Brazilian scale of hearing and language development: normality curve for infants and children from 0 to 24 months old with normal hearing

Introduction: Cochlear implants are currently the most effective technological resource to facilitate access to the hearing world for deaf people. Their use, especially when implanted early in children, reduces the impact of deafness on hearing as well as on the development of spoken language. Objective: To validate the first part of the Brazilian Scale of Hearing and Language Development (EDAL-1, in the Portuguese acronym) and to establish the normal curve in infants and children aged between 0 and 24 months old with normal hearing. Method: This is an experimental study of a descriptive nature, conducted with 92 infants and children with normal hearing. Every infant/child was evaluated audiologically, and the EDAL-1 was applied to their parents. The responses were categorized by applying the EDAL-1 every 3 months for each child. Results: The EDAL-1 was shown to be easily applied by the researcher and easily understood by the parents. It was possible to classify the sample every 3 months and describe the results. The average of the responses found in terms of scores for each age category shows an increasing scale following the evolution of the chronological age: 3 months-34.23 points; 6 months-54.68 points; 9 months-73 points; 12 months- 82.5 points; 15 months-87 points; 18 months-91 points; 21 months-92.5 points, and 24 months-95.83 points. Conclusion: The normal curve for EDAL-1 was successfully established. The averages can be considered as the standard protocol for normality, serving as a reference for comparison with other populations (AU)

Speech therapy teleconsultations of a public telehealth service in a developing country.

Our aim is to assess speech therapy teleconsultations performed by the Telehealth Network of Minas Gerais, a public telehealth service that attends 722 cities in Brazil, to demonstrate the importance of the telehealth to support these professionals. In this observational retrospective study, consecutive speech therapy teleconsultations performed by the Telehealth Network of Minas Gerais, Brazil, from February 2011 to May 2014, were analyzed. Socio-demographic characteristics of the cities which requested teleconsultations were assessed, and teleconsultations were analyzed based on the type of query. Throughout the study, 259 valid speech therapy teleconsultations were performed. There were no significant differences in socio-demographic characteristics of municipalities that requested and did not request speech therapy teleconsultations. Speech therapists (65%), nurses (27%) and physicians (5%) requested the highest number of teleconsultations, mostly related to the area of language (47%), oral motor skills (29%), voice (20%), audiology (18%) and dysphagia (10%). In conclusion, teleconsultations demonstrated to be a potential tool for speech therapists working in remote areas.

Mudanças fonológicas obtidas no tratamento de sujeitos comparando diferentes modelos de terapia / Phonological changes obtained in the treatment of subjects comparing different therapy models

TEMA: há muitas opções de tratamento para o desvio fonológico os quais buscam melhorar a comunicação das crianças. OBJETIVO: este estudo visa analisar o Percentual de Consoantes Corretas-Revisado, o número de fonemas adquiridos no sistema fonológico e os tipos de generalizações obtidas no tratamento, comparando diferentes modelos de terapia em sujeitos com diferentes gravidades do desvio fonológico. MÉTODO: a amostra constou de 21 crianças, com idade média de 5:7 anos. Foram realizadas as avaliações fonoaudiológicas e exames complementares. Após a realização destas avaliações, as crianças foram classificadas em grupos de acordo com o modelo de terapia e gravidade do desvio fonológico. O Percentual de Consoantes Corretas-Revisado, o número de fonemas adquiridos e os tipos de generalizações foram analisados e comparados em cada modelo e entre os modelos terapêuticos, por meio das avaliações inicial e final. RESULTADOS: ao comparar os itens em cada modelo observaram-se evoluções nos três modelos pesquisados. Na comparação entre modelos, os maiores aumentos de percentuais encontram-se nos Modelos ABAB-Retirada e Provas Múltiplas e Oposições Máximas, apesar de a análise estatística mostrar que não há diferença significativa entre eles. CONCLUSÃO: os três modelos aplicados foram eficazes no tratamento destas crianças com desvio fonológico, pois proporcionaram um aumento no Percentual de Consoantes Corretas-Revisado, no número de fonemas adquiridos e nos tipos de generalizações pesquisados.

BACKGROUND: there are many options of phonological disorder treatments that aim at improving children's communication. AIM: to analyze the Percentage of Consonants Correct-Revised, the number of acquired phonemes in the phonological system and the types of generalizations obtained in treatment, comparing different therapy models in subjects with different severity levels of phonological disorder. METHOD: participants were 21 children, mean age 5:7 years. All subjects underwent speech, language and hearing evaluations and additional exams. Children were then divided into groups according to therapy model and severity level of phonological disorder. The Percentage of Consonants Correct-Revised, the number of acquired phonemes and the types of generalizations were analyzed and compared within and between each therapeutic model, considering pre and post therapy evaluations. RESULTS: it was possible to observe improvement in the three analyzed therapy models. When comparing the therapy models, the greater improvement in percentage terms was observed for the ABAB-Withdrawal and Multiple Probes Model and the Maximal Oppositions Model, even though the statistical analysis indicated no significant difference. CONCLUSION: the three therapy models were effective for the treatment of children with phonological disorder because they all of them provided an increase in the Percentage of Consonants Correct-Revised, in the number of acquired phonemes and in the types of analyzed generalizations.

Psychogenic dysphonia associated to other diseases: a challenge for speech therapy.

BACKGROUND: success and difficulties in the treatment of psychogenic dysphonia. AIM: to discuss the limitations of speech therapy for psychogenic dysphonia associated with other diseases. METHOD: evaluation protocols and therapy registrations were used for discussion of the case. RESULTS: the patient arrived with a significant voice change and after evaluation psychogenic dysphonia was diagnosed. The treatment involved vocal activation and modification of the fixed adjustment. Positive changes were observed such as stability in vocal patterns and reduction of hoarseness, roughness, breathiness and throat discomfort and in the quality of life related to voice, but these changes were not sustained since other existing health problems aggravated. CONCLUSION: speech therapy may be limited, although challenging, when psychogenic dysphonia occurs concomitantly to other diseases.

Disfonia psicogênica associada a outras doenças: desafio para o tratamento fonoaudiológico / Psychogenic dysphonia associated to other diseases: a challenge for speech therapy

TEMA: sucessos e dificuldades no tratamento de disfonia psicogênica. OBJETIVO: discutir as limitações da terapia fonoaudiológica para disfonia psicogênica associada a outras doenças. MÉTODO: foram utilizados protocolos de avaliação e registros de terapia para discussão do caso. RESULTADOS: a paciente chegou com importante alteração vocal e, após avaliação, diagnosticou-se disfonia psicogênica. O tratamento envolveu ativação vocal e modificação do ajuste fixado. Observaram-se mudanças positivas como estabilidade no padrão vocal, redução da rouquidão, aspereza, soprosidade e desconforto laríngeo e na qualidade de vida relacionada à voz, mas que não se sustentaram na medida em que houve piora dos outros problemas de saúde. CONCLUSÃO: o tratamento fonoaudiológico pode ser limitado, contudo desafiador, quando a disfonia psicogênica ocorre de maneira concomitante com outras doenças.

BACKGROUND: success and difficulties in the treatment of psychogenic dysphonia. AIM: to discuss the limitations of speech therapy for psychogenic dysphonia associated with other diseases. METHOD: evaluation protocols and therapy registrations were used for discussion of the case. RESULTS: the patient arrived with a significant voice change and after evaluation psychogenic dysphonia was diagnosed. The treatment involved vocal activation and modification of the fixed adjustment. Positive changes were observed such as stability in vocal patterns and reduction of hoarseness, roughness, breathiness and throat discomfort and in the quality of life related to voice, but these changes were not sustained since other existing health problems aggravated. CONCLUSION: speech therapy may be limited, although challenging, when psychogenic dysphonia occurs concomitantly to other diseases.

Phonological changes obtained in the treatment of subjects comparing different therapy models.

BACKGROUND: There are many options of phonological disorder treatments that aim at improving children's communication. AIM: To analyze the Percentage of Consonants Correct-Revised, the number of acquired phonemes in the phonological system and the types of generalizations obtained in treatment, comparing different therapy models in subjects with different severity levels of phonological disorder. METHOD: Participants were 21 children, mean age 5:7 years. All subjects underwent speech, language and hearing evaluations and additional exams. Children were then divided into groups according to therapy model and severity level of phonological disorder. The Percentage of Consonants Correct-Revised, the number of acquired phonemes and the types of generalizations were analyzed and compared within and between each therapeutic model, considering pre and post therapy evaluations. RESULTS: It was possible to observe improvement in the three analyzed therapy models. When comparing the therapy models, the greater improvement in percentage terms was observed for the ABAB-Withdrawal and Multiple Probes Model and the Maximal Oppositions Model, even though the statistical analysis indicated no significant difference. CONCLUSION: The three therapy models were effective for the treatment of children with phonological disorder because they all of them provided an increase in the Percentage of Consonants Correct-Revised, in the number of acquired phonemes and in the types of analyzed generalizations.

Análise da eficácia terapêutica em três modelos fonológicos de abordagem contrastiva / Therapeutic efficacy analysis of three contrastive approach phonological models

BACKGROUND: phonological therapy in subjects with phonological disorders. AIM: to compare the efficacy of three contrastive approach models in three different severities of phonological disorder. METHOD: participants of the study were nine subjects with phonological disorders, with ages ranging between 4:2 and 6:6 years. All subjects were evaluated prior to and after phonological therapy. Three groups, with three subjects each, were determined for treatment. Each group presented one individual with severe, one with moderate-severe and one with mild-moderate phonological disorder. Each group was treated using a different therapy model - Minimal Opposition, Maximal Oppositions/Empty Set and Multiple Opposition. Results were analyzed according to the Friedman Test, considering p < 0.05; a descriptive analysis was also performed among the models. RESULTS: there was no statistical difference among the models considering the severity of phonological disorder. The Minimal and Maximal Oppositions/Empty Set approaches favored a greater number of sound acquisitions in the phonetic inventory of subjects with severe and moderate-severe disorder. On the other hand, the Multiple Oppositions approach favored a better performance of sound acquisition in the phonological system and a decrease in the impaired distinctive features in severe and moderate-severe disorder. CONCLUSION: the models of therapy were effective in the treatment of different severities of phonological disorders observing the best performance in children with severe and moderate-severe disorder.

TEMA: terapia fonológica em crianças com desvio fonológico. OBJETIVO: comparar a eficácia de três modelos de abordagem contrastiva em três diferentes gravidades do desvio fonológico. MÉTODO: a amostra constituiu-se de nove sujeitos com desvio fonológico, com idades entre 4:2 e 6:6. Todos foram avaliados, antes e após a terapia fonológica. Foram estabelecidos três grupos para o tratamento, sendo todos constituídos por três sujeitos, cada grupo tinha um representante com desvio severo, moderado-severo e médio-moderado. Cada grupo foi tratado por um modelo - Oposições Mínimas, Oposições Máximas/Empty Set e Oposições Múltiplas. Posteriormente, realizou-se análise estatística dos dados, utilizando o Teste de Friedman, considerando-se p < 0,05 e análise descritiva entre os modelos. RESULTADOS: não houve diferença estatisticamente significante entre os modelos considerando-se a gravidade do desvio fonológico. Os Modelos de Oposições Mínimas e Oposições Máximas/Empty Set favoreceram maior número de aquisição de sons no inventário fonético nos sujeitos com graus severos e moderado-severo, enquanto que o Modelo de Oposições Múltiplas favoreceu melhor desempenho na aquisição de sons no sistema fonológico e diminuição dos traços distintivos alterados nos desvio severos e moderado-severos. CONCLUSÃO: os modelos de terapia foram eficazes no tratamento das diferentes gravidades do desvio fonológico, observando-se melhor desempenho das crianças com desvio severo e moderado-severo.

A ótica dos usuários sobre a oferta do atendimento fonoaudiológico no Sistema Único de Saúde (SUS) em Salvador / The users' view on the delivery of speech therapy in the Brazilian Unified Health System in Salvador (Bahia, Brazil)

Este artigo tem por objetivo analisar a oferta do atendimento fonoaudiológico do SUS no município de Salvador. Realizamos trinta entrevistas com usuários, em oito serviços de saúde e em turnos diferenciados, e constatamos que a oferta do atendimento de fonoaudiologia, neste município, encontra-se direcionada para pacientes da média e alta-complexidade. Há uma distribuição aleatória e desigual dos atendimentos nos distritos sanitários. Constatamos as múltiplas dificuldades dos usuários no acesso a este cuidado, que podem ser explicadas pela especialização da oferta, pela fragmentação da rede e déficit dos procedimentos fonoaudiológicos, estimado em 131.315 por ano. Em direção à aproximação do conceito de desigualdades justas ou suportáveis e para reverter às iniquidades do acesso à fonoaudiologia, sugerimos a urgência do planejamento deste cuidado nos três níveis de atenção.

This article intends to analyze the supply of speech therapy services by the Brazilian Unified Health System in the city of Salvador. We have made thirty interviews with users at eight healthcare facilities, in differentiated shifts and we verified that the offer of speech therapy, in this city, is directed to medium and high complexity patients. There is a random and unequal distribution of services at sanitary districts. We have also noticed the multiple difficulties faced by users in accessing this treatment, which can be explained by the specialization of the offer, the network fragmentation and the deficit in speech therapy procedures, estimated in 131,315 per year. Therefore, regarding the concept of fair or bearable inequalities, and in order to reverse the inequities in the access to speech therapy, we suggest an urgent planning for this treatment in the three levels of attention.

[The users' view on the delivery of speech therapy in the Brazilian Unified Health System in Salvador (Bahia, Brazil)]. / A ótica dos usuários sobre a oferta do atendimento fonoaudiológico no Sistema Unico de Saúde (SUS) em Salvador.

This article intends to analyze the supply of speech therapy services by the Brazilian Unified Health System in the city of Salvador. We have made thirty interviews with users at eight healthcare facilities, in differentiated shifts and we verified that the offer of speech therapy, in this city, is directed to medium and high complexity patients. There is a random and unequal distribution of services at sanitary districts. We have also noticed the multiple difficulties faced by users in accessing this treatment, which can be explained by the specialization of the offer, the network fragmentation and the deficit in speech therapy procedures, estimated in 131,315 per year. Therefore, regarding the concept of fair or bearable inequalities, and in order to reverse the inequities in the access to speech therapy, we suggest an urgent planning for this treatment in the three levels of attention.

Therapeutic efficacy analysis of three contrastive approach phonological models.

BACKGROUND: Phonological therapy in subjects with phonological disorders. AIM: To compare the efficacy of three contrastive approach models in three different severities of phonological disorder. METHOD: Participants of the study were nine subjects with phonological disorders, with ages ranging between 4:2 and 6:6 years. All subjects were evaluated prior to and after phonological therapy. Three groups, with three subjects each, were determined for treatment. Each group presented one individual with severe, one with moderate-severe and one with mild-moderate phonological disorder. Each group was treated using a different therapy model--Minimal Opposition, Maximal Oppositions/Empty Set and Multiple Opposition. Results were analyzed according to the Friedman Test, considering p < 0.05; a descriptive analysis was also performed among the models. RESULTS: There was no statistical difference among the models considering the severity of phonological disorder. The Minimal and Maximal Oppositions/Empty Set approaches favored a greater number of sound acquisitions in the phonetic inventory of subjects with severe and moderate-severe disorder. On the other hand, the Multiple Oppositions approach favored a better performance of sound acquisition in the phonological system and a decrease in the impaired distinctive features in severe and moderate-severe disorder. CONCLUSION: The models of therapy were effective in the treatment of different severities of phonological disorders observing the best performance in children with severe and moderate-severe disorder.

Therapy effectiveness for phonological disorders with different therapeutic approaches.

BACKGROUND: phonological therapy. AIM: to evaluate the effectiveness of three different therapy models regarding changes in the phonological system of subjects with different phonological disorder (PD) severity levels. METHOD: the research group was composed by 66 subjects, 43 males and 23 females, with ages between 4:4 and 8:2 years, who were part of a school clinic database. All subjects were evaluated, before and after a period of 15 to 25 sessions of phonological therapy, using the Child's Phonological Assessment. Based on this assessment, the severity level of the PD was determined using the Percentage Consonants Correct - PCC, and by calculating the number of Non-Acquired Segments -NAS and the percentage of Acquired Segments (AS) after treatment. The subjects were treated using the following approaches: ABAB-Withdrawal and Multiple Probes, Modified Maximum Opposition and Modified Cycles Models. For the statistical analysis the T-Test was used with a significance level of 5%. RESULTS: the statistical analysis indicated an increase in the PCC and in the percentage of AS, as well as a reduction in the number of NAS for all groups. These results were statistically significant for the majority of the groups. CONCLUSION: the results indicate that the three therapy approaches were effective in the treatment of children with PD, and were effective in treating different severity levels. Besides that, most of the changes occurred in the phonological system of the groups with more severe PD.

Eficácia da terapia para desvios fonológicos com diferentes modelos terapêuticos / Therapy effectiveness for phonological disorders with different therapeutic approaches

TEMA: terapia fonológica. OBJETIVO: avaliar a eficácia do tratamento em três diferentes modelos de terapia quanto às mudanças no sistema fonológico de sujeitos com diferentes gravidades do Desvio Fonológico (DF). MÉTODO: a amostra constituiu-se de 66 sujeitos, com idades entre 4:4 e 8:2, sendo 43 do sexo masculino e 23 do feminino, integrantes do banco de dados de uma clínica escola. Todos foram avaliados, antes e após um período de 15 a 25 sessões de terapia fonológica, utilizando-se a Avaliação Fonológica da Criança, a partir da qual foi determinada a gravidade do DF conforme o Percentual de Consoantes Corretas - PCC, o número de Segmentos Não Adquiridos - SNA , e o percentual de Segmentos Adquiridos (SA) após o período de tratamento. Os sujeitos foram tratados pelos modelos ABAB-Retirada e Provas Múltiplas, Oposições Máximas Modificado e Ciclos Modificado. Posteriormente, realizou-se análise estatística dos dados, utilizando o Teste T para amostras iguais, considerando-se p < 0,05. RESULTADOS: verificou-se um aumento do PCC e do percentual de SA, bem como redução do número de SNA em todos os grupos tratados pelos diferentes modelos de terapia. Estes resultados foram estatisticamente significativos para a maioria dos grupos. CONCLUSÃO: os resultados permitem afirmar que os três modelos de terapia aplicados foram eficazes no tratamento de crianças com DF, para as diferentes gravidades do desvio. Além disso, as maiores mudanças no sistema fonológico ocorreram para os grupos com DF de grau mais acentuado.

BACKGROUND: phonological therapy. AIM: to evaluate the effectiveness of three different therapy models regarding changes in the phonological system of subjects with different phonological disorder (PD) severity levels. METHOD: the research group was composed by 66 subjects, 43 males and 23 females, with ages between 4:4 and 8:2 years, who were part of a school clinic database. All subjects were evaluated, before and after a period of 15 to 25 sessions of phonological therapy, using the Child's Phonological Assessment. Based on this assessment, the severity level of the PD was determined using the Percentage Consonants Correct - PCC, and by calculating the number of Non-Acquired Segments -NAS and the percentage of Acquired Segments (AS) after treatment. The subjects were treated using the following approaches: ABAB-Withdrawal and Multiple Probes, Modified Maximum Opposition and Modified Cycles Models. For the statistical analysis the T-Test was used with a significance level of 5 percent. RESULTS: the statistical analysis indicated an increase in the PCC and in the percentage of AS, as well as a reduction in the number of NAS for all groups. These results were statistically significant for the majority of the groups. CONCLUSION: the results indicate that the three therapy approaches were effective in the treatment of children with PD, and were effective in treating different severity levels. Besides that, most of the changes occurred in the phonological system of the groups with more severe PD.

[Changes in behavior associated to the use of voice after a speech therapy intervention with professionals of child day care centers]. / Mudanças em comportamentos relacionados com o uso da voz após intervenção fonoaudiológica junto a educadoras de creche.

BACKGROUND: preventive programs have been used with teachers with the purpose of lowering the number of risk factors for voice disorders. However, few studies have focused on the effectiveness of these programs. AIM: to assess changes in behaviors that are considered, according to the specific literature, as having a negative impact on the voice, during a speech therapy intervention program offered to educators. METHOD: an experimental study where a theoretical-practical program involving the professional use of voice was developed with 26 educators from two day care centers of São Paulo. This program involved five monthly meetings, working up to a total of twelve hours. During the program, topics concerning negative behaviors that affect the voice were discussed. On four of the meetings the educators filled in a protocol, making it possible to analyze the frequency on which they presented those specific behaviors. Later on, scores were given to the answers on the protocol in order to compare the findings during the program. For this comparison the statistical test of Wilcoxon and the linear tendency chi-square test were used. RESULTS: the gradual decrease in the use of voice out of work was observed, as well as in speaking with a very low or high pitch voice and in eating excessively before sleeping. There was an increase in the occurrence of coughing in the third application of the protocol. As for the overall monthly averages, statistically significant differences were not found when comparing the four applications of the protocol. The overall average score was of 11.75, which was considered moderately abusive. CONCLUSION: the changes that were observed during the program were interesting, but very restrict which makes one wonder about the real effects of this kind of practice and how much broader changes rely on small individual changes. Actions that involve information about vocal well-being exclusively should be revised.

Mudanças em comportamentos relacionados com o uso da voz após intervenção fonoaudiológica junto a educadoras de creche / Changes in behavior associated to the use of voice after a speech therapy intervention with professionals of child day care centers

TEMA: programas preventivos têm sido indicados para diminuir a ocorrência de fatores de risco para alteração de voz em professores, mas poucos estudos têm enfocado sua eficácia. OBJETIVO: avaliar mudanças em comportamentos considerados na literatura especializada como negativos para a voz, ao longo de programa de intervenção fonoaudiológica oferecido a educadoras. MÉTODO: estudo experimental onde foi desenvolvido programa teórico-prático abordando uso vocal profissional junto a 26 educadoras de duas creches paulistas. Ocorreram cinco encontros mensais num total de doze horas. Durante o programa foram abordadas questões sobre comportamentos negativos para o uso vocal. As educadoras preencheram, em quatro encontros, protocolo que possibilitou analisar a freqüência em que apresentaram esses comportamentos. Após, foram construídos escores que possibilitaram comparar esses achados ao longo do programa, com uso dos testes de Wilcoxon e Qui-quadrado de tendência linear. RESULTADOS: observouse diminuição gradativa no uso da voz fora do trabalho, no falar muito grave ou agudo e no comer em excesso antes de dormir. Houve aumento da ocorrência de tosse na terceira aplicação do protocolo. Quanto às médias gerais mensais, não foram observadas diferenças estatisticamente significativas ao se comparar as quatro aplicações. O escore médio geral foi 11,75, considerado moderadamente abusivo. CONCLUSÃO: as mudanças observadas ao longo do programa foram interessantes, mas muito restritas, levando à reflexão sobre o alcance deste tipo de prática e o quanto mudanças mais amplas não dependem apenas de pequenas mudanças individuais, o que em geral é preconizado. Ações que envolvam exclusivamente informações sobre bem estar vocal devem ser revistas.

BACKGROUND: preventive programs have been used with teachers with the purpose of lowering the number of risk factors for voice disorders. However, few studies have focused on the effectiveness of these programs. AIM: to assess changes in behaviors that are considered, according to the specific literature, as having a negative impact on the voice, during a speech therapy intervention program offered to educators. METHOD: an experimental study where a theoretical-practical program involving the professional use of voice was developed with 26 educators from two day care centers of São Paulo. This program involved five monthly meetings, working up to a total of twelve hours. During the program, topics concerning negative behaviors that affect the voice were discussed. On four of the meetings the educators filled in a protocol, making it possible to analyze the frequency on which they presented those specific behaviors. Later on, scores were given to the answers on the protocol in order to compare the findings during the program. For this comparison the statistical test of Wilcoxon and the linear tendency chi-square test were used. RESULTS: the gradual decrease in the use of voice out of work was observed, as well as in speaking with a very low or high pitch voice and in eating excessively before sleeping. There was an increase in the occurrence of coughing in the third application of the protocol. As for the overall monthly averages, statistically significant differences were not found when comparing the four applications of the protocol. The overall average score was of 11.75, which was considered moderately abusive. CONCLUSION: the changes that were observed during the program were interesting, but very restrict which makes one wonder about the real effects of this kind of practice and how much broader changes rely on small individual changes. Actions that involve information about vocal well-being exclusively should be revised.

[Comparative analyses of the effectiveness of three different phonological therapy models]. / Análise comparativa da eficiência de três diferentes modelos de terapia fonológica.

BACKGROUND: phonological therapy in children with phonological disorders. AIM: to verify changes in the phonological system of children with phonological disorders, based on the comparison of number of acquired phonemes, number of sounds in the phonetic inventory and altered distinctive features, before and after therapy, and to verify differences between therapy models: Modified Cycles, Maximal Oppositions and ABAB--Withdrawal and Multiple Probes. METHOD: the research group was composed of 21 subjects, 15 male and 6 female, with phonological disorders, who had already completed speech-language treatment. The initial and final phonological assessments were compared taking into consideration the number of phonemes in the phonological systems, the number of sounds in the phonetic inventory and the altered distinctive features. Phonological changes that resulted from the application of the three therapeutic models were also compared. RESULTS: statistically significant differences were observed between the initial and final assessments in all of the three therapeutic models considering the number of acquired phonemes and the altered distinctive features, whereas in the phonetic inventory a statistically significant difference was observed only between the ABAB--Withdrawal and Multiple Probes and the Maximal Oppositions model. No statistical difference was observed between the therapy models. CONCLUSION: the three therapy models were effective in the treatment of children with phonological disorders, once all of the children presented improvement of their phonological system, phonetic inventory and altered distinctive features. No significant statistical difference was found between the models

Análise comparativa da eficiência de três diferentes modelos de terapia fonológica / Comparative analyses of the effectiveness of three different phonological therapy models

TEMA: terapia fonológica em crianças com desvios fonológicos. OBJETIVO: comparar as mudanças referentes ao sistema fonológico de crianças com desvio fonológico, com base na comparação do número de fonemas adquiridos, número de sons estabelecidos no inventário fonético e traços distintivos alterados, antes e após a terapia, e verificar se houve diferença em relação a estas mudanças de acordo como o modelo de terapia utilizado - Ciclos Modificado, Oposições Máximas e ABAB - Retirada e Provas Múltiplas. MÉTODO: o grupo pesquisado foi constituído por 21 sujeitos, sendo 15 do sexo masculino e 6 do sexo feminino, com desvios fonológicos que já haviam recebido alta do atendimento fonoaudiológico. Foram comparadas a avaliação fonológica inicial e a avaliação após a terapia em relação ao número de sons estabelecidos nos sistemas fonológicos, o número de sons presentes nos inventários fonéticos e os traços distintivos alterados; também foram comparadas as mudanças fonológicas resultantes da aplicação dos três modelos terapêuticos. RESULTADOS: observou-se diferença estatisticamente significante entre as avaliações iniciais e finais nos três modelos quanto aos fonemas estabelecidos no sistema fonológico e traços distintivos alterados, enquanto que no inventário fonético, houve diferença estatística significante somente entre os modelos ABAB - Retirada e Provas Múltiplas e Oposições Máximas. Não houve diferença estatística entre os modelos terapêuticos. CONCLUSÃO: os modelos de terapia foram efetivos no tratamento das crianças com desvio fonológico, pois estas apresentaram evolução nos seus sistemas fonológicos, inventários fonéticos e traços distintivos alterados, não havendo diferença estatisticamente significante entre os modelos.

BACKGROUND: phonological therapy in children with phonological disorders. AIM: to verify changes in the phonological system of children with phonological disorders, based on the comparison of number of acquired phonemes, number of sounds in the phonetic inventory and altered distinctive features, before and after therapy, and to verify differences between therapy models: Modified Cycles, Maximal Oppositions and ABAB - Withdrawal and Multiple Probes. METHOD: the research group was composed of 21 subjects, 15 male and 6 female, with phonological disorders, who had already completed speech-language treatment. The initial and final phonological assessments were compared taking into consideration the number of phonemes in the phonological systems, the number of sounds in the phonetic inventory and the altered distinctive features. Phonological changes that resulted from the application of the three therapeutic models were also compared. RESULTS: statistically significant differences were observed between the initial and final assessments in all of the three therapeutic models considering the number of acquired phonemes and the altered distinctive features, whereas in the phonetic inventory a statistically significant difference was observed only between the ABAB - Withdrawal and Multiple Probes and the Maximal Oppositions model. No statistical difference was observed between the therapy models. CONCLUSION: the three therapy models were effective in the treatment of children with phonological disorders, once all of the children presented improvement of their phonological system, phonetic inventory and altered distinctive features. No significant statistical difference was found between the models.

Reabilitação vocal pós-laringectomia total: resultados em longo prazo com prótese fonatória Blom-Singer® de longa permanência / Speech rehabilitation after total laryngectomy: long-term results with indwelling voice prosthesis Blom-Singer®

Avaliar o uso em longo prazo de próteses fonatórias (PF) para reabilitação fonatória de pacientes submetidos à laringectomia total (LT). Foram estudados a influência do tempo de realização da punção tráqueo-esofágica (PTE), o uso de radioterapia pós-operatória (RTXpos-op), idade e seguimento do paciente, sobre a taxa de sucesso de uso da PF. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODOS: Setenta e um pacientes submetidos à LT e reabilitados com PF de longa permanência. Todos foram avaliados por otorrinolaringologista e fonoaudióloga, quanto aos aspectos funcionais vocais, durante o seguimento. Os dados relativos a tempo de colocação da PF, tempo de utilização da PF, uso de RTXpos-op, idade do paciente, tempo de seguimento e tempo de duração de cada PF foram anotados. RESULTADOS: Houve 87 por cento de pacientes com PTE primária e 13 por cento com secundária. O tempo de seguimento variou de 12 a 87 meses, com média de 38 meses para a PTE primária e 51 meses para a secundária. Houve 59 por cento de pacientes submetidos a RTXpos-op. A taxa de sucesso geral foi de 94 por cento. Na PTE primária foi de 97 por cento e na secundária 78 por cento (p=0,07) e, após dois anos, foi de 96 por cento na PTE primária e 75 por cento na secundária (p=0,07). Utilização de RTXpos-op e idade do paciente não influenciaram no sucesso de utilização de PF, independentemente do tempo de seguimento. CONCLUSÕES: Houve tendência de maior sucesso na reabilitação vocal de pacientes submetidos à LT com a PTE primária. O uso de RTXpos-op e idade não influenciou nesta taxa de sucesso.

Speech rehabilitation after total laryngectomy: long-term results with indwelling voice prosthesis Blom-Singer.

UNLABELLED: To evaluate long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). We studied the influence of time of performance of tracheo-esophageal puncture (TEP), use of radiotherapy (XRT), patients' age and length of follow-up, on the rate of success of use of VP. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. Both otolaryngologist and speech pathologist evaluated all patients for the vocal functional issues during the follow-up. The relative data on time of placement of VP, time of use of PF, use of XRT, age, length of follow-up and interval of duration of each VP were recorded during the follow-up. RESULTS: There was 87% of patients with primary TEP and 13% with secondary. The follow-up varied from 12 to 87 months, with average of 38 months for primary and 51 months for secondary TEP. There were 59% of patients submitted to XRT. The general rate of success was of 94%. In primary TEP it was of 97% and in the secondary, it was 78% (p=0.07) and after two years, the success rate was of 96% in primary TEP and 75% in secondary TEP (p=0.07). The use of XRT and patient age did not influence the success of use of VP among primary and secondary TEP, independently of length of follow-up. CONCLUSION: Tendency to greater success rate in voice rehabilitation after TL with primary TEP was observed. Postoperative XRT and age did not influence success rate.