INTERVENÇÕES FONOLÓGICAS EM CRIANÇAS COM DESVIO FONOLÓGICO: UMA REVISÃO SISTEMÁTICA

Introdução: Dentre os distúrbios dos sons da fala, tem-se o desvio fonológico, sendo este caracterizado por erros na produção de fala. A partir dos achados da avaliação fonológica, o terapeuta deverá selecionar a proposta de intervenção mais adequada para cada caso dentre os diversos modelos elaborados a partir de teorias linguísticas que buscam alcançar a reorganização fonológica. Objetivo: Avaliar a intervenção fonológica para os casos de desvios fonológicos no Português Brasileiro Método: a revisão sistemática foi conduzida conforme as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca por artigos científicos foi conduzida por dois pesquisadores independentes nas bases de dados Medline (Pubmed), LILACS, SciELO, Cochrane Library e Scopus. A pesquisa foi realizada com os descritores [(Phonological disorders) or (Phonological impairment) or (Speech sound disorders) or (Articulation Disorders) or (Language and Hearing Sciences) and (Speech Therapy) or (Speech Intervention) or (Phonological treatment) or (Phonological Intervention)] e compreendeu o período de janeiro de 2015 a maio de 2020. Resultados: Todas as crianças apresentaram evolução e ampliação no sistemas fonológicos, independente da intervenção fonológica escolhida para o caso. Entretanto, os estudos que aliaram a terapia tradicional com outros recursos alternativos (exemplo, softwares) obtiveram resultados promissores. Conclusão: Apesar dos resultados terem sido eficazes nos estudos analisados, não foi possível sistematizar a escolha da intervenção com o quadro clínico dos sujeitos em decorrência da falta de uniformização dos sujeitos e ao delineamento metodológico. Não é possível realizar conclusões sistemáticas com relação à intervenção fonológica de crianças brasileiras.

Phonological Treatment Options for Children with Expressive Language Impairment

The vast majority of treatment efficacy research in the area of phonology focuses on issues relevant to children who have significant limitations in productive phonology but are “typically developing” in most other ways. The base of evidence to guide clinicians on planning intervention for children with phonological and cooccurring expressive language difficulties (PD + LI) is less well developed. Thus, the goal of this paper is to summarize the evidence on two treatment procedures designed to facilitate growth in phonological inventory for children who also require direct intervention to target other aspects of expressive language. We first review what is known about the delicate interaction between phonology and grammatical morphology. We focus the remainder of the summary on what is known about how to best address the more complex needs of children with PD + LI in intervention.

The Complexity Approach to Phonological Treatment: How to Select Treatment Targets

Purpose There are a number of evidence-based treatments for preschool children with phonological disorders (Baker & McLeod, 2011). However, a recent survey by Brumbaugh and Smit (2013) suggests that speech-language pathologists are not equally familiar with all evidence-based treatment alternatives, particularly the complexity approach. The goal of this clinical tutorial is to provide coaching on the implementation of the complexity approach in clinical practice, focusing on treatment target selection. Method Evidence related to selecting targets for treatment based on characteristics of the targets (i.e., developmental norms, implicational universals) and characteristics of children's knowledge of the targets (i.e., accuracy, stimulability) is reviewed. Free resources are provided to aid clinicians in assessing accuracy and stimulability of singletons and clusters. Use of treatment target selection and generalization prediction worksheets is illustrated with 3 preschool children. Results Clinicians can integrate multiple pieces of information to select complex targets and successfully apply the complexity approach to their own clinical practice. Conclusion Incorporating the complexity approach into clinical practice will expand the range of evidence-based treatment options that clinicians can use when treating preschool children with phonological disorders. Supplemental Material S1 https://doi.org/10.23641/asha.6007562 KU ScholarWorks Supplemental Material http://hdl.handle.net/1808/24767

Implementing Evidence-Based Practice: Selecting Treatment Words to Boost Phonological Learning

Purpose Word selection has typically been thought of as an inactive ingredient in phonological treatment, but emerging evidence suggests that word selection is an active ingredient that can impact phonological learning. The goals of this tutorial are to (a) review the emerging single-subject evidence on the influence of word characteristics on phonological learning in clinical treatment, (b) outline hypotheses regarding the mechanism of action of word characteristics, and (c) provide resources to support clinicians incorporating word selection as an active ingredient in their approach to phonological treatment. Method Research demonstrating the influence of the word frequency, neighborhood density, age of acquisition, and lexicality of treatment stimuli on phonological learning is summarized. The mechanism of action for each characteristic is hypothesized. Methods from the research studies are used to create a free set of evidence-based treatment materials targeting most of the mid-8 and late-8 consonants. Results Clinicians have numerous evidence-based options to consider when selecting stimuli for phonological treatment including (a) high-frequency and high-density words, (b) low-frequency and high-density words, (c) high-frequency and mixed-density words, (d) low-frequency and late-acquired words, and (e) nonwords. Conclusion Incorporating word characteristics into phonological treatment may boost phonological learning. KU ScholarWorks Supplemental Material http://hdl.handle.net/1808/24768

Abstract WP174: Intensive Phonology Treatment Promotes Recovery in Reading in Chronic Aphasia Post Stroke

Therapies specifically targeting naming deficits are common because these deficits remain one of the most common and pervasive deficits seen in post-stroke aphasia (Goodglass & Wingfield, 1997). Past studies have used single lexical item retrieval (Nickels, 2002) as the framework for both semantic and phonological treatment. The efficacy of this technique is unclear when applied to reading, writing, and lexical retrieval deficits (Boyle, 2004a, 2004b; Coelho, McHugh, & Boyle, 2000). This study aimed to resolve these issues by implementing an easy to replicate design with a randomized control trial. 12 subjects enrolled in intensive speech therapy at Austin Speech Labs were selected for the study. They were randomly assigned to a Semantic (ST) (n=6) or phonological treatment (PT) (n=6) group. Subjects received comprehensive pre and post-testing using the Western Aphasia Battery-Revised (WAB-R), Boston Naming Test (BNT). The subject’s phonological awareness was assessed using subtests of Psycholinguistic Assessment of Language Processing in Aphasia (PALPA).Each participant attended three hours of therapy for a total of 40 hours of therapy. PT: The first eight weeks focused on mastering individual consonants and vowels and blending sounds to read single words. The second 8-week module focused on training consonants clusters, and spelling. ST: The first and second module focused on describing object attributes to aid reading, naming, and writing. An independent T-test (p-value of .05) was used to examine significant differences found in the post-test scores between each group. A paired t-test (p-value=. 05) was run to determine significant differences in pre and post-test scores across both treatment groups. The majority of participants showed increases between pre and post-testing in all subtests. The phonology group showed significant increases in letter length spelling, letter sounding, spoken and written letter matching, and syllable length reading PALPA subtests. The Semantic group showed significant increases in the WAB verbal commands and repetition subtests as well as the PALPA and spoken and written letter matching subtest. Conclusion: Phonology focused treatment appears to be beneficial despite differences in underlying impairments.

Phonological Treatment Approaches for Spoken Word Production in Aphasia

This article provides an overview of phonological treatment approaches for anomia in individuals with aphasia. The role of phonology in language processing, as well as the impact of phonological impairment on communication is initially discussed. Then, traditional phonologically based treatment approaches, including phonological, orthographic, indirect, guided, and mixed cueing methods, are described. Collectively, these cueing treatment approaches aim to facilitate word retrieval by stimulating residual phonological abilities. An alternative treatment approach, phonomotor treatment, is also examined. Phonomotor treatment aims to rebuild sublexical, phonological sequence knowledge and phonological awareness as a means to strengthen lexical processing and whole-word naming. This treatment is supported by a parallel-distributed processing model of phonology and therefore promotes multimodal training of individual phonemes and phoneme sequences in an effort to enhance the neural connectivity supporting underlying phonological processing mechanisms. The article concludes with suggestions for clinical application and implementation.