IALP Progamma

International Association of Logopedics and Phoniatrics
The worldwide organization of professionals and scientists in communication, voice, speech language pathology, audiology and swallowing
WHERE PRACTICE MEETS SCIENCE

August 25-29, 2013 Lingotto Congress Centre Torino, Italy
FINAL PROGRAM & ABSTRACT BOOK
Under the Auspices of
City of Turin Universit degli Studi di Torino Societ Italiana di Foniatria e Logopedia (SIFEL) Associazione Geriatri Extraospedalieri (AGE) Associazione Igienisti Dentali Italiani (AIDI) Associazione Italiana di Otorinoloringoiatria e Geriatria (AIOG) Associazione Italiana Fisioterapisti (AIFI) Associazione Italiana Terapisti Occupazionali (AITO) Associazione Nazionale Dentisti Italiani (ANDI) Associazione Nazionale Unitaria Psicomotricisti e Terapisti della Neuro e Psicomotricit dellet evolutiva Italiani (ANUPI) Federazione Logopedisti Italiani (FLI) Gruppo Italiani Studio Disfagia (GISD) Societ Italiana di Audiologia e Foniatria (SIAF) Societ Italiana di Geriatria e Gerontologia (SIGG) Societ Italiana di Pediatria (SIP) Societ Italiana di Psicogeriatria (AIP) Societ Italiana Geriatria Ospedale e Territorio (SIGOT) Societ Scientica Logopedisti Italiani (SSLI) Comit Permanent de Liaison des Orthophonistes / Logopedes de lUnion Europenne (CPLOL) Deutsche Gesellschaft fr Sprach-und Stimmheilkunde e.V. (DGSS) South African Speech Language Hearing Association (SASLHA)
Table of Contents
WELCOME ADDRESS MESSAGE OF THE PRESIDENT OF THE CONGRESS IALP COMMITTEES CONGRESS COMMITTEES CONGRESS MAIN REPORTS CONGRESS SPECIAL EVENTS SCIENTIFIC PROGRAM SCIENTIFIC SCIENTIFIC SCIENTIFIC SCIENTIFIC SCIENTIFIC PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM SUNDAY AUGUST 25TH, 2013 MONDAY AUGUST 26TH, 2013 TUESDAY AUGUST 27TH, 2013 WEDNESDAY AUGUST 28TH, 2013 THURSDAY AUGUST 29TH, 2013
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GENERAL INFORMATION REGISTRATION INFORMATION SOCIAL PROGRAM CONGRESS VENUE PLAN INSTRUCTION FOR PRESENTERS & POSTER PRESENTATIONS POSTER LIST ABSTRACT POSTER PRESENTATIONS ABSTRACT ORAL PRESENTATIONS
PAGE 44 PAGE 45 PAGE 45 PAGE 46 PAGE 48 PAGE 49 PAGE 62 PAGE 137
Welcome address
Dear Colleagues: Welcome to the 29th World Congress of the International Association of Logopedics and Phoniatrics (IALP), the oldest international organization working from a global perspective on scientific, educational and professional issues affecting persons with communication, language, voice, speech, hearing and swallowing disorders. It is an honor and a privilege to hold our Congress for this first time in the beautiful city of Torino, Italy. This vibrant city with its great history, culture, and opportunities to explore its many points of interest is a most fitting and welcoming place in which to hold our meeting whose theme is Where Science Meets Practice. Attending the Congress are physicians, clinicians and scientists from all over the world who have come together to share and discuss recent research findings, and educational and professional advances. The Congress will provide us with opportunities to meet, and share perspectives with colleagues that will enrich our work, and enable our thinking to transcend geographic and cultural boundaries. The social activities that have been planned will also enable us to relax and enjoy the rich setting in which our meeting is being held and will provide additional opportunities to meet and network with colleagues. Italy is famous for its gracious hospitality. Benvenuto! Godetevelo, e grazie mille.
Tanya M. Gallagher President of the 29 th IALP Congress
Message of the Chair of the Organizing Committee
Im profoundly glad, proud and pleased to be able to welcome you at the 29th World Congress of the IALP, International Association of Logopedics and Phoniatrics, the only scientific and professional organization in the world with knowledge and competence on each chapter of the pathophysiology of the communication and the deglutition in the child, adult and geriatric ages. Actually IALP represents a specialized sciencearea which is engaged in the normal functioning and disorders of communication, voice, speech, language, audiology and swallowing in the educational, cognitive, professional aspects. Next year will be the 90th anniversary of the foundation of the IALP, which was constituted in Wien in 1924 by a group of phoniatricians, mainly of MidEurope, guided by Emil Frocshels; in that time neither medical doctors nor riabilitators formally specialized in communicology existed. In the following years the IALP extended to the entire Europe and in the 60s to the whole world with increasing participation of logopaedists who are now the absolute majority of the members, coming from more than 60 countries. The sectors of competence of logopedics and phoniatrics are overlapping and include specifically the physiology and the pathology (and related fields) in their scientific and professional aspects (diagnostic, prognostic, habilitative, rehabilitative, care, social) in the following fields: - Voice - Speech - Language - Fluency (especially verbal) - The entire aspects of the communication and other related (or not) abilities and in particular aphasia, the neuromotricity (dysarthria, anarthria), the encephalic holism (oligophremia, dementia) - Child communication - Deafness (especially of the child) - Learning (dyslexia, disortographia, dyscalculia) - The interpersonal relationship (dual. e.g. Autism) and plural, e.g. social and mainly cultural and the multilinguism - Artistic aspects (musical, theatric) - Deglutition Obviously, to handle the above mentioned sectors is absolutely necessary to manage well scientifically and professionally the following propaedeutic areas: linguistics, acoustics, auxology, neurology and neuroscience. The field is so large that probably the professional beyond a core competence could be divided in: - A generic profession with abilities in all fields - Many specialized competences: age linked (evolutive, adult, involutive), sectorialized (auditive, neurologic, interpersonal and social etc) or even over-specialized (voice, artists). The professional competences, respectively logopaedics and phoniatrics, have a large overlapping and there are not rigidly differentiated competences. Logopedists are mainly involved diagnostically to recognize the type and the degree of the impairment; they also play a key role in the habilitative and rehabilitative remediation (intends in an omnicomprehensive way) as well as in the collegial evaluation with school and social professionals. Phoniatricians, or in their absence other physicians such as pediatricians, neurologists, ENT, are mainly devoted to analysis of the etiology and the pathology, the pharmacological and surgical care, the collegial evaluation with other medical specialists (for their specific competences); besides, Phoniatricians are often responsible of the case management. What I have mentioned above is widely reflected by the IALP committees: Augmentative Alternative Communication, Aphasia, Audiology, Child Language, Dysphagia, Educational Committee For Phoniatrics, Education C For Speech And Language Pathology, Fluency, History, Motor Speech Disorders, Multilingual Affairs, Voice. The SIFEL, the Italian Society of Phoniatrics and Logopaedics, is very happy to welcome you in Torino, the first capital of Italy in 1861. It is the
second time (after Padua in 1962) that we have a IALP Congress organized in Italy. Torino is the city where the Italian Communicology started in 1932 with Renato Segre, followed by Giuseppe Bellussi and later in collaboration with Lucio Croatto. In Torino we had since 1972 different kinds of Logopedic programs and a Phoniatric speciality for physicians. The enormous work of our university clinic made Torino the main Italian reference for communicology and swallowing. Torino, as location for the congress, offers many attractions (e.g. the Egyptian Museum - the second in the world the Royal Castle and specially the Venaria Reale, called the Italian Versailles, the National Auto museum, the Cinema Museum inside the Mole Antonelliana). Many parks, also on the River Po, a big variety for eating and drinking (the wines of the piedmontese region are the best of Europe), daily and night entertainment will delight your staying. Do not forget to taste the chocolate of Torino. Thanking you very much for your numerous and qualified presence for which we are particularly proud, I wish you maximum of pleasure, of usefulness, of the creation and consolidation of the mutual relationships and of the future perspectives of the profession. A special thanks to the organizing committee and staff and especially to Roberto Albera, Antonio Schindler and Irene Vernero, who did the maximum of the work to prepare the congress which without them would have been impossible.
Prof. Oskar Schindler Chair of the Organizing Committee
IALP Committees
EXECUTIVE COMMITTEE IALP 2010-2013 President: Tanya Gallagher (USA) Immediate Past President: Mara Behlau (Brazil) Treasurer: Tadeus Nawka (Germany) Secretary: Bruce Murdoch (Austria) President Elect: Helen Grech (Malta) Vice President: Oskar Schindler (Italy) Editor Ex. Officer: Gary Weismer (USA)
IALP BOARD AT LARGE Claudia Andrade (Brazil) Lilly Li Rong Cheng (USA) Pamela Enderby (UK) Heila Jordaan (South Africa) Katrin Neumann (Germany) Philippe Paquier (Belgium) Michael Robb (New Zealand)) Antonio Schindler (Italy) Brian Shulman (USA) Ken Watkin (USA)
IALP OFFICE MANAGER Robbin King (USA)
IALP Committees
AUGMENTATIVE ALTERNATIVE COMMUNICATION COMMITTEE

Chair: Judy Montgomery, USA Committee members Martine Smith (Ireland), Permelia McCain (USA), Gonda Pickl (Austria)
FLUENCY COMMITTEE
Chair: Hans-Georg Bosshardt, Germany Committee members Joseph Agius (Malta), Henny Bijleveld (Belgium), Michael Blomgren (USA), Vronique Aumont Boucand (France), Luisella Cocco (Italy), Claudia dAndrade (Brazil), Kurt Eggers (Belgium), Steen Fibiger (Denmark), George Fourlas (Greece), Sharon Millard (Great Britain), Ann Packman (Australia), Frances M. Cook (UK) Consultant, Margaret Leahy (Ireland) Consultant, Katrin Neumann (Germany) Consultant, Herman F.M. Peters (The Netherlands) Consultant, Beatriz de Touzet (Argentina) Consultant, Yohko Wakabe (Japan) Consultant
APHASIA COMMITTEE
Chair: Anu Klippi, Finland Committee members Plagie Beeson (USA), Fofi Constandinidou (Cyprus), Katerina Hilari (UK), Simon Horton (UK), Claire Penn (South Africa), Anastasia Raymer (USA), Luise Springer (Germany), Linda Worrall (Australia), Nada Zemva (Slovenia)
HISTORY COMMITTEE
Chair: Dolores Battle, Usa Committee members All past presidents
AUDIOLOGY COMMITTEE
Chair: Katrin Neumann, Germany Committee members Peter Alberti (Canada), Xingkuan Bu (China), Renata Mota Mamede de Carvallo (Brazil), Corina Farfn-Reyes (Chile), Gilbert Herer (USA), Kajsa-Mia Holgers (Sweden), Sebastian Hoth (Germany), Anu Sharma (USA), Somaia Tawfik (Egypt)
MOTOR SPEECH DISORDERS COMMITTEE

Chair: Bruce Murdoch, Australia Committee members Pamela Enderby (UK), Lena Hartelius (Sweden), Ben Maassen (The Netherlands), Malcolm McNeil (USA), Angela Morgan (Australia), Michael Robb (New Zealand), Gwen van Nuffelen (Belgium), Tara Whitehill (China)
CHILD LANGUAGE COMMITTEE

Chair: Yvette Hyter, USA Committee members Sarah Eyal (Israel), Gail Gillon (New Zealand), Yvette Hus (Canada), Ana Luiza Navas (Brazil), Kakia Petinou (Cyprus), Osnat Segal (Israel), Leonor Scliar Cabral (Brazil), Yumiko Tanaka Welty (Japan), Yiannis Vogindroukas (Greece), Carol Westby (USA)
MULTILINGUAL AFFAIRS COMMITTEE

Chair: Heila Jordaan, South Africa Committee members Barbara Dodd (Australia), Brian Goldstein (USA), Elin Thoradottir (Canada), Willem van Steenbrugge (Australia), Maria Kambanorou (Cyprus), Marion Fredman (Israel), Yvette Hus (Canada) Consultant
DYSPHAGIA COMMITEE
Chair: Kenneth Watkin, Canada Committee members Sandra Ettema (USA), Takahiro Ono (Japan), Antonio Schindler (Italy)
VOICE COMMITTEE
Chair: Rahul Shrivastav, USA Committee members Ofer Amir (Israel), Estella Ma (China), Eiji Yumoto (Japan), Janet Baker (Australia), Philippe Dejonckere (Belgium and the Netherlands), Thomas Murry (USA), Eeva Sala (Finland), Ron Baken (USA) Consultant, Mara Behlau (Brazil) Consultant, Diane Bless (USA) Consultant, Eva B. Holmberg (Sweden)
EDUCATIONAL COMMITTEE FOR PHONIATRICS

Chair: Berit Schneider, Austria Committee members Antoinette am Zehnhoff-Dinnesen (Germany) Per Ake Lindestad (Sweden), Virginie Woisard (France), Bozena (Poland)
EDUCATION COMMITTEE FOR SPEECH AND LANGUAGE PATHOLOGY

Chair: Fernanda Dreux Fernandes, Brazil Committee members Victor Acosta (Spain), Dobrinka Georgieva (Bulgaria), Hortencia Kayser (USA), Lindy McAllister (Australia), Sharynne McLeod (Australia), Lemmietta McNeilly (USA), Masae Shiroma (Japan), Brian Shulman (USA), Chin-Hsing Tseng (Taiwan), Thomaz Woznick (Poland), Hilde Chantrain (Belgium) Consultant, Lilly Cheng Li-Rong (USA) Consultant, Matti Lehtihalmes (Finland) Consultant
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Congress Committees
CONGRESS SCIENTIFIC COMMITTEE

Chair: Antonio Schindler (Italy) Editorial staff: Gary Weismer (USA)
FLUENCY
Hans-Georg Bosshardt (Germany) Margaret Leahy (Ireland) Kurt Eggers (Belgium) Ann Packman (Australia) Michael Blomgren (USA)
AFFILIATED SOCIETIES
Mara Behlau (Brazil) Helen Grech (Malta) Tanya Gallagher (USA)
HISTORY
Dolores Battle (USA) Oskar Schindler (Italy)
APHASIA
Anu Klippi (Finland) Simon Horton (UK) Stacie Raymer (USA)
MOTOR SPEECH DISORDERS

Bruce Murdoch (Australia) Angela Morgan (Australia) Ben Maassen (The Netherlands) Michael Robb (New Zealand)
AUGMENTATIVA ALTERNATIVE COMMUNICATION

Judith Montgomery (USA) Gonda Pickl (Austria) Jayanti Ray (USA)
MULTILINGUAL AFFAIRS
Heila Jordaan (South Africa) Marion Friedman (Israel) Brian Goldstein (USA)
AUDIOLOGY
Philip Newall (Australia) Karl White (USA) Katrine Neumann (Germany)
VOICE
Rahul Shrivastav (USA & India) Philippe Dejonckere (Belgium and the Netherlands) Ofer Amir (Israel)
CHILD LANGUAGE
Carol Westby (USA) Osnat Segal (Israel) Kakia Petinou (Cyprus)
ORGANIZING COMMITTEE
Oskar Schindler - Chair (Italy) Roberto Albera - Co-Chair (Italy) Antonio Schindler (Italy) Irene Vernero (Italy) Antonella Cusimano (Italy) Daniela Ginocchio (Italy) Patrizia Maruzzi (Italy) Francesco Mozzanica (Italy) Rossella Mu (Italy) Simona Raimondo (Italy) Letizia Scarponi (Italy) Massimo Spadola Bisetti (Italy)
DYSPHAGIA
Kenneth L Watkin (USA) Jeri Logemann (USA) Sandra Ettema (USA)
EDUCATION FOR PHONIATRICS

Berit Schneider-Stickler (Austria) Bozena (Poland) Per Ake Lindstad (Sweden)
EDUCATION FOR SPEECH AND LANGUAGE PATHOLOGY

Sharynne McLeod (Australia) Dorbrinka Georgieva (Bulgaria) Fernanda Dreux M. Fernandes (Brazil)
Congress Main Reports
MONDAY 26TH AUGUST 2013

MAIN REPORT 1 NeUromotor speech impairment: its all in the talking Main Presenter: Wolfram Ziegler (Germany) Discussants: Elina Tripoliti (England), Sabine Skodda (Germany)
08.30-10.30
Auditorium
ITALIAN CME ACCREDITATION
Abstract A major aim of this talk is to explicate the uniqueness of the motor activity of speaking and to emphasize its domain-specificity, i. e., its affiliation with the domain of linguistic expression. I will, as a starting point, take a theoretical stance and discuss (1) neurobiological data, (2) observations on practice-related neural plasticity, and (3) clinical reports supporting the specificity-hypothesis. The far-reaching theoretical consequences of this perspective will be outlined briefly. The second part of the talk then deals with implications of the domain-specific view for clinical research and clinical practice. In this part I will discuss the relevance of various speech and nonspeech tasks in neuroimaging, physiological experimentation, clinical assessment, and treatment, especially from the perspectives of acoustic vs. somatosensory reference frame models of speech motor control. I will propose an approach which combines a profound theoretical understanding of motor speech impairment with practical issues of their clinical management.
TUESDAY 27TH AUGUST 2013

MAIN REPORT 2
08.30-10.30
Auditorium
CognitiVe ReserVe: Implications For Assessment and InterVention Main Presenter: Yaakov Stern (USA) Discussants: Claire Penn (South Africa), Sue Franklin (Ireland) Abstract The concept of reserve is used to explain that observation that some individuals function better than others in the presence of brain pathology. Brain reserve refers to the individual differences in the anatomic substrate. Cognitive refers to differences in the flexibility or adaptivity of cognitive networks. Epidemiologic evidence indicates that a set of life exposures including higher educational and occupational attainment, and engaging in leisure activities is associated with a lower risk of incident dementia, suggesting that these life exposures may enhance cognitive reserve. Imaging studies have been designed to explore the neural substrates of cognitive reserve. Also, controlled clinical studies can test specific exposures that may enhance reserve. The concept of cognitive reserve also has important implications for clinical practice.
THURSDAY 29TH AUGUST 2013

MAIN REPORT 3
08.30-10.30
Auditorium
DEVELOPMENTAL LANGUAGE DISORDERS: CHALLENGES AND IMPLICATIONS OF CROSS GROUP COMPARISON Main Presenter: Susan Ellis Weismer (USA) Discussant: Paavo H.T. Leppnen (Finland), Anna Maria Chilosi (Italy) Abstract Historically, specific language impairment (SLI) and language deficits associated with autism spectrum disorders (ASD) have been viewed as distinct developmental language disorders. However, over the last decade or so a considerable amount of research has explored general similarities or specific areas of overlap between children with SLI and ASD based on language and cognitive profiles, neuroimaging findings, and genetic research. The theoretical assumptions regarding the nature of these developmental disorders as well as the clinical classification schemes that are used to identify the children necessarily influence the extent to which SLI and ASD are viewed as overlapping or distinct conditions. In addition to differing theoretical perspectives, the criteria used to diagnosis these two populations varies across countries and even across investigators within a given country. This necessarily impacts the findings from comparative investigations of these groups. With these challenges in mind, clinical implications of evidence for similarities and distinctions between children with SLI and ASD will be discussed with respect to differential diagnosis and treatment
Congress Special Events
MONDAY 26TH AUGUST 2013
14.45-16.15
Auditorium
SP1 - Challenges in occUpational Voice disorders: legal aspects ITALIAN CME ACCREDITATION CHAIR: Tadeus Nawka CO-CHAIR: Andrea Ricci Maccarini Speakers: Thomas Murry, Massimo Magnani, ORIETTA CALCINONI, VIVEKA LYBERG-HLANDER, IRMA ILOMKI, BERNHARD RICHTER
11.45-13.15
Auditorium
SP2 - WHO WORLD REPORT IN DISABILITY IMPLEMENTING SOLUTIONS ITALIAN CME ACCREDITATION CHAIR: MARA BEHLAU CO-CHAIR: OSKAR SCHINDLER SPEAKERS: MARA BEHLAU, TANYA GALLAGHER, ALANA MARGARET, PATRICIA PRELOCK, CHISTINE STONE, OSKAR SCHINDLER, TADUES NAWKA
14.45-16.15
Auditorium
SP3 - MANAGEMENT OF SWALLOWING DISORDERS IN THE ELDERLY ITALIAN CME ACCREDITATION CHAIR: ANTONIO SCHINDLER CO-CHAIR: PERE Clave SPEAKERS: DAVID Smithard, PERE Clave, MAURITS Vandewoude, ANTONIO Schindler, ENRICO Alfonsi
WEDNESDAY 28TH AUGUST 2013
14.30-16.00
Auditorium
SP4 - ACHIEVING BEST OUTCOME IN CHILDREN WITH COCHLEAR IMPLANTS Chair: Helen Grech Co-Chair: Alessandro Martini Speakers: Roberta Buhagiar, Sebastian Hoth, Alessandro Martini, Katrin Neumann
THURSDAY 29TH AUGUST 2013
14.45-16.15
Auditorium
SP5 - COMMUNICATION DISORDERS IN THE MULTILINGUAL POPULATION ITALIAN CME ACCREDITATION CHAIR: LILLY CHENG CO-CHAIR: ANDREA MARINI SPEAKERS: RITA MARI, MARINA PORRELLI, PAOLA BONIFACCI, STEPHANIE BELLOCCHI, SANDRA LEVEY, BENJAMIN R. TSOU
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Scientific Program
MAIN REPORT SPECIAL EVENT SYMPOSIUM SEMINAR SHORT SEMINAR FREE PAPERS
MR SP SY SE SS FP
Sunday 25th August 2013

VOICE COMMITTEE MEETING
10.00-13.00
LONDRA HALL

MOTOR SPEECH COMMITTEE MEETING
MADRID HALL

APHASIA COMMITTEE MEETING
LISBONA HALL

DYSPHAGIA COMMITTEE MEETING
ATENE HALL

FLUENCY COMMITTEE MEETING
DUBLINO HALL

CHILD LANGUAGE COMMITTEE MEETING
COPENHAGHEN HALL

AAC COMMITTEE MEETING
14.00-16.00
LONDRA HALL

EDUCATION FOR PHONIATRICS COMMITTEE MEETING
MADRID HALL

EDUCATION FOR SPEECH AND LANGUAGE PATHOLOGY COMMITTEE MEETING
LISBONA HALL

AUDIOLOGY COMMITTEE MEETING
ATENE HALL

MULTILINGUAL AFFAIRS COMMITTEE MEETING
DUBLINO HALL

OPENING CEREMONY
16.00-19.00
AUDITORIUM

WELCOME RECEPTION
19.00-20.00
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Monday 26th August 2013

MAIN REPORT
08.30-10.30
MR1 - NeUromotor speech impairment: its all in the talking CHAIRS: Gary Weismer (USA) Pamela Enderby (UK) Main Presenter: Wolfram Ziegler (Germany) Discussants: Elina Tripoliti (England) - Sabine Skodda (Germany)
AUDITORIUM
11.00-11.45
AUDITORIUM
CHILD LANGUAGE FREE PAPERS 1 ITALIAN CME ACCREDITATION CHAIRS: Donatella Croatto (Italy) - Helen Grech (Malta) 11.00-11.15 FP1 - A SYSTEMATIC REVIEW OF THE NTERVENTIONS USED ITH PRESCHOOL CHILDREN WITH PRIMARY SPEECH AND LANGUAGE IMPAIRMENT Juliet Goldbart - Sam Harding - Lydia Morgan - Naomi Parker - Elizabeth Lewis Julie Marshall - Sue Roulstone (UK) 11.15-11.30 FP2 - INTERVENTIONS FOR PRESCHOOL CHILDREN WITH PRIMARY SPEECH AND LANGUAGE IMPAIRMENT WHAT SPEECH AND LANGUAGE THERAPISTS DO AND WHAT INFLUENCES THEM Julie Marshall - Lydia Morgan - Julie Ward and Sue Roulstone (UK) 11.30-11.45 FP3 - IDENTIFYING COMPONENTS OF INTERVENTIONS OR PRESCHOOL CHILDREN WITH PRIMARY SPEECH AND LANGUAGE DIFFICULTIES SUE ROULSTONE - LYDIA MORGAN - NAOMI PARKER - JULIE MARSHALL (UK)
LONDRA HALL
CHILD LANGUAGE FREE PAPERS 2 CHAIRS: Tanya Gallagher (USA) Irene Vernero (Italy) 11.00-11.15 FP4 - THE DEVELOPMENT AND NORMALIZATIONOF A SPEECH OUTPUT TEST FOR CHILDREN: THE COMPUTER ARTICULATION INSTRUMENT LEENKE VAN HAAFTEN - SANNE DIEPEVEEN - BERT DE SWART - BEN MAASSEN (NETHERLANDS) 11.15-11.30 FP5 - SCREENING FOR SPEECH DELAY: RELIABILITY, VALIDITY AND NORMATIVE DATA OF A REPETITION TEST FOR ITALIAN CHILDREN ANNA COLOMBO - MARTINA TRESOLDI - ELENA FAVERO - PAOLA VELARDO - FRANCESCO MOZZANICA ANTONIO SCHINDLER (ITALY) 11.30-11.45 FP6 - PHONETIC OR PHONOLOGICAL THERAPY. WHICH MODEL MORE INDICATED FOR CHILDREN THAT REDUCE THE CONSONANT CLUSTER AND APPLY THE REPAIR STRATEGY? VANESSA GIACCHINI - HELENA BOLLI MOTA - CAROLINA LISBA MEZZOMO (BRAZIL)

VOICE FREE PAPERS 1 CHAIRS: RAFFAELE Sorrentino (ITALY) - MA Estella (CHINA) 11.00-11.15 FP7 - THE SPEAKING FUNDAMENTAL FREQUENCY AND VOICE TYPE OF OPERA SINGERS SEMYON CHERNOBELSKY (RUSSIAN FEDERATION)
MADRID HALL
11.15-11.30 FP8 - NEURONAL CORRELATES OF SONG PERCEPTION IN COMPARISON OF SINGERS, ACTORS AND LAYMEN KEN ROSSLAU - SIBYLLE HERHOLZ - ARNE KNIEF - DIRK DEUSTER- ANTOINETTE AM ZEHNHOFF-DINNESEN CHRISTO PANTEV - CHRISTIAN DOBEL (GERMANY) 11.30.11.45 FP9 - VOICE CLASSIFICATION IN PRACTICE: CRITERIA IN CONTEMPORARY SINGING EDUCATION: AN EXPLORATORY STUDY FELIX DE JONG - HUGO LYCKE (BAHAMAS)
LISBONA HALL
CHILD LANGUAGE FREE PAPERS 3 CHAIRS: Sharynne McLeod (Australia) Tiziana Rossetto (Italy) 11.00-11.15 FP10 - DEVELOPING A CLINICAL MEASURE FOR PHONOLOGICAL DEVELOPMENT: RELIABILITY OF THE PHONOLOGICAL MEAN LENGTH OF UTTERANCE MIEKE BEERS - MARIANNE RODENBURG-VAN WEE - ELLEN GERRITS (NETHERLANDS) 11.15-11.30 FP11 - ANALYSIS OF ATYPICAL ACQUISITION SYSTEMS THROUGH THE MODELO PADRO DE AQUISIO DE CONTRASTES: CASE REPORT VANESSA GIACCHINI - HELENA BOLLI MOTA (BRAZIL) 11.30-11.45 FP12 - THE AUDIOPHONIATRIC ASSESSMENT IN THE DIAGNOSTIC EVALUATIO OF THE CHILD OF 24-30 MONTHS WITH DELAY/LANGUAGE DISORDER ARCADIO VACALEBRE - ATTILIO COVINO - ANGELO CORTILE - RAFFAELE IZZO (ITALY)
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11.00-11.45
ATENE HALL
AAC FREE PAPERS 1 CHAIRS: Gonda Pickl (Austria) Elena Favero ( Italy) 11.00-11.15 FP13 - COMMUNICATION INTERVENTION FOR CHILDREN AND ADULTS WITH COMPLEX COMMUNICATION NEEDS: PARENTS AND RESEARCHERS PRIORITIES JULIET GOLDBART (UK) 11.15-.11.30 FP14 - HELPING PARENTS WITH INTELLECTUAL IMPAIRMENTS TO UNDERSTAND: COMMUNICATION FACILITATION IN PARENTING MEETINGS ALISON MATTHEWS - JOIS STANSFIELD (UK) 11.30-11.45 FP15 - OUTCOME MEASURES APPROPRIATE FOR AUGMENTATIVE AND ALTERNATIVE COMMUNICATION SERVICES PAMELA ENDERBY (UK)
DUBLINO HALL
DYSPHAGIA FREE PAPERS 1 CHAIRS: FULVIO Vico (ITALY) Kenneth Watkin,(Canada) 11.00-11.15 FP16 - DYSPHAGIA ASSESMENT IN HOSPITALIZED PATIENTS BETWEEN SEPTEMBER 2010 AND NOVEMBER 2012 AZIA MARIA SAMMARTANO - MANUELE CENA - ANTONELLA CUSIMANO - FRANCESCA MILAN MASSIMO SPADOLA BISETTI - ROBERTO ALBERA (ITALY) 11.15-11.30 FP17 - RADIOLOGICAL IMAGING IN DYSPHAGIA ASSESSMENT: PRELIMINARY REPORT FOR A COMBINED SCINTIGRAPHY-SPET/CT APPROACH PROCEDURE VINCENZO SALLUSTIO - ANTONIO ANASTASIA - CRISTIANA RAGANO CARACCIOLO - SILVIA PEDE PIERO GIORGIO PEDE - KATIA MORCIANO - DANILO PATROCINIO (ITALY) 11.30-11.45 FP18 - MEALTIME ASSESSMENT SCALE (MAS) MARCO GILARDONE - DEBORA VALENTINI - ANTONIO SCHINDLER (ITALY)
COPENHAGHEN HALL
AUDIOLOGY FREE PAPERS 1 CHAIRS: ANTONIO Pirodda (ITALY) - Somaya Tawfik (Egypht) 11.00-11.15 FP19 - SPACE-TIME RELATIONS IN LANGUAGE EXPRESSION OF HEARING IMPAIRED STUDENTS ADINDA DUL (CROATIA) 11.15-11.30 FP20 - THE NATIONAL PUBLIC NETWORK OF HEARING AIDS LABORATORIES IN VENEZUELA RAMON HERNNDEZ- VILLORIA (VENZUELA) 11.30-11.45 FP21 - ACOUSTIC ANALYSIS OF VOWEL PRODUCTION IN HEARING IMPAIRED CHILDREN USING COCHLEAR IMPLANT NARGES JAFARY - FARIBA YADEGARI (IRAN)
11.45-13.15
AUDITORIUM
CHILD LANGUAGE COMMITTEE SYMPOSIUM 1 ITALIAN CME ACCREDITATION CHAIRS: Yvette Hyter (USA) - Ioannis Vogindroukas (Greece) SY1 - BRAIN, COGNITION, AND LANGUAGE CONNECTIONS HYTER YVETTE - CAROL WESTBY - VOGINDROUKAS IAONNIS - OSNAT SEGAL - YVETTE HUS - KAKIA PETINOU

AUDIOLOGY COMMITTEE SYMPOSIUM SY2 CHAIRS: Katrin Neumann, (Germany) - ETTORE Cassandro (ITALY) INTELLECTUAL DISABILITIES AND HEARING LOSS GILBERT R. HERER (GERMANY)
LONDRA HALL
FINDINGS OF STUDIES ON COMMUNICATION DISORDERS IN PERSONS WITH INTELLECTUAL DISABILITIES KATRIN NEUMANN - DENISE ROSENBERGER - JAN-PETER THOMAS (GERMANY)
11.45-12.30
MADRID HALL
VOICE SHORT SEMINAR 1 CHAIRS: FABRIZIO Colombani (ITALY) - EKATERINA Osipenko (RUSSIA) SS1 - NEW PROCEDURES IN PHONOSURGERY ANDREA RICCI-MACCARINI - ANGELO GHIDINI - FLAVIO PIERI - ALFONSO BORRAGAN - GIOVANNI DE ROSSI MASSIMO MAGNANI (TALY)
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11.45-12.30
LISBONA HALL
CHILD LANGUAGE FREE PAPERS 4 CHAIRS: RAFFAELLA Citro (ITALY) Yvette Hyter (USA) 11.45-12.00 FP22 - TRAINING OF COMMUNITY HEALTH AGENTS TO USE RISK INDICATORS FOR SYMPTOMS IN WRITING AND SPEAKING BRUNA DIOGENES - REGINA MARIA FREIRE (BRAZIL) 12.00-12.15 FP23 - GLOBAL PATIENT CARE IN LEARNING DISORDERS: AN INTEGRATED AND ENVIRONMENTAL INTERVENTION METHODOLOGY ELEONORA PASQUA - MANUELA CALANCA - MARTINA MASSINI - EMILIANO RIDOLFI (ITALY) 12.15-12.30 FP24 - PLAYING AS A HEALTH PROMOTION STRATEGY IN PRIMARY CARE JANAINA VENEZIAN - REGINA MARIA FREIRE (BRAZIL)
ATENE HALL
AAC FREE PAPERS 2 CHAIRS: Martine Smith (Ireland) Rossella Mu (Italy) 11.45-12.00 FP25 - AN ILLUSTRATION OF GRAPHIC SYMBOL PRACTICES OF SPEECH AND LANGUAGE THERAPISTS AND TEACHERS ELIADA PAMPOULOU SALOWM - PANAYIOTIS ANGELIDES (CYPRUS) 12.00-12.15 FP26 - CRITERIA FOR DESIGNING ARABIC ASSISTIVE AUGMENTATIVE COMMUNICATION SOFTWARE FOR DYSPHASIA PATIENTS AMAL DARWISH (EGYPT)
DUBLINO HALL
DYSPHAGIA SHORT SEMINAR 1 CHAIRS: RAFFAELE Vittiello (ITALY) - TAKAHIRO Ono (JAPAN) SS2 - IMPACT OF TRAINING ON PERFORMANCE AND DOCUMENTATION OF ORAL CARE IN ACUTE CARE HOSPITAL NANCY SWIGERT (USA)

VOICE FREE PAPERS 2 CHAIRS: SALVATORE Ragusa (ITALY) - VICTOR Acosta (SPAIN) 11.45-12.00 FP27 - HOW DOES A SINGER COPE WITH VOICE PROBLEM? GISELE OLIVEIRA - CAMILA PASSOS - MARA BEHLAU (BRAZIL)
COPENHAGHEN HALL
12.00 -12.15 FP28 - VALIDATION OF THE ITALIAN VERSION OF THE SINGING VOICE HANDICAP INDEX Baracca Giovanna - Cantarella Giovanna - Forti Stella - Fussi Franco (italy) 12.15-12.30 FP29 - EFFECTS OF VOICE THERAPY ON VOICE HANDICAP OF POPULAR SINGERS GISELE OLIVEIRA - FERNANDA FERREIRA DA SILVA - FELIPE MORETI - MARA BEHLAU (BRAZIL)
12.30-13.15
MADRID HALL
VOICE SHORT SEMINAR 2 CHAIRS: LIBERO AGOSTINO TURINO (Italy) - Eiji Yumoto (Giappone) SS3 - EVALUATION OF PROFESSIONAL VOICE FUNCTION USING NEWLY DEVELOPED TWO TYPES OF VOICE-MAPS HARUHITO SAIDA - MASAKO SAIDA - HAJIME HIROSE (JAPAN)

EDUCATION FOR PHONIATRICS COMMITTEE REPORT CHAIRS: VIRGINIE WOISARD (FRANCE) , BOZENA WOSNIKA, PER-KE LINDESTAD
LISBONA HALL
ATENE HALL
AAC SHORT SEMINAR 1 CHAIRS: Permelia McCain (USA) Elena Favero (Italy) SS4 - AN INTEGRATED VOCABULARY INTERVENTION APPROACH FOR CHILDREN WHO USE AIDED COMMUNICATION MARTINE SMITH - SINEAD CARR - JENNIFER OBRIEN (IRELAND)

DYSPHAGIA SHORT SEMINAR 2 CHAIRS: ANDREA Cavalot (Italy) ENRICO PAGANELLI (Italy) SS5 - LINGUAL FRENULUM PROTOCOLS WITH SCORES IRENE MARCHESAN (BRAZIL)
14
DUBLINO HALL
12.30-13.15
COPENHAGHEN HALL
VOICE FREE PAPERS 3 CHAIRS: PAOLO Pisani (ITALY) - Felix de Jong (Netherland) 12.30-12.45 FP30 - DO TEACHERS CHANGE COPING STRATEGIES TO DEAL WITH DYSPHONIA AFTER VOICE THERAPY? GISELE OLIVEIRA - RENATA BINDI - FABIANA ZAMBON - MARA BEHLAU (BRAZIL) 12.45-13.00 FP31 - VOICE DISORDERS AND USE OF VOICE ACCORDING TO ROLE AND CONTEXT: IS THERE A RELATIONSHIP? NICOLA Angelillo - BRIGIDA Di Costanzo - MARIA ROSARIA Barillari - UMBERTO Barillari (Italy) 13.00-13.15 FP32 - THE MEANING OF BELIEFS IN LEADING VOICE-INSTRUMENT-VOICE COACHING FUTURE PRE-SCHOOL TEACHERS RAIJA PERKO (FINLAND)
13.15-14.00
BREAK
14.00-14.45
AUDITORIUM
CHILD LANGUAGE FREE PAPERS 5 ITALIAN CME ACCREDITATION CHAIRS: Ana Luiza Navas (Brazil) - Gail Gillon (New Zeland) 14.00-14.15 FP33 - PRESCHOOL CHILDRENS ENGAGEMENT IN SPEECH AND LANGUAGE THERAPY SAM HARDING - JANE COAD - HELEN HAMBLY - LYDIA MORGAN - NAOMI PARKER - NORMA DAYKINI SUE ROULSTONE (UK) 14.15-14.30 FP34 - A SYSTEMATIC REVIEW OF THE INTERVENTIONS TO IMPROVE PRESCHOOL CHILDRENS PHONOLOGICAL AWARENESS AND SPEECH OUTPUT YVONNE WREN - SAM HARDING - JULIET GOLDBART - LYDIA MORGAN - NAOMI PARKER - ELIZABETH LEWIS JULIE MARSHALL - SUE ROULSTONE (UK) 14.30-14.45 FP35 - STORY TELLING IN GREEK PRE-SCHOOLERS IOANNIS VOGINDROUKAS - EVRIPIDES CHELAS - KONSTANTINOS PAPARIZOS - ELENI KIVRAKIDOU (GREECE)
LONDRA HALL
CHILD LANGUAGE FREE PAPERS 6 CHAIRS: Carol Westby (USA) - Ana Luiza Navas (Brazil) 14.00-14.15 FP36 - THE IMPORTANCE OF SPEECH THERAPY IN A SECTOR OF EARLY STIMULATION ON A NON-PROFIT INSTITUTION IN SOUTHERN BRAZIL VANESSA GIACCHINI - ALINE TONIAL (BRAZIL) 14.15-14.30 FP37 - PROPOSAL OF SPEECH THERAPY BASED ON A MODEL OF ORGANIZATION OF LANGUAGE SYMPTOMS. A CASE STUDY CINTHIA FERREIRA GONALVES - REGINA MARIA FREIRE (BRAZIL) 14.30-14.45 FP38 - SPEECH AND LANGUAGE DIFFICULTIES IN YOUNG OFFENDER POPULATIONS: A COMPARATIVE RESEARCH STUDY IN UK AND ITALY FOR SCREENING AND INTERVENTION RAFFAELLA CITRO - HAZEL RODDAM - ANNA GIULIA DE CAGNO - TIZIANA ROSSETTO - SARAH HENEKER KAREN BENEDYK (UK, Italy)

VOICE SHORT SEMINAR 3 CHAIRS: FABRIZIO Balzarini (ITALY) - Thomas Murry (USA) SS6 - VOCAL FOLD PARALYSIS: A STRUCTURED VOICE AND SWALLOWING APPROACH GAETANO FAVA - GISELE OLIVEIRA (USA)
MADRID HALL
LISBONA HALL
VOICE FREE PAPERS 4 CHAIRS: KOICHI Tomoda (JAPAN) - PAOLO CANZI (ITALY) 14.00-14.15 FP39 - EFFECT OF IMMEDIATE RECONSTRUCTION OF THE RECURRENT LARYNGEAL NERVE ON THREE- DIMENSIONAL CONFIGURATION OF THE VOCAL FOLDS DURING PHONATION EIJI YUMOTO - NARIHIRO KODAMA - KOHEI NISHIMOTO - TETSUJI SANUKI (JAPAN) 14.15-14.30 FP40 - LONG-TERM VOCAL OUTCOMES OF NERVE-MUSCLE PEDICLE FLAP IMPLANTATION COMBINED WITH ARYTENOID ADDUCTION FOR UNILATERAL VOCAL FOLD PARALYSIS. NARIHIRO KODAMA - TETSUJI SANUKI - NENA NARAJOS - EIJI YUMOTO (JAPAN) 14.30-14.45 FP41 - IMPACT OF ARYTENOID ADDUCTION FOR UNILATERAL VOCAL FOLD PARALYSIS RYOJI TOKASHIKI - SHUN INOUE (JAPAN)
15
14.00-14.45
ATENE HALL
AAC SHORT SEMINAR 2 CHAIRS: Gonda Pickl (Austria) - Judy Montgomery (USA) SS7 - INTERACTING WITH FIRST GENERATION MIGRANT PARENTS OF CHILDREN WITH MULTIPLE DISABILITIES AND COMPLEX COMMUNICATION NEEDS CRITICAL ISSUES AND CONSIDERATIONS GONDA PICKL (AUSTRIA)
DUBLINO HALL
DYSPHAGIA FREE PAPERS 2 CHAIRS: MAURO Magnano (ITALY) - Paermelia Enderby (uk) 14.00-14.15 FP42 - CAIRO UNIVERSITY HOSPITALS DYSPHAGIA REHABILITATION PROGRAM FOR EGYPTIAN PATIENTS UNDERGOING SUPRACRICOID LARYNGECTOMIES: A STATE OF THE ART AYA SHEIKHANY - LOAUY EL SHARKAWY - AZZA ADEL - Wen-Ying YehIA ALY (EGYPT) 14.15-14.30 FP43 - PRELIMINARY DATA ON SWALLOWING AFTER SUBTOTAL LARYNGECTOMY WITH TRACHEOHYOIDOPEXY ANTONIO SCHINDLER - NICOLE PIZZORNI - MARCO FANTINI - FRANCESCO OTTAVIANI - GIUSEPPE RIZZOTTO GIOVANNI SUCCO (ITALY) 14.30-14.45 FP44 - HYPOPHARYNGEAL MUCOSAL FLAP RECONSTRUCTION IN ENDOSCOPIC SUPRAGLOTTIC LARYNGECTOMY SALVATORE COSCARELLI - GIUDITTA MANNELLI - GIAMPIERO PARRINELLO - ORESTE GALLO (ITALY)
COPENHAGHEN HALL
AUDIOLOGY SHORT SEMINAR 1 CHAIRS: ANTONIO Cesarani (ITALY) ANU Sharma (USA) SS8 - OUTCOME OF AUDITORY TRAINING PROGRAMS IN EGYPTIAN CHILDREN WITH CENTRAL AUDITORY PROCESSING DISORDERS SOMAIA TAWFIK - WAFAA ELKHOLY - AMANI SHALABY - MERHAN THABET - DALIA HASSEN (EGYPTH)
14.45-16.15
AUDITORIUM
SPECIAL EVENT ITALIAN CME ACCREDITATION CHAIRS: Tadeus Nawka (Germany) - Andrea Ricci Maccarini (Italy) SP1 - Challenges in occUpational Voice disorders: legal aspects Speakers: Thomas Murry - Massimo Magnani - Andrea Ricci Maccarini - Tadeus Nawka
ORIETTA CALCINONI - VIVEKA LYBERG-HLANDER - IRMA ILOMKI - BERNHARD RICHTER
MADRID HALL
AAC COMMITTEE SYMPOSIUM CHAIRS: Judy Montgomery (USA) - Elisabetta Genovese (Italy) SY3 - AUGMENTATIVE AND ALTERNATIV COMMUNICATION AVCROSS THE LIFE SPAN JUDY MONTGOMERY - PERMELIA MCCAIN - GONDA PICKL - JAYNATI RAY - MARTINE SMITH (IRELAND)
14.45-15.30
LONDRA HALL
CHILD LANGUAGE SHORT SEMINAR 1 CHAIRS: Irene Walsh (Irlanda) - Tiziana Rossetto (Italy) SS9 - CHILD WORD FINDING: DIFFERENTIAL DIAGNOSIS OF SEMANTIC AND PHONOLOGICAL WORD FINDING ERROR PATTERNS DIANE J. GERMAN (USA)
LISBONA HALL
VOICE FREE PAPERS 5 CHAIRS: Yohko Wakabe (Japan) - Philippe Paquier (BELGIUM) 14.45-15.00 FP45 - THE EFFECTIVENESS OF INTERVENTION BY SPEECH THERAPY IN VOCAL FOLD PARALYSIS: OBJECTIVE ASSESSMENT PEDRO MELO PESTANA - SUSANA VAZ FREITAS - CECLIA ALMEIDA E SOUSA (PORTUGAL) 15.00-15.15 FP46 - UNILATERAL VOCAL CORD PARALYSIS: E FFICIENCY OF VOICE THERAPY NICOLA Angelillo - BRIGIDA Di Costanzo - MARIA ROSARIA Barillari - UMBERTO Barillari (Italy) 15.15-15.30 FP47 - LARYNGEAL ELECTRICAL STIMULATION FOR VOCAL FOLD PARALYSIS MOHAMAD SADEGH SEIFPANAHI - TAHMINEH SALMALIAN (IRAN)
16
14.45-15.30
ATENE HALL
CHILD LANGUAGE FREE PAPERS 7 CHAIRS: Monica Panella (Italy) - Osnat Segal (Israel) 14.45-15.00 FP48 - EFFECT OF HEAVY METAL POISONING ON THE DEVELOPMENT OF LANGUAGE IN SOHAG GOVERNORATE CHILDREN AHLAM EL-ADAWY - MAHA HILAL - KHALED ABO-ELHAGAG - SOHIER SOLIMAN (EGYPTH) 15.00-15.15 FP49 - READING AND WRITING ABILITIES IN CHILDREN WITH PHENYLKETONURIA DIONSIA APARECIDA CUSIN LAMNICA - MARIANA GERMANO GEJO FERNANDA DA LUZ ANASTCIO-PESSAN (BRAZIL) 15.15-15.30 FP50 - LANGUAGE DEVELOPMENT OF 3-7 YEAR OLD CHILDREN BORN FOLLOWING ASSISTED OVOCYTE ACTIVATION (AOA) EVELIEN DHAESELEER - FRAUKE VANDEN MEERSCHAUT - HANNELORE GYSELS - YLENIA THIENPONT GRIET DE WITTE - BJRN HEINDRYCKX - AN OOSTRA - HERBERT ROEYERS - PETRA DE SUTTER KRISTIANE VAN LIERDE (BELGIUM)
DUBLINO HALL
DYSPHAGIA FREE PAPERS 3 CHAIRS: TONI Pazzaia (ITALY) - GUGLIELMO DAGNA (ITALY) 14.45-15.00 FP51 - PEDIATRIC OBSTRUCTIVE SLEEP APNEA AND ORAL FUNCTIONS ELENA PIUMETTO - IRENE VERNERO - PAMELA GIORDANO - SARA CARENA - GUENDALINA PROCOPIO DANIELA FILIPPINI - ROBERTO ALBERA (ITALY) 15.00-15.15 FP52 - OROPHARYNGEAL DYSPHAGIA IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME FRANCESCO MOZZANICA - ANTONIO SCHINDLER - GIULIA SONZINI - DANIELA PLEBANI EMANUELE URBANI - MARIKA PECIS - NICOLA MONTANO (ITALY) 15.15-15.30 FP53 - SWALLOWING DISORDERS IN PATIENTS WITH RESPIRATORY FAILURE. THE GOOD CLINICAL PRACTICE OF SWALLOWING REHABILITATION IN HOSPITAL: FROM THE SCREENING TO DISCHARGE NICOLETTA BONISOLI - DENISE ZANINI - VALENTINA PASETTO (ITALy)
COPENHAGHEN HALL
AUDIOLOGY FREE PAPERS 2 CHAIRS: Beatrice FABIO (ITALY) - Mamede de Carvallo Renata Moda (Brazil) 14.45-15.00 FP54 - THE ROLE OF THE LANGUAGE THERAPIST WITH DEAF CHILDREN AND THE PARENTS COCHLEAR IMPLANT AND SIGN LANGUAGE MARIA CECILIA DE MOURA - PAULA SCAREL DE MEDEIROS - VERA REGINA V. TEIXEIRA (BRAZIL) 15.00-15.15 FP55 - PARENTAL VIEW OF FUNCTIONAL OUTCOME OF COCHLEAR IMPLANTED CHILDREN FRANCES NAN MAI WANG - CHE-MING WU - CHU-JUNG LIU (CHINA) 15.15-15.30 FP56 - THE ROLE OF THE LANGUAGE THERAPIST WITH DEAF CHILDREN PARENTS CHOICES MARIA CECILIA DE MOURA - ANA CAROLINA PRISCO - LUIZA BORGES BARCELLOS SANDRA REGINA LEITE DE CAMPOS (BRAZIL)
15.30-16.15
LONDRA HALL
CHILD LANGUAGE SHORT SEMINAR 2 CHAIRS: Yvette Hus (Canada) - Yumiko Tanaka Welty (Japan) SS10 - CHILD WORD FINDING: DIFFERENTIAL DIAGNOSIS OF SEMANTIC AND PHONOLOGICAL WORD FINDING ERROR PATTERNS DIANE J. GERMAN (USA)
LISBONA HALL
VOICE FREE PAPERS 6 CHAIRS: PAOLO TAVORNINA (ITALY) - Gwen van Nuffelen (Belgium) 15.30-15.45 FP57 - LARYNGEAL CANCER TREATMENT: CRITICAL REVIEW OF BRAZILIAN LITERATURE PUBLISHED OVER THE LAST TEN YEARS MONIQUE PACHECO - BRBARA GOULART 15.45-16.00 FP58 - ANALYZING VOICE ONSET TIME IN ESOPHAGEAL SPEECH LEILA GHASISIN - ZAHRA GHAYOUMI (IRAN) 16.00-16.15 FP59 - EARLY AND LATE COMPLICATIONS IN CONSERVATIVE LARYNGEAL SURGERY SALVATORE COSCARELLI - GIUDITTA MANNELLI - GUGLIELMO LAROTONDA - ROBERTO SANTORO GIUSEPPE MECCARIELLO - ORESTE GALLO (ITALY)
17
15.30-16.15
ATENE HALL
CHILD LANGUAGE FREE PAPERS 8 CHAIRS: Victor Acosta (Spain) - Dobrinka Georgieva (Bulgaria) 15.30-15.45 FP60 - REHABILITATION OF SEMANTIC AND PRAGMATIC ABILITIES IN SUBJECTS WITH HEARING LOSS PAOLA Napolitano - NICOLA Angelillo - BRIGIDA Di Costanzo - MARIA ROSARIA Barillari - UMBERTO Barillari (Italy) 15.45-16.00 FP61 - SEMANTIC AND PRAGMATIC IMPAIRMENT IN CHILDREN NICOLA Angelillo - BRIGIDA Di Costanzo - MARIA ROSARIA Barillari - UMBERTO Barillari (Italy) 16.00-16.15 FP62 - CLINICAL INTERVENTION PLANNING FOR CHILDRENS PRAGMATIC LANGUAGE DISORDERS TANYA GALLAGHER (USA)
DUBLINO HALL
DYSPHAGIA FREE PAPERS 4 CHAIRS: MAURIZIO Catalani (ITALY) - Kurt Eggers (Belgium) 15.30-15.45 FP63 - PREVALENCE AND COMPLEXITY OF MANAGEMENT OF DYSPHAGIA IN A HURBAN TERTIARY CARE HOSPITAL OF TURIN: QUALITATIVE AND QUANTITATIVE ANALYSIS Simona Raimondo (Italy) 15.45-16.00 FP64 - SWALLOWING MANAGEMENT OF PATIENTS LIVING AT HOME: THE EXPERIENCE OF SLPS SERVICE IN TURIN GIULIA GINTOLI - ROSSELLA MU - LAURA OMEGNA - STEFANIA MARIO - SILVIA ROSSO MELANIA RUFFINELLO - LOREDANA TROTTA - GISELLA GHIGO - PATRIZIA STENI (ITALY) 16.00-16.15 FP65 - THE ROLE OF THE CLINICAL NETS FOR PATIENTS WITH SWALLOWING DISORDERS: FROM HOSPITAL TO HOME CARE PATRIZIA LOPEZ (ITALY)
COPENHAGHEN HALL
AUDIOLOGY FREE PAPERS 3 CHAIRS: MASSIMO Macario (ITALY) - Corina Farfn-Reyes (Chile) 15.30-15.45 FP66 - THE PRAGMATIC PROFILE OF CHILDREN WITH UNILATERAL COCHLEAR IMPLANT. LUCIA DALATRI - SARA GIANNANTONIO - SUSANNA BULDRINI - VALERIO NEPOTI GAETANO PALUDETTI (ITALY) 15.45-16.00 FP67 - IMPACT OF AUDITORY MEMORY ON SPEECH AND LANGUAGE PRODUCTION IN COCHLEAR IMPLANTED CHILDREN BRANKA MIKIC - DANICA MIRIC - MINA MIKIC-NIKOLIC - SANJA OSTOJIC - MAJA ASANOVIC NENAD ARSOVIC (SERBIA) 16.00-16.15 FP68 - COMPARISON BETWEEN PHONOLOGICAL SKILLS OF CHILDREN WITH COCHLEAR IMPLANT AND CHILDREN WITH NORMAL HEARING SHIVA EBRAHIMIAN - SAMINE RAZEGHI - MEHRI SAFARI - SAYED BASIR HASHEMI - FIROOZ SADIGHI (IRAN)
16.45-18.15
LONDRA HALL
CHILD LANGUAGE SEMINAR 1 CHAIRS: Bozena Wiskirs-Woznica (Poland) - MARINA Tripodi (ITALY) SE1 - STRATEGIES FOR ASSESSING DEVELOPMENT OF THEORY OF MIND Carol Westby (USA)
16.45-17.30
AUDITORIUM
SWALLOWING COMMITTEE SYMPOSIUM ITALIAN CME ACCREDITATION SY4 - IALP DYSPHAGIA COMMITTEE SESSION: CURRENT TOPICS IN DYSPHAGIA DIAGNOSTICS AND MANAGEMENT CHAIRS: Kenneth Watkin (Canada) - Antonio Schindler (Italy) Recent advances in dysphagia diagnostics KENNETH WATKIN (USA) Late chemoradiation treatment-related swallow effects in head and neck cancer patients J Logemann PhD CCC-SLP, BRS-S (USA Dysphagia screening: where are we and where are we going? Antonio Schindler (ITALY) Temporal measures and observations of video-fluoroscopic study of swallowing Tamer Abou-Elsaad, MD, PhD. (Egypt) Pediatric Dysphagia in a Medical Practice Sandra L. Ettema, MD, PhD, CCC-SLP (USA)
18
16.45-17.30
MADRID HALL
UEP SHORT SEMINAR - GENDER VOCOLOGY CHAIRS: ANDREA Cavalot (ITALY) - Neuschaefer Rube Christiane (Germany) SS11 - GENDER SPECIFIC VOICE FITTING IN TRANSGENDER FELIX DE JONG - CHRISTIANE NEUSCHAEFER-RUBE (GERMANY)
LISBONA HALL
CHILD LANGUAGE FREE PAPERS 9 CHAIRS: Shulman Brian (USA) Lemmietta McNeilly (USA) 16.45-17.00 FP69 - NEUROPSYCHOLOGICAL EVALUATION OF HIGHER CORTICAL FUNCTIONS CHILDREN WITH CLEFT PALATE MARIA DE LOURDES MERIGHI TABAQUIM TABAQUIM (BRAZIL) 17.00-17.15 FP70 - THE SPEECH DEVELOPMENT OF CHILDREN AGED 4 TO 5 WITH CLEFT PALATE DOMINIQUE WESTON - ALISON PURCELL - PATRICIA MCCABE - MICHEAL MCGLYNN - MELISSA PARKIN SHARYN GRIEG (AUSTRALIA) 17.15-17.30 FP71 - IMPACT OF OBTURATION OF PALATAL FISTULAE ON THE SPEECH QUALITY IN PATIENTS WITH CLEFT PALATES VIRGINIE WOISARD (FRANCE) - EMMANUELLE NOIRRIT-ESCLASSAN - VANESSA VANDREBECK (FRANCE)
ATENE HALL
AAC SHORT SEMINAR 3 CHAIRS: Montgomery Judy (USA) - Smith Martine (Irlanda) SS12 - PRACTICAL APPLICATIONS OF AUGMENTATIVE AND ALTERNATIVE COMMUNICATION SYSTEMS IN CHILDREN BIRTH TO THREE YEARS OLD PERMELIA MCCAIN (USA)
DUBLINO HALL
VOICE FREE PAPERS 7 CHAIRS: GIOVANNI Succo (ITALY) - Ofer Amir (Israel) 16.45-17.00 FP72 - STATISTICAL ANALYSIS OF THE RELIABILITY OF ACOUSTIC AND ELECTROGLOTTOGRAPHIC PERTURBATION PARAMETERS FOR THE DETECTION OF VOCAL ROUGHNESS KIYOHITO HOSOKAWA - MAKOTO OGAWA - HIDENORI INOHARA (JAPAN) 17.00-17.15 FP73 - RELEVANCE OF GLOTTAL FLOW PARAMETERS TO THE PERCEPTION OF VOICE QUALITY GLUCIA LAS SALOMO (SWDEN) 17.15-17.30 FP74 - VOICE ASSESSMENT USING NONLINEAR DESCRIPTORS AND TRADITIONAL ACOUSTICAL ANALYSIS MARIA EUGENIA DAJER (BRAZIL)
COPENHAGHEN HALL
AUDIOLOGY FREE PAPERS 4 CHAIRS: Gilbert Herer (USA) - RICCARDO Dosdegani (ITALY) 16.45-17.00 FP75 - APPLICATION OF LOW-REDUNDANCY AND DICHOTIC TESTS IN AUDIOLOGICAL DIAGNOSIS OF SCLEROSIS MULTIPLEX Ilona Kaminska - WALDEMAR WOJNOWSKI - BOZENA WISKIRS-WOZNICA - MIECZYSLAW WENDER HANNA CZERNIEJEWSKA (POLAND) 17.00-17.15 FP76 - CENTRAL AUDITORY PROCESSING DISORDER IN CHILDREN WITH DYSORTOGRAPHIA OLGA DLOUHA (CZECH REPUBLIC) 17.15-17.30 FP77 - CENTRAL AUDITORY PROCESSING DISORDERS: REFERRAL GUIDELINES & DIAGNOSTIC CRITERIA SOMAIA TAWFIK (EGYPTH)
17.30-19.00
AUDITORIUM
VOICE COMMITTEE SYMPOSIUM ITALIAN CME ACCREDITATION CHAIRS: Rahul Shrivastav (Usa) - Umberto Barillari (Italy) SY5 - INTERDISCIPLINARY COOPERATION IN VOICE RESEARCH: INDISPENSABLE, INSPIRING AND FRUITFUL! RAHUL SHRIVASTAV - LANA SHEKIM - KATRIN NEUMANN - CLAUDIA MANFREDI - GIOVANNA CANTARELLA MIEKE MOERMAN - PHILIPPE DEJONCKERE (USA)
17.30-18.15
MADRID HALL
UEP SHORT SEMINAr: VELAR INSUFFICIENCY CHAIRS: VIRIGNIE Woisard (FRANCE) - Maurizio Accordi (Italy) SS13 - VELOPHARYNGEAL INSUFFICIENCY UTE PROESCHEL - ANDREA SCHWAB - NICOLE STUHRMANN - LUCA AUTELITANO (ITALY, GERMANY)
19
17.30-18.15
LISBONA HALL
CHILD LANGUAGE FREE PAPERS 10 CHAIRS: Hortencia Kayser (USA) Kakia Petinou (Cyprus) 17.30-17.45 FP78 - THE NASALITY SEVERITY INDEX: AN OBJECTIVE, MULTIPARAMETRIC APPROACH OF HYPERNASALITY KIM BETTENS - FLORIS WUYTS - PAUL CORTHALS - KRISTIANE VAN LIERDE (BELGIUM) 17.45-18.00 FP79 - NASOMETRY IN ITALIAN YOUNG CHILDREN: OUR EXPERIENCE WITH ITS CLINICAL APPLICATION MAURIZIO ACCORDI - FIORENZA DEROSAS - SABRINA AGNELLI (ITALY) 18.00-18.15 FP80 - NASALANCE SCORES IN THE SPEECH OF NORMAL PERSIAN-SPEAKING CHILDREN 3/6-6/6 YEARS OLD IN TEHRAN HEDIEH HASHEMI - NAHID JALILE VAND - ALI GHORBANI - MOHAMMAD KAMALI (IRAN)
ATENE HALL
AAC SHORT SEMINAR 4 chairs: PARMELIA Mc CAIn (USA) - Gonda Pickl (Austria) SS14 - ASSISTED COMPUTER SOFTWARE IN PEDIATRIC CLINIC COMMUNICATION DISORDERS HABILITATION AMAL SALAHELDIN DARWISH (EGYPH)
DUBLINO HALL
DYSPHAGIA FREE PAPERS 5 chairs: ETTORE Passet (ITALY) - Simon Horton (UK) 17.30-17.45 FP81 - FROM WORDS TO ACTIONS: THE IMPORTANCE OF INTER-DISCIPLINARY TRAINING FOR LEARNING THE CORRECT EVALUATION AND TREATMENT OF DYSPHAGIA ROBERTO ANTENUCCI - ROSSELLA RAGGI - BARBARA OLIZZI - MICHELA BENVENUTI - GIULIA GIOVANARDI GIULIA BELLINI - CECILIA CARDINALI (ITALY) 17.45-18.00 FP82 - EFFICACY OF DYSPHAGIA SCREENING IN PREDICTING AB-INGESTIS PNEUMONIA IN POSTSTROKE PATIENTS ELENA GARAVAGLIA - FRANCESCO MOZZANICA - LETIZIA SCARPONI - PATRIZIA FRANZA - PAOLA GAMBARO ANTONIO SCHINDLER (ITALY) 18.00-18.15 FP83 - TELE-REHABILITATION FOR DYSPHAGIC PATIENTS: A PRELIMINARY STUDY VINCENZO SALLUSTIO - AGNESE CONTINI - SILVIA PEDE - ALESSANDRO DE STEFANO - DANILO PATROCINIO (ITALY)
COPENHAGHEN HALL
AUDIOLOGY FREE PAPERS 5 chairs: Roberto Albera (Italy) - Xingkuan Bu (China) 17.30-17.45 FP84 - TEST OF AUDITORY SUSTAINED ATTENTION IN DIFFERENT AGE GROUPS MARIA RENATA JOS - MARIA FERNANDA CAPOANI GARCIA MONDELLI - MARIZA RIBEIRO FENIMAN (BRAZIL) 17.45-18.00 FP85 - BINAURAL INTELLIGIBILITY LEVEL DIFFERENCES FOR MANDARIN TONE RECOGNITION IN SPEECH-SPECTRUM NOISE CHENG-YU HO (CHINA) 18.00-18.15 FP86 - AUDITORY CORTICAL EVOKED POTENTIALS WITH COMPETING NOISE IN CHILDREN WITH AUDITORY FIGURE GROUND DEFICIT MOHAMMAD HASSAAN (EGYPTH)
18.15-19.00
LONDRA HALL
CHILD LANGUAGE SHORT SEMINAR 3 chairs: Yiannis Vogindroukas (Greece) Masae Shiroma (Japan) SS15 - PROCESSING OF TEMPORAL SPEECH CUES IN CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT AND DYSLEXIC CHILDREN WITH FAMILIAL RISK AT PRE-SCHOOL AGE PAAVO H.T. LEPPNEN - LEENA ERVAST - ANNA KAREN - KAISA LOHVANSUU - JARMO A. HMLINEN HEIKKI LYYTINEN (Finland)
20
18.15-19.00
MADRID HALL
CHILD LANGUAGE FREE PAPERS 11 chairs: Sharynne McLeod (Australia) Chin-Hsing Tseng (Taiwan) 18.15-18.30 FP87 - PHONOLOGICAL PROCESSING IN INDIVIDUALS WITH ATTENTION DEFICIT DISORDER AND HYPERACTIVITY LUCIANA MENDONA ALVES - CLAUDIA MACHADO SIQUEIRA - HELMA SOUZA - VANESSA SOUZA DEBORA LODI - JULIANA AGUIAR - JULIANA FLORES - LETCIA CELESTE - MARIA DO CARMO FERREIRA (BRAZIL) 18.30-18.45 FP88 - THE EFFCTIVENESS OF A MULTI SENSORY THERAPEUTIC PROGRAM IN ENHANCING LANGUAGE SKILLS FOR CHILDREN WITH ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD) TAHANY EL.SAYED AHMAD (KUWAIT) 18.45-19.00 FP89 - COMPLEXITIES AND CAPABILITIES: EXPLORATION OF COMMUNICATION PROFILE OF CHILDREN WITH A PRIMARY DIAGNOSIS OF ATTENTION DEFICIT (HIPERACTIVITY) DISORDER IRENE WALSH - LOUISE GAFFNEY - DEIRDRE MAC EVILLY - SARAH BURNS - MARY SCULLION - GERALDINE BROSNAN (IRELAND)

UEP GENERAL ASSEMBLY
LISBONA HALL

AAC SHORT SEMINAR 5 chairs: Rossella Mu (Italy) Elena Favero (Italy) SS16 - BENCHMARKING IN AAC SERVICES PAMELA ENDERBY (UK)
ATENE HALL
DUBLINO HALL
DYSPHAGIA FREE PAPERS 6 chairs: VITTORIO Ferrero (ITALY) - Thomaz Woznick (Poland) 18.15-18.30 FP90 - ENDOSCOPIC AND ELECTROPHISIOLOGICAL EVALUATION OF NEUROLOGICAL DYSPHAGIA: CLINICAL FEATURE AND INSTRUMENTAL CORRELATION. FEDERICA MURA - GIULIA BERTINO - MAURO FRESIA - ENRICO ALFONSI - MARCO BENAZZO (ITALY) 18.30-18.45 FP91 - PROGNOSIS OF NEUROGENIC DYSPHAGIA BY CONVENTIONAL SWALLOWING THERAPY VERSUS NMES (NEURO MUSCULAR ELECTRICAL STIMULATION) COUPLED WITH CONVENTIONAL SWALLOWING TRAINING IN SUB ACUTE HOSPITAL AT QATAR DRAMAL AHMAD - AZHAR OMAR (QUATAR) 18.45-19.00 FP92 - THE EFFECTIVENESS OF COMPENSATORY POSTURES IN THE MANAGEMENT OF DYSPHAGIA CAUSED BY PHARINGEAL AND PHARYNGO-LARINGEAL UNILATERAL PARALYSIS: SEARCH FOR CLINICAL EVIDENCE ROSALBA DI ROSA (ITALY)
COPENHAGHEN HALL
AUDIOLOGY FREE PAPERS 6 chairs: ANTONInO Pira (ITALY) - Kajsa-Mia Holgers (Sweden) 18.15-18.30 FP93 - PAEDIATRIC AURAL REHABILITATION SERVICES: A SURVEY OF AUDIOLOGISTS IN SOUTH AFRICA KARA HOFFMAN - LAVANITHUM JOSEPH (SOUTH Africa) 18.30-18.45 FP94 - ADVANTAGES OF MULTIDISCIPLINARY APPROACH IN CHILDREN WITH COMPLEX SYNDROME SARA GHISELLI - SILVIA MONTINO - ENZO EMANUELLI - PATRIZIA TREVISI - ALESSANDRO MARTINI (ITALY) 18.45-19.00 FP95 - CHILDREN WITH SEVERE/PROFOUND HEARING LOSS ACHIEVE AGE-APPROPRIATE SPEECH/ LANGUAGE BY 3 YEARS-OF-AGE: CONTRIBUTION OF E3BP MANAGEMENT. ANNE NIVELLES FULCHER - ALISON PURCELL - ELISE BAKER - NATALIE MUNRO (Australia)
21
Tuesday 27th August 2013

MAIN REPORT
08.30-10.30
AUDITORIUM
ITALIAN CME ACCREDITATION MR2 - CognitiVe ReserVe: Implications For Assessment and InterVention CHAIRS: Philippe Paquier (BELGIUM) - Bruce Murdoch (Australia) Main Presenter: Yaakov Stern (United States) Discussants: Claire Penn (South Africa) - Sue Franklin (Ireland)
11.00-11.45
AUDITORIUM
CHILD LANGUAGE FREE PAPERS 12 ITALIAN CME ACCREDITATION CHAIRS: Donatella Croatto (Italy) Sharynne McLeod (Australia) 11.00-11.15 FP96 - PROMOTING LEARNING STRATEGIES ACCORDING TO THE COGNITIVE STYLE OF YOUNG PEOPLE AFFECTED BY LEARNING DISORDERS: THE AFTERSCHOOL EXPERIENCE MANUELA CALANCA - MARTINA MASSINI - ELEONORA PASQUA - CHRISTIAN VERONESI (ITALY) 11.15-11.30 FP97 - OPTIMISING TEACHER-LEARNER INTERACTIONS: A CRITICAL PROMOTIVE SLP INTERVENTION HARSHA KATHARD - MERSHEN PILLAY (SOUTH AFRICA) 11.30-11.45 FP98 - A NEW SOFTWARE INTEGRATED INTELLIGENT LEARNING ENVIRONMENT FOR READING AND WRITING (ILEARNRW) IN DYSLEXIA: THEORETICAL PRINCIPLES AND MAIN OBJECTIVES ELENI MITROPOULOU - VICTORIA ZAKOOULOU - ANTONIOS SYMVONIS (GREECE)
LONDRA HALL
VOICE SHORT SEMINAR 4 CHAIRS: Pecorari Giancarlo (Italy) MARIA ENRICA AMASIO (ITALY) SS17 - BEHAVIOR ASSESSMENT BATTERY: MULTI-MODAL ASSESSMENT OF THE AFFECTIVE, BEHAVIORAL AND COGNITIVE DIMENSIONS SURROUNDING SPASMODIC DYSPHONIA IN ADULTS MARTINE VANRYCKEGHEM - BARI HOFFMAN RUDDY - GENE BRUTTEN - JEFFREY LEHMAN (USA)
MADRID HALL
FLUENCY FREE PAPERS 1 CHAIRS: Kurt Eggers (Belgium) Steen Fibiger (Denmark) 11.00-11.15 FP99 - ACOUSTIC ANALYSES OF DIADOCHOKINESIS IN FLUENT AND STUTTERING CHILDREN CLAUDIA ANDRADE - FERNANDA SASSI - FABIOLA JUSTE - SILMARA RONDON - ANA PAULA RITTO CLAUDA COLALTO (BRAZIL) 11.15-11.30 FP100 - STUTTERING MEASUREMENT: THE UTILITY AND APPLICABILTY OF THE APM MEASURING PHONATION OUTPUT IN ADULTS WHO STUTTER, BEFORE AND AFTER TREATMENT LAUREN MENDES (AUSTRALIA) 11.30-11.45 FP101 - ITALIAN PUBLIC OPINION ON STUTTERING: THE POSHA-S AS AN INVESTIGATIVE TOOL EMILIA CAPPARELLI - FRANCESCA DEL GADO - DONATELLA TOMAIUOLI - PAOLA FALCONE KENNETH O. ST.LOUIS (USA)

MULTILINGUAL AFFAIRS SHORT SEMINAR 1 CHAIR: Rossetto Tiziana (Italy) SS18 - MULTILINGUALISM, A HIDDEN REALITY MIRJAM BLUMENTHAL (NETHERLANDS)
LISBONA HALL
ATENE HALL
VOICE FREE PAPERS 8 CHAIRS: GUIDO Bongioannini (ITALY) - Ma ESTELLA (CHINA) 11.00-11.15 FP102 - STROBOSCOPY STILL A POWERFUL INSTRUMENT FOR VOCAL DISABILITY IN 21ST CENTURY KOICHIRO SAITO - HARUNA YABE - KOSUKE UNO (JAPAN) 11.15-11.30 FP103 - CHEAP AND PORTABLE HIGH DEFINITION VIDEOENDOSCOPY, HOW TO DO IT? AHMED GENEID (FINLAND) 11.30-11.45 FP104 - VIDEOSTROBOKYMOGRAPHY OF THE VOCAL FOLD IN CASES OF REINKE EDEMA PAULINA KRASNODEBSKA - AGATA SZKIE KOWSKA - BEATA MIAKIEWICZ - HENRYK SKAR (POLAND)
22
11.00-11.45
DUBLINO HALL
DYSPHAGIA FREE PAPERS 7 CHAIRS: BEATRICE Travalca Cupilllo (ITALY) - Sandra Ettema (USA) 11.00-11.15 FP105 - PROPOSAL FOR AN INTEGRATED APPROACH IN ADULT NEUROLOGICAL DYSPHAGIC PATIENTS WITH INJURIES OF THE POSTERIOR CRANIAL FOSSA LISA POLI, MANUELE TAVELLA (ITALY) 11.15-11-30 FP106 - COORDINATION OF SWALLOWING AND BREATHING IN PATIENT WITH AMYOTROPHIC LATERAL SCLEROSIS FEDERICA BIANCHI - ANTONIO SCHINDLER - ELISABETTA ROMA - CHRISTIAN LUNETTA - NADIA CELLOTTO DANIELA GINOCCHIO (ITALY) 11-30-11.45 FP107 - IMPACT ASSESSMENT OF A TRAINING COURSE ON TRACHEOSTOMY AND DECANNULATION IN HOSPITAL MICHELA BENVENUTI - GIAMPIERO FERRARI - ROSSANA DALOGNA - DOMENICO CUDA (ITALY)
COPENHAGHEN HALL
AUDIOLOGY FREE PAPERS 7 CHAIRS: GAETANO Paludetti Sebastian Hoth (Germany) 11.00-11.15 FP108 - LEBERS HEREDITARY OPTIC NEUROPATHY WITH HEARING AND NEUROPSYCHOLOGIC IMPAIRMENT AND FAMILIAR ACCUMULATION MULTIPLE CASE REPORT JAKUB DRATA - ANNA HANUOV - A JIRSKOV (CZECH REPUBLIC) 11.15-11.30 FP109 - EVALUATION OF CLEAR SPEECH PERCEPTION IN PATIENTS WITH AUDITORY NEUROPATHY SALWA MOURAD - SOMAIA TAWFEEK - AMANI SHALABY - MOHAMED ABD-EL-GHAFFAR (EGYPTH) 11.30-11.45 FP110 - FROGS AND SNAKES: TYPICAL ACQUISITION OF CONSONANT CLUSTERS IN AUDITORY-VERBAL PRESCHOOL CHILDREN WITH SEVERE/PROFOUND HEARING LOSS ANNE NIVELLES FULCHER - ELISE BAKER - ALISON PURCELL - NATALIE MUNRO (AUSTRALIA)

SPECIAL EVENT
11.45-13.15
SP2 - WHO WORLD REPORT IN DISABILITY IMPLEMENTING SOLUTIONS CHAIRS: Mara Behlau (Brazil) - Oskar Schindler (Italy)
AUDITORIUM
MARA BEHLAU (BRAZIL) - TANYA GALLAGHER (USA) - ALANA MARGARET (SWITZERLAND) - PATRICIA PRELOCK (USA) - CHRISTINE STONE (AUSTRALIA) - OSKAR SCHINDLER (ITALY) - Tadeus NAWKA (GERMANY)

RoUnd Table GISD ROLE OF THE SPEECH THERAPIST IN AMYOTROPHIC LATERAL SCLEROSIS CHAIRS: Giovanni Ruoppolo (Italy) Kenneth Watkin (Canada) Disorders of verbal communication in ALS Elisabetta Losi - Federica Frigeri Swallowing disorders in ALS Bruno Fattori- Andrea Nacci
LONDRA HALL
Role and significance of speech therapy rehabilitation in ALS dysphagia (Antonio Amitrano-Giulia Mazio) Functional surgery in ALS Daniele Farneti Nutrition management in ALS Augusta Palmo Telemedicine-assisted for patients with advanced ALS and their caregivers Danilo Patrocinio - Vincenzo Sallustio
MADRID HALL
FLUENCY SEMINAR 1 CHAIRS: George Fourlas (Greece) - Sharon Millard (UK) SE2 - COUNSELING/TRAINING PROFESSIONALS AND PARENTS OF CHILDREN WHO ARE DISFLUENT PATRICIA MERCAITIS (USA)
LISBONA HALL
MULTILINGUAL AFFAIRS SEMINAR 1 CHAIR: CLAUDIA De Canio (ITALY) SE3 - A SYSTEMATIC REVIEW OF THE OUTCOMES OF CHILDREN WITH HEARING LOSS WHO USE LANGUAGES OTHER THAN ENGLISH KATHRYN CROWE - SHARYNNE MCLEOD (AUSTRALIA)
23
11.45-12.30
ATENE HALL
CHILD LANGUAGE SEMINAR 2 CHAIRS: Joseph Agius (Malta) HERAMM FM Peters (THE NETHERLANDS) SE4 - THE TABLET: APPS ALL THE WAY THROUGH THERAPY THE COST EFFECTIVE WAY PERMELIA MCCAIN (USA)
DUBLINO HALL
DYSPHAGIA SHORT SEMINAR 3 CHAIRS: Andretta Pasqualina ( Italy) - TAKAHIRO Ono (JAPAN) SS19 - ORTHODONTIC TREATMENT AND AIR WAY MODIFICATIONS; IMPORTANCE OF MIOFUNCTIONAL THERAPY LUCA LEVRINI (ITALY)
COPENHAGHEN ALL
MULTILINGUAL AFFAIR SHORT SEMINAR 2 CHAIRS: Maria Kambanorou (Cyprus) - Willem van Steenbrugge (Australia) SS20 - SUPPORTING MULTILINGUAL CHILDREN WITH SPEECH SOUND DISORDERS: PEOPLE, PRACTICALITIES, AND POLICY Sarah Verdon - Sharynne Mcleod (AUSTRALIA)
12.30-13.15
DUBLINO HALL
DYSPHAGIA SHORT SEMINAR 4 CHAIRS: Stefano Carossa (Italy) - FRANCESCO PIGA (ITALY) SS21 - A TUTORIAL ON ARIWAY PROTECTION DEFICITS FOR THE DYSPHAGIA SPECIALIST KAREN HEGLAND - MICHELLE TROCHE (USA)
COPENHAGHEN HALL
AUDIOLOGY SHORT SEMINAR 2 CHAIRS: ALESSANDRO Martini ( Italy) Anu Sharma (USA) SS22 - OBJECTIVE HEARING ASSESSMENT IN EARLY CHILDHOOD: ADVANCES AND RECENT CONVENTIONS SEBASTIAN HOTH (GERMANY)
13.15-14.00
BREAK
14.00-14.45
AUDITORIUM
CHILD LANGUAGE FREE PAPERS 13 ITALIAN CME ACCREDITATION CHAIRS: Elisabetta Genovese (Italy) - Barbara Dodd (Australia) 14.00-14.15 FP111 - BRAZILIAN PARENTS PERCEPTION ABOUT COMMUNICATION DISORDERS IN CHILDHOOD GABRIELA WOLFF - BRBARA GOULART (BRAZIL) 14.15-14.30 FP112 - PARENTS PERCEPTION ABOUT COMMUNICATION DISORDERS IN CHILDHOOD GABRIELA STABEL WOLFF - CARLOS PODALIRIO BORGES DE ALMEIDA BRBARA NIEGIA GARCIA DE GOULART (BRAZIL) 14.30-14.45 FP113 - PARENTAL PERSPECTIVES ON A BRIEF PARENT-CHILD SHARED-READING PROGRAM FOR TYPICALLY DEVELOPING CULTURALLY AND LINGUISTICALLY DIVERSE PRESCHOOLERS KARLA WASHINGTON - DILLON DAVIS - RACHEL GREENE (USA)
LONDRA HALL
VOICE SHORT SEMINAR 5 CHAIRS: GIOVANNI Cavallo (ITALY) - VIRGINIE Woisard (FRANCE) SS23 - PRE AND POST SURGERY PHONIATRIC EVALUATION IN PATIENTS TRANSGENDER MALE-TO-FEMALE CANDIDATES FOR TYPE IV THYROPLASTY (CRICOTHYROID APPROXIMATION) DIEGO COSSU (ITALY)
24
14.00-14.45
MADRID HALL
CHILD LANGUAGE FREE PAPERS 14 CHAIRS: Lindy McAllister (Australia) Hilde Chantrain (Belgium) 14.00-14.15 FP114 - EVALUATION AND COMPARISON OF SYNTACTIC SPECIFICATION IN 1.5-2.5 YEARS OLD NORMAL PERSIAN CHILDREN IN TEHRAN CITY MARYAM GHELMANI POUR - TAHERE SIMA SHIRAZI - MASOUD KARIMLU - REZA NILI POUR HOSSEIN KARIMI (IRAN) 14.15-14.30 FP115 - LANGUAGE DEVELOPMENT IN GREEK TYPICAL DEVELOPED CHILDREN IOANNIS VOGINDROUKAS - EVRIPIDES CHELAS - KONSTANTINOS PAPARIZOS - ELENI KIVRAKIDOU (GREECE) 14.30-14.45 FP116 - WHATS IN AN EARLY WORD? CHARACTERISTICS AND DEVELOPMENT OF WORD PRODUCTION IN YOUNG MALTESE CHILDREN DANIELA GATT - HELEN GRECH - BARBARA DODD (MALTA-UK)
LISBONA HALL
CHILD LANGUAGE FREE PAPERS 15 CHAIRS: Hilde Chantrain (Belgium) Gail Gillon (New Zealand) 14.00-14.15 FP117 - GRAMMATICALITY AND COMPLEXITY IN THE USE OF SENTENCES IN CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT MARIANGELA MAGGIOLO - CARMEN JULIA COLOMA - MARA MERCEDES PAVEZ - CLAUDIA ARAYA CHRISTIN PEALOZA (CHILE) 14.15-14.30 FP118 - LEXICAL LEARNING AND PHONOLOGICAL PROCESSING IN TAIWANESE YOUNG CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT PAO-HSIANG CHI (CHINA) 14.30-14.45 FP119 - LEXICAL RETRIEVAL DEFICITS IN MULTILINGUAL SPECIFIC LANGUAGE IMPAIRMENT MARIA KAMBANAROS (CYPRUS)

VOICE FREE PAPERS 9 CHAIRS: MARCO Piemonte (ITALY) - Per Ake Lindestad (Sweden) 14.00-14.15 FP120 - SELECTION OF METHODS IN VOICE THERAPY BIRTE MEIER - TINA OPPERMANN - IRIS BURG - VERENA ROGG - KATHARINA NOLTE ULLA BEUSHAUSEN (GERMANY)
ATENE HALL
14.15-14.30 FP121 - COST-EFFECTIVENESS AND VOICE ANALYSIS IN LOGOPEDIC PRACTICE: EXPERIENCE WITH PRAAT MARTA COMPAGNUCCI - ROBERTA MAZZOCCHI - SANTI CENTORRINO (ITALY) 14.30-14.45 FP122 - THE EFFECTIVENESS OF THE INTEGRATIVE VOICE THERAPIE REGARDING THE OBJECTIVES oF INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH, ICF EVEMARIE HAUPT - JULIA HLSCHEIDT (AUSTRA)
DUBLINO HALL
DYSPHAGIA FREE PAPERS 8 CHAIRS: ELISABETTA Losi (ITALY) - Antonio Schindler (ITALY) 14.00-14.15 FP123 - INCIDENCE OF DYSPHAGIA AND VOCAL CORD PALSY IN CHIARI MALFORMATION WITH OR WITHOUT SYRINGOMYELIA ANDREA CANALE - PALMA CIARAMITARO - FEDERICO DAGNA - GIULIANO FACCANI - ROBERTO ALBERA (ITALY) 14.15-14.30 FP124 - FEEDING AND FEEDING DIFFICULTIES IN TYPICALLY DEVELOPING CHILDREN AGED 18-26 MONTHS PANAGIOTIS PAPADATOS - KONSTANTINOS VANTANAS - AGGELIKI KOTSOPOULOS (GREECE) 14.30-14.45 FP125 - DYSPHAGIA AND SWALLOWING RELATED FACTORS IN ADULTS WITH ACQUIRED ANOXIC BRAIN INJURY: DATA OF 28 PATIENTS ALESSANDRA TURLETTI - DANIELA ALIBERTI - FABIA ROMANO - ERIKA CRAVERO - MARZIA BIANCHI LAURA BERGAMASCO - MARIA DILENO - MARIA AUSILIA GALOTTI - ANNA MARIA MILETTO (ITALY)
COPENHAGHEN HALL
AUDIOLOGY FREE PAPERS 8 CHAIRS: MAURIZIO Iengo (ITALY) Katrin Neumann (Germany) 14.00-14.15 FP126 - RELATIONSHIP BETWEEN QUANTITATIVE WORK AND MUSCULOSKELETAL COMPLAINTS IN OCCUPATIONAL AUDIOLOGISTS BRBARA NIEGIA GOULART - KELY KRUMMENAM (BRAZIL) 14.15-14.30 FP127 - CORRELATION OF ANGIODYNOGRAPHIC FINDINGS OF THE CAROTID AND VERTEBRAL ARTERIES AND HEARING SENSITIVITY IN MIDDLE-AGED AND OLDER ADULTS HUI-CHI TIEN - KO KUEI (CHINA)
25

SPECIAL EVENT
14.45 -16.15
AUDITORIUM
ITALIAN CME ACCREDITATION SP3 - MANAGEMENT OF SWALLOWING DISORDERS IN THE ELDERLY CHAIRS: Antonio Schindler (ITALY) - Pere Clave (SPAIN) Prevalence of dysphagia and its complication in the elderly David Smithard Pathophysiology of dysphagia in the elderly and its nutritional and respiratory complications Pere Clave The role of sarcopenia in primary and secondary presbyphagia Maurits Vandewoude How can we screen dysphagia in the elderly? Antonio Schindler Management of presbyphagia in nursing homes David Smithard New frontiers in the treatment of presbyphagia (TMS and TDCS) Enrico Alfonsi To PEG or not to PEG? Maurits Vandewoude
LONDRA HALL
FLUENCY COMMITTEE SYMPOSIUM CHAIRS: Hans-Georg Bosshardt (Germany) - Donatella Tomaiuoli (Italy) SY6 - MEASURING STUTTERING IN PRESCHOOL-AGE CHILDREN ACROSS DIFFERENT LANGUAGES: AN INTERNATIONAL ON-LINE STUDY Hans-Georg Bosshardt - Ann Packman - Jens Kretschmann - Joseph Agius Vronique Aumont-Boucand - Mehdi Bakhtiar - Luisella Cocco - Bodil Damgaard Bjarne Dammsbo - Marie-Ccile de Lajudie - Steen Fibiger - George Fourlas Clmence Mennecier - Sharon Millard - Veronika Schade (GERMANY, AUSTRIA, ITALY, MALTA)
LISBONA HALL
MULTILINGUAL AFFAIRS SEMINAR 2 CHAIRS: Brian Goldstein (USA) - Marion Fredman (Israel) SE5 - MULTILINGUAL CHILDRENS SPEECH, LANGUAGE, AND HEARING SHARYNNE MCLEOD - KATE CROWE - KARLA WASHINGTON - SARAH VERDON - CAROLINE BOWEN DAVID MCKINNON - LORAINE FORDHAM - TERESA CHING - MAUREEN SAMMS-VAUGHAN HUBERT DEVONISH (USA, AUSTRALIA, JAMAICA)
DUBLINO HALL
AAC SEMINAR 1 CHAIRS: Montgomery Judy (USA) - Gonda Pickl (Austria) SE6 - AUGMENTATIVE AND ALTERNATIVE COMMUNICATION STATE OF THE ART STATE OF THE FUTURE CAROLYN WILES HIGDON (USA)
14.45 -15.30
MADRID HALL
CHILD LANGUAGE SHORT SEMINAR 4 CHAIRS: Dolores Battle (USA) - Lilly Cheng Li-Rong (USA) SS24 - HOPE, RESILIENCE, AND COMPETENCE: IDENTITY AND MEANING-MAKING IN THE NARRATIVES OF CHILDREN WITH PRIMARY SPEECH/LANGUAGE IMPAIRMENTS RENA LYONS (IRELAND)
ATENE HALL
VOICE FREE PAPERS 10 CHAIRS: TIZIANA Fuschini (ITALY) - Eiji Yumoto (Japan) 14.45-15.00 FP128 - IDENTIFICATION OF THREE NATURAL VOICE GROUPS BY PHONETOGRAPHY - A DATA DRIVEN APPROACH Felix De Jong - Hugo Lycke - Anna Ivanova - Wivine Decoster - Marc Van Hulle (BELGIUM) 15.00-15.15 FP129 - VOICE CHARACTERISTICS IN ITALIAN PATIENTS WITH DYSPHONIA MURAT ATAC - FRANCESCO MOZZANICA - DANIELA GINOCCHIO - PATRIZIA MARUZZI - LETIZIA SCARPONI FRANCESCO OTTAVIANI - ANTONIO SCHINDLER (ITALY) 15.15-15.30 FP130 - PSYCHOLOGICAL CHARACTERISTICS OF FUNCTIONAL DYSPHONIA: DIFFERENCES BETWEEN HYPERKINETIC AND HYPOKINETIC PATIENTS CHIARA CHIALVA - NATASCIA BRONDINO - ROBERTO PAGANI - EDGARDO CAVERZASI - GIULIA BERTINO MARIA SILVIA MIGLIAZZI - CARLO ROBOTTI - MARCO BENAZZO (ITALY)
26
14.45 -15.30
COPENHAGHEN HALL
AUDIOLOGY SHORT SEMINAR 3 CHAIRS: Elisabetta Genovese (Italy ) Somaia Tawfik (Egypt) SS25 - DYNAMIC MANAGEMENT OF (CENTRAL) AUDITORY PROCESSING DISORDERS INGRID GIELOW - DIANA MELISSA FARIA (BRAZIL)
15.30 16.15
MADRID HALL
CHILD LANGUAGE SHORT SEMINAR 5 chairs: Yvette Hus (Canada) Yvette Hyter (USA) SS26 - OUTCOMES OF INTERVENTION: THE PERSPECTIVES OF PARENTS AND CHILDREN WITH SPEECH, LANGUAGE AND COMMUNICATION IMPAIRMENTS SUE ROULSTONE (UK)
ATENE HALL
VOICE FREE PAPERS 11 chairs: Franco Fussi ( Italy) Ron Baken (USA) 15.30-15.45 FP131 - ACOUSTIC VALUES OF THE HUMAN VOICE IN THE SEVEN ALBA EMOTING EMOTIONAL STATES LUIS ALEJANDRO ROMERO ROMERO - SOLANGE DURAN ELICER - CARLA EVA BADANI SCHONEWEG - KAREN OLEA ORTEGA - MARA JOSEFINA AZOCAR FUENTES - RODRIGO FERNANDO PREZ PREZ - FELIPE EDUARDO MONTERO GUARDA - ANTONIO CHANDUV RAMIREZ - ALFREDO ALARCN GMEZ - BENJAMN ORTIZ (CHILE) 15.45-16.00 FP132- IS HOARSE VOICE REALLY SEXY?: LISTENERS ATTITUDE TOWARD DYSPHONIC SPEAKERS OFER AMIR - REUT LEVINE-YUNDOF (ISRAEL) 16.00-16.15 FP133 - SPEECH RANGE PROFILE IN DIFFERENT EMOTIONS GLAUCYA MADAZIO - LUANA CURTI - MARA BEHLAU (BRAZIL)
COPENHAGHEN HALL
AUDIOLOGY SHORT SEMINAR 4 chairs: STEFANO Berretini (ITALY) - Gilbert Herer (USA) SS27 - ALL THE DAY I CAN LISTEN, TALK AND SING: A REHABILITATIVE SOURCE FOR INFANT AND TODDLER WITH HEARING LOSS CHRISTINE ROCCA - MARIA NICASTRI - ERSILIA BOSCO - GABRIELLA TRAISCI - LETIZIA GUERZONI ILARIA PATELLI (ITALY)
16.45-18.15
AUDITORIUM
MULTILINGUAL AFFAIRS COMMITTEE SYMPOSIUM - SY7 CHAIRS: Heila Jordaan (South Africa) Barbara Dodd (Australia)
Identification of language impairment in english second language learners HEILA JORDAAN (SOUTH AFRICA) Comparing multilingual to bilectal children on expressivereceptive measures MARIA KAMBANAROS (CIPRUS) Icelandic as an L2: Assessment of educational need and screening for language impairment ELIN THORDARDOTTIR (CANADA) How much does bilingual exposure affect test performance? Implications for the identification of language impairment in bilingual children ELIN THORDARDOTTIR (CANADA)

ATOS SPONSORED SYMPOSIUM INSTRUCTORS: CINDY VAN DEN BOER (SWEDEN) - SIMONE SVELTO (ITALY) - PETRA JONGMANS (SWEDEN) Chairman: Antonio Sarno (ITALY)
LONDRA HALL
MADRID HALL
FLUENCY SEMINAR 2 CHAIRS: Luisella Cocco (Italy) Ann Packman (Australia) SE7 - THE CAMPERDOWN PROGRAM FOR ADULTS WHO STUTTER: OVERVIEW AND PRACTICAL GUIDELINES SUE OBRIAN (AUSTRALIA)
27
16.45-17.30
LISBONA HALL
CHILD LANGUAGE FREE PAPERS 16 CHAIRS: Leonor Scliar Cabral (Brazil) AILEEN Patterson (UK) 16.45-17.00 FP134 - THE EQUINE ASSISTED THERAPY AS STRATEGY IN SPEECH LANGUAGE PATHOLOGY INTERVENTION PEDRO MELO PESTANA - SUSANA VAZ FREITAS (PORTUGAL) 17.00-17.15 FP135 - THE EFFECTIVENESS OF THE ADAPTED BOX CLEVER PROGRAMME ON DEVELOPING VOCABULARY AND NARRATIVE SKILLS IN YOUNG CHILDREN WITH LANGUAGE-LEARNING DIFFICULTIES IN SRI LANKA SHYAMANI HETTIARACHCHI - NICKY MORONEY - SENERATH ATTANAYAKE - LASANTHI DASKON-ATTANAYAKE JONATHAN SOLOMON - LALANI DISSANAYAKE (SRI LANKA) 17.15-17.30 FP136 - THE EFFECT OF VOCABULARY TRAINING IN PRESCHOOLERS WITH DEVELOPMENTAL LANGUAGE DISORDERS GERRITS ELLEN - FLOOR COHEN TERVAERT - NOELLE UILENBURG (NETHERLANDS)

VOICE FREE PAPERS 12 CHAIRS: CARLO Catalano (ITALY) - Diane Bless (USA) 16.45-17.00 FP137 - EFFECT OF VOCAL FUNCTION EXERCISES FOR PRESBYPHONIA SHUN INOUE - RYOUJI TOKASHIKI (JAPAN)
ATENE HALL
17.00-17.15 FP138 - EFFECT OF THE FLOW RESISTANT STRAW EXERCISE ACCORDING TO PERFORMANCE TIME MARA BEHLAU - SABRINA PAES (BRAZIL) 17.15-17.30 FP139 - IMMEDIATE EFFECTS OF THE FINNISH RESONANCE TUBE METHOD ON BEHAVIORAL DYSPHONIA MARA BEHLAU - SABRINA PAES - FABIANA ZAMBON - ROSIANE YAMASAKI - SUSANNA SIMBERG (BRAZIL, FINLAND)
DUBLINO HALL
DYSPHAGIA FREE PAPERS 9 CHAIRS: DANIELE Farneti (ITALY) - Kenneth Watkin (Canada) 16.45-17.00 FP140 - ELECTROYOMYOGRAPHY ANALYSIS OF MASSETER AND SUPRAHYOID MUSCLES IN THE ORAL PHASE OF THE SWALLOWING OF HEALTHY ADULT PEOPLE ANDREA CRISTINA ROSSI DI GIOIA - ESTHER MANDELBAUM GONALVES BIANCHINI (BRAZIL) 17.00-17.15 FP141 - COMPARISON OF TIMING ABNORMALITIES LEADING TO PENETRATION VERSUS ASPIRATION DURING THE OROPHARYNGEAL SWALLOW NOGAH NATIV - JERILYN LOGEMANN, PHD - PETER KAHRILAS, MD (USA) 17.15-17.30 FP142 - THE INFLUENCE OF TONGUE, JAW, AND LIPS POSITION ON PHARYNGEAL SWALLOW Yamori Mana (Japan)
COPENHAGHEN HALL
EDUCATION FOR Speech and LangUage Pathology SHORT SEMINAR 1 CHAIRS: RAFFAELLA Citro (ITALY) - Chin-Hsing Tseng (Taiwan) SS28 - HOW DO SPEECH PATHOLOGY & AUDIOLOGY POPULATION BASED INTERVENTIONS SERVE THE UNDERSERVED? Mershen Pillay (SOUTH AFRICA)

SIFEL GENERAL ASSEMBLY
17.30-18.15
LISBONA HALL
ATENE HALL
VOICE FREE PAPERS 13 CHAIRS: Diego Cossu (Italy) Eva B. Holmberg (Sweden) 17.30-17.45 FP143 - COMPARISON OF INTENSIVE AND STANDARD VOICE THERAPY IN THE MANAGEMENT OF VOCAL NODULES: A SIX MONTHS FOLLOW-UP SHERRY FU - DEBORAH THEODOROS - LIZ WARD (AUSTRALIA) 17.45-18.00 FP144 - IMMEDIATE EFFECTIVENESS OF HUMMING ON COMPUTED ELECTROGLOTTOGRAPHIC PRAMETERS IN DYSPHONIC PATIENTS WITH MUSCLE TENSION DYSPHONIA MAKOTO OGAWA - KIYOHITO HOSOKAWA - HIDENORI INOHARA (JAPAN) 18.00-18.15 FP145 - THE EFFECTIVENESS OF THE COMPREHENSIVE VOICE REHABILITATION PROGRAM COMPARED WITH VOCAL FUNCTION EXERCISES TO TREAT FUNCTIONAL DYSPHONIA: A RANDOMIZED BLINDED CLINICAL TRIAL VANESSA PEDROSA - ANTNIO PONTES - PAULO PONTES - MARIA STELLA PECCIN - MARA BEHLAU (BRAZIL)
28
17.30-18.15
DUBLINO HALL
MULTILINGUAL AFFAIRS FREE PAPERS 1 CHAIRS: Matti Lehtihalmes (Finland) MARY Overton (SWITZERLAND) 17.30-17.45 FP146 - SEARCH (STUDY OF ENVIRONMENT ON ABORIGINAL RESILIENCE & CHILD HEALTH): USING CULTURALLY APPROPRIATE ASSESSMENTS WITH URBAN AUSTRALIAN ABORIGINAL CHILDREN ALISON PURCELL - HASANTHA GUNESEKERA - DEBRA FERNANDO (AUSTRALIA) 17.45-18.00 FP147 - SEARCH (STUDY OF ENVIRONMENT ON ABORIGINAL RESILIENCE & CHILD HEALTH): HEARING, SPEECH AND DEVELOPMENTAL OUTCOMES ALISON PURCELL - HASANTHA GUNESEKERA - SUSAN WOOLFENDEN (AUSTRALIA) 18.00-18.15 FP148 - SPEECH THERAPY AND THE BILINGUALISM FOR THE DEAF Maria Cecilia De Moura - Vinicius Nascimento (BRAZIL)
COPENHAGHEN HALL
AUDIOLOGY SHORT SEMINAR 5 CHAIRS: GIUSEPPE Gitti (ITALY) - Renata Mota Mamede de Carvallo (Brazil) SS29 - DEVELOPMENT OF A CANTONESE LEXICAL TONE DICHOTIC LISTENING TEST. A STEP TOWARDS IDENTIFYING INDIVIDUALS WITH AUDITORY PROCESSING DISORDERS KEVIN YUEN (CHINA)

IALP GENERAL ASSEMBLY
18.15-19.00
AUDITORIUM
29
Wednesday 28th August 2013

CITY tOUR
08.30 14. 30

SPECIAL EVENT
14.30 16.00
SP4 - ACHIEVING BEST OUTCOME IN CHILDREN WITH COCHLEAR IMPLANTS ChairS: ALESSANDRO Martini (ITALY) - Helen Grech (MALTA) Issues Related to Implanting Children at Younger Ages and the Effects on Outcomes Roberta Buhagiar (UK) Optimization of objective measures and behavioral examination in speech processor fitting Sebastian Hoth (Germany) Cochlear Implants in difficult cases Alessandro Martini (Italy)
AUDITORIUM
Achieving Best Outcome in Children with Cochlear Implants: A Pediatric-Audiological and Surgical Perspective Katrin Neumann (Germany)
LONDRA HALL
AFFILIATED SOCIETY ROUND TABLE CHAIRS: Mara Behlau (Brazil) Tanya Gallagher (USA) EMERGING ISSUES IN SPEECH LANGUAGE PATHOLOGY IN YOUR COUNTRY MARA Behlau (BRAZIL) - IRENE Marchesan (BRAZIL) - CATHY Pringle (SOUTH AFRICA) - MAEVE Murphy (IRELAND) - YEH Weng-Ying (TAIWAN) - BOZENA Wiskirs-Woznica (POLAND)

FLUENCY SEMINAR 3 CHAIRS: Donatella Tomaiuoli (Italy) - Frances M. Cook (UK) SE8 - STUTTERING THERAPY: WORKING ABOVE AND BELOW THE SURFACE Michael Blomgren (Usa)
MADRID HALL
COPENHAGHEN HALL
MULTILINGUAL AFFAIRS SEMINAR 3 CHAIRS: Willem van Steenbrugge (Australia) Tara Whitehill (China) SE9 - SERVICE DELIVERY TO BILINGUAL INDIVIDUALS BY MONOLINGUAL CLINICIANS: ITS MORE THAN LANGUAGE TOMMIE ROBINSON - LEMMIETTA MCNEILLY (USA)
14.30 15.15
LISBONA HALL
APHASIA FREE PAPERS 1 CHAIRS: Claire Penn (South Africa) Anu Klippi (Finland) 14.30-14.45 FP149 - THE BOSTON NAMING TEST FOR MALTESE-SPEAKING ADULTS: ADMINISTRATION AND SCORING MODIFICATIONS Ritienne Grima (Malta) - Sue Franklin (Ireland) 14.45-15.00 FP150 - EARLY ASSESSMENT OF COMMUNICATIVE DISORDERS IN PATIENTS WITH ACUTE STROKE: RESULTS OF AN ITALIAN MULTICENTER STUDY Sandra Peccini - Ilaria Revolon - Nicola Falocci - Irene Gall - Maria Antonella Gori Grazia Signorini - Simona Raimondo - Maurizio Paciaroni (ITALY) 15.00-15.15 FP151 - VALIDATION OF THE ITALIAN AACHNER APHASIE BEDSIDE TEST (I-AABT) FOR THE ASSESSMENT OF APHASIA IN THE ACUTE PHASE Francesca Martufi - Simona Raimondo - Nicoletta Cavagna - Antonio Schindler (ITALY)
30
14.30 15.15
ATENE HALL
MOTOR SPEECH DISORDERS FREE PAPERS 1 CHAIRS: ANTONIO Amitrano (ITALY) - Angela Morgan (Australia) 14.30-14.45 FP152 - RELATION BETWEEN VOICE HANDICAP INDEX (VHI) AND DISEASE SEVERITY IN IRANIAN PATIENTS WITH PARKINSONS DISEASE Fatemeh Madjdinasab - Negin Moradi - Hedieh Hashemi - Gholamali Shahidi Siamak Karkheiran Masoud Salehi (IRAN) 14.45-15.00 FP153 - ANALYSIS OF SPEECH FLUENCY IN PARKINSONS DISEASE Natalia Casagrande - Thais Minett - Karin Ortiz (Brazil) 15.00-15.15 FP154 - PERCEPTION AND COMPREHENSION OF COMMUNICATIVE FUNCTIONS OF PROSODY IN INDIVIDUALS WITH DYSARTHRIA DUE TO PARKINSONS DISEASE Heidi Martens - Gwen Van Nuffelen - Marc De Bodt (Belgium)
DUBLINO HALL
EDUCATION FOR SPEECH AND LANGUAGE PATHOLOGY FREE PAPERS 1 CHAIRS: Dobrinka Georgieva (Bulgaria) Hortencia Kayser (USA) 14.30-14.45 FP155 - AN ACADEMIC MODEL OF COMBINING UNDERGRADUATE AND GRADUATE STUDIES PROVIDES STUDENTS A COHESIVE AND ACCELERATED CLINICAL EXPERIENCE Nicole Magaldi (United States) 14.45-15.00 FP156 - TEACHING AND OBJECTIVES OF THE UNIVERSITY DEGREE IN SPEECH THERAPY Debora Lantelme - Serena Paione - Lucia Pecoraro - Daria Protti - Oskar Schindler (Italy) 15.00-15.15 FP157 - IDENTIFYING APPROACHES AND THEMES FOR A LONGITUDINAL STUDY OF THE PROFESSIONAL DEVELOPMENT OF STUDENTS OF AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY Dorthe Hansen - Jytte Isaksen (Denmark)
15.15-16.00
LISBONA HALL
APHASIA FREE PAPERS 2 CHAIRS: Simon Horton (UK) Anastasia Raymer (USA) 15.15-15.30 FP158 - PERFORMANCE OF APHASIC PATIENTS ON A LIMB PRAXIA BATTERY Joana Mantovani-Nagaoka - Karin Ortiz (Brazil) 15.30-15.45 FP159 - VERBAL STEREOTYPE: A MALADAPTIVE RECOVERY? A PILOT STUDY Ins Rodrigues - Martin Lauterbach - Ndia Canrio - Alexandre Castro-Caldas (PORTUGAL) 15.45-16.00 FP160 - GENERATIVE NAMING IN MOROCCAN ARABIC-ENGLISH BILINGUAL SPEAKERS : REFERENTIAL DATA FOR APHASIA Bouzekri Touri (MOROCCO)
ATENE HALL
MOTOR SPEECH DISORDERS FREE PAPERS 2 CHAIRS: Ben Maassen (The Netherlands) Gwen van Nuffelen (Belgium) 15.15-15.30 FP161 - PARKINSONS DISEASE AND DEAF PEOPLE: SELF-PERCEPTIONS AND INTERPRETER PERCEPTIONS OF CHANGES IN COMMUNICATION WITH SIGN LANGUAGE Pirkko Rautakoski - Kirsti Martikainen (FINLAND) 15.30-15.45 FP162 - CLINICAL OUTCOMES OF PROVIDING LSVT LOUD VIA TELEREHABILITATION TO THE RURAL HOME Anne Hill - Deborah Theodoros - Trevor Russell (AUSTRALIA) 15.45-16.00 FP163 - FOCAL TASK SPECIFIC EMBOUCHURE DYSTONIA: EVALUATION PROTOCOL AND SPEECH THERAPY PROPOSAL. A PILOT CASE Eleonora Don - Pasqualina Andretta - Serena De Pellegrin - Anna Lazzarini (Italy)

EDUCATION FOR SPEECH AND LANGUAGE PATHOLOGY FREE PAPERS 2 CHAIRS: Thomaz Woznick (Poland) Chin-Hsing Tseng (Taiwan) 15.15-15.30 FP164 - STUDENT TRAINING IN SPEECH LANGUAGE PATHOLOGY IN SERBIA Mile Vukovic - Irena Vukovic (Serbia)
DUBLINO HALL
15.30-15.45 FP165 - IMPLEMENTING TEACHING AND RESEARCH IN SPEECH LANGUAGE PATHOLOGY: BULGARIAN EXPERIENCE Dobrinka Georgieva (Bulgaria) 15.45-16.00 FP166 - NETQUES: PAIN, PLEASURE AND POSITIVE OUTCOMES OF PAN-EUROPEAN PROJECT PARTNERSHIP, PRODUCING AND PROMOTING STANDARDS IN SPEECH AND LANGUAGE THERAPY EDUCATION Aileen Patterson - Jois Stansfield - Kristina Hansson - Martin Peleman - Baiba Trinite Zsolt Csfalvay (UK)
31
16.30 -18.00
AUDITORIUM
SIFEL MAIN REPORT - MOTOR SPEECH DISORDERS ITALIAN CME ACCREDITATION CHAIRS: Irene Vernero (Italy) Antoinette am Zehnhoff-Dinnesen (Germany) DYSARTHRIA: CAN WE DO MORE? GIOVANNI Ruoppolo - ANTONIO AMITRANO - CHIARA BONAZZI - ELISABETTA LOSI - GIULIA MAZIO DANILO PATROCINIO - FRANCESCA ROMANA PEZZELLA - AGNESE ROSSI - GIUILIA ROSSI VINCENZO SALLUSTIO - ILENIA SCHETTINO - ANTONIO SCHINDLER (Italy)
LISBONA HALL
FLUECY SEMINAR 4 CHAIRS: Henny Bijleveld (Belgium) Steen Fibiger (Denmark) SE10 - RE-SHAPING STUTTERING MODIFICATION THERAPY: WOULD DR. VAN RIPER BE AMUSED? Joseph G. Agius (Malta)
COPENHAGHEN HALL
EDUCATION FOR SPEECH AND LANGUAGE PATOLOGY committee symposiUm SY8 - EDUCATING SLPs FOR PROFESSIONAL PRACTICE IN DIFFERENT ENVIRONMENTS SESSIONS 1 AND 2 TOMASZ WOZNIAK - DOBRINKA GEOGIEVA - SEYHUN TOPBIAS - MIRELA DURANOVIC - NADJA ZEMVA MILE VUKOVIC - KATERINA VITASKOVA (BULGARIA)
16.30-17.15
LONDRA HALL
CHILD LANGUAGE SHORT SEMINAR 6 CHAIRS: Gail Gillon (New Zealand) Leonor Scliar Cabral (Brazil) SS30 - A QUALITATIVE ANALYSIS OF HINDRANCES TO PLAY AND STRATEGIES FOR UTILIZING SCRIPTS FOR SCAFFOLDING TO IMPROVE LANGAUGE SKILLS IN PRESCHOOLERS Irene Torres (Unite States) - Lidia Rodriguez (Spain)

APHASIA SHORT SEMINAR 1 CHAIRS: CARLO Caltagirone (ITALY) - Linda Worrall (Australia) SS31 - IMPROVING QUALITY OF LIFE IN APHASIA THROUGH LIFE STORY TELLING. A BIOGRAPHIC-NARRATIVE APPROACH Sabine Corsten - Jrgen Konradi - Erika Schimpf - Friedericke Hardering Annerose Keilmann (GERMANY)
MADRID HALL
ATENE HALL
DYSPHAGIA SHORT SEMINAR 5 CHAIRS: BRUNO Fattori (ITALY) - Tadeus Nawka (Germany) SS32 - SWALLOW-RESPIRATORY RELATIONSHIPS AND THE IMPACT ON DYSPHAGIA MANAGEMENT Michelle Troche - Karen Hegland (USA)

EDUCATION FOR SPEECH AND LANGUAGE PATOLOGY FREE PAPERS 3 CHAIRS: Raimondo Simona (Italy) Citro Rossella (Italy) 16.30-16.45 FP167 - SPEECH AND LANGUAGE THERAPY: USING THE PAST TO INFORM THE FUTURE Jois Stansfield - Iysha Barratt (UK)
DUBLINO HALL
16.45-17.00 FP 168 - Speech SoUnd Disorders: Interaction between Phonological and AUditory. PerceptUal Processing Tatiane Barrozzo 17.00-17.15 FP169 - CPLOL EDUCATION COMMITTEE: WORKING GROUP REPORT, DOCUMENTING FORMS OF CLINICAL PRACTICE I INITIAL EDUCATION IN EUROPE, (2009-2012) Overton Venet Mary - Thora Masdottir - Bettina Heinzelmann - Baiba Trinite Anne-Lise Rvgvold - Irene Vernero - Maria Vlassopoulos (SWITZELAND, ICELAND, LATVIA, NORWAY, ITALY, GREECE)
17.15-18.00
LONDRA HALL
CHILD LANGUAGE SHORT SEMINAR 7 CHAIRS: Osnat Segal (Israel) - Leonor Scliar Cabral (BRAZIL) SS33 - AN EXPLORATION OF BRITISH-TAMIL AND SRI LANKAN-TAMIL MOTHERS BELIEFS ON CHILD LANGUAGE DEVELOPMENT AND CHILD LANGUAGE IMPAIRMENT AND THEIR VIEWS ON SPEECH AND LANGUAGE THERAPY AND MATERNAL INT Shyamani Hettiarachchi (SRI LANKA)
32
17.15-18.00
MADRID HALL
APHASIA SHORT SEMINAR 2 CHAIRS: Luise Springer (Germany) Nada Zemva (Slovenia) SS34 - AWAKE SURGERY: THE ROLE OF SPEECH THERAPIST IN THE PROCEDURE OF CORTICAL MAPPING AND MONITORING Anna Lazzarini - Pasqualina Andretta - Serena De Pellegrin (ITALY)

DYSPHAGIA SHORT SEMINAR 6 CHAIRS: ANDREA Nacci (ITALY) - DANIELE Farneti (ITALY) SS35 - THE USE OF ACOUSTIC ANALYSIS SOFTWARES IN DYSPHAGIAS THERAPY Ingrid Gielow (BRAZIL)
ATENE HALL
DUBLINO HALL
EDUCATIONAL FOR SPEECH AND LANGUAGE PATHOLOGY FREE PAPERS 4 CHAIRS: Hilde Chantrain (Belgium) Matti Lehtihalmes (Finland) 17.15-17.30 FP170 - LITERACY IN THE BRAZILIAN UNIVERSITY: STUDENTS OF SPECIAL EDUCATION IN INCLUSIVE PERSPECTIVE Ana Paula Santana (BRAZIL) 17.30-17.45 FP171- PSYCHO-COMMUNICATION DISORDERS WITHIN MOROCCAN UNIVERSITY STUDENTS OF HARD SCIENCE MAJORS Bouzekri Touri - F.Z Ahra Soubhi - Noureddine Knouzi - Mohammed Talbi Laurent Lima (MOROCCO, FRANCE) 17.45-18.00 FP172 - HOUSEHOLD SURVEY CHALLENGES ON SELF-DECLARED COMMUNICATION DISORDERS Brbara Goulart - Brasilia Maria Chiari - Vanessa Martins-Reis (BRAZIL)
18.00-18.45
AUDITORIUM
VOICE SHORT SEMINAR 6 ITALIAN CME ACCREDITATION CHAIRS: Philippe Dejonckere (Belgium and the Netherlands) Berit Schneider (Austria) SS37 - ESTILL VOICE CRAFT (TM) - CLINICAL APPLICATION OF JO ESTILL MODEL FOR VOICE QUALITYS CONTROL Sandra Fantino (Italy)
LONDRA HALL
MOTOR SPEECH DISORDERS SHORT SEMINAR 1 CHAIRS: Lena Hartelius (Sweden) Michael Robb (New Zealand) SS38 - COMMUNICATION CHANGES IN PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS DURING TWO YEARS FOLLOW-UP Tanja Makkonen - Anna-Maija Korpijaakko-Huuhka (FINLAND)
MADRID HALL
APHASIA SHORT SEMINAR 3 CHAIRS: Plagie Beeson (Cyprus) Simon Horton (UK) SS39 - THEORETICAL-METHODOLOGICAL ASPECTS OF LINGUISTIC ACTIVITIES DEVELOPED AT CCA. A CENTER FOR APHASIC SUBJECTS IN BRAZIL Novaes-Pinto - Rosana do Carmo (BRAZIL)
LISBONA HALL
FLUENCY FREE PAPERS 2 CHAIRS: George Fourlas (Greece) Margaret Leahy (Ireland) 18.00-18.15 FP173 - DEVELOPING AN INTERNET VERSION OF THE LIDCOMBE PROGRAM OF EARLY STUTTERING INTERVENTION Sabine Van Eerdenbrugh - Ann Packman - Sue Obrian - Mark Onslow (AUSTRALIA) 18.15.-18.30 FP174 - IMMEDIATE EFFECTS OF ALTERED AUDITORY FEEDBACK ON ASSOCIATED MOTOR BEHAVIORS OF PEOPLE WHO STUTTER Kyriaki Kyriakou - Brenda Seal (USA) 18.30-18.45 FP175 - A STUDY ON THE EFFICACY OF A GROUP THERAPY COMBINING FLUENCY SHAPING THERAPY WITH STRESS INOCULATION TRAINING ON MANDARIN-SPEAKING ADULTS WITH STUTTERING Shu-Lan Yang (China)
33
18.00-18.45
ATENE HALL
VOICE FREE PAPERS 14 CHAIRS: LUCIA Dalatri (ITALY) - MASAKI Watanabe (japan) 18.00-18.15 FP176 - VOICE IN FEMALE-TO-MALE TRANSSEXUAL PERSONS AFTER LONG-TERM CROSS-SEX HORMONAL THERAPY Marjan Cosyns - David Dedecker - Fleur Van De Peer - Tine Daelman - Sofie Laenen John Van Borsel - Guy Tsjoen (BELGIUM) 18.15.-18.30 FP177 - PROPOSAL OF A NEW SELF-EVALUATION VOICE QUESTIONNAIRE FOR TRANSGENDER/ TRANSSEXUAL INDIVIDUALS Francesco Avanzini (ITALY) 18.30-18.45 FP178 - THE COMPLEX THERAPY OF TEENAGERS VOICE DISORDERS IN THE PERIOD OF MUTATION Olga Orlova - Tatyana Garashenko - Kamola Sultanova - Polina Estrova (RUSSIAN FEDERATION)
DUBLINO HALL
EDUCATION FOR SPEECH AND LANGUAGE PATOLOGY FREE PAPERS 5 CHAIRS: Sharynne McLeod (Australia) Masae Shiroma (Japan) 18.00-18.15 FP179 - FOUNDATIONS FOR INCLUSION: ANALYSIS OF STATEMENTS OF FUTURE PROFESSIONALS ABOUT BEING DEAF AND BEING BLIND THE IMPORTANCE TO LEARN Maria Cecilia De Moura - Elcie F. Salzano Masini (BRAZIL) 18.15.-18.30 FP180 - CULTURAL COMPETENCE IS IMPORTANT FOR EFFECTIVE SERVICE PROVISION. BUT HOW SYSTEMATICALLY DO WE DEVELOP SKILLS ACROSS THE UNDERGRADUATE CURRICULUM? Eliabeth Clark (AUSTRALIA)
COPENHAGHEN HALL
MULTILINGUAL AFFAIR FREE PAPERS 3 CHAIRS: Yvette Hus (Canada) - Heila Jordaan (South Africa) 18.00-18.15 FP181 - THE EARLY DEVELOPMENT OF THE LEXICON IN MONOLINGUAL AND BILINGUAL FINNISH CHILDREN Jenny Lindman (Finland) 18.15-18.30 FP182 - THE PERFORMANCE OF MALTESE BILINGUAL CHILDREN ON A MALTESE-ENGLISH NON-WORD REPETITION TASK Nadine Calleja - Helen Grech - Doris-Eva Bamiou (MALTA, UK) 18.30-18.45 FP183 - ASSESMENT OF LANGUAGE ABILITIES OF BILINGUAL CHILDREN IN LITHUANIA Vilma Makauskiene - Regina Ivoskuviene (LITHUANIA)
34
Thursday 29th August 2013

08.30 - 10.30 AUDITOURIUM
MAIN REPORT ITALIAN CME ACCREDITATION CHAIRS: Tanya Gallagher (USA) Helen Grech (MALTA) MR3 - DEVELOPMENTAL LANGUAGE DISORDERS: CHALLENGES AND IMPLICATIONS OF CROSS GROUP COMPARISON
11.00-11.45
AUDITORIUM
CHILD LANGUAGE FREE PAPERS 17 ITALIAN CME ACCREDITATION CHAIRS: Carol Westby (USA) Leonor Scliar Cabral (Brazil) 11.00-11.15 FP184 - VALIDITATION OF AN ARABIC TEST FOR EVALUATING ACQUIRED SKILLS IN COMMUNICATION Wen-Ying Yehia Amin Aboras (EGYPTH) 11.15-11.30 FP185 - STORY GENERATION IN AUTISM SPECTRUM DISORDER: A NEW LOOK WITH A NEW BOOK Wendy Arnott - Rebecca Banney - Keely Harper-Hill (AUSTRALIA) 11.30-11.45 FP186 - EVALUATING SYNTACTIC AWARENESS IN AUTISM Cristina De Andrade Varanda - Fernanda Dreux Miranda Fernandes (BRAZIL)
LONDRA HALL
VOICE FREE PAPERS 15 CHAIRS: graziano Brozzi (italY) - VALERIO DI FORTUNAO (ITALY) 11.00-11.15 FP187 - LONG TERM EFFECTS OF INFANCY LARYNGEAL RECONSTRUCTION ON HEALTH AND VOICE-RELATED QUALITY OF LIFE Ahmed Geneid - Assi Aherto - Niklas Pakkasjrvi - Risto Roine - Harri Sintonen - Harry Lindahl Anne Pitkaranta (FINLAND) 11.15-11.30 FP188 - INJECTION LARYNGOPLASTY BY THYROHYOID APPROACH USING CURVED 23G CATHELIN NEEDLE Fumimasa Toyomura - Ryoji Tokasiki - Mamoru Suzuki (JAPAN) 11.30-11.45 FP189 - QUALITY OF LIFE BEFORE AND AFTER TYPE II THYROPLASTY FOR ADDUCTOR SPASMODIC DYSPHONIA Tetsuji Sanuki - Eiji Yumoto - Narihiro Kodama (JAPAN)
MADRID HALL
VOICE FREE PAPERS 16 CHAIRS: VINCENZO Di Nicola (ITALY) - VIRGINIE Woisard (FRANCE) 11.00-11.15 FP190 - LARYNGEAL PROPRIOCEPTION AND MUCOSAL REFLEXES IN HUMAN VOCALIZATION CONTROL WITH AND WITHOUT AUDITORY FEEDBACK: APPLICATION IN VOICE THERAPY AND PEDAGOGY Elisabetta Rosa - Nico Paolo Paolillo (Italy) 11.15-11.30 FP191 - THE USE OF SOUND PRESSURE LEVEL (SPL) METER APPS IN THE CLINICAL SETTING Gaetano Fava - Gisele Oliveira (BRAZIL, USA) 11.30-11.45 FP192 - IMAGING OF THE HUMAN VOCAL FOLD WITH HIGH FREQUENCY ULTRASOUND. POTENTIAL APPLICATION IN DIAGNOSIS AND TREATMENT OF LARYNGEAL GLOTTIC LESIONS Salvatore Coscarelli - Giuditta Mannelli - Luca Leone - Giuseppe Meccariello Giovanni Babbino - Oreste Gallo (ITALY)
LISBONA HALL
APHASIA FREE PAPERS 3 CHAIRS: Claire Penn (South Africa) Anu Klippi (Finland) 11.00-11.15 FP193 - FUNCTIONAL COMMUNICATION SKILLS IN PERSONS WITH ALZHEIMERS DEMENTIA Rossella Mu - Elena Calosso - Antonio Schindler (Italy) 11.15-11.30 FP194 - BRIDGING GERIATRY AND LINGUISTICS: NARRATIVE PERSEVERATIONS IN MILD COGNITIVE IMPAIRMENT Luciana Brandi - Dimitri Becheri - Alice Canossi (Italy) 11.30-11.45 FP195 - NON-THALAMIC SUBCORTICAL APHASIA DUE TO LEFT CENTRUM SEMIOVALIS AND BASAL GANGLIA INFARCT Mozhgan Asadi - Fariba Yadegari - Leila Ghasisin (Iran)
35
11.00-11.45
ATENE HALL
FLUENCY FREE PAPERS 3 CHAIRS: De Canio C Beatriz de Touzet (ARGENTINA) 11.00-11.15 FP196 - AN EXPERIENCE ON DIRECT INVOLVEMENT OF PARENTS IN THE MULTIDIMENSIONAL THERAPY OF THE PREADOLESCENT STUTTERING PATIENT Matilde Maria Marulli - Donatella Tomaiuoli - Roberta Siddi - Maria Grazia Spinetti (Italy) 11.15-11.30 FP197 - OUTCOME OF STUTTERING THERAPY ON EGYPTIAN SCHOOL-AGED CHILDREN USING SPEAK FREELY PROGRAM LENGTH OF PRESENTATION Wen-Ying Yehia Aboras - Reham El-Maghrabi - Walaa Mohsen (Egypt) 11.30-11.45 FP198 - CHILDHOOD STUTTERING: REHABILITATION WITH THE STENDORO ROCCA METHODOLOGY Renzo Rocca - Giorgio Stendoro - Silvia Gotti - Silvana Pasetti (Italy)
DUBLINO HALL
MOTOR SPEECH DISORDERS FREE PAPERS 3 CHAIRS: DANILO Patrocinio (ITALY) - Angela Morgan (Australia) 11.00-11.15 FP199 - OUTCOME MEASURES FOR REHABILITATION OF COMMUNICATION AND SWALLOWING DISORDERS IN MULTIPLE SCLEROSIS Maria Laura Lopes De Carvalho - Antonella Cusimano - Giampaolo Brichetto (Italy) 11.15-11.30 FP200 - RELIABILITY AND VALIDITY OF A SHORT FORM QOL-DYS (QOL-DYS 20) TO MEASURE QUALITY OF LIFE IN DYSARTHRIC ITALIAN SPEAKER Serena Arima - Danilo Patrocinio - Antonio Schindler (Italy) 11.30-11.45 FP201 - ORAL DIADOCHOKINESIS IN DYSARTHIC SPEAKERS WITH AND WITHOUT LESIONS TO BASAL GANGLIA AND/OR CEREBELLUM Caroline Oliveira - Simone Barreto - Karin Ortiz (Brazil)
COPENHAGHEN HALL
EDUCATION FOR SPEECH AND LANGUAGE PATHOLOGY SHORT SEMINAR 2 CHAIRS: Tiziana Rossetto (Italy) - BEN Mondelaers (THE NETHERLANDS) SS40 - CROSS-POLLINATION OF OROFACIAL MYOLOGY BETWEEN SOUTH AND NORTH AMERICA Licia Coceani Paskay - Irene Marchesan (Brazil)
11.45-13.15
AUDITORIUM
MOTOR SPEECH DISORDERS COMMITTEE SYMPOSIUM 1 CHAIRS: Bruce Murdoch (Australia) - DANILO PATROCINIO (ITALY) SY9 - Evaluation of motor learning principles in speech and nonspeech tasks Ramesh Kaipa (New Zealand) Michael Robb (New Zealand)
Assessment and treatment of motor speech disorders using Transcranial magnetic stimulation Bruce Murdoch (Australia). Caroline Barwood (Australia) Outcome measurement and AAC services review of measures and development of a new tool Pamela Enderby (UK)
LONDRA HALL
EDUCATION FOR SPeECH AND LANGUAGE PATOLOGY COMMITTEE SYMPOSIUM 2 CHAIRS: MICHELE KaufmanN-MEYER (ITALY) - Miranda Fernandes (BRAZIL) SY10 - EDUCATING SLPS FOR PROFESSIONAL PRACTICE IN DIFFERENT ENVIRONMENTS SESSIONS 1 AND 2 Lemmieta McNeilly (USA) - Qi Guosheng (CHIAN) - Lindy McAllister (AUSTRALIA) - Kevin Yuen (CHINA) - Li Rong Cheng (USA) - Hayde F Wertzner (BRAZIL)
11.45 - 12.30
MADRID HALL
VOICE FREE PAPERS 17 CHAIRS: Eiji Yumoto (Japan) Franco Fussi (Italy) 11.45-12.00 FP202 - GENDER AND AGE IDENTIFICATION OF INDIVIDUALS WITH AND WITHOUT DYSPHONIA GISELE OLIVEIRA - GAETANO FAVA - CAMILA SAUDA SANTIEIRO - MARA BEHLAU (USA-BRAZIL) 12.00-12.15 FP203 - GENDER-SPECIFIC VOICE PERCEPTION IN THE BRAIN. FMRI-DATA IN ADULT VOLUNTEERS Christiane Neuschaefer-Rube - Jessica Junger - Katharina Pauly - Peter Birkholz Frank Schneider - Christian Kohler - Sabine Brhr - Birgit Derntl - Ute Habel (USA) 12.15-12.30 FP204-MAGNETIC RESONANCE MICROIMAGING OF THE PEDIATRIC HUMAN LARYNX Gisele Oliveira - Ian Rowland - Elizabeth Hutchinson - Yo Kishimoto - Nathan Welham (USA)
36
11.45 - 12.30
LISBONA HALL
APHASIA FREE PAPERS 4 CHAIRS: Plagie Beeson (Cyprus) Linda Worrall (Australia) 11.45-12.00 FP205 - THE ART OF SHARED DECISION MAKING: EXAMPLES FROM OUTCOME EVALUATION OF APHASIA THERAPY Jytte Isaksen (DENMARK) 12.00-12.15 FP206 - DO WE TREAT FUNCTIONALLY RELEVANT ITEMS IN APHASIA THERAPY? CURRENT CHALLENGES AND NEW TOOLS Kati Renvall - Lyndsey Nickels - Bronwyn Davidson (AUSTRALIA) 12.15-12.30 FP207 - APHASIA:FROM MEDICAL PRACTICES TO THE SPEECH AND LANGUAGE CLINICS Gisele Gouvea Da Silva - Regina Maria Freire (BRAZIL)

FLUENCY FREE PAPERS 4 CHAIRS: Luisella Cocco (Italy) Ann Packman (AUSTRALIA) 11.45-12.00 FP208 - WORD-FINAL DYSFLUENCIES: ARE THEY STUTTERING? Verity Macmillan - Artemi Kokolakis - Ann Packman (AUSTRALIA)
ATENE HALL
12.00-12.15 FP209 - RESULTS OF INTERNAL EXAMINATIONS OF STUTTERERS Eva Prikrylova - Pavel Florian - Hana Kubesova - Ilona Kejklickova (CZECH REPUBLIC) 12.15-12.30 FP210 - PROFILING SUBJECTS THAT STUTTER: THE RESULTS OF A SURVEY Donatella Tomaiuoli - Emilia Capparelli - Francesca Del Gado - Paola Falcone Emanuela Lucchini - Maria Grazia Spinetti (ITALY)
DUBLINO HALL
DYSPHAGIA SHORT SEMINAR 7 CHAIRS: MICHELE Barbara (ITALY) Elena Piumetto (Italy) SS41 - SHOULD POOR PEOPLE, WHO CANNOT EAT OR DRINK SAFELY, BE TREATED DIFFERENTLY? DYSPHAGIA SERVICES IN RESOURCE CONSTRAINED CONTEXTS Mershen Pillay - Harsha Kathard (SOUTH AFRICA)
COPENHAGHEN HALL
MULTILINGUAL AFFAIRS SHORT SEMINAR 5 CHAIRS: Elin Thoradottir (Canada) Yvette Hus (Canada) SS42 - QUALITATIVE BARRIERS TO SPECIALIZED THERAPIES FOR HISPANIC PEDIATRIC POPULATIONS WITH SPECIAL HEALTH CARE NEEDS DrKatandria Love Johnson (USA)
12.30-13.15
MADRID HALL
VOICE FREE PAPERS 18 CHAIRS: KOICHI Tomoda (JAPAN) Janet Baker (Australia) 12.30 -12.45 FP211 - ROLE OF MEDICAL TREATMENT AND VOICE THERAPY IN ADULTS LARYNGOMALICIA Amal Salaheldin Darwish (EGYPT) 12.45-13.00 FP212 - EFFECT OF HEMODIALYSIS ON VOICE: AN ACOUSTIC AND AERODYNAMIC ANALYSIS Eman Hassan - Ahlam El-Adawy - Dalia Yasseen - Effat Tony (EGYPT) 13.00-13.15 FP213 - THE POST-TRAUMATIC SUBLUXATION ARYTENOID: CASE REPORT Michele Barbara - Teresa Maino - Francesco Cariti - Vincenzo Calabrese (ITALY)

APHASIA FREE PAPERS 5 CHAIRS: Katerina Hilari (UK) Simon Horton (UK) 12.30 -12.45 FP214 - APHASIA GROUP TREATMENT: PRESENT OUTLOOK AND FUTURE PROSPECTS Chiara Finesso - Serena De Pellegrin - Cinzia Finco (Italy)
LISBONA HALL
12.45-13.00 FP215 - A COMPARISON OF MELODIC INTONATION THERAPY AND RESPONSE ELABORATION TRAINING IN TREATING PERSONS WITH NON-FLUENT APHASIA Chin-Hsing Tseng - Cher-Wei Hsu (China) 13.00-13.15 FP216 - FILM LANGUAGE AND APHASIA: IN SEARCH OF CRITERIA OF A SIMPLIFIED FILM SYNOPSIS THROUGH THE SILENT FILMS OF CHARLIE CHAPLIN. Angelica Stefania Renata Trovarelli - Gabriella Barilari (Italy)
37
12.30-13.15
ATENE HALL
FLUENCY FREE PAPERS 5 CHAIRS: Katrin Neumann (Germany) Herman F.M. Peters (The Netherlands) 12.30 -12.45 FP217 - RELATION BETWEEN STUTTERING AND ANXIETY DISORDERS AMONGST ITALIAN CILDREN WHO STUTTER: A PRELIMINARY STUDY Luisella Cocco - Simona Bernardini - Claudio Zmarich - Mario Di Pietro - Giulia Natarelli (ITALY) 12.45-13.00 FP218 - ATTENTIONAL SHIFTING FUNCTION OF SCHOOL-AGED CHILDREN WHO DO AND DO NOT STUTTER Kowsar Esfandeh - Mohammad Ali Nazari (IRAN) 13.00-13.15 FP219 - PREVALENCE AND MODE OF INHERITANCE OF STUTTERING IN PRIMARY SCHOOLS IN CAIRO Mahmoud Youssef Abou El-Ella - Marwa Mahmoud Saleh - Mohamed Abd El Adl Sawy Ihab Chehad Habil - Lamiaa Mohamed El Assal (Egypt)

DISPHAGIA SHORT SEMINAR 8 CHAIRS: FILIPPO Barbiera (ITALY) - ANDREA Canale (ITALY) SS43 - SWALLOWING REHABILITATION AFTER HEAD AND NECK CANCER SURGERIES Tamer Abou-Elsaad (Egypt)
DUBLINO HALL
COPENHAGHEN HALL
VOICE SHORT SEMINAR 7 CHAIRS: ORIETTA Vecchio (ITALY) Ofer Amir (Israel) SS44 - THE VELO-PHARINGEAL PUMP: A NEW METHOD FOR REHABILITATION OF LARYNGECTOMEES Nico Paolo Paolillo - Roberto Leoni - Emma Ferri (ITALY)
13.15-14.00
BREAK
14.00-14.45
AUDITORIUM
CHILD LANGUAGE FREE PAPERS 18 ITALIAN CME ACCREDITATION CHAIRS: Yvette Hyter (USA) Kakia Petinou (Cyprus) 14.00 -14.15 FP220 - DIFFERENCES IN GESTURE USE AND CANONICAL BABBLING IN INFANTS LATER DIAGNOSED WITH SPECIFIC LANGUAGE IMPAIRMENT Nicole Magaldi Magaldi (USA) 14.15 -14.30 FP221 - CONVERSATIONAL REPAIR STRATEGIES IN 4 YEAR OLD CHILDREN Zahra Ghayoumi - Leila Ghasisin - Faeze Farzadi (Iran) 14.30-14.45 FP222 - EXPLORING EVIDENCE OF DEFICIT AND THEORIES OF THERAPY FOR CHILDREN WITH SPECIFIC RECEPTIVE LANGUAGE IMPAIRMENT Morgan Lydia - Sue Roulstone (UK)
LONDRA HALL
VOICE SHORT SEMINAR 8 CHAIRS: EUGENIO Tremante (ITALY) - Neuschaefer Rube Christiane (Germany) SS45 - PHARYNGOESOPHAGEAL SEGMENT CONFIGURATION RELATED TO ESOPHAGEAL AND TRACHEOESOPHAGEAL SPEECH AND VOICE QUALITY Marina Lang Fouquet - Mara Behlau - Antnio Jos Gonalves (Brazil)
MADRID HALL
EDUCATION FOR SPEECH AND LANGUAGE PATHOLOGY SHORT SEMINAR 3 CHAIRS: RAFFAELLA Citro (ITALY) - AILEEN Patterson (UK) SS46 - THE COLLABORATIVE PRACTICES OF HEALTH AND EDUCATION PROFESSIONALS IN THE MANAGEMENT OF CHILDREN WITH COMMUNICATION DIFFICULTIES Jane Mccormack - Catherine Easton (Australia)
38
14.00-14.45
LISBONA HALL
APHASIA FREE PAPERS 6 CHAIRS: Anastasia Raymer (USA) - Luise Springer (Germany) 14.00-14.15 FP223 - SEVERE ACQUIRED BRAIN INJURY: CASE STUDY ANALYSIS OF THE PAST FIVE YEARS ON MAJOR ISSUES OF SPEECH THERAPY INTEREST Angela Lucia Fogliato - Patrizia Cancialosi - Claudia Machetta - Natalia Giunta Lorella Cocchini - Patrizia Milani - Giuseppe Massazza - Maurizio Beatrici (Italy) 14.15 -14.30 FP224 - NEW INSTRUMENTS FOR RESEARCH ON SEVERE ACQUIRED BRAIN NJURIES Patrizia Cancialosi - Melania Saffila - Donato Quercia - Federica Gatti - Chiara Trucco Rosaria Balbo - Francesca Auxilia (Italy) 14.30-14.45 FP225 - THE RELEVANCE OF CASE-STUDIES IN APHASIA RESEARCH: WHAT THEY TELL US ABOUT LANGUAGE FUNCTIONING AND ABOUT LINGUISTIC-COGNITIVE REORGANIZATIONAL PROCESSES ROSANA NOVAES - MIRIAN CAZAROTTI (BRAZIL)
ATENE HALL
VOICE FREE PAPERS 19 CHAIRS: MASAKI Watanabe (japan) - LUCIA Dalatri (ITALY) 14.00-14.15 FP226 - HOW MANY CASES OF LARYNGOPHARYNGEAL REFLUX SUSPECTED BY LARYNGOSCOPY ARE GERD-RELATED? ROLE OF GAS REFLUXES Andrea Nacci - Giovanna Baracca - Nicola De Bortoli - Valentina Mancini - Stefania Santopadre - Santino Marchi - Stefano Berrettini - Bruno Fattori (Italy) 14.15 -14.30 FP227 - VOICE DISORDERS IN TEACHERS FROM PRIMARY SCHOOL: A MULTIDISCIPLINARY EVALUATION THROUGH QUESTIONNAIRES, LARYNGOSTROBOSCOPY AND VOICE ANALYSIS FRANCESCA LIRA LUCE - ROBERTO TEGGI - BARBARA RAMELLA - MATTEO BIAFORA - LAURA GIRASOLI MARIO BUSSI (ITALY) 14.30-14.45 FP228 - AN EDUCATIONAL MOVIE OF LARYNGEAL ELECTROMYOGRAPHY PROCEDURES USING HOOKED-WIRE ELECTRODES IN PHONIATRICS Ken-Ichi Sakakibara - Seiji Niimi - Hiroshi Imagawa - Akihito Yamauchi - Hisayuki Yokonishi Mamiko Otsuka (Japan)

PRESIDENT ELECT COMMITTEE CHAIRS MEETING
DUBLINO HALL
COPENHAGHEN HALL
DYSPHAGIA SHORT SEMINAR 9 CHAIRS: BEATRICE Travalca Cupillo (ITALY) - Vernero Irene (Italy) SS47 - THE ROLE OF SPEECH LANGUAGE PATHOLOGIST IN TAKING CHARGE OF THE PRETERM INFANT: EMPOWERING PREMIES IN THE T.I.N. (N.I.C.U.) Monica Panella (Italy)

SPECIAL EVENT
14.45-16.15
SP5 - COMMUNICATION DISORDERS IN THE MULTILINGUAL POPULATION CHAIRS: Lilly Cheng Li-Rong (USA) - ANDREA MARINI (ITALY) The identification of differences versus disorder: evidence-based assessment and intervention sandra levey Sociolinguistic and pathological language variations: problems of complementarity and overlap Benjamin K. Tsou Atypical development in dual language children: SLI or delay? Rita Mari - Marina Porrelli
AUDITORIUM
Bilingual profiles, reading acquisition and bilingual advantage: how to evaluate strengths and difficulties in bilingual and second language learning children Paola Bonifacci - Stephanie Bellocchi
14.45-15.30
LONDRA HALL
MOTOR SPEECH DISORDERS COMMITTEE SYMPOSIUM 2 CHAIRS: Bruce Murdoch (Australia) Giovanni Ruoppolo (Italy) SY11 - AUTOMATED INTONATION ASSESSMENT AND TREATMENT IN DYSARTHRIA Heidi Martens - Gwen Van Nuffelen - Tomas Dekens - Lukas Latacz - Diana Torres Werner Verhelst - Marc De Bodt (BELGIUM, CUBA) Repetitive transcranial magnetic stimulation combined with intensive voice therapy to improve speech function in Parkinsons disease: a clinical case study Caroline Barwood - Bruce Murdoch (AUSTRALIA)
39
14.45-15.30
MADRID HALL
EDUCATION FOR SPEECH AND LANGUAGE PATHOLOGY SHORT SEMINAR 4 CHAIRS: Hilde Chantrain (Belgium) FLORINDA De Simini (ITALY) SS48 - COMMUNICATION DISABILITY IN A GLOBAL CONTEXT - PART 1: CHALLENGES FROM THE WORLD REPORT ON DISABILITY Wylie Karen (Australia)
LISBONA HALL
APHASIA FREE PAPERS 7 CHAIRS: Mu Rossella (Italy) F. Costandinidou 14.45-15.00 FP229 - APHASIA SEVERITY, QUALITY OF LIFE AND AN OBJECTIVE, MEASURE OF PARTICIPATION: A SENSECAM PILOT STUDY Sue Franklin - Claire Smyth - Selena Ouellet - Liane Deasy (Ireland) 15.00-15.15 FP230 - LANGUAGE SKILLS AND THE QUALITY OF LIFE OF PATIENTS WITH RIGHT HEMISPHERE STROKE TREATED WITH INTRAVENOUS ALTEPLASE TREATMENT Paivi Numminen - Anna-Maija Korpijaakko-Huuhka (Finland) 15.15 -15.30 FP231 - WHAT CAN WE LEARN FROM USING LONG TERM SAQOL-39 IN PEOPLE WITH APHASIA Nada emva (Slovenia)
ATENE HALL
VOICE FREE PAPERS 20 CHAIRS: FRANCESCO Avanzini (ITALY) - Diane Bless (USA) 14.45-15.00 FP232 - VOICE OF MILITARY COMMAND Sandra Mara Almeida Ferreira - Ariane Kassia Nunes Alves - Eliana Midori Hanayama (Brazil) 15.00-15.15 FP233 - THE EFFECTIVENESS OF MANUAL CIRCUMLARYNGEAL THERAPY IN FUTURE ELITE VOCAL PERFORMERS: A PILOT STUDY Evelien Dhaeseleer - Sofie Claeys - Kristiane Van Lierde (Belgium) 15.15 -15.30 FP234 - DEVELOPMENT AND VALIDATION OF THE VOICE FATIGUE HANDICAP INDEX (VFHI): CLINICAL, PSYCHOMETRIC AND PSYCOSOCIAL FACETS Nico Paolo Paolillo - Emiliano De Quarto - Giuseppe Pantaleo (Italy)
DUBLINO HALL
DYSPHAGIA SHORT SEMNAR 10 CHAIRS: Kenneth Watkin (Canada) - DANIELE Farneti (ITALY) SS49 - THE ENDOSCOPIC EVALUATION OF DYSPHAGIA SEVERITY: A WAY OF CONSIDERING POOLING IN THE CLINICAL SETTING Daniele Farneti - Raffaella Prencipe - Andrea Nacci - Valentina Mancini - Bruno Fattori Elisabetta Genovese (Italy)
COPENHAGHEN HALL
VOICE SHORT SEMINAR 9 CHAIRS: Massimo Spadola Bisetti (Italy) Ron Baken (USA) SS50 - THE PROPRIOCEPTIVE ELASTIC METHOD (PROEL) IN VOICE THERAPY. Alfonso Borragn (Spain) - Valentina Romizzi - Andrea Ricci Maccarini - Emanuela Lucchini (Italy)
15.30-16.15
MADRID HALL
EDUCATION FOR SPEECH AND LANGUAGE PATHOLOGY SHORT SEMINAR 5 CHAIRS: Raimondo Simona (Italy) Brian Shulman (USA) SS51 - COMMUNICATION DISABILITY IN A GLOBAL CONTEXT - PART 2: POPULATION-BASED CHALLENGES AND A PUBLIC HEALTH RESPONSE FOR SPEECH-LANGUAGE PATHOLOGISTS Bronwyn Davidson - Karen Wylie - Julie Marshall - James Law - Lindy Mcallister (AUSTRALIA, UK)
LISBONA HALL
MULTILINGUAL AFFAIRS SHORT SEMINAR 6 CHAIRS: Brian Goldstein (USA) MARIA KAMBANAROS (CIPRUS) SS52 - WHAT WE NEED TO KNOW ABOUT THE COMMUNICATION NEEDS OF PERSONS DISPLACED DUE TO NATURAL DISASTERS, WAR AND/OR CIVIL CONFLICT Dolores Battle (USA)
40
15.30 -16.15
ATENE HALL
VOICE FREE PAPERS 21 CHAIRS: ANNA Bellomo (ITALY) - Eeva Sala (Finland) 15.30-15.45 FP235 - CROSS-CULTURAL ADAPTATION OF THE ITALIAN VERSION OF THE VOICE ACTIVITY PARTICIPATION PROFILE-VAPP Gaetano Fava (USA) 15.45-16.00 FP236 - THE DUTCH PEDIATRIC VOICE HANDICAP INDEX: A SELF-REPORT INSTRUMENT FOR CHILDREN AGED 7-12 TO MEASURE IMPACT OF DYSPHONIA Dominique Dautzenberg - Marjet Bosma - Merel Fris - Maud Schouwerwou - Else De Haan Marietta Aprea (the Netherlands) 16.00-16.15 FP237 - VOICE HANDICAP INDEX (VHI) IN PERSIAN-SPEAKING PARKINSONS DISEASES PATIENTS Fatemeh Madjdinasab - Negim Moradi - Gholamali Shahidi - Masoud Salehi (IRAN)
DUBLINO HALL
CHILD LANGUAGE FREE PAPERS 19 CHAIRS: Ana Luiza Navas (Brazil) - Sarah Eyal (Israel) 15.30-15.45 FP238 - THE RSR-DSA QUESTIONNAIRE: A SCREENING TOOL FOR THE IDENTIFICATION OF CASES AT RISK OF LEARNING DISABILITIES. RESULTS FROM A Pozzoli Angela - Claudia Cappa - Paola Guglielmino - Sara Giulivi (ITALY, SWITZERLAND) 15.45-16.00 FP239 - A SCREENING ON SPECIFIC LEARNING DISABILITIES IN A HIGH GENETIC HOMOGENEITY AREA Claudia Cappa - Fabrizio Meloni ,Sara Giulivi - Carlo Muzio - Antonino Schilir Paola Guglielmino (Italy) 16.00-16.15 FP240 - THE PERCEPTION OF FLUENCY IN THE READING ALOUD OF DYSLEXIC CHILDREN AND REGULAR READERS Luciana Mendona Alves - Leticia Celeste - Csar Reis - Muriel Lalain - Alain Ghio (BRAZIL)
COPENHAGHEN HALL
DYSPHAGIA SHORT SEMINAR 11 CHAIRS: MATTIA Di Ciccio (ITALY) - Sandra Ettema (USA) SS53 - THE TAKING CHARGE LOGOPEDIC OF THE SWALLOW IN THE CHILD WITH CEREBRAL PALSY: FEEDING, DROOLING AND POSTURAL DYNAMIC. THE BOBATHS CONCEPT LIKE LOGOPEDIC RESOURCES Monica Panella (Italy)
16.45-18.15
AUDITORIUM
APHASIA COMMITTEE SYMPOSIUM SY12 ITALIAN CME ACCREDITATION CHAIRS: Anu Klippi (Finland) Linda Worrall (Australia) 16.45-17.30 QUALITY OF LIFE IN APHASIA: CONCEPTUALISATION, MEASUREMENT AND CURRENT KNOWLEDGE Katerina Hilari - Claire Penn (UK, SOUTH AFRICA) 17.30-18.15 AN INTERNATIONAL SURVEY ON QUALITY OF LIFE IN APHASIA: RESULTS FROM 16 COUNTRIES Anu Klippi - Claire Penn - Fofi Constantinidou - Nada emva - Katerina Hilari - Simon Horton Anastasia Raymer - Linda Worrall - Sarah Wallace - Sarah Wallace (FINLAND, SOUTH AFRICA, SLOVENIA, UK, AUSTRALIA)
LONDRA HALL
EDUCATION FOR SPEECH AND LANGUAGE PATHOLOGY COMMITTEE SYMPOSIUM 2 CHAIRS: Miranda Fernandes (BRAZIL) - Mu Rossella (Italy) SY13 - EDUCATING SLPS - DIFFERENT EXPERIENCES IN BUILDING RESEARCHERS SESSIONS 1 AND 2 Brian B. Shulman - Dobrinka GeoRgieva - Sharynne McLeod - Brooke Hallowel - Masae Shiroma John Bernthal - Lin hong Chin - Matty Letihalmes - Fernanda Dreux M. Fernandes (BRAZIL)
16.45-17.30
MADRID HALL
VOICE SHORT SEMINAR 10 CHAIRS: MARINA Tripodi (ITALY) - Ofer Amir (Israel) SS54 - MUSCLE TENSION DYSPHONIA: CLINICAL CASES Rosiane Yamasaki - Glaucya Madazio - Mara Behlau (BRAZIL)

VOICE SHORT SEMINAR 11 CHAIRS: Mara Behlau (Brazil) ANDREA Canale (ITALY) SS55 - CHRONIC COUGH: SYMPTOMS OF A SENSORY DISEASE Thomas Murry (Usa)
LISBONA HALL
41
16.45-17.30
ATENE HALL
VOICE FREE PAPERS 22 CHAIRS: Philippe Dejonckere (Belgium and the Netherlands) EUGENIO Tremante (ITALY) 16.45-17.00 FP241 - TELE-FON, A PROMISING CONCEPT IN TELE-HEALTH Mieke Moerman (Belgium) 17.00 -17.15 FP242 - EVALUATING THE EFFECIENCY OF EARLY VOICE THERAPY IN UNILATERAL VOCAL FOLD PARALYSIS USING VOICE PROBLEM SELF ASSESSMENT SCALE Manal Mohammed El-Banna (EGYPT) 17.15-17.30 FP243 - THE SPEECH THERAPIST`S VOICE BEFORE AND AFTER VOCAL TIREDNESS Svetlana Torbica Marinkovic (SERBIA)
DUBLINO HALL
MOTOR SPEECH DISORDERS FREE PAPERS 4 CHAIRS: Pamela Enderby (UK) Angela Morgan (Australia) 16.45-17.00 FP244 - IDENTIFICATION OF DOMINANCE BY MRI-NAVIGATED REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN PATIENTS WITH BRAIN TUMOURS Gianluca Isoardo - Michele Naddeo - Antonio Melcarne - Andrea Limberti - Patrizia Cancialosi Carola Juneman - Domenico Serpella - Maria Maddalena Ferraris - Maria Consuelo Valentini Maurizio Beatrici - Letizia Luciano - Cesare Scopece - Giuliano Faccani (ITALY) 17.00 -17.15 FP245 - VOWEL QUALITY AND SPEECH INTELLIGIBILITY OF FINNISH ORAL CANCER PATIENTS 5 YEARS POST-TREATMENT Marika Muttilainen - Anna-Maija Korpijaakko-Huuhka - Elsa Horila (FINLAND) 17.15-17.30 FP246 - CHILDHOOD APRAXIA OF SPEECH: CHECKLIST REVISITED Anniek Van Doornik - Mark Pertijs (the Netherlands)
17.30-18.15
MADRID HALL
VOICE SHORT SEMINAR 12 CHAIRS: Eva B. Holmberg (Sweden) - Eiji Yumoto (Japan) SS56 - EXPLORING RIGID AND FLEXIBLE STRAWS WITH AND WITHOUT WATER RESISTANCE FOR VOCAL CONDITIONING AND THERAPY Glaucya Madazio - Gisele Oliveira - Mara Behlau (BRAZIL)
LISBONA HALL
MULTILINGUAL AFFAIRS FREE PAPERS 3 CHAIRS: Barbara Dodd (Australia) Marion Friedman (Israel) 17.30-17.45 FP247 - GRAMMATICALITY AND COMPLEXITY IN THE USE OF SENTENCES IN CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT Mariangela Maggiolo Landaeta - Mara Mercedes Pavez - Carmen Julia Coloma Tirapegui Claudia Araya - Phristian Pealoza (CILE) 17.45-18.00 FP248 - SENSITIVITY AND SPECIFICITY FOR NONWORD REPETITION (NWR) AND SENTENCE REPETITION (SR) IN DISCRIMINATING BILINGUAL CHILDREN WITH AND WITHOUT SPECIFIC LANGUAGE IMPAIREMENT (SLI) Natalia Meir - Sharon Armon Lotem (ISRAEL) 18.00-18.15 FP249 - THE EFFECT OF MULTILINGUALISM ON THE DEVELOPMENT OF PHONEMIC AWARENESS - A REVIEW Yvonne Wren - Helen Hambly - Sue Roulstone (UK)

GISD GENERAL ASSEMBLY
ATENE HALL
42
17.30-18.15
DUBLINO HALL
MOTOR SPEECH DISORDERS FREE PAPERS 5 CHAIRS: Michael Robb (New Zealand) Yvette Hus (Canada) 17.30-17.45 FP250 - PROTOCOL FOR THE EVALUATION OF SPEECH INTELLIGIBILITY IN DYSARTHRIAS: EVIDENCE oF RELIABILITY AND VALIDITY Ortiz karin Zaro (BRAZIL) 17.45-18.00 FP251 - THE DUTCH DYSARTHRIA ASSESSMENT: ALSO A RELIABLE INSTRUMENT? Simone Knuijt - Hanneke Kalf - Harry Goos - Puck Goossens - Judith Kocken - Lotte Kromhout Bert De Swart - Alexander Geurts (NETHERLANDS) 18.00-18.15 FP252 - INTELLIGIBILITY ASSESSMENT OF DYSARTHRIC ITALIAN SPEECH: CORRELATIONS BETWEEN ACOUSTIC MEASURES AND AUDITORY PERCEPTUAL RATINGS Barbara Gili Fivela - Vincenzo Sallustio - Silvia Pede - Mirko Grimaldi - Danilo Patrocinio (ITALY)

CLOSING CERIMONY
18.15-19.00
AUDITORIUM
43
General Information
29th World Congress of the International Association of Logopedics and Phoniatrics Lunches
No official lunches are provided. Lunch facilities are available in the Mall on the first level of the Congress Center.
Italian CME accreditation

The sessions in Auditorium has been accredited to Italian Health Ministry for Continual Education in Medicine who attributes 14 CME Credits for the following Italian Professionals: Medical doctors (Audiology and Phoniatrics) and Logopaedics. Ask to the Congress Secretariat the CME papers to get credits.
This program is offered for up to 2.4 ASHA CEUs (Various levels; Professional area). ASHA Members who are interesting in ASHA CEUs must follow the following instructions: Go to the link http://learningcenter.asha.org/diweb/event When the user clicks on the link, they will either have to sign into the ASHA Web site, or set up a new account. When they enter LMS, they will see the following instructions: To start reporting your sessions, select the name of the Event. You may view a summary of the sessions youve reported by selecting Review and Confirm. After entering all of the sessions you attended for the entire event and reviewing your record, 1. Select Finalize Record 2. Enter three things you learned for the event 3. Select Confirm & Finalize Note: you will not be able to add sessions or change your event record after Finalizing. After finalizing your record, you will have immediate access to your Certificate of Completion.
Dress Code
Dress is informal throughout the entire congress.
Hotel Accommodation & Touristic information

The registration desk will handle all enquiries related to touristic information and hotel accommodation.
Parking
Parking with fee is available at the underground parking area of the Congress venue. If you park in the city centre in the controlled parking zones within the blue markings, you have to pay a fee that comes about 1.3 and 2.50 Euros for 1 hour parking. Private vehicle traffic and parking are strictly controlled inside the city centre ZTL (limited traffic zone). The signs at the entrance to the ZTL show the hours that restrictions are enforced.
Date and Congress Venue

August 25-29, 2013 Centro Congressi Lingotto - Via Nizza, 280 - Turin (Italy)
Local Transportation in Torino

Public transport in the city is well organized. Trams, buses and metro operate without conductors on board. Tickets must be purchased in advance at tobacco shops or metro stations.
Meeting & Exhibition Venue

The Congress will be held at the Lingotto Conference Centre (Centro Congressi Lingotto Via Nizza, 280 Torino). The Congress site is served by an extensive public transport network, mainly metro, buses & tram (lines 1, 18, 35 are available from the city centre to Lingotto Conference Centre).
Taxis
You can take a taxi anywhere in the city. You can ask the concierge of your hotel to call one for you or you can dial the +39 011-5730.
Currency, Exchange, Credit Cards

The official currency in Italy is the Euro. You can exchange foreign currency in several banks and Currency Exchange Businesses. Bank cheques are not so widespread and rarely accepted. Credit cards are very common in the urban areas. Shops and restaurants that normally accept credits cards display a list of these cards on their shop windows. Its advisable to carry some cash with, since for small purchases, shops do normally prefer to be paid cash. Bank opening hours: Mo Fri: from 08:30 a.m. to 01:30 p.m. and from 02:30 p.m. to 04:30 p.m. Banks are closed on Saturdays and Sundays.
Congress Secretariat Operating Hours

The secretariat will be open during the congress, as follows: Sunday, August 25th, 2013: 15.00-19.30 Monday, August 26th, 2013: 07.30-19.00 Tuesday, August 27th, 2013: 07.30-19.00 Wednesday, August 28th, 2013: 08.00-19.00 Thursday, August 29th, 2013: 07.30-19.30
Language
The official language of the Congress is English. Simultaneous translation into Italian will be provided for the Auditorium. Headsets will be distributed at the desk outside the Auditorium.
Shopping hours
The usual shopping hours in Torino are from 09:00 to 19:00; in big shopping centres up to 21:00. The 8 Gallery of Lingotto centre (in the same building of the Congress Venue) has more than 90 shops, a multiplex cinema, 12 restaurants and bars, a supermarket, a Postal office and a Bank. Its opening hours are Monday: 14-22; Tuesday-Sunday: 10-22.
Speakers Ready room

Slide Center for speakers is located at Auditorium Foyer, in front of the reception desks.
Smoking
Smoking is not allowed inside the Congress buildings, at the venues for the social functions and in all public locals in the city. Smokers are kindly required to smoke outdoors or in the smoking areas.
Internet Connection
Wi-Fi connection is available in the Auditorium Foyer. Ask the secretariat for passwords.
Coffee Breaks
Coffee will be offered during the coffee breaks, according to the time schedule mentioned in the programme. If you wish to have a coffee or a snack any other time, please note that there is a coffee shop at the reception level.
Electricity Supply
In Italy electricity is generally supplied at 220 volts and a frequency of 50 Hz. Plugs are normally with two or three pins. Plug adaptors or converters might be necessary for those coming e.g. from the USA, UK and Japan.
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Telephones
International calls can be made using any public telephone in the city centre. Please remember to dial the international code of the country you want to call to. The dialling code for Italy is +39 followed by the code of the city (i.e. if you want to call Torino you should dial +39 011 and the telephone number of the person you are calling). Pre-paid telephone cards are very easy to use and can be bought in any tobacco shop or in newsstands. Dont forget that Emergencies Numbers are free of charge. Phone numbers in case of emergency: Ambulance: 118; Police: 112 & 113; Firework: 115
Weather
The average High in August is 25 and the low is 18. We suggest you to bring a cotton wool pullover with you. Rainy days may be expected.
Liability
The organizers cannot accept liability for any personal accidents, loss of belongings or damage to private property of participants and accompanying persons that may occur during the Congress.
Registration Information
Registration (vat 21% included)
Registration for IALP Non-member Registration for Affiliated societies members SIFEL members IM (Individual Member) of IALP Students* Accompanying person Gala Dinner * Please provide a student document On site registration 700,00 630,00 610,00 530,00 300,00 260,00 65,00
Registration Fee (for accompanying persons)

The accompanying fee includes access to the Opening Ceremony and Welcome Reception, exhibition, half day tour to Reggia di Venaria Reale and to the Closing Ceremony.
Badges
Participants, exhibitors and accompanying persons are kindly requested to wear their badges during all congress activities and social events. Entry will not be permitted without a badge. In case you lose your badge, please proceed directly to the Congress Secretariat in order to get a new one.
Certificate of Attendance
Certificate of Attendance will be available on request at the registration desk from 29th August 2013, at 14.30.
Registration Fee (for participants and students)

The active participants registration fee includes access to all scientific sessions, exhibition, the Opening Ceremony and Welcome Reception, one congress bag, a copy of the Final Program & Abstracts book, half day tour to Reggia di Venaria Reale, Closing Ceremony, simultaneous translation into Italian for the Main Hall.
Social Program
AUGUST 28th, 2013 AUGUST 28th, 2013
HALF DAY JOURNEY TO REGGIA DI VENARIA REALE

INCLUDED IN THE REGISTRATION FEE La Venaria Reale is one of the finest examples of the majesty of 17th and 18th century architecture. The monumental palace, that covers an overall surface of over 80,000 square meters, is a celebration of universal baroque: the enchanting scenario of the Hall of Diana designed by Amedeo di Castellamonte, the solemnity of the Great Gallery and the Church of St. Hubert, the grandiose complex of the Juvarra Stables designed by Filippo Juvarra in the 18th century, the sumptuous decorations and the imaginative installations by Peter Greenaway on life at court are the ideal setting for the Theatre of History and Magnificence, the permanent display devoted to the House of Savoy that takes our visitors on a tour that extends over almost 2 km, from the underground level to the piano nobile of the Reggia. The tour includes: - Buses leaving from Centro Congressi Lingotto at 8.30 - Entrance ticket to visit Reggia di Venaria and its park - Buses leaving from Reggia di Venaria at 12.30 to Centro Congressi Lingotto
GALA DINNER at Museo Nazionale dellAutomobile

NOT INCLUDED IN THE REGISTRATION FEE - ask to the Congress Secretariat for availability The National Automobile Museum is reopening after a radical, large-scale transformation of its contents and its building. The Museum has a new look, thanks to a modern, innovative design: this is not just a simple architectural renovation, but a new amenity redesigned to be placed among the most cutting-edge of European cultural centres. Its a museum that can attract to it not only an audience of specialists but of young people, families and students and is a space for all the local people, who will find in the rebuilt complex a place where they can meet and socialize. The path taking you around the exhibition tells the story and the evolution of the motor car, as well as thesocial themes linked to it, its transformation from a means of transport to an object of worship, from its origins right up to the contemporary evolution of creative thought, and all this is done with spectacular displays showing off the valuable pieces in the collection. Gala Dinner fee includes: - Entrance ticket to visit the Museo Nazioanle dellAutomobile - Buffet dinner - Musical entertainment
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Congress Venue Plan
CONFERENCE CENTRE ENTRANCE (side railroad)
COPENHAGHEN HALL
TOURIST INFORMATION HEADSET DISTRIBUTION CONGRESS SECRETARIAT SLIDE CENTER
IALP SECRETARIAT
CONFERENCE CENTRE ENTRANCE (side via Nizza)
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Lingotto Conference Centre
DUBLINO HALL
ATENE HALL
AUDITORIUM
EXHIBITION AREA
HOTEL
POSTER AREA
MADRID HALL
LONDRA HALL
LISBONA HALL
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Instruction for Presenters & Poster Presentations

Thank you for sharing your expertise at IALP 2013. Based on feedback from the most successful IALP presentations, we would like to make some suggestions for increasing presentation effectiveness. These recommendations are directly from attendees ratings and remarks on session evaluations. While we acknowledge that many presenters are very experienced, we hope these suggestions will be helpful to all presenters for optimizing presentations for the IALP audience. - It is strongly recommended that you deliver your presentation 2hrs prior to the session, so please be so kind to deliver your USB flash disk on time. Please note that the speaker ready room will operate as the Congress Secretariat so please feel free to drop by and ask questions: Sunday, August 25th, 2013: 15.00-19.30 Monday, August 26th, 2013: 07.30-19.00 Tuesday, August 27th, 2013: 07.30-19.00 Wednesday, August 28th, 2013: 08.00-19.00 Thursday, August 29th, 2013: 07.30-19.30
Speaker Ready Room

- The speaker ready room is located in the Auditorium Foyer (please check the Congress Venue Map in order to find the specific place). - All presentations for oral sessions will be submitted to the Speaker Ready room where they will be distributed to the appropriate computer by our technicians. - LCD projectors and computers will be provided for all sessions; presentations are preloaded on the computers inside the session room. You may not use your own laptop. This is strictly enforced, in order to avoid or minimize any technical problem arise. - There will be wireless microphones for questions, where needed. - The computers in the speaker ready room and each of the session rooms are exactly alike. If your presentation looks good in the speaker ready room, it will look good in the session. Please note that if your presentation has audio, you should inform the technician in the speaker ready room.
Presentation Tips
- Please be so kind to speak slowly, simply and clearly. Make it easier for non-native English speakers to take meaningful notes and more fully understand all the content of your presentation. - Finish your talk on time or early. Respect the break times. - It will be very helpful for the attendees to give them examples during your presentation. - Use your slides as a visual tool, and to remind you of main points and do not read the text directly off your slides.
Poster Presentation
Please find here below important information about poster presentations:
P001-P093 TOPIC: Augmentative/Alternative Communication & Child Language

They will be displayed on Monday, AUgUst 26 , 2013 Placement: 08.00-09.00 on 26/8
th
P200-P269 TOPIC: Multilingual affairs, Aphasia, Motor Speech Disorders, Education Phoniatrics, Education for Speech and Language Pathology & Affiliated Societies
They will be displayed on ThUrsday, AUgUst 29th, 2013 Placement: 08.00-09.00 on 29/8 Poster session: 10.30-11.30 on 29/8 (during that hours you are kindly requested to be in front of your poster) Dismantling: 17.30-18.30 on 29/8
Poster session: 10.30-11.30 on 26/8 (during that hours you are kindly requested to be in front of your poster) Dismantling: 17.30-18.30 on 26/8
Important P094-P199 TOPIC: Voice, Fluency, Audiology & Dysphagia

They will be displayed on TUesday, AUgUst 27th, 2013 Placement: 08.00-09.00 on 27/8 Poster session: 10.30-11.30 on 27/8 (during that hours you are kindly requested to be in front of your poster) Dismantling: 17.30-18.30 on 27/8 Your poster should be cm 70w and 100h. Please hang up your poster where number of your poster is in the poster hanger. Note that in case you will not follow the above date/time schedule, the Organizing Committee and Congress Secretariat, are not responsible in case of loss or damage of your poster.
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Poster List
P001
USE OF AAC AS NEW SYSTEM IN COMMUNICATION DISABILITY AMAL AHMAD, AZHAR O MAR (QUATAR)
P012
RELATIONSHIP BETWEEN PRAGMATIC COMMUNICATIVE AND SOCIAL SKILLS IN THE SPECIFIC LANGUAGE IMPAIRMENT (SLI) DAGMA VENTURINI MARQUES ABRAMIDES, DANIELA DE OLIVEIRA MANOEL, FABIANA CRISTINA CARLINO (BRAZIL)
P002
ADAPTED TEXT MESSAGING SMS IN ELDERLY PRELIMINARY RESEARCH RESULTS MAJA OGRIN (SLOVENIA)
P013
TELEDUCATION: VIRTUAL LEARNING ENVIRONMENT IN SPEECH THERAPY ALINE MARTINS, DAGMA VENTURINI MARQUES ABRAMIDES, LUCIANA PAULA MAXIMINO, MARLIA CANCIAN BERTOZZO (BRAZIL)
P003
EFFECTS OF ICONICITY IN TAIWAN SIGN LANGUAGE AND AMERICAN SIGN LANGUAGE EXPERIENCE ON TAIWAN SIGN LANGUAGE LEXICON COMPREHENSION CHIN-HSING TSENG, HSIU-TAN LIU, JUNG-HSING CHANG (TAIWAN-CHINA)
P014
SPEECH AND LANGUAGE DATA BANK: TEACHING AND RESEARCHING TOOL REGINA MARIA FREIRE, CAMILA PARDUCCI, GABRIELA VALIENGO FEITAL DE SOUZA (BRAZIL)
P004
USING MULTIPLE WAYS IN SENSORY APHASIC SPEECH THERAPY: CASE STUDY ELEN FRANCO, NATALIA GUTIERREZ CARLETO, ALINE MEGUMI ARAKAWA, CRISTINA DO ESPIRITO SANTO, DIONISIA APARECIDA CUSIN LAMNICA, MAGALI DE LOURDES CALDANA (BRAZIL)
P015
LANGUAGE IMPAIRMENTS IN CHILDREN WITH ADHD AND IN CHILDREN WITH READING DISORDER WENCHE ANDERSEN HELLAND (NORWAY)
P005
HANDIPHONE- AN AID FOR VOICE COMMUNICATION ROBERTO RUSSO (ITALY)
P016
INTERVENTION PROGRAM IN ORAL LANGUAGE FOR CHILDREN WITH LANGUAGE DELAY CAMILLA GUARNIERI, BIANCA RODRIGUES LOPES GONALVES, CAMILA MAYUMI ABE, SIMONE APARECIDA LOPES-HERRERA (brazil)
P006
MEASURING QUALITY OF LIFE OF CHILDREN EXPERIENCING DISABILITIES IN SRI LANKA: DIFFERING PERSPECTIVES OF CHILDREN, CAREGIVERS AND PROFESSIONALS SHYAMANI HETTIARACHCHI (SRI LANKA)
P017
THE EFFECTIVENESS OF ALTERNATIVE CLINICAL-HOME SPEECH-LANGUAGE THERAPY PROGRAM TO ENHANCE SOCIAL INTERACTION SKILLS IN PRE-SCHOOL CHILD WITH ADHD: A CASE STUDY TAHANY EL SAYED AHMAD (KUWAIT)
P007
EASY: A NEW TOOL TO USE AAC IN THE ACUTE PHASE GABRIELLA BARILARI , PATRIZIA CANCIALOSI , JESSICA SACCATO (ITALY)
P018
SPEECH THERAPY INTERVENTION RESULTS OF PSYCHOLINGUISTIC SKILLS IN A CASE OF CONGENITAL TOXOPLASMOSIS CAMILA DE CASTRO CORRA, MARIA RENATA JOS, VANESSA LUISA DESTRO FIDNCIO, ANA PAOLA NICOLIELO, SIMONE APARECIDA LOPES-HERRERA, LUCIANA PAULA MAXIMINO (BRAZIL)
P008
TIME OF THERAPY AND COMMUNICATION SKILLS OF NONVERBAL AUTISTIC CHILDREN FACED WITH AN ALTERNATIVE COMMUNICATION SYSTEM JACY PERISSINOTO, MNICA BEVILACQUA, ANA CARINA TAMANAHA (BRAZIL)
P009
FLUENCY AND READING COMPREHENSION IN STUDENTS FROM 3RD TO 5TH GRADE LEVEL SIMONE CAPELLINI, MARA MARTINS (BRAZIL)
P019
RELATIONSHIP BETWEEN THE SOCIOECONOMIC AND SELFREPORTED SPEECH LANGUAGE DISORDERS CARLA CARDOSO, KAREN GARCIA, DANIELA REGINA MOLINIAVEJONAS (BRAZIL)
P010
CARE OF CHILDREN WITH SEVERE SPECIFIC LANGUAGE DISORDERS AND ADHD (PRESCHOOL AGE) KLARA ANGHELESCU, EVA SKODOVA (CZECH REPUBLIC)
P020
SIGNS OF STRESS IN SCHOOL CHILDREN WITH AND WITHOUT LEARNING TROUBLE PATRCIA ABREU PIINHEIRO CRENITTE, THAIS GONALVES, JANANA BORBA GARBO (BRAZIL)
P011
PERCEPTIONPRODUCTION RELATIONS IN SUBSTITUTION PHONOLOGICAL PROCESSES IN CHILDREN WITH LANGUAGE DISORDERS WHO SPEECH SPANISH AMPARO YGUAL FERNNDEZ, JOS FRANCISCO CERVERA MRIDA (SPAIN)
P021
ORIENTATION PROGRAM FOR PARENTS OF CHILDREN WITH LANGUAGE DISORDERS BIANCA RODRIGUES LOPES GONALVES, CAMILA MAYUMI ABE, SIMONE APARECIDA LOPES-HERRERA (BRAZIL)
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P022
PERCEPTUAL PERFORMANCE IN CHILDREN ON THE NASAL IDENTIFICATION TASK LARISSA CRISTINA BERTI, RIKA GUIMARES MARQUES (BRAZIL)
P033
SPEECH BULB IN CHILDREN WITH CLEFT PALATE MARIA INS PEGORARO-KROOK, RAQUEL RODRIGUES, HOMERO AFERRI,MELINA WHITAKER, JOSIANE ALVES NEVES, JENIFFER DE CASSIA RILLO DUTKA, OLLIVIA MESQUITA VIEIRA DE SOUZA (BRAZIL)
P023
LANGUAGE THERAPY RESULTS IN CHILDREN AND ADOLESCENTS WITH AUTISM SPECTRUM DISORDERS FERNANDA DREUX M. FERNANDES, CIBELLE A.H. AMATO, LETICIA A. NASCIMENTO (BRAZIL)
P034
PROMOTING THEORY OF MIND IN BULLIES AND VICTIMS LAMONTAGNE JANELLE (USA)
P024
GROSS MOTOR, FINE MOTOR-ADAPTIVE, PERSONAL AND SOCIAL LANGUAGE SKILLS IN PREMATURE CHILDREN AND TYPICAL DIONSIA APARECIDA CUSIN LAMNICA, CAMILA DA COSTA RIBEIRO (BRAZIL)
P035
IMPACT OF TIMING OF PRIMARY PALATAL SURGERY AND CLEFT TYPE ON SPEECH OUTCOME PARISA REZAEI, SABA SADEGHI, MASOUME SAMANI (IRAN)
P036
CHECKLIST FOR EVALUATE PRAGMATIC SKILLS IN CHILDREN CAMILA MAYUMI ABE, BIANCA RODRIGUES LOPES GONALVES, CAMILLA GUARNIERI, SIMONE APARECIDA LOPES-HERRERA (BRAZIL)
P025
EARLY IDENTIFICATION OF COMMUNICATION DISORDERS IN CHILDREN DANIELA REGINA MOLINI-AVEJONAS, SILMARA RONDON, MARIA INS VIEIRA COUTO, CIBELLE AMATO, CARLA CARDOSO (BRAZIL)
P037
S.A.M. METHOD (SENSE AND MIND): THE BODY LEARNING ANNALISA ZUIN, MANUELA CAPETTINI, ADRIANA BORTOLOTTI, ANNALISA RISOLI (ITALY)
P026
THE EFFECTIVNESS OF ALTERNATIVE CLINIC-HOME SPEECHLANGUAGE THERAPY PROGRAM TO ENHANCE SOCIAL INTERACTION SKILLS IN PRE-SCHOOL CHILD WITH ADHD: A CASE STUDY TAHAN EL SAYED AHMAD (KUWAIT)
P038
RUSSIAN MODERN TRENDS AND ALGORITHMS PSYCOPEDAGOGICAL SUPPORT PRESCHOOL CHILDREN WITH SPECIFIC LANGUAGE DISORDER TATIANA TUMANOVA, TATIANA FILICHEVA (RUSSIAN FEDERATION)
P027
AN INVESTIGATION INTO THE GAZE OF THOSE WITH AUTISM CHIZUKO UTIYAMA (JAPAN)
P039
WORKING MEMORY AND PHONOLOGICAL AWARENESS IN STUDENTS FROM CYCLE I OF ELEMENTARY SCHOOL MARIA SILVIA CRNIO, BEATRIZ CAMPOS MAGALHES DE S DE S, APARECIDO JOS COUTO SOARES SOARES (BRAZIL)
P028
P-LARSP: DEVELOPMENTAL LANGUAGE PROFILE FOR PERSIAN CHILDREN MARYAM GHELMANI POUR, TAHERE SIMA SHIRAZI, MASOUD KARIMLU, REZA NILI POUR, HOSSEIN KARIMI (IRAN)
P040
EFFECTIVENESS OF READING RATE ASSESSMENT MEASURED IN SYLLABLES PER MINUTE APARECIDO JOS COUTO SOARES SOARES, HAYDE FIZSBEIN WERTZNER WERTZNER, MARIA SILVIA CRNIO CRNIO (BRAZIL)
P029
MEASURES OF TIME TO SPEECH AND LANGUAGE THERAPY FOR CHILDREN WITH AUTISM SPECTRUM DISORDER ANA CARINA TAMANAHA, JACY PERISSINOTO (BRAZIL)
P030
METAPHONOLOGICAL GROUP TRAINING: ENHANCEMENT EXPERIENCES AS PREREQUISITES FOR READING AND WRITING ANDREA BROGI, VALENTINA CAMPANELLA, ALESSANDRO MALANDRINI (ITALY)
P041
PHONOLOGICAL AWARENESS DISORDERS OF LANGUAGE IN PACIENTS WITH MALFORMATION: WAS THERE COMORBIDITY? ZELITA GUEDES, ANA PAULA BAUTZER (BRAZIL)
P042
EFFICACY AND OVERALL LEVEL OF AGREEMENT AMONG AUDITORY-PERCPTUAL AND INSTRUMENTAL ASSESSMENT OF SPEECH IN CLEFT LIP AND PALATE MARIA INES PEGORARO-KROOK, MAIRA PERICO, JENIFFER DUTKA, EDNA PADILHA , OLIVIA MESQUISTA VIEIRA DE SOUZA, FABIANE RODRIGUES, GABRIELA ZUIM, ANA FLAVIA RODRIGUES, GABRIELA LIMA (BRAZIL)
P031
RELATIONSHIP BETWEEN VERBAL IQ (VIQ) SCORES, PERFORMANCE IQPIQSUBTESTS, AND READING COMPREHENSION TEST IN HEARING-IMPAIRED CHILDREN KAHORU HASHIMOTO, MASAKO NOTOYA, HIROMI HARADA, MAKOTO ITO, TOMOKAZU YOSHIZAKI (JAPAN)
P032
THE PECULIARITIES OF PERCEPTION AND UNDERSTANDING OF LITERARY WORKS BY CHILDREN WITH SPEECH VIOLATIONS ZAHAROVA TATYANA VASILYEVNA ZAHAROVA, MOISEEVA ALYONA ANDREEVNA MOISEEVA (RUSSIAN FEDERATION)
P043
LANGUAGE SKILLS AND WORKING MEMORY IN CHILDREN WITH CLEFT PALATE MARIA DE LOURDES MERIGHI TABAQUIM TABAQUIM, MRCIA REGINA FERRO FERRO, DIONSIA APARECIDA CUSIN LAMNICA LAMNICA (BRAZIL)
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P044
NARRATIVE SKILLS AND BODY SCHEME DEVELOPMENT IN PERUVIAN IMMIGRANTS CHILDREN IN CHILE: PRELIMINARY OUTCOMES MARIANGELA MAGGIOLO LANDAETA, MARCELA VEGA RIVERO, MELITA CRISTALDI, RAL FERNNDEZ CARBONE (CILE)
P055
THE USE OF VERBS BY BRAZILIAN CHILDREN WITH DOWN SYNDROME: COMPARISON BETWEEN TWO SITUATIONS LIVIA MARIA IENNE, SUELLY OLIVAN LIMONGI (BRAZIL)
P056
SPEECH DISFLUENCY IN THE NARRATIVES OF BRAZILIAN PORTUGUESE SPEAKING CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT AND THEIR AGED-MATCHED PEERS DEBORA BEFI-LOPES, ANA CCERES, SUELEN MARQUES, MARCELY VIEIRA (BRAZIL)
P045
COMPARING EFFECTS BETWEEN ELECTRONIC AND PRINTED TEXTBOOKS IN JAPANESE CHILDREN WITH READING DIFFICULTIES YUMIKO TANAKA WELTY (JAPAN)
P046
ANALYSIS OF THE PRODUCTIVE PHONOLOGICAL KNOWLEDGE OF A CHILD WITH DOWN SYNDROME VA S. TAR (HUNGARY)
P057
LONG LATENCY AUDITORY EVOKED POTENTIALS (LLAEP) IN THE STUDY OF READING AND WRITING DISORDERS. A SYSTEMATIC REVIEW THAIS FREIRE, THAIS DOS SANTOS GONALVES, PATRCIA ABREU PINHEIRO CRENITTE (BRAZIL)
P047
SOCIAL INTERACTION AND COMMUNICATION OF CHILDREN WITH NEUROMOTOR DISABILITIES: PARENTS AND SLPS APPLICATION OF THE BRAZILIAN VERSION OF THE PEDI DANIELE THEODORO OSTROSCHI, REGINA YU SHON CHUN (BRAZIL)
P058
SPEECH-LANGUAGE PATHOLOGIST INTERVENTION ON THE MACROSTRUCTURE OF ORAL NARRATIVE IN BRAZILIAN CHILDREN WITH DOWN SYNDROME PILOT STUDY ROSANGELA VIANA ANDRADE, SUELLY C. O. LIMONGI (BRAZIL)
P048
THE PECULIARITIES OF NONVERBAL CODING AND DECODING OF NONVERBAL MEANS OF COMMUNICATION OF CHILDREN WITH THE SPEECH UNDERDEVELOPMENT LEKHANOVA OLGA LEO;DOVNA LEKHANOVA (RUSSIAN FEDERATION)
P059
HEBREW LANGUAGE ASSESSMENT MEASURE FOR PRESCHOOL CHILDREN: A COMPARISON BETWEEN TYPICALLY DEVELOPING CHILDREN AND CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT IRIT KATZENBERGER, SARA MEILIJSON (ISRAEL)
P049
EFFICACY OF THE VISO-MOTOR INTERVENTION FOR STUDENTS WITH DEVELOPMENTAL DYSLEXIA CAPELLINI SIMONE, FUSCO NATLIA, GERMANO GISELI DONADON (BRAZIL)
P060
ARTICULATORY AND PHONOLOGICAL CHARACTERISTICS OF CHILDREN WITH SSD AND ABSENT SOUNDS HAYDE FISZBEIN WERTZNER, THAS ZEMLICKAS SILVA, MARINA JORGE PULGA, LUCIANA OLIVEIRA PAGAN-NEVES (BRAZIL)
P050
CONTRIBUTIONS OF SPEECH-LANGUAGE PATHOLOGY TO COMPREHENSIVE HEALTHCARE TO CHILDREN IN A UNIVERSAL HEALTHCARE SYSTEM KATIA DE CASSIA BOTASSO, MARIA TERESA PEREIRA CAVALHEIRO (BRAZIL)
P061
SPEECH INCONSISTENCY AND ARTICULATION RATE IN CHILDREN WITH SSD HAYDE FISZBEIN WERTZNER, DANIRA TAVARES FRANCISCO, TATIANE FARIA BARROZO, LUCIANA PAGAN-NEVES (BRAZIL)
P051
RAPID SERIAL NAMING, READING AND WRITING SKILLS IN STUDENTS OF BRAZILIAN ELEMENTARY EDUCATION BIANCA QUEIROGA, MARIANA PEIXOTO (BRAZIL)
P062
REPAIR STRATEGIES USED BY MANDARIN CHINESE SPEAKING CHILDREN WITH HIGH-FUNCTIONING ASD IN TAIWAN PAO-HSIANG CHI, PEI MEI LU (TAIWAN)
P052
PARENTING STYLES OF MOTHERS OF INDIVIDUALS WITH CLEFT PALATE ULLISSES HERRERA CHAVES, SIMONE APARECIDA LOPESHERRERA, OLGA MARIA PIAZENTIN ROLIM, JOSE ROBERTO PEREIRA LAURIS (BRAZIL)
P063
AN ACOUSTIC ANALYSIS OF FRICATIVE PRODUCTION A COMPARISON OF /S/ COARTICULATION DEVELOPMENT IN FINNISH-SPEAKING CHILDREN PENTTI KRKK (FINLAND)
P053
PERFORMANCE OF PHONOLOGICAL AWARENESS IN CHILDREN WITH ATTENTION DEFICIT HIPERACTIVITY DISORDER TALITA FERNANDA GONALVES, PATRICIA ABREU PINHEIRO CRENITTE (BRAZIL)
P064
LANGUAGE INTERVENTION IN ORAL NARRATIVES WITH AND WITHOUT TECHNOLOGICAL RESOURCES FOR CHILDREN WITH LANGUAGE DELAY NACHALE HELEN MACIEL BISPO, BIANCA RODRIGUES LOPES GONALVES, CAMILA MAYUMI ABE, CAMILLA GUARNIERI, SIMONE APARECIDA LOPES-HERRERA (BRAZIL)
P054
ABILITY OF CHILDREN TO CONSTRUCT PICTURE-BASED NARRATIVES IN RELATION TO COGNITIVE AND LINGUISTIC ABILITY MITSURU KOSAKA, JUN TANEMURA (JAPAN)
P065
PHONOLOGICAL ASSESSMENT - ANALYSIS COMPARING THE USE OF TRADITIONAL AND TECHNOLOGICAL RESOURCES ANA PAOLA NICOLIELO, BIANCA RODRIGUES LOPES GONALVES, CAMILA MAYUMI ABE, CAMILLA GUARNIERI, SIMONE APARECIDA LOPES-HERRERA (BRAZIL)
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P066
SPEECH DISTURBANCES IN CHILDREN WITH EPILEPSY YI-JEN CHEN, YUNG-JUNG CHEN, CHIN-HSING TSENG (CHINA)
P078
SCHOOLING INFLUENCE ON COGNITIVE-LINGUISTIC SKILLS MARIA SILVIA CRNIO CRNIO, BLENDA REGINA ZOCCAL LICAS LICAS, APARECIDO JOS COUTO SOARES SOARES (BRAZIL)
P067
RELATED ASPECTS TO THE CANDIDATE SUSCEPTIBILITY GENES FOR DEVELOPMENTAL DYSLEXIA: A SYSTEMATIC REVIEW THAS GONALVES, THAS FREIRE, PATRCIA CRENITTE (BRAZIL)
P079
RELATIONSHIPS BETWEEN SYNTACTIC DEVELOPMENT AND VOCABULARY AND CONVERSATIONAL ABILITIES IN PERSAVE DEVELPOMENTAL DISDODER CHILDREN DURING THE SCHOOL PERIOD SATSUKI ADACHI , YASUKO IKEDA, IKUYO FUJITA,HIROMI HARADA, KAHORU HASHIMOTO,MASAKO NOTOYA (JAPAN)
P068
DO AX AND ABX PERCEPTION TASKS PROVIDE THE SAME INFORMATION ABOUT PERCEPTION OF SPEECH SOUNDS IN CHILDREN WITH SPEECH SOUNDS DISORDERS? AMPARO YGUAL FERNNDEZ, JOS FRANCISCO CERVERA MRIDA (SPAIN)
P080
SPECIFIC LANGUAGE IMPAIRMENT: PERFORMANCE IN TESTS OF PHONOLOGICAL WORKING MEMORY AND OF SUSTAINED AUDITORY ATTENTION LIDIANE Y. SAWASAKI , MARIZA R. FENIMAN, SIMONE R.V. HAGE (BRAZIL)
P069
RECEPTIVE AND EXPRESSIVE VOCABULARY PERFORMANCE IN INDIVIDUALS WITH DIPLEGIA CEREBRAL PALSY DIONSIA APARECIDA CUSIN LAMNICA, CORA SOFIA TAKAYA PAIVA (BRAZIL)
P081
WISC-III INDEX SCORE PROFILES IN VELO-CARDIOFACIAL SYNDROME ASSOCIATED WITH VELOPHARYNGEAL INSUFFICIENCY MIYUKI GOTO, RYUSAKU HASHIMOTO, SATOKO KASAI, KENJI KOBAYASHI, EIKO TAMASHIGE, SATOKO IMAI, NORIKO NISHIZAWA (JAPAN)
P070
ANALYSIS OF PRODUCTION OF TEXTS OF THE BASIC EDUCATION SCHOOL OF BRAZILIAN CHILDREN MARIA APARECIDA G. SANTOS, NAYARA S. BARINI, SIMONE R.V. HAGE (BRAZIL)
P082
SPEECH-LANGUAGE PATHOLOGIST INTERVENTION ON THE MACROSTRUCTURE OF ORAL NARRATIVE IN BRAZILIAN CHILDREN WITH DOWN SYNDROME PILOT STUDY ROSANGELA VIANA ANDRADE, SUELLY LIMONGI (BRAZIL)
P071
COMMUNICATION AND RESPONSIVITY IN AUTISM SPECTRUM DISORDERS LILIANE P. MIILHER , FERNANDA DREUX M. FERNANDES (BRAZIL)
P083
DOES THE PATTERN OF SILENT PAUSES DIFFER BETWEEN TYPICALLY DEVELOPING CHILDREN AND CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT? DEBORA BEFII-LOPES, ANA CCERES, LETCIA BACCHIN, PAULA PEDOTT (BRAZIL)
P072
ASSESSMENT OF SEMANTIC AND LEXICAL SYSTEM IN DEVELOPENTAL AGE: RESEARCH THROUGH EXPRESSIVE VOCABULARY TEST-SECOND EDITION (EVT-2) LEONARDA GISOLDI, FEDERICA MANEO, CHIARA BORELLO (ITALY)
P084
EXPERIENCE IN RESEARCH OF METALINGUAL ABILITIES OF CHILDREN WITH SPEECH UNDERDEVELOPMENT NATALIA SHARIPOVA (RUSSIAN FEDERATION)
P073
FIGURATIVE LANGUAGE COMPREHENSION IN STUDENTS WITH READING DISABILITIES IN TAIWAN PAO-HSIANG CHI (TAIWAN)
P085
RELATIONSHIP BETWEEN VERBAL IQ (VIQ) SCORES, PERFORMANCE IQ (PIQ) SUBTESTS, AND READING COMPREHENSION TEST IN HEARING-IMPAIRED CHILDREN KAHORU HASHIMOTO, MASAKO NOTOYA, HIROMI HARADA, MAKOTO ITO (JAPAN)
P074
FAMILIAL AND GENETIC FACTORS IN NEURODEVELOPMENTAL DISORDERS: THE CASE FOR PRACTICE-BASED EVIDENCE MARIA VLASSOPOULOS , HAZEL RODDAM (GREECE, UK)
P075
FLUCTUATIONS IN (PSEUDO-)SYLLABLES OCCURRENCES IN ITALIAN CHILDREN FROM 6 TO 18 MONTHS OLD ANTONIO ROMANO, BRUNA SCANAVINO (ITALY)
P086
EARLY IDENTIFICATION AND INTERVENTION FOR CHILDREN WITH AUTISM IN BOLIVIA T. ROSARIO ROMAN, LINDA R WATSON, ELIZABETH R CRAIS (USA)
P076
EFFICACY OF THE USE OF ASSISTIVE TECHNOLOGY BY STUDENTS WITH DEVELOPMENTAL DYSLEXIA PINHEIRO FBIO HENRIQUE, CAPELLINI SIMONE (BRAZIL)
P087
AUDITORY PITCH PROCESSING IN 5- TO 6-YEAR-OLD CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT AND TYPICALLY DEVELOPING CHILDREN LEENA ERVAST, MATTI LEHTIHALMES, KAISU HEINNEN, SWANTJE ZACHAU, MARI VEIJOLA, ELISA HEIKKINEN, KAISA LOHVANSUU, KALERVO SUOMINEN, MIRJA LUOTONEN, PAAVO H.T. LEPPNEN (FINLAND)
P077
MEAN LENGTH UTTERANCE AS AN ASSESSMENT INSTRUMENT OF THE LINGUISTIC ABILITIES OF BRAZILIAN CHILDREN WITH DOWN SYNDROME ANGELA MARIA DE AMORIM CARVALHO, SUELLY OLIVAN LIMONGI (BRAZIL)
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P088
EARLY STAGE BRAIN PROCESSING OF SPEECH IS DIFFERENTLY RELATED TO READING MEASURES IN TYPICALLY READING CHILDREN AND THOSE WITH DYSLEXIA KAISA LOHVANSUU, JARMO A. HMLINEN, PAAVO H.T. LEPPNEN (FINLAND)
P099
ANALYSIS OF THE VOCAL RESISTANCE OF CHOIR SINGERS BY MEANS OF VOICE SELF-PERCEPTION BEFORE AND AFTER CONTINUOUS SINGING FERNANDA ONOFRE ONOFRE, EDWIN TAMASHIRO, MARIA YUKA ALMEIDA PRADO, HILTON MARCOS ALVES RICZ, LILIAN NETO AGUIARRICZ (BRAZIL)
P089
VALIDITY OF MANDARIN TOKEN TEST WITH TAIWANESE CHILDREN 7 TO 12 YEARS OLD USING RASCH MODEL ANALYSIS YUEH-HSIEN LIN, CHIN-HSING TSENG, YUH-YIH WU (TAIWAN)
P0100
RESULTS OF ESOPHAGEAL VOICE TRAINING LIBOR CERNY (CZECH REPUBLIC)
P090
PHONOLOGICAL REMEDIATION IN SCHOOLS WITH DEVELOPMENTAL DYSLEXIA: CONTRIBUTION COGNITIVE POTENTIAL P300 PATRCIA ABREU PINHEIRO CRENITTE, ERIKA FERRAZ (BRAZIL)
P0101
LENGTH OF PAUSES IN PROSODIC LIMITS IN THEATRICAL ACTING MILENA FRAGA (BRAZIL)
P0102
THE OLFACTORY AND GUSTATORY FUNCTIONS HAD BEEN DECREASED IN LARYNGECTOMYSED. ADA SALVETTI CAVALCANTI CALDAS , VERA LCIA DUTRA FACUNDES, DANIELE ANDRADE CUNHA, PATRCIA MARIA MENDES BALATA, LEILA BASTOS LEAL, LUCIANA NGELO BEZERRA, HILTON JUSTINO SILVA (BRAZIL)
P091
A RANDOMIZED CONTROLLED TRIAL OF TWO SYNTACTIC TREATMENT PROCEDURES IN SCHOOL-AGE CHINESE CHILDREN WITH LANUAGE DISORDERS CAROL K. S. TO, LOUISE W. O. HUI (HONG KONG)
P092
MACROSTRUCTURE ASPECTS IN THE ORAL NARRATIVE OF INDIVIDUALS WITH FETAL ALCOHOL SPECTRUM DISORDERS GIULIA GANTHOUS, NATALIA ROSSI, CLIA GIACHETI (BRAZIL)
P0103
ALTERNATIVE TONGUE MOTION (ATM) AS A DIAGNOSTIC TOOL FOR MUSCLE TENSION DYSPHONIA (MTD) OSAMU SHIROMOTO, MIKA TAKAHASHI , TOSHIHIDE HARADA (BRAZIL)
P093
INTERVENTION PROGRAM FOR DEVELOPMENT OF VERBAL COMMUNICATIVE SKILLS IN PARENTS OF CHILDREN WITH LANGUAGE DISORDERS BIANCA RODRIGUES LOPES GONALVES, NATHLIA BOCCA LOURENO MACHADO, CAMILA MAYUMI ABE, SIMONE APARECIDA LOPES-HERRERA (BRAZIL)
P0104
VOICE REHABILITATION OF PATIENTS WITH LARYNX BENIGN DISEASES IN COMBINATION WITH LARYNGOPGARYNGEAL REFLUX EKATERINA OSIPENKO, MARINA GERASIMENKO, NATALIA DERZHAVINA, NINA LAZARENKO (RUSSIAN FEDERATION)
P094
DYSPHONIA: EVALUATION OF CASE HISTORY MICHELE BARBARA, TERESA MAINO (ITALY)
P105
AN EVALUATION OF SINGLE BREATH PHONATION TIME TESTING AS AN INDICATOR OF VOCAL FUNCTION IN SPEECH TOMOYUKI HAJI (JAPAN)
P095
PERCEPTUAL AND ACOUSTIC VOICE CHARACTERISTICS FOLLOWING BOTULINUM TOXIN TREATMENT: A CASE STUDY JAYANTI RAY (USA)
P106
COENZYME Q10 TERCLATRATE + VITAMINE A IN THE TREATMENT OF FUNCTIONAL VOICE DISORDERS GIANCARLO PECORARI, JURI NADALIN, LUCA RAIMONDO, GIUSEPPE RIVA, MATTEO SENSINI, ANNA ACCORNERO, AGOSTINO SERRA, LUIGI MAIOLINO, MASSIMO MAGNANI, ANDREA RICCI MACCARINI, PASQUALE CASSANO, LUCIANO MAGALDI, CLAUDIO VICINI, ALDO CAMPANINI, GIORGIO PERETTI, RENZO MORA, CARLO ANTONIO LEONE, ANGELO CAMAIONI, VALERIO DAMIANI, GAETANO PALUDETTI, LUCIA DALATRI , MARCO DE VINCENTIIS, ANTONIO GRECO, GIOVANNI RUOPPOLO, CARLO GIORDANO (ITALY)
P096
THE STUDY OF THE VOICE THERAPY IN OUR DEPARTMENT ERI MIYATA, MAKOTO MIYAMOTO, KOICHI TOMODA (JAPAN)
P097
VOCAL COMPLAINTS AND QUALITY OF LIFE IN FEMALE TEACHING STUDENTS ELIANA FABRON, MARINA LUDOVICO MASTRIA, SIMONE FIUZA REGAONE, SUELY MAYUMI MOTONAGA, LUCIANA TAVARES SEBASTIO (BRAZIL)
P107
VOCAL PROFILE AND QUALITY OF LIFE AND VOICE IN PATIENTS SUBMITTED TO RADIOTHERAPY FOR ADVANCED HEAD AND NECK CANCER ALINE GONALVES, ELISABETE CARRARA DE- ANGELIS, RAFAELA TOSCANO, CSSIO PELLIZZON, CELSO MELLO, LUIS PAULO KOWALSKI, LUCIANA DALL AGNOL, RENATA AZEVEDO, FERNANDO LEONHARDT, MARCIO ABRAHO (BRAZIL)
P098
QUALITY OF LIFE, ACOUSTIC AND PERCEPTUAL ANALYSIS OF VOICE IN PARTIAL LARYNGECTOMY IARA BITTANTE DE OLIVEIRA OLIVEIRA, JOSE FRANCISCO SALLES CHAGAS CHAGAS, ELAINE PAVAN GAGARTINI GARGANTINI, ELIANE DOS SANTOS FERNANDEZ FERNANDEZ (BRAZIL)
P108
ANALISYS QUALITY OF LIFE AFTER VOICE THERAPY: A LOGITUDINAL STUDY ANA CRISTINA CRTES GAMA, JOSIANE MENDES FERREIRA, NATHLIA FERREIRA CAMPOS, IARA BARRETO BASSI, LETCIA CALDAS TEIXEIRA, MARCO AURLIO ROCHA SANTOS (BRAZIL)
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P109
COMPARISON OF NASALANCE BETWEEN TOTAL LARYNGECTOMEES WHO USE A TRACHEOESOPHAGEAL PROSTHESIS AND HEALTHY INDIVIDUALS LLIAN NETO AGUIAR-RICZ, ADRIANA PEREIRA DEFINA IQUEDA, TELMA KIOKO TAKESHITA-MONARETTI, HILTON MARCOS ALVES RICZ (BRAZIL)
P120
EFFECTS OF HYDRATION BEFORE AND AFTER VOCAL WARM-UP IN SINGERS Kelly C A Silverio (1), Ldia Cristina da Silva Teles ( 1), Carla Marques de Sousa Xavier (1), Maria Aparecida Miranda de Paula Machado (1)
P110
CHAOS THEORY AND NONLINEAR ACOUSTIC ANALYSIS: ARTICLES REVIEW RENATA FURIA (BRAZIL)
P121
VOICE ONSET TIME FOR THE WORD-INITIAL VOICELESS CONSONANT /T/ IN SPASMODIC DYSPHONIA -A COMPARISON WITH NORMAL CONTROLSSAORI YANAGIDA, NORIKO NISHIZAWA (JAPAN)
P111
TWO CASES DIAGNOSED WITH THYROARYTENOID MUSCLE PARALYSIS MAKOTO MIYAMOTO, ERI MIYATA, KOICHI TOMODA (JAPAN)
P122
USE OF SURFACE ELECTROMYOGRAPHY IN PHONATION STUDIES: AN INTEGRATIVE REVIEW PATRCIA MARIA MENDES BALATA, HILTON JUSTINO SILVA, KLYVIA JULIANA ROCHA MORAES, LEANDRO DE ARAJO PERNAMBUCO, LUCIANA NGELO BEZERRA, DANIELE ANDRADE CUNHA, SILVIA REGINA ARRUDA MORAES (BRAZIL)
P112
STUDY OF DISEASE MODELS OF VOCAL NODULES CHANGE OF THE POSITION OF THE VOCAL PROCESS DUE TO THE EFFECT OF VOICE TRAINING. YOSHIHIRO IWATA (JAPAN)
P123
INCOMPLETE SWALLOWING AND RETRACTED TONGUE MANEUVERS FOR ELECTROMYOGRAPHIC SIGNAL NORMALIZATION OF THE EXTRINSIC MUSCLES OF THE LARYNX PATRICIA MARIA MENDES BALATA, HILTON JUSTINO SILVA, GERLANE KARLA OLIVEIRA NASCIMENTO, KLYVIA JULIANA ROCHA MORAES, LEANDRO DE ARAJO PERNAMBUCO, MARIA CLARA R FREITAS, LEILANE M LIMA , RENATA S BRAGA, SNTIA R SOUZA, LUCIANA NGELO BEZERRA, DANIELE ANDRADE CUNHA, SILVIA REGINA A MORAES (BRAZIL)
P113
POSITION OF THE LARYNX DURING LYRICAL SINGING IN PROFESSIONAL AND AMATEUR FEMALE SINGERS SNIZHANA DRAHAN, HILTON RICZ , TELMA KIOKO TAKESHITAMONARETTI, LLIAN AGUIAR-RICZ (BRAZIL)
P114
ALTERNATIVE TONGUE MOTION (ATM) AS A DIAGNOSTIC TOOL FOR MUSCLE TENSION DYSPHONIA OSAMU SHIROMOTO, MIKA TAKAHASHI , TOSHIHIDE HARADA (JAPAN)
P124
VOICE RESISTANCE IN YOUNG WOMEN BEFORE AND AFTER CONTINUOUS TALKING FOR 30, 60, 90 AND 120 MINUTES LLIAN NETO AGUIAR-RICZ, PATRCIA MASSUCATTO MILANELLO , ARIANE DAMASCENO PELLICANI, LILIAM FERNANDA PAZETTO, PATRICIA PEREIRA, STHAEL ANDRADE MARQUES, HILTON MARCOS ALVES RICZ (BRAZIL)
P115
ADAPTATION TO THE DUTCH, VALIDATION AND NORMATIVE DATA OF THE VOICE HANDICAP INDEX-10 ANNELIES LABAERE, ELINE DE JONG, ELINE QUINTIENS (BELGIUM)
P125
MEASUREMENT OF VOCAL TRACT DIMENSION OF LARYNGECTOMEES USING PHARYNGOMETRY MANWA NG (HONG KONG)
P116
INFLUENCE OF SEVERE AIRFLOW LIMITATION ON SPEECH BREATHING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: PRELIMINARY OBSERVATIONS EVELIINA JOENSUU (FINLAND)
P126
PHONATION IN AN ATMOSPHERE OF 100% RELATIVE HUMIDITY: EFFECTS ON VOICE HOARSENESS ROSSELLA MUO, BARBARA RAMELLA, DANIELA SARANDRIA, ALFONSO BORRAGAN TORRE (ITALY SPAIN)
P117
VOICE AND SPEECH PROFICIENCY OF TOTAL LARYNGECTOMEES USING A TRACHEOESOPHAGEAL PROSTHESIS TELMA KIOKO TAKESHITA-MONARETTI, LLIAN NETO AGUIARRICZ, HILTON MARCOS ALVES RICZ (BRAZIL)
P127
ACOUSTIC COMPARISON BETWEEN TWO DIFFERENT TECHNIQUES OF ENDOSCOPIC RESECTION OF BENIGN LARYNGEAL LESIONS DR. REHAM EL-MAGHRABY, PROF. DR.MOHAMED ABD-EL MONEAM, PROF. DR. ALAA EL DIN GAAFAR, DR. SAAD ABD-EL GAWAD (EGYPT)
P118
AMPLITUDE OF ESOPHAGEAL PRESSURE IN TOTAL LARYNGECTOMEES USING A TRACHEOESOPHAGEAL PROSTHESIS DURING SWALLOWING AND PHONATION TELMA KIOKO TAKESHITA-MONARETTI, HILTON MARCOS ALVES RICZ , ROBERTO OLIVEIRA DANTAS, LLIAN NETO AGUIAR-RICZ (BRAZIL)
P128
THE ROLE OF COENZYME Q10 AND VIT.A IN SINGERS VOCAL RECOVERY: DOSIMETRIC ANALYSIS FRANCO FUSSI, GIACOMO BELLO (ITALY)
P119
NONLINEAR ANALYSIS OF VOICES OF PATIENTS UNDERGOING VERTICAL PARTIAL LARYNGECTOMY RENATA FURIA SANCHEZ, LDIA CRISTINA SILVA TELES (BRAZIL)
P129
TRANSLATION AND CROSS-CULTURAL VALIDATION OF THE SELF-EVALUATION OF COMMUNICATION EXPERIENCES AFTER LARINGECTOMY QUESTIONNAIRE FOR THE BRAZILIAN PORTUGUESE GABRIELA FAHL, BRBARA GARCIA DE GOULART (BRAZIL)
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P130
HOW TO BEHAVE THE LARYNGEAL MUCOSA OF DESCENDANTS OF CONSUMER OF CAFFEINE? (EXPERIMENTAL STUDY) GERLANE KARLA OLIVEIRA NASCIMENTO, DANIELE ANDRADE CUNHA, LUCIANA NGELO BEZERRA, HILTON JUSTINO SILVA, MARIA DE FTIMA GALDINO SILVEIRA (BRAZIL)
P141
FIRST RESULTS OF COMMUNICATIVE PARTICIPATION IN PRESCHOOL CHILDREN WHO STUTTER USING THE FOCUS-G SANDRA NEUMANN (GERMANY)
P142
MULTIDIMENSIONAL APPROACH OF SCHOOL-AGE JAPANESE CHILDREN WHO DEVELOPED STUTTERING FOCUSING ON DIRECT SPEECH TREATMENT MASAMUTSU KENJO (JAPAN)
P131
LOCALIZATION, FREQUENCY AND INTENSITY OF MUSCLE PAIN IN WOMEN WITH VOCAL NODULES KELLY CRISTINA ALVES SILVERIO, LARISSA DONALONSO SIQUEIRA, LDIA TELES, CHRISTIANO DE GIACOMO CARNEIRO, HARDYNN WESLEY SAUNDERS ROCHA TAVARES, ALCIONE GHEDINI BRASOLOTTO (BRAZIL)
P143
LISTENERS PERCEPTIONS OF DIGITALLY MANIPULATED MOMENTS OF HESITATIONS NORIMUNE KAWAI (JAPAN)
P132
LONG-TERM OUTCOME MEASUREMENTS OF VOCAL HYGIENE PROGRAM AND RESONANT VOICE THERAPY FOR HYPERFUNCTIONAL VOICE DISORDERED PATIENTS SHENG HWA CHEN (TAIWAN)
P144
SPEECH RATE CHARACTERISTICS OF FUTURE SPEECH LANGUAGE PATHOLOGISTS LAUREN LIPUMA, MICHELLE BACH, ELISA PITCHON, MARK PELLOWSKI (USA)
P133
TRAINING AND TESTING APPLICATION FOR AUDIO PERCEPTUAL EVALUATION VOICE-PE (VOICE PERCEPTUAL EVALUATION) SUSANA VAZ FREITAS, VTOR ALMEIDA , PEDRO MELO PESTANA, ANBAL FERREIRA (PORTUGAL)
P145
NEUROGENIC STUTTERING AFTER TRAUMATIC BRAIN INJURY. CHALLENGES IN EVALUATION NELLY LEIPAKKA, ANNA-MAIJA KORPIJAAKKO-HUUHKA (FINLAND)
P134
IMMEDIATE EFFECT OF LARYNGEAL MANUAL THERAPY IN DYSPHONIC WOMEN KELLY CRISTINA ALVES SILVERIO, ANA VITRIA RONDON, ANA PAULA REIMANN, LARISSA DONALONSO SIQUEIRA, LIDIA TELES, ALCIONE GHEDINI BRASOLOTTO (BRAZIL)
P146
DEVELOPMENT AND EVALUATION OF A CYBERTUTOR ABOUT HEARING HEALTH CAMILA DE CASTRO CORRA, RICELLY AVILA DA SILVA, CSSIA DE SOUZA PARDO-FANTON, WANDERLIA QUINHONEIRO BLASCA (BRAZIL)
P135
HESITATIONS IN THE BEGINNING OF ENUNCIATES: INTERVIEWS WITH CHILDREN ABOUT TWO KINDS OF PEDAGOGIC WORKSHOPS CRISTYANE CAMARGO SAMPAIO VILLEGA (BRAZIL)
P147
HEARING HEALTH EDUCATION IN BRAZIL WANDERLIA QUINHONEIRO BLASCA, CAMILA DE CASTRO CORRA, CSSIA DE SOUZA PARDO-FANTON (BRAZIL)
P136
ART THERAPY AS A PART OF COMPLEX THERAPY OF STUTTERING ILONA KEJKLICKOVA , PETR STANICEK, PAVEL FLORIAN (CZECH REPUBLIC)
P148
KANAZAWA METHOD-BASED LONG-TERM STUDY ON LANGUAGE DEVELOPMENT IN A CHIL WITH SEVERE HEARING IMPAIRMENT HIROMI HARADA, MASAKO NOTOYA, KAHORU HASHIMOTO, SATSUKI ADACHI, MAKOTO ITO, TOMOKAZU YOSHIZAKI (JAPAN)
P137
THE PROPRIOCEPTIVE ELASTIC METHOD IN THE SPEECH THERAPY TREATMENT OF FLUENCY DISORDERS GLORIA VILLA, ROSSELLA MUO, GIULIA CRISTINELLI, ANNA ACCORNERO (ITALY)
P149
ACOUSTIC CHANGES OF SPEECH SIGNAL AFTER COCHLEAR IMPLANTATION AT THE AGE OTHER THAN OPTIMAL KATARINA PAVICIC DOKOZA, ADINDA DULCIC, KORALJKA BAKOTA (CROATIA)
P138
EFFECTS OF COGNITIVE TRAINING ON VERBAL FLUENCY IN ADULTS WITH DOWN SYNDROME. Renata SalvadorinI, MARGHERITA BOZZA, STEFANIA BARGAGNA (ITALY)
P150
EPIDEMIOLOGICAL ASPECTS OF HEARING HEALTH WITH EMPHASIS IN CERUMEN IMPACTION IN INSTITUTIONALIZED ELDERLY OF BAURU, SO PAULO, BRASIL ALINE ARAKAWA , RAFAEL DAMASCENO, ELEN FRANCO, CRISTINA SANTO, JOS ROBERTO BASTOS, MAGALI CALDANA (BRAZIL)
P139
ORAL READING GUIDANCE AND TRAINING TO JAPANESE CHILDREN WHO STUTTER WITH READING PROBLEMS MASAKI WATANABE, MASAMUTSU KENJO (JAPAN)
P151
ANALYSIS OF HEARING SCREENING IN PREMATURE DIONSIA APARECIDA CUSIN LAMNICA, CAROLINE KAUFFMANN BECARO, NAYARA SALOMO BARINI, SIMONE ROCHA DE VASCONCELLOS HAGE, KTIA DE FREITAS ALVARENGA (BRAZIL)
P140
A CASE STUDY ON THE EFFICACY OF A FLUENCY SHAPING THERAPY WITH COGNITIVE-BEHAVIORAL APPROACH ON A MANDARIN-SPEAKING ADULT WITH STUTTERING TSUNG-HSIEN TSAI, SHU-LAN YANG, JUNG-JIUN SHIE, YAFANG CHENG (CHINA)
55
P152
MEASUREMENT OF THE SIGNAL/NOISE RATIO IN CLASSROOMS OF CHILDREN USERS OF FM SYSTEM MARIA RENATA JOS, VANESSA LUISA DESTRO FIDNCIO, REGINA TANGERINO DE SOUZA JACOB, ADRIANE LIMA MORTARI MORET, MARIA CECLIA BEVILACQUA (BRAZIL)
P162
THE FUNCTIONAL AUDITORY PERFORMANCE INDICATORS APPLIED TO BRAZILIAN CHILDREN KARINA FERREIRA, REGINA TANGERINO SOUZA JACOB, MARIA CECILA BEVILACQUA, ADRIANE LIMA MORTARI MORET (BRAZIL)
P153
EFFECTS OF SPEECH STIMULUS ON CORTICAL AUDITORY EVOKED POTENTIALS AND AUDITORY COGNITIVE P3 KTIA DE FREITAS ALVARENGA, LETICIA CRISTINA VICENTE, RAQUEL CAROLINE FERREIRA LOPES, RUBEM ABRO SILVA, MARCOS ROBERTO BANHARA (BRAZIL)
P163
THE PECULIARITIES OF PRONUNCIATION OF ORAL SPEECH AND ITS SELF-CHECKING OF DEAF CHILDREN DENISOVA OLGA ALEXANDROVNA DENISOVA, KAZANSKAYA VERA LVOVNA KAZANSKAYA (RUSSIAN FEDERATION)
P154
ARTERIOSCLEROSIS AS A CAUSE OF GENDER DIFFERENCES IN HEARING LOSS BASED ON ANTI-AGING HEARING DOCK FINDINGS KAZUYO MISE, NOBUHIRO HAKUBA, YASUHARU TABARA, KIYOFUMI GYO (JAPAN)
P164
RELATIONSHIP BETWEEN FREQUENCY-SPECIFIC AUDITORY BRAINSTEM RESPONSE AND BEHAVIORAL THRESHOLDS IN CHILDREN WITH HEARING LOSS NATLIA RAMOS, MABEL GONALVES ALMEIDA, DORIS R LEWIS (BRAZIL)
P155
COMPARING TONEBURST AND NARROW BAND CE-CHIRP AUDITORY BRAINSTEM RESPONSES (ABRS) IN YOUNG INFANTS GABRIELA I R RODRIGUES, DORIS R LEWIS (BRAZIL)
P165
THE DEVELOPMENT OF AUDITORY PROCESSING TEST BATTERY FOR CHILDREN BEY-LIH CHANG, FANG-LIU SU (TAIWAN)
P166
ASSOCIATION BETWEEN TEMPORAL AUDITORY PROCESSING AND PHONOLOGICAL AWARENESS IN CHILDREN WITH READING AND WRITING DISORDERS APARECIDO JOS SOARES, SEISSE GABRIELA SANCHES, NADIA VILELA, DBORA CRISTINA ALVES, RENATA M CARVALLO, MARIA SILVIA CARNIO (BRAZIL)
P156
THE MATURATION OF THE AUDITORY NERVE AND BRAINSTEM IN THE FIRST YEAR OF LIFE LETICIA CRISTINA VICENTE, KTIA DE FREITAS ALVARENGA, JOICY AMORIM, RAQUEL SAMPAIO AGOSTINHO-PESSE, LILIAN CSSIA BORNIA JACOB-CORTELETTI (BRAZIL)
P157
CHANGES IN ELDERLY ORAL COMMUNICATION: HEALTH KNOWLEDGE TRANSMISSION TO PROFESSIONALS IN THE AMAZON REGION ALINE MEGUMI ARAKAWA, NATLIA CARLETO, ELEN CAROLINE FRANCO, CRISTINA SANTO, ARIDNES OLIVEIRA, MNICA FRANA, JOS ROBERTO BASTOS, MAGALI CALDANA (BRAZIL)
P167
UNIVERSAL NEONATAL HEARING SCREENING PROGRAMME AT VENEZUELA RAMON HERNANDEZ-VILLORIA (VENEZUELA)
P168
OUTCOMES IN ELDERLY PATIENTS WITH COCHLEAR IMPLANT ALICE BENATTI, ROBERTO BOVO, VALENTINA CARRIERI, ALESSANDRO MARTINI (ITALY)
P158
COCHLEAR FUNCTION AT ULTRA-HIGH FREQUENCIES IN PARENTS OF INDIVIDUALS WITH AUTOSOMAL RECESSIVE HEARING LOSS JAQUELINE MEDEIROS MELLO, VALTER AUGUSTO DELLAROSA, SEISSE GABRIELA SANCHES (BRAZIL)
P169
PHONIATRIC-AND SPEECH THERAPY MANAGEMENT IN AMYOTROPHIC LATERAL SCLEROSIS IN PIEDMONT VALENTINA PASIAN, ELENA PIUMETTO, ANNA ACCORNERO, ROBERTO ALBERA, ADRIANO CHI (ITALY)
P159
HEARING IMPAIRED CHILDREN AND COCHLEAR IMPLANT: LANGUAGE AND AUDITORY SKILL DEVELOPMENT ELIANE DELGADO PINHEIRO (BRAZIL)
P170
TONGUE BASE HYPERTROPHY AS A CAUSE OF DYSPHAGIA MASSIMO SPADOLA BISETTI, ANTONELLA CUSIMANO (ITALY)
P171
AN ALGORITHM FOR MANAGING THE TREATMENT OF PATIENTS WITH SWALLOWING DISORDER EGLUTE SLIAUTERIENE (LITHUANIA)
P160
THEORY OF MIND AND DEAFNESS: IMPLICATIONS FOR LITERACY AND SOCIAL DEVELOPMENT ELIZABETH MARTINEZ (USA)
P172
CASE REPORT: COMBINED TREATMENT OF APHASIA AND APHONIA WITH SURFACE ELECTRICAL STIMULATION OF THE PHARYNGEAL MUSCLES ( VITALSTIM SYSTEM) MARCO ANDREOLI, MARIUCCIA FRANZONI, MARIA GRAZIA CATTANEO (ITALY)
P161
WHICH CHARACTERISTCS ARE ASSOCIATED WITH AUDITORY PROCESSING DISORDERS: A SYSTEMATIC REVIEW ELLEN DE WIT, MARGOT VISSER-BOCHANE, CEES VAN DER SCHANS, BERT STEENBERGEN, PIM VAN DIJK, MARGREET LUINGE (NETHERLANDS)
P173
DYSPHAGIA IN ADULT AND ELDERLY PATIENTS: PRESENTATION OF A HEALTH CARE PATHWAY SPADOLA BISETTI MASSIMO, MU ROSSELLA, VERNERO IRENE, PALMO AUGUSTA, ROVERA LIDIA, MANCINO VITTORIA, FARINA ENZO C., RAIMONDO SIMONA (ITALY)
56
P175
APPLICATION OF SURFACE ELECTROMYOGRAPHY IN ASSESSMENT OF SWALLOWING FUNCTION IN DYSPHAGIC STROKE PATIENTS MEI-JU KO, TYNG-GUEY WANG, WEI-NI CHOU, BOR-SHYH LIN, CHIN-HSING TSENG (TAIWAN)
P186
MEALTIME ASSESSMENT SCALE (MAS) MARCO GILARDONE, DEBORA VALENTINI, ANTONIO SCHINDLER (ITALY)
P187
QUANTITATIVE INSTRUMENTS FOR SMELL EVALUACION IN CHILDREN: AN ITEGRATIVE REVIEW RAISSA GOMES FONSECA MOURA, DANIELE ANDRADE CUNHA, LUCIANA NGELO BEZERRA, CAROLINA DE LIMA GUSMO GOMES, HILTON JUSTINO SILVA (BRAZIL)
P176
HISTOLOGICAL CHARACTERISTICS OF HUMAN LINGUAL FRENULUM ROBERTA LOPES DE CASTRO MARTINELLI, IRENE QUEIROZ MARCHESAN, REINALDO JORDO GUSMO, GIDRE BERRETIN-FELIX, ANTONIO DE CASTRO RODRIGUES (BRAZIL)
P177
SWALLOWING DISORDERS IN MYOTONIC DYSTROPHY TYPE 1 EMANUELE GOBBI, ANTONELLO DAMIANI, GIUSEPPE MARIA ANTONIO ALGIERI, MARIA CRISTINA GORI, FLAVIA RUBINI, MAURIZIO CRISPO (ITALY)
P188
LINGUAL FRENULUM AT THE FIRST MONTHS OF LIFE MARCHESAN IRENE, MARTINELLI ROBERTA (BRAZIL)
P189
STUDY ON SUCKING IN THE FIRST TWO MONTHS OF LIFE USING A NEW GENERATION NIPPLE ELENA GROSSO, ANNA SCARANO, PAOLA CIRAVEGNA, IRENE VERNERO (ITALY)
P178
SEVERE ACQUIRED BRAIN INJURY AND TRACHEAL CANNULA: SPEECH THERAPY-PHISIOTHERAPY INTEGRATED APPROACH ROSSELLA BESSONE, PATRIZIA CANCIALOSI, MELANIA SAFFILA, ANNA MORRA, MAURIZIO BEATRICI (ITALY)
P190
DYSPHAGIA IN SEVERE ACQUIRED BRAIN INJURY AND SPINAL CORD INJURY PATIENTS FROM ACUTE PHASE: A THERAPEUTIC PATH PURPOSE PATRIZIA CANCIALOSI, ROSSELLA BESSONE, MELANIA SAFFILA, NADIA AFFILASTRO, GIOVANNA BALL , ANGELA LUCIA FOGLIATO, MAURIZIO BEATRICI (ITALY)
P179
A DYNAMIC VIDEOFLUOROSCOPIC EVALUATION OF DYSPHAGIA IN PROGRESSIVE NEURODEGENERATIVE DISEASES SATOKO KASAI, NORIKO NISHIZAWA, ERIKA KUDOU, TOMOKO IIZUMI, KENJI KINOSHITA, FUMIYUKI SUZUKI, SEIJI KIKUCHI (JAPAN)
P191
INTERDISCIPLINARY MEDICAL AND NO MEDICAL APPROACH TO THE DYSFAGIC PATIENT. WHEN THE RIABILITATION ENTER IN THE HOSPITALS KITCHEN: BIELLAS EXPERIENCE MENEGHELLO MARA (ITALY)
P180
CHEWING AND SWALLOWING IN POMPES DISEASE AND MITOCHONDRIAL DISEASE ZELITA GUEDES, NOEMIA CAROLINE SOUZA, LUIZA TELES BARRETO MENDES, ANA MARIA MARTINS (BRAZIL)
P192
INTEGRATION BETWEEN CLINICAL AND INSTRUMENTAL EVALUATION IN PEDIATRIC DYSPHAGIA: EXPERIENCE IN A URBAN TERTIARY CARE HOSPITAL OF TURIN ELENA GROSSO, ELENA FAVERO, ELSA JULIANI, DEBORAH BONELLI, ANTONIO SCHINDLER, OSKAR SCHINDLER, ROBERTO ALBERA (ITALY)
P181
LINGUAL FRENOTOMY: CHANGES IN SUCKING AND SWALLOWING IRENE QUEIROZ MARCHESAN, SLPS; ROBERTA LOPES DE CASTRO MARTINELLI, SLPS; REINALDO JORDO GUSMO, ENT (BRAZIL)
P182
MANEUVER FOR VISUALIZATION OF POSTERIOR LINGUAL FRENULUM IN INFANTS MARTINELLI ROBERTA, MARCHESAN IRENE (BRAZIL)
P193
CLINICAL PROGNOSTIC INDICATORS OF SWALLOWING FUNCTIONAL OUTCOME FOLLOWING PROLONGED OROTRACHEAL INTUBATION DANIELLE MORAES, CLAUDIA REGINA ANDRADE (BRAZIL)
P183
RELATIONSHIP BETWEEN THE ANATOMIC CHARACTERISTICS OF THE LINGUAL FRENULUM AND SUCKING AND SWALLOWING FUNCTIONS IN INFANTS ROBERTA MARTINELLI; IRENE MARCHESAN; GIEDRE BERRETIN-FELIX (BRAZIL)
P194
DYSPHAGIA IN CHILDREN WITH SEVERE MALFORMATION, NEUROLOGIC IMPAIRMENT OR GENETIC DISEASES ZELITA GUEDES (BRAZIL)
P195
FUNCTIONAL OUTCOMES OF SWALLOWING REHABILITATION IN HEAD AND NECK CANCER PATIENTS. A RETROSPECTIVE EVALUATION. LAURA OMEGNA, GIULIA GINTOLI, SILVIA ROSSO, GISELLA GHIGO, PATRIZIA STENI (ITALY)
P184
RESULTS OF PILOT STUDY: APPLICATION OF CAREGIVER MEALTIME AND DYSPHAGIA QUESTIONNAIRE VITROTTI LAURA, RAIMONDO SIMONA, BERGAMASCO LAURA (ITALY)
P185
USE OF SCALE DRS (DYSPHAGIA RISK SCORE) FOR THE IDENTIFICATION OF THE DYSPHAGIC PATIENT AT HOME MONICA PANELLA, MARA MENEGHELLO, BIBIANA ZULBERTI, DENISE TRUISI, LIA RUSCA, MICHELANGELO VALENTI (ITALY)
P196
OROPHARYNGEAL DYSPHAGIA IN PATIENTS AFFECTED BY HEAD AND NECK CANCER UNDERGOING COMBINED RADIOTHERAPY, CHEMIOTHERAPY AND SURGICAL TREATMENT VALENTINA BONSANGUE, CHIARA DI PEDE, ANTONIO FRIZZIERO, STEFANO MASIERO (ITALY)
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P197
MULTIDISCIPLINARY EVALUATION OF AGE-RELATED SWALLOWING DISORDERS BY ENDOSCOPIC, FLUOROGRAPHIC AND MANOMETRIC STUDIES KAORI NISHIKUBO, MASAMITSU HYODO (JAPAN)
P209
MANAGING DEMANDS AFTER A MEDICAL TRAUMA: CAREGIVER PERSPECTIVES AND STRATEGIES ROANNE BRICE, ALEJANDRO BRICE (USA)
P198
A DEVICE FOR QUANTITATIVE EVALUATION OF CHEEK FORCE BERBERT MONALISE, THOMAS CARLOS, MARCHESAN IRENE, MARCZAK ROGRIO (BRAZIL)
P210
TREATMENT-INDUCED SPEECH AND LANGUAGE RELEARNING PROCESS IN APHASIA AND LINGUISTIC NEUROPLASTICITY PAULA HEIKKINEN, ANU KLIPPI, JYRKI MKEL (FINLAND)
P199
HYOLARYNGEAL MUSCLE ACTIVATION DURING TWO REHABILITATIVE DYSPHAGIA EXERCISES CHRISTOPHER WATTS (USA)
P211
APHASIA AN ALTERATION OF THE VERBAL GESTURE: EVALUATION AND REHABILITATION. ANTROPO-PHENOMENOLOGY APPROACH LIDIA GOMATO (ITALY)
P200
EARLY SPEECH THERAPY INTERVENTION FOR PRESCHOOL CHILDREN IN BILINGUAL ENVIRONMENTS CHIERI KATO (GERMANY)
P212
EFFECTIVENESS OF MELODIC INTONATION THERAPY IN APHASIC PATIENT: A CASE REPORT CRISTINA ESPRITO SANTO, ALINE MEGUMI ARAKAWA, ELEN CAROLINE FRANCO, NATLIA GUTIERREZ CARLETO, MAGALI DE LOURDES CALDANA (BRAZIL)
P201
MULTILINGUAL CHILDREN IN SPEECH THERAPY SERVICES IN PIEDMONT GIULIA GIUNTOLI, IRENE VERNERO (ITALY)
P213
CRITERIA FOR DESIGNING ARABIC AUGMENTATIVE COMMUNICATION SOFTWARE FOR DYSPHASIA PATIENTS AMAL SALAHELDIN DARWISH (EGYPT)
P202
TEAMING ACROSS CULTURES: PROGRAM DEVELOPMENT FOR MEXICAN CHILDREN WITH DISABILITIES T. ROSARIO ROMAN, SANDRA NETTLETON, MARIA GUADALUPE MARENTES (USA)
P214
ASSESSING LANGUAGE IN GREEK APHASIC PATIENTS USING THE COMPREHENSIVE APHASIA TEST (CAT) SOULTANA PAPADOPOULOU, ELENI MORFIDI (GREECE)
P203
FEAUTURES OF SOCIOCULTURAL ADAPTATION OF YOUNGER SCHOOL-AGED CHIL-DREN BROUGHT UP IN BILINGUAL MIGRANT FAMILIES IRINA BUCHILOVA, TARLAN ALIYEVA (RUSSIAN FEDERATION)
P215
CONVERSAZIONI NARRATIVE LABORATORY TO ENHANCE FUNCTIONAL COMMUNICATION BETWEEN PERSONS WITH APHASIA: A PRELIMINARY STUDY ROSSELLA MUO, MARISTELLA CRIELESI, MARCELLA DI PIETRO, STEFANO MONTE (ITALY)
P204
BILINGUAL PERSON WITH SEVERE ACQUIRED BRAIN INJURY: AN APPROPRIATE LOGOPEDIC TAKE IN CHARGE PATRIZIA CANCIALOSI, MELANIA SAFFILA, ROSSELLA BESSONE, ELISA CARRABS, ELENA ARNOLFO, GIULIA PIVOTTO (ITALY)
P216
DISORDERS OF CONSCIOUSNESS AND AWARENESS IN SEVERE ACQUIRED BRAIN INJURY: BIOETHICS COMPARE WITH SPEECH THERAPY ANGELA LUCIA FOGLIATO, SARA VESCO, CARLA CORBELLA, FRANCA BALBO MOSSETTO (ITALY)
P205
RELATIONSHIP BETWEEN CHILD EXPOSURE TO MULTIPLE LANGUAGES AND COMMUNICATION PROBLEMS KARIN GENARO, RUTH PA, MARIA CLAUDIA CUNHA (BRAZIL)
P217
CORRELATION BETWEEN QUALITY OF LIFE OF THE APHASIC PATIENT AND HIS FAMILY NATALIA CARLETO, ALINE ARAKAWA, CRISTINA SANTO, ELEN FRANCO, MAGALI CALDANA (BRAZIL
P206
WORKING WITH CLIENTS FROM CULTURALLY AND LINGUISTICALLY DIVERSE BACKGROUNDS: KNOWLEDGE, PERCEPTIONS AND EXPERIENCE OF FINAL YEAR SPEECH PATHOLOGY STUDENTS IN AUSTRALIA CORI WILLIAMS (AUSTRALIA)
P218
APHASIA GROUPS: A DISCUSSION ABOUT THE SPEECH LANGUAGE REHABILITATION ANA PAULA SANTANA, ANA CRISTINA GUARINELLO (BRAZIL)
P207
THE INDUCTIVE APPROACH FOR LANGUAGE ASSESSMENT WITH MULTILINGUAL CHILDREN BY MONOLINGUAL THERAPISTS WIEBKE SCHARFF RETHFELDT (GERMANY)
P219
BENEFITS OF A PROGRAM OF SPEECH LANGUAGE PATHOLOGY AND PSYCHOLOGICAL ORIENTATION TO FAMILIES OF BRAIN INJURED PATIENTS NATALIA CARLETO, MARIA LUCIA DE CARVALHO, MAGALI CALDANA (BRAZIL)
P208
A FIRST PERSON ACCOUNT OF RECOVERY FROM A SUB-ARACHNOID HEMORRHAGE ALEJANDRO BRICE, ROANNE BRICE (USA)
P220
A CASE OF FOREIGN LANGUAGE ICTAL SPEECH ASSOCIATED WITH TEMPORAL LOBE EPILEPSY ELENI DIMA, ANITA MCALLISTER, HELENA GAUFFIN, ANNEMARIE LANDTBLOM (SWEDEN)
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P221
SPEECH THERAPY GROUP EFFICACY FOR PRAGMATIC DISORDERS IN PATIENTS WITH SEVERE ACQUIRED BRAIN INJURY VALENTINA CANTOIA, FRANCESCA AUXILIA, PAOLA TAVERNA, PATRIZIA CANCIALOSI (ITALY)
P231
RE-EXAMINING VERB DEFICITS EXHIBITED BY JAPANESE SPEAKERS WITH APHASIA IN SUB-TESTS OF SALA NORIKO NAGATSUKA, TAKASHI YOSHIDA (JAPAN)
P232
CROSS-CULTURAL ADAPTATION INTO ITALIAN AND VALIDATION OF THE AMERICAN SPEECH-LANGUAGE AND HEARING ASSOCIATION - FUNCTIONAL ASSESSMENT OF COMMUNICATION SKILLS FOR ADULTS (ASHA-FACS) ROSSELLA MUO, PATRIZIA CANCIALOSI, BARBARA CARRUBBA CACCIOLA, LAURA GALIMBERTI, ANTONIO SCHINDLER (ITALY)
P222
APHASIA: CHANGES IN NEUROIMAGING AFTER TREATMENT SPEECH THERAPY, CASE REPORT ANGELA LUCIA FOGLIATO, SARA VESCO, ROSSELLA BESSONE, ANGELINA CISTARO, PIERCARLO FANIA, MAURIZIO BEATRICI, FRANCA BALBO MOSSETTO (ITALY)
P223
PERSONS WITH APHASIA AFTER CVA AND SUBJECTS WITH DEGENERATIVE DISORDERS OF CNS - COMPARATIVE STUDY WITH USING CZECH EXPERIMENTAL VERSION THE BUTT NON-VERBAL REASONING TEST KAREL NEUBAUER, UHAJDOV, IVETA MRZKOV (CZECH REPUBLIC)
P233
NOSTRIL MORPHOMETRY EVALUATION BEFORE AND AFTER CLEFT LIP SURGICAL CORRECTION: CLINICAL EVIDENCES MARIO JORGE FRASSY FEIJO, STELLA RAMOS BRANDO, RUI MANOEL RODRIGUES PEREIRA, MARIANA BATISTA DE SOUZA SANTOS, LUCIANA NGELO BEZERRA, DANIELE ANDRADE CUNHA, HILTON JUSTINO SILVA (BRAZIL)
P224
THERAPEUTICAL FOLLOW-UP OF NON-FLUENT APHASIC SUBJECTS: THE LINGUISTIC-COGNITIVE WORK THROUTH THE DEVELOPMENT OF NARRATIVES CAZAROTTI PACHECO MIRIAN, NOVAES PINTO ROSANA DO CARMO (BRAZIL)
P234
ORAL BREATH: CHEWING CHANGES IN AN ALLERGIC RHINITIS AN INTEGRATIVE REVIEW LUCIANA NGELO BEZERRA, DANIELE ANDRADE CUNHA, ANA CAROLINA CARDOSO MELO, KLYVIA JULIANA ROCHA MORAES, RENATA ANDRADE CUNHA, PATRCIA MARIA MENDES BALATA, DCIO MEDEIROS, HILTON JUSTINO SILVA (BRAZIL)
P225
EFFECTS OF ORAL READING VERSUS CONFRONTATION NAMING ON COGNITIVE PROCESSING SPEED IN ELDERLY INDIVIDUALS AGES 65-74 YEARS CHRISTY FLECK, MELINDA CORWIN (USA)
P235
HEAD AND NECK POSTURE IN CHILDREN WITH MOUTH BREATHING SECONDARY TO ALLERGIC RHINITIS LUCIANA NGELO BEZERRA, HILTON JUSTINO SILVA, ANA CAROLINA CARDOSO MELO, KLYVIA JULIANA ROCHA MORAES, RENATA ANDRADE CUNHA, GERLANE KARLA BEZERRA OLIVEIRA NASCIMENTO, DANIELE ANDRADE CUNHA, DCIO MEDEIROS (BRAZIL)
P226
EMOTINAL WORK WITH APHASIC PERSONS: USING LANGS IMAGES ALBERTO GIACHERO, MARIATERESA MOLO, MARINA ZETTIN, MAURIZIO TIRASSA, STEFANO BALASINI, CRISTIAN RUGIERO, MELANIE CALATI (ITALY)
P236
CHEWING TIME IN ORAL BREATHING SECONDARY TO ALLERGIC RHINITIS LUCIANA NGELO BEZERRA, DANIELE ANDRADE CUNHA, ANA CAROLINA CARDOSO MELO, KLYVIA JULIANA ROCHA MORAES, RENATA ANDRADE CUNHA, PATRCIA MARIA MENDES BALATA, GERLANE KARLA BEZERRA OLIVEIRA NASCIMENTO, DCIO MEDEIROS, HILTON JUSTINO SILVA (BRAZIL)
P227
PROMOTING PARTICIPATION IN PERSONS WITH APHASIA: A MULTIPROFESSIONAL SOCIAL APPROACH ROSSELLA MUO, MARCELLA DI PIETRO, MARISTELLA CRIELESI, ALESSIA CONGIA, LORENA LA ROCCA, STEFANO MONTE (ITALY)
P237
NOSTRIL MORPHOMETRIC ANALYSIS PRE AND POST-SURGERY IN CLEFT-LIP CHILDREN MARIO JORGE FRASSY FEIJO, STELLA RAMOS BRANDO, RUI MANOEL RODRIGUES PEREIRA, MARIANA BATISTA DE SOUZA SANTOS, DANIELE ANDRADE CUNHA, LUCIANA NGELO BEZERRA, HILTON JUSTINO SILVA (BRAZIL)
P228
SPEECH-LANGUAGE PATHOLOGISTS PERCEPTIONS OF THE ROLE OF MULTIMODAL COMMUNICATION ASSESSMENT FOR PEOPLE WITH APHASIA MALI GIL, TAL LEBEL (ISRAEL)
P229
RELATIONSHIP BETWEEN BRAIN ACTIVITY IN WORD GENERATION UNDER DIFFERENT STRATEGIES AND INDIVIDUAL DIFFERENCE OF WORKING MEMORY CAPACITY: AN FMRI STUDY MIMPEI KAWAMURA (JAPAN)
P238
OROPHARYNGEAL EXERCISES IMPROVED ADHERENCE TO CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT GIOVANA DIAFRIA, ROGERIO SANTOS-SILVA, EVELI TRUKSINAS, FERNANDA HADDAD, RENATA SANTOS, SILVANA BOMMARITO, LUIZ CARLOS GREGRIO, SERGIO TUFIK, LIA RITA AZEREDO BITTENCOURT (BRAZIL)
P230
PRODUCTION OF L1-L2 COMMON SYLLABLES IN APRAXIA OF SPEECH: A STUDY OF BILINGUAL PRODUCTION IN A LATE SWEDISH-FRENCH BILINGUAL MARY OVERTON VENET, MARINA LAGANARO (SWISS)
P239
THE IMPACT OF MUSIC THERAPY IN THE PARKINSONS DISEASES TREATMENT ELEN FRANCO, ALINE MEGUMI ARAKAWA, CRISTINA DO ESPIRITO SANTO, NATLIA GUTIERREZ CARLETO, MNICA LIMA FRANA, ARIADNES NOBREGA OLIVEIRA, MAGALI DE LOURDES CALDANA (BRAZIL)
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P240
PERCEPTUAL AND ACOUSTIC VOICE AND SPEECH ANALYSIS IN DYSARTHRIAS MARINA PADOVANI, MARA BEHLAU (BRAZIL)
P251
COGNITIVE-PERCEPTUAL EXAMINATION OF REMEDIATION APPROACHES TO HYPOKINETIC DYSARTHRIA MEGAN MCAULIFFE, SARAH KERR, ELIZABETH GIBSON, TIM ANDERSON, PATRICK LASHELL (NEW ZEALAND)
P241
EFFECT OF SPEECH THERAPY AS ADJUNCT TREATMENT TO CPAP, ON THE QUALITY OF LIFE OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA GIOVANA DIAFRIA, LUCIANA BADKE, ROGRIO SANTOSSILVA, SILVANA BOMMARITO, SERGIO TUFIK, LIA RITA AZEREDO BITTENCOURT (BRAZIL)
P252
THE IALP VALUE FOR THE DEVELOPMENT OF LOGOPEDICS AND PHONOATRICS IN RUSSIA OLGA ORLOVA , GENNADY IVANCHENKO, LEV RUDIN, ELENA LEVINA (RUSSIAN FEDERATION)
P242
AGLOSSIA: CASE REPORT SILVANA BOMMARITO, LUCIANA ESCANOELA ZANATO, MARILENA MANNO VIEIRA (BRAZIL)
P253
ADOPT THE CHILD WITH DISABILITY- IMPLEMENTING HOME PROGRAM BY PSYCHOLOGY STUDENTS ON OUTREACH IN SEMI-RURAL SOUTH AFRICA AGATA NATALIA RUNOWICZ (SOUTH AFRICA)
P243
AGREEMENT BETWEEN PERCEPTUAL TESTS AND NASOENDOSCOPY IN THE DIAGNOSTIC OF VELOPHARYNGEAL DYSFUNCTION GABRIELA LIMA, JENIFFER DUTKA, OLIVIA MESQUITA VIEIRA DE SOUZA, MELINA WHITAKER, JOSIANE DENARDI ALVES NEVES, VIIVIANE MARINO, MARIA INES PEGORARO-KROOK (BRAZIL)
P254
STUDIOUSLY: TOWARDS A SELF-MANAGEMENT OF THE STUDY PROCESS USING META-COGNITIVE STRATEGIES ELENA VIOTTO, NOEMI DOMENINO, ANNALAURA PETTERUTI, MARCELLA POCCHIOLA (ITALY)
P255
EXPLORING EQUAL RELATIONSHIPS IN A DISABILITY PROVISION (PHD THESIS IN PROGRESS) ELLIANNA MANTAKA-BRINKMANN (UK)
P244
MAXIMUM PERFORMANCE TESTS OF SPEECH PRODUCTION SIMONE KNUIJT, BERT DE SWART, HARRY GOOS, HANNEKE KALF (NETHERLANDS)
P256
YOUNG DOCTOR PROJECT: INTERACTIVE TELEDUCATION IN PROCESSES AND DISORDERS OF COMMUNICATION WANDERLIA QUINHONEIRO BLASCA, CAMILA DE CASTRO CORRA, ALINE MARTINS, JLIA SPERANZA ZABEU, CSSIA DE SOUZA PARDO-FANTON, RICELLY AVILA DA SILVA, MIRELA MACHADO PICOLINI, ALCIONE GHEDINI BRASOLOTTO, GIDRE BERRETIN-FELIX, LUCIANA PAULA MAXIMINO (BRAZIL)
P245
USING TRAINING VIDEOS IN DYSARTHRIA ASSESSMENT EDUCATION SIMONE KNUIJT, HANNEKE KALF, PUCK GOOSSENS, HARRY GOOS, BERT DE SWART (NETHERLANDS)
P246
MYOFUNCTIONAL THERAPY COMBINED TO BOTULINUM TOXIN INJECTIONS IN LONG STANDING FACIAL PARALYSIS PAULA NUNES TOLEDO, MARCUS CASTRO FERREIRA, ALESSANDRA GRASSI SALLES (BRAZIL)
P257
THE UNIVERSITY EXTENSION AS A LINK BETWEEN THE UNIVERSITY AND SOCIETY MAGALI DE LOURDES CALDANA, ELEN CAROLINE FRANCO, ALINE MEGUMI ARAKAWA, CRISTINA DO ESPIRITO SANTO, NATALIA GUTIERREZ CARLETO, MNICA LIMA FRANA, ARIADNES NBREGA OLIVEIRA, RAFAEL JOS DAMASCENO, ANGELA XAVIER, ROOSEVELT DA SILVA BASTOS, JOS ROBERTO DE MAGALHES BASTOS (BRAZIL)
P247
ACQUISITION OF BITE FORCE: LARYNGECTOMIZED STUDY GERLANE KARLA OLIVEIRA NASCIMENTO, DANIELE ANDRADE CU, LUCIANA NGELO BEZERRA, HILTON JUSTINO SILVA (BRAZIL)
P258
STUDENT TRAINING IN SPEECH LANGUAGE PATHOLOGY IN BULGARIA DOBRINKA GEORGIEVA (BULGARIA)
P248
CONCORDANCE BETWEEN PERCEPTUAL TESTS AND VIDEOFLUOROSCOPY IN THE DIAGNOSTIC OF VELOPHARYNGEAL DYSFUNCTION MARA DE SOUZA PRICO, JENIFFER DE CSSIA RILLO DUTKA, OLVIA MESQUITA DE SOUZA VIEIRA, EDNA ZAKRZEVSKI PADILHA, FABIANE RODRIGUES LARANGEIRA, MARIA INS PEGORARO-KROOK (BRAZIL)
P259
THE TRAINING METHODOLOGIES BETWEEN CONTINUING MEDICAL EDUCATION AND INNOVATION FRANCA BALBO MOSSETTO, ANGELA LUCIA FOGLIATO, SARA VESCO (ITALY)
P249
SPEECH TREATMENT BY DAF IN DYSARTHRIAS: IMMEDIATE EFFECTS IN CLINIC AND CUMULATIVE EFFECTS OF 3-MONTH TREATMENT USING A PORTABLE DEVICE EIJI SHIMURA, KAZUHIKO KAKEHI (JAPAN)
P260
SPEECH-LANGUAGE AND HEARING SCIENCES ACTUATION WITH RIVERINE COMMUNITIES IN THE BRAZILIAN AMAZON REGION CRISTINA ESPRITO SANTO, ALINE MEGUMI ARAKAWA, ELEN CAROLINE FRANCO, MNICA LIMA FRANA, ANGELA XAVIER, ARIADNES NOBREGA OLIVEIRA, ROOSEVELT DA SILVA BASTOS, JOS ROBERTO MAGALHES BASTOS, MAGALI DE LOURDES CALDANA (BRAZIL)
P250
DEVELOPMENT AND VALIDATION OF THE DUTCH DYSARTHRIA ASSESSMENT SIMONE KNUIJT, HANNEKE KALF , HARRY GOOS, PUCK GOOSSENS, JUDITH KOCKEN, LOTTE KROMHOUT, ALEXANDER GEURTS, BERT DE SWART (NETHERLANDS)
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P261
FRICATIVES AS A MEASURE FOR PREDICTING LATER LANGUAGE DEVELOPMENT CREAGHEAD NANCY, SOTTO CAROLYN, REDLE ERIN, BANDARANYAKE DAKSHIKA, STRUNJAS JEAN-NEILS (USA)
P262
ENHANCING GRADUATE STUDENT LEARNING OUTCOMES WITH PORTABLE LABS IN ASSISTIVE TECHNOLOGY JAYANTI RAY (USA)
P263
CASE STUDY METHOD IN TEACHING ANATOMY: AN EXPLORATION OF THE MENTAL SELF-GOVERNMENTAL MODEL JAYANTI RAY (USA)
P263bis
AN INNOVATIVE WEB-PLATFORM FOR LEARNING DISABILITIES STEFANIA ROMANIELLO, LAURA GRASSO, CHIARA TOMATIS, SABRINA ATZEI, GABRIELA FERRAZ (ITALY)
P264
LITHUANIAN ASSOCIATION OF LOGOPEDISTS VILMA MAKAUSKIENE, REGINA IVOSKUVIENE, DAIVA KAIRIENE (LITHUANIA)
P265
EMERGING ISSUES AND PRACTICE PATTERNS FOR THE SPEECH PATHOLOGY PROFESSION IN AUSTRALIA CHRISTINE STONE (AUSTRALIA)
P266
UNION OF THE EUROPEAN PHONIATRICIANS - STATUS QUO AND PERSPECTIVES ANTOINETTE AM ZEHNHOFF-DINNESEN, LUCYNA SCHALEN, ANTONIO SCHINDLER, VIRGINIE WOISARD (FRANCE) , CHRISTIANE NEUSCHAEFER-RUBE (GERMANY, SWEDEN, ITALY)
P267
ABOUT THE SPEECH-LANGUAGE-HEARING ASSOCIATION, TAIWAN WEN-YING YEH (TAIWAN)
P268
EMERGING ISSUES AND PRACTICE PATTERNS IN YOUR COUNTRY WEN-YING YEH (TAIWAN)
P269
EMERGING ISSUES AND PRACTICE PATTERNS FOR SPEECHLANGUAGE PATHOLOGISTS AND AUDIOLOGISTS IN THE UNITED STATES PATRICIA PRELOCK, ARLENE PIETRANTON (USA)
P270
AFFILIATED SOCIETIES THE LANGUAGE THERAPY/AUDIOLOGY IN BRAZIL: DESCRIPTION, ADVANCES AND DIFFICULTIES IN THE PERSPECTIVE OF THE FEDERAL BOARD Bianca Queiroga, Maria Cecilia de Moura (BRAZIL)
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Abstact - Poster Presentation

P001
USE OF AAC AS NEW SYSTEM IN COMMUNICATION DISABILITY AMAL AHMAD, AZHAR O MAR (1) HAMAD MEDICAL CORPORATION, RHUMELLAH HOSPITAL, DOHA, QATAR (1)
Success in life can be directly related to the ability to communicate. Full interpersonal communication substantially enhances an individuals potential for education, employment, and independence. Therefore, it is imperative that the goal of augmentative and alternative communication (ACC) use be the most effective interactive communication possible. For more than three decades now, the field known as Augmentative and Alternative Communication (AAC) has addressed the communication needs of individuals who cannot consistently rely on speech for functional communication. Changes that result from aphasia are sudden, unexpected, and unwanted. Adjustment is difficult for the person with aphasia. It also presents a great challenge to the family.There may be tension among family members and feelings of frustration and helplessness. The condition may seem hopeless. they may feel neglected and may find it difficult to have a family dependent on it. AAC Defined: ASHA defines AAC as an area of clinical practice that attempts to compensate (either temporarily or permanently) for the impairment and disability patterns of individuals with severe expressive communication disorders (i.e., the severely speech-language and writing impaired). AAC incorporates the individuals full communication abilities and may include any existing speech or vocalizations, gestures, manual signs, and aided communication. AAC is truly multimodal, permitting individuals to use every mode possible to communicate. The ability to use AAC devices may change over time, although sometimes very slowly, and as Rackensperger so clearly illustrates, the AAC system chosen today may not be the best system tomorrow. In any case, an AAC system is an integrated group of four components used by an individual to enhance communication. These four components are symbols, aids, techniques, and/or strategies. Rehabilitation: Most people who rely on AAC can benefit from the ongoing services of speech-language pathologists and other professionals. Evidencebased practice using observational methods, baseline data collection, language activity monitoring, and automated performance measurement tools yields the most effective results. Todays growth in rehabilitation services and distance learning are opening up new venues for intervention. Success! -When people who rely on AAC have the benefit of a methodical and scientific process in the selection and application of an AAC system, they also have the highest potential for personal achievement. Who Uses AAC:- Those who encounter difficulty communicating via speech cross the life span from the young child to the older adult.
P003
EFFECTS OF ICONICITY IN TAIWAN SIGN LANGUAGE AND AMERICAN SIGN LANGUAGE EXPERIENCE ON TAIWAN SIGN LANGUAGE LEXICON COMPREHENSION CHIN-HSING TSENG HSIU-TAN LIU (1),(2) JUNG-HSING CHANG (3) SPEECH LANGUAGE PATHOLOGY & AUDIOLOGY, CHUNG SHAN MEDICAL UNIVERSITY, TAICHUNG, TAIWAN, PROVINCE OF CHINA (1) - PROFESSOR OF GRADUATE INSTITUTE OF AUDIOLOGY AND SPEECH PATHOLOGY, NATIONAL KAOHSIUNG NORMAL UNIVERSITY, KAOHSIUNG, TAIWAN, PROVINCE OF CHINA (2) - PROFESSOR OF THE INSTITUTE OF LINGUISTICS, NATIONAL CHUNG CHENG UNIVERSITY, CHAYI, TAIWAN, PROVINCE OF CHINA (3)
Abstract: Iconicity is defined as the correspondence between form and meaning. In the 70s iconicity was considered sub-standard; a language that was considered highly iconic was not a real language (Liddell, 2003). Now, it is realized that iconicity is a characteristic of all languages, spoken and signed. However, there is more iconicity in sign language. The purpose of this study is to explore the effects of iconicity in Taiwan Sign Language (TSL) and the experience of American Sign Language(ASL) on the lexicon comprehension of TSL. In experiment 1, 35 participants were asked to do the TSL lexicon comprehension test. They were all university students in Taiwan with no experience of TSL at all. They were asked to see the TSL vocabulary video, then guess the meaning of the TSL word, and choose the one picture of 4 pictures whose meaning is most correspondent to the TSL word. There are 50 words in the test. In experiment 2, 18 participants were asked to do the same TSL lexicon test. They all were university students in the USA. They have rich ASL experience but no TSL experience. They were asked to see the TSL vocabulary video, then guess the meaning of the TSL word, and chose the one picture of 4 pictures whose meaning is most correspondent to the TSL word. The results showed both ASL signers and Taiwan non signers can benefit from the iconicity in TSL on the TSL vocabularies test. However ASL signers performance is better than Taiwan non singers. It seems that ASL experience helped them to get the meaning of the TSL signs. For Taiwan non signers, iconicity of TSL helps them to understand the signs. For ASL signers, both iconicity and the ASL experience helped them to understand the signs. Learner Outcomes: To explore how much iconicity in Taiwan Sign Language; To know the effect of iconicity on the lexicon comprehension; To know the effect of American Sign Language experience on the lexicon comprehension of Taiwan Sign language.
P002
ADAPTED TEXT MESSAGING SMS IN ELDERLY PRELIMINARY RESEARCH RESULTS MAJA OGRIN (1) UNIVERSITY REHABILITATION INSTITUTE, REPUBLIC OF SLOVENIA, HOSPITAL/UNIVERSITY, LJUBLJANA, SLOVENIA (1)
Abstract: Nowadays, mobile text messaging is a widely spread unique method of communication. An example of this messaging is the use of short messages SMS, which is far less frequently used among the elderly than among younger persons. Based on available data, an evaluation of the use of SMS among the elderly in Slovenia was made. It was found that among approximately 350,000 mobile phone users aged from 55 to 75 as many as 250,000 do not use SMS messages. Reading and writing SMS can be an important way of including the elderly into the information society. The research was based on the hypothesis that the use of short messages SMS could be interesting to those who are separated from their relatives due to long-term rehabilitation. The aim of the research was to describe the characteristic of mobile text messaging and by means of a questionnaire define and analyze the reasons why the elderly do not consider this type of communication useful enough or easy to use. The data collected with the questionnaire served as a basis for the development of an innovative system of simple text messaging, which was technically designed and developed at the Faculty of electrical engineering in Ljubljana. Learner Outcomes: Participants will learn about the characteristics of text messaging in the elderly and about possible adaptations that enable the elderly simple and effective communication with SMS messages.
P004
USING MULTIPLE WAYS IN SENSORY APHASIC SPEECH THERAPY: CASE STUDY ELEN FRANCO (1) - NATALIA GUTIERREZ CARLETO (1) ALINE MEGUMI ARAKAWA (1) - CRISTINA DO ESPIRITO SANTO (1) DIONISIA APARECIDA CUSIN LAMNICA (1) MAGALI DE LOURDES CALDANA (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRASIL (1)
Abstract: The American Speech-Language-Hearing Association defines language as a complex and dynamic system of conventional symbols, used in various ways during the communication. Changes in brain regions responsible for speech and language, can bring the aphasia, which is defined as the as the loss or impairment of language function caused by brain disease. Aphasic individuals may require supplementary resources of communication and/or altern-5. Learner Outcomes: The Participant will be able to: 1. Know about language disorders resulting from stroke; 2. Discuss forms of intervention in aphasia; 3. Know about Augmentative Alternative Communication.
P005
HANDIPHONE- AN AID FOR VOICE COMMUNICATION ROBERTO RUSSO (1) ISMB, POLITECNICO DI TORINO, TORINO, ITALY (1)
Abstract: Handiphone is a software that transforms words and sentences written in abbreviated form into voice, in order to give the opportunity of vocal communication to disabled people who have problems in speech production within a framework of cognitive integrity. The aim is to increase the range of autonomy of persons with different forms of motor disability, but with good intellectual capability, giving them a better chance to communicate. The application can be adapted to the users individual characteristics
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according to the personal diseases and to their severity. Increasing the range of autonomy, Handiphone contributes to the person construction with the achievement of improved psycho-physical balance, which is essential to make appropriate entries in social relationship and also at work. Abbreviated writing helps people who have reduced mobility, allowing them to be able to use a small number of keystrokes and get full writing. The software reduces interlocutors waiting time and it allows to hold a conversation quite easily, especially when the conversation takes place within groups of people.It is effective in all cases in which the disabled person must be directly heard, when writing with alphabetic communicator, sms or e-mail, is not enough. It is also possible using Handiphone in a telephone conversation in short messages. The research has been carried out as a first step to achieve an appropriate software to a computer or a laptop with Windows system and then to a tablet with Android system. In this second case, a real vocal communicator usable anywhere is obtained, thanks to the reduced size and weight of the devices, as well as the duration of the battery that allows functioning for a whole day. Handiphone must be integrated with a speech synthesizer. It is possible using the native one from Android devices or others with different quality characteristics available on free of charge from Internet. The volume of the voice can also be enhanced with a Bluetooth speakers. On the market, there are also several aids that may replace the traditional keyboard adding new functionalities in order to make possible even writing in cases of high compromised manual ability. Particularly, in the Windows version of Handiphone a scanning keyboard is already integrated and common phrases can be recalled by appropriate tracking systems. Examples of abbreviations: Handiphone program is really helpful to speak = hdp prg is rly hpf to spk. This software is also suitable for blind people = ts sfw is als stb for bld ppl. See you tomorrow = syt. we meet next week = wmnw. Learner Outcomes: You can have a voice communicator using a standard tablet with no need for expensive equipment specifically made for the disabled. Handiphone is designed for people, adults and children, who know writing, even it is possible to obtain a version with icons. The database of abbreviated words and phrases could be easily customized by the user and shared with the web community.
P006
MEASURING QUALITY OF LIFE OF CHILDREN EXPERIENCING DISABILITIES IN SRI LANKA: DIFFERING PERSPECTIVES OF CHILDREN, CAREGIVERS AND PROFESSIONALS SHYAMANI HETTIARACHCHI (1) DEPARTMENT OF DISABILITY STUDIES, FACULTY OF MEDICINE, UNIVERSITY OF KELANIYA, RAGAMA, SRI LANKA (1)
Abstract: The dependence on parents/caregivers, for instance, during mealtimes, puts added stress on the child, caregiver and the family (Reilly, Wishbeach & Carr, 2007). Studies investigating the perceived QOL of children with cerebral palsy report that a decrease in QOL is related to factors such as the parentchild relationship, low levels of social participation, access to healthcare services, psychological well-being and the childs physical functioning (Lim & Wong, 2009; Sentenac & Arnaud, 2008; Vargus-Adams, 2005). Overall, there has been a lack of attention given to the inclusion of parental and child perspectives when devising QOL measures (Parkinson, Rice & Young, 2011). Children, primary caregivers, healthcare professionals and educationists may have diverse perspectives on the childs QOL. Children have been found to rate their QOL higher than their primary caregivers; parents and professionals indicate disagreement although showing a comparable pattern (Dickson, Parkinson et al., 2007). One challenge is in devising accessible QOL measures for children with disabilities. In addition, QOL measures developed in the west may not be easily translatable to resource-poor countries in the east. Existing measures may not be able to fully capture the realities and expectations of QOL by children experiencing disabilities, their primary caregivers and professionals. Multiple informants are required to gain a comprehensive, accurate and valid assessment of a childs QOL in order to address issues of QOL in therapy and at policy level. Learner Outcomes: Describe the QOL of children experiencing disabilities as reported by primary caregivers, healthcare professionals and the children; Identify factors influencing the QOL of the child with disabilities, the primary caregiver and the family in Sri Lanka; Devise a range of child-friendly and accessible QOL measures for children; Compare with QOL of typically-developing children in the general population as reported by primary caregivers and typicallydeveloping children.
difficulties in health care because it is able to influence the assessment of consciousness, communication and language, cognitive functions and deficits and also outcomes and quality of therapeutic interventions. The Augmentative and Alternative Communication (AAC) includes ways of communication which can facilitate and improve communication to all people who have difficulty in using the most common communication channels, especially oral language and writing. Aim of the study The research project here presented aims to describe the project and experimentation of a model of innovative alternative augmentative communication, which facilitates communication and interaction since the acute phase. Methods The tool EASY uses the environment (the context) to facilitate the expression of the needs of the patient, which touches on the screen cells with images depicting the various hospital spaces (the room, the bathroom, the gym), or of his home, familiar objects and people (health professionals, family members and himself). Then are opened, in logical hypertext, windows that from time to time specify better the need to express. Besides, it is possible to conduct a short initial assessment of visual acuity and perception, auditory acuity, verbal comprehension, to modulate the communicator according to the residual capacity of the patient. After processing the content of the communicator it was started the experimental phase of its use with many inpatients of intensive rehabilitation centers for people with Acquired Brain Injury (ABI), to highlight the strengths and weaknesses of the tool, and be able to make the necessary changes, in view of its wider dissemination. Results As the trial is still in progress, there is no reliable data available, but the expected and partial results are an increase in the activation of inpatients with communicative deficits in acute phase, due to the use of a tablet, and a major compliance with health professionals.Furthermore an increase of the possibilities related to Activities and Participation (ICF) and an improved quality of life, from the point of view of patients, family members and also of operators that interface with patient and family are detected. Conclusions In conclusion it is considered that EASY is a valuable aid to facilitate the communicative exchange at a delicate and difficult stage such as the acute phase, for adult patients with communication and language difficulties. Learner Outcomes: The participant will be able to: understand the rational design of this communicator (software); become aware of an initial assessment for seriously ill patients that allows the modeling of a communicator according to their residual capacity and deficit; get to know its applications and implications in clinical practice, in particular with communication vulnerable patients.
P008
TIME OF THERAPY AND COMMUNICATION SKILLS OF NON-VERBAL AUTISTIC CHILDREN FACED WITH AN ALTERNATIVE COMMUNICATION SYSTEM JACY PERISSINOTO (1) - MNICA BEVILACQUA (1) ANA CARINA TAMANAHA (1) UNIVERSIDADE FEDERAL DE SO PAULO, DEPARTAMENTO DE FONOAUDIOLOGIA, SO PAULO, BRAZIL (1)
Abstract: Many autistic subjects are considered non-verbal since they are not able to use the linguistic code and seldom use gestures to compensate for the absence of speech. Considering that the use of alternative communication promotes expressive and receptive communication, the hypothesis is that its use will have positive implications in the pragmatic skills of autistic subjects within a minimum period of twelve sessions. The aim of the study was to verify the communication skills of non-verbal autistic subjects with different interlocutors in a pictorial alternative communication program in two moments of therapeutic intervention.This study was approved by the Research Ethics Committee of the Federal University of So Paulo UNIFESP Sao Paulo Brazil under number 1843/10. The parents/caregivers were aware of the methodological procedures and signed an informed consent term. The sample was composed of five non-verbal autistic boys aged in between 5 and 10 years, diagnosed by a multidisciplinary team using criteria in the ICD 10 (1998) and DSM IVTr (2005) and assisted at the Speech-Language Pathology Research Laboratory at Federal University of Sao Paulo. Moment 1 consisted of children assessment with instruments: Autism Behavior Checklist (Krug et al., 1993) as adapted for Brazilian Portuguese by Marteleto (2003); Language Development Survey (Rescorla, 1989) and Peabody Picture Vocabulary Test (Dunn, 1965), both adapted for Brazilian Portuguese by Capovilla, Capovilla (1997); functional communication profile using a pragmatics protocol (Fernandes, 2000) and Vocabulary Selection Spreadsheet (Bondy, Frost, 2009). To increase possibilities of the subjects communicative skills more than one interaction session with different interlocutors more and less directed - were filmed and analyzed: free play, semi-directed play with therapist, semi-directed play with mother and Directed/Imitation. After initial assessment the children began direct and indirect speech therapy interventions with the same therapist to implement the Picture Exchange Communication System PECS. Moment 2 was the re-assessment of children using the same instruments after 12 therapy sessions. The analysis of the implementation of the PECS evidenced that all participants increased their graphic vocabulary, had phase changes with heterogeneous performance of subjects in phase acquisitions. In pragmatics there was significant decrease in total communication acts and communicative acts per minute in the Direct/Imitation situation. There was significant difference in occupancy of communicative space by children during Free
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P007
EASY: A NEW TOOL TO USE AAC IN THE ACUTE PHASE GABRIELLA BARILARI (1) - PATRIZIA CANCIALOSI (2) JESSICA SACCATO (3) SLP DEPARTMENT, CLINIC MADONNA DEI BOSCHI, BUTTIGLIERA ALTA (TURIN), ITALY (1) - PRESIDIO C.T.O./ M. ADELAIDE - S.C. RRF GRAVI CEREBROLESIONI ACQUISITE, AOU CITT DELLA SALUTE E DELLA SCIENZA, TURIN, ITALY (2) MEDICINE AND SURGERY FACULTY, UNIVERSITY OF TURIN, TURIN, ITALY (3)
Abstract: The possibility to communicate early and effectively in hospitals already in the acute phase is essential for patients with communication
Play and Directed/Imitation, greater in Free Play and smaller in Directed/ Imitation. The change in interlocutor did not show significant differences regarding the childrens occupation of communicative space. More interpersonal communicative functions increased in Semi-Directed Play with therapist and the less interpersonal functions decreased in Directed/Imitation situation. Regarding the means of communication used, there were mainly gestures. As far as vocabulary, there was significant increase in receptive oral vocabulary. There were no significant differences in adaptive behaviors, only a tendency characterized by decrease in intensity and frequency of certain behaviors in the sensory and personal-social sub-areas. This study showed that the use of alternative communication favored better adequacy of functional communication, especially in directed and semi-directed situations with the Speech-Language Therapist. There was an increase in oral receptive and graphic expressive vocabulary. Learner Outcomes: The participant will be able to: 1. Familiarize with the alternative communication system named Picture Exchange Communication System (PECS). 2. Verify the benefits of the use of the PECS in communication skills of non-verbal autistic subjects with different interlocutors in a minimum period of twelve sessions. 3. Understand the importance of using alternative tools before and after the implementation of the PECS in order to measure intervention effects.
because of the very low active vocabulary; the child is unable to understand what is being said; the inability of others to understand what the child is saying. Due to ADHD the child is unable to fully concentrate on one task and see it to its completion. Because of having ADHD and SLI the child is often diagnosed with having multiple behaviourial disordes. It is vital that the correct diagnosis is made in order to eliminate any incorrect assessments such as mental retardation,any hearing disorder or pervasive developmental disorders (autism), dysartria.For a complete and correct diagnosis it is necessary for the child to be seen by doctors specilizing in foniatrie? , clinical speech therapist, psychologist, neurologist and child psychatrist. If the diagnosis is made early enough and the correct therapy started, even in worse cases of SLI and ADHD is possible to prevent serious behaviourial problems. Even if treatment was begun priar to going to school, the probability of the children having these specific learning disabilities is very real. For the most difficult cases, the children can go to the only state- sponsored clinic where the children can get specialised ambulatory care including overnight stays. As part of the services offered at the clinic, there is a school for these children that prepares them for entering regular school. A high percentage of the children who undergo treatment at this special clinic and attend the special school successfully integrate into regular schools.
P009
FLUENCY AND READING COMPREHENSION IN STUDENTS FROM 3RD TO 5TH GRADE LEVEL SIMONE CAPELLINI (1) - MARA MARTINS (2) FACULDADE DE FILOSOFIA E CINCIAS, UNIVERSIDADE ESTADUAL PAULISTA JLIO DE MESQUITA FILHO, MARLIA - SP, BRAZIL (1) - FACULDADE DE FILOSOFIA E CINCIAS, UNIVERSIDADE ESTADUAL PAULISTA JLIO DE MESQUITA FILHO, MARLIA SO PAULO, BRAZIL (2)
Abstract: Knowing the importance of improving the quality of education of students in relation to the development and learning of reading, aspects of a fluent reading were investigated in this study. This study aimed to characterize the performance on fluency and reading comprehension of the students elementary school I. Participated in this study 97 students from 3rd to 5th grade level of the public school of the Marlia City, So Paulo, Brazil, of both genders, aged of 7 years to 11 years and 11 months old, distributed in the following groups: Group I (GI): composed of 32 students from 3rd grade level, Group II (GII): composed of 28 students from 4th grade level and Group III (GIII): composed of 37 students from 5th grade level. As procedure were realized to evaluate of the time for reading, prosody and text comprehension. The oral reading of a text and application of a test with multiple choice questions to evaluate the performance in the comprehension of the groups was recorded for later analysis. The performance in reading fluency of the students was able to reveal aspects of the difficulties that present during the processing of reading. It was verified that the students of GI, showed performed worse when compared with GII and GIII, revealing that the measures used in the evaluation were effective in the identifying of differences between groups, evidencing profiles of fluent readers. Learner Outcomes: The Participant will be able to: 1. know the controversies about the measures of fluency in reading, 2. understand the need for measures of fluency, as prosody for assessment in different languages; 3. understand features the reading fluency of students from 3rd to 5th grade.
P011
PERCEPTIONPRODUCTION RELATIONS IN SUBSTITUTION PHONOLOGICAL PROCESSES IN CHILDREN WITH LANGUAGE DISORDERS WHO SPEECH SPANISH AMPARO YGUAL FERNNDEZ (1) JOS FRANCISCO CERVERA MRIDA (2) UNIVERSIDAD DE VALENCIA, UNIVERSITY, VALENCIA, SPAIN (1) - DEPARTAMENTO DE LOGOPEDIA. FACULTAD DE PSICOLOGA Y CIENCIAS DE LA EDUCACIN. UNIVERSIDAD CATLICA DE VALENCIA, UNIVERSITY, VALENCIA, SPAIN (2)
Abstract: Auditory perception skills of children with developmental language disorders are more limited than in typically developing children. It is difficult to determine how they influence each others ability to discriminate and to pronounce the phonemes in children with language disorders. For most researchers, perception difficulties of phonemes cause developmental delay in pronunciation, while for others there is a mutual influence. The aim of this work is to determine which consonants sounds in Spanish occur more likely perceptual difficulty and which the articulatory difficulty. Eightysix children with specific language disorder participated with a mean age of 4 years and 7 months. Phonological processes (speech error patterns) were identified. It was constructed and applied a specific test of speech perception for each child, depending on his speech errors. We wanted to know if sounds, that the child mispronounced, were perceived correctly. We analyzed the relationship between articulatory and perceptual skills of children with substitute processes by two comparisons: first, the set of all detected processes; and second the three most common substitute processes to determine whether the nature of the consonant involved more likely perceptive difficulty. The results report a relationship between articulatory and perceptual skills and that the nature of the consonant determines more likely perceptual difficulties or more likely articulator difficulties. These results are relevant to the assessment, design and effectiveness of speech therapy programs. Learner Outcomes: The Participant will be able to: Know the controversies on perception production relations in speech sound disorders and its therapy; Know an evaluation protocol of perception for children with speech sounds disorders applicable to clinical situations; Know that the nature of the consonant sounds also influences their better or worse perception; Know how likely frequently substitute processes, in speech sounds disorders, include difficulties in perception in Spanish language.
P010
CARE OF CHILDREN WITH SEVERE SPECIFIC LANGUAGE DISORDERS AND ADHD (PRESCHOOL AGE) KLARA ANGHELESCU (1) - EVA SKODOVA (2) PRIVATE, PRIVAT AMBULATORY, PRAGUE, CZECH REPUBLIC (1) - STATE HOSPITAL, DEPARTMENT OF FONIATRICS, PRAGUE, CZECH REPUBLIC (2)
Abstract: Specific Language Disorders (SLI) affects the entire sensory and motor system. Speech development is always delayed, specifically aberant with the late development typically affecting the fonemic hearing. ADHD is a attention disorder which includes hyperactivity and abnormal cognitive function, motor perception function and also affects emotional and social growth. Czech is a very complicated language especially its grammar and the pronunciation of some the letters in the alfabet. Even some czech native speakers have great difficulty in pronouncing these letters correctly. The children with severe SLI are often like foreign speakers: in other words, when they are trying to speak and communicated in czech. Because ot the inability of the brain to properly decode what they hear, speech comprehension is severly affected including the ability to remember , e.g, being unable to remember what was just said to them five minutes before. This is known as short term memory disorder. ADHD combined with SLI complicates the speech rehabilitation especially at the preschool age. Because of the age of the child and because of that child very short attention span. The consequence of this is that they react unpredictably in any given situation. This can be aggravated by aggressive behaviour, such as: the child doesnt understand what is expected of him; the child is unable to express himself
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P012
RELATIONSHIP BETWEEN PRAGMATIC COMMUNICATIVE AND SOCIAL SKILLS IN THE SPECIFIC LANGUAGE IMPAIRMENT (SLI) DAGMA VENTURINI MARQUES ABRAMIDES (1) DANIELA DE OLIVEIRA MANOEL (1) FABIANA CRISTINA CARLINO (2) DEPARTMENT OF SPEECH PATHOLOGY, SCHOOL OF DENTISTRY OF BAURU, UNIVERSITY OF SO PAULO, BAURU-SO PAULO, BRAZIL (1) - ESPECIAL EDUCATION PROGRAM OF GRADUATE, FEDERAL UNIVERSITY OF SO CARLOS, SO CARLOS- SP, BRAZIL (2)
Abstract: Progressively, the child acquires and uses more interactive communication functions, which control or direct the behavior of others, and this is an inherent need for social interaction of human beings, which stimulates the initial linguistic output. The communicative intention is initially conducted through gesture and visual attention, and with the onset of speech, the pragmatic abilities manifest themselves more productive, through nominations, comments, requests for information, and object of attention, answers, protests and greetings. However, normal development does not always occur and it is not uncommon appears alterations such as the Specific Language Impairment (SLI), a possible framework with difficulties in the comprehension
and expression of speech and language but in the absence of mental disorder, hearing loss, intellectual deficit or severe emotional problems. Thus, the objective of this study was to examine the relationship between pragmatic communication and components of social skills in children with SLI. Participants included 18 children; age between seven and nine years, being that half (n = 9) was the experimental group (EG) with diagnosis of SLI, and half (n = 9) was the control group (CG). Both groups were comprised of three females and six males. The children were evaluated for their pragmatic skills by protocols (sampling and video recording of speech-language) in structured situations of interaction. Significant group differences were obtained, indicating that the EG was less effective communication, whereas the CG showed communicative abilities more elaborate. Data analyses indicated that greater difficulty on pragmatic abilities leads at worst performance in interpersonal relationships. In conclusion, avoidance behavior of these children as part of their language difficulties may be considered worrying, since the use of language as a vehicle of communication allows the interaction with their peers, whether child or adult, and thus encourages the exchange information, experiences, emotions, and contributes to learning. We emphasize the importance of the interface between the field theoretical-practical of Social Skills, and area of Speech-Language Patology for the development of assessment tools and intervention more effectives addressed the children with SLI. Learner Outcomes: knowledge about field theoretical-practical of Social Skills; knowledge about the implication of SLI in components of social skills; reflections of the interface between the field theoretical-practical of Social Skills of speech and language assessment and therapy for children with SLI.
P013
TELEDUCATION: VIRTUAL LEARNING ENVIRONMENT IN SPEECH THERAPY ALINE MARTINS (1) - DAGMA VENTURINI MARQUES ABRAMIDES (1) - LUCIANA PAULA MAXIMINO (1) MARLIA CANCIAN BERTOZZO (1) FACULTY OF DENTISTRY OF BAURU, UNIVERSITY OF SO PAULO, BAURU, BRASIL (1)
Abstract: The first years of a childs life are the most important to the process of language acquisition and development, as well as for her overall development. The proper stimulation in this period is essential, so when changes in an infants language development are noted, these should be diagnosed as early as possible so that, if necessary, the intervention process is performed. Professionals and families are extremely important in this process, as well as the pediatric doctor who systematically accompanies the child in the early years of her life. The present study aimed to develop and analyze an electronic media material in the field of speech pathology, focusing on acquisition and development of childrens language to guide pediatric doctors, using the Interactive Tele-education. The methodology consisted of a literature review in the databases SciELO-Brazil, Lilacs, Medline and Pubmed, as well as books and theses in the area about the stages of language development, chronologically, from birth to the age of 7, pointing out the main characteristics and developmental marks at each stage, in order to prepare the material that would later be implemented in the virtual learning environment in a blog format. The developed material is available at the electronic address http://fonoaudiologiaparapediatras.wordpress.com/. An evaluation was made by 63 speech therapists using two questionnaires: the first one was an adaptation of Emory (Health-Related Web Site Evaluation Form Emory - University Rollins School of Public Health, 1998) and the second one was a specific evaluation of the blog content, prepared by the researcher. The results demonstrated that the blog had been rated as Excellent regarding the aspects: content, accuracy, authorship, updates, public, navigation, external links and structure, as well as in the specific content evaluation. Thereby, a virtual learning environment, in blog format, was developed, containing information about the acquisition and development of language in order to guide pediatric doctors from typical phases to changes, prevention, stages of development and possible referrals. Learner Outcomes: Know a Virtual learning environment about the acquisition and development of childrens language; Know the importance of the integrated performance of Speech Therapy and Pediatrics; Know about the importance of telehealth for Speech Therapy and its growth, Know the stages of developing a virtual learning environment, Know the evaluation tools
data bank that is available and to highlight the importance of this kind of tool for teaching support and research in the field of Speech and Language acquisition and pathology. METHOD: A detailed description of the material in the Speech and Language Data Bank, which contains around 606 corpora. Moreover, the paper comprises a description of the methodology of data collection and storage, from their transcriptions of oral or visual form to the written form. RESULTS: The database contains 606 corpora corresponding top: 84.65% of corpora are of children between 0-7 years in the process of language acquisition and 15.34% of corpora corresponding to subjects with language symptoms. From the clinical diagnosis 42.4% are of aphasia; 32.95% of language delay; 6,81% of Articulation Disorders, Reading and Writing Disorder are 4.54%; Dysphonia (3.40%); Stuttering (3.40%) and Rhinolalia (2.37%). CONCLUSION: It is important to expose this data banke because of the diversity of the material that was collected and transcribed. In addition, the availability of the data to the scientific community via software allowed the researchers to choose from the data, decreasing the time it would take to collect their own speech data. This study contains Brazilian data from children speaking Portuguese; and it allows for comparative research on the process of language acquisition in several languages. Learner Outcomes: Get acquainted with data on language acquisition of Brazilian children; Get acquainted with the tools that allow access to normal or pathological speech and language data; Get to know the Speech and Language Data bank; Realize how the Corpora data bank in Speech and Language Pathology and acquisition is a very useful tool for teaching and researching; Encourage comparative research in language processes and acquisition in several languages.
P015
LANGUAGE IMPAIRMENTS IN CHILDREN WITH ADHD AND IN CHILDREN WITH READING DISORDER WENCHE ANDERSEN HELLAND (NORWAY)
Abstract: Attention deficit hyperactivity disorder (ADHD) and reading disorder (RD) are the two most prevalent neurodevelopmental disorders of childhood, and high rates of comorbidity have been reported for both disorders. This large scale population-based study aimed to explore whether children with symptoms of ADHD, children with symptoms of RD, children with symptoms of both ADHD and RD and a control group could be differentiated from each other regarding different aspects of language; phonology, expressive language, receptive language and pragmatics. Method: Out of a sample of 5672 children aged 7-9 years four groups were initially derived based on the results from a screening questionnaire distributed to teachers and parents of the children; children with RD (N=332); children with ADHD (N=169); children with AD/HD + RD (N=121) and a control group (N=5050). However, in this presentation we are focusing on the pure groups, and consequently the comorbid group (children with symptoms of both ADHD and RD) are excluded. Results:The clinical groups differed significantly from each other as well as from the control group regarding phonology and expressive language; the RD group being more severely impaired than the ADHD group. On receptive language significant differences were also revealed between all groups, but on this measure the ADHD group was performing poorest, followed by the RD group and the control group. Regarding pragmatics there was a clear trend in the direction of the ADHD group being most impaired, however this difference between the ADHD group and the RD group failed to reach significance (p=.02) with significance level set at p<.01 (p=.02).Conclusions: In sum these findings support findings from clinical samples pointing to a considerable rate of language impairments both in children with symptoms of ADHD and in children with symptoms of RD. Although this two clinical groups share many symptoms of language impairments, they can, at least in this study, be differentiated from each other regarding their language profiles Learner Outcomes: The clinical groups differed significantly from each other as well as from a control group on measures of phonology, expressive language and receptive language; the ADHD group performed significantly better than the RD group as to phonology and expressive language; the ADHD group was significantly more impaired than the RD group regarding receptive language; there was a clear trend in the direction of the ADHD group performing poorer than the RD group regarding pragmatics. However, this difference failed to reach statistical significance.
P014
SPEECH AND LANGUAGE DATA BANK: TEACHING AND RESEARCHING TOOL REGINA MARIA FREIRE (1) - CAMILA PARDUCCI (1) - GABRIELA VALIENGO FEITAL DE SOUZA (1) FUNDACAO SAO PAULO, PONTIFICAL CATHOLIC UNIVERSITY OF SAO PAULO, SAO PAULO, BRAZIL (1)
Abstract: The Speech and Language Data bank from the research group Language and Subjectivity which belongs to the graduate studies program in Speech Pathology at the Pontifical Catholic University of Sao Paulo was created in 1997 aiming to increase interdisciplinary discussion and to accommodate concerns in this field. This database provided accessibility to those interested in researching language. OBJECTIVE: The purpose of this study is to introduce the scientific community to the speech and language
P016
INTERVENTION PROGRAM IN ORAL LANGUAGE FOR CHILDREN WITH LANGUAGE DELAY CAMILLA GUARNIERI, BIANCA RODRIGUES LOPES GONALVES, CAMILA MAYUMI ABE, SIMONE APARECIDA LOPES-HERRERA BAURU SCHOOL OF DENTISTRY (FOB), UNIVERSITY OF SO PAULO (USP), BAURU, BRAZIL (1)
Abstract: The acquisition and development of the language are primary in a childs life, especially because language is one of the main means of social interaction. Therefore, it is of great importance that a good language development has been assured to children and, when necessary, a good intervention in their difficulties. Currently, in the field of childrens language, different therapeutic approaches are argued, but the necessity of
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development of structured therapeutic programs is verified, elaborated with technical and scientific quality so that they may stimulate the different abilities of language, aiming to consider the specificities of every child. Such intervention programs would guide speech-language pathologists to plan their intervention and provide greater efficiency on intervention process. The aim of this study, still in progress, is to elaborate and test the efficiency of a program of stimulation of oral language for children with language delay from the ages of three to six years old. The referred intervention program was divided into stages of 24 sessions and, at the end of each one, each child to it submitted will be reassessed for the verification of the level of their language abilities. Until the present moment, there has been the proposal and the planning of interventions, considering that until the end of the first semester of 2013, the same will be implemented and tested in its efficiency. The proposed program was elaborated with technical and scientific quality to guide and improve the speech-language intervention in the cases of child language delay, emphasizing the stimulation of phonetic-phonological, syntactical, semantical-lexical and pragmatic levels of the language. The intervention program will be applied in ten children with language delay without any other commitments (sensory and/or neurological), considering that there will be a pre-intervention and a post-intervention in every child of the sample. The complete intervention program counts with two stages of 24 intervention sessions each, totaling 48 sessions, performed in a twicea-week frequency, considering that every step will last a quarter of year. In pre-intervention and post-intervention assessment the phonetic inventory, and phonological organization, the receptive and expressive vocabulary, the syntactical and pragmatic abilities of the child will be analyzed. The pre-intervention and post-intervention tests will also be applied in control group (children with language delay that are not under intervention yet). For ethical issues, by the end of the research the children of control group will receive the same intervention program proposed. As expected results, there is the significant improvement in every language level in pre-intervention and post-intervention comparison on children who have participated in the proposed program when compared to the children of control group, proving then the efficiency of the proposed program. Learner Outcomes: Learn about an intervention program structured for the stimulation of oral language in children with language change; Know how a structured intervention program will facilitate the therapeutic planning of speech therapists, making it simpler and more efficient and it will also bring proposals of strategies, what will facilitate not only the planning, but also the whole therapeutic process; Reflect about the therapeutic approaches focusing differentially the levels of language.
P018
SPEECH THERAPY INTERVENTION RESULTS OF PSYCHOLINGUISTIC SKILLS IN A CASE OF CONGENITAL TOXOPLASMOSIS CAMILA DE CASTRO CORRA (1) - MARIA RENATA JOS (1) VANESSA LUISA DESTRO FIDNCIO (1) ANA PAOLA NICOLIELO (1) SIMONE APARECIDA LOPES-HERRERA (1) LUCIANA PAULA MAXIMINO (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, SO PAULO, BRAZIL (1)
Abstract: Express and understand language involves a lot of brain mechanisms that are responsible for processing. So, lesions in certain brain regions may impair this ability. Congenital toxoplasmosis can cause spots of calcification in the brain and changes in the process of reception. Thus, studies suggest the need to investigate the changes triggered in the psycholinguistic skills. This study aims to describe the evolution process of psycholinguistic abilities of a child with a history of congenital toxoplasmosis after speech therapy. The child is male and has six years old. Your parents were looking for treatment with complaint that his son speaks totally wrong, but did not have difficulty to understanding the language. For the evaluation of communication skills was used the Illinois Test of Psycholinguistic Abilities (ITPA), considering the representational level auditory-vocal and visual-motor test (Auditory Reception, Auditory Association, Verbal Expression, Visual Reception, and Visual Expression Association Manual) and automatic level auditory-vocal and visual-motor (auditory Sequential Memory, Closura grammar, Visual Sequential Memory and Visual Closura). The patient underwent 45 sessions of speech therapy for eight months, based on psycholinguistic model focusing on the language and psycholinguistic skills, with the aplication of ITPA test before and after speech therapy.
P017
THE EFFECTIVENESS OF ALTERNATIVE CLINICAL-HOME SPEECH-LANGUAGE THERAPY PROGRAM TO ENHANCE SOCIAL INTERACTION SKILLS IN PRE-SCHOOL CHILD WITH ADHD: A CASE STUDY TAHANY EL SAYED AHMAD (1) PRIVATE CLINIC OF PSYCHOLOY CONSULTANT, PRIVATE CLINIC OF PSYCHOLOY CONSULTANT, KUWAIT, KUWAIT (1)
Abstract: A poor pragmatic language skill is a sign of abnormal criteria in the children development, Pragmatic language use as spouts into executive skills as in planning, organizing and scans regular behaviours in children with ADHD. The goals behind this study to prompt family , school teachers and pre-school child with ADHD to cope with essential pragmatic language skills as a basic requirement at home, school and society for long life success. The study investigated a child aged 4.8 Yrs. in Kindergarten bilingual Arabic/English American School. A strategy of combination therapy was used with ADHD child with typical development children. The participants given a behavioural and speech therapy in the same time based on Alternative Clinical-Home Play Therapy Program for practicing and reviewing appropriate social skills. Results: the Alternative Clinical-Home Speech-Language Therapy Program and co-training interventions demonstrates that there is appropriate evidence for their efficacy in reducing symptoms of ADHD in pre-school child, as measured by school teachers who indicated that theres a notable changing in the child behaviour and direct observation of child compared with the supporting group was outstanding. Discussion: The study results indicate that Alternative Clinical-Home Play Therapy Program beside combination therapy shows potential efficiency in enhancing social interaction intervention for children with ADHD. These findings suggest that delivering social skills training programs to homes and schools system, involving parents, relatives, teachers and peers groups as a natural sittings focusing on pragmatic language skills, may increase the effectiveness under the supervision of program professionals. Learner Outcomes: The author goals are implementing an easy and fast program to help pre-school child to participate in daily school activities and learn good model of pragmatic language skills to appropriate level of performance by using many modes of learning, naturalistic settings, positive peer models, imitation skills and socially valid skills .Also, the program designed under the child need when it was hard to run it at clinic, we transfer our work to be clinic-home-clinic, and outcomes would improve pragmatic language skills as essential developmental requirements in a comfortable, familiar environment.
The results were obtained by calculating the TE (total score), SE (scale score) and age corresponding to the score obtained in the test. Thus, the following results were obtained in the pre-intervention: EB: Auditory Reception = 23; Hearing Association = 15; Verbal Expression = 13; Visual Reception = 11; Association Visual = 15; Expression Manual = 20; Auditory Sequential Memory = 10; Closura grammatical = 16; Sequential Memory Visual = 10; Closura Visual = 15. In Post-intervention, there was a trend of high scoring in most levels evaluated, with the following results: EB: Auditory Reception = 40; Hearing Association = 22; Verbal Expression = 10; Visual Reception = 15; Association Visual = 25; Expression Manual = 24; Auditory Sequential Memory = 11; Closura grammar = 17; Visual Sequential Memory = 6; Closura Visual = 19. Thus, the results of the ITPA test, pre-and post-intervention were obtained with the average earnings representational levels and automatic auditory-vocal and visual-motor; total score with 4.1 points higher on assessment post-therapy (sd = 6.19), Scale score of 3.4 points (SD = 6.43) and average overshoot of 20.8 months (SD = 25.44). In the auditory-vocal, there was significant progress and the gains made post-therapeutic intervention in representational level were higher compared to the automatic level, implying that the skills that interfere with communication were potentiated. This type of evaluation is warranted to allow the identification of the level that should be further explored by means of facilitating strategies to acquire new skills. We highlight the importance of further studies investigating this issue in order to provide better clarification related to difficulties in psycholinguistic skills displayed by children with Congenital Toxoplasmosis
Learner Outcomes: Knowing some implications caused by congenital toxoplasmosis;Relate changes in psycholinguistic skills with congenital toxoplasmosis; Describe the evolution of psycholinguistic skills in a child with Congenital Toxoplasmosis, before and after speech therapy.
P019
RELATIONSHIP BETWEEN THE SOCIOECONOMIC AND SELF-REPORTED SPEECH LANGUAGE DISORDERS CARLA CARDOSO (1) - KAREN GARCIA (1) DANIELA REGINA MOLINI-AVEJONAS (2) UNEB, UNEB, SALVADOR, BRAZIL (1) - UNIVERSIDADE DE SO PAULO, FMUSP, SO PAULO, BRAZIL (2)
Abstract: The conditions are social determinants of health status. Some studies have shown that social factors affect individual biological conditions, risk behaviors, environmental exposures and access to resources for health promotion. Through preventive measures and the integration of an interdisciplinary team of professional speech therapy may act directly on the actions of health promotion assisting in the prevention and detection of diseases, disabilities and health disorders, as well as the training of other professionals working in this system. The objective of this study is to identify the combination of socioeconomic and self-reported speech language
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disorders a group of subjects in the city of Camaari, Bahia. Be accompanied by all the children of both sexes, aged four years and one month to five years and eleven months, assisted by the Family Health Program of Basic Units of Health Districts selected for this research. All participants must be registered with the Family Health Program of Basic Health Units included in the project and be accompanied by Community Health Agents (CHA). The subjects will be assessed in their own homes, at the time of the visit of the Community Health Agents who will serve as facilitator in the relationship between subject and researcher. All Community Health Workers will be trained in the areas of language, hearing, oral motor and speech. Participated in this study 167 children. For composition of research groups, children will be divided into three groups according to socioeconomic conditions according to the criteria established by IBGE/2012: GROUP 01 Low Socioeconomic; GROUP 02 Average Socioeconomic, GROUP 03 - High Socioeconomic. The procedures for selection and application inventory speech language of patients were initiated only after the relevant ethical processes: the opinion of the ethics committee (CEP/UNEB no 116.083/2012) and sign the informed consent. The inventory speech language was applied directly with parents or guardians.Data were plotted as given criteria: 0 to 50% for changes; 51% to 75% with a probability of change (range carefully) and 76% to 100% without any change. Of the 167 subjects, 117 (70, 06%) made up the group 01, 50 (29, 94%) group 02 and no members in group 03. The results show a small percentage of self-reference speech language disorders, regardless of socioeconomic group. Among the participants in this study, only 1,8% self-reported changes, but 41,31% are in the range of high probability of change. Parents and caregivers who self-reported absence of disorder, but they are presented in the range of high probability of change (51% - 75%) will be accompanied by workshops for health promotion in the area of speech therapy and those who self-reported changes are evaluated and if necessary forwarded to therapy. We highlight here the need for prior knowledge of the community in which they will share health, thereby promoting actions more effective, because they are adapted to the needs of each community. Learner Outcomes: The importance of knowledge of the population; The importance of using screening instruments for detecting needs of each population; The need for partnership with key individual of communities.
P021
ORIENTATION PROGRAM FOR PARENTS OF CHILDREN WITH LANGUAGE DISORDERS BIANCA RODRIGUES LOPES GONALVES, CAMILA MAYUMI ABE, SIMONE APARECIDA LOPES-HERRERA BAURU SCHOOL OF DENTISTRY (FOB), UNIVERSITY OF SO PAULO (USP), BAURU, BRAZIL (1)
Abstract: Verbal language is a form of communication used by most people for the transmission of message, expressing thoughts, feelings and inclusion in the social environment. Children with language disorders has difficulty communicating, even with their parents. It is essential involve parents in speech-language intervention because the involvement allows them to be propagators of the knowledge they have acquired about language disorder for all family, teachers and other parents in the same situation. One of the ways to involve parents in speech-language intervention is by forming groups of parents. The aim was to propose, implement and verify the effectiveness of orientation program for parents of children with language delay and specific language impairment. The research was conducted in the Clinic of Speech, Hearing and Language Pathology at Bauru School of Dentistry, University of So Paulo (FOB-USP), Brazil, under the protocol of the ethics committee (56/2010). Participants were 10 parents of 10 children of both genders, 3-6 aged, diagnosed with language delay and specific language impairment. The program lasted for 10 sessions (weekly), lasting 50 minutes each. Questionnaires were used and inventories in parents and children before and after intervention. The questionnaires were applied in parents: a questionnaire characterization of the family system, an inventory of parenting styles, a questionnaire to identify verbal communicative skills. The researcher also developed other three instruments for data collect: a checklist on effective use of verbal communicative skills in parent-child interaction, a questionnaire for verify parents groups satisfaction with a language of their children and a questionnaire for verify the quality of activities developed in a parents group. The instruments were applied in children: an assessment test of language development, a test to evaluate the phonology and vocabulary and a behavioral observation protocol. The program addressed issues related to language development, as well as parental behaviors that facilitate this development. Regarding the results of the parents, it was observed that, after the program, there was a statistically significant improvement in parental satisfaction in relation to the language of children and increase in a use of verbal communicative skills by parents during their interaction with the children. In children, it was observed that these improved quantitatively the level of language development by several tests. Therefore, the research showed that the application of protocols, questionnaires and surveys on children and parents could make the evaluation of this intervention program, noting that most of the results when compared pre and post intervention, showed differences both qualitative and quantitative and, for some results, these differences were statistically significant. Furthermore, the protocols, questionnaires, surveys and activities used in this research could be use as tools for development and evaluation of others parent groups not only in speech-language intervention, but also in other areas of health.
P020
SIGNS OF STRESS IN SCHOOL CHILDREN WITH AND WITHOUT LEARNING TROUBLE PATRCIA ABREU PIINHEIRO CRENITTE (1) - THAIS GONALVES (1) JANANA BORBA GARBO (1) UNIVERSITY OF SO PAULO, FACULTY OF ODONTOLOGY OF BAURU - FOB/USP, BAURU, BRAZIL (1)
Abstract: Several factors may influence childrens school performance, so that difficulties in this process may be caused by organic, intellectual/ cognitive and emotional aspects. The child stress can be considered an aggravating factor in such difficultis, since it directly influences the childs behavior, and thus can collaborate to childs failure in school. The aim of this study is to compare the level of child stress between children with and without learning disability. Thirty two children participated in the study, of both sexes, between 8 and 12 years, divided in following groups: GIA - 8 children with Learning Disability in diagnosis process by an interdisciplinary equip, at Clinic of Speech Pathology of Dentistry School of Bauru, University of So Paulo, according to the DSM-IV and ICD-10 criteria; GIB 8 children with learning Disability in therapeutic process (GI B), at the same institution; GII - 16 children without any learning problem to read and write, being this the control group. Children from three groups were submitted to Child Stress Scale (ESI) developed by Lipp and Lucarelli (1998). The scale of child stress is composed of 35 items with Likert scale from 0 to 4 points, grouped under four factors: physical reactions, psychological reactions, psychological reactions to depressive component and psychophysiological reactions. The results showed, overall, that there is no predominance of stressors signals in all groups studied. In all groups (GIA, IGI and GIB) most children got no stressors signs, and the differences between the groups were not statistically significant for the analyzed parameters. Therefore, in this study, stress was not decisive for school performance, because no statistically significant differences were found between children with and without learning disorder. However, we emphasize the need for new researches with larger samples to determine if emotional factors such as stress really have influence in school performance of children with learning disability. Learner Outcomes: reflect on the possible emotional problems faced by children with learning disability; understand how stress can prejudice child learning; discuss the importance of assess the emotional aspects for improving the academic performance of children with and without learning disabilities.
P022
PERCEPTUAL PERFORMANCE IN CHILDREN ON THE NASAL IDENTIFICATION TASK LARISSA CRISTINA BERTI (1) - RIKA GUIMARES MARQUES (1) FACULDADE DE FILOSOFIA E CINCIAS, SO PAULO STATE UNIVERSITY (UNESP/MARLIA, UNESP/SJRP), MARLIA - SP, BRAZIL (1)
Abstract: Introduction and aims of the study: Auditory perceptual deficits have repeatedly have been observed in children with developmental communicative disorders. Nevertheless relatively little is known about the prior development of normal childrens auditory perceptual ability, specifically to perceptually identify phonic contrasts. In this study, we investigated the ability of normal children to identify the contrast among nasal sounds of the Brazilian Portuguese (henceforth BP). Mostly, the aims of this study were: (i) to verify if there is a determined contrast among nasal sounds that presents a greater difficulty in its identification; and, (ii) in case there is, to verify whether the contrast of greater difficulty follows - or not - the same trend described in terms of the production. Nasals as a class are interesting for an inquiry into the relative salience of contrast because their place characteristics are notoriously difficult to perceive. Methods: There are three nasal phonemes in syllabic onset in BP: /m/, /n/ and //. A forced-choice minimal-pair identification task involving the three nasals was conducted with 52 children, 4-5 years old, using PERCEVAL software. The stimuli used in the identification task consisted of a typical adults recordings of the familiar disyllabic words (minimum pairs) contrasting the nasal sounds. The acoustic stimulus was presented to the children using headphones and they needed to choose which stimulus-correspondent picture was shown on the computer screen. Both presentation time and reaction time of the stimulus were measured by PERCEVAL software.Results: Our results showed that the perceptual accuracy was 87% of correct response. The reaction time of the incorrect response was significantly higher than the reaction time of the correct response (t=-2,92, df=51, p=0,00). According to the confusion matrix, the perceptual difficulty varies due to the phonetic distance among nasal
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contrasts. That is, the longer the phonetic distance is; the smaller the similarity perceptual will be, enabling the identification of contrast among the nasals.Conclusions: The auditory perceptual mastering of the nasal contrast in BP occurs gradually and, within this class, there seems to be a hierarchy in the perceptual mastering. The parallel between perceptual and productive acquisition orders of vocalic contrasts does not always hold.
P023
LANGUAGE THERAPY RESULTS IN CHILDREN AND ADOLESCENTS WITH AUTISM SPECTRUM DISORDERS FERNANDA DREUX M. FERNANDES (1) - CIBELLE A.H. AMATO (1) LETICIA A. NASCIMENTO (1) SCHOOL OF MEDICINE, UNIVERSIDADE DE SO PAULO, SO PAULO, BRAZIL (1)
Abstract: This presentation will report the results of a study with 142 individuals (ages 2 to 16) with autism spectrum disorders (ASD) attending specialized language therapy. The aims of the study involved: verify the association between the participants social demographic characteristics (mainly gender and age) and the adherence to the therapeutic process and verify the association between the age at the therapy onset and the clinical evolution. The outcomes of the therapeutic process were verified after a period of two years. Method included the use of information obtained by the use of the Functional Communicative Profile (FCP) and the Social Cognitive Performance (SCP). The FCP proposes the determination of the number of communicative acts expressed per minute by the subject, the communicative means used and the communications interactivity. The SCP identifies the subjects better performance in the areas of vocal and gestural communicative intent, vocal and gestural imitation, tool use, combinatory play and symbolic play. The variables considered were: age at first speechlanguage assessment, gender and psychiatric diagnosis. The clinical evolution indexes considered the increase on: each of the SCPs score, number of communicative acts per minute, communications interactive proportion and proportion of use of the verbal communicative mean. Results regarding the diagnosis indicated associated diagnosis of neurological disorders in 5.5 of the participants, language disorders in 4.5% and genetic syndromes in 9.0% of them. Results also show a gender distribution similar to what has been reported by the literature for several years, that is, a male prevalence of 3:1. In what refer to the chronological age at the first assessment, is was observed that children that started speech-language therapy before the 6th year of life tended to continue the process for a longer period while those who were brought to the service with more than 10 years tend to abandon treatment more frequently. Girls tend to be brought to treatment latter in life and to maintain the process for a shorter period. Children receiving language therapy at earlier ages tend to present more clinical evolution indexes than those who started this process as older children or adolescents. However, it is not an absolute tendency; variables such as environmental factors, severity of the symptoms at the therapy onset, association with other intervention and educational resources, and, mostly, consistent attendance to the weekly sessions most probably play a fundamental role to the overall individual results. These issues should be considered in future researches. However, these data, referring to a large population confirm the notion that although early intervention generally lead to better and faster results, older children and adolescents with ASD should also have access to language therapy, because they also show some clinical evolution. Learner Outcomes: Consider some of the variables that may have interference in the speech-language therapy process with individual with ASD; reflect about the need of some balance between early intervention and the provision of services to older children, adolescents and even adults; Identify possible objective measures of clinical evolution in language therapy process with ASD individuals
II (EG-II) with 16 extremely premature; Control Group-I (CG-I) with 20 typical children and Control Group -II (CG-II) with 16 typical children, matched by chronological age and sex. The evaluation consisted of signing the free consent term, which was clarified by those responsible; anamnesis protocol and development assessments through the Denver Developmental Screening Test-II (Denver-II), which assesses the personal-social, fine motor-adaptive, language and gross motor areas. Participants also underwent psychological evaluation through the Stanford-Binet scale for calculating the mental age (MA) and intelligence quotient (IQ). Statistical analysis was performed as follows: when groups had normal distribution, we used Student t test. When at least one of the groups had no normal distribution was used the Mann-Whitney test. Comparing the results regarding the Gross Motor, Fine Motor-Adaptive, Personal-Social and Language skills between EG-I and CG-I and EG-II and CG-II; there was statistical difference in all areas. It was observed that there was no difference when comparing the four abilities tested by the scale in children CG-I and CG-II, which demonstrates the homogeneity of the group. It is noteworthy that in the Denver II test, the CG-I and CG-II obtained normative performances in all areas. Premature children in the EG-I group had better average in personal-social skills, followed by language, fine motor, gross motor and adaptive areas. Premature childrens EG-II showed better average in language ability, then the area of personal-social, gross motor and fine-adaptive motor. We highlight the worst average in gross motor skill for both groups (EG-I e EG-II), which relates to the influence of motor performance in premature infants. Although the results indicate that the premature groups behaved homogeneously, the casuistry has characteristics of heterogeneity, considering that some children had low, average and above results. The results of this study confirm the findings of other studies regarding prematurity and its interferences in the course of typical development. Learner Outcomes: Knowledge about the development of premature infants; Knowledge about the fine motor, adaptive, gross motor, language and personal-social skills in premature infants; Knowledge about the changes resulting from prematurity
P025
EARLY IDENTIFICATION OF COMMUNICATION DISORDERS IN CHILDREN DANIELA REGINA MOLINI-AVEJONAS (1) - SILMARA RONDON (2) MARIA INS VIEIRA COUTO (2) - CIBELLE AMATO (2) CARLA CARDOSO (3) UNIVERSIDADE DE SO PAULO, FMUSP, SO PAULO, BRAZIL (1) - USP, FMUSP, SO PAULO, BRAZIL (2) - UNEB, UNEB, SALVADOR, BRAZIL (3)
Abstract: Health professionals should have the knowledge about the prevalence for a particular disease in the community in order to allocate sufficient resources. The surveys are instruments used as subsidies for formulating and evaluating public policy, becoming increasing its use in several countries as a support tool in planning health. The aim of the study was to identify children with possible speech and language disorders through the application of a translated and adapted questionnaire (How Does Your Child Hear and Talk?; ASHA, 2006). The study was conducted with 353 children from West region of So Paulo which was facing poor social economic conditions. Children were allocated in seven different groups, according to their age, varying from zero to five years and eleven months. The procedures for selection and evaluation of the subjects were started only after the study submission and approval in relevant institutional ethical processes. Parents or children guardians were interviewed during the daily routine consultations in pediatrics and answered questions regarding the childs language development from the material about language development in a specific hard disc designed in paper from an American scientific society. When the parents or guardians of children could not answer some of the questions, the value assigned was zero. The percentage of positive answers were evaluated and the results were considered to guide the management of the children by the researchers. Children who were less than 50% of positive answers responses on the hard disc about speech and language development, were submitted to a speech and language assessment in a specific health center of So Paulo. Learner Outcomes: Acquire knowledge about how to apply a fast type of screening; Know how to early identify communication disorders in children; Acquire knowledge about Speech-Language and Hearing milestones.
P024
GROSS MOTOR, FINE MOTOR-ADAPTIVE, PERSONAL AND SOCIAL LANGUAGE SKILLS IN PREMATURE CHILDREN AND TYPICAL DIONSIA APARECIDA CUSIN LAMNICA (1) CAMILA DA COSTA RIBEIRO (1) DEPARTMENT OF SPEECH AND LANGUAGE PATHOLOGY, SCHOOL OF DENTISTRY OF BAURU, UNIVERSITY OF SO PAULO, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: Prematurity is considered a biological risk factor for causing interferences in typical children development. Such interferences may occur in learning and in several areas, such as motor, linguistic and personal-social. However, the nature of these complications is not yet fully understood. Studies have shown the influence of premature birth on infant development. The aim of this study was to compare the overall development among premature infants and children with typical development between the ages of two to three years, through the Denver Developmental Screening Test-II. The research was conducted in the Speech and Language Clinic of the School of Dentistry of Bauru, University of So Paulo (FOB-USP) under the protocol of the ethics committee (035/2011). Participants were divided into four groups: Experimental Group-I (EG-I) with 20 premature; Experimental Group
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P026
THE EFFECTIVNESS OF ALTERNATIVE CLINIC-HOME SPEECH-LANGUAGE THERAPY PROGRAM TO ENHANCE SOCIAL INTERACTION SKILLS IN PRE-SCHOOL CHILD WITH ADHD: A CASE STUDY TAHAN EL SAYED AHMAD (1) AMERICAN BILINGUAL SCHOOL FOR SPECIAL NEEDS, SPEECH-LANGUAGE CENTER, SALMYIA, KUWAIT (1)
Abstract: A poor pragmatic language skill is a sign of abnormal criteria in the children development, Pragmatic language use as spouts into executive skills as in planning, organizing and scans regular behaviours in children with ADHD. The goals behind this study to prompt family , school teachers and pre-school child with ADHD to cope with essential pragmatic language
skills as a basic requirement at home, school and society for long life success. The study investigated a child aged 4.8 Yrs. in Kindergarten bilingual Arabic/English American School. A strategy of combination therapy was used with ADHD child with typical development children. The participants given a behavioural and speech therapy in the same time based on Alternative Clinical-Home Play Therapy Program for practicing and reviewing appropriate social skills. Results: the Alternative Clinical-Home Speech-Language Therapy Program and co-training interventions demonstrates that there is appropriate evidence for their efficacy in reducing symptoms of ADHD in pre-school child, as measured by school teachers who indicated that theres a notable changing in the child behaviour and direct observation of child compared with the supporting group was outstanding. Discussion: The study results indicate that Alternative Clinical-Home Play Therapy Program beside combination therapy shows potential efficiency in enhancing social interaction intervention for children with ADHD. These findings suggest that delivering social skills training programs to homes and schools system, involving parents, relatives, teachers and peers groups as a natural sittings focusing on pragmatic language skills, may increase the effectiveness under the supervision of program professionals. Learner Outcomes: The author goals are implementing an easy and fast program to help pre-school child to participate in daily school activities and learn good model of pragmatic language skills to appropriate level of performance by using many modes of learning, naturalistic settings, positive peer models, imitation skills and socially valid skills .Also, the program designed under the child need when it was hard to run it at clinic, we transfer our work to be clinic-home-clinic, and outcomes would improve pragmatic language skills as essential developmental requirements in a comfortable, familiar environment.
Abstract: This paper describe P-LARSP, an adaptation of the LARSP profile for Persian. It is based on data collected as part of a across sectional and descriptive_analytic study of 97 monolingual Persian speaking children between the ages of 1;6 &2;0 and 2;0 &2;6. The resulting profile chart represents the full renge of grammatical structure produce in spontaneous utterance by these children. stage 2&3 of LARSP with this collected data. Kindergartens were selected randomly, and then 1.5-2.5 years old children that had necessary critics , were included in the study. for each child,100 sentences were recorded. These sentences selected from subjects spontaneous utterance. Number of sentence structure show more development than the LARSP profile .In stage 2 of LARSP MLU is 2 word but in this paper is 3 word and in stage 3 of LARSP MLU is 3 but in this paper is 4 word. About negative sentence and copula verb of LARSP on 4 stage but in this paper seen on 3 stage (2;0 & 2;6). Another data is similar with LARSP profile. Resulting of this paper provide a assessing language impairment in Persian and can be used to compare the language of different children as well as same childs language at different stage of development
P029
MEASURES OF TIME TO SPEECH AND LANGUAGE THERAPY FOR CHILDREN WITH AUTISM SPECTRUM DISORDER ANA CARINA TAMANAHA (1) - JACY PERISSINOTO (1) UNIFESP, UNIFESP, SO PAULO, BRAZIL (1)
Abstract: The purpose this study was to identify a time parameter of speech and language therapy for children with Autistic Spectrum Disorders assisted by the association of both direct and indirect actions, as only by indirect shares. The design of this study is the Clinical Trial. The sample was composed of 11 autistic children, 4- 10 years old. These children were randomly divided into two groups: Six were receiving both direct and indirect intervention (Therapy Group-TG), and five were receiving exclusively indirect intervention (Orientation Group-OG). We used the following parts of ASIEP-2 (Krug et al, 1993): Autism Behavior Checklist (ABC), Interaction Assessment (IA) and Sample of Vocal Behavior (SVB) on three occasions: at the beginning, six months later and 12 months later. We observed there was greater evolution of Therapy Group TG in the Autism Behavior Checklist, Interaction Assessment and Sample of Vocal Behavior, specially between 0 and 1 time. The six month period is strong evidence for indirect action and for the association between indirect and direct actions. This measure of time can be a parameter for speech and language therapy for children with autism spectrum disorders. Learner Outcomes: know to identify a time parameter of speech and language therapy for children with Autistic Spectrum Disorders assisted by the association of both direct and indirect actions, as only by indirect shares; know about speech and language therapy for children with Autistic Spectrum Disorders
P027
AN INVESTIGATION INTO THE GAZE OF THOSE WITH AUTISM CHIZUKO UTIYAMA (1) DEPARTMENT OF SPEECH, LANGUAGE AND HEARING THERAPY, MEJIRO UNIVERSITY, SAITAMA-CITY, JAPAN (1)
Abstract: The viewpoint of an autistic child was investigated using a viewpoint searching machine/eye tracker in order to clarify the relation between language acquisition and the shared attention of autistic children. In order to understand what visual stimulus is being focused on, a picture with the name known, a picture with the name unknown, the face of the mother from the front and side, and hiragana letters indicating the name of the picture were used as stimulation materials. The subjects included an autistic female child with a vocabulary age of 4 years and 10 months old (chronological age: 8 years old) and a neurotypical male child (chronological age: 4 years and 8 months old) with the same vocabulary age. As a result, no difference was found in the gaze duration for the picture with the name known and the picture with the name unknown in the autistic child, while the neurotypical child gazed at the picture with the name unknown more than the picture with the name known. There was no difference in the gaze duration according to the direction of the face regarding the face of the mother from the front and side, although the neurotypical child expressed a short gaze duration regarding the face from the side. The target autistic child acquired understanding and transmission of spoken language with letters as the mediator; however, the gaze duration of letters was longer with the presentation of an acoustic stimulus, while there was no difference in the gaze duration for the neurotypical child. The autistic child was less likely to focus on pictures with the name unknown, a possible resistance towards new stimulation was suggested, and it was believed that this characteristic is involved in the disability of automatically acquiring new vocabulary and expanding vocabulary. The autistic child was not able to search in the gaze direction of the mother, thus exhibiting an inability to share attention with the mother. The neurotypical child gazed at the indicated object by understanding the meaning of the gaze direction of the mother, exhibiting the establishment of shared attention. Regarding the present autistic child who acquired spoken language from letters, it was presumed that she focused on the letters when a voice was introduced, connecting the voice and letters and promoting understanding and transmission of spoken language, thus supporting the acquisition of spoken language. Learner Outcomes: I would like to convey to the participants that children with autism spectrum disorder also have joint-attention disorder. At the same time, I would like to convey that in children with autism spectrum disorder, there is a relationship between linguistic development and gaze movement. Such children, who have acquired verbal language via kana characters because they did not have the ability to speak, understand the importance of letters.
P030
METAPHONOLOGICAL GROUP TRAINING: ENHANCEMENT EXPERIENCES AS PREREQUISITES FOR READING AND WRITING ANDREA BROGI (1) - VALENTINA CAMPANELLA (2) ALESSANDRO MALANDRINI (1) SIENA UNIVERSITY, SANTA MARIA ALLE SCOTTE HOSPITAL, SIENA UNIVERSITY, SIENA, ITALY (1) - CENTRO DEDALO, SIENA, ITALY (2)
Abstract: It has been shown that almost the 30% of patients with Specific Language Disorder develop a Specific Learning Disability. Recent studies point out that metaphonology can be an useful instrument in the management of Specific Language Disorder patients and therefore in the Specific Learning Disability prevention. A new conception of metaphonological training has been built, in order to enhance the global metaphonology skills at the basis of a correct learning development. This training is composed of 80 games created and built particularly for this purpose. A group of 10 patients with Specific Language Disorder has been enrolled in this study; One was attending the second year of the primary school and the others were attending the last year of the preschool. Two of the children were been lost at the follow up. Patients have been preliminary evaluated with a CMF test; then, the same test has been re-proposed after four months to verify the training efficacy. The CMF test administered after the metaphonological enhancement, pointed out that: six children out of 8 improved their skills. Moreover, the most of them reached the highest score. Only 2 patients didnt show a positive evolution or an incisive improvement. The results obtained showed that a specific metaphonological enhancement conducted during the last year of the preschool, bring to an improvement of the metaphonological tasks and to a consequent decrease of the probabilities of a Specific Learning Disability development. For what concerns the failure of this training for the 2 sisters attending the first year of primary school we think it may be related to a suspected syndrome case that is still under investigation. Although this preliminary study underlines the preventive importance that this particular training could have, it can not demonstrate with absolute certainty that it would assure a total Specific Language Disability prevention and needs further investigation with also an improvement of the series of cases. Learner Outcomes: Know that almost the 30% of patients with Specific
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P028
P-LARSP: DEVELOPMENTAL LANGUAGE PROFILE FOR PERSIAN CHILDREN MARYAM GHELMANI POUR (1) - TAHERE SIMA SHIRAZI (1) MASOUD KARIMLU (1) - REZA NILI POUR (1) HOSSEIN KARIMI (1) ABA REHABILITATION RESEARCH CENTER, WELFARE AND RHABILITATION UNIVERSITY, TEHRAN, IRAN (1)
Language Disorder develop a Specific Learning Disability; Understand that solid metaphonological skills are fundamental for a normal learning development; Learn that this metaphonological training seems an effective instrument to improve global metaphonological skills.
P031
RELATIONSHIP BETWEEN VERBAL IQ (VIQ) SCORES, PERFORMANCE IQPIQSUBTESTS, AND READING COMPREHENSION TEST IN HEARING-IMPAIRED CHILDREN KAHORU HASHIMOTO (1) - MASAKO NOTOYA (1) - HIROMI HARADA (2) - MAKOTO ITO (1) - TOMOKAZU YOSHIZAKI (1) KANAZAWA, UNIVERSITY, KANAZAWA, JAPAN (1) - SEIREI, UNIVERSITY, HAMAMATSU, JAPAN (2)
Abstract: Introduction: Retardation of oral language ability of hearing-impaired pupils by several years is reported authors in the all of the world. Our previous studies have reported that many hearing-impaired children undergoing the Kanazawa Method training, a multisensory-based language training method implemented in our clinic, have acquired the almost same level of language skills as hearing children. Purpose: We analyzed the results of subtest items using the Wechsler Intelligence Scale and Reading Comprehension Test in hearing-impaired children who had received training by Kanazawa method during the preschool period in our clinic. Method: Thirty-three congenitally hearing-impaired children/adults participated in this study. All of the subjects aged 9 > years and can speak Japanese oral language. Their scores of WISC/WAIS-,WAIS-R and Kyoken Style Reading Comprehension Test analyzed ; 1)Relationship between verbal IQ (VIQ) scores and Performance IQPIQwas investigated. 2) Correlation of VIQ and PIQ subtests scores of WISC/WAIS- was investigated. 3) Moreover, we compared WISC/WAIS-,WAIS-R with Kyoken Style Reading Comprehension Test. Results: 1) The VIQ score in 33 subjects varied from 54 to 135 with the mean being 94.2 (SD = 19.3). The PIQ score varied from 89 to 134, with the mean being 110.8 (SD = 12.5). 2) There was no correlation between the PIQ and VIQ scores received by the subjects. There was no significant difference between the normal range VIQ group and the group with VIQ < 80 in their mean PIQ score, but there was significant difference in subtests Picture Comprehension of PIQ. 3) There was significant correlation between the VIQ scores and the total scores of Kyoken style Reading Comprehension Test. Conclusion: The Kanazawa method was designed to encourage hearingimpaired children to acquire words and sentences using sign language and written language with auditory/oral training. This method promotes ability to learn language structures in infantile periods.By this method, many severe hearing-impaired children can acquire oral language sufficiently
violations (clinically diagnosed alaliya, dizartriya) participated in research at different stages. For our research a diagnostic technique Studying of influence of fiction on emotional experience of preschool children by A.D. Kosheleva which consists of special diagnostic tasks was used. The analysis of the received data allowed to mark out the peculiarities of perception and understanding of literary works by children with speech violations. In research the variable attitude of parents to the usage of fiction in education of children is also revealed. These data confirm the idea about the necessity of special work on formation of understanding of works of fiction as one of effective means of development of social emotions and social intellect.
P033
SPEECH BULB IN CHILDREN WITH CLEFT PALATE MARIA INS PEGORARO-KROOK (1) - RAQUEL RODRIGUES (2) HOMERO AFERRI (3) - MELINA WHITAKER (3) - JOSIANE ALVES NEVES (3) - JENIFFER DE CASSIA RILLO DUTKA (2) - OLLIVIA MESQUITA VIEIRA DE SOUZA (2) DEPARTMENT OF SPEECH, LANGUAGE AND AUDIOLOGY, BAURU COLLEGE OF DENTISTRY; HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES, BAURU SCHOOL OF DENTISTRY; HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1) - DEPARTMENT OF SPEECH, LANGUAGE AND AUDIOLOGY, BAURU COLLEGE OF DENTISTRY, UNIVERSITY OF SAO PAULO, BAURU, BRAZIL (2) - HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (3)
Abstract: Background and Purpose: Individuals with cleft palate can present with VPI after primary palatoplasty and thus require secondary physical management which may involve surgery or prosthesis. In some cases a speech bulb (SB) can be used temporarily to optimize surgery by functioning as a diagnostic or therapeutic tool for the manipulation of the VP mechanism. The successful use of the SB depends on factors that still need to be investigated. The objective of this study was to document speech and prosthodontic outcome of prosthetic treatment of VPI. Methods: Thirty patients with VPI after primary correction of unilateral cleft lip and palate with mean age of 9 years participated in this study. All patients were treated for at least 6 months with SB with the goal of improving pharyngeal walls displacement during speech in order to optimize a future surgical repair of VPI. Speech outcome was assessed by the Bzoch cul-de-sac test and by a group of 3 speech pathologist who rated paired productions of 5 oral phrases using a 2-point scale for judgment of presence or absence of hypernasality with and without SB. Duration and complications observed during the process of construction and adaptation of the SB was identified with a systematic review of the prosthodontists records. Results: A score of 2.6 for the 10-point cul-de-sac test was retrieved from the records of patients with the SB compared to 9.8 for those without SB, and this difference in the index of presence of hypernasality between both conditions was found to be statistically significant (p<0.001; Wilcoxon). The 4-point scale was used with an intrajudge agreement of 100% with SB and 83% without SB, with an interjudge agreement of 89% for the condition with SB and 93% for the condition without the SB. Listener judgments of recorded speech revealed presence of hypernasality for 93% (N=28) of the recording obtained without the SB and for 30% (N=9) of the recording obtained without the SB, and this difference was found to be statistically significant(p<0.001; Wilcoxon). The mean duration of the process for construction of the SB was 8 months with need for replacement of that for 56% patients due to breakage and retention difficulties during the process. Since the device was constructed in parts (anterior, intermediary, and bulb) and the patients were given time to adjust to each small change, the gag reflex was observed during fittings only for 23% of the patients. When present, gagging was resolved within few days with a specific training conducted by the SLP. After the adaptation of the SB all patients were sent to bulb reduction program aimed to obtaining maximum displacement of velopharyngeal structures for later referral for surgical repair. Conclusion: While the process for the construction of the SB was long, it was guided to minimize discomfort and improve tolerance and use of the device. The use of the SB significantly eliminated hypernasality for 70% of the patients. Learner Outcomes: This presentation will report speech outcome with and without SB in children with VPI after primary repair of cleft palate, and will describe the stages, the time and the complications involved in the construction of a SB fostering a discussion regarding the use of the prosthetic management of VPI as a resource to improve outcome of future surgical correction.
P032
THE PECULIARITIES OF PERCEPTION AND UNDERSTANDING OF LITERARY WORKS BY CHILDREN WITH SPEECH VIOLATIONS ZAHAROVA TATYANA VASILYEVNA ZAHAROVA (1) - MOISEEVA ALYONA ANDREEVNA MOISEEVA (1) INSTITUTE OF PEDAGOGY AND PSYCHOLOGY / THE DEPARTMENT OF SPEECH PATHOLOGY EDUCATION, CHEREPOVETS STATE UNIVERSITY, CHEREPOVETS, RUSSIAN FEDERATION (1)
Abstract: Authors carried out an experimental study of processes of perception and understanding of literary works by preschool aged children with speech violations. The concepts of assimilation of social experience by children of preschool age (L.A. Venger, V.S. Mukhina, V.A. Petrovsky, A.M. Vinogradova, L.M. Klarina, E.S. Evdokimova, N.L. Kryazheva A.V. Zaporozhets); theories of perception and understanding of works of fiction by children of preschool age (A.V. Zaporozhets, L.P. Strelkova, V.G. Belinsky, I.V. Dubrovina, V. Oklender, M.M. Alekseeva, V.I.Yashina, M.B. Yeliseyeva, N.L.Kryazheva, L.S. Voyushina, M.V. Matiukhina, T.S. Mikhalchik, N.F. Prokina, L.N. Rozhina, L.F. Ostrovskaya, S.V. Peterina, L.M. Gurovich); the concepts of personal and speech development of children with the general underdevelopment of speech (D.R. Minyazheva, I.V. Kovyazina, O.K. Agavelyan, O.A. Lekhanova, E.A. Kizimova, E.N. Vasilyeva, G.N. Efremova, E.E. Dmitrieva, V.A. Kovshikov, L.M. Shipitsina, L.S. Volkova, I.Yu. Kondratenko) are put in a basis of this work. For our research a diagnostic technique Studying of influence of fiction on emotional experience of preschool children by A.D. Kosheleva which consists of special diagnostic tasks was used. 60 children at the age of 6-7 with speech violations (clinically diagnosed alaliya, dizartriya) participated in research at different stages. The analysis of the received data allowed to mark out the peculiarities of perception and understanding of literary works by children with speech violations. In research the variable attitude of parents to the usage of fiction in education of children is also revealed. These data confirm the idea about the necessity of special work on formation of understanding of literary works as one of effective means of development of social emotions and social intellect. Learner Outcomes: Authors carried out an experimental study of processes of perception and understanding of literary works by preschool aged children with speech violations. 60 children at the age of 6-7 with speech
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P034
PROMOTING THEORY OF MIND IN BULLIES AND VICTIMS Janelle Lamontagne (1), Carol Westby (1) (1) Bilingual Multicultural Services Usa , ALBUQUERQUE, NM, UNITED STATES
Abstract: Bullying among students is a huge issue in schools. It is a particular problem for children and adolescents with language impairment, autism, and attention-deficit hyperactivity disorder (Chen & Schwartz, 2012;
Redman, 2011). Instances of bullying have been increasing in recent years in schools. And bullying appears to be happening at earlier ages and with greater frequency (Monks, Smith, & Swettenham, 2005; Vlachou, Andreou, Botsoglou, & Didaskalou, 2011). The seeds of bullying and victimization occur in the preschool and early elementary years. Several recent studies have proposed that deficits in theory of mind (ToM) before elementary school might be involved (Gasser & Keller, 2009; Jansen, Veenstra, Ormel, Verhulst, & Reijneveld, 2011; Shakoor, S. et al, 2012; Vlachou, Andreou, Botsoglou, & Didaskalou, 2011). Poor ToM at age 5 predicts becoming a victim or bully-victim in early adolescence. ToM deficits vary in bullies, victims, and bully victims . (Bully-victims are involved in aggressive exchanges as both initiators and targets. Bullies are only aggressors; they are not victimized). Studies typically show that children who are victims and bully-victims have social skill/ToM deficits. Although some bullies exhibit ToM deficits, most show intact or superior ToM skills (Gini, 2006; Monks, Smith, & Swettenham, 2005). These competencies may allow them to anticipate others thought and actions and therefore to efficaciously manipulate the group processes underlying the dynamics of bullying. Both bullies and bully-victims exhibit deficits in moral motivation. Even though they know what is morally right or wrong, they did not feel obligated to do the right thing (Gasser & Keller, 2009). Although many children who are victims have deficits in ToM, some victims have adequate ToM. Their victimization is related to withdrawn behaviors and shy or fearful temperaments that inhibit their responses to bullies. Their social skills needs are somewhat different from victims and bully-victims who do not have ToM deficits. Research points to the need for early intervention and the need for intervention programs to consider the specific needs of bullies, bully-victim, and victims. Identifying and supporting children with poor ToM early in life could help reduce their vulnerability for involvement in bullying and thus limit its adverse effects on mental health. This poster summarizes the research on the relationships between ToM and language competence in children who are bullies, victims, and bully-victims and reports on a program to promote social-emotional skills in kindergarten through third grade children who exhibit bully-like and victim-like behaviors. Lesson activities address students who need help with behaviors such as being inclusive or exclusive, teasing, bossiness, hurtful behavior, impulsive behavior, tolerance, understanding and expressing feelings, etc. Each lesson employs strategies for developing self awareness and self regulation-mood management. The nature specific objectives of ToM interventions vary for bullies, victims, and bully-victims. Learner Outcomes: Participants will be able to describe the social skills and theory of mind knowledge of bullies, bully-victims, and victims; participants will be able to explain the components of a social-emotional program to address social awareness and self-regulation; participates will be able to select stories to develop specific aspects of theory of mind, social understanding, and self-regulation.
Learner Outcomes: know frequency of cleft palate children demonstrated hypernasality; know no significant differences between 5 groups for hypernasality based on cleft type, know no significant relationship between age of primary palatal surgery and number of children with significant hypernasality.; understand the need of additional researches to determine variables that might have masked the influence of timing of primary surgery and cleft type.
P036
CHECKLIST FOR EVALUATE PRAGMATIC SKILLS IN CHILDREN CAMILA MAYUMI ABE, BIANCA RODRIGUES LOPES GONALVES, CAMILLA GUARNIERI, SIMONE APARECIDA LOPES-HERRERA BAURU SCHOOL OF DENTISTRY (FOB), UNIVERSITY OF SO PAULO (USP), BAURU, BRAZIL (1)
Abstract: Part of pragmatic studies focuses on the use of communication skills, which refer to the individuals ability to participate in a dyad, aiming communicative exchange. The communication skills allow the use of language for different purposes and functions, contextual cues to determine what is said and the interaction between people to start, maintain or end conversations. In Brazil, there is still no checklist for evaluate pragmatic skills validated or standardized to Portuguese, obeying the statistical and scientific rigor required, and the materials that are available demand an extensive analysis time. With this focus, the work presented here was aimed at drawing up a checklist for characterize the child pragmatic profile, in order to provide a reduction in analysis time for researchers and clinicians. We designed a protocol based on a preexisting checklist in this area. To be able to verify whether there were statistically significant differences were made recordings of the dyad of 40 children of both genders with his parents, aged 4-7 years, 20 with typical language development, to compose the control group and 20 with language delay, to compose an experimental group, in order to examine the possible use of such a checklist in different populations, ensuring permeability. A speech-language pathologist has been trained as independent observer by the researcher to conduct the evaluation of the videos for subsequent statistical analysis and calculation of reliability. At the end of the work, you can get a checklist easy to apply, with reduced application time and that can be permeable to detect changes in the use of communicative skills in children with language disorders. This checklist consists of four categories related to the dialogical skills, adjustment, narrative-discursive and non-interactive (imaginative language functions), in which the observer can note three possible options analysis (present / absent / not observable in the sample). If present, there are the options of marking the appropriateness or inappropriateness of use. For its easy applicability this instrument will allow that the analysis of verbal communicative skills will be performed more frequently by clinical audiologists or research area. A future validation and standardization may be proposed from this checklist developed here. Learner Outcomes: Learn a new instrument to assess verbal communication skills, which can be analyzed faster and more practical when compared with assessment tools currently available in Portuguese; Know how it was done the creation of the checklist, which can serve as a model for developing other assessment tools for different areas of child language; Understand how the checklist, unlike some instruments, which account for the amount of skills used by children, is concerned with the quality of use of these skills, making sure that the child is able to use the skill properly or not during the interaction and if the skill was considered amenable to observation in the sample considered.
P035
IMPACT OF TIMING OF PRIMARY PALATAL SURGERY AND CLEFT TYPE ON SPEECH OUTCOME PARISA REZAEI (1) - SABA SADEGHI (1) - MASOUME SAMANI (1) DEPARTMENT OF SPEECH THERAPY, SCHOOL OF REHABILITATION, ISFAHAN UNIVERSITY OF MEDICAL SCIENCES, ISFAHAN, IRAN (1)
Abstract: There are various types of clefts of the primary and secondary palate and various degrees of severity. Despite the relatively long history of palatal surgery, little consensus has been reached regarding the best surgical techniques, and even less regarding optimal timing. There are still no standard protocols to address the issues of ideal timing for cleft palate repair to attain optimal speech and to avoid abnormal maxillofacial growth after repair. Palatal repairs are often descried as early or late closure with unclear definition of early and late. This study was conducted to examine the frequency of preschoolers with cleft palate who demonstrate hypernasality. The impact of the time of primary palatal surgery and cleft type on moderate to severe hypernasality was also examined. Methods: A group of 46 Iranian preschoolers aged 3-6 years with repaird cleft palate was assessed using Universal Parameters for Reporting Speech Outcomes in Individuals With Cleft Palate Farsi Edition. Cleft types were bilateral cleft lip and palate (BCLP; n=5, 10/9%), unilateral cleft lip and palate (UCLP; n=20, 43/5%), cleft of the hard and soft palate (HSP; n=10, 21/7%), cleft of the soft palate only (SPO; n=6, 13%) and submucous cleft palate (SMCP; n=5, 10/9%). Judgments of hypernasality were made by two certified speech and language pathologist and were made using a 4-point rating scale. 33 Had a primary palatal surgery prior to 12 months of age, 7 had surgery at 12-18 months of age, and 6 had surgery after 18 months.Results: 78/3 percent of the children demonstrate moderate to severe hypernasality. There were no significant differences between 5 groups for hypernasality based on cleft type. The analysis, also, revealed no significant relationship between age of primary palatal surgery and number of children with significant hypernasality. Conclusion: Because of the high amount of hypernasality in all children, the need for research documenting the efficacy of surgeries employed with these children, is essential. In this study the age range was wide, and there was the small number of children in each cleft palate group. The Additional research is needed to determine if there are variables that might have masked the influence of timing of primary surgery and cleft type
P037
S.A.M. METHOD (SENSE AND MIND): THE BODY LEARNING ANNALISA ZUIN (1) - MANUELA CAPETTINI (2) - ADRIANA BORTOLOTTI (3) - ANNALISA RISOLI (2) DON CARLO GNOCCHI FOUNDATION, CENTRO SANTA MARIA AL CASTELLO, PESSANO CON BORNAGO (MI), ITALY (1) - DON CARLO GNOCCHI FOUNDATION, VILLA RONZONI DI SEREGNO, SEREGNO, ITALY (2) - CATTOLICA SACRO CUORE, UNIVERSITA, MILANO, ITALY (3)
Abstract: We present the basic theoric model of S.a.M (Sense and Mind) method and its rehabilitation structure. This method was designed by a group of rehabilitators with a multi-year experience, who has reconciled the last years studies from neurosciences field with the clinic daily life. Considering the body as the first motor of knowledge and the space as the medium of every activity, this approach facilitate the multi-modal integration of the sensorial channels due to allow the passage from the concrete experience of the movement to the different levels of abstraction. The generalization is favored by the structuring of mental manipulated images, in addition to specific instruments to set in on the lacking areas. A lot of attention is given to the temporal aspects, in particular to rhythm and synchrony, basic elements for the learnings and the re-learnings. The method finds its application also in the rehabilitation of different diseases of the evolutive ages, as dyspraxia, dysgraphia, dyscalculia, the development difficulties of the executive functions. Learner Outcomes: introduce a new rehabilitative approach, based on the theory of Embodied Cognition and the theory of mirror neurons, which has, as foudamental element, the concep of the body as the first motro of knowledge; share experienceand new projects in the field of speech therapy
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leading to open own mind to a broader concep of rehabilitation and to understand how to approach sometimes too much specific, to not only darken the real aim of the treatment, but also the causes of the difficulty; make known the concep that the space and the time are two basic elements for the life of each one and only settino proper attentino on them can be learned or re-learned through the body to take conscience and knowledge of own skills; present an approach to the treatment of dysgraphia that imagines all other components that approach in writing from the postural aspect to use of mental images.
P038
RUSSIAN MODERN TRENDS AND ALGORITHMS PSYCOPEDAGOGICAL SUPPORT PRESCHOOL CHILDREN WITH SPECIFIC LANGUAGE DISORDER TATIANA TUMANOVA (1) - TATIANA FILICHEVA (1) MOSCOW CITY PEDAGOGICAL UNIVERCITY, MOSCOW CITY PEDAGOGICAL UNIVERCITY, MOSCOW, RUSSIAN FEDERATION (1)
Abstract: In modern Russia, revealed an increase in the number of preschool children of primary school age who have speech disorders. Speech therapy to help them based on a number of principles, selected L. Vygotsky R.Levina and later - by modern scholars. Currently, the program has been successfully implemented to overcome the underdevelopment of speech in preschool children by Prof. Tatiana Filicheva, Galina Chirkina and their disciples. The program consists of a series of modules focusing on children of different ages and from different states of speech. Their structure is the following sections: - Stages and patterns of development of the childs speech in ontogeny, as well as conditions that are important for the normal development of childrens speech; - Etiology general underdevelopment of speech, the clinical part of this category of children; - Principles, methods and differential (depending on the age and status of the speech) content of speech therapy examination of children with general speech underdevelopment; - Psycho-educational characteristics of children with a first, second, third and fourth levels of speech development, currently on a scientific level; - Differentiated speech therapy programs work with children of different age groups I, II, III, IV levels of speech development, provided information on the corrective training operation, maintenance speech therapy classes, speech therapy sessions on topics of periods of study and teaching materials complemented by extensive, with each year of study completed totals requirements for speech and language skills of children, summarizing information about their potential generated in the corrective action etc. Learner Outcomes: know, that in modern Russia for decades successfully implementing and developing programs (authors Prof.r Tatiana Filicheva and Galina Chirkina ) to address the underdevelopment of speech in preschool children; know, that the program consists of several modules; know, that each module aimed at children of different ages, with different states of speech.
1st and 5th grade. There was found no significant difference in WM between 1st and 5th students. Thus, this study is not in line with other studies that claimed WM increases as the schooling advancement. Several researchers have found correlation between WM and oral language highlighting that WM increases with age and schooling due to rise of feedback speed. This hypothesis was confirmed in this study since all subjects performed oral language assessment, suggesting WM increase can be related to oral language mastering. Some studies depict syllabic awareness is mastered before phonemic skills and schooling provides improvement in phonemic awareness. This was found in this study concerning syllabic activities, on the other hand it was not noticed a strong improvement in phonemic awareness. The lack of correlation between PA and WM leads to new discussions concerning those skills. Further, it can promote best reflections in order to identify which one has more influence on the other. Data in this study allows affirm that WM is essential to PA development, however the inverse relation was not verified. Students from 5th grade showed greater performance in PA than 1st grade students. However, it was found similar results to WM, which suggests no increasing of that skill with the schooling advancement. Learner Outcomes: Know that the performance in WM seems to be more related to oral language development than to schooling advancement; understand why to Brazilian students, schooling advancement allows stronger increasing in syllabic activities than phonemic. 3. Know that the correlation between PA and WM might not be mutual as previously claimed, but otherwise, univocal. 4. Understand why similarity of psedowords does not interfere in WM.
P040
EFFECTIVENESS OF READING RATE ASSESSMENT MEASURED IN SYLLABLES PER MINUTE APARECIDO JOS COUTO SOARES SOARES (1) HAYDE FIZSBEIN WERTZNER WERTZNER (1) MARIA SILVIA CRNIO CRNIO (1) DEPARTMENT OF PHYSIOTHERAPY, SPEECH AND LANGUAGE PATHOLOGY AND OCCUPATIONAL THERAPY OF MEDICAL SCHOOL (FMUSP), UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Applying a measure which disregards the texts features and its complexity, might favor the comparison of Reading Rate (RR) in children who are in different levels of schooling. In studies in which speech rate is assessed it is often used the syllables per minute (SPM) measure because it isolates the extension and number of words effect. Thus, this study aimed to compare the performance of children from the 3rd and 4th grade of elementary school using both WPM and SPM. Each child read a text according to the grade that she/he was. The two texts used differed between each other concerning total number of word and its extension, number of syllables and syllabic structure. Thus, in the text used to children from 4th grade there were more words as well as disyllables and trisylables words, with greater syllabic structure. All data were submitted to statistical analysis. To compare RR distribution it was applied Mann-Whitney test with level significance of 0,05. Data showed WPM mean of 60,1 to the 3rd grade and 60,2 to the 4th. There was no significant difference in WPM distribution between the groups (p=0,930), therefore, this measure did not differ the groups. Concerning SPM, the mean was 115,2 to the 3rd grade and 147,2 to the 4th grade. Statistical analysis showed a tendency of greater mean to the 4th grade (p=0,036). There are evidences that SPM measure was more effective to show difference of RR in children who are in different levels of schooling. Furthermore, SPM revealed a better profile of RR and it can be used to compare reading skills using different texts. On the other hand, WPM measure seems to be more suitable when children have to read the same text. As the schooling levels advances, it is noticed an increase in the number, extension and complexity of the words in the texts used. This has an important role in WPM measure since it takes more time to pronounce a polysyllable word than a monosyllable. It can lead to misunderstandings if only WPM measure be used. It is important to point out that even considering that the proficient reader uses mostly the lexical route, that is, recognizes the word as a whole and not per syllables, the RR is calculated as the articulation of words in a certain time period. That means there is not advisable to disregard the extension of the words when calculating RR. Thus, this study strongly contributes concerning the different ways of measure the RR, pointing out a measure which isolates the word extension effect and also the syllable complexity. That leads to best distinguish reading skills of children. since SPM can be used in different situations either assessment or research. The SPM measure was more effective to show the difference between children of 3rd and 4th grade once it isolates linguistic-textual aspects, on the contrary of WPM measure. Learner Outcomes: Know that SPM measure best distinguishes RR of children who are in different levels of schooling; understand why the use of WPM measure can jeopardize the reading skills profile when different texts are used; know why SPM measure is more precise to characterize RR and can be used in different sets of assessments (either with a unique text or using different texts).
P039
WORKING MEMORY AND PHONOLOGICAL AWARENESS IN STUDENTS FROM CYCLE I OF ELEMENTARY SCHOOL MARIA SILVIA CRNIO (1) - BEATRIZ CAMPOS MAGALHES DE S DE S (1) - APARECIDO JOS COUTO SOARES SOARES (1) DEPARTMENT OF PHYSIOTHERAPY, SPEECH AND LANGUAGE PATHOLOGY AND OCCUPATIONAL THERAPY OF MEDICAL SCHOOL (FMUSP), UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Several studies pointed out the relationship between Phonological Awareness (PA) and Working Memory (WM) and claimed that those skills have an important role in reading and writing acquisition. Nevertheless, studies which investigate the relationship between the skills previously mentioned are mainly concerned about initial grades of elementary schools. This way this study aimed to investigate the performance in PA and WM of children in the final of cycle I of the elementary school as well as the relationship (1st and 5th grade). The subjects were 80 students, both genders from a public elementary school where most children are from a slum in So Paulo. WM was assessed using Pseudoword Repetion Test (PRT). PA was assessed in syllabic and phonemic levels involving rhyme, synthesis, split and manipulating activities. The maximum score was 40 to syllabic level and 30 to phonemic. Data were analyzed using Wilcoxon, Mann-Whitney tests and Spearman correlation coefficient with significance level of 5%. The mean score were similar to 1st and 5th students regarding WM (37,6 and 38,2 respectively). Regarding PA, 5th grade showed greater both to syllabic and phonemics activities. Students from 1st grade showed better performance in syllabic activities (mean of 23,7) than phonemic (mean 9,2). Moreover, it was found significant difference between the performance of students from 1st and 5st grade in WM and PA, which greater mean to WM. Comparing the performance of 1st and 5th students concerning WM, no significance difference was found both to similarity and total score. Regarding PA, significant difference was found between total score, syllabic and phonemic activities. There was found no correlation of performance in none of tests used to both
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P041
PHONOLOGICAL AWARENESS DISORDERS OF LANGUAGE IN PACIENTS WITH MALFORMATION: WAS THERE COMORBIDITY? ZELITA GUEDES (1) - ANA PAULA BAUTZER (1) ESCOLA PAULISTA DE MEDICINA - DEPARTAMENTO DE FONOAUDIOLOGIA, UNIVERSIDADE FEDERAL DE SO PAULO, SO PAULO, BRASIL (1)
Abstract: This research tries to verify the existence of phonological awareness deficits in individuals born with cleft lip and/or palate associated with genetic syndromes or not by comparing them to a group of individuals without malformation but with disorder of reading and writing and phonological awareness deficit. There were compared 25 children divided into three groups: children with cleft lip and palate associated with the genetic syndrome (GI), children with isolated cleft lip and palate (GII) that were compared to children with diagnose of reading and writing disorder and phonological awareness deficit (GIII). Data collection was carried out in a speech therapy clinic that two tests were applied for evaluating speech and language: ABFW Child Language testing in the area of phonology and Confias Phonological Awareness: Sequence Evaluation Instrument, within the clinical routine both in use at Brazil. The group with cleft lip and palate associated with genetics syndrome (GI) presents the greatest manifestations of phonological awareness deficits compared to the other groups. This group presents greater difficulties in performing tasks with: the initial syllable; the initial sound; synthesis; and also features more changes rather than omissions in phonemes, besides dispenses longest time in the automation process. The children of the three groups showed signs of phonological awareness deficits. The founded differences between GI and GII although not significant may suggest that the comorbidity of conditions makes difficulty to the acquisition and development of speech and language. Such observations recommend the compulsory use of phonological intervention to the group with cleft lip and palate associated to genetic syndromes. Learner Outcomes: The participants will see that phonological evaluation and intervention are important to the children with isolated cleft palate or with genetic syndromes.
Learner Outcomes: To present sensitivity of test and exams commonly used to assess speech outcomeand to establish the overall level of agreement among the measures used to document speech, fostering a discussion regarding agreement among different modalities of measures.
P043
LANGUAGE SKILLS AND WORKING MEMORY IN CHILDREN WITH CLEFT PALATE MARIA DE LOURDES MERIGHI TABAQUIM TABAQUIM (1) MRCIA REGINA FERRO FERRO (2) - DIONSIA APARECIDA CUSIN LAMNICA LAMNICA (1) UNIVERSITY OF SO PAULO, HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES/ SCHOOL OF DENTISTRY OF BAURU, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1) UNIVERSITY OF SO PAULO, HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES / UNIVERSITY OF SO PAULO, BAURU, BRAZIL (2)
Abstract: The condition requires individual efforts dynamic, cognitive and behavioral, that change constantly to manage the demands internal and / or external adaptation and psychosocial context. Although intellectual ability is in the average for a large number of this population, especially without the involvement syndromic, another significant percentage demonstrates low academic performance, with levels less than expected for age and education, with losses in cognitive functions such as language, attention and memory, involved in academic activities in reading, writing and calculation. The objective of this research was to identify the attentional resources, memory, visual and written language in children with cleft palate. The study included clinical quantitative, descriptive and inferential statistics, 20 children with cleft lip and palate, aged 7 to 11 years old, both sexes, intellectual level expected for their age, complaining of poor academic performance. As research instruments were used: Coloured Progressive Matrices Test, to assess nonverbal intelligence visuo-spatial logic; Academic Performance Test-TDE, in order to assess the ability of reading and writing; and the Divided Attention Test - TEDIF -1, to measure the levels of selective attention, sustained and alternating. Statistical analysis was performed using the method description. The results showed the expected average percentiles for age with satisfactory visuospatial resources to establish relationships analog and logical sequence similarity. In academic tasks read and write single words, 56% were rated below average, and the written evidence, the more altered. It was found that 62.5% of the sample had scores below the average in tests related to visual attention and working memory, both in the number of correct as at runtime. Although participants had complaints of poor academic performance, 44% had scores in the standard expected for the age group and educational level in reading and writing, and 37.5% in tests of visual attention and working memory. It is inferred that this may be due to academic performance is related to several biological variables, psychosocial and educational. The study identified that the resources of working memory involving selective attention, sustained and alternating proved lagged by age and education, compromising efficiency in writing tasks. We identified difficulties in writing words of low and high frequency, indicating limitations in competence of this function and damage on the school. Learner Outcomes: Discuss cognitive functions and skills of reading and writing in individuals with cleft palate repaired; Know about the risk factors for changes in the learning of children with cleft lip and palate; Reflect on the limitations and cognitive potentialities of children with cleft palate.
P042
EFFICACY AND OVERALL LEVEL OF AGREEMENT AMONG AUDITORY-PERCPTUAL AND INSTRUMENTAL ASSESSMENT OF SPEECH IN CLEFT LIP AND PALATE MARIA INES PEGORARO-KROOK (1) - MAIRA PERICO (1) JENIFFER DUTKA (1) - EDNA PADILHA (1) - OLIVIA MESQUISTA VIEIRA DE SOUZA (1) - FABIANE RODRIGUES (1) - GABRIELA ZUIM (2) - ANA FLAVIA RODRIGUES (2) - GABRIELA LIMA (1) DEPARTMENT OF SPEECH/LANGUAGE PATHOLOGY AND AUDIOLOGY, BAURU COLLEGE OF DENTISTRY AND HOSPITAL FOR REHABILITATION OF CRANIOFACIAL DISORDERS, UNIVERSITY OF SAO PAULO, BAURU, BRAZIL (1) - HOSPITAL FOR REHABILITATION OF CRANIOFACIAL DISORDERS, UNIVERSITY OF SAO PAULO, BAURU, BRAZIL (2)
Abstract: Background and Purpose: To establish sensitivity of the exams commonly used to confirm speech outcome after primary palatoplasty and to establish the overall level of agreement among the measures used to document speech.Methods: The results of auditory-perceptual and instrumental assessment of speech were studied for a group of 19 individuals with operated unilateral cleft lip and palate. For auditory perceptual assessment the outcome of a 4-point scale and a cul-de-sac test were studied while for instrumental assessment the interpretation of videofluoroscopic and nasoendoscopic evaluation of velopharyngeal function was considered. Sensitivity among the four modalities of evaluation of speech outcome was calculated. A measure of agreement between all exams was established with kappa statistics. Results: Sensitivity measures varied between 76% and 100% when all modalities of assessment were considered. Video fluoroscopic assessment confirmed 100% of the 4-point scale and the naso endocopic assessment findings but failed to confirm the cul-de-sac test findings in 15% of the cases. Naso endocopic assessment failed to confirm the findings of the cul-de-sac test in 21% of the cases, the video fluoroscopics findings in 14% of the cases and the findings of the 4-point scale in 7% of the cases. The cul-de-sac test confirmed 100% the findings of the 4-point scale but failed to confirm the video fluoroscopics findings in 24% and the naso endoscopic findings in 8% of the cases. The 4-point scale failed to confirm the findings of the cul-de-sac test and the video fluoroscopics findings in 24% of the cases and in 19% of the cases of naso endoscopic assessment. With regard to the overall level of agreement among the measures used to document speech the findings showed an agreement of 79% between Cul-de-Sac Test and video fluoroscopy, of 84% between Cul-de-Sac Test and 4-point scale, and 84% between 4-point scale and video fluoroscopy. Conclusion: Sensitivity of the different modalities used clinically to document speech outcome after management of cleft lip and palate was found within acceptable level with very good agreement between the tests-exams.
P044
NARRATIVE SKILLS AND BODY SCHEME DEVELOPMENT IN PERUVIAN IMMIGRANTS CHILDREN IN CHILE: PRELIMINARY OUTCOMES MARIANGELA MAGGIOLO LANDAETA (1) - MARCELA VEGA RIVERO (2) - MELITA CRISTALDI (2) - RAL FERNNDEZ CARBONE (3) SCHOOL OF SPEECH AND LANGUAGE PATHOLOGY MEDICINE FACULTY UNIVERSITY OF CHILE, UNIVERSITY, SANTIAGO OF CHILE, CILE (1) - SCHOOL OF SPEECH AND LANGUAGE PATHOLOGY MEDICINE FACULTY UNIVERSITY OF CHILE, UNIVERSIT, SANTIAGO OF CHILE, CILE (2) - SCHOOL OF SPEECH AND LANGUAGE PATHOLOGY CENTER FOR ADVANCED RESEARCH IN EDUCATION UNIVERSITY OF CHILE, UNIVERSIT, SANTIAGO OF CHILE, CILE (3)
Abstract: Since the psychomotor development is carried out from the act to the thought, the body experience evolution allows the subject construction by itself. The relationship between subjects and objects promotes the genesis of motor schemes, which are also mediated by adults. Moreover, the language development is enabled by environmental experiences during the early stages of childhood. Consequently these experiences contribute to the world mental representation, which is in turn organized by linguistic competences, particularly by narrative skills. Multiculturalism is an important factor to consider when studying the child development throughout different dimensions. The identification and integration of these dimensions are crucial into regular and
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special education settings. The present study aimed to characterize the body schema development and initial narrative skills in a group of Latin American immigrant children ranged between 4-5 years of age in Chile. Twenty-three preschool children, Peruvian immigrants were assessed. All participants had a low socioeconomic status and vulnerable social conditions. None of them demonstrated sensory or neurological disorders. Informed consent was obtained from parents. Goodenough Human Figure Test was used to assess body schema and image. Narrative skills were assessed using a discourse narrative evaluation test. 26% (n=6) of children demonstrated deficits in early narrative skills (scripts), which implies a narrative development level below normal range. Furthermore, 47.8% (n=11) of participants evidenced a delayed body schema development. It is important to highlight that 4 from the 6 children with narrative development deficits, also demonstrated a body schema below normal range. These preliminary findings are the first stage of a descriptive study whose purpose is to corroborate that a large number of immigrant children have not yet achieved the expected body scheme and narrative skills development. Since psychomotor development, narrative skills and school success are highly related, the assessed subjects set constitute a risk group for future schooling. Learner Outcomes: Immigrants children are a group of interest for speech and language therapist and psychomotricist because they are a risk group to achieve an adequate child development; Narrative skills and psychomotor development are underdeveloped areas in a important proportion in this group; The early identification of narrative and psychomotor dficit in immigrant children could be reduce the negative impact on literacy.
phonological assessment in order to determine the level of linguistic functioning. The present case study aims to show how a phonological assessment procedure can reveal the special weaknesses within a given phonological system.A 10-year-old boy with translocation Down syndrome accompanied by hypotonia participated in the investigation. Data collection was based on a word repetition task. The elicited data were analysed in terms of the phonetic and phonemic inventory, the distribution of phonemes, the word and syllable shapes used, and both the pattern and stability of errors. Results revealed that the child has a very limited phoneme inventory with positional constraints, but an almost unimpaired phonetic inventory. He uses words of a simple structure including predominantly open syllables. In addition, there are a considerable number of interactional and structural simplifications resulting in an initial voiceless stop/medial fricative <CVCV> pattern. Finally, the errors can be characterized by an atypical pattern including chronological mismatch and inconsistency. In summary, findings indicate a disordered phonological development and raise the possibility that motor planning difficulties are also present. Learner Outcomes: understand the importance of phonological assessment in the evaluation of speech of children with DS; know the key elements of a comprehensive phonological profile.
P047
SOCIAL INTERACTION AND COMMUNICATION OF CHILDREN WITH NEUROMOTOR DISABILITIES: PARENTS AND SLPS APPLICATION OF THE BRAZILIAN VERSION OF THE PEDI DANIELE THEODORO OSTROSCHI (1) - REGINA YU SHON CHUN (1) UNIVERSITY OF CAMPINAS (UNICAMP), UNIVERSITY OF CAMPINAS, CAMPINAS, BRAZIL (1)
Abstract: Introduction: Several factors such as maternal malnutrition, extreme prematurity, and various syndromes, could change child development. In this case, timely intervention can promote the overall progress of these children at risk, considering that this action involves the participation of family/caregivers and a multidisciplinary team, including the Speech and Language Pathologist (SLP). In Brazil, there are few standardized protocols for assessment of language. In the area of Occupational Therapy and Physical Therapy in our country, one instrument utilized for pediatric evaluation of disability is the PEDI - Pediatric Evaluation of Disability Inventory. This instrument was validated for investigation of communication and social interaction aspects of children at risk. Objectives: To analyze the social interaction and communication of children with neuromotor disorders from the perspective of family/caregivers and the SLP and to characterize the children and families/caregivers profile. Subjects and Methods: It was enrolled 35 family members/caregivers from 38 children aged 12 to 36 months, with neuromotor disabilities and development risk factors who, attended the Early Stimulation Programme of a Brazilian Institution APAE - from a midsize city in the countryside of So Paulo, Brazil and the SLP professional (therapist and researcher). Data collection was performed through three sources: (i) study of medical records (ii) information gathered with family/caregivers and (iii) application of the PEDI - it was used the first part of this instrument, focusing on social function skills, which included aspects of communication and social interaction. We performed descriptive statistics, inferential and factorial data compared to the reference values of the PEDI. Results: Regarding the distribution of diagnosis, cerebral palsy was more frequent. Most family members/caregivers were mothers (88%), followed, grandparents (6%) and parents (3%). Age varied between 19 and 45 years, with high school education and occupation as reported home work (67%). The responses of family members/caregivers showed greater agreement on communication skills (68%) and social interaction (53%). The responses of the PEDI showed developmental hold backs in communication skills and social interaction of evaluated children in relation to the instrument values in the perspective of both family/caregivers and the professional/researcher. Conclusions: According to the family/caregivers and the SLP, the majority of children in this study presented values below those of the PEDI reference, showing skills delay in social interaction and communication. The results demonstrate that PEDI is a useful and complementary instrument for SLP clinical evaluation. It provides knowledge of functional skills related to social function (communication and interaction), which can guide the professional as well as the team design intervention strategies, obtain data from involved family and professionals, from language and interactions view, autonomy and quality of life of the children at risk development. This perspective highlights the possibilities of PEDI in a multi or interdisciplinary approach in the view of a comprehensive health care for the studied group population. Learner Outcomes: learn about the importance of the family /caregivers perceptions in the early intervention of child with neuromotor disabilities in addition to the SLP view; understand PEDI - Pediatric Evaluation of Disability Inventory as a useful and complementary tool to the SLP clinical evaluation.
P045
COMPARING EFFECTS BETWEEN ELECTRONIC AND PRINTED TEXTBOOKS IN JAPANESE CHILDREN WITH READING DIFFICULTIES YUMIKO TANAKA WELTY (1) OSAKA UNIVERSITY OF ARTS, UNIVERSITY, OSAKA, JAPAN (1)
Abstract: Electronic books (e-books) are becoming prevalent for teaching in classrooms. Most e-books read aloud and can highlight words or sentences as they are read. These functions are thought to assist the poor readers who cannot effectively decode letters, therefore more for the compensation use. Recently, research asks a different question: whether these functions of ebooks might promote such reading skills as decoding and comprehension of children with reading difficulties (RD). This study was done to compare which was more effective for decoding and comprehension in children with RD, e-textbooks or regular printed textbooks. Ten students (9 boys and 1 girl) between 3rd and 5th grades attended in two phases of an intensive readinglanguage intervention using the two media, printed textbooks and e-books. The intervention program was planned to enhance both decoding and comprehension for reading as well as language learning, as Snowling and Hulme (2012) suggested. The trained teaching assistants (TAs) implemented the program daily on a one-by-one basis for 20 minutes. The students activities included repetition, summarizing and explaining the content of what they read, applying new vocabulary into new sentences, etc. All students started Phase 1 intervention with regular paper textbooks followed by Phase 2 with etextbooks. Two expository chapters in language textbooks for each grade were chosen for the comparison. Most of the students improved their test scores, and the degree of improvement was bigger in younger students, as expected. We did not find any consistent tendency to show that either printed or e- textbook produced more improvement. The average scores and the standard deviation of the post-tests were 82.0 and 11.0 for the regular textbook and 82.7 and 8.7 for the e-textbook, indicating no significant difference between the two media. However, we saw a few different patterns in their improvement; some students improved more with printed textbooks than with e-textbooks, whereas other students did better with the e-textbook. We further looked at such factors of the students as types of reading difficulties, language weakness, and social-behavioral problems in relations to the pattern of their responses to the two media. We found that the effectiveness of the media is affected by multiple factors. Therefore, the selection of books, printed or electronic, for struggling readers should be made not only by assessment of reading but also with the students characteristics in mind. Learner Outcomes: understand what the electronic textbooks are; know the characteristics of Japanese children with reading difficulties; understand how to use the electronic textbooks for intervening children with reading difficulties.
P046
ANALYSIS OF THE PRODUCTIVE PHONOLOGICAL KNOWLEDGE OF A CHILD WITH DOWN SYNDROME VA S. TAR (1) BRCZI GUSZTV FACULTY OF SPECIAL EDUCATION, ELTE, BUDAPEST, HUNGARY (1)
Abstract: Studies on the linguistic abilities of children with Down syndrome (DS) revealed poor articulatory and phonological skills. However, due to the diverse combinations of factors hindering phonological development, a great deal of variability exists in the speech of the DS population. The clinical implication of these findings is that it is important to perform a comprehensive
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P048
THE PECULIARITIES OF NONVERBAL CODING AND DECODING OF NONVERBAL MEANS OF COMMUNICATION OF CHILDREN WITH THE SPEECH UNDERDEVELOPMENT LEKHANOVA OLGA LEO, DOVNA LEKHANOVA (1) INSTITUTE OF PEDAGOGY AND PSYCHOLOGY / THE DEPARTMENT OF SPEECH PATHOLOGY EDUCATION, CHEREPOVETS STATE UNIVERSITY, CHEREPOVETS, RUSSIAN FEDERATION (1)
Abstract: The author carried out an experimental study of the processes of nonverbal coding and of decoding of nonverbal means of communication of children at the age of 5-6 years old with speech underdevelopment. I.N. Gorelovs concept about nonverbal means of communication as functional basis of speech and the concept of N.I. Zhinkin about code transitions in inner speech are put in a basis of our work. Representation about children with speech underdevelopment and allocation of such children from groups of children of the same age is performed due to the concept of R.E. Levina about the general underdevelopment of speech and its levels. The diagnostic technique, which consists of monitoring and specific diagnostic tasks, was used to conduct this research. Observation allowed us to define the peculiarities of nonverbal signs in the free communication and to evaluate the impact of nonverbal components of communication of surrounding people on a childs behavior. Diagnostic tasks were aimed at creating situations in which the child could demonstrate understanding of non-verbal signs and their usage in different communicational situations. The choice of the meanings for nonverbal coding was made according to the questionnaire materials for parents (adapted by professors of A.I. Herzens Russian Sate Pedagogical University which is called The test of speech and communicative development of children of early age: words and gestures), taking into consideration the works of E.I. Isenina, S.N. Tseytlin and the dictionary of the Russian gestures by A.A. Akishina. Groups of offered word meanings were differentiated and characterized by maximum (emblem), average (illustrators) and minimum (affektor) isolation of an external form of a nonverbal sign from its meaning. 180 children at the age of 5-6 years old participated in the study at various stages: 60 children with normal speech development, and 120 children with speech deficiency (clinically diagnosed alalia, dysarthria, dislaliya). Analysis of the obtained data allowed to allocate typological groups of children which are characterized by the different features of non-verbal encoding and decoding. The first type (43.3% of children with speech underdevelopment) is characterized by obvious difficulties in nonverbal encoding immaturity of communicative speech intention and emotional expression of speech in the situation when relative preservation of understanding of non-verbal communication existed. The second type (31.7% of children with speech underdevelopment) is characterized by difficulties in decoding of nonverbal means of communication, by confirmedness of preconditions of probabilistic forecasting in the situation when relative preservation of non-verbal expression of emotions and values exists. The third type (25% of children with speech underdevelopment) is characterized by violations of understanding and usage of non-verbal means of communication, and by complex immature of nonverbal prerequisites of speech. Difficulties of encoding and decoding of non-verbal means of communication which are common for all children with speech underdevelopment are also carried out in the study. These children showed a narrowing of the repertoire of used non-verbal signs, simplifying the semantics of non-verbal means of communication and a narrowing of a range of situations for their usage. The data of the difficulties of the verbal and nonverbal code transitions of such children are obtained in the study. In the process of study we managed to get the comparative data of the nonverbal means of communication between children with normal development of speech and children with speech underdevelopment. Analysis of the results allowed us to determine a typology of non-verbal coding errors. Types of errors of non-verbal encoding are divided into the following groups: wrong reproduction and unmotivated replacement; themed replacement; antonymic replacement; verbal substitution and echolalia. It was found that non-verbal coding errors had connections with the type of speech underdevelopment (dysarthria, alalia, dyslalia). Each group of errors has typical features and special distribution. It turned out that, in most cases, nonverbal functional basis of speech is not formed at children with speech underdevelopment. These studies support the idea that national non-verbal means of communication provide the cognitive and communicative basis for the development of the mother tongue. Thus, experimental research allowed us to define a typology of non-verbal encoding and decoding, as well as a thesaurus, and specific non-verbal means of communication of Russian children at the age of 5-6 years old with preserved speech and speech underdevelopment. Learner Outcomes: The author carried out an experimental study of the processes of nonverbal coding and of decoding of nonverbal means of communication of children at the age of 5-6 years old with speech underdevelopment. 180 children at the age of 5-6 years old participated in the study at various stages: 60 children with normal speech development, and 120 children with speech deficiency (clinically diagnosed alalia, dysarthria, dislaliya). The diagnostic technique, which consists of monitoring and specific diagnostic tasks, was used to conduct this research. Analysis of the obtained data allowed us to allocate typological groups of children which are characterized by the different features of non-verbal encoding and decoding. The first type is characterized by obvious difficulties in nonverbal encoding immaturity of communicative speech intention and emotional expression of speech in the situation when relative preservation of understanding of
non-verbal communication existed. The second type is characterized by difficulties in decoding of non-verbal means of communication, by confirmedness of preconditions of probabilistic forecasting in the situation when relative preservation of non-verbal expression of emotions and values exists. The third type is characterized by violations of understanding and usage of non-verbal means of communication, and by complex immature of nonverbal prerequisites of speech. Difficulties of encoding and decoding of nonverbal means of communication which are common for all children with speech underdevelopment are also carried out in the study: a narrowing of the repertoire of used non-verbal signs, simplifying the semantics of nonverbal means of communication and a narrowing of a range of situations for their usage; the difficulties of the verbal and nonverbal code transitions of. Analysis of the results allowed us to determine a typology of non-verbal coding errors: wrong reproduction and unmotivated replacement; themed replacement; antonymic replacement; verbal substitution and echolalia. Each group of errors has typical features and special distribution. These studies support the idea that national non-verbal means of communication provide the cognitive and communicative basis for the development of the mother tongue. The conclusion is that, in most cases, nonverbal functional basis of speech is not formed at children with speech underdevelopment.
P049
EFFICACY OF THE VISO-MOTOR INTERVENTION FOR STUDENTS WITH DEVELOPMENTAL DYSLEXIA CAPELLINI SIMONE, FUSCO NATLIA, GERMANO GISELI DONADON (BRAZIL) FACULDADE DE FILOSOFIA E CINCIAS - FFC, UNIVERSIDADE ESTADUAL PAULISTA - UNESP, MARLIA - SP, BRAZIL
Abstract: Students with dyslexia have propensity to express difficulties in visual perceptual because they had visual dysfunction in brain areas responsible for visuospatial processing, which are implied in writing. To perform the handwriting, the students need to use skills sensory-motor and cognitive while to formulate an idea, plan the syntax and spelling of each phrase, making integration between motor aspects and spelling to produce the text and evaluate the result. There are few studies that describe the use of intervention programs with visuomotor difficulties, then, this study aimed to verify the effectiveness of the intervention program with the skills of perception visual-motor skills in students with developmental dyslexia. Twenty students participated from this study, from 3rd to 5th grade of elementary school (Marlia-SP, Brazil), aged between eight to eleven years old, being divided into four groups: GI (10 students with developmental dyslexia) and GII (10 students good readers). In pre and post-testing, GI and GII were submitted to the Visual Perceptual Skills Test (TVPS-3) and to Dysgraphia Scale. The results were statistically analyzed, and showed for the Dysgraphia Scale that 80% of students of GI and 30% of the students of GII were classified as dysgraphic in pre-testing; in the post-testing 40% students of GI and 0% students of GII were classified as dysgraphic in post-testing. Regarding TVPS-3, in pretesting situation 70% of students of GI had the performance classified as below average for the total process; in post-testing situation, 60% of GI students had the performance classified within the average. For the students of GII, in pre-testing 20% had the performance classified as below average and in post-testing 90% were classified within the average. These results indicated the effectiveness of the intervention program. In conclusion, the intervention program was effective for students with dyslexia and to good readers, and may become an instrument for teachers and for medical professionals, PDF created with pdfFactory trial version www. pdffactory.com which may contribute to the teaching and learning of perception vision -motor as well as minimize the problems of students writing.
P050
CONTRIBUTIONS OF SPEECH-LANGUAGE PATHOLOGY TO COMPREHENSIVE HEALTHCARE TO CHILDREN IN A UNIVERSAL HEALTHCARE SYSTEM KATIA DE CASSIA BOTASSO (1) - MARIA TERESA PEREIRA CAVALHEIRO (1) PREFEITURA MUNICIPAL DE MOGI MIRIM/SP, UNIVERSIT, MOGI MIRIM, BRASILE (1)
Abstract: Ensuring health as a social right in the Constitution of the Federative Republic of Brazil, enacted in 1998, pointed the need for professionals from different categories to participate in achieving the principle of integrality. The Constitution defines the Sistema nico de Sude (Unified Health System) - SUS, regulated by law 8.080/90 - which present the conditions for promoting, protecting and recovering health, organization and operation of the services; and law 8.142/90 - which points the participation of the community in managing the SUS. Given the complexity of health needs, it becomes evident that it is important for Speech-Language Pathology to participate in organizing the services and actions that make up the SUS. This work aims to: report the structure of a Speech-Language Pathology service, which has sought to provide universal access to demands related to human communication; (2) describe the work process of comprehensive healthcare to children, aiming to disseminate, prevent and rehabilitate factors related to child language in both health and education; (3) show production indexes related to child health. In the city of Mogi Mirim (state of
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So Paulo/Brazil), Speech-Language Pathology services have existed since the 80s and today there are 12 professionals working on it. Since 2000, part of the actions were decentralized to all UBSs of the city, which became the gateway to all needs, at other levels of care, with no age or pathology restrictions. The service is structured in the following levels/actions: (1) Primary Care: screening, development monitoring (newborns and children up to the age of 4), care to pregnant women, work in local schools, guidance for parents and/or caregivers, assisted waitlist and song therapy project - geared to the elderly; (2) Specialized Care: speech therapy, audiological evaluation (Universal Newborn Hearing Screening, Brainstem Evoked Response Audiometry, Audiometry and Immittance Testing), follow up on hearing aid users, special education, Atendimento Domiciliar Teraputico (Therapeutic Homecare) - ADOT - and worker health. By means of the Legislature, the Universal Newborn Hearing Screening law was drafted and enacted. Since 2009, some indexes regarding actions of the primary and specialized care are on the City`s Health Agenda. Considerations: The path of the service previously geared to a small portion of the population and which, nowadays, ensures universal access to Speech-Language Pathology - shows the need of taking into consideration all SUS principles and guidelines in the organization of Speech-Language Pathology services. Integrating the actions of primary, specialized and hospital care and the inter-section partnerships favor the promotion of the integral health of the individual. Caring for children from the first years of life - which allows promotion of the health and early detection of problems - significantly decreased the number of children referred to specialized care, minimizing the negative aspects that communication disorders can cause to the health of the population. Learner Outcomes: Show the structure of a Speech-Language Pathology service, which was organized to meet the guidelines of the Sistema nico de Sade (Unified Health System) - SUS - in Brazil. The SUS is responsible for providing comprehensive healthcare to all Brazilians, including care related to human communication; Promote reflection on the commitment of the Speech-Language Pathologists to comprehensive healthcare to children, in the aspects related to human communication; Share experiences that contribute to planning and intervening, in a multidisciplinary and multiprofessional way, to promote, prevent and rehabilitate the factors related to child language, both in health and education; Discuss the importance of epidemiology, health information systems and the definition of administrative processes - which produce indexes for managing, planning and evaluating Speech-Language Pathology services.
P052
PARENTING STYLES OF MOTHERS OF INDIVIDUALS WITH CLEFT PALATE ULLISSES HERRERA CHAVES (1) - SIMONE APARECIDA LOPESHERRERA (2) - OLGA MARIA PIAZENTIN ROLIM (3) - JOSE ROBERTO PEREIRA LAURIS (1) HOSPITAL OF CRANIOFACIAL ANOMALIES (HRAC), UNIVERSITY OF SO PAULO (USP), BAURU, BRAZIL (1) - BAURU SCHOOL OF DENTISTRY (FOB), UNIVERSITY OF SO PAULO (USP), BAURU, BRAZIL (2) - UNIVERSIDADE ESTADUAL JULIO DE MESQUITA FILHO (UNESP), UNIVERSIDADE ESTADUAL JULIO DE MESQUITA FILHO (UNESP), BAURU, BRAZIL (3)
Abstract: The relationship between parents and children is fundamental to the biopsychosocial development of children. There is a consensus that the educational practices are crucial variables for the formation of individual development. They can be positive or negative and produce prosocial behavior or antisocial individuals. There are many variables that can affect the mother-child relationship and educational practices, including the presence of lip and palate in children. The purpose of this research was to identify, describe and compare the parenting styles and parenting practices of mothers of individuals with cleft palate, from the responses of them and their children treated at the Hospital for Rehabilitation of Craniofacial Anomalies - HRACUSP. For this purpose, the theoretical model of parental styles and literature about the viewpoint Family Systems Theory were used. Mothers (n= 50) and children (n=50) with unilateral and bilateral cleft lip and palate participants in this study were in attendance at HRAC-USP, located in the city of Bauru, SP. The children were aged between eight and twelve years. The instrument used to collect data on mothers and their children was the Parenting Styles Inventory - IEP. The results showed that 50% of mothers and 82% of children responded that the mothers parenting styles were at risk. Were compared and correlated each educational practices and demographics data, confirming the data found in the index sample parenting styles. The results showed that the higher the income age and parentss education, less likely to use risk education, therefore, the lower the score on these variables, the greater use of educational risk. Families with more than one child showed more positive parenting practices (risk or otherwise), whether or not mothers work outside the home showed no influence on the results of the use of parenting risk and no risk. Considering these results, the conclusion is that programs for prevention, intervention and guidance to families at risk are necessary. Studies are needed to include other variables that may interfere with the interaction of the family, for example, in groups of children without disability, children with behavioral problems, among others. Learner Outcomes: Learn about parenting styles and parenting practices of mothers of individuals with cleft palate; Know a instrument for measurement parenting styles and parenting practices, like a Parenting Styles Inventory IEP; Reflect about the necessity of programs of prevention, intervention and guidance to families at risk and non-risks children with cleft palate.
P051
RAPID SERIAL NAMING, READING AND WRITING SKILLS IN STUDENTS OF BRAZILIAN ELEMENTARY EDUCATION BIANCA QUEIROGA (1) - MARIANA PEIXOTO (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, UNIVERSIDADE FEDERAL DE PERNAMBUCO, RECIFE, BRAZIL (1)
Abstract: Learning disabilities, especially those relating to the acquisition of reading and writing, have been the focus of much research. Although simple, literacy has been a serious problem in the reality of Brazilian basic education, and its failure usually extends all curriculum subjects (like history, geography, biology), and impairs learning and child development. As a result, Brazil has one of the worlds worst indicators in basic education. Studies that are interested in investigating the causes of learning difficulties have highlighted the importance of early identification of these difficulties, include to establish the differential diagnosis of dyslexia and other conditions that affect learning process. Appropriate and immediate intervention, with attention focused on the literacy process, can prevent or minimize deficits in childs development. Performed for more than thirty years, rapid serial naming tests are easy to apply and can be made even before the child starts their school phase. Tests of rapid naming have been used as important collaborators in diagnosing problems related to reading and writing. As the name implies, are tests that assesses the ability to quickly appoint; figures, objects, numbers, letters. The objective of this study was to correlate the performance of students of Brazilian elementary school in rapid serial naming with their development in reading and writing activities. The study was conducted in a private elementary school in the city of Recife, state of Pernambuco, Brazil. The population was composed of 37 students, 13 boys and 24 girls, from 2nd to 5th grade. The students were asked to perform a rapid serial naming test, oral reading, reading comprehension and writing activities. All childrens guardians signed the consent form for the research. The study was approved by the Ethics in Research Involving Human Subjects of the Center for Health Sciences, University Federal of Pernambuco with record n 350/11. The results showed that the performance of the 37 students was heavily influenced by education level. Participants demonstrated more easily in naming objects, but they are more rapid in naming numbers and letters and needed more time to name objects. Possibly the semantic load of objects, as well as the number of syllables and phonemes justifies these results. A strong correlation was found between performance in activities of serial naming and activities that involve reading and writing, corroborating the literature. These findings confirm similar studies already done and alert to the great value for the use of these tests to assess knowledge of beginner readers and writers, to identify early problems in reading and writing process.
P053
PERFORMANCE OF PHONOLOGICAL AWARENESS IN CHILDREN WITH ATTENTION DEFICIT HIPERACTIVITY DISORDER TALITA FERNANDA GONALVES (1) - PATRICIA ABREU PINHEIRO CRENITTE (1) FACULDADE DE ODONTOLOGIA DE BAURU, UNIVERSIDADE DE SO PAULO, BAURU, BRAZIL (1)
Abstract: The attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder of childhood and is present among most of the students. Studies show that individuals with ADHD may have difficulty in school and low-income skill Phonological Awareness (PA). The PA may be defined as an ability to manipulate the structure of noise words from the replacement of a particular sound to the segmentation of smaller units. The PA is an important factor in the development of reading and writing, and a precursor to formal reading. The aim of the study was to compare the performance of phonological awareness in children with and without ADHD. The study included 30 school aged children, whose ages ranged from nine to twelve years old and education varied from the 4th to the 7th grade. It included both genders (male and female), 24 (80%) male children and 6 (20%) female children, 15 with ADHD, Experimental Group (EG) and 15 children with typical development, Control Group (CG), who attended elementary school in public and private schools. Children of the EG were diagnosed by an interdisciplinary team and the criteria for diagnosis is the DSM-IV TR. The children of EG were selected for phonoaudiological evaluation, after confirmation of the diagnosis of ADHD combined type. The CG was formed by participants without any complaints related to learning disabilities or attention according to school information and evaluation criteria of the researcher. Compared the CG with EG for chronological age, gender and type of institution (public or private). A phonological awareness Test was applied to rate the phonological awareness Sequential Assessment Tool (CONFIAS). This test consists of two parts, the first corresponding to the syllabic awareness the second part representing the phoneme awareness. The application followed the proposal by initiating sequential tasks that involve awareness of syllable and then those relating to the level of the phoneme, respecting
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their order. For this study we used the results in syllable level, phoneme and total. The score of the test was performed in a specific protocol. Correct answers are worth one point and inaccurate are worth zero. In the part of the syllable, the maximum score is 40 and in the part of the phoneme, the maximum score is 30, totaling 70 points. From the obtained results, it was observed that children of EG presented a lower performance compared to the CG, both in the subtest syllable, and in the phonemic, with significance among the groups. Thus, we found that children with ADHD had difficulties in this skill, this difficulty can compromise acquisitions, such as reading and writing. Children with ADHD have difficulty recognizing that words can be broken into smaller units of sounds and that, in fact, the letters constituting the printed word, represent the sounds in spoken word. For children learning to read and write, they should understand the link between phonemes and graphemes. Learner Outcomes: Know the phonoaudiological characteristics of ADHD cases; Receive information regarding demonstrations in the evaluation process; Understand the difficulties of reading and writing in cases of ADHD; Understand the importance of PA in the acquisition of reading and writing.
P055
THE USE OF VERBS BY BRAZILIAN CHILDREN WITH DOWN SYNDROME: COMPARISON BETWEEN TWO SITUATIONS LIVIA MARIA IENNE (1) - SUELLY OLIVAN LIMONGI (1) FACULTY OF MEDICINE, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: The aim of the present study was to verify and characterize the use of verbs regarding their nature and syntactic inflexion by Brazilian Portuguese-speaking children with Down syndrome (DS), considering two different interaction situations: with the therapist, and with the caregiver. Participants were 27 children with DS between 5 and 12 years of age, who had oral language as the main Communicative mean. Subjects were divided into three groups with nine participants each, according to chronological and mental age (PTONI): G1, chronological age between 5.1 and 7.6 years and mental age between 3.0 and 3.11 years; G2, chronological age between 7.7 and 10.0 years and mental age between 4.0 and 4.11 years; G3, chronological age between 10.1 and 12.6 years and mental age between 5.0 and 5.11 years. Participants were submitted to free interaction situations with the therapist and with the caregiver. The first 100 utterances after the initial five minutes of interaction were transcribed, and the verbs used were analyzed using a specific protocol, according to the following criteria: 1) type of verb (auxiliary [AUX], copular [COP], action [ACT]); 2) syntactic role of the verb (intransitive [INT], direct transitive [DT], indirect transitive [IT], ditransitive [DTT]; 3) verb mood (indicative [IND], subjunctive [SUBJ], infinitive [INF], participle [PART], gerund [GER]); 4) verbal tense (past [PAS], present [PRE], future [FUT]); 5) number and person (first person [1S, 1P], second [2S, 2P], and third [3S, 3P], singular and plural). Statistical analysis used ANOVA, Tukeys multiple comparison test, and Students t test. A significance level of 0.05 was adopted. The descriptive analysis to compare groups data in each interaction situation showed significant differences between groups for all variables during interaction with the therapist, and only for GER during interaction with the caregiver. The analysis of each variable in each group for comparison between both interaction situations showed more production of verbs always during interaction with the therapist. This difference was significant or tended towards significance for: 1) COP for G2 (p=.011) and G3 (p=.093); 2) DT for G1 (p=.020); 3) DTT for G3 (p=.025); GER for G2 (p=.030); 5) 3S for G2 (p=.019). The overall analysis showed that the use of verbs increased with the age of participants, considering both chronological and mental age. This finding indicates semantic and syntactic development. The results in this study corroborate the literature. Subjects produced more action verbs, which are more concrete and easily comprehended; more direct transitive verbs in the indicative mood, allowing the use of simpler complements; more verbs in the present tense, used in the report real-time facts; and more verbs in the third person, singular. The cognitive development, the data collection situation, and the influence of the linguistic environment might justify these findings for this population. Learner Outcomes: This study helped identify: How Brazilian Portuguesespeaking children with Down syndrome use verbs during language development, considering the variables: type, syntactic role, mood, tense, number, and person; The interlocutors influence and importance in the use of verbs by children with Down syndrome in free interaction situation; The influence of the type of activity carried out during free interaction situations between adults and children with Down syndrome regarding the use of verbs;The difference between linguistic requests performed by caregivers and therapists during free interaction situations with children with Down syndrome, and their influence on the use of verbs.
P054
ABILITY OF CHILDREN TO CONSTRUCT PICTURE-BASED NARRATIVES IN RELATION TO COGNITIVE AND LINGUISTIC ABILITY MITSURU KOSAKA (1) - JUN TANEMURA (1) DIVISION OF SPEECH\LANGUAGE PATHOLOGY AND AUDIOLOGY DEPARTMENT OF SENSORY SCIENCE, KAWASAKI UNIVERSITY OF MEDICAL WELFARE, KURASHIKI, JAPAN (1)
Abstract: The assessment of childrens narratives involves multilateral dimensions of their development, including their linguistic, cognitive, and social abilities. In this cross-population study, we use a wordless picture book to examine an ability of typically developing children in relation to narrative structure and content. Methods Subjects comprised 29 monolingual Japanese typically developing children (age: 4;01-6;03). First, each child was presented with 10 pages of a wordless picture book. They were then asked to tell the story to the experimenter while looking the pictures. Next, the retelling task was examined with simpler content from another original picture book. All narratives were recorded with an MD player and transcribed for analysis. The Picture Vocabulary Test-Revised was also carried out to examine the vocabulary comprehension of each child. Childrens narratives were analyzed based on the following variables: (1) story length involving self-sufficient words; (2) number of particles and auxiliary verbs used as syntactic markers; (3) number of total morphological errors, which assessed their morphosyntactic ability; (4) the number of basic words used to represent propositional content; and (5) the narrative structure of each story was analyzed. Results The length of the childrens narratives varied, even in same age groups. The number of self-sufficient words showed a significant increase, particularly in the narratives of children over 5 and a half years old. No morphosyntactic errors were found in the childrens narratives. The appearance ratio of basic words varied among the children. Most of the words used to tell each story comprised the basic words previously identified. However, the basic words appeared more frequently in the retelling task than in the narrative task. In the narrative structure, children aged 5 years and older were able to provide more detailed structure containing substantially more information. Children less than 5 years old were able to provide more information in the retelling task than in the narrative task; however, their retellings often consisted of narratives that were out of order when compared to the original story. Discussion The narratives told by younger children were shorter in length and contained less propositional content. Therefore, their narratives lacked some necessary information. They had difficulty using their linguistic knowledge to compose an adequate narrative. To express the situation illustrated in each picture, the subjects had to distinguish and select the elements of information necessary for the narrative from those that were present only for context and temporal association. They had to integrate the picture into an overarching story and use their linguistic knowledge to represent and express their idea. Children less than 5 years old found it difficult to distinguish and select the appropriate information from the picture. Even the children aged 5 years and over were not able to sufficiently integrate the pictures and narratives. These results indicate that children under school age are too immature to form narratives comparable to adult native speakers, and thus need to attain further cognitive and linguistic abilities through their experiences in order to develop such an ability. Learner Outcomes: understand the processes of language acquisition; know the analysis of discourse and story; know the development of childrens narratives.
P056
SPEECH DISFLUENCY IN THE NARRATIVES OF BRAZILIAN PORTUGUESE SPEAKING CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT AND THEIR AGED-MATCHED PEERS DEBORA BEFI-LOPES (1) - ANA CCERES (1) SUELEN MARQUES (1) - MARCELY VIEIRA (1) DEPARTMENT OF PHYSIOTHERAPY, COMMUNICATION SCIENCE & DISORDERS, AND OCCUPATIONAL THERAPY OF THE FACULTY OF MEDICAL SCIENCES, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: The production of fluent speech involves smoothly and accurately movements from various parts of the vocal tract and also depends on the activation of linguistic information, which is influenced by context. Therefore, it is easy to understand that when failures occur in this process, fluency is interrupted, producing disruptions in speech. Children with specific language impairment (SLI) show deficits in speech elaboration, due to difficulties in text organization, understanding the temporal relations of cause and effect, and also because they have less linguistic structural knowledge. This study aimed (1) to verify the distribution of speech disfluency types in the narratives of children with specific language impairment (SLI) and typically developing language (TDL) children and (2) to compare speech disfluencies of children with (SLI) and their aged-matched peers. Forty TDL children and twenty SLI children, aged 7 to 10 years, participated in this study. The groups were matched for age and for each SLI child there should be two TDL children. All participants had Brazilian Portuguese as their native language
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and resided in the city of So Paulo (Brazil). In order to enable children to produce narratives, a series of 15 stories, each one based on a four-scenesequence, was used. Once the child organized each sequence and told the story, the narratives were transcribed and their disfluencies were counted. After it, each disfluency was classified as stuttering-like disfluencies (SLD), such as part-word repetition, single-syllable word repetition, disrhythmic phonation prolongations, blocks and broken words; and other disfluencies (OD), such as interjection, revision / abandoned utterances and multisyllable / phrase repetition. No significant difference was found between the distribution of disfluency types for TDL children, but other disfluencies were more frequent for SLI children. When the groups were compared, significantly more stuttering-like and other disfluencies occurred for SLI children. Speech disfluency occurrence in narratives demonstrated that SLI childrens speech shows more disfluencies than theirs peers do, which confirms the overload in their linguistic system. These findings suggest that in speech production tasks SLI children need more time to plan and to formulate their utterances, once they have less familiarity with linguistic information. Learner Outcomes: know the differences of speech disfluency type occurrence between typically developing language children and children with specific language impairment; know the characteristic of speech disfluencies in children with specific language impairment; understand the impact of specific language impairment on speech fluency.
P058
SPEECH-LANGUAGE PATHOLOGIST INTERVENTION ON THE MACROSTRUCTURE OF ORAL NARRATIVE IN BRAZILIAN CHILDREN WITH DOWN SYNDROME PILOT STUDY ROSANGELA VIANA ANDRADE (1) - SUELLY C. O. LIMONGI (1) COLLEGE OF MEDICINE, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: There are few studies which depict the narrative skills of children and adolescents with Down syndrome (DS) mainly regarding its use in clinical intervention. This study aimed to verify the efficacy of speech-language pathologist intervention on the macrostructure of oral narrative of children and adolescents with DS. Participated in this study five Brazilian children and adolescents with DS and chronological age between 10 and 15 years old. Their mental age was (PTONI) between 5.0 and 6.0 years. Data collection counted on two assessments (initial and final) with a gap of 18 months between them (approximately 72 therapeutic sessions for each participant). The material used were: assessment: a sample of an oral narrative of the book Frog, Where Are You?; therapeutic process: storybooks. The obtained data were subjected to statistical analysis aiming to verify the evolution of the participants comparing its results in the initial and final assessment. Data analysis was based on the model used by Miles and Chapman (2002) which considers the macrostructure concerning three variables: components of the plot line; the search theme and the protagonists misadventures. To statistical analysis it was used the the nonparametric test Wilcoxon Signed Ranks. The significance level adopted was 0,05. Considering the initial and final assessments, respectively, it was found the results as follows: components of the plots: 83% - 100%; 2. Theme 33% - 78%; 3. Misadventures 38% - 63%; total: 48% - 83%. The results pointed out an improvement in the oral narrative of the participants in all of the analyzed aspects. Thus, it is important and confirms what some studies have claimed regarding the importance of the intervention on the skill narratives of individuals with DS. This way, the results show that all the subjects obtained progressing improvements in understanding and establishing causal and inferential relations regarding events in stories. Consequently they had an increase in their syntactic complexity as well as in the sequential and logical organization concerning either an issue or theme. Thus, occurred integration between linguistics and cognitive skills leading to a better understanding of happenings and utterance simultaneously. This way, there are such relevant data referring to individuals with DS. Since this is a pilot study it is likely that raising the sample, there will be more noticeable all the significant statistically differences in all aspects. Thus it is important a study with a larger sample. In conclusion, the Speech-Language Pathologist intervention on the macrostructure of narrative in Brazilian children and adolescents with DS was effective, confirming the few data found in researches. Learner Outcomes: know the intervention on narrative skills is effective in lexical expansion of the individuals with DS speakers of Brazilian Portuguese; know the intervention on narrative promotes the integration between linguistics and cognitive skills in the individual with DS; understand how important is the use of visual stimuli in activities involving memory of children with DS.
P057
LONG LATENCY AUDITORY EVOKED POTENTIALS (LLAEP) IN THE STUDY OF READING AND WRITING DISORDERS. A SYSTEMATIC REVIEW THAIS FREIRE (1) - THAIS DOS SANTOS GONALVES (2) PATRCIA ABREU PINHEIRO CRENITTE (2) DEPARTMENT OF SPEECH PATHOLOGY AND HEARING SCIENCES, UNIVERSITY OF SO PAULO, BAURU, - (1) - DEPARTMENT OF SPEECH PATHOLOGY AND HEARING SCIENCES, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (2)
Abstract: Recently, studies have strengthened the contribution of Long Latency Auditory Evoked Potentials (LLAEP) in the investigation of essential cognitive skills for the appropriate development of reading and writing. The LLAEP reflect the neuroelectric activity of the auditory pathway mainly from the regions of the thalamus and auditory cortex. The main LLAEP described are: P1, N1, P2, N2, P300 and the Mismatch Negativity Cortical Evoked Responses (MMN) which provide information about the functioning of the Central Auditory Nervous System (CANS). Nowadays, it is admitted that individuals with reading and writing disorders may present delay in the development of listening skills involving dysfunctions on CANS, which may interfere in the learning process. Considering these findings the scientific literature indicates that the LLAEP could be an objective index to offer more information about the individuals with learning disorders.Therefore, this study aimed, through a systematic review, answer the question: Is the LLAEP a tool that shows differences between children with reading-writing disorders comparing to normal children? This systematic review is part of a masters degree program at the University of Sao Paulo, Brazil. Papers published until January 2013 was included from Web of Science, PubMed and Scielo databases following a comprehensive search strategy, using the keywords combination: Learning Disorders and Event-Related Potentials, P300; Learning Disorders and Evoked Potentials, Auditory; Dyslexia and Event-Related Potentials, P300; Dyslexia and Evoked Potentials, Auditory. All the appropriated terms was previously checked in Mesh database. There were accepted only studies involving case-control groups, individuals diagnosed with dyslexia, learning problems, learning disabilities or reading disabilities and alphabetical language populations. All articles included also answered the described question. Case reports, individuals with Attention Deficit Hyperactivity Disorder or with risk factors (without confirmed diagnosis) for reading and writing disorders were excluded. Fifty-six studies were found matching all the inclusion criteria. Forty-four of these studies (78%) showed that there is a positive consensus about the applicability of the LLAEP (including the main potentials P1, N1, P2, N2, P3, MMN). The measure of the PEALL in subjects with learning disorders shows a decreased in amplitude and increase in latency indices compared with subjects without disorders. Only twelve studies (22%) showed no statistically significant differences between reading-writing disorders groups and control groups in at least one type of the LLAEP, in the latency and/or in the amplitude. Evidence suggests that LLAEP is a resource that shows differences between children with reading-writing disorders compared to children without these impairments. The studies that didnt show statistically significant difference may be related to different methodological variables adopted in the reviewed studies. Learner Outcomes: Understanding the relationship between the PEALL and learning disorders; Know the applicability of electrophysiological procedures to the diagnostic process; Know the applicability of electrophysiological procedures on the clinical intervention; Correlating the Audiology and Language studies; Know the neural mechanisms patterns of the central auditory system on children with and without learning disorders.
P059
HEBREW LANGUAGE ASSESSMENT MEASURE FOR PRESCHOOL CHILDREN: A COMPARISON BETWEEN TYPICALLY DEVELOPING CHILDREN AND CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT
IRIT KATZENBERGER (1) - SARA MEILIJSON (1) HADASSAH ACADEMIC COLLEGE, UNIVERSITY, JERUSALEM, ISRAEL (1) Abstract: Purpose: To apply the Katzenberger Hebrew Language Assessment for Pre-School Children (henceforth: the KHLA) to a group of children who were independently defined by their SLPs as having specific language impairment (SLI) and to find whether the KHLA distinguishes between typically developing (TDL) and language impaired children. The assessment included 6 areas: Auditory Processing, Lexicon, Grammar, Phonological Awareness, Semantic Categorization and Narration of Picture-Series. The study focuses on the psychometric aspect of the test.Method: Participants included 454 (383 TDL; 71 SLI) mid-high SES, monolingual native speakers of Hebrew, aged 4;0-5;11 years. Results: The KHLA was found useful for distinguishing between TDL and SLI when the identification is based on the total Z-score or at least two of the area-specific Z-scores in -1.25 SD cutoff points. The results provide a ranking order for assessment: Grammar, Auditory Processing, Semantic Categorization, Narration of Picture-Series/Lexicon and Phonological Awareness. Conclusions: The main clinical implications of this study point to the need to consider the optimal cutoff point of -1.25 SD for diagnosis of SLI children and to apply the entire test for assessment. In cases when the clinician may decide to assess only two or three areas, it is recommended to apply the ranking order as described in the study. Learner Outcomes: Although the KHLA presents an assessment tool that is directly adapted to the language-specific structures and typology of Hebrew, its principles could be usefully adapted for use in other languages as well, including the variety of domains that it examines, in the form of the six different areas assessed.
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P060
ARTICULATORY AND PHONOLOGICAL CHARACTERISTICS OF CHILDREN WITH SSD AND ABSENT SOUNDS
HAYDE FISZBEIN WERTZNER (1) - THAS ZEMLICKAS SILVA (1) MARINA JORGE PULGA (1) - LUCIANA OLIVEIRA PAGAN-NEVES (1) UNIVERSITY OF SAO PAULO, MEDICAL SCHOOL, SAO PAULO, BRAZIL (1) Abstract: The aim of the present study is to characterize speech sound disorders (SSD) by using the indexes Percentage of Consonants Correct Revised (PCC-R), Relative Substitution Index (RSI), Relative Omission Index (ROI), Relative Distortion Index (RDI), Speech Inconsistency Test (SIT) and articulation rate in children with absent sounds. Forty children aged between 5:1 and 7:9 years-old were selected to participate at the study but only 29 children presented one or more absent sounds from the phonetic inventory. The 29 children were divided into two groups: Group 1 with 23 stimulable children for at least one absent sound (G1) and Group 2 with six non-stimulable children (G2). All children were submitted to a Brazilian Portuguese phonology test consisted on imitation task and picture naming task, SIT, articulation rate evaluation and Stimulablity test. The severity indexes were calculated based on the phonology test. The analysis of SIT demonstrated that 15 children from the stimulable group (G1) and all the six children from the non-stimulable group (G2) were consistent. Analysis of the phonetic inventory indicated that the majority of children with SSD demonstrated difficulty in producing consonant clusters. The correlation between the number of absent sounds with PCC-R indicated that the number of absent sounds tends to decrease when the PCC-R value is higher. The comparison between the PCC-R mean value observed for G1 and G2 was not different indicating that the severity of SSD is not determined only by the fact of being stimulable or non-stimulable to a particular sound (or group of sounds). The analysis of the relationship between ROI, RSI and RDI for G1 and G2 indicated that no particular index error was predominant. However, we observed that mean values of ROI and RDI were lower than RSI for both stimulable and non-stimulable children. No significant difference of the number of phones per second was observed between G1 and G2 considering both short and long sentences indicating no relation between the articulation rate and the fact of being stimulable or non-stimulable. Therefore, SIT was the only test that distinguished the two groups of children indicating that children that are not stimulable to the absent sounds presented a specific difficulty with the production of one or more sounds. Considering that articulatory and phonological measures did not differentiate groups and that the non-stimulable children were consistent there are evidences that although inappropriate, the sound representation is part of their phonologic system. Learner Outcomes: learn the advantage of using articulatory and phonological assessment instruments with children with SSD; learn that children with SSD have difficulty to produce complex structures; know that complex structures are the most non-stimulable compared with others sounds; know some phonological characteristics of stimulable and non-stimulable children to the absent sounds.
free talk, story picture description, play). A stacked series of three prompt for requests for clarification (RQCL; ie What?, I dont understand, I still dont know) were designed to elicit these childrens verbal response. The verbal responses to each RQCL were then coded for analyses of conversational repair strategies. The results showed that: a) children with HFA were similar to TD children in evidencing repetition, revision, and addition type of repair. b) children with HFA were significantly more likely to respond to an RQCL with an inappropriate response. Learner Outcomes: know the design of conversation situation to elicit childrens conversational repair; understand the conversational repair abilities in children with ASD from a cross linguistic perspective.
P063
AN ACOUSTIC ANALYSIS OF FRICATIVE PRODUCTION. A COMPARISON OF /S/ COARTICULATION DEVELOPMENT IN FINNISH-SPEAKING CHILDREN PENTTI KRKK (1) LOGOPEDICS AND PHONETICS, UNIVERSITY OF OULU, OULU, FINLAND (1)
Abstract: In adult Finnish speech, several coarticulatory effects appear in the production of /s/(S). There is a gap in the data available for young children in the process of acquiring the phonetic features of S especially in combinatorial sequences of S and vowels (V). The present study attempts to document both normal (typical) and deviant (atypical) acoustic variation of childrens S productions in SV and VS contexts in three age groups. The subjects of the study were 5 children in each age group. Linear Predictive Coding (LPC) and spectral moments analyses (M1 and M3) were performed on spoken utterances of select combinations of SV and VS to determine the acoustic manifestations of vowel-induced coarticulation on S productions. Results indicate a number of differences in the dynamic spectral features of S in the age groups. One of the acoustic measures exhibiting differences was the temporal variation of M1. The results suggest that there are salient developmental stages in the childrens progress toward adult-like phonetic realizations of S and V sequences. Learner Outcomes: acoustics of fricative sounds; coarticulatory effects of vowels on fricatives; developmental aspects of child language and speech
P064
LANGUAGE INTERVENTION IN ORAL NARRATIVES WITH AND WITHOUT TECHNOLOGICAL RESOURCES FOR CHILDREN WITH LANGUAGE DELAY NACHALE HELEN MACIEL BISPO, BIANCA RODRIGUES LOPES GONALVES, CAMILA MAYUMI ABE, CAMILLA GUARNIERI, SIMONE APARECIDA LOPES-HERRERA BAURU SCHOOL OF DENTISTRY (FOB), UNIVERSITY OF SO PAULO (USP), BAURU, BRAZIL (1)
Abstract: The narrative abilities are essential for communication and inclusion of children in society and provide important information about its development. Children with language delay (LD) show changes in the language and, among them, the deficit in the preparation of narrative discourse. Thus there is a need for speech-language intervention directed to the profile and needs of these children in storytelling abilities. For this, the technological resources have proven effective, encouraging children in their language development by different sensory pathways. The aim was to describe the effects of a language intervention program focused on the development of narrative abilities in children with LD. The study included 20 children of both genders, 3-6 aged, diagnosed with LD at the Clinic of Speech, Hearing and Language Pathology, Bauru School of Dentistry, University of So Paulo (FOB-USP). The children were divided into two groups, namely: the experimental group (EG) and control group (CG), and the groups were differentiated only by the strategies used, in which the CG were underwent intervention using concrete materials, without the use of technological resources for intervention and the EG were underwent intervention using technological resources. For ethical reasons, after data collection, the CG were also underwent intervention with the same resources that the EG. Their narrative abilities were evaluated before and after the intervention and, after evaluation, both groups were underwent language intervention. The intervention program consisted of 10 individual assistance with weekly frequency and duration of 50 minutes each, directed to the development of narrative abilities. We emphasize that intervention program (both CG as EG) were designed specifically for this research. At the end of the intervention, participants were evaluated again and their data from pre-intervention and post-intervention were analyzed in a descriptive and comparative statistical analysis. It was observed that both groups showed improvement in narrative abilities after intervention. The EG children demonstrated motor skills to use technological resources and greater motivation in the intervention compared with the CG. In relation to developing narrative abilities, observed better results in the group stimulated by technological resources. Thus, we conclude that the language intervention directed toward the development of the narrative abilities was effective in this research, showing better performance in children undergoing intervention with technology resources. It is believed that this result was due to the stimulation of multiple sensory
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P061
SPEECH INCONSISTENCY AND ARTICULATION RATE IN CHILDREN WITH SSD
HAYDE FISZBEIN WERTZNER (1) - DANIRA TAVARES FRANCISCO (1) TATIANE FARIA BARROZO (1) - LUCIANA PAGAN-NEVES (1) UNIVERSITY OF SAO PAULO, MEDICAL SCHOOL, SO PAULO, BRAZIL (1) Abstract: Children with Speech Sound Disorder (SSD) present different characteristics reinforcing their heterogeneity. An important step to the diagnosis of the disorder is to verify the association between cognitive-linguistic processing and oro-motor processing difficulties. Recent researches still stands on how to improve assessment tools and facilitate application procedures for a better description of the disorder. The aim of the study was to relate phonological measures to articulation rate and speech inconsistency Learner Outcomes: Understand the behavior of children with SSD according to speech inconsistency classification and phonological and articulatory measurement; Verify the articulation rate in both short and long sentences and understand how this measurement is related to the most frequente types of speech errors in children with SSD; Learn how age is related to articulatory and phonological variables in children with SSD
P062
REPAIR STRATEGIES USED BY MANDARIN CHINESE SPEAKING CHILDREN WITH HIGH-FUNCTIONING ASD IN TAIWAN PAO-HSIANG CHI (1) - PEI MEI LU (1) DEPARTMENT OF SPECIAL EDUCATION, NATIONAL TAIPEI UNIVERSITY OF EDUCATION, TAIPEI, TAIWAN, PROVINCE OF CHINA (1)
Abstract: The main purpose of this study was to investigate the conversational repair skill in children with high-functioning autism Spectrum disorder (HFA) compared with typically developing children (TD). Ten school-aged children (age 9 to 12) with HFA and 10 TD children participated in this study. All participants were tested in three different conversation situation (i.e.
pathways presented by new technologies and greater motivation of children facing these resources. Learner Outcomes: Learn about the importance of assessment and intervention with narrative abilities in children with language delay; Know a program of assessment and intervention in narrative abilities; Reflect about the planning of language intervention for development of narrative abilities in steps and how this planning can facilitate the process of rehabilitation, since the beginning of the therapeutic intervention until discharge; Have access to a proposal for a new method of intervention, following the technological development in the world, with a comparison of this method with resources already submitted.
P065
PHONOLOGICAL ASSESSMENT - ANALYSIS COMPARING THE USE OF TRADITIONAL AND TECHNOLOGICAL RESOURCES ANA PAOLA NICOLIELO, BIANCA RODRIGUES LOPES GONALVES, CAMILA MAYUMI ABE, CAMILLA GUARNIERI, SIMONE APARECIDA LOPES-HERRERA BAURU SCHOOL OF DENTISTRY (FOB), UNIVERSITY OF SO PAULO (USP), BAURU, BRAZIL (1)
Abstract: The phonological development and its amendments worries because of its high incidence in the pediatric population. The term phonological refers to the organization and classification of speech sounds that are used in a contrastive form in a given language, is a broader term that articulatory, because it applies to all aspects of the study of speech sounds in a language, including its production and perception and cognitive issues. The Phonological Disorder is defined as a difficulty in speech, characterized by the inadequate use of phonological rules used by adult speakers and may involve errors in the production and perception of sounds or organization. On production, the difficulty is manifested by severity and by unintelligible speech to varying degrees, caused by speech problems with therapy indication. The early referral for diagnosis and speech therapy reduces the risk of occurrence of difficulties in learning read and write , based on the relation the phoneme / grapheme and is directly related to phonological processing. Before the diagnosis, performed by specific evaluation, is necessary determine the childs phonetic inventory, analyze the structures and the distribution of syllabic sounds present in these structures, as well as in words. Over the years, in Brazil, some procedures have been used to carry out the evaluation of the phonological aspect, which are considered traditional in clinical practice. However, with the advent of technology, there are new proposals for evaluation by using the technological resources, with the goal of facilitating the audiologist evaluation process, reducing the time of application and analysis, as well as easy access devices such as tablet (for example the Ipad). The aim of this study was to verify the reliability of two procedures used to assess phonological aspect, one traditional and other using technological resource (application for tablet), and compare the performance obtained in these. The study included 20 children of both genders, 4-7 aged, with phonological disorder. The research was conducted in the Clinic of Speech, Hearing and Language Pathology at the Bauru School of Dentistry, University of So Paulo (FOB-USP), Brazil. All ethicals principles were respected. For evaluation we used the following procedures: for the traditional evaluation in Portuguese - Phonology Child Language Test (ABFW); for evaluation using technology was used application developed for Ipad Evaluation of Phonology and Articulation of Portuguese (AFAP), being performed comparative statistical analysis. The results confirmed the reliability of both forms of evaluation, and the phonological processes such as the percentage of hits / errors detected by both forms of analysis were similar. Statistical analysis showed no statistically significant difference in the performance comparison of the two forms of evaluation. This study presented a new procedure that uses technology and proved to be as efficient as a traditional procedure for evaluation of the phonological aspect of the Portuguese language. The use of technological resources has become increasingly common and can be a great ally in clinical practice. Learner Outcomes: Learning a new resource evaluation with the use of a technological resource designed for iPad ; Verifying effectiveness, application, main characteristics and efficiency for the diagnosis of Phonological Disorders with a technological resource.
results in repeated seizures, which lead to temporary brain dysfuction and requiring prolonged and sometimes lifelong drug therapy. Epilepsy have various impact on cognition, memory, behavior, emotion, and motor skills. However, there are few studies on the communication /language performance of patients with epilepsy. Recent studies have indicated that different types of seizure attack have affected on the language performance. Speech and/or language impairment, such as moderate fluency disorder, naming difficulty and comprehension impairment were found in children with epilepsy. Staden et al. demonstrated that specific language impairment on reading, spelling and expressive grammar occur during ictal period. Donna et al. Indicated that patients may have verbal dyspraxia, naming difficulty, reading and wtiting disabilities as well. Scheffer et al. Reported that verbal dyspraxia and language disorder may be noted in children with Rolandic seizure. Parkinson revealed that a relatively high ratio of acquire language problems in children with epilepsy regardless of their seizure types. Thus, epilepsy in childhood, even with better prognosis, may have language impairment. This study aims to investigate the language performance in school children with epilepsy. Learner Outcomes: In this study, we found that epileptic children, even some of them reaching seizure free, had high rates of linguistic dysfunction. The risk factors for language imapirment were seizure type, number of seizure attacks, epilepsy type and seizure duration. Thus, children with epilepsy are in need of careful speech and language evaluation
P067
RELATED ASPECTS TO THE CANDIDATE SUSCEPTIBILITY GENES FOR DEVELOPMENTAL DYSLEXIA: A SYSTEMATIC REVIEW THAS GONALVES (1) - THAS FREIRE (1) PATRCIA CRENITTE (1) UNIVERSITY OF SAO PAULO, COLLEGE OF DENTISTRY OF BAURU, BAURU, BRAZIL (1)
Abstract: Developmental dyslexia (DD) or Reading Disability (RD) is the most common learning disorder that affects approximately 5 to 17 % of school-aged children, however, their exact causal mechanisms are beginning to be known recently. Studies suggest that dyslexia is a heritable disorder. Yet, 75 % of the phenotypic variance can be explained by genetic component. Until now were identified at least 11 risk loci involved in the susceptibility of dyslexia, including 2q22.3, 7q32, 11q13.4, DYX1 to DYX6, DYX8, and DYX9. Most of the identified dyslexia candidate genes by linkage analysis and association studies were integrated into a theoretical molecular signaling network responsible for regulating neuronal migration. Although the associated candidate genes with risk of dyslexia have been described in the literature, the results of many studies still show controversies between genes and the manifestations of dyslexia. Then, the goal of this study was, through the systematic review, answer the question: What are the most related candidate genes with dyslexia described in the literature in the last 5 years?Were consulted online electronic databases (PubMed, ISI Web of Science and Scielo), and were searched papers latest five years, using the search terms dyslexia and genetic. Studies eligible for inclusion in systematic review had to fulfill the criteria: (1) casecontrol study or Trait Disequilibrium Test (TDT) family design, (2) confirmed diagnostic of dyslexia. Were excluded no control population, duplicate of previous publication, animal studies, reviews, and unpublished reports. After an extensive search, a total of 132 potentially relevant publications about genetic of dyslexia, only 28 publications met the inclusion criteria. Thus, the most studied gene was DCDC2 (10 studies), and that 7 found no association of the gene with dyslexia, 3 found this association. The second most studied gene was the KIAA0319 (7 studies), and that 5 found association with dyslexia and only 2 not found. The third most studied gene is the DYX1C1 (6 studies), and that 3 found association with dyslexia and 3 not found. Then, with two studies are ZNF804A genes (both found association with dyslexia) and CMIP (one study found the association and the other not found). The remaining genes had only 1 study, and was found association with dyslexia in the FOXP2 gene, DGKI, GRIN2B, CYP19A1, MC5R, DYM and NEDD4L, and no association with dyslexia genes in MRPL19/C2ORF3, ROBO1, CNTNAP2, TTRAP, THEM2 , VMP (NRSN1) and ATP2C2. Then, in this study, it was found that KIAA0319 gene shows the most consistent evidence of linkage for DD. This study found discrepancies in the results of studies in most genes studied. The analysis accuracy (and reproducibility) of these data is limited by the difficulty inherent in the definition, evaluation and characterization of the DD phenotype, the small sample sizes available for this type of analysis, the genetic heterogeneity of the population and the limitations of the statistical methods used. However, is necessary more studies with a lager sample size in an independent population. And for consistent results, these issues should be reflected in the methodology of future studies. Learner Outcomes: reflect on the causes of dyslexia; update themselves about the candidates for susceptibility genes for dyslexia; understand the relationship between these genes and dyslexia; reflect on the methodological difficulties in genetic studies of dyslexia, in order to improve the quality of future studies
P066
SPEECH DISTURBANCES IN CHILDREN WITH EPILEPSY YI-JEN CHEN (1) - YUNG-JUNG CHEN (2) - CHIN-HSING TSENG (3) AFFILIATED SOCIETIES, DEPARTMENT OF OTORHINOLARYNGOLOGY, NATIONAL CHENG-KUNG UNIVERSITY HOSPITAL, TAINAN, TAIWAN, PROVINCE OF CHINA (1) - AFFILIATED SOCIETIES, DEPARTMENT OF PEDIATRICS, COLLEGE OF MEDICINE, NATIONAL CHENG-KUNG UNIVERSITY, TAINAN, TAIWAN, PROVINCE OF CHINA (2) AFFILIATED SOCIETIES, GRADUATE INSTITUTE OF AUDIOLOGY AND SPEECH THERAPY, NATIONAL KAOHSIUNG NORMAL UNIVERSITY, KAOHSIUNG, TAIWAN, PROVINCE OF CHINA (3)
Abstract: Epilepsy is one of the chronic brain disesases, resulting from congenital or acquired causes. It is a recurrent cerebral dysfunction disorder
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P068
DO AX AND ABX PERCEPTION TASKS PROVIDE THE SAME INFORMATION ABOUT PERCEPTION OF SPEECH SOUNDS IN CHILDREN WITH SPEECH SOUNDS DISORDERS? AMPARO YGUAL FERNNDEZ (1) JOS FRANCISCO CERVERA MRIDA (2) DEPARTAMENTO DE PSICOLOGA EVOLUTIVA Y DE LA EDUCACIN. FACULTAD DE PSICOLOGA. UNIVERSIDAD DE VALENCIA., UNIVERSITY, VALENCIA, SPAIN (1) - FACULTAD DE PSICOLOGA Y CIENCIAS DE LA EDUCACIN. UNIVERSIDAD CATLICA DE VALENCIA, UNIVERSIDAD, VALENCIA, SPAIN (2)
Abstract: The aim of this study was to determine if the information that AX and ABX perception tasks provide is the same or not about perception of speech sounds in a sample of children with speech sounds disorders. Participants were 86 children with an age range of 3 to 5 years old, with a mean 4 years and 7 months. They had speech sounds disorders and were selected from a sample of 1283 children from 11 different schools of Valencia (Spain) whose first language was Spanish. First, we assessed speech production. Depending on the errors made by each child, we was constructed and applied AX and ABX tasks, using Locke criteria for assessing speech perception in children with developmental language disorders. We analyzed whether the results between the two tasks were related and we determined the strength of the agreement between the results of the two tasks. The results support the hypothesis that both tasks are related when they measured speech perception in children. However the degree of agreement only stands at an acceptable level, perhaps because they evaluate different aspects of speech perception. The alternative of applying both tasks, given the low investment of time, it may be a prudent approach in clinical practice. Learner Outcomes: Know the methods used to assess phonological discrimination in preschool children; Understand the differences between the various methods; Know a concrete way to apply the evaluation criteria proposed by Locke (1981) to real clinical situations.
P070
ANALYSIS OF PRODUCTION OF TEXTS OF THE BASIC EDUCATION SCHOOL OF BRAZILIAN CHILDREN MARIA APARECIDA G. SANTOS (1) - NAYARA S. BARINI (1) SIMONE R.V. HAGE (1) UNIVERSITY OF SO PAULO, UNIVERSITY OF SO PAULO SPEECH-LANGUAGE PATHOLOGY/AUDIOLOGY DEPARTAMENT, BAURU, BRASIL (1)
Abstract: Both the school and the clinic find themselves faced with the task of checking the skills of children for reading and writing, as well as identify those children with difficulties in the acquisition of these skills. These difficulties may be the result of obstacles encountered by students during school, but may also be the manifestation of disorders. Instruments that may assist in differentiating between written profiles that are part of the literacy process and those who are enduring disturbances flags should be built and tested. The objectives of this study were: to obtain reference values for a protocol analysis of text production; characterize the writing skills of students without language difficulties and learning from the 4th to 7th year of elementary school; compare the performance of students in public school and private and the skills for the text production. We selected 160 students of elementary school from the 4th to 7th grade, aged between 8 and 12 years, from public and private schools. To belong to the sample, children should submit academic performance compatible with the school year in the Teste de Desempenho Escolar TDE. The children were asked to write three essays as Protocol Analysis of Textual Production. For students of 4th and 5th years were asked to write a narrative, describing a game rules and the writing of a ticket. For students in the 6th and 7th years were also requested three productions of text, a narrative with the theme: movies; game rules and the writing of a letter. Upon completion of the composition of the texts, they were analyzed according to the protocol that examined the abilities of aesthetic coherence, cohesion, clarity and conciseness, cultural norms and grammatical and lexical structure. Descriptive statistical analysis was performed. For comparison of groups of private and public schools was used the Mann-Whitney test. Was obtained reference values for the performance of 160 students from the 4th to 7th year for all skills assessed in the production of texts. In aesthetic skill, the students of the 5th year of both the private and public schools scored the best performance among all years. Coherence and cohesion remained homogeneous in private school with a good performance. For public school students, this skill was more heterogeneous, probably due to the literacy method in which teachers make their students write without worrying too much about the rules, valuing content. What does not happen in private school, where teaching maintains a more traditional line, maintaining a standard of education. The ability for grammatical and lexical structure, the students from private and public school has the most knowledge of formal writing, or perform meaningful sentences himself, using simple and compound periods. Comparing the two groups, private and public schools, all variables indicated better performance of private school. Thus, the development of a protocol to characterize and compare the writing skills of students that can be used by teachers and speech pathology, may serve as a tool for early identification of changes in textual production-related Learning Disorders. Learner Outcomes: Know a protocol analysis of production of texts that can be used by teachers and speech pathologist and could be a tool in the early identification of changes in textual production-related Learning Disorders; Know the characteristics of the text production of primary schools; Understand the possible differences in the production of texts of children studying in public schools and private schools
P069
RECEPTIVE AND EXPRESSIVE VOCABULARY PERFORMANCE IN INDIVIDUALS WITH DIPLEGIA CEREBRAL PALSY DIONSIA APARECIDA CUSIN LAMNICA (1) CORA SOFIA TAKAYA PAIVA (1) DEPARTMENT OF SPEECH AND LANGUAGE PATHOLOGY, SCHOOL OF DENTISTRY OF BAURU, UNIVERSITY OF SO PAULO, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: In cerebral palsy motor limitation may result in difficulties in interacting and manipulating with the environment, which leads to missing opportunities in enabling the linguistic repertoire and consequently interfering with language development. The aim of this study was to compare the linguistic performance as the receptive and expressive vocabulary of children with PC-D to children with typical development of the same mental age. The research was conducted at the Speech and Language Clinic of the School of Dentistry of Bauru, University of So Paulo (FOB-USP) under the protocol of the ethics committee (096/2010). Inclusion criteria for the experimental group (EG) were: diagnosed spastic diplegia cerebral palsy (CP-D), chronological age between 36 and 83 months; absence of sensorineural hearing loss and visual alterations. Inclusion criteria for the control group (CG) were: present typical development, matched by mental age (AM) and gender. The procedures used were: Assessment of Intellectual Quotient through the StanfordBinet test; Gross Motor Function Classification System - GMFCS; Denver II Developmental Screening Test; Communicative Behavior Observation (OCC); MacArthur Inventory (Brazilian standardization); Peabody Picture Vocabulary Test (PPVT) and Language Test for Young Children ABFW-Vocabulary. The study included 10 subjects in the GE and 10 in the control group, 60% female and 40% male. The chronological age (CA) of EG ranged from 44 to 83 months and CG 33-83 months. The IM ranged between 34 to 84 months. The IQ scores ranged in the EG from 77 to 100 (average 94.4) and in the CG from 101 to 114 (average 104.2). As the GMFCS ranking in individuals with CP, 70% were classified as level II and 30% in level III.Statistical analysis consisted of descriptive analysis and application of the Students t test, MannWhitney Test, Paired t Test, Spearman Correlation and Pearson Correlation. The results showed that there was no significant statistical difference in the comparison between groups at OCC, MacArthur and TVIP. In Denver II, with the exception of gross motor skill, there was also no difference in personalsocial skills, fine motor-adaptive and language, although the indication of tendency. When comparing the different procedures it was not found significant statistical correlations. The results of this study can reaffirm that cognitive ability is closely linked to language ability. Individuals with CP-D when compared to their peers of the same mental age, showed no significant deficits, especially in relation to lexical repertoire, as well as in social skills, language and fine motor-adaptive, although the CA of the EG was above the CG. This study brings speculations that can promote understanding of linguistic performance, as the receptive and expressive vocabulary of individuals with CP-D. Learner Outcomes: Knowledge about CP-D and receptive and expressive abilities; Knowledge about the implication of CP-D in the language learning process; Speculations of the linguistic development in individuals with CP-D.
P071
COMMUNICATION AND RESPONSIVITY IN AUTISM SPECTRUM DISORDERS LILIANE P. MIILHER (1) - FERNANDA DREUX M. FERNANDES (1) SCHOOL OF MEDICINE, UNIVERSIDADE DE SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Studies with large groups of individuals with Autism Spectrum Disorders (ASD) are undoubtedly necessary to determine aspects that can be generalized and applied to different realities. However studies with smaller groups, aiming to deeply and carefully analyze specific aspects that may contribute to the clinical rationale are also important to the improvement of assessment and intervention methods. The purpose of this research was to compare the pragmatic profile of children with ASD referring to the communicative initiatives and the bi-dimensional communicative profile involving the aspects of initiative and responsivity. It also aimed to analyze the most common types of responses presented by the studied individuals. The method proposes: Thirty recorded samples of interaction between speechlanguage therapist and children with ASD (mean age 9 years and 6 months) sessions were analyzed. The samples were transcribed and data analyzed about number of communicative acts, occupation of the communicative space, use of communicative means (verbal, vocal and gestural) and total number of participations (initiatives and responses). The responses were qualified as non-answer, adequate answer, inadequate answer and pragmatically inappropriate answer. Results show that there were
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significant differences in the comparison of the numbers of initiatives and total participations and of occupation of communicative space and total number of communicative acts. There was also a significant difference in the number of adequate answers. Conclusion: results show the need to consider the bi-dimensional communicative profile and qualify the answers in order to determine the childs communication abilities. Learner Outcomes: Consider the importance of considering the responses when analyzing the communication of ASD children; Identify the different types of answer and whether they are appropriate to the interactive process; identify the need of communication environments that allow the subject to exercise all communicative roles.
average readers outperformed students with reading disabilities on comprehension of all types of figurative language, verbal analogical reasoning, matrix reasoning and working memory. In addition, figurative language comprehension, verbal analogical reasoning, was found to be associated with nonverbal reasoning. However, working memory was not associated with figurative language comprehension or verbal analogical reasoning. Learner Outcomes: know the figurative language comprehension test designed in Mandarin Chinese; understand the figurative language comprehension abilities in children with reading disabilities from a cross linguistic perspective.
P072
ASSESSMENT OF SEMANTIC AND LEXICAL SYSTEM IN DEVELOPENTAL AGE: RESEARCH THROUGH EXPRESSIVE VOCABULARY TEST-SECOND EDITION (EVT-2) LEONARDA GISOLDI (1) - FEDERICA MANEO (2) CHIARA BORELLO (3) SSN, ASL TO2, TORINO, ITALY (1) - LIBERO PROFESSIONISTA, LIBERO PROFESSIONISTA, TORINO, ITALY (2) - CENTRO DI RIABILITAZIONE FERRERO, OSPEDALE DI ALBA, ALBA, ITALY (3)
Abstract: The acquisition of language is an important and complex process, it involves the achievement of specific skills in phonological, morpho -syntactic, lexical-semantic and pragmatic area. Each one becomes an object of assessment in clinical phoniatric-speech therapy to identify and understand what aspects enabled. A closer look to the Italian situation allows to find a shortage about the assessment tools of semantic-lexical. Therefore this research wished to suggest a new American test called Expressive Vocabulary Test-Second Edition (KT Williams, 2007) and to verify the applicability to the Italian population, in individuals of preschool and school age. The EVT-2 evaluates the expressive vocabulary and word retrieval of subjects aged from 2 years and 6 months to 90 years (and beyond). Purposes of the Research were to assess the development of expressive vocabulary semantic-lexical in Italian children aged between 5 and 8 years (with the administration of both forms A and B of EVT-2), to make an intra-subjective assessment comparing the results obtained between first and second administration of the test (with the same sample and examiner) and to compare the results obtained with the American normative data. The experiment was carried out by two graduate students of the Degree in Speech Therapy in Turin at various schools in the city of Turin, Asti and Venaria, it included 281 children aged between 5 and 8 years. The assessment involved the administration of: Test Santucci mod. Schindler, Esame Fonemico di prima consultazione (screening test), Peabody Picture Vocabulary Test-Italian version and Forms A and B of EVT-2 (lexical-semantic level). The protocol EVT-2 was administered twice, at a distance of about a month apart, at the same sample by the same examiner to verify the applicability of the test-retest. Practicality, originality, functionality and wide range of applicability are some of the advantages of the test highlighted during the research phase. The comparison between the first and second administration of both forms of the test appears statistically significant for each level of schooling examined, as the results obtained at the second administration appear best. It should be noted, moreover, almost linear evolution of language competence in comprehension and lexical-semantic production and there is a direct proportionality between the increase in vocabulary and increasing the range of schooling. The comparison between the performance obtained for the test EVT-2 and PPVTItalian Version noted a positive correlation between the two protocols for each level of schooling studied and the results obtained confirm that receptive vocabulary of a subject is normally wider than expressive. Research on the Italian sample confirm the parallelism between Forms A and B and demonstrate the reliability of the application of the American test on the Italian population. The EVT-2 is a more recent and innovative and it could therefore be used as a tool for assessing the expressive vocabulary of the child.
P074
FAMILIAL AND GENETIC FACTORS IN NEURODEVELOPMENTAL DISORDERS: THE CASE FOR PRACTICE-BASED EVIDENCE MARIA VLASSOPOULOS (1) - HAZEL RODDAM (2) UNIVERSITY OF ATHENS, SCHOOL OF MEDICINE, ATHENS, GREECE (1) - UNIVERSITY OF CENTRAL LANCASHIRE, UNIVERSITY OF CENTRAL LANCASHIRE, LANCASHIRE, UNITED KINGDOM (2)
Abstract: The topic for this study is the familial and genetic component in complex cases of neurodevelopmental disorders which are associated with a range of speech, language and communication difficulties. It is imperative for all healthcare professionals working with these families to understand better the nature and potential long-term outcomes of these conditions. In particular the implications for case management and intervention decisions need to be considered. This study was based at the Child and Adolescent Mental Health Unit of the 1st Department of Psychiatry, University of Athens, which is a community-based service serving the inhabitants of four Athenian boroughs. This service offers assessment and intervention to children with a variety of mental, learning and developmental disorders, as well as counseling and guidance for their families. The interdisciplinary team model at this Early Intervention Unit includes joint assessment and joint intervention sessions by a highly experienced speech and language therapist, child psychiatrist, psychologist, occupational therapist, education specialists and social workers. This collaborative practice model affords the opportunity for greater awareness of the respective research evidence bases, as well as the prospect for interdisciplinary research designs. A retrospective casenote review indicated that a number of families after the initial assessment and/or treatment of one of their children had subsequently returned with other siblings for assessment. The genetic basis of developmental and neurodevelopmental disorders is well-documented in the literature, however the interaction of the occurrence of these disorders within the same family is still under investigation. There is also a dearth of research evidence regarding the effectiveness of models of healthcare interventions in such complex cases, particularly with consideration for Quality of Life issues for these families. To compound the significant gaps in the research knowledge base for these low-incidence and complex cases, there are considerable methodological challenges which have been acknowledged to the design of research studies which could answer the most pressing questions raised by the families and professionals working in this field (Roulstone & McLeod, 2011). The potential value of descriptive case studies should not be underestimated for learning from these low incidence and clinically complex cases; however, methodological rigour is essential to guard against anecdotal tendency: the plural of anecdotes is not evidence (Reilley, 2010). For this reason there is a need to identify specific research designs which are relevant and appropriate for single cases; and to demonstrate the potential for experienced clinicians to undertake these small-scale research studies within their own caseload, maximizing the use of routinely collected clinical data. In this way, the concept of Practice-Based Evidence is exemplified. Learner Outcomes: the importance of interdisciplinary study of neurodevelopmental disorders; how this may impact on their intervention and case management of language disorder in complex cases; how experienced clinicians can contribute to the research evidence base through practice-based evidence; that there are a range of relevant research designs dependent on the specific questions to be investigated.
P073
FIGURATIVE LANGUAGE COMPREHENSION IN STUDENTS WITH READING DISABILITIES IN TAIWAN PAO-HSIANG CHI (1) DEPARTMENT OF SPECIAL EDUCATION, NATIONAL TAIPEI UNIVERSITY OF EDUCATION, TAIPEI, TAIWAN, PROVINCE OF CHINA (1)
Abstract: The purpose of this study was to investigate whether Mandarin Chinese- speaking students with reading disabilities had more problems in comprehension of different types of figurative language (i.e. similes, metaphors, idiom, proverbs, hyperbole), and performed worse on tasks of verbal analogy, as compared to average readers. In addition, it was aimed to explore whether comprehension of figurative language, verbal analogical reasoning , nonverbal reasoning and working memory were related to each other. Forty sixth grade students with reading disabilities and 40 average readers matched based on grade, sex and SES participated in this study. All the participants were administered one figurative language comprehension test, one verbal analogical test developed by the researcher, one working memory test and one nonverbal reasoning test (SPM). The results indicated that
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P075
FLUCTUATIONS IN (PSEUDO-)SYLLABLES OCCURRENCES IN ITALIAN CHILDREN FROM 6 TO 18 MONTHS OLD ANTONIO ROMANO (1) - BRUNA SCANAVINO (2) DEP. FOREIGN LANGUAGES AND LIT. AND MOD. CULT., UNIVERSITY OF TURIN, TURIN, ITALY (1) - DIPARTIMENTO DI FISICA SANITARIA, AZIENDA OSPEDIALIERA CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, TURIN, ITALY (2)
Abstract: In this presentation we highlight the need for a narrow encoding of early speech productions. Moreover, we encourage a better knowledge of the properties of articulatory universal sound patterns when dealing with non specific child language. This helps avoiding to force the mapping of linguistically constrained structures on fluctuating realizations. We will show how such approach also allows a better account of the pretended conditioning sources throughout the observed period.
Learner Outcomes: Narrow transcriptions in IPA and Ext-IPA will be proposed as well as a selection of syllabic models and patterns (with the special reference to co-articulatory processes and perceptual mapping); Reference is made to phonetic inventories of the worlds languages and to their organization in larger structures and frames; A general knowledge of the most authoritative models in this field is required.
P076
EFFICACY OF THE USE OF ASSISTIVE TECHNOLOGY BY STUDENTS WITH DEVELOPMENTAL DYSLEXIA PINHEIRO FBIO HENRIQUE, CAPELLINI SIMONE FACULDADE DE FILOSOFIA E CINCIAS - FFC, UNIVERSIDADE ESTADUAL PAULISTA - UNESP, MARLIA - SP, BRAZIL
Abstract: To verify the effectiveness of the use of assistive technology with students with developmental dyslexia. Methods: 20 students participated of this study, from 3rd grade students from public elementary schools divided into Groups I (GI) and II (GII). GI was composed by 10 students with developmental dyslexia submitted to the text-to-speech software, and GII: 10 students with developmental dyslexia not submitted to the text-tospeech software. As an oral reading procedure we used texts indicated by teachers of 3rd grade of municipal schools. The analysis of reading texts was made by the engraving to score of errors reading words (accuracy reading), total time of reading and speed reading (showed in the words for minutes). The speed reading is calculated by the multiplication the word numbers of the text in seconds. The comprehension of the text was made with four questions showed succession the text where the students ought to answer orally. All the procedures were used before and after the use to the text-tospeech software. Results: The results were statistically analyzed and evidenced that for the students of the group GI there was statistically significant differences between the score of errors reading words, total time and speed reading decreasing in situation of post-evaluation. The reading comprehension improved after the use of text-to-speech software in the students of GI. The group GII not modified their Performance in the score of errors reading words, total time, speed or comprehension reading in the both moments of evaluation. Conclusion: The findings evidence the effectiveness of the use of assistive technology by students with developmental dyslexia because the performance in the variables of reading improved in the situation of post-testing when compared with the pre-testing, showing the text-to-speech software used in this study helped the development of variables of reading interfering in the performance in the comprehension of the text read. Learner Outcomes: The use of technology as a way to minimize the reading difficulties of students with developmental dyslexia is a reality and learn a little more about its use with students enable understanding of how these strategies can be implemented and its widespread use. This study seeks to demonstrate that the more avenues of information are used and offered to students with dyslexia, the better the result in the reading assignments proposals, so the vocabulary and level of understanding of the material read by dyslexics present a significant gain and her gap tends to be decreased when compared to the group class, or even to students with developmental dyslexia who do not have the opportunity to have a software that assists in these activities.
results showed an average increase with age, more accentuated in the TDC group, followed by children with SLI and DS. This increase was more evident between the age ranges of 4 and 5 years for TDC and DS subjects. The study showed that children with DS presented lower MLU scores than children with SLI and TDC, indicating differences between groups, morphosyntactic deficits, and language development delay. It was also observed that morphosyntactic abilities were more developed in older age ranges. Overall, the group with DS was more similar to the group of TDC than to the SLI group regarding morphosyntactic development in older age ranges, despite the linguistic difference between the groups. The use of MLU and all the variables related fulfilled the purpose of this study and proved to be a reliable and efficient instrument to describe grammar and general language development of Brazilian Portuguese-speaking children with DS. These results confirm the validity of using MLU as an assessment instrument with this population.
P078
SCHOOLING INFLUENCE ON COGNITIVE-LINGUISTIC SKILLS MARIA SILVIA CRNIO CRNIO (1) - BLENDA REGINA ZOCCAL LICAS LICAS (1) - APARECIDO JOS COUTO SOARES SOARES (1) DEPARTMENT OF PHYSIOTHERAPY, SPEECH AND LANGUAGE PATHOLOGY AND OCCUPATIONAL THERAPY OF MEDICAL SCHOOL (FMUSP), UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Investigating the influence of schooling on Phonemic Awareness (PA) and Rapid Automatic Naming (RAN) might provide relevant parameters both to therapeutic program and reading disorders. Thus, this study aimed to verify the influence of schooling on PA and RAN as well as its possible correlation in students from 3rd and 4th grade of elementary school. As subjects, the study counted on 57 students from 3rd and 4th grade of elementary school. PA was assessed in rhyme, alliteration, synthesis and split activities and the maximum score was 30. Regarding RAN it was used the Comprehensive Test of Phonological Processing (CTOPP) as depicted in the test. Data were analyzed using Wilcoxon, Mann-Whitney tests and Spearman correlation coefficient with significance level of 5%. Regarding PA, 3rd grade students showed lower mean than students from 4th grade (21,52 and 23,57 respectively), with no significant difference. Concerning RAN all students showed greater mean of time to name colors (95,66 and 92,21 respectively) and objects (88,03 and 84,43). Similarly, all students showed greater mean of errors for naming colors. There was significant difference between the students only concerning time to naming (0,0010) and the frequency of error to numbers (0,002). There was found no correlation among PA and RAN skills in 3rd grade students. On the other hand, negative correlation was found between PA and RAN activities to 4th grade students. Considering all students as a whole group, no significant correlation was found between PA and RAN. Regarding PA, it was expected significant difference between the 3rd and 4th grade students but it was not found in this sample. Thus, it is possible to speculate that it might be related due to the emphasis given in syllables in the school where the research was performed, and also the level of literacy of the families. Concerning RAN, the time spent by all students was greater to objects and colors as previously claimed by others researchers. According to this data, time spent to naming colors and objects is due to attentional, perceptual and visual process to recover the lexicon. The negative correlation found between PA and RAN to 4th grade students confirmed several studies which have showed that the best performance in PA, the less will be the time spent in RAN. This correlation was not found in colors and objects naming. A hypotheses related to this data is that naming colors and objects involves semantic access and not only decoding skills which is related to PA. Data provided in this study is not in line with previously researches concerning schooling advancement and cognitive-linguistic skills. Nevertheless it points out the possible influence of other factors which might interfere in the improvement of WM and PA not only the formal education. Schooling was not a decisive factor in the PA performance of this sample. However, regarding RAN skills were influenced by the schooling since 4th grade students showed greater performance. Further, data suggest that PA and RAN might be influenced by other variables, not only formal education. Learner Outcomes: Know that schooling was not a decisive factor on the performance in PA to this sample; Understand why RAN skills to objects and colors demand more time to execution; Know that external factors might have influence on the performance in PA and RAN of Brazilian students.
P077
MEAN LENGTH UTTERANCE AS AN ASSESSMENT INSTRUMENT OF THE LINGUISTIC ABILITIES OF BRAZILIAN CHILDREN WITH DOWN SYNDROME ANGELA MARIA DE AMORIM CARVALHO (1) - SUELLY OLIVAN LIMONGI (2) FACULTY OF MEDICINE, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1) - FACULTY OF MEDICINE, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (2)
Abstract: Down syndrome (DS) leads to disorders in all development processes, particularly in the linguistic processes. The language development of children with DS is characterized by a delay, mainly regarding morphosyntactic aspects. These deficits are confirmed by Mean Length Utterance (MLU) scores lower than expected for chronological age (CA), as well as for mental age (MA), when compared to typically developing children (TDC). In international literature, MLU has been considered the most acceptable and effective index to measure grammatical and morphological development both in TDC and in children with language disorders, such as those with Specific Language Impairment (SLI) and DS. Studies that have compared children with SLI and DS show similarities between their performances regarding MLU. Brazilian researches using MLU as an assessment tool to measure morphosyntactic aspects in DS are scarce. The purpose of the present study was to describe the linguistic abilities of Brazilian Portuguese-speaking children with DS through MLU analysis. Three groups of children participated in the study, each composed of 25 subjects: a group of children with DS (research group), and two control groups, one of children with SLI and one of TDC. Data for the control groups are retrospective from a previous study. Each group was subdivided into three subgroups according to the age range (3, 4, and 5 years old). The research group was paired to the control groups by MA. A total of 2500 utterances was obtained from children with DS for MLU analysis. The
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P079
RELATIONSHIPS BETWEEN SYNTACTIC DEVELOPMENT AND VOCABULARY AND CONVERSATIONAL ABILITIES IN PERSAVE DEVELPOMENTAL DISDODER CHILDREN DURING THE SCHOOL PERIOD SATSUKI ADACHI (1) - YASUKO IKEDA (1) - IKUYO FUJITA (2) - HIROMI HARADA (1) - KAHORU HASHIMOTO (3) - MASAKO NOTOYA (3) SEIREI CHRISTOPHER UNIVERSITY, UNIVERSITY, HAMAMATSU, JAPAN (1) - INTERNATIONAL UNIVERSITY OF HEALTH AND WELFARE, UNIVERSITY, OTAWARA, JAPAN (2) KANAZAWA UNIVERSITY, UNIVERSITY, KANAZAWA, JAPAN (3)
Abstract: The majority of previous studies on language development in children with pervasive developmental disorder (PDD) focused on pragmatic abilities, rather than syntactic abilities. This paper reports the results of a study examining the characteristics of syntactic development in PDD children, and its relationship with vocabulary and conversational abilities. Subjects were thirteen male PDD children aged 6 years and 2 months to 11 years and 10 months (mean: 7 years and 2 months), all of whom were diagnosed during the infantile period, were studied in comparison with 22 healthy children at first and second elementary school grades. Methods: The Syntactic processing Test for Aphasia (STA), Picture Vocabulary Test (PVT), Verb Test for Aphasia Vocabulary Examination (verb comprehension and expression), S-S Method/Question-Answer Relationship Test (Q&A), Raven Colored Progressive Matrices (RCPM), and WISC-III number counting were performed to analyze the relationship between each test score. Results were as follows; 1) Scores for PDD children were significantly lower than those for healthy children in all tests, except for the intelligence test (P<0.05). 2) A correlation was observed between STA auditory comprehension, PVT, verb comprehension, and Q&A in healthy children, and between STA auditory comprehension, STA production, PVT, verb comprehension, Q&A, and AMS in PDD children. The STA production was correlated with verb compression and expression, PCPM, Q&A, and AMS. 3) The syntactic comprehension level corresponded to word-order or particle strategies in healthy children, while it was limited to semantic and word-order strategies in PDD children. From these results, despite delays in syntactic development, the development of compression strategies in PDD children was similar to that in healthy children, suggesting an interaction between the development of syntactic processing and vocabulary and conversational abilities. Learner Outcomes: Significant lower Scores for PDD children than those for healthy children in all tests, except for the intelligence test; A correlation was observed between STA auditory comprehension, PVT, verb comprehension, and Q&A in healthy children, and between STA auditory comprehension, STA production, PVT, verb comprehension, Q&A, and AMS in PDD children; The STA production was correlated with verb compression and expression, PCPM, Q&A, and AMS; The syntactic comprehension level corresponded to word-order or particle strategies in healthy children, while it was limited to semantic and word-order strategies in PDD children; Despite delays in syntactic development, the development of compression strategies in PDD children was similar to that in healthy children.
P081
WISC-III INDEX SCORE PROFILES IN VELO-CARDIOFACIAL SYNDROME ASSOCIATED WITH VELOPHARYNGEAL INSUFFICIENCY MIYUKI GOTO (1) - RYUSAKU HASHIMOTO (1) - SATOKO KASAI (1) - KENJI KOBAYASHI (1) - EIKO TAMASHIGE (1) - SATOKO IMAI (1) - NORIKO NISHIZAWA (1) DEPARTMENT OF COMMUNICATION DISORDERS, HEALTH SCIENCES UNIVERSITY OF HOKKAIDO, SAPPORO, JAPAN (1)
Abstract: Background: Velo-Cardio-Facial Syndrome (VCFS) is a relatively frequent autosomal deletion syndrome with an estimated prevalence of 1:6000. It is caused by microdeletions in region q11 of chromosome 22, and is also known as 22q11.2 deletion syndrome. The major characteristics include velopharyngeal insufficiency, cardiac anomalies, mid-facial dysmorhphism and neurocognitive abnormalities. The population of VCFS patients is not negligible in clinics dealing with speech output disorders associated with velopharyngeal insufficiency. Kitano (2009) investigated the factors affecting speech results after pharyngeal flap operation in VCFS and pointed out that full-scale IQ (FSIQ) is a significant factor for speech outcome. The average FSIQ of VCFS children has been estimated to be about 75, with an intellectual profile characterized by a discrepancy between verbal IQ (VIQ) and performance IQ (PIQ), favoring the VIQ. Although these data have been confirmed repeatedly in Western countries, reports on the intellectual profile of Japanese children with VCFS have been limited. Learner Outcomes: review the reports on the specific intellectual profile of VCFS; understand the need to investigate the cognitive profile and speech outcome of VCFS: know that VCFS patients comprise a group specified by their characteristic cognitive profile within the speech output disorders associated with velopharyngeal insufficiency.
P082
SPEECH-LANGUAGE PATHOLOGIST INTERVENTION ON THE MACROSTRUCTURE OF ORAL NARRATIVE IN BRAZILIAN CHILDREN WITH DOWN SYNDROME PILOT STUDY ROSANGELA VIANA ANDRADE (1) - SUELLY LIMONGI (1) SCHOOL OF MEDICINE, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: There are few studies which depict the narrative skills of children and adolescents with Down syndrome (DS) mainly regarding its use in clinical intervention. This study aimed to verify the efficacy of speech-language pathologist intervention on the macrostructure of oral narrative of children and adolescents with DS. Participated in this study five Brazilian children and adolescents with DS and chronological age between 10 and 15 years old. Their mental age was (PTONI) between 5.0 and 6.0 years. Data collection counted on two assessments (initial and final) with a gap of 18 months between them (approximately 72 therapeutic sessions for each participant). The material used were: assessment: a sample of an oral narrative of the book Frog, Where Are You?; therapeutic process: storybooks. The obtained data were subjected to statistical analysis aiming to verify the evolution of the participants comparing its results in the initial and final assessment. Data analysis was based on the model used by Miles and Chapman (2002) which considers the macrostructure concerning three variables: components of the plot line; the search theme and the protagonists misadventures. To statistical analysis it was used the the nonparametric test Wilcoxon Signed Ranks. The significance level adopted was 0,05. Considering the initial and final assessments, respectively, it was found the results as follows: components of the plots: 83% - 100%; 2. Theme 33% - 78%; 3. Misadventures 38% - 63%; total: 48% - 83%. The results pointed out an improvement in the oral narrative of the participants in all of the analyzed aspects. Thus, it is important and confirms what some studies have claimed regarding the importance of the intervention on the skill narratives of individuals with DS. This way, the results show that all the subjects obtained progressing improvements in understanding and establishing causal and inferential relations regarding events in stories. Consequently they had an increase in their syntactic complexity as well as in the sequential and logical organization concerning either an issue or theme. Thus, occurred integration between linguistics and cognitive skills leading to a better understanding of happenings and utterance simultaneously. This way, there are such relevant data referring to individuals with DS. since this is a pilot study it is likely that raising the sample, there will be more noticeable all the significant statistically differences in all aspects. Thus it is important a study with a larger sample. In conclusion, the Speech-Language Pathologi4rative skills is effective in lexical expansion of the individuals with DS speakers of Brazilian Portuguese; How the intervention on narrative promotes the integration between linguistics and cognitive skills in the individual with DS; How important is using visual stimuli in activities involving memory of children with DS.
P080
SPECIFIC LANGUAGE IMPAIRMENT: PERFORMANCE IN TESTS OF PHONOLOGICAL WORKING MEMORY AND OF SUSTAINED AUDITORY ATTENTION LIDIANE Y. SAWASAKI (1) - MARIZA R. FENIMAN (1) - SIMONE R.V. HAGE (1) UNIVERSITY OF SO PAULO, UNIVERSITY OF SO PAULO SPEECH-LANGUAGE PATHOLOGY/AUDIOLOGY DEPARTAMENT, BAURU, BRASIL (1)
Abstract: Hypotheses are being pointed to explain the linguistic difficulties in the Specific Language Impairment (SLI), among them, we can mention limitations in the Phonological working memory (PWM). So, the objective of the present study was to verify the childrens acting with SLI in tests of sustained auditory attention (SAA), and still, to verify if there is correlation among them. 12 children have participated in this study with ages between 6 and 10 years, nine boys and three girls with diagnosis of SLI. The following tests were applied: Phonological working memory test nonwords and digits and Sustained Auditory Attention Ability Test (SAAAT). In the two tests applied, PWM and SAAAT results found lower than normal. In the literature there is strong evidence that children with SLI have poor performance in tasks involving PWM storing a verbal stimulus, a fact also confirmed in this study. As it was verified in this study, SLI can also be associated to difficulties in the sustained attention. It was possible to verify from this study that pictures of SLI can show difficulties, besides PWM and of SAA. Same not having correlation among the tests, the vast majority of children with SLI showed a performance deficit in the skills tested. Learner Outcomes: Know the Sustained Auditory Attention Ability Test (SAAAT), its objectives and application form; Know the performance of children with Specific Language Impairment on tests of sustained attention and working memory; Understand the possible relationship between language deficits in Specific Language Impairment and memory skills and attention.
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P083
DOES THE PATTERN OF SILENT PAUSES DIFFER BETWEEN TYPICALLY DEVELOPING CHILDREN AND CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT? DEBORA BEFII-LOPES (1) - ANA CCERES (1) - LETCIA BACCHIN (1) - PAULA PEDOTT (1) DEPARTMENT OF PHYSIOTHERAPY, COMMUNICATION SCIENCE & DISORDERS, AND OCCUPATIONAL THERAPY OF THE FACULTY OF MEDICAL SCIENCES, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: The silent pause is a strategy to gain time to formulate the statement without adding words, or when there is an overload of information related to language processing. Word class acquisition prioritizes those in open class and, later on, children learn closed class words. This pattern is justified because open-class words show concrete reference and are context related, while closedclass words are more abstract and works as connectors between words and phrases. Considering the possible relations between fluency speech and word class usage, this study aimed (1) to compare the mean duration of silent pauses preceding open class words (nouns, adjectives, verbs, adverbs and numbers) and closed class words (articles, prepositions, conjunctions, pronouns and interjections) during oral narratives of typically developing language children and children with specific language impairment; and also (2) to verify whether this pattern differs in these two groups of children. Forty TDL children and twenty SLI children, aged 7 to 10 years, participated in this study. The groups were matched for age and for each SLI child there should be two TDL children. All participants had Brazilian Portuguese as their native language and resided in the city of So Paulo (Brazil). In order to enable children to produce narratives, a series of 15 stories, each one based on a four-scene-sequence, was used. Once the child organized each sequence and told the story, the narratives were transcribed and their files were acoustically analyzed in Audacity software (1.3 Beta). These procedures allowed the measurement of the duration of each word enunciated and, consequently, the establishment of the interval between each of these words. After these intervals were established, the resulting file was processed in software specifically developed for this research, which calculates the duration of silent pauses (in milliseconds) immediately before each word for each child. The mean duration of silent pauses was longer when preceding closed class words for both groups. When groups were compared, the mean duration of silent pauses for both open and closed class words was significantly longer for SLI children. It suggests that lexical acquisition reflects general linguistic difficulties, and longer silent pauses indicate that SLI children need more time to process linguistic information even in lexical level. Learner Outcomes: know the differences of silent pauses pattern between typically developing language children and children with specific language impairment; know the characteristic of silent pauses in children with specific language impairment; understand the impact of specific language impairment on speech fluency; understand how word type relates to speech fluency.
follow) appears. Structural distortions during speaking significantly affect the process to analyze lexical units, possibilities independently to operate a syllable structure of a word (for instance, transformation). Low readiness to independent operation with structural elements of the native language reflects peculiarities of development of metalingual abilities by children with underdeveloped speech. Learner Outcomes: the controversies about metalingual abilities of children with speech nderdevelopment; considers abilities of children to apprehend, pronounce, and analyze the syllable structure of a word in native language; mistakes, which are made by children with underdevelopment during performance of exercises, which require metalingual reflexing.
P085
RELATIONSHIP BETWEEN VERBAL IQ (VIQ) SCORES, PERFORMANCE IQ (PIQ) SUBTESTS, AND READING COMPREHENSION TEST IN HEARING-IMPAIRED CHILDREN KAHORU HASHIMOTO (1) - MASAKO NOTOYA (1) HIROMI HARADA (2) - MAKOTO ITO (1) KANAZAWA, UNIVERSITY, KANAZAWA, JAPAN (1) SEIREI, UNIVERSITY, HAMAMASTU, JAPAN (2)
Abstract: Retardation of oral language ability of hearing-impaired pupils by several years is reported authors in the all of the world. Our previous studies have reported that many hearing-impaired children undergoing the Kanazawa Method training, a multisensory-based language training method implemented in our clinic, have acquired the almost same level of language skills as hearing children. We analyzed the results of subtest items using the Wechsler Intelligence Scale and Reading Comprehension Test in hearing-impaired children who had received training by Kanazawa method during the preschool period in our clinic. Thirty-three congenitally hearingimpaired children/adults participated in this study. All of the subjects aged 9 > years and can speak Japanese oral language. Their scores of WISC/ WAIS-,WAIS-R and Kyoken Style Reading Comprehension Test analyzed ; 1)Relationship between verbal IQ (VIQ) scores and Performance IQPIQwas investigated. 2) Correlation of VIQ and PIQ subtests scores of WISC/WAIS was investigated. 3) Moreover, we compared WISC/WAIS-, WAIS-R with Kyoken Style Reading Comprehension Test. The VIQ score in 33 subjects varied from 54 to 135 with the mean being 94.2 (SD = 19.3). The PIQ score varied from 89 to 134, with the mean being 110.8 (SD = 12.5). There was no correlation between the PIQ and VIQ scores received by the subjects. There was no significant difference between the normal range VIQ group and the group with VIQ < 80 in their mean PIQ score, but there was significant difference in subtests Picture Comprehension of PIQ. There was significant correlation between the VIQ scores and the total scores of Kyoken style Reading Comprehension Test. The Kanazawa method was designed to encourage hearing-impaired children to acquire words and sentences using sign language and written language with auditory/oral training. This method promotes ability to learn language structures in infantile periods. By this method, many severe hearing-impaired children can acquire oral language sufficiently. Learner Outcomes: Even severely hearing-impaired children can be acquired oral language sufficiently; No correlation between the PIQ and VIQ scores received by the subjects; No significant difference between the normal range VIQ group and the group with VIQ < 80 in their mean PIQ score, but there was significant difference in subtests Picture Comprehension of PIQ; Significant correlation between the VIQ scores and the total scores of Kyoken style Reading Comprehension Test
P084
EXPERIENCE IN RESEARCH OF METALINGUAL ABILITIES OF CHILDREN WITH SPEECH UNDERDEVELOPMENT NATALIA SHARIPOVA (1) MPSU, MPSU, MOSCOW, RUSSIAN FEDERATION (1)
Abstract: One of significant criterions of a metalinguistic manner of behavior of a five-year-old child is considered to be a possibility of conscious manipulating with syllable components of a word: dividing into syllables, definition of initial and different elements, presence/absence of syllable and rhythmic distortion and others. The aim of our research is to find out peculiarity of a metalingual ability of five-year-old children. Children from Moscow, whose speech development did not correspond to their age group, took part in this experiment. In anamnesis late beginning of speech could be observed (after three years), delay in forming of all the sides in spoken language: soundarticulatory, grammar, lexical, etc. Firm inability to self-sufficient mastering the syllable structure of a word is an expressed peculiarity of children with this kind of breach. We supposed that distortion of syllable word order by children of this category takes place not only on the level of pronouncing, but also on the level of perceiving. Moreover, it is rather hard for them without assistance consciously to operate structural elements of a word, it indicates about lower readiness to metalingual activity. To achieve this aim special exercises have been worked out, whose execution activate cognitive mechanisms of a child, and informs about peculiarities of development of a metalingual ability. The exercises have been given in a playing form, and they have been accompanied with picture material. Lets consider some of them: 1) Definition of presence / absence of structural distortion in the word (Identification)/; 2) Transposition of syllables with the purpose of getting new words (Transformation); 3) Completion of a started word (probable prediction). The results of the experiment are as follows: Illegibility, diffusivity of sensor standards, insufficient differentiation of words identification characterizes possibilities to perceive and identify words and their structural elements. It is obvious that his own habitual wrong variant of pronouncing for a child with underdeveloped speech can exist as the only true or one the possible ones (i.e. generalizing). Deformation of identification processes and probabilistic prediction (identification of that element, which must
P086
EARLY IDENTIFICATION AND INTERVENTION FOR CHILDREN WITH AUTISM IN BOLIVIA T. ROSARIO ROMAN (1) - LINDA R WATSON (2) ELIZABETH R CRAIS (2) BILINGUAL MULTICULTURAL SERVICES, INC, PRIVATE PRACTICE, ALBUQUERQUE, UNITED STATES (1) - THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL, UNIVERSITY, CHAPEL HILL, UNITED STATES (2)
Abstract: Speech-Language Pathologists (SLPs) in the United States are invited to share their knowledge on assessing and serving culturally and linguistically diverse (CLD) populations around the world. This poster will exemplify how a team of professionals (including three SLPS and an MD) from North Carolina and New Mexico traveled to Bolivia to present a two day conference in each three cities of Bolivia. Through the conferences, the team interacted with Partners of the Americas members, parents of children with Autism Spectrum Disorders, and various higher education students and professionals concerned with Autism. Conference participants in each location participated in discussion groups to identify: (a) the major challenges related to ASD in Bolivia; (b) strengths in Bolivia and/or the local community; (c) priorities for addressing the needs related to ASD in Bolivia; (d) shortterm steps; and (e) resources needed. A compilation of the findings across the three cities was then sent to the organizing Bolivian committees to help them plan their next steps in enhancing ASD awareness and services in Bolivia. This process may serve as a model for others exploring educational
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opportunities in other countries. To provide appropriate assessment and intervention in Bolivia, one has to understand Bolivians beliefs and values about communication in life experiences Learner Outcomes: Recognize participants rights as well as language, sensory and cultural differences related to ASD in Bolivia; Identify the major challenges and strengths in Bolivia and/or the local community; Help to develop a strategic plan or long-range action plan to guide the efforts related to ASD for the next five to seven years in Bolivia
P087
AUDITORY PITCH PROCESSING IN 5- TO 6-YEAR-OLD CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT AND TYPICALLY DEVELOPING CHILDREN LEENA ERVAST (1) - MATTI LEHTIHALMES (1) - KAISU HEINNEN (1) SWANTJE ZACHAU (1) - MARI VEIJOLA (2) - ELISA HEIKKINEN (1) KAISA LOHVANSUU (3) - KALERVO SUOMINEN (4) MIRJA LUOTONEN (2) - PAAVO H.T. LEPPNEN (3) FACULTY OF HUMANITIES, LOGOPEDICS, UNIVERSITY OF OULU, OULU, FINLAND (1) - DEPARTMENT OF PHONIATRICS, OULU UNIVERSITY HOSPITAL, OULU, FINLAND (2) - DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF JYVSKYL, JYVSKYL, FINLAND (3) - DEPARTMENT OF CLINICAL NEUROPHYSIOLOGY, OULU UNIVERSITY HOSPITAL, OULU, FINLAND (4)
Abstract: The ability of the brain to recognize different acoustic cues (e.g. frequency changes in rapid temporal succession) is important for phonemic perception and thus for successful language development. We studied how children with specific language impairment (SLI) and typically developing (TD) Finnish-speaking children process non-verbal stimuli. Twenty-four children with SLI and twelve typically developing 5- to 6-year-old children participated in the study. Auditory processing skills were assessed by using brain event-related potentials (ERPs). The stimulus pairs with two sine tones were presented in a passive oddball/ MMN paradigm. The standard stimulus (80%) was a tone pair with a 150 ms within-pair interval (WPI) and the pitch deviant stimulus (20%) was similar but having a pitch change in the 2nd tone. The 2nd tone including the pitch change generated a fronto-central negative response in both groups, but with longer latencies and decreased amplitude in the SLI-group in comparison to the TD-group. The response to the standard stimulus also differed between the groups. The two tones in the pair generated a merged response pattern in the SLIgroup, whereas in the TD-group two distinct responses to the both tones in the pair were observed. In the TD-group, a clear T-complex was found at the right temporal channels as well as two distinct peaks for the pitch deviant stimulus at the latencies of 340 and 410 ms. These peaks were smaller in amplitude or missing in the SLI-group. Instead, in the SLI-group a similar response pattern was found at same latencies but at the left temporal scalp site. Children with SLI did not discriminate the pitch change in the tone pair as well as TD-children. Atypical responses were also observed for the standard stimulus, suggesting differences also in basic auditory processing. The smaller responses to the second tone in the pitch deviant stimulus indicated less efficient pitch change detection in children with SLI. Atypical change detection was also reflected in an atypical hemispheric pattern. The TD-group processed pitc4ecially in temporally complex sounds.
better performance in the spelling task. In dyslexic readers, no association between obligatory ERPs and pseudoword decoding time was found. These results indicate that basic level speech processing is related to phonological processing, spelling accuracy, and decoding speed, but differently in dyslexic and typical readers. In typical readers, the associations of the responses at the right hemisphere to behavioral measures are in line with findings of right hemispheric dominance of vowel processing. Dyslexic readers show, in contrast, the opposite hemispheric pattern in the brain-behavior associations. This suggests differences in the organization of the neurocognitive processes related to reading and writing. Learner Outcomes: the neurocognitive background of dyslexia, the eventrelated potential methodology and analysis methods; the speech sound processing deficit and its associations to reading and writing skills
P089
VALIDITY OF MANDARIN TOKEN TEST WITH TAIWANESE CHILDREN 7 TO 12 YEARS OLD USING RASCH MODEL ANALYSIS YUEH-HSIEN LIN (1) - CHIN-HSING TSENG (2) - YUH-YIH WU (3) SPECIAL EDUCATION CENTER, NATIONAL TAIWAN NORMAL UNIVERSITY, TAIPEI, TAIWAN, PROVINCE OF CHINA (1) GRADUATE INSTITUTE OF AUDIOLOGY AND SPEECH THERAPY, NATIONAL KAOHSIUNG NORMAL UNIVERSITY, KOHSIUNG, TAIWAN, PROVINCE OF CHINA (2) - GRADUATE INSTITUTE OF SPECIAL EDUCATION, NATIONAL KAOSHIUNG NORMAL UNIVERSITY, KAOHSIUNG, TAIWAN, PROVINCE OF CHINA (3)
Abstract: The Token Test is a popular neuropsychological test for assessing auditory comprehension with various disordered population of varying ages since De Renzi and Vignolo published their ideas in 1962. This test requires subjects to point to or manipulate the plastic tokens, which vary in color, size and shape, according to the spoken commands given by the examiner, in order to estimate the subjects auditory comprehension ability. Sixteen years ago, Tseng developed a version of Token Test as a part of a comprehensive battery of cognitive functions for Chinese speaking children aged 5 to 8. It consists of three subtests and 29 items which vary in sentence length, sentence complexity, and number of dimensions of the referred tokens. Despite of its normative data, this early version is short of adequate information about validity and reliability. To remedy its weaknesses, Lin, Tseng, and Wu recently revised the original test by adding and rewriting some items and applied it to children aged 3 to 6. It is the purpose of this study to verify the validity of Mandarin Token Test with children aged 7 to 12 by means of the Rasch model analysis. Two groups of children aged 7 to 12 were recruited as subjects. The typically developing (TD) group consisted of 1,402 children while the disability group was comprised of 1,388 children with learning disabilities, autism, or intellectual disabilities. Two sets of test items were employed, with 27 common items and 3 or 4 items specific to each set. The WINSTEPS software was employed to examine whether there was a good fit between the subjects performance and the model requirements. We first looked at the model fit of the data which came from both the TD group and the disability group. The results indicated the in-fit and the out-fit mean squares were both excellent. In other words, the performance on the test did reflect the true ability of the test taker. We then used concurrent estimation to achieve vertical scaling. As such despite the use of two different sets of test items across age groups, it was possible to compare the estimates of their abilities with vertical scaling. The overall trend shows that the MTT scores increased linearly with age. Finally we examined the relationship between the MTT scores and Wechsler Intelligence Scale for Children III among the disabled children. Moderate correlation coefficients were found between MTT scores and the four IQ indexes. More importantly, the MTT appears to correlate better with Verbal Comprehension and Freedom from Distractibility than Perceptual Organization and Processing Speed. Learner Outcomes: understand the construction rationale behind the Token Test; o appreciate the technique of Rasch model analysis, and to recognize the construct validity of the Mandarin Token Test.
P088
EARLY STAGE BRAIN PROCESSING OF SPEECH IS DIFFERENTLY RELATED TO READING MEASURES IN TYPICALLY READING CHILDREN AND THOSE WITH DYSLEXIA KAISA LOHVANSUU (1) - JARMO A. HMLINEN (1) PAAVO H.T. LEPPNEN (1) DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF JYVSKYL, JYVSKYL, FINLAND (1)
Abstract: Speech processing deficit has been reported to be related to a specific reading disability, dyslexia. However, the role of speech processing problems as a risk factor for dyslexia still remain unclear. Here our purpose was to study whether brain responses reflecting early stages of speech processing (obligatory event-related potentials, ERPs) would be related to phonological processing, decoding and spelling skills in children with and without dyslexia. Brain event-related potentials (ERPs) of 911-yearold Finnish children (50 typical and 58 dyslexic readers) were recorded to a repeated vowel /i/ presented in a cross-linguistic oddball paradigm of a European NeuroDys study. Temporal principal component analysis (tPCA) was applied to identify the obligatory auditory responses. The ERP responses to vowel /i/ at the time windows of P1 (70 ms) and N1 (110 ms) were differently associated with behavioral measures in dyslexic readers compared to typical readers. In typical readers, a larger P1 response at the right temporal areas was related to better performance in pseudoword phoneme deletion and pseudoword spelling tasks as well as faster pseudoword reading time. A larger response at the N1 time window was related to faster pseudoword decoding only. In dyslexic readers, however, a larger right hemispheric P1 was only related to pseudoword repetition. Instead, larger left hemispheric responses at the P1 and N1 time windows were related to
P090
PHONOLOGICAL REMEDIATION IN SCHOOLS WITH DEVELOPMENTAL DYSLEXIA: CONTRIBUTION COGNITIVE POTENTIAL P300 PATRCIA ABREU PINHEIRO CRENITTE (1) - ERIKA FERRAZ (1) DEPARTMENT OF SPEECH PATHOLOGY, COLLEGE OF DENTISTRY OF BAURU, UNIVERSITY OF SAO PAULO, UNIVERSITY OF SAO PAULO, BAURU, BRAZIL (1)
Abstract: The use of therapeutic activities of phonological skills training seeks to maximize the phonological abilities of subjects with learning difficulties. Such programs lead to an improvement on the phonological analysis of written language, perception, production and manipulation of sounds and syllables, interfering directly in the reading ability and comprehension of subjects undergoing training. The first signs of dyslexia appear at the beginning of written language acquisition, when the child has difficulty to relate sounds to letters8. The ability to manipulate and recognize sound
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structures of words, as well the ability to make rhymes, counting syllables and reading pseudo-words requires the development of phonological awareness. The use of the cognitive potential P300 allows the evaluation of auditory processing, objectively. Auditory evoked potentials refer to a change in electrical activity in response to an acoustic or electrical stimulus, which occurs in peripheral and central auditory system. The P300 potential occurs when the individual consciously discriminate the presence of an acoustic stimulus presented in tone burst or speech17;6. The use of therapeutic activities of phonological skills training seeks to maximize the phonological abilities of individuals with learning difficulties. Such programs lead to an improvement on the phonological analysis of written language, perception, production and manipulation of sounds and syllables, interfering directly in the reading ability and comprehension of subjects submitted to training. The aim of this study was to evaluate the procedures of phonological awareness, lexical access and phonological memory, and verify the applicability of the Cognitive Auditory Evoked Potential - CAEP-P300 as an indicator of therapeutic developments in children with developmental dyslexia, in pre and post phonological remediation program. Were evaluated 20 children diagnosed with developmental dyslexia, aged 8-14 years, group I (GI) composed of 10 students submitted to the program, and group II (GII), composed of 10 students who did not were submitted to remediation program. Comparing the results obtained in both periods between groups were statistically significant differences in all the test items Phonological Awareness for Group I. The same occurred with the test of phonological memory and lexical access for objects and colors. In the P300 test there was statistically significant difference for the latency of the P3 component. In group II there was no statistically significant difference for any of the tests used. Thus, the phonological remediation program was beneficial to not only quantitative but mostly qualitative in children with developmental dyslexia in the phonological processing abilities assessed, and the Cognitive Auditory Evoked Potential - CAEP-P300 proved to be a useful tool for objective monitoring of the therapeutic developments of these subjects. Learner Outcomes: This study will enable even greater theoretical study on the characteristics cognitive-linguistic of individuals with learning disorders, before and after direct instruction in phonological skills, reading and writing, thus enabling the use of an instrument that can promote the improvement of certain skills in a short period of time, contributing mainly to improve the academic performance of these children.
P091
A RANDOMIZED CONTROLLED TRIAL OF TWO SYNTACTIC TREATMENT PROCEDURES IN SCHOOL-AGE CHINESE CHILDREN WITH LANUAGE DISORDERS CAROL K. S. TO (1) - LOUISE W. O. HUI (2) DIVISION OF SPEECH, THE UNIVERSITY OF HONG KONG, HONG KONG, HONG KONG (1) - EDUCATION BUREAU, HONG KONG SAR GOVERNMENT, HONG KONG, HONG KONG (2)
Abstract: Purpose. This study aims to evaluate the efficacy of two procedures for syntax intervention, namely the Sentence-Combining (SC) and NarrativeBased (NAR) procedures using a randomized-controlled-trial (RCT) design. These two procedures have been indicated to be effective in previous case reports and expert opinions. Methods. A total of 50 Cantonese-speaking school age children with language impairment participated in the study. Pre- and post-treatment scores on the outcomes measured by a standardized language assessment, was subject to mixed effect model ANOVAs. Results. Children in both treatment approaches demonstrated significant growth after four months of intervention. Interaction effect was not significant suggesting that both treatment approaches showed similar effect. Conclusions. Both treatment approaches were equally efficacious. By using the study design of RCT, this study provided stronger evidence to support language intervention in school years. Future research can examine which types of children are more likely to benefit more from one method or the other. Learner Outcomes: Randomized Controlled Trial provides strong evidence on treatment efficacy. Many conventional treatment approaches still await strong evidence to assist clinicians decision making during selection of treatment approaches.
regarding the specific development of oral narrative skill.Studies on the oral narrative of individuals with a history of maternal alcohol consumption during pregnancy are still scarce, although the presence of cognitive and language impairment or deficits have been reported in these individuals. Among the most cited cognitive deficits stands out the executive function, that is very important for the organization macrostructural narrative and semantic and syntactic changes. The few studies on the discursive abilities of individuals with FASD which include the oral narrative have described the presence of deficits in both the macro and microstructural dimension of the narrative, including cohesion and coherence problems, significant deficits in the use of strategies pragmatic narrative and developing content with semantic concepts ambiguous, redundant and inconsistent. The analysis of the use of the structural components of story has often been used in research with individuals with language disorders and typically developing in search of information about the development of the narrative story schema by providing an important measure of narrative macrostructure. The aim of this study was to investigate macrostructures aspects in the oral narrative of individuals with FASD and compare to typical language development, taking account the presence of typical story grammar components. Participants were sixteen individuals with clinically confirmed by the FASD diagnostic tool 4-Digit Diagnostic Code, ten females and six males, aged between six and 16 years (M = 9.7 years). Typical language developments group was compound by sixteen individuals paired in gender and chronological age of FASD group. Oral narrative was elicited using a story generation task with the book Frog, where are you. Narratives sample were transcribed and coded considering the presence of story grammar components (scenario, theme, plot, solve problem, misadventures). The data obtained were analyzed using descriptive statistical procedures for analyzing the performance of the sample and nonparametric - Mann Whitney test for comparison of observed performance to their respective controls using the Statistical Package for Social Sciences - SPSS version 19. The results showed that individuals with FASD had lower scores compared to the control group, according to scores on the macrostructure, measuring the presence of typical elements of the narrative scheme of stories. The difference in results between the groups was statistically significant for the Global Score; this variable is the sum of all elements measured. The element with the highest score for individuals with FASD was the presence of scenario, with the lowest scores the presence of problem solving. Learner Outcomes: information about the main features of narrative schema history of individuals with FASD, as macrostructure aspects; have a comparative perspective of the typical and atypical development of the narrative schema history of individuals with FASD in compared to their peers of the same chronological age, regarding the macro-structure of the narrative; meet the quantitative methods of research macrostructure narrative oral history; know the range of variables described in diagnoses on FASD; understand the importance of developing tools for characterization of language deficit described this population as a tool for early diagnosis and effective therapeutic procedure; exchange information with researchers from different places for the results presented.
P093
INTERVENTION PROGRAM FOR DEVELOPMENT OF VERBAL COMMUNICATIVE SKILLS IN PARENTS OF CHILDREN WITH LANGUAGE DISORDERS BIANCA RODRIGUES LOPES GONALVES, NATHLIA BOCCA LOURENO MACHADO, CAMILA MAYUMI ABE, SIMONE APARECIDA LOPES-HERRERA BAURU SCHOOL OF DENTISTRY (FOB), UNIVERSITY OF SO PAULO (USP), BAURU, BRAZIL (1)
Abstract: Language disorders (LD) affect approximately 5-10% of children in pre-school. Due to the importance of the acquisition and development of language, both in the social environment as in education process, children with LD have a tendency to manifest deficits in these areas. However, these problems can be avoided if the difficulties are addressed in a systematic way by professionals and family. The main objective was to develop, implement and test the effectiveness of a language intervention program for development of verbal communicative skills in parents of children with language disorders. The secondary objective was to delineate the functional communicative profile of parents of children with LD before and after the intervention. Participants were 10 dyads of parents and children with LD, of both genders, 3-6 aged, patients at Clinic of Speech, Hearing and Language Pathology at Bauru School of Dentistry, University of So Paulo (FOB-USP), Brazil. This research was developed in 3 phases: Phase 1 survey of verbal communicative skills (VCS) in parents of children with LD (recordings of spontaneous interaction of parents and children), as pre-intervention; Phase 2 - planning and design of intervention program and all materials used (CD-ROM, DVD, manuals and videos) and Phase 3 - implementation of the intervention program, with conducting a new survey of VCS in those parents (post-intervention). In this program, we used theoretical and practical strategies, using theoretical materials (handouts) and practical activities with audio-visual resources (DVDs, CD-ROMS, videos) and strategies of video modeling, role-playing and practical activities that were implemented in the family environment. In data analysis, it was performed independent observation, for calculating concordance interobserver and comparative
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P092
MACROSTRUCTURE ASPECTS IN THE ORAL NARRATIVE OF INDIVIDUALS WITH FETAL ALCOHOL SPECTRUM DISORDERS GIULIA GANTHOUS (1) - NATALIA ROSSI (1) - CLIA GIACHETI (1) UNIVERSIDADE ESTADUAL PAULISTA - UNESP, CENTRO DE ESTUDOS DA EDUCAO E SADE - UNESP, MARLIA, BRAZIL (1)
Abstract: In the last two decades, few studies have been designed with the objective of characterizing the performance of narrative and distinct pathologies; describing peculiar characteristics in structuring stories from different variables and their influences on storytelling, as language speakers, neurological conditions, or auditory processing. The use of narrative task has proposed as an assessment tool to investigate the disturbances of oral language, both for expressive ability as receptive to. Therefore, authors have been comparing populations with specific diseases, and coursing with language disorders, with the normative population in order to contrast the differences
statistical analysis pre-intervention and post-intervention. The results show that there was an increase in the use of VCS from parents when compared pre-intervention and post intervention. In the pre-intervention, the mean of VCS use was 18,7 and, in the post-intervention, it was 30.1; the median in the pre-intervention was 18 and, in the post-intervention, was 28; the pre-intervention range was 17-20 VCS and, in the post-intervention, the range was 27-33 VCS. The comparison of the recording of the interaction of parents and children before and after the intervention showed a statistically significant difference. Thus, the intervention program with parents in the development of VCS showed how important is a parental involvement during the intervention process of their children, allowing parents to participate actively in speech-language intervention. This results show how and what activities can be carried out in intervention and in family environment in order to promote the improvement of verbal communicative skills in parents and in their children. Learner Outcomes: Know about how to develop a training program for development verbal communicative skills in parents of children with language disorders; Learn procedures to develop intervention programs with parents and verify the effectiveness of these programs.
P097
VOCAL COMPLAINTS AND QUALITY OF LIFE IN FEMALE TEACHING STUDENTS ELIANA FABRON (1) - MARINA LUDOVICO MASTRIA (2) SIMONE FIUZA REGAONE (1) - SUELY MAYUMI MOTONAGA (1) - LUCIANA TAVARES SEBASTIO (1) UNIVERSIDADE ESTADUAL PAULISTA JLIO DE MESQUITA FILHO, UNIVERSITY, MARLIA, BRAZIL (1) - FACULDADE DE MEDICINA DE SO JOS DO RIO PRETO - FAMERP/ HOSPITAL DE BASE, UNIVERSITY, SO JOS DO RIO PRETO, BRAZIL (2)
Abstract: Literature has been showing how important are the studies and orientations concerning teacherss vocal health, while they are students, leading to prevention of vocal disturbs. the main aim of this study was to investigate the impact caused by the beginning of teaching activities on Teaching students, and the specific aims were: a) to compare the selfperception of vocal alteration and vocal complaints among first and last year students; b) to compare the results of a protocol of self-assessment of the life quality related to voice among these students; c) to investigate the relation between the vocal complaints and self-reported vocal problems; d) to verify the relation between the results of self-perception of vocal problems and the results of protocol of self- assessment of the life quality related to voice. The study included 89 students of a Pedagogy College, being 47 students of the first year (G1) and 42 of the fourth year (G2). Initially was applied a questionnaire to collect identification data, information on vocal complaints and general health of each participant. The students should answer whether they perceived that they had a vocal problem and then they should answer closed questions related to voice complaints. The PPAV protocol was used. The PPAV presents a total of 28 questions with one question that is related to self-perceived severity of voice problem, four questions are related to effect on job, twelve questions are related to effect on daily communication, four, related to effect on social communication and seven questions related to effect on emotions. The Teaching students were asked if they had any vocal problem and 51,10% of G1 and 64,3% of G2, answered affirmatively, however there was no statistically significant difference (p = 0,208). Questionnaire analysis showed an increase in amount and kind of voice complaint pointed out by the students in the last year of course. The first year students reported pain in the neck (61.7%); sore throat (61.7%); roughness (61.9%); nape tension (52,4%) and the last year students reported vocal fatigue (71.4%); pain in the neck (51.7%); effort to speak (51.7%); sore throat (81%); nape tension (52.4%); and voice variations through the day (59.5%). When we compared the results of the domains of PPAV among students of G1 and G2, we noted equality between the two groups of students in relation to self-perception of the effect of voice in his life (p> 0.05). The value found in G1 and G2 for total, presented an average of 17.8 and of 24.6 points. Whereas the two groups of students did not differ on the responses of VAPP, the relationship between self-perception and vocal problem was calculated together, found a positive correlation in all areas of PPAV and perception of vocal problem (p <0.001). The student who indicated some vocal problem also presented higher values in the results of PPAV. According to our data, some students related to have problems with their voice and presented vocal complaints, however those do not cause a great impact on their quality of life. Learner Outcomes: discuss about vocal complaints and quality of life of Teaching students; know about the impact of early learning activities in internships at the end of graduation; discuss the importance of studying teachers voice before starting his job.
P094
DYSPHONIA: EVALUATION OF CASE HISTORY MICHELE BARBARA (1) - TERESA MAINO (2) OTORINOLARINGOIATRIA, OSPEDALE DIMICCOLI, BARLETTA (BT), ITALY (1) - OTORINOLARINGOIATRIA, AZ OSP.-UNIV POLICLINICO, BARI, ITALY (2)
P095
PERCEPTUAL AND ACOUSTIC VOICE CHARACTERISTICS FOLLOWING BOTULINUM TOXIN TREATMENT: A CASE STUDY JAYANTI RAY (1) DEPT OF COMMUNICATION DISORDERS, SOUTHEAST MISSOURI STATE UNIVERSITY, CAPE GIRARDEAU, UNITED STATES (1)
Abstract: The purpose of this study was to investigate changes in acoustic and perceptual features of voice across a period of 12 weeks following Botulinum Toxin injections in a client with a diagnosis of Spasmodic Dysphonia with Torticollis. The primary objective of this study was to collect voice samples on a weekly basis and analyze them using both acoustic and perceptual parameters. Although, the results did not show any significant difference between voice samples obtained during pre and post-botox injections, future research is suggested to explore the long-term effects of botox injections on voice and quality of life of persons with spasmodic dysphonia. Learner Outcomes: Describe the effects of Botox on voice of a client with adductor spasmodic dysphonia; Compare acoustic and perceptual characteristics of post-Botox voice samples collected over a period of 12 weeks; Identify the clients self-perception of vocal quality after Botox injections.
P096
THE STUDY OF THE VOICE THERAPY IN OUR DEPARTMENT ERI MIYATA (1) - MAKOTO MIYAMOTO (1) - KOICHI TOMODA (1) DEPARTMENT OF OTORHINOLARYNGOLOGY-HEAD & NECK SURGERY, KANSAI MEDICAL UNIVERSITY, HIRAKATA, JAPAN (1)
Abstract: Voice therapy is a preferred treatment for voice problems. Voice problems often necessitate voice therapy in order to change the method of vocal mechanism. We analyzed the factor of patient who the voice therapy could not be completed such dropout cases. We examined 271 patients with voice problem for about 2 years in our department. Out of 271 patients, 101 patients had performed only the voice therapy. Subjects were 56 male and 45 female, aged from 18 to 85 years (average 60.9). Most of the laryngeal diseases consist of sulcus vocalis and vocal cord atrophy, unilateral vocal fold paralysis, functional vocal cord disorders. Out of 101 patients treated with voice therapy by the speech therapist, 48 were completed a therapy and 29 were dropout. The average period of voice therapy completion was 4.2 months, average time was 7.5. While in the case of dropout, the average period of voice therapy dropout was 2.5 months, and average time was 2.5. There was a strong association between the period and times of voice therapy in the group of completed and dropout. Learner Outcomes: to know the turning point of voice therapy for voice problems
P098
QUALITY OF LIFE, ACOUSTIC AND PERCEPTUAL ANALYSIS OF VOICE IN PARTIAL LARYNGECTOMY IARA BITTANTE DE OLIVEIRA OLIVEIRA (1) - JOSE FRANCISCO SALLES CHAGAS CHAGAS (1) - ELAINE PAVAN GAGARTINI GARGANTINI (1) - ELIANE DOS SANTOS FERNANDEZ FERNANDEZ (1) PONTIFCIA UNIVERSIDADE CATLICA DE CAMPINAS, HOSPITAL E MATERNIDADE CELSO PIERRO, CAMPINAS, BRAZIL (1)
Abstract: Vertical partial laryngectomies knowingly result in voice disorders which may cause impacton quality of life. Aim: outlining a voice profile of individuals with organic dysphonia due to partial laryngectomy (PL), by investigating the self-perception of voice and global health, the impact of the dysphonia on quality of life (QOL), and the perceptual and acoustic analysis of voice. Method: 15 male subjects, mean age of 61 years old, with organic dysphonia were studied; all subjects underwent PL. Perceptual analysis of voice was conducted double-blind using the GRBASI scale. The acoustic analysis considered the following parameters: fundamental frequency, jitter and shimmer, harmonic-to-noise ratio, and phonatory deviation diagram using the software VOXMETRIA. In order to analyze the impact of the dysphonia on subjects` quality of life, the following instruments were used: Voice related quality of life V-RQOL, Voice Activity and Participation Profile VAPP, Voice Handicap Index - VHI. The protocol Health-Related Quality
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of Life - SF 36 was used to measure health conditions influencing quality of life after surgery. Aspects of self-assessment of voice, perception of severity and global health were compared to a control group of 15 subjects without vocal complaints, matching age, gender and education level. Results: subjects with partial laryngectomy assessed their voices from bad to good through the V-RQOL, while the control group evaluated from reasonable to excellent. The acoustic analysis f0 of voices varied between 91,59 Hz and 182,79 Hz, with altered measures of shimmer and/or jitter, agreeing with results of the perceptual analysis which revealed voices with a global degree of deviation from moderate to intense, despite the majority of subjects having qualified their voices as good or reasonable (85,5%). Nevertheless, the V-RQOL demonstrated 56,9% of gross scores compatible with dysphonic voices. The VHI showed predominance of the organic domain impacting on QOL. Conclusion: the degree of vocal deviation of subjects was from moderate to intense corroborating the acoustic parameters which were highly altered. However, subjects classified their voices as reasonable or good. Results suggest some kind of resignification of the concept of quality of life by the subjects of this study, that facing the diagnosis of laryngeal cancer and the submission to a mutilating surgery, tend to have a better self-perception of voice related QOL in comparison to other types of functional or organicfunctional dysphonia. Subjects presented scores not always compatible with their actual condition in the different instruments used. Learner Outcomes: The congress member who reads this article (poster) will be able to learn about: how subjects with partial laryngectomy assessed their voices in comparison to subjects without vocal complaints, control group; self-perception of voice related QOL from a group of subjects that were underwent partial laryngectomy by observing results of some protocols as: Voice related quality of life (V-RQOL), Voice Activity and Participation Profile (VAPP), Voice Handicap Index (VHI) and Health-Related Quality of Life SF 36 questionnaire.
completed by 33 patients. The quality esophageal voice after education is used by 10 patients, i.e. 23% of those who began the regular care Learner Outcomes: The participants will be able to find the effectiveness of educational care in oesophageal voice training
P101
LENGTH OF PAUSES IN PROSODIC LIMITS IN THEATRICAL ACTING MILENA FRAGA (1) FACULDADE DE FILOSOFIA E CINCIAS, UNIVERSIDADE ESTADUAL PAULISTA JULIO DE MESQUITA FILHO (UNESP), MARLIA, BRAZIL (1)
Abstract: In literature toward to the work with voice in theater actors we can find, centrally, studies with organic issues involved in vocal process, as illuse or voice abuse. To a lesser extent we find work that contrast issues about interpretation and expressive resources, as than few that contrast the linguistic resources of interpretation. This study points, rightly, a linguistic resource the pause and its collaboration to acting. The aim of the study is to verify in what the extent the length of pauses strengthen the Prosodic Hierarchy, considering utterance (U) and intonational phrase (I). For this study were used four recordings of actors (A1; A2; A3; A4), two men and two women, belonging to a database of the research group Grupo de Pesquisa Estudos sobre a Linguagem (GPEL/CNPq). The actors interpreted, freely, the same part of one theatrical text, previously memorized, without knowing the research proposal. The recordings were done, individually, inside a room with acoustic treatment. Thereafter, ten judges heard and selected the locations that were judged occur pauses, with criterion of agreement with a minimum of 70% of coincidence of judgment. Was accomplished too the metering of the V_V units (vowel-vowel) in which there were the occurrence of pause perceived by judges, through the acoustic analysis with the software Praat. Were calculated too measures of central tendency and dispersion of the values of these V_V units length, in seconds, for limits of U and I in interpretations. An independent samples T-Test was apply to compare the length of V_V units in U and I. We adopted a significance level of 0.05. Learner Outcomes: This research can raise elements to deepen the dialogue between different knowledge fields. They are also expected theoretical and practical contributions to the speech therapy with actors and even for the work of actors preparation
P099
ANALYSIS OF THE VOCAL RESISTANCE OF CHOIR SINGERS BY MEANS OF VOICE SELF-PERCEPTION BEFORE AND AFTER CONTINUOUS SINGING FERNANDA ONOFRE ONOFRE (1) - EDWIN TAMASHIRO (2) MARIA YUKA ALMEIDA PRADO (3) - HILTON MARCOS ALVES RICZ (1) - LILIAN NETO AGUIARRICZ (1) DEPARTMENT OF OPHTHALMOLOGY, OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY, UNIVERSITY OF SO PAULO, RIBEIRAO PRETO, BRAZIL (1) - DEPARTMENT OF OPHTHALMOLOGY, OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY, UNIVERSITY OF SO PAULO, RIBEIRO PRETO, BRAZIL (2) - DEPARTMENT OF MUSIC OF THE SCHOOL OF PHILOSOPHY, SCIENCES AND LETTERS OF RIBEIRO PRETO, UNIVERSITY OF SO PAULO, RIBEIRAO PRETO, BRAZIL (3)
Abstract: Singers who continuously use their voice and perceive changes in it usually report vocal fatigue as a reduction of the ability to project and sustain their voice, a reduction of vocal potency, hoarseness and effort for voice production. The objective of the present study was to analyze comparatively the voice of choir singers before and after a 60 minute period of continuous singing by means of perceptive-tactile kinesthesic and auditory voice self-evaluation. The study was conducted on 10 female choir singers aged 18 to 35 years (mean: 25.3 years) with experience of at least one year in choir singing. Self-evaluation of the level of effort was performed before and after the continuous singing test using a visual-analogue scale. Nine participants concluded the test of one hour duration and one of them gave up after 45 minutes, stating that she felt excessively tired, with signs of vocal fatigue. At the end of the continuous singing test the participants reported an increased sensation of hoarseness, a more acute pitch, a voice of strong intensity, a voice of weak intensity, voice breaks, effort to talk, laryngeal constriction to talk, fatigue talking, throat dryness, pain when swallowing saliva, increased throat clearing, and other symptoms. The most important of the latter was breathiness, with these parameters demonstrating a difference between the pre-test and post-test periods. In contrast, the symptoms related to a sensation of aphonia, pain in the neck, pain in the shoulders, grave pitch, reduced projection, neck tension, shoulder tension, sore throat, burning throat and cough did not differ between periods. Learner Outcomes: The participant will learn the results of the analysis of vocal resistance of choir singers by means of voice self-perception before and after continuous singing.
P102
THE OLFACTORY AND GUSTATORY FUNCTIONS HAD BEEN DECREASED IN LARYNGECTOMYSED. ADA SALVETTI CAVALCANTI CALDAS (1) - VERA LCIA DUTRA FACUNDES (1) - DANIELE ANDRADE CUNHA (1) - PATRCIA MARIA MENDES BALATA (1) - LEILA BASTOS LEAL (1) LUCIANA NGELO BEZERRA (1) - HILTON JUSTINO SILVA (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND ALLERGY/IMMUNOLOGY AMBULATORY, RECIFE, BRASILE (1)
Abstract: Introduction: After a total laryngectomy surgery, nasal airflow is definitely transferred for the tracheostoma, compromising the arrival of odorant molecules into the nasal cavity, which may reflect changes in olfactory and gustatory perception in these individuals. Objective: To evaluate the functions of smell and taste in laryngectomized individuals. Study Design: Case series type. Materials and Methods: The sample included a group of 25 patients who underwent total laryngectomy and another group of 25 patients compared to normal rinologicamente. The function was assessed through gustatory buds strips of filter paper. For assessment of olfactory function test was applied Brief Smell Identification Test. Results: In the group of laryngectomized hypogeusia frequency was higher (80%, p <0.05), as well as hyposmia (88%, p <0.001). Furthermore, this group showed a higher incidence of hyposmia and hypogeusia concomitantly (72%, p <0.001). Conclusion: The decrease in olfactory function and gustatory in laryngectomized was evidenced in this study. In discriminating tastes the bitter taste did not differ between groups at the expense of other flavors. In the olfactory aspect, the laryngectomized had worse performance in detecting odors and alert related to food. Learner Outcomes: Learning about olfactory function in laryngectomysed; How to evaluate the olfactory function in total laryngectomy; Learning about gustatory function in laryngectomysed; How to evaluate the gustatory function in total laryngectomy
P100
RESULTS OF ESOPHAGEAL VOICE TRAINING LIBOR CERNY (1) PHONIATRIC DEPT. OF THE 1ST MEDICAL FACULTY, CHARLES UNIVERSITY, PRAGUE, CZECH REPUBLIC (1)
Abstract: The author presents the results of a complete group of 56 patients after total laryngectomy having been in our care in the period of 2008 2013. Regular education care was attended by 43 patients, 8 women and 35 men in mean age 60,2 years. The whole education process was
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ALTERNATIVE TONGUE MOTION (ATM) AS A DIAGNOSTIC TOOL FOR MUSCLE TENSION DYSPHONIA (MTD) OSAMU SHIROMOTO (1) - MIKA TAKAHASHI (2) - TOSHIHIDE HARADA (3) DEPT.OF COMMUNICATION SCIENCES AND DISORDERS, PREFECTURAL UNIVERSITY OF HIROSHIMA, MIHARA, JAPAN (1) - DEPT.OF COMMUNICATION SCIENCES AND DISORDERS, PREFECTURAL UNIVERSITY OF HIROSHIMA, MIHARA, JAPAN (2) - FACULTY OF HEALTH AND WELFARE, PREFECTURAL UNIVERSITY OF HIROSHIMA, MIHARA, JAPAN (3)
Abstract: [Background] We have attempted to develop a clinical diagnostic tool of Muscle Tension Dysphonia (MTD) using alternative tongue motion (ATM). ATM in individuals with MTD is of interest because individuals with MTD tend to restrict motions of the tongue and have tension in the extralaryngeal muscles. Additionally, clinical observation suggests that the degree of tension may be influenced by the presence or absence of phonation during ATM. We examined if 1) the rate of ATM and muscle activity during ATM in individuals with MTD are different from those in normal speakers, and 2) the rate of ATM and muscle activity during ATM without phonation is different from that with phonation. [Participants] Five young healthy male volunteers( mean age 20 1.2 yr.) and 8 young healthy female volunteers (mean age 238.1 yr.) participated in this study as a normal group, and 2 male MTD patients (mean age 31.57.8 yr.) and 4 female MTD patients(mean age 31.37 yr.)as a MTD group. Normal health status was confirmed by medical history. None of the normal participants reported history of voice problems. [Measurement] STCL (Stress Tolerance Check List) was administered to all participants as a measure of subjective stress. There was no significant difference between two groups. The heart rate was measured as an index of autonomic nervous system function during ATM task. There was no significant difference between two groups. We used surface electromyography (SEMG) of the submental muscles to investigate stressor-evoked changes in extralaryngeal muscles activities. All recording were scaled with respect to 100% maximum voluntary contraction (MVC) measured by each electrocode. [Results] No significant differences were found during Japanese vowel phonation between the two groups in the submental SEMG. There were significant differences between the two groups in SEMG during ATM (forward and backward) with phonation and ATM (right and left) without phonation. In the rate of ATM, there were significant differences with phonation between the two groups during (right and left, forward and backward), but no significant differences were found without phonation. [Conclusions] MTD patients show slower rates of ATM with phonation compared to normal participants. SEMG activity of submental muscles showed more increase with phonation during ATM (forward and backward) than normal participants. The results suggest the possibility that ATM can be used as a diagnostic tool for MTD. Learner Outcomes: To determine if the rate of ATM and muscle activity during ATM in individuals with MTD are different from those in normal speakers; To determine if the rate of ATM and the muscle activity during ATM without phonation is different from that with phonation
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AN EVALUATION OF SINGLE BREATH PHONATION TIME TESTING AS AN INDICATOR OF VOCAL FUNCTION IN SPEECH TOMOYUKI HAJI (1) DEPARTMENT OF OTOLARYNGOLOGY, KURASHIKI CENTRAL HOSPITAL, KURASHIKI, JAPAN (1)
Abstract: In order to evaluate phonation time during natural speech we measured the phonation time of patients while they counted numbers in Japanese in a single breath. The phonation time was measured from the commencement of the test until the first breath was taken, which we termed the single breath phonation time (SBPT). We then compared these results to evaluate any correlation with MPT and respiratory function to determine the efficacy of this method. 28 healthy control subjects (14 males and 14 females) and 45 subjects with laryngeal lesions (predominately unilateral recurrent laryngeal nerve palsy) were enrolled in the study. Based on the results of our study, SBPT testing was useful in evaluating vocal function during speech. Furthermore, our results indicated that MPT test results of less than ten seconds largely affected phonation in speech by excessive intake of breath, whereas MPT test results more than ten seconds affected little in speech and also indicated that tidal volume had a larger effect on phonation in speech compared to vital capacity. Learner Outcomes: What is single breath phonation time and how it is measured; The relationship between SBPT and MPT; The relationship between SBMT and respiratory function.
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COENZYME Q10 TERCLATRATE + VITAMINE A IN THE TREATMENT OF FUNCTIONAL VOICE DISORDERS GIANCARLO PECORARI (1) - JURI NADALIN (1) - LUCA RAIMONDO (1) - GIUSEPPE RIVA (1) - MATTEO SENSINI (1) - ANNA ACCORNERO (1) - AGOSTINO SERRA (2) - LUIGI MAIOLINO (2) - MASSIMO MAGNANI (3) - ANDREA RICCI MACCARINI (3) - PASQUALE CASSANO (4) - LUCIANO MAGALDI (4) - CLAUDIO VICINI (5) - ALDO CAMPANINI (5) - GIORGIO PERETTI (6) - RENZO MORA (6) - CARLO ANTONIO LEONE (7) - ANGELO CAMAIONI (8) - VALERIO DAMIANI (8) - GAETANO PALUDETTI (9) - LUCIA DALATRI (9) - MARCO DE VINCENTIIS (10) - ANTONIO GRECO (10) - GIOVANNI RUOPPOLO (10) CARLO GIORDANO (1) 1ST ENT DIVISION, UNIVERSITY OF TORINO, TORINO, ITALY (1) - ENT DIVISION, UNIVERSITY OF CATANIA, CATANIA, ITALY (2) - ENT DIVISION, OSPEDALE BUFALINI DI CESENA, CESENA, ITALY (3) - ENT DIVISION, UNIVERSITY OF FOGGIA, FOGGIA, ITALY (4) - ENT DIVISION, OSPEDALE MORGAGNI PIERANTONI DI FORL, FORL, ITALY (5) - ENT DIVISION, UNIVERSITY OF GENOVA, GENOVA, ITALY (6) - ENT DIVISION, A.O. COLLI-MONALDI DI NAPOLI, NAPOLI, ITALY (7) - ENT DIVISION, OSPEDALE SAN GIOVANNI DI ROMA, ROMA, ITALY (8) - ENT DIVISION, UNIVERSIT CATTOLICA SACRO CUORE DI ROMA, ROMA, ITALY (9) - ENT DIVISION, SAPIENZA UNIVERSIT DI ROMA, ROMA, ITALY (10)
Abstract: Aim of this study was to evaluate the effectiveness of Coenzyme Q10-Ter and Vitamin A in functional voice disorders. One hundred and seventy-one patients were treated with CoQ10-ter and vitamin A twice a day for twenty days. A general otolaryngological/foniatric and logopedic examination were performed by means of physical examination, videolaringostroboscopy, GIRBAS scale, Voice Handicap Index questionnaire, MultiDimensional Voice analysis and Maximum Phonation Time (MPT) were performed before treatment, after 20 days from the beginning and 20 days from the suspension. In all patients an improvement was observed in almost all parameters considered after treatment. In conclusion The proposed therapy increases vocal performance allowing a good recovery of vocal fold tension. Coenzyme Q-Ter and Vitamin A resulted effective in treatment of patients with functional voice disorders (caused by vocal malmenage or surmenage), supporting repairing processes, increasing bioavailability of main nutrients necessary for vocal fold function and providing a good durability after treatment suspension.
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VOICE REHABILITATION OF PATIENTS WITH LARYNX BENIGN DISEASES IN COMBINATION WITH LARYNGOPGARYNGEAL REFLUX EKATERINA OSIPENKO (1) - MARINA GERASIMENKO (2) NATALIA DERZHAVINA (1) - NINA LAZARENKO (2) FEDERAL RESEARCH CLINICAL CENTRE OF OTORHINOLARYNGOLOGY OF RUSSIAN FEDERATION MINISTRY OF PUBLIC HEALTH, PHONIATRICS DEPARTMENT WITH LABORATORY OF A VOCAL AND SCENIC VOICE, MOSCOW, RUSSIAN FEDERATION (1) - MOSCOW REGIONAL RESEARCH CLINICAL INSTITUTE NAMED AFTER MF VLADIMIRSKY, PHYSICAL THERAPY AND REHABILITATION DEPARTMENT, MOSCOW, RUSSIAN FEDERATION (2)
Abstract: Voice incidence of people with voice speech professions is rather high and has no tendency to be reduced. Various authors note an increase in the voice incidence of teachers from 3040% in 3060ies of the last century up to 5560% at the end of 90ies years. Very important is the fact that larynx tumors are often diagnosed for non-smoking patients, the patients experiencing voice loads due to their professional activity. Among the most important ecological factors providing formation of the larynx pathological process most researchers name the laryngopharyngeal reflux (LPR). The research objective is: to improve efficiency of voice professionals with voice pathologies under the diagnosed LPR. We have offered an efficient complex method to rehabilitate voice professionals after resection of larynx tumors under LPR, including the use of drug therapy and physiotherapy. In this work we present results achieved by us during examination and treatment of 37 patients suffering benign larynx tumors accompanied by LPR. Learner Outcomes: know the technique of therapy of laryngopharyngeal reflux preparations of group of inhibitors of a protonew pomp in combination with intralaringealny low-intensive laser influence.
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P107
VOCAL PROFILE AND QUALITY OF LIFE AND VOICE IN PATIENTS SUBMITTED TO RADIOTHERAPY FOR ADVANCED HEAD AND NECK CANCER ALINE GONALVES (1) - ELISABETE CARRARA DE- ANGELIS (2) - RAFAELA TOSCANO (3) - CSSIO PELLIZZON (2) - CELSO MELLO (2) - LUIS PAULO KOWALSKI (2) - LUCIANA DALL AGNOL (2) - RENATA AZEVEDO (3) - FERNANDO LEONHARDT (3) - MARCIO ABRAHO (3) FUNDAO ANTNIO PRUDENTE -HOSPITAL A.C.CAMARGO, HOSPITAL A.C.CAMARGO, SO PAULO, BRAZIL (1) - FUNDAO ANTNIO PRUDENTE - HOSPITAL A.C.CAMARGO, HOSPITAL A.C.CAMARGO, SO PAULO, BRAZIL (2) - UNIVERSIDADE FEDERAL DE SO PAULO - UNIFESP, UNIVERSIDADE FEDERAL DE SO PAULO - UNIFESP, SO PAULO, BRAZIL (3)
Abstract: Introduction: Voice disorders are actually of major interest after radiotherapy for early glottic cancer. Although the larynx may not be the primary site of irradiation, radiotherapy of the head and neck region may result in voice disorders. Objective: The aim of this study is to analyze the vocal quality and quality of life of patients submitted to radiotherapy for advanced squamous cell carcinomas of the oropharynx, larynx and hypopharynx. Study design: A prospective cross-sectional cohort, multi institutional study. Setting: A tertiary cancer hospital and a tertiary university hospital. Methods: Inclusion criteria: patients older than 18 years-old; with advanced head and neck cancer (Stages III and IV) of oropharynx, larynx and hypopharynx; radiotherapy treatment (exclusive or concurrent chemotherapy); with vocal complaints after radiotherapy. Exclusion criteria: patients submitted to previous head and neck surgery; severe dysphagia; collagen diseases; head and neck tumor in activity after treatment; and neurological disorders. Assessment of the voice outcomes was performed one month after treatment. The auditoryperceptive analysis (GRBASI scale, maximum phonation time, loudness and pitch), acoustic evaluation (Multi Dimensional Voice Program - MDVP by Kay Elemetrics Corp, Lincoln Park, NJ) and the Voice Handicap Index questionnaire (VHI) were used in the study. Results: Twenty-five patients were enrolled. Eighteen patients (72%) were male and 7 (28%) female. The mean age was 55 years. Primary site: Larynx 12 (48%), oropharynx 10 (40%) and hypopharynx 3 (12%). Roughness was the main complaint in 21 (84%) of patients. The vocal evaluation presented moderate roughness in 12 (48%) patients, slight instability in 15 (60%) and slight breathness in 9(36%). The mean maximum phonation time was of 10,5 seconds, low pitch in 12 (48%) and weak loudness in 17(68%). The acoustic parameters were increased to Jitter, Shimmer, VTI, vFo, NHR, vAm e PPQ. The VHI showed physical, functional and organic disability in all patients after treatment. Conclusion: Patients with advanced squamous cell carcinomas of the oropharynx, hypopharynx and larynx presents moderate vocal complaints and impairment in quality of life and voice after radiotherapy. Speech therapy is required for rehabilitation after radiotherapy treatment. Learner Outcomes: Assessment of the vocal quality of patients submitted to radiotherapy for advanced squamous cell carcinoma of the oropharynx, larynx and hypopharynx; Assessment of the quality of life and voice of these patients.
after the therapy an improvement of social communication and total score was observed. This group also showed impairment in the self-perception of voice disturbance comparing the mean scores before and after the therapy. In the group who abandoned the therapy its was observed an impairment in the work parameters, social communication and total score comparing the mean scores before and after therapy. Both groups showed differences in all evaluated parameters when the questionnaires were applied, showing a negative impact in the quality of life in the group who did not completed the therapy. Conclusions: The speech therapy for dysphonic female teachers affects positively in the quality of life immediately after the therapy and in a mean of two years of follow up. In dysphonic female teachers who did not completed the treatment the negative impact in the quality of life worsens in a mean of two years of follow up. Learner Outcomes: Comprehend the impact in the quality of life related to the voice in dysphonic female teachers; Asses the results of the speech therapy in the quality of life in teachers who completed the therapy; Comprehend the impact in the quality of life in teachers who did not complete the speech therapy; Perceive the impact in the quality of life related to the voice in dysphonic female teachers after the therapy, the quality of life of voice who abandoned the therapy after two years of follow up.
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COMPARISON OF NASALANCE BETWEEN TOTAL LARYNGECTOMEES WHO USE A TRACHEOESOPHAGEAL PROSTHESIS AND HEALTHY INDIVIDUALS LLIAN NETO AGUIAR-RICZ (1) - ADRIANA PEREIRA DEFINA IQUEDA (1) - TELMA KIOKO TAKESHITA-MONARETTI (1) HILTON MARCOS ALVES RICZ (1) SCHOOL OF MEDICINE OF RIBEIRAO PRETO, UNIVERSITY OF SAO PAULO, RIBEIRO PRETO, BRAZIL (1)
Abstract: Total laryngectomy results in the loss of the sound source and rehabilitation with tracheoesophageal voice and the use of a phonatory prosthesis has been widely used because of its satisfactory results and the rapid rehabilitation obtained. Tracheoesophageal voice uses the esophagus, the pharyngoesophageal transition and the pharynx for sound production, although the mechanisms of vocal resonance using the oropharynx and rhinopharynx are preserved for vocal production. However, there is no information about the interference of the rhinopharynx with the production of tracheoesophageal voice. For this reason, the objective of the present study was to determine the nasalance values of the tracheoesophageal voice and speech of total laryngectomees using a prosthesis (study group) and speaking Brazilian Portuguese and to compare them to laryngeal speakers (control groups). The study was conducted on 25 total laryngectomees using a tracheoesophageal prosthesis, 20 men and five women aged 52 to 82 years (mean: 61 years and five months). The control group consisted of 40 volunteers, 28 men and 12 women aged 44 to 80 years (mean: 61 years and nine months). All participants were submitted to nasovideoendoscopic examination for anatomofunctional evaluation of the rhinopharynx and the velopharyngeal mechanism and for objective evaluation of nasalance using a nasometer. The speech sample consisted of oral and nasal sentences standardized for Brazilian Portuguese. The results revealed that nasalance did not differ between groups (p = 0.13) during the emission of oral sentences. However, for the nasal sentences, the laryngectomees demonstrated greater nsalance (p = 0.001). The sensitivity of nasalance in identifying total laryngectomees during the emission of nasal sentences was 80% and specificity was 72.5%, with a cut-off value stipulated at 54.5%. For the oral sentences, for a cut-off value of 19.5%, sensitivity was 36% and specificity 80%. We conclude that total laryngectomees have more nasalance, supporting the idea that the impedance of the remaining vocal tract after laryngectomy does not prevent the presence of nasal and oral acoustic energy for the production of the respective sounds. Learner Outcomes: By means of this study, the intention is to collaborate with researchers and clinicians interested in the area of rehabilitation of total laryngectomees regarding: - knowledge of nasalance for nasal and oral sentences of the speech of total laryngectomees who use a tracheoesophageal prosthesis;- to help establish normative values of nasalance for total laryngectomees who use a speech prosthesis in order to favor clinical phoaudiologic evaluation
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ANALISYS QUALITY OF LIFE AFTER VOICE THERAPY: A LOGITUDINAL STUDY ANA CRISTINA CRTES GAMA, JOSIANE MENDES FERREIRA, NATHLIA FERREIRA CAMPOS, IARA BARRETO BASSI, LETCIA CALDAS TEIXEIRA, MARCO AURLIO ROCHA SANTOS (BRAZIL)
Abstract: Introduction: The study of the quality of life is been used to evaluate physical and psychosocial disabilities in humans. In health care the improvement of the quality of life should be the final result after a treatment. Recently the voice of teachers is receiving more attention from Speech-Language Pathologists, due to the evidences that these professionals are in risk of voice abnormalities related to vocal abuse, impairing their quality of life. Vocal therapy can ameliorate this problem since many vocal users like teachers show goods results with speech therapy. After the end of the therapy it is important to the patients to keep the vocal pattern obtained in order to maintain their social and professional use of the voice. Objective: Evaluate the long term results of the speech therapy in the quality of life of female teachers after the treatment compared with those who abandoned the therapy for dysphonia. Methods: longitudinal study comparing the results of the speech therapy of teachers of public schools in Belo Horizonte with dysphonia with the results of a group of teachers who abandoned the speech therapy, at least six months. 33 female teachers who completed the therapy and 20 teachers that abandoned the treatment were contacted by phone calls and invited answer the Vocal Activities Participation Profile (VAPP) sent by mail. The VAPP is a self- assessment survey based on 28 questions comprising the following parameters: self -perception of the voice quality disturbance, effects of the disturbance in daily communication, social communication and their emotions. The VAPP was selected to this study because it is easy to apply and gives a great description of the functional impairment. Results: In the group who completed the therapy before and
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CHAOS THEORY AND NONLINEAR ACOUSTIC ANALYSIS: ARTICLES REVIEW RENATA FURIA (1) UNIVERSITY OF SO PAULO, DEPARTMENT OF BIOENGINEERING AT UNIVERSITY, SO CARLOS, BRAZIL (1)
Abstract: Acoustic Analysis has proved a useful tool to provide objective measures and quantify vocal features. Traditionally, most programs for voice acoustic analysis uses linear calculation, as Transform Fourier. However, currently, studies have investigated nonlinear methods application for voice acoustic analysis. These studies have shown that nonlinear dynamic methods can contribute significantly to understand chaos in voice and its relationship with instabilities and vocal disorders. Different methods have
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been used to nonlinear acoustic analysis, but it is necessary to survey which methods are most used until now. The objective of this study is to review scientific literature about vocal acoustic analysis by nonlinear dynamic methods and identify the main methods used so far. We used the PubMed database to perform the search for papers. We used for search the following descriptors: analysis, nonlinear, voice. And they were surveyed simultaneously (analysis and nonlinear and voice) in all fields. Limits were set to only return articles in English and in humans. The search returned 73 papers. Of these 73 papers, 44 abstracts report the use of nonlinear acoustic analysis methods and were selected for analysis. After papers analysis it was found that: 5 studies (11.4%) analyzed only normal voices, 14 studies (31.8%) analyzed only pathological voices, and 25 studies (56.8%) analyzed both normal and pathological voices. The nonlinear acoustic analysis methods most commonly cited were: correlation dimension (present in 24 studies), entropy (present in 14 studies), Lyapunovs exponents (present in 9 studies), phase space reconstruction (present in 6 studies), and fractal analysis (present in 4 studies) which correspond respectively to 54.5%, 31.8%, 20.5%, 13.6%, e 9.1%. Other methods of nonlinear acoustic analysis were reported singly in eight studies. Based on these findings, we can identify three main research lines into methods for nonlinear acoustic analysis for human voice: correlation dimension, entropy and Lyapunovs exponents. Correlation dimension is a geometric measure that describes correlation strength between two points on the trajectory in phase space. Entropy calculates the rate of loss of data about the state of a dynamic system over the time. And Lyapunovs exponents measure the average exponential divergence or convergence of nearby orbits in phase space. Nonlinear acoustic analysis methods have shown promising because they provide non redundant information about voice signal, which may contribute to clinical practice, especially in the diagnosis of pathological voices. Learner Outcomes: Know new methods for voice acoustic analysis; Identify main research lines into methods for nonlinear acoustic analysis for human voice; Realize the importance of this new method to complement the acoustic analysis of voice
-44 years of age) of Largest angle between the left and right of the vocal process was 5.6 1.8 .Swing angle of the right vocal process is 8.6 2.1 , the left side was 7.2 1.5 .Shows the results of vocal nodule group (eight female, 22 -58 years of age) of Largest angle between the left and right of the vocal process was 17.0 7.9 .Swing angle of the right vocal process is 13.0 5.6 , the left side was 11.0 4.3 .Angle of vocal nodules showed a larger value than that of the normal vocal cord. Vocal nodules (3 female ,27 -57 years old) conducted a four-week training voice. As a result, they are healed nodules. Largest angle between the left and right vocal process of time before training was 25.0 14.7 .Swing angle of the right vocal process is 17.0 8.5 , the left side was 11.0 4.3 . After training the largest angle between the left and right vocal process was 11.0 4.6 . Swing angle of the right vocal process is 5.6 3.7 , the left side was 4.0 1.0 . Each angle was reduced by training. In the pathogenesis of vocal nodules, I think the angle of the vocal process is very deep relationship. Learner Outcomes: know the epidemiology of vocal nodules ; To understand the new evaluation method of high-speed video of the vocal cords; You can check for the difference between normal larynx and vocal nodules vocal process, especially with a focus on style movement of the vocal cords; Understand changes in vocal fold movement by voice training.
P114
ALTERNATIVE TONGUE MOTION (ATM) AS A DIAGNOSTIC TOOL FOR MUSCLE TENSION DYSPHONIA OSAMU SHIROMOTO (1) - MIKA TAKAHASHI (2) - TOSHIHIDE HARADA (1) FACULTY OF HEALTH AND WELFARE, PREFECTURAL UNIVERSITY OF HIROSHIMA, MIHARA, JAPAN (1) - FACULTY OF HEALTH AND WELFARE, PREFECTURAL UNIVERSITY OF HIROSHIMA, MIHARA, JAPAN (2)
Abstract: [Background] The diagnosis of MTD relies on the presence of medial compression of the false vocal folds and /or anterior-posterior compression of the true vocal folds through video-laryngoscopy. This patterns is generally considered a hallmark of MTD, however, this pattern is also seen in speakers without MTD and may not, therefore, be diagnostically useful. We have attempted to develop a clinical diagnostic tool of MTD using alternative tongue motion (ATM). ATM in individuals with MTD is of interest because individuals with MTD tend to restrict motions of the tongue and have tension in the extralaryngeal muscles. Additionally, clinical observation suggests that the degree of tension may be influenced by the presence or absence of phonation during ATM. We examined if 1) the rate of ATM and muscle activity during ATM in individuals with MTD are different from those in normal speakers, and 2) the rate of ATM and muscle activity during ATM without phonation is different from that with phonation. [Objective] To determine if the frequency of ATM and muscle activity during ATM in individuals with MTD are different from those in normal speakers To determine if the frequency of ATM and the muscle activity during ATM without phonation is different from that with phonation [Design] Cross sectional design. [Participants] Five young healthy male volunteers( mean age 20 1.2 yr.) and 8 young healthy female volunteers (mean age 238.1 yr.) participated in this study as a normal group, and 2 male MTD patients (mean age 31.57.8 yr.) and 4 female MTD patients(mean age 31.37 yr.)as a MTD group. Normal health status was confirmed by medical history. None of the normal participants reported history of voice problems.[Measurement] STCL (Stress Tolerance Check List) was administered to all participants as a measure of subjective stress. There was no significant difference between two groups. The heart rate was measured as an index of autonomic nervous system function during ATM task. There was no significant difference between two groups. We used surface electromyography (SEMG) of the submental muscles to investigate stressor-evoked changes in extralaryngeal muscles activities. All recording were scaled with respect to 100% maximum voluntary contraction (MVC) measured by each electrocode. [Results] No significant differences were found during Japanese vowel phonation between the two groups in the submental SEMG. There were significant differences between the two groups in SEMG during ATM (forward and backward) with phonation and ATM 8right and left) without phonation. In the rate of ATM, there were significant differences with phonation between the two groups during (right and left, forward and backward), but no signif4uscles showed more increase with honation during ATM (forward and backward) than normal participants. The results suggest the possibility that ATM can be used as a diagnostic tool for MTD.
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TWO CASES DIAGNOSED WITH THYROARYTENOID MUSCLE PARALYSIS MAKOTO MIYAMOTO (1) - ERI MIYATA (1) - KOICHI TOMODA (1) DEPARTMENT OF OTORHINOLARYNGOLOGY-HEAD & NECK SURGERY,, KANSAI MEDICAL UNIVERSITY, JAPAN, HIRAKATA, JAPAN (1)
Abstract: Recurrent laryngeal nerve sequentially branches into posterior cricoarytenoid muscle, arytenoid muscle, lateral cricoarytenoid muscle and thyroarytenoid muscle. It seems that individual branch of the recurrent laryngeal nerve is easy to be affected by such a very localized penetrating injury. Thyroarytenoid muscle paralysis is theoretically exists. It is rare in case and diagnosed by the laryngeal electromyogram. We would report two cases of thyroarytenoid muscle paralysis. We performed laryngeal electromyography (EMG) to bilateral cricothyroid and thyroarytenoid muscle by percutaneous technique. The affected side of cricothyroid muscle was normal, while in the affected side of thyroarytenoid muscle was abnormal in two patients. The laryngeal movement of thyroarytenoid muscle paralysis looks normal, however the paralyzed side of vocal cord often p4 know the rare cases of thyroarytenoid muscle paralysis.
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STUDY OF DISEASE MODELS OF VOCAL NODULES CHANGE OF THE POSITION OF THE VOCAL PROCESS DUE TO THE EFFECT OF VOICE TRAINING. YOSHIHIRO IWATA (1) DEPARTMENT OF OTOLARYNGOLOGY FUJITA HEALTH UNIVERSITY, FUJITA HEALTH UNIVERSITY, TOYOAKE AICHI (1)
Abstract: Think pathogenesis of vocal nodules is still largely unknown. I think it can cause if it becomes apparent, the development of efficient treatments. Vocal nodules are present in multiple disease women short length of the vocal cords, vocal nodules are almost no disease in men with long vocal chords. Posterior glottic gap is present in high frequency in women. Consider the size of the gap in the rear glottis larynx with vocal cord nodule disease. Trajectory of the vocal process is related to the direction in which the arytenoid cartilage is moved according to the vocal cord movement. Width is observed as the rotating swing vocal process. Width is small swing, the angle of the left and right vocal process is small, normal larynx and vocal cords, the membranous portion of the vocal cord pair would have been substantially parallel to the motion. Disease in vocal nodules, we expect the width is greater than the angle of the left and right swing and big, rear glottal gap is large, and the large width of the vibration of the membranous portion of the vocal cords.I thought thereby large vibration, vocal cords edge repeats the collision, and make a scratch on the vocal cord mucosa. Weve taken using a (3333 fps) high-speed camera to vocal nodules. We have focused on the gap observed posterior glottis. Recording was carried out in the same way normal larynx. Weve taken during phonation effortless. I have analyzed the projection angle of the vocal cords in order from the plurality of images. The measurement results show normal larynx group (4 women, 22
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ADAPTATION TO THE DUTCH, VALIDATION AND NORMATIVE DATA OF THE VOICE HANDICAP INDEX-10 ANNELIES LABAERE (1) - ELINE DE JONG (1) - ELINE QUINTIENS (1) DEPARTMENT OF SPEECH AND LANGUAGE THERAPY AND AUDIOLOGY, THOMAS MORE ANTWERPEN, ANTWERPEN, BELGIUM (1)
Abstract: The use of self-evaluation scales is considered to be an essential part of voice assessment, as it reveals the impact of the voice problem on the patients daily life. The Voice Handicap Index developed by Jacobson in
1997 has been proven to accurately assess the voice handicap of a patient, but it is a rather long questionnaire. Therefore in 2004 Rosen et al designed a new shortened VHI-10 questionnaire, including 10 statements from the 30-item VHI form. The aim of this study was to adapt the VHI-10 to the Dutch, to validate the instrument en to collect normative data. The English VHI-10 scale was translated to Dutch by 2 speech therapists and 2 linguists who were native Dutch speakers. The different versions were compared and one final version was composed. This final version was again translated to English by a native English speaking linguist and compared with the original VHI-10. 200 subjects without voice disorder completed the Dutch versions of both the VHI and VHI-10. The results were analyzed for mean, standard error of mean (SEM) and standard deviation (SD). Correlations between VHI and VHI-10 were calculated. Results: analysis of 200 VHI questionnaires revealed a mean of 8,17 (SEM = 0,77 ; SD = 7,73) . The VHI-10 questionnaires were analyzed to show a mean of 1,89 (SEM= 0,22 ; SD = 2,22) . Scores of male and female subjects did not differ significantly. A high correlation was found between VHI and VHI-10 (r = .86, p< .001). Conclusions: the Dutch VHI-10 can be considered as a valid alternative for the original VHI. This study offers first normative data for the Dutch VHI-10. Based on our findings, VHI-10 score 7 should be considered abnormal. Authors remark: subsequently VHI and VHI-10 data in 100 patients with voice disorders have been collected and are analyzed at the present. By the time of the conference this part of the study will be completed and the data can be added to the presentation. Learner Outcomes: understand the value of validated self rating scales in different languages; understand the need for collecting normative data; know the translation process of the VHI-10 to the Dutch language; know the normative data of the Dutch VHI-10 and the correlations between VHI and VHI-10.
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VOICE AND SPEECH PROFICIENCY OF TOTAL LARYNGECTOMEES USING A TRACHEOESOPHAGEAL PROSTHESIS TELMA KIOKO TAKESHITA-MONARETTI (1) - LLIAN NETO AGUIAR-RICZ (1) - HILTON MARCOS ALVES RICZ (1) SCHOOL OF MEDICINE OF RIBEIRAO PRETO, UNIVERSITY OF SAO PAULO, RIBEIRO PRETO, BRAZIL (1)
Abstract: Among the existing forms of alaryngeal communication, the voice with a tracheoesophageal prosthesis has been considered to be the method of choice among total laryngectomees and therapists, although there is variation in the quality of acquired voice and speech. The objective of the present study was to characterize the voice and speech of total laryngectomees speaking with a tracheoesophageal prosthesis and to determine their differential parameters. Twenty total laryngectomees (17 men and three women with a mean age of 62 years) speaking with secondary insertion of a tracheoesophageal prosthesis, participated in the study. The patients were submitted to individual voice and speech recording in an acoustically treated room with monitoring of noise level (mean: 42.5 dB), temperaturre (mean: 26.6C) and ambient humidity (mean: 41.6%). Voice and speech were recorded with a video camera, with the subject being asked to performed prolonged emission of the vowels a, i, u at habitual frequency and intensity, to count from one to twenty, to sing Happy birthday to you!, and to emit spontaneous speech in response to the question: What are the advantages and disadvantages of using a voice prosthesis?. Vocal intensity was measured by the sustained emission of the vowel a using a digital decibel meter. Dynamic extension was also determined using the information obtained with the decibel meter, considering subtraction of minimum intensity from maximum intensity. The maximum times of phonation of the vowels a, i, u were measured twice with a digital chronometer and the final mean emission was calculated. For the characterization of voice and speech with a tracheoesophageal prosthesis, we adapted a protocol validated for the evaluation of communication with a tracheoesophageal prosthesis, which considers three global aspects (phonatory skills, additional aspects and general judgment). In the final judgment, the participants were characterized as good, moderate or poor speakers according to the criteria established by the protocol. All the parameters of the protocol, except the quantitative ones, were rated by three speech therapists with experience in the rehabilitation of total laryngectomees. The proportions of response to the final rating of the experts for each voice and speech parameter of the protocol were compared by the Chi-square test for equality of proportions in one-way tables, with the level of significance set at p < 0.05. Most participants (65%) were characterized as moderate speakers, 10% as good speakers and 25% as poor speakers (p<0.01). Vocal extension was the parameter most often rated as poor, demonstrating the difficulty of the participants in controlling their vocal intensity. Of the components evaluated, only vocal quality (p<0.07), speech intelligibility (p<0.07) and audibility of inspiration (p<0.65) did not demonstrate a significant difference for the characterization of the speakers as good, moderate or poor, emphasizing the importance of exploring other parameters capable of indicating the quality of alaryngeal communication during speech therapy, without considering only its acquisition, but also its refinement. Learner Outcomes: By means of this study we intend to collaborate with researchers and clinicians who are interested in the area of rehabilitation of total laryngectomees regarding:- the need for more judicious evaluation and rehabilitation aiming at the acquisition and refinement of alaryngeal communication by means of a tracheoesophageal prosthesis, based on the detection of voice and speech parameters that should be better explored in therapy in order to maximize the quality of communication. - the establishment of normative criteria for the evaluation of total laryngectomees rehabilitated with a tracheoesophageal prosthesis in order to favor a standardized clinical evaluation and to permit reproduction of the method. - the necessity and the importance of developing validated instruments for the evaluation of voice and speech in total laryngectomees using a tracheoesophageal prosthesis.
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INFLUENCE OF SEVERE AIRFLOW LIMITATION ON SPEECH BREATHING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: PRELIMINARY OBSERVATIONS EVELIINA JOENSUU (1) UNIVERSITY OF OULU, UNIVERSITY OF OULU, FACULTY OF HUMANITIES, LOGOPEDICS, OULU, FINLAND (1)
Abstract: Introduction: Speaking sets remarkable demands particularly on the expiratory phase of Breathing. The controlling activity of expiration is more complex while speaking than during physical exertion. Airflow limitation caused by chronic obstructive pulmonary disease (COPD) manifest especially in expiratory volume and flow. These circumstances cause patients with COPD to experience dyspnea during speaking and difficulty to adapt their breathing to the combination of communication and ventilation demands. Only a few studies have been conducted of the characteristics and variability of speech breathing in patients with COPD. We also know very little of how COPD may manifest in the maximum performance tests of speech production such as the length of extended utterance and maximum phonation time (MPT) of sustained phonation. Aims: The purpose of this study was to explore the maximum phonation time (MPT) and the length of extended utterance in a group of patients with COPD and to analyze conceivable correlations with the severity of the disease (degree of the airflow limitation). This study is a preliminary part of a Masters thesis study on influence of severe airflow limitation on speech breathing in patients with COPD. Methods: The sustained vowel /a/ and the extended utterance (counting) of 20 patients with COPD were audio-recorded. The patients were divided into two groups according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2011) Spirometric Classification of COPD severity stage : Group 1 GOLD Stage III (severe COPD), n=12; and Group 2 Stage IV (very severe COPD), n=8. The audio signal was used to determine MPT and the length of extended utterance. Severity stage of COPD was compared to MPT and to the length of extended utterance. The data were analyzed statistically by using the SPSS program. Results: The analysis showed a trend for shorter length of extended utterance among the patients in group 2 (stage IV, 7.62 sec) than in group 1 (stage III, 12.42 sec) (p = 0.082). There was no significant difference between the two groups in MPT of sustained vowel /a/. Conclusions: These results show a trend to the possible correlations between the severity stage of airflow limitation caused by COPD and the reduction in the length of extended utterance. A bigger sample size of the speakers with COPD might reveal a statistically significant reduction in the utterance length between the two groups of severe and very severe COPD. Learner Outcomes: receive basic knowledge of COPD; know why there is a call for investigation of speech breathing in speakers with COPD; know the preliminary observations of the influence of airflow limitation typical of COPD on different forms of speech breathing
P118
AMPLITUDE OF ESOPHAGEAL PRESSURE IN TOTAL LARYNGECTOMEES USING A TRACHEOESOPHAGEAL PROSTHESIS DURING SWALLOWING AND PHONATION TELMA KIOKO TAKESHITA-MONARETTI (1) - HILTON MARCOS ALVES RICZ (1) - ROBERTO OLIVEIRA DANTAS (1) - LLIAN NETO AGUIAR-RICZ (1) SCHOOL OF MEDICINE OF RIBEIRAO PRETO, UNIVERSITY OF SAO PAULO, RIBEIRO PRETO, BRAZIL (1)
Abstract: After total laryngectomy, the digestive tract becomes responsible for alaryngeal vocal production in a secondary and adapted manner, with the motor changes of the esophagus provoked by surgery possibly being involved in the re-establishment of oral communication of the laryngectomee. The objectives of the present study were to compare the pressure amplitudes of the proximal, middle and distal esophagus and to correlate them during swallowing and phonation in total laryngectomees speaking
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with the secondary insertion of a tracheoesophageal prosthesis. Twenty total laryngectomees speaking with the secondary insertion of a tracheoesophageal prosthesis, 17 men and three women with a mean age of 62 years, participated in the study. The participants were submitted to manometry examination for the determination of the amplitude of intraluminal esophageal (proximal, middle and distal) pressure during fluid swallowing and during the emission of the sustained vowel a at habitual frequency and intensity. The nonparametric Spearman correlation coefficient was calculated to determine the correlation of the intraluminal pressure amplitudes obtained for the proximal, middle and distal esophagus, and the nonparametric Friedman test was used to compare the intraluminal pressure amplitudes obtained in the proximal, middle and distal esophagus during swallowing and phonation. When a significant difference was detected, the Wilcoxon test with Bonferroni correction was applied. The level of significance was set at p 0.05. Only the pressure amplitude of the proximal esophagus showed a significant and positive correlation (p<0.007) between swallowing and phonation. During swallowing, the distal esophageal pressure amplitude was significantly higher (83.44 mmHg) than the medial one (55.96 mmHg) and the proximal one (40.38 mmHg). However, there was no significant difference in esophageal pressure during phonation. The proximal esophagus proved to have a similar pressure behavior during swallowing and phonation in total laryngectomees speaking with a tracheoesophageal prosthesis, with each one respecting his own direction of air flow and food transit, with esophageal pressure amplitude increasing in the latter as a function of the possible sum of forces originating from peristalsis. Learner Outcomes: By means of this study we intend to collaborate with researchers and clinicians interested in the area of rehabilitation of total laryngectomees regarding:- the understanding of esophageal behavior after total laryngectomy considering swallowing function; - the influence of the anatomy and physiology of the esophagus on the quality of alaryngeal vocal rehabilitation, especially for esophageal phonation and with a tracheoesophageal prosthesis;- the establishment of normative values of esophageal pressure amplitude during swallowing and phonation in total laryngectomees in order to favor standardized clinical evaluation and to permit methodological reproduction.
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NONLINEAR ANALYSIS OF VOICES OF PATIENTS UNDERGOING VERTICAL PARTIAL LARYNGECTOMY RENATA FURIA SANCHEZ (1) - LDIA CRISTINA SILVA TELES (2) PROGRAMA DE PS-GRADUAO INTERUNIDADES BIOENGENHARIA - EESC/FMRP/IQSC, UNIVERSIDADE DE SO PAULO, SO CARLOS, BRAZIL (1) - FACULDADE DE ODONTOLOGIA DE BAURU, UNIVERSIDADE DE SO PAULO, BAURU, BRAZIL (2)
Abstract: Acoustic assessment of voice of patients undergoing treatment for cancer of the larynx has been studied in the international scientific community, however, the acoustic analysis are limited in conventional assessments of voices where the noise is very intense, the main characteristic of the voices of patients undergoing partial laryngectomy, not allowing a reliable analysis. The Vocal Dynamic Visual Patterns (VDVP) analysis is a current method of acoustic analysis, which allows the evaluation of the voice in a new light, independent of conventional mathematical algorithms. The aim of this study is to evaluate the voices of patients undergoing vertical partial laryngectomy (VPL) analysis applying VDVP. We analyzed 31 samples of speech signals the sustained vowel / a / in Brazilian Portuguese adult subjects of both genders, submitted to VPL in the Department of Head and Neck Surgery at the Amaral Carvalho Hospital. We selected excerpts stationary 200 milliseconds and a portion less than 10 cycles in duration, for more detailed analysis of the dynamics for each of the samples analyzed with the technique of VDVP. For the qualitative assessment of VDVP, we considered three aspects of configuration: a) Number of loops, b) Regularity of traces c) convergence of the traces. The results of qualitative analysis of VDVP showed that the dynamics of the voices of these patients is directly related to the anatomical and physiological characteristics of the larynx after VPL. In conclusion, this tool allows another form of information (visual) evaluation and treatment of diseases of the larynx. Learner Outcomes: understand the method The Vocal Dynamic Visual Patterns (VDVP) nonlinear acoustic evaluation of voice; know the characteristic of the evaluation of the method; evaluate the applicability of the technique in the voices of individuals who underwent vertical partial laryngectomy.
known that hydration is essential for lubrication of mucosa of the vocal folds and to achieve a good performance in vocal production. However, there is a lack of information about the effects of hydration upon the vocal warm-up in singers. The aim of this study was to investigate the influence of systemic hydration on the singers voices, before and after vocal warming. Sixteen healthy choristers, four men (25%) and 12 women (75%), aging from 26 to 72 years (mean age: 49.414.7 years), without vocal and auditory complains at the days of evaluations, and not previously submitted to surgical procedures of larynx, were included in this study. All participants recorded their voices, before (1) and after (2) of performing vocalization exercises for warming of the voice, during twenty minutes, under two conditions: without the water intake in the previous 12 hours to the recording; and with consumption of three and two liters of water, to men and women, respectively, along the day before the recordings. The hydration degree was evaluated by the methods of colorimetry and specific gravity of urine. The following variables were investigated by acoustic analysis: fundamental frequency (F0), jitter, shimmer and NHR by Multi-Dimensional Voice Program-KayPentax. The perceptual analysis of voice was performed by three speech therapists, using visual analogue scale that assessed the vowel /a/ the general voice degree, breathiness, roughness, pitch and unstability in a section of the general degree of voice. The self-perception of voice in different hydration conditions was related through interviews. It was possible to recognize the individuals hydrated (H) and dehydrated (D) by means of analyses of urine. Pearsons Correlation test showed a strong correlation between colorimetry and specific gravity of urine data (R=0.807, p<0.05). The t test revealed that F0 decreased significantly in the hydrated treatment, before (H1) and after (H2) warming-up of voice (F0H1 = 211 Hz and F0H2 = 226 Hz), compared to dehydrated condition (F0D1 = 224 Hz and F0D2 = 247 Hz). There were not diferences in other acoustic variables between hydrated and dehydrated conditions (p < 0.05). Pitch decreased in hydrated individuals, before and after vocal warming (p<0.05). The self-perception of choristers showed 75% reporting an improvement of voice when hydrated, and 87.5% in the same condition after vocal warming-up. The hydration degree has acted positively in the singers voice and favored vocal warming with less effort and greater flexibility by allowing lower friction between the vocal folds. Learner Outcomes: The participant will be able to: 1. know and discuss about the importance of hydration in vocal production, 2. know and discuss about the importance of hydration in the warm-up voice, 3. know how to evaluate the hydration level of the professional voice.
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VOICE ONSET TIME FOR THE WORD-INITIAL VOICELESS CONSONANT /T/ IN SPASMODIC DYSPHONIA -A COMPARISON WITH NORMAL CONTROLSSAORI YANAGIDA (1) - NORIKO NISHIZAWA (2) ASSISTANT PROFESSOR, DEPARTMENT OF COMMUNICATION DISORDERS, SCHOOL OF PSYCHOLOGICAL SCIENCES, HEALTH SCIENCES UNIVERSITY OF HOKKAIDO, SAPPORO, JAPAN (1) PROFESSOR, DEPARTMENT OF COMMUNICATION DISORDERS, SCHOOL OF PSYCHOLOGICAL SCIENCES, HEALTH SCIENCES UNIVERSITY OF HOKKAIDO, SAPPORO, JAPAN (2)
Abstract: Purpose: Criteria for spasmodic dysphonia (SD) as an independent voice disorder have not yet been established, and the current standardized assessment method is not sufficient for the objective evaluation of severity or its effects. Acoustic methods for the evaluation of voice symptoms in SD have focused on vocal spasm severity, including the number of voice breaks, fundamental frequency (F0), Jitter, Shimmer, harmonics-to-noise ratio (HNR), maximum phonation time (MPT), voice onset time (VOT). The purpose of this study was to demonstrate the characteristics of voice symptoms in SD by measuring VOTs, and to discuss the relationship between VOT prolongation and a pause or silence between the test word and the preceding word.Procedures: Subjects included thirty-seven patients with adductor spasmodic dysphonia (ADSD), eight patients with abductor spasmodic dysphonia (ABSD) and ten normal controls. The reading task was the text of The north wind and the sun (Kitakaze to taiyo in Japanese). The word taiyo (the sun) was repeated three times in the whole text, each of which was differentiated by the position in the sentence: 1) in a sentence without preceding punctuation, 2) in a sentence following a comma, and 3) at the beginning of a sentence following a period. The VOT for the word-initial voiceless consonant /t/ in taiyo was the measurement target. The speech samples read by the subjects were picked up by a condenser microphone in a quiet room and recorded digitally on a personal computer. The VOT for the target syllables was measured as the interval between the release of an oral constriction and the start of glottal pulsing. Results: A pause or silence between the test word and the preceding word tended to be prolonged gradually under conditions 1 to 3. Under condition 2, where a comma preceded the test word, the patients VOTs for the word-initial voiceless consonant were significantly longer than those of the controls (p < 0.05). Equally, under condition 3, where a period preceded the test word, the ABSD patients VOTs were significantly longer than those of the controls (p < 0.05). Prolongation of the VOTs was related to the pause or silence between the test word and the preceding word. A comparison of VOTs between ADSD and ABSD patients showed no significant difference under any of the three conditions. Conclusion: Abnormal prolongation of the VOTs was related to
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EFFECTS OF HYDRATION BEFORE AND AFTER VOCAL WARM-UP IN SINGERS Kelly C A Silverio (1), Ldia Cristina da Silva Teles ( 1), Carla Marques de Sousa Xavier (1), Maria Aparecida Miranda de Paula Machado (1) (1) Bauru School of Dentistry, University of So Paulo, Bauru Campus
Abstract: The practice of exercises for vocal warming has shown great benefits to enhancement of voice, as well as the stress reduction in singing. It is
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the pause or silence between the test word and the preceding word. VOT measurement for the word-initial voiceless consonant was suggested to be a useful method for quantifying voice symptoms associated with SD. Learner Outcomes: review the current methodologies for evaluation of spasmodic dysphonia; understand the disturbance of VOT control in SD patients and get an insight into the effects of laryngeal adjustment to voicing control in articulation
P124
VOICE RESISTANCE IN YOUNG WOMEN BEFORE AND AFTER CONTINUOUS TALKING FOR 30, 60, 90 AND 120 MINUTES LLIAN NETO AGUIAR-RICZ (1) - PATRCIA MASSUCATTO MILANELLO (1) - ARIANE DAMASCENO PELLICANI (1) - LILIAM FERNANDA PAZETTO (1) - PATRICIA PEREIRA (1) - STHAEL ANDRADE MARQUES (1) - HILTON MARCOS ALVES RICZ (1) SCHOOL OF MEDICINE OF RIBEIRAO PRETO, UNIVERSITY OF SAO PAULO, RIBEIRO PRETO, BRAZIL (1)
Abstract: Vocal fatigue is considered to be one of the most common and debilitating symptoms, generating vocal disorders. It is frequently detected in individuals who use their voice professionally. Several physiological biomechanical mechanisms, as well as physical, psychological and environmental aspects can contribute to vocal fatigue. The time of vocal resistance ranges from 15 minutes to 2 hours; however, changes in vocal quality are likely to occur if talking is maintained for at least one hour. The objective of the present study was to analyze and compare the voice of young women before and after a test of continuous talking for 30, 60, 90 and 120 minutes. This was a cross-sectional study involving the analysis of a data bank containing files of 63 types of voice of young women with no previous history of dysphonia. The voices were divided into four groups according to the testing time to which they were submitted. Group A (30 minutes) - 17 voices; Group B (60 minutes) - 18 individuals; Group C (90 minutes) - 14 individuals; Group D (120 minutes) - 14 individuals. The participants were submitted to videolaryngostroboscopy in order to exclude any vocal problem and, before and after each continuous talk test, they were instructed to produce the sustained vowel /a/ with habitual vocal intensity and frequency, for a total of two samples per participant. A standard text for reading and continuous repetition for 30, 60, 90 and 120 minutes was offered for the continuous talk test. The sample was characterized by perceptive-auditory analysis of vocal parameters according to the GRBASI scale by means of independent rating by three speech therapists specializing in voice, and acoustic voice analysis was performed using the MDVP Voice Program software - KAY laboratory Multi-Speech Model 3700, before and after the continuous talk tests. The reliability of the experts regarding the categorical variables of each parameter analyzed was determined by description of the percentage of concordant ratings (66% or more) and discordant ratings (less than 66%) for each qualitative parameter evaluated. To this end, the more experienced rater (J1) in the area was considered to be the reference expert for each crossing of analysis with the remaining raters, designated J2 and J3. Based on the greater percentage of agreement between experts, the predominance of a parameter was characterized for the continuous talk post-test situation. The quantitative parameters of the protocol and their association with the categorical parameters were described as mean, standard deviation and range. A tendency to an increased fundamental frequency was observed in all measurements performed in both conditions of analysis. The prolonged use of voice by means of continuous reading produced elevation of fundamental frequency in healthy young women at 30, 60, 90 and 120 minutes. Regarding the perceptive-auditory analysis, the raters agreed that a discrete general degree was maintained for all times of the continuous talk test. Learner Outcomes: By means of this study, the intention is to contribute to knowledge about vocal resistance:- Understanding of vocal resistance which will permit the promotion of preventive actions aimed at voice professionals such as teachers, singers, lawyers, and telemarketing operators, among others; - Knowledge of vocal parameters (acoustic and perceptive-auditory measurements) before and after a prolonged time of voice use
P122
USE OF SURFACE ELECTROMYOGRAPHY IN PHONATION STUDIES: AN INTEGRATIVE REVIEW PATRCIA MARIA MENDES BALATA (1) - HILTON JUSTINO SILVA (1) - KLYVIA JULIANA ROCHA MORAES (1) - LEANDRO DE ARAJO PERNAMBUCO (1) - LUCIANA NGELO BEZERRA (1) - DANIELE ANDRADE CUNHA (1) - SILVIA REGINA ARRUDA MORAES (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND IMMUNOLOGY/ALLERGY AMBULATORY, RECIFE, BRAZIL (1)
Abstract: Introduction: The surface electromyography has been used to assess extrinsic laryngeal muscles involved in chewing and swallowing, but little has been studied to assess these muscles in phonation. Objective: To investigate the current state of knowledge regarding the use of surface electromyography in the evaluation of electrical activity of the extrinsic muscles of larynx during phonation by means of an integrative review. Methods: We searched articles and other papers published in PubMed, Medline/Bireme and Scielo databases, published between 1980 and 2012, using the descriptors: surface electromyography and voice, surface electromyography and phonation, surface electromyography and dysphonia. The selection of articles was in according to criteria of inclusion and exclusion. Data Synthesis: It was performed by a cross critical matrix. We selected 27 papers, 24 articles and 03 theses. The studies differed methodologically as to sample size and investigation techniques, making it difficult to compare them, but showed differences in electrical activity between the studied groups, dysphonics, non dysphonics, singers, and others. Conclusion: Electromyography has clinical applicability since technical precautions to application and analysis are obeyed. However, it is necessary to adopt a universal system of assessment tasks an4muscles; Knowledge regarding the use of the surface electromyography use in extrinsic muscles of larynx during phonation; Clinical applicability of electromyography
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INCOMPLETE SWALLOWING AND RETRACTED TONGUE MANEUVERS FOR ELECTROMYOGRAPHIC SIGNAL NORMALIZATION OF THE EXTRINSIC MUSCLES OF THE LARYNX PATRICIA MARIA MENDES BALATA (1) - HILTON JUSTINO SILVA (1) - GERLANE KARLA OLIVEIRA NASCIMENTO (1) KLYVIA JULIANA ROCHA MORAES (1) - LEANDRO DE ARAJO PERNAMBUCO (1) - MARIA CLARA R FREITAS (1) - LEILANE M LIMA (1) - RENATA S BRAGA (1) - SNTIA R SOUZA (1) LUCIANA NGELO BEZERRA (1) - DANIELE ANDRADE CUNHA (1) - SILVIA REGINA A MORAES (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, CLINICAL HOSPITAL PEDIATRICS AND ALLERGY/IMMUNOLOGU AMBULATORY, RECIFE, BRASILE (1)
Abstract: PURPOSE: To investigate which muscles maneuvers provide larger electric activity (EA) of the suprahyoid (SH) and infrahyoid (IH) muscles to be used as surface electromyography (SEMG) signal normalization reference. METHODS: The electrical potentials of the SH and IH muscles of 12 subjects were evaluated using six muscular maneuvers, involving the position of the tongue and effort. It was selected as maximum voluntary sustained activity maneuver, the one having the minor coefficient of variation and the smallest value for each muscle group. The EA signal was converted using the root mean square in microvolts. It was considered then the maximum signal of each maneuver as the difference between the mean of three measures and the resting potential. RESULTS: The maneuvers that provided higher mean potentials with minor coefficient of variation and smallest P value were incomplete swallowing (IS) with effort (mean potential equal to 56.738.68 with coefficient of variation of 15.30%) in SH group, and tongue retracted with mouth open (TROM, mean potential equal to 46.577.83 with coefficient of variation of 16.81%) in IH group. CONCLUSION: The IS with effort and TROM maneuvers should be considered for signal normalization in these muscles, respectively, and may provide conditions for using the SEMG in voice clinic. SIGNIFICANCE: The use of normalization standards in researches of SH and IH muscles in the voice area will allow comparisons among future works. Learner Outcomes: Maneuvers that provided higher mean potentials, Use of normalization standards in researches of suprahyoid and infrahyoid muscles in the voice area.
P125
MEASUREMENT OF VOCAL TRACT DIMENSION OF LARYNGECTOMEES USING PHARYNGOMETRY MANWA NG (1) SPEECH SCIENCE LABORATORY, UNIVERSITY OF HONG KONG, HONG KONG, HONG KONG (1)
Abstract: Total laryngectomy involves the removal of the entire laryngeal structures including the hyoid bone and all laryngeal cartilages, usually due to terminal laryngeal cancer. Despite the contradictory findings reported in the literature, previous studies generally revealed a shortened vocal tract after total laryngectomy. Yet, these studies were either based on acoustics (vowel formants) or x-ray imaging. Detailed measurements of vocal tract configuration of individuals after total laryngectomy are not available. A comparison of vocal tract configuration between alaryngeal and laryngeal individuals is lacking. The present study made use of acoustic reflection technology to measure vocal tract configuration, and alaryngeal speakers were compared with normal laryngeal speakers. Thirty alaryngeal and 30 laryngeal speakers participated in the study. The two groups of speakers were matched with age, height and weight, and they were all native speakers of Cantonese. Various vocal tract configuration dimensions were obtained by using a pharyngometer based on acoustic reflection. Six vocal tract measurements were calculated that included length (in cm) and volume (in mL) of the oral cavity, the pharyngeal cavity and the entire vocal tract. Results revealed no significant difference for all vocal tract parameters between the alaryngeal and laryngeal groups. However, though not statistically significant,
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alaryngeal speakers appear to have longer oral length and larger oral volume, but shorter length and smaller volume of the pharyngeal cavity and the entire vocal tract than the laryngeal speakers. Learner Outcomes: Understand the surgical procedure of total laryngectomy; Know about the use of pharyngometry in measuring vocal tract configuration; Know the possible difference in vocal tract configuration between alaryngeal and laryngeal speakers.
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ACOUSTIC COMPARISON BETWEEN TWO DIFFERENT TECHNIQUES OF ENDOSCOPIC RESECTION OF BENIGN LARYNGEAL LESIONS DR. REHAM EL-MAGHRABY (1) - PROF. DR.MOHAMED ABD-EL MONEAM (2) - PROF. DR. ALAA EL DIN GAAFAR (3) - DR. SAAD ABD-EL GAWAD (4) UNIT OF PHONIATRICS, ENT DEPARTMENT, FACULTY OF MEDICINE, ALEXANDRIA UNIVERSITY, ALEXANDRIA, EGYPT (1) - ENT DEPARTMENT FACULTY OF MEDICINE, ALEXANDRIA UNIVERSITY, ALEXANDRIA, EGYPT (2) - ENT DEPARTMENT, FACULTY OF MEDICINE, ALEXANDRIA UNVERSITY, ALEXANDRIA, EGYPT (3) - ENT DEPARTMENT, FACULTY OF MEDICINE, ALEXANDRIA UNIVERSITY, ALEXANDRIA, EGYPT (4)
Abstract: Benign vocal folds mucosal lesions such as vocal nodules, polyps, and contact granuloma are common among patients with voice disorders. Surgical management of benign laryngeal lesions includes laser ablation, cold knife excision, and recently the microdebrider. Dealing with vocal fold lesions presents challenge to physicians, most studies reported good results applying laser surgery, and other studies have indicated that cold knife surgery has the benefit of protecting vocal fold from thermal injury. Microdebrider as a new technology in management of laryngeal lesions is a powered rotatory dissection device with suction assistance; its used before in orthopedic surgery and sinus surgery. The aim of this work is to assess the microdebrider as a tool for excision of benign laryngeal lesions and compare its results (intra-operative and post-operative) with those of microlaryngeal surgery by cold instruments. Forty patients with benign vocal fold lesions were included (25 females and 15 males) with age ranging from 24 to 51 years; mean age being 34.0+7.71years. They were randomly divided into 2 groups; group (I) subjected to excision of lesions by the conventional instruments. Group (II) subjected to excision of lesions by the microdebrider. Each patient was subjected to the protocol of voice assessment preoperatively and three weeks post operatively. The Patients were assessed subjectively by voice problem self assessment scale (VPSS), and objectively by laryngoscopy , stroboscopy and acoustic analysis. No significant difference in the acoustic parameters between the two groups, but there was significant difference between the preoperative and the post-operative acoustic parameters for each group. Post-operatively, satisfactory improved with resolution of the lesions in both groups. This study showed that the microdebrider was determined to be a safe, accurate and reliable method in removal of benign vocal fold lesions but does not offer major advantages compared to the standard instruments. Learner Outcomes: The participant will be able to: 1- know that microdebrider has the advantages of greater improvement in voice quality, shorter procedure times, fast debulking of obstructive laryngeal lesions; 2- understand that there is limitations of this technique including the inability to control margins for histological purposes. Therefore, its use is contraindicated for excisional biopsies, in which surgical margins and depth of invasion are critical for subsequent treatment decisions; 3-know that microdebriders are not indicated for the resection of vascular lesions because of the difficulty in obtaining hemostasis;4- know that as the present devices have two functions: cutting and suction we hope that the future devices have added a cauterization function to have a device with three functions : cutting, suction and cauterization, such a combination would be a time efficient and eliminating the need to switch tools when cauterization is needed.
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PHONATION IN AN ATMOSPHERE OF 100% RELATIVE HUMIDITY: EFFECTS ON VOICE HOARSENESS ROSSELLA MUO (1) - BARBARA RAMELLA (2) - DANIELA SARANDRIA (2) - ALFONSO BORRAGAN TORRE (3) REHABILITATION DEPARTMENT, ASL TO1, TURIN, ITALY (1) - ENT DEPARTMENT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY (2) - PHONIATRIC AND LOGOPEDIC CENTRE, PHONIATRIC AND LOGOPEDIC CENTRE, SANTANDER, SPAIN (3)
Abstract: Introduction. Vocal hygiene is usually considered a critical component of comprehensive vocal rehabilitation programs or in some cases a therapeutic tool for voice treatment itself. Vocal hygiene programs often include suggestions to increase hydration, typically considered as systemic, topical and environmental hydration (1). Although the importance of vocal fold moisturization in maintaining optimal vocal physiology is well known (2, 3), however, exact hydration quantity, frequency and techniques to increase hydration have not been described (2). Furthermore, hydration suggestions usually concern systemic and environmental hydration but rarely address local hydration of vocal folds. Aim of the study. To describe an easily-applicable and fast local hydration treatment and to observe voice changes in patients with dysphonia after treatment. Methods. Fifty patients with dysphonia asking for a Phoniatric assessment or a Speech and Language rehabilitation treatment were enrolled. Vocal Tract Moisturization treatment consists of placing a moistened gauze over the patients nose and asking them to breathe normally for 10 minutes through the said gauze. The gauze is kept moist at minute intervals by resoaking in water, wringing out excess liquid, and then replaced in the same position as before (Gauzal Hydration). All patients were recorded immediately before and after Gauzal Hydration. Two different experiments were proposed in two different days: experiment 1) patients breathe naturally through the gauze for 10 minutes; experiment 2) patients both breathe through the gauze and pronounce a low /u/ and a glissando /i/ for 3 seconds; between phonations patients must breathe through the gauze guaranteeing maximum intake of moisture. A second group of patients also was asked to perform Gauzal Hydration with phonation for 10 minutes, twice a day for a period of 15 days. Voices analysis consist on four levels: acoustic analysis of the voice (MDVP, spectroscopy, Maximum Phonation Time); perceptual evaluation of dysphonia (GIRBAS); morphofunctional analysis of phonatory system; subjective rating of symptoms. Acoustic analysis of the recorded voices were based on a sustained /a/, as long as possible. Perceptual evaluation of dysphonia was conducted by two researchers blind to each other on the basis of both the sustained /a/ and three minutes of spontaneous speech. Results from the two researchers were analyzed. Morphofunctional analysis of phonatory system was done considering mucosal wave amplitude and glottic closure. Subjective rating of symptoms considered patients reporting on vocal fatigue, hoarseness, vocal effort, and other parameters on the basis of a four point likert scale. Results. Preliminary results of the patients tested show statistically significant changes in voice intensity (t-test = -3,26, sig .006) and in the MDVP parameter ATRI (T-test = 3,16, sig. .006). Preliminary results of perceptual evaluation show that the change of vocal performance is very apparent with hoarseness significantly reduced. Furthermore, the mucosal wave is observed to be wider. Conclusions. Moisturization via the respiratory tract is much faster and more effective than moisturization via the digestive tract. A piece of dampened gauze placed on the nose can considerably reduce a dysphonia. Learner Outcomes: The main objective is to attract attention to the hydration of the upper airway as a suitable degree of moisture will improve and even normalize a voice.
P128
THE ROLE OF COENZYME Q10 AND VIT.A IN SINGERS VOCAL RECOVERY: DOSIMETRIC ANALYSIS FRANCO FUSSI (1) - GIACOMO BELLO (2) CENTRO AUDIOLOGICO FONIATRICO, USL RAVENNA, RAVENNA, ITALY (1) - UNIVERSIT DEGLI STUDI DI FERRARA, UNIVERSIT DEGLI STUDI DI FERRARA, FERRARA, ITALY (2)
Abstract: Singing voice can be considered as a high-cost physic performance, involving the activity of a great range of muscles and the ability of establishing the correct synergy between breathing, phonation and resonance; it requires also energy to communicate an artistic message to the audience through vocal interpretation. Over time this activity can discharge energy resource used by the singer and increase the risk of a performance failure. The aim of the study is:to examine the effect of the CoQ10 in association with vit.A as an energetic support in the good health singer. In order, a dosimetric index (Voice Recovery Index VRI) was used; to detect which kind of vocal style, according with their performances, can receive a benefit; to analyze dosimetric values with auto-perceived comparison. Fifteen good-health singers were enrolled in this study, 7 male and 8 female. The mean age was 45.4 9.3 (range 21-54). Ten of them were modern singers, five were classical singers. They were divided them into two groups: the experimental group was composed by 9 singers, the control group by 6. The singers in the experimental group were treated with CoQ10 terclatrate and vit.A for 15 days; the control group was given a placebo. Subjective impressions with the CSHI/MSHI questionnaires (Classical/Modern Singing Handicap Index) were also collected. Each singers performed for 20 before the treatment,
Participants will learn an easy system to hydrate the vocal folds. We will analyze the results and the changes in their voices and in the larynx function through the stroboscope.
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and the same performance was repeated after the treatment (15 days). The APM dosimeter (Ambulatory Phonation Monitor) Kay Pentax 3200 was used to collect glottal information though the VRI, built by the ratio between the cycles of vibration dose (Dc) and the total distance dose (Dd) as an indicator of voice recovery and, inversely, of vocal fatigue. Caffeine intake and smoking habit have been considered. The standard variation of VRI (VRI) was analyzed, as an indicator of energy vocal dissipation during phonation: little values of VRI indicate an increase of the period after that vocal fatigue occurs. The findings are: there is a significant difference (=0.09) between the dosimetric data of experimental and control group, using Fishers exact test; this dosimetric difference refers mainly to modern singers, with no correlation with sex, caffeine intake and smoking habit; the MSHI/CSHI data do not correlate with dosimetric data. In the experimental group we found a little increase of voice handicap average (+0.6) while the control group the variation is -5.5. This pilot study suggest the opportunity that the CoQ10 could be an energy supplier for good-health singers, thanks to its effect of delaying the vocal fatigue during a performance. The effect is more evident in modern singers than in classical singers, and this is probably due to the differences between technical features: classical singers have to reach a reliable and resistant voice through a constant and heavy training, while in modern singers interpretative aspects are more enphasized, and technical preparation is not as important as for classical or opera singers. Therefore, the bracing effect of CoQ10 is more evident and measurable in modern singers. Learner Outcomes: know the specific characteristics of singers vocal fatigue; know the possibility to evaluate through APM vocal fatigue/recovery; understand the effect of CoQ10-vit.A intaking.
P129
TRANSLATION AND CROSS-CULTURAL VALIDATION OF THE SELF-EVALUATION OF COMMUNICATION EXPERIENCES AFTER LARINGECTOMY QUESTIONNAIRE FOR THE BRAZILIAN PORTUGUESE GABRIELA FAHL (1) - BRBARA GARCIA DE GOULART (1) PROGRAMA DE PS GRADUAO EM EPIDEMIOLOGIA, UNIVERSIDADE FEDERAL DO RIO GRANDE DO SUL, PORTO ALEGRE, BRAZIL (1)
Abstract: The treatment for larynx cancer is aggressive and traumatic, commonly implying a lower quality of life for the patient, which means a decrease on the perceived welfare of the patient during and after the disease. Defined as a mutilating disease by some authors, because of the significant alterations this cancer makes in the physical, functional, emotional and social aspects of the patients lives, it became important to study treatments that do not impact so hardly the patients quality of life and, therefore, stimulate their recovery. Although laryngeal cancer represents 25% of head and neck cancers, only 1% of cancers occurs in this region and thus is considered rare and framed, often put along with other head and neck cancers. Its features, however, differ from this large group: the loss of smell, the presence of a tracheostome and the removal of the vocal folds represent a considerable decrease in the quality of life of these patients, which is not observed in other types of cancer. Thinking about it, Professor Blood developed and published, in 1993, a quality of life questionnaire specifically for laryngectomized patients. Originally published in English, the questionnaire has 35 questions specific to that group. For its growing importance in the medical area, since the number of larynx cancer cases is increasing, especially among females, it becomes necessary to expand the tools that can help professionals in the choice of treatment and to provide tools for understanding the implications of each treatment for the patients life. To this end, we seek to make a cross-cultural translation and validation, trying not only to translate the questionnaire from English into Portuguese, but also to adapt to the context and issues of the Brazilian society. Learner Outcomes: It is expected that the participant leave the presentation knowing, in a basic level, how a cross-cultural validation is done, its importance and where they can look for more detailed information in case they need to translate and validate a questionnaire.
day of life. Methods: The experiment was carried out in the annex of the Anatomy Department at the Center for Biological Sciences (CCB) of the Federal University of Pernambuco (UFPE)/Brazil after approval by the Ethics Committee on Animal Experiments. The experiment was used in 12 Wistar rats and 40 descendants of these puppies. The rats were divided into two groups: control and treated. In the treated group, the mother rats received caffeine diluted to 0.1% in drinking water from 21 to 120 day of life and resulted in offspring of treated group (PT); the control group did not received additives in their drinking water and gave rise to offspring of the control group (PC). At 30 days of offspring life, the animals were anesthetized and their larynx were removed and fixed by immersion in 10% formalin solution. The material underwent histologic battery and was analyzed by light microscopy. Measurements of mucosal thickness in the posterior larynx were performed with the aid of Scion Image software for Windows, Release 4.0.2 Beta. Results: The results revealed low weight birth and decreased of offspring body length. Histological changes in the laryngeal mucosa were also observed as a sign of gastroesophageal reflux presence. Discussion: The low weight found in PT confirms the findings of other studies which claim that consuming 300mg or more of caffeine by day during pregnancy, besides inducing prematurity is associated with low weight birth, which can be especially detrimental to development. The decrease in body size of the PT animals corroborate with revelations described in a study which showed that 200mg of caffeine daily doses can significantly reduces placenta blood flow, probably through vasoconstriction, which can lead to reduced fetal growth. There was a signal of possible local inflammation in the laryngeal mucosa of the PT group, and this factor may be related to the gastroesophageal reflux presence. Another finding was hyperkeratosis formed in response to irritation of low intensity for a long period of time. Conclusion: The results of this study suggest that caffeine consumption during pregnancy and lactation periods, in rats, induces a decrease in weight and body size of the offspring, as well as the emergence of changes in the mucous lining of the larynx, in its posterior portion, probably caused by pathological reflux of gastric contents. Learner Outcomes: Changes caused by caffeine in pregnancy rats, Changes in larynx mucous because de caffeine exposure; Reduction of blood flow into placenta in rats and human; Lower weight birth and reduce body size in caffeine consumers offspring.
P131
LOCALIZATION, FREQUENCY AND INTENSITY OF MUSCLE PAIN IN WOMEN WITH VOCAL NODULES KELLY CRISTINA ALVES SILVERIO (1) - LARISSA DONALONSO SIQUEIRA (1) - LDIA TELES (1) - CHRISTIANO DE GIACOMO CARNEIRO (2) - HARDYNN WESLEY SAUNDERS ROCHA TAVARES (2) - ALCIONE GHEDINI BRASOLOTTO (1) SPEECH-LANGUAGE PATHOLOGY/AUDIOLOGY DEPARTMENT AT BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU CAMPUS/SP, BRAZIL., UNIVERSITY OF SO PAULO, BAURU CAMPUS/SP, BAURU, BRAZIL (1) - HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES (HRACUSP), UNIVERSITY OF SO PAULO, BAURU CAMPUS/SP, BRAZIL., HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES (HRAC-USP), UNIVERSITY OF SO PAULO, BAURU CAMPUS/SP, BRAZIL., BAURU, BRAZIL (2)
Abstract: Some types of dysphonia may be associated with muscle strain, which causes body discomfort, especially pain in the cervical area. This condition is observed in some individuals with vocal nodules. One type of muscle strain associated with dysphonia is described in the literature as Muscle Tension Dysphonia (MTD), which is defined as a vocal alteration caused by excessive effort in the laryngeal and paralaryngeal muscles, which generally results in vocal and laryngeal alterations. The aim of the study is to investigate the location, frequency and intensity of muscle pain in women with vocal nodules in comparison to women without vocal complaints and normal voices. Were selected 26 women, ranging in age from 18 to 45 years, sorted in two groups: Dysphonic Group (DG) 13 women with vocal nodules and muscular tension dysphonia; Control Group (CG) 13 women without vocal complaints and with normal voices. All the volunteers signed the informed consent (CEP099/2011) and answered a protocol, adapted from Nordic Musculoskeletal Questionnaire marking the location and frequency of symptoms pain on the temporal area, masseters, submandibular areas, front and back of the neck, shoulders, upper back, elbows, fists/hands/fingers, lower back, hip/this, knees and ankles/feet. To investigate the frequency of pain, the volunteer should mark the body part in which pain was present in the last 12 months, and also mark the frequency of each symptom: never, rarely, occasionally or always. For each site of pain reported, the following values were distributed: never=0, rarely=1, occasionally=2, and always=3. The intensity of pain was measured by visual-analogue scale with a length of 100 millimeters. This scale was added to the same protocol containing the drawing of the body parts that the participants used to mark the frequency of pain. Then, for each site of pain reported, the volunteer should mark the spot of the scale that characterize their pain with a vertical line, considering that the left limit of the line meant no pain, and the right limit meant the worst pain possible. These markings were measured with a ruler for posterior statistical analysis. The DG and CG groups were compared using the MannWhitney test (p<0.05).The dysphonic women (DG) reported frequency of pain
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P130
HOW TO BEHAVE THE LARYNGEAL MUCOSA OF DESCENDANTS OF CONSUMER OF CAFFEINE? (EXPERIMENTAL STUDY) GERLANE KARLA OLIVEIRA NASCIMENTO (1) - DANIELE ANDRADE CUNHA (1) - LUCIANA NGELO BEZERRA (1) HILTON JUSTINO SILVA (1) - MARIA DE FTIMA GALDINO SILVEIRA (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND ALLERGY/IMMUNOLOGY AMBULATORY, RECIFE, BRAZIL (1)
Abstract: Introduction: Caffeine is widely consumed by the world population, and there are still doubts in the scientific literature if this practice can cause undesirable consequences on human reproduction and in general health of this consumers and their descendants. In pregnant women, the caffeine intake easily crosses the placental barrier, in substantial amounts passing to several embryonic tissues. Objective: To perform histomorphometric analysis of the posterior larynx mucosa region of the rats (Wistar) descendants submitted to caffeine treatment from 21 to 120
as occasionally and always in the larynx (p=0.019), back of the neck (p=0.012) and shoulders (p=0.026) significantly greater than the CG women. While in the CG women the symptoms of pain in the larynx and back of the neck were marked more often as never and rarely. In the same way the intensity of pain was reported significant greater in the back of the neck (p=0.019) in the dysphonic group (DG). This study concluded that muscle pain in the laryngeal area, back of the neck and shoulders are more frequent, and also pain in the back of the neck is more intense in women with nodules and muscle tension dysphonia than women without vocal complaints. Learner Outcomes: know and discuss about the importance of assessing the location, frequency and intensity of muscle pain in dysphonic women and women without vocal complaints; know how to evaluate the pain in dysphonic pacients
P132
LONG-TERM OUTCOME MEASUREMENTS OF VOCAL HYGIENE PROGRAM AND RESONANT VOICE THERAPY FOR HYPERFUNCTIONAL VOICE DISORDERED PATIENTS SHENG HWA CHEN (1) DEPARTMENT OF SPEECH AND HEARING DISORDERS AND SCIENCES, NATIONAL TAIPEI UNIVERSITY OF NURSING AND HEALTH SCIENCES, TAIPEI, TAIWAN, PROVINCE OF CHINA (1)
Abstract: About 40% of voice disordered populations are hyperfunctional dysphonia.Resonant voice therapy and vocal hygiene education have beam reported to be effective to a variety of voice disordered patients. However, no research has been done on the long term effects of the 2 methods on hyperfunctional dysphonic patients. The purpose of the study is to investigate long-term outcomes in vocal function, communication function, and life quality of vocal hygiene program and resonant voice therapy for hyperfunctional voice disordered patients. The research subjects were 86 hyperfunctional voice disordered patients. The subjects were randomly assigned into 2 groups: 1) vocal hygiene group (VH group); and 2) resonant voice therapy group (RVT group). Subjects in VH group received vocal hygiene education; and subjects in RVT group received resonant voice therapy. All subjects received vocal function, communication function, voice self report, and life quality evaluations pre, post 2 weeks, 1 year, and 2 years treatment. Twoway ANOVA repeated measurement, Post Hoc Scheffe , and paired-t test were used for statistical analysis. The results revealed that in auditory perceptual judgment, overall voice severity and the severity of pitch, roughness, strain, monotone, resonance, and glottal fry for RVT group were significantly reduced post 2 weeks and 1 years treatment. The severity of monotone for VH group was significantly reduced post 1 years treatment. In acoustic measurements, jitter (%) for RVT group was significantly reduced post 2 weeks, 1 year, and 2 years treatment; and for VH group was significantly reduced post 2 years treatment. Self-reported voice severity for both RVT and VH groups was significantly reduced post 2 weeks and 1 years treatment. In Voice Handicap Index (VHI), the score of physical scale for both RVT and VH was significantly reduced post 2 weeks and 1 years treatment. The score of emotion scale and total scale for RVT group were significantly reduced post 2 weeks and 1 years treatment; and for VH group were significantly reduced post 1 years treatment. In aerodynamic and WHOQOL-BREF Taiwan Version measurements, no significant difference was found for both RVT and VH groups at any time interval. The results indicate that both resonant voice therapy and vocal hygiene education have short-term, mid-term, and long-term outcomes for hyperfunctional dysphonic patients. However, resonant voice therapy show more short-term, mid-term, and long-term effects in voice characteristics, vocal function, and communication function than vocal hygiene education. Learner Outcomes: know the research design of controlled study for outcomes of different voice therapies; understand assessment tools and parameters for measurement of voice therapy outcomes: know the long-term outcomes of resonant voice therapy and vocal hygiene education; and understand clinical application of resonant voice therapy and vocal hygiene education for hyperfunctional dysphonic patients.
(10 voices) made with two different scales. The user can select the VAS (visual analog scale) or EAI (equal appearing interval). It is possible to use visual anchors visual and auditory anchors or to make the entire classification of voices without any kind of help in the explanation about the audio perceptual parameter that is being analyzed. In the end of each assessment, the application automatically creates a report that reflects the individual classification of every voice, for each one of the audio perceptual parameter (GRBAS), comparing them with the average classification of a group of six experts. At this moment it is also possible to listen to the voices and think over the score given by users and experts. This report can also be printed. Conclusions: the Voice - Perceptual Evaluation (Voice-PE) is a software program designed for training and testing skills related to audio perceptual evaluation of the human voice. Learner Outcomes: Understand the concept of audio perceptual evaluation; Recognize the audio perceptual parameters of the GRBAS scale; Use and train the audio perceptual evaluation through an equal appearing scale and visual analogic scale; Understand the importance of a permanent training to increase the consistency of internal standards of audio perceptual classification.
P134
IMMEDIATE EFFECT OF LARYNGEAL MANUAL THERAPY IN DYSPHONIC WOMEN KELLY CRISTINA ALVES SILVERIO (1) - ANA VITRIA RONDON (1) ANA PAULA REIMANN (1) - LARISSA DONALONSO SIQUEIRA (1) LIDIA TELES (1) - ALCIONE GHEDINI BRASOLOTTO (1) SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY DEPARTMENT OF THE BAURU SCHOOL OF DENTISTRY/ UNIVERSITY OF SO PAULO - FOB/USP, BAURU, SO PAU, SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY DEPARTMENT OF THE BAURU SCHOOL OF DENTISTRY/ UNIVERSITY OF SO PAULO - FOB/USP, BAURU, SO PAULO, BRAZIL, BAURU, BRAZIL (1)
Abstract: Laryngeal Manual Therapy (LMT) consists of the massaging of the paralaryngeal muscles aiming at relaxing them, involving the sternocleidomastoid muscle, suprahyoid muscle and thyrohyoid membrane. The emerging and more current literature has begun to offer evidence for the effectiveness of this type of approach and has recommended LMT for the reduction of musculoskeletal tension associated to vocal hyperfunction. Therefore, LMT has been applied on individuals with various types of dysphonia in which muscle tension is present. The aim of the study is to investigate the immediate effect of Laryngeal Manual Therapy (LMT) on the vocal tract discomfort reported by dysphonic women and by women without any vocal complaint. We selected 30 women ranging in age from 18 to 45 years, sorted into two groups: Dysphonic Group (DG) 15 women with functional or organofunctional dysphonia; Control Group (CG) 15 women without vocal complaints and with normal voices. After signing the informed consent (CEP097/2011), the women answered a Vocal Discomfort Scale (VTD) protocol presented by Morrison et al (2009). The VTD scale is a self-rating scale which enables patients to record the frequency and severity of their vocal tract symptoms, but we studied the severity of symptoms: burning, tightness, dryness, aching, tickling, soreness, irritability, and lump in the throat. The volunteers completed the VTD scale on their own, without any interference from the clinician. They completed the VTD scale immediately before and immediately after the LMT (Morrison et al, 2009). During the LMT each volunteer was seated on an upright chair with a straight, low back with the clinician standing behind the volunteer. The volunteers kept quiet during the procedure. The LMT consisted of bimanual circular massage of the sternocleidomastoid muscle, larynx and kneading of the supralaryngeal area with the fingers of one hand. Circular massage was applied to the hyoid bone, along its length. When the supralaryngeal muscles were less resistant to digital pressure, the larynx was depressed by pressure applied bimanually to the superior edge of the thyroid cartilage. Changes in tension of the perilaryngeal musculature, if any, were monitored by application of alternate lateral digital pressure to the thyroid cartilage (Morrison et al, 2009). The LMT was applied for 20 minutes. The DG and CG groups were compared using the paired t-test (p<0.05). After the LMT the dysphonic women (DG) reported significant improvement in burning (p=0.006), tightness (p=0,007), aching (p=0.003), irritability (p=0.0019), and lump in the throat (p=0.003). On the other hand the CG women reported significant improvement in tightness (p=0.039), dryness (p=0.007), aching (p=0.044), tickling (p=0.001), soreness (p=0.000) and irritability (p=0.000). This study concluded that LMT immediately reduces the intensity of vocal tract discomfort in dysphonic women and in women without vocal complaints. However, laryngeal symptoms such as dryness, tickling and soreness did not get better immediately after LMT on dysphonic women. Learner Outcomes: know the immediate effects that Laryngeal Manual Therapy produces in dysphonic women and in women without vocal complaints, regarding laryngeal symptoms.
P133
TRAINING AND TESTING APPLICATION FOR AUDIO PERCEPTUAL EVALUATION VOICE-PE (VOICE PERCEPTUAL EVALUATION) SUSANA VAZ FREITAS (1) - VTOR ALMEIDA (1) - PEDRO MELO PESTANA (2) - ANBAL FERREIRA (1) FACULDADE DE ENGENHARIA, UNIVERSIDADE DO PORTO, PORTO, PORTUGAL (1) - FACULDADE DE CINCIAS DA SADE, UNIVERSIDADE FERNANDO PESSOA, PORTO, PORTUGAL (2)
Abstract: Objectives: development of an application tool to support the audio perceptual evaluation of human voice. It aims to increase the intraobserver consistency of this type of measurement and classification of voice parameters.Methods and Results: the Voice-PE software program was designed in C++ and Qt, because their libraries include all the graphic interface options that the application presents. It is structured upon a database of 90 different voices with the possibility of selecting between two types of classification individual evaluation (15 voices) versus comparative evaluation
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P135
HESITATIONS IN THE BEGINNING OF ENUNCIATES: INTERVIEWS WITH CHILDREN ABOUT TWO KINDS OF PEDAGOGIC WORKSHOPS CRISTYANE CAMARGO SAMPAIO VILLEGA (1) FACULDADE DE FILOSOFIA E CINCIAS, UNIVERSIDADE ESTADUAL PAULISTA - JULIO DE MESQUITA FILHO (UNESP MARLIA), MARLIA, BRAZIL (1)
Abstract: During childhood, due to the complexity of language acquisition, the hesitations been particularly marked in the speech of children, most often causing disruptions in their flow. In literature about speech therapy, hesitations have been related predominantly to pathological conditions (such as stuttering). In the linguistic literature, we can find jobs that show without hesitation relates them with pathology, in which indicate that disfluency is a normal process of language acquisition. Seeking both to contribute to the literature speech therapy, as for linguistics to literature, the proposal of this research was to analyze the hesitations in the beginning of enunciates in childrens language in looking under linguistic-discursive. In that looking at the hesitations are seen as subject to negotiation with the other constituent of his speech. Data from this study were drawn from a database, organized by group Grupo de Pesquisa Estudos sobre a Linguagem (GPEL/ CNPq). This database consists of speech samples of children in language acquisition. This database were chosen four children (S01; S02; S03; S04) between five and six years old, who were in kindergarten in a public school in Marlia - the state of So Paulo - Brazil -. The inclusion criterion was the participation of these children in eight educational workshops, prepared by the teaching staff of the school. Such workshops were divided into two groups. Group 1 (G1) consisted of four workshops where children were able to experience, in some way, what would be learned, as the planting of a plant or cake confection. Group 2 (G2) was also constituted of four workshops, in which children heard the count of childrens stories. One week after each workshop, children were individually interviewed in order to verify your appropriation of knowledge produced in these workshops. The eight interviews were recorded (in audio and in video) inside a acoustic hood. Then, they were transcribed, and the occurrence and complexity of hesitations brands were judged by three judges. Was used criterion of 80% agreement between judges. Learner Outcomes: to observe how children, in the final process of language acquisition, uses the hesitation at the beginning of enunciates; to observe evidence of lower / higher production complexity of enunciates to the child as well as the way in which children deal with such complexity.
teenage or adult stutterers (minimum age >16) Each participant underwent a formal evaluation of fluency and related communication aspects (e.g communication attitude) pre and post 5 treatment sessions with activities based on Pro-El method. A Questionnaire of Outcome and Customer Satisfaction was completed during the post assessment in order to verify achievement of some goals set by the Pro-El method. Results - Preliminary results from informal observations and data analysis of pre / post evaluation on a preliminary sample of 10 young-adult stutterers, show an overall improvement in fluency. Statistical analysis on spontaneous speech results does not lead to significant results (p value t-test: 0,45) and shows high possibility to obtain a false negative due to important individual variability. The reading context shows a borderline significance value (t-test: p=0.09). Numerosity required to obtain statistically significant results is 50 individuals. Although the p-values are not significant (t-test: p=0,26), comparison between disfluencies percentage ratio post/pre in reading and spontaneous speech contexts shows a difference issues between standard deviations and respective mean values, indicating a less involvement of individual variability than in the contexts considered singularly. Significant results could be achieved through the contribution of 30 individuals. The questionnaires OASES show a considerable improvement of subjective perception of the disorder. All sections show a p value (t-test pre-post) very close to statistical significance, in particular, there is a significant improvement related to Reactions to Stuttering (t-test p=0,01). General Information (t-test p= 0,08) and Global Scores (t-test p= 0,07) are near to reach statistical significance. A sample of 20 individuals would allow to obtain statistically significant results. The scores average relative to the items of Questionnaire of Outcome and Customer Satisfaction is 4,13 0,49. Conclusions - Through this pilot trial, the application of Proprioceptive Elastic method in the management of fluency disorders proved to be an added value to the traditional speech therapy treatment, which will not show up as an alternative, but as a support for a more efficient achievement of provided rehabilitation goals. Further studies on treatment efficacy are needed. Learner Outcomes: Learning about an innovative method (PROEL) that can be used in the treatment of stuttering in young adult people. Data from this pilot trial did not allow to achieve statistically significant results, despite clear evidence of a positive trend in the improvement of verbal fluency. The use of the PROEL method has had very successful even on the subjective perception of the disorder: at the end of the short cycle of the trial, people show an improvement relative to communication skills aspects. This pilot trial do not want to give an alternative to traditional treatment widely supported by literature, but to provide a support for a more efficient achievement of provided rehabilitation goals.
P136
ART THERAPY AS A PART OF COMPLEX THERAPY OF STUTTERING ILONA KEJKLICKOVA (1) - PETR STANICEK (1) - PAVEL FLORIAN (1) PRIVATE CLINIC LOGO, CLINIC LOGO, BRNO, CZECH REPUBLIC (1)
Abstract: Implementing art therapy into therapeutic process of stammering has a significantly positive effect. Art therapy demonstrably influences patients psyche and his self-recognition which is very important for improvement of speech fluency. Self-confidence, self-recognition, certainty in dealing with people, and positive approach towards communication is the goal we would like to reach in the treatment of stuttering. Learner Outcomes: get the information about facility of Private clinic LOGO in Czech republic, understand the principles of art therapy and how it is used in speech therapy treatment and stuttering therapy, get to know some art therapy technigues, get to know about personality of therapist and structure of art therapy lesson.
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EFFECTS OF COGNITIVE TRAINING ON VERBAL FLUENCY IN ADULTS WITH DOWN SYNDROME. Renata SalvadorinI (2) - MARGHERITA BOZZA (1) STEFANIA BARGAGNA (2) IRCCS STELLA MARIS, UNIVERSITY, PISA, ITALY (1) - IRCCS STELLA MARIS, HOSPITAL, CALAMBRONE (PI), ITALY (2)
Abstract: Language skills in individuals with DS include deficits in phonology and speech intelligibility grater deficits in language production when compared to comprehension and non-verbal cognition; and greater deficits in syntax when compared to lexical knowledge and pragmatics. Not specific treatment of language skills are descript in DS. Strong evidence has been recently gathered supporting the beneficial effects of environmental enrichment (EE) on several aspects of brain development and brain plasticity in the mouse model of DS. EE constitutes a useful experimental paradigm to investigate the effect of changes in life style on biological parameters. We want evaluated the effect of an intervention of EE based on a psycho-physical training on the language in adults with DS. Forty subjects (21 males and 19 females) participated in the study. Their mean age was 34 years (range: 26 to 46). In nine subject is not possible do all the tests for poor compliance. All subjects were randomized in two group: the first is been trained, the second continue with their ordinary activities. All subjects were submitted to a language evaluation before (T0), after the training (first group) or after 3 months (second group) (T1) and after six months (T2). A language evaluation included: semantic fluency and phonological fluency, sentence comprehension (Test of Comprehension of Grammar for children, TCGB) and test of clitics. The training was carried out 3 times a week and consisted of different activities, both individual and in group, finalized to enhance cognitive abilities. We compared them in terms of number of correct answers that one subject gives in all categories (Total Score). Total score between of training group (group 1) and control (group 0) as been compared at different times (T0, T1, T2). We observed that the mean of Total score in Group 0 increase between T0 and T1 and decreased between T1 and T2. Instead in Group 1 the mean of Total score in Group 1 increased between T0, T1 and T2. The Tests of Between-Subjects confirms a significant main effect of training (group 1) as compared to control group (group 0). No statistically significant results there are in the sentence comprehension (TCGB) and test of clitics, although there is an increase of results as in training group as in control group between T1 and T3. This training is not a specific language stimulation, but through a stimulation of the executive functions has led a significantly enhancement of semantic fluency in the treated subjects. The data confirm that is possible an improvement also in adults with DS and
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THE PROPRIOCEPTIVE ELASTIC METHOD IN THE SPEECH THERAPY TREATMENT OF FLUENCY DISORDERS GLORIA VILLA (1) - ROSSELLA MUO (1) - GIULIA CRISTINELLI (2) - ANNA ACCORNERO (2) REHABILITATION DEPARTMENT, ASL TO1, TURIN, ITALY (1) UNIVERSITY OF TURIN, UNIVERSITY OF TURIN, TURIN, ITALY (2)
Abstract: Introduction - In scientific literature we find a high number of rehabilitation approaches to stuttering. Literature reviews have shown that rehabilitation approaches based on the use of facilitating verbal techniques are not of immediate acquisition and show some serious problems, like relapses and the risk of overly unnatural speech (Andrew et al.1980; Boberg e Kully, 1994). One of the major features of stutterer speech is the presence of blocks in phonation, accompanied by strain sensation or muscle tension. The Proprioceptive Elastic (Pro-El) method, developed by Prof. Borragan for the rehabilitation of voice disorders (Borragn et al. 2008), aimed 1) to facilitate voice elasticity searching a new equilibrium of the honatory system through muscle stiffness reduction and 2) to higher proprioceptive control of the organs involved in speech production facilitating the regulation of speech. Aim - Aim of the study is to test the use of Pro-El method in SLPs treatment for teenage and adult stutterers. Methods - The study involves 30
greater resilience of acquisitions in subjects who carried out the treatment Learner Outcomes: know the linguistic characteristics of adults with Down syndrome; understand the importance of linguistic and cognitive stimulation in adults with Down syndrome; receive suggestions to treat language in adults.
P139
ORAL READING GUIDANCE AND TRAINING TO JAPANESE CHILDREN WHO STUTTER WITH READING PROBLEMS MASAKI WATANABE (1) - MASAMUTSU KENJO (2) CLASSROOM OF COMMUNICATION DISORDER, KUZUTSUKA HIGASHI ELEMENTARY SCHOOL, NIIGATA, JAPAN (1) DEPARTMENT OF SPECIAL EDUCATION, FUKUOKA UNIVERSITY OF EDUCATION, MUNAKATA, JAPAN (2)
Abstract: To three Japanese school children who stutter having reading problems (but they did not have the diagnosis of the LD and developmental dyslexia) as well, we provided guidance about slow oral reading with soft vocal onset by stretching the vowels and by also incorporating choral reading method for stutter, while making them aware of cohesive meaning of each paragraph for developmental dyslexia. As a result, improvements were seen in both stuttering and reading mistakes. After providing training and guidance, with regard to symptoms of stuttering, prolongations was hardly observed, but repetitions and speech errors followed their saying it again by correcting the errors became key symptoms. Guidance was provided keeping in mind the improvement in self-monitoring skills in target children regarding decrease in reading speed. After the guidance and training, we found that subjects reading speeds were not uniform, for two subjects it reduced, for one subject it increased. Relationship with cluttering in target children was low. It came to light that in such cases, combined reading training for stutter and developmental dyslexia might be effective Learner Outcomes: The participants are now discussing this guidance and training method for Japanese speaking children who stutter with reading problems (excluding the children with the diagnosis of LD and/or developmental dyslexia).
client were disputed by discussions, and developed his positive attitudes toward communication (Menzies, Onslow, Ann Packman, & OBrian). This stuttering client had significant improvements measured by the standardized and self-reported tools. His SLDs reduced from 17.16 to 2.08 per 100 syllables, and his stuttered syllables also decreased from 24.56% to 9.24% in a conversation, and from 15.94% to 0.4% in a reading speech sample, respectively. Overall, the clients stuttering severity improved from severe to moderate level, and he reported only 3 points on the 7-point scale of stuttering severity. There was no difference existed in the stuttered syllables between with and without a witness in the clinic at the last session. It seems that a fluency shaping therapy with cognitive-behavioral approach is effective for reducing the disfluencies of the stuttering adult who spoke in front of a strange witness because the disputes against on unhelpful thoughts decreased his anxieties on talking, and also the client had more time to manage his disfluencies during speech through fluency shaping. However, more detailed information regarding the anxiety in different conditions of the client should be collected through assessment tools and more subjects are needed to reduplicate the findings in this study. Learner Outcomes: recognize the strategies of fluency shaping therapy and cognitive-behavioral therapy; use the skills of fluency shaping therapy and cognitive-behavioral therapy on the adults with stuttering; understand how unhelpful thoughts impact on the adults with stuttering; combine a fluency shaping therapy with a cognitive-behavioral therapy to treat stuttering adults.
P141
FIRST RESULTS OF COMMUNICATIVE PARTICIPATION IN PRESCHOOL CHILDREN WHO STUTTER USING THE FOCUS-G SANDRA NEUMANN (1) INSTITUTE OF NEUROSCIENCE AND MEDICIN (INM-3), RESEARCH CENTRE JUELICH, JUELICH,, GERMANY (1)
Abstract: Stuttering impacts on the child in a variety of ways, notably in terms of communicative impairment and psychosocial impact (Cook, Donlan & Howell 2012). Children who stutter are at high risk for reduced social and communicative participation caused by anxiety or being teased by peers (Kefalianos et al. 2012). There are any previous studies investigating in detail the communicative participation in children who stutter aged 3;0-5;11 years. In 2012 the Focus on the Outcomes of Communication Under Six (FOCUS) was published (Thomas-Stonell et al. 2012), which emphasizes on Activities and Participation component of the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY, WHO 2007). It can be used to take a snapshot of communicative skills of any child with speech, language and communication needs in between 1;0 and 5;11 years. The case-control study investigated the communicative participation of preschool children who stutter using the FOCUS-G (German) -parent and clinician views- in correlation to existence and severity of physical concomitant behavior. The study included 20 children (3;0-5;11 yrs.) who stutter (10 with and 10 without physical concomitant behavior) their caregivers and SLTs, compared to 20 healthy controls, matched in age and sex. For assessment the FOCUS-G (parent and clinician version) and the Stuttering Severity Instrument-Fourth Edition (SSI-4, Riley 2009), part Physical Concomitants were used. All families gave written consent. FOCUS-G forms were filled out by caregiver and the SLT of the child. The part of the SSI-4 was figured out by an academically-trained SLP (experienced fluency disorders) and digital videotaped. Statistical analysis of the FOCUS-G Total Score and Scoring Profile was done by using SPSS 21. Non-parametric statistics were chosen and correlations were calculated with Spearmans rank correlation coefficient. The Caregivers and SLTs of the children who stutter scored their children significantly lower on the FOCUS-G total score compared to reference data of the control group. Results show a more negative communicative participation on group level but with individual variation. The existence and severity of physical concomitant behavior correlated significantly with the FOCUS-G scores. According to the ICF-CY components Body Functions or Activities and Participation, profile results showed also significant lower average scores. Study results indicate direct correlation of childrens stuttering and restriction of communicative participation. The FOCUS-G allows to emphasize individual profiles of communicative participation restrictions in children. This may help clinicians to enhance speech-language intervention in children who stutter with a focus on specific items of Activities and Participation (ICF-CY). Learner Outcomes: know the application of the ICF-CY in preschool children who stutter; understand the assessment Focus on the Outcomes of Communication Under Six (FOCUS) and its scoring profile and 3. know first results of individual profiles of communicative participation restrictions in children who stutter in correlation to existence and severity of physical concomitant behavior.
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A CASE STUDY ON THE EFFICACY OF A FLUENCY SHAPING THERAPY WITH COGNITIVE-BEHAVIORAL APPROACH ON A MANDARIN-SPEAKING ADULT WITH STUTTERING TSUNG-HSIEN TSAI (1) - SHU-LAN YANG (2) - JUNG-JIUN SHIE (3) YA-FANG CHENG (4) GRADUATE INSTITUTE OF AUDIOLOGY AND SPEECH THERAPY, NATIONAL KAOHSIUNG NORMAL UNIVERSITY, KAOHSIUNG, TAIWAN, PROVINCE OF CHINA (1) - DEPARTMENT OF SPECIAL EDUCATION, NATIONAL PINGTUNG UNIVERSITY OF EDUCATION, PINGTUNG, TAIWAN, PROVINCE OF CHINA (2) - DEPARTMENT OF OCCUPATIONAL THERAPY, SHU-ZEN COLLEGE OF MEDICINE AND MANAGEMENT, KAOHSIUNG, TAIWAN, PROVINCE OF CHINA (3) - SCHOOL OF SPEECHLANGUAGE PATHOLOGY AND AUDIOLOGY, CHUNG SHAN MEDICAL UNIVERSITY, TAICHUNG, TAIWAN, PROVINCE OF CHINA (4)
Abstract: There are studies that suggest stuttering clients improve their speech through prolonged speech techniques (Packman, Onslow and van Doorn ,1994; Onslow, Costa, Andrews, Harrison and Packman,1996), and they maintained their gains until follow-up (Howie, Tanner, and Andrews, 1981). However, the unhelpful thoughts on communication exacerbate the speech performances of people with stuttering (Menzies, Onslow, Packman, & OBrian, 2009). Since the cognitive-behavioral therapy focusing on systematic desensitization (Wolpe, 1958) and disputing on irrational thoughts (Ellis, 1965) is effective to reduce the anxieties of clients, the researchers employed a fluency shaping therapy (Guitar, 1998) with cognitive-behavioral approach should decrease the disfluencies of people with stuttering while they talk. Therefore, the objective of this study was to determine the efficacy of employing the method which combines a fluency shaping therapy with a cognitive-behavioral approach to treat a Mandarin-speaking adult with stuttering. A twenty-one-year-old male adult with stuttering who spoke mandarin was diagnosed as having severe stuttering by The Stuttering Severity Instrument: Forth Edition, SSI-4 Mandarin Edition (Yang & Chong, 2011) and SLD (stuttering-like-disfluency, Yairi & Ambrose, 1996). In addition, the stuttering client had high anxieties and disfluencies during speech while someone watched, and 6 points was rated by the client on a 7-point scale of stuttering severity. He had 10 therapies which were one hour in each per week. The therapies combined a fluency shaping therapy with a cognitive-behavioral therapy, and focused on speaking slowly, taking a breath at syntactic boundaries, discussing unhelpful expectations, and practicing in different communicational situations. The therapeutic strategies included modeling of the therapist, and practicing through readings, monologues, and conversations. Especially, in order to help the client overcome his difficulties of speaking in front of witnesses, people with various familiar degrees gradually participated in the practicing processes in the clinic. Additionally, the unhelpful thoughts of the stuttering
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MULTIDIMENSIONAL APPROACH OF SCHOOL-AGE JAPANESE CHILDREN WHO DEVELOPED STUTTERING FOCUSING ON DIRECT SPEECH TREATMENT MASAMUTSU KENJO (1) DEPARTMENT OF SPECIAL EDUCATION, FUKUOKA UNIVERSITY OF EDUCATION, MUNAKATA, JAPAN (1)
Abstract: The present study discusses the concept of multidimensional approach including environmental modification method and psychological support focusing on direct speech treatment on school-age Japanese speaking children who developed stuttering. 5 children who developed stuttering (Stuttering severity was 5-7 based on the Iowa scale for rating severity of stuttering) between the onset age of 2 4, and who were studying between third to sixth grade of elementary school at the time of starting the treatment. Treatment methods: (1) Direct speech treatment: 1) With gentle voice onset such that it will go with exhalation after inhalation of air, subjects were asked to produce sounds and speak with feeling and slowly stretching the vowel. They were mainly asked to read aloud Kana characters. Paper containing words and sentences they used during treatment were distributed, and it was conveyed that it would be good if they practice it as a homework. 2) For sentences that contained sounds frequently stuttered by subjects at the beginning of the sentences or at the beginning of words, subjects were asked to read aloud slowly. 3) Question and answer: Clinician applying the treatment asked questions very slowly, and subjects were asked to respond with slow speech. Once they became fluent, this was conducted at the normal speed of talking. 4) With regard to words that had high frequency of stuttering and that children considered as their weak point, person applying the treatment slowly demonstrated the model speech, and conducted treatment by chorus speech and echoing. 5) Free conversation was held with person applying the treatment including parents about day-to-day life topics. (2) Counseling support: Including conversation regarding stuttering, free conversation was held. (3) Play therapy: After direct speech treatment, student clinician applied child centered play therapy. (4) Parent counseling: Parents of the children were interviewed regarding situation at home and school, and concept of environmental modification was discussed. Progress: Stuttering of the children significantly improved (Stuttering severity changed from 5-7 to 0-4) after starting the treatment, and behavioral and psychological improvements like decline in avoidance reaction were seen. Fluency in reading out was achieved in early stages in all subjects. Until stuttering improved, although they didnt relapse to the severe state prior to the start of treatment, but if fluctuated according to various happenings in day-to-day life. Discussion: Effectiveness of this treatment method was demonstrated as substantial improvement was shown in stuttering in all children. This proved the importance of applying treatment and provided support by combining environmental modification and counseling support due to the necessity of handling changes in stuttering of subjects and providing psychological support to them. These results showed the effectiveness of conducting speech treatment of word sounds with high frequency of stuttering. With regard to frequency and timing of treatment, for stuttering that does not result in concurrent disorders and delayed development, treatment was found effective even if it is conducted about once in a month. Learner Outcomes: Participants should discuss about multidimensional treatment methods for school-age Japanese speaking children who developed stuttering focusing on the direct speech treatment.
assessment and treatment of individuals who stutter. Findings from this investigation will hopefully aid in developing more effective speech rate modification procedures for speech-language pathologists who work with people who stutter. Learner Outcomes: assess the relationship between a clinicians expressive and perceived speech rate, and how it relates to the assessment and treatment of individuals who stutter; learn about effective speech rate modification procedures for speech-language pathologists who work with people who stutter.
P145
NEUROGENIC STUTTERING AFTER TRAUMATIC BRAIN INJURY. CHALLENGES IN EVALUATION NELLY LEIPAKKA (1) - ANNA-MAIJA KORPIJAAKKO-HUUHKA (1) UNIVERSITY OF TAMPERE, UNIVERSITY OF TAMPERE, TAMPERE, FINLAND (1)
Abstract: Neurogenic stuttering is an acquired disorder of speech fluency in adults resulting most commonly from traumatic brain injury (TBI), stroke, progressive degenerative diseases and drug usage. As brain damage of any kind may affect communication ability in many ways, it is important to consider what makes the core of neurogenic stuttering and what features are more general consequencies of the brain damage. For example, wordfinding difficulties, language formulation difficulties and apraxia of speech are often observed in patients with TBI. Difficulty in finding words manifests in pauses, hesitations and repairs, and apraxia of speech affects repetition of syllables and words. In addition, problems in planning and executing narrative discourse may result in disfluencies. All these features may sound like neurogenic stuttering. No method to analyze neurogenic stuttering exists, but previous studies have used methods created to assess developmental stuttering (like SSI-3). Lack of data, together with non-specific research methods and the co-occurrence of other speech-language problems with neurogenic stuttering evidently result in diagnostic difficulties and reduced awareness of the nature of neurogenic stuttering. We examined neurogenic stuttering characteristics in five male patients with traumatic brain injury (TBI). They had been examined by a speech and language pathologist and thus confirmed to suffer from neurogenic stuttering. The fluency of their speech was assessed in three tasks: sentence repetition, spontaneous speech and narrative. A new method to analyze speech characteristics and a new severity scale were created. The 5-levels severity of stuttering scale took into account both stuttering frequency, average length of the longest stuttered sequences and stuttering types. The SS% increased linearly as the cognitive demands of the task increased in patients A and B, and so did the types of stuttering. For example, patient A didnt stutter at all in the sentence repetition task, but in spontaneous speech the SS% was 8,3 and he produced repetitions and prolongations. In the narrative task, the SS% was the highest (14,4) and he also produced blocks. The average durations of the three longest stuttered sequences also varied across patients and tasks resulting in a distribution of severity levels. In spontaneous speech the average length of stuttered sequences in patient A was 17,6 seconds (range 13,1 22,0 s). With the SS% of 8,3 his stuttering severity was considered very severe. Patient Bs stuttering severity was also very severe (SS%=13,7, average duration 12,7 s). Patient Cs and patient Ds stuttering was evaluated to be mild (C: SS%=3,4, duration 2,8 s and D: SS%=3,4, duration 1,0 s). Patient Es stuttering severity level was moderate (SS%=5,4, duration 4,1 s). The new approach to assess neurogenic stuttering proved fruitful. It seems functional in that it takes into account both the frequency of stuttering in various discourses and the time lost in stuttering but also the specific features of neurogenic stuttering. The severity scale differentiates between speakers and tasks. Further research is naturally needed to test the new measures is larger samples and also in different languages. Learner Outcomes: discuss the characteristics of neurogenic stuttering after TBI; understand the complexity in stuttering evaluation when patient have cognitive deficits after TBI and learn a new analyzing method and a new evaluating scale. After this poster session the participants will understand that the classical methods used in evaluation of developmental stuttering (like SSI-3) are not reliable when evaluating neurogenic stuttering because they do not take into account cognitive problems or physical deficiencies. In poster session we would like discuss of the other stuttering-like disfluencies because they were observed in the study.
P143
LISTENERS PERCEPTIONS OF DIGITALLY MANIPULATED MOMENTS OF HESITATIONS NORIMUNE KAWAI (1) THE CENTER FOR SPECIAL NEEDS EDUCATION RESEARCH AND PRACTICE, HIROSHIMA UNIVERSITY, HIROSHIMA, JAPAN (1)
Abstract: This study examined how listeners perceive hesitations as a part of stuttering behavior when the number and duration of silent moments within a passage were altered. Sixty Japanese listeners participated in this study. The results showed that when frequency and duration of hesitations increased, the listeners perceived them as stuttered Learner Outcomes: Understand that listeners perceive speech as stuttered when frequency and duration of hesitations increased, and know that listeners do not pay much attention to silent hesitations that occur 5% of the time even when they occur for about half a second in duration.
P146
DEVELOPMENT AND EVALUATION OF A CYBERTUTOR ABOUT HEARING HEALTH CAMILA DE CASTRO CORRA (1) - RICELLY AVILA DA SILVA (1) CSSIA DE SOUZA PARDO-FANTON (1) WANDERLIA QUINHONEIRO BLASCA (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, SO PAULO, BRAZIL (1)
Abstract: The Cybertutor (electronic tutor) is a technology of information and communication which enables the availability of health information, by means of joining several resources that motivate users. This tool is considered converging to dissemination of knowledge about hearing, aiming to prevent hearing disorders and precociously treat them when needed, besides
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SPEECH RATE CHARACTERISTICS OF FUTURE SPEECH LANGUAGE PATHOLOGISTS LAUREN LIPUMA (1) - MICHELLE BACH (1) - ELISA PITCHON (1) - MARK PELLOWSKI (1) DEPARTMENT OF AUDIOLOGY, SPEECH LANGUAGE PATHOLOGY, AND DEAF STUDIES, TOWSON UNIVERSITY, TOWSON, MD., UNITED STATES (1)
Abstract: This investigation assessed the relationship between student clinicians expressive and perceived speech rate, and how it relates to the
the social inclusion of hearing impaired patients. Also, virtual learning environment, is a rich resource of TICs which provides support to several activities of teaching, in the case of this study it was used to insertion of information about Hearing Health, emphasizing basal concepts about sounds, hearing, hearing skills, hearing loss (causes and consequences) possibilities of hearing and audiology intervention and prevention of hearing alterations. Although, it is verified the importance of evaluates the language level used in such contents and the subjective perception of target public to improving the tool. It was aimed to develop and insert contents about hearing health in a Cybertutor and evaluate the legibility level (objective) and the quality of the content and the material available (subjective). To develop the contents, it was used textual and audiovisual resources, based on scientific publications, selecting, summarizing and adapting the material language, besides the use of audiovisual resources, like videos of the CD-ROM Virtual Man of Hearing, to make the educational material motivator and attractive. Using to evaluate, in an objective manner, the Flesch Reading Facility Index (FRFI) and, subjectively, with a questionnaire created by the research authors answered by 10 students of the 9th grade. It was developed two modules about hearing health: Hearing Health and Intervention and Rehabilitation, receiving respectively FRI score 50.8% and 51.14%, it was required, as minimum level of instruction, the Elementary School graduation (in Brazil, 6th to 9th grades) for the comprehension of the material. Concerning the language and the material of the contents inserted in the Cybertutor, the students evaluation was: 55.5% as excellent, 38.2% as satisfactory, 6.3% reasonable and 0% as unsatisfactory. The contents inserted in the Cybertutor about hearing health presented a facilitator level of language for age of the target public, and also verified a good subjective evaluation of students, promoting the access to information. Learner Outcomes: Knowing the development process of hearing health Cybertutor, Create the contents in a Cybertutor about Hearing Health, 3. Evaluate the legibility level, objectively, and the quality, subjectively, of Cybertutor.
P148
KANAZAWA METHOD-BASED LONG-TERM STUDY ON LANGUAGE DEVELOPMENT IN A CHIL WITH SEVERE HEARING IMPAIRMENT HIROMI HARADA (1) - MASAKO NOTOYA (2) - KAHORU HASHIMOTO (2) - SATSUKI ADACHI (1) - MAKOTO ITO (2) TOMOKAZU YOSHIZAKI (2) SEIREI CHRISTOPHER UNIVERSITY, UNIVERSITY, HAMAMATSU, JAPAN (1) - KANAZAWA UNIVERSITY, UNIVERSITY, KANAZAWA, JAPAN (2)
Abstract: In Japan, delays in the development of vocabulary and syntactic processing have been reported in children with hearing impairment even when using cochlear implants. To address this problem, we focused on sign and written languages, and adopted a language training method using them (Kanazawa method) for children, including 0-year-olds, in addition to auditory-oral approaches, based on the idea that it is possible for children with hearing impairment to sufficiently develop vocabulary and syntactic processing during the infantile period, using not only auditory-oral language, but also written language. This study retrospectively examined 1 infant with severe hearing impairment, focusing on her development of vocabulary and syntactic processing. She was initially diagnosed through the neonatal hearing screening system, and underwent consultation at our hospital at the age of 5 months; at that time, her hearing level was more than 115 dB, and she began to use a hearing aid. At the age of 2 years and 5 months, the use of cochlear implants was initiated. To support the childs development of vocabulary and syntactic processing, we analyzed developmental records by her parents and her sentences created without postpositional particles. Results were as follows: 1) Following the initial appearance of two-word sentences using sign language without particles at the age of 1 year and 6 months, training enabled her to communicate with her parents using various sentences with 10 types of particle. 2) Training based on the developmental records enabled her to communicate using various sentences with 14 types of particle before 2 years and 3 months of age. 3) Sentences with 11 types of particle were created in one month at the age of 2 years before starting to use cochlear implants; 8 of them were case-making. 4) At 6 years of age, her speech development was favorable; on WISC III-based assessment, she showed a verbal IQ score of 116, and a performance IQ score of 107. She was able to write letters, and create her own stories. In this study, the Kanazawa method supported the possibility of providing training for the appropriate use of particles even during the infantile period, based on behavioral developmental records by the parents and the childs own sentences, and promoting the development of vocabulary and syntactic processing in both auditory-oral and written languages. Learner Outcomes: Acquire oral language for children with severe hearing impairment ; Sufficiently develop her language abilities during the infantile period; To be able to acquire of functional words which are very difficult for hearing-impaired children; Catch the verbal IQ sufficiently; Transfer from Sign language to oral language
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HEARING HEALTH EDUCATION IN BRAZIL WANDERLIA QUINHONEIRO BLASCA (1) - CAMILA DE CASTRO CORRA (1) - CSSIA DE SOUZA PARDO-FANTON (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, SO PAULO, BRAZIL (1)
Abstract: It is estimated that at least 5.7 million people in Brazil has disabling hearing impairment and the vast majority of them rely on services provided by the National Health System (SUS). The SUS offers free of charge hearing health care from prevention to treatment and management, including the provision of hearing aids and cochlear implants by means of low, medium and high complexity audiology accredited services located in different regions of the country. The new hearing health care policy approved by the Ministry of Health in 2004 aims to make available one high complexity audiology service for every 1.5 million habitants. This hearing health care net is still in development and so far the majority of the cities provided with SUS services are located in the Southeast region of Brazil. Nowadays, it is believed that, to develop education is to create new strategies for information access, providing a better interaction between student and knowledge. Thus, an important project in Telehealth is the Project Young Doctor. This project is a multi-professional activity, which use resources of Telehealth, Interactive Teleducation and Virtual Man Project, aiming to motivate students of high school and elementary and undergraduation to develop co-operative works that promote health and improve the life quality in communities by academic-university tutoring. This study aims to create a collaborative learning networking as an educational pattern in hearing health, capacitating students of elementary and high school about the theme hearing health, emphasizing aspects of prevention, diagnosis, rehabilitation, but mainly, the population orientation about aspects of bullying and social inclusion of the hearing impairment persons in school and society. With interactive dynamics, the themes created by undergraduate and graduate students, had involved students of elementary and high school in the developing of strategies to learn about hearing abilities and the prevention of possible hearing disorders caused by electronic equipments, which were transmitted by the young doctors to the community. To develop the Young Doctor Project, as support to the proposal was created and developed the Telehealth League of the Bauru School of Dentistry USP aiming among its objectives, provide support to projects in the Telehealth and Teleducation area, one of these, it is the Young Doctor Project, emphasizing the SpeechLanguage and Hearing area, that results on the hierarchy of knowledge, specifically about communication disorders. Based on these affirmations, it is evident that actions directed to education and health thematic, are of great relevance in national scenario. In sum, all and any action, as the proposal of this study, which are guided by the premise of improvement and capacitation of professors and students must be stimulated by educational practices, especially those that approach Teleducation. Learner Outcomes: Knowing the actions of health promotion in themes related to Hearing Health, according to the pattern of the Young Doctor Project; Knowing some Technologies of Information and Communication to motivate the hierarchy of knowledge; Describe the results of Young Doctor Project actions done in Brazil about Hearing Health
P149
ACOUSTIC CHANGES OF SPEECH SIGNAL AFTER COCHLEAR IMPLANTATION AT THE AGE OTHER THAN OPTIMAL KATARINA PAVICIC DOKOZA (1) - ADINDA DULCIC (1) KORALJKA BAKOTA (1) SUVAG, POLYCLINIC, ZAGREB, CROATIA (1)
Abstract: In this research we examine the precision of time and place adverbs used by hearing impaired students with cochlear implants. EXAMINEE SAMPLE - The survey was carried out on 9 hearing impaired examinees diagnosed anacusis, with cochlear implants. The average chronological age of examinees is 13.2 years. The control sample consists of 7 students of age equal to the age of experimental sample and of normal hearing and speech status. TIME AND PLACE OF EXAMINATION The examination has been in writing and carried out in one of the Zagreb elementary schools where hearing impaired examinees are integrated and in one of the Zagreb regular schools. It has been done during 2011. MEASURING INSTRUMENT - Lexical knowledge has been examined by series of examination tests. Examination tests are arranged in sets of 10 tests in each set. Examination test series has 20 questions in total. METHOD OF ANALYSIS - Results analysis from the area of language development testing of hearing impaired examinees has been carried out at the level of descriptive statistics. The differences between the groups of examinees in relation to some variables have been identified by the one-way analysis of variance. GOAL OF RESEARCH - We wanted to examine the acquisition of language denotation of time and place adverbs in hearing impaired examinees with cochlear implants. HYPOTHESIS Following the goals defined by research we started from the hypothesis: H1 There is statistically significant difference in acquisition of time adverbs between hearing impaired examinees with cochlear implants integrated into regular schools and normal hearing examinees; H2 There is statistically significant difference in acquisition of place adverbs between hearing impaired examinees with cochlear implants integrated into regular schools and normal hearing examinees. CONCLUSION The comprehension of time and place adverbs with their concrete and general characteristics
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significantly influences the functioning of speech, language and speechlanguage thought. The examinees with cochlear implants show that they know how to use time and place adverbs, but that they have difficulties when adverbs are placed in complex sentences in inversion and when they are not defined by concrete characteristics
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EPIDEMIOLOGICAL ASPECTS OF HEARING HEALTH WITH EMPHASIS IN CERUMEN IMPACTION IN INSTITUTIONALIZED ELDERLY OF BAURU, SO PAULO, BRASIL ALINE ARAKAWA RAFAEL DAMASCENO (1) - (1) - ELEN FRANCO (1) - CRISTINA SANTO (1) - JOS ROBERTO BASTOS (1) MAGALI CALDANA (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: The aging process includes a natural phenomenon marked by gradual organic change, reflected in the cultural, social and emotional aspects. In particular, the sensory field, there are the hearing disorders such as presbyacusis. However, the possible causes of hearing loss propulsion, a sometimes overlooked determinant is called cerumen impaction. In addition to these, in this age group, is considered limited the health care hearing. So, the objective of this study was perform an epidemiological survey on hearing health, emphasizing the presence of cerumen impaction in elderly residents of an ILPI from the city of Bauru, SP. The sample was composed of 22 elderly nursing home residents, who underwent an initial questionnaire about hearing health, and an inspection of the external ear canal. In the results, could observe a considerable awareness of hearing loss (41%) and pain (36.4%), and a low percentage of residents who hold consultations to speech language pathologist (23%) and that did audiological tests (36%). Regarding the cleaning of the external auditory canal, 91% made it and in 50% of these, the removal of cerumen is the key motivation. Already, among the items used for this procedure, fit, flexible rods, towel, matches, clamps and finger. In the inspection, 55% had impaction, and in 42% it was bilateral. Therefore, were concludes that there was a high incidence of cerumen impaction of the residents, which perform the cleaning of the ear canal erroneously. Highlight for the low level of visits speech language pathologist to and audiological tests. Learner Outcomes: Identify the prevalence of cerumen impaction in elderly residents of a Long Permanence Institution of Bauru, So Paulo, Brasil; Characterize the hearing health of the elderly residents of a Long Permanence Institution of Bauru, So Paulo, Brasil; Compare the presence of cerumen as the various items used in hygiene hearing
loss was found hiperbilirrubina, ICU for a period exceeding five days, ototoxic drugs, mechanical ventilation for longer than five days, a family history of hereditary hearing impairment, congenital infections and syndromes associated with conductive or sensorineural hearing loss. In variable rates of Apgar at 1st and 5th minute of life of the newborn was observed that most of the children had rates of 8 to 10. In newborn hearing screening, it was observed that 95.65% of newborns obtained result is 4.35% and failed, being referred for audiological evaluation. As a result, found no child with hearing loss, however, they should be monitored for the development of auditory function and language due to existing risk factors and the possibility of late onset hearing loss. Learner Outcomes: Knowledge about newborn hearing screening in premature; Knowledge about risk factors for hearing loss in premature babies.
P152
MEASUREMENT OF THE SIGNAL/NOISE RATIO IN CLASSROOMS OF CHILDREN USERS OF FM SYSTEM MARIA RENATA JOS (1) - VANESSA LUISA DESTRO FIDNCIO (1) REGINA TANGERINO DE SOUZA JACOB (1) - ADRIANE LIMA MORTARI MORET (1) - MARIA CECLIA BEVILACQUA (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Noise is a factor that contributes negatively to the ability to understand speech, which can harm the development of children with hearing impairment. In classrooms, speech is rarely transmitted to children without interference Abstract: from background noise. At the same time, the effective transmission of auditory information is essential for better academic performance. In most learning environments, which further interferes so there is a good speech perception is not the type of noise or the overall level of background noise, but the signal / noise ratio. The FM system works as the most effective way to improve the uptake of speech signal and eliminate the effects of distance, noise and reverberation, especially in the educational environment. Objective: To evaluate the signal / noise ratio that the hearing impaired are exposed in school environment and compare with the speech reception threshold. Methods: The study was conducted in the Clinic of the Department of Speech Pathology and Audiology, University of So Paulo - Bauru and in public and private schools, with students with deaf and spoken language established, using hearing aids and/or IC coupled to FM System. The measurement of signal to noise ratio was achieved by the use of a portable digital recorder and an audio processing program computer, according to the technique of guarantee sound. To assess speech perception in noise was applied the Brazilian version of the Hearing in Noise Test (HINT), free field in two stages: first with the child using only their individual hearing aids and/or cochlear implant and a second time with an FM system coupled to the individual device. Results: All children had better speech perception in noise using the FM system. We observed that only in one classroom the signal/noise ratio is adequate for the hearing impaired. We found statistically significant differences between the values of the s/r in different positions, showing that the position of the student in the classroom really affect the quality of the s/n a which it is exposed. It was also proven that the higher the number of students, the lower the ratio s/n of the classroom. The s/n ratio of the classroom in real situations of learning showed up with a value closer to the s/n ratio in which the subject can understand speech with the use of FM, demonstrating that the use of the device is essential for best speech understanding in that environment. Learner Outcomes: understand the importance of establishing a signal / noise ratio appropriate in school environments; understand the need for methodologies to analyze the signal/noise ratio in school environments; understand the importance of the FM systems, especially for children with hearing loss in school age.
P151
ANALYSIS OF HEARING SCREENING IN PREMATURE DIONSIA APARECIDA CUSIN LAMNICA (1) - CAROLINE KAUFFMANN BECARO (1) - NAYARA SALOMO BARINI (1) - SIMONE ROCHA DE VASCONCELLOS HAGE (1) - KTIA DE FREITAS ALVARENGA (1) DEPARTMENT OF SPEECH AND LANGUAGE PATHOLOGY, SCHOOL OF DENTISTRY OF BAURU, UNIVERSITY OF SO PAULO, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: Prematurity is considered a biological risk factor for causing interference in typically developing children. Among the various dimensions, hearing plays an important role in the overall development of the child, especially in relation to language acquisition. Due to the large neuronal plasticity, the diagnosis of hearing impairment should be performed early in life, because this is a critical period considered and ideal for stimulation and development of auditory skills and language. The aim of this study was to characterize the profile of premature children for sex, maternal age, gestational age, mode of delivery, risk factors for hearing loss and audiological findings verify the premature children, born in 2008, who underwent Newborn Hearing Screening Maternity Santa Isabel in the city of Bauru / SP, which was the responsibility of the Department of Speech Pathology, School of Dentistry of Bauru / University of So Paulo. The survey was conducted through analysis of medical records of Hearing Screening Program, Clinical Speech Bauru School of Dentistry of Bauru, under the protocol of the ethics commission 037 547/2012. The inclusion criteria for this analysis were records of preterm infants, born between January to December of 2008, gestational age less than 37 weeks and appearing on the Statement of Consent. Research Transient Evoked Otoacoustic Emissions (TEOAE) was performed with the equipment Chapel, triage module, nonlinear stimulus clicks with peak 80dB SPL and window of 12.5 ms. It was considered the result is obtained when the presence of TEOAE with 70% reproducibility and signal / noise 6dB at frequencies of 2, 3 and 4 kHz, at the end of 2080 stimuli. We performed a descriptive statistical analysis containing values of absolute and relative frequency of the variables mentioned. The study consisted of 161 cases of premature infants screened in 2008. Of these, 55.27% are male and 44.73% female. As for the type of delivery, 50.31% of cases underwent cesarean. Regarding the variable maternal age was observed minimum age of 13 years. In relation to gestational age 93.16% of babies born between 28 and 36 weeks. According to birth weight, most children are between 1000 to 2500 grams. Among the risk factors for hearing
P153
EFFECTS OF SPEECH STIMULUS ON CORTICAL AUDITORY EVOKED POTENTIALS AND AUDITORY COGNITIVE P3 KTIA DE FREITAS ALVARENGA (1) - LETICIA CRISTINA VICENTE (1) - RAQUEL CAROLINE FERREIRA LOPES (1) RUBEM ABRO SILVA (2) - MARCOS ROBERTO BANHARA (3) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1) - FEDERAL UNIVERSITY OF SO CARLOS, FEDERAL UNIVERSITY OF SO CARLOS, SO CARLOS, BRAZIL (2) - SANTO ANTONIO HOSPITAL, SANTO ANTONIO HOSPITAL, SALVADOR, BRAZIL (3)
Abstract: Cortical auditory evoked potentials and auditory cognitive P3 reflect the functional use of the auditory system in response to auditory stimuli, providing information about the detection and discrimination, which is highly dependent of cognitive processes as attention and memory. Using speech stimulus to record the evoked responses is important for understanding how its complexity influences the characteristics of the cortical potential generated, as the latency and amplitude. The aim of this study was to characterize the cortical auditory evoked potentials and the P3 auditory cognitive potential with the vocalic and consonantal contrast stimuli in normal-hearing individuals. Thirty-one normal-hearing individuals in the age range between 7 and 30 years, participated in this study. The cortical
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auditory evoked potentials and the P3 auditory cognitive were recorded with the active electrodes positioned in Fz and Cz. Using an auditory oddball paradigm, a consonantal (/ba/-/da/) and a vocalic (/i/-/a/) speech contrast were used to elicit the cortical response. To evaluate the results, it was considered the latencies of N1, P2, N2 and P3 components and the amplitude of the P3 component obtained in the channels Fz and Cz with the two speech contrast stimuli. The component N1 was detected in 23/31 individuals; the P2 in 26/31 individuals; the N2 and the P3 in 29/31 individuals. It was observed a statistically significant difference between the speech contrast stimuli used and the latencies of the components N2 (p=0,00) and P3 (p=0,00), as well as between the active electrode considered (Fz/Cz) and the latency and amplitude P3 values. These correlations did not occur for the exogenous components N1 and P2. The speech contrast stimuli, vocalic or consonantal, must be taken into account in the analysis of the cortical auditory evoked potentials, component N2, and auditory cognitive P3. Learner Outcomes: Know the auditory evoked potentials and auditory cognitive P3 can be applied in clinic; Know the consonantal contrast value latencies are larger than the vocal contrast; Understand the importance of consider the type of stimulus in the analysis of the cortical auditory evoked potential and auditory cognitive P3.
P154
ARTERIOSCLEROSIS AS A CAUSE OF GENDER DIFFERENCES IN HEARING LOSS BASED ON ANTI-AGING HEARING DOCK FINDINGS KAZUYO MISE (1) - NOBUHIRO HAKUBA (1) YASUHARU TABARA (2) - KIYOFUMI GYO (1) EHIME UNIVERSITY, EHIME UNIVERSITY, TOON, (1) KYOTO UNIVERSITY, KYOTO UNIVERSITY, KYOTO, (2) JAPAN
Abstract: As part of a medical checkup for atherosclerotic diseases, an assessment called Anti-Aging Dock was established at our hospital; accompanying this, we opened an Anti-Aging Hearing Dock that focused on hearing issues in December 2009. The brachial-ankle pulse wave velocity (PWV) and intimal plus medical thickness of the carotid artery (IMT) were used to assess atherosclerosis. The IMT is the distance between the inner echogenic line, representing the intima-blood interface, and the outer echogenic line, representing the adventitia-media junction. The progression of age-related hearing loss is evaluated by measuring pure tone audiometry, the speech discrimination test, and the distortion product otoacoustic emission (DPOAE). Medical counseling was provided to each participant. This study evaluated the relationship between gender differences in hearing loss and the severity of arteriosclerosis or diabetes mellitus based on data from the Anti-Aging Hearing Dock. The study enrolled 212 people (89 men, 123 women) with a mean age of 68.0 (range 2688) years, who visited the anti-aging hearing dock from December 2009 to May 2012. This study included 381 ears with no history of ear disease or abnormalities. To evaluate the association of hearing loss with arteriosclerosis, multiple regression analysis modeling was used with hearing and hemoglobinA1c as dependent variables. The difference between males and females at each hearing threshold frequency and the IMT level were analyzed statistically using the Students t-test at the 5% significance level. Multiple regression analysis evaluated the relationship between age and the hearing threshold at all frequencies. The IMT was correlated with the hearing threshold at 18 kHz. The HemoglobinA1c level was not correlated with the hearing threshold at any frequency. The total average hearing threshold of males was significantly higher than that of females with statistical significance at 2 (P<0.05), 4, and 8 kHz (both P<0.001). In addition, the hearing threshold of males was significantly higher than that of females for the 4049-year-old group at 4 kHz, the 5059-year-old group at 8 kHz, and the 6069- and 7079-yearold groups at 4 and 8 kHz. The IMT level was significantly greater in males than females for the 6069- and 7079-year-old groups. Our results suggest that arteriosclerosis has a strong effect on progressive age-related hearing loss at high frequencies. Furthermore, this hearing threshold shift at highfrequencies in males might be affected by the significantly high IMT in males. We speculate that atherosclerosis is one of the major causes of hearing loss at high frequencies in males, rather than the influence of environmental noise. Learner Outcomes: understand the association between arteriosclerosis and age-related hearing loss; know that there are gender differences in the progression of hearing loss and arteriosclerosis; know atherosclerosis is one of the major causes of hearing loss at high frequencies in males.
of characteristics (latency and amplitude) between toneburst and narrow CEchirp stimuli on ABR recording was analyzed in normal hearing infants. Method: 500, 1000, 2000 and 4000 Hz toneburst and narrow band CEchirp auditory brainstem responses (ABRs) were recorded in 40 normal-hearing infants between 1 and 3 months. The amplitude and latency parameters of the ABR were collected for each of the four stimulus levels: 80, 60, 40, and 20 dB nHL. Both stimuli started from 80 dB nHL using alternating polarity and the rates were both 27.1/s. Results: The toneburst latencies are greater than narrow band CE-chirp latencies for all intensities at 500, 1000 and 2000 Hz (p<0,001). However, at 4000 Hz this difference was not significant. At 500 Hz, wave V amplitude is larger for toneburst than narrow CE-chirp (p < 0,001) in 80 dB nHL. The difference between the two stimuli in 60 dB nHL was not significant (p = 0.495) and at 40 and 20 dB nHL the wave V narrow band CE-chirp amplitude is greater than toneburst amplitude (p < 0.001). At 1000 Hz, 2000 Hz and 4000 Hz there is no difference between the wave V toneburst and narrow band CE-chirp amplitudes at 80 dB nHL (p = 0.940; p = 0.776 and p = 0.217 respectively). On the other hand, in the levels to 60, 40 and 20 dB nHL, narrow band CE-chirp amplitudes are larger than toneburst amplitude (p < 0.001). Conclusion: Narrow band CE-chirp ABRs generates shorter latencies than the toneburst ABRs, especially to low frequencies. Higher amplitudes were found with narrow band CE-chirp stimuli for all frequencies tested, except to high levels. Learner Outcomes: The participant will be able to follow up the efforts and the advances in the studies of new stimuli, focusing the improvement of electrophisiological measures in the Pediatric Audiology field. The NHS has brought the need to improve the tools which are used in order to estimate the hearing in young infants.
P156
THE MATURATION OF THE AUDITORY NERVE AND BRAINSTEM IN THE FIRST YEAR OF LIFE LETICIA CRISTINA VICENTE (1) - KTIA DE FREITAS ALVARENGA (1) - JOICY AMORIM (1) - RAQUEL SAMPAIO AGOSTINHO-PESSE (1) - LILIAN CSSIA BORNIA JACOBCORTELETTI (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: The electrophysiological threshold recorded with the brainstem auditory evoked potential (BAEP) using click in the early infancy is affected by the maturation of the auditory pathway. The maturation process may be different in children with risk factor for hearing loss, mainly the prematurity. The aim of this study is to evidence the maturational aspects of the electrophysiological thresholds recorded with the BAEP-click, considering the presence or absence of risk factors for hearing loss. The 115 exams of children with no hearing loss who underwent electrophysiological threshold testing with BAEP-click until one year of age were analyzed and divided according to age: G1- 0 to 1 month and 29 days; G2- 2 months to 5 months and 29 days; G3- 6 months to 11 months and 29 days, and according to the presence or absence of risk factors for hearing loss: P- with one or more risk factors and N - No risk factor. The Mann-Whitney test was used to compare the electrophysiological thresholds between the groups. No significant correlation was found between age, risk factors and electrophysiological thresholds; however 34 children with thresholds obtained initially with values of 30 to 60 dB HL, independent of the age, had normal audiologic function, with thresholds values in 20 or 25 dB HL in the follow-up. There was a variance on the electrophysiological threshold in the first year of life, similarly in the presence or absence of risk factors for hearing loss, which should be considered for accurate analysis of the results obtained in the recording of BAEP-click. Learner Outcomes: Understand the importance of the BAEP in children evaluation; Understand the influence of the auditory central maturation process in the BAEP threshold; Know the BAEP threshold values that we have found in normal-hearing infants.
P157
CHANGES IN ELDERLY ORAL COMMUNICATION: HEALTH KNOWLEDGE TRANSMISSION TO PROFESSIONALS IN THE AMAZON REGION ALINE MEGUMI ARAKAWA (1) - NATLIA CARLETO (1) ELEN CAROLINE FRANCO (1) - CRISTINA SANTO (1) ARIDNES OLIVEIRA (1) - MNICA FRANA (1) JOS ROBERTO BASTOS (1) - MAGALI CALDANA (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: The community health agente (CHA) is considered a health professional who has a key role in the Brazilian health system implementation because of their direct contact with the population, wich has increased in the number of elderly and their aging process. The purpose of this study was to evaluate a training program for CHA from Monte Negro, a Brazilian amazon city, about aging and its aspects related in Speech, language and Hearing Sciences and elaborate a CD-ROM with content covered in the
P155
COMPARING TONEBURST AND NARROW BAND CE-CHIRP AUDITORY BRAINSTEM RESPONSES (ABRS) IN YOUNG INFANTS GABRIELA I R RODRIGUES (1) - DORIS R LEWIS (1) PEPG EM FONOAUDIOLOGIA, PONTIFCIA UNIVERSIDADE CATLICA DE SO PAULO, SO PAULO, BRAZIL (1)
Abstract: The CE-chirp stimulus was developed to produce maximum simultaneous displacement along the cochlear partition by compensating for frequency-dependent traveling-time differences. The narrow CE-chirp stimuli are obtained by decomposing the broadband CE-Chirp into four components that constitute a subset of the CE-Chirp. Objective: the difference
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training program. The sample was constituted by 29 individuals, who were asked to fill a questionnaire about their socioeconomic status and another one about aging and its aspects related in Speech, language and Hearing Sciences, at a time before and after completion of the training course. The results pointed that in the socioeconomic analysis 90% of the sample was in the higher lower class, 79% lived in the rural area and 45% have completed high school. After the training program that only an area presented a worsening score (Oral facial motor skills) and the others (voice, audiology, speech and language, and general health) showed an improvement. The statistic analysis by each question applied and by each specific areas, respectively (McNemar and Wilcoxon Tests) showed statistically significant difference in Audiology (p<0,05). In the last meeting a CD-ROM was given to the participants and to the Department of Health with the content covered in the training program, and so the knowledge gained can be played in the local community, also allowing future reference all content developed. Thus, its been concluded that the training program met its objectives for the CHA forwarding knowledge for who needs to work with the community by providing quality of life improvements, with emphasis in Audiology. The preparation of the CD-ROM was important to record the content offered as well as to a subsequent query seeing there is no speech language therapist and audiologist there. Learner Outcomes: characterize Brazilian amazon regions CHA about their knowledge about the aging and its aspects related in Speech, language and Hearing Sciences before and after the completion of a training course; Show the importance of health education for health promotion; Provide knowledge to value human resources; show the Audiology as an area that has gained prominence in places where the community is in need of health care resources and away from major centers
P159
HEARING IMPAIRED CHILDREN AND COCHLEAR IMPLANT: LANGUAGE AND AUDITORY SKILL DEVELOPMENT ELIANE DELGADO PINHEIRO (1) UNIVERSIDADE ESTADUAL PAULISTA, UNESP, MARILIA, BRAZIL (1)
Abstract: In Brazil, efforts have been made by professionals so that the Public Health Policies contemplate important issues related to Hearing Health. The discussions and proposals address the early diagnosis of hearing loss, as well as speech therapy and adaptation of devices that provide access to speech sounds. These are important factors in order for auditory skills to be developed in an important period of neurological maturation, enabling the development of oral communication. The cochlear implant (CI) is a technological resource which enables profound sensorineural hearing impaired children have access to speech sounds. However, various factors can affect the development of auditory function. The aim of this study was to analyze the auditory and language performance one year after cochlear implant surgery in two children under similar conditions of speech therapy, family participation and different ages at the time of cochlear implant surgery. Methodology: The study included two children with pre-lingual profound sensorineural hearing loss using CI. The children were selected because they presented similar conditions: participation in a program with aurioral approach, time of CI use and auditory stimulation, CI type, speech processor and family participation. The difference between the two is in relation to the childrens age at the time of surgery (11 months and 33 months). Assessments were made one year after cochlear implant surgery. The interaction between mother and child was assessed by using the Lickert Scale for behaviors that involve language and hearing stimulation. The Minimum Auditory Capacity Evaluation Test (known in Brazil as TACAM) and Infant - Toddler Meaningful Auditory Integration Scale (IT-MAIS) were used to evaluate auditory skills. After the procedures, the auditory skills were classified according to the category of hearing. For language assessment, analysis of the medical records was performed, specifically in pragmatic situations of the language. We also used the Meaningful Use of Speech Scale (MUSS). After the procedures, the language of the children was classified according to the categories of expressive language. Results: In the analysis of interaction, the mothers had scores that often refered to hearing and language stimulation. The child who received CI at 11 months showed scores: TACAM 100%, IT-MAIS 97.5%, MUSS 100%. The child who received CI at 33 months showed scores: TACAM 91.6%, IT-MAIS 80% , MUSS 67.5%. Both children are in category 6 for hearing, recognizing open-set words and category 3 for expressive language, i.e., construct simple sentences, of two or three words. Conclusion: The data show that despite the difference in scores, after a year of CI use, the children reached the same categories of hearing and language. This aspect can be analyzed considering that even the child who received cochlear implants at 33 months, previously used individual hearing aids and, family participation is effective in a program with aurioral approach. Learner Outcomes: know the recent organization in public policies related to hearing in Brazil; know the categorization of language used in attending the hearing impaired in Brazil; 3) discuss the variables that affect the auditory function and language development.
P158
COCHLEAR FUNCTION AT ULTRA-HIGH FREQUENCIES IN PARENTS OF INDIVIDUALS WITH AUTOSOMAL RECESSIVE HEARING LOSS JAQUELINE MEDEIROS MELLO (1) - VALTER AUGUSTO DELLAROSA (1) - SEISSE GABRIELA SANCHES (2) ING UNIVERSITY -, UNINGA, MARINGA, BRAZIL (1) - SCHOOL OF MEDICINE - FMUSP, UNIVERSITY OF SAO PAULO, SAO PAULO, BRAZIL (2)
Abstract: Our objective was to assess cochlear function in the parents of individuals with autosomal recessive hearing loss by measuring distortion product otoacoustic emissions (DPOAEs) at conventional frequencies and at ultra-high frequencies, comparing the responses in the study group with those obtained from a group of gender- and age-matched controls. Method The study sample consisted of 56 individuals (age, 2058 years), who were divided into two groups: the study group, which comprised 28 individuals (14 females in the 2055 year age bracket [mean age, 32.8 years] and 14 males in the 2058 year age bracket [mean age, 35.2 years]) who were parents of individuals with autosomal recessive hearing loss; and the control group, which comprised 28 individuals (14 females and 14 males) who had no hearing impairment and were age-matched to those in the study group. The subjects underwent pure tone audiometry, tympanometry, and contralateral acoustic reflex threshold testing, together with DPOAE testing at conventional and ultra-high frequencies. Results Pure tone audiometry ( 2508,000 Hz) and contralateral acoustic reflex showed thresholds that were mostly within the normal range in both groups. There were no significant differences between the right and left ears or between the study and control groups in terms of the results of pure tone audiometry and contralateral acoustic reflex threshold testing. However, there were statistically significant differences between the study and control groups in terms of DPOAE levels, which were lower in the study group at all frequencies tested. Quantitative analysis of the DPOAEs at conventional and ultra-high frequencies showed that DPOAE levels tended to be higher in the control group than in the study group, although there were no statistically significant differences between the right and left ears in either group. Qualitative analysis of the DPOAEs at conventional frequencies and at ultra-high frequencies revealed that normal results were more common in the control group than in the study group. At ultra-high frequencies, 64.3% of the individuals in the study group showed normal results, compared with 91.1% of those in the control group, the difference between the two groups being statistically significant. The Z-test showed that, at ultra-high frequencies, the proportion of normal test results was significantly higher in the control group than in the study group (p=0.002). CONCLUSION: We found that DPOAEs at conventional frequencies and at ultra-high frequencies were both able to distinguish between study group individuals and control group individuals. This suggests that, in individuals with heterozygous mutations in the GJB2 gene, damage to the active process in outer hair cells occurs before it manifests clinically as abnormal results on basic hearing tests. Learner Outcomes : Know the auditory profile in parents of individuals with autosomal recessive hearing loss; Identify the differences between conventional and ultra-highfrequency DPOAE ;Understand that although the individuals with heterozygous mutations in the GJB2 gene and those without were found to be similar in terms of the results of basic hearing tests, they were found to be different in terms of DPOAEs.
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THEORY OF MIND AND DEAFNESS: IMPLICATIONS FOR LITERACY AND SOCIAL DEVELOPMENT ELIZABETH MARTINEZ (1) UNIVERSITY OF NORTH CAROLINA, UNIVERSITY OF NORTH CAROLINA, CHAPEL HILL, NC, UNITED STATES (1)
Abstract: Persons who are deaf or hard-of- hearing typically (DHH) exhibit low literacy (Lederberg, Schick, & Spencer, 2012). A recent investigation showed a median reading comprehension score for deaf 10 year olds that was equivalent to the average reading score of a hearing child in the 7th month of first grade; the median comprehension score for 17-year-old deaf students was equivalent to the average score for hearing children in the 5th month of third grade (Gallaudet Research Institute, 2004). DHH children exhibit deficits in both mapping the sounds of language onto print and broad language skills needed for comprehension. Understandably, DHH children have difficulty accessing the phonological code of English and without fluent access to the code, reading comprehension is compromised (Kelly & BaracCikoja, 2006). Difficulty in mastering the code and reduced vocabulary, however, cannot account for all the text comprehension difficulties exhibited by these students. Even DHH students who have adequate word recognition skills still exhibit difficulty with comprehension (Miller, 2010). For example, both prelingually deafened adolescents who used spoken English to read short narratives and prelingually deafened adolescents who watched the same narratives signed to them, responded no better than chance to questions about the passages that required temporal or causal inferences (Doran & Anderson, 2003). Studies also show that DHH children are at increased risk for exhibiting challenging behaviors, social-behavioral difficulties, and pragmatic communication difficulties. Compared to their hearing peers, deaf children show a lower self-esteem, fewer prosocial, and more withdrawn behaviors in the company of their peers; they feel less accepted, but more often rejected and lonely (Keilmann, Limberger, & Mann, 2007; Mejstad, Heiling, & Svedin, 2008). Furthermore, teachers and parents also
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report more emotional and behavioral problems in deaf children (Dammeyer, 2010). DHH children of hearing parents and late-signing DHH children typically are also quite delayed in cognitive ToM (attributing mental states to oneself and others and to understanding that others have beliefs, thoughts, desires, and intentions that are different from ones own) (Schick, de Villiers, de Villiers, & Hoffmeister, 2007). They also exhibit delays/deficits in affective ToM (recognizing and regulating ones own affective states and inferring the affective states of others). Findings from several studies have suggested that deaf children have difficulties with emotion identification (Dyck, Farrugia, Shochet, & Holmes-Brown, 2004; Ludlow, et al., 2010). They have difficulties describing emotions such as surprised or curious, indicating under what circumstances a person would experience such an emotion, and they use less effective emotion regulation strategies than hearing children (Rieffe, 2010). Cognitive and affective ToM are essential for making appropriate inferences in social interactions and academic contexts and regulating ones own learning and emotions; hence, ToM deficits can contribute to literacy and social difficulties. This poster will (a) describe ToM skills in DHH children and how deficits in ToM influence their reading comprehension and social skills, (b) give possible explanations for ToM deficits exhibited by DHH children, and (c) describe strategies to facilitate ToM development in DHH children. Learner Outcomes: Participants will be able to describe the theory of mind skills in deaf persons and persons with severe hearing loss and how these deficits influence reading comprehension and social skills; Participants will be able to give possible explanations for the theory of mind deficits exhibited by deaf persons and persons with severe hearing loss; Participants will be able to implement strategies to facilitate development of theory of mind in deaf persons and persons with severe hearing loss
P162
THE FUNCTIONAL AUDITORY PERFORMANCE INDICATORS APPLIED TO BRAZILIAN CHILDREN KARINA FERREIRA (1) - REGINA TANGERINO SOUZA JACOB (1) - MARIA CECILA BEVILACQUA (1) - ADRIANE LIMA MORTARI MORET (1) DEPARTMENT OF SPEECH PATHOLOGY. BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: Clinical tests have been developed to evaluate speech perception in young children in the matter to uncover the real improvements on their hearing skills after the use of individual hearing aids or cochlear implant. Standardized instruments should be used to assist children with all kinds of hearing loss, among them the Functional Auditory Performance Indicators (FAPI). Its evaluation creates an auditory skills profile after all items are applied in the seven hierarchical categories. FAPI covers all age groups, monitors childs hearing profile development and improves listening skills and the therapeutic intervention. The aim of this study was to apply the FAPI in Brazilian children with normal hearing, generate the expected score for each age group (birth to five years old), evaluate its reproducibility and prepare a Brazilian-Portuguese application manual. The selection process consisted with clinical interview, clinical otoscopy, acoustic impedance measurements and auditory behavior assessment in order to select a normal hearing population. Thirty children were selected and divided into ten groups according to their age, with interval of six months old. Afterward, ten children randomly selected were evaluated twice with approximately seven days in between by different examiners to verify the reproducibility of inventory application. It was found that the average time for children aged until 6 months the FAPI application lasted twenty minutes; one hour and half for children between 12 and 48 months old; and thirty minutes for children older than 48 months old. The minimum reproducibility inter examiners was 0.94 and it was prepared a manual with suggestions and rules for the FAPI application. The FAPI showed high reproducibility which enables its use by different examiners and different populations. The application manual was important to codify the application for all users. The inventory is a useful tool to monitor auditory skills development because it can be used in all ages and adapted to evaluation strategies. Learner Outcomes: reflect on the auditory perceptual assessment for hearing-impaired individuals; understand the need of standard evaluation protocol; know about the reproducibility and applicability of FAPI; 4. reflect on the hearing skills development.
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WHICH CHARACTERISTCS ARE ASSOCIATED WITH AUDITORY PROCESSING DISORDERS: A SYSTEMATIC REVIEW ELLEN DE WIT (1) - MARGOT VISSER-BOCHANE (1) - CEES VAN DER SCHANS (1) - BERT STEENBERGEN (2) - PIM VAN DIJK (3) - MARGREET LUINGE (1) PROFESSORSHIP IN HEALTH CARE AND NURSING, HANZE UNIVERSITY OF APPLIED SCIENCES GRONINGEN, GRONINGEN, NETHERLANDS (1) - BEHAVIOURAL SCIENCE INSTITUTE, RADBOUD UNIVERSITY NIJMEGEN, NIJMEGEN, NETHERLANDS (2) - DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD & NECK SURGERY, UNIVERSITY MEDICAL CENTER GRONINGEN, UNIVERSITY OF GRONINGEN, GRONINGEN, NETHERLANDS (3)
Abstract: After fifty years of research there is still debate on the concept of auditory processing disorders (APD). Academics and clinicians are far from reaching consensus on basic issues of definition, assessment, and diagnosis of APD. Therefore, we conducted a systematic review to examine: (1) the characteristics associated with APD; and (2) the overlap between the characteristics of APD with other disorders such as specific language impairment (SLI), dyslexia, attention deficit hyperactivity disorder (ADHD) and autism. The purpose of this systematic review is to decide whether APD can be regarded as a unique and identifiable clinical entity. A systematic search of the literature was conducted in 6 databases (PubMed, CINAHL, Eric, PsychINFO, Communication & Mass Media Complete and EMBASE) using the key words auditory processing, auditory diseases, central [Mesh], auditory perceptual, and auditory perception. Titles and abstracts of the selected articles were independently screened on the inclusion and exclusion criteria by two reviewers. Articles were considered eligible when the study contained subjects (<18 yrs.) with (suspected) auditory processing disorders, the articles were published in peer-reviewed journals, were written in English, and contained information about characteristics or symptoms of APD. Exclusion criteria were articles concerning participants with brain damage, neuropathy, cochlear implants or Down syndrome. Methodological quality of the selected studies was quantified using the ASHAs levels-ofevidence scheme. The two reviewers, blind to each others results, appraised each study on the basis of this scheme. A total of 2781 citations were identified of which 54 articles met the inclusion criteria. Preliminary results showed no support for the existent of APD as a unique and identifiable clinical entity. No symptoms which are specifically attributed to problems in the auditory modality were found in the included studies. Methodological quality of most included articles was questionable because of small and heterogeneous groups of participants, large variation in the criteria used for diagnosing APD, and comorbidity within the included participants. Learner Outcomes: know the controversies on auditory processing disorders; know the characteristics of auditory processing disorders found in the literature; know if APD should be considered as a unimodal disorder, an auditoryspecific dysfunction of speech sound processing, or a multimodal disorder representing a larger processing deficit.
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THE PECULIARITIES OF PRONUNCIATION OF ORAL SPEECH AND ITS SELF-CHECKING OF DEAF CHILDREN DENISOVA OLGA ALEXANDROVNA DENISOVA (1) KAZANSKAYA VERA LVOVNA KAZANSKAYA (2) INSTITUTE OF PEDAGOGY AND PSYCHOLOGY / THE DEPARTMENT OF SPEECH PATHOLOGY EDUCATION, CHEREPOVETS STATE UNIVERSITY, CHEREPOVETS, RUSSIAN FEDERATION (1) - THE DEPARTMENT OF PRESCHOOL DEFECTOLOGY, MOSCOW PEDAGOGICAL STATE UNIVERSITY, MOSCOW, RUSSIAN FEDERATION (2)
Abstract: An experimental study of the pronunciation of oral speech and its self-checking by deaf children of the senior preschool age was realized by the authors. The researches by Rau F.F., Rau F.A., Beltyukov V.I., Bagrova I.G., Volkova K.A., Denisova O.A. Leongard E.I., Pelymskay T.V., Slezina N.F. Shmatko N.D. are put in a basis of work. For research the authors analytical technique that allows to control the quality of pronunciation of deaf children of preschool age was used. It lets the teacher understand the speech of the child, his real achievements and real progress of the child in formation of oral speech. Experimental observation allowed to define the peculiarities of the pronunciation of oral speech of deaf children of the senior preschool age; to reveal uncontrolled by the child defects of pronunciation which are reflected in reproduction of sound-syllabic structure of words of deaf children; to trace the dependence of average phonetic formation of speech and an indicator of distinctness of a pronunciation on the degree of formation of skill of self-checking over a pronunciation of deaf preschool children. Diagnostic tasks were aimed at examination of the various sides of pronunciation: speech breath, unity, voice, sounds of speech, verbal stress, tempo of speech, rules of an orthoepic pronunciation. They also included researches of distinctness of speech and self-checking of pronunciation. During the experimental study the attention was paid to dependence of phonetic registration and distinctness of speech on formation of self-checking of pronunciation of deaf children. 156 deaf children of the senior preschool age participated in research at different stages (decrease in hearing more than 90 db - decibel). The analysis of the received data allowed to describe peculiarities and typology of mistakes of the various sides of oral speech of deaf children. Analyzing the received results, we carried out: childrens speech breath doesnt comply the program requirements; 28% of children dont have gross violations in the voice concerning force, height and a timbre; the indicators of a pronunciation of sounds by deaf children is the highest 53%, but despite it speech of children contains a large amount of defects,
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replacements (regulated and independent), admissions; it was established that the verbal stress at reproduction of words and phrases isnt observed in cases of 75,3%, words are pronounced with the equal stress or the final syllable is allocated. Orthoepic rules arent observed in 88%. Violation of unity of pronunciation is noted in 73,6% (here the sound, syllable pronunciation of words and part word pronunciation belong), a large number of mistakes is observed at confluence of consonants (additional sounds are noted in 62,5%). As for reproduction of sound structure of the word, we must say that deaf children often dont realize even those opportunities which they have according to analytical check of a sound pronunciation. The average indicator of phonetic registration of speech of deaf children of the senior preschool age made - 32,9%. As a whole, the pronunciation of oral speech of deaf children of senior age is at a low level. The analysis of the results of our research of distinctness of speech of deaf children of the senior preschool age showed us that the average indicator of distinctness of speech of deaf children made 25,7%. As a result of the analysis of selfcontrol of pronunciation we carried out that purposeful self-checking was absent in 100%; in the process of our examination uniformity of receptions of self-checking (motive support were used by 11%, acoustical by 7,8%, tactile and vibration by 7,3%, visual by 5,5 by %) is revealed. Self-checking of sounds of speech was absent by 48% of children, of unity of speech and speech breath by 75%, the self-control of the tempo-rhythmic part of speech isnt created in 77%, of orthoepic rules by 88% of children. Our examination confirmed our assumption that one of the reasons of such condition of a pronunciation and distinctness of speech of deaf children is the absence of necessary knowledge and nonformation of skills of self-checking of the pronunciation of oral speech. Learner Outcomes: An experimental study of the pronunciation of oral speech and its self-checking by deaf children of the senior preschool age was realized by the authors. 156 deaf children of the senior preschool age participated in research at different stages (decrease in hearing more than 90 db). The analysis of the received data allowed to describe peculiarities and typology of mistakes of the various sides of oral speech of deaf children. For research the authors analytical technique that allows to control the quality of pronunciation of deaf children of preschool age was used. It lets the teacher understand the speech of the child, his real achievements and real progress of the child in formation of oral speech. Experimental observation allowed to define the peculiarities of the pronunciation of oral speech of deaf children of the senior preschool age; to reveal uncontrolled by the child defects of pronunciation which are reflected in reproduction of sound-syllabic structure of words of deaf children; to trace the dependence of average phonetic formation of speech and an indicator of distinctness of a pronunciation on the degree of formation of skill of self-checking over a pronunciation of deaf preschool children. The analysis of the pronunciation of oral speech of deaf children of the senior preschool age allowed us to draw the following conclusions: speaking about the pronunciation of oral speech unevenness in assimilation of the various sides of a pronunciation is revealed; unevenness of a condition of skills appears because of deaf preschool children of senior age have more perfect skills in a pronunciation of sounds in comparison with a voice, observance of norms of an orthoepy (rules of correct pronunciation), speech breath, a verbal stress, tempo of speech. Low level of pronunciation skills and distinctness of speech is noted at deaf children of the senior preschool age due to the lack of conscious self-checking of the pronunciation of oral speech. The pronunciation of oral speech of deaf children of the senior preschool age is in direct dependence on formation of skills of self-checking of it.
Learner Outcomes: The participant will be able to learn how to perform a Tone-ABR, which parameters should be used, and how to correctly understand the results . Some difficulties on collectin data will be brought up.
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THE DEVELOPMENT OF AUDITORY PROCESSING TEST BATTERY FOR CHILDREN BEY-LIH CHANG (1) - FANG-LIU SU (2) DEPARTMENT OF SPECIAL EDUCATION, NATIONAL TAIWAN NORMAL UNIVERSITY, TAIPEI, TAIWAN, PROVINCE OF CHINA (1) - SPECIAL EDUCATION CENTER, NATIONAL TAIWAN NORMAL UNIVERSITY, TAIPEI, TAIWAN, PROVINCE OF CHINA (2)
Abstract: In order to screen, to make a diagnosis, and to decide the need for future investigation for children with auditory processing disorders, the purpose of this study was to develop an Auditory Processing Test Battery for children aged from 6-12. According to the listening characteristics of children with auditory processing disorders and the definition made by American Speech-Language Hearing Association in 2005, the Auditory Processing Test Battery for Children was developed. It included the Listening Behaviors Checklist and the Auditory Processing Tests. The Listening Behaviors Checklist was used as a tool for teachers to ascertain the likelihood that a child may be with auditory processing disorders. Beside the childs background information, there were three parts in the checklist: the frequency of auditory problems exhibited by the child (9 items), and the childs listening skills, as compared with peers in quiet and in noise (15 items respectively). The auditory domains and types of test measures of Auditory Processing Tests were: (1) Auditory discrimination tests: including frequency discrimination (12 items), and tone discrimination (18 items); (2) Auditory temporal processing tests: including duration discrimination (16 items) and gap detection (22 items); (3) Dichotic listening test: dichotic digits (12 items); (4) Low redundancy speech test: including digits in competing (48 items), filtered speech (10 items), compressed speech (24 items); (5) Binaural interaction test: lateralization (30 items). Each test contained direction, 2-3 practice items and formal items. Concerned about childrens attention and motivation of making responses, a computerassisted system was designed and used. Low linguistic loading and time of testing were also considered. The preliminary results were as follows: For the Listening Behaviors Checklist, 1852 children (981 male, 871 female) from kindergarten to 5th grade were screened by their room teachers. The expert validity, item analysis, Cronbach , and factor analysis were used to test the reliability and validity of the checklist. The results were satisfactory. For the Auditory Processing Tests, 138 Children screened from the checklist as the suspected group with auditory processing disorders. Another 138 children without auditory processing disorders and any other significant disabilities were chosen as match group. There were matched on gender and grade distribution. Both groups will be assessed by pure tone audiometry firstly in March to May, and only those whose pure tone average and all tested frequency thresholds were less than 25 dB will receive the Auditory Processing Tests with their most comfortable level. And the results will answer the reliability, validity, sensitivity and specificity of the Auditory Processing Tests. Learner Outcomes: the procedure of development of the Auditory Processing Test Battery for children in Taiwan; The reliability, validity, sensitivity and specificity of the Auditory Processing Test Battery; The challenges of developing the test battery and suggestions of the application of the battery.
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RELATIONSHIP BETWEEN FREQUENCY-SPECIFIC AUDITORY BRAINSTEM RESPONSE AND BEHAVIORAL THRESHOLDS IN CHILDREN WITH HEARING LOSS NATLIA RAMOS (1) - MABEL GONALVES ALMEIDA (1) DORIS R LEWIS (1) PEPG EM FONOAUDIOLOGIA, PONTIFICIA UNIVERSIDADE CATLICA DE SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Introduction: The Frequency-Specific Brainstem Auditory Evoked Potential (FS-ABR or Tone-ABR) contributes to the early diagnosis of hearing loss, once it allows a precise auditory assessment of infants and young children for different frequencies. Objective: To compare the results of ToneABR and behavioral auditory thresholds obtained on follow-op audiometry, at 0.5, 1, 2, 4 kHz in infants and young children with sensorineural hearing loss, by air and bone conduction. Method: Ten children up to three years old, diagnosed with sensorineural hearing loss, met the inclusion criteria in order to participate of this study. Tone-ABR and behavioral audiometry was registered for 0.5, 1, 2 and 4 kHz, by air and bone conduction. The results of both procedures were correlated (Pearson) in order to verify if ToneABR is able to predict auditory status of children with hearing impairment. Results: The results showed strong correlation for all frequencies tested by air-conduction; however, the bone-conduction testing showed a strong correlation at 0.5, 1 and 2 kHz, and moderate correlation at 4 kHz. Conclusion: The air and bone-conduction Tone-ABR at 500, 1000, 2000 and 4000 Hz showed good correlations between its results and the behavioral audiometry, and therefore, it is a useful tool in the hearing assessment of children under three years old.
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ASSOCIATION BETWEEN TEMPORAL AUDITORY PROCESSING AND PHONOLOGICAL AWARENESS IN CHILDREN WITH READING AND WRITING DISORDERS APARECIDO JOS SOARES (1) - SEISSE GABRIELA SANCHES (1) NADIA VILELA (1) - DBORA CRISTINA ALVES (1) RENATA M CARVALLO (1) - MARIA SILVIA CARNIO (1) UNIVERSITY OF SAO PAULO, SCHOOL OF MEDICINE (FMUSP), UNIVERSITY OF SAO PAULO, SAO PAULO, BRAZIL (1)
Abstract: Several studies have shown that individuals with reading and writing disorders may have a delay in the development of auditory skills which might interfere in the learning process. Phonological awareness is related to the skill of splitting words in shorter segments and it is linked to the performance in reading activities. Writing and reading disorders also involves the processing of temporal features of stimuli which can differ in sensorial characteristics according to the group of sounds spoken. Thus, it is necessary to investigate the possible association between the performance in phonological awareness and temporal auditory processing since the proper response of auditory processing has an important role in speech perception, learning process and language comprehension. This way, temporal auditory processing might be a prerequisite to reading and writing development. This study aimed to analyze whether there is association between temporal auditory tests and phonological awareness in individuals with reading and writing disorders. Children with either reading/writing disorders (confirmed after specific assessment) and normal hearing thresholds, aged between 8 to 12 years old, were subjects of this study. All subjects performed phonological
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awareness assessment using a standardized test to Brazilian Portuguese. In order to assess the auditory temporal processing it was used Duration Pattern Tests (DPT) and Frequency Pattern Test (FPT). The performance of students was compared to standardized values to children with typical development in the skills assessed in this study either to phonological awareness and auditory temporal processing. Descriptive analysis showed low performance in syllabic and phonemic activities of phonological awareness as well as in temporal auditory tests. Fisher Test indicated association between disorders in auditory temporal processing and phonological awareness (p>0,001) suggesting that disorders in temporal processing contributes to low performance in phonological awareness tasks. There was association between performance in temporal auditory tests and phonological awareness. Data found contributes to reflections concerning including temporal auditory assessment among procedures used in the assessment of individuals with reading and writing disorders. Learner Outcomes: know the source of relationship between auditory processing disorders and reading and writing disorders; understand why temporal auditory processing disorder can be related to reading skills; know why the temporal auditory processing training have to make part of the therapeutic program in reading disorders.
their preimplantation scores but performed less well than younger patients, probably due to differences in central temporal processing. Counseling, rehabilitation, psychological motivations and family support are important aspects that can influence implant outcomes. Learner Outcomes: know the controversies on auditory perceptual assessment in elderly patients with cochlear implant; understand the need of validated cognitive tools in the implanted patients; know the characteristic of the GDS scale and MOCA test; know the correlations between motivational status and cochlear implant outcomes.
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PHONIATRIC-AND SPEECH THERAPY MANAGEMENT IN AMYOTROPHIC LATERAL SCLEROSIS IN PIEDMONT VALENTINA PASIAN (1) - ELENA PIUMETTO (2) ANNA ACCORNERO (2) - ROBERTO ALBERA (2) - ADRIANO CHI (1) DIPARTIMENTO DI NEUROSCIENZE, UNIVERSIT DEGLI STUDI DI TORINO, TORINO, ITALY (1) - DIPARTIMENTO DI SCIENZE CHIRURGICHE, UNIVERSIT DEGLI STUDI DI TORINO, TURIN, ITALY (2)
Abstract: Once the disease has been diagnosed by the Neurology Service of the Regional Center for Amyotrophic Lateral Sclerosis (CRESLA), a timely and well-coordinated phoniatric and speech therapy intervention is implemented. Hereby we describe the activities organized in the dedicated clinic and we report case histories of the period 2011 to 2012, with an analysis of the clinical data of the patients studied together with their clinical evolution concerning the functions of communication and swallowing. Learner Outcomes: know the specific guidelines of ALS patients; understand the need follow up timing; understand different intervention programs, understand the important of daily management of communication and swallowing difficulties in ALS patients; know the important of teamwork.
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UNIVERSAL NEONATAL HEARING SCREENING PROGRAMME AT VENEZUELA RAMON HERNANDEZ-VILLORIA (1) MINISTERIO DEL PODER POPULAR PARA LA SALUD, INSTITUTO VENEZOLANO DE LA AUDICIN Y EL LENGUAJE, CARACAS, VENEZUELA (1)
Abstract: Introduction and aims of the study: Since 2011 it was began in Venezuela, a South America country, an Universal Neonatal Hearing Screening Programme (UNHSP), of public character and not yet obligatory by law. In Venezuela the birth rate is about 20 and was born near 570,000 in 2012. The aim of this presentation is to describe the design of the programme and the resources utilized for its onset. Methods: it was perform a mixture documental and information analysis on public released official files. Results: The programme comprises three phases. The first phase detects possible cases of hearing impairment utilizing otoacoustics emissions combined with AABR in the Rooms of Neonatology of ninety health centers, to the first 48 hours of life. The second phase utilizes ASSABR (by bone and air conduction), for the confirmation of probable cases in the Pediatrics Services, it applies between the 4 and the 24 weeks of life. The third phase, for the final diagnosis of the cases utilizes SSBERA in the Services of Pediatrics, Neurological pediatrics, Otology or Phoniatrics of 120 centers linked with 20 diagnostic units. These twenty diagnostic unitsnodes correspond to Services of Phoniatrics that are linked with a network of twelve Public Hearing Aids Laboratories and a National Cochlear Implant Protocol to develope. Conclusions: At present the UNHSP has a expected cover about 60% of the born in the country and expects to obtain the first hearing impairment incident results for December, 2012. Learner Outcomes: To know about the existence and status of the Universal Neonatal Hearing Screening Programme at Venezuela; To understand the proposed flowchart for the Programme based upon OAE, AABR, ASSABR and SSBERA ; To know the educational solutions developed for the training of specialized in auditory detection and diagnosis staff.
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TONGUE BASE HYPERTROPHY AS A CAUSE OF DYSPHAGIA MASSIMO SPADOLA BISETTI (1) - ANTONELLA CUSIMANO (1) AZIENDA OSPEDALIERA CITT DELLA SALUTE, OSPEDALE SAN GIOVANNI BATTISTA, TORINO, ITALY (1)
Abstract: Tongue base hypertrophy is capable determine hindrance of the pharingeal trigger with stagnation of food in the glossoepiglottical vallecules or hindering the movement of epiglottic tilt. Although its not dangerous, subjects could feel a subjectively sense of heavy uncofortableness. In this preliminary study 12 subjects were analysed with fibroendoscopic evaluation and afterward they were treated with drugs therapy. Learner Outcomes: Presence of symptoms of pharyngeal bolus with no history of clinical signs of dysphagia requires a deeper instrumental evaluation that could evidence a mechanical obstruction; the a greater incidence of the phenomenom in female subjects raises questions about correlation with presence of a majority of female patients raises the suspicion of a correlation with the idea of bolus hysterical . a definition used frequently in the past, as well as allows us to hypothesize a correlation with the hormone assay.
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OUTCOMES IN ELDERLY PATIENTS WITH COCHLEAR IMPLANT ALICE BENATTI (1) - ROBERTO BOVO (1) - VALENTINA CARRIERI (1) ALESSANDRO MARTINI (2) COU OF OTORHINOLARYNGOLOGY AND OTOSURGERY, PADUA, PADUA, ITALY (1) - COU OF OTORHINOLARYNGOLOGY AND OTOSURGERY - DEPARTMENT OF NEUROSCIENCES, PADUA, PADUA, ITALY (2)
Abstract: Profound hearing loss in the elderly is responsible for a significant reduction in quality of life due to social isolation, increased dependence, anxiety and depression that contribute to the worsening of cognitive functions. The aims of the present study are to review auditory outcomes, mental statement and personal satisfaction degree in subjects aged 65 years and older who underwent cochlear implantation at a tertiary referral center. A retrospective observational study was conducted on 47 implanted patients (age 65-85 years). At surgery time, 43 patients were affected by profound, bilateral and post-verbal hearing loss (progressive genetic deafness or sudden hearing loss in previous hearing impairment, meningitis, trauma, ototoxic drugs, severe otosclerosis) and 4 patients were suffering from congenital hearing loss. Auditory performances were evaluated with open-set word and sentence recognition testing. Cognitive functions and motivational status were assessed using the MOCA (Montreal Cognitive Assessment) test and the GDS (Geriatric Depression Scale). Furthermore, the personal satisfaction degree was evaluated with a specific questionnaire developed at our clinics. In conclusion, the elderly population showed significant improvement in auditory performance tests following cochlear implantation compared to
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AN ALGORITHM FOR MANAGING THE TREATMENT OF PATIENTS WITH SWALLOWING DISORDER EGLUTE SLIAUTERIENE (1) ABROMISKES REHABILITATION HOSPITAL, ABROMISKES REHABILITATION HOSPITAL, ABROMISKES, LITHUANIA (1)
Abstract: Managing the treatment process of patients with suspected dysphagia in Abromiskes rehabilitation hospital (Lithuania Republic) was implemented in 2010 with the purpose to avoid aspirations. The aim of the study is to form a managing algorithm which ensures maximal safety of the patients who were suspected to have a dysphagia. The additional result is presenting how the level of dysphagia was changed while the algorithm was used. A doctor, a speech therapist, the rehabilitation team and a dietitian were cooperating to ensure the best treatment of the patient and the algorithm illiustrates those connections. The efficiency of the algorithm was studied in 2010-2011 at Abromiks Rehabilitation Hospital. Hundred twenty-six patients, 74 males and 52 females, who was suspected of having dysphagia, were enrolled in this study during the 2-year period. The study showed that 106 patients reached higher level of dysphagia (using Dysphagia outcome and severity scale to evaluate the level of dysphagia) than they had in the begining of the treatment. Learner Outcomes: know the algorithm of management of patients with swallowing disorder; Understand the importance of speech therapist role in the treatment process; know the reliability of the algorithm
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CASE REPORT: COMBINED TREATMENT OF APHASIA AND APHONIA WITH SURFACE ELECTRICAL STIMULATION OF THE PHARYNGEAL MUSCLES ( VITALSTIM SYSTEM) MARCO ANDREOLI (1) - MARIUCCIA FRANZONI (1) - MARIA GRAZIA CATTANEO (1) ASL VALLE CAMONICA-SEBINO, ESINE HOSPITAL, ESINE, ITALY (1)
Abstract: Introduction: dysphagia is configured as one of the most complicated sequelae of cerebrovascular damage; it predisposes to an increased risk of lung infections, malnutrition, dehydration and serious deterioration in life quality. The only treatment deemed fit to treat dysphagia is represented by the ability of the swallowing rehabilitation therapist: the rehabilitation treatment is mainly based on the ability of the specialist to address the recovery of the swallowing function through compensatory mechanisms or facilitating postures. A few years ago an electro-medical equipment for the swallowing rehabilitation (VitalStim System) has been commercially introduced. It works by transcutaneous stimulation of the pharyngeal muscles and it has been designed to support the work of the therapist. Case report: female, 57 years old; in June 2011 had a surgery for cervical syringomyelia; she developed left hemispheric haemorrhage that required decompressive craniectomy and ventriculoperitoneal shunt. Post-operatively, the patient presented a semi-comatose state; tetraparesis, aphasia and tracheomalacia requiring cannula armed to the hull and continuous bronchial aspirations. During the hospitalisation at a different Rehabilitation Center she regained a good motor coordination along with a partial improvement of the degree of attention. Despite having undertaken adequate logopedic rehabilitation, she remained aphagic and totally dependent on the tracheal cannula. In May 2012 the patient was hospitalised at the our Department; during the admission screening it became clear that she had a salivary lake covering the entire larynx with continuous aspiration and hypomobility of the vocal cords. Method and Instruments: the patient has been treated with logopedic therapy associated to electro-stimulation of the pharyngeal muscles for a total of eight weeks, 30 minutes twice a day 5 times a week. During the treatment the patient has learned to control the secretions so that has been possible to position a Biesalsky cannula. She has been discharged in August 2012 while continuing to follow the electro-stimulation at home with the same frequency. In September 2012 the patient came back to our Department where she restarted the combined treatment. During the new period of hospitalisation it has been possible to recover a good level of consciousness and a semi total control of the secretions so that it was possible to position a Shilley cannula. A phonatory recovery followed by the patient capacity to swallow minimal quantity of water-gel was registered. The patient has been discharged in November 2012 and she is still undertaking the combined phonatory-logopedic therapy keeping the cannula completely closed during the whole day. The patient is waiting for another hospitalisation to remove the tracheostomy cannula and to refine the swallowing capacity. Conclusion: the standard logopedic treatment associated to the electro-stimulation of the pharyngeal muscles has allowed to recover a sever case of aphagia and dysphonia. The patient has the tracheostomy cannula closed since three months and she is waiting to conclude the rehabilitation cycle so to recover a functional swallowing activity. On our previous clinical experience, cases so complex like the one above did not achieve a sufficient recover to guarantee to the patient a discrete quality of life.
efficient patients care based on evidence based practice recommendations/ criteria. DPTs can optimize outcomes both in the acute care and home care settings. The Diagnostic and Therapeutic Pathway for dysphagia in adult and elderly patients, commissioned by the Piedmont Region (Department of Health Protection and the Regional Health Service - A.Re.SS), was published in 2013.Suggestions for a clinical pathway for oropharyngeal dysphagia in adults and elderly derived from prevalence and incidence high rates of complications, decreased quality of life and high social, health and economic impact of swallowing disorders. The multidisciplinary team defined two reference paths dedicated to home or nursing home patients and to in-patient hospitalized in acute care hospitals. The following steps guided the process of drafting the document: Scientific literature review aimed to identify guidelines, systematic reviews and recent studies related to oropharingeal dysphagia. Assessment of the guidelines selected with the AGREE 2 method and evaluation of evidence level, based on a shared grading system. Translation into Italian of selected recommendations and evidences about diagnostic, treatment and care of dysphagia.Elaboration of new recommendations done by the group experts involved, for those fields that were not covered by the selected literature evidence. This Diagnostic and Therapeutic Pathway aims to promote organizational and clinical integration between professionals and health organizations, increasing interventions uniformity and continuity of care for patients with oropharyngeal dysphagia. DTPs design tries to identify all best practice activities for the majority of patients, most of the time; it also include prompts for choosing the best activity at the appropriate time and references for ascertaining whether best actions have been carried out and if results have been as expected. In this way results are recorded and important questions and actions are not overlooked. Learner Outcomes: to define the Therapeutic Diagnostic Path of dysphagia describing the methodology used for its preparation; to promote organizational and clinical integration from professionals and health organizations; to promote uniformity and continuity of interventions for patients with oropharyngeal dysphagia, share practical tools for screening of dysphagia and malnutrition.
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APPLICATION OF SURFACE ELECTROMYOGRAPHY IN ASSESSMENT OF SWALLOWING FUNCTION IN DYSPHAGIC STROKE PATIENTS MEI-JU KO (1) - TYNG-GUEY WANG (2) - WEI-NI CHOU (3) BOR-SHYH LIN (4) - CHIN-HSING TSENG (5) DIVISION OF REHABILITATION MEDICINE., CHI-MEI MEDICAL CENTER, TAINAN, TAIWAN, PROVINCE OF CHINA (1) DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION., NATIONAL TAIWAN UNIVERSITY HOSPITAL, TAIPEI, TAIWAN, PROVINCE OF CHINA (2) - DIVISION OF REHABILITATION MEDICINE, CHI-MEI MEDICAL CENTER, TAINAN, TAIWAN, PROVINCE OF CHINA (3) - INSTITUTE OF PHOTONICS & OPTOELECTRONICS ENGINEERING., ASSISTANT PROFESSOR OF NATIONAL CHIAO TUNG UNIVERSITY., TAINAN, TAIWAN, PROVINCE OF CHINA (4) - GRADUATE INSTITUTE OF AUDIOLOGY AND SPEECH THERAPY, NATIONAL KAOHSIUNG NORMAL UNIVERSITY, KAOHSIUNG, TAIWAN, PROVINCE OF CHINA (5)
Abstract: Dysphagia is a common complication in stroke patient. It not only impedes the quality of life but also increases the risk of pulmonary complications and even mortality. The videofluoroscopic swallowing study are take as the golden standard methods to assess dysphagia. However, it cant be performed in the bedside. Our purpose is to investigate whether there is a difference of the sEMG during swallowing between normal population and stroke patients with dysphagia. After analyzing the signals, sEMG may be used as a quantifiable tools for dysphagia evaluation over the bedside. We obtained sEMG during swallowing, which consist of bilateral swallowing myoelectric signals, and compared the difference between stroke patients with dysphagia and normal population. We follow the method of Vaiman(2007) sEMG swallowing evaluation process when designing our study project. We recruited 20 stroke patients with dysphagia , and 20 normal subjects. Of all the participates, sEMG of four group of muscles(both sides) including obicularis oris,masseter,submental muscles and infra-hyoid muscles,during swallowing of 5 c.c. of water were recorded, Of the recorded sEMG, 7 variables such as baseline, average amplitude, peak amplitude, duration, peak latency, onset and offset relative to the orbicularis oris were analyzed. Results are as followed: 1.Independent t test was used to define the difference between the two groups. The results show that dysphagic stroke patients had significant slow onset in masseter, submental, and infrahyoid muscles and also slow in peak latency of submental muscles when compared with the normal subjects. The results implied that the dysphagic stroke patients had slow activation of swallowing muscles, indicating the probable delay triggering of the swallowing reflex and the timing of laryngeal closure during swallowing. These parameters are well known to be critical for safe swallowing. Instead, the strength of the tested swallowing muscles was intact when compared with the normal subjects; 2.When evaluating the relevant coefficient of all parameters and functional oral intake scale(FOIS),We found that only the average amplitude and peak amplitude of the masseter
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DYSPHAGIA IN ADULT AND ELDERLY PATIENTS: PRESENTATION OF A HEALTH CARE PATHWAY SPADOLA BISETTI MASSIMO (1) - MU ROSSELLA (2) VERNERO IRENE (3) - PALMO AUGUSTA (4) - ROVERA LIDIA (5) MANCINO VITTORIA (6) - FARINA ENZO C. (7) RAIMONDO SIMONA (8) PHYSICIAN PHONIATRIC, AUDIOLOGIST AND OTORHINOLARYNGOLOGIST, CITT DELLA SALUTE E DELLA SCIENZA, MOLINETTE HOSPITAL, TURIN, ITALY (1) - SPEECH AND LANGUAGE PATHOLOGIST, REHABILITATION DEPARTMENT ASL TO1, TURIN, ITALY (2) - SPEECH AND LANGUAGE PATHOLOGIST, UNIVERSITY OF STUDY OF TURIN, TURIN, ITALY (3) - NUTRITIONIST, CITT DELLA SALUTE E DELLA SCIENZA, MOLINETTE HOSPITAL, TURIN, ITALY (4) - NUTRITIONIST, MAURIZIANO HOSPITAL, TURIN, ITALY (5) - DIETITIAN, CITT DELLA SALUTE E DELLA SCIENZA, MOLINETTE HOSPITAL, TURIN, ITALY (6) - PHYSICIAN SURGEON, CITT DELLA SALUTE E DELLA SCIENZA, MOLINETTE HOSPITAL, TURIN, ITALY (7) - SPEECH AND LANGUAGE PATHOLOGIST, CITT DELLA SALUTE E DELLA SCIENZA, MOLINETTE HOSPITAL, TURIN, ITALY (8)
Abstract: Diagnostic and Therapeutic Pathway (DTP) is one of the most used tool for quality management and standardization of care. It has been shown that DTPs implementation can both reduce the variability in clinical practice and improve clinical outcomes. DPTs promote an organized and
is significantly related with FOIS. Therefore, we concluded that sEMG recorded can only reflect how the swallowing muscles activities but still cant be use to measure or interpret ones functional oral intake ability. Learner Outcomes: understand the basic knowledge about the swallowing physiology; Understand the basic knowledge about the surface electromyographic parameters; Know the meanings of functional oral intake scale
Learner Outcomes: correlate the swallowing disorders to the muscolar impairment using the MDRS Scale and the DOSS; plan the study of swallowing only for the patients who really need it.
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SEVERE ACQUIRED BRAIN INJURY AND TRACHEAL CANNULA: SPEECH THERAPY-PHISIOTHERAPY INTEGRATED APPROACH ROSSELLA BESSONE (1) - PATRIZIA CANCIALOSI (1) MELANIA SAFFILA (1) - ANNA MORRA (1) - MAURIZIO BEATRICI (1) DEPARTMENT OF THE PHYSICAL MEDICINE AND REHABILITATION 2, UNIVERSITY OF TURIN HOSPITAL CORPORATION CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, HOSPITAL UNIT C.T.O./ M. ADELAIDE, TURIN (TO), ITALY (1)
Abstract: The management of the person with severe acquired brain injury (ABI ) with endotracheal tube (TC) admitted to a tertiary hospital in early post-acute phase turns out to be complex and involve different areas of professional competence. This will require an integrated interdisciplinary approach involving multiple health professionals and that, in addition to the critical organizational and managerial, provides an opportunity to share and enhance the language and common knowledge. Central point of interest is the oro-pharyngeal airway crossroads, inevitably involved in following the placement of CET, resulting in disorders of the functions of respiration, phonation and swallowing. Aim of the study - With this work we want to present a possible way of taking care of the person with ABI and bearer of tracheal cannula aimed at the joint achievement of the common objectives speech therapy and physiotherapy-breathing. Methods - After a specific literature search, it was therefore outlined a possible speech therapy and breathing physiotherapy take charge on daily treatments, each for 30-45 minutes, according with the clinical condition of the patient. The people involved in this study were all suffering from severe acquired brain injuries in early post-acute rehabilitation phase and bearers of endotracheal tube. Results - Those results were recorded: greater attention to the needs of the person with TC by the entire department staff (even those who do not deal with him directly); difficulties in interprofessional communication but common perception of better management of the person with endotracheal tube and enhancement of professional skills of the therapists involved; reduction (containment) of complications related to TC; restart as soon as possible of oral nutrition without risk of penetration / aspiration. Conclusions - In conclusion, since the study thus showed the usefulness of a multidisciplinary management of people with ABI and TC, it is important to continue the project with expansion of the case studies and the consequent possibility to get more information for clinical practice and to identify the degree of appropriateness of integrated speech therapy - breathing physiotherapy approach with this type of patients. Learner Outcomes: give knowledge of rehabilitative objectives that are in common and differentiate speech therapy and respiratory-physiotherapy with people affected by ABI and bearer of tracheal cannula in the early post-acute phase; give knowledge and evaluate the possibility and advantages/disadvantages of an integrated speech therapy-breathing physiotherapy take charge.
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HISTOLOGICAL CHARACTERISTICS OF HUMAN LINGUAL FRENULUM ROBERTA LOPES DE CASTRO MARTINELLI, IRENE QUEIROZ MARCHESAN, REINALDO JORDO GUSMO, GIDRE BERRETIN-FELIX, ANTONIO DE CASTRO RODRIGUES CEFAC POST GRADUATION IN HEALTH AND EDUCATION, CEFAC, SAO PAULO, BRAZIL, UNICAMP, UNICAMP, CAMPINAS, BRAZIL, UNIVERSIDADE DE SAO PAULO, UNIVERSIDADE DE SAO PAULO, BAURU, BRAZIL
Abstract: The lingual frenulum is a small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the tongue. Recent studies have reported that the anatomic variations of the lingual frenulum may be justified by the persistence of midline sublingual tissue that did not undergo apoptosis during embryonic development, what may cause tongue movement restriction. In literature studies describing the histological characteristics of the human lingual frenulum were not found, except studies on dogs lingual frenulum histology. Knowledge of the histology of the lingual frenulum may contribute to differentiating the characteristics of each type of frenulum and to providing information about the presence of elasticity and the natural process of rupture reported in literature. The aim of this study was to describe the histological characteristics of human lingual frenulum. For this purpose, a lingual frenulum evaluation proposed by Marchesan (2010) was administered to 50 children from public schools. 8 children out of 50 had lingual frenulum alterations, being: 4 with anterior fixation; 1 with short frenulum; 1with short frenulum and anterior fixation and 2 with ankyloglossia. The 8 children underwent lingual frenectomy where the materials for analysis were taken from. 7-micrometerthick tissues sections were performed. Staining was employed using haematoxylin paired with eosin (H&E), Massons trichrome and picrosirius red. The lingual frenulum had the same constitution of the oral cavity mucosa. The different types of lingual frenulum had different constitution especially in relation to the presence of muscle fibers. The frenulum with ankyloglossia had significant bundles of muscle fibers scattered on the fold mucosa, and high frequency of collagen type I. The short frenulum also had some muscle fibers; however, in lower concentration when compared to the frenulum with ankyloglossia. The anterior frenulum was morphologically similar to the normal frenulum. The short frenulum with anterior fixation also had the same normal characteristics. The analysis of the histological sections demonstrated that the characteristics of the anterior frenulum and the short frenulum with anterior fixation were similar to the normal oral mucosa. Fascicles of striated skeletal muscle fibers and high density of collagen fibers type I were observed in short frenulum and in frenulum with ankyloglossia.
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SWALLOWING DISORDERS IN MYOTONIC DYSTROPHY TYPE 1 EMANUELE GOBBI (1) - ANTONELLO DAMIANI (1) - GIUSEPPE MARIA ANTONIO ALGIERI (1) - MARIA CRISTINA GORI (1) FLAVIA RUBINI (1) - MAURIZIO CRISPO (1) UNIONE ITALIANA LOTTA ALLA DISTROFIA MUSCOLARE ONLUS - SEZIONE LAZIALE, UNIONE ITALIANA LOTTA ALLA DISTROFIA MUSCOLARE ONLUS - SEZIONE LAZIALE, ROME, ITALY (1)
Abstract: Introduction: swallowing disorders are common findings regarding neuromuscolar diseases, particulary in myotonic dystrophy type 1 (DM1). Aim of this work is to correlate the swallowing disorder to the muscolar impairment. Materials and methods: 39 patients (mean age 48,15) are submitted to the clinical evaluation using Muscolar Disability Rating Scale (MDRS) and Dysphagia Outcome and Severity Scale (DOSS). The study of the swallowing mechanism was conducted through the standard technique, using a clinical test of the oral-tongue structures and an endoscopic assessment of the hypopharyngeal-laryngeal structures with a flexible instrument (FEES). Under endoscopic evaluation, swallowing tests with different thicknesses were conducted, digitally recording the whole procedure. Therefore, the correlation between MDRS and DOSS have been analysed, along with the statistical analysis of the critical 2. Results: 39 patients were included in the study. The totality of the patients was distribuited in a DOSS level between 6 and 5, while MDRS ranged from 1 to 5. Two patients had MDRS=1 (DOSS level 6=1; level 5=1), six patients had MDRS=2 (DOSS level 6=3; level 5=3); nineteen patients had MDRS=3 (DOSS level 6=2; level 5=17), eleven patients had MDRS=4 (DOSS level 6=1; level 5=10) and one patient had MDRS=5 (DOSS level 5). The analysis of the critical 2 revealed a statistically significant correlation between MDRS and DOSS (2 critic=27,64>13,28 - p=0,01)
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A DYNAMIC VIDEOFLUOROSCOPIC EVALUATION OF DYSPHAGIA IN PROGRESSIVE NEURODEGENERATIVE DISEASES SATOKO KASAI (1) - NORIKO NISHIZAWA (1) - ERIKA KUDOU (2) TOMOKO IIZUMI (1) - KENJI KINOSHITA (1) - FUMIYUKI SUZUKI (3) SEIJI KIKUCHI (4) DEPARTMENT OF COMMUNICATION DISORDERS, SCHOOL OF PSYCHOLOGICAL SCIENCES, HEALTH SCIENCES UNIVERSITY OF HOKKAIDO, SAPPORO, JAPAN (1) - DEPARTMENT OF REHABILITATION, SHINSAPPORO NEUROSURGICAL HOSPITAL, SAPPORO, JAPAN (2) - DEPARTMENT OF OTOLARYNGOLOGY, HOKKAIDO MEDICAL CENTER, SAPPORO, JAPAN (3) DEPARTMENT OF NEUROLOGY, HOKKAIDO MEDICAL CENTER, SAPPORO, JAPAN (4)
Abstract: Introduction and aims of the study: The UC Davis dynamic swallow study (DSS) is an analysis tool for the quantitative measurement of videofluoroscopy that allows the evaluation of gesture timing, bolus transit timing and structural displacement in dysphagic patients with reference to normative values. The authors have undertaken a preliminary test of the reproducibility of DSS analysis using normal Japanese subjects and confirmed that the normative values reported in the original article are applicable as a reference in Japanese subjects. Swallowing difficulty is one of the life threatening complications associated with progressive neurodegenerative diseases. However, the dynamics of these multi-centric swallowing disorders remain to be fully clarified in quantitative terms. In an attempt to evaluate the timing and structural displacement of swallowing in patients with neuromotor dysphagia, dynamic videofluoroscopic analysis was performed. Study design: Prospective observational study. Subjects: Patients with
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progressive neurodegenerative diseases who underwent videofluoroscopic examination of swallowing at Hokkaido Medical Center. The subjects were divided into three groups according to background disorder; motor neuron disease (MND), idiopathic Parkinsons disease (PD) and multiple system atrophy (MSA). Method: Lateral videofluoroscopic views during command swallow were recorded on a digital video recorder with a superimposed video timer. Analysis of timing and structural displacement was made offline in accordance with the DSS manual1). Parameters listed below were measured and compared to the normative DSS values 2, 3). 1. Bolus transit time: a. Oropharyngeal transit time: The time between the entrance of the head of the bolus into the oropharynx and its arrival at the valleculae; b. Hypopharyngeal transit time: The time between the arrival of the head of the bolus at the valleculae and the clearance of the tail of the bolus from the pharyngoesophaeal segment (PES); 2. Timing of airway protection: The timing of supraglottic closure relative to the arrival of the bolus at the PES; 3. Pharyngeal constriction ratio (PCR): The ratio of the pharyngeal area at maximum constriction to the pharyngeal area during oral holding of a small bolus. Results: A significant increase in oropharyngeal transit time was noted in patients with Parkinsons disease. Delays in airway closure were noted in patients with aspiration. The ratio of the pharyngeal area at maximal constriction to that at full expansion (pharyngeal constriction ratio) was significantly increased, suggesting pharyngeal weakness during bolus passage. Conclusions: The findings of the present study were compatible with the motor disturbances associated with the background disease. The DSS is thought to be a useful approach for the quantitative analysis of multi-centric swallowing disorders in neuromotor dysphagia.
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MANEUVER FOR VISUALIZATION OF POSTERIOR LINGUAL FRENULUM IN INFANTS MARTINELLI ROBERTA, MARCHESAN IRENE EFAC POST GRADUATION IN HEALTH IN EDUCATION, CEFAC, SAO PAULO, BRAZIL
Abstract: Differentiating anatomical variations of lingual frenulum requires extensive knowledge of the anatomy of the tongue and the floor of the mouth. Anatomic alterations of tongue and floor of the mouth may effect the tongue movements. Evaluating infants requires ability and experience. The evaluation must be quick, non-invasive, low risk, and must allow identification of possible lingual frenulum interferences with breastfeeding. A two-part protocol was designed to evaluate the lingual frenulum in infants (Martinelli et al, 2012). The first part consists of clinical history with specific questions about family history and breastfeeding. The second consists of the clinical examination including: anatomo-functional, non-nutritive and nutritive sucking evaluations. Although the protocol was considered an effective tool for assessing and diagnosing lingual frenulum, posterior frenulum was difficult to visualize by elevating the lateral margins of the tongue. The aim of this work is to describe a maneuver that assists visualization of posterior lingual frenulum. The lingual frenulum protocol designed by Martinelli et al (2012) was administered to 100 full-term healthy infants, aged 30 days. 29 infants had posterior frenulum; consequently, lingual frenulum visualization was not possible by elevating the lateral margins of the tongue. A new maneuver to assist visualization of posterior lingual frenulum was performed. The new maneuver consists of two actions: elevating and pushing back the tongue. The maneuver allows visualization and scoring of lingual frenulum thickness and attachment to the tongue and to the floor of the mouth, as proposed in the protocol. Visualizing the lingual frenulum is essential for a consistent diagnosis. The new maneuver has proven to be efficient to visualize the posterior lingual frenulum. Learner Outcomes: The Participant will be able to recognize a maneuver that assists visualization of posterior lingual frenulum.
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CHEWING AND SWALLOWING IN POMPES DISEASE AND MITOCHONDRIAL DISEASE ZELITA GUEDES (1) - NOEMIA CAROLINE SOUZA (1) LUIZA TELES BARRETO MENDES (1) - ANA MARIA MARTINS (1) ESCOLA PAULISTA DE MEDICINA - DEPARTAMENTO DE FONOAUDIOLOGIA, UNIVERSIDADE FEDERAL DE SO PAULO, SO PAULO, BRASIL (1)
Abstract: The work with rare diseases as hereditary metabolic disease in children needs a great knowledge about biochemistry, neurology and also dysphagia. It is necessary To know well the different diseases and their characteristics to help the patients in their feeding difficulties Learner Outcomes: The participant will see that different patients with different diseases have similar feeding difficulties that need specific care.
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RELATIONSHIP BETWEEN THE ANATOMIC CHARACTERISTICS OF THE LINGUAL FRENULUM AND SUCKING AND SWALLOWING FUNCTIONS IN INFANTS ROBERTA MARTINELLI - IRENE MARCHESAN GIEDRE BERRETIN-FELIX CEFAC POST GRADUATION IN HEALTH IN EDUCATION, CEFAC, SAO PAULO, BRAZIL, UNIVERSIDADE DE SAO PAULO, UNIVERSIDADE DE SAO PAULO, BAURU, BRAZIL
Abstract: Differentiating the anatomical variations of the lingual frenulum requires extensive knowledge of the anatomy of the tongue and the floor of the mouth in order to identify whether the findings may compromise the tongue movements and the orofacial functions. The aim of this study was to verify whether the anatomical variations of the lingual frenulum interfere with the sucking and swallowing in full-term infants. A specific protocol including clinical history, anatomical and functional evaluations was designed and administered to 100 healthy full-term infants. 16 infants had altered frenulum. By analyzing the data from the 16 infants with lingual frenulum alteration, it was possible to verify the characteristics that indicate alteration. In the anatomo-functional evaluation, the indicators were the tendency of tongue position during crying, the shape of the tip of the tongue when elevated, and the lingual frenulum attachment to the tongue. In the non-nutritive sucking evaluation all 16 infants demonstrated uncoordinated tongue movements. By evaluating nutritive sucking during breastfeeding, the analysis demonstrated that the infants with frenulum alteration had a few sucks with long pauses, uncoordinated sucking/swallowing/breathing, unsystematic or frequent tongue clicking as well as nipple biting. The shape of the tongue when elevated during crying and the lingual frenulum attachment to the tongue are anatomical characteristics of the lingual frenulum that interfere with the movement of the tongue during non-nutritive sucking and the rhythm of sucking during breastfeeding. From the results and the experience of administrating the protocol it was possible to diagnose the anatomical variations of the lingual frenulum that may interfere with the functions of sucking and swallowing during breastfeeding Learner Outcomes: The participant will be able to recognize when the anatomical variations of the lingual frenulum interfere with the sucking and swallowing in full-term infants.
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LINGUAL FRENOTOMY: CHANGES IN SUCKING AND SWALLOWING IRENE QUEIROZ MARCHESAN, SLPS; ROBERTA LOPES DE CASTRO MARTINELLI, SLPS; REINALDO JORDO GUSMO, ENT CEFAC POST GRADUATION IN HEALTH AND EDUCATION, CEFAC, SAO PAULO, BRAZIL, UNIVERSIDADE DE SAO PAULO, UNIVERSIDADE DE SAO PAULO, BAURU, BRAZIL
Abstract: The World Health Organization (WHO) has recommended exclusive breastfeeding for 6 months. Breast milk promotes sensory and cognitive development, and protects the infants against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhea or pneumonia, and helps for a quicker recovery during illness. Ankyloglossia has been increasingly cited as a cause for breastfeeding difficulties, although with much controversy. Several studies have suggested an elective conduct, indicating frenotomy, taking into account maternal complaints and latch-on difficulties. In the literature, the relationship between frenotomy and the functions of sucking and swallowing is not established. The aim of this work is to identify changes in the functions of sucking and swallowing in infants after frenotomy. For this a prospective longitudinal study was carried out on full-term infants of both genders. The lingual frenulum protocol for infants, proposed by Martinelli et al (2012) was administered. 12 infants were diagnosed with ankyloglossia, being 10 males and 2 females. The parents were informed about the need for frenotomy. An otolaryngologist performed all surgeries, and immediately after frenotomy, infants were breastfed. Mothers reported presence or absence of pain, as well as possible differences in sucking. After 30 days, nutritive sucking was re-evaluated using the same protocol. Pre and postsurgical data were statistically analyzed using T Test. Before frenotomy 5 infants had uncoordinated tongue movements, and all 12 infants had tongue cupping and strong sucks during non-nutritive sucking. During nutritive sucking, 4 infants showed frequent choking due to imprecise coordinating suck-swallow-breathe functions. Immediately after frenotomy, mothers breastfed their children, and all reported pain absence and appropriated latchon. In the re-evaluation, after 30 days, all mothers reported improvement in the feeding and sleeping cycles of infants. Post frenotomy data concerning nutritive sucking demonstrated improvement in the function of sucking. The 4 infants, who had frequent choking, were able to coordinate suck-swallowbreathe functions. It was possible to conclude that the functions of sucking and swallowing during breastfeeding improved after lingual frenotomy.
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RESULTS OF PILOT STUDY: APPLICATION OF CAREGIVER MEALTIME AND DYSPHAGIA QUESTIONNAIRE VITROTTI LAURA (1) - RAIMONDO SIMONA (2) BERGAMASCO LAURA (3) SPEECH AND LANGUAGE PATHOLOGIST, PRESIDIO SANITARIO AUSILIATRICE FONDAZIONE DON CARLO GNOCCHI ONLUS, TURIN, ITALY (1) - SPEECH AND LANGUAGE PATHOLOGIST, CITY OF HEALTH AND SCIENCE OF TURIN, MOLINETTE HOSPITAL, SERVICE OF OTOLARYNGOLOGY, AUDIOLOGY AND PHONIATRY., TURIN, ITALY (2) - FULL PROFESSOR OF EXPERIMENTAL PHYSICS, UNIVERSITY OF STUDY OF TURIN, TURIN, ITALY (3)
Abstract: Caregivers are key players in the management of patients with chronic dysphagia: the behavior of family members or caregivers is essential to ensure patient safety and to promote their quality of life. At the same time, the literature review documents that the lack of compliance of caregivers with speech therapists recommendations may be an important contribution to the swallowing and feeding problems of the patient with chronic dysphagia with consequent increased probability of aspiration pneumonia and other sequelae. Following an extensive literature review, useful to investigate the role of the caregiver in the management of adult dysphagic patients, the authors selected, translated and adapted to the Italian context the Caregiver Mealtime and Dysphagia Questionnaire. The original questionnaire was developed in 2008 by Colodny to assess the reasons for caregiver noncompliance with speech therapists recommendations (fear of interfering with the quality of life of the patient, disagreement with the speech therapists recommendations, lack of knowledge). Our questionnaire was administered to caregivers of 13 patients with chronic dysphagia hospitalized for complications from internal medicine departments of a big hospital in Turin (City of Health and Science of Turin, Molinette Hospital) in order to investigate compliance and adherence of caregiver at patientsadmission and after exposure to speech therapy counselling. The authors examined some characteristics of patients and caregivers to establish how they might possible affect the outcome of therapeutic care. Despite the small size of the sample, the use of the adaptation of the Italian Caregiver Mealtime and Dysphagia Questionnaire showed: the applicability of the instrument in the Italian context; the change in the compliance with speech therapists recommendations after the counselling (p = 0.001 - the finding is statistically significant). After counselling there are changes in the score of the three interpretation factors of questions: quality of life of the patient (p = 0.02), disagree with speech therapist (p = 5x10-4) and avoidance (p = 0.01); the influence of some patients features on the positive change in the compliance: caregiver of patients with history of aspiration pneumonia are more likely to listen to the instructions of the clinical (RR= 0,37; 95% CI=0.3-6.7 ) showing the protective effect of the disease experience); the influence of some caregivers features in positive change in the compliance: women have 37% more chance than men to be compliant (95% CI = 0.1 - 0.7) and caregiver with education of 8 years are more cooperative on the compliance with feeding guidelines(RR= 1.33; 95% CI= 0.3-5.0). Moreover, even without statistical validity being a parent, especially a mother, seems to be a protective factor (RR= 0.6; 95% CI= 0.04-7.07). It follows that caregivers play a key role in the management of patients with chronic dysphagia. They should be considered active part of the rehabilitation team and an important element for the success of clinical diagnostic and therapeutic workup. Caregivers characteristics and their exposure to speech therapy counseling can determinate the outcome. This confirms what is reported in the literature and observed in clinical practice. Learner Outcomes: Raising awareness on the importance of the caregiver active role in the diagnostic and therapeutic workup of patients with chronic dysphagia; Providing clinicians with an objective tool to assess the collaboration of caregivers of patients with chronic dysphagia; Emphasizing the importance of speech therapy counseling in the management of patients with chronic dysphagia.
nutritional intake, weight loss (cachexia and malnutrition), dehydration and death. The effect of dysphagia on patient survival (and the length of hospital stay) alsooccupy an important place. The use of adequate nursing and early intervention, via a speech pathologist and nutritional specialist, protect the patient from the risk of malnutrition and aspiration pneumonia. At the hospital of the ASL BI this has been ongoing for years: the use of screening procedures for dysphagia are implemented by trained nurses. These procedures are not available at the place where the access of nursing of patients with health problems takes place through the ADI (Integrated Home Care). Due to the increasing call for help and integration of those involved in the care of dysphagic pcs by the nursing staff and users, it has been proposed, through a nursing thesis project in collaboration with (the complex structure of Rehabilitation Medicine and Hygiene Service Dietetics and Nutrition) to use a DRS system integrated with the NSR scale (Nutritional Risk Screening) in the potentially dysphagic patient (over 75 years, with neurological disease-GCA or regression or with oncological oral and / or gastrointestinal tract disturbances). The study is on observational quantity: a sample of patients at home who occupy the territory of Biella and whosatisfy the requirements described above.
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MEALTIME ASSESSMENT SCALE (MAS) MARCO GILARDONE (1) - DEBORA VALENTINI (1) ANTONIO SCHINDLER (2) CASA DI CURA, DIPARTIMENTO DI SCIENZE NEURO RIABILITATIVE, CASA DI CURA PRIVATA DEL POLICLINICO, MILANO, ITALY (1) - CLINICA OTORINOLARINGOIATRICA, AZIENDA OSPEDALIERA LUIGI SACCO, UNIVERSIT DEGLI STUDI DI MILANO, MILANO, ITALY (2)
Abstract: Swallowing is usually assessed at the beside or in dedicated clinics performing videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallowing (FEES). There are no available tool to assess swallowing in a more ecological situation, such as during a meal. The aim of the study is to develop and validate a scale for the evaluation of dysphagia, which can provide both a qualitative and quantitative assessment of the difficulties of dysphagic patients during the meal. The tool developed was called Mealtime Assessment Scale (MAS). The advantage of the MAS relies not only in the possibility of a more ecological assessment, but also in the possibility to assess a whole meal, lasting longer and including several more swallows than those assessed during VFS or FEES. Elements such as fatigue or environmental barriers could therefore be analyzed. MATERIALS AND METHODS The work was divided in several phases: phase 1): item development; phase 2) field testing and item reduction; phase 3) reliability and validity analysis. Items were developed on the basis of other mealtime scales and panel discussion among dysphagia clinical experts. Field test were performed on a first sample of 40 dysphagic patients. For phase 3 the scale was administered on a group of 70 non dysphagic patients, and another control group of 70 dysphagic patients. Fifty patients with dysphagia were observed simultaneously by two speech therapists for inter-subject reliability analysis. Patients with dysphagia underwent clinical assessment of dysphagia, scored through the MASA system and the ASHA-NOMS scale. RESULTS Phase 1: the Mealtime Assessment Scale (MAS) consists of three sections: preliminary assessment, rheological properties of food and kind of nutrition, dysphagic symptoms during mealtime. Each section is made-up of a series of items with a score ranging from 0 (severe difficulty) to 3 (normal). For each item a brief and clear qualitative description has been given. Phase 2: based on internal consistency values the items of the MAS have been reduced to 30 (13 for section 1, 4 for section 2, 13 for section 3). Phase 3: Inter-rater subjective reliability (using the Spearman test) obtained a coefficient greater than 0.7 in all sections (0.85 calculated over the entire scale). Internal consistency of the scale was 0.805. The MAS scores in dysphagic and non dysphagic patients were statistical significant on Mann-Whitney test. A weak yet positive correlation between the MASA system, the ASHANOMS and the MAS was found. CONCLUSIONS The MAS is a promising tool for dysphagia assessment in an echological context.
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USE OF SCALE DRS (DYSPHAGIA RISK SCORE) FOR THE IDENTIFICATION OF THE DYSPHAGIC PATIENT AT HOME MONICA PANELLA (1) - MARA MENEGHELLO (1) BIBIANA ZULBERTI (1) - DENISE TRUISI (2) - LIA RUSCA (1) MICHELANGELO VALENTI (1) ASLBI BIELLA, HOSPITAL, BIELLA, ITALY (1) - ASLBI BIELLA, UNIVERSITY, NOVARA, ITALY (2)
Abstract: Dysphagia is a disorder in the progression of a substance from the mouth to the stomach. It alters the normal swallowing which is in turn defined as the ability to engage and substain solid, liquid, gaseous or mixed substances from the mouth to the stomach. It Recognizes a multifactorial pathogenesis and should be addressed with the help of different professionals (multidisciplinary team). This disorder can lead to serious consequences on the overall status of the person as the short-term complications it causes are related to crisis of asphyxia and bronchopneumonia. Where long-term respiratory problems are concerned these can include reduced
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QUANTITATIVE INSTRUMENTS FOR SMELL EVALUACION IN CHILDREN: AN ITEGRATIVE REVIEW RAISSA GOMES FONSECA MOURA (1) - DANIELE ANDRADE CUNHA (1) - LUCIANA NGELO BEZERRA (1) - CAROLINA DE LIMA GUSMO GOMES (1) - HILTON JUSTINO SILVA (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND ALLERGY/IMMUNOLOGY AMBULATORY, RECIFE, BRASILE (1)
Abstract: INTRODUCTION: The smell is a chemistry sensory function performed under responsibility of the olfactory system and is extremely important for the living beings survival. To the odors be detected and subsequently broken down it is necessary that the olfactory system is in proper working order. Otherwise, different methods are used to smell evaluation in order to quantify these possible difficulties and changes. The smell evaluation in children is usually performed using methods that vary according to the applicability and eligibility of the instruments used. Moreover, the
used tests havent an exclusive use in this population, being the same also used in other stages of human development. However, it is seen that in all these phases, the quantitative instruments are most commonly used. OBJECTIVE: Perform a research at the literature, by systematically way, the quantitative smell evaluation instruments used in studies with children. SEARCH STRATEGY: Performed in PUBMED and BIREME at the databases MEDLINE by BIREME, LILACS and SciELO Regional, following the steps of selecting and reviewing journals found and selected. SELECTION CRITERIA: Selected original papers related to the theme, performed only in children, at Portuguese, English and Spanish language. It was excluded studies in other stages of human development, exclusively or concurrently with the pediatric population; animal studies, literature review articles, essays and book chapters, unique case articles and editorials. DATA ANALYSIS: Performed through a cataloging protocol created for this study, including the following points: author/year, location, population/sample, age, study purpose, methods and main results. RESULTS: We found 6945 articles from search for descriptors and free terms. 4634 were excluded by the title, 2175 by the abstract and 87 by full text reading, being 49 articles selected, in which 34 articles were repeated in databases and therefore 15 articles were analyzed in this review. CONCLUSIONS: Observed the lack of standardization of instruments used for quantitative smell evaluation in children, with great variability in the methodology of the tests, thereby diminishing the effectiveness and reliability of results. Learner Outcomes: Clarify the importance of performing the quantitative evaluation of smell in children; Report on the methodological possibilities of quantitative evaluation of smell in children, Emphasize the need for standardization of quantitative instruments used in the evaluation of smell in children.
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LINGUAL FRENULUM AT THE FIRST MONTHS OF LIFE MARCHESAN IRENE, MARTINELLI ROBERTA CEFAC POST GRADUATION IN HEALTH AND EDUCATION, CEFAC, SAO PAULO, BRAZIL, UNIVERSIDADE DE SAO PAULO, UNIVERSIDADE DE SAO PAULO, BROTAS, BRAZIL
Abstract: Anatomical variations of the lingual frenulum are a controversial subject among the different groups of health professionals, and poorly described in the literature. Some authors report that tongue frenulum in newborns connects the apex of the tongue to the base of the mandibular alveolar process, and during bone development and growth, the lingual frenulum moves to the central position, on the tongues underside midline. For this reason, these authors believe that the alteration diagnosis should not be carried out before five years of age. They also state that because of growth, the frenulum may stretch or be elongated, or undergo a spontaneous rupture. However, the findings in the literature do not correspond to the findings of clinical practice. Recently, studies have reported that the anatomical variations of the lingual frenulum are due to embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth. That may explain the variations of lingual frenulum as well as the divergence among the authors. The aim of this work was to compare the development of the lingual frenulum in infants at the 1st and 6th months of life to observe possible changes. Video recordings of 25 infants of both genders were taken at the 1st and 6th months of life. Three speech-language pathologists, specialists in orofacial functions, analyzed the videos. Anatomical aspects of frenulum, thickness, and attachment to the tongue and to the floor of the mouth were evaluated. 25 infants were evaluated at the first month of life. Lingual frenulum was visible in only 17 infants. At six months the infants were re-evaluated. Changes concerning thickness, attachment to the tongue and to the floor of the mouth did not occur. Although some authors state that lingual frenulum changes spontaneously, changes concerning thickness, attachment to the tongue and to the floor of the mouth were not observed between the first and the sixth months of life.
Methods: the researchers have worked on a volunteer sample of 32 healthy bottle-fed infants aged from 30 to 80 days, and a volunteer sample of 18 healthy breast-fed infants from 18 to 84 days. The feeding was recorded on a video-camera and evaluated through clinical observation taking into consideration fluency, attachment, rhythm, sucking-swallowing-breathing coordination, wellness, fatigue, feeding time and sucking efficiency (flow rate). Finally a questionnaire was proposed to families in order to compare their remarks with the clinical evaluation. Results: as a result the milk intake and the duration of breast- and bottle-feeding were as follows: 111.72 46.12 ml and 113.036 45.120 ml, 15.06 6.08 min and 11.36 4.06 min, in breast- and bottle-feeding, respectively. The flow rate with the new nipple resulted similar to the breast-feeding rate (breast-fed infants: 8.57 5.78 ml/min; bottle-fed infants: 10.19 4.39 ml/min). Analyzing the questionnaires, it was found that the most parents opinions agreed with the clinical evaluation (90% about breast-fed infants, 85% about bottle-fed infants). Intra- and inter-subjective validity for both groups resulted higher than 0.8, on the statistical K of Kohen basis, which indicates good intraand inter-subjective reliability. Conclusion: the mean flow rate was compared with other clinical studies: it turned out similar to the data of former research in breast-fed infants (8.57 5.78 ml / min; M. Taki et al. 2008: 6.6 3.5 ml/min), while in the experimental group it turned out lower and more similar to breast-feeding (10.19 4.399 ml / min; study M. Taki et al. 2008: 16.9 5.2 ml / min). Therefore lower flow rate with the new nipple, compared with other nipple units, appears more similar to breast-feeding, as a possible consequence of the lower milk flow. The infant is compelled to suck in a more active way, with greater involvement of the oral musculature, as he is in breast-feeding. Learner Outcomes: discriminate physiological sucking patterns in breastand bottle-feeding in the first six month of life; compare physiological sucking with a new generation bottle and breast-feeding.
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DYSPHAGIA IN SEVERE ACQUIRED BRAIN INJURY AND SPINAL CORD INJURY PATIENTS FROM ACUTE PHASE: A THERAPEUTIC PATH PURPOSE PATRIZIA CANCIALOSI (1) - ROSSELLA BESSONE (1) - MELANIA SAFFILA (2) - NADIA AFFILASTRO (1) - GIOVANNA BALL (2) ANGELA LUCIA FOGLIATO (2) - MAURIZIO BEATRICI (2) DEPARTMENT OF THE PHYSICAL MEDICINE AND REHABILITATION 2, UNIVERSITY OF TURIN HOSPITAL CORPORATION CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, HOSPITAL UNIT C.T.O./ M. ADELAIDE, TURIN, ITALY (1) - DEPARTMENT OF THE PHYSICAL MEDICINE AND REHABILITATION 2, UNIVERSITY OF TURIN HOSPITAL CORPORATION CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, HOSPITAL UNIT C.T.O./ M. ADELAIDE, TURIN (TO), ITALY (2)
Abstract: Introduction: The Diagnostic Therapeutic Welfare Path of the dysphagic patient in the CTO-M.Adelaide Hospital of Turins Hospital AOU Citt della Salute e della Scienza di Torino provides an early speech therapy take in charge for patients with severe Acquired Brain Injuries (ABI), polytrauma, spinal cord injuries and burns, but with a greater percentage of patients with ABI and spinal cord injuries. Aim of the study: Since the management of dysphagia in Spinal Cord Injuries is a topic that is still not very well known nor developed, with this work we want to provide on the one hand the speech therapy rehabilitation of the dysphagic patient, differentiated for pathology (ABI and spinal cord injury) and on the other hand we intend to emphasize the common and the distinctive elements, to highlight the special features and a consequent improvement in clinical practice.Methods:After some brief definitions, we proceed to the description of the Diagnostic Therapeutic Path of the dysphagic person, both with and without tracheal cannula, and to the interdisciplinary management, inserting two paths of specific care for the patient with ABI and the one with spinal cord injury. Regarding the patient with ABI, both the assessment and the rehabilitation treatment must necessarily take into account and adjust the performance and responsiveness of fluctuating degree of patient cooperation, both within the single session than during the whole rehabilitation process, with crossing phases of minimal responsiveness, agitation and space-time disorientation, as it is possible to see in the scale Levels of Cognitive Functioning (LCF, Hagen 1979). As for patients with spinal cord injury, it is essential to take into account the speech therapy implications related to this pathology, which consist essentially in dysphagic or voice disorders, due to the narrow and often variables reports that the adjacent anatomical structures have with the cervical spine. Results: From a literature search and a several years experience, emerges much more an urgent need to describe an interdisciplinary treatment path, which is scientifically valid and provides theoretical basis to support the clinical management of dysphagia in spinal cord injuries, as evidenced by a comparison with the ABI, bringing a significant data collection of both diseases. Conclusion: In conclusion, we believe that a comparison of the management of dysphagic patients with two different pathologies may give useful and meaningful elements to identify the best clinical practice, and especially to health gain to the patient and improve his quality of life
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STUDY ON SUCKING IN THE FIRST TWO MONTHS OF LIFE USING A NEW GENERATION NIPPLE ELENA GROSSO (1) - ANNA SCARANO (2) - PAOLA CIRAVEGNA (2) - IRENE VERNERO (1) CITT DELLA SALUTE E DELLA SCIENZA OF TURIN, MOLINETTE HOSPITAL, SERVICE OF OTOLARYNGOLOGY, AUDIOLOGY AND PHONIATRY, CITT DELLA SALUTE E DELLA SCIENZA OF TURIN, MOLINETTE HOSPITAL, SERVICE OF OTOLARYNGOLOGY, AUDIOLOGY AND PHONIATRY, TORINO, ITALY (1) - SLT AT THE UNIVERSITY OF TURIN, SLT AT THE UNIVERSITY OF TURIN, TORINO, ITALY (2)
Abstract: Background: in recent years the International Scientific Community has been particularly involved in the study of the newborns swallowing physiology both because of the peculiar characteristics of this function, and of diagnostic and clinical implications for childrens disease. Aim: the goal of this research is to study a new artificial nipple and compare the natural with the artificial sucking mechanism as to verify if the characteristics of the latest are really similar to the natural method. Means and
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Learner Outcomes: to Give knowledge of the main characteristics of dysphagia in spinal cord injury and severe acquired brain injury; to Give knowledge of the management of logopedic issues for the patient with brain injury and / or spinal cord injury, recognizing the clinical signs, identifying the most appropriate rehabilitative techniques to prevent possible complications;to Provide the main team management strategies for dysphagic people with these two diseases.
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INTERDISCIPLINARY MEDICAL AND NO MEDICAL APPROACH TO THE DYSFAGIC PATIENT. WHEN THE RIABILITATION ENTER IN THE HOSPITALS KITCHEN: BIELLAS EXPERIENCE MENEGHELLO MARA ASLBI BIELLA, HOSPITAL, BIELLA, ITALY
Abstract: In interdisciplinary approach to the dysphagic patient the role/intervention of the rehabilitation team begins with extraoral preparatory phase namely with all the modifications of texture, viscosity, temperature, homogeneity, appetizing quality/ appetizing characteristics and volume of bolus that will be introduced in the oral cavity (Schindler 2001). Building a research team on dysphagia in order to pinpoint the specific course of diagnosis and intervention on hospitalized dysphagic patients, a review of hospital menu and an applications of the phase 1 and 2 and sharing of results with medical and non-medical staff Learner Outcomes: Making of an interdisciplinary team in direct interaction with kitchen staff, definition of new diets with appetizing products and right texture which were pinpointed by speech therapist especially for dysphagic patient; Sharing of the process and the way of treatment of dysphagic patient, involvement of nursing staff in guaranteeing the safe treatment of dysphagic patient by monitoring new diets
unachievable from clinical and FEES evaluation: the youngest the children are, the highest radiation dose they absorb. Learner Outcomes: to provide an epidemiological survey about our pediatric dysphagic patients; to explain diagnostic and therapeutic decisions in the management of pediatric dysphagia, in our experience, in particular about integration between clinical and instrumental evaluation; to explain when we choose to prescribe VFG; to provide data about dosimetric detection in infants and children that have been studied with VFG.
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CLINICAL PROGNOSTIC INDICATORS OF SWALLOWING FUNCTIONAL OUTCOME FOLLOWING PROLONGED OROTRACHEAL INTUBATION DANIELLE MORAES (1) - CLAUDIA REGINA ANDRADE (2) HOSPITAL DAS CLINICAS, SCHOOL OF MEDICINE, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1) - SCHOOL OF MEDICINE,, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (2)
Abstract: To determine prognostic indicators of swallowing functional outcomes in patients submitted to prolonged orotracheal intubation (OTI). The prognostic factors analyzed for 148 patients submitted to prolonged OTI included dysphagia severity rate at the initial swallowing assessment and at dysphagia resolution/hospital discharge, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubation, intubation time and length of hospital stay. Patients were divided in two groups according to age: GI 18 to 54 years and GII 55 years. Correlation analysis, linear regression and descriptive statistics were used to analyze these variables. The variable that had prognostic value and had an influence on the swallowing functional outcome at hospital discharge was the classification of dysphagia severity rate at the first swallowing assessment for both age groups. The results of the study also indicated a trend to significance regarding the time to initiate oral feeding, suggesting that younger adults initiated oral feeding earlier. Studies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder. Additionally, this study stresses the importance of the initial assessment ratings. Learner Outcomes: know that the swallowing functional level at admission is a significant prognostic indicator of good swallowing outcome at hospital setting; to know the perspectives of the SLP treatment for orotracheal intubation patients at hospital settings; to observe the age differences regarding the deglutition recovery process, indicating that younger adults have a better chance of reaching good swallowing outcome at hospital discharge; to understand the importance of measuring indicators for the rehabilitative process management;
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INTEGRATION BETWEEN CLINICAL AND INSTRUMENTAL EVALUATION IN PEDIATRIC DYSPHAGIA: EXPERIENCE IN A URBAN TERTIARY CARE HOSPITAL OF TURIN ELENA GROSSO (1) - ELENA FAVERO (1) - ELSA JULIANI (2) DEBORAH BONELLI (1) - ANTONIO SCHINDLER (3) OSKAR SCHINDLER (1) - ROBERTO ALBERA (1) SERVICE OF OTOLARYNGOLOGY, AUDIOLOGY AND PHONIATRICS, CITT DELLA SALUTE E DELLA SCIENZA OF TURIN, MOLINETTE HOSPITAL, TURIN, ITALY (1) - SERVICE OF RADIOLOGY, CITT DELLA SALUTE E DELLA SCIENZA OF TURIN, MOLINETTE HOSPITAL, TURIN, ITALY (2) DEPARTMENT OF OTOLARYNGOLOGY, SACCO HOSPITAL, MILAN, ITALY (3)
Abstract: Introduction: Pediatric swallowing is a complex process that involves several anatomic structures and physiological functions; thus, swallowing and feeding assessment require a clinical and instrumental evaluation that can examine all the swallowing process in its highly complex and integrated systems and functions. Pediatric swallowing assessment begins with clinical examination; then, if it is necessary, an instrumental analysis can integrate the assessment. The instrumental methods used for evaluating swallowing function, include fiberoptic endoscopic examination of swallowing (FEES) and videofluorographic swallow study (VFG). The instrumental assessment of swallowing might answer specific diagnostic questions arising from clinical evaluation; integration between clinical and instrumental evaluation allows to establish a precise management and it guides therapeutic decisions, particularly in pediatric population with feeding and swallowing problems. Aim: Aim of the study is to provide a retrospective epidemiological analysis on our pediatric dysphagic patients and to show diagnostic and therapeutic decisions in the management of these patients. We also would like to explain the criteria we used to decide when VFG is necessary after clinical and FEES evaluation, on the basis of radiological risk in children. Methods: The epidemiological analysis relies on descriptive statistics of two separate populations: 1) 554 pediatric patients with swallowing and feeding disorders evaluated through VFG in a urban tertiary care Hospital of Turin in a 11-year period; 2) 596 pediatric patients, with swallowing and feeding disorders, assessed jointly by clinical and instrumental examinations in the Phoniatrics Clinic of the same hospital over a six years period. Results: Diagnostic categories were: neurologic impairment (69%), cranial-facial anomalies (10%), cardiorespiratory problem (6%), behavioral impairment (13%), gastrointestinal problem (2%). Childrens feeding was: oral (60%), enteral (32%) and both oral and enteral (8%). After clinical and instrumental swallowing evaluation, feeding indication was oral feeding (54%), enteral feeding (30%), both oral and enteral feeding (16 %). As a result a speech pathology rehabilitation was prescribed (79%) - except for severe pathologies. Discussion: The analyzed data considered: 1) diagnostic methods used for identification and assessment of feeding and swallowing disorders on the basis of integration between clinical and instrumental evaluation results and 2) detection of radiation dose during VFG achieved using probes. A compared VFG/ Head CT Scan Dosimetric detection study further supported the diagnostic decisions to restrict VFG to selected children. In infants and young children VFG is indicated only when closely necessary to add information which is
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DYSPHAGIA IN CHILDREN WITH SEVERE MALFORMATION, NEUROLOGIC IMPAIRMENT OR GENETIC DISEASES ZELITA GUEDES (1) ESCOLA PAULISTA DE MEDICINA - DEPARTAMENTO DE FONOAUDIOLOGIA, UNIVERSIDADE FEDERAL DE SO PAULO, SO PAULO, BRASIL (1)
Abstract: Dysphagia is a common manifestation in patients with severe malformation, neurologic impairment or genetic diseases. To classify the type of dysphagia in a group of patients with genetic syndromes and cleft palate; neurologic diseases and Inborn Error of Metabolism as Pierre Robin syndrome, disease of Van der Woud, Apert, Crouzon, Schpritzen, Goldenhar, Holoprosencephaly, Mbius Syndrome, Cerebral Palsy, Dandy Walker and Muchopolysacharidosis. Near 77 male and female patients with ages between 3 months and 18 years were evaluated as to swallowing according to Shepard (1991) scale. The research was conducted under the principles of the Declaration of Helsinki and was approved by an institutional ethics review board. We used feeding-bottle, spoon and cup as utensils. The patients received water, pasty meal and hard bread to eat depending on their possibility. They were evaluated by a speech and myofunctional pathologist in a Public Hospital at So Paulo, Brazil. The resulting classification was 19,4% I; 3,89% II; 19,4% III; 22% IV; 19,4% V; 15,5% VI. Many patients had to change the food consistency because they had choked and coughed during the swallowing and/or had had numerous pneumonias according to clinical history. Some patients had only to correct the posture and the utensils and others had to change the nourishment via from oral to enteric, by means of gastrostomy. It is necessary to evaluate the patients chewing and swallowing abilities in order to provide their parents with adequate counseling. Learner Outcomes: The participants will see that this scale of dysphagia is a secured tool to evaluate children with different diseases and it is possible to guide the parents with facility because they understand the topics of the scale.
P195
FUNCTIONAL OUTCOMES OF SWALLOWING REHABILITATION IN HEAD AND NECK CANCER PATIENTS. A RETROSPECTIVE EVALUATION. LAURA OMEGNA (1) - GIULIA GINTOLI (2) - SILVIA ROSSO (3) GISELLA GHIGO (3) - PATRIZIA STENI (3) ASL TORINO1, MARTINI HOSPITAL, TURIN, ITALY (1) - ORDINE MAURIZIANO, HOSPITAL, TURIN, ITALY (2) - ASL TO1, HOSPITAL MARTINI, TURIN, ITALY (3)
Abstract: Swallowing disorders are a frequent complication in patients with head and neck cancer. Dysphagia may cause nutritional risks, affect survival in case of aspiration pneumonia and impact on the patients quality of life. Swallowing disorders are related to both the surgical approach and the removed tissue. The swallowing rehabilitation after surgery of the upper aerodigestive tract is facilitated by the onset of compensatory attitudes: residual structures must develop vicarious functions. Many studies show how radiotherapy and chemotherapy adversely impact on swallowing abilities, especially during the oral and pharyngeal phases. Studies emphasize the need of early rehabilitation and the presence of the SLP in the multidisciplinary team. At present however studies on the organization, procedure and duration of speech therapy in patients undergoing head and neck surgery are extremely limited. Aim - This study aims at describing some demographics and clinical characteristics of head and neck cancer patients. Timing, frequency and duration of SLP therapy for dysphagia after surgery were recorded, along with the outcome of swallowing functions at hospital discharge, and at the end of outpatient rehabilitation. Methods - The study was based on head neck cancer patients who, between 01/01/2009 and 31/12/2012, underwent surgery at the ENT Department of the Martini Hospital in Turin, and who were treated for dysphagia by the SLP of the same hospital. Data include: gender, age, kind of surgery, number of patients receiving radiotherapy, time elapsed between the surgery and the first speech therapy assessment, number of sessions delivered during hospitalization, number of patients who continued in day hospital. Outcomes were measured with ASHA NOMS scale. Results-The sample is of 88 patients. The mean age 62.6 years. 76.14% are men.The surgeries are so represented: mouth and oropharynx surgery 22.73%, 35.23% surgery of the oral cavity, larynx surgery 34.1%, 7.95% other surgery. The time interval between surgery and the first assessment of speech therapy is an average of 9.9 days. Number of speech therapy sessions provided during hospitalization: average 10.2. At the first SLP assessment 95.45% of patients fed enterally, After surgery, 85 .23% of the patients had a level 1 scale ASHA NOMS and the 3.41% level 4. At the discharges 72.73% of patients had resumed feeding by mouth, 15.91% retained enteral nutrition, 10.22% had a mixed feeding. The 6.82% of patients were at level 1, while patients with a score greater than or equal to 4 were the 71.58%. 40 patients (45.45%) continued treatment as outpatients. 10 average paid sessions. For 19 patients swallowing functionality was monitored during radiotherapy. In 68.42% of cases there is a deterioration. After radiotherapy, patients continued treatment and speech therapy and for 15 (78.95%) there was a recovery of swallowing function Conclusions - Good levels of outcome of swallowing functionality after SLP treatment are seen in the sample. Patients undergoing partial laryngectomy mouth and oropharynx surgery require extensive rehabilitation and present a greater workload for the speech therapist. We can see a correlation between radiation therapy and severity of dysphagia. Learner Outcomes: Illustrate timing, frequency and duration of speech therapy treatment for dysphagia after surgery in head and neck cancer patients and describe the outcome of swallowing functions; Through the elaboration of collected data, describe the clinical and welfare characteristics of the patients who were examined and their rehabilitation needs; Stimulate the programming of rehabilitation intervention proposals studied on specific clinical target
fullcourse of three-dimensional conformal radiotherapy (3DCRT, an average of 30 sessions, mean dose 60 Gy); 18 patients underwent radical surgery and then adjuvant radiotherapy (Group 1), 11 patients underwent radical surgery followed by chemoradiotherapy (Group 2), 9 patients received radiotherapy alone (Group 3) and 9 patients were treated with chemoradiotherapy. (Group 4). Patients had cancer of the hypopharynx/larynx (n= 15; 33%), oropharynx (n=14; 30%), nasopharynx (n =6; 13%), oral cavity (n= 5; 10%), salivary glands (n= 3; 6%), esophagus (n=2; 4%), lateral cervical localizations of lymphomas (n=2; 4%). All patients received videofluoroscopy and/or flexible endoscopic evaluation of swallowing; dysphagia severity was scored through Dysphagia Outcome Severity Scale (DOSS). Results: Instrumental evaluation highlighted oral phase impairment including reduced lingual range of motion and strength with altered bolus formation and transport; pharyngeal phase was also altered with impaired tongue posterior base movement, impaired velopharyngeal closure, delayed triggering of the pharyngeal swallow, reduced pharyngeal contraction, reduced laryngeal elevation, reduced cricopharyngeal opening and visible cricopharyngeal bar with impaired bolus clearance and aspiration. Acute OD (soon after radiotherapy) occurred in 13 patients (28%); OD appeared within 1 year in 12 subjects (24%), while it occurred after 10 years in 22 patients (48%). Twentythree patients (50%) presented mild OD (DOSS 5); 8 patients (17%) presented moderate OD (DOSS 3); 15 patients (33%) had gastrostomy or jejunostomy for nutrition (DOSS 1). Nineteen patients (39%) complained of OD for all consistencies, 15 (33%) for solid foods, 8 (17%) for fluids, 5 (11%) for fluids and solids. In particular, patients who maintained adequate oral nutrition were respectively: 66% in group 1, 54% in group 2, 44% in group 3, 11% in group 4. Patients who needed non oral feeding were: 22% in group 1, 27% in group 2, 33% in group 3, 66% in group 4. Conclusions: Radiotherapy alone or in combination with chemotherapy and surgical treatment can have a major impact on swallowing function in patients affected by head and neck cancer. OD can occur early or long after completion of radiotherapy. Future studies are needed to determine optimal radiotherapy regimens to minimize structural damages; further it would be desirable to take charge patients early, monitor them and examine efficacy of swallow exercise programs on a long-term basis.
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MULTIDISCIPLINARY EVALUATION OF AGE-RELATED SWALLOWING DISORDERS BY ENDOSCOPIC, FLUOROGRAPHIC AND MANOMETRIC STUDIES KAORI NISHIKUBO (1) - MASAMITSU HYODO (2) TAKANOKO, HOSPITAL, MATSUYAMA-CITY,EHIME-KEN, JAPAN (1) - KOCHI UNIVERSITY MEDICAL SCHOOL, UNIVERSITY, NANKOKU-CITY,KOCHI-KEN, JAPAN (2)
Abstract: Swallowing disorders are common in the elderly and may lead to progressive worsening of mobility, decrease of quality of life, and higher risk of mortality. The aim of this study is to evaluate swallowing functions in the healthy elderly subjects with a combination of videoendoscopic, videofluorographic, and manometric examinations and compare with those in young adults. Sixty-two elderly healthy volunteers (13 males and 49 females, range: 60-87 years, mean 68.2 years) and 8 young healthy volunteers (2 males and 6 females, range: 21-32 years, mean 24.3 years) were enrolled in this study. The subjects were classified into three groups (young adult group, 60-70 years group, and >70 years group). None of them had histories of cerebrovascular accidents, neuromuscular diseases, or any other diseases which may affect swallowing function. Multidisciplinary evaluation was used to obtain quantitative and objective data of swallow function. Aging was associated with a significant delay of pharyngeal swallowing reflex, and decrease of pharyngeal clearance, increase of laryngeal elevation delay time (LEDT) and pharyngeal transition time (PTT), decrease of degree of laryngeal elevation (%LE) and significant decrease of glottal closure reflex. Insufficient opening of the upper esophageal sphincter (UES) and lengthened UES zone were observed in 19% and 21% of the subjects, respectively. In conclusion, the present study indicated a delay of initiation of pharyngeal swallowing reflex and malfunctions of the muscles related to swallowing, especially of the cricopharyngeal muscle in the elderly. Learner Outcomes: know the effect of aging on the swallowing function in elderly ; understand the mechanism of dysphagia in elderly patient; recommend the prevention method of swallowing disorders by aging.
P196
OROPHARYNGEAL DYSPHAGIA IN PATIENTS AFFECTED BY HEAD AND NECK CANCER UNDERGOING COMBINED RADIOTHERAPY, CHEMIOTHERAPY AND SURGICAL TREATMENT VALENTINA BONSANGUE (1) - CHIARA DI PEDE (1) - ANTONIO FRIZZIERO (1) - STEFANO MASIERO (1) MEDICINA FISICA E RIABILITATIVA, UNIVERSIT DEGLI STUDI DI PADOVA, PADOVA, ITALY (1)
Abstract: Introduction: Many patients affected by head and neck cancer undergo chemoradiation treatment, often associated with surgical treatment, and may present clinical features of oropharyngeal dysphagia (OD). The pathophysiological dysfunction responsible for the onset of dysphagia can be: muscles, skin, salivary glands and connective tissue fibrosis, oral, pharyngeal and laryngeal hypoaesthesia due to damage of the peripheral nervous system. The aim of this retrospective study was to evaluate the characteristics, the timing of onset of OD in patients treated with radiotherapy for head and neck cancer. Materials and Methods: We recruited 47 outpatients (34 males and 13 females, mean age at diagnosis of cancer 59.3 years) with head and neck cancer between 2004 and 2010. Subjects received a
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A DEVICE FOR QUANTITATIVE EVALUATION OF CHEEK FORCE Marchesan Irene (1) - Berbert Monalise (2) Thomas Carlos (2) - Marczak Rogrio (2) (1) CEFAC Health and Education Pos Graduation, CEFAC Health and Education Pos Graduation, So Paulo, Brazil, (2) University Federal University of Rio Grande do Sul, Hospital University of Rio Grande do Sul, Porto Alegre, Brazil
Abstract: Inadequate force of the cheeks may compromise the tooth positioning and functions such as chewing, swallowing and contribute to aesthetic deformities on the face in humans (DAndrea and Barbaix, 2006). In
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clinical speech-language pathology practice, cheeks force is usually evaluated qualitatively. Perception and practical experience are used to classify them. This paper aims to present a new method for the quantitative evaluation of the cheeks force in humans. The development of the prototype was based on the principles and tools of Production Engineering Products. QFD (Quality Function Deployment - Quality Function Deployment) is a tool that aims to transform the customers needs or technical requirements into product development (Govers, 1996; Carnevalli et al., 2004). Five individuals were evaluated, ranging between 18 and 35 years old, males, normal with regard to the cheeks force by a perceptual evaluation. The average values of the average force was 5,64 N and the maximum force was 7,76 N. The subjects evaluated demonstrated force values with coefficient of variation considered low (11%). Quantitative evaluation can reduces the subjectivity and increases the probability of proper diagnosis of the cheeks force, especially in cases of slight changes in force, and moreover it is more sensitive for detecting small differences in strength observed with the progression of disease or therapy.The cheek force was quantitatively evaluated through the device developed (which is still in testing phase) and further studies are planned.This device might contribute to the completion the diagnosis process and treatment of changes the structure in question. Learner outcomes: The Participant will be able to: 1. Understand a new method for the quantitative evaluation of the cheeks force in humans. 2. know the process of developing of the new equipment for health 3. know the characteristic of the cheeks force.
in Germany, where she was required to speak German. To maintain her language skills in Japanese, she participated in a Japanese playgroup once every 2 weeks and communicated with her grandparents living in Japan once a week through Skype. Although she could speak Japanese fluently, she could only speak simple German sentences and resorted to nonverbal communication in kindergarten. She commenced her weekly speech therapy with a German therapist when she was 3 years and 8 months old. After 20 speech therapy sessions (7 months), including encouragement of utterance through play, activities to increase the power of understanding and sentence building through games, spontaneous conversations were possible and her understanding was improved. At home, her parents were advised to avoid close-ended (yes/no) questions and use open-ended questions in German. Later, she was able to describe her experience at kindergarten as I am feeling better gradually and told her parents, I would like to take lessons in ballet. Her ability to speak in her Japanese dialect remained consistent. When mastering a foreign language at a young age, intervention by speech therapy may be effective in motivating, improving communication and increasing the sphere of involvement in various activities. I wish to implement such speech therapy interventions for children of foreign parents in Japan. Learner Outcomes: The participant will learn details of a case of a bilingual Japanese child learning the German language, will understand the effectiveness of speech therapy in this case and realize the importance of early speech therapy for preschool children living in bilingual or multilingual environments.
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HYOLARYNGEAL MUSCLE ACTIVATION DURING TWO REHABILITATIVE DYSPHAGIA EXERCISES CHRISTOPHER WATTS (1) DEPT. OF COMMUNICATION SCIENCES & DISORDERS, TEXAS CHRISTIAN UNIVERSITY, FORT WORTH, UNITED STATES (1)
Abstract: The purpose of this study was to investigate the effects of a new resistance-based chin-to-chest exercise (CtC) on measures of hyolaryngeal muscle activation compared to a head-lift exercise. A group of normal (without dysphagia) young females (N=20) without history of dysphagia, cervical spine conditions, neurological disease, or head/neck cancer (mean age = 22.5) were counterbalanced into two groups where they performed the CtC exercise first followed by the head-lift exercise, or vice-versa. The CtC exercise required jaw opening into a semi-rigid chin brace secured against the upper torso for a duration of 10 seconds. The isometric head-lift exercise required lifting and holding the head from a supine position for 10 seconds. The degree to which each exercise activated the suprahyoid muscles was measured using submental surface electromyography (sEMG). Dependent variables included the peak microvolts (V) during 10 seconds of sustained contraction and the difference in V from rest to peak contraction for each exercise. Results indicated that activation in the submental hyolaryngeal musculature as measured via sEMG was significantly greater when participants performed the CtC exercise compared to the head-lift exercise. Measures of peak V during contraction were significantly greater for CtC (t=10.72, p<.001) compared to the head-lift exercise, and difference measures in V calculated between rest and contraction for each exercise revealed a two-fold increase in hyolaryngeal muscular activation for CtC (t=8.27, p<.001). Results support the need for further investigations to determine if the CtC exercise has a positive effect as a rehabilitative exercise for clinical populations with dysphagia secondary to UES dysfunction where hyolaryngeal excursion is an underlying physiological impairment. Learner Outcomes: Participants will be able to identify submental muscles involved in hyolaryngeal excursion during swallowing, Participants will be able to describe the utility of sEMG for measuring muscular activity during swallowing;Participants will be able to describe the procedures of the headlift exercise for dysphagia and the CtC exercise.
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MULTILINGUAL CHILDREN IN SPEECH THERAPY SERVICES IN PIEDMONT GIULIA GIUNTOLI (1) - IRENE VERNERO (2) DEPARTMENT OF REEDUCATION AND FUCTIONAL REHABILITATION OF MARTINI HOSPITAL IN TURIN., HOSPITAL, TURIN, ITALY (1) - UNIVERSITY OF TURIN,, UNIVERSITY, TURIN, ITALY (2)
Abstract: Multilingualism is nowadays very frequent in Italy, traditionally considered as a monoculture Country from the official culture. In Italy foreign residents represent about 6,3% of the population; Multilingual Affairs Committee of the IALP has developped Guidelines for working with children with language diseases in different Communities but they are not yet wellknown enough. It could be difficult to establish, in a speech therapy assessment, if a child has got a language or communication pathology, rather than social and educational shortage concerning different or minority languages. The purpose of this study is to investigate the knowledge, the behavior and the strategies of speech therapists who are taking care of foreigners sons; the Italian speech therapist cant choose formal materials for the assessment, standardized testing are not available in all languages, so he has only some surveys about lexical and comprehension competences to use. We have create a survey to investigate the real situation of our Region, the Piedmont. The survey has been send to SLT and phoniatricians of our Region, in children SLT centres. 100 Surveys sended; 45 received; 12 of them come from speech therapist who are not working with multilingual people.Language and learning diseases are the most frequent troubles, and also deafness, autism and dysphagia; the 20% of cases uses a cultural mediator-trainer.The 48% of SLT uses a bilingual parent to communicate with children.In the assessment the 33% of SLT dont use children mother tongue, because they have not any tools, in the other cases they made just counseling and conversations with foreigner families. The new Italian cultural context with emergent cultures and new values imposes to health professionals and to SLT, in particular, to consider difficulties that are in different linguistic cultures. Learner Outcomes: Knowing and identifying piedmont SLT perspective on this subject; Identify and make some proposals to ALP about IALP Guidelines and new points of view on education and multilingualism; Reflecting on future directions on the Italian SLT for bilingual and multilingual children.
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EARLY SPEECH THERAPY INTERVENTION FOR PRESCHOOL CHILDREN IN BILINGUAL ENVIRONMENTS CHIERI KATO (1) THE JAPAN SOCIETY OF LOGOPEDICS AND PHONIATRICS,THE JAPANESE ASSOSIATION OF SPEECH-LANGUAGE-HEARING THERAPISTS, I AM NOT AFFILIATED TO ANY PARTICULAR HOSPITAL OR UNIVERSITY, MAINZ, GERMANY (1)
Abstract: When children live in places where different languages are spoken in and outside their homes, they must learn both their mother tongue and the foreign language. Although there are few cases where speech therapy is provided for foreign children living in Japan, early interventions are available for children of immigrants in Germany. In Mainz, 7 Japanese children (3-7years old) underwent this intervention. Of these, four had problems with pronunciation and/or grammar. Here I report the case of one of these children whose speech and understanding were improved. Speech therapy expanded the range of activity for this child and gave her the courage to communicate. A 3-year-old girl of Japanese nationality was living in Mainz, Germany since the age of 14 months. Her mother tongue was Japanese. Since the age of 2 years and 9 months, she attended kindergarten
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P202
TEAMING ACROSS CULTURES: PROGRAM DEVELOPMENT FOR MEXICAN CHILDREN WITH DISABILITIES T. ROSARIO ROMAN (1) - SANDRA NETTLETON (2) - MARIA GUADALUPE MARENTES (2) BILINGUAL MULTICULTURAL SERVICES, INC, PRIVATE PRACTICE, ALBUQUERQUE, - (1) - UNIVERSITY OF NEW MEXICO, UNIVERSITY, ALBUQUERQUE, UNITED STATES (2)
Abstract: Speech-Language Pathologists (SLPs) and Occupational Therapists (OTs) in the United States are increasingly serving culturally and linguistically diverse (CLD) populations. This poster displays how the International Classification of Functioning-Youth Version has been used across disciplines to implement culturally responsive services to Mexican families while taking into account beliefs and values. Learner Outcomes: Recognize participants rights as well as language, motor, sensory and cultural differences; Identify the ways that restrictions in activities and contextual factors influence childrens participation in life activities; Design multidisciplinary interventions that address childrens unique needs for participation in family and school environments.
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FEAUTURES OF SOCIOCULTURAL ADAPTATION OF YOUNGER SCHOOL-AGED CHIL-DREN BROUGHT UP IN BILINGUAL MIGRANT FAMILIES IRINA BUCHILOVA (1) - TARLAN ALIYEVA (1) CHEREPOVETS STATE UNIVERSITY, INSTITUTE OF PEDAGOGY AND PSYCHOLOGY, CHEREPOVETS, RUSSIAN FEDERATION (1)
Abstract: In contemporary science there are different approaches to understanding of essence bilingualism its impact on social and personal development of children. At the same time, data on the specific socio-cultural development of migrants in the Russian-speaking environment scarce. There is no description of the work to ensure the social integration of children of primary school age who are brought up in bilingual migrant families that determine the relevance of the development of diagnostic and developmental programs in this area. Language - one of the essential characteristics of a nation, which is closely linked to the national psychology, with self-awareness and identity of the people. For each language - culture ethnic group, the original vision of the world. Modern conditions of life of the community is associated with considerable migration or non-Aboriginal people living in the Russian-speaking environment in which they usually do not lose their native language, and therefore the language development of children of school age occurs in a bilingual (I.V. Babenko .V. Gukalenko, I. A. Iliyaeva, E.A. Kozhemyakin, L.M.Suhorukova, etc.). To overcome the challenges of socio-cultural adaptation of school-age children who are brought up in bilingual migrant families, require a different approach to the organization of interaction of the participants of the educational process, develop a comprehensive program of psychological and pedagogical support to migrant children, aimed at improving the social maturity in a multicultural environment. In developing programs should be culturally sensitive, traditions, norms, religion, ethnic groups, who are educated in Russian schools. Learner Outcomes: globalization and integration, change in the geopolitical picture of the world. The emergence of large groups of migrants in different countries has exacerbated the problem of their adaptation in new socio-cultural environment, making significant changes in the society of the country receiving migrants. Children have always participated in the process of migration which does not run smoothly. Migrant children suffer of the processes of cultural deadaptation, loss of language space in a new socio-cultural and linguistic environment. This aspect is very topical to the study in both, the theoretical level, and for practical life of a modern society. Migrants and their children represent different nationalities, countries with different cultural traditions, different social characteristics which emphasizes set of problems of both - social, psycho educational and economic levels. One of the aspects of sociocultural adaptation of migrants children is the problem of language difficulties that arise while studying in Russian schools. Psycho educational acuteness of bilingualism problem may be mitigated by additional or compensatory education, that is, having started teaching in native language, gradually introduce a new language; to allow the students to preserve their native language, intellectual and emotional contacts with their culture. At present time there is no description of work system for ensuring the social integration of children of primary school age brought up in bilingual migrant families that determines the actuality of the designing of diagnostic and developmental programs in this area.
analyze the growing phenomenon of cognitive and linguistic-communicative deficits in bilingual adults, and in particular aphasia. Later, after a hint to the ABI and the main specific deficits, and to a description of the so-called bilingual brain, is intended to propose some interesting evaluation tools, including one specific to the aphasia (BAT), in order to perform the best possible rehabilitation. Methods -At first we focused on the study of brain processing and storage of language in bilingual subjects, then the research has been aimed at analyzing the tools that exist in our country, to assess a person with bilingual or multilingual aphasia. For aphasia was analyzed the Bilingual Aphasie Test (BAT) of Paradis and Libben, which was carried out in-depth analysis and which have been described in two variants: the BAT short form and Bilingual Aphasie Screening Test. Instead, for cognitive deficits, were searched tests in other languages. Results - Research has revealed that at the moment in Italy there arent many exhaustive tools in particular for the bilingual aphasia, and has been identified for this purpose the Bilingual Aphasie Test (BAT) of Paradis and Libben, of which have been widely highlighted the strengths and weaknesses. Instead, for the assessment of cognitive deficits has been identified a battery of simple tests normally used and translated into foreign languages above mentioned, and used with ABI patients. Conclusions- For cognitive deficits the identified battery is auseful tool, and for the aphasia assessment of bilingual subjects in the BAT represents, in our opinion, a valuable tool. Learner Outcomes: The literature search carried out provides at the participant study material essential to study in deep a subject still little explored in Italy but of great interest and importance. The deep analysis of BAT was oriented to bring out the strengths and weaknesses as well as to submit its two variants: the BAT short form and Bilingual Aphasie Screening Test. The participant will then have sufficient tools to learn and use the BAT in its various forms. For the cognitive deficits the identified battery will be a useful tool in foreign patients with ABI.
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RELATIONSHIP BETWEEN CHILD EXPOSURE TO MULTIPLE LANGUAGES AND COMMUNICATION PROBLEMS KARIN GENARO (1) - RUTH PA (1) - MARIA CLAUDIA CUNHA (1) PONTIFICIA UNIVERSIDADE CATOLICA DE SAO PAULO, PUC/SP, SAO PAULO, BRAZIL (1)
Abstract: INTRODUCTION The occurrence of language problems in children exposed to more than one language during the process of oral language acquisition is an area of growth within speech therapists clinics. A scientific analysis of such occurrences is needed. Aim: to describe the problems of communication that children exposed to multiple languages develop during their language acquisition process. METHOD A quantitative research conducted from a database of oral language reports performed during 2007 through 2009. Causality: 187 subjects from both sexes and multiple nationalities. Inclusion Criteria: the totality of students from two bilingual schools located in Sao Paulo, Brazil, with ages between 1;6 and 5;0 years which underwent a speech therapist screening between 2007 and 2009. Procedure: Database creation (in Excel format) with the following variables: age, sex, language disorders (LD), hearing (H), or voice (V) . As for the Language disorders, these were categorized as language acquisition detainment (LAD), phonological disorder (PD), discursive elaboration disorder (DED) and fluency problems (FP). Descriptive statistical analysis (frequency and percentages) of collected data. RESULTS In total (n=187) of screened subjects 31% have shown 01 or 02 communication problems as shown below: 57 with language disorders, 5 with voice disorders and no occurrence about hearing disorders. Within language disorders we found: 44 (77%) phonological disorders, 6 (10%) language acquisition detainment, 5 (8%) discursive elaboration disorder and 3 (5%) fluency problems. DISCUSSION The occurrence of communication problems proved to be meaningful since it has, overall, affected one third of the sample. Above all, our findings indicate a prevalence of phonological disorder within the studied population, suggesting further research is needed on their nature and characteristics.
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BILINGUAL PERSON WITH SEVERE ACQUIRED BRAIN INJURY: AN APPROPRIATE LOGOPEDIC TAKE IN CHARGE PATRIZIA CANCIALOSI (1) - MELANIA SAFFILA (1) - ROSSELLA BESSONE (1) - ELISA CARRABS (2) - ELENA ARNOLFO (3) GIULIA PIVOTTO (4) AOU CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, PRESIDIO C.T.O./ M. ADELAIDE - S.C. RRF GRAVI CEREBROLESIONI ACQUISITE, VIA ZURETTI 29, 10126 TORINO, UNIVERSIT DEGLI STUDI DI TORINO, TORINO, ITALY (1) - FREELANCER SPEECH THERAPIST, CENTRO EDU IN VIALE GANDHI 3 AVIGLIANA, (TO), TORINO, ITALY (2) - FREELANCER SPEECH THERAPIST, ARS MEDICA, CENTRO STUDI DENTALI, VERZUOLO, CUNEO, ITALY (3) STUDENT, UNIVERSIT DEGLI STUDI DI TORINO, TORINO, ITALY (4)
Abstract: From the Nineties up to now there was a growing increase in the foreign population in Italy and in the number of bilingual adults affected by ABI, which have aphasia, within specific deficits of language. Recent data showed, in fact, that about 50% of the world population uses a second language over their mother tongue. Romanian citizens, with nearly one million residents, represented the prevailing foreign community. Soon after are Moroccan nationals, Albanian, Chinese, Ukrainians and Filipinos. Since even in our hospital in the acute phase and at our neuro rehabilitation department for people with severe acquired brain injury, the number of foreign patients hospitalized rose ever more significant, the need for speech-language pathologists to identify tools for appropriate assessment for a subsequent speech and language rehabilitation, it is increasingly urgent and essential. Aim of the study - The primary objective of this paper is first to
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WORKING WITH CLIENTS FROM CULTURALLY AND LINGUISTICALLY DIVERSE BACKGROUNDS: KNOWLEDGE, PERCEPTIONS AND EXPERIENCE OF FINAL YEAR SPEECH PATHOLOGY STUDENTS IN AUSTRALIA CORI WILLIAMS (1) CURTIN UNIVERSITY, UNIVERSITY, PERTH, AUSTRALIA (1)
Abstract: In countries with culturally diverse populations, such as Australia, speech-language pathologists (SLPs) must be equipped to work with people from a range of different cultural backgrounds. This presents challenges for the profession in providing appropriate services to this population. Is the provision of multilingual professionals the answer to these challenges? In a recent survey of Australian SLPs working with children from multilingual backgrounds, close to half of respondents indicated that they had at least minimal competence in a language other than English, but only 9.4% reported proficiency. The languages reported to be spoken by the SLPs did not correspond well to those spoken by the children and families with whom they worked. If the provision of multilingual professionals who speak the
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same language as their clients is difficult to achieve, then education of professionals must be sufficient to provide a firm foundation for the challenges of practice with this population. Overall, respondents to the survey of Australian SLPs reported that they felt that their university training had not prepared them adequately for working with this population (75.6%), and 19.5% were unsure. The majority (42.5%) of respondents had been practising SLPs for more than 10 years, thus raising the possibility that changes to university curricula may have led to changes in the knowledge and perceptions of graduates. The current study set out to survey the knowledge, perceptions and experience of final year speech pathology students regarding working with clients from multilingual backgrounds. The online questionnaire was completed by 62 final year students from four universities. The majority of respondents (75%) were enrolled in Bachelor level courses (4 years duration), and the remainder in Graduate Entry Masters courses (2 years duration). A range of different question types (including those which allowed respondents to enter text data) related to students linguistic background, training, and perceptions about and experience in working with multilingual clients. Questions regarding working with both children and adults were included. This presentation will highlight differences in the language background, knowledge and perceptions of practising SLPs and final year students. Student perceptions of their preparation for working with multilingual clients will be highlighted, and implications for educational programs discussed. Learner Outcomes: The challenges facing SLPs working with clients from multilingual backgrounds; The demographic profile of SLPs entering the profession in Australia; Student perceptions of contributions to their learning in the area of working with clients from multilingual backgrounds; Directions for development of competence in working with clients from multilingual backgrounds
and reflecting the multiple language background of a multilingual child following the Inductive Approach and clinical intercultural competent interpretation of language performance.
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A FIRST PERSON ACCOUNT OF RECOVERY FROM A SUBARACHNOID HEMORRHAGE ALEJANDRO BRICE (1) - ROANNE BRICE (2) UNIVERSITY OF SOUTH FLORIDA ST. PETERSBURG, UNIVERSITY OF SOUTH FLORIDA ST. PETERSBURG, ST. PETERSBURG, FL, UNITED STATES (1) - UNIVERSITY OF CENTRAL FLORIDA, UNIVERSITY OF CENTRAL FLORIDA, ORLANDO, FL, UNITED STATES (2)
Abstract: This presentation focuses on what patients and family members may experience when a neurological trauma occurs. It is the personal story of the first and second presenters perspectives when the first speaker suffered a subarachnoid hemorrhage (SAH) to the vertebral artery; which supplies blood to the unpaired basilar artery (near the circle of Willis) and also to major portions of the brain (Bear, Connors, & Paradiso, 2007). This presentation also discusses the spouses perspective in dealing with such a trauma. Both are certified and state licensed speech-language pathologists with numerous years of clinical experience and also numerous years of teaching experience. Both also have numerous years of clinical experience in medical settings. Learner Outcomes: The patient and spouses perspectives regarding his cognitive and mental abilities, emotional recovery, and overall recovery will be discussed. Patient and spouse strategies will be presented that facilitated Alejandros recovery. It is expected that participants at the end of this session will be able to: Identify the main symptoms of a subarachnoid hemorrhage; Identify the main patient factors in cognitive rehabilitation; and, Identify the main issues in the spouses role in rehabilitation.
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THE INDUCTIVE APPROACH FOR LANGUAGE ASSESSMENT WITH MULTILINGUAL CHILDREN BY MONOLINGUAL THERAPISTS WIEBKE SCHARFF RETHFELDT (1) LOGOCOM, INSTITUT, MEHRSPRACHIGKEIT UND INTERKULTURALITT, BREMEN, GERMANY (1)
Abstract: Background - The most general aim of assessment is identification differentiating typical from atypical language development. With regards to serving the very heterogeneous group of multilingual children, language assessment is one of the greatest challenges faced by monolingual speech and language therapists (SLT). The associated difficulties have been discussed in a number of recent articles (Bedore and Pea 2008). It is generally recommended that multilingual children be assessed in both their languages (IALP 2011, ASHA 1985). However, this multilingual assessment often proves to be remarkably difficult to implement: (a) due to the lack of systematic, norm-referenced assessment materials in a number of languages, and (b) due the open question, even in those cases where assessment in both languages is feasible, how the results should be interpreted with languages differing in structure and in use as well as in developmental sequences and milestones, and (c) due to the lack of bilingual professional speech language therapists with regard to the mismatches in client and clinician languages and cultures. These circumstances may result in two typical misidentifications: overidentification by classifying language differences as language impairment (LI), and underidentification by falsely attributing possible language deficits to the multilingual background of a child. Method - The Inductive Approach to differentiate LI from lack of language skills will be introduced as a result of own research (Scharff Rethfeldt 2013), which combines direct and indirect language measures, based upon Cummins theories (2001). Following the Inductive Approach, the SLT will be able to drive a differential diagnosis by considering the patients individual background including both languages and cultures (i.e. Bilingual Patients Profile including culturally diverse case history and preassessment information) when using standardized tools. Examples will be presented from findings from research on 25 children with different linguistic backgrounds and migration background for which German is a second language, which is gradually being acquired before 6 years of age in different natural contexts (Scharff Rethfeldt 2010). Results and Learning Objective- Administering and interpreting standardized measures in a nonstandardized format by using dynamic methods and processoriented procedures helps the SLT to receive more information of the language competences of linguistically diverse children in order to differentiate under- and overidentification in multilingual assessment as part of the Inductive Approach (Scharff Rethfeldt 2013). Even monolingual SLT may be able to differentiate nondisabled children from those with SLT when considering and reflecting the multiple language background of a multilingual child following the Inductive Approach and clinical intercultural competent interpretation of language performance. Learner Outcomes: Administering and interpreting standardized measures in a nonstandardized format by using dynamic methods and processoriented procedures helps the SLT to receive more information of the language competences of linguistically diverse children in order to differentiate underand Overidentification in multilingual assessment as part of the Inductive Approach (Scharff Rethfeldt 2013). Even monolingual SLT may be able to differentiate nondisabled children from those with SLT when considering
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P209
MANAGING DEMANDS AFTER A MEDICAL TRAUMA: CAREGIVER PERSPECTIVES AND STRATEGIES ROANNE BRICE (1) - ALEJANDRO BRICE (2) UNIVERSITY OF CENTRAL FLORIDA, UNIVERSITY OF CENTRAL FLORIDA, ORLANDO, FL, UNITED STATES (1) - UNIVERSITY OF SOUTH FLORIDA, ST. PETERSBURG, UNIVERSITY OF SOUTH FLORIDA, ST. PETERSBURG, ST. PETERSBURG, FL, UNITED STATES (2)
Abstract: this presentation focuses a case study of an individual who experienced a subarachnoid hemorrhage as a result of an aneurysm to the vertebral artery. The focus of the presentation is from the spouses perspective and provides strategies that can be used to cope and adjust to the demands of caregiving. It is the first and second presenters description of the medical, therapeutic, and emotional journey after the second presenters trauma. Both are certified and state licensed speech-language pathologists with numerous years of clinical experience. The focus of the presentation is from the spouses perspective and provides strategies that can be used to cope and adjust to the demands of caregiving. Learner Outcomes: Identify the main symptoms of a subarachnoid hemorrhage; Identify the main patient factors in cognitive rehabilitation; and, Identify the main issues in the caregivers role in rehabilitation; Identify strategies caregivers can use to cope and adjust to demands during and after a medical crisis.
P210
TREATMENT-INDUCED SPEECH AND LANGUAGE RELEARNING PROCESS IN APHASIA AND LINGUISTIC NEUROPLASTICITY PAULA HEIKKINEN (1) - - ANU KLIPPI (1) - JYRKI MKEL (2) INSTITUTE OF BEHAVIOURAL SCIENCES, UNIVERSITY OF HELSINKI, HELSINKI, FINLAND (1) - HELSINKI UNIVERSITY HOSPITAL, UNIVERSITY OF HELSINKI, HELSINKI, FINLAND (2)
Abstract: Recent advances in neurorehabilitation research have several implications for speech and language relearning in aphasia therapy. New behavioural treatment approaches to speech and language therapy emphasize massed practice in a short time, thus maximizing therapy quantity and frequency and, therefore, the correlation of the behavioural and neuronal changes. A new kind of therapy approach to post-stroke aphasia, Intensive Language-Action Therapy (ILAT, previously CILT) based on modern neurorehabilitation principles has been developed. New technology provides interesting possibilities for rehabilitation, too. With transcranial magnetic stimulation (TMS), one can modulate neural activity in the cortex. It is based on the principle of electromagnetic induction in which a magnetic field is used to carry an electrical stimulating current into the brain. Repeated stimulation with TMS leads to lasting effects on excitability and changes in synaptic connections which is the basis of learning, having the potential to be harnessed for therapeutic purposes in the human brain. The aim of the
study is to compare the effects of ILAT and rTMS as well as to examine the effect of their combination on aphasia. Our primary hypothesis is that the combination of ILAT and TMS gives the most effective alleviation of aphasic symptoms. Up to now, 11 voluntary persons with chronic aphasia are recruited for this rehabilitation study (4 groups). When suitable groups of three have been formed, the groups have been randomized to the intervention group A (ILAT and rTMS) or B (ILAT and placeborTMS). Intervention group A initially received a 2 weeks period of rTMS followed by a 2 weeks period of rTMS combined with ILAT. Intervention group B initially received a 2 weeks period of sham/placebo rTMS followed by a 2 weeks period of sham/placebo rTMS combined with ILAT. The total treatment period was 4 weeks. Subjects received daily rTMS or placebo rTMS treatments, 5 days a week for 4 weeks (20 treatments). The preliminary results are based on the test scores given by the WAB, the Boston naming test and the Action naming test. The preliminary results suggest that action naming (verbs) improved in the cases and in some of the cases remarkably. Most of the improvement was discovered at the latter period when the subjects were treated with the combination of TMS and ILAT. After the first part of treatment (TMS only) results show only moderate improvement. Learner Outcomes: By reading the poster attendees should have a better understanding of a) ILAT-method and; b) rTMS-method in aphasia rehabilitation; and c) the methodology used in a therapy outcome study.
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EFFECTIVENESS OF MELODIC INTONATION THERAPY IN APHASIC PATIENT: A CASE REPORT CRISTINA ESPRITO SANTO (1) - ALINE MEGUMI ARAKAWA (1) - ELEN CAROLINE FRANCO (1) - NATLIA GUTIERREZ CARLETO (1) - MAGALI DE LOURDES CALDANA (1) FACULDADE DE ODONTOLOGIA DE BAURU, UNIVERSIDADE DE SO PAULO, BAURU, BRASIL (1)
Abstract: Stroke is among the diseases that commonly affect older adults. This type of neurological affection can be ischemic or hemorrhagic stroke, permanent or transitory, and lead to motor, sensory, perceptual and communication deficit although the picture varies according to the neurological affected area. Aphasia is a communication disorders present in some frames and can affect the production and/or comprehension of oral and/or written language. The speech language therapy in aphasia seeks to communication recover, helping the patient to fully utilize all your residual skills. The aim of this study was describe the effectiveness of melodic therapy in patient with aphasia after stroke. In this case, the patient is male, 61 years old, righthanded, had an ischemic Stroke in 2009, July. He is attended at the SpeechLanguage and Hearing Sciences Clinic of the Bauru School of Dentistry University of So Paulo. The speech language therapy occurs twice a week and he came to the Clinic 32 months after diagnosis. The initial assessment showed changes in oral language with preserved comprehension. During oral emission, the semiology type presented were flotation stereotyping without meaningless linguistic stage. The gesture recognition, accompanying rhythms and melody abilities are preserved. Three months after speech language therapy focused on Melodic Intonation Therapy (MIT), the patient has decreased stereotyping and its increased the repeatability and spontaneous naming capacities. The therapeutic proposals submitted for aphasic patients can be numerous and among them is the MIT. This statement is quite accurate for aphasic patients after Stroke presenting oral comprehension and expression changes preserved. Throughout the process the patient will learn to repeat, control their automatic and voluntary emissions and learn and practic without error. Progressively the sentences are transferred to the speak, because throughout the process, the patient learns to repeat, control automatic and voluntary emissions, and practice this learning. At this point it is possible to introduce other therapeutic method directed to the communication and language development. It can be concluded that despite the patient started using the MIT after 32 months of involvement, the therapeutic approach contributed significantly to aphasic frame improvement. This study reaffirms the importance of evaluation and speech language therapy specific and detailed, for patient rehabilitation in the case of acquired brain injury and thereby individuals quality of life improvement. Learner Outcomes: know the efficacy of Melodic Intonation Therapy in an individual with aphasia post stroke; know the importance of a detailed evaluation to approach an appropriate treatment; know the consequences of a stroke; discuss therapeutic approaches for aphasic patients.
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APHASIA AN ALTERATION OF THE VERBAL GESTURE: EVALUATION AND REHABILITATION. ANTROPOPHENOMENOLOGY APPROACH LIDIA GOMATO (1) OSPEDALE DI NEURORIABILITAZIONE, SAN GIOVANNI BATTISTA A.C.I.S.M.O.M -, ROMA, ITALY (1)
Abstract: It is an opinion shared by many that in science, the good kind of it, there must be everything that is present in life. The neurosciences have been based until now on concepts of stability, repeatability and formal description of the experience, but in a living system what really counts are the variabilities, diversity and behaviors in ecosystems that are constantly changing. Phenomenology, whose founding father was Husserl, focuses his research on the lived experience of The subject with his body always in connection with the World. Both body and World get involved in a circular functional life, in which perception and movement intersect and co-constitute themselves. Through intentional acts that make sense, that are goal-directed, the organism discover the world, which it is not objectively given; the living subject through its body constitutes the temporal-space dimensions corresponding to the way in which he is in the world, so we can say that each subject has its own environment experienced. It is in the Neurophenomenology that has been found a new research method that can combine science and philosophy. This approach bypasses the connectionism and cognitive science that split a person in two: mind and body. The phenomenological method has the assignment of showing the correlations and the co-production between the subjective and objective dimension of a man; being the opposite of reductionism. From this point of view, language is a gesture of the body and how M.Merleau Ponty writes: One of the possible uses of our body,; language and thought are therefore influnced by subjective experiences and relationship of human existence. The gestural communication has its origins and developed over time in different levels of dynamic structuring. Anthropological phenomenology is interested in studying these dynamic structures that interact in the language, denying a conception of the language based on mental contents and representations. This approach is a new challenge in compairason with the traditional Aphasia therapy that is based on the evaluation and rehabilitation of language as a consequence of a broken mental mechanism.It is important in rehabilitation to have a method that detects and exploits the residual possibility of the act of communication in aphasia patients. The anthropo-phenomenological perspective tries to understand the language in its creative becoming communication gesture, always in progress and having a communication focused goal. The gesture finds its roots in the body. The speech therapy of aphasic disorder must therefore no longer be limited to evaluating the language aphasia in relation to the standard language of sain individuals but must lead to a deeper research in all possible levels in planning the gesture: from the basic level as the mimic gesture to the highest one such as verbal gesture. Learner Outcomes: observe how language is considered by the athropo-phenomenological view; how to apply the phenomenological method to study aphasic disorder; introduced to the parameters and Longhian aphasia classification; illustration of evaluation protocol the aphasic profile; case studies using therapeutic strategies of the proposed method in aphasic disorder.
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CRITERIA FOR DESIGNING ARABIC AUGMENTATIVE COMMUNICATION SOFTWARE FOR DYSPHASIA PATIENTS AMAL SALAHELDIN DARWISH (1) HEARING AND SPEECH INSTITUTION IMBABA CAIRO, PHYSICAL MEDICINE & REHABILITATION HOSPITAL IN KUWAIT, CAIRO, EGYPT (1)
Abstract: Dysphasia is frustrating disability that occur with Patients with brain insults. Now the use of new technology, to design the computerized verbal, and non- verbal software to help the aphasic Arab people considered a must by introducing the new technological facilities in order to start with simple audiovisual programs (multi-sensory channel stimulation approach programs). To give the chance for the aphasic patients and their families by which they can overcome their communicative problems. In these software we applied the computerized Arabic aphasia therapeutic program to *100 right handed medically stable patients (male & female) dysphasia patients. *The program applied as soon as possible after the brain incidence, as the patient will be in the recovery stage and the stimulation of the language & mental area will be more easy before the stationary stages). * Age will vary from 11-70 years old. * The Arabic language is the mother language for the patient from different Arabic countries. * Different etiological factors of the brain insults. *Another 100 patients matched in all previous criteria treated with old traditional therapeutic programs such as 1- Environmental language intervention, 2- Wepman`s thought centered therapy, 3- Melodic intonation therapy, 4- Self adjusting therapy, 5Manual Multi-sensory approach method, *Evaluation Schedule 1- Careful history taking, 2- Neurological examination, 3- Vocal tract examination, 4- Neurological investigations, 5- Psychometric evaluation test may be applied when the patient cognition is affected or there is mood or behavioral changes, 6- Audiological & ophthalmologic consultation when needed, 7-Language test (Kotby ET AL;1980). As follow 1-Expressive language: * Auditory memory span. * Automatic speech. * Spontaneous speech. -Words finding difficulties. -Preservation. -Repetition. -Disturbance in form, contents, syntax, and Prosody. 2-Understanding speech, This may be gesture,
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question, order and token. 3- Understanding written text. This could be Questions, Orders & Matching. 4- Reading. Test for reading letters, words and text. 5-Writing . Names, Composition &Dictation. 6-Calculation simple & compound. Therapeutic Plans *40 sessions will be applied in 4 months duration 3 sessions /week. 30 individual sessions to start the facilitation of the improvement of the communicative skills. 10 group sessions in order to prepare the patient to communicate with others with same condition for psychological support. N.B A number of factors may influence the number of consecutive therapeutic weeks on which an individual client enrolls (such as family and personal commitments, travel plans, holidays, and need for a rest, all may influence the design of the programs duration). Patronized Plan for the Software Plane will be designed for each patient according to his physical condition, daily activity needs, and his educational level. Based on English augmentative assistive communication devices such as - Message mate word+. - Speaking dynamically pro. - Spring board... etc. Interactive computer therapy provides numerous of advantages over traditional paper and pencil modalities. These include: Consistent presentation and feedback, Increased number of trials translating into more therapy, Opportunity to learn vocational skills, like word processing or data entry, Opportunity to use software programs which reinforce treatment strategies. Increased level of independence enjoyed in accomplishing computer practice. Supportive group setting decreases reluctance to use computers. Opportunity to practice new skills on the computer, such as spell check or speech synthesis. It could be used in an Individual sessions or group sessions as 1- Individual therapy sessions focus upon the rehabilitation of speaking, listening, reading and writing, as well as associated problem areas such as memory deficits. Goals in these areas are individualized and may target the recovery of specific functions or the development of alternative compensatory strategies; 2-Small group therapy sessions offer clients opportunities to apply new communication skills to conversational contexts. A therapist mediates these interactions and supports each client in the pursuit of individualized goals for conversational participation. Learner Outcomes: The importance of audio-visual channel approach with computers software in dysphasia rehabilitation; The parameter which should be considered in different level for dysphasia rehabilitation; The possibility to reduce time and effort during rehabilitation program for dysphasia patient; The potency of computer software rehabilitation program versus traditional method.
progressively increased. The concept of living successfully with aphasia has recently emerged in aphasiology, encouraging a focus on positive rather than negative outcomes. The chronic nature of aphasia has led some authors to suggest that interventions should aim to enable individuals to live successfully despite their communication disability (Brown et al, 2011). The C.I.R.P. group of Carlo Molo Foundation organized operative communication groups called Conversazioni Narrative, co-conducted by an SLP and a psychologist/psychotherapist both experts with aphasia. Group therapy can increase communication abilities, social relationship abilities and mood and decrease caregiver burden. It is also assumed to contribute moving patients from rehabilitation to living successfully with aphasia. Aim of the study is to verify the impact of Conversazioni Narrative group on functional communication abilities, social participation, relationship engagement, patients mood and caregivers burden. Materials and Methods. Group participants were patients with chronic aphasia selected among patients attending to the CIRP or speech and language treatment at Rehabilitation Department ASL TO1. Motivation in participation was considered as a key element. Patients with communicative deficits other than aphasia, minimal/absent or very severe linguistic deficits or difficulties in transportation hindering the group participation were excluded. All patients attending the Conversazioni Narrative group underwent both a speech and language and a psychological assessment three times: before the beginning of the group (T0), after its conclusion (T1) and after 6 months (T2). Linguistic and communicative abilities were assessed with the Aachener Aphasie Test, the Italian version of the American Speech-Language and Hearing Association Functional Communication Skills for Adults (ASHA-FACS) and the ASHA NOMS pragmatic scale. Social Network was used to collect communicative partner network. Psychological assessment include mood evaluation of both patients and caregivers and care burden. Assessment include the Visual Analog Mood Scales, the Stroke Aphasic Depression Questionnaire (SADQ 10), the Caregiver Burden Inventory (CBI) and the Beck Depression Inventory (BDI). Moreover all patients were videotaped during a guided conversation and a picture description tasks, in order to analyze communication strategies (for example gestures). Results. Preliminary results will be presented. Learner Outcomes: understand the importance of considering social participation for persons with aphasia; know a proposal to enhance communication and social participation for persons with aphasia; understand better the relation between communication abilities, mood and caregiver burden.
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ASSESSING LANGUAGE IN GREEK APHASIC PATIENTS USING THE COMPREHENSIVE APHASIA TEST (CAT) SOULTANA PAPADOPOULOU (1) - ELENI MORFIDI (2) REHABILITATION CENTRE, UNIVERSITY HOSPITAL OF IOANNINA, IOANNINA, GREECE (1) - DEPARTMENT OF PRIMARY EDUCATION, UNIVERSITY OF IOANNINA, IOANNINA, GREECE (2)
Abstract: The current study explores aspects of cognitive and linguistic deficits in aphasic patients using the Comprehensive Aphasia Test (CAT). It includes a brief cognitive and an extensive language battery. In addition, it provides a self-evaluation of the patient on his/her quality of life. The advantages in using CAT are encapsulated in the five components of the oral and written language. Twenty one language subtests assess comprehension, expression, repetition of oral language, reading and writing. A small-scale research was designed using twenty one aphasic patients (13 males and 8 females) aged 25 to 65, who had been recovering after stroke or brain injury. They were in a post-acute stage of aphasia and inferred to hospital clinic for speech and language therapy. CAT was administered in order to examine their performance on the respective subtests. The results indicate that CAT effectively reveals individual strengths and weaknesses but complementary measures may be used to shed more light on cognitive and linguistic aspects needing further attention. Learner Outcomes: be informed about the administration of the CAT test; learn how to administer this specific battery to aphasic patients and acknowledge that the quality of life should be assesses at the same time as linguistic and cognitive disabilities.
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DISORDERS OF CONSCIOUSNESS AND AWARENESS IN SEVERE ACQUIRED BRAIN INJURY: BIOETHICS COMPARE WITH SPEECH THERAPY ANGELA LUCIA FOGLIATO (1) - SARA VESCO (2) - CARLA CORBELLA (3) - FRANCA BALBO MOSSETTO (4) DEPARTMENT OF MEDICINE PHYSICAL AND REHABILITATION 2, HOSPITAL CORPORATION CITT DELLA SALUTE E DELLA SCIENZA DI TORINO HOSPITAL UNIT C.T.O./M.ADELAIDE, TURIN, ITALY (1) - DEPARTMENT OF MEDICINE PHYSICAL AND REHABILITATION, HOSPITAL MARTINI ASL TO1, TURIN, ITALY (2) - RELIGIOUS INSTITUTE SUORE AUSILIATRICI DEL PURGATORIO, FACULTY THEOLOGY OF THE NORTHERN SECTION OF TURIN, TURIN (TO), ITALY (3) - DEPARTMENT OF THE CHILD AND ADOLESCENT NEUROPSYCHIATRY, LOCAL HEALTH ASL TORINO 2, TURIN (TO), ITALY (4)
Abstract: The subject of consciousness has fascinated human beings at least since the period of the early Greek philosophers. In recent years an increase of interest concerning the altered state of consciousness was observed. Disorders of consciousness (DOC) raise profound scientific, clinical, ethical, and philosophical questions. Patients in minimally conscious state, requiring individualized communication systems and targeted therapies performed by Speech and Language Therapists, raise numerous bioethic questions and deontology dilemmas for healthcare workers. A brief review of some current views of consciousness and awareness is provided. Will be try a brief review of some current views regarding the concepts of consciousness and awareness. In addition, it will be analyzed what are the main disorders of consciousness and awareness found in patients with Acquired Brain Injury , as well as areas in which the Speech and Language Pathology (SLP) are involved. It will be tried to analyze references in rules, bibliography and ministries, national and international, ethical and professional standards the speech therapist has to comply in their professional action. Learner Outcomes: to Learn that the differential diagnosis of disorders of consciousness is difficult, the rate of diagnostic error is about 40%; to Deepen summarizing terminology and main features of disorders of consciousness (DOCs or Disorders of Counsciouness) regarding the ABI proposed by current scientific literature; to Ensure that the presence of disorders of consciousness is considered one of the worst factors for functional recovery of patients and affects the quality of life and their social reintegration; to Determine the role of Speech and Language Pathology in the management of DOC communicative disorders related to a patients brain injury; to Detect and bring out some ethical and legal questions regarding the management of speech rehabilitation therapy of patients with disorders of consciousness and awareness, emerging predominant in everyday practice.
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CONVERSAZIONI NARRATIVE LABORATORY TO ENHANCE FUNCTIONAL COMMUNICATION BETWEEN PERSONS WITH APHASIA: A PRELIMINARY STUDY ROSSELLA MUO (1) - MARISTELLA CRIELESI (2) MARCELLA DI PIETRO (2) - STEFANO MONTE (2) REHABILITATION DEPARTMENT, ASL TO1, TORINO, ITALY (1) CENTRO INTERVENTO E RICERCA IN PSICOLOGIA, FONDAZIONE CARLO MOLO ONLUS, TORINO, ITALY (2)
Abstract: Introduction. Aphasia is traditionally defined as an acquired neurogenic language disorder most commonly caused by stroke. Changes in language processing associated with aphasia can affect everyday interactions and result in changed relationships, poor vocational outcomes, and decreased quality-of-life and psychological well-being. Over the past few decades, attention to functional communication abilities in real-situation
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CORRELATION BETWEEN QUALITY OF LIFE OF THE APHASIC PATIENT AND HIS FAMILY NATALIA CARLETO (1) - ALINE ARAKAWA (1) - CRISTINA SANTO (1) - ELEN FRANCO (1) - MAGALI CALDANA (1) FACULTY OF DENTISTRY OF BAURU, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: Stroke can be defined as a quick development of clinical focal or global disturbances signs of brain function bringing consequence symptoms lasting more than 24 hours. Aphasia is a language impairment, which occurs when someone suffers a brain injury related to this area. The communication losses shown by the aphasic person will reflect on social and daily life activities. Family members that were involved also feel affected by changing their quality of life. This study aimed to investigate the main factors that affect the quality of life of aphasic person post stroke and their families and verifying the correlation between these factors. The quality of life questionnaires was applied in the aphasic individuals (SSQOL) and relatives (WHOQOL). As a result, the domains least affected regarding the questionnaire administered to the aphasic individuals were: mobility (96.67%) and personal care (90%). Already the most affect domains were: language (49%) and behavior (55%). The domains least affected regarding the questionnaire given to relatives (WHOQOL-Bref) were: personal relationships (80%) and psychological (76.06%). Already the most affected domains were: physical (72.38%) and environment (69.58%). There was a statistically significant relationship between aphasic person and his family quality of life. Given the above, it was observed the impairment in quality of life both of the family as well as the aphasic individual after the stroke episode Learner Outcomes: know the main factors that affect the quality of life of aphasic person and their families; understand the difficulties experienced by both; direct guidelines for the aphasic person and their family during the process of rehabilitation, increasing the quality of life; know the importance of developing studies using specific questionnaires regarding pathology studied, as well as the importance of studying the impacts caused by stroke and aphasia by individuals and their families.
patients with impaired communication, and compromises the quality of life (physical and mental) of family caregivers affect negatively in the process of rehabilitation of the cared person, since the overload tests limits physical, psychological, and posture coping of family caregivers toward life. The purpose was to develop and evaluate the program of speech language pathology and psychological guidance to family of adult brain injured patients. Were invited to participate in the program all family members of patients treated in training course of adult language, at speech therapy clinic. The program was developed in the period from September to November 2010, with 21 family members in 9 meetings lasting 50 minutes each, being 3 with themes of speech therapy and 6 of psychology. In all the meetings were present the speech language pathologist and psychologist. Were used newsletters prepared by researchers. At the end of the meetings, a questionnaire was applied for a quantitative and qualitative evaluation of the program. Eighteen family members responded to the questionnaire, 100% say that the orientation program has met the expectations of the group, 89% have had the opportunity to transmit the issues discussed in that meetings to other family members and 83% the availability to participate in all meetings. It was possible to see the benefits of the program to the family members, with emphasis on aspects about the topics covered. Learner Outcomes: . know about the importance of informing family members about changes in oral and written communication that can be found in adults and the elderly brain injured; understand the need for family participation with the multidisciplinary team during the rehabilitation process; understand the benefits of a group of multidisciplinary orientation to family members; reflect on the need of performing multidisciplinary orientation groups.
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A CASE OF FOREIGN LANGUAGE ICTAL SPEECH ASSOCIATED WITH TEMPORAL LOBE EPILEPSY ELENI DIMA (1) - ANITA MCALLISTER (2) - HELENA GAUFFIN (1) - ANNE-MARIE LANDTBLOM (1) DEPARTMENT OF NEUROLOGY, LINKPING UNIVERSITY HOSPITAL, LINKPING, SWEDEN (1) - DEPARTMENT OF CLINICAL AND EXPERIMENTAL MEDICIN SPEECH AND LANGUAGE PATHOLOGY, LINKPING UNIVERSITY, LINKPING, SWEDEN (2)
Abstract: Epilepsy is a chronic disease characterized by seizures. It can principally be classified according to the seizure type and onset. Temporal lobe epilepsy(TLE) is the most frequent type of focal onset epilepsy. Automatisms, a set of brief, unconscious behaviors, is one of the cardinal signs associated with TLE. Foreign language ictal speech automatism(FLISA) is a rare ictal sign in TLE. According to existing literature FLISA are more likely to occur in men with non- dominant TLE. We present a rare case of a woman, with TLE arising from the dominant hemisphere, who experiences complex partial seizures( CPSs) during which she is unable to speak her first language(L1, in this case Swedish) but can communicate in a foreign language(L2, in this case English). We reviewed existing literature, relative to the subject. Our hypothesis about the pathogenic mechanism is that the epileptical activity affects the brain area representing the Swedish language but not the area representing English. The patient consciously decides to use the available English language in order to communicate. Learner Outcomes: get to know FLISA, a rare ictal sign of temporal lobe epilepsy; get a brief review of the mostly referred literature about the localization of the second language in the brain; listen/read a case presentation of a rare ictal sign, associated with the second language.
P218
APHASIA GROUPS: A DISCUSSION ABOUT THE SPEECH LANGUAGE REHABILITATION ANA PAULA SANTANA (1) - ANA CRISTINA GUARINELLO (2) UNIVERSIDADE FEDERAL DE SANTA CATARINA, UNIVERSIDADE FEDERAL DE SANTA CATARINA, FLORIANPOLIS, BRAZIL (1) - UNIVERSIDADE TUIUTI DO PARAN, UNIVERSIDADE TUIUTI DO PARAN, CURITIBA, BRAZIL (2)
Abstract: The research about group therapy with aphasic people only started at the end of the twentieth century. These studies point out the interaction as an import aspect in the therapeutic process. The goal of this research is to discuss in which way interactions constitute effective therapeutic practices in the rehabilitation of these individuals. To discuss these questions, we will use data collected in an aphasic group placed in the University Tuiuti of Paran, located in Curitiba/Brazil. All of the aphasic people that participated in the study had left-hemisphere cerebrovascular accident. All sessions are video-recorded, transcribed and analyzed according to enunciative-discursive approach of neurolinguistics. This perspective is based in sociocultural approaches (Vygotsky). The results show that the group facilitates the practice of discursive situations with different individuals, besides the possibility of developing interactions that surpass the dyad therapist-patient and promotes social life activities for the aphasics. As a consequence, group therapy change the aphasic`s place: from a non-competent subject to a competent subject in spite of your difficult. The interactions in the group are significant to subjective, linguistic, cognitive and social questions. Learner Outcomes: It is expected that the work presented will: (i) demonstrate to the attendees the formation of the aphasic group; (ii) show interactions occur inside the aphasic group; (iii) demonstrate the effectiveness of the aphasic group.
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SPEECH THERAPY GROUP EFFICACY FOR PRAGMATIC DISORDERS IN PATIENTS WITH SEVERE ACQUIRED BRAIN INJURY VALENTINA CANTOIA (1) - FRANCESCA AUXILIA (1) - PAOLA TAVERNA (1) - PATRIZIA CANCIALOSI (2) FONDAZIONE DON GNOCCHI ONLUS, PRESIDIO SANITARIO AUSILIATRICE, TURIN, ITALY (1) - PRESIDIO C.T.O./ M. ADELAIDE - S.C. RRF GRAVI CEREBROLESIONI ACQUISITE, AOU CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, TURIN, ITALY (2)
Abstract: Introduction - Patients with severe brain damage, at vascular, traumatic or anoxic etiology, have a reduction of communication efficacy, with lack of attention, memory, reasoning, consciousness and behavioural or cognitive difficulties. Aim of the study - This research aims at verifying the efficacy of group therapy and how group setting modifies the outcome compared to individual sessions. Methods - The examined data cover a temporal span of approximately six years: from 2006 to 2012. Patients attended a Day-Hospital in Health Post Ausiliatrice Don Gnocchi Foundation, in Turin. Two samples of patients in Day Hospital with pragmatic disorders were examined: the first one had done group therapy, the second one had done only individual sessions. Both of them had severe Acquired Brain Injury (ABI), of traumatic or vascular etiology. For each subject who had done either individual or group therapies, we compared the results obtained by
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P219
BENEFITS OF A PROGRAM OF SPEECH LANGUAGE PATHOLOGY AND PSYCHOLOGICAL ORIENTATION TO FAMILIES OF BRAIN INJURED PATIENTS NATALIA CARLETO (1) - MARIA LUCIA DE CARVALHO (2) MAGALI CALDANA (1) FACULTY OF DENTISTRY OF BAURU, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1) - HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (2)
Abstract: The language, whether spoken or written, plays a key role in every activity we undertake. Language impairment could lead to a restriction of individual communication with the environment, including family interactions and social life. The family plays a key role in the rehabilitation process of
three different scales (Functional Independence Measure-FIM, Functional Assessment Measure FAM; Levels of Cognitive Functioning-revised LCF-R) at the beginning of the treatment and after three months. Results - The results showed that over 50% of the patients who followed speech therapy in group sessions showed a significant improvement, compared with people who had only individual sessions. Conclusions - The survey outcome indicates that rehabilitation group can gradually facilitate communication with more people and in increasingly difficult contexts, making it similar to everyday situations and is therefore a valid strategy for social and schoolwork reintegration. Learner Outcomes: Learn three of the scales used to assess people with ABI: FIM, FAM and LCF-R; Analyze the level of detail of the improvements recorded by the three scales considered, Assess the efficacy of group rehabilitation for pragmatic deficits, comparing the results obtained from the sample of subjects who followed a rehabilitation group with the other sample, composed by people who followed only individual treatment.
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PERSONS WITH APHASIA AFTER CVA AND SUBJECTS WITH DEGENERATIVE DISORDERS OF CNS - COMPARATIVE STUDY WITH USING CZECH EXPERIMENTAL VERSION THE BUTT NON-VERBAL REASONING TEST KAREL NEUBAUER (1) - UHAJDOV (1) - IVETA MRZKOV (1) DEPARTMENT OF SPECIAL EDUCATION, SUBDEPARTMENT OD COMMUNICATION AND SENSORY DISORDERS, FAKULTY OF EDUCATION, UNIVERSITY HRADEC KRLOV, HRADEC KRLOV, CZECH REPUBLIC (1)
Abstract: The diagnostics adequate or inadequate skills respond to practical life situation is directly connected with effectiveness of rehabilitation process and achievement of good independence in communication and personal live of person with disorder of communication. The diagnostics requires to display important practical life situation and their solving with using judgement and experience, that is not fixed on verbal language entrance and respects situation persons with acquired disorders of communication. The Butt Non-Verbal Reasoning Test (2004, BNVR) is for persons with aphasia after CVA and persons with degenerative disorders of central nervous system new possibility, how use results comparative study with using Czech experimental version BNVR for diagnostic of these persons in Czech language environment. The aim of the study include: a) usage Czech experimental version test BNVR, that shall basis for processing results, leading to the formation Czech version hereof investigation; b) analysis of achieved results at goal band of persons with aphasia after CVA, persons with degenerative disorder of central nervous systm, and comparation of results with the control group of healthy persons. Results first period of comparative study include thee group of person - first group of 20 persons with aphasia after CVA, second group of 20 fathers with degenerative disorder of central nervous system, third group is control group 20 persons without communications deficit. The study includes and comparative upward revaluation of results another diagnostic material, which is in these areas widely exploited (Token test, Mini Mental State Examination) for all diagnosed persons. Results of study support have highly suggestive scatter of results of diagnosed persons and necessity of development hereof type of assessment way. Make possible also comparison with results of authors The Butt Non-Verbal Reasoning Test (BUTT, BUCKS, 2004). In primary group included twenty persons with diagnosed cerebral lesions (CVA), 8 women, 12 men, all persons shows aphasia. Mean age was 62 years (range 34 - 73 years). Control group of 10 healthy persons included 7 women and 3 men. Mean age was 62 years (range 45 - 65 years). The second group was for twenty persons with diagnosed degenerative disorder central nervous system, 20 women, 11 persons with Alzheimer disease, 3 subjects with Parkinson disease, 6 persons with vascular disorder. All of personnel this group shewed syndrom of dementia. Mean age was 82 years (range 70 - 93 years). The control group of 10 elderly without degenerative disorder central nervous system included 8 women and 2 men. Mean age was 82 years (range 69 - 96 years). Persons with aphasia after CVA had deficits in the area semantic and visual distractors, in accordance with record previous studies BNVR. Correlation of results in both nonverbal tests, BNVR and Revised Token test (RTT), was significant at design with using non - parametric Chi- square as positive in significance level 0,05. Subjects with diagnosed degenerative disorder central nervous system embody considerable scatter in results in MMSE (24 4 level of rezults), then in whole range cognitive handicap. On this account wasnt performe of statistic collation results, but was elect form particular collation results of both diagnostic materials. Error count in BNVR were to be captive in span extreme position 0 - 7 mistake from 10 impositions, average is in value 2,7. Toward achievement statistically processed results will necessary subsequently to find more homogenous group persons with degenerative disorder central nervous system. Learner Outcomes: to know specific problems of assessment of persons with acquired disorders communication on neurogenic basis, most of all persons with aphasia or cognitive - communication disorders, be connected with usage adequate methods estimation failed modality communication system, also with problems estimation pragmatic communication and problem-solving ability thus handicapped people.
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APHASIA: CHANGES IN NEUROIMAGING AFTER TREATMENT SPEECH THERAPY, CASE REPORT ANGELA LUCIA FOGLIATO (1) - SARA VESCO (2) - ROSSELLA BESSONE (1) - ANGELINA CISTARO (3) - PIERCARLO FANIA (3) - MAURIZIO BEATRICI (1) - FRANCA BALBO MOSSETTO (4) DEPARTMENT OF MEDICINE PHYSICAL AND REHABILITATION 2, HOSPITAL CORPORATION CITT DELLA SALUTE E DELLA SCIENZA DI TORINO HOSPITAL UNIT C.T.O./M.ADELAIDE, TURIN, ITALY (1) - DEPARTMENT OF MEDICINE PHYSICAL AND REHABILITATION, HOSPITAL MARTINI ASLTO1, TURIN, ITALY (2) - RADIOLOGY CENTER POSITRON EMISSION TOMOGRAPHY, IRMET SPA TURIN, TURIN, ITALY (3) - DEPARTMENT OF THE CHILD AND ADOLESCENT NEUROPSYCHIATRY, LOCAL HEALTH ASL TORINO 2, TURIN, ITALY (4)
Abstract: The study of language disorders has proved of great importance in the research on language faculty and localization of brain functions. A large part of the knowledge of brain functions albeit still partial, comes from an analysis of deficits caused by brain diseases of different origin. The knowledge of the effects of the interventions in speech therapy rehabilitation training on brain reorganization and functional recovery is not always obvious and remains incomplete. Recent studies carried out with modern neuroimaging methods on the functioning of individual brain areas seem to open promising prospects on the possibilities to use this type of information to deepening our knowledge in several areas, among them the rehabilitative procedures, which can then be based on neurobiological as well as cognitive assumptions. On this basis, the aim of this work, is to present a case report of a case of non-fluent aphasia Broca type, hemorrhagic vascular etiology, as well as to quantify and define the changes in brain metabolism that follows from the rehabilitation speech therapy. The patient followed a specific protocol of treatment and was subjected to evaluation of deficit aphasia and cognitive-communication through standardized test batteries at the beginning and the end of the cycle rehabilitative speech therapy, in correspondence with the conduct of the neuroradiological study. It was chosen as investigation neuroradiological method the Positron Emission Tomography-Computed Tomography study with 18F-Fluorodeoxyglucose (18F-FDG-PET/TC) in order to obtain an objective and systematic evaluation of metabolism of individual brain areas to be correlated with cognitive, communicative and language ability of the patient. Particularly, adjustments in functional improvements of communication and language have been highlighted over time (12 and 18 months after initiation of treatment), evident both in terms of standardized assessment and at pragmatic level, and in parallel, at the level of neuroimages (18F-FDG-PET/TC).These neuroimages revelead an improvement of metabolism in associative areas in prefrontal antero-mesial left area and fronto-lateral bilateral areas as well as at the level of left basal ganglia and left thalamus. So, the survey highlights interesting preliminary observations, needing to be confirmed by further research, in particular with regard to prognostic orientation that could come from evaluation of the injury degree of metabolic / anatomical regions of the brain, and about the most appropriate therapeutic rehabilitation to follow (using compensation/ resume function). This information could then be available soon after the acute event. Learner Outcomes: to deepen his/her knowledge general modern techniques such as 18F-FDG-PET/TC examination; to know a possible model to take in charge aphasic patient in speech therapy and its practical application; to deepen the knowledge of possibilities of applying the radiodiagnostic techniques described, while verifying the effectiveness of speech therapy treatment.
P224
THERAPEUTICAL FOLLOW-UP OF NON-FLUENT APHASIC SUBJECTS: THE LINGUISTIC-COGNITIVE WORK THROUTH THE DEVELOPMENT OF NARRATIVES CAZAROTTI PACHECO MIRIAN, NOVAES PINTO ROSANA DO CARMO INSTITUTO DE ESTUDOS DA LINGUAGEM (LANGUAGE STUDIES INSTITUTE), UNIVERSIDADE ESTADUAL DE CAMPINAS (STATE UNIVERSITY OF CAMPINAS), CAMPINAS, BRAZIL
Abstract: The main goal of this presentation is to argue that the work with the narrative genre is a privileged locus to approach two very important issues in the field of aphasiology: (i) the understanding of aphasia itself i.e., how a brain lesion may impact the language system on all its levels of organization (phonetic/phonological, syntactic, lexical-semantic, pragmatic
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and discursive); (ii) how the work with narratives during the therapeutic follow-up may help aphasic subjects even those non-fluent reorganize language and signification processes (verbal and non-verbal) despite all their difficulties. We defend, therefore, that narrative discourses may be understood as a methodology which makes it possible to elicit data in effective use of language, in real interactions. To develop our reflection, we selected two dialogic episodes produced among aphasic and non-aphasic subjects in sessions of Centro de Convivncia de Afsicos (A center for aphasic subjects - Group 3 of CCA). Data were video-recorded, afterwards transcribed and analyzed according to qualitative approaches (Ges, 2000, Ginzburg, 1989, Vigotski, 1984/2003) which guide researches in our field (Discursive Neurolinguistics). The results of our analysis show a remarkable difficulty the subjects have for finding words, which in turn leads to a high occurrence of pauses and hesitations, of single-word utterances or even of non-verbal signs or gestures, which are generally interpreted as deficits, in traditional studies. Despite these difficulties, however, our conception of language allows us to recognize all these non-verbal or single-word productions as utterances (Bakhtin, 1997) and reinforce what Coudry (1986/1998) has stated, since her founding work in Discursive Neurolinguistics: There is language in aphasia. Aphasic utterances, in our work, have been analyzed in agreement with bakhtinian terminology, recurring to the concepts of utterance, finalizations, speech will, dialogue, dialogism and responsive comprehension, among others, in order to describe and explain how aphasics are able to develop narratives even the non-fluent aphasics, who often recur to non-verbal utterances in interaction with their partners/ interlocutors. What is usually taken as an evidence of a deficit in neuropsychological theories can be interpreted, in our theorization, as an evidence of linguistic reformulation, i.e, of epilinguistic operations. In other words, as evidence that the subject works with the linguistic resources he/she still has available in order to build (dialogically) a linguistic utterance (verbal or non-verbal), with the help of his interlocutor/partner. It is relevant to mention that while the subjects narrate their own story or any other story or fact (real or imaginary), they not only reorganize their language resources/system, but also their memory (or memories). The last point to bring up is that in the therapeutic setting, each subject learns to listen to the other and to give the other more time (Ponzio, 2010). Besides, he/she learns how to grasp from the others speech some hints to reorganize his own utterance and how to get by, despite the limits imposed by aphasia conditions. Learner Outcomes: It is expected that the poster presented will (i) publicize the work and reflections which we have been developing with aphasic subjects, more specifically the work with narratives; (ii) discuss the relevance of qualitative approaches to aphasia research; (iii) inspire research and clinical work towards a dialogical approach on aphasia.
elderly individuals. The majority of the research to date has focused on the increase of cognitive processing speed in children as it relates to language and reading disorders. Although research in children maybe applicable to adults with neurogenic disorders, further research is needed for evidencedbased treatments of adults who are aging typically or who present with mild cognitive impairment (MCI). Clinical implications for the early detection and treatment of MCI will be discussed in regard to the education or training of speech-language pathology graduate students. Learner Outcomes: Participants will be able to describe major elements of cognitive processing; Participants will be able to discuss the effects of different tasks on cognitive processing speed; Participants will be able to identify tasks which may prevent cognitive decline.
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EMOTIONAL WORK WITH APHASIC PERSONS: USING LANGS IMAGES ALBERTO GIACHERO (1) - MARIATERESA MOLO (1) MARINA ZETTIN (2) - MAURIZIO TIRASSA (3) - STEFANO BALASINI (1) CRISTIAN RUGIERO (1) - MELANIE CALATI (1) FONDAZIONE CARLO MOLO ONLUS, LABORATORIO SPERIMENTALE AFASIA, UNIVERSIT DEGLI STUDI DI TORINO, TURIN, ITALY (1) - CENTRO PUZZLE, UNIVERSIT DEGLI STUDI DI TORINO, TURIN, ITALY (2) - UNIVERSIT DEGLI STUDI DI TORINO, TURIN, ITALY (3)
Abstract: Over the last decades, approaches to aphasia and its rehabilitation have evolved from focusing solely on language impairment and restoration to considering the wider communicative and inter-subjective context in which language is embedded. This has led to the development of pragmatic-functional approaches (e.g., Davis and Wilcox, 1985; Carlomagno, 2002), which view communication as a special type of social action (Tirassa & Bosco, 2008) and design treatments accordingly. In this framework, it appears natural to broaden the focus to take emotions into account as well. We describe the implementation of a pragmatic-functional training for the group treatment of motor aphasia, which involves the use of Langs images within the conversational context. The treatment was held at the Laboratorio Sperimentale Afasia of the Fondazione Carlo Molo Onlus in Turin (Italy). Langs images (Lang, 1997) have a highly emotional content (standardized for hedonic valence, activation and dominance). In the treatment we describe they were used, on the one hand, to support the patients bringing in specific emotional experiences relevant to their relational life, and, on the other hand, to provide a visual anchor to which the focus of communication could be brought back when contents became too complex for the patients to manage them verbally, or when communication in the group became excessively fragmented. Each group of participants included three or four persons with mild motor aphasia, and was conducted by two expert psychologists as facilitators. The groups were assembled according to criteria of homogeneity in the severity of the disorder. The treatment was structured on two sessions a week for a total of 24 weeks (six months); the first session of each week was videotaped; in the second session, a montage of sequences extracted and edited from the tape was used, in addition to discussion from the facilitators and the other members of the group, as a feedback to foster each participants self-awareness of their communicative weak and strong points and the development of automatic self-correction on their part. Using Langs images has the goal of improving the participants communicative effectiveness in inter-subjective contexts and consequently their quality of life, through a strengthening of their ability to narratively manage their personal emotional experiences. In order to evaluate the effectiveness of the treatment, and in accordance with the European guidelines concerning rehabilitation, each participants cognitive functions, linguistic abilities, communication and conversation skills, and psycho-social aspects were assessed twice, one before the beginning of the training and the other at its end. In this presentation the results obtained by a sample of 10 patients with motor aphasia are shown. They participated in the training after the completion of classical speech therapy rehabilitation and therefore can be considered to be in the chronic phase. During the period of this training, none of them was simultaneously undergoing other types of activities explicitly aimed at improving communication abilities: therefore, the results obtained are likely to be causally related to the treatment. Learner Outcomes: Value of a pragmatic-functional approach to the rehabilitation of motor aphasia; Value of group rehabilitation; Mutual influence of emotional experiences and conversational skills; Opportunity to work on the personal level with aphasic patients.
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EFFECTS OF ORAL READING VERSUS CONFRONTATION NAMING ON COGNITIVE PROCESSING SPEED IN ELDERLY INDIVIDUALS AGES 65-74 YEARS CHRISTY FLECK (1) - MELINDA CORWIN (1) DEPT. OF SPEECH, LANGUAGE AND HEARING SCIENCES, TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER, LUBBOCK, UNITED STATES (1)
Abstract: Clinical tools are beneficial for determining typical versus atypical cognitive processing speed, but can a person increase his/her cognitive processing speed? Research has indicated that exposure to oral reading or confrontation naming tasks could potentially increase overall cognitive processing speed. Slower cognitive processing speed involves slower word recognition, which results in breakdowns in reading fluency. Approaches to remediating reading fluency (and in turn, cognitive processing speed) include word recognition practice or repeated reading of texts. Increased speed and accuracy during confrontation naming tasks has also been correlated with an individuals cognitive processing speed: Quickly and accurately naming objects or pictures results in efficient cognitive processing speed. The objective of this study is to investigate whether exposure to oral reading or confrontation naming tasks could potentially increase overall cognitive processing speed in normal elderly individuals. These tasks have a proven basis for increasing cognitive processing speed in other populations (Levy, Abello, & Lysnchuk, 1997; Wolf &Segal, 1992). Specifically, the purpose of this research is to determine if participation in a 4-week program involving oral reading or confrontation naming tasks will maintain or increase cognitive processing speed in normal elderly individuals. A pretest-posttest control group design was used to assess the effects of an oral reading and confrontation naming program on cognitive processing speed. Forty-five individuals consented to take part in the study. The participants had no known or family-reported history of neurological impairment. All participants were tested to verify typical cognitive functioning with the Montreal Cognitive Assessment (MoCA) and the Saint Louis University Mental Status (SLUMS). Baseline and post-treatment measurements were obtained using A QuickTest of Cognitive Processing Speed (AQT) including the Color, Form, and Color + Form subtests and the Stroop Color and Word Test. Results of a repeated measures analysis of variance will be reported to determine if the assigned tasks (confrontation naming and/or oral reading) resulted in increased cognitive processing speed. This research is significant because it assesses possible ways to increase cognitive processing speed in normal
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PROMOTING PARTICIPATION IN PERSONS WITH APHASIA: A MULTIPROFESSIONAL SOCIAL APPROACH ROSSELLA MUO (1) - MARCELLA DI PIETRO (2) - MARISTELLA CRIELESI (2) - ALESSIA CONGIA (2) - LORENA LA ROCCA (2) STEFANO MONTE (2) REHABILITATION DEPARTMENT, ASL TO1, TURIN, ITALY (1) CENTRO INTERVENTO E RICERCA IN PSICOLOGIA (C.I.R.P.), FONDAZIONE CARLO MOLO ONLUS, TURIN, ITALY (2)
Abstract: Introduction. Aphasia is traditionally defined as an acquired neurogenic language disorder most commonly caused by stroke. Changes in language processing associated with aphasia can have broad-ranging impacts on daily life, affecting the quality and quantity of everyday interactions and resulting in changed relationships, poor vocational outcomes, and decreased quality-of-life and psychological well-being. Aphasia has also an impact on family members (Brown et al, 2011). The concept of living successfully with aphasia has recently emerged in aphasiology, encouraging a focus on positive rather than negative outcomes. Living with Aphasia Framework for Outcome Measurement (A-FROM) (Kagan et al, 2007) is a conceptual framework adapted from the World Health Organization International Classification of Functioning, Disability and Health (ICF) (World Health Organization, 2001). A-FROM framework includes four domains (impairment, participation in life situations, communication and language environment, and personal factors) and their interactions, in relation to aphasia-related Quality of Life. The Centro Intervento e Ricerca in Psicologia (CIRP) of the Carlo Molo Foundation offers integrated multiprofessional treatments and support activities to persons with aphasia throughout the entire course of the disease, with special interest in the post rehabilitation. CIRPs activities include psychological support, social worker counseling, legal counseling, social theater activities and SLP consultant in agreement with ASL TO1 Rehabilitation Department; all activities are related to patients needs, will and desires. CIRPs proposals aims are 1) to help persons with aphasia both coping with the fact that they have been left with a chronic disability, 2) to help persons with aphasia starting living successfully with aphasia, 3) to raise public awareness on aphasia and persons with aphasia. Psychological and psychotherapy intervention is focused on processing the change of living. It is aimed to Self re-organization and the ability to use remaining resources. SLPs proposal include co-conduction of conversational groups, called Conversazioni Narrative and training activities for caregivers, students or others. Counseling for both persons with aphasia and their caregivers or language and communications assessment are provided when needed. Social theatre groups aims at first to help persons with aphasia both familiarizing with theatre language and strengthening non verbal communication abilities (first level group, called AlfabetoTeatro); second level group, called NarrAzioni Teatrali, is thought to be a real theatre group, where people act and perform a theatre product based on aphasia experience and perceived emotion linked with aphasia; groups productions are performed outside the CIRP in order to spread groups messages and are a precious tool to raise public awareness. All our groups are co-conducted and involve peer support. Social workers activities are aimed both to help persons with aphasia and their caregivers with legal procedure and to find relevant recreational activities in their environment. Moreover, among CIRP activities, meetings for caregivers training in Supported Conversation for Adults with Aphasia (SCA) were periodically organized. Aim of the presentation is to give a description of CIRPs activities in order to share social approach and information on useful activities for person with aphasia. Learner Outcomes: understand the importance of integrated multiprofessional activities, understand the importance of social participation for persons with aphasia; know a proposal to enhance life skills for persons with aphasia.
rethinking process of the intervention plans for people with aphasia. Learner Outcomes: Recognize the challenges in matching AAC to people with Aphasia, Distinguish between partner-dependent and independent communicators, Describe the perceptions of SLPs regarding the usage of the multimodal assessment for people with Aphasia.
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RELATIONSHIP BETWEEN BRAIN ACTIVITY IN WORD GENERATION UNDER DIFFERENT STRATEGIES AND INDIVIDUAL DIFFERENCE OF WORKING MEMORY CAPACITY: AN FMRI STUDY MIMPEI KAWAMURA (1) SPEECH-LANGUAGE-HEARING THERAPY, DEPARTMENT OF REHABILITATION, FUKUI COLLEGE OF HEALTH SCIENCES, FUKUI, JAPAN (1)
Abstract: Introduction: By using Word fluency task with three different strategies, Kawamura et al (2012) suggested a behavioral indicator that the difference of Working Memory Capacity influences and produces the individual difference in word generation, but did not clarify its neuroscientific basis. This study has examined through fMRI (functional Magnetic Resonance Imaging) the relationship between the brain activity in word generation and the individual difference of Working Memory Capacity.Method: 1) Subjects: 19 healthy native speakers of Japanese with an average age of 24.13.75 years old and were divided into 10 high-span and 9 low-span Working Memory Capacity groups according to the Japanese reading span test. 2) fMRI task: Word fluency task (category, letter and verb conditions) was carried out under the inner speech control separately according to each condition. The brain activity under each condition was shot by the 1.5T fMRI and BOLD signals were calculated. The experiment protocol used a block design of a 30s rest30s task30s rest trial. Analysis of the data was done by SPM8, an analyzing soft for fMRI and the significant difference of an activation region of the brain was examined by the difference method (T-test: p<.001 uncorrected). The coordinate where a significant activation was recognized was converted from MNI coordinate to the Talairach. Results: It was in the Left Middle and Interior frontal gyrus that significant activation under all three conditions was recognized in both High-span and Low-span Working Memory Capacity groups. Moreover, it was only limited to the High-span Working Memory Capacity group that significant activation under Letter condition was recognized in the Left Superior frontal gyrus and that significant activation under Verb condition was recognized in the Left Precuneus and Left basal ganglia. Discussion: This study has clarified that the brain regions related to word generation are different according to the difference of Working Memory Capacity and under the different strategies; especially it seems essential that the activation of such regions as the Left Precuneus and Left basal ganglia(Putamen, Caudate, Thalamus) should be engaged in the smooth verb generation. Learner Outcomes: The Participant will be able to know: that the brain activity while being in word generation differs according to the difference of an individuals working memory capacity; how the brain functions while it generates words efficiently; and how an effective rehabilitation will be applied to an aphasiac from the viewpoint of working memory functions.
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PRODUCTION OF L1-L2 COMMON SYLLABLES IN APRAXIA OF SPEECH: A STUDY OF BILINGUAL PRODUCTION IN A LATE SWEDISH-FRENCH BILINGUAL MARY OVERTON VENET (1) - MARINA LAGANARO (1) FACULTY OF PSYCHOLOGY AND EDUCATIONAL SCIENCES, UNIVERSITY OF GENEVA, GENEVA, SWITZERLAND (1)
Abstract: Late bilinguals produce the second language with greater effort than L1 and with a foreign accent, which is probably due to the fact that motor plans in L2 are based on L1. In the psycholinguistic literature, early bilinguals are thought to possess independent syllabic representations whereas these representations may be shared in late-bilinguals. This hypothesis serves to explain why characteristics of L1 influence L2 language processing in these late-bilinguals, and it may explain patterns in cases of acquired language disorders. In this single case experimental study of bilingual production in a late bilingual stroke patient with acquired Apraxia of Speech (AOS), our principal goal was to investigate the nature and organization of syllabic representations for syllables which are phonologically common across both languages. In particular, we wished to explore the influence of the mother tongue (L1 Swedish) on syllable production in the late-acquired second language (L2 French) after stroke. We investigated the issue of language specific versus shared representations via the syllable frequency effect, which is thought to index the retrieval of syllable sized representations during speech production. We constructed 144 pseudo-words composed of syllables of high and low frequency in French and Swedish respectively. The patient and 3 matched bilingual control subjects were asked to read and repeat the pseudo-words. We also analyzed the acoustic properties of pre- post-stroke L2 production thanks to a pre-morbid video data provided by the patient. Production accuracy was higher on pseudo-words composed of syllables of high frequency in both languages relative to pseudo-words
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SPEECH-LANGUAGE PATHOLOGISTS PERCEPTIONS OF THE ROLE OF MULTIMODAL COMMUNICATION ASSESSMENT FOR PEOPLE WITH APHASIA MALI GIL (1) - TAL LEBEL (2) LOEWNSTEIB REHABILITATION HOSPITAL, HOSPITAL, RAANANA, ISRAEL (1) - UNIVERSITY OF HAIFA, UNIVERSITY, HAIFA, ISRAEL (2)
Abstract: Matching Augmentative and Alternative Communication (AAC) aids to people with aphasia is a challenging task, especially due to the need to achieve a significant change in the approach of staff, family members, and the patients themselves. This study aimed to examine the perceptions of clinicians working in a rehabilitation hospital regarding the role of multimodal communication assessment in the process of planning intervention for people with aphasia. Twelve speech-language pathologists conducted the Multimodal Communication Screening Test (MCST-A) for 24 people with aphasia of varying degrees of severity (each clinician assessed the communication of two patients), and classified them according to AAC-Aphasia Categories of Communicators. Clinicians attitudes about the contribution of the assessment tools to the decision-making and planning processes were examined using in-depth interviews that were recorded, transcribed, and analyzed. The extensive information gathered through the interviews appeared to stimulate a
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containing syllables which were of low frequency in one language (whether French or Swedish) and the highest error rate was observed on pseudowords composed of low frequency syllables in both languages. The same results were observed in both reading and repetition tasks and accuracy was comparable across frequency categories in controls. The observation that frequency of use summed across languages influences production accuracy in this patient suggests shared syllabic motor plans (a unique representation used in L1 and L2), which is consistent with the hypothesis of common gestural scores in late bilingual speakers presented above. On the other hand, comparison between pre-post-morbid productions in L2 showed syllabic lengthening after stroke in L2, which was modulated by frequency in L1. This latter result also suggests a common repository of syllabic phonetic scores for L1 and L2. Our results show that, in the case of our patient, a late-bilingual speaker with moderate AOS, syllabic representations appear to be organized according to frequency, complexity and language-specificity : that is, according to whether they are shared between French and Swedish.In the discussion, in the light of these findings, we propose some ideas relative to the complex questions that are assessment and intervention in bilingual AOS.Syllable structure of the mother-tongue and its effect on L2 performance in apraxia of speech: a study of bilingual production in a Swedish-French bilingual patient. Learner Outcomes: Reflecting on present bilingual assessment procedures; Creating case-specific bilingual assessment materials; Learning about the importance of syllables in oral .
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CROSS-CULTURAL ADAPTATION INTO ITALIAN AND VALIDATION OF THE AMERICAN SPEECH-LANGUAGE AND HEARING ASSOCIATION - FUNCTIONAL ASSESSMENT OF COMMUNICATION SKILLS FOR ADULTS (ASHA-FACS) ROSSELLA MUO (1) - PATRIZIA CANCIALOSI (2) BARBARA CARRUBBA CACCIOLA (3) - LAURA GALIMBERTI (4) ANTONIO SCHINDLER (5) REHABILITATION DEPARTMENT, ASL TO 1, TURIN, ITALY (1) PRESIDIO C.T.O./ M. ADELAIDE, HOSPITAL AOU CITT DELLA SALUTE E DELLA SCIENZA, TURIN, ITALY (2) - MEDICAL OFFICE MIRAFIORI, MEDICAL OFFICE MIRAFIORI, TURIN, ITALY (3) - SELF EMPLOYED, SELF EMPLOYED, SAN REMO, ITALY (4) - CLINICAL SCIENCE DEPARTMENT L. SACCO, MILAN UNIVERSITY, MILAN, ITALY (5)
Abstract: Introduction. Impairment of communicative-linguistic and cognitive functions are common after stroke and traumatic brain injury. Clinical assessment of language function is mainly performed through specific tools, such as Aachener Aphasie Test. Standardized assessment of pragmatic abilities, functional abilities, and communicative competence is less common in clinical practice, even though suggested by many recent national and international guidelines (1, 2). The American Speech-language and Hearing Association - Functional Assessment of Communication Skills For Adults (ASHA-FACS) (3) is a measures of communication disability and may be used as an outcome measure (4). The scale investigates functional communication; functional communication is defined as the ability to receive or convey a message, regardless of the mode, to communicate effectively and independently, in natural environments. The ASHA-FACS is divided in 4 domains of functional communication abilities (social communication, communication of basic needs, reading, writing and number concepts and daily planning). The ASHA-FACS has been translated and adapted into Italian in 2001 (5), but Italian version of ASHA-FACS has not yet been validated. Aim of the study. The aim of the study is to validate the Italian version of the ASHA-FACS scale. Methods. One hundred healthy adult subjects without neurological disorders nor communicative-cognitive deficits were enrolled for the definition of a normative sample; healthy controls were stratified by age (< 30, 31-60, 61-70, > 71) and evaluated with Mini Mental State Examination (MMSE); only persons with MMSE > 24 were included in the study. Forty persons with aphasia following stroke or traumatic brain injury were enrolled. ASHAFACS was completed by two different examinators, blind to each other, at the same time and after a week, to calculate inter- and intra-subjects reliability. Validity study was conducted on 60 aphasic and traumatic brain injured (TBI) patients; all patients were assessed with Functional Independent Measure (FIM) and ASHA FACS. Aachener Aphasie Test (AAT) was used to assess aphasic persons and Levels of Cognitive Functions scale (LCF) for TBI persons. Statistical analysis were conducted with SPSS. Results. All healthy persons showed very high level of functional communication abilities in all domains of communication independence and all qualitative dimensions scores; scores were respectively higher than 6, on a 7-point scale, and higher than 4, on a 5-point scale. Italian version of ASHA-FACS showed high internal consistency (Cronbachs alpha >.9) and high intra- and inter-reliability (Pearsons r >.9 and >.88, respectively). Correlations between ASHA-FACS scores and FIM (comprehension, expression, social interaction, problem solving and memory) were high and generally highly significant in aphasic persons. Highest correlations were found between ASHA-FACS and problem solving and comprehension subscales. Correlations between ASHA-FACS and AAT were generally from moderate to high and highly significant. Highest correlations were found between ASHA FACS and AAT spontaneous speech, token test and comprehension subtests. Correlations between ASHA-FACS and LCF were generally low and did not reach statistical significance.Conclusions. Our results suggest good internal consistency and test-retest reliability and satisfactory concurrent validity. Authors suggest the application of ASHA-FACS to the Italian population of patients with communicative deficits due to cerebral lesion. Learner Outcomes: understand better the importance of communication abilities besides linguistic function; understand better the importance of considering functional communication for persons with aphasia; know a validated tool to measure functional communication.
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RE-EXAMINING VERB DEFICITS EXHIBITED BY JAPANESE SPEAKERS WITH APHASIA IN SUB-TESTS OF SALA NORIKO NAGATSUKA (1) - TAKASHI YOSHIDA (2) SOPHIA LINGUISTIC INSTITUTE FOR INTERNATIONAL COMMUNICATION, SOPHIA UNIVERSITY, TOKYO, JAPAN (1) SPEECH-LANGUAGE THERAPY PROGRAM, AICHI SHUKUTOKU UNIVERSITY, NAGOYA, JAPAN (2)
Abstract: Selective verb or noun deficits have been observed in language processing in aphasia. Some studies have suggested that verb deficits may be attributable to semantic differences rather than grammatical class. Among psycholinguistic variables, imageability of words has been reported to affect single-word processing of verbs. The aim of the present study is to re-examine the data obtained in comprehension tasks as well as production tasks of verbs and nouns by Japanese speakers with aphasia from a perspective of the effect of imageablity. Twenty-one patients, 17 males and 4 females, with mild to severe aphasia participated in the study. Performances of twelve sub-tests from SALA (Sophia Analysis of Language in Aphasia) were investigated; SALA is a psycholinguistic assessment tool for Japanese speakers. The tests were in the following six kinds of tasks in nouns and verbs: word-to-picture matching (words presented auditorily and visually), semantic similarity judgments (presented auditorily and visually), spoken naming, and written naming. First, the results of each task were compared as a group of patients between nouns and verbs. For spoken naming, the participants performance for verbs was similar to nouns. The remaining five tasks showed predominant deficits in verbs. Since items of each task in SALA were not sufficiently controlled in psycholinguistic variables such as familiarity and imageability, we took a process of designating sub-sets that comprise only items controlled in those variables in order to genuinely compare grammatical class. As a result sixteen items were selected from each test. The scores for those items were tallied up and re-examined. The differences between verbs and nouns decreased in the sub-set version compared with the original one, but performances in similarity judgments were still significantly worse in verbs. The results suggest that verb impairments are not solely attributable to imageability of words. Especially for similarity judgments, possible differences required in operations of verbs from those of nouns were discussed. Performances were also analyzed by each individual participant. Eight patients, 4 fluent and 4 non-fluent, were identified as verb-impaired in at least one of the tasks in the sub-set version. Six out of the eight patients showed verb deficits in only a single task. The effect of imageability was not generally demonstrated across modalities within an individual, which indicates that their deficits are not central or semantic. We concluded that the differences in processing between verbs and nouns cannot be explained by simple factors. Verbs probably have to be examined taking relevant syntactic features into consideration. Limitations of a singleword processing model were also suggested. Learner Outcomes: Japanese speakers with aphasia exhibit worse performance on verbs than nouns in various tasks including semantic similarity judgments; imageability seems to play a certain role in verb deficits but it is not a sole factor; within each individual patient the effect of imageability was not generally observed across modalities indicating that their deficits are not central or semantic; and verbs have to be examined in multiple aspects such as relevant features in syntactic processing including argument structures.
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NOSTRIL MORPHOMETRY EVALUATION BEFORE AND AFTER CLEFT LIP SURGICAL CORRECTION: CLINICAL EVIDENCES MARIO JORGE FRASSY FEIJO (1) - STELLA RAMOS BRANDO (1) - RUI MANOEL RODRIGUES PEREIRA (1) - MARIANA BATISTA DE SOUZA SANTOS (1) - LUCIANA NGELO BEZERRA (1) - DANIELE ANDRADE CUNHA (1) - HILTON JUSTINO SILVA (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND ALLERGY/IMMUNOLOGY AMBULATORY, RECIFE, BRASILE (1)
Abstract: Purpose: To review systematically the morphological changes of the nostrils of patients undergoing surgery for correction of cleft lip and identify in the literature, the issues involved in the evaluation of these
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functions to this population. Research strategy: A review was conducted, searching for clinical evidence, from MedLine, and the search data occurred in January 2012. Selection Criteria: Original articles, research subjects have as individuals with cleft lip or cleft palate with unilateral nostril anthropometric measurements before and after surgical correction of cleft lip. Measurements of soft tissues, including articles in Portuguese, Spanish, English and French. Data analysis: There were 1343 articles from the search descriptors and free terms. Of these, five articles were selected. Results: Most studies in this review evaluated children in Eastern countries, under different measurement techniques, but with the aid of computers, and evaluations, especially nasal and nostril wide, with results that, together, show improvement nostril asymmetry postoperatively compared with preoperatively. Conclusion: there is a reduction of the total width of nasal compared preoperative and postoperative patients with cleft lip. Keywords: Cleft lip; Anthropometry; photogrammetry; nostril; Reconstructive Surgical Procedures. Learner Outcomes: Review the condition of the nostril morphometry, of cleft lip patients, before and after cleft surgery, as well as identify the issues involved in assessing these changes to this population.
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ORAL BREATH: CHEWING CHANGES IN AN ALLERGIC RHINITIS AN INTEGRATIVE REVIEW LUCIANA NGELO BEZERRA (1) - DANIELE ANDRADE CUNHA (1) - ANA CAROLINA CARDOSO MELO (1) - KLYVIA JULIANA ROCHA MORAES (1) - RENATA ANDRADE CUNHA (1) - PATRCIA MARIA MENDES BALATA (1) - DCIO MEDEIROS (1) - HILTON JUSTINO SILVA (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND IMMUNOLOGY/ALLERGY AMBULATORY, RECIFE, BRAZIL (1)
Abstract: INTRODUCTION: The individual with oral breathing predominantly breathe through the mouth due to nasal obstruction. Among the main causes of mouth breathing they stand out the allergic rhinitis The main causes stands allergic rhinitis (inflammation of the nasal mucosa, mediated by E Imunoglobulin after antigen exposure). According to the ARIA (Allergic Rhinitis and Its Impact on Asthma) initiative, the allergic rhinitis can be classified as: intermittent or persistent (in relation to duration) and light, moderate or severe (in relation to severity of symptoms). They classic signs and symptoms are nasal obstruction, watery rhinorrhea, sneezing and nasal itching, and mouth breathing. Mouth breathing has some features like morphofunctional alterations of the stomatognathic system, craniofacial changes, myofunctional and imbalances in the body axis. OBJECTIVE: To examine studies related to chewing changes in children with mouth breathing due to allergic rhinitis. METHODS: It was performed a search at the main databases, Bireme (LILACS, MedLine, SciELOBr) and MEDLINE (PubMed) for articles that covered chewing changes in children with mouth breathing secondary to allergic rhinitis. We used the following keywords: Mastication, Mouth Breathing as DeCS/MeSH; Allergic Rhinitis term as free/MeSH, mouth breathing as free terms, in Portuguese, English and Spanish. RESULTS: We found 1986 articles and of these 15 were repeated in the databases. After evaluation remained only 2 full articles. DISCUSSION: The two articles, by the same author, evaluated the chewing in a patient with mouth breathing secondary to allergic rhinitis and only observed the behavior mouth during the chewing process, if occurs lips sealing. They observed high frequency of open-mouthed chewing with kneading pattern at the 4-11 years group and a statistically significant difference in this group to prefer feed pasty consistency. They concluded that the increase in nasal obstruction scores and breathing changes intensity, chewing, brething have significant correlation. They claim that nasal obstruction is directly related to the changes of masticatory function and breathing mode. Other authors analyzed chewing in children with mouth breathing and most showed a negative interference in chewing over the mastication time, leftover food in the mouth, lips posture and noise during chewing. CONCLUSION: We did not found in this integrative review studies that evaluated the performance further mastication in children with mouth breathing secondary to allergic rhinitis. So far, none of the respondents addressed the masticatory preference side, no time chewing or other likely changes in masticatory function in patients with allergic rhinitis.
functions and the body axis. Several authors investigated children with mouth breathing posture and found that most of them had anterior head, protruding shoulders and hypotonic abdomen. OBJECTIVE: To investigate changes in the head and neck posture and anterior-posterior displacement of the body axis in children with mouth breathing secondary to allergic rhinitis. METHOD: This study was approved by the ethics committee on human research, being conducted at the pediatrics and allergy/immunology ambulatory of the Clinical Hospital of the Federal University of Pernambuco, Brazil. The sample was comprised by 11 children with mouth breathing secondary to allergic rhinitis, between 6 and 11 years old. The children underwent postural photogrammetry evaluation and the images were analyzed using the SAPO software. RESULTS: Of the 11 children, 3 (27.27%) were female and the total mean age was 7.81 1.83 years old. Eight (72.72%) children had head tilted to the left, nine (81.81%) with anteriorization head and 9/11 (81.81%) with the body axis posterior moved. DISCUSSION: The mouth occlusion is part of the stomatognathic system. Thus, a disorder in this occlusion may pass on the body as a whole. In mouth breathing syndrome, usually observed anteriorization head and mild neck extension. These findings were found in our study. CONCLUSION: It is suggested that the mouth breathing leads to myofunctional changes generating global postural imbalances. More studies on this topic should be conducted to confirm the association between mouth breathing and postural change, thereby encouraging early intervention on postural correction. Learner Outcomes: How to evaluate posture in children with mouth breathing; Changes in posture of children with mouth breathing secondary to allergic rhinitis; Compensatory body changes in children with mouth breathing secondary to allergic rhinitis.
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CHEWING TIME IN ORAL BREATHING SECONDARY TO ALLERGIC RHINITIS LUCIANA NGELO BEZERRA (1) - DANIELE ANDRADE CUNHA (1) ANA CAROLINA CARDOSO MELO (1) - KLYVIA JULIANA ROCHA MORAES (1) - RENATA ANDRADE CUNHA (1) - PATRCIA MARIA MENDES BALATA (1) - GERLANE KARLA BEZERRA OLIVEIRA NASCIMENTO (1) - DCIO MEDEIROS (1) - HILTON JUSTINO SILVA (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND IMMUNOLOGY/ALLERGY AMBULATORY, RECIFE, BRAZIL (1)
Abstract: INTRODUCTION: The oral breathing is a syndrome with specific signs and symptoms and may have the degree vary according to the pathology. One cause of high prevalence of mouth breathing is the allergic rhinitis, whose main signs and symptoms, spontaneously reversible or with treatment, are: nasal obstruction, watery rhinorrhea, sneezing and nasal itching, beyond mouth breathing. Depending on the exposure mouth breathing time, we can observe some remarkable physical changes in this population, especially in relation to the stomatognathic system whose main function is the chewing (initial phase of the digestive process). OBJECTIVE: To evaluate the chewing time in children and teen ager with mouth breathing secondary to allergic rhinitis. METHODS: This study was approved by the ethics committee on human research and performed in pediatrics and immunology/allergy ambulatory of the Pernambuco Federal University of Clinical Hospital, Brazil. The sample was divided into two groups: G1 (children with allergic rhinitis) and G2 (children without allergic rhinitis). The chewing assessment was performed through filming, being considered the time needed to chew a 25g french bread (produced on the day of filming). The child remained seated, with his feet flat on the floor, in front of the camera. It was used to statistical analysis the BioEstat 5.3 and Excel (with mean and standard deviation) softwares. RESULTS: It was evaluated 11 children in G1 and 10 in G2 group. The normality test obtained a p=0.2953 to G2 and p=0.4997 to G1. The mean chewing time difference between the groups was 44.50 s, in which the G1 got chewing time average 15% smaller than the G2. DISCUSSION: Most studies that addressed chewing with mouth breathing children showed negative interference in mastication in relation to chewing time, leftover food in the mouth, lips posture and noise chewing. Our partial results are also in accordance with the literature, when comparing children with nasal breathing to mouth breathing, indicating reduction in chewing time in children with mouth breathing. According to Silva et al (2007), the chewing time in children with mouth breathing shows a reduction due to the need to stop chewing to breathe. CONCLUSION: Although this study brings only partial data, it has been shown so far, that the chewing time is reduced in subjects with mouth breathing secondary to allergic rhinitis. Learner Outcomes: How to evaluate chewing in children with mouth breathing; Differences between mouth breathing and nasal breathing, Chewing time in children with mouth breathing secondary to allergic rhinitis.
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HEAD AND NECK POSTURE IN CHILDREN WITH MOUTH BREATHING SECONDARY TO ALLERGIC RHINITIS LUCIANA NGELO BEZERRA (1) - HILTON JUSTINO SILVA (1) ANA CAROLINA CARDOSO MELO (1) - KLYVIA JULIANA ROCHA MORAES (1) - RENATA ANDRADE CUNHA (1) - GERLANE KARLA BEZERRA OLIVEIRA NASCIMENTO (1) - DANIELE ANDRADE CUNHA (1) - DCIO MEDEIROS (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND ALLERGY/IMMUNOLOGY AMBULATORY, RECIFE, BRASIL (1)
Abstract: INTRODCTION: In allergic rhinitis, depending on the age and degree of nasal obstruction, it can be seen mouth breathing type, which can lead myofunctional imbalances if its prolonged, changes in stomathognatic
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NOSTRIL MORPHOMETRIC ANALYSIS PRE AND POST-SURGERY IN CLEFT-LIP CHILDREN MARIO JORGE FRASSY FEIJO (1) - STELLA RAMOS BRANDO (1) RUI MANOEL RODRIGUES PEREIRA (1) - MARIANA BATISTA DE SOUZA SANTOS (1) - DANIELE ANDRADE CUNHA (1) LUCIANA NGELO BEZERRA (1) - HILTON JUSTINO SILVA (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND ALLERGY/IMMUNOLOGY AMBULATORY, RECIFE, BRAZIL (1)
Abstract: Objective: To compare nostril morphometry before and after unilateral cleft lip surgical correction. Design: Observational, descriptive and cross-sectional. Participants: Were included cleft lip children (UCL, UCL+A, UCLP), underwent surgical correction up to the end of second year of life at Cadefi/IMIP in the period January 2012 to May 2012. Randomization or masking were not performed. Were excluded from patients who did not undergo postoperative follow-up. Number of patients participants was 11. Interventions All patients underwent both measurement methods, with calipers and photogrammetry, for six distances: nasal height and width, height and width of the nostrils, cleft and non cleft sides. To standardize measurements, we compared the indexes of nasal width-height, nostrils height and width. Main Outcome Measure: Occurs change in postoperative nasal measures with improved nostril symmetry. Results: There was nasal and cleft side nostril width reduction after surgery measured with calipers or Photogrammetry. When compared rates, the relationship of nasal widthheight and nostril height showed no statistically significant difference (p> 0.05). Nostril width index decreased postoperatively, identified in both measurement methods (p <0.02, p <0.01). When compared measurement techniques, both nostrils height showed statistically significant difference (p <0.03 and p <0.01). Conclusions: Occurs improve of nostril symmetry when compared pre and postoperative measurements. For the assessment of symmetry, two measurement methods were concordant. When compared the methods, preoperatively, it is concluded that may occur difference in the nostrils heights values. Both methods can be used in postoperative measurements, with no statistical difference. Learner Outcomes: Evaluate pre and postoperative anthropometric measurements; To assessment of symmetry, two measurement methods, photogrammetry.
palate and increase in the adherence to CPAP in comparison to the CPAP Group. Conclusion: Our findings suggest that the phonoaudiological therapy, in patients with OSAS, could be considered an alternative treatment and an adjunct intervention strategy in the adherence to CPAP use.
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THE IMPACT OF MUSIC THERAPY IN THE PARKINSONS DISEASES TREATMENT ELEN FRANCO (1) - ALINE MEGUMI ARAKAWA (1) CRISTINA DO ESPIRITO SANTO (1) - NATLIA GUTIERREZ CARLETO (1) MNICA LIMA FRANA (1) - ARIADNES NOBREGA OLIVEIRA (1) -MAGALI DE LOURDES CALDANA (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRASIL (1)
Abstract: The Parkinson Disease (PD) is a progressive disorder, and chronic neurodegenerative disorder that occurs in the nervous system, involving the brain basal ganglia causing disturbances in tone, posture and voluntary movements, and it can also affect aspects of speech articulation, voice and swallowing. In this context, music therapy can be an alternative in the treatment of disease that affect individuals cognitive, physical or subjective abilities. Purpose: Describe the therapeutic process and evolution of and elderly patient with PD, attended in the Speech Therapy Clinic of the Bauru Dental School University of So Paulo. Case report: J.V.R, male, 70 years old, had the PD diagnosed 12 years ago. The first symptoms appeared in 1989 with tremors in both hands simultaneously and were treated as essential tremor for 10 years. Disease progression was noted by himself when began having difficulties in his jog (banking), cause he required a lot of writing and communicative skills. The symptoms have been getting worse over time reflecting in the daily life activities, such as bath time and climb stairs. He makes use of medicines for five years, noting worsening of his own clinical feature this year. He have attends speech therapy twice a week, since the month of March 2011 in the Speech Therapy Clinic of the Bauru Dental School. The speech evaluation showed changes in written language and voice (voice slurred, breathy, inadequate coordination between breathing with reduced speech rate). Results: after four months of speech therapy with a focus on music therapy was noticeable improvement in the patients quality of life, relieving the symptoms generated by the disease, and noted a great improvement in emotional framework. It were used therapeutic strategies involving singing and history of classical music. Discussion: the music is working like a facilitator to promote communication, learning, expression, among other aspects considered relevant in therapy as providing improvements in regard to emotional, mental, social and cognitive aspects. This is observed in this study about the quick evolution of this patient during therapy sessions. The use of music enabled stronger ties between therapist and patient as well as noting a clear motivational growth of both. Conclusion: In these cases, it is important to conduct the therapeutic process an evaluation and detailed speech language therapy, which can contribute in directing the patients rehabilitation in PD cases. Thus develop strategies to promote a quickly and effectively social rehabilitation with pleasure and motivation. Learner Outcomes: Know about speech disorders resulting from Parkinson Disease; Discuss forms of intervention in Parkinson Disease; Know about music therapy in the Parkinsons Diseases treatment.
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OROPHARYNGEAL EXERCISES IMPROVED ADHERENCE TO CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT GIOVANA DIAFRIA (1) - ROGERIO SANTOS-SILVA (2) - EVELI TRUKSINAS (2) - FERNANDA HADDAD (2) - RENATA SANTOS (3) - SILVANA BOMMARITO (3) - LUIZ CARLOS GREGRIO (4) SERGIO TUFIK (2) - LIA RITA AZEREDO BITTENCOURT (2) UNIVERSIDADE FEDERAL DE SO PAULO, UNIFESP, SAO PAULO, - (1) - UNIVERSIDADE FEDERAL DE SO PAULO, UNIFESP, SAO PAULO, BRAZIL (2) - UNIVERSIDADE FEDERAL DE SO PAULO, UNIFESP, SAO PAULO, BRAZIL (3) - UNIVERSIDADE FEDERAL DE SO PAULO, UNIFESP, SO PAULO, BRAZIL (4)
Abstract: Introduction: The neuromuscular alterations on the pharynx seem to be one of the factors related to the pathophysiology of the Obstructive Sleep Apnea Syndrome (OSAS). Nonetheless, the literature works investigating the phonotherapeutic treatment in these patients are scarse and controversial. Objective: Assess the effects of phonotherapeutic exercises performed in isolation and associated to the continuous positive airway pressure treatment (CPAP) in patients with OSAS in clinical and polysomnography parameters. Methods: Adult males, with OSAS, were randomly divided in four treatment groups: Placebo: 24 individuals submitted to phonotherapeutic placebo therapy; Phonoaudiological Therapy: 27 individuals submitted to phonoaudiological therapy; CPAP treatment: 27 individuals submitted to CPAP; Combined (CPAP+Phonoaudiological Therapy): 22 individuals submitted to CPAP treatment and phonoaudiological therapy. The groups received treatment during three months. All patients were submitted to pre- and post-treatment evaluation and after three weeks of washout, including quality of life questionnaires, excessive sleepiness, Psychomotor Vigilance Test, polysomnography and phonoaudiological evaluation. Results: 100 men were evaluated, with age of 48,111,2 (mean standard deviation), body mass index (BMI) of 27,44,9 kg/m2, score on the Epworth Sleepiness Scale (ESS) of 12,73,0 and apnea-hypopnea index (AHI) of 30,920,6 events/hour. All treatment groups (Phonoaudiological Therapy, CPAP and Combinated) presented reduction in ESS and in snoring with the treatment, given that the Phonoaudiological Therapy group maintained this improvement after the washout. The reduction of AHI occurred in the groups with treatment, being more expressive in the presence of CPAP, with improvement of the minimal oxyhemoglobin saturation (SpO2) and arousals throughout the night. The Phonoaudiological Therapy Group improved in more quality of life dominium and in the increase of tension of the tongue and soft palate comparing with the Placebo Group. The Combinated Group presented significant improvement in the tension of the tongue and soft
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PERCEPTUAL AND ACOUSTIC VOICE AND SPEECH ANALYSIS IN DYSARTHRIAS MARINA PADOVANI (1) - MARA BEHLAU (1) CENTRO DE ESTUDOS DA VOZ, UNIVERSIDADE FEDERAL DE SO PAULO, SO PAULO, BRAZIL (1)
Abstract: The typical characterization of dysarthrias, combined by perceptual and acoustic data, provides better information regarding the neuromotor skills for speech and communicative effectiveness. The aim of this study was to characterize dysarthrias by auditory perceptual and acoustic assessments of voice and speech. Voice and speech samples from 106 individuals, both sexes, were analyzed and divided into groups: dystonia (LD), amyotrophic lateral sclerosis (ALS) and amyotrophic lateral sclerosis wi th predominant bulbar symptoms (ALSb), Myasthenia Gravis (MG), Parkinsons disease (PD), essential vocal tremor (EVT) and controls up to and above 45 years. The a vowel and iu diphthong were recorded under the recommended conditions. Data were analyzed by visual analogue scale and Multi-Dimensional Voice Program, Kay Elemetrics, and Vox Metria, CTS Informatica, acoustic programs. The results showed that the rhythm discriminated dysarthrias from controls, and dystonia from dysarthria, except in articulatory integrity. The fundamental frequency variability in semitones differentiated all dysarthric from the controls, followed by the coefficient of fundamental frequency variability in% and standard deviation of fundamental frequency. The stability, MFTR and Matr variables showed satisfactory accuracy and better sensitivity. ShimmAPQ also showed satisfactory accuracy, but better specificity, whereas the extent of F0 variability (st) showed good accuracy with good stability and sensitivity. Therefore, there were correlations perceptual and acoustic measures in dysarthric patients.
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EFFECT OF SPEECH THERAPY AS ADJUNCT TREATMENT TO CPAP, ON THE QUALITY OF LIFE OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA GIOVANA DIAFRIA (1) - LUCIANA BADKE (2) ROGRIO SANTOS-SILVA (1) - SILVANA BOMMARITO (1) SERGIO TUFIK (3) - LIA RITA AZEREDO BITTENCOURT (3) UNIVERSIDADE FEDERAL DE SO PAULO, UNIFESP, SO PAULO, BRAZIL (1) - UNIVERSIDADE FEDERAL DE SO PAULO, UNIFESP, SAO PAULO, BRAZIL (2) - UNIVERSIDADE FEDERAL DE SO PAULO, UNIFESP, SO PAULO, BRAZIL (3)
Abstract: Background: Patients with obstructive sleep apnea (OSA) exhibit reduced quality of life (QoL) due to their daytime symptoms, which restrict their social activities. The available data for QoL after treatment with continuous positive airway pressure (CPAP) are inconclusive, and few studies have assessed QoL after treatment with speech therapy or other methods that increase the tonus of the upper airway muscles or with a combination of these therapies. The aim of this study was to assess the effect of speech therapy alone or combined with CPAP on QoL in patients with OSA using three different questionnaires. Methods: Male patients with OSA were randomly allocated to four treatment groups: Placebo, 24 patients subjected to sham speech therapy; Speech Therapy, 27 patients subjected to speech therapy; CPAP, 27 patients subjected to treatment with CPAP; and Combination, 22 patients subjected to treatment with CPAP and speech therapy. All patients were treated for three months. Participants were assessed before and after treatment and after three weeks of washout using QoL questionnaires (Functional Outcomes of Sleep Questionnaire - FOSQ, World Health Organization Quality of Life WHOQoL-Bref, and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), excessive sleepiness scale (Epworth Sleepiness Scale - ESS), polysomnography (PSG), and speech therapy assessment. Results: A total of 100 men aged 48.111.2 (mean standard deviation) years, body mass index of 27.44.9 Kg/m2, ESS of 12.73.0, and apnea-hypopnea index (AHI) of 30.920.6. After treatment, Speech Therapy and Combination groups showed improvement in the physical domain score of the WHOQoL-Bref and in the functional capacity domain score of the SF-36. Conclusions: Our results suggest that speech therapy alone and in association with CPAP might be an alternative treatment for the improvement of QoL in patients with OSA.
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AGREEMENT BETWEEN PERCEPTUAL TESTS AND NASOENDOSCOPY IN THE DIAGNOSTIC OF VELOPHARYNGEAL DYSFUNCTION GABRIELA LIMA (1) - JENIFFER DUTKA (2) - OLIVIA MESQUITA VIEIRA DE SOUZA (3) - MELINA WHITAKER (4) - JOSIANE DENARDI ALVES NEVES (4) - VIIVIANE MARINO (5) - MARIA INES PEGORARO-KROOK (3) GRADUATION PROGRAM IN SPEECH, LANGUAGE AND HEARING PROCESS AND DISORDERS, BAURU COLLEGE OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1) - DEPARTMENT OF SPEECH, LANGUAGE AND AUDIOLOGY, BAURU COLLEGE OF DENTISTRY; HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES, UNIVESITY OF SAO PAULO, BAURU, BRAZIL (2) - DEPARTMENT OF SPEECH, LANGUAGE AND AUDIOLOGY, BAURU COLLEGE OF DENTISTRY; HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES, UNIVERSITY OF SAO PAULO, BAURU, BRAZIL (3) - HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES, UNIVERSITY OF SAO PAULO, BAURU, BRAZIL (4) - DEPARTMENT OF SPEECH, LANGUAGE AND AUDIOLOGY, UNESP, MARILIA, BRAZIL (5)
Abstract: Introduction: Perceptual assessment is the gold standard for assessment of hypernasality related to cleft palate and velopharyngeal dysfunction (VPD). Because speech pathologists generally rely on perceptual measures for assessing velopharyngeal (VP) function for speech, tests of cul-de-sac hypernasal resonance and inappropriate nasal air emission are often chosen as the two primary measures for determining success or failure of the palatal surgery in establishing a functional VP mechanism. It is acknowledged that instrumental assessment, such as nasoendoscopy and videofluoroscopy, supplement speech findings, but there is a need for a reliable and valid comprehensive protocol for assessing the agreement between perceptual and instrumental assessments of speech. Objective: Investigate the agreement between the results of the Hypernasality and Nasal Air Emission Tests (THIPER and TEAN), described by Bzoch (2004), and those obtained from nasoendoscopy (NASO), for the diagnostic of VPD. Material and Methods: The scores of the TEAN and THIPER were collected from patients records, and nasoendoscopic recordings were obtained from the data bank of the Institution. The sample was composed by 43 NASO recordings and 43 TEAN and THIPER scores obtained in the same day (not at the same time), from a caseload of 33 unilateral cleft lip and palate patients, both genders, with age ranging from 5 to 15 years. The NASO recordings of the speech samples papapa, Papai pediu pipoca and A bab beijou o beb were edited in a randomized sequence in a DVD and were judged by three experienced speech pathologists as no VP closure, consistent VP closure and inconsistent VP closure. Results: Intra-judge percentage agreements were 93% to both samples papapa and Papai pediu pipoca and 97% to A bab beijou o beb. When the scores of TEAN were compared with the NASO judgements, the agreement for the sample papapa was regular, and for Papai pediu pipoca and A bab beijou o beb was small. Comparing the THIPER scores with NASO judgements, a small agreement for all the three samples was observed. In the NASO recordings judged as presenting no-VP closure the agreement with the TEAN scores was almost perfect for the samples papapa and Papai pediu pipoca and substantial for the sample A bab beijou o beb. The agreement between NASO judgements and THIPER scores was moderate for all the three samples. Comparing the NASO judgements with the TEAN scores when both (instrumental and perceptual) suggested consistent VP closure a poor agreement was observed for all the three samples and comparing with THIPER scores was small for the sample papapa and poor for the samples Papai pediu pipoca and A bab beijou o beb. The agreement between both tests (TEAN and THIPER) and NASO judgements suggested inconsistent VP closure was small for all three samples. Conclusion: The results of this study allow to conclude that the scores of TEAN and THIPER scores indicating no-VP closure were the only ones which presented good agreement with the NASO judgements, opposed to the ones which indicating consistent our inconsistent VP closure which presented poor agreement. Learner Outcomes: There is a need for a reliable and valid comprehensive protocol for assessing the agreement between perceptual and instrumental assessments of speech. The participant will learn the results of the agreement between Hypernasality and Nasal Air Emission Tests, described by Bzoch (2004), with those obtained from nasoendoscopy for the diagnostic of velopharyngeal dysfunction in patients with cleft palate.
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AGLOSSIA: CASE REPORT SILVANA BOMMARITO (1) - LUCIANA ESCANOELA ZANATO (1) MARILENA MANNO VIEIRA (1) UNIVERSIDADE FEDERAL DE SO PAULO, UNIFESP/EPM, SO PAULO, BRAZIL (1)
Abstract: Aglossia is a rare condition caused by a failure during tongue embryogenesis process (fourth to eighth weeks of gestational). The tongue is the most mobile organ of the body and is associated with coordinated activities such as sucking, swallowing, chewing and speaking, and is an organ that contributes to the normal development of the teeth and jaw. In the literature, few cases are described and are mostly associated with genetic syndromes. The aim of this study is to describe the speech therapy manifestations in the case of 8-year-old girl with complete aglossia. Case Report: According to information provided by the mother, during pregnancy there were no complications. The maternal family carries the gene for hemophilia. Regarding to psychomotor development: the child walked at 2 years old and talked at 1,6 year old, she is currently enrolled in a regular school. Her diet, since she was born, is exclusively oral. Currently the complaint is related to aspects of speech and swallowing. Structures were phonoarticulatory examined: facial asymmetry, abnormal mobility and tone of the buccinator muscles, the lips are occluded in the resting condition, however it is possible to observe decreased tone of the lower lip, hard palate and soft palate insufficient atretic. Functional assessment of swallowing was observed as pressing lip to swallow, hyperfunctional masseter, chin muscle tension and muscle activity perioral swallowing and choking to solid. In electromyographic examination of the muscles of the face, there were found hyperfunction of the masticatory muscles and neck during water swallowing. Regarding to speech articulation, there were disorder and hypernasal phonetic resonance with the following changes: alveolar posteriorly, omission and nasalization of liquid, nasalization of plosives. About the conduct and orthodontic treatment, she is making expansion of the hard palate and speech Therapy to maximize the present structures and operate more efficiently things as saliva control, chewing and speech. Discussion and Conclusion: Aglossia is a condition rarely described in the literature. It is known that the tongue plays an important role in oral motor development and craniofacial development mainly reflected in the lower third of the face and dentition. The absence of this structure causes injury in stomatognathic functions. The comprehensive care to these individuals become paramount, with myofunctional therapy associated with orthodontic intervention, and it is possible to observe an improvement in saliva control, greater efficiency in chewing and swallowing and improved adaptation mainly solid foods. Therefore, we highlight the need for interdisciplinary approach to provide a better quality of life.
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MAXIMUM PERFORMANCE TESTS OF SPEECH PRODUCTION SIMONE KNUIJT (1) - BERT DE SWART (2) - HARRY GOOS (3) HANNEKE KALF (1) DEPARTMENT OF REHABILITATION / SPEECH LANGUAGE PATHOLOGY, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (1) - INSTITUTE OF HEALTH STUDIES AND DEPARTMENT OF REHABILITATION / SPEECH LANGUAGE PATHOLOGY, HAN UNIVERSITY OF APPLIED SCIENCES NIJMEGEN AND RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (2) - INSTITUTE OF HEALTH STUDIES AND DEPARTMENT OF SPEECH THERAPY, HAN UNIVERSITY OF APPLIED SCIENCES NIJMEGEN AND HOSPITAL RIVIERENLAND TIEL, NIJMEGEN AND TIEL, NETHERLANDS (3)
Abstract: Reference values of maximum performance tests of speech production were collected in a group of 89 healthy Dutch adults. Age seems only to be a factor of influence above 70, except for MPV. Length and smoking influence MPD, but other personal characteristics didnt influence the performances. The reference values will be added to the Dutch Dysarthria Assessment. The purpose is to enlarge the group in order to set lower limits of normal. Learner Outcomes: Describe four main maximum performance tasks of speech production; Describe the influence of age on maximum performance in speech tasks by healthy adults.
and to 9.33 after botulinum toxin injection; in Group B it was 3.35, went to 10,0. The Physical Function Score in Group A was significantly higher, both after myofunctional therapy and after botulinum toxin injection. There was no difference of the Physical Function Score for Group B. The Social/ Well-Being Function Score in Group A was also significantly higher after myofunctional rehabilitation and also at the end of both treatments. After myofunctional therapy patients presented better Facial Disability Index scores and higher Clinical Scores on the paralyzed side of the face. The association of myofunctional therapy to the injection of the botulinum toxin benefited equally all patients Learner Outcomes: After myofunctional therapy, the paralyzed side of the face showed higher Clinical Scores and higher Facial Disability Index. The association of myofunctional therapy to the injection of the botulinum toxin benefited equally all patients, reducing facial asymmetry and promoted Physical Function and Social/Well-Being.
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ACQUISITION OF BITE FORCE: LARYNGECTOMIZED STUDY GERLANE KARLA OLIVEIRA NASCIMENTO (1) - DANIELE ANDRADE CU (1) - LUCIANA NGELO BEZERRA (1) - HILTON JUSTINO SILVA (1) UNIVERSIDADE FEDERAL DE PERNAMBUCO, PEDIATRICS AND ALLERGY/IMMUNOLOGY AMBULATORY, RECIFE, BRASILE (1)
Abstract: Introduction: The bite force, one of the chewing function components, its exerted by the jaw elevator muscles and regulated by the nervous, muscular, skeletal and dental systems. Its quantification can be performed with the aid of load cells which undergo deformity (bite) cause hmic variation in this sensor or strain gages, generating an electrical potential corresponding to the applied force in kilograms-force (kgf). The quantification of this chewing component can help in the diagnosis and therapy of functions and disorders of the stomatognathic system (SE). Objective: To verify the bite force values of volunteers who underwent total laryngectomy. Methods: The study was approved by the Ethics Committee and Human Research of HCP (recorded in Protocol n 42/2009) and involved a sample composed by fifteen males gender total laryngectomized with a mean age of 64 years. The bite force was measured with the aid of load cell positioned in three regions and different times: 1) between the central incisors; 2) between the right molars of the dental arch tooth; 3) between the left molars of the arch tooth. The results of this experiment were subjected to statistical analysis for later. Results: The strength values found in the incision had an average of 25.77 Kgf. In right unilateral bite in the molar region was obtained average value of 23.53 Kgf. During unilateral left bite between the molars, the mean value was 30.54 Kgf. Discussion: The act of standard chewing requires harmony between jaw movements, being the force applied to the chewing stages synchronously distributed to ensure the balance of the SE muscles and its functions. Regarding strength parameters found during incision of subjects with total laryngectomy, it can be estimated that there are closer to the expected values in a standard incision. In our findings we observed a slight difference between the mean values of bite force between the molars when compared to the right and left sides of the dental arch. This difference may be related to greater demand side muscle since in laryngectomized has compensation of the bite force involved muscles, which reinforces our hypothesis. Conclusion: The anatomofunctional changes associated to the total laryngectomy surgery not seem to interfere significantly in the bite force parameters. Learner Outcomes: Changes in laryngectomyzed chewing; Bite force in total laryngectomyzed subjects; How to evaluate the bite force in laryngectomyzed subjects.
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USING TRAINING VIDEOS IN DYSARTHRIA ASSESSMENT EDUCATION SIMONE KNUIJT (1) - HANNEKE KALF (1) - PUCK GOOSSENS (2) HARRY GOOS (3) - BERT DE SWART (2) DEPARTMENT OF REHABILITATION / SPEECH LANGUAGE PATHOLOGY, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (1) - INSTITUTE OF HEALTH STUDIES AND DEPARTMENT OF REHABILITATION / SPEECH LANGUAGE THERAPY, HAN UNIVERSITY OF APPLIED SCIENCES NIJMEGEN AND RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (2) - INSTITUTE OF HEALTH STUDIES AND DEPARTMENT OF SPEECH THERAPY, HAN UNIVERSITY OF APPLIED SCIENCES NIJMEGEN AND HOSPITAL RIVIERENLAND TIEL, NIJMEGEN AND TIEL, NETHERLANDS (3)
Abstract: Because the interrater reliability of perceptual dysarthria assessment is low, training videos are being developed to educate both experienced speech language therapists (SLTs) and students. Standardized videos were made of 54 dysarthric patients, using the Dutch Dysarthria Assessment. In order to reach consensus about the type and severity of the dysarthria in all patients, consensus meetings were held with 7 highly experienced SLTs. This resulted in adequate case descriptions. A pilot experiment with 28 students was conducted. The students judged 10 patients before and after a one-day training with use of the videos. The training videos were selected, based on type and severity of the dysarthrias. This pilot study showed a significant improvement on agreement with the consensus by the experienced SLTs on two types of dysarthria (hypokinetic and hyperkinetic). In an additional reliability experiment with SLTs, only the written case descriptions in combination with the videos are going to be used to explore the learning effect in experienced SLTs. Learner Outcomes: Describe the need for training videos of dysarthric patients to educate SLT students; Describe the effect of using training videos as part of one-day dysarthria training.
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CONCORDANCE BETWEEN PERCEPTUAL TESTS AND VIDEOFLUOROSCOPY IN THE DIAGNOSTIC OF VELOPHARYNGEAL DYSFUNCTION MARA DE SOUZA PRICO (1) - JENIFFER DE CSSIA RILLO DUTKA (2) - OLVIA MESQUITA DE SOUZA VIEIRA (3) - EDNA ZAKRZEVSKI PADILHA (1) - FABIANE RODRIGUES LARANGEIRA (1) - MARIA INS PEGORARO-KROOK (2) BAURU COLLEGE OF DENTISTRY, UNIVERSITY OF SAO PAULO, BAURU, BRAZIL (1) - DEPARTMENT OF SPEECH, LANGUAGE AND AUDIOLOGY/ BAURU COLLEGE OF DENTISTRY, HOSPITAL FOR REHABILITATION OF CRANIOFACIAL DISORDERS/ UNIVERSITY OF SAO PAULO, BAURU, BRAZIL (2) - DEPARTMENT OF SPEECH, LANGUAGE AND AUDIOLOGY/ BAURU COLLEGE OF DENTISTRY, UNIVERSITY OF SAO PAULO, BAURU, BRAZIL (3)
Abstract: Introduction: Velopharyngeal insufficiency and incompetency are types of velopharyngeal dysfunction (VPD) which require different types of treatment. For those cases who present with velopharyngeal insufficiency a physical procedure, such as surgery or prosthesis, is the treatment of choice and for those who present velopharyngeal incompetency, speech therapy should be indicated. None effective treatment should be indicated if a precise differential diagnostic of the VPD type is done, and for this purpose a
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MYOFUNCTIONAL THERAPY COMBINED TO BOTULINUM TOXIN INJECTIONS IN LONG STANDING FACIAL PARALYSIS PAULA NUNES TOLEDO (1) - MARCUS CASTRO FERREIRA (2) ALESSANDRA GRASSI SALLES (3) CENTRO DE ESTUDOS DAS FACULDADES METROPOLITANAS UNIDAS, CLINICAL HOSPITAL, SO PAULO, BRAZIL (1) UNIVERSITY OF SO PAULO, CLINICAL HOSPITAL, SO PAULO, BRAZIL (2) - UNIVERSITY DE SO PAULO, CLINICAL HOSPITAL, SO PAULO, BRAZIL (3)
Abstract: Quantify the benefits of myofunctional therapy associated to botulinum toxin injection in patients with long standing facial unilateral palsy. Twenty-five patients with long standing facial palsy were studied; all had been previously treated for facial reanimation. Patients were divided in two groups; Group A did the myofunctional therapy sessions with the speech therapist before the botulinum toxin injection, while the participants of Group B did the myofunctional therapy after it. The Clinical Score of the paralyzed side of Group A was 5.75, went to 6.92 after myofunctional therapy
clinical and instrumental speech evaluation is always necessary. Perceptual speech evaluation is considered to be the gold standard procedure for many investigators to identify speech and voice disorders in an individual with cleft palate. Literature describes some methods and specific tests to provide the differential diagnostic of VPD, such as the Hypernasality and Nasal Air Emission Tests described by Bzoch (2004), which aim to evaluate velopharyngeal function and dysfunction. Image instrumental exams, such as videofluoroscopy complement the perceptual evaluation findings and are frequently used to define surgical procedures. Not found a study to verify that the concordance between perceptual tests proposed by Bzoch (2004) with the results of the videofluoroscopy. Objective: To investigate the concordance between the results of tests Hypernasality (THIPER) and Nasal Air Emission (TEAN) and the imaging findings of videofluorocopia the diagnosis of VPD in individuals with cleft palate. Material and Methods: The sample consisted of 89 trials of videofluoroscopy examinations and 89 trials of scores TEAN and THIPER. We tested the concordance between the interpretation of results of perceptual tests and findings of videofluoroscopy, for this analysis the sample was divided into three groups of different types of Velopharyngeal Closure (VC), the non velopharyngeal closure (NVC), the closing inconsistent velopharyngeal (CIV) and consistent velopharyngeal closure (CVC). We used the Kappa test. Results: The overall level of concordance between the results of TEAN and videofluoroscopy was substantial and regular Kappa value, compared three types of VC separately for the NVC the concordance was almost perfect for CIV was small and regular for CVC, already to the situation THIPER and videofluoroscopy the general concordance was substantial and moderate Kappa value, for the NVC the concordance was almost perfect, for CIV was regular and moderate to CVC. Conclusion: There was a good level of general concordance among perceptual tests and the videofluoroscopy, indicating that in most cases the two evaluations indicated the same result. But the kind of VC that showed better concordance with the perceptual tests was the NVC. Learner Outcomes: What is velopharyngeal dysfunction (VPD); How to make the differential diagnosis of VPD; Application of clinical evaluation (perceptual) and Instrumental.
correlate rather well with the efficacy of portable DAF treatment. (This work was supported by Grant-in-Aid for Scientific Research 10424889). Learner Outcomes: know a way of speaking prolong vowel length in DAF usage; the effect of delayed auditory feedback for dysarthrias; know the relationship between improvement of speech intelligibility and acoustic characteristics (reduction of speaking rate, extension of vowel length, and expansion of vowel space in the F1-F2 space, etc.).
P250
DEVELOPMENT AND VALIDATION OF THE DUTCH DYSARTHRIA ASSESSMENT SIMONE KNUIJT (1) - HANNEKE KALF (1) - HARRY GOOS (2) PUCK GOOSSENS (3) - JUDITH KOCKEN (4) - LOTTE KROMHOUT (5) ALEXANDER GEURTS (6) - BERT DE SWART (7) DEPARTMENT OF REHABILITATION / SPEECH LANGUAGE PATHOLOGY, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (1) - INSTITUTE OF HEALTH STUDIES AND DEPARTMENT OF SPEECH THERAPY, HAN UNIVERSITY OF APPLIED SCIENCES NIJMEGEN AND HOSPITAL RIVIERENLAND TIEL, NIJMEGEN AND TIEL, NETHERLANDS (2) - INSTITUTE OF HEALTH STUDIES AND DEPARTMENT OF REHABILITATION / SPEECH LANGUAGE PATHOLOGY, HAN UNIVERSITY OF APPLIED SCIENCES NIJMEGEN AND RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (3) - DEPARTMENT OF SPEECH THERAPY, RIJNSTATE HOSPITAL, ARNHEM, NETHERLANDS (4) - DEPARTMENT OF SPEECH THERAPY, CANISIUS WILHELMINA HOSPITAL, NIJMEGEN, NETHERLANDS (5) - DEPARTMENT OF REHABILITATION MEDICINE, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (6) - DEPARTMENT OF REHABILITATION MEDICINE / SPEECH LANGUAGE PATHOLOGY, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (7)
Abstract: The purpose of this study was to develop the Dutch Dysarthria Assessment (DDA). A project group of seven highly experienced speech-language pathologists evaluated Dutch dysarthria assessments and compared them with international standards. A concept version of the DDA was made, including speech tasks (spontaneous speech, reading, maximum repetition rate, maximum phonation duration, fundamental frequency range, maximum phonation volume), assessment form and tutorial. An online Delphi round was performed to get feedback from colleagues in the Netherlands and Belgium (Flanders). This resulted in numerous comments and suggestions for changes regarding items and terminology of the assessment form and tutorial. All remarks were discussed in the project group, after which new versions of the tutorial and assessment form were completed. Forty-five patients were assessed using the pre-final version of the DDA. Besides the DDA, two questionnaires, an intelligibility assessment and a fluency task were included for validation measurements. The project group reached agreement regarding the type and severity of the dysarthria of all patients. A factor analysis confirmed the traditionally domains of speech (articulation, phonation, respiration, prosody, nasal resonance). Validation measurements were satisfactory. A second Delphi round is conducted to reach consensus about the new version of the tutorial and the assessment form. Pending the outcome of the second Delphi round, the final version will be published in 2013. Learner Outcomes: Describe the methodological steps in the development of a dysarthria assessment; Describe the development and validation of the Dutch Dysarthria Assessment.
P249
SPEECH TREATMENT BY DAF IN DYSARTHRIAS: IMMEDIATE EFFECTS IN CLINIC AND CUMULATIVE EFFECTS OF 3-MONTH TREATMENT USING A PORTABLE DEVICE EIJI SHIMURA (1) - KAZUHIKO KAKEHI (2) DEPARTMENT OF SPEECH, LANGUAGE AND HEARING SCIENCES, NIIGATA UNIVERSITY OF HEALTH AND WELFARE, UNIVERSITY, NIIGATA, JAPAN (1) - INSTITUTE FOR ADVANCED STUDIES IN ARTIFICIAL INTELLIGENCE, CHUKYO UNIVERSITY, UNIVERSITY, AICHI, JAPAN (2)
Abstract: Purpose: Several rehabilitation methods to control speech rate are currently available and have been widely used to improve speech intelligibility in patients with dysarthria. However, the speech intelligibility of dysarthric patients shows less improvement in daily life and this is largely because most of the currently available treatment methods are not practical for use in daily life. Delayed auditory feedback (DAF) is one of the speech rate control methods available, and a small portable DAF device has been developed recently to provide practical, daily DAF treatment for patients with dysarthria. The efficacy of DAF in certain hypokinetic dysarthrias has been reported, and it has also been shown recently that DAF is effective in some cases of unilateral upper motor neuron (UUMN) and ataxic dysarthrias. The aim of this study was to investigate (a) the immediate effects of DAF in dysarthric patients in clinic, (b) the effects of a portable DAF device treatment used for approximately 3 months, and (c) the correlation between the immediate effects of DAF and the cumulative effects of treatment with a portable DAF device. Method: First, the immediate effects of DAF were investigated in 8 dysarthric patients (UUMN, hypokinetic, ataxic, and mixed) using a set of tasks that included free conversation and reading a long sentence aloud. Either task A (long sentence reading and free conversation without DAF) or task B (long sentence reading and free conversation with DAF) was performed once in every week in the order of A-B-A. Patients were instructed to prolong vowel length when using DAF. The immediate effects of DAF were evaluated by measuring speech intelligibility, speech rate, vowel length, and vowel formant frequencies. Then, the effect of portable DAF treatment was investigated in 3 of the 8 patients (cases 2, 4, and 6) who were able to participate in portable DAF treatment after the evaluation. They wore a portable DAF and engaged in 20-min. practice every day for 3 months. The effect was evaluated without DAF before and after the treatment by the same measuring for the immediate effect. Results and Discussion: With DAF, speech intelligibility in free conversation significantly improved in 6 of 8 dysarthric patients (UUMN, hypokinetic, ataxic, and mixed), suggesting that DAF is beneficial not only for hypokinetic dysarthrias, but also for other types of dysarthrias. Outcome of portable DAF treatment was favorable in case 4, in which the intelligibility of free conversation was improved from 3.6 to 3, and of long-sentence mildly from 2.8 to 2.5. Single-word intelligibility was also improved from 68.3% to 89.7%, and the F1/F2 vowel space was expanded in the single-word test. Although the intelligibility of free conversation improved slightly in case 6, little improvement was observed in case 2. Among the three cases, significant improvement was observed only in case 4, with slightly better improvement seen in case 2 than in case 6. The direct effects of DAF
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P251
COGNITIVE-PERCEPTUAL EXAMINATION OF REMEDIATION APPROACHES TO HYPOKINETIC DYSARTHRIA MEGAN MCAULIFFE (1) - SARAH KERR (1) - ELIZABETH GIBSON (1) TIM ANDERSON (2) - PATRICK LASHELL (3) DEPARTMENT OF COMMUNICATION DISORDERS & NZ INSTITUTE OF LANGUAGE, BRAIN & BEHAVIOUR, UNIVERSITY OF CANTERBURY, CHRISTCHURCH, NEW ZEALAND (1) - NEW ZEALAND BRAIN RESEARCH INSTITUTE, UNIVERSITY OF OTAGO, CHRISTCHURCH, NEW ZEALAND (2) - NZ INSTITUTE OF LANGUAGE, BRAIN & BEHAVIOUR, UNIVERSITY OF CANTERBURY, CHRISTCHURCH, NEW ZEALAND (3)
Abstract: Speech treatment for individuals with hypokinetic dysarthria commonly focuses on behavioural modification of speech rate and vocal loudness. However, very little is known regarding how these modifications affect listener processing of hypokinetic dysarthric speech. This study aimed to determine how increased vocal loudness and rate reduction affected listeners cognitive-perceptual processing of hypokinetic dysarthric speech. Fifty-one participants aged 18 to 30 years completed a speech perception experiment,
hearing test and receptive vocabulary test. For the perception task, experimental stimuli were elicited from five individuals with moderate hypokinetic dysarthria in habitual, loud and slow speaking modes. Listener participants were allocated to habitual (n = 17), loud (n = 17) and slow (n = 17) experimental conditions. Transcripts derived from a phrase repetition task were coded for accuracy, segmental (syllable resemblance) and suprasegmental (lexical boundary) error patterns. Results of the study revealed that transcript accuracy was highest, overall, in the slow condition. However in the loud condition, improvement was evidenced across the experiment. Error analysis revealed that listeners in the loud condition appeared to prioritize segmental cues in comprehending hypokinetic dysarthric speech; whereas suprasegmental cues were preferentially weighted in the slow condition. Furthermore, a listeners receptive vocabulary was predictive of their transcription accuracy and resemblance of syllable errors to the target. The findings of the study appear to indicate that increased loudness and rate reduction have differential effects on listeners processing of dysarthric speech. Learner Outcomes: After listening to this presentation, participants will be able to: (1) Describe the effects of hypokinetic dysarthria upon speech production; (2) Describe the cognitive-perceptual approach to conceptualizing rehabilitation strategies in dysarthria; and (3) Identify possible cognitiveperceptual outcomes of slow and loud speech on listener processing
P254
STUDIOUSLY: TOWARDS A SELF-MANAGEMENT OF THE STUDY PROCESS USING META-COGNITIVE STRATEGIES ELENA VIOTTO (1) - NOEMI DOMENINO (1) - ANNALAURA PETTERUTI (1) - MARCELLA POCCHIOLA (1) MULTICODEX, TORINO, TORINO, ITALY (1)
Abstract: Since few years, at the Co-op. Soc. Multicodex of Turin, a speech theraphy office, there is a laboratory organized in small groups, with the aim of integrating text meta-comprehension skills with the independent management of the study process. The laboratory is for children between the ages of 11-14 years with specific learning difficulties. The training of groups speech therapy allows children to bring out and experiment cooperative learning strategies: through concrete experiences of sharing, a child can learn to use his/her own resources and take control over his/her information elaboration process (functional use of strategies). The contents of the laboratory are focused on the management and integration of available resources, understanding and analysis of the text of study, organization and control of time. The program includes 10 sessions of one-hour meeting, with an initial assessment and a final re-test (the evaluation meetings last 90 minutes). This practice is effective in order to create targeted stimulation activities and to modify the aspects that criticality determine the creation of discomfort in children, compromising the learning. The revaluation is intended to verify the effectiveness of training by identifying critical issues. The goal of the program is to provide skills to reduce functional and operational difficulties in the management of the study. The theories and research to which the laboratory refers are those of the University of Padova, MT Research Group Learner Outcomes: The data analysis has been done comparing the weighted scores of the test and re-test phase, in relation to statistical averages for age and education of children; Overall, an increase in knowledge has been observed, as well as the effectiveness of using strategic behaviors; in some cases there is a direct application in tests study re-test; In order to continue the study it would be necessary to integrate the speech therapy training in the scholar context, calling for the co-action of rehabilitation together with the School, Family, tutors and other educational agencies; The laboratory has been recently conceived: this has not allowed, for the moment, to carry out the study on a larger number of participants, nor to schedule follow-up workshops after few months; both the aspects could be the basis for further studies.
P252
THE IALP VALUE FOR THE DEVELOPMENT OF LOGOPEDICS AND PHONOATRICS IN RUSSIA OLGA ORLOVA (1) - GENNADY IVANCHENKO (1) - LEV RUDIN (2) - ELENA LEVINA (3) FEDERAL STATE SCIENTIFIC CLINICAL CENTRE OF OTORHINOLARYNGOLOGY, FEDERAL STATE SCIENTIFIC CLINICAL CENTRE OF OTORHINOLARYNGOLOGY, MOSCOW, RUSSIAN FEDERATION (1) - THE RUSSIAN PUBLIC ACADEMY OF VOICE, THE RUSSIAN PUBLIC ACADEMY OF VOICE, MOSCOW, RUSSIAN FEDERATION (2) - THE INSTITUTE OF SPECIAL EDUCATION, MOSCOW CITY TEACHERS TRAINING UNIVERSITY, MOSCOW, RUSSIAN FEDERATION (3)
Abstract: In the article you will find the historical materials about the participation of Russian phoniatrists and logopedists jn the international congresses and its value for the development of logopedics and phoniatrics in Russia. Learner Outcomes: know the details of international activity of Russian phoniatrists and logopedists; know the value of IALP for the development of logopedics and phoniatrics in Russia.
P255
EXPLORING EQUAL RELATIONSHIPS IN A DISABILITY PROVISION (PHD THESIS IN PROGRESS) ELLIANNA MANTAKA-BRINKMANN (1) DEPARTMENT OF DEVELOPMENT AND SOCIETY, SHEFFIELD HALLAM UNIVERSITY, SHEFFIELD, UNITED KINGDOM (1)
Abstract: Introduction - This research project tries to reflect on my work as a speech and language therapist in one of the very few institutions left in Greece for children and adults with disabilities having a very long history in this domain. The aim of this study is to try to understand how the relationships between parents, children or adults, and professionals could be established in a more democratic balance gaining understanding of participants perspectives and perhaps establishing the potential for change. Within this relationship triangle it is important to understand what kind of role takes each of the key participants by connecting the three groups, parents, children and adults and professionals together and trying to establish first a common understanding on the basic definition of disability. What is the meaning? What are the consequences for the disabled people, their families and / or the environment where they grow up and try to find a place in the society? The different understanding of disability and the different perspective of the participants will be explored in the context of the medical model and the social model and how these impact upon speech and language therapy practice and research including also the experience of other professionals gaining a better and broader understanding how they comprehend and perceive the issues that are going to be researched from their point of view taken also cultural diversities in consideration. Moreover, achieving this it could be also worthy to look and to study some more issues that are very much related to this balance and emerge across different settings. Looking closely, parents, professionals, children or adults have relationships of power between them. Each of them has different expectations and therefore exist different opinions. As a result misunderstandings might occur. The different relationships of power could be better if they were democratically balanced. Otherwise they can cause several problems and sometimes an unsuccessful cooperation. Moreover, the meaning of identity for each of the participants of each group will give some information looking more thoroughly for people that have an insider status and for me as a researcher, being an outsider. Through this paper there will be an introduction to these issues that are going to be researched and some theoretical background are going to be presented using ethnography as methodological approach with observations and semi-structured interviews and taking in consideration the ethical issues that might occur. The research projectBeing a practitioner and working for many years in this disability provision I started to realize that relationships are very important and very fragile when it comes to the point to speak, reflect, and work with disability. The thesis is about a balanced (isosceles) triangle that represents the three different
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P253
ADOPT THE CHILD WITH DISABILITY- IMPLEMENTING HOME PROGRAM BY PSYCHOLOGY STUDENTS ON OUTREACH IN SEMI-RURAL SOUTH AFRICA AGATA NATALIA RUNOWICZ (1) ASSOCIATION FOR THE PERSONS WITH PHYSIACL DISABILITY, SASLHA, RHODES UNIVERSITY, ZA, GRAHAMSTOWN, SOUTH AFRICA (1)
Abstract: Background: To make students outreach mere purposeful and offer experience with disability and on the other hand to assist children from developmental Clinic we plan a project with RU Psychology Dept. and APD/DOH Therapist.Participants RU Psychology Dept. outreach coordinator, Rehab Manager APD SW and development worker, Therapists DOH and 40 students. Aims- DOH-To help with home program and broaden intervention; Students-To observe relationship and learn and feedback to therapists; Students-To familiarize with disability and developmental delays and gain experience; Coordinator To guide and support students and promote reflective intervention, run supervision session; All- to promote disability issues at Psychology dept.; Therapists to insure workable home program and assist with implementation; APD assist with transport, translation etc. facilitation; Means; Staff; Car; Toy Library and space; Communication and advice. Process. Strategy and aims planned by Agata and Lisa. Presentation of Dev. Clinic and APD works at RU- Introduction of children and students making teams. Visits, programs adjustments, negotiations. Supervisions monthly, feedback and follow up by APD and DOH. Summary, party and reflections. Outcome: Files of reflections, DVD with interviews, see example-. Way forward. Recommendation for RU Clinic next year to carry on with the project Learner Outcomes: Families to have a facilitator and supporter in implementation of home program and with time to have child communicating and functioning better and parenting more rewarding and specific to childs needs, DOH-to help with home program and broaden intervention; Studentsto observe relationship and learn and feedback to therapists, to familiarize with disability and developmental delays and gain experience, Coordinator to guide and support students and promote reflective intervention, run supervision session, all- to promote disability issues at Psychology dept.; Therapists, to insure workable home program and assist with implementation, APD to assist with transport, translation etc. facilitation.
groups of people-parents, professionals and children or adults- that come to work and cooperate together in a provision where disability is seen sometimes differently from each member of these groups. The setting where this research project is going to take place is one of the very few institutions that left in Greece and has a very long history in this domain making the research more challenging. On the other side, could give the chance for further research in this field for other similar settings. In the literature and in the research, through the last decades, there is a lot of research that has been done between professionals and parents or between disabled people and professionals but few researchers has been occupied with all the three together trying to find a democratic model that could help to gain a better understanding of participants perspectives and perhaps establishing the potential for some change. I will try to look this model in a more holistic view analyzing each group individually by describing the characteristics, expectations and their contribution to the educational process. After describing the key participants we have to understand what connects them. Are the relationships of reliance and respect between each other that play an important role? What influences their diverse views and believes? Are there different expectations from each other? The different views about disability, relationships of power and identity as insider or outsider are issues that can connect professionals, parents and children/adults that come together and they need to discuss, find solutions and start or continue an educational program in different placements. Furthermore, respect, complementary expertise and a willingness to learn from each other are also issues for partnership and balanced relationships. Looking in the literature of the last years some research has been done on the relationship between parents and professionals or between professionals and children or people with a disability but not all of the three together. On the other side little research has been done from the point of view of health professionals try to use an ethnographic research approach. Such an alternative to the medical model makes the research for health professionals more challenging and tries to include ways in which a non-disabled professional can conduct research that could give some information through observations and interviews giving in such a way a better understanding and perhaps a potential for change. Furthermore, post qualification development and further training can be beneficial not only for the professionals themselves but also may have a positive impact for the children and the families who interact with them. Another very important issue is to achieve in a possible way that professional could use the social model as a theoretical foundation for practice and research within their own discipline. It would also contribute to parents to look back their rights as parents and to take decisions for themselves and for their children because parents should be partners in planning and decision making from the moment that are the long-term caregivers of their children . Additionally, it will give the possibility to disabled children/adults to have a voice throughout this research project. Obviously, this is not enough but a start for more health professionals to discover an appropriate position in relation to disabled people, research and social model of disability trying to develop a dialogue between them. Children and adults perhaps will learn more about themselves and be more involved in the process of their educational program without feeling so much oppressed and disempowered. Because, it is important to have the opportunity for other professionals to understand and accept the different points of view of disabled people as long as of parents and vice versa. Moreover, the contribution of having the possibility through this research project to increase the study of similar works in Greece since the literature is very limited in this field for health and other professionals. Furthermore, it should be perhaps possible for the participants to repositions themselves as professional, parents and disabled people. Besides, part of self-knowing that professionals require is also important to become aware consciously and unconsciously by our peers and by the culture of the organization in which professionals work. Lastly, this thesis could speak the world of disability giving an understanding of hearing the voice of disabled people, parents and professionals. In such a way is perhaps going come into the light different belief of disability and different ways to be challenged with disability in everyday life. It is central for researchers and academics to study disability but in reality sometimes the things are different. Professionals do not sometimes have the time to realize their mistakes and they do not have the time to reflect about their work. Parents on the other side try to confront with a maze of problems without realizing the positive parts that may occur every day. Disabled people live sometimes in their dis-ability to do things that they want and dream of, without having any support from the society or the environment. Consequently, hearing the voices of insiders and outsiders will perhaps come to a better understanding of disability and the constructions of it improving the relationships and the acceptance between each other.
P256
YOUNG DOCTOR PROJECT: INTERACTIVE TELEDUCATION IN PROCESSES AND DISORDERS OF COMMUNICATION WANDERLIA QUINHONEIRO BLASCA (1) - CAMILA DE CASTRO CORRA (1) - ALINE MARTINS (1) - JLIA SPERANZA ZABEU (1) - CSSIA DE SOUZA PARDO-FANTON (1) - RICELLY AVILA DA SILVA (1) - MIRELA MACHADO PICOLINI (1) - ALCIONE GHEDINI BRASOLOTTO (1) - GIDRE BERRETIN-FELIX (1) - LUCIANA PAULA MAXIMINO (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, SO PAULO, BRAZIL (1)
Abstract: In health area, the Technologies of Information and Communication (TICs) are increasingly used as a way to motivate the hierarchy of knowledge. For a country with continental dimensions as Brazil, it is necessary to use modern resources of Interactive Teleducation to promote the efficient integration of the professionals involved in health activities, enabling learning and discussions, complementing and empowering traditional methodologies. Projects based on the Interactive Teleducation are dynamics converted to sustainable actions which disseminate health knowledge, with the contribution of technologic resources Technologies of Information and Communication. In this manner, the Young Doctor Project in themes of the Speech-Language and Hearing sciences area was develop to prevention and precociously detection of communication disorders. It was aimed to present and describe the actions of health promotion in themes related to Processes and Disorders of Communication, according to the pattern of the Young Doctor Project. The training program related to the themes occurred by several education methodologies lectures, cybertutor access, workshops/ activities, and different evaluations of the program and its competencies. The contents applied on students of the elementary and high school of public and private institutions, were developed by undergraduation and postgraduation students, guided by the professors of the university. During 2008 until 2012 were developed eight versions, in Bauru and Arealva (inner cities of So Paulo), of the Young Doctor Project about Hearing Health, Vocal Health, Genetics Syndromes and Cleft Palate, training 113 students which, at the end of the project, operated as young doctors, communicating the acquired knowledge in health to 4.230 people, among other students, professors, employees and community, during cultural fairs and lectures. The project initiated in 2008, with 17 students of the 9th year of the elementary school at the Infant and Elementary Education Criarte, enclosing the theme Hearing Health and Vocal Health. Aiming higher approaching of the contents, the project developed in the year of 2009 in a school of Bauru and one school of Arealva, verifying large dissemination of knowledge, by reaching 1.300 people in contact with both themes. In the year of 2010, the project explored another theme, the Genetics Syndromes, proposing to disseminate knowledge about genetic syndromes and promote the handicap inclusion in school. For the success of the action, the practical activities were developed in the sector of recreation of the Hospital for Rehabilitation of Craniofacial Anomalies of So Paulo HRAC-USP. In 2011 and 2012, two themes were developed in different schools: Hearing Health and Cleft Palate, and it was verified the effective learning about the aspects enclosed, satisfaction of the material displayed in the cybertutor and mainly changes in the students behavior, who were touched by the theme bullying, and became at the end of the project communicators of knowledge and consequently supporters in this process of inclusion. It was observed satisfactory results in the versions developed on different themes, creating collaborative learning networks. Learner Outcomes: Knowing the actions of health promotion in themes related to Processes and Disorders of Communication, according to the pattern of the Young Doctor Project, Knowing some Technologies of Information and Communication to motivate the hierarchy of knowledge, Describe the results of Young Doctor Project actions done in Brazil about Processes and Disorders of Communication.
P257
THE UNIVERSITY EXTENSION AS A LINK BETWEEN THE UNIVERSITY AND SOCIETY MAGALI DE LOURDES CALDANA (1) - ELEN CAROLINE FRANCO (1) - ALINE MEGUMI ARAKAWA (1) - CRISTINA DO ESPIRITO SANTO (1) - NATALIA GUTIERREZ CARLETO (1) - MNICA LIMA FRANA (1) - ARIADNES NBREGA OLIVEIRA (1) - RAFAEL JOS DAMASCENO (1) - ANGELA XAVIER (1) - ROOSEVELT DA SILVA BASTOS (1) - JOS ROBERTO DE MAGALHES BASTOS (1) BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, BAURU, BRASIL (1)
Abstract: The project USP in Rondnia began in 2002 as a proposal for interdisciplinary university work in Speech Language Pathology and Audiology and Dentistry of the Faculty of Dentistry of Bauru, University of So Paulo. The main objective is to promote health in the state of Rondnia, more specifically in the municipality of Monte Negro-RO. On average two expeditions are held annually during the university vacations, usually in February and July, the expedition team of speech therapy and dentistry is normally made
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up of 26 undergraduate students in the last year, 6 post-graduate students and 4 professors. During the activities, actions are taken in teaching, research and community outreach. Todays actions are aimed at health education, aiming to train local human resources. Therefore, there are conducted training courses for teachers face meetings during the expeditions, and distance learning via videoconferencing. The same work is also being promoted at the local community health workers. To make this work of teleeducation was signed a partnership with the Department of Telemedicine, Faculty of Medicine, USP. Also there have been two courses in Cybertutor format, which had the following themes: the aging process and the process of inclusion of children with special needs in mainstream education. The courses target audience is teachers with the main goal from beyond the transmission of knowledge in classroom situation, analyze the performance of teachers in an online course, considering the limited knowledge with digital technology. Attendances in the areas of audiology, language, voice, orofacial motricity, restorative dentistry and dental surgery are also performed during the expeditions. Several studies have been done so far with the aim of epidemiological description of the conditions of general health and specific diseases and to plan further research through the monitoring of initiatives already undertaken. Learner Outcomes: Know the extension activities of the University of Sao Paulo in the Brazilian Amazon; Discuss the extension actions of the University of Sao Paulo in the Brazilian Amazon; Know about health education in Speech Pathology and Audiology.
Improvement Groups, carried out within the organization, represent systems to interpret and improve the cognitive spiral of organization: we are in the Education Field. The poster illustrates some formative experiences aimed at Speech and Language Pathologyst, which produce new conditions for learning and modification of professional conduct, taking in consideration different types of training previously described (Community of Practice / Group of improvement) and by combining the use of computer technology. Learner Outcomes: To diffuse educational experiences of Communities of Practice and knowledge as a training tool dedicated to Speech and Language Pathologists; To describe participatory tools for learning in situations where knowledge is joined to practice and where learning is an activity inherent to the work process;To present potential uses of informatics and network to support professional training, for both group and individual
P260
SPEECH-LANGUAGE AND HEARING SCIENCES ACTUATION WITH RIVERINE COMMUNITIES IN THE BRAZILIAN AMAZON REGION CRISTINA ESPRITO SANTO (1) - ALINE MEGUMI ARAKAWA (1) - ELEN CAROLINE FRANCO (2) - MNICA LIMA FRANA (1) - ANGELA XAVIER (1) - ARIADNES NOBREGA OLIVEIRA (1) - ROOSEVELT DA SILVA BASTOS (1) - JOS ROBERTO MAGALHES BASTOS (1) - MAGALI DE LOURDES CALDANA (1) FACULDADE DE ODONTOLOGIA DE BAURU, UNIVERSIDADE DE SO PAULO, BAURU, BRASIL (1) - FACULDADE DE ODONTOGIA DE BAURU, UNIVERSIDADE DE SO PAULO, BAURU, BRASIL (2)
Abstract: The riverine population is a term that refers to any coastal population that lives and subsists mainly on the margins of the river where inhabits, having a dependency relationship with this in their basic needs for food, transportation, work and livelihood. Local inhabitants are isolated not only from the general culture, such as the access to print media, television and radio, the others residents and especially to the health care access. This study aimed to report the Speech-language and Hearing sciences actions performed in riverside communities in the Amazon region. The actions were realized during expeditions Project FOB-USP in Rondnia in communities named Tabajara and Calama, and the villages named Demarcation and Rio Preto. The procedure realized were clinical attendance and educational activities involving the language development, hearing care, breast-feeding, vocal health, oral habits, health and general hygiene. Regarding the clinical procedures it were performed anamnesis, external ear canal inspection, hearing screening, oral language assessment, written language assessment, guidance and referrals required, as well as WHOQOL-Bref application. During visits to the communities were performed a total of 1.008 speech language therapy procedures, being: 104 anamnesis, 134 external auditory canal inspections, 134 hearing screenings, 43 oral language assessments, 19 written language assessments, 15 attendances in reading workshop, 106 guidelines, 3 referrals, 416 attendances in health education and 34 WHOQOL-Bref applications. During the contact with these communities it can be verified the need for education and health promotion, and primary care in a continuous and lasting way because this is a population with high health care needs. These communities needs go beyond the Speech-language and Hearing Sciences care, requiring orientations about general health, education and leisure. In the region there is no Speech-language and Hearing Sciences assistance thus the professional who could help then with these kind of care. Thus this professional must be able to guide not only the therapies aspects, but the aspects of general health and citizenship due to social deprivation that the population faces.Thinking about these communities social deprivation we can conclude that these activities are very important to benefit the population with the services offered. In the other hand students are also benefited with these shares, being inserted in a different culture from their origin, as well as improving speech language therapy techniques in regions devoid of health care, reflecting positively for their professional training. Thus, all parts are favored with actions like these. Learner Outcomes: characterize the Speech-langauge and Hearing Sciences actions performed in the districts named Tabajara and Calama, and villages named Demarcation and Rio Preto; Check the life conditions of riverine communities, their needs and demands of health; Development of health education activities aimed a quality of life improvement of riverine communities visited; Show the benefits received by undergraduates students.
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STUDENT TRAINING IN SPEECH LANGUAGE PATHOLOGY IN BULGARIA DOBRINKA GEORGIEVA (1) SOUTH WEST UNIVERSITY, FACULTY OF PUBLIC HEALTH AND SPORT, BLAGOEVGRAD, BULGARIA (1)
Abstract: Speech Language Pathology (Logopedics) is a young interdisciplinary area of study in Bulgaria. The present study is an overview of student training in Speech Language Pathology (SLP) in Bulgaria. The data were collected using a questionnaire developed by Soderpalm (2006), than supplemented by Georgieva (2010), and Georgieva and Wozniak (2013). In Bulgaria SLP has its roots in Special education and is centralized in the university frames. All educational programs has positive accreditation provided by the National Agency of Accreditation and Evaluation. Special accent in the study is put on the new paradigm Evidence Based Practice (according to the revised IALP guidelines, 2010) and application of the research based teaching in SLP. The professional bodies that govern clinical practice in Public health fields do not use EBP. There are no established guidelines based on existing logopedics practice which is not well documented. Most SLPs in Bulgaria sampled work in educational setting, clinical organization and social day centers. The private practice is not regulated by law. Practicing SLPs are not registered by the Health Profession Council (HPC). Learner Outcomes: The participant will be able to know more about (1) Logopedics development in Bulgaria; (2) characteristics of Logopedics program; (3) qualification of logopedists; (4) clinical practicum time during logopedics education; (5) implementation of the evidence-based practice
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THE TRAINING METHODOLOGIES BETWEEN CONTINUING MEDICAL EDUCATION AND INNOVATION FRANCA BALBO MOSSETTO (1) - ANGELA LUCIA FOGLIATO (2) SARA VESCO (3) DEPARTMENT OF THE CHILD AND THE ADOLESCENT NEUROPSYCHIATRY, LOCAL HEALTH ASL TORINO 2, TURIN, ITALY (1) - DEPARTMENT OF MEDICINE PHYSICAL AND REHABILITATION 2, HOSPITAL CORPORATION CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, HOSPITAL UNIT C.T.O.-M.ADELAIDE, TURIN, ITALY (2) - DEPARTMENT OF MEDICINE PHYSICAL AND REHABILITATION, HOSPITAL MARTINI, TURIN, ITALY (3)
Abstract: The reality of health care is today designed as a set of complex organizations in which human professional resources are as fundamental as indispensable. They are a strategic element and one of the critical factors for success of productive organizations, especially for health care organizations. However, the true value is not generated by knowledge, but by the use made of it in terms of improvement and change. The acquisition of knowledge and skills can be done in very different ways such as experience and training. The educational activities and training serving to maintain, develop and increase the knowledge, skills and performance of health workers was introduced in Italy by art. 16a et seq. of Legislative Decree no. 229 of 1999, regulating aspects of Continuing Education said Continuing Medical Education (CME). The setting and training opportunities can be very different. Currently the Italian CME system describes and allows many different forms of educational projects such as Residential Education, Distance Learning (DL or Formazione a Distanza FAD), Field Training, Training blended. Communities of Practice and Learning and/or
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FRICATIVES AS A MEASURE FOR PREDICTING LATER LANGUAGE DEVELOPMENT CREAGHEAD NANCY, SOTTO CAROLYN, REDLE ERIN, BANDARANYAKE DAKSHIKA, STRUNJAS JEAN-NEILS ARMSTONG UNIVERSITY, CINCINNATI CHILDRENS HOSPITAL MEDICAL CENTER, UNIVERSITY OF CINCINNATI, UNIVERSITY OF CINCINNATY (USA)
Abstract: This study investigated the potential relationship between early speech sound development and later language skills by examining the acquisition of fricatives as one class of phonemes that might be predictive.
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Language develops at variable rates in young children, but identification of markers that might suggest delay are needed and have not been identified. Because of their advanced perceptual, motoric, and phonological demands, production of fricatives in words may be one marker. This study examined whether children who produced fricatives in words by 18 months had better expressive language at 18, 24, and 30 months than children who did not. Toddlers were identified at 9 months and followed in their homes at six month intervals until 18 months to determine the age at which at least one fricative appeared in words. The expressive language skills of 37 toddlers who did and did not produce fricatives in words by 18 months of age were then compared longitudinally at 18, 24 and 30 months of age using the MacArthur-Bates Communicative Development Inventories: Words & Sentences (MBCDI: WS). Results indicated that expressive vocabulary scores and the use of grammatical markers were significantly better for children who produced fricatives by 18 months than for those who did not. This effect was consistent across scores at 18, 24, and 30 months. Only presence of fricatives at 18 months was related to language scores. The total number of consonants and total number of fricatives produced at 18 months did not significantly predict expressive vocabulary scores. Because children who produced fricatives by 18 months demonstrated better expressive language skills than their peers who did not produce fricatives by 18 months, as measured by vocabulary and grammatical markers, it is suggested that the early production of fricatives by toddlers may indicate faster expressive language development during the period 18 to 30 months. It is not known whether this potential relationship continues after 30 months. Further longitudinal investigation is needed. Learner Outcomes: Describe the factors related to acquisition of fricatives in English; Describe the potential relationship between speech sound acquisition and language acquisition; Describe the advantages and cautions of using speech sound acquisition as a predictor of language acquisition based on the research.
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AN INNOVATIVE WEB-PLATFORM FOR LEARNING DISABILITIES STEFANIA ROMANIELLO (1), LAURA GRASSO (1), CHIARA TOMATIS (1), SABRINA ATZEI (1), GABRIELA FERRAZ (1) (1) AREA ONLUS MEDIATECA GIOVANNA RECCHI
Abstract: DSABoard is a web-based platform, which can be accessed from tablet or pc, designed for children aged between 9 and 13 years with a learning disability; also focuses on their teachers and caregivers (tutors). The project was developed in Area, a no-profit organization based in Turin, that takes care of children, adolescents and young adults with disability, thanks to the contribution of Vodafone Italy Foundation. The design idea behind DSABoard is to put together in a single device online some useful tools to study (calculator, voice recorder, exercises, spreadsheet, multiplication table), and the technical aids that can manage childrens difficulties (text-tospeech, mind maps, multilingual translator). DSABoard operates, therefore, as a virtual tool box or an ideal studios desk, equipped with the necessary tools to support children studying. To access the platform users need a username and a password, that will be provided by the website admin. DSABoard is made up of 3 main areas which users can access: one aimed at children in elementary school, one for middle school students and one for professionals (teachers, speech therapists, psychologists, etc..). Two different scenes were designed for users: the first is a spacial background, made of planets, spaceships, aliens and astronauts and the second one is a rock band concert on stage. To menage all devices, tutors can access a back office platform which allow them to personalize activities for their students and evaluate users feedback. Once logged in, children will be in a homepage that shows 5 characters, each puts them in connection with a section of work and with specific tools: 1. Calculate (calculator, multiplication table, spreadsheet); 2. Writing and reading (text-to-speech, voice recorder, multi-language translator); 3. Study (mind maps);4. Games (puzzles, memory etc..);The fifth character refers to the Trial, a device that contains a set of tasks (write a text + listen with text-to-speech + read, record and hear to verify tracks quality + create a mind map of the text to study), which help users to study and do homework in less exhausting way. DSABoard allow students to learn an effective method of study that may turns them more independent.
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ENHANCING GRADUATE STUDENT LEARNING OUTCOMES WITH PORTABLE LABS IN ASSISTIVE TECHNOLOGY JAYANTI RAY (1) DEPT OF COMMUNICATION DISORDERS, SOUTHEAST MISSOURI STATE UNIVERSITY, CAPE GIRARDEAU, UNITED STATES (1)
Abstract: The current study, involving 16 graduate students, compared student test scores before and after training with the AAC/AT software lab using i-Pads. The goal was to improve students conceptual and applied learning in the area of AAC/AT. The objective of the study was to determine if there was a significant difference between the pre- and post-test scores obtained before and after AAC training labs respectively. The study also addressed major pedagogical strategies related to student success Learner Outcomes: Describe how i-Pad serves as a teaching and learning tool in AT/AAC instructions to graduate students; Identify i-Pad apps that facilitate both learning and motivation in students; Identify teaching and learning strategies that enhance students clinical performance and service learning.
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LITHUANIAN ASSOCIATION OF LOGOPEDISTS VILMA MAKAUSKIENE (1) - REGINA IVOSKUVIENE (1) - DAIVA KAIRIENE (1) LITHIUANIAN LOGOPEDISTS ASSOCIATION, SIAULIAI UNIVERSITY, SIAULIAI, LITHUANIA (1)
Abstract: Services and Activities of the Association- Lithuania has well developed of logopedic services. It is roots reach the beginning of 19th c. when the country restored its right to educate children in the native language and it was necessary to organize schooling, train teachers, publish texts books and develop education methodologies. A low of compulsory primary education passed in 1922 was a strong impulse for the logopedic practice. In the pre-war medical, education and psychological literature stammering, voice, articulation difficulties, reading disabilities and methods dealing with them were analyzed. Doctors had to take care of the children with visual, hearing, mental and speech-language impairments. The observation and research of speech problems has been influenced by the development of psychology science of psychology in Lithuania. After the 2nd Word War when the most teachers and educators of independent Lithuania were exiled to Siberia and educational literature became inaccessible, in the issue of dealing with speech disorders had to be dealt with anew. The period between 1958 and 1960 was of a particular importance. Professional development courses were first organized for the stuff of professional institutions and some lectures on logopedics were delivered. Speech therapist started to be trained in Siauliai city. In 1962 on decision of the Council of Ministers logopedic aid post attached to outpatient clinics and high schools were established in towns and regions centers. With the increase in the numbers of qualified specialists, logopedic service network developed very intensively. At present tree major institutions organize speech therapy service in Lithuania: Ministry of Educations and Sciences, Ministry of Health Protection and Ministry of Social Security and Protection. The Ministry of Education and Sciences coordinates speech therapy services in educational institutes which provide services to pre-school and school ages children. The Ministry of Health Protection speech therapy services in the Viltis community care homes and pensions. In-service training for logopedits is provided by the In-Service Training Institute of Siauliai University, Educational Department Institute of Lithuania and by other in-service training centrs in major cities in Lithuania. The Association of Logopedists of Lithuania- Association of Logopedists of Lithuania started its activities on 1 April 1992. The Regulations of the Association were registered with the Ministry of Justice of the Republic of Lithuania. The Association unites logopedists, working in institucions under the Ministries of Education and Science, Health Protection and Social Security and Labour. The Association is open to all employees, sponsors, etc. The Aims and Tasks of the Association of Logopedists of Lithuania - The main aim is to contribute to the professional development of specialists working in the field. Other aims are as follows: 1. To join logopedists and
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CASE STUDY METHOD IN TEACHING ANATOMY: AN EXPLORATION OF THE MENTAL SELF-GOVERNMENTAL MODEL JAYANTI RAY (1) DEPT OF COMMUNICATION DISORDERS, SOUTHEAST MISSOURI STATE UNIVERSITY, CAPE GIRARDEAU, UNITED STATES (1)
Abstract: The purpose of this study was to enhance undergraduate students cognitive milieu with learning styles such as executive, legislative, and judiciary according to the Mental Self-Governmental Model (Sternberg, 1990; 1994) using a database of clinical pathways with various case scenarios. The study also aimed to increase explicit learning and perception of learning by students while taking into consideration the major cognitive learning styles based on the above-mentioned model. Two groups of undergraduate students (control and experimental groups) were chosen for the study. The experimental group received case studies with embedded cognitive tools, whereas the control group received traditional case studies. Both groups took content-based pre-and posttests. Results indicated that the experimental group performed significantly better in explicit problem solving than the control group on multiple-choice questions since they were exposed to the cognitive learning components. No significant differences in class participation scores and group assignment scores were noted between the two groups. A qualitative analysis of class observation notes during class discussions indicated that students expressed their thoughts quite coherently as they focused on multiple facets of the given clinical problem simultaneously. The efficacy of case-based learning modules will be discussed. Learner Outcomes: Describe various learning styles such as executive, legislative, and judiciary according to the Mental Self-Governmental Model; Describe the impact of various cognitive tools embedded in casebased learning modules; Identify cognitive strategies recruited by students for effectively learning multiple facets of case studies.
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persons with speech and communication difficulties as well as other interested people to help solving the problems. 2. To solve other important theoretical and practical problems of logopedics. In other to achieve its aims, the Association of Logopedists of Lithuania implements the following tasks: 1. Develops implements or participates in programs and projects designed to help people with speech, language and communication difficulties; 2.Takes an active part in the development of the overall educational reform; 3. provides opportunities for the association members to update their professional knowledge and skills in order to be eligible for the higher professional qualification category; 4. participates in practical training of prospective logopedists at the Faculty of Special Education of Siauliai University at both Bachelors and Masters level; 5.collects and keeps data on children and adults with speech impairments and on institutions providing logopedic help for these; 6.collaborates with appropriate ministries and non-governmental organizations in other to improve the system of logopedic services; 7.solves other problems geared towards the implementation of the aims of the Association. Major issues in Lithuania - The structure of providing speech therapy shows that the service are available to most persons with speech-language problems however there are a number of problematic issues, such as: The difficulty of detecting and eliminating speech impairments due to decrease in the number of children attending the nursery schools and other pre-school institutions and providing services to children who do not attend any schools. A set of problems associated with prevention of speech problems, preventive measures being depended on level of heath care and culture level of the community insufficient early speech therapy: the network of such institutions is underdevelopment help to the children with in-born neurological symptoms is delayed. Insufficient services for the adults: people who have lost their speaking abilities receive help only in the hospitals and in out-patients clinics in some cities. Lack of SLTs dealing with voice and fluency problems.Lack of systematic effective methods to deal with stammering, cluttering, autism, mutism and service disabilities in general oral motor skills. Providing logopedic services in the country still remains a major problem.
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UNION OF THE EUROPEAN PHONIATRICIANS - STATUS QUO AND PERSPECTIVES ANTOINETTE AM ZEHNHOFF-DINNESEN (1) - LUCYNA SCHALEN (2) - ANTONIO SCHINDLER (3) - VIRGINIE WOISARD (4) - CHRISTIANE NEUSCHAEFER-RUBE (5) UNIVERSITY HOSPITAL MNSTER, DEPARTMENT OF PHONIATRICS AND PEDAUDIOLOGY, MNSTER, GERMANY (1) - DEPARTMENT OF PHONIATRICS ENT CLINIC, UNIVERSITY HOSPITAL LUND, LUND, SWEDEN (2) - U.O. OTORINOLARINGOIATRIA, AZIENDA OSPEDALIERA - POLO UNIVERSITARIO L. SACCO, TURIN, ITALY (3) - UNIT DE LA VOIX ET DE LA DGLUTITION, HPITAL LARREY - CENTRE HOSPITALO UNIVERSITAIRE DE TOULOUSE, TOULOUSE, FRANCE (4) - CLINIC OF PHONIATRICS, PEDAUDIOLOGY AND COMMUNICATION DISORDERS, UNIVERSITY HOSPITAL AACHEN AND MEDICAL FACULTY OF THE RWTH AACHEN UNIVERSITY, AACHEN, GERMANY (5)
Abstract: Phoniatrics is the medical specialty of voice, swallowing, speech, language, and hearing disorders. In 1971 the Union of the European Phoniatricians (UEP) was founded. Since 2011, UEP is in a phase of reorganization. Presently, the association is registered in Helsinki, Finland. Phoniatricians from 24 countries are represented by their National UEP Coordinators. The current board is elected for the term 2011 to 2014, see the UEP homepage: www.phoniatrics-uep.org. UEP aims to bring together the physicians who are active in the fascinating medical specialty of Phoniatrics to promote scientific work and to give support in rofessional problems. In addition, UEP intends to intensify the contacts to related disciplines. UEP informs continuously all members about congresses, symposia and workshops concerning voice, swallowing, speech-, language-, and hearing disorders. UEP intends to intensify the cooperation with related societies, e. g. the European Laryngological Society (ELS), the International Association of Logopedics and Phoniatrics (IALP), The Pan-Europan Voice Conference (PEVOC), The World Voice Consortium (WVC), The Collegium Medicorum Theatri (CoMet), The International Association of Physicians in Audiology (IAPA), the Bureau International dAudiophonologie (BIAP), and the Comit Permanent de Liaison des Orthophonistes / Logopdes de lUnion Europenne (CPLOL). Thankfully, UEP presentations/guest sessions could be organised in 2012 on the ELS congress in Helsinki, the commemorative congress 90 Years Phoniatrics in Czech Republic and Slovakia in Prague, the IAPA congress in Beijing and The WVC Congress in Luxor. UEP is very pleased to have in 2013 the opportunity to organize a guest session on the PEVOC congress in Prague and two workshops on the IALP congress in Turin where the next Annual General Assembly of UEP will take place. Moreover, in 2013, UEP members will participate as invited speakers at the Meeting of the European Academy of Otorhinolaryngology-Head and Neck Surgery, and of the Confederation of the European Otorhinolaryngology and Head and Neck Surgery (CE ORL-HNS) in Nice, and on the World Congress of the International Federation of Otolaryngological Societies (IFOS) in Seoul. The next UEP congress will take place in 2014 in Moscow with contributions of representatives of the related societies under the main topic: Phoniatrics an interdisciplinary specialty. Detailed information can be found at the congress website www.uep2014.com from March 2014 on. Annually, a UEP bulletin, reporting news about relevant developments of Phoniatrics in the different countries, is emailed to all UEP members. Up to now, the country specific medical training programs are varying. In some countries, Phoniatrics is combined with Audiology or Pedaudiology. UEP will try to harmonize the medical training in Phoniatrics in cooperation with the European Union of Medical Specialists (U.E.M.S.) in Brussels Learner Outcomes: The attendees will learn about the goals of the Union of the European Phoniatricians, the present state of the UEP and its current activities. The most important information is to promote contacts and cooperation between phoniatricians and to intensify interdisciplinary collaboration with professionals of related disciplines.
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EMERGING ISSUES AND PRACTICE PATTERNS FOR THE SPEECH PATHOLOGY PROFESSION IN AUSTRALIA CHRISTINE STONE (1) SPEECH PATHOLOGY AUSTRALIA, N/A, MELBOURNE, AUSTRALIA (1)
Abstract: The speech pathology profession in Australia has progressively built upon its solid foundation from its inception during the 1940s through to the current day. While there has been an ever increasing broadening of the role and scope of the profession, the last decade has seen exponential changes to the practice of speech pathology with increasing complexity of client needs leading to advanced diagnostic and therapeutic processes, alongside specialised practice becoming common place. At the same time, the changing political and funding landscape impacting on delivery of services means the profession is required to adapt readily and capitalise on opportunities that present themselves with new programs across health, education and the disability sectors. Yet there are many areas where the profession is still not well recognised or its role and expertise not fully utilised. Areas such as mental health, juvenile justice and forensic health hold opportunities for the profession to have a considerably higher profile and positive impact. In aged care, the professions role has been in part diluted due to decisions based on funding imperatives rather than the needs of the individual. While within education, although the profession has a well accepted role in providing direct client management, a broader role in building the capacity and knowledge of early childhood educators and teachers has not yet been cemented. Additionally, with the launch of the ground-breaking National Disability Insurance Scheme across Australia, there is a need to ensure that speech pathologists are viewed as vital providers of services to those presenting with complex disabilities. The Australian speech pathology profession has a long established commitment to ensuring speech pathologists practise at a high standard which meets both the professions and communitys expectations. Imperative to the growing scope and specialisation of the profession is the need to ensure high quality, safe and competent practice. By the nature of communication and swallowing disorders, speech pathologists work with people who are physically, socially and emotionally vulnerable and it is incumbent upon the profession to ensure it delivers ethical, efficacious and evidenced based practice. Speech Pathology Australia has in place a robust self-regulation program for its members, which is being further strengthened to mirror the standards and requirements of formal registration (not yet required for speech pathologists). Supporting the ongoing professional development and extension of knowledge and skills of the profession, Speech Pathology Australia provides a range of evidenced based practice resources and continuing education programs as well as access to the latest clinical and academic research. In this poster, the emerging broadening of the practice of speech pathologists in Australia and the framework to support the profession to embrace these challenges will be explored.
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ABOUT THE SPEECH-LANGUAGE-HEARING ASSOCIATION, TAIWAN YEH WEN-YING (1) TAIWAN SPEECH-LANGUAGE-HEARING ASSOCIATION, TRISERVICE GENERAL HOSPITAL, TAIPEI, TAIWAN, PROVINCE OF CHINA (1)
Abstract: The Speech-Language-Hearing Association of Taiwan is the professional and scientific association representing for over 1337 members. Members and affiliates are speech-language pathologists, audiologists, and speech, language, and hearing scientists who work in hospitals, rehabilitation centres, schools and education centres, private practice, and organizations for those with specific disabilities. The association was established in 1986, and our role is to provide quality service to our members, coordinate professional development events in the field of speech-language and hearing, and to hold academic exchange events with others internationally.
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EMERGING ISSUES AND PRACTICE PATTERNS IN YOUR COUNTRY WEN YING YEH (1) TAIWAN SPEECH-LANGUAGE-HEARING ASSOCIATION, TRISERVICE GENERAL HOSPITAL, TAIPEI, TAIWAN, PROVINCE OF CHINA (1)
Abstract: The Speech-Language-Hearing Association of Taiwan is the professional and scientific association representing for over 1337 members. Members and affiliates are speech-language pathologists, audiologists, and speech, language, and hearing scientists who work in hospitals, rehabilitation centres, schools and education centres, private practice, and organizations for those with specific disabilities. The association was established in 1986, and our role is to provide quality service to our members, coordinate professional development events in the field of speech-language and hearing, and to hold academic exchange events with others internationally.
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EMERGING ISSUES AND PRACTICE PATTERNS FOR SPEECHLANGUAGE PATHOLOGISTS AND AUDIOLOGISTS IN THE UNITED STATES PATRICIA PRELOCK (1) - ARLENE PIETRANTON (2) AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION, UNIVERSITY OF VERMONT, ROCKVILLE, UNITED STATES (1) AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION, NA, ROCKVILLE, UNITED STATES (2)
Abstract: Speech-language pathologists and audiologists practicing in the United States are faced with many challenges and opportunities across employment settings. The reimbursement models, Affordable Care Act, Paperwork documentation and the need for clinicians to demonstrate the value that speech-language pathology and audiology services yield a patient are among the myriad of elements impacting service delivery practices in the U.S. How services are rendered, by whom and how services are reimbursed are under review and subject to modifications. The U.S. government has several mandates that require clinicians to project how much progress a patient will make in 30 days. School districts require clinicians to plan intervention based on how the students communication problems negatively impact their educational performance and to demonstrate the added value of services for the students academic performance. In 2012, ASHA hosted a Changing Health Care Landscape that addressed the many changes occurring in the health care arena and recommendations to prepare audiologists and speech-language pathologists to meet the needs the changing needs. In 2011, a SLP Professional Summit was conducted to address the service delivery continuum in education. This poster will highlight some of the trends and issues that are impacting clinical practice for audiologists and speech-language pathologists. Learner Outcomes: The participant will be able to describe: At least 2 driving forces behind changes in the U.S. health care delivery for speech-language pathology and audiology; At least 2 strategies for speech-language pathologists and audiologists to successfully navigate the changing landscape of U.S. healthcare economics; Interprofessional practice based on the World Health Organizations definition; the WHO definition of Interprofessional education; locations of appropriate topical resources on the ASHA website www.asha.org
and duties of the language therapists/audiologists, in order to adapt to the new demands and fast transformations of society. In 2006, accompanying the growth of the profession, as much in the professional field as in the scientific one, the CFFa made a resolution recognizing four specialties in language therapy/audiology: audiology, language, oral motricity and voice. In 2010, it added to the roll of specialties in language therapy/audiology the areas of dysphasia, collective health and educational actuation.In 2012, these specialties were enclosed in the Brazilian Classification of Occupations, hich is an important document of the Ministry of the Work and Employment for the identification of the Brazilian work market and for the understanding of the attributions of each regulated profession. The CFFa works by commissions, some are mandatory, such as the Commission of Orientation and Fiscalization and the Commission of Ethics and others created by the need to address the different categories of Speech Professionals. Examples of the non mandatory commissions are: the Commission of Health, that searches to accompany the actions of the Health department in the field of public and private health, and the Commission of Education, that seeks to accompany the actions of the Ministry of the Education. In respect to the Education, the CFFa has considered necessary to extend offers of work in the segment, believing that the profession can contribute very much to the improvement of the Brazilian basic education. Today in Brazil, the health field employs a greater number of professionals than the education field. Over the years, the CFFa has also extended its form of action to the Brazilian legislative field. This is done by the presentation of bills and by integrating other subjects of interest of the category. For this the CFFa counts on assessorship and one proper commission to accompany legislative subjects. As an example, we are working to rule that would limit the weekly work hours of the Brazilian language therapists/audiologists at 30 hours, following the rules of the International Work Organization. Beyond the proper subjects, the CFFa participates, together with entities of other professions regulated in the country, of general subjects of interest to society, as for example, the defense for bigger financing for Brazilian public health. Other priority actions in the current management of the CFFa are related to the spreading of the profession for the society in general and the sensitization of managers in the areas of health and education. National campaigns are accomplished with the aiming at presenting our work for the population in general.The growing of the population, the increasing work market of the language therapists/audiologists and the bigger category consciousness has taken the Language Therapy/Audiology Boards to the constant revision of their actions and all its legislations. We have won many conquests, but there is still a lot to be accomplished and the profession lacks of bigger recognition and visibility in our country. However, these difficulties are not related only to the Language Therapy/Audiology profession but to all the professionals who act in health and education in Brazil.
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AFFILIATED SOCIETIES THE LANGUAGE THERAPY/AUDIOLOGY IN BRAZIL: DESCRIPTION, ADVANCES AND DIFFICULTIES IN THE PERSPECTIVE OF THE FEDERAL BOARD Bianca Queiroga (1); Maria Cecilia de Moura (2) President of the Federal Board of Language Therapy/Audiology/Management 2013/2016 (1) Vice-president of the Federal Board of Language (2)
Abstract: The Federal Board of Language Therapy/Audiology (CFFa) is a public autarchy linked to the Brazilian Federal Government Ministry of Work and Employment, created by the law that regulates the profession in the country (Law 6,965/1981), that has as objectives to exert normative functions, rethinking and implementing acts that show how the law should be applied, creating resolutions and other instruments, that will be used to direct the professional exercise of the Language Therapy/Audiology in the entire country.In this direction, the CFFa is an entity that supports important services to society. Its members, called council members, are elected among other professionals and exercise the mandate without remuneration, for a period of three years. Brazil has approximately 36,000 language therapists/audiologists, split between eight Regional Councils. There is a bigger concentration of professionals in the southeast region and a smaller concentration in the north of the country. The CFFa initiated its activities in 1983 and, as early as 1984, approved the first Code of Ethics of the profession. The current Code of Ethics was approved in 2004 and regulates the rights
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Abstact - Oral Presentation

MONDAY 26TH AUGUST
MR1
NEUROMOTOR SPEECH IMPAIRMENT: ITS ALL IN THE TALKING MAIN PRESENTER: WOLFRAM ZIEGLER (GERMANY) DISCUSSANTS: ELINA TRIPOLITI (ENGLAND) SABINE SKODDA (GERMANY)
Abstract: A major aim of this talk is to explicate the uniqueness of the motor activity of speaking and to emphasize its domain-specificity, i.e., its affiliation with the domain of linguistic expression. I will, as a starting point, take a theoretical stance and discuss (1) neurobiological data, (2) observations on practice-related neural plasticity, and (3) clinical reports supporting the specificity-hypothesis. The far-reaching theoretical consequences of this perspective will be outlined briefly. The second part of the talk then deals with implications of the domain-specific view for clinical research and clinical practice. In this part I will discuss the relevance of various speech and nonspeech tasks in neuroimaging, physiological experimentation, clinical assessment, and treatment, especially from the perspectives of acoustic vs. somatosensory reference frame models of speech motor control. I will propose an approach which combines a profound theoretical understanding of motor speech impairment with practical issues of their clinical management. which contexts had participated in which interventions with what outcomes. Information regarding; number of participants, demographics of the children (age and gender), study design, the type of intervention, who delivered the intervention, in which context, and with which assessments/outcomes were collated. The majority (53%) of retained studies investigated, or contained, an assessment of language. These 108 papers were split evenly between measuring receptive language, expressive language, grammar or a combination of these. There were 81 papers which focused on articulation, phonology and phonological awareness of which some included language and literacy outcomes. Other papers contained measures of social language, communication and behaviour. A total of 17,661 children participated across these studies. The number of child participants in each study ranged from 1-3001 with a mean of 89 and a median of 21 with just over 70 studies having less than 10 participants. As suggested from the number of participants in each study, the research designs were mostly case studies, case series and small n group studies. There were also 16 randomised controlled trials. The paper will present the results of the quality appraisal showing the varying quality of research and make recommendations regarding the design and reporting of intervention studies. A systematic map of the evidence will be presented using the ten therapy themes as the basis for the analysis. This provides graphic evidence of the strength of evidence for each therapy theme and the gaps in the evidence base underpinning practice. The findings of the review will be discussed in light of their implications for care pathway design. Learning Outcomes: An understanding of the range of evidence underpinning interventions for preschool children. A critical view of the research designs used to evaluate these interventions. An overview of a practice-based typology of interventions for preschool children with primary speech and language impairments
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A SYSTEMATIC REVIEW OF THE INTERVENTIONS USED WITH PRESCHOOL CHILDREN WITH PRIMARY SPEECH AND LANGUAGE IMPAIRMENT JULIET GOLDBART(1) - SAM HARDING(2) - LYDIA MORGAN(2) NAOMI PARKER(2) - ELIZABETH LEWIS(1) - JULIE MARSHALL(1) SUE ROULSTONE(2),(3) (1) DEPT OF HEALTH PROFESSIONS, MANCHESTER METROPOLITAN UNIVERSITY (MMU) (2) BRISTOL SPEECH AND LANGUAGE THERAPY RESEARCH UNIT, FRENCHAY HOSPITAL (3) THE UNIVERSITY OF THE WEST OF ENGLAND, BRISTOL (UWE)
Abstract: Systematic reviews of interventions for children with speech and language impairments have shown some evidence of effectiveness for some interventions [3,4]. However, there is also evidence of a gap between the therapy speech and language therapists deliver and the evidence to support current practice [5]. Furthermore, for interventions to be appropriately targeted to subgroups of children, it is important to determine which interventions are most effective with which children in which contexts [6]. The aim of this systematic review was to identify which interventions are effective for which preschool children in which contexts, using a practicebased model of interventions to determine the subgroups of interventions. Sixteen databases including Cinahl, Embase and Medline were searched, for peer-reviewed English-language publications, between January 1980 and November 2011. Search strings included key words pertaining to; speech, language, communication, developmental disorders, paediatric, and research design. Fifty five thousand two hundred and seventy one publications were identified and reviewed and excluded, following Cochrane guidelines and specified inclusion/exclusion criteria, by a trained team of speech and language therapists and psychologists. The remaining publications were then quality assessed using the PEDro (Physiotherapy Evidence Database) and Single Case Experimental Design (SCED) critical appraisal tool. Studies were then categorised according to an intervention typology developed from focus group discussion with 40 speech and language therapists. [1,2]. Two hundred and four publications met the search criteria. These required: 80 percent or more of the participants to be between 2;00 and 5;11; children who had or were at-risk of developing, PSLI; no other overt developmental and psychological delay; an interventions study which either directly targeted PSLI or used a speech and language assessment as an outcome measure. Inclusion criteria for study design were broad in order to allow exploration of a range of contextual. Quality was judged using criteria such as; eligibility criteria being specified, random allocation to groups, allocation concealment, blinding, baseline comparisons, intention to treat analysis, appropriateness of statistical comparisons. The intervention typology generated from the SLT focus groups identified ten therapy categories which were used to group the interventions. These included; improving parent/adult child interaction, laying foundation skills, increasing childs participation and fostering parent/adult understanding. Data was then extracted, following a realist synthesis model to determine which children in
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INTERVENTIONS FOR PRESCHOOL CHILDREN WITH PRIMARY SPEECH AND LANGUAGE IMPAIRMENT. WHAT SPEECH AND LANGUAGE THERAPISTS DO AND WHAT INFLUENCES THEM JULIE MARSHALL (1) - LYDIA MORGAN (2) - JULIE WARD (2) SUE ROULSTONE (2) HEALTH PROFESSIONS DEPARTMENT, MANCHESTER METROPOLITAN UNIVERSITY, MANCHESTER, UNITED KINGDOM (1) - BRISTOL SPEECH AND LANGUAGE THERAPY RESEARCH UNIT, FRENCHAY HOSPITAL, BRISTOL, UNITED KINGDOM (2)
Abstract: Children with speech and language impairments are commonly classified into two broad groups, primary and secondary. Primary speech and language impairment (PSLI) exists in apparent isolation from any other identifiable condition. Children with PSLI constitute a significant and important group, as PSLI is one of the most prevalent of childhood developmental disorders. A systematic review of prevalence noted a median of 5.9% for children with PSLI up to seven years old [1]. Research demonstrates that children with PSLI have an increased risk of difficulties in spelling, constructing written narratives, and reading disabilities and an association with behaviour difficulties is a common finding. Research further suggests that PSLI is a relatively stable long-term condition that can persist into adulthood, with an increased likelihood of cognitive and literacy difficulties, mental health issues, social isolation and poorer employment prospects. Speech and language therapist (SLT)-led interventions for children with PSLI have been characterised in a number of ways, for example, as direct or indirect; as didactic, naturalistic or hybrid approaches; as therapist-centred, parent-as-therapist aide, family-centred and family-friendly [2,3]. There are overlaps between these ways of conceptualising SLT-led interventions. None however provide an overarching analysis of the principles, characteristics and components and associated outcomes that would allow systematic evaluation of the active ingredients. This lack of analysis means that it is difficult to stratify interventions according to their suitability for differing subgroups of children and families. Furthermore, there is evidence that speech and language therapists adapt and combine the interventions they use, for specific children, families and contexts, although there is a lack of detailed understanding about why, when and how they do so. Furthermore, systematic reviews of interventions for children with PSLI show evidence of positive results, particularly for children with expressive vocabulary and phonological impairments. Despite this finding, interventions used in common practice are not always those supported by research evidence and research evidence is not always used by SLTs. This paper presents the results of two written surveys designed to identify interventions SLTs in England commonly use with preschool children with PSLI . The surveys also examine how and why they might modify their intervention with specific children. This work was carried out as part of the Child Talk What Works programme of research. Two on-line surveys were sent to SLTs in England, through a variety of contacts:
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Special Interest Group leads, other professional networks, personal contacts and the Royal College of Speech and Language Therapists media. In the first, short, survey SLTs were asked what intervention activities and strategies they use with preschool children with PSLI and what factors might lead to them modifying these interventions. They were also asked to describe a common intervention they use and how they might adapt it. In the second survey, SLTs were asked about a specific child with PSLI aged 2;00-5;11 years old, with whom they had worked. Respondents were asked about the childs speech and language abilities, as well as other child variables such as their behaviour, confidence and engagement. They were also asked about family and contextual factors, such as ethnicity and socio-economic status. Respondents described (from lists, with options to add more information) types of intervention activities and strategies used, as well as the location, frequency and agent of intervention. Many of the questions and response options were generated from previous research [4,5] and from a series of focus groups carried out with SLTs in England, as part of the same programme of research. One hundred and ninety-one SLTs responded to the first survey. They reported a range of activities, with some overlaps between activities for children with language difficulties (receptive, expressive or combined) and for children with speech difficulties. The most popular interventions included auditory discrimination activities, activities using information carrying words and vocabulary activities, although there were no activities that all SLTs reported using with a specific disorder group. The strategies they used were varied but, perhaps unsurprisingly, were less likely to be disorder group specific. The most commonly reported factors that led SLTs to adapt their interventions included the severity of the childs disorder, the childs interest and level of self-awareness and parental understanding. The presentation will describe the intervention activities, strategies and modifications in more detail. Two hundred and seventeen SLTs responded to the second survey. The presentation will describe the patterns of intervention activities and strategies used by SLTs for children with different types of PSLI. It will also describe the child, family and contextual factors that SLTs consider to be important when planning intervention. Learning outcomes: Increased understanding of the research evidence regarding interventions for preschool children with Primary Speech and Language Impairment. Increased knowledge of SLT intervention activities and strategies used with preschool children with Primary Speech and Language Impairment, in England . An understanding of how and why SLTs modify the interventions they provide to individual preschool children with Primary Speech and Language Impairment.
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IDENTIFYING COMPONENTS OF INTERVENTIONS FOR PRESCHOOL CHILDREN WITH PRIMARY SPEECH AND LANGUAGE DIFFICULTIES SUE ROULSTONE (1) - LYDIA MORGAN (1) - NAOMI PARKER (1) JULIE MARSHALL (2) BRISTOL SPEECH AND LANGUAGE THERAPY RESEARCH UNIT, UNIVERSITY OF THE WEST OF ENGLAND, BRISTOL, UNITED KINGDOM (1) - DEPARTMENT OF HEALTH PROFESSIONS, MANCHESTER METROPOLITAN UNIVERSITY, MANCHESTER, UNITED KINGDOM (2)
Abstract: Systematic reviews of interventions for children with language impairments have indicated there is evidence to support their effectiveness [1,2]. However, some interventions have been found to be differentially effective with different populations. For example, Robinson and Emde, in their analysis of Head Start programmes (which included interventions focusing on parent-child interaction), found that significant changes in interactions were only found in mothers with depression or with depression and negative attitudes [3]. Furthermore, interventions that have been compared are often overlapping rather than distinct and it is not always possible to identify the active ingredients that bring about change [4]. Roberts & Kaiser noted that, although training of parents was found to bring about changes in childrens language, the type of parent training offered varied and it was not possible to identify any particular characteristics of the parent training that made it effective [2]. Thus, in order to improve the design of studies that evaluate the effects of interventions, it is necessary to identify the various components and their contribution to the overall package of care.The study presented in this paper is part of a larger to study to develop a typology of speech and language therapists (SLTs) interventions. The aim of the study reported here is to investigate SLTs perspectives on the interventions they offer for preschool children with primary speech and language impairments (PSLI) in order to identify key components of those interventions. It is acknowledged that diagnosis and categorisation of childrens impairments is challenging in the preschool years, so we use the term PSLI to refer broadly to those children who speech and language impairments are not overtly associated with other developmental, neurological or physical conditions. Nine focus groups were held in six speech and language therapy services in England. Services were purposively selected to provide a range of demographic characteristics (socioeconomic status, ethnicity, urban/rural, transient population, English as an additional language). Participants in the focus groups were SLTs (n = 40) who had experience of working with preschool children with PSLI. They were asked to describe the interventions they used with these children and their reasons for using these interventions. The
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ensuing discussions were recorded digitally, transcribed in full and imported into NVivo9, to support management of data. Two types of analyses were carried out: content and thematic analysis. For the content analysis, a coding framework was developed based on experience of the focus groups and on a preliminary read through of the data. Interventions were classified in terms of activities, strategies, materials or resources and programmes generating a total of twelve intervention codes. Two speech and language therapist members of the research team coded the data. These researchers examined each others coding in a validation exercise, where 20% of the transcript was checked for consistency of coding technique. Any discrepancies were discussed until consensus was reached. The thematic analysis took an iterative approach, where tentative themes were developed and categorised. Themes were then examined and re-examined against the data. All coded sections of texts were independently checked by another researcher, to explore the validity of the themes and search for any possible gaps. The 6 steps from Braun and Clarke were used to guide the thematic analysis [5].Ten therapy themes emerged from the thematic analysis: i) laying foundation skills; ii) increasing sound awareness; iii) fostering parent or adult understanding/ empowering parents; iv) improving parent/adult child interaction; v) improving structure or content of language; vi) improving comprehension; vii) increasing childs participation; viii) improving speech and articulation; ix) encouraging child to self-monitor and x) encouraging generalisation. The presentation will present each along with an explanation of the theme and illustrative quotes from the data.Since thematic coding coded large sections of text, and content analysis coded individual words, phrases and smaller sections of text it was possible to cross-tabulate the two using the NVivo9 software. Each therapy theme was cross-tabulated with all twelve intervention codes (activities, strategies, resources, programmes), in order to identify which interventions were associated with which therapy themes. For example, within discussion of the theme increasing sound awareness, therapists had referred to resources such as Jolly Phonics, activities such as listening games, syllable counting and strategies, such as the use of visual cues and signing. Examples will be provided for each therapy theme. The findings will be presented in terms of a possible typology of interventions for preschool children with PSLI . The next steps of the larger programme will be described, which includes systematic reviews that focus on each therapy theme. Applications of the typology to the description and development of intervention packages will be discussed along with the implications of the typology for future research. Learning outcomes: An understanding of a practice-based typology of interventions for preschool children with primary speech and language impairments. Increased understanding of the variety of ways that interventions are described. Increasing awareness of which intervention activities, strategies and resources relate to particular intervention purposes.
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THE DEVELOPMENT AND NORMALIZATION OF A SPEECH OUTPUT TEST FOR CHILDREN: THE COMPUTER ARTICULATION INSTRUMENT LEENKE VAN HAAFTEN (1) - SANNE DIEPEVEEN (2) BERT DE SWART (1) - BEN MAASSEN (3) DEPARTMENT OF REHABILITATION, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (1) FACULTY OF HEALTH, HAN UNIVERSITY OF APPLIED SCIENCES, NIJMEGEN, NETHERLANDS (2) - DEPT.OF NEUROLINGUISTICS & UNIVERSITY MEDICAL CENTRE, UNIVERSITY OF
Abstract: Background - The differential diagnosis between subtypes of speech sound disorders (SSD), especially between phonological-based disorders and motor speech disorders (dysarthria and childhood apraxia of speech) is one of the main issues in the field of speech pathology in childhood. However, to date, there are no generally accepted definitions of criteria for differential diagnosis. There is still no consensus on the classification of subgroups and how they are best differentially diagnosed. This seems to be due to the complex neurocognitive, linguistic and motor processes involved in speech production. Children with SSD have deficits at one or more points in the speech processing system (phonological encoding, speech motor planning, speech motor programming, motor execution). In clinical management the differentiation between subtypes of SSD is important for choosing the right intervention targets. A clinician can be directed towards the best treatment approaches by defining the speech processing level at which the underlying deficit is localized. To date, there is a large number of intervention methods. However, the current diagnostic instruments provides insufficient information for choosing the right treatment approach. Therefore, the first aim of this study is to develop a test that yields measures of the degree of involvement of subtypes of underlying speech deficits, to contribute to diagnostic differentiation between phonological disorder and motor speech disorder, in particular childhood apraxia of speech. Secondly, a standardized and norm referenced test is needed to differentiate children with a delayed or abnormal speech development from typically developing children and, specifically in the educational system in the Netherlands, to refer children with speech and language difficulties to special education. Methods - To meet the above requirements, a small battery of speech production tasks was developed based on a series of studies in children with
developmental and acquired SSD (Thoonen, 1998; Nijland, 2003), resulting in the Computer Articulation Instrument (CAI). The CAI has a modular structure and it provides an interactive administration of five speech tasks. The tasks consisted of (1) picture naming, (2) word and (3) nonword repetition and, (4) error consistency -five productions of the same word- and (5) maximum repetition rate (MRR), thereby covering phonological and speech motor skills. These tasks were constructed for children in the age range of 2 to 7 years. In total 1120 typically developing children are in the process of being tested, representative for region and urbanization in the Netherlands and divided into fourteen age categories (3 and 6 months). Normal hearing and attending a Dutch primary school were inclusion criteria. The obtained norm data leads to an important and widely applicable instrument for the assessment of speech development. The norm referenced CAI differentiates children with a delayed or abnormal speech development from typically developing children and it can contribute to diagnostic differentiation between phonological disorder and motor speech disorder. The analyses of the childrens speech productions are based on phonetic transcription. The evaluation of MRR (number of syllables per second) is based on acoustic measurements. Error consistency is measured by dividing the number of different forms into the number of productions. Both the administration of the tests and the analyses of the speech are computer implemented. The CAI has an open structure, which means that all stimulus material (spoken instructions, the pictures for the naming task, audio-targets for the wordand nonword repetition tasks, and audio-examples for the MRR-tasks) is stored in separate files. Also, target phonetic transcriptions of the test items in IPA and the rules for analyzing transcribed utterances in relation to the targets, are stored in separate files. This implies that the CAI-software can be used to construct tests in other languages than Dutch/Flemish. Two types of analyses are conducted. The words and nonwords from the naming and imitation tasks are phonetically transcribed by the experimenter, thereby making use of correct target transcriptions. The experimenter edits in the childs production errors. Inventories of productions -occurrences- of particular syllable structures, syllable-initial and -final consonants, and vowel types, as well as error counts by comparing the childs productions with the targets, are derived automatically by the application of a set of implemented phonetic analysis rules. Error counts comprise syllable structure errors, such as cluster reduction, initial or final consonant deletion, and phonemic errors, such as backing (substitution of a labial of coronal consonant by a velar consonant), or stopping. Error consistency is measured by dividing the number of different forms into the number of productions. The analyses of the Maximum Repetition Rate task are based on acoustic measurements and consist of counting the number of syllables in a certain amount of time, thereby obtaining the number of syllables per second. Furthermore, to make a start with developing differential diagnostic criteria, the CAI is used in several clinical settings, such that the speech performances of children with a variety of speech sound disorders (SSD), can be analyzed and compared. Results - At the conference, results of the norm data of the 4- 5- and 6- year old children will be available. Preliminary analyses show several developmental trends. Several speech characteristics, such as consonant substitutions, cluster reduction and number of syllables per second on the MRR task, were found in the typically developing children that show a significant developmental trend, with little or no overlap between age groups. Speech samples of children with speech difficulties are currently under analysis. Conclusion - The CAI was developed to provide a norm-referenced test for measuring phonological and speech motor skills in children in the age range of 2 to 7 years. The norms can be used to differentiate children with a delayed or abnormal speech development from typically developing children. Secondly, the CAI is especially designed for differentiating children with a phonological disorder from children with motor speech disorders. Several developmental trends were found in the preliminary analyses. Learning Outcomes: The attendant will be able to: describe the main characteristics of normal speech development of 4- 5- and 6 year old children; describe different speech tasks that yields measures of the degree of involvement of subtypes of underlying speech deficits; use this knowledge for differential diagnosis of speech disorders in children.
of screening tests. No standardized instruments to screen speech abilities in Italian children are currently available. Schindlers repetition test represent a suitable instrument for speech screening: it is made of 31 words, which include all Italian phonemes, and its administration lasts about 2 minutes. However, no data exist on its psychometrics properties, so that its administration cant screen properly speech abilities in Italian children. The aim of the study is 1) to assess reliability of Schindlers repetition test; 2) to establish normative data for speech development in Italian children; 3) to analyze concurrent validity. To pursue these aims, the study was divided in 3 different phases: reliability analysis (phase 1), normative data generation (phase 2) and concurrent validity analysis (phase 3). A total of 607 children, aged range between 3.0 and 10.8 years were included in the study. One-hundred-forty children were recruited in phase 1: 50 presented a speech sound disorder (SSD) and 90 no symptom of disordered speech. Inclusion criteria for the 90 children without SSD were: walking age > 14 months, deafness, speech sound disorder, cleft lip/palate, cerebral palsy, mental retardation, autistic spectrum disorders, one or both parents non Italian speaking. All the children recruited for phase 1 of study underwent the repetition test twice, with a 2 weeks interval between the two test; the first administration of the repetition test was concurrently scored by two different examiners. During the repetition test the rater utters a word and the children was asked to repeat it. On the basis of auditory perceptual evaluation, the rater consider whether the word is uttered with or without phonetic distortions or substitutions. In phase 2: 557 children aged between 3 and 5,11 years were recruited; exclusion criteria were: walking age > 14 months, deafness, speech sound disorder, cleft lip/palate, cerebral palsy, mental retardation, autistic spectrum disorders, one or both parents non Italian speaking. These children were divided into 3 groups depending on the age: 170 children aged 36-47 months, 182 children aged 48-59 months and 205 children aged 60-71 months. Fifty children with SSD were recruited for phase 3: their speech was analyzed through Schindlers repetition test and a more comprehensive articulation test, including all Italian phonemes and clusters in different position within the word (Rossis Articulation Test). The collected data were statistically analyzed. In phase 1: inter-subject and intra-subject reliability were analyzed through k coefficient. In phase 2: mean error for each target phoneme at different ages were considered. In phase 3: the results of the two articulation tests were compared through k coefficient. The results of phase 1: inter-subject and intra-subject reliability in children with normal speech presented a k valued ranging between 0.6 and 1. Inter-subject reliability of children with speech sound disorder presented a k value ranging between 0.5 and 1; intra-subject reliability of this group presented k value ranging between 0.8 and 1. These values can be considered satisfactory. The results of phase 2: in all age subgroups plosives, fricatives and affricates were present in 100% of the children. In the group aged 36-47 only 50% of the children managed to repeat two consonant cluster; the % increased to 80% and 95% in the other two groups of children. These results reflected the improvement that occurred during normal development of children. The results of phase 3: k coefficient for concurrence with results of Rossis Articulation Test ranged between 0.11 and 1. A correspondence was shown for most of the data. In fact Rossis Articulation Test provides a more accurate speech assessment than the screening test and it is recommended when the screening test gives a positive outcome. In conclusion Schindlers repetition test can be considered as a reliable and valid instrument to screen speech abilities in Italian children between the age of 3.0 and 10.8. The establishment of normative data makes it more applicable in clinical practice. Furthermore, it can be used to collect data about the prevalence of speech delay in Italian children. Learning outcomes: The participant will be able: to understand the importance of screening for speech delay; to understand the need of standardized instrument for speech screening ; to know the characteristics of Schindlers repetition test; to know the reliability, normative data and concurrent validity of Schindlers repetition test; to understand the clinical implications of Schindlers repetition test as a screening instrument.
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PHONETIC OR PHONOLOGICAL THERAPY. WHICH MODEL MORE INDICATED FOR CHILDREN THAT REDUCE THE CONSONANT CLUSTER AND APPLY THE REPAIR STRATEGY? VANESSA GIACCHINI (1) - HELENA BOLLI MOTA (1) CAROLINA LISBA MEZZOMO (1) UNIVERSIDADE FEDERAL DE SANTA MARIA, UNIVERSIDADE FEDERAL DE SANTA MARIA, SANTA MARIA, BRASIL (1)
Abstract: For the study of phonological disorders is initially important to understand how the typical phonological development occurs. You could say that considered typical phonological acquisition occurs when the child establishes a phonological system consistent with the target-adult, which means, like the speech of the social group where it is inserted. This process occurs in Brazilian Portuguese, from birth to approximately age of 5:0, in a gradual, non-linear and respecting individual difference of each infant. However, some children do not follow this sequence of development and expects its phonological system is organized differently than expected. In such cases there is a phonological system that differs from the target language and inappropriate in relation to the phonology of the language of their environment. These cases are called phonological disorders. In Brazilian
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SCREENING FOR SPEECH DELAY: RELIABILITY, VALIDITY AND NORMATIVE DATA OF A REPETITION TEST FOR ITALIAN CHILDREN ANNA COLOMBO (1) - MARTINA TRESOLDI (1) - ELENA FAVERO (2) PAOLA VELARDO (2) - FRANCESCO MOZZANICA (1) ANTONIO SCHINDLER (3) DEPARTMENT OF CLINICAL SCIENCES L. SACCO (1) DEPARTMENT OF AUDIOLOGY AND PHONIATRICS, S. (2) DEPARTMENT OF CLINICAL SCIENCES L. SACCO, UNIVERSITY OF MILAN, MILAN (3)
Abstract: The presence of speech delay in early childhood is a relatively common problem: the prevalence ranges from 2.3% to 24.6%, as reported in different studies. Such delays are important because they cause concern to parents and they can be associated with behavioral/other difficulties, although a substantial proportion of children are likely to have difficulties which resolve spontaneously in the pre-school period. The early identification and treatment of children with speech delay can be improved by the implementation
Portuguese the syllabic structure of the consonant cluster (C1C2V) is the last to reach stability within the phonological system, and structure is more commonly compromised in cases of phonological disorders. During the course of acquiring the consonant cluster children use repair strategies. Repair strategies are adopted to match resources to the production target system. In the consonant cluster is the most used strategy for simplifying the structure C1V. Research with acoustic analysis showed the use of compensatory lengthening strategy. This strategy would be to maintain the space in syllable C2 through lengthening of the vowel or consonant. The implementation of this strategy denotes knowledge of syllabic structure and an underlying representation as target-adult. The guiding hypothesis of this study is that there is phonological knowledge about the underlying syllabic structure C1C2V in children who carry the compensatory lengthening when the structure of the consonant cluster is still not completed properly. Based on this hypothesis the aim of this research was to observe the therapeutic approach (phonetic or phonological) more effective for children with phonological disorders who carry out the strategy of compensatory lengthening in cases of C1C2V C1V. For this study we selected four children who employed the strategy of compensatory lengthening the consonant cluster reduction and had in its inventory phonetic segments [l] and [r]. The strategy of compensatory lengthening was verified by comparing the times of vowel/ fricative in syllable consonant with simplified with time of emission of the same vowel/fricative in a syllable with simple onset (eg ex.: prato - [patu] x pato - [patu]; frio - [fiw] x fio - [fiw]) these recordings were analyzed acoustically through audio-processing software PRAAT. These children were divided into two groups; one group with two children was submitted to phonological therapy, based on the Model Minimal Pairs contrasting syllabic structure. And the other group, also with two children, underwent therapy phonetic/articulatory, emphasizing the co-articulation of sound, the use of visual cues, tactile cues, kinesthetic cues and auditory cues and articulatory training. Each child received individual sessions twice a week, the consultations lasted around 45min. The children were discharged after reaching a percentage of 80% accuracy on structures worked in therapy. To check the time difference of phonetic and phonological therapy, applied the test T (significance level of 5%). The results showed that compared the average number of sessions of each group; the patients of Group Therapy Phonetics needed half the number of sessions compared with patients who received phonological therapy. The average was 12 sessions for the Group for the acquisition of Phonetic consonant cluster, while Group Phonological needed 24 sessions. Despite this difference was not statistically significant (p = 0.40), in clinical practice her speech therapy should be considered since there is a difference time therapy when applied different models. The search results agree with the hypothesis of the study expected that children who have a strategy compensatory lengthening would take less time to acquire the consonant cluster when subjected to therapy phonetic/articulatory. With this result we can understand that children who produce the strategy of compensatory lengthening when he can not perform the consonant cluster correctly are demonstrating that already has underlay in the form of the syllabic structure of the consonant cluster. It makes sense that the difficulty lies in the articulation joint of sounds that form the consonant cluster, not knowledge of syllable structure. This idea was reinforced by faster results in children undergoing therapy phonetic/articulatory. Thus the study indicates that in cases where children have phonetic evidence (in the case of this research strategy compensatory lengthening) priority is given to an approach phonetic/articulatory treatment of phonological disorders. Since the child already has knowledge of phonological structures, so the obstacle would be the translation of this knowledge into a phonological motor action suitable for the realization of the phoneme/syllable appropriate. This study also reinforces the use of spectrographic analysis of speech data. The strategy of compensatory lengthening was possible only be checked accurately due to the use of the spectrograph, which ensured that the children in the study were employing a strategy. Acoustic analysis allows a more accurate assessment of the childs speech data, enabling the speech therapist clue realize that just by hearing transcript would not be perceived. It is concluded that the guiding hypothesis appears to be confirmed since the therapeutic approach that most favors the patient performs the strategy in cases of compensatory lengthening of the consonant cluster reduction is one that assists in implementing phonetic and not the therapy that helps in phonological organization. The study results are important because they demonstrate the clinical speech therapy difference in the time of speech therapy assisting in a practical area of speech therapy. Learning outcome: The Participant will be able to: know the models of therapy phonetic and phonological therapy employed; Check the importance of spectrographic evaluation in the selection of the therapeutic model; Knowing the exercises phonetic/articulatory used in the study; Knowing the phonological exercises used in the study.
the standard categories. This helps to explain the difficulty and uncertainty often determined their voice type correctly. encountered by singing students and their teachers in determining their voice type a question which concerns most singers and some worry that their teacher has not determine When consulting the phoniatrician on this matter singers are often concerned about the length of their vocal folds. Many are worried by any discrepancy between their habitual Speaking Fundamental Frequency (SFF) and their supposed voice type. Many singing teachers, when attempting to determine voice type, are guided by the tone of the students speaking voice, believing that each voice type correlates to SFF; the lower the speaking voice (SFF), the lower the voice type, and vice versa. This study was conducted in order to determine the validity of this hypothesis. Seventy five opera singers (45 men and 30 women) aged between 19 and 40 years were examined; 60 of them were singing students at a conservatory and 15 were professional opera soloists. The voice type of the subjects had been determined by their singing teacher, and in all cases the subject was satisfied with this categorization. Male voices were classified as tenors, baritones or basses; female voices as either sopranos or mezzo-sopranos. The software package Praat was used for determining SFF in all subjects. It was found that inter-subject variation of SFF in all groups was large: 120-161 Hz in tenors, 111-147 Hz in baritones, 110-123 Hz in basses, 207-285 Hz in sopranos and 173-275 Hz in mezzo-sopranos. The mean SFF was 142.4 Hz (SD 15.0) in tenors, 123.2 Hz (SD 10.2) in baritones, 118.8 Hz (SD 8.7) in basses, 233.7 Hz (SD 23.1) in sopranos and 205.9 Hz (SD 18.9) in mezzo-sopranos. In tenors and baritones, tenors and basses, sopranos and mezzos the mean SFF differences were significant, respectively. However, the difference between the mean SFF of the basses and baritones who were examined was nonsignificant; this could be explained by the fact that eight of the basses were of the bass-baritone fach and were also capable of singing dramatic baritone roles. It is concluded that voice type does depend on SFF: the lower singing voice, the lower SFF, and vice versa. However, classification of the voice solely on the basis of SFF is unreliable; nevertheless, SFF could be used in conjunction with other evidence to assist in a classification. Singers should be aware of the possible discrepancy between SFF and voice type: this applies particularly to students and their singing teachers. Learning outcomes: The Participant will be able to: know how frequently discrepancy between SFF and voice type can be found in classical singers; understand what to do if difference between voice tone and voice type has appeared during study in Music College; know which consequences will be appeared if vocalist sings using inappropriate voice type.
FP8
NEURONAL CORRELATES OF SONG PERCEPTION IN COMPARISON OF SINGERS, ACTORS AND LAYMEN KEN ROSSLAU (1) - SIBYLLE HERHOLZ (2) - ARNE KNIEF (1) DIRK DEUSTER (1) - ANTOINETTE AM ZEHNHOFF-DINNESEN (1) CHRISTO PANTEV (2) - CHRISTIAN DOBEL (2) DEPARTMENT OF PHONIATRICS AND PEDIATRIC AUDIOLOGY, UNIVERSITY HOSPITAL MNSTER, MNSTER, GERMANY (1) INSTITUTE FOR BIOMAGNETISM AND BIOSIGNALANALYSIS, UNIVERSITY OF MNSTER, MNSTER, GERMANY (2)
Abstract: Recent research has increased our knowledge about the organization of neuronal networks for speech and music perception and suggests training-induced and interdependent modulation of musical and speech abilities (Moreno and others 2009). Because opera singers are musically trained and actors are speech trained voice users who both gained their expertise on a similar extent of expressive voice practice on stage, it is informative to compare neurophysiological data with respect to these fields of expertise. Referring to a very similar semantically and syntactically rule system, a complex and intertwined cerebral network for language and music processing is assumed (Koelsch 2005; Peretz and others 2009; Schon and others 2010; Zatorre, Peretz, Penhune 2009). Nevertheless, there is a lack for a comparison of the same linguistic and musical manipulated stimulus material in two dimensions, so as a recited and sung version. The goal of our study was to investigate music and speech perception of professional singers and actors compared to laymen in order to disentangle the training induced cortical networks for processing music and speech. In order to stimulate on a high artistic level, we decided to use excerpts of German Lied songs of Franz Schubert since this music is frequently performed and represents a typical repertoire. Also, the lyrical basis for these songs is similar in structure to material that actors recite in a dramatic performance. Most importantly, a characteristic of German Lied songs is a close integration of music and lyrics, typically without singing several notes on one syllable, which are frequent in operatic arias. Since the songs are based on poetry, it is feasible to present the material both in a spoken and in a sung condition comparing modality specific processing of semantic and syntactic aspects. Therefore, we used 30 short excerpts of Lied-songs of the romantic epoch (music by the German composer Franz Schubert, lyrics by Wilhelm Mueller) from the cycles Beautiful miller-girl and Winter journey for stimulation in the experiment. The excerpts consisted of a rhyming couplet with a monosyllabic ending and the original melody line composed by Franz Schubert. For all excerpts a version sung a capella (without accompaniment) and a recited, spoken version were recorded using a high-fidelity recording system.
FP7
THE SPEAKING FUNDAMENTAL FREQUENCY AND VOICE TYPE OF OPERA SINGERS SEMYON CHERNOBELSKY (1) OPERA HOUSE, ACADEMY OF MUSIC, KRASNOYARSK, RUSSIAN FEDERATION (1)
Abstract: In a biological sense the concept of singing voice type does not exist. Voice types in the context of classical opera are no more than reference points for their classification and so some singers voices fall in between
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For the recording, the same professionally educated singer sang and recited all excerpts. For each modality (sung and spoken), the 30 excerpts were presented in four different conditions resulting in 120 stimuli per modality. In the first condition the original line was presented in the correct sung/ spoken version. In the second condition the pitch of the last word was decreased or increased in the sung version by a half tone out of key in compliance with the original melodic contour (syntactic violation), and in the spoken version by an increase of fundamental frequency of 35 % (prosodic violation), which represents a violation of the expected decrease of prosody for a clause of statement. In the third condition the original last word of the excerpt was exchanged by a semantical incongruent word. These semantical incongruent monosyllabic words fulfilled the original rhyme scheme. In the fourth condition we presented a double incongruency at the end of the excerpt with incorrect pitch ending (syntactic/ prosodic violation) and a semantical incongruent last word. 13 professional singers, 13 professional actors and 13 laymen took part on this experiment. After presentation of each stimulus subjects had to judge the accuracy of the semantic congruence of the last word and the accuracy of the pitch of the last word, both for sung and for spoken stimuli. Subjects gave their response via successive button presses and were visually prompted to give their responses, with the prompt for the first judgment appearing 1500 ms after stimulus offset. During stimulus presentation, magnetoencephalographic (MEG) signals were recorded continuously using a whole-head device with 275 first-order axial SQUID gradiometers (Omega 275, CTF, VSM MedTech, Coquitlam, Canada), filtered online (150 Hz low-pass for aliasing, 50 Hz notch for European power grid) and sampled at 600 Hz. The continuous data were then band-pass filtered offline in a 0.1 48 Hz range using a zero phase second order Butterworth filter. The triggers for data analysis were set at the beginning of the last word for each stimulus. The present analyses were based on an isotropic spherical head model with 2 (azimuth and polar direction) 197 dipolar sources evenly distributed on an inner spherical shell. Sphere position and radius were estimated in order to optimally fit the digitized head shape. The L2MNE amplitudes were analyzed with a point-wise repeated measures ANOVA with the within-subject factor CONDITION and the between-subject factor GROUP separately for the spoken and sung modality. The interpretation of the early neuronal activity (200-500 ms after last word onset) revealed conditional and modality specific differences of neuronal activity in overlapping temporal areas on both hemispheres without any dependence to the kind of expertise. As a sign of intertwined neuronal networks (Kolinsky and others 2009; Schon, Gordon, Besson 2005; Schon and others 2010) and first time shown for same stimulus material in a recited and sung modality, there were activity peaks after semantic violations for the spoken modality in left temporal areas and peaks after prosodic/ syntactic violations for the spoken as well as for the sung modality in right temporal areas. Despite of bitemporal activation (Maess and others 2001; Maess and others 2006), a higher activation of the right hemisphere was significant for nearly all conditions and for both modalities. Significant group differences appeared as late neuronal activity (600-1700 ms) again for both modalities in right temporal and left parietal areas and were interpreted as a form of inner rehearsal of musical phrases, also described as musical mental presentation (Brodsky and Rubinstein 2008; Gordon 1993) and musical imagery (Zatorre, Halpern, Bouffard 2010). Learning outcomes: Because of the combination of linguistical and musical content, art songs are a unique stimulus material for investigating the dependence of music and speech; Assuming that the above mentioned findings are not prerequisite for professional singing, this study is in line with those findings arguing for brain plasticity effects after long-term training; Human brain mapping, especially with the function of source localization, is still a good method for the investigation of basic neuronal processes; Previous assumption of local and uni-hemispheric dominant processing is changing for the insight of complex neuronal networks on both hemispheres; Singers seem to have a unique mechanism for memorizing phrases in a spoken and a sung context; This study presents neuronal correlates of musical imagery in a time window known for working memory processes.
FP9
VOICE CLASSIFICATION IN PRACTICE: CRITERIA IN CONTEMPORARY SINGING EDUCATION - AN EXPLORATORY STUDY FELIX DE JONG (1) - HUGO LYCKE (2) ENT-HEAD AND NECK, EXPERIMENTAL ORL, KATHOLIC UNIVERSITY LEUVEN, LEUVEN, BELGIUM (1) ENT-HEAD AND NECK, EXPERIMENTAL ORL, KATHOLIC UNIVERSITY LEUVEN, LEUVEN, BAHAMAS (2)
Abstract: The vocal capacity must be estimated to know the possibilities and impossibilities of the voice in order to avoid damage of the voice and to optimize vocal performance. Voice classification is a method to estimate the vocal capacity and composers of vocal music wrote and write repertoires that fit to the possibilities of the voice, in classical music indicated as voice classes. Traditionally, voices are classified into three principal categories: for the female voice alto, mezzo-soprano, and soprano, and for the male voice bass, baritone, and tenor. Additionally to the classic voice types, there are many subtypes, according to different roles (Fach, e.g. for the soprano voice: coloratura soprano, lyric soprano, dramatic soprano, soubrette). Classification
of a voice determines the frequency and intensity range in which a singer can work without harming or fatiguing his voice and to which repertoire he should be assigned by the singing teacher. Correct classification of the singers voice is indispensable in order to achieve optimum performance. The biographies of famous and less famous singers frequently mention examples of the pernicious outcomes for their voices and for their careers caused by incorrect voice classification and various studies show the great prevalence of voice disorders by incorrect voice classification among singing students, singers and singing teachers. Many manuals on singing techniques do not mention how to classify a voice and scientific publications on voice classification are scarce. Over the years, many factors have been mentioned which provide an indication for classifying a voice, according to the six basic voice types mentioned above, such as the size of the person, the dimensions of the vocal folds, the shape and the volume of the resonating cavities, the general and vocal muscular constitution, biotypological traits, tessitura, the speaking fundamental frequency, the passagios, the voice timbre, endocrine and sexual aspects, and the neuropsychic condition. The investigation of all these anatomical and biotypological factors usually require several complex instruments and above all, highly trained experts. Voice range, timbre and register transitions are considered to be important classification criteria. However, the assessment of tessitura, speaking fundamental frequency, passagios, and voice timbre require an experienced ear.Voice classification has a great impact on a singers life, but often experts disagree and singers question the received label(s) and stick to their own opinions. In addition to this, conductors, scientists, physicians, speech and voice pathologists, almost everybody (including the subject himself) feels entitled to express his opinion on this matter. The aim of this study was to explore the opinion of contemporary singing teachers about the utility of voice classification and which criteria they use in voice classification. Subjects and methods. One questionnaire (Q 1) was sent to all 200 private singing teachers who were registered at the commercial Dutch Internet site www.vocalisten.nl, and who mentioned their e-mail address. The singing teachers were asked if voice classification was important to them and why. They were also asked what criteria for voice classification they applied. A second questionnaire (Q2) was sent to 22 singing teachers of one Classic conservatory and two Musical Theatre conservatories. They were asked to classify their singing students and to indicate on what criteria their voice classification was based. They classified a total of 165 singing students: 81 singing students at the Classic conservatory, 63 singing students at one Musical Theatre conservatory, and 21 singing students at the other Musical Theatre conservatory. Results. Q1. From the 200 singing teachers 72 answers were received from 58 female (80.6%) and 14 male (19.4%) singing teachers. Consequently, the response rate is 36.0%. Although most of these singing teachers had a classical singing training, each of them recommended him/herself on the website for many specialties and musical styles (up to 24 in one teacher). Most popular styles were Musical Theatre (66.7%), Classic (50.0%), Pop and Jazz (each 43.8%), Dutch Pop (19.0%), a Capella (17.0%), Close Harmony (16.0%), Lied (15.0%) and Opera (13.0%). Fourty-four singing teachers (61.1%) found that voice classification is important for at least one reason, while 28 singing teachers (38.9%) stated that voice classification was not an important issue for their teaching. Most singing teachers (n=66, 91.7%) provided information about their criteria for voice classification. These criteria for voice classification can be sorted into: physical features, acoustical features, specific methods, miscellaneous, and other factors. Six respondents (8.3%) did not mention any criteria for voice classification. Most frequently used acoustical parameters for voice classification were frequency range/ tessitura (56.0%), voice quality/timbre (56.0%). One singing teacher used a purely commercial approach: voice classification on demand. Q2. All singing teachers of the conservatories responded. Frequency range/tessitura and voice quality/timbre were used by all conservatory singing teachers as voice classification criteria, except for one Classical singing teacher who used no voice classification criteria at all. Singing teachers of the three conservatories used a different set of voice classification criteria per singing student. Moreover, voice classification criteria also appeared to be dependent on the type of conservatory. Singing teachers of the Classical conservatory used two to seven different criteria. Except for three singing teachers, using only frequency range/tessitura, timbre, and register transition as voice classification criteria, all other singing teachers used quite different sets of criteria, while one Classical singing teacher used no classification criteria at all. In Classical singing teachers vocal development and frequency range of belt were not used as voice classification parameters. Singing teachers of the Musical Theatre conservatories used two to 11 different criteria. They all used frequency range /tessitura and voice quality/timbre as voice classification criteria. The frequency range of belt was specifically mentioned by five of the 10 singing teachers of Musical Theatre. Conclusions. The results of this study indicate that there is a marked difference of attitude towards voice classification in singing teachers and that different criteria for voice classification are used. Apparently, there is no consensus about the advisability and criteria of voice classification among the various singing teachers in this study. This asks for a generally accepted protocol for objective voice classification and consensus about what parameters should be used. Learning Outcomes: The results of this study demonstrate that different parameters of the voice range profile (VRP) are able to yield a clear separation into three clusters for each gender. Such a result is remarkable, since the finding of a discontinuous distribution may not be expected from biological
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variables. One can wonder if ancient composers of vocal music had an innate feeling about the existence of three natural basic human voice categories. Further studies are necessary to link the results of the statistically obtained cluster separation, which discriminate between three basic voice categories, to the three basic female voice categories as commonly interpreted by most composers of vocal music and singing teachers. We assume that our methodology can be useful, not only in determining a basic voice type for singers, but also in providing interesting cues for voice diagnosis and voice therapy in general, taking into account the relationship of all different human vocalizations. Most parameters that have lead to the cluster separation, however, are not easily understandable in clinical terms. Therefore, it is not easy to link them to the clinical situation, nor can the difference between these parameters that have lead to the clustering of female and male voices readily be explained. Each of the features that yielded the clear separation into three clusters for each gender has to do with register transition. The location of the register transition zone is important marker in the VPR and should be considered in view of the basic voice type of each gender. The pertinent study indicates that there exist three basic voice types, corresponding with classic voice types or not. This points at the need of voice classification, also in modern music, where not a similar vocal repertoire has been written like in classic music. The finding that different parameters of the VRP are able to yield a clear separation into three clusters for each gender indicates that VRP can open a new era of voice research.
FP11
ANALYSIS OF ATYPICAL ACQUISITION SYSTEMS THROUGH THE MODELO PADRO DE AQUISIO DE CONTRASTES: CASE REPORT VANESSA GIACCHINI (1) - HELENA BOLLI MOTA (1) UNIVERSIDADE FEDERAL DE SANTA MARIA, UNIVERSIDADE FEDERAL DE SANTA MARIA, SANTA MARIA, BRASIL (1)
Abstract: There are some theoretical models engaged in assessment of phonological acquisition in the child, both in typical acquisition as the acquisition atypical. However, these models focus their analysis in the evaluation and production of segments, if the segments were produced correctly, incorrectly or omitted, and it is from this that profile acquisition of children, as well as deviant cases in the therapeutic methodology. The model Padro de Aquisio de Contrastes (PAC) appears to change focus this assessment, since the PAC is to evaluate and classify phonological disorders through research contrasts. With the phonological assessment following the premises of the PAC, you can see the contrasts which are already present in the childs phonological system, as well as those who are in the process of acquiring and absent. The model identifies the possibilities contrastive system, showing which distinctions the child is able to produce phonological terms and contexts in which there is loss of these contrast. Thus, the segment is analyzed individually, but the contrast he has. From this new proposal this paper aims to describe the phonological system of a child with atypical phonological development through the PAC model. To carry out this study we performed a collection of early speech, pre-therapy. The child participating in the study are female (S1), was 6 years old at the time of collection and the reviews were diagnosed with phonological disorders. To obtain the data was used a standardized tool for collecting, recording was done in a quiet environment, and the data were transcribed and reviewed by two speech pathologists with expertise in phonetic transcription. After they transcribed the data were analyzed according to the assumptions of the PAC, evaluating the four phases of the proposed acquisition by the model. For determining the acquisition status or not the contrast in each context we used the following percentage: contrast obtained when the values were between 76% to 100% correct productions; unstable when the contrast use was between 51% to 75% correct productions, and absent when the value was less than or equal to 50%. The data demonstrate that in the first step (which is represented by the diagram in red) are acquired contrasts between consonants and obstruents. It is acquired the contrast of the articulation point of dorsal plosive, plosive labial and coronal plosive. And its acquired the feature [coronal] and [anterior] in the nasal. However, at this stage model to the feature [+voiced] in plosives should be established, which is not observed in the data of S1. In the second stage (represented by the color blue in the diagram) is acquired the contrast between coronal fricatives versus labial fricatives. The feature [+continuant] that allows the distinction between plosives versus fricatives and feature [+voiced] in fricatives is being acquired (represented by diagonal lines in the diagram). In the third stage (represented by yellow in the diagram), the contrast between coronal fricative anterior versus non-anterior coronal fricative is in acquisition. At this stage it is expected to the emergence of the feature [+approximant] allowing the contrast between liquid and nasal. Also expected to be the feature [+voice] in //, but neither of these contrasts is present in the childs inventory. In the fourth phase (shown in green in the diagram) the PAC model is not expected to acquire a trace, only combination of traits. However the system of child studied, there is a rearrangement of features, this makes the child does not get any segment of the class of liquid, the last class segment of the acquisition by the model. In the case of children studied is observed that none of the steps proposed acquisition is fully acquired by PAC. In first step the child has difficulties in establishing the feature [voice], failing to make the distinction between voiced and unvoiced plosives. This demonstrates the difficulty of (S1) is not related as to articulation point, which is already acquired for this class, but to control the vocal cords. The second stage is still being acquired the feature [+continuant] by the child. What does the child do not have complete distinction between stops and fricatives. Unlike the previous stage, at this stage, the child has the feature [voice] in the acquisition and labial fricatives in previous coronal fricatives. Again, the child presents no difficulties as the point of articulation of fricatives. In the third stage, the child has not acquired the feature [-approximant] not distinguishing between nasal and liquid. Yet at this stage, the child has the feature [anterior] in the process of acquisition in coronal fricatives. The child continues without the feature [+ voice] in your system. In the fourth step the model is expected that the child has acquired all the liquid /l, , R, r/ However, the child does not have any of these elements. From the description obtained by PAC is clear that the child that was studied has a speech disorder, since there is a gap in the process of phonological acquisition, with early stages still incomplete while the later stages have elements already present. The data presented emphasize that the model is able to describe atypical acquisition systems, demonstrating the differences between phases and differentiate cases of phonological disorders and phonological delays. It is concluded that the employed model PAC is adequate for describing speech disorders. Through the stages of acquisition proposed by PAC was possible to visualize the organization of the childs phonological system, but also aroused possible therapeutic interventions based on traits that are in the process of acquisition. Learning outcomes: The Participant will be able to: Know a new proposal for phonological assessment based through contrasts; Understand the
FP10
DEVELOPING A CLINICAL MEASURE FOR PHONOLOGICAL DEVELOPMENT: RELIABILITY OF THE PHONOLOGICAL MEAN LENGTH OF UTTERANCE MIEKE BEERS (1) - MARIANNE RODENBURG-VAN WEE (2) ELLEN GERRITS (1) UTRECHT UNIVERSITY OF APPLIED SCIENCES (1) RESEARCH CENTRE FOR INNOVATION IN HEALTH CARE, UTRECHT UNIVERISTY OF APPLIED SCIENCES, UTRECHT, NETHERLANDS (2)
Abstract: In the clinical setting either a phonological contrast analysis or a phonological process analysis is used to determine a childs phonological age. Both procedures, however, have their limitations. A contrast analysis reveals the inventory of acquired and missing segments and contrasts. A phonological process analysis only shows the developmental status of a predetermined set of segments and contrasts. Phonological contrast analysis is more exhaustive than a process analysis, but also time consuming since it is based on a spontaneous language sample. More importantly, both procedures focus on the production accuracy of individual segments and not on whole-word productions. Variability in accuracy of individual segments often depends on lexical factors, such as word frequency and phonological neighborhood density (correspondence between segments in number of features). For clinical use a measurement tool for determining phonological age is required that includes a childs acquired and non-acquired phonemes, takes production variability into account and is straightforward to use. As a useful clinical tool the Phonological Mean Length of Utterance (pMLU) will be proposed in this presentation. Like MLU this measure determines at the word level the mean length of a set of words targeted by a child, taking into account the number of correctly produced segments in each word. Originally this measure was proposed in Ingram (2002) as the basis for four measures that estimate a childs phonological abilities at the whole word level. As a reference he proposed five developmental stages for the pMLU. Attention for these measures has recently been revived in the literature. Recently, one of the measures based on pMLU was used by Sosa & Stoel-Gammon (2012) to show that lexical factors (word frequency and neighborhood density) had a significant effect on phonological variability in early word productions. Also, it has recently been shown that the pMLU is able to distinguish between specifically language impaired (SLI) children and normally developing children (Kunnari, et al., 2012). This presentation will show the results of a reliability study of the Phonological Mean Length of Utterance (pMLU) that is currently being performed at our centre. Using the spontaneous speech samples of 40 normally developing Dutch children between 1;0-4;0 years correlation analyses will be performed between the pMLU of each child and their developmental level based on a standardized Dutch procedure for contrast analysis. The reliability of the PMLU will be determined for different sample sizes of 50, 75 and 100 words from the spontaneous speech samples. A small sample size would enhance this measures clinical relevance. Clinical relevance will also be shown by applying the pMLU measure to the spontaneous speech samples of 15 phonologically-impaired children. The pMLU is a calculation measure that can easily be incorporated as a tool into phonological analysis software. In conclusion this presentation will show that the pMLU is an exhaustive clinical tool, which is straightforward to use. The pMLU provides information on a childs level of phonological development taking variability in accuracy at the word level into account. Learning outcome: Participants of this presentation will: Understand that the phonological mean length of utterance measures phonological and lexical abilities; Know how to apply the phonological mean length of utterance to determine phonological age; Know the reliability of the phonological mean length of utterance in different sample sizes of the spontaneous speech of children acquiring Dutch.
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application of the PAC model of atypical phonological acquisition; Know the importance of phonological assessments with emphasis on contrasts; Verify the ability of the model in the differentiation of phonological disorders and phonological delays.
FP12
THE AUDIOPHONIATRIC ASSESSMENT IN THE DIAGNOSTIC EVALUATIO OF THE CHILD OF 24-30 MONTHS WITH DELAY/ LANGUAGE DISORDER ARCADIO VACALEBRE (1) - ATTILIO COVINO (2) ANGELO CORTILE (3) - RAFFAELE IZZO (3) ASL NA3 SUD, ASL NA3 SUD, TORRE DEL GRECO, ITALY (1) CENTRO DI RIABILITAZIONE HORIZON SAN GIORGIO A CREMANO, SAN GIORGIO A CREMANO, ITALY (2) AO SANTOBONO, NAPOLI, ITALY (3)
Abstract: In recent years, more and more frequent medical consultation with a speech therapist for the children aged between 24 and 30 months who do not have adequate language development. In general, parents are alarmed by the small number of words produced by the children, more rarely by the absence of words, or words from the production of much altered in the phonological component (only monosyllables, systematic use of the same words in all phono etc..).Verbal language is a function under close supervision by the parents, who often neglect a number of extra-linguistic manifestations that can accompany a development report atypical or delayed.And the physician phoniatrics investigate all functions in the game related to the development of language, to access a diagnostic definition from which to necessary treatment options.Etiopathogenetic a condition to consider is the hearing loss, especially in the forms of mild and medium, which can pass undetected by the absence of the most striking phenomena that instead accompany it to the forms of entities severe and deep, both in terms of poor reactivity to sounds and ambient noise and vocals, that vowel production also altered.It task of the specialist speech therapist investigate the auditory function of children with evidence of indication of shape and / or delivery of the object to stimuli proposed to mouth screen and voice weak or whispered, checking also how it can change a childs response to the change of intensity of the stimulus voice (for example, the child is strong and fast in delivery indication or aloud, and it is not a weak voice). Upon completion of such functional tests auditory it will assess the state of health of the middle ear with the otoscopy and examination impedenzometrico, and then proceed in case of need to a deepening audiological with an audiometric test conditional infant or to the study of evoked potentials auditory brainstem. It clear that in case of diagnosis of sensorineural hearing loss or mixed with prosthesis will proceed to take charge of the child speech therapy, ensuring in any case, the middle-ear transmission problems with drugs or surgical remedies. Another condition etiopathogenetic to consider is that due to a developmental disorder motor organization, considering the verbal language into its component praxic-phonetic-articulatory. In this case the reduced verbal production of the child would be the expression of a difficulty in achieving articulatory postures and combinations thereof, with the consequent restriction of the verb motor. Typically an examination of praxies linguobuccofacciali can find weaknesses, as well as the inventory valuation phonetic and phonological configurations produced. Frequently are also found difficulty in chewing and poor acceptance of foods consistent with power still semi-solid and pureed as signs of dysfunction gold motoria.La phoniatric examination, however, must also consider extraoral signs with respect to the manual, for the correlations between neuroevolutive mouth and hand, often finding signs of embarrassment in manipulative activities, considering these subjects little recourse to mimic hand gestures, being also such activities matrix motor.Its common to see these kids engines difficulty in jumping, running, and cycling in a history of delayed motor development (often a lack of crawling or its implementation so atypical, delayed walking towards 16-18 months). these children live evil the functional dissociation between good verbal comprehension, valid internal language and verbalization difficulties that interfere with clear effects comunicopatici also on social relations. And useless with these children require the repetition of the word or deny what has been asked of them if they have not verbalizzato.Per these children the diagnosis can be of a specific developmental disorder of speech isolated (F80) or with a comorbid specific developmental disorder of motor function (F82), for what would be a specific developmental disorder mixed (F83). The operational impacts of such diagnosis can cover a range guidance for parents on how to deal communicatively their baby with this difficulty, the making family game engines and game specific exercises for oral motor and manual, taking charge and speech therapy sometimes psychomotor.Another condition etiopathogenetic to consider is that of language-specific developmental disorders (F80), the existence of peculiar difficulties in the construction of language, taken as competence, and which manifests itself as a restriction of verbal performance. In these children may outweigh the neuropsychological disorders of discrimination and auditory-verbal memory, impairment of both the understanding of speech production at all levels, or noise may occur more selective for only one level (phonological, lexical, morpho-syntactic ) and usually only verbal expression. It clear that in the age group 24-30 months is difficult to investigate all levels of verbal language because it is still in the developmental stage and for the reduced quantity of language to be analyzed.Its useful for this purpose with the help of the Questionnaire Mc Arthur to transcribe parents the words as they are
spoken by the children, together with the answers on the verbal comprehension and use of gestures, to obtain data on the nature of the disorder. The specialist speech therapist will then proceed in diagnosis of exclusion of other causes that support the language disorder, conducting tests of auditory reception and possibly the audiological diagnostics, tests on motor skills, cognitive tests, including whether the communication skills of the child extraverbal , which are often valid with the use of compensatory gestures, facial expressions and simple strings from verbal referential value as onomatopoeia. Other data on these lines of investigation can be derived also from the anamnestic interview with the parents, who generally report that the child lacks only the word.For these children is shown taking charge logopedic in 2-3 months if not there is a significant verbal-linguistic evolution in terms of quality and quantity, enabling parents with images and photos, selecting good sounds of words, doing exercises game linguobuccofacciali for telephones and the production of the words, whereas the beginning of the treatment between 30 and 36 months.Another particular clinical condition is represented by the presence of attention disorder with hyperactivity (hyperkinetic disorders F90), in which the alteration of the processes of analysis, discrimination and storage of data, hampers the construction of the warehouse phonological of words, and more in general the internal language, with the consequence of a verbal production limited, not so much difficulty verb motor, but for non-mental representation of the words. The abnormal quantity and quality of the movements of these children, the difficulty to focus and integrate data, prevents them from real-time processing the formal components (signifiers) and the functional (meaning) of the verbal message, finding in best cases a discrete verbal understanding, although the phenomena of inattention auditory are always present.At the level of the speech pathologist for evaluation hyperkinetic behavior of the child will find it hard to interact with him with images and objects, and the anamnestic interview with parents, problems will arise in the type of game, within the rules, as well as in biological rhythms such as sleep -wake. In these children, there may be elements of inaccuracy motor but the pathophysiological corpus is given the inability of the brain to process and store simultaneously all significant components of the experience, and among them the verbal element is the most penalized for its nature volatile than the other stimuli that persist over time and space as visual ones. For such children to school can be a solution since it is implementing a new environment with new rules and situations, or direct them to a psychomotor therapy in the first instance, and re-evaluating the temporal evolution and the indication for speech therapy. In any case, counseling with parents and will be useful in order to regulate the childs behavior, the sequence of events during the day and the optimization of its spaces and living environments.A further condition is represented by etiopathogenetic significant global developmental disorders (F84), in which the paradox is that the consultation is the speech therapist for speech problems of the child, not with objectively evaluating the entire corpus of existing dysfunctional other events. Children with these disorders show significant difficulties in communication-verbal eye contact with absent or inconsistent, with interaction impaired, with or without lability in attention and activity shared with instrumental use of the other (performative richiestivo) without activating it as a partner communicative and cognitive-emotional (declarative performative).These children have difficulty relating with peers and show atypical behavioral interests with repetitive, stereotypic, geometric approaches to reality and do not tolerate changes and unpredictability in daily life, obsession with order and the immutability of things and environments. Failure emergency language in these children is always linked to difficulties in processing and integration of stimuli, often working in the sense iperanalitico and fragmented with a focus on chunks of reality, and penalty element vebale, by its nature volatile . For these children must be sent to a deepening neuropsychiatric, a psychomotor therapy and audiologic evaluation.Remain to be considered those conditions etiopathogenetic psycho-emotional relationships (F88 F89 F93) where the contract language can be more or less voluntarily as part of a withdrawal relational and performance of the child, together with a set of behaviors and particular symptoms in everyday life, which may also provide a selective communication with family members and / or peers. Its right, however, that in the examination phoniatric are made all the feedback on quoted to exclude or establish such frameworks clinical and functional managers disorder or language delay, so as to give the right value to emotional disorders, which are frequently reactive effects comunicopatici limitations minutes, sending in any case the child to study neuropsychiatric child.To the argument of a reality show diagnostics possible at a young age, trying to characterize the failure or reduced emergence of verbal language, so you can make the most appropriate treatment options, and it is beyond doubt that the professional most accredited for this analysis is Physician speech pathologist.Learning objectivesThe participant will be able to analyze the modes of classification and diagnosis language impairment/ delay in children of 24-30 months. Learning outcomes: The participant will be able to analyze the modes of classification and diagnosis language impairment/ delay in children of 24-30 months.
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FP13
COMMUNICATION INTERVENTION FOR CHILDREN AND ADULTS WITH COMPLEX COMMUNICATION NEEDS: PARENTS AND RESEARCHERS PRIORITIES JULIET GOLDBART (1) RESEARCH INSTITUTE FOR HEALTH & SOCIAL CHANGE, MANCHESTER METROPOLITAN UNIVERSITY, MANCHESTER, UNITED KINGDOM (1)
Abstract: Introduction: Children and adults with complex communication needs (CCN) including those with profound and multiple intellectual disabilities (PIMD), severe learning disabilities with challenging behaviour and severe autistic spectrum disorders, are likely to need on-going intervention to support and enhance their communication skills. A wide diversity of interventions is available (Nakken & Vlaskamp, 2007) but the evidence base for many of these is very limited, with speech and language therapists using interventions with varying levels of evidential support (Chadwick et al, 2009). Evidence-based practice can be viewed as comprising three components; research data, expert clinical opinion and patient perspectives (e.g. Sackett, 1996). Given the limitations of research evidence, and the importance of family involvement in clinical decision-making (e.g. ASHA Professional Issues Statement, 2010), it is useful to explore the perspectives and priorities of both parents of children and young people with CCN and experts in education and speech and language therapy. Method: An exploratory, qualitative approach was adopted. Initially, parents and other family carers were invited to participate through four organisations which provide support for parents of children and adults with profound or complex disabilities. Two of these organisations had a particular remit for supporting parents from ethnic minorities. One of the parents groups organised a focus group (of eight parents), others passed details of the project to parents by email or word of mouth. This generated several email responses and one interview, including parents from ethnic minorities. Contact with another parents group generated four interviews. As initial participation seemed to be rather slow, details of the project were posted on the PMLD Network Forum. This resulted in further email responses and one interview, either directly or through organisations such as the Challenging Behaviour Foundation. Many of the e-responses were very detailed, with some including documents such as Communication Passports. These parents were well placed to contribute to this report. Of the 30 children and adults they refer to, six rely entirely on informal communication such as idiosyncratic gestures and facial expression that their parents and carers interpret. Three have a few single words, which tend to be used rather idiosyncratically. Five are successfully using high-tech communication aids. The remaining children and adults use combinations of modes such as Objects of Reference, signs, symbols and photographs. Parents were asked for their views on four topics: What parents and family carers see as the most useful strategies in communicating with their sons and daughters. What they think other people should know about their son or daughters communication. What communication strategies help their son or daughter to have some participation in the community. If their son or daughter has a direct payment or personalised budget, what the family are looking for in terms of communication skills when they employ carers or personal assistants. The professional experts were purposively sampled, via emails (n=18) to researchers who had recently published on communication and PIMD and/or who were members of an international Special Interest Research Group on PIMD. Responses were received from 11 international researcher-practitioners in Australia, Britain and the Netherlands. Respondents were called the researchers. This group was asked the following questions: What are the most important strategies that communication partners can use to facilitate successful communication with people with complex communication needs? What communication skills can people with complex communication needs learn or use to support their community engagement? What are the most important issues and components in training staff to work with people with complex communication needs? What do you consider to be the key conceptual issues in communication in relation to people with complex communication needs? Findings: Eleven responses were received from researchers and 30 from parents.Data from emails, interviews and focus groups were listened to and / or read repeatedly as applicable, then coded and analysed thematically (Braun & Clarke, 2006). Two researchers coded the data and reached consensus on the emergent themes. There were both similarities and differences between parents and researchers views. A range of specific intervention approaches was identified by both groups, with a higher proportion of researchers mentioning named interventions such as Intensive Interaction (Samuel et al., 2008). Some parents were critical of approaches used, explaining that they were not appropriate for their son or daughters developmental level. Communication Passports (e.g. Millar & Aitken, 2003) and related means for collating and sharing information were recommended by both groups, with some parents sending completed passports as examples. Parents were very concerned that their sons and daughters health, and their sensory skills and difficulties, would critically affect their communication, and so require regular assessment and monitoring. The training of direct care staff was of concern to both groups, with strong consensus that parents and other people who know the individual well should be closely involved in this training. The prevailing view of researchers was that formal, one-off teaching sessions were ineffective. Staff needed an apprenticeship-type approach, with on-going support. In addition to input on formal intervention
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approaches, researchers considered that staff needed training in knowledge, skills and attitude. For parents, the main focus was on attitude; they felt that nothing could be achieved unless staff had a positive, caring attitude to those with whom they worked. Conclusions: These findings have implications for speech and language therapy practice and for research. Many parents appeared to be unaware of the communication interventions being carried out with their sons and daughters. This suggests that valuable opportunities to involve families in communication development are being missed. Further research is needed to develop the evidence base for communication interventions with this client groups, so that therapy recommendations can be made with greater confidence. Finally, there is a need to recruit, retain and train high-quality staff who are committed to providing diverse and satisfying communication opportunities for the people for whom they work. Learning Outcomes: Participants will have a greater understanding of: The communication needs and difficulties of children and adults with severe and profound intellectual impairment; Parents perspectives and priorities for communication interventions with their sons and daughters with severe and profound intellectual impairment; Expert researchers and practitioners priorities for communication interventions with children and adults with severe and profound intellectual impairment; Research priorities in communication intervention for children and adults with severe and profound intellectual impairment; Issues affecting evidence based practice with children and adults with severe and profound intellectual impairment.
FP14
HELPING PARENTS WITH INTELLECTUAL IMPAIRMENTS TO UNDERSTAND: COMMUNICATION FACILITATION IN PARENTING MEETINGS ALISON MATTHEWS (1) - JOIS STANSFIELD (2) COMMUNICATION THERAPY, PENNINE NHS FOUNDATION TRUST, OLDHAM, UNITED KINGDOM (1) - RESEARCH INSTITUTE OF HEALTH AND SOCIAL CHANGE, MANCHESTER METROPOLITAN UNIVERSITY, MANCHESTER, UNITED KINGDOM (2)
Abstract: The Communication Facilitator is a role in the early stages of development. The role can support people with intellectual impairments in a variety of meetings, including social work led child protection meetings where there are high stakes for not understanding, resulting in the potential removal of children from the parental home. In child protection proceedings complex language, competing priorities from professionals and a huge amount of advice, all presented verbally, are regular features. Child protection meetings are challenging, not least because the emotional demands of the situation can reduce the parents ability to process information they would typically be able to understand. The role of the Communication Facilitator is to slow the pace of communication in a meeting, clarify any unfamiliar vocabulary and produce a picture summary during the progression of a meeting. This supports intellectually impaired parents, who often have limited verbal and literacy skills. The Communication Facilitator role promotes the areas of good practice identified by Forrester et al (2007). Method: Case one: The Communication Facilitator role. Accessible information training has been provided by the local SLT team, for 256 staff in the last 5 years. Key areas include the need to adjust communication to support a persons comprehension, recognise breakdown in communication and using alternative and augmentative strategies to facilitate communication. The Communication Facilitator role was developed in response to specific challenges in child protection meetings. Case 2: The DVD. A training film demonstrating the ways in which communication could be facilitated was produced. Developing the film presented a challenge in terms of confidentiality and ethics, therefore it uses a simulated client (an actor). The film outlines the way in which a Communication Facilitator can be used to enhance child protection meetings. Two scenarios are played out. The first illustrates bad practice and was drawn from a real case which had been anonymised. The second scenario shows a meeting with same issues but demonstrating the Communication Facilitator role supporting both the intellectually impaired parent and the staff team in understanding all the issues. Case 3: Social work training. The SLT team was invited to provide training for the local childrens social worker team. Two sessions were presented. The first covered a brief introduction to intellectual imppairment, an outline of the role of the SLT with parents with intellectual impairment and the impact of policy, law and disputed evidence. Participants were then asked to consider a list of adaptive skills and describe how a deficit in this area might affect parenting. In session two content included examples of adapted documents used in child protection. These documents were anonymised and copies were provided on a disc. The session included an overview of mild intellectual impairments and the types of impairment which might be encountered and associated communication and literacy issues. The latter half of the session focused on the communication facilitator role, using the DVD materials. Following each training session individual questionnaire feedback was requested. Case 4: Service user involvement. An intellectually impaired parent was also asked to review the video in order to comment on usability and the potential effectiveness of using a Communication Facilitator - Results and discussion: 12 participants attended the first social work training session and 8 the second session. All participants returned feedback questionnaires after each session. Responses to the training were
positive, although as the feedback was immediately post training it may not reflectlong term changes in behaviour. Feedback about the resources shown included: I now have first-hand knowledge that these resources work, so will continue to work with them. Training session two was reported to have had an impact on participants level of awareness about people with intellectual impairments ability to understand. Comments on the use of the DVD as part of the training included: It will make me think about how best to help people to understand what Im talking about.. After watching both films The intellectually impaired parent was able to draw up a list with the SLT identifying how she would like the meetings to run and factors which contributed to her feeling unable to participate. She said she thought the use of pictures helped to make the meeting clear. Factors which demonstrate the effectiveness of the Communication Facilitator include: changes to professionals communication, reduction rate of speech, increased use of pausing, simplification of the vocabulary used to describe any concerns. In addition, ensuring the use of pictures supports understanding and reduces the demands on lyliteracy skills. All of these adaptations are likely to support the intellectually impaired parentsability to process the language. Comments from Social Workers following the introduction of the role have been that it helps distinguish between a lack of understanding versus lack of compliance in the intellectually impaired parent concerned. Previously the impression had been that the intellectually impaired parents were typically seen as difficult and non-compliant rather than being confused, afraid and unable to understand. The process used with the Communication Facilitator role has increased the clarity over concerns about parenting and supports the prioritisation of any concerns raised. The fact that group members are asked to comment individually also seems to changes the perception of ownership of concerns, moving from the perception that it is the childs Social Worker who has the concerns, to a collective concern and shared by core group members. In the future it is planned to analyse the communication features in a child protection meeting with and without the communication facilitator role and to compare these meetings. An additional refinement could be the development of a priorities sheet for parents to take away from the meeting, with clearly outlined priorities with timescales attached. The major impact of the Communication Facilitator is to support both professionals and the intellectually impaired parent to understand the care and protection processes so that parents on-going participation in decisions that affect their lives and the lives of their children is assured. Learning outcomes: Understand the communication demands on parents with intellectual impairments; Recognise the impact of communication breakdown on parenting; Understand the role of the communication facilitator in child protection meetings with parents with intellectual impairments .
FP16
DYSPHAGIA ASSESMENT IN HOSPITALIZED PATIENTS BETWEEN SEPTEMBER 2010 AND NOVEMBER 2012 AZIA MARIA SAMMARTANO (1) - MANUELE CENA (1) ANTONELLA CUSIMANO (1) - FRANCESCA MILAN (1) MASSIMO SPADOLA BISETTI (1) - ROBERTO ALBERA (1) ENT - AUDIOLOGY AND PHONIATRY DEPARTMENT, UNIVERSITY OF TURIN - CITTA DELLA SALUTE E DELLA SCIENZA, TURIN, ITALY (1)
Abstract: The aim of our study is to evaluate the dysphagia level, the type and frequency of treatment of this disorder in hospitalized patients. 952 patients underwent a ent-phoniatric evaluation considering a medical evaluation of swallowing. Instrumental analysis, such as fibroscopy or videofluoroscopy of swallowing, have been reserved to a small part of patients. These medical assesments permitted to understand the dysphagia outcome level and so the need of a swallowing reeducation. Learning outcomes: The Participant will be able to: understand the increasing request of medical examination for dysphagia in a hospital with lots of admissions per years; know how to manage dysphagic hospitalized patients; know the characteristic of clinical evaluation and instrumental approach; know how to choose between clincial examinatione, fibroscopy swallowing study or videofluoroscopy swallowing study.
FP17
RADIOLOGICAL IMAGING IN DYSPHAGIA ASSESSMENT: PRELIMINARY REPORT FOR A COMBINED SCINTIGRAPHYSPET/CT APPROACH PROCEDURE. VINCENZO SALLUSTIO (1) - ANTONIO ANASTASIA (2) CRISTIANA RAGANO CARACCIOLO (2) - SILVIA PEDE (1) PIERO GIORGIO PEDE (2) - KATIA MORCIANO (2) DANILO PATROCINIO (1) PHONIATRICS AND COMMUNICATIVE DISORDERS REHABILITATION CENTER AT DEPARTMENT OF REHABILITATION, AZIENDA SANITARIA LOCALE DI LECCE, LECCE, ITALY (1) - NUCLEAR MEDICINE UNIT, AZIENDA OSPEDALIERA CARDINALE PANICO, TRICASE, ITALY (2)
Abstract: Oropharyngoesophageal scintigraphy (OPES) permits dynamic and semi-quantitative investigation of the swallowing; however, it is partially lacking in spatial resolution. Conversely, the single photon emission tomography and computed tomography (SPET/CT) allows high spatial resolutions and can be performed using the same radioactive tracer as in OPES. The aim of the study was to evaluate the accuracy in dysphagia assessment of a procedure including both OPES and hybrid SPET/CT with image fusion after ingestion of a single tracer and to compare the results to the findings observed with the fiber-optic endoscopic evaluation of swallowing (FEES). The study reports preliminary data collected from 20 patients (mean age: 62.7 13.7 years) affected with neurological diseases, post-surgical dysphagia or anatomical oesophageal alterations who underwent clinical evaluation for dysphagia from October 2012 to January 2013. Initially, the subjects were studied by means of FEES; then they underwent a two step procedure. During the first step the OPES was carried out with dynamic data capture after ingestion of liquid bolus marked with 99mTc-DTPA. Qualitative and semi-quantitative evaluations were performed using ROI boxes set on oral, pharyngeal end oesophageal regions; the activity/time curves, the transit times and the retention indexes were calculated. The second step consisted in a high resolution hybrid SPET/CT for a morpho-functional evaluation of the oropharyngeal area and oesophagus, searching for possible penetration and/or inhalation into the tracheo-bronchial tubes. The calculated exposure to radiation was 1,9 mSv. The collected data shown that a pre-deglutitory fall was detected in 13 patients by FEES and in 6 patients by OPES. Liquid bolus retention was observed in 7 patients by FEES and in 14 subjects by OPES-SPET/CT. Penetration in 1 patient and no inhalation were observed in our sample by FEES; OPES-SPET/CT detected inhalation in 3 patients. The procedure allowed to identify the oesophageal achalasia as the cause of dysphagia in one patient and minor oesophageal anatomy alterations in 6 patients. OPES reported a delayed opening of the lower oesophageal sphincter in 4 patients and a delayed opening of the upper oesophageal sphincter in 1 patient. A slower oesophagus transit was documented in 5 subjects. These preliminary data suggest that the hybrid SPET/CT with image fusion can be very helpful to evaluate simultaneously both the pharyngeal and oesophageal morphology and the presence of trace of the liquid bolus retention, penetration and inhalation into the tracheo-bronchial tubes. The SPET/CT spatial resolution in the study of swallowing results far better than that achieved by the OPES alone. The data also suggest that the SPET/CT scans associated with OPES improve the accuracy of the radiological evaluation of dysphagia. In combination, OPES and SPET/CT are able to detect penetration and inhalation better than the FEES alone. Conversely, OPES can underestimate pre-deglutitory falls. That could be presumably due to interfering background noise related to the ROI boxes setting. The data support the hypothesis that the combined OPES-SPET/CT procedure could be a valid radiological integration to FEES. However, further investigation is
FP15
OUTCOME MEASURES APPROPRIATE FOR AUGMENTATIVE AND ALTERNATIVE COMMUNICATION SERVICES PAMELA ENDERBY (1) UNIVERSITY OF SHEFFIELD, SHEFFIELD, UNITED KINGDOM (1)
Abstract: Purpose. Internationally there have been many changes in the delivery of health, education and social care services over the last decade. However, there are two central pillars which have become of increasing importance in most strategy and policy documents. These pillars emphasise the importance of sustaining and improving the quality of service delivery which is related to the second requirement to demonstrate cost effective service delivery. Services are required to collect, report and learn from outcome measurement. This paper discusses the importance of outcome measures in improving augmentative and alternative communication (AAC) services. Method. The presentation will summarise the purpose and value of outcome measurement and review those commonly used in AAC services reflecting on conceptual frameworks including the International Classification of Functioning (WHO). Results. 23 measures were identified from the literature. These incorporate general measures, specific measures, measures as part of general management systems and measures of accreditation and qualification. No measure incorporated all of the domains consistent with the ICF and has therefore informed the development of a particular outcome measure (AAC TOM) ensuring that basic principles of the International Classification of Functioning are retained and the measure can be used in benchmarking. The principles of the Therapy Outcome Measure have been incorporated into the version for AAC and will allow comparison of service delivery and reflection of change in persons using AAC devices. Conclusion. The developed AAC TOM is to be used in an audit of AAC services in England.
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needed for a better evaluation of the proposed procedure reliability. Learning outcomes: know the OPES and SPET/CT imaging techniques as options in dysphagia assessment; know the advantages of each procedure; understand the diagnostic improvements achieved by the combination of the two techniques integrated with FEES; know the need of further investigation for a complete evaluation of the proposed procedure reliability.
FP18
MEALTIME ASSESSMENT SCALE (MAS) MARCO GILARDONE (1) - DEBORA VALENTINI (1) ANTONIO SCHINDLER (2) NEUROSCIENCES REHABILITATION DEPARTMENT, CASA DI CURA DEL POLICLINICO, MILAN, ITALY (1) UNIVERSITY OF MILAN, OSPEDALE SACCO, MILAN, ITALY (2)
Abstract: Swallowing is usually assessed at the beside or in dedicated clinics performing videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallowing. There are no available tool to assess swallowing in a more ecological situation, such as during a meal. The aim of the study is to develop and validate a scale for the evaluation of dysphagia, which can provide both a qualitative and quantitative assessment of the difficulties of dysphagic patients during the meal. The tool developed was called Mealtime Assessment Scale (MAS). The advantage of the MAS relies not only in the possibility of a more ecological assessment, but also in the possibility to assess a whole meal, lasting longer and including several more swallows than those assessed during VFS or FEES. Elements such as fatigue or environmental barriers could therefore be analyzed. Learning outcomes: Know a new method for dysphagia assessment; Find dysphagia signs and symptoms during mealtime; Have a new instrument for dysphagia follow-up
is comprised of, from the Ministerio del Poder Popular (Secretary) for the Health. The objective of this presentation is to describe the design of the network and to show the decisions of management of hearing aids that has been taken in their development to optimize the material and humans existing resources. Methods: it was perform a mixture documental and information analysis on public released official files. Results: The first phase of development of the Network consisted of a Central Hearing Aids Laboratory (CHAL) with 3D (three dimensional) technology for the print of ear moulds and eleven Peripheral Hearing Aids Laboratories (PHAL) with 3D scanners for the ear silicon impressions images capture and sent by e-mail to the CHAL. Also it implied the formation of the personal that did not exist in the public sector before the start of the network. The network covers at present the capital and eleven main cities of the country. In 2013 it is projected to add 4 cities more and in the following three years is desired to become to have 1 CHAL, 24 PHAL and a mobile Laboratory. Conclusions: In the first couple of year of activities of the network they were offered, free of charge for the end user, around 6,500 hearing aids, in their almost totality of the type BTE and a small proportion ITE and others types. In 2013 it expects to offer more than 6,000 units between BTE, ITE, RITE and BEM types. Learning outcomes: To know about the existence and status of the National Public Hearing Aids Laboratories Network in Venezuela; To understand the proposed flowchart for the mass production of custom otoplastics elements in the public sector; To know the educational solutions developed for the training of specialized in hearing aids staff.
FP21
ACOUSTIC ANALYSIS OF VOWEL PRODUCTION IN HEARING IMPAIRED CHILDREN USING COCHLEAR IMPLANT NARGES JAFARY (1) - FARIBA YADEGARI (1) UNIVERSITY OF SOCIAL WELFARE AND REHABILITATION SCIENCES, UNIVERSITY OF SOCIAL WELFARE AND REHABILITATION SCIENCES, TEHRAN, IRAN (1)
Abstract: Hearing and auditory perceptual feedback are crucial parts of human voice production. Deaf speakers differ considerably from normally hearing speakers regarding auditory- motor interface controlling speech production. The purpose of this study was to compare vowel productions by cochlear implant (CI) children, and normal-hearing (NH) children. The participants were 20 children (12 girls and 8 boys) using cochlear implant (CI) with age range of 5;1 (years , months) to 9 years old who received a multichannel CI at an average age of 2;8 ( years , months). All of patients had congenital hearing loss, and each child received its first hearing aid (HA) before the age of 3 years. They had at least a 6 months experience of their current device (CI). They participated in speech and hearing rehabilitation programs before and after CI surgery, and had no other handicaps. The otorhinolaryngological examination provid normal vocal tract structures and oral-motor skills of CI children. The control group consisted of 20 normal hearing children (12 girls and 8 boys) with age range of 5 to 9 years old. Two groups were matched by age. Participants were native speakers of Persian who were asked to produce the vowels /i/, /e/, //, /u/,/o/, and //. The average of first formant frequency (F1) and second formant frequency (F2) and the F2/F1 ratio of six vowels were measured using Praat software (version 5.3.13). Independent t-test was conducted to examine the differences in F1 and F2 and F2 /F1 ratio values in two groups. The area of the vowel space were compared. Results revealed that mean values of F1 were increased in CI children. Mean value of F1 for vowel /i/, F2 for vowel /o/, and the mean value of F2/F1 ratio for vowel /i/ were significantly different (P < 0/05). The changes in F1and F2 showed a centralized vowel space for CI children. As this study indicated, F1 are increased in CI children. Probably this condition is due to the fact that CI children tend to over-articulate. This situation hypothetically can be explained by a lack of auditory feedback and an attempt by hearing impaired children to compensate via proprioceptive feedback during articulatory process. Learning outcomes: Know using acoustic analyses may be useful for indicating deviations in vowel production of prelingually cochlear implant children; Thinking of possible benefits of changing the emphasis of speech rehabilitative programs from visual to auditory feedback to highlight F2 changes in vowel productions.
FP19
SPACE-TIME RELATIONS IN LANGUAGE EXPRESSION OF HEARING IMPAIRED STUDENTS ADINDA DUL (1) SUVAG, POLYCLINIC, ZAGREB, CROATIA (1)
Abstract: In this research we examine the precision of time and place adverbs used by hearing impaired students with cochlear implants. EXAMINEE SAMPLE - The survey was carried out on 9 hearing impaired examinees diagnosed anacusis, with cochlear implants. The average chronological age of examinees is 13.2 years. The control sample consists of 7 students of age equal to the age of experimental sample and of normal hearing and speech status. TIME AND PLACE OF EXAMINATION The examination has been in writing and carried out in one of the Zagreb elementary schools where hearing impaired examinees are integrated and in one of the Zagreb regular schools. It has been done during 2011. MEASURING INSTRUMENT - Lexical knowledge has been examined by series of examination tests. Examination tests are arranged in sets of 10 tests in each set. Examination test series has 20 questions in total. METHOD OF ANALYSIS - Results analysis from the area of language development testing of hearing impaired examinees has been carried out at the level of descriptive statistics. The differences between the groups of examinees in relation to some variables have been identified by the one-way analysis of variance. GOAL OF RESEARCH - We wanted to examine the acquisition of language denotation of time and place adverbs in hearing impaired examinees with cochlear implants. HYPOTHESIS Following the goals defined by research we started from the hypothesis: H1 There is statistically significant difference in acquisition of time adverbs between hearing impaired examinees with cochlear implants integrated into regular schools and normal hearing examinees; H2 There is statistically significant difference in acquisition of place adverbs between hearing impaired examinees with cochlear implants integrated into regular schools and normal hearing examinees. CONCLUSION The comprehension of time and place adverbs with their concrete and general characteristics significantly influences the functioning of speech, language and speechlanguage thought. The examinees with cochlear implants show that they know how to use time and place adverbs, but that they have difficulties when adverbs are placed in complex sentences in inversion and when they are not defined by concrete characteristics.
SY1
BRAIN, COGNITION AND LANGUAGE CONNECTIONS HYTER YVETTE (1) - CAROL WESTBY (2) VOGINDROUKAS IAONNIS (3) - OSNAT SEGAL (4) YVETTE HUS (5) - KAKIA PETINOU (6) WESTERN MICHIGAN UNIVERSITY, KALAMAZOO, UZBEKISTAN (1) BILINGUAL MULTICULTURAL SERVICES, UNIVERSITY, PRINCETON, UNITED STATES (2) - PSYCHIATRIC HOSPITAL OF THESSALONIKI, THESSALONIKI, GREECE (3) - TEL-AVIV UNIVERSITY, TEL-AVIV, ISRAEL (4) - TAV COLLEGE, MONTREAL, QUEBEC, UNIVERSITY, MONTREAL, CANADA (5) - EUROPEAN UNIVERSITY CYPRUS, CYPRUS (6)
Abstract: This series of six presentations by members of the IALP Child Language Committee will focus on the relationship among the brain,
FP20
THE NATIONAL PUBLIC NETWORK OF HEARING AIDS LABORATORIES IN VENEZUELA RAMON HERNNDEZ- VILLORIA (1) MINISTERIO DEL PODER POPULAR PARA LA SALUD, INSTITUTO VENEZOLANO DE LA UDICION Y EL LENGUAJE, CARACAS, VENEZUELA (1)
Abstract: Introduction and aims of the study: From 2010 to now it is developing in Venezuela, septentrional South American country, with near twenty nine million inhabitants and an estimation of auditory disability people about eight thousand, a Program of Attention in Health for the People with Auditory Disability that a National Public Hearing Aids Laboratories Network
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cognition, and language. These papers begin with a summary of the research literature on different types of Theory of Mind, and will address the neurodevelopmental and cognitive underpinnings of language for typically developing children and adolescents, as well as those who are late talkers, struggling readers, have histories of maltreatment and prenatal alcohol exposure, and diagnosed with autism. Abstract for Paper 1: Deficits in theory of mind (ToM) underlie many of the social-emotional difficulties exhibited by persons with autism spectrum disorder, and persons with other communication disorders (e.g., language impairment, deafness, attention-deficit hyperactivity disorder). Because ToM deficits are commonly associated with language impairment, it is imperative that speech language pathologists recognize the behavioral variations in ToM and understand the possible neurological underpinnings for these variations. Researchers have documented four aspects of ToM (Abu-Akel & Shamay-Tsoory, 2011; Lucariello, 2004): Cognitive ToM: The ability to attribute mental states -- beliefs, intents, desires, pretending, knowledge, etc. -- to oneself and others and to understand that others have beliefs, desires, and intentions that are different from ones own; Affective ToM: Process of inferring the affective states of others by sharing their emotions and by understanding the others emotions; Interpersonal ToM: Cognitive and affective ToM for others (recognizing thoughts and emotions of others and making inferences about them); Intrapersonal ToM: Cognitive and affective ToM for oneself (a sense of self and reflecting on ones own thoughts and emotions and using this information to learn and plan); Advances in neuroscience have provided insights into neurological bases for ToM deficits. Each aspect of ToM has a different neurological base. When adults engage in cognitive ToM tasks, the following cortical areas are activated: dorsal lateral prefrontal, temporoparietal junction, superior temporal sulci (STS), temporal poles, medial prefrontal cortex (mPFC), and precuneus/posterior cingulate (Abu-Akel & Shamay-Tsoory, 2011). By age 9, childrens neural processing of cognitive ToM tasks is similar to adults (Saxe, et al, 2009). Affective ToM tasks activate some of the same areas as cognitive ToM tasks, but in addition activate the orbital frontal gyrus and inferior lateral frontal gyrus (Shamay-Tsoory, Tibi-Elhanany, & Aharon-Peretz, 2007). Affective ToM has a longer developmental course (both behaviorally and neurologically) than cognitive ToM (Sebastian, et al, 2012). Cognitive ToM tasks can be processed by attention to the language information alone; affective ToM typically also requires interpretation of facial cues. The inferior occipital gyri must perceive facial features, the fusiform gyrus must perceive the unique identity of the face, and the superior temporal sulcus must note the changeable aspects of the face (perception of eye gaze, expression, and lip movement) (Ward, 2012). The discovery of mirror neurons provided a neurological basis for affective ToM. Keysers and colleagues (2006; 2007) have shown that people who are more empathic according to self-report questionnaires have stronger activations in the mirror system for emotions. Ramachandran (2009) speculates that mirror neurons also provide the neurological basis of human self-awareness (intrapersonal ToM). He hypothesizes that these neurons can not only help simulate other peoples behavior but can be turned inward to create meta-representations of your own earlier brain processes. This presentation will review the current literature on the different types of ToM, the neurological bases for components of ToM, and neurodevelopmental changes that occur as children develop ToM. Abstract for Paper 2: Cognitive Supports of Social Communication in Children with Histories of Maltreatment and Prenatal Alcohol Exposure Social communication is supported by interdependent relationships among social cognitive skills, which are used to interpret our social world (BaronCohen, 1991). Such skills include perspective taking and intention reading (being able to see other points of view and knowing the reason behind others behaviors) (Olswang, Coggins, & Timler, 2001; Perkins, 2007), executive functions (decision making, planning and behavior regulation) (McCloskey, Perkins, & Van Divner, 2009; Olswang et al., 2001), affective states (limbic system) (Sloane, 2010; Hyter & Sloane, 2013), and working memory (the ability to hold onto information while processing other information) (Olswang et al., 2001; Hyter, 2012; Hyter & Sloane, 2013). These skills together facilitate the expression of ones own intentions, their ability to interpret the viewpoints and intentions of others, have the mental flexibility to adapt to various communicative contexts, and engaged in self regulatory behaviors (Timler, 2008; McCloskey, Perkins, & Van Divner, 2009) all while holding onto how to regulate themselves and carry out the communicative or interactive goals. If any one of these skills is missing in action then there will likely be difficulties in social communication skills. Both complex trauma, resulting from chronic maltreatment, and prenatal alcohol exposure affect the central nervous system and multiple domains of child development, resulting in similarities in the neurodevelopmental profile of children with these conditions. This presentation will explain the effects of chronic maltreatment and prenatal alcohol exposure on the brain, discuss a conceptual model of the relationships among the cognitive underpinnings of social communication, and present data on the social communication skills for children, ages 6 10 years, who are affected by complex trauma, prenatal alcohol exposure, or both conditions. Abstract for Paper 3: Reading the Mind in the Eyes Test (Child) in Children with High Functioning Autism Theory of mind is the capacity we have to understand mental states such as beliefs, feelings, desires, hopes, and intentions in oneself but also to understand that others can have different beliefs or desires from us. There
is significant evidence that most children with autism have impairments in the development of a theory of mind (Baron-Cohen 1992,1993). Such a deficit may play a substantial role in the development of social, communicative and imaginative abilities and can be expressed very early, from at least the end of the first year of life. Using the Eyes Test (Child) (BaronCohen, Wheelwright, Hill, Raste, & Plumb, 2001) as a measurement tool we examined the qualitative and quantitative differences between youngsters with and without High Functioning Autism (HFA) and typically developed adults. For this study, normal adults (N= 23) were selected according to their working environment in order to accomplish a better heterogeneity. Typical children (N= 54) were recruited from public schools (Mean Age= 9.9) . HFA participants (N= 18 with Mean Age= 10), age-matched with the typical children, were selected from public child psychiatric services. All participants were examined with the Eyes Test (Child) one at a time in a quiet environment. In this test participants are presented 28 photographs of the eye-region of the face and are asked to choose which one of the four words best describes what the person in the photograph is thinking or feeling. Results indicate that adults mean score (M=17.3, SD=2.5) was slightly higher than typical childrens (M=16.4, SD=3), while the HFA children scored lower than the typical children (M= 14.1, SD=3.9). Although there was only 2-point difference - between children with autism and the typically developing ones it was significant ( < .01). The highest scoring photograph description was the man was sad (94.7%). Obviously it was the easiest feeling for the participants to recognize or to put themselves into the mind of the other person. The results of this study support the findings of other studies but also provide significant outcomes for a younger population than previously reported. We conclude that more studies should be conducted using the Eyes Test (Child) since it can be used both as a standardized measurement and an evaluation tool. Abstract for Paper 4: How High-Functioning Autistic Adolescents Judge Emotions in Lexical-Prosodic Congruent and Incongruent Conditions Children on the autistic-spectrum are considered to have difficulties in the perception, comprehension and production of prosodic information. These difficulties influence their ability to understand and produce intents and emotions in speech. Studies, so far, focused on the ability of autistic children to produce prosodic cues to convey emotional meaning. Little data, however, is available on the ability of high-functioning autistic adolescence (HFAA) to comprehend emotions carried via the prosody of the speech signal. In order to understand the meaning of speech the speaker has to pay attention to both lexical and prosodic cues. In many cases the lexical and prosodic information are congruent, that is, convey the same meaning (e.g., when the speaker says Im fine in a happy voice). In some cases, however, the lexical and prosodic information are incongruent, that is, do not convey the same meaning (e.g., when the speaker says Im fine in a sad voice). Developmental studies in the English language have suggested that when young typically-developing children have to judge the meaning of lexicalprosodic incongruent sentences they tend to base their judgments on lexical information. However, older typically-developing children and adults tend to base their judgments on the prosodic information that reflect the real intent of the speaker. The purpose of the present study was to assess the ability of 24 HFAA to use prosody in order to understand the meaning of the speaker in lexically-prosodic congruent and incongruent conditions. The participants included 12 HFAA that were integrated in regular schools with typically developing children, and 12 HFAA that studied in a special school for adolescences on the autistic spectrum. Both groups of HFAA differed significantly on their scores in the Autism-Spectrum Quotient (AQ) i.e. a measure of autistic traits. Additional Thirty-two typically developing children (TDC) aged 6 to 9 years of age and 17 adults aged 20-26 years of age were also tested. The participants were asked: a) to judge the emotional meaning of words (sad/happy) based on lexical or prosodic content alone (when prosody/ lexical dimensions of the words were neutral, respectively), b) to decide on the emotional intent in lexical-prosodic congruent and incongruent conditions. The results showed that both groups of HFAA judged the emotional meaning of words accurately when the words included only one type of information (lexical or prosody) or when the two types of lexical and prosodic information were congruent. In the incongruent condition, only HFAA that learn in regular schools showed a statistically significant preference for judging words based on prosodic information. HFAA that learned in a special school did not show a statistically significant preference for judging the words based on prosodic information, similarly TDC 8 to 9 years of age. The results of the present study suggest that: a) there is an association between the level of function of the HFAA in every-day life and their ability to process prosody, and b) the ability to process prosody in incongruent conditions can be a sensitive measure for the degree of autistic characteristics in HFAA. Abstract for Paper 5: Executive Functions: The Occult Variable in Reading Disabilities Struggling readers view reading as a visual process with decoding as the goal while effective readers view reading as thinking with comprehension as the objective. They get that comprehension needs depend on the given text and task, they choose effective strategies, and allocate attentional and memory resources accordingly. Tunmer (2008) found that many students with reading disabilities are identified with persisting reading comprehension problems even after intervention designed to prevent/remediate their difficulties. Why might that be? This presentation will stress that the crucial difference between effective and struggling readers/ learners is their metacognitive competence, and self-regulation skills, i.e. executive functions (Schraw and Moshman, 1995; Williams, J.P. 1998).
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Schraw and Moshman note that these have a long developmental trajectory, and adults tend to have more knowledge or awareness about their own cognition and are better able to talk about that knowledge than do young children. However, children as young as 6 years can reflect on their own learning providing they are familiar with the information. A multipleperson case study that includes narratives (based on narrative medicine paradigm, Columbia University, 2013) will be presented to demonstrate the reciprocal connections between language, reading, and executive functions of struggling readers, and to highlight their persistent difficulties in reading, executive dysfunctions, poor self-reflection processes, and limited awareness of how to do school (Westby, 1997). The theoretical framework used here is Vygotskian (Vygotsky, 1989): language is pivotal in metacognitive and self-regulation processes; these develop via guided dialogue with teachers. Executive functions have a reciprocal influence on language processes, and consequently affect reading/learning (Singer & Bashir, 1999). Research shows that improved executive functions impact positively on learning to read and reading to learn (Armbruster, Echols, & Brown, 1983; Singer & Bashir, 1999). The significance and implication for intervention and education is clear: evaluation of students language and reading competence without examining and uncovering their executive dysfunction in self-regulation and the metacognitive domain is inefficient and insufficient. Explicit braiding of reading instruction and metacognitive processes improvement is critical in the combat against persisting reading and learning disabilities, and this can best be achieved in the clinic and the classroom using the Vygotskian dialogic pedagogical framework. Abstract for Paper 6: How Early Language Phenotypes Correlate With Later Linguistic Abilities: Variable Predictive Factors for Later Language Pathways Early language delay has frequently been associated with persistent linguistic challenges spanning into school age years. It has been suggested cross linguistically that an early language delay between ages 24 to 28 months may or may not affect later language skills depending on a number of cluster factors one can combine to determine the childs not so innocent early linguistic precaution. Looking into the each childs linguistic phenotype one needs to keep in mind that language development (typical or atypical) follows a dynamic system path suggesting that variable and different linguistic characteristics surface as a function of each particular age level. The current 5-year longitudinal investigation has been examining the linguistic skills of children labeled as late talkers on the bases of restricted expressive vocabulary at intake ages of 28 months. Data analyses included various parameters such as expressive and receptive vocabulary, phonetic inventories, MLU-W etc. Cluster predictive factors for language outcomes at age 4 years included phonetic inventories, phonological skills as well as familial history in the form of behavioral genetic history analysis (pedigree analyses). One additional, albeit, interesting issue emerging from this work is the need to develop general linguistic and epigenetic clusters, as well as language specific parameters that can be combined in the diagnosis and prognosis of children with early delay. Finally, particular focus is given to issues related to the persistence of phonological immaturity in these youngsters and its impact on lexical access, semantic representations, speech intelligibility, possibility for apraxia of speech and/or specific language impairment Learning outcomes: Describe the neurological underpinnings for the various aspects of theory of mind; Discuss the effects of maltreatment and prenatal alcohol exposure on social cognitive skills; Describe how eye gaze is involved in the communication process; Explain how the ability to process prosody in incongruent lexical-prosodic conditions can be a sensitive measure for the degree of autistic characteristics in HFAA; Discover the relationship between executive functioning and student learning and performance.
loss for adults with ID; know by comparison the significantly less prevalence rate of hearing loss for people without ID in the general population; understand the significant amounts of sensorineural hearing loss, conductive/ mixed hearing loss and ear wax in external ear canals of adults with ID; recognize the need for annual hearing and ear canal examinations for all adults with ID, along with the need for parents/caregivers/primary healthcare personnel to serve as advocates for such annual examinations and immediate follow-up care as needed.
FINDINGS OF STUDIES ON COMMUNICATION DISORDERS IN PERSONS WITH INTELLECTUAL DISABILITIES KATRIN NEUMANN (1) - DENISE ROSENBERGER (2) JAN-PETER THOMAS (2) DEPT. OF PHONIATRICS AND PEDIATRIC AUDIOLOGY, CLINIC OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY, RUHR-UNIVERSITY OF BOCHUM, BOCHUM, GERMANY (1) - CLINIC OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY, RUHR-UNIVERSITY OF BOCHUM, BOCHUM, GERMANY (2)
Abstract: Persons with ID are at an increased risk for communication disorders including peripheral hearing loss, central auditory processing disorders and language impairments. To further investigate these disorders three studies were conducted during the German Special Olympics Summer Games in Munich in 2012 as well as in residential homes. One study compared the ability of persons with ID to self-asses their pure tone audiometry (PTA) thresholds by an adaptive PTA screening procedure (Magic, device Sentiero, Path medical GmbH) which is designed like a computer game. The PTA thresholds as obtained in 118 persons with ID by the adaptive self-assessment at 1000, 2000, and 4000 Hz for each ear were compared with the respective thresholds gained by a conventional PTA which was performed by audiological professionals. For all six comparisons high correlations with correlation coefficients ranging between and .43 and .84 (p<0.001) were found. The thresholds as obtained with the Magic were all between 0.2 and 5.8 dB HL below the PTA thresholds, confirming that most persons with ID are able to judge their peripheral hearing on a tone level and even more sensitive than with a conventional PTA. Furthermore, to assess central auditory processing abilities, a psychoacoustic test was developed as an electronic memory game and implemented into the Sentiero device (Neumann, 2012). With an adaptive three-alternative force-choice paradigm in three subtests the discrimination thresholds for non-speech stimuli (tone duration, intensity, frequency) were determined and in two further subtests those ones for speech stimuli (place of articulation and voicing of consonants). The test was performed with 51 persons with ID. Elevated thresholds for both non-speech and speech stimuli were assessed. Mean thresholds for tone duration were 161.4 ms, for frequency 189.2 Hz, and 8.3 dB for tone intensity as measured for right ears. For comparison, the respective values for non-disabled persons are 29.5 ms, 14.2 Hz, and 2.7 dB (Ludwig, 2008). The mean number or correct answers from 12 possible answers were 6.7 for place of articulation and 6.3 for voicing of consonants (right ears). Hence, a disturbed cerebral auditory processing has to be expected regularly in persons with ID. in another study, grammatical abilities of 249 persons with ID were tested by assessing their ability to produce correct plural forms of nonsense nouns. Pictures of funny monsters were presented to the subjects and they were asked, for example This is a Malli. And these are two(Mallis)? Most of the tested subjects had no concept for the plural production. They either produced wrong plural suffixes or did not change the singular forms or changed the latter completely. For the best item only 45 % correct answers were given. Together, hearing disorders, central auditory processing disorders, and language disorders restrict the communication abilities of subjects with ID and should either be prevented by regular audiological and ontological checkups or treated properly (hearing disorders) or require an adapted communication. Learning outcomes: judge the prevalence of communication disorders such as hearing disorders and central auditory processing disorders and their sequelae for language abilities, functioning, activities and participation, and for general quality of life of persons with intellectual disability; compare the high prevalences of hearing disorders in persons with intellectual disabilities with those of mentally healthy populations and explain their causes; evaluate the opportunities of diagnosing hearing disorders and central auditory processing disorders in persons with intellectual disability; discuss the status of grammatical concepts in persons with intellectual disability; understand the role of adequate verbal communication with persons with intellectual disability.
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INTELLECTUAL DISABILITIES AND HEARING LOSS GILBERT R. HERER (1) GEORGE WASHINGTON UNIVERSITY, CHILDRENS NATIONAL MEDICAL CENTER, WASHINGTON, DC, UNITED STATES (1)
Abstract: Undetected/untreated hearing loss imposes significant limitations upon individuals with intellectual disabilities (ID). It can interfere with cognitive development, impede communicative and social interactions, and limit vocational aspirations. Over the past decade, the hearing of 9,961 people with ID was evaluated at Special Olympics sports events. This report provides outcome findings. A striking 24% of hearing loss was found, 1.4 times greater than the general population of similar ages (18 to 55 years). Most hearing loss was previously undetected, unserved or undertreated. Thirteen percent have sensorineural hearing losses, and most could benefit from hearing aids. An additional 11% showed conductive/mixed losses needing medical attention. Further, ear canal examinations revealed that 41% of all persons with ID, not just those with hearing loss, exhibited the presence of significant ear wax. These overall outcomes highlight the need for parents, caregivers, primary care physicians, other healthcare providers and teachers to be informed about high prevalences of hearing loss and ear canal hygiene problems among people with ID. They need to serve as advocates for annual hearing and ear evaluations, and to assure immediate interventions once hearing loss and ear canal issues are identified. Learning outcomes: know the hearing screening/testing protocol for identifying hearing loss and ear canal conditions of large groups of people with intellectual disabilities (ID); understand the high prevalence rate of hearing
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NEW PROCEDURES IN PHONOSURGERY ANDREA RICCI-MACCARINI (1) - ANGELO GHIDINI (2) FLAVIO PIERI (1) - ALFONSO BORRAGAN (3) GIOVANNI DE ROSSI (4) - MASSIMO MAGNANI (1) ENT DEPT, BUFALINI HOSPITAL, CESENA, ITALY (1) ENT CLINIC, UNIVERSITY OF MODENA, MODENA, ITALY (2) PHONIATRICS AND LOGOPEDICS CENTER, PHONIATRICS AND LOGOPEDICS CENTER, SANTANDER, SPAIN (3) ENT AND PHONIATRIC ENDOSCOPY SERVICE, ULSS 20 VERONA, VERONA, ITALY (4)
Abstract: The 3 main phonosurgical techniques that we employ for the treatment of voice disorders are phonomicrosurgery, thyroplasty and fiberendoscopic phonosurgery. The new procedures that can be considered as real innovations in the different approaches are: - for the phonomicrosurgery, the Freeing of the mucosa technique proposed by Bouchayer, the injection laryngoplasty and the use of the CO2 laser with the Acu Blade software; for the thyroplasty, the use of the Montgomery implant in particular in the reconstruction of the vocal fold after total cordectomy; - for the fiberendoscopic phonosurgery, the injection laryngoplasty, the use of the KTP laser and the CO2 laser with flexible fibers; The fiberendoscopic technique is an office-based phonosurgical procedure, with a minimally invasive approach. Learning outcomes: The participant will be informed about the new procedures which now are employed for the surgical treatment of voice disorders. We will show videoclips of clinical cases and the instrumentation employed for performing the new phonosurgical procedures under local or under general anaesthesia. In particular the participant will learn the office based phonosurgery, which is very useful for the phonosurgeon in order to solve many voice problems with a minimally invasive procedure.
FP22
TRAINING OF COMMUNITY HEALTH AGENTS TO USE RISK INDICATORS FOR SYMPTOMS IN WRITING AND SPEAKING BRUNA DIOGENES (1) - REGINA MARIA FREIRE (1) FUNDACAO SAO PAULO, PONTIFICAL CATHOLIC UNIVERSITY OF SAO PAULO, SAO PAULO, BRAZIL (1)
Abstract: AIM: The purpose of this study is to analyze the education process of Community Health Agents (CHA) to use risk indicators for symptoms in speech and writing, during home visitations. An unfolding of this aim is to highlight the possibilities and limitations of these indicators in the detection of risks for the development of language disorders. METHOD: a training course was administered for 42 community health agents, comprising six (6) family health teams, belonging to the North Health Department of So Paulo. In order to support the development of the program, sheets about risk indicators for the speaker and the reader / writer and two questionnaires (a pretest and a posttest) were handed out. The program involved three steps, in a total of 12 hours of training. Children identified as being at risk by the CHA were made part of a group concerning health promotion in language and the ones with the highest risks for developing oral and / or written language disorders were referred for specific care. RESULTS: The training proposal was able to bring the theory on the risk indicators closer to the personal and professional experiences of health agents. By identifying children at risk for language development, promotion actions and interventions can be structured. Learning outcomes: To share the current situation of Public Health in Brazil, particularly in So Paulo; To share the proposal of risk indicators for the development of language, speech and writing that can be discussed and understood by listeners as an alternative form of action in the health of both the Mother and Child; From the discussions with the participants we would like to listen to their suggestions as assets to the educational proposal presented; To highlight the uniqueness of the use of indicators in the field of oral and written language, primarily from the perspective of language as constitutive of the subject.
both the disorder reduction and the full development of the persons potential. Based on these assumptions, a global intervention methodology for subjects with LD is presented. Beyond working on the areas weakened by the disorder, it aims at fostering giving importance to the person, through the valorization of their strengths within an environmental context. The proposed intervention is integrated and consists of three levels: rehabilitative (strengthening of insufficient skills and treatment of psychopathological aspects), habilitative (acquisition and strengthening of specific functions) and educational (promoting the persons psychosocial growth and the activation of environmental resources). The intervention starts with a global evaluation phase determining, within the aforementioned levels, the areas which need intervention and strengthening. The rehabilitative project includes the sharing of therapeutic goals with family and school (familiar counseling and design of an individualized syllabus with the teachers). If necessary, a group therapy covering both emotional (motivation, self-esteem, acceptance of the disorder) and psychopathological aspects is also offered. According to the age groups of the subjects and to the goals that have been set, the project includes the design of a habilitative program working on study skills through the use of compensatory tools and a metacognitive training. In order to plan a program which takes into account the person and which views the environment as the basis for an individual growth, rehabilitative and habilitative interventions are conceived within the framework of a broader educational project including informative and formative courses for families and schools. There are also a series of activities allowing the students to challenge themselves and their skills in contexts which are stimulating and alternative to the classical therapy. Students are encouraged to take part in outside activities, from which people with LD are generally precluded. An example of these activities is the setting up of a newsroom collaborating with a publishing house for the proofreading of children storybooks and the creation and publication of a monthly magazine. In addition to this, the program offers the possibility of working in an LD specific afterschool group and informative and formative courses on the use of compensatory tools. These courses, along with the informative and awareness courses, also involve parents. In particular, the importance given to the person, rather than to the disorder and the environmental context in which the proposed methodology is realized increase the effectiveness of the rehabilitative treatment reducing the psychopathological risks associated with LD. Learning outcomes: Presenting a global intervention methodology for subjects with LD, based on the Consensus Conference guidelines; Fostering giving importance to the person, through the valorization of their strengths within an environmental context; Presenting a series of integrative activities allowing the students to challenge themselves and their skills in contexts which are stimulating and alternative to the classical therapy.
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PLAYING AS A HEALTH PROMOTION STRATEGY IN PRIMARY CARE JANAINA VENEZIAN (1) - REGINA MARIA FREIRE (1) FUNDACAO SAO PAULO, PONTIFICAL CATHOLIC UNIVERSITY OF SAO PAULO, SAO PAULO, BRAZIL (1)
Abstract: Objective: to present a proposal of a workshop for children, focusing on playing as a possibility of action for the speech and language specialist in the field of health promotion, alongside the participants of the Family Health Strategy (FHS). Method: Description of the construction and operation of the group of children in the Basic Health Unit (BHU) Vila Terezinha. The group for children is open and occurs monthly in a hall at the Independent Presbyterian Church in Vila Terezinha, located in the Brasilndia area, lasting 2 hours. On average, 25 children and 10 parents attend each group meeting. The strategies used are popular games, theater, storytelling and crafts. The insertion of the speech and language therapist from the Family Health Support Nucleus (FHSN) of the BHU, occurs both through participation in the group, with the children and their families, and later, in the discussions, promoting interactions in between the members of the group and enabling teams family health strategy teams - Nurses and community health agents (CHA) to deal with issues regarding language. Results: In the period in between March 2012 and February 2013, 9 groups, 9 planning meetings and five meetings about the importance of playing during childhood were conducted. During the group sessions, the childrens involvement in activities was observed, as well as the surprise of the FHS team in realizing that simple proposals created bonds with children. The activity of playing promoted interaction among participants who, in that space, could play different roles than their usual ones, children were regarded as such, and not as adults, a position in which they often place themselves in their social context, those with problems in development could also enjoy symmetrical relationships with other children, the families were able to play and talk about their stories of childhood playing, and, thus, reframing them. Health professionals such as nurses and CHAs who, in the process, planning meetings, and discussion groups, could explore their creativity and other ways to treat health, sometimes playing with puppets or playing hopscotch, and finally value and an understand in a different way how their proposals can influence child development and family relations. Conclusion: The children group proved to be an important tool for the speech and language therapist in promoting health, affecting children, their families and family health teams, promoting social inclusion and citizenship.
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GLOBAL PATIENT CARE IN LEARNING DISORDERS: AN INTEGRATED AND ENVIRONMENTAL INTERVENTION METHODOLOGY ELEONORA PASQUA (1) - MANUELA CALANCA (1) MARTINA MASSINI (1) - EMILIANO RIDOLFI (1) C.R.C. BALBUZIE, SAPIENZA UNIVERSITY OF ROME, ROME, ITALY (1)
Abstract: Prognosis in Learning Disorder, intended as evolution of the disorder, school success and job integration, can be influenced by a series of factors, such as the functional profile of the subject, the method used in structuring the specialized intervention (both in terms of times and tools used), the kind of school requests and the way in which the disorder is managed by the family. In defining care criteria, the Italian Consensus Conference has specified that the intervention must be integrated and must promote
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Learning outcomes: Exposing how Public Health functions in So Paulo, Brazil, particularly in the segment of health promotion in speech and language therapy, Exposing the structuring, organization and implementation of a childrens play group as a health promotion action; To share the experience of the FHSN Speech and language therapists in Basic Health Units (BHUs) in the outskirts of So Paulo.
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AN ILLUSTRATION OF GRAPHIC SYMBOL PRACTICES OF SPEECH AND LANGUAGE THERAPISTS AND TEACHERS ELIADA PAMPOULOU SALOWM (1) - PANAYIOTIS ANGELIDES (2) RESEARCHER, PHD STUDENT, UNIVERSITY OF NICOSIA RESEARCH FOUNDATION/ KINGS COLLEGE LONDON, NICOSIA, CYPRUS (1) - PROFESSOR, HEAD OF THE DEPARTMENT OF EDUCATION, UNIVERSITY OF NICOSIA, NICOSIA, CYPRUS (2)
Abstract: Since the 1960s, graphic symbols have been mainly used to support pupils with communication difficulties and were usually found in special needs schools examples include the Blissymbol system and Picture Communication Symbols set. However, it has also been suggested that graphic symbols can support learning to enable pupils to access the curriculum and participate in classroom activities (Abbott, 2000, Detheridge and Detheridge, 2002, Greenstock, 2009). These are examples of symbol practices that can be found in some mainstream schools (Pampoulou and Detheridge, 2007). So far, however, there is limited research focusing on the experiences of professionals who use graphic symbols in mainstream primary schools. The research questions proposed herein were: how do professionals make sense of the way they use graphic symbols; what are professionals perceptions about graphic symbols; and to what extent do speech and language therapists and teachers work closely in order to support their students in mainstream schools. A qualitative design was employed with a focus on interpretative phenomenological approach (Smith, 2004). The main method of data collection was semi-structured, in depth interviews, although other methods were employed (observations, visual evidence, and the researcher keeping a reflective journal). Participants were identified through a postal survey (questionnaires) conducted in two Local Authorities in England and in Cyprus. Nine participants were recruited as the case studies of this research. Participants were from different professional backgrounds, including speech and language therapy, special education and nursery. Key findings suggest that the professional role of participants influences the way they use graphic symbols. It was the goal of all participants to support their students in coping with their difficulties; in addition, to enable them to be further included in mainstream education. Other findings suggest that all professionals follow a process of reasoning which incorporates information about the student, goals/objectives and the different ways that graphic symbols can be used. Further research is needed in order to test the findings of this research among a wider population. The project is co-funded by the Republic of Cyprus and the European Regional Development Fund of the EU through the Research Promotion Foundation of Cyprus. Learning outcomes: Familiarisation with the different available graphic symbol sets and systems; Familiarisation with the different ways that graphic symbols can be used (both in special and mainstream education); An exploration of the beliefs of speech and language therapists and teachers about graphic symbols; An exploration of the features that can promote or prohibit collaboration among professionals who work in the same school setting.
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CRITERIA FOR DESIGNING ARABIC ASSISTIVE AUGMENTATIVE COMMUNICATION SOFTWARE FOR DYSPHASIA PATIENTS AMAL DARWISH (1) HEARING AND SPEECH INSTITUTION IMBABA CAIRO, PHYSICAL MEDICINE & REHABILITATION HOSPITAL IN KUWAIT, CAIRO, EGYPT (1)
Abstract: Assistive Aim of the work This project use new technology, to design the computerized Arabic verbal, and non- verbal software to help the aphasic Arab people, by introducing the new technological facilities in order to start with simple audiovisual programs (multi-sensory channel stimulation approach programs). To give the chance for the aphasic patients and their families by which they can overcome their communicative problems. In these software wenapplied the computerized Arabic aphasia therapeutic program to *100 right handed medically stable patients (male & female) dysphasia patients. *The program will applied as soon as possible after the brain incidence, as the patient will be in the recovery stage and the stimulation of the language & mental area will be more easy before the stationary stages). * Age will vary from 11-70 years old. * The Arabic language is the mother language for the patient from different Arabic countries. * Different etiological factors of the brain insults. *Another 100 patients matched in all previous criteria treated with old traditional therapeutic programs such as 1- Environmental language intervention. 2- Wepman`s thought centered therapy 3- Melodic intonation therapy. 4- Self adjusting therapy. 5- Manual Multi-sensory approach method. *Evaluation Schedule 1- Careful history taking. 2-Neurological examination. 3-Vocal tract examination. 4-Neurological investigations. 5-Psychometric
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evaluation test may be applied when the patient cognition is affected or there is mood or behavioral changes. 6-Audiological & ophthalmologic consultation when needed. 7-Language test (Kotby ET AL;1980). As follow 1-Expressive language: * Auditory memory span. * Automatic speech. * Spontaneous speech. -Words finding difficulties. -Preservation. -Repetition. -Disturbance in form, contents, syntax, and Prosody. 2-Understanding speech, This may be gesture, question, order and token. 3-Understanding written text. This could be Questions, Orders & Matching. 4- Reading. Test for reading letters, words and text. 5-Writing Names,Composition &Dictation. 6-Calculation simple & compound. This is Dysphasia test curve (example for the curve which will be done for every patient before & after the training). Kotby.et al;1980 Therapeutic Plans *40 sessions will be applied in 4 months duration 3 sessions /week. 30 individual sessions to start the facilitation of the improvement of the communicative skills. 10 group sessions in order to prepare the patient to communicate with others with same condition for psychological support. N.B A number of factors may influence the number of consecutive therapeutic weeks on which an individual client enrolls (such as family and personal commitments, travel plans, holidays, and need for a rest, all may influence the design of the programs duration). Patronized Plan for the Software Plane will be designed for each patient according to his physical condition, daily activity needs, and his educational level. Based on English augmentative assistive communication devices such as - Message mate word+. - Speaking dynamically pro. - Spring board etc Interactive computer therapy provides numerous of advantages over traditional paper and pencil modalities. These include: Consistent presentation and feedback ; Increased number of trials translating into more therapy. Opportunity to learn vocational skills, like word processing or data entry. Opportunity to use software programs which reinforce treatment strategies. Increased level of independence enjoyed in accomplishing computer practice. Supportive group setting decreases reluctance to use computers. Opportunity to practice new skills on the computer, such as spell check or speech synthesis. It could be used in an Individual sessions or group sessions as 1- Individual therapy sessions focus upon the rehabilitation of speaking, listening, reading and writing, as well as associated problem areas such as memory deficits. Goals in these areas are individualized and may target the recovery of specific functions or the development of alternative compensatory strategies. 2- Small group therapy sessions offer clients opportunities to apply new communication skills to conversational contexts. A therapist mediates these interactions and supports each client in the pursuit of individualized goals for conversational participation. Therapy goals: The therapy may include improving skills in attention, comprehension, written and oral expression, speech and voice production, problem solving, and vocational skills. Therapy services are designed for the individual clients needs and may include language production, functional to high-level language, and language comprehension of simple and complex communication. Use of compensatory strategies and therapeutic strategies such as Melodic Intonation Therapy, Computer-aided therapy may supplement standard language therapy.Putting in mind some basic roles to reach the maximum benefits of the management program - Aim of Computerized Arabic Training software. An important component of our Computer Training Programs (software) is 1- It is Arabic software which will be patterned to meets the Arabic patients needs to use the modern technology with ease. 2-The patient can use it any where with a variety of hard ware according to his demands and his social level. 3-There is on-going interaction between the therapist, client, and computer. 4-It can be upgraded according to the needs of the patient & circumstances. 5-The clinician has more time to devote to actual therapy because data collection and analysis of computer therapy are much less time consuming for the clinician than more traditional modalities. The dysphasia test will reapplied to each patient after 4 months (40 sessions). Documentation and Reporting: 1- Reported medical history, and neurological status. 2 -Score for the first & second Dysphasia test with statistical graphing. 3-The development of the individualized treatment plan(with wide selection of software available and tailored by the clinician) to specific client goals &tailored as patient needs as follow. The *1st level: semantic groups level On which the patient can see 100 picture with written text labeling the photo & there it wa was tagged with voice signal suitable to the patient. Considering following points. Patient Arabic accent.(Egyptian, Kuwaiti, Jordanian, etc.) Acoustics augmentation (It have melodic rhyme &volume could be modulated according to the patient hearing level) to stimulate auditory reception, perception and processing. Visual augmentation & stimulation. (The picture is clear with attractive colors could be adjusted with the patient culture) to stimulate to stimulate visual sensory and psychic areas. It will be in categorizing as it will stimulate different receptive expressive language aspects in all its functional use most of the daily living needs and activity. The correspondent written text labeling each picture written in the native language of the patients. To stimulate patient language with reading as well as visual and auditory stimulation. English written text as there was a lot of caregiver for patients are talking English, as the patient may need to print it out & use it as communicative method at the beginning of the therapy or with failure of developing fluent functioning speech. It was edited in a simple non sophisticated program to be easy to handle with the patient, who may have so sort of physical disability. Key board and mouse for left handed could be advised for patient to use it in ease. If the patient has some difficulties to handle program, family member can taught to help him. Sound could be used on or off in more advanced stage. For facilitation purpose for the patient. When the patient receptive score more than75 %& expressive core reach more than 50%, shifting to next level,(receptive score by identifying objects and
expressive by uttering the correct words). * Level 2 2words sentence level With a different kind of two words sentences are added collecting numerical sentences, adjective sentences, verb sentences. It will be tagged with voice and written text as in 1st level. Syntactic component will built up in this level with no scoring as the patient capability and length of the sentence will mislead the scoring at this level. It will include 100 picture for testing the patient receptive and expressive skills and the patient The patient receptive score reach 50%& expressive score reach to 25% shifting to next level, could be achieved. *Level 3 long sentences level At this level score mainly to elongate the patient uttered sentences in order to build up, a highly function expressive skills, for such patients &to correct his semantic, syntactic & pragmatic aspects for his receptive & expressive skills as follows. Groups of pictures with noun and verb tens sentences with no animation tagged with text and voice. Group of pictures not tagged with written text to give the patient the chance to improve his active speech performance. Group of complex animated picture to discuss with the patient, to encourage the receptive expressive semantic and pragmatic component of his speech capability. There will be mounting in task difficulties according to the patient capability & educational level. Reading training will start at this level. Writing trials will start at the level of untagged pictures &it can start from semantic and increase in difficulty level. Writing could be on the paper or key board and we can add a different hard ware to help the patient to use the computer by any mean (hand , head ,leg , blowing or even eye blinking) with different kind. *Level 4 ( Arabic Video-phonetic software) Which can help to correct the associated paraphasia, and dyspraxia if it is associated with other type of dysphasia. It is a software recorded for normal male &female during uttering the different Arabic phoneme (with 3 syllabic utterance associates /a/,/i/&/u/) which is commonly used in Arabic language to facilitate the utterance of the patient although it is the 4th level it could be used in association of the previous 3 level according to the patient situation. As apraxia is an important challenging problem, may facing the patient during his trial for active speech. Family Role during the therapy period We give the patient caregiver a copy from the program level and teach him how to use it how to help the patient to train daily at least 1 hour per day. NB. Computer training may also include learning to use technology for educational, and vocational pursuits.
Learning outcomes: State the relationship between oral hygiene and overall health, including pulmonary health; Describe the role that speech-language pathologists can have in developing training programs for oral care; Discuss the success of an education-based model for increasing performance and documentation of oral care.
FP27
HOW DOES A SINGER COPE WITH VOICE PROBLEM? GISELE OLIVEIRA (1) - CAMILA PASSOS (2) - MARA BEHLAU (2) CEV - CENTRO DE ESTUDOS DA VOZ, SAO PAULO, BRAZIL, TOURO COLLEGE, NEW YORK, US, SAO PAULO, BRAZIL (1) CEV - CENTRO DE ESTUDOS DA VOZ, SAO PAULO, BRAZIL (2)
Abstract: Purpose: Investigate coping strategies used by classical and popular singers with vocal complaint and vocal symptoms and check the relationship among coping and vocal complaint and symptoms. Methods: 47 singers with vocal complaint, 26 popular singers (20 women and 6 men with mean of age 33.4 years) and 21 classical singers(11 women and 10 men with mean of age 41.8 years). The procedures carried out were: Identification and investigation questionnaire, Vocal signs and symptoms Questionnaire and the Brazilian version of the Voice Disability Coping Questionnaire - VDCQ. Results: The total VDCQ score did not show any significant difference among the groups (classical singers total score 55.8; popular singers total score 46.7 p=0.113). Classical singers reported using more problem-focused strategies than popular singers (p=0.006). The kind of vocal complaint did not show any relationship both with the type of coping strategy and with the VDCQ total score. The classical singers that reported having trouble singing high notes had higher VDCQ scores, (Score: 67.9; p=0.021) demonstrating that they try to deal with their voice problem by using more strategies. The presence of other signs and symptoms did not influence the type of strategy used nor the VDCQ score for both groups. Conclusions: Classical and popular singers use similar amount of coping strategies to deal with a voice problem, however classical singers use a higher number of problem-focused strategies. The kind of complaint and most of vocal symptoms do not have a relationship with coping strategies used by classical and popular singers. Learning outcomes: Learn the concept of coping; Differentiate emotionfocused strategies from problem-focused strategies; Discuss how classical and popular singers cope with their voice problems.
SS2
IMPACT OF TRAINING ON PERFORMANCE AND DOCUMENTATION OF ORAL CARE IN ACUTE CARE HOSPITAL NANCY SWIGERT (1) CENTRAL BAPTIST HOSPITAL, CENTRAL BAPTIST HOSPITAL, LEXINGTON, UNITED STATES (1)
Abstract: Oral care is typically the responsibility of nursing assistants, who often lack knowledge of the relationship of oral care to overall health and who rate the importance of oral care low compared to other duties they must perform. Speech-language pathologists can take a leadership role in developing a program to improve oral care in their health care facility. Nurses in critical care units are more aware of the importance of oral care than nurses in other areas of hospitals. A training program for nursing assistants was developed by speech-language pathologists in a community-based, not-for-profit hospital. A total of 106 nursing assistants from six different non-critical care nursing units were trained in small groups or utilizing a web-based training. A survey tool was developed to gather information on: demographics (e.g. years of experience, training in oral care); knowledge of the relationship between oral care and health; beliefs about oral care; practices. The survey was administered to patient care techs(nursing assistants) in each of the 4 identified medical/surgical (med/surg) areas. They then immediately attended an educational session designed to address knowledge, beliefs and practices. Training included background information on the relationship between oral hygiene and pulmonary health and other health conditions. Training was also provided on appropriate method for oral care. Demonstrations of correct technique were provided for oral care for: patients with natural teeth; patients completely edentulous; patients edentulous or partially edentulous with partial plates or full dentures. The participants were required to demonstrate how to perform oral care and their skill was documented on a validation tool. Baseline data from the electronic charting system were obtained regarding how often oral care was documented compared to other activities of daily living (e.g. bathing, dressing). This data was gathered from the 4 targeted units and two med/surg units where live training would not take place. Those latter two units were later trained with a web-based version of the training. We gathered this information to determine if education on oral care could increase the frequency with which oral care performance is documented. Three months after the training was completed, the survey was administered again. Some changes in knowledge occurred after the training, but specific knowledge deficits remained. Changes in practice were reported. Frequency of charting oral care was collected again on the 4 units who received live training and the two units who received web-based training. Charting data was obtained again at three subsequent points in time over the next year. Improvements in documentation of oral care remained better than baseline, with some decrease after the initial focus period. A pilot project was also initiated to incorporate the use of a volunteer to supplement the work done by the nursing assistants on one floor. The results of the pilot project will be described as well as current efforts to expand the use of volunteers in the performance of oral care.
FP28
VALIDATION OF THE ITALIAN VERSION OF THE SINGING VOICE HANDICAP INDEX GIOVANNA BARACCA (1) - GIOVANNA CANTARELLA (1) STELLA FORTI (2) - FRANCO FUSSI (3) FONDAZIONE IRCCS C GRANDA OSPEDALE MAGGIORE POLICLINICO, UNIT OPERATIVA COMPLESSA OTORINOLARINGOIATRIA, MILANO, ITALY (1) - FONDAZIONE IRCCS C GRANDA OSPEDALE MAGGIORE POLICLINICO, UO AUDIOLOGIA, MILANO, ITALY (2) - AUSL RAVENNA, CENTRO AUDIOLOGICO FONIATRICO, RAVENNA, ITALY (3)
Abstract: Singers constitute a specific population particularly sensitive to vocal disability, which may have a higher impact on their quality of life compared to non-singers. In 2007 Cohen et al. created and validated a specific questionnaire, the Singing Voice Handicap Index (SVHI), aimed to measure the physical, social, emotional and economic impact of voice problems on singers lives. Aim of this study was to validate the Italian version of the VSHI for singers. An Italian translation of the validated English version of the SVHI has been carried out and discussed with several voicecare professionals. The Italian version of SVHI was administered to 214 consecutive singers (91 males, 123 females, mean age of 32.6210.85). 100 of them complained of a voice problem, 114 were in a healthy voice condition. All subjects underwent a phoniatric consultation with videolaryngostroboscopy to ascertain the vocal folds conditions. Internal consistency, test-retest reliability, clinical validity to discriminate between healthy and pathological vocal fold conditions were assessed. Internal consistency of the Italian version of the VSHI showed a Cronbachs of 0.97. No redundancy was found for any item. The test-retest reliability was assessed by comparing the responses obtained by all subjects in two different administrations of the questionnaire: the difference resulted non-significant (p=ns). The total scores of SVHI in healthy singers resulted significantly lower than the one obtained in the group of singers with a vocal fold abnormality (p<0.001, t- test). The Italian version of the SVHI was successfully validated as an instrument with proper internal consistency and reliability for self-evaluation of handicap related to voice problems in singing. Learning outcomes: Know the specific impact of voice self-perceived handicap in singers; Understand the need of a specific validated tool for self-assessment of singing voice problems in different languages; Know the characteristics and the validity of the Italian version of the Singing Voice Handicap Index.
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EFFECTS OF VOICE THERAPY ON VOICE HANDICAP OF POPULAR SINGERS GISELE OLIVEIRA (1) - FERNANDA FERREIRA DA SILVA (2) FELIPE MORETI (2) - MARA BEHLAU (2) CEV - CENTRO DE ESTUDOS DA VOZ, SAO PAULO, BRAZIL, TOURO COLLEGE, NEW YORK, US, NEW YORK, UNITED STATES (1) CEV - CENTRO DE ESTUDOS DA VOZ, SAO PAULO, BRAZIL (2)
Abstract: Voice disorders can cause important impact on the well-being of singers, not only by compromising their daily and professional activities, but also their quality of life. Vocal self-rating questionnaires specifically focused on singing voice offer important information for measuring the impact of such disorder on singers life. They are also essential for assessing the perception of treatment outcome. The purpose of this study was to check the effects of a vocal rehabilitation program on the self-reported vocal handicap of popular professional singers with dysphonia. 49 popular professional singers, aged between 18 to 45 years, with an otolaryngologic diagnosis of behavioral dysphonia and indication for voice therapy were distributed into two groups: Experimental group EG with 29 singers submitted to voice therapy and Control group CG with 20 singers that were not submitted to voice therapy. All participants filled out the MSHI Modern Singing Handicap Index and self-rated both their speaking and singing voice in two different moments. The MSHI has 30 items and 3 subscales: impairment, handicap and disability. The vocal rehabilitation program delivered to the EG consisted of eight 40-minute individual sessions, on a weekly basis. The program addressed relaxation of the muscles of the scapular region, phonatory-respiratory coordination, mucosa pliability, softening of voice output, resonance balance, improvement of articulation, customized vocal warm-up and cool-down. The CG was submitted to the same assessment at the same period of time as the EG, however it remained without voice therapy in the waiting list for treatment. There was a statistical reduction of all MSHI scores (p<0.001) after rehabilitation for the EG (impairment: 16.7 to 4.4, handicap: 13.1 to 2.6, disability: 23.2 to 8.7 and total: 52.7 to 15.3). On the other hand, the CG had an increase of the MSHI scores in the handicap subscale (9 to 9.9, p=0.037) and total score (44.8 to 47.3; p=0.047); however the other two subscales did not present significant differences (impairment: 16.1 to 16.7, p=0.358, disability: 20.3 to 21.5; p=0.079). The EG had an increase of the number of singing class hours (hours/week), from 1 to 1.3 hours (p=0.005), while the CG did not present such change (from 1.2 to 1.3 hours; p=0.317). 69% of the individuals from the EG reported a better speaking voice after therapy, while only 10% of the individuals from the CG did the same. 72.4% of the singers from the EG reported a better singing voice after therapy and only 10% of the CG perceived an improvement on their singing voice. The reduction of the MSHI scores after therapy indicates that vocal rehabilitation may positively influence quality of life decreasing the perceived handicap and producing an improvement on the singers quality of life. Therefore, it may be considered as an important tool to be used in the voice clinic. Popular singers submitted to voice therapy presented a reduction of the perceive vocal handicap during singing, increase of singing class hours per week and a greater satisfaction with their speaking and singing voice. Learning outcomes: Understand the advantages of a specific self-assessment questionnaire for singing voice; Learn how a self-rating instrument can identify changes after voice therapy; Learn to measure the real impact of a voice deviation on popular singers life with dysphonia and how voice therapy changes their perception.
pattern of the laryngeal control. The horizontal axis represents the voice pitch, while the vertical axis represents the flow rate measured by a commercially available instrument. In this map, the relationship between the voice range and the flow rate is expressed. It is also possible to indicate the classification of vocal cord vibration patterns in this map. The pattern of vocal cord vibration at the boundary region of voice register change recorded by a high-speed camera (Nac:Memrecam GX-5Plus) will be shown during our oral presentation. The second is Voice-Map L-V(V:Vocal tract configuration) , comparing the estimated vocal tract configuration with the laryngeal control in term of degree of glottal closure estimated by Electroglottography (EGG). The horizontal axis represents vocal tract configuration, while the vertical axis represents the laryngeal control. In the vertical axis, the weaker glottal closure is shown upward. Therefore, the more strained voice is shown in the lower region, while the breathy phonation is represented in the upper region. It was found that the vocalization method is effectively expressed by using Voice Map E-L and Voice Map L-V. It was also suggested that the control of vocalization to create various patterns of voice could be designed by the use of the 2 maps. Thus, the use of these 2 maps appeared to be effective for an objective evaluation of vocal abilities of professional voice users. Learning outcomes: Basic studies of voice function by measuring physiological data including the flow rate, fundamental frequency of voice, and glottal behaviors(evaluated by means of EGG); Understanding of the coordination among the respiratory and laryngeal control and vocal tract adjustments; Possible application of the present result for future pedagological practice in voice training for professional voice users.
SS4
AN INTEGRATED VOCABULARY INTERVENTION APPROACH FOR CHILDREN WHO USE AIDED COMMUNICATION MARTINE SMITH (1) - SINEAD CARR (1) - JENNIFER OBRIEN (1) DEPARTMENT OF CLINICAL SPEECH AND LANGUAGE STUDIES, TRINITY COLLEGE DUBLIN, DUBLIN, IRELAND (1)
Abstract: Children using aided communication often struggle to acquire the vocabulary and literacy skills required to become effective communicators. Research with speaking children suggests that effective vocabulary intervention should incorporate explicit instruction within authentic learning experiences, addressing both conceptual and structural aspects of word knowledge. Story book reading offers an ideal context in which to nest targeted vocabulary intervention, particularly for young children. The aim of the intervention study reported here was to develop, implement and evaluate a vocabulary instruction programme for children who use aided communication. The goal was to apply an integrated intervention framework addressing receptive knowledge of target words, recognition of associated symbol representations, sight-word recognition of orthographic representations of the target vocabulary, knowledge of spelling and communicative use of the target vocabulary in structured and spontaneous interaction. The hypthesis explored in this study was that integration of word identification and communication intervention supports acquisition of word identification skills that generalizes across contexts. Using a framework described by Blachowicz and Obrochta (2005), opportunities were created to See, Hear, Analyze and Use target vocabulary linked to shared storybook reading. A set of 10 target words was introduced over a 12-week intervention period, structured around weekly group sessions with four children aged 6-10 who use aided communication. All participants attended a service for children with physical disabilities and used aided communication as a primary mode of communication. Target vocabulary was selected on the basis of frequency of occurrence, content relevance to story book activities, orthographic structure and communicative function and availability within each childs communication system. An additional set of 10 target words served as a comparison measure. Intervention centred on shared storybook reading and associated activities. Carryover activities within the classroom consolidated knowledge of vocabulary introduced within each group session. A single-subject quasi-experimental design was selected, due to the heterogeneity of the participants. Outcome measures included: identification of target words from an array of symbols; use of target vocabulary in structured clinical interactions; recognition of target vocabulary orthographic forms; and spelling accuracy of target vocabulary. All participants demonstrated gains across all aspects of vocabulary knowledge, although patterns of change varied within the group. Increases were also noted in non-target words that received incidental exposure during intervention. The results of the study suggest that an integrated vocabulary intervention approach that incorporates a focus on word reading, spelling, receptive knowledge and expressive use of symbols has a positive impact on the word-learning of children who use aided communication. Learning outcomes: to identify the unique vocabulary learning needs of children using aided communication; to describe key components of an integrated approach to vocabulary intervention; to describe the key adaptations that are required in introducing vocabulary for children with severe speech and physical impairments and plan activities relevant to this goal with this client group
SS3
EVALUATION OF PROFESSIONAL VOICE FUNCTION USING NEWLY DEVELOPED TWO TYPES OF VOICE-MAPS HARUHITO SAIDA (1) - MASAKO SAIDA (2) - HAJIME HIROSE (3) VOICE TEC VOCAL ART SCIENCE LABORATORY, SAIDA ENT CLINIC, OKURAYAMA 3-42-16 KOUHOKU YOKOHAMA KANAGAWA, JAPAN (1) - DEPARTMENT OF MUSIC COLLEGE OF ART, NIHON UNIVERSITY, ASAHIGAOKA 2-42-1 NERIMA TOKYO, JAPAN (2) - MEDICAL DEPARTMENT, UNIVERSITY OF TOKYO, HONGOU 7-3-1 BUNKYO TOUKYO, JAPAN (3)
Abstract: It is often the case that professional voice users do not show any noticeable vocal problem during ordinary voice evaluations at ENT clinic, mainly because those tests are usually performed to evaluate simple and easy phonation. In general, however, professional voice users use their voice in more effortful conditions during their performances. Further, professional voice users present a variety of vocalizations depending on the performing situation, and therefore, there is no single way in their vocalization. Thus, more appropriate methods should be necessary for evaluating their voice. As a preliminary approach to objective assessment of vocalization method in professional voice users, we developed two types of Voice-Maps, based on the concept that the regulation of voice is effected by cooperative controls of expiratory, laryngeal and vocal tract components during vocal performances. The present paper proposed the use of 2 types Voice-Maps for the assessment of vocal regulation of professional voice. The first Voice-Map is Voice-Map E-L (E:Expiratory control, L:Laryngeal control) comparing the flow rate during phonation as an indication of the expiratory function with voice pitch as an indication of the
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SS5
LINGUAL FRENULUM PROTOCOLS WITH SCORES IRENE MARCHESAN (1) CEFAC - POST GRADUATION IN HEALTH AND EDUCATION, CEFAC, SAO PAULO, BRAZIL (1)
Abstract: The tongue participates actively in the functions of sucking, swallowing, chewing and speech. The lingual frenulum effects the movement of the tongue. When the lingual frenulum cells dont undergo apoptosis completely during the embryologic development, the residual tissue may restrain the movements of the tongue. Differentiating the anatomical variations requires extensive knowledge of the anatomy of the tongue and the floor of the mouth in order to identify whether the findings may compromise the tongue movements and the orofacial functions. When health professionals evaluate the lingual frenulum, they diagnose it as normal or altered depending on the criteria used. Usually, professionals evaluate the lingual frenulum by observing the appearance and the mobility of the tongue. Some of the existing protocols evaluate the size of the frenulum, where it is attached, and propose objective measurements. Other authors focus on one or another specific item, which they consider a determining factor to diagnose frenulum alterations. As the tongue takes part in orofacial functions, aspects such as shape, size, and range of movements must be tested. Two protocols with scores were designed to evaluate the tongue and the frenulum. The content of the presentation consists of presenting and demonstrating the administration of two protocols: a lingual frenulum protocol with scores designed for infants and the other for children over 5 years old and adults. These protocols enable health professionals, such as: speech language pathologists, dentists and physicians to evaluate and diagnose lingual frenulum alterations. The protocol for infants is a two-part protocol designed to evaluate the lingual frenulum. The first part consists of clinical history with specific questions about family history and breastfeeding. The second part consists of clinical examination: anatomo-functional, non-nutritive and nutritive sucking evaluations. Evaluating simultaneously the characteristics of the lingual frenulum and the functions of sucking and swallowing during breastfeeding is important for an accurate diagnosis. This protocol provides assessment of the tongue shape, fixation, thickness, potential movements and functions. The protocol with scores for children and adults is designed to diagnose possible frenulum alterations, as well as to provide information to relate anatomical frenulum alterations to functional alterations. It consists of history and clinical examination. The history relates the subjects complaints and general identification questions. The specific questions investigate the relationship among the frenulum and other aspects, such as family history, breastfeeding, swallowing, chewing, oral habits, speech, voice and previous frenulum surgeries. The clinical examination is divided in two parts: the first investigates general aspects of the frenulum and tongue, and the second investigates the tongues mobility and position in the oral cavity, speech production and compensatory patterns used by the subject. According to the scores, the frenulum can be considered altered or normal. Both protocols have demonstrated to be an effective tool for assessing and diagnosing the anatomical alterations of the lingual frenulum and orofacial functions. Early lingual frenulum assessment avoids early weaning, future speech alterations, which may interfere with self-esteem, social and professional life. Learning outcomes: know the lingual frenulum definition and the importance of assessment; learn how to classify the different types of lingual frenulum; know the possible interferences of the altered lingual frenulum and consequences; understand the importance of using a protocol, and not only visual inspection;learn the criteria for assessing lingual frenulum using specific protocols for infants, children and adults.
coping. CONCLUSION: Teachers use more problem-focused strategies, both before and after treatment. The worse the voice-related quality of life is perceived, the more coping strategies are used. Learning outcomes: Understand the concept of coping; Differentiate emotion-focused strategies from problem-focused strategies; Discuss how teachers cope with their voice problems; Discuss the effect of voice therapy on coping strategies used by teachers to deal with their voice problem.
FP31
VOICE DISORDERS AND USE OF VOICE ACCORDING TO ROLE AND CONTEXT: IS THERE A RELATIONSHIP? N. ANGELILLO (1) - B. DI COSTANZO (1) - M. R. BARILLARI (1) U. BARILLARI (1) UNIT OF PHONIATRY AND AUDIOLOGY, SECOND UNIVERSITY OF NAPLES, ITALY (1)
Abstract: From our experience and according to literature data, the individuals with non-organic voice disorders show specific psychological traits and, particularly, an anxious and non-assertive personality, which is frequently associated with aggressivity and impulsivity. On the basis of these personality traits, we suppose that the individuals with functional dysphonia are not able to use adequately their voice in respect of the role and of the context. Probably, they tend to give an excessive importance to the volume of their voice, using it inadequately as an instrument to impose themselves. We underline the necessity of examining these aspects in assessment and treatment of functional dysphonia. Learning outcomes: the Participant will be able to: know influence of emotions and personality on the voice; understand relationship between emotional status, personality and voice problems: know the necessity of examining personality traits in assessment and treatment of functional dysphonia.
FP32
THE MEANING OF BELIEFS IN LEADING VOICE-INSTRUMENTVOICE COACHING FUTURE PRE-SCHOOL TEACHERS RAIJA PERKO (1) DEPARTMENT OF EDUCATION, UNIIVERSITY OF JYVSKYL, JYVSKYL, FINLAND (1)
Abstract: This presentation aims at stimulating discussion on the meaning of beliefs and mental aspects of voice production and to outline voice coaching tools used in voice education in teacher training. There has been much research on physical aspects of caring for the professional voice. Its also important to increase awareness of the meaning of mental processes in voice production. This presentation introduces some lines of teacher students own findings and reframings of beliefs behind mental processing strategies in leading voice-instrument. In voice coaching lessons future preschool teachers attitudes and mental processing strategies were compared to some of the lines and directions of master model, my mentors` Vilho Kekkonen who is 103 years old diploma singer, the oldest concertizing tenor singer in the world after Guinness record book. While student made ecological changes in a level of beliefs changes were heard also in a level of action leading the voice-instrument. Students own experiences were: I thought voice can be best controlled in the area of throat. Voice and air should let go freely in the body, you should not lead it too much. Voice -coaching lesson is really important and a must for us future teachers.
FP33
PRESCHOOL CHILDRENS ENGAGEMENT IN SPEECH AND LANGUAGE THERAPY SAM HARDING (1) - JANE COAD (2) - HELEN HAMBLY (1) LYDIA MORGAN (1) - NAOMI PARKER (1) - NORMA DAYKINI (3) SUE ROULSTONE (1) BRISTOL SPEECH AND LANGUAGE THERAPY RESEARCH UNIT, FRENCHAY HOSPITAL, BRISTOL, UNITED KINGDOM (1) FACULTY OF HEALTH AND LIFE SCIENCES, COVENTRY UNIVERSITY, COVENTRY, UNITED KINGDOM (2) HEALTH AND APPLIED SOCIAL SCIENCES, UNIVERSITY OF THE WEST OF ENGLAND, BRISTOL, UNITED KINGDOM (3)
Abstract: Traditionally, childhood and childrens lives have been explored solely through the views and understanding of their adult carers (parents/ grandparents/ guardians/ teachers etc) who claim to speak for children. This excludes the child from the research process. This view is being challenged by researchers and practitioners who acknowledge childrens right to be heard and believe that their voice should be valued in its own right. Children possess distinctive cognitive and social developmental characteristics which the researcher, wishing to use child informants, must consider during the research design and methodology. This can be challenging with very young children. It is important that children are recognised as integral to the process and practice of the speech and language therapy (SLT) interventions they receive and therefore that their views and experiences are understood. Although practitioners evaluate childrens engagement in
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DO TEACHERS CHANGE COPING STRATEGIES TO DEAL WITH DYSPHONIA AFTER VOICE THERAPY? GISELE OLIVEIRA (1) - RENATA BINDI (2) - FABIANA ZAMBON (3) MARA BEHLAU (2) CEV - CENTRO DE ESTUDOS DA VOZ, SAO PAULO, BRAZIL, TOURO COLLEGE, NEW YORK, US, SAO PAULO, BRAZIL (1) CEV - CENTRO DE ESTUDOS DA VOZ, SAO PAULO, BRAZIL (2) - CEV - CENTRO DE ESTUDOS DA VOZ, SINPRO SINDICATO DOS PROFESSORES DE SAO PAULO, SAO PAULO, BRAZIL (3)
Abstract: Teachers are at risk of developing dysphonia due to the high professional voice demand they have and little is known about the coping strategies they use to deal with their voice problem. PURPOSE: To investigate changes in coping strategies reported by teachers after eight sessions of voice therapy. METHODS: 22 female teachers and 1 male teacher between 27 and 50 years old (media=39.6) participated. The procedures performed were: an eight-session treatment program, administration of the Voice Disability Coping Questionnaire and the Voice-Related Quality of Life Questionnaire, and a pre and post-treatment voice perceptual analysis. RESULTS: Teachers perceived better quality of life related to voice after the completion of the eight sessions of voice therapy. They also reported using more problem-focused strategies both before and after treatment. There was a positive correlation between self-reported voice-related quality of life and
interventions as an on-going part of their assessment and evaluation, it is unusual for this to be an explicit part of their work. This study aimed to explore preschool childrens engagement with SLT interventions. Twenty-four children aged between 2;2 and 4;00, who had not received SLT input met in groups of four, in their usual preschool setting. Selected SLT interventions were undertaken with the groups. The environment and activities were video and audio recorded and an additional camera was worn by the children (on a headband), to provide a childs eye view. These recordings were subsequently analysed for behavioural markers of levels of engagement (e.g. eye contact). Following the SLT intervention, the children participated in a play-based/creative arts session, facilitated by an Arts Therapy Practitioner, involving methods such as music making or storytelling. The aim of this was to explore the childrens reflections on the SLT intervention. The SLT techniques were chosen following consideration of the cultural context, familiarity and likely responsiveness of the children and were those that SLTs had previously described during focus group sessions that are part of a broader programme of research to investigate SLT practice with preschool children. Each child attended a modal average of 4 (range 1 - 4) sessions, each lasting one hour. In excess of 72 hours of digital video data, field notes and audio files were collected. Framework Analysis was used to describe the childrens engagement using categories identified through the analysis process. Three iterations of analysis produced themes and contextual effects which form an overarching model of the childrens engagement in relation to the activities and resources used during the SLT interventions. The categories that emerged focused on elements of engagement including the childrens vocalisations, body language, watching and listening, as well as active and passive attention. Learning outcomes: Increased understanding of methodologies which enable childrens views to be understood; A framework for exploring preschool childrens engagement in interventions; Gaining a childs perspective on speech and language therapy interventions.
will present which interventions have been used with specific subgroups of children (both in terms of age and speech sound disorder subgroups). It will present the results of the quality appraisal showing the varying quality of research and make recommendations regarding the design and reporting of intervention studies for the future. The paper will also discuss the implications of the review findings for current practice. Learning outcomes: the use of speech sound interventions with specific age groups and diagnostic categories of preschool children; the quality ratings of the identified research studies; Attendees will participate in discussion of the implications for practice.
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STORY TELLING IN GREEK PRE-SCHOOLERS IOANNIS VOGINDROUKAS (1) - EVRIPIDES CHELAS (2) KONSTANTINOS PAPARIZOS (3) - ELENI KIVRAKIDOU (4) MEDICO PEADAGOGICAL CENTER, PSYCHIATRIC HOSPITAL OF THESSALONIKI, THESSALONIKI, GREECE (1) PRIVATE PRACTICE, IOANNINA, GREECE (2) PRIVATE PRACTICE, KASTORIA, GREECE (3) PRIVATE PRACTICE, THESSALONIKI, GREECE (4)
Abstract: Narration, or storytelling, is defined as orally presenting causally related events or an experience in temporal order (Hughes, McGillivray, &Schmidek, 1997; Peterson, 1990). Narrative discourse plays a critical role in the development of discourse and literacy, and forms the bases of many social interactions (McCabe, 1996). Narrative skills begin to develop in the preschool years and continue to be refined throughout childhood and school-age. The purpose of this study is to present and discuss the unique data, in Greek language, of childrens narrative abilities through a five picture event sequencing story. Results of the study indicate that Greek preschoolers scored very well in story sequence as well as in narrative abilities. In both variables more than half of the participants scored substantially well in all key factors of the assessment. Learning outcomes: The primary objective of this study was to examine the ability of story sequencing and the narrative skills based in this story in Greek preschoolers; Results of the study indicate that Greek preschoolers scored very well in story sequence as well as in narrative abilities; Sequencing results are high but may be higher if more participants take part; Narrative skills indicate a good narrative in terms of the number of words but there is no adequate context, syntax and grammar based on the age of the participants; Strength of the study is that this is the first study expressive ability is measured based on a specific picture sequence task and not in single pictures
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A SYSTEMATIC REVIEW OF THE INTERVENTIONS TO IMPROVE PRESCHOOL CHILDRENS PHONOLOGICAL AWARENESS AND SPEECH OUTPUT YVONNE WREN (1) - SAM HARDING (1) - JULIET GOLDBART (2) LYDIA MORGAN (1) - NAOMI PARKER (1) - ELIZABETH LEWIS (2) JULIE MARSHALL (2) - SUE ROULSTONE (1) BRISTOL SPEECH AND LANGUAGE THERAPY RESEARCH UNIT, UNIVERSITY OF THE WEST OF ENGLAND, BRISTOL, UNITED KINGDOM (1) - DEPTARTMENT OF HEALTH PROFESSIONS, MANCHESTER METROPOLITAN UNIVERSITY, MANCHESTER, UNITED KINGDOM (2)
Abstract: To date there have been a number of systematic literature reviews that have examined the effectiveness of interventions for children with speech sound disorders (SSD). Generally the results of these reviews have been encouraging although they have often highlighted the fact that much of the evidence is at a relatively low level and that therefore currently, the relative effectiveness of one intervention over another in particular instances is not clear. Furthermore, for interventions to be appropriately targeted to subgroups of children, it is important to determine which interventions are most effective with which children in which contexts. It was the purpose of this systematic review to assess these variables. This question reflects a realist perspective [1] which recognises that complex interventions targeting complex problems cannot necessarily be rigidly applied but will be adapted by individuals (i.e. therapists) for individuals (in this case, children). The review was part of a larger review investigating all interventions for preschool children with primary speech and language impairments. Thus the search strings were wide ranging and included key words pertaining to speech, language, communication, developmental disorders and paediatrics, as well as research design. Sixteen databases including Cinahl, Embase and Medline were searched, for peer-reviewed English-language publications, between January 1980 and November 2011. The search generated fifty five thousand two hundred and seventy one publications which were then reviewed and excluded, following Cochrane guidelines and specified inclusion/exclusion criteria, by a trained team of research speech and language therapists and psychologists. Inclusion criteria for study design were kept broad in order to allow for the exploration of contextual influences. Two hundred and four publications met the search criteria. The remaining publications were then quality assessed using the PEDro scale (Physiotherapy Evidence Database) and the Single Case Experimental Design (SCED) scale - critical appraisal tools examining factors such as clear eligibility criteria, random allocation, allocation concealment, blinding, baseline comparisons, intention to treat analysis, appropriateness of statistical comparisons [2,3]. A preliminary examination of the studies identified the primary focus of the intervention along with the key outcomes measured. From this, 81 papers were identified that focused on interventions for speech sound disorders. These 81 papers are the focus of this presentation. Manuscripts identified in the speech sound disorders section were predominantly case series and non-randomised, small group designs, incorporating such devices as multiple and staggered baselines, and AB(A) designs. There were also two retrospective reviews of case notes, seven single case studies and six randomised controlled trials. The number of children included in each study ranged from 1 to 1009, with a mean of 44 and a median of 11. The paper
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FP36
THE IMPORTANCE OF SPEECH THERAPY IN A SECTOR OF EARLY STIMULATION ON A NON-PROFIT INSTITUTION IN SOUTHERN BRAZIL VANESSA GIACCHINI (1) - ALINE TONIAL (2) UNIVERSIDADE FEDERAL DE SANTA MARIA, SANTA MARIA, BRASIL (1) UNIVERSIDADE DE PASSO FUNDO, PASSO FUNDO, BRASIL (2)
Abstract: The premature stimulation is defined like a therapeutic technique that approaches, in an elaborate way, several impulses that can interfere in the child maturation, with the objective of stimulating and to smooth the positions that help the motor and cognitive development in children with some disability. The premature stimulation is not a technique purely speech therapy, it evolves other sciences, such as physiotherapy, occupational therapy, psychology and it has as an objective to stimulate children with special needs in some cerebral fields: sensory, motor, cognitive, and concerning to language, and to guide the relatives in how to do this stimulation in an effective way. The aim of this study is to present the progress in the language and in the oral motor skills checked in children seen in the sector of premature stimulation of APAE Marau - RS, during the period March 2010 to March 2011. Eleven children were evaluated in the premature stimulation department, with the following diagnostics: 3 children with Down syndrome, 4 children with developmental disabilities and 4 children with Cerebral Palsy. The children`s age was between 0 and 3:9 months. To the language evaluation has been followed the Protocolo de Observao Comportamental (PROC). In the evaluation of the stomatognathic system used the specific protocol for assessment of these structures and skills. Those assessments were made with the permission of the parents or the responsible for the children. The results were analyzed in a qualitative way. All the children have presented progress in the language development and in the oral motor skills aspects. The children with developmental disabilities were the ones who present a better performance in the language development, going from simple attempts to talkative subjects, with sentences construction and significant increase of vocabulary. One of the children was discharged due the great progress obtained. The children with Down syndrome and Cerebral Palsy also have presented progress, but slower, and have started the use of words as well, but just one of the four children has managed to evolve to the level of sentence. The children with Down syndrome and Cerebral Palsy have got good progress relating to their oral motor
skills, showing improvement on the control of the saliva, tongue positioning, joining lips posture and oral breathing. It`s good to stress that all the children were included in the regular school, early childhood education, and that they were treated twice a week at APAE in Marau RS. These results highlight the importance of early stimulation in the early years of a childs life, emphasizing its role in brain maturation in children with special needs and underlining the role of the speech therapist in this work. Learning outcomes: Know the functioning of sector of early stimulation of a nonprofit institution in southern Brazil; Know the instrumentalization speech attendant to the sector of early stimulation; Verify progress with the children seen in the sector of early stimulation; Know the joint program between the speech therapist and physiotherapist in the sector of early stimulation.
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PROPOSAL OF SPEECH THERAPY BASED ON A MODEL OF ORGANIZATION OF LANGUAGE SYMPTOMS. A CASE STUDY. CINTHIA FERREIRA GONALVES (1) - REGINA MARIA FREIRE (1) FUNDACAO SAO PAULO, PONTIFICAL CAHTOLIC UNIVERSITY OF SAO PAULO, SAO PAULO, BRAZIL (1)
Abstract: OBJECTIVE: This paper aims to present a Case Study of a child with symptoms in oral language, undergoing speech therapy, sketching a speech analysis of the patient in a dialogical situation with the therapist. As an extension of this analysis, a proposal for speech therapy will be devised. METHODS: Speech sessions were recorded and transcribed from July 2010 to November 2011, of a six year old male child with symptoms in speech. The dialogue between the patient and the therapist was recorded and clippings were extracted followed by a phonetical prospect analysis. The therapeutical intervention followed the principles of the organization model of language symptoms, which assumes that these emerge in between a horizontal axis: writing, language and speech and a vertical axis: subject, Other, metaphor and metonymy. CASE: A case of a 6 year old male child with speech symptoms will be reported. The therapy followed the principles of the method above, in dialogical activities from the sanction procedure. The sanction which is a metaprocedure is defined as an action which point of view not only specifies the therapists management within the speech therapy clinic, but also distinguishes it from the psychoanalytic, psychological or medical practices. (GOUVA, FREIRE E DUNKER, 2011). After fifteen months the child is being discharged. CONCLUSION: the speech symptoms indicate changes in the language function inscribed in the translation operation, switching from one significant to another, keeping the same meaning, when the speaker produces a sound where the language requires another, and the therapeutic intervention, acting over the horizontal axis (writing, speech, language), shows effectiveness of the adopted model. Learning outcomes: Read a clinical trial in an innovative way, beginning on the proposal of a speech therapy organization model; Present a specific management of the speech therapist within the speech therapy clinic and distinguish it from the psychoanalytic, psychological or medical practices; Discuss the hypothesis of the sanction model for the speech therapy.
assessment against a group of 26 young people in mainstream secondary schools. Prevalence of SLCN amongst young people reporting to both Ealing and Hammersmith & Fulham YOSs was found to be in line with, if towards the higher end of, previous research in the UK at 88 per cent. In Italy all the subjects of the experimental group had difficulties at least in one of the tasks and 60% failed in the linguistic tasks while in the control group this happened only in 23% of the cases. Whilst some young people and key workers reported benefits from the therapy in informal interviews and surveys, these findings were not statistically significant and cannot be claimed to robustly demonstrate a link between speech and language therapy and positive outcomes. Case studies written by the HSSLT who provided therapy to the young people suggest an improvement for some participants, and particularly those with moderate SLCN. Many young people who took part and their key workers identified positive impacts following speech and language therapy, which have significant potential to improve quality of life. Further research, with a longer intervention period, a larger sample size and some enhancement to the SLCN assessments is needed to more robustly demonstrate the benefits of speech and language therapy for young people who have offended, particularly with regards to the longer-term outcomes, including the incidence of re-offending. Learning outcomes: understand the prevalence of SLCN in the population of young offenders; learn about one method of SLCN screening in adolescents and young people; identify the application of SLT expertise in Youth Offending Services; recognise the advantages of SLCN screening of young offenders; appreciate the need to train key workers to improve their communicative skills.
SS6
VOCAL FOLD PARALYSIS: A STRUCTURED VOICE AND SWALLOWING APPROACH GAETANO FAVA (1) - GISELE OLIVEIRA (2) COLUMBIA UNIVERSITY MEDICAL CENTER, THE INSTITUTE FOR VOICE AND SWALLOWING- PHELPS MEMORIAL HOSPITAL CENTER, NEW YORK, UNITED STATES (1) - TOURO COLLEGE, CENTRO DE ESTUDOS DA VOZ- CEV, NEW YORK, UNITED STATES (2)
Abstract: The vagus nerve paralysis is the most common neurological disorder. The incidence of vocal folds paralysis in the general population is not known. The left vocal fold is the most frequently affected, probably due to the fact that the left inferior laryngeal nerve is longer. Depending on the level that the lesion occurs, it can involve one single branch or multiple branches of the nerve; therefore it may affect voice, respiration, deglutition and airway protection. The goal of the present seminar is to discuss with the participants a structured voice and swallowing management approach for patients with vocal fold paralysis. We are going to present an overview of 7 different paralyses, but targeting only the ones in which voice and swallowing intervention are applicable and effective. A chart with the level of the lesion, effect on vocal folds, phonation, soft palate, resonance, associated signs and unilateral and bilateral approaches will be presented and discussed. Voice and swallowing treatment options will be provided separately and overlapping aspects will be outlined. The rationale for voice rehabilitation will be based on the following objectives: 1. reduction of translaryngeal airflow; 2.increase of vocal fold flexibility; and 3.increase of glottal resistance. The rationale for swallowing rehabilitation will be based on the following objectives: 1. improve airway protection and eliminate laryngeal penetration and aspiration risk; 2. introduce compensatory swallowing maneuvers and 3. improve overall pharyngeal and laryngeal function for swallowing. Several voice and swallowing techniques and exercises will be demonstrated and practiced with the participants. Learning outcomes: Learn to differentiate between the types of vocal fold paralyses; Determine which clients will be appropriate for voice or swallowing intervention, based on the position of the paralytic vocal fold; Understand and learn how to perform compensatory swallowing maneuvers; Understand and learn how to perform swallowing and voice therapy exercises
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SPEECH AND LANGUAGE DIFFICULTIES IN YOUNG OFFENDER POPULATIONS: A COMPARATIVE RESEARCH STUDY IN UK AND ITALY FOR SCREENING AND INTERVENTION RAFFAELLA CITRO (1) - HAZEL RODDAM (2) ANNA GIULIA DE CAGNO (1) - TIZIANA ROSSETTO (1) SARAH HENEKER (3) - KAREN BENEDYK (3) FEDERAZIONE LOGOPEDISTI ITALIANI, X, ROME, ITALY (1) UNIVERSITY OF CENTRAL LANCASHIRE, X, PRESTON, UNITED KINGDOM (2) - EALING NHS, X, LONDON, UNITED KINGDOM (3)
Abstract: Research evidence emerging in different countries indicates that juvenile offenders are likely to be at significant risk for previously unrecognised language impairment. A figure of 60-90% of young offenders having Speech, Language and Communication Needs (SLCN) is emerging in UK. The Youth Offending Speech and Language Therapy (YOSALT) research project in UK was carried out by partners coordinated by Ealing Council to: add to the evidence base on the prevalence of SLCN in UK Youth Offending Services (YOS); develop a screening tool to identify young people who may have SLCN; develop an intervention pack to work for young offenders SLCN; raise awareness of the prevalence and nature of communication needs amongst youth justice practitioners and increase their confidence and skills; conduct the first study in Italy to identify the prevalence of SLCN in youth justice setting. In Ealing YOS 47 young people on orders were selected at random and screened and assessed for communication difficulties, then they had therapy sessions with a Highly Specialist Speech and Language Therapist (HSSLT). In Hammersmith & Fulham YOS 33 young people were screened for difficulties but did not receive the therapy sessions, consenting to acting as a comparison group. Using self-rating questionnaires, structured interviews and assessment on various language tasks, both groups were then measured again to see if any improvements had taken place. At the same time the research team in Italy used a translated and culturally adapted version of the UK screening tool to assess 35 young offenders attending Juvenile Justice services in the Lombardy region, and then compared their
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EFFECT OF IMMEDIATE RECONSTRUCTION OF THE RECURRENT LARYNGEAL NERVE ON THREE-DIMENSIONAL CONFIGURATION OF THE VOCAL FOLDS DURING PHONATION EIJI YUMOTO (1) - NARIHIRO KODAMA (1) KOHEI NISHIMOTO (1) - TETSUJI SANUKI (1) OTOLARYNGOLOGY-HEAD AND NECK SURGERY, KUMAMOTO UNIVERSITY, KUMAMOTO, JAPAN (1)
Abstract: Purpose: Immediate reconstruction of the recurrent laryngeal nerve (RLN) following resection of the nerve together with invading cancer provides an excellent postoperative vocal function. This paper aims at determining perioperative changes in alignment and thickness of the vocal fold (VF) after immediate reconstruction of the RLN. Patients and Methods: The RLN was reconstructed immediately after resection of malignancies on 10 patients who had had unilateral VF paresis or paralysis. Four of them underwent three-dimensional computed tomography (3DCT) during inhalation and phonation pre- and postoperatively and served as subjects. Three with
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thyroid cancer received nerve implantation using a piece of great auricular nerve and the other with cervical metastasis of breast cancer underwent nerve transfer to the ansa cervicalis nerve. Results: Periods between surgery and 3DCT ranged from 13 to 24 months with a mean of 19.5. Normal vocal function was obtained in the four patients over time. Preoperatively, all had posterior glottal gap. The affected VF in two patients was thinner than its mate during phonation. In one patient, the affected VF remained to be thin during both maneuvers. The affected VF in the other was thinner during phonation than during inhalation. Postoperatively, the posterior glottis approximated at the midline and the thickness of the affected VF increased being symmetrical with the healthy side during phonation in all patients. Conclusions: Immediate reconstruction of the RLN results in median location and thickening of the affected VF during phonation and, therefore, provides excellent vocal function although its movement is not recovered.
FP40
LONG-TERM VOCAL OUTCOMES OF NERVE-MUSCLE PEDICLE FLAP IMPLANTATION COMBINED WITH ARYTENOID ADDUCTION FOR UNILATERAL VOCAL FOLD PARALYSIS NARIHIRO KODAMA (1) - TETSUJI SANUKI (1) NENA NARAJOS (1) - EIJI YUMOTO (1) KUMAMOTO UNIVERSITY GRADUATE SCHOOL OF MEDICINE DEPARTMENT OF OTOLARYNGOLOGY HEAD & NECK SURGERY, KUMAMOTO UNIVERSITY HOSPITAL, KUMAMOTO, JAPAN (1)
Abstract: Forty-nine subjects suffering from severe paralytic dysphonia between July 2002 and December 2011 were treated with NMP flap implantation combined with AA at Kumamoto University Hospital. The case group consisted of 24 men and 25 women (age mean 58.9 years). The mean period from onset to surgery was 9.5 months. Under general anesthesia, a NMP flap was made using an ansa cervicalis branch and a piece of the sternohyoid muscle. A window was opened in the paralytic side of the thyroid ala at the level of the vocal fold. Then, AA was performed and the NMP flap was implanted onto the thyroarytenoid muscle through the window under microscopic guidance. To assess long-term vocal outcomes of NMP flap implantation combined with AA using videostroboscopic, aerodynamic, and perceptual analysis for two years. Regularity, amplitude, and glottal gap of vocal fold vibration, maximum phonation time (MPT), mean airflow rate (MFR), and perceptual voice quality (Grade and Breathiness of GRBAS scales) were evaluated preoperatively and at five different time points (1, 3, 6, 12, and 24 months) postoperatively over a two-year duration. Regulatory and amplitude parameters of vocal fold vibrations were employed a three point grading scale. Evaluation of glottal gap parameters was employed a five point grading scale. Those parameters of vocal fold vibration were evaluated using random assignment by 3 otolaryngologists and one speech pathologist. Grade (G) and Breathiness (B) scales were evaluated using random assignment by 2 otolaryngologists and one speech pathologist. All voice parameters of this study improved significantly after surgery. At the postoperative longitudinal evaluation, regulatory and amplitude parameters of 24 months after surgery showed significant improvement compared with those of 1, 3, and 6 months after surgery in videostroboscopic analysis, whereas there are no significant differences in the glottal gap parameter. The measurements for MPT at 24months after surgery were significantly improved when compared with 1, 3 and 6 months after surgery. For MFR, the measurements at 24 months after surgery showed significant improvement compared with that of 3 months after surgery. In perceptual analysis, G and B scores of 24 months were significantly improved when compared with scores of 1, 3, and 6 months. Furthermore, G and B scores of 12 month after surgery were significantly improved compared with those of 1, and 3 months after surgery. The measurements of all voice parameters were significantly improved after long-term follow-up compared with early postoperative measurements. Videostroboscopic, aerodynamic, and perceptual analysis of the NMP flap combined with AA in unilateral vocal fold paralysis patients showed significant continuous improvement over the two-year follow up period. Therefore, NMP flap combined with AA provides excellent vocal function for the treatment of severe dysphonia of unilateral vocal fold paralysis. Learning outcomes: Know efficacy of modified NMP flap combined with AA for the treatment of UVFP; Know NMP flap combined with AA provides excellent vocal function for the treatment of severe dysphonia of UVFP.
of vocal fold through the type1Thyroplasty window. To develop and evaluate the voice outcomes of real AA, we compared our result of AA to results of other procedures aiming arytenoids to adduct without real AA. Materials and methods: Fifty two patients with UVFP were treated between October 2007 and January 2010 in our institute.All patients underwent AA performed through fenestration of the thyroid ala combined with type I thyroplasty (fenestration approach: Tokashiki et al. Laryngoscope 2007). The operations were performed under local anesthesia. Vocal cord medialization was confirmedendoscopically during the operation. In all cases, maximum phonation time (MPT) and mean airflow rate (MFR) were measured before and after the operation. The results were compared to other results reported by other institute trying arytenoid to adduct without real AA such as fat injection laryngoplasty, fascia implantation laryngoplasty, type 1 thyroplasty using Montgomery implant. Results: In our procedure, 49 of the 52 patients achieved an MPT of over 10 s after surgery. The other 3 cases, whose MPTs were 9 s after the operation,had low breathing capacity because of lung disease. The MFRs, which ranged from 236 to 1908 ml/s before the operation, improved to under 200 ml/s except in 3 patients, whose MFRs were 200 to 230 ml/s. There were no patients whose voice did not improved. On the other hand, there ware some patients whose voice did not improved or got worse in other procedures. Conclusion: AA is considered to be necessary to obtain confirming resultsand have prevalence of voice improvement compare to other procedures. Learning outcomes: know most important etiology of unilateral vocal fold paralysis is the passive movement of affected side (Jostle sign): understand AA is useful for any type of paralysis is AA: know how to perform AA to obtain promising results.
SS7
INTERACTING WITH FIRST GENERATION MIGRANT PARENTS OF CHILDREN WITH MULTIPLE DISABILITIES AND COMPLEX COMMUNICATION NEEDS CRITICAL ISSUES AND CONSIDERATIONS GONDA PICKL (1) PDAGOGISCHE HOCHSCHULE STEIERMARK, STYRIAN UNIVERSITY FOR TEACHER EDUCATION, GRAZ, AUSTRIA (1)
Abstract: Due to global population movement today no country can be considered monolingual; therefore, teachers in most countries are confronted with an increasing number of children with severe and multiple disabilities and complex communication needs who at home are exposed to languages different from the language used at school. Critical for assessment and intervention with these children is a close parent-teacher-interaction; however, issues such as language barriers, different cultural perceptions and parents` previous experiences with schools and authorities in their home country may provide obstacles to a successful and effective interaction. The aim of this study was to explore the issues which are critical to an effective parentteacher-interaction. Based on observations, qualitative research interviews and analysis in the tradition of grounded theory four major categories emerged, for which mutual influences and dependencies are discussed: E.g., the first category, regularity of contacts between parents and teachers, is influenced by having a common language for successful interaction and by the classroom situation. Teachers knowledge of and interest in the childs home culture and language (the second category) strongly influence the culturally sensitive use of communication aids, which in turn is influenced by the teachers` expertise in AAC (augmentative and alternative communication) and in teaching children with severe disabilities. Regarding the third category, teachers` knowledge of the child`s communicative abilities in the first language, one third of the participating teachers in the study had no knowledge about the childs communicative abilities in his or her home language. One third reported no differences in the childs communicative abilities in the languages used in school and at home, which was explained by the severity of the childs disability, and one third knew about the childs higher communicative abilities in his/her home language compared to the language used in school. Teachers` knowledge about communication needs in the child`s family (the fourth category) varied greatly; most parents did not share family problems related to the childs disability and special communication modes with their childs teachers. When teachers knew about the childs communication needs and possible difficulties within his/her family, the knowledge was based on extraordinary efforts to establish a close relationship with the family and the dedication of extra time. The results of the study indicate that effective parent-teacher-interaction is a prerequisite for successful communication intervention for children with severe disabilities and a home language other than the language spoken in school. While some of the findings confirm and build on existing knowledge, this study adds is a deeper understanding of the relevant issues for the interaction between parents and teachers. More attention should be paid to the perspectives of first and second generation migrant parents. Teachers need to take into account a range of potentially different perspectives when planning for education and intervention. Bridging the culture gap between different views on disabilities, education, intervention, and parental input and participation seems to be central for effective parent-teacher-interaction, and for overcoming linguistic barriers. Learning outcomes: to identify critical issues for successful interaction between teachers and first generation migrant parents with another first
FP41
IMPACT OF ARYTENOID ADDUCTION FOR UNILATERAL VOCAL FOLD PARALYSIS RYOJI TOKASHIKI (1) - SHUN INOUE (1) SHINJYUKU VOICE CLINIC, TOKYO, JAPAN (1)
Abstract: Introduction: There are many operation procedures for unilateral vocal cord paralysis (UVFP).We consider arytenoid adduction (AA) is necessary for every grade of UVFP because AA reproduce natural adduction of arytenoids cartilage. However no reports showed prevalence of AA comparer to other operation such as medialization thyroplasty or injection laryngoplasty. On the other hand, There are some reports trying arytenoid to adduct by injecting materials near to the vocal process or by pushing posterior part
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language than the language spoken at school; to explain why a close parentteacher-interaction is central for effective communication intervention for children with severe disabilities, complex communication needs and a home language other than the language spoken in school; to describe ways of data collection, analysis and presentation which are traditionally used in the qualitative research method of grounded theory; understand mutual influences and dependencies among issues which are critical for successful interaction with parents who have another family language and different cultural traditions; learn strategies to overcome linguistic and cultural barriers in the interaction with first generation migrant parents and to use augmentative and alternative communication in a culturally sensitive mode.
FP42
CAIRO UNIVERSITY HOSPITALS DYSPHAGIA REHABILITATION PROGRAM FOR EGYPTIAN PATIENTS UNDERGOING SUPRACRICOID LARYNGECTOMIES: A STATE OF THE ART AYA SHEIKHANY (1) - LOAUY EL SHARKAWY (2) AZZA ADEL (1) - YEHIA ALY (3) PHONIATRICS UNIT, ENT DEPARTMENT, KASR EL AINY HOSPITAL, CAIRO UNIVERSITY, CAIRO, EGYPT (1) - ENT DEPARTMENT, KASR EL AINY HOSPITAL, CAIRO UNIVERSITY, CAIRO, EGYPT (2) RADIOLOGY DEPARTMENT, KASR EL AINY HOSPITAL, CAIRO UNIVERSITY, CAIRO, EGYPT (3)
Abstract: The ultimate goal of every clinician treating laryngeal cancer is the extirpation of the disease with the maintenance of voice functionality and swallowing. The objective of this work is to evaluate the outcome of deglutition after Supra-Cricoid Laryngectomies and to design a program and culturally validate it for its rehabilitation in an attempt to improve the quality of life of those patients. This prospective non randomized clinical trial was done in the period between October 2009 and October 2011, 20 patients who underwent supracricoid laryngectomies at the ENT department Cairo University were enrolled in this study. Pre as well as Post-operative assessment and rehabilitation program were designed and applied. The hospital stay of the 20 patients included in this study was found to be positively correlated with the day of onset of oral feeding and the day of removal of the nasogastric tube. The patients in this study achieved their full nutritional autonomy with return to their normal dietary patterns by the end of the 2nd month. Rehabilitation program of dysphagia is essential to ensure the full speedy return to normal quality of life in patients who underwent Supracricoid Laryngectomy within the first three postoperative months. Learning outcomes: The various effects of Supracricoid Laryngectomies on swallowing; The various types of aspiration and dysphagia encountered; Assessment protocols used and various clinical, radiological and instrumental tools used for assessment for dysphagia; The alternatives routes of alimentation and difficulties faced during the tailoring and application of this program; The experience of Cairo university hospitals in the rehabilitation of post-surgical dysphagia and generalizing it to their daily clinical practice will also be discussed
the SF36 questionnaire to assess quality of life. Results: Mean values of the PAS were 3.7 (range 1-8) for liquids, 1.8 (range 1-8) for semisolids and 3.4 (range 1-8) for solids, while mean values of the Pooling score were respectively 5.4 (range 4-9), 5.2 (range 4-9) and 6.6 (range 4-10).. The mean value of DOSS was 4.5 (range 2-6). Premature spillage was present in 4 subjects with liquid, in 2 subjects with semisolids and in 3 subjects with solids. Piecemeal deglutition was present in only one patient with semisolid bolus. In the Italian MDADI mean values were 78.5 (range 55-96) for the total score, 72 (range 20-100) for the global score, 78.7 (range 50-100) for the emotional scale, 77.6 (range 55-100) for the physical scale and 81.2 (range 44-100) for the functional scale. SF-36 questionnaires mean values were 81.5 (range 15-100) for physical activity, 50 (range 0-100) for physical roles limitation, 77.8 (range 41-100) for physical ache, 65.3 (range 45-92) for general health, 62 (range 35-90) for vitality, 69.7 (range 37-100) for social activities, 50 (range 0-100) for emotional roles limitation and 64 (range 24-100) for mental health. Conclusions: Preliminary data on swallowing after THIP or THIEP showed that patients were on average mild/ mild moderate dysphagic and perceived little disability in eating. Quality of life was moderately impaired. Further studies will be conducted on a wider patients group, including voice results and investigating intra- and interrater reliability of the subjective assessments. Learning outcomes: what tracheohyoidopexy (THIP) and tracheohyoidoepiglottopexy (THIEP) are; when THIP and THIEP are indicated; what THIP and THIEPs swallowing functional results could be on the basis of preliminary data.
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HYPOPHARYNGEAL MUCOSAL FLAP RECONSTRUCTION IN ENDOSCOPIC SUPRAGLOTTIC LARYNGECTOMY SALVATORE COSCARELLI (1) - GIUDITTA MANNELLI (2) GIAMPIERO PARRINELLO (2) - ORESTE GALLO (2) PHONIATRICS SECTION UNIT, UNIVERSITY OF FLORENCE, FLORENCE, ITALY (1) - FIRST CLINIC OF OTOLARYNGOLOGY, HEAD AND NECK SURGERY, AZIENDA OSPEDALIEROUNIVERSITARIA CAREGGI, UNIVERSITY OF FLORENCE, FLORENCE, ITALY (2)
Abstract: Introduction. Nowadays, preservation of voice, swallowing and airway is mandatory in early to moderately advanced supraglottic cancers. Endoscopic laser microsurgery, during last years, has achieved oncological results comparable to those obtained by classic supraglottic laryngectomy; although endoscopic approach offers several surgical advantages and helps in reducing postoperative complications, in case of tumor resection extented to laryngeal posterior region the risk of swallowing disturbances could still persist. Here, we propose an endoscopic laryngoplasty in order to improve swallow rehabilitation in patients treated by extented CO2 laser supraglottic laryngectomy. Materials and Methods. Here, we performed and described a new mucosal flap reconstruction technique in a cohort of seven patients, affected by supraglottic laryngeal squamous cell carcinoma, who has been treated by CO2 laser tumor resection with a posterior extention. We evaluated each patients by clinical-endoscopic and videofluoroscopy postoperative exams, and swallow function was tested also by MD Anderson Dysphagia Inventory (MDADI) questionnaire. Results. We observed no early complications. Swallowing exercises with thicken liquids and videofluoroscopy confirmed the absence of aspiration after two days in all cases, and MDADI mean value result was of 98. The surgical wound healed within 3-6 weeks without any major complications including infection, necrosis and hemorrahage. Conclusions. Our results suggest to harvest a hypopharyngeal mucosal flap in all patients who require a laryngeal supraglottic posterior resection, with or without arytenoidectomy. Learning outcomes: Learn how to harvest the hypopharyngeal mucosal flap; Control post-operative effect of this flap in reducing time of recovery of physiological swallowing and voice outcome.
FP43
PRELIMINARY DATA ON SWALLOWING AFTER SUBTOTAL LARYNGECTOMY WITH TRACHEOHYOIDOPEXY ANTONIO SCHINDLER (1) - NICOLE PIZZORNI (1) MARCO FANTINI (2) - FRANCESCO OTTAVIANI (3) GIUSEPPE RIZZOTTO (4) - GIOVANNI SUCCO (2) DEPARTMENT OF BIOMEDICAL AND CLINICAL SCIENCES L. SACCO, UNIVERSITY OF MILAN, MILAN, ITALY (1) ENT DEPARTMENT S. LUIGI GONZAGA HOSPITAL, UNIVERSITY OF TURIN, TURIN, ITALY (2) - DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILAN, ITALY (3) - DEPARTMENT OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY, VITTORIO VENETO CIVIL HOSPITAL, VITTORIO VENETO, ITALY (4)
Abstract: Purpose: Tracheohyoidopexy (THIP) is a subtotal surgical technique consisting in the subtotal removal of the larynx maintaining one or two cricoarytenoid units (A or A-A) and subsequent tracheohyoidopexy. A variation is tracheohyoidoepiglottopexy (THIEP), where the suprahyoid epiglottis is preserved. THIP allows glottic tumours with subglottic and/or anterior extension to be treated. The aim of this study is to report preliminary data on swallowing in a group of patient who underwent THIP or THIEP. Methods: Ten male patients with a mean age of 63 years (range 40-77) who underwent supratracheal partial laryngectomy (one THIEP + A-A, seven THIEP + A, two THIP + A) at a mean distance of 31 months (range 4-95) were involved in the study. Fiberoptic endoscopic evaluation of swallowing (FEES) technique was used to evaluate swallowing skills with liquid, semisolid and solid boluses. FEES recordings were assessed by a blind rater, a speech and language therapist, who underwent a specific training. PenetrationAspiration Scale (PAS), Pooling score and the Dysphagia Outcome and Severity Scale (DOSS) were used. Premature spillage and piecemeal deglutition were assessed. Each subject completed the Italian MD Anderson Dysphagia Inventory (MDADI) to investigate dysphagia-related disability and
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OUTCOME OF AUDITORY TRAINING PROGRAMS IN EGYPTIAN CHILDREN WITH CENTRAL AUDITORY PROCESSING DISORDERS SOMAIA TAWFIK (1) - WAFAA ELKHOLY (1) - AMANI SHALABY (1) MERHAN THABET (1) - DALIA HASSEN (1) FACULTY OF MEDICINE, AIN SHAMS UNIVERSITY, CAIRO, EGYPT (1)
Abstract: Auditory training (AT) is an essential component of a comprehensive approach to treat central auditory processing disorders (C) APD in children with language learning problems. Auditory training maximizes Central auditory nervous system plasticity which is the key for changing auditory performance. AT is classified into formal & informal training activities. Formal AT programs are conducted by a qualified audiologist in the clinic while informal programs are used in everyday training environments such as schools or home ( Musiek 1999). Computer-based auditory training programs have been introduced as an efficient approach for (C) APD remediation. They offer the advantages of multi-sensory stimulation in an engaging format, provide generous feedback and reinforcement that facilitate intensive training. Arabic computer-based auditory training materials were developed and applied on children with (C) APD. Evaluation
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of the treatment outcome using subjective & objective measures showed positive results with improved performance of (c)APD children. Computerbased auditory training materials showed markedly improved performance and maximum benefit regarding treatment outcome. This reflects that they are effective intervention tools in children with (C) APD. Learning outcomes: know the role of auditory training programs in management of central auditory processing disorders; understand the principle of computer based remediation programs& know the characteristic of this program; know how to design the intervention plan on children with (C)APD; Know the measures of outcome of central auditory remediation
SP1
CHALLENGES IN OCCUPATIONAL VOICE DISORDERS: LEGAL ASPECTS TADEUS NAWKA (1) - ANDREA RICCI MACCARINI (2) Department of Audiology and Phoniatrics, CharitUniversittsmedizin Berlin (1) U.O. ORL, BUFALINI HOSPITAL, CESENA, ITALY (2)
Abstract: There are no fixed rules for the assessment of the severity of voice disorders. Even today in Germany professional voice users do not have the chance of recognition of an occupational disease. The medical specialties use different criteria than legal institutions. By systematic examination of environmental influences and individual constitution clinicians and therapists have very detailed knowledge about occupational vocal load. These observations lead to the development of questionnaires reflecting subjective statements. Two authors will demonstrate their results from field studies with teachers who form a large group of occupational voice users. Thestatements of the examined professional voice users are not generally recognised because subjective assessments are still questioned. It has to be stressed, however, thatsubjective assessmentsconstitute one of the fundamental dimensions of voice documentation and vocal functioning. Voice impairment criteria have to be based on the documentation of the patients perception of his or her voice disorder and then the clinicians documentation. The convincing interpretation of these data may support people on a legal basis who are in need because of voice problems. Voice therapy, phonosurgery, oriented on restoration, maintenance, or preservation of voice function, and permanent preventive care of professional voice users are the main instruments in the hand ofspecialists working in the field of voice disorders. The challenge is how to find out the truth about the vocal performance, how to estimate correctly the degree of impairment, and how to give a reliable prognosis. Each of the experts in this special event will give substantiated answers to these questions that are under discussion and urgently need to be answered. Learning Outcomes: In this special event participants will learn about methods of voice assessment as performed in voice clinics and offices as well as in hospitals. It is necessary to describe voice function not only qualitatively. The evaluation of a voice related limitation for an occupational voice user has to be quantified, too. Voice therapy does not only focus on individual behaviour and voicing techniques but also includes how to behave in noisy and stressing situation. As an ultimate means phonosurgery may repair organic damages of the structures for voice production. The better choice is prevention, which can be practised on the basis of trust in cooperation between health services and professional voice users.
media to show a wide variety of augmentative and alternative communication for toddlers, children and adults. Frequently asked questions about AAC will be addressed from several viewpoints. This proposed session is for an IALP Augmentative and Alternative Communication Committee session at the 29th World Congress, organized by the Chair, Dr. Judy Montgomery. Learning outcomes: identify challenges throughout the life span of AAC users and their families from assessment to daily use; identify types of AAC devices for multiple age levels (no-, low- and high tech, systems for adults with CVA, TBI, dementia, and dysarthria); locate AAC devices, costs, avenues of financing, reimbursement, and insurance; define avenues to pursue with AAC users at various ages, skill sets, and with many communication partners; suggest strategies to help users acquire skills to be successful AAC users with a wide range of communication partners.
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CHILD WORD FINDING: DIFFERENTIAL DIAGNOSIS OF SEMANTIC AND PHONOLOGICAL WORD FINDING ERROR PATTERNS DIANE J. GERMAN (1) NATIONAL LOUIS UNIVERSITY, UNIVERSITY, CHICAGO, IL, UNITED STATES (1)
Abstract: Informal and Formal Procedures for the Differential Diagnosis (DD) of semantic and form based Word-Finding (WF) error patterns in oral language (OL) will be presented. Lexical models representing the theoretical underpinnings of semantic and form based lexical access will be highlighted; procedures for the DD of WF error patterns will be explained; and a formal test that emobodies the DD model will be highlighted, the Test of Word Finding, Third Edition (TWF-3, German, 2013). First, an adapted lexical model (German, 2000, 2013) will be presented to describe the theoretical underpinnings of semantic versus phonological WF error patterns in OL. This model, adapted from a prominent lexical model (Levelt, 1989, 1991, 2001; Goldrick & Rapp, 2002, 2007), will be used to explain 4 stages of lexical access and illustrate 3 WF error patterns, Pattern 1, lemma-related semantic errors, Pattern 2, form-related blocked errors, and Pattern 3, form/ segment-related phonologic errors. Second, using this model of DD, WF behaviors that differentiate WF patterns in OL will be described as follow: 1) speed/accuracy profiles differentiates Error Pattern 1 (fast/inaccurate) from Pattern 2 (slow /accurate or inaccurate) and Pattern 3 (slow/inaccurate); 2) responsiveness to phonemic cueing differentiates Pattern 2 from Pattern 3; 3) ability to imitate evasive words differentiates Pattern 3 from articulation difficulties; 4) substitution types differentiates Pattern 1 (semantic subsitutions) from Pattern 2 (No Responses) and Pattern 3 (phonolgoical approximations); and 5) WF behaviors in discourse differentiates Pattern 1 (resvisions and substitutions) from Pattern 2 (gestures, extra verbalizations, delays, time fillers, and empty words) and Pattern 3 (repetitions, revisions, and substitutions). Third, based on research (German & Newman, 2007), lexical factors (target word frequency, phonolgical neighborhood, age of acquisition, and rated familiarity) of words will be matched to learners WF error patterns to demonstrate how one can predict which words will be difficult in OL based on the learners WF patterns. Fourth, the TWF-3 formal and informal assessments will be described. The formal assessment, standardized on a representative sample of 1200 students, measures learners accuracy/ speed in 4 single-word naming contexts, Section 1, Picture Naming Nouns; Section 2, Sentence Completion Naming; Section 3, Picture Naming Verbs; and Section 4, Picture Naming Catgories. The Informal Assessment, which draws on the adpated lexical model discussed above to facilitate the DD of WF patterns, will be explained. Examiners are asked to check all naming errors for target word comprehension to rule out underlying receptive language difficulties; cue learners with the target words first syllable to identify Error Pattern 2; solicit target word imitaion to differentiate Error Pattern 3 from articulation errors; and anlyze substitutions to differentiate all 3 Error Patterns (semantic substitutions suggest Pattern 1; no response type substitutions suggest Pattern 2; and phonological substitutions suggest Pattern 3.). In conlusion, partipants will learn a DD model for WF; a formal assessment appropriate for conducting this DD; and an understanding that the lexical factors of words may predict which words will be challenging for which students, based on nature of their WF error patterns. Learning outcomes: Paeticipants will learn a model for the differential diagnosis of 3 WF error types, Error Pattern 1, Lemma Related Semantic Errors; Error Pattern 2, Form Related Blocked Errors, and Error Pattern 3, Form and Segment Related Phonologic Errors. In this process they will: become familiar with how these 3 WF error types map on lexical access models; learn characteristics of these error types as manifested in convergent and divergent naming tasks; beome familiar with how lexical factors of words might draw out these 3 WF error patterns; and become familiar with the new Test of Word Finding, Third Edition (TWF-3) (in press), a formal WF assessment instrucment designed to identify these 3 WF error patterns in English.
SY3
AUGMENTATIVE AND ALTERNATIV COMMUNICATION AVCROSS THE LIFE SPAN JUDY MONTGOMERY (1) - PERMELIA MCCAIN (2) GONDA PICKL (3) - JAYNATI RAY (4) - MARTINE SMITH (5) CHAPMAN UNIVERSITY, UNIVERSITY, ORANGE, CA, UNITED STATES (1) - SUNNY DAYS INCE, SCHOOL, PITTSTLOWN, NJ, UNITED STATES (2) - PADAGOGISCHE HOCHSCHULE STEIERMARK, UNIVERSITY, GRAZ, AUSTRIA (3) - SOUTHEAST MISSOURI STATE UNIVERSITY, UNIVERSITY, CAPE GIORARDEAU, MO, UNITED STATES (4) - TRINITY COLLEGE, UNIVERSITY, DUBLIN, IRELAND (5)
Abstract: Over an individuals lifespan AAC is supportive in numerous ways, forms and is replete with many challenges. Join us to learn about AAC across the lifespan and address types, costs, challenges, programs, communication partners, family concerns and life changes. AAC used at home, school, advanced education, careers, jobs and after traumatic injury or illness will be discussed from a global perspective. While all of the above areas are of vital importance, we also consider the family, their culture, perception, social interaction, and how all of these will affect our relationships, use of a communication system, their perception of how the system looks, how it is powered, its flexibility and ease of use to make their family life easier. We help families understand that changes are a crucial part of the learning and growing process, just they are for children who use speech. Special considerations will also be made for families who have had traumatic episodes in which siblings have lost their speech. These families have challenging emotional issues that must be confronted as well as social and educational concerns. Case studies will be used throughout the presentation, including
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FP45
THE EFFECTIVENESS OF INTERVENTION BY SPEECH THERAPY IN VOCAL FOLD PARALYSIS: OBJECTIVE ASSESSMENT PEDRO MELO PESTANA (1) - SUSANA VAZ FREITAS (2) CECLIA ALMEIDA E SOUSA (2) UNIVERSIDADE FERNANDO PESSOA, FACULDADE DE CINCIAS DA SADE, PORTO, PORTUGAL (1) - CENTRO HOSPITALAR DO PORTO, HOSPITAL GERAL DE SANTO ANTNIO, PORTO, PORTUGAL (2)
Abstract: Objective: To analyze the results achieved by a group of patients with vocal fold paralysis using objective assessment measures before and after intervention of Speech Therapy. Methods: Retrospective analysis of the results obtained by a group of 38 patients with vocal cord paralysis underwent intervention by Speech Therapy at a Central Hospital. Results: The type of paralysis was variable and the majority of subjects had unilateral paralysis in paramedian position. Differences in performance parameters of jitter, shimmer and NNE were significant (p <0.05). The average number of sessions needed was 13.29 7.95. Conclusions: Speech Therapy intervention in cases of vocal fold paralysis started early is effective and avoided surgical procedures, since they have significant improvements in voice quality with therapeutic intervention. Learning outcomes: know the definition of vocal fold paralysis and its consequences on voice and swallowing; Recognize the importance of multidimensionality of voice evaluation and the contribution of the acoustic method; Understanding differences between acoustic measures as a result of voice therapy; Recognize the importance and the efficacy of voice therapy in the quality of voice.
FP48
EFFECT OF HEAVY METAL POISONING ON THE DEVELOPMENT OF LANGUAGE IN SOHAG GOVERNORATE CHILDREN AHLAM EL-ADAWY (1) - MAHA HILAL (2) KHALED ABO-ELHAGAG (2) - SOHIER SOLIMAN (2) PHONIATRICS UNIT, SOHAG UNIVERSITY HOSPITAL, FACULTY OF MEDICINE, SOHAG UNIVERSITY, SOHAG, EGYPT (1) FORENSIC MEDICINE AND CLINICAL TOXICOLOGY DEPARTMENT, SOHAG UNIVERSITY HOSPITAL, FACULTY OF MEDICINE, SOHAG UNIVERSITY, SOHAG, EGYPT (2)
Abstract: Heavy metals have been recognized as powerful toxins for many years. Toxic exposure to these metals arises in diverse circumstances including environmental, therapeutic and industrial exposure. There is a spectrum of exposure patterns from chronic low levels such as exposure of children to lead paint in older houses, to acute high-dose exposure either intentionally or by accident. Exposure to heavy metals causes impairment of language and learning. Each metal has a specific influence on language; as affection on cognitive function, mentality, hearing or behavior. The present study has been conducted on 50 children with language disorder. The children have been assessed clinically, arabic language test and IQ Estimation. Comparing to 20 normal cases taken as control, the diseased children showed significant retardation in the development of language, IQ levels and development of other body activities such as sitting, walking and talking. The level of some heavy metals (Cu, Pb, Cd, Mn, Zn), estimated in the blood of intoxicated children by Inductively Coupled Plasma Mass Spectrometry or ICP-MS which is an analytical technique used for elemental determinations. Where they showed higher levels than in normal children. A relationship between the language retardation and high levels of heavy metals in the blood have been recorded. It can be concluded that Heavy metal poisoning in childhood might affect the language development in addition to the development of body activities. The present study recommendation is to screen heavy metal levels in the blood of children in early childhood and try to manage those cases with significantly high levels and follow up them by clinical and laboratory examination to avoid delayed language development. Learning outcomes: Know the controversies on the effect heavy metal on the language; Understand the need further studies that as screening test for heavy metal in case with delayed language development, effect of treatment of heavy metal poisining on the language development, and the pathogenesis of language affection.
FP46
UNILATERAL VOCAL CORD PARALYSIS: EFFICIENCY OF VOICE THERAPY M. R. BARILLARI (1) - N. ANGELILLO (1) - B. DI COSTANZO (1) U. BARILLARI (1) UNIT OF PHONIATRY AND AUDIOLOGY, SECOND UNIVERSITY OF NAPLES, ITALY (1)
Abstract: Vocal cord paralysis refers to the complete or partial immobility of one or both vocal cords usually caused by an injury to the laryngeal peripheral nervous system that includes superior laryngeal nerves and recurrent laryngeal nerves. The choice and efficiency of treatment in patients with vocal cord paralysis change according to the kind of paralysis, unilateral or bilateral, and the position in which one or both vocal cords are paralyzed, adduction, abduction or paramedian. We assessed the mobility of vocal cords and the quality of voice in 97 patients (48 to 65 year-old, 62 females and 35 males) with unilateral vocal cord paralysis caused by different factors, before and after voice therapy. We obtained recovery of mobility or hypomobility in 46% of cases, persistence of immobility with good or excellent improvement of vocal parameters in 44% of cases, unsatisfactory results only in remaining 10%. Learning outcomes: know the aetiology of vocal cord paralysis; understand the correct assessment and treatment of vocal cord paralysis; know the efficiency of voice therapy in unilateral vocal cord paralysis.
FP49
READING AND WRITING ABILITIES IN CHILDREN WITH PHENYLKETONURIA DIONSIA APARECIDA CUSIN LAMNICA (1) MARIANA GERMANO GEJO (1) FERNANDA DA LUZ ANASTCIO-PESSAN (1) DEPARTMENT OF SPEECH AND LANGUAGE PATHOLOGY, SCHOOL OF DENTISTRY OF BAURU, UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: Phenylketonuria (PKU) is characterized by partial or total deficiency in the hepatic enzyme phenylalanine hydroxylase which, in excess, interfere with cerebral protein synthesis and causes diffuse alterations in the central nervous system. This autosomal recessive metabolic disorder is manifested by intellectual reduction, hyperactivity, tremor, microcephaly, growth failure, autistic behavior and/or conduct disorder, when untreated. Normal physiological values of phenylalanine (Phe) blood should be kept between 2-4mg/dL, especially in the first years of life. At school age the maintenance of levels up to 6 mg / dL is acceptable, and below 10 mg / dL during the subsequent years of treatment. Individuals with PKU even diagnosed and treated early, can present difficulties in the area of language, executive functions, attention deficits and hyperactivity. The aim of this study was to verify the performance in reading and writing in students with PKU treated since the neonatal period. The study was approved by the Research Ethics Committee (protocol 075/2010). Participants were 17 individuals diagnosed with PKU treated since the neonatal period, of both gender, with age varying between 7 years and 2 months and 14 years. The assessments consisted of interviews with parents and obtain data from medical records for monitoring the disease since birth and application of School Performance Test (SPT). The medical records analysis regarding the control of PKU indicated that even treated since the neonatal period, the participants had difficulty maintaining safe levels of Phe in the blood over the years. As for IQ, 82.35% had scores between 70 and 90 points for the Test of Raven Colored Progressive Matrices and 17.56% had scores below 70. In the interview with parents was found that 23.53% of the participants were considered hyperactive by relatives and teachers, 70.59% were considered inattentive and only 5.88% had no complaints about it. The application of SPT analysis revealed that in the writing subtest 76.48% of the participants underperformed their school grade, 11.76% were on average and 11.76% were higher. In reading subtest 76.48% of the participants underperformed their school grade, 17.64 were on average and 5.88% higher. PKU individuals need to have strict control of normative Phe blood levels to prevent the deleterious effects of this alteration in the central nervous system and consequently interference in learning and behavior. Participants showed
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LARYNGEAL ELECTRICAL STIMULATION FOR VOCAL FOLD PARALYSIS MOHAMAD SADEGH SEIFPANAHI (1) - TAHMINEH SALMALIAN (2) HAMEDAN UNIVERSITY OF MEDICAL SCIENCES, SPEECH THERAPY DEPARTMENT, LECTURER, HAMEDAN, IRAN (1) WELFARE AND REHABILITATION UNIVERSITY, TEHRAN, IRAN (2)
Abstract: Vocal fold paralysis (VFP); refers to the complete denervation of vocal folds, loss of voluntary movements, and then subsequent voice disorders. Aim of this review is to investigate the different laryngeal electrical stimulation (LES) attempts and their effectiveness on voice restoration. In order to more elucidating importance of LES at first some conventional therapeutic procedures for VFP such as voice therapy and surgery has been introduced briefly and then comprehensively LES in animal studies and also in human studies in two types of implanted and surface LES has been discussed. The animal studies supporting the feasibility of applying implanted LES for restoration laryngeal functions, however limited available human studies do not confirm effectiveness of implanted LES for restoration voice. In the same way findings from applying surface LES in normal people didnt induce significant changes in voice parameters; on the other side according to the only 2 available published studies, surface LES was effective in enhancing some voice functions and vocal fold adductions although there are some debates regarding the results and methods of the studies.
evidence of difficulties in reading and writing, difficulty engaging in behaviors directed and failures in maintaining attention. There is the need for knowledge of this clinical condition to propose preventive and rehabilitative measures aimed at improving the quality of life of these individuals. The children with PKU, even diagnosed and treated early in the course of their lives, had difficulties in reading and writing skills, obtaining scores below expectations for their education level. Learning outcomes: knowledge about phenylketonuria; knowledge about the implication of phenylketonuria in the learning process; reflections of speech and language therapy for people with phenylketonuria.
FP52
OROPHARYNGEAL DYSPHAGIA IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME FRANCESCO MOZZANICA (1) - ANTONIO SCHINDLER (1) GIULIA SONZINI (1) - DANIELA PLEBANI (1) EMANUELE URBANI (1) - MARIKA PECIS (1) - NICOLA MONTANO (1) UNIVERSIT DEGLI STUDI DI MILANO, MILAN, ITALY (1)
Abstract: Patients with obstructive sleep apnea syndrome (OSAS) may be affected by swallowing abnormalities. Although previous studies demonstrated that patients with OSAS presented subclinical manifestations of abnormal swallowing, in no one different textures and volumes have been systematically studied. The aim of this cross-sectional study is to analyze the signs and symptoms of oropharyngeal dysphagia using fiberoptic endoscopic evaluation of swallowing (FEES) examination with different textures and volumes in a large cohort of patients with OSAS of different severity. Seventy-two patients with OSAS without symptoms of dysphagia were enrolled in this study. Depending on the OSAS severity, the cohort of patients was divided in two groups: 30 patients with moderate OSAS (Group 1) and 42 patients with severe OSAS (Group 2). Each patient underwent FEES using 5 ml, 10 ml, 20 ml of liquids and semisolids, and solids. Spillage, penetration, aspiration, retentions and piecemeal deglutition were considered and the penetration/aspiration scales (PAS), the pooling score (PS) and the dysphagia outcome and severity scale (DOSS) were used for quantitative analysis. Each patient also completed the SWAL-QOL questionnaire in order to obtain data about the patients quality of life related to the swallowing impairment. Fourty-six out patients (64%) presented spillage, 20 (28%) piecemeal deglutition, 26 (36%) penetration and 30 (44%) retention. No differences were found in the PAS, PS and DOSS scores between patients with moderate and severe OSAS with the non-parametric test of Mann-Whitney. Patients with severe OSAS scored higher in the General Burden and Food subscales of SWAL-QOL. Depending on DOSS score the cohort of patients was divided in two additional groups: Group A was composed by 26 patients with signs of dysphagia and with a DOSS score between 1 and 5. Group B was composed by 46 patients without signs of dysphagia and with a DOSS score of 6 or 7. Patients with signs of dysphagia scored lower in the General Burden and Symptoms subscales of the SWAL-QOL questionnaire. In conclusion OSAS patients show signs of swallowing impairment during FEES examination in about half of the population; clinicians involved in the management of patients OSAS are invited to include questions on swallowing during history taking in their clinical practice. Learning outcomes: Know that patients with OSAS may be affected by subclinical swallowing abnormalities; Learn which type of textures and volumes determine more likely the swallowing abnormalities; Understand the role of FEES in the evaluation of a patients with OSAS; Understand the importance of swallowing assessment in patients with OSAS.
FP50
LANGUAGE DEVELOPMENT OF 3-7 YEAR OLD CHILDREN BORN FOLLOWING ASSISTED OOCYTE ACTIVATION (AOA) EVELIEN DHAESELEER (1) - FRAUKE VANDEN MEERSCHAUT (1) HANNELORE GYSELS (1) - YLENIA THIENPONT (1) GRIET DE WITTE (1) - BJRN HEINDRYCKX (1) - AN OOSTRA (1) HERBERT ROEYERS (1) - PETRA DE SUTTER (1) KRISTIANE VAN LIERDE (1) GHENT UNIVERSITY, GHENT, BELGIUM (1)
Abstract: Assisted oocyte activation (AOA) using a calcium ionophore has been used during more than a decade following ICSI fertilization failure. However, since AOA does not mimic precisely the physiological fertilization process, concerns exist about its use in human assisted reproduction technology (ART). We assessed the neonatal and neurodevelopmental outcome of children aged 3y who had been born following AOA in our centre. Twenty-one children participated in the study (81% response rate; mean age 63.6 21.07 months). Neonatal data were collected via questionnaires. Neurodevelopmental outcome was tested using the Reynell Developmental Language Scales (RTOS) or Clinical Evaluation of Language Fundamentals (CELF), Wechsler Preschool and Primary Scale of Intelligence (WPPSI) or Wechsler Intelligence Scale for Children (WISC) and the Movement ABC III. Behavior was scored by the Social Communication Questionnaire (SCQ), the Child Behavior Checklist (CBCL) and the Teachers Report Form (TRF). For all tests and questionnaires, the mean outcomes lied within the expected ranges. These are first data on the developmental outcome of AOA children. The high response rate and the robustness of the tests support the data, which are reassuring, though still to be considered preliminary. Therefore, AOA should still be performed only in selected couples. Learning outcomes: know the neonatal outcome of 3 to 7 year old children of this study born after AOA; know the language development of 3 to 7 year old children of this study born after AOA; know the cognitive development of 3 to 7 year old children of this study born after AOA; Understand the need to follow-up children born after ICSI or AOA.
FP51
PEDIATRIC OBSTRUCTIVE SLEEP APNEA AND ORAL FUNCTIONS ELENA PIUMETTO (1) - IRENE VERNERO (1) - PAMELA GIORDANO (1) SARA CARENA (1) - GUENDALINA PROCOPIO (1) DANIELA FILIPPINI (1) - ROBERTO ALBERA (1) ORL II (PROF. ALBERA), HEALTH AND SCIENZE CITY HOSPITAL, UNIVERSITY OF TURIN, TURIN, ITALY (1)
Abstract: Pediatric obstructive sleep apnea (OSAS) can be considered a multiorgan disorder that need to be treated because of the risk of serious complications such as mental retard, growth retard, cardiac complications, low school performance, attention impairment, hyperactivity and executive function impairment. Our study consisted of two parts. In the first one we analyzed the correlation between OSAS and the presence of infantile swallowing, dental and orofacial alterations and poor praxia performance, in the second part we evaluated the effect of adenotonsillectomy on these problems. Follow-up evaluation confirmed the efficacy of adenotonsillectomy in solving most OSAS symptoms, strengthened by a positive correlation (p<0.0000001 summing all parameters), while secondary signs of the pathology seem not to improve significantly, without any specific treatment, so that oral breathing, swallowing alterations and speech disorders involving linguo-dental phonemes, recur. In conlcusion this study pointed out the importance of consider the possibility that children with OSAS can present speech and swallowing alterations and that speech therapy after adenotonsillectomy could be considered usefull to restore the physiological oral functions. Learning outcomes: hygiene and development of swallowing; counseling brochure concerning oral breathing
FP53
SWALLOWING DISORDERS IN PATIENTS WITH RESPIRATORY FAILURE. THE GOOD CLINICAL PRACTICE OF SWALLOWING REHABILITATION IN HOSPITAL: FROM THE SCREENING TO DISCHARGE NICOLETTA BONISOLI (1) - DENISE ZANINI (2) VALENTINA PASETTO (3) F.L.I. TRIVENETO, DEPARTMENT OF REHABILITATION, VERONA, ITALY (1) - F.L.I. TRIVENETO, RESIDENTIAL HEALTH CARE CITT DI VERONA, VERONA, ITALY (2) - F.L.I. TRIVENETO, REHABILITATION CENTER DON CALABRIA, REHABILITATION CENTER UILDM (MUSCULAR DYSTROPHY), VERONA, ITALY (3)
Abstract: Respiratory Failure is a pathological condition in which the respiratory system is not able to cope with the demands of the organism, hesitating in a condition of precarious equilibrium. Dysphagia is a swallowing alteration caused by structural injuries and/or neurological deficits. Looking at the past literature, there are only few studies demonstrating an alteration of swallowing phases in patients with respiratory failure. By administration of the Dysphagia Widened Screening tool, the present study aims to determine whether there is a real and significant index of prevalence of swallowing disorders in people suffering from Chronic Obstructive Pulmonary Disease (C.O.P.D.) and Respiratory Failure. The study also intends to verify and/or to confirm whether dysphagia and respiratory pathology are linked. A functional logopedic Assessment of swallowing was done on 11 patients reported positive by the Screening procedure - in order to determine the presence, the gravity and the type of dysphagia and the possible association between the sign of dysphagia and the respiratory pathology. A logopedic treatment was done on some patients (upon suggestion of the Phoniatrics). Establishing an adequate course of treatment for the patient with a risk of dysphagia, allowed an early identification of the symptom and/or sign of dysphagia and the recovery of the physiological swallowing or the attainment of a functional swallowing. This work raised awareness of ward staff to dysphagia and promoted the Swallowing specialized personnels presence in the
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Pneumological Rehabilitation division, in order to create an interdisciplinary management of people with swallowing disorders. Learning outcomes: The present work has highlighted the importance to devote more attention to the swallowing function in patient with Respiratory Failure. 1. the recovery of swallowing has improved the quality of life and appropriate counselling has allowed the patient to cope better with the outcome of the disease, also reducing the time and cost of hospitalization in the department. 2. It is very important to gather information about the patients emotional state, as they allow to model the relational approach that the hole equipe health care should take to facilitate the process of care and rehabilitation of the patient during hospitalization, obtaining better collaboration, thus optimizing the timing and speech therapy duration of the act itself.
FP56
THE ROLE OF THE LANGUAGE THERAPIST WITH DEAF CHILDREN PARENTS CHOICES MARIA CECILIA DE MOURA (1) - ANA CAROLINA PRISCO (1) LUIZA BORGES BARCELLOS (1) - SANDRA REGINA LEITE DE CAMPOS (2) PUCSP, SAO PAULO, BRAZIL (1) - UNIVERSIDADE FEDERAL DE SAO PAULO - CAMPO NORTE, SAO PAULO, BRAZIL (2)
Abstract: This research focused on understanding the rapprochement between hearing parents and their Deaf child as he acquires Brazilian sign language (LIBRAS) as their mother tongue and how the parents deal with the cochlear implant. This process of acquisition was done by a Deaf Instructor and a language therapist, coordinator of the Stimulation Program. The program intends to make it possible for the children to be involved in a bilingual program with the issues that appear from the Cochlear Implant medical approach. The work was focused on the parenthood and the possibility of the children to be recognized not just as Deaf but as children. It was extraordinary the cyclical movement that appeared between the bet of the parents on their children and the development of them. The results show that the role of the language therapist is essential for the wellbeing of all involved. Therefore, the language therapist involved in the education of Deaf people must create bonding experiences between the family and the deaf child, take in consideration that the Deaf person belongs to a smaller linguistic group. Learning outcomes: With this work it is possible to show that the language therapist has an important role with Deaf children and their families and that the use of the Cochlear Implant doesnt avoid the use of Sign Language.
FP54
THE ROLE OF THE LANGUAGE THERAPIST WITH DEAF CHILDREN AND THE PARENTS COCHLEAR IMPLANT AND SIGN LANGUAGE MARIA CECILIA DE MOURA (1) - PAULA SCAREL DE MEDEIROS (1) VERA REGINA. V. TEIXEIRA (1) FACHS, PUCSP, SAO PAULO, BRAZIL (1)
Abstract: This research focused on understanding the rapprochement between hearing parents and their Deaf child as he acquires Brazilian sign language (LIBRAS) as their mother tongue and how the parents deal with the cochlear implant. This process of acquisition was done by a Deaf Instructor and a language therapist, coordinator of the Stimulation Program. The program intends to make it possible for the children to be involved in a bilingual program with the issues that appear from the Cochlear Implant medical approach. The work was focused on the parenthood and the possibility of the children to be recognized not just as Deaf but as children. It was extraordinary the cyclical movement that appeared between the bet of the parents on their children and the development of them. The results show that the role of the language therapist is essential for the wellbeing of all involved. Therefore, the language therapist involved in the education of Deaf people must create bonding experiences between the family and the deaf child, take in consideration that the Deaf person belongs to a smaller linguistic group. Learning outcomes: show that the language therapist has an important role with Deaf children and their families and that the use of the Cochlear Implant doesnt avoid the use of Sign Language.
SS10
CHILD WORD FINDING: DIFFERENTIAL DIAGNOSIS OF SEMANTIC AND PHONOLOGICAL WORD FINDING ERROR PATTERNS DIANE J. GERMAN (1) NATIONAL LOUIS UNIVERSITY, UNIVERSITY, CHICAGO, IL, UNITED STATES (1)
Abstract: Informal and Formal Procedures for the Differential Diagnosis (DD) of semantic and form based Word-Finding (WF) error patterns in oral language (OL) will be presented. Lexical models representing the theoretical underpinnings of semantic and form based lexical access will be highlighted; procedures for the DD of WF error patterns will be explained; and a formal test that emobodies the DD model will be highlighted, the Test of Word Finding, Third Edition (TWF-3, German, 2013). First, an adapted lexical model (German, 2000, 2013) will be presented to describe the theoretical underpinnings of semantic versus phonological WF error patterns in OL. This model, adapted from a prominent lexical model (Levelt, 1989, 1991, 2001; Goldrick & Rapp, 2002, 2007), will be used to explain 4 stages of lexical access and illustrate 3 WF error patterns, Pattern 1, lemma-related semantic errors, Pattern 2, form-related blocked errors, and Pattern 3, form/ segment-related phonologic errors. Second, using this model of DD, WF behaviors that differentiate WF patterns in OL will be described as follow: 1) speed/accuracy profiles differentiates Error Pattern 1 (fast/inaccurate) from Pattern 2 (slow /accurate or inaccurate) and Pattern 3 (slow/inaccurate); 2) responsiveness to phonemic cueing differentiates Pattern 2 from Pattern 3; 3) ability to imitate evasive words differentiates Pattern 3 from articulation difficulties; 4) substitution types differentiates Pattern 1 (semantic subsitutions) from Pattern 2 (No Responses) and Pattern 3 (phonolgoical approximations); and 5) WF behaviors in discourse differentiates Pattern 1 (resvisions and substitutions) from Pattern 2 (gestures, extra verbalizations, delays, time fillers, and empty words) and Pattern 3 (repetitions, revisions, and substitutions). Third, based on research (German & Newman, 2007), lexical factors (target word frequency, phonolgical neighborhood, age of acquisition, and rated familiarity) of words will be matched to learners WF error patterns to demonstrate how one can predict which words will be difficult in OL based on the learners WF patterns. Fourth, the TWF-3 formal and informal assessments will be described. The formal assessment, standardized on a representative sample of 1200 students, measures learners accuracy/ speed in 4 single-word naming contexts, Section 1, Picture Naming Nouns; Section 2, Sentence Completion Naming; Section 3, Picture Naming Verbs; and Section 4, Picture Naming Catgories. The Informal Assessment, which draws on the adpated lexical model discussed above to facilitate the DD of WF patterns, will be explained. Examiners are asked to check all naming errors for target word comprehension to rule out underlying receptive language difficulties; cue learners with the target words first syllable to identify Error Pattern 2; solicit target word imitaion to differentiate Error Pattern 3 from articulation errors; and anlyze substitutions to differentiate all 3 Error Patterns (semantic substitutions suggest Pattern 1; no response type substitutions suggest Pattern 2; and phonological substitutions suggest Pattern 3.) . In conlusion, partipants will learn a DD model for WF; a formal assessment appropriate for conducting this DD; and an understanding that the lexical factors of words may predict which words will be challenging for which students, based on nature of their WF error patterns. Learning outcomes: Paeticipants will learn a model for the differential diagnosis of 3 WF error types, Error Pattern 1, Lemma Related Semantic Errors;
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FP55
PARENTAL VIEW OF FUNCTIONAL OUTCOME OF COCHLEA IMPLANTED CHILDREN FRANCES NAN MAI WANG (1) - CHE-MING WU (2) - CHU-JUNG LIU (1) CHUNG SHAN MEDICAL UNIVERSITY HOSPITAL, TAICHUNG, TAIWAN, PROVINCE OF CHINA (1) CHANG GUNG MEMORIAL HOSPITAL, CHANG GUNG UNIVERSITY, TAOYUAN, TAIWAN, PROVINCE OF CHINA (2)
Abstract: Cochlear implants are known to have great impact on the lives of recipients and their families. This study aimed parents perspective of functional outcome of cochlear implanted children with four-year device experiences. Background factors and other abilities of the children were explored with this outcome. Methods: This is prospective questionnaire survey of parental view of cochlea implantation upon their children. Sixty three children (mean=7.35 years) received their unilateral implants at mean age of 3.28 years, and with 4.07-year device experiences were included for this investigation. A closedset 46-item questionnaire of the parents views of their implanted children in Mandarin Chinese in a 5-point Likert-type scale was developed to measure functional outcome of families and children. The questionnaire included the questions of impact of the family and the statements regarding situation of their implanted children in reality. Correlation statistics was conducted to examine the functional outcome with childrens background factors and with childrens ability of IQ, language and speech perception. Results: The majority of families were satisfied with childrens improvement of General functioning and Social relationships though CIs. Childrens Communication and Education did not reach parents expectation as other domains. Parents particularly agreed to continue to support their children even with CIs use experience. No significant correlation was found between functional outcome with childrens background factors, neither with children other abilities. Conclusions: Mandarin Chinese parents of cochlear implanted children demonstrated that CIs affects their children in a wide variety of ways. Learning outcomes: parental view of functional outcome measure survey of cochlea implanted children; functional outcome results from Mandarin Chinese parental view; possible relation between the functional outcome with implanted childrens background factors and other abilities
Error Pattern 2, Form Related Blocked Errors, and Error Pattern 3, Form and Segment Related Phonologic Errors. In this process they will: become familiar with how these 3 WF error types map on lexical access models; learn characteristics of these error types as manifested in convergent and divergent naming tasks; beome familiar with how lexical factors of words might draw out these 3 WF error patterns; and become familiar with the new Test of Word Finding, Third Edition (TWF-3) (in press), a formal WF assessment instrucment designed to identify these 3 WF error patterns in English.
FP59
EARLY AND LATE COMPLICATIONS IN CONSERVATIVE LARYNGEAL SURGERY SALVATORE COSCARELLI (1) - GIUDITTA MANNELLI (2) GUGLIELMO LAROTONDA (2) - ROBERTO SANTORO (2) GIUSEPPE MECCARIELLO (2) - ORESTE GALLO (2) PHONIATRICS SECTION UNIT, UNIVERSITY OF FLORENCE, FLORENCE, ITALY (1) - FIRST CLINIC OF OTOLARYNGOLOGY, HEAD AND NECK SURGERY, AZIENDA OSPEDALIEROUNIVERSITARIA CAREGGI, UNIVERSITY OF FLORENCE, FLORENCE, ITALY (2)
Abstract: Purpose/Objective. The objective of the study was to assess the incidence of early and late post-operative complications of partial laryngectomy, by identifing patient and tumor related predicting factors of post-operative complications. Materials and Methods. A total of 535 patients who had partial laryngectomy were treated with partial conservative approach (10 open cordectomy, 82 frontolateral, 96 cricohyoidopexy, 36 cricohyoidoepiglottopexy, 2 tracheohyoidoepiglottopexy, 309 supraglottic laryngectomies) for squamous cell carcinoma of the larynx from 1984 to 2007 at ENT Clinic University of Florence, Italy. Post-operative complications were recorded and categorized into local, swallowing, airway and systemic complications. Patients- and tumor- related factors associated with a high risk of complications were analyzed by univariate and multivariate analysis. Results. The overall complication rate was 23.55%. Airway complications were the most frequent and occurred in 73 (13.64%) patients. Dysphagia occurred in 39 (7.8%) and local in 33 (6.16%) patients, respectively. Laryngocutaneous fistula occured in 15 (2.8%) patients. Multivariate analysis showed that alcohol consumption (p=0.035) and T stage (p=0.02) were indipendent predictors of local and airway complications; whereas, type of surgery seemed to be related to dysphagia (p=0.0001). Previous irradiation did not show any significant impact in our series for the occurence for laryngocutaneous fistula. Conclusions. Partial laryngectomy is associated with a high incidence of post-operative complications, frequently due to type of surgery and tumor stage. Learning outcomes: How to assess the risk for early and late complications after partial open laryngectomies; Better selection of ideal candicates for laryngeal conservation surgery; Inform and be aware phoniatrics and speech pathologists of the possible swallowing and airway complications related to this kind of surgery.
FP57
LARYNGEAL CANCER TREATMENT: CRITICAL REVIEW OF BRAZILIAN LITERATURE PUBLISHED OVER THE LAST TEN YEARS MONIQUE PACHECO (1) - BRBARA GOULART (1) UNIVERSIDADE FEDERAL DO RIO GRANDE DO SUL, CURSO DE FONOAUDIOLOGIA, PORTO ALEGRE, BRAZIL (1)
Abstract: Purpose: To analyze the characteristics of the Brazilian scientific bibliographic production about the larynx cancer treatment in the last ten years. Research strategy: It was followed the Cochrane Handbook precepts, that involved the formulation of the question to investigate, the localization, the studies selection and the critical assessment of the articles. Selection criteria: The articles published between 2002 and 2011 were shortlisted by the data base LILACS e ScIELO, using the laringect$ descriptor. Data analyses: It was analyzed the full texts, potentially relevant for the review, using a standardized form, when the following data were collected: goals, research design, characteristics of the research group, findings and discussion about the larynx cancer treatment. Results: Initially it was identified 292 studies. After the tittles and abstracts review, consideration of inclusion and exclusion test, coherence check with the researched thematic and elimination of the studies which were at the same time in more than one data base, 70 were sure enough analyzed to be larynx related to the topic in its descriptors and/or in the abstracts. Conclusion: From this research it is possible to verify gaps and opportunities for the development of studies that verify standardized techniques of larynx cancer treatment in Brazil with the increasing of analytical and interventional studies based on clinical trials randomized, considering especially guidelines as CONSORT, STROBE e GRADE for its planning and publication.
FP58
ANALYZING VOICE ONSET TIME IN ESOPHAGEAL SPEECH LEILA GHASISIN (1) - ZAHRA GHAYOUMI (1) SPEECH-LANGUAGE DEPARTMENT, UNIVERSITY OF SOCIAL WELFARE AND REHABILITATION SCIENCES, TEHRAN, IRAN (1)
Abstract: Introduction: Esophageal speech can be viewed as one of the main methods of helping patients to communicate after laryngectomy. This new sound source can influence certain characteristics of speech sounds including their voice onset times. Voice onset time (VOT) is an important perceptual cue in distinguishing voiced from voiceless stops. From a physiological stand-point, it reflects a fine-tuned coordination of timing between articulatory and the phonatory systems. In Persian, like many languages,the contrast between /b, d, g/and/p, t, k/ pairs is dened by VOT. The present study attempted to examine the VOT in stops sounds of esophageal speech in Persian. Material & Method: In this case-report study, a report about 4 people who underwent laryngectomy is presented. All participants were male native Persian speakers and had used esophageal speech for professional purposes over the 6 months prior to the onset of the study. The speech materials were six CV syllables formed through combining above-mentioned six Persian initial stops and six main vowels of this language. The items were presented in written form and the participants were asked to read each twice while they productions audio-taped. All recordings were conducted in a silent room located in the home of patient using a laptop computers built-in sound recorder (model:VAIO P688) which was connected to a Clear Chat PC Wireless headset. Subsequently, the VOT of each speech sample was measured using Praat software version 5.2. In order to ensure the consistency and reliability in VOT measurements, intra- and inter-rater reliability were evaluated. Results: Acoustic analysis revealed that 4 people with laryngectomy produced VOT in normal renge.VOT values for voiced stop consonants were in the range of -25 to zero. Voiceless stops had a voice onset time over zero. The results indicated the VOT values increase as the place of articulation moves from anterior to posterior position along the vocal tract. Conclusion: the present findings indicated that people who used esophageal speech could produce VOT values of voiced and voiceless stops consonants. Learning outcomes: get information about the VOT; Identify the importance as a key in diagnosing sounds; be familiar with the standard esophageal speech; be familiar with Persian consonants
FP60
REHABILITATION OF SEMANTIC AND PRAGMATIC ABILITIES IN SUBJECTS WITH HEARING LOSS P. napolitano (1) - N. ANGELILLO (1) - M. R. BARILLARI (1) B. DI COSTANZO (1) - U. BARILLARI (1) UNIT OF PHONIATRY AND AUDIOLOGY, SECOND UNIVERSITY OF NAPLES, ITALY (1)
Abstract: The semantic development is based on the childs ability to reason, to understand, and to have an idea of the surrounding world. The pragmatics is based on the childs ability to experience different situations during his growth. For these reasons, it appears clear that the semantic and pragmatic difficulties experienced by a child with hearing loss refer to the impossibility to understand the verbal message and to code it at a higher level. In fact many authors find not useful to study the semantic and pragmatic difficulties experienced by a patient, whose rehabilitation aim is reaching grammatically and phonologically correct language. In our experience, we have noticed that communicating with a person means mainly understanding her communicative intentions. When the child grows up, he is expected to understand how the language can be used in different contexts. The subjects with severe or profound hearing loss show a deficit of the semantic and pragmatic abilities as a consequence of the hearing impairment. In fact the hearing represents the most important sensorial channel used to increase the knowledge. A hearing impairment causes a deficit in the development of many superior integrative processes that can be seriously damaged. Several studies demonstrated that if the impaired channel is early restored through an effective prosthesis and an adequate rehabilitation, the patient begins the school with normal cognitive and linguistic abilities. Learning outcomes: know the semantic and pragmatic aspects of language; understand the clinical features of semantic and pragmatic impairment in subjects with hearing loss; know the rehabilitation of semantic and pragmatic difficulties in subjects with hearing loss.
FP61
SEMANTIC AND PRAGMATIC IMPAIRMENT IN CHILDREN N. ANGELILLO (1) - M. R. BARILLARI (1) - B. DI COSTANZO (1) U. BARILLARI (1) UNIT OF PHONIATRY AND AUDIOLOGY, SECOND UNIVERSITY OF NAPLES, ITALY (1)
Abstract: Semantics investigates the meaning of the linguistic expressions: words, phrases, sentences, discourse. Pragmatics is about how language performs in the real communicative situations: what we say, how we say
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it, our body language and whether it is appropriate to the given situation. Children with impairments of these skills show difficulties meaning of what is being said, responding appropriately either verbally or non-verbally and using language in social situations. It is challenging to ascribe the deficit of semantic and pragmatic abilities to one specific single cause. Though often linked to an exact nosological description, this deficit is often due to multiple pathological conditions, thus assuming the characteristics of a multifactorial disorder and presenting itself as peculiar element of numerous clinical pictures. Today, the semantic and pragmatic deficit is often misdiagnosed for the little relevance attributed to the assessment and rehabilitation of the language non-formal aspects. Learning outcomes: know the semantic and pragmatic aspects of language; understand the clinical features of semantic and pragmatic impairment; know the etiology of semantic and pragmatic impairment in children.
FP62
CLINICAL INTERVENTION PLANNING FOR CHILDRENS PRAGMATIC LANGUAGE DISORDERS TANYA GALLAGHER (1) UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN, CHAMPAIGN, ILLINOIS, UNITED STATES (1)
Abstract: Regardless of how carefully researchers have tried to characterize childrens pragmatic language difficulties, the most frequent finding has been variability within and across children. Compared to typically developing children either at the same age or at the same language structural developmental stage, children with pragmatic language difficulties have been found to use more or less of whatever was being counted and/or to do something atypical compared to the behaviors of the typically developing children. Clinical diagnostic labels, such as specific language impairment, were not as predictive of the pattern or severity of pragmatic difficulties as had been hoped (Gallagher, 1991; 2010; Adams, 2008). Research has indicated that pragmatic interaction difficulties can be due to the presence of any one or more underlying component skill deficits affecting their ability to encode and decode language; to integrate and interpret information; to encode and decode intentions, beliefs and feelings; to perform the executive functions of planning, goal setting and problem solving; to remember in the short and long term procedural, declarative, episodic, and general world knowledge; and, to encode and decode culturally sensitive verbal and nonverbal conversational behaviors used for topic introduction, cohesion, and turn-taking. Interactional difficulties also reflect the childrens ability to compensate for their underlying component deficits and their interactive partners willingness to also accommodate and compensate in light of those difficulties. Similar compensatory surface behaviors could be the result of different underlying skill deficits and vice versa and successful interactions were co-constructed by the children and their partners. These compensatory adaptations can be conscious but need not be and can include linguistic simplifications, increased dependence on context, and the incorporation of a broader set of communicative devices such as gestures, gaze, facial expressions, etc. (Perkins, 2002, 2007). Since interactional success is the result of complex interrelationships among a number of variables, clinical intervention planning for pragmatic language disorders must be multi-dimensional with expanded pragmatic intervention goals, interventional methodologies and types of intervention agents. The implications of this increased complexity will be discussed and examples will be reviewed. Learning outcomes: Describe the implications for intervention planning that pragmatic success is co-constructed; Describe how clinical intervention methodologies have been expanded; Describe how peers and parents can be incorporated into childrens pragmatic language intervention
that dysphagia rehabilitation in an acute care setting is requested from different departments because of its prevalence and severity. The patient with OD, especially in acute and unstable clinical conditions, presents complex health needs. Her/his management requires a multidisciplinary approach and a high professional specialization, because of the particular setting of care and the often insufficient length of hospital stay. Skilled specialists (phoniatrics and speech language pathologist) are needed for the early assessment and the best management and remediation programs must be continuously revised in time according to changes imposed by economics in health systems (reduction of length of hospital stay, reduction of resources, complexity and costs of patient pathways). Learning outcomes: To demonstrate the usefulness of swallowing rehabilitation in the acute phase; To provide the scientific community a model for the management of patients with acute oropharyngeal dysphagia; To signal the need to improve risk prevention plans, reduce costs, monitor and optimise resources, activate program training activities aimed at professionals in the health care; To signal the need to develop further procedures useful for promoting the quality of life of the patient.
FP64
SWALLOWING MANAGEMENT OF PATIENTS LIVING AT HOME: THE EXPERIENCE OF SLPS SERVICE IN TURIN GIULIA GINTOLI (1) - ROSSELLA MUO (2) - LAURA OMEGNA (3) STEFANIA MARIO (2) - SILVIA ROSSO (2) - MELANIA RUFFINELLO (2) LOREDANA TROTTA (2) - GISELLA GHIGO (2) PATRIZIA STENI (3) ORDINE MAURIZIANO, HOSPITAL, TURIN, ITALY (1) ASLTO1, HOSPITAL, TURIN, ITALY (2) ASL TO1, HOSPITAL MARTINI, TURIN, ITALY (3)
Abstract: Recent surveys individualize Italy as the oldest country in Europe where we can see the increase of a considerable population of frail old people. These persons run continuous risks with regards to their health and they often live at home or in nursing homes. The control of the good swallowing functioning in elderly people is very important because it aims at avoiding effects particularly dangerous for their health in particular aspiration pneumonia, a bad nutritional condition and dehydration. The SLP, as a case manager of dysphagia, controls the therapeutic continuity among the patients different treatment settings. If we know the assumptions of both normative and clinic kind which subtend the SLP management of domiciliary dysphagic old adults, there are not inquires about the way how domiciliary SLP services actually work: for instance what is the speech therapists working load and what does this intervention concentrate? AIM: the survey describes the main demographic and clinic variables of dysphagic patients who live at home and afferent to the speech therapy service of Rehabilitation Department of ASL TO1 and the sort of intervention provided with each one of them by SLPs. Methods: The data of patients signalled for dysphagia and followed at home from July 1 to December 31 2011 were drawn from the database of SLP Service and their case notes were consulted. The data taken into consideration were: age, gender, typology of domicile, pathology, characteristics of the assumed diet and way of hydration before and after the SLPs domiciliary assessment. A score according to swallowing scale ASHA NOMS was given to each patient. Results: Our sample consists of 191 domiciliary dysphagic patients. The average age is 81,2. Women are 57,07% and the 22% of the patients live in nursing homes. The pathologies from which they mostly suffer are mainly neurologic diseases. The third level of ASHA NOMS was given to 38,74% of patients, the fourth to 21,47%, the fifth to 20,94%, the second to 6,81%, the sixth to 4,71% and finally the first to 3,66%. The SLPs intervention concentraded, above all, on adaptative precautions and on the counseling to caregivers. If before the assessment 52,88% of patients assumed liquids without any restriction, after the assessment 47,37% can continue to assume water even if with precautionary directions while they are forbidden to 48,95%. Watergel or thicknening were prescribed to 59,16% of patients. Conclusions: The characteristics of domiciliary old patients compel the SLPs to concentrate on the modification of consistencies, on the sharing of behavioural precautions and on the relative counseling. SLPs prescritions modified the diet of those patients whose dysphagia wasnt yet evident, determining just some repairs both for the people who were already subject to prescriptions and for those who had already some choices regarding the food consistency because of alterations of oral functionality or other problems. With respect to hydration, the SLP swallowing assessment implied a small increase of patients who were forbidden to drink affecting, instead, the way of assuming liquids and their quantity and quality. Learning outcomes: Illustrate a model of dysphagic patients treated at home by speech therapists inside a path of long term care; Through the elaboration of collected data, describe the clinical and welfare characteristics of the patients who were examined and their rehabilitation needs; Stimulate the programming of rehabilitation intervention proposals studied on specific clinical target.
FP63
PREVALENCE AND COMPLEXITY OF MANAGEMENT OF DYSPHAGIA IN A HURBAN TERTIARY CARE HOSPITAL OF TURIN: QUALITATIVE AND QUANTITATIVE ANALYSIS RAIMONDO SIMONA (1) SPEECH AND LANGUAGE PATHOLOGIST, CITY OF HEALTH AND SCIENCE OF TURIN, MOLINETTE HOSPITAL, TURIN, ITALY (1)
Abstract: The incidence of oropharyngeal dysphagia in acute care hospital patients is high and requires a structured and multidisciplinary approach to ensure practical application of recently published guidelines and research evidence. This prospective study provide an epidemiological survey on the incidence of oropharyngeal dysphagia in an Italian large teaching acute care hospital and investigate management complexity and effectiveness of swallowing rehabilitation in patients with complex diseases or still clinically unstable. During 2012 the various hospital departments required about one thousand evaluations from phoniatrics (92% patients with neurological or medical disorders had a suspicion of dysphagia). 320 patients who underwent the foniatric visit were assigned to speech language pathologists for treatment. The swallowing impairment was moderate to severe at the moment of referral, whereas after swallowing therapy most patients were able to eat by mouth. Speech language pathologist management promoted the swallowing function and reduced the risk of aspiration in patients treated: theese data are statistically significant (p=10-28 ). The study demonstrate
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FP65
THE ROLE OF THE CLINICAL NETS FOR PATIENTS WITH SWALLOWING DISORDERS: FROM HOSPITAL TO HOME CARE PATRIZIA LOPEZ (1) AREA VASTA 2 REGIONE MARCHE, HOSPITAL HOME CARE, SENIGALLIA, ITALY (1)
Abstract: Since 2009 the Region Marche (Central Italy) has focused on the appropriateness of the health care process of patients with stroke. Dysphagia is a sign that can be underestimated in the elderly or after a stroke. The Stroke Project aims to emphasize the attention of the healthcare workers on the assessment of the swallowing disorders. In the local sanitary agency of Senigallia (Province of Ancona) the proportion of residents >65 y. is larger than the Italian mean (23.8% vs. 20.1%). About 12% of these elderly persons are not self-sufficient. New clinical pathways have been designed to assist these patients with swallowing disorders. The most crucial steps are the planned delivery from hospital and the community care. Learning outcomes: improve the care standards of the elderly with swallowing disorders both in hospital and in the community care; improve the quality of life of the patients with swallowing disorders; reduce the number of readmission among elderly patients because of malnutrition
FP67
IMPACT OF AUDITORY MEMORY ON SPEECH AND LANGUAGE PRODUCTION IN COCHLEAR IMPLANTED CHILDREN BRANKA MIKIC (1) - DANICA MIRIC (1) - MINA MIKIC NIKOLIC (2) SANJA OSTOJIC (2) - MAJA ASANOVIC (1) NENAD ARSOVIC (1) CLINICAL CENTRE OF SERBIA, CLINIC FOR ENT AND HNS, BELGRADE, SERBIA (1) FASPER, BELGRADE UNIVERSITY, BELGRADE, SERBIA (2)
Abstract: Speech perception and production in cochlear implanted children depends on several factors such as auditory input, hearing threshold, auditory processing and higher cortical function intelligence, cognition, attention and auditory memory. Early implantation, before the age of 3 is essential because of central nervous system plasticity and possibility of cortical of reorganization. Shorter auditory deprivation time enables prelingually deaf kids to develop better receptive and expressive speech and approach norms for their hearing peers. The authors have tested 50 cochlear implanted children with more than two years of cochlear implant experience using Test of picture description to assess sentence quality and two tests of auditory memory, one using verbal material and the other using digit span recall. Children were divided in two groups: A (n=27) implanted at the age 1-3 y and B (n=23) implanted at the age 4-6 y. All of the children in this study had normal intellectual capacity and were enrolled in intensive postoperative speech and hearing rehabilitation. The results have shown that earlier implanted children developed better vocabulary, using longer sentences with better grammar, than those implanted later. Short-term verbal memory tests and forward and backward digit span recall have shown that early implantation followed by intensive rehabilitation results in improved short term and working memory in congenitally deaf children. Short term auditory memory is an important segment of speech and language development of cochlear implanted children. It affects learning and cognitive processes considerably. Cochlear implantation improves auditory memory and both receptive and expressive speech, especially if performed before the age of 3. Earlier implanted children perform better on memory and language tests than those implanted later because of greater CNS plasticity. Learning outcomes: the factors affecting speech development in cochlear implanted children, testing of auditory memory in CI children using verbal and numeric material, sentence quality in CI children following postoperative rehabilitation.
FP66
THE PRAGMATIC PROFILE OF CHILDREN WITH UNILATERAL COCHLEAR IMPLANT LUCIA DALATRI (1) - SARA GIANNANTONIO (1) SUSANNA BULDRINI (1) - VALERIO NEPOTI (1) GAETANO PALUDETTI (1) HEAD AND NECK DEPARTMENT, CATHOLIC UNIVERSITY OF THE SACRED HEART, ROMA, ITALY (1)
Abstract: A proper development of the pragmatic function allows people to direct communication towards specific purposes, to control the conversational rules and to manage all those non-unique aspects of the message conveyed by analogies, metaphors and figurative use of language. Besides, who has a good pragmatic competence is able to facilitate access to information for the interlocutor, knows how to make assumptions about the others communicative intentions, is able to reformulate a not understood message, and to seek clarification when he or she does not understand. The pragmatic competence seems to be the point of weakness of the linguistic skills of hearing impaired subjects. In this context, there are significant differences between deaf and hearing children. The main difficulties in hard-of-hearing children are: the literal interpretation of vocabulary and symbolic, abstract and idiomatic expressions; more complex uses of verbal language which require inferential skills, mastery of logical connections, skills in shifts alternation and conversational rules knowledge. The hearing loss makes it difficult for hearing impaired people to control all of the rules underlying effective speech acts production even when a good level of language formal aspects competence is reached. In this study, the test battery for pragmatic skills APL-MEDEA (Lorusso, 2009) was administered to 11 children with unilateral cochlear implant. The findings, which appear to confirm a lack of pragmatic skills, are in line with scientific literature as hearing loss-related language difficulties can have an impact on functional use of language, both due to a lexical limit and complex syntactic structures decoding troubles. Although it might seem an already acquired data, there is an interesting observation when comparing average scores obtained in each sub-domain of the APL-MEDEA test between study and control groups children. The standard deviation pattern from normal hearing peers mean scores would seem to configure a pragmatic profile with respect to the investigated subareas. This hypothesis is supported by the fact that, even correcting data for hearing age, the onfiguration of this profile is maintained, revealing and confirming the most deficient sub-skills. In the light of these results, the Authors believe that a more systematic use of APL-MEDEA test, suitably adapted for hearing impaired population, could integrate the functional evaluation of cochlear implanted children, contributing to the drafting of a more targeted intervention program Learning outcomes: Definition of pragmatic competence in normal hearing subjects; Comparison between cochlear implant recipients and normal hearing childrens pragmatic skills; Description of a typical pragmatic profile of hearing impaired children, that is the evidence of systematically poorer pragmatic subcomponents in the study sample despite quite normal formal language competence.
FP68
COMPARISON BETWEEN PHONOLOGICAL SKILLS OF CHILDREN WITH COCHLEAR IMPLANT AND CHILDREN WITH NORMAL HEARING. SHIVA EBRAHIMIAN (1) - SAMINE RAZEGHI (2) - MEHRI SAFARI (3) SAYED BASIR HASHEMI (4) - FIROOZ SADIGHI (5) FACULTY MEMBER OF SPEECH THERAPY DEPT. OF SHIRAZ UNIVERSITY OF MEDICAL SCIENCES, SHIRAZ, IRAN (1) SHIRAZ UNIVERSITY, SHIRAZ UNIVERSITY, SHIRAZ, IRAN (2 COCHLEAR IMPLANT CENTER, KHALILI HOSPITAL, SHIRAZ, IRAN (3) COCHLEAR IMPLANT CENTER, SHIRAZ UNIVERSITY OF MEDICAL SCIENCES, SHIRAZ, IRAN (4) SCHOOL OF LITRATURE AND HUMAN SCIENCES, SHIRAZ UNIVERSITY, SHIRAZ, IRAN (5)
Abstract: In order to achieve establishment of communication, Mankind has made use of different devices among which language has been the most prominent one and Speech is the dynamic flow of language. the most important speech perception organ is the auditory system, the ability to hear is taken as the joining axis of human communication and nothing will be meaningful and intelligible without sounds. The number of participants in the patient group with profound hearing loss was 30. These participants were between ages of five to eight. In this study, two tests were used: a scale for measuring the IQ score and a language test. In order to assess the participants IQ score, Wechslers non-verbal IQ test were used. In order to determine the phonological skills of each participant, These 3 subtests of Test of Language Development (TOLD) were used: Word Discrimination, Word Analysis and Word Articulation. The results revealed that the mean of children with Cochlear Implant in Word Discrimination) M=5/97) and Word Articulation (M=3/83(are significantly lower than normal children. In Word Analysis ( M=9/03)subtest, there was no significant difference between two groups. By and large, the results were in line with the findings of the studies done by other researchers. Learning outcomes: The reader will be able to understand the phonological differences between children with cochlear implant and normal children between ages of five to eight. These two groups have same IQ, and this matching help researcher to control the affect of IQ on language. Word Discrimination) M=5/97) and Word Articulation (M=3/83(in children with Cochlear Implant are significantly lower than normal children. . In Word Analysis ( M=9/03) subtest, there was no significant difference between two groups.
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STRATEGIES FOR ASSESSING DEVELOPMENT OF THEORY OF MIND CAROL WESTBY (1) BILINGUAL MULTICULTURAL SERVICES PRINCETON NE, USA (1)
Abstract: Theory of mind (ToM) deficits and delays in developing ToM are characteristic of persons with a variety of communication impairments (e.g., autism, deafness, specific language impairment, attention deficit hyperactivity disorder, those who have experienced abuse/neglect, and those from low socio-economic environments). Deficits in ToM are associated with difficulties making appropriate inferences in social and academic situations, and hence with poor social interactions and comprehension deficits. Researchers have documented four aspects of ToM (Abu-Akel & ShamayTsoory, 2011; Lucariello, 2004): Cognitive ToM: Ability to attribute mental states to oneself and others and to understand that others have beliefs, thoughts, desires, and intentions that are different from ones own; Affective ToM: Process of inferring the affective states of others by sharing their emotions and understanding the others emotions; Interpersonal ToM: Cognitive and affective ToM for others; Intrapersonal ToM: Cognitive and affective ToM for oneself . Given the role of ToM in social and academic functioning, it is important that SLPs recognize behaviors that indicate delays/deficits in ToM and have strategies for assessing and developing the range of ToM skills in persons they serve. The classic developmental milestone for cognitive ToM, which emerges between 4 to 5 years of age, is the ability to attribute false belief, that is, to recognize that others can have beliefs about the world that are not true and that they act on these false beliefs (Wellman & Liu, 2004). The emergence of pretend play around 17 months represents a precursor to cognitive ToM (Doherty, 2009). When children imagine that a block is a cookie and pretend to eat it, they are aware that they are pretending -- they recognize thought as separate from reality. Affective ToM begins at birth with primary intersubjectivity which depends on mirror neurons and reflects an infants to use and respond to eye contact, facial affects, vocal behavior in interactions with caregivers. With secondary intersubjectivity, which develops at the end of the first year of life, children are able to use others reactions/emotions as a reference point determine the emotional meaning of an unfamiliar person or object and determine their behaviors effect on others. As affective ToM develops during the preschool years, children become able to recognize and label a variety of emotions, associate emotions with situations, and predict persons behaviors based on their emotional responses ToM (Pons, Harris, & de Rosnay, 2004). A variety of tasks employing observations, vignettes, videos, and questionnaires have been developed to assess interpersonal and intrapersonal cognitive and affective from infancy through adolescence/adult (e.g., Legerstee, 2005; Liddle & Nettle, 2006; OHare, 2009; Peterson & Wellman, 2009; Pons, Harris, & de Rosnay, 2004; Shamay-Tsoory, Tibi-Elhanany, & Aharon-Peretz, 2007); White, et al, 2011). This presentation will (a) present a framework for understanding the types of ToM, (b) describe the developmental stages of theory of mind from infancy through adolescence, and (c) present strategies for assessing development of the four aspects of ToM from infancy through adolescence. Learning outcomes: describe the developmental stages of theory of mind from infancy through adolescence; explain environmental factors that influence ToM development; design a protocol for assessing development of ToM.
of healthcare services through the use of pervasive healthcare technologies. The growth in published research supports the need for increased interdisciplinary research, expansion of the number of randomized controlled clinical trials of devices, methods of diagnosis and therapeutic protocols. Of special need is increased research on normal swallow physiology, swallow pathophysiology, advanced pediatric diagnostic methods, and advanced pediatric treatment methods. In addition as clinical practice changes along with advanced pervasive health technologies more research on the efficacy of pervasive health technology in speech and language pathology is needed. Late chemoradiation treatment-related swallow effects in head and neck cancer patients J. LOGEMANN PHD CCC-SLP, BRS-S (USA)
Abstract: Purpose: The purpose of this study was to understand effects of intensity modulated radiotherapy (IMRT) which is designed to minimize radiation doses to structures related to swallowing to reduce the effects of radiotherapy and chemo radiation. This study related laryngeal radiation doses to aspiration at 12 months post treatment in 29 head and neck (non-larynx) cancer patients treated with IMRT chemoradiation. Methods: Patients were assessed for swallowing post chemoradiation and aspiration was assessed by the clinician performing the modified barium swallow. Dose-volume histograms for the larynx determined the percent laryngeal volume that received at least 60 Gray (Gy) of radiation (V60). Patients who did not aspirate before treatment were observed 12 months post treatment and classified as aspirating (n=10) or not aspirating (n=19) at 12 months. The rank sum test compared the median V60 between aspirators and non-aspirators. Similar comparisons were done for V50, V65, V70, V75 and average larynx dose. Results: Aspirators had a median V60 of 90% (standard error 8.1%) while nonaspirators had a median V60 of 33% (standard error=7.3%), p=0.03. A V60 cut point of 48% separated aspiration groups with a sensitivity of 90% and specificity of 74%. Comparisons at 65Gy were also significant but comparisons at 50, 70 and 75Gy were not. The median average dose to the larynx was 6122Gy in aspirators and 5870 in nonaspirators (p=0.03). Conclusion: Patients with head and neck cancer (excluding laryngeal cancer) who acquired aspiration post chemoradiation treatment with IMRT received higher radiation doses to the larynx than those who were free of aspiration before and after treatment. Reducing radiation dose to selected swallowing structures could prevent long-term swallowing dysfunction.
Dysphagia screening: we are we and where are we going ANTONIO SCHINDLER (ITALY)
Abstract: Oropharyngeal dysphagia (OD) is a highly prevalent clinical condition; in acute care-settings up to 12-15% of the population can present OD, while in nursing homes the prevalence may reach 60%. In rehabilitative settings OD prevalence has not been fully analyzed but it is expected to be between 15% and 60%. The consequences of OD can be severe and include malnutrition, dehydration, aspiration pneumonia and death. The management of OD is therefore necessary in order to prevent complication and requires multiprofessional teams, which are not yet widespread and are currently available only in selected areas. In most of the countries there is a large discrepancy between the patients with OD and the multiprofessional teams available. In order to manage the large case-load a three step model has been suggested and it is currently applied in several settings; step 1: dysphagia screening; step 2: bedside examination (BSE); step 3: instrumental assessment. Dysphagia screening is performed by a non-expert in OD and aims at identifying population at risk for dysphagia; BSE is performed by an expert in dysphagia and allows clinical decision on eating or feeding decision in most of the cases; instrumental assessment is performed by experts with the help of additional tools, as in the case of videofluoroscopy (VFS) and fiberoptic endoscopic evaluation of swallowing (FEES), and allows swallowing pathophysiology assessment. Over 50 different screening tools are available in the literature; however, data on reliability and accuracy from different research groups are available for stroke patients. The aim for the future is to validate screening tools for population suffering from different diseases and different settings.
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IALP DYSPHAGIA COMMITTEE SESSION: CURRENT TOPICS IN DYSPHAGIA DIAGNOSTICS AND MANAGEMENT Recent advances in dysphagia diagnostics KENNETH WATKIN UNIVERSITY OF ILLINOIS, CHAMPAIGN, IL, UNITED STATES (1) Abstract: Approximately 6 % (396,476,085) of the worlds population (6,607,934,746) has dysphagia. The incidence of dysphagia is particularly significant in acute care settings (2545%) and long-term care units (50%). 1 in 17 people will develop dysphagia in their lifetime. 50 75% of stroke patients and 6 - 70% of patients under going radiation therapy for head and neck cancer will develop dysphagia. It is estimated that dysphagia prevalence in neurological disease such as Parkinsons Disease and ALS may be as high as 90%. 75% of nursing home residents exhibit some form of dysphagia and half of over 60 millions Americans over the age of 60 will experience dysphagia at some point after age 60. Most importantly dysphasia has a profound impact on the quality of life. Researchers from around the world continue to advance our understanding of normal swallowing (deglutition) and dysphagia and to develop advanced methods for the evaluation and treatment of dysphagia. In this article we will examine the research trends in swallowing and dysphagia and will explore recent advances in the normal swallow physiology and swallow pathophysiology as well as recent advances in evaluating deglutition, management of dysphagia in adults and children as well as recent efforts to reduce healthcare costs and increase the provisions
Temporal measures and observations of video-fluoroscopic study of swallowing TAMER ABOU-ELSAAD, MD, PHD. (EGYPT)
Abstract: This introductory presentation is directed to the beginner swallowing therapists who started their career in the field of swallowing assessment and rehabilitation and are interested to make research on swallowing function and oro-pharyngeal dysphagia. The presentation will focus on demonstrating the temporal measures of swallowing and the physiological breakdowns of oro-pharyngeal deglutition. The presentation will include: The biomechanical events that happen in the oral and pharyngeal stages of swallowing. How to conduct a modified barium study (MBS) to assess oropharyngeal swallowing with the emphasis on: (a) the equipments needed, (b) the contrast test material used, (c) the technique of MBS study, and (d) the videofluroscopic image analysis. How to analysis the temporal measures in accordance to the bolus movement in the oro-pharynx.
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Pediatric dysphagia in a medical practice SANDRA L. ETTEMA, MD, PHD, CCC-SLP

Abstract: Many children present to the physicians office with a complaint from the parents that feeding, swallowing, eating, or sucking is difficult for their child, takes too much time, and/or leads to gagging and choking. This can be very exhausting and stressful for parents and results in dysfunctional as well as fearful meal times. There is a vast differential for these complaints which must be carefully evaluated by a team of professionals that are familiar with all aspects of dysphagia and how it may affect a childs growth and development. A multidisciplinary approach to management of these children is discussed in detail and how the team as a whole promotes safe and adequate nutrition, thus maintaining the optimal health for the child. Our practice provides a continuity of care for children with complex medical and surgical issues involving the airway, gastrointestinal, pulmonary, and nervous systems. The Pediatric Swallowing Clinic provides comprehensive assessment, treatment, and follow-up provided by a multidisciplinary team of specialists including allergy, audiology, gastroenterology, general surgery, genetics, neurology, nutrition, nursing, otolaryngology, pulmonology, radiology, and speech-language pathology including feeding and swallowing disorders. The initial evaluation of dysphagia in our clinic involves a thorough interview and examination by a Speech-Language Pathologist and complete upper airway evaluation by the Otolaryngologist. Further treatment is then arranged with the appropriate specialists to obtain the optimal health and nutritional status for the child. Pediatric dysphagia can be quite complex but with a multidisciplinary approach the outcomes will prove positive for all involved. Learning outcomes: At the end of this Dysphagia Committee Session, the learners will be able to: Recognize various differential diagnoses for techniques swallowing and feeding disorders; Identify various multidisciplinary team specialists and how they may provide continuity of care for dysphagia patients; Understand the steps in an initial evaluation of dysphagia in swallowing/feeding evaluation with particular emphasis on the Otolaryngology evaluation; Understand the role of radiotherapy and IMRT; know the meaning of a screening program; know the three step model for screening and managing patients with dysphagia; know the most commonly used and better validated screening tools; know the need for future research in screening tools development and validation
effects should be diminished by voice therapy. In this workshop specific features of logopedic and surgical treatment are discussed. Attention will be paid to the holistic character of voice adjustment. Especially the patient is a partner in the treatment and has to play an active role. At last, the therapists should have sympathy for the transgender person with his identity crisis. Learning outcomes: Not only pitch determines whether a voice sounds like a female or male voice. Besides other voice and speech characteristics like formants, prosody, intensity, word and language usage, other, non-verbal factors (gesticulations, facial expressions and look) are of importance. These aspects should be taken into account in a holistic process of gender specific voice fitting; In gender specific voice fitting individually performed stepby-step morphing of the transgender natural voice can be used to create examples of an ideal gender-fitted voice. In this way, it can be a practical aspect in logopedic treatment. The voice training can be supported by acoustic software used for various biofeedback approaches; The side effects of surgical intervention should be diminished by voice therapy. Voice therapy after surgical intervention will make the results better. A holistic approach of voice adjustment in transgender dysphonia is a necessary framework in gender specific voice fitting, The transgender individual is living in a wrong body. The man-to-woman transgender feels like a woman but lives in a male body, and vice versa. This causes much sorrow. Besides poor well being, the transgender often encounters much misunderstanding from family and friends and experiences many problems in their professional field. The therapists should have sympathy for the transgender person with his identity crisis.
FP69
NEUROPSYCHOLOGICAL EVALUATION OF HIGHER CORTICAL FUNCTIONS CHILDREN WITH CLEFT PALATE. MARIA DE LOURDES MERIGHI TABAQUIM TABAQUIM (1) UNIVERSITY OF SO PAULO, HOSPITAL FOR REHABILITATION OF CRANIOFACIAL ANOMALIES/SCHOOL OF DENTISTRY UNIVERSITY OF SO PAULO, BAURU, BRAZIL (1)
Abstract: The condition of cleft lip and palate requires individual efforts dynamics, cognitive and behavioral, that change constantly to manage the demands internal and / or external adaptation and psychosocial context. Although intellectual ability is in the average for a large contingent of the population with cleft lip and palate, especially without the involvement of syndrome, a significant percentage demonstrates low academic performance, with lower than expected levels for their age in activities related to neuropsychological functions such as attention, memory, perception and language. Whereas subjects with cleft lip and palate are more vulnerable to recurrent otitis and losses in auditory processing, attention, and that show signs of risk for delay in the acquisition of speech and language skills of neuropsychological research shows to be effective in the diagnostic process and targeting intervention programs. Neuropsychological assessment of children with cleft lip and palate, subject to corrective surgeries, has been a little explored field of study, although essential for identifying markers such as language, attention and memory, among others. The aim of this study was to investigate the neuropsychological functions of children with cleft lip and palate, of both sexes, aged 7-12 years. Tools were used Coloured Progressive Matrices for identification of brainpower and Neuropsychological examination consisted of ten sets of tests and sub-tests that assessed cognitive abilities perceptual-motor, attention, memory, receptive and expressive language, semantic and pragmatic performance in activities of reading, writing and arithmetic. The performances were classified by type of cleft, analyzed from the functional dynamics of cortical areas and their associations, and described quantitatively and qualitatively by group. We utilized the nonparametric Kruskal Wallis and Chi-square with 2 degrees of freedom and probability 0,367879, whose independent variable was the function, and dependent performance. For individual comparisons, we used the Miller test, with significance level of 0,05, statistically not significant, although with descriptive representation. With the average intellectual level expected for their age, the group with cleft post foramen performances had more impaired in all functions of attention and working memory resources were with neuropsychological scores lower for all groups (md=58), with group post foramen, the most affected (md=52). The cognitive linguistic profiles were demoted (md=60), implying a lack of resources semantic and pragmatic communication. The function of the hand, with similar average percentage of correct ansers in 88,7, considering all groups evaluated. When analyzed genders, it was found that females obtained higher scores (slightly outdated) compared to males (moderately lagged), being the best performances seen in subjects with cleft transforamen and lowest in post foramen (moderate to severe). The study demonstrated feature neuropsychological lower than expected for the age and education of children with cleft lip and palate, with diagnostic significance in the processing of sustained attention and working memory, auditory-visual, indicating the need for targeted intervention for the rehabilitation of cognitive functions identified. Learning outcomes: Identify the skills for learning of children with specific congenital anomalies; Knowing the characteristics of neuropsychological testing as a tool for evaluating motor functions, perception, language and memory; Understand the diagnostic significance in the processing of attention, auditory working memory, visual and cognitive-linguistic functions
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GENDER SPECIFIC VOICE FITTING IN TRANSGENDER FELIX DE JONG (1) - CHRISTIANE NEUSCHAEFER-RUBE (2) ENT-HEAD AND NECK, EXPERIMENTAL ORL, KATHOLIC UNIVERSTY LEUVEN, LEUVEN, BELGIUM (1) - CLINIC OF PHONIATRICS, PEDAUDIOLOGY AND COMMUNICATION DISORDERS, UNIVERSITY HOSPITAL OF THE RWTH AACHEN UNIVERSITY, AACHEN, GERMANY (2)
Abstract: Adjustment of the voice is necessary for proper gender identity in transgenders. Not only pitch determines whether a voice sounds like a female or male voice. Also non-verbal factors are of importance. Stereotypically, men have a lower habitual voice pitch and speak louder than women. Their voice quality is usually more dark and of less prosody. Men are said to have a more tough and rough voice usage and a more slipshod articulation. They would produce shorter sentences. Women would frequently use words of reinforcement, diminutives and use a different vocabulary. Furthermore, women would use gesticulations more frequently, show different facial expressions and move in a different manner compared to males. In order to achieve an efficient voice fitting the authors recommend an early phoniatric consultation. The ENT specialist/phoniatrician takes the medical history and performs a general ENT and specific laryngological examination. The voice therapist carries out an extensive assessment of voice, speech and language, focussed on the above mentioned gender characteristics and performs acoustic voice analysis. The first therapeutical approach in gender specific voice fitting will be logopedic treatment. Female-to-male transgenders develop a lower fundamental frequency usually after their hormonal treatment. In contrast, male-to-female transgenders need early care to achieve a proper gender-fitted voice. Thereby, care must be taken not to exaggerate. Using different prototypic female voice samples realistic goals have to be defined in consultation with the patients. Sometimes an individually performed step-by-step morphing of the transgender natural voice can be used to create examples of an ideal gender-fitted voice. The voice training can be supported by acoustic software used for various biofeedback approaches. If a sufficient result is not obtained by logopedic treatment, surgical intervention can be considered. The most frequently applied direct intervention on the vocal folds is anterior chordopexy, i.e. shortening of the vibratory length of the vocal folds. An other procedure is tightening up the vocal folds by laser. The most frequently applied laryngeal framework surgical procedure is cricothyroid approximation, that imitates the function of the cricothyroid muscle. Other framework techniques make the larynx smaller by removing its front and shortening of the vocal folds; thyrohyoid approximation raises the resonance of the pharynx by shortening the pharyngeal resonator chamber. The possibilities and limitations of the therapy should be discussed with the patient. Voice therapy requires continuous attention and effort. After laryngeal framework surgery, modulation of the voice is decreased, especially in singing. There will be a loss of vocal range at the low end and less pronounced at the top end. Also voice intensity is decreased. These side
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FP70
THE SPEECH DEVELOPMENT OF CHILDREN AGED 4 TO 5 WITH CLEFT PALATE DOMINIQUE WESTON (1) - ALISON PURCELL (1) PATRICIA MCCABE (1) - MICHEAL MCGLYNN (2) MELISSA PARKIN (3) - SHARYN GRIEG (3) SPEECH PATHOLOGY, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (1) - PLASTIC SURGERY, SYDNEY CHILDRENS HOSPITALS NETWORK (RANDWICK), SYDNEY, AUSTRALIA (2) - SPEECH PATHOLOGY, SYDNEY CHILDRENS HOSPITALS NETWORK (RANDWICK), SYDNEY, AUSTRALIA (3)
Abstract: Children with cleft lip and palate (CP) frequently have impaired speech development. The speech sound difficulties of children with CP may be phonetic or phonologic in nature. Phonetic disorders are the result of imprecise or inaccurate physical movements involved in shaping the vocal tract above the larynx to produce individual phonemes. Phonemic (also called phonological) disorders are linguistic in nature and reflect the childs organisation of sound patterns. For the most part, the research literature describing the speech skills of children with CP has been written from a phonetic perspective with investigators considering CP speech as an articulatory disorder with an anatomical aetiology. However, the differences in speech development of children with CP can also be influenced by phonemic errors For children with CP the presence of phonological speech errors may be yet another factor impacting reading and academic learning. For children without clefts, there is clear evidence that children with phonological disorders are more at risk for problems in early reading achievement. In examining the speech development of children with CP, it is also important to consider word shapes (monosyllabic, disyllabic and polysyllabic words) as they provide different information for clinical decision making. For example, in typically developing children aged 3;0 to 7;11 years, significantly lower consonant accuracy has been reported in polysyllabic words in comparison to mono- and disyllabic words. Polysyllabic words are a sensitive indicator of speech and language impairment, predicting later speech impairment and literacy problem. Little is known regarding polysyllabic word development in children with CP. This study had three aims 1) To investigate if children with CP experience more speech errors than typically developing children; 2) Do children with CP experience a higher phonetic accuracy than their phonemic accuracy; and 3) Are polysyllabic words more vulnerable to error than monosyllabic words? This was a prospective study of a consecutive cohort of 14 children with cleft lip and palate aged 4;0 to 5;8. Phonetic and phonological analysis of the speech samples were collected and phonetically transcribed. Analysis was undertaken using the PROPH+ component within the Computerized Profiling Package: At 4 years of age, participants phonemic accuracy was greater than their phonetic accuracy t(18)=-2.54 (p<0.05), however by 5 years of age no significant difference was found t(6)=-2.18 (p>0.05). The production of polysyllabic words was not found to be significantly different from monosyllabic words t(22)=0.70 (p>0.05). Oral structure deficits resulting from the cleft significantly impacted the speech performance of the children at 4 years of age, with participants experiencing a significantly higher phonemic accuracy compared to their phonetic accuracy. The phonetic and phonemic scores of children with CP improved with age. At 5 years of age, participants phonetic accuracy was not significantly different to their phonemic accuracy. However, phonemic accuracy was still below average mean scores of typically developing children at both ages 4 and 5. The production of polysyllabic words was not found to be more vulnerable to speech errors than monosyllable words.
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PRACTICAL APPLICATIONS OF AUGMENTATIVE AND ALTERNATIVE COMMUNICATION SYSTEMS IN CHILDREN BIRTH TO THREE YEARS OLD PERMELIA MCCAIN (1) SUNNY DAYS INCORPORATED, N/A, PITTSTOWN, U.S.A. (1)
Abstract: Medical science continues to develop the technology and medical procedures to make it possible for infants born very early to survive, recognize medical issues early and diagnose them, more astute parents are recognizing speech delays in their children and seeking help early through hospitals and Early Intervention Programs and society is encouraging children with multiple disabilities to be a part of school and community programs. To make all of these things more successful a mode of communication should be developed as early as possible with all children. Communication begins immediately and continues through our lifetime so should AAC to insure that this happens for all children whether it is going to be a life-long mode or a supplementary mode while speech and language develops. Use of AAC has been most successful when it follows a developmental pathway that supports both receptive and expressive communication. Encouraging receptive vocabulary grow through all the senses, exploring the environment with assistance to learn through all the senses and including physical movement to reinforce have been successful with very young disabled children. Children who have limited access to their environment must have a multimodal means of communication with the use of all their modalities to learn. Ideas and strategies that have been used with the birth to three populations will be discussed and samples of materials used will be given. Children who experience communication delay have a totally different need for AAC to assist them in developing language. Both family and child frustration often develops when communication does not develop beyond sounds and crying or temper tantrums. AAC can help reduce this frustration by adding gesture, sign or AAC to teach the communication process and support the family while the child develops speech. As speech develops Aided Language Stimulation then helps support the development of syntax and conversation. This program will review the literature; describe materials and programs used in an early intervention program that has been successful with children birth to three. Systems from no tech (gesture and signs), low tech (simple object, symbol or photo systems), and medium tech (simple single switch devices) to the IPAD, used as both a simple single switch device to a level of Aided Language Stimulation. All materials and programs used will be cost effective for families and therapist. Evidence Based Practice will be supported with publication data.
FP72
STATISTICAL ANALYSIS OF THE RELIABILITY OF ACOUSTIC AND ELECTROGLOTTOGRAPHIC PERTURBATION PARAMETERS FOR THE DETECTION OF VOCAL ROUGHNESS KIYOHITO HOSOKAWA (1) - MAKOTO OGAWA (1) HIDENORI INOHARA (1) DEPARTMENT OF OTORHINOLARYNGOLOGY-HEAD AND NECK SURGERY, OSAKA UNIVERSITY GRADUATE SCHOOL OF MEDICINE, OSAKA, JAPAN (1)
Abstract: Background: In the estimation of the severity of pathological voices, subjective perceptual ratings such as the GRBAS scale and objective techniques to quantify the level of cycle-to-cycle irregularities in Ac signals including the period/amplitude perturbation parameters have been used worldwide. However, some recent studies pointed out the poor reliabilities of these acoustic measures especially for the detection of mild vocal disturbances. Electroglottography (EGG) is a technique used to analyze the vibratory characteristics of the vocal folds by detecting impedance changes across the larynx. Several studies implied that the perturbation parameters of EGG signals could be finer indicators to detect abnormal voice conditions than those of Ac signals. However, no studies have evaluated the discriminative abilities of these EGG measures. The aim of this study was to verify whether the EGG perturbation parameters could be superior indicators to traditional Ac measures, particularly for the detection of mild vocal roughness. Patients and Methods: We enrolled 40 non-dysphonic participants and 87 dysphonic patients with vocal roughness (organic dysphonia: 48, muscle tension dysphonia(MTD): 39). The diagnosis of organic dysphonia was determined by the findings from a laryngoscopy. In addition, that of MTD was defined by the presence of a rough/strained voice and supraglottic contraction during phonation without any organic abnormalities. After otolaryngological assessments, simultaneous Ac and EGG recordings were made in a sound-treated room. The head-worn condenser microphone was laterally positioned 2 cm from the lips and the EGG electrodes were fitted on the neck over the bilateral lamina of the thyroid cartilage. Each participant was directed to phonate a sustained vowel /e:/ at a comfortable pitch and loudness for approximately three seconds. The Ac and EGG signals were low-pass-filtered at 10 kHz and band-pass-filtered from 40 Hz to 5 kHz, respectively. The same intervals of approximately 1000 msec from both signals were extracted for the calculation of a five-point period perturbation quotient (PPQ) and an 11-point amplitude perturbation quotient (APQ). The participants in each dysphonic group were further divided into the mild and severe groups based on the severity of the R scores. The receiver operating
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FP71
IMPACT OF OBTURATION OF PALATAL FISTULAE ON THE SPEECH QUALITY IN PATIENTS WITH CLEFT PALATES VIRGINIE WOISARD (1) - EMMANUELLE NOIRRIT-ESCLASSAN (2) - VANESSA VANDREBECK (1) VOICE AND DEGLUTITION UNIT, ENT DEPARTMENT, UNIVERSITARY HOSPITAL OF TOULOUSE, TOULOUSE, FRANCE (1) - ODONTOLOGY, UNIVERSITARY HOSPITAL OF TOULOUSE, TOULOUSE, FRANCE (2)
Abstract: The aim of this prospective study is to measure the nasal and oral air flow during phonation, before and after obturation. Patients and Methods Inclusion Criteria : Children with age 3 to 18 years, non syndromic clefts, palatal fistulae. Corpus used : syllable (pi), sentence containing stop consonants and a nasal phonem, denomination from a pictured scene. Analysis criteria : percentage of nasality, value of acceleration of explosion, perceived nasality and intelligibility, tolerance of the proposed device. Results: Only 5 children were included due to the observation of an increase in the percentage of nasality. The value of acceleration of explosion increased in all patients. A decrease in the perceived nasality was noted in all but one patient. Amelioration of intelligibility was observed in 3 out of 5 children. The tolerance of the device was favorable. Conclusion: The small number of patients studied does not allow for conclusions about the efficiency of the obturation. The described method, as well as, the introduction of the speed of explosion of stop consonants, offer new perspectives to study the evolution of phonation in a prospective way.
characteristic (ROC) analyses were applied to evaluate the discriminative abilities. Results: In the analyses between the whole dysphonic and control groups, the value of areas under the curve (AUC) for EGG-PPQ was significantly higher than that for the Ac-PPQ. Next, the ROC analyses between the mildly dysphonic and control groups demonstrated that the AUC values for EGG-PPQ/EGG-APQ were significantly higher than those for Ac-PPQ/AcAPQ, respectively. In the analyses of the mild MTD group, the AUC values for EGG-PPQ/EGG-APQ were significantly higher than those for the Ac-PPQ/ Ac-APQ, respectively. Concerning the mild-organic group, the AUC value for EGG-PPQ was significantly higher than that for Ac-PPQ. Conclusions: The present study demonstrated that both of the period and amplitude perturbation parameters of EGG signals showed higher accuracies than those of Ac signals, especially for the detection of mild vocal roughness. These results suggested that the EGG perturbation parameters could be better substitute for the traditional Ac perturbations. Learning outcomes: By the ending of our presentation, attendees will be able to: 1. recognize the limitations and disadvantages of the present methodologies to quantitate the vocal abnormalities; 2. learn a statistical method to analyze reliabilities of diagnostic examinations for voice disorders; 3. find new possibilities of electroglottography in the diagnosis of voice disorders.
FP74
VOICE ASSESSMENT USING NONLINEAR DESCRIPTORS AND TRADITIONAL ACOUSTICAL ANALYSIS MARIA EUGENIA DAJER (1) DEPARTAMENT OF EAR, NOSE AND THROAT- MEDICINE FACULTY, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Voice assessment requires the use of many perspectives, including acoustical analysis, which complements perceptual voice evaluation and provides quasi-objective data. Scientists suggested that perturbation analysis might not be applicable to aperiodic signals, as dysphonic voices. In the last decades new approaches, as nonlinear methods have shown promising results for voice analysis. The goal of the current study is to analyze and compare healthy and dysphonic female voices using perceptual and acoustical analysis, as well as, nonlinear descriptors. Methods: twenty nine patients, all female, participated in this study. Thirteen presented no voice complain or laryngeal pathology, and the other sixteen presented different laryngeal diagnosis and dysphonic voices. All women underwent a routine evaluation and the sustained vowel (/ae/) was recorded and submitted to qualitative and quantitative analysis. For acoustical analysis we extracted F0 and vocal perturbation parameters, jitter and shimmer. Perceptual analysis was performed using visual analog scale. We applied phase-space reconstruction and Poincar section techniques for nonlinear analysis. Mann-Whitney test was applied for statistical analysis. Results: perceptual parameters, jitter and quantitative nonlinear descriptors were statistically different between the groups. Conclusion: nonlinear approach can be added to the assessment clinical protocol as a valuable tool, since it can highlight important unique information, such is as regularity and periodicity of the vocal signal. Futures studies will increase the number of subjects and will included male voices to the data. Learning outcomes: know the new approach of nonlinear dynamics. for voice analysis; Understand the application of nonlinear descriptors for voice analysis and evaluate the possibilities and the limitations of this approach.
FP73
RELEVANCE OF GLOTTAL FLOW PARAMETERS TO THE PERCEPTION OF VOICE QUALITY GLUCIA LAS SALOMO (1) DEPARTMENT OF SPEECH HEARING AND MUSIC, ROYAL INSTITUTE OF TECHNOLOGY (KTH), STOCKHOLM, SWEDEN (1)
Abstract: A better understanding of the aerodynamic characteristics of the voice, such as the ones represented by parameters of the glottal flow waveforms, has been considered promising to improve the objective assessment of voice quality. However, the potential applications of such measurements for voice evaluation have still not been fully exploited. There is uncertainty regarding which parameters would best reflect significant differences between laryngeal adjustments, as well as to the specific relevance of such parameters for the auditory-perception of the voice quality. Glottal flow waveforms can be obtained by means of inverse filtering. They show the airflow pattern at the glottis, thus providing an accurate representation of vocal folds movement during the vibratory cycle. These waveforms have been a target for research over several decades, though rarely used in voice clinic. The purpose of this study is to investigate: The glottal aerodynamic characteristics of different laryngeal adjustments; The relevance of glottal flow parameters to the perception of voice quality. Analyses of 104 flow glottograms of vowels with the same pitch produced in modal and falsetto registers were carried out regarding to different glottal parameters: closed quotient (Qclosed); peak-to-peak airflow amplitude (AC amplitude); maximum flow declination rate (MFDR); amplitude quotient, i.e. the ratio between the AC amplitude and MFDR, and its corresponding normalized amplitude quotient (NAQ); the level difference between the two lowest partials in the spectrum of the flow glottograms (H1 H2). We assumed that laryngeal adjustments in modal and falsetto phonations should vary considerable and we wanted to see if such variations could be systematically expressed by means of glottal flow parameters. The perceptual characteristics of these sounds were evaluated by a panel of 16 voice experts. The results showed systematic differences between the glottal flow parameters values for different laryngeal adjustments. Tones with a high value of Qclosed and low values of H1H2 and of NAQ were typically associated with voices perceived as produced in modal, and vice versa. The Qclosed parameter showed the strongest correlation with the perceived voice quality. A stepwise multiple regression analysis showed that the Qclosed was the strongest predictor of voices perceived as produced in modal, followed by H1H2, MFDR, and AC amplitude. NAQ was the parameter that showed the strongest correlation with the number of votes for modal voices (r=0.830). A cluster analysis of the flow glottogram parameters showed a continuum along the range of values for each of the parameters. Voices were unanimously perceived as belonging to one or to the other category when they were at the extremes of this continuum. These results suggested that: 1. differences in laryngeal adjustments can be systematically expressed by means of glottal flow parameters; 2. different glottogram parameters can be varied continuously and combined differently during phonation; 3. specific combinations or clusters of aerodynamics characteristics are likely to be associated with different perceived voice qualities; 4. the categorization of a perceived voice quality seems to be clearly distinct the wider these clusters are apart in the continuum of each of the parameters values. Learning outcomes: how glottal flow parameters show the aerodynamic characteristics of different laryngeal adjustments; the relevance of some glottal flow parameters to the perception of voice quality; some limitations of inverse filtering.
FP75
APPLICATION OF LOW-REDUNDANCY AND DICHOTIC TESTS IN AUDIOLOGICAL DIAGNOSIS OF SCLEROSIS MULTIPLEX WALDEMAR WOJNOWSKI (1) - BOZENA WISKIRS-WOZNICA (1) MIECZYSLAW WENDER (2) - HANNA CZERNIEJEWSKA (1) Ilona Kaminska (2) DEPARTMENT OF PHONIATRICS AND AUDIOLOGY, UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND (1) - DEPARTMENT OF NEUROLOGY, UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND (2)
Abstract: Introduction: Multiple sclerosis (sclerosis multiplex) is one of the most frequent demyelinating diseases in the course of which a multifocal inflammatory process occurs, together with disintegration of the axons of nerve fibres and their myelin sheaths. Clinical observation remains to be the main criterion and the following additional examinations: magnetic resonance, assessment of the IgG index, electrophysiological tests (somatosensory, audio and visual evoked responses) and low redundancy speech tests, help to confirm the MS diagnosis. Aim: The aim of the study was to assess central auditory disorders, the so-called central auditory processing disorders, in patients with multiple sclerosis with the use of new low redundancy speech audiometry tests and the influence of the advancement of the disease on test results. Material and methods: 62 patients (47 women and 15 men) with diagnosed progressive-relapsing multiple sclerosis, aged 20-55, were included into the study. The study group was further subdivided into two groups, depending on time after onset of the disease. The first subgroup comprised patients with <5 year-period between the symptoms onset and beginning of the study (average 2,8+1,4). The second subgroup included 30 patients with >5 year-period between the symptoms onset and beginning of the study (average 29+_1,6). All studied participants underwent a numeral and verbal dichotic test with the use of minimal pairs divided into two channels by means of Cool Edit Pro 2.0 with 55dB HL and monaural test with excluded frequencies for the right and the left ear. The same software was used for the alternate binaural Calearo Test. The control group consisted of 75 randomly chosen volunteers (aged 14-63) from amongst the students. Results: In the filtered speech test statistically significant differences concerned all studied filtrations, in case of dichotic tests, the left-ear and twoear hearing suppression was notable, connected mostly with the presence of demyelinating changes in corpus callosum and impaired synchronization between the hemispheres. Problems in the integration functions was also noted in the Calearo Test, where not only low-redundancy (3-syllable) but also high-redundancy (5-syllable) words were not recognized. Conclusions: Hearing disorders, both peripheral and central, are one of the first non-specific symptoms of multiple sclerosis, similarly to symptoms from the organ of sight. More extensive application of dichotic tests, both monaural and dichotic, may facilitate early diagnosis of the disease. Test accessibility and economic factors (low costs) are a great advantage. Additionally, dichotic tests may either indicate the effectiveness of the multiple sclerosis therapy or signal progression of demyelinating changes, what is not always visible in imaging tests.
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Learning outcomes: know central auditory processing disorders which accompany multiple sclerosis; know the following examinations which help to confirm the MS diagnosis; understand the idea of filtered-speech test; know the correlations between the results of filtreted-speech test and duration of MS.
SY5
INTERDISCIPLINARY COOPERATION IN VOICE RESEARCH: INDISPENSABLE, INSPIRING AND FRUITFUL! PHILIPPE DEJONCKERE (1) - CLAUDIA MANFREDI (2) GIOVANNA CANTARELLA (3) - KATRIN NEUMANN (4) MIEKE MOERMAN (5) - RAHUL SHRIVASTAV (6) FEDERAL INSTITUTE FOR OCCUPATIONAL DISEASES, BRUSSELS; CATHOLIC UNIVERSITY OF LEUVEN, DEPT OF NEUROSCIENCES (EXPERIMENTAL ORL), BRUSSELS / LEUVEN, BELGIUM (1) DEPT. OF INFORMATION ENGINEERING, UNIVERSITY OF FLORENCE, FLORENCE, ITALY (2) OSPEDALE MAGGIORE POLICLINICO MILANO, DEPT. OF ORL/ PHONIATRICS/PHONOSURGERY, UNIVERSITY OF MILAN, ITALY (3) ST. ELISABETH UNIVERSITY HOSPITAL , DEPT. OF PHONIATRICS AND PEDAUDIOLOGY, UNIVERSITY OF BOCHUM, BOCHUM, GERMANY (4) DEPT. OF ORL - PHONIATRICS - HEAD AND NECK SURGERY, PALFIJN & MARIA MIDDELARES HOSPITAL, GHENT, BELGIUM (5) DEPT. OF SPEECH, LANGUAGE AND HEARING SCIENCES, UNIVERSITY OF FLORIDA, GAINESVILLE, UNITED STATES (6)
Abstract: From 2006 to 2011 ran COST-Action 2103 Advanced Voice Assessment funded by the EU. COST (European Cooperation in Science and Technology) is one of the longest-running European frameworks supporting cooperation among scientists and researchers across Europe. Our Action was mainly focusing on applying basic research in voice physics, physiology and modelling for improving the assessment techniques of normal and pathological voices. A better understanding of the pathogenesis of deviant voice quality can be helpful in prevention of voice disorders particularly in occupational voice users, and more accurate assessment procedures make possible better comparisons between treatment approaches for voice diseases, and thus evidence based health care. The Action was based on a cooperation between on the one hand engineers / physicists, experts in signal analysis and processing, and on the other hand laryngologists/phoniatricians/voice scientists, experts in care and cure of voice (19 countries). The essence of our Action was the effective communication and cooperation between the two disciplines within the COST network. This cooperation pertained to various domains of voice science. Five important fields are presented, showing concrete results for the clinician, ongoing research and perspectives. In each domain, is demonstrated how bringing together two different domains and philosophies of scientific knowledge is a challenge, and how the interdisciplinary cooperation within a network is the cornerstone of successful achievement. Learning outcomes: In current voice research, cooperation between on the one hand engineers / physicists, experts in signal analysis and processing, and on the other hand laryngologists/phoniatricians/voice scientists, experts in care and cure of voice is essential; Computer-modelling of vocal fold vibration can have relevant applications in voice pathology and treatment; Advanced acoustic analysis and voice monitoring has several new applications, as substitution voices, spasmodic dysphonia voices, newborn cry, tremor, young autistic children, snoring; Neuro-imaging techniques can usefully be combined with acoustic analysis, perceptual evaluation and patients self-evaluation for better understanding pathophysiology of spasmodic dysphonia and treatment effects.
FP76
CENTRAL AUDITORY PROCESSING DISORDER IN CHILDREN WITH DYSORTOGRAPHIA OLGA DLOUHA (1) DEPT. OF PHONIATRICS, THE FIRST FACULTY OF MEDICINE, CHARLES UNIVERSITY, AND GENERAL UNIVERSITY HOSPITAL, PRAGUE, CZECH REPUBLIC (1)
Abstract: Central auditory processing disorders (CAPD) may occur in children with developmental speech-language impairment, with learning disabilities and with attention deficit. Central auditory processing tests are classified in several categories: monotic, dichotic, binaural tests. Dichotic listening: stimuli perceived simultaneously but being different. This is a technique of simultaneously presentation of different stimuli in both ears. The aim of our study is to: a) record the dichotic listening in normal school children and children with dysortographia (range 8-10 yrs. old); b) analyse the relationship between results these mentioned two groups. We developed special dichotic tests in Czech language. The tests aim at taking into account the dichotic perception possibilities using simple words (two-syllable words) and short sentences, in which case the central integration, temporal processing and linked short-term memory quality can be evaluated, as well as association ability of the children, as the case may be. 52 school children with residual form of specific language impairment (SLI) with dysortographia were compared with 22 normal developing children, who had undergone dichotic listening. The threshold value of dichotic presentation of words was at 60 dB HL using the two-channel audiometer. The results evaluate the percentage rate of success of the words recognized. Results of the dichotic speech test in 52 children with dysortographia in the age of 8 - 10 yrs.: average rate of success of these children was 85.58 % in test 1, 86.83 % in test 2, and 86.73 % in test 3, 72.98 % in test 4 and 60.95 % in test 5. Rate of success of the control group was 98.63 %, 98.40 %, 99.31 %, 92.27 % and 87.50 %. Highly significant differences (p 0.001) were confirmed by statistical evaluation using the pair t-test in cases of test number 4 and 5 (dichotic listening of multisyllables 4 words in one sentence). Results of the tests in children with dysortographia confirmed integration problems in the central perception area and the short-term memory disorder. Older children with dysortographia as residual forms of SLI do not show such a typical symptomatology in their spontaneous speech expression, however, difficulties still remain in them especially on the phonological level and on the auditory differentiation level of distinctive phonemes features. Learning outcomes: know symptomatology of SLI and of CAPD; understand dichotic listening problems; 3) know relationship between dysortographia and CAPD.
FP77
CENTRAL AUDITORY PROCESSING DISORDERS: REFERRAL GUIDELINES & DIAGNOSTIC CRITERIA SOMAIA TAWFIK (1) FACULTY OF MEDICINE, AIN SHAMS UNIVERSITY, CAIRO, EGYPT (1)
Abstract: Auditory processing disorder is a deficit in the processing of auditory information. It is a deficit in neural processing of auditory stimuli that is not due to higher order language or cognitive factors (ASHA, 2005). It can occur alone or coexist with other disorders including attention deficit disorder ( ADHD), language impairment & learning disability. It has a negative impact on language development, academic achievement & social adjustment. Identification, assessment & management of auditory processing disorders (APD) in children is one of the most exciting, challenging &controversial areas in audiology scope of practice. The wide range of intellectual, behavioral, educational, psychological, medical and social issues associated with (C) APD require appropriate guidelines for referral & multidisciplinary team approach for assessment. The seminar will focus on assessing (C) APDs using a comprehensive test battery that provides adequate information to describe the functional parameters of the childs skills across a variety of auditory behaviors and provides a differential diagnosis. It will also highlight the role of Integration of the audiological test results with results of speech language pathology, psychology, learning disabilities and other specialties that can guide for appropriate diagnosis and intervention plan. Learning outcomes: Understand the theory and principles of central auditory function & dysfunction; Summarize the steps for selection and evaluation of patients with central auditory processing disorders; List the indications for central auditory testing &selection of the appropriate protocol for evaluation of children; Outline the principle of multidisciplinary approach in diagnosis of central auditory processing disorders.
SS13
VELOPHARYNGEAL INSUFFICIENCY UTE PROESCHEL (1) - ANDREA SCHWAB (2) NICOLE STUHRMANN (3) - LUCA AUTELITANO (4) INSTITUT FR PHONIATRIE UND PDAUDIOLOGIE, VESTISCHE KINDER- UND JUGENDKLINIK DATTELN, DATTELN, GERMANY (1) NONE, MNCHEN, GERMANY (2) ABTEILUNG FR PHONIATRIE UND PDAUDIOLOGIE, UNIVERSITTSKLINIKUM HEIDELBERG, HEIDELBERG, GERMANY (3) CLEFT LIP AND PALATE REGIONAL CENTER, SAN PAOLO HOSPITAL, MILAN, ITALY (4)
Abstract: The workshop will focus on the different therapeutic aspects of velopharyngeal insufficiency (VPI). The different etiologies such as Cleft palate, certain anatomical conditions, defects after surgical procedures or palsy are only pointed out shortly. The phoniatrician than will give an overview of the diagnostic procedures which should take place in cases with hypernasality / velopharyngeal insufficiency. The speech pathologist will present the possibilities of early intervention in children with a high risk for velopharyngeal insufficiencies such as the Castillo Morales method. She will also point out which functional therapeutic procedures have proved to be more or less helpful in overcoming hypernasality. She will also point out the limits of functional therapy. The phoniatrician will demonstrate the possibility of biofeedback therapy in children with functional velopharyngeal insufficiency which could
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not dealt with in speech therapy only. The oral surgent will than give an overview of the different surgical techniques possible such as velopharyngoplasty, augmentation, push-back procedures and pharyngoplasties. He will point out the indications for surgery, the timing of the operation as well as the advantages and disadvantages of the different procedures. Finally the speakers will discuss different opinions about special conditions with the audience. Learning outcomes: know about the etiologies of velopharnygeal insufficiency (VPI); understand the different functions in swallowing and speaking; know the diagnostic tools as well as the conservative and surgical measures to overcome VPI; discuss the pros and cons of the different therapeutic methods; advise on the best treatment for the individual patient with VPI.
55 to 87 % (average 67.14) for nasals. It is difficult to draw meaningful conclusions for the second group, especially in cases where nasal escape is not constant. Considering pathological the scores with a rate higher than the maximum value found in normal subjects (group I), we found that the consonant cluster where a pathological nasality is more constant is the fricatives / affricates one. It is followed by voiced plosives and voiceless plosives . Comparing these results with those obtained with subjective evaluation with auscultation tube, we can say that they are similar in the two methods.
FP80
NASALANCE SCORES IN THE SPEECH OF NORMAL PERSIANSPEAKING CHILDREN 3/6-6/6 YEARS OLD IN TEHRAN. HEDIEH HASHEMI (1) - NAHID JALILE VAND (2) ALI GHORBANI (2) - MOHAMMAD KAMALI (3) DEPARTMENT OF SPEECH PATHOLOGY, SEMNAN UNIVERSITY OF MEDICAL SCIENCES, SEMNAN, IRAN (1) DEPARTMENT OF SPEECH THERAPY, FACULTY OF REHABILITATION SCIENCES, TEHRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN (2) DEPARTMENT OF REHABILITATION MANAGEMENT, FACULTY OF REHABILITATION SCIENCES, TEHRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN (3)
Abstract: Background and Aim: In the process of assessing the nasalance scores in speech, typically it is vital to know about normative data. While the differences between nasalance scores in normal and abnormal cases are not correctly measured. The main objective of this survey was to obtain normative data on nasalance scores in normal Persian speaking children aged between 3.5 to 6.5 years old that is used in research and clinical trials. Methods: In this cross-sectional study, nasalance scores were measured in the speech of 112 children (55 male, 57female) ranging in age group from 3.5 to 6.5 years old. After auditory screening and speech assessments, the subjects who get the sufficient criterions, entered the study. Speech sample was obtained by imitation and repeating nasal and oral sentences and mean nasalance scores was measured by Nasal view soft ware. Results: A mean nasalance score of 46.25%was obtained for nasal sentences and a mean score of 43.67% for fricative sentences, 43.41% for affricative sentences and 42.21% for stop sentences. There was higher nasalance scores in girls but the difference was not significant (p=0/201) but there was a significant difference in nasalance scores between different age groups in stop (p= 0.037), fricative (p= 0.036) and nasal sentences(p= 0.032). Conclusion: Findings of this study prepared good statistical data about nasalance scores in normal Persian-speaking children aged 3.6-6.6 years old, which can be a good start for preparing standards of speech in children and provides comparisons between normal and abnormal scores .The survey also shows that nasalance scores can be different in sentences with same manner of articulation and can be affected by presence or absence of nasal consonants and even age. In fact, according to normative data more nasalance scores were measured in older ages. Learning outcomes: Know the normal nasalance scores in Persian-speaking children compared with other languages; Understand the effects of consonantal contexts on nasalance scores in normal Persian speaking children; Know that the nasalance scores are higher in fricative sentences compared with other oral sentences; Understand the difference between nasal and oral sentences is significant while it seems lower than the difference in other languages.
FP78
THE NASALITY SEVERITY INDEX: AN OBJECTIVE, MULTIPARAMETRIC APPROACH OF HYPERNASALITY KIM BETTENS (1) - FLORIS WUYTS (2) - PAUL CORTHALS (1) KRISTIANE VAN LIERDE (1) DEPARTMENT OF OTORHINOLARYNGOLOGY AND LOGOPAEDIC AND AUDIOLOGIC SCIENCES, GHENT UNIVERSITY, GHENT, BELGIUM (1) BIOMEDICAL PHYSICS, UNIVERSITY OF ANTWERP, ANTWERP, BELGIUM (2)
Abstract: Resonance disorders are a multidisciplinary problem and occur in multiple craniofacial pathologies. Based on the multidimensional nature of resonance, a multivariate approach is obliged in the diagnostic assessment of resonance pathologies. The purpose of the present study was to refine the Nasality Severity Index (NSI), an objective multiparametric index for hypernasality, based on the results of cleft palate patients and an age matched control group. a total of 18 cleft palate patients (8 girls, 10 boys, mean age 8;5y (SE 5.6)) and 30 normal developing children without any resonance disorder (15 girls, 15 boys, mean age 8;4y (SE 5.6)), aged 4 to 12 years old, were subject of an objective test battery and a perceptual judgment. A Nasometer (model 6450) was used to obtain nasalance scores (3 sounds and 2 reading passages). Furthermore, the difference of the mean amount of energy between the two first energy peaks of the sound /i/ and the difference in bandwidth of the first formant of the sound /i/ with open en closed nose was determined by spectral analysis. Aaerodynamic values were calculated using the Maximum Duration Time (MDT). Linear discriminant analysis was used to calculate the optimal index. The refined NSI is a linear combination of 3 variables, where each variable has his own weight. The equation is: NSI = (0.13 x nasalance /i/ (%))- (0.15 x nasalance oral text (%)) (0.34 x energy difference /i/ (dB)) + 10.46 by which a sensitivity and specificity of 100% was found. The average NSI in children with a perceptual normal nasality is +5.00 (SE 0.35), whereas the average NSI in children with a perceived hypernasality is -5.00 (SD 0.49). The index can easily been utilized in daily clinical practice and forms an added value in the assessment of hypernasality. However, the determination of normative values will be essential to promote its daily clinical use. The possible influence of language also has to be taken into account and therefore needs further research. Additionally, the impact of treatment and cleft type on the NSI can form the object of future research so that the NSI can become an added value in making decisions about treatment options in nasality disorders. Learning outcomes: Understand the importance of a multiparametric approach in the assessment of resonance disorders, List various objective assessment techniques for the assessment of resonance disorders; Describe the obtained parameters necessary to calculate the Nasality Severity Index values.
SS14
ASSISTED COMPUTER SOFTWARE IN PEDIATRIC CLINIC COMMUNICATION DISORDERS HABILITATION AMAL SALAHELDIN DARWISH (1) HEARING AND SPEECH INSTITUTION IMBABA CAIRO, PHYSICAL MEDICINE & REHABILITATION HOSPITAL IN KUWAIT, CAIRO, EGYPT (1)
Abstract: Communication is one way of providing the people with a powerful means of influencing others and the environment. Our ability to communicate is truly important, as it is the only way to connect us to our world. A childs brain is a magnificent engine for learning. A child learns to crawl, then walk, run and explore. A child learns to reason, to pay attention, to remember. It is more dramatic in the way a child learns language, babies learn to speak by listening. And all of us all over the world help them by modulating our sounds of the quicksilver flow of speech in fundamentally the same way. Simply, when confronted with a baby, adults produce a signal that is raised about an octave in pitch and slows down very carefully and creates these swooping contours. Its not a job interview voice. Its a very distinct voice thats fetching to a baby. Why would every person on the planet do it if its not important? Language acquisition is the primary area of concern as the child grows and develops. When the child have difficulties to develop his language and speech normally computers can help them with its variety of hardware and software to produce a lot of modification of the surrounding fields to help them to capture their lost part of language and speech development. * Pediatric Communication Disorders. Language Disorders 1) Delayed Language Development in which the child cant follow the normal language development chart. Speech Disorders: 1)
FP79
NASOMETRY IN ITALIAN YOUNG CHILDREN: OUR EXPERIENCE WITH ITS CLINICAL APPLICATION MAURIZIO ACCORDI (1) - FIORENZA DEROSAS (1) SABRINA AGNELLI (1) CENTRO MEDICO DI FONIATRIA, HOSPITAL, PADOVA, ITALY (1)
Abstract: OBJECTIVES: the purpose of this study was to obtain normative nasalance scores for Italian young children using significant Italian speech samples. No literature was found about normal nasalance data, in particular about young children. Normal scores in children 4-6 years of age are necessary for the assessment of patients with velopharyngeal disorders because they should be treated before the age of six in order to reduce the impact on language development. The obtained data had been used in the assessment of patients with disturbed nasality caused by velopharyngeal insufficiency METHODS: the study included 87 subjects divided into two groups. Group I: 50 children (29 famels , 21 males) from 4 to 6 years of age without any language disorder, pharyngeal functional or organic defects, and deafness. Group II: 37 subjects (20 famels, 17 males) with cleft or non - cleft palate velopharyngeal insufficiency. All subject were asked to repeat 4 groups of three words, with different phonetic characteristics (voiceless plosives, voiced plosives, fricatives/affricates, nasals). The Nasometer II 6400 was used for the analysis of speech samples. RESULTS: Normal nasalance scores (group I) of the tested words are between 5 to 25 % (average 11.1) for voiceless plosives, between 5 to 23% (average 9.88) for voiced plosives, between 7 to 30 % (average 14.25) for fricatives and affricates, between
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Dysarthria: articulation disorders. 2) Stuttering: fluency disturbances. 3) Nasality: Resonance disorders. 4) Dyslalia: difficulties with sounds pronunciation. Voice Disorders - Aphonia and Dysphonia: Absence or change of voice. Delayed Language Development (DLD) is defined as the inability to exchange (understand or express) the thought, feeling at the expected age. It also can be define as the child inability to follow the normal chart of language maturation (Kotby1980). Language Behavior could be in the form of listening, speaking, reading & writing although it is primarily an aura/oral system. *Children with lag behind their peers in language production and language comprehension, which contributes to learning and reading disabilities in school. *There are lots of causes to can produce Delayed language development (DLD). 1-Sensory deprivation: Hearing , visual & oral sensation (both superficial and propioceptive) with the level of attention & higher integration. 2-Mental retardation. 3-Minimal brain dysfunction such as in SLI, &hyperactive child with attention deficit ,which will be manifested with impaired concentration level , auditory perception & slow development of spoken language, articulation errors, with reading& writing difficulties, with clumsy behavior. 4- Psychiatric Disorders (Childhood schizophrenia, autistic behavior& social deprivation). 5- Global developmental delay. 6Psychological problem (imitating smaller brother , fighting Parents Etc) 7- Social inadequacy (e.g.. working mother& foreigner servants.) 8- Brain Damage with motor Deficit. Communication disorders can also affect students in the public schools. It is expected when the children enter their twos and grow into three and four, they will have a remarkable number of ways to tell adults what they need. Even if the words dont all sound right, a normally developing child will make many efforts to communicate and will make his point effectively. Young children ask so many questions. Children who dont ask questions or tell adults what they want may have a communication disorder. Children with SLI may not produce any words until they are nearly two years old. At age three, they may talk, but cant be understood. As they grow, they will struggle to learn new words, make conversation and sound coherent. Today, research is underway to determine which children do not outgrow this pattern of delayed speech. By age 4 to 5 years, DLD could be a signpost of a lasting disability that persists throughout the school years. Early identification and intervention are considered best practices, in order to minimize possible academic risks. Learning outcomes: Orientation for common soft wares used in different pediatric communicative disorders; Types of communication disorders in pediatric clinic; Role of each software with each possible hard ware accessory; Early intervention with ACCD in pediatric clinic and its role in Special needs schools
Index (48.5%), cuffed tubes management (30.6%), drugs administration via Nasogastric tube or PEG (45.5%) and posture (29%). A low percentage of correct answers, about basic routine activities, was highlighted. The explanation of this fact is unclear, be it through a lack of being checked over, or a lack of training. In the final evaluation test the percentage of right answers reaches 87%. Another purpose of the Group would be to improve this element through greater clearness and interaction with attendees. The majority of the participants judged that the topics dealt with were highly significant and the course was very effective for their continuing education, in particular for the activities carried out in practical lessons. The data concerning the average of the pre and post-course results are statistically significant as far as the learning effectiveness is concerned. The acceptance ratings confirm the need of interdisciplinary, theoretical and practical training for dysphagia addressed by all health care workers. Learning outcomes: understand the importance of interdisciplinary and multiprofessional team of speech therapists, physiatrists, phoniatristsotolaryngologists, nurses, physiotherapists, lung specialists, nutritionists, geriatricians, neuropsychologists, neurologists and occupational therapists, with full knowledge that the problem of dysphagia transverses all of these medical professions and that only by working together in respect to each specific profession can a response be generated for a problem of such great magnitude which, unfortunately, still remains barely noted amongst professionals and often creates grave problems for patients who are affected by the illness ; know the importance of training health workers about basic information to evaluate and recognize the signs and symptoms of dysphagia, in order to unify the procedure of evaluation, be it for acute patients or for rehabilitation wards; know the salience of pre-tests and final evaluations in order to verify the pre-existing skills and the effectiveness of the course; understand the importance of practical training for acquiring specific competences: main nursing techniques (oral cavity hygiene, care and cleaning of cannulas, brochoaspiration, stoma and PEG medications), as well as those concerning physical therapy (adopting appropriate postures using specific aids, hypertonia reduction and evaluation and treatment of assisted cough) and speech therapy (training for evaluation schedules, choosing textures and cuffed tube management with a pressure gauge)
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EFFICACY OF DYSPHAGIA SCREENING IN PREDICTING AB-INGESTIS PNEUMONIA IN POSTSTROKE PATIENTS GARAVAGLIA ELENA (1) - MOZZANICA FRANCESCO (1) URBANI E (1) SCHINDLER ANTONIO (1) DEPARTMENT OF CLINICAL SCIENCES L. SACCO, UNIVERSITY OF MILAN, MILAN (1)
Abstract: Medical complications are frequent in acute stroke patients and may increase mortality and length of stay in hospital. In particular, pneumonia represent an important complication of stroke, affecting up to one third of patients. The risk factors of pneumonia are poor oral hygiene, compromised level of consciousness, severe post-stroke disability, older age and swallowing dysfunction. The estimated incidence of post-stroke dysphagia ranges between 29% and 78% and may cause penetration and/or aspiration of food into the airways that could lead to the development of ab ingestis pneumonia. For this reason, a systematic use of dysphagia screening is highly recommended since it can reduce the incidence of stroke-associated pneumonia (SAP) and therefore improve clinical outcome. The aim of this study is to assess the effectiveness of dysphagia screening for prevention of SAP in Italian acute stroke patients admitted to the intensive care unit (ICU). In the period from January 2011 and December 2011 a total of 169 acute stroke patients admitted to the ICU of H. Sacco University Hospital of Milan were enrolled. All patients were evaluated following the SSA protocol (Standardized Swallowing Assessment). Inclusion criteria were ischemic stroke, hemorrhagic stroke, TIA, with cortical, subcortical and brainstem lesions. Exclusion criteria were encephalopathy, focal epilepsy and speech disorders. Data regarding presence of aphasia and dysarthria, alimentation and incidence of pulmonary complications in the immediate post-stroke period and after at least 6 months follow-up were recorded and analyzed. All the 169 patient enrolled in the study were evaluated by trained nurses following SSA protocol. Depending on the results of SSA evaluation, the cohort of patients was divided into two groups. The first one (group 1) was composed by one-hundred-seven patients (63%) without signs of dysphagia. The second one (group 2) was composed by 62 patients (37%) resulted positive in the SSA examination. These latters were referred to the Speech and Language Pathology and Phoniatric department in order to deeper analyze the swallowing impairment. Patients in group 2 appeared older, with a mayor stroke gravity and more frequently affected by aphasia and dysarthria than the patients included in group 1. Sixteen subjects (9.5%) developed pneumonia during the hospitalization period. Six of them, all with artificial nutrition, developed a right or bilateral pneumonia while 10 patients developed a left pneumonia. Almost all the patients that developed a right pneumonia were positive to the SSA test. The 5.2% of the 134 patients contacted by telephone 6 month after the hospitalization developed a pneumonia during this period. In conclusion, a correct SSA evaluation is associated with a low incidence of pneumonia. Thus, the dysphagia screening in post-stroke patients is useful in the identification of subject at risk to develop pneumologic complications. Enteral nutrition does not reduce to
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FP81
FROM WORDS TO ACTIONS: THE IMPORTANCE OF INTERDISCIPLINARY TRAINING FOR LEARNING THE CORRECT EVALUATION AND TREATMENT OF DYSPHAGIA ROBERTO ANTENUCCI (1) - ROSSELLA RAGGI (1) - BARBARA OLIZZI (1) MICHELA BENVENUTI (1) - GIULIA GIOVANARDI (1) - GIULIA BELLINI (1) CECILIA CARDINALI (1) AZIENDA UNIT SANITARIA LOCALE, REHABILITATION MEDICINE, PIACENZA, ITALY (1)
Abstract: Dysphagia is still not very well-known despite the serious risks patients are exposed to. An early diagnosis is essential and can be achieved by following specific evaluation and treatment paths within a complete synergy of team members who are dealing with the issue. The repercussions of not identifying or adequately treating dysphagia resulted in the constitution of an interdisciplinary and multiprofessional team which organized a training course within the public hospital in Piacenza. The objectives were to comprehend the dimensions of the problem, acquire basic information to evaluate and recognize the signs and symptoms of dysphagia in such a way as to intervene in an early and efficient manor, and avoiding frequent and grave consequences such as malnutrition, ab-ingestis pneumonia and social seclusion. The training course is addressed to the majority of hospital staff. Instructors are members from interdisciplinary groups: physiatrists, phoniatrist-otolaryngologists, lung specialists, nutritionists, geriatricians, neuropsychologists, speech therapists, physical therapists and nurses. The course requires classroom taught lessons and practical lessons in small groups. The contents consist in defining physiopathology, epidemiology and guidelines of dysphagia, its complications, evaluation techniques and treatments, with an overview of the specific skills of all the workers involved. Classroom taught lessons are integrated by showing film clips. The practical lessons consist of training sessions on the main nursing techniques, as well as those concerning physical therapy and speech therapy. In order to verify the pre-existing skills and the efficiency of the course, an anonymous pretest identical to the final evaluation test, was carried out. It consists of 10 questions among which are: swallowing pathophysiology, dysphagia evaluation, cuffed trach tubes management, administration of drugs via PEG and posture during feeding. There have been 277 participants over 7 editions of the course: nurses (181), doctors (27), physiotherapists (23), care assistants (22), speech therapists (9), educators (5), chemistries (3), radiology technicians (3), psychologists (2), sanitary assistants (1) and psychomotor therapists (1). The analysis of the pre-test results highlights an average of 41.7% of right answers; the questions with the highest percentage of wrong answers concern: instrumental evaluation (14% right answers), Body Mass
zero the risk of develop pulmonary complication and this must be considered in the management of dysphagic patients. Learning outcomes: Know the importance of systematic dysphagia screening in post-stroke patients; Understand the role of the speech language pathologist and deglutologist in the management of a post-stroke patients with dysphagia; Understand that artificial nutrition does not reduce to zero the risk of develop pulmonary complications
FP83
TELE-REHABILITATION FOR DYSPHAGIC PATIENTS: A PRELIMINARY STUDY VINCENZO SALLUSTIO (1) - AGNESE CONTINI (1) - SILVIA PEDE (1) ALESSANDRO DE STEFANO (1) - DANILO PATROCINIO (1) PHONIATRICS AND COMMUNICATIVE DISORDERS REHABILITATION CENTER DEPARTMENT OF REHABILITATION, AZIENDA SANITARIA LOCALE DI LECCE, LECCE, ITALY (1)
Abstract: Tele-rehabilitation is a branch of tele-medicine, in which health services are remotely delivered to patients through information technology and telecommunication systems. The implementation of tele-medicine in rehabilitation allows the patients to accomplish the treatment at their home under specialized supervisors and permits to reduce the bothers and the social costs related to outpatient treatments. The aim of this study was to test tele-rehabilitation in the remote treatment of patients suffering from dysphagia and to verify the existence of any improvement in terms of efficacy and satisfaction for these patients and theirs care givers. Methods: We enrolled 21 not bedridden adult patients affected with dysphagia evaluated in our Center in September 2012. The study was organized in three phases: T0 = enrolment, T1 = after 3 months, T2 = after 6 months. At T0 all patients underwent to ENT evaluation, fiber-optic endoscopic evaluation of swallowing (FEES) and meal consumption observation. The severity of dysphagia was graded according to the ASHA NOMS Swallowing scale and a self assessment of dysphagia-related disability was carried out using the MD Anderson Dysphagia Inventory (MDADI). All patients care-givers underwent to self administrated Coping Inventory for Stressful Situations (CISS). Then a speech pathologist trained patients and care-givers to use computer and web-cam connection and to perform postural exercises, manoeuvres and behavioural strategies at home. T0 was completed in 4 to 8 individual outpatient sessions. After completion of these steps the tele-rehabilitation started using teleconference. At T1 the severity of dysphagia was evaluated again and the patients and the care givers answered a 10 items satisfaction questionnaire. T2 is still in progress and at this stage the patients and the care-givers are evaluated as in T0 and the satisfaction questionnaire as in T1 is administered again. Results: Out of 21 patients eligible for the teletreatment only 18 completed the T1 stage (15 men, 3 women; age range: 47 to 81 years). Fifteen dysphagic patients were suffering from neurological diseases and 3 were affected with dysphagia as result of laryngeal surgery for head and neck tumours. At T1 an improvement on the ASHA scale was detected in 6 patients. The satisfaction questionnaires showed that patients stated a substantial favourable consideration about the procedures (reduced discomfort with the transportation, greater motivation in following the training program, increased self-confidence during the meal time and greater compliance with the rehabilitation program). The patients also declared that the relationship with the health personnel hasnt been negatively affected by the used technology. The care givers also appreciated the convenience of the tele-treatment; they reported more time to devote to their daily personal activities, greater self-confidence, smaller discomfort with the patients transfer. Conclusion: The observed results suggest that the tele-rehabilitation method is efficient in reducing the swallowing functional impairment, although the illness progression in degenerative neurological diseases can frustrate the results. The tele-rehabilitation also seems to be appreciated both by patients and care-givers. These preliminary data indicate this method as a cost-effective alternative in the management of patients affected with dysphagia. Learning outcomes: know the advantages of remotely delivering some health services through information technology and telecommunication systems; know the specific characteristics related to the implementation of telemedicine to the rehabilitation program in dysphagic patients; understand the possible positive role of tele-rehabilitation in dysphagia for patients and care-givers in terms of increased self-confidence and compliance and reduced discomfort and social costs.
operation, attention can be classified into: alternating, divided, selective and sustained. The auditory attention is the ability to maintain attention on a main sound stimulus, and when it comes to sustained auditory attention, it is expected that the subject hold the attention of auditory stimuli over a period of time. Therefore, the research aims to evaluate the performance of older adults with normal hearing in a behavioral test of sustained auditory attention and compare the results obtained with the standardization of the test performed in children with hearing loss in order to verify the influence that this attention skill suffers in the aging process, using as tool the Sustained Auditory Attention Ability Test - SAAAT. The SAAAT is a method used to assess auditory attention by assessing the ability of the subject to listen to auditory stimuli over a prolonged period of time, and respond only to the specific stimulus. The tasks required are the auditory vigilance and sustained auditory attention. The test performance is verified by the total score of the mistakes and the decrease of vigilance. The study included 20 elderly subjects (aged over 60 years) - Group 1, and 20 adult subjects (aged 18 to 30 years) - Group 2, of both genders with normal bilateral hearing. The evaluation process consisted of applying an attention Questionnaire, pure tone audiometry, speech audiometry, immittance, and SAAAT. The results in Group 1 and Group 2 were compared to normative data of the test in Brazilian children aged 11 years old. The averages for the total error score were 11.0, 2.0, and 5.5, for children, adults and seniors, respectively. It was observed that the children obtained the mean total error score higher than that in Group 1, which was higher than that found in Group 2. Regarding the decrease of vigilance in children aged 11 years old, it is expected that the score is 4. For groups of adults and elderly the average score was 0.4. Thus, one can see different performances between the populations studied, with better performance of adult subjects. Learning outcomes: Recognize the importance of sustained auditory attention, Check sustained auditory attention in different age groups, Check applicability of SAAAT for adults and seniors and groups.
FP85
BINAURAL INTELLIGIBILITY LEVEL DIFFERENCES FOR MANDARIN TONE RECOGNITION IN SPEECH-SPECTRUM NOISE CHENG-YU HO (1) INSTITUTE OF BIOMEDICAL ENGINEERING, NATIONAL YANGMING UNIVERSITY, TAIPEI, TAIWAN, PROVINCE OF CHINA (1)
Abstract: The binaural intelligibility level difference (BILD), which has been described as the differences of recognition thresholds between signals in the noise which both signal and noise are presented in the same phase at the both ears (we called this listening condition as homophasic condition, S0N0), while the signal is presented 180 degree out-of-phasic and the noise is presented in phasic at the both ears (we called this listening condition as antiphasic condition, SN0). The recognition thresholds for antiphasic condition (SN0) are less than homophasic condition (S0N0). The binaural intelligibility level differences are larger at low frequencies which are less than 500 Hz and the masking level differences are smaller at high frequencies. In former studies, the importance of fundamental frequency for Mandarin tone recognition has been demonstrated. Therefore, this study investigated the binaural intelligibility level difference (BILD) for Mandarin tone recognition in speech-spectrum noise. In this study, the Mandarin tone recognition thresholds were measured by the 50 % correct of tone recognition in each target-to-masker ratios (TMRs) for vowels /i/ and /u/ with four tones in speech-spectrum noise as signal interaurally in-phase (S0N0) or out-of-phase (SN0). 12 normal-hearing (aged 23-30) native Mandarin subjects participated in this study. Their audiometric thresholds are all better than 20 dB HL. The result indicated that the average thresholds of Mandarin tone recognition, threshold differences between SN0 and S0N0 condition in statistic method by Paired-Samples T test are not significant (p>0.05). The results of this study suggested that the recognition thresholds of Mandarin tone do not decrease as the phase-inversion. Learning outcomes: The BILDs for Mandarin tone recognition which mainly based on the energy of low frequency. Whether vowel /i/ and /u/ are suitable for using as BILD materials.
FP86
AUDITORY CORTICAL EVOKED POTENTIALS WITH COMPETING NOISE IN CHILDREN WITH AUDITORY FIGURE GROUND DEFICIT MOHAMMAD HASSAAN (1) FACULTY OF MEDICIES, ZAGAZIG UNIVERSITY, ZAGAZIG, EGYPT (1)
Abstract: School-children who have difficulty in figure ground auditory message from background noise, constitute a considerable portion of those with learning disabilities. Following up those children after remediation is mainly conducted by psychophysical tests. This may not be sufficient considering the possible learning effect of the psychophysical tests. Moreover, these tests do not reflect directly how the auditory centers act in these situations. The cortical N1-P2 complex with and without ipsilateral competing noise was measured in 15 preparatory school-children complaining of auditory figure ground deficit. Their results were compared to 15 age matched children with normal auditory figure ground ability. The N1-P2 complex of both groups revealed marked distortion of the morphology and depression of the amplitude when being recorded with noise competition. These abnormalities
FP84
TEST OF AUDITORY SUSTAINED ATTENTION IN DIFFERENT AGE GROUPS MARIA RENATA JOS, (1) - MARIA FERNANDA CAPOANI GARCIA MONDELLI (1) - MARIZA RIBEIRO FENIMAN (1) DEPARTMENT OF SPEECH-LANGUAGE PATHOLOGY BAURU SCHOOL OF DENTISTRY, UNIVERSITY OF SO PAULO, UNIVERSIT, SO PAULO, BRASILE (1)
Abstract: Attention is a cognitive skill essential to learning and retaining new information and it requires that the individual focus the mental processes on a primary task for the remaining to stay in the background. According to the
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were more pronounced in children with auditory figure ground deficit than in normal children. After 8 sessions of noise desensitization rehabilitation, the affected children were re-evaluated again. The results revealed significant improvement in psychophysical testing and the amplitude of N-P2 complex in noise condition. Despite that improvement, the potential still less enhanced than that of normal children. Learning outcomes: Understand the effect of background noise on children with auditory figure ground deficit, Know the recording parameters of auditory evoked cortical potentials and Use the remediation material of auditory figure ground deficit.
SS16
PROCESSING OF TEMPORAL SPEECH CUES IN CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT AND DYSLEXIC CHILDREN WITH FAMILIAL RISK AT PRE-SCHOOL AGE PAAVO H.T. LEPPNEN (1) - LEENA ERVAST (2) - ANNA KAREN (1) KAISA LOHVANSUU (1) - JARMO A. HMLINEN (1) HEIKKI LYYTINEN (1) DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF JYVSKYL, JYVSKYL, FINLAND (1) - DEPARTMENT OF FINNISH, INFORMATION STUDIES AND LOGOPEDICS, UNIVERSITY OF OULU, OULU, FINLAND (2)
Abstract: Phonological and language problems found in children with specific language impairment (SLI) and dyslexia could be due to common neural substrates which are related to speech processing deficits. Here we investigated in two studies the brain event-related potentials (ERPs) to temporal speech cues in children with SLI and those with familial risk for dyslexia at pre-school age. Associations to later reading skills were also investigated in children at risk for dyslexia. Brain responses for pseudowords varying in consonant duration and presented in an oddball /MMN paradigm were measured in 4-7-year-old children. Children with SLI (24) were diagnosed before the ERP measurements and compared to 12 control children of the same age. Children at risk for dyslexia were later on divided into three groups based on reading skills assessed at 9 years of age at the 2nd grade in school. Thus the ERPs obtained at pre-school age in 10 at-risk children with later dyslexia were compared to those of 27 at-risk children and 28 control children with typical reading skills. The brain responses of both SLI and dyslexic children differed from those of control children with clearest effects for the response to the short /ata/. The brain response at ca. 250 ms (N250 characteristic to child ERPs) for the second syllable onset had enhanced amplitude and atypical laterality in both the SLI and dyslexic groups compared to the control group. Differences between the clinical groups also existed; only SLI children showed an atypical obligatory response at about 90 ms. The brain responses of children with dyslexia and controls were also associated with reading accuracy and speed at school age. Our results indicate that children with SLI and at-risk children with later dyslexia show atypical processing of temporal cues in speech at pre-school age. Enhanced N250 responses could be related to less specific neuronal activation and poorer formation of stimulus representations during the experiment and less specific long-term phonetic representations. The results also suggest that speech processing problems may be a common risk factor for specific language impairment and developmental dyslexia. However, differences at the phenotype level also suggest that these two developmental disorders may differ in other underlying cognitive deficits and genetic profile, which also shape language and reading development. Learning outcomes: understand the neurocognitive approach to language development and how to assess auditory processing using brain measures; know neurocognitive assessment methods, in particular brain event-related potentials (ERPs), which helps to understand the relevant literature; be able to understand common mechanisms, in terms of risk factors, for two language related disorders, SLI and dyslexia; to know about the predictive role of pre-school aged neurocognitive factors for later development at school age in typically developing children and those with familial risk for dyslexia.
mechanisms play an important role in the development of fluent reading. Furthermore, there is an abundant amount of evidence to suggest that reading problems are due to a deficit in phonological processing. This deficit comprehends problems in phonological awareness, short-term memory, and rapid automatized naming and it is due to a problem in the specification of phonological representations. The purpose of this work is to describe the skills performance of the phonological processing components in subjects with ADHD. The methods consisted in a descriptive analytical study of the evaluation data of the phonological processing skills of 45 subjects, with ages between 7 and 16 years, with a multiprofessional diagnosis of ADHD. All data was obtained from the medical records of the subjects evaluated by the Laboratrio de Estudos dos Transtornos de Aprendizagem (LETRA) Laboratory for the Study of Learning Disorders of the Hospital and Clinics (HC) of Federal University of Minas Gerais, between the years of 2008 and 2011. The analyzed results include the Phonological Awareness test, proposed by the battery of tests BELEC, the Rapid Serial Naming (RAN) test and Working Memory test. Two variables were considered in this analysis: the age and the presence or absence of associated comorbidities. The results showed that groups tend to differentiate themselves when the age variable is analyzed, on the Phonological Awareness tests and RAN. When the comorbidity variable was analyzed, the Phonological Awareness was more influenced by the presence of comorbidities. On the Working Memory skills, by the same light, there were no differences between the groups. This research revealed that the largest deficit in phonological processing was observed in phonological awareness skills, according to the age and comorbidity variables, followed by the lexicons access skills, according to the age variable. About the Working Memory, there was no difference between groups. Learning outcomes: Children with ADHD may present problems in phonological processing; The deficit shown by children with ADHD may include problems in phonological awareness, short-term memory, and rapid automatized naming; The major deficit in phonological processing was observed in phonological awareness skills followed by the lexicons access skills.
FP88
THE EFFCTIVENESS OF A MULTI SENSORY THERAPEUTIC PROGRAM IN ENHANCING LANGUAGE SKILLS FOR CHILDREN WITH ATTENTION DEFICIT HYPERACTIVE DISORDER(ADHD) TAHANY EL.SAYED AHMAD (1) AMERICAN BILINGUAL SCHOOL FOR SPECIAL NEEDS, CENTER OF SPEECH-LANGUAGE THERAPY, SALMYIA, KUWAIT (1)
Abstract: This study aims to identify reading program based on multimedia as an educational tool to stimulate multi sensory and investigates its effectiveness which could help to develop language skills in children with Attention Deficit Hyperactive Disorder. The study used the experimental design. The study sample consisted of two groups (20) children in grade (1) primary school. They were divided into two groups: experimental group of (10) children who were introduced to the multi sensory program and the control group were (10) children with whom the traditional way was used during speech-language session. Children in each group aged (7: 6) chronological age. The study sample (ADHD) is given during the study an opportunity to develop new behavioural, social pragmatics and language skills... To verify the results of the study statistical nonparametric methods Mann-Whitny and Wilcoxon Signed Rank tests were used. Study results showed that there are statistically significant differences before and after applying toward the children in the experimental group thats we used with them the multi sensory therapeutic program. It also reached significant differences between study groups scores of the (experimental and controller) in telemetric, towards experimental group. The ADHD children in the experimental group who were involved in the program had greater chance to developed language skills than children using traditional methods. Learning outcomes: The present study aimed to identify the effectiveness of multi sensory based on reading as an educational tool based on the employment of modern teaching techniques to enhancing language skills of children from the category of attention deficit disorder and hyperactivity, were hired, the program of current thesis as a means of therapeutic tool by stimulating a number of senses to develop language skills, in an interesting and attractive way to exemplify their interests. Also, adapted students behaviour by connecting the program with intensive behaviour modification program in the same time. Furthermore, it gave opportunity to had larger group of ten or more during therapeutic sessions.
FP87
PHONOLOGICAL PROCESSING IN INDIVIDUALS WITH ATTENTION DEFICIT DISORDER AND HYPERACTIVITY LUCIANA MENDONA ALVES (1) - CLAUDIA MACHADO SIQUEIRA (2) HELMA SOUZA (1) - VANESSA SOUZA (1) - DEBORA LODI (2) JULIANA AGUIAR (2) - JULIANA FLORES (2) - LETCIA CELESTE (3) MARIA DO CARMO FERREIRA (2) IZABELA HENDRIX UNIVERSITY, BELO HORIZONTE, BRAZIL (1) HOSPITAL AND CLINICS (HC) OF FEDERAL UNIVERSITY OF MINAS GERAIS, BELO HORIZONTE, BRAZIL (2) UNIVERSITY OF BRASLIA - UNB, BRASLIA, BRAZIL (3)
Abstract: The group of problems involved in DSM-IV diagnostic category of attention deficit - hyperactivity disorder (ADHD) is the most frequent condition faced in clinical environment. It is a disorder defined by inattention, hyperactivity and impulsivity. This is the most prevalent among all the child neurodevelopmental disorders. Recent studies referred that attentional
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FP89
COMPLEXITIES AND CAPABILITIES: EXPLORATIONS OF COMMUNICATION PROFILES OF CHILDREN WITH A PRIMARY DIAGNOSIS OF ATTENTION DEFICIT (HYPERACTIVITY) DISORDER IRENE WALSH (1) - LOUISE GAFFNEY (1) - DEIRDRE MAC EVILLY (2) SARAH BURNS (2) - MARY SCULLION (2) - GERALDINE BROSNAN (2) TRINITY COLLEGE DUBLIN, DUBLIN, IRELAND (1) LUCENA CLINIC, DUBLIN, IRELAND (2)
Abstract: Attention Deficit (Hyperactivity) Disorder is one of the most frequently occurring psychiatric disorders presenting at many Child and Adolescent Mental Health Services. It is also a disorder that has at its core, language dysfunction in terms of language use for self-regulation of behaviour, often coupled with language impairment as evidenced on routine language assessments. Additionally, these children frequently present with secondary diagnoses, for example Autistic Spectrum Disorder. As such then, these children present to the speech and language therapist with highly complex language and communication profiles, with great heterogeneity across presentations. Part of this heterogeneity is a mix of strengths and needs - or complexities and capabilities warranting a speech and language therapists attention if effective intervention is to be delivered. This paper will bring together findings from investigations of children with a primary diagnosis of Attention Deficit (Hyperactivity) Disorder presenting at a Child and Adolescent Mental Health Service. Forty school-aged children were assessed over three one-hour sessions. Receptive and expressive language, along with vocabulary and reading ability (in terms of reading accuracy and comprehension) were all assessed on well-know standardised tests. Narrative ability was also investigated informally through discourse analysis, while general pragmatic skills were assessed via a parental checklist. Findings will confirm the heterogeneity of this clinical group as they present at a Child and Adolescent Mental Health Service. Though relatively high numbers of the children presented with language impairment on the measures used, closer analysis revealed key areas of relative strength, particularly in narrative and some pragmatics areas. No generalisations can be made about language functioning in Attention Deficit Disorder, as an obvious confounding variable was presence of a secondary diagnoses, the most common of which was autistic spectrum disorder. Discussion will focus on the complexities and capabilities of this clinical group, with a particular eye to how assessment measures can not only reveal impairment but actively hide ability. A specific focus will be on how, through an adapted form of narrative analysis, assessments may be rendered more informative in presenting a realistic and more useful profile of these children as they present clinically, and almost regardless of psychiatric diagnosis. Implications for how we assess this clinical group in an efficacious manner to inform best practice for this group will therefore be discussed. Learning outcomes: appreciate the complexity of language and communication profiles of some children with Attention Deficit (Hyperactivity) Disorder; learn about informal narrative assessment and understand the need for more carefully designed assessment of this clinical group.
FP90
ENDOSCOPIC AND ELECTROPHISIOLOGICAL EVALUATION OF NEUROLOGICAL DYSPHAGIA: CLINICAL FEATURE AND INSTRUMENTAL CORRELATION FEDERICA MURA (1) - GIULIA BERTINO (1) - MAURO FRESIA (2) ENRICO ALFONSI (2) - MARCO BENAZZO (1) DEPARTMENT OF OTOLARYNGOLOGY HEAD NECK SURGERY, IRCCSS, POLICLINICO S. MATTEO FOUNDATION, UNIVERSITY OF PAVIA, PAVIA, ITALY (1) - DEPARTMENT OF NEUROPHISIOPATOLOGY, IRCCS, NEUROLOGICAL INSTITUTE C. MONDINO FOUNDATION, UNIVERSITY OF PAVIA, PAVIA, ITALY (2)
Abstract: Dysphagia is a frequent finding in neurological patients ( >80% with advanced stage disease). The swallowing impairment, in these patients, increases the risk of malnutrition and aspiration pneumonia, with a consequent major probability of death. Therefore, evaluation of the swallowing status is essential in neurological patients with clinical or subclinical dysphagia, in order to to adopt the early medical and rehabilitative strategies necessary to ensure adequate and secure dietary intake. Since 2008 we have developed, together with a Neurological Institute, a diagnostic workup for patients with neurogenic dysphagia, including both the fiberoptic endoscopic evaluation of swallowing (FEES) and the electrophysiologic study (EPS) of the oral and pharyngeal phases of swallowing. The purpose of this study was to identify the existence of any characteristic patterns of abnormal swallowing mechanics in three main groups of neurological diseases and to assess the correspondence between the endoscopic and the electrophysiological findings. From January 2008 to December 2012, 151 patients (64 F, 87 M; range 22-87 y, mean 66 y) with neurogenic dysphagia resulting from the consequence of stroke, Parkinsons disease or Parkinsonism, and motor neuron or demyelinating diseases, were submitted to FEES and EPS. The degree of impairment of the oral phase, the degree of impairment of the pharyngeal phase, the degree of relaxation of the upper esophageal sphincter (UES) and the presence of penetration / aspiration were investigated. The severity degree of dysphagia was assessed according to the ONeil scale. The analysis was conducted on the entire sample and then divided in the three aforementioned neurological groups of diseases, in order to verify the existence of specific alterations for the different pathologies. Moreover, the analysis of correlation between the endoscopic and electrophysiological findings was made to verify the correspondence between these two different methods. A grade I of dysphagia, evaluated by FEES, was found in 46% of patients. Specifically, the oral phase was delayed in most cases (75%); the pharyngeal phase was incomplete in 49% of cases and not altered in 44% of cases. Similar percentages were found after EPS (oral phase delayed in 70% of cases and incomplete pharyngeal phase in 57%). A suspect incomplete relaxation of UES was found in 36% of patients submitted to FEES and in 26% of the patients submitted to EPS. This difference was statistically significant. The same analysis, conducted on the 3 different groups showed the same behaviour. In particular there were not peculiar patterns of dysphagia in the neurological pathologies considerated. FEES can be considered the method of choice to investigate the presence of dysphagia in patients with neurological disease but must be integrated by EPS if there is a suspicion of pathology of the UES. The informations resulting from the two studies allow a better definition of the neurogenic dysphagia and, consequently, the adoption of a tailored therapeutic strategy for each patient. Learning outcomes: know the tools to assess dysphagia in neurological patients; know what to evaluate with the fiberoptic endoscopic evaluation of swallowing (FEES); know the use of electrophysiological investigations of oropharyngeal swallowing (EPS).
SS16
BENCHMARKING IN AAC SERVICES PAMELA ENDERBY (1) UNIVERSITY OF SHEFFIELD, SHEFFIELD, UNITED KINGDOM (1)
Abstract: Purpose. Internationally there have been many changes in the delivery of health, education and social care services over the last decade. However, there are two central pillars which have become of increasing importance in most strategy and policy documents. These pillars emphasise the importance of sustaining and improving the quality of service delivery which is related to the second requirement to demonstrate cost effective service delivery. Services are required to collect, report and learn from outcome measurement. This paper discusses the importance of outcome measures in improving augmentative and alternative communication (AAC) services. Method. The presentation will summarise the purpose and value of outcome measurement and review those commonly used in AAC services reflecting on conceptual frameworks including the International Classification of Functioning (WHO). Results. 23 measures were identified from the literature. These incorporate general measures, specific measures, measures as part of general management systems and measures of accreditation and qualification. No measure incorporated all of the domains consistent with the ICF and has therefore informed the development of a particular outcome measure (AAC TOM) ensuring that basic principles of the International Classification of Functioning are retained and the measure can be used in benchmarking. The principles of the Therapy Outcome Measure have been incorporated into the version for AAC and will allow comparison of service delivery and reflection of change in persons using AAC devices. Conclusion. The developed AAC TOM is to be used in an audit of AAC services in England. Learning outcomes: importance of and need for outcome measurement; principles of benchmarking; value of benchmarking; principles of International Classification of Functioning; features of the Therapy Outcome Measure
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FP91
PROGNOSIS OF NEUROGENIC DYSPHAGIA BY CONVENTIONAL SWALLOWING THERAPY VERSUS NMES (NEURO MUSCULAR ELECTRICAL STIMULATION) COUPLED WITH CONVENTIONAL SWALLOWING TRAINING IN SUB ACUTE HOSPITAL AT QATAR DRAMAL AHMAD (1) - DR AZHAR OMAR (1) HAMAD MEDICAL CORPORATION, RHUMELLHA, DOHA, QATAR (1)
Abstract: This comparative study was intended to study the effects of VitalStim therapy coupled with conventional swallowing training on recovery of neurogenic dysphagia; A total of 50 dysphagia patients were randomly selected among sub acute post Traumatic Brain Injury and Cerebro Vascular Accident cases and evenly divided into two groups: Conventional Swallowing therapy group, and NMSE plus conventional swallowing therapy group. Before and after the treatment swallowing function was evaluated by using Swallowing Ability Function Evaluation (SAFE). Outcomes were analyzed for changes in oral and pharyngeal phase dysphagia severity, diet consistency and improvement from non-oral to oral intake. There were significant differences in SAFE score in each group between before and after treatment. Following 8-week treatment, SAFE score was significantly greater in the NMSE therapy plus conventional swallowing training group than Conventional swallowing therapy group. It was concluded that VitalStim therapy coupled with conventional swallowing training was conducive to recovery of neurogenic dysphagia.
Learning outcomes: Effectiveness of Swallowing Intervention using combined mode (Vital stim and Traditonal dysphagia therapy); Remarkable progress in swallowing abilities within shorter duration of therapeutic intervention; Maintenance in the improvement of swallowing function following combined therapeutic intervention across different trial consistencies.
FP92
THE EFFECTIVENESS OF COMPENSATORY POSTURES IN THE MANAGEMENT OF DYSPHAGIA CAUSED BY PHARINGEAL AND PHARYNGO-LARINGEAL UNILATERAL PARALYSIS: SEARCH FOR CLINICAL EVIDENCE DI ROSA ROSALBA (1) SPEECH AND LANGUAGE PATHOLOGIST, CITT DELLA SALUTE E DELLA SCIENZA, TURIN, ITALY (1)
Abstract: Research into the efficacy of treatment procedures in dysphagia is truly in its infancy (Logemann, 2006). In particularly there are few studies in literature considering the effectiveness of compensatory postures, and the majority of them have been conducted on small groups of dysphagic patients having the same etiology (Ashford et al., 2009; McCabe et al. 2009). A good opportunity to investigate treatment efficacy for dysphagia is offered by videofluroscopic studies (Logemann, 2006). Our study is based on the retrospective analysis of 4576 videoflurographic reports, performed from the beginning of January 2005 until the end of November 2012 which led to a sample of 87 patients selected according to the swallowing deficit presented during the execution of the videoflurographic exam and according to the compensatory posture implemented by the radiologist to offset the reported deficit. Our goal was to evaluate the effectiveness of two different compensatory postures used in the management of the 87 patients: posture I with head rotated toward the damaged side, in order to exclude the deficit side and permit the bolus transit on the healthy side (Logemann, 1983; Logemann et al. 1989, Logemann 1993; Logemann et al 1994; Ohmae et al. 1998; Tsukamoto 2000; Nakayama et al. 2012), and posture II, with head rotated in association with chin-down position, designed to add a better protection of the airway (Logemann, 1998). Posture I was applied to 7 patients presenting unilateral pharyngeal paralysis, whereas Posture II involved a subgroup of 64 patients with unilateral pharyngo-laryngeal paralysis and another one composed by 16 patients with unilateral pharyngeal paralysis. For each patient the outcome was classified as positive (absence of aspiration in the airway for semi-solid and liquid consistencies and absence of after-swallow stasis), negative (aspiration with at least one between semisolid or liquid consistencies tested), partially positive (presence of either after-swallow stasis for the semi-solid consistency or of liquid penetration). The results of our analysis indicate a percentage of positive outcomes reaching 100% for Posture I; for Posture II the full success rate is lower, 63% when assumed by patients with pharyngo-laryngeal deficit and only 38% for patients with pharyngeal deficit. The outcome of patients with the pharyngeal deficit treated with Posture I was significantly better than for patients treated with Posture II. Learning outcomes: The effectiveness of compensatory postures may be influenced by variables (fatigue,compliance, degree of head rotation or flexion); -The effectiveness of compensatory postures should always be confirmed by an instrumental examination and monitored during speech-therapy treatment; It would be helpful for the speech-therapist to assess the effectiveness of compensatory postures carrying out swallowing assessment using FEES (in Italy this procedure is currently not allowed).
and 55% with cochlear implant candidacy assessment and monitoring, but only 44% were involved with cochlear implant MAPping. The extent to which they were involved varied. Hearing aid fitting received the highest ratings with 55% being quite involved, compared to 33% for cochlear implant candidacy and 26% for MAPping. Communication assessment and intervention was conducted by the majority of audiologists. Seventy six percent conducted communication assessments, 83% offered speech and language intervention, with 92% providing parent guidance, and 66% offering school based therapy. The level of involvement on these aspects varied considerably though. Only 51% were quite involved in communication assessments, 43% with speech and language intervention, 55% parent guidance and 38% school based therapy. The study revealed that the majority of audiologist were more confident in working with older children rather than younger children in the early intervention stage of 0-3 years. Only 37 % were positively confident. Confidence increased as the child got older. Further, the degree of hearing loss also had an influence. The older the child was, the more confident the clinician was. Only 60% were positively confident working with children with severe to profound hearing loss. Various challenges were reported, including system challenges (language and cultural barriers, funding, lack of access and awareness of services, and late diagnosis), challenges relating to working with families (family involvement, poverty, HIV\ AIDS), and practice challenges (lack of resources, undergraduate training in counseling, time constraints, and inter professional collaboration). The implications of the study will be discussed. Learning outcomes: Awareness of the complexity of audiological practice with the paediatric population, in a developing country context; Increased awareness by audiologists of the need to focus on the critical aspect of intervention following diagnosis of hearing loss in infants and young children.
FP94
ADVANTAGES OF MULTIDISCIPLINARY APPROACH IN CHILDREN WITH COMPLEX SYNDROME SARA GHISELLI (1) - SILVIA MONTINO (2) - ENZO EMANUELLI (2) PATRIZIA TREVISI (1) - ALESSANDRO MARTINI (1)
ORL-OTOSURGERY, UNIVERSITY OF PADUA, PADOVA, ITALY (1) ORLOTOSURGERY, HOSPITAL OF PADUA, PADOVA, ITALY (2) Abstract: The aim of the study is to demonstrate the better outcome in children with hearing loss and complex disability when treated by multidisciplinary specialists working in the same medical facility. Often, in clinical practice, these patients are treated by different specialists in fragmentary manner and in different medical facilities with serious problems of communication among them resulting in non-shared and non-effective rehabilitation project. The multidisciplinary evaluation is carried out by interdisciplinary staff, including speech and language pathologist and audiology, otorhinolaryngology and neuroradiology specialists and it is focused on clinical and communicative, perceptive and swallowing aspects. In the last year four children with complex syndrome (between 1 and 3 years old) came to our attention. At the first evaluation they showed psychomotor and communicative retardation, facial dimorphism, cleft and lip palate surgically corrected during the first months of life, respiratory distress, enteral feeding (PEG) and suspect hearing loss. These characteristics appeared in patients with different severities. During every medical examination, our patients were always evaluated by a reworking of the ChIP (Childrens Implant Profile). Petrous bone CT or head CT and brain MRI were performed on three children finding in all cases a malformation of the medium or inner ear. The typology and the gravity of the hearing loss were evaluated with audiologic tests (including pure tone audiometry, otoacustic emission and tympanometry) at different stages in relation to the anatomy and the surgical correction of the otolaryngology problems. All the patients have been found with conductive hearing loss. When needed, a hearing aid solution has been provided. A FEES (Flexible Fiberoptic Examination of Swallowing) was performed by the otorhinolaryngologist specialist in order to evaluate oropharyngeal anatomy, palatal motility and oral reflexes. Some children have undergone adenotonsillectomy and repair of congenital choanal atresia using the transnasal endoscopic approach without post surgery stenting. Children were rated from the point of view of communication, auditory perception and swallowing ability by speech and language pathologist. The therapist made her evaluation using NEAP (Nottingham Early Assessment Package) and observing swallowing ability and oral functions (praxis and sensitivity). Based on the results, we have implemented a perceptive training, a communication process by oral approach or non-conventional approach (eg. gestures, signs, augmentative communication), a stimulation or unawareness oral alimentary iter. After some months from the beginning of the multidisciplinary treatment the outcome of our patients is better than single disability treatment. Improved auditory threshold, improved respiratory distress, decreased oral pharyngeal secretion have lead to augmentation of perception and communication for a better life quality. This result could not have been so good without a tight collaboration among the team allowing every specialist to work knowing all the domains of disability involved. Learning outcomes: Multidisciplinary approach in children with hearing loss and complex syndrome; Observation of swallowing ability and stimulation oral alimentary in children with enteral feeding; Global evaluation at different stages in relation to every single clinical and therapeutic change.
FP93
PAEDIATRIC AURAL REHABILITATION SERVICES: A SURVEY OF AUDIOLOGISTS IN SOUTH AFRICA KARA HOFFMAN (1) - LAVANITHUM JOSEPH (1) UNIVERSITY OF KWAZULU-NATAL, DISCIPLINE OF AUDIOLOGY, DURBAN, SOUTH AFRICA (1)
Abstract: While early identification and intervention are being promoted in audiological practice and training since the last decade especially, the profession of Audiology still grapples with the issues of implementation. There are standards and guidelines used in developed countries around the world, which are adopted by developing countries like South Africa, but difficulties exist with regard to service delivery to the majority of the population. The audiologists scope of practice for managing infants and young children demands skills across a range of areas which can be very challenging in providing a comprehensive intervention service. This study reports on the experience of audiologists in SA with regard to the provision of paediatric aural rehabilitation. A descriptive survey was conducted to gather data from all audiologists registered with the Health Professions Council of South Africa practicing paediatric audiology. Two hundred and thirty give audiologists responded to the postal survey, of which only 121 (52%) where practising paediatric audiology. The majority of these respondents (64%), were in private practice, with 98% female. Audiologists reported on their involvement in both rehabilitation technology and communication intervention aspects, describing the extent of their involvement, their confidence in providing the service, and challenges experienced. With regard to rehabitative technology, 80% of the audiologists were involved with hearing aid fittings/verification,
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FP95
CHILDREN WITH SEVERE/PROFOUND HEARING LOSS ACHIEVE AGE-APPROPRIATE SPEECH/LANGUAGE BY 3 YEARS-OF-AGE: CONTRIBUTION OF E3BP MANAGEMENT ANNE NIVELLES FULCHER (1) - ALISON PURCELL (2) ELISE BAKER (2) - NATALIE MUNRO (2) THE SHEPHERD CENTRE, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (1) - DISCIPLINE OF SPEECH PATHOLOGY, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (2)
Abstract: Research data from the USA in 2007 indicates that 30% of school graduates with congenital severe/profound hearing loss (HL) were functionally illiterate. Can these outcomes be improved? What contribution might E3BP management provide? This paper will present data from two studies concerning speech/language outcomes for children with congenital severe/profound HL. First, we explored research/clinician identified variables that may influence speech/language outcomes for this cohort of children. Secondly, we investigated whether adherence to 1-3-6 guidelines could facilitate age appropriate speech/language performances by 3 years-of-age. Specifically, if a child with congenital severe/profound HL experienced: Universal Newborn Screening (UNHS) by 1 month-of-age, verification of HL/amplification by 3 months and early intervention within an auditoryverbal (AV) program by 6 months, plus cochlear implantation (CI) prior to 18 months, is typical development possible by 3 years-of-age? Initially, an E3BP framework was adopted whereby a qualitative analysis of clinician interviews along with a quantitative examination of published research indicators was conducted in order to identify variables that may impact upon the speech/language progress for children with congenital severe/profound HL. Secondly, a variety of standardised speech/language assessments were utilized in order to conduct a prospective analysis of outcomes for 45 children with early-identified HL at ages 3-, 4- and 5-years. Results indicated: a) Three major facilitator variables and three major barriers to progress were identified. b) Strategies were instigated in order to address a number of the identified barriers. c) Subsequent analysis of prospectively collected data indicated that by age 3 years, 93% of all early-identified participants scored within normal limits (WNL) for speech; 90% were WNL for understanding vocabulary; and 95% were WNL for receptive and expressive language. Progress was maintained and improved so that by age 5 years, 96% were WNL for speech, with 100% WNL for language, including children with profound HL. Unexpectedly, children with early-identified severe/profound HL significantly outperformed both those with mild and moderate HL at 3-, 4- and 5-years of age, specifically with respect to speech. These findings are noteworthy and will be discussed. Overall conclusions: a) Most children with all severities of HL and no other concomitant diagnosed condition, who were diagnosed by 1 month; received amplification by 3 months; enrolled into AV intervention by 6 months and received a CI by 18 months if required, were able to achieve speech and language outcomes commensurate with their typically hearing peers by age 3 years. b) Individuality of children, families and intervention services will always require strategic management which can significantly improve speech/language performances. Learning outcomes: Explain the essential processes involved in adopting an E3BP framework for clinical management for children identified with HL in early infancy. Particular emphasis will be placed on the need to gather: External evidence: regarding standardized measures, identifying studies which report children with early identified HL who are able to achieve speech/language outcomes commensurate with hearing peers; Internal evidence: regarding barriers and facilitators to progress for children with HL who attended an auditory-verbal (AV) clinic, and , Implication for changes to workplace practice generated post analysis of these barriers and facilitators; Explain why the E3BP framework is suitable to adopt when best practice decisions are being made in order to assist children with severe/profound hearing loss; Describe a series of facilitators and barriers to speech language progress for children with severe/profound HL who are participating in AV early intervention; Describe and discuss the speech/language outcomes of preschoolers with early-identified HL who have received auditory-verbal early intervention, specifically with respect to standardised assessment measures, noting that typical performances are possible by age 3.
TUESDAY 27TH AUGUST

MR2
COGNITIVE RESERVE; IMPLICATIONS FOR ASSESSMENT AND INTERVENTION MAIN PRESENTER: YAAKOV STERN (UNITED STATES) DISCUSSANTS: CLAIRE PENN (SOUTH AFRICA) - SUE FRANKLIN (IRELAND)
Abstract: The concept of reserve is used to explain that observation that some individuals function better than others in the presence of brain pathology. Brain reserve refers to the individual differences in the anatomic substrate. Cognitive refers to differences in the flexibility or adaptivity of cognitive networks. Epidemiologic evidence indicates that a set of life exposures including higher educational and occupational attainment, and engaging in leisure activities is associated with a lower risk of incident dementia, suggesting that these life exposures may enhance cognitive reserve. Imaging studies have been designed to explore the neural substrates of cognitive reserve. Also, controlled clinical studies can test specific exposures that may enhance reserve. The concept of cognitive reserve also has important implications for clinical practice.
FP96
PROMOTING LEARNING STRATEGIES ACCORDING TO THE COGNITIVE STYLE OF YOUNG PEOPLE AFFECTED BY LEARNING DISORDERS: THE AFTERSCHOOL EXPERIENCE MANUELA CALANCA (1) - MARTINA MASSINI (1) ELEONORA PASQUA (1) - CHRISTIAN VERONESI (1) C.R.C. BALBUZIE, SAPIENZA UNIVERSITY OF ROME, ROME, ITALY (1)
Abstract: Learning Disorder is a chronic developmental and persisting disorder. In Italy studies which focused in particular on the reading disorder, have outlined three developmental profiles: recovered, compensated and persisting dyslexia. If the deficit hasnt been completely recovered, functional consequences might manifest, according to the severity of the clinical picture: early fatigue, difficulty in text understanding and low efficacy in applying learning strategies, inability to study alone, down to a total rejection of school. As providing an appropriate school curriculum is essential, there has been the necessity to include in the guidelines of the treatment the proposal of: habilitative interventions especially focused on the compensation process. Compensating a teenager with LD means not only giving them the knowledge and the know-how about the use of compensatory technologies. Above all, it means helping them develop a compensatory strategy that is the processes, the learning or working styles which can help reduce their disability. On this basis we have conceived an Afterschool for young people with LD aimed at interiorizing the learning strategies in line with the cognitive style of each teenager.In particular, the project pursues the goal of making students become competent in using technological tools, in developing and personalizing metacognitive strategies of comprehension and learning in order to reduce the deficit on functional level as well as to increase the psychological features of self-esteem and general motivation. Compared with other similar projects born in Italy during last year, the specific nature of this program lays in its particular structure concerning the formation of a group (specific inclusion criteria) as well as in the planning of specific or group goals and also in the setting up of a network system (family support and school collaboration). The formation of a group which is homogeneous in relation to both clinical features and individual profiles is essential to assure an effective and individualized work. The group goals are distributed along the whole program length. The aim is to promote an active participation of the young people through discussion, exchange group sessions and promotion of cooperative learning strategies. At the end of the project, the participants showed increased functional skills (text comprehension) and learning abilities (awareness and use of learning strategies, with an improved index of coherence between the two criteria). Moreover, they showed an increasing general motivation in parallel with a reduction of the anxiety-inducing factors related to the learning skills. Learning Outcomes: The importance of habilitative activities within the taking in charge of people with LD, according to the care criteria of the Italian Consensus Conference. Focus on the effective use of compensatory tools within the meta-cognitive training on studying abilities. Focus on the setting up of a network system as a support of the activities proposed. The Afterschool experience and its effectiveness
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FP97
OPTIMISING TEACHER-LEARNER INTERACTIONS: A CRITICAL PROMOTIVE SLP INTERVENTION HARSHA KATHARD (1) - MERSHEN PILLAY (2) DEPARTMENT OF HEALTH AND REHABILITATION SCIENCES, UNIVERSITY OF CAPE TOWN, CAPE TOWN, SOUTH AFRICA (1) SPEECH-LANGUAGE PATHOLOGY, STELLENBOSCH UNIVERSITY, CAPE TOWN, SOUTH AFRICA (2)
Abstract: Given current imperatives for SLPs to develop contextually-responsive, population-based preventative/ promotive interventions, this paper highlights the importance of science in advancing this practice. The argument made here is that to practice differently SLPs must also generate knowledge differently. Using classrooms as potential spaces for reaching the population of leaners and teachers to enhance communication, this exploration in South African classrooms was driven by an inclusive population interest i.e. which interventions have potential to benefit learners and teachers. In order to be contextually-responsive the research problem was defined collectively by teachers and learners. They identified everyday teacher-learner interactions during instruction as a significant part of their classroom communication challenge. In short, teachers spoke too much and learners did not participate. A critical research paradigm guided the study and therefore teacher-learner interaction was constructed as a collective, relational, linguistic, social-cultural and, importantly, a political process of joint mean-making. The research question asked was: What is the nature of teacher-learner interaction and how does it advance/impede communication in classrooms? Evidence was gathered from video-recorded data in nine classrooms (grades 4-7). The teacher-learner interactions were transcribed and independently verified. The video data and the transcriptions were viewed repeatedly by the research team during the data immersion process. Thereafter, each lesson was analysed using the Dialogic Inquiry Tool (Reznitskaya, 2012). The tool analyses the interactions in relation to authority, feedback, questions and meta-level reflections, explanation and collaboration. Furthermore it differentiates between communication behaviours typical of monologic and dialogic teacher-learner interactions. Importantly, it acknowledges the continuum between monologic and dialogic interactions and considers the transition behaviours. The main finding in this study was the dominance of teacher- controlled monologic interactions closing down/ impeding opportunities for joint-meaning. The monologue was achieved by teachers maintaining authority through strict control of turntaking, asking close-ended questions, limiting opportunities for explanation and questioning by learners and failing to connect learners ideas to each other. Learners succumbed to authority by obeying the rules for turn-talking and responding with short answers, often in chorus. The pervasive nature of this limiting interaction pattern was observed across all classrooms. This finding is of concern the everyday classroom communication environment is counterproductive for learning. These socialised interaction patterns have been have been sedimented through powerful historical, cultural and political processes and therefore resistant to change. However, a further finding was that the occasional breaks in the monologic pattern signalled the potential for shifting towards dialogic teacher-learner. The breaks in monologue occurred when the teacher asked open-ended questions and requested clarification and explanations. The discussion focusses on how SLPs can optimise teacher-learner interactions through collaboration with key roleplayers in an education system. Furthermore, it considers the importance and potential impact of this preventative/promotive intervention as part of a battery of interventions. In concluding, the importance of research-practice partnerships in creating different practices is explored. Learning Outcomes: The participant will: Gain understanding of concepts relating to population-based, context-responsive SLP interventions in classrooms as context . Understand the importance of the critical research paradigm for knowledge construction and how it generated evidence in this study. Know the importance of teacher-learner interaction as a research and practice focus for SLPs. Understand how SLPs can play a role in developing interventions which optimise teacher- learner interactions.
of the Integrated Intelligent Learning Environment for Reading and Writing (ILearnRW) Project. More specifically, the aim of the ILearnRW is to contribute towards a move away from traditional assistive software which uses a computer simply as an alternative to pen and paper and towards developing next generation learning software which uses a computer to facilitate the learning process for children with dyslexia and/or dysorhographia. The ILearnRW system will support both the Greek and English languages. The target group will be children of primary school age with specific developmental learning difficulties (dyslexia and dysorthographia). The main learning features that are defined as crucial to be included in the proposed software system are the following: User modeling: In an intelligent learning system, a profile for each learner should be built including the learners age, the type of dyslexia, the error types and their severity, the degree of progress. Teaching strategies: The interaction of a learning system with a child should be based on a teaching strategy that supports the individual user in recovering its difficulties in reading and writing. Classification of learning material: Text classification and content classification with respect to the individual users profile must be a major component in integrated learning software such as ILearnRW. Personalized content presentation: The text presentation could be enriched by visual techniques which combine highlighting, text-reformatting and word segmentation. Evaluation of learning process: In the frame of the estimation of the learning progress and the update of the learners profile, the games are aimed to be utilized as an evaluation tool and an updating mechanism. On-line resource bank: An on-line resource bank should be available in order the users, the educators and experts could be helped by multimodal learning material, collected from everywhere. The ILearnRW software will utilize innovative delivery methods that are suitable for children and result in high degree of engagements such as mini games, reading activities and tests and will, for the first time, attempt to integrate all the above in a more sophisticated serious game. Learning Outcomes: The Participant will be able to: 1. understand the structures of innovative software applications in learning difficulties; 2. know the possibilities and the perspectives of the ILearnRW Integrated Intelligent Learning Environment for Reading and Writing; 3. know the alternative approaches of the intervention procedures in learning difficulties; 4. understand the learning environment as the most essential element of the software systems for users with dyslexia/dysorthographia.
SS17
BEHAVIOR ASSESSMENT BATTERY: MULTI-MODAL ASSESSMENT OF THE AFFECTIVE, BEHAVIORAL AND COGNITIVE DIMENSIONS SURROUNDING SPASMODIC DYSPHONIA IN ADULTS MARTINE VANRYCKEGHEM (1) - BARI HOFFMAN RUDDY (1) GENE BRUTTEN (1) - JEFFREY LEHMAN (2) UNIVERSITY OF CENTRAL FLORIDA, ORLANDO, UNITED STATES (1) THE EAR NOSE THROAT AND PLASTIC SURGERY ASSOCIATES, WINTER PARK, UNITED STATES (2)
Abstract: Assessment and treatment of adults with Spasmodic Dysphonia has, until now, often been dealt with in a rather mono-dimensional way. Nevertheless, clinical experience indicates that these individuals suffer from more than just a voice problem. Often they report experiencing a goodly amount of anxiety while speaking in certain situations and think about their voice in a negative way. Moreover, they also report using associated behaviors in order to cope with their voice problem. The extent of this affective, behavioral and cognitive component surrounding the disorder of Spasmodic Dysphonia, has not been systematically studied. Therefore, it was the purpose of this study to assess emotional reaction and speech disruption related to particular situations, the behaviors of avoidance and escape being used and the extent of negative speech-associated attitude, among individuals with Spasmodic Dysphonia. In order to determine whether or not adults with Spasmodic Dysphonia score differently compared to control subjects and people who stutter, an adaptation of the existing Behavior Assessment Battery (BAB-Voice) (Brutten & Vanryckeghem, 2011) was administered to 41individuals with Spasmodic Dysphonia and 21 typical speakers. Results indicated that people with SD reported a negative speech-associated attitude, negative emotional reaction and speech disruption in particular situations and the use of a significant amount of avoidance and escape behaviors. The scores on each of the BAB tests were statistically significantly elevated over those of typical speakers. Comparison with data from previous research with adults who stutter, indicates that people with Spasmodic Dysphonia respond in a similar way as those who stutter. This introspective information gives the clinician an inside view of the Spasmodic Dysphonia disorder. It not only adds important dimensions to the assessment of people with Spasmodic Dysphonia, but immediately provides a road map pointing to the targets of treatment. Learning Outcomes: The participant will be able to: 1. demonstrate data on a multidimensional assessment tool for individual with Spasmodic Dysphonia; 2. understand the speech-associated behaviors of avoidance and escape, speech-associated attitude, emotional reaction and speech disruption related to particular situations among individuals with SD; 3.demonstrate knowledge of the similarities and differences in the affective, behavioral and cognitive variables in individuals with SD in comparison to typical speakers and PWS
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FP98
A NEW SOFTWARE INTEGRATED INTELLIGENT LEARNING ENVIRONMENT FOR READING AND WRITING (ILEARNRW) IN DYSLEXIA: THEORETICAL PRINCIPLES AND MAIN OBJECTIVES ELENI MITROPOULOU (2) - VICTORIA ZAKOOULOU (1) ANTONIOS SYMVONIS (2) TECHNOLOGICAL INSTITUTE OF EDUCATION, UNIVERSITY, IOANNINA, GREECE (1) NATIONAL TECHNICAL UNIVERSITY OF ATHENS (NTUA), ATHENS, GREECE (2)
Abstract: Reading disorders such as dyslexia affect a significant number of people. The use of assistive computer software in dyslexia composes an effective perspective; it provides multi-sensory feedback to the reader in order to reinforce his core reading skills, contributing also to the comprehension process. However, the issue that demands more research into the contribution of computer technology in dyslexia is its effectiveness in the learning process itself; this effectiveness composes the fundamental principle
FP99
ACOUSTIC ANALYSES OF DIADOCHOKINESIS IN FLUENT AND STUTTERING CHILDREN CLAUDIA ANDRADE (1) - FERNANDA SASSI (1) - FABIOLA JUSTE (1) SILMARA RONDON (1) - ANA PAULA RITTO (1) - CLAUDA COLALTO (1) SCHOOL OF MEDICINE, UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Although the etiology of stuttering is controversial, a widely held view is that it in part reflects a disorder in how different components of the speech-motor system are coordinated. This general perspective has motivated studies that examine the relative timing of the movements of different structures in the fluent speech of persons who stutter. The purpose of the study was to acoustically compare the performance of children who do and do not stutter on diadochokinesis (DDK) tasks in terms of syllable duration, syllable periods and peak intensity. Participants for this study were all native speakers of Brazilian Portuguese and included 26 children (Group 1 G1), 17 boys and 9 girls, who were diagnosed by two independent speech pathologists as exhibiting stuttering behaviors. Participants of G1 were divided into two age groups: preschoolers (ages between 4.0 and 7.11 years), with 16 individuals and school aged children (ages between 8.0 and 11.11 years), with 10 individuals. The 26 speakers were recorded by a speech pathologist while producing spontaneous speech. The 20 control speakers (Group 2 G2), 11 boys and 9 girls, were unpaid volunteers who reported no history of speech or hearing difficulty. Participants of G2 were also divided into the same age groups as proposed for G1: preschoolers, with 8 individuals and school aged children, with 12 individuals. For recordings of the DDK task, the repetition rate of articulatory segments was analyzed through a task involving the ability to alternate (AMR - alternating motion rates) movements. Participants were asked to repeat, without interruption, the sequence pa-pa-pa as fast as possible and without losing articulatory precision as soon as they heard the chronometer beep. Three sequences of 15 seconds were collected. Only fluent productions were considered for analysis. For each executable DDK sample file, the consonant-vowel (CV) syllables duration, the peak intensity within each CV syllable (voice onset plus vocalic interval) and the average period between the CV syllables were manually measured by the second author using the PRAAT software. SPSS 17 was used for statistical analyses. The Kolmogorv-Smirnov test indicated that the data did not present a normal distribution. For this reason the nonparametric Mann-Whitney U test was used for within and between group comparisons (p<0.05).Our study found no significant differences between children who stutter and do not stutter regarding the acoustic patterns produced on the DDK tasks. Significant differences were found for age comparisons independently of the speech fluency. Overall, preschoolers presented a poorer performance. These results indicate that the observed differences are related to speech-motor age development and not to stuttering itself. Acoustic studies show that speech segment durations are most variable, both within and between subjects during childhood, then gradually decrease to adult levels by age eleven to thirteen years. A possible explanation for the results of the present study is that children who stutter presented higher coefficients of variations to exploit motor equivalence in order to achieve accurate sound production (absence of speech disruptions). Learning Outcomes: The participant will be able to: 1. know the controversies on using DDK tasks to assess stuttering and fluent children; 2. understand the impact of language and motor development on speech production; 3. know the correlations of DDK and speech fluency.
days of the week, pre and post treatment). Further, all participants were interviewed about their experience wearing the device. The main aims of this study were to investigate whether Ambulatory Phonation Monitor (APM) technology is acceptable, from the perspective of adults who stutter, to use as an outcome measure to quantify any change in phonatory output after treatment. Additionally, to ascertain if there is an increase in output after intensive Smooth Speech treatment in adults who stutter.
FP101
ITALIAN PUBLIC OPINION ON STUTTERING: THE POSHA-S AS AN INVESTIGATIVE TOOL EMILIA CAPPARELLI (1) - FRANCESCA DEL GADO (1) DONATELLA TOMAIUOLI (1) - PAOLA FALCONE (1) KENNETH O. ST.LOUIS (2) CRC BALBUZIE, SAPIENZA UNIVERSITY ROME, ROME, ITALY (1) WEST VIRGINIA UNIVERSITY, MORGANTOWN, WEST VIRGINIA, UNITED STATES (2)
Abstract: Carrying out a survey into public opinion is useful in order to find out and understand widespread attitudes on a particular argument. Several surveys of this type have been carried out in a number of countries around the world regarding stuttering The results have highlighted the fact that normally fluent people perceive this disorder in a negative way, thereby revealing the existence of a negative stereotype in relation to this disorder and the stutterer. Negative stereotypes can create social barriers and affect the quality of a stutterers life. The stutterer, in fact, may undergo the negative influence of the interlocutors prejudices, often acting out avoidance behaviours in relation to those situations in which a verbal interaction is required. On the other hand, a positive social environment around the stutterer, will create those conditions that will bring about an improvement in the quality of his life. It is therefore important to understand and analyze opinions and attitudes of normally fluent people in relation to this disorder, detecting possible prejudices to then identify appropriate ways for modifying these beliefs. So far, no study on the subject which includes standardized tests has been published in Italy.This work presents the results of a research carried out into Italian public opinion on the theme of stuttering, on a sample group consisting of 300 non-stutterers from northern, central and southern regions of Italy, aged between 18 and 60 with varying educational backgrounds. The interviewees have had no direct contact either through family , work and/or professional with stutterers, in order to ensure that their opinions are not a reflection of these circumstances. This study was conducted by administering the POSHA-S (Public Opinion Survey of Human Attributes- Stuttering). It aims to describe and analyze opinions and attitudes on the disorder, evaluating in particular the degree of influence that demographic variables such as gender, age and educational level have on the general impression that subjects develop of the disorder. Learning Outcomes: Acquire knowledge and awareness on existing opinions and attitudes towards stuttering in Italy and on the existence of stereotypes that concern both the disorder and the stutterer. Consider how a negative stereotype may influence a stuttering subject. Consider carefully how negative stereotypes can have a negative impact on the people who find themselves in a dialogue with those who stutter. Consider carefully possible educational interventions to modify public opinion on the disorder.
SS18
MULTILINGUALISM, A HIDDEN REALITY MIRJAM BLUMENTHAL (1) ROYAL KENTALIS, ST. MICHIELSLGESTEL, NETHERLANDS (1)
Abstract: If in a multilingual family a child is born that turns out to have a auditory / communicative disability the parents nd professionals dont know what to do: raise the child in one language, or more? From 20072009 a methodology was developed to advise parents who are in this situation. After that the author (Blumenthal, 2009), together with a 2nd author Margreet Verboom, found out that professionals need to actually see what happens in the homes of these families. This to convince them that the home language in most cases is necessary for child and parent, for communicative success at home. Method: A film was made showing situations at home in multilingual families with children with different auditory / communicative disabilities. Results:In the film situations in multilingual homes are shown, parents explain how they deal with the multilingual upbringing of their children, how they were sometimes misadvised, and how the child manages in family gatherings during holidays in the homeland. Experts give evidence based views, and good practices are shown: for example diagnostic work with an interpreter, advising parents to read storybooks in their home language. The professionals who watched the film were all very enthusiastic. now I understand why parents are so keen on keeping their home language The most interesting part is when the parents explain their point of view. They share their uncertainties and reflect on the fact that their own intuition was better than some of the expert advice they received. At IALP2013 we want to show the film. The film is originally made in Dutch, later subtitled in English.Conclusion:The multilingual situation of children and parents should be taken more seriously by professionals A one size fits all solution is never good enough: only custom made works.
FP100
STUTTERING MEASUREMENT: THE UTILITY AND APPLICABILTY OF THE APM MEASURING PHONATION OUTPUT IN ADULTS WHO STUTTER, BEFORE AND AFTER TREATMENT LAUREN MENDES (1) DEPARTMENT OF HUMAN COMMUNICATION SCIENCES, LA TROBE UNIVERSITY, MELBOURNE, AUSTRALIA (1)
Abstract: Stuttering is multifaceted, variable and at times fleeting, so accurate evaluation and measurement of stuttering is difficult to determine. Outcome measurement in stuttering is an area of much investigation and discussion in the literature. Inghams (1984) landmark text highlighted the need for the development of a stuttering measure that is multi-dimensional. This paper will address the difficulty with measuring broader aspects of stuttering, beyond frequency and thus, ascertaining reliable treatment outcomes. This study involved measuring phonation time (i.e. aspects of verbal output) in adults who stutter, pre- and post-intensive stuttering treatment. The device trialed has not been used previously with people who stutter. The device used to measure phonation in this study is the Ambulatory Phonation Monitor (APM) developed by KayPENTAX (KayPENTAX, 2011). The APM is a portable device which was worn by the participants to automatically collect aspects of their vocal activity throughout the day. This is an automatised process which has been shown to be able to be managed by adults with other speech problems. The participants wore the device all day for 3 days prior to treatment and then 3 days following treatment (on the same
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Learning Outcomes: The stories of parents that were misadvised , and images of multilingual families in action at home, make the student feel that the home language is important for a child with a disability.
FP102
STROBOSCOPY. STILL A POWERFUL INSTRUMENT FOR VOCAL DISABILITY IN 21ST CENTURY KOICHIRO SAITO (1) - HARUNA YABE (1) - KOSUKE UNO (1) DEPARTMENT OF OTOLARYNGOLOGY-HNS, KEIO UNIVERSITY SCHOOL OF MEDICINE, TOKYO, JAPAN (1)
Abstract: Stroboscopy was first utilized to visualize the vocalizing larynx by Oertel in 1895. In Japan, laryngeal stroboscopy was first introduced in 1943 by Kirikae to visualize and analyze the physiology of the vocalizing vocal folds. Since then, technology of laryngeal endoscopy has been improving. As for the equipment, flexible endoscopes, such as fiberscope and videoscope are getting more popular than laryngeal mirror and rigid endoscope. When we talk about the imaging technology, investigations using high-speed imaging systems are underway to detect and analyze the real motion of the vibrating vocal folds. Other updated imaging techniques such as Narrow Band Imaging (NBI) are also highlighted to be potentially useful especially to clearly visualize the organic laryngeal lesions. We consider that it is meaningful to notice that laryngeal stroboscopy is still an indispensable epoch-making examination procedure for careful investigation and diagnosis of vocal disabilities despite the innovative improvement of endoscopes. We have been performing laryngeal endoscopic examinations on over 3200 cases per year in total. Of these, stroboscopy occupies around 1700 examinations every year. In our laryngeal clinic, we care multiple diseases including benign or malignant laryngeal tumors, inflammatory lesions and functional vocal problems. Thus, even only when we look at the frequency of the laryngeal stroboscopy examinations, we can speculate the indispensability of stroboscopy to evaluate laryngeal function. In our clinic, we often perform the combined use of flexible endoscopy and rigid endoscopy for detailed observation on the patients with laryngeal problems. Stroboscopy is mainly performed using rigid endoscope and flexible videoscopy is commonly used under xenon light. In our daily examinations, we have experienced the advantages of stroboscopy even over novel flexible videoscopy in not a few cases in obtaining key findings for correct diagnoses of diseased larynges. In this presentation, we intend to show multiple cases in which stroboscopic examinations were exceedingly useful for precise investigation of disabled larynges and reconsider the clinical utility and essence of stroboscopy. Tips for successful stroboscopy to fully utilize the advantages of this procedure includes 1) examination of the vocalizing larynx in multiple pitches and vowels, 2) careful observation of the vocal folds vibration on both sides not limited in the waveform of the lesion itself, 3) investigation of the bubbles around the lesion, 4) utilization of a slow motion video replay, and 5) examination of the vocalizing larynx using stroboscopy through flexible videoscope in selected cases. It is our mission to improve the quality of the patient care based on the careful assessment of diseased larynges. For this purpose, it is important to develop the novel technologies, however, we should not hesitate to further utilize the advantages of historical stroboscopy for the accurate assessment and diagnosis of vocal disability. We believe that the clinical utility of stroboscopy can not be over emphasized even in the 21st century. Learning Outcomes: The participants will be able to: 1. compare and learn the characteristics of laryngeal flexible videoscopy using xenon light and laryngeal stroboscopy mainly performed by rigid laryngoscope; 2. understand the tips for successful stroboscopy to fully utilize the advantages of this procedure; 3. re-recognize the indispensability of stroboscopy for precise evaluation and understanding of the vocal pathology. Our presentation implies multiple hints directly useful for the improvement of daily clinical practice to care patients with vocal disabilities.
quality which is cheap. The system is ultra-light and weighs 660 grams and costs less than 3500 euros. It includes HD camera, continuous light source and rigid endoscope. All parts of it are commercially available from different companies. The author will also give an account on recent developments in the field and the future of light and portable videoendoscopy devices. Learning Outcomes: To know about the developments in the field of portable and HD videoendoscopy systems. To know how to assemble own cheap and portable HD videoendoscopy system.
FP104
VIDEOSTROBOKYMOGRAPHY OF THE VOCAL FOLD IN CASES OF REINKE EDEMA PAULINA KRASNODEBSKA (1) - AGATA SZKIE KOWSKA (1) BEATA MIAKIEWICZ (1) - HENRYK SKARYSKI (1) INSTITUTE OF PHYSIOLOGY AND PATHOLOGY OF HEARING, KAJETANY, POLAND (1)
Abstract: Background: F.Reinke described a space in the vocal folds, which is known as the superficial lamina propria (Hirano). Excessive chronic swelling and disturbed structure of this space leads to Reinkes edema. According to the severity of the disease, Yonekawa proposed in 1988 a three-degree classification. Videostrobokymography (VSK) describes glottal function with objective parameters open (OQ) and closed (CQ) quotients. Aim: The purpose of the study was to compare OQ and CQ from patients with normal voice and those with Reinke edema. The relation between OQ and CQ and the stage of edema described by Yonekawa was calculated. Material and Methods: 87 patients were enrolled in the study. Using VSK recording, parameters were measured from the anterior, medial, and posterior third of the vocal folds. Yonekawas classification was used to classify the edema. Results: Mean values (from the anterior, middle, and posterior third) from the control group were OQ (0,54; 0,55; 0,59); CQ (0,46; 0,45; 0,41). Mean values from patients with Reinke edema were OQ (0,44; 0,46; 0,52); CQ (0,56; 0,54; 0,48). Results from the whole glottis in the control group were OQ 0,56 and CQ 0,44. In patients with Reinke edema the values were OQ 0,48 and CQ 0,52. Differences in OQ and CQ measured from each third of the glottis as well as differences between mean values for the whole glottis were significant between the control and test group. A dependence between the value of parameters and the location of swelling was seen. Conclusions: OQ and CQ of the glottal chink objectively parameterize the vibratory function of the vocal folds. Reinke edema, classified according to the Yonekawa scheme, provides an easy way to objectively assess the glottis. Learning Outcomes: The kymography mode of videostrobokymography as a useful complement to classical stroboscopy. Its help in differential diagnosis of Reinke edema. Differences in OQ and CQ between patients with normal voices and patients with Reinke edema. Rrelation between the Open and Closed quotient and the occurrence of edema, corresponding with stages of the Yonekawa scale.
FP105
PROPOSAL FOR AN INTEGRATED APPROACH IN ADULT NEUROLOGICAL DYSPHAGIC PATIENTS WITH INJURIES OF THE POSTERIOR CRANIAL FOSSA LISA POLI (1) - MANUELE TAVELLA (1) PRIVATE HOSPITAL MADONNA DEI BOSCHI, PRIVATE HOSPITAL MADONNA DEI BOSCHI, BUTTIGLIERA ALTA, ITALY (1)
Abstract: The adult neurological dysphagic patient is clinically complex; the aims of this work are, in agreement with provisions contained in the Guidelines on Dysphagia: - to develop a rehabilitation integrated program, managed by speech therapist and physiotherapist with medical supervision, in patients with Wallenberg Syndrome and dysphagia after posterior cranial fossa structures lesions; - to facilitate the recovery of the correct swallowing dynamics with stable effects, increasing awareness and self management through postural changes and structural adaptions. This approach is based on : - segmental mobilization, - postural reprogramming, - restoration of neural conduction, - specific speech therapist intervention (stimulations, compensations, dietary adaptations). The speech therapist developed and implemented the rehabilitation project of the dysphagic symptoms through: - assessment of the swallowing disorders, - identification of compensatory strategies, - eso and endo-oral stimulation of the tactile and thermal sensitivity finalized to the recovery of a functional swallowing, - constant comparison and collaboration with the physiotherapist. The physiotherapist structured his own intervention on the base of the specific competences: searching for the retrieval of proper posture, acting on the fascial component, trying to eliminate the points of tension that can promote incorrect postures; - optimizing recovery and control of deep muscles stabilizing the neck, in static and dynamic conditions; - acting on the vertebral and cranial component, considered as a mechanical interfaces, inhibiting the normal sliding of the cervical neural component and its connection with the cranial nerves; - encouraging the restoration of normal motor and sensory innervation, through the mobilization of peripheral neural component (Occipital and Cranial Nerves). Remedial intervention aimed to maintain laryngeal elevation, the upper esophageal sphincter functionality and a harmonic swallowing act. Weve observed 30 patients admitted to the private hospital in which we
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FP103
CHEAP AND PORTABLE HIGH DEFINITION VIDEOENDOSCOPY, HOW TO DO IT? AHMED GENEID (1) ENT AND PHONIATRICS DEPARTMENT, HELSINKI UNIVERSITY HOSPITAL, HELSINKI, FINLAND (1)
Abstract: Optical visualization of the larynx started with the introduction of laryngeal mirror in 1855 by Manuel Garcia. Since then, the developments in the field of optical assessment of the larynx never stopped. The idea of stroboscopy was introduced by Oertel in 1879. Last century witnessed a major development in video systems that enable video recording of the larynx as well as stroboscopy examination of the vocal folds. It also witnessed the development of other new techniques for optical examination of the vocal folds such as kymography and high speed recording. The need for better quality of recorded videos has increasing and coupled with the need for portable and lighter systems. A portable videoendoscopy system is also needed for different reasons such as: doing bed side examinations, examination in private clinics and research reasons. Also, they may be of huge interest for voice clinicians from developing countries. The author presents his own experience on assembling a portable system of High Definition (HD) recording
operate, near Turin, 16 males and 14 females, with an age in the range 50 - 85 years, with alterations of the structures of the posterior cranial fossa, . Our experience is currently limited, but allowed us to optimize the outcome, encouraging a return to a stable and functional swallowing, in the presence of serious impairment of the swallowing dynamics. We also observed a reduction in dietary compensation, an increase in the awareness and a greater possibility of voluntary control of the act, thanks to the recovery of a correct posture and tactile and thermic sensitivity. Wider studies are necessary, of course, especially to assess some aspects: the integrated intervention speech therapist / physiotherapist can be relatively strenuous for the patients, in relation to the complex requests that involves; apllication in patients with disturbances in attentional level and language comprehension; identification of alternative strategies for patient with contraindications (i.e. epilepsy). Learner Outcomes: consider that the collaboration between different professions is possible and useful in the case of dysphagia ; broaden the vision of the assessment and treatment of adult neurological dysphagic patients; consider the introduction of new methods of treatment.
Learning Outcomes: The present study demonstrates the effectiveness of a theoretical and practical course in improving the clinical competence of healthcare professionals involved in decannulation and in terms of organizational impact.
FP108
LEBERS HEREDITARY OPTIC NEUROPATHY WITH HEARING AND NEUROPSYCHOLOGIC IMPAIRMENT AND FAMILIAR ACCUMULATION MULTIPLE CASE REPORT JAKUB DRATA (1) - ANNA HANUOV (2) - N. JIRSKOV (3) DEPARTMENT OF OTORHINOLARYNGOLOGY AND HEAD AND NECK SURGERY, UNIVERSITY HOSPITAL HRADEC KRALOVE, CHARLES UNIVERSITY IN PRAGUE, FACULTY OF MEDICINE IN HRADEC KRALOVE, HRADEC KRLOV, CZECH REPUBLIC (1) DEPARTMENT OF PSYCHIATRY, UNIVERSITY HOSPITAL HRADEC KRALOVE, CHARLES UNIVERSITY IN PRAGUE, FACULTY OF MEDICINE IN HRADEC KRALOVE, HRADEC KRLOV, CZECH REPUBLIC (2) DEPARTMENT OF OPHTHALMOLOGY, UNIVERSITY HOSPITAL HRADEC KRALOVE, CHARLES UNIVERSITY IN PRAGUE, FACULTY OF MEDICINE IN HRADEC KRALOVE, HRADEC KRLOV, CZECH REPUBLIC (3)
Abstract: Lebers hereditary optic neuropathy (LHON) is a classical type of mitochondrially hereditary disease with autosomal dominant (AD) pattern of transfer, the substance of which is genetically caused retinal ganglion cells (RGC) degeneration. Main three types of mtDNA point mutations are responsible for most of LHON cases. The phenotype is dependent on the mutation penetrance, sex and possibly other, environmental factors. The disease leads to loss of central vision and may cause blindness, usually consequently on both eyes. Men are usually affected more severely, but all their children are always free of he mutation (maternal mtDNA only is passed on the offspring). Cases with neurologic symptomatology are called LHON-plus syndrome. Therapy is symptomatic; attempts of specific therapy are experimental. A 14 years old girl with previously diagnosed LHON syndrome (typical 11778G>A mutation), was referred first to the ORL Dept. Hradec Kralove in November 2008 for hearing loss, without tinnitus or any other ear symptoms, vertigo or neurologic symptomatology. The ophthalmologic examination showed only mild impairment of central visual acuity. Sister of the proband, their mother, and her brother suffer from the LHON too. Audiological examination was performed, disclosing perceptive hearing loss at levels of 50 70 dB, without signs of retrocochlear lesion; vestibulological, neurologal and magnetic resonance examination of the brain was normal. The girl was equipped with hearing aids. In the follow-up, the dominating problem of the proband remains psychiatric. Hearing and vision remain stable, the patient is not regarded as deaf blind. Perceptive hearing loss was confirmed also at the mother of the proband. Sister of the proband, being also confirmed for LHON genotype, has normal vision and hearing. The association of LHON-like symptoms with hearing loss has been reported in cases with inherited optic neuropathies like Optic atrophy-1 gene mutations and the Wolfram syndrome. So far, no case of LHON syndrome with the typical mtDNA 11778 mutation, associated with hearing loss, has been described. The proband family remains in follow-up. Learning Outcomes: The Participant will be able to get acquainted with a classical type of relatively rare mitochondrial hereditary disease; learn a yet not published information about classical LHON associated with hearing loss; understand the problem of multidisciplinar approach to the deafblindness and other multiple communication handicaps.
FP106
COORDINATION OF SWALLOWING AND BREATHING IN PATIENT WITH AMYOTROPHIC LATERAL SCLEROSIS FEDERICA BIANCHI (1) - ANTONIO SCHINDLER (2) ELISABETTA ROMA (2) - CHRISTIAN LUNETTA (2) NADIA CELLOTTO (2) DANIELA GINOCCHIO (2) IRCCS SALVATORE MAUGERI, OSPEDALE, MILANO, ITALIA (1) UNIVERSIT DEGLI STUDI DI MILANO, MILAN, (2)
Abstract: The Coordination of swallowing and breathing is essential to the prevention of pulmonary aspiration. Among the diseases that can cause an alteration of this fine coordination mechanism there are numerous neurological diseases, including Amyotrophic Lateral Sclerosis (ALS). The aim of the study is to analyze the coordination of swallowing and breathing in ALS patients. Methods: Combined FEES, respiratory phase and submental S-EMG recordings were analyzed in 13 patients with ALS. The following swallow tasks were considered: spontaneous swallow during a 5 minutes recording with and without endoscopic control and 5 voluntary dry swallows; single as well as sequential deglutition with thin liquid (5, 10, 50 ml) and semisolid bolus (5, 10 ml). For each swallow, offline from the digitized recordings, the following variables were measured: 1) duration of the sustained swallowing apnea; 2) numbers of swallows/bolus; 3) respiratory phases surrounding each swallow. Patients were divided into those who had a safe swallow and those with an unsafe swallow, according to the grade obtained in the Penetration Aspiration Scale (PAS) and in the Dysphagia Outcome and Severity Scale (DOSS). Respiratory parameters were collected. Mann-Whitney and Spearman nonparametric tests were used for statistical analysis. Results: No difference was found in apnea duration and number of swallows measured with endoscopic control and those measured without it (p= 0.281). A total of 644 swallows with either thin liquid or semisolid were analyzed. In 50.1% of the patients the deglutition was followed by the expiration phase. Percentage of inspiration-deglutition-inspiration pattern depended on viscosity and decreased with semisolid bolus. The average of swallowing apnea duration was 1.7 seconds. This laps of time depended on swallowing task, bolus viscosity and size. The average numbers of swallow/bolus was 2.06. This number doubled in patients with an unsafe swallow and depended on bolus viscosity and size. A strong correlation between SpO2 and swallowing apnea duration on Spearman test was found (r = 0.8). No correlation between swallowing apnea duration and numbers of swallows/bolus was found. Conclusions: Many parameters describing coordination of swallowing and breathing in patient with ALS are modified compared with the same data found in literature on healthy adults. Consequences on the planning of the speech and language treatment should be considerd, introducing strategies to improve the coordination between swallowing and breathing in order to reduce the risk of pulmonary aspiration. Learning Outcomes: The Participant will be able to: 1) know the physiology of coordination between swallowing and breathing in ALS patients; 2) know the relationship between dysphagia, respiratory pattern and alteration in coordination of swallowing and breathing in ALS patient; 3) understand the importance of introducing strategies to improve coordination between swallowing and breathing in dysphagia treatment of this group of patient
FP109
EVALUATION OF CLEAR SPEECH PERCEPTION IN PATIENTS WITH AUDITORY NEUROPATHY SALWA MOURAD (1) - SOMAIA TAWFEEK (2) - AMANI SHALABY (2) MOHAMED ABD-EL-GHAFFAR (1) SOHAG UNIVERSITY, SOHAG, EGYPT (1) AIN SHAMS UNIVERSITY, CAIRO, EGYPT (2)
Abstract: Auditory neuropathy (AN) is a special type of hearing loss that is characterized by disrupted auditory nerve activity with concurrently normal or near normal cochlear amplification function . Temporal modification of speech by enhancing temporal properties in clear speech can be beneficial in enhancing speech intelligibility in auditory neuropathy patients. Clear speech was developed in English language & studies showed it is more intelligible to patients with sensory neural hearing loss & auditory neuropathy. The aim of the study is a) develop and standardize Arabic clear speech materials; b) evaluate the performance of patients with auditory neuropathy (AN) on Arabic clear speech. The present study was conducted in three phases. Phase one: included the development & recording of clear & conversational Arabic speech materials. Clear speech duration was twice that of conversational speech. Phase two: included establishing norms on the developed materials by evaluation of 30 adult normal subjects. Phase three: comprised evaluation of performance of 40 adult patients with AN on conversational and clear speech. Patients were tested in quiet & noisy
FP107
IMPACT ASSESSMENT OF A TRAINING COURSE ON TRACHEOSTOMY AND DECANNULATION IN HOSPITAL MICHELA BENVENUTI (1) - GIAMPIERO FERRARI (1) ROSSANA DALOGNA (1) - DOMENICO CUDA (1) OTORHINOLARYNGOLOGY, HOSPITAL GUGLIELMO DA SALICETO, PIACENZA, ITALY (1)
Abstract: The decision to decannulation a patient with trachetomy in a hospital setting requires a structured and methodical approach and is often due to inappropriate requests for advice that are likely to impede the orderly development of clinical functional units within departments phoniatric and logopedics. For these reasons we decided to evaluate the impact of a training on the knowledge of the most common protocols for decannulation by the hospital personnel involved with this type of patients.
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listening conditions. A significant clear speech advantage was observed in intelligibility for all listening conditions for all AN patients. Clear speech advantage was 16.7 % over conversational speech. However, all patients with AN showed poor performance on clear speech in noise at all SNRs. Patients with AN most likely drive the advantage of clear speech over conversational speech from enhanced temporal properties in clear speech. This study suggests the use of clear speech in remediation of patients with auditory neuropathy in order to improve their ability to communicate. Learning objectives: 1.Clear speech was developed and standardized on normal subjects. 2. Patients with AN demonstrated a significant clear speech advantage in comparison to conversational speech. 3. AN patients performed poorly in speech recognition in noise at all SNRs and the score decrease as well as the SNR decrease. 4. There was no difference between monaural and binaural modes of stimulation in patients with AN.
FP110
FROGS AND SNAKES: TYPICAL ACQUISITION OF CONSONANT CLUSTERS IN AUDITORY-VERBAL PRESCHOOL CHILDREN WITH SEVERE/PROFOUND HEARING LOSS ANNE NIVELLES FULCHER (1) - ELISE BAKER (2) ALISON PURCELL (2) - NATALIE MUNRO (2) THE SHEPHERD CENTRE, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (1) - DISCIPLINE OF SPEECH PATHOLOGY, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (2)
Abstract: Early-identified severe/profound hearing loss (HL) following universal newborn hearing screening (UNHS) has been associated with improved speech and language outcomes. However, speech outcome reports have typically been based on broad measures of speech intelligibility and/ or singleton consonant accuracy with little known about production of consonant clusters (CCs). Using a prospective design we examined the range and accuracy of CCs produced by a homogenous cohort of 12 children earlyidentified with severe/profound HL aged 3- and 4-years. All children demonstrated bilateral aided thresholds within a range of 15 - 25 dB HL across all frequencies, were optimally amplified with cochlear implants (11/12) or hearing aids (1/12) and attended auditory-verbal (AV) early intervention. Standardized speech and language assessments were administered. CCs were strategically sampled in single-word and conversational speech contexts. All standard scores for speech, receptive and expressive language were within normal limits. All children produced CCs commensurate with expectations for typically developing hearing peers at 3- and 4- years-of-age. Childrens production of phonetically complex morphophonemes (final CCs marking grammatical morphemes), was also in keeping with developmental expectations. Future research needs to identify factors which contributed to these encouraging outcomes. Learning Outcomes: The Participant will be able to Explain why consonant clusters are important to consider when describing the speech production skills of children with severe/profound hearing loss; describe a comprehensive speech assessment battery for preschool-age children with severe/profound hearing loss; describe the speech outcomes of preschool with early identified severe/profound hearing loss who have received auditory-verbal therapy, specifically with respect to production of consonant clusters, noting that typical acquisition is possible.
outcomes.The cross cutting recommendations of the report, based on the main findings, are as follows: 1. Enable access to all mainstream systems and services; 2. Invest in programs and services for people with disabilities; 3. Adopt a national disability strategy and plan of action; 4. Involve people with disabilities; 5. Improve human resource capacity; 6. Provide adequate funding and improve affordability; 7. Increase public awareness and understanding about disability; 8. Improve the availability and quality of data on disability; 9. Strengthen and support research on disability. The recommendations offered should be transformed into actions, which require a strong commitment from all the people involved. Although it is understandable that governments have the most important role in this project, other partners should also encourage their implementation, such as national agencies, organizations of people with disabilities, service providers, academic institutions, scientific societies, private sector, communities and people with disabilities and their families. At this round table, 5 national associations were asked to share their reflections and actions on this subject. The American. Speech-Language and Hearing Association ASHA will present the initiatives and specific strategies and activities employed by this association and its members. The Speech Pathology Australia SPA will address the need of a systematic effort which involves more than the governmental agencies and will present use of the National Disability Insurance Scheme as a platform to engage policy makers and improve the recognition and support of people living with communication disability. The Societ Italiana di Logopedia e Foniatria SIFEL, a multiprofessional organization will highlight the responsibility of the academic world and the need of involving students, scientist, clinicians and professors in the strategy of implementing the main recommendations. Finally, the Deutsche Gesellschaft fr Phoniatrie und Pdaudiologie DGPP will present the disability module for voice disorders assessment, reinforcing the use of low cost solutions for the patient evaluation such as self-reported questionnaires. Learning outcomes: 1. To review the main recommendations proposed by the WHO World Report on Disability; 2. To understand the challenges in implementing the recommendations to individuals with communication disorders; 3. To appreciate the different efforts faced by some professional associations;4. To be aware of simple cost-effective strategies that can be easily introduced in the clinical practice
ROUD TABLE GISD - ROLE OF THE SPEECH THERAPIST IN AMYOTROPHIC LATERAL SCLEROSIS GIULIA CHIARELLO - NICOLETTA DE LUCA - BRUNO FATTORI ANDREA NACCI - ANTONIO AMITRANO GIULIA MAZIO DANILO PATROCINIO, ITALY
Abstract: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurological disease that presents several problems in the long-term management. Dysphonia, dysphagia, malnutrition, depression, impairment cognitive, respiratory insufficiency affect the quality of life and worsen the prognosis of the disease. This round table reviews dysphonia, dysarthria, and dysphagia are three of the most common bulbar manifestations of ALS and are often the presenting symptoms in bulbar-onset patients. For this reason, the speech therapist has an important role in diagnosis and rehabilitation. These manifestations are correlated with the decreased tongue strength and mobility and follow their trend over time may have a role in assessing the prognosis. The progressive voice dysfunctions and worsening dysphagia, assessed with FEES, allows to follow the clinical course of ALS. The instrumental study of dysphagia helps to schedule an appropriate speech rehabilitation therapy and adequate nutrition management, prevents inhalation, delays the problems of malnutrition and the need to program a tracheotomy and a gastrostomy, by improving as long as possible the life quality of these patients. In selected cases of ALS patients functional surgery can be performed, for exemple in order to decrease sialorrhea according to a better course of symptoms. In this round table the role and the utility of tele-assistance for patients with advanced ALS and their caregivers are analized too . Telemedicine-assisted integrated care provides a nurse-centred, home-monitoring programme that can be a useful way of following up ALS patients.
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WHO WORLD REPORT IN DISABILITY. IMPLEMENTING SOLUTIONS MARA BEHLAU (BRAZIL) - TANYA GALLAGHER (USA) - ALANA MARGARET (SWITZERLAND) - PATRICIA PRELOCK (USA) CHRISTINE STONE (AUSTRALIA) - OSKAR SCHINDLER (ITALY) Tadeus NAWKA (GERMANY)
Abstract: On June 9, 2011, at the headquarters of the United Nations in New York, the first WORLD REPORT ON DISABILITY was launched, the result of four years of work by the World Health Organization (WHO), the World Bank and hundreds of contributors and reviewers. The launch was attended by dignitaries, international authorities, presidents of scientific societies and NGOs, artists and people with disabilities. Human communication disorders were included in the report, and IALP will continue to build on its relationship with WHO and increase its involvement in implementation of the recommendations of the report. The main messages of the report highlight a paradigm shift in approaches to disability. A disability is the result of interactions among the individual, his or her health condition and the environment. The emphasis on the removal of environmental barriers that limit inclusion is a priority. Disabilities disproportionately affect vulnerable populations and are more common in women, the elderly and those who are underprivileged. Moreover, countries with low income have a higher prevalence of disabilities. Disabilities are variable and stereotyped images are restrictive. Although impairments correlate with disadvantage, the degree can be variable. It was found that children with physical disabilities often experience less disadvantage than those with sensory or mental disabilities. Overall the report indicated that people with disabilities face barriers in accessing health services, education, employment, transport and information, and therefore have worse health and lower socioeconomic
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COUNSELING/TRAINING PROFESSIONALS AND PARENTS OF CHILDREN WHO ARE DISFLUENT PATRICIA MERCAITIS (1) DEPT OF COMMUNICATION DISORDERS, UNIVERSITY OF MASSACHUSETTS AMHERST, AMHERST, MA, UNITED STATES (1)
Abstract: The fluency counseling/training program includes basic information on developmental fluency disorders, pertinent key words, differences between normal nonfluencies and abnormal disfluencies, and between stuttering and cluttering. Extensive discussion will be provided on the various program components which might be used to counsel and train other professionals and parents/caregivers. Extensive discussion will be provided on the various interaction skills which can be used by professionals, parents/ caregivers to enhance the childs fluent speech. Strategies will be provided for stimulating a disfluent child to initiate and respond to communication regarding her/his needs across functional communication situations and settings. A set of print and web-based resources will be provided to seminar participants. Time will be provided for responding to participants questions.
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Learning Outcomes: Participants will be able to differentiate between a normally disfluent child and a child with abnormal disfluencies. Participants will be able to differentiate between stuttering and cluttering. Participants will be able to identify important components in a parent fluency counseling/ training program. Participants will be able to describe an optimal sequence of counseling/training program components. Participants will be able to describe a set of fluency-enhancing communication strategies for use with disfluent children.
heterosexual biological men. Learning Outcomes: The conference attendees will learn about voice and voice change in female-to-male transsexual persons and its influencing factors.
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ORTHODONTIC TREATMENT AND AIR WAY MODIFICATIONS; IMPORTANCE OF MIOFUNCTIONAL THERAPY LUCA LEVRINI (1) UNIVERSIT DEGLI STUDI DELLINSUBRIA (1)
Abstract : Orthodontic treatments currently have high potential in the treatment of patients affected by a deficit of growth of the jaws, both superior and inferior. The treatment could be applied not only to correct the anatomical anomaly, but it can also become an essential element in solving the related functional problem, such as breathing, swallowing and atypical sleeping apnea, pathologies which are often inter-related. In such a context, undertaking an integrated therapeutic approach between orthodontist and logopedist is an essential measure. The orthodontic treatment alone cannot guarantee a completely successful result unless it is associated with a parallel and concurrent oral/facial gymnastics or neuromuscular re-education, designed to re-educate the altered basic functions such as breathing and atypical swallowing. In particular, in the first phase, nasal washes and increased tone of masticatory musculature. The volumetric changes induced in the upper airways by rapid maxillary expander in growing patients and by the mandibular engines in adult patients will be illustrated. Such results will be proved and displayed with fluid dynamic, real and virtual endoscopy. In conclusion, the clinical conditions of occlusion requiring expansion of the maxillary or mandibular propulsion will be identified and described in a simple manner. Learning Outcomes: Showcase and discuss the respiratory advantages of orthopedic treatment in children and adults; identify and describe the conditions of occlusion that require orthopedic jaw treatment; propose a strategy of exercises and neuromuscular re-education for patients with respiratory defects
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A SYSTEMATIC REVIEW OF THE OUTCOMES OF CHILDREN WITH HEARING LOSS WHO USE LANGUAGES OTHER THAN ENGLISH KATHRYN CROWE (1) - SHARYNNE MCLEOD (1) CHARLES STURT UNIVERSITY, UNIVERSITY, BATHURST, AUSTRALIA (1)
Abstract:The purpose of this paper is to provide a systematic review of 117 studies examining the spoken language, speech intelligibility, speech production, and lexical tone outcomes of children with hearing loss who use spoken languages other than English. A search was conducted for studies published in English between 2000 and 2011 describing the speech and language skills of children with hearing loss. One hundred and seventeen and 117 studies were identified which met the inclusion criteria. These Of these studies, 109 described monolingual children and eight described multilingual children. Overall described 20 languages were included, with two studies providing a cross-linguistic comparison of children with hearing loss. 109 studies describing monolingual children and eight studies describing multilingual children met the inclusion criteria, andThe studies were examined with reference to the following domains: a) the methodologies used b) the research quality of the publication, c) the childrens outcomes, and d) the factors affecting childrens outcomes. In general, better outcomes were associated with a younger age of diagnosis, younger age of amplification, and less severe hearing loss in the majority of studies which included these variables. This finding is concordant consistent with many studies of the speech and language outcomes of English-speaking children. The studies examined presented varied findings in regards to the outcomes of oral multilingual children with hearing loss. Cross-linguistic comparison of childrens outcomes between studies conducted in different languages was not possible due to differences across studies in the specific outcomes assessed, assessment and analysis methods, and participant characteristics. Many of the studies reviewed had weaknesses relating to their consideration and reporting, and consideration, of blinding of researchers, participant characteristics, and examiner reliability. Learning Outcomes: The participant will be able to: know the range of factors which may impact differences in speech and language development across languages for children with hearing loss; Understand the need for including detailed description of methodology and participant characteristics in publication of research; Develop an awareness of the need and possibilities of cross-linguistic comparison of the speech and language development of children with hearing loss; Gain an understanding for the need for further research into the development and outcomes of spoken language multilingualism in children with hearing loss.
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SUPPORTING MULTILINGUAL CHILDREN WITH SPEECH SOUND DISORDERS: PEOPLE, PRACTICALITIES, AND POLICY SARAH VERDON (1) - SHARYNNE MCLEOD (1) CHARLES STURT UNIVERSITY, BATHURST, AUSTRALIA (1)
Abstract: In many nations across the world the speech-language pathology profession is faced with the challenging task of preparing an often linguistically homogenous workforce to provide services to increasingly multilingual caseloads. On a daily basis, many speech-language pathologists (SLPs) are required to provide services to children who do not speak the same language(s) as them. Much research has been conducted internationally regarding the many challenges that multilingual children pose in SLP practice throughout the therapeutic process from referral through to discharge. However, little has been published to outline an optimal approach to working effectively with multilingual children to ensure positive outcomes for their future. An international expert panel on multilingual childrens speech was assembled containing 14 experts in multilingual speech and speech acquisition. Members had worked in 15 countries and spoke nine languages. The panel met in Cork, Ireland to discuss aspirations for an optimal approach to working with multilingual children with speech sound disorders. The discussion scaffold arose from a literature review regarding SLPs practices with multilingual children. The 6-hour discussion was audio-recorded, professionally transcribed, checked by the authors, and sent to panel members to ensure agreement and obtain consent for use in further research. Transcripts (127 pages) were analysed using a heuristic framework to deconstruct and re-assemble individual components of the discussion as they apply to the practice of speech-language pathology with multilingual children to identify tensions that occurred both within and between different components. Tensions and collisions between theoretical best practice and the reality of practice arose in three central domains: people, practicalities and policy. In each of these domains there was a continual emphasis placed upon the need to shift from a linear, medicallybased approach to assessment and intervention towards a holistic consideration of children and their functioning and participation in context. The most poignant finding of this research is not the need for uniform practice, as was initially intended, but more importantly to be uniform in the way we think about practice. It is not possible to formulate and implement one gold standard method of assessment and intervention for multilingual children with speech sound disorders because of (a) the vast differences that occur in the form and use of individual languages, (b) the added complexities of multiple language systems developing simultaneously within the one child, and (c) the policies and procedures afforded by individual social and political contexts. It is possible to underpin practice with a framework that ensures comprehensive assessment, accurate diagnosis, and effective intervention. This framework is built around the World Health Organizations International Classification of Functioning, Disability and Health: Children and Youth version (ICF-CY). In addition, it is essential that SLPs attain a level of cultural competence to ensure that optimal services can be provided to all children regardless of the context in which they live and the languages they speak. The purpose of this presentation is to share the aspirations of the panel for improving cultural
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THE TABLET: APPS ALL THE WAY THROUGH THERAPY THE COST EFFECTIVE WAY PERMELIA MCCAIN (1) SUNNY DAYS INCORPORATED, PITTSTOWN, UNITED STATES (1)
Abstract: Aim. The aim of the present study was to document voice in a large group of transsexual men post sex reassignment surgery (SRS). In addition, factors influencing the fundamental frequency (F0) were explored. Methods. The final subject group consisted of 38 transsexual men, who participated in a larger study investigating their postoperative health. Fasting morning blood samples were collected, and dermatologic, urological, voice, bone, and body composition evaluations were executed. The participants were on average 8.7 years after SRS and started testosterone substitution therapy at least 2 years before SRS. A control group was matched to the subject group for age and smoking behaviour and comprised 38 heterosexual biological males. Voice assessment consisted of the recording of three speech tasks, i.e. sustained vowel phonation, counting from 1 to 10, and reading a standardized text. Subsequently, speech samples were acoustically analysed for measures of pitch, intonation, and perturbation. Results. The average median F0 of the transsexual men amounted to 104, 109, and 114 Hz in sustained vowel phonation, counting, and reading, respectively. There were no significant differences between the transsexual and heterosexual biological men for any of the acoustic variables tested. Two factors correlated significantly with the median F0 of the transsexual men in reading: haematocrit level and average length of CAG repeats in the X-chromosomal androgen receptor gene, which is indicative for androgen sensitivity. Specifically, higher haematocrit levels and longer CAG repeats were associated with a lower median F0 in reading. Conclusion. In general, the administration of androgens in transsexual men appears to result in a male voice that cannot be acoustically distinguished from the voice of
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competence within the SLP profession and providing quality services to multilingual children with speech sound disorders. Learning Outcomes: The participant will be able to understand the complexities of multilingual practice and the challenges faced by SLPs when working with multilingual children with speech sound disorders. Apply the concepts of the ICF-CY to SLP practice with multilingual children to ensure an holistic approach to assessment, diagnosis and intervention. Understand the importance of cultural competency when working with children from culturally and linguistically diverse backgrounds.
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A TUTORIAL ON ARIWAY PROTECTION DEFICITS FOR THE DYSPHAGIA SPECIALIST KAREN HEGLAND (1) - MICHELLE TROCHE (1) UNIVERSITY OF FLORIDA, DEPARTMENT OF SPEECH LANGUAGE AND HEARING SCIENCES, GAINESVILLE, UNITED STATES (1)
Abstract: Clinicians specializing in the area of dysphagia play an important role in the evaluation and treatment of airway protection deficits. While practitioners are already evaluating and treating swallowing deficits, cough deficits often co-occur with dysphagia. This course is designed to provide an overview of cough function and dysfunction, its evaluation and treatment. Cough includes a highly coordinated sequence of muscle contractions involving the pharynx, larynx, and lower airway. The goal of a cough is to eject material from the airway, including aspirate material and endogenously produced material. Cough is measured most commonly by evaluation of the rate of airflow during the three phases of cough, including the inspiratory phase, compression phase, and expiratory phase. Cough may be produced either voluntarily or reflexively. Normal cough function is termed eutussic. Disordered cough is termed dystussic. With regard to airway protective function, disordered cough can be atussic indicating a lack of reflex cough response, as is the case for silent aspiration. As well, cough may be hypotussic, meaning the cough function is present but diminished with regard to response to material in the airway. Hypotussic cough disorder may involve sensory or motor pathways. There is a wide range of tools clinicians use to evaluate cough function. The first tool most clinicians employ is the ear to identify whether there is a voluntary cough response, and if so whether it is weak or strong. As well, whether the patient coughs during or after swallowing trials is noted during both clinical evaluation and during evaluation using imaging techniques, such as fluoroscopy. Other tools that specifically measure cough airflow include peak flow meters and spirometers. In the laboratory, we use a digital spirometer coupled to a respiratory flow head in order to obtain respiratory and cough airflow data, recorded to a desktop computer. Various equipment configurations allows for evaluation of both reflex and voluntary cough. Multiple studies have shown that weakness or absence of a voluntary or reflex cough response is related to the presence of dysphagia and aspiration. Specifically, compression phase duration, peak expiratory flow rate, and cough volume acceleration are sensitive and specific predictors of swallowing dysfunction in patient populations. Disorders of cough and swallow often occur simultaneously, potentially resulting in undercompensated or uncompensated airway compromise and increasing the likelihood of related pulmonary sequelae. Treatment for cough disorders is in the beginning stages of development and application. The need for pharmacological treatment aimed at improved cough, primarily by re-sensitizing the reflex, is necessary and there is some preliminary evidence that capsaicin taken orally may improve the cough sensory response. Behaviorally, expiratory muscle strength training improves cough function in terms of expiratory airflows and subsequent ability to effectively clear material from the lower airway. Learning outcomes: The participant will be able to: 1) provide an overview of normal cough, 2) discuss the relationship between disordered cough and swallowing, and 3) discuss assessment and treatment options currently available to clinicians in the management of dystussia.
responses) evoked by click stimuli and ASSRs (auditory steady state responses) at 250 or 500 Hz appears to be most convenient. Regarding the low frequency range, ABRs evoked by chirps rather than those evoked by masked tone bursts (notch noise) are a reasonable alternative to the ASSRs. With regard to the optimization of response detection at low stimulus levels, the necessity to consider and reduce the residual noise has been demonstrated convincingly by many recent investigations [e.g. 1]. Another important aspect is the automatic detection of responses, which contributes to yielding user-independent results. The efforts towards a better quality standard are documented in the recommendations of a national German expert group which have been published recently [2]. Further progress will possibly originate from a new approach considered in the 2nd topic. Conventionally, the accuracy of a method is derived from the comparison of objective thresholds with behavioral thresholds. This procedure has the disadvantage that both measures, the value under test as well as the reference, are susceptible to errors which can be considerable. A quality judgment which does not involve other methods would be more specific for the method under test. A promising tool to attain this goal is the use of step functions which describe the discrimination of responses around the detection threshold. Since all responses are dichotomous in nature in the sense that they can only be absent (0) or present (1), the behavior of a specific method can be modeled by a Boltzmann function whose transition from 0 to 1 defines the response threshold [3]. The slope at the point of inflection is derived from a fit to the data gained in a population of 12 normal hearing persons who were examined with ABRs evoked by click stimuli, cortical responses evoked by tone bursts at 1000 Hz and ASSRs at 500 Hz. The slope at 50% response probability lies between 6.5% per dB (ASSR) and 28.3% per dB (click ABR). This slope seems to be useful as a single parameter criterion which has the potential to a universal comparison of methods independent of the factors which obscure the determination of behavioral thresholds.
FP111
BRAZILIAN PARENTS PERCEPTION ABOUT COMMUNICATION DISORDENS IN CHILDHOOD GABRIELA WOLFF (1) - BRBARA GOULART (1) UNIVERSIDADE FEDERAL DO RIO GRANDE DO SUL, PORTO ALEGRE, BRAZIL (1)
Abstract: Objective: To know the perception of brazilian parents about the occurrence and factors associated with speech-language and hearing disorders in early childhood. Methods: From interviews using a structured questionnaire, 75 parents of preschool children in southern Brazil were interviewed. The following variables were studied: gender, age, number of children and knowledge of the phonological disorders, such as age for language changes, results of hearing problems, behavior problems before speech therapy, what the deleterious habits can cause in children and knowledge about the speech therapy. Results: In case of suspicion of speech-language disorder, 46 (61.3%) of parents seek evaluation by speechlanguage therapist and 37 (49.3%) by pediatricians. As higher the education level of parents, more they tend to consider the age group between 4-5 years old as the final age to the phonological acquisition and overcoming of speech disorders related to language development (p = 0.005). The relevancy between parents knowledge about babys bottle and pacifier with their schooling was not statistically significant (p = 0.549). Conclusion: The parents knowledge has converged with the recommendations in the present regarding the occurrence and comorbidities associated with hearing difficulties and acquisition and language development in early childhood.
FP112
PARENTS PERCEPTION ABOUT COMMUNICATION DISORDERS IN CHILDHOOD GABRIELA STABEL WOLFF (1) - CARLOS PODALIRIO BORGES DE ALMEIDA (2) - BRBARA NIEGIA GARCIA DE GOULART (2) APAE, ASSOCIATION OF PARENTS AND FRIENDS OF EXCEPTIONAL, SO LEOPOLDO, BRAZIL (1) - UFRGS, FEDERAL UNIVERSITY OF RIO GRANDE DO SUL, PORTO ALEGRE, BRAZIL (2)
Abstract: The main objective of this work is know parents perception about the occurrence and the factors associated to speech-language and hearing disorders in early childhood. Through interviews using a structured questionnaire, 75 preschoolers parents in southern Brazil were interviewed. The following variables were studied: gender, age, number of children and knowledge of the phonological disorders, such as age for language changes, results of hearing problems, behavior problems before speech therapy, what the deleterious habits can cause in children and knowledge about the speech therapy. In case of suspicion of speech-language disorder, 46 (61.3%) of parents would seek for a speech-language therapist evaluation and 37 (49.3%) for a pediatricians. As higher the parents education level, more they tend to consider the age group between 4-5 years old as the final age to phonological acquisition and overcoming of speech disorders related to language development (p = 0.005). The relevancy between parents knowledge about babys bottle and pacifier and their schooling was not statistically significant (p = 0.549). The parents knowledge has converged with the recommendations in the present regarding the occurrence and
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OBJECTIVE HEARING ASSESSMENT IN EARLY CHILDHOOD: ADVANCES AND RECENT CONVENTIONS SEBASTIAN HOTH (1) UNIVERSITTSKLINIKUM, HNO-KLINIK, HEIDELBERG, GERMANY (1)
Abstract: The early detection of infant hearing loss is one of the utmost challenges of current audiological research and application. The situation is characterized by an increasing need of examinations and the broad spectrum of methods which are suitable to objectify the type and amount of hearing loss. Since some of the methods cover a similar range of demands and claims, some confusion arose among clinicians and professionals. Orientation could be restored by (1st) defining accurately the needs and (2nd) comparing thoroughly the methods with respect to their reliability and accuracy. Within the frame of follow-up to newborn screening, the attitude related to the requirements mutated from very ambitious to a primarily pragmatic point of view: It is better to have two reliable threshold values than four less accurate estimates. Among the methods covering the frequency range from 250 to 4000 Hz, the combination of ABRs (auditory brainstem
comorbidities associated with hearing difficulties and language development and acquisition in early childhood. Learning outcomes: The Participant will be able to: 1. Know parents perception about phonoaudiological problems in the early childhood; 2. Know the factors associated of phonoaudiological problems in the early childhood in parents perception; 3. Know the relation between the parents knowledge level, their education and how they see the phonoaudiological disorders measurable symptoms; 4. understand proportional relation between the parents knowledge level, their education and speech therapist to be consulted in case of speech delay suspect and consequently the professional intervention when the child is in the first childhood.
FP114
EVALUATION AND COMPARISON OF SYNTACTIC SPECIFICATION IN 1.5-2.5 YEARS OLD NORMAL PERSIAN CHILDREN IN TEHRAN CITY MARYAM GHELMANI POUR (1) - TAHERE SIMA SHIRAZI (1) MASOUD KARIMLU (1) - REZA NILI POUR (1) - HOSSEIN KARIMI (1) ABA REHABILITATION RESEARCH CENTER, WELFARE AND RHABILITATION UNIVERSITY, TEHRAN, IRAN (1)
Abstract: Evaluation and comparison of syntactic specification in 1.5-2.5 years old normal Persian children in Tehran city. Objective: The research is about some syntactic specification normal Persian children 1.5 2.5 years old. Methods: this research is across-sectional and descriptive-analytic study, that has done in 97 children. Kindergartens were selected randomly, and then 1.5-2.5 years old children that had necessary critics were included in the study. For each child 100 sentences were recorded. These sentences selected from subjects spontaneous utterance. Variables are: sentence type, sentence function and MLU . Variables were analyzed in 4 age groups (1821 ,21-24 ,24-27, and 27-30 months). Findings: MLU from 1.6 months in firs group changes to 2.7 months in fourth, sentence in first group includes verb subject, objective and involve predicates, copula, verb part, adverb and in forth group. In first group we have one and two sentence; 2 and 3 words sentences have been seen in 2th and 3th groups. One word were added to sentence in forth. Development at imperative sentence and major sentence was significant; but after 21- 24 months age we can not see any significant development at minor sentence. Question sentences, between first and fourth age groups, was significantly. Development for command sentences and MLU is significant. Exclude in 2th and 3th age groups. Conclusions: results shows significant development in major and imperative sentences; other variables show less development that this ones. Exclamatory sentence didnt see. We can not be that using word or any structure by child means that that the structure has learned by whom. We should examined any morphosyntactic unite by special tasks.
FP113
PARENTAL PERSPECTIVES ON A BRIEF PARENT-CHILD SHARED-READING PROGRAM FOR TYPICALLY DEVELOPING CULTURALLY AND LINGUISTICALLY DIVERSE PRESCHOOLERS KARLA WASHINGTON (1) - DILLON DAVIS (1) - RACHEL GREENE (1) UNIVERSITY OF CINCINNATI, CINCINNATI, UNITED STATES (1)
Abstract: Background: Regardless of the language spoken, the home environment is the most influential place for facilitating emergent literacy skills. Thus, parents reading to their children has been promoted as the way to facilitate literacy development. However, a recent review has shown that parentchild shared-reading experiences alone are insufficient in fostering emergent literacy development. The inclusion of explicit instructions to children about print during shared-reading activities has proven benefits to future literacy attainment. As a group, speech-language pathologists (SLPs) can successfully facilitate literacy development in preschoolers who may be typically developing, but are at-risk for failure in developing these skills in English (e.g., English language learners [ELLs], living in poverty). SLPs can train parents during an intervention program on how to engage in print referencing techniques to explicitly teach their children about print during shared-reading activities at home. Parents may find this program enjoyable and may even change the way that they read with their children. To date, however, there is a dearth of information about parental perspectives on different aspects of parent shared-reading programs. Consideration of parental perspectives could provide useful insights that guide best practices in speech-language pathology for parent-based emergent literacy interventions for at-risk preschoolers. Learning Outcomes: Participants will learn about how to include parents in the assessment and intervention process for emergent literacy in at risk preschoolers. Participants will gain an understanding of parents perspectives on program enjoyment and maintenance during a shared-reading program. Participants will gain an understanding of direct instruction strategies designed to enhance parent-child reading practices for emergent literacy development. Participants will learn that including parents in the assessment and intervention process can inform practice, thus supporting the engagement of best practice in speech-language pathology.
FP115
LANGUAGE DEVELOPMENT IN GREEK TYPICAL DEVELOPED CHILDREN IOANNIS VOGINDROUKAS (1) - EVRIPIDES CHELAS (2) KONSTANTINOS PAPARIZOS (3) - ELENI KIVRAKIDOU (4) MEDICO PEADAGOGICAL CENTER, PSYCHIATRIC HOSPITAL OF THESSALONIKI, THESSALONIKI, GREECE (1) PRIVATE PRACTICE, IOANNINA, GUADELOUPE (2) PRIVATE PRACTICE, KASTORIA, GREECE (3) PRIVATE PRACTICE, THESSALONIKI, GREECE (4)
Abstract: Child language development is one of the most crucial fields of human communication sciences. Despite the big amount of tests currently used from professionals around the world the Greek language is one of the least researched languages specifics in the field of human communication. The Test of Receptive and Expressive Language Abilities (TRELA) (Vogindroukas, Grigoriadou 2009) is one of the attempts of creating a test for evaluating the language and communication difficulties. Aim of this study is to determine how developed is the language in terms of personal pronouns (subjective and objective forms) and possessive pronouns as well as in pragmatic abilities in the preschool age. Our findings indicate that children score better in subjective cases of personal pronouns than in objective forms. Regarding pragmatic abilities children present difficulties in specific social situations. Learning Outcomes: The primary objective of this study was to examine the development and usage of pronouns as well as pragmatic abilities in Greek preschoolers. Results indicate the difficulty of mastering in the objective case of personal pronouns and the pragmatic abilities in the preschool age. Rates of the study are very useful for all the specialists and teachers dealing with the Greek language, as they can know what to expect from children of that age.
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PRE AND POST SURGERY PHONIATRIC EVALUATION IN PATIENTS TRANSGENDER MALE-TO-FEMALE CANDIDATES FOR TYPE IV THYROPLASTY (CRICOTHYROID APPROXIMATION) DIEGO COSSU (1) SANTA CROCE HOSPITAL, MONCALIERI, ITALY (1)
Abstract: Phoniatric evaluation starts with the correct information to the patient, stressing that the phonosurgery can act on only one of the factors that generate the voice, that is the vocal cord. Laryngostroboscopy evaluates the general morphology of the larynx as a whole (using Xion Matrix duo HD). Then we shall examine the functional patterns through analysis of the acoustic spectrum according to the modified protocol of Yang (using CSL 4500 and VRP) and manual test of preoperative approximation. It is administered the self-assessment test of the voice. After the thyroplasty a period of vocal rest of at least one week is required, after which a new evaluation is made with laryngostroboscopy and functional tests with particular attention to the variations of the indices of perturbation and the vocal range. The selfassessment test of the voice is administered again. Learning Outcomes: Proper approach to the patient MtF; proper laryngostroboscopic techniques; proper phonosurgical techniques; correct use of pre-and postoperative voice analysis; analysis and treatment of potential complications.
FP116
WHATS IN AN EARLY WORD? CHARACTERISTICS AND DEVELOPMENT OF WORD PRODUCTION IN YOUNG MALTESE CHILDREN DANIELA GATT (1) - HELEN GRECH (1) - BARBARA DODD (2) UNIVERSITY OF MALTA, MSIDA, MALTA (1) CITY UNIVERSITY, LONDON, UNITED KINGDOM (2)
Abstract: In childrens emergent language use, true words having adult form and content may be accompanied by other vocal productions. Young children may produce non-word vocalisations that sound word-like but do not appear meaningful. Also possible are utterances that convey a consistent meaning but do not coincide with the content and/or form of adult words. The latter are referred to as pre-words in the present text, since they act as precursors to true words. The different types of vocalisations present in young childrens output make the identification of early words far from straightforward. The reported investigation attempted to lay out criteria for differentiating non-words, pre-words and true words in spontaneous samples
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of typically-developing Maltese childrens language use. Both true words and pre-words were regarded as lexical items because of their consistency in meaning. Once identification standards were set up, non-word and pre-word measures were derived from the sample data and the respective developmental trajectories analysed. First, the extent to which non-words featured in the spontaneous utterances produced by two longitudinal cohorts was investigated. One longitudinal group (N = 9) was followed between the ages of 12 and 24 months. Data from the other longitudinal cohort (N = 7) were gathered between 18 and 30 months. Childrens spontaneous use of pre-words was then examined as a function of vocabulary size. The sampled vocabularies of 60 children aged between 12 and 30 months were analysed for this purpose. Results showed non-word mean scores to exceed the total number of true words and pre-words only at 12 months. By 30 months, word vocalisations were found to be in absolute majority. Minimal numbers of pre-words relative to true words were revealed. Findings demonstrated that objective criteria for word identification are needed to pull apart non-words and words in childrens early vocalisations. Further, the scarcity of pre-words implied that a single category of lexical items that incorporated pre-words alongside true words was adequate for analysing the participants productive vocabulary skills. Learning Outcomes: The participant will: become familiar with word identification criteria that should facilitate the analysis of language samples obtained from young children in research and clinical settings appreciate the developmental profiles shown by non-words and pre-words in the utterances produced by typically-developing children exposed primarily to Maltese appreciate the relevance of results as preliminary reference measures against which to the expressive abilities of young children with potential languagelearning difficulties may be compared understand how the study outcomes compare to results obtained from similar studies in other languages, enhancing their awareness of the mechanisms that regulate language development.
FP118
LEXICAL LEARNING AND PHONOLOGICAL PROCESSING IN TAIWANESE YOUNG CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT. PAO-HSIANG CHI (1) DEPARTMENT OF SPECIAL EDUCATION, NATIONAL TAIPEI UNIVERSITY OF EDUCATION, TAIPEI, TAIWAN, PROVINCE OF CHINA (1)
Abstract: The aim of the study is to: a) examine the novel word learning in Mandarin Chinese-speaking children with specific language impairment (SLI) in Taiwan; b) analyze the relationship between novel word learning and phonological processing abilities. Twenty one children (4;25;0) with SLI and 21 children with typical language development (TL) participated in this study. All the participants were asked to learn novel words in a series of experimental condition. In addition, these children were administered one phonological processing test. Overall, the current study indicate that Taiwanese young children with SLI evidenced more difficulties in learning novel words as compared to their counterparts. Moreover, it was also found that phonological processing were significantly related to SLI childrens word learning. Learning outcomes: The participants will be able to : know the phonological processing test designed in Mandarin Chinese; understand the word learning abilities in children with SLI from a cross linguistic perspective; know the effect of phonological processing on word learning in children with SLI.
FP119
LEXICAL RETRIEVAL DEFICITS IN MULTILINGUAL SPECIFIC LANGUAGE IMPAIRMENT MARIA KAMBANAROS (1) CYPRUS ACQUISITION TEAM, UNIVERSITY OF CYPRUS, NICOSIA, CYPRUS (1)
Abstract: This case study reports on lexical retrieval deficits in a neurologically intact multilingual child (I.S.) with specific language impairment (SLI). Multilingual SLI is of exceptional clinical and theoretical interest because one can test whether the findings are an artefact of (a) specific language(s) or have a wider application, namely, apply to all languages. The research questions are: Is the lexical retrieval deficit evident in all languages? Is the extent of the deficit similar or different cross-linguistically? Are error types consistent across languages? What is the underlying locus of lexical retrieval deficits in multilingual SLI? What can the level(s) of breakdown tell us about language representation in the multilingual brain? I.S. was an 8;6-year-old female born and raised in the Republic of Cyprus. She was exposed to both Cypriot Greek (fathers language) and Bulgarian (mothers language) from birth. From early school age at 4;6, she has attended an English-speaking private school where she was also instructed in Standard Modern Greek on a weekly basis (5 hours/week) from first grade. Her general IQ score (WISCIII) was 84, placing her in the low average range, but her non-verbal IQ was 102. Lexical retrieval was compared on confrontation (picture) naming and connected speech. For the latter, a narrative retell task was analysed for the total number of sentences (t-units) produced and mean length of utterance (MLU). See Table 1 for results for Greek, English and Bulgarian. Overall, severe lexical retrieval deficits are evident in all three languages across tasks. Furthermore, effects of language(s) and task(s) did surface. For example, I.S. appeared to (i) retrieve more ords in Bulgarian, (ii) produce more sentences in Greek, and (iii) have the highest MLU for English. The findings will be discussed in relation to linguistically and processing based accounts. Learning outcomes: To become aware of how lexical retrieval deficits manifest in a multilingual child with SLI. ; to understand the potential loci of lexical retrieval deficits in SLI; to become familiar with cross-linguistic tools used to assess lexical retrieval deficits in SLI.
FP117
GRAMMATICALITY AND COMPLEXITY IN THE USE OF SENTENCES IN CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT MARIANGELA MAGGIOLO (1) - CARMEN JULIA COLOMA (1) MARA MERCEDES PAVEZ (1) - CLAUDIA ARAYA (1) CHRISTIN PEALOZA (1) ESCUELA DE FONOAUDIOLOGA, UNIVERSITY OF CHILE, SANTIAGO, CHILE (1)
Abstract: This research discusses the grammatical performance of children with Specific Language Impairment (SLI). The purpose of the study is to characterize and compare the use of sentences in terms of complexity and grammaticality in a group of preschool and school children with SLI. 47 children divided into four groups participated: 10 preschoolers with SLI (4.0 to 5.11 years), 13 school children with SLI (6.0 to 7.11 years), 13 preschoolers with typical language development (TLD) (4,0 - 5.11 years) and 11 school children with typical language development (6.0 to 7.11 years) matched by chronological age with children with SLI. Children narratives, obtained from recounted, were analyzed to identify simple, complex, grammatical and ungrammatical sentences. The results show that preschool children with SLI differ significantly from school children with SLI in the proportion of the total of a) simple sentences (preschoolers 84.3% vs. school children 71.6%), b) complex (preschoolers 15.6% vs. school children 28.3%) and simple ungrammatical (37.4% vs. 25.8%). In relation to the grammatical complexity in children with SLI, they present a smaller proportion of complex sentences (preschool children 15.6%, school children 28.3%) than children with TLD (preschoolers 33.9%, school children 37.8%). Regarding grammaticality, both preschoolers with SLI (41.6%) and school children (35.6%) have a higher percentage of ungrammatical sentences than children with TLD (preschoolers 28.3% and school children 14.7%). The results suggest that school children with sli increase their grammatical development because the proportion of complex sentences expands and the percentages of simple and ungrammatical simple sentences decrease. the comparison with children with tld could demonstrate a different pattern in terms of the complexity and ungrammaticality of their sentences, because children with sli produce less complex and more ungrammatical sentences. Learning Outcomes: The participants will be able to 1. Know some evidence that children with SLI present different characteristics from children with typical language development in terms of complexity of the sentences they produce. 2. Know that children with SLI make more mistakes in expression than children with typical language development as they show more ungrammaticality in their sentences. 3. Know preschool children with SLI produce less complex sentences than school children with sli, suggesting an increase in their grammatical development, despite the nuclear deficit at this level.
FP120
SELECTION OF METHODS IN VOICE THERAPY BIRTE MEIER (1) - TINA OPPERMANN (1) - IRIS BURG (1) VERENA ROGG (1) - KATHARINA NOLTE (1) - ULLA BEUSHAUSEN (1) DEPARTMENT OF SPEECVH AND LANGUAGE THERAPY, HAWK HOCHSCHULE HILDESHEIN/HOLZMINDEN/GTTINGEN, HILDESHEIM, GERMANY (1)
Abstract: In an online survey with about 430 voice therapists in Germany, Austria and Switzerland the therapists were asked about the methods used to carry out voice therapy. The results show that a highly significant majority of therapists do not apply one specific method, but work in a unique combination of methods with individual clients. Furthermore the majority of therapists stated that mental stress of the can be seen as a cause of functional voice disorders. In these cases counseling is a part of their voice therapy, but not the direct (psychotherapeutic) intervention. Over half of the respondents also stated that the limit of 20 sessions per treatment case, as predefined by the German Regulations Governing the Prescription of Remedies, were not sufficient. They also stressed a need for improved interdisciplinary cooperation with referring physicians.
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Learning outcomes: The topic has not been under research before. The participants will be able to know the controversies about an orientation in respect of methods versus of functional principles in the therapy of voice disorders and the framework requirements of a successful voice therapy.
FP123
INCIDENCE OF DYSPHAGIA AND VOCAL CORD PALSY IN CHIARI MALFORMATION WITH OR WITHOUT SYRINGOMYELIA ANDREA CANALE (1) - PALMA CIARAMITARO (2) FEDERICO DAGNA (1) - GIULIANO FACCANI (2) - ROBERTO ALBERA (1) ENT - AUDIOLOGY AND PHONIATRY, CITT DELLA SALUTE E DELLA SCIENZA, TORINO, ITALY (1) DEPARTMENT OF NEUROPHYSIOLOGY, CITT DELLA SALUTE E DELLA SCIENZA, TORINO, ITALY (2)
Abstract: Chiari Malformation (CM) is a congenital anomaly of the posterior cranial fossa associated to defects of the neural tube. Its association with syringomyelia ranges from 32% to 74%. Syringomyelia is a chronic neurological disease morphologically defined at Magnetic Resonance Imaging as the presence of single or multiple fluid-filled cavities within the spinal cord and/or the bulb (syringobulbia). Clinical presentation in CM varies from asymptomatic incidental abnormality discovered by imaging for other indications to symptoms arising from increased intracranial pressure, brainstem compression, cerebellar dysfunction, or concomitant spinal cord syrinx. Dysphagia and dysphonia are considered unusual in CM1 patients and their incidence according to the literature is 2,5-6% and 7% respectively. Neuroimaging findings for Chiari I malformation have typically revealed descent of the cerebellar tonsils by 5 mm beyond the foramen magnum into the spinal canal. However no correlations have been pointed out between the extent of tonsils herniation and the presence and severity of symptoms. AIM: 1) to evaluate the incidence of dysphagia/dysphonia in a series of patients with CM1 with and without syringomielia; 2) to verify the possibility that dysphagia/dysphonia can be markers of severity in Chiari syndrome. METHODS: the study group was made up of 66 patients with CM consecutively evaluated at CRESSC in 2012. Of the overall sample 25 patients (6 males, 19 females; age 30-64 years, average age 53 yrs 13.7), who reported dysphagia/dysphonia during neurological assessment, underwent phoniatric evaluation. Phoniatric consultation consisted in the evaluation of the praxic abilities and fiberoptic endoscopic evaluation of swallowing; the severity of dysphagia was classified with the ONeils scale and attention was focused on motility deficits of the larynx. RESULTS: in our series the incidence of either dysphagia or dysphonia was 11% and 7.6% respectively. Of the 25 patients submitted to phoniatric evaluation just 10 (40%) had clinical signs of dysfunction; in particular 7 patients (28%) had moderate dysphagia (ONeil 4 -5) and 5 (20%) showed vocal cord palsy; both signs coexisted in 2 patients (8%). These patients had both clinical and neuroradiological diagnosis of CM 1 with (60%) or without (40%) associated syringomyelia; 2 (8%) of them presented also syringobulbia. 7 out of 10 underwent surgical treatment. Of the 15 patients without clinical signs of dysphagia/dysphonia 53% had isolated CM 1 and 47% had associated syringomyelia. None of them had syringobulbia 5 of them were surgically treated. The differences between groups were not statistically significant at Fisher test (p=0,81). DISCUSSION: As regards dysphonia the incidence rate in our sample (7,6%) was consistent with the sole literature report on topic; on the contrary the incidence of dysphagia was higher (11%) than expected. Although not supported by statistical evidence, the association of syringomyelia appeared higher in patients with clinical signs of dysphagia and or dysphonia. Moreover syrngobulbia seems to be a negative prognostic factor as it was exclusive of those 2 patients with both symptoms. This tendency will need further studies with larger sample to be confirmed and get statistical validation. Learning outcomes: incidence of syringomyelia/bulbia in association with Chiari Malformation type 1 incidence of dysphagia/dysphonia in Chiari Malformation with and without syringomyelia pathophysiology of dysphagia and dysphonia in Chiari Malformation.
FP121
COST-EFFECTIVENESS AND VOICE ANALYSIS IN LOGOPEDIC PRACTICE: EXPERIENCE WITH PRAAT MARTA COMPAGNUCCI (1) - ROBERTA MAZZOCCHI (2) SANTI CENTORRINO (1) UNIVERSIT DEGLI STUDI DI SIENA, FACOLT DI MEDICINA E CHIRURGIA, CDL IN LOGOPEDIA, SIENA, ITALY (1) SERVIZIO DI FONIATRIA E LOGOPEDIA, OSPEDALE DI SPOLETO, SPOLETO, ITALY (2)
Abstract: Evidence based medicine (EBM) has become a paradigm of modern medicine, according to which the health system and private medical practices are formed. Indeed every clinical reasoning must be validated by incontrovertible evidence, widely shared and easily applicable, because of an increasing need for restraining and justify health care expenditure. Despite this, the diagnostics and the clinical assessment of the presence and entity of dysphonia are still based on methodologies which use essentially subjective-perceptive criteria. These techniques, although valid and not substitutable, require trained expert doctors and do not have a certain objectivity and uniqueness. Therefore, it has been increasingly confirmed the idea that these procedures should be always accompanied by a quantitative and objective determination of dysphonia, that nowadays can be obtained through electroacoustic and multiparametric analysis of vocal signal. The digital instruments internationally more diffused have an extremely high cost, and they are not easy to be found in sanitary structures. For this reason, in order to attempt a good cost-benefit analysis, it is now more desirable the use of low-cost and more easily accessible software. The purpose of this study was to bring a normative contribute in the field of low-cost vocal analysis, by examining the possibilities, the reliability and the limits of the Praat software in voice evaluation. We have experimented a protocol for objective voice evaluation; proposed a reference normative for 13 vocal parameters of Praat software; proved the softwares validity at quantifying the results of the logopedic treatment; measured a possible correlation between the variation of a vocal parameter and a specific type of dysphonia. The investigation has been carried out on the voices of 19 euphonic subjects and 278 dysphonic patients affected by various laryngeal pathology. For each subject, 3 samples of sustained vowel /a/ at a comfortable pitch, constant amplitude, and flat tone were obtained, for a minimum of 5 seconds, with a 22050 Hz sampling rate and a specific Pitch Range for male and female voices. We have found: statistically relevant differences between healthy and pathological voices; the values for the thresholds between normal and pathological voices for each parameter (+1DS); four vocal parameters most ndicative of pathology: Jitter Local, Shimmer dB, Mean H/N e Fraction of Locally Unvoiced Frames; statistically elevant differences between pre- and post-therapy values; vocal analysis is highly influenced by the etiology of dysphonia. Praat allows us to have a free method of objective evaluation of voice, to be used for the discrimination between pathological and nonpathological voices and for the quantization of the entity of dysphonia. This software is a valid help to objectively monitor the trend and the effects of rehabilitative treatments, and we can also hypothesize a future use of Praat as an instrument of discrimination among different types of voice disease.
FP122
THE EFFECTIVENESS OF THE INTEGRATIVE VOICE THERAPIE REGARDING THE OBJECTIVES OF INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH, ICF EVEMARIE HAUPT (1) - JULIA HLSCHEIDT (2) PRIVATE PRAXIS, MNCHEN (1) LOGOPEDIC DEPARTMENT, UNIVERSITY, INNSBRUCK, AUSTRIA (2)
Abstract: The ICF, International Classification of Functioning, Disability and Health, provides a unique and standard language to describe functioning and disabilities across range of communication disorders (Ma et alt. 2007). It is also globally standard for the evaluation of voice therapy in the four key components of ICF. This study examines the effectiveness of the Integrative Voice Therapy by Evemarie Haupt regarding the objectives of the ICF. A survey of about 40 randomised patients was conducted by questionnaire. The results show an improvement in all areas required by the ICF. Thus, the analysis indicates a high degree of effectiveness of this holistic method concerning the objectives of the ICF. Learning outcomes: The Participant will be able to: 1.) know the aims of ICF spezialised for voice therapy. 2.) understand the holistic aspects of the Integrative Voice Therapy (IVT). 3.) know by evaluation of about 40 patientsquestionaire the effectiveness of this voice therapy Method IVT concerning ICF components.
FP124
FEEDING AND FEEDING DIFFICULTIES IN TYPICALLY DEVELOPING CHILDREN AGED 18-26 MONTHS PANAGIOTIS PAPADATOS (1) - KONSTANTINOS VANTANAS (1) AGGELIKI KOTSOPOULOS (2) TECHNOLOGICAL EDUCATIONAL INSTITUTE OF PATRAS, PATRAS, GREECE (1) TECHNOLOGICAL EDUCATIONAL INSTITUTE OF PATRAS, MESOLOGGI, GREECE (2)
Abstract:The present research study was conducted in order to find out about the feeding habits and perhaps difficulties that typically developing children in Greece go through at the different milestones of development. The sample numbered 90 children (N=90) with a mean age approximately 26 months and a standard deviation of 5 months. The sample was completely balanced regarding the gender (45 males and 45 females). The gathering of information was performed through a questionnaire (Kotsopoulou et al, 2010) which was completed in an interview with the childrens feeders. The children were aged from 18 to 36 months and were divided into three groups. First group was aged between 18 and 23 months, the second group was aged between 24 and 29 months and finally the last group was aged between 30 to 36 months. The questionnaire contained questions which
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had to do with personal details of the children, their medical history, feeding milestones starting from infancy and continued to present feeding, as well as questions regarding behaviors and habits during mealtime. The results showed that above 80% of the toddlers drank from a glass, used a straw, and ate with a spoon at the age of 18 months, and 90% chewed their food at 12 months. These results agree with those of Arvedson Brodsky, 2002. A large number of the sample (75,6%) continued to drink milk from the bottle at 36 months, while in the study by Dietz Stern (2012) they stopped at 24months. At the age of 30 to 36 months 62% of the sample ate independently. The toddlers preferred solid or semisolid food, and at lukewarm temperature. A large number of the sample at early ages (18 to 23 months) showed repulsion at certain smells or types of food, preference for the use of the same feeding utensils and vomiting. These behaviors are also observed in children in the spectrum of autism but in much higher frequency and at later stages of development. We recommend repetition of the present study with children with developmental disorders e.g autism, cerebral palsy, Down syndrome and mental retardation. Learning outcomes: From this study, researchers and parents will be able to recognize whether children at the age between 18-36 months follow the typical feeding development. They will also be able to define whether some feeding difficulties are typical or are signs of a feeding disorder which needs to be observed.
FP126
RELATIONSHIP BETWEEN QUANTITATIVE WORK AND MUSCULOSKELETAL COMPLAINTS IN OCCUPATIONAL AUDIOLOGISTS BRBARA NIEGIA GOULART (1) - KELY KRUMMENAM (2) FEDERAL UNIVERSITY OF RIO GRANDE DO SUL, FEDERAL UNIVERSITY OF RIO GRANDE DO SUL, PORTO ALEGRE, BRAZIL (1) IPASEM, IPASEM, NOVO HAMBURGO, BRAZIL (2)
Abstract: To know the prevalence and factors associated with musculoskeletal disorders in occupational audiologists. All the 22 occupational audiologists who were working at least one year answered questions about general and occupational data and the Nordic Musculoskeletal Questionnaire (NMQ). We used descriptive statistics to present the results through the distributions of absolute and relative frequencies, arithmetic means and their standard deviation. The variables were tabulated using the chi-square test with significance at p 0.05. The mean age was 29.5 years (SD = 4.9), 86.3% had musculoskeletal complaints in the last 12 months and/or in the last 7 days. The body regions most affected were the neck, shoulders, wrists/hands/fingers, dorsal and lumbar spine. The weekly duration of work was significantly associated with complaints of pain in wrists/hands/fingers (p = 0.007). The presence of pain in the elbow (p = 0.014) and forearm (p = 0.021) correlated significantly with the number of hearing tests daily, and the number of periodic audiometry was significantly associated with the presence of pain in the elbow (p = 0.026) and lumbar (p = 0.048). Occupational audiologists seem to be exposed to have musculoskeletal disorders probably associated to attitude and repeating movements related to their professional tasks at work. The small sample size and the method of the study doesnt allow to understand the complex relationship of musculoskeletal disorders and occupational audiology work. Learning outcomes: The Participant will be able to: 1. know the prevalence of musculoskeletal disorders in occupational audiologists; 2. Know the factors associated of musculoskeletal disorders in occupational udiologists; 3. Know the characteristic of QNSO tool; 4. understand the relationship of musculoskeletal disorders in the work of occupational audiologist.
FP125
DYSPHAGIA AND SWALLOWING RELATED FACTORS IN ADULTS WITH ACQUIRED ANOXIC BRAIN INJURY: DATA OF 28 PATIENTS ALESSANDRA TURLETTI (1) - DANIELA ALIBERTI (1) FABIA ROMANO (2) - ERIKA CRAVERO (1) - MARZIA BIANCHI (1) LAURA BERGAMASCO (3) - MARIA DILENO (1) MARIA AUSILIA GALOTTI (1) - ANNA MARIA MILETTO (1) A.O. ORDINE MAURIZIANO, HOSPITAL, TURIN, ITALY (1) STUDENT, UNIVERSITY OF TURIN, TURIN, ITALY (2) UNIVERSITY OF TURIN, TURIN, ITALY (3)
Abstract: There is an increasing number of adults who have sustained a non-traumatic brain injury and who are admitted to Intensive Rehabilitation centres (II Consensus Conference, 2006; Cullen N.K., 2011).Even if rehabilitation management of patients affected by anoxic brain injury (AnBI) needs a huge investment of resources, there is a small volume of research about AnBI patients outcome (Cullen N.K., 2011). Moreover there is no publication about swallowing disorders. Our goal was to investigate the dysphagia severity and outcome and record the factors conditioning swallowing recovery in AnBI patients. The study examine a cohort of 28 AnBI patients was admitted to the Rehabilitation Unit at Maurizianos Hospital from January 2005 to January 2012. A follow-up of each patients medical and speech pathology records was conducted at 3, 6 and 12 months following the injury, in order to collect: consciousness /cognitive state (Levels of Cognitive Functioning-LCF Scale Hagen C., 1979), Functional Independence Measure (FIM Score Granger, 1982), respiratory complications, presence of tracheostomy, presence and severity (seriousness) of swallowing disability (Dysphagia Outcome and Severity Scale: DOSS; ONeil K.H., 1999), presence of motor skills impairment, oral pathological reflexes. The development over months and the relationship with DOSS of each of these data were assessed. Then the 28 patients cohort was divided in two subgroups according to DOSS results at 3 months: subgroup 1 (dysphagic): 21 patients with DOSS 5 subgroup 2: 7 patients with DOSS 6 . Over months the change of LCF Scale, FIM score, presence of racheostomy and DOSS, is statistically significant both in the 28 patients cohort and in the dysphagic patients subgroup (DOSS 5 at 3 months). In 28 patients cohort, DOSS results are related to LCF and FIM score. Dysphagia is frequently present in our patients cohort. Actually 75% of AnBI patients has still swallowing alterations at 3 months. The median DOSS value suggests that complete or partial nonoral nutrition is necessary. Recovery from dysphagia occurs mainly during the first 6 months postinjury.Furthermore, the percentage of patients requiring a tracheostomy decreases from 3 to 6 months postinjury and doesnt change anymore. The above data seem to be consistent with researches about the recovery of consciousness by AnBi patients. Swallowing improvement correlates with both the improvement of consciousness/cognitive level and functional ability (FIM) and with reduction of both tracheostomy and pathological oral reflexes. Consequently it is reasonable to assume, also suggested by clinical practice, that cognitive status might influence swallowing. Finally this study intends to contribute to the AnBI patients dysphagia knowledge, which is necessary in decisions about appropriateness, times and ways of speech-language pathologist rehabilitation of these patients. Learning outcomes: Dysphagia is a significant disorder in the anoxic brain injury patients, Recovery from dysphagia occurs mainly during the first 6 months post-injury. It is important that speech-language pathologist evaluation and treatment consider the presence and evolution of deficits more significantly correlated with dysphagia (tracheostomy, autonomy, consciousness/congnitive level, oral pathological reflexes).
FP127
CORRELATION OF ANGIODYNOGRAPHIC FINDINGS OF THE CAROTID AND VERTEBRAL ARTERIES AND HEARING SENSITIVITY IN MIDDLE-AGED AND OLDER ADULTS KO KUEI (1) - HUI-CHI TIEN (1) GRADUATE INSTITUTE OF SPEECH AND HEARING DISORDERS AND SCIENCES, NATIOANL TAIPEI UNIVERSITY OF NURSING AND HEALTH SCIENCES, TAIPEI, TAIWAN, PROVINCE OF CHINA (1)
Abstract: Age-related hearing loss is a multifactorial process and is thought to result from age-related degeneration of the cochlea plus the cumulative effects of extrinsic and intrinsic factors. In particular, recent studies have revealed an intriguing and inconclusive association between cardiovascular risk factors and age-related hearing loss. The primary objective of the present study was to further evaluate the relationship between cardiovascular health and hearing sensitivity in adults over 50 years of age by using Doppler ultrasound techniques and conventional hearing tests. A cross-sectional correlational study was conducted. A total of 90 subjects of both genders (mean age = 62.9 9.5 years) with either symmetrical sensorineural hearing loss or hearing thresholds within normal limits were included in the study. The results of pure-tone audiometry were compared to that of angiodynographic measurements of the carotid and vertebral arteries. In addition, other clinical data, including chronic disease history, blood chemistry, anthropometric measurements, and blood pressure, were collected as supplementary information for cardiovascular risk assessment. As revealed by the multiple regression analyses, after adjustment for age and gender, the time-averaged maximum velocity and end-diastolic velocity of the internal carotid artery and vertebral artery accounted for an additional 5% to 9% of the variance in the three-frequency and four-frequency pure-tone averages. The flow velocity parameters were negatively correlated with hearing sensitivity. Furthermore, the results of the logistic regression analyses showed that the time-averaged maximum velocity and end-diastolic velocity of the vertebral artery were significant predictors of hearing loss independently of age, gender, and hypertension in the subjects. On the other hand, while the presence of carotid plaque and hypertension were significantly related to hearing thresholds at most test frequencies, these two variables were not significant predictors of hearing loss. In addition, the relationship between the intima-media thickness of the common carotid artery and hearing sensitivity was not significant after adjustment for age and gender. The findings of the study suggested that, among the various angiodynographic measurements, the time-averaged maximum velocity and end-diastolic velocity of the vertebral artery are most prominently associated with hearing sensitivity, and the presence of carotid plaque and hypertension may also be related to age-related hearing loss. Therefore, the current study added further evidence for an association between cardiovascular health and age-related hearing loss. These preliminary findings on extracranial arteries need to be verified in future studies with larger sample sizes. Learning Outcomes: To further the understanding of the relationship between cardiovascular health and age-related hearing loss.
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SP3
MANAGEMENT OF SWALLOWING DISORDERS IN THE ELDERLY Smithard D - Clave P - Vandewoude M ANTONIO SchindleR ENRICO Alfonsi
Abstract: By the year 2020 it is estimated that 16.4% of the population will be over the age of 65 and a significant proportion of those elderly will have dysphagia. Dysphagia has be reported in about 5% of the general population aged over 79 years, and in 16% of people over 87 years. The figure increases to up to 60% among institutionalized elderly people with increased risk of related complications (aspiration pneumonia, dehydration, malnutrition). Dysphagia affects >30% of patients with stroke; 6080% of patients with neurodegenerative diseases. Various age-related changes in oropharyngeal swallow function have been observed among older adults. The healthy older swallow is slow. Several findings revealed that age-related change in lingual pressure generation is one of the contributing factors to dysphagia in the elderly. Besides, the initiation of laryngeal and pharyngeal events, including laryngeal vestibule closure, are delayed. It has been speculated that the more voluntary oral events become uncoupled from the more neurally hardwired brainstem pharyngeal response which includes airway protection. Thus, in older healthy adults it is not uncommon for the bolus to be adjacent to an open airway by pooling or pocketing in pharynx increasing the risk of aspiration. Dysphagia causes malnutrition, dehydration, impaired quality of life, lower respiratory tract infections, aspiration pneumonia, and poor prognosis including prolonged hospital stay and enhanced morbidity and mortality in several phenotypes of older patients ranging from independently living older people, hospitalized older patients and nursing home residents. Sarcopenia has been recognized as an important factor leading to dysphagia in the elderly. Sarcopenia is characterized first by a decrease in the size of the muscle, along with a reduction in muscle structural characteristics, as replacement of muscle fibres with fat, an increase in fibrosis, changes in muscle metabolism, oxidative stress, and degeneration of the neuromuscular junction. Combined, these changes lead to progressive loss of muscle function and frailty. Although most of the initial work in this area has been performed in the limb musculature, emerging work in cranial-innervated muscles is quite relevant to swallowing in older individuals. Dysphagia evaluation varies according to the clinical setting. The comprehensive diagnostic approaches available for the hospitalized dysphagic senior, including interdisciplinary dysphagia teams frequently available only in academic or larger hospital systems, may not logistically always be feasible for institutionalized elders. This places the responsibility for screening for swallowing problems on nursing staff who interact with patients on a daily basis. Although several dysphagia screening are available, most of them have been validated for some diseases, such as stroke, or in specific clinical settings, such as acute hospital. Reliability, validity, sensitivity and specificity of dysphagia screening tools should be analyzed for elderly patients in different settings including nursing homes and clinical conditions. Recently, electrophysiological techniques have been suggested to precisely measure kinesiologic and biomechanical aspects of propulsive and pharyngeal phases of swallowing. These techniques, easy and minimally invasive, could also be used during bedside examination. An improvement of swallowing activities by increasing the neural control of this function could be achieved with new electrophysiological techniques: repetitive transcranial magnetic stimulation inducing theta burst (TBS) with high frequency and transcranial direct current stimulation (tDCS). Recent studies indicate that these approaches seem to be useful for improving dysphagia symptoms in pathological conditions such as stroke. The role of TBS and tDCS in the elderly are currently object of investigation. Oropharyngeal dysphagia is potentially life threatening. In the elderly crucial decisions often must be made that influence the patients safety, health and QOL. Among these perplexing issues is the question of continuing oral intake or providing nonoral enteral nutrition. Percutaneous endoscopic gastrostomy (PEG) tubes are placed for a variety of reasons and clinical situations, especially when the patient cannot or will not eat, when the gut is functional, and when the patient can safely tolerate the procedure. However, the decision involves a complex process taking into account the patients wishes as well as the religious and moral convictions of the surrogate decision makers. PEG tubes have been placed in elderly patients and patients with dementia with the intent of treating malnutrition, preventing and healing pressure sores, and improving functional status. The evidence supporting the positive effects of PEG in the elderly is imited; therefore one must tailor the decision to each individual patient.
SY6
MEASURING STUTTERING IN PRESCHOOL-AGE CHILDREN ACROSS DIFFERENT LANGUAGES: AN INTERNATIONAL ON-LINE STUDY HANS-GEORG BOSSHARDT - ANN PACKMAN - JENS KRETSCHMANN JOSEPH AGIUS - VRONIQUE AUMONTBOUCAND - MEHDI BAKHTIAR LUISELLA COCCO - BODIL DAMGAARD - BJARNE DAMMSBO MARIE-CCILE DE LAJUDIE - STEEN FIBIGER - GEORGE FOURLAS CLMENCE MENNECIER - SHARON MILLARD VERONIKA SCHADE
Abstract: With widespread migration and settlement of refugees, there are now many children around the world who do not speak the first language of their country of residence. Hence, many speech-language pathologists (SLPs) are now working in culturally and linguistically diverse communities and having to identify and measure stuttering in a language other than their own. The members of the IALP Fluency Committee have designed a study in which 2-minute speech samples from seven preschool-age children speaking different languages are evaluated for stuttering severity. The languages are Danish, English, French, German, Greek, Italian and Persian (Farsi). The judges are seven groups of speech-language pathologists (SLPs), each group consisting of 15 native speakers of each of these languages. The judges have experience with treatment and/or diagnosis of stuttering in preschoolage children. The study is conducted over the Internet. Judges are given a password to the Internet site, which was developed especially for this study. They access instructions in their own language and also complete a questionnaire about their professional experience with children who stutter. They then watch the seven 2-minute videos, which are presented in random order across judges. In Step 1, they view all videos in succession, in order to familiarize themselves with the children. In Step 2, the videos are re-played with a pause after each one, during which the judges record their stuttering severity rating for the child and also the confidence with which they gave that rating. The rating scale used is the 10-point stuttering severity scale used in the Lidcombe Program of Early Stuttering Intervention, where 0 = no stuttering, 1 = extremely mild stuttering, and 10 = extremely severe stuttering. The primary aim of the study is to determine agreement between the ratings of the native and non-native speakers. It is hypothesized that there will be higher agreement amongst judges for the child speaking their own language. Further research question are about the subjective confidence in the adequateness of the severity ratings and their relationship to the severity ratings. In this seminar, there will be four presentations of 15 minutes each, as follows: (1) ationale for the study and its technical, methodological, and statistical bases. (2) Agreement of stuttering severity ratings within and between groups of judges. (3) The effects of native language, professional experience and confidence on agreement for severity ratings (4) The implications of the findings for clinical practice and research.There will then be a final 30-minute session in which videos of stuttering children will be shown, followed by a panel discussion with questions from the audience. This project is a collaborative effort involving many researchers and SLPs working across cultural and language boundaries. The only previous crosslanguage study of preschool stuttering children compared English-speaking and Icelandic-speaking SLPs measures of stuttering in Icelandic-speaking children. In that study, both groups of judges demonstrated good agreement. The present study builds on the Icelandic study by increasing the number of languages spoken by both the children and the judges. Learning Outcomes: The participants will learn how a multi-language online study can be realized, how confidential audiovisual material can be presented within such a research context, how stuttering severity ratings are related to the native language of speaker and judge, and how professional experience as a SLP is related to stuttering severity ratings and confidence in using the stuttering severity rating scale.
SE5
MULTILINGUAL CHILDRENS SPEECH, LANGUAGE AND HEARING SHARYNNE MCLEOD (1) - KATE CROWE (1) - KARLA WASHINGTON (2) SARAH VERDON (1) - CAROLINE BOWEN (3) - DAVID MCKINNON (1) LORAINE FORDHAM (1) - TERESA CHING (4) MAUREEN SAMMS-VAUGHAN (5) - HUBERT DEVONISH (5) CHARLES STURT UNIVERSITY, BATHURST, AUSTRALIA (1) UNIVERSITY OF CINCINNATI, CINCINNATI, UNITED STATES (2) MACQUARIE UNIVERSITY, SYDNEY, AUSTRALIA (3) HEARING CRC, NATIONAL ACOUSTIC LABORATORIES, AUSTRALIAN HEARING, SYDNEY, AUSTRALIA (4) UNIVERSITY OF THE WEST INDIES, KINGSTON, JAMAICA (5)
Abstract: Throughout the world many children and their families who access speech-language pathology services are multilingual. This seminar includes five papers that address multilingual childrens speech, language, and hearing and focuses on language, mode (speech vs. sign), and dialect from the
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perspectives of speech-language pathologists, parents, and children. Paper 1: Multilingual children with speech sound disorders: Creation of a position paper by an international expert panel. This paper outlines the development of the Multilingual Children with Speech Sound Disorders: Position Paper (www.csu.edu.au/research/multilingual-speech/position-paper) to guide speech-language pathologists (SLPs) facilitation of multilingual childrens speech. The position paper was created by an international expert panel of 57 who had worked in 33 countries and used 26 languages in professional practice. The resulting position paper is structured using the International Classification of Functioning, Disability and Health and incorporates recommendations for (a) children and families, (b) SLPs assessment and intervention, (c) SLPs professional practice, and (d) SLPs collaboration with other professionals. Paper 2: Multilingual children with hearing loss: Factors influencing parents choice regarding speech, sign, or multilingualism. Newborn screening for hearing loss means that caregivers must make decisions regarding their childrens communication earlier than at any time in the past. Influences on caregiver decision-making about their childrens communication mode and language use were examined for 177 caregivers of Australian children with hearing loss. After qualitative and quantitative analysis of caregiver responses, the most frequently reported influences were identified to be advice and attitudes, childrens characteristics and opportunities, practicalities of communication, and fostering belonging. Paper 3: Considerations during speech and language assessment for bidialectal children in Jamaica.Most Jamaican children speak both Standard Jamaican English (acrolect) and Jamaican (basilect). However, most speech-language pathology assessments focus on childrens production in one standard dialect. Twenty four typically developing 3-to-6-year-old Jamaican children completed receptive and expressive speech and language assessments in Standard Jamaican English with one SLP and in Jamaican with a second SLP. Children demonstrated code switching between SLPs, with specific communication patterns observed for each language. Parental reports corroborated the direct observations for each child. Paper 4: Patterns of language acquisition, usage, and loss in young multilingual children.Patterns of language acquisition, use, and maintenance were investigated using the nationally representative Longitudinal Study of Australian Children. Information about 5,107 children was collected three times during the first five years of life. Different patterns of language use were apparent, depending on the languages that children spoke. For example, children who spoke Arabic and Vietnamese tended to be immersed in language learning from birth and continued using these languages across the first five years of life. In contrast, children who spoke European languages such as Spanish and Greek tended to speak these languages at 2-3 years of age then reduce usage at 4-5 years. These data enrich understanding of the heterogeneous nature of multilingual speech acquisition and facilitate appropriate support for young multilingual children. Paper 5: Quantifying multilingual childrens speech across 30 languages: Intelligibility in Context Scale The Intelligibility in Context Scale (ICS, McLeod, Harrison, & McCormack, 2012) is a 7-item parent report measure of childrens intelligibility in daily life. The ICS was trialled with parents of 120 4- to 5-year-old Australian children to ascertain construct, criterion, and content validity and reliability. The ICS has been translated into 30 languages (including Arabic, Bulgarian, Italian, Japanese, Russian, Spanish, Somali) and use with multilingual children will be discussed. Learning Outcomes: Participants will learn about resources such as the Multilingual Children with Speech Sound Disorders: Position Paper and the Intelligibility in Context Scale that they may be able to use in their research and clinical practice with multilingual children. Participants will outline factors that influence parents choice of language mode and use for children with hearing loss. Participants will gain an understanding the variation in multilingual childrens language acquisition, use and maintenance between different language groups. Participants will learn that unique communication patterns can be observed during speech-language assessment for bidialectal children.
International Classification of Functioning, Disability, and Health (WHO ICF) will be included in the outcomes discussion. Outcomes measurement is a hot topic and a moving target that directs our predictions for the future. It is hoped that the perspectives, information, and advice presented in this program will contribute to a positive future for the practice of augmentative and alternative communication. The session will conclude with an examination of methods for evaluating organizational performance, with a review of current issues and mandated data collection that are key features in accreditation and standard setting processes. Although accreditation/ standard setting/educational quality differs from country to country, the core standards and issues remain the same. These will be discussed as they relate to AAC and the special populations. Learning Outcomes: Participants will understand the current state of the profession in the area of augmentative and alternative communication. Participants will be able to select assessment steps and treatment steps in case simulations. Participants will be able to leave the session with the ability to use the WHO ICF classification for treatment purposes. Participants will be able to identify barriers that may affect practice in AAC. Participants will be able to identify core standards necessary for training program delivery in the area of AAC. Biographical Sketch: Dr. Carolyn Wiles Higdon, Professor, University of Mississippi, Vice President of Finance on American Speech Language Hearing Associations Board of Directors (2012-2014), and noted expert in AAC and neurogenics. Dr. Higdon has published and presented in AAC, adult and pediatric neurogenics, education and medical legal/policy/ accreditation standards, and in international rehabilitation topics.
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HOPE, RESILIENCE, AND COMPETENCE: IDENTITY AND MEANING-MAKING IN THE NARRATIVES OF CHILDREN WITH PRIMARY SPEECH/LANGUAGE IMPAIRMENTS RENA LYONS (1) UNIVERSITY OF WEST OF ENGLAND (BRISTOL) AND NUI GALWAY, GALWAY, IRELAND (1)
Abstract: Primary speech/language impairment (PSLI) is an umbrella term used to describe children with a range of profiles, all of which include marked speech and/or language impairments, in the context of normal cognitive abilities (Botting & Conti-Ramsden, 2004). Research on the narratives of these children has primarily been deficit-focused. The aims of this study were to explore how children with primary speech /language impairments (PSLI) construct their identities and make sense of their experiences. Methods: The methodology used in this study was narrative inquiry. The participants were eleven children aged 9-12 years diagnosed with PSLI. The main methods used to generate data were interviews, brain-storming activities, photography, draw and tell techniques, field-notes, and my reflective diary. The data were analysed using a number of data analysis methods including an analysis of the verbal and non-verbal evaluation markers that the children used in their narratives, how they positioned themselves in their narratives (e.g., as agent or recipient of actions), analysis of identities enacted and rejected in their stories, and thematic analysis both within and across cases. The interactional context of the interview was also explored to investigate how we (children and me as researcher) generated narratives and negotiated the agenda. Results: The children presented with multiple identities. In some narratives they presented themselves as the heroes in pursuit of goals, and in others they presented themselves in more passive roles. All of the children conceptualised their speech/language impairments in different ways and there was variability in terms of the importance that the children seemed to assign to them. The children did identity work in their narratives by presenting, resisting and negotiating their identities with others. They were aware of the discourse of normality and disability. The facilitators of well-being included relationships with family and friends and their involvement in meaningful activities, which provided them with a sense of value and belonging. The barriers to well-being included social exclusion and sometimes specialist education provision singled them out as being different to peers. Discussion: Although these children presented with communication impairments, they could talk about the ups and downs they encounter and negotiate in their daily lives. The findings support the relational theory i.e., the children did identity work in their narratives and identity is not fixed but rather fluid and negotiated on an on-going basis. Listening to the childrens narratives provided new insights into what its like to be them. Methodological issues will be discussed e.g., tellership (generating narratives with children with communication impairment), learning from the member-checking process, and the tellability factor (what constitutes a story?). The boundaries of narrative inquiry need to be broadened so that the voices of people with communication impairments, who may be less able to produce coherent accounts of their experiences, can be heard. The implications for practice are also discussed Learning Outcomes: Participants will be able to: discuss theoretical models of identity and meaning-makingDiscuss the value of narrative inquiry as a methodology. Reflect on ways in which we can promote positive identities and well-being in children with primary speech/language impairments
SE6
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION STATE OF THE ART STATE OF THE FUTURE CAROLYN WILES HIGDON (1) DEPARTMENT OF COMMUNICATION SCIENCES AND DISORDERS, UNIVERSITY OF MISSISSIPPI, OXFORD, MS, UNITED STATES (1)
Abstract: This session reviews where augmentative and alternative communication research and treatment is at this time. Discussion will include the use of tablet technology and apps, as well as some of the development in the use of brain interfaces for communication and assistive technology controls. The presentation will include a series of the top 50 applications that are useful for speech-language pathologists, parents, occupational therapists, and physical therapists as well as classroom teachers. In addition, to the state of the art discussion with the gold standard applications, will be a presentation of case studies that are being developed for case simulations in the area of adult neurogenics, pediatric brain injury and developmental delays, as well as in the area of children and adults on the autism spectrum. The cases will include treatment plans and a series of questions that are necessary to process when doing assessments and planning for treatment. Medical and educational outcomes from an international perspective and outcomes within special populations will be discussed/available for these cases. The current version and influence of the World Health Organizations
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FP128
IDENTIFICATION OF THREE NATURAL VOICE GROUPS BY PHONETOGRAPHY - A DATA DRIVEN APPROACH FELIX DE JONG (1) - HUGO LYCKE (2) - ANNA IVANOVA (3) WIVINE DECOSTER (2) - MARC VAN HULLE (4) ENT-HEAD AND NECK, EXPERIMENTAL ORL, KATHOLIC UNIVERSITY LEUVEN, LEUVEN, BELGIUM (1) - EXPERIMENTAL ORL, KATHOLIC UNIVERSITY LEUVEN, LEUVEN, BELGIUM (2) - LEUVEN STATISTICS RESEARCH CENTRE, KATHOLIC UNIVERSITY LEUVEN, LEUVEN, BELGIUM (3) - LAB. NEUROPHYSIOLOGY, KATHOLIC UNIVERSITY LEUVEN, LEUVEN, BELGIUM (4)
Abstract: There is no generally accepted objective method in voice classification. One may question the existence of three basic female and male voice types by nature. In an attempt to break out of the controversy, a datadriven approach is applied, which imposes minimal assumptions on the nature of the data, what elements to use for its analysis, and even the existence of natural voice groups. The aim of this study was to verify the existence of individual- or combinations voice range profile (VRP) parameters with which the data can be partitioned into a number of clearly separated clusters as a basis for discriminating between basic female and male voice categories. Subjects and Methods. The data from 206 female conservatory singing students (18 - 25 years) and 256 male subjects (18 52 years), consisting of 9 young singing students, 17 professional singers, 61 professional choir singers and 169 with and without singing experience, was investigated. In this study parameters were used, derived from the geometry of the VRP; the register transition zone; the geometry of the chest/head voice parts and the linear characteristics of the minimum and maximum intensity curves. Additionally, a number of voice frequency and intensity ratios and differences were defined based on some of the above parameters. After preprocessing the data we applied Wards minimum method to assess whether the data displays any natural clusters (groupings). However, Wards method could not be decisive as it could return more than one statistically plausible cluster solution. In order to break the tie, we need an additional method. Furthermore, we want to identify which parameter is crucial for discriminating between the voice clusters. We decided to use K-means clustering in combination with a forward or backward feature selection procedure to define the discriminative parameters and the cluster migration index to decide which cluster solution is more consistent across discriminative parameter combinations identified, and adopt that as the final cluster solution. The analyses were performed using Statistical Analysis SAS/STAT software (release 9.2). Results. In both the female and male voices Wards procedure indicated that there could be three or four clusters in the data. In using K-means clustering, both a forward and backward feature selection procedure was applied to both clustering options. Based on the migration index, the three-cluster solution turned out to be the most consistent one. The parameter that led to the best three-cluster separation in the female voices was the ratio of the perimeter length of the chest voice part of the voice range profile versus the total perimeter length. The parameter that led to the best three-cluster separation in the male voices was the frequency of the register dip. Conclusions. The results of this study demonstrate that different parameters of the VRP are able to yield a clear separation into three clusters for each gender. A second salient result of this study is the finding that each of these features has to do with register transition, which is an important aspect in voice classification in singing practise. Learning outcomes: the results of this study demonstrate that different parameters of the voice range profile (VRP) are able to yield a clear separation into three clusters for each gender. Such a result is remarkable, since the finding of a discontinuous distribution may not be expected from biological variables. One can wonder if ancient composers of vocal music had an innate feeling about the existence of three natural basic human voice categories. Further studies are necessary to link the results of the statistically obtained cluster separation, which discriminate between three basic voice categories, to the three basic female voice categories as commonly interpreted by most composers of vocal music and singing teachers. We assume that our methodology can be useful, not only in determining a basic voice type for singers, but also in providing interesting cues for voice diagnosis and voice therapy in general, taking into account the relationship of all different human vocalizations. Most parameters that have lead to the cluster separation, however, are not easily understandable in clinical terms. Therefore, it is not easy to link them to the clinical situation, nor can the difference between these parameters that have lead to the clustering of female and male voices readily be explained. Each of the features that yielded the clear separation into three clusters for each gender has to do with register transition. The location of the register transition zone is important marker in the VPR and should be considered in view of the basic voice type of each gender. The pertinent study indicates that there exist three basic voice types, corresponding with classic voice types or not. This points at the need of voice classification, also in modern music, where not a similar vocal repertoire has been written like in classic music. The finding that different parameters of the VRP are able to yield a clear separation into three clusters for each gender indicates that VRP can open a new era of voice research.
FP129
VOICE CHARACTERISTICS IN ITALIAN PATIENTS WITH DYSPHONIA MURAT ATAC (1) - FRANCESCO MOZZANICA (2) - DANIELA GINOCCHIO (2) - PATRIZIA MARUZZI (2) - LETIZIA SCARPONI (2) - FRANCESCO OTTAVIANI (2) - ANTONIO SCHINDLER (3) ISTANBUL, TURCHIA (1) - ITALIA (2) - UNIVERSIT DEGLI STUDI DI MILANO, MILANO, ITALIA (3)
Abstract: Epidemiologic studies on the prevalence of voice disorders in the treatment-seeking population are rare. However, voice disorders lead to voice dysfunction or dysphonia and affect up to one third of dults at least once in their lifetime with consequent lost work productivity and increased healthcare costs. Valid and reliable epidemiological information on voice disorders would greatly enhance the ability to plan future health-care provision. Unfortunately, even if some prevalence data exist for adult voice disorders, the large part of these information are confined to specific groups of professional voice users or specific pathological conditions. The aim of this study is to obtain epidemiological data about the laryngeal pathology in an Italian treatment-seeking population. All new patients seeking treatment for dysphonia at the Phoniatric Department of L. Sacco University Hospital between January 2005 and December 2011 were included in the study. Each patient was evaluated following a multidimensional assessment. This protocol included five different approaches: videolaryngostroboscopy, perception, acoustics, aerodynamics and self-rating by the patient. Based on the videolaryngostroboscopic examination the cohort of patients was divided into four groups: 123 subjects had functional dysphonia, 141 had organic dysphonia, 80 had neurological dysphonia and 84 had no signs of laryngeal pathology. The mean age of the participants was 46.6 18.7 years (range 6-88). A total of 428 patients were included in the study. The laryngeal paralysis were frequently diagnosed (15%), followed by vocal fold nodules (10%). Pathologies were found to occur more often in females (p = 0.01). In professional voice users the functional dysphonia was more frequently diagnosed. The results of perception, acoustics, aerodynamics and self-rating assessment were different in the four groups of patients. In particular, patients with neurological dysphonia scored worse in GIRBAS scale, Jitter and Shimmer analysis, Maximum Phonation Time (MPT) and Voice Handicap Index (VHI). In conclusion laryngeal paralysis were overall the most common cause of voice disorders, followed by vocal fold nodules. Females patients were more frequently affected by dysphonia. Professional voice users were more frequently affected by functional dysphonia. Patients with neurological dysphonia obtained worse scores in the multidimensional voice assessment. Learning Outcomes: The Participant will be able to: Know the prevalence of the different type of dysphonia in the Italian treatment-seeking population; Know the more frequent vocal disease and their relationship with the age, gender and risk factors; Understand the role of the multimensional approach in the management of a patient complaining dysphonia.
FP130
PSYCHOLOGICAL CHARACTERISTICS OF FUNCTIONAL DYSPHONIA: DIFFERENCES BETWEEN HYPERKINETIC AND HYPOKINETIC PATIENTS CHIARA CHIALVA (1) - NATASCIA BRONDINO (2) ROBERTO PAGANI (2) - EDGARDO CAVERZASI (2) GIULIA BERTINO (1) - MARIA SILVIA MIGLIAZZI (1) CARLO ROBOTTI (1) - MARCO BENAZZO (1) IRCCS POLICLINICO SAN MATTEO FOUNDATION, DEPARTMENT OF OTOLARYNGOLOGY- UNIVERSITY OF PAVIA, PAVIA, ITALY (1) DEPARTMENT OF BRAIN AND BEHAVIOURAL SCIENCES, SECTION OF PSYCHIATRY, UNIVERSITY OF PAVIA, PAVIA, ITALY (2)
Abstract: Functional dysphonia (FD) is characterized by the presence of an abnormal voice in the absence of any structural or neurogenic pathology. FD could appear both as a functional hypokinetic disorder or, more frequently, as a functional hyperkinetic dysphonia. Even though the presence of a poorly regulated activity of the laryngeal muscles has been regarded as the pathophysiological mechanisms leading to FD, the etiopathogenetic causes of FD are still to be elucidated. In this regard, conversion reaction, hypochondriasis and personality traits have been considered as potential factors involved in the etiology of FD: for instance, increased laryngeal muscle tension in response to anxiety, stress and depression has been proposed to play a key role in functional voice disorders. However, to date little empirical evidence of this hypothesis has been provided. The aim of this study was to evaluate personality traits in different types of functional dysphonia and healthy controls and to study the potential correlations between psychological and medical aspects. One hundred and four patients with functional dysphonia (84 hyperkinetic and 20 hypokinetic), attending our Centre from June 2011 to December 2012, were consecutively enrolled. Additionally, we recruited 53 healthy controls. All subjects underwent a videolaryngostroboscopy, acoustic and aerodynamic voice evaluation. All subjects filled the Voice Handicap Index (VHI), aimed at evaluating the patients perception of her/his own voice, the Temperament and Character Inventory (TCI), a self-report questionnaire investigating personality traits and the Symptom
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Checklist 90 (SCL-90), a self-evaluation inventory, covering several aspects of psychological distress. One-way analysis of variance (ANOVA) was used to compare the hyperkinetic, hypokinetic and control groups. Additionally, Pearson correlations coefficient was used to correlate VHI and TCI and SCL-90 scores. We observed significant differences between several psychological characteristics in the three groups: for example, somatization symptoms were more frequent in dysphonic patients compared to controls. The presence of a significantly lower self-esteem was observed in hypokinetic patients compared to controls and hyperkinetic patients. Voice Handicap Index scores were positively correlated with the severity of psychological distress at the SCL-90. Personality traits seemed to be associated with functional dysphonia, and differed not only between controls and patients, but also among functional dysphonia groups. Our results seemed to point out the presence of a different personality profile in the two dysphonic subgroups. In particular in the hyperkinetic group the presence of a high novelty seeking score, usually associated, from a neurobiological point of view, to the presence of a high dopaminergic tone, could be potentially related to the high muscular tension and reactivity observed in this patient group. Additionally, our findings underlined the elevated psychological distress observed in dysphonic patients compared to controls. This distress is also reflected in the positive strong correlation measured between the severity of symptoms and the VHI score. These data may suggest the usefulness of an integrated approach to the dysphonic patient, taking into account not only medical and physical aspects, but also emotional and psychological characteristics of the individual. Learning Outcomes: The Participant will be able to: 1. know the importance of psychological factors in functional dysphonic patients; 2. understand the importance of a multi-disciplinary evaluation of this type of patients: 3.know the different personality profile between controls and hyper- and hypokinetic patients; 4. discuss the potential implications of these findings for treatment.
SS26
OUTCOMES OF INTERVENTION: THE PERSPECTIVES OF PARENTS AND CHILDREN WITH SPEECH, LANGUAGE AND COMMUNICATION IMPAIRMENTS SUE ROULSTONE (UK)
Abstract: Research to evaluate the effectiveness of interventions for children with speech, language and communication impairment tends to focus on the objective measurement of childrens linguistic skills. However, there is increasing interest and concern in the views of the children themselves and their parents regarding the impact both of their impairment and any intervention. This paper will present a series of studies that were part of a large programme of research, the Better Communication Research Programme, designed to enhance the evidence base and inform the delivery of better outcomes for children and young people. The aim of this aspect of the programme was to explore the meaning of better outcomes for children with a wide range of speech, language and communication impairments and their parents. Data collection processes included seven workshops with children, five focus groups with parents and a national electronic survey. These all focused specifically on the topic of better outcomes. In addition, during telephone interviews with 139 parents whose children were participating in a prospective cohort study of children with language impairment or autism spectrum disorders, parents were asked their hopes and aspirations for their child for the forthcoming academic year. A systematic review of existing parent- and self-report instruments explored which outcomes, that were valued by parents and children, were examined by the various instruments. The findings suggested that children valued their family, friends and their pets and the fun they have with teachers and family. They were proud of their achievements and had individual aspirations for the future. They acknowledged areas of difficulty but rarely specified difficulties with speech and language skills. Parents valued developments in the childrens communication skills that facilitated the childs independence and social inclusion. Both parents and children wanted to see changes in the behaviour of other people around them. The systematic review established that a range of parent- and selfreport instruments were available that mapped onto the outcomes valued by the children and their parents. The discussion will reflect on the implications for the design and evaluation of interventions in order to better target outcomes that are desired by children and their families. Learning Outcomes: Increased understanding of the perspectives of children and their parents An overview of parent- and child- report measures of quality of life Increased understanding of outcomes measures valued by parents and their children
SS25
DYNAMIC MANAGEMENT OF (CENTRAL) AUDITORY PROCESSING DISORDERS INGRID GIELOW (1) - DIANA MELISSA FARIA (2) CENTRO DE ESTUDOS DA VOZ - CEV, FUNDAO GETLIO VARGAS, SO PAULO, BRAZIL (1) - COMMUNICAR, CENTRO DE ESTUDOS DA VOZ - CEV, SOROCABA, BRAZIL (2)
Abstract: When a (central) auditory processing disorder (CAPD) is diagnosed, the auditory skills which are failing can be stimulated concerning the central nervous system plasticity. The auditory training consists in intensive experiences to improve the auditory abilities, allowing the processes and skills involved to become stronger, and to develop compensatory mechanisms. To identify the possible auditory skills involved in a CAPD that may affect ones learning, attention and communication abilities, it is fundamental to guide the patients therapy and management. The understanding of the occurrence of specific disorders in the auditory skills may help the audiologist and the SLP in drafting directions to early stimulation at school, as well as developing strategies focused on the patient needs. The objectives of this presentation are: (1) to show the occurrence of CAPD and their types in patients, based on the analysis of exams; (2) to relate the assessments results to the auditory processing skills to be stimulated and (3) to present strategies to develop the impaired auditory skills. After identifying the difficulties, a specific rehabilitation program might include strategies to stimulate the localization of the sound source, the auditory memory, the ability of comprehension in a noisy environment, the auditory closure, frequency and temporal patterns discrimination, inter-hemispheric strategies, which might improve the dichotic auditory skills, even when stimulated with motor or visual strategies, auditory analysis and synthesis, including phonological awareness, methalinguistic abilities, trying to bring to the subjects real life the abilities trained in the therapy room, and methacognitive strategies, aiming to make the subject aware of his/her difficulties, and stimulating them to develop compensatory strategies. There are some standardized materials available for the clinicians use. However, after a series of repetitions of the same exercises, the interest of the patient may reduce. Thus, considering the patients context and settings, it is possible to create monotic and dichotic strategies using softwares and simple computer resources. Thats why this approach is called a dynamic management of CAPD: the strategies are personalized according to the patients needs and personal preferences. For a metalinguistic approach, language stimulation activities might be prepared by integrating power point templates to sounds and auditory stimuli. In those cases, the use of headphones connected to the computer might be indicated. A website with auditory exercises and audiovisual games was implemented and will be demonstrated during the seminar, as well as how the activities were created. Learning Outcomes: The objectives of this presentation are: (1) to show the occurrence of (central) auditory processing disorders in patients attended on private practice, based on the analysis of exams; (2) to relate the assessments results to the auditory processing skills to be stimulated and (3) to present strategies to develop the impaired auditory skills.
FP131
ACOUSTIC VALUES OF THE HUMAN VOICE IN THE SEVEN ALBA EMOTING EMOTIONAL STATES LUIS ALEJANDRO ROMERO ROMERO (1) - SOLANGE DURAN ELICER (2) CARLA EVA BADANI SCHONEWEG (3) - KAREN OLEA ORTEGA (1) MARA JOSEFINA AZOCAR FUENTES (1) - RODRIGO FERNANDO PREZ PREZ (1) - FELIPE EDUARDO MONTERO GUARDA (3) ANTONIO CHANDUV RAMIREZ (3) - ALFREDO ALARCN GMEZ (2) BENJAMN ORTIZ (3) SCHOOL OF COMMUNICATION SCIENCES AND DISORDERS, UNIVERSITY OF CHILE, SANTIAGO, CHILE (1) - DEPARTAMENTO DE TEATRO, UNIVERSIDAD DE PLAYA ANCHA, VALPARASO, CHILE (2) DEPARTMENT OF MUSIC AND SONOLOGY, UNIVERSITY OF CHILE, SANTIAGO, CHILE (3)
Abstract: Alba Emoting Training, defined as a psycho-physiological technique to help actors to create and control real emotions, is a method used for actors to access different levels of seven specific emotions: happiness, sadness, fear, anger, eroticism, tenderness and neutral state. These emotional states are performed according to the use of three types of patterns: breathing patterns, postural patterns and facial expression patterns. Considering that breathing and postural patterns influence the production of human voice, it is possible to assume the existence of a fourth pattern related to the vocal features of each emotional state. There is no evidence available in the literature on this subject. This cross-sectional and prospective study aimed to describe the vocal changes across the seven emotional states described in the Alba Emoting Training. Acoustic measures were used in the present study. A group of 18 native Spanish speakers, acting student (diagnosed with no vocal disorders) were weekly trained on Alba Emoting method during a three month period.Recordings were carried out in a sound treated room. It must be confirmed the no voice disorder condition at the sampling recording time. Participants were required to interpret a phonetically balanced text. All the emotional states proposed by Alba Emoting Training were performed, independently. Audio samples were acoustically analyzed by subject and by emotion. SPSS software was used to perform statistical analysis. A bivariate correlation matrix (Spearman r) was carried out. Intensity and fundamental frequency variations during emotional expression for the seven basic emotions were observed. These changes were dependent neither on gender nor on age. Regarding frequency, every emotional state shows a particular frequency. Differences in intensity changes
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(dynamic range) were not as evident as for frequency range. Learning Outcomes: The Participant will be able to: 1. Become acquainted about the vocal variations during the different emotions, supported on objective acoustic data; 2. Know the influence of breathing patterns of emotions in vocal performances, through the intensity values presented.; 3. Know the influence of posture patterns of emotions in vocal desempeoa, through frequency shown values.
SS27
ALL THE DAY I CAN LISTEN, TALK AND SING: A REHABILITATIVE SOURCE FOR INFANT AND TODDLER WITH HEARING LOSS CHRISTINE ROCCA (1) - MARIA NICASTRI (2) - ERSILIA BOSCO (2) GABRIELLA TRAISCI (2) - LETIZIA GUERZONI (3) - ILARIA PATELLI (4) MARY HARE SCHOOL FOR DEAF CHILDREN, MARY HARE SCHOOL FOR DEAF CHILDREN, ARLINGTON MANOR, UNITED KINGDOM (1) DEPARTMENT OF SENSE ORGANS, UNIVERSITY SAPIENZA, ROME, ITALY (2) ENT DEPARTMENT, G. DA SALICETO HOSPITAL, PIACENZA, ITALY (3) ENT DEPARTMENT, OSPEDALI RIUNITI, BERGAMO, ITALY (4)
Abstract: Age of intervention in children affected by hearing loss is decreasing and increasingly often specialists have the possibility to work with them already by the age of 3 months. Early intervention requires an important change in the traditional concept of rehabilitation that turn rather into habilitation and guide to optimize the environment of the young children so that they can naturally recover the normal learning process of communication and language acquisition (incidental learning). In this concern, daily interactions and routines become important opportunities of learning and development. On the other hand, is well known as sing song voice and music are important during the early phases of growth: infants and toddlers like music and songs, that naturally give the possibility to play with voice, prosody and language. At the moment there are no rehabilitation tools that join these two important resources of learning. The present work has two aims. The first one is to show the implementation of a rehabilitation tool All the Day I can Listen, Talk and Sing (ADILTS), that takes advantage of the playful aspects of music and songs, to help both professionals and parents to adequately develop listening and communication skills of infant and young toddler with hearing aids or cochlear implant, during the daily interactions and routines. The second aim is to show the preliminary impact of the new tool on parents and children. Four Centers (one in London and three in Italy) cooperated to implement ADILTS, available both in English and Italian language. The tool is directed to children aged 3 to 36 months and structured in three parts: a simple illustrated book that narrates the daily time of a child, with musical tracks and songs thought for each fundamental routine; activities and simple games suggested for each daily moment, selected for infant (3-18 months) and toddler (19-36 months) to guide parents and professionals to effectively communicate during all the day with their children; a section containing simple and clear descriptions of the normal steps that each child follows during his growth and checklists to monitor the child progress and discuss it with professionals. A questionnaire was implemented to measure the easiness, the perceived benefit, the acceptance and the pleasure of the tool. Theorical basis, the structure and samples of ADILTS will be presented, together with the preliminary results on 10 families of children aged 6-18 months and 19-36 months.ADILTS is well accepted. Parents express the usefulness of the tool in considering the natural use of music and songs during the interaction with their children, in improving their mode to communicate with children during the day and, finally, in having a clear idea and certainty of whats doing and which will be the next step along the normal developmental stages, so quieting excessive anxiety and requests to the child. Learning Outcomes: The participant will be able to: understand the importance of daily routines in communication development and how to use effectively them; use music to naturally develop rhythm, pitch and loudness control, vocal play and language skills in children with hearing loss; guide parents towards correct interactions through all the day; use a simple and rapid monitor of progress tool.
FP132
IS HOARSE VOICE REALLY SEXY? LISTENERS ATTITUDE TOWARD DYSPHONIC SPEAKERS OFER AMIR (1) - REUT LEVINE-YUNDOF (1) DEPARTMENT OF COMMUNICATION DISORDERS, TEL-AVIV UNIVERSITY, TEL-AVIV, ISRAEL (1)
Abstract: Introduction: The Human voice provides extensive information about the speaker, in addition to the intended communicational message. Therefore, voice is an essential part in the process of forming an initial attitude toward the speaker. People with communication disorders are typically judged by listeners more negatively than normally speaking people. This trend, however, was not reported consistently in the literature for all types of speech and communication disorders. This study examined listeners attitude towards hoarse speakers. In addition, the study evaluated the effect of speaker and listeners age and gender on these attitudes. Methods: Seventyfour nave listeners evaluated recorded voice samples of six dysphonic and six non-dysphonic speakers. Evaluation was performed using twelve attitude rating-scales. In addition, these scales were arranged into three categories, to allow an attitude factor-analysis. Results: Statistically significant negative attitudes towards dysphonic speakers were found on most scales (p<0.001). Dysphonic women were rated more negatively than dysphonic men were. Nonetheless, listeners gender and age did not bias their attitude towards speakers. These results were further supported by a factor-analysis performed on the original attitude rating scores. Conclusions: Our findings demonstrate the negative attitudes with which dysphonic speakers are faced and the fact that women are affected by these attitudes more than men. In addition, it highlights the importance of addressing and relating to these facets in the diagnostic and therapeutic process. Learning Outcomes: The participant will be able to: 1. describe listeners attitudes toward dysphonic speakers, 2. evaluate the differences in attitudes toward men and women in general, and in dysphonia in particular, 3. appreciate the importance of addressing listeners attitudes toward dysphonia in clinical settings.
FP133
SPEECH RANGE PROFILE IN DIFFERENT EMOTIONS GLAUCYA MADAZIO (1) - LUANA CURTI (2) - MARA BEHLAU (3) CEV, SO PAULO, BRAZIL (1) - CEV, SENAC, SO PAULO, BRAZIL (2) - CEV, UNIFESP, SO PAULO, BRAZIL (3)
Abstract: Emotions effects on speech are observed by changes in fundamental frequency, intensity and in duration aspects of the emission. Fundamental frequency and intensity variations may be analyzed by Speech Range Profile (SRP), a two-dimensional graphic built on these last two parameters data. The speech rate may be analyzed by objective assessment, as time measurement of emissions duration. The purpose of the current research is to obtain the Phonetogram of four basic emotions - sadness, fear, joy and anger performed by professional actors in order to identify in SRP and in duration measurements of speech the parameters that distinguished and contributed to perceptual evaluation of the emotions. Methods: 38 professional actors participated of the research, 17 men and 21 women, mean age of 29 years, healthy voices, and mean acting time of 7 years. The speech sample analyzed was counting number from 20 to 30, in the four basic emotions. Three laics listened to the 152 samples recordings (4 emissions for each participant) and were guided to identify the emotion of each speech sample. Only the actors that had all the emotions identified were considered to the emotions phonetogram. Two groups were paired identified and unidentified emotions to parameters of distinction analysis. The samples were acoustically analyzed by Vocalgrama (CTS Informtica, version 1.6) obtaining the SRP acoustic parameters and its area, adding the calculus of speed rate. Results: The graphic area, the voice intensity and speed rate were the acoustic parameters that most distinguished the emotions. Emotions of high activity, as joy and anger, had bigger area in the graphic, increased vocal intensity and high speed rate; the emotions sadness and fear had smaller SRP area, low intensity, and slower speed rate. The graphic area was devious in identified and unidentified emotions, with restricted voice intensity variations in unidentified emotions. Conclusions: SRP had different configuration in emotions, as narrow in sadness and fear (lower frequency and intensity) and broad in joy and anger. The speech rate is slower in sadness and fear and faster in joy and anger. The voice intensity variations are able to distinguish the identified emotions from unidentified ones. Learning Outcomes: To understand the acoustic parameters that characterize basic emotions To learn to use Vocalgrama software in voice preparation of actors in order to facilitate the emotions expressions. To associate acoustic parameters searching for healthy emotions performances of actors.
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SY7
MULTILINGUAL AFFAIRS COMMITTEE SYMPOSIUM HEILA JORDAAN (1) - MARIA KAMBANAROS (2) SVETLANA KARPAVA (2) - KLEANTHES GROHMANN (2) ELIN THORDARDOTTIR (3) SOUTH AFRICA (1), CIPRUS (2), CANADA (3) Identification of language impairment in english second language learners
Abstract: The identification of language impairment in bilingual children is complex. This presentation describes the identification of specific language impairment in the L2 (English) of grade 2 children using sentence repetition as a measure. The approach adopted in this research was to assess a large group of children and select those who scored 1 or more standard deviations below the mean of the peer group on a sentence repetition test (Redmond, 2005) as at risk for language impairment. A total of 22/241 children met this criteria. Their language profiles and reading comprehension skills were then further assessed and analysed to describe the manifestations of language impairment in the L2 and to determine whether these manifestations were similar or different to those seen in English L1 language impaired
children and to what extent language impaired children can acquire a L2. Learning Outcomes: The participant will understand 1. The value of sentence repetition as a tool for identification of language impairment 2. The importance of comparing second language learners to a peer group in a similar educational context 3. The similarities and differences between the manifestations of language impairment in L1 and L2 English language learners. 4. The implications for theories of language impairment.
Comparing multilingual to bilectal children on expressive-receptive measures

Abstract: Previous studies have shown that children acquiring two languages simultaneously can either perform similar to monolingual peers on measures of lexical and syntactic development, or lag behind (see e.g. Thordardottir et al., 2006). This study aimed to investigate the effect of bilingual exposure (Cypriot Greek and Russian) on childrens performance on measures of lexical and morphosyntactic development in the standard language (Modern Greek) in the diglossic speaker community of Cyprus. 21 children participated, ranging in age from 5;4 to 6;8, divided into two groups: (1)10 multilingual Cypriot GreekRussian pre-schoolers (7 girls, 3 boys; mean age 6;5), who were exposed to both languages from birth in a one-parentonelanguage environment, and to Standard Modern Greek at school; (2) 11 children of bilectal CypriotStandard Modern Greek background (5 girls, 6 boys; mean age 6;3), matched on socio-economic backgrounds and geographical area with the multilingual children. All children were administered the following subtests of the preschool version of the Developmental Verbal IQ Test (DVIQ; Stavrakaki & Tsimpli, 2000). For expressive language, the vocabulary subtest (27 items) and the production of morphosyntax subtest (24 items); for receptive language, the metalinguistic concept subtest (25 items) and the receptive morphosyntax subtest (31 items). The results revealed no significant differences between multilingual and bilectal children on measures of lexical development/vocabulary and measures of receptive language. However, the multilingual children performed significantly worse than their bilectal peers on the production of morphosyntax (multilingual mean: 15.9, bilectal mean: 19.7, p=.015). Our results will be discussed in relation to (i) language-specific factors, especially how the particular language combination of Cypriot GreekRussian acquired by the children may influence their performance in Standard Greek; and (ii) the socio-syntax of development hypothesis (Grohmann, 2011), i.e. the schooling effect of Standard Greek on language performance. Learning outcomes: To understand the effect of bilingual exposure on childrens performance on measures of lexical and morphosyntactic development; to develop an awareness of bilectalism or of children growing up in a diglossic setting; to become acquainted with the socio-syntax of development hypothesis.
from children with language impairment based on their tests scores. A difficulty in establishing normative reference bases for bilingual children is the heterogeneity within the bilingual population. Among the many factors that impact the rate of development of bilingual children, one of the strongest may be the amount of exposure they have had to each language. This talk will present the results of a series of studies examining the effect of amount of bilingual exposure on bilingual performance on tests of language knowledge and language processing, and studies which examine the application of these bilingual normative data to the identification of language impairment in bilingual children. Preschool children learning French and English simultaneously (age 3 years and age 5 years, n=140) were administered a battery of tests in each language. Their amount of exposure to each language from birth was assessed by detailed parent report. Within each age group, children were matched on nonverbal cognitive level and socio-economic status, but differed on relative amount of exposure to each language, spanning the continuum from monolingual speakers, speakers with more exposure to English or French and speakers with equal exposure to the two languages. Amount of exposure exerted a strong influence on the rate of acquisition of vocabulary. Grammatical morphology as assessed in spontaneous language was also highly influenced by amount of exposure in terms of diversity and accuracy, with children with uneuqual exposure patterns exhibiting similarly unequal levels of grammatical competence and making different types of errors in each language. However, performance on measures that target language processing (notably nonword repetition) were much less affected by amount of exposure. A comparison of the vocabulary scores and nonword repetition scores of monolingual and bilingual children with and without language impairment showed that nonword repetition accurately separated groups of children with and without language impairment regardless of bilingualism. Overall, the results of these studies suggest ways in which the documentation of typical bilingual development can aid in the accurate identification of language impairment in young bilingual children. Preliminary data on young preschool children will be presented as well, extending these findings to an older age group. Learning outcomes: Participants will 1) gain a better understanding of the variables that affect the rate of bilingual language development, notably the effect of amount of exposure, 2) appreciate the difficulty inherent in the identification of language impairment in bilingual children, 3) be familiarized with the application of bilingual normative data to the identification of language impairment in bilingual children.
Icelandic as an l2: assessment of educational need and screening for language impairment
Abstract: I mmigration is a relatively new phenomenon in Iceland. Within only the last decade, the number of children in Icelandic schools who speak another language at home has increased rapidly. Previous research has indicated that Icelandic is learned less rapidly than English as an L2. This may be related to the structure of the language, to the low economic value associated with it, and to assessment instruments used. The present study examined the Icelandic language skills of 3 age groups of L2 learners and native speakers of Icelandic: children in grades 1-3, in grades 4-6 and grades 8-10 (n=250). The L2 learners included children whose L1 is tonal and whose L1 is not tonal given teacher reports that the former group experiences more difficulty in learning Icelandic. A new assessment tool was developed for this study, with four subtests targeting receptive and expressive vocabulary, definitions of words, phrases and idioms, and grammaticality judgment. Difficulty level was based in part on the language level of textbooks employed in Icelandic schools. An Icelandic test of nonword repetition was administered as well. In all three age groups, the L2 speakers scored significantly lower than native speaker controls. No significant difference was found between L2 speakers from tonal and non-tonal languages. L2 speakers performed as well as native Icelandic speakers on nonword repetition, suggesting that nonword repetition may be a useful screener for language impairment in L2 speakers. The results will be discussed further in terms of their relation to age of arrival and length of residence in Iceland. Learning Outcomes: Participants will be able to: 1)Familiarize themselves with the typical course of L2 acquisition by school-age children in the areas of vocabulary, grammatical development, 2) understand how the rate of learning relates to the age at which bilingual exposure begins, the length of residence, the language of origin and the economic value of the L2, 3) understand the different assessment procedures required to assess the needs of L2 children attending monolingual school in the L2 and the presence of a language impairment.
ATOS SPONSORED SYMPOSIUM WELCOME TO ATOS MEDICALS POST-LARYNGECTOMY PULMONARY REHABILITATION SYMPOSIUM CINDY VAN DEN BOER (1) - SIMONE SVELTO (2) - PETRA JONGMANS (3) DEPARTMENT OF HEAD & NECK ONCOLOGY & SURGERY NKI-AVL (1) SLP, DISTREX (2) - ATOS MEDICAL AB (3) Chairman: Antonio Sarno, Department of Otorhinolaryngology, Prato Hospital
Abstract: After total laryngectomy, the entire larynx is removed leading to a permanent disconnection of the upper and lower airways. Consequently, breathing is only possible through a permanent tracheostomy in the neck instead of the nose and mouth. Therefore, the nasal functions of warming, humidifying, and filtering of the inhaled air are lost and the intratracheal climate is dramatically worse (colder and drier) than the intratracheal climate when breathing normally through the nose. These changes lead to a wide range of pulmonary complaints such as frequent coughing, excessive mucus production and crusting. A large number of patients (>50%) complain of increased chest infections, which is most probably due to the loss of the nasal functions as well. The respiratory symptoms also significantly affect the quality of life of the patient. Several studies have demonstrated the clinical benefits of HME (Heat and Moisture Exchanger) use in laryngectomized patients, starting from as early as 1990. These benefits include a significant reduction in mucus production, coughing, forced expectoration, and stoma cleaning, as well as significant improvements in related aspects such as psychosocial functioning, voice and speech, fatigue, anxiety and depression, and sleeping. Recent studies have also shown that the use of an HME leads to an almost immediate improvement of the intratracheal climate in various climate conditions. Different types of HME are available, depending on the situation and preference of the patient. This presentation will be divided into three sections. First the physiological aspects of HME use are discussed, followed by an overview of the literature. During a hands on session it will be shown how to use the HME and the different attachment methods. Learning outcomes: : People will have (basic) knowledge of the functioning and need for the HME in restoring pulmonary function in the laryngectomized patient and clinical knowledge on how to use these products
How much does bilingual exposure affect test performance? Implications for the identification of language impairment in bilingual children
Abstract: The identification of language impairment in bilingual children is one of the great challenges faced by clinicians. The language knowledge of bilingual children are distributed over two languages, therefore, they can be expected to score lower than monolingual children when tested in each language separately. This, in turn, makes them hard to distinguish
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SE7
THE CAMPERDOWN PROGRAM FOR ADULTS WHO STUTTER: OVERVIEW AND PRACTICAL GUIDELINES SUE OBRIAN (1) AUSTRALIAN STUTTERING RESEARCH CENTRE, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (1)
Abstract: The Camperdown Program is an evidence-based, speech restructuring treatment for adults and adolescents who stutter. It can be implemented in individual or group format. The primary aim of the program is to reduce stuttering in everyday speaking situations. Aim: This seminar aims to familiarize participants with the program components and will use activities to teach participants the basic skills needed to implement the program. Prerequisites: The seminar is recommended for speech-language pathologists. Participants may benefit from reading the program manual in advance of the seminar. The manual and clinic forms can be downloaded from the website of the Australian Stuttering Research Centre (http://sydney.edu.au/ health-sciences/asrc/health_professionals/asrc_download.shtml) under the heading Camperdown Program Treatment Manual. Content: The seminar will begin with a brief overview of the program and the evidence in support of its outcomes. In the practical part of the seminar, activities will assist participants to gains skills in using, and teaching to clients, the essential components of the program the fluency technique, the stuttering severity rating scale and speech naturalness rating scale. Instatement of stutter-free speech using speech cycles will be demonstrated using video examples. Practical guidelines will also be given to help participants to move their clients through the problem-solving sessions. Learning Outcomes: At the conclusion of the seminar, participants should be able to: Know where to find relevant research articles about and the manual for the program; Describe the essential components of the program; Understand and use the program measurement scales; Teach prolonged speech using a video exemplar; Confidently guide a client through speech cycles.
FP135
THE EFFECTIVENESS OF THE ADAPTED BOX CLEVER PROGRAMME ON DEVELOPING VOCABULARY AND NARRATIVE SKILLS IN YOUNG CHILDREN WITH LANGUAGE-LEARNING DIFFICULTIES IN SRI LANKA SHYAMANI HETTIARACHCHI (1) - NICKY MORONEY (2) SENERATH ATTANAYAKE (3) - LASANTHI DASKON-ATTANAYAKE (3) - JONATHAN SOLOMON (4) - LALANI DISSANAYAKE (5) DEPARTMENT OF DISABILITY STUDIES, FACULTY OF MEDICINE, UNIVERSITY OF KELANIYA, RAGAMA, SRI LANKA (1) EAST LONDON NHS FOUNDATION TRUST, LONDON, UK (2) FREELANCE LAWYER AND DISABILITY-RIGHTS ACTIVITS, COLOMBO, SRI LANKA (3) CHRISTOPHER MITHRI CENTRE, SRI LANKA, COMMUNITY CENTRE, COLOMBO, SRI LANKA (4) SPECIAL SCHOOL, SPECIAL SCHOOL, COLOMBO, SRI LANKA (5)
Abstract: Speech and Language Therapy is a relatively new field in Sri Lanka with approximately 50-60 qualified therapists for a population of 20 million (1). Children with language-learning difficulties living outside of larger cities or from families experiencing socio-economic difficulties are particularly at a disadvantage from accessing available services (2). Whole-class intervention approaches facilitated by teachers or teaching assistants may be the key to providing speech and language therapy services to children currently not accessing therapy. Box Clever (3) is a method of language stimulation within the classroom (p.18) that incorporates aspects of non-directive play (4, 5) and target themes to scaffold and encourage language development. This approach has been used successfully with children in the foundation stage in Newham, London, to support the development of vocabulary and narrative skills (3). The aim of the current study was to determine the effectiveness of the Box Clever language enrichment whole-class programme to support vocabulary and narrative skills in primary school children experiencing language-learning difficulties. Ninety children (30 Sinhala-speaking; 30 Sri Lankan Tamil-speaking; 30 Sri Lankan sign language users) with language-learning difficulties between the ages of 5-12 years from special schools were included in the study. The modified Box Clever language-enrichment programme was offered as a whole-class approach twice a week for 12 weeks through the class teacher. Modifications were made to the programme to reflect cross-cultural research (6, 7, 8, 9, and 10) incorporating didactic language-teaching strategies and culturally-relevant themes to this non-directive therapy approach. Pre- and post-intervention language measures and statistical analysis of language scores were undertaken of receptive and expressive vocabulary on a picture-naming task of target and general vocabulary. In addition, content and syntactic analyses of narrative skills were undertaken using an adapted version of the Peter and the Cat Narrative Assessment (11) and Saman and the Baby Elephant Narrative Assessment, an informal local assessment. There were statistically significant differences in receptive and expressive vocabulary skills on target vocabulary items post-intervention in the participants from all three groups. Although positive gains were found in the receptive and expressive vocabulary skills for general vocabulary, this result was not statistical significant. Positive qualitative differences in the content and syntactic use were also observed post-intervention in the narratives of all participants. There was evidence of the emergence of complex syntactic structures in the narratives of some children. In addition, there were positive changes in the childrens levels of attention and motivation and in their play skills during the therapy sessions. Learning Outcomes: The participants will be able to: Appreciate the need for devising new therapy approaches and service delivery models in resource-poor contexts or hard to reach clients from ethnic minority communities; Understand the difficulties with implementing non-directive play therapy with clients from Noon-Caucasian ethnic minority communities; Understand the need to engage in collaborative, multi-disciplinary practice within educational settings.
FP134
THE EQUINE ASSISTED THERAPY AS STRATEGY IN SPEECH LANGUAGE PATHOLOGY INTERVENTION PEDRO MELO PESTANA (1) - SUSANA VAZ FREITAS (1) FACULDADE DE CINCIAS DA SADE, UNIVERSIDADE FERNANDO PESSOA, PORTO, PORTUGAL (1)
Abstract: Introduction: The Equine Assisted Therapy (EAT) is a therapeutic strategy globally investigated and reported evidences of being more effective in achieving the objectives of Speech Therapy. Research is scant and sometimes its relevance is devalued. Objective: With this study we intend to justify the presence of a speech therapist in an equine assisted therapy facility. Methods: Descriptive variables were analyzed (age classes; functional diagnostics; need for Speech Therapy; communication, language and speech goals, established in EAT program) for the 24 cases that benefit of an EAT program in northern Portugal. We describe, briefly, the study population and settle inferences about the need for a speech therapist in the context of an Equestrian Center. Results: It was found that the use of this program predominates in the age groups under 13 years. The diagnoses being most followed are communication disorders due to autism spectrum disorder. All cases with some type of disorder within the communication, language and speech components, which are mastered by the speech therapist, attend Equine Assisted Therapy program and develop those areas in this specific setting. Conclusion: This research underscores the importance of integrating a speech therapist in the team of an Equine Assisted Therapy program with greater relevance in preschool and school ages. Their role is most requested by patients with communication disorders due to autism spectrum disorders (ASD) but they have a role in all established diagnoses involving communication, language and speech impairments. Learning Outcomes: The Participant will be able to: Recognize the concept of EAT as a strategy in the rehabilitation areas, such as speech-language pathology; Identify the most common casuistic attending an EAT facility for speech therapy; Understanding the relationship between fulfillment of speech and language objectives in an EAT program concerning different diagnoses, age classes and identification of SLPs necessity; Recognize the importance of including a SLP in an EAT team.
FP136
THE EFFECT OF VOCABULARY TRAINING IN PRESCHOOLERS WITH DEVELOPMENTAL LANGUAGE DISORDERS GERRITS ELLEN (1) - FLOOR COHEN TERVAERT (2) NOELLE UILENBURG (3) RESEARCH GROUP SPEECH AND LANGUAGE THERAPY, HU UNIVERSITY OF APPLIED SCIENCES, UTRECHT, NETHERLANDS (1) LANGUAGE UNIT, NSDSK, AMSTERDAM, NETHERLANDS (2) RESEARCH AND DEVELOPMENT, NSDSK, AMSTERDAM, NETHERLANDS (3)
Abstract: This study aimed at evaluating the effect of a new vocabulary intervention protocol compared to usual care by speech and language therapists. Outcome was the difference between number of target words produced in a pre- and posttest by preschoolers with developmental language disorders. The intervention period was four weeks.Participants were 22 Dutch children with developmental language problems. They were 2 to 4 years old and attended a special language unit at kindergarten. The children were randomly assigned to a new vocabulary training protocol (experimental group)
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or to usual care (control group). Both interventions were scheduled for three 15 minutes-sessions per week for four weeks, in total 12 sessions. The preand posttest consisted of a naming task with pictures of 50 language-level appropriate words. 25 target words were selected for use in both interventions: 18 nouns and 7 verbs. The other 25 of the 50-words list served as control for spontaneous vocabulary growth. Experimental training consisted of evoked production of target words that were presented in situation scripts like Summer or The Zoo. The situation scripts consisted of play sessions with toys in which given utterances with target words were modeled by the speech therapists. The experimental training followed the four steps for successful teaching of new words, prepare, explain, consolidate, and check, described in Van Den Nulft & Verhallen (2010). Control intervention consisted of usual care: storybook telling and table-top activities in which target words were used. The results showed that all children produced more words after four weeks vocabulary intervention, except for one child. More importantly, children in the experimental group had learned four times more target words than children in the control group. In both groups there also was an increase in number of untargeted control words. However, the experimental group had learned much more target words than untargeted words. This difference was absent in the control group: the number of new target words was similar to that of untargeted words. The number of new verbs was limited compared to the number of new nouns. This confirms previous findings that verb learning is specifically impaired in children with developmental language disorders. In addition we found a difference between language level subgroups. Children with a language level of below age 2 (the lowest level in this study) learned significantly less new words than the children with a more advanced language level. The results of this study suggest that a very structured vocabulary training protocol enhances the number of new words learned in preschoolers with developmental language disorders. Learning Outcomes: The congress attendees will learn: The need for effect and efficacy studies in speech and language therapy; Outcomes of studies on efficacy of vocabulary training in children with specific language impairment; Methodology of randomized controlled trial; To provide effective vocabulary training
analysis (maximum phonation time - MPT, fundamental frequency - F0 and its variability, jitter, shimmer, glottal to noise excitation - GNE, noise and irregularity). Results: regarding the DG, it was predominantly positive response after three minutes of exercise, improving effort to speak, MPT and variability of F0; with the continuity of the exercise these parameters worsened, and phonatory effort perceived during the exercise was gradually worsening over time. Concerning the HVG, the MPT was the only parameter modified, which improved after one minute. Conclusions: positive vocal changes were observed with the flow resistant straw exercise, however there are dosage restrictions. Learning Outcomes: The Participant will be able to: 1. Learn the influence of time of execution of the flow resistant straw exercise; 2. Understand the multidimensional impact of a vocal exercise; 3. Understand the importance of using this technique in improving the standard normal vocal; 4. Identify the risks associated with the execution of a vocal exercise.
FP139
IMMEDIATE EFFECTS OF THE FINNISH RESONANCE TUBE METHOD ON BEHAVIORAL DYSPHONIA MARA BEHLAU (1) - SABRINA PAES (1) - FABIANA ZAMBON (2) ROSIANE YAMASAKI (1) - SUSANNA SIMBERG (3) CENTRO DE ESTUDOS DA VOZ - CEV, UNIFESP, SO PAULO, BRAZIL (1) - CENTRO DE ESTUDOS DA VOZ - CEV E TEACHERS UNION OF SAO PAULO CITY, UNIFESP, SO PAULO, BRAZIL (2) LOGOPEDICS AT ABO AKADEMI UNIVERSITY, TURKU, FINLAND (3)
Abstract: Background: The purpose was to investigate the immediate effects of the Finnish resonance tube method in teachers with behavioral dysphonia. Methods: 25 female teachers (m=39.9 years of age) with a history of dysphonia for over five years were included. Additional inclusion criteria were diagnostic of chronic behavioral dysphonia, indication for speech therapy and the absence of any prior speech therapy. Subjects produced three sets of 10 tokens of sustained phonation with one minute rest interval between tokens in a 27cm glass tube immersed in at least two centimeters of water. Voice samples were recorded before and after these sets. The effects of these exercises were evaluated by self-assessment, perceptual auditory analysis, and acoustic evaluation involving extraction of fundamental frequency (F0) and visual spectrographic analysis. Results: 68% of the teachers reported increased phonatory comfort and 52% reported improved voice quality after performing the exercises. Perceptual analysis indicated improved voice quality in the connected speech samples, confirmed by decreased instability, subharmonics, noise in high frequencies, and tendency to reduced low frequency noise on spectrographic evaluation. Additionally, mean F0 decreased. Conclusion: the Finnish resonance tube method produced increased phonatory comfort and vocal changes that suggest diminished hyperfunction. Learning Outcomes: The Participant will be able to: 1. Understand the immediate effects of the Finnish resonance tube method in behavioral dysphonia; 2. Understand the multidimensional impact of a vocal exercise; 3. Understand the benefits of this technique for this population; 4. Know the potential discomfort of this technique in immediate effect.
FP137
EFFECT OF VOCAL FUNCTION EXERCISES FOR PRESBYPHONIA SHUN INOUE (1) - RYOUJI TOKASHIKI (1) SHINJYUKU VOICE CLINIC, SHINJYUKU, JAPAN (1)
Abstract: We herein present the results of voice exercises as a treatment for presbyphonia. The subjects were 31 patients (13 males, 18 females) diagnosed with presbyphonia. All patients performed a modified version of vocal function exercises (VFE), and their changes in maximum phonation time (MPT), maximum expiration time (MET), vocal range, several acoustic parameters (shimmer, jitter, NHR), and voice handicap index (VHI) were evaluated before and after treatment. One month following initiation of therapy, all patients showed significant improvement in MPT, MET, pitch range, acoustic parameters, and VHI. MPT, pitch range, and VHI showed further and significant improvements at 2 months after therapy initiation. Voice therapy can improve vocal function in elderly people by improving acoustic parameters and lessening patients subjective symptoms of presbyphonia. Learning Outcomes: The participant will be able to: 1. know voice therapy is greatly improve voice quality of presbyphonia in short period (1-3month) without any surgical treatment. 2. know the vocal improvements were likely due to the higher load employed in the exercises.
FP140
ELECTROYOMYOGRAPHY ANALYSIS OF MASSETER AND SUPRAHYOID MUSCLES IN THE ORAL PHASE OF THE SWALLOWING OF HEALTHY ADULT PEOPLE ANDREA CRISTINA ROSSI DI GIOIA (1) ESTHER MANDELBAUM GONALVES BIANCHINI (1) UNIVERSITY VEIGA DE ALMEIDA, RIO DE JANEIRO, BRAZIL (1)
Abstract: The swallowing is a dynamic phenomenon divided into phases: oral, as voluntary phase, the pharyngeal and the esofagogastric as involuntariness showed the existence of a first stage characterized as a complex and coordinate activation of the muscles mandibular elevators (masseters and anterior temporalis) and muscles of the neck (sternocleidomastoids). The volume, the density and the viscosity of the material to be degutted determined the pressure to be generated into the oral cavity during the ejection, influencing the pharyngeal phase. The electromyography is a procedure not invasive, where sensors are utilized to detect the best variations of electrical potential amplitude that can occurred with the activation of the muscle tissue, obeyed the relation between the electromyography signal magnitude and the muscle contraction produced. The objective of this work is to evaluate the swallowing by the analysis of the electromyography activity of the masseter and suprahyoid muscles, trying characterized the dry and liquid voluntary swallowing with volume standardization. The 29 individuals that participate of this study were healthy adult without alteration in the deglutition and that have age between 18 and 50 years old, without complaints of swallowing or dysphagia history, no craniofacial deformity and no orthodontic treatment. Before the explanations about the procedures involved in the research, the volunteers signed the term of inform consent. It was observed that there is significative increase in the highest values of electrical potentials of the right, left and in the highest potential sides of the masseters in relation to the suprahyodes muscles in the swallowing of saliva, 10 and 20 ml of water. There isnt significative difference (p<0.05) at medium values of potentials between both muscles for the 3 types of swallowing. It was founded more
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FP138
EFFECT OF THE FLOW RESISTANT STRAW EXERCISE ACCORDING TO PERFORMANCE TIME MARA BEHLAU (1) - SABRINA PAES (1) CENTRO DE ESTUDOS DA VOZ - CEV, UNIFESP, SO PAULO, BRAZIL (1)
Abstract: Background: To verify the effect of the flow resistant straw exercise in women with behavioral dysphonia as well as in women with healthy voice according to performance time. Methods: 25 dysphonic women (DG), mean age of 35 years old (SD=10.5), with vocal complaint, voice deviation, diagnostic of chronic behavioral dysphonia and absence of any prior speech therapy, and 30 women with healthy voice (HVG), mean age of 31.6 years old (SD=10.3), without vocal complaint, neutral voice quality and lack of laryngeal variation. The participants were instructed to emit a continuous sound in a high resistance straw for as long as phonation remained comfortable, breathing when necessary up to complete a minute. Participants should had minded the phonatory effort applied during the exercise and then should had registered its intensity on a visual analog scale (VAS) of 100mm (0=effortless and 100=maximum effort). Other three similar series were made in sequence, lasting two minutes each, totaling in one, three, five and seven minutes of exercise. Samples of sustained vowel ae and counting numbers were recorded before the exercise accomplishment and after each series. During this task participants had to mind the effort applied to speak, then, should had registered its intensity in another VAS of 100mm. The effect of the exercise at different times was verified by self-assessment of phonatory effort (in speech and in exercise) and acoustic
potentials registred for the suprahyoids, considering the maximum values of the potentials obtained in the different swallowing with significative differences for the e types of swallowing, confirmed more activity of these muscle group during the swallowing, independent of type of ingest volume. For each type of swallowing the relation between the electrical potention of masseters and suprahyoids muscles were evaluated and statistical results were obtained for swallowing of 20 ml with significance (p<0.05). In this volume of swallowing, significative relation between the electrical activities of the studies muscles groups were observed, related o the most values of the masseters potentials, independently of the side rigth or left, with the potentials of the suprahyoids. For the swallowing of 20ml of water, the increase the potential of one of the muscles, increase the value expected of the potential of it antagonist. There is a direct relation between the electrical activity of studies muscles groups for swallowing of 20ml independently of the side rigth or left. More experimental study will be necessary to develop the relation with these muscles and others who participate in the swallowing. Learning Outcomes: The participant will be able to: 1) understand the figures about electromyoghraphy of the masseter and suphahyoid muscles in the different swallowing experiments; 2) see in the figures the difference in the stimulation of the antagonist muscle in response of the other muscle when swallowing 10 and 20ml of water; 3) know the synergistic way of the cooperation with the muscles of swallowing during this action.
the fluency under that condition was especially remarkable. All generation also performed significantly prolonged swallow latency under (b) condition. The elderlys prolongation of the swallowing latency under that condition was especially remarkable. These results suggest followings. 1) The deterioration of pharyngeal swallow function starts in middle age. 2) Jaw and lips closure is more important than neutral tongue elevation at beginning and during the swallow. 3) The Influence of oromotor dysfunction on pharyngeal swallow must be more serious in the elderly adults than in other generations. Learning Outcomes: The Participant will be able to know followings: It is necessary for middle-aged and elderly adults to be illuminated the appropriate feeding method for preventing aspiration, malnutrition and choking from when they are healthy; You have to suspect dysphagia when the patient indicates the features of oromotor dysfunction; The jaw and lips closure must be trained before the straight tongue elevation.
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HOW DO SPEECH PATHOLOGY & AUDIOLOGY POPULATION BASED INTERVENTIONS SERVE THE UNDERSERVED? MERSHEN PILLAY (1) UNIVERSITY OF STELLENBOSCH, CAPE TOWN, SOUTH AFRICA (1)
Abstract: Population based interventions may be useful in addressing the needs of populations that have been marginalised by Speech Pathology and Audiology services. Globally, it is established that Speech Pathology and Audiology professions promote the values and beliefs of middle-class, urban, White, Euro-American, Judeo-Christian, literate peoples. These values may be transplanted, in muted or mutated forms, even when these professions are practiced in places such as in Africa or Asia. However, our world consists mainly of people who are poor. They are also mainly not white, nor are they mainly European or North American, Judeo-Christian or even mainly literate. It is these populations, the majority peoples of the world, who may be marginalised by our services. Arguably, population based interventions may benefit all underserved populations from Antigua to Zululand, Alaska to Zion or Anqing to Zhangzhou. Given that, as a strategy and a philosophy of practice, population based intervention has great potential to serve the underserved, how then have the professions of Speech Pathology and Audiology considered such practices? In responding to this inquiry, we ask: What have we meant when practising population- based interventions? For example, for an Audiologist practicing within a population based framework, will she focus on the early identification or screening of hearing loss? Or, perhaps, for a Speech Pathologist population based intervention is about patient/family education regarding communication disorders in adults post-stroke. In order to investigate what Speech Pathologists and Audiologists mean by population based interventions, a qualitative literature review is presented of activities identified by published researcher-authors as engaging population based interventions (and associated activities). A technical, descriptive overview of the following data will be presented: The core question asked is: What is the nature of Speech Pathology and Audiology driven, population based interventions? Disciplinary field of practice where population based interventions have been used; Type, location and nature of population based intervention activity; Personnel involved in performing the population based activity; Procedures and equipment used to perform the population based activity; Feature analysis of the population engaged during the activity such as age range, cultural, racial and linguistic factors. This technical description of Speech Pathology/Audiology driven, population based interventions are presented vis-a-vis two further levels of analyses. Firstly, information obtained from the descriptive review of the literature is used to generate associated conceptual parameters of population, population based and of intervention as used by Speech Pathologists, Audiologists and related professions. Secondly, this data is mapped onto a critical evaluation of population based intervention relative to marginalised populations in the world. Therefore, the next level of analysis is focussed on the kinds of population based interventions provided to marginalised populations to manage people and their communication and/or swallowing disorders. Finally, we present theoretical and practical explorations of how population based interventions may address practice inequalities for Speech Pathology and Audiology services with a cautionary acknowledgement of the threat of the dominant, valued focus on individualised, curative rehabilitation. Learning Outcomes: At the end of this seminar, attendees will: Be able to identify three challenges of population based interventions; Be left with the choice to continue practicing as they always have or to re-consider practice that fundamentally shifts their public based interventions.
FP141
COMPARISON OF TIMING ABNORMALITIES LEADING TO PENETRATION VERSUS ASPIRATION DURING THE OROPHARYNGEAL SWALLOW NOGAH NATIV (1) - JERILYN LOGEMANN (1) - PETER KAHRILAS (2) DEPARTMENT OF COMMUNICATION SCIENCES AND DISORDERS, NORTHWESTERN UNIVERSITY, CHICAGO, UNITED STATES (1) DEPARTMENT OF MEDICINE, FEINBERG SCHOOL OF MEDICINE, NORTHWESTERN UNIVERSITY, CHICAGO, UNITED STATES (2)
Abstract: Background: Penetration and aspiration during the oropharyngeal swallow can have different clinical implications. This study examined the pathophysiologic mechanism that differentiates the two events. Methods: This retrospective study compared temporal measures of swallows of patients who presented with penetration-only on the Modified Barium Swallow Study, those who showed aspiration (during the swallow) and normal control subjects. Results: Significantly longer timing measures were found for the penetration and aspiration groups compared to the normal group. Aspiration group intervals were similar or shorter compared to the penetration group. Conclusions: Aspiration during the swallow was not associated with a more severe timing disorder than penetration. In addition to the timing deficit, there is likely an additional, neuromuscular disorder at the vocal fold level, allowing for deeper invasion of material into the airway in the aspiration cases. In addition, findings point to slow laryngeal elevation, and not a delayed onset of the pharyngeal response, as the dominant cause for the deficient timing aspect of aspiration during the swallow. Learning Outcomes: The participant will be able to: 1) Understand the different theories explaining pathophysiologic differences between penetration and aspiration during the swallow 2) Apply the findings of this current study to differentiating between penetration and aspiration and mechanisms responsible for aspiration during the swallow. 3) Apply clinical implications of findings arising from this study to the reading of videofluoroscopic studies.
FP142
THE INFLUENCE OF TONGUE, JAW, AND LIPS POSITION ON PHARYNGEAL SWALLOW MANA YAMORI (1) - YUKA MURAKAMI (1) - ERIKO KUWABATA (1) - SAORI NYUGAKU (1) DEPARTMENT OF COMMUNICATION SCIENCES AND DISORDERS, FACULTY OF HEALTH AND WELFARE, PREFECTURAL UNIVERSITY OF HIROSHIMA, MIHARA, JAPAN (1)
Abstract: Prevention against aspiration pneumonia and malnutrition requires not only detecting oropharyngeal dysphagia on a simple method in early stages, but also giving the appropriate rehabilitation swiftly. In this paper, we studied relation between oromotor dysfunctions and pharyngeal stage of the swallow among different age groups. The purpose of this study was to investigate how affected pharyngeal swallow by changing position of the tongue, jaw and lips in young, middle-aged, and elderly adults. 27 young (average age 20.480.89 years16 middle-aged (average age 43.508.20 years, and 10 elderly (average age 71.06.90 yearshealthy participants were recruited. All participants performed the Repetitive Saliva Swallow Test (RSST) under four conditions changing the position of the tongue, jaw and lips simulated oromotor dysfunction. The conditions are as followings; (a) normal position, (b) jaw and lips opening, (c) tongue down, (d) deviated tongue down. Their swallow fluency and the first swallow latency were measured in each condition. In all conditions, the swallow fluency of the elderly and middle-aged decreased significantly than the youngs. All generation showed significant lower fluencies under condition (b), (c), (d) than condition (a). The lowest fluency was performed under (b) condition in each age group. The elderlys decrease of
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FP143
COMPARISON OF INTENSIVE AND STANDARD VOICE THERAPY IN THE MANAGEMENT OF VOCAL NODULES: AT SIX MONTHS FOLLOW-UP SHERRY FU (1) - DEBORAH THEODOROS (1) - LIZ WARD (2) DIVISION OF SPEECH PATHOLOGY, UNIVERSITY OF QUEENSLAND, BRISBANE, AUSTRALIA (1) - CENTRE FOR FUNCTIONING AND HEALTH RESEARCH (CFAHR), QUEENSLAND HEALTH, BRISBANE, AUSTRALIA (2)
Abstract: Although there has been extensive research on the effectiveness of various voice therapy approaches in the treatment of vocal nodules, there
has been a lack of agreement or recommendation as to the intensity of voice therapy for this population. Hence, the aim of the study was to determine the effect of intensive voice treatment for vocal nodules on auditory perceptual ratings, acoustic and aerodynamic parameters, compared to standard voice treatment. A cohort of 53 adult female participants was allocated to two groups: intensive treatment and traditional treatment. The intensive treatment model consisted of one session of vocal hygiene followed by eight sessions of voice therapy which were given within a three week period. The traditional treatment model consisted of the same number of sessions of voice therapy which were given once a week for eight weeks, consistent with current management practices in our service. Auditory perceptual ratings, acoustic parameters and aerodynamic measurements were evaluated before, after treatment, and at six months follow-up. Analysis revealed significant (p<0.05) improvements in acoustic parameters (Fo, jitter, shimmer) pre to post treatment in both groups. Continued improvements were noted in the acoustic parameters of (jitter, shimmer, noise-to-harmonic ratio) for the intensive voice therapy group at six month follow-up. No significant differences were noted in aerodynamic parameters pre to post treatment in either group. There was a trend towards improvements in perceptual ratings in both groups. Overall, the findings indicate positive benefits from intensive voice therapy which are comparable or better than those achieved with traditional weekly voice therapy. Learning Outcomes: The participant will be able to: 1. know the important information concerning the optimal duration and intensity of voice therapy for patients with vocal nodules; 2. provide their own clients with information regarding therapy intensity; 3. understand how therapy intensity effects acoustic and aerodynamic measurements and auditory perceptual ratings.
normal participants; 2. understand the perturbation parameters for acoustic signals and those of EGG signals; 3. compare the change of EGG parameters for the irregularities of vocal cord vibration and a parameter for the degree of vocal fold contact.
FP145
THE EFFECTIVENESS OF THE COMPREHENSIVE VOICE REHABILITATION PROGRAM COMPARED WITH VOCAL FUNCTION EXERCISES TO TREAT FUNCTIONAL DYSPHONIA: A RANDOMIZED BLINDED CLINICAL TRIAL. VANESSA PEDROSA (1) - ANTNIO PONTES (1) - PAULO PONTES (1) MARIA STELLA PECCIN (1) - MARA BEHLAU (2) FEDERAL UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (1) CENTER FOR VOICE STUDIES, FEDERAL UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (2)
Abstract: Background: Voice therapy is considered the best treatment for functional dysphonia. The goal of speech therapy is to reduce vocal limitations and improve voice-related quality of life. Different types of voice treatment have been applied to a wide range of voice disturbances; some describe specific approaches, some refer to organized therapy programs and still others are eclectic approaches that use a combination of strategies. To date, few studies have tested the effectiveness of treatment regarding treatment duration, improvement of voice quality, quality of life and laryngeal condition. Objective: To evaluate the effectiveness of the Comprehensive Voice Rehabilitation Program (CVRP) compared to Vocal Function Exercises (VFE) to treat functional dysphonia. Methods: 80 voice professionals ranging in age from 18 to 50 years old who raised complaints about their voices and have presented signs or symptoms functional dysphonia for over six months were randomized into two equally sized voice treatment groups subject to: a) the CVRP; or b) VFE. The volunteers were evaluated by a speech and language pathologist and an otolaryngologist through a program consisting of three evaluations and six voice treatment sessions, with the three evaluations conducted before speech therapy, at the time of the patients completion of the treatment sessions and one month following the treatment sessions. The outcomes evaluated were the scores obtained according to the Voice-Related Quality Of Life Index (VRQOL) and to the Voice Handicap Index (VHI), a perceptual evaluation of the subjects voice and a visual examination of the larynx. Otorhinolaryngology and speech therapy evaluations were blinded and identified using random numbers. Results: The randomization process produced comparable groups in terms of age, gender, signs and symptoms. There was a increase in the mean score of the VRQOL (64.44 to 82.19 in the CVRP group; 72.00 to 87.00 in the VFE group), and a decrease in the means score of the VHI (43.00 to 21.32 in the CVRP group; 31.52 to 17.70 in the VFE group), auditory perception (48.63 to 33.33 in the CVRP group; 46.88 to 40.5 in the VFE group), and visual examination of the larynx (81.42 to 44.17 in the CVRP group; 75.63 to 51.75 in the VFE group). The CVRP effect size was 1.09 for the VRQOL, 1.17 for the VHI, 0.79 for perceptual evaluation of the voice and 1.01 for visual examination of the larynx. The VFE effect size was 0.86 for the VRQOL, 0.62 for the VHI, 0.48 for the perceptual evaluation of voice and 0.51 for the visual examination of the larynx. Ten percent of patients were lost over the course of the study. Conclusion: The Comprehensive Voice Rehabilitation Program was as effective as Vocal Function Exercises in a comparison of continuous data. According to an epidemiological analysis, the probability of a patient improving on account of treatment under the Comprehensive Voice Rehabilitation Program was greater than on account of treatment using Vocal Function Exercises. Learning Outcomes: To learn the steps of a clinical trial of voice therapies. To understand the importance of other dysphonia treatment protocols using a symptomatic approach. To identify differences in treatment protocols. To appreciate the need to conduct clinical trials of voice therapies.
FP144
IMMEDIATE EFFECTIVENESS OF HUMMING ON COMPUTED ELECTROGLOTTOGRAPHIC PRAMETERS IN DYSPHONIC PATIENTS WITH MUSCLE TENSION DYSPHONIA MAKOTO OGAWA (1) - KIYOHITO HOSOKAWA (1) HIDENORI INOHARA (1) DEPARTMENT OF OTORHINOLARYNGOLOGY-HEAD AND NECK SURGERY, OSAKA UNIVERSITY GRADUATE SCHOOL OF MEDICINE, OSAKA, JAPAN (1)
Abstract: Background: In patients with muscle tension dysohonia (MTD), voice therapy sessions using humming were reported to bring improvements in the perceptual voice qualities, the degree of supraglottic compression and acoustic (Ac)/electroglottographic (EGG) computed parameters. In addition, it was reported that voice therapy using humming relieved vocal disturbances not only in dysphonic patients but also in non-dysphonic speakers. However, the cause-result relationship between humming and the vocal outcomes remains to be sufficiently elucidated. Based on the results from relevant literatures, we hypothesized that humming would have a direct influence on the condition of the vocal fold vibration and adduction. The aim of this study was to investigate the immediate effects of humming on the computed parameters of Ac and EGG signals for the regularity of vocal fold vibration and the degree of vocal fold contact in MTD patients and non-dysphonic speakers.Patients and Methods: We enrolled 17 dysphonic participants showing supraglottic compression without any organic abnormalities in the vocal folds and 17 nondysphonic control participants. However, the participants showing contact between the supraglottic structures were excluded. After performing otolaryngological assessments, simultaneous Ac and EGG recordings were made in a sound-treated room. The head-worn condenser microphone was laterally positioned 2 cm from the lips and the EGG electrodes were fitted on the neck over the bilateral lamina of the thyroid cartilage. For approximately three seconds, each participant was directed to phonate a sustained vowel /e:/ at a natural and comfortable pitch and loudness, and subsequently induced to hum /m:/ in a relaxed manner with maximum resonance. The Ac and EGG signals were low-pass-filtered at 10 kHz and band-pass-filtered from 40 Hz to 5 kHz using a finite impulse response digital filter, respectively. The same intervals of approximately 1000 msec from both signals were extracted for the calculation of a five-point period perturbation quotient (PPQ) and an 11-point amplitude perturbation quotient (APQ). The EGG contact quotient of peak amplitude 35% (EGG-CQ) was also calculated. Results: Significant differences in the sustained vowel between the patients with the different diagnoses were found in the EGG-PPQ/APQ as well as the Ac-PPQ/APQ. In the MTD participants, humming brought about significant decreases in the EGG-PPQ/APQ as well as the Ac-PPQ/APQ. Even in the control participants, the EGG-PPQ/APQ showed significant decreases during humming. In the comparison of the EGG-CQ, no significant differences were found between the sustained vowel and humming phonations in either of the two groups. Conclusions: It was demonstrated that humming itself induced corrective effects on the EGG perturbation parameters, suggesting that humming could correct the period irregularity of the vocal fold vibration and cycle-to-cycle fluctuation of the vocal fold contact area. However, the EGG-CQ showed no difference between the phonation types or between the diagnoses. These results suggest that the effects of humming on the perceptual voice qualities were dependent on the adjustment of vocal fold vibration rather than the relief of the vocal fold contact. Learning Outcomes: By the ending of our presentation, attendees will be able to: 1. know the actual effects of humming phonation on the condition of the vocal folds using EGG in patients with muscle tension dysphonia and
FP146
SEARCH (STUDY OF ENVIRONMENT ON ABORIGINAL RESILIENCE & CHILD HEALTH): USING CULTURALLY APPROPRIATE ASSESSMENTS WITH URBAN AUSTRALIAN ABORIGINAL CHILDREN ALISON PURCELL (1) - HASANTHA GUNASEKERA (2) SANDRA BAILEY (4) - EMILY BANKS (4) - ALAN CASS (4) KATHLEEN CLAPHAM (4) - SANDRA EADES (4) - PETER MCINTYRE (4) BEVERLEY RAPHAEL (4) - SALLY REDMAN (4) FRANK VINCENT (4) ANNA WILLIAMSON (4) - SUSAN WOOLFENDEN (4) DEBRA FERNANDO (3), JONATHAN CRAIG (4) SPEECH PATHOLOGY, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (1) - SYDNEY MEDICAL SCHOOL, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (2) - SEARCH STUDY, THE SAX INSTITUTE, SYDNEY, AUSTRALIA (3) - AUSTRALIA (4)
Abstract: Information about urban Australian Aboriginal children is limited. More than half of the Aboriginal population of Australia lives in cities or large regional centres, yet only 11% of Aboriginal health publications in
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the last five years have focused on urban Aboriginal people and fewer on urban Aboriginal children. SEARCH (Study of Environment on Aboriginal Resilience and Child Health) is a community-initiated study involving urban Aboriginal children attending Aboriginal Community Controlled Health Services (ACCHSs). SEARCH is Australias largest prospective cohort study of urban Aboriginal children, providing the first comprehensive information on the causes of health and illness in this group. This project is a partnership between ACCHSs, the Aboriginal Health and Medical Research Council, and a senior team of researchers to develop evidence to improve the health of urban Aboriginal children. SEARCH aims to describe the communication development of urban Australian Aboriginal children, investigate factors associated with communication development and examine the appropriateness of standard speech pathology tests for urban Aboriginal communities. At October 2011, over 1600 children have been recruited to the study. 1500 have received audiology assessment to measure ear health and 578 have received assessment of speech and language development (children 1 to 7 years). This paper will introduce the SEARCH study and present the speech and language assessment protocol used by the SEARCH speech pathologists. It will outline the processes undertaken to ensure that the SEARCH speech and language assessment tools and scoring procedures are culturally sensitive and appropriate for urban Aboriginal children. Learning Outcomes: Participants will learn How to work in collaboration with Aboriginal communities; How to develop culturally safe and appropriate assessment tools for urban Aboriginal children; To be able to analyse and report in a culturally safe and appropriate manner the communication abilities of urban Aboriginal children.
theoretical conceptions of work with the Deaf. The corpus was analyzed according to the Bardin (1977) propose in which the organization of the analysis is done around five chronological poles: pre-analysis, exploration of the material, the processing of the results, inference and interpretation considering the three main theme: Bilingualism, Deaf Culture and Sign Language. We conclude that the representations that have the language therapists about Bilingualism, Deaf Culture and Brazilian Sign Language cannot be defined in just one word or phrase, because it is very varied. However, we could realize that language therapists are aware that there are other ways of understanding the Deaf and although many questions are still present paradigms regarding the role of the language therapists in an approach that considers Sign Language and Deaf culture prevalent as points of importance on the work with the Deaf. Sign Language, Deaf culture and the aspects related to them are present in the mind of the language therapists, which was not the case five years ago before the laws. Learning Outcomes: This work is important to show the need for the Speech/ language therapists to be aware of the Deaf community, culture and identity. It can promote a reflection among the professionals and students about the new paradigms that are on society nowadays about the Deaf and allow to move to other forms of work.
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DEVELOPMENT OF A CANTONESE LEXICAL TONE DICHOTIC LISTENING TEST: A STEP TOWARDS IDENTIFYING INDIVIDUALS WITH AUDITORY PROCESSING DISORDERS KEVIN YUEN (1) PHD, MSC (AUDIOLOGY), BSC (SPEECH & HEARING SC), OSPEDALE, HONG KONG, (1)
Abstract: There is behavioral (Bellis & Ferre, 1999; Moncrieff & Musiek, 2002) and electrophysiological (Kraus et al., 1996; Wible, Nicol, & Kraus, 2005) evidence on the association between auditory processing difficulties and language or learning difficulties. Even mild APD, if left undiagnosed and untreated in early childhood years, may exert a significant negative effect on childrens social, communication, language and academic competencies and other life functions (Heine & Slone, 2008). Unfortunately, if they reach adolescence before the auditory processing problem surfaces, they may experience problems in coping with high academic demands. Without locally developed standardized materials, identifying and diagnosing children with APD, or effectively intervening would be very difficult, if not impossible. In Hong Kong, the test materials dedicated to the assessment of auditory processing function in children is scarce. Dichotic listening (DL) tests are key diagnostic tools for auditory processing disorders (Jerger, 2007). In DL tests, two different acoustic stimuli are presented to each ear simultaneously. Dichotic listening (DL) testing paradigm is a well-documented research method that reveals how auditory information is processed from one side (such as the right ear) when a competing signal is simultaneously presented from the other side (such as the left ear). The top-down versus bottom-up two-component processing model explains the laterality effects of different testing conditions for DL (Hiscock & Kinsbourne, 2011). By the age of two or even earlier, normally developing children have already acquired lexical tone production and perception close to that of adult form as reported in cross-sectional and longitudinal studies in Cantonese (Lee, 2012; So & Dodd, 1995; Tse, 1978). The development of the DL test using Cantonese lexical tones has a potential to identify native speakers of Cantonese especially very young children who are at risk for typical auditory processing development. The development of the new Cantonese lexical tone dichotic listening is based on the top-down-bottom-up two-step information processing model. Under this model, by contrasting the performance in divided attention, right directed attention listening, and left directed attention listening, when compared with the norms, individuals with different information processing deficit profiles can be identified which are bottom-up stimulusdriven processing deficits, top-down instruction-driven processing deficit, and both. We have tested our innovative test procedure in lexical tone DL in 60 young adults in Hong Kong. This presentation will discuss the outcomes of this study on adults and the motivation for conducting a large-scale development study for typically developing and developmentally disabled Cantonese-speaking children.
FP147
SEARCH (STUDY OF ENVIRONMENT ON ABORIGINAL RESILIENCE & CHILD HEALTH): HEARING, SPEECH AND DEVELOPMENTAL OUTCOMES ALISON PURCELL (1) - HASANTHA GUNASEKERA (2) SANDRA BAILEY (4) - EMILY BANKS (4) - ALAN CASS (4) KATHLEEN CLAPHAM (4) - SANDRA EADES (4) - PETER MCINTYRE (4) BEVERLEY RAPHAEL (4) - SALLY REDMAN (4) FRANK VINCENT (4) ANNA WILLIAMSON (4) - SUSAN WOOLFENDEN (4) DEBRA FERNANDO (3), JONATHAN CRAIG (4) SPEECH PATHOLOGY, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (1) - SYDNEY MEDICAL SCHOOL, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (2) - SEARCH STUDY, THE SAX INSTITUTE, SYDNEY, AUSTRALIA (3) - AUSTRALIA (4)
Abstract: Australian Aboriginal children living in remote communities experience a high burden of middle ear disease but little is known about the burden in urban Australian Aboriginal children. Data are also scarce on hearing, speech and language impairment abilities in urban Aboriginal children. The Study of Environment on Aboriginal Resilience and Child Health (SEARCH) is a large cohort study examining the health of urban Aboriginal children attending four Aboriginal Community Controlled Health Organisations in western Sydney, Newcastle, and Wagga Wagga. This paper will present the frequency of middle ear disease, hearing impairment, developmental and speech and language delays in urban Aboriginal children.Audiologists examined the middle ears of all children, and completed hearing assessments with age-appropriate techniques on all compliant children. A speech pathologist performed the Parents Evaluation of Developmental concerns (PEDs) and age and culturally appropriate speech and language assessments on all children younger than 8 years. Receptive and expressive language scores below 16th percentile were considered impaired. Middle ear disease (acute otitis media, otitis media with effusion, perforation or chronic suppurative otitis media) was identified in 418/1126 children (37.1%). Severe middle ear disease (wet or dry perforation) was identified in 2%. Hearing impairment (>20dB loss in the best ear) was identified in 80/781 children (10.2%), of whom 71/80 (89%) had middle ear disease. Speech skills were not age-appropriate in 46% of children (0-8yrs). Receptive language impairment was found in 36.7% children (0-5yrs) and expressive language impairment was found in 36.2% children (0-5yrs). Learning Outcomes: Participants will learn The incidence of hearing loss in urban Australian Aboriginal children; The incidence of Aboriginal parent concerns regarding their childs development; The incidence of speech and language impairment in urban Australian Aboriginal children.
FP148
SPEECH THERAPY AND THE BILINGUALISM FOR THE DEAF MARIA CECILIA DE MOURA (1) - VINICIUS NASCIMENTO (2) PONTFICIA UNIVERSIDADE CATLICA DE SAO PAULO, SAO PAULO, BRAZIL (1) - FACULDADE SINGULARIDADES DE EDUCAO, SAO PAULO, BRAZIL (2)
Abstract: The objective of this work is to understand what is the representation of language therapists have about bilingual education, Deaf culture and Sign Language and how these aspects are considered in speech therapy practice. For that, it was done interviews with nineteen language therapists formed by different universities in Brazil that correspond to various
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WEDNESDAY 28TH AUGUST

SP4
ACHIEVING BEST OUTCOME IN CHILDREN WITH COCHLEAR IMPLANTS HELEN GRECH (1) - ROBERTA BUHAGIAR (2) KATRIN NEUMANN (3) - ALESSANDRO MARTINI (4) IALP, UNIVERSITY, MSIDA, MALTA (1) UNivERSITY OF SOUTHAMPTON, UNITED KINGDOM (2) RUHRGEBIET, CLINIC OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY, RUHR-UNIVERSITY OF BOCHUM, GERMANY (3) ENT-AUDIOLOGY, NEUROSCIENCES DEPT., UNIVERSITY HOSPITAL, PADOVA, ITALY (4)
Abstract Presentation 1: Issues Related to Implanting Children at Younger Ages and the Effects on Outcomes: Cochlear implantation in children has seen great advancements in recent years. We are now able to detect hearing loss at birth and consequently implant at younger ages. We are consistently looking at expanding the criteria for implantation and implanting more diverse patients. Bilateral implantation is becoming more common in children and there is more evidence of the benefits of bilateral implantation and associated benefit in quality of life. Multidisciplinary input is of utmost importance in order to help children reach their full potential and this is becoming more evident as more children with complex needs are being implanted. This session will aim to explore the issues related to implanting children at younger ages and the effects on outcomes. Outcomes with bilateral implantation (for both simultaneous and sequential patients) and benefits in quality of life will also be discussed. Rehabilitation methods, including music packages, will be explored with a view to support the development of individual needs. Abstract Presentation 2: Optimization of objective measures and behavioral examination in speech processor fitting: The benefit of a cochlear implant (CI) is highly correlated to the adequateness and quality of speech processor (SP) fitting since it is the SP which determines the properties of all electric stimuli. Besides the fundamental parameters such as pulse rate and frequency coding, the transduction of sound intensity to stimulus strength is the crucial factor of sound and speech encoding. While in juveniles and adults the lower limit of stimulation (LSL = lowest sensation level) and its equivalent at the upper end of the scale (UCL = upper comfortable level) are easily adjusted in cooperation with the recipient, in children the individual map parameters LSL and UCL are fitted on the basis of objective measures and observation of behaviour. The objective measures originate from intraoperative recordings of the electrically evoked compound action potential (ECAP) and the intra-operative observation of the acoustic reflex (ESRT = threshold of electrically evoked stapedial reflex). In the first post-operative power-up session, the values of LSL and UCL are adapted according to empirical prescription rules based primarily on ECAP data. These initial values are then corrected according to behavioural examination, especially the aided threshold for wobble tones in free sound field. This threshold should be highly correlated to the LSL values (T-level) of the actual map since the CI system delivers a stimulus of exactly this strength if the acoustic input reaches the corresponding trigger level (T-SPL). It can easily be understood that a reduction of LSL below the true electric threshold leads to an elevation of the acoustic threshold. In contrast, the consequence of too high LSL values depends on the principles of signal coding: In systems which dont deliver any stimulus below the trigger level, the acoustic threshold will be unchanged if LSL is raised. This causal law directly implicates a simple rule for the fitting of LSL: The correct value is found if a further elevation of LSL does not affect the acoustic threshold. In our experiments conducted in order to prove this rule, 25 adult recipients of the Cochlear CP810 system have been examined. The aided threshold was determined with 4 maps characterized by variations of LSL from 0 CL to -10 CL, +10 CL and +20 CL (CL = cochlear current level). The results show that the threshold is shifted by approximately 2 dB if LSL is modified by 10 % in the average, the largest effect being observed at 1000 Hz. Abstract Presentation 3: Cochlear Implants in difficult cases: A cochlear implant (CI) is a partially implanted electronic device that can help to provide a sense of sound and support speech to severely to profoundly hearing impaired patients. Children and adults who are profoundly or severely hearing impaired can be fitted with cochlear implants. According to the Food and Drug Administration, approximately 188,000 people worldwide have received implants. Regarding the costs/efficacy ratio, the CI is expensive, in particular because of the cost of the high technological device, long life support, but even if healthcare costs are high, the savings in terms of indirect costs and quality of life are important. The CI, in fact, has a positive impact in terms of quality of life. With regard to the results after cochlear implantation in relation to early implantation, better linguistic results are reported in children implanted before 12 months of life, even if no sufficient data exist regarding the relation between this advantage and the duration of implant use and how long this advantage persists in the subsequent years. With regard to cochlear implantation in children older than 12 months the studies show better hearing and linguistic results in children implanted at earlier ages. A sensitive period under 24-36 months has been identified over which cochlear implantation is reported to be less effective in terms of improvement in speech and hearing results. With regard to clinical effectiveness
of bilateral cochlear implantation, greater benefits from bilateral implants compared to monolateral ones when assessing hearing in quiet and in noise and in sound localization abilities are reported to be present in both case of simultaneous or sequential bilateral implantation. However, with regard to the delay between the surgeries in sequential bilateral implantation, although benefit is reported to be present even after very long delays, on average long delays between surgeries seems to negatively affect the outcome with the second implant. A particular aspect is the expected outcome in children with malformed cochlea and/or associated disabilities. With regard to benefits after cochlear implantation in children with multiple disabilities, benefits in terms of speech perception and communication as well as in quality of the daily life are reported even if benefits are slower and lower in comparison to those generally attained by implanted children without additional disabilities. Regarding the cases of cochlear malformations, the benefits are discussed in relationship with the type and grade of malformation. Abstract Presentation 4: Achieving Best Outcome in Children with Cochlear Implants: A Pediatric-Audiological and Surgical Perspective: During the past decade, the indications for the treatment of children with cochlear implants (CIs) have been extended and refined which was paralleled by a better outcome from these devices in general. The hearing loss for fitting children with CIs decreased from complete or close to deafness to a profound hearing loss of about 80 dB in the worst ear, even if the better ear has a mild or moderate hearing loss. Also for children with unilateral deafness and normal hearing on the other ear the fitting of a CI starts to become the standard treatment. For children with a profound hearing loss in the high frequencies above 1 kHz and hearing in the lower frequencies (partial deafness), combined electric acoustic stimulation might be beneficial, given that the hearing loss has not progressed over a longer period (Skarzynski & Lorens 2010). The extension of CI indication to children with auditory neuropathy even if their hearing loss is not a profound one but their speech performance is poor extended the treatment indication to the respective children. Furthermore, evidence for a significant rehabilitation progress, even if slow, of multi-handicapped or intellectually disabled children fitted with CIs, led to an increased confidence in the benefit of CIs also for such children. Improved electrode design and speech processing strategies enable a tailoring of a CI to an individual child. In particular, different lengths and degrees of flexibility of the electrodes are available in order to ensure the protection of residual hearing or to meet the restrictions of cochlear malformations or calcifications. Principles of soft surgery such as avoiding cochleostomy drillings if possible and the use of the round window access, a smooth and slow insertion of the electrode, and membrane protection by applying deport corticoids considerably enhanced the CI outcome in children. Improved speech strategies such as FSP (Fine Structure Processing), ADRO (Adaptive Dynamic Range Optimization) or HiRes 120TM aiming on a more refined coding of the temporal envelope of sound signals and of their temporal fine structure, on an optimization of the dynamic range of sound signals, and on and a better pitch resolution, improved the outcome of CI treatment in children considerably during the past years. The implementation of Newborn Hearing Screening programs in many countries and regions ensured that the standard age of treating babies with CIs decreased more and more. In many centers, unilateral CI surgery is carried out from age 6 months of life on, and bilateral simultaneous implantation from age 8 months on, because an implantation as early as possible ensures the best physiological conditions for a maturation of the auditory cortex and a good outcome. Furthermore, rehabilitation concepts have been adapted to babies and young infants by focusing on prosodic and musical elements in a more systematic way than before. Learning Outcomes: After attending this roundtable, participants will be able to:Understand advances in cochlear implantation and electric acoustic / hybrid treatment options for children with hearing loss; Discuss the specific problems of speech processor fitting in children; Apply empirical rules for the optimization of speech processor fitting; Understand the importance of objective frequency-specific diagnostics of hearing acuity in neonates and infants for an improved indication of fitting of cochlear implants; Have updated knowledge on the current criteria for cochlear implant candidature; Understand the role and the importance of the multidisciplinary team pre- and post-implantation in order to ensure that the child with a cochlear implant progresses optimally in terms of communication skills, educational achievement and in overall quality of life.
AFFILIATES SOCIETIES ROUND TABLE - EMERGING ISSUES IN SPEECH LANGUAGE PATHOLOGY IN YOUR COUNTRY BEHLAU M (1) - MARCHESAN I (2) - PRINGLE C - MURPHY M WENG-YING Y - WISKIRSKA-WOZNICA B CENTRO DE ESTUDOS DA VOZ - CEV, UNIFESP, SO, UNIVERSIT, SAO, BRASILE (1) CEFAC, UNIVERSIT, SAO PAULO, BRAZIL, BRASILE (2)
Abstract: IALP has more than 60 affiliate societies among its members. These associations are mostly national and a single profession representative: speech language pathology. There are some mixed profession associations and some exclusively for physicians. The international scenario presents a complex, diverse and multifaceted panorama. However, there is a common ground in which specialists develop their competencies. SLP is well established as a health profession, even if in some countries the main
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core is educational. The educational background can vary from a technical course to a full education program (PhD Level). This range of educational level surely impacts the scope of practice, autonomy and knowledge acquirement. The goal of this special session is to offer a panorama from 5 countries: Brazil, the second largest population of SLP in the world, will present the challenges in education and services delivery on a continental dimension country; South Africa will present their current situation and possibilities of the current status on the mutual recognition agreement for speech therapists with the English speaking countries; Taiwan, the fastest growing market, will share their difficulties in dealing with only 2 undergraduate and 3 graduate programs; Ireland, a country with traditional programs will show their reflection on the European Union and the initiative to supporting new graduates in the current economic climate; finally, Poland will present the perspective of the phoniatricians, an unique medical specialty which is traditionally in charge of patients with communication disorders in their country. The field of communication disorders and sciences shares many interfaces with medicine, psychology, linguistic and education. The academic background started from different scenarios in different countries, which has added some expressive differences both in the philosophical orientation and scope of practice. The profession itself is relatively young and in some countries the academic programs have less than one decade of existence. The tendency is to have a well-established health profession but the degree of professional autonomy and the kind of specialization may vary according to the country. The access to higher education master and doctorate program is still a challenge in many countries. Learning Outcomes: To understand differences among the countries; To comprehend challenges in service delivery; To identify emerging issues and future challenges in different countries; To recognize the importance of multicultural competence.
access services. SLPs need to be knowledgeable about the cultures without engaging in stereotyping. Using interpreters facilitates the communication but it is important to establish good working relationships with the patients, family members and interpreters. There are strategies that monolingual SLPs can employ to establish a rapport with the family and yield significant clinical outcomes for the patients communication skills. Respect and trust are key tenents of relationship building. Learning Outcomes: The participants will be able to: Identify 3-5 components of cultural competence; Utilize strategies that will result in improved communication for patient and families; Identify strategies that can employed successfully to build respectful relationships with patients and families; Develop paradigms that facilitate culturally appropriate interactions between the clinician and the patient and family.
FP149
THE BOSTON NAMING TEST FOR MALTESE-SPEAKING ADULTS: ADMINISTRATION AND SCORING MODIFICATIONS RITIENNE GRIMA (1) - SUE FRANKLIN (2) COMMUNICATION THERAPY DEPARTMENT, FACULTY OF HEALTH SCIENCES, UNIVERSITY OF MALTA, MSIDA, MALTA (1) DEPARTMENT OF SPEECH AND LANGUAGE THERAPY, FACULTY OF EDUCATION AND HEALTH SCIENCES, UNIVERSITY OF LIMERICK, IRELAND (2)
Abstract: Introduction: The Boston Naming Test (Kaplan et al 1983) is the most widely used naming test worldwide in both research and clinical settings. It is standardized on numerous populations and it is useful in the investigation of suspected word finding difficulties in adults. Aim: This research aimed to determine whether the Boston Naming Test (BNT) may also be used to assess Maltese-speaking adults with suspected naming impairments, and it also sought to propose an adaptation of the BNT to suit the linguistic and cultural characteristics of the Maltese population. Methodology: Sixty healthy Maltese-speaking adults aged between 20 and 85 years participated. The sixty images from the BNT were presented via a laptop to record naming performance. The BNT was, then, used to collect data from 18 Maltese people with aphasia (PWA). Scores were compared to data obtained from the healthy controls. Results: Only 38 items of the BNT had at least 70% name agreement. Therefore, a reduced test of 38 items was proposed and two alternative scoring methods were described: strict (accepting only dominant responses and their cognates) and lenient scoring (accepting all possible responses, including English equivalents). A significant difference was found between the mean scores obtained by the PWA and the healthy controls. This gave an indication of the tests ability to differentiate between impaired and unimpaired naming. However, some controls obtained very low scores resulting in a degree of overlap between the scores obtained by the controls and the PWA, showing that scores alone may not be sufficient to differentiate between the two groups. Comparison of error profiles of PWA and controls showed that errors provide additional evidence for identifying individuals with impaired naming. Several types of errors were only evident in the data obtained from PWA, and common types of errors which were also produced by the controls were more frequently produced by PWA. Conclusion: A reduced set of the BNT was found to be suitable for assessing Maltese individuals with suspected naming impairments, and lenient scoring is the preferred method of scoring for this population as it gives credit to all acceptable responses. Apart from comparing scores to normative data, it is necessary to analyse error profiles as the occurrence of atypical errors is a determining factor in diagnosing a person with a naming impairment. Learning Outcomes: The participant will: ppreciate the need of having standardised assessment tools for each individual population; understand that popular tests may be modified to accommodate the linguistic and cultural characteristics of particular populations; comprehend that test modifications may be necessary in terms of administration procedures, as well as in terms scoring methods; understand that lenient scoring is useful when interpreting results of naming tests (i) which are administered on multilingual populations, and (ii) which were originally developed and normed on a diverse population; and quantitative scores may not be enough to make decisions about diagnosis of naming impairments in adults.
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STUTTERING THERAPY: WORKING ABOVE AND BELOW THE SURFACE MICHAEL BLOMGREN (1) UNIVERSITY OF UTAH, DEPT. OF COMMUNICATION SCIENCES & DISORDERS, SALT LAKE CITY, UTAH, UNITED STATES (1)
Abstract: The University of Utah Intensive Stuttering Clinic will be described. This clinic has treated over 80 people who stutter during the past 12 years. The clinic is a 60 hour, two-week, intensive group treatment program that offers a combination of fluency shaping and stuttering modification approaches. The presentation will address the relationship between treating surface stuttering behaviors (i.e., the actual moments of stuttering) and treating subsurface symptoms of stuttering such as anxiety, poor self-confidence, avoidance, etc. First, the basics of applying speech motor therapy will be outlined - specifically the techniques of prolonged speech, gentle vocal onsets, and reduced articulatory pressure will be detailed. Second, the importance and basic strategies of treating the symptoms of stuttering (anxiety, fear, avoidance, low self-esteem, etc.) will be presented - specifically, the strategies of using positive discourse, disclosure, and desensitization. Treatment outcomes data from 45 adult stuttering speakers will also be presented. A series of nine different speech fluency and affective-based measures (i.e., mood, anxiety, perceptions of stuttering) were assessed pretreatment, post-treatment and six months post-treatment. Mean changes in scores before and after treatment indicated clinically positive and statistically significant changes on all measures. Discussion will focus on the strengths, weaknesses, and durability of an approach that focuses on both speech motor strategies and also attitudes related to stuttering and speaking. Learning Outcomes: Participants will be able to: Understand the relationship between treating surface stuttering behaviors and treating subsurface symptoms of stuttering such as anxiety, poor self-confidence, avoidance, etc.; Understand the basics of applying speech motor therapy using prolonged speech, gentle vocal onsets, and reduced articulatory pressure; Appreciate the importance and basics of treating the symptoms of stuttering using positive discourse, disclosure, and desensitization.
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SERVICE DELIVERY TO BILINGUAL INDIVIDUALS BY MONOLINGUAL CLINICIANS: ITS MORE THAN LANGUAGE TOMMIE ROBINSON (1) - LEMMIETTA MCNEILLY (2) SCOTTISH RITE CENTER FOR CHILDHOOD LANGUAGE DISORDERS, CHILDRENS NATIONAL MEDICAL CENTER, WASHINGTON, UNITED STATES (1) AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION, ROCKVILLE, U.S.A. (2)
Abstract: The number of individuals living in the United States that speak languages other than English and have communication disorders is continuing to increase. Most speech-language pathologists that practice in the U.S. are monolinguals. They face challenges in meeting the needs of bilingual individuals. While the primary language spoken in the home impacts the service delivery process the clinical profile involves more than the language spoken. Cultural values, beliefs and practices impact how families seek and
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FP150
EARLY ASSESSMENT OF COMMUNICATIVE DISORDERS IN PATIENTS WITH ACUTE STROKE: RESULTS OF AN ITALIAN MULTICENTER STUDY SANDRA PECCINI (1) - ILARIA REVOLON (2) - NICOLA FALOCCI (3) IRENE GALL (4) - MARIA A. GORI (5) - GRAZIA SIGNORINI (5) SIMONA RAIMONDO (6) - MAURIZIO PACIARONI (7) SPEECH THERAPIST, SANTA MARIA DELLA MISERICORDIA HOSPITAL, DIVISION OF INTERNAL AND CARDIOVASCULAR MEDICINE, STROKE UNIT, PERUGIA, ITALY (1) - SPEECH THERAPIST FREELANCE PROFESSIONAL, GIOVANNI XXIII INSTITUTE, LESSONA, ITALY (2) REGIONAL COUNCIL OF UMBRIA, EMPLOYEE AT THE PUBLIC POLICY EVALUATION BUREAU, PERUGIA, ITALY (3) - SPEECH THERAPIST, IRCCS CENTRO DI RIABILITAZIONE DON CARLO GNOCCHI, FIRENZE, ITALY (4) SPEECH THERAPIST, AUSL11 EMPOLI, REHABILITATION UNIT, EMPOLI, ITALY (5) - SPEECH THERAPIST, CITY OF HEALTH AND SCIENCE OF TURIN, MOLINETTE HOSPITAL, SERVICE OF OTOLARYNGOLOGY, AUDIOLOGY AND PHONIATRY, TORINO, ITALY (6) - MD, VASCULAR NEUROLOGIST, CHIEF OF STROKE UNIT AND DIVISION OF INTERNAL AND CARDIOVASCULAR MEDICINE, SANTA MARIA DELLA MISERICORDIA HOSPITAL. STROKE UNIT AND DIVISION OF INTERNAL AND CARDIOVASCULAR MEDICINE, PERUGIA, ITALY (7)
Abstract: Approximately one third of patients affected by stroke develop aphasia. The diagnosis of aphasia is typically carried out in post-acute phase using well established tests such as AAT (Aachener Aphasie Test). However, despite clinical and neuropsychological instability are prominent in acute phase, a number of studies demonstrated the importance of assessing aphasia few days after brain injury to maximize rehabilitation gains. Early screening assessment tools should include specific features that thoroughly account for the clinical condition of patients in this phase. Only two standardized tests are available in Italian to date for the evaluation of aphasia in acute phase, known as I-AABT (Italian Aachner Aphasie Bedside Test) and ELLM (Esame del Linguaggio al Letto del Malato). The latter is a new Italian bedside examination of acquired language impairments. PARLA (Post-stroke Assessment for the Recognition of Language Abnormalities) study is an Italian multicenter study aiming at evaluating the correlation between ELLM and AAT and determining the agreement between diagnoses inferred in acute and post-acute phases. PARLA study includes 50 patients who developed aphasia as a consequence of a first stroke and that were hospitalized in Perugia promoter center of the study, Turin and Empoli (Italy). All examined patients were subjected to both ELLM and AAT tests. The former was administered within 15 days from the stroke onset (T0), whereas the latter was employed from the 30-th day after stroke (T1). We firstly evidenced that the mean values of most subtests tend to grow from T0 to T1. Secondly, we found a global positive correlation between ELLM and AAT results. Partcularly, more than a half of the examined parameters, show a correlation coefficient greater than or equal to r=0.7. Thirdly, according to the traditional classification of aphasia, we found a general fair agreement between ELLM and AAT (k=0.28). We finally classified aphasias according to their fluency characteristics and observed a good (k=0.68) and fair (K=0.37) agreement between diagnoses of non-fluent and fluent aphasias, respectively. All in all, and despite diagnostic power in acute phase is potentially limited by clinical instability, our preliminary results suggest that ELLM can be regarded as a reliable, valid tool to assess aphasia in Italian patients affected by acute stroke. Learning Outcomes: Implement formal assessment of communicative disorders in the acute phase; Present a standardized Italian tool useful for the evaluation of aphasic patients in acute phase; Share an Italian useful evaluation tool to monitor the evolution of verbal production and oral comprehension in patients with acute stroke, also suitable for a first diagnosis of aphasia and a better definition of rehabilitation plans.DYSPHAGIA
as the introduction and widespread diffusion of stroke units. The Aachner Aphasia Bedside Test (AABT) is a validated German useful tool for this purpose. The aim of the study is to validate the Italian AABT (I-AABT). Materials and Methods: The study consisted of 4 phases: phase 1. test-retest and inter-subject reliability analysis; phase 2. concurrent validity analysis; phase 3. construct validity analysis; 4. sensibility to change over time. The I-AABT has been applied to 248 in-patients in two large Italian acute care hospitals. For phase 1. 46 stroke patients in acute phase have been assessed through the I-AABT twice the same day by the same examiner and by two different examiners to analyze test-retest and inter-subject reliability. For phase 2. 30 stroke patients with aphasia in post-acute phase have been assessed by the same examiner through I-AABT and AAT (Aachner Aphasie Test) to establish concurrent validity. For phase 3. 70 left emisphere stroke patients in acute phase, 30 in-patients from general medicine departments without neurological disorders and 48 stroke patients in acute phase with a right brain damage have been assessed through the I-AABT to assess construct validity. For phase 4. 24 patients in sub-acute phase have been assessed through both I-AABT and AAT before and after 40 days of successful intensive language therapy. Results: phase 1. both test-retest and inter-subject reliability were high on Spearman test; r ranged between r = 0.84 and r = 0.99 in test-retest reliability and between r = 0.79 and 0.99 in inter-subject reliability study. Phase 2: a strong correlation between subtest of I-AABT and AAT on Spearman test was found (comprehension test: r = 0.87, naming test: r = 0.94). Phase 3: most I-AABT subtests showed significant different scores of Mann-Whitney test in patients with right brain damage compared to patients with left brain damage; subtests on global communication were the only subtests in which no significant difference between these two group of acute stroke patients was found. All I-AABT subtests showed significant different scores of MannWhiteny test in acute left brain damage stroke patients compared to other acute in-patients without brain damage. Phase 4: a significant improvement on several AAT subtest (token test, comprehension, repetition, naming) and I-AABT subtest (automatic language, comprehension, naming, oral praxias) before and after language therapy was found on Wilcoxon signed test. Conclusion: the I-AABT is easily applicable in acute stroke patients and it is a reliable and valid tool for the assessment of aphasia in Italian acute stroke patients; its application is recommended in everyday clinical practice. Learning Outcomes: To show that the assessment of aphasia in acute phase is an important clinical goal for the management of stroke patients; To provide an Italian useful tool for the assessment of aphasia in acute phase; To provide a validated and standardized test on the Italian population
FP152
RELATION BETWEEN VOICE HANDICAP INDEX (VHI) AND DISEASE SEVERITY IN IRANIAN PATIENTS WITH PARKINSONS DISEASE FATEMEH MADJDINASAB (1) - NEGIN MORADI (2) HEDIEH HASHEMI (3) - GHOLAMALI SHAHIDI (4) SIAMAK KARKHEIRAN (5) - MASOUD SALEHI (6) MSC SPEECH AND LANGUAGE PATHOLOGY, DEPARTMENT OF SPEECH THERAPY, JUNDISHAPUR UNIVERSITY OF MEDICAL SCIENCES, AHVAZ, IRAN (1) - LECTURER, MUSCULOSKELETAL REHABILITATION RESEARCH CENTER, DEPARTMENT OF SPEECH THERAPY, SCHOOL OF REHABILITATION, JUNDISHAPUR UNIVERSITY OF MEDICAL SCIENCES, AHVAZ, IRAN (2) - DEPT. OF SPEECH AND LANGUAGE THERAPY, FACULTY OF REHABILITATION SCIENCES, SEMNAN UNIVERSITY OF MEDICAL SCIENCES, SEMNAN, IRAN (3) ASSISTANT PROFESSOR OF NEUROLOGY, TEHRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN (4) - NEUROLOGIST OF MOVEMENT DISORDERS CLINIC, RASOOL AKRAM HOSPITAL, TEHRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN (5) - ASSISTANT PROFESSOR OF BIOSTATISTICS, FACULTY OF MANAGEMENT AND MEDICAL INFORMATICS, TEHRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN (6)
Abstract: Parkinsons disease (PD) is the second common neurodegenerative disease in the world. One third of PD patients have mentioned dysphonia as their most debilitating communication deficit. Patient-based measurements, such as Voice Handicap Index (VHI) shows the effect of Voice disorder on patients life and add necessary supplementary information to clinical and physiological Voice assessment. There are a few studies about relation between VHI and disease severity (motor disorders) in PD and none of them showed any significant correlation. There is not any research about Iranian PD patients Voice disorder specially about the effect of Voice disorder on their quality of life(QOL) . The goal of this study was to find any correlation between VHI and PD severity (and motor disabilities) in Iranian patients. This study was done on 23 PD patients (13 male, 10 female) who reported a voice disorder related to their disease .They were selected from attendants of movement disorders clinic of Rasool Akram hospital, the educational and treating center of Tehran University of Medical Sciences. Participants were chosen from January until June of 2011 by convenience sampling. All of participants used levodopa as the main drug and both of voice and neurological tests were done in the on state. They had no other neurological or
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FP151
VALIDATION OF THE ITALIAN AACHNER APHASIE BEDSIDE TEST (I-AABT) FOR THE ASSESSMENT OF APHASIA IN THE ACUTE PHASE MARTUFI FRANCESCA (1) RAIMONDO SIMONA (2) CAVAGNA NICOLETTA (3) - SCHINDLER ANTONIO (4) SPEECH AND LANGUAGE PATHOLOGIST, CITT DELLA SALUTE E DELLA SCIENZA, MOLINETTE HOSPITAL, TURIN, ITALY (1) SPEECH AND LANGUAGE PATHOLOGIST, CENTRO DIDATTICO LIBRO APERTO, PINEROLO, ITALY (2) - SPEECH AND LANGUAGE PATHOLOGIST, LUIGI SACCO HOSPITAL, MILAN, ITALY (3) MEDICAL DOCTOR, SPECIALIZED IN PHONIATRICS, UNIVERSITY OF MILAN, MILAN, ITALY (4)
Abstract: Background and purpose: the assessment of aphasia in acute care settings is getting more important and more popular in the last years. Several factor contributed to this change in the management of patients with aphasia,
movement disorders, and they older than 50. Disease severity evaluated by 2 neurological test: Hoehn and Yahr(H&Y) and Unified Parkinsons Disease Rating Scale-part3 (UPDRS-III). Each patient completed the Iranian version of the VHI too. The correlation between disease severity and VHI questionnaire and its 3 domains (Functional, Emotional, Physical) was evaluated by Pearson and Spearman correlation coefficient based on patients sex, UPDRS score, H&Y score and VHI. There was not any significant difference between VHI-T and its domains score in both sex. Total VHI score(VHI-T) and its 3 domains had no relationship with disease severity (H&Y) in all patients and by sex separation. However, there was a positive correlation between VHI-T and disease severity according to UPDRS-III (r=0.485). There was also a relation between physical and functional domains of VHI and UPDRS (rP=0.530, rF=0.479) while no relationship observed regarding sex differences. 9 out of 18 UPDRS-III subscales had strong relationship with VHI-T and all 3 subscales. Parkinsons Disease affects all of speech subsystems specially voice. Voice disorders may influence on patient quality of life. Patientbased assessments show this affection. Iranian PD patients feel handicap according to voice disorder caused by PD and their QOL (based on voice handicap) were out of normal range. VHI is an important issue offered to be used in Iranian PD patients beside other perceptual and instrumental assessments. Patient satisfaction of voice decreases by increasing of disease severity and progression of motor disabilities. More studies are necessary to investigate any differences in gender. Learning Outcomes: The Participant will be able to: Know about voice disorder in Iranian PD patients; understand the importance of patient-based assessments like VHI in determination of voice disorder affection on quality of life of PD; Know the relation between VHI and disease severity in PD; Know the correlation between VHI subscales and motor disabilities in Iranian PD patients.
Controls showed significantly superior performance compared to patients for both non-verbal praxia (7.61.8 versus 4.91.6; t(58)= 5.88; 95%CI= 1.76 to 3.57; p< 0.001) and praxia of speech (12.00.6 versus 11.01.1; t(58)= 4.26; 95%CI= 0.53 to 1.47; p< 0.001). Total score for expected dysarthria symptoms was significantly lower in the CG compared to the PDG (1.10.7 versus 6.71.3; t(58)= -20.2; 95%CI= -6.0 to -4.9; p< 0.001). In the PDG, correlations between total dysfluencies and non-verbal apraxia and apraxia of speech were weak, whereas correlation with dysarthria was moderate. Conclusions: The stutter type dysfluencies are present in the speech of PD patients and they are more related to the dysarthria. Learning Outcomes: Attendees will learn from this presentation: How disarthria is correlated with apraxia in Parkinsons Disease (PD); How apraxia and disarthria interferes on fluency disorders in PD; The role of Basal ganglia dysfunction in communication disorders in PD.
FP154
PERCEPTION AND COMPREHENSION OF COMMUNICATIVE FUNCTIONS OF PROSODY IN INDIVIDUALS WITH DYSARTHRIA DUE TO PARKINSONS DISEASE HEIDI MARTENS (1) - GWEN VAN NUFFELEN (1) - MARC DE BODT (1) REHABILITATION CENTRE FOR COMMUNICATION DISORDERS, ANTWERP UNIVERSITY HOSPITAL, EDEGEM, BELGIUM (1)
Abstract: The aim of this presentation is twofold: (1) to present a new framework for assessing receptive prosodic skills in Dutch speaking individuals with dysarthria, (2) to present results of a study using the new assessment framework in a group of individuals with dysarthria due to Parkinsons disease (PD). A new test battery was designed to assess both perception of prosodic form by means of discrimination tasks (lower-level receptive skills) and comprehension of prosodic meaning by means of identification tasks (higher-level receptive skills). Both subtests evaluate reception of five pivotal communicative functions of prosody in Dutch: lexical stress, boundary marking, focus, sentence modality, and emotional prosody. Fifty-two cognitively unimpaired participants were recruited: 26 individuals with PD (18 male; 8 female; age range: 50-83) and 26 healthy controls matched for gender and age. In a cross-over design, half of the participants first took the perception subtest and afterwards the comprehension subtest, the other half took the test in reverse order. Between groups, no significant differences were found for global perception of prosodic form or global comprehension of prosodic meaning. In addition, no significant differences could be observed for any specific prosodic communicative function. Within groups, significant differences were found between perception of prosodic form and comprehension of prosodic meaning. No sequence effect could be demonstrated concerning subtest order. In both groups, age was significantly negatively related to assessment scores. Individuals with PD, tested in an early stage of the disease and having intact cognition, demonstrate receptive prosodic skills comparable to healthy age-matched individuals. For both groups, comprehension tasks were significantly more difficult than perception tasks. It would be interesting to investigate whether the difference would be as significant in a younger control group, since age has been described as a factor affecting prosody comprehension. Learning Outcomes: Participants will be able to: enumerate four reasons why it may be important to assess receptive prosodic skills in individuals with dysarthria; enumerate the two main principles upon which the proposed receptive prosody assessment tool for individuals with dysarthria is based; formulate the expected outcome concerning receptive prosodic skills in mildly dysarthric individuals with relatively early-stage Parkinsons disease and no apparent signs of depression or cognitive impairment.
FP153
ANALYSIS OF SPEECH FLUENCY IN PARKINSONS DISEASE NATALIA CASAGRANDE (1) - THAIS MINETT (1) - KARIN ORTIZ (1) UNIVERSIDADE FEDERAL DE SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Introduction: Basal ganglia dysfunction is the determining factor in the physiopathology of hallmark features of Parkinsons Disease (PD). Hypokinetic dysarthria is commonly associated to PD, with impaired speech fluency being one of the symptoms of this condition. Studies investigating the relationship between stuttering and basal ganglia have indicated that basal ganglia circuits play a major role in stuttering mechanisms. Among acquired speech disorders in PD, motor changes characteristic of dysarthria occur but speech is rarely described as apraxic. Speech deficits in PD are believed to stem not only from loss of muscular control but also problems in planning and programming of speech. Thus, PD patients are at risk of presenting with both non-verbal apraxia and apraxia of speech. The aim of this study was to assess the frequency of occurrence, and characterize the typology, of disfluencies of speech in individuals with PD, correlating these with dysarthria and with alterations in verbal and non-verbal praxis. Methods: This study was approved by the Research Ethics Committee of the Federal University of So Paulo (UNIFESP process 0843/09). A cross-sectional study involving a sample of 60 adults matched for gender, age and schooling was carried out. The study group (PDG) comprised 30 adults with idiopathic PD from the Movement Disorders sector of the Neurology Discipline of Unifesp, and the control group (CG) comprised 30 healthy adults. The general criteria for inclusion were: age older than or equal to 50 years; schooling greater than or equal to 4 years; absence of personal or family history of developmental or psychogenic stutter; absence of history of stroke or previous cranioencephalic trauma, alcoholism or use of illicit drugs, and visual or auditory deficits which could affect performance on the tasks; normal performance on Mini-mental state exam for schooling level. The PDG included individuals diagnosed with Parkinsons Disease, who had not been submitted to neurosurgery, at stages 2, 2.5 or 3 on the Hoehn & Yahr scale , and currently undergoing treatment with medications for PD. All patients were assessed during the on stage of medication. The CG comprised healthy adults presenting with less than 3% stutter dysfluencies or less than 10% common speech dysfluencies, according to the criteria of the Stuttering Severity Instrument (SSI-3). Speech fluency was assessed based on the production of a narrative. The criteria used for collection and analysis of the speech samples were those proposed in the Speech Fluency Assessment Protocol , which dysfluencies are divided into common and stutter types. Palilalia episodes were also evaluated and classified as stutter dysfluency. Verbal and non-verbal praxis were assessed using the oral agility subtest from the Boston Diagnostic Aphasia Examination. Presence or absence of dysarthria was confirmed by means of structural and functional assessment of the basic functions: respiration, phonation, articulation, resonance and prosody. After comparing performance of the two groups on tasks assessing speech fluency, non-verbal praxia and praxia of speech, and basic motor functions altered in speech, statistical analyses were performed to determine the relationship among total dysfluencies, apraxia and dysarthria in PD. Results: The total number of dysfluencies in the CG was significantly lower than in the PDG (4.82.6 versus 8.96.7; t(58)= -3.12; 95%CI= -6.7 to 1.4; p= 0.003), a difference attributed to the number of stutter dysfluencies ((0,030,18 versus 4,535,71; t(58)= -4,31; 95%IC= -6,59 a -2,41; p< 0,001) as opposed to common type dysfluencies (4.62.6 versus 4.33.6; t(58)= 0.53; 95%CI= -1.2 to 2.1; p= 0.598).
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FP155
AN ACADEMIC MODEL OF COMBINING UNFERGRADUATE AND GRADUATE STUDIES PROVIDES STUDENTS A COHESIVE AND ACCELERATED CLINICAL EXPERIENCE NICOLE MAGALDI (1) - EVALYN LAMBERT (1) WILLIAM PATERSON UNIVERSITY, WAYNE, NJ, UNITED STATES (1)
Abstract: In the United States, most students seeking to become speechlanguage pathologists do so by completing a bachelors degree (BA) and then a masters degree (MS), with the two degrees completed separately and often at two different colleges or universities. In 2009 William Paterson University began a combined BA/MS program in which highly qualified students apply for admission to the masters program during their bachelors degree, and, if accepted, are guaranteed admission into the graduate program upon completion of the bachelors degree. Students who are admitted into this program receive two distinct degrees (i.e. bachelors degree and masters degree) but do so in an extremely cohesive fashion as the two degrees are combined. Previous to the implementation of the BA/MS program, less than 10% of the in-coming class of graduate students in the Communication Disorders and Sciences program had completed their bachelors degree at William Paterson University. This percentage increased significantly after the implementation of the combined BA/MS program such that in the last class of graduate students admitted (fall, 2012), 60% of the students had completed their bachelors degree at William Paterson
University and continued on directly from their bachelors degree to their masters degree as part of the combined BA/MS program. This program provides continuity between the students undergraduate and graduate degrees and as a consequence, students receive an extremely cohesive clinical experience greatly accelerating their preparedness as clinicians. Most students who obtain a separate bachelors degree and masters degree in Communication Disorders or a related field do not begin any direct clinical work until they begin their masters degree. However, students in the combined BA/MS program begin their clinical training in their last year of their bachelors degree where they receive considerable mentorship and experience working with patients with communication disorders. This experience begins during the first semester of their senior year when undergraduate students are paired with each other and work as a team with a single client. They receive direct, specific guidance from a clinical supervisor and participate in a mandatory weekly seminar taught in which practical topics relating to the therapeutic process are discussed. In the second semester of their senior year the students gain more autonomy in the clinical setting and begin working one-on-one with a client, still directly supervised by the clinical supervisor and participating in the weekly seminar. This model has resulted in students who are much more prepared for the clinical work involved at the masters level. They typically begin their graduate studies having accrued up to 50 hours of direct clinical experience at the bachelors level and are prepared to work with more complex and involved cases as a result of this cohesive experience. A survey assessing students perceptions of their own clinical preparedness indicate that students who have completed the combined BA/MS program feel significantly more prepared than those who begin their masters degree without direct clinical experience as undergraduates. Learning Outcomes: The participant will be able to: Understand the framework for a cohesive bachelors/masters (BA/MS) program in Communication Disorders or related fields; Learn the benefits of academic programs providing students with an early and cohesive clinical experience; Know how to implement a guided and cohesive clinical experience for beginning student clinicians
developing and maintaining high professional standards and, in due time, facilitating cross borders exchange of knowledge and professional figures, are essential elements for the future growth of speech therapy. Learning Outcomes: To describe the historical foundations and philosophy underlying the origins of the Speech Therapy Degree Course of Turin; To Identify and underline the main characteristics and strengths of the Speech Therapy Degree course in Turin, with regard to the study plan, the internships and the state exam; To compare the academic education of Speech Therapists in Turin with European Educational Standards.
FP157
IDENTIFYING APPROACHES AND THEMES FOR A LONGITUDINAL STUDY OF THE PROFESSIONAL DEVELOPMENT OF STUDENTS OF AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY DORTHE HANSEN (1) - JYTTE ISAKSEN (1) INSTITUTE OF LANGUAGE AND COMMUNICATION, UNIVERSITY OF SOUTHERN DENMARK, ODENSE, DENMARK (1)
Abstract: The professional development of students of audiology and speech-language pathology (SLP) is only sparsely described. The few studies on the subject have primarily focused on one or a few aspects of training for audiologist or speech pathologist, and no studies so far have had a longitudinal approach to the professional development of the students and their own perceptions hereof. The present phenomenological study is preliminary to a longitudinal study of a group (approximately 80 persons) of audiology and SLP students at University of Southern Denmark. The object of the longitudinal study is to follow the students from the first semester of the programme until two years after completed training in order to describe the students perspectives on their professional development. The object of the present study is twofold, that is 1) to identify a number of relevant themes for further exploration in the initial part of the longitudinal study and 2) to test a qualitative design to approach the longitudinal study. With regard to the qualitative design two methods are tested: a) The semi structured individual interview, and b) a task of professional judgement based on a constructed short client case. The purpose of the latter is to make a basis for the interviewees to reflect on their professional progression. The themes to make a basis for the initial part of the longitudinal study will be identified in the interviews as well as in the task of professional judgement. Hence, we see the two methods as supporting each other. The participants in the present study are 8 students of audiology and 8 students of speech and language pathology at University of Southern Denmark. All students are in the second semester of their respective programmes. We expect that the results of the present study will show that the semi structured interview is a useful method for studying the perspectives of the audiology and SLP students on their professional development. Regarding the task of professional judgement based on a constructed short client case, we expect it to result in concrete participant reflections that can be used to exemplify and illustrate the supposedly more general answers from the interviews. Furthermore, we expect the answers generated from the client cases to be comparable with regard to issues raised amongst the cohort as well as by the individual student from year one towards post-graduation. Learning Outcomes: The participants will be able to identify relevant themes regarding audiology and SLP students perception of their professional development; understand the importance of the insights gained through a longitudinal study of professional development, and know the benefits and disadvantages of the methods used for reflection upon professional development.
FP156
TEACHING AND OBJECTIVES OF THE UNIVERSITY DEGREE IN SPEECH THERAPY DEBORA LANTELME (1) - SERENA PAIONE (1) LUCIA PECORARO (1) - DARIA PROTTI (1) - OSKAR SCHINDLER (2) FACULTY OF SPEECH THERAPY, UNIVERSITY OF TURIN, TURIN, ITALY (1) - AUDIOLOGY AND PHONIATRICS DEPARTMENT, CITTA DELLA SALUTE E DELLA SCIENZA - MOLINETTE HOSPITAL, TURIN, ITALY (2)
Abstract: This project originates from the desire to increase general awareness and knowledge on speech therapy university courses, and to illustrate the academic offer, history and structure of the Speech Therapy Faculty of the University of Turin. The Speech Therapy School of Turin, was founded by R. Segre and G. Bellussi in 1932. From 1963, Professor Oskar Schindler contributed to the organization of the first course of Speech Therapy and to the study of human communication physiopathology and swallowing disorders. The main national reforms at university level have lead to the development of the present educational offer for speech therapists (Undergraduate, PostGraduate and Master Degrees) (L. 270/2004).The undergraduate course in Speech Therapy offered by the Medical School of Turin (Decree MURST 2 April 2001 n.136) is a three years degree (180 ECTS). It is followed by a Post-Graduate degree (120 ECTS) in Rehabilitation Science for Healthcare Professionals (in accordance with the Carta di Bologna, June 19 1999, and following documents), that is addressed to different professional figures of the rehabilitation sector. In 2005 we introduced the first Italian Master Degree for swallowing disorders.At undergraduate level the university forms 90 students (30 per academic year). Acceptance is reserved to the 30 top scoring students in the admission test. At the end of the three years course the University graduates 30 students, and qualifies them for the profession of speech therapist. A core section of the study plan is training trough internships. The students will complete a 900 hours internship (62 ECTS) that takes place across the three academic years.The internship starts in October and ends in June. Each student carries out its training in each location for a period of three months. That allows him/her to come in contact with various structures of the city of Turin and surrounding areas that offer speech therapy rehabilitation. The structures are either private or belonging to the National Health System. The final exam qualifies for professional practice. It includes a graduation thesis and an exam related to specific professional knowledge, applied to clinical cases. The exam is attended by a commission of Faculty professors, by a member of the Ministry of Education University and Research, and by two representatives of the Italian Federation of Speech Therapists (FLI, D.I. 19 February, 2009). Our university course complies with the guidelines regarding the Minimum European Educational Standards set by the Comit Permanent de Liaison des Orthophonistes / Logopedes de lUnion Europenne (CPLOL) (adopted by the general assembly of Riga May 12th 2007), and with those set by the IALP (2009) concerning the Education for Speech and Language Pathologists.Our faculty also participates to the Net-Quest project regarding speech therapists standards of education. Harmonizing basic education,
FP158
PERFORMANCE OF APHASIC PATIENTS ON A LIMB PRAXIA BATTERY JOANA MANTOVANI-NAGAOKA (1) - KARIN ORTIZ (1) UNIVERSIDADE FEDERAL DE SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Apraxia is a disorder of learned gestures and skilled movements, in the absence of sensory or motor pathway deficits, cognitive impairment, inattention to commands or poor oral comprehension. Some studies have reported a strong relationship between this disorder and left cerebral hemisphere damage, with numerous case studies on limb apraxia involving aphasic patients The aim of this study was to investigate the performance of aphasic individuals on a limb praxia battery by comparing patient results to those of healthy subjects without neurological damage, matched for gender, age and schooling. This study involved 44 healthy volunteers without neurological impairments, comprising the Control Group (CG), and 28 aphasic patients forming the Aphasic Group (AG).The study was approved by the Research Ethics Committee of the Federal University of So Paulo (Process CEP 0170/05). All participants were assessed using a Limb Praxia Battery consisting of subtests evaluating lexical-semantic aspects related to the production of gestures as well as motor movements, in response to oral commands and by imitation as follows:oral comprehension of actions and objects; naming of actions and objects; recognition of object function; definition of object function; recognition of transitive gestures (those involving use of objects); ideomotor praxia, with and without use of objects; ideational praxia, with and without use of objects; symbolic gestures; static and
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dynamic imitation of meaningless gestures. After application of the battery, performance of the CG and AG was compared using the analysis of variance test (ANOVA).A probability (p) value of less than 0.05 was adopted as statistically significant. The performance of the CG was superior to the AG on language tasks for naming of actions and objects, as well as recognizing and defining the function of instruments. Impaired language processing abilities secondary to aphasia are the most likely explanation for the poorer performance of the AG on these tasks. The AG also had worse performance on the subtests ideational praxia and imitation of meaningless dynamic gestures. In the present study, we ascribe impairments in lexical-semantic processing to problems accessing gestural representations when producing pantomimes (ideational praxia subtest), consequently hampering the performance of aphasic patients. This conceptual disorder may also explain the worse performance of this patient group on the dynamic imitation of meaningless gestures test (dynamic imitation subtest), since several studies have shown that, besides merely transforming an observed movement (by visuo-motor conversion mechanisms) into the programming and execution of the same movement, imitation of meaningless motor acts involves, contrary to expectations, semantic concepts when representing conceptual notions about the human body. Based on these results, it can be concluded that aphasics have worse performance on tasks of language, ideational praxia and imitation of dynamic gestures, compared to healthy subjects without neurological impairment, matched for gender, age and schooling. Learning Outcomes: Attendees will learn from this presentation: How to investigate limb apraxia in aphasic patients; How language disorders can be associated with limb apraxia in aphasic patients; The value of limb apraxia assessment in aphasic patients.
counterbalanced over two sessions. Responses were transcribed, translated and tabulated for each category. The mean number of items named was greater for English (39.88) than for Arabic (38.16) and greater for animals (A=14.56; E=14.64) and food (A= 12.84; E=13.32) than for clothes (A=10.76; E=11.92). A two way analysis of variance revealed a significant effect for category (F=11.044, p<.05), but not language (F=1.187, p.>05) or the interaction of language and category (F=.357; p>.05). Language proficiency on a 5 point rating scale was greater for Arabic (mean=4.88) than for English (mean=3.92). The mean number of translational equivalents (same item produced in each language) was greater for animals (6.84) than for clothes (5.8) or food (5.56). Correlation of the total number of translation equivalents with language proficiency ratings was significant for Arabic (r = .43, p. <.05) but not for English (r = .26, p. >.05). The study provides normative data on expected frequencies of naming for the categories of food, animals and clothes for bilingual Arabic-English speakers that can be used to interpret results from adults with language disorders. Learning Outcomes: Based on the presentation, participants will be able to: Describe procedures for assessing generative naming in bilingual speakers; identify factors that effect language proficiency ratings in bilingual speakers, and discuss the relationship between language proficiency and translational equivalents in generative naming tasks.
FP161
PARKINSONS DISEASE AND DEAF PEOPLE: SELF-PERCEPTIONS AND INTERPRETER PERCEPTIONS OF CHANGES IN COMMUNICATION WITH SIGN LANGUAGE PIRKKO RAUTAKOSKI (1) - KIRSTI MARTIKAINEN (2) DEPARTMENT OF PSYCHOLOGY AND LOGOPEDICS, ABO AKADEMI UNIVERSITY, TURKU, FINLAND (1) THE FINNISH PARKINSON ASSOCIATION, TURKU, FINLAND (2)
Abstract: Hypokinesia, bradykinesia and rigidity, typical features of Parkinsons diseases (PD), have articulatory consequences in speech as well as in using sign language (Kegl, Cohen, Poizner, 1999; Trail, Fox, Ramig, Sapir, Howard, & Lai, 2005). The literature contains results showing that the signs of deaf people with PD become smaller and less precise, the movements become slower, the facial expressions reduced, and the signs are produced in a smaller space in front of the signer (Brentari, Poizner, & Kegl, 1995; Kegl et. al., 1999; Loew, Kegl, & Poizner, 1995; Poizner, Kegl, 1992; Tyrone, Kegl, Poizner, 1999). In spite of these objective findings there are no studies on subjective experiences of deaf PD patients. The aim of the present research was to study if deaf people with PD perceive difficulty in communicating. Another aim was to ascertain if a communication partner, in this case the interpreter, has difficulty understanding their signing. Three deaf people using sign language were interviewed and asked to assess if the PD has caused difficulty in their communication. A structured interview was used. Their interpreter was asked to assess if she had difficulty in communicating with them and if their signing was atypical. The deaf participants with PD perceived some difficulty communicating with other people but they did not associate these difficulties with changes in their own signing performance. The interpreter found it difficult to understand them because of the atypical features in signing. The results indicate that deaf people with PD are unaware of the changes in their signing. Learning Outcomes: The Participant will be able to: 1. understand how deaf people with Parkinsons disease perceive their communication problems; 2. recognize the effect of Parkinsons disease in using sign language; 3. understand the need of rehabilitation deaf people with Parkinsons disease have.
FP159
VERBAL STEREOTYPE: A MALADAPTIVE RECOVERY? A PILOT STUDY INS RODRIGUES (1) - MARTIN LAUTERBACH (2) NDIA CANRIO (1) - ALEXANDRE CASTRO-CALDAS (1) INSTITUTE OF HEALTH SCIENCES, THE CATHOLIC UNIVERSITY OF PORTUGAL,, LISBON, PORTUGAL (1) HOSPITAL DA LUZ, LISBON, PORTUGAL (2)
Abstract: Background: Recovery from aphasia due to stroke is a major issue that implies functional reorganization of the language system in the brain. There is little information in the literature about the functional and anatomical correlates of verbal stereotype that is usually associated with nonfluent aphasia. An important question to answer is, if the large lesions of the left hemisphere explain sufficiently the poor prognosis of these patients, or if there are other mechanisms that cause frequently the persistence of this symptom? Aim: In this pilot study, we primarily wanted to identify the cortical areas that are activated when patients produce a verbal stereotype, using fMRI techniques. Methods: With a 3 Tesla MRI utility we explored brain activation in response to language tasks in 10 chronic nonfluent aphasia patients (6 with and 4 without verbal stereotype) and in 5 control subjects. In particular, we performed 2 block design fMRI sequences correspondingly to a categorization task and a nomination task. In order to analyze the whole brain activation pattern in each group, a GLM Multi-study procedure was performed. Results: As expected, healthy controls showed a significant dominance for the left hemisphere in all language tasks. In contrast all subjects with verbal stereotype show an increased right activation in all language tasks. The results also revealed that increased activation in preserved left hemisphere areas were correlated with better oral expression. Conclusions: Our preliminary results support the idea that right hemisphere recruitment may be maladaptive in some cases and may reflect inefficient language processing rather than being beneficial for a better language performance. Learning Outcomes: The Participant will be able to: know the controversies on language recovery; Better understand the role from the right hemisphere in language recovery the characteristic of the INFVo scale; know more about verbal stereotypes and its possible causes.
FP162
CLINICAL OUTCOMES OF PROVIDING LSVTLOUD VIA TELEREHABILITATION TO THE RURAL HOME ANNE HILL (1) - DEBORAH THEODOROS (1) - TREVOR RUSSELL (1) THE UNIVERSITY OF QUEENSLAND, UNIVERSITY, BRISBANE, AUSTRALIA (1)
Abstract: Parkinsons disease (PD) is a highly prevalent neurodegenerative disease in which the associated hypokinetic dysarthria can have a significant effect upon an individuals communication effectiveness and quality of life. Fortunately, an efficacious treatment for this speech disorder exists, the Lee Silverman Voice Treatment (LSVTLOUD). LSVTLOUD is an intensive program involving 16 one hour daily treatment sessions across a period of four weeks. However, access to this treatment is problematic due to the limited availability of certified LSVTLOUD clinicians, and mobility issues often encountered by people with PD. Recent studies in telerehabilitation have demonstrated the validity and reliability of Internet-based delivery of this treatment in a laboratory setting (Constantinescu et al., 2011). The current study investigates the clinical outcomes of the telerehabilitation delivery of LSVTLOUD to people with PD residing in non-metropolitan areas of South-East Queensland. Twenty participants with mild to moderate hypokinetic dysarthria associated with PD were assessed twice at baseline and twice post-treatment in their home using the eHAB telerehabilitation system. The majority of participants were male (75%), with only 5 female participants. Average age of participants was 68.15 years (range 50-81 years). Assessments followed the LSVTLOUD protocol of sustained phonation,
FP160
GENERATIVE NAMING IN MOROCCAN ARABIC-ENGLISH BILINGUAL SPEAKERS : REFERENTIAL DATA FOR APHASIA BOUZEKRI TOURI (1) FACULTE DES SCIENCES BEN MSIK CASABLANCA, UNIVERSITY HASSAN II MOHAMMEDIA - CASABLANCA, MOROCCO (1)
Abstract: The purpose of this study was to establish a generative naming database for unimpaired Moroccan Arabic-English bilingual speakers to serve as a reference for interpretation of results from bilingual individuals with language deficits due to brain damage (Munoz & Marquardt, 2003). Twenty-five Moroccan Arabic-English bilingual adults (15 female, 10 male; mean age = 27) completed a language history questionnaire to determine bilingual status and proficiency in each language. A sequential Moroccan Arabic-English bilingual experimenter obtained category-naming data for the categories of food, clothes, and animals. Each participant was asked to name as many items as possible in each category using either Arabic or English during a 60 second trial. Categories and languages were
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pitch range glides, reading and monologue tasks. Participants also completed questionnaires relating to quality of life. Communication partners completed a short questionnaire pre and post treatment on their perception of the participants communication. All participants then completed the LSVTLOUD treatment protocol via telerehabilitation. Results revealed significant differences between pre and post measures for the sound pressure parameters of sustained phonation, reading, monologue and pitch range. Perceptual analysis of speech intelligibility and loudness were completed using a paired comparison rating system. Analysis of paired comparison ratings using a Chi square test revealed a significant change in loudness, but no significant change in speech intelligibility. Communication partners reported significant change post treatment in overall communicative ability, speech intelligibility, initiation of conversation with familiar communication partners and need for repetitions. Initiation of conversation with unfamiliar communication partners did not significantly improve post treatment. Analysis of the PDQ-39 revealed significant improvement in the communication domain only. Overall participant satisfaction with the telerehabilitation delivery of LSVTLOUD was very high at 100%, with other satisfaction parameters also rated in the very high category (range: 90-100%). Clinician satisfaction with the telerehabilitation delivery of LSVTLOUD was more varied. Clinicians rated telerehabilitation delivery as satisfactory 90% of the time, however, felt that the visual quality was appropriate only 75% of the time. The majority of clinicians felt that telerehabilitation enabled them to competently deliver the LSVTLOUD program. Content analysis was used to derive themes relating to the telerehabilitation delivery of this intensive intervention. These themes will be discussed. Overall, results from this study support the feasibility of delivering LSVTLOUD via telerehabilitation. Learning Outcomes: Participants will learn of the ecological validity of delivering LSVTLOUD into the home. Participants will learn about the eHAB telerehabilitation system used in the project. Participants will learn how telerehabilitation delivery into the home can have a significant impact on access to intensive treatment programs.
by the patient himself. The comparison between the fMRI images, pre- and post-treatment, highlighted a structural modification of the grey matter. The quality and the quantity of the data collected during the after treatment evaluation highlighted a considerable improvement generated by the therapy. The positive result achieved have been obtained thorough the efficient and effective cooperation of professional of different disciplines. Learning Outcomes: The Participant will be able to: 1. understand the complexity of Focal Task-Specific Embouchure Dystonia; 2. know the utility of the specific evaluation program; 3. understand the characteristics and the structure of the specific treatment; 4. understand the central role of the multidisciplinary team.
FP164
STUDENT TRAINING IN SPEECH LANGUAGE PATHOLOGY IN SERBIA MILE VUKOVIC (1) - IRENA VUKOVIC (1) UNIVERSITY OF BELGRADE, FACULTY OF SPECIAL EDUCATION AND REHABILATATION, BELGRADE, SERBIA (1)
Abstract: The present study is an overview of student training in Speech Language Pathology (SLP) in Serbia. The data were collected using a questionnaire developed by Soderpalm (2006), than supplemented by Georgieva (2010), and in 2013 revised by Georgieva and Wozniak. In Serbia SLP has its root in special education and is centralized in the university frames. The training program of speech language pathologists is in accordance with the Bologna Declaration and has positive accreditation provided by the National Commission for Accreditation and Evaluation. The Speech Language Pathology study program is focused on gaining competence in preventing, diagnosing, and treating speech and language disorders and human communication, as well as training researchers in SLP. Learning Outcomes: The participant will have the opportunity to learn about: 1. the training system of speech language pathologists in Serbia; 2. fields of study included in the SLP training system; 3. professional titles awarded to students upon cmpleating undergraduate and master academic studies; 4. the way to obtain a PhD degree; 5. types of institutions where speech language pahologists are employed.
FP163
FOCAL TASCK SPECIFIC EMBOUCHURE DYSTONIA: EVALUATION PROTOCOL AND SPEECH THERAPY PROPOSAL. A PILOT CASE ELEONORA DON (1) - PASQUALINA ANDRETTA (2) SERENA DE PELLEGRIN (1) - ANNA LAZZARINI (1) SPEECH THERAPIST, AZIENDA OSPEDALIERA UNIVERSIT DI PADOVA-CLINICA NEUROLOGICA I, PADOVA, ITALY (1) - SPEECH THERAPIST, ASL 3 BASSANO DEL GRAPPA (VI) - STRUTTURA COMPLESSA DI O.R.L. - AMBULATORIO DI FONIATRIA E LOGOPEDIA, BASSANO DEL GRAPPA, ITALY (2)
Abstract: Focal Task-Specific Embouchure Dystonia (FTSED) is a rare form of focal dystonia that affects, in a selective manner, the lower facial muscles and jaw structures involved in the embouchure of woodwind or brass instrument players. The present study aimed at evaluating and treating FTSED symptoms of a single specific case (male, 54 years old, professional trombonist). As the causes of such condition are yet to be concretely clarified, for the purpose of this study, we supposed that FTSED is related to the alteration of motor cortex output and somatosensory input, associated with the malfunction of cortical plasticity processes. The case was undertaken by a multidisciplinary team (speech therapist, neurologist, radiologist) at the Department of Neurology of the Hospital of Padua. After a thorough review and analysis of the related literature two assessment protocols were created. The first one deals with the evaluation of the orofacial praxias and with the mutual relation between other oral tasks of the stomatognathic apparatus and the manifestation of FTSED; also examines the possible interdependence between embouchure dystonia and hand focal dystonia. The second protocol generates from the need to keep a record of the alterations of sound quality and from the need to observe and classify possible manifestations of dystonia, occurring during the music performance. To measure muscular strength and function and to examine facial sensor abilities, it was make use of Martins protocol for the Evaluation of Face, Neck and Swallowing Functions (Martin, Couture, Eyoum; 1997), together with Garliners instrumental evaluation for the orofacial muscle balance. The evaluation was concluded with a fMRI (functional Magnetic Resonance Imaging). The speech treatment was planned with reference to three specific rehabilitative methodologies: Orofacial Therapy (CastilloMorales), Myofunctional Therapy (Garliner - Andretta) and the Orofacial Function Regulation Therapy (Martin). The therapy was focused on orofacial myofunctional disorder, assuming that any activity aiming at normalizing the muscle motility, generates an improvement of motor sequences of the oral functions. Consequently, the result will be an augmentation of the embouchure regulation and control, through a generalization process. The multidisciplinary theme agrees on the assumption that the specific dystonic symptoms are the result of an alteration of the homuncular lips organization, affecting both the functional aspects and structural one. In association with the central function deficit and its peripheral consequences, a disorder of the facial muscles has been detected, mainly caused by the compensative strategies activated by the patient, as an attempt to limit the dystonic manifestations. The speech treatment was based on this theory and lead to a muscular normalization and a decrease of the dystonic manifestations during the music performance. Also the sound quality was improved, as confirmed
FP165
IMPLEMENTING TEACHING AND RESEARCH IN SPEECH LANGUAGE PATHOLOGY: BULGARIAN EXPERIENCE DOBRINKA GEORGIEVA (1) SOUTH WEST UNIVERSITY, FACULTY OF PUBLIC HEALTH AND SPORT, BLAGOEVGRAD, BULGARIA (1)
Abstract: The present study proposed a theoretical framework for integrating teaching, research, and practice in SLP. Our experience of introducing research-informed teaching (RIT) and evidence-based practice (EBP) into the undergraduate curriculum at South West University in Bulgaria is described. The key prerequisites for linking research and teaching and its clinical representation in SLP Bachelor and Masters degree programs are discussed. One of the purposes of the study is to put accent how to encourage critical thinking and clinical problem-solving skills in students and teachers. We propose a strategic framework for integrating teaching, research, and practice in SLP based on a model developed at the School of Public Health and Clinical Sciences in the University of Central Lancashire (UCLAN), UK. Method: In order to realize the main purpose of this examination, were adopted three major tasks: (i) a review of the curricula and courses in SLP along with an analysis of the prerequisites for research and teaching; (ii) a literature survey on the leading definitions and concepts of linking teaching and research; (iii) development of a strategic vision for implementation of a RIT model in SLP. Learning Outcomes: The participant will be able to know more about (1) implementation of research informed teaching in SLP and its relation with evidence based practice in Bulgaria; (2) strategic vision for implementation of a RIT model in SLP.
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NETQUES: PAIN, PLEASURE AND POSITIVE OUTCOMES OF PAN-EUROPEAN PROJECT PARTNERSHIP, PRODUCING AND PROMOTING STANDARDS IN SPEECH AND LANGUAGE THERAPY EDUCATION AILEEN PATTERSON (1) - JOIS STANSFIELD (2) KRISTINA HANSSON (3) - MARTIN PELEMAN (4) BAIBA TRINITE (5) - ZSOLT CSFALVAY, (6) COMIT PERMANENT DE LIAISON DES ORTHOPHONISTES/ LOGOPDES DE LUNION EUROPENNE CPLOL, N, PARIS, FRANCE (1) - FACULTY OF HEALTH, PSYCHOLOGY AND SOCIAL CARE, MANCHESTER METROPLOITAN UNIVERSITY, MANCHESTER, UNITED KINGDOM (2) - LUNDS UNIVERSITET, DEPARTMENT OF LOGOPEDICS AND PHONIATRICS, LUND, SWEDEN (3) - ARTEVELDE UNIVERSITY COLLEGE GHENT, DEPARTMENT OF LOGOPEDIE, GHENT, BELGIUM (4) LOGOPEDICS/VOICE AND SPEECH LABORATORY, LIEPAJAS UNIVERSITATE, LIEPAJA, LATVIA (5) - COMENIUS UNIVERSITY, DEPARTMENT OF COMMUNICATION DISORDERS, BRATISLAVA, SLOVAKIA (6)
Abstract: The level of initial education, curricular structures and terminology in Speech and Language Therapy (SLT) education programmes varies across EU-countries, making comparisons of expectations/competencies of SLTs difficult. The acronym used throughout for the profession and professional is SLT, however in Europe the professional is also known as logopaedist and in French orthophoniste. As the European Union has developed and increased its membership, so also has EU legislation to encourage crossborder mobility and recognition of qualifications across member states. This has led to a definite need to be able to assess and analyse education programmes within and across EU and beyond. It is a goal of the profession and indeed the European Union that all citizens can access equally high standards of care, and also allow mobility of the work force across European borders. The SLT profession also is firmly established in a global context. CPLOL, Comit Permanent de Liaison des Orthophonistes/Logopdes de lUnion Europenne, the European umbrella organization of SLT associations in member countries is coordinating an EU-project, NetQues, Network for Tuning Standards and Quality of Education programmes in Speech and Language Therapy (Logopaedics) across Europe, based on a multilateral academic and professional network of 65 partners from 31 European countries. The three-year project (20102013), now in its final phase, receives 75% funding from the European Commissions ERASMUS Life Long Learning Programme through EACEA. This presentation provides information on the process and outcomes of this pan-European project involving SLT educationalists across Europe. The project is establishing agreements on areas of commonality in SLT education and also looks at differences, allows sharing good practice, with the aim of quality improvement and enhancement. The role of SLT education in meeting the need for a dynamic profession within changing demands of society and knowledge is important in enabling the public to access good quality appropriately educated SLT professionals. Across Europe SLT is generally a recognised autonomous profession, although the degrees of that autonomy vary. The NetQues project seeks to set out quality standards by providing consensus guidelines for programmes across Europe based on expectations of the newly qualified SLT, resulting from an extensive survey of SLT education practice and professional standards across all countries of Europe with respondents from key stakeholders across SLT educationlists/academics, graduates and employers. Following the EU recognized Tuning Methodology, NetQues is defining SLT European educational benchmarks while also facilitating the sharing of best practice in teaching, learning and assessment, commencing with a comparative study of relevance of Subject Specific and Generic Competences across all programmes. and thus a key outcome is the production of agreed key competences and reference points or benchmarks. The presentation provides the preliminary findings of the research. However the challenge of bringing together professionals across Europe must not be underestimated. SLTs come from a wide range of experiences, education, cultures, and health care and education systems and of course linguistic backgrounds but fortunately there are many similarities in professional goals and practice. The presentation also addresses how the project met such challenges. Learning Outcomes: Attendees will be able to identify some main challenges of professional collaborations working across European boundaries and how they may be addressed; Become more familiar with the use of Tuning methodology as a method of comparing education programmes in SLT; Be able to identify key differences and similarities in design and implementation of SLT education programmes in Europe; Be able to identify key competences required to be demonstrated by the newly qualified SLT on completion of a European education programme, across different models of education.
SIFEL MAIN REPORT - MOTOR SPEECH DISORDERS: DYSARTHRIA: CAN WE DO MORE? GIOVANNI RUOPPOLO, ANTONIO AMITRANO, CHIARA BONAZZI, ELISABETTA LOSI, GIULIA MAZIO, DANILO PATROCINIO, FRANCESCA ROMANA PEZZELLA, AGNESE ROSSI, GIUILIA ROSSI, VINCENZO SALLUSTIO, ILENIA SCHETTINO, ANTONIO SCHINDLER, ITALY
Abstract: Dysarthria is a neurological motor speech disorder, common in older people, often responsible for a severe restriction in communicative participation. Despite the high prevalence and the relevance of the related social impact, speech therapists usually report limited interest in the management of this speech disorder. The aim of our Report is to draw the attention of health operators involved in the care for neurological patients to dysarthria and related worsening of quality of life. In this field an active research has been carried out in last decades and new tools are now available for rehabilitation. Dysarthria is characterized by slow, weak, imprecise and/or uncoordinated movements of the speech musculature that result in a speech impairment varying from an imperceptible deficit to a complete unintelligibility. Acquired dysarthria can be progressive, as in degenerative diseases such as Parkinsons disease, multiple sclerosis or motor neuron disease, or nonprogressive, as in stroke or traumatic brain injury. The first part of the Report will be dedicated to the dysarthria assessment. A review of perceptual analysis techniques will be presented after discussing the main elements of the motor speech examination in different assessment instruments. Greater attention will be given to the acoustic analysis of the dysarthric speech, a promising approach to improve diagnostic accuracy. However an examination of the speech difficulties of the patient, as complete as possible, cannot be considered exhaustive if it does not take into account the covert aspects, the subjective consequences related to the communication deficit. An Italian tool developed to measure the quality of life (QOL) in the dysarthric speaker will be presented. The second part of the Report will focus on dysarthria treatment, the challenge of the third millennium for speech therapists. The traditional rehabilitation techniques have been improved trough the modern theories of motor relearning and new tools have become available such as the Lee Silverman Voice Treatment which proved to be effective in treating voice and speech disorders in individuals with Parkinsons Disease (PD). Another proposal for dysarthria rehabilitation in PD will be also submitted, based on the influence of music, theater, manual activity and writing on vocal and mental abilities on a group of patients suffering from PD. Finally close attention will be given to the augmentative and alternative communication (AAC), an umbrella term that encompasses all techniques, strategies and technologies used to supplement speech in persons temporarily or permanently impaired in the production of spoken or written language. Within dysarthria domain AAC is performed as a communication oriented approach and is focused not only on the patient but also on environment and care givers. AAC is used by patients with a wide range of speech and language impairments, and is always highly recommended in case of severe dysarthria because, as suggested in the Communication Bill of Rights, All people with a disability of any extent or severity have a basic right to affect, through communication, the conditions of their existence.
SE10
RE-SHAPING STUTTERING MODIFICATION THERAPY: WOULD DR VAN RIPER BE AMUSED? JOSEPH AGIUS (1) UNIVERSITY OF MLALTA, SAN GWANN, MALTA (1)
Abstract: One of Van Ripers important phases in Stuttering Modification Therapy is desensitation phase. This presentation shows how to use creativity and humor as a desensitization technique. The most creative aspect of language is humour and it is one of the most important topics in the study of communication. Pedagogical trends in recent decades have also shifted toward the promotion of a more relaxed learning environment emphasizing making learning fun. Research has shown that children who stutter view speaking more negatively and experience more negative speech-related emotions than do non-stuttering peers. However, while practical strategies for helping children who stutter change their feelings and beliefs about stuttering are widely available, speech language pathologists feel uncomfortable targeting such goals. Strategies are needed to use in treatment that could help clinicians help children make changes. These tools could assist the child in finding a balance between modifying speech and developing and maintaining healthier attitudes and feelings. Creativity and humor are used as tools to help children problem solve and broaden perception to develop and maintain positive attitudes towards themselves and communication. Desensitization is a behavioural intervention. By using humor in stuttering therapy, the repeated pairing of a humor response with exposure to a feared stimulus gradually diminishes the feelings of anxiety evoked by the stimulus. Current research on humour and stuttering is presented .The results of a study exploring shifts in the attitude and feelings of school-age children who stutter following a thinking skills programme are presented. The findings of this study led to a suggested model of intervention, the Smart Intervention Strategy (SIS), with school-aged children who stutter. Included in this framework is the humor component. The use of humour as a therapeutic tool is explored and the theory and rationale for its application in therapy is discussed.
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Learning Outcomes: Participants will: Understand the experience of humor and identify the core therapeutic impacts of humor; Become familiar with the results of a study exploring shifts in attitudes and feelings following a thinking skills program; Distinguish between the physical, emotional, and cognitive benefits of humor; Be introduced to current humour reseach and studies on the relationship of humour and stuttering; Learn how creativity and humour can be beneficial in fluency intervention.
SS30
A QUALITATIVE ANALYSIS OF HINDRANCES TO PLAY AND STRATEGIES FOR UTILIZING SCRIPTS FOR SCAFFOLDING TO IMPROVE LANGAUGE SKILLS IN PRESCHOOLERS. IRENE TORRES (1) - LIDIA RODRIGUEZ (2) HASC, NONE, BROOKLYN, NY, UNITED STATES (1) UNIVERSITY OF CASTILLA DE LA MANCHA, TALAVERA DE LA REINA, SPAIN (2)
Abstract: The importance of play in child development is not refuted but current trends towards higher kindergarten standards tend to create a great deal of emphasis on academic work, even in the preschool years. However, anecdotal information indicates that even in programs where a play-based curriculum is in place there is reluctance on the part of the adults to engage in play and that even when they do their play is not always structured in a way to maximize the childrens experience. This trend has been observed in the US and in Europe. Numerous authors (Westby, Gonzalez-Moreno, Lazaro and others) provide evidence that play is important to language learning and to literacy. Vygotsky and other constructivists demonstrate that children learn best through experience and therefore through play. Additionally, Westby has demonstrated clear connections between play and early language development. Vocabulary and theory of mind concepts learned through play foster skills needed for literacy. Without experience and vocabulary children cannot learn to read or comprehend what they read. Research tell us that pretend play has also been linked to the use of language functions, decontextualized language used in literacy and to reflective thinking or theory of mind. Higher levels of symbolic play and literacy both require the ability to comprehend and use language without the benefit of contextual support from the environment. Children who exhibit greater decontextualization in their play by substituting objects or taking on imaginative roles also use more explicit, decontextualized language involving elaborated noun phrases, temporal and causal conjunctions, past tense and future aspect, and metacognitive verbs (Pellegrini, 1985). Inability to use decontextualized language has been associated with school failure. (Michaels & Collins, 1984; Zwiers, 2008). The use of language for a wider variety of functions and projecting into the thoughts and feelings of others is more highly developed in children who play. Pretend play, thus, provides a mechanism for developing and practicing the cognitive and linguistic skills that underlie literacy. It is believed that the use of scripts for adults in play will foster their ability to engage in play and to more effectively use scaffolding for language development. This technique is not well documented but experience indicates that it has been used effectively in many settings. This session will examine a qualitative analysis of the results of a survey designed to explore factors affecting play and outline some of the problems that adults have with play. It will examine the idea that scripts advance and support the use of play in the classroom and in therapy because they overcome many of the emotional deterrents to play for adults and provide a vehicle for scaffolding language for children. Techniques for developing strategies for encouraging play in the classroom and therapy as well as developing scripts geared toward scaffolding scenarios for language impaired or delayed children will be presented. Learning Outcomes: Participants will understand the importance of play in preschool intervention; participants will be able to identify some of the deterrents to utilizing play in a school setting; Participants will be able to discuss the value of developing strategies for scaffolding language during play; Participants will be able to discuss the importance and effectiveness of scripts in play intervention.
competencies, i.e. the ability to mediate identity through social interaction one of the main problems of aphasic patients. Although biography work can support processes of sense-making, specific concepts in aphasia therapy are still not established. Only a few studies show the efficiency of such an intervention, which we want to refine. In detail we aim at supporting identity renegotiation and social participation, and at bolstering the patients sense of competence. The study was set in a pre- and post-testdesign with a follow-up assessment three months after the intervention. Face-to-face interviews and group sessions were provided over ten weeks. Three narrative interviews, a kind of in-depth interview, were conducted to give participants the chance to tell their life narration. In two further semistructured interviews group topics were prepared. Altogether seven group interventions were conducted. In a multimodal approach we support the narrations e.g. by pictures. A battery of measurement instruments was used to measure the multidimensional construct of QoL. We present the results of 17 participants with a chronic but different type of aphasia. For group intervention participants were divided into three groups. In accordance with our expectations, we found a significant improvement in health-related QoL. Also self-reported states of mood as e.g. happiness grew significantly. As expected overall life satisfaction which is a very broadly based and stable judgment did not change. According to self-reports in semi-structured interviews at the end of the intervention participants experienced a change in perspective accompanied by a change in quality of participation. Beyond the results we want to discuss how our intervention can be integrated in speech therapy. Learning Outcomes: Participants should become acquainted with: the psychosocial situation of people of aphasia and psychosocial approaches in aphasia; concepts of identity and narrative competence as well as of Quality of Life(QoL); quantitative and qualitative assessments for the measurement of (QoL) in aphasia biography work: a short sketch of the theory, methods of biography work in face-to-face settings and group settings, possibilities of modification and support for people with aphasia; empirical data that show the effectiveness of such an approach.
SS32
SWALLOW-RESPIRATORY RELATIONSHIPS AND THE IMPACT ON DYSPHAGIA MANAGEMENT MICHELLE TROCHE (1) - KAREN HEGLAND (1) UNIVERSITY OF FLORIDA, DEPARTMENT OF SPEECH LANGUAGE AND HEARING SCIENCES, GAINESVILLE, UNITED STATES (1)
Abstract: There is an intricate relationship between respiration and swallowing. For most healthy individuals without dysphagia, single swallows are both preceded and followed by expiration. It is consistently reported across research groups that over 90% of swallows are followed by expiration. It is hypothesized that the observed interaction of the respiratory system with deglutition is related to the role of sensory receptors responsive to subglottal pressure during airway closure for swallow. The generation of subglottal pressure (positive or negative) is, in part, dependent on lung volume given the relationship between lung volume and relaxation pressure. In fact, there is a range of lung volumes that enables the most efficient, and safest, execution of a swallow task. Breakdown in the normal respiratory-swallow relationship can result in swallowing dysfunction. In a study completed by our research group we found that in individuals with mild to moderate PD severity (H&Y IIIV), only 70% of swallows were followed with expiration, compared to over 90% expected for healthy individuals. Within our PD cohort, those who exhibited penetration and/or aspiration showed a greater predominance of inspiration occurring after a swallow compared to those with no penetration or aspiration. In an effort to understand the relationship between disordered swallowing and respiration, our research group has become interested in the role of patient perception of breathing effort, or dyspnea, as it relates to swallowing performance. Our work in over 50 patients with PD has revealed that dyspnea and associated anxiety are related to decreases in swallowing-related quality. Clinicians who specialize in dysphagia should consider respiratory-swallow relationships in the evaluation and treatment of their patient. Static measures of pulmonary function, swallow-specific respiratory measures, and subjective, patient self reported measures of dyspnea or breathing effort should form part of the dysphagia evaluation. This information is integral to the development of the dysphagia treatment and management plan. The goal of this short seminar is to: 1) describe the intricate relationship between respiration and swallowing and 2) present methods by which clinicians can properly account for respiratory based changes in the evaluation and treatment of patients with dysphagia Learning Outcomes: The participant will be able to: Describe the intricate relationship between respiration and swallowing, identify patients at-risk for increased airway compromise secondary to disruption of the swallowrespiratory relationship, and present methods by which clinicians can properly evaluate respiratory-based changes in the evaluation and treatment of patients with dysphagia.
SS31
IMPROVING QUALITY OF LIFE IN APHASIA THROUGH LIFE STORY TELLING A BIOGRAPHIC-NARRATIVE APPROACH SABINE CORSTEN (1) - JRGEN KONRADI (1) - ERIKA SCHIMPF (1) FRIEDERICKE HARDERING (2) ANNEROSE KEILMANN (3) DEPARTMENT FOR HEALTH CARE & NURSING - LOGOPEDICS, CATHOLIC UNIVERSITY OF APPLIED SCIENCES MAINZ, MAINZ, GERMANY (1) - INSTITUTE FOR SOCIAL AND POLITICAL SCIENCES, GOETHE-UNIVERSITY FRANKFURT A.M., FRANKFURT, GERMANY (2) - DEPARTMENT FOR COMMUNICATION DISORDERS, UNIVERSITY MEDICAL CENTER MAINZ, MAINZ, GERMANY (3)
Abstract: In the current study an interdisciplinary multimodal approach of biographic-narrative work to improve Quality of Life (QoL) in aphasia is developed and evaluated. Many persons with aphasia experience a diminished participation and a massive loss of QoL. Sociocultural theories focus on narrative identity as an explanatory construct in understanding QoL issues. The construct of narrative identity concentrates on biographic-narrative
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FP167
SPEECH AND LANGUAGE THERAPY: USING THE PAST TO INFORM THE FUTURE JOIS STANSFIELD (1) - IYSHA BARRATT (1) RESEARCH INSTITUTE IN HEALTH AND SOCIAL CHANGE, MANCHESTER METROPOLITAN UNIVERSITY, MANCHESTER, UNITED KINGDOM (1)
Abstract: Background: In the past two years the history of speech and language therapy in the UK has been a topic of interest for the general public, following the success of the film The Kings Speech, which outlined the challenges faced by the UK king, George VI and the efforts of an apparently maverick speech and language therapist to help him overcome a disabling stutter. This speech and language therapist (SLT), Lionel Logue, was one of the founders of the professional body now known as the Royal College of Speech and Language Therapists (RCSLT). The UK SLT profession, however, has its roots in earlier activities. Documentation of the developing profession is available from the last two centuries. This study outlines some of the major themes in the speech and language therapy literature from the early 1800s to the 21st century. Method: Historical literature held by the UK professional body, RCSLT and one UK university was reviewed using purposive sampling, to identify and evaluate the content which emerged in successive decades of the UK profession. Framework analysis was used to identify themes which emerged over the period. The literature included the RCSLT archive, the International Journal of Language and Communication Disorders and its predecessors, and historical sources from the nineteenth century to the present day, across the UK, held at one UK university. Results: 19th century literature is characterised by practitioners who had little formal training and who advertised their services with testimonials from clients. Changes in the decades of the 20th century were related to major changes in social conditions, war, professionalisation, and social policy, with the profession moving from independent private practice to the NHS and professional regulation. Specific themes include the development of the professional body; changes in student education; the explosion of research supporting evidence based practice; and the changes in the media available for service delivery. Conclusion: Literature from the late nineteenth century onwards indicates that the impact of many external factors have influenced the direction of the profession. This continues to the present day, with research, but also political changes, and at present, war, still impacting upon the SLT practice. The literature reviewed also indicates that professionals from medicine, education and a range of other relevant disciplines, not least speech and language therapists, have contributed to the evidence base upon which SLTs base their practice, with theory informing practice and practice informing theory. History can inform the future development of our profession. Learning Outcomes: The participant will: Gain a current view of the history of the profession of SLT in the UK; Understand the events which influenced the development of the UK SLT profession; Recognise the implications that a study of the history of the profession may have for the its future development.
FP169
CPLOL EDUCATION COMMITTEE: WORKING GROUP REPORT, DOCUMENTING FORMS OF CLINICAL PRACTICE I INITIAL EDUCATION IN EUROPE, (2009-2012) OVERTON VENET MARY (1) - THORA MASDOTTIR (2) BETTINA HEINZELMANN (3) - BAIBA TRINITE (4) ANNE-LISE RVGVOLD (5) - IRENE VERNERO (6) MARIA VLASSOPOULOS (7) UNIVERSITY OF GENEVA, FACULTY OF PSYCHOLOGY, MASTERS PROGRAMME IN SLT, GENEVA, SWITZERLAND (1) - UNIVERSITY OF ICELAND, MEDICAL DEPARTMENT, PROGRAMME OF COMMUNICATION DISORDERS, NATIONAL HEARING AND SPEECH INSTITUTE OF ICELAND, REJKJAVIK, ICELAND (2) - ROSS SCHULE LEHRANSTALT FUER LOGOPAEDIE, LOGOPAEDIE, HANOVER, GERMANY (3) LIEPAJA UNIVERSITY, SLT PROGRAMME, LIPAJA, LATVIA (4) UNIVERSITY OF OSLO, DEPT. OF SPECIAL NEEDS EDUCATION, OSLO, NORWAY (5) - UNIVERSIT DI TORINO, LAUREA DI LOGOPEDIA, TURIN, ITALY (6) - UNIVERSITY OF ATHENS, SCHOOL OF MEDICINE, ATHENS, GREECE (7)
Abstract: Within CPLOL, at the Turin GA in October 2009 (Position Statement on Clinical Practice in initial education), the Education Commission was mandated to further earlier investigations into the organization of clinical education in the member states. The question posed was: how do higher education establishments who train SLTs in the CPLOL member states go about providing clinical Practice education (hereafter, CP) and what forms does this clinical education take, be it in the university or in the clinics? The first objective was to carry out a detailed survey of existing forms of CP, both existing and to identify possible future forms of CP, in initial education only. The purpose of the enquiry and the final report is to allow CPLOL members to compare, change, develop curricula and evaluate existing contents during initial education in their countries. The principal results of the enquiry will be presented, encompassing data received from 28 of the 32 CPLOL member associations. One possible outcome of the report could be to contribute to the Tuning objectives of the NetQues enquiry, which aims at a degree of harmonization of SLT education standards within Europe.
SY8
EDUCATING SLPS FOR PROFESSIONAL PRACTICE IN DIFFERENT ENVIRONMENTS - SESSION 1 AND 2 TOMASZ WOZNIAK - DOBRINKA GEOGIEVA - SEYHUN TOPBIAS MIRELA DURANOVIC - NADJA ZEMVA - MILE VUKOVIC KATERINA VITASKOVA (BULGARIA)
Abstract: This seminar is proposed by the Education Committee for Speech and Language Pathology. It will be conducted in two 90-minute sessions, with presentations by representatives from over one dozen different countries, all of them with significant experience in educating speech and language pathologists in undergraduate and graduate levels. These presentations will address the different challenges posed by various educational needs and standards and professional certification/accreditation systems. Participants will also report on solutions to local specific issues that may be adapted or applied to other situations. They will discuss about the advantages and difficulties in building a set of statements that could be shared on a global perspective. Confirmed participants are: Tomasz Wozniak, from Poland; Suzana Jelcic, from Croatia; Nadia Zemva, from Slovenija; Mirela Duranovic, representing Bosnia and Hercegovina; Peter Lajos, from Hungary; Katerina Vitaskova, from the Chec Republic; Mile Vukovic from Serbia; Lemietta McNeilly, from the United States, representing the American Speech-Language Hearing Association; Chin-Hsing Tseng, from Taiwan; Hayde Wertzner, from Brazil; Sharyne Mcleod, from Australia and Seihun Topbash, from Turkey. Learning Outcomes: The Participant will: 1. Know the different challenges regarding the education of SLPs in different regions of the world; 2. Identify the solutions proposed, their results and the possibility of application in different situations; 3. Identify similarities, possible associations, common points of interest and alternatives to collaboration with colleagues form different parts of the world.
FP168
SPEECH SOUND DISORDERS: INTERACTION BETWEEN PHONOLOGICAL AND AUDITORY-PERCEPTUAL PROCESSING
TATIANE BARROZZO (1) UNIVERSITY OF SAO PAULO - DEPARTMENT OF SPEECH SCIENCE (1) Abstract: Objective: To describe the performance of SSD children in a phonology test (PT), speech inconsistency test (SIT), phonological awareness test (PAT) and central auditory processing assessment (CAP) according to the presence or absence of otitis media history, and to analyze the similarities between subjects according to phonological performance. Patients and Methods: 21 children with SSD between 7:0 and 9:11 years old, both genders, 5 with otitis media history (G1) and 16 without otitis media history (G2). PT, SIT, CAP and PAT (visual and auditory versions) were applied. Results: No significant differences were found between G1 and G2 for any of the variables, except for one subtest of PAT (visual version). Three clusters were identified according to phonological performance, which differed in severity, age and changes in CAP and SIT. Conclusion: Evidence from the study suggests that children with and without otitis media history had similar phonological performance and SI, metaphonological abilities and CAP. The tests that were applied in this study effectively demonstrated the interaction between auditory perceptual, cognitive linguistic and motor speech processing in children with either more or less severe forms of disorders. When a childs phonological performance is more committed, all three forms of processing are quite altered, whereas when phonological severity is lower, these processes are less affected.
SS33
AN EXPLORATION OF BRITISH-TAMIL AND SRI LANKAN-TAMIL MOTHERS BELIEFS ON CHILD LANGUAGE DEVELOPMENT AND CHILD LANGUAGE IMPAIRMENT AND THEIR VIEWS ON SPEECH AND LANGUAGE THERAPY AND MATERNAL INT SHYAMANI HETTIARACHCHI (1) DEPARTMENT OF DISABILITY STUDIES, FACULTY OF MEDICINE, UNIVERSITY OF KELANIYA, RAGAMA, SRI LANKA (1)
Abstract: Within the UK, families from an ethnic minority background show a general trend of poor attendance at speech and language therapy appointments (Morris, 2004). This study examines maternal beliefs and behaviour concerning child language development, language impairment and two
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therapy approaches in an attempt to understand the cultural context that may impact on the low uptake of speech and language therapy services. Two cohorts of mothers (40 UK-based Tamils and 30 Sri Lanka based Tamils) were the primary participants in the study. Interviews were conducted to ascertain their beliefs and explanations of child language acquisition and language impairment, with a modified grounded theory approach used to code, analyse and generate a conceptual framework to understand these beliefs. Of the ten themes identified, religious-cultural influence emerged as the core theme impacting beliefs with implications for whether Tamil parents seek speech and language therapy support and how they engage with the therapy approach offered. Video-data of the two cohorts linguistic interaction styles in dyadic interaction with their 3;00 to 4; 06 year-old preschool children with primary language impairment or typically developing language skills was analyzed using a coded interpretative-analytical system. The analysis considered whether there was a difference in the maternal interaction style depending on the childs language competence. It also considered whether the UK-based mothers linguistic behavior converged more easily with the assumptions and established therapy practice embedded in the widely employed Hanen parent programme (Manolson, 1992) and Parent Child Interaction (PCI) approach (Kelman and Schneider, 1994). The conclusion was, that despite possible wider acculturation of the UKbased mothers, there was no significant difference between the two groups and that the currently dominant therapy practice was no more acceptable to them as to the Sri Lanka based group. A directive interaction style was observed across the two countries and levels of child language competence. This means that the direct maternal interaction style reflects the influence of the heritage-culture rather than the childs language competence. This further supports the need to review the cultural sensitivity of the PCI and Hanen-based therapy approaches offered. Subsequent framework analysis of maternal views on two therapy approaches (a didactic approach more in common with the heritage-culture and a PCI approach reflective of the therapy intervention usually offered) reinforced the conclusion that mothers favored adult-led, directive therapy approaches and that this cultural attenuation influenced Tamil mothers low uptake of speech and language therapy. Taken together, these findings suggest a range of reasons (in isolation or combination) that affect the poor uptake of speech and language therapy services by this community. The study concludes by discussing the key clinical implications for the way speech and language therapists and policy-makers make use of parental beliefs, views, and interaction behavior within assessment and intervention. Learning Outcomes: The participants will be able to: Appreciate current best practice for bilingual or multilingual children experiencing languagelearning difficulties; Be aware of the interface between culture, beliefs/ perceptions and mother-child interaction styles; Understand more about maternal beliefs, perceptions and culture-specific mother-child interaction patterns in South Asian culture; Understand the difficulties with implementing non-directive play therapy within South Asian culture.
suitable for the procedure. Depending upon the location of the tumour and the peculiarities of the patient, the Speech Therapist has proposed linguistic test (naming of objects, Italian regions and familiar faces), motor and computing tasks to be performed in the operating room. On the basis of the errors made by the patient, brain areas functionally related to the fulfillment of these tasks were identified in the left and right hemisphere. The Awake Surgery has made possible to optimize the benefit/risk ratio of the surgery and to increase the extent of resection while decreasing the rate of postoperative sequelae. This is possible if the tasks proposed to the patient, during the steps of mapping and removal of the mass, have been defined on the basis of the peculiarities of the patient himself. During surgery, in addition, the analysis of the presence and type of errors, made by the Speech Therapist, guide the surgeon in identifying functional areas to be preserved. Speech Therapists skills and knowledge are crucial during the course of the entire procedure, and particularly for early taking charge of the patient, with positive effects on quality of life. Learning Outcomes: The Partecipant will be able to: 1) know the peculiarities of the Awake Surgery; 2) understand the importance of setting up a specialized team for the execution of the procedure; 3) understand the role of the Speech Therapist in Awake Surgery and how his skills and knowledge are essential in pre-, intra- and post-operative evaluation.
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THE USE OF ACOUSTIC ANALYSIS SOFTWARES IN DYSPHAGIAS THERAPY
INGRID GIELOW (1) CEV, CENTRO DE ESTUDOS DA VOZ, SO PAULO, BRAZIL (1) Abstract: A safe deglutition should coordinate precisely swallowing and breathing, as the food to be swallowed and the air share the same oropharyngeal path. So, there is an interruption of respiration, called swallow apnea, during the swallowing phase. Also, noise is produced both in the airway during breathing, and the process of bolus driving. The cervical auscultation (CA) is the procedure that amplifies the sounds of swallowing, and it may be useful to assess the pharyngeal phase of swallowing, thus helping to determine the integrity of the mechanism of airway protection. It was shown to be a good tool to find aspiration, or to identify patients at risk for aspiration. Combining CA with acoustic analysis, it is possible to register visually the resulting acoustic wave and to determine some of its parameters. The use of some low cost acoustic analysis softwares for voice assessment will be shown as clinical alternatives to the expensive specific existing systems. With the acoustic spectrography, it is possible to identify the instant of the swallow apnea, and the two or three distinct clicks associated with swallowing, and the expiration after the swallow apnea. Theoretically, the longer the duration of the apnea, the safer is the protection system of the lower airways. The swallowing sounds recordings obtained with microphones connected to computers are processed with softwares such as Vox Metria, Fono View and Ear Mix (www.ctsinformatica.com.br), PRAAT, GRAM, among others. These softwares allow the scanning of the sounds, the transformation of audio signals into visual representations, and the exact measurements and reviewing of the acoustic registers, if necessary. However, a great issue is the adaptation of the software and its interface with the microphone to each computer, usually requiring many tests with several microphones and professional softwares to find the combination that best processes the fragile swallowing signals. In clinical practice, the visual analysis may help to identify the presence of swallow apnea, as well as monitoring the practice of maneuvers, especially those involving swallowing apnea, such as the supraglottic swallow maneuver and Mendelsons maneuver. Considering that an individual without a perceptible swallow apnea is a potential patient at risk for aspiration, the CA may be a helpful prediction tool. It also may be a potential strategy for biofeedback, in which the patient monitors his records while performing exercises or swallowing, as well as a resource for training professionals in the field of swallowing disorders. It is important to say that practice is fundamental for the reliability of the CA and its acoustic analysis. It is a procedure that may be used for clinical decision support, but no decision can be taken only based on its findings. Learning Outcomes: How to use some popular acoustic analysis programs for voice in the field of dysphagia management; How to collect the sounds of swallowing; What to look for at the spectrographic registers; Possibilities and limits of the acoustic analysis in cervical auscultation.
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AWAKE SURGERY: THE ROLE OF SPEECH THERAPIST IN THE PROCEDURE OF CORTICAL MAPPING AND MONITORING. ANNA LAZZARINI (1) - PASQUALINA ANDRETTA (2) SERENA DE PELLEGRIN (1) CLINICA NEUROLOGICA I, AZIENDA OSPEDALIERA UNIVERSIT DI PADOVA, PADOVA, ITALY (1) - STRUTTURA COMPLESSA DI ORL- AMBULATORIO DI FONIATRIA E LOGOPEDIA, ASL 3, BASSANO DEL GRAPPA (VI), ITALY (2)
Abstract: The innovative technique named Awake Surgery, in association with Cortical Mapping and Monitoring, allows the removal of tumours located in eloquent areas (Duffau H., 2007; Bizzi A, 2009). Intra-operative realtime cortico-subcortical Mapping enables the identification of functional areas, through the direct electrical stimulation (DES) associated with the execution of specific tasks (Duffau H, 2009). A site is considered functional when the stimulation of this area leads to an interruption in the performance of the task (Talacchi A, 2009). During the tumour removal, the Monitoring provides a continuous stimulation of subcortical sites, in order to verify the integrity of the function investigated (Duffau H, 2005; Talacchi A, 2009). For the success of the surgery it is important to constitute a specialized team (Talacchi A, 2009) that includes Neurosurgeons, Anesthesiologists, Neurologists, Nurses, Neurophysiologists, Neuropsychologists and Speech Therapists. The Speech Therapist performs, in three different stages, a full, detailed and planned on the basis of the patients deficits assessment; in pre-operative evaluation the objective is to provide information on cognitive functions affected by the lesion (Duffau H, 2010), identify the functions to be monitored during surgery and related tests to be performed. During the surgery, the Speech Therapist has to analyze the errors occurred after patients brain stimulation, to allow the identification of eloquent cortical and subcortical sites (Duffau H, 2010). Post-operative cognitive-linguistic assessment is necessary to acquire information on the outcome of surgery (Duffau H, 2008), to monitor the evolution of the sub-acute phase and to program an adeguate treatment plan. In order to describe the role and importance of the Speech Therapist amongst the neuro-oncology team, were evaluated 39 patients candidates to the procedure of Awake Surgery. After the preoperative evaluation of the team, 18 patients were identified as
FP170
LITERACY IN THE BRAZILIAN UNIVERSITY: STUDENTS OF SPECIAL EDUCATION IN INCLUSIVE PERSPECTIVE ANA PAULA SANTANA (1) UNIVERSIDADE FEDERAL DE SANTA CATARINA, FLORIANPOLIS, BRAZIL (1)
Abstract: The condition of those who read and write, or, in other words, the state or conditions of who respond properly to social demands by the broad and differentiated use of writing and reading is denominated literacy (Soares, 1998). As is school, university is one of the great agencies of literacy. Considering that most of the Brazilian population has showed a low degree of literacy, admittance in university does not guarantee access to new practices of it. During their formation in higher education many students
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demonstrate difficulties in interpreting and producing written work, both in what refers to the construction of gender as in the construction of argumentative texts that relate theories, facts, ideas and criticism. If that is the reality of the so called normal students, even more worrying is the situation of those who are a part of the target audience of special education in an inclusive perspective. These students may present auditive, mental and visual deficiencies, global development disorders, multiple deficiencies and some may even present functional disorders: learning difficulties, dyslexia, oral language alteration, etc. What that means is: with the implementation of laws about inclusion there is an increased accessibility of students who are the target audience of special education reaching higher education. However, their conclusion of these courses is not guaranteed. There are difficulties that prevent them to stay at the universities, which are related with their low degrees of literacy. In this sense, learning difficulties, of producing and interpreting texts affect significantly their permanency in universities. But what are those difficulties? What are their literacy practices? The objective of this work is to analyze the literacy practices and the difficulties related to such practices experienced by university students who are the target audience of special education in an inclusive perspective. This is a qualitative research that correspond to a semi-structured interview to collect information about the literacy practices of students, their family members and their current difficulties. Five students from a university in Brazil who have reported having difficulties with written language have taken part in this research. The analysis was based in a historic-cultural approach (Bakhtin, 1929/1981). The result shows that students with brain paralysis, dyslexia, or who are deaf, have low practices of literacy e present difficulties in producing and interpreting secondary genders. The idea of abandoning their course is recurring. From those results we see the importance of this discussion to think actions that may promote better practices of literacy. In this sense, speech therapy can and should participate in interdisciplinary actions between health and education. Learning Outcomes: It is expected that this paper can contribute to the following: (i) Verify what are the language difficulties of the university students;(ii) comprehend more about the practice of literacy of these students; discuss the role of educational speech therapy in the university.
FP172
HOUSEHOLD SURVEY CHALLENGES ON SELF-DECLARED COMMUNICATION DISORDERS BRBARA GOULART (1) - BRASILIA MARIA CHIARI (2) VANESSA MARTINS-REIS (3) UNIVERSIDADE FEDERAL DO RIO GRANDE DO SUL, PROGRAMA DE PS-GRADUAO EM EPIDEMIOLOGIA, PORTO ALEGRE, BRAZIL (1) - UNIVERSIDADE FEDERAL DE SO PAULO, DEPARTAMENTO DE FONOAUDIOLOGIA, SO PAULO, BRAZIL (2) UNIVERSIDADE FEDERAL DE MINAS GERAIS, DEPARTAMENTO DE FONOAUDIOLOGIA, BELO HORIZONTE, BRAZIL (3)
Abstract: Purpose: based on surveys already performed around the world, this paper aims at discussing solutions to the challenges intrinsic to the implementation of a population survey of self-declared communication disorders (CD) in relation to the instruments of research, planning and logistics for the implementation of the study. Methods: based on the analysis of age and educational status distribution in the target population, the multistage stratified probabilistic sample was determined also to address the stages of the lifecycle. In order to check the self-reported communication disorders, two previously validated questionnaires were used: DCH-POP-C for infants and children up to 24 months old and DCH-POP for 25-month old children to adults. Both questionnaires have a block of questions of general identification of home, location, number of residents, age and gender of all residents, as well as the history of speech-language therapy, being answered by one of the household residents (proxy). Results: the main challenges for the planning and execution of the study are: selection, training and maintenance team of interviewers aim at maintaining low rates of refusal to participate in the study ( 5%); and the initial approach to the interviews for the critical success in this regard. Conclusion: despite the huge challenges posed by population surveys, mapping the occurrence of communication disorders is relevant to the planning and development of actions, especially to the most vulnerable population.
FP171
PSYCHO-COMMUNICATION DISORDERS WITHIN MOROCCAN UNIVERSITY STUDENTS OF HARD SCIENCE MAJORS BOUZEKRI TOURI (1) - F.Z AHRA SOUBHI (1) - NOUREDDINE KNOUZI (1) - MOHAMMED TALBI (1) - LAURENT LIMA (2) FACULTE DES SCIENCES, UNIVERSITE HASSAN II MOHAMMEDIA CASABLANCA, MOROCCO (1) - UNIVERSIT PIERRE MENDS FRANCE GRENOBLE 2, GRENOBLE, FRANCE (2)
Abstract: The purpose of this study was to explore the effects of psycho-communication disorders factors on school efficiency of university students of hard science majors in Morocco. Twenty-two age-matched students without psycho-communication disorders also completed the study. A large pool of 229 university students participated in the study. The participants included boys and girls from 18 to 20 years of age living in rural and urban areas of Casablanca and Mohammedia in Morocco. Case history interviews, and questionnaire made of sixteen chapters of at least 10 items each were completed for each of the participants. The measures provided data on the type and severity of students psycho-communication disorders. Results for each student were scored and data from students with psycho-communication disorders were compared. Results from the behavioural and communication disorders chapters questionnaire and normal groups showed differences in psychological status for students with communication disorders measures. Examination of individual participant results found an important incidence of psychological factors affecting students school efficiency. Based on the results from the behavioural and communication disorders questionnaire, psycho-communication factors were identified as important to the maintenance of communication disorders for four of the students whose school results were gradually declining. Learning Outcomes: The Participant will be able to: know the differences of psycho-communication assessment tools of communication disorders; understand the utility of a complementary tool of assessment of communication disorders: psychogenic tests; be aware of the nuances between factors that could cause a communication disorder.
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ESTILL VOICE CRAFT (TM) - CLINICAL APPLICATION OF JO ESTILL MODEL FOR VOICE QUALITYS CONTROL SANDRA FANTINO (1) INDIPENDENT, NONE, TORINO, ITALY (1)
Abstract: Estill Voice Craft EVT, created and developed by Jo Estill, a well-known American performer, scientist and teacher, is a method useful for all professional or non professional voice (singer, actors/actress, school teachers, nurses, lawyers and so on). It is meant to be used by students of singing teachers, acting teachers, speech therapists, public school teachers and every voice owners who participated in a course of Voice Craft presented by the author or a licensed seminar leader. Since 1992, the Method is divided into 2 disciplenes: Voice Craft; Artistry Performance. What will be developed is the fist discipline: Voice Craft - The Technique. Insights from voice teaching that began in 1962 and notes from laboratory research 1973-1979 at Upstate Medical Center in Syracuse, New York, supported that structures within the mechanism in the larynx and in the vocal tract could be independently controlled. This is possible by exercises called Compulsory Figure that permits to move any movable structure on a continuum from one extremity/position to another (Open or Relaxed Half Open Close or Active). The purpose in the exercises is to learn to control specific parts of the vocal mechanism as independently as possible without interference with movement from other structures. These exercises are about vocal athletics not cultural aesthetics and the only bad tone is one that hurts or scratches or constricts the larynx (Jo Estill). Just these assumption allows an se across the board of the Technique. So the practice of some of these exercises could be useful for a great number of physical and/or psychological problems that may be responsible for voice dysfunction. What I believe to be most important for patients in each voice approach treatment is to knows the territory quoting Prof Hill from The Music Man and in this case with territory he refers to some basic anatomy of the instrument used to vocalize. This is the way to provide the patient the possibility to visualize the instrument as necessary condition to develop and improve intellectual knowledge and kinesthetic skill. Further, I believe that effort concept, just the crucial difference between this and other traditional teaching system (Jo Estill), is a very necessary element of training, indeed, the first exercise (Compulsory Figure) in the Model, concerns effort. Just about this important concept, as speech therapist I commonly work with patients with dysphonia. They are artists (singers, and/or actors), professional voices (teachers, managers and so on) but also people with problems in daily use of voice. Working with them, I realized that sometimes they have difficulty understanding the concept of Effort and even more often they have trouble applying it. So, I sought a way to help them to overcome these difficulties. This led me to consider two terms: Work and Effort. The term Work can have a positive connotation: dynamic and flexible muscular work involving the whole body, intended to reduce laryngeal fatigue. The term Effort can be taken in the negative sense of term: muscular contraction involving the whole body, resulting in laryngeal constriction. My idea is based on the
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assumption that Work and Effort have the same characteristics, but they should run on separate but parallel tracks. WORK 1) Work can be localized; 2) Work can be quantified; 3) Work can be of different kind; 4) Work has a tendency to spread; 5) Work is emotionally charged; 6) Work can be monitored constantly. EFFORT 1) Effort can be localized; 2) Effort can be quantified; 3) Effort can be of different kind; 4) Effort has a tendency to spread; 5) Effort is emotionally charged; 6) Effort can be monitored constantly. So both Work and Effort may be involved in vocalization, Just for this reason in reference to the sixth characteristic, we can say that both Work and Effort can be monitored constantly, but, perhaps it is more important for us to say that both Work and Effort MUST be monitored constantly. As people with voice problems need more awareness of how the voice works and even if I believe that every basic figure in level one, can be really useful to solve different vocal problems, other compulsory figures I think to be necessary in most of vocal rehabilitation treatment are: Laryngeal constriction this figure has to do with the control of true and false folds recognizing the location, the direction and the degree of both work and/or effort; Anchoring it means to use the large external muscles of head and neck (Anchoring I) and of torso (Anchoring II) , to gain maximum control of the internal smaller muscles in the larynx to constitute one kind of support described as singing in the mask and the respiratory muscles to constitute the appoggio. Layngeal onset the goal of this figure is to recognize the three different onsets in which each one has a different relationship between breath and tone; So, these figures are for me, the basics figures for every one who has a voice but, according my experience, this method represents the best instrument in voice coach. So we can say that Estill Voice Craft represents the real union between art and knowledge.
the patients to admit that their speech is no more functional. Secondly, the functional capacity of communication changes in time. Thirdly, communication aid adjustment is a demanding and a continuing process. A successful process that serves the communicative autonomy of the patient is based on regular monitoring of changes in speech production and functional capacity of communication by a speech therapist. Learning Outcomes: The Participant will: 1. understand that the ability to speak declines radically in most patients with ALS; and 2. that most patients with ALS need several AAC means to replace speech. The Participant will also realize that 3. it is not easy to replace speech with technological communication means, and 4. regular monitoring of changes in speech productions and functional capacity of communication by a speech therapist is essential as the disease progresses.
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THEORETICAL-METHODOLOGICAL ASPECTS OF LINGUISTIC ACTIVITIES DEVELOPED AT CCA. A CENTER FOR APHASIC SUBJECTS IN BRAZIL NOVAES PINTO - ROSANA DO CARMO (BRAZIL)
Abstract: The main goals of presenting this paper at the 29th World Congress of IALP are (i) to discuss the theoretical-methodological basis of language activities we have been developing with aphasic subjects for over 20 years at CCA Centro de Convivncia de Afsicos (Department of Linguistics, Language Studies Institute/IEL, State University of Campinas/UNICAMP, So Paulo/Brazil) and (ii) to socialize some of the results we have been reaching with those subjects who weekly attend CCA in group and individual speech-therapy sessions. All the activities are planned and carried out by a team of researchers - Linguists and Speech Therapists - and by under-graduate and graduate students from Linguistics and Speech Therapy courses. All sessions are video-recorded and afterwards transcribed and analyzed according to the microgenetic paradigm (Vygotsky). Data collected consist of dialogic interactions among aphasic and non-aphasic subjects in which they are encouraged to talk about several themes. The group is very heterogeneous regarding the types of aphasia and severity. Our aim is not to classify the subjects or their aphasia according to etiological causes, neither according to oral or written production/understanding difficulties. We believe this heterogeneity is constitutive of human relations and our experience with aphasics has shown that this is, in fact, what enriches the interactions. By doing so, at the same time they expose their linguistic-cognitive difficulties and also are oriented/helped in order to (re)organize language, memory, attention etc and recognize themselves as subjects, despite the limits imposed by the pathology. Besides, the data obtained during the dialogical episodes allow theorization on language functioning in normal and pathological states and indicate productive ways for conducting adequate language therapies, centered in meaningful activities. The studies of aphasia in this perspective began in Brazil with the work of Coudry, in the early 1980s, when she defended that longitudinal and qualitative approach, which takes into consideration what is still preserved in the language system and also considers his/her pragmatic and discursive competence can better account for the complexity of any kind of aphasia. Besides comprehending underlying processes to the production and understanding of language in normality and pathologies, it interests us to help the aphasics develop alternative strategies (verbal and/or non-verbal) in order to achieve signification and to resist as much as they can as social and linguistic subjects. The enunciative-discursive neurolinguistics is based on the socio-cultural approaches developed by Vygotsky, who highlights the importance of the mediating role of language for the development of all the other complex functions and of thought. In other words, language is not simply - or only - an instrument of communication or of reasoning, but it also shapes our understanding of the world. It is expected that this work, besides publicizing the results of the researches being developed, may inspire other researches and clinical works towards a dialogical and qualitative approach on aphasia. Learning Outcomes: It is expected that the work presented will (i) publicize the results which have been obtained with aphasics in a dialogical perspective at CCA; (ii) discuss the relevance of qualitative approaches to aphasia research and (iii) inspire research and clinical work towards a dialogical approach on aphasia.
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COMMUNICATION CHANGES IN PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS DURING TWO YEARS FOLLOW-UP TANJA MAKKONEN (1) - ANNA-MAIJA KORPIJAAKKOHUUHKA (2) TAMPERE UNIVERSITY HOSPITAL, NEUROLOGY AND REHABILITATION, UNIVERSITY OF TAMPERE, LOGOPEDICS, TAMPERE, FINLAND (1) - UNIVERSITY OF TAMPERE, LOGOPEDICS, TAMPERE, FINLAND (2)
Abstract: The main goal of speech therapy is to maintain the communicative autonomy for people with Amyotrophic Lateral Sclerosis (ALS). When the natural speech is starting to decline, speech must be combined with other approaches to communication. The aim of this study is to describe how the ability to communicate changes in patients with ALS during a two years follow-up. Here we report 1) for how long speech remains a functional way to communicate, 2) how the functional capacity of communication changes, 3) what kind of augmentative and alternative communication (AAC) technology the patients with ALS use beside the diminishing speech and after it is no longer functional and 4) the number of different communication means used. The sample includes 30 subjects, and the data was gathered in 157 speech therapy assessments. The follow-up started at the first speech therapy visit at Tampere University Hospital. The data is challenging because the number of the participants declined during the follow-up as many of them passed away. The follow-up periods also varied according to clinical needs of the participants. Adequacy of speech was evaluated as adequate or poor by using the ALS severity scale of speech. The intelligibility of speech was evaluated by a professional listener group. Functional capacity of communication was evaluated by classifying the need and usage of augmentative communication means into six different categories. The means of communication used by the participants were listed according to their own report. If the participants used more than one communication means, the primary, secondary, third and fourth communication means were asked to be ranked. During the first six months speech remained adequate for most of the participants and it remained the primary means of communication during the first 9 months. Individual variation of speech intelligibility was wide during the first year of follow-up, but narrowed at 15 months observation point. During the last 6 months the variation increased again. The functional capacity of communication declined in two cycles, first during the first year and again after 15 months of follow-up. Majority of those participants, who did not speak, reported using high technology AAC more typically than low technology as the main communication means. At least 10 % of them used more than one means at each observation point. During the second year of follow-up 30 to 56 % of the remaining participants used more than one means of communication. It is obvious that the ability to speak declines radically in most patients with ALS. It is not, however, easy to replace speech with other means of communication. Firstly, it is hard for
FP173
DEVELOPING AN INTERNET VERSION OF THE LIDCOMBE PROGRAM OF EARLY STUTTERING INTERVENTION SABINE VAN EERDENBRUGH (1) - ANN PACKMAN (1) SUE OBRIAN (1) - MARK ONSLOW (1) AUSTRALIAN STUTTERING RESEARCH CENTRE, UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (1)
Abstract: The use of Internet-based technology is becoming more widespread in speech-language pathology practice. Internet-based components are now being used in various ways to complement face-to-face assessment, treatment and/or follow-up. At the Australian Stuttering Research Centre, we are currently developing an Internet-based version of the Lidcombe Program for early stuttering. The Lidcombe Program is an operant treatment that parents conduct daily with their children during structured and unstructured conversations. The speech-language pathologist (SLP) guides parents in
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doing this during weekly visits to the clinic. The primary aim in developing the Internet version is to increase access for parents to the program. The development of a viable interactive Internet version of the Lidcombe Program is a complex procedure, and extensive trialling of all components will be done before the program is available publicly. The first component, in which parents learn the skills required for implementing the program, is now fully developed. A study in which this training component is tested is the topic of this presentation. In this training component, parents receive information about stuttering and about Lidcombe Program procedures, including how to (1) recognise stuttering and rate stuttering severity, (2) choose appropriate activities for use during treatment times, (3) adjust conversations to promote stutter-free speech during treatment times and (4) reinforce stutter-free speech as appropriate. Learning activities for parents include identifying target behaviours from videos, evaluating Lidcombe Program procedures as demonstrated by parents in videos, reflecting on their own childs stuttering and practising the procedures they have learned with their own child at home. The content of the training component is structured and gradually increases in complexity. Contingencies for stuttering are not introduced until later in the program.Eight parents of preschool children who stutter have undertaken the training. Outcomes and parent reports of their experiences with the training will be presented. We will show features of the Internet program, with examples of procedures in the training component. We will discuss possible concerns of SLPs about the Internet Lidcombe Program and also its merits and potential advantages. When fully developed, the Internet Lidcombe Program may be used as a standalone treatment, either on its own or as part of a stepped-care service delivery model. SLPs may also want to use this first component to offer extra training in Lidcombe Program procedures. Offering parents this training before starting the actual Lidcombe Program face-to-face could increase parent skills and hence reduce treatment time. SLPs may also find the Internet Lidcombe Program useful for updating their own skills in delivering the program. Learning Outcomes: Attendees will: gain insight into the structure of the Internet Lidcombe Program-training; understand the outcomes of the trial of the Internet Lidcombe Program-training; understand how internet-based technology can enrich speech and language practice; appreciate how the Internet Lidcombe Program, in particular the parent training, can potentially be used in speech and language practice.
therapy with stress inoculation training on Mandarin-speaking adults with stuttering. The results showed that the stuttering group that had the therapy combining fluency shaping therapy with stress inoculation training decreased their average disfluencies more than the stuttering group did without therapy. There were 5 (62.5%) stuttering adults with therapy improved, 1 (12.5%) maintained and 2 (25%) regressed in their speech performances. However, for the speech performances in the stuttering group without therapy, only 2 (25%) stuttering adults improved, 3 (37.5%) maintained and 3 (37.5%) regressed. In terms of self-rated severity, the stuttering group with therapy rated their average severity as 4.43 points on a 7-point scale before the group treatment, but 3.25 points at the end. They improved, on average, 1.18 points on a 7-point scale. In addition, in regard to communication anxiety, the average score of the stuttering group with therapy decreased from 40.50 to 37.71 (-2.79), and for the stuttering group without therapy, it decreased from 33.88 to 32.63 (-1.25). The stuttering adults who had group therapy reduced more communication anxiety than those of the stuttering adults without therapy. It seems that a fluency shaping therapy combined with stress inoculation training is effective for the stuttering adults who speak Mandarin. This may be because the stress inoculation training reduced stuttering adults anxieties in talking in daily life; the therapeutic members also had more time to manage their disfluencies in speech through fluency shaping skills. The most helpful strategies for the stuttering adults to manage their disfluencies of speech were practicing relaxation, speaking slowly and replacing negative self-statements with positive self-statements. Learning Outcomes: The participants will be able to: 1. realize the main skills of fluency shaping therapy and stress inoculation training, 2. employ fluency shaping therapy combining with stress inoculation training to treat stuttering adults, and 3. know how to conduct research regarding the treatment efficacy of a group therapy.
FP176
VOICE IN FEMALE-TO-MALE TRANSSEXUAL PERSONS AFTER LONG-TERM CROSS-SEX HORMONAL THERAPY MARJAN COSYNS (1) - DAVID DEDECKER (2) - FLEUR VAN DE PEER (2) TINE DAELMAN (1) - SOFIE LAENEN (1) - JOHN VAN BORSEL (1) GUY TSJOEN (2) DEPARTMENT OF OTO-RHINO-LARYNGOLOGY AND LOGOPAEDIC-AUDIOLOGICAL SCIENCES, GHENT UNIVERSITY, GENT, BELGIUM (1) DEPARTMENT OF ENDOCRINOLOGY ANDROLOGY, GHENT UNIVERSITY HOSPITAL, GENT, BELGIUM (2)
Abstract: Aim. The aim of the present study was to document voice in a large group of transsexual men post sex reassignment surgery (SRS). In addition, factors influencing the fundamental frequency (F0) were explored. Methods. The final subject group consisted of 38 transsexual men, who participated in a larger study investigating their postoperative health. Fasting morning blood samples were collected, and dermatologic, urological, voice, bone, and body composition evaluations were executed. The participants were on average 8.7 years after SRS and started testosterone substitution therapy at least 2 years before SRS. A control group was matched to the subject group for age and smoking behaviour and comprised 38 heterosexual biological males. Voice assessment consisted of the recording of three speech tasks, i.e. sustained vowel phonation, counting from 1 to 10, and reading a standardized text. Subsequently, speech samples were acoustically analysed for measures of pitch, intonation, and perturbation. Results. The average median F0 of the transsexual men amounted to 104, 109, and 114 Hz in sustained vowel phonation, counting, and reading, respectively. There were no significant differences between the transsexual and heterosexual biological men for any of the acoustic variables tested. Two factors correlated significantly with the median F0 of the transsexual men in reading: haematocrit level and average length of CAG repeats in the X-chromosomal androgen receptor gene, which is indicative for androgen sensitivity. Specifically, higher haematocrit levels and longer CAG repeats were associated with a lower median F0 in reading. Conclusion. In general, the administration of androgens in transsexual men appears to result in a male voice that cannot be acoustically distinguished from the voice of heterosexual biological men. Learning Outcomes: The conference attendees will learn about voice and voice change in female-to-male transsexual persons and its influencing factors.
FP174
IMMEDIATE EFFECTS OF ALTERED AUDITORY FEEDBACK ON ASSOCIATED MOTOR BEHAVIORS OF PEOPLE WHO STUTTER KYRIAKI KYRIAKOU (1) - BRENDA SEAL (1) GALLAUDET UNIVERSITY, WASHINGTON, DC, UNITED STATES (1)
Abstract: Background: Stuttering may cause difficulty in communicating, socializing and participating in occupational activities and is often accompanied by secondary behaviors (i.e., motor behaviors). Assistive technology, including altered auditory feedback (AAF) devices, is often recommended for people who stutter in order to increase their fluency of speech. Multiple studies revealed that AAF devices are effective in reducing stuttering. However, there is no study to our knowledge that examines the effects of AAF devices on secondary behaviors of stuttering (e.g., motor behaviors). Aims: This study will examine the immediate effects of an AAF device on motor behaviors associated with stuttering as measured by their frequency during monologue and conversation. Method: Fifteen participants who stutter and exhibit associated motor behaviors of stuttering will participate in the study. The study will contain a measurement of associated motor behaviors of stuttering during monologue and conversation with and without an altered auditory feedback device in place. Learning Outcomes: After completing this session, participants will be able to: Increase knowledge about the immediate effects of an AAF device on motor behaviors associated with stuttering in people who stutter as measured by their frequency; Potentially recommend AAF that will enable clients to decrease their motor behaviors associated with stuttering, enhance their communication and engage in social situations more frequently;
FP175
A STUDY ON THE EFFICACY OF A GROUP THERAPY COMBINING FLUENCY SHAPING THERAPY WITH STRESS INOCULATION TRAINING ON MANDARIN-SPEAKING ADULTS WITH STUTTERING SHU-LAN YANG (1) DEPARTMENT OF SPECIAL EDUCATION, NATIONAL PINGTUNG UNIVERSITY OF EDUCATION, PINGTUNG, TAIWAN, PROVINCE OF CHINA (1)
Abstract: Fluency shaping therapy is an effective procedure for reducing the disfluencies and tensions of stuttering adults while they talk. Stress inoculation training can be used to lower clients anxieties and help them manage their stress in certain conditions. The researcher combined fluency shaping therapy with stress inoculation training to treat 8 stuttering adults in a group therapy. There were 2.5 hours in a session per week; in total, the members had group therapy for 25 hours in 10 weeks. The purpose of this study is to determine the efficacy of group therapy which combines fluency shaping
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FP177
PROPOSAL OF A NEW SELF-EVALUATION VOICE QUESTIONNAIRE FOR TRANSGENDER / TRANSSEXUAL INDIVIDUALS FRANCESCO AVANZINI (1) GENERAL HOSPITAL, BOLZANO/BOZEN, ITALY (1)
Abstract: According to ONIG guidelines, follow-up is aimed to check the psycho-physiological and social integration and the complex emotional experiences resulting from an adjustment path. For a thorough evaluation of patients undergoing various therapeutical options, moreover if changing the voice quality, assessment should include a self-reported evaluation that
investigates the related emotional, psychosocial, physiological and acousticperceptual aspects. The principal aim of this study was to elaborate a specific self- evaluation questionnaire that investigates the psychosocial and emotional benefit that Transgender (TG) /Transsexual individuals may obtain from voice surgery. The secondary purpose was addressed to evaluate the relationships between the kind of phonosurgical treatment and its impact on the Quality of Life of those individuals. We decide to develop and validate a Self-reporting Questionnaire for Transgender (TG) / Transsexual (TS) individuals that afford a voice surgery that explores the relationships between self-perceived voice quality and quality of life (QoL). This instrument is a 30-items questionnaire, with which the subjects rate each statement using a 5-points scale. The Questionnaire was administered to 8 TG patients and to a control group (n=10) before and after 2 weeks following the phonosurgical treatment.. The expected results should provide speakers perception predictors for the impact of the new voice on psychosocial well-being of transgender/transsexual individuals after vocal feminization treatment. Learning Outcomes: Utilization of new diagnostic tools for a thorough evaluation of Transgender / Transsexual individuals undergoing phonosurgical treatments. A more detailed and specific approach for the multidisciplinary evaluation of Transgender / Transsexual individuals. An instrument that allow a specific, thorough and few time-consuming evaluation of the results of combined surgical/rehabilitative treatment, in a psychophysical and social perspective.
lack one of the distance senses, in fact, from the point of view of perception, cognition and possibilities for social inclusion, have deep differences and specificities which require further studies. Its relevance to draw attention to the knowledge about the specificity of the perception and cognition of people who do not have one of the two distance senses (hearing or sight) and to the conditions necessary to ensure that those persons make use of their own possibility of elaboration for understanding of the world around and become able to communicate and have autonomy in their way to feel, think and act. This presentation will show the data collected and the analysis of responses of speech therapy students of five universities. This presentation will allow to view if the courses contemplated or not what was required to prepare these future professionals for the care of deaf and blind students and provided situations that experience the specific knowledge required on the work of these specialists. This is an invitation to a joint reflection with other professional in the area of speech therapy about the university education in which the area of study and research include perception, its specificities and the complex issue of cognition, thinking and language. Learning Outcomes: This work is important to show the need for more investment on the formation of the students of the Speech Language courses to deal with deafness/hearing impairment and blindness/ vision impairment individuals in order to achieve the goals demanded by the society the real inclusion of these persons. It shows the deficiencies on the formation and gives a sketch of educational scenario is nowadays in Brazil and Portugal.
FP178
THE COMPLEX THERAPY OF TEENAGERS VOICE DISORDERS IN THE PERIOD OF MUTATION OLGA ORLOVA (1) - TATYANA GARASHENKO (2) KAMOLA SULTANOVA (3) - POLINA ESTROVA (4) MOSCOW CITY TEACHERS TRAINING UNIVERSITY, FEDERAL STATE SCIENTIFIC CLINICAL CENTRE OF OTORHINOLARYNGOLOGY, MOSCOW, RUSSIAN FEDERATION (1) - FEDERAL STATE SCIENTIFIC CLINICAL CENTRE OF OTORHINOLARYNGOLOGY, MOSCOW, RUSSIAN FEDERATION (2) - THE RUSSIAN PUBLIC ACADEMY OF VOICE, MOSCOW, RUSSIAN FEDERATION (3) - SHOLOKHOV MOSCOW STATE UNIVERSITY FOR THE HUMANITIES, MOSCOW, RUSSIAN FEDERATION (4)
Abstract: Voice mutation of the adolescents is a physiological process. The authors describe the acoustic voice parameters in different mutation periods. The complex therapy is developed by the authors and its effectiveness is proved. Learning Outcomes: The participant will be able to: know the acoustic voice characteristics in pre-mutation, mutation and post-mutation periods; know about complex voice correction method during the mutation period; know about the use of ISLA in the complex therapy.
FP180
CULTURAL COMPETENCE IS IMPORTANT FOR EFFECTIVE SERVICE PROVISION, BUT HOW SYSTEMATICALLY DO WE DEVELOP SKILLS ACROSS THE UNDERGRADUATE CURRICULUM? ELIABETH CLARK (1) SCHOOL OF COMMUNITY HEALTH, CHARLES STURT UNIVERSITY, ALBURY, AUSTRALIA (1)
Abstract: Cultural competence is an important and under-researched issue in speech pathology service provision in Australia, as in many countries. This paper will report on the challenges and benefits of developing a framework for incorporating cross-cultural competence across the speech pathology curriculum in one Australian speech pathology program. A detailed analysis of literature arising from governments, health organizations and the speech pathology profession shows that cultural competence of health practitioners in multi-cultural and multi-lingual societies is a critical issue. The explosion of frameworks and guidelines in recent years is testimony to the fact that cultural incompetence remains at the heart of challenges in providing effective and timely health services to a range of marginalised groups within the Australian community. The formal adoption of the W.H.O.s International Classification of Function, by the speech pathology profession in Australia, as the overarching framework of practice has implications in terms of cultural competence training for undergraduate speech pathologists. The ICF highlights the importance of taking into account the ways contextual factors and individual characteristics of each client impact on health and wellbeing. The framework developed at Charles Sturt University incorporates elements of two relevant existing frameworks: the Indigenous Cultural Competence framework introduced at Charles Sturt University in 2010, and the Australian National Health and Medical Research Councils Guide to cultural competence in health which clearly identifies expectations for individual health workers, health professions and health organisations. An initial mapping of the existing curriculum showed that, while there has been a commitment to cultural diversity since the inception the Charles Sturt university program, this commitment has not always translated into tangible and substantial learning activities across the four years of the speech pathology undergraduate curriculum. Issues pertaining to linguistic and cultural diversity form central assessable elements of two first year subjects, and one final year subject, but content in other subjects is ad hoc and generally not part of assessable content. From this mapping process, a detailed description of the attitudes, knowledge and skills required of graduating speech pathologists was developed in order to identify the most relevant subjects for inclusion of specific content around cultural competence in each year of the program. Classroom learning activities and assessment items have been developed and trialled in four subjects to date, with mixed feedback from students and staff. Students rate practical skills sessions more highly than they do more theoretical aspects of their curriculum and few are able to reflect on the institutional barriers that exist for clients from marginalised groups in Australia. Staff indicate the challenges of incorporating cultural dimensions into assessment items in ways that are relevant. Ongoing formal review processed instituted by the University do not currently give sufficient weight to cultural aspects of the curriculum. Learning Outcomes: Participants will be able to: Understand the drivers for increasing cultural competence in undergraduate speech pathology training; Critique the mix of attitude, knowledge and skills required for effective crosscultural practice in speech pathology; Know the range of learning activities developed in one undergraduate training program in Australia; Reflect on the ways in which their own practice could become more culturally sensitive.
FP179
FOUNDATIONS FOR INCLUSION: ANALYSIS OF STATEMENTS OF FUTURE PROFESSIONALS ABOUT BEING DEAF AND BEING BLIND THE IMPORTANCE TO LEARN. MARIA CECILIA DE MOURA (1) - ELCIE F. SALZANO MASINI (2) PONTFICIA UNIVERSIDADE CATLICA DE SAO PAULO, PUCSP, SAO PAULO, BRAZIL (1) - INSTITUTO PRESBITERIANO MACKENZIE, INSTITUTO PRESVITERIANO MACKENZIE, SAO PAULO, BRAZIL (2)
Abstract: This research gave continuity to the researches entitled Foundations for inclusion that deals with the scholar and social inclusion of sensory disabled people - theme that is present in Brazilian legislation, scientific meetings and educational projects as well as in universities. It sought to clarify the knowledge that students of the last year of the courses of pedagogy, speech therapy and psychology had about being deaf or blind and how is their learning process. Theoretically grounded and investigation based (MASINI, 1984, 1994, 1999, 2002; Moura, 2000) this research expands studies about the knowledge required from professionals to have access to the perceptual experience of those who do not have hearing or vision, providing them the learning act making meaningful learning. It considers in this way the sensory impairment and their specific characteristics; the learning act and the characteristics of the cognition process, understood as reception, organization and elaboration of information in the world around. The data were collected in public universities from four States of Brazil and of a public University in the city of Setubal in Portugal.For the data collection, fourteen professionals PhD in the fields of education, psychology and speech therapy participated voluntarily in other three States other than Sao Paulo and Portugal; ten professionals worked in the Sao Paulo group, composed of PhDs, master degrees and graduates of those three areas. The originality of this research is in gathering educational theory and practice, while investigating the required professional knowledge, trained in different areas, to work with the deaf or the blind student to provide meaningful learning; in offering analysis material to the so much debated and confusing issue of educational inclusion of deaf and blind student, which although seem similar since both
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FP181
THE EARLY DEVELOPMENT OF THE LEXICON IN MONOLINGUAL AND BILINGUAL FINNISH CHILDREN JENNY LINDMAN (1) DEPARTMENT OF PSYCHOLOGY AND LOGOPEDICS, ABO AKADEMI UNIVERSITY, TURKU, FINLAND (1)
Abstract: The number of children being raised in bilingual homes is large and growing, but the course of language development in these children is not yet well described or understood (McCardle & Hoff, 2006). An important aspect of language development is the acquisition of the lexicon. Bilingual children seem to have a smaller vocabulary than monolingual children when their two languages are looked at separately. However, when looking at the total vocabulary of bilingual children, it seems to be of the same size as that of monolingual children (Pearson et al., 1993; Hoff, Core, Place, Rumiche, Seor, & Parra, 2012). The main purpose of this study is to examine the development and size of monolingual and simultaneously bilingual childrens receptive and expressive lexicons at one and two years of age. The purpose is also to compare the development of the lexicon for the two groups and to investigate whether or not different background factors, such as language disorders in the family and language environment, correlate with the development. The participants at the first age point of one year are 30 children that have been exposed to Swedish and Finnish from birth and 70 children that have been exposed only to Swedish. At two years, the participants are 15 children exposed to Swedish and Finnish from birth and 80 children exposed only to Swedish. The material is collected using the Swedish (Eriksson & Berglund, 2002) and the Finnish (Lyytinen, 1999) versions of The MacArthur-Bates Communication Development Inventories (CDI) two forms (Fenson et al., 2007). The parents filled in the questionnaires when the children were one and two years of age. The parents of the Swedishspeaking children completed the Swedish form of the CDI, while the parents of the bilingual Swedish-Finnish-speaking children completed one form in Swedish and one in Finnish. The material for this study is collected within the multidisciplinary STEPS Study, which main aim is to search for precursors and causes of problems in child health and wellbeing (Lagstrm et al., 2012). The data will be analyzed during spring 2013, and the results will be reported and discussed. Learning Outcomes: The participants will be able to: learn about bilingual language acquisition and lexicon sizes; understand the differences between monolingual and bilingual lexical growth; know which language environmental and familial background factors correlate with language development.
FP183
ASSESMENT OF LANGUAGE ABILITIES OF BILINGUAL CHILDREN IN LITHUANIA VILMA MAKAUSKIENE (1) - REGINA IVOSKUVIENE (2) SIAULIAI UNIVERSITY, KAUNAS, LITHUANIA (1) SIAULIAI UNIVERSITY, SIAULIAI, LITHUANIA (2)
Abstract: The increasing migration fosters the need of cultural competence for SLTs working with bilingual children. Early foreign language is becoming an increasingly common phenomenon across the world. The culturally competent SLT seeks to be aware of his / her own assumptions, attempts to understand the worldview of culturally diverse clients and is practicing culturally relevant and appropriate service skills (Sue, Sue, 2003). Clinicians should understand various cultural groups and accept clients and their families as individuals within the general framework of their community and culture. Clinicians in many countries are confronted with the need to distinguish language differences (LD) from SLI or language learning disabilities (LLD). It is common for multilingual children to be assigned as having a speech or language disorder. Bilingualism was involved in Lithuanian classification of speech and language disorders till 2011. When attempting to differentiate whether children are manifesting bilingualism or language disorders, it is important to have basic knowledge how various languages influence the production on the first language and to be familiar with normal process of second language acquisition (Genesee et al., 2004; Kayser, 2002). Some children may learn the second language with minimal problems and others can experience different difficulties. In this case it is important to know if a child has developed two languages simultaneously or sequentially and differentiate problems of second language acquisition from speech language disorders. Diagnostic instruments for differentiation typical development of bilingualism and speech language disorders (LLD) are necessary to identify linguistically impaired children at the earliest stages as possible and provide adequate intervention. Such instruments are not yet available in some languages in the countries that do not have uniform testing materials that could be applied to assess whether the child has appropriate linguistic knowledge, one of such countries is Lithuania (Ruzaite, Dabasinskiene, 2011). There are few ways in which professional can assess bilingual children and help them to reflect their abilities (Roseberry-McKibbin, 2003): give instructions in two languages, rephrase confused instructions, give an extra examples, ect. It is important to do not identify a needing speech therapy or special education solely on the basis of test scores. Because the use of standardized tests poses many difficulties when professionals are evaluating bilingual students, the use of informal procedures and instruments for the assessment has become increasingly frequent (Goldstein, 2004; Laing, Kamhi, 2003). Speech language therapists can obtain information about bilingual children through case history, use observations, evaluate students ability to interact in everyday situations, use questionnaires for teachers, parents or others (Roseberry-McKibbin, 2003). It is recommended to use dynamic approach to assessment of these children in which student is evaluated over time in test teach retest format. Dynamic assessment evaluates students ability to learn and may be a sign that child has LLD or SLI (Long, 2005). If the student has LLD, problems in communication should be evident in both second and the primary language, because speech language disorders affect childs ability to learn any language. Learning Outcomes: The Participant will be able to: know the key principles about identification of SLI among bilingual children; understand the need of validated tests for children in different languages: know the therapy methods for bilingual SLI children.
FP182
THE PERFORMANCE OF MALTESE BILINGUAL CHILDREN ON A MALTESE-ENGLISH NON-WORD REPETITION TASK NADINE CALLEJA (1) - HELEN GRECH (1) - DORIS-EVA BAMIOU (2) DEPARTMENT OF COMMUNICATION THERAPY, UNIVERSITY OF MALTA, MSIDA, MALTA (1) - NEURO-OTOLOGY DEPARTMENT, NATIONAL HOSPITAL FOR NEUROLOGY & NEUROSURGERY, LONDON, UNITED KINGDOM (2)
Abstract: Non-word repetition tasks (NWRT) are used clinically as markers for language impairment and other communication difficulties such as auditory processing disorder. Since NWRT tap particularly on phonological memory these need to be language specific although attempts at constructing quasi-universal NWRTs are being made. The unique bilingual context in the Maltese Islands present a challenge to clinicians particularly since standardized language related assessments are still being developed and standardized. This paper presents preliminary findings related to the construction of a NWRT for bilingual Maltese-English children. Data of responses of 30 typically developing (TD) Maltese bilingual children aged between 5;00 and 5;11 years for two non-word repetition tasks are presented. The children in the study were all Maltese sequentially bilingual children. All children were exposed to both Maltese and English. 23 children spoke Maltese as their first language (L1), while 7 children used English as their first language. One list was based on Maltese phonotactic rules and other language specific phonological characteristics while the other task was based on English phonotacatics and phonology. The characteristics on which the lists were based included syllable length and the presence or absence of consonant clusters or consonant sequences. Both lists were audio-recorded by a native bilingual speaker and presented through laptop and speakers. The children were asked to repeat the words heard. Half of the children were presented with the Maltese-based non-word list first, while the other half were required to repeat the English non-words first. There was little difference in performance between the Maltese-based and the English-based non-word tasks and no statistical significant difference in performance between the two tasks (t-test p=0.39) was identified. More errors were produced in words that contained consonant clusters/sequences. This difference was more pronounced in the Maltese-based non-word list. As the number of syllables increased more errors were produced in both non-word lists. Learning Outcomes: The participants will understand: The specific features of the non-word; The outcomes non-word repetition in Maltese-English bilingual children
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THURSDAY 29TH AUGUST

MR3
DEVELOPMENTAL LANGUAGE DISORDERS: CHALLENGES AND IMPLICATIONS OF CROSS GROUP COMPARISON SUSAN ELLIS WEISMER (USA)
Abstract: Historically, specific language impairment (SLI) and language deficits associated with autism spectrum disorders (ASD) have been viewed as distinct developmental language disorders. However, over the last decade or so a considerable amount of research has explored general similarities or specific areas of overlap between children with SLI and ASD based on language and cognitive profiles, neuroimaging findings, and genetic research. The theoretical assumptions regarding the nature of these developmental disorders as well as the clinical classification schemes that are used to identify the children necessarily influence the extent to which SLI and ASD are viewed as overlapping or distinct conditions. In addition to differing theoretical perspectives, the criteria used to diagnosis these two populations varies across countries and even across investigators within a given country. This necessarily impacts the findings from comparative investigations of these groups. With these challenges in mind, clinical implications of evidence for similarities and distinctions between children with SLI and ASD will be discussed with respect to differential diagnosis and treatment.
FP184
VALIDITATION OF AN ARABIC TEST FOR EVALUATING ACQUIRED SKILLS IN COMMUNICATION YEHIA AMIN ABORAS (1) FACULTY OF MEDICINE, ENT DEPARTMENT, UNIT OF PHONIATRICS, UNIVERSITY OF ALEXANDRIA, ALEXANDRIA, EGYPT (1)
Abstract: Prelinguistic behaviors occur before the onset of words. Individual differences of prelinguistic skills contribute to language outcome in typically developing children. Deficits of certain prelinguistic skills in important disorders as ASD will be as red flags for suspicion and then early diagnosis with the advantage of early intervention for those children. This target raises the importance of knowing prelinguistic skills, their important milestones and how to evaluate them. The aim of the study is to adapt Evaluating Acquired Skills in Communication- Revised (EASIC-R) test and to test its reliability and validity on Egyptian children. Some modification needed to be done to the Arabic version of EASIC-R to adapt with the Egyptian culture. Rearrangement of the order of question was done to facilitate the qualitative scoring which was added to the qualitative scoring of the original test. Grouping of the tasks into three inventories; Inventory I assess the prelinguistic and early communicative skills for children age up to 2 years, and it is composed of three composites (social, symbolic and speech). Inventory II has two components; inventory II receptive and inventory II expressive and they assess language developmental skills for children above 2 years. One hundred and eighty normal children and one hundred and eighty six delayed language developed children were enrolled in the study, their age ranged from 9 months to 6 years divided into 12 age categories with age interval 3 months from 9 months to 2 years, 6 months from 2 years to 5 years and the last group from 5 to 6 years. The two groups were matched regarding age and sex. Reliability of the test was proven by test retest method with 2 weeks interval, and through the internal consistency. The reliability of the EASIC-R - Arabic version - inventories was tested by Kappa test where high reliability was proven and a high significance for all test items was found (p<0.001). Internal consistency is tested using Cronbachs coefficient alpha. The high values of alpha; in the inventory I (0.73 to 0.93), in the receptive inventory II (0.73 to 0.95) and in the expressive inventory II (0.73 to 0.93) denote significant correlation between each item to the total test. This concluded that all test items in the test measure the same characteristics. Validity of EASIC-R - Arabic version - was tested by content validity, construct validity (developmental validity), internal consistency, known group comparison and criterion related validity, convergent and divergent validity to prove high validity of the test. A developmental profile for the early communicative skills emerging in the first two years was identified. Learning outcomes: the attendance for the poster will be able to: identify the prelinguistic skills; identify the important milestones in early communication development through first two years of Egyptian children; know the characteristic of the Arabic version of EASIC-R test; know the reliability and validity of Arabic version of EASIC-R test
language ability, children with ASD have been shown to generate stories with reduced syntactic complexity and fewer evaluative terms (Capps, Losh, & Thurber, 2000). The Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore, & Risi, 1998) is a semi-structured standardised assessment that includes having the client tell a story using stimuli such as the book Tuesday (Weisner, 1991), however, the narrative sample is not formally analysed for its linguistic content. The present study aimed to utilise the unique opportunity provided by the ADOS and the book Tuesday to comprehensively compare the narratives generated by children with ASD and age, gender, and language matched typically developing (TD) children. Participants were children with ASD (n = 11) and TD controls (n = 17), aged 9-15 years and matched for language and non-verbal intelligence. Participants were introduced to Tuesday and asked to look through the book before telling the story. All stories were audiotaped for later transcription and analysis by a rater who was blind to the participants group membership. A second blind rater re-analysed 21% of the samples (n = 6) to establish reliability which was high (>89%) for all measures. The stories were analysed for: Surface structure: word length, number of mazes and errors, lexical diversity (number of different words), type token ratio (TTR), syntactic diversity (number of different types of complex sentence), syntactic complexity (clauses per t-unit). Microstructure: cohesion (introduction of and maintenance of reference to main character) Macrostructure: story grammar, evaluation (emotion & cognition, intensifiers). The results indicated that the two groups differed significantly with respect to the number of errors and syntactic complexity while the measure of lexical diversity approached significance. With respect to cohesion, more participants in both groups used indefinite noun phrases (some frogs) than definite noun phrases (the frogs) when introducing the main character, however, the proportion who used indefinite noun phrases was greater for the TD group (TD = 65%; ASD = 55%). Once introduced, the pattern for maintaining reference to the frogs was similar for the two groups (pronouns > noun phrases), however, the ASD group used significantly fewer pronouns to refer to supporting characters and tended to use more ambiguous pronouns. The ASD group recorded significantly lower overall story grammar scores than the TD group but no differences in the use of evaluative terms. Despite having normal receptive and expressive language abilities, participants with ASD demonstrated impairments at all levels of narrative structure. More specifically, the ASD group produced narratives with reduced lexical and syntactic complexity, that were less cohesive, and that included fewer story grammar elements than their control counterparts. By comprehensively examining all levels of narrative structure, the present study provides preliminary support for the ADOS narrative task and Tuesday as valid assessment tools for story generation in ASD. Learning outcomes: To understand how the ADOS may be used to inform language profiling in ASD; To be able to describe differences in the stories generated by children with ASD and those told by typically developing children; To understand that children with ASD and apparently normal language skills may experience problems with narrative generation.
FP186
EVALUATING SYNTACTIC AWARENESS IN AUTISM CRISTINA DE ANDRADE VARANDA (1) FERNANDA DREUX MIRANDA FERNANDES (1) FACULDADE DE MEDICINA, UNIVERSIDADE DE SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Ten subjects on the autism spectrum (ranging from 5 years and 7 months to 14 years and 8 months) were evaluated in syntactic awareness through the Adapted Syntactic Awareness Test and different linguistic profiles were found: inferior performance in the correction of ungrammatical sentences and ungrammatical and non-semantic sentences, inferior performance in the correction of ungrammatical and non-semantic sentences, average performance in all subtests and above average in grammatical judgment and superior performance in all four subtests. The results of this research cannot be generalized, but revealed evidence of interference of failures that are present on the autism spectrum with the abilities required in the proposed tasks. Learning outcomes: the results of this research cannot be generalized, once the number of subjects was small and it is known that there is a great variability among the subjects with autism, in general. Therefore, it is desirable that a new range of possible investigations can be opened in order to refine the models of intervention and also to amplify the variety of linguistic profiles described in the autism spectrum.Plans of intervention for subjects of the different subgroups would be necessary to optimize the success in the several types of syntactic tasks in order to improve the academic, social and emotional outcomes of the subjects with autism. The results of this research suggest a perspective of dimensional understanding of the subjects with autism instead of a categorical one, as the diagnostic criteria usually indicate
FP185
STORY GENERATION IN AUTISM SPECTRUM DISORDER: A NEW LOOK WITH A NEW BOOK WENDY ARNOTT (1) - REBECCA BANNEY (1) - KEELY HARPERHILL (1) THE UNIVERSITY OF QUEENSLAND, UNIVERSITY, BRISBANE, AUSTRALIA (1)
Abstract: There is considerable research suggesting that narrative generation is a sensitive tool for profiling subtle language difficulties in children with autism spectrum disorder (ASD). Even in the presence of normal general
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FP187
LONG TERM EFFECTS OF INFANCY LARYNGEAL RECONSTRUCTION ON HEALTH AND VOICE-RELATED QUALITY OF LIFE AHMED GENEID (1) - ASSI AHERTO (1) - NIKLAS PAKKASJRVI (2) RISTO ROINE (3) - HARRI SINTONEN (4) - HARRY LINDAHL (2) - ANNE PITKARANTA (1) DEPARTMENT OF OTOLARYNGOLOGY AND PHONIATRICS, HELSINKI UNIVERSITY HOSPITALS/HELSINKI UNIVERSITY, HELSINKI, FINLAND (1) - HELSINKI UNIVERSITY CHILDRENS HOSPITAL, HELSINKI UNIVERSITY CENTRAL HOSPITALS/ HELSINKI UNIVERSITY, HELSINKI, FINLAND (2) - HELSINKI AND UUSIMAA HOSPITAL DISTRICT, RESEARCH AND DEVELOPMENT, HELSINKI, HELSINKI, FINLAND (3) DEPARTMENT OF PUBLIC HEALTH, HELSINKI UNIVERSITY, HELSINKI, FINLAND (4)
Abstract: In this study, we aimed to investigate children who were underwent a laryngeal split in ealy infancy for voice, its related quality of life (VRQoL) and health related quality of life (HRQoL). Retrospective review of register of Helsinki University Central Hospital for the period from January 1990 till December 2005 revealed that 17 underwent the operation. Ten of them fulfilled the inclusion criteria and participated in the study. Age- and gender matched controls were included as control group. Methods included the following: the generic 16D and 17D questionnaires to assess HRQoL; the Pediatric Voice Outcomes Survey (PVOS); the pediatric voice-related quality of life (PVRQoL) instrument; indirect laryngoscopy and perceptual voice assessment for the children. Results showed that scores of HRQoL and PVRQoL did not differ between the controls and study group. Subjects had significantly lower PVOS scores than the controls (P < 0.01).Perceptual assessment showed that study group had worse off quality on the following paramters: voice is strained, voice is hoarse or husky, and voice is weak/ does not resonate (P < 0.05). Accordingly, the results of the study point to laryngeal split as possibly causing lower PVOS scores and perceptual voice quality among children operated in early infancy.
strangled quality. Type II thyroplasty is a laryngeal framework surgery based on the hypothesis that the voice symptoms in AdSD are a consequence of excessively tight glottal closure. Type II thyroplasty is a laryngeal framework surgery based on the hypothesis that the voice symptoms in AdSD are a consequence of excessively tight glottal closure. Previously, we reported the outcome of type II thyroplasty for AdSD using a patient questionnaire and objective perceptual, aerodynamic, and acoustic analysis. Type II thyroplasty provides relief from voice strangulation in patients with AdSD, but none of these methods quantifies the effects of AdSD on a patients quality of life. To determine the effectiveness of type II thyroplasty for AdSD by perceptual analysis using the Voice Handicap Index-10 (VHI-10) and by acoustic analysis. Subjects and Methods: Sixteen patients with AdSD underwent type II thyroplasty between August 2006 and October 2010. VHI-10 scores were determined before and at least 2 years after surgery. Around the same time points as VHI-10 evaluation, acoustic parameters including jitter, shimmer, harmonic-to-noise ratio (HNR), standard deviation of F0 (SDF0), and degree of voice breaks (DVB) were assessed. Results: The average follow-up interval was 30.1 months. In the perceptual analysis, the mean VHI-10 score improved significantly, from 26.7 to 4.08. All patients had significantly improved VHI-10 scores, representing improved functional, physical, and emotional well-being. In the acoustic analysis, jitter, shimmer, HNR, SDF0, and DVB improved significantly after surgery. Significant correlations were found between the VHI-10 score and each of the acoustic parameters (jitter, shimmer, HNR, SDF0, and DVB). Conclusion: The treatment of AdSD with type II thyroplasty significantly improved voice quality of life and acoustic parameters in our patients. Our study also revealed a significant relationship between acoustic parameters and VHI-10 scores. Learning outcomes: the participant will be able to: know type II thyroplasty with a titanium bridge was found to be a very effective therapy for AdSD; know the outcome of Type II Thyroplasty for Adductor Spasmodic Dysphonia.
FP190
LARYNGEAL PROPRIOCEPTION AND MUCOSAL REFLEXES IN HUMAN VOCALIZATION CONTROL WITH AND WITHOUT AUDITORY FEEDBACK: APPLICATION IN VOICE THERAPY AND PEDAGOGY ELISABETTA ROSA (1) - NICO PAOLO PAOLILLO (2) IMPAROLE CENTER CERNUSCO SUL NAVIGLIO, FREELANCER, MILANO, ITALY (1) - AZIENDA OSPEDALIERA DI LECCO, OSPEDALE SAN LEOPOLDO MANDIC, MERATE - LECCO, ITALY (2)
Abstract: Background: The present study was undertaken to clarify the role of both laryngeal proprioception and mucosal reflexes in controlling vocalization, through activation of three couples of intrinsic laryngeal muscles (TA, CT, IA), with and without acoustic voice production and comparing the results before and after local hypopharyngo-laryngeal anaesthesia. A number of recent electro-physiological studies reveals that there are no muscles spindles both in the Thyroarytenoid (TA) and the Cricothyroid (CT) fibers. On the contrary, there is presence of spindles in the other intrinsic laryngeal muscles, including Interarytenoid (IA) muscles. Methods: we considered some exercises that focus on isolated laryngeal movements, as described in the Method of voice training EVT, aka Estill Voicecraft, to be performed first in relaxed apnea, then with an expiratory airflow (silent practice), to assess what the laryngeal muscle response was in either case. Three praxis were chosen: 1) retraction of the false vocal folds; 2) tilting of the thyroid cartilage; 3) contraction of the aryepiglottic sphincter. Subjects were requested to perform: 1) each single praxis during normal voicing of the vowel /i/ on a comfortable pitch in modal register; 2) the same praxis in empty relaxed apnea; 3) the same praxis during slow expiratory airflow; 4) all the three previous steps after local hypopharyngo-laryngeal anaesthesia. In this study our goal was to determine: a) if muscular activity during vocalization and silent practice of a given exercise were matching; b) which way is more suitable to stimulate a specific muscular activity silently; c) the efficacy of personal sensations compared to endoscopic objectivity. Results: all the subjects werent able to perform the first two praxis in apnea, while they all could perform them during expiratory airflow. As for the third praxis, all participants were able to perform it both in apnea and during expiratory airflow. After local hypopharyngo-laryngeal anaesthesia, we found that the first two praxis could not be performed both in apnea and in silent practice. Instead, performing the third praxis was possible in either way. Conclusion: Silent practice exercises increases knowledge and consciousness of laryngeal movements; helps vocal control in case of lessened or altered auditory feedback (reduction of Lombard Effect); eases the development of muscular memory, shortening the time for motor learning; can be helpful in voice rehabilitation and pedagogy. Learning outcomes: learn the difference between proprioception and somatosensory perception in voice production; know what silent practice is and how to perform it; learn the applications of silent practice in voice rehabilitation and pedagogy.
FP188
INJECTION LARYNGOPLASTY BY THYROHYOID APPROACH USING CURVED 23G CATHELIN NEEDLE FUMIMASA TOYOMURA (1) - RYOJI TOKASIKI (2) MAMORU SUZUKI (1) DEPERTMENT OF OTORHINOLARINGOLOGY, TOKYO MEDICAL UNIVERSITY, TOKYO, JAPAN (1) - SINJUKU VOICE CLINIC, TOKYO, JAPAN (2)
Abstract: Injection laryngoplasty is performed for vocal fold paralysis or atrophy. When injection is performed as an office based surgery under topical anesthesia, trans oral needle injection method has been popular. Because the needle is too long, some amount of injection material is left inside vain. On the other hand, some patients cannot endure this procedure because of gag reflex. In this presentation we introduce new method of percutaenous injection laryngoplasty using curved 23G 60mm needle through thyrohyoid approach. This procedure is performed under laryngeal endoscopic view after topical anesthesia. The 23 G needle bended at the two points , about 1cm and 2cm from the tip, is inserted to the vocal fold through 2-3mm above the superior thyroid notch. Initially, the needle should be inserted completely inside the larynx so that posterior part of the second bend can be observed(1).The deep initial pass enables the needle to reach not only the vocal fold(2) but the vocal process(3)and posterior part of the vocal fold(4). This way enables surgeon to have better approach to whole part of the vocal fold from anterior to posterior in all directions. We performed this injection laryngoplasty in over 500 cases such as injection for Unilateral vocal fold paralysis or botulinum toxin injection for adducter spasmodic dysphonia since January 2012. Additionally this procedure is useful not only injection but incision for vocal fold cyst or nodules. This method is very simple and useful without technical or medical failure. Learning outcomes: the participant will be able to know how this method is useful and novel because the procedure is simple, safe, and easy.
FP189
QUALITY OF LIFE BEFORE AND AFTER TYPE II THYROPLASTY FOR ADDUCTOR SPASMODIC DYSPHONIA TETSUJI SANUKI (1) - EIJI YUMOTO (1) - NARIHIRO KODAMA (1) DEPARTMENT OF OTOLARYNGOLOGY HEAD & NECK SURGERY, GRADUATE SCHOOL OF MEDICINE, KUMAMOTO UNIVERSITY, KUMAMOTO, JAPAN (1)
Abstract: Objectives: Spasmodic dysphonia (SD) is a focal laryngeal dystonia. In its most common form, adductor spasmodic dysphonia (AdSD), abnormal contraction of the thyroarytenoid (TA) and lateral cricothyroid (LCA) muscles results in excessive spasm and disproportionate glottal closure. Consequently, the voice is characterized by stoppages and a strained/
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FP191
THE USE OF SOUND PRESSURE LEVEL (SPL) METER APPS IN THE CLINICAL SETTING GAETANO FAVA (1) - GISELE OLIVEIRA (2) COLUMBIA UNIVERSITY MEDICAL CENTER, INSTITUTE FOR VOICE AND SWALLOWING- PHELPS MEMORIAL HOSPITAL CENTER, NEW YORK, NY, UNITED STATES (1) - TOURO COLLEGE, NEW YORK US, CENTRO DE ESTUDOS DA VOZ (CEV), SAO PAULO BRAZIL, NEW YORK, NY, UNITED STATES (2)
Abstract: Background: The use of sound pressure level (SPL) meters in the field of speech-language pathology is widely used. SPL meters are used to measure vocal intensity or vocal loudness. The most commonly used standard SPL meter is the RadioShack digital sound level meter. With the advent of smartphones and tablets, the use of apps has become popular and many clinicians are using them in their practices. Many SPL meter apps are available online, with a wide price range. The purpose of this study is to compare sound pressure level (SPL) readings between a standard digital SPL meter and SPL meter iPhone apps. Methods: Devices used were a standard RadioShack SPL meter and iPhone 3G. A total of two SPL meter apps were chosen from the iPhone app store, which will be identified as app1 and app2. This study was conducted in two parts. The first part consisted in measuring SPLs of pure tones in an audiology sound proof booth in order to obtain additional SPL reading information other than human voices. Pure tone measurements followed the standard frequency audiometer exam procedure: 125, 250, 500, 1000, 2000, 4000, and 8000 Hz. For the purpose of this experiment the sound levels assessed were 60, 70, 80, 90, and 100 dB SPL. The second part of the study consisted in measuring SPLs of human voices. Participants of this study were 20 vocally healthy adults, 10 males and 10 females, with age range between 18 and 65. The speech task consisted of a sustained vowel ah at a comfortable pitch for approximately 10 seconds at three different vocal intensities: Soft, habitual, and loud - with a device-to-mouth distance of 50 cm. The iPhone and standard SPL meter microphones were lined up at an equal distance from the participants mouth. Recordings were obtained in an audiology sound proof booth and simultaneously captured on the standard SPL meter and on each iPhone app. Results: Pure Tone SPL meter readings between the standard SPL meter and app1 revealed no significant differences for all sound pressure measured (60 p=0.107; 70 p=0.218; 80 p=0.374; 90 p=0.584, and 100 dB SPL p=0.516), while readings between the standard SPL meter and app2 revealed significant differences for all sound pressure levels measured (60 p<0.001; 70 p<0.001; 80 p<0.001; 90 p=0.008), except for 100 dB (p=0.126). Comparison of SPL meter readings between devices with human subjects revealed no significant differences with app1 across loudness levels measured (soft p=0.085; habitual p=0.095; loud p=0.105), and significant differences with app2 readings across loudness levels (soft p=0.002; habitual p<0.001; loud p<0.001). Conclusion: This study demonstrated that not all SPL meter iPhone apps produce accurate results. Therefore, clinicians should interpret results from these devices with caution. One of the limitations of this study is that only two apps were compared. Further study is warranted to compare more SPL meter apps to assess for potential differences or similarities in SPL readings against a standard SPL level meter. Learning outcomes: understand use of SPL meter apps in the clinical setting; learn how to utilize SPL meter devices and apps for measuring voice loudness; discuss the importance of careful use new available technology, as this study demonstrated that not all SPL meter apps produce the same result.
the controlateral healthy one. Methods. High frequency ultrasound imaging was performed under saline immersion during microlaryngoscopy using a 20MHz transdusers (Aloka, alpha 6, UST533). Results. The epithelial surface, lamina propria, ligament and underling glottic muscle were clearly identified with high frequency ultrasound. More specifically, ligament showed hyperechoic signal which allowed an easy injection of saline solution as well as of other biomaterials exactly within the superficial lamina propria. Useful ultrasound color-doppler resolution of neovasculature in infiltrative malignant lesions was also obtained to deeps of at least 10 mm within the tissue, thus allowing a more accurate evaluation of deeper infiltration. Conclusions. This preliminary study suggests the capability of high frequency ultrasound to image the layer anatomy of the human vocal fold and might allow to document the involvment of vocal fold structure by benign and malignant laryngeal lesion, indicating that this uninvasive in vivo technology holds a strong potential in endoscopic and phonosurgical procedures. Learning outcomes: the participant will be able to: know the anatomy of laryngeal structures by ultrasound imaging; analyze the role of ultrasound in the evaluation of vocal cord infiltration and motility; help surgeons in planning the best therapy for different same staged lesions.
FP193
FUNCTIONAL COMMUNICATION SKILLS IN PERSONS WITH ALZHEIMERS DEMENTIA ROSSELLA MUO (1) - ELENA CALOSSO (2) - ANTONIO SCHINDLER (3) REHABILITATION DEPARTMENT, ASL TO1, TURIN, ITALY (1) SERVICE OF OTOLARYNGOLOGY, AUDIOLOGY AND PHONIATRY, UNIVERSITY OF TURIN, TURIN, ITALY (2) - CLINICAL SCIENCE DEPARTMENT, L. SACCO - MILAN UNIVERSITY, MILAN, ITALY (3)
Abstract: Introduction. Alzheimers disease (AD) is the most prevalent cause of irreversible dementia. AD associated deficits include cognitive and linguistic alterations that increase as the disease worsen. Functional limitation in everyday activities is always associated. The disability related to functional communication limitations seems to have a significant impact in everyday life of AD patients and their significant others. Communicative deficits increase the burden of caregivers and the risk of early institutionalization. The aim of the study is to investigate functional communication abilities in patients with AD at different stages of the disease. Methods. Sixty AD patients participated in the study. Diagnosis of probable AD was made according to NINCDS-ADRDA research task force criteria. Mini Mental State Examination (MMSE) and Global Deterioration Scale (GDS) were used to stage the degree of cognitive impairment and the stage of disease, respectively. Patients recruited were stratified into three groups on the basis of GDS score: group 1 - mild-moderate cognitive decline (GDS = 3 or 4), group 2 - moderately severe cognitive decline (GDS = 5), group 3 severe or very severe cognitive decline (GDS = 6 or 7). The validated Italian version of the American Speechlanguage Hearing Association Functional Assessment of Communication Skills for adults (ASHA-FACS) was administered to all patients in order to assess functional communication abilities. Correlation between ASHA-FACS and both MMSE and GDS scores were calculated through Spearman Rho test. Results. Preliminary results on 41 patients shows that all AD patients show limitations in functional communication even in early stage of disease; severe AD patients retain very few communication abilities. Difficulties increase with the progression of disease as the correlations between FACS and both GDS and MMSE scores were highly significant. No patients reached the maximum score, neither in domains of the ASHA-FACS Communication Independence (range = 1,1-5,9, on a 7-point scale), nor in domains of the ASHA-FACS Qualitative dimension of communication (range = 1-4.2, on a 5-point scale). All functional communication abilities decline progressively as the disease worsen; independence mean score decline from 4.6 in group 1, to 2 in group 3; qualitative dimension mean score decline from 3.3 in group 1, to 1.8 in group 3. All the correlations between FACS domains and GDS and MMSE scores were highly significant (p<0.001). Correlations between FACS items and GDS and MMSE scores were high, in particular for reading, writing, and number concepts (respectively -.86 and .83), adequacy (respectively -.83 and .85) and appropriateness (respectively -.84 and .84); on the contrary, communication of basic needs (respectively -.71 and .61) and communication sharing (respectively -.63 and .60) showed lower correlations. Conclusions. AD patients showed some kind of limitations in functional communication activities at all stages of disease; even though language impairments are usually investigated, their impact on daily living and on communication activity is very often neglected. It is the authors opinion that functional assessment of communication is helpful in order to have a complete framework of the disease and its impact on demented patients and their families and caregivers. Learning outcomes: the participant will be able to: understand better the importance of communication abilities besides linguistic function; understand better the importance of considering functional communication for persons with aphasia; know a validated tool to measure functional communication.
FP192
IMAGING OF THE HUMAN VOCAL FOLD WITH HIGH FREQUENCY ULTRASOUND. POTENTIAL APPLICATION IN DIAGNOSIS AND TREATMENT OF LARYNGEAL GLOTTIC LESIONS. SALVATORE COSCARELLI (1) - GIUDITTA MANNELLI (2) LUCA LEONE (2) - GIUSEPPE MECCARIELLO (2) - GIOVANNI BABBINO (3) - ORESTE GALLO (2) PHONIATRICS SECTION UNIT, UNIVERSITY OF FLORENCE, FLORENCE, ITALY (1) - FIRST CLINIC OF OTOLARYNGOLOGY, HEAD AND NECK SURGERY, AZIENDA OSPEDALIEROUNIVERSITARIA CAREGGI, UNIVERSITY OF FLORENCE, FLORENCE, ITALY (2) - RADIOLOGY CLINIC, AZIENDA OSPEDALIERO-UNIVERSITARIA RUGGI DARAGONA, UNIVERSITY OF SALERNO, SALERNO, ITALY (3)
Abstract: Background. High frequency ultrasound tecnique can not be used externally for evaluation of laryngeal structure because of cartilage frame. Conversely, its potential endoscopic application might help in assisting in diagnosis and treatment of vocal fold pathology, by visualizating also glottic microstructures non invasively. The aim of this study was to assess the ability of high frequency ultrasound to image vocal vold anatomy and injected biomaterials. Study design. The vocal folds of ten consecutive patients affected by unilateral glottic lesion, admitted for diagnostic microlaryngoscopy were evaluated comparing pathological vocal cord with
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FP194
BRIDGING GERIATRY AND LINGUISTICS: NARRATIVE PERSEVERATIONS IN MILD COGNITIVE IMPAIRMENT LUCIANA BRANDI (1) - DIMITRI BECHERI (2) - ALICE CANOSSI (1) DEPARTMENT OF LANGUAGES, LITERATURES AND INTERCULTURAL STUDIES, UNIVERSITY OF FLORENCE, FLORENCE, ITALY (1) - PRATO HOSPITAL, PRATO, ITALY (2)
Abstract: Perseverations have been identified from a lot of year as a topic in dementia patients (Freeman and Gathercole 1966), but in the geriatric literature attention has not been paid on the presence of perseverations in speech production of patients affected by Mild Cognitive Impairment (MCI). This syndrome, represents a grey zone between normal and pathological behaviour in the elderly; in the last years growing interests were devoted to MCI given its possibility of developing in dementias syndrome, such as Alzheimer disease. Through the linguistic analysis of the verbal productions from 6 patient affected by MCI, we show that narrative perseverations provides an identifying and useful aspect of the syndrome. Neuro-psychogeriatric instruments and textual linguistic methods are joined together, on our belief that an interdisciplinary view can help a best knowledge of the syndrome. Finally, the presence of perseverations gives evidence to links with different memory diseases. Learning outcomes: perseveration; mild cognitive impairment; use of non invasive methodology; memory systems
FP196
AN EXPERIENCE ON DIRECT INVOLVEMENT OF PARENTS IN THE MULTIDIMENSIONAL THERAPY OF THE PREADOLESCENT STUTTERING PATIENT
MATILDE MARIA MARULLI (1) - DONATELLA TOMAIUOLI (1) ROBERTA SIDDI (1) - MARIA GRAZIA SPINETTI (1)
C.R.C. BALBUZIE, SAPIENZA UNIVERSITY OF ROME, ROME, ITALY (1)

Abstract: A number of studies conducted in many countries around the world have shown there to be a positive correlation between the frequency of dysfluencies shown by young people and the concern felt and manifested by the parents. This concern, as well as hindering the work of the therapist, has a negative influence on the childs perception of himself and his language, at the critical age of preadolescence in which many physical and psychological changes take place and relations with parents easily enter into crisis.The presence of a conflictual dialogue within the family has a negative influence on the childs speech and leads the parent to focus on resolving the stuttering symptom and developing very high therapeutic expectations. The experience developed consists of training sessions during which the children, guided by the therapists, will communicate to the parents the difficulties they experience when verbalizing and when using techniques that facilitate verbalization learnt previously in their therapy. The activity was carried out on the normally fluent parents of eight stuttering preadolescents, aged between 11 and 13. The work considers three encounters with the young to prepare the activity that will be proposed in the three subsequent encounters with the parents. The aim is that of making the latter aware of the difficulties that the children experience during their rehabilitative training both regarding their negative experience when verbalizing and the application of techniques that facilitate verbalization. The aim is that of increasing awareness on the part of parents in relation to the difficulties that their children encounter in managing their stuttering. From the results a marked improvement in parental understanding of the stuttering problem emerges. Moreover, we can observe in the adults that participate, a greater awareness of their childs difficulties in applying techniques learnt during their therapy that facilitate verbalization. Learning outcomes: to learn about the possibility of modifying the level of knowledge parents have of stuttering; to learn about the possibility and ways of increasing parental awareness in relation to the childs difficulty in managing the disorder, situations connected to verbalization and the application of what has been learnt during the therapy to the outside world; to experiment having parents present in the therapy of stuttering preadolescent patients in order to improve the environmental factors; to learn about the possibility and ways of sharing and transmitting techniques that facilitate verbalization from the patient to other family members.
FP195
NON-THALAMIC SUBCORTICAL APHASIA DUE TO LEFT CENTRUM SEMIOVALIS AND BASAL GANGLIA INFARCT MOZHGAN ASADI (1) - FARIBA YADEGARI (1) - LEILA GHASISIN (1) MEDICAL COUNCIL OF ISLAMIC REPUBLIC OF IRAN, UNIVERSITY OF SOCIAL WELFARE & REHABILITATION, TEHRAN, IRAN (1)
Abstract: Recently, some theoretical issues have been raised regarding the language functions of subcortical structures such as globus pallidus and thalamus. A variety of fluent and nonfluent aphasias have been reported after left basal ganglia stroke. We report the case of a 59-year-old right handed, quadrilingual man (his languages consisted of Persian, French, English, Hebrew) with right hemiplegia, recovered mild dysarthria and no verbal apraxia, who 22 months post-onset of his CVA showed a nonfluent aphasia with moderate anomia. Regarding his quadrilinguality we should mention that his first language was Persian until adulthood. English and French were learnt formally at youth and were mastered gradually during the patients business travels to Europe and USA. He learned Hebrew just as his religious language, not at his natural communicative settings through childhood. The patient reported that after stroke he had difficulty communicating in all languages but received speech therapy only in Persian. The patient became aphasic suddenly upon a discrete infarction in the left centrum semiovalis and basal ganglia as revealed by MRI. His cognitive status on Persian version of Mini-Mental State Examination (MMSE) wasnearlynormal (score=25) at 22 months post-onset time. Examining his language functions using Persian version of Boston diagnostic aphasia examination(BDAE), Boston naming test(BNT) and Persian version of Bilingual aphasia test(BAT)(parts A & B) revealed a mild-to-moderate Broca-type aphasia which was characterized by fairly well performance in tasksof verbal auditory discrimination, auditory and reading comprehension, verbal and nonverbal fluency, oral reading, letter and word dictation, lexical decision and repetition. Nevertheless the patient showed some deficits in auditory and reading comprehension of slightly complex sentences. Concerning semantic abilities, the patient demonstrated little difficulty in judging semantic categories, synonyms, antonyms and producing word antonyms. Yet, on oral confrontation naming task, the participants errors based on Kohn and Goodglass (1985) naming error categorization were as follows: no response, negated responses which comprised negation of semantic paraphasias (for example for bed, the patient said, chair, no it is not a chair), semantic paraphasias and circumlocutions. The anomia in his spontaneous speech was evidenced by slow rate, frequent filled pauses (e.g., e um), repetitions and reformulations. Seemingly, this case is consistent with Crosson (1985), Wallesch (1997, 1999) who considered a possible neuroregulatory or neuromodulatory linguistic role for subcortical structures via a cortico-striato-pallido-thalamocortical loop. They hypothesized that the basal ganglia system and thalamus might influence language output and damage to these systems may result in fluent or nonfluent aphasia with erroneous responses predominated by semantic paraphasia.This case report seems to approve this assumption because a brain damage confined to subcortical areas resulted in language impairments with semantic paraphasia. Learning outcomes: the participant will be able to: 1. understand the role of subcortical areas such as basal ganglia in language processing; 2. Know the symptoms of subcortical aphasia; 3. Define naming errors following subcortical aphasia representative of underlying deficits.
FP197
OUTCOME OF STUTTERING THERAPY ON EGYPTIAN SCHOOL-AGED CHILDREN USING SPEAK FREELY PROGRAM LENGTH OF PRESENTATION YEHIA ABORAS (1) - REHAM EL-MAGHRABI (1) - WALAA MOHSEN (1) UNIT OF PHONIATRICS - FACULTY OF MEDICINE, ALEXANDRIA UNIVERSITY, ALEXANDRIA, EGYPT (1)
Abstract: The study is designed to adapt and apply the Speak Freely Program of stuttering intervention for Arabic speaking school-aged stuttering children and to explore its effectiveness as a therapeutic tool. The presented training program depends on improving the physical dimension for stutters by teaching both, stuttering modification and fluency shaping techniques based on the speak freely program. Some adaptations were made to the program activities to fit the Arabic sounds. The presented worked was conducted on 25 stuttering children of both sexes in the age range of 7- 18 years. The subjects were divided into two age groups: group I (7- 12ys) and group II (12.1- 18ys). Each patient was subjected to the protocol of stuttering evaluation that entails: A) History taking and analysis of complaints, B) Observing features of stuttered speech (core behavior, secondary reactions, devices to cancel stuttering, escape, antiexpectancy) and overt behaviors. C) Stuttering Severity Instrument (SSI-3) was used to assess stuttering moments in a speech sample and reading aloud. d) Psychometric battery was used to compare between pre- and post-therapeutic anxiety and depression scale. D) Two objective evaluation used: First spectral analysis to measure the voice onset time (VOT), formant transition (FT) and vowel duration (VD) for all subjects fluent productions of monosyllabic words with initial /t/ and /d/. Second, Visipitch to measure fundamental frequency (FF), relative average perturbation (RAP), amplitude, shimmer, voiced percent (Voiced %), voiceless % and pause % in an automatic, reading and spontaneous speech samples. The study showed that the younger stutterers have better outcome of the therapeutic program. Results of stuttering severity instrument (SSI-3) and the anxiety and the depressive state of the studied children respectively showed a highly significant difference between the pre-therapeutic and the post-therapeutic values of the two studied groups. FT of the (voiced and voiceless) and the VD of (voiceless) monosyllabic words revealed a difference after therapy. Both groups showed higher post- therapeutic values for
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the voiced %, voiceless % and the amplitude measurements. To conclude, stuttering therapy alters the acoustic properties of stutterers fluent speech concomitantly with reducing stuttering frequency. Learning outcomes: the participant will be able to: know the main phases and stages of the speak freely program; identify the scheme of the assessment protocol for stuttering that include subjective, quasi-objective and objective parameters; define the parameters that significantly correlated with the improvement stuttering severity; know the variables that may affect therapy outcome as age and consanguinity.
FP198
CHILDHOOD STUTTERING: REHABILITATION WITH THE STENDORO ROCCA METHODOLOGY RENZO ROCCA (1) - GIORGIO STENDORO (1) - SILVIA GOTTI (1) SILVANA PASETTI (1) CURA BALBUZIE STENDORO ROCCA, MILANO, ITALY (1)
Abstract: Methodology of treatment: Globally, stuttering is defined as a complex, multi-factorial and multidimensional disorder determined by physiological, environmental, genetic, cognitive, linguistic emotional factors. (Rustin 1986; Manning, 2001). All variables listed above play an important role in the onset and maintenance of the disorder (Gregory, 1999). According to Stendoro-Rocca, the pathogenesis of the disorder emanates from a vocal cord laryngo-spasm that inhibits the mechanical flow of the air current. This spasm of the glottis paralyzes and hinders the formation of sound. In the stuttering disorder two components are taken into consideration: the innate component, characterized by a response to tension, stress, effort of the chordal adduction. The other is the learned component which involves overstress which induces chordal closure and the consequent spasm of phonatory systems. The laryngo-spasm causes interruption of the process of exhalation and hinders the forming chord vibration sound (tonic, clonic seizures and mixed blocks). The goal of the technique is to stimulate the stutterers ability to control the pre-sound closure of the vocal cords. Therefore we must correct the position of pre phonation of vocal cords: a breath, airflow or breathing, maintaining the vocal cords opened and relaxed. The StendoroRocca methodology offers 17 meetings within two months, in a small group formed of four to six age-homogeneous subjects in order to facilitate the decomposing and re-composing of interests. Group leaders, psychologists and speech therapists all present and sitting in the same room with the subjects at the same time, are all guiding the interaction and internalization of the technique in order to automate the pneumo-phonic harmony, anticipatory in the block of phonatory spasms and thus activating the generalization of the process itself, required in many instances in social and cultural discourse. This combination between practitioners and patients in a continuous rapport of meeting-discussion-clarification between the social and the individual aspects promotes speech fluency within the subject and gradual release from verbal and somatic strategies, which often preclude the desire to communicate. Through a constant application of strategies of anticipation, control and adjusting of the phonatory spasms, the base cause in stuttering disorder, the subject starts the process of automatic control of pre-phonatory spasms. Learning outcomes: presentation of the methodology Stendoro Rocca applied in preschool and school age children. Role of the parents in the learning process and maintenance of fluency in the childs continuous development in his/hers need for support from family and school
28 for dysphonia. For dysphagia only water swallowing test result showed a statistical significant difference with p =0,002. For Communication disorders the statistical analysis showed statistical significant differences for the following outcomes: time for sustain S (p=0,0048); ability to repeat S series (p=0,038); Girbas scale (P=0,027); italian phonetically balanced test (p=0,00000); Italian phonetic test (p= 0,0034); rapidly Pa-Ta-Ka repetitions (p=0,047). In conclusion rehabilitation for communication and swallowing disorders in Multiple sclerosis give benefits. Efficacy of rehabilitation treatment for communication disorders in MS could be measured with some outcomes while for dysphagia is needed to find appropriate outcomes. Learning outcomes: the participant will be able to: know the usefulness of rehabilitation for communication and swallowing disorders in Multiple sclerosis; understand the needed of measure efficacy of rehabilitation treatments; to know which outcomes could be useful for rehabilitation treatment of communication disorders in MS.
FP200
RELIABILITY AND VALIDITY OF A SHORT FORM QOL-DYS (QOL-DYS 20) TO MEASURE QUALITY OF LIFE IN DYSARTHRIC ITALIAN SPEAKER SERENA ARIMA (1) - DANILO PATROCINIO (2) ANTONIO SCHINDLER (3) DEPARTMENT OF MODELS AND METHODS FOR ECONOMY, TERRITORY AND FINANCE, UNIVERSITY LA SAPIENZA, ROME, ITALY (1) - PHONIATRICS AND COMMUNICATIVE DISORDERS REHABILITATION CENTER AT DEPARTMENT OF REHABILITATION, AZIENDA SANITARIA LOCALE DI LECCE, LECCE, ITALY (2) DEPARTMENT OF BIOMEDICAL AND CLINICAL SCIENCES L. SACCO, UNIVERSITY OF MILAN, MILAN, ITALY (3)
Abstract: The Quality of Life for the Dysarthric Speaker (QOL-DyS) is a reliable and valid tool to assess the quality of life (QOL) in patients with dysarthria (Piacentini et al. 2011). The questionnaire proposed by Piacentini et al. (2011) was developed on the basis of the questionnaire entitled Dysarthria from the Point of View of the Dysarthric Patient, published by Yorkston et. al (1994). The original questionnaire consisted of 100 items subdivided in four areas: speech characteristics of the word (SC), situational difficulty (SD), compensatory strategies (CS) and perceived reactions (PR) of others. Piacentini et al. (2011) proposed a translated version of the questionnaire and reduced the questionnaire to 40 items. In QOL-Dys questionnaire respondents could answer to each item in five possible ways: always, often, occasionally, seldom or never, depending on how often he/ she experienced the situation or feeling in his/her daily life. A score is associated to each item so that a total score can be computed for each patient. They administrated the 100-items questionnaire to a sample of 50 patients: according to item-total correlation scores and expert opinion about the clinical relevance of item they selected representative items. However, it may happen that also the reduced version proposed in Piacentini et al. (2011) results too long, leading to time consuming, expensive administration, and possibly inaccurate response. The main goal of this paper is to define a model-based procedure for reducing the number of items in QOL-Dys 40 questionnaire so that its reduced version has the same characteristics in terms of QOL evaluation of the complete one. A different strategy for reducing the number of items is proposed: we use statistical models known in psychometric literature as item response models and we select significant items according to these model-based estimates. A clustering algorithm has been adopted in order to select groups of items equivalent in terms of difficulty and discriminant power. We have applied our item reduction strategy to a sample of 105 dyshartric patients. Five items have been selected for each area so that the reduced questionnaire consists of 20 items. The reliability of the proposed reduced questionnaire has been assessed comparing the latent traits estimated with the complete questionnaire and with the reduced one. The respondents have been ranked in the same way in terms of QOL evaluation and the correlation coefficient between the latent trait estimates is about 92% confirming that the reduced version of the questionnaire estimates the latent trait as accurately as the complete one. Learning outcomes: the participant will be able to: know the use of the QOLDys questionnaire in the evaluation of the perceived quality of life in subjects suffering for dysarthria; understand the use of the statistical model-based approach in large data sets to reduce the item number for questionnaires with semi-quantitative answers, maintaining the same quality of estimates; know the reliability of this method to create a reduced version of QOL-Dys questionnaire for Italian patients limited to 20 items (QOL-Dys 20) having the same clinical value as the extended version and a reduced time consumption.
FP199
OUTCOME MESURES FOR REHABILITATION OF COMMUNICATION AND SWALLOWING DISORDERS IN MULTIPLE SCLEROSIS MARIA LAURA LOPES DE CARVALHO (1) - ANTONELLA CUSIMANO (1) - GIAMPAOLO BRICHETTO (1) ASSOCIAZIONE ITALIANA SCLEROSI MULTIPLA, SERVIZIO DI RIABILITAZIONE, GENOVA, ITALY (1)
Abstract: Multiple Sclerosis (MS) is a chronic autoimmune disorder affecting movement, sensation and bodilyu functions. It is caused by destruction of the myelin insulation covering nerve fibers (neurons) in the central nervous system (brain and spinal cord). Dysphagia is a relatively common symptom in MS it in which it can potentially cause severe problems. It is refered by 33%-40% MS patients. Over 40% of MS patients refer communication symptoms that include dysarthria and dysphonia. Interdisciplinary approach to manage MS patients include rehabilitation interventions for swallowing and communication disorders. However literature lacks observational or randomized control studies that aim to assess the efficacy of speech therapy. The aim of this study is evaluate the efficacy of several speech therapy outcomes through an prospective observational study. MS subjects consecutively referred to AISM Rehabilitation Centre of Genoa in 2012 with swallowing or communication disorders were included in this study. All MS subjects were clinically defined following the McDonalds criteria. After informed consent was obtained subjects were submitted to speech therapy treatment as outpatients. All them were evaluated before (T0) and after treatment (T1) with different outcomes for functional domain. 81 subjects were involved in this study 72% females and 28% males with mean age of 53,96 years (SD10,8). 22 subjects were evaluated for Dysphagia, 44 for dysartria and
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FP201
ORAL DIADOCHOKINESIS IN DYSARTHIC SPEAKERS WITH AND WITHOUT LESIONS TO BASAL GANGLIA AND/OR CEREBELLUM CAROLINE OLIVEIRA (1) - SIMONE BARRETO (1) - KARIN ORTIZ (1) UNIVERSIDADE FEDERAL DE SO PAULO, UNIVERSIDADE FEDERAL DE SO PAULO, SO PAULO, BRAZIL (1)
Abstract: Individuals with lesions to the basal ganglia and/or cerebellum can present deficits in motor programming. Some studies on speech in dysarthric patients have been conducted using the temporal acoustic measurements obtained on the Oral Diadochokinesis (DDK) test to characterize performance and compare these individuals with each other and with normal subjects. Thus, since dysarthric individuals with lesions to basal ganglia and/or cerebellum can also present impaired motor programming of speech, oral diadochokinesis may serve as a sensitive marker for identifying the speech deficit in this patient group. The aim of the present study was to compare performances of dysarthric patients with and without lesions to the basal ganglia and/or cerebellum on an oral diadochokinesis task. This study included 30 dysarthric adults, Brazilian Portuguese native speakers. Medical diagnosis of neurologic disorder was confirmed by neuroimaging scan. Patients were stratified into two groups based on the presence (19 patients G1) or absence (11 patients G2) of lesions to the basal ganglia and/or cerebellum. Diadochokinetic measurements were determined using sound recordings of performances on the DDK test from the Dysarthria Protocol. Subjects were instructed to repeat the syllables /pa/, / ta/ and /ka/ as well as the syllable sequence /pataka/ at a natural loudness and pitch several times as rapidly as possible, after a deep breath. These samples were analyzed acoustically using broad band spectrograms by the Praat program, based on the three medial seconds of each utterance. The following measurements were obtained for each task: diadochokinetic rate (number of syllables per second), mean duration of syllables and breaks (in milliseconds) in addition to measurements of variability (coefficient of variation).The study sample was characterized and differences determined, by comparing the groups for demographic variables (gender and age) and the clinical variable (time with lesion). With regard to performance on /pa/, / ta/, /ka/ and /pataka/ repetition tasks, the groups were compared statistically for the variables diadochokinetic rate as well as mean and variability of the duration of syllables and breaks. The Mann-Whitney non-parametric test for independent samples was applied for comparisons involving numerical variables. The Chi-square test was employed to analyse the categorical sex variable. A significance level of 5% was adopted for all tests. Subjects in both groups had overall lower diadochokinetic rates compared to those of normal individuals, whose reference values range, on average, from five to seven syllables per second in adults. Moreover, akin to healthy subjects without disturbances, this rate was most reduced upon posteriorization of the sequence. The comparative analysis of performance on the oral DDK task by the two groups found no statistically significant differences for the measurements collected. Dysarthric speakers with lesions to the basal ganglia and/or cerebellum did not differ to patients without these lesions to brain structures in terms of oral diadochokinesis performance. Learning outcomes: the participants will be able to: 1. Discuss the role of the basal ganglia and/or cerebellum; 2. Analyze Oral Diadochokinesis results in patients with different sites of lesion;3. Discuss how these structures are always related to motor speech disorders
SY9
MOTOR SPEECH DISORDERS COMMITTEE SYMPOSIUM 1 BRUCE MURDOCH (1) - PAMELA ENDERBY (2) - MICHAEL ROBB (3) UNIVERSITY OF QUEENSLAND, AUSTRALIA (1) - UNVERSITY OF SHEFFIELD, UNITED KINGDOM (2)
Abstract: Kaipa,R., and Robb, M. Evaluation of motor learning principles in speech and nonspeech tasks.|A brief primer on principles of motor learning will be provided, followed by examples of how a variety of these principles can be applied to the learning of speech and non-speech motor tasks. The usefulness of incorporating motor learning principles into a clinical setting is explored. Murdoch,B. and Barwood, C. Assessment and treatment of motor speech disorders using Transcranial magnetic stimulation.Recent years have witnessed increasing interest in the use of brain stimulation techniques for the rehabilitation of impaired motor function associated with a range of neurological disorders.such as stroke and Parkinsons disease. This presentation will review the evidence supporting the use of Transcranial magnetic stimulation (TMS) as a treatment for dysarthria . The basic principles and operation of TMS will be outlined and hypotheses underlying studies devised to test the efficacy of TMS based treatments discussed. More specifically the findings of studies that have employed TMS as a treatment for articulatory and voice problems in hypokinetic dysarthria will be described and discussed and the possible future role of brain stimulation procedures in clinical practice highlighted Enderby, P. Outcome measurement and AAC services review of measures and development of a new tool. Internationally there have been many changes in the delivery of health, education and social care services over the last decade. However, there are two central pillars which have become of increasing importance in most strategy and policy documents. These pillars emphasise the importance of sustaining and improving the quality of service delivery which is related to the second requirement to demonstrate cost effective service delivery. Services are required to collect, report and learn from outcome measurement. This paper discusses the importance of outcome measures in improving augmentative and alternative communication (AAC) services. The presentation will summarise the purpose and value of outcome measurement and review those commonly used in AAC services reflecting on conceptual frameworks including the International Classification of Functioning (WHO). Twenty three measures were identified from the literature. These incorporate general measures, specific measures, measures as part of general management systems and measures of accreditation and qualification. No measure incorporated all of the domains consistent with the ICF and has therefore informed the development of a particular outcome measure (AAC TOM) ensuring that basic principles of the International Classification of Functioning are retained and the measure can be used in benchmarking. The principles of the Therapy Outcome Measure have been incorporated into the version for AAC and will allow comparison of service delivery and reflection of change in persons using AAC devices.It was concluded that the developed AAC TOM is to be used in an audit of AAC services in England.
SY10
EDUCATING SLPS FOR PROFESSIONAL PRACTICE IN DIFFERENT ENVIRONMENTS SESSIONS 1 AND 2 FERNANDA DREUX M. FERNANDES (1) UNIVERSIDADE DE SO PAULO, SCHOOL OF MEDICINE, SO PAULO, BRAZIL (1)
Abstract: This seminar is proposed by the Education Committee for Speech and Language Pathology. It will be conducted in two 90-minute sessions, with presentations by representatives from over one dozen different countries, all of them with significant experience in educating speech and language pathologists in undergraduate and graduate levels. These presentations will address the different challenges posed by various educational needs and standards and professional certification/accreditation systems. Participants will also report on solutions to local specific issues that may be adapted or applied to other situations. They will discuss about the advantages and difficulties in building a set of statements that could be shared on a global perspective. Confirmed participants are: Tomasz Wozniak, from Poland; Suzana Jelcic, from Croatia; Nadia Zemva, from Slovenija; Mirela Duranovic, representing Bosnia and Hercegovina; Peter Lajos, from Hungary; Katerina Vitaskova, from the Chec Republic; Mile Vukovic from Serbia; Lemietta McNeilly, from the United States, representing the American Speech-Language Hearing Association; Chin-Hsing Tseng, from Taiwan; Hayde Wertzner, from Brazil; Sharyne Mcleod, from Australia and Seihun Topbash, from Turkey. Learning outcomes: the participant will: 1. Know the different challenges regarding the education of SLPs in different regions of the world; 2. Identify the solutions proposed, their results and the possibility of application in different situations; 3. Identify similarities, possible associations, common points of interest and alternatives to collaboration with colleagues form different parts of the world.
SS40
CROSS-POLLINATION OF OROFACIAL MYOLOGY BETWEEN SOUTH AND NORTH AMERICA LICIA COCEANI PASKAY (1) - IRENE MARCHESAN (2) ACADEMY OF OROFACIAL MYOFUNCTIONAL THERAPY (AOMT), LOS ANGELES, CALIFORNIA, UNITED STATES (1) - CEFAC HEALTH AND EDUCATION CENTER, CEFAC, SO PAULO, BRAZIL (2)
Abstract: This session presents the state-of-the-art in orofacial myology/orofacial motricity from the perspective of two clinical realities: South America and North America. Advancements in evaluation, prevention and treatment of orofacial myofunctional disorders, current research studies, trends, projects, cross-cultural aspects and multidisciplinary aspects of a patients care are presented, with the purpose of building bridges between professionals and to promote best practice protocols across continents and cultures. Learning outcomes: the participants will be able to: acquire information on new assessment and therapy tools in orofacial myology/orofacial motricity (OM); compare various models of delivery of preventive care, assessment and treatment of orofacial myofunctional disorders; explore current and future application of OM in a wide range of disorders and conditions; explore current and future application of OM in a multidisciplinary team approach to patients care; compare and contrast North and South American therapy delivery models applicable to other countries; review some significant North and South American studies and their implication in better patient care
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FP202
GENDER AND AGE IDENTIFICATION OF INDIVIDUALS WITH AND WITHOUT DYSPHONIA GISELE OLIVEIRA (1) - GAETANO FAVA (2) - CAMILA SAUDA SANTIEIRO (3) - MARA BEHLAU (3) CEV - CENTRO DE ESTUDOS DA VOZ, SAO PAULO, BRAZIL, TOURO COLLEGE, NEW YORK, UNITED STATES (1) COLUMBIA UNIVERSITY MEDICAL CENTER, INSTITUTE FOR VOICE AND SWALLOWING AT PHELPS MEMORIAL HOSPITAL CENTER, NEW YORK, UNITED STATES (2) CEV - CENTRO DE ESTUDOS DA VOZ, SAO PAULO, BRAZIL (3)
Abstract: Introduction: The human voice carries many acoustic features that define the speaker, allowing identification of characteristics such as gender and age. Studies in the past have examined the identification of voices of vocally healthy speakers across ages and gender. Dysphonia is a condition that may alter some of these vocal features. Therefore, the identification process may be more challenging or inaccurate. The purpose of the present study was to assess the possibility of identifying gender and age of individuals with and without dysphonia across the lifespan and between genders. Methods: The population was composed of 96 individuals with mean age of 40.8, ranging from 4 to 80 years of age, 48 of them had dysphonia, 24 males with mean age of 39 years and 24 females with mean age of 43.2 years, and 48 of them did not have dysphonia, 24 males with mean age of 38.6 and 24 females with mean age of 39.9 years. Individuals were distributed into 8 groups according to the following age ranges: 0-10; 11-20, 21-30, 31-40, 41-50, 51-60, 61-70, 71-80. Each age range group had 6 individuals, 3 males and 3 females. The speech samples elicited from the subjects were counting numbers from 1 to 10, which were recorded and randomly presented to a judge panel made up of 4 speech-language pathologists specialized in voice. Judges had to identify gender and age of the subject by listening to the speech samples. Judges presented with adequate inter-judge reliability. Results: Dysphonic and non-dysphonic individuals had their genders and age identified similarly (gender p=0.561; age p=0.937). The same thing happened with age and gender when male and female individuals were compared (female age p=0.465; male age p=0.525; female gender p=0.986; male gender p=0.399). Gender of individuals with dysphonia was identified with 93.8% accuracy, while their age range with 38.5%. Gender of individuals without dysphonia was identified with 95.8% accuracy, while their age range with 39.1%. Both women and mens gender was identified correctly 93.8% in the group with dysphonia, while 94.8% of womens gender and 96.9% of mens gender were correctly identified in the group without dysphonia. Womens age range was identified correctly 36.5% in the group with dysphonia, and 42.7% in the group without dysphonia. Mens age range was identified correctly 40.6% in the group with dysphonia, and 35.4% in the group without dysphonia. Conclusion: Dysphonia does not influence gender and age identification. Male and female are equally identified by their voices, although age ranges seem not to be. Gender is more easily identifiable than age. Learning Outcomes: Understand the importance of perceptual analysis in the voice examination process and the acoustic features that voices provide. Understand that it is overall possible to identify gender and age groups based on perceptual voice analysis regardless of the presence of dysphonia. Understand that overall gender is more identifiable than age, regardless of the presence of dysphonia. Understand that certain dysphonic age groups are more difficult to identify perceptually than others. Participants will be able to identify these age groups.
total) were male or female voices. The stimulus material consisted of a set of six 3-syllable german nouns spoken by 5 male and 5 female speakers each. In addition, three morphed versions of each natural stimulus were generated to transform them progressively into gender-ambigious samples. The morphing was performed by Praat. The fundamental frequency contours of the original recordings were shifted by 2, 4, and 6 semitones in the direction of the speakers opposite sex. In addition, the formant frequencies were adjusted to simulate shorter or longer vocal tract lengths. The fMRI data acquisition was carried out on a 3 T Siemens Trio MR Scanner using echo-planar imaging sensitive to BOLD contrast in a sequence of 36 slices covering the entire brain. The 2 x 4 design of the decision task enclosed the factors voice sex (male/female) and morphing condition (original recording, shifted by 2, 4, 6 semitones). The fMRI data analysis was performed using SPM8 implemented in MATLAB 2010b. The main results of our behavioral and imaging study are that volunteers of both sexes showed a better performance in respect of the identification of opposite-sex samples. Gender ambigious voice samples evoked increased responses in the mid cingulate cortex and in the bilateral inferior frontal gyri. Voice samples of opposite sex induced a stronger activation in a fronto-temporal neural network. In conclusion, our data show evidence of a gender-specific processing for male and female voices, both on a neural and on a behavioral level. Furthermore, our results demonstrate a higher neural and perceptual sensitivity of humans for voices of the opposite sex. Learning outcomes: the Participant: will be able to know the cerebral topography of voice perception areas regarding to voice samples belonging to the same vs. the opposite sex of perceptual raters; will get information about gender-related differencies in respect of the identification rate of male and female voices; will be introduced into a method of VoiceMorphing to generate gender-ambigious voices; learn about neural differences in the perception of natural vs. morphed gender-ambigious voice samples
FP204
MAGNETIC RESONANCE MICROIMAGING OF THE PEDIATRIC HUMAN LARYNX GISELE OLIVEIRA (1) - IAN ROWLAND (2) - ELIZABETH HUTCHINSON (2) - YO KISHIMOTO (2) - NATHAN WELHAM (2) UNIVERSITY OF WISCONSIN-MADISON, MADISON, WI, TOURO COLLEGE, NEW YORK, UNITED STATES (1) - UNIVERSITY OF WISCONSIN-MADISON, MADISON, UNITED STATES (2)
Abstract: Purpose: The purpose of this study was to compare morphological characteristics of the pediatric larynx using MR microscopy and standard histological analysis. Methods: Two human larynges obtained from autopsy cases were included in this study: one from a 13-month-old male and another from a 10-year-old female. The male specimen was normal; the female specimen presented with a vocal process cyst on gross examination. MR microscopy was performed using a 4.7 T Varian Inova Imaging and Spectroscopy system and a Varian 2.5 cm inner diameter quadrature volume coil. The resolution used for the 13-month-old male larynx analysis was ~90m and for the 10-year-old female larynx was ~120 m. In order to highlight specific tissue characteristics, 2D spin echo images were acquired using T1W (with and without fat suppression) and T2W sequences. Samples were also suspended in a gadolinium-based contrast agent to increase signal when using a 3D T1W gradient echo sequence. Diffusion tensor imaging (DTI) was employed to evaluate fiber directionality. 3D data reconstruction was performed using ImageJ and Osirix software. For histological analysis, wholemount specimens were paraffin embedded and sectioned at 5-m thickness in the axial plane. Ten sections were obtained every 500 m from the supraglottis and subglottis; serial sections were obtained from the glottis. Routine hematoxylin and eosin, trichrome, elastin van Gieson and Alcian blue stains were performed, followed by bright field microscopy. Results: MR imaging allowed clear delineation of important anatomic features such as the vocal fold macula flavae and its substructures, as well as the vocal ligament, and mass lesions, with ~100m resolution. Clear anatomic and microstructural differences were noted between the two specimens, presumably due to developmental stage and/or sex. DTI confirmed fiber directionality within the major intrinsic laryngeal muscles, as well as the lamina propria. The MR data provided histologic-level detail, as evidenced by comparison of parallel MR slices and histological sections in the axial plane. Conclusion: MR microscopy allows the non-destructive evaluation of pediatric laryngeal and vocal fold microstructural features at ~100m resolution. Data can be collected in 3D and resliced in any plane. It therefore shows promise as a clinical and research tool in laryngology and voice science. Learning outcomes: understand basic magnetic resonance microimaging principles; appreciate the applicability of magnetic resonance microimaging to study of the developing human larynx; identify laryngeal structures in magnetic resonance microimages and histological sections.
FP203
GENDER-SPECIFIC VOICE PERCEPTION IN THE BRAIN. FMRIDATA IN ADULT VOLUNTEERS CHRISTIANE NEUSCHAEFER-RUBE (1) - JESSICA JUNGER (2) KATHARINA PAULY (2) - PETER BIRKHOLZ (1) - FRANK SCHNEIDER (2) - CHRISTIAN KOHLER (3) - SABINE BRHR (2) BIRGIT DERNTL (2) UTE HABEL (2) CLINIC OF PHONIATRICS, PEDAUDIOLOGY AND COMMUNICATION DISORDERS, UNIVERSITY HOSPITAL AND MEDICAL FACULTY OF THE RWTH AACHEN UNIVERSITY, AACHEN, GERMANY (1) - CLINIC OF PSYCHIATRY, PSYCHOTHERAPY AND PSYCHOSOMATICS, UNIVERSITY HOSPITAL AND MEDICAL FACULTY OF THE RWTH AACHEN UNIVERSITY, AACHEN, GERMANY (2) - DEPARTMENT OF PSYCHIATRY, NEUROPSYCHIATRY DIVISION, UNIVERSITY OF PENNSYLVANIA SCHOOL OF MEDICINE, PHILADELPHIA, PA, UNITED STATES (3)
Abstract: In human communication male and female speakers can be easily distinguished. That is true because the voice is an important sex differentiating marker. However, little is known about the neural processing of voices generated by speakers of the same vs. the opposite sex of the listener. Therefore, we present data of an fMRI study performed with 19 female and 20 male adult volunteers. During the fMRI-measurement, the volunteers were asked to determine whether voice samples presented by headphones (240 in
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FP205
THE ART OF SHARED DECISION MAKING: EXAMPLES FROM OUTCOME EVALUATION OF APHASIA THERAPY JYTTE ISAKSEN (1) INSTITUTE OF LANGUAGE AND COMMUNICATION, UNIVERSITY OF SOUTHERN DENMARK, ODENSE, DENMARK (1)
Abstract: The objectives of shared decision making are for both the client and the professional to participate in exchange of information, discuss, negotiate and make decisions in genuine fellowship with the stated benefits of higher compliance, empowerment, increased client satisfaction and reduction of stress and anxiety. Although barriers as limited resources, unwillingness from either of the participants together with an unequal power balance are described. Persons with aphasia has earlier expressed preferences for shared decision making, but it is not further investigated how the participants actually manage the activity when aphasia is involved. The study aims to describe the complex premises present in the speech-language therapists effort to collaborate and reach agreement with the persons with aphasia and their significant others and how the therapists handle these premises throughout sessions of outcome evaluation. 34 sessions of outcome evaluation with speech-language therapists and persons with aphasia was video recorded and following the 12 participating therapist was interviewed. Through content analysis of the interviews topics were identified concerning efforts to include clients in decision making as well difficulties in doing so. The findings were afterwards further clarified by ethnomethodological conversation analysis of selected video clips. Regardless of the clinicians heartfelt wish to collaborate and include their clients with aphasia in decision making about e.g. ending therapy or setting new goals it showed to be difficult to integrate professional and personal views with opinions of the clients. The clinician tries to solve it by preparing themselves for the shared decision making and at the same time being flexible in integrating views of the clients, which is further complicated by the aphasia. Learning outcomes: the participant will be able to: know speech-language therapists views and perceptions of shared decision making; know the methods the speech-language therapists use to involve persons with aphasia in decision making; understand the problematic issues in such ways to involve persons with aphasia; understand the consequences of aphasia in shared decision making.
extracted from three separate studies. The fourth resource represents the 1000 most frequent words retrieved from a large psycholinguistic database. Considering that most aphasia treatment studies have reported item-specific effects without generalisation to untreated items, careful selection of target items is important. Use of frequency-based topic and vocabulary lists can be one way to increase the number of items that are potentially relevant for many people. They can also guide selection of more individual vocabularies. Our proposal should not be interpreted as recommending rigid use of pre-determined stimulus lists but rather as providing informed guidance for selecting functionally relevant therapy items. The agenda for future research is to identify vocabulary within the most common topics and to determine effective methods of treatment for word classes other than nouns and verbs. Learning outcomes: to promote discussion and debate on the meaning and use of functionally relevant items for aphasia therapy; to provide review of the aphasia literature and studies from related fields including Augmentative and Alternative Communication (AAC), to determine strengths and weaknesses of two approaches to vocabulary selection: by investigating generally frequent and personally chosen vocabulary; to create awareness of new resources to inform the selection of items for the treatment of word retrieval disorders (anomia) that are based on systematic analysis of language data; to develop a research agenda to identify vocabulary within the most common topics of everyday conversation and to determine effective methods of treatment for word classes other than nouns and verbs.
FP207
APHASIA:FROM MEDICAL PRACTICES TO THE SPEECH AND LANGUAGE CLINICS GISELE GOUVEA DA SILVA (1) - REGINA MARIA FREIRE (1) FUNDACAO SAO PAULO, PONTIFICAL CATHOLIC UNIVERSITY OF SAO PAULO, SAO PAULO, BRAZIL (1)
Abstract: Introduction: long ago, a new condition of the speaker, in consequence to the loss of language, became known and was nominated aphasia. This condition was widely studied in the nineteenth century by neurologists focusing on the anatomo-clinical method, and therefore diagnosed as resulting from brain injury. Aim: To study cases of aphasia from the semiological, etiological, diagnostic and therapeutic elements from Medicine and to investigate their implications in therapeutic intervention in cases of aphasia in the speech and language clinical practice. Method: This study is a review of clinical cases described in Medicine, during the nineteenth century. Four clinical cases diagnosed with aphasia were selected, where descriptions enabled the extraction of semiological, etiological and therapeutic elements, an observance of the relationship between the medical doctor and the aphasic subject and, also, the extraction of the overlapping clinical operations in language and through language. Results: Case 1: Semiology: the patient could utter one syllable, which was usually repeated twice consecutively. No matter the question, the patient always answered tan tan. Etiology: softening of the middle part of the frontal lobe of the left hemisphere. Diagnosis: Brocas aphasia. Therapeutics: none. Case 2: Semiology: The patient seemed lucid, understood all that was said to him, made desperate efforts to speak, but no words were uttered, other than yes and no. Etiology: internal fracture of the skull, which left a splinter bone, pressing the third frontal gyrus. Diagnosis: transcortical motor aphasia. Therapy: trepanation. When the patient awoke from anesthesia, language was recovered. Case 3: Semiology: the patient did not react when spoken to, and when communication attempts were made, she continuously repeated: Je ne veux pas!, in a tone of extreme impatience. Etiology: bilateral cortical foci. Diagnosis: Agnosia aphasia. Therapy: The doctor would barely touch her wrist and the patient recognized him, correctly said his name, and spoke to him without disturbances in her speech until he released her hand, and she became once again inaccessible. Case 4: Semiology: The patient, when the name of an object was announced, was able to point it out, but not to find the acoustic image corresponding to the presented object. Etiology: reduction of sensory impressions. Diagnosis: Mixed transcortical aphasia. Therapy: The patient was able to recall names he was lacking by writing them, if the object could be simultaneously held within sight. He looked at the object and then wrote the first letter of its name, reread this letter and spoke continuously, then looked at the object again, wrote the second letter and pronounced both letters, thus proceeding until the last letter was found, and, hence, the name he sought. Conclusions: Points can be extracted from the cases for treating aphasia in speech and language clinics, such as, in case 3, where the therapeutic happens by a transliteration operation and in case 4, where the operation of transcription is the mainstay of treatment. Finally, we conclude that aphasia is a new condition for speakers and that the basis for the speech and language treatment may be associated with the operations of translation, transcription and transliteration. Learning outcomes: the participant will be able to: study clinical cases of aphasia, highlighting the vicissitudes and idiosyncrasies of each case; deepen the notion of structure and its clinical semiological, etiologic, diagnostic and therapeutic elements; understand the concepts of translation, transcription and transliteration as operations that include the symptom in speech; critically examine clinical structure, which adheres to the therapeutic act: extract the foundation of the relationship between the aphasic subject and the other and its effects on language, speech and writing in order to recognize the speaker.
FP206
DO WE TREAT FUNCTIONALLY RELEVANT ITEMS IN APHASIA THERAPY?: CURRENT CHALLENGES AND NEW TOOLS KATI RENVALL (1) - LYNDSEY NICKELS (1) - BRONWYN DAVIDSON (2) CENTRE FOR CLINICAL RESEARCH EXCELLENCE (CCRE) IN APHASIA REHABILITATION, ARC CENTRE OF EXCELLENCE IN COGNITION AND ITS DISORDERS, DEPARTMENT OF COGNITIVE SCIENCE, MACQUARIE UNIVERSITY, SYDNEY, AUSTRALIA (1) CENTRE FOR CLINICAL RESEARCH EXCELLENCE (CCRE) IN APHASIA REHABILITATION, DEPARTMENT OF AUDIOLOGY & SPEECH PATHOLOGY, THE UNIVERSITY OF MELBOURNE, MELBOURNE, AUSTRALIA (2)
Abstract: Aphasiologists aim to select functional, relevant and useful items for use in therapy, yet the field lacks clear definitions of these terms. Strategies and tools to enable identification of items that are truly functionally relevant are also lacking. The purpose of this paper is to present a brief review of the meaning of functionally relevant for aphasiology, to discuss challenges in identifying functionally relevant items, and to provide guidance in the selection of these items for treatment of acquired language disorders and word retrieval disorders (anomia) in particular. This study includes a literature review, analyses of existing language databases, and provision of new tools that may be used to guide selection of therapy items at two levels: vocabulary and topics of conversations. Review of the aphasia literature shows that the field lacks clear definitions, thus in order to clarify the meaning of functional, we define two types of functionally relevant items: generally frequent and personally chosen vocabulary. By reviewing the aphasia literature and studies from related fields including Augmentative and Alternative Communication (AAC), we determine strengths and weaknesses of these approaches. We show that one of the major challenges is that aphasiologists typically aim to treat items which are intuitively the most common for people in general but have no tools to objectively identify frequent words. A related challenge is that most reported therapy studies are directed at concrete nouns and verbs although, as confirmed by our analyses, the most common words in everyday use are abstract and include words from other word classes (e.g., pronouns, conjunctions, adjectives, and adverbs). There is also a lack of instructions and published materials to guide selection of other, more personally relevant items. This paper reports on reanalysis of existing datasets of adult speakers everyday conversations and the use of a large psycholinguistic database to provide four new resources for making selection of therapy items easier and more objective in the future. The first resource provides evidence of the most frequent topics in older adults conversations. The second is another topic-related resource drawn from the everyday conversations of both healthy and aphasic older people. The third resource is a collation of the most frequent words used by older adults as part of their everyday conversations
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FP208
WORD-FINAL DYSFLUENCIES: ARE THEY STUTTERING? VERITY MACMILLAN (1) - ARTEMI KOKOLAKIS (2) ANN PACKMAN (2) SOUTH WEST SYDNEY LOCAL HEALTH NETWORK, STUTTERING UNIT, SYDNEY, AUSTRALIA (1) - AUSTRALIAN STUTTERING RESEARCH CENTRE, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (2)
Abstract: Developmental stuttering is a common disorder in childhood, with a recent epidemiological study reporting a cumulative incidence of more then 10% by age 4 years. Stuttering in young children typically consists of dysfluencies at the beginning of words, for example Wh-wh-where is it? However, there are some reports of children and adults repeating parts of syllables at the end of words rather than at the start of them. While these word-final dysfluencies (W-FD) have been observed in children and adults with a history of cerebral insult or neurological disorder, they have also been observed in children without any such history. It is the latter that is the topic of this presentation. We report on 12 young children with W-FDs, ranging in age from 1 year 10 months to 7 years. All were recruited within a 24-month period and all but two of them were brought to our clinics by a parent because they were stuttering. Indeed, on assessment, all the children displayed the typical dysfluencies of stuttering as well as W-FDs. None had a history of cerebral insult or neurological disorder. All but three of the children were from four families. We made audio recordings of these children and are analyzing their W-FDs acoustically. In this presentation we will overview all 12 children and report on two brothers in detail. Acoustic displays of the W-FDs of the children will be presented. In our analyses to date, the following have been found to be typical of W-FDs: repetition(s) of the syllable rime, in contrast to the repetition of syllable onset, or onset and nucleus, in developmental stuttering.; minimal associated struggle or tension; volume decreasing across repetitions; occurring both within and at the end of utterances. It would appear that the prevalence of W-FDs is much lower than that of developmental stuttering. However, the fact that we recruited 12 children in 2 years leads us to agree with a previous suggestion that they are under-reported. Our analyses suggest that this may be because W-FDs are not associated with struggle or tension and because volume tends to diminish across the repetitions. Interestingly, there is no consensus in the extant reports of whether W-FDs should be conceptualized as developmental stuttering. While W-FDs do not fit the World Health Organization definition of stuttering, they are encompassed in the first of the three categories of the Lidcombe Behavioral Data Language of stuttering, namely repeated movements. In this presentation, we will discuss the various explanations of W-FDs offered by previous authors and explore the possibility that W-FDs may be a form of stuttering. In this discussion we will consider current theoretical models of stuttering and draw on what is currently known about the neural processes thought to underpin the disorder. Learning outcomes: the participant will: learn about the prevalence of developmental stuttering; understand the topography of developmental stuttering; understand the topography of final-word dysfluencies; think about how current theory and brain research might explain final-word dysfluencies.
directly with the results of other monitoring of our clients, e.g. neurological, phoniatric or psychological examinations. Stuttering clients are exposed to a constant stress due to the necessity to speak, i.e. to do what they know they are handicapped in. This fact should lead to a blood pressure increase, but our investigations and results have not confirmed that. Private clinic LOGO - centre for diagnostic and therapy of speech disorders: clinical speech diagnostic and therapy; phoniatrics; neurology; physiotherapy; internal medicine; EEG Biofeedback; psychology; psychiatry.Relaxation and cosmetics. Social welfare institution for preschool children with communication disorders. Therapeutical stays. Learning outcomes: participants will be able to: get the information about facility of Private clinic LOGO in Czech republic; get the information about results of laboratory examinations in stutterers and about specific findings in this group; get know the explanation of causes of lower cholesterol levels and lower blood pressure values in stutterers.
FP210
PROFILING SUBJECTS THAT STUTTER: THE RESULTS OF A SURVEY DONATELLA TOMAIUOLI (1) - EMILIA CAPPARELLI (1) FRANCESCA DEL GADO (1) - PAOLA FALCONE (1) EMANUELA LUCCHINI (1) - MARIA GRAZIA SPINETTI (1) C.R.C. BALBUZIE, SAPIENZA UNIVERSITY OF ROME, ROME, ITALY
Abstract: Stuttering is a complex multifactorial disorder, in which a number of heterogeneous elements interact in an unpredictable way. The multifactorial nature of this disorder requires a multidimensional assessment and treatment of the subject which goes beyond simply the manifest aspect-; it is also important for the treatment to reflect elements of differentiation and personalization in response to the patient (among the programs utilized, the MIDA-SP may be viewed as such). The result of an assessment with a multidimensional base may find a further qualification synthesis in that it allows the subject being observed to be connected to the individual characteristics of a specific subjective profile. Profiling stuttering subjects is a useful tool for synthesizing the result of an assessment and in order to provide the subject with a direction in his therapeutic work. It can be carried out on subjects of different ages, on the basis of different types of variables chosen. Each profile therefore can identify a subgroup of subjects that present characteristics which are tendentially homogenous among themselves, and which translate into typical elements of that very subgroup. The profiling proposed operates involves the classification of subjects on the basis of two parameters: the manifest aspects (symptomatological) and the hidden aspects (syndromic) which emerge during the assessment. The results of a study conducted on a sample of 300 stuttering patients aged between 6 and 40 and classified according to the described system of profiling are also provided. The sample was subjected to a multifunctional structural assessment allowing the level of severity of manifest and hidden aspects to be measured so as to permit the profiling of the subject. Some parameters were analyzed, among which the frequency of single profiles per age group and gender type, observing, among other things, a significant difference in the distribution of the profile frequency in the adult subgroups compared to the childrens subgroup. Learning outcomes: acknowledgment and awareness of existing stuttering profiles, in order to provide the subject with a proper direction in his therapeutic work; acknowledgment and awareness of distribution of the different profiles among the population, in order to promote the application of the profiling system proposed; reflect on the considerably different distribution among profiles in adults and children.
FP209
RESULTS OF INTERNAL EXAMINATIONS OF STUTTERERS EVA PRIKRYLOVA (1) - PAVEL FLORIAN (1) - HANA KUBESOVA (1) - ILONA KEJKLICKOVA (1) PRIVATE CLINIC LOGO, BRNO, CZECH REPUBLIC (1)
Abstract: The private clinic LOGO s.r.o. has been dealing with stuttering therapy. In order to set the best (individual) therapy, any client is submitted to a complex medical examination. The internal medical examination contributes to higher efficiency of prescribed procedures and prevents them from being contraindications for some other difficulties. From the practical point of view we monitored the possible occurrence of heart defects in stuttering clients which could complicate hydrotherapy, vegetative dystonies causing collapses, and ion imbalances. Owing to the permanent stress due to dislogia we expected the tendency toward higher blood pressure or disorders of lipid mechanism. The monitored group of clients comprised of 58 men and 4 women at the age from 15 to 25 years clients were examined at the beginning of therapy. The examination consisted of: Detailed anamnesis diseases, accidents, surgeries; Detection whether a client suffers from any allergy; detection whether a client uses pharmaceuticals; blood pressure measuring; heart rate measuring; isometric test handgrip; blood sample taking - Ca, Mg, Na, K ion levels, hepatic tests - AST, ALT, cholesterol; EKG - if a heart defect was suspected; Results of laboratory examination: calcium and magnesium serum levels did not differ from the standard; ion levels did not differ from the standard as well. No deviations from liver and kidneys function were found out; decreased cholesterol level was ascertained - 61 %-; lower values of blood pressure; tendency towards reduced blood pressure reactivity to the handgrip examination was found out. Explanation of causes of lower cholesterol levels and lower blood pressure values: in stuttering clients, higher muscle work should be taken into account when they strive for communication, and the muscle work is constant, continuous throughout the time they are awake. The conclusions of internal examinations correlate
SS41
SHOULD POOR PEOPLE, WHO CANNOT EAT OR DRINK SAFELY, BE TREATED DIFFERENTLY?: DYSPHAGIA SERVICES IN RESOURCE CONSTRAINED CONTEXTS MERSHEN PILLAY (1) - HARSHA KATHARD (2) UNIVERSITY OF STELLENBOSCH, CAPE TOWN, SOUTH AFRICA (1) UNIVERSITY OF CAPE TOWN, CAPE TOWN, SOUTH AFRICA (2)
Abstract: Dysphagia is a life-threatening and debilitating condition affecting millions of people worldwide. This seminar focuses on re-considering what best practice means for especially people living in contexts where resources are constrained. For example, the considered gold standard dysphagia diagnostic test is the modified barium swallow study. This radiological method involves costly diagnostic equipment, requiring specialist trained personnel and is usually a tertiary service offered via well-resourced medical facilities. These, and similar services, are rarely found in resource constrained contexts. What then, in places where high-technology is not readily available, will be considered best practice? While economically developing contexts are at greater risk of resource constraints, this is not an exclusive situation for third world people only. Economically developed contexts such as the USA, England and Australia also have resource constraints that will determine the kinds of services that are meted to its poorer peoples. There is a case for resource-constrained contexts to be identified functionally rather than only geographically. Indeed,
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disabled people in economically developed countries receive inequitable health care services (Wiley, et al, 2013) in surprisingly similar ways to people in economically developing countries. In such contexts, practitioners are troubled by the following: How may we prescribe food thickeners when access to food is insecure? How do patients pay for videofluoroscopic swallow studies without medical aid? Who will safely feed the pensioner who returns to his small home alone on discharge? These are some of the questions that point to the need to position how people with dysphagia are managed in all kinds of resource constrained contexts. Specific case examples will be illuminated from 10 (ten) countries to clarify dysphagia practices relative to resource constraints and include the following cases from: Australia; England; India; Madagascar; Portugal; South Africa; Sri Lanka; Uganda; United Arab Emirates; United States of America. Additionally, as non-citizens, international migrants with dysphagia are reviewed as a special, vulnerable population with unique resource constraints. Several areas for the development of appropriate clinical and theoretical resources will be identified. For example, the role of standardised and/or structured formal clinical evaluations are re-valued along with alternative complimentary technologies such as cervical auscultation, use of non-commercial food thickeners. Significantly, this review promotes the development of a critically reflective science for dysphagia practitioners. Here, the emphasis is on transcending basic technical thinking that currently may hamstring practitioners into believing axioms like high-technology is the best solution to deeper practice, service issues. Note: This seminar is part of a service/research population based project and references a special panel meeting planned for the IALP symposium in 2013. At this panel meeting delegates will contribute short reviews of dysphagia services from Australia, England, India, Madagascar, Portugal, South Africa, Sri Lanka, Uganda, United Arab Emirates and the United States of America. This will be a meeting of dysphagia practitioners who have theorised/worked in resource constrained environments. This group will focus on the development of practice standards relative to exigent realities such as basic health care needs, food, water and sanitation. Learning outcomes: at the end of this seminar, attendees will: be able to identify FIVE features of contexts that are considered resource constrained contexts; identify at least THREE risks and THREE benefits of the current focus on high-technology for low resourced contexts; consider at least ONE alternative practice that achieves the same result for any aspect of dysphagia management across assessment, diagnosis and/or treatment of people with dysphagia.
FP211
ROLE OF MEDICAL TREATMENT AND VOICE THERAPY IN ADULTS LARYNGEOMALICIA AMAL SALAHELDIN DARWISH (1) HEARING AND SPEECH INSTITUTION IMBABA CAIRO, PHYSICAL MEDICINE & REHABILITATION HOSPITAL IN KUWAIT, CAIRO, EGYPT (1)
Abstract: Laryngomalacia, which means weak larynx in Greek, is most commonly seen in infants and children up to 2 years old. When laryngomalacia occurs in adults, specially with sever restricted diet whether postoperative, or with malnourished people may lead to serious complication which may be manifested as simple as dysphonia, and phonathenic manifestation, or serious dysphagia with it complicated chronic chest complication. This also can be the result as complication changes that occur in the epiglottis with aging, but it is often secondary to other problems such as head or neck surgery, malnutrition, radiation treatment for cancer in the head or neck area, and long standing neurological disorders such as strokes. Physicians should consider late-onset LM as a potential cause of dysphonia, dyspnea, and feeding difficulties in toddlers, sleep apnea in children, and exercise intolerance in adults and teenagers. This study will discuss the retrograde study for 20 patients (12 females and 6 males) in PMR Hospital in Kuwait after early diagnosis with fulfillment the investigatory protocol for dysphonic and dysphagia patient, to reach the diagnosis with other laboratory investigation needed for such patient will improve their outcome in the therapy protocol, in form of pharmacotherapy and voice therapy. The outcome of this diagnostic therapeutic protocol give a very good out come to reduce the symptoms & outcome reach to 19 patients complete recovery of symptoms and 1 patients with debilitating neoplastic gastric disorders didnt show any improvement. Learning outcomes: the Participant will be able to have an idea about the: protocol for the diagnosis a case of dysphonia in PMR hospital in Kuwait; protocol for the diagnosis a case of dysphagia in PMR hospital in Kuwait; lab Investigation needed for such patients; protocol for proper Medical & Voice therapy for such cases.
FP212
EFFECT OF HEMODIALYSIS ON VOICE: AN ACOUSTIC AND AERODYNAMIC ANALYSIS EMAN HASSAN (1) - AHLAM EL-ADAWY (2) - DALIA YASSEEN (1) - EFFAT TONY (3) PHONIATRICS UNIT, ASSUIT UNIVERSITY HOSPITAL, ASSUIT, EGYPT (1) - PHONIATRICS UNIT, SOHAG UNIVERSITY HOSPITAL, FACULTY OF MEDICINE, SOHAG, EGYPT (2) NEPHROLOGY UNIT, ASSUIT UNIVERSITY HOSPITAL, ASSUIT, EGYPT (3)
Abstract: Objective: This study was conducted with the purpose of analyzing the effects of hemodialysis on voice characteristics of patients with chronic renal failure. Design: A total of 66 patients were participated in the study, including 26 males and 40 females ranging in age from 19 to 68 years. Patients underwent evaluation of their voice directly before and after hemodialysis using computerized speech lab (CSL) (4300, Kay Elemetrics Corp.) and Aerophone II Model 6800 Kay Elemetrics Corp. The vocal acoustic parameters studied include average pitch, jitter, shimmer and noise-to-harmonic ratio. The aerodynamic parameters include vital capacity, maximum phonation time, phonation quotient, mean flow rate, sub glottic pressure and glottal efficiency. The data were analyzed using the paired t-test for the total sample, the male and female subgroups and also for the patient underwent ultrafiltration with hemodialysis. Results: In the total sample and in the female subgroup, there is a significant difference in phonation quotient after hemodialysis. The male subgroup showed no significant differences in all acoustic and aerodynamic parameters after hemodialysis. The group with positive ultrafiltration showed significant differences in both vital capacity and phonation quotient after hemodialysis. Conclusion: There was no effect of hemodialysis on acoustic characteristics of voice; however, there was a decrease in vital capacity and phonation quotient after hemodialysis especially with ultrafiltration. Recommendation: Further studies that include auditory perceptual assessment of voice and stroboscopic examination of the vocal folds may help in detecting subtle changes that may occur after hemodialysis. Key words: Hemodialysis, Acoustic and aerodynamic parameters of voice. Learning outcomes: the Participant will be able to: know the controversies on the effect of hemodialysis on acoustic and aerodynamic characteristics of voice in patients with chronic renal failure. There was a decrease in vital capacity and phonation quotient which may result from the complications of hemodialysis not from the hemodialysis itself or due to electrolytes disturbance especially with +ve ultrafiltration; understand the need Further studies that include auditory perceptual assessment of voice and stroboscopic examination of the vocal folds may help in detecting subtle changes that may occur after hemodialysis.
SS42
QUALITATIVE BARRIERS TO SPECIALIZED THERAPIES FOR HISPANIC PEDIATRIC POPULATIONS WITH SPECIAL HEALTH CARE NEEDS KATANDRIA LOVE JOHNSON (1) UNT HEALTH SCIENCE CENTER AT FORT WORTH, CHILDRENS MEDICAL CENTER OF DALLAS; COOK CHILDRENS OF FORT WORTH, FORT WORTH, UNITED STATES (1)
Abstract: Healthcare access and utilization disparities related to race, ethnicity and socioeconomic status persist in the U.S. This quantitative study examined the predisposing, enabling and need factors that influence healthcare utilization among Hispanic children with special healthcare needs (CSHCN) with a need for specialized therapeutic services (speech, occupational, or physical therapy). In addition, an adapted framework of the Andersen socio-behavioral model (2006) was used to explain what qualitative factors contributed to the lack of healthcare service utilization. A statistical analysis was conducted utilizing the 2005-2006 National Survey of Children with Special Healthcare Needs. Bivariate and multiple logistic regression models were performed to determine the level of association between these factors and predicted use of specialized therapies among Hispanic CSHCN. Binary logistic analysis revealed that younger Hispanic CSHCN were 44% less likely to report needing specialized therapeutic services (OR 0.56, 95% CI 0.48, 0.67). In addition, Hispanic CSHCN were 43% and 73% less likely to need specialized therapeutic services who had Medicaid (OR 0.57 95% CI 0.46, 0.70) and whose doctors communicated with other providers (OR 0.27, 95% CI 0.23, 0.31). Age (OR 0.35, 95% CI 0.22, 0.57), having Medicaid (OR 0.53, 95% CI 0.30, 0.94) and the enabling factor, communication with other healthcare providers, (OR 0.28, 95% CI 0.18, 0.43) remained strong predictors of specialized therapeutic service need among this population in the multiple logistic analysis. Evidencebased healthcare service delivery programs are needed to identify those predisposing and enabling factors that affect healthcare utilization for Hispanic CSHCN. In addition, those quality of life outcomes that can be improved through the early identification and treatment of Hispanic CSHCN may lead to decreased frequency of specialized therapeutic service utilization. Learning outcomes: attendees will explain the statistical framework for Hispanic children with special healthcare needs (CSHCN) in the U.S. They will describe how the Andersen model relates to qualitative facilitators to healthcare services for Hispanic CSHCN. Finally, attendees will evaluate several strategies in which healthcare providers can educate their multicultural/lingual families on how to navigate through the provider ancillary consult process.
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FP213
THE POST-TRAUMATIC SUBLUXATION ARYTENOID: CASE REPORT MICHELE BARBARA (1) - TERESA MAINO (2) - FRANCESCO CARITI (1) VINCENZO CALABRESE (1) OTORINOLARINGOIATRIA, OSPEDALE DIMICCOLI, BARLETTA, ITALY (1) - OTORINOLARINGOIATRIA, A.O. - UNIV. POLICLINICO, BARI, ITALY (2)
Abstract: The sub-luxation arytenoid is a laryngeal dysfunction post-traumatic, characterized by a shift of the arytenoid cartilage and from a disjunction partial facet joint from its natural position defined crico-arytenoid articulation. This traumatic event causes a chordal immobility resulting in aphonia.The articulation cricoaritenoidea is a diartrosi to type condyloid; the movement of the arytenoids occurs simultaneously in three directions: anterior-medial direction that allows the adduction of ccvv, postero-lateral direction that allows abduction of ccvv and a third rotation movement. But the most important movement is bascule. Such movement with a lever action causes not only the displacement antero-medial aspect of the arytenoid body, but also the vertical displacement of the vocal process that arises in a lower position with respect to the against side. All this in the course of the pneumo-phonic, reason why the rehabilitation logopedic is proposed for the remediation of such trauma, which through the use of appropriate vocal exercises is able to obtain, in patients, the reactivation of the joint motor crico-arytenoid with restoration of motility and function of the voice, without resorting to invasive methods. It is essential to make an early diagnosis of subluxation crico-arytenoid based on the mechanism of injury, clinical history, symptoms, and physical examination. The symptoms reported are in the immediate post-trauma pain, aphonia and sometimes the presence of edema and stridor. The examination is divided into two phases: inspection that allows you to appreciate the morphology and mobility laryngeal palpation and external checks the symmetry and integrity of the laryngeal structures. Only after completing this first phase of approach you can change to an instrumental analysis such as fibrolaringostroboscopia, EMG and CT. The EMG if it detects action potentials of mm. tiroaritenoidei shows a normal activity and confirm the diagnosis of subluxation. The TC, finally, will provide crucial because the image of the dislocation at the joint. Learning outcomes: the participant will be able to: 1. know the best vocality is based on all rehabilitation exercises for the treatment of unilateral immobility 2. the use of a specific maneuver <mobilizzazione vibratoria> arytenoid, in which it is essential to the visual feed-back by the patient, in the initial phase of treatment 3.know The maneuver so make determines the elevation of the larynx, the sphincter constriction ari-epiglottal and, above all, the elevation, the hyper-adduction and the vibration of the cusps arytenoid.
the comparison of the data emerged from the survey with the literature so far produced, we can identify a list of features that are essential for a good practice of group therapy, especially referred to the treatment of aphasia. As a matter of fact, group treatment is finally recognized as a valid method for rehabilitation purposes. The frequency of the session is typically weekly and one-hour session of length is generally the normal procedure. A group includes a maximum of 10 patients, with similar pathologies/clinical diagnosis and type of cognitive language framework, but of different age, gender and education. In the groups with patients suffering from aphasic problems the most followed criterion of inclusion seems to be the seriousness of the syndrome. The session is usually run by a Speech and Language Therapist supported by other Health Professionals. Conclusion: This work can be considered a starting point for more accurate studies to come on the rehabilitative methodologies, in order to increase the knowledge about shared and useful criteria for a good practice in group therapy. Learning outcomes: the Participant will be able to: 1. Understand the importance of Group Treatment as a useful opportunity to treat patients 2. Know some criteria used to made up and run Group Treatment, especially Aphasia Group Treatment, on the international outline 3. Know the real utilization of Group Treatment in Italy and the criteria according to which a group is made up and run. 4. Know the shared principles both in the international literature and in the criteria followed in the practice of group therapy in Italy considered useful for a good practice of this kind of treatment.
FP215
A COMPARISON OF MELODIC INTONATION THERAPY AND RESPONSE ELABORATION TRAINING IN TREATING PERSONS WITH NON-FLUENT APHASIA CHIN-HSING TSENG (1) - CHER-WEI HSU (2) DEPARTMENT OF AUDIOLOGY AND SPEECH THERAPY, NATIONAL KAOHSIUNG NORMAL UNIVERSITY, KAOHSIUNG, TAIWAN, PROVINCE OF CHINA (1) - DEPARTMENT OF SPECIAL EDUCATION, NATIONAL KAOHSIUNG NORMAL UNIVERSITY, KAOHSIUNG, TAIWAN, PROVINCE OF CHINA (2)
Abstract: The purpose of this study was to directly compare the treatment effectiveness of Melodic Intonation Therapy and Response Elaboration Training for persons with non-fluent aphasia by means of a group comparison design. Sixteen persons with non-fluent aphasia participated in a 20week MIT or RET program. Neither treatment group demonstrated substantial generalization effects as shown by the overall scores on two language batteries. The training effect was found to occur for the MIT group with the verbal-agility subtest of the BDAE (Chinese version) and for the RET group with the sentence-repetition subtest of the Concise Chinese Aphasia Test. These results seemed to indicate that either treatment approach improves task-specific abilities. Learning outcomes: the participants shall: become aware of the need of research on the comparative treatment efficacy between different approaches; appreciate the procedures involved in the group comparison design for treatment efficacy studies; find out about the limited generalization effects arising from the treatment programs studied.
FP214
APHASIA GROUP TREATMENT: PRESENT OUTLOOK AND FUTURE PROSPECTS CHIARA FINESSO (1) - SERENA DE PELLEGRIN (2) - CINZIA FINCO (3) SPEECH THERAPIST, UNIVERSITY OF PADUA, SCHIO (VICENZA), ITALY (1) - SPEECH THERAPIST, AZIENDA OSPEDALIERA UNIVERSIT DI PADOVA - CLINICA NEUROLOGICA PADOVA, ITALY (2) SPEECH THERAPIST, AZIENDA ULSS17, ESTE - MONTAGNANA (PADOVA), ITALY (3)
Abstract: Introduction: According to the literature and to the Linee guida sulla gestione logopedica del paziente afasico adulto the Group Treatment can be a useful opportunity to treat people suffering from aphasia. The benefits derived from this treatment concern both the cognitive linguistic aspect and quality of life, in fact group treatment can influence positively not only the patients lives, but also it can improve the standard of their familys quality of life. Now we will try to find out the shared principles both in the international literature and in the criteria followed in the practice of group therapy in Italy. Materials and methods: In the first part of the study we will examine the international literature about group treatment: special attention will be payed to the Group Treatment for Aphasic Patients. In detail, we are investigating the reference criteria for inclusion in the therapy and exclusion from it, the structure of the group itself, the organization of the sessions, the group management strategies, the aims and the effectiveness of the treatment. Then we will focus on Italy, to investigate the real utilization of group therapy and the criteria according to which a group is made up and run. We have particularly taken into consideration the group structure and the structure of the sessions, the criteria for the inclusion in and the exclusion from the therapy and the purposes for which it is used. To this purpose a questionnaire has been drawn up and sent by e-mail to a number of public and private Speech and Language Therapy Services. Results: Out of 52 questionnaires sent, 39 questionnaires were returned and were properly filled in. The information obtained confirm the utilization of the group treatment, but also reveals that its practice is not widespread and often not based on shared characteristics as well. However, there is apparently an increasing interest in this kind of treatment. From
FP216
FILM LANGUAGE AND APHASIA: IN SEARCH OF CRITERIA OF A SIMPLIFIED FILM SYNOPSIS THROUGH THE SILENT FILMS OF CHARLIE CHAPLIN ANGELICA TROVARELLI (1) - GABRIELLA BARILARI (2) UNIVERSITY OF TURIN AT TURINS HOSPITAL AOU CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, SAN GIOVANNI BATTISTA DI TORINO, TURIN, ITALY (1) - CLINIC MADONNA DEI BOSCHI , BUTTIGLIERA ALTA TURIN, ITALY (2)
Abstract: This project began in 2009, as part of a research on aphasia conducted with the University of Turin and the Association Informazione Facile non-profit organization, funded by the Foundazione Carlo Molo non-profit organization. This project was taken up in 2012 and is currently being conducted both at the Presidio Ausiliatrice - Fondazione Don Gnocchi - Turin and the Laboratorio Sperimentale Afasia in Turin. In this project groups of adult aphasics have been involved, following a selection based on the severity of their aphasic disorder, according to previous diagnosis, at the Presidio Ausiliatrice - Fondazione Don Gnocchi - Turin and the Laboratorio Sperimentale Afasia in Turin. The subjects benefit from the vision of the film taken from the silent films of Charlie Chaplin. The aim of this work is to identify the criteria for syntactic film (assembly) that will facilitate comprehension of narrative conveyed with cinematic technique. The films choices have been, to this end, revisited and reassembled according to these criteria facilitations: identifying hubs narrative; inclusion in those paragraphs, titles clarified them as episodes (chapters) of a narrative whole; reduction and cutting of secondary episodes; the subjects, after watching each film; complete a questionnaire to verify their understanding with multiple choice questions. This questionnaire includes: requests for verification of understanding of each episode; test questions on a comprehensive understanding of the movie presented. The research is still ongoing and the end of data
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collection is scheduled for the end of March. At the moment it has already proved very popular and obtained a significant participation by all parties. The results will be usable by May, in the literature and on the occasion of the IALP 2013 it will be publicly disclosed, for the first time. Learning outcomes: the participant will be able to: understand the rationale of the research (simplified syntax film); understand the consequences for the patient in daily practice and in the recognition of oneself as a good communicator.
FP217
RELATION BETWEEN STUTTERING AND ANXIETY DISORDERS AMONGST ITALIAN CILDREN WHO STUTTER: A PRELIMINARY STUDY LUISELLA COCCO (1) - SIMONA BERNARDINI (2) - CLAUDIO ZMARICH (3) - MARIO DI PIETRO (4) - GIULIA NATARELLI (5) ASL TO 4 CIRI, CHIVASSO, IVREA, SERVIZIO DI R.R.F., SETTIMO TORINESE, ITALY (1) - CENTRO MEDICO DI FONIATRIA, PADOVA, ITALY (2) - ISTITUTO DI SCIENZE E TECNOLOGIE DELLA COGNIZIONE DEL C.N.R, SEDE DI PADOVA, PADOVA, ITALY (3) - ULLS 17, SERVIZIO ET EVOLUTIVA, MONSELICE, PADOVA, ITALY (4) - UNIVERSIT DI PADOVA, PADOVA, ITALY (5)
Abstract: Introduction and aims of the study: The relationship between anxiety and stuttering has been widely studied. Previous researches run with Children Who Stutter (CWS) and Adult Who Stutter (AWS), have shown increase of negative emotional reactions, as anxiety, to particular speech situations and in AWS, also, comorbidities with Social Anxiety Disorder. The purpose of this preliminary study is twofold: investigate about comorbidities between stuttering, the general level of anxiety and state anxiety (in speech situations), in CWS; to determine if the amount of negative emotional reaction to particular speech situations and the amount of anxiety reported by CWS are significantly higher compared to CWNS as a group. Past research has indicated that CWS is equal to CWNS as regards to trait anxiety but differs because of the significant increase of state anxiety in speech situations due to the fear of receiving a negative evaluation. Methods: In order to evaluate the general level of anxiety and its component the Italian translation of the Revised Childrens Manifest Anxiety Scale, Second Edition (49 items) (RCMAS-2), and the Speech Situation ChecklistEmotion Reaction (SSC-ER) (55 items) were administered to 33 CWS (9 females and 24 males) and 33 CWNS (7 females and 26 males) aged from 10 to 14. They were successively recoded in two groups of ages: the younger, from 10 to 11 years, and the older, from 12 to 14 years. Both the CWS and CWNS included in this study were recruited from a National Health Service in Padua or in Turin. The determination that the participants in this investigation stuttered was made by a fluency specialist using the Stuttering Severity Instrument-3.Results: A series of univariate ANOVAs, with Status (stuttering\ non stuttering) and Age (younger\older) as independent variables and SSC-ER scores and total and subscales RCMAS-2 scores as dependent variables, were performed. CWS were significantly higher than CWNS as to SSC-ER scores, and also the interaction between Status and Age resulted significant, with CWS increasing and CWNS decreasing the SSC-ER scores along with increase in the age. CWS were also significantly higher than CWNS as to the subscale DEF scores of RCMAS-2. A series of separate correlations between SSC-ER scores and every subscale of RCMAS-2 were performed for CWS and CWNS. Interestingly, the CWS SSC-ER scores did not correlate significantly with any subscales of RCMAS-2, whereas the same correlations were significant and positive for CWNS. Furthermore, the CWNS displaying high levels of SSC-ER were more likely to score high levels of anxiety on the RCMAS-2, whereas the CWS scoring high levels of SCC-ER did not display such a correlation. In conclusion, present findings suggest that CWS present higher levels of emotional reaction in communication experiences than CWNS, these levels increase as they grow up, but they seem not to have a specific comorbidities with anxiety disorders. Instead, anxiety seems to be a contingent phenomenon restricted to situations of speech. Further, the fact that CWS manifested attitudes towards defensive reactions perhaps could be ascribed to a need of social acceptation. Learning outcomes: the participant will be able to understand and explain: 1. the relationship between anxiety and stuttering in the Italian CWS. 2. the three components of psychological construct of Anxiety . 3. the comorbidities between stuttering, state anxiety (in speech situations), trait anxiety and social anxiety.
between children who stutter(CWS) and children who not stutter(CWNS) in attentional shifting function with wisconcin card sorting test and b)examine of relationship between Attentional Shifting function and chronological age in CWS and CWNS. Participants consisted of 30 children (21 boys and 9 girls) diagnosed with developmental stuttering and 30 typically developing nonstuttering children, matched by age and gender to the children who stutter. The mean age was 9;5 years (SD = 1;61 years; range = 7;0213;00) for the CWS and 9;8 years (SD = 1;69 years; range = 7;0113;00) for the CWNS. In this study, The Wisconsin Card Sorting Test (WCST),was used that assess the shifting function in CWS and CWNS.These variables were examined in WCSR:total numbers of1)categories completed(CC), 2)perseverative responses(PR), 3)errors(TE), 4)non-perseverative errors(NPE), 5)tries(TT), 6)trying to complete the first pattern, 7)failure to maintain set and the time of performance test. Between group analysis showed significant differences for all of the indexes in wisconcin test, Except failure to maintain set and non perseverative errors.The number of categories completed in children who stutter was significantly less than that control group (p<0/05),But perseverative responses,total errors,total tries, the time of performance test and trying to complete the first pattern were higher in stuttering group than in the nonstuttering group. There were significant correlations between these variabales(CWNS:the time of performance test, total tries,trying to complete the first pattern & CWS: total errors,nonpersevaritive errors and the time of performance test ) and chronological .There were significant negative correlations between chronological age and the wisconcin test variables, for both CWS and CWNS, reveals that less total errors,nonpersevaritive errors, the time of performance test,total tries,trying to complete the first pattern occurred with increasing age. The purpose of this study was to test experimentally previous findings of differences in attentional shifting between CWS and CWNS,using a Wisconcin cart sorting test. Based on these previous findings, we hypothesized that CWS, as a group, would be lower in attentional shifting compared to CWNS. Our results, based on wisconcin card sorting test, provide further support for the hypothesis that CWS and CWNS differ in attentional shifting. CWS, as a group, were lower in attentional shifting, which suggests a lowered ability to transfer attentional focus from one activity to another. The findings were linked to previous attentional shiftinf-related studies and to emerging theoretical frameworks of stuttering development. Therefore these findings were taken to suggest a possible role for attentional processes in developmental stuttering. Learning outcomes: the participant will be able to: (1) describe the concept of Attentional Shifting, and its functional significance; (2) describe the findings on Attentional Shifting in CWS; (3) identify which WCST test variables differentiated between CWS and CWNS; and (4) summarize the theoretical implications for the development of stuttering and the possible clinical implications.
FP219
PREVALENCE AND MODE OF INHERITANCE OF STUTTERING IN PRIMARY SCHOOLS IN CAIRO MAHMOUD YOUSSEF ABOU EL-ELLA (1) MARWA MAHMOUD SALEH (1) - MOHAMED ABD EL ADL SAWY (1) IHAB CHEHAD HABIL (1) - LAMIAA MOHAMED EL ASSAL (1) UNIT OF PHONIATRICS, FACULTY OF MEDICINE, AIN SHAMS UNIVERSITY, CAIRO, EGYPT (1)
Abstract: Background: Stuttering appears in all cultures and has been a problem for human kind for at least 40 centuries. It has been controversial topic for decades concerning its definitions, cause, different methods of assessment and treatment. Aims and method: In the light of absence of sufficient information concerning the prevalence of stuttering in the Egyptian population, this epidemiologic study was done in order to investigate stuttering prevalence among the primary students and to establish informative base line data about the size and distribution of stuttering from a population- based survey in Cairo using questionnaires in order to provide a proper stratum for further research. 8765 student, aged 7-12 years were screened for stuttering by clinical interview. The positive cases had questionnaire to help us to know any similar condition in the family and help us to study Pedigrees to suggest the mode of inheritance. Results: From our research, we found the prevalence of stuttering in primary schools in Cairo is 1%.The male is twice more susceptible to stuttering as male: female ratio is 2.6:1. From the pedigree study it was found that the mode of inheritance for stuttering is most probably an autosomal dominant disorder. Conclusions: Stuttering is a common speech disorder among primary school children with prevalence rate1%.A child has a greater risk for stuttering if any members of the family stutter. Inheriting a predisposition to stutter may explain why stuttering runs in families.
FP218
ATTENTIONAL SHIFTING FUNCTION OF SCHOOL-AGED CHILDREN WHO DO AND DO NOT STUTTER KOWSAR ESFANDEH (1) - MOHAMMAD ALI NAZARI (2) TEHARAN UNIVERSITY OF MEDICAL SCIENCES, TEHARAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN (1) PAARAND, TBRIZ UNIVERSITY, TABRIZ, IRAN (2)
Abstract: Attention plays an important role in speech and language processing.Studies are limited about relation between attention and language development.The purpose of this study was to examine the a)differences
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SWALLOWING REHABILITATION AFTER HEAD AND NECK CANCER SURGERIES
TAMER ABOU-ELSAAD (1) UNIT OF PHONIATRICS, ORL DEPARTMENT, FACULTY OF MEDICINE, MANSOURA UNIVERSITY, MANSOURA, EGYPT (1) Abstract: The breakdown of the physiological and/or bio-mechanical neuromotor events of the swallowing phases lead to dysphagia. The Disconfigurations after surgical and radio-therapeutic management of head
and neck cancer can result in:(i) Anatomic defects and discontinuity of food passages;(ii) Imperfect closure of the laryngeal sphincters; (iii) Scar and fibrosis that could lead to fixation of the larynx and surrounding structures; (iv) Secretions whether excessively accumulated or excessive dryness. The location, size and extent of the tumor as well as the surgical reconstruction procedure can significantly affect the functional outcome of swallowing. The aim of this presentation is to highlight the effect of head and neck cancer surgeries on the swallowing function and to demonstrate the role of the phoniatrician/speech language therapist/logopedics for swallowing assessment and rehabilitation of these cases. The presentation will include How to assess a case of oro-pharyngeal dysphagia following head and neck cancer surgeries. How to conduct a modified barium study (MBS) to assess oro-pharyngeal swallowing. Modalities of swallowing rehabilitation after head and neck cancer surgeries, namely: (A) Behavior Readjustment Therapy (BRAT); (B) Intra-oral prosthetics; (C) Surgical intervention ; and (D) Alternative routes of alimentation. Video demonstration of cases with head and neck cancer surgeries with highlighting the breakdown in swallowing function in these cases and the swallowing strategies applied for them. Learning outcomes: the participant will be able to: identify the effects of head and neck cancer surgeries on the physiological breakdown of oro-pharyngeal swallowing; recognize the evaluation protocol of swallowing disorders in adults with emphasis on the use of videofluroscopic assessment protocol and analysis; make decision on appropriate management techniques to use for improvement of the swallowing function in these patients with emphasis on behavior re-adjustment therapy (BRAT).
SS44
THE VELO-PHARINGEAL PUMP: A NEW METHOD FOR REHABILITATION OF LARYNGECTOMEES NICO PAOLO PAOLILLO (1) - ROBERTO LEONI (2) - EMMA FERRI (1) AZIENDA OSPEDALIERA DI LECCO, OSPEDALE SAN LEOPOLDO MANDIC, MERATE - LECCO, ITALY (1) - OSPEDALE DI TREVIGLIO, TREVIGLIO, ITALY (2)
Abstract: the recovery of voice and speech after total laryngectomy is one of the most important goals in rehabilitation of patients subjected to this mutilation. There are many lost or modified organic functions: sphincteric function, smell, taste, breathing, voice and speech. There are various methods to obtain a new voice (esophageal, tracheo-esophageal prothesis, electrolarinx) and perhaps the most physiological and complete is the esophageal one. Rehabilitators, supported by phoniatricians and speech-terapists, have an essential role in rehabilitation and should follow specific protocols designed to facilitate learning and improvement of a good technique. The features of a good esophageal voice are: no noise during air injection, no noise from the tracheostoma, no long time intervals between air injection and voice production, appropriate loudness and phonation time, fluent and uninterrupted speech, pleasant and steady tone of voice, good pronunciation, appropriate rhythm, expression, modulation, lack of effort. The velo-pharyngeal pump is a cyclic exercise that enables the automation of the cyclical process consisting of injection of air through the upper esophageal sphincter (UES) and the subsequent and immediate expulsion of the same air again through the upper esophageal sphincter. All anatomic and physiological features will be explained. The aim of this workshop is to describe all the phases of this new didactic method that tends to get all the cited requirements to obtain a satisfactory esophageal voice through a structured rehabilitation program. We will show videos, endoscopies, radiological examinations, electro-acoustic analyses to confirm the validity of this new approach to the rehabilitation for laryngectomees. Well explain the anatomical an physiological bases and the different steps of this rehabilitation process. Learning outcomes: learn the anatomical and physiological bases and the endoscopic, radiological, electro-acoustic features peculiar of this new rehabilitation method for laryngectomees; learn how to perform and to teach the velo-pharyngeal pump; learn all the practical rehabilitation steps of this didactic method; understand the diversity and the innovation of this method, compared to the other.
on gender, socio-economic status, and ethnicity. Home videos of each child between the ages of six and 12 months were collected and analyzed in terms of babbling rate and type of gesture use. Videos were viewed and matched for context, so that the context was the same for all comparisons. Each vocalization made by the child was transcribed and coded as either a non-canonical vocalization or canonical babbling. Gestures were analyzed in terms of gesture type (deictic, conventional, ritualized requests) and frequency of use. The conversational context was also noted for each behavior, so that gestures and vocalizations were coded as being made spontaneously, in response, or in imitation. In order to analyze possible differences and changes in behaviors at different ages, data were separated into three intervals: 6-7 months, 8-9 months, and 10-12 months. Ten percent of all videos were coded by a second reviewer blind to the infants diagnosis and interrater reliability was 90% for vocalizations and 92% for gestures.An independent samples t-test revealed that at 10 12 months of age the SLI group had a significantly lower total rate of gesture use than the TD group (t= 2.59, p <.05, Mean (SLI) = 1.79, Mean (TD) = 15.77). Although no statistically significant difference was noted in the two groups babbling rate, two very distinct patterns emerged. At the 8 9 month age range the TD infants had a mean rate of canonical babbling more than six times the rate of the SLI infants (SLI: 6.25, TD: 40.25). The majority of the SLI groups vocalizations at all three age ranges were non-canonical vocalizations, and their rate of canonical babbling barely increased from the period of 6-7 to 10-12 months. At the 10-12 month range only 20% of the SLI groups total vocalizations were canonical babbles. The rate of canonical babbling in the TD group steadily increased through the three age ranges so that at 10-12 months more than half of their vocalizations were canonical babbles. These results provide some of the first evidence of early markers of SLI in infancy and have significant clinical implications with respect to assessment and treatment of young children. Learning outcomes: the participant will demonstrate knowledge of prelinguistic behaviors and their established links to normal language development; the participant will demonstrate an understanding of the relationship between prelinguistic behaviors and language development in a child with Specific Language Impairment; the participant will demonstrate knowledge of the implications of early diagnosis of Specific Language Impairment on long-term language outcomes.
FP221
CONVERSATIONAL REPAIR STRATEGIES IN 4 YEAR OLD CHILDREN ZAHRA GHAYOUMI (1) - LEILA GHASISIN (1) - FAEZE FARZADI (2) DEPARTMENT OF SPEECH AND LANGUAGE, UNIVERSITY OF SOCIAL WELFARE AND REHABILITATION SCIENCES, TEHRAN, IRAN (1) - SPEECH THERAPY, IMAM KHOMEINI HOSPITAL, TEHRAN, IRAN (2)
Abstract: The ability of conversational repair is a subset of pragmatic language which is used for clarification of messages in communication failures. This skill makes speakers able to monitor and repair of their conversations and thus, helps listeners to obtain a better understanding of unclear messages. If listener does not understand speakers intention, and speaker cannot find a way of repairing the conversation to clear his/her massage, communication will fail. Conversational repair consists of different strategies including repetition(repeating all or parts of the utterance without adding or changing the structure of it), revision(maintaining meaning of primary utterance despite the significant modification of the structure of utterance), addition(adding some information to primary utterance), cue-repair(providing background information or definition and description of the primary utterance) and inappropriate response(providing inappropriate response or failure to respond). This study aims to examine and identify the skill of conversational repair in 4 year old children, to determine different used conversational repair strategies and compare them among girls and boys. This study is a descriptive-analytic research. Fifty Persian speaking 4 year old normal children (25 girls and 25 boys) were selected randomly from kindergartens in the city of Ahwaz (Iran). The tasks of this study were two serial pictures in which examiner creates eliciting situation of one of conversational repair methods during retelling of them. Percentage of the usage of different kinds of conversational repair in each group has been calculated and then, the results have been analyzed using independent T-statistical test. Based on our study, the applied conversational repair strategies in order of most frequent to least frequent use in 4 year old children were repetition, addition, cue-repair, inappropriate response and revision in girls and, repetition, addition, cue-repair, revision and inappropriate response in boys. Results analysis shows that there is a significant difference in average percentage of using repetition and addition between two gender groups of the study. Persons with language developmental delay or difficulty should have appropriate tools for dealing with failures in communication. So, its necessary for speech and language therapists to take into account the conversational repair strategies in clinical settings. Information about different types of conversational repair strategies and percentage of their usage in each gender seem to be useful and necessary. As repetition and addition were the most used strategies both by boys and girls, they should be considered more in clinical settings when therapists work with children.In this study, although both girls and boys use repetition and addition strategies the most, boys use the repetition strategy significantly more than girls. Repetition
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FP220
DIFFERENCES IN GESTURE USE AND CANONICAL BABBLING IN INFANTS LATER DIAGNOSED WITH SPECIFIC LANGUAGE IMPAIRMENT NICOLE MAGALDI (1) WILLIAM PATERSON UNIVERSITY, WAYNE, NJ, UNITED STATES (1)
Abstract: Previous findings in the area of babbling and gesture development suggest that infant babbling and gesture use may be affected by language impairments to come (Stoel- Gammon, 1989; Thal, Tobias, and Morrison, 1991), and therefore may act as early markers of Specific Language Impairment (SLI). To date there have been few studies that have directly examined the prelinguistic behaviors of infants later diagnosed with SLI. This study compared the home videos of ten infants, five who were later diagnosed with a SLI and five typically developing children (TD), to determine whether children with SLI demonstrate differences in their gesture use and babbling behaviors during infancy. Subjects were matched based
strategy includes repeating all or parts of utterance without addition of any new information or modification of the original utterance. So, this may show the lower language skills of boys compared to girls at this age. On the other hand, the cause of higher usage of addition by girls compared to boys could represent their higher skills of the language which makes them able to use synonym vocabulary and add some information to the primary utterance to clarify their messages. Learning outcomes: finding the average percentage of using conversational repair strategies in 4 year old children in different genders; finding the difference between the kind of used repair strategies in different genders; finding the order of repair strategies frequency used by this group of children
SS45
PHARYNGOESOPHAGEAL SEGMENT CONFIGURATION RELATED TO ESOPHAGEAL AND TRACHEOESOPHAGEAL SPEECH AND VOICE QUALITY MARINA LANG FOUQUET (1) - MARA BEHLAU (2) ANTNIO JOS GONALVES (1) FACULDADE DE CINCIAS MDICAS DA SANTA CASA DE SO PAULO, HOSPITAL IRMANDADE DA SANTA CASA DE MISERICRDIA DE SO PAULO, SO PAULO, BRAZIL (1) CENTRO DE ESTUDOS DA VOZ - CEV, UNIVERSIDADE FEDERAL DE SO PAULO - UNIFESP, SO PAULO, BRAZIL (2)
Abstract: In order to resume their life quality, it is very important for totally laryngectomized patients to develop a satisfactory oral communication. There is no doubt that tracheoesophageal (TE) voice is the best option, with better speech fluency provided by pulmonary air; but in developing countries, the esophageal voice is still a common form of oral rehabilitation after total laryngectomy. The pharyngoesophageal segment (PES) is the sound source of esophageal and TE voices. A common reason for failures in the acquisition of both forms of communication is the presence of hypertonic or spasmodic pharyngeal constrictor muscles, but it is still unclear, in patients that develop a satisfactory communication, why some are very good while others are only moderate speakers. The explanation for this could be the differences in pharyngoesophageal segment (PES) configuration, which can be optimally studied by videofluoroscopy (VF). We studied the relation between voice and speech quality and PES configuration in two consecutive researches, the first with esophageal voice and the second with traqueoesophageal voice. The purpose of this presentation is to compare the findings with both rehabilitation forms. Esophageal and tracheoesophageal speech and voice production of 60 laryngectomized patients, 30 in each group, was evaluated. The esophageal speakers were divided into three categories based on a well-known fluency scale for esophageal voice: fluent (9), moderately fluent (10) and non-fluent (11). TE voice and speech was evaluated by auditory perceptual analyses of voice and temporal speech aspects. As TE voice is characterized by longer emissions, it was possible to make a visual inspection of a narrow-band spectrogram, and acoustic signal typing was defined as I, II, III or IV. General judgment of TE speech fluency was also evaluated as fluent speech (21), moderately fluent (7) or not fluent (2). The evaluation of VF recording consisted of visual perceptual parameters and quantitative measures of PES, during phonation and swallowing, in lateral view. Quantitative measures common to both groups were length of the PES and anteroposterior distance of PES. One perceptual parameter that was possible to evaluate only in TE group was the degree of contact between the prominence of PES and its anterior wall, defined as absent/mild, moderate and intense. The results show that esophageal fluent speakers had shorter PE segments (1-17mm) compared to moderately fluent speakers (17.1-29.9mm). Perceptually, fluent esophageal speakers presented with a predominantly rough vocal quality, while moderately fluent speakers had tense quality. On the other hand, the best TE speakers had also shorter PE segments, in addition to longer anteroposterior distance, moderate contact between the prominence of PES and its anterior wall, rough voice and more harmonic acoustic signal typing (Type I-II). Patients with intense contact of the prominence had a hyperfunctional voice quality and the worst articulation. Patients with absent/mild contact of the prominence had longer PE segments and shorter anteroposterior distance, the voice quality was very rough with low pitch and the acoustic signal typing was characterized by absence of harmonics (type IV). Videofluoroscopic findings highly correlated with the quality of esophageal and tracheoesophageal speech. Learning outcomes: learn which objective measurements can be made to evaluate the pharyngoesophageal segment (PES) and esophagus function during esophageal and traqueoesophageal (TE) voice emissions; learn which criteria may possibly be used for perceptual and objective evaluation of esophageal and TE voice and speech; understand the relations between perceptual and objective measurement from de PES, quality of esophageal and TE voices and speech fluency; understand how to use the findings from these researches in the clinical practice.
FP222
EXPLORING EVIDENCE OF DEFICIT AND THEORIES OF THERAPY FOR CHILDREN WITH SPECIFIC RECEPTIVE LANGUAGE IMPAIRMENT MORGAN LYDIA (1) - SUE ROULSTONE (1) THE BRISTOL SPEECH AND LANGUAGE THERAPY RESEARCH UNIT, UNIVERSITY OF THE WEST OF ENGLAND, BRISTOL, UNITED KINGDOM (1)
Abstract: Children with specific receptive language impairments (SRLI) have been found to be vulnerable to negative outcomes later in life, in terms of mental health, behaviour and literacy. Currently there is a lack of evidence that demonstrates the efficacy of interventions for this population. The Medical Research Council (MRC) recommends that development of interventions should focus on identifying the evidence base and developing theory. This study set out to identify the deficits from the literature, and to develop theory of intervention, using intervention studies and data from focus group discussions with speech and language therapists (SLTs). A systematic literature review was conducted of the cognitive and linguistic deficits in SRLI. A total of 4,373 citations were identified through a wide search strategy of 11 databases. 37 studies examining a cognitive or linguistic deficit in children with SRLI emerged. The majority of the studies included in the review examined factors related to information processing, identifying deficits particularly for short term and working memory. There was mixed evidence for the presence of auditory processing difficulties, and weak evidence for temporal processing difficulties. Grammar and word learning were identified as areas of particular difficulty for this population. However, a number of issues were identified with the validity of studies in the area. Following the systematic review, intervention literature for children with SRLI was explored. It was found that that there weak link between intervention studies and the range of deficit studies identified in the SLR, emphasising the need for new primary research. Three focus groups with expert SLTs (n= 16) were conducted, followed by a workshop with therapists (n= 23) with a broader range of speech and language therapy experience. Participants were asked to discuss interventions they employ in relation to the deficits identified in the systematic review, and to describe the theoretical underpinnings for these interventions. Thematic analysis revealed core therapy techniques as well as common approaches for selecting targets across groups. Common approaches for selecting targets included consultation with teachers or teaching assistants, developmental order, functionality, priority areas, national curriculum vs. core concepts and severity of difficulty. Core therapy techniques included active pre-teaching, child enjoyment, feedback, hierarchical, making connections, multi-sensory, practice and tailoring to child. Thematic analysis revealed a range of impairment based interventions. However, a number of interventions appeared to be assistive in nature; that is, they focused on maximising the childs existing skill sets. A model of interventions for SRLI will be presented which summarises the findings, incorporating SLT targets for SLI as well as the different foci of intervention. The findings were used to explore possible mechanisms of change for interventions in SRLI. Difficulties with clarifying mechanisms of change in SRLI were identified. Without a clear perspective on how change is brought about, it is difficult to design evaluations that are sufficiently sensitive to detect changes. Routes forward for clarifying mechanisms of change will be discussed. This work demonstrates the value in utlising the MRC guidance in the development and evaluation of interventions. Learning outcomes: an understanding of the evidence of deficits in children with SRLI; an overview of interventions SLTs use with children with specific receptive language impairment; increased understanding of core therapy techniques and common approaches for selecting targets in children with specific receptive language impairment; reflection on possible mechanisms of change for interventions for children with specific receptive language impairment.
SS46
THE COLLABORATIVE PRACTICES OF HEALTH AND EDUCATION PROFESSIONALS IN THE MANAGEMENT OF CHILDREN WITH COMMUNICATION DIFFICULTIES JANE MCCORMACK (1) - CATHERINE EASTON (1) SCHOOL OF COMMUNITY HEALTH, CHARLES STURT UNIVERSITY, ALBURY, AUSTRALIA (1)
Abstract: Communication difficulties are highly prevalent in childhood and have been associated with later academic, social, and occupational difficulties. Early speech-language pathology intervention is effective in ameliorating communication difficulties and minimising the potential long-term consequences. However, failure to commence intervention before the age of five means the critical time for effective and efficient intervention may have passed. Therefore, it is critical that children with communication difficulties are identified early and accurately, and have access to timely intervention services. In Australia, preschool children with communication difficulties
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are at the interface of health and education. They are considered to experience a condition which should be managed by a health professional (i.e. a speech-language pathologist, SLP); however, health services are not always accessible. While all Australian preschool children now have access to 15 hours per week in an educational service (preschool or childcare centre), early childhood educators (ECEs) are not trained to identify and manage communication difficulties. Thus, there is significant potential to support children with communication difficulties within their everyday environments through collaboration between SLPs and ECEs. This paper reports on a project which investigated the training, confidence and current practices of both SLPs and ECEs when working with preschool children with communication difficulties. Further, it explores the perceptions of need for support, and barriers and facilitators to the identification and management of children from the perspective of both professions. This project incorporated two stages based on a mixed methods research design. A questionnaire distributed to speech pathologists and ECEs working with children with communication difficulties across Australia provided initial quantitative data. Results of the questionnaire were used to develop questions for subsequent focus groups with participants from the two professions. In this seminar, the results of this new Australian research will be presented, and suggestions made regarding a best practice model for collaboration between SLPs and ECEs supporting preschool children with communication difficulties. Discussion of the model and its application to international contexts will occur. Learning outcomes: The participants will understand the strengths and challenges of collaborative practice; participants will understand the desires/needs of SLPs and ECEs regarding effective collaborative practice; participants will consider how a new model of collaborative practice might apply to their current practices and context, and comment on strengths and challenges of the model, as well as identifying possible improvements.
FP224
NEW INSTRUMENTS FOR RESEARCH ON SEVERE ACQUIRED BRAIN INJURIES PATRIZIA CANCIALOSI (1) - MELANIA SAFFILA (1) - DONATO QUERCIA (2) - FEDERICA GATTI (3) - CHIARA TRUCCO (4) ROSARIA BALBO (5) FRANCESCA AUXILIA (6) AOU CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, PRESIDIO C.T.O./ M. ADELAIDE - S.C. RRF GRAVI CEREBROLESIONI ACQUISITE, , UNIVERSIT DEGLI STUDI DI TORINO, , ITALY (1) - FREELANCER, POLITECNICO DI TORINO, TORINO, ITALY (2) CENTRO EDU AVIGLIANA ERIKSON, UNIVERSIT DEGLI STUDI DI TORINO, AVIGLIANA (TO), ITALY (3) - STUDENTE, UNIVERSIT DEGLI STUDI DI TORINO, TORINO, ITALY (4) - FREELANCER, UNIVERSIT DEGLI STUDI DI TORINO, TORINO, ITALY (5) PRESIDIO SANITARIO AUSILIATRICE, FONDAZIONE DON GNOCCHI ONLUS, UNIVERSIT DEGLI STUDI DI TORINO, TORINO, ITALY (6)
Abstract: Introduction: In this work, first of all are considered some definitions of the World Health Organization (WHO, 2002) related to the patient, who is first of all, a person, or bio-psycho-social unit (ICF, 2002), with a body and functions, activities and participation in the social world, which requires a real and comprehensive response to his health needs. The WHO defined in 1946 these needs as physical, emotional and social well-being and in 1986 also as a need to realize aspirations and satisfy their needs and adapt to the environment. Moreover, we intend to describe briefly the main deficits of severe acquired brain injury (ABI), such as dysphagia, the linguistic-communicative disorders and deficits of cognitive functions related to communication and language. In addition the method of working for goals, is shown with a description of the main systematized rehabilitative speech therapy objectives, that it is intended to achieve and that refer to domains in the International Classification of Functioning, disability and health (ICF), drawn up by the WHO in 2001. Aim of the study: The ultimate goal of the paper is to describe ORDIS-Dysphagia Rehabilitation Objectives, a computer program, which as ORCEL-Rehabilitation Objectives Communication and Language, is based on the application Microsoft Access. The primary function of these programs is to create a database, to facilitate the personal and clinical data collection, and the achieved goals of patients with Severe Acquired Brain Injury (ABI). These goals are important process indicators of rehabilitation. Methods: Between the two instruments which will be described, ORDIS, the software for dysphagia, was chosen for a study that involved the SLP of AOU City Health and Science of Turin, CTO / M. Adelaide Post S.C. RRF Severe Brain Injury and the Health Post Ausiliatrice Don Gnocchi Foundation.The sample consists of dysphagic patients collected from June 2011 to May 2012. There was also a completion of the data up to December 2012,and the process is now in place. Results: Analysis of the results showed that work with this method allows the speech therapist and the team to know clearly, what are the main systematized objectives to be achieved, with greater efficiency and effectiveness, and also to demonstrate the rehabilitation to the patient and to their families and caregivers with a detailed report and with clear indicators in order to secure a review of the achievement of the expected outcome. Conclusions: In conclusion, the study had the following purposes: describe ORCEL and ORDIS tools, as practical applications of working for goals and paths, wether for communication and language, or for deficits of cognitive functions related to communication and language or for dysphagia; collect a number of the most significant data as possible from the epidemiological point of view; obtain information through the tool ORDIS, about the recovery time of the various functions and sub-functions on swallowing; experiment and test in practice the new instrument ORDIS to detect and correct any problems, so as to make it presentable and acceptable as project. Learning outcomes: the participant through this work will be able to: get to know the main speech therapy objectives related to communication and language and dysphagia, divided by systematized paths; obtain information to use the ORDIS and ORCEL programs for data collection, SLP reporting and reporting of individual achieved objectives; have an example of practical application of these programs in relation to data about dysphagia in ABI.
FP223
SEVERE ACQUIRED BRAIN INJURY: CASE STUDY ANALYSIS OF THE PAST FIVE YEARS ON MAJOR ISSUES OF SPEECH THERAPY INTEREST ANGELA LUCIA FOGLIATO (1) - PATRIZIA CANCIALOSI (1) CLAUDIA MACHETTA (1) - NATALIA GIUNTA (1) - LORELLA COCCHINI (1) - PATRIZIA MILANI (2) - GIUSEPPE MASSAZZA (3) - MAURIZIO BEATRICI (1) DEPARTMENT OF THE MEDICINE PHYSICAL AND REHABILITATION 2, UNIVERSITY OF TURIN HOSPITAL CORPORATION CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, HOSPITAL UNIT C.T.O./ M. ADELAIDE, TURIN, ITALY (1) - POSTGRADUATE SCHOOL OF PHYSICAL MEDICINE AND REHABILITATION, FACULTY OF MEDICINE AND SURGERY, UNIVERSITY OF TURIN, TURIN, ITALY (2) - UNIVERSITY DEPARTMENT OF TRAUMATOLOGY, ORTHOPAEDICS AND OCCUPATIONAL MEDICINE, UNIVERSITY OF TURIN, FACULTY OF MEDICINE AND SURGERY, TURIN, ITALY (3)
Abstract: Severe Acquired Brain Injury (ABI) is a brain damage caused by trauma or other reasons, which determines a more or less prolonged state of coma and sensory-motor, cognitive and behavioral impairments, involving severe disability. The rehabilitation team of University of Turin Hospital Corporation Citt della Salute e della Scienza di Torino, Hospital Unit C.T.O. / M. Adelaide, Department of Medicine Physical and Rehabilitation, provides consulting in the intensive care and neurosurgery by completing the individual rehabilitation form (DGR 2007,april 2) and works with inpatients and outpatients. This paper aims to present and discuss data on the cases of the last five years, on key issues relevant to speech therapy in patients with severe ABI. A database was created regarding patients it was cared about in five years by our team between the second half of 2008 and December 2012. The 1162 patients included in the database are all suffering from severe ABI and the data cover both the acute and the post-acute phase. The etiology appears to be predominantly traumatic, then vascular, neoplastic and degenerative. From the collected data emerges how dysphagic, cognitive-behavioral and communicative-linguistic problems are relevant, both qualitatively and quantitatively in patients management and prognosis of a possible autonomys recovery. These issues emerge in the analysis of numerical data base and show their qualitative influence at the level of quality management and patient outcome. Since the rehabilitation begins at the moment in which the patient has a prognosis of survival after the damaging event, the data analysis shows evidence of the need for an early rehabilitative take-over, that from multidisciplinary becomes interdisciplinary and increasingly transdisciplinary, aiming at helping the patient and his family to reach the best quality of life from a physical, functional and social point of view. Learning outcomes: The participant will be able: to highlight the possible operating rehabilitation procedures in the management of severe ABI from the acute to the outcome phase; to know and highlight the management of speech therapy problems of a patient with severe ABI; to know the main operational strategies for team managing of patients with severe ABI; to enquire at a quantitative and statistical level about rehabilitation data related to ABI as well as a speech therapy taking charge.
FP225
THE RELEVANCE OF CASE-STUDIES IN APHASIA RESEARCH: WHAT THEY TELL US ABOUT LANGUAGE FUNCTIONING AND ABOUT LINGUISTIC-COGNITIVE REORGANIZATIONAL PROCESSES ROSANA C. NOVAES PINTO (1) - MIRIAN CAZAROTTI PACHECO (1) DEPARTMENT OF LINGUISTICS/LANGUAGE STUDIES INSTITUTE, STATE UNIVERSITY OF CAMPINAS (IEL/UNICAMP), SO PAULO, BRAZIL (1)
Abstract: Introduction and objectives: The main purposes of this presentation are (i) to argue in favor of case-studies as a very productive methodology of research in aphasiology and (ii) to present the case-study of TR, a non-fluent aphasic Brazilian lady, in order to illustrate how the work carried in a center for aphasic subjects, oriented by a discursive perspective, helped her to develop incredibly rich verbal and non-verbal alternative/creative
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strategies of communication. Miceli (2001: 658) emphasizes the contribution given by case-studies to neuropsychological research, more specifically in the understanding of aphasia: Much of the theoretical progress in the Neurology and Neuropsychology of aphasia results from the detailed study of individual aphasic subjects. We have been carrying case-studies in aphasia for over twenty years at the Language Studies Institute (IEL)/ UNICAMP and we have learnt much both about language functioning but also about the benefits the work developed at CCA brings to the aphasic subjects that attend the weekly meetings. Theoretical-methodological basis of the work developed: The work we develop with aphasic subjects at CCA (Centro de Convivncia de Afsicos [Center for Aphasics]) in Brazil, has a strong discursive orientation, guided by social-historical-cultural approaches to language (Coudry 1988, Novaes-Pinto 1999, Novaes-Pinto & Santana 2009a, 2009b). Among the main theoretical basis, we mention Vygotskys postulates of the higher mental functions, Lurias conception of brain as a dynamic and plastic complex functional system and language as a constitutive activity with a dialogical nature (Franchi, 1977; Bakhtin, 1997). Discussion of a case study: TR is a 60 yr. lady who has been attending CCA for almost three years. When she first arrived, most of her utterances were limited to one... two, produced while showing two fingers (the index and the middle) of her left hand, one at a time. By this expression one, two she meant all sorts of things and it demanded from all of us much attention to all available clues in order to unveil at least part of her speech will. With time, we developed, together, alternative means to get closer to what she wanted to say. She started making more use of gestures and facial expressions, pointing to something which could help us understand the discursive topic she would like to address and, thus, refined a translation system using a wide network of verbal and non-verbal signs. More recently, she started telling short stories and very wisely she conducts her interlocutors through her narratives, giving them all kinds of clues, exploring the shared knowledge and all non-verbal elements she can use, in order to make herself understood. Final considerations: We would like to highlight the case-study of TR as a singular one, once it provides evidence that even in extremely severe cases in which the production of utterances are very reduced and stereotyped real and meaningful activities (especially organized through narratives, but also with activities which deal with other discourse genres) have a strong, positive and reorganizing role, which in turn allows aphasic subjects to see themselves again as social subjects. Learning outcomes: it is expected that the paper presented will (i) publicize the work and reflections which have been developed with aphasic subjects at the CCA (Center for aphasic subjects)/IEL (Language Studies Institute/ UNICAMP (State University of Campinas)/Brazil; (ii) discuss the relevance of case-studies and qualitative approaches for aphasia research and for therapeutic follow up of aphasic subjects (iii) inspire research and clinical work towards a dialogical approach on aphasia.
PPI therapy (P < 0.001). A significant reduction in LPS symptoms. On the other hand, such result was not recorded for LPS. Esophagitis was detected in 2/41 patients, and ineffective esophageal motility was found in 3/41 patients. The MII-pH analysis showed an abnormal AET in 5/41 patients (2 ERD and 3 NERD); 11/41 patients had a normal AET and a positive association between symptoms and refluxes (HE), and 25/41 patients had a normal AET and a negative association between symptoms and refluxes (no GERD patients). It is noteworthy that HE patients had a positive association with typical GERD-related symptoms. Gas refluxes were found more frequently in patients with globus (29.7 3.6) and hoarseness (21.5 7.4) than in patients with heartburn or regurgitation (7.8 6.2). Gas refluxes were positively associated with extra-esophageal symptoms (P < 0.05). Overall, no differences were found among the three groups of patients in terms of the frequency of laryngeal signs. The proximal reflux was abnormal in patients with ERD/NERD only. The differences observed by means of MII-pH analysis among the three subgroups of patients (ERD/NERD, HE, no GERD) were not demonstrated with the RSI and RFS. Moreover, only the number of gas refluxes was found to have a significant association with the RFS (P = 0.028 and P = 0.026, nominal and numerical correlation, respectively). In this presentation we will discuss our results and the potential role of gas refluxes in causing laryngopharyngeal symptoms. Learning outcomes: the Participant will be able to: understand the importance, in the study of LPR, of tests such as upper endoscopy, stationary esophageal manometry, and in particular as 24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring; understand the importance of using rating scales (reflux finding score - RFS and reflux symptom index - RSI) in clinical ENT and phoniatric practice; understand the risk of overdiagnosis of LPR and the relative risk of unnecessary prescribing therapies with IPPs; learn about new pathogenic hypothesis about laryngopharyngeal symptoms (LPS) and in particular the role of gas refluxes.
FP227
VOICE DISORDERS IN TEACHERS FROM PRIMARY SCHOOL: A MULTIDISCIPLINARY EVALUATION THROUGH QUESTIONNAIRES, LARYNGOSTROBOSCOPY AND VOICE ANALYSIS FRANCESCA LIRA LUCE (1) - ROBERTO TEGGI (1) BARBARA RAMELLA (1) - MATTEO BIAFORA (1) LAURA GIRASOLI (1) - MARIO BUSSI (1) DEPARTMENT OF OTOLARYNGOLOGY, OSPEDALE SAN RAFFAELE, MILAN, ITALY (1)
Abstract: Previous works focused on a higher prevalence of voice disorders in teachers, and vocal loading might be the main causal factor; aim of the study was to assess the prevalence in a sample of teachers from primary school and evaluate possible cofactors. Our sample was composed by 157 teachers (155 females, mean age 46 years old). They were asked to complete three self-administrated questionnaires: the first one with clinical data, the second was the Italian validated translation of VHI (Voice Handicap Index) and finally the Italian validated version of the Self-Report Measures of Job Stressors and Strain (scales that are designed to measure three stressor and one strain). In the same day they performed a laryngostroboscopic exam and a logopedic evaluation. Results were compared with those of a control group composed by accompanying people. Teachers presented a higher rate of abnormalities at laryngostroboscopic examination (51.6% vs. 16%). Among them 7.1% presented nodules. Teachers also presented a lower voice fundamental frequency than controls. In our sample, vocal folds disorders were not correlated with the years of teaching, smoking, coffee consumption and anxiety levels. Our findings are in accordance with previous works about the prevalence of pathologic subjects among teachers; nonetheless the prevalence of nodules was lower than in previous works and voice loading did not present a correlation with laryngostroboscopic findings. Italian law does not include any guide regarding voice education and screening in subjects with high vocal loading. Our work underline this necessity. Learning outcomes: know the prevalence and risk factors of voice disorders in Italian teachers from primary school; understand the need of a multidisciplinary evaluation of voice disorders, through self-completed questionnaires, laryngostroboscopic examination and logopedic evaluation; understand the necessity of a preventive voice program in all teachers, possibly at the beginning of their work activity.
FP226
HOW MANY CASES OF LARYNGOPHARYNGEAL REFLUX SUSPECTED BY LARYNGOSCOPY ARE GERD-RELATED? ROLE OF GAS REFLUXES ANDREA NACCI (1) - GIOVANNA BARACCA (2) - NICOLA DE BORTOLI (3) - VALENTINA MANCINI (1) - STEFANIA SANTOPADRE (1) - SANTINO MARCHI (3) - STEFANO BERRETTINI (1) - BRUNO FATTORI (1) UNIT OF PHONIATRY AND AUDIOLOGY, DEPARTMENT OF NEUROSCIENCE, UNIVERSITY OF PISA, PISA, ITALY (1) OTOLARYNGOLOGY DEPARTMENT, FONDAZIONE IRCCS CA GRANDA, OSPEDALE MAGGIORE POLICLINICO, MILAN, ITALY (2) - DIVISION OF GASTROENTEROLOGY, UNIVERSITY OF PISA, PISA, ITALY (3)
Abstract: AIM: To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR). METHODS: 41 consecutive patients came to our attention in ENT Audiology an Phoniatric Unit of Pisa, for laryngopharyngeal symptoms (LPS). LPR diagnosis was suspected by ENT and phoniatric specialists using laryngoscopic and laryngostroboscopic evaluation and using the reflux finding score (RFS) and reflux symptom index (RSI). The hypothetical LPR were empirically treated with PPIs for at least 8 week, and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale, GIS; visual analogue scale, VAS). After a 16-d wash-out from PPIs, all patients underwent an upper endoscopy, stationary esophageal manometry, 24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring. A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD), pathological acid exposure time (AET) in the absence of esophageal erosions (NERD), and a positive correlation between symptoms and refluxes (hypersensitive esophagus, HE). RESULTS: All subjects reported one or more LPS. Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation). The most frequent laryngoscopic findings were: posterior laryngeal hyperaemia, posterior commissure hypertrophy, diffuse laryngeal oedema and thick endolaryngeal mucus. The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P < 0.05); conversely, 23/41 did not report any clinical improvement. At the same time, the VAS analysis showed a significant reduction in typical GERD symptoms after
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FP228
AN EDUCATIONAL MOVIE OF LARYNGEAL ELECTROMYOGRAPHY PROCEDURES USING HOOKED-WIRE ELECTRODES IN PHONIATRICS KEN-ICHI SAKAKIBARA (1) - SEIJI NIIMI (2) - HIROSHI IMAGAWA (3) - AKIHITO YAMAUCHI (3) - HISAYUKI YOKONISHI (4) MAMIKO OTSUKA (5) DEPARTMENT OF COMMUNICATION DISORDERS, HEALTH SCIENCES UNIVERSITY OF HOKKAIDO, SAPPORO, JAPAN (1) - DEPARTMENT OF SPEECH AND HEARING SCIENCE, INTERNATIONAL UNIVERSITY OF HEALTH AND WELFARE, OTAWARA, JAPAN (2) - DEPARTMENT OF OTOLARYNGOLOGY, THE UNIVERSITY OF TOKYO, TOKYO, JAPAN (3) DEPARTMENT OF OTOLARYNGOLOGY, TOKYO METROPOLITAN POLICE HOSPITAL, TOKYO, JAPAN (4) - DEPARTMENT OF OTOLARYNGOLOGY, KUMADA CLINIC, TOKYO, JAPAN (5)
Abstract: In this presentation, we will introduce educational movie of laryngeal electromyographic procedures which are recently made by our research group. The movie shows details on the procedure of the laryngeal electromyography (EMG) using hooked-wire electrodes. The movie includes (i) explanation of theoretical fundamentals of the laryngeal EMG; (ii) how to make hooked-wire electrodes; (iii) explanation of special instruments; (iv) anesthesia technique; (v) peroral / percutaneous insertion technique; (vi) verification tasks; and (vii) demonstration of laryngeal EMG measurement in practical experiments. All procedures are instructed by experienced experimenters. We will show some parts of the movie and emphasize the importance of using movie for learning the laryngeal EMG procedures. All contents will be open to the public on the web in near future. Learning outcomes: in this presentation, attendees will learn the following: theoretical fundamentals of the laryngeal EMG measurement; how to proceed the laryngeal EMG experiment practically; pitfalls and tips of the laryngeal EMG experiments.
SP5
COMMUNICATION DISORDERS IN THE MULTILINGUAL POPULATION The identification of differences versus disorders: evidence-based assessment and intervention SANDRA LEVEY (1) CITY UNIVERSITY OF NEW YORK, USA (1)
Abstract: Some bilingual speakers have been over-identified as having a disorder, because of the use of inappropriate assessment methods or devices. Others have been under-identified, as practitioners may be unaware of the signs of a true disorder. Research-based assessment methods are discussed that prevent misidentification. These methods include a language history for the first (L1) and second (L2) languages, dynamic assessment, conceptual scoring to take account of the speakers L1 and L2 vocabulary skills, and an examination of language processing capacity. An intervention plan is discussed that takes into account the bilingual speakers language history and proficiency to assure successful intervention. Learning outcomes: participants will gain knowledge of the appropriate assessment approaches for working with bilingual speakers; participants will gain knowledge of the appropriate intervention approaches when working with bilingual speakers, participants will gain knowledge of the signs of true disorders when working with bilingual speakers.
Sociolinguistic and Pathological Language Variations: Problems of Complementarity and Overlap BENJAMIN K. TSOU
Abstract: An individuals language may vary from a linguistic norm for: (1) pathological reasons such as physical or neurological impairment, or (2) societal reasons such as differences in social background and developmental trajectory, including L1 and L2 learning. (1) is usually found in 5% to 10% of a given population, but there are many more cases of (2). While there is recognition of the importance of the distinction between the two kinds of variations in diagnosis and in language remediation, little attempt has been made to look into the related issues holistically. This is especially significant as the world increasingly evolves towards urban bilingualism and multilingualism. In the case of ontological developments, variations according to linguistic norms along the age gradient are important, and a further distinction must be made between L1 and L2 learning situations, and in relation to language degeneration because of Dementia and Alzheimers disease. Thus, the language varieties found amongst dialect speakers and language learners also offer interesting comparison with these cases. This sociolinguistic continuum represented by balanced-bilingualism and semi- bilingualism as two extremes must not be understated in relation to pathologicallyinduced language variations. We propose to examine some relevant critical issues in the light of the development of a language assessment instrument for a multilingual Chinese population, HKCOLAS (Hong Kong Cantonese Oral Language Assessment Scale). Learning outcomes: participants will learn to appreciate the important difference between sociolinguistic and pathological language variations; participants will gain knowledge to help identify such differences; participants will learn how relevant issues are dealt with in full-scale language assessment.
SS47
THE ROLE OF SPEECH LANGUAGE PATHOLOGIST IN TAKING CHARGE OF THE PRETERM INFANT: EMPOWERING PREMIES IN THE T.I.N. (N.I.C.U.) MONICA PANELLA (1) ASLBI - BIELLA, HOSPITAL, BIELLA, ITALY (1)
Abstract: The outcome of the preterm infant, does not only depend on biological risk factors (low birth weight, immaturity of the nervous system,) but also on important effects deriving from environmental elements. T.I.N., an essential resource for preterm infants with its pecularites of emergency, does not however always result as suitable for the psychophysical development of the infant. The numerous actions regarding his/her looking-after, as well as various clinical actions and the organization of the work, which, often, do not keep in consideration the physiological biorhytms of the infant, paradoxically, trasforming the set procedures to ensure the highest level of neonatal care into risk factors for the following neuropsychological development of the newborn. it is known that decreasing the level of stress through the reduction of external stimulations and applying a careful programme of postural cures, the general condition of the preterm improve noticeably. A reduction in the duration of assisted ventilation, an earlier capacity in autonomous feeding, a reduction in the entity of complications and a better neurovegetative development are obtained. From the awareness of the extreme complexity of the needs of the pathological newborn the CARE concept has been developed: a set of strategies directed towards the reduction of preterm stress during their stay in T.I.N. the preterm infant is often in need of being fed via the positioning of naso-gastric or oro-gastric tubes. CARE embraces the following: the integration of parents in the caring, the oral stimulation finalized towards the non-nutritional sucking and subsequently towards nutritional sucking promoting breast feeding. The role of the S.L.P., in its specificity of deglutological skills, involves taking on the task of observing the functions of the mouth, the compilation of the neuromotor balance , evaluating non nutritive sucking and nutritive sucking , as well as its implementation, evaluating eating skills through the sharing of knowledge and techniques with the healthcare team and the family, this last considered as playing a major part in the road to curing the child, following up the rehabilitation process when returning home, via follow-ups and counselling and, where necessary, the taking over by territorial healthcare facilities. Learning outcomes: Participants will receive information concerning the specific times for evaluation, rehabilitation and follow-ups concerning the logopedistic action in neonatal intensive care units and on discharging of the child.
Atypical development in dual language children: SLI or delay? RITA MARI (1) - MARINA PORRELLI (1) NEUROPSYCHIATRIC CLINIC IN MODENA, ITALY (1)
Abstract: Tools traditionally used to assess language development and SLI show some important weaknessess when applied to dual language children, as they are not tested for that group of patients. To achieve better diagnostic accuracy, it is important to gather precise information on time and quality of exposure to both languages, the development of language in L1, and the presence of risk factors for SLI both for monolingual and bilingual children. We have developed a parents questionnaire (ALT) which helps to obtain an accurate picture of dual language development and that we hope can be used as a frame to give a more precise diagnostic meaning to ordinary assessment procedures.
Bilingual profiles, reading acquisition and bilingual advantage: how to evaluate strengths and difficulties in bilingual and second language learning children PAOLA BONIFACCI (1) - STEPHANIE BELLOCCHI (2) UNIVERSITY OF BOLOGNA, ITALY (1) AIX MARSEILLE UNIVERSIT, FRANCE (2)
Abstract: An increasing number of children are exposed to a reading system in a language that is different from their L1, both because of migration processes or increased learning occasions. These children can be defined as bilingual children or second language learners, based on the type of linguistic exposure they received (Paradis, Genesee, & Crago, 2011). Often, immigrant children have been described to perform more poorly than monolingual children in reading tasks (Slavin & Cheung, 2003) whereas a parallel research line on the bilingual advantage reports better capacities in non-verbal skills (e.g., Bialystok, 2009; Bonifacci, Giombini, Bellocchi, & Contento, 2011).
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We discuss some research inputs on assessment tools for evaluating L1/L2 bilingual profile and protective factors for L2 acquisition, together with evidences on the cognitive and metalinguistic bilingual advantage.
SY11
MOTOR SPEECH DISORDERS COMMITTEE SYMPOSIUM 2 Automated intonation assessment and treatment in dysarthria HEIDI MARTENS (1) - GWEN VAN NUFFELEN (1) - TOMAS DEKENS (2) LUKAS LATACZ (2) - DIANA TORRES (3) - WERNER VERHELST (2) MARC DE BODT (1) REHABILITATION CENTRE FOR COMMUNICATION DISORDERS, ANTWERP UNIVERSITY HOSPITAL, EDEGEM, BELGIUM (1) DEPARTMENT OF ELECTRONICS AND INFORMATICS (ETRO), VRIJE UNIVERSITEIT BRUSSEL, BRUSSELS, BELGIUM (2) - RESEARCH CENTER ON ELECTRONICS AND INFORMATION TECHNOLOGIES (CEETI), CENTRAL UNIVERSITY OF LAS VILLAS, SANTA CLARA, CUBA (3)
Abstract: Prosody assessment and treatment in dysarthria is clinically relevant, since prosodic impairment can have a negative impact on speech intelligibility and thus on participation in daily life conversation. Current prosody assessment lacks standardization, is mostly auditory-perceptual and as a result susceptible to error and bias, and some prosody assessment methods are time-consuming. Current prosody treatment relies on modelling and auditory-perceptual feedback and is consequently usually confined to therapy sessions in the presence of a speech and language therapist (SLT). We propose a new, speech-technology based software tool, aimed at Dutch speaking individuals with dysarthria, which tries to overcome the aforementioned drawbacks of current assessment and treatment practices, by using a new algorithm for automated intonation assessment and treatment. The tool provides not only auditory, but also automated visual and numerical feedback on accuracy of sentence modality intonation (the statement/question intonation contrast) in prosodic minimal pairs such as Karen plays tennis. and Karen plays tennis?. This enables SLTs to obtain an objective assessment in a standardized and fast way, and enables dysarthric speakers to practise intensively without the presence of an SLT being required. Speech samples of 20 healthy and 36 dysarthric speakers were recorded. Perceptual classification by three SLTs of utterances as either statements or questions was first used as a reference for developing an automatic sentence modality classifier for dysarthric speech, and then compared to the automated classification. The intonation classification algorithm works well for dysarthric speech: high classification accuracy was obtained for statements (97.9%), accuracy for questions being somewhat lower (90.3%). A graphical user interface was created for the assessment and training software application, with special attention to adequate feedback on prosodic performance after assessment and during training. The training programme, conceived along the lines of the assessment, allows for intonation training by means of various speech tasks. Clinical trials were organized in order to gather user feedback from dysarthric speakers and SLTs. The assessment and treatment software application, tailored to the specific needs of endusers on the basis of user feedback, is fully operational and ready for demonstration. Future research will focus on optimization of a speech rate algorithm currently being developed and on creation of a sentence stress algorithm, both for dysarthric speech. Learning outcomes: participants will be able to: enumerate two advantages of the presented automated prosody assessment and treatment tool over auditory-perceptual prosody assessment and treatment practices; explain which prosodic aspect can be assessed and trained with the new tool; state the accuracy of the intonation algorithm in dysarthric speech.
following rTMS, and the success of intensive voice therapy regimes reported in the literature, this clinical case study presentation aims to trial a combination of these therapy using speech and lingual kinematic outcomes. Methods: A single participant with idiopathic PD was administered a 10 day course of 5Hz rTMS in combination with 10 days of intensive voice therapy for 1 hour per day, focusing on increasing loudness, pitch and rate of speech. Outcomes measures including behavioural assessments and lingual kinematic (utilising state of the art electromagnetic articulography- EMA) were administered up to 6 months post rTMS. These behavioural and lingual kinematic results for this patient will be presented and discussed. Learning outcomes: attendees will learn: the mechanism of action of transcranial magnetic stimulation; the effect of transcranial magnetic stimulation on the motor cortex; how transcranial magnetic stimulation can be combined with traditional therapy techniques.
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COMMUNICATION DISABILITY IN A GLOBAL CONTEXT - PART 1: CHALLENGES FROM THE WORLD REPORT ON DISABILITY KAREN WYLIE (1) - JULIE MARSHALL (2) - BRONWYN DAVIDSON (3)LINDY MCALLISTER (4) UNIVERSITY OF SYDNEY, AUSTRALIA (1) MANCHESTER METROPOLITAN UNIVERSITY, UNITED KINGDOM (2)UNIVERSITY OF MELBOURNE, AUSTRALIA (3) UNIVERSITY OF SYDNEY, AUSTRALIA (4)
Abstract: In February, 2013, the International Journal of Speech-Language Pathology (IJSLP) published a special issue on Implications of the World Report on Disability (World Health Organisation and the World Bank, 2011) for the speech-language pathology (SLP) profession. This presentation will extend the dialog begun in that issue. It will provide an opportunity critically to examine the phenomenon of communication disability and SLP practices within a global context. Data on the prevalence of communication disability is not foregrounded in the World Report on Disability. In many countries of the world people with a communication disability receive limited or no rehabilitation services. Even for countries with more developed SLP services, there remain inequities in delivery. The challenges of providing services to underserved populations encourages consideration of organisational change and novel ways of securing access to services for children and adults with communication disability in both Majority and Minority world countries. The World Report on Disability, with its call for the engagement of people with disability, improved disability data collection, increased public awareness and understanding, and a call to strengthen and support research on disability, provides major challenges to the conceptualization and delivery of equitable services for people with communication disabilities around the world. Four key questions will be addressed in the symposium, with selected presentations from academics, researchers, and clinicians around the world. These are: of the estimated one billion people with disabilities, how many have a communication disability?; where are the gaps in speechlanguage pathology service provision?; how do we ensure that population level needs for peoples communication and swallowing receive adequate public attention?; how can the speech-language pathology profession be responsive to the needs of underserved PWCD, in ways which will influence change to improve policies, services, and practices, and promote equity? (Wylie, McAllister, Davidson, & Marshall, 2013, p2). This session will overview key issues from the WRD and highlight implications for PWCD. Issues, challenges and possible solutions to meeting the needs of PWCD will be discussed. There will be an examination of frameworks from organizational change theory, together with the biopsychosocial model of disability presented in the World Health Organisations International Classification of Functioning, Disability and Health (ICF) (WHO, 2001), in order to extend understanding and debate on global initiatives for responding to the needs of people with communication disability. Factors which may influence future service provision for PWCD globally will also be discussed. These factors include the importance of epidemiological data, possible of new roles and strategies for speech-language pathologists and others, the opportunities and challenges of community-directed versus individually-focused approaches, and the suggestion of public health communication disability workers and mid-tier workers to complement or replace the work of more traditional speech-language pathologists. Learning outcomes: awareness of the implications of the WRD for services for people with communication disability (PWCD); understanding of issues relating to equity and access to SLP services globally, linked to the WRD; appreciation of limitations of current medical and individually-focussed models of intervention for people PWCD, in meeting the needs of the population; increase understanding of the possibilities of public health and population-focussed approaches in responding to communication disability.
Repetitive transcranial magnetic stimulation combined with intensive voice therapy to improve speech function in Parkinsons disease: a clinical case study CAROLINE BARWOOD (1) - BRUCE MURDOCH (2) THE UNIVERSITY OF QUEENSLAND, CENTRE FOR NEUROGENIC COMMUNICATION DISORDERS RESEARCH, BRSIABNE, AUSTRALIA (1) - THE UNIVERSITY OF QUEENSLAND, CENTRE FOR NEUROGENIC COMMUNICATION DISORDERS RESEARCH, BRISBANE, AUSTRALIA (2)
Abstract: Background: There is a clear need to source efficacious methods of treatment for of dysarthria given the high incidence and psychosocial impact of this speech disorder in individuals with PD (Oxtoby, 1982). Repetitive transcranial magnetic stimulation (rTMS), a non-invasive method of altering neural activity has recently been trialled as therapeutic technique to improve articulation in PD with positive results (Murdoch, Ng & Barwood, 2012). Given that neuroimaging has revealed that improved speech outcomes in PD subsequent to treatment with intensive voice therapy are associated with increased activity in the motor and pre-motor cortex , the use of high-frequency rTMS [5Hz rTMS is proven to increase cortical excitability in the motor cortex (Gow et al., 2004], provided in combination with intensive voice therapy, these techniques may yield heightened treatment efficacy for speech dysfunction in PD. Aims: Based on the positive outcomes reported
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APHASIA SEVERITY, QUALITY OF LIFE AND AN OBJECTIVE, MEASURE OF PARTICIPATION: A SENSECAM PILOT STUDY SUE FRANKLIN (1) - CLAIRE SMYTH (1) - SELENA OUELLET (1) LIANE DEASY (1) DEPARTMENT OF CLINICAL THERAPIES, UNIVERSITY OF LIMERICK, LIMERICK, IRELAND (1)
Abstract: Aim: Research to date has been inconclusive on the issue of how predictive language impairment is of lived disability. We describe a preliminary study to establish a methodology to explore the relationship between aphasia severity, rated quality of life (QoL) and a potentially more objective measure of participation. Method: Twelve people with aphasia (of varying severity) were assessed using the Comprehensive Aphasia Test (Swinburn et al, 2004). The people with aphasia were then asked to rate aspects of quality of life using the SAQOL-39 (Hilari, 2002). To gain a more objective idea of social participation the people with aphasia were asked to wear a SenseCam (Microsoft Corporation, 2003). The SenseCam images were analysed to give counts of number of people, number of interactions, number of activities and number of types of activity. Results: Analyses confirmed that scores on the CAT correlated with communication and psychosocial subdomains of the SAQOL-39, but not with the overall quality of life score. The relationship between these two assessments and the SenseCam scores is more complex. Aphasia severity correlated with the SenseCam measure of number of types of activities carried out. Both aphasia severity and the SAQOL-39 psychosocial sub-domain correlated with number of participants interactions with other people. However, these were negative correlations; the more severe the aphasia the greater the number of interactions. Discussion: These preliminary results accord with findings that there may be a relationship between language impairment and quality of life. When participation was measured more directly, using the SenseCam, more severe aphasia was associated with carrying out fewer activities, but more interactions with people. The latter finding, while initially surprising, may reflect a loss of autonomy, rather than increased socialising. Conclusion: This correlational methodology shows promise for future, bigger studies to investigate the relationship between language impairment and disability. The use of the SenseCam to provide quantitative measures of participation should be supplemented by more qualitative analysis, allowing for an evaluation of, for example, the quality of interactions seen on the images. Learning outcomes: understand the importance of measuring participation for people with aphasia; consider methods of objectively measuring participation; consider the relationships between aphasia severity, quality of life and participation.
and in storytelling, i.e. in tasks requiring effective word search and short term memory. Both groups showed some recovery within the 12 months follow-up. The patients in both groups felt their communication to be effective from the beginning of the follow up. The answers of the spouses were similar. The patients in both groups reported their quality of life remaining good after the stroke in aspects of communication and physiology, but felt their psychosocial wellbeing and general feeling of energy in life reduced. Right hemisphere stroke patients appear to have no difficulties in speech production or understanding the language as expected based on the literature. Some difficulties in more complex tasks were, however, noticed. The persons studied showed only mild impairments in the communication aspect of quality of life. Further studies are needed to evaluate right hemisphere patients with more severe consequences of stroke. Learning outcomes: the participant will: learn about the language skills of patients with right hemisphere stroke; learn to diagnose language and communication difficulties not obvious to find; learn to provide proper information about cognitive defects to stroke patients themselves and to their caretakers.
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WHAT CAN WE LEARN FROM USING LONG TERM SAQOL-39 IN PEOPLE WITH APHASIA NADA EMVA (1) UNIVERSITY REHABILITATION INSTITUTE REPUBLIC OF SLOVENIA, HOSPITAL/UNIVERSITY, LJUBLJANA, SLOVENIA (1)
Abstract: Routine clinical practice in rehabilitation programmes needs to make more use of assessment in quality of life. The views of people with aphasia are routinely not evaluated during their treatment, despite the recommendation that therapy should be aimed at optimization of the individual sense of well being and quality of life. They should have the possibility to assess and report their individual perception of the impact of illness and its treatment on their quality of life. Stroke and Aphasia Quality of Life Scale (SAQOL-39; Hilari, Byng, Lamping& Smith, 2003) is a self report tool applicable to stroke patients with aphasia. It is an outcome measure, which can be applied for clinical audit and prioritisation of the treatment. SAQOL-39 can be used at different occasions during rehabilitation process, which is very important due to the fact, that stroke patients need different interventions at different time-points. A trained speech language pathologist was facilitated interview to allow the individuals with aphasia to express their views. SAQOL-39 was used to assess physical, communication, physiological, energy domains and overall quality of life. It was used in different time post onset in each participant. The first interview was performed usually during a programme of rehabilitation intervention after treatment in acute hospital and when the patient spent a weekend at home. Then we repeated interviews in conjunction of outpatient therapy. The results of the each interview were discussed with aphasic person to select the most appropriate approach to improve her/his quality of life and to follow up changes in different domains and overall quality of life. Long term use of the SAQOL-39 for people with aphasia can highlight the consumers views, needs and her/his priorities. In this way, flexibility of individual rehabilitation goals is possible, and the most appropriate support can be provided, which is adjusted to the individual needs. To achieve meaningful and positive life changes, sometimes the intervention should be more focused and targeted to individuals interests who can produce changes in real everyday life but not limited to particular domain. Using SAQOL-39 in different time living with aphasia can shows us the different needs which determining goals for intervention and improving areas of relative weakness in people with chronic aphasia. Learning outcomes: The participants will be able to understand what quality of life in aphasia means using the SAQOL-39 as tool for assessing a key concept of quality of life.
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LANGUAGE SKILLS AND THE QUALITY OF LIFE OF PATIENTS WITH RIGHT HEMISPHERE STROKE TREATED WITH INTRAVENOUS ALTEPLASE TREATMENT PAIVI NUMMINEN (1) - ANNA-MAIJA KORPIJAAKKO-HUUHKA (1) UNIVERSITY OF TAMPERE, TAMPERE UNIVERSITY HOSPITAL, TAMPERE, FINLAND (1)
Abstract: Stroke is the most important cause of morbidity and long-term disability in Europe. The intravenous alteplace administered within 4 hours after the onset of symptoms significantly improves clinical outcome in patients with acute ischemic stroke. However, there is only limited amount of scientific reports of language skills after intravenous alteplase treatment. It is important to recognize the patients with communication impairment already at acute stage in order to start and plan the treatment efficiently and systematically. The aim of this study was to examine linguistic outcome, communication skills and quality of life after stroke within one-year followup. The study group consists of 10 right hemisphere first ever stroke patients. Six of them were treated with intravenous alteplase and four patients were treated conservatively. The linguistic skills of the patients treated with alteplase were compared to those treated conservatively. MRI pictures were taken at acute stage and at 12 months post onset. Neurological, neuropsychological and logopedic examination were repeated at acute stage and at 6 and 12 months post onset. This study is a part of a multidisciplinary study called The improvement of cognitive symptoms after intravenous alteplace treatment in stroke patients one year follow up ongoing at Tampere University Hospital. The linguistic abilities were examined at three observation points with logopedic tests and two discourse samples. Overall language performance was assessed with the WAB. Verbal fluency was evaluated in three semantic categories (animals, pieces of clothing and fruits) and in three phonemic categories (words starting with letters P, A and S). Storytelling skills were evaluated by a cartoon story and working memory with a story repetition task. At 6 and 12 months picture naming was assessed with the BNT and an action naming test. The understanding of speech was evaluated with the Token test and rapid naming with the Rapid naming test. Communicative effectiveness was evaluated with the CETI both from the patients themselves and their spouses. The quality of life was assessed at 6 months and at 12 months post onset with the SAQOL 39 questionnaire.The patients were not aphasic according to traditional aphasia tests. However, they showed some difficulties in phonemic and semantic fluency
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VOICE OF MILITARY COMMAND SANDRA MARA ALMEIDA FERREIRA (1) - ARIANE KASSIA NUNES ALVES (1) - ELIANA MIDORI HANAYAMA (1) CEFAC, CENTRO DE ESPECIALIZACAO EM FONOAUDIOLOGIA CLINICA, SAO PAULO, BRAZIL (1)
Abstract: Objectiv: To trace the vocal profile in a command voice at a military man. Method: The auditory perceptive analysis about voice profile a subject, masculine sex, military, in four use situations: in a spontaneous speech, narrating a funny situation, during the airplane command and during the troop command, for three speech therapysts who works in a voice area. The comparison parameters among the vocal demands were: Loudness, Pitch, speed, articulation, projection, emphasis, vocal attack, gestures, resonance and posture. Results: During the situation of troop command, the subjects voice presented larger variations when compared with the other three situations of vocal use, mainly in relation to the pitch (more serious), loudness (higher), posture, articulation and projection (quite projected voice), parameters these probably related to the intention to act on the other, and vitality. Conclusion: The parameters used for the analysis suffered modification in all the situations and the most intense variations were observed in the use a command voice.
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THE EFFECTIVENESS OF MANUAL CIRCUMLARYNGEAL THERAPY IN FUTURE ELITE VOCAL PERFORMERS: A PILOT STUDY EVELIEN DHAESELEER (1) - SOFIE CLAEYS (1) KRISTIANE VAN LIERDE (1) GHENT UNIVERSITY, GHENT, BELGIUM (1)
Abstract: The purpose of this study is to investigate the impact of a single session of Manual Circumlaryngeal Therapy on the vocal characteristics of future elite vocal performers (musical students). A pretest-posttest control group design was used. Sixteen musical students were randomly divided in an experimental and control group. The experimental group received Manual Circumlaryngeal Therapy during 20 minutes whereas the control group was instructed to have complete vocal rest during 20 minutes. Immediately before and after the therapy or vocal rest an identical objective voice assessment protocol (aerodynamic measurement, acoustic analysis, voice range profile and Dysphonia Severity Index) was performed. Vocal parameters were compared before and after Manual Circumlaryngeal Therapy in the experimental group and before and after vocal rest in the control group using the Wilcoxon Signed Rank test. In the experimental group a significant difference in DSI was found between the measurement before and after Manual Circumlaryngeal Therapy. The median DSI increased from 6.3 before to 7.2 after Manual Circumlaryngeal Therapy. No differences in DSI were found in the control group between the two measurements. The results of this pilot study suggest that Manual Circumlaryngeal Therapy can also improve vocal capacities in healthy trained voices of future elite vocal performers. Learning outcomes: the congress attendees will be able t: know the effect of Manual Circumlaryngeal Therapy on the vocal characteristics in future elite vocal performers; understand the general principles of Manual Circumlaryngeal Therapy; know the vocal characteristics of future musical actors.
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THE ENDOSCOPIC EVALUATION OF DYSPHAGIA SEVERITY: A WAY OF CONSIDERING POOLING IN THE CLINICAL SETTING. DANIELE FARNETI (1) - RAFFAELLA PRENCIPE (1) - ANDREA NACCI (2) - VALENTINA MANCINI (2) - BRUNO FATTORI (2) ELISABETTA GENOVESE (3) AUDIOLOGY AND PHONIATRY SERVICE, INFERMI HOSPITAL, RIMINI, ITALY (1) - ENT AUDIOLOGY PHONIATRY UNIT, UNIVERSITY OF PISA, PISA, ITALY (2) - AUDIOLOGY SERVICE, UNIVERSITY OF MODENA, MODENA, ITALY (3)
Abstract: The study evaluates the intra-inter rater reliability of the Pooling score (P-score) in the clinical endoscopic evaluation of severity of swallowing disorder, considering residue in the pharynx and larynx. Four judges evaluated 30 short film of pharyngeal transit of 10 solid (1/4 of cracker), 11 creamy (1 tablespoon of jam) and 9 liquid (1 tablespoon 5 cc of water colored with methylene blue, 1 cc in 100 ml) boluses of 23 subjects (10M/13F, age from 31 to 76 yrs, mean age 58,56 yrs).with various morbid conditions. The films were randomly distributed in 2 CDs: CD0, see at time 0 and after 7 days, and CD1, seen one day after CD0. Prior to scoring the film, the judges had a 30 minute session on the explanation of P-score, to allow its correct application. The inter-and intra-rater reliability was calculated, using the intraclass correlation coefficient ICC (3, k) for items site, amount, management and the P-score total. The coefficient ICC (3, k) was found to be respectively: 0.999, 0.997, 1.00 and 0.999. The analysis of variance showed no statistically significant dependency by the consistency in the differences detected. Learning outcomes: the participant will be able to: 1. know the controversies on evaluating the severity of dysphagia; 2. understand the need of validated scales of evaluation; 3. know the characteristic of the P-score; 4. know the reliability of the P-score
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DEVELOPMENT AND VALIDATION OF THE VOICE FATIGUE HANDICAP INDEX (VFHI): CLINICAL, PSYCHOMETRIC AND PSYCOSOCIAL FACETS NICO PAOLO PAOLILLO (1) - EMILIANO DE QUARTO (2) GIUSEPPE PANTALEO (3) AZIENDA OSPEDALIERA DI LECCO, OSPEDALE SAN LEOPOLDO MANDIC, MERATE - LECCO, ITALY (1) FREELANCER, TARANTO, ITALY (2) SAN RAFFAELE UNIVERSITY, MILANO, ITALY (3)
Abstract: Background: all types of dysphonia are characterized by varying degrees of vocal fatigue which affects emotional, psychosocial and working conditions. To date, no instruments exist to quantify and self-assess emotional, psychosocial and working consequences of voice fatigue. Methods: we developed the Voice Fatigue Handicap Index (VFHI), a 3-parts questionnaire assessing functional, emotional, and physical components of voice fatigue, by selecting a subsample of 30 items from an initial pool of 60, according to the Cronbachs alpha if item deleted procedure. Content validity and internal consistency of the final version was evaluated. Eighty-seven participants with voice disorderswith and without voice complaintsand 60 participants without voice complaints completed the questionnaire. VHI comparison questionnaires were administered both (a) to enable comparisons among the two types of questionnaires (VFHI vs. traditional VHI) and (b) to assess the internal validity of the new instrument. In order to assess test-retest reliability we administered 35 tests in a group of pathologic respondents with a 10-15 days interval. To assess sensitivity, clinical validity and responsiveness of the instrument, we administered 20 tests in a group of respondents with voice disorders considered before and after therapy (medical therapy, surgery, speech therapy). Results: statistical analyses testify to the soundness of VFHI, demonstrate its usefulness in clinical practice for spoken voice, and confirm its construct validity, sensitivity, reliability, responsiveness and clinical validity. Conclusion: VFHI can be considered a more sensitive tool than VHI, in that it identifies a higher number of specific characteristics of vocal fatigue than previous psychometric tests, while pointing outat the same timevocal disorders even in borderline cases. Learning outcomes: Learn how to perform the steps of development and validation process of a new self-rated instrument for voice assessment; Understand how to administer the VFHI for better quantification and selfassessment of vocal fatigue; Understand the importance of the use of VFHI as an instrument to identify vocal disorders even in borderline cases; understand the prospective to use VFHI to predict the predisposition to voice disorders especially in people who are at risk of voice pathologies without current voice complaints.
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THE PROPRIOCEPTIVE ELASTIC METHOD (PROEL) IN VOICE THERAPY ALFONSO BORRAGN (1) - VALENTINA ROMIZZI (2) ANDREA RICCI MACCARINI (3) - EMANUELA LUCCHINI (4) PHONIATRICS AND LOGOPEDICS CENTER, CANTABRIA UNIVERSITY, SANTANDER, SPAIN (1) - SSA AUDIOLOGY, PHONIATRICS AND ENT, UMBRIA 2, AUSL, SPOLETO, ITALY (2) U.O. ORL, BUFALINI HOSPITAL, CESENA, ITALY (3) AUDIOLOGY AND PHONIATRICS SERVICE, UNIVERSITY OF PADOVA, CA FONCELLO HOSPITAL, TREVISO, ITALY (4)
Abstract: The Proprioceptive Elastic Method (PROEL) is a method for voice therapy that has been developed in our Centers over the last 15 years. The work is formalized in 5 phases: 1.Control of risk factors, especially inflammatory factors and problems of hydration and lubrication; 2.Shock stimuli on the vocal tract (especially proprioception using dumbbell weights, ice , vibrators, TENS ...); 3.Distension of muscular rigidity seeking elasticity using unstable equilibrium, generation of energy through motion; overhead body suspension using elastic trapeze ropes that eliminate weight; 4.Projection and resonance with counter-resistance systems, for instance, speaking inside a mask immediately opens cavities of the vocal tract; 5.Sensation of comfort. An experimental learning method is used where the dysphonic patient compares his/her voice before and after performing a proposed task. This task creates an immediate change in the voice that the patient experiences and assimilates. This method has been applied on more than 2000 patients showing different pathologies, with good results. The mean duration of therapy was 12 sessions. The PROEL method breaks the mold of many concepts of classical vocal therapy. Patient acceptance is optimum, as they not only achieve control over their problem but also experience a fun and emotional sensation. The patient with dysphonia feels they have learned, acquired and assimilated a different way to talk and one with which they feel comfortable. Learning outcomes: The main objective is to teach body distension through unstable balance techniques. In addition, the participants learn how to coprogramme body motion with the muscular movement of the phonatory system in order to gain elasticity and to remove rigidity. And finally, we check inflammatory factors as being the origin of most dysphonia processes and their control by means of hydration and lubrication.
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COMMUNICATION DISABILITY IN A GLOBAL CONTEXT - PART 2: POPULATION-BASED CHALLENGES AND A PUBLIC HEALTH RESPONSE FOR SPEECH-LANGUAGE PATHOLOGISTS BRONWYN DAVIDSON (1) - KAREN WYLIE (2) - JULIE MARSHALL (3) - JAMES LAW (4) - LINDY MCALLISTER (5) DEPARTMENT OF AUDIOLOGY AND SPEECH PATHOLOGY, FACULTY OF MEDICINE, DENTISTRY AND HEALTH SCIENCES, THE UNIVERSITY OF MELBOURNE, MELBOURNE, AUSTRALIA (1) - THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (2) -MANCHESTER METROPOLITAN UNIVERSITY, MANCHESTER, UNITED KINGDOM (3) INSTITUTE OF HEALTH AND SOCIETY, SCHOOL OF EDUCATION, COMMUNICATION AND LANGUAGE SCIENCES, UNIVERSITY OF NEWCASTLE, NEWCASTLE-UPON-TYNE, UNITED KINGDOM (4) FACULTY OF HEALTH SCIENCES, THE UNIVERSITY OF SYDNEY, SYDNEY, AUSTRALIA (5)
Abstract: Public health (PH) is defined as the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society (Acheson, 1988). Modern PH is based on the premise that many health conditions, are at least in part, influenced by a web of factors such as lifestyle, environmental, economic, social, and genetic factors. Levels of prevention: primary, secondary and tertiary, are a key reference point for PH interventions. This presentation will use these levels of prevention to examine the work of speech-language pathologists (SLPs) and approaches that take a preventative role in responding to communication disability. SLPs have traditionally used a predominantly individually-focused approach to rehabilitation. It is however increasingly apparent that this approach fails to ensure equitable services and may not be the optimal response to meeting the communicative needs of all people with communication disorders (PWCD). The expanded population data contained in the World Report on Disability (World Health Organization and The World Bank, 2011) prompts a consideration of whether an individualistic rehabilitation model will ever have the capacity equitably to meet the needs of large populations of people with communication disability. Ultimately PH approaches to communication disorders may have the potential to work across at least 2 dimensions: prevention and impact. This session will include discussion by leading proponents of a public health approach to communication disability. They will present concepts of public health applicable to population-based approaches for PWCD. Session participants will be invited to discuss barriers and facilitators in their country/work context, to the adoption of PH approaches. The session will conclude with synthesis of issues and recommendations about PH approaches to meeting the needs of PWCD. Four key issues will be raised: Are PH approaches to the delivery of services for PWCD necessary or viable? Where would PH approaches sit in the current spectrum of approaches to services for PWCD, including medical model rehabilitation and community-based rehabilitation? Do SLPs have the knowledge and skills to work within PH approaches? Are other type(s) of communication disability professionals needed to develop and deliver PH services for PWCD? Learning outcomes: increased understanding of the potential of public health approaches in responding to the communicative health and wellbeing of communities; increased understanding of the ways in which public health could be utilised in serving needs of people with communication disabilities; understanding of barriers and facilitators to implementing a public health approach to serving people with communication disabilities in specific contexts; increased knowledge with which to advocate in their country/work setting for public health approaches for meeting the needs of people with communication disabilities.
hear the approaching warriors in time to seek refuge. When the earthquake and tsunami struck the Indian Ocean in 2004, nearly 1 million persons were displaced and 5 million were deprived of services. The WHO estimated that 5-7% of the people in the shelters or emergency camps had a disability. When the earthquake and gigantic Tsunami struck Japan in 2011, more than 20,000 lives and 500,000 homes were lost. Power outages made it difficult for person on respirators to obtain needed electrical power and severe fuel shortages made it difficult to run portable generators or electronic communication devices. It is estimated that 56% of the victims who lost their lives in the tsunami were over 65 years old, more than double the average. The death ratio among those who were registered as a person with a disability was also twice the average. When earthquakes shattered buildings in Haiti in 2010 persons with communication impairments were limited in their ability to call for help or to respond to those who are seeking survivors in rubble. It is usual for public address messages about evacuation and the location of emergency services to be inaccessible to person with visual and auditory sensory impairment. The WHO estimates that between 7 and 10 percent of the worlds population lives with disabilities. Among displaced persons, the number with disabilities may be even higher such that is it estimated that between 2.5 and 3.5 million of the worlds 35 million displaced persons live with disabilities, one third of them being children. As this seminar will demonstrate how displaced people with communication and sensory disabilities are disproportionately affected by the natural disasters and geo/political conflict and will address how speech pathologists can work with local governments and other agencies in the development of disaster preparedness plans and in meeting the humanitarian needs of displaced and refugee persons with communication impairments. Learning outcomes: attendees will learn: about the issues involving persons with communication and other disabilities who are displaced by tornadoes, hurricanes, floods and tsunamis; about the issues involving persons with communication impairments who are refugees and others forced to migrate from their home country or region because of geo-political conflict including war; attendees will learn about the needs of persons with communication and other disabilities when confronted with natural disaster and/or geo-political conflict; attendees will earn what they can do to address the needs of PWCD in disaster preparedness and prevention of further problems created by disasters and geo-political conflict and in providing services during resettlement and readjustment.
FP235
CROSS-CULTURAL ADAPTATION OF THE ITALIAN VERSION OF THE VOICE ACTIVITY PARTICIPATION PROFILE VAPP GAETANO FAVA (1) COLUMBIA UNIVERSITY MEDICAL CENTER, THE INSTITUTE FOR VOICE AND SWALLOWING- PHELPS MEMORIAL HOSPITAL CENTER, NEW YORK, UNITED STATES (1)
Abstract: Background: The VAPP, originally developed in English, is a selfassessment tool used to measure individuals voice activity limitation and participation restriction. Based on the fact that the cultural/linguistic adaptation is an essential step of validating a protocol in another language, the purpose was to linguistically and culturally adapt the VAPP into Italian. Methods: The adaptation was performed in accordance to the Scientific Advisory Committee of the Medical Outcomes Trust. The translation was performed by one bilingual speech-language pathologist (SLP) and by one bilingual interpreter, who knew about the purpose of this project. A bilingual English teacher, who had not participated in the previous step, performed the back translation. A committee composed by three SLPs specialized in voice and one laryngologist compared the forward and backward translations, to assess for any discrepancies. A final version was produced and called Profilo di Attivit e Partecipazione Vocale-PAPV. A not applicable option was included to each item and was administered to 17 individuals with voice problems, 6 males and 11 females, aged between 21 to 55 years. Results: All items were relevant, as no patients chose the not applicable option. However, four individuals, who had a lower educational level, did not fully understand the instructions of the opening statement. Therefore, the questionnaire was further reviewed and adjusted to clarify the information. Otherwise, no items were changed and/or deleted. The PAPV kept the same structure as the original version. Conclusion: The cultural equivalence of the Italian VAPP was demonstrated and entitled PAPV. PAPV validation is currently in process. Learning outcomes: learn how to perform all the steps of an instrument cultural and linguistic adaptation process; understand the importance of the cultural and linguistic adaptation step in the validation process of a selfrating instrument into another language other than the original; understand the importance of the use of PAPV as a voice-related quality of life instrument to address activity limitation and participation restriction in order to better conduct the intervention process; understand how to administer the PAPV once the validation process has been completed
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WHAT WE NEED TO KNOW ABOUT THE COMMUNICATION NEEDS OF PERSONS DISPLACED DUE TO NATURAL DISASTERS, WAR AND/OR CIVIL CONFLICT DOLORES BATTLE (1) BUFFALO STATE COLLEGE (SUNY), BUFFALO NEW YORK, USA (1)
Abstract: The World Health Organization (WHO) estimates that 35 million people around the world have been displaced because of natural disasters such as floods, earthquakes, hurricanes or tsunamis. In addition the number of persons who have been displaced who have fled their homeland due to civil conflict or war increases daily. Displaced persons of all abilities encounter severe challenges; however, these difficulties are amplified for persons with disabilities. Despite humanitarian efforts to provide care for displaced persons in refugee camps, assistance and protection measures designed for the majority very rarely meet the specific needs of those with disabilities. Persons with disabilities are disproportionately affected by the disaster since many are unable to flee the impending danger or to seek refuge because of mobility impairment. Many are unable to hear or access emergency information. Many persons with communication or sensory impairments are unable to access information about impending danger, such as gunshot, or verbal warnings. For example, in the 1997 Rwanda Genocide, deaf persons in a rehabilitation center were killed because they could not
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THE DUTCH PEDIATRIC VOICE HANDICAP INDEX: A SELF-REPORT INSTRUMENT FOR CHILDREN AGED 7-12 TO MEASURE IMPACT OF DYSPHONIA DOMINIQUE DAUTZENBERG (1) - MARJET BOSMA (1) MEREL FRIS (1) - MAUD SCHOUWERWOU (1) - ELSE DE HAAN (1) - MARIETTA APREA (1) UNIVERSITY OF APPLIED SCIENCES UTRECHT, UTRECHT, NETHERLANDS (1)
Abstract: The objective of this study was to develop a Dutch instrument to evaluate the effects of dysphonia on children. Instead of using parent-proxy reports, we set out to develop a self-report instrument suitable for children aged 7-12 years of age. Based on the Pediatric Voice Handicap Index (Zur et al., 2007), a questionnaire for parents, we constructed The Dutch Pediatric Voice Handicap Index for children (pVHI-k-NL), an instrument that quantifies the functional, physical and emotional consequences of dysphonia as experienced by the child him-/herself. A pilot study was performed to review the usability of the pVHI-k-NL and to obtain an impression of its reliability, internal consistency and (clinical) validity. Seven children with dysphonia and eight healthy children completed the questionnaire. Parents completed a similar questionnaire regarding their child (i.e. parent-proxy report). Usability was reviewed by assessing childrens comprehension of the questions, their ability to complete the questionnaire and the time they needed to complete it. Based on this pilot study we conclude that the comprehensibility of the pVHI-k-NL is satisfactory: children are able to complete the questionnaire on their own and within twenty minutes. A detailed comparison of parent and child responses showed little difference between their scores. The internal consistency of the pVHI-k-NL as a whole appears to be good (Crohnbachs alpha = 0.818). With regard to the subscales, only the physical scale shows good internal consistency (Crohnbachs alpha= 0.804). Total scores were higher for children with dysphonia compared to healthy children (respectively 29 and 9 points on average), influenced mostly by the higher scores obtained by dysphonic children on the physical subscale. Given the limited number of participants in this pilot study, the results regarding reliability and validity should only be considered as indicative. A study to validate this self-report instrument for dysphonic children is currently carried out in the Netherlands. Based on the present study, we believe that the pVHI-k-NL is a useful addition to the clinical practice of speech and language therapists and otorhinolaryngologists working with a pediatric population. Learning outcomes: the Participant will be able to: 1. understand why a self-report instrument is of value regarding clinical decision making in voice disordered patients aged 7-12; 2. understand what changes were made to adapt the pVHI to a self-report instrument for 7-12 year olds; 3. understand what parallel assessment of parent and child responses revealed.
attendants of movement disorders clinic of Rasool Akram hospital, the educational and treating center of Tehran University of Medical Sciences(MDC_ TUMS).Participants were chosen from June until November of 2011 by convenience sampling. VHI total score (VHIT) and its domains including functional(VHIF), Emotional(VHIE) and Physical(VHIP) were assessed in all of participants and by sex. The correlation between VHIT, 3 domains, age and disease duration evaluated by Pearson correlation coefficient based on patients sex. Nearly 83% of PDP reported voice handicap. There wasnt statistical difference between VHIT(r=0.220) and 3 domains in both sex. . VHIT had a positive correlation with age(r=0.339),both VHIF(r=0.303) and VHIE(r=0.381) showed relationship with age. By sex separation the only significant relation was observed between female VHIE and age(r=0.485). There was a correlation between VHIT(r=0.302) and VHIF(r=0.353) with disease duration. By sex segregation, VHIT(r=0.463) and domains showed significantly relationship with disease duration in males group but there was no any correlation between these variables in females. This study indicates that Iranian PD patients have voice handicap and the Persian version of VHI is an appropriate tool for investigation of their perceptions from voice disorder. By increasing of age and disease duration patients feel more voice handicap and need more attention to their voice disorder. Age increasing have important role in females VHI subscales but disease duration in males VHI subscales. The males patient need more protection for voice handicap resulted from PD and its influences on reducing QOL. Learning outcomes: The Participant will be able to: 1. Know about voice disorder and handicap in Iranian PD patients; 2. understand the importance of patient-based assessments like VHI(Persian version) in determination of voice disorder affection on PD quality of life 3. Know the relation between VHI and domains with age and disease duration in Persian-speaking PD patients; 4. Know about sex-based differences between VHI and 3 domains, age, disease duration.
FP238
THE RSR-DSA QUESTIONNAIRE: A SCREENING TOOL FOR THE IDENTIFICATION OF CASES AT RISK OF LEARNING DISABILITIES. RESULTS FROM A RESEARCH POZZOLI ANGELA (1) - CLAUDIA CAPPA (2) PAOLA GUGLIELMINO (2) - SARA GIULIVI (3) DEGREE COURSE IN SPEECH THERAPY, UNIVERSITY OF SPEECH THERAPY, TURIN, ITALY (1) ISAC-CNR TURIN, ITALY, CNR, TURIN, ITALY (2) DFA-SUPSI LOCARNO, SWITZERLAND, DFA-SUPSI LOCARNO, SWITZERLAND, LOCARNO, SWITZERLAND (3)
Abstract: Specific Learning Disabilities (SLD) are often associated with low self-esteem and poor social skills. For this reason it is important to get early detections of children at risk in order to adopt appropriate educational interventions. In Italy, however, there is lack of validated screening tools for the identification of behavioural manifestations of learning difficulties/ disabilities. Moreover, all research studies carried out before 2007 did not make reference to univocal diagnostic criteria. The present study stems from the above considerations and has the aim to: a) check the reliability of the validated RSR-DSA questionnaire as a screening tool for primary school first grade classes; b) verify the correlation between the questionnaire and a speech therapy protocol made up of standardized tests; c) achieve an early identification of children at risk of specific learning disabilities within a whole population, in order to put in place a specific enhancement program. The research consists of a longitudinal study carried out in a town in the district of Turin, Settimo Torinese. It involved all the towns primary schools, for a total of 21 first grade classes. It covered a period of two school years.417 children were recruited for the study, in particular 222 females and 195 males. The two exclusion criteria were certification of mental retardation, according to the Italian Law n 104/92, and prolonged absence from school. A first assessment was carried out at the end of the school year 2011. All children were administered collective dictation and reading comprehension tests by classroom teachers. They were also administered, by speech terapists, an individual decoding test and a metaphonological skills test. At the same time, the RSR-DSA questionnaire was filled in both by teachers and parents. Children were considered at risk of SLD if they failed in at least one task (reading, writing or phonological manipulation). A total of 153 children was identified as at risk. After the identification, parents were suggested to carry out a summer training program based on specific activities aimed to enhance the learning skills of their children. A second level assessment was carried out during the second half of second grade year. Based on teachers reports, 54 out of 153 children no longer manifested learning difficulties. The remaining 99 children who still manifested learning difficulties were administered collective and individual tests for the second grade by speech therapists. 7,4% of children (31) resulted positive in the tests and were put in contact with the health services for further testing, in order to receive a diagnosis. The results of the present study confirmed the suitability of the RSR-DSA questionnaire for the identification of cases at risk. Moreover, they showed that a specific enhancement program allows to discriminate children with learning difficulties from pupils with SLD. Compared to the speech therapy protocol, the questionnaire seems to be a better screening tool: not only does it analyse reading and writing skills, but also calculation, emotional aspects, motor-praxical abilities and
FP237
VOICE HANDICAP INDEX (VHI) IN PERSIAN-SPEAKING PARKINSONS DISEASES PATIENTS FATEMEH MADJDINASAB (1) - NEGIM MORADI (2) GHOLAMALI SHAHIDI (3) - MASOUD SALEHI (4) DEPARTMENT OF SPEECH THERAPY, SCHOOL OF REHABILITATION, AHVAZ JUNDISHAPUR UNIVERSITY OF MEDICAL SCIENCES, AHVAZ, IRAN (1) LECTURER, MUSCULOSKELETAL REHABILITATION RESEARCH CENTER, DEPARTMENT OF SPEECH THERAPY, SCHOOL OF REHABILITATION, AHVAZ JUNDISHAPUR UNIVERSITY OF MEDICAL SCIENCES, AHVAZ, IRAN (2) ASSISTANT PROFESSOR OF NEUROLOGY, TEHRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN (3) ASSISTANT PROFESSOR OF BIOSTATISTICS, FACULTY OF MANAGEMENT AND MEDICAL INFORMATICS, TEHRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN (4)
Abstract: The evaluation of health and treatment results not only must be include of well-being or quality of life(QOL) but also frequency and severity of disease(World Health Organization). The quality of life is a subjective personal concept. Parkinsons disease(PD) is the common progressive neurodegenerative disease that affects all aspects of speech subsystems and reduces patients quality of life. Voice is influenced in PD patients(PDP) more effectively than other speech subsystems. Voice consist of different aspects, so several various assessments are needed for its evaluation. Neither objective nor perceptual assessments can evaluate the amount of handicap resulting from voice disorders (VD). Voice Handicap Index (VHI) is the most applicable subjective self-rating questionnaire used for assessing QOL based on voice handicap. Recently, it is translated and validated in Persian language but there in not any research about VHI and its domains in Iranian PDP solely and by sufficient sample size. The aim of this study was to investigate VHI and 3 domains scores in Persian-speaking PDP; and the probable differences between VHI domains scores(in total patients and both sex) and relation between disease duration with VHI scores. This study was done on 50 PD patients who reported VD resulted from PD. They were selected from
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neuropsychological functions. Furthermore, it is fast and does not involve children directly. Learning outcomes: The participants will be able to: 1. understand the importance of early detections of children at risk of SLD; 2. comprehend the need of validated screening tools for the early stages of the primary school; 3. know the reliability of the RSR-DSA questionnaire for the identification of children at risk.
FP239
A SCREENING ON SPECIFIC LEARNING DISABILITIES IN A HIGH GENETIC HOMOGENEITY AREA CLAUDIA CAPPA (1) - FABRIZIO MELONI (2) - SARA GIULIVI (3) CARLO MUZIO (1) - ANTONINO SCHILIR (2) PAOLA GUGLIELMINO (4) ISAC-CNR TURIN ITALY (1) - SERVIZIO DI NPI ASL 4 DI LANUSEI, ITALY (2) - SUPSI LOCARNO, SWITZERLAND (3) UNIVERSIT DI TORINO, ITALY (4)
Abstract: The present research is about the prevalence of Specific Learning Disabilities in a specific area of Italy, Ogliastra (Sardinia). This region has experienced centuries of isolation, which led to high genetic homogeneity and made the area particularly interesting for studies on different kinds of pathologies. Here we are going to describe the results of a screening carried out in 23 second grade classes in the Ogliastra region, for a total of 285 pupils. The tool used for the screening was RSR-DSA. Questionnaire for the detection of learning difficulties and disorders, for first and second grade. The tool is made up of two checklists, one for parents and one for teachers, in order to collect information about the child not only in relation to the school context, but also with regard to the home context. The checklists items cover 9 areas of competence: reading, writing, calculation abilities, language, memory and attention, motor-praxic area, visual perceptual area, behavioural area, emotional and affective area. The RSR-DSA questionnaire detected 34/285 cases at risk. Due to possible discrepancies between teachers and parents responses, regarding the same aspects of the childs profile, it was considered necessary to analyse the questionnaire results in combination with the overall achievement of the pupils classes. This led to exclude 5 cases out of the above mentioned 34, and to reintroduce further 17 cases out of the original 285. On the whole, 46 pupils (29+17) were considered in need of further examinations. This first epidemiological investigation allowed to detect 5,26% of children with SLD. Among them, 13.33% (0,70% on the total) were cases of SLD in comorbidity with ADHD and another 13.33% were in comorbidity with a language disorder. The prevalence result obtained by the first national epidemiological investigation was 3,1-3,2%, which is much lower than the percentage obtained in the present. Considering the characteristics of the area where the study was carried out, this discrepancy may further confirm the genetic basis of SLD. Further investigation in the territory would be desirable.
study demonstrated the importance of attention to suprasegmental features of language when analyzing reading. These characteristics are important not only to better describe the reading of dyslexic children, but also for the monitoring of fluency in reading at school, with all the students. The scale proved to be an important tool for monitoring fluency in reading and also for identification of poor readers, which would be indicative for monitoring and referral for diagnosis. The Muldidimensional Fluency Scale can be used as a tool for screening and monitoring for both clinicians and teachers in regular classrooms. Learning outcomes: the participant will be able to: comprehend the relationship between prosody and reading, considering the perceptive aspects; visualize the main differences between a group of children with dyslexia and a control group regarding reading fluency and prosody; comprehend that the prosody aspect of fluency reading has a multilanguage variable.
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THE TAKING CHARGE LOGOPEDIC OF THE SWALLOW IN THE CHILD WITH CEREBRAL PALSY: FEEDING, DROOLING AND POSTURAL DYNAMIC. THE BOBATHS CONCEPT LIKE LOGOPEDIC RESOURCES
MONICA PANELLA (1) ASLBI - BIELLA, HOSPITAL, BIELLA, ITALY (1) Abstract: The deglutologycal taking charge of cerebral palsy child, provides, through food intake (when its possible), o non- nutritive endo-oral stimulation, the normalization of the sensivity and the development and/or the improvement of the movements and of the oro-face-mouth functions. Function such as sucking, swallowing, chewing, the closure of the mouth, the control and the salivas management, are integral part of the rehabilitation aspects. The observation and the evaluation by the S.L.P., must include the skills of breathing, of food intake, of moviments of the tongue, verbal and nonverbal communication, recognizing the influence kinetic and postural and turning there into rehabilitation tools. The Bobaths concept identifies in the rehabilitation the person at the heart, with his/her interaction with the environment, the planning and the development of strategie sto achieve the purpose functional. The rehabilitator is the person that facilities efficient response through feedback and feedforward (highly specialized and focussed rehabilitation tools). Learning outcomes: the participants will have targeted and specific information on the assessment, rehabilitation and how to draw the rehabilitation project of the child with cerebral palsy
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APHASIA COMMITTEE SYMPOSIUM Quality of life in aphasia: conceptualisation, measurement and current knowledge
KATERINA HILARI (1) - CLAIRE PENN (2) CITY UNIVERSITY LONDON, UNITED KINGDOM (1) - UNIVERSITY OF WITWATERSRAND, JOHANNESBURG, SOUTH AFRICA (2) Abstract: Intervention and service provision for people with aphasia aim to produce changes in peoples well-being and quality of life. Yet quality of life is an elusive term and clinicians are often uncertain about how to target it in intervention. This presentation will provide a summary of current conceptualisations of quality of life and related concepts. The distinction between the World Health Organisation conceptualisation of quality of life and the more narrowly focused health-related quality of life will be highlighted. We will introduce measurement approaches (generic, disease-specific and domain specific) and provide information about tools that can be used in clinical practice to screen emotional state, social relationships and social support, and quality of life / health-related quality of life. Current research on factors affecting the emotional well-being, social participation and overall quality of life of people with aphasia will be presented. Lastly, implications for intervention will be drawn and the need to incorporate quality of life outcomes in the evaluation of interventions will be raised. Learning outcomes: by the end of this presentation attendees should have a better understanding of: what quality of life in aphasia means; ways of assessing quality of life in aphasia; main factors affecting quality of life in aphasia and implications for intervention of the above.
FP240
THE PERCEPTION OF FLUENCY IN THE READING ALOUD OF DYSLEXIC CHILDREN AND REGULAR READERS LUCIANA MENDONA ALVES (1) - LETICIA CELESTE (2) CSAR REIS (3) - MURIEL LALAIN (4) - ALAIN GHIO (4) IZABELA HENDRIX UNIVERSITY, BELO HORIZONTE, BRAZIL (1) UNIVERSITY OF BRASLIA (UNB), BRASLIA, BRAZIL (2) FEDERAL UNIVERSITY OF MINAS GERAIS (UFMG), BELO HORIZONTE, BRAZIL (3) AIX-MARSEILLE UNIVERSITY, CNRS, LABORATOIRE PAROLE ET LANGAGE (LPL), AIX EN PROVENCE, FRANCE (4)
Abstract: The aim of the study is to: a) test the effectiveness of Multidimensional Fluency Scale in detecting reading problems and assess the impact of prosodic abilities in order to identify dyslexic readers. The methodology consisted of the presentation of sentences extracted from the text reading by dyslexic children and normal developing readers to judges who should classify each extract according to Muldidimensional Reading Fluency Scale. Samples of 3 different sections of the reading of 10 dyslexic children and 10 normal developing readers of the same age and education (mean age 9.5 years), all native speakers of Portuguese, were randomly and blindly presented to 20 judges, 10 of them Brazilian judges and 10 French judges. The experiment was run at Perceval software. Each extract heard by the judges should be classified (noting the characteristics outlined in the scale scores from 1(very abnormal) to 4 (normal), according to the specifications given for each score) on the following items: A. Expression B.Phrasing, and C.Rythm D.Pace. The mean response for dyslexia group were significantly lower when compared to the control group. That is, the scale used works well as an indicator of reading problems because it was able to define well the classification between the two groups, clearly distinguishing the group of dyslexic children as no fluent readers and the group of regular readers as fluent. There was no statistically significant difference in the responses between the Brazilian and French judges. That is, the perception of these suprasegmental features is important for the classification of fluency in reading, regardless of the perceived content read. The conclusion is thus that prosodic skills are strong factors for identifying dyslexic readers. The
An international survey on quality of life in aphasia: results from 16 countries ANU KLIPPI (1) - CLAIRE PENN (2) - FOFI CONSTANTINIDOU (3) NADA EMVA (4) - KATERINA HILARI (5) - SIMON HORTON (6) ANASTASIA RAYMER (7) - LINDA WORRALL (8) - SARAH WALLACE (8) INSTITUTE OF BEHAVIOURAL SCIENCES, UNIVERSITY OF HELSINKI, HELSINKI, FINLAND (1) DEPT SPEECH PATHOLOGY AND AUDIOLOGY, UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, SOUTH AFRICA (2) DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF CYPRUS, NICOSIA, CYPRUS (3)
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UNIVERSITY REHABILITATION INSTITUTE REPUBLIC OF SLOVENIA, LJUBLJANA, SLOVENIA (4) DIVISION OF LANGUAGE AND COMMUNICATION SCIENCE, CITY UNIVERSITY LONDON, LONDON, UNITED KINGDOM (5) SCHOOL OF ALLIED HEALTH PROFESSIONS, UNIVERSITY OF EAST ANGLIA, NORWICH, UNITED KINGDOM (6) OLD DOMINION UNIVERSITY, NORFOLK, VIRGINIA, USA (7) SCHOOL OF HEALTH AND REHABILITATION SCIENCES, THE UNIVERSITY OF QUEENSLAND, QUEENSLAND, AUSTRALIA (8)
Abstract: Quality of life (Qql) in aphasia is an elusive term which has many meanings. Recent research in several countries has acknowledged the importance of this notion for the person living with aphasia and there has been considerable discussion regarding the most appropriate tools for measurement as well as for incorporating this notion into authentic intervention. There is a need to determine how contextual issues influence policy and practices and the IALP aphasia committee has thus initiated a research project involving an international survey on this concept. This presentation will provide preliminary feedback on this survey and will report on the following issues: definition, evaluation and emerging recommendations. Preliminary data from 16 countries will be presented and there will be a consideration of how specific contextual factors such as language, access to services and sociocultural factors interact with frameworks for analyzing the concept of quality of life. The presentation thus hopes to integrate current issues in the field, suggest reasons for the diversity of findings and generate some future international research goals. Learning outcomes: by the end of this presentation attendees should be able to: an international perspective on the definitions and clinical practices of quality of life in aphasia based on the international survey directed to speech and language therapists; variation of the (outcome) measures used in assessing quality of life in aphasia in different countries; how cultural factors interact with frameworks for analyzing the concept of quality of life; and implications for intervention.
as organic vocal fold lesions, glottic insufficiency, laryngopharyngeal reflux, hormonal imbalance, and upper airway infections. MTD can be divided into two groups. Primary MTD, a dysphonia occurs in the absence of organic vocal fold lesions. It is possible to observe normal vocal fold movements, glottic and/or supraglottic constriction, presence of strain and, in some cases, excessive elongation of the vocal folds. Secondary MTD occurs in presence of organic alterations and, besides glottic and supraglottic constriction it is possible to observe vocal folds lesions such as vocal nodules, cysts, polyps and mucosal edema or rigidity. Under physical examination is also possible to observe higher position of the larynx and hyoid bone ate rest, vocal tract constriction, pain in response to increased pressure on the larynx. According to the literature, the main foundations of the voice rehabilitation should include an approach to reduce tension of the laryngeal muscles that can promote normal laryngeal activity and normal voice production. A lower positioning of the larynx may also allow for more balanced phonation. A direct therapy is the traditional approach, and may involve circumlaryngeal manual therapy and vocal exercises. The effectiveness of voice therapy has been shown in randomized studies based on perceptual evaluation of voice quality, voice handicap ratings, and acoustic analysis. Improvements in vocal quality are often perceived in the first therapy session. In the seminar, we will report three cases of MTD, one primary and two secondary, from the evaluation process to the clinical treatment conclusion. The presentation comprises laryngeal images and voice samples obtained in the evaluation process, during the performance of some vocal techniques and after the reduction of symptoms. Learning outcomes: to identify the main characteristics of primary and secondary MTD, by means of theoretical presentation of real cases; to practice the auditory and visual evaluation of cases; to comprehend the clinical rationale for selecting therapeutical approaches.
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CHRONIC COUGH: SYMPTOMS OF A SENSORY DISEASE THOMAS MURRY (1) WEILL CORNELL MEDICAL COLLEGE, CORNELL UNIVERSITY, NEW YORK, UNITED STATES (1)
Abstract: Chronic cough is a significant medical problem worldwide. It accounts for the largest number of patient visits to a doctor. The onset is often unknown. Patients report a number of additional symptoms that often accompany the chronic cough such as hoarseness, breathing difficulties, choking and swallowing problems. The numbers of treatments tried are often directed at problems of the nasopharynx or gastroenterological system in an attempt to control the cough with nasal steroids or decongestants or reflux medicines. The larynx is often overlooked. Non-pulmonary chronic cough may be diagnosed in patients who complain of shortness of breath, choking, and voice disorders. When the larynx is examined, clinicians may observe a normal larynx, inflammation, and/or the presence of paradoxical vocal fold motion. The complaints by the patients may be attributed to clinical observations or they may range from dysphagia, post nasal drip or gastroesophageal reflux disease. Factors such as duration of the condition, time line of which symptom actually came first, and co-occurrence of other conditions make the diagnosis and the treatment a challenge. These factors may include neurological changes, upper respiratory infections or pulmonary disease that have come on since the onset of the cough or may \have been present prior to the cough. In most cases, the true cause of chronic cough is never identified. Moreover, without a definitive diagnosis, treatment often fails and the patient is left to seek other options or even just simply they live with it. In many cases, patients report partial resolution of the problem and stop seeking treatment. In others, medications help to diminish the problem and the patient is satisfied with partial resolution. All too often, these medications offer short term help but after a period of time the symptoms return. The purpose of the presentation is to present data that focuses the diagnosis and treatment of non pulmonary chronic cough on the larynx. Evidence of chronic cough and its relationship to laryngeal dysfunction will be presented through existing evidence and case studies. Learning outcomes: the Participant will be able to: know the common symptoms of long trm, non-pulmonary chronic cough; understand the need to establish a time line for the onset of the chronic cough; know how to interpret a laryngeal exam to determine if vocal fold paresis, paradoxical vocal fold motion or muscle tension dysphonia are contributors to chronic cough.
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EDUCATING SLPS DIFFERENT EXPERIENCES IN BUILDING RESEARCHERS SESSIONS 1 AND 2 BRIAN B. SHULMAN - DOBRINKA GEORGIEVA SHARYNNE MCLEOD - BROOKE HALLOWEL - MASAE SHIROMA JOHN BERNTHAL - LIN HONG CHIN - MATTY LETIHALMES FERNANDA DREUX M. FERNANDES
Abstract: This is the second seminar is proposed by the Education Committee for Speech and Language Pathology. It will be conducted in two 90-minute sessions, with presentations by SLP professors from 10 different countries, all of them with significant experience in research and also in educating speech and language pathologists in undergraduate and graduate levels. These presentations will deal with regarding the role of research in the education process of SLPs. Several experiences and their development will be reported. Discussions will aim to encourage collaborative work and exchanges. Confirmed participants are: Dobrinka Georgieva from Bulgaria; Victor Acosta from Spain; Brian Shullman from the United States; Lindy McAlister from Australia; Lilly Chang from Taiwan; Matti Letihalmes from Finland; Fernanda Dreux from Brazil, representing the Brazilian SLP&A Association; Brooke Hallowell representing the Council for Academic Programs in Communication Sciences and Disorders and John Bernthal, representing ASHAs International Issues Board. Learning outcomes: the participant will be able to: identify the opportunities for including research as a teaching tool in the education of SLPs; propose different levels and demands for students in different steps of the professional education and identify possible associations, common points of interest and alternatives for collaboration, integration and improving communication.
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MUSCLE TENSION DYSPHONIA: CLINICAL CASES ROSIANE YAMASAKI (1) - GLAUCYA MADAZIO (2) MARA BEHLAU (3) CENTRO DE ESTUDOS DA VOZ, HOSPITAL DAS CLNICAS FACULDADE DE MEDICINA DA USP, SO PAULO, BRAZIL (1) CENTRO DE ESTUDOS DA VOZ, SO PAULO, BRAZIL (2) CENTRO DE ESTUDOS DA VOZ, UNIVERSIDADE FEDERAL DE SO PAULO UNIFESP AND INSPER, SO PAULO, BRAZIL (3)
Abstract: Muscle tension dysphonia (MTD) is characterized by excessive tension of the intrinsic and extrinsic laryngeal muscles. The muscle effort can be apparent throughout the vocal tract and involves specific constrictions, which modify the shape and size of the resonators. It is most frequently observed in women, with a typically slow and progression. MTD patients may present with tense voice quality, aphonia, breathiness, hoarseness, excessively high pitch, odynophonia, globus pharyngeous, reduced vocal range and vocal fatigue. The cause of MTD is multifactorial, including personality traits (elevated levels of introversion, neuroticism, anxiety, and depression), vocal misuse, and compensatory mechanisms of an underlying disease such
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FP241
TELE-FON, A PROMISING CONCEPT IN TELE-HEALTH MIEKE MOERMAN, BELGIUM
Abstract: In the field of language pathologists and phoniatrics only few manuscripts concerning tele-therapy have been published. Publications concerning tele-practice for voice therapy are even scarcer. Probably this is due to the fact that designing an applicable software program for voice therapy is very demanding. We take up the challenge to develop software for simultaneous tele-communication, voice registration and analysis both visually as auditory. A close cooperation between phoniatrics, biomedical engineering and informatics resulted in designing Tele-FON, software for providing remote voice therapy. The phoniatrician and speech therapist provide the expert knowledge and developed: 1) Informational database
elaborating on structural, anatomical and functional items. The patient (or therapist) can consult this database at all time. 2) database describing General exercises applicable for all voice pathologies, such as posture, basic breathing exercises , 3) database with Specific exercises such as glottis adduction exercises, resonator exercises, The databases are connected through links, providing additional information. In biomedical engineering the first aim was the proper acquisition and processing of the voice signal (recording takes place in an acoustically non-isolated room), the storage and principal feature extraction, and designing an easy-to-use interface, so that the patient can perform the exercices by himself. The IT department created a quick, private and reliable visual communication via internet. Using the existing videoconference infrastructure with the disadvantage of being committed to certain time blocks and locations evolved to a private communication line between two individuals, independent from space or time. In practice tele-voice therapy commences by a face-to -face contact between therapist and patient, similar to ordinary voice therapy. At this moment the therapist decides which exercises the patient has to perform in a certain period of time, with a certain frequency a week. Tele-FON wants to make telecontacts possible in order to replace some not all!- face-to-face contacts. Tele-FON has a double goal: i) registration of the exercises and ii) providing real time tele-contacts. Tele-intervention offers several advantages: 1) the lack of need for transport stands for a reduction of costs and time. In larger countries such as Australia, USA, Canada distance was an important argument in favor of tele-health; in Europe, however, the traffic overload and waste of time is. 2) reducing transport fits in the environmental awareness. It diminishes pollution and creates the potential for healthier surroundings. 3) Tele-FON enables surveillance by the therapist, increasing therapy compliance and therapy effectiveness. However, the latter statement must still be proven and is subject of the next phase in this project, together with exploring the patients satisfaction. Learning outcomes: the participant will be aware of: the complexity of televoice practice, the demands for tele-intervention, the need of multidisciplinary approach.
quality during vocal production. The aim of this study was to examine acoustic speech characteristics of speech therapist before and after vocal exhaustion by using multidimensional voice analysis. The study included 17 men and women, ages 25 to 45. Multidimensional Voice Program Kay Elemetrics 4300, was used for voice analysis in this research. Statistical packet SPSSv. 13 was used in data processing. The methods of descriptive statistics were applied, as well parametric and nonparametric analysis of correlation between evaluated variables. The obtained results show that the statistically significant differences in average values of parameters occur as a direct result of vocal tiredness. Professional use of voice, along with smoking habits can also be linked to voice change in a speech therapist. Learning outcomes: The aim of this study was to determine if there was vocal tiredness in the group that does not belong to the group of voice professionals. This study was conducted on a relatively small number of people, so no definitive conclusions should be made. However, it was concluded that there were parameters indicating vocal tiredness in speech therapists. Therefore, we can ask ourselves the question: Are speech therapists supposed to be categorized as voice professionals?
FP244
IDENTIFICATION OF DOMINANCE BY MRI-NAVIGATED REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN PATIENTS WITH BRAIN TUMOURS GIANLUCA ISOARDO (1) - MICHELE NADDEO (2) - ANTONIO MELCARNE (2) - ANDREA LIMBERTI (2) - PATRIZIA CANCIALOSI (3) - CAROLA JUNEMAN (2) - DOMENICO SERPELLA (1) - MARIA MADDALENA FERRARIS (4) - MARIA CONSUELO VALENTINI (4) - MAURIZIO BEATRICI (3) - LETIZIA LUCIANO (5) - CESARE SCOPECE (2) - GIULIANO FACCANI (2) SSCVD CLINICAL NEUROPHYSIOLOGY, HOSPITAL CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, TURIN, ITALY (1) SC NEUROSURGERY, HOSPITAL CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, TURIN, ITALY (2) SC RRF GRAVI CEREBROLESIONI ACQUISITE, HOSPITAL CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, TURIN, ITALY (3) SC NEURORADIOLOGY, HOSPITAL CITT DELLA SALUTE E DELLA SCIENZA DI TORINO, TURIN, ITALY (4) SLP DEGREE- MEDICINE FACULTY, UNIVERSITY OF TURIN, TURIN, ITALY (5)
Abstract: Identification of brain language areas location is particularly relevant for proper surgical removal of frontal and temporal tumours. Functional magnetic resonance imaging (fMRI) and intraoperative mapping may identify language areas in patients with brain tumours. However fMRI results may be hampered by peritumoural neovascularisation and intraoperative mapping needs the patient being awake during surgery. High frequency repetitive transcranial magnetic stimulation (hf-rTMS) may temporary disrupt higher cerebral functions, including language. Speech arrest (SA) has been reported in a variable percentage of patients after hfrTMS. Here we report our experience with preoperative MRI-navigated hfrTMS for detection of language dominance in 14 patients with brain tumours (4 males, 10 females, mean age 50.3 18 years). Four of them had glioblastoma multiforme, 3 had oligodendroglioma (grade II in 1, grade III in 2), 1 had astrocitoma grade III, 2 oligoastrocitoma grade III and 3 had metastases. Tumours were involved frontal lobe in 8 (left in 6, right in 2), temporal lobe in 7 (left in 5, right in 2). Navigated 4 Hz rTMS was performed using isotropic 240 x 240 x 240 Gd-enhancing-T1 MRI. After determining the motor hot spot, rTMS was performed at the level of the inferior frontal cortex and around the tumour cortical surface. Stimulation intensity was increased or decreased from 50% of maximal stimulation output (MSO) to the minimal percentage MSO eliciting SA of slurred speech when counting aloud. SA was found at the level of left frontal lobe in 4 patients; 1 patient had SA at the level of right inferior frontal gyrus. In 2 patients it was not possible to induce any speech disturbance. In the remaining patients slurred speech was evident during rTMS. Bilateral or controlateral tonic or phasic contraction of perioral muscles was evident in all but one patient. In all patients fMRI was concordant with the side of dominance. The two patients in which we failed to induce any speech disturbance had symmetrical bilateral activation in in fMRI during language tasks. In conclusion, MRI-navigated rTMS seems to be capable of identifying language lateralisation in patients with brain tumours. Learning outcomes: the attendees will learn: how MRI-navigated rTMS works; how to exploit MRI-navigated rTMS to identify dominance in patients with brain tumours; how to approach and how to collaborate with patients with brain tumours in the preoperative phase.
FP242
EVALUATING THE EFFECIENCY OF EARLY VOICE THERAPY IN UNILATERAL VOCAL FOLD PARALYSIS USING VOICE PROBLEM SELF ASSESSMENT SCALE MANAL MOHAMMED EL-BANNA (EGYPT) (1) UNIVERSITY OF ALEXANDRIA, EGYPT (1)
Abstract: Early Intervention of vocal fold immobility, which is a debilitating disorder, is expected to improve the patients quality of life. The aim of this interventional study was to study the efficacy of early voice therapy in patient with unilateral vocal fold paralysis as revealed by patient-based evaluation. The total number of 42 patients with vocal fold immobility was enrolled in the study, their ages ranged from 22-52 years. The selection of studied population was restricted to patients with iatrogenic or surgical etiologies to be able to determine the onset time of the insult. Patient with clinically significant aspiration were excluded from the study. All studied patients were subjected to protocol of voice evaluation including; complete history taking, auditory perceptual analysis and endoscopic examination. Data regarding quality of life self assessment of patients voice problem using Voice problem self assessment scale (VPSS-20) was collected at initial and follow up assessment. The studied patients were classified into three groups. Group A consisted of 22 patients enrolled in early voice therapy program for 20 sessions; Group B did not receive voice therapy for logistic reasons and Group C was enrolled late in voice therapy session after a period of at least six months. Statistical analysis was used to compare results of initial and follow up data to determine the patients benefit from voice therapy. It was concluded that early voice therapy of unilateral vocal fold paralysis is effective in improving patients quality of life. Voice therapy in general resulted in reduction of glottis gap and improvement of voice quality if applied early while improvement encountered in late onset of voice therapy was attributed to reduction of compensatory hyperfunctional behaviors. Learning outcomes: the Participant will be able to: knowledge the importance of early voice therapy role in management of vocal fold paralysis; understand the effect of early voice therapy in improving voice quality in cases of vocal fold paralysis; determine the efficacy of VPSS-20 in evaluating quality of life in cases vocal fold paralysis.
FP243
THE SPEECH THERAPIST`S VOICE BEFORE AND AFTER VOCAL TIREDNESS SVETLANA TORBICA MARINKOVIC (1) - MARINA RADJELOVIC (1) KRISTINA SULOVIC PETKOVIC (1) CENTER FOR SPECIAL EDUCATION TORBICA, BELGRADE, SERBIA (1)
Abstract: Voice is an extremely variable dimension of speech. Lately, a great progress has been made in broad range of clinical tools that can help in effective measuring voices attributes. Vocal problems, tiredness and exhaustion, are connected to continuous vocal production. Vocal tiredness affects the acoustic characteristics of speech and leads to change in acoustic
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FP245
VOWEL QUALITY AND SPEECH INTELLIGIBILITY OF FINNISH ORAL CANCER PATIENTS 5 YEARS POST-TREATMENT MARIKA MUTTILAINEN (1) - ANNA-MAIJA KORPIJAAKKOHUUHKA (2) - ELSA HORILA (3) TAMPERE UNIVERSITY HOSPITAL, TAMPERE, FINLAND (1) UNIVERSITY OF TAMPERE, TAMPERE, FINLAND (2) CITY OF VANTAA, UNIVERSITY OF TAMPERE, VANTAA, FINLAND (3)
Abstract: Oral cancer is among the 10 most common cancers in the world. Treatment of oral cancer can severely damage a persons speech and swallowing function. Treatment of oral cancer has therefore focused to find the best possible curative treatment that has minimal effect on the oral function. This study focuses on long-term speech production outcome in a small group of Finnish oral cancer patients. In earlier studies vowel formant analyses proved to be a valid measures of speech quality in patients with deviant speech originating from oral cancer. Vowel identity is characterized by acoustic correlates and is primarily determined by its formants. Sixteen participants, 9 male and 7 female (mean age 66, 5 years, SD=8, 02 years), were surgically treated for oral cancer (in 5 cases cancer of the tongue and in 11 cases of the tonsils cancer) between years 2005 and 2007, a mean of 54,56 months (SD =7,65 months) before this study. For thirteen patients a micro vascular reconstruction was completed on the operative site. Two patients were treated only operatively, two had postoperative IMRT radiation therapy, and 11 patients received postoperative chemo radiation (IMRT). The patients with recurrent cancer were excluded. The patients read out a list of Finnish words that included all Finnish vowels (monophthongs) in stressed short and long positions in a sentence like composition. Every vowel was presented in six different consonant surroundings. The data was collected with a Zoom Handy recorder H2 using the 16-bit/44.1kHz WAV format together with AKG C 555 L head microphone. The acoustic data was analyzed with Praat (version 5.2.19 for Windows). The vowel segments, totally 96 per subject, were manually selected from the sentences. For every vowel the first (F1) and second (F2) formants were analyzed. The results were presented as psychoacoustic formant maps. In addition, the patients speech intelligibility in a story generation task was perceptually evaluated by two speech therapists on a 4-point scale. The psychoacoustic maps showed a large interindividual variation of vowel spaces. The vowel spaces of six out of 16 patients matched the normative Finnish psychoacoustic map. Decreased F1 values were found for seven patients, thus their front vowels were located more posteriorly. Decreased F2 values were measured for two patients, their mid and high vowels showing lower than normal position. Only one patient showed clear changes in both F1 and F2 values, and thus a centralized vowel space. The site of the tumor had no statistical significance in relation to vowel formants. Speech intelligibility was evaluated as normal in nine patients, but four patients had mild mild articulatory deviations, two moderate defects and one patient had a severe speech disorder affecting speech intelligibility. Statistically significantly lower intelligibility of speech was perceived in patients with cancer of the tongue than those with cancer of the tonsils. However, the quality of vowel spaces did not predict speech intelligibility in this study. Learning outcomes: The Participant will be able to: 1. to understand how oral cancer treatment may affect vowel production 2. To learn how speakers treated with oral cancer differ from standard Finnish speakers by their monophtong vowels.
Learning outcomes: the participant will: know the key-features on Childhood Apraxia of Speech; understand the need to compare recent insights in CAS to existing diagnostic tools; know the content of the concept for a new checklist in Dutch (translated into English)
SS56
EXPLORING RIGID AND FLEXIBLE STRAWS WITH AND WITHOUT WATER RESISTANCE FOR VOCAL CONDITIONING AND THERAPY GLAUCYA MADAZIO (1) - GISELE OLIVEIRA (2) - MARA BEHLAU (3) CEV, SO PAULO, BRAZIL (1) - CEV, TOURO COLLEGE, NEW YORK, UNITED STATES (2) - CEV, UNIFESP, SO PAULO, BRAZIL (3)
Abstract: Background: The basic premise of the semi-occluded vocal tract exercises (SOVTE) is that vocal lesions can be reduced or even completely resolved if mucosal vibration dose and collision force is reduced. SOVTE provide several adjustments, such as: a more economic and efficient voice production, source-filter interaction (glottic and supraglottic dynamic), a slightly abducted or adducted vocal folds (due to retroflex pressure), reduction of airflow (better respiratory control) and less vocal folds collision force. The continuous use of SOVTE can increase vocal endurance, particularly on vocal fatigue cases and professional voice users. Phonation into tubes is considered a SOVTE and it has been used since the XIXth century. There are many different options of using tubes with different sizes and materials, such as small rigid straws, flexible silicone or rigid glass tubes. Moreover, resistance can be added by inserting the tube in the water. Purpose: The goal of the present workshop is to explore different options of semi-occluded vocal tract exercises with tubes, for improving glottal efficiency. Vocal tract elongation using tubes is a traditional approach in Nordic countries. Recently, the use of thin rigid straw has been heavily promoted for both voice conditioning and therapy. A sequence of combined tubes will also be presented. Procedures: Participants will perform several exercises using the thin hard straw, silicone flexible and rigid glass tubes immersed in water or into the air. A sequence of combined exercises, using first the silicone flexible straw into a bottle of water followed by high resistance exercise with a thin straw into the air will be introduced as an option to creating a better glottic closure and a more stable vibratory pattern, increasing vocal endurance. The main applications of this sequence are the same for any semi-occluded vocal tract exercise: to produce a gentle adduction/abduction, regardless the usual adjustment, and to increase vocal endurance, particularly for vocal fatigue and professional voice. The rationale for using first the flexible tube into the water is to enhance kinesthetic sensations and to improve feedback before going to a more abstract exercise, i.e., blowing sound through a thin straw. This sequence can also be used as a first step for vocal warm-up prior to any regular exercise program, adding a series of low and high notes and glissandi. After mastering the whole sequence, it is easier to trigger the interaction between laryngeal source and vocal tract resonance by using only the sounded lips gesture repeated times. Suggestions for hypo and hyperfunctional conditions will be provided and discussed. Learning outcomes: understand the effect of SOVTE on voice production; learn how to administer the options in using semi-occluded vocal tract exercises with tubes; learn how use the sequence of combined exercises presented at the seminar
FP246
CHILDHOOD APRAXIA OF SPEECH: CHECKLIST REVISITED ANNIEK VAN DOORNIK (1) - MARK PERTIJS (1) OPLEIDING VOOR LOGOPEDIE, HU UNIVERSITY OF APPLIED SCIENCES UTRECHT, UTRECHT, NETHERLANDS (1)
Abstract: Background: Childhood Apraxia of Speech (CAS) is a severe speech sound disorder that still is not fully understood. Despite the unknown origin and the lack of a validated list of diagnostic features, there is consensus for three clinical markers of CAS: (a) inconsistent errors on consonants and vowels in repeated productions of syllables or words, (b) lengthened and disrupted coarticulatory transitions between sounds and syllables, and (c) inappropriate prosody, especially in the realization of lexical or phrasal stress (ASHA, 2007). In the Netherlands, Childhood Apraxia of Speech is diagnosed by speech language therapists using the CAS features checklist 1993 CAS 93 and full assessment by the Dutch version of the Nuffield Dyspraxia Programme (1992). Aims: The present study compared CAS 93 used in the Netherlands with the key features of CAS listed by ASHA (2007) with the aim of developing an updated checklist. Methods: CAS 93 consisting of 53 items based on 12 suspected features of CAS (Erlings et al., 1993) was compared to the key features of CAS listed by ASHA (2007). An additional feature of CAS was added by the investigators to CAS 93, namely, searching articulation, based on research carried out in the Netherlands (Maassen et al., 2009; Terband et al., 2009; Terband et al., 2010). Results: The comparison showed that CAS 93 includes several items that are not specific for CAS. A new checklist was developed consisting of 9 features with a limited set of items allowing efficient identification of CAS by speech language therapists in a clinical setting. Conclusions: CAS 93 should be replaced by the revised checklist that is in accordance with current insights into clinical markers of CAS.
FP247
GRAMMATICALITY AND COMPLEXITY IN THE USE OF SENTENCES IN CHILDREN WITH SPECIFIC LANGUAGE IMPAIRMENT MARIANGELA MAGGIOLO LANDAETA (1) - MARA MERCEDES PAVEZ (1) - CARMEN JULIA COLOMA TIRAPEGUI (2) - CLAUDIA ARAYA (2) PHRISTIAN PEALOZA (2) SCHOOL OF SPEECH AND LANGUAGE PATHOLOGY MEDICAL SCHOOL UNIVERSITY OF CHILE, UNIVERSITY, SANTIAGO OF CHILE, CILE (1) - SCHOOL OF SPEECH AND LANGUAGE PATHOLOGY CENTER FOR ADVANCED RESEARCH IN EDUCATION UNIVERSITY OF CHILE, UNIVERSIT, SANTIAGO OF CHILE, CILE (2)
Abstract: This research discusses the grammatical performance of children with Specific Language Impairment (SLI). The purpose of the study is to characterize and compare the use of sentences in terms of complexity and grammaticality in a group of preschool and school children with SLI. 47 children divided into four groups participated: 10 preschoolers with SLI (4.0 to 5.11 years), 13 school children with SLI (6.0 to 7.11 years), 13 preschoolers with typical language development (TLD) (4,0 - 5.11 years) and 11 school children with typical language development (6.0 to 7.11 years) matched by chronological age with children with SLI. Children narratives, obtained from recounted, were analyzed to identify simple, complex, grammatical and ungrammatical sentences. The results show that preschool children with SLI differ significantly from school children with SLI in the proportion of the total of a) simple sentences (preschoolers 84.3% vs. school children 71.6%), b) complex (preschoolers 15.6% vs. school children 28.3%) and simple ungrammatical (37.4% vs. 25.8%). In relation
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to the grammatical complexity in children with SLI, they present a smaller proportion of complex sentences (preschool children 15.6%, school children 28.3%) than children with TLD (preschoolers 33.9%, school children 37.8%). Regarding grammaticality, both preschoolers with SLI (41.6%) and school children (35.6%) have a higher percentage of ungrammatical sentences than children with TLD (preschoolers 28.3% and school children 14.7%). The results suggest that school children with sli increase their grammatical development because the proportion of complex sentences expands and the percentages of simple and ungrammatical simple sentences decrease. the comparison with children with tld could demonstrate a different pattern in terms of the complexity and ungrammaticality of their sentences, because children with sli produce less complex and more ungrammatical sentences. Learning outcomes: The participants will be able to: Know some evidence that children with SLI present different characteristics from children with typical language development in terms of complexity of the sentences they produce; know that children with SLI make more mistakes in expression than children with typical language development as they show more ungrammaticality in their sentences; know preschool children with SLI produce less complex sentences than school children with sli, suggesting an increase in their grammatical development, despite the nuclear deficit at this level.
FP249
THE EFFECT OF MULTILINGUALISM ON THE DEVELOPMENT OF PHONEMIC AWARENESS - A REVIEW YVONNE WREN (1) - HELEN HAMBLY (1) - SUE ROULSTONE (1) BRISTOL SPEECH & LANGUAGE THERAPY RESEARCH UNIT, FRENCHAY HOSPITAL/UNIVERSITY OF THE WEST OF ENGLAND, BRISTOL, UNITED KINGDOM (1)
Abstract: Multilingualism is the norm in many parts of the world and, with increased migration, it is also becoming more common in countries whose residents are typically monolingual. There is an increasing body of literature on the impact of multilingualism on speech and language development and disorder which it is hoped will assist clinicians and researchers. This paper reports on a review of the literature specifically relating to the development of phonemic awareness in children who are typically developing and multilingual. Phonemic awareness refers to the skills involved in identifying phonemes in speech and develops alongside speech and early literacy development. Children with difficulties in these skills may present with a speech disorder or later, with difficulties acquiring literacy skills. Each language uses a specific set of phonemes and phonotactic rules for combining phonemes in the structure of its sound system. As a child learns to talk, they subconsciously acquire an awareness of these phonemes and rules for combining them specific to the language they hear around them. When children are exposed to two or more languages, they are required to develop phonemic awareness across more than one language. There will usually be some overlap between each language and therefore the child must also learn which features are universal to all of the languages they are exposed to and which are exclusive to each. In order to understand how a child might struggle with this process, resulting in a phonologically based speech disorder, it is important to first understand the way in which typically developing children who are exposed to more than one language manage to develop phonemic awareness skills. The objective of this review was to identify papers which have focused on phonemic awareness in multilingual children and compare their performance with monolingual children to discover common themes which could have a clinical application. The review was part of a larger systematic review of speech acquisition more generally in multilingual children. Seven electronic databases were searched for scientific studies published between 1960 and 2010. Bibliographies were also searched and key authors contacted. Studies were included if i) the sample included individuals speaking more than one language, ii) one of the languages spoken was English, iii) the study investigated an aspect of speech acquisition, such as phoneme repertoire or phonological error patterns, (iv) participants were children (<18yrs). Studies were analysed thematically. A total of 93 studies were identified that fulfilled the criteria of which thirteen studies included phonemic awareness tasks. These were summarised in terms of methods and key findings and a process of quality appraisal was carried out. The results suggested a variable pattern of performance on tasks across multilingual and monolingual children. Variation was shown dependent on the characteristics of the languages spoken with some multilingual children showing an advantage in phonemic awareness skills. Implications for both research and clinical practice will be discussed as well as the degree to which the findings can be generalised to other language pairings. Learning outcomes: at the end of this paper, participants will: understand the role of phonemic awareness in speech development; understand the impact of multilingualism on phonemic awareness; have an overview of studies of phonemic awareness in multilingual children; understand the potential needs of children who are multilingual and speech impaired in the clinical setting.
FP248
SENSITIVITY AND SPECIFICITY FOR NONWORD REPETITION (NWR) AND SENTENCE REPETITION (SR) IN DISCRIMINATING BILINGUAL CHILDREN WITH AND WITHOUT SPECIFIC LANGUAGE IMPAIREMENT (SLI) NATALIA MEIR (1) - SHARON ARMON LOTEM (2) THE ENGLISH DEPARTMENT, BAR-ILAN UNIVERSITY, RAMAT GAN, ISRAEL (1) - GONDA BRAIN RESEARCH CENTER, BARILAN UNIVERSITY, RAMAT GAN, ISRAEL (2)
Abstract: Purpose: Nonword Repetition (Bishop, North, & Donlan, 1996) and Sentence Repetition (Conti-Ramsden, Botting, & Faragher, 2001) are two screening measures that have proven to be reliable markers for teasing apart monolingual children with and without SLI. The study aimed to examine the validity of NWR and SR in Russian as the first language (L1) and Hebrew as the second language (L2) of sequential bilingual Russian-Hebrew speaking pre-school children with typical language development (BiTLD) and a similar group with specific language impairment (BiSLI). Method: 33 bilingual children with TLD (mean age 74.45 months) and 8 bilingual children with SLI (mean age 77.36) participated in the study. The Ravens Coloured Progressive Matrices non-verbal IQ test (Raven, 1998) was administered to control for non-verbal IQ. Background information on children`s age, age of L2/Hebrew onset and the length of exposure to L2/Hebrew was noted via parental questionnaires. Children`s language proficiency (LP) in L1/Russian was measured on The Russian Language Proficiency Test for Multilingual Children (Gagarina, Klassert, & Topaj, 2010) and in L2/Hebrew on the Goralnik Screening Test for Hebrew (Goralnik, 1995). Sentence repetition (SR) tasks were developed for Russian and Hebrew within COST Action IS0804 testing 56 sentences of different length and complexity. Shortened versions of the NWR tasks in Russian and in Hebrew (ArmonLotem & Chiat, 2012) were used. NWR and SR tasks were pre-recorded for the consistency of presentation. Results: BiTLD performed significantly better on SR and NWR in both languages (in L1 and L2) than BiSLI. Better sensitivity, specificity and accuracy rates were yielded for SR in comparison with NWR with higher rates for tasks in L2/Hebrew. Sensitivity for NWR was 63% for L1 and 75% for L2, specificity was 77% for L1 and 71% for L2. Sensitivity for SR was associated with 88% in both languages, whereas specificity was lower (61% for L1 and 70% for L2). Specificity improved when the length of exposure was considered: 82% of BiTLD with more than 2 years of exposure to L2 obtained passing scores on NWR in L2/Hebrew and 91% on SR in L2/Hebrew. A strong association between children`s level of proficiency and SR performance was observed uniquely in each language (for Russian r=.80, p<.001 and for Hebrew r=.77, p<.001). A significant correlation was detected between LP and NWR only in L1/Russian (r=.39, p<.05). Positive correlations were yielded between NWR and SR only in L1/ Russian (r=.54, p<.001). No correlations were detected between the tasks across languages. Conclusions: NWR and SR seem to be potentially useful tools in teasing apart bilingual children with and without SLI. Learning outcomes: participants will: learn about language assessment procedures in a country where there are no bilingual norms for L2/ mainstream language assessment and no standardised norms either for monolingual and bilingual assessment in L1; get familiar with diagnostic power of SR and NWR in bilingual children; gain an understanding of the association between LoE and children`s performance on NWR and SR; understand the relationship between language proficiency in L1 and L2 and children`s performance on NWR and SR.
FP250
PROTOCOL FOR THE EVALUATION OF SPEECH INTELLIGIBILITY IN DYSARTHRIAS: EVIDENCE OF RELIABILITY AND VALIDITY SIMONE DOS SANTOS BARRETO (1) - KARIN ZAZO ORTIZ (2) FLUMINENSE FEDERAL UNIVERSITY, NOVA FRIBURGO, BRAZIL (1) FEDERAL UNIVERSITY OF SO PAULO, SO PAULO, BRAZIL (2)
Abstract: Intelligibility assessments of dysarthric speech have taken on different forms with several methods and procedures described to date. In Brazil, preliminary studies have been conducted to develop an instrument for assessing intelligibility in Brazilian dysarthric speakers, namely, the Protocol for the Evaluation of Speech Intelligibility in dysarthrias (PESI). However, further studies are needed to determine the reliability and validity of its measurements so as to guide its use in both clinical and research settings. The aims of the present study were to assess inter-rater reliability, internal consistency as well as criterion validity of scores for the sentences and words subtests of the PESI. A cross-sectional study was carried out, which was previously approved by the Research Ethics Committee of the Institution. This study included 180 adult volunteers divided into three groups: 30 dysarthric speakers (DG), 30 control speakers (CG) and 120 listeners. Speech samples produced by DG and CG were recorded for intelligibility analysis. Listeners were designated to perform the task of transcribing the recorded speech samples produced by the two groups of speakers. The intelligibility was assessed using the sentences and words subtests from the PESI. These subtests entail sound recording of two lists of speech stimuli
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uttered by the speakers (one list containing 25 sentences and the other with 60 single words), and subsequent orthographic transcription of these samples by the listeners. The transcriptions were analyzed and scored according to the phonemic correspondence between the orthographic transcription and target stimuli. Intelligibility scores were calculated according to percentage words correctly transcribed in each subtest: words of sentences and single words. The intelligibility measurements obtained exhibited a high level of inter-rater reliability, 0.94 for sentences and 0.96 for single words. Regarding internal consistency, a Cronbachs alpha of 0.93 was found for the items from the single word subtest of the PESI. Analysis of the areas under the ROC curves revealed that measurements of intelligibility of sentences and single words from the PESI had a high discriminatory power, respectively 0.82 and 0.95. Comparison between the two areas showed that the single words had significantly greater discriminatory power than sentences (p=0.009). Based on the coordinates on the ROC curves of the speech intelligibility scores, cut-off scores were calculated for each measurement, 96.8 for sentences and 89.5 for single words. Reliability estimates exceeding 0.70 indicate measurements with adequate levels of correlation. The inter-rater reliability and internal consistency found in the present study showed that PESI scores are reliable for these aspects. With regard to the criterion validity of intelligibility scores measured in this study, the two scores had a high discriminatory ability, albeit greater for the single word score. The scores on the sentences and words subtests of the PESI showed satisfactory preliminary evidence of reliability and validity of the construct for inter-rater reliability, internal consistency and criterion validity. It is now important that these results are replicated using larger, more representative samples of the dysarthric population to allow more accurate generalizations. Learning outcomes: the participant will be able toknow the psychometric properties of a test for evaluation of speech intelligibility; know the reliability of the measurements produced by the Protocol for the Evaluation of Speech Intelligibility in dysarthrias (PESI); know the validity of the measurements produced by the PESI; analyze the use of PESI in both clinical and research settings; and (5) know how speech intelligibility of dysarthric population have been evaluated in Brazil.
which is confirmed by the high intrarater reliability. During consensus meetings we reached agreement on type and severity of the dysarthrias in all patients. Most discussions were about terminology and whether symptoms were part of the disorder or a compensation related to the disorder. Training can improve judging skills, but this effect was only present in 2 types of dysarthria. This confirms the need of including training videos to the DDA and a second reliability experiment with experienced SLTs will be conducted, using those training videos. Learning outcomes: after this session, participants are able to: explain low interrater reliability of dysarthria types, also by experienced SLPs; to describe two methods of improving interrater reliability of diagnosing dysarthria types.
FP252
INTELLIGIBILITY ASSESSMENT OF DYSARTHRIC ITALIAN SPEECH: CORRELATIONS BETWEEN ACOUSTIC MEASURES AND AUDITORY PERCEPTUAL RATINGS BARBARA GILI FIVELA (1) - VINCENZO SALLUSTIO (2) SILVIA PEDE (2) - MIRKO GRIMALDI (1) - DANILO PATROCINIO (2) CENTRO DI RICERCA INTERDISCIPLINARE SUL LINGUAGGIO, UNIVERSIT DEL SALENTO, LECCE, ITALY (1) - PHONIATRICS AND COMMUNICATIVE DISORDERS REHABILITATION CENTER, DEPT. REHABILITATION, ASL LECCE, LECCE, ITALY (2)
Abstract: Intelligibility may be defined as the degree to which the speech of a person may be understood by a listener and is related to functional limitation and disability. Intelligibility checks are included in protocols used for clinical assessment of dysarthria, a motor speech disorder of movement or movement control (Duffy 2005), and are usually based on subjective ratings (e.g., in Robertsons Dysarthia Profile (RDP) 1982, Fussi-Cantagallo1999). However, there is a clear need of objective ratings of intelligibility, such as that consisting in the prediction of intelligibility by means of acoustic measures related to vocalic/consonantal contrasts (e.g., Kent et al 1989; Turner et al 1995). Aim of this work is to check the correlation between intelligibility judgements, subjectively assigned by listeners according to a regular clinical procedure (RDP), and acoustic measurements relating to both segments (Vs,Cs) and prosodic-intonational linguistic events (e.g., pitch accents in statement-question and focus interpretation). The hypotheses are that 1) there are acoustic measures of linguistically relevant events that are correlated to speech intelligibility, at both segmental and prosodic level; 2) as for the latter, the timing of prosodic-intonational events with respect to segments is a good predictor of intelligibility. Moreover, as phonetic complexity may easily affect articulation accuracy, another hypothesis is that 3) intelligibility predictions can be made not only by checking the accuracy in distinguishing specific (vocalic/consonantal) contrasts, but also by analysing articulation accuracy in contexts of increasing phonetic complexity (e.g., in consonant-clusters and intonational events rising-falling F0 on the same syllable). The corpus used was composed by two blocks, for investigating word and intonation-prosody production respectively. In the first block, 30 bisyllabic, initially-stressed target-words showed initial syllables including consonants and clusters of increasing phonetic complexity, due to the number of Cs and to their place of articulation; they were proposed in isolation, in pairs and within a brief passage (for control, clusters were also produced in monosyllabic-pseudowords in both isolation and carrier sentences). In the second block, 10 target utterances represented statements and questions, with falling and rising intonation patterns, and showed different focus structures, one of which, in Italian, induces the realization of risingfalling patterns aligned with one syllable. Twenty Parkinson Desease patients and 10 controls were recorded while reading the corpus aloud at XX-hospital. Firstly, materials were judged by three raters, by using the RDI 4-point scale, and inter-rater reliability was calculated; secondly, acoustic analysis was performed, by manually labelling relevant landmarks and automatically extracting acoustic measures (e.g., time/frequency at landmarks, Cs andVs duration, F2, fricative noise and burst amplitude, amplitude for adjacent Cs, tonaltarget-to-segmental-boundary latency). Preliminary results confirm finding described in the literature and show that intelligibility ratings correlate with various acoustic measures relating to segments. Moreover, as for the intonational-prosodic level, a strong acoustic-to-intelligibility correlation regards timing, as tonal events appear to be anticipated with respect to segments at lower intelligibility levels. Finally, acoustic results confirm that phonetic complexity affects accuracy in production and correlates to intelligibility judgements, at both segmental and prosodic-intonational level, offering extra evidence for acoustic-to-intelligibility predictions. Learning outcomes: the Participant will be able to: know benefits and drawbacks of the main methods used to assess dysarthric speech intelligibility; understand the importance of prosody and intonation for speech intelligibility; know which are the acoustic measures that better correlate with auditory perceptual ratings, as for both the segmental string, that is vowels and consonants that compose words and sentences, and prosodic and intonational events; understand that there may be language-specific aspects that have to be taken into account when applying specific procedures and when comparing results with those described in the scientific literature.
FP251
THE DUTCH DYSARTHRIA ASSESSMENT: ALSO A RELIABLE INSTRUMENT? SIMONE KNUIJT (1) - HANNEKE KALF (1) - HARRY GOOS (2) PUCK GOOSSENS (3) - JUDITH KOCKEN (4) - LOTTE KROMHOUT (5) - BERT DE SWART (3) - ALEXANDER GEURTS (6) DEPARTMENT OF REHABILITATION / SPEECH LANGUAGE PATHOLOGY, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (1) - INSTITUTE OF HEALTH STUDIES AND DEPARTMENT OF SPEECH THERAPY, HAN UNIVERSITY OF APPLIED SCIENCES NIJMEGEN AND HOSPITAL RIVIERENLAND TIEL, NIJMEGEN AND TIEL, NETHERLANDS (2) - INSTITUTE OF HEALTH STUDIES AND DEPARTMENT OF REHABILITATION / SPEECH LANGUAGE PATHOLOGY, HAN UNIVERSITY OF APPLIED SCIENCES NIJMEGEN AND RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (3) - DEPARTMENT OF SPEECH THERAPY, RIJNSTATE HOSPITAL, A, NETHERLANDS (4) - DEPARTMENT OF SPEECH THERAPY, CANISIUS WILHELMINA HOSPITAL, NIJMEGEN, NETHERLANDS (5) - DEPARTMENT OF REHABILITATION / REHABILITATION MEDICINE, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTRE, NIJMEGEN, NETHERLANDS (6)
Abstract: Purpose: From 2010 to 2012 the Dutch Dysarthria Assessment (DDA) has been developed and validated. A two round Delphi process was used to reach consensus about the speech tasks, assessment form and tutorial. The DDA was validated against two questionnaires, an intelligibility test and a fluency task. The purpose of the current study was to investigate the reliability of the DDA. Method: Fifty-four patients with dysarthria were examined using the pre-final version of the DDA and all assessments were videotaped. To calculate interrater reliability, dysarthria type and severity of 43 patients were judged by three experienced speech language therapists (SLTs), who were blinded to the medical diagnose. For intrarater reliability, one SLT judged 10 patients two times with an interval of two weeks. To examine if training would improve the diagnostic skills of students 28 speech language therapy students judged 10 patients before and after a one-day training. Results: The interrater reliability on the severity was good (ICC = .83), but the interrater reliability on the different types of dysarthria was only high for the hypokinetic dysarthrias (Kappa = .80). For the other dysarthrias the Kappas were .26 for flaccid, .36 for spastic, -.04 for hyperkinetic and .30 for undetermined dysarthria, while the intrarater reliability regarding dysarthria types was good (Kappas between .62 and 1 on the different types). Therefore consensus meetings were organized to analyze and improve consensus about the type of the dysarthrias. After training, students were significantly better in diagnosing dysarthria types in particular the hypokinetic (p = .003) and hyperkinetic (p = .014) dysarthrias. Discussion: Much to our surprise, the interrater reliability of dysarthria types by experienced SLTs was rather low. Apparently, experienced clinicians judge dysarthria types on a more individually shaped pattern of characteristics then we expected,
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