Comparação dos efeitos de duas técnicas fisioterapêuticas respiratórias em parâmetros cardiorrespiratórios de lactentes com bronquiolite viral aguda Comparison of the effects that two different respiratory physical therapy techniques have on cardiorespiratory parameters in infants with acute viral bronchiolitis

OBJETIVO: Comparar os efeitos das técnicas de aumento do fluxo expiratório (AFE) e vibração associada à drenagem postural (DP) nos parâmetros cardiorrespiratórios de frequência cardíaca (FC), frequência respiratória (FR) e SpO2 de lactentes com bronquiolite viral aguda (BVA). MÉTODOS: Foram analisados lactentes com diagnóstico clínico e radiológico de BVA. A FC, FR e SpO2 foram registradas em quatro tempos: antes do procedimento e após 10, 30 e 60 min do término do procedimento. Os pacientes foram divididos em três grupos: submetido à AFE; submetido à vibração/DP; e controle. RESULTADOS: Foram incluídos no estudo 81 lactentes, 27 em cada grupo de estudo, com média de idade de 4,52 meses e peso médio de 6,56 kg. Na comparação por ANOVA, as médias da FR, FC e SpO2 nos grupos AFE e vibração/DP não apresentaram diferenças significantes em relação ao grupo controle (p > 0,05). Considerando somente os quatro tempos, houve queda significante dos valores médios de FR nos grupos AFE e vibração/DP em relação ao controle (p < 0,05). CONCLUSÕES: A aplicação de AFE e de vibração associada à DP não apresentou um benefício global na melhora dos parâmetros cardiorrespiratórios em lactentes com BVA. Quando analisados isoladamente no decorrer do tempo, a fisioterapia respiratória parece contribuir na diminuição da FR nesses pacientes.<br>OBJECTIVE: To compare the expiratory flow increase technique (EFIT) and vibration accompanied by postural drainage (PD) in terms of their effects on the heart rate (HR), respiratory rate (RR) and SpO2 of infants with acute viral bronchiolitis (AVB). METHODS: Infants with clinical and radiological diagnosis of AVB were analyzed. The HR, RR and SpO2 were registered at four time points: prior to the procedure; and at 10, 30 and 60 min after the procedure. The patients were divided into three groups: submitted to the EFIT; submitted to vibration/PD; and control. RESULTS: We included 81 infants, 27 per group, with a mean age of 4.52 years and a mean weight of 6.56 kg. Using ANOVA, we found that the EFIT and vibration/PD groups presented no significant differences in relation to the control group in terms of the mean values for HR, RR or SpO2 (p > 0.05). Considering only the four time points evaluated, the mean RR was significantly lower in the EFIT and vibration/PD groups than in the control group (p < 0.05). CONCLUSIONS: In terms of overall improvement of cardiorespiratory parameters, neither the EFIT nor vibration/PD provided any benefit to infants with BVA. However, over time, respiratory physical therapy seems to contribute to decreasing the RR in these patients

Segregation of lexical and sub-lexical reading processes in the left perisylvian cortex.

International audienceA fundamental issue in cognitive neuroscience is the existence of two major, sub-lexical and lexical, reading processes and their possible segregation in the left posterior perisylvian cortex. Using cortical electrostimulation mapping, we identified the cortical areas involved on reading either orthographically irregular words (lexical, "direct" process) or pronounceable pseudowords (sublexical, "indirect" process) in 14 right-handed neurosurgical patients while video-recording behavioral effects. Intraoperative neuronavigation system and Montreal Neurological Institute (MNI) stereotactic coordinates were used to identify the localization of stimulation sites. Fifty-one reading interference areas were found that affected either words (14 areas), or pseudo-words (11 areas), or both (26 areas). Forty-one (80%) corresponded to the impairment of the phonological level of reading processes. Reading processes involved discrete, highly localized perisylvian cortical areas with individual variability. MNI coordinates throughout the group exhibited a clear segregation according to the tested reading route; specific pseudo-word reading interferences were concentrated in a restricted inferior and anterior subpart of the left supramarginal gyrus (barycentre x = -68.1; y = -25.9; z = 30.2; Brodmann's area 40) while specific word reading areas were located almost exclusively alongside the left superior temporal gyrus. Although half of the reading interferences found were nonspecific, the finding of specific lexical or sublexical interferences is new evidence that lexical and sublexical processes of reading could be partially supported by distinct cortical sub-regions despite their anatomical proximity. These data are in line with many brain activation studies that showed that left superior temporal and inferior parietal regions had a crucial role respectively in word and pseudoword reading and were core regions for dyslexia