Características Fonoaudiológicas de Pacientes Atendidos por um Serviço de Genética Clínica / Speech-language Pathology Characteristics of Patients Assisted by a Clinical Genetics Service / Características de patología del habla y lenguaje de Pacientes Atendidos por un Servicio de Genética Clínica

Introdução: O trabalho conjunto da genética médica e da fonoaudiologia é essencial, contribuindo para o desenvolvimento de procedimentos que auxiliam no tratamento de pacientes com distúrbios da comunicação. Objetivo: Analisar as características fonoaudiológicas de pacientes pediátricos atendidos por um serviço de genética clínica. Método: Estudo transversal observacional, realizado com pacientes atendidos pelo serviço de genética de um hospital em Porto Alegre. Para a coleta de dados, aplicou-se um questionário relacionado as áreas de audição, deglutição, motricidade orofacial, voz e linguagem. Resultados: A amostra foi constituída por 54 participantes com idades entre 8 meses e 17 anos (média de idade 6 anos e 5 meses). 24,07% (n=13) dos pacientes apresentaram diagnóstico de síndrome, e 59,26% (n=32) tinham atraso no desenvolvimento neuropsicomotor. Com relação ao perfil fonoaudiológico, 81,48% (n=44) apresentaram algum hábito oral deletério durante a infância. 16,67% (n=9) percebiam alguma dificuldade para ouvir e 29,62% (n=16) para deglutir. 85,19% (n=46) dos participantes manifestaram a linguagem oral desenvolvida e, destes, 71,74% (n=33) apresentavam trocas na fala. 33,33% (n=18) já estavam em atendimento fonoaudiológico, e outros 24,07% (n=13) estavam na fila de espera para este atendimento. Conclusões: Uma parte significativa dos pacientes apresentou queixas e/ou manifestações nas áreas da comunicação humana, principalmente em relação à linguagem, à fala e aos hábitos orais deletérios. Esses dados destacam a importância do encaminhamento para a equipe de fonoaudiologia. (AU)

Introduction: The collaborative efforts of medical genetics and speech therapy are essential, contributing to the development of procedures that assist in treating patients with communication disorders. Objective: To analyze the speech therapy characteristics of pediatric patients seen by a clinical genetics service. Methods: Observational cross-sectional study conducted with patients seen at the genetics service of a hospital in Porto Alegre. A questionnaire related to hearing, swallowing, orofacial motricity, voice, and language areas was used for data collection. Results: The sample consisted of 54 participants aged between 8 months and 17 years, with an average age of 6 years and 5 months. 24.07% (n=13) of the patients had a diagnosis of syndrome, and 59.26% (n=32) had delayed neuropsychomotor development. Regarding the speech therapy profile, 81.48% (n=44) had some harmful oral habit during childhood. 16.67% (n=9) reported some difficulty in hearing, and 29.62% (n=16) in swallowing. 85.19% (n=46) of the participants showed developed oral language, and of these, 71.74% (n=33) made speech substitutions. 33.33% (n=18) of the patients were already undergoing speech therapy, and another 24.07% (n=13) were on the waiting list for this treatment. Conclusions: A significant portion of the patients presented complaints and/or manifestations in the areas of human communication, especially regarding language, speech, and harmful oral habits. These data highlight the importance of referral to the speech therapy team. (AU)

Introducción: La colaboración entre genética médica y foniatría es esencial para desarrollar procedimientos que ayuden en el tratamiento de pacientes con trastornos de la comunicación. Objetivo:Analizar las características de patología del habla y lenguaje de pacientes pediátricos atendidos por un servicio de genética clínica. Método: Estudio transversal observacional con pacientes atendidos por el servicio de genética de un hospital en Porto Alegre. Se aplicó un cuestionario sobre audición, deglución, motricidad orofacial, voz y lenguaje. Resultados: La muestra consistió en 54 participantes con edades comprendidas entre 8 meses y 17 años (media: 6 años y 5 meses). El 24,07% (n=13) de los pacientes tenían un diagnóstico de síndrome, y el 59,26% (n=32) presentaron retraso en el desarrollo neuropsicomotor. En cuanto al perfil foniatra, el 81,48% (n=44) presentaron algún hábito oral perjudicial durante la infancia. El 16,67% (n=9) reportaron dificultades para oír, y el 29,62% (n=16) para tragar. El 85,19% (n=46) manifestaron lenguaje oral desarrollado y, de ellos, el 71,74% (n=33) realizaban intercambios en el habla. El 33,33% (n=18) de los pacientes ya estaban en tratamiento foniatra y el 24,07% (n=13) estaban en lista de espera para este tratamiento. Conclusiones: Una parte significativa de los pacientes presentó quejas y/o manifestaciones en las áreas de la comunicación humana, especialmente en relación con el lenguaje, el habla y los hábitos orales perjudiciales, enfatizando la importancia de la derivación al equipo de foniatría. (AU)

Questões e tensões da história da fonoaudiologia contadas a partir de seus documentos normatizadores / Issues and tensions in the history of speech therapy told from its standardizing documents / Cuestiones y tensiones en la historia de la logopedia contadas a partir de sus documentos normalizadores

Introdução: A Fonoaudiologia é uma profissão jovem, mas sua regulamentação, entretanto, é fruto de um longo processo, iniciado algumas décadas antes. Vários documentos deixam marcas desta trajetória e contam histórias das questões e tensões presentes no momento de sua elaboração. Objetivos: Discutir a questão da autonomia do profissional da Fonoaudiologia a partir da análise de alguns de seus documentos normatizadores, considerando dois momentos significativos: a) a mudança de tecnólogo para profissional de nível superior, em 1981 e b) a ameaça de perda de direitos na ocasião da tramitação do Projeto de Lei do Ato Médico, em 2001. Método: Pesquisa documental, descritiva exploratória, de caráter qualitativo. Resultados: A palavra diagnóstico aparece de forma implícita no texto da Lei 6965/81 e no primeiro Código de Ética, em 1984, e de forma explícita, enquanto competência do fonoaudiólogo, nos códigos de 1995 e 2004. A palavra autonomia não aparece na Lei nem no código de 1984. É mencionada de forma restrita no código de 1995 e apenas referida como autonomia profissional ampla no código de 2004. Conclusão: Analisar as questões e as tensões presentes na elaboração de documentos normativos de uma profissão permite destacar o conjunto de valores, as disputas de poder e o caráter ético e político presente nestas definições. Permite também perceber o quanto estes processos são dinâmicos, incessantes e, ainda, o quanto algumas situações se colocam no tempo presente, resgatando debates antigos. (AU)

Introduction: Speech therapy is a young profession, but its regulation, however, is the result of a long process, started a few decades earlier. Several documents leave marks of this trajectory and tell stories of the issues and tensions present at the time of their preparation. Objectives: To discuss the issue of the autonomy of Speech Therapy professionals based on the analysis of some of their standardizing documents, considering two significant moments: a) the change from technologist to higher education professional, in 1981 and b) the threat of loss of rights in occasion of the processing of the Medical Act Bill, in 2001. Method: Documentary, exploratory, qualitative research. Results: The word diagnosis appears implicitly in the text of Law 6965/81 and in the first Code of Ethics, in 1984, and explicitly, as a speech therapist competence, in the codes of 1995 and 2004. The word autonomy does not appear in the Law nor in the 1984 code. It is mentioned in a restricted way in the 1995 code and only referred to as broad professional autonomy in the 2004 code. Conclusion: Analyzing the issues and tensions present in the preparation of normative documents for a profession allows us to highlight the set of values, power disputes and the ethical and political character present in these definitions. It also allows us to understand how dynamic and incessant these processes are and, also, how much some situations arise in the present time, rescuing old debates. (AU)

Introducción: La logopedia es una profesión joven, pero su regulación, sin embargo, es el resultado de un largo proceso, iniciado algunas décadas antes. Varios documentos dejan huellas de esta trayectoria y cuentan historias de los problemas y tensiones presentes en el momento de su preparación. Objetivos:Discutir la cuestión de la autonomía de los profesionales de Logopedia a partir del análisis de algunos de sus documentos normativos, considerando dos momentos significativos: a) el paso de tecnólogo a profesional de educación superior, en 1981 y b) la amenaza de pérdida de derechos con motivo de la tramitación del Proyecto de Ley Médica, en 2001. Método: Investigación documental, exploratoria, cualitativa. Resultados: La palabra diagnóstico aparece implícitamente en el texto de la Ley 6965/81 y en el primer Código de Ética, de 1984, y explícitamente, como competencia del logopeda, en los códigos de 1995 y 2004. La palabra autonomía no aparece en la Ley ni en el código de 1984. Se menciona de forma restringida en el código de 1995 y sólo se la denomina amplia autonomía profesional en el código de 2004. Conclusión: Analizar las cuestiones y tensiones presentes en la elaboración de documentos normativos para una profesión permite resaltar el conjunto de valores, las disputas de poder y el carácter ético y político presentes en estas definiciones. También nos permite comprender cuán dinámicos e incesantes son estos procesos y, también, cuánto surgen algunas situaciones en la actualidad, rescatando viejos debates. (AU)

Awareness and knowledge of dementia and its communication disorders amongst Brazilian speech and language therapists.

BACKGROUND: Speech and language therapists (SLTs) play an important role in assessing and rehabilitating communication disorders in people with dementia, but there is evidence to suggest that they do not receive appropriate training to provide management and support during their training. AIM: To investigate the level of awareness and knowledge that practising SLTs from Brazil have about dementia and their role in the care of dementia through an online survey. METHODS & PROCEDURES: An online survey tool was developed to collect information from practising Brazilian SLTs regarding their knowledge about dementia, awareness about their role in the care of people with dementia, and opinions on how SLTs may be better prepared to work in the dementia field. The survey was disseminated via social media, websites, and e-mail lists of researchers and stakeholders. OUTCOMES & RESULTS: A total of 227 SLTs completed the survey. Participants showed good knowledge of dementia in general, while their answers were less accurate on primary progressive aphasia. Regarding the awareness by SLTs of their role in the care of people with dementia, most agreed or strongly agreed that SLTs could help people in the diagnosis, treatment and prevention of dementia (> 80%). However, fewer participants agreed or strongly agreed that they felt confident in contributing to the treatment and diagnosis process of dementia (about 50%). To improve the training of SLTs in Brazil, most participants believed that it would be necessary to improve the teaching of dementia at the undergraduate speech and language therapy curriculum level and to develop recommendations or guidelines about speech and language therapy practice in dementia. CONCLUSIONS & IMPLICATIONS: The results of this survey point to a need for improvement in the knowledge and confidence of Brazilian SLTs about dementia. To reach this goal, targeted training courses and applied practice opportunities should be embedded within university curricula and training programmes. WHAT THIS PAPER ADDS: What is already known on the subject Many studies confirm the importance of speech and language therapy in the non-pharmacological treatment of people with dementia. However, other evidence suggests to a possible lack of training for Brazilian SLTs, especially in the curriculum of undergraduate courses. What this paper adds to existing knowledge This study reveals that Brazilian SLTs have substantial knowledge of dementia and recognize the significance of their role in treating people with dementia. However, a minority expressed confidence in their ability to assess and treat people with dementia. What are the potential or actual clinical implications of this work? The findings of this research demonstrate that Brazilian SLTs have good knowledge of dementia and endorse their professional role in dementia care; however, they lack confidence in their own skills and expertise in diagnostic assessment and treatment of dementia. Interventions aimed at boosting the SLT's confidence level could lead to improved patients outcomes and overall quality of care within clinical settings.

Longitudinal neuropsychological performance of post-stroke adults with and without rehabilitation.

This study compared the neuropsychological performance of two post-stroke groups, one undergoing rehabilitation and the other not receiving any intervention, on the acute and chronic stroke phases, and explored sociodemographic and neurological variables associated with changes in performance over time. Sixty-three adults underwent neuropsychological assessment with the Cognitive Screening Instrument (TRIACOG) less than thirty days after having a stroke and were reassessed three to six months after stroke. Thirty-eight participants did not undertake rehabilitation and twenty-five did physiotherapy and/or speech therapy between the two time points. The frequency of cognitive deficits (between groups) and the range of cognitive assessment scores over time (between and within groups) were analyzed. There was a significant decrease in the frequency of neuropsychological deficits and improvement on neuropsychological assessment scores over time only in the group undergoing rehabilitation. Severity of the neurological condition, years of education and being in rehabilitation explained the longitudinal changes in several cognitive domains measured by TRIACOG. Engaging in rehabilitation within three to six months post-stroke is crucial for enhancing the recovery of neuropsychological deficits. Cognitive screening instruments like TRIACOG can be used by health professionals to identify stroke-related neuropsychological changes and plan interventions.

Association between Self-Perception of Chewing, Chewing Behavior, and the Presence of Gastrointestinal Symptoms in Candidates for Bariatric Surgery.

Given the changes in the digestive tract post-bariatric surgery, adapting to a new pattern of eating behavior becomes crucial, with special attention to the specifics of chewing mechanics. This study aimed to investigate the association between self-perception of chewing, chewing behavior, and the presence of gastrointestinal symptoms in preoperative patients undergoing bariatric surgery. Sixty adult candidates for bariatric surgery at a public hospital in Belém (Brazil) were analyzed. Participants predominantly exhibited unilateral chewing patterns (91.6%), a fast chewing rhythm (73.3%), a large food bolus (80%), liquid intake during meals (36.7%), and 41.7% reported that chewing could cause some issue. Significant associations were found between the perception of causing problems and chewing scarcity (p = 0.006), diarrhea (p = 0.004), absence of slow chewing (p = 0.048), and frequent cutting of food with front teeth (p = 0.034). These findings reveal a relationship between the perception of chewing problems and chewing scarcity, presence of diarrhea, and fast chewing.

Comparative analysis of masseter muscle electrical activity by nasal patency in children with rhinitis and asthma: a pilot observational study.

PURPOSE: This pilot cross-sectional study aimed to evaluate differences in electromyographic activity patterns of the masseter muscle according to the nasal patency in children with rhinitis and asthma. METHODS: The study included 43 children aged 5-14 years with rhinitis and/or asthma. Patients underwent peak nasal inspiratory flow (PNIF) measurement to assess nasal patency, and electromyographic evaluation of the right and left masseter muscles during chewing and at rest. Electromyographic activity patterns according to nasal patency were compared using the Mann-Whitney test, and effect sizes were measured using the Glass rank biserial (rb) correlation. A p-value of < 0.05 was considered statistically significant. RESULTS: No significant differences in electromyographic activity of the masseter muscle at rest, during unilateral chewing, or during habitual chewing were found between the groups. However, we found that patients with low nasal patency had a median electric activity of the right masseter muscle during maximum contraction of 60.53 (51.74-72.43), while those with adequate nasal patency had a median of 77.40 (56.71-88.45). Although the difference in myoelectric activity between the groups did not reach statistical significance (p = 0.061) at the adopted significance level of 5%, the size of the difference between groups were considered moderate (rb = 0.338) and a potential association between nasal patency and the muscular function of the masseter muscle could be suggested. CONCLUSION: The study found no differences in the electromyographic activity of the masseter muscle at rest, during unilateral chewing, or during habitual chewing among children with rhinitis and asthma based on nasal patency. Further research with larger sample sizes is needed to validate these findings and gain a better understanding of the impact of nasal patency on the muscular function of the masseter muscle.

Electrical activity of the masseter and suprahyoid muscles and aspects of swallowing in children and adolescents with osteogenesis imperfecta

ABSTRACT Purpose: to characterize the electrical activation of the masseter and suprahyoid muscles at rest and during swallowing tasks, to compare it with clinical aspects of swallowing. Methods: a cross-sectional study, divided into mild osteogenesis imperfecta and moderate-to-severe osteogenesis imperfecta groups. Surface electromyography was performed on the masseter and suprahyoid muscles at rest and during swallowing tasks. The Orofacial Myofunctional Evaluation with Scores assessment form was used to assess clinical aspects of swallowing. Results: moderate-to-severe osteogenesis imperfecta participants presented a higher percentage of masseter activation than mild osteogenesis imperfecta ones. Regarding the clinical aspects of swallowing, the total sample presented 40.9% normal lip occlusion or with slight effort; 59.1% demonstrated tongue protrusion and 50% showed two other signs of atypical function. Furthermore, the higher the score for lip activity during swallowing, the lower the activation of the suprahyoid muscles at rest. Conclusions: the activation of the suprahyoid muscles while swallowing saliva and during consecutive swallows of liquid was similar, and activation during different tasks was higher in the moderate-to-severe osteogenesis imperfecta group. The better the labial myofunctional condition during swallowing, the lower the electrical activation of the suprahyoid muscles at rest.

The impact of the COVID-19 pandemic on the access to speech-language-hearing outpatient procedures of the Brazilian Unified Health System / O impacto da pandemia da Covid-19 no acesso aos procedimentos ambulatoriais de fonoaudiologia do Sistema Único de Saúde

ABSTRACT Purpose: to analyze the percentage variation in the indicator of access to speech-language-hearing procedures in the Unified Health System, during the pandemic. Methods: an ecological study carried out through outpatient productions made available in the Outpatient Information System of the Unified Health System, from 2019 to 2021. Outpatient productions were grouped into Health Promotion and Prevention Actions (01); Procedures with Diagnostic Purposes (02); Clinical Procedures (03); and Orthoses, Prosthetics, and Special Materials (07) per year and region of Brazil. The data were processed by TabNet, and access indicators were calculated, tabulated, and displayed on a thematic map. Results: the indicators of access to outpatient speech-language-hearing procedures decreased from 2019 to 2020 and increased in 2021, though still below the 2019 productions. The Southeast region had the greatest reduction in the supply indicator, and health promotion and prevention actions had the greatest reduction among procedure groups. The North region was the only region that maintained the pattern in access indicators in 2021, in relation to 2019. Conclusion: the access to procedures decreased in almost all Brazilian regions and procedure groups.

RESUMO Objetivo: analisar a variação percentual do indicador de acesso aos procedimentos fonoaudiológicos no Sistema Único de Saúde durante a pandemia. Métodos: trata-se de um estudo ecológico, realizado por meio das produções ambulatoriais disponibilizadas no Sistema de Informações Ambulatoriais do Sistema Único de Saúde, de 2019 a 2021. As produções ambulatoriais foram agrupadas em Ações de Promoção e Prevenção em Saúde (01); Procedimentos com Finalidade Diagnóstica (02); Procedimentos Clínicos (03); e Órteses, Próteses e Materiais Especiais (07), por ano e pelas regiões do Brasil. Os dados foram processados pelo TabNet, os indicadores de acesso foram calculados, tabulados e dispostos em um mapa temático. Resultados: houve redução nos indicadores de acesso aos procedimentos ambulatoriais de Fonoaudiologia entre 2019 e 2020. Em 2021, houve aumento, mas não superou as produções de 2019. A região com maior redução do indicador de oferta foi o Sudeste, e o grupo de procedimentos com maior redução foi o de ações de promoção e prevenção à saúde. A região Norte foi a única que apresentou um padrão de manutenção nos indicadores de acesso de 2021 em relação a 2019. Conclusão: houve redução no acesso aos procedimentos em quase todas as regiões do Brasil e grupos de procedimentos.

Assessment approaches in speech therapy: Considerations on choice between phonological assessment and child language test / Abordagens de avaliação em Fonoaudiologia: considerações sobre a escolha entre avaliação fonológica e teste de linguagem infantil

ABSTRACT Purpose: to evaluate the agreement between the results obtained from the Child Phonological Assessment (AFC in Portuguese) and Child Language Test (ABFW) protocols, regarding the severity of the phonological disorder, occurrence of errors in sound production, and absence of sounds. Methods: speech data from ten male children, aged 4 to 8 years, diagnosed with phonological disorder, were analyzed. Data were collected using the AFC and ABFW-Phonology protocols and analyzed through descriptive and comparative statistical analysis, using Spearman's Rank Correlation Coefficient (p<0.05). Results: high agreement between the protocols was found. Both protocols agree on the severity of the disorder, and both agree on the production of errors in the phonological system, with minor discrepancies. Only two subjects showed a percentage difference above 10% in error production. Conclusion: the AFC and ABFW protocols demonstrated strong agreement on the evaluated aspects. Both provide adequate and similar descriptions of the phonological system, and the choice between them and their application should depend on the therapist's experience.

RESUMO Objetivo: avaliar a concordância entre os resultados obtidos a partir dos protocolos Avaliação Fonológica da Criança (AFC) e Teste de Linguagem Infantil (ABFW) em relação à gravidade do transtorno fonológico, à ocorrência de erros na produção de sons e à ausência de sons. Métodos: foram analisados os dados de fala de dez crianças do sexo masculino, com idades entre 4 e 8 anos, diagnosticadas com transtorno fonológico. Os dados foram coletados usando os protocolos AFC e ABFW-Fonologia. Esses foram analisados a partir de análise estatística descritiva e comparativa, a partir do Coeficiente de Correlação de Spearman (p<0,05). Resultados: verificou-se alta concordância entre os protocolos. Os protocolos concordam quanto à gravidade do transtorno, e ambos acordam quanto à produção de erros no sistema fonológico, com pequenas discordâncias. Apenas dois sujeitos apresentaram diferença percentual acima de 10% entre a produção dos erros. Conclusão: os protocolos AFC e ABFW demonstraram uma forte concordância nos aspectos avaliados. Ambos oferecem descrições adequadas e similares do sistema fonológico e a escolha entre eles deve depender da experiência do terapeuta na sua aplicação.

A formação em saúde coletiva nos cursos de fonoaudiologia de instituições públicas do Nordeste: um estudo a partir das matrizes curriculares / Public health training in public institutions' speech-language-hearing programs in Northeastern Brazil: a curricular framework study

RESUMO Objetivo Descrever as características da formação inicial em saúde coletiva de fonoaudiólogos do Nordeste do Brasil. Método A pesquisa foi realizada com base nas matrizes curriculares de Instituições de Ensino Superior (IES) públicas do Nordeste a partir das quais foram analisados dados gerais dos cursos de Fonoaudiologia de cada Instituição ー estado em que está localizado, carga horária total e última reformulação de matriz curricular; e dados que diziam respeito especificamente às disciplinas relacionadas à Saúde Coletiva ー carga horária de cada disciplina, semestre de oferta, conteúdo da ementa, caráter teórico, prático, teórico-prático ou estágio, se obrigatória ou optativa. Resultados Os dados revelam que existem oito IES públicas do nordeste que oferecem o curso de Fonoaudiologia, sendo que os Projetos Pedagógicos de Cursos datam de 2009 a 2021. A Carga Horária (CH) total das disciplinas vinculadas à área de Saúde Coletiva varia de 7,5% a 20,5% da CH total dos cursos analisados. A maioria destas disciplinas é eletiva, tem caráter teórico e é ofertada na primeira metade da formação. Conclusão A formação inicial em saúde coletiva de fonoaudiólogos de IES públicas do nordeste parece ainda estar embasada em práticas tradicionais, que acabam distanciando os discentes do campo da saúde coletiva e de práticas que atendam os princípios do Sistema Único de Saúde, e as reais necessidades da população, especialmente na Atenção Primária à Saúde.

ABSTRACT Purpose To describe the characteristics of the initial public health training for speech-language-hearing therapists in Northeastern Brazil. Methods The research was based on the curricular framework of public higher education institutions in the Northeast. The analysis approached each institution's general speech-language-hearing program data (state where it is located, total course load, and most recent curricular framework reformulation) and specific data on public health courses (their individual course load, the term when it is offered, syllabus content, whether it was theoretical, practical, both, or internship, and whether it was required or elective). Results The data show that eight public higher education institutions in the Northeast offer speech-language-hearing programs, whose pedagogical frameworks date from 2009 to 2021. The total course load of those related to public health ranges from 7.5% to 20.5% of the total program among those analyzed. Most courses were elective, exclusively theoretical, and were offered in the first half of the program. Conclusion The initial public health training for speech-language-hearing therapists in public higher education institutions in the Northeast still seems to be based on traditional practices. These create a distance between students, public health, and practices that meet the principles of Health Unic System (in Portuguese - Sistema Único de Saúde) and the population's real needs, especially in primary healthcare

Deslizamentos de posição subjetiva em enunciados tidos como ecolálicos de uma criança com Distúrbio de Linguagem: um estudo de caso / Subjective position sliding in utterances perceived as echolalic in a child with Language Disorder: a case study

RESUMO Sob ótica linguístico-discursiva de orientação francesa, foram investigadas marcas de subjetividade numa cadeia de enunciados tidos como ecolálicos, ancorados na estrutura linguística recorrente X quer Y?. No interior de uma sessão de fonoterapia, essa cadeia foi produzida por J., uma criança do sexo feminino, com 10 anos de idade à época da coleta dos dados, com diagnóstico fonoaudiológico de distúrbio de linguagem e diagnóstico médico de psicose precoce. Um conjunto de flutuações linguísticas indiciaram um deslizamento de posição subjetiva na cadeia analisada. Tais flutuações envolveram elementos sintáticos, lexicais, semânticos, morfológicos e prosódicos. Discursivamente, as flutuações deixaram rastros de um deslizamento de posição subjetiva, ou seja, de sujeito falado (cê quer Y?) para falante/desejante (eu quero Y.) na cadeia formada por esses enunciados. Desse modo, enunciados tidos como ecolálicos podem dar pistas do desejo do sujeito em sua relação com o O/outro, por meio de suas flutuações linguísticas e de seus deslizamentos discursivos. Portanto, embora não irrompam de forma convencional, tais enunciados podem mostrar possibilidades de mudanças de posição subjetiva. Por conseguinte, uma contribuição da investigação relatada à clínica de linguagem é a de que, no setting terapêutico, pode haver escuta para enunciados que, em primeira instância, poderiam ser tidos como colados/enraizados no dizer do outro. Na clínica de linguagem é possível, então, dar lugar a novos/outros sentidos a tais enunciados, de maneira a favorecer a constituição do sujeito da/na linguagem a partir de enunciados frequentemente interpretados como esvaziados de subjetividade.

ABSTRACT Within a linguistic-discursive framework, subject markers in a chain of utterances considered to be echolalia based on the recurring linguistic structure does X want Y? were investigated. This chain was produced during a speech therapy session by J., a female child, 10-years-old at the time of data collection, and with a speech-language pathology diagnosis of language disorder and a medical diagnosis of early psychosis. A set of linguistic fluctuations indicated a sliding of the subject position in the analyzed chain. Such fluctuations involved syntactic, lexical, semantic, morphological and prosodic elements. Discursively, the fluctuations left traces of a sliding of the subject position in the chain formed by these utterances, from a spoken subject (do you want Y?) to a speaking/desiring one (I want Y.). In this way, utterances considered echolalia can provide clues, via their linguistic fluctuations and discursive slippages, about the subject's desire in their relationship with the O/other. Given this, although they do not emerge in a conventional way, such utterances can demonstrate possibilities for changes in subject position. A contribution of the present research for clinical practice involving language in therapeutic settings therefore, was to highlight a listening to utterances, which could be seen as connected/grounded in the speech of the other. In clinical practice involving language, it is possible to create space for new/other senses for utterances, to allow the constitution of the subject of/in language, based on utterances often interpreted as being devoid of subjectivity.

Estrategia para fomentar el principio de beneficencia en la comunicación entre el logofonoaudiólogo, el paciente afásico y su familia

Introducción: La comunicación por parte del logofonoaudiólogo con el paciente afásico y su familia garantiza el bienestar biopsicosocial de estos y favorece una adecuada relación médico-paciente. Objetivo: Evaluar una propuesta de estrategia para el fomento del principio de beneficencia entre el logofonoaudiólogo, el paciente afásico y su familia en el Policlínico Universitario Dr. René Vallejo Ortiz, ciudad de Manzanillo, Granma, Cuba. Método: Fue aplicada la técnica de Iadov o criterio de usuario que permitió evaluar la propuesta. Para ello se encuestaron 15 logofonoaudiólogos de la provincia de Granma, Cuba, se escogieron de manera intencional 10, cuyas cualidades cumplían los requisitos exigidos para ser considerados usuarios. Se utilizaron diferentes métodos, técnicas y procedimientos para procesar y analizar los datos recogidos. La escala valorativa Likert facilitó la interpretación cualitativa de los datos recogidos. Resultados: Desde el criterio individual el 60 % de los usuarios consideró la propuesta bastante adecuada; la valoración más baja fue de adecuada (20 %). El cálculo de la valoración grupal, el índice obtenido (0,5 %) le confirió confiabilidad a la propuesta para ser implementada. Conclusiones: Los usuarios consideran que la propuesta de estrategia cumple con los requisitos para la aplicación. No obstante, existen algunos elementos que pudieran dificultar la ejecución de la misma: la incorrecta preparación científico-metodológica de los facilitadores, el uso inadecuado de los métodos y técnicas educativas, así como la negativa de aquellos logofonoaudiólogos que no concienticen la necesidad de alcanzar modos de actuación acorde a los principios y valores profesionales.

Introduction: Communication by the speech-language pathologist with the aphasic patient and his family guarantees their biopsychosocial well-being and promotes an adequate doctor-patient relationship. Objective: To evaluate a proposed strategy to promote the principle of beneficence between the speech-language pathologist, the aphasic patient and their family at the Policlínico Universitario Dr. René Vallejo Ortiz, Manzanillo city, Granma province, Cuba. Method: The Iadov technique or user criteria was applied that allowed the proposal to be evaluated. For this, 15 speech-language pathologists from the province of Granma, were surveyed; 10 were intentionally chosen, whose qualities met the requirements to be considered users. Different methods, techniques and procedures were used to process and analyze the data collected. The Likert rating scale facilitated the qualitative interpretation of the data collected. Results: From individual criteria, 60% of users considered the proposal quite appropriate; the lowest rating was adequate (20%). The calculation of the group assessment, the index obtained (0.5%) conferred reliability to the proposal to be implemented. Conclusions: Users consider that the strategy proposal meets the requirements for the application. However, there are some elements that could make its execution difficult: the incorrect scientific-methodological preparation of the facilitators, the inappropriate use of educational methods and techniques, as well as the refusal of those speech-language pathologists who do not raise awareness of the need to achieve methods. of action in accordance with professional principles and values.

Introdução: A comunicação do fonoaudiólogo com o paciente afásico e sua família garante o seu bem-estar biopsicossocial e promove uma adequada relação médico-paciente. Objetivo: Avaliar uma proposta de estratégia para promover o princípio da beneficência entre o fonoaudiólogo, o paciente afásico e sua familia na Policlínico Universitario Dr. René Vallejo Ortiz, cidade de Manzanillo, Granma, Cuba. Método: Foi aplicada a técnica de Iadov ou critérios de usuário que permitiram avaliar a proposta. Para isso, foram entrevistados 15 fonoaudiólogos da província de Granma, foram escolhidos 10 intencionalmente, cujas qualidades atendiam aos requisitos para serem considerados usuários. Diferentes métodos, técnicas e procedimentos foram utilizados para processar e analisar os dados coletados. A escala de classificação Likert facilitou a interpretação qualitativa dos dados coletados. Resultados: A partir de critérios individuais, 60% dos usuários consideraram a proposta bastante adequada; a classificação mais baixa foi adequada (20%). No cálculo da avaliação do grupo, o índice obtido (0,5%) conferiu confiabilidade à proposta a ser implementada. Conclusões: Os usuários consideram que a proposta de estratégia atende aos requisitos para aplicação. Porém, existem alguns elementos que podem dificultar sua execução: o incorreto preparo científico-metodológico dos facilitadores, o uso inadequado de métodos e técnicas educativas, bem como a recusa dos fonoaudiólogos que não conscientizam sobre o necessidade de alcançar métodos de ação de acordo com princípios e valores profissionais.

Utilização da bandagem elástica funcional no tratamento fonoaudiológico da paralisia facial pós-AVC na fase aguda / Use of athletic tape in the speech-language-hearing treatment of post-stroke facial paralysis in the acute phase

RESUMO Objetivo Verificar a eficácia do uso da bandagem elástica funcional associada à terapia miofuncional no tratamento fonoaudiológico da paralisia facial pós-acidente vascular cerebral na fase aguda. Método Estudo clínico controlado randomizado com 88 pacientes com paralisia facial na fase aguda do acidente vascular cerebral. A amostra foi alocada em: Grupo 1: reabilitação com terapia miofuncional orofacial e utilização da bandagem elástica funcional nos músculos zigomáticos maior e menor paralisados; Grupo 2: reabilitação apenas com terapia miofuncional orofacial na face paralisada; Grupo 3: sem qualquer intervenção fonoaudiológica para paralisia facial. Na avaliação foram solicitados os movimentos de mímica facial e o grau do comprometimento foi determinado de acordo com a escala de House e Brackmann. A incompetência do movimento foi obtida a partir de medições da face com paquímetro digital. Após a avaliação, a intervenção foi realizada de acordo como determinado para os grupos 1 e 2. Os participantes dos três grupos foram reavaliados após 15 dias. A análise estatística utilizada foi das equações generalizadas. Resultados Os grupos foram homogêneos quanto à idade, medida de incapacidade e funcionalidade, gravidade do comprometimento neurológico e da paralisia facial pré-intervenção. O grupo 1 teve melhora significativa na medida canto externo do olho à comissura labial, com melhores resultados quando comparado aos grupos 2 e 3. Conclusão A bandagem elástica funcional associada a terapia miofuncional orofacial apresentou melhor resultado no tratamento da paralisia facial após acidente vascular cerebral no local onde foi aplicado.

ABSTRACT Purpose To verify the efficacy of using athletic tape associated with myofunctional therapy in the speech-language-hearing treatment of facial palsy after stroke in the acute phase. Method Randomized controlled clinical study with 88 patients with facial palsy in the acute phase of stroke. The sample was allocated in: Group 1: rehabilitation with orofacial myofunctional therapy and use of athletic tape on the paralyzed zygomaticus major and minor muscles; Group 2: rehabilitation alone with orofacial myofunctional therapy on the paralyzed face; Group 3: no speech-language-hearing intervention for facial paralysis. In the evaluation, facial expression movements were requested, and the degree of impairment was determined according to the House and Brackmann scale. Movement incompetence was obtained from measurements of the face with a digital caliper. After the evaluation, the intervention was carried out as determined for groups 1 and 2. The participants of the three groups were reassessed after 15 days. The statistical analysis used was the generalized equations. Results The groups were homogeneous in terms of age, measure of disability and functioning, severity of neurological impairment and pre-intervention facial paralysis. Group 1 had a significant improvement in the measure from the lateral canthus to the corner of the mouth, with better results than groups 2 and 3. Conclusion The athletic tape associated with orofacial myofunctional therapy had better results in the treatment of facial paralysis after stroke in the place where it was applied.

Relação entre prematuridade e dificuldades na transição da consistência alimentar na infância: uma revisão sistemática / Relationship between prematurity and difficulties in the transition of food consistency in childhood: a systematic review

RESUMO Objetivo Revisar a literatura de maneira sistematizada acerca da relação do impacto da prematuridade na transição das consistências alimentares em lactentes no período de introdução da alimentação complementar. Estratégia de pesquisa Foram pesquisados os bancos de dados EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), LIVIVO, PubMed/Medline, Scopus e Web of Science e Google Scholar, Open Grey e ProQuest Dissertations & Theses na literatura cinzenta foram pesquisados desde 10/08/2020. Critérios de seleção "PECOS": População (P): Lactentes, Exposição (E): Prematuridade, Comparação (C): Recém-nascidos a termo, Desfecho (O): Progressão de consistências alimentares em recém-nascidos prematuros com ou sem comparação, Tipos de estudos (S): Estudo de coorte; Caso-controle; Transversal. Análise dos dados A qualidade metodológica dos estudos observacionais selecionados foi avaliada usando a Meta-Analysis of Statistics Assessment and Review Instrument (MASTARI). Resultados Um total de 3.310 artigos foram encontrados, sendo 9 selecionados para a realização da síntese qualitativa. Nos estudos selecionados foi observada a relação entre intervenções orais invasivas e dificuldade alimentar para todas as habilidades avaliadas e quanto menor a idade gestacional, mais frequente são os comportamentos de dificuldades alimentares. Conclusão Não foi observada relação entre a prematuridade e dificuldades na progressão das consistências no período da introdução das consistências alimentares na maioria dos estudos, somente três deles demonstraram tal relação.

ABSTRACT Purpose To systematically review the literature regarding the impact of prematurity on the transition of food consistencies in infants during the introduction of complementary feeding. Research strategies Searches were conducted in the EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, and Web of Science databases, Google Scholar; for gray literature, searches were conducted on Open Gray, and ProQuest Dissertations & Theses databases, from August 10, 2020, onwards. Selection criteria "PECOS" was selected to determine inclusion criteria: Population (P): Infants; Exposure (E): Prematurity; Comparison (C): Full-term newborns; Outcomes (O): Progression of food consistencies in premature newborns with or without comparison; Study design (S): Cohort study, Case-control; Cross-sectional. Data analysis The methodological quality of the selected observational studies was assessed using the Meta-Analysis of Statistics Assessment and Review Instrument (MASTARI). Results A total of 3,310 articles were found, of which nine were selected for qualitative synthesis. Among the selected studies, a relationship between invasive oral interventions and feeding difficulties was observed for all assessed skills, with feeding difficulties being more frequent in infants with lower gestational age. Conclusion Most studies found no significant relationship between prematurity and difficulties in the progression of food consistencies during the introduction of complementary feeding; only three studies demonstrated such a relationship.

O que cantores amadores que se apresentam em cultos religiosos conhecem sobre saúde e higiene vocal? / What do amateur singers who perform in religious services know about vocal health and hygiene?

RESUMO Objetivo Descrever o conhecimento de cantores amadores que se apresentam em cultos religiosos sobre saúde e higiene vocal e comparar esses achados em dois momentos distintos. Métodos Pesquisa descritiva, longitudinal, com 100 participantes que praticavam canto amador em cultos religiosos; idades entre 18 e 82 anos (média 33,72 anos), 54 mulheres e 46 homens. Os participantes responderam ao Questionário Inicial, que inclui dados pessoais e autoavaliação vocal, e ao Questionário de Saúde e Higiene Vocal, este em dois momentos, com intervalo de 20 dias e com as questões aleatorizadas. Foi dada devolutiva desse questionário após cada aplicação, por meio da apresentação das respostas corretas de cada um de seus itens. Os dados foram analisados de forma descritiva e inferencial. Resultados A maior parte dos cantores referiu algum grau de alteração vocal e relatou ao menos um sintoma vocal (principalmente pigarro e falha na voz). A pontuação foi maior na segunda aplicação do questionário e não houve correlação entre a autoavaliação vocal e a pontuação obtida. Conclusão Cantores amadores de ambos os gêneros que se apresentam em cultos religiosos demonstraram conhecimento sobre saúde e higiene vocal correspondente ao de indivíduos vocalmente saudáveis, acima do ponto de corte em ambas as aplicações do Questionário de Saúde e Higiene Vocal. Contudo, a maioria referiu alterações e sintomas vocais. Verificou-se aumento do conhecimento sobre saúde e higiene vocal na segunda aplicação, ainda que discreto. O nível de conhecimento sobre saúde e higiene vocal não se correlacionou com o grau de alteração vocal.

ABSTRACT Purpose To describe the knowledge of amateur singers who perform in religious services, about vocal health and hygiene, and compare these findings at two different moments. Methods Descriptive, longitudinal research with 100 participants who practice amateur singing in religious services; ages between 18 and 82 years (average 33.72 years), 54 women and 46 men. Participants answered the Initial Questionnaire (Q1), which includes personal data and vocal self-assessment, and the Vocal Health and Hygiene Questionnaire (QSHV), on two occasions with an interval of 20 days and with the questions randomized. The participants were given a feed-back of the QSHV after each application i.e. the correct answers to each item. The data were analyzed descriptively and inferentially. Results Most singers reported some degree of self-assessed vocal alteration and reported at least one vocal symptom (mainly throat clearing and voice failure). The score was higher in the second application of the QSHV and there was no correlation between the vocal self-assessment and the score obtained in the QSHV. Conclusion Amateur singers of both sexes who perform in religious services demonstrated knowledge about vocal health and hygiene corresponding to that of vocally healthy individuals, above the cutoff point in both applications; however, the majority reported vocal changes and symptoms. There was an increase in knowledge about vocal health and hygiene in the second application, however discreet. The level of knowledge about vocal health and hygiene did not correlate with the degree of vocal alteration.

Service guidelines, models, and protocols for integrating rehabilitation services in primary healthcare in Brazil, Russia, India, China, and South Africa: a scoping review.

PURPOSE: The WHO emphasises that rehabilitation services must be integrated into primary healthcare as an inherent part of universal health coverage. However, there is limited research on the integration of rehabilitation services in primary healthcare in low- and middle-income countries. The purpose of this paper is to identify and describe the literature on service guidelines, models, and protocols that support the integration of rehabilitation services in primary healthcare in the BRICS countries (Brazil, Russia, India, China, and South Africa). METHODS: A scoping review guided by Arksey and O'Malley's framework was conducted. Structured database and website searches identified published and unpublished records from 2010, which were subjected to eligibility criteria. Mendeley, JBI SUMARI, and Microsoft Excel were used to extract and synthesise the data. RESULTS: The search strategy identified 542 records. Thirty-two records met the inclusion criteria. Shared care and community-based rehabilitation were the most reported practice models, and the implementation of the models, guidelines, and protocols was mostly described in mental health services. CONCLUSION: This review discusses BRICS countries' rehabilitation service guidelines, models, and protocols for primary healthcare integration and implementation challenges. Rehabilitation professionals should rethink, realign, and apply existing models because of the lack of primary healthcare integration directives.

The integration of rehabilitation services in low-resourced and remote settings can be improved by involving community health workers and community rehabilitation workers in transdisciplinary teams.Peer support workers and community health workers can improve rehabilitation outcomes, particularly through shared care models that emphasize peer-to-peer learning, mentoring, and coaching.Self-management interventions can have a positive impact on functional outcomes.Integrated rehabilitation services in primary healthcare can be supported through community-based rehabilitation, which emphasises community involvement and engagement.

How to build measurable treatment goals? A taxonomy of outcome criteria for vocal intervention monitoring

Introduction: The complexity of the vocal phenomenon hinders the therapist's ability to quickly and effectively monitor the achievements obtained by the patient through vocal intervention. The assessment of therapeutic progress relies on the therapist's capability to utilize valid, reliable, and meaningful outcome criteria. Aim: Develop a conceptual framework of outcome criteria to be used in the treatment plans designed by speech-language pathologists for patients with vocal complaints. Methodology: Qualitative, conceptual, and model-type research in which a critical review is conducted through a non-probabilistic theoretical sampling of the theoretical models of therapy treatment plans, the outcome criteria involved and their relevance to voice intervention. Building upon this, a taxonomy of outcome criteria is proposed for verifying therapeutic progress in voice therapy. Results: A conceptual outcome criteria framework is proposed. This model incorporates quantitative, qualitative, and mixed criteria to monitor the diverse aspects of vocal function in the context of voice intervention. Conclusion: The model provides a precise guide to assess the results achieved by the patient in vocal intervention through treatment goals.

Introducción: La complejidad del fenómeno vocal dificulta que el/la terapeuta monitoree de manera rápida y eficaz los logros obtenidos por el/la usuario/a mediante la intervención fonoaudiológica. La evaluación del avance terapéutico depende de la habilidad del/la terapeuta para emplear criterios de medición válidos, confiables y significativos. Objetivo: Desarrollar un modelo teórico de criterios de logro para su consideración en la formulación de los objetivos operacionales en las planificaciones terapéuticas que emplean los profesionales fonoaudiólogos en la atención de usuarios/as que presentan queja vocal. Metodología: Investigación cualitativa, de tipo conceptual y modélica, en la que se lleva a cabo una revisión crítica de la literatura a través de un muestreo teórico no probabilístico de los modelos teóricos propuestos para la formulación y medición de objetivos en el contexto terapéutico y sus alcances respecto de la intervención vocal. A partir de ello, se propone una taxonomía de criterios de logro para la verificación del avance terapéutico. Resultados: Se propone una taxonomía organizada en torno a criterios de logro cuantitativos, cualitativos y mixtos, los que son propuestos para el monitoreo de diversos aspectos de la función vocal en el contexto de la intervención fonoaudiológica. Conclusión: El modelo proporciona una guía precisa para evaluar de manera efectiva el progreso y los resultados alcanzados por el/la usuario/a en el abordaje fonoaudiológico vocal a través de los objetivos operacionales planteados para la intervención.

Risk of Dysphonia in Legal Professionals: Proposal for a Screening Protocol

Introduction: Due to the communicative requirements inherent to the profession, the legal professional benefits from speech therapy monitoring for the proper use of the voice and to avoid the occurrence of vocal disorders. The development of specific instruments will contribute with more relevant data to guide this monitoring. Objective: To verify the applicability of the General Dysphonia Risk Screening Protocol (DRSP-G) and the Specific Dysphonia Risk Screening Protocol for Legal Professionals (DRSP-LP) and to correlate the average scores of both with vocal deviation, sex, age, professional performance time, vocal signs and symptoms, and vocal self-assessment. Methods: Fifty legal professionals participated. All participants completed the DRSP-G and DRSP-LP and recorded their voices for detection of the presence of altered vocal quality. Results: Most participants presented a high risk of dysphonia, which was higher in men. Altered vocal quality was observed in 34% of the participants. The items with the highest scores in the DRSP-G were talking a lot (76%), excessive daily coffee intake (70%), contact with smokers (60%), and insufficient hydration and sleep (48%); in the DRSP-LP, alcohol consumption (68%) and exposure to air conditioning (64%). There was no correlation between risk scores and the degree of dysphonia, or with age or length of professional experience. The DRSP-G score correlated with vocal signs and symptoms and vocal self-perception. Conclusions: The joint application of the DRSP-G and the DRSP-LP enabled a quantitative and qualitative analysis of risk factors for dysphonia in legal professionals.

Introducción: Debido a las exigencias comunicativas inherentes a la profesión, el profesional del derecho se beneficia del seguimiento logopédico para el correcto uso de la voz y para evitar la aparición de trastornos vocales. El desarrollo de instrumentos específicos contribuirá con datos más relevantes para guiar este seguimiento. Objetivo: Verificar la aplicabilidad del Protocolo General de Detección de Riesgo de Disfonía (DRSP-G) y el Protocolo de Detección de Riesgo Específico para Profesionales del Derecho (DRSP-LP) y correlacionar las puntuaciones de ambos con varias variables de interés. Metodología: Participaron 50 profesionales del derecho. Todos completaron el DRSP-G y DRSP-LP y grabaron sus voces para detectar la presencia de alteraciones en la calidad de la voz. Resultados: La mayoría presentó un alto riesgo de disfonía, que fue mayor en los hombres. Se observó alteración en la calidad de la voz en el 34% de los participantes. Los ítems con puntajes más altos en el DRSP-G fueron hablar mucho (76%), ingesta diaria excesiva de café (70%), contacto con fumadores (60%) e hidratación y sueño insuficientes (48%); y en el DRSP-LP, consumo de alcohol (68%) y exposición al aire acondicionado (64%). No hubo correlación entre las puntuaciones de riesgo y el grado de disfonía, ni con la edad o la antigüedad profesional. La puntuación DRSP-G se correlacionó con los signos y síntomas vocales y la autopercepción vocal. Conclusiones: La aplicación conjunta del DRSP-G y el DRSP-LP permitió un análisis cuantitativo y cualitativo de los factores de riesgo de disfonía en profesionales del derecho.

What Factors Determine the Use of Volitional and Non-Volitional Devices in Vocal Interventions Performed by Brazilian Speech-Language Pathologists?

OBJECTIVE: To analyze the determining factors for using devices in vocal interventions and characterize their use by Brazilian speech-language pathologists (SLPs). METHODS: This cross-sectional observational study had a sample of 148 SLPs with clinical practice in voice. They answered an online questionnaire via Google Forms about sociodemographic data, training, work in the area, and the use of devices in vocal interventions. Data were analyzed descriptively and inferentially. RESULTS: Tubes, straws, and masks were the most commonly used devices. SLPs specializing in voice are more inclined to use thermotherapy and kinesio tapings while being less inclined to use therapeutic ultrasounds and nebulizers. Voice specialists are less likely to employ electrostimulation. The choice to use photobiomodulation and auditory monitoring devices is influenced by the years of clinical experience, whereas the speech-language therapy training duration affects the use of electrostimulation. The age of the professional also plays a role in the utilization of vibratory stimulation. Vibratory stimulation, auditory monitoring devices, thermotherapy, and nebulization are more frequently utilized among individuals who rely on their voices for occupational purposes, whereas electrostimulation is less common. The use of photobiomodulation is infrequent in children; vibratory stimulation is more common in adolescents, and thermotherapy is relatively common among older individuals. Most of these devices are typically prescribed in execution time during vocal intervention. CONCLUSION: The specialization, the time since graduation and in the occupation, and the target population of the service are the determining factors for the use of devices. They are used in vocal therapy and training, targeting vocal function.

Speech therapy assistance to the transgender population: an experience report / Atendimento fonoaudiológico à população transgênera: um relato de experiência

An incompatible voice with one's own identity is a theme frequently pointed out by the transgender population in speech therapy sessions. Speech therapy is a technique that allows the adjustment of the speaker's voice within a range of possibilities. The speech-language pathologist's role is to provide training, guidance, and counseling to this population, taking into account the specificities of each individual. In light of this, this study aims to report the experience of undergraduate students and speech-language professionals in providing care to the transgender population in a communication laboratory. Initially, key concepts, such as the differences between sex, gender, gender identity, and sexual orientation, are presented. Topics addressed include the violence suffered by the transgender population, the pursuit of vocal adaptation, the creation and development of the communication clinic, the support and assistance provided by professionals to the transgender population and their families, as well as the procedures adopted by the clinic. Among the conclusions, it is highlighted that speech therapy has demonstrated the importance of individual-centered care, legitimizing the guarantee of promoting the users' health. Furthermore, the importance of the speech-language professional in the vocal and communicative improvement of this population, which is often stigmatized, is emphasized (AU).

Voz incompatível com a própria identidade é um tema frequentemente apontado pela população transgênera em atendimentos fonoaudiológicos. A fonoterapia é uma técnica que permite a adequação da voz do falante, dentro de um campo de possibilidades. Ao fonoaudiólogo cabe o treinamento, a orientação e o aconselhamento dessa população, levando em conta as especificidades de cada indivíduo. Diante disso, este estudo tem como objetivo relatar a experiência de estudantes de graduação e profissionais de Fonoaudiologia no atendimento voltado à população transgênera em um laboratório de comunicação. Inicialmente são apresentados conceitos-chave, tais como as diferenças entre sexo, gênero, identidade de gênero, e orientação sexual. São abordados temas como a violência sofrida pela população trans, a busca pela adequação vocal, a criação e o desenvolvimento do ambulatório de comunicação, o acolhimento e o suporte prestado pelos profissionais à população trans e a seus familiares, além dos procedimentos adotados pelo ambulatório. Dentre as conclusões, destaca-se que a assistência fonoaudiológica tem mostrado a importância do cuidado centrado no indivíduo, legitimando a garantia da promoção de saúde dos usuários. Ademais, é destacada a importância do profissional de fonoaudiologia no aprimoramento vocal e comunicativo dessa população que é frequentemente estigmatizada (AU).