Proposta de protocolo de avaliação de praxias verbais para crianças
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Data
2020-07-24
Autores
Araújo, Lisiane Pereira de [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Os prejuízos de natureza práxica têm sido apontados como parte do quadro de manifestações de mudanças persistentes na fala, dentre elas, a Apraxia de Fala na Infância. O objetivo deste estudo foi desenvolver uma proposta de protocolo para avaliação de praxias verbais para crianças. As seguintes etapas foram realizadas: (1) revisão de literatura para delimitação conceitual e objetivos do protocolo, bem como a definição do formato de avaliação a ser proposto; (2) construção das tarefas, sistema de pontuação e classificação do desempenho da criança no protocolo; e (3) estruturação do protocolo (folha de aplicação e registro). O Protocolo de Avaliação de Praxias Verbais, versão para Criança (ProAPV-Criança), foi proposto e está organizado em 16 tarefas com ordem crescente de complexidade (onomatopeia, ditongos, sílabas, palavras com diferentes estruturas silábicas, palavras inventadas, frases, aumento da complexidade da produção da fala, diadococinesias e fala encadeada). A proposta de avaliação dinâmica foi a escolhida para respaldar o protocolo e fornecer informações sobre o nível de modificabilidade da fala da criança, mediante o uso de pistas articulatórias. O uso das pistas foi definido com base no número de erros durante a imitação sequencial do item-alvo. Foram definidas nove características clínicas sugestivas de prejuízos no planejamento e programação motora da fala, as quais foram observadas a partir das respostas nas tarefas (erro em consoante, erro em vogal, tateio articulatório, alteração prosódica, inconsistência, prejuízo de coarticulação, erro com o aumento da complexidade da produção da fala, lentificação e/ou erro de sequencialização em tarefas diadococinéticas e aumento da ininteligibidade em fala encadeada). Foi proposto um sistema de pontuação e cálculo de porcentagens para estabelecer o nível de dificuldade e o nível de modificabilidade da fala. O protocolo é uma proposta de avaliação estruturada e sistematizada para a coleta e a análise de dados de crianças de 5 a 10 anos e 11 meses. A proposta buscou uma forma de complementar a avaliação fonoaudiológica clínica de crianças que apresentam alterações persistentes no desenvolvimento da fala e que podem apresentar, como parte do quadro de manifestações, prejuízos nas praxias verbais. Faz-se necessário um estudo de validação.
The praxis impairments have been pointed out as part of the manifestations of persistent changes in speech, including the Childhood Apraxia of Speech. The objective of the study was to develop a proposal for a protocol for the assessment of verbal praxis for children. The following steps were performed: (1) literature review for conceptual delimitation and objectives of the protocol, as well as the definition of the evaluation format to be proposed; (2) construction of tasks, scoring system and classification of the child's performance in the protocol and (3) structuring of the protocol (application sheet and records). The Evaluation Protocol for Verbal Praxis, version for Children (ProAPV-Child), was proposed and organized in 16 tasks with increasing order of complexity (onomatopoeia, diphthongs, syllables, words with different syllabic structures, invented words, phrases, increased complexity of speech production, diadochokinesis and chained speech). The dynamic assessment proposal was chosen to support the protocol and provide information on the child's level of speech modification, using articulatory clues. The use of the clues was defined based on the number of errors during the sequential imitation of the target item. Nine clinical characteristics suggestive of impairments in speech motor planning and programming were defined, which will be observed from the responses in the tasks (consonant error, vowel error, groping, stress errors (prosodic subsystem), inconsistency, impairment of coarticulation, error with the increased complexity of speech production, slow rate and/or sequencing errors in diadochokinetic tasks and increased unintelligibility in connected speech). A system of scoring and calculating percentages was proposed to establish the level of difficulty and the level of speech modifiability. The protocol is a proposal for structured and systematic assessment based on the collection and analysis of data from children aged 5 to 10 years and 11 months. The proposal seeks a complementary form of clinical speech therapy assessment of children that display persistent changes in speech development and that may manifest, as part of a broader set of conditions, losses in verbal praxis. A validation study is necessary.
The praxis impairments have been pointed out as part of the manifestations of persistent changes in speech, including the Childhood Apraxia of Speech. The objective of the study was to develop a proposal for a protocol for the assessment of verbal praxis for children. The following steps were performed: (1) literature review for conceptual delimitation and objectives of the protocol, as well as the definition of the evaluation format to be proposed; (2) construction of tasks, scoring system and classification of the child's performance in the protocol and (3) structuring of the protocol (application sheet and records). The Evaluation Protocol for Verbal Praxis, version for Children (ProAPV-Child), was proposed and organized in 16 tasks with increasing order of complexity (onomatopoeia, diphthongs, syllables, words with different syllabic structures, invented words, phrases, increased complexity of speech production, diadochokinesis and chained speech). The dynamic assessment proposal was chosen to support the protocol and provide information on the child's level of speech modification, using articulatory clues. The use of the clues was defined based on the number of errors during the sequential imitation of the target item. Nine clinical characteristics suggestive of impairments in speech motor planning and programming were defined, which will be observed from the responses in the tasks (consonant error, vowel error, groping, stress errors (prosodic subsystem), inconsistency, impairment of coarticulation, error with the increased complexity of speech production, slow rate and/or sequencing errors in diadochokinetic tasks and increased unintelligibility in connected speech). A system of scoring and calculating percentages was proposed to establish the level of difficulty and the level of speech modifiability. The protocol is a proposal for structured and systematic assessment based on the collection and analysis of data from children aged 5 to 10 years and 11 months. The proposal seeks a complementary form of clinical speech therapy assessment of children that display persistent changes in speech development and that may manifest, as part of a broader set of conditions, losses in verbal praxis. A validation study is necessary.
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Palavras-chave
Fala, Desenvolvimento da criança, Habilidades motoras, Protocolos, Apraxia, Speech, Child development, Motor skills, Protocols