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Introducción: La esclerosis lateral amiotrófica (ELA) es la forma más común de enfermedad degenerativa de motoneurona en la edad adulta y es considerada una enfermedad terminal. Por lo mismo, el accionar del fonoaudiólogo debe considerar el respeto a los principios bioéticos básicos para garantizar una asistencia adecuada. Objetivo: Conocer aquellas consideraciones bioéticas relacionadas al manejo y estudio de personas con ELA para luego brindar una aproximación hacia el quehacer fonoaudiológico. Método: Se efectuó una búsqueda bibliográfica en las bases de datos PubMed, Scopus y SciELO. Se filtraron artículos publicados desde 2000 hasta junio de 2023 y fueron seleccionados aquellos que abordaban algún componente bioético en población con ELA. Resultados: Aspectos relacionados al uso del consentimiento informado y a la toma de decisiones compartidas destacaron como elementos esenciales para apoyar la autonomía de las personas. Conclusión: Una correcta comunicación y una toma de decisiones compartida son claves para respetar la autonomía de las personas. A su vez, la estandarización de procedimientos mediante la investigación clínica permitirá aportar al cumplimiento de los principios bioéticos de beneficencia y no maleficencia, indispensables para la práctica profesional.
Introduction: Amyotrophic lateral sclerosis (ALS) is the most common form of degenerative motor neuron disease in adulthood and is considered a terminal disease. For this reason, the actions of the speech therapist must consider respect for basic bioethical principles to guarantee adequate assistance. Objective: To know those bioethical considerations related to the management and study of people with ALS to then provide an approach to speech therapy. Methodology: A bibliographic search was carried out in the PubMed, Scopus, and SciELO databases. Articles published from 2000 to June 2023 were filtered and those that addressed a bioethical component in the population with ALS were selected. Results: Aspects related to the use of informed consent and shared decision-making stood out as essential elements to support people's autonomy. Conclusion: Proper communication and shared decision-making are key to respecting people's autonomy. In turn, the standardization of procedures through clinical research will contribute to compliance with the bioethical principles of beneficence and non-maleficence, essential for professional practice.
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In a context where different protocols for recommended practices in clinical voice assessment exist, while there are gaps in the literature regarding the evidence base supporting assessment procedures and measures, clinicians from regions where a strong community holding expertise in clinical and scientific voice practices lack can struggle to confidently develop their voice assessment practices. In an effort to improve voice assessment practices and strengthen professional identity among speech-language pathologists in Quebec, Canada, a community of practice (CoP) was established, with the aim of promoting knowledge sharing, implementing change in clinical practice, and improving professional identity. Thirty-nine participants took part in the CoP activities conducted over a four-month period, including virtual meetings and in-person workshops. Participants had a high rate of attendance (> 74% participation rate in virtual meetings), and were highly satisfied with their participation and intended to remain involved after the project's end. Statistically significant changes in voice assessment practices were observed post-CoP, regarding probability of performing assessments (p < .001), and perceived importance of assessment for evaluative purposes (p <.001), as well as improvements in assessment specific confidence, specifically for procedure of auditory-perceptual assessment (p < .001) and purpose of aerodynamic assessment (p = .05). Moreover, there was an increase in professional identity post-CoP (p < .001) and participants felt they made significant learnings. The present study highlighted the need to involve SLPs in future research to identify assessments that are relevant to the specific evaluative objectives of SLPs working with voice, and suggests CoPs are an efficient tool for that purpose.
En un contexto en el que existen diferentes protocolos para las prácticas recomendadas en la evaluación vocal clínica, y en el que se presentan vacíos en la literatura respecto a la base de evidencia que respalda los procedimientos y medidas de evaluación, los profesionales de regiones donde no hay una comunidad sólida con experiencia en prácticas vocales clínicas y científicas pueden enfrentar dificultades para desarrollar con confianza sus prácticas de evaluación vocal. Con el propósito de mejorar las prácticas de evaluación vocal y fortalecer la identidad profesional entre los logopedas de Quebec, Canadá, se estableció una comunidad de práctica (CdP). Esta tenía como objetivo fomentar el intercambio de conocimientos, implementar cambios en la práctica clínica y mejorar la identidad profesional. Un total de treinta y nueve participantes se involucraron en las actividades de la CdP, llevadas a cabo durante un período de cuatro meses, que incluyeron reuniones virtuales y talleres presenciales. Los participantes tuvieron una alta tasa de asistencia (> 74% de participación en las reuniones virtuales) y expresaron un alto grado de satisfacción con su participación, manifestando su intención de continuar involucrados después de la finalización del proyecto. Se observaron cambios estadísticamente significativos en las prácticas de evaluación vocal posterior a la CdP, en lo que respecta a la probabilidad de llevar a cabo evaluaciones (p < .001) y la percepción de la importancia de la evaluación con fines evaluativos (p < .001), así como mejoras en la confianza específica en la evaluación, particularmente en el procedimiento de evaluación auditivo-perceptual (p < .001) y el propósito de la evaluación aerodinámica (p = .05). Además, se registró un aumento en la identidad profesional posterior a la CdP (p < .001) y los participantes sintieron que obtuvieron aprendizajes significativos. El presente estudio destacó la necesidad de involucrar a los logopedas en investigaciones futuras, para identificar evaluaciones pertinentes a los objetivos evaluativos específicos de los logopedas que trabajan con la voz, y sugiere que las CdP son una herramienta eficiente con ese propósito.
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Abstract Purpose The Awake Breathing Pattern Assessment (ABPA) is a prototypical clinical grid recently designed through an international consensus of Speech and Language Pathologists (SLPs) to categorize the awake and habitual breathing pattern during the orofacial myofunctional assessment. This cross-sectional study aims to explore the psychometric properties of the ABPA in a preschool population. Methods 133 children from 2;11 to 6 years old were assessed with the ABPA. The percentage of time spent breathing through the mouth was objectively measured by a CO2 sensor and used as a baseline measurement. We first performed a multivariate Latent Profile Analysis based on the CO2 measurement and a parental questionnaire to define the number of categories that best characterize the breathing pattern. Subsequently, we assessed the intra- and inter-rater reliability, internal consistency criterion validity, construct validity and sensitivity and specificity. Results The awake breathing pattern can best be described by two groups: nasal and mouth breathing. The ABPA, initially designed in three groups, was adjusted accordingly. This final version showed excellent intra-rater and inter-rater reliability. There was a significant correlation between the ABPA and the CO2 measurement. The ABPA showed a fair sensitivity and a good specificity. Conclusion The reference tool based on CO2 data was used in children for the first time and was found to be reliable. The ABPA is a suitable tool for SLPs to confirm the diagnosis of mouth breathing in preschool children if more sensitive screening tools, like parental questionnaires, are used beforehand.
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RESUMO Objetivo validar o conteúdo do Teste de Concordância de Scripts em Fonoaudiologia, denominado FonoTCS. Método Trata-se de estudo de validação de conteúdo de instrumento. Participaram da construção do FonoTCS cinco fonoaudiólogas, doutoras e docentes, com média de 24,8 anos de atuação profissional, que chegaram a um consenso durante o processo de construção do teste. Elaborou-se 30 questões e 120 itens contemplando as áreas de atuação fonoaudiológica. Em seguida, 15 fonoaudiólogas com titulação mínima de mestre, e com, no mínimo, 10 anos de atuação clínica generalista receberam eletronicamente o FonoTCS para validação de conteúdo por meio de questionário sobre critérios de clareza, ética e pertinência do conteúdo das questões. Para a análise das respostas calculou-se o Coeficiente de Validade de Conteúdo Corrigido de todas as afirmativas. Foram revisadas as questões com porcentagem de concordância igual ou inferior a 80%. Resultados 13 avaliadores responderam a análise, todos do sexo feminino, com média de idade de 39,07 anos, sendo oito mestres e cinco doutoras, com atuação clínica generalista média de 15,38 anos. Os valores médios do Coeficiente de Validade de Conteúdo Corrigido foram 0,93 e 0,95 para o critério de clareza; 0,98 e 0,92 para o critério de pertinência; e 0,99 para o critério de ética. Duas questões apresentaram notas de 0,78 e 0,80, sendo ambas da área de audiologia no domínio de avaliação/diagnóstico, para a questão relacionada ao critério de pertinência, sendo revisadas e reestruturadas pelos juízes. Conclusão O FonoTCS é um instrumento válido do ponto de vista do conteúdo.
ABSTRACT Purpose To validate the content of the Speech-Language Pathology Concordance Test called FonoTCS. Methods This is a content validation study of the instrument. Five speech-language pathologists, all with doctoral degrees and teaching experience, averaging 24.8 years of professional practice, participated in the development of FonoTCS and reached a consensus during the process. Thirty questions and 120 items were created, covering seven areas of speech-language pathology expertise across three domains. For content validation, FonoTCS was electronically sent to 15 evaluators to respond to a questionnaire with five questions, rated on a five-point scale, regarding the criteria of clarity, ethics, and relevance of the questions. The Corrected Content Validity Coefficient was calculated for all statements to analyze the responses. Questions with agreement percentages equal to or less than 80% were revised. Results Thirteen evaluators, all female, with an average age of 39.07 years, including eight with master's degrees and five with doctoral degrees, and an average clinical practice experience of 15.38 years, participated in the analysis. The average Corrected Content Validity Coefficient values for the clarity criterion were 0.93 and 0.95, for the relevance criterion 0.98 and 0.92, and for the ethics criterion 0.99. Two questions received scores of 0.78 and 0.80, both related to the audiology area in the assessment/diagnosis domain, specifically question 2 regarding the relevance criterion. These questions were reviewed and restructured by the judges. Conclusion FonoTCS is a valid instrument from a content perspective.
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ABSTRACT Purpose Prospective memory (PM) questionnaires are frequently used to evaluate perceptions of PM skills in daily life. This study aimed to systematically investigate communication-specific attributes using pre-existing PM self-rating questionnaires to inform clinicians and researchers about the role of PM in cognitive communicative evaluations. Methods PM-related items from three questionnaires (i.e., Prospective Memory Questionnaire, Comprehensive Assessment of Prospective Memory, and Prospective and Retrospective Memory Questionnaire) were compiled and embedded in Google Forms and distributed to 70 Speech-Language Pathologists (SLPs) with expertise in Cognitive Communicative Disorders across India. Participants first identified items related to communication, and were then contacted to rate the communication-related PM items using a Likert scale for their degree of appropriateness. Responses from 40 SLPs were obtained and subjected to item-content validity index (i-CVI) and exploratory factor analysis (EFA). Results Of the 114 PM items, 28 received ratings over 50% for their relevance to communication. Of the 28 items, 21 had an i-CVI score greater than 0.8. After the removal of overlapping content, 14 items were finalized and subjected to EFA, which resulted in four factors: PM failure due to loss of communicative content, PM failure due to loss of communicative intent, PM cost due to ongoing interference, and PM failure linked to the priority of communicative intent. Conclusion This study highlights communication-related aspects of PM that can be used as a framework for SLPs to assess and research PM skills.
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RESUMO Objetivo Criar um checklist da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) a partir de categorias relevantes para o desenvolvimento de fala e linguagem, segundo a percepção de pais e fonoaudiólogos. Método Realizou-se aplicação piloto e pesquisa. Na pesquisa participaram 100 pais de pré-escolares, com desenvolvimento típico de linguagem/cognição e 57 fonoaudiólogos especialistas em linguagem. Elaborou-se questionário com 199 categorias da CIF dos componentes de funções do corpo, atividades e participação e fatores ambientais. Cada categoria foi pontuada como: indispensável (2); importante (1) ou sem importância (0). Realizou-se a análise estatística (descritiva, soma, cluster/Método K-means e Mann-Whitney). Resultados Com a soma dos pontos (indispensável, importante e sem importância) e a quantidade de respostas indispensável, foram identificadas as categorias de maior relevância para cada grupo de respondentes, assim como o conjunto de categorias em comum (72 consideradas de maior influência). A listagem comum aos grupos contou com os três componentes: funções do corpo (30 categorias/40% do total), atividades e participação (35/49,29%) e fatores ambientais (sete/13,20%). Das categorias selecionadas, 58,33% apresentaram resultados estatisticamente significantes entre os grupos, quanto à relevância dada. Conclusão As categorias foram consideradas com pontuações distintas entre os grupos: as de funções do corpo foram mais pontuadas pelos fonoaudiólogos, enquanto as de fatores ambientais pelos pais. Assim, foi possível criar um checklist a partir da identificação das categorias mais relevantes para o desenvolvimento de fala e linguagem, em idade pré-escolar, contemplando os componentes funções do corpo, atividades e participação e fatores ambientais.
ABSTRACT Purpose Create a checklist of the International Classification of Functioning, Disability and Health (ICF) based on relevant categories for the development of speech and language, according to the perception of parents and speech therapists. Methods Pilot application and research were carried out. 100 parents of preschool children with typical language/cognition development and 57 language specialist speech therapists participated in the survey. A questionnaire was created with 199 ICF categories of body function components, activities and participation, and environmental factors. Each category was scored as: indispensable (2); important (1) or unimportant (0). Statistical analysis was performed (descriptive, sum, cluster/K-means and Mann-Whitney method). Results With the sum of the points (essential, important and unimportant) and the number of responses essential, the most relevant categories were identified for each group of respondents, as well as the set of categories in common (72 considered to have the greatest influence). The common list to the groups included the three components: body functions (30 categories/40% of the total), activities and participation (35/49.29%) and environmental factors (seven/13.20%). From the selected categories, 58.33% presented statistically significant results between the groups, regarding the relevance given. Conclusions The categories were considered with different scores between the groups: those of body functions were more scored by speech therapists, while those of environmental factors by parents. Thus, it was possible to create a checklist from the identification of the most relevant categories for the development of speech and language, in preschool age, contemplating the components of body functions, activities and participation and environmental factors.
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ABSTRACT Purpose: to analyze the telehealth speech therapy approach in patients with oropharyngeal dysphagia and determine the applications and effects of this practice. Methods: the following descriptors were used for selection: Telerehabilitation, Telemedicine, "Remote Consultation", "Healthcare Delivery", "Distance Counseling", "Therapy, Computer-Assisted", "Speech-Language Pathology", "Speech Therapy", "Swallowing Disorders", Dysphagia, "Bottle Feeding" and "Enteral Nutrition" in PubMed, MedLine, Scopus and Web of Science databases and in the gray literature, by Google Scholar and ProQuest. Studies were selected without time limits, in Portuguese, English and Spanish, that described the applicability and/or effects of telehealth in speech therapy practice in patients with swallowing disorders/dysphagia, regardless of gender and age. For analysis, the following were considered: level of scientific evidence and recommendation, telehealth modality, objectives, methods and results/conclusion. Literature Review: 490 articles were found and, after exclusion of duplicates, analysis of titles, abstracts and reading of full articles, 22 studies were selected. The articles were classified into telehealth modalities: tele-education, telediagnosis, teleconsulting, teleregulation and telemonitoring. Conclusion: the telehealth modalities described had a great potential to promote significant improvements in patients presented with swallowing disorders/dysphagia, suggesting them as viable for speech therapy services. Among them, teleconsultation was the least addressed.
RESUMO Objetivo: analisar a abordagem fonoaudiológica por meio da telessaúde em pacientes com disfagia e determinar as aplicações e efeitos desta prática. Métodos: para seleção foram utilizados os descritores: Telerehabilitation, Telemedicine, "Remote Consultation", "Delivery of Health Care", "Distance Counseling", "Therapy, Computer-Assisted", "Speech-Language Pathology", "Speech Therapy", "Deglutition Disorders", Dysphagia, "Bottle Feeding" e "Enteral Nutrition" nas bases de dados PubMed, MedLine, Scopus e Web of Science e na literatura cinzenta, por meio do Google Acadêmico e ProQuest. Foram selecionados estudos sem delimitação de tempo, nas línguas português, inglês e espanhol, que descrevessem a aplicabilidade e/ou efeitos da telessaúde na prática fonoaudiológica junto à pacientes com alteração da deglutição/disfagia, sem restrição de sexo e idade. Para análise considerou-se: nível de evidência científica e recomendação, modalidade de telessaúde, objetivos, métodos e resultados/conclusão. Revisão da Literatura: foram encontrados 490 artigos e, após exclusão de duplicatas, análise dos títulos, resumos e leitura completa dos artigos, 22 estudos foram selecionados. Os artigos foram classificados nas modalidades da telessaúde: tele-educação, telediagnóstico, teleconsultoria, telerregulação e telemonitoramento. Conclusão: as modalidades de telessaúde descritas tiveram grande potencial para promover melhoras significativas em pacientes com alteração de deglutição/disfagia, sugerindo-as como viáveis para serviços fonoaudiológicos. Entre elas, a teleconsulta foi a menos explorada.
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Los trastornos por evitación/restricción de la ingesta, han sido ampliamente descritos por la similitud en sus características y las consecuencias que estas traen sobre el desarrollo crecimiento de los niños que lo experimentan. La alimentación exigente es un trastorno de tipo multifactorial, en donde los niños muestran comportamientos negativos frente a la comida o tienen preferencia por un grupo de alimentos. Esta revisión narrativa de la literatura tiene como objetivo presentar las últimas investigaciones relacionadas con la alimentación exigente, ofreciendo una guía sobre signos y síntomas, evaluación e intervención en los niños con alimentación exigente realizada por el equipo multiprofesional. La revisión de literatura fue conducida en las bases de datos PubMed y Scopus, aplicando como principal criterio de inclusión artículos en inglés, español y portugués, sobre alimentación exigente en niños entre el nacimiento y los 5 años. Los resultados de esta revisión apuntan que la alimentación exigente estaría determinada por tres estadios importantes en la vida del niño; la gestación, la fase temprana de alimentación y las experiencias durante su segundo año de vida, por lo tanto, se requiere reconocer las señales de alerta (rechazo a comer determinados alimentos, falta de habilidades para alimentarse, duración excesiva durante los tiempo de alimentación etc.,), lo que permite realizar una evaluación temprana, que guie la intervención terapéutica, favoreciendo así una alimentación segura y eficaz para la nutrición y calidad de vida del niño.
Avoidant/Restrictive Food Intake Disorders have been widely described due to the similarity in their characteristics and the consequences they have on the development and growth of children who experience them. Picky eating is a multifactorial disorder where children exhibit negative behaviors towards food or show preference for a specific group of foods. This narrative literature review aims to present the latest research related to picky eating, offering guidance on signs and symptoms, assessment, and intervention in children with picky eating conducted by a multidisciplinary team. The literature review was conducted using the PubMed and Scopus databases, with the main inclusion criterion being articles in English, Spanish, and Portuguese, on picky eating in children from birth to 5 years old. The results of this review suggest that picky eating is determined by three important stages in a child's life; gestation, the early phase of feeding, and experiences during their second year of life. Therefore, it is necessary to recognize warning signs (refusal to eat certain foods, lack of feeding skills, excessive duration during feeding times, etc.), which allows for an early assessment that guides therapeutic intervention, thus promoting safe and effective feeding for the nutrition and quality of life of the child.
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La traqueostomía es un procedimiento quirúrgico enfocado en brindar una vía de respiración alterna, en el que sus mayores consecuencias son las afectaciones comunicativas y deglutorias. La evaluación e intervención fonoaudiológica es indispensable dentro del proceso de rehabilitación de pacientes traqueostomizados, teniendo en cuenta las secuelas comunicativas, deglutorias y de fonación asociadas a este procedimiento. El presente artículo tiene como objetivo destacar el rol y actuar fonoaudiológico dentro de la restauración de las funciones alteradas en el caso de una paciente femenina con traqueostomía, quien acude al servicio de urgencias de un hospital público de Bogotá, Colombia. Se aplicaron pruebas estandarizadas y subjetivas para la valoración fonoaudiológica, estableciendo así el plan de manejo enfocado en la restauración de la deglución y la fonación, así como la intervención para el mantenimiento del estado orofacial, sensibilidad y movilidad de las estructuras. Se evidenciaron mejoras en la efectividad y seguridad deglutoria, una exitosa adaptación de válvula fonatoria y mantenimiento de habilidades de lenguaje y cognición, preservando el estado comunicativo. En conclusión, este estudio de caso brinda un aporte significativo con respecto a la importancia del actuar fonoaudiológico, la aplicación de conocimientos y estrategias basadas en la literatura y el análisis, evaluación e intervención.
Tracheostomy is a surgical procedure focused on providing an alternate breathing path, in which its greatest consequences are communication and swallowing impairments.Speech therapy evaluation and intervention is essential within the rehabilitation process of tracheostomized patients, taking into account the swallowing and phonatory consequences associated. The aim of this article is to highlight the role and actions of the speech language therapist in the restoration of altered functions in the case of a female patient with atracheostomy, who went to the emergency department of a public hospital in Bogotá,Colombia, due to swallowing disorders. Standardized and subjective tests were applied for speech therapy assessment. The management plan was developed focused on the restoration of swallowing and phonatory function as well as the intervention to maintain the orofacial state, sensitivity and mobility of the structures. Improvements were evident in swallowing effectiveness and safety, a successful adaptation of the speaking valve and maintenance of language and cognition skills, preserving the communicative state. In conclusion, this case study provides a significant contribution regarding regarding the importance of the speech therapist role, the application of knowledge and strategies based on literature and analysis, evaluation and intervention.
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Objetivo: Analizar la percepción de los profesionales Fonoaudiólogos respecto al uso de nuevas Tecnologías de la Información y Comunicación en los procesos de evaluación e intervención fonoaudiológica. Métodos: Diseño de investigación cuantitativo, descriptivo, de corte transversal. Un total de 123 participantes contestaron el cuestionario de percepción. Se analizaron 14 ítems del módulo II, para los cuales se calculó el promedio, desviación estándar y coeficiente de variación. Además, se analizaron las respuestas positivas, respuestas neutras y respuestas negativas sobre el uso de las nuevas Tecnologías de la Información y Comunicación, la efectividad en distintos grupos etarios y las mejoras en los procesos de evaluación e intervención. Resultados: El 80% de los participantes declara que el uso de nuevas Tecnologías de la Información y Comunicación es efectivo en el proceso de evaluación, mientras que el 83% opina lo mismo en relación con la intervención. Además, el 51% declara que no tiene claridad de las mejoras en los resultados del proceso de evaluación y el 46% declara lo mismo en el proceso de intervención. Conclusión: Los profesionales perciben que las nuevas Tecnologías de la Información y Comunicación tienen mayor efectividad en niños y niñas mayores de 6 años. El uso de Tablet y Computador es percibido por los participantes como apropiado, sin embargo, no garantiza mejoras en los resultados de los procesos de evaluación e intervención. Los resultados respaldan futuras investigaciones en el campo de fonoaudiología para mejorar la atención a los usuarios y aprovechar las ventajas en este campo
Objective: To analyze the perception of speech-language pathologists professionals regarding the utilization of new Information and Communication Technologies in speechlanguage evaluation and intervention processes. Methods: Quantitative, descriptive, cross-sectional research design. A total of 123 participants responded to the perception questionnaire. Fourteen items were analyzed, for which the mean, standard deviation, and coefficient of variation were calculated. Furthermore, positive, neutral, and negative responses were examined concerning the use of new Information and Communication Technologies, their effectiveness across different age groups, and improvements in evaluation and intervention processes. Results: 80% of the participants affirm that the use of new Information and Communication Technologies is effective in the evaluation process, and 83% hold the same opinion regarding intervention. Furthermore, 51% state that they lack clarity regarding improvements in evaluation process outcomes with the use of new Information and Communication Technologies, while 46% declare the same in the intervention process. Conclusion: Professionals perceive that new Information and Communication Technologies are more effective for children over 6 years old. The use of tablet and computer is perceived by the participants as appropiate; however, it does not guarantee improvements in the outcomes of evaluation and intervention processes. The results support future research in the field of speech-language pathology to enhance user care and capitalize on the advantages of this domain
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Objective: To verify the relationship between smoking, age, schooling, and the vocal self-perception of trans women. Methods: Cross-sectional observational quantitative study conducted with 24 trans women over 18 years old, living in their affirmed gender for a minimum of 6 months. Data collection involved selected questions from the translated and authorized Portuguese version of the Trans Woman Voice Questionnaire (TWVQ) and information regarding age, education, occupation, and smoking status. All variables were analyzed descriptively, and the association with smoking was assessed using Pearson's Chi-square, Fisher's Exact, Student's T, and Mann-Whitney tests, with a significance level of 5%. Results: The mean age of trans women was 28.2 +/- 6.5 years (range: 21 - 48). Most participants (41.6%) had completed their high school education and pursued diverse careers. Regarding smoking habits, 58.3% of women were either current smokers or had smoked at least 100 cigarettes in their lifetime. A statistically significant association was found between smoking and age (p = 0.001), with smokers having a lower average age (24.9 years) compared to nonsmokers (32.9 years). However, no statistical significance was observed between smoking, education, and self-perception of vocal femininity. Only 9 (37.5%) trans women perceived their voices as feminine, while 17 (70.7%) desired a more feminine-sounding voice. Limitation: The limited sample size in this study may have constrained the ability to detect significant differences between the analyzed groups using statistical tests. Conclusion: The smoking prevalence was notably high among younger trans women. However, there was no statistically significant difference in vocal self-perception between those who smoked and those who did not. The majority of trans women expressed a desire for their voices to sound more feminine, particularly among smokers.
Objetivo: Verificar la relación entre el tabaquismo, edad, escolaridad y la autopercepción vocal de mujeres trans. Métodos: Estudio observacional transversal cuantitativo realizado con 24 mujeres trans mayores de 18 años, que viven en su género afirmado durante 6 meses. Para la recolección de datos se utilizaron preguntas seleccionadas de la versión portuguesa traducida y autorizada del Trans Woman Voice Questionnaire (TWVQ) y datos sobre edad, educación, ocupación y tabaquismo. Todas las variables se analizaron descriptivamente y la asociación con el tabaquismo se realizó mediante las pruebas Chi-cuadrado de Pearson, Exacta de Fisher, T de Student y Mann Whitney, con un nivel de significación del 5%. Resultados: La edad promedio de las mujeres trans fue de 28,2 +/- 6,5 (rango 21 - 48). La mayoría de las participantes (41,6%) había terminado la escuela secundaria con carreras muy diversas. Respecto al tabaquismo, el 58,3% de las mujeres fuman actualmente o han fumado al menos 100 cigarrillos en su vida. Hubo una asociación estadísticamente significativa entre el tabaquismo y la edad (p = 0,001), en la que la edad promedio entre los fumadores (24,9 años) fue menor que la de los no fumadores (32,9 años). No hubo significación estadística entre el tabaquismo, la educación y la autopercepción vocal. Solo 9 (37,5%) mujeres trans actualmente consideran su voz femenina y 17 (70,7%) dijeron que la voz ideal podría sonar más femenina. Limitación: La pequeña casuística puede haber limitado la identificación de diferencias entre los grupos analizados a través de pruebas estadísticas. Conclusión: El tabaquismo fue alto entre las mujeres trans, especialmente las más jóvenes. La autopercepción vocal no fue estadísticamente diferente entre los grupos de fumadores y no fumadores. La mayoría de las mujeres trans dijeron que sus voces podrían sonar más femeninas, especialmente las fumadoras.
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Introducción: Son pocos los estudios que describen cómo la pandemia por COVID-19 ha afectado las prácticas clínicas de los profesionales en fonoaudiología, y es aún más escaso el conocimiento de este impacto en países latinoamericanos, como Colombia. Objetivo: Describir el impacto de la pandemia por COVID-19 sobre el ejercicio de la fonoaudiología clínica, así como las adaptaciones implementadas para garantizar la atención de salud en Colombia. Materiales y métodos: Estudio de corte transversal en el que se aplicó un cuestionario online entre enero y febrero de 2021 a fonoaudiólogos clínicos con experiencia en el área. El cuestionario indagó sobre variables sociodemográficas y categorías como el ejercicio profesional clínico y el impacto del COVID-19 en la práctica clínica fonoaudiológica. Los resultados se analizaron descriptivamente y se aplicó Chi2 de independencia para encontrar posibles asociaciones. Resultados: El 9 % de los profesionales perdió su trabajo debido a la pandemia, y del total restante, el 14 % optó por la telesalud. Existen restricciones de intervención, principalmente en la atención deglutoria y de habla, así como adaptaciones que buscan proteger la salud del paciente y el profesional. Se evidencia que el entrenamiento en atención con pacientes con COVID-19 promueve el uso de elementos de protección personal (p < 0,01), la construcción de protocolos de atención institucional (p < 0,01) y la estabilidad de tiempos de intervención durante las sesiones (p < 0,04). Conclusiones: la pandemia por COVID-19 impactó la práctica clínica fonoaudiológica y modificó el actuar de los profesionales no sólo por la adopción de medidas de bioseguridad sino por la transición a la teleconsulta para garantizar la atención en salud.
Introduction: Few studies have described how the COVID-19 pandemic has affected the clinical practices of speech and language therapists, and the knowledge of this impact in Latin American countries, such as Colombia, is even scarcer. The aim of the present study was to describe the impact of the COVID-19 pandemic on the clinical practice of speech and language therapy, as well as the adaptations implemented to guarantee health care in Colombia. Materials and methods: Cross-sectional study, in which an online questionnaire was applied between January and February 2021 to speech and language therapists with experience in the clinical area. The instrument inquired about sociodemographic variables and categories such as clinical professional practice and the impact of COVID-19 on clinical speech and language therapy practice. The results were analyzed descriptively and chi-square for independence was applied to find associations. Results: Nine percent of the professionals lost their jobs due to the pandemic, and of the remaining total, 14% opted for telehealth. There are intervention restrictions, in swallowing and speech care, as well as adaptations that seek to protect the health of the patient and the professional. It is evidenced that training in care with patients with COVID-19 promotes the use of personal protection elements (p<0.01), the construction of institutional care protocols (p<0.01) and the stability of intervention times during the sessions (p<0.04). Conclusions: The COVID-19 pandemic impacted clinical Speech and Language Therapy practice and changed the actions of professionals, not only by adopting biosecurity measures, but also by the transition to telehealth to guarantee health care.
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Abstract Several studies have shown that, in the school setting, speech-language therapy has a significant impact on the detection, promotion and approach to the processes inherent to human communication as a basis for learning, participation, and inclusion. Despite this, recent regulations on education in Colombia do not clearly define the work of these health professionals in this scenario. Considering the above, the objective of this paper was to present a critical analysis of the role of speech-language pathologists in the context of inclusive education in Colombia. The first part of this article analyzes the problems regarding the denomination of speech-language pathology and the relevance of its functions. Then, the role of these professionals in the educational setting is addressed. Finally, some actions are proposed to vindicate the role of speech-language pathologists in equity and inclusion in education in terms of the elimination of environmental barriers and the strengthening of capacities according to the individual characteristics of students.
Resumen Varios estudios han mostrado que, en el escenario escolar, la fonoaudiologia tiene un impacto significativo en la detección, la promoción y el abordaje de los procesos inherentes a la comunicación humana como base para el aprendizaje, la participación y la inclusión. A pesar de esto, las disposiciones normativas recientes en Colombia no definen claramente el quehacer de este profesional en este escenario. Teniendo en cuenta lo anterior, el objetivo de este artículo fue presentar un análisis crítico sobre el papel del fonoaudiólogo en el contexto de la educación inclusiva en Colombia. En la primera parte del presente artículo se analizan los problemas en la denominación de la fonoaudiología y la pertinencia de sus funciones. Luego, se aborda el rol de este profesional en el contexto educativo. En la última parte se proponen algunas acciones para reivindicar el rol de los fonoaudiólogos en la inclusión y la equidad en la educación en términos de la eliminación de barreras del entorno y el fortalecimiento de capacidades de acuerdo con las particularidades de los estudiantes.
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Objetivo: investigar as alterações fonoaudiológicas encontradas em casos de violência intrafamiliar contra crianças e adolescentes, bem como analisar a evolução e o desfecho dos casos atendidos por fonoaudiólogos. Método: Estudo transversal, produzido por meio da aplicação de questionários com fonoaudiólogos clínicos que atendiam a crianças e adolescentes nos estados do Paraná e Santa Catarina. A exploração dos dados foi pautada na metodologia de Análise do Conteúdo (AC). Resultados: Dos 75 fonoaudiólogos pesquisados, 52% atenderam a crianças e/ou adolescentes suspeitos ou confirmados de sofrerem violência. Deste número, 59,5% dos profissionais continuaram acompanhado os casos e 40,5% descontinuaram o acompanhamento. Conclusão: As alterações na linguagem foi a queixa fonoaudiológica mais encontrada nas vítimas. Em muitos casos não foi possível obter informações sobre o desfecho da situação de violência, devido ao abandono do trabalho fonoaudiológico. Nas situações com desfechos favoráveis, este acontecimento ocorreu devido à remoção do agressor do contexto familiar, o acompanhamento de todos os envolvidos ou o encaminhamento da vítima para tratamentos interdisciplinares. Com relação ao desenrolar da queixa fonoaudiológica, os casos que tiveram evolução, foram os acompanhados de maneira interdisciplinar, principalmente com tratamento psicólogo dos envolvidos. Pode-se notar, também, que os profissionais que relacionaram a queixa fonoaudiológica com a situação de violência atuaram de forma mais humanizada, olhando o sujeito como um todo, permitindo o seu progresso terapêutico. (AU)
Purpose: This study aimed to investigate the speech-language disorders found in cases of domestic violence against children and adolescents and to analyze the evolution and outcome of cases assisted by Speech, Language Pathology and Audiology professionals. Methods: Cross-sectional study, produced through the application of questionnaires to clinical Speech, Language Pathology and Audiology professionals who assisted children and adolescents in the states of Paraná and Santa Catarina. Data exploration was based on the Content Analysis methodology. Results: Of the 75 Speech, Language Pathology and Audiology professionals surveyed, 52% assisted children and/or adolescents suspected or confirmed to be victims of violence. Regarding this number, 59.5% of the professionals continued to monitor the cases, and 40.5% discontinued the follow-up. Conclusion: Language changes comprised the speech-language pathology complaint most found in the victims. In many cases, it was not possible to obtain information about the outcome of the situation of violence due to the abandonment of Speech, Language Pathology and Audiology work. In situations with favorable outcomes, this event occurred due to the removal of the aggressor from the family context, the monitoring of all those involved, or the referral of the victim to interdisciplinary treatments. Regarding the development of the speech-language pathology complaint, the cases that evolved were followed up in an interdisciplinary manner, mainly with psychological treatment for those involved. Professionals who related the speech-language pathology complaint to the situation of violence acted more humanely, looking at the subjects as a whole and allowing their therapeutic progress. (AU)
Propósito: investigar los trastornos del habla y el lenguaje encontrados en casos de violencia doméstica contra niños y adolescentes, así como analizar la evolución y el rechazo de dos casos tratados por logopedas. Método: Estudio transversal, producido a través de la aplicación de cuestionarios con logopedas clínicos que atendían a niños y adolescentes en los estados de Paraná y Santa Catarina. La exploración de datos se basó en la metodología de Análisis de Contenido (CA). Resultados: De los 75 fonoaudiólogos encuestados, el 52% asiste a niños y/o adolescentes sospechosos o confirmados de ser víctimas de violencia. De ese número, 59,5% de los profesionales continuaron con el acompañamiento de los casos y 40,5% interrumpieron el seguimiento. Conclusión: Los cambios en el lenguaje fueron la queja de patología del habla y lenguaje más frecuente en las víctimas. En muchos casos no fue posible obtener información sobre el desenlace de la situación de violencia, debido al abandono del trabajo logopédico. En situaciones con resultados favorables, este evento se produjo por la separación del agresor del contexto familiar, el seguimiento de todos los implicados o la derivación de la víctima a tratamientos interdisciplinarios. En cuanto a la evolución del cuadro patológico del habla-lenguaje, los casos que evolucionaron fueron seguidos de manera interdisciplinaria, principalmente con tratamiento psicológico para los involucrados. También se puede notar que los profesionales que relacionaron la denuncia de fonoaudiología con la situación de violencia actuaron de forma más humana, mirando al sujeto como un todo, permitiendo su progreso terapéutico.(AU)
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Humanos , Niño , Adolescente , Maltrato a los Niños , Fonoaudiología , Exposición a la Violencia , Estudios Transversales , Encuestas y Cuestionarios , Relaciones Familiares/psicología , Disfonía/etiología , Trastornos de la Audición/etiologíaRESUMEN
Abstract Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objectives To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.
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Introducción: Los procesos normativos hacen parte vital del desarrollo en las diferentes culturas, al regular, sancionar, reconocer los deberes y derechos de los sujetos que conforman una sociedad; esto también aplica a la profesión de la fonoaudiología, la cual actualmente se encuentra reglamentada por la ley 376 de 1997 del Ministerio de Educación Nacional. Sin embargo, la Fonoaudiología en Colombia cuenta con 58 años de historia, de los cuales en las últimas dos décadas ha demostrado sus avances en el contexto laboral, generando cambios en competencias y roles de esta profesión. Pese a estos cambios la ley no ha tenido actualizaciones durante los 21 años posteriores a su sanción. Por lo anterior se realiza una revisión documental; identificando las normativas que reglamentan la profesión de la fonoaudiología en distintos países, analizándolas frente a la colombiana, con esta información recabada se realiza una encuesta estructurada por medio de la cual se determinó que para el gremio es contundente contar con la reforma a la Ley 376 y a su vez manifestaron estar de acuerdo con lo que se contempla dentro de la propuesta de reforma. Este proceso se está desarrollando por medio de un trabajo articulado entre la Asociación Colombiana de Fonoaudiología ASOFONO, el equipo de abogados y el senador ponente; con el objetivo de brindar un soporte que reglamente de manera actualizada a la profesión, conllevando a un beneficio de la profesión y el gremio en general.
Regulatory processes are a vital part of development in different cultures, by regulating, sanctioning, and recognizing the duties and rights of the subjects that make up a society. This also applies to the profession of speech therapy, which is currently regulated by Law 376 of 1997 of the Ministry of National Education. However, Speech Therapy in Colombia has 58 years of history, of which in the last two decades it has demonstrated its advances in the labor context, generating changes in competencies and roles of this profession. Despite these changes, the law has not been updated during the 21 years after its enactment. Therefore, a documentary review is carried out; identifying the regulations that regulate the profession of speech therapy in different countries, analyzing them against the Colombian one, with this information collected, a structured survey is carried out through which it was determined that for the union it is forceful to have the reform of Law 376 and in turn stated that they agree with what is contemplated in the reform proposal. This process is being developed through an articulated work between the Colombian Association of Speech Therapy ASOFONO, the team of lawyers and the senator speaker; with the aim of providing support that regulates the profession in an updated way, leading to a benefit for the profession and the guild in general.
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HumanosRESUMEN
ABSTRACT Purpose mouth breathing (MB) has detrimental effects on children's growth. Diagnosis of MB is possible through a multidisciplinary approach including Speech-Language Pathologist's (SLP) assessment; however, SLPs currently have little to no defined selection criteria to determine the awake and habitual breathing pattern. This study aims at identifying relevant criteria for the assessment of the habitual and awake breathing pattern of preschool children, and developing a grid that would help SLPs diagnose MB in their clinical practice. Methods A three-rounded online international Delphi process was conducted to achieve a consensus on the relevant items and their interpretation. Agreement was established through a Content Validity Ratio calculation. Based on the agreed items, we developed a grid through a scoring function. Results Observing the child at rest (i.e., time spent with an open/closed mouth and position of the tongue/lips) was considered the most important criterion. The experts also considered that observing the breathing pattern while chewing (open/closed mouth) and after swallowing (i.e., air intake and open/ closed mouth just after swallowing) should provide relevant but secondary information in decision-making. We were able to establish a clinical grid based on those criteria. Conclusion The Delphi procedure provided content-valid criteria and conditions of observation for the myofunctional SLP assessment of the awake and habitual breathing pattern in preschoolers. A clinical validation of the developed prototype grid should be conducted in preschool children to explore its effectiveness in the diagnosis of MB.
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Objective: The review describes the changes related to sleep-breathing disorders, com- munication and feeding processes in subjects with CF, through a scoping review. Meth- ods: A scoping review based on the PRISMA protocol was carried out in Pubmed, Lilacs and Scopus databases, to investigate the possibility of including SLP in the treatment of patients with CF. The inclusion criteria included studies that addressed communication and eating processes and disorders related to CF. Studies with a sample that presented other comorbidities that would justify the worsening of the condition, or secondary stud- ies, were excluded. There was no time or language delimitation. Results: The search found 1566 works, 27 Lilacs, 1009 Pubmed and 530 Scopus, by analysis of titles, abstract and reading in full. A total of 30 articles were selected for inclusion, 2 Lilacs, 22 Pubmed and 6 Scopus, all related to Speech-Language Pathology. Conclusion: It was observed that there is a poor sleep quality due to nocturnal desaturation, mild and moderate obstructive apnea. In studies related to hearing, individuals had sensorineural hearing loss. Speech-Language Pathology is of paramount importance in monitoring these sub- jects.
Objetivo: Descrever alterações relacionadas aos processos de distúrbios respiratórios do sono, comunicação e alimentação em sujeitos com FC, por meio de uma scoping review. Métodos: Foi realizada uma scoping review nas bases de dados Pubmed, Lilacs e Scopus, para investigar a possibilidade de incluir o fonoaudiólogo no tratamento de pacientes com FC, utilizando o checklist PRISMA. Os critérios de inclusão incluíram estudos que abor- dassem processos de comunicação e alimentação e distúrbios relacionados à FC. Foram excluídos estudos com amostra que apresentasse outras comorbidades que justificassem o agravamento do quadro, ou estudos secundários. Não houve delimitação de tempo ou idioma. Resultados: A busca encontrou 1566 trabalhos, sendo 27 Lilacs, 1009 Pubmed e 530 Scopus, por meio de análise de títulos, resumo e leitura na íntegra. Foram seleciona- dos para inclusão 30 artigos, sendo 2 Lilacs, 22 Pubmed e 6 Scopus, todos relacionados à Fonoaudiologia. Conclusão: Observou-se que há má qualidade do sono devido à dessa- turação noturna, apneia obstrutiva leve e moderada. Em estudos relacionados à audição, os indivíduos apresentaram perda auditiva neurossensorial. A Fonoaudiologia é de suma importância no acompanhamento desses sujeitos.
Objetivo: Describir las alteraciones relacionadas con los procesos de trastornos respira- torios del sueño, comunicación y alimentación en sujetos con FQ, a través de una revisión de alcance. Métodos: Se realizó una revisión de alcance en las bases de datos Pubmed, Lilacs y Scopus, para investigar la posibilidad de incluir al logopeda en el tratamiento de pacientes con FQ, utilizando la lista de verificación PRISMA. Los criterios de inclusión incluyeron estudios que abordaran los procesos de comunicación y alimentación y los trastornos relacionados con la FQ. Se excluyeron los estudios con una muestra que pre- sentaba otras comorbilidades que justificasen el empeoramiento del cuadro, o estudios secundarios. No había delimitación de tiempo ni de idioma. Resultados: La búsqueda en- contró 1566 trabajos, de los cuales 27 fueron Lilacs, 1009 Pubmed y 530 Scopus, me- diante análisis de títulos, resúmenes y lectura completa. Se seleccionaron 30 artículos para inclusión, 2 Lilacs, 22 Pubmed y 6 Scopus, todos relacionados con Logopedia. Con- clusión: Se observó que existe mala calidad del sueño por desaturación nocturna, apnea obstructiva leve y moderada. En estudios relacionados con la audición, los individuos tenían pérdida auditiva neurosensorial. La logopedia es de suma importancia en el segui- miento de estos sujetos.
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RESUMEN Objetivo Estimar la confiabilidad y reproducibilidad de un corpus de scripts diseñado para el pregrado de fonoaudiología. Método Estudio observacional de tipo descriptivo y temporalidad transversal. Se estimó la validez de constructo a partir del coeficiente α de Cronbach y la reproducibilidad con el índice Kappa de Fleiss. Las pruebas analíticas consideraron un nivel de significancia p<0.05. Resultados Se creó un corpus de 80 scripts organizados en 4 áreas de la fonoaudiología el que fue validado por 41 fonoaudiólogos. La experiencia promedio de los profesionales fue de 17.1 años (Std. Err: 2.4; IC 95%: 11.7-22.6). La confiabilidad del corpus fue α: 0.67 y el acuerdo interevaluador, κ: 0.29. Conclusión Los puntajes de confiabilidad y reproducibilidad del corpus creado fueron similares a los reportados por estudios previos en otras profesiones de la salud. Contar con estrategias validadas que se orienten al desarrollo de competencias y complementen las acciones formativas, contribuirá a incrementar la calidad en la formación de futuros profesionales de la salud.
ABSTRACT Purpose To estimate the reliability of scripts designed for undergraduate Speech-Language Therapy students. Methods A descriptive cross-sectional study was carried out. Qualitative variables were summarized by frequency or proportion and quantitative through means (CI 95%). Reliability was estimated through Cronbach's α coefficient, and inter-rater agreement was determined using Fleiss's Kappa index. The analytical tests considered a significance level of p<0.05. Results 80 scripts organized in four areas of speech-language therapy were validated by 41 speech-language pathologists. The average experience of the professionals was 17.1 years. The reliability of the corpus was α: 0.67 (min= 0.34; max: 0.84), and the inter-rater agreement κ: 0.29 (min: 0.07; max: 0.45). Conclusion The corpus's reliability scores were similar to those reported by previous studies in different health professions. Having validated strategies aimed at developing proficiency and supporting classic training actions in undergraduate courses will contribute to increasing the quality of future health professionals.
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ABSTRACT Primary Progressive Aphasia (PPA) is a progressive language disorder associated with frontotemporal impairment and mainly affects the left hemisphere of the brain. In general, this condition compromises abilities related to comprehension and expression of language. The diagnosis of PPA depends on in-depth knowledge regarding functions of language, neurology, and neuropsychology. Speech and language therapists (SLTs) have a pivotal role in the diagnosis and rehabilitation of PPA. The absence of these professionals involved in the diagnosis and rehabilitation may reflect on the quality of care of people with PPA. Objective: To identify the sociodemographic, educational, and professional practice characteristics of SLTs who work with people with PPA in Brazil. Methods: An online questionnaire was disseminated to reach SLTs across Brazil. The questionnaire collected information regarding sociodemographics, training and education, practice (time, setting, service provision), and sources of referral. Results: The study included 71 participants (95.8% women). Specialization was the most frequent educational level followed by master's degree, and participants where mainly from the Southeast and South regions of Brazil. Neurologists were the professionals who most referred patients with PPA to SLTs. Finally, SLTs worked primarily in homecare settings and provided mainly individual therapy services. Conclusion: SLTs who work with PPA in Brazil can be characterized mainly as professionals with postgraduate degrees, relatively young, and from the South and Southeast regions of Brazil.
RESUMO A afasia progressiva primária (APP) é um distúrbio progressivo da linguagem associado à atrofia de regiões frontotemporais predominantemente do hemisfério esquerdo do cérebro. De modo geral, a APP afeta as capacidades compreensivas e expressivas da linguagem. O diagnóstico depende de profissionais com profundo conhecimento das funções da linguagem, neurologia e neuropsicologia. A fonoaudiologia tem papel essencial no diagnóstico e reabilitação da APP, e a ausência de fonoaudiólogos nesses processos pode refletir na qualidade do cuidado das pessoas com APP. Objetivo: Identificar as características sociodemográficas, educacionais e de atuação profissional de fonoaudiólogos que atuam com APP no Brasil. Métodos: Foi distribuído um questionário em formato online para fonoaudiólogos de todo o Brasil. O questionário coletou informações sobre aspectos sociodemográficos, de formação, atuação profissional (tempo, local de atuação, tipo de serviço oferecido) e fontes de encaminhamento. Resultados: O estudo incluiu 71 participantes (95,8% mulheres). O nível educacional mais frequente foi a especialização, e as regiões demográficas com maior incidência de profissionais que atendiam APP foram as Regiões Sudeste e Sul do país. Os neurologistas foram os profissionais que mais encaminhavam pacientes com APP para os fonoaudiólogos. Por fim, os fonoaudiólogos atuavam, principalmente, em homecare e realizando, em sua maioria, terapia individual. Conclusão: Os fonoaudiólogos que atuam com APP no Brasil podem ser caracterizados principalmente como profissionais pós-graduados, relativamente jovens e das Regiões Sul e Sudeste do Brasil.