Intensive speech therapy, combined with the use of the speech bulb, yielded positive outcomes in the rehabilitation of a clinical case with severe speech disorders associated with velopharyngeal dysfunction in Pierre Robin Sequence.
Pinto, MDB. Resultados da fonoterapia intensiva para correção da oclusiva glotal e fricativa faríngea na fissura labiopalatina [tese].
Introduction Compensatory articulations are speech disorders due to the attempt of the individual with cleft palate/velopharyngeal dysfunction to generate intraoral pressure to produce high-pressure consonants. Speech therapy is the indicated intervention for their correction, and an intensive speech therapy meets the facilitating conditions for the correction of glottal stop articulation, which is the most common compensatory articulation. Objective To investigate the influence of an intensive speech therapy program (ISTP) to correct glottal stop articulation in the speech of individuals with cleft palate. Methods Speech recordings of 37 operated cleft palate participants of both genders (mean age = 19 years old) were rated by 3 experienced speech/language pathologists. Their task was to rate the presence and absence of glottal stops in the 6 Brazilian Portuguese occlusive consonants (p, b, t, d, k, g) distributed within several places in 6 sentences. Results Out of the 325 pretherapy target consonants rated with glottal stop, 197 (61%) remained with this error, and 128 (39%) no longer presented it. The comparison of the pre- and posttherapy results showed: a) a statical significance for the p1, p2, p3, p4, t1, k1, k2 and d6 consonants (McNemar test; p < 0.05); b) a statistical significance for the p consonant in relation to the k, b, d, g consonants and for the t consonant in relation to the b, d, and g consonants (chi-squared test; p < 0.05) in the comparison of the proportion improvement among the 6 occlusive consonants. Conclusion The ISTP influenced the correction of glottal stops in the speech of individuals with cleft palate.
A fissura de lábio e palato envolve a região do rebordo alveolar, podendo ocasionar desenvolvimento anômalo dos dentes, na região da falha que alteram o alinhamento dentário, comprometendo a estética do sorriso. Além disso, as cirurgias para sua correção podem apresentar efeitos restritivos no desenvolvimento da maxila trazendo alterações no terço médio da face, incluindo a atresia maxilar. Esta pode acarretar em instabilidade oclusal, estética insatisfatória, alterações fonéticas e respiração bucal. Uma vez que as cirurgias de correção da fissura de palato não tenham sido completamente bem sucedidas, o indivíduo pode apresentar uma disfunção velofaríngea. Esta compromete o equilíbrio da ressonância entre as cavidades nasal e oral, ocasionando alterações na fala como: compensações articulatórias e hipernasalidade. A proposta deste trabalho é descrever a reabilitação protética de um paciente, do sexo masculino, 26 anos de idade, com fissura transforame incisivo bilaterale diagnósticos de atresia maxilar e disfunção velofaríngea, devido às sequelas pós-cirúrgicas. Com o objetivo de reabilitar a estética e as funções orais deste indivíduo, foi confeccionada uma prótese parcial removível de recobrimento, retida por coroas metálicas fresadas, nos dentes 23 e 26, e coroas metálicas nos dentes 13 e 16, unidas por uma barra e uso de sistema barra-clip, para melhorar sua retenção. Para a reabilitação de fala, foi proposto um obturador faríngeo associado à prótese dentária. Conclui-se que este tratamento proporcionou melhora da sua estética, bem como as funções alimentação e fala, proporcionando, assim, melhora da autoestima e qualidade de vida do indivíduo.
Purpose: to investigate the effectiveness of a pharyngeal bulb prosthesis to eliminate hypernasality in patients with operated cleft palate presenting with diagnosis of hypodynamic velopharynx. Methods: twenty patients with cleft palate, ages 11-40 years, presenting hypodynamic velopharynx participated in the study. Patients had their speech audio recorded twice, with and without prosthesis, simultaneously with nasometry. Three speechpathologists rated the presence and absence of hypernasality. Perceptual and nasometric data without and with prosthesis were compared, using the McNemar Test (p<0.05). Results: three (15%) patients presented hypernasality without prosthesis and normal resonance with prosthesis, 3 (15%), normal resonance without prosthesis and hypernasality with prosthesis, 9 (45%), hypernasality without and with prosthesis, and 5 (25%), normal resonance in both conditions. Nasometry (≤27% cut off): 1 (5%), presented scores >27% without prosthesis and <27% with prosthesis, 2 (10%), scores <27% without prosthesis and >27% with prosthesis, 17 (85%), scores >27% in both conditions, and 1(5%), scores <27% in both conditions. The comparisons between the results were not significant (p=1.000). Conclusion: the pharyngeal bulb prosthesis alone is insufficient to eliminate hypernasality of patients presented with hypodynamic velopharynx. To this purpose, the combination between the prosthesis and speech therapy is required.
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