Neuromodulation: A combined-therapy protocol for speech rehabilitation in a child with cerebral palsy.

INTRODUCTION: Transcranial direct current stimulation (tDCS) modulates cortical activity and potentiates functional gains achieved during therapeutic protocols. The aim of Integrative Speech Therapy Protocol is to rehabilitate speech in patients with impairments regarding neuropyschomotor development by combining oral motor stimuli, specific articulatory production, and the stimulation of phonological aspects of language. OBJECTIVE: Investigate the effect of transcranial direct current stimulation combined to integrative speech therapy in a child with cerebral palsy. METHODS: We performed a case study with tDCS and speech therapy in a patient with cerebral palsy and apraxia of speech. To assess the patient's speech, we used a parameterized test for the Brazilian Portuguese speech - ABFW. The CFCS and Vicking Speech Scales presented level IV and III, respectively. The patient underwent two periods with ten stimulation sessions each: first with anodal stimulation over Broca's area; and second over the left dorsolateral prefrontal cortex. Two indices were calculated: the percentage of consonants correct; and percentage of consonants correct-revised. Descriptive statistics were employed for the clinical data. For the outcomes, changes in each score were calculated as the difference in pre-intervention and post-intervention using Wilcoxon-Mann-Whitney test. RESULTS: Increases were found in percentage of correct consonants indices as well as to produce two-syllable and three-syllable words after both types of stimulation, characterized mainly by correct vowels that marked the presence of the syllable. Number of phonemes increased 0 to 4 at first the stimulation and 4 to 10 at the second. CONCLUSION: The combined-therapy program contributed to improve the speech rehabilitation results in a patient with cerebral palsy.

Transcranial direct current stimulation combined with integrative speech therapy in a child with cerebral palsy: A case report.

The aim of this study was to describe the results of the first case combining integrative speech therapy with anodal transcranial direct current stimulation (tDCS) over Broca's area in a child with cerebral palsy. The ABFW phonology test was used to analyze speech based on the Percentage of Correct Consonants (PCC) and Percentage of Correct Consonants - Revised (PCC-R). After treatment, increases were found in both PCC (Imitation: 53.63%-78.10%; Nomination: 53.19%-70.21%) and PPC-R (Imitation: 64.54%-83.63%; Nomination: 61.70%-77.65%). Moreover, reductions occurred in distortions, substitutions and improvement was found in oral performance, especially tongue mobility (AMIOFE-mobility before = 4 after = 7). The child demonstrated a clinically important improvement in speech fluency as shown in results of imitation number of correct consonants and phonemes acquire. Based on these promising findings, continuing research in this field should be conducted with controlled clinical trials.

Pathway evidence of how musical perception predicts word-level reading ability in children with reading difficulties.

OBJECTIVE: To investigate whether specific domains of musical perception (temporal and melodic domains) predict the word-level reading skills of eight- to ten-year-old children (n = 235) with reading difficulties, normal quotient of intelligence, and no previous exposure to music education classes. METHOD: A general-specific solution of the Montreal Battery of Evaluation of Amusia (MBEA), which underlies a musical perception construct and is constituted by three latent factors (the general, temporal, and the melodic domain), was regressed on word-level reading skills (rate of correct isolated words/non-words read per minute). RESULTS: General and melodic latent domains predicted word-level reading skills.

Effectiveness of music education for the improvement of reading skills and academic achievement in young poor readers: a pragmatic cluster-randomized, controlled clinical trial.

INTRODUCTION: Difficulties in word-level reading skills are prevalent in Brazilian schools and may deter children from gaining the knowledge obtained through reading and academic achievement. Music education has emerged as a potential method to improve reading skills because due to a common neurobiological substratum. OBJECTIVE: To evaluate the effectiveness of music education for the improvement of reading skills and academic achievement among children (eight to 10 years of age) with reading difficulties. METHOD: 235 children with reading difficulties in 10 schools participated in a five-month, randomized clinical trial in cluster (RCT) in an impoverished zone within the city of São Paulo to test the effects of music education intervention while assessing reading skills and academic achievement during the school year. Five schools were chosen randomly to incorporate music classes (n = 114), and five served as controls (n = 121). Two different methods of analysis were used to evaluate the effectiveness of the intervention: The standard method was intention-to-treat (ITT), and the other was the Complier Average Causal Effect (CACE) estimation method, which took compliance status into account. RESULTS: The ITT analyses were not very promising; only one marginal effect existed for the rate of correct real words read per minute. Indeed, considering ITT, improvements were observed in the secondary outcomes (slope of Portuguese = 0.21 [p<0.001] and slope of math = 0.25 [p<0.001]). As for CACE estimation (i.e., complier children versus non-complier children), more promising effects were observed in terms of the rate of correct words read per minute [ß = 13.98, p<0.001] and phonological awareness [ß = 19.72, p<0.001] as well as secondary outcomes (academic achievement in Portuguese [ß = 0.77, p<0.0001] and math [ß = 0.49, p<0.001] throughout the school year). CONCLUSION: The results may be seen as promising, but they are not, in themselves, enough to make music lessons as public policy.

Music education for improving reading skills in children and adolescents with dyslexia.

BACKGROUND: Dyslexia (or developmental dyslexia or specific reading disability) is a specific learning disorder that has a neurobiological origin. It is marked by difficulties with accurate or fluent recognition of words and poor spelling in people who have average or above average intelligence and these difficulties cannot be attributed to another cause, for example, poor vision, hearing difficulty, or lack of socio-environmental opportunities, motivation, or adequate instruction. Studies have correlated reading skills with musical abilities. It has been hypothesized that musical training may be able to remediate timing difficulties, improve pitch perception, or increase spatial awareness, thereby having a positive effect on skills needed in the development of language and literacy. OBJECTIVES: To study the effectiveness of music education on reading skills (that is, oral reading skills, reading comprehension, reading fluency, phonological awareness, and spelling) in children and adolescents with dyslexia. SEARCH METHODS: We searched the following electronic databases in June 2012: CENTRAL (2012, Issue 5), MEDLINE (1948 to May Week 4 2012 ), EMBASE (1980 to 2012 Week 22), CINAHL (searched 7 June 2012), LILACS (searched 7 June 2012), PsycINFO (1887 to May Week 5 2012), ERIC (searched 7 June 2012), Arts and Humanities Citation Index (1970 to 6 June 2012), Conference Proceedings Citation Index - Social Sciences and Humanities (1990 to 6 June 2012), and WorldCat (searched 7 June 2012). We also searched the WHO International Clinical Trials Registry Platform (ICTRP) and reference lists of studies. We did not apply any date or language limits. SELECTION CRITERIA: We planned to include randomized controlled trials. We looked for studies that included at least one of our primary outcomes. The primary outcomes were related to the main domain of the reading: oral reading skills, reading comprehension, reading fluency, phonological awareness, and spelling, measured through validated instruments. The secondary outcomes were self esteem and academic achievement. DATA COLLECTION AND ANALYSIS: Two authors (HCM and RBA) independently screened all titles and abstracts identified through the search strategy to determine their eligibility. For our analysis we had planned to use mean difference for continuous data, with 95% confidence intervals, and to use the random-effects statistical model when the effect estimates of two or more studies could be combined in a meta-analysis. MAIN RESULTS: We retrieved 851 references via the search strategy. No randomized controlled trials testing music education for the improvement of reading skills in children with dyslexia could be included in this review. AUTHORS' CONCLUSIONS: There is no evidence available from randomized controlled trials on which to base a judgment about the effectiveness of music education for the improvement of reading skills in children and adolescents with dyslexia. This uncertainty warrants further research via randomized controlled trials, involving a interdisciplinary team: musicians, hearing and speech therapists, psychologists, and physicians.

Estudio clínico fonoaudiológico de las funciones de deglución y masticación en las personas mayores / Clinical phonoaudiological assessment of deglutition and mastication in the elderly

Se describe la evaluación clínica de las funciones de deglución y masticación en 28 personas mayores, sin enfermedad neurológica o neuromuscular previa, mediante un protocolo que analiza la salud bucal, el tipo de alimentación y los aspectos de la función estática (posición de reposo de la lengua) y dinámica de los órganos fonoarticulatorios, tanto con cavidad bucal vacía como en el acto de la masticación y fase oral de la deglución. Se observó una deficiencia importante en la salud bucal de los participantes, con dificultad para ingerir sólidos en relación con la pérdida de piezas dentarias. La debilidad de la musculatura lingual y facial están relacionadas. También se observó una posición de reposo lingual habitualmente baja y apoyo anterior de la lengua durante la deglución

We describe the clinical evaluation of deglutition and chewing functions in 28 elderly individuals without previous neurological or neuromuscular disorders, through a protocol that analyses oral health, type of feeding, and aspects of static function (resting tongue position) and the dynamics of the phonoarticulatory organs, both when the oral cavity is empty --as in the act of chewing-- and in the oral phase of deglutition. Participants were found to have poor oral health and difficulty in ingesting solid food related to tooth loss, as well as an associated weakness of the lingual and facial musculature. We also observed a normally low resting tongue position and anterior support of the tongue during deglutition