The Precentral Insular Cortical Network for Speech Articulation.

Apraxia of speech is a motor disorder characterized by the impaired ability to coordinate the sequential articulatory movements necessary to produce speech. The critical cortical area(s) involved in speech apraxia remain controversial because many of the previously reported cases had additional aphasic impairments, preventing localization of the specific cortical circuit necessary for the somatomotor execution of speech. Four patients with "pure speech apraxia" (i.e., who had no aphasic and orofacial motor impairments) are reported here. The critical lesion in all four patients involved, in the left hemisphere, the precentral gyrus of the insula (gyrus brevis III) and, to a lesser extent, the nearby areas with which it is strongly connected: the adjacent subcentral opercular cortex (part of secondary somatosensory cortex) and the most inferior part of the central sulcus where the orofacial musculature is represented. There was no damage to rostrally adjacent Broca's area in the inferior frontal gyrus. The present study demonstrates the critical circuit for the coordination of complex articulatory movements prior to and during the execution of the motor speech plans. Importantly, this specific cortical circuit is different from those that relate to the cognitive aspects of language production (e.g., Broca's area on the inferior frontal gyrus).

Análise da intervenção fonoaudiológica em apraxia de fala na síndrome de Down: um estudo de caso / Analysis of speech-language pathology intervention in speech apraxia in Down syndrome: a case study / Análisis de la intervención fonoaudiológica en la apraxia del habla en el síndrome de Down: un estudio de caso

Introdução: A síndrome de Down (SD), trissomia do cromossomo 21, é uma condição genética que se caracteriza por um déficit cognitivo e atraso global do desenvolvimento. Dentre as habilidades que podem apresentar fragilidades, merecem destaque as alterações envolvendo a linguagem expressiva, com comprometimentos na fala. Essas alterações podem interferir no planejamento e na programação motora, caracterizando a ocorrência da apraxia de fala na infância, um distúrbio de origem neurológica, no qual a precisão e a consistência dos movimentos subjacentes à fala são prejudicadas na ausência de déficits neuromusculares. Objetivo: Apresentar a intervenção fonoaudiológica voltada à apraxia de fala em uma criança com SD. Método: O participante foi um menino com 07 anos de idade, diagnosticado com apraxia de fala associada à SD. A intervenção foi individualizada, baseada nos princípios do aprendizado motor e realizada durante 10 sessões, de 30 minutos cada. Na apresentação do caso, são abordados os dados da avaliação fonoaudiológica, os objetivos e procedimentos utilizados no planejamento terapêutico proposto. Resultados: Os dados coletados durante as sessões foram descritos e os efeitos da fonoterapia foram analisados. Os dados da reavaliação apontaram que os movimentos de praxias não verbais apresentaram melhores escores após a intervenção, sendo os resultados mais expressivos. Além disso, os resultados foram positivos quanto à estimulação para o desenvolvimento da fala, com os melhores resultados obtidos nos fonemas bilabiais /p, b e m/ e no fonema glotal /h/. Conclusão: A intervenção apresentou resultados satisfatórios, disponibilizando informações relevantes para uma melhor prática clínica na área.

Introduction: Down syndrome (DS), chromosome 21 trisomy, is a genetic condition that stands out for its cognitive deficit and global developmental delay. Among the skills that may present difficulties in the development, these skills deserve to be highlighted as changes involving expressive language, with speech impairment. These changes can interfere with motor planning and programming, characterizing the occurrence of apraxia of speech in childhood, a disorder of neurological origin, in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits. Objective: To present a speech therapy intervention aimed at apraxia of speech in a child with DS. Method: The participant was a 07-year-old boy, diagnosed with speech apraxia associated with DS. The intervention was individualized, based on the principles of motor development and performed for 10 sessions, of 30 minutes each. In the presentation of the case, it is the data of the speech therapy evaluation, the objectives and procedures used in the proposed therapeutic planning. Results: The data collected during the combinations were previous and the effects of speech therapy were approved. The reassessment data showed that the movements of non-verbal praxis had better scores after the intervention, with the results being more expressive. In addition, the positive results regarding stimulation for speech development, with the best results obtained in the bilabial phonemes /p,b and m/ and in the glottal phoneme /h/. Conclusion: The intervention presents satisfactory results, providing high information for a better clinical practice in the area.

Introducción: El síndrome de Down (SD), trisomía del cromosoma 21, es una condición genética que se destaca por su déficit cognitivo y retraso global del desarrollo. Entre las habilidades que pueden presentar dificultades en el desarrollo, estas habilidades merecen ser destacadas como cambios que involucran el lenguaje expresivo, con alteraciones del habla. Estos cambios pueden interferir con la planificación y programación motora, lo que caracteriza la aparición de apraxia del habla en la infancia, un trastorno neurológico en el que la precisión y la coherencia de los movimientos subyacentes al habla se ven afectadas en ausencia de déficits neuromusculares. Objetivo: presentar una intervención logopédica dirigida a la apraxia del habla en un niño con SD. Método: El participante era un niño de 07 años, diagnosticado de apraxia del habla asociada a SD. La intervención fue individualizada, en base a los principios del motor y se realizó por 10 vías, de 30 minutos cada una. En la presentación del caso, son los datos de la evaluación logopédica, los objetivos y procedimientos utilizados en la planificación terapéutica propuesta. Resultados: Los datos recolectados durante las combinaciones fueron previos y se aprobaron los efectos de la logopedia. Los datos de la reevaluación mostraron que los movimientos de praxis no verbal tuvieron mejores puntuaciones después de la intervención, siendo los resultados más expresivos. Además, los resultados positivos en cuanto a estimulación para el desarrollo del habla, con los mejores resultados obtenidos en los fonemas bilabiales / p, bym / y en el fonema glotal / h /. Conclusión: La intervención presenta resultados satisfactorios, brindando alta información para una mejor práctica clínica en el área.

Percent Consonant Correct as an Outcome Measure for Cleft Speech in an Intervention Study.

BACKGROUND/AIMS: Percent consonant correct (PCC) was originally described by Shriberg and Kwiatkowski [J Speech Hear Disord. 1982 Aug;47(3):256-70] as a severity metric for phonological speech disorders, and has been adapted and used in many studies on speech sound disorders. It is well-recognized that cleft speech is complex, consisting of several interacting parameters assessed simultaneously, with error sounds not in the listener's own language. In speech outcome studies, narrow phonetic transcription and the reporting of intra- and inter-rater reliability are acknowledged as the gold standard. However, cleft speech brings special challenges to this task, as complex speech disorders are known to be associated with low transcriber agreement. Recent studies informed the decision to use PCC as the primary outcome measure in a cleft speech intervention study, given its common usage and familiarity. The aim was to specifically evaluate the intra- and inter-rater reliability of PCC in an intervention study, in contrast to other types of speech outcome studies. METHODS: Two trained and experienced listeners analyzed 119 recordings, randomly selected from five data points before, during, and following intervention. The PCC score was separately calculated for words and sentences/phrases. RESULTS: Using intraclass correlations (ICCs), Phase 1 results showed poor reliability for targets elicited for words (ICC = 0.07) and sentences/phrases (ICC = 0.42). Differences in classification of errors as glottal stops and consonant deletion accounted for this. Following further training, a second reliability study was undertaken showing improvement in the number of targets elicited in words (ICC = 0.85) and sentences/phrases (ICC = 0.94). There was very good inter-rater reliability for the PCC score on the word dataset (ICC = 0.9) and the sentence dataset (ICC = 0.88). Very good intra-rater reliability (ICC = 1.0) was found for the PCC score in both words and sentences/phrases for each listener. One listener consistently gave higher modified PCC scores. CONCLUSIONS: In cleft speech intervention studies, reliability of the number of targets elicited should be reported. Listeners need to distinguish between glottal articulation and consonant deletion, in order that the PCC score is meaningful. Attention should be paid to where listeners are reliable, but their pattern of scores consistently differs but in a consistent way. More research is needed on measuring the resolution of articulation difficulties in cleft intervention studies.

Consideraciones para la intervención de los apoyos de la comunicación y el lenguaje en la escuela inclusiva / Considerations for the intervention on communication and language supports in the inclusive school

La evolución de la integración educativa hacia el paradigma de la inclusión representa un cambio radical en la perspectiva de análisis de la realidad de las escuelas, en cuanto a la diversidad del alumnado, y de las propuestas de intervención que se centran ahora no en los déficits y limitaciones del individuo, sino en las oportunidades y alternativas que les ofrece el contexto. La puesta en práctica del modelo inclusivo requiere la creación de equipos docentes, que incluyan al profesorado de apoyo como elemento clave para el desarrollo del proyecto. Miembros de este equipo de apoyo son los especialistas en comunicación y lenguaje, que plantean, en un modelo de educación inclusiva, una intervención no de carácter clínico ni terapéutico ni aislado, sino integral que considera el entorno natural del aula como clave para el proceso de adquisición y desarrollo de la capacidad lingüística y comunicativa de todos los alumnos. Este modelo de intervención tiene en el trabajo en equipo y la colaboración el elemento fundamental para garantizar el éxito en la implementación y desarrollo del modelo de la educación inclusiva, que plantea la necesidad de ofrecer propuestas coordinadas entre el apoyo y el tutor a partir de dimensiones y áreas curriculares comunes para trabajar la diversidad del alumnado en cuento a la comunicación y el lenguaje, que potencien y trabajen elementos válidos para todos e imprescindibles para algunos

The evolution of educational integration towards a paradigm of inclusiveness represents a radical change in the perspective of analysing school reality with regard to student diversity and intervention proposals, focused now not on individual shortcomings and limitations, but on the opportunities and alternatives offered to them in this context. Putting an inclusive model into practice requires setting up teaching teams, including support for teachers as a key element to implement the project. Members of this support team are specialists in communication and language which they suggest, in an inclusive education model, an intervention without a clinical, therapeutic or isolated nature, but rather as an integral part that takes into account the natural setting of the classroom as key for the process of acquiring and developing linguistic and communication skills amongst all students. Teamwork and collaboration are the key elements of this intervention model to ensure the inclusive education model is successfully implemented and rolled out. It includes the need to offer coordinated proposals between the support and tutor staff based on curricular dimensions and areas to work on student diversity regarding communication and language, which strengthen and work on elements that are valid for all students and which are essential for some

Impact of vocal techniques on vocal improvement / Efecto de las técnicas vocales en la mejora voca

Introduction: Vocal techniques have shown to be important strategies to improve, promote and rehabilitate vocal health. Purpose: Verify the immediate impact of vocal techniques on the improvement of acoustic and aerodynamic parameters, vocal deviation and self-assessment. Methods: Descriptive, observational, comparative study including 40 women without vocal complaints, age range 18-45 years, equally divided into four groups according to the technique applied. The participants underwent voice assessment before and after performing the vocal technique. Each technique was performed for 1min and participants were re-evaluated in order to measure the immediate effects of the techniques on the parameters evaluated. For the analysis of the variables, the non-parametric Wilcoxon test was used. Results: Among the techniques studied, the high-pitched sound proved more effective in improving the acoustic and perceptual parameters, although in the other techniques was noticed a tendency to improvement in the result, but without statistical significance. In the self-assessment, the techniques to increase the maximum phonation time by softening the emission were more accepted by participants than those related to phonation resistance, which require more effort to be performed. Conclusion: The high-pitched sound technique favored an improved performance of participants in all parameters evaluated, although the other techniques studied showed a tendency to improvement in the evaluation measures

Introducción: Las técnicas vocales han demostrado ser importantes estrategias para mejorar, promover y rehabilitar la salud vocal. Objetivo: Determinar el efecto inmediato de técnicas vocales en la mejora de los parámetros acústicos y aerodinámicos de la voz, la desviación vocal y la autoevaluación. Metodología: Estudio descriptivo y observacional comparativo. El estudio incluyó a 40 mujeres sin quejas vocales, con edades comprendidas entre 18 y 45 años, igualmente divididas en 4 grupos, de acuerdo con la técnica dada. Las participantes fueron sometidas a evaluación vocal antes y después de la ejecución de la técnica vocal. Cada técnica fue dada por el tiempo de un minuto, y las participantes fueron re-evaluados con el fin de medir el impacto inmediato de las técnicas en los parámetros evaluados. Para el análisis de las variables de este estudio, se utilizó la prueba no paramétrica de Wilcoxon. Resultados: Entre las técnicas estudiadas la que produjo mejores resultados fue la del sonido agudo, aunque en las otras técnicas se observó una tendencia a la mejora del resultado, pero sin significación estadística. En la autoevaluación, las técnicas para aumentar el tiempo máximo de fonación mediante el ablandamiento de la emisión fueron más aceptadas por las participantes que las relacionadas con la resistencia a la fonación, que requieren más esfuerzo para ser realizadas. Conclusión: La técnica de sonido agudo favoreció un mejor rendimiento de las participantes en todos los parámetros, aunque las otras técnicas estudiadas han mostrado una tendencia a la mejora de las medidas de evaluación

Estudio bibliométrico de la producción científica encontrada en Scopus y Web Of Science sobre rehabilitación vocal fisiológica / Bibliometric analysis of the scientific production found in Scopus and Web Of Science about physiological vocal rehabilitation

Introducción: El presente estudio analiza la producción científica internacional encontrada en Scopus y Web of Science relacionada con la Corriente de Rehabilitación Vocal Fisiológica en el periodo 2006 a 2015. Metodología: Estudio exploratorio-descriptivo con 3 fases de desarrollo: a) selección de palabras clave y criterios de búsqueda; b) búsqueda y sistematización de información; c) análisis de la información. Resultados: La mayor producción científica se identifica en la herramienta de búsqueda Scopus bajo el criterio de búsqueda «voice therapy». Se analizaron un total de 167 publicaciones, realizando correlaciones a partir de las variables año, criterios de búsqueda, autores, factor de impacto por cuartil y por citación. Conclusión: Existe alta correlación y grado de solapamiento entre ambas bases de datos. Sin embargo, Scopus comparada con Web of Science, con relación a las líneas de la Corriente de Rehabilitación Vocal Fisiológica y para el periodo estudiado, presentó un mayor porcentaje de producción científica. Las líneas con mayor impacto científico son «terapia Lee Silverman» y «ejercicios de la función vocal». «Ejercicios TVSO» y «terapia de voz resonante», con menos porcentaje de publicaciones, desde 2011 incrementan progresivamente factores de alto impacto

Introduction: The present study looks at the international scientific production found in Scopus and Web of Science, related to the Physiological Vocal Rehabilitation Current in the period 2006-2015. Methodology: Exploratory-descriptive study with three phases of development: A) selection of keywords and search criteria; B) search and systematization of information; C) analysis of information. Results: The highest scientific production is identified in the Scopus search tool under the "voice therapy" search criterion. A total of 167 publications were analyzed, making correlations from the year, search criteria, authors, impact factor by quartile and by citation variables. Conclusion: There is a high correlation and degree of overlap between the two databases. However, Scopus compared to Web of Science, in relation to the Physiological Vocal Rehabilitation Current lines and for the period studied, presented a higher percentage of scientific production. The lines with the greatest scientific impact are "Lee Silverman therapy" and "vocal function exercises". "SOVT exercises" and "resonant voice therapy", with less percentage of publications, since 2011 progressively increase high impact factors

Intervention for children with phonological impairment: Knowledge, practices and intervention intensity in the UK.

BACKGROUND: Across the world, research has shown that intervention for children with phonological impairment can be both effective and efficient. However, it has also raised concerns about the translation of this evidence to practice, highlighting questions around clinician knowledge and the understanding of approaches, and the intensity of intervention provided within real-life clinical contexts. AIMS: To investigate the clinical management of phonological impairment by speech and language therapists (SLTs) in the United Kingdom (UK). METHODS & PROCEDURES: An anonymous, UK-wide, online survey was developed using Qualtrics. The target audience were UK-based SLTs who worked with children with phonological impairment. The following topics were explored: (1) SLTs' understanding of intervention approaches; (2) SLTs' use of intervention approaches to treat phonological impairment; and (3) SLTs' provision of intervention intensity for children with phonological impairment. OUTCOMES & RESULTS: A total of 166 responses were analyzed. To remediate phonological impairment, SLTs most commonly used speech discrimination (79.5%), conventional minimal pairs (77.3%), phonological awareness therapy (75.6%) and traditional articulation therapy (48.4%). Participants least frequently used the complexity approaches targeting the empty set (82.9%) and two- to three-element clusters (75%) as well as the cycles approach (75.6%). Results also showed that some SLTs were uncertain of what the empty set and two- to three-element clusters approaches entailed. In terms of intervention intensity, participants predominantly provided intervention once per week (69%) for a total of 9-12 sessions (ranging from five to 30 sessions, 71.5%) and elicited targets 10-30 times in single words per session (59.4%) in sessions lasting 21-30 min (41.4%). CONCLUSIONS & IMPLICATIONS: The most commonly used intervention approaches identified in the current survey (i.e., speech discrimination, conventional minimal pairs and phonological awareness therapy) may be used eclectically by SLTs, which could impact upon the effectiveness and efficiency of treatment for phonological impairment. The current study also highlighted that almost half the participants always/often used traditional articulation therapy to remediate phonological impairment, even though this approach has been found to be less effective for this difficulty. Additionally, it appears that the currently provided intervention intensity for phonological impairment in the UK is significantly lower than what is indicated in the literature. Therefore, a research-practice gap exists for SLTs in the UK working with children with phonological impairment.

Visual stimuli in intervention approaches for pre-schoolers diagnosed with phonological delay.

The aim of this study was to develop and content validate specific speech and language intervention picture cards: The Letter-Sound (L&S) cards. The present study was also focused on assessing the influence of these cards on letter-sound correspondences and speech sound production. An expert panel of six speech and language therapists analysed and discussed the L&S cards based on several criteria previously established. A Speech and Language Therapist carried out a 6-week therapeutic intervention with a group of seven Portuguese phonologically delayed pre-schoolers aged 5;3 to 6;5. The modified Bland-Altman method revealed good agreement among evaluators, that is the majority of the values was between the agreement limits. Additional outcome measures were collected before and after the therapeutic intervention process. Results indicate that the L&S cards facilitate the acquisition of letter-sound correspondences. Regarding speech sound production, some improvements were also observed at word level. The L&S cards are therefore likely to give phonetic cues, which are crucial for the correct production of therapeutic targets. These visual cues seemed to have helped children with phonological delay develop the above-mentioned skills.

Modeling Alphabet Skills as Instructive Feedback Within a Phonological Awareness Intervention.

PURPOSE: This study evaluated the efficacy of an instructive feedback strategy for modeling letter names and sounds during presentation of positive feedback within a small-group phonological awareness intervention for preschoolers. METHOD: Two experiments were conducted using multiple-baseline designs across children and behaviors. Letter name and sound identification and performance on a phonological awareness fluency measure served as the primary outcome variables. Six children completed Experiment 1. A progressive time delay was added to instructive feedback to elicit a response from the 9 children in the second experiment. RESULTS: In the first experiment, 6 children demonstrated gains on phonological awareness but not alphabet knowledge. With the addition of progressive time delay in the second experiment, all 9 children demonstrated gains on letter name and sound identification as well as phonological awareness skills. CONCLUSIONS: Progressive time delay to prompt children's responses appears to bolster the effects of instructive feedback as an efficient strategy for modeling alphabet skills within a broader early literacy curriculum. Modeling alphabet skills did not detract from, and may have enhanced, phonological awareness instruction for preschoolers.

Increased activation of the hippocampus during a Chinese character subvocalization task in adults with cleft lip and palate palatoplasty and speech therapy.

This study aimed to explore brain activation in patients with cleft lip and palate (CLP) using a Chinese character subvocalization task, in which the stimuli were selected from a clinical articulation evaluation test. CLP is a congenital disability. Individuals with CLP usually have articulation disorder caused by abnormal lip and palate structure. Previous studies showed that primary somatosensory and motor areas had a significant difference in activation in patients with CLP. However, whether brain activation was restored to a normal level after palatoplasty and speech rehabilitation is not clear. Two groups, adults after palatoplasty with speech training and age-matched and sex-matched controls, participated in this study. Brain activation during Chinese character subvocalization task and behavioral data were recorded using functional MRI. Patients with CLP responded to the target significantly more slowly compared with the controls, whereas no significant difference in accuracy was found between the groups. Brain activation had similar patterns between groups. Broca's area, Wernicke's area, motor areas, somatosensory areas, and insula in both hemispheres, and the dorsolateral prefrontal cortex and the ventrolateral prefrontal cortex in the right hemisphere were activated in both groups, with no statistically significant difference. Furthermore, the two-sample t-test showed that the hippocampus in the left hemisphere was activated significantly in patients with CLP compared with the controls. The results suggested that the hippocampus might be involved in the language-related neural circuit in patients with CLP and play a role of pronunciation retrieval to help patients with CLP to complete the pronunciation effectively.

Investigation of the speech results of posterior pharyngeal wall augmentation with fat grafting for treatment of velopharyngeal insufficiency.

PURPOSE: The purpose of this study was to evaluate the speech results of posterior pharyngeal wall augmentation (PPWA) with fat grafting both in the early and late postoperative period, and to clarify the impact of the procedure concomitant with speech therapy. MATERIALS AND METHODS: This is a prospective case-control study. The study involved 87 cleft palate ± cleft lip patients with velopharyngeal insufficiency (VPI) who has been treated with PPWA. Patients were separated into two groups according to age; the first group consisted of 49 pediatric participants between 6 and 12 years of age and the second group consisted of 38 adolescent participants between 13 and 18 years of age. Preoperative velopharyngeal function and articulation were compared postoperatively at the following time points: the 3rd month, 12th month, 18th month and 24th month. The velopharyngeal function was evaluated with regards to the velopharyngeal closure type and velopharyngeal closure amount, by using the pediatric flexible nasoendoscopy and the nasometer methods. In the nasometer evaluation, nasalance sores were measured by using nonsense syllables and meaningful sentences. The Ankara Articulation Test (AAT) (Ege et al., 2004) was used to detect compensatory articulation products secondary to VPI. Consonant production error types and frequencies were determined according the guidelines stated in the study of Hardin-Jones et al. (2009). These were Pharyngeal Fricatives - Posterior Nasal Fricatives/Stop Production, Glottal Stop Production, Middorsum Palatal Stop Production, Nasal Frictional Production, Posterior Nasal Frictional Production/Phoneme Specific Nasal Emission, use of Nasal Consonants for Oral Consonants, and Replacement of Trills. All the participants received concurrent speech therapy four times, twice in the post-operative period between 1 and 3 months and twice between 3 and 6 months. RESULTS: PPWA improved the speech performance from the 18th month to 24th month of the postoperative period. AAT assessment of the first group after 24 months comparing the post-PPWA with the preoperative data showed a highly significant decrease with regard to compensatory production errors and hypernasality; however, in the second group, the same comparison revealed a highly significant decrease in regard to the degree of hypernasality and a significant difference in terms of glottal articulation and pharyngealization of fricatives. A circular closure pattern was observed in 17 individuals with cleft palate at a rate of 70.6%. CONCLUSION: PPWA with concurrent speech therapy is an acceptable surgical method to correct VPI and to improve speech performance.

Phonological Treatment Approaches for Spoken Word Production in Aphasia.

This article provides an overview of phonological treatment approaches for anomia in individuals with aphasia. The role of phonology in language processing, as well as the impact of phonological impairment on communication is initially discussed. Then, traditional phonologically based treatment approaches, including phonological, orthographic, indirect, guided, and mixed cueing methods, are described. Collectively, these cueing treatment approaches aim to facilitate word retrieval by stimulating residual phonological abilities. An alternative treatment approach, phonomotor treatment, is also examined. Phonomotor treatment aims to rebuild sublexical, phonological sequence knowledge and phonological awareness as a means to strengthen lexical processing and whole-word naming. This treatment is supported by a parallel-distributed processing model of phonology and therefore promotes multimodal training of individual phonemes and phoneme sequences in an effort to enhance the neural connectivity supporting underlying phonological processing mechanisms. The article concludes with suggestions for clinical application and implementation.

Phonologic and Acoustic Analysis of Speech Following Glossectomy and the Effect of Rehabilitation on Speech Outcomes.

PURPOSE: Changes in acoustic features in the perioperative phase for elucidating the mechanisms of articulation disorder and the effect of perioperative rehabilitation were studied prospectively. MATERIALS AND METHODS: Sixty-two patients with 62 tongue cancer were divided into a partial glossectomy group (n = 40) and a reconstruction group (n = 22). Acoustic characteristics were analyzed during the preoperative and postoperative periods and after rehabilitation using the first and second formants of the vowels /a/, /i/, and /u/; the triangular vowel space area (tVSA); and the slopes of formant transitions. RESULTS: In the 2 groups, decreases in the tVSA and formant slopes were found from the preoperative to the postoperative period, and the acoustic characteristics of the reconstruction group especially improved to preoperative values after rehabilitation. Analysis of the postoperative period showed that acoustic characteristics were altered at the site of surgical resection. CONCLUSION: Changes of acoustic variables are related to excision size and site, suggesting the distinctive tongue portion for the articulation of each speech sound. Perioperative rehabilitation could activate the articulators and increase the range of movement of the remaining tongue, especially the preserved anterior tongue.

Longitudinal Evaluation of Community Support Project to Improve Oral Function in Japanese Elderly.

Change in oral function was evaluated longitudinally in elderly persons participating in an Exercises for Healthy Oral Function program implemented as part of the Long-Term Care Prevention Project. The participants comprised high-risk and healthy persons aged 65 yr or over. A questionnaire was used to classify them into two groups ('every day or sometimes' or 'rarely') at the end of the study for a comparison of change in repetitive saliva swallowing test (RSST) scores and oral diadochokinesis between 3 time points: at before, at immediately after, and at 1 yr after completion of the program. The average RSST score showed a decrease at 1 yr after intervention, but the difference was not statistically significant. Oral diadochokinesis showed a significant increase for all syllables upon completion of the program compared with at the beginning. This was followed by a significant decrease at 1 yr later compared with at the time of completion in the 'rarely' group for all syllables, but not in the 'every day or sometimes' group. In addition, the number of repetitions was significantly lower in the 'rarely' group than in the 'every day or sometimes' group for all syllables at 1 yr after completion. The results of the present study suggest that Long-Term Care Prevention Projects are necessary to maintain and improve oral function.

Speech characteristics after articulation therapy in children with cleft palate and velopharyngeal dysfunction - A single case experimental design.

OBJECTIVE: The aim of this study was to investigate the impact of an intensive 10-week course of articulation therapy on articulation errors in cleft lip and palate patients who have Velopharyngeal Insufficiency (VPI), non-oral and passive cleft speech characteristics. METHODS: Five children with cleft palate (+/-cleft lip) with VPI and non-oral and passive cleft speech characteristics underwent 40 intensive articulation therapies over 10 weeks in a single case experimental design. The percentage of non-oral CSCs (NCSCs), passive CSCs (PCSCs), stimulable consonants (SC), correct consonants in word imitation (CCI), and correct consonants in picture naming (CCN) were captured at baseline, during intervention and in follow up phases. Visual analysis and two effect size indexes of Percentage of Nonoverlapping Data and Percentage of Improvement Rate Difference were analyzed. RESULTS: Articulation therapy resulted in visible decrease in NCSCs for all 5 participants across the intervention phases. Intervention was effective in changing percentage of passive CSCs in two different ways; it reduced the PCSCs in three cases and resulted in an increase in PCSCs in the other two cases. This was interpreted as intervention having changed the non-oral CSCs to consonants produced within the oral cavity but with passive characteristics affecting manner of production including weakness, nasalized plosives and nasal realizations of plosives and fricatives. Percent SC increased throughout the intervention period in all five patients. All participants demonstrated an increase in percentage of CCI and CCN suggesting an increase in the consonant inventory. Follow-up data showed that all the subjects were able to maintain their ability to articulate learned phonemes correctly even after a 4-week break from intervention. CONCLUSION: This single case experimental study supports the hypothesis that speech intervention in patients with VPI can result in an improvement in oral placements and passive CSCs.

Eficacia del entrenamiento en praxias fonoarticulatorias en los trastornos de los sonidos del habla en niños de 4 años / Efficacy of training on phonoarticulatory exercises in speech sound disorders in 4-year-old children

Durante el desarrollo del lenguaje, algunos niños encuentran dificultades para articular fonemas o grupos consonánticos, sin que haya una causa neurológica ni orgánica aparente. El tratamiento de estas dificultades ha comprendido técnicas diversas, otorgando poca importancia a las praxias fonoarticulatorias. Estas praxias consisten en la realización de movimientos programados y organizados de forma intencional y coordinada dirigidos a controlar los músculos faciales y los órganos activos de la articulación, como son lengua, labios y paladar blando. Ante la falta de conocimiento sobre la relevancia de estas praxias para la prevención y tratamiento de las dificultades articulatorias en los trastornos de los sonidos del habla, nos planteamos como objetivo aplicar un programa de intervención en una muestra de niños de 4 años con problemas articulatorios. Para ello, se evaluó a un grupo de 25 niños de 4.6 años de media de edad. De ellos, 15 no tenían adquiridos todos los fonemas, de modo que fueron distribuidos en un grupo de tratamiento (8 niños) y un grupo de control (7 niños). Los niños del grupo de tratamiento se sometieron a un programa de intervención de 2 sesiones semanales de 30-45 min cada una durante un periodo de 3 meses. Finalizado el tratamiento, los 15 niños fueron evaluados de nuevo y se hizo un seguimiento 10 meses después. Los resultados muestran una tendencia a la mejora en el grupo de tratamiento que además se mantiene en los 10 meses posteriores, y esto es especialmente significativo para los niños con alteraciones más graves, es decir, más de 7 fonemas sin producir (AU)

In language development, some children find difficulties in pronouncing certain phonemes or groups of phonemes, in absence of a clear neurological or organic cause. The intervention on these difficulties has implied different techniques, but it has paid little attention to phonoarticulatory exercises. These exercises consist of programmed movements organised in an intentional and coordinated way, and focused in controlling facial muscles and articulatory active organs, such as the tongue, lips and soft palate. As there is little knowledge about the relevance of motor training to prevent and treat articulatory problems in speech sound disorders, our aim was to apply an intervention program in a sample of four-year-olds with these kinds of difficulties. Thus, 25 children with a mean age of 4.6 years were assessed. 15 of them had missing phonemes or groups of phonemes, so they were distributed in a treatment group (8 children) and a control group (7 children). The 8 children in the experimental group underwent an intervention program with two weekly 30-45 minutes sessions for a period of 3 months. Once the treatment was finished, the 15 children were again assessed and a following test was done 10 months afterwards. Results show a trend of improvement, in the experimental group, that remains for the following 10 months, and this is especially significant for the subjects with more severe disorders, that is, with more than seven missing phonemes (AU)

Sensitive periods and language in cochlear implant users.

This study explores the hypothesis that the existence of a short sensitive period for lower-level speech perception/articulation skills, and a long one for higher-level language skills, may partly explain the language outcomes of children with cochlear implants (CIs). The participants were fourteen children fitted with a CI before their second birthday. Data about their language skills and the environmental conditions (e.g. Family Involvement in rehabilitation) were obtained over a period of three years. Age at implantation correlated exclusively with the ratio of errors of place of articulation, a phonological feature for which CIs provide insufficient information. The degree of Family Involvement was significantly correlated with the remaining language measures. We conclude that small plasticity reductions affecting lower-level skills may partly explain the difficulties of some CI users in developing language.

Ultrasound visual feedback in articulation therapy following partial glossectomy.

UNLABELLED: Disordered speech is common following treatment for tongue cancer, however there is insufficient high quality evidence to guide clinical decision making about treatment. This study investigated use of ultrasound tongue imaging as a visual feedback tool to guide tongue placement during articulation therapy with two participants following partial glossectomy. A Phase I multiple baseline design across behaviors was used to investigate therapeutic effect of ultrasound visual feedback during speech rehabilitation. Percent consonants correct and speech intelligibility at sentence level were used to measure acquisition, generalization and maintenance of speech skills for treated and untreated related phonemes, while unrelated phonemes were tested to demonstrate experimental control. Swallowing and oromotor measures were also taken to monitor change. Sentence intelligibility was not a sensitive measure of speech change, but both participants demonstrated significant change in percent consonants correct for treated phonemes. One participant also demonstrated generalization to non-treated phonemes. Control phonemes along with swallow and oromotor measures remained stable throughout the study. This study establishes therapeutic benefit of ultrasound visual feedback in speech rehabilitation following partial glossectomy. LEARNING OUTCOMES: Readers will be able to explain why and how tongue cancer surgery impacts on articulation precision. Readers will also be able to explain the acquisition, generalization and maintenance effects in the study.

Efecto de una estimulación musical en el desarrollo fonológico del lenguaje en niños del nivel preescolar / The effect of a musical stimulation in the phonological development of language in preschoolchildren

Introducción: en la edad preescolar, los niños frecuentemente intentan simplificar su lenguaje. Estas estrategias de simplificación, llamadas procesos de simplificación fonológica, los cuales se sub dividen en tres: de estructura silábica, de asimilación y de sustitución; estas son eliminadas paulatinamente durante el desarrollo fonológico hasta presentar nulos o escasos procesos a los seis años. Si los procesos persisten se considera un trastorno fonológico la cual es abarcada mediante la terapia fonológica tradicional la cual ofrece varias estrategias que buscan la generalización en las producciones del niño, es decir sin abordar todos los blancos posibles ya que los procesos presentan una importante variación individual. Una estrategia innovadora dentro de este enfoque es la aplicación de la música, la cual presenta varias similitudes con el lenguaje hablado. Objetivo: determinar el efecto de la estimulación musical con canciones infantiles en el desarrollo del aspecto fonológico del lenguaje de los alumnos de preescolar del Centro Educacional "Sagrados Corazones de Jesús y de María". Materiales y método: experimental intra-grupo, porque se realiza una intervención en una misma población que sirve de control. Se utiliza el TEPROSIF-R como instrumento de evaluación a 55 niños que acuden al preescolar y las canciones infantiles como instrumento de intervención. Resultados: se observó post intervención, una reducción significativa de la media de los procesos de estructura silábica y de los procesos de sustitución. Se apreció que la disminución de la media de los procesos de asimilación en relación a la media de los procesos de sustitución fue menos significativa, debido a que estos fueron menos frecuentes en los sujetos de estudio. Conclusión: tendencia a la reducción de los casos de niveles en riesgo y en déficit y por ende, un aumento significativo del número de alumnos con un nivel de desempeño fonológico normal en un 20%, debido al efecto directo de la intervención con canciones infantiles.

Introduction: in preschool, children often try to simplify their language. These strategies of simplification, called phonological simplification processes, which are sub divided into three: syllabic structure, assimilation and substitution are gradually eliminated during phonological development until they are reduced with little or no process at age of six. If processes persist they must be considered a phonological disorder which is approached by the traditional phonological therapy which offers several strategies that seeks generalization in productions of the child, without addressing all possible targets as processes exhibit significant individual variation. An innovative strategy in this approach is the application of music, which has several similarities with spoken language. Objective: to determine the effect of musical stimulation with nursery rhymes in the development of the phonological aspect of language in students who attend preschool education at the Educational Center "Sagrados Corazones de Jesus y María". Materials and methods: experimental intra-group because an intervention on the same control population is performed. The TEPROSIF-R is used as an assessment tool to evaluate the phonological aspect of language to 55 children attending the preschool education and nursery rhymes as an instrument of intervention. Results: a significant reduction of the average in the processes related to syllabic structure and substitution processes is observed. It is noted that the decrease in mean of assimilation processes in relation to the average substitution process was less significant, because these were less frequent in the study subjects. Conclusion: a tendency of reduced cases in levels at risk and deficit is evident and therefore, a significant increase in the number of students with a normal level of phonological performance by 20% due to the direct effect of the intervention with nursery rhymes.

Audio-vocal responses elicited in adult cochlear implant users.

Auditory deprivation experienced prior to receiving a cochlear implant could compromise neural connections that allow for modulation of vocalization using auditory feedback. In this report, pitch-shift stimuli were presented to adult cochlear implant users to test whether compensatory motor changes in vocal F0 could be elicited. In five of six participants, rapid adjustments in vocal F0 were detected following the stimuli, which resemble the cortically mediated pitch-shift responses observed in typical hearing individuals. These findings suggest that cochlear implants can convey vocal F0 shifts to the auditory pathway that might benefit audio-vocal monitoring.