Revista CEFAC
https://revistacefac.org.br/article/doi/10.1590/1982-0216/202527410824
Revista CEFAC
Original Articles

Telepractice in speech sound disorder treatment in the Unified Health System: A pilot pragmatic study

Telefonoaudiologia no tratamento do transtorno fonológico no Sistema Único de Saúde: estudo piloto de um ensaio clínico pragmático

Jesus Cláudio Gabana-Silveira; Carolina Lisbôa Mezzomo; Helena Bolli Mota

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Abstract

Purpose: to compare face-to-face speech therapy with telepractice and hybrid models for children with phonological impairment (PI) in the unified health system, and to describe participant socioeconomic and racial/ethnic profiles.

Methods: twelve boys with PI (mean age 6.2) were divided into telepractice, face-to-face, and hybrid groups. They were assessed (ABFW Phonology) before and after 11 therapy sessions with ABAB-Withdrawal and multiple probes approach. Percentage of Consonants Correct-Revised (PCC-R) and phonological systems were analyzed. Associations between therapy improvement and target sound acquisition, intention-to-treat, race/ethnicity, and socioeconomics were examined (Fisher's exact test, p≤0.05).

Results: significant PCC-R and phonological system improvements (p≤0.05) occurred post-therapy across all 12 participants, regardless of group. Improvement was associated with target sound acquisition and intention-to-treat, but not with race/ethnicity or sociodemographics.

Conclusion: telepractice, face-to-face, and hybrid therapy yielded similar outcomes for children presented with PI. Race/ethnicity and socioeconomic factors did not affect therapy improvement.

Keywords

Speech, Language and Hearing Sciences; Speech Sound Disorder; Telemedicine; Unified Health System; Pragmatic Clinical Trial

Resumo

Objetivo: comparar o tratamento fonoaudiológico presencial com a terapia por telefonoaudiologia e híbrida para crianças com transtorno fonológico no sistema único de saúde e caracterizar o perfil socioeconômico e de raça/cor dos participantes.

Métodos: doze meninos com transtorno fonológico, com idade média de 6:2 anos, foram divididos em três grupos: telefonoaudiologia, presencial e híbrido. Eles foram avaliados com a parte de Fonologia do ABFW, antes e após 11 sessões com a abordagem terapêutica ABAB-Retirada e provas múltiplas. A partir da avaliação, calculou-se o percentual de consoantes corretas revisado (PCC-R) e determinou-se o sistema fonológico geral dos participantes. A associação entre a melhora terapêutica e a aquisição do som-alvo, intenção de tratar, raça/cor e perfil sociodemográfico foi verificada (teste exato de Fisher, p≤0,05%).

Resultados: houve aumento significante (p≤0,05%) do PCC-R e do sistema fonológico geral após a terapia nos doze participantes, independentemente do grupo terapêutico. Houve associação entre a melhora e aquisição do som alvo; e a melhora e a intenção de tratar. Não houve associação entre a melhora e raça/cor e perfil sociodemográfico.

Conclusão: as formas de tratamento propostas demonstraram resultados similares. Os dados de raça/cor e socioeconômicos não influenciaram na melhora.

Palavras-chave

Fonoaudiologia; Transtorno Fonológico; Telemedicina; Sistema Único de Saúde; Ensaio Clínico Pragmático

Referencias

1. Dimer NA, Canto-Soares N do, Santos-Teixeira L dos, Goulart BNG de. The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: An experience report. CoDAS. 2020;32(3):e20200144. https://doi.org/10.1590/2317-1782/20192020144 PMID: 32578694.

2. Hassanati F, Mowzoon H, Soleimani F, Nobakht Z, Vameghi M, Takafolli M. Face-to-face and telespeech therapy services for children during the COVID-19 pandemic: A scoping review. Iran J Child Neurol 2023;17:9-41. https://doi.org/10.22037/ijcn.v17i3.42084

3. Farias IKM de S, Araújo ANB de, Nascimento CMB do, Xavier IA de LN, Vilela MBR. Characterization of care provided at a Speech Therapy School Clinic affiliated with the Brazilian public healthcare system. Rev. CEFAC. 2020;22(1):e10119. https://doi.org/10.1590/1982-0216/202022110119

4. Longo IA, Tupinelli GG, Hermógenes C, Ferreira LV, Molini-Avejonas DR. Prevalence of speech and language disorders in children in the western region of São Paulo. CoDAS. 2017;29(6):e20160036. https://doi.org/10.1590/2317-1782/20172016036 PMID: 29160334.

5. Andrade CRF de. Speech-language idiopathic disorder prevalence in children from one to eleven years of age. Rev Saúde Pública. 1997;31(5):495-501. https://doi.org/10.1590/S0034-89101997000600008 PMID: 9629727.

6. Molini-Avejonas DR, Estevam SF, Couto MIV. Organization of the referral and counter-referral system in a speech-language pathology and audiology clinic-school. CoDAS. 2015;27(3):273-8. https://doi.org/10.1590/2317-1782/20152014158 PMID: 26222945.

7. Diniz RD, Bordin R. Demanda em Fonoaudiologia em um serviço público municipal da região sul do Brasil. Rev soc bras fonoaudiol. 2011;16(2):126-31. https://doi.org/10.1590/S1516-80342011000200004

8. César A de M, Maksud SS. Caracterização da demanda de fonoaudiologia no serviço público municipal de Ribeirão das Neves - MG. Rev. CEFAC. 2007;9(1):133-8. https://doi.org/10.1590/S1516-18462007000100017

9. Dias RF, Mezzomo CL. Speech therapy for phonological disorders with basis on stimulation of phonological awareness skills. Distúrb. Comun. 2016;28(1):14-25. https://revistas.pucsp.br/index.php/dic/article/view/25425

10. Shriberg LD, Kwiatkowski J, Mabie HL. Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay. Clinical Linguistics & Phonetics. 2019;33:679-706. https://doi.org/10.1080/02699206.2019.1595731 PMID: 30987467.

11. Ceron MI, Simoni SND, Urrutia GAU, Keske-Soares M. Segmental acquisition of Brazilian Portuguese: Onset simple, complex and coda. CoDAS. 2022;34:e20200439. https://doi.org/10.1590/2317-1782/20212020439 PMID: 35043859.

12. Baker E, Williams AL, McLeod S, McCauley R. Elements of phonological interventions for children with speech sound disorders: The development of a taxonomy. Am J Speech Lang Pathol. 2018;27(3):906-35. https://doi.org/10.1044/2018_AJSLP-17-0127 PMID: 29801043.

13. Storkel HL. The complexity approach to phonological treatment: How to select treatment targets. Lang Speech Hear Serv Sch. 2018;49:463-81. https://doi.org/10.1044/2017_LSHSS-17-0082 PMID: 29582052.

14. Barberena L da S, Mota HB, Keske-Soares M. Phonological changes obtained by treatment based on ABAB-Withdrawal and Multiple-Probes Approach in different severity levels of phonological disorders. Rev. CEFAC. 2015;17(Suppl 1):44-51. https://doi.org/10.1590/s1516-18462013005000053

15. Mota HB. Aquisição segmental do Português: um modelo implicacional de complexidade de traços. Letras de Hoje. 1997;32. https://revistaseletronicas.pucrs.br/ojs/index.php/fale/article/view/15290/10082

16. Grogan-Johnson S, Schmidt AM, Schenker J, Alvares R, Rowan LE, Taylor J. A comparison of speech sound intervention delivered by telepractice and side-by-side service delivery models. Commun Disord Q. 2013;34:210-20. https://doi.org/10.1177/1525740113484965

17. Lopes MACQ, Oliveira GMM de, Maia LM. Digital health, universal right, duty of the state? Arq Bras Cardiol. 2019;113:429-34. https://doi.org/10.5935/abc.20190161

18. Coutinho E da SF, Huf G, Bloch KV. Ensaios clínicos pragmáticos: uma opção na construção de evidências em saúde. Cad Saúde Pública. 2003;19(4):1189-93. https://doi.org/10.1590/S0102-311X2003000400039 PMID: 12973582.

19. Zwarenstein M, Treweek S, Gagnier JJ, Altman DG, Tunis S, Haynes B, Oxman AD, Moher D, CONSORT group, Pragmatic Trials in Healthcare (Practihc) group. Improving the reporting of pragmatic trials: An extension of the CONSORT statement. BMJ. 2008 Nov 11;337:a2390. https://doi.org/10.1136/bmj.a2390 PMID: 19001484.

20. Dodd B. Re-evaluating evidence for best practice in paediatric speech-language pathology. Folia Phoniatr Logop. 2021;73:63-74. https://doi.org/10.1159/000505265 PMID: 31940655.

21. Wertzner HF. Fonologia. In: Andrade CRF, Befi-Lopes DM, Fernandes FDM, Wertzner HF, editors. ABFW: Teste de Linguagem Infantil nas Áreas de Fonologia, Vocabulário, Fluência e Pragmática - Terceira Edição Revisada, Ampliada e Atualizada. 3rd ed., Barueri: Pro-Fono; 2023. p. 5-40.

22. Shriberg LD, Austin D, Lewis BA, McSweeny JL, Wilson DL. The percentage of consonants correct (PCC) metric: Extensions and reliability data. J Speech Lang Hear Res. 1997;40(4):708-22. https://doi.org/10.1044/jslhr.4004.708 PMID: 9263938.

23. Shriberg LD, Kwiatkowski J. Phonological disorders III: A procedure for assessing severity of involvement. J Speech Hear Disord. 1982;47(3):256-70. https://doi.org/10.1044/jshd.4703.256

24. Bernhardt B. Developmental implications of nonlinear phonological theory. Clin Linguist Phon. 1992;6:259-81. https://doi.org/10.3109/02699209208985536

25. Nascimento LCR. Brincando com os Sons: jogos para a terapia de distúrbios articulatórios. 1 ed. rev. atual. Barueri: Pro-Fono; 2009.

26. Bohn GP, Santos RS. The acquisition of pre-tonic vowels in Brazilian Portuguese. Alfa Rev Linguíst (São José Rio Preto) 2018;62:195-226. https://doi.org/10.1590/1981-5794-1804-9

27. Maravalhas RDA, Santana DD, Salles-Costa R, Veiga GVD. Changes in meal frequency among adolescents living in a socially vulnerable area of the Rio de Janeiro metropolitan region, Brazil. Ciênc Saúde Coletiva. 2022;27(1):387-98. https://doi.org/10.1590/1413-81232022271.28092020 PMID: 35043916.

28. Abrucio FL, Rodrigues RV, Milanello TRS, Melo YM de. Ascensão e crise do Sistema de Assistência Social (SUAS) no federalismo brasileiro. Rev Katálysis. 2023;26(2):243-54. https://doi.org/10.1590/1982-0259.2023.e91292

29. Combiths P, Escobedo A, Barlow JA, Pruitt-Lord S. Complexity and cross-linguistic transfer in intervention for Spanish-English bilingual children with speech sound disorder. J Monolingual Biling Speech. 2022;4(3):234-70. https://doi.org/10.1558/jmbs.23445

30. Nizeyimana E, Joseph C, Plastow N, Dawood G, Louw QA. A scoping review of feasibility, cost, access to rehabilitation services and implementation of telerehabilitation: Implications for low- and middle-income countries. Digital Health. 2022;8:205520762211316. https://doi.org/10.1177/20552076221131670 PMID: 36249480.

31. Rizzotto MLF, Costa AM, Lobato L de V da C. Crise climática e os novos desafios para os sistemas de saúde: o caso das enchentes no Rio Grande do Sul/Brasil. Saúde Em Debate. 2024;48. https://doi.org/10.1590/2358-28982024141edp

32. Baker E, Masso S, Huynh K, Sugden E. Optimizing outcomes for children with phonological impairment: A systematic search and review of outcome and experience measures reported in intervention research. LSHSS. 2022;53(3):732-48. https://doi.org/10.1044/2022_LSHSS-21-00132 PMID: 35394819.
 


Submitted date:
26/08/2024

Accepted date:
28/04/2025

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