Hearing Therapy Research Articles

Access to and effectiveness of support services for students in extended curriculum programmes at a South African university

In South Africa, many students enter university without the skills required for success in higher education. Extended curriculum programmes (ECP) were developed to provide students who showed potential but were underprepared with the necessary foundations to achieve success in higher education. Student support services are essential to student success. This has been apparent especially in universities enrolling academically underprepared students. This study, conducted by the Office of the Academic Advisor at the Faculty of Medicine and Health Sciences at Stellenbosch University, aimed to explore the effectiveness of and participation in support services available to students in the ECP. The last cohort of ECP students was accepted at the faculty in 2018 for the MBChB, BSc Physiotherapy, and BSc Speech-Language and Hearing Therapy degrees. On successful completion of the ECP, students join the second year of their respective mainstream programme and are tracked throughout their academic career with dedicated support services offered to them. As students transition from the ECP, they need to utilise their own agency to access the support services available. A quantitative survey including qualitative responses was used for data collection and was explored using thematic analysis. Specifically, the study explored students’ awareness and utilisation of, and their expressed interest in, the available support services. It was important to investigate the support needs of ECP students as an increasing need for support services had been identified during the COVID-19 pandemic. Furthermore, minimal data were evident on support needs of senior ECP students and especially on this population in health sciences. The research gave greater insight into students’ support needs. The findings indicated that students were familiar with and had accessed support services to an extent that they were able to share firsthand experiences of accessing support at the university.

Sensory integration of the vestibular system as a component of complex rehabilitation of a child with hearing loss

Introduction. The vestibular system is one of the most important human sensory systems, morphologically connected with the auditory system. The fetus starts responding to sound at around 16 weeks of development and its inner ear begins developing at 4 weeks. Proper receiving and processing of sound dictates development and comprehension of speech. The organ of hearing can be damaged during fetal development, birth or in the postnatal period. The damage to the organ of hearing affects the sensory systems’ integration. Training of sensory integration can be successfully introduced as a part of integrated rehabilitation of a child with hearing loss. Purpose. The work describes Sensory Integration used in speech and hearing therapy. Examples of hearing exercises have been included. The therapy was conducted in years 2019-2021 in Polish Association of the Deaf Toruń and Bydgoszcz facilities. Rehabilitation of the organ of hearing. The organ of hearing can be damaged during fetal development, birth or in the postnatal period. The rehabilitation of the organ of hearing begins as soon as the damage is recognized. The child, after being supplied with hearing aids or an cochlear implant, sometimes before that, is referred for speech and hearing therapy. In the process of widely understood rehabilitation, if complex action is required, included are physiotherapy and Sensory Integration- which was done at Polish Association of the Deaf Toruń and Bydgoszcz facilities. Sensory Integration in children with hearing loss. In children with hearing loss parallel to speech, pedagogical and psychological therapies conducted are other such as Sensory Integration, physical therapy or other forms of rehabilitation individually chosen depending on the needs of the child. Conclusion. Hearing exercises in accordance with the concept of Sensory Integration applied parallel to other forms of therapy can be used as a part of complex rehabilitation of a child with hearing loss.

The Effect of Spiritual Therapy Listening to Morattal Al-Qur'an Surah Ar-Rahman on Student Anxiety at STIKES Cirebon 2024

Students who are completing their final assignments can experience anxiety. One effort to reduce the anxiety level of students preparing their final assignments is by listening to Murottal Al-Qur'an. The purpose of this study was to determine the effect of spiritual therapy listening to mutual Al-Qur'an Surah Ar-Rahman on the anxiety of final-year nursing undergraduate students at STIKes Cirebon. This study used a quasi-experimental research method with a one-group pretest-posttest design. The sample in this study was 48 respondents. The data analysis technique used was the Wilcoxon test. The study results have a ρ value 0.000 (ρ <0.05). This means that H0 failed to be rejected, meaning spiritual therapy listening to Murottal Al-Qur'an Surah Ar-Rahman can reduce anxiety levels in final-year nursing undergraduate students at STIKES Cirebon 2024. The results of this study can be used as a source of information to increase knowledge about the effect of spiritual therapy by listening to Murottal Al-Qur'an. Al-Qur'an stimulants are superior to other hearing therapies because they can produce delta waves to reduce anxiety.

A new portable Fresnel magnifying loupe for nystagmus observation: a clinical education and clinical practice setting study

BackgroundDizziness is a common complaint of patients treated by primary care physicians. It is predominantly caused by peripheral vestibular disorders; however, central nervous system disorders should be excluded. Examination of the eye movements and nystagmus can help differentiate the disorders of the central nervous system from the peripheral vestibular disorders; however, it is often not performed appropriately. In medical education practice, nystagmus observation may facilitate an understanding of vestibular function and nystagmus characteristics. Thus, we proposed a medical education practice to master nystagmus observation using a recently developed portable Fresnel magnifying loupe that could be shielded by one eye.MethodsThirty-three students from the Department of Physical Therapy and the Department of Speech, Language, and Hearing Therapy of the Mejiro University participated in this study. Postrotatory nystagmus was measured and compared using the new loupe and control methods, namely the naked eye and Frenzel goggles; we rated the ease of visibility using a five-point scale.ResultsThe number of detected cases of nystagmus was significantly higher with the new loupe than with the naked eye (p = 0.001). In addition, there were no significant differences in the nystagmus counts between the observations using the new loupe and Frenzel goggles (p = 0.087). No significant difference was observed in the visibility of eye movements between the loupe and naked eye (p = 1.00). The Frenzel goggles provided better visibility compared to that by the loupe (p = 0.034); however, none of the participants reported poor visibility using any of these methods.ConclusionsOur newly developed Fresnel loupe allows for the observation of nystagmus counts a level of reduction in fixation suppression similar to that of Frenzel goggles in an educational practice setting. Furthermore, it enables the detection of significantly more nystagmus counts compared to that by the naked eye. It offers several advantages over Frenzel goggles, including its lightweight, thin, durable, and portable design. Additionally, the loupe does not rely on a power source and can be used under normal room lighting conditions.Trial registrationThis study was approved by the Medical Research Ethics Committee of Mejiro University (approval number: 21medicine-021).

Ginsenoside Rc from Panax Ginseng Ameliorates Palmitate-Induced UB/OC-2 Cochlear Cell Injury.

By 2050, at least 700 million people will require hearing therapy while 2.5 billion are projected to suffer from hearing loss. Sensorineural hearing loss (SNHL) arises from the inability of the inner ear to convert fluid waves into neural electric signals because of injury to cochlear hair cells that has resulted in their death. In addition, systemic chronic inflammation implicated in other pathologies may exacerbate cell death leading to SNHL. Phytochemicals have emerged as a possible solution because of the growing evidence of their anti-inflammatory, antioxidant, and anti-apoptotic properties. Ginseng and its bioactive molecules, ginsenosides, exhibit effects that suppress pro-inflammatory signaling and protect against apoptosis. In the current study, we investigated the effects of ginsenoside Rc (G-Rc) on UB/OC-2 primary murine sensory hair cell survival in response to palmitate-induced injury. G-Rc promoted UB/OC-2 cell survival and cell cycle progression. Additionally, G-Rc enhanced the differentiation of UB/OC-2 cells into functional sensory hair cells and alleviated palmitate-induced inflammation, endoplasmic reticulum stress, and apoptosis. The current study offers novel insights into the effects of G-Rc as a potential adjuvant for SNHL and warrants further studies elucidating the molecular mechanisms.

What is the burden of tinnitus?

Tinnitus is a complex experience that often occurs alongside other health conditions, including hearing loss. In the UK, as in other western countries, patterns of health are changing with a rise in multi-morbidity and complexity of health conditions. As we age, we can expect to live with multiple health conditions. Burden of illness has long been recognised. Less well recognised is the burden that accumulates from the treatment of health conditions. This qualitative thematic analysis of patient accounts described the cumulative burdens of tinnitus, both the experience of hearing the tinnitus and from the treatments undertaken. Between 2017-8 we conducted interviews with 38 participants who were help-seekers in a range of contrasting UK clinical services (Physician led, Audiology led and Hearing Therapy led). We examined these interview data using reflexive thematic analysis methods to identify and explore the cumulative burdens for those who live with and seek help for their tinnitus. Specifically, we used six phased approach to determine and group themes. The themes provide a coherent description of the nature of the burden that people with tinnitus experience. In tinnitus, as with most chronic health conditions, the largest treatment workload is devolved to the patient. Patients are required to implement treatments, learn about tinnitus and find new ways of coping. Yet this work happens invisibly, without recognition from clinicians who measure outcomes but not the efforts made to achieve outcomes. Patient-centred care depends upon the recognition of the cumulative burdens that patients experience.

Hearing screening using the uHear™ smartphone-based app: reproducibility of results from two response modes.

Estimate the reproducibility of hearing screening results using the uHear™ smartphone-based app in two response modes: self-test response and test-operator. Reliability study conducted with 65 individuals aged ≥18 years assisted at the Speech-language and Hearing Therapy clinic of a public higher-education institution. Hearing screening was conducted by a single researcher using the uHear app and earbud headphones in a soundproof booth. Participants responded to sound stimuli in both self-test response mode and test-operator mode. The order in which these two uHear test modes were applied was altered according to the entrance of each participant in the study. The correspondence between the hearing thresholds obtained from each response mode was analyzed and their Intraclass Correlation Coefficient (ICC) was estimated. A correspondence of ±5 dBHL >75% was observed between these hearing thresholds. The ICC values showed excellent agreement between the two response modes at all frequencies >40 dBHL tested. The two hearing screening response modes using the uHear app presented high reproducibility, suggesting that the test-operator mode is a viable alternative when the self-test response mode is not recommended.

Associação entre a Enfermagem e a Fonoaudiologia na identificação de risco para disfagia: estudo transversal analítico

Abstract Objective to investigate and demonstrate the association between the self-perceived swallowing assessment carried out by nurses and the dysphagia risk classification carried out by speech therapists in hospitalized elderly patients. Method an analytical cross-sectional study using the Eating Assessment Tool and the Speech and Hearing Therapy Protocol for Dysphagia Risk Assessment in 52 elderly patients in a medical clinic, as well as collecting sociodemographic data and health conditions. Fisher's exact test and logistic regression for odds ratios were used for statistical analysis. Results there was an association (p=0.01) between the nurse's assessment and that of the speech therapist, with an odds ratio of a hospitalized elderly person exposed to the risk of dysphagia by the Eating Assessment Tool presenting a change in the Speech Therapy Protocol for Dysphagia Risk Assessment (OR 3.89 95% CI: 1.10-13.68). Conclusion and implications for practice the findings indicate that there is an association between the nurse's assessment and that of the speech therapist in swallowing disorders and that Nursing can act to identify risks, prevent and rehabilitate dysphagia.

DSLchild-Algorithm-Based Hearing Aid Fitting Can Improve Speech Comprehension in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss.

Background: Patients with chronic tinnitus and mild-to-moderate hearing loss (HL) can experience difficulties with speech comprehension (SC). The present study investigated SC benefits of a two-component hearing therapy. Methods: One-hundred-seventy-seven gender-stratified patients underwent binaural DSLchild-algorithm-based hearing aid (HA) fitting and conducted auditory training exercises. SC was measured at four timepoints under three noise interference conditions each (0, 55, and 65 dB): after screening (t0; without HAs), HA- fitting (t1), additional auditory training (t2), and at 70-day follow-up (t3). Repeated-measure analyses of covariance investigated the effects of HAs (t0–t1), auditory training (t1–t2), and the stability of the combined effect (t2–t3) on SC per noise interference level and HL subgroup. Correlational analyses examined associations between SC, age, and psychological indices. Results: Patients showed mildly elevated tinnitus-related distress, which was negatively associated with SC in patients with mild but not moderate HL. At 0 dB, the intervention lastingly improved SC for patients with mild and moderate HL; at 55 dB, for patients with mild HL only. These effects were mainly driven by HAs. Conclusions: The here-investigated treatment demonstrates some SC-benefit under conditions of no or little noise interference. The auditory training component warrants further investigation regarding non-audiological treatment outcomes.

Algorithm-Based Hearing and Speech Therapy Rehabilitation after Cochlear Implantation.

Introduction: Due to the changes in the indication range for cochlear implants and the demographic development towards an aging society, more and more people are in receipt of cochlear implants. An implantation requires a close-meshed audiological and logopedic aftercare. Hearing therapy rehabilitation currently requires great personnel effort and is time consuming. Hearing and speech therapy rehabilitation can be supported by digital hearing training programs. However, the apps currently on the market are to a limited degree personalized and structured. Increasing digitalization makes it possible, especially in times of pandemics, to decouple hearing therapy treatment from everyday clinical practice. Material and Methods: For this purpose, an app is in development that provides hearing therapy tailored to the patient. The individual factors that influence hearing outcome are considered. Using intelligent algorithms, the app determines the selection of exercises, the level of difficulty and the speed at which the difficulty is increased. Results: The app works autonomously without being connected to local speech therapists. In addition, the app is able to analyze patient difficulties within the exercises and provides conclusions about the need for technical adjustments. Conclusions: The presented newly developed app represents a possibility to support, replace, expand and improve the classic outpatient hearing and speech therapy after CI implantation. The way the application works allows it to reach more people and provide a time- and cost-saving alternative to traditional therapy.

Hearing Therapy Improves Tinnitus-Related Distress in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss: A Randomized-Controlled Cross-Over Design.

Background: The psychological effects of hearing aids and auditory training are underinvestigated. Objective: To assess the short- and long-term effects of an industry-developed auditory training on tinnitus-related distress, perceived stress, and psychological epiphenomena in patients with chronic tinnitus and mild-to-moderate hearing loss. Method: One-hundred-seventy-seven gender-stratified patients were randomized to an immediate [IIG] or delayed [DIG] intervention group. Following binaural hearing aid fitting, participants completed a CD-enhanced 14-days self-study program. Applying a randomized-controlled cross-over design, psychological measures were obtained at four times: pre-treatment/wait [IIG: t1; DIG: wait], post-treatment/pre-treatment [IIG: t2; DIG: t1], follow-up/post-treatment [IIG: t3; DIG: t2], and follow-up [DIG: t3]. Between- and within-group analyses investigated treatment-related effects and their stability at a 70-day follow-up. Results: Overall, distress symptom severity was mild. Unlike the DIG, the IIG showed significant improvements in tinnitus-related distress. Some psychological epiphenomena, notably anxiety, slightly improved in both groups. Within-group analyses demonstrated the stability of the tinnitus-distress-related effects, alongside uncontrolled improvements of perceived stress and mood-related symptoms at follow-up. Conclusions: The investigated hearing therapy lastingly improves tinnitus-related distress in mildly distressed patients with chronic tinnitus and mild-to-moderate hearing loss. Beneficial psychological knock-on effects deserve further investigation.

Коррекция нарушения звукопроизношения у старших дошкольников с фонетико-фонематическим недоразвитием речи

The research featured senior preschoolers with phonetic-phonemic speech underdevelopment. The authors described the peculiarities of speech development in such children and analyzed related publications. As a rule, impaired sound pronunciation includes low tempo and weak voluntary regulation. The study featured substitutions, distortion, or absence of various sounds. The authors tested a set of measures aimed at correcting speech disorders in senior preschool children with phonetic-phonemic speech underdevelopment. The experiment revealed a combination of incorrect pronunciation with sounds that were partially consistent in a certain context. Cognitive parameters included difficulties in memorizing verbal information and poor auditory memory. The subjects failed active speech tests and could not remember oral information. The article also introduces data on the specifics of speech therapy of phonemic hearing.

Developing the educational guidelines and model core curriculum for speech-language-hearing therapists in Japan

Children with autism and language developmental delays have unique needs when it comes to language learning. Speech-language-hearing therapists (SLHTs) are qualified to fulfil these needs, as one of the areas of their expertise, providing necessary treatment and support. Unfortunately, however, the existing number of SLHTs is not sufficient to meet the growing demand for these types of professionals in Japan. A reason for this is likely to be the low pass rate for qualifying therapists. As such, if researchers can find a way to increase this pass rate, the number of qualified SLHTs would increase and demand would be met. This is the goal of Professor Chizuko Uchiyama and her team based at the Department of Speech, Language and Hearing Therapy, Mejiro University, Japan, and Japanese Association of Speech-Language-Hearing Therapists. Chizuko, who is herself a trained SLHT, created a model core curriculum (MCC) that was completed in 2018 and complies with specific training rules and guidelines for SLHTs and also takes into account the educational content that is anticipated to be needed in the future. The goals of this work are to improve the training education provided to SLHTs, thereby increasing the national examination pass-rate for qualified therapists of this kind and producing high-quality SLHTs. This will ultimately ensure there is an adequate number of qualified SLHTs to fulfill growing demand and lead to a higher standard of education and care for children with autism and language development delays. The larger impact of this will be enhanced societal welfare and benefits for people with communication and hearing problems.

Trastornos persistentes de los sonidos del habla en niños con y sin alteraciones del lenguaje: características fonológicas y desempeño motor oral

ObjectiveTo identify oral motor performance skills and characterize the phonological system of primary school children aged between 8 and 12years without alterations in speech sounds and/or oral and written language, and in children who present speech changes with or without reading and writing difficulties. MethodThe study included 79 elementary school children between 8 and 12years from public schools and the outpatient clinic of Unifesp's Department of Speech and Hearing Therapy. The ABFW evaluation protocol (naming) was applied and, after analysis, the children were divided into three groups: CG (control group) with no change in speech and written language, GE1 (research group1) with speech impairment and no change in reading and writing, and GE2 (research group2) with speech and reading and writing impairment. The PCC index of the three groups was calculated. Tests for diadochokinesia, praxis and oral skills were applied in all children. Kruskal-Wallis tests, with multiple comparisons of Tukey, and the Mann-Whitney test were used to compare the performance between the groups. The significance level considered was .05 (5%). ResultsThe ABFW naming test and the PCC index were similar for GE1 and GE2, although GE2 showed 5 children with mild and 1 with moderately severe speech impairment. The others presented only mild alterations. The most predominant alterations between the two groups were 65.78% simplification of the consonant encounter, 34.21% simplification of the final consonant and 28.94% liquid simplification. The GE2 presented the worst performance in the diadochokinesis tests. Lingual praxia abilities showed the worst performance, with the CG presenting 11.36% of difficulties, while GE1 presented 41.17% and GE2 57.14%. ConclusionIn groups GE1 and GE2, the predominant speech changes were simplification of the consonant encounter, simplification of the final consonant and liquid simplification. The GE2 group (children with reading and writing difficulties) performed less well in tests of speed and repetition (neuromotor maturation) and in language skills, which suggests deficit of the oral motor domain. This study highlights the need to evaluate oral motor performance in children with persistent speech disorders with or without difficulties in reading and writing.

Impacto de la hipoacusia unilateral en el desarrollo del lenguaje

Background and objectiveEven if apparently unilateral hearing loss (UHL) goes unnoticed, it has been known for 40 years that its presence leads to academic and behavioural problems. Due to the shortage of published studies and the variability of the results, our purpose is to evaluate the impact of this condition by making a formal study of language in children with UHL, analysing predisposing factors and including the parents’ point of view. MethodsA group of 16 children between 3 to 15 years old were selected; all had an early diagnosis of prelingual UHL, with a variability in grade and type. Several language tests have been applied: “EMLE”, “EDAF”, “PLON-R/BLOC-SR” and “Evaluación Fonológica del habla infantil” (Laura Bosch). In addition, we obtained the parents’ opinion about the impact on their children's language development with UHL, through an ad hoc questionnaire. ResultsRegardless of the impaired ear, the grade and type of UHL, the global development of language showed a normal range, which improved with age and possibly depends on the socio-educational level of the family. The main alterations were found in morphosyntax. In profound UHL, the outcome in the phonological registry and in reading and writing are lower than in the other categories. According to the parental questionnaire responses, more educational and speech language support is required and some behavioural changes were also detected, mostly at school. ConclusionsOnly a few language alterations were detected; we realize that parents do not attach much importance to this deficit. Although the impact of UHL on the development of a specific child cannot be determined, for prevention information is essential on possible consequences, as well as early detection of any variation through close monitoring, speech and hearing therapy.

Factors associated to functional recovery of left vocal fold motion impairment at two-years-old age in very preterm infants

ObjectiveTo describe a cohort of neonates with left vocal fold motion impairment (LVFMI) and the factors associated to it in the neonatal period; procedures required during LVFMI treatment; and clinical outcomes at the age of 2-years. An additional objective was to study those factors which are likely to be most associated to functional recovery of LVFMI at this age. MethodsA cohort of patients born in a tertiary care hospital with a diagnosis of left VFMI was included. Factors registered were: gender; clinical presentation at the time of examination; diagnosis of other laryngeal defects associated; data related to their neonatal period (gestational age, congenital heart defects corrective surgery required, neurologic disease, bronchopulmonary dysplasia, non-invasive ventilation required, invasive ventilation required, and tracheostomy required); treatment applied for LVFMI (tracheostomy and/or laryngeal surgery); need of language and hearing therapy; and outcomes considered by the pediatric otolaryngologist at the 2 years-old follow-up visit. ResultsA total of 56 patients with LVFMI diagnosis were included. Only 10 patients (17.9%) showed functional recovery from LVFMI at the age of 2 years. We found significant negative association between this recovery and language and hearing therapy (p = 0.03), which was also associated to psychomotor retardation (p < 0.001). Multivariate analysis produced similar results, being language and hearing therapy the only significant factor associated to a worse outcome (OR = 4.77 [CI95% 1.14; 20.08] p = 0.03). ConclusionPsychomotor development retardation is negatively associated to functional recovery of full speech in a preterm infant's population with LVFMI diagnosis, regardless of other factors related to LVFMI etiology and severity.

Treatment indicators influence speech therapy discharge time.

To compare the treatment time for acquired neurological disorders of communication and the reason for discharge of users of a medium complexity care service for two periods: before and after implementation of treatment indicators. A retrospective cohort study was carried out involving the analysis of medical records of users of the Adult Language Sector of the Speech and Hearing Therapy Service of the Integrated Rehabilitation Center, seen before and after treatment indicators implementation. 129 electronic medical records of users who remained under treatment until discharge from speech therapy in the two studied periods were analyzed. The mean duration of speech therapy for these users was 10.9 months for the first period and 7.8 months for the second period. After implementation of the indicators with regular reassessments, 72 out of the 89 users continued with treatment. There was a statistically significant difference in the therapy average time and reason for discharge before and after treatment indicators implementation. After treatment indicators implementation, there was a reduction of the average speech therapy treatment time for communication disorders and an increase of speech therapy discharge percentage of users seen in a Brazilian service of medium complexity.

THE ROLE OF FAMILY INTERVENTION IN EARLY DETECTION OF CONGENITAL DEAFNESS: A CASE STUDY

Congenital deafness is a hearing loss disorder that occurs at birth and is one of the disorders that can cause complications when it is not treated.1 Children with hearing loss will face difficulties such as poor development outcomes, including poor speech and language skills and face difficulties with cognition and social-emotional interactions. Early intervention has been proven to be one of the most important factors leading to good outcomes for children with congenital hearing loss.2 This case study is intended to highlight the importance of early case detections, early interventions and how family support plays a crucial role in the development of children with hearing loss. With the support of her family, Ms. DRP has gone through several speech and hearing therapies since her surgery and has proven to have an above-average linguistic abilities, showing that early problem detection does not hinder the development and achievement of children with congenital hearing loss.

The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report.

We present an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients who were previously seen on an outpatient basis in a primary health care service. The Speech-Language Therapy (SLT) team was monitoring twenty-five users when the first cases of COVID-19 were notified in southern Brazil. Of these, it was judged that twelve patients required at least a monitoring call every two weeks. Teleconsultations were available in this first stage, on an emergency basis, during the implementation of the project in this format. The idea was to guarantee, due to the suspension of the SLT sessions, the maintenance of the care service for patients who could suffer worsening of their cases or even comorbidities. The appointments were carried out by video calls by SLT students, therapists of the extension project, and supervised by a speech-language therapist, synchronously. All conversations and orientations during the teleconsultation were conducted as calmly as possible and, in the case of infant patients, permeated by some playful activities. Telehealth has shown to be an efficient resource for the care of patients with SLT demands, enabling remote care with the same quality as face-to-face care. Besides, it has relevant potential, once there is a significant number of patients, who need SLT assessment and live in regions where there is a shortage of qualified professionals.

A emergência do gesto de apontar na Síndrome de Down em contexto clínico

A síndrome de Down (SD) é uma condição genética que provoca uma série de alterações no desenvolvimento linguístico da criança. Em relação à linguagem, é importante considerar sua natureza multimodal, assumindo-a como um envelope linguístico (ÁVILA-NÓBREGA, 2018) constituído de gestos, fala e olhar. Desse modo, é fundamental observar como o envelope linguístico multimodal emerge e é mobilizado pela criança com SD, em diferentes contextos. Este trabalho teve o objetivo de analisar a emergência do gesto do apontar de crianças com SD, em contextos de atendimento clínico. O estudo foi desenvolvido na Clínica Escola de Fonoaudiologia de uma instituição de ensino superior da Paraíba, a partir do registro de atendimentos terapêuticos fonoaudiológicos de duas díades: estagiária e criança com SD. Os dados foram registrados qualitativamente no programa ELAN – EUDICO Linguistic Annotator. Pode-se observar que o gesto de apontar emergiu com frequência no envelope linguístico multimodal das crianças, facilitando sua interação com as estagiárias, bem como na atenção conjunta e referência.