Gagueira desenvolvimental persistente: avaliação da fluência pré e pós-programa terapêutico

Objetivo: comparar a fluência de crianças com gagueira quanto à porcentagem de sílabas gaguejadas, porcentagem de descontinuidade da fala, fluxo de sílabas e palavras por minuto e gravidade da gagueira, em situação de pré e pós-aplicação do programa de intervenção fonoaudiológica. Método: participaram 10 crianças, na faixa etária de 6.0 a 11.11 anos, sendo 9 do gênero masculino e 1 do gênero feminino, provenientes do Laboratório de Estudos da Fluência. Todos os participantes deste estudo foram submetidos aos seguintes procedimentos agrupados em três etapas: (a) avaliação da fluência inicial; (b) desenvolvimento do processo terapêutico, e; (c) reavaliação da fluência. Resultado: em relação à avaliação após o programa terapêutico, observou-se uma melhora relevante no perfil da fluência, pois a maioria das medidas analisadas (descontinuidade de fala, disfluências gagas, fluxo de sílabas por minuto e gravidade da gagueira) apresentou diferenças estatisticamente significantes. Os achados indicaram que houve uma redução quantitativa nas rupturas o que ocasionou um aumento no fluxo de sílabas por minuto, e também uma diminuição na gravidade da gagueira. Estes resultados confirmam a eficácia terapêutica do programa de terapia aplicado. Conclusão: os resultados encontrados podem auxiliar o fonoaudiólogo em sua prática clínica, tanto na terapia como na realização do diagnóstico e do controle da eficácia terapêutica.

Efeitos de ensino envolvendo equivalência entre palavra ditada, palavra escrita e objeto sobre a inteligibilidade da fala em adolescente com hipoplasia cerebelar

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A study of the role of the FOXP2 and CNTNAP2 genes in persistent developmental stuttering

A number of speech disorders including stuttering have been shown to have important genetic contributions, as indicated by high heritability estimates from twin and other studies. We studied the potential contribution to stuttering from variants in the FOXP2 gene, which have previously been associated with developmental verbal dyspraxia, and from variants in the CNTNAP2 gene, which have been associated with specific language impairment (SLI). DNA sequence analysis of these two genes in a group of 602 unrelated cases, all with familial persistent developmental stuttering, revealed no excess of potentially deleterious coding sequence variants in the cases compared to a matched group of 487 well characterized neurologically normal controls. This was compared to the distribution of variants in the GNPTAB, GNPTG, and NAGPA genes which have previously been associated with persistent stuttering. Using an expanded subject data set, we again found that NAGPA showed significantly different mutation frequencies in North Americans of European descent (p = 0.0091) and a significant difference existed in the mutation frequency of GNPTAB in Brazilians (p = 0.00050). No significant differences in mutation frequency in the FOXP2 and CNTNAP2 genes were observed between cases and controls. To examine the pattern of expression of these five genes in the human brain, real time quantitative reverse transcription PCR was performed on RNA purified from 27 different human brain regions. The expression patterns of FOXP2 and CNTNAP2 were generally different from those of GNPTAB, GNPTG and NAPGA in terms of relatively lower expression in the cerebellum. This study provides an improved estimate of the contribution of mutations in GNPTAB, GNPTG and NAGPA to persistent stuttering, and suggests that variants in FOXP2 and CNTNAP2 are not involved in the genesis of familial persistent stuttering. This, together with the different brain expression patterns of GNPTAB, GNPTG, and NAGPA compared to that of FOXP2 and CNTNAP2, suggests that the genetic neuropathological origins of stuttering differ from those of verbal dyspraxia and SLI. Published by Elsevier Inc.

Estabelecimento do contraste entre as fricativas por crianças com transtorno fonológico: manipulação de pistas acústicas

The present study focuses on the presence of covert contrasts in the speech of children with a phonological disorder. The hypothesis is that children with phonological disorders manipulate secondary acoustic cues in an attempt to distinguish the phonological contrasts. We used five audio recordings of the speech of five children with speech disorders, between four and five years of age, who showed the so-called “phonic substitution” involving the sound group of the fricatives. The data were edited and analyzed using the software PRAAT. A phonetic transcription of the first repetition of each child was performed by three evaluators, reaching a 66% agreement level. After the transcription, we carried out a contrastive phonological analysis of the production of the five children and, finally, an acoustic analysis of all the “substitutions”, based on six parameters. We discovered the existence of covert contrasts in the productions auditorily regarded as homophones by the evaluators, representing a total of 54% of total substitutions identified through an impressionistic approach by the evaluators. Children with phonological disorders are seen to rely on secondary acoustic cues in an attempt to distinguish fricative phonemes. The data obtained in this study allow us to reflect on the importance of considering the phonetic detail within the phonological models.

Nasalance during use of pharyngeal and glottal place of production

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O atraso na retroalimentação auditiva e seus efeitos nas disfluências típicas da gagueira

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Desenvolvimento da linguagem oral em crianças afastadas da família de origem

For a complete development of oral language it's necessary the development of genetic roots of thought and utterance postulates by Vygotsky, yet the meditation of adult and the influence social and cultural that is around the child. In cases of children moved away from their birth family by judicial ways because of neglect there, is a new modality of refuge in Brazil, that is the home refuge, which is the object of our research. The present study shows an investigation about the development of speech in a child that was moved away from his birth family and forwarded to Foster Family to comprehend the contributions and activities that help in child development. The research was performed through an approach of qualitative interpretation of bibliographic type and area type. The data analysis allowed us conclude the new social and cultural way that the watched child was inserted helps in his development in a significant way enabling a qualitative jump in speech and psychic functions phase

Desenvolvimento da linguagem oral em crianças afastadas da família de origem

For a complete development of oral language it's necessary the development of genetic roots of thought and utterance postulates by Vygotsky, yet the meditation of adult and the influence social and cultural that is around the child. In cases of children moved away from their birth family by judicial ways because of neglect there, is a new modality of refuge in Brazil, that is the home refuge, which is the object of our research. The present study shows an investigation about the development of speech in a child that was moved away from his birth family and forwarded to Foster Family to comprehend the contributions and activities that help in child development. The research was performed through an approach of qualitative interpretation of bibliographic type and area type. The data analysis allowed us conclude the new social and cultural way that the watched child was inserted helps in his development in a significant way enabling a qualitative jump in speech and psychic functions phase

Habilidades auditivas e medidas da imitância acústica em crianças de 4 a 6 anos de idade

OBJETIVO: avaliar o desempenho em habilidades auditivas e as condições de orelha média de crianças de 4 a 6 anos de idade. MÉTODO: foram aplicados os testes de detecção sonora (audiômetro pediátrico em 20dBNA), a Avaliação Simplificada do Processamento Auditivo (ASPA) e as medidas de imitância acústica (handtymp com tom de 226Hz) em 61 crianças com média de idade de 5,65 anos. Para comparar os resultados das provas de habilidades auditivas e das medidas da imitância acústica foi aplicado o teste exato de Fisher com nível de significância de p< 0,05. RESULTADOS: houve alteração em pelo menos uma das habilidades auditivas investigadas em 24,6% das crianças. Houve alteração timpanométrica em 34,4% das crianças e 64% foram classificadas no critério "falha" para a pesquisa do reflexo acústico ispilateral. As crianças mais jovens apresentaram maior ocorrência de alterações de orelha média, mas não houve diferença estatisticamente significante entre as diferentes idades para as provas realizadas. CONCLUSÃO: as crianças mais jovens apresentaram maior ocorrência de alterações nas provas de habilidades auditivas e nas medidas de imitância acústica. Programas de investigação e acompanhamento das condições de orelha média e das habilidades auditivas em idade pré-escolar e escolar podem eliminar ou minimizar intercorrências que alterariam o desenvolvimento sócio-linguístico.

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.

Ankyloglossia: facts and myths in diagnosis and treatment

BACKGROUND: The objective of this study was to systematically review the diagnostic criteria, indications, and need for treatment of ankyloglossia (tongue-tie), as well as the various treatment options for patients in different age groups. METHODS: The MEDLINE databases and the Cochrane Library were searched according to well-defined criteria, resulting in 64 included articles. The evidence regarding the classifications of tongue-tie, epidemiologic data, inheritance, breastfeeding problems, impaired tongue mobility, speech disorders, malocclusion, gingival recessions, therapy, and complications due to surgery was analyzed in detail. RESULTS: Different classifications for ankyloglossia have been proposed but not uniformly accepted. Breastfeeding problems in neonates could be associated with a tongue-tie, but not enough controlled trials have been performed to identify an ideal treatment option. In children and adults with ankyloglossia, limitations in tongue mobility are present, but the individual degree of discomfort, as well as the severity of an associated speech problem, are subjective and difficult to categorize. There is no evidence supporting the development of gingival recessions because of ankyloglossia. Frenotomy, frenectomy, and frenuloplasty are the main surgical treatment options to release/remove an ankyloglossia. Because of the limited evidence available, no specific surgical method can be favored. CONCLUSIONS: The lack of an accepted definition and classification of ankyloglossia makes comparisons between studies almost impossible. Because almost no controlled prospective trials for surgical interventions in patients with tongue-ties are present in the literature, no conclusive suggestions regarding the method of choice can be made. It also remains controversial which tongue-ties need to be surgically removed and which can be left to observation.

Desarrollo de videojuegos para rehabilitación de la voz en entornos móviles

Este proyecto consiste en crear una serie de tres pequeños videojuegos incluidos en una sola aplicación, para plataformas móviles Android, que permitan en cualquier lugar entrenar la estética de la voz del paciente con problemas de fonación. Dependiendo de los aspectos de la voz (sonidos sonoros y sordos, el pitch y la intensidad) a trabajar se le asignará un ejercicio u otro. En primer lugar se introduce el concepto de rehabilitación de la voz y en qué casos es necesario. Seguidamente se realiza un trabajo de búsqueda en el que se identifican las distintas plataformas de desarrollo de videojuegos que son compatibles con los sistemas Android, así como para la captura de audio y las librerías de procesado de señal. A continuación se eligen las herramientas que presentan las mejores capacidades y con las que se va a trabajar. Estas son el motor de juego Andengine, para la parte gráfica, el entorno Java específico de Android, para la captura de muestras de audio y la librería JTransforms que realiza transformadas de Fourier permitiendo procesar el audio para la detección de pitch. Al desarrollar y ensamblar los distintos bloques se prioriza el funcionamiento en tiempo real de la aplicación. Las líneas de mejora y conclusiones se comentan en el último capítulo del trabajo así como el manual de usuario para mayor comprensión. ABSTRACT. The main aim of this project is to create an application for mobile devices which includes three small speech therapy videogames for the Android OS. These videogames allow patients to train certain voice parameters (such as voice and unvoiced sounds, pitch and intensity) wherever they want and need to. First, an overview of the concept of voice rehabilitation and its uses for patients with speech disorders is given. Secondly a study has been made to identify the most suitable video game engine for the Android OS, the best possible way to capture audio from the device and the audio processing library which will combine with the latter. Therefore, the chosen tools are exposed. Andengine has been selected regarding the game engine, Android’s Java framework for audio capture and the fast Fourier transform library, JTransforms, for pitch detection. Real time processing is vital for the proper functioning of the application. Lines of improvement and other conclusions are discussed in the last part of this dissertation paper.

Introducing the pressure-sensing palatograph - the next frontier in electropalatography

Primary Objective. To extend the capabilities of current electropalatography (EPG) systems by developing a pressure-sensing EPG system. An initial trial of a prototype pressure-sensing palate will be presented. Research Design. The processes involved in designing the pressure sensors are outlined, with Hall effect transistors being selected. These units are compact, offer high sensitivity and are inexpensive. An initial prototype acrylic palate was constructed with five embedded pressure sensors. Syllable repetitions were recorded from one adult female. Main Outcomes, Results and Future Directions. The pressure-sensing palate was capable of recording dynamic tongue-to-palate pressures, with minimal to no interference to speech detected perceptually. With a restricted number of sensors, problems were encountered in optimally positioning the sensors to detect the consonant lingual pressures. Further developments are planned for various aspects of the pressure-sensing system. Conclusions. Although only in the prototype stage, the pressure-sensing palate represents the new generation of EPG. Comprehensive analysis of tongue-to-palate contacts, including pressure measures, is expected to enable more specific and effective therapeutic techniques to be developed for a variety of speech disorders.

Analysis of articulatory dynamics in dysarthria following brain injury in childhood using electromagnetic articulography and electropalatography

Two physiological assessments, electromagnetic articulography (EMA) and electropalatography (EPG), were used simultaneously to investigate the articulatory dynamics in an 18-year-old male with dysarthria 9 years following traumatic brain injury (TBI). Eight words consisting of /t, s, integral, k/ in word initial and word final positions were produced up to 10 times. A nonneurologically impaired male served as a control subject. Six parameters were analyzed using EMA: velocity, acceleration, deceleration, distance, duration, and motion path of tongue movements. Using EPG, the pattern and amount of tongue-to-palate contact and the duration of the closure/constriction phase of each consonant produced were assessed. Timing disturbances in the TBI speaker's speech were highlighted in perceptual assessments in the form of prolonged phonemes and a reduced speech rate. EMA analysis revealed that the approach and release phase durations of the consonant productions were within normal limits. Kinematic strategies such as decreased velocity and decreased distances traveled by the tongue, however, may have counterbalanced each other to produce these appropriate results. EPG examination revealed significantly longer closure/constriction phase periods, which may have contributed to the prolonged phonemes and reduced speech rate observed. The implications of these findings for the development of treatment programs for dysarthria subsequent to TBI will be highlighted.