Brazilian practice guidelines for stroke rehabilitation: Part II.

The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I.

The Guidelines for Stroke Rehabilitation are the result of a joint effort by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology aiming to guide professionals involved in the rehabilitation process to reduce functional disability and increase individual autonomy. Members of the group participated in web discussion forums with predefined themes, followed by videoconference meetings in which issues were discussed, leading to a consensus. These guidelines, divided into two parts, focus on the implications of recent clinical trials, systematic reviews, and meta-analyses in stroke rehabilitation literature. The main objective was to guide physicians, physiotherapists, speech therapists, occupational therapists, nurses, nutritionists, and other professionals involved in post-stroke care. Recommendations and levels of evidence were adapted according to the currently available literature. Part I discusses topics on rehabilitation in the acute phase, as well as prevention and management of frequent conditions and comorbidities after stroke.

Cannabinoids in Neurology - Position paper from Scientific Departments from Brazilian Academy of Neurology.

Cannabinoids comprehend endocannabinoids, phytocannabinoids, and synthetic cannabinoids, with actions both in the central and peripherical nervous systems. A considerable amount of publications have been made in recent years, although cannabis has been known for over a thousand years. Scientific Departments from the Brazilian Academy of Neurology described evidence for medical use in their areas. Literature is constantly changing, and possible new evidence can emerge in the next days or months. Prescription of these substances must be discussed with patients and their families, with knowledge about adverse events and their efficacy.

Aerodynamic, eletroglottographic and acoustic measures of the voiced postalveolar fricative. / Medidas aerodinâmicas, eletroglotográficas e acústicas na produção da fricativa pós-alveolar vozeada.

PURPOSE: Describe and correlate phonological and complementary measures regarding aerodynamics, electroglottography, acoustics, and perceptual judgment of production of the voiced fricative sound /ʒ/ comparing the performance of Brazilian Portuguese-speaking children with and without speech sound disorders. METHODS: Study participants were 30 children aged 5 years to 7 years and 11 months divided into a group of children with typical development - Control Group (CG) and a group of children with speech sound disorders - Research Group (RG). Phonology (PCC, PCC-R, and occurrence of phonological processes) and the aerodynamic (amplitude of the oral airflow and f0), eletroglottographic (open quotient) and acoustic (classification of voicing) measures were evaluated. RESULTS: Numerically, children with speech sound disorders presented higher relative oral airflow amplitude, lower relative f0, and open quotient indicative of less efficient voicing production compared with those of children with typical development. The weak voicing values ​​showed that 66.1% of the children with speech sound disorders presented weaker voicing of the fricative sound /ʒ/ compared with that of the posterior vowel sound, and between-groups comparison demonstrated that these children presented greater difficulty in voicing. The acoustic analysis of speech used to classify the weak/strong voicing showed variations, especially regarding the classification partially devoiced. CONCLUSION: Results suggest that the strategies for voicing production and voicing maintenance of the fricative sound /ʒ/ are still variable in children aged 5 years to 7 years and 11 months; however, children with speech sound disorders seem to have more difficulties in using them effectively. In addition, the study shows the importance of applying complementary tests to obtain a more detailed diagnosis.

OBJETIVO: Descrever e correlacionar medidas fonológicas à aerodinâmica, EGG, acústica e julgamento perceptivo da produção do som /ʒ/, comparando o desempenho de crianças com e sem transtorno fonológico, falantes do Português Brasileiro. MÉTODO: Participaram 30 crianças com idade entre 5:0 e 7:11 anos separadas em grupo controle e grupo de crianças com transtorno fonológico. Avaliou-se a fonologia (cálculo de PCC e PCC-R e ocorrência dos processos fonológicos) e as medidas aerodinâmicas (amplitude do fluxo aéreo oral e f0), eletroglotográficas (quociente de abertura) e acústicas (classificação do vozeamento). RESULTADOS: As crianças com transtorno fonológico apresentaram, numericamente, amplitude do fluxo oral relativo maior, f0 relativo menor e quociente de abertura indicativo de uma voz menos eficiente na produção do vozeamento quando comparadas às crianças sem transtorno fonológico. Os valores de weak voicing demonstraram que, em 66,1% das crianças com transtorno fonológico, o vozeamento da fricativa foi mais fraco, comparado ao da vogal seguinte, e a comparação entre grupos indicou que essas crianças apresentaram maior dificuldade no vozeamento. Quanto à descrição da classificação de vozeamento, de acordo com a análise acústica e do weak/strong voicing, verificou-se que há algumas variações, principalmente para a classificação "parcialmente desvozeado". CONCLUSÃO: Os resultados sugerem que as estratégias de produção e manutenção do vozeamento da fricativa vozeada /ʒ/ ainda são variáveis em crianças na idade estudada, porém as crianças com transtorno fonológico parecem ter mais dificuldades em utilizá-las de modo eficaz. Além disso, o estudo aponta para a importância da aplicação de provas complementares para um diagnóstico mais detalhado.

Sensitivity and specificity of the Percentage of Consonants Correct-Revised in the identification of speech sound disorder. / Sensibilidade e especificidade da Porcentagem de Consoantes Corretas Revisada na identificação do transtorno fonológico.

PURPOSE: The purpose of the study was to determine the sensitivity and specificity, and to establish cutoff points for the severity index Percentage of Consonants Correct - Revised (PCC-R) in Brazilian Portuguese-speaking children with and without speech sound disorders. METHODS: 72 children between 5:00 and 7:11 years old - 36 children without speech and language complaints and 36 children with speech sound disorders. The PCC-R was applied to the figure naming and word imitation tasks that are part of the ABFW Child Language Test. Results were statistically analyzed. The ROC curve was performed and sensitivity and specificity values ​​of the index were verified. RESULTS: The group of children without speech sound disorders presented greater PCC-R values in both tasks, regardless of the gender of the participants. The cutoff value observed for the picture naming task was 93.4%, with a sensitivity value of 0.89 and specificity of 0.94 (age independent). For the word imitation task, results were age-dependent: for age group ≤6:5 years old, the cutoff value was 91.0% (sensitivity of 0.77 and specificity of 0.94) and for age group >6:5 years-old, the cutoff value was 93.9% (sensitivity of 0.93 and specificity of 0.94). CONCLUSION: Given the high sensitivity and specificity of PCC-R, we can conclude that the index was effective in discriminating and identifying children with and without speech sound disorders.

Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I / Diretrizes da Academia Brasileira de Neurologia para reabilitação do acidente vascular cerebral: parte I

ABSTRACT The Guidelines for Stroke Rehabilitation are the result of a joint effort by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology aiming to guide professionals involved in the rehabilitation process to reduce functional disability and increase individual autonomy. Members of the group participated in web discussion forums with predefined themes, followed by videoconference meetings in which issues were discussed, leading to a consensus. These guidelines, divided into two parts, focus on the implications of recent clinical trials, systematic reviews, and meta-analyses in stroke rehabilitation literature. The main objective was to guide physicians, physiotherapists, speech therapists, occupational therapists, nurses, nutritionists, and other professionals involved in post-stroke care. Recommendations and levels of evidence were adapted according to the currently available literature. Part I discusses topics on rehabilitation in the acute phase, as well as prevention and management of frequent conditions and comorbidities after stroke.

RESUMO As Diretrizes Brasileiras para Reabilitação do AVC são fruto de um esforço conjunto do Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia com o objetivo de orientar os profissionais envolvidos no processo de reabilitação para a redução da incapacidade funcional e aumento da autonomia dos indivíduos. Membros do grupo acima participaram de fóruns de discussão na web com pré-temas, seguidos de reuniões por videoconferência em que as controvérsias foram discutidas, levando a um consenso. Essas diretrizes, divididas em duas partes, focam as implicações de recentes ensaios clínicos, revisões sistemáticas e metanálises sobre reabilitação do AVC. O objetivo principal é servir de orientação a médicos, fisioterapeutas, fonoaudiólogos, terapeutas ocupacionais, enfermeiros, nutricionistas e demais profissionais envolvidos no cuidado pós-AVC. As recomendações e níveis de evidência foram adaptados de acordo com a literatura disponível atualmente. Aqui é apresentada a Parte I sobre tópicos de reabilitação na fase aguda, prevenção e tratamento de doenças e comorbidades frequentes após o AVC.

Brazilian practice guidelines for stroke rehabilitation: part II / Diretrizes brasileiras para reabilitação no acidente vascular cerebral: parte II

Abstract The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

Resumo As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderênciaao usode medicamentos, cuidados paliativos,ofuturodareabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

The influence of (central) auditory processing disorder in speech sound disorders.

INTRODUCTION: Considering the importance of auditory information for the acquisition and organization of phonological rules, the assessment of (central) auditory processing contributes to both the diagnosis and targeting of speech therapy in children with speech sound disorders. OBJECTIVE: To study phonological measures and (central) auditory processing of children with speech sound disorder. METHODS: Clinical and experimental study, with 21 subjects with speech sound disorder aged between 7.0 and 9.11 years, divided into two groups according to their (central) auditory processing disorder. The assessment comprised tests of phonology, speech inconsistency, and metalinguistic abilities. RESULTS: The group with (central) auditory processing disorder demonstrated greater severity of speech sound disorder. The cutoff value obtained for the process density index was the one that best characterized the occurrence of phonological processes for children above 7 years of age. CONCLUSION: The comparison among the tests evaluated between the two groups showed differences in some phonological and metalinguistic abilities. Children with an index value above 0.54 demonstrated strong tendencies towards presenting a (central) auditory processing disorder, and this measure was effective to indicate the need for evaluation in children with speech sound disorder.

The influence of (central) auditory processing disorder on the severity of speech-sound disorders in children.

OBJECTIVE: To identify a cutoff value based on the Percentage of Consonants Correct-Revised index that could indicate the likelihood of a child with a speech-sound disorder also having a (central) auditory processing disorder . METHODS: Language, audiological and (central) auditory processing evaluations were administered. The participants were 27 subjects with speech-sound disorders aged 7 to 10 years and 11 months who were divided into two different groups according to their (central) auditory processing evaluation results. RESULTS: When a (central) auditory processing disorder was present in association with a speech disorder, the children tended to have lower scores on phonological assessments. A greater severity of speech disorder was related to a greater probability of the child having a (central) auditory processing disorder. The use of a cutoff value for the Percentage of Consonants Correct-Revised index successfully distinguished between children with and without a (central) auditory processing disorder. CONCLUSIONS: The severity of speech-sound disorder in children was influenced by the presence of (central) auditory processing disorder. The attempt to identify a cutoff value based on a severity index was successful.

Cannabinoids in Neurology - Position paper from Scientific Departments from Brazilian Academy of Neurology / Canabinoides em Neurologia - Artigo de posicionamento dos Departamentos Científicos da Academia Brasileira de Neurologia

ABSTRACT Cannabinoids comprehend endocannabinoids, phytocannabinoids, and synthetic cannabinoids, with actions both in the central and peripherical nervous systems. A considerable amount of publications have been made in recent years, although cannabis has been known for over a thousand years. Scientific Departments from the Brazilian Academy of Neurology described evidence for medical use in their areas. Literature is constantly changing, and possible new evidence can emerge in the next days or months. Prescription of these substances must be discussed with patients and their families, with knowledge about adverse events and their efficacy.

RESUMO Os canabinoides compreendem os endocanabinoides, fitocanabinoides e os canabinoides sintéticos e desempenham ações no sistema nervoso central e periférico. Uma quantidade enorme de publicações tem sido lançada nos últimos anos, embora a cannabis seja conhecida por milênios. Os Departamentos Científicos da Academia Brasileira de Neurologia descreveram as evidências do uso médico em suas áreas. A literatura está em constantes mudanças e possíveis novas evidências podem surgir nos próximos dias ou meses. A prescrição dessas substâncias deve ser discutida com os pacientes e suas famílias, com conhecimento sobre eventos adversos e sua eficácia.

Tongue contour for /s/ and /∫/ in children with speech sound disorder.

PURPOSE: To describe the tongue shape for /s/ and /∫/ sounds in three different groups of children with and without speech sound disorder. METHODS: The six participants were divided into three groups: Group 1--two typically developing children, Group 2--two children with speech sound disorder presenting any other phonological processes but not the ones involving the production of the /∫/ and Group 3--two children with speech sound disorder presenting any phonological processes associated to the presence of the phonological process of palatal fronting (these two children produced /∫/ as /s/) aged between 5 and 8 years old, all speakers of Brazilian Portuguese. The data were the words /'∫avi/ (key) and /'sapu/ (frog). Tongue contour was individually traced for the five productions of each target word. RESULTS: The analysis of the tongue contour pointed to evidences that both /s/ and /∫/ were produced using distinct tongue contours for G1 and G2. The production of these two groups was more stable than G3. The tongue contour for /s/ and /∫/ from the children in G3 was similar, indicating that their production was undifferentiated. CONCLUSION: The use of the ultrasound applied to the speech analysis was effective to confirm the perceptual analysis of the sound made ​​by the speech-language pathologist.

Implications of diadochokinesia in children with speech sound disorder.

PURPOSE: To verify the performance of children with and without speech sound disorder in oral motor skills measured by oral diadochokinesia according to age and gender and to compare the results by two different methods of analysis. METHODS: Participants were 72 subjects aged from 5 years to 7 years and 11 months divided into four subgroups according to the presence of speech sound disorder (Study Group and Control Group) and age (<6 years and 5 months and >6 years and 5 months). Diadochokinesia skills were assessed by the repetition of the sequences 'pa', 'ta', 'ka' and 'pataka' measured both manually and by the software Motor Speech Profile®. RESULTS: Gender was statistically different for both groups but it did not influence on the number of sequences per second produced. Correlation between the number of sequences per second and age was observed for all sequences (except for 'ka') only for the control group children. Comparison between groups did not indicate differences between the number of sequences per second and age. Results presented strong agreement between the values of oral diadochokinesia measured manually and by MSP. CONCLUSION: This research demonstrated the importance of using different methods of analysis on the functional evaluation of oro-motor processing aspects of children with speech sound disorder and evidenced the oro-motor difficulties on children aged under than eight years old.

Medidas aerodinâmicas, eletroglotográficas e acústicas na produção da fricativa pós-alveolar vozeada / Aerodynamic, eletroglottographic and acoustic measures of the voiced postalveolar fricative

RESUMO Objetivo Descrever e correlacionar medidas fonológicas à aerodinâmica, EGG, acústica e julgamento perceptivo da produção do som /ʒ/, comparando o desempenho de crianças com e sem transtorno fonológico, falantes do Português Brasileiro. Método Participaram 30 crianças com idade entre 5:0 e 7:11 anos separadas em grupo controle e grupo de crianças com transtorno fonológico. Avaliou-se a fonologia (cálculo de PCC e PCC-R e ocorrência dos processos fonológicos) e as medidas aerodinâmicas (amplitude do fluxo aéreo oral e f0), eletroglotográficas (quociente de abertura) e acústicas (classificação do vozeamento). Resultados As crianças com transtorno fonológico apresentaram, numericamente, amplitude do fluxo oral relativo maior, f0 relativo menor e quociente de abertura indicativo de uma voz menos eficiente na produção do vozeamento quando comparadas às crianças sem transtorno fonológico. Os valores de weak voicing demonstraram que, em 66,1% das crianças com transtorno fonológico, o vozeamento da fricativa foi mais fraco, comparado ao da vogal seguinte, e a comparação entre grupos indicou que essas crianças apresentaram maior dificuldade no vozeamento. Quanto à descrição da classificação de vozeamento, de acordo com a análise acústica e do weak/strong voicing, verificou-se que há algumas variações, principalmente para a classificação "parcialmente desvozeado". Conclusão Os resultados sugerem que as estratégias de produção e manutenção do vozeamento da fricativa vozeada /ʒ/ ainda são variáveis em crianças na idade estudada, porém as crianças com transtorno fonológico parecem ter mais dificuldades em utilizá-las de modo eficaz. Além disso, o estudo aponta para a importância da aplicação de provas complementares para um diagnóstico mais detalhado.

ABSTRACT Purpose Describe and correlate phonological and complementary measures regarding aerodynamics, electroglottography, acoustics, and perceptual judgment of production of the voiced fricative sound /ʒ/ comparing the performance of Brazilian Portuguese-speaking children with and without speech sound disorders. Methods Study participants were 30 children aged 5 years to 7 years and 11 months divided into a group of children with typical development - Control Group (CG) and a group of children with speech sound disorders - Research Group (RG). Phonology (PCC, PCC-R, and occurrence of phonological processes) and the aerodynamic (amplitude of the oral airflow and f0), eletroglottographic (open quotient) and acoustic (classification of voicing) measures were evaluated. Results Numerically, children with speech sound disorders presented higher relative oral airflow amplitude, lower relative f0, and open quotient indicative of less efficient voicing production compared with those of children with typical development. The weak voicing values ​​showed that 66.1% of the children with speech sound disorders presented weaker voicing of the fricative sound /ʒ/ compared with that of the posterior vowel sound, and between-groups comparison demonstrated that these children presented greater difficulty in voicing. The acoustic analysis of speech used to classify the weak/strong voicing showed variations, especially regarding the classification partially devoiced. Conclusion Results suggest that the strategies for voicing production and voicing maintenance of the fricative sound /ʒ/ are still variable in children aged 5 years to 7 years and 11 months; however, children with speech sound disorders seem to have more difficulties in using them effectively. In addition, the study shows the importance of applying complementary tests to obtain a more detailed diagnosis.

Sensibilidade e especificidade da Porcentagem de Consoantes Corretas Revisada na identificação do transtorno fonológico / Sensitivity and specificity of the Percentage of Consonants Correct-Revised in the identification of speech sound disorder

RESUMO Objetivo Verificar a sensibilidade, especificidade e estabelecer pontos de corte para o índice Porcentagem de Consoantes Corretas Revisado (PCC-R) em crianças com e sem transtorno fonológico falantes do Português Brasileiro. Método Participaram 72 crianças com idade entre 5:00 e 7:11 anos, sendo 36 sem queixas de alteração de fala e linguagem e 36 crianças com diagnóstico fonoaudiológico de transtorno fonológico. O índice de gravidade PCC-R foi aplicado nas provas de nomeação de figuras e de imitação de palavras do Teste de Linguagem Infantil ABFW. Os resultados foram analisados estatisticamente. Foi realizada a curva Roc e obtidos os valores de sensibilidade e especificidade do índice. Resultados O grupo de crianças sem transtorno fonológico apresentou valores do PCC-R maiores nas duas provas, independentemente do gênero dos participantes. O valor de corte na prova de nomeação de figuras foi de 93,4%, com sensibilidade de 0,89 e especificidade de 0,94, independentemente da idade. Já na prova de imitação de palavras, os valores obtidos variaram de acordo com a idade. Para a faixa etária ≤6:5 anos, o valor de corte foi de 91,0%, com sensibilidade de 0,77 e especificidade de 0,94. Para a faixa etária >6:5 anos, o valor de corte foi de 93,9%, com sensibilidade de 0,93 e especificidade de 0,94. Conclusão Dada a alta sensibilidade e especificidade do PCC-R, o índice foi efetivo na discriminação e identificação de crianças com e sem transtorno fonológico.

ABSTRACT Purpose The purpose of the study was to determine the sensitivity and specificity, and to establish cutoff points for the severity index Percentage of Consonants Correct - Revised (PCC-R) in Brazilian Portuguese-speaking children with and without speech sound disorders. Methods 72 children between 5:00 and 7:11 years old - 36 children without speech and language complaints and 36 children with speech sound disorders. The PCC-R was applied to the figure naming and word imitation tasks that are part of the ABFW Child Language Test. Results were statistically analyzed. The ROC curve was performed and sensitivity and specificity values ​​of the index were verified. Results The group of children without speech sound disorders presented greater PCC-R values in both tasks, regardless of the gender of the participants. The cutoff value observed for the picture naming task was 93.4%, with a sensitivity value of 0.89 and specificity of 0.94 (age independent). For the word imitation task, results were age-dependent: for age group ≤6:5 years old, the cutoff value was 91.0% (sensitivity of 0.77 and specificity of 0.94) and for age group >6:5 years-old, the cutoff value was 93.9% (sensitivity of 0.93 and specificity of 0.94). Conclusion Given the high sensitivity and specificity of PCC-R, we can conclude that the index was effective in discriminating and identifying children with and without speech sound disorders.

The influence of (central) auditory processing disorder in speech sound disorders / Influência do transtorno do processamento auditivo (central) no transtorno fonológico

ABSTRACT INTRODUCTION: Considering the importance of auditory information for the acquisition and organization of phonological rules, the assessment of (central) auditory processing contributes to both the diagnosis and targeting of speech therapy in children with speech sound disorders. OBJECTIVE: To study phonological measures and (central) auditory processing of children with speech sound disorder. METHODS: Clinical and experimental study, with 21 subjects with speech sound disorder aged between 7.0 and 9.11 years, divided into two groups according to their (central) auditory processing disorder. The assessment comprised tests of phonology, speech inconsistency, and metalinguistic abilities. RESULTS: The group with (central) auditory processing disorder demonstrated greater severity of speech sound disorder. The cutoff value obtained for the process density index was the one that best characterized the occurrence of phonological processes for children above 7 years of age. CONCLUSION: The comparison among the tests evaluated between the two groups showed differences in some phonological and metalinguistic abilities. Children with an index value above 0.54 demonstrated strong tendencies towards presenting a (central) auditory processing disorder, and this measure was effective to indicate the need for evaluation in children with speech sound disorder.

RESUMO INTRODUÇÃO: Considerando a importância das informações recebidas auditivamente para a aquisição e organização das regras fonológicas, a avaliação do processamento auditivo (central) traz contribuições significativas para o diagnóstico e direcionamento da intervenção fonoaudiologia das crianças com transtorno fonológico. OBJETIVO: Estudar as medidas fonológicas e o processamento auditivo (central) de crianças com transtorno fonológico. MÉTODO: Estudo clínico e experimental com 21 sujeitos com transtorno fonológico, entre 7,0 e 9,11 anos, separados em dois grupos: com e sem transtorno do processamento auditivo (central). Foram avaliadas as provas de fonologia, inconsistência de fala e habilidades metalinguísticas. RESULTADOS: O grupo com transtorno do processamento auditivo (central) apresentou maior gravidade do transtorno fonológico. O valor de corte obtido para o process density index foi o que melhor caracterizou a ocorrência dos processos fonológicos para crianças acima de sete anos. CONCLUSÃO: A comparação do desempenho das provas avaliadas nos dois grupos mostrou diferenças quanto a alguns aspectos fonológicos e metalinguísticas. As crianças com valor do índice acima de 0,54 demonstraram uma forte tendência a apresentar alteração no processamento auditivo (central), sendo que esta medida foi efetiva para indicar a necessidade de avaliação de crianças com transtorno fonológico.

Acoustical parameters of Brazilian Portuguese liquids in phonological disorder.

BACKGROUND: Phonological disorder is one of the most frequent speech and language deficit observed in children and therefore studies using objective evaluation measurements should be developed and implemented during the diagnostic process. AIM: To describe the acoustic characteristics of /l/ and /r/ liquid sounds. METHOD: Speech production samples of 20 children with and without phonological disorder were gathered and acoustically analyzed. Six words were selected for repetition: /se'bola/, /'lama/, [see text]. The analyzed acoustic parameters were F1, F2 and F3, duration and steady-state portion from the target sound and slope analysis. RESULTS: For words containing /l/, the duration parameter was the great differentiator between the two groups; values of the control group were higher than those found for the group with phonological disorder. Considering words containing /r/ that were correctly produced by the control group and that were always substituted by /l/ in the disordered group, parameters involving duration presented higher values in the disordered group. Slope analysis demonstrated higher values for the control group. CONCLUSION: Articulation accuracy of children in the control group was, overall, higher even when considering correctly produced words by the group with phonological disorder containing /l/. The analysis of other acoustic parameters, as well as the application of these parameters to other sounds of the Portuguese language, can help clinicians to make a precise evaluation and, consequently, to improve their therapeutic work.

Habilidades metafonológicas em crianças com transtorno fonológico: a interferência da idade e da gravidade / Metaphonological skills among children with speech sound disorder: the influence of age and disorder severity

Objetivo O presente trabalho teve como objetivo investigar o desempenho de crianças com Transtorno Fonológico nas habilidades metafonológicas avaliadas pelo teste Lindamood Auditory Conceptualization Test (LAC-adaptado para o Português-Brasileiro), de acordo com a idade e a gravidade do transtorno. Métodos Foram avaliadas 50 crianças com Transtorno Fonológico, idade entre 5 anos e 7 anos e 11 meses, submetidas à aplicação das três categorias (I-A; I-B; II) do Lindamood Auditory Conceptualization Test e, posteriormente, agrupadas por idade e pela gravidade, de acordo com a aplicação do Índice de gravidade de Porcentagem de Consoantes Corretas-Revisado. Resultados As habilidades avaliadas indicaram que as crianças, cujo valor do Índice de gravidade de Porcentagem de Consoantes Corretas-Revisado foi inferior a 85%, destacando-se a gravidade associada à idade (crianças de menor faixa etária), apresentaram maior dificuldade na percepção auditiva e sistema fonológico mais desorganizado, evidenciado nas habilidades metafonológicas mais simples do teste, que envolvem a discriminação de unidades fonêmicas isoladas. As tarefas complexas não acrescentam informações para determinar quais aspectos do conhecimento cognitivo-linguístico da criança com transtorno fonológico está mais alterado. Conclusão As habilidades avaliadas indicaram que as crianças que apresentaram maior gravidade do transtorno fonológico, e, portanto um sistema fonológico mais desorganizado, apresentaram maior dificuldade na percepção auditiva. Os resultados indicam ainda que crianças com transtorno fonológico, independentemente da gravidade, têm dificuldade em habilidades metafonológicas mais complexas, sendo que as mais graves também apresentam dificuldades ...

Purpose The objective of the present study is to assess the metaphonological skill levels of children with speech sound disorders as a function of age and disorder severity as assessed by the Lindamood Auditory Conceptualization Test (LAC-3 adapted to the Brazilian Portuguese language). Methods Fifty children with speech sound disorder between the ages of five years and seven years and 11 months were given three versions (I-A, I-B and II) of the Lindamood Auditory Conceptualization Test and then divided by age and speech sound disorder severity assessed by Percentage Consonants Correct-Revised (PCC-R) scores. Results The skills testing results indicate that younger children with 85% PCC-R or less experience greater difficulty than the other children with auditory perception and exhibit more disorganized phonological systems, as shown in their execution of simple metaphonological skills throughout testing, which involve discriminating between isolated phonemic units. The complex task results do not provide sufficient information to determine which cognitive-linguistic knowledge features among children with speech sound disorder are most heavily affected. Conclusion The skills testing results indicate that children with more severe speech sound disorder, who thus present higher degrees of phonological system disorganization, experience greater difficulty in the area of auditory perception. The results further indicate that regardless of the degree of disorder severity, children with phonological disorders struggle with more complex metaphonological skills, and those with greater degrees of disorder severity also struggle to master simpler metaphonological tasks. .

Ocorrência de erros fonológicos de acordo com a gravidade em crianças com transtorno fonológico / Occurrence of phonological errors according to severity in children with speech sound disorder

Objetivo descrever e quantificar os erros de fala de crianças com transtorno fonológico de acordo com seu desempenho no índice porcentagem de consoantes corretas-revisado e process density index, além de determinar se as crianças com diferentes graus de gravidade diferem quanto ao erro articulatório predominante na fala. Métodos foram analisadas as amostras de fala de 21 crianças com transtorno fonológico de ambos os gêneros, com idades entre 5;2 e 7;11 anos. A partir de duas provas de fonologia (nomeação de figuras e imitação de palavras) foram calculados os índices absolutos de substituição, omissão e distorção, a porcentagem de consoantes corretas-revisado e o process density index Resultados houve diferenças quanto ao tipo de erro predominante na fala indicando que a substituição foi o tipo de erro mais ocorrente. Para as crianças com maior gravidade a substituição foi o tipo de erro de fala predominante e, para aquelas com grau menor gravidade, observou-se ocorrência semelhante dos diferentes tipos de erros. Na análise da amostra total as correlações apontaram que quanto maior a ocorrência de substituição menor o número de distorção Conclusão de forma geral, a substituição foi o tipo de erro mais ocorrente. As crianças menos graves apresentaram equivalência entre os tipos de erros e as mais graves, maior ocorrência de substituições. Os índices absolutos foram efetivos e eficientes para indicar o tipo de erro mais frequente em função da gravidade do transtorno. .

Purpose to describe and quantify speech errors in children with speech sound disorder according to severity calculated by the indexes percentage of consonants correct revised and process density index and also to determine whether children with different degrees of severity differ in the predominant error observed during speech production. Methods speech samples of 21 children aged between 5;2 and 7;11 years-old with speech sound disorder were analyzed. Absolute indexes of substitution, omission and distortion, percentage of consonants correct revised and process density index were calculated based on two phonology tasks (picture naming and imitation of words). Results there were differences in the predominant type of error in speech indicating that substitution was the most occurring type of error. Substitution was the most frequent type of error for the most severe children while for the less severe ones the study did not indicate a prevalent type of error. The analysis of the total sample the correlation analysis indicated that the higher the occurrence of substitution less the number of distortion. Conclusion in general terms substitution was the most frequent type of error. Equivalence of the type of errors was observed for the less sever children while substitution was the most frequent type of error for the more sever group of children. Absolute indexes were effective and efficient to indicate the most frequent type of error according to the severity of the disorder. .