Certains enfants souffrant de maladies bronchopulmonaires et de maladies neuromusculaires présentent lors de l'évaluation de la force des muscles respiratoires des valeurs anormales et évaluent mal leur état dyspnéique. Le peu de gène respiratoire ressenti par ces patients permet d'émettre l'hypothèse qu'une anomalie de l'intégration corticale des afférences somesthésiques d'origines respiratoires serait responsable. Une nouvelle technique d'exploration neurophysiologique, les potentiels évoqués respiratoires (PER) provoqués par l'occlusion des voies aériennes permet d'investiguer cette voie.Des manoeuvres volitionnelles d'évaluation de la force des muscles respiratoires (Sniffs et SNIP) et non volitionnels (stimulation magnétique) ainsi que les PER ont été enregistrés chez des enfants sains et atteints de pathologies respiratoires et neuromusculaires.Les valeurs de force des muscles respiratoires enregistrées dans les différents groupes étaient semblables. Les composantes des PER enregistrées au sommet de la pariétale ascendante (C3-Cz ; C4-Cz) ont toutes été retrouvées chez les enfants sains et les enfants malades. Seules N1 et P2 ont été plus souvent recueillies chez les patients atteints de maladies neuromusculaires que chez les enfants souffrant de pathologies bronchopulmonaires (p < 0,005).Ces études ont montré que la force des muscles respiratoires peut être évaluée par différentes manœuvres chez les enfants atteints de maladies pulmonaires chroniques et de maladies neuromusculaires et que ces enfants présentent des altérations des PER. / Some children with chronic lung and neuromuscular diseases showed abnormal values of respiratory muscle strength and misjudge their dyspneic state. These breathing difficulties allow us to hypothesize an abnormal integration of cortical somatosensory afferents. A new neurophysiological approach, Respiratory Related Evoked Potentials (RREPs) caused by upper airways occlusion allows to investigate this pathway.Volitional manoeuvres assessment of the strength of respiratory muscles (Sniff and SNIP) and non-volitional (Magnetic stimulation) and RREPs were recorded in healthy and children suffering from respiratory and neuromuscular diseases.Respiratory muscle strength values recorded in different groups by these techniques were similar. The components of RREPs recorded at C3-Cz and C4-Cz have all been found in healthy children and patients. Only N1 and P2 were more often collected from patients with neuromuscular diseases than in children with lung disease (p <0.005).These studies have shown that muscle strength breathing can be assessed by different manoeuvres in children with chronic lung diseases, neuromuscular diseases and thatChildren show alterations of RREPs.

L'analyse des accidents aériens fait ressortir ces dernières années le rôle crucial desopérateurs humains, et leurs erreurs qui peuvent avoir des conséquences dramatiques. Uncas particulier d’erreur humaine reste cependant peu abordé : la surdité inattentionnelle,c’est-à-dire l’incapacité temporaire à entendre, à prendre conscience d’une informationauditive. Dans le domaine de l’aéronautique, cette défaillance cognitive est évidementcritique, car elle signifie l’omission d’alarmes auditives. Le premier enjeu de ce projet derecherche est de définir des métriques comportementales et physiologiquescaractéristiques de la surdité inattentionnelle. Pour cela, nous nous sommes intéressés enparticulier à deux postes de travail fondamentaux de la sécurité aérienne et soumis à desalarmes auditives : le pilotage et le contrôle aérien. Nous avons cherché à mettre enévidence les conditions contextuelles favorisant l’apparition de la surdité inattentionnelle,notamment la charge de travail des opérateurs. Un second enjeu était d’identifier despistes d’adaptation des interfaces avec les pilotes et les contrôleurs aériens, permettant deprévenir ou limiter la surdité inattentionnelle à ces postes spécifiques. Pour répondre àcette problématique, 3 expériences ont été menées. La première a étudié l’impact de lacharge de travail sur le traitement des alarmes auditives lors d’une tâche d’atterrissage.Elle a permis de déterminer que la P300 était un indicateur de la surdité. La secondeexpérimentation a porté sur l’impact du design des alarmes visuelles sur les capacités detraitement cognitif des alarmes auditives, dans le cadre du contrôle aérien. Les résultatsnous ont montré une restauration de la P3b auditive avec le design visuel amélioré. Enfinla dernière expérience a testé la pertinence de mesures oculaires pour détecter lescontextes favorisant la surdité inattentionnelle. Ces résultats ouvrent des pistesprometteuses de prévention et de détection de la surdité inattentionnelle aux postescritiques de la sécurité aérienne. / The analysis of airplane accidents has recently highlighted the crucial role of humanoperators, their mistakes having potential dramatic consequences. A specific type ofhuman error remains little discussed: inattentional deafness, which is defined as thetemporary inability to hear or to become aware of auditory information. In aeronautics,this cognitive failure is obviously critical because it can lead to the omission of auditoryalarms. The first challenge of this research project is to define behavioral and physiologicalcharacteristics of inattentional deafness. For this purpose, we focused on the twofundamental jobs in aviation safety and subjected to auditory alarms: piloting and airtraffic control. We planned to highlight the contextual conditions favoring the appearanceof inattentional deafness, in particular the operators' workload. A second challenge was toidentify potential adaptation in the interfaces with pilots and air traffic controllers toprevent or limit the apparition inattentional deafness. To address these issues, threeexperiments were conducted. The first experiment studied the impact of workload on thetreatment of auditory alarms during a landing task. It was determined that P3b was anindicator of deafness. The second experiment focused on the impact of design visualalarms on cognitive processing abilities auditory alarms, as part of air traffic control. Theresults showed a restoration of auditory P300 with the enhanced visual design us. Finally,the last experiment tested the relevance of eye measurements to detect contexts favoringinattentional deafness. These results open promising possibilities for prevention anddetection of inattentional deafness in critical positions of aviation safety.

Le lobe temporal est classiquement divisé en deux systèmes fonctionnels: la voie visuelle ventrale et le système mnésique temporal médial. Cependant, cette séparation fonctionnelle a été remise en question par plusieurs études suggérant que le lobe temporal médial serait mieux compris comme une extension de la voie visuelle ventrale hiérarchiquement organisée. Le but de cette thèse était d’étudier le rôle perceptivo-mnésique du lobe temporal médial. Nous avons ainsi voulu tester à l’aide d’enregistrement électro-encéphalographiques intracérébraux (SEEG) si : (i) les régions médiale, ventrale et latérale du lobe temporal pouvaient être regroupées dans des ensembles fonctionnellement distincts et, (ii) quelles régions étaient à l’interface de ces ensembles fonctionnels. Pour répondre à ces questions, nous avons étudié la connectivité effective dérivée de potentiels évoqués cortico-corticaux issus de stimulations électriques de faible intensité et de basse fréquence (0.5mA, 1Hz, 4ms) réalisées chez 16 patients atteints d’épilepsies pharmaco-résistantes temporale ou temporo-occipitale, lors de leur évaluation pré-chirurgicale par la surveillance à long terme des activités intracérebrales électro-encéphalographiques. Onze régions d'intérêt ont été délimitées au sein du lobe temporal en fonction de repères anatomiques tels que les gyri et sulci. Un modèle de connectivité effective au sein du lobe temporal a été extrait, basé sur les caractéristiques électrophysiologiques des potentiels évoqués cortico-corticaux, telles que les occurrences, amplitudes et latences des pics de la première composante du potentiel évoqué. Le modèle a été discuté du point de vue d’une organisation fonctionnelle globale du fait de la non-indépendance de ses caractéristiques électrophysiologiques. L’amplitude et la latence des potentiels évoqués ont montré des distributions de probabilité cohérente avec les observations de transfert d'informations cognitive. La théorie des graphes nous a fourni des algorithmes pouvant extraire les caractéristiques pertinentes du réseau, telles que la centralité des régions, leur ségrégation fonctionnelle ou les voies d’interaction entre les sous-ensembles fonctionnels des régions du lobe temporal. En particulier, le cortex rhinal est apparu comme la structure la plus centrale du lobe temporal alors que le gyrus temporal supérieur était la moins centrale. Le lobe temporal médial a pu être ségrégué en un ensemble fonctionnel à part entière. Le pôle temporal est apparu comme une zone de convergence et de transfert de l’information provenant des structures du lobe temporal latéral vers les structures médiales. Le gyrus fusiforme antérieur a montré des caractéristiques d’interface duale de convergence d’afférences néocorticales et de rétrocontrôle issu des structures médiales. Par ailleurs, l'hippocampe a montré un rôle d’amplificateur du signal des afférences néocorticales passant par l’amygdale et le cortex rhinal, pour être redistribuée vers les structures limbiques. L’hippocampe postérieur se comportait comme une voie de sortie des structures médiales modulant le gyrus parahippocampique postérieur de manière quasi-unidirectionnelle. Notre étude fournit un modèle régional ou macroscopique du transfert de l’information électro-physiologique au sein du lobe temporal humain. Nos résultats ont été discutés à la lumière des modèles cognitifs actuels de ‘complétion de l’information’ et du ‘binding temporel’ / The temporal lobe is conventionally divided into two functional systems: the ventral visual pathway and the medial temporal mnemonic system. However, this functional separation has been questioned by several studies suggesting that the medial temporal lobe would be better understood as an extension of the ventral visual pathway hierarchically organized. The aim of this thesis was to study the perceptive-mnestic role of the medial temporal lobe. We have tested using intracerebral EEG recordings (SEEG) if (i) the medial, lateral and ventral regions of the temporal lobe could be grouped into functionally distinct modules and, (ii) which areas were at the interface of these functional modules. To answer these questions, we studied the effective connectivity derived from cortico-cortical evoked potentials elicited by electrical stimulations from low intensity, low frequency (0.5mA, 1Hz, 4ms) conducted in 16 patients with drug-resistant temporal or temporo-occipital epilepsies at their pre-surgical long-term monitoring of intracerebral electroencephalographic activity. Eleven regions of interest were defined within the temporal lobe based on anatomical landmarks such as gyri and sulci. We built an effective connectivity model within the temporal lobe, based on the electrophysiological characteristics of cortico-cortical evoked potentials, such as the occurences, latencies and amplitudes of the peaks of the first component of the evoked potential. The model was discussed from the perspective of a global functional organization due to the non-independence of its electrophysiological characteristics. The amplitude and latency of the evoked potentials showed consistent probability distributions with the information transfer in cognitive observations. Graph theory has provided algorithms that can extract the relevant characteristics of the network, such as the centrality of the regions, their functional segregations or the ways of interaction between functional subsets of the regions within the temporal lobe. In particular, the rhinal cortex appeared as the most central structure of the temporal lobe whereas the superior temporal gyrus appeared as the less central. The medial temporal lobe could be segregated as a functional module by itself. The temporal pole appeared as a convergence area of the information transfer from the lateral temporal lobe structures to the medial structures. Anterior fusiform gyrus acted as a dual interface of convergence of neocortical afferences and feedback from medial structures. Furthermore, the hippocampus behaved as an amplifier of neocortical afferent signal passing through the amygdala and the rhinal cortex, and redistributed this amplification to the limbic structures. The posterior hippocampus acted as a way out of the medial structures modulating the posterior parahippocampal gyrus in a almost unidirectional manner. Our study provides a regional or macroscopic model of the transfer of electro-physiological information within the human temporal lobe. Our results were discussed in line with current cognitive models of 'pattern completion' and 'temporal binding'

O objetivo do estudo foi medir a acuidade visual (AV) em crianças com diagnóstico de hidrocefalia, apresentando ou não a válvula de derivação ventricular (DVP). Participaram da pesquisa um total de 55 crianças (34 F e 21M) com diagnóstico de hidrocefalia (45 com DVP e 10 sem DVP), com idade entre zero a 291 semanas (média 74 semanas). A AV foi medida pela técnica do Potencial Visual Evocado de Varredura e os resultados foram comparados a valores de referência (Norcia, 1985b). Os diagnósticos etiológicos que levaram à hidrocefalia foram: hemorragia intracraniana (25 crianças), mielomeningocele (20 crianças) e hidrocefalia congênita (10 crianças). O diagnóstico de hidrocefalia foi estabelecido em média no 16° dia de vida. Verificamos que, 31 crianças tiveram o procedimento realizado com menos de 15 dias do diagnóstico de hidrocefalia enquanto que em 14 a válvula foi instalada após 15 dias. Das 55 crianças avaliadas no 1° exame, 18 fizeram o 2° exame, 13 fizeram o 3° exame, 10 completaram quatro exames e apenas cinco completaram as cinco avaliações. Os resultados mostram que dentre as 101 avaliações de AV realizadas em todas as crianças, 95 exames (94%) se mostraram alterados e seis normais. Não há diferença estatística entre a AV das crianças sem derivação em comparação com aquelas crianças cuja DVP foi realizada com tempo de derivação maior que 15 dias (p = 0.699). Houve, todavia, uma diferença estatística na AV, quando comparamos as crianças, cujas derivações foram realizadas em até 15 dias do diagnóstico da hidrocefalia, com aquelas cuja derivação foi realizada após 15 dias (p = 0.038) ou com aquelas que não foram derivadas (p = 0.031). Crianças que não tiveram complicações na DVP tiveram um melhor resultado de AV quando comparado com o grupo com complicação (p = 0.0001). No grupo de crianças com complicação, novamente aquelas que foram derivadas com tempo inferior a 15 dias do diagnóstico da hidrocefalia apresentou melhores resultados de AV quando comparado com aquelas crianças com complicação cuja derivação foi realizada com mais de 15 dias (p = 0.029). Nós concluímos que é possível a medida da acuidade visual de resolução pelos PVEs de varredura em crianças com diagnóstico de hidrocefalia e os valores geralmente são piores comparando aos valores normativos. O tempo da derivação e o número de complicações decorrentes da DVP parecem interferir nesta diferença. Em nosso conhecimento, este foi o primeiro trabalho a avaliar progressivamente, a acuidade visual de crianças, nos primeiros anos de vida, com hidrocefalia, com ou sem DVP e correlacionar o resultado com o tempo de derivações e número de complicações. Apesar da grande evolução tecnológica alcançada pela oftalmologia, ainda não somos capazes de prevenir as alterações visuais detectáveis pelo simples exame de AV nas crianças com hidrocefalia. O tempo para a inserção da válvula de derivação e o tratamento para as complicações ainda são medidas retardadas devido à prematuridade, instabilidade hemodinâmica e a não autorização do familiar. Estes motivos podem comprometer o desenvolvimento visual destas crianças. / The objective was to measure the visual acuity (VA) of children with the diagnosis of hydrocephalus with or without peritoneal-ventricular shunt (PVS). A total of 55 children with the diagnosis of hydrocephalus (45 with PVS and 10 without PVS) were included in the study (34F and 21M), with an age range of 0 to 291 weeks (mean=74 weeks). The VA was measured by the sweep visual evoked potential technique and the results were compared with reference values proposed by Norcia (1985b). Etiological diagnosis of the hydrocephalus was as follows: intracranial hemorrhage (25 children), meningomyelocele (20 children) and congenital hydrocephalus (10 children). The diagnosis of hydrocephalus was made in an average time of 16 days of life. After the diagnosis, the insertion of the PVS, when made, was accomplished in average on the 16th day. Of those with a PVS, in 31 the ventricular valve was inserted before 15 days after the diagnosis whereas in 14 in shunt was inserted after 15 days. Of the 55 children evaluated in the first exam, 18 were evaluated in a second exam, 13 did the third exam, 10 completed 4 exams and only 5 completed the 5 evaluations. The results of the 101 sweep visual evoked potential performed in all children, 95 exams (94%) were abnormal and only 6 were normal. There was no statistical difference in the VA of children without a ventricular shunt in comparison with those in which the shunt was inserted after 15 days of the diagnosis of hydrocephalus (p=0.699). There was, however, a statistical difference in the VA between children with a ventricular shunt inserted before 15 days of the diagnosis and children with a ventricular shunt after 15 days (p=0.038) or those without a shunt (p=0.031). Children with no complications of the ventricular shunt had a better VA as compared to those with shunt complications (p= 0.0001). In the group of children with complications, again those who had a shunt inserted before 15 days bad better VA results in comparison to those in whom the shunt was inserted after 15days (p=0.029). We concluded that measuring visual acuity by sweep visual evoked potential is feasible in children with the diagnosis of hydrocephalus and that results are usually worse comparing with reference values. The timing for insertion of a ventricular shunt and the occurrence of complications of this procedure are factors that may influence the VA. To our knowledge, this is the first study that progressively evaluated the VA in children, of early age, with hydrocephalus, with or without a ventricular shunt and correlated the VA with the timing and complications of the ventricular shunt. Despite the great technological advance in ophthalmology, we are still unable to prevent visual impairments, detectable by simple visual acuity tests, in children with hydrocephalus. The timing of the insertion of the ventricular shunt and the adequate treatment of the potential complications may be delayed due to prematurity, hemodynamic instability and family refusal. This delay may compromise the visual development of these children.

O objetivo do presente estudo foi estimar a especificidade e taxa de falso-positivo de protocolos de triagem auditiva neonatal (TAN), realizados com os procedimentos emissões otoacústicas evocadas transientes-módulo triagem (EOAet) e potenciais evocados auditivos de tronco encefálico automático (PEATEa), de forma isolada ou combinada, aplicados em uma ou duas etapas. Participaram deste estudo 200 recém-nascidos, selecionados aleatoriamente, submetidos à triagem auditiva, no período entre Março/2006 e Julho/2006. A estimativa da taxa de falso-positivo e da especificidade foi realizada com a TAN em uma etapa e com três protocolos: protocolo 1, TAN realizada em duas etapas com EOAet; protocolo 2, TAN realizada em duas etapas com PEATEa; e protocolo 3, TAN realizada em uma etapa com dois procedimentos - teste com EOAet seguido de reteste com PEATEa para os recém-nascidos que não passaram no primeiro procedimento. Os resultados mostraram alta taxa de falso-positivo na triagem auditiva realizada em uma etapa para ambos os procedimentos. Apesar de não ter havido diferença estatisticamente significante quando comparadas as taxas de encaminhamento para diagnóstico audiológico obtidos nos protocolos com EOAet e com PEATEa, o protocolo com EOAet encaminhou 4 vezes mais recém-nascidos. O protocolo com EOAet e PEATEa apresentou a maior taxa de encaminhamento (6%), com diferença estatisticamente significante ao ser comparado com os protocolos 1 (EOAet) e 2 (PEATEa). Concluiu-se que a triagem auditiva neonatal deve ser realizada em duas etapas (teste-reteste), a fim de reduzir a taxa de falso-positivo e de encaminhamento, aumentando a especificidade; a taxa de falso-positivo e conseqüentemente a especificidade foram melhores no protocolo com PEATEa, seguido dos protocolos com EOAet e com EOAet e PEATEa. / O objetivo do presente estudo foi estimar a especificidade e taxa de falso-positivo de protocolos de triagem auditiva neonatal (TAN), realizados com os procedimentos emissões otoacústicas evocadas transientes-módulo triagem (EOAet) e potenciais evocados auditivos de tronco encefálico automático (PEATEa), de forma isolada ou combinada, aplicados em uma ou duas etapas. Participaram deste estudo 200 recém-nascidos, selecionados aleatoriamente, submetidos à triagem auditiva, no período entre Março/2006 e Julho/2006. A estimativa da taxa de falso-positivo e da especificidade foi realizada com a TAN em uma etapa e com três protocolos: protocolo 1, TAN realizada em duas etapas com EOAet; protocolo 2, TAN realizada em duas etapas com PEATEa; e protocolo 3, TAN realizada em uma etapa com dois procedimentos - teste com EOAet seguido de reteste com PEATEa para os recém-nascidos que não passaram no primeiro procedimento. Os resultados mostraram alta taxa de falso-positivo na triagem auditiva realizada em uma etapa para ambos os procedimentos. Apesar de não ter havido diferença estatisticamente significante quando comparadas as taxas de encaminhamento para diagnóstico audiológico obtidos nos protocolos com EOAet e com PEATEa, o protocolo com EOAet encaminhou 4 vezes mais recém-nascidos. O protocolo com EOAet e PEATEa apresentou a maior taxa de encaminhamento (6%), com diferença estatisticamente significante ao ser comparado com os protocolos 1 (EOAet) e 2 (PEATEa). Concluiu-se que a triagem auditiva neonatal deve ser realizada em duas etapas (teste-reteste), a fim de reduzir a taxa de falso-positivo e de encaminhamento, aumentando a especificidade; a taxa de falso-positivo e conseqüentemente a especificidade foram melhores no protocolo com PEATEa, seguido dos protocolos com EOAet e com EOAet e PEATEa.

Objetivo: Realizar uma investigação do sistema auditivo em indivíduos com displasia frontonasal quanto à acuidade e quanto à condução do estímulo sonoro até o nível do tronco encefálico, correlacionando com as características clínicas. Modelo: Análise prospectiva descrevendo os achados da avaliação audiológica em indivíduos com sinais clínicos de displasia frontonasal. Local de Execução: Setor de Genética, HRAC-USP. Participantes: 21 pacientes, na faixa etária de 7 a 42 anos, sendo 14 do sexo feminino e 7 do sexo masculino. Variáveis: Limiares audiométricos em decibels nas frequências de 0,25 a 8 kHz nas duas orelhas, tipo de curva timpanométrica nas duas orelhas, latências absolutas das ondas I, III e V; latências interpicos I-V, III-V e I-III e diferença interaural da onda V do PEATE, em milissegundos, para cada orelha. Resultados: Limiares audiométricos normais em 15 (70%) indivíduos e alterados em 5 (25%), a maior parte dos casos compatíveis com perda auditiva condutiva. Na timpanometria, 30 orelhas (72%) apresentaram curva tipo A, 5 (12%) tipo C, 4 (9%) tipo Ar e 3 (7%) tipo B. Os valores médios em milissegundos das latências absolutas e interpicos nas orelhas direita e esquerda respectivamente foram os seguintes. Onda I: 1,92 e 1,91; onda III: 3,97 e 3,97; onda V: 5,88 e 5,88; interpicos I-V: 3,96 e 3,97; interpicos III-V: 1,91 e 1,92; interpicos I-III: 2,05 e 2,03 e diferença interaural da onda V: 0,04. Conclusões: Os indivíduos com DFN estudados não apresentaram alterações na via auditiva desde sua porção periférica até o tronco encefálico. As alterações condutivas encontradas são provavelmente relacionadas às patologias de orelha média decorrentes da fissura de palato, presente nesses casos. Sugerimos a avaliação de níveis mais altos dentro do sistema auditivo. / Objective: To evaluate the auditory system in patients with frontonasal dysplasia (FND) considering hearing sensitivity and sound stimulus conduction from cochlea to brainstem. Model: A prospective analysis describing audiological evaluation results in patients with clinical signs of FND. Setting: Genetics Department, HRAC-USP. Participants: 21 patients, aged from 7 to 42 years, 14 females and 7 males. Variables: Audiometric thresholds, in decibels, obtained by testing frequencies from 0,25 to 8 kHz, both ears; type of tympanometric curve in both ears; waves I, III and V absolute latencies; interpeak intervals I-V, III-V and I-III and wave V interear difference of ABR, in milisseconds, considering both right and left ears. Results: Hearing thresholds were normal in 15 (70%) patients and abnormal in 5 (25%), most with conductive hearing loss. Tympanometric curve was type A in 30 (72%) ears, type C in 5 (12%), type Ar in 4 (9%) and type B in 3 (7%). Mean values, in milisseconds, of absolute latencies and interpeaks recorded from right and left ears, respectivelly, were: wave I= 1,92 and 1,91; wave III= 3,97 and 3,97; wave V= 5,88 and 5,88; interpeak I-V= 3,96 and 3,97; interpeak III-V= 1,91 and 1,92; interpeak I-III= 2,05 and 2,03 and wave V interear difference= 0,04. Conclusions: Patients with FND showed no abnormalities in the auditory system from cochlea to brainstem in our study. Mild conductive hearing loss found in some of them is probably related to cleft palate, occurring in these cases. We suggest further evaluation of hearing pathways in higher levels.

O distúrbio de aprendizagem (DA) é um transtorno de origem neurobiológica caracterizado por falhas no processamento cognitivo-linguístico, auditivo e visual que prejudicam, principalmente, as habilidades de leitura, escrita e raciocínio matemático. Estudos reforçam a necessidade da intervenção fonoaudiológica dirigida à população com DA. Como alternativa para o tratamento do DA são adotados os programas de remediação fonológica que visam o treino de habilidades metalinguísticas e o ensino da relação letra-som necessários para a aprendizagem do sistema de escrita. A literatura ainda reforça o uso de estratégias não somente fonológicas, mas que envolvam diretamente a leitura e a escrita. Considerando o exposto, o objetivo do presente trabalho foi verificar os efeitos de um programa de remediação fonológica associado à leitura e escrita em escolares com DA e verificar a aplicabilidade dos Potenciais Evocados Auditivos Corticais (PEAC-P1-N1-P2) como indicadores de evolução terapêutica. Foram selecionados 20 escolares na faixa etária de 8 a 14 anos, de ambos os gêneros, diagnosticados com DA por equipe interdisciplinar da FOB-USP. Os participantes foram divididos em 2 grupos: Grupo Experimental (10 escolares) e Grupo Controle (10 escolares). O GE foi submetido ao programa de remediação para comparação com escolares do GC que inicialmente não receberam a intervenção. Foram realizadas avaliações pré e pós a aplicação do programa de remediação para verificar o desempenho cognitivo-linguístico dos participantes nas habilidades do processamento fonológico, leitura (velocidade e compreensão), escrita (palavras, pseudopalavras e produção textual), memória auditiva e visual. As atividades do programa de remediação foram aplicadas em 24 sessões. Os atendimentos foram individuais, realizados 2 vezes por semana, com duração de 50 minutos. Os resultados revelaram que o desempenho cognitivo-linguístico do grupo submetido à intervenção foi estatisticamente superior (p<0,05) ao do grupo não remediado em todas as habilidades avaliadas, exceto na memória visual, cujo grupo não remediado também apresentou evolução. Portanto, observou-se que a remediação fonológica associada à leitura e escrita promoveu resultados significantes nas habilidades do processamento fonológico, memória auditiva, leitura (velocidade e compreensão) e escrita (palavras, pseudopalavras e produção textual). Com relação aos PEAC, constatou-se diferença significante entre os grupos nos valores de latência do componente P1. Considerando que as mudanças no P1 foram observadas somente no grupo submetido à intervenção, pode-se inferir que as mudanças nos valores de latência desse componente foram influenciadas pela remediação. Portanto, verifica-se que o programa de remediação, empregado no presente estudo, promoveu melhoras significantes nas habilidades cognitivo-linguísticas dos escolares com DA, as quais puderam ser monitoradas por meio do componente P1 dos PEAC. / The learning disability (LD) is a neurological disorder characterized by deficits on cognitive-linguistic processing that impair the learning of reading, writing and mathematical reasoning. Studies reinforce the necessity of speech therapy aimed to LD population. The phonological remediation programs are adopted as an alternative for the treatment of LD. These programs focus on metalinguistic skills and the instruction of letter-sound relationship, essential to learning the writing system. It´s also recommended the association between phonological strategies with reading and writing skills. Considering the above, the main objective of this work was to verify the effects of a phonological remediation program associated with reading and writing strategies in children with LD. It was also evaluated the applicability of Cortical Auditory Evoked Potentials (CAEP) P1-N1-2 complex as indicators of therapeutic progress. There were selected 20 students in the age of 8-14 years, both genders, diagnosed with LD by an interdisciplinary team of FOB-USP. The students were divided into 2 groups: experimental group (10 students) and control group (10 students). The EG was submitted to the remediation program to be compared with GC which initially did not receive the intervention. The groups were evaluated pre and post the remediation program to verify their performances. The activities of the remediation program were implemented in 24 sessions (individual sessions, performed 2 times per week, lasting 50 minutes). The results revealed that cognitive-linguistic performance of the intervention group was statistically superior (p<0.05) compared with the group not submitted to remediation program in all abilities assessed, except in visual memory, whose CG also showed progress. Therefore, it was observed that phonological remediation program associated with reading and writing was able to promote significant results in phonological processing, visual memory, reading (speed and comprehension) and writing (words, invented words and text production). With respect to CAEP, there was significant difference between the groups just for the latency value of P1 component. Considering that changes in P1 were observed just in the intervention group it is noted that latency values of this component were influenced by the remediation program. Therefore, it appears that remediation program, conducted in the present study, promoted significant improvements on cognitive-linguistic skills of students with LD, which can be monitored through the P1 component of CAEP.

Objetivo: Avaliar repercussões da exposição ocupacional a uma mistura de solventes orgânicos sobre o desempenho visual de um grupo de frentistas. Método: Foram aplicados testes de ordenamento e discriminação de matizes, campo visual e sensibilidade ao contraste espacial de luminância em 25 frentistas (20 homens, M=36,4 anos, DP=8,9) e 25 controles sem histórico de exposição crônica a solventes (10 homens, M=33,8 anos, DP=8,8). As concentrações metabólitos urinários de tolueno (M=0,3 g/g de creatinina; DP=0,16) e xileno (M=0,1 g/g de creatinina; DP=0,02) e o tempo de trabalho (M=9,6 anos; DP=6,2) foram utilizados como indicativos da exposição dos frentistas. Os participantes foram submetidos a exame oftalmológico, e quando necessário, corrigir a acuidade visual para 20/20. Todas as medidas foram realizadas monocularmente com um olho escolhido ao acaso, com exceção do Potencial Visual Evocado Multifocal (PVEmf) e da campimetria. Para avaliar a visão de cores, utilizamos o Lanthony D15-d e Cambridge Colour Test 2.0. Na campimetria estática automatizada foi utilizado o protocolo branco-branco 24-2 do aparelho Humphrey Field Analyzer II-750i. A atividade elétrica visual cortical foi avaliada com o sistema de PVEmf Veris Science 5.2.4, utilizando um estímulo de 60 setores. A sensibilidade ao contraste espacial de luminância foi avaliada no teste Metropsis, para grades senoidais em 7 frequências espaciais de 0,2 a 20,0 cpg. Resultados: Os escores do grupo de frentistas e do grupo controle foram comparados pelo teste Mann-Whitney U. No teste de discriminação de cores (CCT), houve diferença estatística significativa entre controles e frentistas para a área total da elipse (p<0,01), elipticidade (p<0,05) e limiares nos eixos protan, deutan e tritan (p<0,05). No D15d houve diferença significativa entre os 8 dois grupos (p<0,01). Os dados da campimetria apresentaram diferenças significativas entre os dois grupos para as excentricidades de 90, 150 e 210, além dos valores de MD e PSD (p<0,05). Dos três frentistas avaliados com o PVEmf, todos apresentaram uma diminuição significativa (p<0,05) da amplitude do sinal (em relação a dados normativos) em um mínimo de 30 setores do campo visual, resultado que não foi observado no grupo controle. Nos testes de visão de cores, foi encontrada uma correlação (Spearman) positiva e significativa entre o tempo de trabalho e os índices do Lanthony D15d (p=0,52; p<0,05) e os limiares no eixo deutan (p=0,59; p<0,05). Na campimetria, houve correlações negativas significativas com o tempo de trabalho para a área da Fóvea (p=-051; p<0,05), e para os anéis de 30 (p=-0,46; p<0,05), 90 (p=-0,46; p<0,05) e 150 (p=-0,46; p<0,05). Não foi encontrada correlação significativa entre a sensibilidade ao contraste e o tempo de trabalho. Conclusões: Os resultados mostram alterações amplas e difusas no processamento visual em decorrência da exposição crônica a solventes orgânicos / Purpose: To evaluate the outcome of chronic occupational exposure to a mixture of solvents on the visual system of a group of gas station workers. Methods: 25 gas station workers (20 male; M=36,4 years old, SD=8,9) and 25 controls (10 male; M=33,8 years old, DP=8,8) with no history of chronic exposure to solvents were tested for hue discrimination and arrangement, spatial contrast sensitivity, visual field and multifocal VEPs. Urinary concentrations of toluene (M=0,3g/g of creatinine; Sd=0,16) and xylene metabolites (M=0,1 g/g creatinine; SD=0), along with the time of work (M=9,6 years; SD=6,2) were used as indicators of the exposure. The participants were submitted to an ophthalmologic examination and corrected the visual acuity to 20/20 whenever needed. All measurements were monocular (eye randomly chosen) and only one eye was tested, except for Multifocal Visual Evoked Potential (mfVEP) and the automated perimetry. Color was evaluated with the Lanthony D15d and Cambridge Colour Test 2.0. Automatic static perimetry used the white-on-white 24-2 protocol of the Humphrey Field Analyzer II-750i. Visual field was also evaluated with the mfVEP system Veris Science 5.2.4. Contrast sensitivity was measured with Metropsis software, using sine wave gratings of 0,2; 0,5; 1,0; 2,0; 5,0; 10,0 and 20,0 cpd. Results: The results for the two groups were compared using the Mann-Whitney U test. In the color discrimination test, the groups were significantly different for the thresholds in the three confusion axis tested (p<0,05), area of the ellipse (p<0,01) and ellipticity (p<0,05). In the color arrangement test, the two groups were significantly different (p<0,01). The automated perimetry results were also significantly different between groups for the 90, 150 e 210 eccentricity rings (p<0,05) and the MD and PSD values (p<0,05). Only three of the workers were tested with the mfVEP so far. All three had at least 30 sectors in the visual field 10 with significant loss of amplitude in the response (p<0,05, when compared to normative data). This result was not observed in the control group. The Spearman correlation coefficient was used to look for significant correlations between time of work and visual performance. For color vision, we found significant positive correlation between time of work and indexes of the Lanthony D15d (p=0,52; p<0,05) and deutan axis thresholds (p=0,59; p<0,05) for the CCT test. The analysis of sensitivity in eccentricity rings of perimetry data showed significant negative correlation with the time of work for the Fovea (p=-051; p<0,05) and rings of 30 (p=-0,46; p<0,05), 90 (p=-0,46; p<0,05) e 150 (p=-0,46; p<0,05). The contrast sensitivity data was not significantly correlated with time of work. Conclusions: The results presented here suggest that chronic occupational exposure to organic solvents leads to changes in the visual system function even when the exposure is within occupational safety limits. The results also suggest that the visual changes are extensive and diffuse

Propõe-se um sistema para processamento em um mini computador, de sinais elétricos da cóclea gravados em fita magnética. As gravações são efetuadas nos hospitais, utilizando-se aparelhos de simples manuseio e de baixo custo. Obtém-se dados que auxiliarão no diagnóstico de patologias do órgão da audição. Os instrumentos existentes para a realização da eletrococleografia são da manipulação complexa além de terem alto custo. O sistema proposto simplifica muito a operação do equipamento empregado nos hospitais, obtendo-se uma redução do custo global do exame. No hospital, deve-se ter um circuito de controle, um gravador, um amplificador e um gerador de estímulos. No centro de computação deve-se ter um mini computador, outro gravador, filtros e uma interface de controle. Foram desenvolvidos no trabalho: o circuito de controle, os filtros, a interface de controle e todos os programas responsáveis pelo processamento. Atualmente, a eletrococleografia em todo o Brasil é realizada em apenas alguns centros hospitalares, devido aos fatores custo e complexidade de manuseio. Em vista dos bons resultados obtidos e do baixo custo do sistema proposto, conclui-se que, com o nosso método, poder-se-ia difundir a eletrococleografia para um grande número de centros hospitalares. / A system is proposed that uses a minicomputer for the processing of electrical potentials from the cochlea. These signals are previously recorded on magnetic tape at hospitals, using simple and inexpensive equipment. The results obtained by the processing provide valuable data for the diagnosis of hearing disorders. The available equipment for electrocochleography at the present time is rather complicated to use and very expensive. The proposed system eases the operation and has a low cost. At the hospital, one must have a control circuit, a tape recorder, an amplifier and a sound stimulator. At the computing center one needs a minicomputer, another tape recorder, filters and a control interface. In this work were developed: the control circuit, the filters, the control interface and all programs used in the processing of the data. Nowadays, the use of electrocochleography in Brazil is limited to a few medical centers, due to the cost and complexity of the equipment. It is hoped that the simpler system proposed here will contribute to a wider use of electrocochleography.

Law Ka Pui, Karlen. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 159-170). / Abstracts in English and Chinese. / Declaration --- p.1 / Abstract --- p.ii / Acknowledgement --- p.vii / Abbreviations --- p.viii / List of Figures --- p.x / List of Tables --- p.xiv / Contents --- p.xvi / Chapter Chapter One - --- Introduction / Chapter 1.1 --- The Cervical Spine / Chapter 1.1.1 --- Anatomy of Typical Cervical Vertebrae --- p.1 / Chapter 1.1.1.1 --- The Vertebral Body / Chapter 1.1.1.2 --- The Vertebral (Neural) Arch / Chapter 1.1.1.3 --- The Vertebral Processes / Chapter 1.1.1.4 --- The Foramina / Chapter 1.1.2 --- Anatomy of Atypical Cervical Vertebrae --- p.6 / Chapter 1.1.3 --- The Cervical Region of Spinal Cord --- p.8 / Chapter 1.1.3.1 --- Structure of the Spinal Cord / Chapter 1.1.3.1.1 --- Gray Matter / Chapter 1.1.3.1.2 --- White Matter / Chapter 1.1.4 --- The Crucial Ascending Tracts in the White Column --- p.11 / Chapter 1.1.4.1 --- Tracts in Dorsal (Posterior) Column / Chapter 1.1.4.2 --- Tracts in the Lateral Column / Chapter 1.1.4.2.1 --- Posterior Spinocerebellar Tract / Chapter 1.1.4.2.2 --- Anterior Spinocerebellar Tract / Chapter 1.1.4.2.3 --- Lateral Spinothalamic Tract / Chapter 1.1.4.2.4 --- Postero-lateral Tract of Lissauer / Chapter 1.1.4.2.5 --- Spino-olivary Tract / Chapter 1.1.4.3 --- Tracts in the Ventral (Anterior) Column / Chapter 1.1.5 --- The Main Descending Tracts of White Column --- p.14 / Chapter 1.1.5.1 --- Tracts in the Dorsal Column / Chapter 1.1.5.2 --- Tracts in the Lateral Column / Chapter 1.1.5.2.1 --- Lateral Corticospinal Tract / Chapter 1.1.5.2.2 --- Rubrospinal Tract / Chapter 1.1.5.3 --- Tracts in Ventral Column / Chapter 1.1.5.3.1 --- Anterior Corticospinal Tract / Chapter 1.1.5.3.2 --- Vestibulospinal Tract and Reticulospinal Tract / Chapter 1.2 --- The Cervical Spinal Nerve Roots / Chapter 1.2.1 --- The Dorsal Roots --- p.16 / Chapter 1.2.2 --- The Ventral Roots --- p.18 / Chapter 1.2.3 --- The Relation between the Afferent and Efferent Nerve Roots --- p.19 / Chapter 1.3 --- Cervical Myelopathy / Chapter 1.3.1 --- Cause of Cervical Spondylotic Myelopathy --- p.21 / Chapter 1.3.2 --- Clinical Symptoms of Cervical Myelopathy --- p.23 / Chapter 1.4 --- Hypothesis --- p.25 / Chapter Chapter Two - --- Methodology / Chapter 2.1 --- Inclusive Criteria of the Study --- p.27 / Chapter 2.2 --- Magnetic Resonance Imaging of the Cervical Spine --- p.29 / Chapter 2.2.1 --- The Setup of the MRI / Chapter 2.2.2 --- Subject Preparation / Chapter 2.2.3 --- Identification of the Most Stenotic Region in the Cervical Spine / Chapter 2.2.4 --- Measurement of the Most Stenotic Cervical Spinal Cord and Canal / Chapter 2.2.4.1 --- Dimensions of the Spinal Cord and Canal in Sagittal Plane / Chapter 2.2.4.2 --- Dimensions of the Spinal Cord and Canal in Coronal Plane / Chapter 2.2.4.3 --- Dimensions of the Spinal Cord and Canal in Horizontal Plane / Chapter 2.2.4.4 --- Compression Ratio of the Sagittal and Coronal Dimension / Chapter 2.2.5 --- Somatosensory Evoked Potential (SEP) Evaluation / Chapter 2.2.6 --- Choice of Stimulation / Chapter 2.2.7 --- Reception of Signals / Chapter 2.2.7.1 --- Erb's Point / Chapter 2.2.7.2 --- Sensory Cortex Reception / Chapter 2.2.7.3 --- Subject Preparation / Chapter 2.3 --- Upper Limb Functional Assessment --- p.44 / Chapter 2.3.1 --- JOA Score for Cervical Myelopathy / Chapter 2.3.1.1 --- Upper Extremity Function / Chapter 2.3.1.2 --- Lower Extremity Function / Chapter 2.3.1.3 --- Sensory Disturbance / Chapter 2.3.1.4 --- Urinary Function / Chapter 2.3.2 --- Jebsen Hand Function Test / Chapter 2.3.2.1 --- Sub-test 2 - Card Turning Test / Chapter 2.3.2.2 --- Sub-test 3 - Small Object Pinching Test / Chapter 2.3.2.3 --- Sub-test 4 - Simulated Feeding Test / Chapter 2.3.2.4 --- Sub-test 5 - Stacking Checkers Test / Chapter 2.3.2.5 --- Sub-test 6 - Large Light Object Picking Test / Chapter 2.3.2.6 --- Sub-test 7 - Heavy Large Object Picking Test / Chapter 2.3.3 --- The Purdue Pegboard Test / Chapter 2.3.3.1 --- Sub-test 1 - Dominant Hand / Chapter 2.3.3.2 --- Sub-test 2 - Non-dominant Hand / Chapter 2.3.3.3 --- Sub-test 3 - Both Hands / Chapter 2.3.3.4 --- Sub-test 4 - Assembly / Chapter 2.4 --- Statistical Analysis Method --- p.74 / Chapter Chapter Three - --- Results / Chapter 3.1 --- Subject Distribution --- p.76 / Chapter 3.2 --- Magnetic Resonance Imaging Measurement --- p.82 / Chapter 3.3 --- Somatosensory Evoked Potentials Recording --- p.94 / Chapter 3.4 --- JOA (Cervical) Scoring --- p.96 / Chapter 3.5 --- Jebsen Hand Function Test Measurement --- p.101 / Chapter 3.6 --- Purdue Pegboard Test Measurement --- p.105 / Chapter 3.7 --- Statistical Analysis Findings --- p.107 / Chapter 3.8 --- Summary --- p.132 / Chapter Chapter Four - --- Discussion / Chapter 4.1 --- Magnetic Resonance Imaging Measurement --- p.134 / Chapter 4.1.1 --- Cervical Myelopathy Subjects has Small Spinal Cord and Canal / Chapter 4.2 --- Somatosensory Evoked Potential of the Median Nerve --- p.140 / Chapter 4.2.1 --- The Latencies were Preserved in Most of the Subjects / Chapter 4.3 --- Cervical Cord Compression Affects the Hand Function Significantly --- p.143 / Chapter 4.3.1 --- Fine Finger Dexterity Deficiency is a Significant Clinical Symptoms of Cervical Myelopathy Subjects / Chapter 4.3.2 --- Deficiency in Manual Dexterity is another Significant Clinical Symptoms of Cervical Myelopathy Subjects / Chapter Chapter Five - --- Summary and Conclusion --- p.153 / Chapter Chapter Six - --- Further Studies / Chapter 6.1 --- Modification in the Sample Recruitment --- p.157 / Chapter 6.2 --- Modification in Assessment Tools and Procedures --- p.158 / Bibliography --- p.159