Desfechos da terapia manual sobre a biomecânica da deglutição, função respiratória e qualidade de vida de indivíduos com DPOC

Abstract

Introduction: pulmonary hyperinflation, a major feature of COPD, results in dysfunction of the respiratory muscles, placing the diaphragm at a mechanical disadvantage and recruitment of accessory breathing muscles. As a result, respiratory function and quality of life (QoL) are impaired. Additionally, deglutition disorders occur frequently, predisposing to the risk of aspiration and exacerbations, attributed to altered thoracoabdominal biomechanics one of the causes of incoordination between breathing/deglutition. Manual Therapy (MT) has been applied in the management of individuals with respiratory dysfunctions, such as the Proprioceptive Neuromuscular Facilitation (PNF) method and the Diaphragmatic Liberation Technique (DLT), providing a better respiratory muscle action. To date, research that has associated both techniques in the management of individuals with COPD has not been found in the literature, as well as its possible implication on deglutition. Objective: to analyze the outcomes of MT on biomechanics of swallowing, respiratory function and QOL of individuals with COPD. Method: 18 individuals with a mean age of 66,06±8,86 years, 61,1% (11) men, and %FEV1 mean 40,28±16,73 were evaluated before and after MT. The measures of the biomechanics of swallowing were: oral transit time, pharyngeal transit time (FTT), number of swallows, vallecular (VL) residues and pyriform sinuses, penetration/aspiration and hiolaringeal excursion in liquid and pasty consistencies. The respiratory function outcomes were: heart rate (HR), respiratory rate (RF), peripheral oxygen saturation (Sats), maximal inspiratory (MIP) and expiratory pressure (MEP), dyspnea (MRC) and QoL (SGRQ). Results: in the biomechanics of swallowing, a significant difference was observed in FTT (p=0,04), residues in VL (p=0,03), maximum hyoid elevation (0,003) and displacement of hyoid (p=0,02) in pasty consistency. In the liquid consistency there was reduction of residues in VL (p=0,001). In the respiratory function, there was a difference in HR (p=0,04), RR (p=0,007), Sats (p<0,0001), MIP and %MIP (p<0,0001), MEP and %MEP (p=0,001). In the QoL the domains symptoms (p=0,001), impact (p=0,001) and total score (p=0,001) differed before and after the program. Conclusion: MT program interfered in the biomechanics of swallowing demonstrated by FTT reduction, VL residues and increased hyoid elevation and displacement in pasty consistency. In the liquid consistency there was reduction of residues in VL. Respiratory function improved vital parameters, increased respiratory muscle strength and improved QoL.