José A. Adrián

Comparing voice-therapy and vocal-hygiene treatments in dysphonia using a limited multidimensional evaluation protocol

PURPOSE This study evaluates the effectiveness of two different programs of voice-treatment on a heterogeneous group of dysphonic speakers and the stability of therapeutic progress for longterm follow-up post-treatment period, using a limited multidimensional protocol of evaluation. METHOD Forty-two participants with voice disorders were randomly assigned to one of two groups. Participants in group 1 received voice-therapy and participants in group 2 received a vocal-hygiene program. Vocal function was assessed before and after treatment. RESULTS MANOVA analysis Pillais trace test shows significant pre-post immediate differences between treatments in favor of direct-intervention. Repeated-measures ANOVAs display significant within subjects main effect for follow-up period in the 8 measures considered. Interaction effects of group×time are also found in five out of the eight continuous variables analyzed (3 aerodynamics-acoustic and 2 self-rating), indicating differences between both treatments. Qualitative dimensions (perceptual, laryngoscopic and spectrographic assessments) also support voice-therapy superiority. CONCLUSIONS Results of this study suggest superiority of a voice-therapy (direct treatment) approach over a vocal-hygiene program (indirect treatment). This advantage is on the majority of the 8 continuous variables analyzed (aerodynamics, acoustic, and self-rating), including qualitative perceptual, laryngoscopic and spectrographic voice-dimensions. The stability of changes is extended during a post-treatment follow-up period. LEARNING OUTCOMES (1) The reader should distinguish the advantage using one type of treatment or another in clinical contexts. (2) The reader must know the most important direct techniques used in clinical treatment of voice disorders.

Estado actual de los Servicios ORL españoles. Heterogeneidad en el manejo de los problemas de voz

Resumen El estudio de la patologia de la voz presenta algunas dificultades como la variabilidad etiologica de estos trastornos o la heterogeneidad y escasa informacion sobre la efectividad de algunos de sus metodos de tratamiento. Diversas investigaciones han elaborado cuestionarios, para obtener informacion acerca de la practica clinica que se realiza en la terapia de la voz. Estos estudios han mostrado la falta o escasa presencia de una evaluacion y control de los metodos usados en los programas de rehabilitacion que utilizan los especialistas. En este trabajo, se ha realizado un ondeo en los Servicios de ORL de los diferentes Hospitales de Espana, con el objetivo de obtener informacion sobre los recursos que se utilizan en la evaluacion y tratamiento de las disfonias. Los resultados muestran una enorme variabilidad en el abordaje clinico de la voz. Sin embargo, podemos observar un total acuerdo en la necesidad de sistematizar esta evaluacion y el contar con la colaboracion de la logopedia en el tratamiento de los trastornos de voz.

CASE STUDY The use of computer‐assisted therapy in anomia rehabilitation: A single‐case report

Background: Research has shown there are three different recognised levels of processing involved in spoken word production: the semantic level, the lexical level, and the phonological level. All of these influence the naming performance of anomic patients. However, there is disagreement regarding the most appropriate strategies for the treatment of anomic problems (repetition, lexical‐phonological cueing, semantic cueing, or a combination of all three). The use of computers seems to offer considerable advantages for the daily work of speech therapists, however there is still discussion as to whether or not computers can help patients achieve goals in therapy, and whether computers really can assist therapists in helping their patients to reach their full potential. Aims: This report describes the Computer‐assisted Anomia Rehabilitation Program (CARP) designed to be used by a speech therapist working with anomic patients. The program uses semantic, phonological, written, and semantic/phonological cueing procedures to promote the naming of objects and actions. A single‐case study is described in an attempt to demonstrate the effectiveness of the program. We hoped to increase naming ability and help the patient internalise these strategies and apply them to untreated items in order to demonstrate the effectiveness of the treatment. Methods & Procedures: This is a single‐case report using ABA design, in which a pre‐treatment naming baseline was obtained followed by a computer‐assisted intervention procedure over a 12‐day period. Post‐treatment evaluation was conducted a month later to determine the extent of the improvement in the subjects denomination performance. We compare the results to control measurements (PALPA Oral Picture Naming test, Ravens Progressive Matrices, and Yesavage Geriatric Scale). Outcomes & Results: Comparison of pre‐ vs post‐treatment results of the practised words indicated improvement in target naming from 53% to 70% correct responses, when tested 30 days after the end of treatment. In addition, significant improvement was also found in an untrained PALPA Oral Picture Naming test (pre: 13/40; post: 26/40). Results in the generalisation group of stimuli can be related to the patients internalisation of strategies provided during treatment and its application to untreated items. On the other hand, no significant gains were observed in other areas of cognition taken as control (IQ measured by the Ravens Matrices). Conclusions: This report shows the effectiveness of the Computer‐assisted Anomia Rehabilitation Program (CARP) in this single case. It suggests that computer‐based programmes can be valid in the treatment of anomic disorders, and proposes further study and development of these systems in clinical practice.

Evaluación funcional y tratamiento logopédico de pacientes con disfonía: resultados de una intervención interdisciplinar de la voz en el ámbito hospitalario

Este trabajo presenta los primeros resultados empiricos obtenidos al utilizar un protocolo interdisciplinar y multidimensional («Teatinos») en la evaluacion functional de pacientes con trastornos de la voz. El objetivo es propiciar una mejor deteccion de las variables de pronostico, recuperacion y prevencion de las disfonias. Los resultados del estudio, llevado a cabo en 8 pacientes con nodulos bilaterales y disfonia, muestran los efectos del entrenamiento vocal (logo edia) en la mejoria de los distintos parametros e indices multidimensionales valorados en la fase pre-tratamiento. Todos los pacientes manifestaron tras la rehabilitacion funcional (fase post-tratamiento) una mejoria subjetiva en el bienestar vocal, en el grado de satisfaccion con su voz, ademas de una disminucion de la ronquera y un aumento de la extension vocal. Asimismo, se observa una desaparicion o reduccion de los nodulos vocales, un menor grado perceptual de la disfonia, una mejora de los parametros acusticos y una recuperacion significativa de los indices aerodinamicos. Por ejemplo, los resultados muestran una mejora de un 22,5 % en el Tiempo Maximo de Fonacion (TMF) al comparar la fase pre vs. post tratamiento logopedico. Las implicaciones de estos resultados en la evaluacion de la efectividad del tratamiento logopedico son tratados en la discusion.

Glotoplastia de Wendler y tratamiento logopédico en la feminización de la voz en transexuales: resultados de la valoración pre- vs. poscirugía

INTRODUCTION With the development of new ENT techniques, many male transsexuals who wish to become women usually request a surgical procedure to raise the fundamental frequency of the voice (feminization). The ENT specialist and the voice-therapist have to use an interdisciplinary approach to this growing social demand. The aim of this study was to show the results in a group of transsexual patients after Wendlers anterior synechiae, with additional voice-therapy treatment. METHODS Ten male transexulas who wish to become women patients who had Wendler glottoplasty and voice-therapy were assessed. The surgical procedure consisted of a de-epithelialization of the anterior third of both vocal folds; this area was sutured and the surface of both vocal folds was vaporised with laser diode. Pre- and postsurgery voice assessment consisted of measuring fundamental frequency (Fo) and maximum phonation time, administering the transgender self-assessment questionnaire (TSEQ) and obtaining perceptual voice assessment by inter-rater agreement. RESULTS All the male transsexuals who wish to become women patients significantly increased their Fo (106 Hz on average) after the treatment. Furthermore, significant improvements were shown in self-reported satisfaction and in the degree of voice feminization. No improvements in the maximum phonation time were observed. CONCLUSIONS Wendler glottoplasty is a surgical procedure to contribute to feminising the voice, with good medium-term results and without noteworthy medical complications. The increase in vocal tone was observed using several pre- and post-surgery control measures and voice therapy.

Disponibilidad y fluidez oral de palabras por categorías semánticas: un estudio prospectivo en adultos de más de 55 años con diferente nivel de escolarización

Este estudio presenta las diferencias obtenidas en un grupo de sujetos sanos considerando su edad, sexo y nivel de escolarizacion al analizar su disponibilidad semiespontanea de produccion oral (fluidez de palabras). Los participantes debian evocar durante 1 minuto de tiempo el mayor numero posible de palabras de una categoria solicitada. Los resultados ponen de manifiesto una significativa mayor capacidad de los adultos de rango de edad menor (55–65) y de mas nivel de escolarizacion en la produccion de palabras validas, en las 9 categorias exploradas. No se aprecian diferencias significativas por sexo. Asimismo, un corpus basico de vocabulario perteneciente a las distintas categorias, segun la frecuencia obtenida y la disponibilidad oral del grupo de participantes evaluados se describe al final de este trabajo (Apendice).

Specific Language Impairment: Evaluation and detection of differential psycholinguistic markers in phonology and morphosyntax in Spanish-speaking children.

BACKGROUND The diagnosis of Specific Language Impairment (SLI) is very complex, given the variety of clinical pictures described in this disorder. Knowledge about the linguistic markers of SLI can facilitate its differentiation from the normal profile of language development. These markers can also be used as tools that may improve diagnostic. AIMS To determine which psycholinguistic markers best discriminate Spanish-speaking children with SLI from children with typical language development. METHOD AND PROCEDURE The performance of 31 Spanish-speaking children with SLI was analysed using a battery of 13 psycholinguistic tasks organized into two areas: phonology and morphosyntax. The performance of the SLI group was compared to that of two subgroups of controls: aged matched (CA) and linguistically matched (CL). OUTCOMES AND RESULTS The data show that the SLI group performed worse than the CA subgroup on all 13 verbal tasks. However, the performance of the SLI group did not significantly differ from that of the CL subgroup on most (11/13) of the tasks. Stepwise discriminant analysis established the canonical function of three tasks (morphologic integration, sentence understanding and diadochokinesis) which significantly discriminated SLI from CA, with sensitivity 84% and specificity 90%. CONCLUSIONS AND IMPLICATIONS These results contribute to determining the psycholinguistic and clinical characteristics of SLI in Spanish-speaking children and provide some methods for screening assessment.

Lengua oral, bilingüismo y dificultades en el aprendizaje de la lengua escrita

Resumen Una buena capacitación en el lenguaje escrito resulta esencial para un adecuado aprendizaje en la educación primaria. Los niños con diferente lengua materna (L1) que llegan a la escuela y aprenden a leer en una lengua distinta (L2), podrían encontrar dificultades. Este estudio evalúa los componentes esenciales del procesamiento de la lengua oral/escrita en una muestra de 194 participantes, 83 monolingues del español (EL1) y 111 bilingües árabe-darija-español (EL2), de cuatro colegios de 3° de primaria de Ceuta. Los resultados no muestran diferencia significativa por grupo (EL1 vs. EL2) en lectura y ortografía en español, en los colegios donde EL1 y EL2 comparten aulas. Sin embargo, se aprecian diferencias significativas en habilidades de compresión oral (v.g. vocabulario y morfosintaxis). Al analizar la proporción de niños EL1 por aula aparecen efectos significativos de la variable colegio en lectura y escritura, controlando el nivel socioeconómico y cultural, el bilingüismo percibido, y el uso del árabe-darija en el entorno familiar. Los niños del colegio A, donde no había participantes EL1, son significativamente peores en el manejo del español, pero buenos en árabe-darija. Además, las diferencias significativas en lectura y escritura constatadas entre los niños EL2 de los cuatro colegios, desaparecen cuando se analizan en un ANOVA tomando a las tareas de morfosintaxis como covariable.