Telefonoaudiologia: uma revisão integrativa / Telephonoaudiology: an integrative review / Telefonoaudiologia: una revisión integradora

Introdução: A pandemia do Coronavírus trouxe a necessidade do distanciamento social. A partir dessa nova realidade, o Conselho Federal de Fonoaudiologia (CFFa) recomendou o uso da telefonoaudiologia para permitir a continuidade do atendimento fonoaudiológico. Embora a telefonoaudiologia não seja uma prática inédita, dúvidas quanto à sua utilização e eficácia, quando comparada ao atendimento presencial, ainda permeia a prática clínica. Objetivo: realizar uma revisão integrativa da literatura sobre a eficácia da telefonoaudiologia comparada ao atendimento presencial. Métodos: foi realizada uma revisão integrativa da literatura cientifica, sem restrição de idioma e tempo, nas bases de dados: Pubmed, Web of Science, Science Direct, Cochrane e Google Scholar. Resultados: vinte e um artigos foram selecionados. A unanimidade dos artigos demostrou que não houve diferença estatística significante entre as configurações. Nos estudos com foco na avaliação, os métodos de teste (presencial X teleavaliação) foram altamente correlacionados e com alta confiabilidade inter examinador. Nos artigos com foco na terapia, em ambas as configurações de tratamento, houve melhora significativa dos parâmetros avaliados. Os artigos que realizaram pesquisa de satisfação na modalidade de telefonoaudiologia, em quase a totalidade dos estudos, os pacientes e/ou responsáveis relataram moderada a alta satisfação e indicaram disposição de participar novamente de avaliação e/ou terapia na configuração de atendimento remoto. Conclusão: a literatura atual em telefonoaudiologia sugere o uso do atendimento remoto e demonstra a não inferioridade deste quando comparado ao atendimento presencial. Porém, a maioria desses estudos apresenta baixa evidência cientifica.

Introduction: The Coronavirus pandemic brought about the need for social distancing. Based on this new reality, the Brazilian Federal Council of Speech, Language and Hearing Sciences (CFFa) recommended the use of telephonoaudiology to enable the continuity of speech therapy assistance. Although this is not an unprecedented practice, doubts about telephonoaudiology use and its effectiveness, when compared to face-to-face care, still permeate the clinical practice. Objective: to perform an integrative review of the literature on the effectiveness of telephonoaudiology technologies when compared to face to face care. Methods: an integrative review of the scientific literature was carried out, without the restriction of language and time, in the databases: Pubmed, Web of Science, Science Direct, Cochrane, and Google Scholar. Results: twenty-one articles were selected. The unanimity of the papers demonstrated that there was no statistically significant difference between the configurations. In studies focused on evaluation, the test methods (face to face vs. telephonoaudiology) were highly correlated and presented high inter-examiner reliability. In papers focusing on therapy, in both treatment configurations, there was a significant improvement in the parameters evaluated. In almost all the papers that conducted telephonoaudiology satisfaction surveys, patients and/or guardians reported moderate to high satisfaction andindicated a willingness to participate again in assessmentand/ortherapy in the configuration of remote care. Conclusion: the current literature on telephonoaudiology suggests the use of remote care and demonstrates its non-inferiority when compared to face to face care. However, most of these studies have low scientific evidence.

Introducción: La pandemia del coronavirus provocó la necesidad de desapego social. Con base en esta nueva realidad, el Consejo Federal de Terapia del Habla (CFFa) recomendó el uso de telefonoaudiologia para permitir la continuidad de la asistencia de la terapia del habla. Si bien el telefonoaudiologia una práctica inédita, las dudas sobre su uso y efectividad, en comparación con la atención presencial, aún impregna la práctica clínica. Objetivo: realizar una revisión integradora de la literatura sobre la efectividad de telefonoaudiologia frente a la atención asistente personal. Métodos: se realizó una revisión integradora de la literatura científica, sin restricciones de idioma y tiempo, en las bases de datos: Pubmed, Web os Science, Science Direct, Cochrane y Google Scholar. Resultados: se seleccionaron veintiún artículos. La unanimidad de los artículos demostró que no hubo diferencia estadísticamente significativa entre las configuraciones. En los estudios centrados en la evaluación, los métodos de prueba (asistente personal versus telefonoaudiologia) estaban altamente correlacionados y tenían una alta confiabilidad entre examinadores. En los artículos centrados en la terapia, en ambas configuraciones de tratamiento, hubo una mejora significativa en los parámetros evaluados. Los artículos que realizaron encuesta de satisfacción en forma de telefonoaudiologia, en casi todos los estudios, los pacientes y / o tutores reportaron satisfacción moderada a alta e indicaron disposición a participar nuevamente en la evaluación y / o terapia en la configuración de la atención remota. Conclusión: la literatura actual sobre s telefonoaudiologia ugiere el uso de la atención remota y demuestra su no inferioridad en comparación con la atención personal. Sin embargo, la mayoría de estos estudios tienen poca evidencia científica.

La telerehabilitación durante la pandemia COVID-19: experiencia de las familias de niños con condiciones crónicas complejas / Telerehabilitation during the COVID-19 pandemic: experience of families of children with complex chronic conditions

La telerehabilitación ha sido una solución rápida y efectiva para la atención de pacientes durante la pandemia COVID-19. Nuestro objetivo ha sido describir la experiencia de las familias de niños con condiciones crónicas complejas (CCC) asistidos con la modalidad de telerehabilitación durante la pandemia. Materiales y métodos: Se ha realizado un estudio observacional, descriptivo y transversal de tipo encuesta online. Se encuestaron familias de niños (1 mes a 5 años de edad) con al menos una CCC que recibieron seguimiento interdisciplinario a distancia durante la pandemia de 2 o más áreas de rehabilitación (kinesiología, fonoaudiología y terapia ocupacional) pertenecientes al Servicio de Kinesiología del Hospital de Pediatría Juan P Garrahan, durante marzo a octubre de 2020. Resultados: El 88,3% de los participantes (n=43) se expresó satisfecho con la modalidad de telerehabilitación. Entre los facilitadores seleccionados por los participantes se mencionan la reducción de tiempos, mayor frecuencia de consultas, disminución de gastos por traslados y mayor comodidad, mientras que entre las barreras se destacaron: el no vínculo con profesionales, alargue en tiempos de tratamiento, problemas de conectividad. El análisis estadístico no indicó diferencias significativas entre quienes se reportaron como más satisfechos según su estrato social (alto o bajo), la disponibilidad de wifi propio, o respecto a la edad del niño. Se reportaron diferencias significativas en cuanto a la distancia al hospital (p=0.034). Conclusión: Esta forma de intervención ofreció nuevas posibilidades de atención que podrían considerarse a futuro en el seguimiento de nuestros pacientes. (AU)

Telerehabilitation has been a fast and effective solution in patient care during the COVID-19 pandemic. Our aim was to describe the experience of families of children with complex chronic conditions (CCC) treated through telerehabilitation during the pandemic. Materials and methods: An observational, descriptive, cross-sectional, online survey study was conducted. Families of children (1 month to 5 years of age) with at least one CCC who received interdisciplinary remote follow-up during the pandemic from two or more rehabilitation areas (physical therapy, speech therapy, and occupational therapy) belonging to the Department of Physical Therapy of Hospital de Pediatría Juan P Garrahan, from March to October 2020, were surveyed. Results: 88.3% of the participants (n=43) expressed satisfaction with the telerehabilitation modality. Among the facilitators selected by the participants, the following were mentioned: time saving, greater frequency of consultations, reduction of travel expenses and greater comfort, while among the barriers, the following stood out: no connection with the professionals, longer treatment times, connectivity problems. Statistical analysis did not show significant differences between those who reported being more satisfied according to socioeconomic level (high or low), availability of their own wifi connection, or age of the child. A significant difference was found for distance to the hospital (p=0.034). Conclusion: This type of intervention provided new possibilities of care that could be considered in the future follow-up of our patients (AU)

Investigação da gravidade da Afasia em um hospital de urgência e emergência: estudo de caso / Investigating the gravity of Aphasia in an urgengy and emergency hospital: case study

Objetivo: Investigar a gravidade da afasia em uma paciente com Acidente Vascular Encefálico (AVE), a partir da aplicação de um teste considerado simples e rápido: o Aphasia Rapid Test (ART). Metodologia: a paciente de 63 anos foi admitida no pronto socorro de um hospital de urgência e emergência com hipótese diagnóstica de AVE, consciente e fora de qualquer procedimento invasivo que comprometesse sua comunicação. Resultados: na primeira avaliação, não apresentou alteração de linguagem. Na segunda, apresentou dificuldade na execução das provas de ordens simples e complexas, repetição de palavras e frases, na tarefa verbal de fluência semântica e na avaliação de disartria. Considerações finais: observou-se durante a pesquisa que no início da internação a paciente não apresentava gravidade para afasia, porém com o decorrer da internação evidenciou-se dificuldades na linguagem mostrando gravidade para o quadro de afasia, além disso, dificuldades motoras as quais comprometeram a realização das atividades de vida diária

Objective: Investigate the severity of aphasia in a patient with stroke, by applying a test considered simple and fast: the Aphasia Rapid Test (ART). Methodology: the 63-year-old patient was admitted to the emergency room of an urgent and emergency hospital with a diagnostic hypothesis of stroke, conscious and out of any invasive procedure that compromised her communication. Results: in the first evaluation, there was no change in language. In the second, he presented difficulty in carrying out the tests of simple and complex orders, repetition of words and phrases, in the verbal task of semantic fluency and in the evaluation of dysarthria. Final considerations: it was observed during the research that at the beginning of the hospitalization, the patient did not present severity for aphasia, however, with the course of hospitalization, language difficulties were evident, showing severity for the condition of aphasia, in addition, motor difficulties which compromised carrying out activities of daily living

Prevalência do risco para Apneia Obstrutiva do Sono em usuários do Programa de Atenção à Saúde de um hospital referência / Prevalence of risk for Obstructive Sleep Apnea in users of the Health Care Program of a reference hospital

Objetivos: O estudo teve por objetivo, verificar a prevalência de indivíduos que apresentam risco intermediário ou alto para desenvolver Apneia Obstrutiva do Sono (AOS) e verificar o nível de conhecimento destes indivíduos sobre a doença. Métodos: É um estudo transversal, quantitativo, descritivo, conduzido nos meses de maio, junho e agosto de 2018, durante a execução do programa "Saúde na Praça". A coleta foi realizada por meio da aplicação do questionário de triagem da apneia obstrutiva do sono (STOP Bang) e questões complementares relacionadas à dados sociodemográficos, doenças preexistentes e à qualidade do sono. As perguntas foram relacionadas ao cansaço, ronco, apneia observada, pressão sanguínea alta, índice de massa corporal (IMC), idade e circunferência cervical. Resultados: Dos 305 indivíduos selecionados, 33,8% apresentaram risco baixo para AOS, 33,8% risco intermediário e 32,5% risco alto. Dos que apresentaram risco alto, a maioria era do sexo masculino (62,6%); 55,6% referiram noctúria, 59,6% relataram dificuldade de concentração, 66,7% déficit de memória, 58,6% déficit de atenção, 62,5% referiram sono agitado, 36,4% suor excessivo enquanto dormem, 72,7% disseram ser hipertensos e 37,4% referiram ser diabéticos. Conclusão: A apneia obstrutiva do sono tem sido pouco abordada em programas de promoção de saúde e o presente estudo mostrou que tanto indivíduos de baixo risco, quanto os de riscos intermediário ou alto, tinham pouco conhecimento sobre a AOS

Objectives: The objective of this study, was to verify the prevalence of individuals with intermediate or high risk for developing OSA and to verify their level of knowledge about the disease. Methods: This is a cross-sectional, quantitative and descriptive study conducted in May, June and August 2018, during the execution of the "Health in the square" program. The collection was performed by applying the obstructive sleep apnea screening questionnaire (STOP Bang) and complementary questions related to sociodemographic data, pre-existing diseases and sleep quality.The questions were related to tiredness, snoring, observed apnea, high blood pressure, body mass index (BMI), age and cervical circumference. Results: Of the 305 individuals selected, 33,8% had low risk for OSA, 33,8% intermediate risk and 32,5% high risk. Of those at high risk, most were male (62,6%), 55,6% reported nocturia, 59,6% reported difficulty concentrating, 66,7% memory deficit, 58,6% attention deficit, 62,5% reported restless sleep, 36,4% reported excessive sweating while sleeping, 72,7% reported being hypertensive and 37,4% reported being diabetic. Conclusion: Obstructive Sleep Apnea has been poorly addressed in health promotion programs and the present study showed that both low-risk and intermediate- or high-risk individuals had little knowledge about OSA

Impairment, disability, and handicap associated with hearing problems and voice disorders among Colombian teachers / Deficiencia, discapacidad y minusvalía asociadas a los problemas de voz y audición en profesores colombianos

Objectives: 1. define the occurrence of work-related hearing problems and voice disorders among teachers that have contacted the Colombian National Board of Disability Assessment (NBDA) for follow-up; 2. identify individual associated factors of hearing problems and voice disorders among teachers; 3. assess the limitations and restrictions due to hearing problems and voice disorders among these participants. Methods: Retrospective study. The National Database of the Colombian NBDA was reviewed. Information on distributions of occupation, individual characteristics, and diagnosis code (ICD-10) was analyzed. Results: Communication disorders among teachers that have contacted the Colom-bian NBDA for follow-up included voice disorders, with a prevalence of 51%, and hearing problems, with a prevalence of 7%. Female teachers who have contacted the Colombian NBDA for follow-up were 4 times more likely to be identified as having voice disorders compared with their male colleagues. Conclusions: While teachers that have contacted the Colombian NBDA for fol-low-up have a high occurrence of voice disorders, hearing problems are more likely to be stated as a debilitating condition. One possible explanation is that teachers who contacted the Colombian NBDA for follow-up continued working even when many voice symptoms were evident, while hearing problems would prevent a teacher from interacting with students, thereby affecting the teaching-learning process soon-er. Nevertheless, with both voice and hearing problems, work performance and social interaction is affected, and, therefore, quality of life is reduced.

Objetivos: 1. definir la ocurrencia de problemas de audición y de voz relacionados con el trabajo de docentes que contactaron la Junta Nacional de Evaluación de la Discapacidad de Colombia (NBDA) para su seguimiento; 2. identificar los factores individuales asociados a los problemas de audición y voz entre los profesores; 3. eva-luar las limitaciones y restricciones debidas a problemas de audición y voz asociados al trabajo entre los participantes.Métodos: estudio retrospectivo. Se revisó la Base de Datos Nacional de la NBDA colombiana. Se analizó información sobre distribuciones de ocupación, característi-cas individuales y código de diagnóstico (CIE-10).Resultados: Los trastornos de comunicación entre los docentes que han contacta-do a la NBDA colombiana para seguimiento incluyeron problemas de la voz, con una prevalencia del 51%, y problemas de audición, con una prevalencia del 7%. Las pro-fesoras que se han puesto en contacto con la NBDA colombiana para el seguimiento tenían 4 veces más probabilidades de ser identificadas con trastornos de la voz en comparación con sus colegas masculinos.Conclusiones: Si bien los maestros que contactaron a la NBDA colombiana para el seguimiento tienen una alta incidencia de trastornos de la voz, es más probable que los problemas de audición se consideren una condición debilitante. Una posible ex-plicación es que los maestros que se comunicaron con la NBDA colombiana para el seguimiento continuaron trabajando incluso cuando muchos síntomas vocales eran evidentes, mientras que los problemas de audición evitarían que un maestro inte-ractuara con los estudiantes, afectando así el proceso de enseñanza-aprendizaje. Sin embargo, tanto con los problemas de voz como de audición, el desempeño laboral y la interacción social se ven afectados y, por lo tanto, la calidad de vida se reduce.

Vocal Pedagogy and the Alexander Technique: a reflection / La pedagogía vocal y la Técnica Alexander: una reflexión

This article is a reflection about the role of the Alexander Technique and its appli-cation and influence in vocal pedagogy. It is based on more than seventeen years of active teaching as a qualified Alexander Technique Teacher and as a professional singer, working alongside vocal pedagogues, teachers, students and professionals. Its objective is to reflect upon the role of body awareness, psychophysical and emotional consciousness, and wellbeing in the realms of vocal pedagogy and singing.

El presente artículo corresponde a una reflexión sobre la Técnica Alexander, su aplicación e influencia dentro del ámbito de la pedagogía vocal. Está basado en los últimos diecisiete años de carrera activa como profesora de Técnica Alexander y cantante profesional, trabajando con cantantes y profesores de canto con el objetivo de lograr una buena reflexión de la importancia del proceso de consciencia corporal, conexión sicofísica y bienestar en la pedagogía vocal

Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte I: Deglución / Clinical considerations for speech-language pathologists in the treatment of people with COVID-19 and tracheostomy. Part I: Swallowing

A la fecha de redacción de este artículo, más de 500 mil personas han sido afectadas por el virus SARS-CoV-2 en Chile, manifestando diferentes grados de la enfermedad COVID-19. Aquellas que sobrellevan condiciones más severas generan una condición que requiere soporte ventilatorio invasivo y tratamiento en unidades de cuidados intensivos, que de prolongarse en el tiempo deriva en la necesidad de una traqueostomía. A pesar de los beneficios que posee esta en la recuperación de personas con dificultades respiratorias, su implementación se asocia a alteraciones deglutorias que se suman a las generadas por COVID-19. Condición que supone un desafío para los/as fonoaudiólogos/as, quienes están expuestos/as al virus debido a su proceder en estructuras del tracto aerodigestivo y la realización de procedimientos potencialmente generadores de aerosol. El objetivo de este artículo es entregar orientaciones y herramientas clínicas para la intervención en la deglución de personas con traqueostomía y COVID-19. Estas emanan de un análisis pragmático de la evidencia disponible a la fecha, interpretadas bajo nuestra experiencia de atender a más de 561 personas con dicha condición. Se espera contribuir a la rehabilitación de la deglución en personas con COVID-19 y traqueostomía. Para ello se expone sobre las características de la deglución en esta población, su tratamiento, consideraciones para el uso de técnicas específicas, y orientaciones para la mejora de la calidad de vida mediante la mantención y/o recuperación de la funcionalidad deglutoria. Siempre bajo un esquema centrado en el cuidado y protección de las personas hospitalizadas y el equipo de salud.

At the time of writing this article, more than a million people have been affected by the SARS-CoV-2 virus in Chile, displaying different degrees of COVID-19 disease. Severe infections generate a condition that requires invasive ventilatory support and treatment in intensive care units, which, when extended in time, makes necessary conducting a tracheostomy. Despite its benefits for the recovery of patients with respiratory difficulties, it is linked to swallowing disorders that add to the problems generated by COVID-19. This represents a challenge for speech pathologists, who are potentially exposed to the virus because they work on structures of the aerodigestive tract and becuase they conduct procedures that may be aerosol-generating. The aim of this article is to provide guidance and clinical tools for swallowing-intervention in people with tracheostomies and COVID-19. Thees tools spring from a pragmatic analysis of the currently available evidence , interpreted based on our experience of caring more than561 infected patients. We hope to contribute to the rehabilitation of swallowing of patients with COVID-19 and a tracheostomy. The characteristics of swallowing in this population, its treatment, considerations for the use of specific techniques, and guidelines for improving the quality of life through the maintenance and/or recovery of swallowing functionality are discussed, focused caring and protecting hospitalized patients and the health team.

Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte II: Mejorando la fonación para facilitar la comunicación / Clinical considerations for speech-language pathologists in the treatment of people with COVID-19 and tracheostomy. Part II: Improving phonation to facilitate communicatio

La enfermedad COVID-19 fue declarada pandemia por la Organización Mundial de la Salud. Su presentación más severa genera una condición que requiere tratamiento en unidades de cuidados intensivos, condición que al prolongarse en el tiempo requiere la implementación de una traqueostomía para facilitar la entrega de soporte ventilatorio invasivo. Si bien este dispositivo posee importantes ventajas que favorecen la recuperación y rehabilitación, también es cierto que genera diversas complicaciones en la comunicación de las personas, condición que se suma a los efectos propios del COVID-19 y la frecuente historia de intubación endotraqueal previa. El objetivo de este artículo es proveer orientaciones y herramientas clínicas para el tratamiento de la fonación para la comunicación en personas con traqueostomía y COVID-19. Se considera para ello las recomendaciones de la literatura existentes a la fecha, bajo un análisis pragmático y basado en nuestra experiencia de atender a más de 561 personas con esta condición. Se exponen las características de la comunicación en esta población, su tratamiento, consideraciones para el uso de técnicas específicas y orientaciones para la mejora de la calidad de vida. Siempre con un enfoque orientado al cuidado y protección de las/os usuarias/os y el equipo de salud, en particular fonoaudiólogas y fonoaudiólogos del país.

The COVID-19 disease was declared a pandemic by the World Health Organization. When most severe, it generates a condition that requires treatment in intensive care units, which, when extended in time, requires implementing of a tracheostomy to facilitate invasive ventilatory support. Although ventilatory support has important advantages that favor recovery and rehabilitation, it generates various complications for patients' communication, a condition that adds to the effects of COVID-19 and the frequent history of previous endotracheal intubation. The aim of this article is to provide guidance and clinical tools for the treatment of phonation to facilitate communication in people with tracheostomy and COVID-19. For this, the recommendations of the existing available literature are considered, under a pragmatic analysis and based on our experience of treating more than 561 infected patients. The characteristics of communication in this population, its treatment, considerations for the use of specific techniques and guidelines to improve quality of life are exposed. Always with an approach oriented to the care and protection of users and the health team, in particular speech-language pathologists in the country.

Recomendaciones para la atención fonoaudiológica en las áreas de audiología y otoneurología en contexto COVID-19: una revisión narrativa / Recommendations for audiologist assistance in the areas of audiology and otoneurology in context COVID-19: a narrative review

La pandemia por el virus SARS-CoV-2 causante de la enfermedad COVID-19 se ha expandido rápidamente a nivel mundial. Las autoridades de salud pública han recomendado limitar las prestaciones de salud no esenciales, buscando el equilibrio entre el riesgo del retraso en el tratamiento y la potencial exposición al virus. En la mayoría de las prestaciones en las áreas de audiología y otoneurología no es posible cumplir con el distanciamiento físico recomendado y la duración de la atención puede superar los 45 minutos, factores que aumentan el riesgo de contagio para el profesional. El objetivo de la presente revisión es describir la evidencia actual sobre las recomendaciones de atención para las áreas de audiología y otoneurología en contexto COVID-19. Además de la búsqueda de artículos científicos en diversas bases de datos, se revisaron las recomendaciones emitidas por las principales asociaciones en el área. La información obtenida se organizó considerando cuatro aspectos clínicos relevantes: prestaciones, procedimientos, elementos de protección personal y limpieza de equipamiento e insumos. La evidencia científica y las sugerencias de las asociaciones están en constante actualización y algunos temas se han desarrollado escasamente. Sin embargo, las recomendaciones coinciden en priorizar la atención a distancia, extremar el uso de elementos de protección personal, implementar protocolos de higiene de manos y limpieza de equipos e insumos. También, se sugiere incorporar estrategias de comunicación alternativas al lenguaje oral con las personas con hipoacusia para facilitar la discriminación de la palabra.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has rapidly spread worldwide. Public health authorities have recommended limiting non-essential healthcare, in search of a balance between the risk of delaying treatment and the potential exposure to the virus. Most services in the audiology and otoneurologyareas can easily exceed 45 minutes and it is not possible to keep the recommended physical distancing. Both factors increase the risk of professionals being infected. Therefore, the purpose of this review is to describe the current evidence about recommendations in audiology and otoneurology care in the context of COVID-19. In addition to the search of scientific articles in various databases, recommendations issued by the mainassociations in the area were consulted. The information was gathered considering four relevant clinical aspects: health careservices, procedures, personal protective equipment and the cleaning of equipment and supplies. Scientific evidence and suggestions made by associations are being constantly updated, and therefore there is limited content on some topics. However, the recommendations agree on prioritizing remote health care, increasing the use of personal protective equipment, implementing protocols for hand hygiene and for the cleaning of equipment and supplies. The incorporation communication strategies other than oral language to interact with people with hearing lossto facilitate speech discrimination is also recommended.

Pauta de pesquisa para apraxia del habla infantil en hispanohablantes: traducción y validación cultural / Check list for childhood apraxia of speech in spanish-speaking population: translation and validation

La apraxia del habla infantil (AHI) es un trastorno pediátrico poco común, en el que, si el niño o niña no es diagnosticado a tiempo, puede desencadenar graves consecuencias a futuro. Los métodos de diagnóstico existentes para este trastorno se encuentran disponibles en idiomas distintos al español, lo que conlleva una dificultad para encontrar un método de diagnóstico válido y consensuado por los fonoaudiólogos para aplicarse a la población hispanohablantes. Es por estoque este estudio pretende dar un primer aporte, realizando la traducción de una herramienta de pesquisa apta para el idioma español, que permita facilitar la labor fonoaudiológica en el diagnóstico. El método que se utilizará es el de traducción y validación de una herramienta de evaluación en salud, al cual se va a incorporar el análisis de un panel de expertos para brindarle validez al instrumento. Los resultados muestran una amplia aceptación del instrumento (94%resultados positivos) con un buen acuerdo entre jueces (IRR inter rater reliability) presentada como probabilidad de acuerdo para todo el instrumento de 0,57 (57%). En conclusión, este estudio brinda una pauta de pesquisa para la AHI, con el fin de facilitar la evaluación fonoaudiológica temprana de los niños y niñas, permitiendo que los usuarios puedan acceder a una atención especializada y confiable acordes con el diagnóstico.

Childhood apraxia of speech (CAS), is a rare disorder during childhood, and it can trigger serious consequences in the future if not treated promptly. The existing diagnostic methods for this disorder are found in the English language only, which leads to difficulties in finding valid and agreed diagnostic methods by speech therapists to apply to the Spanish-speaking population. Hence, this study aims to provide the translation of an evaluation tool which is suitable for Spanish-speaking countries and that facilitates phonoaudiological work in the diagnosis. The method that will be used is that of translation-retranslation, to which the analysis of an expert opinion will be incorporated to give validity to the instrument. The results expose a wide acceptance of the instrument (94% of positive results) with substantial agreement among experts (IRR inter rater reliability), presented as agreement probability for the entire instrument of 0.57 (57%). In conclusion, this study provides a research pattern for AHI, to facilitate the early phonoaudiological evaluation of children, allowing the patients to access reliable care regarding to diagnosis.

Protocolo de evaluación fonoaudiológica integral del neonato y su pertinencia para el abordaje de la lactancia materna / Integral speech therapy evaluation protocol of the newborn and the relevance to the breastfeeding intervention

Innumerables estudios realizados por diferentes áreas de la salud demuestran los beneficios de la lactancia materna (LM) exclusiva y el crecimiento armónico de las estructuras craneofaciales para el adecuado desarrollo posterior de funciones orales como la respiración, deglución y el habla. La intervención temprana por parte del profesional en fonoaudiología en las Unidades de Cuidados Intensivos (UCI), evidencia beneficios indiscutibles pues promueve la autoeficacia en la madre, la lactancia materna y con esta, la disminución de comorbilidades en el bebé, así como la reducción del tiempo para la implementación de la vía oral. Es importante resaltar la importancia que tiene para el fonoaudiólogo contar con instrumentos validados que permitan diagnósticos oportunos y por ende tratamientos efectivos. La presente investigación es de tipo descriptiva, con una metodología mixta y diseño no experimental; debido a que se orientó hacia la verificación de la validez de contenido (externa), del Protocolo de Evaluación Fonoaudiológica Integral del Neonato EFIN, determinando además su pertinencia, al ser usado como instrumento orientador dentro del rol que ejerce el fonoaudiólogo en la lactancia materna. Para efectos de validez en términos de suficiencia, pertinencia y claridad se realiza la validación a través del juicio de expertos, con un panel compuesto por profesionales de diferentes países latinoamericanos dentro de los cuales se encuentra Colombia, Perú, Chile, Brasil y Argentina, obteniendo una validez fuerte de la totalidad del protocolo, con un coeficiente de validez según el coeficiente estadístico V de Aiken superior a 0,81. Para medir la utilidad del instrumento EFIN en el abordaje de la lactancia materna, se realiza una encuesta tipo Likert observando frecuencias absolutas homogéneas que permitieron ver el instrumento como una herramienta de gran utilidad, no solo para la lactancia materna sino para todas las áreas de neonatología en las que participa el fonoaudiólogo.

Countless studies carried out by different health areas demonstrate the benefits of exclusive breastfeeding (BF) and the harmonious growth of craniofacial structures for the proper subsequent development of oral functions such as breathing, swallowing and speech. Early intervention by the professional in speech therapy in Intensive Care Units (ICU) shows undeniable benefits as it promotes self-efficacy in the mother, breastfeeding and with it, the reduction of comorbidities in the baby, as well as the reduction of time for the implementation of the oral route. It is important to highlight the importance for the speech pathologist to have validated instruments that allow timely diagnoses and therefore effective treatments.This research is descriptive, with a mixed methodology and non-experimental design; Since it was oriented towards the verification of the validity of the content (external) of the EFIN Comprehensive Speech Therapy Assessment Protocol of the Newborn, also determining its relevance, as it is used as a guiding instrument within the role of the speech therapist in breastfeeding.For validity purposes in terms of sufficiency, relevance and clarity, the validation is carried out through the judgment of experts, with a panel made up of professionals from different Latin American countries, including Colombia, Peru, Chile, Brazil and Argentina, obtaining strong validity of the entire protocol, with a validity coefficient according to Aiken's V statistical coefficient greater than 0.81. To measure the usefulness of the EFIN instrument in the approach to breastfeeding, a Likert-type survey is carried out observing homogeneous absolute frequencies that allowed us to see the instrument as a very useful tool, not only for breastfeeding but for all areas of neonatology in which the speech therapist participates

The role of speech therapist in the patient care team for bariatric surgery / Rol del fonoaudiólogo en el equipo de atención al paciente para cirugía bariátrica

The work of the speech therapist with patients undergoing Bariatric Surgery (BS) is still little explored, although essential for the adequate preparation of the subject for surgery, as well as for his short and long term recovery. Given its importance and it's still limited performance in this scenario, the objective of this study was to verify the perception of patients about the importance and effectiveness of speech therapy both in the pre and postoperative period of BS. Questionnaires were carried out with 44 patients divided into 4 groups, according to the moment of bariatric surgery follow-up. Most of the subjects were unaware of the role of the speech therapist at the beginning of the treatment, but they considered their guidance and their presence in the team relevant during the process. The ignorance of the role of the Speech-Language Pathologist in the care of bariatric patients is related to the incipient participation of Speech-Language Pathologists in this scenario. The positive impact of speech therapy guidelines in the preoperative period improves quality of life, provides information and clarifies subjects' doubts and fears, enhancing results and minimizing postoperative problems. The professional's guidance in relation to the aspects experienced in the patients' daily lives implies a consensus on the importance of the participation of the Speech Therapist during the process of monitoring the BS. Patients' perception of the importance of the guidelines received by the Speech-Language Pathologist was well-known, as well as their necessary participation in the multidisciplinary team. The results demonstrated the effectiveness of speech therapy both in the pre and in the short and long term postoperative period.

La labor del fonoaudiólogo con pacientes sometidos a Cirugía Bariátrica (CB) es aún poco explorada, aunque fundamental para la adecuada preparación del sujeto para la cirugía, así como para su recuperación a corto y largo plazo. Dada su importancia y su aún limitado desempeño en este escenario, el objetivo de este estudio fue verificar la percepción de los pacientes sobre la importancia y efectividad de la logopedia tanto en el período pre como postoperatorio de CB. Se realizaron cuestionarios con 44 pacientes divididos en 4 grupos, según el momento del seguimiento de la cirugía bariátrica. Resultados: La mayoría de los sujetos desconocían el rol del fonoaudiólogo al inicio del tratamiento, pero consideraron relevante su orientación y presencia en el equipo durante el proceso. El desconocimiento del papel del fonoaudiólogo en la atención de los pacientes bariátricos se relaciona con la incipiente participación de los fonoaudiólogos en este escenario. El impacto positivo de las pautas de fonoaudiología en el período preoperatorio mejora la calidad de vida, brinda información y aclara las dudas y temores de los sujetos, potenciando los resultados y minimizando los problemas postoperatorios. La orientación del profesional en relación con los aspectos vividos en la vida diaria de los pacientes implica un consenso sobre la importancia de la participación del fonoaudiólogo durante el proceso de seguimiento de CB. Es conocida la percepción de los pacientes sobre la importancia de las guías recibidas por el fonoaudiólogo, así como su necesaria participación en el equipo multidisciplinario. Los resultados demostraron la eficacia de la fonoaudiología tanto en el pre como en el postoperatorio a corto y largo plazo.

Brief Montreal-Toulouse Language Assessment Battery: adaptation and content validity

Background Evaluating patients in the acute phase of brain damage allows for the early detection of cognitive and linguistic impairments and the implementation of more effective interventions. However, few cross-cultural instruments are available for the bedside assessment of language abilities. The aim of this study was to develop a brief assessment instrument and evaluate its content validity. Methods Stimuli for the new assessment instrument were selected from the M1-Alpha and MTL-BR batteries (Stage 1). Sixty-five images were redesigned and analyzed by non-expert judges (Stage 2). This was followed by the analysis of expert judges (Stage 3), where nine speech pathologists with doctoral training and experience in aphasiology and/or linguistics evaluated the images, words, nonwords, and phrases for inclusion in the instrument. Two pilot studies (Stage 4) were then conducted in order to identify any remaining errors in the instrument and scoring instructions. Results Sixty of the 65 figures examined by the judges achieved inter-rater agreement rates of at least 80%. Modifications were suggested to 22 images, which were therefore reanalyzed by the judges, who reached high levels of inter-rater agreement (AC1 = 0.98 [CI = 0.96-1]). New types of stimuli such as nonwords and irregular words were also inserted in the Brief Battery and favorably evaluated by the expert judges. Optional tasks were also developed for specific diagnostic situations. After the correction of errors detected in Stage 4, the final version of the instrument was obtained. Conclusion This study confirmed the content validity of the Brief MTL-BR Battery. The method used in this investigation was effective and can be used in future studies to develop brief instruments based on preexisting assessment batteries.

Microstomia: Aplicação da fotogrametria para mensurar a eficiência da órtese oral associada à terapia fonoaudiológica / Microstomy: Application of photogrammetry to measure the efficiency of oral orthosis associated with speech therapy

OBJETIVO: Esse estudo teve como propósito verificar, por meio da fotogrametria computadorizada, a eficácia do uso da órtese oral como auxiliar na terapia fonoaudiológica. MÉTODO: Após a documentação fotográfica, cada paciente foi submetido a terapia fonoaudiológica, por meio da terapia miofuncional orofacial, associada ao uso da órtese oral, confeccionada segundo Borges et al. (2011). Ao término do tratamento, foi realizado novo registro fotográfico, em seguida, a mensuração da dimensão vertical (distância entre lábio superior/inferior) e horizontal (distância entre comissuras direita/esquerda), com o uso do programa Corel Draw X3. RESULTADOS: As médias da abertura bucal aumentaram da avaliação inicial para a avaliação final, tendo aumentado 5,1 mm no sentido horizontal (67,3 mm para 72,4 mm) e 13,9 mm no sentido vertical (de 32,7 mm para 46,6 mm). Essas diferenças se revelam significativas para as avaliações (p <0,05). CONCLUSÃO: O uso da órtese oral associado a terapia fonoaudiológica demonstrou ser eficaz como mais um instrumento na prevenção da microstomia.

OBJECTIVES: The aim of this study was to through computerized photogrammetry, the efficacy of oral orthosis as an aid in speech therapy. METHODS: After the photographic documentation, each patient underwent speech therapy, through orofacial myofunctional therapy, associated with the use of an oral orthosis, made according to Borges et al. (2011). At the end of the treatment, a new photographic record was taken, then the vertical dimension measurement (distance between upper lip) and horizontal (distance between corners right/left), using the program Corel Draw X3. RESULTS: The mean mouth opening increased from the initial evaluation to the final evaluation, increasing 5.1 mm in the horizontal direction (67.3 mm to 72.4 mm) and 13.9 mm in the vertical direction (from 32.7 mm to 46.6 mm). These differences are significant for the evaluations (p<0.05). CONCLUSION: The use of oral orthosis associated with speech therapy proved to be effective as another tool in the prevention of microstomia.

Intervención logopédica desde enfoques naturalistas / Speech therapy intervention from naturalistic approaches

No disponible

Intervención fonoaudiológica para la feminización de la voz en una persona transgénero MTF: estudio de caso / Phoniatric intervention for voice feminization in a transgender person MTF: a case study

El término transgénero hace referencia a aquellas personas cuya identidad de género (masculino -femenino) difiere del sexo (hombre ­mujer). La persona transgénero presenta un conflicto entre la identidad sexual y su condición biológica, debido a que esta última, ya está ajustada a unas características que están dadas desde el nacimiento. Una de las mayores dificultades que presentan es en la feminización de voz, debido a que esta es percibida como la del género opuesto. Por ello, usualmente realizan cambios vocales sin una técnica adecuada, recurriendo principalmente a tratamientos quirúrgicos u hormonales, desconociendo la terapia fonoaudiológica como una alternativa para mejorar su calidad vocal e interacción social. Dado lo anterior, el objetivo de este trabajo fue determinar la efectividad de la intervención fonoaudiológica para la feminización de la voz en una persona Transgénero MTF (Male to Female). Se utilizó un diseño descriptivo, cuantitativo, usando un diseño longitudinal de serie de estudio de caso de reversión ABA. La intervención se estructuró, principalmente, en tres apartados: evaluación inicial, intervención y reevaluación final. Los resultados mostraron una variación significativa en las cualidades acústico-perceptuales de la voz, la que presentó mayores características de una voz femenina, con modificaciones en el patrón fonorespiratorio y en la postura. En conclusión, la intervención fonoaudiológica fue efectiva debido a que se lograron cambios que permitieron lograr una voz más femenina en la persona tratada.

The term transgender denotes a person whose gender identity (male-female) is different from their sex (men-women). A transgender person presents a contradiction between sexual identity and biological condition, because the latter is determined by certain given characteristics since birth. One of the most difficult issues is the feminization of the person's voice (in the case if male to female), since it is perceived as being in the opposite end of gender. For this reason, usually male to female transgenders engage in vocal changes without appropriate techniques, resorting mostly to surgical procedures or hormonal treatments and ignoring speech and language therapy as an alternative to improve their vocal quality and social interaction. Therefore, the main goal of this work was to determine the effectiveness of the phoniatric intervention in order to produce the feminization of the voice in a transgender individual MTF. The methodology used is a quantitative, descriptive, using a longitudinal design of ABA reversion case study series. The intervention was structured in three main sections: initial evaluation, intervention and final re-evaluation. The results showed a significant variation in the acoustic perceptual qualities of the voice, with a more feminine voice involving modifications in the phonorespiratory pattern and in the posture. In conclusion, the phoniatric intervention was effective because achieved changes led to a more feminine voice.

Perforación iatrogénica faringoesofágica tratada con prótesis esofágica totalmente cubierta: reporte de caso / Iatrogenic pharyngoesophageal perforations treated with fully covered self-expandable metal stents: Case report

No disponible

Fonoaudiologia e cirurgia ortognática: revisão de literatura / Speech therapy and orthognathic surgery: a literature review

Introdução: As deformidades dentofaciais estão associadas às alterações de oclusões dentárias, que podem causar modificações no sistema miofuncional de acordo com o tipo de desproporção. Essas deformidades, podem provocar alterações e/ou adaptações no sistema estomatognático. O objetivo desse estudo foi identificar, com base na literatura arbitrada, a relação entre a Fonoaudiologia e a Cirurgia Ortognática. Método: Foi realizado levantamento bibliográfico sem período específico, nas bases de dados PubMed, SciELO e BVS. Resultados: Foram avaliados 15 artigos de forma crítica, quanto ao tipo de estudo, seus objetivos, número e gênero dos participantes, metodologia, resultados e conclusões. Os artigos foram agrupados com base nos seus objetivos em 1) Grupo Fonoaudiologia (GF); 2) Grupo Mudanças (GM); 3) Grupo Técnicas (GT) e 4) Grupo Outros (GO). Conclusão: Pouco se encontrou sobre a intervenção fonoaudiológica direta, sendo a maioria dos estudos direcionada às mudanças estéticas e funcionais do tecido duro e mole de pacientes submetidos à cirurgia ortognática. Houve também estudos que abordaram métodos e/ou exames específicos para verificar as mudanças nos tecidos moles e duros do perfil facial dos pacientes submetidos à cirurgia ortognática e estudo que detalhou o perfil dos indivíduos que realizaram tratamento para deformidade dentofacial e síndrome da Apneia e Hipopneia do Sono.

Introduction: Dentofacial deformities are associated with changes in dental occlusion, which may cause changes in the myofunctional system according to the type of disproportion. These deformities can cause changes and/or adaptations in the stomatognathic system. The objective of this study was to identify the relationship between speech therapy and orthognathic surgery based on refereed publications. Method: A bibliographic survey was conducted without considering a specific publication period in the databases, PubMed, SciELO and BVS. Results: Fifteen articles were critically evaluated with respect to the type of study, objectives, number and sex of participants, methodology, results and conclusions. Based on their aims, the articles were grouped into 1) speech-therapy group (STG); 2) changes group (CG); 3) techniques group (GT) and 4) others group (OG). Conclusion: There is little information regarding direct speech therapy intervention, and the majority of the studies were directed to the aesthetic and functional changes in the hard and soft tissue in patients who underwent orthognathic surgery. Some studies addressed methods and/or specific examination procedures to verify the changes in the soft and hard tissues of the facial profile of patients who underwent orthognathic surgery, and a study detailed the profile of individuals who underwent treatment for dentofacial deformity and apnea-hypopnea syndrome.

Repercusiones sociales de la disfagia / Social impact of dysphagia

Objetivo. Valorar la realidad social y la percepción funcional que tienen los cuidadores principales acerca de la calidad de vida de los sujetos diagnosticados con disfagia. Métodos. La investigación se desarrolló partiendo de lineamientos de la resolución 008430 del 4 de octubre de 1993, que rige en Colombia las normas científica, técnica y administrativa para la investigación en salud. La elección de la muestra se realizó a partir del estudio de las historias clínicas y el diagnóstico de disfagia; el instrumento fue validado a través del Método Delphi, el cual busca dar confiabilidad a un instrumento a partir de la opinión de un panel de expertos. Resultados. Los cuidadores indican que el mejor dominio en la percepción de calidad de vida del sujeto con disfagia es el psicológico, sin embargo, este se encuentra por debajo del 80%, entendido como una percepción aceptable. Al analizar la individualidad, se detecta como porcentaje más bajo un 53.66% vs. el 84.15% que corresponde al más alto; el resultado promedio evidenció un 68.75% de percepción de calidad de vida, correspondiente según la propuesta de rangos de percepción, a una percepción aceptable; este valor equivale al promedio obtenido de 112.74 puntos de 164 posibles. Conclusiones. Desde los aspectos terapéuticos, los profesionales no pueden olvidar al cuidador, ya que es un factor en la rehabilitación que también necesitará atención. No se puede permitir que el cuidador principal genere cansancio, estrés o despreocupación a causa de las largas cargas de trabajo en su labor de cuidar

Purpose. To assess the social reality and the functional perception that the main caregivers have about the quality of life of the subjects diagnosed with dysphagia. Methods. The research was developed based on the guidelines of resolution 008430 of October 4, 1993, which governs the scientific, technical and administrative standards for health research in Colombia. The choice of the sample was made from the study of the clinical histories and the diagnosis of dysphagia; the instrument was validated through the Delphi method, which seeks to give reliability to an instrument based on the opinion of a panel of experts. Results. Caregivers indicate that the best domain in the perception of quality of life of the subject with dysphagia is the psychological, but this is below 80%, understood as an acceptable perception. When analyzing the individuality, it is detected as a lower percentage 53.66%, versus 84.15% that corresponds to the highest. The average result showed a 68.75% perception of quality of life, corresponding to an acceptable perception according to the proposed ranges of perception. This value is equivalent to the average obtained of 112.74 points out of 164 possible. Conclusions. From the therapeutic aspects, professionals cannot forget the caregiver, since it is a factor in the rehabilitation that will also need attention. The primary caregiver cannot be allowed to create fatigue, stress, or unconcern because of the long workloads in their caring work