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- Down syndrome: otolaryngological effects of rapid maxillary expansionPublication . Moura, C. Pinto de; Andrade, D.; Cunha, L. M.; Tavares, M. J.; Gonçalves, Maria João; Vaz, P.; Barros, H.; Pueschel, S. M.; Clemente, M. PaisPhenotypical Down syndrome includes pharyngeal and maxillary hypoplasia and, frequently, constricted maxillary arch with nasal obstruction. This clinical trial assessed the effects of rapid maxillary expansion on ENT disorders in 24 children with Down syndrome randomly allocated to receive either rapid maxillary expansion or not. Each group received ENT and speech therapy assessments before expansion and after the device had been removed. In the rapid maxillary expansion group, the yearly ENT infection rate was reduced when assessed after device removal (p < 0.01). The parents of rapid maxillary expansion children reported a reduction in respiratory obstruction symptoms. Audiological assessment revealed improvements in the rapid maxillary expansion group (p < 0.01). Cephalometry showed increased maxillary width in the rapid maxillary expansion group. Rapid maxillary expansion resulted in a reduction in hearing loss, yearly rate of ENT infections and parentally assessed symptoms of upper airway obstruction, compared with no treatment. These findings are probably related to expanded oronasal space, due to rapid maxillary expansion.
- Dosage, intensity and frequency of language therapy for aphasia: An individual participant data network meta-analysisPublication . Brady, Marian C.; Patrício, BrígidaOptimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia. Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori–defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI). Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with >20 to 50 hours SLT dosage (18.37 [10.58–26.16] Western Aphasia Battery–Aphasia Quotient; 5.23 [1.51–8.95] Aachen Aphasia Test–Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3–5+ days/week), and comprehension (4–5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours, <3 hours/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was <30%. Risk of trial bias was low to moderate; low for meta-biases. Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services.
- Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysisPublication . Brady, Marian C.; Patrício, BrígidaStroke rehabilitation interventions are routinely personalized to address individuals’ needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild–moderate/ moderate–severe based on language outcomes’ median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants’ greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3–4 SLT-h/week; ⩾ 50 hours). For moderate–severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild–moderate participants’ greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males’ greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. We observed a treatment response in most subgroups’ overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild–moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate–severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
- Risk factors for voice disorders among Fado singers: A cross-sectional studyPublication . Pestana, Pedro; Freitas, Susana Vaz; Manso, Maria ConceiçãoFado is an urban Portuguese musical style rooted in popular culture. Previously found data suggests that Fado singers may have an increased risk of developing voice disorders. To determine the risk factors for the development of voice disorders among Fado singers. A cross-sectional study was conducted through the administration of a questionnaire containing questions related to voice disorders in singers. The relationship between personal and social data, musical background, performance demands and habits, vocal health and wellbeing, and strategies to overcome voice problems are reported. Beyond a comprehensive characterization, odds ratios (ORs) and their 95% confidence intervals (CIs) for the association with voice disorders were calculated through univariate and multivariate logistic regression analyses. The significant risk factors for voice disorders were as follows in decreasing order: nose-related disorders; decongestants or antihistamines; oral contraceptives or hormone replacement therapy; previous smoking habits; and vocal fatigue after performances. These activities significantly increased the risk of developing voice disorders. The evidence from this study and the relative low prevalence of self-reported voice disorders suggest that these singers may develop a kind of protective combination of factors beyond the scope of this research.
- Evaluation of the ability to sing easily: Adaptation and validation to the European Portuguese languagePublication . Pestana, Pedro Melo; Freitas, Susana Vaz; Alegria, Rita; Manso, Maria ConceiçãoA number of voice assessment tools are currently in use in both clinical and research settings. The Evaluation of the Ability to Sing Easily offers a comprehensive self-assessment tool designed for singers. EASE captures subtle changes in vocal health by inquiring about the subject's current experience. This makes Evaluation of the Ability to Sing Easily a valuable tool for the early identification of vocal issues and the monitoring of a singer's overall vocal health. Objective: This study aimed to adapt and validate the Evaluation of the Ability to Sing Easily for European Portuguese and assess its psychometric properties. Methodology: A five-step cross-cultural adaptation process was followed, including forward translation, backward translation, committee review, pilot testing, and finalization. The Evaluation of the Ability to Sing Easily for European Portuguese was then administered to 120 singers (Fado and Choir) to evaluate internal consistency and known-groups validity. Results: The pilot test identified and resolved ambiguities in seven Evaluation of the Ability to Sing Easily for European Portuguese items. Internal consistency was high, with Cronbach's alpha exceeding 0.80 for the Evaluation of the Ability to Sing Easily scale and sub-scales in both Fado and Choir singers. Fado singers reported higher vocal fatigue scores, while Choir singers reported higher Pathologic Risk Indicators scores. A weak negative correlation between singing load and PRI scores was observed in Choir singers. Conclusion: The Evaluation of the Ability to Sing Easily for European Portuguese demonstrates good internal consistency and cultural relevance for Portuguese singers. Known-groups validity suggests potential differences in vocal function between Fado and Choir singers. Further research is needed to explore external validity, test-retest reliability, and applicability to other singing styles.
- Cross‑cultural adaptation and validation of the european portuguese Dysphagia handicap indexPublication . Silva‑Carvalho, Isabel ; Martins, Adriana ; Casanova, Maria Jorge ; Freitas, Susana Vaz; Meireles, LuísThe Dysphagia Handicap Index (DHI) is a valid Health-related Quality of Life (HRQoL) 25-item questionnaire assessing the physical, functional, and emotional aspects of patients with oropharyngeal dysphagia (OD), of heterogeneous etiologies. The purpose of this study is to translate and validate the European Portuguese-DHI (EP-DHI). This is a prospective study that was carried out at Centro Hospitalar Universitário do Porto (CHUPorto). The generated EP-DHI was administered to 132 patients with OD and 112 healthy control subjects. 132 patients undergoing fiberoptic endoscopic examination of swallowing (FEES). 15 patients were contacted by phone, 2 or 3 weeks later after the first interview to repeat the questionnaire. The validity of concurrent criteria was evaluated by comparing the results of the EP-DHI score with the score attributed to the pathological findings found in FEES and, consequently, Functional Oral Intake Scale (FOIS). The internal consistency of EP-DHI was successful: Cronbach’s alpha coefficient for total EP-DHI was 0.874. The test–retest reliability for the total and the three EP-DHI subscales obtained a Pearson's correlation coefficient ranged from 0.990 to 0.712. This study demonstrates that EP-DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on physical, functional, and emotional aspects of patient’s quality of life, among an European Portuguese sample.
- Speech and language therapy degree: reflections about school admission criteria in Portugal and worldwidePublication . Soares, Elsa Marta; Lima, Etelvina; Pinto, Carina; Franco, Débora; Salvador, Andreia; Lopes, Inês; Pós de Mina, SóniaThe purpose of this study is to identify the admission processes to the speech and language therapy degree worldwide and characterize how Portuguese speech and language therapists assess the candidates to the speech and language therapy degree.This is a descriptive, exploratory, and cross-sectional study. This study is divided into two studies. Questionnaires were used to collect data in both studies. The data were inserted and analyzed through descriptive statistics (via Statistical Package for the Social Sciences (SPSS) version 27) and content analysis. Considering study 1, the results show that there are no school admission criteria performed by a speech and language therapist in most countries. However, in some institutions, there are some specific procedures considering the acceptance of applicants to enter the speech and language therapy degree. Study 2 reveals that Portuguese speech and language therapists use mainly informal assessment procedures when performing school admission criteria. The skills/areas most valued as school admission criteria for accessing the degree are writing and reading skills. Most participants consider it essential to perform the school admission criteria before candidates can access the speech and language therapy degree. There are different procedures worldwide considering the entrance in speech and language therapy degree. If school admission criteria should or should not exist is a matter of debate concerning inclusion and non-discrimination policies. Even in Portugal, where school admission criteria are mandatory, there is a high variability of procedures. All these results state the importance of discussing this matter in more depth, involving all the institutions and entities that formally represent the scientific area of speech and language therapy.
- Who participates in aphasia research? An analysis of the REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE) data setPublication . Patrício, BrigidaPeople with aphasia present with different of demographic, language, stroke, and impairment profiles. A Cochrane review found that two-thirds of included trials had comparison data on participants at baseline (Brady, Kelly, Godwin, Enderby, & Campbell, 2016). Participant selection may have a considerable impact on the effectiveness of therapeutic interventions (Hallowell, 2008) while participant description is vital to interpretate the clinical relevance to patient subgroup (external validity). Inadequate description of aphasia research participants has been highlighted (Brady et al., 2016; Brookshire, 1983; Roberts, Code, & McNeil, 2003) as have data collection recommendations and reporting in prospective aphasia research studies.
- Characterization of the families participation in the local intervention teamsPublication . Pinto, Marta Joana de Sousa; Serrano, Ana MariaNational and international studies about the participation of families in early intervention services have led to a research project that intends to understand the participation of families in the support provided by the Local Intervention Teams, the National System of Early Intervention in Childhood (SNIPI). Family members of children between the ages of 0 and 6 were interviewed, fulflling the eligibility criteria to integrate these teams, with the aim to identify what families understand by active participation and how these families participate at all times in the intervention, in line with Family-Centered Practices, as well as to identify facilitators and barriers to active family involvement, to help practitioners identify techniques and strategies that keep parental participants active in the support provided by the Local Intervention Teams. An interview and a questionnaire, the Enabling Practices Scale, were used for data collection. Te interview script was developed by the author, according to the bibliographic collection previously done and with her professional practice in early intervention over the last years. Also, the author used the Enabling Practices Scale which was to be completed by family members at the end of their interview. Te selected instrument came from the collection and bibliographic analysis of the available evaluation tools on the subject. Data collection took place between March and December 2016 and a total of twenty relatives were contacted in the North, Center, Lisbon, Alentejo and Algarve regions. : Te results show attitudes (perception) of the participation of the families, about the support provided to them by the Local Early Intervention Teams. In this article, we intend to present the results obtained with the interviews conducted and with the completion of the Enabling Practices Scale by family members, characterizing the perception of the participation of the families, about the support provided to them by the Local Early Intervention Teams.
- Avaliação da participação das famílias no apoio prestado pelas equipas de intervenção precocePublication . Pinto, Marta; Serrano, Ana MariaOs estudos nacionais e internacionais respeitantes à participação das famílias nos serviços de intervenção precoce conduziram a autora à investigação desta temática na realidade portuguesa. Desta forma, foi desenvolvido um projeto de investigação onde se pretende compreender a participação das famílias nos apoios prestados pelo Sistema Nacional de Intervenção Precoce na Infância (SNIPI), bem como os facilitadores e as barreiras a essa participação, de forma a ajudar os profissionais a identificar as técnicas e as estratégias que mantêm os pais participantes ativos nos apoios prestados pelas Equipas Locais de Intervenção. Neste âmbito, a autora tem estado a desenvolver um estudo qualitativo, em que pretende entrevistar profissionais de intervenção precoce, a exercerem funções em Equipas Locais de Intervenção e familiares de crianças entre os zero e os seis anos de idade, com necessidades especiais, cumprindo os critérios de elegibilidade para integrarem estas equipas e desta forma, identificar como é que as famílias participam em todos os momentos da intervenção, de acordo com o que são as Práticas Centradas na Família. Os guiões de entrevista que serão utilizados para entrevistar quer os profissionais, quer as famílias de crianças entre os zero e os seis anos de idade têm sido desenvolvidos pela autora, de acordo com a recolha bibliográfica efetuada e com a sua prática profissional em intervenção precoce, ao longo dos últimos anos. Paralelamente, a autora utilizará uma checklist, para preenchimento pelos familiares das crianças apoiadas nas Equipas Locais de Intervenção. A checklist selecionada surgiu da recolha bibliográfica efetuada acerca dos instrumentos de avaliação disponíveis sobre o tema. Esta checklist será traduzida e adaptada, com a devida autorização do autor, de acordo com a realidade portuguesa. Neste artigo, a autora pretende descrever os procedimentos e os resultados das sucessivas fases de construção e adaptação dos instrumentos que lhe permitirão a fiabilidade e validade dos resultados finais nesta investigação.
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