commissures, popping the apex, sucking and vibrating. In the evaluation of the performance of the game, in the comparison of the total time and the total of targets difference between the groups was observed for: total time; total time down; total time of the first and third 12 targets; total left targets; total targets up; total targets for the first 12 targets. In the intragroup comparison of the variable total time, there was a difference only in the direction and for the two groups. In the intragroup comparison of the total target variable a difference was observed only for precision and only in the group with change in mobility. When evaluating only the participants with altered lingual mobility, we observed a difference in total time to: bulge and retract; touch commissures; to touch the papilla, being the greatest time among the individuals with great alteration. And in the total of targets a difference was observed in: precision; protrude and retract; touch commissures; touch the papilla, with the total of targets being lower among individuals with major alteration or inadequacy. Regarding the feedback questionnaires, the results showed high rates of interest and fun and low rates of pain and fatigue in both groups. In addition, more than 70% of the participants found the game easy to carry out and approximately 88% reported that they would like to do it again. Conclusion: the performance of individuals from both groups in the present study was analyzed and it was observed that the new instrument can serve as a motivation for individuals in rehabilitation of tongue mobility. The obtained data suggest that the group of individuals with tongue alterate mobility presented a bigger alteration in the speech- language patology aspects and also in the aspects related to the game.