Claudia Regina Furquim de Andrade

Protocolo fonoaudiológico de avaliação do risco para disfagia (PARD)

PURPOSE: The aim of this study was to constitute a pilot protocol proposal to risk identification of dysphagia. This protocol is proposed to identify and to interpret the swallowing disorders, to characterize the penetration or aspiration clinical signals, to define promptly the dysphagia severity and to establish the management based in the results of the evaluation. METHODS: The Dysphagia Risk Evaluation Protocol is based in extensive literature about dysphagia. The common points were maintained and the points with no literature consensus were dismissed. RESULTS: The Dysphagia Risk Evaluation Protocol is constituted by three parts: water swallowing test, puree deglutition test, dysphagia severity scale and management. CONCLUSION: The Dysphagia Risk Evaluation Protocol is based in a theoretical proposition and depends of its application on population basis for its validation. Also contributes to a full beside evaluation that guides the speech-language pathologists and consolidate the evidence-based practice. The next step of this research will be experimental.

Relationship between the stuttering severity index and speech rate

CONTEXT The speech rate is one of the parameters considered when investigating speech fluency and is an important variable in the assessment of individuals with communication complaints. OBJECTIVE To correlate the stuttering severity index with one of the indices used for assessing fluency/speech rate. DESIGN Cross-sectional study. SETTING Fluency and Fluency Disorders Investigation Laboratory, Faculdade de Medicina da Universidade de São Paulo. PARTICIPANTS Seventy adults with stuttering diagnosis. MAIN MEASUREMENTS A speech sample from each participant containing at least 200 fluent syllables was videotaped and analyzed according to a stuttering severity index test and speech rate parameters. RESULTS The results obtained in this study indicate that the stuttering severity and the speech rate present significant variation, i.e., the more severe the stuttering is, the lower the speech rate in words and syllables per minute. DISCUSSION AND CONCLUSION The results suggest that speech rate is an important indicator of fluency levels and should be incorporated in the assessment and treatment of stuttering. This study represents a first attempt to identify the possible subtypes of developmental stuttering. DEFINITION Objective tests that quantify diseases are important in their diagnosis, treatment and prognosis.

Effects of high adherence to mediterranean or low-fat diets in medicated secondary prevention patients.

Although the Mediterranean diet (MD) and the low-fat Therapeutic Lifestyle Changes Diet (TLCD) promote equivalent increases in event-free survival in secondary coronary prevention, possible mechanisms of such complete dietary patterns in these patients, usually medicated, are unclear. The aim of this study was to investigate the effects of the MD versus the TLCD in markers of endothelial function, oxidative stress, and inflammation after acute coronary syndromes. Comparison was made between 3 months of the MD (n = 21; rich in whole grains, vegetables, fruits, nuts, and olive oil, plus red wine) and the TLCD (n = 19; plus phytosterols 2 g/day) in a highly homogenous population of stable patients who experienced coronary events in the previous 2 years (aged 45 to 65 years, all men) allocated to each diet under a strategy designed to optimize adherence, documented as >90%. Baseline demographics, body mass index and clinical data, and use of statins and other drugs were similar between groups. The MD and TLCD promoted similar decreases in body mass index and blood pressure (p ≤0.001) and particularly in plasma asymmetric dimethylarginine levels (p = 0.02) and l-arginine/asymmetric dimethylarginine ratios (p = 0.01). The 2 diets did not further enhance flow-mediated brachial artery dilation compared to baseline (4.4 ± 4.0%). Compared to the TLCD, the MD promoted decreases in blood leukocyte count (p = 0.025) and increases in high-density lipoprotein levels (p = 0.053) and baseline brachial artery diameter. Compared to the MD, the TLCD decreased low-density lipoprotein and oxidized low-density lipoprotein plasma levels, although the ratio of oxidized to total low-density lipoprotein remained unaltered. Glucose, high-sensitivity C-reactive protein, triglycerides, myeloperoxidase, intercellular adhesion molecular, vascular cell adhesion molecule, and glutathione serum and plasma levels remained unchanged with either diet. In conclusion, medicated secondary prevention patients show evident although small responses to the MD and the TLCD, with improved markers of redox homeostasis and metabolic effects potentially related to atheroprotection.

Prevalência das desordens idiopáticas da fala e da linguagem em crianças de um a onze anos de idade

OBJETIVO: Apresentacao do perfil epidemiologico das patologias fonoaudiologicas de fala e linguagem, de causa idiopatica, especificamente relacionado a prevalencia dessas desordens na populacao infantil de 1 a 11 anos de idade. METODO: As criancas foram avaliadas nos aspectos de fala, linguagem e sistema miofuncional oral. Estabelecido o diagnostico fonoaudiologico, foram os mesmos classificados segundo a manifestacao predominante. Apos agrupadas as categorias das desordens, foram diferenciadas as idades e aplicados os calculos de prevalencia. RESULTADOS: De um total de 2.980 criancas, 125 delas eram portadoras de desordens fonoaudiologicas (prevalencia de 4,19). A prevalencia geral mais elevada foi referente a faixa etaria de 3 a 8 anos, sendo a fase critica dos 4 aos 5 anos. As patologias de manifestacao primaria mais prevalentes foram, em ordem de frequencia: disturbios articulatorios, defasagens na aquisicao e desenvolvimento da linguagem oral e desordens miofuncionais orais e de funcoes neuro vegetativas. CONCLUSAO: As desordens fonoaudiologicas constituem importante segmento nos agravos a saude infantil, sendo necessario que sejam urgentemente estruturados programas fonoaudiologicos preventivos e curativos. Em sua precariedade, o sistema de saude brasileiro nao oferece uma rede de apoio para o atendimento aos portadores de patologias da comunicacao, existindo apenas esforcos isolados em algumas unidades de saude.

Tipologia das rupturas de fala e classes gramaticais em crianças gagas e fluentes

BACKGROUND Developmental stuttering is a pathology which begins during childhood. during the phase of language acquisition and development and is characterized as being chronic. AIM To verify the influence of typology and grammatical classes on the occurrence of speech disruptions of stuttering and fluent children. METHOD Participants of this study were 80 children, with ages between 4.0 and 11.11 years, residents in the city of São Paulo. Participants were divided in two groups: GI (research group) was composed by 40 children (29 male and 11 female) with the diagnosis of stuttering, and with no other associated communication. neurologic and cognitive deficits: GII (control group) was composed by 40 fluent children, paired by age and gender with the participants of GI. RESULTS The data indicate that the groups do not differ regarding the occurrence of typical disfluencies. Less typical disflucncies occurred predominantly for GI. As for the grammatical class, speech disruptions were more frequent in function words for both groups. CONCLUSION These results indicate that the analyses of speech disruptions, in terms of typology and grammatical classes, bring several information that are necessary for the assessment and diagnosis of childhood stuttering. This analysis points the differences and similarities between stuttering and fluent children.

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

BackgroundEducational 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.MethodsStudents 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.ResultsStudents 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.ConclusionsThe 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.

Movimentos mandibulares na fala: interferência das disfunções temporomandibulares segundo índices de dor

BACKGROUND temporomandibular disorders can cause general alterations of the mandibular movements due to modification in the condition of muscles and articulations. Electrognathography, a computerized exam used to complement the diagnosis of these disorders, allows the objective delineation and record of the mandibular movements, determining their amplitude and speed. AIM to verify the characteristics of mandibular movements of individuals with temporomandibular dysfunction and in asymptomatic individuals during speech, through computerized electrognathography, analyzing possible interferences of this dysfunction and severity implications regarding pain indexes. METHOD 135 adults were divided in four groups based on their pain indexes, using a numeric scale: zero for pain absence, one for mild pain, two for moderate pain and three for severe pain. Mandibular movements were observed during the sequential naming of balanced pictures taking in consideration the occurrence of phonemes in the Brazilian Portuguese language. Records were obtained using computerized electrognathography (BioEGN - BioPak system). RESULTS the analysis of the results point that differences indicated as significant for mandibular opening amplitude and mandibular closing speed occurred between index zero and all of the other pain indexes. Regarding mandibular opening speed during speech, statistically significant differences were obtained between index zero and index three. It was observed that mandibular movements in speech are discreet, with an anteroposterior component and deviations in laterality. CONCLUSION the presence of temporomandibular dysfunctions causes reduction in the values of maximum mandibular opening and a reduction in both mandibular opening speed and mandibular closing speed during speech The different pain indexes: mild, moderate and severe do not seem to determine larger reduction of these values.

Processamento linguístico e processamento auditivo temporal em crianças com distúrbio específico de linguagem

BACKGROUND: several studies suggest the association of specific language impairment (SLI) to deficits in auditory processing.It has been evidenced that children with SLI present deficit in brief stimuli discrimination. Such deficit would lead to difficulties in developing phonological abilities necessary to map phonemes and to effectively and automatically code and decode words and sentences. However, the correlation between temporal processing (TP) and specific deficits in language disorders - such as syntactic comprehension abilities - has received little or no attention. AIM: to analyze the correlation between: TP (through the Frequency Pattern Test - FPT) and Syntactic Complexity Comprehension (through a Sentence Comprehension Task). METHOD: Sixteen children with typical language development (8;9 ± 1;1 years) and seven children with SLI (8;1 ± 1;2 years) participated on the study. RESULTS: Accuracy of both groups decreased with the increase on syntactic complexity (both p < 0.01). On the between groups comparison, performance difference on the Test of Syntactic Complexity Comprehension (TSCC) was statistically significant (p = 0.02).As expected, children with SLI presented FPT performance outside reference values. On the SLI group, correlations between TSCC and FPT were positive and higher for high syntactic complexity (r = 0.97) than for low syntactic complexity (r = 0.51). CONCLUSION: Results suggest that FPT is positively correlated to syntactic complexity comprehension abilities.The low performance on FPT could serve as an additional indicator of deficits in complex linguistic processing. Future studies should consider, besides the increase of the sample, longitudinal studies that investigate the effect of frequency pattern auditory training on performance in high syntactic complexity comprehension tasks.

Sintomas indicativos de disfagia em portadores de DPOC

OBJECTIVE To identify symptoms of dysphagia in individuals with COPD, based on their responses on a self-perception questionnaire. METHODS The study comprised 35 individuals with COPD and 35 healthy individuals, matched for age and gender. The study group was assessed regarding COPD severity; sensation of dyspnea; body mass index (BMI); and symptoms of dysphagia. The control group was assessed regarding BMI and symptoms of dysphagia. RESULTS The most common symptoms of dysphagia in the study group were pharyngeal symptoms/airway protection (p < 0.001); esophageal symptoms/history of pneumonia (p < 0.001); and nutritional symptoms (p < 0.001). Positive correlations were found between the following pairs of variables: FEV₁ and BMI (r = 0.567; p < 0.001); pharyngeal symptoms/airway protection and dyspnea (r = 0.408; p = 0.015); and esophageal symptoms/history of pneumonia and pharyngeal symptoms/airway protection (r = 0.531; p = 0.001). There was a negative correlation between nutritional symptoms and BMI (r = -0.046; p < 0.008). CONCLUSIONS Our results show that the individuals with COPD presented with symptoms of dysphagia that were associated with the pharyngeal and esophageal phases of swallowing, as well as with the mechanism of airway protection, a history of pneumonia, and nutritional symptoms.

A Model of Mandibular Movements During Speech: Normative Pilot Study for the Brazilian Portuguese Language

Abstract The precision of speech articulation is related to the possibility and freedom of the mandibular movements, modifying the spaces in order to allow the different articulatory positions of each sound. Electrognathography allows the objective delineation and registration of the mandibular movements, determining the level of opening, translations and velocity of these movements. Its use is a resource that can establish quantitative diagnostic parameters. The aim of this study was to verify the amplitude, velocity and characterization of the mandibular movements during speech using computerized electrognathography. Participants were 40 adults, male and female, with no temporomandibular disorders; with no missing teeth; with no dental occlusion alterations or dentofacial deformities; with no dental prostheses; and with no communication, neurological or cognitive deficits. The mandibular movements were observed during the sequential naming of pictures containing all the phonemes of the Brazilian Portuguese language. The registrations were obtained using electrognathography (BioENG – BioPak system), assessing the spatial position, course and velocity of the mandibular movements. The mean values of velocity were: 88.65 mm/sec during opening and 89.90mm/sec during closing. The mean values of amplitude were: sagittal opening: 12.77 mm, frontal opening: 11.21 mm, protrusion: 1.22 mm; retrusion 5.67 mm; translations to the right: 1.49 mm and to the left: 1.59 mm. The velocity of opening is directly related to that of closing. The amplitude of opening demonstrates a direct correlation with the velocity of opening and closing. All participants presented lateral translations during the course of the jaw. The assessment of speech in normal individuals is characterized by: discreet mandibular movements with an anteroposterior component and lateral translations. This study allowed for the delineation of a profile of the mandibular movements during speech in asymptomatic individuals.