Phonetic Impairment Research Articles

Frenectomia para restituição fono-motricial da língua

Objetivo: Relatar o caso clínico de frenectomia lingual em uma criança com anquiloglossia, visando sua restituição fono-motricial. Descrição do caso: Paciente do sexo masculino, melanorderma, sete anos de idade, com queixa de bullying no ambiente escolar devido à dificuldade na dicção. Ao exame clínico, observou-se o freio lingual curto e fixado ao ápice da língua, resultando na limitação da protrusão e da projeção da língua em direção ao palato duro, além do comprometimento na dicção de alguns fonemas, confirmando o diagnóstico de anquiloglossia. Como conduta terapêutica, optou-se pela intervenção cirúrgica convencional (frenectomia). No pós-operatório imediato foi observado o freio centralizado no ventre lingual, bem como a eficiência na elevação e protrusão da língua. Uma vez que o paciente continuava com comprometimento fonético, o mesmo foi encaminhado para fonoterapia. Durante o acompanhamento pôde-se constatar melhora na fonação e ausência de queixas relacionadas aos aspectos comportamentais e convívio escolar. Considerações finais: A frenectomia de um freio lingual curto, tardiamente diagnosticado, apresenta-se como uma técnica cirúrgica de fácil execução e com potencial para restabelecer as funções motriciais da língua. Além disso, a instituição de uma abordagem multiprofisional, associando intervenção cirúrgica à fonoaudiológica, contribuiu para a restituição fonética e reinserção social do paciente.

Phonological and phonetic impairment in aphasic speech: an acoustic study of the voice onset time of six French-speaking aphasic patients

ABSTRACTThe aim of the present study is to contribute to the description of the speech production deficits in French-speaking aphasic patients, so as to shed light on their potential phonetic and/or phonological disorders. Acoustic studies of aphasics’ speech productions remain relatively infrequent, especially in French, and when entering into the specifics, often lead to inconsistent results. We conducted a multiple-case study on six aphasic patients, four with non-fluent aphasia and two with fluent aphasia. They were administered a variety of language and neuropsychological tasks, then they participated in a customized non-word repetition task. Acoustic analyses of their speech productions were performed, focussing on VOT as the main acoustic correlate of the voicing contrast for oral stops. Other atypicalities in their productions were also classified. Results showed variable and mainly “mixed” phonetic-phonological impairment profiles that differed from the traditional hypotheses made in the literature about the speech deficits to be expected as a function of type of aphasia. Our results support the use of acoustic analyses in order to complete language examination in aphasic patients but also suggest that the frontier between phonological and phonetic impairment is not clear-cut. These outcomes are better accounted for by theories and models postulating close relationships between the phonological and phonetic levels of processing.

Comparative study of splinted and unsplinted implant-retained maxillary overdentures without palatal coverage: A literature review

The palatal coverage is considered as an auxiliary element in the distribution of tensile strains on implant maxillary total prosthesis (implant overdentures) bases, either implant-supported or retained. However, complaints in some patients due to palate and phonetic impairment are constant. The palatal coverage removal would allow the improvement of these issues as well as pharyngeal control, salivary flow and hygiene. Thus, this literature review proposed to analyze the survival rates of dental implants retaining an implant maxillary overdenture without palatal coverage in edentulous maxilla. The review was conducted in Medline database, via PubMed between 2000 to 2016 period, and limited to English language publications. The search strategy took the following key-words, referencing title and / or abstract: dental implants; maxilla; maxillary; overdenture; and palatal coverage. According the data, the rehabilitation of the maxillary edentulous with four implant-supported overdentures with bar attachments and implant-retained with ball attachments has shown great survival rates of dental implants, but there are a few studies reporting the survival rate of implant overdentures. It was concluded that the prosthetic rehabilitation of total maxillary edentulous patients is viable through palateless implant overdentures when a minimum of four to six implants were used with careful planning and execution. KeywordsDental Implants; Maxilla; Overdenture and Palatal coverage.

Patient-Perceived Morbidity and Subjective Functional Impairment Following Immediate Transition from a Failing Dentition to Fixed Implant Rehabilitation.

Failing residual dentition gives rise to patient concerns about the surgical and prosthodontic management of immediate implant rehabilitation. The purpose of this study was to assess subjective patient experiences of full-arch immediate implant loading. Patients made a transition from poor dentition in the maxilla (25 patients) or mandible (25 patients) to full-arch rehabilitation on the day of extraction using four interantral or interforaminal implants. Provisional restoration was performed, and postoperative pain, swelling, and patient-perceived impairment in the first week was recorded. Absence of pain was reported by 40%, 52%, and 66% of patients, on the day of surgery, on the first day after surgery, and on the second day after surgery, respectively; pain levels decreased significantly (from 1.8 to 0.9, P < .001) and patient-reported swelling decreased from 1.5 to 1.3 (P = .058) on a 10-point scale. Postoperative impairment of everyday life and work (mean score = 1.1) was significantly less pronounced than impairment of food intake (mean score = 2.2; P = .004) or speech (mean score = 1.9; P = .002). Of these patients, 88% would again undergo the procedure without doubt. Although patient-perceived morbidity after immediate full-arch implant rehabilitation is low in general, minor masticatory and phonetic impairment should be taken into account.

Locus of phonological deficits in adults with dyslexia

Dyslexia is a developmental disorder that has traditionally been viewed as the consequence of impaired phonology. However, recent evidence suggests that the phonological deficits observed in dyslexia may reflect phonetic impairment earlier in the processing stream. The goal of the current work is to test this hypothesis. We use a phoneme-monitoring task to evaluate the relative use of two sources of information for making phonemic decisions (e.g., deciding if “dog” begins with /b/ or /d/). One source comes from a prelexical analysis of the speech signal (phonetic information) and the other source comes from a postlexical analysis (phonological information). Research has shown that healthy listeners flexibly shift between these sources based on experience with the acoustic signal. Specifically, phonemic decisions for native speech reflect phonetic information whereas phonemic decisions for foreign-accented speech reflect the use of phonological information. The interpretation is that phonetic processing is difficult for the foreign-accented speech, leading to a greater reliance on a postlexical analysis. If adults with dyslexia have impairment in phonetic processing, then we predict that phonemic decisions will reflect the use of phonological information for both types of speech, suggesting that the native speech signal is being processed as if it were accented.

Musculo-Nasomucosal Unit With Complete Lateral Bony Freeing and Medial Rotation for Ideal C-Shape Restoration and Retropositioning of the Levator Veli Palatini

No definitive procedure for cleft repair has been identified yet as the gold standard. Accordingly, this work tried to appraise the hypothesis that if the bony detachment and full retropositioning of the levator veli palatini muscle can ideally present an anatomical C-shape muscular sling restoration and if this is accompanied with pushback palatoplasty, would this present a better result in terms of tissue fistulation and phonetic impairment? A series of 74 different degrees of palatal clefts were operated by pushback palatoplasty combined with a modified approach of the levator vili palatini. This muscle was dissected only from the oral mucosa while kept attached to the nasal one as a musculo-nasomucosal unit. This unit was completely detached from the bony margin of the hard palate and then medially rotated and retropositioned in a typical C-shape mobile sling. Evaluations included suture line assessment and fistula development, and following the child's need for speech therapy. There were no intraoperative complications. Definite anterior fistulae with nasal air and foot leakage were observed in 2 cases. Four cases had postoperative velopharyngeal incompetence with a need for speech therapy. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all cleft types, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this unpublished technique.

Patterns of Impairments in AOS and Mechanisms of Interaction Between Phonological and Phonetic Encoding

One reason why the diagnosis of apraxia of speech (AOS) and its underlying impairment are often debated may lie in the fact that most patients do not display pure patterns of AOS. Mixed patterns are clearly acknowledged at other levels of impairment (e.g., lexical-semantic and lexical-phonological), and they have contributed to debate about the degree of interaction between encoding levels; by contrast, mixed impairments and mechanisms of interaction are less acknowledged at the levels of phonological and phonetic processes. Here, the author aims at bringing together empirical evidence in favor of an interaction between phonological and phonetic encoding and of the predominance of mixed patterns of impairment over pure phonetic impairment. The author reviews empirical results from acoustic and psycholinguistic studies, both with healthy speakers and speakers with brain damage, favoring independent phonological and phonetic encoding and separable impairments as well as recent research pointing to an interaction between phonological and phonetic encoding processes and overlapping patterns of impairments. Acknowledging interaction between phonological and phonetic processing has clear consequences on the definition of patterns of impairment. In particular, phonetic errors have not necessarily a phonetic origin, and most patterns of impairment are bound to display both phonological and phonetic features.

Dyslexia Impairs Speech Recognition but Can Spare Phonological Competence

Dyslexia is associated with numerous deficits to speech processing. Accordingly, a large literature asserts that dyslexics manifest a phonological deficit. Few studies, however, have assessed the phonological grammar of dyslexics, and none has distinguished a phonological deficit from a phonetic impairment. Here, we show that these two sources can be dissociated. Three experiments demonstrate that a group of adult dyslexics studied here is impaired in phonetic discrimination (e.g., ba vs. pa), and their deficit compromises even the basic ability to identify acoustic stimuli as human speech. Remarkably, the ability of these individuals to generalize grammatical phonological rules is intact. Like typical readers, these Hebrew-speaking dyslexics identified ill-formed AAB stems (e.g., titug) as less wordlike than well-formed ABB controls (e.g., gitut), and both groups automatically extended this rule to nonspeech stimuli, irrespective of reading ability. The contrast between the phonetic and phonological capacities of these individuals demonstrates that the algebraic engine that generates phonological patterns is distinct from the phonetic interface that implements them. While dyslexia compromises the phonetic system, certain core aspects of the phonological grammar can be spared.

Quality of life after microscopic periradicular surgery using two different incision techniques: a randomized clinical study

To monitor the quality of life of patients after periradicular surgery when two different flap designs were used. Forty patients with teeth having a periradicular lesion of endodontic origin were included according to specific selection criteria. Patients were randomly assigned to two groups. In one group a sulcular incision (SI) with complete papilla mobilization was made, and in the other group a papilla-base incision (PBI) was used. Periradicular surgery was performed using a surgical microscope. Parameters related to life quality were recorded daily in the first week post-surgery using a questionnaire. Pain was evaluated with a 0-100 visual analog scale (VAS). Other symptoms (swelling, bleeding and nausea), plus functions (chewing, speaking, sleeping, daily routine and work) were assessed using a five-point scale. Analgesic intake was recorded. Fisher's test and unpaired t-test were used to assess the difference between groups. The VAS score for pain, and the scores for swelling, chewing and phonetic impairment, peaked on days 1 and 2 postoperatively. A significant difference in favour of the PBI group was found for chewing and swelling in the first 4 days. Starting from day 3 post-surgery, the PBI group reported a significantly more rapid decrease in pain levels and analgesics use than the SI group (P < 0.05). The other parameters were similar in the two groups. The papilla-base incision technique may be preferred as reduction of pain levels, swelling and drug intake were more rapid in the first week postoperatively compared with cases in which a sulcular incision was used.

Speech production impairments following left and right hemisphere stroke

A speech production impairment can occur following damage to either the left or right hemisphere. The nature of the impairment, however, differs depending on which hemisphere is damaged and within the left hemisphere, whether the damage is to the anterior or posterior language areas. This paper reviews the recent literature on the types of speech production impairments that follow damage to the left and right cerebral hemispheres. Damage to the left hemisphere anterior language area causes primarily a phonetic impairment, i.e. a deficit in executing the articulatory maneuvers of sound production with a preserved ability to select the correct sound. Damage to the left hemisphere posterior language area causes primarily a phonological impairment, i.e. a deficit in the correct selection of a sound with an intact ability to implement the articulatory maneuvers for that incorrect sound. Damage to the right hemisphere can cause a speech production problem to the prosodic aspects of language. These differences have direct implications for the theraputic remediation of these speech production impairments.

Selective acoustic phonetic impairment and lexical access in an aphasic patient

The relationship between acoustic-phonetic disturbances and lexical access was explored in an aphasic patient. M.L. had a restricted disturbance of phonemic discrimination that affected the discrimination of voicing contrasts in nonword stimuli. Despite this impairment, her discrimination of voicing contrasts in words and her comprehension of auditorily presented words containing voiced segments was excellent. Performance on lexical decision was impaired: M.L.'s rejection of nonwords was poor and her reaction times and error rates for word stimuli showed a trend toward being influenced by the lexical status (word or nonword) of the item that would be formed by a change in voicing. The results are consistent with a role for a phonemic code in auditory word recognition, coupled with lexical-to-acoustic/phonetic feedback, but are also compatible with the view that other access codes for the Phonological Input Lexicon are also available.