Rev. CEFAC. 2019;21(1):e14318 http://dx.doi.org/10.1590/1982-0216/201921114318 Original articles Physiology of exercise in orofacial motricity: knowledge about the issue Geciane Maria Xavier Torres1 https://orcid.org/0000-0002-2686-5374 Carla Patrícia Hernandez Alves Ribeiro César1 https://orcid.org/0000-0002-9439-9352 1 Universidade Federal de Sergipe - UFS, ABSTRACT Lagarto, Sergipe, Brasil. Objective: to investigate the knowledge of speech therapists about the physiology of Conflict of interests: Nonexistent exercise in orofacial motricity. Methods: 38 speech therapists working in orofacial motricity in the state of Sergipe, Brazil, graduated from institutions of higher education in Brazil, answered eleven clo- sed questions about the type of exercise, frequency, time of muscle contraction, serial number and signs and symptoms of muscular fatigue. The results were analyzed by the Kolmogorov-Smirnov and Chi-square tests (5% significance). Results: the variation of the exercises regarding the time of contraction was cited by the majority (89.47%) and the serial number throughout therapy by all the participants. There was a 60.52% improvement on the isometric and isotonic exercises, 55.26% on the application of exercises in asymmetries and 47.34% on the sequence of exer- cises according to the type of muscular contraction. The majority of the participants conducted home exercises for more than three days a week (73.69%), and .63% par- ticipants indicated the interval time between one minute and two minutes. The most commonly reported signs and symptoms of muscle fatigue in the face were tremor / fibrillation (78.95%). Conclusion: the knowledge of the study group about the physiology of exercise still lacks greater technical-scientific subsidies. Keywords: Exercise Therapy; Stomatognathic System; Professional Practice; Speech, Language and Hearing Sciences Received on: October 1st, 2018 Accept on: December 21, 2018 Corresponding address: Geciane Maria Xavier Torres Rua Dr. Augusto Lopes Pontes, 455F CEP: 41760-035 - Salvador, Bahia, Brasil E-mail: [email protected] 1/10 14318 Torres GMX, César CPHAR Exercise Physiology and Speech, Language and Hearing Sciences 2/10 | Torres GMX, César CPHAR INTRODUCTION corrective functional training. Therapeutic planning Orofacial motricity, with the purpose of reestab- should take into account the particularities of the patient 9 lishing the oral functions, appropriates two lines of and be directed to the specific difficulties encountered . reasoning: myotherapy and myofunctional therapy1. When choosing myotherapy as a therapeutic line Myotherapy aims, through specific exercises, to modify for the reestablishment of orofacial functions, the muscular behavior, while myofunctional therapy works audiologist must know the reason for this choice. The directly with the oral functions that are to be adapted, exercise should not be the goal of therapy, but rather thus, aiming at muscle modification2. a tool that allows the patient to improve his perception These muscle modifications occur due to the and adjust his muscle tonus, if changed. Therefore, it characteristics of the skeletal muscle tissue, since it is important that therapists, before thinking about the has a voluntary contraction and is fixed in the skeletal exercises that will be used, seek knowledge about the system. It is composed of muscle fascicles, that is, anatomy and physiology of all orofacial muscles1. groups of muscle fibers composed of myofibrils and In the scientific literature, studies on muscle training these, of myofilaments that slide between them during in the face are scarce, and it is essential that the muscle contraction3. This contraction is activated by the Speech, Language and Hearing Sciences researches nervous system4, which activate this contraction, and that involve orofacial myofunctional exercises inves- there are two types of contraction: the isotonic and the tigate the physiology of the exercises that are used in isometric, adapting to the fixation points of the muscle5. the therapeutic process1,2. The isotonic contraction occurs when one extremity Therefore, this paper intends to investigate the of the muscle is fixed, and the other is movable, against knowledge of speech therapists about the physiology a constant force, determining the diminution of the of exercise in orofacial motricity. size of the muscle and consequent movement of the follow-up to which it is fixed. The isometric approach, however, occurs when the two muscular extremities METHODS are fixed, determining the increase of tension or Quantitative, descriptive and cross-sectional force, without shortening the muscle or perceivable research, approved by the Research Ethics Committee 5 movement . of the Federal University of Sergipe under the No. The facial muscles, because they are skeletal 1.536.684 and CAAE No. 55208516.6.0000.5546. striatum, are accustomed to these two types of For the composition of the sample, a sample calcu- contraction, but they differ from the others because lation was made based on the number of speech thera- they do not present facial sheaths, one of the charac- pists in the state of Sergipe (n = 304), according to the teristics of the skeletal muscles, and many of their fibers search conducted in September 2016, on the page of are inserted directly into the skin of the face6. the Regional Speech, Language and Hearing Sciences In addition to the anatomical orofacial and cervical Council (4th Region). knowledge, the speech therapist should also know about exercise physiology, which aims to study the A margin of error of 20% and a confidence interval acute and chronic effects of physical exercise on the of 99% were used, obtaining the sample value of 38 structure and function of the various organ systems7. subjects. Participants read and signed a Free and In order to explain the acute and chronic effects of Informed Consent Form, in compliance with Resolution exercise on cellular functions, in its fullness, exercise No 466 / 12 of the National Health Council, which was physiology needs to describe the responses observed sent by e-mail. as a result of exercise and physical training and explain Eligibility criteria were adopted for the inclusion of the mechanisms involved. It is important to emphasize speech therapists working with Orofacial Motricity, that the effects of exercises on different organic attending patients with myofunctional orofacial functions depend on the characteristics of those who dysfunction, in the state of Sergipe, without distinction execute them8. regarding gender and age. The exclusion criteria In Orofacial Motricity, treatment is a process that were for those who worked in other areas of Speech, involves the development of the patient’s perception Language and Hearing Sciences, with titles stricto of what is altered; the preparation of skeletal facial sensu and still working in the area of higher education muscles, usually performed with exercises; and guided in Orofacial Motricity. Rev. CEFAC. 2019;21(1):e14318 | doi: 10.1590/1982-0216/201921114318 Exercise Physiology and Speech, Language and Hearing Sciences | 3/10 The collection of data occurred from the completion For the composition of the sample, invitation was of an online form, specially developed for the accom- made by social network (Facebook) and by conve- plishment of the research. nience (e-mail and telephone) to speech therapists in For its elaboration, eleven questions were adapted the state of Sergipe, where a link was made available from the questionnaire proposed in the literature10, to access the form (https://docs.google .com/forms/d/ containing questions of multiple choice, with content e/1FAIpQLScmVtLaQyU3FthfEtr7xbKCIUzitupFSr13P2 that included the type of exercise, frequency, time qr9Zk2UW_ARA / viewform? usp = send_form), which of muscle contraction, serial number and signs and was built in Google docs. symptoms of muscular fatigue. All questions were The results obtained were made available in an Excel mandatory. spreadsheet (Microsoft® Office package) and analyzed In order to verify whether or not the form met the by descriptive statistics, using a simple percentage, objectives proposed for the research, two judges determining means and standard deviation. Afterwards, (SEZMB and CPHARC), with specialization in orofacial the data were tabulated and processed by the motricity for more than five years and professional Statistical Package for Social Sciences (SPSS), version performance for more than twenty years, analyzed the 21.0. The normality of the samples was observed by content of the collection instrument of data, verifying the Kolmogorov-Smirnov or the Shapiro-Wilk tests. the representativeness of the items regarding concepts The Kolmogorov-Smirnov or the Shapiro-Wilk tests that were intended to be measured and, after adjust- observed the normality of the samples. In order to ments and consensus, the collection instrument was detect differences between groups of speech therapist applied to fifteen professional audiologists as a pilot professionals with or without specialization who work phase - for testing the instrument. After this phase, the or not in the area of orofacial motricity, regarding the instrument was considered calibrated by judges and knowledge about the physiology of exercise in orofacial professionals, who were not included in the scope motricity, the Pearson’s Chi-square test was used. The of the research sample. The final version of the data chi-square test was also used in the