The purpose of this study was to check the effect of cryostimulation in the oropharyngeal sensitivity and afterward in the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke.To select the patients of this research, the following procedures were made: record analysis, interview with the patient and family, speech evaluation of the neurogenic dysphagia in hospital beds and videofluoroscopy test. At the end of the selection, seven adults subjects of both sex were envolved in this study, six men and one woman, with age ranging from 28 to 64, all of them with stroke, without other pathology of base and with oropharyngeal dysphagia. After the selected patients had been passed by the procedures above described and been in accordance with the criteria of inclusion and exlcusion estabilished by the research, they were submitted to the cryostimulation technique. The technique was made three times a day, during four days in a row, an overall of thirty daily applications for each structure ( anterior faucial pillar, posterior oropharyngeal wall, soft palate and back tongue). Next the technique application, the patients were evaluated again following the same criteria. There was a described analysis of data before and after cryostimulation of the clinic evaluation ranges and of the videofluoroscopy test. The data referring to time measurements of total swallowing time, oral transit time up to the swallowing reaction and pharynx transit time of swallowing reaction up to the pharinx cleaning were also analized and were compared, before and after cryostimulation. To compare the results of before and after cryostimulation and obtain significant factor, the test t-student was used and the Fisher test, with significance 5% (p<0,05). The results showed that the cryostimulation was effective in the oropharinx sensitivity recuperation in six of the seven subjects, with statistic significance. Also there were significant improvements, statistically speaking, in the improvement of swallowing reaction and in the premature escape in six subjects. Therefore, the subjects showed an improvement in the aspects proposed by the objectives of this study after the cryostimulation, and these results can be seen as in the speech evaluation as in the videofluoroscopy test. / Esta pesquisa teve como objetivos verificar o efeito da crioestimulação na sensibilidade orofaríngea, na reação de deglutição e escape prematuro de alimentos em pacientes com disfagia neurogênica após acidente vascular encefálico (AVE). Para selecionar os pacientes da pesquisa, foram realizados os seguintes procedimentos: análise do prontuário, anamnese, avaliação fonoaudiológica das disfagias neurogênicas em leito hospitalar e exame de videofluoroscopia. Ao final da seleção, participaram deste estudo sete sujeitos adultos de ambos os sexos, sendo seis homens e uma mulher, com idades variando entre 28 a 64 anos, todos com diagnóstico de AVE, sem outra patologia de base e tendo como conseqüência disfagia orofaríngea. Depois dos pacientes selecionados terem passado pelos procedimentos acima descritos e estarem em conformidade com os critérios de inclusão e exclusão estabelecidos pela pesquisa, estes foram submetidos à técnica da crioestimulação. A técnica foi realizada três vezes ao dia, durante quatro dias seguidos totalizando trinta aplicações diárias para cada estrutura (pilares fauceais, parede posterior da orofaringe, palato mole e dorso da língua). Após a aplicação da técnica os pacientes foram reavaliados seguindo os mesmos critérios. Foi realizada análise descritiva dos dados pré e pós crioestimulação das variáveis da avaliação clínica e do exame de videofluoroscopia. Os dados referentes às medidas de tempo dos aspectos de tempo total de deglutição, tempo de trânsito oral até a reação de deglutição e tempo de trânsito faríngeo, da reação de deglutição até a limpeza faríngea também foram analisados e comparados, pré e pós crioestimulação. Para comparar os resultados pré e pós crioestimulação e obter fator de significância, utilizaram-se o teste t-student e o teste Fisher, com significância 5% (p<0,05). Os resultados mostraram que a crioestimulação foi efetiva na recuperação da sensibilidade orofaríngea em seis dos sete sujeitos, com significância estatística. Também se observaram melhoras estatisticamente significativas na reação de deglutição e no escape prematuro em seis sujeitos. Portanto, os sujeitos apresentaram melhora nos aspectos propostos pelos objetivos deste estudo após a crioestimulação, resultados estes visualizados tanto na avaliação fonoaudiológica como na avaliação videofluoroscópica.

Cette thèse a été effectuée sous le couvert d’une convention CIFRE issue d’une collaboration entre la Société Cryantal (Lognes, France) et les laboratoires universitaires C3S (EA 4660) et MOVE (EA 6314) de Franche-Comté et de Poitiers. Elle a été articulée autour du développement d’une nouvelle technologie de chambre de Cryothérapie Corps Entier (CCE). Le travail mené au cours de ces quatre années a eu pour objectifs : 1) L’identification des besoins technologiques et méthodologiques à partir d’études conduites sur le terrain et de l’analyse de la littérature scientifique ; 2) Le développement d’un prototype de chambre CCE à partir des besoins identifiés ; 3) La validation technologique du prototype en vue de son industrialisation ; 4) D’apporter des perspectives d’évolutions futures pour le développement du prototype afin qu’il devienne une chambre CEE commercialisable. Afin de répondre à ces objectifs, la thèse a été divisée en deux parties distinctes.La première partie met en évidence les applications pratiques et les besoins technologiques afin d’identifier les limites et avantages des différentes méthodes et techniques utilisées en vue du développement d’un nouveau prototype de chambre CCE. Les études conduites sur le terrain dans les conditions réelles de compétition ont montré que la CCE n’était pas vécue comme une contrainte importante par les athlètes et qu’elle leur permettait d’améliorer la qualité de leur sommeil perçu. Nous avons également montré que des individus avec un indice de masse corporel moins élevé supportaient moins bien les expositions au froid extrême en cabine comparé à ceux possédant un indice de masse corporel plus important. La revue de littérature scientifique a mis en évidence le manque crucial de données valides concernant les températures d’exposition dans les chambres et cabines. Elle pointe également pour la première fois, l’ensemble des protocoles d’expositions utilisés à ce jour dans les domaines d’applications relatifs aux pathologies traumatiques et de récupération physique. Elle crée le lien indispensable entre les différents domaines d’utilisation de la CCE et les différentes technologies utilisées.La seconde partie expose l’ensemble du développement technologique du prototype de la nouvelle chambre CCE, sa validation et son optimisation pour pouvoir prétendre à sa commercialisation. Elle comporte une étude scientifique de validation technologique du prototype de chambre de CCE basé sur la variation de la température cutanée des individus exposés. Les résultats ont montré que les variations de température cutanée engendrées par l’exposition avec la nouvelle technologie étaient similaires aux variations rapportées avec les autres technologies existantes. Les mesures préliminaires réalisées sur le prototype ont permis d’apporter des perspectives d’évolutions futures en vue de la commercialisation de la chambre. / This thesis has been completed as part of a CIFRE agreement between the research and development department of the Cryantal Company (Lognes, France) and the C3S (EA4660) and MOVE (EA6314) laboratories from the Universities of Franche-Comté and Poitiers. The aim of the thesis was the development of a new technology of whole-body Cryotherapy (WBC) chamber. The various studies that we conducted centred on : – the identification of technological and methodological requirements from field studies and the analysis of scientific literature; – the development of a WBC chamber prototype according to the identified requirements; – the technological validation of the prototype to its industrialization; and – the evolution of the prototype toward a marketable version. The thesis was divided into two parts. The first part highlights the practical applications and the technological requirements to identify the limits and the advantages of the existing methodologies and technologies in order to develop a new WBC chamber device. Studies performed in the field during competitions showed that WBC is well tolerated by athletes and can be used during heavy competition periods and/or during training periods. We also demonstrated that female athletes with lower body-mass indexes seem to be much more sensitive to cold than female athletes with higher body-mass indexes. The literature review reported a lack of data concerning the actual temperature inside the WBC chamber and cabin. The lack of methodological information for the exposure protocol was also pointed out. It creates the link between the field of application of the WBC and the different technology used. The second part presents the technological development of the new WBC chamber prototype, its validation, and its optimisation in order to be commercialized. This part includes a validation study of the prototype based on the effects of a 3-minute exposure on the skin temperature decrease of exposed individuals. The results showed a similar decrease to those observed with other WBC existing technologies. This is certainly due to the homogeneity of the temperature of exposure and the new technology developed. Preliminary measurements of the prototype allowed for the prospect of the commercialization of this new WBC chamber.