Fernanda Chiarion Sassi

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.

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.

Fonoaudiologia e autismo: resultado de três diferentes modelos de terapia de linguagem

BACKGROUND language and communication disorders are essential features of the autistic spectrum disorders, and are part of the diagnostic criteria. AIM to verify the existence of observable differences in the functional communicative profile and in the social cognitive performance of autistic children and adolescents receiving language therapy in three different situations. Assessment focused on the period of modified intervention and on the following period. METHOD subjects were children and adolescents with psychiatric diagnosis within the autistic spectrum. Participants were divided in three groups according to the intervention received during a period of six months. RESULTS determined observable differences, but not statistically significant. The group that presented the most progress was the one in which the subjects received therapy in pairs. The fact that none of groups presented a decrease in their progress indicators, as well as the fact that in a few situations the number of subjects who presented progress increased after this period was not expected. CONCLUSION the results of the present study reinforce that the procedures used to determine the individual abilities and inabilities were useful in planning the intervention procedures.BACKGROUND: language and communication disorders are essential features of the autistic spectrum disorders, and are part of the diagnostic criteria. AIM: to verify the existence of observable differences in the functional communicative profile and in the social cognitive performance of autistic children and adolescents receiving language therapy in three different situations. Assessment focused on the period of modified intervention and on the following period. METHOD: subjects were children and adolescents with psychiatric diagnosis within the autistic spectrum. Participants were divided in three groups according to the intervention received during a period of six months. RESULTS: determined observable differences, but not statistically significant. The group that presented the most progress was the one in which the subjects received therapy in pairs. The fact that none of groups presented a decrease in their progress indicators, as well as the fact that in a few situations the number of subjects who presented progress increased after this period was not expected. CONCLUSION: the results of the present study reinforce that the procedures used to determine the individual abilities and inabilities were useful in planning the intervention procedures.

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

IntroductionThe development of postextubation swallowing dysfunction is well documented in the literature with high prevalence in most studies. However, there are relatively few studies with specific outcomes that focus on the follow-up of these patients until hospital discharge. The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI).MethodsWe conducted a retrospective, observational cohort study from 2010 to 2012 of all patients over 18 years of age admitted to a university hospital ICU who were submitted to prolonged OTI and subsequently received a bedside swallow evaluation (BSE) by a speech pathologist. The prognostic factors analyzed included dysphagia severity rate at the initial swallowing assessment and at hospital discharge, age, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubations, intubation time and length of hospital stay.ResultsAfter we excluded patients with neurologic diseases, tracheostomy, esophageal dysphagia and those who were submitted to surgical procedures involving the head and neck, our study sample size was 148 patients. The logistic regression model was used to examine the relationships between independent variables. In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes.ConclusionsStudies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder. Additionally, this study stresses the importance of the initial assessment ratings.

Atividades de fala e não-fala em gagueira: estudo preliminar

BACKGROUND: stuttering. AIM: to compare muscle activation in fluent and stuttering individuals during speech and non-speech tasks. METHOD: six adults divided in two groups: G1 - three fluent individuals; G2 - three stuttering individuals. Muscle activity (surface electromyography) was captured by disposable electrodes fixed in four regions. Testing situations: muscle rest tension, speech reaction time, non-verbal activity, verbal activity. RESULTS: There was no significant statistical difference between the groups for the rest tension; G2 present longer speech reaction times; G2 presented muscle activity during the non-verbal task similar to that observed during rest; Muscle activity of G1 and G2 during the verbal task demonstrated to be similar. CONCLUSION: these results suggests that for G2 there is a poor control of timing for the coordination of motor processes.

Oral Motor Movements and Swallowing in Patients with Myotonic Dystrophy Type 1

Oropharyngeal dysphagia and esophageal motility disorders were found to be the most important causes of aspiration pneumonia in patients with myotonic dystrophy. The purpose of this report was to evaluate clinical characteristics of the oral motor movements and swallowing of individuals with myotonic dystrophy type 1 (DM1) using a standardized clinical protocol and surface electromyography (sEMG). Participants were 40 individuals divided in two groups: G1 composed of 20 adults with DM1 and G2 composed of 20 healthy volunteers paired by age and gender to the individuals in G1. Statistical analysis included one-way ANOVA with two factors for within- and between-group comparisons and Bonferroni correction for multiple comparisons. Patients with DM1 presented deficits in posture, position, and mobility of the oral motor structures, as well as compromised mastication and deglutition. The sEMG data indicated that these patients had longer muscle activations during swallowing events. The longer duration of sEMG in the group of patients with DM1 is possibly related to myotonia and/or incoordination of the muscles involved in the swallowing process or could reflect a physiological adaptation for safe swallowing.

Modelamento da fluência com o uso da eletromiografia de superfície: estudo piloto

BACKGROUND: the use of a technological resource in fluency promotion. AIM: to verify the effectiveness of a stuttering treatment based on the use of surface electromyography (SEMG) exclusively. METHOD: participants were four stuttering adults of both genders. Assessment, pre and post-treatment, consisted of a speech gathering session and the analyses of the rest tension and of the reaction time for speech. Treatment consisted of twelve twenty minute training sessions monitored by SEMG. RESULTS: there was a statistically significant reduction in the number of stuttering-like disfluencies (p = 0.094) and in the number of other disfluencies (p = 0.014). The other parameters, as well as differences in the electromyographic measurements, did not present significant variation. CONCLUSION: SEMG proved to be effective in the reduction of stuttering, with no need of association to other techniques.

Clinical dysphagia risk predictors after prolonged orotracheal intubation

OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population.

Eletromiografia e diadococinesia: estudo com crianças fluentes e com gagueira

BACKGROUND: electromyography and diadochokinesia. AIM: to analyze the oral movement rate in children with persistent developmental stuttering and in normally fluent children during the repetition of articulatory segments (diadochokinesia - DDK). METHOD: participants of the study were 50 children, with no distinction of gender and race, enrolled in public schools (primary and junior) of Sao Paulo city and Great Sao Paulo, whose families agreed, through informed consent, with the research procedures. The research group (GI) consisted of 19 children diagnosed as stutterers. The control group (GII) consisted of 31 fluent children. RESULTS: the results of the study indicate that there were great similarities in performance in the DDK tasks for both groups. Standard deviation values were high for both groups. CONCLUSION: statistically significant differences were observed for the ability of sequential movement, i.e. when looking at ANOVA results the group of fluent children presented a better ability to move their articulators rapidly when producing sequential segments (pa/ta/ka).

Qualidade de vida em indivíduos com gagueira desenvolvimental persistente

BACKGROUND: quality of life. AIM: to verify the influence of the readiness of speech - regarding affective, behavioral and cognitive reactions - over the life quality of fluent individuals and those with persistent developmental stuttering (PDS). METHOD: 40 adults divided in two groups, paired by gender and age. The research group (GI) consisted of 20 individuals with PDS, with no other associated deficit. The research group (GII) consisted of 20 fluent individuals. All of the participants answered a Self-Assessment Protocol - version for adults. This protocol is composed by three thematic sessions, each one presenting five questions. Each question should be answered by choosing a number on a scale that varies from 1 (completely disagree) to 7 (completely agree). The first session corresponds to the affective reactions, the second to the behavioral reactions and the third to the cognitive reactions. All of the participants answered all of the 15 questions. RESULTS: the findings indicate that a difference in the perception of speech and speech fluency exists between fluent individuals and individuals with PDS. For the individuals with PDS, the different stuttering severity levels did not present divergent points; on the contrary, even the individuals with mild PDS presented the same affective, behavioral and cognitive profiles of those with a more severe stuttering. CONCLUSION: the results indicate that the experience with stuttering is different among the individuals in terms of the observable speech characteristics, functional communication difficulties experienced by the individual in everyday situations, having a negative impact in the quality of life.