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.

L'objectiu principal de la investigació va ser estudiar els efectes ocasionats per un hàbit de respiració oral en les diferents estructures orofacials i analitzar la relació entre respiració oral i deglució atípica. Per a això, es van definir les estructures que poden sofrir alteració per la inspiració oral i que són objecte d'estudi. La selecció de la mostra es va realitzar a partir de la revisió de 762 històries clíniques dels pacients que van iniciar tractament en el Servei de Logopèdia de l'Hospital de Nens de Barcelona. Es van descartar 389 nens que no s'ajustaven als nostres criteris de selecció, quedant 373 per a la realització de la investigació (309 amb respiració oral i 64 amb respiració nasal). Es va utilitzar per a la recollida de dades un protocol d'evolució i un protocol de trastorns miofuncionals. L'anàlisi dels resultats es va realitzar a través d'una metodologia correlacional que ens va permetre comptabilitzar les diferències estructurals i funcionals entre els nens amb respiració oral i nasal. Es van obtenir estadístics Chi-quadrat i V de Cramer a partir de taules de contingències. Els resultats obtinguts mostren diferències significatives en la majoria de les estructures orofacials entre els respiradores orals i nasals. I reflecteixen relació entre respiració oral i deglució atípica. / El objetivo principal de la investigación fue estudiar los efectos ocasionados por un hábito de respiración oral en las diferentes estructuras orofaciales y analizar la relación entre respiración oral y deglución atípica.Para ello, se definieron las estructuras que pueden sufrir alteración por la inspiración oral y que son objeto de estudio.La selección de la muestra se realizó a partir de la revisión de 762 historias clínicas de los pacientes que iniciaron tratamiento en el Servicio de Logopedia del Hospital de Nens de Barcelona.Se descartaron 389 niños que no se ajustaban a nuestros criterios de selección, quedando 373 para la realización de la investigación (309 con respiración oral y 64 con respiración nasal).Se utilizó para la recogida de datos un protocolo de evolución y un protocolo de trastornos miofuncionales.El análisis de los resultados se realizó a través de una metodología correlacional que nos permitió contabilizar las diferencias estructurales y funcionales entre los niños con respiración oral y nasal. Se obtuvieron estadísticos Chi-cuadrado y V de Cramer a partir de tablas de contingencias.Los resultados obtenidos muestran diferencias significativas en la mayoría de las estructuras orofaciales entre los respiradores orales y nasales. Y reflejan relación entre respiración oral y deglución atípica. / The main objective of the research was to study the effects caused by a habit of oral respiration on different orofacial structures and analyze the relationship between oral respiration and atypical swallowing. Thereby, there were defined structures that may suffer alteration by the oral inspiration and which are under consideration. The sample selection was made after reviewing medical history of 762 patients who started treatment within the Logopedia Service at "Hospital de Nens" in Barcelona. It ruled that 389 children did not meet our criteria for selection, leaving 373 for conducting the research (309 to 64 with oral respiration and nasal respiration). A development protocol and a miofunctional disorder protocol were both used for data collection.The analysis of the results was conducted through a correlational methodology that allowed us to account for structural and functional differences between children with oral and nasal respiration. We obtained Chi-square statistical and V of Cramer from contingency tables. The results show significant differences in most orofacial structures between oral and nasal respirators. And they reflect a relationship between oral respiration and atypical swallowing.

No description available.

Normally swallowing occurs completely without effort. Should the act of swallowing for some reason be impaired, it becomes difficult to eat and drink. Dysphagia is the medical term for eating and swallowing disorders. Dysphagia is common in people with dementia, but the prevalence is not yet fully evaluated. The most common cause of death in people with dementia is aspiration pneumonia, which can be caused by dysphagia. In Sweden investigation and treatment of dysphagia are performed by speech and language pathologists (SLPs) but few of them work with dementia care. This study aims to identify the prevalence of dysphagia in people with dementia, living in a nursing home. The screening methods SSA-S and LtL were used to test the swallowing of 38 participants between 68-96 years of age (M = 86 years). To examine the participants’ oral health the risk assessment tool ROAG was used. When tested with the water swallowing test SSA-S 71,1% of the participants showed signs of aspiration, 36,8% had an oral transit time over 5 seconds, measured with LtL and 92% of the participants had an affected oral health, showing one or more symptoms of severity grade 2 according to ROAG. When adding up the results from the two screening tests a total of 86,8% of the participants showed signs of some kind of swallowing difficulty. Correlation analysis did not show any statistically significant correlations between SSA-S, oral transit time, oral health, or age. The present study found that there is a great need for interventions from speech and language pathologists in people with dementia. / Normalt sker sväljning helt utan ansträngning. Skulle sväljningen av någon anledning inte fungera som den ska, blir det svårt att äta och dricka. Den medicinska termen för ät- och sväljsvårigheter är dysfagi. Dysfagi är vanligt hos personer med demens men det är ännu inte helt kartlagt hur vanligt det är. Hos personer med demens är den vanligaste dödsorsaken aspirationspneumoni, vilket kan orsakas av dysfagi. I Sverige är det logopeder som utreder och behandlar dysfagi men det är få som är verksamma inom demensvården. Den här studien syftar till att kartlägga förekomst av dysfagi hos personer med demenssjukdom boende på ett vård- och omsorgsboende. Med screeningmetoderna SSA-S och LtL genomfördes undersökningar av sväljförmågan hos 38 personer mellan 68-96 års ålder (M = 86 år). För att undersöka deltagarnas munhälsa användes riskbedömningsverktyget ROAG. Av deltagarna fick 71,1 % utslag på vattensväljningstestet SSA-S, 36,8 % hade en oral transporttid över 5 sekunder, mätt med LtL och 92 % av deltagarna hade en nedsatt munhälsa med ett eller flera symptom av grad 2 i munhålan, enligt ROAG. Vid sammanräkning av resultaten från de två screeningtesten uppvisade totalt 86,8 % av deltagarna tecken på någon form av sväljsvårighet. Korrelationsberäkningar visade inga statistiskt signifikanta samband mellan resultat på SSA-S, oral transporttid, munhälsa eller ålder. Studien visar på ett stort behov av logopediska insatser hos gruppen personer med demenssjukdom.

Introduction: Une respiration buccale est souvent associée à une faible musculature oro-faciale et à une position basse de la langue, pouvant mener aux malocclusions et au potentiel de développer des problèmes de respiration pendant le sommeil chez les enfants. Objectifs: Évaluer l’efficacité de la thérapie oro-faciale myofonctionnelle sur le rétablissement d’une déglutition physiologique et d’une respiration nasale en développant une posture linguale et labiale normale au repos. Méthodes: Cette étude contrôlée randomisée prospective à simple aveugle a évalué 37 patients (six à quatorze ans) divisés en deux groupes où un groupe a reçu une thérapie complète (7 séances), comprenant des exercices pour la correction du patron de déglutition et de la posture linguale, et l’autre groupe a reçu une thérapie sommaire, corrigeant seulement la posture linguale (3 séances). Des suivis à trois mois et à un an post-traitement ont été effectués pour les deux groupes. Résultats: Les résultats des deux traitements, soient la thérapie complète et la thérapie sommaire, sont similaires (p = 0.59) et également efficaces pour la correction de la déglutition atypique et le rétablissement d’une respiration nasale, avec une différence significative entre les évaluations avant et après traitement (p = 0.001), qui demeure stable après un an post-traitement. Conclusion: Le traitement avec des exercices spécifiques pour une correction d’une propulsion linguale ne serait pas une composante absolue d’une thérapie oro-faciale myofonctionnelle afin de rétablir une posture linguale adéquate au repos et un patron de respiration nasale chez les enfants n’ayant pas d’autre problème fonctionnel connu. / Introduction: Mouth breathing is often associated with a weak orofacial musculature and a low resting tongue position, leading to malocclusion and potentially sleep-disordered breathing in children. Objective: To evaluate the effect of orofacial myofunctional therapy on the reestablishment of a mature pattern of swallowing and nasal breathing by stabilizing a proper position of the tongue and lips at rest. Methods: This prospective randomized single-blind controlled study evaluated 37 patients (age six to fourteen years) divided into two groups who received either a complete orofacial myofunctional therapy (7 sessions) including swallowing pattern and tongue posture, or a simplified therapy modifying their tongue posture (3 sessions). Both groups were seen at three months and one year following treatment completion. Results: Results suggested that treatment outcomes were similar when treating tongue-lip posture at rest along with tongue thrust, and treating without addressing tongue thrust (p = 0.59). Both treatments were efficacious as there was a significant difference between the pre- and post- evaluations for both groups (p < 0.001), and these differences remained stable at the one year follow-up. Conclusion: Treating a tongue thrust habit with specific related exercises, may not be a necessary component of an orofacial myofunctional therapy to reestablish tongue posture at rest and nasal breathing in children with no other functional problems.

Made available in DSpace on 2016-06-02T19:03:57Z (GMT). No. of bitstreams: 1 5415.pdf: 8638421 bytes, checksum: 0e5c5abf95c786434202fdae3e69dc1e (MD5) Previous issue date: 2013-06-24 / Financiadora de Estudos e Projetos / The resolution enhancement of an image is always desirable, independently of its objective, but mainly if the image has the purpose of visual analysis. The hardware development for increasing the image resolution still has a higher cost than the algorithmic solutions for super-resolution. Like image restoration, super-resolution is also an ill-conditioned inverse problem, and has an infinite number of solutions. This work analyzes the iterative restoration methods (Van Cittert, Tikhonov-Miller and Conjugate Gradiente) which propose solutions for the ill-conditioning problem and compares them with the IBP method (Iterative Back Projection). The analysis of the found similarities is the basis of a generalization, such that other iterative restoration methods can have their properties adapted, as regularization of the ill-conditioning, noise reduction and other degradations and the increase of the convergence rate can be incorporated to the techniques of super-resolution. Two new methods were created as case studies of the proposed generalization: the first one is a super-resolution method for dynamic magnetic resonance imaging (MRI) of the swallowing process, that uses an adaptiveWiener filtering as regularization and a non-rigid registration; and the second one is a pan sharpening method of SPOT satellite bands, that uses sampling based on sensor s characteristics and non-adaptive Wiener filtering. / A melhora da resolução de uma imagem é sempre desejada, independentemente de seu objetivo, mas principalmente se destinada a análise visual. O desenvolvimento de hardware para o aumento de resolução de uma imagem em sua captura ainda possui o custo mais elevado do que as soluções algorítmicas de super resolução (SR). Assim como a restauração de imagens, a super resolução também é um problema inverso mal-condicionado e possui infinitas soluções. Este trabalho analisa métodos de restauração iterativos (Van Cittert, Tikhonov-Miller e Gradiente Conjugado) que proponham soluções para o problema do malcondicionamento e os compara com o método IBP (Iterative Back-Projection). A análise das semelhanças encontradas é base para uma generalização de modo que outros métodos iterativos de restauração possam ter suas propriedades adaptadas, tais como regularização do mal-condicionamento, redução do ruído e outras degradações e aumento na taxa de convergência, para que possam ser incorporadas à técnicas de super resolução. Dois novos métodos foram criados como estudo de caso da generalização proposta: o primeiro é um método de super-resolução para imageamento por ressonância magnética (MRI) dinâmico do processo de deglutição, que utiliza uma filtragem de Wiener adaptativa como regularização e registro não-rígido; o segundo é um método de pansharpening das bandas do satélite SPOT, que utiliza amostragem baseada nas características do sensor e filtragem de Wiener não-adaptativa.