Treatment for Childhood Apraxia of Speech: Past, Present, and Future.

PURPOSE: The purposes of this review article were to provide an introduction to and "bird's-eye" overview of the current evidence base for treatment of childhood apraxia of speech (CAS), identify some gaps and trends in this rapidly growing literature, and formulate some future research directions, in order to advance the evidence base and clinical practice for children with CAS. METHOD: Following a brief introduction outlining important concepts, a narrative review of the CAS treatment literature is provided, and trends and future directions are identified based on this review. The review is organized around four fundamental treatment research questions: (a) "Does Treatment X work?", (b) "Does Treatment X work better than Treatment Y?", (c) "For whom does Treatment X work?", and (d) "What does 'work' mean, anyway?" RESULTS: A wide range of CAS treatments with varying degrees of evidence for efficacy exists. Research is beginning to emerge that compares different treatments and seeks to determine optimal treatment parameters. Few studies to date have explored child-level predictors of treatment response, and the evidence base currently is limited in scope with respect to populations and outcomes studied. CONCLUSIONS: A growing evidence base supports the efficacy of a number of treatments for CAS. However, many important gaps in the literature were identified that warrant redoubled and sustained research attention. Research is beginning to emerge that addresses treatment optimization, comparison, candidacy, and outcomes. Suggestions for future research are offered, and the concept of a hypothesized pathway was applied to CAS to illustrate how components of an intervention can effect change in a clinical goal and can help guide development and refinement of treatments for children with CAS.

Performance in the accuracy task in children with Childhood Apraxia of Speech after an integrated intervention of literacy and motor skills.

Difficult in literacy skills are often seen in children with Childhood Apraxia of Speech (CAS). This occurs because oral language has direct relationship with reading and writing learning. The purpose of this study was to evaluate the performance in the accuracy task of an integrated phonoarticulatory awareness, motor skills and literacy intervention of three children with CAS. Three boys between 5;3 and 5;8 years of age, with CAS, were offered 2 hours per week of therapy sessions based on literacy and motor skills. The children were assessed before and after therapy and at a maintenance assessment 1 month after the treatment ceased. The children improved on the accuracy task considering their deficits level. Improvement was maintained at the maintenance assessment. Therapy based on literacy considering phonoarticulatory awareness and motor skills can help children with CAS, but the severity of the children's communication problems must be taken into consideration.

Intensive therapy for speech rehabilitation of a patient with cleft lip and palate: a case report / Terapia intensiva para a reabilitação da fala em paciente com fissura labiopalatina: relato de caso

ABSTRACT Intensive therapy is an alternative to accelerate the therapeutic process of individuals with cleft lip and palate. The purpose of this study is to describe an intensive speech therapy program and compare the results before and after the program on a child with previously operated right unilateral cleft lip and palate and velopharyngeal insufficiency, using a speech bulb. Sixty therapy sessions were carried out over a 4-week period. Before and after, anamnesis, speech assessment and evaluation of the velopharyngeal function with nasofibroscopy, were performed. The patient presented with adequate resonance and speech intelligibility, reduction of obligatory disorders and compensatory articulations, after intensive therapy with the speech bulb and reduction of velopharyngeal gap, after intensive therapy with and without the speech bulb. Progress was achieved with the intensive speech therapy.

RESUMO A terapia intensiva é uma alternativa para acelerar o processo terapêutico de indivíduos com fissura labiopalatina. O objetivo desse estudo foi descrever, aplicar um programa de terapia intensiva e comparar a evolução antes e após o programa de fonoterapia de uma criança com fissura transforame incisivo unilateral direita operada e insuficiência velofaríngea em uso de prótese de palato obturadora. Foram realizadas 60 sessões de terapia, durante 4 semanas. Antes e após, aplicou-se anamnese, avaliação da fala e nasofibroscopia. Como resultado, a paciente apresentou adequação da ressonância e da inteligibilidade de fala, diminuição dos distúrbios obrigatórios e das articulações compensatórias após terapia intensiva com prótese de palato obturadora; e redução do gap velofaríngeo após a terapia intensiva com e sem o uso da prótese. Concluiu-se que a fonoterapia intensiva proporcionou evolução do caso.

Profile of patients undergoing speech-language therapy in a physical and rehabilitation medicine hospital service / Perfil de usuarios que reciben atención fonoaudiológica en un servicio hospitalario de medicina física y rehabilitación

ABSTRACT Purpose: to analyze the profile and risk factors of patients attended by speech therapists in a hospital service of physical and rehabilitation medicine (P&RM) of the public health system. Methods: a retrospective cohort study was carried out. The variables were summarized using frequencies, proportions, and measures of central tendency. Relative risks (RR) were estimated, using the incidence ratio (IC:95%) and the bilateral Fisher's exact test. A level of significance was considered p <0.05. Results: 23,365 speech therapy activities distributed in 8,416 sessions were carried out between September 2016 to September 2018, with patients admitted to a P&RM service. The activities focused people over 60 years in the areas of swallowing (28.6%) and cognition (11.7%). Age equal to or greater than 60 years was identified as a risk factor for admission, due to cerebrovascular disease of 1.36 (95% CI: 1.24-1.49; p = 0.001), and belonging to section B of the National Health Fund (FONASA), 1.37 (95% CI: 1.29-1.46, p = 0.001). The RR for respiratory pathology was greater in the winter period: 1.63 (95% CI: 1.50-1.76; p = 0.001). Conclusion: elderly and low-income people are more likely to need speech therapy rehabilitation in the context of P&RM service.

RESUMEN Objetivo: analizar el perfil y factores de riesgo de usuarios atendidos por fonoaudiólogos en un servicio hospitalario de medicina física y rehabilitación (SMFyR) de la red pública de salud. Métodos: se realizó un estudio de cohortes retrospectivo. Las variables fueron resumidas mediante frecuencias, proporciones y medidas de tendencia central. Los riesgos relativos (RR) se estimaron mediante razón de incidencias (IC:95%) y la prueba exacta de Fisher bilateral. Se consideró un nivel de significancia p<0,05. Resultados: 23.365 prestaciones fonoaudiológicas distribuidas en 8416 sesiones se realizaron entre los meses de septiembre de los años 2016 y 2018, en un SMFyR. Las prestaciones se concentraron en personas mayores de 60 años en las áreas de la deglución (28,6%) y cognición (11,7%). Se identificó como factor de riesgo para ingreso por enfermedad cerebrovascular la edad igual o superior a 60 años 1,36 (IC., 95%: 1,24-1,49; p = 0,001) y pertenecer al tramo B del fondo nacional de salud 1,37 (IC., 95%: 1,29-1,46; p =0,001). El RR por patología respiratoria fue mayor en el periodo invernal 1.63 (IC., 95%: 1,50-1,76; p= 0,001). Conclusión: las personas mayores y de bajos ingresos presentan mayor riesgo de requerir rehabilitación fonoaudiológica en el contexto de un SMFyR.

Apraxia of speech and language delay: the complexity of diagnosis and treatment of symptomatic children. / Apraxia de fala e atraso de linguagem: a complexidade do diagnóstico e tratamento em quadros sintomáticos de crianças.

Apraxia of speech is defined as the inability to sequence the movements required for accurate articulatory production, traditionally involving a deficit in speech motor programming. Language clinicians often confront about speech inconsistency clinical cases, which raise questions concerning the differential diagnosis between apraxia and language disorders. Such problem often results in the difficulty to establish an adequate treatment decision. In this work, we discuss a clinical report in which both diagnosis and treatment raise questions about the apraxic speech condition in childhood. We start from the recognition that, in apraxia, it seems imperative to consider that the body to be considered is the one that surpasses its organic functions and structure. Clinical consequences are drawn from the premise that the human body is one whose ear can listen, and mouth can speak, i.e., the organic structure is a material realm open to the incidence of language and its "music", which creates the speaking body.

Define-se apraxia de fala como a inabilidade de sequenciar os movimentos necessários a uma produção articulatória acurada, cuja explicação, tradicionalmente, é remetida a um déficit na programação motora da fala. Não é infrequente que clínicos de linguagem se defrontem com casos clínicos em que a inconsistência da fala coloca questões quanto ao diagnóstico diferencial entre apraxia e quadros considerados de linguagem. O reflexo desse impasse é observado na dificuldade em estabelecer uma direção de tratamento adequada ao problema apresentado. Neste trabalho, apresentamos o relato de um caso clínico em que tanto o diagnóstico quanto o tratamento mobilizam discussões a respeito da condição apráxica de fala na infância. Nas apraxias, partimos do reconhecimento de que o corpo colocado em evidência é aquele que ultrapassa sua configuração puramente orgânica. Consequências clínicas são retiradas da premissa de que o corpo humano é aquele cuja orelha pode escutar e a boca, falar, ou seja, é estrutura orgânica posta a funcionar de maneira especial pela incidência da música da linguagem a invocar o corpo falante.

Praxias bucofonatorias con dispositivos bucales y realidad virtual inmersiva: un estudio piloto / Bucco-phonatory training practices with oral devices and immersive virtual reality: a pilot study

El presente trabajo evalúa la efectividad de una intervención utilizando Praxias bucofonatorias con dispositivos bucales en conjunto con realidad virtual inmersiva (RVI), mediante programas diseñados para estimular estados de relajación e interacción en diferentes ambientes virtuales. Para ello, se aplicó la terapia integrada de vibro estimulación bucal palatina, ejercitación lingual y la exposición a imágenes y sonidos empleando RVI en un grupo de 6 niños con el diagnóstico de dislalia. Se comparó los resultados de esta intervención con el de una intervención utilizando únicamente la vibro estimulación bucal palatina en un grupo de 20 niños con diagnóstico de dislalia. Finalmente, se aplicó la terapia integrada de vibro estimulación bucal palatina, ejercitación lingual y RVI en un grupo de niños con autismo. Los resultados observados mostraron que la terapia con dispositivos bucales combinadas con RVI tendía a producir mayores avances que la terapia sin RVI. Además, se observó diferentes grados de avances individuales y grupales en el dominio fonético dependiendo las habilidades de hablainicial, los niños con mejores habilidades presentaban mayores avances. El grupo de niños con autismo presentó menores avances respecto de los otros dos grupos. A pesar de las limitantes del presente estudio (diferente cantidad de sujetos por grupo y distintas edades) puede considerarse esta propuesta como prometedora para futuros estudios.

This study assesses the effectiveness of a therapy using Bucco-phonatory training practices with buccal devices and immersive virtual reality (RVI) through programs designed to stimulate states of relaxation and interaction in different virtual environments. In order to do so, an integrated therapy based on Intra buccal stimulation by means of vibrations in the palatal area, daily lingual exercises with a lingual exerciser device, and exposure to images and sounds using RVI was applied to a group of 6 children diagnosed with dyslalia. The results of this intervention were compared with those obtained in an intervention based only on intra buccal stimulation by means of vibrations in the palatal area (conducted on a a group of 20 children diagnosed with dyslalia). Finally, the integrated therapy of intra buccal stimulation by means of vibrations in the palatal area, lingual exercises, and RVI was applied to a group of children with autism. The results showed that therapy with oral devices combined with RVI tended to produce greater advances than therapy without RVI. In addition, individual differences in group advances in the phonetic domain were observed depending on the initial speech skills, children with better abilities presented greater advances. The group of children with autism progressed less than the other two groups. Even considering the limitations of this study, such as the heterogeneity in terms of group size and age, results can be considered as promising for future studies.

Avaliação de crianças com Síndrome de Down através da CIF-CJ: comparação da visão dos pais e das terapeutas / Evaluation of children with Down's Syndrome through ICF-CJ: comparison of parents 'and therapists' vision / Evaluación de niños con Síndrome de Down a través de la CIF-CJ: comparación de la visión de los padres y de los terapeutas

Introdução: A chegada de um filho com deficiência traz muitos desafios aos familiares podendo impactar na funcionalidade da criança. A visão que a família possui da criança nem sempre condiz tanto com suas potencialidades quanto com déficits. Por isso, interessa comparar a visão dos pais e terapeutas da criança. Objetivo: Comparar a visão dos pais e dos terapeutas em relação à funcionalidade de crianças com Síndrome de Down (SD). Métodos: Trata-se de um estudo qualitativo, de amostra por conveniência, com três crianças com SD, seus pais e terapeutas. A coleta de dados se deu por meio da aplicação da CIF-CJ com um dos responsáveis da criança e com a terapeuta estagiária responsável por cada caso, todos atendidos em clínica-escola de Fonoaudiologia. Resultados: Após análise dos três casos observou-se que a diferença nas respostas entre familiares e terapeutas esteve concentrada na percepção da linguagem das crianças, sobretudo em relação à fala. Também se observou que os terapeutas percebem a relação dos familiares com os profissionais de saúde mais frágeis do que os pais. Os resultados reforçam a importância sobre um olhar sobre a funcionalidade na clínica da infância. Conclusão: Na comparação da funcionalidade na percepção de pais e terapeutas, destacou-se a diferença na percepção da produção linguística das crianças.

Introduction: The arrival of a disabled child brings many challenges to the family members and can impact on the child's functionality. The family's view of the child does not always match both their potentialities and deficits. It is therefore important to compare the views of the child's parents and therapists. Objective: To compare the views of parents and therapists regarding the functionality of children with Down Syndrome (DS). Methods: This is a qualitative, sample-for-convenience study with three children with DS, their parents and therapists. Data collection was done through the application of the CIF-CJ with one of the responsible of the child and with the trainee therapist responsible for each case, all of whom were attended at university speech-language pathology clinic. Results: After analyzing the three cases, it was observed that the difference in the responses of the family and the therapists was concentrated in the children language, especially in relation to speech. It has also been observed that therapists perceive the relationship of family members with health professionals who are more fragile than their parents. The results reinforce the importance of looking at functionality in childhood clinic. Conclusion: In the comparison of functionality in the perception of parents and therapists, the difference in perception of the children's linguistic production was highlighted.

Introducción: La llegada de un hijo con discapacidad trae muchos desafíos a los familiares que pueden impactar en la funcionalidad del niño. La visión que la familia posee del niño no siempre condice tanto con sus potencialidades como con déficits. Por eso, interesa comparar la visión de los padres y terapeutas del niño. Objetivo: comparar la visión de los padres y de los terapeutas en relación a la funcionalidad de niños con Síndrome de Down (SD). Metodos: Se trata de un estudio cualitativo, de muestra por conveniencia, con tres niños con SD, sus padres y terapeutas. La recolección de datos se dio por medio de la aplicación de la CIF-CJ con uno de los responsables del niño y con la terapeuta pasante responsable de cada caso, todos atendidos en clínica-escuela de Fonoaudiología. Resultados: Después del análisis de los tres casos se observó que la diferencia en la respuesta de los familiares y de los terapeutas estuvo concentrada en la percepción del lenguaje de los niños, sobre todo en relación al habla. También se observó que los terapeutas perciben la relación de los familiares con los profesionales de salud más frágiles que los padres. Los resultados refuerzan la importancia sobre una mirada sobre la funcionalidad en la clínica de la niñez. Conclusión: En la comparación de la funcionalidad en la percepción de padres y terapeutas, se destacó la diferencia en la percepción de la producción lingüística de los niños.

Influence of speech-language therapy on P300 outcome in patients with language disorders: a meta-analysis / Influência da terapia fonoaudiológica no resultado do P300 em pacientes distúrbio de linguagem: uma metanálise

Abstract Introduction: The patient's evolution in the audiology and speech-language clinic acts as a motivator of the therapeutic process, contributing to patient adherence to the treatment and allowing the therapist to review and/or maintain their clinical therapeutic conducts. Electrophysiological measures, such as the P300 evoked potential, help in the evaluation, understanding and monitoring of human communication disorders, thus facilitating the prognosis definition in each case. Objective: To determine whether the audiology and speech-language therapy influences the variation of P300 latency and amplitude in patients with speech disorders undergoing speech therapy. Methods: This is a systematic review with meta-analysis, in which the following databases were searched: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature bases: OpenGrey.eu and DissOnline. The inclusion criteria were randomized or non-randomized clinical trials, without language or date restriction, which evaluated children with language disorders undergoing speech therapy, monitored by P300, compared to children without intervention. Results: The mean difference between the latencies in the group submitted to therapy and the control group was −20.12 ms with a 95% confidence interval of −43.98 to 3.74 ms (p = 0.08, I 2 = 25% and p value = 0.26). The mean difference between the amplitudes of the group submitted to therapy and the control group was 0.73 uV with a 95% confidence interval of −1.77 to 3.23 uV (p = 0.57, I 2 = 0% and p value = 0.47). Conclusion: The present meta-analysis demonstrates that speech therapy does not influence the latency and amplitude results of the P300 evoked potential in children undergoing speech therapy intervention.

Resumo Introdução: A evolução do paciente na clínica fonoaudiológica atua como fator motivador do processo terapêutico, contribui para a sua adesão ao tratamento e possibilita ao terapeuta a revisão e/ou a manutenção de suas condutas. As medidas eletrofisiológicas, como o potencial evocado P300, auxiliam na avaliação, na compreensão e no monitoramento dos distúrbios da comunicação humana, facilitam, dessa forma, a definição do prognóstico de cada caso. Objetivo: Determinar se a terapia fonoaudiológica influencia na variação da latência e da amplitude do P300 em pacientes com distúrbio de linguagem submetidos à terapia fonoaudiológica. Método: Revisão sistemática com metanálise, na qual foram feitas buscas nas seguintes bases de dados: Pubmed, ScienceDirect, Scopus, Web of Science, SciELO e Lilacs, além das bases de literatura cinzenta: OpenGrey.eu e DissOnline. Foram considerados critérios de inclusão: ensaios clínicos aleatórios ou não, sem restrição de idiomas ou data, que submeteram crianças com distúrbio de linguagem à terapia fonoaudiológica, monitoradas pelo P300, comparadas a crianças sem intervenção. Resultados: A diferença média entre as latências do grupo submetido à terapia e do grupo controle foi de -20,12 ms com intervalo de confiança 95% entre -43,98 e 3,74 ms (p = 0,08; I2 = 25% e o valor de p = 0,26). A diferença média entre as amplitudes do grupo submetido à terapia e do grupo controle foi de 0,73 uV com intervalo de confiança de 95% entre -1,77 e 3,23 uV (p = 0,57; I2 = 0% e o valor de p = 0,47). Conclusão: A terapia fonoaudiológica não influencia nos resultados de latência e amplitude do potencial evocado P300 em crianças submetidas à intervenção fonoaudiológica.

Speech-Language Disorders in 22q11.2 Deletion Syndrome: Best Practices for Diagnosis and Management.

Purpose Speech and language disorders are hallmark features of 22q11.2 deletion syndrome (22qDS). Learning disabilities, cognitive deficits, palate abnormalities, velopharyngeal dysfunction, behavioral differences, and various medical and psychiatric conditions are also major features of this syndrome. The goal of this document is to summarize the state of the art of current clinical and scientific knowledge regarding 22qDS for speech-language pathologists (SLPs) and provide recommendations for clinical management. Method Best practices for management of individuals with 22qDS were developed by consensus of an expert international group of SLPs and researchers with expertise in 22qDS. These care recommendations are based on the authors' research, clinical experience, and literature review. Results This document describes the features of 22qDS as well as evaluation procedures, treatment protocols, and associated management recommendations for SLPs for the often complex communication disorders present in this population. Conclusion Early diagnosis and appropriate management of speech-language disorders in 22qDS is essential to optimize outcomes and to minimize the long-term effects of communication impairments. Knowledge of this diagnosis also allows anticipatory care and guidance regarding associated features for families, health care, and educational professionals.

Influence of speech-language therapy on P300 outcome in patients with language disorders: a meta-analysis.

INTRODUCTION: The patient's evolution in the audiology and speech-language clinic acts as a motivator of the therapeutic process, contributing to patient adherence to the treatment and allowing the therapist to review and/or maintain their clinical therapeutic conducts. Electrophysiological measures, such as the P300 evoked potential, help in the evaluation, understanding and monitoring of human communication disorders, thus facilitating the prognosis definition in each case. OBJECTIVE: To determine whether the audiology and speech-language therapy influences the variation of P300 latency and amplitude in patients with speech disorders undergoing speech therapy. METHODS: This is a systematic review with meta-analysis, in which the following databases were searched: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature bases: OpenGrey.eu and DissOnline. The inclusion criteria were randomized or non-randomized clinical trials, without language or date restriction, which evaluated children with language disorders undergoing speech therapy, monitored by P300, compared to children without intervention. RESULTS: The mean difference between the latencies in the group submitted to therapy and the control group was -20.12ms with a 95% confidence interval of -43.98 to 3.74ms (p=0.08, I2=25% and p value=0.26). The mean difference between the amplitudes of the group submitted to therapy and the control group was 0.73uV with a 95% confidence interval of -1.77 to 3.23uV (p=0.57, I2=0% and p value=0.47). CONCLUSION: The present meta-analysis demonstrates that speech therapy does not influence the latency and amplitude results of the P300 evoked potential in children undergoing speech therapy intervention.

Apraxia de fala e atraso de linguagem: a complexidade do diagnóstico e tratamento em quadros sintomáticos de crianças / Apraxia of speech and language delay: the complexity of diagnosis and treatment of symptomatic children

RESUMO Define-se apraxia de fala como a inabilidade de sequenciar os movimentos necessários a uma produção articulatória acurada, cuja explicação, tradicionalmente, é remetida a um déficit na programação motora da fala. Não é infrequente que clínicos de linguagem se defrontem com casos clínicos em que a inconsistência da fala coloca questões quanto ao diagnóstico diferencial entre apraxia e quadros considerados de linguagem. O reflexo desse impasse é observado na dificuldade em estabelecer uma direção de tratamento adequada ao problema apresentado. Neste trabalho, apresentamos o relato de um caso clínico em que tanto o diagnóstico quanto o tratamento mobilizam discussões a respeito da condição apráxica de fala na infância. Nas apraxias, partimos do reconhecimento de que o corpo colocado em evidência é aquele que ultrapassa sua configuração puramente orgânica. Consequências clínicas são retiradas da premissa de que o corpo humano é aquele cuja orelha pode escutar e a boca, falar, ou seja, é estrutura orgânica posta a funcionar de maneira especial pela incidência da música da linguagem a invocar o corpo falante.

ABSTRACT Apraxia of speech is defined as the inability to sequence the movements required for accurate articulatory production, traditionally involving a deficit in speech motor programming. Language clinicians often confront about speech inconsistency clinical cases, which raise questions concerning the differential diagnosis between apraxia and language disorders. Such problem often results in the difficulty to establish an adequate treatment decision. In this work, we discuss a clinical report in which both diagnosis and treatment raise questions about the apraxic speech condition in childhood. We start from the recognition that, in apraxia, it seems imperative to consider that the body to be considered is the one that surpasses its organic functions and structure. Clinical consequences are drawn from the premise that the human body is one whose ear can listen, and mouth can speak, i.e., the organic structure is a material realm open to the incidence of language and its "music", which creates the speaking body.

Group climate in the voice therapy of patients with Parkinson's Disease. / Clima de grupo na terapia vocal de pacientes com Doença de Parkinson.

PURPOSE: To verify the impact that group dynamics and coaching strategies have on the PD patients voice, speech and communication, as well as the group climate. METHODS: 16 individuals with mild to moderate dysarthria due to the PD were divided into two groups: the CG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 additional support sessions; and the EG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 sessions with group dynamics and coaching strategies. The Living with Dysarthria questionnaire (LwD), the self-evaluation of voice, speech and communication, and the perceptual-auditory analysis of the vocal quality were assess in 3 moments: pre-traditional therapy (pre); post-traditional therapy (post 1); and post support sessions/coaching strategies (post 2); in post 1 and post 2 moments, the Group Climate Questionnaire (GCQ) was also applied. RESULTS: CG and EG showed an improvement in the LwD from pre to post 1 and post 2 moments. Voice self-evaluation was better for the EG - when pre was compared with post 2 and when post 1 was compared with post 2 - ranging from regular to very good; both groups presented improvement in the communication self-evaluation. The perceptual-auditory evaluation of the vocal quality was better for the EG in the post 1 moment. No difference was found for the GCQ; however, the EG presented lower avoidance scores in post 2. CONCLUSION: All patients showed improvement in the voice, speech and communication self-evaluation; EG showed lower avoidance scores, creating a more collaborative and propitious environment for speech therapy.

Cultural adaptation of the short Self-Regulation Questionnaire: suggestions for the speech area. / Adaptação cultural do Questionário Reduzido de Autorregulação: sugestões de aplicação para área de voz.

PURPOSE: To present the translated and linguistic and culturally adapted version of the Short self-regulation Questionnaire (SSRQ) for the Brazilian Portuguese and to check its applicability to patients with dysphonia. METHODS: The SSRQ is a tool used to evaluate the ability to self-regulate behavior; it has 31 items and generates three scores: total index of individual self-regulation capacity and partial scores for goal setting and impulse control. Each item should be scored by means of a Likert-type 5-point scale; the total score ranges from 29 to 145 points. The original instrument was translated and culturally adapted to Brazilian Portuguese by two English-speaking speech therapists who combined their translations and made linguistic adjustments to compose a single final version. This version was back-translated by a third speech therapist with experience in validation studies and without knowledge of the original instrument. The translation and the back-translation were compared with each other and with the original English version by five speech therapists that reached a consensus on additional changes. In this way, the final version was produced. This was called "Questionário Reduzido de Autorregulação" (QRAR). The QRAR was applied to 45 randomly chosen subjects with and without dysphonia in a teaching clinic. RESULTS: No item had to be eliminated, since the respondents did not find it difficult to indicate their answers. CONCLUSION: The "Questionário Reduzido de Autorregulação" (QRAR) has been successfully translated and culturally and linguistically adapted to Brazilian and Portuguese and can be applied to individuals with voice problems.

Different outcomes of phonemic verbal fluency in Parkinson's disease patients with subthalamic nucleus deep brain stimulation.

Subthalamic nucleus deep brain stimulation (STN-DBS) is a surgical technique to treat motor symptoms in patients with Parkinson's disease (PD). Studies have shown that STN-DBS may cause a decline in verbal fluency performance. We aimed to verify the effects of STN-DBS on the performance of phonemic verbal fluency in Brazilian PD patients. Sixteen participants were evaluated on the Unified Parkinson's Disease Rating Scale - Part III and for phonemic fluency ("FAS" version) in the conditions of on- and off-stimulation. We identified two different patterns of phonemic verbal fluency outcomes. The results indicate that there may be no expected pattern of effect of bilateral STN-DBS in the phonemic fluency, and patients may present with different outcomes for some reason not well understood.

Electropalatography and its correlation to tongue movement ultrasonography in speech analysis. / Eletropalatografia e sua correlação à ultrassonografia do movimento de língua nas análises da fala.

PURPOSE: To analyze the use of electropalatography and ultrasonography regarding speech therapy through literature narrative review. RESEARCH STRATEGIES: A literature review was conducted at PubMed and Scielo databases, using descriptors as electropalatography, electropalatography AND evaluation, electropalatography AND therapy, electropalatography AND ultrasonography, electropalatography AND speech. SELECTION CRITERIA: The research criteria selected in the database were: studies in the past five years and studies in humans. In the pre-selection, studies that were duplicate, not fully available, and have shown no direct relation with electropalatography in speech-language therapy were discarded. DATA ANALYSIS: Data analysis was performed descriptively, following subdivisions: title, area, year, subject, implementation, and conclusion of the study. RESULTS: Twenty one papers were selected, eight of them using the term electropalatography, two with the keywords electropalatography AND evaluation, six with the keywords electropalatography AND therapy, three of them with the keywords electropalatography AND ultrasonography, and two papers with the keywords electropalatography AND speech. CONCLUSION: Different types of research involving the use of electropalatography in the field of speech-language therapy were found and analyzed. Few researches have concomitantly used electropalatography and ultrasonography.

Different outcomes of phonemic verbal fluency in Parkinson's disease patients with subthalamic nucleus deep brain stimulation / Diferentes desfechos na tarefa de fluência verbal fonêmica em pacientes com doença de Parkinson submetidos à estimulação cerebral profunda

ABSTRACT Subthalamic nucleus deep brain stimulation (STN-DBS) is a surgical technique to treat motor symptoms in patients with Parkinson’s disease (PD). Studies have shown that STN-DBS may cause a decline in verbal fluency performance. We aimed to verify the effects of STN-DBS on the performance of phonemic verbal fluency in Brazilian PD patients. Sixteen participants were evaluated on the Unified Parkinson’s Disease Rating Scale - Part III and for phonemic fluency (“FAS” version) in the conditions of on- and off-stimulation. We identified two different patterns of phonemic verbal fluency outcomes. The results indicate that there may be no expected pattern of effect of bilateral STN-DBS in the phonemic fluency, and patients may present with different outcomes for some reason not well understood.

RESUMO A estimulação cerebral profunda do núcleo subtalâmico (ECP-NST) é uma técnica cirúrgica para tratar sintomas motores na doença de Parkinson (DP). Estudos têm mostrado que ECP-NST pode causar um declínio no desempenho de fluência verbal. O objetivo do estudo foi verificar os efeitos da ECP-NST sobre o desempenho da fluência verbal fonêmica em indivíduos brasileiros com DP. Dezesseis participantes foram avaliados quanto ao desempenho motor (UPDRS-III) e à fluência verbal fonêmica (versão “FAS”) nas condições de estimulação ligada e desligada. Identificamos dois padrões diferentes de resultados de fluência verbal fonêmica. Os resultados indicam que pode não haver um padrão esperado de efeito de ECP-NST bilateral na fluência fonêmica, e os pacientes podem apresentar desfechos diferentes de acordo com alguma razão não bem compreendida.

Who to Refer for Speech Therapy at 4 Years of Age Versus Who to "Watch and Wait"?

OBJECTIVE: To examine predictors of speech disorder resolution versus persistence at age 7 years in children with speech errors at age 4 years. STUDY DESIGN: Participants were drawn from a longitudinal, community cohort. Assessment at age 4 years (N?=?1494) identified children with speech errors. Reassessment at age 7 years allowed categorization into resolved or persistent categories. Logistic regression examined predictors of speech outcome, including family history, sex, socioeconomic status, nonverbal intelligence, and speech error type (delay vs disorder). RESULTS: At age 7 years, persistent errors were seen in over 40% of children who had errors at age 4 years. Speech symptomatology was the only significant predictor of outcome (P?=?.02). Children with disordered errors at age 4 years were twice as likely to have poor speech outcomes at age 7 years compared with those with delayed errors. CONCLUSIONS: Children with speech delay at age 4 years seem more likely to resolve, and this might justify a "watch and wait" approach. In contrast, those with speech disorder at age 4 years appear to be at greater risk for persistent difficulties, and could be prioritized for therapy to offset long-term impacts.

Clima de grupo na terapia vocal de pacientes com Doença de Parkinson / Group climate in the voice therapy of patients with Parkinson's Disease

RESUMO Objetivo Verificar impacto de estratégias de coaching e de dinâmica dos grupos na voz, fala, comunicação e clima do grupo de pacientes com DP. Método Participaram 16 indivíduos com disartria leve a moderada por DP, divididos em: GC (8 pacientes), terapia tradicional (12 sessões mais 4 de reforço), e GE (8 pacientes), terapia tradicional (12 sessões) acrescida de 4 sessões de estratégias de coaching de dinâmica dos grupos. Foi aplicado questionário Vivendo com Disartria - VcD, além de autoavaliação da voz, fala e comunicação e análise perceptivo-auditiva da voz, nos momentos: pré-terapia, pós-terapia tradicional (pós 1) e pós-reforço/estratégias de coaching (pós 2); no pós 1 e 2 foi aplicado o Questionário Clima de Grupo - QCG. Resultados GC e GE apresentaram melhores escores do VcD, comparando pré com pós 1 e pós 2. A autoavaliação da voz foi melhor no GE, comparando pré com pós 2 e pós 1 com pós 2, de regular para muito boa; ambos apresentaram melhora na autoavaliação da comunicação. A análise perceptivo-auditiva foi diferente entre os grupos no pós 1, com vozes melhores no GE. Sem diferença em QCG; contudo, GE apresentou menor evitação no pós 2. Conclusão Pacientes apresentaram melhor autoavaliação da voz, fala e comunicação nas duas modalidades de terapia; GE mostrou redução na evitação, tornando o ambiente mais colaborativo e propício para a terapia fonoaudiológica.

ABSTRACT Purpose To verify the impact that group dynamics and coaching strategies have on the PD patients voice, speech and communication, as well as the group climate. Methods 16 individuals with mild to moderate dysarthria due to the PD were divided into two groups: the CG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 additional support sessions; and the EG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 sessions with group dynamics and coaching strategies. The Living with Dysarthria questionnaire (LwD), the self-evaluation of voice, speech and communication, and the perceptual-auditory analysis of the vocal quality were assess in 3 moments: pre-traditional therapy (pre); post-traditional therapy (post 1); and post support sessions/coaching strategies (post 2); in post 1 and post 2 moments, the Group Climate Questionnaire (GCQ) was also applied. Results CG and EG showed an improvement in the LwD from pre to post 1 and post 2 moments. Voice self-evaluation was better for the EG - when pre was compared with post 2 and when post 1 was compared with post 2 - ranging from regular to very good; both groups presented improvement in the communication self-evaluation. The perceptual-auditory evaluation of the vocal quality was better for the EG in the post 1 moment. No difference was found for the GCQ; however, the EG presented lower avoidance scores in post 2. Conclusion All patients showed improvement in the voice, speech and communication self-evaluation; EG showed lower avoidance scores, creating a more collaborative and propitious environment for speech therapy.

Eletropalatografia e sua correlação à ultrassonografia do movimento de língua nas análises da fala / Electropalatography and its correlation to tongue movement ultrasonography in speech analysis

RESUMO Objetivo Analisar o uso da eletropalatografia e ultrassonografia na área da Fonoaudiologia por meio de revisão narrativa de literatura. Estratégia de pesquisa Foi realizada pesquisa bibliográfica nas bases de dados PubMed e Scielo, utilizando como descritores electropalatography, electropalatography AND evaluation, electropalatography AND therapy, electropalatography AND ultrasonography, electropalatography AND speech. Critérios de seleção Como critério da pesquisa em base de dados, foram selecionados: estudos dos últimos cinco anos e estudos em humanos. Na pré-seleção, foram descartados estudos duplicados, não disponibilizados na íntegra e que não apresentassem relação direta da eletropalatografia para a área da Fonoaudiologia. Análise dos dados A análise de dados foi realizada de forma descritiva, seguindo as subdivisões: título, área, ano, tema, aplicação e conclusão do estudo. Resultados Foram selecionados vinte e um artigos, oito deles utilizando o termo electropalatography, dois com os descritores electropalatography AND evaluation, seis artigos com os descritores electropalatography AND therapy, três artigos com os descritores electropalatography AND ultrasonography e dois artigos com os descritores electropalatography AND speech. Conclusão Foram encontrados e analisados diferentes tipos de pesquisas envolvendo o uso da eletropalatografia na área da Fonoaudiologia. Poucas pesquisas utilizaram concomitantemente a eletropalatografia e a ultrassonografia.

ABSTRACT Purpose To analyze the use of electropalatography and ultrasonography regarding speech therapy through literature narrative review. Research strategies A literature review was conducted at PubMed and Scielo databases, using descriptors as electropalatography, electropalatography AND evaluation, electropalatography AND therapy, electropalatography AND ultrasonography, electropalatography AND speech. Selection criteria The research criteria selected in the database were: studies in the past five years and studies in humans. In the pre-selection, studies that were duplicate, not fully available, and have shown no direct relation with electropalatography in speech-language therapy were discarded. Data analysis Data analysis was performed descriptively, following subdivisions: title, area, year, subject, implementation, and conclusion of the study. Results Twenty one papers were selected, eight of them using the term electropalatography, two with the keywords electropalatography AND evaluation, six with the keywords electropalatography AND therapy, three of them with the keywords electropalatography AND ultrasonography, and two papers with the keywords electropalatography AND speech. Conclusion Different types of research involving the use of electropalatography in the field of speech-language therapy were found and analyzed. Few researches have concomitantly used electropalatography and ultrasonography.

Adaptação cultural do Questionário Reduzido de Autorregulação: sugestões de aplicação para área de voz / Cultural adaptation of the short Self-Regulation Questionnaire: suggestions for the speech area

RESUMO Objetivo Apresentar a versão traduzida e adaptada linguística e culturalmente para o português brasileiro do Short Self-Regulation Questionnaire (SSRQ) e verificar sua aplicabilidade para pacientes com disfonia. Método O SSRQ é um instrumento para avaliar a capacidade de autorregular o comportamento; possui 31 itens e gera três escores: o índice total da capacidade de autorregulação individual e os escores estabelecimento de objetivos e controle de impulsos. Cada item deve ser graduado por meio de uma escala de Likert de 5 pontos; o escore total varia de 29 a 145 pontos. O instrumento original foi traduzido e adaptado culturalmente para o português brasileiro por duas fonoaudiólogas fluentes em inglês, que combinaram suas traduções e realizaram ajustes linguísticos para compor uma versão única final. Essa versão foi retrotraduzida para o inglês por uma terceira fonoaudióloga com experiência em estudos de validação e sem conhecimento do instrumento original. A tradução e a retrotradução foram comparadas entre si e ao instrumento original em inglês por cinco fonoaudiólogas que chegaram a um consenso para mudanças adicionais. Dessa forma, produziu-se a versão final, chamada Questionário Reduzido de Autorregulação (QRAR), que foi aplicado em 45 indivíduos com e sem disfonia, escolhidos de forma aleatória em uma clínica escola. Resultados Nenhum item teve de ser eliminado, já que os respondentes não encontraram dificuldades em marcar suas respostas. Conclusão O Questionário Reduzido de Autorregulação (QRAR) foi traduzido e adaptado cultural e linguisticamente para o português brasileiro e pode ser aplicado, com êxito, em indivíduos com problemas de voz.

ABSTRACT Purpose To present the translated and linguistic and culturally adapted version of the Short self-regulation Questionnaire (SSRQ) for the Brazilian Portuguese and to check its applicability to patients with dysphonia. Methods The SSRQ is a tool used to evaluate the ability to self-regulate behavior; it has 31 items and generates three scores: total index of individual self-regulation capacity and partial scores for goal setting and impulse control. Each item should be scored by means of a Likert-type 5-point scale; the total score ranges from 29 to 145 points. The original instrument was translated and culturally adapted to Brazilian Portuguese by two English-speaking speech therapists who combined their translations and made linguistic adjustments to compose a single final version. This version was back-translated by a third speech therapist with experience in validation studies and without knowledge of the original instrument. The translation and the back-translation were compared with each other and with the original English version by five speech therapists that reached a consensus on additional changes. In this way, the final version was produced. This was called "Questionário Reduzido de Autorregulação" (QRAR). The QRAR was applied to 45 randomly chosen subjects with and without dysphonia in a teaching clinic. Results No item had to be eliminated, since the respondents did not find it difficult to indicate their answers. Conclusion The "Questionário Reduzido de Autorregulação" (QRAR) has been successfully translated and culturally and linguistically adapted to Brazilian and Portuguese and can be applied to individuals with voice problems.