Protocolo de avaliação para apraxia de fala adquirida / Assessment protocol for acquired apraxia of speech

RESUMO Objetivo Elaborar um protocolo de avaliação do planejamento motor da fala com estímulos fonologicamente balanceados para o português brasileiro e que contemple todas as variáveis necessárias para este diagnóstico. Método Foram realizadas três etapas: Na primeira, construíram-se listas de palavras cujo critério principal foram os padrões silábicos e acentuais. Do levantamento realizado na Etapa 1, procedeu-se à seleção dos vocábulos que compuseram a primeira versão do protocolo na Etapa 2, reunidas em duas tarefas: de repetição e de Leitura em Voz Alta (LVA). Em seguida, investigou-se a ocorrência das palavras usando a base de dados do Corpus Brasileiro (PUC-SP) - Linguateca. Na etapa 3 realizou-se a análise estatística para verificar se as listas de repetição e de LVA estavam equilibradas quanto à ocorrência das palavras. Assim, as listas foram distribuídas em quartis e foram analisadas de forma descritiva e bivariada. O nível de significância utilizado foi de 5%. Resultados Após a realização de todas as etapas, foi possível obter as palavras que compuseram as listas das tarefas de repetição e de LVA. Finalmente, foram então acrescidas ao protocolo as demais tarefas consideradas essenciais para a avaliação da apraxia como as taxas diadococinéticas e a prancha para a emissão oral espontânea. Conclusão O protocolo desenvolvido contém as tarefas consideradas padrão para a avaliação da apraxia de fala pela literatura internacional, o que torna esse instrumento importante para o diagnóstico desse distúrbio em falantes do português brasileiro.

ABSTRACT Purpose To develop an assessment protocol for speech motor planning with phonologically balanced stimuli for Brazilian Portuguese, including all necessary variables for this diagnosis. Methods Three stages were carried out: In the first, word lists were built with the main criterion being syllabic and accentual patterns. From the survey conducted in Stage 1, the words that composed the first version of the protocol lists in Stage 2 were selected, and grouped into two fundamental tasks for diagnosing acquired apraxia of speech (AOS): repetition and Reading Aloud (RA). In Stage 3, the occurrence of words was investigated using the Brazilian Corpus (PUC-SP) - Linguateca database, and a statistical analysis was performed to verify if the repetition and RA lists were balanced in terms of the occurrences. Thus, the lists were distributed in quartiles and submitted to both descriptive and bivariate analyses. A significance level of 5% (p<0.05) was adopted. Results After completion of all stages, the words that composed the lists of the repetition and RA tasks were obtained. Finally, other tasks considered essential for the assessment of AOS, such as diadochokinetic rates and the board for spontaneous oral emission, were then added to the protocol. Conclusion The developed protocol contains the tasks considered standard for the assessment of AOS according to the international literature, which makes this instrument important for diagnosing this disorder in speakers of Brazilian Portuguese.

Instrumento de Avaliação Fonológica: evidências de validade de construto / Phonological Assessment Instrument: evidence of construct validity

RESUMO Objetivo Investigar evidências de validade de construto para um Instrumento de Avaliação Fonológica para o Português Brasileiro, baseadas nos dados de diagnóstico gerados por sua própria aplicação a partir da análise contrastiva e do grau de severidade de fala. Método A amostra foi composta por dados de 176 crianças, com idades entre cinco até nove anos. Foram avaliadas pelo Instrumento de Avaliação Fonológica e classificadas em com transtorno fonológico ou em desenvolvimento fonológico típico, comparando tais resultados aos critérios para o transtorno no DSM-5. A busca por evidências da validade de construto contou com a concordância entre os dois métodos de avaliação, aplicando o Coeficiente Kappa. Para a diferenciação entre os grupos, utilizou-se o teste t de Student para amostras independentes. Buscou-se a investigação dos índices do instrumento pela estatística da Curva de Receiver Operating Characteristic para obter valores de área, ponto de corte, sensibilidade, especificidade, acurácia, valor preditivo positivo e negativo. Resultados O instrumento apresentou concordância e diferenciação significativa entre as classificações. Quanto aos parâmetros de desempenho, exibe ponto de corte para diagnóstico com resultados iguais ou maiores do que 96,17%, excelente valor de área sob a curva, assim como percentuais satisfatórios para as outras análises investigadas. Conclusão O conjunto de dados encontrados indicam evidências para validade de construto do Instrumento de Avaliação Fonológica, apresentando uma contribuição útil e válida ao arsenal de avaliação clínica e de pesquisa envolvendo diagnóstico de Transtorno Fonológico e, com seu resultado de acurácia, contribuiu as propriedades de desempenho dos instrumentos utilizados na Fonoaudiologia.

ABSTRACT Purpose To investigate evidence of construct validity for a Phonological Assessment Instrument for Brazilian Portuguese, based on the diagnostic data generated by its application from contrastive analysis and speech severity. Methods The sample consisted of 176 children, aged between five to nine years old. They were evaluated with the Phonological Assessment Instrument and then classified as having Speech Sound Disorder or in typical phonological development, comparing these results to the criteria described for the disorder in the DSM-5. The search for evidence of construct validity relied on the agreement between the two assessment methods while applying the Kappa Coefficient. To differentiate between groups, Student's t-test was used for independent samples. We sought to investigate the instrument indexes using the Receiver Operating Characteristic Curve statistics to obtain values for area, cut-off point, sensitivity, specificity, accuracy, and positive and negative predictive value. Results The instrument showed agreement and significant differentiation between the classifications. As for the performance parameters, it shows a cut-off point for diagnosis with results equal to or greater than 96.17%, an excellent area under the curve, as well as satisfactory percentages for the other analyses investigated. Conclusion The data indicated evidence for the construct validity of the Phonological Assessment Instrument, presenting a useful and valid contribution to the arsenal of clinical assessment and research involving the diagnosis of Speech Sound Disorder and, with its accuracy result, contributed to the properties of performance of instruments used in Speech, Language and Hearing Sciences.

Uso do método de Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares (PROMPT) no Transtorno do Espectro Autista: um estudo de caso / Use of the Prompts for Reestructuring Oral Muscular Phonetic Targets (PROMPT) in Autism Spectrum Disorder: a case study

RESUMO O Transtorno do Espectro Autista (TEA) é classificado pelo Manual de Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) como um Transtorno do Neurodesenvolvimento, sendo caracterizado, principalmente, por alterações na comunicação social e pela presença de um repertório restrito de atividades e interesses. Na literatura, há muitos estudos sobre autismo, fala e linguagem, mas poucos correlacionando fala e autismo. Este estudo teve como finalidade realizar um estudo de caso que abordou autismo, fala e PROMPT (Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares) e mensurou a melhora da fala no participante com autismo, utilizando o método. Foram definidas palavras-alvo para toda a intervenção, conforme o Sistema de Observação e Análise (SOA) e Hierarquia Motora de Fala (HMF), que fazem parte da avaliação de PROMPT. Após a avaliação, o participante foi atendido por 16 sessões, uma vez semanalmente. Após análise dos dados, observou-se melhora em todos os aspectos que foram delineados de acordo com a avaliação no pré-tratamento, como controle fonatório, controle mandibular, controle lábio-facial e controle lingual, como também no movimento sequenciado, apesar deste não ser o objetivo traçado na avaliação. Também foi possível mensurar melhora no número de vocábulos adequados, número de fonemas adequados, porcentagens de consoantes corretas - revisado (PCC-R) e inteligibilidade.

ABSTRACT Autism Spectrum Disorder (ASD) is classified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a neurodevelopmental disorder, whose characteristics are mainly deficits in social communication and a restricted range of interests. There are several studies about autism, speech, and language in the literature, but few correlate speech and autism. This study aims to carry out a case study that will address autism, speech, and PROMPT (Restructuring Oral Muscular Phonetic Targets) and also to describe the speech improvement in the participant with autism using the method. The target words were defined for the entire intervention according to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH), which are parts of the PROMPT evaluation. After the evaluation, the participant was attended for 16 sessions, once weekly, with the objective of improving their speech. After analyzing the data, it was possible to observe improvement in all aspects outlined according to the pre-treatment evaluation of the method such as phonatory control, mandibular control, lip-facial control and lingual control as well as in the sequenced movement although this was not the aim outlined in the evaluation. It was also possible to measure the improvement of an adequate number of words, an adequate number of phonemes, percentages of correct consonants - revised (PCC-R), and intelligibility.

Analysis of the characteristics and therapeutic effect of consonant errors in children with functional articulation disorders at different ages / 口腔疾病防治

Objective@#Analyzing the characteristics of consonant errors in children with functional dysarthria in different age groups and the effect of speech training provides a reference for clinical treatment. @*Methods @#This study followed medical ethics, and informed consent has been obtained from patients. Speech data from 388 patients with functional dysarthria were retrospectively studied. They were divided into two groups at the age of 6, namely, the preschool group (4-6 years old) of 226 patients and the school age group (6-13 years old, including 6 years old) of 162 patients. The characteristics of consonant pronunciation errors from four aspects were analyzed: average number of errors, pronunciation location, pronunciation method, and error type. One-on-one speech training was conducted, with a training frequency of once a week and once for 30 minutes. The training method was carried out in the order of phoneme training, syllable training, vocabulary training, sentence training, and short text and conversation training. The effects of speech training in the two groups were compared. @*Results@#Analysis by pronunciation location: both age groups had the highest frequency of errors in tongue tip posterior sounds; the school age group had the lowest error frequency for labiodental consonants, and the preschool group had the lowest error frequency for bilabial consonants. According to the analysis of pronunciation mode, both age groups had the highest error frequency of aspirated affricate and the lowest error frequency of nasal sound. Analysis by error type: both age groups are mainly characterized by substitution and omission. Compared with the preschool group, most consonants of patients in the school group tend to improve in terms of pronunciation location, pronunciation mode, and error types. Compared with the preschool group, the two types of errors-palatalization and lateralization-increased in frequency in the school group, but the trend of increased lateralization was not statistically significant. After 6.7 and 5.5 sessions of speech training, the pronunciation of the preschool group and the school-age group significantly improved; the cure rate of the school-age group was 84.9% (118/139), and that of the preschool group was 77.1% (91/118). There was no statistically significant difference in the cure rate between the two groups.@*Conclusion@# Functional dysarthria may improve with age, but it may not completely self-heal. Children of different age groups can achieve good treatment results through scientific and reasonable speech training.

Research progress on early speech interventions for children with cleft lip and palate / 口腔疾病防治

@#Children born with cleft lip and palate (CLP) are at high risk of disorders involving early speech production, and these problems can persist into later childhood, leading to the emergence of compensatory articulation errors. These difficulties in early vocalization directly impact the subsequent development of children's speech and vocabulary. Studies have shown that providing naturalistic interventions, such as milieu teaching and focused stimulation, for children with CLP in the first three years of life have positive impacts on the speech development of children, such as the potential to increase phonemic inventories and the percentage of correct consonants. In addition to speech and language therapists who perform systematic speech therapy, parents can be trained and supervised to deliver early speech intervention. The percentage of correct consonants can be used to assess outcome measures of speech intervention when combined with other measures, such as consonant inventory and speech intelligibility. However, much recent research in the field has focused on older children. Therefore, it must be determined if intervening during the early phase of typical speech development leads to better results. Future research should use more robust methodological designs to determine whether early speech intervention exhibits a positive impact on the speech and future physical and mental development of children with CLP.

Use of the diadochokinetic index DDKCCVP% in the detection of articulatory inaccuracies in Parkinson's disease: a preliminary exploratory study / Utilidad del índice diadococinético DDKCVP% para la detección de imprecisiones articulatorias en enfermedad de Parkinson: estudio exploratorio preliminar

ABSTRACT Purpose: to explore whether the diadochokinetic index of syllable production variability (DDKcvp%) is useful for the detection of articulatory inaccuracies in different stages of Parkinson's disease (PD). Methods: a diadochokinetic speech task of the consonant-vowel type [pa-pa-pa] was applied to 18 people with PD (classified in stages of progression from 1 to 5 according to the Hoehn & Yahr scale) to determine their diadochokinetic performance. Records of the study group were compared to a reference value obtained from a control group made up of 40 subjects. Results: 77.78% of the study group showed articulatory inaccuracies. The DDKcvp% index allowed to detect articulatory difficulties from stage 1 of PD, and its variation showed that articulatory deficits were permanent from stage 2 onwards. A significant and direct correlation was obtained between the increase in the DDKcvp% index and the increase in the stage of evolution of the participants. Conclusion: DDKcvp% index evaluated by means of a simple and fast consonant-vowel diadochokinetic task [pa-pa-pa], could be useful to determine articulatory inaccuracies in different stages of PD, although it is suggested that investigation of this index in larger sample sizes be conducted.

RESUMEN Objetivo: explorar si el índice diadococinético de variabilidad de la producción silábica (DDKcvp%) es útil para la detección de imprecisiones articulatorias en distintos estadios de la Enfermedad de Parkinson (EP). Métodos: se aplicó una tarea diadococinética de habla del tipo consonante-vocal [pa-pa-pa] a 18 personas con EP (clasificadas en estadios de evolución del 1 al 5 según la escala Hoehn & Yahr) para determinar su rendimiento diadococinético. Los registros del grupo de estudio fueron comparados con un valor de referencia obtenido de un grupo control compuesto por 40 personas. Resultados: el 77,78% del grupo de estudio evidenció imprecisiones articulatorias. Además, el índice DDKcvp% permitió pesquisar dificultades articulatorias desde el estadio 1 de la EP, y su variación evidenció que los déficits articulatorios son permanentes desde el estadio 2 en adelante. También, se obtuvo una correlación significativa y directa entre el aumento del índice DDKcvp% con el incremento del estadio de evolución en el que se encontraban los participantes. Conclusión: el índice DDKcvp%, evaluado mediante una tarea diadococinética simple y rápida tipo consonante-vocal [pa-pa-pa], podría presentar una correcta utilidad para determinar imprecisiones articulatorias en distintos estadios de la EP, aunque se sugiere continuar investigando este índice en tamaños muestrales más amplios.

Acoustic analysis of an articulation assessment and training system / 中华物理医学与康复杂志

Objective:To compare the differences in important parameters between the articulation assessment and training system of intelligently extracted speech with those from the Praat acoustic software and those manually extracted.Methods:The speech of thirty-two normal subjects was captured using the intelligent articulation assessment and training system and using Praat acoustic software. The former analyzed the mean fundamental frequencies (mF0s), the first formant peaks (F1s) and the second formant peak (F2s) of the sustained vowels /a/, /i/ and /u/. The speech parameters collected by the traditional Praat software were extracted and analyzed by professionals. The two tools′ consistency in terms of these important acoustic parameters was analyzed.Results:The results with all 32 subjects when retested returned ICC values above 0.9 with all three vowels with the exception of mF0 for /u/ (ICC=0.75), indicating excellent retest reliability for the articulation assessment and training system. The ICC values also indicated excellent consistency between the two kinds of software in analyzing mF0, F1 and F2 of the three vowels. The mF0, F1, F2, FCR, VAI, tongue spacing, VSA, and mandibular spacing of all three vowels were mostly distributed within the 95% confidence interval of the data points in Bland-Altman plots, indicating the high accuracy of both acoustic analysis systems in speech measurement. The mean fundamental frequency values of the male long vowels /a/, /i/ and /u/ were all significantly lower than for the female long versions.Conclusions:The retest reliability of the articulation assessment and training system was good, and the results of the articulation check in the natural state were in good consistency compared to the Praat check and were interchangeable in the articulation check.

Articulación de maestrías y especialidades con el doctorado en la Escuela Nacional de Salud Pública / A proposal for the articulation of specialties and master's with doctoral programs in the National School of Public Health

Introducción: La formación doctoral recaba relaciones internas entre los escenarios científicos y académicos. Objetivo: Exponer la propuesta de articulación de las maestrías y especialidades con el proceso de formación doctoral en la Escuela Nacional de Salud Pública. Métodos: Se realizó un estudio cualitativo fenomenológico, en el que participaron doctores de la Escuela Nacional de Salud Pública con implicación en la formación doctoral de otras formas académicas y graduados. Se realizó un grupo de discusión mediante un foro virtual, donde se discutió la necesidad de contar con un plan de acción para la articulación, así como su conformación definitiva. Resultados: Las voces apoyaron la necesidad de contar con dicha articulación y emitieron criterios que permitieron el perfeccionamiento de la propuesta sometida a debate. Conclusiones: La articulación especialidad-maestría-doctorado de la Escuela Nacional de Salud Pública garantiza el involucramiento de los actores implicados en su ejecución y permite avizorar los logros que se propone en cuanto al fortalecimiento de la formación doctoral de la institución, desde sus propias formas académicas. Deberá favorecer el tránsito rápido y exitoso de un mayor número de profesionales hacia la formación doctoral en ciencias de la salud. Sus presupuestos, propósitos, acciones y responsables responden a las circunstancias en que esta propuesta surge y a las necesidades actuales, lo cual no limita su perfeccionamiento continuo y necesario(AU)

Introduction: Doctoral training comprises internal relationships between scientific and academic scenarios. Objective: To show a proposal for articulating the master's program and specialties with the doctoral training process of the National School of Public Health. Methods: A qualitative and phenomenological study was carried out, with the participation of doctors from the National School of Public Health involved in the doctoral training of other academic modalities and graduates. A discussion group was held through a virtual forum, where the need for an articulation action plan was discussed, as well as its definitive creation. Results: The speaking participants supported the need to have such articulation and issued criteria that allowed the improvement of the proposal submitted for discussion. Conclusions: The specialty-master's program-doctorate program articulation of the National School of Public Health guarantees that actors be involved in its implementation and makes it possible to foresee the proposed achievements in terms of strengthening the institution's doctoral training, based on its own academic modalities. It should favor the rapid and successful transition of a greater number of professionals towards doctoral training in health sciences. Its foundations, purposes, actions and responsible actors respond to the circumstances in which this proposal arises, as well as to the current needs, which does not limit its continuous and necessary improvement(AU)

Understanding speech disorders for clinical practice

Speech is the vocal utterance of language and it is considered disordered in three underlying ways: voice, articulation, and fluency, its disorder is to be studied from same pattern. The features that should be considered in determining a voice disorder are: Volume: how loudly or softly we speak, Pitch: how pleasant or unpleasant Quality: the highness or lowness of one’s voice, Rate: the speed at which one speaks. Homeoapthic repertory shows these symptoms, but caution is mechanical problem should not consider as dynamic derangement.

Speech training based on mirror neuron theory can improve children′s functional articulation disorders / 中华物理医学与康复杂志

Objective:To observe the effect of speech training based on mirror neuron theory on children with functional articulation disorder (FAD).Methods:Fifty children with FAD were randomly divided into a training group and a control group, each of 25. Both groups received 30 minutes of conventional speech training 5 times a week for 24 weeks, while the training group was additionally given 20 minutes of speech training based on mirror neuron theory simultaneously. Before and after the intervention, both groups were evaluated using the articulation speech ability assessment scale and the oral motor ability assessment scale.Results:Before the treatment, there were no significant differences between the 2 groups in any of the measurements. After the treatment, significant improvement was observed in all of the measurements for both groups, but at that point the training group′s articulation, motor ability of the lower jaw, tongue and lips were all significantly superior to the control group′s averages.Conclusions:Speech training based on mirror neuron theory can significantly improve the articulation, intelligibility and oral motor functioning of children with functional articulation disorder.

Influência da qualidade das próteses totais na prevalência de disfunção temporomandibular / Influence of quality of total prostheses on the prevalence of temporomandibular disorder

Introduction Temporomandibular disorder (TMD) involves the mastication and temporomandibular articulation muscles. Completely toothless patients with prostheses should be thoroughly assessed since edentulism causes damage that can lead to TMD onset. Objective This study aims to assess the effect of the technical quality of total prostheses (TPs) on TMD occurrence in patients with bimaxillary TPs. Material and method 154 patients responded to a questionnaire to obtain personal data, information regarding prostheses, anamnestic index for TMD, and the prosthesis quality index. Result Of the 154 patients examined, 64 (41.6%) had no TMD, 61 (39.6%) had mild TMD, 23 (14.9%) moderate, and only 6 (3.9%) showed severe TMD. As for the quality of total prosthesis, 78 (50.6%) completely toothless individuals had satisfactory TPs while 76 (49.4) presented unsatisfactory prostheses. Regarding the time using total prosthesis, around 50% of individuals with up to 10 years use presented some degree of TMD and 70% of individuals with over 10 years presented TMD. Conclusion Considering the methodology used and the population studied, we conclude that the quality of the TPs did not influence the incidence of TMD.

Introdução A disfunção temporomandibular (DTM) é uma desordem que envolve os músculos da mastigação e da articulação temporomandibular. Pacientes desdentados totais e que utilizam protéses requerem uma avaliação criteriosa, já que o edentulismo leva a prejuízos que podem contribuir para o aparecimento de DTM. Objetivo O objetivo deste presente estudo foi avaliar o efeito da qualidade técnica das próteses totais (PTs) na incidência de DTM em pacientes portadores de PTs bi-maxilares. Material e método Foi aplicado um questionário a 154 pacientes contendo os dados pessoais, o histórico das próteses, o índice anamnésico para DTM e o índice de qualidade de prótese. Resultado Dos 154 pacientes examinados, 64 (41,6%) estavam livres de DTM, 61 (39,6%) possuíam DTM leve, 23 (14,9%), moderada e apenas 6 (3,9%) mostravam DTM severa. Quanto à qualidade da prótese total, 78 (50,6%) desdentados totais portavam PTs satisfatórias e 76 (49,4) estavam com próteses insatisfatórias. Quanto ao tempo de uso da prótese total, cerca de 50% dos indivíduos com até 10 anos de uso apresentaram algum grau de DTM e 70% dos indivíduos com mais de 10 anos acusaram a presença de DTM. Conclusão Considerando-se a metodologia empregada e a população estudada, pôde-se concluir que a qualidade das PTs não influenciou na presença de DTM.

Review of articulated elbow orthotics for joint stiffness rehabilitation / Revisão de órteses articuladas de cotovelo para reabilitação de rigidez articular

ABSTRACT Joint stiffness is the most common complication in elbow injuries, presenting several etiologies and pathophysiological mechanisms that hinder treatment and prognosis. Prevention and treatment of joint contracture depend on the cause of stiffness, and early intervention should modify its outcomes. The methods used may be conservative or surgical, alone or in combination, according to each individual situation. Objective: Review articles on articulated elbow orthosis for joint stiffness rehabilitation. Methods: A literature review was conducted in journals available at the PubMed, Medline and LILACS databases, using the following Health Science Descriptors (DeCS): orthotic devices; braces; elbow; elbow joint; contracture; joint disorders. It sought to retrieve and analyze studies with the highest level of evidence that have already been conducted on articulated elbow orthosis for joint stiffness rehabilitation. Results: After applying the inclusion and exclusion criteria, four articles were included from PubMed and none from Medline or LILACS. Of the four PubMed articles, two were systematic reviews and two were randomized clinical trials. Conclusion: Articulated elbow orthoses can benefit joint stiffness treatment, improving range of motion and pain, showing superior effect compared to non-articulated plaster orthotics. Level of Evidence III, Systematic Review of Level III Studies.

RESUMO A rigidez articular é a principal complicação do cotovelo, afetando o tratamento e o prognóstico. O manejo da contratura articular se baseia na sua etiologia, e a intervenção precoce deve modificar o desfecho dessa complicação. Objetivo: Revisar artigos sobre órtese articulada de cotovelo para reabilitação de rigidez articular. Métodos: Foi realizada uma revisão bibliográfica em periódicos disponíveis do PubMed, Medline e LILACS, utilizando os Descritores em Ciências da Saúde (DeCS): aparelhos ortopédicos; braquetes; cotovelo; articulação do cotovelo; contratura; e transtornos da articulação. A intenção foi estabelecer e conhecer estudos de alto poder de evidência já realizados, que tenham tido como referência a temática de órteses articuladas de cotovelo para reabilitação de rigidez articular. Resultados: Após a aplicação dos critérios de inclusão e exclusão, revisaram-se artigos indexados no PubMed, Medline e LILACS, encontrando-se quatro artigos pelo PubMed e nenhum pelo Medline ou LILACS. Dos quatro artigos, dois eram revisões sistemáticas e dois eram ensaios clínicos randomizados. Conclusão: Órteses articuladas de cotovelo podem ser benéficas no tratamento de rigidez articular, sendo sugerido que melhoram amplitude de movimentos (ADM) e dor, inclusive com efeito superior em relação às órteses não articuladas gessadas. Nível de Evidência III, Revisão Sistemática de Estudos de Nível III.

Aspectos anatômicos e funcionais da língua após frenectomia em gemelares: relato de casos clínicos / Anatomic and functional aspects of the tongue after frenectomy in twin: clinical cases report

Objetivo: Relatar dois casos clínicos de alteração de frênulo lingual em gemelares, com 10 anos de idade, ambas do sexo feminino, avaliadas nos aspectos anatômicos e funcionais da língua antes e 15 dias após a frenectomia. Relato de casos: Inicialmente, o odontopediatra realizou a anamnese com a mãe. Em seguida, as participantes foram submetidas à avaliação clínica odontológica e, posteriormente, foi realizada a avaliação fonoaudiológica do frênulo lingual. A avaliação fonoaudiológica foi realizada por meio do Protocolo de Avaliação do Frênulo da Língua, que foi aplicado antes e 15 dias após a frenectomia. As duas participantes apresentaram melhor desempenho em provas anatômicas após o procedimento cirúrgico. Entretanto, algumas alterações, principalmente ao elevar a língua, continuaram sendo observadas em uma das pacientes 15 dias após a frenectomia. Ademais, as duas participantes passaram a executar a maioria dos movimentos de língua com maior precisão. No que se refere à fala, somente a participante que apresentava um maior número de alterações fonéticas anteriores, permaneceu com algumas alterações na fala decorridos 15 dias da cirurgia. Discussão: Algumas dificuldades envolvendo mobilidade da língua e alterações na fala podem persistir após a realização da cirurgia, indicando a necessidade de intervenção fonoaudiológica específica. Conclusão: Ambos os casos apresentaram melhora no desempenho tanto nas provas anatômicas quanto funcionais após a frenectomia.

Aim: to report two clinical cases of alteration of the lingual frenulum in twins, aged 10 years, both female, evaluated in the anatomical and functional aspects of the tongue before and 15 days after the frenectomy. Case reports: Initially, the paediatric dentistry performed the anamnesis with the mother. Then, the participants were submitted to a dental clinical evaluation and, sub-sequently, the speech language pathologist evaluation of the lingual frenulum was performed. The speech language pathologist assessment was performed using the Tongue Frenulum Evaluation Protocol, which was applied before and 15 days after the frenectomy. Both participants performed better in anatomical tests after the surgical procedure. However, some changes, especially when elevating the tongue, continued to be observed in one of the patients 15 days after the frenectomy. In addition, the two participants started to perform most of the tongue movements with greater precision. About speech, only the participant who had a greater number of previous phonetic changes, remained with some speech disorders after 15 days of surgery. Discussion: Some di-fficulties involving mobility of the tongue and changes in speech may persist after surgery, indicating the need for specific speech therapy intervention. Conclusion:Both cases showed improvement in performance both in anatomical and functional tests after frenectomy

Problemas del habla asociados a la disglosia labial y palatal / Speech disorders associated with labial and palatal cleft

RESUMEN Fundamento: según la Organización Mundial de la Salud, el paladar y labio fisurado son malformaciones del aparato estomatognático que producen problemas conocidos como disglosia labial y palatal. Estas afectan a una de las funciones del aparato estomatognático como es la fonación. Objetivo: analizar los problemas bucofonatorios asociados a la disglosia labial y palatal. Métodos: se realizó un estudio de tipo no experimental, descriptivo de corte trasversal. La población de estudio estuvo conformada por 62 pacientes de la Fundación Operación Sonrisa Ecuador, de los cuales se seleccionaron 42 mediante un muestreo no probabilístico intencional. La técnica que se utilizó fue la observación con sus instrumentos la historia clínica y el algoritmo de la escala del habla. Resultados: la escala del habla nasolabial, dentopalatina, test de esfuerzo y el total mostraron una correlación negativa escasa con los trastornos de la salud bucodental agrupados. Por otro lado, la escala del habla test de esfuerzo evidenció una asociación negativa débil con relación a los trastornos de salud bucodental agrupadas. La escala nasolabial provocado y velofaríngea no mostraron correlación en ningún nivel con respecto a los trastornos de la salud bucodental agrupados. Conclusiones: la mayor dificultad en la producción de los fonemas fue dentopalatina en /t/, /d/, /l/, /rr/, /ll/. Dentro de la escala del habla, la media del indicador test de esfuerzo mostró la evaluación más baja.

ABSTRACT Background: according to the World Health Organization, the cleft lip and cleft palate are oral disorders that produce speech problems. These ones affect one of the functions of the stomatognathic system such as phonation. Objective: to analyze the oral problems associated with labial and palatal cleft. Methods: a non-experimental, descriptive, transversal study was carried out. The population was constituted of seventy-two patients whose medical records which were filled out by professionals in different health areas of Operation Smile, forty-two of them were selected based on criteria through intentional non-probabilistic sampling. The observation was applied as technique and its instrument was the medical records and the speech algorithm. Results : the nose-labial speech scale, dent-palatine, stress test and the total showed a low negative correlation with the grouped oral pathologies. On the other hand, the stress test speech scale showed a weak negative association in relation to the grouped oral disorders. The provoked nasolabial scale and velopharyngeal did not correlate at any level with respect to the grouped oral pathologies. Conclusion: the greatest difficulty in the production of phonemes was dent-palatine in / t /, / d /, / l /, / rr /, / ll /. The speech scale showed that the average of the effort test indicator showed the lowest evaluation.

Valor de la distancia entre la tuberosidad anterior de la tibia y el surco intercondíleo en la inestabilidad patelofemoral / Value from the tibial-tuberosity to trochlear groove distance in the patellofemoral instability

La inestabilidad patelofemoral es una entidad que afecta principalmente a adolescentes y adultos jóvenes. En su diagnóstico se consideran elementos clínicos e imagenológicos, en especial para medir la distancia entre la tuberosidad anterior de la tibia y el surco intercondíleo, que permite la selección de la técnica quirúrgica en cada paciente, en específico la transferencia de la tuberosidad anterior de la tibia. En este artículo se exponen brevemente algunos aspectos de interés sobre el tema: métodos imagenológicos empleados en estos pacientes (radiografía simple, tomografía axial computarizada, imagen por resonancia magnética) y valores de referencia considerados como normales; también se describe por pasos cómo medir la distancia entre la tuberosidad anterior de la tibia y el surco intercondíleo.

The patellofemoral instability is an entity that mainly affects adolescents and young adults. In its diagnosis clinical and imaging elements are considered, especially to measure the tibial-tuberosity to trochlear groove distance that allows the selection of the surgical technique in each patient, in specific the transfer of the tibial-tuberosity. In this work some aspects of interest on the topic are shortly exposed: the imaging methods used in these patients (simple x-rays, computerized axial tomography, magnetic resonance imaging) and the reference values considered as normal; it is also described step by step how to measure the tibial-tuberosity to trochlear groove distance.

Design and Experimental Study on Flexible Articulation of Electric Stapler / 医用生物力学

Objective To design a notched flexible articulation applied to electric stapler and study its turning performance. Methods The notched flexible articulation was designed and modeled. The kinematics and statics models of the articulation were established for simulation calculations. The stress, deflection angle, top displacement and driving force of the articulation with 3 different turning structures were studied under equal and variable stiffness of symmetrical notches by using finite element simulation. An experimental platform for performance test of the turning structure was built to verify the simulation results and the model. Results The theoretical model of the turning structure in bending process was basically consistent with the experimental results. With the optimization of symmetrical notch stiffness, the maximum stress of the articulation with variable stiffness was reduced by 20.64% and 39.20%, respectively. The articulation with variable stiffness required the smallest tensile force during bending, which was 33.41% lower than that of the articulation with equal stiffness, and the tip displacement (30.8 mm) along the bending plane was the smallest. The maximum deflection angle for the articulation with 3 different turning structures all could reach 90°. Conclusions The kinematics and statics models of the articulation can be used for the calculation of its tensile force and position changes. The turning performance of the articulation with variable stiffness using symmetrical notch is better than that with equal stiffness. The notched flexible articulation meets the design requirements and the turning needs of electric stapler.

Liuzijue qigong for stroke survivors with dysarthria / 中华物理医学与康复杂志

Objective:To document any improvement in the breathing control of stroke survivors with dysarthria after practicing Liuzijue qigong.Methods:A total of 157 stroke survivors with dysarthria and abnormal respiration control were randomly divided into an observation group and a control group. Both groups were given traditional breathing training and basic articulation training (including articulatory organ training and speech training). The observation group also received training in Liuzijue qigong. It requires inhaling through the nose and exhaling through the mouth while producing the speech sounds xu, he, hu, si, chui and xi. The training lasted two weeks. Both groups were then evaluated using the modified Frenchay dysarthria assessment. Maximum phonation time, maximum counting ability and volume were also recorded as secondary indexes.Results:After the 2-week intervention, significant improvement was observed in the average scores on all of the indexes, with all of the observation group′s average scores except for volume significantly better than those of the control group. The average volume scores were significantly improved, but not significantly different.Conclusion:Supplementing basic articulation training with Liuzijue qigong can improve respiratory function and the speaking ability of stroke survivors with dysarthria. It is worthy of wider clinical application.

Tradução e adaptação transcultural do protocolo Kaufman Speech Praxis Test for Children (KSPT) / Translation and cross-cultural adaptation of the Kaufman Speech Praxis Test for Children (KSPT) protocol

RESUMO Objetivo Apresentar o instrumento Kaufman Speech Praxis Test for Children - KSPT, bem como sua adaptação transcultural para o Brasil. Método Após a permissão de utilização do KSPT pela detentora dos direitos autorais, e cumprimento dos aspectos éticos, o instrumento foi traduzido e adaptado para o português brasileiro, com manutenção de equivalências semântica, idiomática, experimental e conceitual, quando pertinente. Resultados Após procedimentos de tradução e adaptação transcultural, não houve mudanças na Parte 1 (Nível de movimento oral); na Parte 2 (Nível silábico e fonêmico simples), 12 palavras-teste foram excluídas e 16 incluídas; e na Parte 3 (Nível silábico e fonêmico complexo), 13 palavras-teste foram excluídas por não apresentarem correspondência em relação às características de produção fonoarticulatória (fonético/fonológico) no Português Brasileiro. Na parte 4 (Extensão e complexidade espontânea - medida subjetiva) não houve alterações da versão em inglês do KSPT. Após todo o processo o material final foi aprovado pela autora e aplicado em crianças para a verificação da usabilidade e verificação de equivalências. A aplicação em população significativa no Brasil para a construção de critérios psicométricos será realizada em etapa futura. Conclusão A tradução do KSPT está finalizada com mudanças em palavras-teste do protocolo de aplicação, para respeitar as características transculturais da língua portuguesa falada no Brasil. Foram respeitadas as equivalências semântica, idiomática, experimental e conceitual, no manual de aplicação, guia de teste clínico e nos enunciados das provas. Espera-se que este instrumento integre avanços para o diagnóstico e acompanhamento de procedimentos de intervenção, trazendo uma contribuição efetiva para esta área.

ABSTRACT Purpose To present the Kaufman Speech Praxis Test for Children - KSPT instrument, as well as its Brazilian cross-cultural adaptation. Methods After obtaining permission to use the KSPT by the copyright holder, and compliance with ethical aspects, the instrument was translated and adapted into Brazilian Portuguese, preserving semantic, idiomatic, experimental and conceptual equivalences, when relevant. Results After translation and cross-cultural adaptation procedures, there were no changes in Part 1 (Oral movement); in Part 2 (Simple Phonemic and Syllabic Level), 12 test words were excluded and 16 were included; and in Part 3 (Complex Phonemic and Syllabic Level), 13 test words were excluded as they failed to correspond to the characteristics of phonoarticulatory production (phonetic/phonological) in Brazilian Portuguese. In part 4 (Spontaneous Length and Complexity - subjective measure) there were no changes to the English version of the KSPT. After the process, the final version of the material was approved by the author and applied to children for usability and equivalences check. The application to a significant population in Brazil for the construction of psychometric criteria will be carried out at a future stage. Conclusion The KSPT translation is completed with changes in test words from the application protocol to respect the cross-cultural characteristics of the Brazilian-Portuguese language. Semantic, idiomatic, experimental and conceptual equivalences were respected throughout the application manual, clinical test guide and test statements. This instrument is expected to integrate advances in the diagnosis and monitoring of intervention procedures, effectively contributing to the area.

Impacto de la dislalia y disglosia en la comprensión verbal en escolares con necesidades especiales; Cuenca, Ecuador / The impact of dyslalia and dysglossia on verbal comprehension in schoolchildren with special needs; Cuenca, Equator

Este estudio analiza la relación entre los trastornos del lenguaje y la comprensión verbal en estudiantes que fueron evaluados como parte del pilotaje desarrollado por el proyecto de investigación "Efectividad del programa integral escalonado en pacientes con necesidades educativas especiales por trastornos del lenguaje y articulación", en la Unidad de Diagnóstico, Investigación Psicopedagógica y Apoyo a la Inclusión (UDIPSAI), Centro de Práctica y Relación con la Sociedad de la Universidad Católica de Cuenca. Se trata de un estudio observacional de tipo descriptivo y analítico; la técnica utilizada fue la psicometría y los instrumentos fueron pruebas para evaluar los trastornos del lenguaje y la inteligencia. Se aplicó la Prueba de Funciones Prelinguísticas y órganos fonoarticuladores, la Prueba de Articulación y la Prueba de Evaluación Clínica de los Fundamentos del Lenguaje. Para calificar la comprensión verbal se utilizó Weschler para niños -V (WISC-V) que investiga la capacidad individual dividida en escalas primarias. Para la investigación se consideró el Indice de Comprensión Verbal con las subescalas de similitudes, vocabulario, comprensión, información y acertijos. Se concluyó que la comprensión verbal es un factor importante para la presencia de trastornos del lenguaje y articulación en niños (AU)

Asociación entre Hiperlaxitud Articular Generalizada y Chasquidos de la Articulación Témporo Mandibular / Association between generalized joint hypermobility and temporomandibular joint clicking

Resumen El objetivo del estudio fue analizar si la hiperlaxitud articular generalizada (HAG) es un factor de riesgo para los trastornos de la articulación temporomandibular (ATM). Para ello se evaluó la posible asociación entre chasquido de la ATM y el diagnóstico de HAG. Se trabajó con la siguiente hipótesis: el paciente con HAG, tendría mayor prevalencia de chasquido a nivel de la ATM que los que no la presentan, constituyendo la HAG un factor de riesgo para padecer un desorden articular (DA). Se examinaron 214 estudiantes de facultad de odontología (FO) de la Universidad de la República (Udelar) de Uruguay, 161 participantes del sexo femenino y 53 masculino, de entre 18 y 30 años (edad media 23.8 años, DE=2.7). A cada participante se le realizó un cuestionario y un examen clínico para diagnóstico de HAG utilizando el índice de Beighton (IB), chasquido, antecedente de trauma maxilofacial, ortodoncia, dentición completa, bloqueo abierto y turno. Todos los exámenes fueron realizados por un investigador ciego calibrado (calibración interoperador chasquido kappa= 0.68; intraoperador Beighton=0.82, chasquido=1). El estudio fue aprobado por el Comité de Ética y todos los participantes firmaron un consentimiento informado. El análisis estadístico de los datos fue realizado en base a un modelo de regresión logística múltiple. La prevalencia de HAG fue 34.16% en el género femenino y 7.55% en el masculino, de chasquido 24.22% para el femenino y 11.32% en el masculino. Las variables género (OR=3,244, p-valor 0,018) y antecedente de traumatismo (OR=2,478, p-valor 0,041) se asociaron significativamente a la presencia de chasquido. No se encontró asociación entre chasquido e HAG. El género femenino y los antecedentes de traumatismo podrían ser factores de riesgo para desórdenes a nivel de la ATM. La ausencia de asociación entre HAG y chasquido en dicho grupo etario (18-30 años), sugiere que dicho factor podría no ser de riesgo para el desarrollo de dichas patologías.

Resumo O objetivo do estudo foi examinar se a hiperlaxidade articular generalizada (HAG) é um fator de risco para disfuncao articulacao temporomandibular (DAT). Isso foi feito avaliando a possível associação entre cliques atm e diagnóstico hag. O trabalho foi feito com a seguinte hipótese: o paciente com HAG, teria maior prevalência de clique no nível atm do que aqueles que não o fazem, tornando a HAG um fator de risco para DAT. Foram examinados 214 alunos de Odontologia da Universidad de la República (Udelar) do Uruguai, 161 do sexo feminino e 53 do sexo masculino, com idade entre 18 e 30 anos (idade média de 23,8 anos, DE:2,7). Cada participante recebeu questionário e exame clínico para diagnóstico de HAG utilizando o índice Beighton (IB), clique, antecedente de trauma maxilofacial, ortodontia, dentição completa, bloqueio aberto e turno. Todos os testes foram realizados por um pesquisador cego calibrado (calibração interoperadora kappa-click-0,68; intraoperador Beighton-0.82, clique-1). O estudo foi aprovado pelo Comitê de Ética e todos os participantes assinaram consentimento informado. A análise estatística dos dados foi realizada com base em um modelo de regressão logística múltipla. A prevalência de HAG foi de 34,16% no sexo feminino e 7,55% no masculino, de clique 24,22% para o feminino e 11,32% para o masculino. As variáveis de gênero (OR-3.244, valor p 0,018) e antecedente do trauma (OR-2.478, valor p 0,041) estiveram significativamente associadas à presença de clique. Não foi encontrada associação entre clique e HAG. O sexo feminino e o histórico de trauma podem ser fatores de risco para distúrbios no nível do articulacao temporomandibular . A ausência de associação entre HAG e click sugere que esse fator pode não estar em risco para o desenvolvimento de tais patologias.

Abstract This study analyzes whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular joint disorders (TMD). Therefore, we evaluated the potential association between TMD clicking and GJH diagnosis. We worked with the following hypothesis: patients with GJH would have a higher prevalence of TMJ clicking than those without it, making GJH a risk factor for joint disorders. Two hundred and fourteen students from the School of Dentistry of Universidad de la República del Uruguay (UdelaR) were examined: 161 female and 53 male, aged 18 to 30 (average age: 23.8 years, SD=2.7). Each participant was given a questionnaire, and a clinical examination was performed to diagnose GJH using the Beighton score (BS), clicking, history of maxillofacial trauma, orthodontics, full dentition, open lock, and shift. A calibrated blind researcher (kappa inter-rater click calibration = 0.68; intra-rater BS score=0.82, click=1) performed all the examinations. The Ethics Committee approved the study, and all the participants signed an informed consent. A multiple logistic regression model was used to analyze the data statistically. GJH prevalence was 34.16% in women and 7.55% in men; clicking prevalence was 24.22% in women and 11.32% in men. There was a significant association between sex (OR=3.244, p-value 0.018) and history of trauma (OR=2.478, p-value 0.041) and the presence of clicking. No association was found between clicking and GJH. Female sex and history of trauma could be risk factors for TMJ disorders. The lack of association between GJH and clicking in this age group (18-30) suggests that GJH may not be a risk factor for developing these pathologies.