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INTRODUÇÃO: A disfunção cervical é uma problemática de elevado impacto pessoal, social e económico a nível mundial. Embora a etiologia da disfunção cervical seja descrita como multifatorial, verifica-se a necessidade do seu melhor esclarecimento. Desta forma, a avaliação física realizada pelo enfermeiro poderá demonstrar-se não ajustada à real condição da pessoa. A literatura tem vindo a evidenciar a relação entre a condição cervical, o funcionamento mandibular e a condição visceral. Com a finalidade de contribuir para a acurácia da avaliação física realizada pelos enfermeiros, o objetivo deste estudo foi avaliar a influência do sistema estomatognático e dos reflexos viscerossomáticos na dor e rigidez articular da coluna cervical. MATERIAL E MÉTODOS: Estudo piloto, com desenho quasi-experimental realizado no período entre Junho e Julho de 2019, em 50 participantes voluntários da população da Universidade Católica Portuguesa Centro Regional do Porto, onde se analisou a influência da alteração da intercuspidação habitual, da desprogramação oclusal e do estímulo de pressão da região cutânea reflexa do ílion/colon na coluna cervical alta. Este estudo foi dividido em dois momentos, onde primeiramente realizamos a análise cinemática e dor na mobilização passiva da coluna cervical alta, com recurso ao Motion Capture System® e à Escala Visual Analógica. No segundo momento avaliamos o limiar de dor à palpação da musculatura eretora do pescoço e das estruturas do sistema estomatognático, com recurso à algometria. Foi ainda analisada a influência dos reflexos viscerossomáticos nas estruturas do sistema estomatognático. RESULTADOS: No Momento I verificou-se em todos os participantes aumento da amplitude média de movimento total e diminuição da dor na mobilização passiva na primeira e segunda vertebra cervical (p<0.001) . Na análise da correlação entre as variáveis, verificou-se as variáveis em estudo se apresentaram estatisticamente iguais (p<0.001). Verificou-se neste estudo que o aumento da amplitude de movimento foi acompanhado de uma diminuição da dor na mobilização passive (p<0.001). No segundo Momento II verificou-se que tanto a desprogramação oclusal como estímulo de pressão na região cutânea reflexa do ílion/colon aumentaram o limiar de dor à palpação da musculatura eretora do pescoço (p<0.001). Neste mesmo sentido, verificamos que reflexos viscerossomáticos apresentaram influência significativa no limiar de dor à palpação das estruturas do sistema estomatognático (p<0.001). CONCLUSÃO: Os resultados deste estudo permitem identificar a interferência do sistema estomatognático e dos reflexos viscerossomáticos na dor e rigidez articular da coluna cervical, evidenciando o complexo cérvico-mandibular-visceral, realçando a importância da sua integração no momento da avaliação física realizada pelos enfermeiros. Deste estudo decorrem dois protocolos que contribuem para a acurácia da avaliação física dos enfermeiros junto da pessoa com disfunção cervical e da pessoa com disfunção do sistema estomatognático.
INTRODUCTION: Cervical dysfunction is a problem with high personal, social and economic impact worldwide. Although its etiology is described as multifactorial, there is a necessity for a better clarification. Therefore, the physical evaluation conducted by the nurse could be unadjusted to the person’s actual condition. Literature has been evidencing the relationship between neck condition, stomatognathic system and visceral condition. In order to contribute to the accuracy of the physical assessment performed by nurses, the purpose of this study was to evaluate the influence of the stomatognathic system and viscerosomatic reflexes on pain and joint stiffness of the cervical spine. MATERIAL AND METHODS: This pilot, with a quasi-experimental design, was performed between June and July of 2019 in 50 volunteering participants from the population of Universidade Católica Portuguesa - Centro Regional do Porto, analyzing the influence of the change in regular intercuspation, occlusal deprogramming and pressure stimulus of the ileum/colon reflex skin region on the high cervical spine. This study was divided in 2 moments, in which firstly we performed the cinematic analysis and pain in the passive mobilization of the high cervical spine, with use of the Motion Capture System® and the Visual Analog Scale. In the second moment we evaluated the pain threshold to palpation of the erector neck muscles and the stomatognathic system structures, using algometric. Additionally, we analyzed the influence of viscerosomatic reflexes in the stomatognathic system structures. RESULTS: In Moment I the study showed, in every patient, a growth in the average range of total motion and a decrease of pain in the passive mobilization in the first and second cervical vertebra (p<0.001). Analyzing the correlation between variables, we verified that the variables under study were statistically equal (p<0.001). It was also shown in this study that the increase of motion range was accompanied by a decrease of pain in the passive mobilization (p<0.001) In Moment II we verified that both occlusal deprogramming and pressure stimulus of the ileum/colon reflex skin region increased the pain threshold to palpation of the erector neck muscles (p<0.001) Accordingly, we observed that viscerosomatic reflexes presented significant influence on the pain threshold to palpation of the stomatognathic system structures (p<0.001) CONCLUSION: The results of this study allow us to identify the intervention of the stomatognathic system and viscerosomatic reflexes in pain and joint stiffness of the neck, evidencing the cervical-mandibular-visceral complex, highlighting the importance of its integration in the physical evaluation moment conducted by nurses. Two protocols emerge from this study that contribute to the accuracy of the nurses' physical assessment of the person with cervical dysfunction and the person with dysfunction of the stomatognathic system.
INTRODUCTION: Cervical dysfunction is a problem with high personal, social and economic impact worldwide. Although its etiology is described as multifactorial, there is a necessity for a better clarification. Therefore, the physical evaluation conducted by the nurse could be unadjusted to the person’s actual condition. Literature has been evidencing the relationship between neck condition, stomatognathic system and visceral condition. In order to contribute to the accuracy of the physical assessment performed by nurses, the purpose of this study was to evaluate the influence of the stomatognathic system and viscerosomatic reflexes on pain and joint stiffness of the cervical spine. MATERIAL AND METHODS: This pilot, with a quasi-experimental design, was performed between June and July of 2019 in 50 volunteering participants from the population of Universidade Católica Portuguesa - Centro Regional do Porto, analyzing the influence of the change in regular intercuspation, occlusal deprogramming and pressure stimulus of the ileum/colon reflex skin region on the high cervical spine. This study was divided in 2 moments, in which firstly we performed the cinematic analysis and pain in the passive mobilization of the high cervical spine, with use of the Motion Capture System® and the Visual Analog Scale. In the second moment we evaluated the pain threshold to palpation of the erector neck muscles and the stomatognathic system structures, using algometric. Additionally, we analyzed the influence of viscerosomatic reflexes in the stomatognathic system structures. RESULTS: In Moment I the study showed, in every patient, a growth in the average range of total motion and a decrease of pain in the passive mobilization in the first and second cervical vertebra (p<0.001). Analyzing the correlation between variables, we verified that the variables under study were statistically equal (p<0.001). It was also shown in this study that the increase of motion range was accompanied by a decrease of pain in the passive mobilization (p<0.001) In Moment II we verified that both occlusal deprogramming and pressure stimulus of the ileum/colon reflex skin region increased the pain threshold to palpation of the erector neck muscles (p<0.001) Accordingly, we observed that viscerosomatic reflexes presented significant influence on the pain threshold to palpation of the stomatognathic system structures (p<0.001) CONCLUSION: The results of this study allow us to identify the intervention of the stomatognathic system and viscerosomatic reflexes in pain and joint stiffness of the neck, evidencing the cervical-mandibular-visceral complex, highlighting the importance of its integration in the physical evaluation moment conducted by nurses. Two protocols emerge from this study that contribute to the accuracy of the nurses' physical assessment of the person with cervical dysfunction and the person with dysfunction of the stomatognathic system.
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Keywords
Avaliação física Amplitude de movimento articular Cervicalgia Dor Processo de enfermagem Reflexos viscerossomáticos Sistema estomatognático Range of movement articular Neck pain Pain Physical examination Nursing process Stomatognathic system Viscerosomatic reflex