Classificação da nasalidade de fala antes e depois de treinamento de profissionais sem experiência na avaliação da hipernasalidade
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Data
2020-04-22
Autores
Manicardi, Flora Taube [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A fala é um importante parâmetro indicativo do sucesso ou insucesso do tratamento cirúrgico da fissura labiopalatina, sendo a hipernasalidade o principal sintoma da disfunção velofaríngea. Sua identificação é feita pela avaliação perceptivo-auditiva, considerada padrão-ouro. Porém, esta avaliação é subjetiva e pode ser influenciada por fatores internos e/ou externos do avaliador. Estratégias como treinamento e/ou uso de amostras de referência são recomendadas, mas ainda não é claro sua influência na classificação da hipernasalidade por fonoaudiólogos sem experiência nesta classificação. Objetivo: Investigar a classificação da hipernasalidade de fala antes e depois de treinamento de profissionais sem experiência na avaliação da hipernasalidade de indivíduos com fissura labiopalatina. Método: Três fonoaudiólogas sem experiência analisaram inicialmente 24 amostras de fala de indivíduos com fissura labiopalatina (baseado em seus próprios critérios), usando escala de quatro pontos (1=ausência de hipernasalidade; 2=hipernasalidade leve; 3-hipernasalidade moderada; 4=hipernasalidade grave). Após uma semana, receberam treinamento perceptivo-auditivo e, na semana seguinte, retreinamento. As 24 amostras de classificação foram reapresentadas uma semana após retreinamento, seguindo os mesmos procedimentos realizados previamente (antes do treinamento perceptivo-auditivo). A análise descritiva dos dados foi feita pela porcentagem de acertos e os testes estatísticos de Wilcoxon, Kolmogorov-Smirnov, Qui-quadrado, V de Cramer e Kappa foram utilizados para verificar as hipóteses do estudo. O nível de significância de 5% foi adotado para todas as análises. Resultados: Em geral, os achados não indicaram melhora após treinamento perceptivo-auditivo (antes 65,3%, depois 62,5%). Porém, no agrupamento dos achados por graus de hipernasalidade, verificou-se melhora na classificação da ausência de hipernasalidade (antes 83%, depois 100%) e na classificação do grau leve (antes 50%, depois 72%). Na comparação dos achados de cada fonoaudióloga com a avaliação padrão-ouro, verificou-se melhores resultados depois do treinamento para uma das avaliadoras, que classificou consistentemente a ausência de hipernasalidade e melhorou sua classificação do grau leve. A análise inferencial dos dados indicou que não houve diferença significativa na porcentagem de acertos antes e depois do treinamento (p<0,972). Na análise dicotômica dos dados (presença e ausência de hipernasalidade), verificou-se associação significativa e forte, com concordância significativa dos resultados das avaliadoras com a avaliação padrão-ouro. A concordância geral entre avaliadoras foi maior após treinamento (0,43 – moderado) do que antes do treinamento (0,31 – regular), porém sem diferença significativa. Ao considerar concordância entre avaliadoras, para cada grau de hipernasalidade separadamente, notou-se diferença significativa entre as análises, antes e depois do treinamento, para os graus ausente e grave, com maior concordância após treinamento nestes dois graus. Houve concordância significativa entre as análises das avaliadoras para o grau leve somente após treinamento perceptivo-auditivo. Conclusão: De forma geral, o treinamento adotado não resultou em melhora na classificação quanto ao grau de hipernasalidade, embora a análise por avaliadora tenha mostrado que este treinamento foi favorável para uma das três avaliadoras. A análise dicotômica mostrou que o treinamento favoreceu uma das avaliadoras, já que esta foi capaz de classificar consistentemente a ausência da hipernasalidade após treinamento. Sugere-se ampliar o treinamento perceptivo-auditivo para classificação da hipernasalidade em estudos futuros, oferecendo treinamentos mais longos.
Introduction: Speech is an important parameter indicating success or failure of surgical treatment of cleft lip and palate, being hypernasality the main symptom of velopharyngeal dysfunction. Its identification is performed by the auditory-perceptual evaluation, considered gold standard. However, this evaluation is subjective and can be influenced by internal and/or external factors of the evaluator. Strategies as training and/or use of reference samples are recommended, but their influence on the classification of hypernasality by speech therapists without experience in this classification is not clear yet. Objective: To investigate the classification of speech hypernasality pre and post-training of professionals without experience in the hypernasality evaluation of individuals with cleft lip and palate. Method: Three speech therapists without experience initially analyzed 24 speech samples from individuals with cleft lip and palate (based on their own criteria), using a four-point scale (1=absent hypernasality; 2=mild hypernasality; 3=moderate hypernasality; 4=severe hypernasality). After one week, they received auditory-perceptual training and, next week, retraining. The 24 classification samples were presented again one week after retraining, following the same procedures performed previously (pre auditory-perceptual training). Data were analyzed descriptively (percentage of correct responses) and Wilcoxon, Kolmogorov-Smirnov, Chi-square, V of Cramer and Kappa statistical tests were used to verify the hypotheses of this study. The significance level of 5% was adopted for all analyses. Results: In general, the findings did not indicate improvement post auditory-perceptual training (pre 65.3%, post 62.5%). However, in the grouping of findings by degrees of hypernasality, there was improvement in the classification of absent hypernasality (pre 83%, post 100%) and in the classification of mild degree (pre 50%, post 72%). When comparing the findings of each speech therapist with the gold standard evaluation, better results were found post-training for one of the evaluators, who consistently classified the absent hypernasality and improved her classification of mild degree. The inferential analysis of data indicated that there was no significant difference in the percentage of correct answers pre and post-training (p <0.972). In the dichotomous analysis of data (present and absent hypernasality), a significant and strong association was found, with significant agreement between the evaluators’ results and the gold standard evaluation. The general agreement between evaluators was higher post-training (0.43-moderate) than pre-training (0.31-regular), but without significant difference. When considering each degree of hypernasality separately, there was a significant difference in the evaluators' analyses, pre and post-training, for the absent and severe degrees, with higher agreement post-training in these two degrees. There was a significant difference between the evaluators' analyses for the mild degree, with concordance only post-training. Conclusion: In general, the training adopted did not result in improvement in the classification regarding the degree of hypernasality, even though the analysis by evaluator showed that this training was favorable for one of the three evaluators. The dichotomous analysis also showed that the training favored one of the evaluators, since this evaluator was able to classify consistently the absent hypernasality post-training. It is suggested to expand the auditory-perceptual training to classify hypernasality in further studies, offering longer training.
Introduction: Speech is an important parameter indicating success or failure of surgical treatment of cleft lip and palate, being hypernasality the main symptom of velopharyngeal dysfunction. Its identification is performed by the auditory-perceptual evaluation, considered gold standard. However, this evaluation is subjective and can be influenced by internal and/or external factors of the evaluator. Strategies as training and/or use of reference samples are recommended, but their influence on the classification of hypernasality by speech therapists without experience in this classification is not clear yet. Objective: To investigate the classification of speech hypernasality pre and post-training of professionals without experience in the hypernasality evaluation of individuals with cleft lip and palate. Method: Three speech therapists without experience initially analyzed 24 speech samples from individuals with cleft lip and palate (based on their own criteria), using a four-point scale (1=absent hypernasality; 2=mild hypernasality; 3=moderate hypernasality; 4=severe hypernasality). After one week, they received auditory-perceptual training and, next week, retraining. The 24 classification samples were presented again one week after retraining, following the same procedures performed previously (pre auditory-perceptual training). Data were analyzed descriptively (percentage of correct responses) and Wilcoxon, Kolmogorov-Smirnov, Chi-square, V of Cramer and Kappa statistical tests were used to verify the hypotheses of this study. The significance level of 5% was adopted for all analyses. Results: In general, the findings did not indicate improvement post auditory-perceptual training (pre 65.3%, post 62.5%). However, in the grouping of findings by degrees of hypernasality, there was improvement in the classification of absent hypernasality (pre 83%, post 100%) and in the classification of mild degree (pre 50%, post 72%). When comparing the findings of each speech therapist with the gold standard evaluation, better results were found post-training for one of the evaluators, who consistently classified the absent hypernasality and improved her classification of mild degree. The inferential analysis of data indicated that there was no significant difference in the percentage of correct answers pre and post-training (p <0.972). In the dichotomous analysis of data (present and absent hypernasality), a significant and strong association was found, with significant agreement between the evaluators’ results and the gold standard evaluation. The general agreement between evaluators was higher post-training (0.43-moderate) than pre-training (0.31-regular), but without significant difference. When considering each degree of hypernasality separately, there was a significant difference in the evaluators' analyses, pre and post-training, for the absent and severe degrees, with higher agreement post-training in these two degrees. There was a significant difference between the evaluators' analyses for the mild degree, with concordance only post-training. Conclusion: In general, the training adopted did not result in improvement in the classification regarding the degree of hypernasality, even though the analysis by evaluator showed that this training was favorable for one of the three evaluators. The dichotomous analysis also showed that the training favored one of the evaluators, since this evaluator was able to classify consistently the absent hypernasality post-training. It is suggested to expand the auditory-perceptual training to classify hypernasality in further studies, offering longer training.
Descrição
Palavras-chave
Fissura palatina, Avaliação perceptivo-auditiva, Fala, Hipernasalidade, Avaliadores, Cleft lip and palate, Auditory-perceptual evaluation, Speech, Hypernasality, Evaluator