Tratamiento psicológico de la tartamudez crónica: estudio descriptivo de cinco casos clínicos / Psychological treatment of persistent stuttering: Descriptive study of five clinical cases

La tartamudez persistente se define por la permanencia de las disfluencias y la presencia de factores cognitivos, conductuales y comunicativos que contribuyen a mantenerla y agravarla. Por tanto, su tratamiento clínico debe centrarse en mejorar la fluidez del habla, asegurar la generalización del nuevo patrón prosódico y manejar los pensamientos disfuncionales y las conductas de evitación social y comunicativa que ayudan a mantener el problema y provocan una pérdida significativa de calidad de vida. Objetivo: Medir la eficacia de un tratamiento estandarizado para pacientes adultos con tartamudez persistente centrado en la fluidez de habla y en los aspectos psicológicos implicados. Material y métodos: Estudio clínico analítico de los resultados de la intervención. Se realizó una evaluación de todos los aspectos implicados en la tartamudez persistente mediante instrumentos validados y registro de habla. Se aplicó el protocolo de un tratamiento para tartamudez crónica. Resultados: Se evaluó la fluidez del habla en muestras de habla espontánea y lectura y las subescalas del cuestionario OASES de cinco pacientes con tartamudez de entre 21 y 25años. El tratamiento redujo el porcentaje de sílabas tartamudeadas en todos los casos, tanto en habla como en lectura, así como una reducción de las puntuaciones en todas las subescalas del OASES. Conclusión: Los resultados clínicos obtenidos indican eficacia del protocolo empleado para la modificación de la frecuencia de tartamudeos y de otros fenómenos asociados. Se exponen algunas consideraciones de interés para los terapeutas de la tartamudez crónica.(AU)

Persistent stuttering is defined by the permanence of disfluencies and the presence of cognitive, behavioral, and communication factors that contribute to maintaining and aggravating it. Therefore, clinical treatment should focus on improving speech fluency, ensuring generalization of the new prosodic pattern, and managing dysfunctional thoughts and social and communicative avoidance behaviors that help maintain the problem and cause significant loss of quality of life in patients. Objective: The main objective is to measure the efficacy of a standardized treatment focused on speech fluency and psychological aspects for adult patients with persistent stuttering. Material and methods: Analytical clinical study of the results of the psychological intervention. An evaluation of all aspects involved in persistent stuttering was carried out using validated instruments and speech recording. The protocol of a clinical treatment for chronic stuttering was applied. Results: Speech fluency in spontaneous speech and reading samples and the OASES questionnaire subscales from five stuttering patients aged 21-25years were assessed. The treatment reduced the percentage of stuttered syllables in all cases, both in speaking and reading, as well as a reduction in scores on all OASES subscales. Conclusion: Clinical results obtained indicate the efficacy of the protocol used to modify the frequency of stuttering and other associated behaviors. Some considerations of interest for therapists of chronic stuttering are exposed.(AU)

Is the Mini-Mental State Examination the best cognitive screening test for less educated people? / O mini-exame de estado mental é o melhor teste de rastreamento cognitivo para indivíduos com menor escolaridade?

ABSTRACT Mini-Mental State Examination (MMSE) results are strongly influenced by educational level. The Brief Cognitive Screening Battery (BCSB) is an alternative assessment tool that provides more accurate results in individuals with less education. Objective: Our aim was to compare the MMSE and BCSB as screening tests. Methods: The MMSE and BCSB were assessed in 112 participants by two evaluators blind to the other test's result. Participants were classified according to their level of education. The influence of education level was analyzed using the Kruskal-Wallis and multiple comparison tests. Results: Scores of the MMSE (p < 0.0001) and the clock-drawing test (p < 0.0001) were influenced by education level but the delayed recall test score was not (p = 0.0804). The verbal fluency test (p = 0.00035) was influenced only by higher educational levels. It took three minutes less to apply the MMSE than to apply the BCSB (p < 0.0001). Conclusions: These findings suggest that the delayed recall test and the verbal fluency test of the BCSB are better than the MMSE and clock-drawing test as tools for evaluating cognition in people with limited education.

Resumo Os resultados do Mini-Exame de Estado Mental (MEEM) são consideravelmente influenciados pelo nível de escolaridade. A Bateria Breve de Rastreio Cognitivo (BBRC) é uma ferramenta de rastreamento cognitivo alternativa que fornece resultados mais acurados em indivíduos com menor nível de escolaridade. Objetivo: Comparar o MEEM e a BBRC como testes de rastreamento cognitivo. Métodos: 112 participantes foram submetidos ao MEEM e a BBRC por 2 avaliadores cegos para o resultados do outro teste. Os participantes foram classificados de acordo o nível de escolaridade. A influência do nível de escolaridade foi analisada utilizando o teste de Kruskal-Wallis e o teste de comparações múltiplas. Resultados: As pontuações do MEEM (p < 0,0001) e do teste do desenho do relógio (p < 0,0001) foram influenciadas pelo nível de escolaridade, porém o teste de memória tardia não sofreu influência do nível de escolaridade (p = 0,0804). O teste de fluência verbal (p = 0,00035) foi influenciado apenas pelos níveis educacionais mais altos. A aplicação do MEEM levou 3 minutos a menos que a da BBRC (p < 0,0001). Conclusão: Os achados desse estudo sugerem que o teste de memória tardia e o teste de fluência verbal da BBRC são mais adequados que o MEEM e o teste do desenho do relógio como ferramentas para avaliação cognitiva em populações com menor nível educacional.

Tarefa de discriminação de fala com pseudopalavras / Speech perception task with pseudowords

RESUMO Objetivo Elaborar uma lista de pseudopalavras em Português Brasileiro para avaliação da habilidade de discriminação auditiva de sons da fala e investigar a consistência interna dos itens de teste e o efeito do ano escolar sobre o desempenho na discriminação. Método Participaram 60 escolares de 3º (N=14), 4º (N=24) e 5º anos (N=22) do Ensino Fundamental (60% meninas) entre 8 anos e 2 meses e 11 anos e 8 meses (99 a 136 meses; M=120,05; DP=10,26), com média de rendimento escolar=7,21 pontos (DP=1,23; mínimo 5,0; máximo 10). Elaboraram-se 48 pares mínimos de pseudopalavras, com estrutura do Português Brasileiro e oponência de apenas um fonema. As repostas dos participantes (se os elementos dos pares eram iguais ou diferentes) foram anotadas e analisadas. Calculou-se o Coeficiente Alfa de Cronbach, o Coeficiente de Correlação de Spearman e o Teste de Bonferroni, com nível de significância de 0,05. Resultados A análise da consistência interna indicou a retirada de 20 pares. Vinte e oito resultantes mostraram boa consistência interna (α=0,84). O máximo de respostas corretas de discriminação dos estudantes foi 34, o mínimo = 16, a média = 30,79 (DP = 3,68). Não foram observadas correlações entre a idade, a nota e o desempenho em discriminação; tampouco foram apontadas diferenças de desempenho entre os anos escolares. Conclusão Grande parte dos itens propostos para avaliação da discriminação auditiva dos sons da fala mostrou boa consistência interna em relação à tarefa. Não foi observada melhora da capacidade de discriminação auditiva dos sons da fala quanto mais velha a criança ou mais adiantado o ano escolar.

ABSTRACT Purpose Prepare a list of pseudowords in Brazilian Portuguese to assess the auditory discrimination ability of schoolchildren and investigate the internal consistency of test items and the effect of school grade on discrimination performance. Methods Study participants were 60 schoolchildren (60% female) enrolled in the 3rd (n=14), 4th (n=24) and 5th (n=22) grades of an elementary school in the city of Sao Paulo, Brazil, aged between eight years and two months and 11 years and eight months (99 to 136 months; mean=120.05; SD=10.26), with average school performance score of 7.21 (minimum 5.0; maximum 10; SD=1.23). Forty-eight minimal pairs of Brazilian Portuguese pseudowords distinguished by a single phoneme were prepared. The participants' responses (whether the elements of the pairs were the same or different) were noted and analyzed. The data were analyzed using the Cronbach's Alpha Coefficient, Spearman's Correlation Coefficient, and Bonferroni Post-hoc Test at significance level of 0.05. Results Internal consistency analysis indicated the deletion of 20 pairs. The 28 items with results showed good internal consistency (α=0.84). The maximum and minimum scores of correct discrimination responses were 34 and 16, respectively (mean=30.79; SD=3.68). No correlation was observed between age, school performance, and discrimination performance, and no difference between school grades was found. Conclusion Most of the items proposed for assessing the auditory discrimination of speech sounds showed good internal consistency in relation to the task. Age and school grade did not improve the auditory discrimination of speech sounds.

Implicações psíquicas no desvio fonológico analisadas por meio dos contos de fadas / Psychic implications in phonological disorder analyzed through fairy tales

Nesta pesquisa analisou-se a relação entre o desvio fonológico e as questões psíquicas envolvidas nessa patologia e a forma como as crianças se posicionaram diante de tal sintoma. O desvio fonológico é uma alteração da fala, com uso inadequado de fonemas e ausência de fatores orgânicos identificáveis. Sua maior ocorrência é constatada entre quatro e oito anos de idade. O objetivo deste estudo foi analisar a posição refratária e outros aspectos psicológicos em crianças com desvio fonológico por meio dos contos de fadas. Empregou-se uma metodologia qualitativa, a partir da análise de conteúdo. Participaram da pesquisa dez crianças, de ambos os sexos, na faixaetária de quatro anos a sete anos e 11 meses, diagnosticadas com desvio fonológico e encaminhadas ao serviço de atendimento fonoaudiológico de uma instituição de ensino superior. Para a coleta de dados, o instrumento utilizado foi os contos de fadas. Os dados foram generalizados e agrupados em categorias temáticas e apontaram que todas as crianças da pesquisa eram refratárias à convenção linguística em virtude de uma dificuldade de sair do período de dependência relativa para a independência, desenvolvendoassim um sintoma de linguagem

Implicações psíquicas no desvio fonológico analisadas por meio dos contos de fadas / Psychic implications in phonological disorder analyzed through fairy tales

Nesta pesquisa analisou-se a relação entre o desvio fonológico e as questões psíquicas envolvidas nessa patologia e a forma como as crianças se posicionaram diante de tal sintoma. O desvio fonológico é uma alteração da fala, com uso inadequado de fonemas e ausência de fatores orgânicos identificáveis. Sua maior ocorrência é constatada entre quatro e oito anos de idade. O objetivo deste estudo foi analisar a posição refratária e outros aspectos psicológicos em crianças com desvio fonológico por meio dos contos de fadas. Empregou-se uma metodologia qualitativa, a partir da análise de conteúdo. Participaram da pesquisa dez crianças, de ambos os sexos, na faixaetária de quatro anos a sete anos e 11 meses, diagnosticadas com desvio fonológico e encaminhadas ao serviço de atendimento fonoaudiológico de uma instituição de ensino superior. Para a coleta de dados, o instrumento utilizado foi os contos de fadas. Os dados foram generalizados e agrupados em categorias temáticas e apontaram que todas as crianças da pesquisa eram refratárias à convenção linguística em virtude de uma dificuldade de sair do período de dependência relativa para a independência, desenvolvendoassim um sintoma de linguagem

This research analyzed the relationship between phonological disorder and the mental issues involved in this pathology, as well as how the children stood before such symptom. Phonological disorder is a speech abnormality characterized by inappropriate use of phonemes and absence of identifiable organic factors. Its greatest occurrence is observed between the ages of 4 and 8 years old. The aim of this study was to analyze the refractory position and other psychological aspects in children with phonological disorders through fairy tales. A qualitative methodology based on content analysis was applied. This study counted with the participation of 10 children of both sexes, aged between 4 and 7 years and 11 months old, diagnosed with phonological disorders and referred to the speech therapy department of a higher education institution. The instrument for data collection was fairy tales. Data was generalized and grouped into thematic categories and showed that all children of the study were refractory in relation to linguistic conventions due to a difficulty to leave the period of relative dependence towards independence, thus developing a speech symptom.

Lexical and phonological processing in visual word recognition by stuttering children: evidence from Spanish

A number of studies have pointed out that stuttering-like disfluencies could be the result of failures in central and linguistic processing. The goal of the present paper is to analyze if stuttering implies deficits in the lexical and phonological processing in visual word recognition. This study compares the performance of 28 children with and without stuttering in a standard lexical decision task in a transparent orthography: Spanish. Word frequency and syllable frequency were manipulated in the experimental words. Stutterers were found to be considerably slower (in their correct responses) and produced more errors than the non- stutterers (χ(1) = 36.63, p < .001, η2 = .60). There was also a facilitation effect of syllable frequency, restricted to low frequency words and only in the stutterers group (t1(10) = 3.67, p < .005; t2(36) = 3.10, p < .001). These outcomes appear to suggest that the decoding process of stutterers exhibits a deficit in the interface between the phonological-syllabic level and the word level (AU)

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Lexical effects in word naming in Spanish children

Reading strategies depend on the consistency of the orthographic system. Recently the use of lexical strategies at early stages of reading acquisition has been shown even in transparent orthographies. The aim of this study was to know how different lexical and sublexical variables affect the reaction times (RTs) and articulation times (ATs) in word reading in Spanish children. A group of 46 children of typical reading level in the second and fourth grades of primary school were asked to read aloud 100 words presented on a computer screen. The stimuli were morphologically simple nouns with different ranges of length, frequency, imageability, orthographic neighbors and age of acquisition (AoA). Reading and articulation time were measured. Differences between means of the second and the fourth grade were seen in RTs (p < .001; Cohens' d = 1.41) and ATs (p < 001; Cohen's d = 1.41) in a t-test. Analyses of mixed-effects revealed that word length, a sublexical variable, and frequency and AoA, lexical variables, affected both grades, mainly on the RTs. The presence of lexical variables reducing RTs and ATs in second grade suggests that lexical reading is present from very early stages in Spanish children (AU)

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Auditory implicit semantic priming in Spanish-speaking children with and without specific language impairment

We analyzed whether Spanish-speaking children with Specific Language Impairment (SLI) showed deficits in lexical-semantic processing/organization, and whether these lexical measures correlated with standardized measures of language abilities. Fourteen children with Typical Language Development (TLD) and 16 age-matched children with SLI (8;0-9;11 years) participated. In a Lexical Decision (LD) task with implicit semantic priming, children judged whether a given speech pair contained two words (semantically related/unrelated) or a word-pseudoword. Children received a comprehensive language and reading test battery. Children with TLD exhibited significant semantic priming; they were faster for semantically related word pairs than for unrelated (p < .001) and than for word-pseudoword pairs (p < .0002). The group with SLI did not exhibit significant semantic priming, despite showing more variability. Children with SLI made significantly slower LDs [F(1, 26) = 4.61, p < .05, partial η2 = .15] and more errors [F(1, 26) = 4.16, p < .05, partial η2 = .13] than children with TLD. Mean response time across all LD conditions and the receptive vocabulary (PPVT-III) were significantly negativity correlated for children with SLI (r = -.71, p = .004). Children with SLI, especially those with the poorest language scores, showed a semantic-lexical deficit and a weakness in lexical-semantic association networks. Their performance on the LD task was significantly slower and poorer than for children with TLD. Increasing a child’s vocabulary may benefit lexical access (AU)

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Discomfort associated with fixed orthodontic appliances: determinant factors and influence on quality of life

OBJECTIVE: To investigate the determinant factors of discomfort attributed to the use of fixed orthodontic appliance and the effect on the quality of life of adolescents. MATERIAL AND METHODS : Two hundred and seventy-two individuals aged between 9 and 18 years old, enrolled in public and private schools and undergoing orthodontic treatment with fixed appliance participated in this cross-sectional study. The participants were randomly selected from a sample comprising 62,496 individuals of the same age group. Data was collected by means of questionnaires and an interview. Discomfort intensity and bio-psychosocial variables were assessed using the Oral Impact on Daily Performance questionnaire. Self-esteem was determined using the Global Negative Self-Evaluation questionnaire. Statistical analysis involved the chi-square test and both simple and multiple Poisson regression analyses. RESULTS: Although most individuals did not present discomfort, there was a prevalence of 15.9% of impact on individuals' daily life exclusively due to the use of fixed orthodontic appliance . Age [PR: 3.2 (95% CI: 1.2-8.5)], speech impairment [PR: 2.2 (95% CI: 1.1-4.6)], poor oral hygiene [PR: 2.4 (95% CI: 1.2-4.8)] and tooth mobility [PR: 3.9 (95% CI: 1.8-8.1)] remained independently associated with a greater prevalence of discomfort (P ≤ 0.05). CONCLUSIONS: Discomfort associated with the use of fixed orthodontic appliances exerted a negative influence on the quality of life of the adolescents comprising the present study. The determinants of this association were age, poor oral hygiene, speech impairment and tooth mobility. .

OBJETIVO: investigar os fatores determinantes do desconforto atribuído ao uso do aparelho ortodôntico fixo e sua influência na qualidade de vida de adolescentes. MÉTODOS: participaram desse estudo transversal 272 indivíduos, com idades entre 9 e 18 anos, estudantes de escolas públicas e privadas, que usavam aparelhos ortodônticos fixos (braquetes). Os participantes foram selecionados aleatoriamente, entre 62.496 indivíduos da mesma faixa etária. A coleta de dados foi feita em forma de entrevista e questionário. A intensidade do desconforto e variáveis biopsicossociais foram avaliadas por meio do Oral Impact on Daily Performance (OIDP). A autoestima foi determinada pela Global Negative Self-Evaluation (GSE). A análise estatística envolveu o teste qui-quadrado e a análise de regressão de Poisson, simples e múltipla. RESULTADOS: embora a maioria dos indivíduos não apresentasse desconforto, observou-se uma prevalência de impacto na vida diária devido, exclusivamente, ao uso do aparelho ortodôntico fixo, de 15,9%. Variáveis idade de 15 a 18 anos [RP = 3,2 (IC 95% = 1,2-8,5)], dificuldade de falar [RP = 2,2 (IC 95% = 1,1-4,6)], dificuldade de limpar a boca [RP = 2,4 (IC95% = 1,2-4,8)] e mobilidade dos dentes [RP = 3,9 (IC 95% = 1,8-8,1)] permaneceram associadas, de forma independente, à maior prevalência de desconforto (p ≤ 05). CONCLUSÕES: desconforto associado ao uso de aparelhos ortodônticos fixos influenciou negativamente a qualidade de vida de adolescentes. Os fatores determinantes foram idade, dificuldade de limpar a boca, de falar e mobilidade dentária. .

The impact of speech disorders quality of life: a questionnaire proposal / Impacto dos disturbios da fala na qualidade de vida: proposta de questionario

PURPOSE: To develop a questionnaire to analyze the impact of speech disorders on quality of life and verify its reliability. METHODS: A literature review on instruments that assess the quality-of-life was performed, particularly those concerning communication disorders. The questionnaire was designed with 18 closed questions: one related to speech impairments, another about quality-of-life, and 16 questions covering the physical, emotional, and social domains. The questionnaire was applied to a population of 24 individuals of both sexes, aged between 12 and 50 years; 12 patients (case group) had phonetic speech disorders, and 12 (control group) had no impairment in oral communication. They were paired according to age and sex. To analyze the reliability of the instrument, the internal consistency of the items was assessed through Cronbach's Alpha coefficient. RESULTS: The internal consistency of the 16 questions concerning the domains was á=0.93; for the physical domain, á=0.71; for the emotional domain, á=0.77; and for the social domain, á=0.85. CONCLUSION: The questionnaire showed good reliability in identifying the impact of speech disorders on the individuals' quality of life. .

OBJETIVO: Elaborar um questionário para analisar o impacto dos distúrbios da fala na qualidade de vida e verificar a sua confiabilidade. MÉTODOS: Foi realizada revisão de literatura sobre instrumentos que avaliavam a qualidade de vida, sobretudo nas alterações de comunicação. Foi elaborado questionário com 18 questões fechadas, sendo uma relativa ao comprometimento de fala, outra à qualidade de vida e as demais 16 questões abrangeram os domínios físico, emocional e social. O questionário foi aplicado em 24 sujeitos de ambos os gêneros com idades entre 12 e 50 anos, sendo 12 indivíduos (grupo caso) com distúrbio de fala de origem fonética e 12 (grupo controle) sem comprometimento de comunicação oral, pareados por idade e gênero. Para análise da confiabilidade do questionário, foi analisada a consistência interna dos itens que o compõem por meio do coeficiente Alfa de Cronbach. RESULTADOS: A consistência interna das 16 questões referentes aos domínios foi de á=0,93; para o domínio físico á=0,71, para o emocional á=0,77 e para o social á=0,85. CONCLUSÃO: O questionário apresentou boa confiabilidade para a identificação do impacto do distúrbio da fala na qualidade de vida dos indivíduos. .

The interaction between awareness of one' s own speech disorder with linguistics variables: distinctive features and severity of phonological disorder / A interacao da consciencia do proprio desvio de fala com as variaveis linguisticas: tracos distintivos e gravidade do desvio fonologico

PURPOSE: To analyze the possible relationship among the awareness of one' s own speech disorder and some aspects of the phonological system, as the number and the type of changed distinctive features, as well as the interaction among the severity of the disorder and the non-specification of distinctive features. METHODS: The analyzed group has 23 children with diagnosis of speech disorder, aged 5:0 to 7:7. The speech data were analyzed through the Distinctive Features Analysis and classified by the Percentage of Correct Consonants. One also applied the Awareness of one' s own speech disorder test. The children were separated in two groups: with awareness of their own speech disorder established (more than 50% of correct identification) and without awareness of their own speech disorder established (less than 50% of correct identification). Finally, the variables of this research were submitted to analysis using descriptive and inferential statistics. RESULTS: The type of changed distinctive features weren' t different between the groups, as well as the total of changed features and the severity disorder. However, a correlation between the severity disorder and the non-specification of distinctive features was verified, because the more severe disorders have more changes in these linguistic variables. CONCLUSION: The awareness of one' s own speech disorder doesn' t seem to be directly influenced by the type and by the number of changed distinctive features, neither by the speech disorder severity. Moreover, one verifies that the greater phonological disorder severity, the greater the number of changed distinctive features. .

OBJETIVO: Analisar a possível relação entre a consciência do desvio de fala e alguns aspectos do sistema fonológico, como o número e o tipo de traços distintivos alterados e a gravidade do desvio fonológico, bem como a interação entre a gravidade do desvio e a não especificação de traços distintivos. MÉTODOS: O grupo pesquisado constitui-se de 23 crianças com diagnóstico de desvio fonológico na faixa etária de 5:0 a 7:7 anos. Os dados de fala foram analisados a partir da Análise por Traços Distintivos e classificados pelo Percentual de Consoantes Corretas. Aplicou-se ainda o Teste de Consciência do Próprio Desvio de Fala. As crianças foram divididas em dois grupos: com consciência do próprio desvio de fala estabelecida (mais de 50% de identificação correta) e com consciência do próprio desvio de fala não estabelecida (menos de 50% de identificação correta). Por fim, as variáveis desta pesquisa foram submetidas à análise estatística descritiva e inferencial. RESULTADOS: O tipo de traços distintivos alterados não se mostrou distinto entre os grupos, assim como o total de traços alterados e a gravidade do desvio. Já uma relação entre a gravidade do desvio e a não especificação de traços distintivos foi verificada, na medida em que os casos mais graves apresentam mais alterações destas variáveis linguísticas. CONCLUSÃO: A consciência do próprio desvio de fala parece não ser diretamente influenciada pelo tipo e número de traços distintivos alterados, nem pela gravidade do desvio fonológico. Além disto, verificou-se que quanto maior a sua gravidade, maior o número de traços distintivos alterados. .

Evaluación de la discriminación de habla en preescolares: comparación de las pruebas ABX y AX / Assessment of speech discrimination in preschool children: comparison of AX and ABX tasks

El objetivo del presente estudio fue averiguar si la información que proporcionan las pruebas ABX y AX sobre la percepción de sonidos del habla en una muestra de niños con trastornos del habla es la misma o no. Participaron 86 niños de edades comprendidas entre los 3 años y 2 meses y los 5 años y 11 meses, siendo la media de 4 años y 7 meses. Fueron seleccionados de entre una muestra de 1.283 niños procedentes de 11 colegios diferentes de la Comunitat Valenciana cuya lengua materna era el español. En primer lugar se evaluó la producción del habla. En función de los errores cometidos por cada niño, se construyeron y aplicaron las pruebas ABX y AX, utilizando los criterios de Locke para la evaluación de la percepción del habla de niños con trastornos del desarrollo del lenguaje. Se analizó si los resultados entre ambas pruebas estaban relacionados o no y se determinó la fuerza de la concordancia entre los resultados de las 2 pruebas. Los resultados avalan la hipótesis de que ambas pruebas están relacionadas en las mediciones realizadas en la muestra, aunque el grado de concordancia solo se sitúa en un nivel aceptable. Es posible que las 2 pruebas midan aspectos distintos de la percepción de habla. La alternativa de aplicar ambas pruebas, teniendo en cuenta la escasa inversión de tiempo, puede ser un criterio de prudencia en la práctica clínica (AU)

The aim of this study was to determine whether the AX and ABX tasks provide the same or different information on perception of speech sounds in a sample of children with speech sound disorders. The participants consisted of 86 children with an age range of 3 to 5 years (mean, 4 years and 7 months). The children had speech sound disorders and were selected from a sample of 1283 children from 11 different schools in Valencia (Spain) whose first language was Spanish. First, we assessed speech production. Depending on the errors made by each child, ABX and AX tasks were constructed and applied, using Locke criteria for assessing speech perception in children with developmental language disorders. We analyzed whether the results of the two tasks were related and we determined the strength of the agreement between the results of the two tasks. The results support the hypothesis that both tasks are related when they measure speech perception in children. However, the degree of agreement was only acceptable, perhaps because the two tasks evaluate different aspects of speech perception. Given the low time investment, application of both tasks may be a prudent approach in clinical practice (AU)

Idiopathic Parkinson's disease: vocal and quality of life analysis / Doença de Parkinson idiopática: análise vocal e da qualidade de vida

OBJECTIVE: To compare voice and life quality of male patients with idiopathic Parkinson's disease, with individuals without disease (Control Group). METHODS: A cross-sectional study that evaluated the voice of individuals with Parkinson's disease, the group was composed of 27 subjects, aged from 39 to 79 years-old (average 59.96). The Control Group was matched on sex and age. Participants underwent voice recording. Perceptual evaluation was made using GRBASI scale, which considers G as the overall degree of dysphonia, R as roughness, B as breathiness, A as asthenia, S as strain and I as instability. The acoustic parameters analyzed were: fundamental frequency, jitter, shimmer, and harmonic to noise ratio (NHR). For vocal self-perception analysis, we used the Voice Related Quality of Life protocol. RESULTS: Fundamental frequency and jitter presented higher values in the Parkinson's group. NHR values were higher in the Control Group. Perceptual analysis showed a deviation ranging. The vocal disorder self-perception demonstrated a worse impact on quality of life. CONCLUSIONS: Individuals with Parkinson's disease have an altered voice quality and a negative impact on quality of life.

OBJETIVO: Comparar a qualidade vocal e a qualidade de vida entre pacientes do sexo masculino com doença de Parkinson idiopática e indivíduos sem a doença (Grupo Controle). MÉTODOS: Estudo transversal que avaliou a voz de 27 indivíduos com doença de Parkinson, com idades entre 39 a 79 anos (média de 59,96). O Grupo Controle foi pareado em sexo e idade. Avaliação perceptiva foi feita usando escala GRBASI, que considera G como o grau global da disfonia, R como a rugosidade, B como soprosidade, A como astenia, S como tensão e I como instabilidade. Os parâmetros acústicos analisados foram: frequência fundamental, jitter, shimmer e harmonic to noise ratio (NHR). Para análise da autopercepção vocal, utilizou-se o protocolo Qualidade de Vida e Voz. RESULTADOS: As medidas frequência fundamental e jitter apresentaram valores mais altos no grupo com doença de Parkinson. Valores de NHR foram maiores no Grupo Controle. Análise perceptivo-auditiva mostrou desvio da qualidade vocal. O distúrbio de autopercepção vocal demonstrou impacto negativo na qualidade de vida. CONCLUSÕES: Indivíduos com doença de Parkinson idiopática apresentam qualidade vocal alterada e impacto negativo na qualidade de vida.

Differential diagnosis between apraxia and dysarthria based on acoustic analysis

Acoustic analysis provides objective quantitative measures of speech that enable a comprehensive and accurate understanding of motor disorders and complement the traditional measures. This paper aims to distinguish between normal and pathological speech, more specifically between apraxia of speech and spastic dysarthria in native Spanish speaking patients using acoustic parameters. Participants (4 aphasic with apraxia of speech, 4 with spastic dysarthria, and 15 without speech disorders) performed three different tasks: repeating the syllable sequence [pa-ta-ka], repeating the isolated syllable [pa] and repeating the vowel sequence [i-u]. The results showed that the normative values of motor control, in general, coincide with those obtained in previous research on native English speakers. They also show that damage to motor control processes results in a decrease in the rate of alternating and sequential movements and an increase in the inter-syllabic time for both types of movements. A subset of the acoustic parameters analyzed, those that measure motor planning processes, enable differentiation between normal population and apraxic and dysarthric patients, and between the latter. The differences between the pathological groups support the distinction between motor planning and motor programming as described by van der Merwe’s model of sensorimotor processing (1997) (AU)

El análisis acústico proporciona medidas cuantitativas objetivas del habla que permiten una comprensión global y más exacta de sus trastornos motores complementando a las medidas tradicionales. En el presente trabajo se realiza un estudio diferencial entre normalidad motora del habla y habla patológica y, dentro de ésta, entre apraxia del habla y disartria espástica basado en parámetros acústicos en pacientes hablantes nativos de español. Los participantes (4 afásicos con apraxia del habla, 4 con disartria espástica y 15 sin patología) realizaron tres tareas: repetir la secuencia silábica [pa-ta-ka], repetir la sílaba aislada [pa] y repetir la secuencia vocálica [i-u]. Los resultados mostraron que los valores normativos de control motor coinciden en general con los obtenidos en investigaciones con hablantes nativos de inglés y que la afectación de los procesos de control motor da lugar a un decremento de la tasa de movimientos alternantes y de movimientos secuenciales así como a un incremento de los tiempos intersilábicos para ambos tipos de movimientos. Un subconjunto de los parámetros acústicos analizados, aquellos que reflejan los procesos de planificación motora, permite diferenciar entre la norma y los pacientes apráxicos y disártricos, y a su vez entre estos. Las diferencias encontradas entre ambos grupos patológicos apoyan la distinción entre planificación motora y programación motora descrita en el modelo de procesamiento sensoriomotor de van der Merwe (1997) (AU)

Processing of spanish preterite regular and irregular verbs: the role of neighborhood density

Research into lexical processes shows that frequency and phonological similarity (neighborhood density) affect word processing and retrieval. Previous studies on inflectional morphology have examined the influence of frequency of occurrence in speech production on the inflectional verb paradigm in English. Limited work has been done to examine the influence of phonological similarity in languages with a more complex morphological system than English. The present study examined the influence of neighborhood density on the processing of Spanish Preterite regular and irregular verbs as produced by thirty native speakers of Spanish. The results of a naming task showed that regular verbs were processed faster and more accurately than irregular ones. Similar to what has been observed in English, a facilitative effect of neighborhood density for -ir verbs was observed in both regular and irregular verbs, such that -ir verbs with dense neighborhoods were produced faster and more accurately than -ir verbs with sparse neighborhoods. However, no neighborhood density effects were observed for -ar verbs (regular and irregular) in reaction times and accuracy rates. Thus, the activation of a specific -ir verb was facilitated by similar sounding verbs regardless of being regular and irregular. Implications for models of morphology language processing are discussed (AU)

De acuerdo a investigación llevada a cabo en torno a procesos léxicos, la frecuencia y la similitud fonológica (vecindario de densidad) afectan al acceso y procesamiento de palabras. Estudios previos sobre morfología flexiva han examinado la influencia de la frecuencia de aparición en actos de producción de habla en el paradigma verbal flexivo del inglés. No existen muchos estudios que examinen la influencia de la similitud fonológica en lenguas con un sistema morfológico más complejo que el que presenta el inglés. En este estudio se ha examinado la influencia de la densidad de vecindario en el procesamiento de verbos regulares e irregulares del español en formas de pretérito por parte de treinta nativo hablantes del español. Los resultados en una tarea de naming mostraron que los verbos regulares se procesaron más rápida y correctamente que los irregulares. Al igual que se ha observado en el inglés, se ha encontrado un efecto facilitador de densidad de vecindario en el caso de los verbos -ir, tanto en sus formas regulares como irregulares, de tal forma que los verbos -ir pertenecientes a un vecindario denso se produjeron más rápida y correctamente que los verbos- ir en vecindarios ermitaños. No obstante, no se han observado efectos de vecindario léxico en los verbos -ar (regulares e irregulares) en cuanto a tiempos de reacción e indices de precisión. Así pues, verbos similares en pronunciación facilitaron la activación de un verbo -ir específico independientemente si el verbo era regular o irregular. Se plantean implicaciones en los modelos de procesamiento morfológico (AU)

Influencia del sexo y el nivel educativo en la fluidez del habla en personas adultas / Influence of gender and educational status on fluent adults' speech fluency

El objetivo de este estudio fue comprobar la influencia del sexo y el nivel educativo en la fluidez del habla en personas adultas. La muestra final estuvo compuesta por 136 adultos brasileños de ambos sexos que hablaban portugués con fluidez, cuyas edades oscilaban entre 18 y < 60 años, distribuidos en los siguientes grupos, según su nivel educativo: educación primaria, educación secundaria y educación superior. Se analizaron sus muestras de habla considerando las variables propuestas en el perfil de la fluidez del habla, a saber: la tipología de las interrupciones (disfluencias normales y tartamudez), velocidad del habla (tanto en palabras como en sílabas por minuto) y la frecuencia de interrupciones (porcentaje de discontinuidad del habla). Teniendo en cuenta las variables analizadas, no se han encontrado diferencias estadísticamente significativas entre los sexos. Para comprobar la influencia del nivel educativo se consideró una diferencia estadísticamente significativa en la ocurrencia de las interjecciones, las revisiones y los prolongamientos. Los participantes con educación superior produjeron menos interjecciones y revisiones que los participantes con estudios de educación primaria, pero más prolongamientos que aquellos con estudios de educación secundaria. Los resultados indicaron que el sexo y el nivel educativo no pueden ser considerados como factores decisivos en la fluidez del habla en los adultos. Con todo, las conclusiones señalan que el nivel educativo influye en el uso de las estructuras semánticas, sintácticas y léxicas, así como en las estrategias utilizadas para superar estas dificultades (AU)

The aim of the study was to verify the influence of gender and educational status on fluent adults' speech fluency. The sample comprised 136 fluent adult Brazilian Portuguese speakers of both genders, whose ages ranged between 18 and < 60, distributed in the following groups, according to the educational status: elementary school, high school and higher education. A 200-fluent-syllable sample, elicited by visual stimulus was collected from each subject. The speech samples were analyzed considering the variables proposed in the Speech Fluency Profile, namely, typology of disruptions (stuttering-like disfluencies and other disfluencies), speech rate (in words / syllables per minute) and frequency of disruptions (percentage of speech discontinuity). Considering the variables analyzed, a lack of statistically significant difference between genders was found. Concerning the influence of educational status, a statistically significant difference in occurrence of interjections, revisions and prolongations was observed. Participants with higher education produced less interjections and revisions than participants with elementary school, but more prolongations than those with high school. Gender and educational status may not be regarded as decisive factors in fluent adults' speech fluency. It seems that the educational status determines the presence of difficulties in leading with semantic-lexical and syntactical structures, as well as the strategies used for overcoming these dificultéis (AU)

Variabilidad en los errores semánticos producidos por pacientes con daño cerebral / Variability in the semantic errors produced by brain-injured patients

Uno de los errores más comunes que cometen los pacientes afásicos durante la producción oral son los errores semánticos. Pero hablar de errores semánticos no es referirse a un tipo único de errores, sino que existen varios subtipos según la relación que exista entre la intención y el error: paradigmáticos cuando la relación es de tipo coordinado; sintagmáticos cuando la relación es de tipo asociado y supraordinados cuando el significado del error engloba al del target. El objetivo de este estudio fue comprobar si estos subtipos de errores semánticos tienen un origen común o proceden de diferentes puntos del sistema. Para ello se comparó el patrón de errores semánticos cometidos por un grupo de enfermos de Alzheimer y otro de pacientes afásicos en una tarea de denominación de dibujos. Se realizaron análisis de los porcentajes de errores, del grado de asociación entre el target y el error, así como de la frecuencia de los errores y sus targets. Los resultados sugieren que los tres subtipos de errores semánticos tienen un origen diferente: los supraordinados se podrían originar a nivel semántico, los sintagmáticos a nivel léxico y los paradigmáticos en ambos niveles de procesamiento

One of the most common types of errors produced by aphasic patients during oral word production is semantic errors. However, although aphasia semantic errors are often treated as a single homogenous group, there are, in fact, several subtypes defined by the nature of the error-target relationship: paradigmatic, if the two words are category coordinates; syntagmatic, if they are associatively related but from different semantic categories; and superordinate, if the meaning of the error is broader than the meaning of the target. The goal of this study was to investigate whether or not these various subtypes of semantic errors have a similar processing origin. With this objective, we compared the patterns of semantic errors made by a group of Alzheimer patients in a picture-naming task with those made by a group of aphasic patients. We examined the percentages of the different error types, the degree of association between target and error, and the frequency values both of errors and targets. The results suggest that the three subtypes of semantic errors have different origins: the superordinate appear to arise at the semantic level, the syntagmatic at the lexical level, and the paradigmatic at both levels of processing

Stress placement and word segmentation by Spanish speakers

Varios estudios han mostrado que el patrón acentual de la lenguamaterna se aplica a estímulos lingüísticos novedosos. En el campo de lasegmentación del habla sintetizada, esta idea ha recibido apoyo deexperimentos con lenguajes en los cuales el patrón acentual coincide con loslímites de las palabras (p.e. Inglés, Finlandés y Holandés). En este estudio,presentamos datos sobre la segmentación del habla en hablantes de Español,cuyo patrón acentual tiende a marcar la penúltima sílaba de las palabras.Los resultados muestran que acentuar la sílaba del medio en las palabrastrisilábicas de un flujo de habla artificial no facilita su segmentación, tal ycomo se podría predecir. Se exploran pues las posibles explicaciones deestos resultados, en la medida en que se relacionan con la interacción declaves estadísticas y acentúales durante la segmentación del habla(AU)

Several studies have shown that the stress pattern of one’s native languageis applied to new linguistic stimuli. Regarding the segmentation of artificialsynthesized speech, this idea has been supported by experiments withlanguages where the stress pattern coincides with word boundaries (i.e.English, Finnish and Dutch). In this study, we present data on speechsegmentation with native Spanish speakers whose stress pattern would markthe penultimate syllable of words. Results show that to stress the middlesyllable of trisyllabic words in an artificial speech stream does not facilitatesegmentation as would be predicted. Possible explanations of these resultsare explored as related to the interaction of statistical and stress cues inspeech segmentation(AU)

Queixa, demanda e desejo na clínica fonoaudiológica: um estudo de caso clínico / Complaint, demand and wish in speech-language pathology clinical practice: a case study

A queixa é o primeiro momento de contato entre paciente e terapeuta e dirá sobre os conteúdos manifestos dos sintomas e sobre os conteúdos latentes relacionados a ela: a demanda e o desejo. O objetivo deste trabalho foi identificar, por meio de um estudo de caso clínico, de que modo o reconhecimento da existência de uma demanda e de elementos relacionados ao desejo, ambos subjacentes à queixa do paciente, podem orientar a condução do processo terapêutico fonoaudiológico desde a entrevista. O método utilizado foi o estudo longitudinal de um caso clínico de um paciente com 11 anos, do sexo masculino, atendido entre setembro/2003 e dezembro/2004, com a queixa enunciada pelo pai: T. não fala, só se comunica por sinais. A interpretação do material clínico foi subsidiada pela articulação entre referenciais teóricos fonoaudiológicos e psicanalíticos. Esse estudo obedeceu às normas éticas estabelecidas para pesquisas com seres humanos. Os resultados apontaram que a demanda do paciente estava relacionada à necessidade de ser escutado pela família e o desejo caminhava em direção à manutenção do sintoma, como forma de assegurar a continuidade do investimento familiar. Tais conteúdos subsidiaram as intervenções terapêuticas que resultaram no aumento da oralidade de T., possibilidade de interlocução e reconfiguração das queixas familiares. A(s) entrevista(s) deve(m) preceder e subsidiar os processos terapêuticos fonoaudiológicos e a queixa deve ser escutada para além da literalidade. A introdução do desejo interdita o tradicional planejamento terapêutico prévio, pois os conteúdos psíquicos relacionados aos sintomas não se submetem e/ou podem ser obstaculizados por atividades pré-programadas.

The complaint is the first contact between pacient and therapist and will provide information about the symptoms and their features. It will also provide data about related subjective issues: demand and wish. The purpose of this paper is to identify, through a case study, how the acknowledgment of wish and demand underlying the subject's explicit complaint can determine the course of the speech-language-therapy process since the first interview. The method was a follow-up study of an 11-year-old boy attending speech-language therapy from September 2003 to December 2004. The father's explicit complaint was T doesn't talk he only communicates through signals. The interpretation of the clinical data was supported by the theoretical speech-and-language-pathology and psychoanalytical frameworks. This study followed ethical procedures determined for research with human beings. Results point out that the patient's demand was related to his need of being heard by his family. On the other hand, his wishes were directed towards the maintenance of the symptoms as a way of securing the continuity of the family's attention. Such information provided the background to the therapeutic intervention that resulted in an improvement of the child's oral utterances and communicative exchange alternatives, reshaping the family's complaints. The interviews should precede and support the speech-language therapy processes and the complaints should be considered beyond its literal meaning. The unspoken wish may interdict planned therapeutic processes because psychic contents related to the symptoms cannot be controlled by pre-programmed activities.

Valoración interlingüística de la producción verbal a partir de una tarea narrativa en el síndrome de Williams / Cross-linguistic assessment of verbal production from a narrative task in Williams Syndrome

El síndrome de Williams es un trastorno causado por una delección en el cromosoma 7, con un perfil cognitivo caracterizado por un retraso mental, dificultad grave en tareas visoespaciales, que contrasta con un desarrollo relativo de la capacidad lingüística y producción narrativa. En este estudio se analizó la ejecución verbal narrativa de dos grupos de sujetos (N= 3) de habla portuguesa y española diagnosticados genéticamente con el SW. Los resultados muestran baja ejecución tanto en el CI verbal como en el CI manipulativo. La tarea narrativa muestra que los sujetos con SW son poco coherentes en términos de su estructura, proceso y contenido. La ejecución verbal se encuentra alterada y no existen diferencias entre ambos grupos evaluados. Los datos nos indican la inexistencia de una disociación entre el funcionamiento cognitivo y la producción lingüística

Williams Syndrome (WS) is a disorder caused by a delection in chromosome 7, with a cognitive profile characterised by mild to moderate mental deficiency and difficulties in visual-spatial processing, which contrasts with a relative preservation of linguistic functions and narrative production. In this study, verbal performance was analysed in two groups of participants (N = 3), Portuguese and Spanish, genetically diagnosed with WS. Scores were low in Verbal IQ, as in Performance IQ. Narrative performance showed low coherence with respect to structure, process, and content. WS verbal performance was affected and there was no difference between both groups. We could not find any dissociation between cognitive functioning and linguistic production