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No description available.

An estimated 15 million individuals in the United States have been formally diagnosed with dysphagia, defined as swallowing dysfunction -- the fifth leading cause of death in Americans over the age of 65. Statistical findings indicate that at least 50% of these individuals have limited access to treatment. However, despite the rapid expansion of telepractice (defined as the use of telecommunications technology to provide services at a distance) as a statistically valid online method for the provision of medical and clinical intervention to those without access, telepractice has yet to consistently incorporate online dysphagia service delivery (referred to as tele-dysphagia) into its clinical scope. This investigation compared the outcomes of traditional face-to-face intervention to online tele-dysphagia intervention by measuring the correct and incorrect responses to visual and auditory cues presented by a clinician during dysphagia intervention sessions. Data analysis conducted via t-test indicated that there was no significant difference in the mean scores from tele-dysphagia method (M = 9.67, SD = 3.74) as compared to face-to-face method (M = 9.00, SD = 2.70), t (28) = - 0.56, p = 0.580. Additionally, inter-rater reliability scores were obtained by determining a Cohen’s kappa coefficient in order to measure the degree of agreement between the two raters. Findings indicated a kappa statistic of k=1 for all items, given a 100% agreement for all trials. Additionally, results of a mixed-design analysis of variance suggested a significant within-subject effect with the use of cues, but there were no significant main effects of between-subject factors (gender, delivery type, etiology, or age) on the patients’ responses. Given that there was no significant statistical difference between the two delivery methods and inter-rater reliability scores demonstrated perfect agreement, we can suggest that the online tele-dysphagia method can potentially yield clinical outcomes similar to a traditional face-to-face method. Results from a mixed-design analysis of variance additionally suggested that there is a significant within-subject effect given the use of cues (F (1, 29)=14.99, p = .001) on patients’ responses. However, there were no significant main effects of between-subject factors (gender, delivery type, etiology, or age) on the patients’ responses. It is hoped that the results of this study will lend validity and direction to future attempts to provide much-needed dysphagia intervention via online service methods. Such attempts, in turn, would have the potential to promote increased longevity and quality of life in those populations currently unable to access such services.

<p> This investigation explores the manifestation of motivation as well as the systematic strategies that speech-language pathology graduate students employ to facilitate motivation in struggling learners. A qualitative paradigm was utilized to study three participant dyads, each one consisting of a child with a language disorder and a speech-language pathology graduate student. The primary source of data was video transcript analysis of a total of 17 representative shared reading sessions. The findings of this study demonstrate that motivation to participate in shared reading is manifested in the continued willingness of the child to participate in shared reading and that motivation was facilitated by the graduate clinician via a variety of therapeutic strategies. </p><p> Eleven common patterns emerged. 1) motivation as sustained participation, 2) a distinct set of functional therapeutic strategies were employed, 3) a wide range of therapeutic strategies were employed, 4) variable but systematic application of the different strategies, 5) interweaving of bursts of mediation and singular episodes of mediation, 6) utilization of collaborative therapeutic strategies/culture of co-investigation, 7) a high level of support prior to turn allocation, 8) successful communicative and reading attempts, 9) responsive collaboration by participants, 10) engagement even in the presence of struggle, and 11) rare occurrence of avoidant behaviors. Results indicate that motivation to engage in learning to read was the result of a wide range of instructional, evaluative, and interactional strategies that worked together to promote motivation to read. In response to these strategies, each participant produced responses that were overwhelmingly successful and even expected. These key variables helped to facilitate therapeutic interaction that was characterized by motivation and success.</p><p> Ultimately, it is apparent that motivation to read is best facilitated by complex, multi-faceted strategy use led by instructional strategies with a significant presence of evaluative and interactional strategies. It can be concluded that the participant behaviors that indicate motivation include primarily successful, expected responses that were facilitated by meaningful, strategic interactional devices.</p>

The effects of intensive multisensory speech training, with and without the use of Visual Phonics techniques, on the speech production of a profoundly hearing-impaired child were studied over a period of 6 weeks. A nine-year-old profoundly hearing-impaired child received 30-40 minutes of intensive speech training daily. Three target phonemes were trained using only multisensory speech training techniques and three target phonemes were trained using multisensory and Visual Phonics training techniques. The subject's productions of target phonemes in trained words and syllables were audio-taped at the end of each training period. Audio-taped productions were rated as correct or incorrect. The number of correct productions in words and syllables were tallied daily. Results show a general trend of improved production for all phonemes trained. There was no differential effect for the training technique used. It was concluded that intensive training, regardless of the technique used, has a positive effect on the speech productions of a profoundly hearing-impaired child.

published_or_final_version / Speech and Hearing Sciences / Master / Master of Philosophy

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The relationship between respiratory muscle fatigue and the function of swallowing is examined here. The main objective of this study is to examine the effects of respiratory muscle fatigue on swallowing physiology in healthy young adults. Specifically, this study aims to determine if differences exist in several swallowing-related parameters (a. the muscle recruitment pattern of the submentals and infrahyoids associated with swallowing, b. the pattern of breathing and swallowing coordination, c. the duration of the breath phases associated with swallowing, d. the duration of swallowing apnea, and e. the secondary swallow frequency) during several different swallowing conditions before, following respiratory muscle fatigue and following recovery. Fifty-four healthy young adults were randomly assigned into two groups, either an inspiratory (MIP) or an expiratory (MEP) muscle fatigue group. Respiratory and swallowing measurements were obtained, during 3 experimental conditions: a baseline condition, after exercise-induced fatigue, and finally, after a 15min rest period. A loaded breathing device was used in order to induce fatigue to the respiratory muscles. Presence of fatigue was determined with the assessment of Maximum Expiratory (PEmax)/Maximum Inspiratory (PImax) Pressures measured with a mouth pressure manometer. Electrophysiologic data were obtained with the use of sEMG on the submental and infrahyoid muscle groups, and with the use of three respiratory belt transducers, placed around the thorax, abdomen and neck. The Borg Scale was used to behaviourally assess perceived sense of breathing effort. Descriptive and inferential statistics were conducted to allow for detailed analysis of differing measures and variances between individuals. Results revealed significant differences between the three experimental conditions in the muscle recruitment patterns of the submental and infrahyoids, in the pattern of breathing and swallowing coordination, in the duration of the swallow-related respiratory cycle and in the frequency of secondary swallows. The duration of the deglutitive apnea was not affected by the presence of respiratory muscle fatigue. In particular, the sEMG Integral of the infahyoids was significantly reduced during the fatigued condition compared to the baseline and post-rest conditions, as opposed to an increase in sEMG integral of the submental muscles observed only in the MEP subject group. Additionally, the occurrence of swallows followed by inspiration was significantly increased during the fatigued condition. Secondary swallow frequency was significantly increased during the fatigued condition. These results suggest an effect of respiratory muscle fatigue on selective swallowing related parameters. These results are of great clinical importance since the observed patterns may increase the risk of aspiration. Results will be discussed with respects to the implications for patients and their therapeutic interventions.

Orientadora: Roberta Gonçalves da Silva / Banca: Célia Maria Giacheti / Banca: Kátia Flores Genaro / Resumo: Introdução: A disfagia orofaríngea neurogênica possui etiologias distintas e a aspiração laringotraqueal é considerada achado de risco co-dependente da sincronia entre vários fatores presentes na biomecânica da deglutição. Objetivo: Este estudo teve por objetivo correlacionar a penetração e/ou aspiração laringotraqueal com resíduos faríngeos e escape oral posterior na disfagia orofaríngea e comparar entre doenças neurológicas distintas. Método: Estudo clínico transversal. Realizada por dois juízes independentes a análise de 74 exames de nasoendoscopia de deglutição de indivíduos com diagnóstico de disfagia orofaríngea por doenças neurológicas distintas como Acidente Vascular Cerebral (AVC), Esclerose Lateral Amiotrófica (ELA) e Doenças de Parkinson (DP), independente do sexo, faixa etária de 32 a 96 anos e média de 65,53 anos. Para análise dos resultados os exames foram divididos em três grupos: o grupo 1 (G1) constou de 41 indivíduos com AVC (média de 68,75 anos), o grupo 2 (G2) de 16 com ELA (média de 57,18 anos) e o grupo 3 (G3) de 17 com DP (média de 72,52 anos). Realizada nasoendoscopia de deglutição nas consistências pastosa, líquida espessada e líquida, no volume de 5 ml, ofertados de uma a três vezes em colher. Para análise dos achados foi aplicada a Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), a Penetration Aspiration Scale (PAS) e foi elaborada escala para mensurar escape oral posterior (EOP) com análise da primeira deglutição e da deglutição considerada ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Neurogenic oropharyngeal dysphagia has different etiologies, and laryngotracheal aspiration is considered a risk finding that is co-dependent on the synchrony between several factors present in swallowing biomechanics. Purpose: The aim of this study was to correlate the laryngotracheal aspiration with pharyngeal residues and posterior oral spillage in oropharyngeal dysphagia and to compare different neurological diseases. Method: Cross-sectional clinical study. Two independent judges performed the analysis of 74 fiberoptic endoscopic examinations of swallowing (FEES) of individuals with diagnosis of oropharyngeal dysphagia due to different neurological diseases such as Cerebrovascular Accident (CVA), Amyotrophic Lateral Sclerosis (ALS) and Parkinson's Disease (PD), regardless of sex, ranging from 32 to 96 years old and mean of 65.53 years old. For the analysis of the results the exams were divided into three groups: group 1 (G1) consisted of 41 individuals with CVA (average of 68,75 years), group 2 (G2) of 16 with ALS (average of 57,18 years), and group 3 (G3) of 17 with PD (average of 72,52 years). FES was performed in in paste, liquid thickened and liquid, in the volume of 5 ml, offered one to three times in a spoon. To analyze the findings was applied the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the Penetration Aspiration Scale (PAS) was developed and a scale was used to measure posterior oral spillage (POS) with analysis of the first swallowin... (Complete abstract click electronic access below) / Mestre

The functional speech sound disorder, American English /r/ articulation errors, presents a unique and confounding clinical challenge as "therapy resistant" residual errors persist into adolescence and adulthood in many cases. Finding paucity of empirical research for /r/ treatment, evidence-based practice (EBP) exploration in motor-related disorders informed clinical practice and research directions. This study investigated the efficacy of "manual mimicry" (a kinesthetic, gestural, and visual cue) in treating intractable /r/ errors in a young adult using a single subject ABAB design. Perceptual accuracy judgments of three types of listeners (experts, graduate clinician, and na��ve listeners) indicated a positive treatment effect of manual mimicry cueing on vocalic /r/ sound productions. Electropalatograpy (EPG) outcome measures showed limited ability to accurately reflect perceptual changes quantitatively. These findings from an exploratory study provide initial evidence that perceptual saliency of /r/ productions may be potentially remediated using a kinesthetic, gestural, and visual cue during treatment. / Rangos School of Health Sciences / Speech-Language Pathology (SLP) / MS / Thesis