Introdução: Indivíduos com fissura labiopalatina podem apresentar alterações de fala específicas decorrentes da disfunção velofaríngea. Objetivo: Elaborar um intrumento para predizer o fechamento velofaríngeo (FVF), baseado na combinação dos sintomas de fala decorrentes da disfunção velofaríngea, aferidas na avaliação perceptivo-auditiva da fala e sua correspondência com a medida objetiva da dimensão do orifício velofaríngeo. Material e Método: Participaram deste estudo, 78 pacientes, com fissura de palato operada, com idade entre 6 e 45 anos. Os pacientes foram submetidos à avaliação aerodinâmica da fala por meio da técnica fluxo-pressão para classificação do FVF (medida da área velofaríngea) e à gravação audiovisual de amostra de fala. As amostras de fala foram editadas e analisadas por três fonoaudiólogas para classificação dos sintomas: hipernasalidade, emissão de ar nasal audível, classificação da competência velofaríngea, turbulência nasal, fraca pressão consonantal, sintomas ativos-articulação compensatória e mímica facial. A correlação entre as características perceptivas da fala e a classificação do FVF foi feita utilizando-se o coeficiente de correlação de Spearman. Foram desenvolvidos dois modelos estatísticos (discriminante e exploratório) a fim de predizer a classificação do FVF. Os testes de sensibilidade e especificidade foram aplicados a fim de se verificar a aplicabilidade clínica dos modelos. Resultados: Verificou-se forte correlação entre todos os sintomas de fala e a classificação do FVF. Ambos os modelos mostraram 88,7% de acertos ao predizer o FVF. A sensibilidade e especificidade para o modelo discriminante foi de 92,3% e 97,2%, respectivamente e de, 96,2% e 94,4% para o modelo exploratório, respectivamente. Conclusão: Foram desenvolvidas e apresentadas dois instrumentos para predizer o FVF a partir dos sintomas perceptivos da fala e a sua correspondência com o fechamento velofaríngeo determinado pela avaliação objetiva. Acredita-se que tais ferramentas contribuirão para o diagnóstico da disfunção velofaríngea na prática clínica. / Introduction: Individuals with cleft lip and palate may present specific speech disorders due to velopharyngeal dysfunction. Objective: To develop a tool in order to predict velopharyngeal closure (VFC), based on the combination of speech symptoms of velopharyngeal dysfunction, assessed in the auditory-perceptual evaluation and its correspondence with the instrumental measurement of velopharyngeal orifice size. Methods: Seventy eight patients with repaired cleft palate, aged 6 to 45 years, participated in this study. The patients undergone aerodynamic evaluation by means of pressure-flow technique to determine velopharyngeal closure (velopharyngeal orifice area) and audiovisual recording of speech samples. The samples were edited and analyzed by three speech-language pathologists for rating the symptoms: hypernasality, audible nasal air emission, velopharyngeal competence rating, nasal turbulence, weak pressure consonant, active symptoms (compensatory articulation error) and facial grimacing. Correlation between the perceptual speech characteristics and the velopharyngeal closure was performed by Spearman\'s correlation coefficient. Two statistical models (discriminant and exploratory) were developed to predict the VFC. The sensitivity and specificity tests were performed in order to verify the clinical applicability of the models. Results: There was a strong correlation between all speech symptoms and VFC. Both models showed 88.7% of accuracy on predicting VFC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model, respectively. Conclusion: In the present study two tools were developed and presented to predict VFC based on speech symptoms and its correspondence with the velopharyngeal closure determined by the objective evaluation. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aimed at comparing three models of contrastive approach in the treatment of different severities of phonological disorder and analyzes the structural generalization obtained. The sample was composed by nine subjects with phonological disorders, being them with the age 4:2 and 6:6 years old. All subjects were evaluated, before and after phonological therapy. Three groups were established for the treatment, having them three subjects each. Every group had one representative with severe, moderate-severe and mild-moderate disorder and each one was treated by one different model Minimal Opposition, Maximal Opposition/Empty Set and Multiple Oppositions. The initial and final phonological assessments were compared taking into consideration the number of phonemes in the phonological systems, the number of sounds in the phonetic inventory, the distinctive features changed, the Percentage of Consonants Correct (PCC) and the generalizations (to non used items during treatment, for other positions in the word, inside a sound class and for other sound class). After, it was carried out the statistical analysis using the Friedman Test, considering p<0, 05 and it was done the descriptive analysis among the models. There was no statistical difference among the models considering the severity of phonological disorder. The Minimal and Maximal Opposition/Empty Set approaches favored a greater number of acquisitions of sounds in the phonetic inventory in subjects with severe and moderate-severe degrees while the Multiple Oppositions approach favored a better performance in the acquisition of sounds in the phonological system and a decrease in the impaired distinctive features in severe and moderate-severe disorder. It was verified an increase of PCC and the occurrence of different types of generalization in all groups however there was no statistical difference among them. The models of therapy were effective in the treatment of different severities of phonological disorders and favored the occurrence of structural generalization observing the best performance in children with severe and moderate-severe disorder. / Este estudo teve como objetivo comparar três modelos com abordagem contrastiva no tratamento de diferentes gravidades do desvio fonológico e analisar a generalização estrutural obtida. A amostra constituiu-se de nove sujeitos com desvio fonológico, com idades entre 4:2 e 6:6. Todos foram avaliados, antes e após a terapia fonológica. Foram estabelecidos três grupos para o tratamento, sendo todos constituídos por três sujeitos, cada grupo tinha um representante com desvio severo, moderado-severo e médio-moderado. Cada grupo foi submetido a um modelo - Oposições Mínimas, Oposições Máximas/Empty Set e Oposições Múltiplas. Foram comparadas as avaliações fonológica inicial e final, considerando-se o número de sons estabelecidos nos sistemas fonológicos, o número de sons presentes nos inventários fonéticos, os traços distintivos alterados, o Percentual de Consoantes Corretas e as generalizações (a itens não-utilizados no tratamento, para outras posições na palavra, dentro de uma classe de sons e para outras classes de sons). Posteriormente, realizou-se análise estatística dos dados, utilizando o Teste de Friedman, considerando-se p<0,05 e análise descritiva entre os modelos. Não houve diferença estatisticamente significante entre os modelos considerando-se a gravidade do desvio fonológico. Os Modelos de Oposições Mínimas e Oposições Máximas/Empty Set favoreceram maior número de aquisição de sons no inventário fonético nos sujeitos com graus severos e moderado-severo, enquanto que o Modelo de Oposições Múltiplas favoreceu melhor desempenho na aquisição de sons no sistema fonológico e diminuição dos traços distintivos alterados nos desvio severos e moderado-severos. Verificou-se aumento do Percentual de Consoantes Corretas e a ocorrência dos diferentes tipos de generalização em todos os grupos estudados, entretanto não houve diferença estatística entre eles. Os modelos de terapia foram eficazes no tratamento das diferentes gravidades do desvio fonológico e favoreceram a ocorrência de generalização observando-se melhor desempenho das crianças com desvio severo e moderado-severo.

Many children, to the 4 or 5 years of age, already present acquired the contrasts of adult phonemic system. However, this process nor always occurs in accordance with the waited one, verifying alterations and shunting lines in speak of children. This study aimed to compare the orofacial praxis abilities in children with Tipical Phonological Development of Speech (TPDS) and with Phonological Disorder (PD). The research was composed for 50 children, who were divided in 30 with TPDS and 20 with PD, and ages between 4 and 8 years-old. The diagnosis of phonological disorder was determined by speech-language evaluations and complementary exams. The children were submit to the Test of Orofacial Praxis (BEARZOTTI et al., 2007), the Test of Articulatory and Bucofacial Praxis (HAGE, 2000) and the evaluation of Stomatognathic System (SS). The obtained results, in general, showed that the children with TPDS had present better performance than the Sequence Moviments carried through after verbal request and for the task of Verbal Praxis after imitation. Still, with the age increase, it had an improvement in the averages of the tests and when the tasks of praxis were carried through after verbal request, they were better than for imitation. Statistically significant results could be observed in relation to the age, for the Verbal Praxis, Orofacial Praxis and Sequence Movements after verbal request for the children between 6:0 and 8:01 years, and for Orofacial Praxis after verbal request for the aged 4:0 to 5:11 years. Thus, it s possible to conclude that the children with PD present more SS, Orofacial Praxis and Articulatory and Bucofacial alterations. Still, averages of rightness improve as age advance, and the children present more facility to realize the tasks after imitation than after verbal request, only. On this form, further studies can help develop this area still poorly developed. / A maior parte das crianças, aos 4 ou 5 anos de idade, já apresenta adquiridos os contrastes do sistema fonêmico adulto. No entanto, este processo nem sempre ocorre de acordo com o esperado, verificando-se alterações e desvios na fala das crianças. Este estudo teve como objetivo comparar as habilidades práxicas orofaciais em crianças com Desenvolvimento Fonológico Típico (DFT) e com Desvio Fonológico Evolutivo (DFE). A pesquisa foi composta por 50 crianças, sendo 30 com DFT e 20 com DFE, e idades entre 4:0 e 8:1 anos. O diagnóstico de desvio fonológico foi determinado pelas avaliações fonoaudiológicas e exames complementares. Aplicaram-se o Teste de Praxias Orofaciais (BEARZOTTI et al., 2007), o Teste de Praxias Articulatórias e Bucofaciais (HAGE, 2000) e a avaliação do Sistema Estomatognático (SE). Os resultados obtidos, de uma forma geral, evidenciaram que as crianças com DFT apresentaram desempenho melhor que as crianças com DFE, em todas as avaliações realizadas. Houve diferença estatisticamente significante para as tarefas de assobiar, vibrar e contrair os lábios na avaliação do SE, para as tarefas de Praxias Orofaciais e Sequência de Movimentos realizadas após solicitação verbal e para a tarefa de Praxias Sonorizadas após imitação. Ainda, com o avanço da idade, houve uma melhora nas médias dos testes e quando as tarefas de praxias eram realizadas após solicitação verbal, eram melhores que por imitação. Houve diferença estatisticamente significante, quanto a faixa etária para as tarefas de Praxias Sonorizadas, Praxias Orofaciais e Sequência de Movimentos por solicitação verbal para as crianças entre 6:0 e 8:1 anos, e para Praxias Orofaciais por solicitação verbal para a faixa etária de 4:0 a 5:11anos. Assim, é possível concluir que as crianças com DFE apresentam mais alterações do SE, das praxias orofaciais, articulatórias e bucofaciais. Ainda, as médias de acertos melhoram com o avanço de idade e as crianças apresentam mais facilidade para realizar as tarefas após imitação que após solicitação verbal, apenas. Dessa forma, novos estudos podem aprofundar mais esta área ainda pouco explorada.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In the pediatric population, the speech disorder is one of the most frequent changes that involve human communication disorders. But, in this area, there is a significant shortage of formal and objective instruments available and suitable to evaluate and diagnose. The goals of an evaluation process just can be achieved when adequate tools and procedures are used. Thus, this study aims to validate an instrument of phonological assessment. In the first stage, a list of words was created, through vocabulary lists child and phonological assessment instruments most commonly used in PB. This list of 722 words was sent to 11 expert judges - three clinical speech therapists, five doctors in speech therapy and three doctors in linguistics that through chosen analysis and criteria, was possible to indicate the most appropriate words to compose the phonological assessment instrument. From these results, was calculated the Kappa agreement obtained between the groups of expert judges and created a new list of words with the most suitable ones. As a result of the previous step, 316 words were shown to be judged by not expert judges. These judges were 72 children, male and female, by public and private schools, aged between 3:0 and 8:11 years. They rated the word by familiarity and naming of the illustration. Words with highest number of correct naming were reanalyzed as theoretical-linguistic another list of words was created with 193 considered best words to make the instrument of child s phonological assessment. / Na população infantil, o desvio fonológico é umas das mais frequentes alterações que envolvem os distúrbios da comunicação humana. Porém, há uma escassez significativa de instrumentos formais e objetivos disponíveis e indicados para avaliação e diagnóstico na área da Fonoaudiologia. Sabemos que os objetivos de um processo de avaliação só podem ser atingidos quando instrumentos e procedimentos adequados são utilizados. Este estudo tem como objetivo realizar a validação do conteúdo de um instrumento de avaliação fonológica. Na primeira etapa, por meio de instrumentos de avaliação fonológica utilizados com mais frequência no PB e listas de vocabulário infantil, foi criada uma lista de palavras. Esta lista de 722 palavras foi enviada a 11 juízes especialistas três fonoaudiólogos-clínicos, cinco fonoaudiólogos doutores em linguística aplicada, e três linguistas doutores para que, através de análise e critérios escolhidos por eles, indicassem as palavras que julgassem mais adequadas para compor o instrumento de avaliação fonológica. A partir desses resultados, foi calculada a concordância Kappa obtida entre os grupos de juízes especialistas, e criada uma nova lista de palavras com as mais indicadas por eles. Como resultado da etapa anterior, 316 palavras foram ilustradas para serem julgadas pelos juízes não especialistas. Estes juízes eram 72 crianças do gênero feminino e masculino, de escolas pública e privada, com idade entre 3:0 e 8:11 anos. Os juízes não especialistas classificaram a palavra quanto à familiaridade e à eliciação, a partir da ilustração individual desta. As palavras com maior número de acertos quanto à familiaridade e eliciação foram posteriormente analisadas conforme referencial teórico-linguístico e, a partir daí, foi elaborada uma lista com palavras consideradas melhores para compor o instrumento de avaliação fonológica infantil, resultando num total de 193 palavras.

The thesis titled Evaluation design therapy of neurogenic disorders of language in clinical speech therapy aims to find out what effect the speech reeducation to improve communication skills in people with acquired neurogenic communication disorders speech. Next, determine whether therapy plays a role during client environment, if the success rate of therapy affected patient's condition and the extent to which the clients are motivated to therapy. The theoretical part summarizes the findings from the literature on neurogenic communication disorders, aphasia and dysarthria. Each chapter is devoted to the terminological definition and definition, etiology, symptoms (for aphasia), classification, diagnostics and therapy. The practical part deals with the research survey. There are set targets mentioned methodology, research sample characteristics and place of the investigation. Following processing of four case studies. Which describes the therapy sessions and individual work with clients. KEYWORDS Neurogenic speech disorders, aphasia, dysarthria, logopedic therapy

La paralysie cérébrale est la pathologie motrice la plus commune dans l’enfance, elle engendre tous types de troubles principalement moteurs. La parole peut notamment être touchée affectant parfois profondément les capacités communicatives des enfants. Les thérapies pour pallier les troubles moteurs de la parole manquent d’efficacité. C’est dans ce cadre que le logiciel RePliCa a été développé afin de rendre leur rééducation plus efficiente. Une variable, encore peu documentée dans le cadre de la rééducation, est identifiée comme influençant grandement les progrès, il s’agitde l’engagement. L’engagement est considéré comme malléable et sensible aux changements environnementaux et pourrait donc être influencé par l’introduction d’un logiciel dans la rééducation. La première partie de cette thèse était consacrée à l’optimisation de cet outil. Dans cet objectif, une série d’études expérimentales a été menée auprès d’enfants au développement typique et a permis l’intégration d’un certain nombre de caractéristiques relatives à l’interface influençant positivement l’engagement. Une grille d’observation a ensuite été créée afin d’évaluer l’engagement des enfants paralysés cérébraux dans la rééducation lors du programme pilote avec le logiciel. L’étude clinique montre des résultats encourageants, l’engagement semblant se maintenir au cours des séances. Ces résultats sont mis en perspectives dans le cadre d’un modèle de l’engagement. / Cerebral Palsy is the most common physical disability in early childhood, resulting in multiple disorders, primarily of motor skills. Speech especially can be impacted and deeply affects children’s communicative abilities. The RePliCa software wasdeveloped to improve the efficiency of motor speech therapy. One variable, engagement, has not been fully researched in the field of rehabilitation but has been identified influential for children’s progress. Engagement is presumed to bemalleable and sensitive to environmental changes and therefore could be influenced by the introduction of software in rehabilitation. The first part of this thesis was devoted to its optimization. To this end, a series of experimental studies wereconducted, enabling the integration of a number of features on the interface in order to promote engagement. Once the software was implemented, engagement in rehabilitation was examined in a clinical study. Results showed encouraging results: engagement can be maintained over time. Results are put in perspective using an engagement model framework

A universal speech facilitation program was developed based on the principles, methods and long-term goals of an existing program, the Speech Motor Learning Program (Van der Merwe, 1985). The development of such a program was indicated because, to date, no systematized intervention program with the aim of general speech facilitation has been attempted to overcome the tremendous challenges of the current rehabilitative scenario in South Africa (shortage of services, untrained staff in the community and multiple language barriers to name a few). The suitability of the SMLP as a starting point for the compilation of a Speech Facilitation Program is illustrated by its clinical success in treating a variety of speech disorders and secondly because it is firmly based on normal speech development and motor learning principles. Based on the SMLP, the SFP was developed and applied to two paired subjects who exhibited general speech and language delay, to determine if the speech facilitation program would facilitate and indeed enhance speech development in the Subjects. The clinical application of the SFP was conducted in an alternating treatment design study using speech facilitation and language treatment respectively. During the treatment phase of the study, probe tests, consisting of ten selected aspects of speech and language, were conducted to determine the effect of the two treatment approaches on these aspects. Three of the aspects showed improvement following treatment with the Speech Facilitation Program. Four aspects showed gradual development throughout the duration of the study, irrespective of the type of treatment and it could possibly be attributed to general development by the subjects as well as regular intervention. Three aspects showed no change during the study. The obtained results seemed to indicate that the SFP influenced speech development positively and that it could be developed into a valuable clinical tool for the treatment of certain speech disorders. / Dissertation (MA (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / unrestricted

Orientador: Viviane Cristina de Castro Marino / Resumo: Introdução: A produção das fricativas alveolares requer constrição anterior precisa da língua, podendo ser percebida pelo próprio falante. Objetivo: Investigar relatos de autopercepção do ponto de constrição da língua na produção de [s] e [z] por mulheres com posicionamento de língua normal e alterado. Métodos: Três fonoaudiólogas analisaram gravações em vídeo da fala espontânea e dirigida de 49 jovens, com idades entre 18 e 28 anos (média=20 anos e 7 meses), classificando-as em: Grupo 1, (G1, n=25), com ausência de alterações no posicionamento da língua e Grupo 2 (G2, n=24), com presença destas alterações. Um treinamento inicial sobre o processo de produção dos sons da fala foi oferecido para todas as jovens, individualmente. O experimento de autopercepção de ponto de constrição da língua foi realizado solicitando a cada jovem de G1 e G2 que relatasse o local em que sua ponta da língua encostava (apical, laminal ou “outros ajustes”) ao produzir [s] e [z] durante a leitura de 24 palavras e 24 pseudopalavras. O teste de Friedman, com comparações para a par pelo teste de Wilcoxon, foi utilizado para análise intragrupo. O teste de Mann-Whitney foi utilizado para as comparações entre grupos. Adotou-se nível de significância de 5%. Resultados: Pontos de constrição apical e laminal na produção de [s] e [z] foram relatados pelas jovens de G1. Pontos de constrição de língua apical, laminal e, também, de “outros ajustes” de língua (região anterior da língua posicionada entre os dentes... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The production of alveolar fricatives requires precise anterior constriction of the tongue, which can be perceived by the own speaker. Objective: To investigate self-perception reports of the tongue constriction in the production of [s] and [z] by women with normal and altered tongue positioning. Methods: Three Speech-Language Pathologists analyzed video recordings of spontaneous and automatic speech tasks of 49 young female, aged 18 and 28 years (mean = 20 years and 7 months), classified into: Group 1, (G1, n = 25), with no changes in tongue positioning and Group 2 (G2, n = 24), with the presence of altered tongue positioning. An initial training on the process of speech sounds production was individually offered to all participant. The experiment of self-perception of the tongue-tip constriction was performed asking each female (G1 and G2) to report the place where her tip of the tongue touched (apical, laminal or “other adjustments”) when producing [s] and [z] while reading 24 words and 24 pseudowords. The Friedman test, with comparisons for the pair by the Wilcoxon test, was used for intragroup analysis. The Mann-Whitney test was used for comparisons between groups. A significance level of 5% was adopted. Results: Apical and laminal tongue constrictions in the production of [s] and [z] were reported by females with no changes in tongue positioning (G1). Apical, laminal points of constriction and, also, “other adjustments” of the tongue (anterior region of th... (Complete abstract click electronic access below) / Mestre

The research reported here deals with the early characterization of Parkinson’s disease (PD), the second most common degenerative disease of the human motor system after Alzheimer’s. PD results from the death of dopaminergic neurons in the substantia nigra region of the brain. Its occurrence is highly correlated with the aging population whose numbers increase with the healthcare benefits of a longer life. Observation of motor control symptoms associated with PD, such as gait and speech analysis, is most often used to evaluate, detect, and diagnose PD. Since speech and some delicate motor functions have provided early detection signs of PD, reliable analysis of these features is a promising objective diagnostic technique for early intervention with any remedial measures. We implement and study here three PD diagnostic methods and their correlation between each other’s results and with the motor functions in subjects diagnosed with and without PD. One initial test documented well in the literature deals with feature analysis of voice during phonation to determine dysphonia measures. Features of the motor function of two fingers were extracted in tests titled “Motor function of alternating finger tapping on a computer keyboard” and “Motor function of the index and thumb finger tapping with an accelerometer”, that we objectively scripted. The voice dysphonia measures were extracted using various software packages like PRAAT, Wavesurfer, and Matlab. In the initial test, several robust feature selection algorithms were used to obtain an optimally selected subset of features. We were able to program distance classifiers, support vector machine (SVM), and hierarchical clustering discrimination approaches for the dichotomous identification of non-PD control subjects and people with Parkinson’s (PWP). Validation tests were implemented to verify the accuracy of the classification processes. We determined the extent of functional agreement between voice and motor functions by correlating test results.

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