UNIVERSITY OF SUCRE

HEALTH SCIENCES FACULTY

PHONE AUDIOLOGY PROGRAM

PROCEDURE MANUAL FOR PRACTICE

PHONE AUDIOLOGICAL CLINIC

EVALUATION, DIAGNOSIS AND INTERVENTION AREAS OF THE

LANGUAGE SPEECH AND HEARING

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 PROCEDURE MANUAL FOR CLINICAL PRACTICE
PHONE AUDIOLOGY

EVALUATION, DIAGNOSIS AND INTERVENTION AREAS OF LANGUAGE

SPEECH AND HEARING

DOCUMENT PREPARED BY:

MARINELA ALVAREZ BORRERO

PATRICIA BERTEL PESTANA MARIA
DEL PILAR DIAZ RIVERO MARTHA
LUCÍA HERNÁNDEZ BLANCO MARIVEL
MONTES ROTELA KARINA UCROS
FUENMAYOR

WITH COLLABORATION OF
MARÍA MARGARITA AGUAS DE LA OSSA
KARINA LASTRE MEZA
KATIA ZAMBRANO RUIZ
LILIANA GONZALEZ FAYAD

UNIVERSITY OF SUCRE
HEALTH SCIENCES FACULTY
PHONE AUDIOLOGY PROGRAM
Sincelejo, August 2012

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 TABLE OF CONTENTS
P.
PRESENTATION 6
1. EVALUATION, DIAGNOSIS AND INTERVENTION AREAS OF 8
VERBAL LANGUAGE IN CHILDREN
1.1 CONCEPTIONS ABOUT LANGUAGE 8
1.2 EVALUATION OF ORAL LANGUAGE 9
1.2.1 Contents of the Oral Language Evaluation 9
1.2.1.1 Anamnesis 9
1.2.1.2 Language Levels 9
1.2.1.3 Metalinguistic Skills 17
1.2.1.4 Psychic Functions Related to Language 18
1.2.1.5 Basic Learning Devices 19
1.3 EXPECTED RESULTS 20
1.3.1 Evaluation Analysis 20
1.3.2 Characterization of the Behavior Communicative 21
/Denominations
1.3.2.1 Comprehensive Level 21
1.3.2.2 Expressive Level 21
1.3.2.3 Mixed 22
1.3.2.4 Secondary 23
1.3.3 Communicative Diagnosis (MPPF I-II) 24
1.3.4 Diagnostic Coding 24
1.4 TREATMENT GUIDELINES 25
1.4.1 25
Therapeutic Indications for specific language disorders (SLD)
1.4.2 26
Therapeutic Indications for Acquired Language Disorders
1.4.3 Intervention Speech therapy in Disorders auditory 27
communicative
2. EVALUATION, DIAGNOSIS AND INTERVENTION OF LANGUAGE 31
AREAS IN ADULTS
2.1 INITIAL CONCEPTIONS 31
2.2 LANGUAGE EVALUATION IN ADULTS 31
2.2.1 Contents of the Language Evaluation in Adults 31
2.2.1.1 Anamnesis 31
2.2.1.2 Expressive Language 32
2.2.1.3 Automatic Language 35
2.2.1.4 Comprehension 37
2.2.1.5 School Codes 38
2.2.1.6 Higher Brain Functions Related to Language 42
2.2.1.7 Basic Learning Devices 43
2.3 EXPECTED RESULTS 46
2.3.1 Characterization of Communicative Behavior/Denomination 46

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2.3.2 Communicative Diagnosis (MPPF I-II) 47
2.3.3 Diagnostic Coding 47
2.4 APHASIA TREATMENT 47
2.4.1 Objectives of Aphasia Treatment 47
2.4.2 Aphasia Rehabilitation Techniques 48
2.4.3 Management of Associated Disorders 48
3. ASSESSMENT, DIAGNOSIS AND TREATMENT OF 51
THE
READING LANGUAGE, NOTIONS AND MATHEMATICAL
3.1 CONCEPTIONS ABOUT LANGUAGE READING, 51
NOTIONS AND MATHEMATICAL CALCULATION
3.2 ASSESSMENT OF THE LANGUAGE 53
READING, THE
3.2.1 Contents of the Evaluation of Literacy Language, Notions and 53
Mathematical Calculation
3.2.1.1 Anamnesis 53
3.2.1.2 Higher Brain Functions related to Literacy, Notions and mathematical 53
calculation.
3.2.1.3 School Codes 57
3.2.1.4 Basic Learning Devices 62
3.3 EXPECTED RESULTS 66
3.3.1 Characterization of the Behavior 66
Communicative/Denominations.
3.3.2 Communicative Diagnosis (MPPF I-II) 68
3.3.3 Diagnostic Coding 68
3.4 TREATMENT GUIDELINES 69
4. EVALUATION, DIAGNOSIS AND INTERVENTION AREAS OF 75
SPEECH
4.1 CONCEPTIONS ABOUT SPEECH 75
4.1.1 Conceptualization of Speech Motor Processes 75
4.1.1.1 Joint 75
4.1.1.2 Breathing 76
4.1.1.3 Phonation 76
4.1.1.4 Resonance 76
4.1.1.5 Prosody 76
4.1.2 Conceptualization of Related Motor Processes 76
4.1.2.1 Feeding 76
4.2 SPEECH EVALUATION 76
4.2.1 Contents of the Evaluation of Speech Motor Processes 77
4.2.1.1 Anamnesis 77
4.2.1.2 Breathing 77
4.2.1.3 Joint 77
4.2.1.4 Phonation 79
4.2.1.5 Resonance 79
4.2.1.6 Prosody (suprasegmental aspects) 80

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4.2.1.7 Fluency 81
4.2.1.8 Feed Motor Process 81
4.3 EXPECTED RESULTS 84
4.3.1 Speech Evaluation Analysis 84
4.3.2 Characterization of communicative behavior/denominations 87
4.3.2.1 Joint 87
4.3.2.2 Phonation 89
4.3.2.3 Resonance 91
4.3.2.4 Prosody 91
4.3.2.5 Fluency 92
4.3.2.6 Feed Motor Process 93
4.3.3 Communicative Diagnosis (MPPF I-II) 95
4.3.4 Diagnostic Coding 95
4.4 TREATMENT GUIDELINES 95
4.4.1 General Considerations of the Intervention 96
4.4.2 Specific Considerations of the Intervention 97
5. EVALUATION, DIAGNOSIS AND INTERVENTION IN THE 100
AUDIOLOGY AREA
5.1 DEFINITION OF AUDIOLOGY 100
5.1.1 Conceptualization of Audiology components 100
5.1.1.1 Hearing Health Promotion 100
5.1.1.2 Prevention of Hearing Disease 102
5.1.2 Audiology Areas 103
5.1.2.1 School Audiology 103
5.1.2.2 Industrial Audiology 104
5.2 HEARING EVALUATION 106
5.2.1 Contents of the Hearing Evaluation 109
5.2.1.1 Anamnesis 109
5.2.1.2 Otoscopy 109
5.2.1.3 Hearing Screening 110
5.2.1.4 Tuning Fork Test 113
5.2.1.5 Audiometry 114
5.2.1.6 Logoaudiometry 117
5.2.1.7 Acoustic Immittance or Impedanciometry 118
5.3 EXPECTED RESULTS 119
5.3.1 Hearing Evaluation Analysis 119
5.3.1.1 Analysis of Audiometry Evaluation 119
5.3.1.2 Analysis of the Evaluation of Speech Audiometry 120
5.3.1.3 Analysis of the Evaluation of Acoustic Immittance 121

5.3.2 Characterization of communicative behavior/denominations 123

5.3.3 Communicative Diagnosis (MPPF I-II) 125
5.3.4 Diagnostic Coding 125
5.4 TREATMENT GUIDELINES 125
BIBLIOGRAPHY 131

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PRESENTATION

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 LANGUAGE AREA

LANGUAGE IN CHILDREN

PATRICIA DEL CARMEN BERTEL PESTANA16

1 .EVALUATION, DIAGNOSIS AND INTERVENTION AREAS OF VERBAL
LANGUAGE IN CHILDREN

1.1 CONCEPTIONS ABOUT LANGUAGE

“The triad Vygotsky, Luria, Leontiev and followers analyze language as a) an

instrument of social interaction, of initial communication, of the child with
adults and peers, of subsequent social communicative exchanges, of
transmission of sociocultural values; and b) a cognitive instrument”,…, “…,
through language it is not only generalized, but the experience of the
historical-social practice of humanity is transmitted to people, consequently
language is the means of communication and appropriation of the experience
of humanity, and at the same time, of the form of existence of that experience
in the consciousness of the human being.17 .
16 SPEAKER AUDIOLOGIST, MASTER IN EDUCATION WITH EMPHASIS ON COGNITION. ASSOCIATE
PROFESSOR OF THE UNIVERSITY OF SUCRE.
17 VYGOTSKI, LURIA, LEONTIEV, cited by MONTEALEGRE, R., Vygotsky and the Conception of Language, communicative activity
and the regulatory role of language in the child. Research Committee for Scientific Development. National University of

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On the other hand, in Piaget's sense18 , language is a particular form of the
symbolic function - a form of representation -, a differentiation of signifiers
(signs and symbols) and meanings (objects or events, both schematic or
conceptualized). Language allows not only to share ideas with other
individuals and, in this way, begin the socialization process, but also to use
mental representations and images, or thoughts, when performing “mental
experiments.”

According to Azcoaga19 , “it is a higher brain function that is acquired through

a learning process that occurs thanks to the existence of sufficient verbal
stimuli in the environment. But, although it could be postulated that language
“develops” from genetically programmed devices that are deployed by virtue
of communicative experiences, this “development” takes place, in any case, in
the cerebral cortex. "It must be considered, in any case, when talking about
the neurobiological basis of language, an active participation of the cerebral
cortex."

Bruner20 conceives language as a symbolic representation of experience, that

is, a system of related categories that incorporates and at the same time
perpetuates a particular way of understanding the world.

1.2 EVALUATION OF ORAL LANGUAGE

Second level procedure to evaluate linguistic systems in oral/signed and

written modality (includes reading and writing processes) to determine
strengths, weaknesses, contributing factors and implications for functional
communication.

Colombia, 1992., p. 30
18 PIAGET, J., CHOMSKY, N., PUTNAM, H. Language Theories, Learning Theories. Critical Editorial. Barcelona, 1983
19 AZCOAGA, J. Higher Brain Functions and their alterations in children and adults. Paidós Editorial. Argentina, 1992. p.277
20 BRUNER, J. Research on Cognitive Development. Pablo del Río Editorial. Madrid, 1980.

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1.2.1 Contents of the Oral Language Evaluation.

1.2.1.1 Anamnesis. It is the collection of most of the data that must be

considered in the knowledge of the child and his difficulties. It ranges from the
reason for consultation, the auditory, visual, neurological and cognitive status
must be taken into account, and the respective medical support must be
obtained.

1.2.1.2 Language Levels.

TO. Phonetic – Phonological Level. Phonetics involves production,

encompassing the sounds that actually appear in the child's speech. Emitting
sounds implies, in addition to neuroanatomical integrity, praxic mastery and
learning.21 . Phonology is the set of sounds that the child uses contrastively to
differentiate meanings. It is evaluated qualitatively and quantitatively through:

❖ Qualitative evaluation of the Phonetic-Phonological level.

- Obtaining and analyzing a language sample that includes repetition,

delayed imitation and spontaneous speech in planned situations, in which
the material is selected according to the individual characteristics of the
child and the objective of the evaluation procedure.
- Directed language : With visual reference, using real objects, drawings,
photographs, etc.
- Intraverbal/completing a sentence with a word: formulation of questions
that involve the articulation of the phoneme, group of phonemes and
syllable structure to be evaluated.
- Observation of linguistic/phonological behavior.

21 GRATIANO, C. and ÁLVAREZ, A. Evaluation of the Phonological aspect of Language, 2004. [ online ] Available from the
internet at: http://www.sld.cu/galerias/pdf/sitios/rehabilitacion-logo/evaluacion_del_aspecto_fonologico_.pdf [accessed
on 26 05-2011].

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 ❖ Quantitative evaluation or standardized methods of the Phonetic-
Phonological level.

- Test to evaluate the Phonological Processes of Simplification (TEPROSIF)

with applicability between 3 years - 5 years, 11 months, by Maggilo, L., M.
and Pavez, G., M.22
- Navarra Oral Language Test-Revised (PLON-R) with applicability between
3-6 years, by Aguinaga, G., Armentia, L., and others23 .

- Analysis of the evaluation of the phonetic-phonological level.

In the analysis of the level, the child's phonological acquisition process will be
taken into account, more specifically Jakobson's chronology, who proposes
that “acquisition involves the learning of contrasts of “features” rather than
sounds.”24 . Likewise, simplification processes / phonological errors or
phonological errors will be analyzed before the age of 6. 25 , or phonological
disorder.

b. Syntactic Level / Morphosyntax. At this level the structure of the

sentences and the order relationships of the components within the
fundamental structures are observed. Thus, Syntax estimates the report and
assesses grammaticality, that is, whether or not the basic organization has
been acquired. And morphology is the rules for constituting words through the
combination of units. Through it, categories such as gender, number, person,
time, among others, are specified. It is evaluated qualitatively and
quantitatively through:

• Qualitative evaluation of the syntactic level/morphosyntax.

22MAGGILO, L., M. and PAVEZ, G., M. Test to evaluate Phonological Simplification Processes –TEPROSIF. School of Speech
Therapy, Faculty of Medicine, University of Chile. Santiago, 2000.
23 AGUINAGA, G., and ARMENTIA, L., and others. Navarra Oral Language Test-Revised (PLON-R). TEA Editions, 2nd Edition.
Madrid, 2005.
24 JAKOBSON, Cited by ACOSTA, V. Language evaluation. Theory and practice of the evaluation process of Children's Linguistic
Behavior. Aljibe Publishing House. Malaga, 1996., p. 54
25 Ibid., p.65

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- Language sample. In planned situations, in which the material is selected
according to the individual characteristics of the child and the objective of
the evaluation procedure.
- Observation of the linguistic/syntactic behavior of natural situations in an
unstructured way. Use of the different grammatical categories and the
plurifunctionality granted to them.
- Provoked production (Describe, complete).

• Quantitative evaluation o Standardized methods of the

Syntactic/morphosyntax level.

- PLON-R, Revised Navarra Oral Language Test with applicability between

3-6 years, by Aguinaga and others.26
- CELF-3, Clinical Evaluation of Language Fundamentals-3 with
applicability between 6-21 years, by Semel and others.27
- ITPA, Illinois Test of Psycholinguistic Aptitudes with applicability between
2.6 -12 years, by Kirk and McCarthy.28
- MacArthur Communicative Development Inventory with applicability
between 8 -30 months29 , Spanish adaptation, by López and others.

• Analysis of the evaluation of the syntactic level/morphosyntax.

In the qualitative evaluation through the language sample, observation of

linguistic behavior, provoked production, the evolutionary patterns of
grammatical development will be considered, such as: The types of syntactic
constructions that they use correctly; sentences containing syntactic errors;
the internal structure of the sentence: coordination, subordination and what
type; the different formal classes of words used and how they are treated

26 AGUINAGA G., ARMENTIA, L., and others. Revised Navarra Oral Language Test. Op. Cit.
27 SEMEL, E., WIIG, E., and SECORD, W. Evaluation of Language Fundamentals CELF-3. Version 3. The Psychological Corporation.
United States, 1997
28 KIRK, S., A., and MCCARTHY, J., J and KIRK, W. Illinois Test of Psycholinguistic Aptitudes – ITPA. TEA Editions. United States,
1968.
29 LÓPEZ, S., GALLEGO, C., GALLO, P., KAROUSOU, A., MARISCAL, S. and Martínez, M. MacArthur Communicative Development
Inventory. TEA Editions Spain, 2005.

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(agreement, gender and number markers, etc.)30 .

In the quantitative evaluation through standardized methods , the guidelines

established in the tests used will be considered:
- PLON-R Navarra Oral Language Test-Revised (3-6 years): Repetition of
phrases and spontaneous verbal expression.
- CELF-3 – Clinical evaluation of language Fundamentals (6 – 21 years).
Word structure, sentence formulation.

30 ACOSTA, V. Language Evaluation. Op. Cit., p.84

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- ITPA - Illinois Test of Psycholinguistic Aptitudes (2.6 years to 12 years).
Grammatical closure, recognition of the basic rules for forming words and
grammatical structures, inflections and derived forms (plurals, adverbs,
prepositions and pronouns).
- MacArthur Communicative Development Inventory, Spanish adaptation (8
months to 30 months). Prelinguistic vocalizations. First words (early
production), grammar (word endings, difficult verbs, surprising words, word
combinations, morphosyntactic complexity).

c. Semantic Level. It focuses on the meaningful relationships established

between the linguistic units produced by an individual and the elements of
their environment, in addition to manifesting themselves in the lexicon, which
studies the meaning of individual words within the phrase and the breadth of
vocabulary. Semantic competence is shown in the analysis of the general
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meaning of sentences . It is evaluated qualitatively and quantitatively
through:

• Qualitative evaluation of the Semantic Level.

- Language sample. Non-verbal tasks (pointing, responding to commands,

following directions) and verbal tasks (definitions, analogies, similarities
and differences, understanding situations, verbal absurdities).
- Observation of linguistic behavior. In natural situations (classroom, home,
practice site,...).
- Observation of directed and spontaneous play. To provoke the child to use
vocabulary, follow rules and plan the game.

• Quantitative evaluation or standardized methods of the Semantic Level.

16
TORRES, J. Language disorders in children with special educational needs. CEAC Editions. Barcelona, 2003. p.126 31

31
- PLON-R, Navarra Oral Language Test - Revised with applicability between
3-6 years, by Aguinaga and others.
- PDLP, Test for the diagnosis of Preschool Language with
applicability between 3-6 years, by Blank et al.32
- CELF-3, Evaluation Clinic of the Language Fundamentals 3, with
applicability between 6-21 years, by Semel and others.
- Token Test or Taken Test - Abbreviated Version with applicability between 3
- 12 years, 11 months, by Renzy and Faglioni.33
- Terman and Merril Scale34 .
- PEABODY –PPVT- Picture vocabulary test with applicability between 2
years, 6 months - 90 years, by Dunn and others35
- ITPA. Illinois Test of Psycholinguistic Aptitudes 36 by Kirk and others, with
applicability between 3 – 10 years.
- MacArthur Communicative Development Inventory, Spanish adaptation with
applicability between 8 - 30 months, by López et al.

• Analysis of the evaluation of the semantic level.

In the qualitative evaluation , through the language sample, observation of

linguistic behavior and observation of directed and spontaneous play, the
following will be taken into account:

- Types of meanings according to Luria 37 and/or Lund and Duchan referenced

by Acosta, V.38 , implies the power to include, exclude and relate or not a
concept in different degrees of complexity of categories: function, location,
sensory-perceptive features, abstract features. (It is recommended to review
and study in detail the reference bibliography) - Capacity for synthesis.
- Analysis capacity.
32 BLANK, M., ROSE, and S. BERLIN, L. Preschool Language Diagnostic Test- PDLP. Pro ed. And International Publisher. Adaptation
for Spanish Speaking. Puerto Rico, 2003.
33DE RENZI, E., VIGNOLO, LA The Token Test: A sensitive test to detect receptive disturbances in aphasics. 1962
34TERMAN,
21 L.M., and MERRILL, M.A. Stanford-Binet Intelligence Scale. Oxford, England, 1973.
3522 DUN, L., M., DUN, L., M. and ARRIBAS, D. Vocabulary Test in Images. PPVT-III PEABODY. TEA Ediciones SA Madrid, 2006.
36KIRK, S., McCARTHY, J. and KIRK, W. Illinois Test of Psycholinguistic Aptitudes. Op. Cit.
23
37LURIA, R. Consciousness and Language. Learning Viewer Editorial. Spain, 2000. p.48
38LUND AND DUCHAN (1988) cited by ACOSTA, V. Language evaluation. Op.cit., p.92

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- Understanding of meaning.
- Establishment of essential and regular relationships, as well as abstract ones.
- Establish structure and activity: the parts that make up the meaning, how
each one acts, how they act with each other.
- The presence of excitatory and/or inhibitory symptoms will be observed, such
as failures in the encoding and decoding of verbal responses such as
paraphasias, anomies, circumlocutions, among others.

In the quantitative evaluation through standardized methods , the guidelines

established in the tests used and the corresponding ages will be considered:
- PLON-R, Navarra Oral Language Test-Revised: Lexicon
comprehensive, identification of basic actions, opposites, basic needs,
categories, actions, body parts, orders, definitions.
- PDLP, Preschool Language Diagnostic Test, (3-6 years and up to 10 years
for children with low academic performance): The child's communicative
performance at the semantic level (strong, weak, moderate).
- CELF-3, Clinical evaluation of language fundamentals. Sentence structure,
concepts and directions (orders), word classes (classification, synonyms,
antonyms). Listening to paragraphs: Interpret and infer information.
- TAKEN TEST (9 years in children from 4th grade onwards): Simple and
complex orders.
- PEABODY (2 – 16 years): Word recognition.
- ITPA (2.6 years – 12 years). Understanding of language.
-MacArthur Communicative Development Inventory, Spanish adaptation (8
months – 30 months). Prelinguistic vocalizations, first words

(early comprehension, global understanding of sentences). Vocabulary (report

on the number of words you understand and say. Patterns of vocabulary
evolution).

d. Pragmatic Level. It studies the functioning of language in social, situational

and communicative contexts, that is, it deals with the set of rules that explain or

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regulate the intentional use of language, taking into account that it is a shared
social system with norms for its correct use. in specific contexts 39 .It is evaluated
qualitatively and quantitatively through:

• Qualitative evaluation of the pragmatic level.

- Language Sample: Conversational

- Observation of the conduct linguistics:In situations
pragmatics (Pragmatics Protocol)

• Quantitative evaluation or standardized methods of the pragmatic level.

- PLON-R, (3-6 years), Navarra Oral Language Test-Revised, by Aguinaga

and others.
- MacArthur Communicative Development Inventory, Spanish adaptation (8
months – 30 months), by López et al.

• Analysis of the evaluation of the pragmatic level

In the qualitative evaluation, through the language sample, observation of

linguistic behavior will be taken into account:
- Communicative functions according to Halliday, M.

- Evolution of conversational skills: Formal organization of the conversation.

Maintenance of the theme, Level of development or mastery of deictic elements
in the discourse, to transmit information about precise referents.
- Metapragmatic capacity.
- Paralinguistic and extralinguistic aspects

In the quantitative or standardized evaluation, the following will be analyzed:

- Of the PLON- R (3- 6

39Op. Cit. p.33

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years) Informative, regulatory functions and
of
self-regulation (metapragmatics).
- Of the Development Inventory
communicative MacArthur (8 months – 30
months).Gestures (gestures, games, actions,…), uses of language.

1.2.1.3 Metalinguistic Skills.

Expressions of the ability to think, speak, understand and manipulate language.

The ability of people to consciously express the nature and properties of
language, a requirement to access reading and writing and, at the same time,
comes from the literacy processes.40 It is evaluated quantitatively through:

• Quantitative or standardized evaluation for Metalinguistic Skills

- Phonological Processing and Initial Reading Test (Taking exclusively the

Phonological Processing subtest) with applicability between 8-10 years, by
Bravo and Pinto41 .

❖ Analysis of the evaluation of metalinguistic skills.

The guidelines established in the Phonological Processing Test and initial

reading (8-10 years) will be considered, taking into account the performance in
the Phonological processing subtests, namely: Auditory discrimination,
integration of phonemes (auditory-phonemic sequence); integration of oral
auditory sequences, word segmentation and oral syllable inversion.

1.2.1.4 Psychic Functions Related to Language.

Psychic functions are specifically human learning processes, the product of a

40 ORTIZ, M. and SEPULVEDA, A. Speech Therapy Dictionary. María Cano University Foundation.2nd. Edition. Bogota, 2004. p.90
41 BRAVO, V., L., and PINTO, G., A. Phonological Processing and Initial Reading Test. Revised version. Chile, 1995.

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learning process, considered as a whole to praxias, gnosias and language.

TO. Orofacial Praxias. They are sets of movements structured to achieve a

purpose, generally automated, learned by repetitive performance that focus on
bucco-lingual functions. They are evaluated qualitatively through:

• Qualitative evaluation of orofacial praxis.

- Form for clinical evaluation of practical functions for the child.

- Format for anatomical and functional exploration of the phonoarticulatory
organs.

• Analysis of the evaluation of orofacial praxis.

- The structure and mobility of the speech organs is taken into account.
- Speed, precision, accuracy of orofacial practices by imitation and following
an order.

b. Auditory Gnosia. It corresponds to the recognition of sounds, noises and

music, important for the organization of language. 42 It is evaluated qualitatively
and quantitatively through:

• Qualitative Evaluation of Auditory Gnosia.

- Informal exploration of discrimination, figure-ground, analysis and synthesis,
memory, among others.

• Quantitative or standardized evaluation of Auditory Gnosia

- Wepman test43 with applicability between 5 – 8 years, from Wepman and
Reynolds.

• Analysis of the evaluation of Auditory Gnosia:

42 AZCOAGA, J. Physiological learning and pedagogical learning. El Ateneo Editorial. Mexico, 2000. p.129
43 WEPMAN, J. and REYNOLDS, W. Wepman Auditory Discrimination Test.Chicago: Language Research Association, USA, 1958.

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In the qualitative evaluation through informal assessment, the child's skills in the
different auditory skills will be considered according to their developmental age.

In the quantitative evaluation through standardized methods, the established

guidelines for the test used will be considered:
- Wepman test (5 - 8 years). Phonological identification.

1.2.1.5 Basic Learning Devices.

They are requirements for the acquisition of learning, which do not result from
previous learning processes (although their characteristics are modified by
them) and are essential in all learning processes.44 .

For the evaluation, the aspects mentioned about the Basic Learning Devices in
section 3.2.1.4 corresponding to the evaluation of Literacy, Calculation and
Mathematical Notions will be taken into account. Likewise, it is necessary to
verify the state of hearing, through referral for audiometry and speech-
audiometry tests.

If it is found that the cause of the linguistic disorder is a hearing deficiency, the
following clinical aspects will be considered in the evaluation process:

- Clinical History: Previous evaluation by audiology and ENT with their hearing
studies and diagnostic results.
- Anamnesis: Relevant data on the patient's auditory development or his
hearing, as well as psychomotor development.
- Application of standardized and non-standardized drums: musical
instruments, toys or sound objects of different tones. CD with recorded sounds.
A hearing trainer should be used when the patient does not have hearing
amplification.

44AZCOAGA, J. Higher brain functions and their alterations in children and adults. Paidós Editorial. Argentina (1992).

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1.3 EXPECTED RESULTS.

1.3.1 Analysis of the evaluation of oral language. Since verbal language is

not a form of representation or a psychic function and on the contrary, it is
constituted as a more elaborate human activity necessary for communication
and regulation of the human being (cognitive function). Therefore, the
evaluation and diagnosis of its specific development should not be reduced to
the independent quantification or qualification of the different levels and related
areas. Consequently, a relational analysis of the different aspects valued is
required to clarify and respond to the fundamental premise of: “what the user
has and why he or she has it.”

1.3.2 Characterization of Communicative Behavior / Denominations.

1.3.2.1 Comprehensive level.

- Developmental aphasia, according to Morley
- Evolutionary auditory agnosia, according to Law
- Language comprehension disorder, according to Ingram45
- Comprehensive developmental dysphasia, according to Benton
- Receptive dysphasia, according to Le Heuzay, Gerárd et Dugas46
- Comprehensive language delay.
- Delay of aphasic pathogenesis, according to Azcoaga, Bello, Citrinovitz,
Derman, and Frutos47
- Comprehensive specific language disorder (SLI) or lexical-semantic SLI,
according to ASHA48
- Disorder in the development of comprehensive language (ASHA)49 .
45 IMGRAM, cited by ACOSTA, MORENO, QUINTANA, RAMOS and ESPINO. Language evaluation. Op. Cit. P.57
46 LE HEUZAY, GERÁRD ET DUGAS, cited by MONFORT, M. AND JUAREZ, A. Dysphasic children. Description and Treatment.
CEPE Editorial. 2nd. Edition. Madrid, 1997. p.34
47AZCOAGA, J. E., BELLO, JA, CRITRINOVITZ, J., DERMAN, B., FRUTOS, WM “Language delays in children.” Editorial Paidós Ibérica,
SA Barcelona, 1990. p.90
48 AMERICAM SPEECH-LANGUAGE-HEARING-ASSOCIATION ASHA, cited by BARRACHINA, TORRENT Y REVENTÓS. Language
Difficulties and Disorders at School, 2002. p.6
49Language Disorder/Language Disorder. The ASHA defines it as the abnormal acquisition – in compression or expression – of
language. The problem may involve all, one or some of the components of the linguistic system (phonological, morphological,
semantic, pragmatic). They usually present problems with language processing or abstraction of significant information for storage
and retrieval by memory. Ibid., p.6
Likewise, Leonard defines language disorder as a delay in the acquisition and development of language without being associated

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1.3.2.2 Expressive level.
- Simple delay or simple language delay, according to Mendilaharsa50

❖ With compromise of the phonological and/or morphosyntactic levels

- Evolutionary apraxia, according to Law

- Dysarthria evolutionary, according to Morley
- Dysphasiaspecific evolutionary, according to Ingram
- Dysphasia expressive, according to Mendilaharsa51
- Time delay expressive of language.
- Anarthric delay, according to Azcoaga, Bello, Citrinovitz, Derman, and
Frutos52
- Specific phonological-syntactic language disorder.
- Disorder in the development of expressive language (ASHA).
- Specific expressive language disorder (SLI).

❖ With phonological commitment.

- Phonological disorder, phonological dyslalia (+6 years), according to Acosta,

Moreno, Quintana, Ramos and Espino53 and Torres54
- Phonological delay (-6 years), according to Acosta, Moreno, Quintana,
Ramos and Espino55 or phonological persistence, according to Bosh
- Phonological simplification processes according to Bosh
- Phonological Programming Disorder, according to Rapin and Allen56
- Verbal Dyspraxia-Audio Muteness, according to Rapin and Allen57

with other factors such as auditory deficits, psychopathological problems, socio-emotional adjustment difficulties and obvious
neurological deficits or brain lesions. Ibid., p.6
50Simple language delay (RSL). It is a maturational delay that corresponds to the limit of normality for language development.
Without alteration of cognitive abilities. Language ability is later than usual and its development is slow and out of phase with
what can be expected from a child of his age. It reduces over time and responds well to speech therapy intervention. It presents its
major phase gap stage between 3 and 4 years, then recovers (Pávez G. M., Schwalm A., Maggiolo L. M., 1986).
51Ibid.
52AZCOAGA, BELLO, CITRINOVITZ, DERMAN and FRUTOS. Language delays in children. Op. Cit.,p. 76
53ACOSTA, MORENO, QUINTANA, RAMOS and ESPINO. Language evaluation. Op. Cit. P.57
54 TORRES, J. Language Disorders in Children with Special Educational Needs. Op. Cit. P.49
55 ACOSTA, MORENO, QUINTANA, RAMOS and ESPINO. Language evaluation. Op. Cit. p.58
56 RAPIN and ALLEN, cited by MONFORT, M. AND JUAREZ, A. Dysphasic children. Op. Cit. p.32
57 Ibid., p.32

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1.3.2.3 Mixed.

- Delay in the development of anarthric-aphasic language, according to

Azcoaga, Bello, Citrinovitz, Derman, and Frutos58 .
- Phonological-Syntactic Disorder. Dysphasia. Better understanding than
expression, according to Rapin and Allen59 .

- Auditory-Verbal Agnosia (Verbal Deafness). Does not understand language,

no or almost no expression, according to Rapin and Allen60 .
- Mixed language disorder.
- Developmental disorder of comprehensive and expressive language,
according to ASHA.

1.3.2.4 Secondary.

- Specific language disorder of a semantic-pragmatic nature/autism,

according to Cáceres and Badajoz
- Audiogenic language delay, according to Azcoaga, Bello, Citrinovitz,
Derman and Frutos61 .
- Language disorder secondary to mental retardation, Down syndrome.
- Allalic delay. When there is a diagnosis of mild and moderate mental
retardation, according to Azcoaga, Bello, Citrinovitz, Derman, and Frutos62
- Allalic syndrome. When there is a diagnosis of severe and profound mental
retardation, according to Azcoaga, Bello, Citrinovitz, Derman, and Frutos63

Example of application of the denominations

Comprehensive level Language delay of aphasic pathogenesis.
Comprehensive language disorder.
Specific disorder of lexical-semantic language
development.

58 The name delay is based on an evolutionary criterion, when the difficulty appears in the first years (up to 5-6 years). AZCOAGA,
BELLO, CITRINOVITZ, DERMAN and FRUTOS. Language delays in children. Op. Cit., p.101
59 RAPIN Y ALLEN, cited by MONFORT Y JUAREZ. Dysphasic Children. Op. Cit. p.32
60 Ibid., p.32
61AZCOAGA, BELLO, CITRINOVITZ, DERMAN, and FRUTOS. Language Delays in children. Op. Cit., p.88
62Ibid., p.88
63 Ibid., p.88

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Phonological level
Phonological delay.
Disorder in phonological programming.
Phonological simplification process.
Level syntactic- Language delay of anarthric pathogenesis.
morphosyntax
1.3.3 Communicative Diagnosis (MPPF I-II)64

- Simple language delay (RSL)

- Expressive language disorder
- Comprehensive language disorder
- Comprehensive and expressive language disorder or mixed language
disorder
- Disorder in phonological programming, according to Rapin and Allen
- Phonological delay.
- Semantic-pragmatic disorder, according to Rapin and Allen65
- Communicative hearing disorder66
- Cognitive communicative disorder

1.3.4Diagnostic Coding

• According to the International Classification of Diseases - ICD 1067 .

- F80.2 Language comprehension disorder, F80.1 Language comprehension

disorder
language expression.
- F80.3 Acquired aphasia with epilepsy (Landau-Kleffner syndrome).

• According to the Diagnostic and Statistical Manual of Mental Disorders-

DSM-IV68 .
64 ASOFONO, ASOAUDIO, NATIONAL UNIVERSITY OF COLOMBIA. Manual of procedures for the Practice of Speech Therapy MPPF
I-II. Bogota, 1998-2001
65 According to Rapin and Allen, the name Semantic Pragmatic Disorder is used both for specific language disorders and for those
secondary to the Autism spectrum.
66 Both Communicative Auditory Disorder and Cognitive Communicative Disorder are linguistic delays as a result of hearing loss
and intellectual deficit respectively.
67 PAN AMERICAN HEALTH ORGANIZATION. OPS. International Statistical Classification of Diseases and other Health problems -
ICD-10. Spanish version, 2003.
68 AMERICAN PSYCHIATRIC ASSOCIATION APA. Diagnostic Manual of Mental Disorders DSM-IV TR. Revised Text, 2000.

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- F80.2 Comprehensive language disorder

F80.1 expressive language disorder.

1.4 TREATMENT GUIDELINES.

The intervention of the different language disorders will be carried out based on
the diagnosis, evaluation analysis and user needs. Thus, interventions can be
planned according to the criteria defined in the MPPF-II Procedure Manual for
Speech Therapy Practice.

1.4.1 Therapeutic Indications for specific language disorders (SLD)

❖ Intervention approaches.

Functional model structuralist model Cognitive model

When implementing this
Consists in place the This model has the basic model in speech therapy
language in he half objective of constructing the intervention, the emphasis is
pragmatic natural language for that placed on mental processes
and interact their and in he
achieve an interaction components or units for prosecution of
between its components. knowledge and language. The objective is to
The goal of therapy is for communication. Focuses integrate to communicate
the user to adapt or adapt to the work on the units of the and represent.
the contextscommunicative verbal components
regarding time and place to identified in the linguistic According to Vygotsky, from
different functions and profile obtained to the sociohistorical
people. from the evaluation as perspective there is
According to this model, the goals of preference to
rules that form the intervention. the
structures are acquired collaborative work,
progressively, since the metalinguistic development,
development of each ID of
component of the language the
is not uniform and therefore language as a sign that
is not learned at the same fulfills a communicative
time. function and a
cognitive as it is the basis of
verbal thought.

Of other part, the

psychogenetic perspective
leans its objectives towards
processes

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 development. The therapy
would focus on activities that
generate cognitive
imbalances that promote the
assimilation and
accommodation of mental
schemas.

❖ Expected results.

Treatment should lead to improvement or increase in verbal language, favoring

behaviors and/or cognitive-communicative processes. Additionally, treatment
may result in recommendations for reevaluation or referrals for other tests or
services.

❖ Clinical processes.

The objectives of the intervention are defined based on the results of the
evaluation. These goals must be subject to periodic reviews to define their
relevance.

1.4.2 Therapeutic indications for acquired language disorders

• Intervention approaches.

In addition to the intervention approaches indicated above (functionalist,

structuralist and cognitive), it is feasible to apply the behavioral approach to
intervene with users with acquired language disorders.

Within the behavioral approach, Bandura69 considers that language is an

observable behavior and as such the therapy is oriented towards the
achievement of measurable objectives, through the implementation of the
principles of classical, operant conditioning and social learning.

69 GÓMEZ, R.; HERNANDEZ, B.; ROJAS, U.; SANTACRUZ,O.; URIBE, R. Clinical Psychiatry. Diagnosis and Treatment in children,
adolescents and adults. 3rd. Edition. Panamericana Medical Editorial. Bogota, 2008. p.71

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 • Expected results.

Treatment should lead to improvement, modification, increase or compensation

of verbal language, favoring cognitive-communicative processes. Therapy
should lead to functional communication that meets the educational, vocational,
social and health demands of the user. Additionally, treatment may result in
recommendations for reevaluation or referrals for other tests or services.

• Clinical processes.

Communication goals are defined based on the results of the evaluation. These
goals must be subject to periodic reviews to define their relevance. The
intervention could require interdisciplinary support depending on the diagnosis.

1.4.3 Speech Therapy Intervention in Auditory-Communicative Disorders

They will be first and second level procedures, which apply specific strategies to
address communicative disorders of audiogenic pathogenesis. These
procedures are aimed at improving, modifying, increasing, compensating and/or
restoring the auditory skills necessary for the development of oral language.
The speech therapist, based on theoretical knowledge, will suggest consultation
or referral to the audiologist and/or ENT to define the treatment to follow. These
will be the ones who define the conduct to be followed with the patient, based
on the results obtained in the audiological studies, as follows:

In the event that the hearing loss is susceptible to medical or surgical treatment,
the ENT will be the one to define it based on auditory studies, generally in
transmission pathologies, Neuroma, among others. In sensory pathology or
agenesis of EAC, it will be treated with auditory amplification selected according
to each case (it must be done by the audiology specialist). In neural pathology
with great impairment of auditory discrimination, the orientation will be aimed at
auditory rehabilitation with augmentative and alternative communication therapy
(Facial lip reading-LLF, Sign Language, etc.).

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In central auditory processing disorders, the use of FM will be guided, as well as
for minimal hearing loss and auditory therapy if required. Any amplified hearing
loss with conventional, implantable hearing aids or cochlear implants must be
accompanied by oral aural rehabilitation, which must be performed by a trained
speech pathologist.

There are different audiological interventions that are specific to the work of the
speech therapist, namely:

-Auditory therapy with oral aural focus.

-Auditory therapy for central auditory processing disorders (CAPD)

Speech therapy practice will encompass oral aural therapeutic intervention,

which is the responsibility of the speech therapist, to address communicative
auditory disorders. This rehabilitation belongs to the language area. Oral aural
intervention may be applicable in the following cases: Children with prelingual
hearing loss under seven years of age, postlingual children or adults of any age,
and children with prelingual hearing loss over seven years of age, but who have
an established communication code with an oralist approach. or manual

General considerations for intervention in auditory-communicative disorders

should include:

-Definition of short, medium and long-term objectives, according to the hearing

pathology, use of hearing aids and age of the patient. These objectives must be
reviewed periodically to determine the patient's satisfactory progress or the
pertinent changes to be made.

-Guidance to the patient and family on the approach to communicative

pathology (Counseling).
-Periodic review and monitoring of the goals and achievements achieved.
-Periodic reassessment to make the appropriate adjustments.
-Referrals and consultations necessary where required.

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 LANGUAGE IN ADULTS

MARTHA LUCIA HERNANDEZ BLANCO70

COLLABORATION
KATIA LUCIA ZAMBRANO RUIZ71
2. EVALUATION, DIAGNOSIS AND INTERVENTION OF LANGUAGE
AREAS IN ADULTS

2.1 INITIAL CONCEPTIONS

Language is undoubtedly one of the most relevant and complex cognitive

functions of the human being and although its study is not exactly simple, its
importance has been confirmed since the beginnings of behavioral sciences.
When it is altered in adults, it manifests as an aphasic disorder as a
consequence of a lesion in the brain areas that control its emission and
comprehension, as well as its components (that is, semantic, phonological,

70 SPECIAL HEALTH AUDIOLOGIST, SPECIALIST IN HEALTH PROMOTION AND PREVENTION MANAGEMENT.

ASSISTANT TEACHER AT THE UNIVERSITY OF SUCRE.
71 PHONE AUDIOLOGIST, SPECIALIST IN TEACHING. ASSISTANT TEACHER AT THE UNIVERSITY OF SUCRE.

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morphological and syntactic knowledge).72 .

2.2 LANGUAGE EVALUATION IN ADULTS

2.2.1 Contents of Language Evaluation in Adults.

2.2.1.1 Anamnesis. It is the step prior to any assessment, in which personal

and family data prior to the illness are recorded. In the case of aphasic patients,
the identification of the communicative and linguistic history is of particular
importance. Likewise, the state of memory, attention and peripheral hearing
must be taken into account for the assessment. It is important to note that to
provide reliable information Both medical (neurological) records and contacting
a family member should be reviewed, since many aphasic individuals are
unable to do so.

2.2.1.2 Expressive Language. It provides data about the characteristics of

fluency/non-fluency, according to the amount of precise information
communicated, allowing the severity of the communication deficit to be
appreciated.

TO. Expression. It is the coding process, it is the passage from thought to

external speech, that is, it is the process in which thought passes to verbal
expression and vice versa through the concept “internal language”. It is
evaluated qualitatively and quantitatively through:

• Qualitative evaluation of the Expression:

- Obtaining and analyzing a language sample.

- Directed language: with visual reference, using objects, drawings,
photographs, etc.

72HELM- ESTABROOKS, N. and ALBERT M.L. Manual of Aphasia Therapy. First edition. Panamericana Medical Editorial. Buenos
Aires, 1994.p.49

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 - Quantitative or standardized evaluation of Expression:

- Boston Test for the Diagnosis of Godglass and Kaplan Aphasia73 .

• Analysis of the evaluation of the Expression.

When obtaining and analyzing a sample of language and directed language, the
following will be taken into account: Number of words uttered (verbal fluency),
length of sentences, articulatory agility, grammatical form, ease of finding
words, prosody, jargon, phonetic deviations, paraphasias Associated disorders
such as: agrammatism, paragrammatisms, empty speech, neologisms, apraxia
of speech.

In the analysis of the standardized tests, the grading criteria for each of the
annotated tests will be taken into account, which are found in the formats
prepared by the author.

- For the Boston test, the following will be examined: oral agility (verbal and
non-verbal), fluency, conversational speech, Verbal Behavior, grammaticality,
prosody, and the presence of error codes such as: paraphasias, verbal
stereotypes, anosognosia, locks anomic, echolalia,
perseverance, etc.

b. Repetition. The ability to reproduce, from auditory presentation, patterns of

familiar speech sounds is normally acquired early in life and constitutes one of
the basic mechanisms of spoken language. It should be explored why it allows
syndromes within the categories of fluency and non-fluency. It is important that
the patient has preserved peripheral hearing, attention and memory skills to
execute this task. It is evaluated qualitatively and quantitatively through:

• Qualitative Evaluation of Repetition

73 GOODGLASS, H. and KAPLAN, E. Evaluation of Aphasias and Related Disorders. Panamericana Medical Editorial. Madrid, 1996.

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- Obtaining a language sample .
- Directed language: with visual reference, using objects, drawings,
photographs, etc.

• Quantitative or standardized evaluation of repetition.

- With standardized tests: Boston Test for the diagnosis of aphasia by Godglass
and Kaplan.

• Analysis of the repetition evaluation

The qualitative analysis through obtaining a sample of language and Directed

Language will be taken into account: the repetition of isolated words and
repetition of sentences, the length and grammatical form of the words will be
observed, repetition of words with different syllabic complexity (one syllable ,
polysyllables, etc.), capacity for articulatory imitation, and the presence of verbal
stereotypies, perseverations, paraphasias, among others, will also be
considered.

In the standardized tests, the own grading criteria will be taken into account,
recorded in the formats established by the authors. The Boston Test for the
diagnosis of aphasia will study: repetition of words, phrases and sentences with
vowel sounds, consonants and syllables with similar sounds, series of syllables,
short/long/complex words, articulatory agility and the presence of error codes
(paraphasias, self-corrections, anosognosia, etc.).

c. Denomination. It is the ability to name words in different semantic categories

such as actions and tools. It is important to consider the patient's vocabulary
when evaluating this aspect, in order to correctly attribute naming errors. It is
evaluated qualitatively and quantitatively through:

• Qualitative evaluation of the Denomination.

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- Obtaining a language sample.
- Directed language: with visual reference, using objects, drawings,
photographs, etc.

❖ Quantitative or standardized evaluation of the denomination.

Boston test for the diagnosis of aphasia by Godglass and Kaplan.

❖ Analysis of the evaluation of the denomination.

When obtaining a sample of language and directed language, the following will
be taken into account : naming by visual confrontation, where semantic
categories such as objects, actions, letters, numbers, colors and body parts are
included; the naming response, in which semantic associations (context) and
naming within a category are observed by analyzing the free memory of
elements within a specific semantic category. The following should be noted:
presence of articulatory difficulty, perseverations, paraphasias, among others. .

Standardized tests have scoring criteria created by the authors. In the Boston
Test, the response will be observed by naming (verbs, colors and numbers),
naming by Visual confrontation (vocabulary test and naming by categories). By
Auditory confrontation (useful to differentiate anomia from visual agnosia),
tactile naming (avoid instruments that provide information through another
sensory channel), prevent bimanual manipulation, by controlled association
(categorical verbal fluency – phonological, semantic).

2.2.1.3 Automatic Language. Provides information about the ability to express

a memorized sequence. It is an elementary sensorimotor skill of spoken
language.

TO. Automated sequences. Automated sequences are verbal tasks that

consist of reciting over-learned material, which makes it possible to induce

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followed speech from the patient. They are evaluated qualitatively and
quantitatively through:

❖ Qualitative evaluation of automated sequences.

- Obtaining a language sample.

- Directed language: with visual reference, using objects, drawings,
photographs, etc.

❖ Quantitative or standardized evaluation of automated sequences.

- Boston Test for the diagnosis of aphasia by Godglass and Kaplan.

❖ Analysis of the evaluation of automated sequences.

To obtain a sample of language and directed language, the following will be

taken into account: serial recitation of numbers, days of the week, letters of the
alphabet, months of the year, as well as oral automations such as prayers and
poems, fluency or lack of fluency, the presence of jargaphasias, verbal
stereotypies, perseverations and lack of evocation.

In the standardized tests, the qualification criteria established by the authors in

each corresponding format will be analyzed. For the Boston test, days of the
week, months of the year, series of numbers and letters of the alphabet will be
studied, and the presence of error codes will also be taken into account. In the
Minnesota Test, the aspect of speech and language.

b. Song/Melody/Rhythm. Ability to produce a correct melody, which should be

distinguished from the ability to produce the lyrics of a song. It is evaluated
qualitatively and quantitatively through:

❖ Qualitative evaluation of Song/Melody/Rhythm.

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- Obtaining a language sample.
- Directed language: with visual reference, using objects, drawings,
photographs, etc.

❖ Quantitative or standardized evaluation of Song/Melody/Rhythm.

- Boston Test for the diagnosis of aphasia by Godglass and Kaplan.

❖ Analysis of the Song/Melody/Rhythm evaluation

In the qualitative evaluation through a language sample and Directed

Language, the following will be taken into account: perseveration of the melody,
presence of paraphasias, ability to follow the rhythm by tapping.

In standardized tests, the scale of points noted in the various scoring tables will
be taken into account. The Boston test for the diagnosis of aphasia analyzes
the recitation of proverbs, melodies and rhythm, the presence of error codes
(perseverations and paraphasias) is observed.

2.2.1.4 Comprehension. It is the ability to recognize a word as a spoken

element of language, to associate meaning with a recognized word and to
interpret the added meaning that the syntax imparts to the words. It is evaluated
qualitatively and quantitatively through:

❖ Qualitative evaluation of understanding.

- Obtaining and analyzing a language sample.

- Directed language: with visual reference, using objects, drawings,

photographs, etc.

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 • Quantitative or standardized assessment of understanding.

- Boston Test for the diagnosis of aphasia by Godglass and Kaplan.

• Compression evaluation analysis

In the qualitative evaluation through the language sample, the following will be
taken into account: understanding of orders (simple and complex/questions),
understanding of isolated words (names of colors, objects, parts of the body,
etc.) and the presence of associated disorders.

In quantitative evaluation through standardized tests, they have grading criteria

created by the authors. For the Boston test, word comprehension, word
discrimination, word comprehension by category, semantic exploration, orders,
complex ideational material (text comprehension), syntactic processing,
grammatical structures, paraphasias, echolalia, etc. will be considered. others.

2.2.1.5 School Codes. It offers information about the ability to carry out any
type of reading, which implies having skills and strategies for reading (words
and pseudowords) and the ability to prepare a message and transcode it into
graphic characters. Likewise, information regarding mathematical calculation
skills.

TO. Reading. It is a process of constructing meaning from the interaction

between the text, the context and the reader. It is evaluated qualitatively and
quantitatively through:

❖ Qualitative evaluation of Reading

- Obtaining a language sample.

- Directed language: with visual reference, using objects, drawings,
photographs, etc.

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 ❖ Quantitative or standardized Reading Assessment.

- Boston Test for the diagnosis of aphasia by Godglass and Kaplan.

❖ Analysis of the reading evaluation.

In the qualitative evaluation through a sample of language and Directed

Language, the following will be taken into account: reading aloud (isolated
words out loud, sentences of greater length and semantic, phonemic and
grammatical complexity) and reading comprehension (association of words with
pictorial samples, similarities and differences, grouping of words according to
semantic category), aspects such as reading level, fluency, prosody,
metalinguistic mastery, reading speed and presence or absence of alexical
phenomena will also be observed.

In the standardized tests, the grading criteria of each of the annotated tests will
be taken into account, which are found in the formats developed by each
author. The Boston test analyzes basic symbolic recognition, word identification,
phonetics, grammatical morphology, reading aloud and reading comprehension,
etc. The presence of error codes (Hemialexia, omissions, literal paralexies,
substitutions) will be noted. Morphological parallelxies and additions).

b. Writing. Complex communicative, cognitive and linguistic activity of written

language production. Psycholinguistic process that consists of representing
words or ideas through conventional signs and in which the transaction between
thought and language takes place74 .It is evaluated qualitatively and
quantitatively through:

• Qualitative evaluation of Writing

- Obtaining a language sample.

74ORTIZ and SEPULVEDA. Speech Therapy Dictionary. Op. Cit. p.69

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- Directed language: with visual reference, using objects, drawings,
photographs, etc.

• Quantitative or standardized evaluation of Writing.

- Boston Test for the diagnosis of aphasia by Godglass and Kaplan.

• Analysis of writing evaluation

In the qualitative evaluation through a sample of language and Directed

Language, the following will be taken into account: graphomotor skills
(producing block letters, quality and content), automatic writing (series of
numbers and the alphabet), writing by confrontation (name of drawn elements ,
words to dictation) and narrative writing (producing isolated words/telling a
story), spelling, syntactic, word retrieval, spelling, etc. skills will be observed.

With standardized tests, the grading criteria for each of the annotated tests will
be taken into account, which are found in the formats prepared by each author.
The Boston test for the diagnosis of aphasia analyzes writing mechanics
(remembering written symbols), basic coding skills (elementary dictation, finding
written words), spelling aloud, written confrontation naming (writing to
dictation ), narrative writing (written formulation), characteristics are observed:
errors in spelling, syntax or semantics or due to the poor construction of the
physical features of the written word.

c. Calculation. It consists of a mechanical procedure, or algorithm, through

which it is possible to know the consequences that arise from previously known
data. It is evaluated qualitatively and quantitatively through:

• Qualitative evaluation of the calculation .

- Basic mathematical operations.

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 • Quantitative or standardized evaluation of the calculation.

- Complementary tests of the Boston Test (subtests of “Arithmetic” and “Setting

the time”) by Godglass and Kaplan

• Analysis of the calculation evaluation.

Exploration in calculation can serve as a criterion to differentiate a perceptual or

visual discrimination problem. In the qualitative evaluation, the effectiveness in
elementary calculation will be analyzed, which will depend on the automatic
conservation of numerical aspects and memory. Likewise, disabilities in
elementary calculation lead to disorders in the functions controlled by the frontal
lobes and right hemisphere and also to attention failures, mental processing
difficulties, and task sequencing.

In the standardized evaluation, the grading criteria for each of the annotated
tests will be taken into account, which are found in the formats developed by
each author. In the Boston Test, the aspect of arithmetic and progressive
complexity for solving basic tasks will be analyzed, as well as numerical
knowledge and its relationships.

2.2.1.6 Higher Brain Functions related to Language.

TO. Visuospatial Gnosia. Visuospatial abilities are made up of two main

components: Visual perception and construction. Visual perception includes the
ability to discriminate all stimuli, analyze new ones, recognize familiar stimuli,
and interpret everything that is seen. Visual-constructional gnosias combine
visual perception with motor responses. It is quantitatively evaluated through:

• Quantitative or standardized evaluation of visuospatial Gnosia.

- Boston Test by Godglass and Kaplan: It is evaluated with complementary

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 tests that contain construction praxia and Quantitative Spatial Battery
(Drawing following instructions, construction with sticks, three-dimensional
blocks).
- Test of the Figure of the King A of King- Osterrieth75 .

• Analysis of the Evaluation of Visuospatial Gnosia.

It will be analyzed according to the qualification criteria of each of the annotated

tests, which are found in the formats developed by each author. The Rey Figure
Test allows us to see the perceptual organization, visual-constructional skills
(copy) and visual memory (immediate and delayed reproduction); Therefore, the
type of copy, the accuracy and richness of the copy and the time of the copy will
be taken into account, as well as allowing the same elements to be seen in
memory playback. The exploration of visuospatial gnosia will determine the
patient's capacity in perceptive and constructive aspects, taking into account
that gnosis difficulties are found to a greater or lesser degree in comprehensive
or expressive aphasias with the exception of mild cases or discrete sequelae.

b. Praxias. Ability to produce intentional movements 76 . It is evaluated

qualitatively through:

• Quantitative or standardized evaluation of practices.

- Boston Test by Godglass and Kaplan in the aspect of Praxis that contains the
components of limb/hand praxis; orofacial/respiratory praxis.

• Analysis of the Evaluation of Praxias.

The analysis will be carried out taking into account the guidelines for scoring the
Boston Test.
75REY, A and OSTERRIETH, P. Rey-Osterrieth Complex Figure Test [ online ] . Available on the internet from :
http://es.scribd.com/doc/39302118/Test-de-La-Figure-Compleja-Del-Rey [ cited February 15, 2011 ] .
76HELM-ESTABROOKS, N. and ALBERT, M. L. Manual of Aphasia Therapy. Op. Cit. p.116

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2.2.1.7 Basic Learning Devices.

For learning to take place, the intervention of a set of neurophysiological

activities is essential in the higher sectors of the central nervous system, which
are called Basic Learning Devices.

TO. Attention. Attention is an important cognitive process for the development

of higher psychic functions, according to Ardila and

Ostrosky77 ,is the patient's ability to focus and sustain attention, before
evaluating more complex functions such as memory, language or the ability to
abstract. It is through attention that information coming from outside is
regulated, organized and selected to proceed with an effective reception. It
allows determining whether the patient is fully awake, alert and able to maintain
a focus of attention, which is basic for the evaluation. It is evaluated qualitatively
and quantitatively through:

• Qualitative evaluation of care.

- Informal evaluation: observation of the patient's behavior during the evaluation

process .

• Quantitative or standardized Evaluation of Care.

- Stroop Test (Spanish version), by Golden JC78

- Continuous Auditory and Visual Performance Test, by Spreen and Strauss.

• Analysis of the evaluation of care.

In the informal evaluation, the following will be taken into account: distractibility
to internal or external stimuli, through continuous execution tasks, analogous
77ARDILA and OSTROSKY. Guide to Neuropsychological Diagnosis. p.127
78GOLDEN,J. c. Colors and Words Test. Spanish adaptation TEA Editorial. 3rd. Edition. Madrid, 2001

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visual tasks that progressively increase complexity, repetition and inversion of
series of numbers.

With standardized tests, the level of attention and fatigue will be analyzed
according to the objectives of the test.

b. Memory. Human memory is the brain function that results from synaptic
connections between neurons. It allows humans to retain
past experiences. Experiences, depending on the temporal scope to which they
correspond, are conventionally classified into short-term memory and long-term
memory. It is evaluated quantitatively through:

• Qualitative evaluation of memory.

- Through the production of visual drawings, non-verbal associated pairs,

memory of figures, response by multiple choice and by pairing, immediate
and deferred memory, immediate logical memory. Evocation of words,
digits, events among others.

• Quantitative or standardized evaluation of memory.

- Test of the figure Rey complex, Rey and Osterrieth.

- Test of Memory Verbal of Lesak and Spreen
- Test of Creep verbal phonological and semanticby Ardila
- Test of memory semantics of Herminia Praita Added79
- Semantic Memory Test with associative increase by Pineda and Ardila

• Analysis of memory evaluation.

At a qualitative level, the type of memory used by the patient (short and/or long

79 PRAITA, A. H. Evaluation of Semantic Memory in patients with Alzheimer's Dementia. National University of Distance Education.
Faculty of Psychology. Psicothema Online Magazine. 2000. Volume 12 No. 2, pp. 192-200. [Online]:
http://www.psicothema.com/pdf/276.pdf . [Consultation: June 2, 2012].

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term) will be analyzed. In the standardized tests, the corresponding scales and
centiles for memory production will be analyzed according to the guidelines of
each test.

c. Sensory perception. The sensory-perceptive capacity belongs to all human

beings. According to Bejart, cited by Gubbay and Kalmar 80 , is the ability to
connect, internalize and interact with the external world, one's own body and
the body of others. It is assessed through standardized and non-standardized
methods:

• Qualitative evaluation of Sensoperception.

• Quantitative or standardized evaluation of Sensoperception.

- Thurstone and Yela Face Difference Perception Test . 81

• Analysis of the evaluation of Sensory Perception.

In the standardized tests, the corresponding scales and centiles for the
production of visual or auditory Sensoperception will be analyzed, according to
the guidelines of each test. At a qualitative level, the visual and auditory
sensory-perceptive appreciation capacity will be analyzed.

2.3 EXPECTED RESULTS

2.3.1 Characterization of communicative behavior / Denominations.

Language disorder or aphasic disorder characterized by (describe the altered
linguistic conditions) secondary to aphasia (type) and/or associated with the
neurological disorder (agraphias, alexias, agnosias, acalculia, hemianopsia,

80 BEJART, cited by GUBBAY, M. and KALMAR, D. Sensory perception, 2005. [in line]
Available from Internet
at : http://www.capitannemo.com.ar/sensopercepcion.htm [accessed on 05-26-2011 ] .
81 THURSTONE, L. and YELA, M. Perception Test of Difference of Faces. [in line]. Available from Internet
at : http://es.scribd.com/doc/7109009/Test-de-PercepciOn-de-Semejanzas-y-Difference2 [Accessed on 05-26-2011].

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among others).
Neurological support should be taken into account. For the analysis, the
theoretical foundations set out below will be considered:

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 APHASIAS
EXPRESSIVE UNDERSTANDING
Non-fluent Fluent Not fluent Fluent
A.R. Luria82 : TO. R. Luria: Goldstein83 Aphasia A.R. Luria: Agnostic
dynamic aphasia Aphasia motor mixed transcortical. acoustic aphasia.
Aphasia motor afferent. Tkatschew and Kiml84 : head87 : Aphasia
efferent Aphasia acoustic Aphasia total. syntactic
amnesiac Tkatschew: Aphasia Weisenburg
transcortical
sensorimotor and
85
Vepman : Aphasia Macbride88 :
Expressive-receptive Receptive aphasia
Fradis86 : Mixed aphasia Goldstein: Aphasia
Global or total aphasia. sensory
TO. R. Luria: Semantic
aphasia.
Goodglass .Goodglass Goodglass and Kaplan Goodglass
Global Aphasia
and and and
Kaplan89 : Aphasia Kaplan: Kaplan: Wernicke's
of Drill, Aphasia of aphasia, and
and conduction, and transcortical sensory
2.3.2 Communicative Diagnosis (MPPF I-II). Expressive and/or
Comprehensive Language Disorder of Central Origin.

2.3.3 Diagnostic Coding. According to ICD 10:

- R470 Aphasia
- R480 Alexia

2.4 APHASIA TREATMENT

2.4.1 Objectives of Aphasia Treatment.

The objectives that will guide the treatment will be the following:

82 LURIA, cited by FAJARDO, L. AND MOYA, C. Neuropsychological Foundations of Language. Editions University of
Salamanca- Caro y Cuervo Institute. 1st. Edition. Bogotá, 1999.p.81
83 GOLDSTEIN, cited by SANTOS and GONZALEZ. Aphasia. Exploration, Diagnosis and Treatment. Editorial Sciences of the
Preschool and special education CEPE. Spain, 2000. p.74
84 Ibid., p.75
85 Ibid., p.74
86 Ibid., p.74
87 Ibid., p.76
88 Ibid., p.76
89 GOODGLASS, H. AND KAPLAN, E. Evaluation of Aphasias and related disorders. Op. cit. p. 64-89

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- Reintegrate or remedy the aphasic patient's ability to speak, understand,
read and write.
- Help the patient develop strategies that compensate or minimize language
problems.
- Locate the associated psychological problems that compromise the quality
of life of the aphasic person and their family members.
- Help the family and loved ones to get involved in communication with the
patient.

2.4.2 Aphasia Rehabilitation Techniques.

The Rehabilitative Techniques that will be used in aphasic treatment are:

- Techniques for restore he language articulate
(Phonematic functionalisms).
- Techniques for grammatical restoration (phrases and sentences marking link
elements).
- Techniques for restoring the ability to recognize and remember words
(naming).
- Techniques for the restoration of comprehension
verbal.
- Techniques to improve socialization, attention and
concentration (leisure activities, group activities, conversational, musical,
drawing workshops, etc.).
- Self help.
- Treatment of the family environment.

2.4.3 Management of associated disorders.

For memory disorders, information retention exercises through the different

sensory channels are recommended (progressively increasing).

For time orientation disorders, the patient will be guided to look for a time

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reference point, such as the date on a daily basis, as well as the management
of time series with mental demands (regressive series). There will be a
reinforcement of spatial relationships with immediate spatial and representative
spatial body reference (graphs, maps).

In auditory gnosis alterations, the area of audio-verbal discrimination will be

worked on, which will be achieved through identification tasks, discrimination of
phonetic oppositions, repetition and reproduction of rhythms; taking into account
individual possibilities.

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 READING LANGUAGE, NOTIONS AND
MATHEMATICAL CALCULATION

MARIVEL MONTES ROTELA90

3. EVALUATION, DIAGNOSIS AND TREATMENT OF READING –
WRITTEN LANGUAGE, NOTIONS AND MATHEMATICAL CALCULATION

3.1 CONCEPTIONS ABOUT READING LANGUAGE, NOTIONS AND

MATHEMATICAL CALCULATION

According to Julio B. from Quiros91 , reading and writing are processes

considered together (reading and writing), since they are mechanisms or an

90 SPEAKERS, SPECIALIST IN FAMILY HEALTH WITH MANAGERIAL EMPHASIS. MASTER IN EDUCATION.

ASSOCIATE PROFESSOR OF THE UNIVERSITY OF SUCRE.
91DE QUIROS, J. b. and SCHRAGER, O. Literacy language and its problems. Panamericana Editorial. Buenos Aires, 1996. p.12

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integral part of language development. According to other authors, each
process is defined independently, even knowing that in learning they are
acquired simultaneously and are part of the language.

Thus, for Child92 , reading is perceiving and understanding the written

sequence of signs and bringing thought to them, to interpret, recover and
value the underlying information in the text configured as ideas, concepts,
problems, reasoning, applications, relationships and attitudinal and aesthetic
experiences, according to the type of speech or genre. In other words, for
Ortíz and Sepúlveda93 , is an interpretive act that consists of knowing how to
guide a series of reasoning towards the interpretation of a message, based on
the knowledge it provides both in text - oral, written, visual - and the reader's
prior knowledge; Likewise, writing is a psycholinguistic process that consists
of representing words and ideas through conventional signs and in which
transactions between thought and language take place.

Azcoaga, Derman and Iglesias94 They consider reading and writing as a new
code derived from language and developed at the expense of a process
required by the need to establish communication that is more lasting than that
of verbal language. For them, the reading and writing code is characterized by
allowing a representation of the phonic units of contemporary languages and
is considered the most economical and accessible to immense masses of
human beings. Reading and writing are learned simultaneously and mutually
reinforce each other based on a common function that supports them, this is
language. To acquire writing, the child then requires language and a good
level of organization of complex manual praxis and visuospatial gnosias, while
for reading he only needs the latter and language.

In general, the term calculation refers, indistinctly, to the action or the result
corresponding to the action of calculating, consisting of carrying out the

92 NIÑO, R. v. The processes of Communication and Language. ECOE Editions. Bogotá, 1985.p.279
93 ORTIZ F. M. and SEPULVEDA, C. Angelica. Speech Therapy Dictionary. OP. Cit., p.104
94 AZCOAGA, J., DERMAN B. and IGLESIAS P., A. Alterations in school learning. PAIDOS Editions. Buenos Aires, 1992. p. 189

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necessary operations to predict the result of a previously conceived action, or
knowing the consequences that can be derived from some data. previously
known. For Azcoaga, Derman and Iglesias 95 , to do mental calculation only
internal language is used while those who operate graphically require both
their internal language and visuospatial gnosias and complex manual
practices related to the configuration of numbers. Both arithmetic operations
and geometric relationships will require a good organization of spatial
relationships that, coordinated with each other in the graphic space, will allow
the relationship of the digits.

On the other hand, according to Piaget, cited by Sandia and Wilmarys 96 The
origin of logical-mathematical thinking must be located in the child's actions on
objects and in the relationships that he establishes between them through his
activity; That is, the acquisition of calculation and mathematical notions is
consistent with the development of the child's thinking, hence its
psychogenetic development (sensorimotor, preoperational, concrete and
formal) is important. From a very early age, the child makes classifications,
compares sets of elements and develops other logical activities, this is
executing a notion, but he is not aware of it and acquires it spontaneously.

3.2 EVALUATION OF READING LANGUAGE, NOTIONS AND

MATHEMATICAL CALCULATION

3.2.1 Contents of the evaluation of Literacy, Notions and Mathematical

Calculation.

3.2.1.1 Anamnesis. It is the collection of most of the data that must be

considered in the knowledge of the child and his difficulties. It covers the
reason for consultation, the auditory, visual, neurological and cognitive status
must be taken into account, and the respective medical support must be
95 Ibid., p.79
96SANDIA, L. and WILMARYS, M. The Mediation of Logical-Mathematical Notions in the Preschool Age. World Literacy Congress
celebrated in Valencia (Spain) [in line]. Available by Internet
from : http://www.waece.org/biblioteca/pdfs/d185.pdf [accessed December 15, 2000]

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obtained.

3.2.1.2 Higher Brain Functions related to literacy, calculation and

mathematical notions.

TO. Visuospatial gnosias. According to Azcoaga97 A gnosia is the

recognition of specific referents through a certain sensory channel. Likewise,
visuospatial gnosia is a complex gnosia that is characterized by the
recognition of distances, spatial orientation and shapes; visual and
proprioceptive afferents (from the extrinsic muscles of the eyes) intervene in
its elaboration. It is evaluated qualitatively and quantitatively through:

• Qualitative Evaluation of Visuospatial Gnosia.

- Copy and reproduction of figures

❖ Quantitative or standardized evaluation of visuospatial Gnosia.

- Graphic Test of Perceptual Organization, by Hilda Santucci98

- Figure of King A and B, by Rey-Osterrieth.
- Visomotor Gestalt Test, by Bender and Koppitz.99

- Analysis of the evaluation of Visuospatial Gnosia.

In the qualitative analysis taken from the reproduction and copy of figures, the
following will be taken into account: location of images in space, location of
distances, proportion of the size of the figures, aspects of the form and
relationships between elements of the figure.

In the analysis of the standardized tests, the qualification criteria of each of the
annotated tests that come in the formats designed by the authors will be taken
97AZCOAGA, J. Higher Brain Functions and their alterations in children and adults. p.
98SANTUCCI, H. cited by ZAZZO, R. and Cols. Manual of the Psychological Examination of the Child. Fundamentals Editorial. pp
443-479
99
BENDER, L and KOPPITZ. Visomotor Gestalt Test. (1938). [online]. Available on the internet at:
http://es.scrib.com/doc/6916023/Test-Bender-Koppitz-Escala-De-Madurgacion-Neuro-Motriz . Consulted [04-25-2011].

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into account: The scores and centiles according to the scales of each test, as
well as their characterization. . In the Santucci Graphic Test of Perceptual
Organization (4-6 years) the success criteria corresponding to orientation,
crossing, shape and their corresponding average score will be analyzed
according to age.

In the King Figure Test A (8 years – adults) and B (4-8 years), the richness
and accuracy of the copy, the type of figure produced by the reproduction and
the time used will be taken into account, according to age.

In the Visomotor Gestalt Test, by Bender and Koppitz (5-10 years, 11

months), aspects absent or present in criteria such as: shape distortion,
rotation, integration, perseveration in the copied figures and their
corresponding average score according to age will be analyzed.

b. manual practices. Praxias in general, “are systems of coordinated

movements based on a result or an intention.” 100 Manual Praxias are
coordinated manual movements that include handling instruments such as
scissors, brush, pencil, crayon, among others . They are evaluated
qualitatively through:

• Qualitative evaluation of manual practices.

- Execution of fine manual movements with instruments: graphic and three-

dimensional tests.

• Analysis of the evaluation of manual practices.

In the analysis of graphic activities, the execution and handling of instruments

(paper and pencil or colors, among others) will be taken into account. In three-
dimensional or execution activities, the use of instruments (scissors, cubes,
folding paper, among others) and the execution of the activity.
100 PIAGET, cited by AZCOAGA. Higher Brain Functions and their Alterations in children and adults. Op.cit., p.95

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c. Language. The language aspects previously described in section 1.2.1.2
will be taken into account and will be complemented with:
• Quantitative or standardized evaluation of Language.

- Verbal Exploration Battery for Learning Disorders -BEVTA 101 , which

includes four tests (Verbal Similarities Test3-S, Concept Nomination Test
Grouped by Categories CAT-V, Immediate Verbal Assimilation Test TAVI,
and SV Verbal Serie Test); of Valdivieso and Pinto.

- Test designed to evaluate Phonological Metalinguistic Skills (PHMF)102 by

Díazy Yacuba.

- Phonological Processing and Initial Reading Test (Processing Subtest) by

Bravo and Pinto.

• Analysis of language evaluation.

In the analysis of the standardized tests, the qualification criteria of each of the
annotated tests that come in the formats designed by the authors will be taken
into account: The scores and centiles according to the scales of each test, as
well as their characterization. .

In the Verbal Exploration Battery for Learning Disorders – BEVTA (10 – 12

years), the averages per test are analyzed and related to what is expected for
their age and socioeconomic level; Likewise, it correlates with the abilities and
skills measured, among which are: auditory reception of oral language,
immediate verbal retention, verbal abstraction, vocabulary recognition,
determination of verbal categories, association of concepts belonging to
categories, verbal attention and reception. and sentence comprehension.

In the Test designed to evaluate Phonological Metalinguistic Skills – PHMF (4

101BRAVO, V.L. and PINTO, G. TO. Verbal Exploration Battery for Learning Disorders –BEVTA. Revised version. Chile, 1987.
102 DIAZ, O. c. and YAKUBA, V. Q. Test designed to evaluate Phonological Metalinguistic Skills –PHMF. Pontifical Catholic
University of Chile, 2000.

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years, 9 months - 6 years, 2 months), the analysis is done qualitatively taking
into account the ability measured, namely: final sounds of words, initial sounds
of words, syllabic segmentation of words, inversion of the syllables of the
words, sounds of the letters and phonemic synthesis of the words.

In the Phonological Processing Test and initial reading (8-10 years), the
contents of the Phonological Processing subtests are analyzed, namely:
auditory discrimination (DA), Auditory-Phonemic Sequence (SA), Integration
of Auditory Oral Sequences (SAO). ), Word Segmentation according to their
Phonemes (SP) and Oral Syllable Inversion (INV).

3.2.1.3School codes.

TO. Reading. According to reading, it is a process of constructing meaning

from the interaction between the text, the context and the reader.
Communicative activity of access and understanding of written language,
requires coordinating a series of processes of various kinds, mostly automatic
and unconscious for the reader.103 . It is evaluated qualitatively and
quantitatively through:

• Qualitative Assessment of Reading.

- Automatic (oral) and comprehensive (silent) reading sample, the latter will be
carried out either by the child and/or the evaluator taking into account the
characteristics and school grade of the user.

• Quantitative or standardized evaluation of Reading.

- Valdivieso and Pinto phonological processing and initial reading test

(Decoding and reading comprehension subtest).

• Analysis of Reading Assessment.

103ORTIZ and SEPULVEDA. Speech Therapy Dictionary. Op.cit., p.101

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In the qualitative analysis, in oral reading the following will be taken into
account: the reading type and its characterization, determining its
correspondence or not with the school grade, according to the reading types
expressed according to the Ministry of National Education-MEN (spelling,
subsyllabic, syllabic, hesitant, current and expressive) and those
contemplated according to Azcoaga, Derman and Iglesias104 (spelling,
syllabification, syllabification with reintegration, internalized syllabification,
dysprosodic fluent reading, prosodic fluent reading). Likewise, reading errors
that correspond to verbographic transcoding will be analyzed.

In comprehensive reading, the level of reading comprehension according to

the MEN will be taken into account. 105 : Literal level (up to 3° EBP), inferential
level (up to 5° EBP), and from 6° onwards the intertextual critic and according
to Azcoaga, Derman and Iglesias106 : Decoding the word, first discrimination of
meanings, grasping the meaning of the meaning, grasping the meaning in
expressive form and understanding the formal aspect of thought. It is
important to consider that these levels will not be assumed definitively, but
rather as an option to characterize states of reading proficiency.

Regarding the quantitative analysis, in the Phonological Processing and initial

reading test (8-10 years), an analysis of the reading decoding subtest will be
carried out, taking into account its raw score, its corresponding grade and
standard deviation according to age.

b. Writing. It is a complex cognitive and linguistic communicative activity for

the production of written language, a psycholinguistic process that consists of
representing words or ideas through conventional signs and in which
transactions between thought and language take place. 107 It is evaluated
qualitatively through:
104AZCOAGA, DERMAN and IGLESIAS. Alterations in school learning. Op. Cit., p.59
105
NATIONAL MINISTRY OF EDUCATION. Spanish language. Curricular Guidelines. Magisterio Editorial Cooperative. Santafé de
Bogotá (1998).p.112
106AZCOAGA, DERMAN and IGLESIAS. Alterations in school learning. Op. Cit., p.63
107 ORTIZ and SEPÚLVEDA. Speech Therapy Dictionary. Op. Cit., p. 69

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 ❖ Qualitative evaluation of Writing.

- Sample of automatic writing (by copy and dictation) taking into account the
school grade and characteristics of the user.
- Comprehensive writing sample (Writing), taking into account the school
grade and characteristics of the user.

• Analysis of writing evaluation.

In automatic writing (dictation and copying), the following will be observed:

Specific writing errors, making the respective classification into dysgraphic
and dysorthographic and type of spelling. Likewise, the type of writing that the
child has will be characterized, according to the graphic aspect contemplated
by Azcoaga, Derman and Iglesias.108 (Pre-calligraphic, children's calligraphy,
post-calligraphic). It is necessary to determine what graphemes and
graphemic synthesis the student uses to form syllables, words and phrases.

In comprehensive writing (writing), the type of constructions that the child

makes, the comprehensive level of writing according to Azcoaga, Derman and
Iglesias will be observed.109 (Preparatory stage, sentence structure
organization stage, word juxtaposition stage with understanding of ambiguity,
enumerative description stage, literary initiation stage, central idea
composition stage, and stylized composition stage) and the level of global and
local coherence of the constructed text, through the elements of cohesion,
precision and morphosyntactic analysis.

c. Calculus and Mathematical Notions. “Mathematical notions require the

contribution of the capacity for conceptualization which, in turn, has required
the acquisition of abstraction and generalization during language learning,…,
the difficulties of internal language already have an impact before schooling
on the capacity for classification, serialization, correspondence, equivalence,
108AZCOAGA, DERMAN and IGLESIAS. Alterations in school learning. Op. Cit., p.60
109
Ibid., p.65

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and compromise the acquisition of conjunctive notions in general. During the
school period,…, the general notions of natural number, mathematical
relationships, operations and their inverses and finally the ability to understand
arithmetic problem statements are affected.110 ”.

A. Mathematical notions. Basic concept that precedes the concept and

numerical relationships and basic operations. It is evaluated qualitatively and
quantitatively through:

• Qualitative evaluation of mathematical notions.

With real or concrete and semi-concrete objects, pre-numerical concepts such

as: term-to-term correspondence, serialization, classification, inclusion of
classes, quantifiers and the notion of number will be verified.

• Quantitative and standardized evaluation of mathematical notions

- Jacobo Feldman's preoperative and operative thinking level test111 .

• Analysis of the evaluation of mathematical notions.

At a qualitative level, it will be taken into account whether the student is able
to match objects, if he orders elements according to reversible transitive
relationships, if he groups and includes objects making qualitative
coincidences, combining subgroups and macrogroups, if he distinguishes
global quantities that contain numerical concepts and if makes number
relationships.

Regarding the test of the preoperative and operative level of thinking (5-12
years), the answers and their correspondence are analyzed according to the
stage of cognitive development that they are going through according to their
age, such as: Classifications, serializations, abbreviation capacity , associative

110Ibid., p.151
111 FELDMAN, J. Test of the level of preoperative and operative thinking. [ online ] Available on the internet from :
http://es.scribd.com/doc/21418632/MANUAL-DE-EVALUACI-oN-PSICOPEDAGOGICA-EXCELENTE [ with access on 03-25 2011 ] .

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capacity, asymmetric relationships, quantifiers, conservations, relationships,
knowledge and ordering of number, among others.

B. Mathematical Calculation. It refers to operational concepts, or the ability

to perform basic arithmetic operations at a mental and graphic level, starting
from the orderly execution of a sequence of steps guided by logical principles.
It is evaluated qualitatively and quantitatively through:

• Qualitative evaluation of mathematical calculation.

- Execution of basic arithmetic operations (addition, subtraction, multiplication,
division) and solving problems according to the school grade.

• Quantitative and standardized evaluation of mathematical calculation.

- Test of the level of preoperative and operative thinking by Jacobo Feldman.

• Analysis of the evaluation of mathematical calculation.

In the qualitative analysis, both management aspects of the concept of

operations and their operability will be taken into account, in order to establish
the cause or not of the difficulty. The understanding of the concept of the
operation, interpretation and resolution of problems with basic operations,
numerical positioning and errors in the operation will be looked at (explain why
they occurred).

Regarding the test of the preoperative and operational level of thinking (5-12
years), the answers and their correspondence are analyzed according to the
stage of cognitive development that they are going through according to their
age, such as: operations (add, subtract, multiply and distribute or divide);
simple and complex solving strategies (mental calculation, borrowing,
carrying, etc.); analytical observation of calculation resolution procedures and
the logical and executive ability to solve arithmetic problem situations.

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3.2.1.3 Basic Learning Devices.

They are requirements for the acquisition of learning, which do not result from
previous learning processes (although their characteristics are modified by
them) and are essential in all learning processes.112 .

TO. Sensory perception . It is capturing, processing and discriminating

external stimuli. It is evaluated qualitatively and quantitatively through:

• Qualitative evaluation of Sensoperception.

To evaluate visual perception, varied visual stimuli will be presented to

determine the different skills of visual-motor coordination, perceptual
constancy, positions and spatial relationships and analysis-synthesis,
according to age. To evaluate auditory perception, auditory stimuli will be
presented that measure skills such as: discrimination, awareness, analysis-
synthesis, auditory memory, according to age.

• Quantitative or standardized evaluation of Sensoperception.

- Auditory Perception Assessment Test113 , with applicability between 3

years, 6 months- 7 years, by Gotzens and Marro.
- Visual Perception Evaluation Method-DTVPby Frostig,114 with applicability
of 4-10 years from Hammill, Pearson and Voress.

• Analysis of perception evaluation.

In the qualitative evaluation through informal assessment, the child's skills in

the different visual and auditory skills will be considered according to their

112AZCOAGA, J. Higher Brain Functions and their alterations in children and adults. Op. Cit. p.
113GOTZENS, B. and MARRO, S. Auditory Perception Assessment Test. Exploring the sounds of Language. Masson Publishing.
Barcelona (2001).
114 HAMMILL, D., PEARSON, N., VORESS, J. Frostig's Visual Perception Evaluation Method-DTVP. Second edition. Modern
Manual Editorial. Mexico 1995.

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developmental age.

In the standardized assessment, referring to the auditory perception

assessment test, the analysis will be done according to the objectives of the
test; that is, qualitatively, taking into account the contents of each of its main
sections: Noises and sounds of language, such as: recognition, discrimination,
analysis, synthesis, closure, auditory association of general and language
noises and sounds.

Regarding Frostig's visual perception-DTVP, an analysis of each subtest of

the test and a rating of the composite quotients (visuomotor integration, with
reduced motor response and general visual) will be carried out.

NOTE: It is always pertinent to confirm through a formal hearing examination

(Audiometry and Speech Audiometry) that auditory perception is in good
condition. If possible, this same suggestion applies to visual perception.

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Attention. Effort or energy required to mentally concentrate for careful
observation and listening115 . The subject's ability to focus on an activity,
responding selectively to a stimulus or stimuli from the widest set of stimuli
that act on their receptor organs. It is evaluated qualitatively and quantitatively
through:

❖ Qualitative evaluation of care.

- The informal evaluation will be done through the observation of the child's
behavior, during the evaluation activities and in the class context.

❖ Quantitative or standardized evaluation of care.

- Intellectual work capacity test, for children over 9 years old from Luria116 .

• Analysis of the evaluation of Attention.

At a qualitative level, the organization of activities will be observed, whether it

is distracted by irrelevant stimuli, the selectivity and the time sustained by
attention (type of attention). In addition, excessive movement, maintenance of
the work position and motor activity will be noted.

With the standardized test, the level of attention and fatigue will be analyzed
according to the objectives of the test.

Memory. Ability to store information perceived through the senses 117 .

Information processing system that not only stores and retrieves information,
but involves a series of processes that construct and reconstruct part of that
100 information and that, despite its enormous power to store practically
101

102 everything, is very vulnerable to responsible internal and external variables.

that memories are sometimes altered or distorted. It is evaluated qualitatively

115ORTIZ and SEPULVEDA. Speech Therapy Dictionary. Op. Cit., p.27

116LURIA, A., R. Intellectual work capacity test. Document in physical archive of the University of Sucre.
117ORTIZ and SEPULVEDA. Speech Therapy Dictionary. Op. Cit., p.109

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and quantitatively through:

• Qualitative evaluation of the Memory:

Informally it can be evaluated through tasks that involve immediate and

mediated visual and auditory memory, taking into account the chronological
age of the child.

• Quantitative or standardized evaluation of the Memory.

- Rey's Complex Figure Test A (4-8 years old) and B (8 - and up), by Rey
and Osterrieth.
- Intellectual work capacity test, for children over 9 years old by Luria.

• Analysis of the evaluation of the Memory.

At a qualitative level, the capacity for evocation in short-term and long-term

memory will be analyzed.

At a quantitative level, in the King's Figure test, the corresponding scales and
centiles for memory reproduction will be analyzed, according to the age of the
student. In the Intellectual Work Capacity test, data are provided on immediate
memory and mediate.

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Motivation. According to Garrido, cited by Pérez 118 It is a psychological
process that from the inside drives action and determines the performance of
educational activities and tasks, which contributes to the child student
participating in them actively and persistently, enabling learning and the
acquisition of knowledge and skills and the competency development. It is
evaluated informally or qualitatively through:

• Qualitative evaluation of Motivation.

It will be assessed informally at three moments of the intervention (before,

during and after the therapeutic session) in order to look at expectations, self-
perception of learning, both positive and negative valences, affective-
emotional reactions, intrinsic-extrinsic motivation, therapist relationship. -
patient and child's attributions for success and failure in school.

3.3 EXPECTED RESULTS

3.3.1 Characterization of the Behavior

Communicative/Denominations.

- Dysorthography. Specific alteration in the learning of the ordering of

graphemes (not before 8-9 years), according to Ardila and Others 119 ;
Zenoff120 and Azcoaga121
- Dysgraphia. Specific learning alteration of the writing configuration. (Not
before 8-9 years), according to squirrel
and others122 ;
Ajuriaguerra 108 ; Zenoff and Azcoaga.

118 GARRIDO, cited by PÉREZ, S., M. Educational Guidance and Learning Difficulties. Thomson Publishing. Spain, 2003. p.175
119ARDILA, M., ROSELLI, M. and MATUTE, E. Neuropsychology of Learning Disorders. Modern Manual Editorial. Mexico,
2005.p.44
120ZENOFF, A. cited by FELD, V. and RODRIGUEZ, Mario. Child Neuropsychology. University Publishing. National University of
Luján. Buenos Aires, 2004. p.215
121AZCOAGA,
107 DERMAN and IGLESIAS. Alterations in School Learning. Op. Cit. p. 101
Ibid., p.33
122108 AJURIAGUERRA, cited by PÉREZ, M. Educational Guidance and Learning Difficulties. Op. cit. p.338

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- Dyscalculia. Specific alteration of calculus learning. (Not before 8-9 years),
according to Ardila and others 109 ; Purse123 ; Zenoff and Azcoaga.
- Dyslexia. Specific alteration in learning to read. (Not before 8-9 years old),
according to Bravo124 ; Azcoaga and Ardila and others125 .
- Dyseidetic Dyslexia according to Myklebust126 o Visual dyslexia, according
to Border127 .
- Auditory Dyslexia according to Myklebust or Dysphonetic Dyslexia
according to Border.
- Specific problems in learning. Difficulties or delays in learning. Learning
disabilities. Minimal neurological problems, according to Kinsbourne and
Caplan.128

The denominations indicated below take into account the maturational

factors / evolutionary criteria (Delay) in the development of the basic functions
prior to learning, before 8-9 years:

- Delay in reading, writing and calculation and mathematical notions as a

result of,…
- Delay in reading and writing due to consequences of,…
- Delay in (automatic) reading and writing and calculation by…
- Learning, reading, writing disorder......characterized by...
- In some cases, the term accompanied could be used
of…when other types of alterations in communication coexist.

Note: It should be noted that according to Kirk S.129 , the term “learning
disabilities” describes a heterogeneous group of children who manifest

109
Ibid., p.49

123 PURSE, cited by PÉREZ, M. Educational Guidance and Learning Difficulties. Op. cit. p.339
124 BRAVO, V. Psychology of School Learning Difficulties. University Publishing. The Sower Collection. Chile, 2002.p. 106
125ARDILA, M., ROSELLI, M. and MATUTE, E. Neuropsychology of Learning Disorders. OP. Cit.p.13
126 MYKLEBUST, cited by AZCOAGA, DERMAN and IGLESIAS. Alterations in School Learning. Op. Cit. p.25
127 BORDER, cited by ARTIGAS, J. Fifteen basic questions about dyslexia. [online] Available on the internet from:
http://www.sld.cu/galerias/pdf/sitios/rehabilitacion-logo/15_cues_de_la_dislexia.pdf [accessed on 06-30-2011]
128 KINSBOURNE, M and CAPLAN, PJ Attention and learning problems in children. Mexican Medical Press Editorial.
Mexico, 1990
129 KIRK, cited by AZCOAGA, DERMAN and IGLESIAS. Alterations in School Learning. Op. Cit. p.23

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unexpected problems in learning, and therefore it is necessary to take into
account what the following concepts refer to:

- The expression “Retardation” “will be used when difficulties appear in the

first school years and are overcome in the course of learning, with or
without the help of special corrective pedagogical methods.”130 .

- The name “Aftermath” “is reserved for those difficulties that, although very
attenuated, can persist in reading and writing throughout the school and
post-school cycle, despite the introduction of corrective pedagogical
methods.”131 .

- “The term “Sequela” will also be used for the disorganization of higher
brain function that gave rise to school learning disorder.132 .

- The name “Disorder” will apply to cases in which the term of acquisition of
the reading and writing codes has ended (9-10 years).

3.3.2 Communicative Diagnosis (MPPF I-II).

- Disorder of literacy or literacy and calculation and mathematical notions.

3.3.3 Diagnostic Coding (ICD-10).

- F81 Specific developmental disorders of school learning.

F81.0 Specific reading disorder.
- F81.1 Specific spelling disorder.
- F81.2 Specific calculus disorder.
- F81.3 Mixed developmental learning disorder at school.
- F81.8 Other developmental disorders of school learning.

130 AZCOAGA, J., DERMAN, B., IGLESIAS, P. Alterations in School Learning. Op. Cit. p.110
131Ibid. p.110
132Ibid. p.110

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- F81.9 Developmental learning disorder, unspecified.

3.4 TREATMENT GUIDELINES

The intervention of children with learning difficulties includes strategies and

activities aimed at improving or developing the functions that the child has not
yet developed, which will mark the precise areas and contents for each
particular case; Therefore, activities for language, visuospatial gnosias and/or
manual praxias must be taken into account, as well as stimulating functions
and skills in the process of initial reading and writing, calculation and
development of thinking strategies. In summary, the treatment must address
to diagnosis, evaluation analysis and user needs.

On the other hand, the different views, approaches or intervention models for
learning problems will be addressed, the most significant being: the
neuropsychological and cognitive models. Both offer attractive approaches to
this problem and have been leaders in different facets; the first
(neuropsychological) pioneering and dominant in much of Latin America and
the second (cognitive) based on Anglo-Saxon neuropsychology, with followers
in many parts of the world.133

133 QUINTANAR, L. and others. Learning Disorders. Neuropsychological Perspectives. Magisterio Editorial Cooperative-
Colombian Institute of Neuroscience. Bogota, 2008. p.14.

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According to Mejía134 For the neuropsychological model, learning problems
can be understood from 3 basic pillars: Basic learning devices (DBA), higher
brain functions (FCS) and emotional affective balance, and based on the
evaluation it allows us to propose a treatment, which aims to find
replacements. of the aspects of the functional systems of the FCS to improve
the possibilities of pedagogical learning, supported by a good functioning of
the DBA and seeking to preserve the emotional affective sphere of the child.

The way this model works is individualized as much as possible, to take into
account the specific condition of the child; although they can be grouped when
the children's pictures coincide for similar methods, but always taking into
account the particularities135 .
According to Mejía136 , the methodology is based on the fact that pedagogical
learning is based on objectives set by culture, and the therapist or speech
therapist is a mediator between the child and the academic learning that he or
she must achieve, with language as the regulator par excellence of the
activity. The speech therapist must plan objectives to achieve, relying on the
use of signals that go from the concrete to the abstract, until the child
internalizes them.137 .The work areas will be:

• Basic Learning Devices (DBA). Seeks to develop the

voluntary attention and memory, achieve the favorable or motivating tendency
towards academic activities of reading, writing, mathematics as means of
communication and instrument to achieve new knowledge and use perception
skills through different channels of reception and integration of information
such as basis for the development of the FCS138 .

121

122
Yo
123
124
125

134Ibid., p.97
135Ibid., p.112
136Ibid., p.113
137Ibid. p.112
138' Ibid. p.109

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❖ Higher Brain Functions (FCS). intends to develop
recognition skills in visuospatial relationships and orientations until achieving
mental images of them to promote the learning of reading, writing and the
appropriation of the numerical code and the management of mathematical
procedures. Develop the skills of recognizing specific sound referents typical
of their language, their synthesis into syllables and words, as well as the
awareness of this processing to promote the development of phonological
processing (phonological awareness), reading and writing learning and its use
for new learning. Develop the semantic network, language functions and use
them for the development of other skills, as well as for pedagogical learning.
Develop recognition skills of specific references of one's own body and its
movement; in order to improve phonological and motor processing involved in
graphic production 126 .

❖ Emotional affective balance. Seeks to preserve harmonious

development
127. 128
emotional affective of the child According to Uribe, cited by Quintanar,
the Cognitive model is based on the theory of general information processing,
based on developmental neuropsychology defended by Temple and others
129
and cited by Quintanar . This model attributes learning difficulties to
deficiencies in the functioning of the mental processes of handling and
processing information, but also to the lack of implementation of strategies by
the adult, to the non-use of them by the learner, and to sufficient automation of
the basic skills required for each learning area.

126 .
' Ibid., p.
127
109
Y
128Ibid., p.110

129Ibid., p.337
Ibid., p. 19

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Some of the methodologies proposed by the cognitive model are based on
direct instruction, through which it is taught how to solve a task and, with the
mediation of the therapist, it is directed through questions to carry it out.
130
Authors such as Monereo, cited by Quintanar and others, propose the use
of strategies such as “modelling, practice, new tasks and automation” as
intervention steps for learning difficulties, being very useful for students with
low performance who attend school. complementary programs to academics.

The work areas of the cognitive model focus on specific areas of learning as
follows:

• Reading. We work from the lexical or visual route and from the
indirect or phonological; Therefore, it must include aspects such as:
perceptual-visual ability (visual perception, visual analysis, visual
discrimination, visual memory, visuospatial and directional ability);
phonological awareness (lexical, syllabic and phonemic awareness); reading
comprehension (analysis and synthesis of texts through cognitive and
metacognitive strategies that seek to identify the internal structure of a text, its
lexicon, its grammar and interpret the meaning; as well as, make aware of
these actions for the benefit of learning) 131 .

• Writing. The graphomotor aspects or psychomotor ability are worked

on,
spelling and written composition, taking into account the phonological or
indirect route and the orthographic or visual route. “The graphomotor aspect
must be intervened to the extent that it affects written communication from the
132
point of view of its visual intelligibility” , to this end mobility activities, coarse
and fine grasp, pressure, tasks to improve form must be included. ,
directionality and size of the features, among others; as well as the
internalization of calligraphic forms. For the orthographic level, phonological
awareness, phoneme-grapheme-phoneme conversion rules, and reading and
writing recognition of spelling rules must be worked on. For written
composition or comprehensive writing, intervention must be made

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progressively from the structure of sentences, to phrases, sentences and
texts, taking care to maintain syntax and cohesion in a regulated manner.139 .

130
Ibid., 345
131
Ibid., p. 364
132Ibid., p.369

• Math . Strategies of basic mathematical skills (numbering,

correspondence, ordering, cardinality, abstraction and relevance),
development of calculation and algorithms (operational concepts to add,
decrease, compose and decompose quantities, as well as to multiply, divide
and their respective steps) must be developed. sequenced or algorithms),
problem solving (development of logical thinking and the executive ability to
program actions to achieve an objective in this case of mathematical order)140 .

139Ibid., p.374
140Ibid., p.384

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 SPEECH AREA

MARINELLA BEATRIZ ALVAREZ BORRERO141

MARIA DEL PILAR DIAZ RIVERO142

4. EVALUATION, DIAGNOSIS AND INTERVENTION AREAS OF SPEECH

4.1 CONCEPTIONS ABOUT SPEECH

Speech or verbal expression is a special and complex function, in which

everything from automated motor skills to cognitive processes (knowledge and
experiences) participate in a structured and organized way at progressive and
different levels of abstraction.

Similarly, the acquisition of speech is a process of perhaps a much more

complex nature, which is closely related to the maturation of the nervous
system, with cognitive and socio-emotional development. Hence, this process
is considered as an aspect of the integral development of the human being
that is, in short, a consequence of the interrelation of multiple factors coming,
on the one hand, from the same individual (endogenous) and, on the other

141 PHONE AUDIOLOGIST. TEACHING SPECIALIST. MASTER IN EDUCATION. ASSOCIATE PROFESSOR OF

THE UNIVERSITY OF SUCRE.
142 PHONOAUDIOLOGY. SPECIALIST IN HEALTH MANAGEMENT AND AUDIT. ASSISTANT TEACHER AT THE
UNIVERSITY OF SUCRE.

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hand, from the environment in which it lives (exogenous).

Thus, breathing, phonation, articulation, resonance and prosody are

considered a group of closely related processes that give rise to the
production of speech.

4.1.1 Conceptualization of Speech Motor Processes

4.1.1.1 Joint143 . Process that is responsible for modifying the flow of air
coming from the lungs, through the movements of articulatory structures such
as lips, tongue, teeth, pharynx, hard and soft palate to give rise to sounds,
phonemes, words and phrases with meaning ”.

4.1.1.2 Breathing144 . It is an involuntary and automatic process, in which

oxygen is extracted from the inspired air and waste gases are expelled with
the expired air, requiring the participation of inspiratory and expiratory muscle
groups.

4.1.1.3 Phonation145 . Mechanism in which different organs, cartilages and

muscles controlled by the cerebrospinal nerves intervene, which in a
combined action result in the production of sound, which are modified by
articulating and resonating structures.

4.1.1.4 Resonance146 . Selective amplification of vocal tone, through the

intervention of supraglottic resonators.

4.1.1.5 Prosody147 . Study of non-segmental phonic facts that contribute to

organizing both lexicon and syntax. These phonic facts have a specific
function in the semantic interpretation of statements and discourse.

143ORTIZ M and SEPÚLVEDA A.. Speech Therapy Dictionary. Op. Cit. p.26
144Ibid., p.142
145Ibid., p.81
146Ibid., p.142
147Ibid.,p. 134

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4.1.2 Conceptualization of Related Motor Processes

4.1.2.1 Food . It is the process through which the ingestion of different

consistencies occurs, allowing the metabolic requirements of the body to be
satisfied. The progress and integration of eating patterns will be the basis for
the development of the motor aspect of speech.

4.2 SPEECH EVALUATION

They are actions carried out within the consultation that lead to describing the
characteristics of patients' oral communication and the skills related to
perceptible phonatory characteristics, measuring aspects of vocal and nasal
function, examining phonatory behavior, measuring aspects of pharyngeal
velum function, the production of speech sounds, identify fluent and disfluent
behaviors and the parameters of normality and abnormality of the orofacial
myofunctional pattern and oral pharyngeal function for swallowing

4.2.1 Contents of the Evaluation of Speech Motor Processes.

4.2.1.1 Anamnesis. The parameters to take into account when planning the
evaluation are the following:
- Clinical history and/or Remission, structural, functional and
neurological, surgical and dental treatments. Analysis of clinical
information.

- Phonoaudiological, voice anamnesis

4.2.1.2 Breathing. Evaluation of respiratory mechanics (type, mode,

frequency, duration of the expiratory murmur and phonatory respiratory
efficiency depending on the word). To evaluate this process, the respiratory
sheet will be applied in children (up to 13 years of age). In the case of adults,
the respiratory behavior test proposed by speech therapists Clara Aponte and
Elsa Morales will be used.

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 • Qualitative and quantitative evaluation of Respiration:

- Assessment of the respiratory process. (Respiratory sheet) in children.

- Assessment of the respiratory process (Respiratory Behavior Examination)
in adults.

4.2.1.3Articulation. They are actions carried out within the consultation that
lead to describing the characteristics of the production of speech sounds. The
assessment is aimed at diagnosing normality or some joint alteration, this
generates recommendations for treatment, follow-up and referral to other tests
or services.

For this aspect, the articulatory point and mode, sonority, resonance (nasal –
oral phonemes), functional examination of the speech organs and oral-facial
praxis will be taken into account.

• Qualitative and quantitative evaluation of the joint.

- Application of standardized and/or non-standardized batteries related to

speech production (articulation sheet, speech sample, Speech Therapy
Articulation Examination - ELA ALBOR 148 , PED dyslalia evaluation
protocol149 TAR Repetition Articulation Test150 .
- Assessment of phono-articulatory organs (condition, structure,
functionality). OFA file

• Assessment of auditory perception.

- Auditory perception sheet in children for ages between 5 and 9 years.

- Gotzens and Marro Auditory Perception Assessment Test.

148GARCIA, GALVE, PRIETO and YUSTE. ELA-ALBOR Articulation Speech Therapy Examination. Preschool and Special Education
Sciences (CEPE). Spain, 1991.
149 LEA WORKING GROUP. Dyslalia Evaluation Protocol. [online] Available on the internet from:
http://web.educastur.princast.es/proyectos/lea/index.php?page=material-de-evaluacion [accessed on 06-30-2011]
150TEST FROM ARTICULATION TO REPETITION (TAR). [online] Available on the internet from:
http://es.scribd.com/doc/59461070/TEST-DE-ARTICULATION-A-LA-REPETICION-1 [accessed on 06-30-2011]

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 • Hearing assessment.

- Audiometry and Logoaudiometry in children and adults.

Note: Phonetic-phonological development must be taken into account in order

to rule out a difficulty from the language point of view.

4.2.1.4 Phonation. Set of procedures to measure vocal function after

otorhinolaryngological examination, in order to identify strengths, weaknesses,
contributing factors and implications for functional communication. It is aimed
at diagnosing voice disorders, describing perceptible phonatory
characteristics, measuring aspects of vocal function and examining phonatory
behavior; may result in recommendations for treatment, follow-up, and referral
for other tests or services .

For this process, the examination of the voice, study of the position of the
larynx at rest and phonation, study of the body and vocal scheme, observation
of the body and extra-laryngeal musculature in vocal function, general
relaxation in vocal function will be taken into account.

• Qualitative and quantitative evaluation of Phonation.

- Application of standardized and/or non-standardized batteries related to

vocal production according to the vocal and musculoskeletal behavior tests
proposed by speech therapists Clara Aponte and Elsa Morales.

- Sieve test: Wilson's vocal profile151

4.2.1.5 Resonance. They are actions carried out within the consultation that
lead to describing the characteristics of skills related to perceptible phonatory
aspects of nasal function, measuring aspects of pharyngeal velum function
and the production of speech sounds.

151RODRIGUEZ AND RODRIGUEZ. Basic forms for collecting clinical, administrative and teaching data. Program
Care teacher. Center for Human Communication. National university of Colombia. Bogota, 2001. Annex FC 9

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 ❖ Qualitative and quantitative evaluation of Resonance

- Application of standardized and/or non-standardized batteries related to

speech production: Resonance sheet according to the parameters taken
by “Fundación Operación Smile” and speech sample. Protocol prepared
according to criteria Henningsson and others152 adapted by operation smile
Colombia.
- Assessment of phono-articulatory organs (condition, structure,
functionality). OFA test.
- Assessment of the respiratory process using the Respiratory Sheet in
children153 .
- Assessment of the respiratory process (behavioral examination
respiratory) in adults.
- Assessment of auditory perception (auditory perception test in children
and/or audiological tests).

4.2.1.6 Prosody (Suprasegmental Aspects). They are actions carried out in

the exercise of the profession that include the study of various phenomena
associated with accent, rhythm and intonation, as well as their physical
manifestations resulting from variations in duration, fundamental frequency
and intensity.

It is related to the musicality of the elocution and involves modifications in the

accentuation and emphasis that should accompany normal elocution.154

The guidelines to take into account for the evaluation of this aspect are the
following:

- Sample of spontaneous speech, conversational, recitation.

- Suprasegmental aspects (intonation, accentuation)

152 HENNINGSSON G, KUEHN D, SELL D, SWEENEY T, TROST-CARDAMONE J, WHITEHILL T, Universal parameters for reporting
speech outcomes in individuals with cleft palate [in line]. Available in Internet
from : http://hablapalabra10.blogspot.com/2010/09/short-term-speech-outcomes-in-late.html [accessed 06-30-2011]
153BUSTS , yes reeducation of voice problems. publishing sciences of preschool and special education cepe. Madrid, 1983. p.31
154AZCOAGA, BELLO, CITRINOVITZ, DERMAN and FRUTOS. Language Delays in Children. Op. Cit., p. 147

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4.2.1.7 Fluency. They are actions carried out within the consultation that
lead to describing the characteristics of skills related to the initiation,
synchronization and coordination of breathing, phonation and articulation .

The parameters for the evaluation of this aspect are the following:

- Analysis of the associated emotional, behavioral, environmental,

psychological and medical aspects.
- Assessment of the type, frequency, duration and severity of fluency
failures under various speaking conditions.
- Assessment of the percentage of speech.
- Assessment of the respiratory process. (Respiratory sheet in children).
- Assessment of the respiratory process (Examination of respiratory
behavior in adults).
- Assessment of phono-articulatory organs (condition). OFA file.
- Review of associated behaviors

4.2.1.8 Feeding Motor Process. They are actions carried out within the
consultation that lead to describing the characteristics of the eating functions
and/or abnormalities of the orofacial myofunctional pattern and in the oral-
pharyngeal function for swallowing .

• Evaluation of the Oral Myofunctional Pattern.

- Observation of the orofacial myofunctional pattern.

- Instrumental diagnostic procedures (Payne technique 155 and

dynamometry156 ).
- Review of medical, clinical and dental treatment records.

155 GIRALDO, MARTINEZ and MONTES. Pilot Study on the application of the Payne Technique in different Occlusal Alterations.
University CES. Medellin, 2005. p. 10 [ in line ] Available in Internet:
http://bdigital.ces.edu.co:8080/dspace/bitstream/123456789/414/1/Estudio_piloto.pdf [ accessed 06-30-2011 ]
156 MARTINEZ, G. Generalities of Isokinetic Dynamometry [ online ] Available on the internet:
http://www.felipeisidro.com/recursos/documentacion_pdf_entrenamiento/dinamometria_isocinetica.pdf [ with access on 30
06-2011 ]

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- Structural evaluation (static assessment) that includes observation of the
face (facial analysis - facial biotype), jaws, lips, tongue, teeth, hard palate,
soft palate and pharynx (analysis of the oral cavity, occlusion)
- Myofunctional assessment of speech organs, dynamic assessment at rest,
mobility and tone of orofacial structures (lips and adjacent muscles,
tongue)
- Postural Analysis - Body Posture. Through observation and photographic
records.
- Evaluation of orofacial functions (breathing, swallowing, chewing,
phonation and articulation), Orofacial muscular behavior of chewing and
swallowing.
- Evaluation of the type, frequency, duration and severity of orofacial habits
under various conditions.

• Evaluation of the Phases of Swallowing.

The parameters for evaluation are the following:

- Review of medical and clinical records that consider any neurological

abnormality. Cognitive status, respiratory status, nutritional status and diet,
current and past complications attributable to dysphagia.

- Structural evaluation that includes observation of the face, jaws, lips,

tongue, teeth, hard palate, soft palate, larynx, pharynx and oral mucosa.
- Functional observation, including observations and measurements of
symmetry, oral sensation, strength, tone and mobility of structures, oral
praxis, cervical control, posture, breastfeeding, sucking, development of
reflexes and involuntary movements.
- Evaluation of the oral, pharyngeal and supraesophageal structures, which
participate in swallowing or feeding, including food preferences, feeding
processes, positioning, swallowing, postural control, general movement
pattern and respiratory coordination.

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- Evaluation of the implications of intubation on oral-pharyngeal function.
- Instrumental evaluation is frequently used in the interpretation of oral,
pharyngeal, and esophageal swallowing (e.g. Video fluorography,
Endoscopy, etc.) performed by other professionals.
- General evaluation is frequently performed, along with evaluation of
specific speech subprocesses and/or oral-pharyngeal function.

Regarding the evaluation of neurological alterations such as facial paralysis, it

is pertinent to evaluate the basic motor processes, in addition to considering
the evaluation of the feeding processes (chewing, swallowing), cranial nerves
(I, V, VII, VIII, IX, ,XII), It must be included:

- Structural evaluation (static assessment) that includes observation of the

face (facial analysis - facial biotype), jaws, lips, tongue, teeth, hard palate,
soft palate and pharynx (analysis of the oral cavity, occlusion).
- Myofunctional assessment of speech organs: dynamic assessment at rest,
mobility and tone of orofacial structures, oral praxis (lips and adjacent
muscles, tongue)

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- Postural Analysis - Body Posture. Through observation and photographic
records.
- Orofacial and craniocervical musculature sensitivity.
- Objective audiological assessment (audiometry, speech audiometry and
impedanciometry)

4.3 EXPECTED RESULTS

4.3.1 Speech Assessment Analysis .

• In Articulation, a synthetic analysis must be carried out taking into

account
tells the difficulties encountered in the evaluation based on the characteristics
of point, articulatory mode, OFA, breathing and auditory perception, describing
the types of errors and the position of the affected phonemes.

• Regarding Phonation, a synthetic analysis should be carried out based

in the characteristics of the muscular appearance, voice qualities, glottal
attack, breathing and resonance. The classification presented by Le Huche
151 152 153 154
, Bustos , Menaldi and Prater of functional dysphonia (depending
on the vocal work performed) and Organic dysphonia (patients with vocal
problems who come to the consultation when the damage is present and
requires diagnostic support (ENT).

• In Resonance, a synthetic analysis must be carried out taking into

account
considers the difficulties encountered in the evaluation based on the
characteristics of the pathology and Bustos' postulates157 , Prater158 ,Boone159 ,
namely:

157BUSTS, I. Reeducation of Voice Problems. Op. cit. p.62

158PRATER, R. and SWIFT, M.A. Manual of Voice Therapeutics. Op. Cit., p.61-65
159 BOONE, D. R. The Voice and the Treatment of Its Alterations. Panamericana Medical Editorial. Barcelona, 1994. p.45

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151
LE HUCHE, F. The voice. Volume 2. Editorial Masson SA Barcelona, 1992. Chapter I Second Part
152
BUSTS, I. Reeducation of Voice Problems. Op. cit. Chapter IV
153 MENALDI, J. The Pathological Voice. Panamericana Medical Editorial. Argentina, 2002. Chapter III

154 PRATTER, R. and SWIFT, R. Manual of Voice Therapeutics. Little Brown Publishing. Barcelona, 1995. Chapter
7
Depending on the cause, whether organic or functional, it is described
whether there is articulatory alteration or not (nasal emissions, coarticulations,
compensatory joints). (Hyper-hypo nasality). Hypernasality is considered
excessive resonance during the production of oral consonants and vowels,
equating this term to Nasality. Hyponasality is deficient production or lacks
nasal resonance, equating the term to denasality.

When only the timbre of the voice is altered it is called Hyperrinophonia and
when the resonance (timbre) is altered and at the same time the articulation of
the phonemes it is called Hyperrinolalia.

For cases of assimilative nasality, this will be diagnosed when the oral
phonemes adjacent to a nasal consonant are nasalized. The coarticulations
present in vocal production will be described.

In cases of Stridence, this will be diagnosed when the shape of the vocal tract
is altered. Which causes a weak and effeminate resonance to occur. The
presence of these characteristics must be described and likewise the
existence of hypertension at the level of the laryngeal and pharyngeal
muscles, as well as the behavior of the vocal timbre, which in these cases
tends to be metallic.

When a resonance alteration occurs due to defective tongue postures

(anterior - posterior), it will be described if there is a weak, dull vocal
resonance quality, if the tongue is retracted, posterior, anterior, and to what
extent the voice quality is being influenced by the deviation of the tongue and
the chronicity of this posture.

• Regarding Prosody, a synthetic analysis must be carried out

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based on the characteristics of prosodic features (stress, intonation).

• In Fluency, reasoning must be carried out taking into account

the difficulties encountered in the evaluation process based on the
characteristics of the muscular and respiratory aspects, phono-articulatory
organs, type, frequency, duration and severity of fluency failures. For this
analysis, Azcoaga's postulates will be taken into account. 160 , andTorres161
who define dysphemia or stuttering as “an alteration in the rhythm of speech
that manifests itself with interruptions in the fluency of the word”, consists of
the involuntary repetition or lengthening of sounds, syllables or words, which
are usually accompanied by sudden movements in whole body; which can
appear between 3 and 7 years (Torres), but must be clearly distinguished from
the developmental stuttering between 3 and 4 years, which is usually normal.

• In the Oral Myofunctional Pattern, the aspects evaluated will be

analyzed
taking into account the structure and functionality of the speech organs, in
addition to the effectiveness and functionality of each orofacial function.

• Regarding the Phases of Swallowing, the aspects will be analyzed

concerning the evaluation so that both anatomical and functional results that
intervene in the swallowing function are detailed.

❖ In cases of peripheral facial paralysis, the processes will be described

affected motors, with general and craniofacial muscle alterations and tone,
chewing and/or swallowing, orofacial sensitivity, secondary to the type of facial
paralysis described by a neurologist and/or physiotherapist

4.3.2 Characterization of the behavior

communicative/denominations

160 AZCOAGA, JE Language Delays in children. Op. Cit. p.130

161 TORRES, J. Language disorders in children with special educational needs. Op. Cit. p.61

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4.3.2.1 Joint

❖ For the characterizations of articulatory alterations, the following

conceptualizations will be taken into account:

Dislalia, according to Azcoaga162 and Fajardo163 : "permanent functional

disorder of the emission of a phoneme without any sensory or motor cause in
a child over 4 years of age", the diagnosis will be characterized as follows:
Difficulty, disorder, alteration, dyslalia... characterized by substitution of the
multiple sound vibrating linguoalveolar phoneme /r/ for the phoneme... /l/ in
initial, middle and final position associated with (short sublingual frenulum or
dysglosias if organic) or due to difficulty in motor coordination, if functional.

Dyglossia (organic dyslalia), according to Torres 164 ""is an alteration in the

articulation of phonemes produced by anomalies in the organs involved in
speech, the cause of which may be organic or acquired (accidents, growth
disorders)."

In cases of neurological disorders “Dysarthrias” according to Le Huche 165 , the

term applies to “joint disorders of central origin.” Currently, this term is
considered to apply to all speech disorders related to the involvement of the
various motor pathways that control the speech apparatus.

According to Lopez166 , the above would be used for neuromotor disorders

"Motor Failure of cerebral origin", whose diagnosis would be characterized as:
cerebral motor disorder or dysfunction, characterized by (the state, structure
and functionality of the orofacial musculature in general and the processes
basic and nutritional motors associated with the type of motor alteration
diagnosed).
162 AZCOAGA, JE Language Delays in children. Op. Cit. p.140
163 FAJARDO, L. and MOYA, C. Neuropsychological Foundations of Language. Op. Cit., p.96
164 TORRES J. Language disorders in children with special educational needs. Op. Cit., p.53
165 LE HUCHE, F. The voice. Volume 3. Op.Cit.,p.109
166LOPEZ, T. M. Motor Failure of Cerebral Origin IMOC. [online] Available on the internet from:
http://www.efisioterapia.net/articulos/imprimer.php?id=100 [ accessed August 15, 2011 ]

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According to Fajardo167 It is a “Disturbance in pronunciation due to a
mechanical cause, whether central or peripheral.” The diagnosis will be
characterized as follows: Articulatory disorder, characterized by... the state,
structure and functionality of the orofacial musculature in general and the
basic motor processes associated with ischemic or hemorrhagic stroke or TBI
will be described.

In cases of Apraxia according to Blasco168 It is defined as “Articulatory

alteration that affects the ability to program the position of the orophonatory
muscles involved in the voluntary production of phonemes due to a phoneme
lesion.” “Alteration in the programming of complex, coordinated and sequential
movements used for the speech production in the absence of paralysis or
injury that prevents movement.

According to Prater169 , “Apraxia of speech is characterized by a disrupted

speech motor program, resulting in an abnormality of voice, breathing, and
articulation.”

According to Darley, cited by Blasco170 Apraxia is defined as “an articulatory

disorder that is the result of a deficiency due to brain damage, of the ability to
program, the placement of speech muscles for the evolutionary production of
phonemes and the sequencing of muscle movements for the production.” of
words ".

• Denominations of articulatory alterations of peripheral origin.

- Dislalia, according to Fajardo171

- Articulation difficulty
- Articulatory failures
167FAJARDO, L. and MOYA, C. Neuropsychological Foundations of Language. Op.cit., p.97
168 BLASCO, T. AND. Apraxia of Speech. Presentation of a clinical case [online] Available on the internet from :
http://www.uv.es/perla/1%5B01%5D.BlascoTamarit.pdf [ accessed August 15, 2011 ]
169PRATER, R. and SWIFT, M.A. Manual of Voice Therapeutics. Op. Cit., p.209
170BLASCO, T. AND. Apraxia of Speech. Presentation of a clinical case. Op. Cit., p.3
171 FAJARDO, L. and MOYA, C. Neuropsychological Foundations of Language. Op. Cit. p.96

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- Articulatory disorder, according to Fajardo, Le Huche
- Phonetic Disorder, according to Torres172

• Denominations of joint alterations of central origin.

- Dysarthria, according to Fajardo, Le Huche173 , Prater174 Julia Torres175

- Joint disorder of central origin, according to Le Huche
- Apraxia of speech, according to Prater176
- Motor brain dysfunction (for CP cases) Blasco177 .
- Motor failure of cerebral origin178

4.3.2.2 Phonation.

❖ To characterize phonation alterations, the following conceptualizations

must be taken into account:

Glottic Dysfunction, organic dysphonia (when there is organic compromise)

characterized by (muscular hypertension, describe qualities of the voice,
glottic attack, breathing, etc.) associated with (laryngeal hyperfunction,
nodules, polyps, etc.), Depending on the degree of alteration (mild, moderate,
severe).

Vocal Dysfunction, Functional Dysphonia (when there is no pathology in the

vocal folds that is associated with structural damage) describe characteristics
associated with (vocal abuse and misuse). Depending on the degree of
alteration (mild, moderate, severe).

❖ Denominations of phonation alterations.

172 TORRES, J. Language disorders in children with special educational needs. Op. Cit., p.46
173 LE HUCHE, F. The voice. Volume 3. Op. Cit., p.109
174PRATER, R. and SWIFT, M.A. Manual of Voice Therapeutics. Op. Cit., p.176-178
175TORRES, J. Language disorders in children with special educational needs. Op. Cit., p.48
176PRATER, R. and SWIFT, M.A. Manual of Voice Therapeutics. Op. Cit., p.209-211
177 BLASCO, T. AND. Apraxia of Speech. Presentation of a clinical case. Op. Cit., p.3
178 LOPEZ, T. M. Motor Failure of Cerebral Origin IMOC. Op. Cit., p.1

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- Dysphonia, according to Jackson-Menaldi, Le Huche179 , Busts180 , Prater181
,
boone182 , Towers183
- Aphonia, according to Jackson-Menaldi, Le Huche184 , Busts185 ,
Prater186 ,
boone187
- Glottic Dysfunction
- organic dysphonia
- Vocal Dysfunction
- Functional dysphonia

179 LE HUCHE, F. The voice. Volume 2. Op. Cit., Second Part, Chapter I, p. 55
180BUSTS, I. Reeducation of Voice Problems. Op. cit. p.49
181PRATER, R. and SWIFT, M.A. Manual of Voice Therapeutics. Op. Cit., p.246
182 BOONE, D.R. The Voice and the Treatment of its alterations. Op. Cit. p.54
183TORRES, J. Language disorders in children with special educational needs. Op. Cit., p.69
184 LE HUCHE, F. The voice. Volume 2. Op. Cit., Second Part, Chapter I, p. 125
185 BUSTS, I. Reeducation of Voice Problems. Op. cit. p.49
186PRATER, R. and SWIFT, M.A. Manual of Voice Therapeutics. Op. Cit., p.246
187 BOONE, D.R. The Voice and the Treatment of its alterations. Op. Cit. p.67

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4.3.2.3 Resonance.

❖ For the characterization of resonance alterations, the following

conceptualizations must be taken into account.

Alteration of resonance and/or excessive nasalization of oral phonemes

and/or nasal, Characterized by… (Characterize substitutions,
omissions and alterations of articulatory point and mode, presence of
coarticulations, nasal emissions, compensatory articulations, glottis beats,
nasal snoring), likewise, respiratory process characterized by... (Describe
respiratory process, state and functionality of the OFA), secondary to …
(Organic or functional velopharyngeal insufficiency and incompetence).

❖ Denominations of Resonance alterations

- Open rhinolalia, according to Le Huche188
- Closed rhinolalia, according to Le Huche189
- Hyperrinolalia
- Hyporhinolalia
- Hypernasality, according to Prater190 and Boone191
- Hyponasality, according toPrater192
- Hyperrhinophonia, according to Busts193
- hyporhinophonia, according to Busts194

4.3.2.4 Prosody.

❖ To characterize prosody alterations, the following conceptualization

must be taken into account:

188
190 LE HUCHE, F. The voice. Volume 3. Op. Cit., p. 91

189
191 Ibid., p.91

190PRATER,
192 R. and SWIFT, M.A. Manual of Voice Therapeutics. Op. Cit., p. 265
191 BOONE, D.R. The Voice and the Treatment of its alterations. Op. Cit. p.13
192PRATER, R. and SWIFT, M.A. Manual of Voice Therapeutics. Op. cit., p.272
193BUSTS, I. Reeducation of Voice Problems. Op. cit. p.64
194Ibid., p.64

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Alteration of prosody characterized by... (Describe accent and intonation, the
melodic movement of words, phrases, tonal behaviors at the end and
beginning of each phonic group and the ascending and descending movement
of the voice in stressed syllables).

❖ Denominations of Prosody alterations.

- Dysprosody, according to Azcoaga195 , Ortíz and Sepúlveda196

4.3.2.5 Fluency.

❖ To characterize fluency alterations, the following conceptualization

must be taken into account:

Stuttering, Dysfluency, Dysphemia, characterized by (Characteristics, type,

severity, frequency of blockages, respiratory type, associated muscular
aspects).

Tachyphemia or taquilalia; It is a confusing, disordered, hasty and rapid way

of speaking that can lead to a lack of phono-respiratory coordination and
omission of syllables and phonemes at the ends of words. Blockages may
occur, however the differential characteristic is that the tachylalic is not
conscious of their difficulties.

❖ Denominations of Fluency alterations.

- Oral disfluency, according to Ortíz and Sepúlveda197

- Alteration in rhythm
- Dysphemia, according to Gallardo and Gallego198 , Towers199
195 AZCOAGA, JE Language Delays in children. Op. Cit. p.140
196 ORTIZ, M. and SEPÚLVEDA, A. Speech Therapy Dictionary. Op. Cit. p.63
197TORRES, J. Language disorders in children with special educational needs. Op. Cit., p.60
198 GALLARDO, R. and GALLEGO, J.L. School speech therapy manual. A practical approach. Aljibe Editions. Third edition. Spain,
2000. p. 243
199TORRES, J. Language disorders in children with special educational needs. Op. Cit., p.61

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- Tachyphemia or Taquilalia, according to Torres200 , Azcoaga201 , Fajardo202
- Stuttering, according to Le Huche
- Bradilalia, according to Azcoaga203

4.3.2.6 Motor Feed Process.

• The characterization of the alterations of the Oral Myofunctional Pattern

can be done:

- Orofacial muscle imbalance (in children): mild, moderate, or severe.

- Atypical swallowing (in adults): For Zambrana and Dalva204 , is considered

such as atypical pressure of the tongue or anterior and/or lateral lingual
interposition during swallowing .

- Orofacial muscular imbalance, characterized by (little strength, excessive

mobility) associated with inadequate oral habit (lingual interposition, labial,
etc.) and/or lip incompetence.

- Severe orofacial muscle imbalance secondary to structural alteration.

200
Ibid., p.61
201 AZCOAGA, JE Language Delays in children. Op. Cit. p.130
202FAJARDO, L. and MOYA, C. Neuropsychological Foundations of Language. Op.cit., p.97
203 AZCOAGA, JE Language Delays in children. Op. Cit. p.146
204 ZAMBRANA, N. and DALVA, L. Speech Therapy and Maxillary Orthopedics in Orofacial Rehabilitation. Editorial Masson, SA
Barcelona, 2001. p.42

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8
- Abnormal chewing and swallowing pattern, associated with lip
incompetence (articulatory alterations) secondary to bad habit (digital
sucking).

- Orofacial muscular imbalance, characterized by (little strength, excessive

mobility) associated with inadequate oral habit (lingual, labial interposition,
etc.).

• Denominations of the alterations of the Oral Myofunctional Pattern

- Atypical swallowing, according to Zambrana and Dalva 203 .

- In case of normality it is called “orofacial muscle balance”.

• The characterizations of the alterations of the swallowing phases can be

described:

- Alterations in swallowing, characterized by (severity, description of

tolerance to food consistencies, route of food administration).

- Swallowing dysfunction, characterized by (severity, description of tolerance

to food consistencies, route of food administration).

- Speech alteration characterized by (affected motor processes, with general

and craniofacial muscle alterations and tone, chewing and/or swallowing,
orofacial sensitivity, secondary to the type of facial paralysis described by
a neurologist and/or physiotherapist .

• Names of the alterations of the Swallowing Phases.

203
Ibid., p.62
Dysphagia, according to Ortiz 204

and Sepúlveda

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4.3.3 Communicative Diagnosis (MPPF I-II)

- Joint disorder (functional or organic of peripheral origin)

- Speech disorder of central origin (Dysarthrias)
- Speech disorder (Motor failure of cerebral origin - Cerebral palsy)
- Disorder of voice
- Disorder of resonance
- Disorder of prosody
- Disorder of fluency
- Disorder of rhythm
- Orofacial myofunctional disorder
- Swallowing function disorder
- Speech and/or swallowing function disorder

4.3.4 Diagnostic Coding

❖ According to CIE 10

- F800 Specific pronunciation disorder.

- R490 Dysphonia.
- R491 Hoarseness.
- R492 Hypernasality and Hyponasality.
- F985 Stuttering (spasmophemia)
- R13 Dysphagia

4.4 TREATMENT GUIDELINES

204
They are first, second and third
ORTIZ,M. and SEPÚLVEDA, A. Speech Therapy Dictionary. Op. Cit. p.58
level procedures that apply specific strategies to implement strategies aimed
at improving, modifying, increasing, compensating and restoring speech
production. It will be carried out taking into account the findings obtained from
the assessment.

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Phoniatric treatment examines the organic conditions of the airways, the
functions of the vocal cords and laryngeal muscles, the resonance organs, the
management of breathing, costal and diaphragmatic support, tessitura and
tonal flexibility, the management of volume, vocal resistance and intonation
security, through a comprehensive phoniatric diagnosis with different
specialized exams.

Speech therapy intervention for speech disorders related to articulation,

nutrition, rhythm and prosody will be aimed at achieving adequate production
of all phonemes and symphonies in both induced and spontaneous speech; to
the establishment of the correct swallowing pattern and the obtaining of an
elocution endowed with fluidity and musicality (intonation and accentuation).

4.4.1 General Considerations of the Intervention

- Definition of short- and long-term objectives, which must be reviewed in

accordance with the periodic revaluation.
- Guidance to the patient and family about the disorder (family counseling).
- Periodic review and monitoring of the goals and achievements achieved.
- Reassessment of the patient's current status (relevant adjustments).
- The treatment can be carried out simultaneously with the intervention of
language and/or communicative function disorders.
- Make relevant and timely referrals, attaching assessment reports.

Interdisciplinarity must be taken into account for the planning and

treatment of disabilities.

4.4.2 Specific considerations of the intervention

- Treatment of the joint leads to improvement, modification, increase or

compensation in the production of articulatory characteristics.
- The indirect intervention aims to achieve the maturation of the phonatory
organs and therefore its sections are similar to those we have mentioned

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 when talking about the stimulation of oral language in Early Childhood
Education although, when we talk about functional dyslalias , its purpose is
already more corrective than preventive and the exercises, although they
must continue to be motivating, have a less recreational component.
- Direct intervention attempts the articulation of the phoneme-problem and
its generalization in spontaneous language. It continues with direct
treatment exercises but mainly affects the point and mode of articulation .
- Speech therapy intervention for swallowing problems (atypical swallowing)
(myofunctional therapy) seeks to correct unbalanced muscles and
orofacial habits. Using physiologically based techniques in which the
chronological development of oropharyngeal functions is taken into
account. (Dictionary of speech therapy).
- The treatment of prosody and fluency is aimed at achieving speech
characterized by prompt initiation, synchronization and coordination of
breathing, phonation and articulation, with variations in tone and intensity.
- Speech therapy intervention for voice problems will be aimed at modifying
vocal habits and correcting voice parameters.

For the development of the phoniatric intervention, the following parameters

will be taken into account:

- At the level of resonators, we will seek to develop a resistant voice in a

productive way for its corresponding use.
- Regarding breathing, the aim will be to achieve a functional respiratory
capacity, in accordance with the vocal emission, for this the diaphragmatic
cost technique will be worked on, the normalization of the respiratory
frequency and the regulation of the murmur in intensity and duration.
- Regarding phonatory exercise, the aim will be to promote the muscle tone
of the vocal cords and therefore restore their normal motility. For correct
re-educational work, the medical diagnosis will be based on which must be
as illuminating as possible. The specialist doctor must record in his report
the tonic state of the larynx and vocal cords.

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 AUDIOLOGY AREA

KARINA UCRÓS FUENMAYOR205

5. EVALUATION, DIAGNOSIS AND INTERVENTION IN THE AUDIOLOGY
AREA

5.1 DEFINITION OF AUDIOLOGY

It is the area of Speech Therapy that is responsible for the promotion,

prevention, identification, evaluation and non-medical treatments of hearing
disorders. This definition is based on that presented by Bess and Humes. 206 , in
which they state that audiology “is a discipline involved in the prevention,
identification and evaluation of hearing disorders, the selection and evaluation
of hearing aids and the habilitation/rehabilitation of individuals with hearing

205SPEAKER-AUDIOLOGIST, SPECIALIST IN AUDIOLOGY. ASSISTANT TEACHER AT THE UNIVERSITY OF

SUCRE
206 BESS, F. and HUME, L. Fundamentals of Audiology. Manual Moderno Editorial, Mexico, 2005.p.

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impairment”, in addition according to Rivas and Ariza 207 It is a complementary
area of otology and as such studies normal and disordered hearing.

5.1.1 CONCEPTUALIZATION OF THE COMPONENTS OF AUDIOLOGY

The actions of the Audiology practice of the Speech Pathologist's competence

are described below:

5.1.1.1 Hearing Health Promotion

The World Health Organization WHO208 In 1998, returning to what was stated in
the Ottawa letter, he defined health promotion as “the process that allows
people to increase control over their health to improve.” Likewise, the WHO in
its Jakarta statement states that

Health promotion constitutes a global political and social process that

encompasses not only actions aimed directly at strengthening the skills and
capacities of individuals, but also those aimed at modifying social,
environmental and economic conditions in order to mitigate their impact. in
public and individual health.

In this order of ideas, Hearing Health Promotion is the process that allows
people to increase control over their hearing health, through actions aimed
directly at promoting the individual's abilities to achieve their hearing well-being
as well as to modify the negative conditions to it, in order to mitigate the impact
on him and the community. These promotional actions will be fundamentally
aimed at women of childbearing age or those who are pregnant, mothers or
caregivers of children under 10 years of age, young people and adults related to
health, education and industry.

207 RIVAS JA and ARIZA HF Treaty of Otology and Audiology. Diagnosis and Surgical Medical Treatment. Editorial Amolca, Bogotá,
2007.p. 119
208WHO-WORLD HEALTH ORGANIZATION. Health Promotion Glossary [ online ] . Available on the internet from:
http://www.educacion.gob.es/dctm/ministerio/educacion/universidades/educacion-superior-universitaria/universidades-
salanos/glosario.pdf?documentId=0901e72b81238071 . [accessed 06-12-2011]

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García and Tabón209 , take up what was stated by the WHO in 1998 and state
that Health Promotion has the following components:

- Construction of a healthy public policy

- Healthy environments
- Social participation
- Development of personal skills
- Reorganization of health systems

Taking into account the above, the actions that will generally be carried out to
promote hearing health in the clinical practices of the Speech Therapy program
at the University of Sucre will be the following:

- Promote healthy listening environments - Promote healthy listening styles

This is through various methodological and communicative strategies such as

talks, training, information campaigns, brochures, promotion of vaccination,
promotion of sanitation programs, development of community hearing
diagnoses, among others.

5.1.1.2 Prevention of Hearing Disease

The OMS210 ,determines that “Disease Prevention” are measures aimed not
only at preventing the onset of discomfort, such as reducing risk factors; but
also those that make it possible to stop its advance and mitigate its
consequences once established.

According to García and Tobón211 The concept of prevention is linked to the

health – disease process. They maintain that Sigerist, in 1945, made the
beginning of a distinction between health promotion and disease prevention and

209 GARCIA, C. and BOARD O. The Promotion of Health in the Sick Person [ online ] Available on the internet from:
http://promocionsalud.ucaldas.edu.co/downloads/Revista%203-4_3.pdf [ accessed June 12, 2011 ]
210 WHO-WORLD HEALTH ORGANIZATION. Health Promotion Glossary. Op. Cit., p.14
211GARCIA, C. and BOARD O. The Promotion of Health in the Sick Person. Op. Cit., p.2

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propose that promotion is for the health of groups without the disease existing, it
seeks to educate in health, increase controls over the determinants of health
and consequently improve it, community participation is essential; On the other
hand, prevention works on the risk factors of the disease in search of preventing
the disease from appearing and minimizing its consequences; Recognizing that
health promotion measures have preventive effects and not the opposite,
prevention, the authors affirm, has to do with the measures of causality of the
disease in any medical model and state that it refers to the “application of
technical measures which include medical aspects and other disciplines that
aim to prevent the onset of the disease (primary prevention), cure it (secondary
prevention) and restore lost capabilities (tertiary prevention).” These levels of
prevention have the following components:

1. Primary prevention
- General health promotion
- Specific protection
2. Secondary prevention
- Early diagnostic
- Timely treatment
- Damage Limitations
3. Tertiary prevention
- Clinical management to avoid relapses
- Rehabilitation

From the above, it is concluded that prevention of hearing disease are

measures aimed at preventing the appearance of hearing loss, stopping its
progression or mitigating its consequences. Likewise, within the clinical
practices of the Speech Therapy program, at the level of hearing prevention,
primary and secondary prevention components framed in school and industrial
audiology will be developed according to the needs of the context.

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6
5.1.2 AREAS OF AUDIOLOGY

5.1.2.1 School Audiology. Bess and Humes212 state that this is responsible for
the identification, assessment and monitoring of all school-age children with
temporary or permanent hearing problems, helping regular teachers with
educational programs for these schoolchildren, also including the selection and
maintenance of aids. auditory,

212 BESS, F. AND HUME, L. Fundamentals of Audiology. Op. Cit. p.

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5.1.2.2 in those who present hearing impairment (this last section corresponds
exclusively to the Audiologist).
5.1.2.3 Industrial Audiology. Bess and Humes213 , describe it as hearing
conservation consultation services, which include: protecting workers from
hearing loss, reducing noise levels and their harmful effects, and providing
protection to workers. Within this subarea, activities will be taken into account to
prevent hearing disease, classified as “Noise-Induced Neurosensory Hearing
Loss” (according to the table of Occupational Diseases), defined by Reina. 214 ,
such as the significant deterioration of the cochlear cells of the inner ear, due to
a combination of metabolic and physical stress, presenting secondarily
degeneration of sensory nerve fibers, the progressive loss of hair cells and is
accompanied by a corresponding decrease in hearing.

Caputo, Akli and León215 , for their part, define noise-induced Sensorineural
Hearing Loss (NIRH), as the partial or total, permanent and cumulative
decrease in the hearing capacity of one or both ears, where the inner ear is
injured; It arises gradually, during and as a result of exposure to harmful levels
of noise in the work environment, continuous or intermittent of relatively high
intensity (>85 dBSPL) over a long period of time; It is necessary to differentiate
it from “Acoustic Trauma”, which is a sudden change in hearing as a result of a
single sudden exposure to an explosive sound. The diagnosis of HNIR is made
clinically by a doctor and may include the study of the history of noise exposure.
HNIR is characterized by having an insidious onset, a progressive course, and
213 a predominantly bilateral and symmetrical presentation; Like all
214

sensorineural hearing loss, it is an irreversible condition, but unlike these,

RHN can be prevented.

Within these prevention activities, among others, talks, training and an

epidemiological surveillance system for hearing conservation that consists of:
213Ibid., p.
214QUEEN, E. M. Epidemiological surveillance system model for hearing conservation. Colombian magazine of audiology,
Audiología Hoy. Vol. 3 No.1. Bogota, 2005. pp 21-43
215CAPUTO, L., AKLI, L., LEÓN, O. Sensorineural Hearing Loss Prevention Program [online]. Available on the internet from:
http://www.google.com.co/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&ved=0CE4QFjAG&url=https%3A%2F%2F2.zoppoz.workers.dev%3A443%2Fhttp%2Fww
w.sanidadfuerzasmilitares.mil.co% 2Findex.php%3Fidcategoria%3D5519%26download%3DY&ei=xJyiT5SmNu-
u0AGdkvHUDA&usg=AFQjCNGGUT1h27XZxmc5OdoSIoeLUYR_Rw [accessed 06-01-2012]

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1. Initial and annual hearing evaluation (baseline and control audiometry)
2. Factor diagnosis (noise evaluation)
3. Evaluation and training on noise and hearing loss
4. Noise control methods (source and medium)
- Classification of noise generating sources.
- Noise control
- Interior acoustic treatments
- Total and partial closures
- Noise transmitted through air ducts
- Vibration isolation
5. Hearing protection (selection and use of protectors)
6. Information registration system
7. Evaluation of the effectiveness, efficiency and effectiveness of the program.

These activities must be carried out within the contents of the Occupational
Health programs: Industrial Hygiene (update of risk panorama, study of
environmental evaluation, control measures), Preventive and worker Medicine
(biological monitoring) and Safety (inspection, investigation of work accidents
and supply of personal protection elements).

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9
To carry out occupational health programs, it is necessary to carry out the
following procedures:

• Baseline audiometry.According to Reina216 is the admission audiometry

that
It must be carried out as part of pre-employment or within 30 days after starting
employment, for those workers exposed to noise levels greater than 80dB (A), it
requires hearing rest of at least 14 hours. For those workers already exposed to
noise levels higher than those stated, prior to the implementation of the
program, the base audiometry will be the best of the audiometries that are
registered for each of them.

• Control Audiometry. It is the audiometry performed within the shift.

normal work without hearing rest and the periodicity depends on the sound
pressure levels to which the workers are exposed. If in the control audiometry
there is an equal or greater change in the hearing thresholds, a confirmatory
audiometry should be performed (Queen217 ).

• Confirmatory audiometry. Must be performed within 30 days

following the control audiometry where the change in threshold was found and
must be carried out within the same parameters as the baseline audiometry and
the worker must be referred in accordance with the provisions of the
occupational health regulations (Queen218 ).

5.2 HEARING EVALUATION

The MPPF-II219 establishes first-level procedures to evaluate and monitor the

status of the peripheral auditory system that includes the external, middle and
internal ear. According to this, the basic audiological evaluation consists of
216
217 Anamnesis, Otoscopy, Audiometry of air and bone pure tones with
218
219
216QUEEN, E. M. Epidemiological surveillance system model for hearing conservation. Op. Cit. p.
217Ibid., p.
218Ibid., p.
219ASOFONO, ASOAUDIO, NATIONAL UNIVERSITY OF COLOMBIA. Manual of procedures for Practice
Speech therapy MPPF-II. Op. Cit., p.73

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appropriate masking, Speech Audiometry and Acoustic Immittance that includes
tympanometry, physical canal volume and evaluation of the acoustic reflex
threshold under the following principles:

- Maintain the maximum well-being of the patients/users served in all

decisions and actions of the practice.
- Recognize that communication is always an interactive process and that the
focus of intervention may include training of those involved in
communication.
- Define the optimal environmental factors related to the procedures.
- Consider aspects related to the severity of the disability or communication
disorder and special needs.
- Examine communication prevention outcomes developed, improve or
maintain functional communication, and optimize quality of life.
- Respect intradisciplinary and interdisciplinary approaches to providing
services.
- Recognize the dignity and privacy of individuals.
- Recognize the importance of documentation and registration.
- Recognize the variety of models and procedures appropriate for service
delivery.
- Recognize the value and importance of obtaining fully informed consent for
procedures that may present risks.

According to Sebastian, Badaracco and Postan 220 , hearing evaluation plays an

important role by determining some factors, such as:

a. Determine the degree of hearing loss.

b. Estimate the location of the lesion within the auditory system.
c. Help establish the cause of the hearing problem.
d. Estimate the extent of the disadvantage caused by hearing loss.
e. Help establish the user's enabling or rehabilitative needs and the
appropriate means to meet those needs.

220 SEBASTIAN, G.; BADARACCO, J.; POSTAN, D. Practical Audiology. Panamericana Medical Editorial. 4th. edition. Buenos Aires,
1987.p.24

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The clinical process of audiology according to Trujillo221 , can be framed from
three moments: the first consists of data collection (anamnesis), observation
and evaluation (audiological examinations), the second refers to the analysis
and diagnosis of the hearing situation and the third consists of the intervention
of the hearing conditions. found on the subject.

The techniques to measure the state of the auditory system must follow a
logical application protocol which is: anamnesis, otoscopy, tuning forks,
acoustic immittance, audiometry and speech audiometry; However, for the
purposes of presentation of this manual and taking into account that these tests
are classified as subjective and objective, said classification system will be used
for their presentation.

The hearing evaluation occurs in two moments, the first through subjective
tests, which are those in which the patient has a direct participation and
therefore are susceptible to manipulation by him, for which sufficient preparation
of the patient is required. clinical, and the second through Objective Tests refer
to those in which the patient does not have direct participation and therefore are
not susceptible to manipulation by him.

5.2.1 Contents of the Hearing Evaluation

5.2.1.1 Anamnesis. It is the interview carried out with the patient or caregiver,
which seeks information that allows us to know the patient and propose the
diagnostic hypothesis. For reasons of experience, in speech therapy practice, it
is recommended that it not stick to a strict format, since it must adapt to the
individual needs, characteristics and age of the subject; However, in general
terms it can include a history should include:

In children, data related to: identification; reason for consultation; pre, peri and

221TRUJILLO, S. Clinical Process in Occupational Audiology. Colombian Journal of Audiology. Audiology Today.Vol. 3 No. 4
November. Bogota, 2006. p.149

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postnatal data; language development; manifestations that lead to suspicion of
a hearing problem; schooling and associated problems. In adults, other aspects
will be investigated: identification; reason for consultation; history of the
evolution of the disease; occupation and job performance.

5.2.1.2 Otoscopy. It is an objective test that allows us to know the state of the
structures of the middle ear, it is fundamental support for the clinical and
functional study of the middle ear. The examination should be performed
systematically and should include inspection and palpation of the pinna and
surrounding areas, examination of the external auditory canal (EAC), and close
examination of the tympanic membrane and its structures.

When evaluating the pinna, attention should be paid to the size, shape and
position in relation to the head, its placement, appearance of the skin and the
presence of nodules or lesions. It is also very important to inspect the
retroauricular area, in order to look for scar areas, abscesses,
lymphadenopathy, among others.

In relation to the EAC, the first thing to observe is its cleanliness. This must be
taken into account in the maneuvers for the extraction of earwax and some
foreign bodies in the audiological office. If it is impossible to remove the
obstructive material, it will be necessary to referral to ENT specialist.
Examination of the EAC may reveal earwax impactions, boils, scaling, and
erythema.

The step to follow is the exploration of the tympanic membrane and its
structures. The parameters that must be taken into account in the exploration
are: position, vascularization, coloration, repair points and alterations.

5.2.1.3 . Hearing Screening. It refers to the application of tests that allow

apparently healthy and asymptomatic populations to identify those people who
present a greater risk, than the general population, of presenting a certain

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alteration; In this way, the test allows us to distinguish in a simple and quick way
individuals who could have a disease from those who do not have it, in the case
of the area of audiology, hearing loss, and the procedure would be hearing
screening.

The National Institute for the Deaf (INSOR)222 suggests that specialized
professionals can make accurate audiological diagnoses at a very early age
through the use of high-tech equipment; However, in the national context the
use of simple tests that allow hearing loss to be detected early is still in force.
The Hearing Screening procedure valid for the Colombian population that
facilitates early diagnosis is described as follows:

• Hearing screenings in children under five years of age. It applies to the

minors between 0 and 5 years old. The procedure and files established by the
INSOR are used.223 expressed in the document “Screening Instrument for the
Early Detection of Hearing Deficiencies in Children under Five Years of Age and
Schoolchildren”, which uses the following tests:

- Otoscopy
- Test of sound instruments (bell, cowbell, drum that corresponds to high,
medium and low frequencies respectively)
- Try with sound objects (rubber doll, rattle and candy paper)
- Try with voice by pointing (words: eyes, shoes, mouth, mom, head, nose).
- The document has established its resources, description, location, response
criteria and formats which must be carried out as presented so that they
have validity and reliability.

• Hearing screening in school children. It is performed on children who

They belong to schools and educational institutions or are of school age. In
accordance with the approaches presented by Katz, Burkard and Medwetsky. 224
222 INSOR. Screening instrument for the early detection of hearing deficiencies in children under five years of age and
schoolchildren. [online] available on the Internet from: http://uaielbanco.jimdo.com/documentos-inclusivos/ [accessed December
11, 2011]
223Ibid., p. 18
224KATZ, J. BURKARD, R. and MEDWETSKY, L. Handbook of Clinical Audiology. Editorial Lippincott Williams&Wilkins,

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This must have the following components and procedures:

Philadelphia.USA,2002.p.483

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 COMPONENTS PROCEDURE CRITERION
Visual inspection (Otoscopy) Look at the state of the structures Refer if any alteration is
and look for defects and if there found in the structures or
is suppuration . presence of suppuration

Audiometry tone sifter With spot of court of Pass: if it responds to the

cigars by air, annual in children 25dBHL at 500Hz, and with signal presented at the
from 1 to 5 grade cutoff point at 20dBHL at 1000, indicated frequency and
2000 and 4000Hz intensity

Failure: if it does not

respond to the
frequency
and
Audiometry tone sifter With 20dBHL cut-off point at Pass: if it responds to the
cigars by air in children from 6 to frequencies 1000, 2000 and signal presented at the
11 grade, like this: once between 4000Hz and 25dBHL cut-off point indicated frequency and
6 and 8 grade and once between at 6000Hz frequency intensity
9 and 11 grade
Failure: if it does not
respond to the
frequency
and
Acoustic immittance: in children between 1 and 3 Refer if children have had
grade administer in conjunction tubes of
Tympanometry Test
with screening audiometry; In placed ventilation or if the
Channel Physical Volume Test children from grades 4 to 11, physical volume of the
administer to children who are channel is elderly to
known to have had some hearing 1.0cm3
loss.

The instruments to perform this screening are: otoscope, audiometer and

impedance meter or immitantiometer, calibrated. It is important to fill out the
established formats for the responses which are not hearing thresholds;
Therefore, they must be noted on a form specially designed for this purpose,
but not on the audiogram, make statistical records of the results of the
procedures performed and make the pertinent referrals. An example of a file

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must include:

- Identification complete data (name, age, school grade, address, telephone

number, mother's name, name of the educational institution, name of the
teacher and date of execution).
- Annotation of answers, like this:

Ear 500Hz 1000Hz 2000Hz 4000Hz 6000Hz

O.D.
I
HEAR

- The pass-fail criteria, referrals and recommendations, as well as the

evaluator's signature.

5.2.1.4 Tuning fork test. It is a non-electronic instrumental methodology

(Gómez)225 . Although the use of tuning forks dates back to the 19th century,
they still do not lose validity given the contribution they give to the topodiagnosis
between conductive, sensory or mixed losses. The most commonly used tuning
fork tests are:

• Rinne test. It consists of comparing bone conduction with

air conduction from the same ear of the patient in terms of duration and
intensity. This test is performed by applying the handle of the tuning fork on the
patient's mastoid and when the patient stops listening, the branches of the
tuning fork are placed near the patient's external auditory canal to see if he
hears it. A positive Rinne (+) is the one obtained when air conduction is better
than bone conduction; suggests sensory hearing loss or normal hearing.
Negative Rinne (-) is determined by better bone conduction than air conduction,
which indicates conductive hearing loss. In this test it is necessary to mask the
opposite ear to avoid confusion on the part of the patient.

225 GÓMEZ, O. Basic Audiology. National University of Colombia Editorial. Bogota, 2004. p.104

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• Weber test. It is performed by applying the handle of the tuning fork in
line
middle over the forehead, upper incisors or skull; compares the bone pathways,
this serves to obtain lateralization. In normal ears or in symmetrical hearing
loss, lateralization is not obtained; lateralization toward a worse ear suggests
conductive injury and toward the better ear, sensory injury. The test is graphed
with the following symbol ←→ directed towards the ear to which it lateralizes,

with the following symbol if it is indifferent ≠ and = if it does not listen.

5.2.1.5 Audiometry. It is a technique created by Bunch and Deam, cited by

García, J.226 , which is used to establish a person's hearing ability (hearing
threshold) and/or rate the degree of hearing loss; It also provides information
regarding the site of injury and in some cases the nature of the cause.
According to Harrell, cited by Katz, Burkard and Medwetsky 227 It is also used in
audiology to monitor the sensitivity of workers in industry, to establish the
hearing status after surgery in patients receiving chemotherapy, and to
establish the power of hearing amplification.

In audiometry, hearing thresholds are measured using an electronic instrument

(audiometer) that generates various pure tones, devoid of harmonics and
emitted at different frequencies, which according to Gómez consist228 of:

- Airborne pure tone testing refers to the transmission of sound sent by an

earphone through the outer and middle ear to the cochlea.
- The evaluation of the bone conduction threshold, which is the transmission
of sound to the cochlea by vibration of the skull.

The hearing threshold is defined as the lowest sound level necessary for a
person to detect the presence of an acoustic signal and is determined in
226BUNCH and DEAM cited by GARCÍA, J. Instruments and Measurements for the Practice of Audiometry [online] Available online
from: http://www.otorrinoweb.com/glosario/ca/217-06-2o03-instrumentos-y-medidas-para-la-practica-de-la-
audiometria.html [ accessed April 12, 2012 ]
227KATZ, J. BURKARD, R. and MEDWETSKY, L. Handbook of Clinical Audiology. Op. Cit., p.71
228 GÓMEZ, O. Basic Audiology. Op. Cit., p-111-114

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decibels ANSI (1996). This acoustic signal is the stimuli that are emitted at
different frequencies between 250 to 8000Hz in normal clinical settings. For the
audiometry procedure, it is necessary to take into account the following
conceptualizations:

- Decibel. It is a unit of measurement based on the logarithmic scale

which is used for the comparison of energy values, allowing this ease in the
calculation and handling of numerical magnitudes, as it is a comparison unit it
needs a “last name” that is, to know what we are comparing it with like this:
dBSPL, sound pressure decibel and dbHL which are hearing level decibels.

- Frequency. It is the number of cycles or times a pattern repeats.

of movement per unit of time. The most used classification of hearing ranges is
the one proposed by Brad Stach, cited by Gómez229 being: normal hearing
between 0 and 10dBHL, minimal hearing loss from 10 to 25 dBHL, mild hearing
loss 25 to 40dBHL, moderate hearing loss 40 to 70dBHL, severe hearing loss
70 to 90dBHL, profound hearing loss more than 90dBHL; In addition, there are
other parameters proposed by Jerger, Goodman and Clark, cited by Gómez230 .

Hearing loss according to Gómez,231 It is defined as a reduction in the sensitivity

of the auditory mechanism, that is, the ear or ears are not sensitive to the
detection of sound at a normal intensity. This term is synonymous with hearing
loss.

The threshold information at each frequency is plotted on a graph called an

audiogram. The audiogram is a diagram used to graphically record hearing
thresholds and other test results. The audiogram is shown in a graph of two
vectors, signal frequencies (Hz) on the X axis and Intensity or hearing level (dB)
on the Y axis; By convention, the following signs are used to refer to the data
obtained in red for the right ear and blue for the left ear as follows:

229Ibid., p.107
230Ibid., p.107
231Ibid., p.214

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- Unmasked right airway: O
- Unmasked left airway:
These symbols are joined by continuous lines of the same color.

- Unmasked right bone conduit: <

- Unmasked left bone pathway: □
These symbols are joined by dashed lines of the same color.

Sometimes it is necessary to use masking to obtain reliable hearing thresholds

and in that case they are graphed like this:

LANGUAGE AREA.........................................................................................................7
LANGUAGE IN CHILDREN..........................................................................................7
PATRICIA DEL CARMEN BERTEL PESTANA...........................................................7
1 .EVALUATION, DIAGNOSIS AND INTERVENTION AREAS OF VERBAL
LANGUAGE IN CHILDREN.......................................................................................7
1.1 CONCEPTIONS ABOUT LANGUAGE...........................................................7
1.2 EVALUATION OF ORAL LANGUAGE.........................................................8
1.2.1 Contents of the Oral Language Evaluation.....................................................9
1.2.1.2 Language Levels..........................................................................................9
1.2.1.3 Metalinguistic Skills........................................................................................17
1.2.1.4 Psychic Functions Related to Language..........................................................18
1.2.1.5 Basic Learning Devices...................................................................................19
1.3 EXPECTED RESULTS.........................................................................................20
1.3.2.1 Comprehensive level.................................................................................20
1.3.2.2 Expressive level.........................................................................................21
1.3.2.3 Mixed.........................................................................................................22
1.3.2.4 Secondary..................................................................................................22
1.3.3 Communicative Diagnosis (MPPF I-II)........................................................23
1.3.4Diagnostic Coding...............................................................................................23
1.4 TREATMENT GUIDELINES..............................................................................24
1.4.1 Therapeutic Indications for specific language disorders (SLD)...................24
1.4.2 Therapeutic indications for acquired language disorders..............................26
1.4.3 Speech Therapy Intervention in Auditory-Communicative Disorders.........27

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LANGUAGE IN ADULTS.............................................................................................29
MARTHA LUCIA HERNANDEZ BLANCO................................................................29
COLLABORATION.......................................................................................................29
KATIA LUCIA ZAMBRANO RUIZ.............................................................................29
2.1 INITIAL CONCEPTIONS...............................................................................29
2.2.1 Contents of Language Evaluation in Adults.................................................30
2.2.1.6 Higher Brain Functions related to Language...................................................39
2.2.1.7 Basic Learning Devices...................................................................................41
2.3 EXPECTED RESULTS....................................................................................44
2.3.3 Diagnostic Coding. According to ICD 10:....................................................45
2.4.1 Objectives of Aphasia Treatment..................................................................46
2.4.2 Aphasia Rehabilitation Techniques...............................................................46
READING LANGUAGE, NOTIONS AND MATHEMATICAL CALCULATION...48
MARIVEL MONTES ROTELA.....................................................................................48
3.1 CONCEPTIONS ABOUT READING LANGUAGE, NOTIONS AND
MATHEMATICAL CALCULATION.......................................................................48
3.2.1 Contents of the evaluation of Literacy, Notions and Mathematical
Calculation...................................................................................................................50
3.2.1.2 Higher Brain Functions related to literacy, calculation and mathematical
notions. 51
3.2.1.3School codes.....................................................................................................54
3.2.1.3 Basic Learning Devices...................................................................................59
3.3.1 Characterization of the Behavior..................................................................63
Communicative/Denominations..................................................................................63
3.3.2 Communicative Diagnosis (MPPF I-II)........................................................65
3.3.3 Diagnostic Coding (ICD-10).........................................................................65
3.4 TREATMENT GUIDELINES.........................................................................66
SPEECH AREA..............................................................................................................71
MARINELLA BEATRIZ ALVAREZ BORRERO........................................................71
MARIA DEL PILAR DIAZ RIVERO............................................................................71
4.1 CONCEPTIONS ABOUT SPEECH................................................................71
4.1.1 Conceptualization of Speech Motor Processes.............................................72
4.1.2 Conceptualization of Related Motor Processes.............................................73
4.2 SPEECH EVALUATION................................................................................73
4.2.1 Contents of the Evaluation of Speech Motor Processes................................73
4.3.1 Speech Assessment Analysis .......................................................................80
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 4.3.2.1 Joint...........................................................................................................83
4.3.2.2 Phonation.........................................................................................................85
4.3.2.3 Resonance........................................................................................................87
4.3.2.4 Prosody............................................................................................................87
4.3.2.5 Fluency............................................................................................................88
4.3.2.6 Motor Feed Process.........................................................................................89
4.3.3 Communicative Diagnosis (MPPF I-II)........................................................91
4.3.4 Diagnostic Coding.........................................................................................91
4.4 TREATMENT GUIDELINES..............................................................................91
4.4.1 General Considerations of the Intervention..................................................92
4.4.2 Specific considerations of the intervention...................................................92
5.1 DEFINITION OF AUDIOLOGY.....................................................................94
5.1.1 CONCEPTUALIZATION OF THE COMPONENTS OF AUDIOLOGY..95
5.1.1.1 Hearing Health Promotion.........................................................................95
5.1.1.2 Prevention of Hearing Disease..................................................................96
5.1.2 AREAS OF AUDIOLOGY................................................................................98
5.2 HEARING EVALUATION................................................................................101
5.2.1 Contents of the Hearing Evaluation............................................................103
5.3 EXPECTED RESULTS.......................................................................................116
5.3.1.1 Analysis of audiometry evaluation..........................................................116
5.3.1.3 Analysis of the Evaluation of Acoustic Immittance or Impedancemetry......118
5.3.3 Communicative Diagnosis (MPPF I-II)......................................................122
5.3.4 Diagnostic Coding.......................................................................................122
5.4 TREATMENT GUIDELINES............................................................................123
5.4.1 Considerations Generals of the Intervention. In audiology the...................123
5.4.2 Language rehabilitation strategies in the hearing area................................124
BIBLIOGRAPHY......................................................................................................127
-

When no answers are found to the corresponding symbols, a downward arrow

is added at the bottom indicating no answer.

To carry out the test, it is necessary to take into account the calibration of the
equipment, information to the examinee, appropriate response strategies for the

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examinee, placement of the headphones, biosafety standards, ear selection,
execution technique, position of the examinee and presentation. Of the signal.

The execution of the test must also follow procedures according to the
technique used by the evaluator: which can be ascending or descending. The
ascending technique is one that goes from a non-audibility threshold to an
audibility threshold, ascending from 5 to 5 dB, and the descending technique
goes from an audibility threshold to a non-audibility threshold, descending from
10 to 10 dB.

5.2.1.6 Logoaudiometry. It is the measure of hearing that uses the voice, the
words are the stimuli and with it it is intended to establish the level of detection
and discrimination of oral language, the main functions of hearing. There are
two reference schools for the practice of speech audiometry:

The French School, whose technique allows establishing the speech

intelligibility curve, was proposed by Portmann M. and C., cited by Gallego and
Sánchez.232 This is based on the search for four thresholds, like this:

- Voice detectability threshold, when the voice is heard but a word of those
evaluated is not understood.

232 PORTMANN, M. and C. Cited by GALLEGO, C. and SANCHEZ M.T. Audiology Today's Vision. Editorial Catholic University of
Manizales. Colombia, 1992. p.105

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- Word detectability threshold, when one of the evaluated words is
discriminated
- Discrimination threshold of 50%, when it responds to 50% of the material
presented
- Maximum discrimination threshold, when it responds to 100% of the material
presented

The American School, whose technique allows establishing three thresholds:

- SAT: corresponds to the minimum level of intensity at which a person can

detect the language stimulus.
- SRT: the reception threshold or Audibility of the word, corresponding to the
minimum intensity level at which 50% of the words are recognized, must be
correlated with the pure tone average.
- SD: this is the last one obtained and corresponds to the discrimination
threshold of the word, which is the maximum discrimination of the language.

5.2.1.7 Acoustic Immittance or Impedanciometry. This assessment allows

establishing the general state of the middle ear, the definition of the presence of
recruitment in cochlear hearing loss and the establishment of retrocochlear
problems. The tests performed in acoustic immittance or impedanciometry are
basically: tympanometry, the physical volume of the canal and the
measurement of the thresholds of the acoustic reflex.

- Physical volume test. Allows you to obtain the absolute size of the
cavity located at the end of the impedance cannula. Different authors propose
233,
normality values for children and adults. According to Gómez normal values
for children are between 0.3 to 1.00cc and in adults between 0.65 to 2.7cc; On
the contrary, according to Rivas233 They are between 1.0 to 1.5 cc in adults and
0.7 to 1.0 cc in children.

233RIVAS JA and ARIZA HF Treaty of Otology and Audiology. Op. Cit., .p. 158
233
GÓMEZ, O. Basic Audiology. Op. Cit., p-104
11
4
- Gradient Value . It has recently gained clinical utility. It is the
measurement of the width of the tympanogram, allowing the detection of
incipient middle ear pathologies and is applied in type A tympanograms.

- The acoustic reflex threshold. Allows the determination of a

hearing loss, confirms conductive hearing losses, establishes the presence of
recruitment and provides valuable information for the differential diagnosis
between cochlear and retrocochlear losses.

5.3 EXPECTED RESULTS

5.3.1 Hearing evaluation analysis. The analysis will be done from the tests
carried out in basic audiology.

5.3.1.1 Analysis of audiometry evaluation.

Among the results that can be obtained from an audiometric assessment are:

- Air and bone conduction within normal ranges, with no gap between them
greater than 10 dBHL, suggesting normal hearing
- Superimposed descended air and bone pathways or with a difference
between them of no more than 10 dBHL, suggests sensory hearing loss.
- Preserved descended and bony airway with gap greater than 10dBHL:
suggests conductive or conductive hearing loss.

- Decreased air and bone conduction, but with a gap greater than 10dBHL, at
least in two frequencies: suggests mixed hearing loss.

For audiometric analysis it is necessary to clarify the following definitions:

- Conductive hearing loss is produced by an alteration in the
transmission of sound through the outer and/or middle ear due to damage to
any of these structures.

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- Mixed hearing loss is hearing loss that occurs when
There are simultaneous lesions of the inner ear and the sound transmission
system (external and middle ear).

- Sensory Hearing Loss is produced when the cells

Sensory, neural, or connections within the cochlea do not work well.

The conclusion of the audiometry must include data regarding the description of
the curves (symmetries or asymmetries), the configuration (semi-flat,
descending, ascending, combination of these, etc.), the type of hearing loss
(sensory, conductive, mixed), the degree (mild, moderate, severe, profound)
and the ear to which that diagnosis belongs (right, left or bilateral). Example:
symmetrical curves with bilateral semi-flat configuration with mild bilateral
conductive hearing loss.

5.3.1.2 Analysis of the Evaluation of Speech Audiometry. Taking into

account the results, the effectiveness of communication is evaluated according
to Katz's classification.234 presented in 1978 as follows:

- Discrimination percentages between 90 and 100% correspond to normal

communicative effectiveness.

- Discrimination percentages between 75 and 90% correspond to a slight

difficulty in communicative effectiveness.

- Discrimination percentages between 60 and 75% correspond to a

moderate difficulty in communicative effectiveness.

- Discrimination percentages between 50 and 60% correspond to a

poor performance in communicative effectiveness

- Discrimination percentage less than 50% corresponds to a very poor

performance of communicative effectiveness.

234

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In speech audiometry, this must include the type of curve, the degree of
discrimination, their configuration, in the case of the French technique, and
significance in communicative efficiency and referenced hearing in the case of
the American technique.

- Example according to French technique: Curve shifted without 100%

discrimination, bell-shaped configuration, in the right ear which suggests...

- Example according to American technique: Speech audiometry shows

normal communicative effectiveness in the right ear

5.3.1.3 Analysis of the Evaluation of Acoustic Immittance or

Impedancemetry.

• Tympanometry. According to the analysis of the type of tympanogram, it

refers to:

- Type A : Compliance and pressure within normal values correlate with

normal hearing or sensory hearing loss.

- Type AD : Increased compliance, normal pressure, correlates with

disruption of the oscicular chain or monomeric membrane.

- Type AS: Decreased compliance, normal pressure, indicates rigidity

pathology.

- Type B: Low compliance, altered pressure, suggests presence of otitis.

- Type C: Normal compliance, altered pressure, suggests dysfunction

tubal.

• Physical volume test. By authors, the reference levels for the analysis are:

For Gomez235 , in children between 0.3 to 1.00cc and in adults between 0.65 to

235GÓMEZ, O. Basic Audiology. Op. Cit., p-104

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2.7cc and according to Rivas236 in children between 0.7 to 1.0cc and adults
between 1.0 to 1.5cc.

The findings that can be obtained from the physical volume of the canal are
normality, decrease due to foreign bodies, atresia, stenosis and bulging of the
tympanic membrane or increase due to small perforations, ventilation tubes or
permeable Mt

• Gradient Value. Its analysis is done from the following normality values:

In children between 60 to -159 dapa and adults between 50 to -110 dapa.

These values are indicators of:

- Values much higher indicate an abnormally wide gradient associated with

processes due to mass increase.
- Values much lower indicate an abnormally narrow gradient, associated with
disorders.

- The threshold of the acoustic reflex. According to its results, the analysis
leans towards:

- Presence of normal reflexes in normal hearing, when the absence of

reflexes is evident with normal hearing, it may be due to incipient
transmission pathology, neuromas or alteration of the VII cranial nerve.

- Decreased acoustic reflexes above the tone threshold to more than 75dBHL
suggest auditory recruitment.

- Increased contralateral acoustic reflexes in relation to ipsilateral ones

suggest possible retrocochlear pathology.

- In conductive hearing loss, the reflex response is elevated or eliminated.

- In mild to severe neural pathologies, it is more common for the reflex to be

236RIVAS JA and ARIZA HF Treaty of Otology and Audiology. Op. Cit., .p. 158

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 elevated or absent than in those with cochlear damage.

In summary, the analysis of the evaluation of acoustic immittance must include

the type of curve, the physical volume data of the canal, the presence or
absence of both ipsilateral and contralateral reflections, possible compromise
and the referred ear. Example: Type A (normal) bilateral tympanogram; physical
volume of the normal symmetrical canal, ipsilateral and contralateral acoustic
reflexes present bilaterally, the analysis suggests good functioning of the middle
ear bilaterally.

5.3.2 Characterization of the behavior

communicative/denominations.

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 ❖ Depending on the type of hearing loss:
- Conductive hearing loss, according to Gómez237 and Rivas 239 ;Hypoacusia
of
Driving, according to Sebastian 240
- Mixed hearing loss, according to Gómez 241 and Rivas 242
- Sensory hearing loss
- Sensorineural or sensorineural hearing loss, according to Gómez 243 and
Rivas 244 ;
Perceptual Hearing Loss, according to Sebastian 245
- Loss of hearing sensitivity, according to Gómez 246
- Hearing Loss induced by Noise, according to Gómez 247
- Sudden hearing loss (idiopathic), according to Gómez 248

❖ According to the grade:

- Mild hearing loss, according to Jerger 249 ; Mild or mild hearing loss,
depending on the
Bureau International de Audiology 250 ; Mild Hearing Loss, according to
Clark 251
- Moderate hearing loss, according to Jerger 252 ; Average hearing loss,
according to
International Bureau of Audiology
- Hearing loss severe, according to Jerger 253
- Hearing loss deep, according to Jerger 254
- Hearing loss Minimum, according to Stach 255

237 Gomez, O. Basic Audiology. Op. Cit., p.71

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- Hearing loss moderate severe, according toStach 256
5.3.3 Communicative Diagnosis (MPPF I-II)

Hearing disorder

5.3.4 Diagnostic Coding.

According to ICD-10:
- H900 Bilateral conductive hearing loss
- H901 Bilateral conductive hearing loss, with contralateral unrestricted
hearing
- H902 Conductive hearing loss, not otherwise specified
- H903 Bilateral sensorineural hearing loss
- H904 Unilateral sensorineural hearing loss, with unrestricted hearing
contralateral
- H905 Sensorineural hearing loss, not otherwise specified
- H906 Bilateral mixed conductive and sensorineural hearing loss
- H907 Mixed conductive and sensorineural hearing loss with hearing
unrestricted contralateral
- H908 Mixed conductive and sensorineural hearing loss, unspecified
- H013 Deafness and dumbness, not elsewhere classified
- H918 Other unspecified hearing loss
- H919 Hearing loss No specified
- H920 Otalgia
- H931 Tinnitus
239
RIVAS JA and ARIZA HF Treaty of Otology and Audiology. Op. Cit., .p. 124
240
SEBASTIAN, G. Practical audiology. Op. Cit. p. 171
241
GÓMEZ, O. Fundamentals of Audiology. Op. Cit., p.71
242
'RIVAS
Y JA and ARIZA HF Treaty of Otology and Audiology. Op. Cit., .p. 125
o GÓMEZ, O. Fundamentals of Audiology. Op. Cit., p.71
243'RIVAS JA and ARIZA HF Treaty of Otology and Audiology. Op. Cit., .p. 124
244I'SEBASTIAN, G. Practical Audiology. Op.cit., p.172
245GÓMEZ, O. Fundamentals of Audiology. Op. Cit., p.70
246Ibid., p.85
247' Ibid., p.88
248' JERGER, cited by GÓMEZ, O. Fundamentals of Audiology. Op. Cit., p.106

2501 INTERNATIONAL BUREAU OF AUDIOLOGY, cited by JIMENEZ, M. Hearing Impairment. CEPE Editorial. Spain, 2003. p.33
251L CLARK, cited by GÓMEZ, O. Fundamentals of Audiology. Op. Cit., p. 106

Ibid., p.106
252 I
253
Ibid., p.106
Ibid., p.106
254
'STACH, cited by GÓMEZ, O. Fundamentals of Audiology. Op. Cit., p.106
255

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- H932 Other perceptions abnormal hearing
- H933 Auditory nerve disorder
- H833 corresponds to noise-induced hearing loss.

5.4 TREATMENT GUIDELINES

256
Ibid., p.106

5.4.1 Considerations Generals of the Intervention. In

audiology the
level intervention corresponds to the level 2 of
attention, these
Procedures are indicated within the MPPF-II speech therapy procedure manual
(2001), to be carried out by speech therapists specializing in Audiology,
therefore the intervention within the audiological area is not proposed in this
manual since it corresponds to the selection and adaptation of hearing
prostheses. .

However, for purposes of illustration or reminder, hearing aids or hearing aids,

as stated by Gómez, 2006, are a portable communication system whose
purpose is to amplify sound. Its main components are a microphone, an
amplifier, a receiver and a power source.

Currently, hearing aids can be behind-the-ear or intracanal and have analog,

programmable or digital technology; For its selection it is necessary to take into
account: age, hearing needs, type and degree of hearing loss.

The direct competence of the speech therapist in auditory rehabilitation

addresses communicative auditory disorders, which correspond to second and
third level of care procedures, according to the MPPF-II, which aim to improve
the receptive and expressive communication skills of an individual with hearing
loss. and help you understand and use your amplification system and/or

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address the management of central auditory processing disorders. These
interventions will be carried out according to the guidelines established in the
intervention item of the language area and must be executed in accordance
with the fundamental components of the MPPF-II (2001).

Auditory rehabilitation according to Gómez,238 is designed to minimize and

alleviate communication difficulties associated with hearing loss. The logical
course of rehabilitation is to provide the individual with the most appropriate
technological support and help them build a level of skills that allow them to
communicate. The effects of hearing loss on communication depend on factors
such as: degree of loss, audiometric configuration of the hearing loss, type of
hearing loss, age of onset, form of onset, comprehension strategies used by the
individual to compensate for the hearing loss. and communicative needs and
the most recommended method will also depend on these factors, that is, the
professional must not show prejudice in favor of any method or school or
system, he must consider what best ensures the maximum final development
and allow the right that the person has. to the opportunity to show what he is
capable of doing.

5.4.2 Language rehabilitation strategies in the hearing area.

• Oral Methods. They can be unisensory, multisensory, audioral.

Unisensory methods are those that use a single stimulation route, among them
we have:

- Auditory Verbal Therapy. In this method the stimuli of speech and

Language will always be the foundations of the work of this type of therapy,
whose main objective is the development of speech perception in order to
increase the possibilities of language decoding and its application to speech
production. This type of therapy is based on three principles: auditory skills,

238 GÓMEZ, O. Basic Audiology. Op. Cit. p.211

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level of stimulation and levels of complexity; auditory skills referring to detection,
discrimination, identification, recognition and understanding, among others;
Stimulus units refer to features, suprasegmental patterns, words, phrases,
speech, etc. and levels of complexity refer to the type of activity, stimulus
format, acoustic contrast, familiarity, etc.

• Tonal Verb Therapy. The main axes of this therapy are

perception and listening comprehension; The verbotonal methodology performs
a non-linear amplification of speech, filtering the message to adjust it to the
optimal field of hearing of each subject, using SUVAG devices to facilitate this
auditory perception. The verbotonal method covers three procedures: individual
treatment, phonetic rhythms and verbotonal class.

Multisensory methods use several ways of stimulation, auditory, visual, tactile,

within this group are:

- Ling Method.Developed in the United States by Daniel Ling,

quoted by Luterman239 , aims to acquire spontaneous language through the
automation of speech processes at the phonetic-phonological level. The
proposed model describes speech acquisition as a developmental process that
occurs in 7 stages that can be carried out simultaneously and according to the
author can be used at any age, hearing loss or school level.

• Audioral Methods. Based on lip reading, such as:

- Complemented word. It is a phonetic system based on

visual contrast and as support for lip reading that according to Cornett, cited by
Luterman240 , eliminates orofacial confusion and makes spoken speech
completely intelligible. The complemented word uses manual systems
(kinemas) devoid of meaning in themselves that, in synchronization with
orofacial movements, manage to clear up the ambiguity that facial lip reading
239 LUTERMAN, D. The Deaf child. Key Editorial Attention to hearing impairment. Madrid, 2009.p.31
240Ibid., p.35

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entails. The word complemented makes use of three different hand positions.

• Gesture methods.

- Dactylology. It is the use of manual signs with one or two

hands to express or communicate a letter, involves replacing the letters with
movements made with the fingers of the hands. Fingerprinting or manual
alphabet is not spontaneous or natural like mimicry, it is necessary to learn it.

- Sign language. Gestural communication is the most

old that exists and is the natural way for deaf people to express their ideas. The
sign language used by deaf adults is a language in a broad sense of the term,
which has the characteristic functions of communication and has its own
syntactic structure expressed through the visual channel.

• Mixed methods.

- Bimodal Communication. It is a system based on the use

simultaneous oral language and gestural support, basically incorporates the
vocabulary of sign language, but uses the syntactic structure of oral language.
The objective of bimodal communication is twofold: on the one hand, to facilitate
the early development of communication and, on the other hand, to enhance
the acquisition of oral language.

- Bilingualism. The bilingual model proposes the learning of the language

of
signs as a first language and oral language as a second. Its first objective is for
the child to reach a high level of competence in sign language; This method
begins the teaching of oral language at age 5, as occurs with the learning of a
foreign language.

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