Syftet med denna studie var att undersöka hur användningen av bedömningsmetoden cervikal auskultation (CA) ser ut hos dysfagilogopeder i Sverige. Våra frågeställningar var: Hur utspridd är metoden inom logopedkåren? Hur utspridd är metoden i landet? Vilka åsikter finns kring metoden bland logopeder i Sverige? Vilka undersökningsmetoder vid dysfagi används mest bland logopeder i Sverige? Totalt deltog 82 personer i studien. Data samlades in genom en webbenkät. Frågorna i enkäten var blandat öppna och slutna. Resultaten visade att 18 % av de svarande använde CA. Det fanns ett signifikant samband mellan hur ofta man använde metoden och hur säker man kände sig i bedömningen. Signifikans hittades också mellan hur ofta man använde CA och hur stor vikt man lade vid det man kom fram till med metoden när man gjorde sin totala bedömning. Större vikt tillskrevs även CA:s resultat av dem som kände sig säkra i att bedöma med CA. Resultaten visade också att ju fler år man hade använt metoden desto säkrare kände man sig i att göra bedömningar med den. Majoriteten av de som använde CA var självlärda eller hade lärt sig metoden genom kollegor. En tanke som uppkom var om logopeder i Sverige eventuellt tror att CA är menat att användas som enskild bedömningsmetod och därmed ersätta icke-instrumentell bedömning. CA tycks inte användas så frekvent i Sverige främst på grund av brister i evidens och tillförlitlighet men många ser fördelar som skulle motivera användning av CA som en del i icke-instrumentell bedömning. / The purpose of this study was to investigate the use of the assessment method cervical auscultation (CA) amongst speech and language pathologists (SLPs) in Sweden working with dysphagia. We wanted to find out: How widespread is the method in the SLP profession? How widespread is the method in the country? What opinions are there about the method amongst SLP´s in Sweden? What assessment methods within dysphagia are mostly used among SLP´s in Sweden? A total of 82 SLPs participated in the study. Data were collected through an online survey. The survey questions were of both quantitative and qualitative nature. The results showed that 18% of the respondents used CA. There was a significant correlation between the frequency of use of the method and how confident SLPs felt in the assessment. Significance was also found between the frequency of use of CA and how much importance SLPs assigned to what was discovered with the method when making the overall assessment. More importance was also ascribed to the results of CA from those who felt confident in assessing with the method. The results also showed that the longer SLPs had used the method, the more confident they felt in assessing with it. The majority of those who used CA were self-taught or had learned the method through colleagues. A thought that arose was whether the SLPs in Sweden possibly believe that CA is meant to be used as the sole method of assessment, replacing non-instrumental assessment. CA does not seem to be used frequently in Sweden, mainly because of lack of evidence and reliability but many see benefits that would justify the use of CA as part of the clinical assessment.

TITLE: Therapy of voice disorders AUTHOR: Michaela Horáková DEPARTMENT: Department of special education SUPERVISOR: Mgr. Miroslava Kotvová ABSTRACT: This diploma thesis deals with the voice disorders and their treatment options. The character of the thesis is mostly theoretical and the thesis is divided into four general parts. The first one elaborates the anatomy and physiology of the vocal tract as a basis for understanding mechanisms of voice pathology development, the second one is devoted to voice disorders and their categorization, and the third part deals with their therapy, as the czech literature reflects it. The last part of this thesis is dedicated to voice disorders therapy in the United States with a practical focus on therapeutical program Lee Silverman Voice Treatment (LSVT) widely used abroad during the treatment of voice disorders especially connected to Parkinson disease. The program is considered to be very effective and it is really popular outside of the Czech republic. LSVT is not well known in the Czech republic yet and there is actually only limited information devoted to this type of voice therapy. For this reason the thesis is based on analysis and comparison of the available foreign texts in order to inform the czech public about its theoretical basis, structure and system,...

O Programa Saúde da Família (PSF) possibilita a aplicação de medidas de promoção da saúde, prevenção de doenças, práticas de diagnóstico e pronto atendimento, visando evitar seqüelas incapacitantes e procurando a maior recuperação funcional possível. Nos últimos anos, a Fonoaudiologia ampliou seu campo de inserção na área da saúde. É essencial que o fonoaudiólogo, e todos os profissionais envolvidos na assistência, administração ou planejamento junto ao Sistema Único de Saúde (SUS), conheçam seus preceitos, as características administrativas e sua repercussão em um contexto mais amplo, além das práticas cotidianas pertencentes a cada especialidade. A Fonoaudiologia, com sua atuação em promoção, prevenção e reabilitação de distúrbios da comunicação humana, vem observando a necessidade da inclusão desses profissionais no PSF uma vez que assume um papel significativo na manutenção da saúde e qualidade de vida. O objetivo deste trabalho foi promover atenção e assistência fonoaudiológica às famílias das crianças assistidas por uma entidade no interior do Estado de São Paulo. O presente estudo foi realizado com 51 famílias de crianças matriculadas totalizando 209 sujeitos. Este trabalho foi realizado por uma equipe multiprofissional, composto por um cirurgião-dentista (pós-graduando), um graduando do curso de Odontologia (último ano), uma fonoaudióloga e uma graduanda em Fonoaudiologia (último ano). Para tanto, foram aplicados questionários para caracterizar as condições econômicas, sociais e acesso aos serviços de saúde dessas famílias. Além disso, realizou-se uma triagem fonoaudiológica de todos os membros da família nas áreas de Linguagem, Voz, Audição e Motricidade Orofacial. Os dados coletados foram analisados de forma descritiva, por meio da distribuição de freqüências absolutas e relativas, sendo os resultados apresentadas em gráficos e tabelas para melhor visualização. Os resultados mostraram que a renda média das famílias visitadas foi de R$ 645,39 e a per capita de R$ 154,71. Em relação à Expressão e Recepção da Linguagem Oral e Escrita verificou-se as seguintes alterações: Inteligibilidade (2,66%), Compreensão (2,13%), Fluência (2,66%), Alteração de fala (17,02%), Leitura (24%), Ditado (21,33%), Escrita Espontânea (42,67%). Na avaliação de Motricidade Oral e Voz os resultados mostraram alterações em Mastigação (17,71%), Respiração (24,48%), Deglutição (2,08%), Musculatura orofacial (13,54%) e Voz (20,83%). As médias dos limiares auditivos da melhor orelha dos sujeitos revelaram níveis de rebaixamento de audição classificadas em Leve (4,64%), Moderada (2,58%) e Severa (0,52%). Houve predomínio de encaminhamentos para atendimentos fonoaudiológicos (Fala e Linguagem, 25,71%) e otorrinolaringológicos (23,57%). Foram realizados encaminhamentos aos serviços públicos pertinentes relacionados à otorrinolaringologia e fonoaudiologia para avaliações, terapias e definição de condutas. Ao final da pesquisa, fora elaborado um material instrucional com orientações relacionadas à saúde fonoaudiológica. De acordo com os resultados obtidos, pode-se concluir que o programa desenvolvido permitiu à população acesso ao serviço de saúde fonoaudiológica promovendo melhoria da qualidade de vida. / The Family Health Program (PSF) enables the implementation of health promotion, disease prevention, diagnosis and ready practice of care, to prevent disabling sequelae and seeking the highest possible functional recovery. In recent years, the Speech and Language Pathology and Audiology expanded its field of insertion in health. It is essential to the speech therapist, and all professionals involved in care, administration or planning from the Unified Health System (SUS), to know the requirements of this system, administrative characteristics and the impact on a wider context, in addition to daily practices in each specialty. The Speech and Language Pathology and Audiology, with its activities in promotion, prevention and rehabilitation of disorders of human communication, has observed the need to include these professionals in the PSF because this professional assumed a significant role in maintaining the health and quality of life. The objective of this research was to promote speech and language pathology and audiology attention and assistance to the families of children assisted by an entity within the State of São Paulo. This study was conducted with 51 families of children enrolled totalizing 209 subjects. This work was performed by a multi-professional team, composed by a dentist (post-graduate student), a student of Dentistry (at the last year), a speech and language pathology and audiology ( therapist and a student at the last year). Questionnaires were applied to characterize the economic and social conditions and to assess the health services of these families. In addition, a screening of all family members in the areas of Language, Voice, Audiology and Oral Motricity. The data were analyzed in a descriptive way and the results presented in graphics and tables for better visualization. The results showed that the average income of households visited was R$ 645.39 and R$ 154.71 per capita. Regarding the Expression and Reception of Oral and Written Language there were the following alterations: Inteligibility (2.66%), Comprehension (2.13%), Fluency (2.66%), Speech Amendment (17.02%), Reading (24%), Dictation (21.33%), Spontaneous Writing (42.67%). In the evaluation of the Oral Motricity and Voice results showed changes in Chewing (17.71%), Respiration (24.48%), Swallowing (2.08%), Orofacial Muscle (13.54%) and Voice (20.83%). The average hearing thresholds of the better ear of the subjects showed lower levels of hearing classified as Mild (4.64%), Moderate (2.58%) and Severe (0.52%). There was a predominance of referrals to speech and language pathology and audiology therapy (Speech and Language, 25.71%) and to Otorrinolaryngologics (23.57%). Referrals were made to the relevant public services related to Otorhinolaryngology and to speech and language pathology and audiology therapy evaluations, treatments and definition of treatments. At the end of the research, instructional material was drawn up with guidelines related to the health of speech and language pathology and audiology. According to the results, the developed program allowed this population the access to Speech and Language Pathology and Audiology health service speech promoting improved quality of life.

Talapraxi är en talmotorikstörning som drabbar planeringen och programmeringen av talet, vilket visar sig som avvikelser i artikulation och prosodi. I dag finns inget svenskt test för utredning av talapraxi. Syftet med studien var därför att utforma ett testbatteri på svenska som är känsligt även för lindriga grader av talapraxi. Detta test pilotnormerades på 50 friska deltagare.  För att kunna studera hur kön, ålder och utbildningsnivå kan inverka på prestationen i testbatteriet, eftersträvades en jämn fördelning när det gäller dessa demografiska bakgrundsvariabler. Uppgifterna konstruerades baserat på tidigare forskning gällande de typiska perceptuella dragen vid talapraxi och på testuppgifter som tidigare har visat sig vara känsliga för talapraxi. Deltagarnas prestation varierade mellan testbatteriets olika uppgifter. På några uppgifter hade en stor andel av deltagarna alla rätt, medan andra uppgifter visade sig vara utmanande även för friska personer. Inga signifikanta könsskillnader fanns för prestationerna på någon av uppgifterna i testbatteriet. Utbildningsnivå och ålder påverkade däremot prestationen på vissa uppgifter. Generellt var effektstyrkorna för utbildningsnivå större än för ålder. Testbatteriet bör i framtiden kunna ge ett bra underlag för bedömning av huruvida talapraxi föreligger eller inte. Det bör också kunna användas vid bedömning av talapraxins svårighetsgrad. För att gå vidare med utvecklingen av testbatteriet bör man fortsätta normeringen på ett större antal personer samt kliniskt validera det på personer med diagnostiserad talapraxi. / Apraxia of speech (AOS) is a motor speech disorder that affects the planning and programming of speech, resulting in articulatory and prosodic distortions. To this date there is no available test in Swedish for assessment of AOS. Therefore, the aim of this study was to construct a test battery that enables the assessment of level of severity of the disorder, including mild AOS. A pilot standardization was performed on 50 healthy speakers. In order to determine whether the performance on the test battery is affected by sex, age or level of education, the selection of participants was stratified by these variables. The tasks were constructed based on previous research regarding the perceptual characteristics of AOS, taking into account also the types of tasks that have proved to be challenging for patients with AOS. The performance varied between different tasks of the test battery. On some tasks a high portion of the participants got very high scores, while other tasks were shown to be challenging even for healthy speakers. No significant sex differences were found on any of the tasks. However, age and level of education significantly affected the performance on some of the tasks. Overall, the effect sizes for level of education were larger than for age. In the future, the test battery should be able to determine the presence or absence and severity of AOS. For further development of the test battery, the standardization should continue using a larger sample. A clinical validation on patients with diagnosed AOS is also of great importance.

Andelen flerspråkiga barn i Sverige ökar och följdaktligen så även behovet av kunskap om deras språkutveckling. Flerspråkiga barns språkutveckling har visat sig skilja sig i viss mån från den hos enspråkiga barn och då normer för flerspråkiga barns språkutveckling saknas i logopedisk verksamhet idag finns en osäkerhet kring hur deras språkutveckling bör bedömas. Föreliggande studie ingår i det internationella forskningsnätverket COST Action IS0804 och ämnar utgöra ett litet bidrag till en växande databank om flerspråkiga barns språkutveckling, i detta fall i jämförelse med enspråkiga barns språkutveckling. Studien utgår från 100 narrativer berättade av sex- och sjuåriga enspråkiga svensktalande och flerspråkiga engelsk-svensktalande barn. Narrativerna eliciterades med hjälp av två bildsekvenser från bedömningsmaterialet MAIN och samlades in inom ramen för tre tidigare magisteruppsatser i logopedi från Uppsala universitet. Resultaten visar att de flesta deltagare förankrade sina narrativer i dåtiden, att de enspråkiga deltagarna förankrade sina narrativer mer konsekvent i ett tempussystem än de flerspråkiga deltagarna, samt att de flerspråkiga deltagarna oftare skiftade tempussystem i sina engelska narrativer. Vidare gjorde alla grupper av deltagare 75-78% av sina referentintroduktioner och 80-82% av sina referentupprätthållanden på samma sätt som förväntas av vuxna. Behärskning av temporal förankring visade sig således variera beroende på språkval och en-/flerspråkighet, medan behärskning av referentiell kohesion visade sig vara mindre beroende av språkval eller en-/flerspråkighet hos svensk- och engelsk-svensktalande barn i tidig skolålder. / The number of bilingual children in Sweden is ever-increasing, and consequently the need for research into their language development is also growing. The language development of bilingual children differs to some extent from that of monolingual children, and as no norms have yet been established within speech and language pathology for bilingual children’s language development, assessment of their language skills is problematic. This study is part of the international research network COST Action IS0804 and aims to make a small contribution to its growing stock of studies on bilingual children’s language development, in this case in comparison with that of monolingual children. The study is based on 100 narratives told by six and seven-year-old monolingual Swedish-speaking children and bilingual English-Swedish-speaking children. The narratives were elicited using two sets of pictures from the assessment material MAIN and were transcribed by the authors of three earlier Master’s theses in Speech and Language Pathology from Uppsala University. The results of this study show that most of the participants anchored their narratives in the past tense, that the monolingual participants anchored their narratives more consistently in one tense than the bilingual participants, and that the bilingual participants mixed tenses more often in their English narratives. Furthermore, all the groups of participants produced 75-78% adequate referent introductions and 80-82% adequate referent maintenance. Thus, temporal anchoring varied according to the choice of language and monolingualism/bilingualism, while referential cohesion was less dependent on the choice of language or monolingualism/bilingualism among Swedish-speaking and English-Swedish-speaking children of six to seven years of age.

Kommunikation är avgörande för att uppnå en god livskvalitet och grundläggande för att kunna förstå andra och göra oss själva förstådda. Grunden för en tillfredsställande kommunikation är att det finns ett samspel mellan de parter som ingår, vilket förutsätter att det sker ett ömsesidigt utbyte mellan samtalsparterna. De funktionsnedsättningar som cerebral pares ofta leder till kan medföra svårigheter för individen att göra sig förstådd. Det saknas idag svenska studier gällande interaktionen hos små barn med grav cerebral pares (CP). Denna studies syfte är att bidra till en ökad kunskap om hur interaktionen ser ut hos yngre barn (1,5-5 år) med grav CP (GMFCS IV-V) och deras närmaste omgivning. Studien är en kombinerad kvantitativ och kvalitativ fallstudie med fokus på strukturella bidrag och pragmatiska funktioner i den gemensamma interaktionen mellan två barn med grav CP och deras kommunikationspartners på respektive barns förskola. Barnen filmades i olika vardagliga aktiviteter och därefter transkriberades filmerna, innan de analyserades med ett strukturerat bedömningsmaterial och med beskrivande statistik. De frågeställningar som undersöktes i studien var: Vilka typer av kommunikativa bidrag använder yngre barn med grav cerebral pares i interaktionen med sin närmaste omgivning? Vilka typer av kommunikativa bidrag använder omgivningen i interaktionen med yngre barn med grav cerebral pares? Skiljer sig barnens sätt att delta åt mellan olika vardagliga aktiviteter? Går det att besvara ovanstående frågeställningar med det bedömningsmaterial som utvecklats och översatts av Paulsson 2011? Resultaten av analysen indikerade att fokusbarnen hade en passiv roll i samtalet och främst producerade responser, medan kommunikationspartnern var mer aktiv och tog fler initiativ. Resultaten går därmed i linje med tidigare studiers resultat, från andra länder och med äldre barn. Bedömningsmaterialet går att använda på målgruppen och kan identifiera mönster och skillnader i kommunikationen hos dessa yngre barn. Materialet kräver dock vidare bearbetning för att säkerställa validiteten i resultaten. Ett mer utvecklat material kan tänkas ligga till grund för framtida forskningsstudier av denna målgrupp samt för att skapa underlag för evidensbaserade logopediska insatser. / Communication is crucial to achieve a good quality of life, and it’s also a vital skill to be able to understand others and to make ourselves understood. The basis of a satisfactory communication is that there is an interaction between all parties involved. This requires that there is a mutual exchange between the conversational partners. Disabilities commonly associated with cerebral palsy often lead to difficulties in the individual’s ability to make him- or herself understood. Today there is a lack of Swedish studies investigating how young children with cerebral palsy (CP) interact. The aim of this study/master thesis is to contribute towards a better understanding of how young children (1,5-5 years old) with severe cerebral palsy (GMFCS IV-V) interact with their immediate surroundings. This thesis is a combined qualitative and quantitative case study focusing on turns and communicative functions in the joint interaction of two children with severe cerebral palsy and their communication partners in each child's preschool. Both children were filmed in various everyday activities and subsequently the films were transcribed before being analyzed with a structured assessment material and presented with descriptive statistics. The issues addressed in this study are: What kind of communicative contributions do young children with severe cerebral palsy use in their interaction with their communication partners? What kind of communicative contributions are used by the communication partners when they interact with young children with severe cerebral palsy? Do the way in which children interact vary between various everyday activities? Is it possible to use the assessment material that was developed and translated by Paulsson 2011 to try to answer the questions above? The result of this study indicated that the children in this study used a passive way of communicating. They mainly produced responses, while their communication partners were more active and made more initiations. The results are thus consistent with the results of previous studies from other countries and with older children. The findings indicate that the material can be used to identify patterns and differences in the communication even for younger children, but it requires further adaptations to ensure the validity of the result. A further developed assessment material may form the basis for future research studies of this target group and may create a basis for evidence-based speech- and language pathology interventions.

Background: The speech- and language deficit aphasia affects 12 000 persons annually in Sweden. Aphasia is caused by injury in the brain and the most common etiology is stroke. According to the tool for describing and assessing aphasia, A-FROM (Kagan et al., 2008), the four following aspects of aphasia need to be considered: severity of aphasia, participation in life situations, communication and language environment and personal factors. Several different interventions and treatments can be performed in every domain. There is scientific evidence for interventions performed by speech and language pathologists; however, the question is yet being discussed since results are unambiguous. Purpose: The main purpose of this study is to investigate which aphasia interventions performed by speech and language pathologists that are supported by evidence. A further purpose is to visit clinical practices to obtain data concerning how speech and language pathologists work with persons with aphasia. Method: Systematic search for literature was executed in seven medical databases. Articles that met certain criteria were graded regarding evidence. The authors additionally made visits to speech and language pathologists at a hospital Svealand, Sweden, for observation and interviewing of speech and language pathologists. Results and conclusions: The level of evidence for interventions varies. No intervention is investigated in more than three included studies and the number of participants is often small. Recommendations for clinical work can be given based on evidence from the included studies. The one intervention that was being studied by the most studies is CIAT/CILT. Interventions targeting expressive language, in particular word retrieval, have the strongest support in evidence. / Bakgrund: Språkstörningen afasi drabbar 12 000 personer årligen i Sverige. Afasi är en förvärvad språkstörning och orsakas av en skada i hjärnan, vanligaste orsaken är stroke.  Enligt ett verktyg för att beskriva och bedöma afasi, A-FROM (Kagan et al. 2008), kan man se till fyra aspekter av afasin: afasisvårigheter, delaktighet i vardagliga situationer, språklig och kommunikativ omgivning samt personliga faktorer. Inom varje domän kan flera olika typer av logopedisk intervention och behandling genomföras. Vetenskaplig evidens stödjer effekt av logopedisk intervention men diskussion pågår då resultaten inte är entydiga. Forskning på området är inte heller entydig kring vilken typ av intervention som har mest evidens att ge effekt. Syfte: Studiens huvudsyfte är att genom granskning av de senaste årens forskning besvara vilka logopediska afasiinterventioner som stöds av evidens. Ett ytterligare syfte är att göra besök i klinisk verksamhet för att inhämta data kring hur logopeder arbetar med personer med afasi. Metod: Systematiska litteratursökningar genomfördes i sju medicinska databaser. Artiklar som uppfyllde uppsatta inklusionskriterier evidensgraderades. Vidare besöktes ett sjukhus i Svealand för auskultation på och intervjuer med legitimerade logopeder. Resultat och slutsats: Studien visade på att afasiinterventioner har varierande grad av evidens. Varje typ av intervention behandlades av endast en eller ett fåtal inkluderade artiklar som ofta hade få försöksdeltagare. Förslag på rekommendationer för kliniskt arbete kan utfärdas utifrån inkluderade studier och deras evidensgrad. Den enskilda interventionen som studerats av flest inkluderade studier (tre studier) är CIAT/CILT. Starkast stöd i evidens har träning av expressiva förmågor, främst ordmobilisering.

O Programa Saúde da Família (PSF) possibilita a aplicação de medidas de promoção da saúde, prevenção de doenças, práticas de diagnóstico e pronto atendimento, visando evitar seqüelas incapacitantes e procurando a maior recuperação funcional possível. Nos últimos anos, a Fonoaudiologia ampliou seu campo de inserção na área da saúde. É essencial que o fonoaudiólogo, e todos os profissionais envolvidos na assistência, administração ou planejamento junto ao Sistema Único de Saúde (SUS), conheçam seus preceitos, as características administrativas e sua repercussão em um contexto mais amplo, além das práticas cotidianas pertencentes a cada especialidade. A Fonoaudiologia, com sua atuação em promoção, prevenção e reabilitação de distúrbios da comunicação humana, vem observando a necessidade da inclusão desses profissionais no PSF uma vez que assume um papel significativo na manutenção da saúde e qualidade de vida. O objetivo deste trabalho foi promover atenção e assistência fonoaudiológica às famílias das crianças assistidas por uma entidade no interior do Estado de São Paulo. O presente estudo foi realizado com 51 famílias de crianças matriculadas totalizando 209 sujeitos. Este trabalho foi realizado por uma equipe multiprofissional, composto por um cirurgião-dentista (pós-graduando), um graduando do curso de Odontologia (último ano), uma fonoaudióloga e uma graduanda em Fonoaudiologia (último ano). Para tanto, foram aplicados questionários para caracterizar as condições econômicas, sociais e acesso aos serviços de saúde dessas famílias. Além disso, realizou-se uma triagem fonoaudiológica de todos os membros da família nas áreas de Linguagem, Voz, Audição e Motricidade Orofacial. Os dados coletados foram analisados de forma descritiva, por meio da distribuição de freqüências absolutas e relativas, sendo os resultados apresentadas em gráficos e tabelas para melhor visualização. Os resultados mostraram que a renda média das famílias visitadas foi de R$ 645,39 e a per capita de R$ 154,71. Em relação à Expressão e Recepção da Linguagem Oral e Escrita verificou-se as seguintes alterações: Inteligibilidade (2,66%), Compreensão (2,13%), Fluência (2,66%), Alteração de fala (17,02%), Leitura (24%), Ditado (21,33%), Escrita Espontânea (42,67%). Na avaliação de Motricidade Oral e Voz os resultados mostraram alterações em Mastigação (17,71%), Respiração (24,48%), Deglutição (2,08%), Musculatura orofacial (13,54%) e Voz (20,83%). As médias dos limiares auditivos da melhor orelha dos sujeitos revelaram níveis de rebaixamento de audição classificadas em Leve (4,64%), Moderada (2,58%) e Severa (0,52%). Houve predomínio de encaminhamentos para atendimentos fonoaudiológicos (Fala e Linguagem, 25,71%) e otorrinolaringológicos (23,57%). Foram realizados encaminhamentos aos serviços públicos pertinentes relacionados à otorrinolaringologia e fonoaudiologia para avaliações, terapias e definição de condutas. Ao final da pesquisa, fora elaborado um material instrucional com orientações relacionadas à saúde fonoaudiológica. De acordo com os resultados obtidos, pode-se concluir que o programa desenvolvido permitiu à população acesso ao serviço de saúde fonoaudiológica promovendo melhoria da qualidade de vida. / The Family Health Program (PSF) enables the implementation of health promotion, disease prevention, diagnosis and ready practice of care, to prevent disabling sequelae and seeking the highest possible functional recovery. In recent years, the Speech and Language Pathology and Audiology expanded its field of insertion in health. It is essential to the speech therapist, and all professionals involved in care, administration or planning from the Unified Health System (SUS), to know the requirements of this system, administrative characteristics and the impact on a wider context, in addition to daily practices in each specialty. The Speech and Language Pathology and Audiology, with its activities in promotion, prevention and rehabilitation of disorders of human communication, has observed the need to include these professionals in the PSF because this professional assumed a significant role in maintaining the health and quality of life. The objective of this research was to promote speech and language pathology and audiology attention and assistance to the families of children assisted by an entity within the State of São Paulo. This study was conducted with 51 families of children enrolled totalizing 209 subjects. This work was performed by a multi-professional team, composed by a dentist (post-graduate student), a student of Dentistry (at the last year), a speech and language pathology and audiology ( therapist and a student at the last year). Questionnaires were applied to characterize the economic and social conditions and to assess the health services of these families. In addition, a screening of all family members in the areas of Language, Voice, Audiology and Oral Motricity. The data were analyzed in a descriptive way and the results presented in graphics and tables for better visualization. The results showed that the average income of households visited was R$ 645.39 and R$ 154.71 per capita. Regarding the Expression and Reception of Oral and Written Language there were the following alterations: Inteligibility (2.66%), Comprehension (2.13%), Fluency (2.66%), Speech Amendment (17.02%), Reading (24%), Dictation (21.33%), Spontaneous Writing (42.67%). In the evaluation of the Oral Motricity and Voice results showed changes in Chewing (17.71%), Respiration (24.48%), Swallowing (2.08%), Orofacial Muscle (13.54%) and Voice (20.83%). The average hearing thresholds of the better ear of the subjects showed lower levels of hearing classified as Mild (4.64%), Moderate (2.58%) and Severe (0.52%). There was a predominance of referrals to speech and language pathology and audiology therapy (Speech and Language, 25.71%) and to Otorrinolaryngologics (23.57%). Referrals were made to the relevant public services related to Otorhinolaryngology and to speech and language pathology and audiology therapy evaluations, treatments and definition of treatments. At the end of the research, instructional material was drawn up with guidelines related to the health of speech and language pathology and audiology. According to the results, the developed program allowed this population the access to Speech and Language Pathology and Audiology health service speech promoting improved quality of life.

Orientador: Regina Yu Shon Chun / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T23:36:59Z (GMT). No. of bitstreams: 1 Carvalho_CintiaMonteiro_M.pdf: 1131725 bytes, checksum: a763a725e0a584e7c3243c01f09d55a9 (MD5) Previous issue date: 2012 / Resumo: Introdução: Em função de causas diversas, uma parcela significativa da população possui algum tipo de comprometimento de linguagem, necessitando de alternativas, tais como a Comunicação Suplementar e Alternativa (CSA) pode proporcionar. A CSA trata-se de área de conhecimento prático, clínico, educacional e de pesquisa, que visa favorecer sujeitos com comprometimento de linguagem, seja oral, escrita ou gestual. A implementação desses recursos da CSA envolve o processo de construção de pranchas de comunicação, foco deste trabalho. Objetivos: Investigar a percepção de familiares e profissionais da saúde em formação que acompanham usuários de Comunicação Suplementar e/ou Alternativa quanto as suas necessidades de modo a subsidiar a construção de pranchas de comunicação em diferentes recursos. Sujeitos e Método: Trata-se de investigação de caráter clínico-qualitativo, cujos participantes foram familiares de usuários de CSA (n= 09) e profissionais de saúde em formação que os acompanham (n=10). A coleta de dados foi realizada por meio de entrevistas semi-estruturadas, gravadas em vídeo e transcritas para análise, segundo critérios de relevância e repetição. As categorias de análise estabelecidas foram: a) Uso e impacto dos recursos de CSA; b) Construção das pranchas de CSA; c) Possibilidades de uso mais efetivo da CSA e d) Dificuldades no uso dos recursos de CSA. Resultados: A maioria dos sujeitos relatou vantagens na comunicação e melhor entendimento do usuário de CSA, embora os achados tenham mostrado uma baixa frequência de uso dos mesmos. No processo de construção das pranchas os sujeitos referiram que são levadas em conta as demandas dos usuários de CSA e da família. Para um uso mais efetivo foram apontadas sugestões em relação à própria prancha. Dentre as dificuldades, foram indicadas: transporte, vocabulário restrito das pranchas e expectativa em relação à fala. No processo de construção das pranchas, foram considerados diversos fatores como as necessidades dos usuários, atuação conjunta entre usuários, família e escola e os profissionais, condições linguísticas, cognitivas e motoras, funcionalidade e adaptação dos recursos, dentre outros. Conclusão: Os achados evidenciam a importância de se rever a formação dos futuros profissionais da saúde para a atuação nesta área tendo em vista proporcionar maior autonomia, independência e qualidade de vida ao usuário de CSA em uma perspectiva de atuação interdisciplinar e integrada com o cuidador e o próprio sujeito. Assim como esses atores, o profissional está em constituição no desenvolvimento desse processo quanto à apropriação e compreensão do papel, uso e vantagens da CSA, implicando um esforço comum de todos os envolvidos para uma atenção integral e integrados / Abstract: Introduction: As a result of several causes, a significant portion of the population has some kind of language impairments requiring different solutions, such as Augmentative and Alternative Communication (AAC). AAC deals with the practical, clinical, educational and investigative knowledge area that aims at assisting individuals with oral, written or sign language impairments. The implementation of AAC resources involves the process of creating communication boards, which is the focus of this paper. Objectives: Investigate the perception of family members and health care workers in training that assist users of Augmentative and Alternative Communication concerning their needs, such as subsidies to create communication boards with different resources. Subjects and Method: It is a clinical-qualitative investigation, with participants that are related to AAC users (n= 09) and trainee health care professionals involved in their follow-up (n=10). Data collection was done through the use of semi-structured interviews, recorded in video and transcribed for analysis, according to relevance and repetition criteria. Analyses categories were established as: a) Use and impact of AAC resources; b) Creating AAC communication boards; c) Possibilities for more effective AAC use and d) Difficulties in the use of AAC resources. Results: Most of the subjects reported advantages in communication and improved comprehension for the AAC user, although our findings revealed low AAC utilization frequency. Regarding the communication board making process, the subjects mentioned that the demands of both AAC users and their family members are taken into account. Suggestions regarding the communication board were made, for more effective use. Among the difficulties pointed out were: transportation, restricted communication boards vocabulary and expectations concerning speech and language. In the communication board making process several factors were considered: AAC users needs, joint action with the AAC user, family and school and the health professionals; linguistic, cognitive and motor status; functionality and adaptation of resources, among others. Conclusion: Our findings point to the importance of reviewing education and training of future health care providers who will work in this field with the purpose of offering more autonomy, independence and quality of life to the AAC user, under a perspective of integrated interdisciplinary care with the caregiver and the subject. Likewise, the professional is increasingly becoming part of the development of this process regarding the appropriation and comprehension of the role, use and advantages of AAC, resulting in a common effort of all involved for integral and integrated care / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

The present study aimed at examining both vocal and laryngeal changes caused by the vocal fry in five female subjects without vocal complaints, signs nor symptoms, with no report of previous voice therapy, and free of inflammatory or allergic processes at the moment of assessment. Initially, a digital recording of sustained emission of /a/ vowel and a recording of a videostroboscopic examination of larynx were performed. Soon after this procedure, the subjects did the vocal fry, in three series of 15 repetitions, with a 30-second interval of passive rest between the series, when the subjects should remain in absolute silence. Immediately after that, both the laryngeal examination and the recording of the vocal emission with the same phonatory task were carried out again. Both laryngeal and vocal data found prior to and after the technique were submitted to acoustic, perceptive-auditive, and videostroboscopic analyses. The perceptive-auditive analysis as well as the videostroboscopic one were performed by six judges (three speech and language pathologists especialized in voice, and three otorhinolaryngologist, respectively). The acoustic analysis was generated by the Multi Speech program of Kay Elemetrics. The analysis of results showed the following effects of the vocal fry: improved vibration of the mucosa of the vocal folds, particularly as to width and symmetry of vibration; improved or sustained voice type and pitch; improved or sustained parameters related to jitter and shimmer as well as the index that suggests glottic noise, suggesting decreased noise; improved index of mild phonation, suggesting greater balance of the degree of coaptation strength and completion of vocal folds closure; sustained or worsened vocal quality and resonance focus, with laryngopharyngeal prevalence; decreased fundamental frequency; and increased frequency variation and width, suggesting phonatory unstableness. Thus, in this study, it was concluded that the vocal fry had a positive effect on the vibration of the mucosa of the vocal folds andon the voice noise as well, and a negative effect on the voice resonance and stability. / O presente estudo teve como objetivo verificar as mudanças vocais e laríngeas ocasionadas pelo som basal em cinco indivíduos adultos do sexo feminino sem queixas, sinais e sintomas vocais e laríngeos, sem relato de terapia vocal anterior e livres de quadro inflamatório ou alérgico no momento da avaliação. Inicialmente, realizou-se gravação digital da emissão sustentada da vogal /a/ e gravação do exame videolaringoestroboscópico da laringe. Imediatamente após, os sujeitos realizaram a técnica do som basal durante três séries de 15 repetições. Em seguida, realizaram-se novamente o exame laríngeo e a gravação da emissão vocal com a mesma tarefa fonatória. Os dados laríngeos e vocais pré e pós-realização da técnica foram submetidos às análises acústica, perceptivo-auditiva e videolaringoestroboscópica, sendo as duas últimas realizadas por seis juízes (três fonoaudiólogas especialistas em voz e três otorrinolaringologistas, respectivamente). A análise acústica foi gerada pelo programa Multi Speech, da Kay Elemetrics. A análise dos resultados evidenciou que o som basal propiciou: melhora da vibração da mucosa das pregas vocais, mais especificamente quanto à amplitude e simetria de vibração; melhora ou manutenção do tipo de voz e do pitch; melhora ou manutenção dos parâmetros relacionados ao jitter e shimmer (PPQ e APQ) e do índice que sugere ruído glótico (NHR), sugerindo diminuição do ruído; melhora do índice de fonação suave (SPI), sugerindo maior equilíbrio do grau de força de coaptação e da completude de fechamento das pregas vocais; manutenção ou piora da qualidade vocal e do foco ressonantal, com predomínio laringofaríngeo;diminuição da freqüência fundamental; e aumento da variação da freqüência (vf0) e amplitude (vAm), sugerindo instabilidade fonatória. Dessa forma, concluiu-se que, neste estudo, o som basal promoveu um efeito positivo sobre a vibração da mucosa das pregas vocais e sobre o ruído na voz, e um efeito negativo sobre a ressonância e a estabilidade da voz.