Performance mastigatória e a sua associação com a amplitude de movimento cervical e função motora global em crianças com Paralisia Cerebral Espástica

Abstract

Objective: to verify whether there is an association between masticatory performance and cervical range of motion and global motor and feeding function in hospitalized children with spastic cerebral palsy. Methods: Cross-sectional, analytical observational study. The study analyzed the mastication and motor function of 30 children with spastic cerebral palsy (CP), aged five to 14 years, treated at a private hospital in Belo Horizonte. Participants were selected according to specific criteria, such as confirmed diagnosis of spastic CP, exclusive oral feeding and absence of acute infection. The speech-language assessment was performed using the orofacial myofunctional assessment: MBGR protocol, which assesses chewing, with a MBGR score from 0 to 10, with higher scores indicating worse performance. Swallowing efficiency was measured by the Eating and Drinking Ability Classification System (EDACS), which classified participants into three groups: Group I, with feeding confidence; Group II, with efficiency limitations; and Group III, with safety limitations. In the physical therapy evaluation, the range of cervical movement was measured by goniometry, while gross motor capacity was assessed by the Gross Motor Function Measure (GMFM) and the Gross Motor Function Classification System (GMFCS), classifying the participants into Group 1, with better mobility (Levels I to III), and Group 2, with worse mobility (Levels IV and V). For statistical analysis, the Chi-square, Mann-Whitney and Kruskal-Wallis tests were applied, with normality verified by the Shapiro-Wilk and Kolmogorov-Smirnov tests. Spearman's rank was also used for continuous variables, considering significant when p≤ 0.05. Data analysis was performed in SPSS, version 25. Results: This study revealed a predominance of male participants (66.7%) with a mean age of 8.73 years (DP: 3,01). Most of the patients had neurological (93.3%) and orthopedic (83.3%) problems, but no metabolic, digestive or hormonal problems. The mean score for the total tone value for the upper lip, lower lip, chin, chin-labial groove, tongue, floor of the mouth, right cheek and left cheek was 4.03, for habitual chewing 4.63, and for swallowing 4.97. The majority had an altered chewing pattern (60%), but were able to chew food (66.7%), with 40% of the guardians reporting regular satisfaction with chewing. The mean cervical range of motion ranged from 36.83º for flexion to 52.03º for lateral flexion, measured within normal standards. The GMFM had a mean of 0.21. The association analysis revealed that the normal chewing pattern is related to EDACS group II, with less impairment of the masticatory function. There was also a significant association between chewing pattern and GMFM, showing that children with better gross motor function have a superior chewing pattern. There was no association with gender or health problems. Habitual chewing was significantly associated with chewing capacity and GMFM, with better results in the groups with greater chewing efficiency. There was a moderate positive correlation between habitual chewing and tone; as habitual chewing increases, the tone score (upper lip, lower lip, chin, chin-labial groove, tongue, floor of the mouth, right cheek and left cheek) also tends to increase, resulting in worse results. Rotation was negative with cervical extension, lateral rotation and GMFM, indicating that greater chewing difficulty is related to worse motor function and lower cervical amplitude. Conclusion: The study suggests that there is an association between chewing performance and cervical amplitude of movement, global motor function and feeding in children with spastic cerebral palsy. Interventions aimed at improving chewing can favor feeding, positively impacting the quality of life of these children.