<p>Barn med Down syndrom (DS) har problem med hypotonus och hyposensitivitet som begränsar rörligheten i ansiktets och munnens muskulatur, vilket därmed försvårar tal och sväljning. Målet med en intra- och extraoralsensorisk behandling är att öka medvetenheten och kontrollen av munnens muskulatur, dess rörelser, spänning och känsel.  Syfte med föreliggande studie var att undersöka effekten av en intra- och extraoralsensorisk intensivbehandling med eltandborste hos en grupp barn med DS och hypotonus. Effekten valdes att studeras utifrån områdena orofacial funktion, läppslutning, talproduktion och oralsensorik. Nio barn i åldrarna 6 till 12 år genomgick behandlingen med fyra behandlingstillfällen i veckan under fyra veckor. Före behandlingsstarten gjordes en baseline-mätning och efter utvärderades behandlingseffekten vid tre tillfällen, utspritt på tre veckor. Bedömningsmaterialet som användes bestod av NOT-S och kompletterande intervjufrågor till föräldrar, delar av STORM och SVANTE samt eftersägning.  Resultaten visar på att det sker någon form av förbättring för alla deltagare, inom minst ett område. Effekten av behandlingen varierade mellan deltagarna. Det är därför viktigt med individanpassad intervention, då samma metod inte alltid fungerar, är meningsfull och mottas lika bra hos alla patienter.</p> / <p>Children with Down syndrome (DS) have problems with hypotonia and hyposensitivity restricting movement of the face and mouth muscles, thus impeding speaking and swallowing. The goal of intra- and extraoral sensory processing is to increase awareness and control of the oral muscles, its movements, tension and oral sensation. The objective of this study is to investigate the effects of an intra- and extraoral sensory intensive treatment with electric toothbrush in a group of children with DS and hypotonia. The effects were studied from the perspectives of orofacial function, lip closure, speech production and oral sensitivity. Nine children aged 6 to 12 years underwent treatment with four sessions per week for four weeks. Before starting treatment, a baseline was performed and afterwards the effects of the treatment were evaluated on three occasions over a period of three weeks. Assessment materials included NOT-S and additional interview questions for the parents, part of STORM and SVANTE, as well as repetition. The results show that there is improvement for all participants in at least one of the studied areas. The outcome of the treatment varied between the participants. Therefore it can be important with individualized intervention, as the same method does not always work or may not be appropriate and not received the same by all patients.</p>

Barn med Down syndrom (DS) har problem med hypotonus och hyposensitivitet som begränsar rörligheten i ansiktets och munnens muskulatur, vilket därmed försvårar tal och sväljning. Målet med en intra- och extraoralsensorisk behandling är att öka medvetenheten och kontrollen av munnens muskulatur, dess rörelser, spänning och känsel.  Syfte med föreliggande studie var att undersöka effekten av en intra- och extraoralsensorisk intensivbehandling med eltandborste hos en grupp barn med DS och hypotonus. Effekten valdes att studeras utifrån områdena orofacial funktion, läppslutning, talproduktion och oralsensorik. Nio barn i åldrarna 6 till 12 år genomgick behandlingen med fyra behandlingstillfällen i veckan under fyra veckor. Före behandlingsstarten gjordes en baseline-mätning och efter utvärderades behandlingseffekten vid tre tillfällen, utspritt på tre veckor. Bedömningsmaterialet som användes bestod av NOT-S och kompletterande intervjufrågor till föräldrar, delar av STORM och SVANTE samt eftersägning.  Resultaten visar på att det sker någon form av förbättring för alla deltagare, inom minst ett område. Effekten av behandlingen varierade mellan deltagarna. Det är därför viktigt med individanpassad intervention, då samma metod inte alltid fungerar, är meningsfull och mottas lika bra hos alla patienter. / Children with Down syndrome (DS) have problems with hypotonia and hyposensitivity restricting movement of the face and mouth muscles, thus impeding speaking and swallowing. The goal of intra- and extraoral sensory processing is to increase awareness and control of the oral muscles, its movements, tension and oral sensation. The objective of this study is to investigate the effects of an intra- and extraoral sensory intensive treatment with electric toothbrush in a group of children with DS and hypotonia. The effects were studied from the perspectives of orofacial function, lip closure, speech production and oral sensitivity. Nine children aged 6 to 12 years underwent treatment with four sessions per week for four weeks. Before starting treatment, a baseline was performed and afterwards the effects of the treatment were evaluated on three occasions over a period of three weeks. Assessment materials included NOT-S and additional interview questions for the parents, part of STORM and SVANTE, as well as repetition. The results show that there is improvement for all participants in at least one of the studied areas. The outcome of the treatment varied between the participants. Therefore it can be important with individualized intervention, as the same method does not always work or may not be appropriate and not received the same by all patients.

Oral and pharyngeal cancer is commonly treated with a combination of radiotherapy and surgery. It is a clinical knowledge that patients often experience severe swallowing disorders following treatment. Since surgical sequelae are instantaneous and obvious, little attention has been paid to other concurrent effects of the treatment. To shed light on this subject, the aim of this thesis was twofold (i) to make a retrospective inventory of the sequelae following treatment and (ii) to perform a prospective, inceptive examination at diagnosis, and to follow-up after radiotherapy, six months and 12 months after surgery. The files of ninety-nine patients revealed that following treatment one-third had to use gastric fistulas and more than nine of ten patients had restricted swallowing capacity. Every second patient could only swallow puréed or liquid food. Adequate intra-oral sensation and discrimination ability is essential for bolus preparation and bolus control, for appropriate elicitation of the swallowing reflex and, hence, for the oral phase of swallowing. At the inceptive examination, the prospective part of the study demonstrated intra-oral discrimination ability in patients was equal to that in healthy controls but was impaired six months after treatment and there was no significant improvement after 12 months. It had been expected that the patient’s healthy, non-tumor side would compensate but it did not. An explanation was found when it was revealed that radiotherapy induced a delayed decline in intra-oral sensation. Sensory decline was not demonstrated within a month after radiotherapy but was manifest six months later. Since the radiotherapy field includes the neck, because of the risk for metastasis, it is highly plausible that pharyngeal sensation declines in a manner corresponding to that found intra-orally when the healthy side is irradiated. In accord with this presumption, pharyngeal swallowing function deteriorated in patents with oral tumors. Cineradiographic evaluation of oral and pharyngeal swallowing function disclosed a significant association between the degree of swallowing dysfunction and the degree of sensory decline and with the degree of impairment of shape recognition. Conclusions: Delayed intra-oral sensory decline, found to be induced by radiotherapy, can be expected to appear in the entire radiation field, including the oral cavity and the pharynx, with adverse effect on swallowing. Testing intra-oral sensation close to the last radiotherapy session is not advisable, because sensory decline does not develop immediately after radiotherapy but manifests after six months. Spontaneous sensory rehabilitation cannot be expected after six months. The significant association between degree of swallowing dysfunction and degree of intra-oral sensory decline and impaired discrimination ability must be considered in the quest for functional rehabilitation of patients treated for oral or pharyngeal cancer.