Effects of the proprioceptive plantar correction in children suffering from atypical swallowing.

This trial experimentation was carried out by the Hospital Board SANTOBONO Hospital board of national importance with a High Pediatric Specialization -Regional center for emergencies

Hospital unity for Othorinolaryngology and cervical-facial Surgery  Responsible : Dr. Nicola MANSI

Simple structure of Phoniatry  Responsible : Dr. Raffaele IZZO

by: Dr. V. de Maio  Specialist in ORL Hosp. SANTOBONO Naples

E. Capolongo, F. Mariosa, L. Villone Logopaedists Hosp. SANTOBONO Naples

Dr. M.A.Fusco  Posturologist Avellino

We selected 50 children, aged between 5 and 11, 25 male patients and 25 female patients, affected by an atypical swallowing and different types of mechanic peripheral alterations in pronouncing some words.

25 of them, 13 male and 12 female, underwent a neuro-muscular logopaedical rehabilitatation's program (group A) , the remaining 25 patients, 12 male and 13 female underwent both a neuro-muscular logopaedical rehabilitation's program and a correction of the ascending postural interferences by means of neuro-bio-mechanic ATTIVO-KS-MEDICAL orthotics  (group B).

FUNCTIONAL  ASSOCIATED PATHOLOGIES
Total Male Female Pathologies
50 25 25  Atypical swallowing
50 25 25 Pronouncing's alterations

38 

76%

18 

72%

20 

80%

 Oral breathing

11 

22%

6 

24%

5 

20%

 Deep bite

19 

38%

7 

28%

12 

48%

 Open bite

3 

6%

2 

8%

1 

4%

  Vocal chords' nodules 
Occlusion's examples 1 / 2 / 3 / 4
FUNCTIONAL MAPPAGE OF THE FEET
Total 50 Male 25 Female 25 Functional Mappage 

32 

64%

13 

52%

19 

76%

 III degree Flat foot 

4 

8%

1 

4%

3 

12%

  II degree Flat foot 

3 

6% 

1 

4% 

2 

8%

  I degree Flat foot 

4 

8% 

4

16%

 

  II degree Claw foot

7 

14% 

6 

24% 

1 

4%

  I  degree Claw foot
Example of morphological plantar stance  before and after three months.
 Functional mappage of the foot's sole of the same female child.

A sample-group of 20 children, 10 male and 10 female, underwent a T.A.C. test (computerized axial imaging) on the HYOID bone both in statics and during the swallowing. 

ALL THE PATIENTS ANALYZED DURING THE SWALLOWING SHOWED A HYOID BONE'S TORSION, THAT WAS HOMOLOGOUS TO THE INCLINATION OF THE REFERRING VERTEBRA. This is, undoubtedly, the first time that the torsion of the hyoid bone occurring during an atypical swallowing was proved in a scientific way.

EXAMPLES OF T.A.C.'S RECORDS TAKEN IN STATICS AND DURING THE SWALLOWING  

 Ex 1 -Ex 2 a -Ex 2 b

The children of both groups, group A and Group B, underwent two cycles of neuro-muscular logopaedical therapy according to the following plan :

6 reeducation's meetings, each one lasting 60 m’ for each cycle, to be performed once a week, including  :

  • Gym's exercises for the tongue ,

  • Gym's exercises for the lips ,

  • Exercises  for the facial muscles ,

  • Gym's exercises for the mandible. 
combined with ::

  • vocalises

  • syllables

  • Phonetic opposition
and with:

  • breathing correction ,

  • Solid foods swallowing ,

  • Liquids swallowing ,

  • Conscious swallowing (voluntary) ,

  • Unconscious swallowing (involuntary) ,

  • automatization.

Group B children used, in addition to the therapy, neuro-bio-mechanical ATTIVO-KS-MEDICAL orthotics for the correction of the posture.

We performed the first check up three months after the beginning of the treatment, at the end of the first two neuro-muscular logopaedic therapy's cycles, 14 meetings.
RESULTS
The parents of 6 children, 4 belonging to group A and 2 to group B,  refused the therapy although they had been  informed previously and in a clear way about the trial experimentation's methods. The parents of the two children belonging to group B radically refused  the plantar treatment and didn't allow to their children to undergo the  logopaedical reeducation, too.

In group B, among the 21 children, that attended the reeducative meeting's correctly, only 8 of them  (38,1% ) were, at the end, completely rehabilitated.

In group B, among the 23 children, who had used proprioceptive stimulation's ATTIVO-KS-MEDICAL orthotics, in addition to the therapy, 15 of them ( 65,2% ), showed a normalization of the previous altered functions.

The 3 children suffering from vocal chords' nodules and insufficiency of the glottis belonged to group B, too. The result of the check up performed three months after the beginning of the combined  treatment was completely negative. 

Remarkable vocal chords' Nodules with glottis insufficiency.
The same female child  after three months.
CONCLUSIONS

Considering, that the neuro-muscular-logopaedical rehabilitation's period lasted the same time for both groups, we noticed that the rehabilitated group B children were almost the double of the group A children (15 B / 8 A).

This entitles us to think that the normalization of the musculo-fascial chains achieved through the proprioceptive plantar stimulation succeeds in enhancing  the functional recovery also in the breathing, swallowing and logopaedical rehabilitation.

The final evaluation will take place 8 months after the beginning of the neuro-muscular reeducative treatment.

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Updated  :03-06-01 .

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