Monika Brunner

Dental fear in children and adolescents: a comparison of forms of anxiety management practised by general and paediatric dentists

BACKGROUND. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. AIM. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. DESIGN. Eight hundred dentists in Germany were interviewed via e-mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. RESULTS. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. CONCLUSIONS. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety.

The Effect of Nasopharyngoscopic Biofeedback in Patients With Cleft Palate and Velopharyngeal Dysfunction

Objective To evaluate the immediate, long-term, and carry-over effects of nasopharyngoscopic biofeedback therapy in patients with cleft palate who exhibit velopharyngeal dysfunction (VPD). Design Pre- versus posttreatment and follow-up comparisons. Setting Cleft palate center of the Heidelberg University Hospital, Heidelberg, Germany. Subjects Eleven patients with VPD who had received conventional speech therapy without showing significant improvement. Interventions A four-stage feedback procedure. The patients watched and evaluated their velopharyngeal (VP) valving during speech by an endoscopic image displayed on a video monitor. Two feedback sessions took place for every target sound. Main Outcome Measures Mean occurrence of VP closure during speech sound production on different linguistic levels. Patients’ self-perception was assessed by a questionnaire and speech diary. Results Significant improvement and stability of VP closure was noted. Mean occurrence of VP closure was 5% before therapy, 91% after two biofeedback sessions, and 86% in the follow-up after 6 months. Velopharyngeal dysfunction associated with compensatory articulation proved to be equally well trained as VPD on sounds with good articulatory placement. No significant difference was observed in the degree of improvement between phoneme-specific VPD and generalized VPD. The transfer to the level of words and sentences was successful and showed significant stability. The stability of VP closure for vowels was less than the stability for fricatives and stop sounds. Patients gained improved auditory and kinesthetic self-perception of their articulation. Conclusions Nasopharyngoscopic biofeedback therapy proves to be a quick and effective method to change VPD. It shows stable results and carry-over effects.

Validität des Heidelberger Vorschulscreenings zur auditiv-kinästhetischen Wahrnehmung und Sprachverarbeitung

Zusammenfassung. Mit dem Heidelberger Vorschulscreening (HVS) zur auditiv-kinasthetischen Wahrnehmung und Sprachverarbeitung von Brunner et al. (2001) liegt ein Testverfahren vor, das sprachanalytische und artikulatorische Fahigkeiten im Vorschulalter erfasst. Ziel der Studie war die Beurteilung der Validitat des HVS. Die Stichprobe der vorliegenden Untersuchung umfasst 103 Kinder, welche als Vorschulkinder zur Normstichprobe des HVS gehorten und ca. zwei Jahre spater, Mitte der zweiten Klasse, Lese-, Rechtschreib- und Intelligenztests bearbeiteten. Der HVS-Gesamtwert und 6 der 7 Untertests zeigten statistisch bedeutsame, vom Vorzeichen her erwartungsgemase und numerisch im unteren bis mittleren Bereich liegende Korrelationen mit der Lese- und Rechtschreibleistung. Die Korrelationen mit der sprachfreien Intelligenz waren im Vergleich dazu seltener signifikant und durchschnittlich niedriger. Das HVS pruft auf okonomische Weise Fahigkeiten, deren Einschrankung ein Risiko fur den Schriftspracherwerb darstellt.

Heidelberg Phoneme Discrimination Test (HLAD): Normative Data for Children of the Third Grade and Correlation with Spelling Ability

Objective: The Heidelberg Phoneme Discrimination Test (HLAD), developed and standardized in 1998, is widely used in the differential diagnosis of dyslexia. Normative data have only been available for children of the 2nd and 4th grades, while norms for the 3rd grade are still missing. Patients andMethods: We assessed three HLAD subtests [auditory phoneme discrimination, kinesthetic phoneme discrimination (repeating minimal pairs) and phoneme analysis] in 140 children of the 3rd grade from eight elementary schools. Writing capacity was tested via DRT3. Results: Comparing children of the 2nd, 3rd and 4th grades, we found a continuing increase in phoneme discrimination capacity with age. This increase was especially evident for the task of auditory comparison. For the 3rd grade, the correlation between HLAD and writing test (qualitative analysis) was 0.55, and 0.36 between HLAD and writing (quantitative analysis). The correlation with writing tasks was highest in the 2nd grade. Conclusion: The steady increase in phoneme discrimination capacity from the 2nd to 4th grade may indicate maturation and learning effects at least until the age of 10 years.

Entwicklung und Erprobung des Heidelberger Vorschulscreenings zur auditiven Wahrnehmung und Sprachverarbeitung (HVS)

Für die Diagnostik auditiver Wahrnehmung und der Sprachverarbeitung im Vorschulalter fehlten bis jetzt standardisierte deutschsprachige Verfahren. Die Entwicklung eines standardisierten Screenings sollte diese diagnostische Lücke schliessen.Die Endform des Verfahrens wurde an 180 Kindern aus 15 Kindergärten erprobt, statistisch analysiert und auf die Gütekriterien hin untersucht. Das Screening enthält folgende 7 Untertests: auditive Merkspanne, expressive Anlautanalyse, Silben segmentieren, phonematische Differenzierung, Artikulomotorik, Wortfamilien erkennen, Reime erkennen. Die Ergebnisse zeigten, dass Reliabilität und Objektivität gewährleistet sind. Der Extremgruppenvergleich ergab, dass Kinder mit Auffälligkeiten der Artikulation, des Wortschatzes, der Hörleistungen und solche mit mangelnder Schulreife signifikant schlechtere Leistungen im HVS erbrachten als Kinder ohne diese Probleme. Der Test erlaubt Kinder mit Sprachverarbeitungsstörungen rechtzeitig vor der Einschulung zu identifizieren.

Video-Feedback-Therapie mit dem flexiblen Nasopharyngoskop

Psychological interviews with cleft palate patients have revealed why a number of these patients do not profit, or do so only on a limited basis, from conventional speech therapy. They dont control articulation by means of the auditory canal. To treat these patients the video feedback therapy with the nasopharyngoscopy (Witzel et al.) was employed as the initial step. The next step was to expand on this method by establishing indication criteria, necessary diagnostic techniques, and an efficient therapy plan. In this paper a single case study is employed to discuss this method and show the results attained by its use.ZusammenfassungAus psychologischen Interviews mit Spaltpatienten wurde deutlich, warum ein Teil der Patienten von der herkömmlichen logopädischen Therapie nicht oder nur unzureichend profitiert. Für diese Patienten wurde die Methode der Video-Feedback-Therapie mit dem Nasopharyngoskop nachWitzel et al. [11] erprobt und erweitert. Krieterien zur Indikation, die notwendige Diagnostik und ein effizienter Therapieaufbau wurden erarbeitet. Die Methode und Ergebnisse werden anhand einer Einzelfallstudie dargestellt und diskutiert.SummaryPsychological interviews with cleft palate patients have revealed why a number of these patients do not profit, or do so only on a limited basis, from conventional speech therapy. They dont control articulation by means of the auditory chanal. To treat these patients the video feedback therapy with the nasopharyngoscopy (Witzel et al. [11]) was employed as the initial step. The next step was to expland on this method by establishing indication criteria, necessary diagnostic techniques, and an efficient therapy plan. In this paper a single case study is employed to discuss this method and show the results attained by its use.

The management of dental anxiety and impact of psychosomatic factors on dentistry: Is recent scientific research translated into German dental practices?

This study investigated the dentists’ knowledge about psychosomatic medicine. Anxiolytic techniques, considerations about psychosomatic medicine, and referrals to psychotherapists were examined by a questionnaire. Overall, 65 percent felt negatively affected by patients with dental fear. Few dentists used relaxation techniques and hypnosis. The relationship between psychosomatic factors and pain perception was well known, but not their impact on wound healing. The frequency of continuing education courses correlated with a broader range of treatment techniques and less difficulties in treatment. Research evidence about the impact of psychological factors on dental treatment has not been translated into dental practice.

Different patterns of velopharyngeal dysfunction in cleft palate patients

ZusammenfassungHintergrundDie velopharyngeale Dysfunktion (VPD) gilt als therapeutisch schwer beeinflussbar. Um die Therapie zu optimieren, wurden die velopharyngealen Bewegungsmuster während des Sprechakts analysiert.Patienten und MethodeVon 25xa0Patienten wurden Sprechsequenzen von insgesamt 89xa0Lauten, die keinen velopharyngealen Verschluss erzielten, videoendoskopisch aufgezeichnet. Die motorischen Muster der VPD wurden durch 3 mit der Nasopharyngoskopie vertraute Therapeuten kategorisiert. Die Inter-Rater-Reliabilität betrug 94%.ErgebnisseEs fanden sich 4xa0abgrenzbare Formen der VPD: 1. VPD bei rückverlagerter Artikulation (38%), 2. VPD bei Koordinationsstörungen von Bewegungsimpuls und Phonation (15%), 3. VPD bei verbaler Dyspraxie, gekennzeichnet durch Suchbewegungen und unpräzise Regulation des Muskeltonus (10%), 4. Phonemspezifische VPD: Verschlussinsuffizienz nur bei einzelnen Lauten (37%).SchlussfolgerungDie Kenntnis der motorischen Muster ermöglicht es, konkrete therapeutische Strategien abzuleiten.AbstractBackgroundVelopharyngeal dysfunction (VPD) is generally known to be difficult to influence. Dysfunctional velopharyngeal motor patterns during speech were analyzed with the aim of optimizing the therapeutic strategies.MethodsVelopharyngeal dysfunctions were videotaped and contextually analyzed during 89 speech sequences in 25 patients. Distinctive features of the motor patterns formed the basis of categorization by three therapists experienced in nasopharyngoscopy. There was a high inter-rater reliability of 94%.ResultsA total of four different function profiles were found:1. VPD with retracted articulatory placement (compensatory articulation) (38%), 2. VPD with motor coordination problems characterized by mistiming of VP movements and voice onset/offset (15%), 3. VPD with verbal dyspraxia characterized by a silent positioning of VP closure before phonation started and a malregulation of muscle tonus (10%) and 4. phoneme-specific VPD (37%).ConclusionSpecific knowledge regarding the characteristics of dysfunctional speech motor patterns enables specifically tailored therapy.BACKGROUNDnVelopharyngeal dysfunction (VPD) is generally known to be difficult to influence. Dysfunctional velopharyngeal motor patterns during speech were analyzed with the aim of optimizing the therapeutic strategies.nnnMETHODSnVelopharyngeal dysfunctions were videotaped and contextually analyzed during 89 speech sequences in 25 patients. Distinctive features of the motor patterns formed the basis of categorization by three therapists experienced in nasopharyngoscopy. There was a high inter-rater reliability of 94%.nnnRESULTSnA total of four different function profiles were found: 1. VPD with retracted articulatory placement (compensatory articulation) (38%), 2. VPD with motor coordination problems characterized by mistiming of VP movements and voice onset/offset (15%), 3. VPD with verbal dyspraxia characterized by a silent positioning of VP closure before phonation started and a malregulation of muscle tonus (10%) and 4. phoneme-specific VPD (37%).nnnCONCLUSIONnSpecific knowledge regarding the characteristics of dysfunctional speech motor patterns enables specifically tailored therapy.

Formen der velopharyngealen Dysfunktion bei Spaltpatienten

ZusammenfassungHintergrundDie velopharyngeale Dysfunktion (VPD) gilt als therapeutisch schwer beeinflussbar. Um die Therapie zu optimieren, wurden die velopharyngealen Bewegungsmuster während des Sprechakts analysiert.Patienten und MethodeVon 25xa0Patienten wurden Sprechsequenzen von insgesamt 89xa0Lauten, die keinen velopharyngealen Verschluss erzielten, videoendoskopisch aufgezeichnet. Die motorischen Muster der VPD wurden durch 3 mit der Nasopharyngoskopie vertraute Therapeuten kategorisiert. Die Inter-Rater-Reliabilität betrug 94%.ErgebnisseEs fanden sich 4xa0abgrenzbare Formen der VPD: 1. VPD bei rückverlagerter Artikulation (38%), 2. VPD bei Koordinationsstörungen von Bewegungsimpuls und Phonation (15%), 3. VPD bei verbaler Dyspraxie, gekennzeichnet durch Suchbewegungen und unpräzise Regulation des Muskeltonus (10%), 4. Phonemspezifische VPD: Verschlussinsuffizienz nur bei einzelnen Lauten (37%).SchlussfolgerungDie Kenntnis der motorischen Muster ermöglicht es, konkrete therapeutische Strategien abzuleiten.AbstractBackgroundVelopharyngeal dysfunction (VPD) is generally known to be difficult to influence. Dysfunctional velopharyngeal motor patterns during speech were analyzed with the aim of optimizing the therapeutic strategies.MethodsVelopharyngeal dysfunctions were videotaped and contextually analyzed during 89 speech sequences in 25 patients. Distinctive features of the motor patterns formed the basis of categorization by three therapists experienced in nasopharyngoscopy. There was a high inter-rater reliability of 94%.ResultsA total of four different function profiles were found:1. VPD with retracted articulatory placement (compensatory articulation) (38%), 2. VPD with motor coordination problems characterized by mistiming of VP movements and voice onset/offset (15%), 3. VPD with verbal dyspraxia characterized by a silent positioning of VP closure before phonation started and a malregulation of muscle tonus (10%) and 4. phoneme-specific VPD (37%).ConclusionSpecific knowledge regarding the characteristics of dysfunctional speech motor patterns enables specifically tailored therapy.BACKGROUNDnVelopharyngeal dysfunction (VPD) is generally known to be difficult to influence. Dysfunctional velopharyngeal motor patterns during speech were analyzed with the aim of optimizing the therapeutic strategies.nnnMETHODSnVelopharyngeal dysfunctions were videotaped and contextually analyzed during 89 speech sequences in 25 patients. Distinctive features of the motor patterns formed the basis of categorization by three therapists experienced in nasopharyngoscopy. There was a high inter-rater reliability of 94%.nnnRESULTSnA total of four different function profiles were found: 1. VPD with retracted articulatory placement (compensatory articulation) (38%), 2. VPD with motor coordination problems characterized by mistiming of VP movements and voice onset/offset (15%), 3. VPD with verbal dyspraxia characterized by a silent positioning of VP closure before phonation started and a malregulation of muscle tonus (10%) and 4. phoneme-specific VPD (37%).nnnCONCLUSIONnSpecific knowledge regarding the characteristics of dysfunctional speech motor patterns enables specifically tailored therapy.

Formen der velopharyngealen Dysfunktion bei Spaltpatienten@@@Different patterns of velopharyngeal dysfunction in cleft palate patients

ZusammenfassungHintergrundDie velopharyngeale Dysfunktion (VPD) gilt als therapeutisch schwer beeinflussbar. Um die Therapie zu optimieren, wurden die velopharyngealen Bewegungsmuster während des Sprechakts analysiert.Patienten und MethodeVon 25xa0Patienten wurden Sprechsequenzen von insgesamt 89xa0Lauten, die keinen velopharyngealen Verschluss erzielten, videoendoskopisch aufgezeichnet. Die motorischen Muster der VPD wurden durch 3 mit der Nasopharyngoskopie vertraute Therapeuten kategorisiert. Die Inter-Rater-Reliabilität betrug 94%.ErgebnisseEs fanden sich 4xa0abgrenzbare Formen der VPD: 1. VPD bei rückverlagerter Artikulation (38%), 2. VPD bei Koordinationsstörungen von Bewegungsimpuls und Phonation (15%), 3. VPD bei verbaler Dyspraxie, gekennzeichnet durch Suchbewegungen und unpräzise Regulation des Muskeltonus (10%), 4. Phonemspezifische VPD: Verschlussinsuffizienz nur bei einzelnen Lauten (37%).SchlussfolgerungDie Kenntnis der motorischen Muster ermöglicht es, konkrete therapeutische Strategien abzuleiten.AbstractBackgroundVelopharyngeal dysfunction (VPD) is generally known to be difficult to influence. Dysfunctional velopharyngeal motor patterns during speech were analyzed with the aim of optimizing the therapeutic strategies.MethodsVelopharyngeal dysfunctions were videotaped and contextually analyzed during 89 speech sequences in 25 patients. Distinctive features of the motor patterns formed the basis of categorization by three therapists experienced in nasopharyngoscopy. There was a high inter-rater reliability of 94%.ResultsA total of four different function profiles were found:1. VPD with retracted articulatory placement (compensatory articulation) (38%), 2. VPD with motor coordination problems characterized by mistiming of VP movements and voice onset/offset (15%), 3. VPD with verbal dyspraxia characterized by a silent positioning of VP closure before phonation started and a malregulation of muscle tonus (10%) and 4. phoneme-specific VPD (37%).ConclusionSpecific knowledge regarding the characteristics of dysfunctional speech motor patterns enables specifically tailored therapy.BACKGROUNDnVelopharyngeal dysfunction (VPD) is generally known to be difficult to influence. Dysfunctional velopharyngeal motor patterns during speech were analyzed with the aim of optimizing the therapeutic strategies.nnnMETHODSnVelopharyngeal dysfunctions were videotaped and contextually analyzed during 89 speech sequences in 25 patients. Distinctive features of the motor patterns formed the basis of categorization by three therapists experienced in nasopharyngoscopy. There was a high inter-rater reliability of 94%.nnnRESULTSnA total of four different function profiles were found: 1. VPD with retracted articulatory placement (compensatory articulation) (38%), 2. VPD with motor coordination problems characterized by mistiming of VP movements and voice onset/offset (15%), 3. VPD with verbal dyspraxia characterized by a silent positioning of VP closure before phonation started and a malregulation of muscle tonus (10%) and 4. phoneme-specific VPD (37%).nnnCONCLUSIONnSpecific knowledge regarding the characteristics of dysfunctional speech motor patterns enables specifically tailored therapy.