Academic and clinical preparation in speech-language pathology and audiology: a global training consortium

ABSTRACT: Purpose: To describe a research-based global curriculum in speech-language pathology and audiology that is part of a funded cross-linguistic consortium among 2 U.S. and 2 Brazilian universities. Method: The need for a global curriculum in speechlanguage pathology and audiology is outlined, and different funding sources are identified to support development of a global curriculum. The U.S. Department of Education’s Fund for the Improvement of Post-Secondary Education (FIPSE), in conjunction with the Brazilian Ministry of Education (Fundacao Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior; CAPES), funded the establishment of a shared research curriculum project, “Consortium for Promoting Cross-Linguistic Understanding of Communication Disabilities in Children” for East Tennessee State University and the University of Northern Iowa and 2 Brazilian universities (Universidade Federal de Santa Maria and Universidade de São Paulo-Baurú). Results: The goals and objectives of the research-based global curriculum are summarized, and a description of an Internet-based course, “Different Languages, One World,” is provided Conclusion: Partnerships such as the FIPSE–CAPES consortium provide a foundation for training future generations of globally and research-prepared practitioners in speechlanguage pathology and audiology.

Investigation of auditory processing disorder and language impairment using the speech-evoked auditory brainstem response

This study investigated whether there are differences in the Speech-Evoked Auditory Brainstem Response among children with Typical Development (TD), (Central) Auditory Processing Disorder (C) APD, and Language Impairment (LI). The speech-evoked Auditory Brainstem Response was tested in 57 children (ages 6-12). The children were placed into three groups: TD (n = 18), (C)APD (n = 18) and LI (n = 21). Speech-evoked ABR were elicited using the five-formant syllable/da/. Three dimensions were defined for analysis, including timing, harmonics, and pitch. A comparative analysis of the responses between the typical development children and children with (C)APD and LI revealed abnormal encoding of the speech acoustic features that are characteristics of speech perception in children with (C)APD and LI, although the two groups differed in their abnormalities. While the children with (C)APD might had a greater difficulty distinguishing stimuli based on timing cues, the children with LI had the additional difficulty of distinguishing speech harmonics, which are important to the identification of speech sounds. These data suggested that an inefficient representation of crucial components of speech sounds may contribute to the difficulties with language processing found in children with LI. Furthermore, these findings may indicate that the neural processes mediated by the auditory brainstem differ among children with auditory processing and speech-language disorders. (C) 2012 Elsevier B.V. All rights reserved.

Ear and electrode effects reduce within-group variability in middle latency response amplitude measures

Objectives: To establish normative amplitude values for relative difference measurements of the middle latency response (MLR) in normal-hearing pediatrics and to determine if these measurements provided a significant reduction of within-group variability when compared to raw, absolute amplitude measures. A relative amplitude difference is defined in the present paper as the difference in Na-Pa amplitude between two electrodes (e.g. vertical bar Na-Pa at C3 minus Na-Pa at C4 vertical bar, or electrode effects) or between two ears (e.g. vertical bar Na-Pa on left ear stimulation minus Na-Pa on right ear stimulation vertical bar, or ear effects). In contrast, an absolute amplitude is defined as a single Na-Pa measurement made at one electrode for stimulation of one ear (e.g. Na-Pa measured at C3 on left ear stimulation). Design: Cross-sectional study. Study sample: 155 pediatrics with normal peripheral and central hearing, and no history of psychological, neurological, or learning disability issues. Results: Within-group variability was significantly smaller for relative differences when compared to absolute amplitude measures. Electrode effects showed significantly less variability than ear effects. Normative values for ear and electrode effects were reported. Conclusions: Relative differences may provide better utility in the clinical diagnosis of central auditory pathology in pediatrics when compared to absolute amplitude measures because these difference measures show significantly lower variability when examined across subjects.

Audiological and electrophysiological assessment of professional pop/rock musicians

In the present study, we evaluated peripheral and central auditory pathways in professional musicians (with and without hearing loss) compared to non-musicians. The goal was to verify if music exposure could affect auditory pathways as a whole. This is a prospective study that compared the results obtained between three groups (musicians with and without hearing loss and non-musicians). Thirty-two male individuals participated and they were assessed by: Immittance measurements, pure-tone air conduction thresholds at all frequencies from 0.25 to 20 kHz, Transient Evoked Otoacoustic Emissions, Auditory Brainstem Response (ABR), and Cognitive Potential. The musicians showed worse hearing thresholds in both conventional and high frequency audiometry when compared to the non-musicians; the mean amplitude of Transient Evoked Otoacoustic Emissions was smaller in the musicians group, but the mean latencies of Auditory Brainstem Response and Cognitive Potential were diminished in the musicians when compared to the non-musicians. Our findings suggest that the population of musicians is at risk for developing music-induced hearing loss. However, the electrophysiological evaluation showed that latency waves of ABR and P300 were diminished in musicians, which may suggest that the auditory training to which these musicians are exposed acts as a facilitator of the acoustic signal transmission to the cortex.

Exchange of disfluency with age from function to content words in Brazilian Portuguese speakers who do and do not stutter

The purpose of this study was to investigate the exchange of disfluencies from function words to content words with age in Brazilian Portuguese speakers who do and do not stutter. Ninety stuttering individuals and 90 controls, native speakers of Brazilian Portuguese, were divided into three age groups (children, adolescents and adults). The study method involved analyzing the occurrence of stuttering on content and function words based on spontaneous speech samples. Results indicated that children tend to be more disfluent on function words. With the increase in age, teenagers and adults who stutter presented a higher number of disfluencies on content words. These findings support the current literature, indicating that with the aging process, there is an exchange of disfluencies from function to content words. This shift in the disfluency pattern may account for a more advanced type of stuttering. The study also demonstrated that disfluencies in Portuguese speakers follow the same pattern of shifting from function to content words with age as for English speakers.

A hearing report from Brazil

The past several decades, the need for hearing health services is still great, especially in the northeast, the Amazonian, and the southern regions Brazil, officially Federative Republic of Brazil, is the largest Portuguese-speaking country, and the fifth largest country in the world by population and by land. The vast land not only brings rich natural resources but also large varieties of exotic vegetation and wildlife. One hundred and ninety-three million inhabitants live in five geographical regions with diverse cultural practices influenced by immigrants from Italy, Spain, Japan, Germany, and other countries. Brazilian people generally are warm-hearted, very welcoming, and resilient. They are optimistic and creative despite having encountered many economic downturns and political challenges throughout history. A bachelor's degree is the entry level for the profession. As only 19 percent of the population aged 18–24 years have access to higher education, the competition for admissions is fierce, especially in government institutions. High school students need to pass tests of general knowledge in a national examination and a university-specific examination. Government educational institutions offer good education without charging tuition. The majority of scientific papers are also produced by scholars working in government institutions. Private institutions are generally ranked lower in academic rigor (Behlau and Gasparini, 2006), except for a few top-ranking institutions. The fields of speech-language pathology and audiology are marked by rapid changes in recent years. Currently, there are 104 undergraduate programs recognized by the Ministry of Education and distributed in all but three federal states of Brazil.

Sobre o objeto da Fonoaudiologia

Este trabalho tematiza a questão do objeto em Fonoaudiologia, discute a pretensa unidade do campo e aponta a inexorabilidade de sua divisão para a concretização de seu estatuto científico. Para fazê-lo assume a linguagem em seus processos patológicos sob a instância da clínica como seu objeto, mas indica a necessidade de se desnaturalizar a linguagem, redefinindo-a como instância simbólica de subjetivação. Isto a afasta definitivamente da Audiologia, aqui entendida como ramificação das ciências ditas biológicas, e do reducionismo a que tem sido submetida ao ser concebida apenas como prática. Por outro lado, instaura o fonoaudiólogo como clínico terapeuta, comprometido com a linguagem de seu paciente e sua cura. Reconhece, ainda, outra paternidade para a Fonoaudiologia, indicando a Lingüística e a Psicanálise - quando adotam as mesmas concepções de sujeito e de linguagem - como lugares de peculiar interesse na constituição do saber fonoaudiológico. Uma vez realocada a Fonoaudiologia terá, diante de sí, a tarefa de reconhecer a clínica como seu espaço privilegiado de problematização de questões, das quais a primeira será o enfrentamento da constituição de seu método clínico. Finalmente, alerta-se o fonoaudiólogo para a ameaça de nova dominação caso não se marque a distinção entre as formas de interpretação que identificam a clínica fonoaudiológica e a particularizam em relação à clínica psicanalítica.

Perfil linguístico de crianças com alteração específica de linguagem

OBJETIVO: Caracterizar o perfil linguístico de crianças com alteração específica de linguagem (AEL) utilizando a versão brasileira do Test of Early Language Development - 3rd edition (TELD-3); comparar as idades cronológica e linguística, e classificar a severidade do quadro. MÉTODOS: O teste foi aplicado individualmente a 46 crianças com idades entre 2 anos e 10 meses e 7 anos e 11 meses, diagnosticadas com AEL, que estavam em atendimento fonoaudiológico semanal. A partir dos dados obtidos, foi realizada a comparação entre a média da idade cronológica e a média da idade linguística equivalente. O tipo de comprometimento foi classificado em misto ou puramente expressivo e o grau de severidade foi estabelecido. RESULTADOS: O comprometimento misto foi o mais frequente nas crianças com AEL, porém a classificação da severidade indicou que a categoria leve foi a mais frequente, tanto na recepção quanto na expressão. A idade linguística esteve abaixo da idade cronológica na maioria dos sujeitos, em ambos os subtestes. A linguagem expressiva foi a mais prejudicada, visto que os sujeitos apresentaram menor média de idade linguística equivalente, além de ter havido maior concentração de sujeitos classificados com alteração abaixo da média e com gravidade mais acentuada. CONCLUSÃO: Nesta população predominam os quadros mistos, com maior prejuízo da expressão e cuja severidade é considerada leve. Além disso, o TELD-3 mostrou ser um instrumento útil no processo diagnóstico destas alterações de linguagem.

Impacto de treinamento auditivo na avaliação perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia

OBJETIVO: Analisar o impacto de treino auditivo na avaliação perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia. MÉTODOS: Durante dois semestres, 17 estudantes que cursavam disciplinas teóricas de fonação (Fonação/Distúrbios da Fonação) analisaram amostras de vozes alteradas e não alteradas (selecionadas para este estudo), por meio da escala GRBAS. Todos receberam treinamento auditivo durante um total de nove encontros semanais, com cerca de 15 minutos de duração cada. Em cada encontro foi apresentado um parâmetro, por meio de vozes diferentes da amostra avaliada, com predominância no aspecto treinado. A avaliação das amostras por meio da escala foi realizada pré e pós o treinamento e em outros quatro momentos ao longo dos encontros. As avaliações dos alunos foram comparadas com uma avaliação de juízas, realizada previamente por três fonoaudiólogos, especialistas em voz. Para verificar a efetividade do treinamento foi usado o teste de Friedman e Índice de Concordância Kappa. RESULTADOS: O índice de acertos dos alunos no momento pré-treinamento foi considerado entre regular e bom. Observou-se manutenção do número de acertos ao longo das avaliações realizadas, para a maioria dos parâmetros da escala. No momento pós-treinamento observou-se melhora na análise da astenia, parâmetro enfatizado a partir das dificuldades apresentadas pelos alunos. Houve diminuição dos acertos no parâmetro rugosidade após este ter sido trabalhado de maneira segmentada em rouquidão e aspereza, e associado a diferentes diagnósticos e parâmetros acústicos. CONCLUSÃO: O treino auditivo potencializa as habilidades iniciais dos alunos, refinando-as para realização da avaliação, além de nortear ajustes em dinâmicas das disciplinas.

Estimulabilidade: medida auxiliar na identificação de dificuldade na produção dos sons

OBJETIVO: Analisar a efetividade da estimulabilidade como prova complementar ao diagnóstico do transtorno fonológico (TF) e descrever o desempenho de crianças com ausência de sons no inventário fonético quanto a sons ausentes estimuláveis, gravidade, gênero, idade e ocorrência de diferentes processos fonológicos. MÉTODOS: Participaram 130 crianças de ambos os gêneros, entre 5 anos e 10 anos e 10 meses de idade, distribuídas em dois grupos: Grupo Pesquisa (GP), composto por 55 crianças com TF; e Grupo Controle (GC), composto por 75 crianças sem alterações fonoaudiológicas. A partir da aplicação da prova de Fonologia, foi calculada a gravidade do TF por meio do Percentual de Consoantes Corretas-Revisada (PCC-R) e verificado o inventário fonético. Para cada som ausente do inventário foi aplicada a estimulabilidade em imitação de palavras. O GP foi dividido em GP1 (27 crianças que apresentaram sons ausentes) e GP2 (28 crianças com inventário completo). RESULTADOS: Nenhuma criança do GC apresentou som ausente no inventário e no GP1 49% apresentaram sons ausentes. Houve ausência da maioria dos sons da língua. As médias do PCC-R foram menores no GP1, indicando maior gravidade. No GP1, 22 crianças foram estimuláveis e cinco não o foram a qualquer som. Houve associação entre os processos fonológicos mais ocorrentes no TF e a necessidade de avaliação da estimulabilidade, o que indica que a dificuldade em produzir os sons ausentes reflete dificuldade de representação fonológica. A estimulabilidade sofre influência da idade, mas não do gênero. CONCLUSÃO: A prova de estimulabilidade é efetiva para identificar dentre crianças com sons ausentes do inventário, aquelas que são estimuláveis. Tais crianças com TF, que apresentam sons ausentes do inventário, são mais graves uma vez que os valores do PCC-R são mais baixos. As crianças com sons ausentes são estimuláveis em sua maioria, e podem não ser estimuláveis para sons com estrutura silábica ou gesto articulatório complexos. A dificuldade em produzir os sons ausentes reflete dificuldade de representação fonológica. A produção motora da fala demonstrou receber influência da maturação de forma semelhante entre meninos e meninas.

Computer game-based and traditional learning method: a comparison regarding students’ knowledge retention

Abstract Background Educational computer games are examples of computer-assisted learning objects, representing an educational strategy of growing interest. Given the changes in the digital world over the last decades, students of the current generation expect technology to be used in advancing their learning requiring a need to change traditional passive learning methodologies to an active multisensory experimental learning methodology. The objective of this study was to compare a computer game-based learning method with a traditional learning method, regarding learning gains and knowledge retention, as means of teaching head and neck Anatomy and Physiology to Speech-Language and Hearing pathology undergraduate students. Methods Students were randomized to participate to one of the learning methods and the data analyst was blinded to which method of learning the students had received. Students’ prior knowledge (i.e. before undergoing the learning method), short-term knowledge retention and long-term knowledge retention (i.e. six months after undergoing the learning method) were assessed with a multiple choice questionnaire. Students’ performance was compared considering the three moments of assessment for both for the mean total score and for separated mean scores for Anatomy questions and for Physiology questions. Results Students that received the game-based method performed better in the pos-test assessment only when considering the Anatomy questions section. Students that received the traditional lecture performed better in both post-test and long-term post-test when considering the Anatomy and Physiology questions. Conclusions The game-based learning method is comparable to the traditional learning method in general and in short-term gains, while the traditional lecture still seems to be more effective to improve students’ short and long-term knowledge retention.

The complexity of narrative interferes in the use of conjunctions in children with specific language impairment

PURPOSE: To verify the use of conjunctions in narratives, and to investigate the influence of stimuli's complexity over the type of conjunctions used by children with specific language impairment (SLI) and children with typical language development. METHODS: Participants were 40 children (20 with typical language development and 20 with SLI) with ages between 7 and 10 years, paired by age range. Fifteen stories with increasing of complexity were used to obtain the narratives; stories were classified into mechanical, behavioral and intentional, and each of them was represented by four scenes. Narratives were analyzed according to occurrence and classification of conjunctions. RESULTS: Both groups used more coordinative than subordinate conjunctions, with significant decrease in the use of conjunctions in the discourse of SLI children. The use of conjunctions varied according to the type of narrative: for coordinative conjunctions, both groups differed only between intentional and behavioral narratives, with higher occurrence in behavioral ones; for subordinate conjunctions, typically developing children's performance did not show differences between narratives, while SLI children presented fewer occurrences in intentional narratives, which was different from other narratives. CONCLUSION: Both groups used more coordinative than subordinate conjunctions; however, typically developing children presented more conjunctions than SLI children. The production of children with SLI was influenced by stimulus, since more complex narratives has less use of subordinate conjunctions.

Impact of a participatory program to reduce noise in a Neonatal Unit

This study evaluated the impact of a participatory program to reduce noise in a neonatal intermediate care unit of a university hospital. A time-series quasi-experimental design was used, in which sound pressure levels were measured before and after the intervention was implemented using the Quest-400 dosimeter. Non-parametric statistical tests were used to compare noise with the level of significance fixed at 5%. Results showed significant reduction of sound pressure levels in the neonatal unit after the intervention program was implemented (p<0.0001). The average Leq before the intervention was 62.5dBA and was reduced to 58.8dBA after the intervention. A reduction of 7.1dBA in the average Lmax(from 104.8 to 87.7dBA) and of 30.6dBA in the average Lpeak(from 138.1 to 107.5dBA) was observed. The program was proven to be effective in significantly reducing noise levels in the neonatal unit, although levels were still more intense than recommended.

Relationship Between Occlusion and Lisping in Children With Cleft Lip and Palate

Introduction: The literature suggests that individuals with history of cleft lip and palate who present with midfacial growth deficiency are at higher risk of presenting lisping. The relationship between distortions during production of linguoalveolar fricative sounds and the severity of malocclusion, however, has not been established for the population with cleft. Objective: To study the association between lisping and dental arch relationship. Methodology: Speech samples and dental arch casts were obtained from 106 children with operated unilateral cleft lip and palate (UCLP) during the stage of mixed dentition and before orthodontic treatment. Videotaped productions of the phrase/u saci saiw sedu/were rated by speech-language pathologists for the identification of lisping during [s]. Dental arch casts were rated by orthodontists using the Goslon Yardstick and the Five-Year Index to establish dental arch relationship. Results: Multiple logistic regression showed no significant association between lisping and dento-occlusal index (p = .802) and age (p = .662). Substantial interjudge agreement during auditory-perceptual ratings was found (kappa = .63). Almost perfect agreement was found between orthodontists while establishing the dental arch relationship (kappa = .81). Discussion: This study failed to reveal an association between lisping and dental arch relationship in children with operated UCLP. Multiple variables may play a role in determining occurrence of lisping, warranting further investigation.

Auditory complaints and audiologic assessment in children with surgically repaired cleft lip and palate

Introduction: At the initial consultation, the speech-language pathologist and audiologist may consider possible diagnostic hypotheses based on the child's history and the parents' complaint. Aim: To investigate the association of hearing complaints with the findings obtained in the conventional audiologic assessment in children with cleft lip and palate. Retrospective study. Methods: We analyzed medical charts of 1000 patients with cleft lip and palate who underwent surgical repair between 1988 and 1995 at a mean age of 6 years 8 months. We excluded charts with records of inconsistent audiological responses and charts with missing data for any of the audiologic evaluations considered. Thus, the sample consisted of 393 records. Results: Two hundred thirty-nine patients presented hearing loss in one or both ears, but only 3.8% reported hearing complaints. The most frequent were otorrhea followed by otalgia. There was no statistical significance between the complaint and gender (p = 0.26) nor between the complaint and hearing loss (p = 0.83). Conclusion: This study showed no association between the hearing complaint and the conventional audiologic assessment