Speech Therapy Evaluation Research Articles

Adaptações na mastigação, deglutição e fonoarticulação em idosos de instituição de longa permanência

OBJETIVO: identificar adaptações existentes nas funções estomatognáticas de mastigação, deglutição e fonoarticulação em idosos de Instituição de longa permanência. MÉTODOS: participaram da pesquisa 34 idosos, sendo 15 do sexo feminino e 19 do sexo masculino na faixa etária de 65 a 88 anos. Foram realizadas entrevistas contendo perguntas sobre a saúde geral e alimentação do idoso e avaliações fonoaudiológicas a fim de caracterizar as funções de mastigação, deglutição e fonoarticulação. RESULTADOS: em relação à mastigação, foi observado que a maioria dos idosos apresentou mastigação adaptada, com participação exagerada da musculatura perioral, movimentos mandibulares verticais e o padrão mastigatório predominante foi bilateral simultâneo. Em relação à deglutição, observou-se que assim como a mastigação, esta função se apresentou adaptada na maioria dos voluntários, com a participação exagerada da musculatura perioral e ruído durante a deglutição. Na avaliação da fonoarticulação, foi visto que mais de 50% dos idosos apresentou escape de ar durante a fala, assim como uma elevação de laringe reduzida e presença de substituição, omissão, distorção e imprecisão. CONCLUSÃO: observou-se que os idosos se adaptam durante o processo de mastigação a fim de manter sua dieta o mais próximo possível da realizada quando jovem. Também foi visto que os pesquisados realizam compensações durante a deglutição. As características fonoarticulatórias encontradas não limitam severamente a comunicação dos idosos atualmente. Foi possível ainda observar que o atendimento ao idoso necessita ser interdisciplinar e que o fonoaudiólogo pode e deve fazer parte dessa equipe auxiliando na prevenção e/ou reabilitação de problemas relacionados às funções estomatognáticas.

A clínica fonoaudiológica e a linguagem escrita: estudo de caso

OBJETIVO: partindo do pressuposto que a atividade lingüística é constitutiva do sujeito, esse trabalho busca discutir o processo de apropriação da escrita, na clínica de linguagem, a partir da relação que o aprendiz estabelece com o outro, fonoaudiólogo. MÉTODOS: foi analisado longitudinalmente o caso de um sujeito dito portador de distúrbio de leitura e escrita, o qual antes de submeter-se a avaliação fonoaudiológica apresentava produções escritas distantes da convenção ortográfica. RESULTADOS: a terapia de linguagem foi eficiente para apropriação da modalidade escrita, já que no decorrer do tratamento houve melhora e superação das queixas. CONCLUSÃO: por meio da atividade conjunta de construção da escrita, na clínica de linguagem, entre o sujeito dessa pesquisa e o fonoaudiólogo, o primeiro pode ser percebido como alguém capaz de fazer uso significativo da escrita.

Make Liberalized Diets More Palatable

Make Liberalized Diets More Palatable

Ototoxicity From Cisplatin Therapy in Childhood Cancer

Cisplatin has been associated with hearing damage. It is usually irreversible, bilateral, and characterized by high-frequency sensorineural hearing loss. This study was carried out to identify impairment of hearing function in children and adolescents with cancer after cisplatin therapy. Twenty-three survivors of childhood cancer treated with cisplatin at our Unit from 1991 to 2004 performed tympanometry, pure tone audiometry, transient otoacoustic emissions, and distortion product otoacoustic emissions (DPOAE). The median age at diagnosis was 12.3 years and the median total dose of cisplatin received was 406 mg/m2. Fifty-two percent of patients had bilateral and in the high frequencies range hearing loss on audiometry. Transient otoacoustic emission and DPOAE abnormalities were detected in 22% and in 71% of the patients, respectively. We found a high concordance between the findings of audiometry and DPOAE (P=0.01). There was no influence of sex and number of ototoxic drugs other than cisplatin on hearing loss. There was a trend for younger age and higher cumulative dose of cisplatin to be associated with greater severity of hearing damage. Our data provide further evidence on hearing damage due to cisplatin therapy in children. The high incidence of patients with hearing function abnormalities found in this study and in previous reports highlights the importance of monitoring hearing function in children and adolescents undergoing cisplatin therapy, or as early as possible at follow-up. This study also demonstrates that DPOAE should be used for screening of hearing abnormalities and, once hearing damage is identified, patients require expert audiologic pediatric evaluation and (where indicated) use of hearing aids and/or speech therapy.

Clinical evaluation of speech therapy for oral surgery patients with articulation disorders

Clinical evaluation of speech therapy for oral surgery patients with articulation disorders

Relação do pico de fluxo expiratório com o tempo de fonação em pacientes asmáticos

OBJETIVO: investigar a possível relação do Pico de Fluxo Expiratório (PFE) com o Tempo Máximo de Fonação (TMF) em pacientes asmáticos. MÉTODOS: a pesquisa enfocou 16 indivíduos com o diagnóstico de asma pura, sendo 9 do gênero feminino e 7 do gênero masculino, atendidos no serviço ambulatorial de pneumologia do Hospital Júlia Kubitschek em BH. A equipe de pneumologia diagnosticou, classificou a asma e realizou o teste PFE. Posteriormente os pacientes foram submetidos à extração de tempo Máximo de Fonação (TMF) para os sons /a/, /i/, /u/, /e áfono/, /e sonoro/, /s/ e /z/. RESULTADOS: dos pacientes atendidos havia 12,50% (2) com asma tratada, 18,75% (3) com asma persistente leve, 43,75% (7) com asma persistente moderada, 6,25% (1) com asma moderada grave e 18,75% (3) com asma persistente grave. Foi observado que quando o TMF encontrava-se reduzido ocorria também uma redução do PFE e quando havia um aumento do TMF era encontrado no PFE valor também maior. CONCLUSÃO: foi possível observar uma associação e uma correlação entre as medidas TMF e PFE que sugerem uma relação direta dessas medidas.

Correlation between the clinical phonoaudiological assessment and electromyographic activity of the masseter muscle

The objective of this paper was to evaluate the specificity of masseter muscle palpation when compared to its electromyographic activity. Twenty-one young female adults, aged between 17 and 25, participated in this research. The speech therapy evaluation data were obtained by two speech therapists through masseter muscle palpation during isometric contraction, and the electromyographic exam was achieved by using bipolar superficial electrodes, positioned on the masseter muscle. The volunteers were instructed to chew the Parafilm M® material bilaterally and simultaneously. The capture of the electromiographic signals occurred during masseter muscle isometric contractions. The electrical activity study of the masticatory muscle was analyzed through the Root Mean Square value during its isotonic contraction. All data were then submitted to Kappa statistical analysis. The results of this study have shown a low correlation between palpation and electromyography (25%), as well as between evaluators (40%). According to the findings of the present study, it could be observed that the correlation between masseter muscle palpation and its electromyographic activity was very low, which allows to conclude that muscular palpation cannot effectively replace the eletromyographical exam, but complement it instead.

VA Stroke Study: neurologist care is associated with increased testing but improved outcomes.

VA Stroke Study (VASt) data were analyzed to determine whether neurologist management affected the process and outcome of care of patients with ischemic stroke. VASt prospectively identified patients with stroke admitted to nine VA hospitals (April 1995 to March 1997). Demographics, stroke severity (Canadian Neurologic Score), stroke subtype (Trial of ORG 10172 in Acute Stroke Treatment [TOAST] classification), tests/procedures, and discharge status (independent, Rankin < or = 2, vs dead or dependent, Rankin 3 through 5) were compared between patients who were or were not cared for by a neurologist. Of 1,073 enrolled patients, 775 (neurologist care, n = 614; non-neurologist, n = 161) with ischemic stroke were admitted from home. Stroke severity (Canadian Neurologic Score 8.7 +/- 0.1 vs 8.4 +/- 0.2; p = 0.44), TOAST subtype (p = 0.55), and patient age (71.4 +/- 0.4 vs 72.4 +/- 0.7; p = 0.23) were similar for neurologists and non-neurologists. Neurologists more frequently obtained MRI (44% vs 16%; p < 0.001), transesophageal echocardiograms (12% vs 2%; p < 0.001), carotid ultrasounds (65% vs 57%; p = 0.05), cerebral angiography (8% vs 1%; p = 0.001), speech (35% vs 18%; p < 0.001), and occupational therapy (46% vs 33%; p = 0.005) evaluations. Brain CT, transthoracic echocardiogram, 24-hour ambulatory ECG use, and hospitalization durations (18.2 +/- 0.8 vs 19.7 +/- 4.1 days; p = 0.725) were similar. Neurologists' patients were less likely to be dead (5.6% vs 13.5%; OR = 0.38; 95% CI 0.22, 0.68; p = 0.001) and less likely to be dead or dependent (46.1% vs 57.1%; OR = 0.64; 95% CI 0.45, 0.92; p = 0.019) at the time of discharge. The benefit remained after controlling for stroke severity and comorbidity (OR = 0.63; 95% CI 0.42, 0.94; p = 0.025). Neurologist care was associated with more extensive testing, but similar lengths of hospitalization and improved outcomes.

ESES Syndrome with Acquired Aphasia

Case Report: A 7‐year‐old boy presented with a 2‐year history of convulsions. Birth history was unremarkable. His motor and mental development were normal until the onset of partial seizures of his face at the age of 5.3 years, usually upon awakening. CBZ failed to control seizures. At 6.3 years he began to display slow speech, drooling, and reading difficulties. Absence attacks began at age 7. Upon examination, muscle weakness and cerebellar ataxia and paresis were absent. He showed sudden loss of tone in the arms when eating or writing, considered to represent negative myoclonus. Laboratory examination including CBC, blood chemistry, CSF studies, and MRI all were normal. EEG showed continuous diffuse spike and wave bursts associated with focal spikes at mid‐temporal and central area in the sleep record. Overnight sleep EEG showed continuous diffuse spike and wave bursts during slow wave sleep. The spike wave index was about 30% among slow wave sleep stages. During REM sleep, rapid eye movements disturbed the discharges of the diffuse spike and wave complex on EEG. His intelligent quotient was about 73 in the Tanaka‐Binnet test. Attention was limited and he could not copy figures accurately due to pour eye‐hand coordination. Speech therapy evaluation found word finding difficulty, paraphasia, slow speech, misuse of different consonants, distortion of vowels, and motor articulatory disturbance or motor aphasia. He lacked oral dyspraxia. During a hospital admission, ACTH‐2 was administered intramuscularly 2 I times in addition to oral administration of valproate, phenytoin, and carbamazepine. Convulsions were controlled, and he gradually recovered from the motor aphasia. Diffuse abnormalities of EEG resolved, but focal spikes remained over centro‐temporal areas during sleep. Cognitive function and vocabulary improved. Negative myoclonus of his hand disappeared. Several months after ACTH therapy, however, he suffered from moderate difficulties with word finding and the EEG deteriorated. Conclusions: ESES syndrome consists of “electrical status epilepticus during sleep”, “nonconvulsive status epilepticus with epileptic negative myoclonus”, “atypical benign partial epilepsy”, and “LandauKleffner syndrome“. According to Ohtahara, Landau‐Kleffner syndrome is characteristic of auditory agnosia. There have been no reports of motor aphasia associated with this syndrome. The present case does not meet criteria for “electrical status epilepticus during sleep” because of the low spike‐wave index but may be considered a variant of ESES. The distinctive features of this case are motor aphasia and negative myoclonus, as well as diffuse spike‐waves during slow wave sleep. Long‐term prognosis of this patient is not presently known.

Issues to consider in the evaluation of speech and language therapy for preschool children.

This paper reviews some of the methodological issues involved in the design of a randomized controlled trial currently underway in Bristol. The trial compares the progress of preschool children randomly allocated to a 'watching-waiting' control group with the experimental group who have immediate access to therapy. This paper reviews a number of relevant studies, which have either followed up preschool children with early language delays or have investigated the effects of therapy with this age group. The basic design of the trial is outlined along with a discussion of the sample, the measurements used and the therapy given.

Trial of intensive compared with weekly speech therapy in preschool children.

Forty two preschool children referred to a speech therapy department were randomly allocated to receive intensive individual speech therapy or the more traditional once weekly approach. Boys and minority ethnic groups were referred most frequently. Speech therapy improved expression more than comprehension, as measured on Reynell scales. The mean improvements were 0.5 SDs (95% confidence intervals (CI) 0.3 to 0.7) and 0.3 (95% CI 0.1 to 0.5) respectively. There was a greater improvement in children receiving intensive compared with weekly therapy in the expression scores (0.8 SDs (95% CI 0.5 to 1.1) v 0.2 SDs (95% CI -0.1 to 0.5]. White and non-white children had similar improvements in comprehension scores but white children had greater improvement in expression scores (1.1 SDs v 0.3 SDs). This difference was seen in both therapy groups. Randomised trials are useful in the evaluation of speech therapy in children.

Staging in Cleft Lip and Palate Habilitation

Treatment staging in cleft lip and cleft palate habilitation is a controversial and complex subject because of the number of variables involved. The time of surgical intervention, as well as the specific surgical technique, should have normal speech as well as optimal growth as realistic goals. A protocol for habilitation includes perinatal presurgical maxillary orthopedics. Lip adhesion is proposed for wide unilateral and asymmetrical bilateral cleft lips at approximately 6 weeks of age. Definitive lip closure is accomplished by the rotationadvancement technique at 3 months of age if lip adhesion is not required or 3 to 4 months after lip adhesion. The soft and hard palate clefts should be closed by 6 to 9 months for optimal speech. Closure of the dentoalveolar cleft is accomplished with a graft of autogenous iliac bone prior to the eruption of the permanent canine when the tooth root is one fourth to one half developed. Palatopharyngoplasty is considered after 3 to 4 years of age following speech therapy and thorough evaluation. Orthognathic surgery may be considered from adolescence to adulthood.

Erratum

An Evaluation of Operant Training and Speech Therapy in the Language Rehabilitation of Moderate Aphasics. N. B. Lincoln, M. J. Pickersgill, A. I. Hankey and C. R. Hilton. Behavioural Psychotherapy 10, p. 163.The authors wish to apologize for mis-describing Hagens work: objective assessments and appropriate statistical analyses were in fact carried ou

An Evaluation of Operant Training and Speech Therapy in the Language Rehabilitation of Moderate Aphasics

Twenty-four moderately asphasic stroke patients attending a rehabilitation centre were treated for 4 weeks with speech therapy and for 4 weeks with either an operant training procedure, based on that devised by Goodkin (1966), or an attention placebo non-specific treatment. Speech therapy was given first to half the patients, while a quarter received operant training first and a quarter non-specific treatment. Results indicated no significant differences between the treatments. These treated patients were also compared in improvements in language abilities with nine moderately aphasic patients from hospitals with very limited speech therapy services. No significant differences between “treated” and “untreated” groups were found over a 4-week period. All groups of patients, however, showed some significant improvements in language abilities.

Progress report on an evaluation of speech therapy for aphasia.

SummaryA feasibility study of a proposed evaluation of speech therapy for acquired aphasia is described.Patients were allocated randomly to either individual speech therapy or an equal amount of intervention from untrained volunteers. Their progress was closely followed for 12 weeks of treatment and subsequently until the end of one year. Thirteen patients completed the study and the results are reported. After some minor changes to the Protocol the Study continues as a large scale, multicentre project.

Proposed evaluation of speech therapy for acquired aphasia.

IntroductionDarley (1972) posed three questions which he felt that speech therapists working with aphasic patients should be investigating. These were: