Verbal, Figural, and Arithmetic Fluency of Children with Cochlear Implants.

Cochlear implantation gives children with prelingual severe hearing loss and deafness the opportunity to develop their hearing abilities, speech, language, cognitive abilities and academic skills with adequate rehabilitation. The aim of the research was to analyze verbal, figural and arithmetic fluency and their interrelationship in children with a cochlear implant (CI) and children with normal hearing (NH). A total of 46 children with CI and 110 children with NH, aged 9 to 16, participated in the research. Verbal fluency was assessed using phonemic and semantic fluency, and non-verbal fluency using figural fluency. Arithmetic fluency was assessed using simple arithmetic tasks within the number range up to 100. The results showed that children with CI achieved poorer results in phonemic fluency (z = -4.92; p < 0.001), semantic fluency (z = -3.89; p < 0.001), figural fluency (z = -3.07; p = 0.002), and arithmetic fluency (z = -4.27; p < 0.001). In both groups, a positive correlation was obtained between the measured modalities and types of fluency. In the group of children with CI, a sex difference was obtained on the phonemic fluency test, in favor of girls. The age of children with CI was correlated with arithmetic fluency. Verbal, figural and arithmetic fluency of children with CI speak in favor of the importance of early auditory and language experiences.

Voice Improvement after Voice Therapy in Female Patients with Unilateral Vocal Fold Paralysis after Thyroid Surgery.

INTRODUCTION: Dysphonic voice is present in patients with unilateral vocal fold paralysis (UVFP). The aim of this study was to present outcomes following rehabilitation of patients with UVFP, performed according to a voice therapy protocol. METHODS: This prospective study comprised 27 women with UVFP who underwent pre- and post-voice therapy assessment. The mean age of patients was 53.19 ± 10.06 years. The protocol included the following: (1) multidimensional assessment of voice quality before treatment; (2) digital laryngeal manipulation voice therapy; (3) voice therapy evaluation which implied repeated multidimensional assessment of voice. RESULTS: The results showed improvement in voice quality following voice therapy with regard to the parameters of the objective voice analysis (maximum fundamental frequency of voice, minimum intensity of voice, jitter, shimmer, harmonics-to-noise ratio, and signal-to-noise ratio, p ˂ 0.05), maximum phonation time, subjective analysis of voice, as well as self-assessment of voice quality on all the subscales and overall score (p ˂ 0.001). CONCLUSION: Implementing a protocol provides clear guidelines at each stage of the treatment. Voice therapy performed using digital laryngeal manipulation improves the majority of the acoustic and perceptual characteristics of the voice.

Assessment of Life Quality in Children with Dysphonia Using Modified Pediatric Voice-Related Quality of Life Questionnaire in Serbia.

(1) Background: Hoarseness is not uncommon in children, especially at school age, as communication with peers is intensified. It is caused by improper use or overuse of the vocal apparatus. (2) Methods: The study included 85 hoarse children aged 6-12 (study group) and 240 healthy children (control group) of the same age. The study group underwent a detailed medical history, phoniatric examination, larynx fiber endoscopy, allergy treatment and the Pediatric Voice-Related Quality of Life questionnaire, modified by Jasmina Stojanovic. (3) Results: Our modified questionnaire revealed the significance of parental perception of a voice disorder in a child after organized activities. Using our modified questionnaire, we were able to determine the most frequent form of a voice disorder in children-speaking too loudly-is often neglected by the environment and can lead to an overall lower life quality. (4) Conclusions: As the presence of hoarseness impairs the quality of life in the pediatric population, awareness of a voice disorder must be recognized and treated on time to overcome the possible side effects on a child's psychological and emotional development.

ARTICULATION OF SPEECH SOUNDS OF SERBIAN LANGUAGE IN CHILDREN AGED SIX TO EIGHT.

INTRODUCTION: Phonetic and phonological system of the healthy members of one linguistic community is fully formed around 8 yedrs of age. The auditory and articulatory habits are established with age and tend to be more difficult to be upgraded and completed later. MATERIAL AND METHODS: The research was done as a cross-sectional study, conducted at the preschool institution "Radosno detinjstvo" and primary school "Branko Radicevic" in Novi Sad. It included 66 children of both genders, aged 6 to 8. The quality of articulation was determined according to the Global Articulation Test by working with each child individually. RESULTS: In each individual vowel, plosive, nasal, lateral and fricative, the quality of articulation was statistically significantly better in the first graders compared to the preschool children (p<0.01). In each affricate, except for the sound /c/, the quality of articulation was statistically significantly better in the first graders than in the preschool children (p<0.01). The quality of articulation of all speech sounds was statistically significantly better in the first graders than in the preschool children (p<0.01). DISCUSSION AND CONCLUSION: The most common disorder of articulation is distortion, while only substitution and substitution associated with distortion are less common. Omission does not occur in children from 6 to 8 years of age. Girls have slightly better quality of articulation. The articulatory disorders are more common in preschool children than in children who are in the first grade of primary school. The most commonly mispronounced sounds belong to the group of affricates and fricatives.

ARTICULATION DISORDERS IN SERBIAN LANGUAGE IN CHILDREN WITH SPEECH PATHOLOGY.

INTRODUCTION: Articulation is the result of speech organs and it means clean, clear and distinct pronunciation of voices in words. MATERIAL AND METHODS: A prospective study included 24 children between 5 and 15 years of age, of both sexes. All children were monolingual, Serbian being their native language. The quality of articulation was tested with Triage articulation test. RESULTS: Neither omission nor distortion of plosives was observed in any of them, whereas substitution of plosives occurred in 12% of patients. Omission of affricates was not observed in any of the subjects, but substitution and distortion occurred in 29%, and 76% of subjects, respectively. Omission of fricatives was found in 29% subjects, substitution in 52%, and distortion in 82% of subjects. Omission and distortion of nasals was not recorded in any of the subjects, and substitution occurred in 6% of children. Omission of laterals was observed in 6%, substitution in 46% and distortion in 52% of subjects with articulation disorders. Discussion and CONCLUSION: Articulation disorders were observed not only in children diagnosed with dyslalia but in those with dysphasia and stuttering as well. Children with speech disorders articulate vowels best, then nasals and plosives. Articulation of fricatives and laterals was found to be most severely deviated, including all three disorders, i.e. substitution, omission and distortion. Spasms of speech muscles and vegetative reactions were also observed in this study, but only in children with stuttering.

Possible factors of success in teaching esophageal speech.

INTRODUCTION: Well-established esophageal voice and speech is the most human-like form of communication of laryngectomized patients. MATERIAL AND METHODS: The study sample consisted of 28 patients of the Department of Ear. Nose and Throat, Clinical Center of Vojvodina in Novi Sad. All patients underwent total laryngectomy because of laryngeal cancer previously confirmed. The patients were divided into two groups based on the success of mastering esophageal voice and speech, group I being successful and group 2 being unsuccessful. Results. All patients were subjected to total laryngectomy and had their hyoid bone removed (100%). Esophageal speech was rated excellent afid good in 71% and 29% of patients from group 1, respectively. There was no significant difference between the successful (group 1) and unsuccessful group (group 2) in time when teaching began (chi2=5.14, p=0.023). Neither was there a statistically significant difference between these two groups regarding the methods applied in teaching esophageal. speech (chi2 = 2.02, p=0.155, which is greater than 0.05). CONCLUSION: The effectiveness of teaching esophageal speech depends significantly on the motivatidn of the patients. It was found that the patients who mastered esophageal speech successfully had'been learning it longer than those who did not master it. The success in mastering esophageal speech did not depend on whether the patients were trained individually or collectively, whereas neither method of training was successful in group 2.

Articulation of sounds in Serbian language in patients who learned esophageal speech successfully.

INTRODUCTION: Articulation of pronounced sounds during the training and subsequent use of esophageal speech is very important because it contributes significantly to intelligibility and aesthetics of spoken words and sentences, as well as of speech and language itself. The aim of this research was to determine the quality of articulation of sounds of Serbian language by groups of sounds in patients who had learned esophageal speech successfully as well as the effect of age and tooth loss on the quality of articulation. MATERIAL AND METHODS: This retrospective-prospective study included 16 patients who had undergone total laryngectomy. Having completed the rehabilitation of speech, these patient used esophageal voice and speech. The quality of articulation was tested by the "Global test of articulation." RESULTS: Esophageal speech was rated with grade 5, 4 and 3 in 62.5%, 31.3% and one patient, respectively. Serbian was the native language of all the patients. The study included 30 sounds of Serbian language in 16 subjects (480 total sounds). Only two patients (12.5%) articulated all sounds properly, whereas 87.5% of them had incorrect articulation. CONCLUSION: The articulation of affricates and fricatives, especially sound /h/ from the group of the fricatives, was found to be the worst in the patients who had successfully mastered esophageal speech. The age and the tooth loss of patients who have mastered esophageal speech do not affect the articulation of sounds in Serbian language.

Voice therapy and assistive techniques in voice disorders caused by unilateral vocal cord pareses.

INTRODUCTION: Dysphonias due to primary neurogenic disorders are a group of voice disorders that can be caused by both central and peripheral disorders of the larynx innervation. There are numerous causes leading to paralysis of superior and/or inferior laryngeal nerves, particularly of the inferior laryngeal or recurrent nerve. VOICE THERAPY IN UNILATERAL VOCAL CORD PARESIS: Vocal therapy is an integral part of the conservative treatment. Specific methods are applied to individual vocal problems, while the non-specific ones are applied to a number of dysphonias. Non-specific methods are further divided into integrated and focused vocal methods. Integrated methods treat the voice and speech disorders as a unified entity of all quality and segments of voice and speech. Focused non-specific methods treat the segments and the quality of voice and speech individually. ASSISTIVE TECHNIQUES IN VOICE DISORDERS CAUSED BY UNILATERAL VOCAL CORD PARESIS: Digital compression of the larynx by Seeman includes the treatment of voice with compression of the thyroid cartilage, thus moving the paralyzed and healthy vocal cord medially and upwards, and medially and downwards, respectively. This leads to the proper occlusion of vocal cords because in these conditions the paralyzed vocal cord is lower than the healthy one. According to the theoretical assumption, when the head anc neck are rotated to one or the other side, the anatomic relations in the neck are change and thus the vocal cords are brought into contact with the resulting reduction of the gap between them and the reduced air flow. CONCLUSION: Studies assessing the efficiency of different methods of vocal therapy are scarce bearing in mind the importance of vocal therapy and the fact that many patients refuse surgical treatment. Research on the efficiency of assistive techniques in phoniatric rehabilitation of patients with unilateral vocal cord paresis yields conflicting results. However, assistive techniques are useful practical methods in vocal rehabilitation of these patients.

Vocal therapy of hyperkinetic dysphonia.

INTRODUCTION: Hyperkinetic (hyperfunctional) dysphonia is a common pathology. The disorder is often found in vocal professionals faced with high vocal requirements. OBJECTIVE: The objective of this study was to evaluate the effects of vocal therapy on voice condition characterized by hyperkinetic dysphonia with prenodular lesions and soft nodules. METHODS: The study included 100 adult patients and 27 children aged 4-16 years with prenodular lesions and soft nodules. A subjective acoustic analysis using the GIRBAS scale was performed prior to and after vocal therapy. Twenty adult patients and 10 children underwent objective acoustic analysis including several acoustic parameters. Pathological vocal qualities (hoarse, harsh and breathy voice) were also obtained by computer analysis. RESULTS: The subjective acoustic analysis revealed a significant (p<0.01) reduction in all dysphonia parameters after vocal treatment in adults and children. After treatment, all levels of dysphonia were lowered in 85% (85/100) of adult patients and 29% (29/100) had a normal voice. Before vocal therapy 9 children had severe, 13 had moderate and 8 slight dysphonia. After vocal therapy only 1 child had severe dysphonia, 7 had moderate, 10 had slight levels of dysphonia and 9 were without voice disorder. The objective acoustic analysis in adults revealed a significant improvement (p≤0.025) in all dysphonia parameters except SD FO and jitter %. In children, the acoustic parameters SD FO, jitter % and NNE (normal noise energy) were significantly improved (p=0.003-0.03). Pathological voice qualities were also improved in adults and children (p<0.05). CONCLUSION: Vocal therapy effectively improves the voice in hyperkinetic dysphonia with prenodular lesions and soft nodules in both adults and children, affectinq diverse acoustic parameters.

[Impact of hearing impairment on quality of life of adolescents].

INTRODUCTION: Hearing impairment, as a type of sensory disability affects the quality of life of adolescents. The aim of this study was to determine whether the quality of life of adolescents with hearing impairments was different from the quality of life of adolescents without disabilities, and to examine the correlation between self--reported quality of life and proxy--report by their parents. MATERIALS AND METHODS: The study included 52 adolescents with hearing impairment and 122 adolescents without developmental disabilities, aged from 13 to 18 years and their parents. Data were collected by a standardized questionnaire, the PedsQL 4.0 Generic Core Scale. The survey was conducted during May and June 2011 in 6 schools in Novi Sad and Belgrade. RESULTS: Adolescents with hearing impairment and their parents reported lower scores on all scales of questionnaire. The average score of physical health was 77.58; p < 0.001 (adolescents), and 75; p = 0,006 (parents); on psycho-social summary scale 75.35; p = 0.025 (adolescents), and 73.37; p = 0.02 (parents). On the overall scale, the adolescents scored 76.13; p < 0.001, and parents reported 73.93; p < 0.001. The parents assessed the quality of life lower than their children. On the total summary scale, a moderate agreement (r = 0.51) was found between self- report and proxy- report. CONCLUSION: Hearing loss affects all aspects of the quality of life of adolescents. A multidisciplinary approach is required in order to provide better conditions for functioning of these children and improve their quality of life.