Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-03-15T13:34:49Z No. of bitstreams: 1 Mirela Silveiro Pollini Caputo.pdf: 3178781 bytes, checksum: 654aae51fe0bef3080c751a985102c5b (MD5) / Made available in DSpace on 2017-03-15T13:34:49Z (GMT). No. of bitstreams: 1 Mirela Silveiro Pollini Caputo.pdf: 3178781 bytes, checksum: 654aae51fe0bef3080c751a985102c5b (MD5) Previous issue date: 2017-02-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: Studies on the vocal and laryngeal aspects of people who stutterer began to be investigated in the 70's. However, in the researched literature were not found publications with a complete voice assessment, considering the auditory and acoustic perceptual aspects along with the analysis of the vocal tract configuration with varying degrees of severity of stuttering. Objective: to describe perceptual, acoustic and vocal tract aspects in a group of subjects with different degrees of stuttering severity. Method: The sample consisted of five male adults, between 20 and 36 years old, with stuttering, each with one degree of severity (very mild, mild, moderate, severe and very severe). In order to determine the degree of severity, they took the Stuttering Severity Instrument 4, and answered a self-evaluation based on the same instrument. The voice of each subject was recorded in an acoustically treated voice laboratory and the nasofibrolaryngoscopic exams were performed by the otorhinolaryngology team of the same institution. For the auditory perceptual evaluation, were used the isolated vowels, the semi-directed speech sample and the reading of a phonetically balanced text with specific protocol. The general grade, roughness, soprosity, tension, and the instability were investigated by means of an analogue scale. In the acoustic analysis, isolated vowels and carrier sentences were used to extract the fundamental frequency (f0), jitter, shimmer, the first three formants and the voice onset time (VOT). The vocal tract configuration was tested with adapted protocol for singing voice and the configuration of the following structures and musculature were analyzed: vocal folds, supraglote, pharynx, tongue and larynx in vertical mobility. Results: in the auditory perceptual evaluation of the voice the two subjects with severity degrees severe and very severe presented a discrete to moderate degree of alteration in all the items investigated except for roughness, which was not presented by any subject. In the acoustic analysis for f0, in both vowels the value was below the reference in four of the five subjects, the same happening for jitter and shimmer. The first and second formants had lower values than did fluent speakers as reported in the literature. And in F3 the findings were varied. VOT was below the reference in all subjects with the exception of the one that was severe, who had the VOT value below only in the third formant. In the vocal tract analysis, it was observed that the higher the degree of severity the greater the number of alterations in stuttered speech, mainly in the supraglottis, pharynx and vertical laryngeal mobility. Conclusion: in the five cases analyzed, it was evident that there is a relationship between the degree of severity and the vocal aspects and configuration of the vocal tract. The three subjects with moderate, severe and very severe degrees of severity presented more changes in the three evaluated aspects / Introdução: os estudos sobre os aspectos vocais e laríngeos de pessoas que gaguejam começaram a ser pesquisados na década de 70. Entretanto, na literatura pesquisada, não foram encontradas publicações que apresentem uma avaliação completa da voz, nos aspectos perceptivos auditivos e acústicos juntamente com a análise da configuração do trato vocal com variação do grau de severidade da gagueira. Objetivo: descrever aspectos vocais perceptivos, acústicos e os ajustes do trato vocal em um grupo de sujeitos com diferentes graus de severidade de gagueira. Método: a amostra foi composta por cinco sujeitos adultos, homens com idade entre 20 e 36 anos com gagueira, cada um com um dos graus de severidade (muito leve, leve, moderado, severo e muito severo). Para determinação do grau de severidade foi realizada a avaliação da fluência segundo o instrumento Stuttering Severity Instrument 4. Também responderam a uma autoavaliação, adaptada do mesmo instrumento. A voz de cada sujeito foi gravada em laboratório de voz acusticamente tratado e na mesma instituição o exame de nasofibrolaringoscopia foi realizado por equipe de otorrinolaringologistas da mesma instituição. Para avaliação perceptiva auditiva foram utilizadas as vogais isoladas, a amostra de fala semidirigida e a leitura de um texto foneticamente balanceado, com protocolo específico. Foi investigado o grau geral, a rugosidade, soprosidade, tensão e instabilidade por meio de escala analógica. Na análise acústica foram utilizadas vogais isoladas e frases veículos para extração da frequência fundamental (f0), jitter, shimmer, os três primeiros formantes e o voice onset time (VOT). A configuração do trato vocal foi realizada com protocolo adaptado feito para voz cantada e que analisou a configuração das seguintes estruturas e musculaturas: pregas vocais, supraglote, faringe, língua e laringe na mobilidade vertical. Resultados: na avaliação perceptiva auditiva da voz os dois sujeitos com grau de severidade severo e muito severo apresentaram alterações em grau discreto a moderado em todos os itens com exceção da rugosidade, que nenhum sujeito apresentou. Na análise acústica para f0 em ambas as vogais o valor esteve abaixo da referência em quatro dos cinco sujeitos, o mesmo aconteceu para jitter e para o shimmer. O primeiro e segundo formantes tiveram valores inferiores aos de sujeitos fluentes relatados na literatura e no F3 os achados foram variados. No VOT todos os sujeitos, menos o com grau severo, tiveram valores abaixo da referência. Esse sujeito só teve o valor abaixo no terceiro formante. Na análise do trato vocal observou-se que quanto maior o grau de severidade maior o número de alterações na fala gaguejada principalmente na supraglote, na faringe e na mobilidade vertical de laringe. Conclusão: nos cinco casos analisados ficou evidente que existe relação entre o grau de severidade da gagueira e os aspectos vocais e da configuração do trato vocal. Os três sujeitos com grau de severidade moderado, severo e muito severo apresentaram mais alterações nos três aspectos avaliados

A fluência refere-se ao fluxo contínuo e suave de produção de fala, porém, quando ocorre a ruptura deste fluxo de fala têm-se o que chamamos de disfluências (alterações da fluência), que variam em maior ou menor grau, dependendo do dia, da emoção envolvida e do domínio sobre o tema da conversação. O que diferencia uma disfluência comum de todos os falantes de uma disfluência gaga é a quantidade de rupturas da fala e a capacidade individual para a pronta recuperação do equilíbrio entre os dois processamentos. Geralmente, percebe-se que um indivíduo apresenta a gagueira (disfluência) já na infância, sendo assim é imprescindível que esta criança realize tratamento fonoaudiológico, de modo que há diversas abordagens terapêuticas e programas fonoadiológicos para este tratamento, porém, independentemente de qual programa ou abordagem terapêutica o fonoaudiólogo optar, se os pais não forem bem orientados e engajados pelo terapeuta para participarem ativamente do processo de intervenção, o progresso deste provavelmente será mais lentificado e desmotivador. O objetivo deste trabalho foi elaborar, implementar e analisar dois programas voltados para crianças disfluentes, sendo um programa de intervenção para as crianças e outro programa de intervenção para o fonoaudiólogo aplicar com os pais. Os participantes da pesquisa foram seis pais de seis crianças disfluentes, com faixa etária de 2 anos e 11 meses a 6 anos e 11 meses, com disponibilidade de participar tanto os pais (grupo de pais) quanto às crianças (terapia fonoaudiológica) do programa completo que foi realizado durante 10 sessões com frequência semanal e duração de 50 minutos cada sessão. Ressalta-se que o programa de pais e crianças foram correlacionados. Foram aplicados protocolos e avaliações pré e pós-intervenção do programa supracitado, de modo que estes dados foram analisados por meio de uma análise estatística comparativa, utilizando-se os testes de Wilcoxon, Mcnemar e NVivo. Nos resultados foi possível observar que, quando comparadas as avaliações pré e pós-intervenção do grupo de pais, houve melhora estatisticamente significante nas características do temperamento que os pais percebiam em seus filhos. Em relação às crianças foi observado que houve uma melhora no grau de severidade da gagueira; em relação ao perfil da fluência ocorreu uma diminuição significativa das disfluências gagas e, quando comparados os sentimentos das crianças em relação à sua fala na pós-intervenção, os sentimentos negativos que na pré-intervenção foram elencados numa maior frequência apareceram numa frequência menor de palavras na pós-intervenção. Portanto, o estudo propôs o uso de um programa que permitisse uma intervenção concomitante na área de fluência de pais e filhos, além de propor o uso de protocolos e questionários que podem ser utilizados como instrumentos para a avaliação e intervenção na área da fluência. Além disso, mostrou a importância da participação dos pais durante o processo interventivo de seus filhos, permitindo que participem ativamente da intervenção fonoaudiológica, compreendam a gagueira e se instrumentalizem sobre quais atividades podem realizar no ambiente doméstico de forma a promover a melhora da fluência de seus filhos. / Fluency refers to the continuous and smooth flow of speech production, but when the speech flow ruptures we have what we call disfluencies (changes in fluency), which vary to a greater or lesser degree depending on the day , The emotion involved and the mastery over the subject of the conversation. What differentiates a common disfluency from all speakers of a gaga dysfluency is the amount of speech disruption and the individual capacity for the prompt recovery of balance between the two processes. It is generally perceived that an individual presents with stuttering (dysfluency) already in childhood, so it is imperative that this child perform speech-language therapy, so that there are several therapeutic approaches and phonoadiological programs for this treatment, however, regardless of which program or Therapeutic approach the speech-language pathologist will choose, if the parents are not well oriented and engaged by the therapist to participate actively in the intervention process, the progress of the intervention will probably be slower and demotivating. The objective of this work was to elaborate, implement and analyze two programs aimed at children with disfluentes, being an intervention program for the children and another intervention program for the phonoaudiologist to apply with the parents. The participants of the study were six parents of six disfluentes children, ranging in age from 2 years and 11 months to 6 years and 11 months, with the participation of both the parents (parents group) and the children (speech therapy) of the complete program Which was performed during 10 sessions with weekly frequency and duration of 50 minutes each session. It is noteworthy that the program of parents and children were correlated. Pre- and post-intervention protocols and evaluations of the aforementioned program were applied, so that these data were analyzed through a comparative statistical analysis, using the Wilcoxon, Mcnemar and NVivo tests. In the results it was possible to observe that, when comparing the pre- and post-intervention evaluations of the parents group, there was a statistically significant improvement in the temperament characteristics that the parents perceived in their children. Regarding the children, it was observed that there was an improvement in the severity degree of stuttering; In relation to the fluency profile, there was a significant decrease in gut disfluencies, and when the children\'s feelings were compared with their speech in the postintervention, the negative feelings that in the preintervention were listed at a higher frequency appeared at a lower frequency of words In post-intervention. Therefore, the study proposed the use of a program that allows a concomitant intervention in the area of fluency of parents and children, besides proposing the use of protocols and questionnaires that can be used as instruments for evaluation and intervention in the area of fluency. In addition, he showed the importance of parental participation during the intervention process of their children, allowing them to participate actively in speech therapy intervention, understand stuttering and to instrumentalize what activities they can perform in the home environment in order to promote the improvement of their children\'s fluency.

Gagueira usualmente inicia ao redor dos três anos de idade, durante o período da aquisição da linguagem, quando as habilidades fonoarticulatórias são adquiridas e expandidas. Isso não é uma simples coincidência. Há muitas conexões e interações entre o desenvolvimento da linguagem e a emergência da gagueira na criança. Para verificar as características das palavras gaguejadas por adultos e crianças falantes do Português Brasileiro, quatro hipóteses foram levantadas e os objetivos para testá-las foram: 1) investigar a localização das gagueiras nas palavras, a classificação silábica e a tonicidade, as tipologias mais frequentes, e a influência do gênero e da faixa etária; 2) verificar o efeito do tempo nas características das palavras gaguejadas (foram escolhidos quatro quinquênios: 1986-1990; 1991-1995; 1996-2000 e 2001-2005); 3) verificar as semelhanças e diferenças entre hesitações normais e gagueira, e 4) desenvolver uma metodologia facilitadora da transcrição e da análise de frequência das palavras coletadas. Foram transcritas as primeiras 100 palavras faladas por sujeitos sem tratamento prévio, na primeira entrevista, num total de 12000 palavras faladas por 60 adultos e 60 crianças, das quais 1326 eram gaguejadas. Um programa de Semântica Eletrônica foi criado para verificar a frequência das ocorrências. Nenhuma diferença significativa foi revelada pela análise estatística entre todas as variáveis investigadas. Bloqueios e repetições foram mais frequentes do que prolongamentos e as gagueiras localizaram-se em 97% das primeiras sílabas das palavras. Extensão e tonicidade silábica não influenciaram a posição da gagueira na palavra. Gênero e faixa etária, assim como o tempo também não mudaram as características das palavras gaguejadas. As características das palavras gaguejadas em 2005 são as mesmas das palavras gaguejadas em 1986. Entre as hesitações normais e a gagueira, as semelhanças foram menores que as diferenças. Hesitações ocorrem entre palavras e gagueiras ocorrem dentro das palavras. O programa de Semântica Eletrônica se mostrou altamente facilitador para a análise da frequência das palavras coletadas. A regularidade encontrada não é das pessoas que gaguejam. A regularidade da gagueira é a regularidade da linguagem. / Stuttering usually begins around three years of age, during the language acquisition time, when the speech-language skills are acquired and expanded. This is not a simple coincidence. There are many connections and interactions between language development and the emergence of stuttering in children. To check the characteristics of words stuttered by adults and children speakers of Brazilian Portuguese, four hypotheses were developed and the goals to test them were: 1) to investigate the stuttering location in words, the syllabic classification and stress, the most common types, and the influence of gender and age group; 2) to determine the effect of time on the characteristics of stuttered words (four year periods were chosen: 1986-1990, 1991-1995, 1996-2000 and 2001-2005); 3) to verify the similarities and differences between normal hesitation and stuttering, and 4) to develop a methodology to facilitate the transcription and analysis of collected words, through a Semantic Web program. The first 100 words spoken by not previously treated subjects, during their first interview, were recorded and transcribed. From the 12,000 words spoken by 60 adults and 60 children, 1,326 were stuttered. An Electronic Semantics program was created to verify the frequency of occurrences. Results: No significant differences were revealed by the statistical analysis for all variables investigated. Blocks and repetitions were more frequent than prolongations; stutterings were located 97% of the time on the first syllables of words. Extension and syllabic stress did not influence the position of stuttering on the word. Gender and age, as well as time, did not change the characteristics of stuttered words. The characteristics of the stuttered words of 2005 are the same as the stuttered words of 1986. Among normal hesitations and stuttering, there were more differences than similarities. The Electronic Semantic program was highly efficient for transcription and analysis of frequency of the collected words. The found regularity of results is not from the people who stutter. The regularity of stuttering is the regularity of language.

Orientador: Danilo Moretti-Ferreira / Banca: Henrique Krieguer / Banca: Claudia Regina Furquim de Andrade / Resumo: A gagueira é um distúrbio da comunicação, mais especificamente da fluência, onde há interrupções e alterações na velocidade do fluxo da fala. Acomete de 3 a 4% dos indivíduos do sexo masculino e de 1 a 2% do sexo feminino, em algum momento de suas vidas. A frequencia pode variar de acordo com a idade: entre crianças em idade pré-escolar de 2,4% a 5% e em idade escolar 1%. Em adultos, estima-se que de 1 a 2% sofram com este distúrbio. Em todas as idades, a gagueira parece ser mais comum no sexo masculino do que no feminino, sendo de 4 a 5 M : 1 F em adultos. Em estudos de subgrupos de gagueira persistente familial, a proporção entre os indivíduos foi de apenas 1,5 M : 1 F. A triagem genômica em famílias de gagos provenientes da América do Norte e da Europa demonstrou a existência de um locus de predisposição a gagueira familial no cromossomo 18 envolvendo a região 18p e um segundo locus na região 18q proximal, sugerindo que exista um locus de predisposição a gagueira familial no cromossomo 18 e que genes adicionais possam existir, além dos fatores ambientais. O objetivo deste trabalho foi a análise de associação nas regiões cromossômicas 18p e 18q proximal através de marcadores microssatélites (2 cM) em 31 famílias brasileiras com gagueira persistente, com mais de um indivíduo gago em idade acima de 6 anos. Utilizou-se para a classificação da gagueira, o SSI aplicado por profissionais especializados nesta disfluência. Foram incluídos todos os indivíduos disponíveis do núcleo familial, independente do sexo, etnia, escolaridade e nível social.Todos os participantes tiveram amostras de seu DNA coletados a partir de amostras de sangue periférico. Foram selecionados 14 marcadores microssatélites do cromossomo 18, genotipados após PCR em seqüenciador automático. Na análise dos dados foram utilizados programas SIMWALK 2, FBAT e POINTER... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Stuttering is a communication disorder, or more precisely, a fluency disorder that causes speech interruptions and changes in speech flow rate. It affects 3- 4% of males and 1-2% of females at some point in their lives. Its frequency may vary with age - it has been reported to be 2.4-5% among children of pre-school age and 1% at school age. In adults, it ranges from 1 to 2%. At all ages, stuttering seems to be more frequent in males than in females, being 4-5M:1F among adults. Studies in subsets of familial persistent stuttering showed a sex ratio of only 1.5M:1F. A genome scan in stuttering families from North America and Europe demonstrated the presence of a predisposing locus for family stuttering on chromosome 18 involving the 18p region and a second locus on proximal 18q (Shugart et al.,2004), suggesting that chromosome 18 may harbor a predisposing locus for this disorder, and that additional genes may exist besides environmental factors. The purpose of this study was to perform the association analysis of chromosomal regions 18p and proximal 18q using microsatellite markers (2 cM) in 31 Brazilian families with at least two stuttering members aged more than 6 years. Stuttering was classified by specialized professionals using SSI. All family members available, regardless of gender, ethnicity, educational or social level were assessed provided that they were older than 6 years. DNA samples from peripheral blood of all participants were collected. Fourteen chromosome 18 microsatellites were genotyped after PCR by automated sequencing. Data were analyzed with software SIMWALK 2, FBAT and POINTER. Association analysis revealed no association of stuttering with 13 microsatellites (one was excluded for being noninformative) demonstrating no association between this phenotype and chromosome 18 in the study population / Mestre

Purpose: The tendency to prioritize negative or threatening social information, a cognitive process known as cognitive bias, has been linked to the development of social anxiety. Given the increased risk for social anxiety among adolescents who stutter (aWS), this project extended the research on cognitive bias to aWS to inform our understanding of the psychosocial factors associated with stuttering in adolescence – the period of development when social anxiety typically emerges. The purpose of this two-part study was to examine group and individual differences in two forms of cognitive bias among aWS and typically fluent controls (TFC) – attentional and interpretation biases. Methods: A sample of 102 adolescents (49 aWS and 53 TFC; 13- to 19-years-old) completed a self-report measure of social anxiety, a computerized attentional bias task, and a computerized interpretation bias task. To assess attentional bias, neutral-negative face pairs were presented in a modified dot-probe paradigm in which response times to engaging and disengaging from neutral, fearful, and angry expressions were measured. To assess interpretation bias, ambiguous verbal and nonverbal social scenarios were presented in a vignette-based recognition task, after which participants endorsed possible negative and positive interpretations of those scenarios. Results: The aWS and TFC reported comparable degrees of social anxiety, although female aWS reported higher levels than male aWS. For the attentional bias task, aWS were faster to engage with fearful faces than to maintain attention on neutral faces, and they were also faster to disengage from fearful and angry faces than to maintain attention on those negative faces. TFC did not demonstrate an attentional preference for any particular face type. For the interpretation bias task, while aWS and TFC rated negative and positive interpretations of verbal and nonverbal scenarios similarly, social anxiety moderated the effect of interpretation characteristics on endorsement of those interpretations; participants with greater social anxiety endorsed negative interpretations of verbal scenarios to a greater degree than those with lower social anxiety, and participants with lower social anxiety endorsed positive interpretations of verbal and nonverbal scenarios to a greater degree than those with higher social anxiety. Conclusions: This study contributes to the existing literature in several meaningful ways. First, this sample of aWS and TFC demonstrated comparable rates of social anxiety, which counters many other reports of group differences in social anxiety in this population. Second, it supports previous preliminary accounts of attentional bias among individuals who stutter. The present findings are novel in that aWS’ rapid engagement with and rapid disengagement from negative faces were observed in the absence of group differences in social anxiety. Third, the results challenge the speculation that stuttering is associated with negative interpretation bias – a relationship that has been proposed in the literature but never empirically investigated. Taken together, these findings provide the groundwork for continued investigation into the role of social information processing on psychosocial outcomes for aWS.

Both theoretical models and empirical evidence implicate the combined influences of high emotional reactivity and low emotional regulation to exacerbation in children's stuttering behavior (e.g., Conture, Walden, Arnold, Graham, Hartfiled, Karrass, 2006; Conture & Walden, 2012; Karrass et al., 2006). Attentional control is a key factor in both the development and implementation of emotional regulation (Bell & Calkins, 2012; Rueda, Posner, & Rothbart, 2004). The purpose of this study was to investigate attentional control along the distraction process in children who stutter using two event-related potential (ERP) experimental tasks: auditory-auditory distraction and visual search. Eight school-age children who stutter (CWS) and eight school-age children who do not stutter (CWNS) were recruited in this study. Using a Go/No Go paradigm, children in this study were asked to discriminate tone duration in the auditory-auditory distraction task and detect specific visual targets in the visual search task in both the auditory and visual tasks. Behavioral measures included reaction time (RT), hit rate (HR, accuracy) and false alarm (FA), while electrophysiological measures included the peak latency and mean amplitude of the mismatch negativity (MMN), P3a, N2pc and reorientation negativity (RON), and N2pc. Each ERP component reflects a specific stage along the distraction process: automatic scanning and change detection (MMN), involuntary orientation to deviants (P3a), attentional filtering (N2pc) and voluntary attentional reorientation (RON). The first three components are involved in the sensory/perceptual processing, while the last component is involved in the goal-directed processing (cognitive control for distraction compensation). These behavioral and ERP results were correlated with temperament data obtained from parent-report questionnaires. There were three main findings. First, CWS, but no CWNS, exhibited a P600 and increased peak latency of the late phase of RON (lRON). The P600 is elicited by violations in rule-governed sequences or the effect of encountering unexpected stimuli, while the lRON reflects evaluation of task-relevant information and motor preparation. The existence of P600 suggests that CWS return and re-evaluate deviants, perhaps due to reduced inhibitory control. As a result, CWS are delayed to start the attentional process reflected by lRON. Second, CWS exhibited a higher rate of false alarms in the auditory-auditory distraction task; this finding confirmed the notion of less efficiency in inhibitory control for CWS. Third, similar to previous research findings, our temperament data also revealed that CWS tended to exhibit relatively high negative affect in combination with relatively low effortful and attentional control, compared to their fluent peers. Taken together, present findings corroborate previous observations of relatively high emotional reactivity and relatively low efficiency in emotional regulation for CWS, including attentional and inhibitory control. Further, our results reveal that the low attentional control in CWS may result from less efficiency in the goal-directed processing for distraction compensation.

This research study examined motor control and procedural learning abilities in the oral and manual motor systems of adults who stutter, using people with Parkinson's disease, and age-matched controls as comparison groups. Participants in this study were asked to track a moving target on a computer screen with their jaw and with their dominant hand. Specifically, we compared their tracking accuracy for predictable and unpredictable signals. Procedural learning (defined as increased accuracy over time) was assessed by examining changes in tracking accuracy within a single tracking trial and between consecutive tracking trials of the same predictable condition. There were two main findings in this study related to tracking accuracy and procedural learning in people who stutter (PWS) and age-matched controls (CPWS). First, our analyses revealed that there was no significant difference between PWS and CPWS in the accuracy of tracking of either predictable or unpredictable conditions for either the hand or the jaw, although a trend was observed in which PWS performed more poorly in both for decreased accuracy. Second, both PWS and CPWS showed evidence of procedural learning to the same extent. There were two main findings in this study related to tracking accuracy and procedural learning in people who have Parkinson's disease (PPD) and age-matched controls (CPPD). First, tracking accuracy analyses revealed that PPD performed significantly more poorly than CPPD during jaw tracking of predictable conditions, but they were not significantly different from CPPD in jaw tracking of unpredictable conditions. During hand tracking PPD differed significantly from CPPD in tracking of both predictable and unpredictable conditions for their less accurate performance. Second, there was no significant difference between the two groups in the extent of procedural learning during jaw tracking. However, during hand tracking the PPD group improved less with time than the CPPD, suggesting that the PPD group had reduced procedural learning ability in the manual motor domain. Lastly, age was found to be an important factor determining tracking accuracy in our participants. Younger participants (PWS and CPWS) in the age range of 18-40 years had significantly better accuracy of jaw and hand tracking than the older individuals (PPD and CPPD) in the age range of 57-79 years.

The Lidcombe-program (LP) is an empirically developed treatment program for stuttering based on behavioral therapy that adopts operant conditioning as methodology. The program is designed for children up to the age of six, and it is mainly conducted in the home environment by a parent under the supervision of a speech-language pathologist (Onslow, 2003a). In countries around the world, studies of outcomes of the program have shown positive effects (Lincoln &Onslow, 1997). LP is conducted in Sweden, but no major long-term study has been performed.Criticism towards LP regards that the intervention would affect the relationship between thechild and the parent in negative ways (Woods, Shearsby, Onslow & Burnham, 2002).The present study is a follow up of children and parents who have undergone treatment withLP. The aim was to investigate how childrens’ fluency of speech changed after treatmentand to examine how parents' experiences of the program can be characterized. Ten parents were included in the study, and they all answered a questionnaire about the experiences of thetreatment. Fluency of speech was documented and assessed in eight children.The results of the present study showed that all of the participating childrens’ stuttering was significantly reduced after treatment. A strong significant correlation between the time the child spent in treatment and the percentage of stuttered syllables at baseline was observed. The majority of the parents had positive experiences of the treatment, and would recommend the program to other families. However, parents also found it difficult to execute the therapy, mainly as regards finding the time in the everyday life of the family. In addition, four of the participating parents disregarded the treatment manual and shared the responsibility of implementing the treatment with their spouse, but this did not appear to influence the outcome of the treatment. / Lidcombe-programmet (LP) är ett empiriskt framtaget behandlingsprogram som grundar sig i beteendeterapi och som antar operant betingning som metod. Behandlingen är utformad för barn upp till sex års ålder och bedrivs huvudsakligen i hemmet av en förälder under handledningav logoped (Onslow, 2003a). I flera länder runt om i världen har uppföljningsstudier visat positiva effekter av programmet (Lincoln & Onslow, 1997). Behandlingsprogrammet bedrivs i Sverige, men ingen större långtidsuppföljning har utförts. Kritik som riktats mot LP avser att interventionsformen påverkar relationen mellan barn och förälder negativt (Woods et al., 2002).Föreliggande studie är en uppföljning av barn och föräldrar som genomgått stamningsbehandling enligt LP. Syftet var att undersöka hur barns talflyt förändrats efter avslutad behandling samt att undersöka hur föräldrars upplevelser av programmet kan karaktäriseras. I studien ingick tio föräldrar, vilka besvarade en enkät kring upplevelser av behandlingen, samt åtta barn vars talfly tdokumenterades och bedömdes.Resultatet visade att samtliga av de deltagande barnens stamning minskade signifikant efteravslutad behandling. Ett starkt signifikant samband mellan tiden barnet spenderade i behandling och andelen stammade stavelser i procent vid behandlingsstart kunde påvisas. Majoriteten av föräldrarna hade positiva upplevelser av behandlingen och samtliga skulle rekommendera behandlingsprogrammet till andra familjer. Dock upplevde föräldrarna vissa svårigheter kring implementeringen av behandlingen, främst avseende att finna tid i vardagen. Fyra av de deltagande föräldrarna frångick behandlingens manual och delade på ansvaret för utförandet medmake/maka eller motsvarande, men detta föreföll inte påverka utgången av behandlingen.

Stamning är en komplex motorisk talstörning, vars neurologisk bakgrund fortfarande inte är klarlagd. En växande mängd studier ger dock stöd för att stamning kan vara orsakat av strukturella avvikelser i den vänstra hemisfären. En studie (Sommer et al., 2003) som använde transkraniell magnetstimulering (TMS) för att undersöka kortikal inhibition hos personer som stammar (PsS) fann som ett bi-fynd att den stammande gruppen hade signifikant högre motortrösklar (MT) för vänster hemisfärs handmotorarea, det vill säga att det krävdes starkare stimulering för att väcka en muskelrespons i den kontralaterala handen. Resultat har dock inte uppmärksammats av senare forskning, och behöver verifieras. Den aktuella studien syftade till att undersöka om PsS tenderar att ha förhöjda MT, samt om det finns avvikande hemisfärsskilnader i MT hos PsS. MT mättes från båda hemisfärernas handmotorareor hos 15 PsS och 15 matchade kontollförsökspersoner med flytande tal. Resultatet visade på signifikant avvikande lateralisering av MT (p = 0,005) hos PsS; tvärtemot gruppen med flytande tal visade den stammande gruppen tendens till lägst MT i höger hemisfär, med 6 av 15 stammande som hade starkare högersidig lateralisering än någon i kontrollgruppen. Samstämmigt med resultaten från Sommer et al. (2003) var MT för vänster hemisfär signifikant högre i den stammande gruppen jämfört med kontrollgruppen (p = 0,049). Däremot fanns ingen tendens till avvikande MT i höger hemisfär (p = 0,92). Den förhöjda vänstersidiga MT kan vara relaterad till strukturella avvikelser i vänster hemisfär hos PsS.

The aim of this paper is to study the long-term effects of stuttering treatment according to the Lidcombe Program in Sweden and to answer questions whether underlying factors may have affected the treatment results. Participants were seven children, one girl and six boys aged 7:10-14:2, who all completed Stage 1 of the program approximately 2-7 years ago.The children were video recorded during a conversation with one of the authors and while reading aloud. Before the recording, their parents estimated the level of stuttering according to a Severity Range (SR) Scale. The evaluations were used as reference for determining whether the recordings were representative for the children´s current speech fluency. Proportions of stuttered syllables (%SS) were calculated from the video recorded material and compared with the proportions of stuttered syllables (%SS) at the time when the first stage of the program was initiated.The results showed that the Lidcombe Program had a significant (z=-2.37, p=0.02) long term effect on stuttering treatment for the participants in this study. The effect size was calculated to 1.05, which indicates a large effect. No correlation between underlying factors and treatment results could be established at group level. However, the results showed differences among the participants and underlying factors as age at stuttering onset and age when treatment was introduced may have affected the treatment results.This is one of the very first long term follow-ups on Swedish preschool children that have been treated according to the Lidcombe Program and the authors hope to see further research. / Studien syftade till att undersöka långtidseffekten av Lidcombeprogrammet för svenska förskolebarn som stammar samt fastställa om bakgrundsfaktorer påverkar behandlingseffekt. I studien deltog sju svensktalande barn, en flicka och sex pojkar, i åldrarna 7:10–14:2, som alla avslutade det första steget i behandlingen för cirka 2-7 år sedan.Långtidsuppföljningen genomfördes i form av videoinspelningar av barnens tal under samtal med en av författarna samt under en högläsningssituation. Föräldrarna till varje barn fick inför inspelningarna skatta sitt barns stamning på en Severity Rating (SR) Scale. Utvärderingarna användes för att få information om huruvida inspelningarna var representativa för barnens tal idag. Utifrån samtliga inspelningar beräknades sedan den procentuella andelen stammade stavelser (%SS) och denna mätning jämfördes sedan med den procentuella andelen stammade stavelser (%SS) för tidpunkten när behandlingen enligt Lidcombeprogrammet introducerades.Resultatet i föreliggande studie visade att Lidcombeprogrammet har haft effekt på lång sikt för deltagarna i föreliggande studie och resultatet var statistiskt signifikant (z=-2.37, p=0.02). Effektstorleken för dessa beräkningar var 1.05, vilket motsvarar en stor effekt. Inget samband kunde påvisas mellan bakgrundsfaktorer och behandlingseffekt på gruppnivå men resultatet på individnivå påvisar skillnader mellan deltagarna avseende ålder vid stamningsdebut och ålder vid behandlingsstart, eventuellt kan detta ha påverkat behandlingsresultatet för enskilda deltagare.Det här är en av de första långtidsuppföljningarna av svenska förskolebarn som behandlats enligt Lidcombeprogrammet och författarna efterfrågar fler studier.