Karin Zazo Ortiz

Microlinguistic aspects of the oral narrative in patients with Alzheimer's disease.

BACKGROUND Alzheimers disease (AD) is characterized by memory loss and cognitive impairment. Phonological, syntactic, semantic and discursive aspects of language may also be affected. Analysis of micro- and macrolinguistic abilities of discourse may assist in diagnosing AD. The aim of this study was to identify changes in the discourse (lexical errors and syntactic index) of AD patients. METHODS 121 elderly subjects narrated a story based on a seven-figure picture description. RESULTS Patients with AD presented more word-finding difficulties, revisions and repetitions, and the syntactic index was lower than controls. CONCLUSION Performance in microlinguistics at the lexical and syntactic levels was lower than expected in participants with AD.

Alterações de linguagem nas fases iniciais da doença de Alzheimer

Alzheimer disease (AD) is usually associated with cognitive, language and behavioral impairments, which can get more and more serious as the disease progresses. The aim of this study is to verify language disorders in the early stages of this disease. Twelve patients meeting criteria for problable AD were evaluated by the Boston test, and all of them scored more than 23 points on the Mini-Mental State Examination. Data acquired on this language evaluation were compared with the average of normal population data. All patients showed language disorders. Statistical differences were found in visual confrontating naming and auditory comphrension tasks. The patients performed well in writing and reading tasks. We believe that there might have had an interference in the patients linguistic task performance due to their memory impairment. We could find language impairments in the early stages of AD.

Influence of schooling on language abilities of adults without linguistic disorders

CONTEXT AND OBJECTIVE In order to properly assess language, sociodemographic variables that can influence the linguistic performance of individuals with or without linguistic disorders need to be taken into account. The aim of this study was to evaluate the influence of schooling and age on the results from the Montreal Toulouse (Modified MT Beta-86) language assessment test among individuals without linguistic disorders. DESIGN AND SETTING Cross-sectional study carried out between March 2006 and August 2007 in the Speech, Language and Hearing Pathology Department of Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil. METHODS Eighty volunteers were selected. Schooling was stratified into three bands: A (1-4 years), B (5-8 years) and C (nine years and over). The age range was from 17 to 80 years. All the subjects underwent the Montreal Toulouse (Modified MT Beta-86) language assessment protocol. RESULTS Statistically significant differences were found in relation to schooling levels, in the tasks of oral comprehension, reading, graphical comprehension, naming, lexical availability, dictation, graphical naming of actions and number reading. Statistically significant age-related differences in dictation and lexical availability tasks were observed. CONCLUSIONS The Montreal Toulouse (Modified MT Beta-86) test seems to be sensitive to variations in schooling and age. These variables should be taken into account when this test is used for assessing patients with brain damage.

Performance of normal adults on Rey Auditory Learning Test: a pilot study

The present study aimed to assess the performance of healthy Brazilian adults on the Rey Auditory Verbal Learning Test (RAVLT), a test devised for assessing memory, and to investigate the influence of the variables age, sex and education on the performance obtained, and finally to suggest scores which may be adopted for assessing memory with this instrument. The performance of 130 individuals, subdivided into groups according to age and education, was assessed. Overall performance decreased with age. Schooling presented a strong and positive relationship with scores on all subitems analyzed except learning, for which no influence was found. Mean scores of subitems analyzed did not differ significantly between men and women, except for the delayed recall subitem. This manuscript describes RAVLT scores according to age and education. In summary, this is a pilot study that presents a profile of Brazilian adults on A1, A7, recognition and LOT subitem.

Análise vocal (auditiva e acústica) nas disartrias

BACKGROUND neurological dysphonias are normally associated to dysarthrias and play an important role when determining the correct diagnosis. The acoustic analysis of the voice is important for understanding the speech motor disorders present in dysarthric patients. AIM to describe the acoustic and auditory-perceptual characteristics of the voice of the different types of dysarthria. METHOD 42 patients with well defined neurological diagnosis of dysarthria, 21 male and 21 female, were evaluated according to auditory-perceptual parameters and acoustic measures. All patients had their voices recorded. Auditory-perceptual voice analysis included: type of voice, resonance (balanced, hypernasal or laryngeal-pharyngeal), loudness (adequate, reduced, increased), pitch (adequate, low, high), and voice onset (isochronic, abrupt or breathy). For the acoustic analysis the following programs were used: GRAM 5.1.7. for the analysis of vocal quality and spectrographic tracing; and Vox Metria to obtain the objective measures. RESULTS data obtained in the auditory-perceptual analysis indicate that the most present vocal quality was the harsh and breathy voice, laryngeal-pharyngeal resonance and instability on vocal onset. In the acoustic analysis the following was observed: instability in the spectrogram, absence of the upper sub harmonics, presence of noise between the harmonics and reduced maximum phonatory time. Jitter, Shimmer and Glottal to Noise Excitation Ratio were altered in all dysarthrias. CONCLUSION the acoustic analysis, associated to the auditory- perceptual assessments, is of assistance in the clinical diagnosis of dysarthrias.

Perfil populacional de pacientes com distúrbios da comunicação humana decorrentes de lesão cerebral, assistidos em hospital terciário

RESUMOObjetivo: caracterizar a populacao de pacientes com lesao neurologica, queixa e presenca de distur-bio da comunicacao, assistidos num Hospital Terciario. Os objetivos especificos foram: verificar a pre-valencia de cada tipo de transtorno de fala e/ou de linguagem, da etiologia neurologica e a origem dos encaminhamentos em relacao ao total de pacientes. Metodo: Trata-se de um estudo retrospectivo, em que foram analisados todos os prontuarios dos pacientes atendidos em 5 anos (2002 a 2006), no Nucleo de Investigacao e Intervencao Fonoaudiologica em Neuropsicolinguistica do Departamento de Fonoaudiologia da Universidade Federal de Sao Paulo,. Resultados: o estudo revelou 244 casos atendidos entre 2002 e 2006. Quanto a caracterizacao da amostra encontramos: quanto ao sexo, 56% eram homens; quanto a idade, 44,3% encontraram-se entre 41- 64 anos; quanto a escolaridade, 39,8% dos pacientes apresentaram 1 a 4 anos de escolaridade; quanto aos encaminhamentos para o atendimento no setor 35,7% eram procedentes do ambulatorio de Neurologia da UNIFESP; quanto a etiologia da lesao, 69,3% foram diagnosticados com Acidente Vascular Cerebral (AVC). Sobre o diagnostico fonoaudiologico, 56,1% foram diagnosticados com Afasia em relacao a linguagem e 33% com Disartria em relacao a fala. Conclusao: a afasia foi o transtorno de linguagem mais prevalente; o mesmo ocorreu com a disartria em relacao a fala; o AVC foi a etiologia neurologica predominante; em relacao ao numero geral de casos avaliado verificou-se que 50% do grupo atendido estavam em programas de reabilitacao; a maioria dos pacientes foram encaminhados pelo servico de Neurologia do Hospital Sao Paulo – UNIFESP. Descritores: Transtornos da Comunicacao; Traumatismos Encefalicos; Epidemiologia

Teste de padrão harmônico em escuta dicótica com dígitos - TDDH

PURPOSE: The aims of this study are the development of an auditory processing test with musical stimuli in dichotic tasks, the characterization of the performance of normal hearing subjects and the comparison between the results and those in the Digits Dichotic Test (TDD). METHODS: The auditory processing test with musical stimuli was elaborated with harmonic digits. The test was denominated Harmonic Pattern Dichotic Digits Test (TDDH) and comprised biaural integration and two stages of biaural separation (left/right), each one with 20 items made up of four harmonic digits. It was applied in 40 individuals of both sexes. They were all adults, their ages ranged from 19 to 52 years old and they spoke Brazilian Portuguese. RESULTS: The results were compared to results of the TDD applied in the same individuals. The individuals had approximately 99% success in all the stages, their performance was higher than the one observed in the TDD - stages of biaural separation. CONCLUSION: We believe that the test elaborated for this study showed applicability in normal hearing individuals. The use of musical stimuli seems to make the performance of individuals easier than the dichotic verbal tests.

Comparação entre as análises auditiva e acústica nas disartrias

PURPOSE: To compare data found in auditory-perceptual analyses (subjective) and acoustic analyses (objective) in dysarthric patients. METHODS: Forty-two patients with well defined neurological diagnosis, 21 male and 21 female, were evaluated in auditory-perceptual parameters and acoustic measures. All patients had their voices recorded. Auditory-perceptual voice analyses were made considering type of voice, resonance (balanced, hipernasal or laryngopharyngeal), loudness (adequate, decreased or increased), pitch (adequate, low or high), vocal attack (isochronic, sudden or breathy), and voice stability (stable or unstable). Acoustic analyses were made with GRAM 5.1.7 Program that considered voice quality and spectrographic tracing, and Vox Metria Program to obtain objective measures. RESULTS: The comparison between auditory-perceptual and acoustic data showed no correlation for all the parameters analyzed. It was found a significant difference between breathiness and shimmer alteration (p=0.048), and between breathiness and harmonics definition (p=0.040), evidencing correlation between noise presence during emission and breathiness. CONCLUSION: Acoustic analysis associated to auditory-perceptual analysis provided different but complementary data, helping the clinical diagnosis of dysarthias.

Influence of brain lesion and educational background on language tests in aphasic subjects

In language assessment, several socio-demographic variables must be taken into account. Objectives To characterize the performance of aphasic patients with different educational background on language tasks and to compare their performance to that of individuals with no language disorders. Methods Thirty aphasic patients and 30 healthy individuals were selected. Patients were divided into two groups according to educational level: A (1–4 years) n=15 and B (5–11 years) n=15. Age ranged from 27 to 78 years. All subjects were submitted to the Montreal Toulouse language assessment protocol. The pertinent statistical tests were applied. Results Educational level interfered in the linguistic performance of normal subjects but not in that of aphasic subjects, whose performance was influenced more by the lesion. Conclusions The present study can contribute toward greater understanding of the influence of lesions and educational background on the language performance of aphasic subjects.

Medidas de inteligibilidade nos distúrbios da fala: revisão crítica da literatura

Background: the reduction in speech intelligibility is considered one of the main characteristics of individuals with speech disorders, and is an important issue for clinical and research investigation. In spite of its relevance, the literature does not present a consensus on how to measure speech intelligibility. Besides the diversity of existent methods, another important issue refers to the influence of certain variables on these measurements and, consequently, on the interpretation of the results. Aim: to investigate evidence on the agreement between speech intelligibility measurements, obtained through different methods, used in the assessment of speech disorders, and to identify the effect of variables related to assessment procedures or to the listener. A critical review of articles indexed in the databases Medline, Web of Science, Lilacs and Scielo, until October 2007, was carried out. The key-word used to perform the search was speech intelligibility. Conclusion: there was no evidence of agreement between the speech intelligibility measurements obtained through different methods in the investigated literature. This fact limits the comparison between clinic and research results on speech intelligibility of individuals with speech disorders. Besides that, it was observed that some variables can interfere in these measurements, such as: type of task and speech stimulus, signal presentation mode, type of required answer and listeners experience with the speaker. These must be considered when interpreting the results of speech intelligibility tests.