Thesis (M Speech Path)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: This study was done in collaboration with the Foundation for Alcohol Related Research (FARR), a non-governmental organization whose primary objective is to develop and maintain Fetal Alcohol Spectrum Disorder (FASD) prevention programmes across South Africa. Research has shown the occurrence of FASD in South Africa to be much higher than in other parts of the world. As part of their prevention programmes, FARR uses a three part diagnostic process, including a maternal interview, a dysmorphological examination, as well as a general developmental assessment. The maternal interview questionnaire that FARR currently uses takes an average of two hours per interviewee to complete. Even though a recent study indicates that FASD prevention programmes administered by FARR can potentially reduce FASD prevalence, shorter maternal interviews could improve the use of FARR resources and the ability of FASD research studies to gather meaningful information and inform future prevention efforts. The main purpose of this study was to adjust the maternal interview questionnaire used by FARR in order to make interviews with mothers shorter while delivering the information needed for successful FASD prevention programmes. Data related to the adequacy of the adjusted maternal interview questionnaire was collected and analysed according to an action research approach in four consecutive phases. The research procedures consisted of two separate focus group interviews with five key role players from FARR. During the first focus group interview the main problems with the questionnaire was identified as being (i) the length of the questionnaire, (ii) the unsuitability of the questionnaire to interview someone other than the biological mother, and (iii) inconsistency between interviewers when using the questionnaire. During the second phase of the study the questionnaire was adjusted and revised as part of a second focus group interview. The interviewers, data capturer and data analyst who used the adjusted questionnaire as part of a larger FASD prevention programme made several suggestions on how the questionnaire could be further adjusted to suit the needs of FARR. These suggestions were addressed during the final phase of the study, after which the adjusted questionnaire was finalized. Findings from the study suggest that identified problems with FARR’s original maternal interview questionnaire were successfully addressed by the adjusted questionnaire, while simultaneously satisfying the objectives of a maternal interview as identified by participants during the first focus group interview. Results confirmed that more maternal interviews could be conducted in the same time period using the adjusted interview questionnaire compared to when the original questionnaire was used, due to the fact that the questionnaire was shorter and took less time to administer. As part of this study an additional questionnaire was developed specifically for caregiver interviews. According to FARR role players, inconsistency between interviewers was for the most past successfully addressed by the development of this additional questionnaire and the development of an interviewer guideline. Recommendations for future research include the further development and evaluation of the caregiver questionnaire and interviewer guideline. / AFRIKAANSE OPSOMMING: Hierdie studie is uitgevoer in samewerking met die “Foundation for Alcohol Related Research” (FARR), ‘n nie-regeringsorganisasie met die primêre objektief om Fetale Alkohol Spektrum Afwyking (FASA) voorkomingsprogramme in Suid-Afrika te ontwikkel en te handhaaf. Volgens navorsing is die voorkoms van FASA in Suid-Afrika beduidend hoër as in ander dele van die wêreld. ‘n Drie-delige diagnostiese proses word as deel van FARR se voorkomingsprogramme gebruik, insluitend ‘n onderhoud gefokus op moeders, ‘n dismorfologiese ondersoek, asook ‘n evaluasie van die kind se algehele ontwikkeling. Die moeder-onderhoudsvraelys wat tans deur FARR gebruik word neem gemiddeld twee ure om te voltooi. Alhoewel ‘n onlangse studie aandui dat die voorkomingsprogramme deur FARR oor die potensiaal beskik om die prevalensie van FASA te verlaag, kan korter moeder-onderhoude potensieël daartoe lei dat bronne beter benut word, asook dat FASA voorkomingstudies betekenisvolle inligting versamel vir die ontwikkeling van toekomstige voorkomingsprogramme. Die hoofdoel van die huidge studie was om die moeder-onderhoudsvraelys wat tans deur FARR gebruik word aan te pas, om sodoende die onderhoude met moeders korter te maak terwyl die nodige inligting vir suksesvolle FASA voorkomingsprogramme steeds verkry word. Gedurende hierdie studie is data rakende die toereikendheid van die aangepaste moederonderhousdvraelys versamel en geanaliseer volgens ‘n aksie-navorsingsbenadering in vier opeenvolgende fases. Die navorsingsprosedures het bestaan uit twee afsonderlike fokusgroeponderhoude met vyf van die sleutelrolspelers van FARR. Gedurende die eerste fokusgroeponderhoud is die hoofprobleme met die vraelys geïdentifiseer as (i) die lengte van die vraelys, (ii) die ongeskiktheid van die vraelys om ‘n onderhoud met iemand anders as die biologiese moeder te voer, en (iii) die inkonsekwentheid tussen onderhoudvoerders met die gebruik van die vraelys. Gedurende die tweede fase van die studie is die vraelys aangepas en hersien as deel van ‘n tweede fokusgroeponderhoud. Die onderhoudvoerders, data verwerker en data analis wat die aangepaste vraelys gebruik het as deel van ‘n groter FASA voorkomingsprogram het verskeie aanbevelings gemaak rakende hoe die vraelys verder aangepas kan word om te voldoen aan FARR se behoeftes. Laasgenoemde aanbevelings is aangespreek gedurende die laaste fase van die studie, waarna die aangepaste vraelys gefinaliseer is. Die bevindinge van die studie dui aan dat die geïdentifiseerde probleme met FARR se oorspronklike moeder-onderhoudsvraelys suksesvol deur die aangepaste vraelys aangespreek is, terwyl die objektiewe van ‘n moeder-onderhoud (soos geïdentifiseer deur die deelnemers aan die eerste fokusgroeponderhoud) steeds vervul is. Resultate het bevestig dat meer moeder-onderhoude in dieselfde tydsperiode met behulp van die aangepaste vraelys gevoer kon word as met die oorspronklike vraelys, as gevolg van die feit dat dit korter was en minder tyd geneem het om te voltooi. As deel van die studie is ‘n bykomstige vraelys spesifiek vir sorggewer-onderhoude ontwikkel. Volgens die FARR rolspelers is inkonsekwentheid tussen die onderhoudvoerders grootliks suksesvol aangespreek deur middel van die ontwikkeling van hierdie bykomstige vraelys asook die ontwikkeling van ‘n riglyn vir onderhoudvoerders. Aanbevelings vir verdere navorsing sluit die verdere ontwikkeling en evaluasie van die sorggewer-vraelys en onderhoudvoerder riglyn in.

Made available in DSpace on 2016-04-04T18:32:40Z (GMT). No. of bitstreams: 1 Cassia Regina B Silva.pdf: 218910 bytes, checksum: f63838379a7f55e170e0e8f0b36e773d (MD5) Previous issue date: 2007-08-21 / Following the line of research of University, Teaching and Formation of Teachers , the objective of this study is to promote reflection about the formation of the speech-language and hearing pathologist for working together with Inclusive Education of deficient children. Data was collected by means of documental analysis and semi-structured interviews with the Director and graduated students of the Speech-Language and Hearing Pathology Course of a university. Being a qualitative study, discussion of dada was conducted along thematic lines within a socio-historical perspective The results of the study indicate that the fact of speech-language and hearing pathologist actuation in Inclusive Education is something recent and is still little explored but it continues to be studied at a slow pace in academic and scientific circles. / Inserida na linha de pesquisa Universidade, Doc?ncia e Forma??o de Professores , esta pesquisa tem como objetivo promover reflex?es sobre a forma??o do fonoaudi?logo para o trabalho junto ? Educa??o Inclusiva de crian?as com defici?ncias. Para tanto, a coleta de dado se deu por meio de an?lise documental e entrevistas semi-estruturadas com diretor e alunos formandos do curso de Fonoaudiologia de uma Institui??o de Ensino Superior. Sendo uma pesquisa qualitativa, a discuss?o dos dados se deu em eixos tem?ticos sob uma perspectiva s?cio-hist?rica. Os resultados da pesquisa apontam para o fato de ser a atua??o fonoaudiol?gica na Educa??o Inclusiva algo recente e ainda pouco explorado, mas que vem sendo estudado nos meios acad?micos e cient?ficos paulatinamente.

One of the lasting concerns in audiology is the unexplained individual differences in speech perception performance even for individuals with similar audiograms. One proposal is that there are cognitive/perceptual individual differences underlying this vulnerability and that these differences are present in normal hearing (NH) individuals but do not reveal themselves in studies that use clear speech produced in quiet (because of a ceiling effect). However, previous studies have failed to uncover cognitive/perceptual variables that explain much of the variance in NH performance on more challenging degraded speech tasks. This lack of strong correlations may be due to either examining the wrong measures (e.g., working memory capacity) or to there being no reliable differences in degraded speech performance in NH listeners (i.e., variability in performance is due to measurement noise). The proposed project has 3 aims; the first, is to establish whether there are reliable individual differences in degraded speech performance for NH listeners that are sustained both across degradation types (speech in noise, compressed speech, noise-vocoded speech) and across multiple testing sessions. The second aim is to establish whether there are reliable differences in NH listeners' ability to adapt their phonetic categories based on short-term statistics both across tasks and across sessions; and finally, to determine whether performance on degraded speech perception tasks are correlated with performance on phonetic adaptability tasks, thus establishing a possible explanatory variable for individual differences in speech perception for NH and hearing impaired listeners.

Purpose: To identify effects of variability of visual input on development of conceptual representations of academic concepts for students with normal language (NL) and language-learning disabilities (LLD). Method: Students with NL (n=38) and LLD (n=11) participated in a computer-based training for introductory biology course concepts. Participants were trained on half the concepts under a low-variability condition and half under a high-variability condition. Participants completed a post-test in which they were asked to identify and rate the accuracy of novel and trained visual representations of the concepts. We performed separate repeated measures ANOVAs to examine the accuracy of identification and ratings. Results: Participants were equally accurate on trained and novel items in the high-variability condition, but were less accurate on novel items only in the low-variability condition. The LLD group showed the same pattern as the NL group; they were just less accurate. Conclusions: Results indicated that high-variability visual input may facilitate the acquisition of academic concepts in both NL and LLD college students. Specifically, it may be beneficial for generalization to novel representations of concepts. Implicit learning methods may be harnessed by college courses to provide students with basic conceptual knowledge when entering courses or beginning new units.

Purpose: This study examines potential cross-linguistic effects on accuracy of codas in newly learned English-like nonwords produced by bilingual Spanish-English-speaking children. Methods: Forty-two bilingual Spanish-English-speaking second-graders (age 7-9) were matched individually with monolingual peers on age (+/- 6 months), sex, and percentile score on the Goldman-Fristoe Test of Articulation (GFTA-2; Goldman & Fristoe, 2000), and matched for group on mother's level of education. Participants named various sea monsters as part of computerized word-learning games. Sixteen syllable-final coda consonants were analyzed for accuracy. These were drawn from thirteen nonwords distributed across five word-learning tasks. Results: Bilingual children were less accurate than monolingual children in production of both shared and unshared codas, though the gap was greater for unshared codas. Both bilingual and monolingual children were more accurate in production of shared codas than unshared codas. Conclusion: The results suggest that native language phonotactics influence accuracy of coda production in bilingual Spanish-English-speaking school-age children during word learning. Influences of native phonology on word learning could potentially impact academic achievement through vocabulary learning in the classroom.

Adults with language impairment have poor language skills, but may or may not have reading deficits. For those identified with literacy difficulties as children, deficits in the skills related to sublexical level decoding skills can persist into adulthood. Decoding deficits, current or remediated, would implicate the sublexical interaction of orthography and phonology. In addition, the heterogeneous reading profiles of adults with language impairment provide an opportunity to examine whether the deficits in this bidirectional link between orthography and phonology are related to reading deficit specifically or language impairment globally. Sixty adults, 30 with language impairment and 30 with typical language, participated in this study. Nonword stimuli, orthogonally varied based on orthographic and phonological neighborhood density, were presented in two sublexical tasks, nonword repetition and nonword spelling. The experiment revealed a pattern of similar responses for adults with and without language impairment. However, adults with impaired language had significantly poorer performance on both the nonword repetition task and the nonword spelling task. Additional analyses indicated that both language and literacy measures predicted the overall performance on the orthogonally varied nonword repetition and nonword spelling tasks. This study highlights the existence of a bidirectional influence between phonological and orthographic processing. For adults with language impairment it appears that this bidirectional link is intact at the sublexical level.

While human speech and the human voice generate acoustical energy up to (and beyond) 20 kHz, the energy above approximately 5 kHz has been largely neglected. Evidence is accruing that this high-frequency energy contains perceptual information relevant to speech and voice, including percepts of quality, localization, and intelligibility. The present research was an initial step in the long-range goal of characterizing high-frequency energy in singing voice and speech, with particular regard for its perceptual role and its potential for modification during voice and speech production.In this study, a database of high-fidelity recordings of talkers was created and used for a broad acoustical analysis and general characterization of high-frequency energy, as well as specific characterization of phoneme category, voice and speech intensity level, and mode of production (speech versus singing) by high-frequency energy content. Directionality of radiation of high-frequency energy from the mouth was also examined. The recordings were used for perceptual experiments wherein listeners were asked to discriminate between speech and voice samples that differed only in high-frequency energy content. Listeners were also subjected to gender discrimination tasks, mode-of-production discrimination tasks, and transcription tasks with samples of speech and singing that contained only high-frequency content. The combination of these experiments has revealed that (1) human listeners are able to detect very subtle level changes in high-frequency energy, and (2) human listeners are able to extract significant perceptual information from high-frequency energy.

Asymmetries of the vocal folds and vocal fold vibration are key features underlying unilateral vocal fold motion impairment (VFMI). The knowledge of what particular asymmetries contribute to breathy voice and which asymmetries must be eliminated to re-establish normal voice will be important to improving evaluation and treatment of VFMI. It was hypothesized that several structural and vibratory asymmetries should lead to predictable changes in the glottal area, flow, and acoustic waveforms, and subsequently a perceived breathy voice quality. The purpose of this project was threefold: 1) to determine how specific vocal fold structural and vibratory asymmetries alter vocal function and perceived voice quality, 2) to determine the improvement in vocal function and voice quality in an abnormal voice with elimination of individual asymmetries, and 3) to develop a battery of vocal function measures that vary with dysphonia in a predictable manner. The approach was to use a computational kinematic model of vocal fold vibration that allows for differential left/right control of parameters such as vocal fold adduction, medial surface bulging, vibratory nodal point, phase, amplitude of vibration, and fundamental frequency. The resultant signals were subjected to aerodynamic and acoustic measurement as well as perceptual rating of voice quality. Results revealed that the degree of vocal process separation was the most influential parameter tested, though asymmetry of bulging, nodal point ratio, and starting phase worsened normal voice quality. Conversely, increased symmetry of bulging, nodal point ratio, amplitude of vibration and starting phase improved disordered voice quality. The amount of improvement to disordered voices varied based on the number of other asymmetries present. None of the six vocal function measures tested were primarily responsive to one particular model parameter, though four measures generally decreased as vocal process separation increased: maximum flow declination rate (MFDR), spectral slope (B0-B2), cepstral peak prominence (CPP), and harmonics-to-noise ratio (HNR). Two of the measures, MFDR and CPP, co-varied with each of the five parameters and robustly correlated with perceived severity.

A disfagia orofaríngea é um déficit frequentemente relacionado à consequências graves, como a desidratação, desnutrição, aspiração, pneumonia e morte. A avaliação fonoaudiológica a beira do leito é indicada para a detecção precoce deste distúrbio, no ambiente hospitalar. Geralmente inclui a coleta de informações acerca da dificuldade de deglutição; revisão da história médica; observação do estado clínico atual; avaliação da fala, voz e estruturas orofaciais e; observação do paciente durante os testes de deglutição com diferentes consistências de alimentos. Neste estudo, foi proposta a elaboração e validação de conteúdo do Protocolo Fonoaudiológico de Introdução e Transição da Alimentação por Via Oral para pacientes com risco para disfagia orofaríngea (PITA). Este protocolo visa auxiliar o fonoaudiólogo no gerenciamento clínico da disfagia, durante a fase de introdução e transição da alimentação por via oral na internação. O processo de elaboração e validação de conteúdo do PITA foi conduzido em três fases. A primeira fase baseou-se na fundamentação teórica e avaliação do protocolo-piloto. A segunda fase teve como objetivo a elaboração do PITA, sendo determinadas as definições constitutivas e operacionais de cada variável eleita. A terceira fase, a validação de aparência e conteúdo foi conduzida por meio da análise de treze juízes com expertise na área de estudo. Durante a terceira fase, os juízes foram convidados a avaliar o PITA, por meio de um questionário de validação de aparência e conteúdo. Para a análise das respostas dos juízes foram aceitos os índices de 0,78 para validação de conteúdo dos itens individualmente (IVC-I) e 0,90 para o índice de validação total do protocolo (IVC-T). Como resultado, o PITA foi constituído por vinte e um itens, com suas respectivas definições constitutivas e operacionais. Os resultados da terceira fase foram divididos em duas etapas. Na primeira, após a avaliação dos juízes, houve necessidade de modificar, incluir e excluir algumas variáveis. Na segunda, após repetição da avaliação dos juízes, os índices calculados apresentaram-se adequados, conforme a proposta do estudo, sendo definida a aparência e conteúdo do protocolo final. Assim, o PITA apresenta-se como um protocolo teórico, elaborado com base na literatura científica disponível. Por meio da avaliação de juízes experientes na área de estudo foi possível aperfeiçoar o instrumento e validá-lo em sua aparência e conteúdo. Outras pesquisas são essenciais para a aplicação experimental em larga escala, abrangendo diferentes fonoaudiólogos, pacientes, doenças de base e instituições. Apesar de ser um instrumento de baixo custo e fácil utilização, há ressalvas quanto à sua subjetividade e adverte-se a necessidade de treinamento prévio do examinador para a correta aplicação do instrumento. / Dysphagia is a deficit often related to serious consequences such as dehydration, malnutrition, aspiration, pneumonia, and death. Speech evaluation at bedside is indicated for early detection of this disorder in the hospital. It usually includes collecting information about dysphagia; medical review; current clinical status; assessment of speech, voice, and orofacial structures and; clinical tests with intake of different food textures. In this study, the development and validation of content of the \"Oral Feeding Transition Protocol (OFTP) was proposed. This protocol aims to assist speech pathologists in the clinical management of dysphagia, during the introduction and the transition to oral feeding at hospitals. The process of developing and validating the content of OFTP was conducted in three phases. The first phase provided theoretical background and evaluation of the pilot protocol. The OFTP was elaborated in the second phase, when the constitutive and operational definitions of each chosen variable were determined. The third phase was carried out in order to validate the protocol content. This validation was performed through the analysis of thirteen judges with expertise in dysphagia. During the third phase, the judges were asked to assess the OFTP, through a questionnaire of content validation. For this analysis the following validation indexes were accepted: 0.78 for individual items (IVC-I), and 0.90 for the overall scale (CVI-T). As a result, the OFTP was composed of 21 items, with their respective constitutive and operational definitions. The results of third phase were divided in two stages. In the first stage, after the judges evaluations, it was necessary to modify, add and delete some variables. In the second stage, after a new evaluation of the judges, the calculated indexes demonstrated to be adequate, as proposed by the study, and the final version of the protocol was determined. The OFTP is a theoretical protocol based on the available scientific literature. The evaluation of expert judges improved the tool and validated appearance and content of the protocol. Further research is essential for the experimental application with a large scale, different speech therapists, patients, underlying diseases, and institutions. The OFTP is a low cost instrument, with simple procedures for application. Despite this, there are concerns about its subjectivity; specific training is needed prior to the correct application of the instrument.

Introdução: A aringectomia subtotal permite a preservação da função da laringe com um bom controle oncológico local da doença, além de manter uma comunicação satisfatória, traqueostomia temporária e disfagia passível de terapia fonoaudiológica. Objetivos: Descrever resultados da avaliação vocal, estruturas remanescentes, comportamento laríngeo em tarefas específicas e resultados da avaliação de deglutição; e comparar a funcionalidade das estruturas remanescentes com os parâmetros de voz e deglutição após laringectomia com cricohioidoepiglotopexia (CHEP) e traqueohioidoepiglotopexia (THEP). Método: Estudo transversal observacional comparativo em que participaram 15 indivíduos submetidos à laringectomia subtotal reconstruídos com CHEP (12) e THEP (3), após restabelecimento da alimentação via oral. Foram avaliados por meio da captação/registro de amostra de fala para análise perceptivo-auditiva, acústica e de agradabilidade da voz; nasofibrolaringoscopia para análise estrutural e exames de deglutição. Resultados: Foi observado grau acentuado de tensão e de desvio de loudness e as vozes foram consideradas desagradáveis. Quanto às estruturas remanescentes, a maioria apresentou atividade supraglótica vestibular mediana e anteroposterior moderadas durante fonação de vogais. A penetração laríngea silente foi encontrada na maioria dos indivíduos, mas nem sempre seguida de aspiração. Na comparação entre as estruturas remanescentes e os resultados funcionais de voz e deglutição, não houve significância estatística em nenhum dos parâmetros avaliados. Conclusão: Indivíduos submetidos à laringectomia subtotal mantêm disfonia acentuada e comumente episódios de penetração silente sem aspiração laringo-traqueal. Não houve significância estatística na comparação entre a funcionalidade das estruturas remanescentes e os parâmetros vocais e deglutição; o número de aritenóides preservado não se mostrou fator prognóstico para parâmetros positivos na avaliação vocal e eficiência da deglutição. Os diferentes ajustes neolaríngeos inviabilizaram estudo de correlação entre as variáveis / Introduction: Subtotal laryngectomy preserve larynx functions and allows adequate local oncological control and also provide an effective communication to the individual, temporary tracheostomy and dysphagia liable to speech-therapy intervention. Purposes: Describe results of vocal assessment, remaining structures, laryngeal behavior in specific tasks and the evaluation of swallowing; and also compare the functioning of remaining structure to voice and swallowing parameters after laryngectomy with cricohyoidoepiglottopexy (CHEP) traqueohyoidoepiglottopexy (THEP). Methods: Comparative observational cross-sectional study which counted on 15 individuals who underwent subtotal laryngectomy reconstructed with CHEP (12) and THEP (3), after re-establishment of oral feeding route. All individuals were assessed through capture/record of a speech sample for both perceptual-acoustic and voice pleasantness analysis, nasofibrolaryngoscopy for structural analysis, and swallowing examination. Results: We noticed pronounced level of tension and loudness deviation and the voices were considered little pleasant or unpleasant. Concerning remaining structure, the majority of individuals presented median vestibular supraglottic activity and moderated activity anteroposterior during phonation of vowels. Silent larynx penetration was found in the most part of individuals, although not commonly related to aspiration. The comparison between remaining structures and functioning results of voice and swallowing pointed no statistical significance among the assessed parameters. Conclusion: Individuals who underwent subtotal laryngectomy maintain pronounced dysphonia e often episodes of silent penetration without laryngotracheal aspiration. There was found no statistical significance between remaining structure functioning and both vocal and swallowing parameters; quantitatively, the maximum phonation time of arytenoid cartilage may influence on both voice pleasantness and perceptual-acoustic analysis