Introdução: A articulação da fala é um dos aspectos fonoaudiológicos mais comprometidos na doença de Parkinson (DP). Pacientes com DP apresentam risco de manifestar apraxia não verbal e verbal. A apraxia não verbal ocorre quando há um déficit na habilidade de sequencialização dos movimentos voluntários não verbais da língua, lábios, mandíbula e outras estruturas orofaciais associadas, e a apraxia verbal é definida como um déficit na habilidade de sequencializar os controles motores necessários para o posicionamento correto dos articuladores durante a produção voluntária da fala. A prevalência com que apraxia da fala ocorre na DP não está bem estabelecida, sendo um distúrbio pouco explorado nesses pacientes. É um estudo inédito, até onde temos conhecimento, quanto à identificação dos erros práxicos verbais na DP. Objetivo: avaliar a prevalência da praxia não verbal e verbal em pacientes com doença de Parkinson, correlacionandoas com idade, escolaridade, tempo de doença e estadiamento da DP (Hoehn e Yahr), assim como correlacionar a apraxia não verbal com a apraxia verbal e identificar os erros práxicos verbais. Método: Estudo quantitativo, observacional, descritivo e de prevalência. Foram avaliados 45 pacientes acometidos pela DP, que realizaram seguimento clínico no ambulatório de Distúrbios do Movimento do Hospital de Clínicas de Porto Alegre, Brasil, através da aplicação do Protocolo de Avaliação da Apraxia da Fala, e o estadiamento da DP foi controlado através da escala de Hoehn e Yahr (H&Y). Resultados: A prevalência de apraxia não verbal e verbal nos pacientes com DP foi de 24,4%. Não houve significância entre apraxia não verbal com idade, escolaridade, tempo de doença, estadiamento da DP (H&Y) e gênero. A correlação entre apraxia verbal e escolaridade foi significante (p≤0,05), mas não houve significância com idade, tempo de doença, estadiamento da DP (H&Y) e gênero. Os tipos de erros práxicos verbais mais frequentes foram as omissões (70,8%). Quanto ao ponto e modo articulatório os fonemas mais alterados foram os dentoalveolares (92%) e os vibrantes (57,7%), consecutivamente. Conclusão: Os pacientes com DP apresentaram apraxia não verbal e verbal com manifestação de muitos erros práxicos verbais, estando a apraxia verbal correlacionada com a escolaridade. / Introduction: The speech articulation is one of the aspects most impaired in Parkinson's disease (PD). Patients PD present risk of expressing nonverbal and verbal apraxia. The nonverbal apraxia occurs when there is a deficit in the sequencing ability of nonverbal voluntary movements of the tongue, lips, jaw and other associated orofacial structures, while the verbal apraxia is defined as a deficit in the ability of sequencing the necessary motor controls in order to place the articulators correctly during the voluntary speech production. The predominance with which apraxia of speech occurs in PD is not well established and rarely explored in these patients. As far as we know, it is an unprecedented study regarding the identification of verbal praxic errors in PD. Objective: To assess the prevalence of nonverbal and verbal apraxia in patients with Parkinson's disease, correlating them with age, education, duration of disease and PD stage (Hoehn e Yahr), as well as to correlate nonverbal with verbal apraxia and identify the verbal praxic errors. Method: Quantitative, observational, descriptive and prevalence study. Forty-five patients with PD were evaluated. They were submitted to the clinical follow-up in the Movement Disorders Clinic of the Cinical Hospital of Porto Alegre, Brazil, through the application of the Speech Apraxia Assessment Protocol. Additionally, the PD stage was controlled through the Hoehn and Yahr scale (H&Y). Results: The prevalence of nonverbal and verbal apraxia in patients with PD was 24.4%. There was no significance between the nonverbal apraxia with age, education, duration of disease, PD stage (H&Y), and genre. The correlation between verbal apraxia and education was significant (p ≤ 0.05), but there was no significance with age, duration of disease, PD stage (H&Y) and genre. Omissions were the most frequent kinds of verbal praxic errors with (70.8 percent). Regarding the place and mode of articulation, the most changed phonemes were the dentoalveolar (92%)and the vibrants (57.7%), consecutively. Conclusion: Patients with PD presented nonverbal and verbal apraxia with manifestation of many verbal praxic errors and verbal apraxia correlated with education levels.

The diploma thesis deals with laterality, the research presents analysis of laterality of six adult people with forced changes in laterality. Then it describes the development of laterality and its types, degrees, types and diagnostics. There is also a historical approach to the left-hand side from the Stone Age to the present. The work focuses on forced changes in laterality in childhood and their influence on the overall development of personality. Six adult respondents, three men and three women aged thirty- eight to seventy-two years were tested for qualitative research. The effects of laterality change were observed in speech, psyche, state of laterality, reading and written speech. The aim of the work was to describe the difficulties that may arise as a result of a forced change in laterality, to find out whether the respondents have to face and to discover their possible survival to adulthood. For all respondents, the laterality and type determined by the test was tested, which was a partial goal. For all respondents, during the interviews, problems related to forced changes in laterality in childhood were manifested or discussed.

This study aimed to estimate the prevalence of speech disorder in a sample of children from a public state school, verify the prevalence of disorder in according to sex; classify the deviation according to type and severity; verify the occurrence of delay in language acquisition in children with phonological disorder; characterize the phonetic inventory and the phonological system of this sample, and verify which the most altered phonemes are. The sample was composed of 91 subjects of both sex, ranging from 5:7 and 7:5. All of them were submitted to speech-language evaluations and phonological assessments that were applied to determine the type and degree of severity of speech disorder as well as the phonetic inventory and the phonological system. For the statistical analysis Qui-Quadrado Test, Variance analysis, t-test and Kruskal-Wallis were used, with level of significance of 5% (p<0,05). Analyses were developed using SPSS 8.0 software. Amongst the 91 subjects 46 (70,3%) had speech disorder and the 27 other (29,7%) presented appropriate speech acquisition (GAFN). Considering the obtained on deviation type, the prevalence was of 18,55% for phonological deviation (GDFo), 2,10% for phonetic deviation (GDFe) and of 5,24% for phonological-phonetic deviation (GDFoFe). Association between delay in language acquisition process and the disorder type was not observed. It was noticed significant statistic association between: masculine gender and the group with speech disorder; the feminine gender and GAFN; GDFe and the tongue altered posture; GDFo and the incomplete phonetic inventory; GAFN and the complete phonetic inventory; GDFo and phonological system altered; GDFe and GAFN and the appropriate phonological system. The sounds with highest omission in the inventory were: /з /, /z/, /r/, /λ / e /g/ and /g/ for GDFo; and /r/,/g /, /z/, /∫/ and /λ / for GDFoFe. The groups GDFe and GAFN presented PCC significantly higher than GDFoFe. The phonemes with most alterations in the phonological system were: /r /, /λ/, /з /∫ / and /z/ for GDFo and /∫ /λ /, /, /r/, /g/ for GDFoFe. In both groups, the majority of subjects presented difficulties with the complex onset, and with the erasure of the rhotic consonants /r/ e /l/. As for the distinctive features it was verified that: GDFo and GDFoFe presented significant statistically altered number of features, more than GAFN; the most altered features for: [+voz] ®-voz], [-ant] ®[+ant], [+cont] ®[-cont], [-voc] ®[+voc] in GDFo and [-ant] ®[+ant], [+voz] ® [-voz], [+ant] ® [-ant] in GDFoFe. Therefore, this research shows that there is high prevalence on speech deviation/disorder in the group of preschoolers studied, and that the larger the number of missing sounds in the phonetic inventory the higher the disorder severity. Furthermore, the high number of alterations in the fricative class and the rhotic consonants suggest that the subjects who present phonological or phonological-phonetic disorders/deviations adopt similar strategies, however not identical to the ones used by children with appropriate phonological development because these classes of phonemes are, according to literature, the last to be acquired. / Este estudo teve por objetivos estimar a prevalência de desvio de fala em uma amostra de pré-escolares de escolas públicas, verificar a prevalência do desvio quanto ao sexo, classificar os desvios quanto ao tipo e à severidade, verificar se em crianças com desvios fonológicos há presença de atraso na aquisição da linguagem, caracterizar o inventário fonético e o sistema fonológico e verificar quais os fonemas mais alterados. A amostra foi formada por 91 sujeitos, de ambos os sexos, com idades entre 5:7 e 7:5. Todos foram submetidos às avaliações fonoaudiológicas e fonológica, realizadas para determinar o tipo e o grau de severidade do desvio de fala, bem como o inventário fonético e o sistema fonológico. Para análise estatística, foram utilizados o Teste Qui-quadrado, a análise de variância, o teste Kruskal-Wallis e o teste t, com nível de significância de 5% (p<0,05). Os dados foram submetidos ao software SPSS 8.0. Dos 91 sujeitos, 46 (70,3%) apresentaram fala com desvio, e os outros 27 (29,7%) apresentaram aquisição de fala normalizada (GAFN). Ao considerar os resultados obtidos por tipo de desvio, a prevalência foi de 18,55% para os desvios fonológicos (GDFo), 2,10% para o desvio fonético (GDFe) e 5,24% para o desvio fonológico-fonético (GDFoFe). Não foi constatada associação entre atraso no processo de aquisição da linguagem e tipo de desvio. Verificou-se associação estatisticamente significativa entre o sexo masculino e o grupo com desvio de fala, o sexo feminino e GAFN, o GDFe e a postura alterada de língua, o GDFo e inventário fonético incompleto, o GAFN e o inventário fonético completo, o GDFo e sistema fonológico alterado e os GDFe e GAFN e o sistema fonológico adequado. Os sons com maior número de omissões no inventário fonético foram: /з /, /z/, /r/, /λ / e /g/ no GDFo, e /r/, /g/, /z/, / ∫ / e / λ / no GDFoFe. Os grupos GDFe e GAFN apresentaram PCC significativamente maior que o do GDFoFe. Os fonemas com mais alterações no sistema fonológico foram: /r/, /λ /, /з / ∫ / e /z/ no GDFo, e / ∫ /, /λ /, /r/, /g/ no GDFoFe. Em ambos os grupos, a maioria dos sujeitos apresentou dificuldades com o onset complexo, com apagamento das líquidas /r/ e /l/. Quanto aos traços distintivos, foi verificado que os GDFo e o GDFoFe apresentaram número de traços alterados estatisticamente significativo e maior que o GAFN e que os traços mais alterados foram [+voz] ®[-voz], [-ant] ®[+ant], [+cont] ®[-cont], [-voc] ®[+voc], no GDFo, e [-ant] ®[+ant], [+voz] ®[-voz], [+ant] ®[-ant], no GDFoFe. Conclui-se, dessa forma, que há alta prevalência de desvios de fala em pré-escolares na população estudada, e quanto maior o número de sons ausentes no inventário fonético, maior pode ser a severidade do desvio. Além disso; o maior número de alterações na classe das fricativas e líquidas sugere que os sujeitos com desvios fonológico ou fonológico-fonético utilizam estratégias semelhantes, embora não idênticas, às das crianças com desenvolvimento fonológico adequado, pois essas classes de fonemas são, de acordo com a literatura consultada, as últimas a serem adquiridas.

No description available.

本篇論文針對三位以臺灣華語為母語的音韻異常兒童，採長期觀察的方式，研究中文顎音[tɕ, tɕʰ, ɕ]的習得狀況與產製現象。習得狀況方面，詳細描述顎音的習得順序、常見的語音錯誤之音韻歷程、延遲的音韻歷程類型、錯誤取代模式隨著年紀增長而改變的情形。產製現象方面，本篇論文探討了顎音所在音節的音節複雜度(Syllable complexity)是否會對顎音的正確率以及錯誤取代狀況有所影響。 本研究共觀察三位年齡為三歲十個月至五歲三個月且正在接受語言治療的音韻異常兒童長達六個月，以每週一次的頻率前往醫院收集幼童與語言治療師之間的自然對話，並利用錄製回來的影音檔做譯寫和分析。 結果顯示，音韻異常兒童的顎音習得狀況有以下現象：(1)顎音發展較為停滯，幾乎沒有隨著年齡的增長而有進步的現象。(2)音韻異常兒童在發顎音時，會系統性的使用不該是他的年齡所應該出現的音韻歷程。(3)顎音的語音錯誤之音韻歷程種類不多，但使用的頻率卻非常頻繁。上述結果皆驗證了前人文獻的研究結果(Stoel-Gammon & Dunn, 1985; Jeng, 2011)。除此之外，本研究也發現音韻異常兒童具有以下特徵：(4)音韻異常兒童能夠察覺兩個音之間送氣特徵(aspiration feature)的不同，在選擇替代音時，也會選擇與目標音有相同送氣特徵的音來取代。(5)音韻異常兒童的語言能力和語言表現之間有落差，也就是說，他們知道能夠區辨出哪個是正確的音，但卻無法正確的使用該語音。(6)音節複雜度會對音韻異常兒童的顎音產製造成影響。因此，音韻異常兒童在顎音的習得狀況和產製表現上都和正常兒童不同。 音韻異常兒童使用的錯誤音的模式顯示塞擦音基底形式中的[stop]成分及[cont]成分並非均等(asymmetrical relationship)，且塞擦音是屬於以左邊的成分為主要核心的語音(left-headed)，並從第一語言習得的觀點為塞擦音的真實面貌提供了一項證據。 / The purpose of this study is to discuss the issue concerning the acquisition and production of Mandarin palatals [tɕ, tɕʰ, ɕ] in Taiwan Mandarin-speaking disordered children. Four aspects regarding the acquisition of Mandarin palatals are included in this study: the order of acquisition, the phonological processes involved, the delayed phonological processes, and the path of error patterns. In addition, the effect of syllable complexity on disordered children’s palatal production is also examined. Three disordered children (aged 3;10 to 5;3) who were identified as having delayed phonological development are investigated in this study. A six-to-seven month of longitudinal observation is conducted by recording the spontaneous speech between the therapists and the children during the process of speech therapy. The results showed that phonologically disordered children have the following characteristics on palatal acquisition and production: (1) static phonemic system that stops at an early level of development, (2) persistent uses of delayed processes, and (3) frequent uses of phonological processes. These characteristics were asserted in the literature (Stoel-Gammon & Dunn, 1985; Jeng, 2011) and have been proved in this study. In addition, we found that disordered children are unconsciously able to notice the aspiration feature of two sounds, and will use an error sound that has an identical aspiration feature with the target. Moreover, the disparity between the linguistic competence and the linguistic performance in the disordered children was also found. Last, syllable complexity has found to affect disordered children’s palatal production. The substitution errors used by the disordered children support Schafer’s (1995) study, in which he claimed that the underlying representation of affricates is left-headed. To sum up, this study has provided a piece of evidence for the unsolved issue of the nature of affricates from the field of first language acquisition, and might serve as a reference for parents and speech therapists for understanding palatal acquisition and production in disordered children.

published_or_final_version / Education / Master / Master of Education

Magistro darbe analizuojamas informacinių technologijų taikymas Lietuvos logopedų darbe. Apie IKT ir KMP taikymą Lietuvos logopedų darbe nėra daug žinoma, nėra parengta išsamių mokslinių straipsnių ar apžvalgų, kurie nurodytų, kokiomis informacinių technologijų programomis ar priemonėmis naudojamasi logopedų darbe, kokios iš jų vyrauja ir kurios yra efektyviausios dirbant su kalbos, kalbėjimo ir komunikacijos sutrikimų turinčiais asmenimis. Praktinis tyrimo naudingumas – atskleisti informacinių technologijų taikymo realybę logopedų darbe su kalbėjimo ir kalbos sutrikimų turinčiais asmenimis. Palyginti pasiekimus šioje srityje Lietuvoje ir užsienio šalyse. Prieduose pateikiamas internetinių svetainių sąrašas, kur galima rasti logopedinėse pratybose pritaikomų lavinimo užduočių. / Master’s thesis analyzes the informational technologies application in Lithuanian speech and language therapists’ work. The aim of this research - to assess the informational and communication technology (ICTs) and computer-based speech training system (CBST) use at the speech and language therapists work in comprehensive schools who work with persons who have language, speech and communication disorders. The empirical part of the paper deals with the use of ICTs/ CBST at speech and language therapists work, their possibility of usage, the coherence between speech therapists qualification and their age, the usage of the programs for development educable self-dependent tools, speech and language therapists interest in various sources of work-related topics and others. In the questionnaire survey (in electronic form) have participated 258 speech and language therapists who work in comprehensive schools.

L’objectif de ce travail, mené en partenariat avec le Département de Chirurgie Oncologique du Centre Paul Strauss à Strasbourg, est d’évaluer les conséquences d’une chirurgie thyroïdienne sur la voix des patients, afin de déceler les différentes perturbations qu’entraîne cette opération chirurgicale, et de mettre au jour les possibles stratégies de compensation ou de réajustements que le patient peut mettre en place, seul ou à l’aide d’une rééducation orthophonique ; il s’agit d’une étude longitudinale. L’évaluation reposait sur l’analyse de signaux acoustiques, à partir desquels une quantité importante d’indices relatifs à la qualité vocale, mais aussi aux comportements articulatoires des locuteurs, a pu être extraite. La production de voyelles soutenues a permis de conduire deux études spectrales. L’étude spatio-temporelle a été rendue possible grâce à l’analyse de logatomes, et plus précisément de séquences VCV. Nous avons mené trois expériences sur le plan acoustique. La première expérience traite des caractéristiques spectrales de la voix de patients ayant subi une thyroïdectomie et ne présentant pas d’immobilité laryngée. La deuxième étude est menée à partir des caractéristiques spectrales de la voix de locuteurs présentant une immobilité laryngée post-thyroïdectomie. Enfin, notre dernière expérience a pour objet, l’étude des caractéristiques spatio-temporelles de la voix de locuteurs qui ont subi une thyroïdectomie et présentant une immobilité laryngée. L’interprétation articulatoire, effectuée à partir des données acoustiques, révèle des perturbations aussi bien des gestes glottiques que des gestes supraglottiques, avec des stratégies de réajustements variables suivant les patients. La conception d’une « cible », comme espace de contrôle pour la réalisation de possibles articulatoires et acoustiques perceptivement acceptables, semble particulièrement pertinente ici, dans la mesure où les locuteurs pathologiques réorganisent leurs productions selon leurs propres contraintes physiologiques et anatomiques, provoquées par leur pathologie. / The aim of this study, conducted in partnership with the Department of Surgical Oncology, Centre Paul Strauss in Strasbourg, is to assess the consequences of thyroid surgery on the voice of patients, in order to identify the various perturbations caused by this surgery, and also to reveal possible compensatory strategies or readjustments that the patient may develop, alone or with speech therapy; this is a longitudinal study. The assessment was based on the analysis of acoustic signals, from which a large amount of cues related to voice quality, but also to articulatory behaviour of speakers was extracted. Production of sustained vowels allowed carrying out two spectral studies. The spatiotemporal study was made possible through the analysis of nonsense words, and more specifically through VCV sequences. We conducted three experiments on the acoustic level. The first experiment deals with the spectral characteristics of the voice of patients who underwent thyroidectomy, with no laryngeal paralysis. The second study was conducted based on spectral characteristics of the voice of speakers with laryngeal post-thyroidectomy paralysis. Our final experiment was to study spatio-temporal characteristics of the voice of speakers who underwent thyroidectomy, with laryngeal paralysis. Articulatory interpretations, made from the acoustic data, reveal perturbations of gestures on both the glottal and supraglottal levels, with readjustment strategies varying according to patients. The concept of a "target" as a control space for execution of possible articulatory and acoustic entities, which are perceptually acceptable, seems particularly relevant in this study, since disordered speakers reorganize their productions according to their own physiological and anatomical constraints, caused by the disorder.

Die Ursache für das idiopathische Stottern ist bis zum jetzigen Zeitpunkt unbekannt. Typischerweise beginnt die Redeflussstörung im Vorschulalter. Es wird davon ausgegangen, dass 1% der Bevölkerung an Stottern leidet. Bei der Frage nach pathophysiologischen Hintergründen von Sprech- und Sprachstörungen ist der Zusammenhang zwischen einer pathologischen, funktionellen Lateralisierung und einer morphologischen Asymmetrie im Bereich von neuronalen Netzwerken der Sprachbildung bereits seit längerem Gegenstand der Forschung. Im Rahmen der vorliegenden Arbeit wurde die Lateralisierung von Sprache bei 17 stotternden Probanden und 20, im Alter entsprechenden, flüssig sprechenden Probanden untersucht. Hierbei wurde die Sprachlateralisierung mithilfe der fMRT sowohl mit einem Satz- als auch mit einem Wortgenerierungsparadigma ermittelt. Ausgehend von den in der fMRT ermittelten Sprachzentren wurde die angrenzende weiße Substanz unter Verwendung der DTI auf eine Asymmetrie hin untersucht. Im Vergleich zu der Gruppe der Normalprobanden zeigten die schwer stotternden Probanden eine Verschiebung der Indexwerte, deren endgültige Ursache offen bleibt. Gesteigerte funktionelle Aktivierung in Bereichen der rechtshemisphärischen Analoga der Sprachzentren scheint ein möglicher Erklärungsansatz. Vorausgegangene funktionelle Untersuchungen u. a. mittels PET und fMRT bei stotternden Probanden belegten eine Überaktivierung von Teilen des motorischen Kortex sowie eine atypische Lateralisierung bei der Produktion von Sprache mit rechtsseitiger Lateralisierung oder eine bilaterale Aktivität. Darüber hinaus zeigte sich eine morphologische Veränderung, im Sinne einer Abnahme einer linkshemisphärischen Asymmetrie bei den schwer stotternden Probanden, besonders in der an das Wernicke-Areal angrenzenden weißen Substanz. Mithilfe der VBM konnten in mehreren früheren Studien morphologische Unterschiede bei Stotternden gezeigt werden. Gegenüber dem rein morphologischen Untersuchungsansatz vorangegangener Untersuchungen berücksichtigte die Kombination der funktionellen und der diffusionsgewichteten Analyse stärker die intraindividuelle Variabilität der Sprachzentren.

The thesis discusses the specific therapeutic methods and techniques that can be used in the context of speech therapy for children with Down syndrome who suffer from symptomatic speech disorder. The thesis includes the complete terminological definition of Down syndrome etiology, diagnosis and detailed elaboration of the therapeutic methods. It also includes complementary therapies that contribute to the overall development of the child's communication skills. The main objective of the thesis is to analyze the speech therapy. It may be an inspiration for speech therapists, parents, teachers in kindergartens and primary schools who take care of children with Down syndrome and want to contribute to improvement of communication skills of the children. The thesis can be a starting point for further scientific work that deals with similar issues. KEYWORDS: Down syndrome, development of communication skills, speech disorder, speech therapy, therapeutic methods and techniques, orofacial stimulation, myofunctional therapy, complementary therapies, case study.