Referred speech-language and hearing complaints in the western region of São Paulo, Brazil

OBJECTIVE: The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of São Paulo, Brazil, highlighting referred speech-language and hearing complaints. METHOD: This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions. RESULTS: Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment. CONCLUSIONS: The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of São Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders. .

Acoustic analyses of diadochokinesis in fluent and stuttering children

OBJECTIVES: The purpose of the study was to acoustically compare the performance of children who do and do not stutter on diadochokinesis tasks in terms of syllable duration, syllable periods, and peak intensity. METHODS: In this case-control study, acoustical analyses were performed on 26 children who stutter and 20 agedmatched normally fluent children (both groups stratified into preschoolers and school-aged children) during a diadochokinesis task: the repetition of articulatory segments through a task testing the ability to alternate movements. Speech fluency was assessed using the Fluency Profile and the Stuttering Severity Instrument. RESULTS: The children who stutter and those who do not did not significantly differ in terms of the acoustic patterns they produced in the diadochokinesis tasks. Significant differences were demonstrated between age groups independent of speech fluency. Overall, the preschoolers performed poorer. These results indicate that the observed differences are related to speech-motor age development and not to stuttering itself. CONCLUSIONS: Acoustic studies demonstrate that speech segment durations are most variable, both within and between subjects, during childhood and then gradually decrease to adult levels by the age of eleven to thirteen years. One possible explanation for the results of the present study is that children who stutter presented higher coefficients of variation to exploit the motor equivalence to achieve accurate sound production (i.e., the absence of speech disruptions).

Redução de sílaba em fala espontânea nas alterações específicas de linguagem / Syllable deletion in spontaneous speech of children with specific language impairment

TEMA: a redução de sílaba (RS) ocorre frequentemente nas Alterações Específicas de Linguagem (AEL), podendo indicar um fator desviante no processo de aquisição fonológica destes sujeitos. OBJETIVO: verificar a ocorrência de RS na fala espontânea de crianças com AEL e a influência dos fatores extensão das palavras e tonicidade para sua ocorrência. MÉTODO: foram sujeitos 27 crianças com AEL, com idades entre 3:0 e 5:11 anos, em tratamento fonoaudiológico semanal, que apresentaram 50 por cento de acertos em provas específicas de fonologia realizadas ou que apresentaram inteligibilidade de fala passível de análise pela fala espontânea. As amostras de fala foram obtidas a partir de interação lúdica com a pesquisadora e pelo discurso eliciado por figuras. A ocorrência de RS foi analisada considerando-se: extensão das palavras produzidas, preferência por sílabas tônicas ou átonas e posição das sílabas nas palavras em que ocorreu RS. RESULTADOS: houve predomínio na produção de palavras dissílabas (X2 = 72,49; p < 0,001), a ocorrência de redução de sílaba foi significantemente maior nas palavras polissílabas (X2 = 11,22; p < 0,004) e as sílabas iniciais foram mais reduzidas (X2 = 34,99; p < 0,001). As sílabas átonas foram reduzidas com maior frequência (Z = -5,79; p < 0,001). CONCLUSÃO: a preferência pela produção de palavras dissílabas confirma a dificuldade dos sujeitos com estruturas silábicas complexas e justifica parte de sua ininteligibilidade em fala espontânea. A predominância da redução de sílabas átonas indica a preferência pela produção do núcleo das palavras, em que a ênfase é dada na sílaba tônica durante a expressão da linguagem.

BACKGROUND: syllable deletion (SD) frequently occurs in Specific Language Impairment and can indicate a deviant factor in the phonologic acquisition process of these subjects. AIM: to verify the occurrence of SD in the spontaneous speech of children with SLI and to verify the influence of word extension and syllable stress in this process. Methods: participants were 27 children with SLI, aged between 3:0 and 5:11 years, in a weekly speech treatment, who presented 50 percent of correct answers in specific phonology assessment tasks or who presented speech intelligibility within levels that allowed assessment through spontaneous speech. Speech samples were obtained during a play interaction situation between the researcher and the child and through speech elicited by the presentation of a picture. The occurrence of SD was analyzed considering the following parameters: extension of the produced words, preference for stressed or unstressed syllables, position of the syllable within the word were SD occurred. RESULTS: there was a preference for the production of dissyllabic words (X2 = 72,49; p < 0,001); the occurrence of SD was significantly higher in polysyllabic words (X2 = 11,22; p < 0,004) and on initial syllables (X2 = 34,99; p < 0,001). Unstressed syllables were more often reduced (Z= -5.79, p <0001). CONCLUSION:the preference for the production of dissyllabic words reassures the difficulty of these children with complex syllabic structures and, in part, explains their spontaneous speech unintelligibility. The predominance of unstressed syllable deletion indicates the preference for producing the nucleus of words, where emphasis is given to the stressed syllable during language expression.

Características iniciais da comunicação verbal de pré-escolares com Alterações Específicas do Desenvolvimento da Linguagem em fala espontânea / Primary characteristics of the verbal communication of preschoolers with Specific Language Impairment in spontaneous speech

OBJETIVO: Verificar desempenho fonológico de pré-escolares com Alterações Específicas do Desenvolvimento da Linguagem (AEDL) em fala espontânea. MÉTODOS: Foram sujeitos 27 crianças com AEDL, entre três anos e cinco anos e 11 meses, em tratamento fonoaudiológico. Foram selecionados aqueles que realizaram ao menos 50 por cento da avaliação da fonologia a partir de provas de nomeação e imitação de palavras, ou que apresentaram inteligibilidade de fala passível de análise. Foram coletadas amostras de fala na prova de pragmática e no discurso eliciado por figuras. Foram realizadas análises a partir da utilização de processos fonológicos do desenvolvimento de linguagem (PD) e idiossincráticos (PI). RESULTADOS: A estatística descritiva (médias de PD e PI) indicou grande variabilidade intra-grupos. Não houve variação em número de processos conforme a idade (PD: p=0,38; PI: p=0,72), porém houve predominância de PD em todas as idades, nas duas provas aplicadas (Z=-6,327; p<0,001). A ocorrência de PD e PI foi maior na prova de pragmática (p<0,001), situação em que o número de palavras produzidas também foi maior (T-valor=8,93; p=0,000). CONCLUSÃO: A grande variabilidade intra-grupo confirma a heterogeneidade dos quadros de AEDL. Pode-se atribuir a ininteligibilidade, que dificulta a avaliação da linguagem expressiva desses sujeitos, à ocorrência de PD e PI concomitantemente. Ademais, a interação desenvolvida durante a prova de pragmática mostrou-se mais efetiva para a obtenção de amostra de fala espontânea para a análise da fonologia, além de confirmar a existência de grandes dificuldades relacionadas à elaboração de idéias e sua expressão em sujeitos com AEDL.

PURPOSE: To verify the phonological performance of preschoolers with Specific Language Impairment (SLI) in spontaneous speech. METHODS: The subjects were 27 children with SLI with ages between three years and five years and 11 months, who attended Speech-Language Pathology therapy. The subjects who carried out at least 50 percent of the phonological assessment or who had speech intelligibility that allowed analysis were selected. Speech samples were obtained from a pragmatics evaluation and from elicited discourse. Analyses considered the use of developmental (DP) and idiossyncratic phonological processes (IP) in spontaneous speech. RESULTS: The descriptive statistics (mean DP and IP) showed large within-group variability. There was no variation in the number of processes according to age (DP: p=0.38; IP: p=0.72), but there was a prevalence of DP in all ages, in both tests (Z=-6.327; p<0.001). The occurrence of DP and IP was higher in the pragmatics evaluation (p<0.001), situation in which the number of words produced was also greater (T-value=8.93; p=0.000). CONCLUSION: The great within-group variability confirms the heterogeneity of SLI. The speech unintelligibility, which hampers the assessment of the expressive language of these subjects, can be attributed to the co-occurrence of DP and IP. Moreover, the interaction during the pragmatics evaluation was more effective for obtaining a sample of spontaneous speech for phonological analysis, and confirms the existence of major difficulties related to the development of ideas and their expression in subjects with SLI.