Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional Manancial UFSM |
Texto Completo: | http://repositorio.ufsm.br/handle/1/27293 |
Resumo: | Introduction: Dysarthrias are motor speech disorders, of a neurogenic nature, which compromise the neuromuscular control of speech subsystems. They are perceptually very heterogeneous, making diagnosis and treatment complex. Objectives: to compare the results of maximum phonation time of /a/ (MPT/a/), acoustic vocal measurements from glottic source and physiological assessments of dysarthric patients; to develop a treatment protocol using visual biofeedback instruments for people with different types of progressive dysarthria; and to apply and to verify the effects of this treatment on speech subsystems and on intelligibility. Methods: In the first study, thirteen patients were classified according to the type of dysarthria and divided according to the functional profile, and underwent assessment of MPT/a/, acoustic vocal analysis of glottal source, electroglottography and nasometry. Results were compared between groups using ANOVA and Tukey tests. In the second study, the elaboration of the protocol consisted of a behavioral, multisystem and physiological approach based on the principles of motor learning, including the provision of instrumental visual biofeedback, in order to sequentially intervene in the speech subsystems usually affected in dysarthrias. The instruments selected for visual biofeedback were the nasometer, the electroglottograph and the ultrasound. The application of the protocol consisted of a multiple case study with adults or elderly people with progressive dysarthria. All were evaluated for breathing, voice, articulation, intelligibility and prosody before and at the end of treatment. Results: In the first study, it was found that the highest fundamental frequency showed a significant difference in the means of the groups, being greater in the hyperfunctional group. MPT/a/ were reduced, several acoustic measurements of the glottic source and electroglottographic measurements were altered in all groups, with no significant difference between groups. As for the results of the elaboration and application of the treatment protocol, improvement in MPT was observed, and some accidents obtained practically normal values, with improvement in glottic efficiency. Most had improvement in vocal parameters. All improved coordination, strength, speed and refinement of the motor act. There was also an improvement in speed, rhythm, tremor and a decrease in the variety of altered parameters, as well as in intonation, pitch, loudness and speed. Breathing pauses were adequate and monopitch and monoloudness were reduced. All achieved intelligibility above 90% in both word and sentence production, and some reached 100%. Conclusion: The results of the first study indicate that the reduction in MPT/a/ in all the functional profiles analyzed suggests air leakage during phonation; deviation of various glottic and electroglottographic source acoustic measures in all groups suggests noise, tremor, and vocal instability; and the increase in fundamental frequency in the hyperfunctional group reinforces vocal instability. Although the characteristics evaluated are expected in dysarthric patients, it is difficult to make a differential diagnosis based on acoustic and physiological vocal parameters. Regarding the treatment protocol, the significant improvement in intelligibility and speech subsystems shows that the protocol is effective in the treatment of people with progressive dysarthria, capable of anticipating worsening and promoting longer communication through speech. |
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2022-12-12T13:19:01Z2022-12-12T13:19:01Z2022-04-01http://repositorio.ufsm.br/handle/1/27293Introduction: Dysarthrias are motor speech disorders, of a neurogenic nature, which compromise the neuromuscular control of speech subsystems. They are perceptually very heterogeneous, making diagnosis and treatment complex. Objectives: to compare the results of maximum phonation time of /a/ (MPT/a/), acoustic vocal measurements from glottic source and physiological assessments of dysarthric patients; to develop a treatment protocol using visual biofeedback instruments for people with different types of progressive dysarthria; and to apply and to verify the effects of this treatment on speech subsystems and on intelligibility. Methods: In the first study, thirteen patients were classified according to the type of dysarthria and divided according to the functional profile, and underwent assessment of MPT/a/, acoustic vocal analysis of glottal source, electroglottography and nasometry. Results were compared between groups using ANOVA and Tukey tests. In the second study, the elaboration of the protocol consisted of a behavioral, multisystem and physiological approach based on the principles of motor learning, including the provision of instrumental visual biofeedback, in order to sequentially intervene in the speech subsystems usually affected in dysarthrias. The instruments selected for visual biofeedback were the nasometer, the electroglottograph and the ultrasound. The application of the protocol consisted of a multiple case study with adults or elderly people with progressive dysarthria. All were evaluated for breathing, voice, articulation, intelligibility and prosody before and at the end of treatment. Results: In the first study, it was found that the highest fundamental frequency showed a significant difference in the means of the groups, being greater in the hyperfunctional group. MPT/a/ were reduced, several acoustic measurements of the glottic source and electroglottographic measurements were altered in all groups, with no significant difference between groups. As for the results of the elaboration and application of the treatment protocol, improvement in MPT was observed, and some accidents obtained practically normal values, with improvement in glottic efficiency. Most had improvement in vocal parameters. All improved coordination, strength, speed and refinement of the motor act. There was also an improvement in speed, rhythm, tremor and a decrease in the variety of altered parameters, as well as in intonation, pitch, loudness and speed. Breathing pauses were adequate and monopitch and monoloudness were reduced. All achieved intelligibility above 90% in both word and sentence production, and some reached 100%. Conclusion: The results of the first study indicate that the reduction in MPT/a/ in all the functional profiles analyzed suggests air leakage during phonation; deviation of various glottic and electroglottographic source acoustic measures in all groups suggests noise, tremor, and vocal instability; and the increase in fundamental frequency in the hyperfunctional group reinforces vocal instability. Although the characteristics evaluated are expected in dysarthric patients, it is difficult to make a differential diagnosis based on acoustic and physiological vocal parameters. Regarding the treatment protocol, the significant improvement in intelligibility and speech subsystems shows that the protocol is effective in the treatment of people with progressive dysarthria, capable of anticipating worsening and promoting longer communication through speech.Introdução: Disartrias são transtornos motores de fala, de ordem neurogênica, que comprometem o controle neuromuscular dos subsistemas da fala. São perceptivamente muito heterogêneas, tornando o diagnóstico e o tratamento complexos. Objetivos: comparar os resultados do tempo máximo de fonação de /a/ (TMF/a/), de medidas vocais acústicas de fonte glótica e de avaliações fisiológicas de pacientes disártricos; desenvolver um protocolo de tratamento utilizando instrumentos de biofeedback visual para pessoas com diferentes tipos de disartria progressiva; e aplicar e verificar os efeitos desse tratamento nos subsistemas da fala e na inteligibilidade. Métodos: No primeiro estudo, treze pacientes foram classificados quanto ao tipo de disartria e divididos de acordo com o perfil funcional, e passaram por avaliação do TMF/a/, análise vocal acústica de fonte glótica, eletroglotografia e nasometria. Os resultados foram comparados entre os grupos por meio dos testes ANOVA e Tukey. No segundo estudo, a elaboração do protocolo consistiu numa abordagem comportamental, multissistêmica e fisiológica fundamentada nos princípios de aprendizagem motora, incluindo a oferta de biofeedback visual instrumental, de modo a intervir sequencialmente nos subsistemas da fala geralmente afetados nas disartrias. Os instrumentos selecionados para biofeedback visual foram o nasômetro, o eletroglotógrafo e o ultrassom. A aplicação do protocolo consistiu num estudo de caso múltiplo com adultos ou idosos que apresentassem disartria progressiva. Todos foram avaliados quanto à respiração, voz, articulação, inteligibilidade e prosódia antes e ao final do tratamento. Resultados: No primeiro estudo verificou-se que a frequência fundamental mais alta apresentou diferença significativa nas médias dos grupos, sendo maior no grupo hiperfuncional. Os TMF/a/ estavam reduzidos, várias medidas acústicas de fonte glótica e as medidas eletroglotográficas se apresentaram alteradas em todos os grupos, sem diferença significativa entre os grupos. Quanto aos resultados da elaboração e aplicação do protocolo de tratamento, observou-se melhora nos TMF, e alguns acasos obtiveram valores praticamente normais, com melhora na eficiência glótica. A maioria teve melhora nos parâmetros vocais. Todos melhoraram coordenação, força, velocidade e refinamento do ato motor. Também observou-se melhora da velocidade, ritmo, tremor e diminuição da variedade de parâmetros alterados, bem como da entonação, pitch, loudness e velocidade. Foram adequadas as pausas para respiração e reduzidos o monopitch e a monoloudness. Todos obtiveram inteligibilidade acima de 90% tanto na produção de palavras quanto frases, e alguns atingiram 100%. Conclusão: Os resultados do primeiro estudo indicam que a redução dos TMF/a/ em todos os perfis funcionais analisados sugere escape aéreo à fonação; o desvio de várias medidas acústicas de fonte glótica e eletroglotográficas em todos os grupos sugere ruído, tremor e instabilidade vocal; e o aumento da frequência fundamental no grupo hiperfuncional reforça a instabilidade vocal. Apesar das características avaliadas serem esperadas em disártricos, há dificuldade de realizar um diagnóstico diferencial a partir de parâmetros vocais acústicos e fisiológicos. Em relação ao protocolo de tratamento, a significativa melhora da inteligibilidade e dos subsistemas da fala evidencia que o protocolo é eficaz ao tratamento de pessoas com disartria progressiva, capaz de antever à piora e promover maior tempo de comunicação através da fala.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESporUniversidade Federal de Santa MariaCentro de Ciências da SaúdePrograma de Pós-Graduação em Distúrbios da Comunicação HumanaUFSMBrasilFonoaudiologiaAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessDisartriaAvaliação perceptivo-auditivaAcústicaTratamentoBiofeedbackDysarthriaAuditory-perceptual assessmentAcousticsTreatmentCNPQ::CIENCIAS DA SAUDE::FONOAUDIOLOGIAMétodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumentalPerceptual and instrumental methods in the dysarthria assessment and results of a proposal for speech therapy intervention with instrumental biofeedbackinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisKeske-Soares, Marciahttp://lattes.cnpq.br/2993790524055307Pagliarin, Karina CarlessoGama, Ana Cristina CôrtesBeber, Bárbara CostaOrtiz, Karin ZazoBarreto, Simone dos Santoshttp://lattes.cnpq.br/7164556523508258Portalete, Caroline Rodrigues40070000000360060060060060060060060073199fed-4459-4038-9c3f-a2ef60e08d9ddb6a8693-360c-4a31-8746-550f07e6519885a0e9a8-c485-445c-aabe-5d93e4fb36144083e35a-dbe2-4989-8f1d-f1ac22c2abd9213a9ea5-686d-47e9-aa8a-c9e477948e6351125c61-e56e-4699-a15a-384b9275399239ad75ea-f2c4-4687-8931-f95b747d70fereponame:Repositório Institucional Manancial UFSMinstname:Universidade Federal de Santa Maria (UFSM)instacron:UFSMCC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; 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dc.title.por.fl_str_mv |
Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental |
dc.title.alternative.eng.fl_str_mv |
Perceptual and instrumental methods in the dysarthria assessment and results of a proposal for speech therapy intervention with instrumental biofeedback |
title |
Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental |
spellingShingle |
Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental Portalete, Caroline Rodrigues Disartria Avaliação perceptivo-auditiva Acústica Tratamento Biofeedback Dysarthria Auditory-perceptual assessment Acoustics Treatment CNPQ::CIENCIAS DA SAUDE::FONOAUDIOLOGIA |
title_short |
Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental |
title_full |
Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental |
title_fullStr |
Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental |
title_full_unstemmed |
Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental |
title_sort |
Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental |
author |
Portalete, Caroline Rodrigues |
author_facet |
Portalete, Caroline Rodrigues |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Keske-Soares, Marcia |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/2993790524055307 |
dc.contributor.advisor-co1.fl_str_mv |
Pagliarin, Karina Carlesso |
dc.contributor.referee1.fl_str_mv |
Gama, Ana Cristina Côrtes |
dc.contributor.referee2.fl_str_mv |
Beber, Bárbara Costa |
dc.contributor.referee3.fl_str_mv |
Ortiz, Karin Zazo |
dc.contributor.referee4.fl_str_mv |
Barreto, Simone dos Santos |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/7164556523508258 |
dc.contributor.author.fl_str_mv |
Portalete, Caroline Rodrigues |
contributor_str_mv |
Keske-Soares, Marcia Pagliarin, Karina Carlesso Gama, Ana Cristina Côrtes Beber, Bárbara Costa Ortiz, Karin Zazo Barreto, Simone dos Santos |
dc.subject.por.fl_str_mv |
Disartria Avaliação perceptivo-auditiva Acústica Tratamento |
topic |
Disartria Avaliação perceptivo-auditiva Acústica Tratamento Biofeedback Dysarthria Auditory-perceptual assessment Acoustics Treatment CNPQ::CIENCIAS DA SAUDE::FONOAUDIOLOGIA |
dc.subject.eng.fl_str_mv |
Biofeedback Dysarthria Auditory-perceptual assessment Acoustics Treatment |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::FONOAUDIOLOGIA |
description |
Introduction: Dysarthrias are motor speech disorders, of a neurogenic nature, which compromise the neuromuscular control of speech subsystems. They are perceptually very heterogeneous, making diagnosis and treatment complex. Objectives: to compare the results of maximum phonation time of /a/ (MPT/a/), acoustic vocal measurements from glottic source and physiological assessments of dysarthric patients; to develop a treatment protocol using visual biofeedback instruments for people with different types of progressive dysarthria; and to apply and to verify the effects of this treatment on speech subsystems and on intelligibility. Methods: In the first study, thirteen patients were classified according to the type of dysarthria and divided according to the functional profile, and underwent assessment of MPT/a/, acoustic vocal analysis of glottal source, electroglottography and nasometry. Results were compared between groups using ANOVA and Tukey tests. In the second study, the elaboration of the protocol consisted of a behavioral, multisystem and physiological approach based on the principles of motor learning, including the provision of instrumental visual biofeedback, in order to sequentially intervene in the speech subsystems usually affected in dysarthrias. The instruments selected for visual biofeedback were the nasometer, the electroglottograph and the ultrasound. The application of the protocol consisted of a multiple case study with adults or elderly people with progressive dysarthria. All were evaluated for breathing, voice, articulation, intelligibility and prosody before and at the end of treatment. Results: In the first study, it was found that the highest fundamental frequency showed a significant difference in the means of the groups, being greater in the hyperfunctional group. MPT/a/ were reduced, several acoustic measurements of the glottic source and electroglottographic measurements were altered in all groups, with no significant difference between groups. As for the results of the elaboration and application of the treatment protocol, improvement in MPT was observed, and some accidents obtained practically normal values, with improvement in glottic efficiency. Most had improvement in vocal parameters. All improved coordination, strength, speed and refinement of the motor act. There was also an improvement in speed, rhythm, tremor and a decrease in the variety of altered parameters, as well as in intonation, pitch, loudness and speed. Breathing pauses were adequate and monopitch and monoloudness were reduced. All achieved intelligibility above 90% in both word and sentence production, and some reached 100%. Conclusion: The results of the first study indicate that the reduction in MPT/a/ in all the functional profiles analyzed suggests air leakage during phonation; deviation of various glottic and electroglottographic source acoustic measures in all groups suggests noise, tremor, and vocal instability; and the increase in fundamental frequency in the hyperfunctional group reinforces vocal instability. Although the characteristics evaluated are expected in dysarthric patients, it is difficult to make a differential diagnosis based on acoustic and physiological vocal parameters. Regarding the treatment protocol, the significant improvement in intelligibility and speech subsystems shows that the protocol is effective in the treatment of people with progressive dysarthria, capable of anticipating worsening and promoting longer communication through speech. |
publishDate |
2022 |
dc.date.accessioned.fl_str_mv |
2022-12-12T13:19:01Z |
dc.date.available.fl_str_mv |
2022-12-12T13:19:01Z |
dc.date.issued.fl_str_mv |
2022-04-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://repositorio.ufsm.br/handle/1/27293 |
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http://repositorio.ufsm.br/handle/1/27293 |
dc.language.iso.fl_str_mv |
por |
language |
por |
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400700000003 |
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600 600 600 600 600 600 600 600 |
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dc.rights.driver.fl_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Centro de Ciências da Saúde |
dc.publisher.program.fl_str_mv |
Programa de Pós-Graduação em Distúrbios da Comunicação Humana |
dc.publisher.initials.fl_str_mv |
UFSM |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Fonoaudiologia |
publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Centro de Ciências da Saúde |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional Manancial UFSM instname:Universidade Federal de Santa Maria (UFSM) instacron:UFSM |
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Universidade Federal de Santa Maria (UFSM) |
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UFSM |
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UFSM |
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Repositório Institucional Manancial UFSM |
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Repositório Institucional Manancial UFSM |
bitstream.url.fl_str_mv |
http://repositorio.ufsm.br/bitstream/1/27293/2/license_rdf http://repositorio.ufsm.br/bitstream/1/27293/3/license.txt http://repositorio.ufsm.br/bitstream/1/27293/1/TES_PPGDCH_2022_PORTALETE_CAROLINE.pdf |
bitstream.checksum.fl_str_mv |
4460e5956bc1d1639be9ae6146a50347 2f0571ecee68693bd5cd3f17c1e075df 8d31df76d73ec9ee5e28ec4e5f727805 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 |
repository.name.fl_str_mv |
Repositório Institucional Manancial UFSM - Universidade Federal de Santa Maria (UFSM) |
repository.mail.fl_str_mv |
ouvidoria@ufsm.br |
_version_ |
1808854694803537920 |