Nasoendoscopy of velopharynx before and during diagnostic therapy

Nasoendoscopy is an important tool for assessing velopharyngeal function. The purpose of this study was to analyze velar and pharyngeal wall movement and velopharyngeal gap during nasoendoscopic evaluation of the velopharynx before and during diagnostic therapy. Nasoendoscopic recordings of 10 children with operated cleft lip and palate were analyzed according to the International Working Group Guidelines. Ratings of movement of velum and pharyngeal walls, and size, location and shape of gaps were analyzed by 3 speech-language pathologists (SLPs). Imaging was obtained during repetitions of the syllable /pa/ during a single nasoendoscopic evaluation: (a) before diagnostic therapy, and (b) after the children were instructed to impound and increase intraoral air pressure (diagnostic therapy). Once the patients impounded and directed air pressure orally, the displacement of the velum, right, left and posterior pharyngeal walls increased 40, 70, 80, and 10%, respectively. Statistical significance for displacement was found only for right and left lateral pharyngeal walls. Reduction in gap size was observed for 30% of the patients and other 40% of the gaps disappeared. Changes in gap size were found to be statistically significant between the two conditions. In nasoendoscopic assessment, the full potential of velopharyngeal displacement may not be completely elicited when the patient is asked only to repeat a speech stimulus. Optimization of information can be done with the use of diagnostic therapy's strategies to manipulate VP function. Assuring the participation of the SLP to conduct diagnostic therapy is essential for management of velopharyngeal dysfunction

Occurrence of consonant production errors in liquid phonemes in children with operated cleft lip and palate

Information about the prevalence of consonant production errors, including compensatory articulations (CA), in individuals with cleft lip and palate (CLP) who speak Brazilian Portuguese is limited, particularly regarding liquid sounds. The literature primarily reports the occurrence of CA for plosive and fricative sounds, since occurrence of CAs in sounds that require higher amounts of oral air pressure is expected. While the use of CA during liquid sound production is not expected, clinical experience suggests that individuals with CLP present with inadequate backing, elevation, and anteriorization of the tongue as well as tongue clicks during production of /r/ and /l/. Objectives: Describe the occurrence of consonant error productions during liquid sounds for children with CLP; compare the occurrence between children operated with the Furlow and von Langenbeck techniques for palatoplasty; and compare the occurrence between children operated between 9-12 months and 15-18 months of age at primary palatoplasty. Material and Methods: A sample of 397 children (237 males and 160 females) with operated unilateral CLP was studied. In this group, 163 underwent palatoplasty with the Furlow procedure and 234 with the modified von Langenbeck procedure. Age at palatoplasty was between 9 and 12 months for 189 children and between 15 and 18 months for 208 children. Data about production of /l/, /r/, /R/, /λ/ and consonant clusters /l/ and /r/ were obtained from speech pathology records. Speech pathologists registered the speech findings after an auditory-perceptual evaluation of the participants at the sixth year of age. Results: The use of middorsum palatal place (MDP) of production was identified for 2% of the sample. Tongue anteriorization of the /l/ production was observed for 55% of the children. No significant difference was found related to surgical technique, but children operated earlier developed the use of the consonant cluster /r/ sooner than children operated later (p=0.040). Conclusion: We found a low occurrence of use of cleft related CA during attempts of production of liquid phonemes, and the variable age at primary palatoplasty significantly interfered with the acquisition of consonant cluster /r/

Compensatory articulation associated to cleft palate or velopharyngeal dysfunction: literature review

TEMA: articulação compensatória na fissura palatina. OBJETIVO: contribuir para o aprofundamento de informações sobre os tipos de articulação compensatória descritos na literatura e, ainda, discutir as implicações e contribuições da avaliação clínica e instrumental na identificação destas produções. CONCLUSÃO: as articulações compensatórias merecem a atenção de clínicos e pesquisadores que atuam no Brasil, já que estas alterações são encontradas com grande freqüência em crianças e adultos com fissura palatina ou disfunção velofaríngea, o que compromete a qualidade de vida destes sujeitos. Os fonoaudiólogos devem aprofundar seus conhecimentos sobre os tipos de articulação compensatória e os procedimentos de avaliação, bem como devem estabelecer programas preventivos que favoreçam a aquisição fonológica sem o desenvolvimento dessas compensações.BACKGROUND: compensatory articulation in cleft lip and palate. PURPOSE: to contribute with information regarding the types of compensatory articulation described in the literature and discuss the implications and contributions of clinical and instrumental evaluation of these speech productions. CONCLUSION: compensatory articulation deserves attention from Brazilian physicians and researchers, since that these productions occur in children and adults with cleft palate and velopharyngeal dysfunction, compromising their speech intelligibility and consequently quality of their lives. Speech-language pathologists need to improve knowledge regarding different types of compensatory articulation and also on the procedures for evaluating these productions, in order to settle preventive programs that favor phonological acquisition in children with cleft palate without developing compensatory articulation

Association for the work of users of Mental Health Care according to the assessment of its workers: operation, overload/satisfaction, promotion of citizenship

Atualmente os servios em sade mental buscam a incluso social dos usurios atravs do trabalho. Diante dessa proposta, os objetivos desta pesquisa foram caracterizar o funcionamento de uma Associao de Trabalho voltada para usurios de servios de sade mental, identificando a satisfao e a sobrecarga gerada nos profissionais, bem como identificar as concepes dos trabalhadores sobre o processo de construo de cidadania dos usurios. Participaram desse estudo os 10 funcionrios da Associao localizada no Estado de Gois. Foram realizadas entrevistas e aplicadas duas escalas, uma sobre a sobrecarga no trabalho e outra sobre a satisfao com o trabalho. Foi possvel identificar que a Associao se encontra organizada nos princpios da Reforma Psiquitrica e que os funcionrios se encontram satisfeitos com o trabalho desenvolvido e com baixa sobrecarga. H, ainda, entre os trabalhadores, um entendimento em relao aos benefcios proporcionados pela associao no que tange construo da cidadania.Nowadays mental health services seek social inclusion through work. Given this proposal, the objectives of this research were to characterize the functioning of a Work Association focused on users of mental health services, identifying satisfaction and overload of work carried by professionals as well as the conceptions of the workers on the process of constructing the users as citizens. Ten employees of the Association in the State of Gois took part of this study. They were interviewed and two scales were applied, one on the overload of work, and the other on job satisfaction. It was possible to identify that the Association is organized on the principles of psychiatric reform and that employees are satisfied with the developing work and with low load of work. Among the workers, there is also an understanding of the benefits provided by the association regarding the construction of citizenship

Associação para o trabalho de usuários em Saúde Mental segundo a avaliação dos seus funcionários: funcionamento, sobrecarga/satisfação, promoção de cidadania

Nowadays mental health services seek social inclusion through work. Given this proposal, the objectives of this research were to characterize the functioning of a Work Association focused on users of mental health services, identifying satisfaction and overload of work carried by professionals as well as the conceptions of the workers on the process of constructing the users as citizens. Ten employees of the Association in the State of Goiás took part of this study. They were interviewed and two scales were applied, one on the overload of work, and the other on job satisfaction. It was possible to identify that the Association is organized on the principles of psychiatric reform and that employees are satisfied with the developing work and with low load of work. Among the workers, there is also an understanding of the benefits provided by the association regarding the construction of citizenship.Atualmente os serviços em saúde mental buscam a inclusão social dos usuários através do trabalho. Diante dessa proposta, os objetivos desta pesquisa foram caracterizar o funcionamento de uma Associação de Trabalho voltada para usuários de serviços de saúde mental, identificando a satisfação e a sobrecarga gerada nos profissionais, bem como identificar as concepções dos trabalhadores sobre o processo de construção de cidadania dos usuários. Participaram desse estudo os 10 funcionários da Associação localizada no Estado de Goiás. Foram realizadas entrevistas e aplicadas duas escalas, uma sobre a sobrecarga no trabalho e outra sobre a satisfação com o trabalho. Foi possível identificar que a Associação se encontra organizada nos princípios da Reforma Psiquiátrica e que os funcionários se encontram satisfeitos com o trabalho desenvolvido e com baixa sobrecarga. Há, ainda, entre os trabalhadores, um entendimento em relação aos benefícios proporcionados pela associação no que tange à construção da cidadania

Speech in different oral prosthetic rehabilitation modalities for elderly individuals

TEMA: a produção da fala nas modalidades de reabilitação oral protética. OBJETIVO: verificar se o tipo de reabilitação oral interfere na produção da fala. MÉTODO: 36 idosos (média = 68 anos), divididos em 3 grupos, foram avaliados: 13 com dentes naturais (A), 13 com prótese total mucosossuportada superior e inferior (B) e 10 com prótese total mucosossuportada superior e implantossuportada inferior (C). A estabilidade das próteses foi avaliada por um dentista e amostras de fala foram analisadas por 5 fonoaudiólogos. Para determinar a freqüência de alteração dos sons da fala utilizou-se o cálculo da Porcentagem de Consoantes Corretas (PCC). RESULTADOS: observou-se poucos casos com alteração de fala, com maior freqüência no grupo C (23,08%), sendo a articulação travada presente em todos os grupos, a redução dos movimentos labiais em dois grupos (A e B) e a articulação exagerada e a falta de controle salivar em um dos grupos (C e B). Quanto à PCC, menor valor foi observado para os fones linguodentais nos grupos B e C (maior ocorrência de alteração), seguido dos fones alveolares, predominando casos sem alteração no grupo A, contrariamente aos demais grupos, sendo a projeção lingual e o ceceio as alterações mais encontradas. Não houve diferença entre os grupos e a maioria do grupo B estava com a prótese inferior insatisfatória, não havendo associação entre alteração de fala e prótese insatisfatória. CONCLUSÃO: apesar da amostra pequena, indivíduos reabilitados com prótese total apresentam alteração nos fones linguodentais e alveolares e o tipo de prótese, bem como a estabilidade desta parece não interferir na produção da fala.BACKGROUND: speech production in different modalities of oral prosthetic rehabilitation. AIM: to study the speech production of subjects submitted to different oral rehabilitation modalities. METHOD: 36 elderly individuals (average = 68 years) of both gender were evaluated. Participants were divided in three groups: 13 subjects with natural teeth (A); 13 edentate using maxillary and mandibular conventional dentures (B); and 10 edentate using maxillary conventional dentures and mandibular implant-supported prosthesis (C). Prosthesis stability was evaluated by a dentist and speech samples were analyzed by five speech-language pathologists. In order to determine the frequency of speech sound alterations, the Percentage of Correct Consonants (PCC) was used. RESULTS: few individuals presented speech alterations. Group C presented a higher occurrence of speech alterations (23.08%). Locked articulation was present in all groups; the reduction in lip movement was observed for groups A and B; exaggerated articulation and absence of saliva control was observed for group C. A smaller Percentage of Correct Consonants value was observed for the linguodental phonemes, in groups B and C, followed by the alveolar phonemes. Group A presented the majority of individuals with no speech alterations. On the other hand, for groups B and C, lisp and tongue projection was frequently observed. No statistical difference was found between the groups. Most of the individuals in group B presented unsatisfactory prosthesis stability, but no association was identified between speech alterations and prosthesis stability. CONCLUSION: despite the small sample, the results of the study suggest that individuals using dentures present alterations in linguodental and alveolar phonemes. The type of prosthesis and its stability do not seem to interfere in speech production

β1 integrin and IL-3R coordinately regulate STAT5 activation and anchorage-dependent proliferation

We previously demonstrated that integrin-dependent adhesion activates STAT5A, a well known target of IL-3–mediated signaling. Here, we show that in endothelial cells the active β1 integrin constitutively associates with the unphosphorylated IL-3 receptor (IL-3R) β common subunit. This association is not sufficient for activating downstream signals. Indeed, only upon fibronectin adhesion is Janus Kinase 2 (JAK2) recruited to the β1 integrin–IL-3R complex and triggers IL-3R β common phosphorylation, leading to the formation of docking sites for activated STAT5A. These events are IL-3 independent but require the integrity of the IL-3R β common. IL-3 treatment increases JAK2 activation and STAT5A and STAT5B tyrosine and serine phosphorylation and leads to cell cycle progression in adherent cells. Expression of an inactive STAT5A inhibits cell cycle progression upon IL-3 treatment, identifying integrin-dependent STAT5A activation as a priming event for IL-3–mediated S phase entry. Consistently, overexpression of a constitutive active STAT5A leads to anchorage-independent cell cycle progression. Therefore, these data provide strong evidence that integrin-dependent STAT5A activation controls IL-3–mediated proliferation

Achados espectrais das vogais [a] e [ã] em diferentes aberturas velofaríngeas

BACKGROUND: the size control of velopharyngeal opening is an important variable for the acoustic profile characterization of hypernasal speech. AIM: to investigate frequency spectral aspects of F1, F2, F3, nasal formant (FN) and anti-formant, in Hertz, for vowels [a] and at different velopharyngeal openings produced in the bulb of a palatal prosthesis replica used by a patient with velopharyngeal insufficiency. METHOD: speech recordings were obtained for four words (pato/mato and panto/manto) produced within a carrier phrase in 5 conditions of velopharyngeal functioning: prosthesis with no openings (control condition: CC); prosthesis with bulb opening of 10mm² (experimental condition with 10mm² opening: EC10), prosthesis with a 20mm² opening (EC20), prosthesis with a 30mm² openning (EC30), and without the prosthesis (ECO). Five speech-language pathologists made a live rating of speech nasality during the reading of an oral passage. The recordings were used for spectral analysis. RESULTS: F1 values were significantly higher for [a] when compared to in all conditions. F2 values for [a] in EC20 and EC30 were significantly lower than values in the other conditions, being closer to the values presented for . F3 values were not significantly different between the testing conditions. There was a relationship between FN and anti-formants, and the auditory perception of nasality for conditions EC10 and EC20. CONCLUSION: significant changes were observed in the studied spectral values according to changes in the velopharyngeal opening size.TEMA: o controle do tamanho da abertura velofaríngea é uma variável importante na caracterização do perfil acústico da fala hipernasal. OBJETIVO: investigar os aspectos espectrais das frequências de F1, F2, F3, formante nasal(FN) e anti-formante, em Hertz, para as vogais [a] e [ã] na presença de aberturas feitas no bulbo de réplicas da prótese de palato de uma paciente com insuficiência velofaríngea. MÉTODO: gravações de produções de quatro palavras (pato/mato e panto/manto) inseridas em frase veículo foram obtidas em cinco condições de funcionamento velofaríngeo: prótese sem aberturas (condição controle: CC), prótese com abertura de 10mm² no bulbo (condição experimental - CE10), com abertura de 20mm² (condição experimental - CE20), com abertura de 30mm² (condição experimental - CE30), e sem prótese (condição experimental aberta - CEA). Cinco fonoaudiólogos julgaram a nasalidade de fala ao vivo, durante a leitura de um texto oral. As gravações foram usadas para análise espectral. RESULTADOS: valores de F1 foram significativamente mais altos para [a] que para [ã] em todas as condições. Valores de F2 para [a] em CE20 e CE30 foram significantemente mais baixos que nas outras condições, aproximando-se dos valores para [ã]. Valores de F3 não foram significativamente diferentes nas diferentes condições. Houve relação entre os achados de FN e anti-formantes e a percepção de nasalidade para as condições CE10 e CE20. CONCLUSÃO: foram observadas mudanças significativas nos valores espectrais estudados de acordo com alterações no tamanho da abertura velofaríngea.Universidade Estadual de Campinas Instituto de Estudos da LinguagemUniversity of FloridaUniversidade de São Paulo Hospital de Reabilitação de Anomalias Craniofaciais Laboratório de Fonética ExperimentalUniversidade Estadual de São Paulo Departamento de FonoaudiologiaUniversidade Federal de São Paulo (UNIFESP)USP Faculdade de Odontologia de Bauru Departamento de FonoaudiologiaUniversidade Estadual de Campinas Instituto de Estudos da Linguagem Departamento de LinguísticaUNIFESPSciEL

Nasalance and nasality at experimental velopharyngeal openings in palatal prosthesis: a case study

The use of prosthetic devices for correction of velopharyngeal insufficiency (VPI) is an alternative treatment for patients with conditions that preclude surgery and for those individuals with a hypofunctional velopharynx (HV) with a poor prognosis for the surgical repair of VPI. Understanding the role and measuring the outcome of prosthetic treatment of velopharyngeal dysfunction requires the use of tools that allow for documenting pre- and post-treatment outcomes. Experimental openings in speech bulbs have been used for simulating VPI in studies documenting changes in aerodynamic, acoustic and kinematics aspects of speech associated with the use of palatal prosthetic devices. The use of nasometry to document changes in speech associated with experimental openings in speech bulbs, however, has not been described in the literature. Objective: This single-subject study investigated nasalance and nasality at the presence of experimental openings drilled through the speech bulb of a patient with HV. Material and Methods: Nasometric recordings of the word "pato" were obtained under 4 velopharyngeal conditions: no-opening (control condition), no speech bulb, speech bulb with a 20 mm² opening, and speech bulb with 30 mm² opening. Five speech-language pathologists performed auditory-perceptual ratings while the subject read an oral passage under all conditions. Results: Kruskal-Wallis test showed significant difference among conditions (p=0.0002), with Scheffé post hoc test indicating difference from the no-opening condition. Conclusion: The changes in nasalance observed after drilling holes of known sizes in a speech bulb suggest that nasometry reflect changes in transfer of sound energy related to different sizes of velopharyngeal opening

The Importance of Accounting for Landscape Position When Investigating Grasslands: A Multidisciplinary Characterisation of a California Coastal Grassland

Grasslands are one of the most common land-cover types, providing important ecosystem services globally, yet few studies have examined grassland critical-zone functioning throughout hillslopes. This study characterised a coastal grassland over a small hillslope at Point Reyes National Seashore, California, using multidisciplinary techniques, combining remotely-sensed, geophysical, plant, and soil measurements. Clustering techniques delineated the study area into four landscape zones, up-, mid-, and down-slope, and a bordering riparian ecotone, which had distinct environmental properties that varied spatially across the site, with depth, and time. Soil moisture increased with depth and down slope towards a bordering riparian zone, and co-varied with soil CO2 flux rates both spatially and temporally. This highlighted three distinct controls of soil moisture on soil respiration: CO2 fluxes were inhibited by high moisture content in the down-slope during the wet winter months, and converged across landscape positions in the dry summer months, while also displaying post-rain pulses. The normalised difference vegetation index (NDVI) ranged from 0.32 (September)–0.80 (April) and correlated positively with soil moisture and aboveground biomass, moving down slope. Yet, NDVI, aboveground biomass, and soil moisture were not correlated to soil organic carbon (SOC) content (0.4%–4.5%), which was highest in the mid-slope. The SOC content may instead be linked to shifts in dominant grassland species and their rhizosphere properties with landscape position. This multidisciplinary characterisation highlighted significant heterogeneity in grassland properties with landscape position, and demonstrated an approach that could be used to characterise other critical-zone environments on hillslopes