Kátia Nemr

The Relationship Between Tongue Trill Performance Duration and Vocal Changes in Dysphonic Women

OBJECTIVE To assess the relationship between tongue trill performance duration and auditory perception and acoustic changes in dysphonic women. STUDY DESIGN Prospective clinical study, with intrasubject comparison. METHODS Twenty-seven women who had vocal nodules were in the experimental group (EG) (tongue trills), and 10 were also in the control group (CG) (placebo exercises). The voices were recorded before and after experimental and placebo exercises at the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of performance. These recordings were randomized, and the auditory perception analysis was carried out by three judges trained in voice analysis. Individual recordings were analyzed using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol, the randomized pairs of recordings were compared, and the better voice was chosen. VoxMetria software (CTS, Parana, Brazil, www.ctsinformatica.com.br) was used to assess the acoustic. RESULTS In the EG, the CAPE-V results showed a predominance of vocal improvement, statistically proven, at m5 of tongue trill exercise, with the best overall rating, the least roughness and breathiness, and increase in pitch level. At m7, strain was significantly higher. In the paired comparison analysis, voices at m5 were considered the best of all moments. There was an increase of the F(0) and glottal-to-noise excitation after m3 and a decrease in noise as in m1. In the CG, vocal changes were discrete compared with those in the EG. CONCLUSION Tongue trill performance duration interfered with the vocal response of dysphonic women, with positive response predominance at m5. At m7, there was an increase of vocal tension and a drop in vocal quality.

Análise da consistência alimentar e tempo de deglutição em crianças com paralisia cerebral tetraplégica espástica

PURPOSE: to evaluate the alimentary consistency and the deglutition time in children with Cerebral Palsy. METHODS: 30 children between 0 and 12 years, with Cerebral Paralysis of the quadriplegic spastic type been evaluated, that were under speech pathology follow-up. RESULTS: the collected data showed that the verbal phase demonstrated to be inefficient or absent in the majority of the children, as well as in the pharyngeal phase of deglutition. More of the half of the evaluated children have shown between moderate to acute verbal motor dysfunction. In relation to the consistency of food and deglutition times, the children with deeply compromised OMF (Oral Motor Function) took more 14.2 times to swallow liquid foods and more 6.4 times for the pasty food. CONCLUSION: before the study, it is possible to conclude that the major difficulty of the child with cerebral paralysis is the verbal phase of deglutition and as bigger the verbal motor dysfunction, the bigger is the time elapsing for swallowing foods in the three studied consistencies. The relations between OMD (Oral Motor Dysfunction) and deglutition time are directly related.

Efetividade da intervenção fonoaudiológica no tempo de alta hospitalar do recém-nascido pré-termo

PURPOSE: to assess the efficacy of speech therapy in reducing hospital time in pre-term newborns. METHODS: comparing 46 pre-term infants between 2000 and 2002 in Marly Sarney maternity when the speech therapy service was not available in that hospital for 50 pre-term infants between 2002 and 2004 when that service was initiated. Data was obtained from patient charts. RESULTS: among the pre term newborns, those that received speech therapy had a shorter hospitalization time: 88% were discharged between day 1 and day 10, 8% between day 11 and day 20 and just 2% stayed between 41 and 50 days and 2% 61 and 70 days. Among those who did not undergo speech therapy just 47,9% were discharged between day 1 and day 10 17,7% of these patients were discharged between the 11th and the 20th day, 10,4% were discharged between the 21st and 30th days, 9,4% were discharged between 31 and 40 days, 9,4% were discharged between 41 and 50 days, 3,1% were discharged between 51 and 60 days and 2,1% were discharged between 61 and 70 days. This aspect was statistically significant (p-value< 0.000). CONCLUSION: the data showed the efficacy of speech therapy with pre-term infants. There was an association between shorter hospitalization time and speech therapy presence.

Relação entre qualidade de vida e auto-percepção da qualidade vocal de pacientes laringectomizados totais: estudo piloto

PURPOSE: to investigate life quality indications in individuals that underwent a total laryngectomy and their relationship with the vocal quality hearing-perceptive aspects. METHODS: the studied population was made up by six total laryngectomized individuals between 40 and 60-year old, of both genders, esophageal or tracheae-esophageal speech speakers. Life and Voice Quality (QVV) protocol (Behlau et al., 2001) and a fluency scale guide (Robe et al. ,1956) were applied for trials of Speech Therapy graduation and post-graduation students; and voice self-perception guide for trials of total laryngectomized individuals. RESULTS: the values for Physical Dominion of QVV were on average 63.19 and in the Social-Emotional Dominion 80.20, considering 100 as threshold. The subjects that showed a low global score are those that feel a major voice discomfort, referred to as tension and hoarseness and that the examiners classified as subjects with limitations to communicate. The subjects with values within the global high score have a better perception of their voice and underwent speech therapy, having been classified by the group of examiners as good speakers who get to give out sentences or have a fluent speech, with no hesitation. CONCLUSION: the score in the Physical Dominion was higher than in the Social-Emotional Dominion, and such data show that the major discomfort appears in the Physical Dominion. The trials carried through by the professionals and by the total laryngectomized individuals were correlated amongst themselves and with QVV.

Disfunções temporomandibulares: sinais, sintomas e abordagem multidisciplinar

PURPOSE: to check the main signs and symptoms of a sample of patients with temporomandibular dysfunction that were or are under orthodontic treatment and observe if there was a possible multidisciplinary treatment. METHODS: data from 125 medical records collected in a orthodontic clinic located in Sorocaba and the analyzed items were: gender, age, profession, complains, three main signs and symptoms of the patients and if they had been submitted to evaluation with a speech therapist, physiotherapist and psychological. RESULTS: feminine predominance, being 107 women (85.6%) and 18 men (14.4%). Average of age: 35 year-old, being the smallest age 14 years and the largest 74 years. Relationship of temporomandibular dysfunction with the professions: 43 - (34.4%) were professional with contract of employment. Complaint brought by the patient: pain in the area of temporomandibular articulation and masseter: 86 - (68.8%). Three main signs and symptoms observed in the orthodontic evaluation: pain in the temporomandibular articulation and masseter area: 98 - 78.4%; unilateral cracks: 55 - 44% and locking: 23 - 18.4%. Conduct of referrals: speech therapy 59 - (47, 2%); physiotherapy 40 (32%) and psychology 53 (42.4%). CONCLUSION: in the researched sample, the prevalence of cases related to temporomandibular dysfunction was higher in the feminine gender, with pain complaint. The main signs and symptoms were: pain, unilateral crack and locking and there was a referral for multidisciplinary cares for speech therapy, physiotherapy and psychology areas.

Desempenho de indivíduos com Síndrome de Down nos testes de consciência fonológica aplicados com e sem apoio visual de figuras

PURPOSE: this study aims at assessing the performance of individuals with Downs Syndrome when phonological awareness is stimulated with illustrations or not. METHODS: the study involved 40 subjects with Downs Syndrome, of both genders, and still in one of the phases of written language acquisition, separated in two random groups, with similar numbers starting from the same phases. A group of twenty subjects did nine tests of the syllable level CONFIAS test for phonological awareness. The second group of twenty did the version of the same test with the adaptation of illustrations. RESULTS: the results revealed that the total average score of the 20 subjects who did the adapted test was significantly higher than the performance of the other 20 who did the test without illustrations. The use of such visual elements as a support in the assessment of phonological awareness led us to conclude that the results show individuals real ability without the interference of a possible short-term hearing memory deficit. CONCLUSION: the results allow us to state that there is a 95% probability of benefit to individuals with Downs Syndrome when illustrations are used in the tests of phonological awareness.

Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and Gender in Brazilians With and Without Voice Disorders

OBJECTIVES This study aims to analyze the Dysphonia Severity Index (DSI) in Brazilians with or without voice disorders and investigate DSIs correlation with gender and auditory-perceptual evaluation data obtained via the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol. STUDY DESIGN A total of 66 Brazilian adults from both genders participated in the study, including 24 patients with dysphonia confirmed on laryngeal examination (dysphonic group [DG]) and 42 volunteers without voice or hearing complaints and without auditory-perceptual voice disorders (nondysphonic group [NDG]). METHODS The vocal tasks included in CAPE-V and DSI were performed and recorded. Data were analyzed by means of the independent t test, the Mann-Whitney U test, and Pearson correlation at the 5% significance level. RESULTS Differences were found in the mean DSI values between the DG and the NDG. Differences were also found in all DSI items between the groups, except for the highest frequency parameter. In the DG, a moderate negative correlation was detected between overall dysphonia severity (CAPE-V) and DSI value, and between breathiness and DSI value, and a weak negative correlation was detected between DSI value and roughness. In the NDG, the maximum phonation time was higher among males. In both groups, the highest frequency parameter was higher among females. CONCLUSIONS The DSI discriminated among Brazilians with or without voice disorders. A correlation was found between some aspects of the DSI and the CAPE-V but not between DSI and gender.

Relação entre Consciência Fonológica e os Níveis de Escrita de escolares da 1ª série do Ensino Fundamental de escola pública do Município de Porto Real - RJ

PURPOSE: to compare the level of phonological awareness with the writing levels concerning first grade students of the elementary education of a public school of Porto Real Municipal District. METHODS: thirty first grade students of both genders, between seven and eleven-year old, were assessed individually through a phonological awareness test (Capovilla and Capovilla) and through a writing test consisting of five pictures. RESULTS: the syllabic-alphabetic/alphabetic group showed a better performance in six tasks of the test than the presyllabic/syllabic group. CONCLUSION: from the achieved results the outcome is that, there is a significant relation between the abilities of phonological awareness and the writing levels of first grade students of the elementary education in a public school of Porto Real Municipal District.

Efetividade da fonoterapia e proposta de intervenção breve em respiradores orais

PURPOSE: to check the effect of speech and language therapy on a group of mouth breathers, as well proposing a minimum therapy for mouth breathing treatment. METHOD: longitudinal prospective study, casuistic on 40 mouth breather subjects who were patients from the Otorhinolaryngology Ambulatory of UNICAMP Hospital. On weeks 0, 12 and 24, we proceeded photographical documentation, clinical assessment, and protocol application in order to categorize the breathing mode, posture (lips and cheeks), strength and movement (lips, cheeks and tongue). The applied therapeutic proposal consisted of practicing and awareness on nasal breathing; maneuvers to warm and vascularize the orofacial muscles; application of points and motor zones on the face; passive maneuvers; use of distal impulse; myofunctional exercises and register of patients’ perception on their olfactive conditions and nasal obstructions. A non-parametric two proportion equality test was used, p < 0.05. RESULTS: nasal breathing function was adjusted. Increase on lip, tongue and cheek strength. Improvement on the movement: lips pouted to the right and left, snap and lip vibration. Vibration and snap of tongue. Simultaneous inflation of the cheeks, inflation of left and right cheeks alternately. The highest therapeutic gain occurred on 12 weeks. From such data it was possible to come up a protocol made up of 12 structured sessions using the strategies from this study. CONCLUSION: the study has demonstrated the effectiveness of using myofunctional rehabilitation for mouth breathers, and the highest therapeutic evolution took place during the 12th week.

Gagueira e disfluência comum na infância: análise das manifestações clínicas nos seus aspectos qualitativos e quantitativos

OBJETIVO: analisar em seus aspectos qualitativos e quantitativos as manifestacoes clinicas da gagueira e da disfluencia comum na faixa etaria de dois a seis anos. METODOS: revisao de Literatura Sistematica a partir de livros e artigos cientificos de Fonoaudiologia indexados no LILACS e no MEDLINE de 1993 a 2005. RESULTADOS: as diferencas qualitativas mais importantes sao: o tipo de unidade linguistica na qual as disfluencias ocorrem, tipologias de disfluencias, presenca ou ausencia de esforco fisico durante a fala e possiveis dificuldades na linguagem. Pre-escolares com gagueira frequentemente apresentam dificuldades em competencias metalinguisticas, especialmente com as metafonologicas, sendo que mais estudos sobre este aspecto sao necessarios. A frequencia de silabas disfluentes e a taxa de elocucao verbal estao entre os parâmetros quantitativos significativos. CONCLUSAO: diferencas na fala e na linguagem parecem ser fatores importantes para distinguir gagueira de disfluencias comuns infantis.