Quality of life of individuals with cleft lip and palate pre- and post-surgical correction of dentofacial deformity.

OBJECTIVE: To assesses the quality of life and the impact of oral health conditions in the pre- and post-surgical correction of dentofacial deformity of individuals with cleft lip and palate. METHOD: Quantitative and prospective study in a referral hospital in the period from June 2011 to May 2013. A total of 50 participants responded the questionnaires World Health Organization Quality of Life - Bref (WHOQOL-Bref) and Oral Health Impact Profile - 14 (OHIP-14), approximately 3 days before and 3 to 12 months after surgery. The "t" test for paired samples and Wilcoxon test were used for statistical analysis with a significance level of 5%. RESULTS: After surgery, differences were found in the domains: Physical, Psychological, Environmental and General Questions of the WHOQOL-Bref and domains: Psychological Discomfort, Psychological Disability, Social Disability, Handicap and Overall Score of OHIP-14. CONCLUSION: Surgical correction of dentofacial deformity improved quality of life and had positive impact of oral health condition. OBJETIVO: Avaliar a qualidade de vida e o impacto das condições de saúde oral nos períodos pré e pós-correção cirúrgica da deformidade dentofacial de indivíduos com fissura labiopalatina operada. MÉTODO: Estudo quantitativo e prospectivo, realizado em um hospital de referência, no período de junho de 2011 a maio de 2013. Participaram 50 indivíduos que responderam aos questionários World Health Organization Quality of Life - Bref (WHOQOL-Bref) e Oral Health Impact Profile - 14 (OHIP-14), aproximadamente 3 dias antes e entre 3 e 12 meses após a cirurgia. Os testes "t" para amostras pareadas e de Wilcoxon foram usados para análise estatística, com nível de significância de 5%. RESULTADOS: Após a cirurgia, foram encontradas diferenças nos domínios: Físico, Psicológico, Meio Ambiente e nas Questões Gerais do WHOQOL-Bref e nos domínios: Desconforto Psicológico, Limitação Psicológica, Limitação Social, Incapacidade e no Escore Geral do OHIP-14. CONCLUSÃO: A correção cirúrgica da deformidade dentofacial propiciou melhora da qualidade de vida e impacto positivo da condição da saúde oral.

Laryngeal malformation in Richieri-Costa Pereira syndrome: new findings.

Laryngeal structural anomalies were described in 13 cases of Richieri-Costa Pereira syndrome, and four previously reported cases were reviewed. The 17 individuals examined had the typical laryngeal anomalies and vocal disorders previously described. The new findings are the laryngeal microweb observed in three cases and arytenoid anteriorization movement observed in 14 cases.

MBGR protocol of orofacial myofunctional evaluation with scores.

The MBGR Protocol with scores was first published in 2009. This protocol was widely administered by speech-language pathologists experienced in orofacial myology in different states from Brazil for four months. From the comments and suggestions of these professionals, the protocol was reviewed and modified. A consistent visual training materials program was prepared, and speech-language pathologists, experienced in orofacial myology from different states of Brazil, Venezuela, Peru, and Colombia were trained with the provided materials. These speech-language pathologists administered the protocol for two years. From the data collected by the speech-language pathologists, modifications were made, and a final version was designed. This final version was administered for two-months by the same speech-language pathologists from Brazil, Venezuela, Peru, and Colombia in order to re-test the final version of MBGR protocol. The aim of this study was to demonstrate the efficiency and effectiveness of the protocol to assess orofacial myofunctional alterations. The final version of the MBGR protocol with scores has proven to be efficient and effective in the identification of individuals experiencing orofacial myofunctional disorders.

MMBRG Protocol - Infants and Preschoolers: Myofunctional Orofacial Clinic Examination. / Protocolo MMBRG ­ Lactentes e Pré-Escolares: Exame Clínico Miofuncional Orofacial.

PURPOSE: To present the Myofunctional Orofacial Clinical Examination Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including its validation. METHODS: Initially, test content-based validity was evaluated from the MBGR Protocol to be used with the age group between 6 and 71 months based on the bibliography and experience between the authors (original and current). For the content and appearance analysis, 10 speech therapists specialized in Orofacial Motricity attended and filled out an electronic form with dichotic and Likert scale questions in two moments. We used the Content Validity Index and the Exact Binomial Test. Then there was a validity based on the response processes analysis followed by a reliability of the Clinical Examination with 155 participants by 7 experienced and calibrated speech therapists, and the examiners between and within agreement was verified by the Intraclass Correlation Coefficient. RESULTS: There were additions, modifications, and exclusions of items according to the age group, resulting in the Myofunctional Orofacial Clinical Examination Protocol for Infants and Preschoolers, which obtained 90.5% agreement; and 100% of the appropriate scores by at least 90% of the specialists. In reliability, most items of the Extraoral and Intraoral Examination and Chewing obtained a reasonable to good, or even excellent, agreement. CONCLUSION: The "Clinical Myofunctional Clinical Examination" was validated based on the test content, response process, and reliability and, along with the "Instructional" and the "Clinical History" is part of the "MMBGR Protocol - Infants and Preschoolers" for speech therapy activities in the age group between 6 and 71 months of age.

OBJETIVO: Apresentar Exame Clínico Miofuncional Orofacial pertencente ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo sua validação. MÉTODO: Inicialmente foi realizada a validade do conteúdo do teste adaptado do Protocolo MBGR, para faixa etária entre 6 e 71 meses, fundamentada na bibliografia e experiência entre autores (originais e atuais). Para análise de conteúdo e aparência participaram 10 fonoaudiólogos especialistas em Motricidade Orofacial, que preencheram formulário eletrônico com questões dicóticas e escala de Likert, em dois momentos. Foi calculado Índice de Validade de Conteúdo e Teste Binomial Exato. Na sequência houve análise da validade baseada nos processos de resposta, seguida da análise da confiabilidade do Exame Clínico, com 155 participantes, por 7 fonoaudiólogos experientes e calibrados, sendo verificada a concordância entre e intra examinadores pelo Coeficiente de Correlação Intraclasse. RESULTADOS: Houve acréscimos, modificações e exclusão de itens conforme faixa etária, concluindo-se o Protocolo Exame Clínico Miofuncional Orofacial para lactentes e pré-escolares, que obteve 90,5% com concordância; e 100% dos escores adequados por pelo menos 90% dos especialistas. Quanto à confiabilidade, a maioria dos itens dos Exames Extraoral e Intraoral e Mastigação obtiveram concordância razoável a boa, ou, até mesmo, excelente. CONCLUSÃO: O "Exame Clínico Miofuncional Orofacial" teve validação baseada no conteúdo do teste, nos processos de resposta e confiabilidade concluída, e junto ao "Instrutivo" e à "História Clínica" integra o "Protocolo MMBGR - Lactentes e Pré-escolares", para atuação fonoaudiológica na faixa etária entre 6 e 71 meses de idade.

MMBGR Protocol - infants and preschoolers: Instructive and Orofacial Myofunctional Clinical History. / Protocolo MMBRG ­ Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial.

PURPOSE: To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. METHODS: Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. RESULTS: We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. CONCLUSION: "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.

OBJETIVO: Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. MÉTODO: Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. RESULTADOS: Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. CONCLUSÃO: "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.

Speech outcomes and velopharyngeal function after surgical treatment of velopharyngeal insufficiency in individuals with signs of velocardiofacial syndrome.

OBJECTIVE: The objective of the study was to analyze if individuals with velocardiofacial syndrome (VCFS) present the same characteristics of speech and velopharyngeal function (VPF) compared with patients with nonsyndromic submucous cleft palate, as well as to compare the effectiveness of palate surgery on the speech function and VPF between groups. METHODS: This was a prospective study performed at the Speech Therapy Sector and Physiology Laboratory, Hospital for Rehabilitation of Craniofacial Anomalies/University of São Paulo.The procedure performed was primary palatoplasty associated or not to superiorly based pharyngeal flap surgery.There were 50 patients with velopharyngeal insufficiency: 25 with signals of VCFS (VCFS group) and 25 without syndrome with submucous cleft palate (SMCP group).The hypernasality was scored by 3 examiners; nasalance was evaluated by nasometry, and VPF was assessed by the size of the velopharyngeal gap on the nasoendoscopy. The evaluations were conducted before and, in average, 18 months after surgery. RESULTS: Before surgery, the VCFS and SMCP groups presented similar speech function and VPF characteristics in all parameters, with no statistically significant differences. After surgery, there was reduction in the hypernasality, nasalance, and VPF in, respectively, 20%, 31%, and 36% of patients in the VCFS group and in 24%, 30%, and 30% in the SMCP group. Elimination/normalization of variables was obtained in 28%, 19%, and 8% of patients in the VCFS group and 20%, 40%, and 25% in the SMCP group, respectively, for hypernasality, nasalance, and VPF. There was no statistically significant difference between groups. CONCLUSIONS: Patients with VCFS presented similar speech function and VPF characteristics as patients with nonsyndromic SMCP. The surgery for velopharyngeal insufficiency correction was equally effective for the improvement and resolution of speech symptoms and VPF in patients with VCFS compared with the SMCP group.

Oral and vocal fold diadochokinesis in children.

AIM: To establish reference values concerning the results of oral and vocal fold diadochokinesis (DDK) assessment, as well as to analyze the differences among gender and age. METHODS: One hundred and fifty Brazilian-Portuguese-speaking children from 8 to 10 years old were assessed. The DDK was assessed through the repetition of 'pa', 'ta', 'ka', 'pataka', 'a' and 'i'. RESULTS: As age increased there was a rise in the average DDK rate, a rise in the coefficient of variation of period for syllable 'ka' and a rise in the coefficient of variation of the peak intensity for the syllable 'ta'. The number of utterances per second of 'ta' was higher for girls than for boys. In trisyllables, 8-year-old girls presented a lower number of utterances than the other subgroups. As age increased, there was a rise in the average DDK rate of the vowel 'i' for girls; there was also a smaller standard deviation and perturbations of the period for this same vowel. CONCLUSION: Oral and vocal fold DDK reference values were established and differences as to gender and age were observed.

Self-perception of tongue tip constriction in alveolar fricatives produced by young women with and without normal tongue positioning. / Autopercepção do ponto de constrição da língua nas fricativas alveolares em mulheres jovens com posicionamento de língua normal e alterado.

PURPOSE: This study investigated the self-perception of 49 women, monolingual speakers of Brazilian Portuguese, about their tongue position for the alveolar articulation of the fricatives [s] and [z]. METHODS: The video recording of speech samples of these 49 women (ages 18 to 28) were analyzed by three Speech-Language Pathologists. They were classified into two groups: Group 1 (G1, n=25), with no alterations in the tongue position during the production of [s] and [z], and Group 2 (G2, n=24), with alterations in the tongue position during the production of [s] and [z]. The tongue position self-perception experiment required the participants to identify the specific tongue constriction point in the production of [s] and [z] (apical, laminal, or "other") during the reading of 24 words and 24 pseudowords. The Friedman test, with posterior paired comparisons, was used for the intragroup analysis. The Mann-Whitney test was used for intergroup comparisons. The statistical significance adopted was 5% (p<0.05). RESULTS: G1 reported apical and laminal tongue constrictions while GE reported these constrictions plus other tongue adjustments. The presence of other tongue adjustments differentiated the groups, G1 and G2 (p=0,002). There were significant differences between [s] and [z] for G1, with the laminal position occurring more often in [s] compared to [z]. CONCLUSION: Women with and without alteration in the tongue position reported apical and laminal constrictions. Howerer, other tongue adjustments were self-perceived in the presence of altered tongue position.

OBJETIVO: Investigar a autopercepção do ponto de constrição da língua na produção de [s] e [z] por jovens monolíngues com posicionamento de língua normal e alterado. MÉTODO: Três fonoaudiólogas analisaram gravações de fala em vídeo de 49 mulheres, com idades entre 18 e 28 anos (média=20 anos e 7 meses), classificando-as em: Grupo 1, (G1, n=25), com ausência de alterações no posicionamento de língua na produção de [s] e [z] e Grupo 2 (G2, n=24), com alterações no posicionamento de língua nestes fones. A autopercepção do ponto de constrição da língua foi investigada questionando cada jovem sobre o local em que sua ponta da língua encostava (apical, laminal ou "outros ajustes") ao produzir [s] e [z] na leitura de palavras e pseudopalavras. O teste de Friedman, com comparações par a par posteriores, foi utilizado para análise intragrupo. O teste de Mann-Whitney foi utilizado para as comparações entre grupos. Adotou-se nível de significância de 5%. RESULTADOS: Em G1 houve relatos de ponto de constrição apical e laminal enquanto em G2 houve estes relatos, e também de outros ajustes de língua. A presença de outros ajustes da língua diferenciou G1 e G2 (p=0,002). Em G1, houve diferença significativa entre [s] e [z], sendo que o ponto laminal ocorreu com mais frequência em [s] do que em [z]. CONCLUSÃO: Jovens com posicionamento de língua normal e alterado relataram pontos de constrição da língua apical e laminal em fricativas alveolares. Porém, outros ajustes de língua foram percebidos diante de posicionamento de língua alterado.

Validation of the MBGR orofacial myofunctional assessment protocol for adults with temporomandibular disorders with disc displacement with reduction. / Validação do protocolo de avaliação miofuncional orofacial MBGR para adultos com disfunção temporomandibular com deslocamento de disco com redução.

PURPOSE: This study aimed at validating the MBGR Orofacial Myofunctional Assessment Protocol (MBGR Protocol) for adults with Temporal Mandibular Disorders (TMD). METHODS: The study sample was composed of 30 adults: 15 with TMD (disc displacement with reduction according to the Research Diagnostic Criteria for Temporomandibular Disorders) and 15 control individuals. The validation process encompassed the content, criterion, and construct of the protocol, as well as its inter- and intra-rater agreement levels and sensitivity and specificity values, considering a 5% statistical significance level. RESULTS: The following validities were confirmed: of content, as the MBGR Protocol covers all functional issues present in patients with TMD; of criterion, with significant correlations between the MBGR and Orofacial Myofunctional Evaluation with Scores (OMES) protocols; of construct, differentiating individuals with and without Orofacial Myofunctional Disorders (OMD) as for pain on palpation and mandible range of motion, with significant correlation between the MBGR clinical evaluation and that using a digital algometer, as well as confirmation of the instrumental assessment for the breathing mode classification. Agreement ranged from poor to very good and from reasonable to very good for the inter- and intra-rater power analyses, respectively. High sensitivity and specificity values were observed. CONCLUSION: The MBGR Protocol proved to be valid for use in adults presented with TMD with disc displacement with reduction and controls, covering all aspects that enable the analysis of OMD in these individuals.

OBJETIVO: Este estudo visou validar o Protocolo de Avaliação Miofuncional Orofacial MBGR para adultos com DTM. MÉTODO: Participaram 30 adultos, sendo 15 com DTM (deslocamento de disco com redução segundo o Research Diagnostic Criteria for Temporomandibular Disorders) e 15 Controles. O processo de validação envolveu a validade de conteúdo, de critério e de construto, além da concordância inter e intra-avaliador, sensibilidade e especificidade. Considerou-se nível de significância de 5%. RESULTADOS: Foram confirmadas as validades de conteúdo, visto que o Protocolo MBGR abarca todas as questões funcionais presentes em indivíduos com DTM; de critério, com correlações significantes entre o MBGR e AMIOFE; e de construto, diferenciando indivíduos com e sem DMO quanto à dor à palpação e mobilidade mandibular, com correlação significante entre a avaliação clínica do MBGR e o uso do algômetro digital, bem como confirmação do exame instrumental para a classificação do modo respiratório. A força de concordância variou de pobre a muito boa para a análise interavaliador e de razoável a muito boa para intra-avaliador. Os valores de sensibilidade e especificidade foram elevados. CONCLUSÃO: O Protocolo MBGR mostrou-se válido para aplicação em adultos com DTM com deslocamento de disco com redução e controles, contemplando todos os aspectos que possibilitam a análise das condições oromiofuncionais nesses indivíduos.

Tongue function and swallowing in individuals with temporomandibular disorders.

BACKGROUND: The tongue participates in the oral phase of swallowing by pushing the food bolus toward the oropharynx. This relationship between tongue function and swallowing is little addressed addressed in individuals with temporomandibular dysfunction (TMD). OBJECTIVE: To analyze the association of functional tongue conditions on swallowing in individuals with TMD. METHODOLOGY: After approval by the Institutional Review Board, the study was conducted on 30 individuals of both sexes, aged 18 to 28 years, with TMD, and not treated for the disorder. Tongue function was assessed as to the mobility, pressure, and oral motor control. Swallowing was analyzed by clinical assessment during ingestion of solid (wafer biscuit) and liquid (water). Data regarding mobility and swallowing were collected using the orofacial myofunctional evaluation protocol. Tongue pressure was measured by the Iowa Oral Performance Instrument, during elevation, protrusion, swallowing, and resistance test. The oral motor control was assessed by the oral diadochokinesis (DDK) test by rapid and repeated emissions of syllables "ta" and "ka". Data were statistically analyzed by the Spearman correlation coefficient, at a significance level of 5%. RESULTS: Relationships were found between tongue function and swallowing for the following aspects: mobility (r=0.741), pressure in protrusion (r=-0.366), swallowing of saliva (r=-0.499), mean DDK rate in emissions "ta" (r=-0.424) and "ka" (r=-0.446), and mean DDK period in emissions "ta" (r=0.424) and "ka" (r=0.446). Thus, the greater the change in tongue mobility, the lower the tongue pressure in protrusion and swallowing of saliva, the lower the emissions per second, the longer the mean time between vocalizations, and the worse the swallowing of individuals with TMD. CONCLUSION: The functional conditions of the tongue regarding mobility, pressure, and oral DDK were associated with swallowing in individuals with TMD.

Influence of vocal and aerodynamics aspects on the voice-related quality of life of older adults.

The pursuit for quality of life urged a better understanding of aspects involved in ageing to minimize its consequences. Although many studies investigated older adults' voice, aspects affecting this population voice-related quality of life have not yet been explored. Objective To investigate how aerodynamics and vocal aspects are associated with voice-related quality of life in older adults. Methodology fifty-six older adults aged 60 years or above - 39 women and 17 men - were evaluated. The following procedures were performed: application of the Voice-Related Quality of Life (V-RQOL) protocol; vocal assessment, including auditory-perceptual and acoustic analysis, from which we obtained fundamental frequency (F 0 ), standard deviation of fundamental frequency (SDF 0 ), shimmer, amplitude perturbation quotient (APQ), jitter, pitch period perturbation quotient (PPQ), and harmonics to noise ratio (HNR); aerodynamic assessment using a spirometer; and maximum phonation time (MPT) for /a/, /s/, /z/ and number counting. Results older adults tend to present high V-RQOL scores. Among women, roughness, APQ, and HNR parameters were negatively correlated with V-RQOL, whereas F 0 was positively. We found no correlation between spirometry measurements and V-RQOL. MPT for /a/, /z/, and number counting was positively correlated with V-RQOL solely among men. Conclusion Vocal roughness and acoustic parameters have a negative impact on the quality of life of older women. Respiratory aspects related to the available air support for speaking affected the most the voice-related quality of life of older men.

Effects of mandibular fixed implant-supported prostheses on masticatory and swallowing functions in completely edentulous elderly individuals.

PURPOSE: To evaluate the effect of oral rehabilitation with immediately loaded fixed implant-supported mandibular prostheses on chewing and swallowing in elderly individuals. MATERIALS AND METHODS: Fifteen completely edentulous patients aged more than 60 years (10 women and five men), wearing removable dentures in both arches, had a mandibular denture replaced by an implant-supported prosthesis. All individuals were evaluated before surgery and again 3, 6, and 18 months later with regard to mastication and swallowing conditions. Examinations entailed an interview, evaluation of tactile sensitivity of the face, and observation of food intake, masticatory type, formations of bolus, and pain during mastication. The swallowing evaluation comprised observation of clinical signs related to the oral and pharyngeal stages of swallowing, as well as the presence of oral residue. The findings of different evaluations before and 3, 6, and 18 months after the surgical-prosthetic procedure were statistically compared by analysis of variance for repeated measurements at a significance level of 5%. RESULTS: The questionnaire revealed a reduction in complaints of masticatory and swallowing disturbances, a decreased need for liquid ingestion, and reduced choking and coughing. Clinical evaluations showed improved oral function and bolus propulsion for both solid and paste-consistency foods; pain during mastication was also resolved. CONCLUSION: Treatment with mandibular implant-supported dentures had positive effects on the clinical aspects of mastication and swallowing in elderly individuals.

Extension and validation of the protocol of orofacial myofunctional assessment for individuals with cleft lip and palate. / Ampliação e validação do protocolo de avaliação miofuncional orofacial para indivíduos com fissura labiopalatina.

PURPOSE: To perform the expansion, validation of the content, criterion and construct of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate; and to define evaluation parameters for the instrument use. METHODS: The expansion of the instrument was performed based on the MBGR protocol; the items, sub items and possibilities of answers of the amplified instrument were analyzed for their clarity by seven examiners for the content validation.. Assessment parameters were developed for the use of the instrument in order to minimize the subjectivity. Four examiners compared the aspects of the protocol to those of another instrument for the criterion validation, and the construct validation was performed comparing the results of pre and post orthognathic surgery treatment. The Content Validation Index and the Kappa, Spearman and Wilcoxon Correlation tests were applied for the validations. RESULTS: The mobility, tonicity and sensitivity aspects of the evaluation were added to the protocol and at content validation, 72% of the items were classified as very clear and 28% as clear. A manual with assessment parameters for all items and sub items of the protocol was constructed. The inter-examiner agreement was moderate. In the comparison of the protocols, for the validation of the criterion, a good relation among them was observed. For the validation of the construct the protocol was able to identify outcome after the treatment. CONCLUSION: The protocol was expanded and considered validated in its entirety: content, criterion and construct, and evaluation parameters for its use were established.

OBJETIVO: Realizar a ampliação, validação de conteúdo, critério e construto de um protocolo de avaliação miofuncional orofacial para indivíduos com fissura labiopalatina e definir parâmetros de avaliação para a utilização do instrumento. MÉTODO: A ampliação do instrumento foi realizada com base no protocolo MBGR; os itens, subitens e possibilidades de respostas do instrumento ampliado foram analisados quanto à clareza por sete examinadores para a validação do conteúdo. Parâmetros de avaliação para a utilização do instrumento foram estabelecidos a fim de minimizar a subjetividade. Quatro examinadores compararam os aspectos do protocolo aos de outro instrumento para a validação de critério, e a validação de construto foi realizada comparando os resultados pré e pós-tratamento cirúrgico do avanço da maxila. Aplicou-se o Índice de Validação do Conteúdo e os testes Kappa, Correlação de Spearman e Wilcoxon para as validações. RESULTADOS: Foram acrescentados os aspectos da avaliação da mobilidade, tonicidade e sensibilidade ao protocolo; na validação do conteúdo, 72% dos itens foram classificados como muito claro e 28%, como claro; construiu-se um manual com parâmetros de avaliação para todos os itens e subitens do protocolo. A concordância interexaminadores apresentou-se moderada. Na comparação dos protocolos, para a validação de critério, foi observada boa relação entre eles. Para a validação do construto, o protocolo demonstrou ser capaz de identificar resultado de tratamento após a realização do tratamento. CONCLUSÃO: O protocolo foi ampliado e considerado validado em sua totalidade: conteúdo, critério e construto, e estabelecidos parâmetros de avaliação para a sua utilização.

[Perceptual and instrumental assessment of velopharyngeal function in asymptomatic submucous cleft palate]. / Avaliação perceptiva e instrumental da funcão velofaríngea na fissura de palato submucosa assintomática.

BACKGROUND: submucous cleft palate (SMCP) may or may not be associated to symptoms of velopharyngeal dysfunction (VPD). AIM: to verify whether patients with SMCP, who were considered as asymptomatic on a perceptual speech evaluation, present absence of hypernasality and adequate velopharyngeal closure on an instrumental assessment. METHOD: 22 patients with SMCP and with no VPD symptoms, of both genders, aged 6 to 46 years, underwent speech acoustic assessment (nasometry)--to determine nasalance scores--and speech aerodynamic assessment (pressure-flow technique)--to verify velopharyngeal closure. The complete agreement between the findings on the perceptual and instrumental assessments was the tested null hypothesis. RESULTS: the pressure-flow technique confirmed the perceptual findings, that is, all patients were diagnosed as having adequate velopharyngeal function on both types of assessment. Nasometry results confirmed the perceptual findings in 15 out of the 20 analyzed patients (75% of the cases). The remaining 5 patients (25%) presented nasalance scores that suggest hypernasality (nasometry). This symptom was not identified by the perceptual evaluation, yielding to the rejection of the null hypothesis. CONCLUSION: results indicate the importance of the combined use of perceptual and instrumental assessments for the diagnosis of VPD in SMCP cases. The follow-up of patients diagnosed as asymptomatic by a perceptual speech evaluation and presenting evidences of VPD on instrumental assessment (e.g. nasometry) is recommended, particularly when dealing with children who are more prone to develop symptoms with aging.

Duration of mastication and oral phase of swallowing in the elderly with different dental conditions: a clinical analysis / Duração da mastigação e da fase oral da deglutição em idosos com diferentes condições dentárias: análise clínica

ABSTRACT Purpose: to measure the total time of mastication and oral phase of swallowing in healthy elderly people, considering different food consistency, the presence of natural teeth, and the type of prosthetic oral rehabilitation, as well to compare dental conditions and consistencies. Methods: a cross-sectional study with 57 healthy elderly people, aged between 60 and 82 years, divided into: dentate group (D) (n=15); and rehabilitated groups; PD: fixed or removable partial dentures in one or both arches (n=15); CRD: maxillary and mandibular complete removable dentures (n=15); ISCD: complete dentures - maxillary removable denture and mandibular implant-supported dentures (n=12). The duration time (seconds) of chewing and of the oral phase of swallowing was measured in the consistencies: solid (a roll slice), pudding (10 ml) and liquid (10 ml). Results: healthy dentate elderly subjects had the following intervals: liquid=1.07±0.35 s; pudding=3.48±1.76 s; and solid=27.88±7.11 s. Statistically significant differences were observed between the D and ISCD groups (p=0.0056) and between D and CRD (p=0.0056) for liquid. For all groups, there was a statistically significant increase between liquid and solid consistencies and between pasty and solid ones (p<0.001). Conclusions: the dentate elderly had shorter oral phase time of swallowing for liquids than the rehabilitated edentulous elderly, but not different from the elderly with partial dentures. Chewing and swallowing time for solid food was longer than that for the other consistencies, regardless of dental condition.

RESUMO Objetivo: mensurar o tempo total da mastigação e da fase oral da deglutição em idosos saudáveis, considerando diferentes consistências alimentares, a presença de dentes naturais e o tipo de reabilitação oral protética, bem como realizar comparação entre as condições dentárias e as consistências. Métodos: estudo transversal com 57 idosos saudáveis, entre 60 e 82 anos, distribuídos em grupo dentado (D) (n=15) e grupos reabilitados: próteses parciais fixas ou removíveis em uma ou ambas as arcadas (PP) (n=15); prótese total removível maxilar e mandibular (PTR) (n=15); prótese total - prótese removível superior e prótese implanto-suportada inferior (PTIS) (n=12). O tempo de duração (segundos) da mastigação e da fase oral da deglutição foi medido nas consistências: sólida (pão francês), pudim (10 ml) e líquida (10 ml). Resultados: idosos dentados saudáveis apresentaram os intervalos: líquido=1,07±0,35 s; pudim=3,48±1,76 s; e sólido=27,88±7,11 s. Foram observadas diferenças estatisticamente significativas entre os grupos D e PTIS (p=0,0056) e entre D e PTR (p=0,0056) para líquido. Para todos os grupos, houve aumento estatisticamente significante entre as consistências líquida e sólida e entre pastosa e sólida (p<0,001). Conclusões: idosos dentados apresentaram menor tempo de fase oral da deglutição para líquidos do que idosos edêntulos totais reabilitados, mas não diferente dos idosos com prótese parcial. O tempo de mastigação e deglutição do alimento sólido foi maior que o das demais consistências, independente da condição dentária.

Protocolo MMBRG - Lactentes e Pré-Escolares: Exame Clínico Miofuncional Orofacial / MMBRG Protocol - Infants and Preschoolers: Myofunctional Orofacial Clinic Examination

RESUMO Objetivo Apresentar Exame Clínico Miofuncional Orofacial pertencente ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo sua validação. Método Inicialmente foi realizada a validade do conteúdo do teste adaptado do Protocolo MBGR, para faixa etária entre 6 e 71 meses, fundamentada na bibliografia e experiência entre autores (originais e atuais). Para análise de conteúdo e aparência participaram 10 fonoaudiólogos especialistas em Motricidade Orofacial, que preencheram formulário eletrônico com questões dicóticas e escala de Likert, em dois momentos. Foi calculado Índice de Validade de Conteúdo e Teste Binomial Exato. Na sequência houve análise da validade baseada nos processos de resposta, seguida da análise da confiabilidade do Exame Clínico, com 155 participantes, por 7 fonoaudiólogos experientes e calibrados, sendo verificada a concordância entre e intra examinadores pelo Coeficiente de Correlação Intraclasse. Resultados Houve acréscimos, modificações e exclusão de itens conforme faixa etária, concluindo-se o Protocolo Exame Clínico Miofuncional Orofacial para lactentes e pré-escolares, que obteve 90,5% com concordância; e 100% dos escores adequados por pelo menos 90% dos especialistas. Quanto à confiabilidade, a maioria dos itens dos Exames Extraoral e Intraoral e Mastigação obtiveram concordância razoável a boa, ou, até mesmo, excelente. Conclusão O "Exame Clínico Miofuncional Orofacial" teve validação baseada no conteúdo do teste, nos processos de resposta e confiabilidade concluída, e junto ao "Instrutivo" e à "História Clínica" integra o "Protocolo MMBGR - Lactentes e Pré-escolares", para atuação fonoaudiológica na faixa etária entre 6 e 71 meses de idade.

ABSTRACT Purpose To present the Myofunctional Orofacial Clinical Examination Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including its validation. Methods Initially, test content-based validity was evaluated from the MBGR Protocol to be used with the age group between 6 and 71 months based on the bibliography and experience between the authors (original and current). For the content and appearance analysis, 10 speech therapists specialized in Orofacial Motricity attended and filled out an electronic form with dichotic and Likert scale questions in two moments. We used the Content Validity Index and the Exact Binomial Test. Then there was a validity based on the response processes analysis followed by a reliability of the Clinical Examination with 155 participants by 7 experienced and calibrated speech therapists, and the examiners between and within agreement was verified by the Intraclass Correlation Coefficient. Results There were additions, modifications, and exclusions of items according to the age group, resulting in the Myofunctional Orofacial Clinical Examination Protocol for Infants and Preschoolers, which obtained 90.5% agreement; and 100% of the appropriate scores by at least 90% of the specialists. In reliability, most items of the Extraoral and Intraoral Examination and Chewing obtained a reasonable to good, or even excellent, agreement. Conclusion The "Clinical Myofunctional Clinical Examination" was validated based on the test content, response process, and reliability and, along with the "Instructional" and the "Clinical History" is part of the "MMBGR Protocol - Infants and Preschoolers" for speech therapy activities in the age group between 6 and 71 months of age.

Protocolo MMBRG - Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial / MMBGR Protocol - infants and preschoolers: Instructive and Orofacial Myofunctional Clinical History

RESUMO Objetivo Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. Método Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. Resultados Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. Conclusão "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.

ABSTRACT Purpose To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. Methods Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. Results We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. Conclusion "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.

Identificação perceptiva do posicionamento da língua na produção de [s] por acadêmicos em Fonoaudiologia / Identificación perceptiva del posicionamiento de la lengua de la producción de [s] por académicos en Fonoaudiología / Perceptual analysis of the tongue position in the production of [s] by SLP students

Introdução: a identificação visual do posicionamento dos articuladores e o resultado auditivo na produção de [s] são necessários para decisões clínicas e monitoramento de tratamento. Para avaliadores não treinados esta tarefa pode ser desafiadora. Objetivo: verificar se avaliadores não treinados são capazes de identificar visualmente posições normal e alterada da língua na produção do [s] e perceber, auditivamente, produções normais e alteradas; bem como buscar quais ajustes da língua são mais difíceis de serem percebidos visualmente e quais resultados auditivos são mais facilmente identificados. Método: dez acadêmicos de Fonoaudiologia analisaram 20 amostras de fala gravadas, 10 com produção normal e 10 alterada do fone [s], sendo as respostas comparadas a uma avaliação padrão-ouro. Na análise foi utilizada a concordância Kappa, o teste Qui-quadrado, o Anova de Medidas repetidas e o teste t Student, com 5% de significância. Resultados: houve associação e concordância com a avaliação padrão-ouro para a posição da língua, com porcentagem média de 40% de respostas corretas para a posição normal, 17,5% quando a língua estava contra os dentes e 10% quando interposta. No resultado auditivo, a maioria dos avaliadores não apresentou associação e concordância com o padrão-ouro, sendo a porcentagem média de 50% de respostas corretas na ausência de distorção e com redução significativa quando presente (18,5%). Conclusão: os acadêmicos tiveram dificuldade na identificação visual da posição da língua, particularmente, quando alterada, bem como na identificação auditiva das produções normal ou alterada, sendo maior quando a distorção estava presente.

Introduction: thevisual identification of articulator positioning and auditory perception in the phoneme [s] are needed for clinical decisions and treatment monitoring. This can be challenging for untrained evaluators. Objective: to verify whether untrained evaluators are able to visually identify typical and atypical tongue positions in the production of phoneme [s] and to auditorily perceive typical and atypical productions; as well as to understand which tongue adjustments are more difficult to be visually perceived and which auditory productions are more easily identified. Methods: ten speech-language pathology students analyzed 20 recorded speech samples, being 10 with typical speech production and 10 atypical speech production regarding the [s] movement, and the answers were compared with a gold-standard evaluation. The Kappa agreement, Chi-squared test, Anova repeated measures and Student ́s t-test were used with 5% of significance. Results: there was an association and agreement with the gold standard evaluation for tongue positioning, with a mean percentage of 40% for correct answers regarding typical position, 17.5% when the tongue was against the teeth and 10% when interposed. In the auditory perception; most evaluators did not show association and agreement with the gold standard evaluation, with an average percentage of 50% for correct answers in the absence of distortion and a significant reduction in the presence (18.5%). Conclusion: the students had difficulty in the visual identification of the tongue positioning for atypical speech productions, as well as in the auditory identification of typical or atypical productions, and the greater difficulty occurred when there was distortion.

Introducción: identificar visualmente el posicionamiento del articulador y el resultado auditivo en la producción del [s] son necesarios para tomar decisiones clínicas y monitorear el tratamiento. Objetivo:verificar si los evaluadores no capacitados pueden identificar visualmente las posiciones normales y alteradas de la lengua en la producción del [s] y percibir auditivamente las producciones normales y alteradas; además buscar qué ajustes de la lengua son más difíciles de percibir visualmente y qué resultados auditivos se identifican más fácilmente. Método: estudiantes de Fonoaudiología analizaron 20 muestras de habla grabadas, 10 con producción normal y 10 con producción del fono [s] alterado. Compararon las respuestas con una evaluación patrón oro. En el análisis utilizaron la concordancia Kappa, la prueba Chi-cuadrado, el Anova de Medidas repetidas y la prueba t de Student, con 5% de significancia. Resultados:hubo asociación y concordancia con la evaluación patrón oro para la posición de la lengua, con media de 40% de respuestas correctas para la posición normal, 17,5% con la lengua contra los dientes y 10% cuando interpuesta. En el resultado auditivo, la mayoría de los evaluadores no presentaron asociación y concordancia con el patrón oro, con media de 50% de aciertos en ausencia de distorsión y con reducción significativa cuando presente (18,5%). Conclusión: los estudiantes tuvieron dificultad en identificar visualmente la posición de la lengua, particularmente cuando alterada, y en la identificación auditiva de producciones normales o alteradas, siendo mayor con la distorsión presente.

Autopercepção do ponto de constrição da língua nas fricativas alveolares em mulheres jovens com posicionamento de língua normal e alterado / Self-perception of tongue tip constriction in alveolar fricatives produced by young women with and without normal tongue positioning

RESUMO Objetivo Investigar a autopercepção do ponto de constrição da língua na produção de [s] e [z] por jovens monolíngues com posicionamento de língua normal e alterado. Método Três fonoaudiólogas analisaram gravações de fala em vídeo de 49 mulheres, com idades entre 18 e 28 anos (média=20 anos e 7 meses), classificando-as em: Grupo 1, (G1, n=25), com ausência de alterações no posicionamento de língua na produção de [s] e [z] e Grupo 2 (G2, n=24), com alterações no posicionamento de língua nestes fones. A autopercepção do ponto de constrição da língua foi investigada questionando cada jovem sobre o local em que sua ponta da língua encostava (apical, laminal ou "outros ajustes") ao produzir [s] e [z] na leitura de palavras e pseudopalavras. O teste de Friedman, com comparações par a par posteriores, foi utilizado para análise intragrupo. O teste de Mann-Whitney foi utilizado para as comparações entre grupos. Adotou-se nível de significância de 5%. Resultados Em G1 houve relatos de ponto de constrição apical e laminal enquanto em G2 houve estes relatos, e também de outros ajustes de língua. A presença de outros ajustes da língua diferenciou G1 e G2 (p=0,002). Em G1, houve diferença significativa entre [s] e [z], sendo que o ponto laminal ocorreu com mais frequência em [s] do que em [z]. Conclusão Jovens com posicionamento de língua normal e alterado relataram pontos de constrição da língua apical e laminal em fricativas alveolares. Porém, outros ajustes de língua foram percebidos diante de posicionamento de língua alterado.

ABSTRACT Purpose This study investigated the self-perception of 49 women, monolingual speakers of Brazilian Portuguese, about their tongue position for the alveolar articulation of the fricatives [s] and [z]. Methods The video recording of speech samples of these 49 women (ages 18 to 28) were analyzed by three Speech-Language Pathologists. They were classified into two groups: Group 1 (G1, n=25), with no alterations in the tongue position during the production of [s] and [z], and Group 2 (G2, n=24), with alterations in the tongue position during the production of [s] and [z]. The tongue position self-perception experiment required the participants to identify the specific tongue constriction point in the production of [s] and [z] (apical, laminal, or "other") during the reading of 24 words and 24 pseudowords. The Friedman test, with posterior paired comparisons, was used for the intragroup analysis. The Mann-Whitney test was used for intergroup comparisons. The statistical significance adopted was 5% (p<0.05). Results G1 reported apical and laminal tongue constrictions while GE reported these constrictions plus other tongue adjustments. The presence of other tongue adjustments differentiated the groups, G1 and G2 (p=0,002). There were significant differences between [s] and [z] for G1, with the laminal position occurring more often in [s] compared to [z]. Conclusion Women with and without alteration in the tongue position reported apical and laminal constrictions. Howerer, other tongue adjustments were self-perceived in the presence of altered tongue position.

[Proposal for velopharyngeal function rating in a speech perceptual assessment]. / Proposta de classificação da função velofaríngea na avaliação perceptivo-auditiva da fala.

BACKGROUND: The perceptual assessment of velopharyngeal function during speech presents some limitations due to its subjectivity. AIM: To propose a method for velopharyngeal function rating based on hypernasality, nasal air emission and compensatory articulation deficits scores. CONCLUSION: The proposed method shows several advantages in terms of clinical and research documentation and for an adequate follow-up of therapeutic and surgical outcomes.