Marileda Barichello Gubiani

Mudanças fonológicas obtidas no tratamento de sujeitos comparando diferentes modelos de terapia

BACKGROUND There are many options of phonological disorder treatments that aim at improving childrens communication. AIM To analyze the Percentage of Consonants Correct-Revised, the number of acquired phonemes in the phonological system and the types of generalizations obtained in treatment, comparing different therapy models in subjects with different severity levels of phonological disorder. METHOD Participants were 21 children, mean age 5:7 years. All subjects underwent speech, language and hearing evaluations and additional exams. Children were then divided into groups according to therapy model and severity level of phonological disorder. The Percentage of Consonants Correct-Revised, the number of acquired phonemes and the types of generalizations were analyzed and compared within and between each therapeutic model, considering pre and post therapy evaluations. RESULTS It was possible to observe improvement in the three analyzed therapy models. When comparing the therapy models, the greater improvement in percentage terms was observed for the ABAB-Withdrawal and Multiple Probes Model and the Maximal Oppositions Model, even though the statistical analysis indicated no significant difference. CONCLUSION The three therapy models were effective for the treatment of children with phonological disorder because they all of them provided an increase in the Percentage of Consonants Correct-Revised, in the number of acquired phonemes and in the types of analyzed generalizations.

Desvio fonológico e alterações práxicas orofaciais e do sistema estomatognático

PURPOSE: to verify and correlate between each other, the performance of the children with Phonological Disorder and with Typical Phonological Development in the evaluation of the Stomatognathic System and in tests being evaluated yours orofacial praxis abilities. METHODS: the sample consisted of 50 children, of both genders, with ages between four and eight years, with Phonological Disorder and with Typical Phonological Development. It was realized the phonological evaluation through the instrument of the Phonological Evaluation of Children. Then, it has applied the Protocol of the Stomatognathic System and the protocol The Orofacial Praxis Test to evaluate the orofacial praxis abilities. The data had been tabulated and submitted the statistical treatment, considering p<0,05. RESULTS: with regard to Stomatognathic System, statistics difference between the groups was observed only whistles in it, contraction and vibration of lips and vibration of tongue, with lower performance of the children with Phonological Disorder. The same was observed to posture of tongue in the suction. The averages gotten in the praxis abilities tasks carried through after Imitation had been better that after Verbal Request, for all the ages. Still, the children with lower age had more alterations that the biggest, and also the children with Phonological Disorder had more difficulties that the children without speech alterations. CONCLUSION: the children with Phonological Disorder present more alterations of Stomatognathic System and the praxis abilities that those with Typical Phonological Development, with improvement of the same with the advance of the age and been relationship with the speech alterations.

O fonema /r/ e as alterações do sistema estomatognático, idade, gênero e gravidade no desvio fonológico

PURPOSE: To compare the production of the phoneme /r/ in children with phonological disorder (PD) and the stomatognathic system (SS) alterations considering the variables age, gender, and severity of the PD. METHODS: The sample was composed by 113 subjects with PD and SS alterations, of both genders, and with ages between 4 years and 8 years and 11 months, divided into two groups, considering the age range: pre-school age (4 years to 5 years and 11 months), and school age (6 years to 8 years and 11 months). The Childs Phonological Assessment and a stomatognathic system evaluation were carried out. The subjects were divided into two groups, according to the severity of PD: More Severe Degrees (MSD) and Milder Degrees (MD). Considering the phonological system, subjects were divided into GI: /r/ established, and GII: /r/ not established. The collected data were tabulated, analyzed and submitted to statistical analysis. RESULTS: No differences were observed between GI and GII regarding tongue, lips and cheeks position, tonicity and mobility, as well as in SS structures and functions. GI obtained better performance only in tongue vibration. It was verified a correlation between the acquisition of phoneme /r/ and age increase; no correlation was found between the acquisition of /r/ and gender. MSD of PD were more frequent in GII, and MD in GI. CONCLUSION: There is no relation between alterations in the PS and in structures and functions of the SS in children with PD; PD is related only with childrens age.ABSTRACT Purpose: To compare the production of the phoneme /r/ in children with phonological disorder (PD) and the stomatognathic system (SS) alterations considering the variables age, gender, and severity of the PD. Methods: The sample was composed by 113 subjects with PD and SS alterations, of both genders, and with ages between 4 years and 8 years and 11 months, divided into two groups, considering the age range: pre-school age (4 years to 5 years and 11 months), and school age (6 years to 8 years and 11 months). The Child’s Phonological Assessment and a stomatognathic system evaluation were carried out. The subjects were divided into two groups, according to the severity of PD: More Severe Degrees (MSD) and Milder Degrees (MD). Considering the phonological system, subjects were divided into GI: /r/ established, and GII: /r/ not established. The collected data were tabulated, analyzed and submitted to statistical analysis. Results: No differences were observed between GI and GII regarding tongue, lips and cheeks posi-tion, tonicity and mobility, as well as in SS structures and functions. GI obtained better performance only in tongue vibration. It was verified a correlation between the acquisition of phoneme /r/ and age increase; no correlation was found between the acquisition of /r/ and gender. MSD of PD were more frequent in GII, and MD in GI.

Instrumentos para avaliação de apraxia de fala infantil

PURPOSE This study systematically reviews the literature on the main tools used to evaluate childhood apraxia of speech (CAS). RESEARCH STRATEGY The search strategy includes Scopus, PubMed, and Embase databases. SELECTION CRITERIA Empirical studies that used tools for assessing CAS were selected. DATA ANALYSIS Articles were selected by two independent researchers. RESULTS The search retrieved 695 articles, out of which 12 were included in the study. Five tools were identified: Verbal Motor Production Assessment for Children, Dynamic Evaluation of Motor Speech Skill, The Orofacial Praxis Test, Kaufman Speech Praxis Test for Children, and Madison Speech Assessment Protocol. There are few instruments available for CAS assessment and most of them are intended to assess praxis and/or orofacial movements, sequences of orofacial movements, articulation of syllables and phonemes, spontaneous speech, and prosody. CONCLUSION There are some tests for assessment and diagnosis of CAS. However, few studies on this topic have been conducted at the national level, as well as protocols to assess and assist in an accurate diagnosis.

Factors Influencing Consonant Acquisition in Brazilian Portuguese–Speaking Children

Purpose We sought to provide valid and reliable data on the acquisition of consonant sounds in speakers of Brazilian Portuguese. Method The sample comprised 733 typically developing monolingual speakers of Brazilian Portuguese (ages 3;0-8;11 [years;months]). The presence of surface speech error patterns, the revised percentage consonants correct, and the age of sound acquisition were evaluated using phonological assessment software. The normative values for these variables were reported using means and standard deviations. Results Age had a significant impact on phoneme production. Increasing age was generally associated with an increase in correct phoneme production, a reduction in error patterns, and an increase in scores on revised percentage consonants correct. Phonological error patterns persisted for a longer time in consonants and consonant clusters acquired later in development. The 2 youngest age groups differed from the remainder of the sample on the frequency of the following phonological patterns: cluster reduction, liquid gliding, fricative deletion-coda, and weak-syllable deletion. Performance was similar between groups starting at 5;0 years old. Conclusion This study confirmed that nasal and stop consonants are acquired first, followed by fricatives and, finally, liquids. We suggest that future studies replicate our investigation in larger samples and younger age groups.

Orofacial Praxis Abilities in Children with Speech Disorders.

Introduction Phonological development occurs in a gradual manner until the age of 7 years. The phonological system is constructed in a similar way for all children, despite presenting some variations in terms of age, paths taken, or repair strategies used. Objective To compare the orofacial praxis abilities of children with typical phonological development (DFT), children with phonetic-phonological impairment (DFoFe), and children with phonological impairment (DF), using two tests to assess the orofacial praxis abilities. Methods The sample consisted of 82 subjects between 4 and 8 years of age who attended public schools (from preschool to the second year of secondary school) in the city of Santa Maria, Brazil. Of these, 29 were diagnosed with DFT, 29 with DF, and 24 with DFoFe; much of this sample was male. Two tests of praxis abilities and assessment of the stomatognathic system were administered. Statistical analysis was performed using the chi-square test, with a significance level of 5%. Results Generally children with DFoFe underperformed in tests of praxis when compared with subjects with DF and DFT. Conclusion The results showed that children with DFoFe have more difficulty in orofacial praxis abilities than subjects in the other groups studied. This result could be expected, because subjects with DFoFe show changes in both phonetic and phonological levels of speech.

Desempenho de crianças com distúrbios dos sons da fala no instrumento "Avaliação dinâmica das habilidades motoras da fala"

Purpose To compare performance between children with typical speech acquisition, phonological disorders, and childhood apraxia of speech for the variables overall articulatory accuracy and consistency of the Dynamic Evaluation of Motor Speech Skill - Brazilian Portuguese version (DEMSS-BR). Methods Study participants were 18 children of both genders aged 4 years and 6 months to 5 years and 8 months. The sample was divided into three groups: six children with typical speech acquisition (TSA), six children with phonological disorder (PD), and six individuals with childhood apraxia of speech (CAS). All participants were submitted to the DEMSS-BR and had their subscores of speech accuracy and consistency measured. Performance comparison between the groups was statistically evaluated using the Mann-Whitney U Test. Results Participants in the group with CAS presented poorer performance for the variables overall articulatory accuracy and consistency compared with those of participants in the other two groups. Conclusion The group of children with childhood apraxia of speech presented poorer performance on the DEMSS-BR compared with those of the groups with typical speech acquisition and phonological disorders. The study demonstrated that the DEMSS-BR assists with differential diagnosis of children with speech sound disorders.

Evidências de validade e fidedignidade de um instrumento de avaliação fonológica

PURPOSE To present evidence of the validity and reliability of a phonological assessment tool developed to assess the phonological inventory of Brazilian Portuguese. METHODS The study included 866 children aged between 3 and 8:11 years, divided into three groups: typical, control and clinical. Participants were evaluated using a phonological assessment software, which prompted the spontaneous naming of a series of images. The childrens responses were audio recorded and transcribed at the time of the assessment, by the software itself. The Cronbachs alpha coefficient was used to evaluate the internal consistency of the instrument for reliability and validity purposes. Criterion validity was examined by comparing the performance of different groups using Students t-test for independent samples. Intra- and inter-rater agreement were investigated using Kendalls tau. Results were considered significant at p ≤ 0.05. RESULTS The present study provided evidence of validity and reliability (internal consistency) for this phonological assessment tool, confirming the reliability of its items and demonstrating excellent agreement rates between examiners regarding its scoring (intra- and inter-rater reliability). The criterion validity assessment demonstrated that the control group outperformed the clinical group across all phonemes, showing that test scores were successful in identifying children with speech sound disorders (phonological disorders). CONCLUSION The present findings provide strong evidence of the validity and reliability of this phonological assessment tool.

Ocorrência do desvio fonológico e de processos fonológicos em aquisição fonológica típica e atípica

Objetivo Determinar a ocorrencia de desvio fonologico quanto a idade, genero e tipo de escola, alem de verificar e analisar os processos fonologicos em casos de aquisicao fonologica tipica e atipica em diferentes faixas etarias. Metodo Participaram 866 criancas com idades entre 3:0 e 8:11, matriculadas em escolas publicas e privadas de Santa Maria-RS. Realizou-se avaliacao fonologica para analisar os processos fonologicos operantes. Resultados 15,26% (n = 132) das criancas avaliadas apresentavam aquisicao fonologica atipica (desvio fonologico). As escolas publicas tiveram maior ocorrencia de desvio fonologico para todas as idades pesquisadas. Houve maior ocorrencia de desvio fonologico nas idades de 4 anos, 5 anos e 6 anos. O genero masculino teve maior ocorrencia que o feminino, com excecao na idade de 3 anos. Na aquisicao fonologica tipica, os processos que mais ocorreram foram: reducao do encontro consonantal, apagamento de liquida nao lateral em coda, substituicao de liquida nao lateral em onset, semivocalizacao de liquida nao lateral em coda e apagamento de silaba atona. No desvio fonologico, foram: substituicao de liquida lateral e nao lateral em onset, apagamento de liquida nao lateral, anteriorizacao de fricativa em onset, apagamento de silaba atona, semivocalizacao de liquida nao lateral em coda e apagamento de liquida nao lateral em coda. Conclusao A media da ocorrencia foi considerada alta e mais frequente nos meninos. E importante saber a ocorrencia e conhecer os processos fonologicos operantes na fala das criancas, pois estes podem auxiliar no diagnostico precoce das alteracoes fonologicas, bem como na elaboracao do planejamento terapeutico.Purpose To determine the occurrence of phonological disorders by age, gender and school type, and analyze the phonological processes observed in typical and atypical phonological development across different age groups. Methods The sample consisted of 866 children aged between 3:0 and 8:11 years, recruited from public and private schools in the city of Santa Maria/RS. A phonological evaluation was performed to analyze the operative phonological processes. Results 15.26% (n = 132) of the sample presented atypical phonological acquisition (phonological disorders). Phonological impairments were more frequent in public school students across all age groups. Phonological alterations were most frequent between ages 4 -to 6, and more prevalent in males than females in all but the youngest age group. The most common phonological processes in typical phonological acquisition were: cluster reduction; nonlateral liquid deletion in coda; nonlateral liquid substitution in onset; semivocalization of lateral liquids in coda; and unstressed syllable deletion. In children with phonological disorders, the most common phonological processes were: lateral and nonlateral liquid substitution in onset position; nonlateral liquid deletion; fronting of fricatives in onset position; unstressed syllable deletion; semivocalization of nonlateral liquid in coda; and nonlateral liquid deletion in coda position. Conclusion Phonological processes were highly prevalent in the present sample, and occurred more often in boys than in girls. Information regarding the type and frequency of phonological processes in both typical phonological acquisition and phonological disorders may contribute to early diagnosis and increase the efficiency of treatment planning.

Mudanças no sistema fonológico após terapia fonológica de abordagem contrastiva

Objetivo: Verificar as mudancas no sistema fonologico (aquisicao de fonemas) e na gravidade do desvio fonologico de sujeitos submetidos a terapia fonologica de abordagem contrastiva, em comparacao a um grupo de sujeitos sem intervencao. Metodos: A amostra foi constituida por 18 sujeitos com idades entre 4 anos e 10 meses e 7 anos e 4 meses, de ambos os generos, com diagnostico de desvio fonologico. Nove sujeitos constituiram o Grupo Experimental (submetidos a terapia fonoaudiologica) e os outros nove constituiram o Grupo Controle (em lista de espera para terapia fonoaudiologica). Todos foram avaliados antes e apos o periodo de terapia de abordagem contrastiva, recebida apenas pelo Grupo Experimental. Os sujeitos de ambos os grupos foram pareados quanto a idade, a gravidade do desvio fonologico, ao numero de fonemas ausentes na primeira Avaliacao Fonologica, e ao periodo de tempo entre a primeira e a segunda avaliacao fonologica. Verificou-se o numero de fonemas adquiridos no sistema fonologico geral e calculou-se o Percentual de Consoantes Corretas-Revisado para a determinacao da gravidade do desvio fonologico, em ambas as avaliacoes fonologicas. Os dados foram analisados estatisticamente. Resultados: O Grupo Experimental adquiriu maior numero de fonemas, que determinaram mudanca na gravidade do desvio fonologico. As diferencas encontradas entre ambos os grupos foram significativas. Conclusao: A terapia fonologica de abordagem contrastiva promove mudancas no sistema fonologico, que influenciam significativamente a aquisicao de fonemas e a mudanca da gravidade.