SUVAG Polyclinic Repository
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Obilježja komunikacije djece s jezično-govornim poremećajima
No full textSpecifičnosti funkcioniranja djece s jezično-govornim i komunikacijskim poremećajima, te porast incidencije i prevalencije ovih razvojnih poremećaja, nameću potrebu boljeg informiranja drugih profesija koje s djecom rade o dijelu najučestalijih poremećaja, a sa svrhom poboljšanja kvalitete komunikacije. Važno je napomenuti da djeca u spontanom govoru koriste one rečenične strukture koje razumiju. Znači, govorno izražavanje određeno je govornim razumijevanjem. Zato i govor sugovornika mora biti pojednostavljen kako bi komunikacija bila uspješna. Ključ uspješne komunikacije je poznavanje funkcioniranja djece s teškoćama, njihovih mogućnosti te pristupa koji su motivirajući i pozitivno utječu na djetetov osjećaj samopoštovanja
Articulation and Phonological Abilities of Children With Cerebral Palsy
No full textCilj ovog istraživanja bio je ispitati i usporediti artikulacijske i fonološke sposobnosti djece s cerebralnom paralizom s njihovim vršnjacima urednoga razvoja. Ispitivanje je provedeno na uzorku 15-ero djece s cerebralnom paralizom te 15- ero djece urednoga razvoja. Skupine su bile izjednačene po spolu i starosnoj dobi. Upotrijebljeni mjerni instrumenti sastojali su se od Testa artikulacije i zadataka za ispitivanje fonoloških vještina. Primijenjeni su relevantni statistički postupci (osnovni statistici, robusna diskriminativna analiza, t-test, hi-kvadrat test, Cochran-Cox metoda). Dobiveni rezultati ukazali su na postojanje statistički značajnih razlika u artikulacijskim i fonološkim sposobnostima između djece s cerebralnom paralizom (CP) i djece urednoga razvoja (UR). Razlikovanju skupina, u manifestnom prostoru, u najvećoj mjeri pridonose varijable brisanje konsonanata (BRISK) te broj artikulacijskih pogrešaka (TESTA). U kreiranju diskriminacijske funkcije značajno sudjeluju i varijable: izdvajanje početnoga glasa (IZPG), fonemska analiza (FONAN) i traženje rime (TRAR). Rezultati potvrđuju i statistički značajne razlike u artikulacijskim i fonološkim sposobnostima prema tipu cerebralne paralize. Skupina djece sa spastičnim tipom cerebralne paralize bila je uspješnija u zadatcima koji su ispitivali fonemsku analizu (FONAN), rastavljanje na slogove, brisanje konsonanata (BRISK), traženje rime (TRAR) te su imali bolje artikulacijske sposobnosti.The goal of this research was to examine and compare articulation and phonological abilities in children with cerebral palsy and their typically developing peers. An examination was conducted on a sample of 15 children with cerebral palsy and 15 typically developing children. The two groups were equalized by gender and age. The measuring instruments used were the Articulation Test and phonological ability tasks. The data were analysed using the robust discriminative analysis, t-test, chi-square test, as well as the Cohran-Cox test. The results showed a signifycant statistical difference in articulation and phonological abilities between children with cerebral palsy and typically developing children. The difference between the groups is for the most part due to the variables deletion of consonants and number of articulation errors. The variables first voice segregation, phonemic analysis, and rhyme searching are also signifi cant in creating this discriminant function. The results also confirm statistical differences in articulation and phonological abilities that are related to the type of cerebral palsy. A group of children with a spastic type of cerebral palsy was more successful in phoneme analysis, syllable analysis, consonant deletion tasks, and rhyme searching tasks. They also had better articulation abilities
SUPPORTIVE PSYCHOTHERAPY IN TREATMENT OF SOMATIC PATIENTS – CASE REPORT
No full textNakon uspješnog liječenja osnovne neurološke bolesti mogu se u nekih bolesnika kao zaostali simptomi pojaviti smetnje ravnoteže, čiji je mehanizam nastanka teško protumačiti i odrediti terapiju koja bi takvim bolesnicima omogućila normalno funkcioniranje. Uz smetnje
ravnoteže postoje i različite psihičke smetnje što često uz neurološku obradu zahtijeva i provedbu mnogih drugih specijalističkih pretraga i testova. Prikazana je bolesnica koja je prema preporuci otorinolaringologa došla u psihijatrijsku ambulantu SUVAG-a zbog stalnih smetnji ravnoteže koje su počele pri liječenju problema s vratnom kralježnicom. Pomnim ispitivanjem otkrilo se da njezine smetnje, kojima se neurološkom i ORL obradom nije mogao pronaći
uzrok, potječu iz najranijeg djetinjstva (strah od majke, nemogućnost suprotstavljanja) i kasnije iz mladosti (izrazita sklonost fantaziranju, što joj je bilo rješenje u svim neugodnim situacijama). U raspravi je naglašena važnost suportivne terapije, tj. odnosa s psihoterapeutom,
što se navodi i u literaturi. Zaključuje se da je prikazani slučaj tipičan primjer povezanosti smetnji ravnoteže i psihičkog stanja, tj. psihička reakcija podupire smetnje ravnoteže, s njima se prepliće te na neki način sprečava uspostavljanje središnjih kompenzacijskih
mehanizama (uočljiva je neusmjerenost u obrtajnom pokusu koja je prisutna i nakon šest mjeseci u inače fizički zdrave osobe, bez dijagnosticiranih smetnji vratne kralježnice).In spite of otoneurological treatment based on previous standardised diagnostic procedures, in some patients with balance disorders symptoms of dizziness and vertigo persist, causing difficulties in normal functioning that are hard to explain and quite challenging
to treat. In addition to balance disorders, different psychological conditions connected to physical symptoms can be observed. In this situation, other tests and diagnostic procedures should be used to establish the emotional condition of the patient. This case report presents a female patient addressed to psychiatric office by otorhinolaryngologist, after a thorough vestibular and neurological examination, because of unusual persistence of vertiginous symptoms that could not be explained by otoneurological reasons. On the other hand, anamnestic data obtained by psychiatrist revealed that some difficulties come from early childhood (fear of her own mother, inability to confront her), and later youth period (tendency to fantasy as a solution for embarrassing situations). The importance of supportive therapy is emphasized in the discussion part of the article, as well as the relationship between patient and therapist, described previously in the literature. We conclude that this case is an obvious example of the connection between balance disorder and
psychological condition where psychological reaction sustains balance disorder and in a way prevents expected central neural mechanisms to compensate for vestibular damage (vestibular reaction to rotation was still pathological and asymmetric after six months, that is unusual in othervise healthy person)
Latencije kognitivnih slušnih evociranih potencijala kod djece s umjetnom pužnicom
No full textUmjetnom pužnicom (UMP-om), prelingvalno slušno oštećena djeca dobivaju mogućnost razvoja slušanja, a time i govora. Najznačajniji čimbenik uspješnosti korištenja umjetnom pužnicom je njezina ugradnja u što ranijoj životnoj dobi jer se time stvaraju preduvjeti za normalan razvoj govora te što ranija, ciljana, planirana i dobro provedena slušno-govorna rehabilitacija. Unatoč tome, kod neke djece slušanje i govor se ne razvijaju prema očekivanju, iako za to ne postoje naoko vidljivi razlozi. Metoda kognitivnih slušnih evociranih potencijala (CAEP) jedan je od načina na koji se može ispitati funkcionalnost slušne kore i viših, kognitivnih funkcija koje sudjeluju u slušno-govornoj obradi. Duljina latencija valova CAEP-a daje podatke o lezijama provođenja slušnog signala na razini slušne kore mozga. U ovom istraživanju sudjelovalo je dvadesetero (20) djece s ugrađenim UMP-om, u dobi od osam do deset godina. Kod desetero (10) njih slušanje i govor se dobro razvija – S3, dok kod njih desetero (10) slušanje i govor se ne razvijaju prema očekivanju – S2. U grupe su razvrstani prema kapacitetu govornog audiograma (KAPRA). Svi su koristili isti tip UMP-a, imali su u trenutku snimanja uključen isti broj kanala i koristili istu strategiju kodiranja procesora. UMP im je ugrađen do dobi od 3 i pol godine. Osim oštećenja sluha, drugih deficita u ove djece nije bilo. Kao kontrolna skupina, metodom slučajnog uzorka, odabrano je desetero (10) djece, uredna sluha i govora, u dobi od osam do deset godina – S1. CAEP-i su snimani na 32-kanalnom uređaju tipa Neuroscan. Korištena su dva podražaja: tonski (1 kHz i 2 kHz) i govorni (dva dupla sloga sastavljena od dva samoglasnika i dva suglasnika). Primijenjena je oddball paradigma, a ispitanici su morali stisnuti gumb kad bi čuli ciljni podražaj. Analizirale su se latencije valova P1, N1, P2, N2 i P3 za ciljni i neciljni podražaj. Usporedba rezultata ispitivanja i statistička obrada neparametrijskim testovima pokazali su da se djeca iz S2 razlikuju od djece iz S1 i S3 u duljini latencija analiziranih valova. Maturacijski procesi, provođenje i zamjećivanje te kognitivna obrada tonskog podražaja sporije se odvijaju u S2, a za govorni podražaj kašnjenje se javlja u kategorizaciji i kognitivnoj obradi. Usporedbom S1 i S3 za govorni podražaj nisu nađene razlike među njima. Razlike su postojale samo u kategorizaciji tonskog podražaja – djeca iz S3 su bila lošija
Speed of processing nouns in mother and non-mother tongue in children with specific language impairment
No full textResearch have shown that speed of processing in children with specific language impairment generally slower than in children with typical language development when it comes to linguistic and non-linguistic tasks. Aim of this research was to examine speed of processing nouns in mother tongue (Croatian) and nouns in English language in children with specific language impairment and in those with typical language development. Three groups of children participated in the study ; (1) children with specific language impairment (SLI), (2) children with typical language development matched to children with SLI on age, and (3) children with typical language development matched to children with SLI on speech-language status. E-prime software was used to examine speed of processing. Lists of nouns chosen on the basis of their frequency in Croatian language were used as stimulus material. English language nouns were chosen based on English language school curriculum for third year of English language studying in primary school. Accuracy and reaction time were dependent variables in this research, and group of children was independent variable. Research procedure included stimulus word presented in auditory form, and children’s task was to choose which one of the three options (presented visually) represents the noun they just heard. One of the pictures represented the target noun, the other contained noun chosen on the basis of phonological similarity with the target noun, and the last one was chosen on the basis of visual similarity with the target noun. Target words were presented to children in random order, and ordering of picture types (i.e. target noun, phonologically and visually similar nouns) was random at each trial. Results were analyzed at quantitative and qualitative level. Data from this research gives support to thesis that children with specific language impairments process mother tongue words at the same speed rate that was observed in children learning English language in educational process, after they learned their mother tongue. Obtained results have implications for creating therapeutic goals when working with children with specific language impairments, as well as for creating educational methods for teaching those children
Development of premature born children – what about language, reading and writing? The speech and language pathologist’s view
No full textIt is known that premature born children are at risk for different kind of difficulties related to language, reading and writing. There are a plethora of studies suggesting a negative influence of adverse biological factors on language acquisition, specifically phonological processing and literacy in premature born children (Kirkegaard at al., 2006 ; Bayless and Stevenson, 2007 ; Luciana at al., 1999 ; Saavalainen at al., 2006). This negative influence can be observed in difficulties in language/linguistic categories important for education and academic achievement – phonological awareness, phonological working memory and phonological naming. METHODS Two groups of children, prematurely born children(n = 34) and children born at term (n = 34) were compared on a set of phonological tasks at the average age of 10.2 year. The average gestational age of prematurely born children and term born children was 34.38 weeks (29-36) and 39.26 weeks (38-41), respectively. The children were matched according to chronological age, gender and maternal educational level. The used tasks encompass phonological synthesis and analysis, spoonerism tasks, repetition of nonsense sentences, letter sequences tasks, digit span. RESULTS Prematurely born children had poorer results on phonological processing tasks in comparison with term born group (p < 0.01). The biological variables are significantly predictive of phonological processing according to the results of regression analyses and quasi- canonical correlation analysis. Therefore biological predictors should be considered as risk indicators for lower language status. Poor language abilities often cause reading and writing problems which strongly determine academic achievement of these children. CONCLUSIONS The results emphasize that biological variables present in prematurity are indicators of risk for some specific aspects of cognitive development. Speech and language pathologist’s monitoring from an early age and continuously during development in premature born children can prevent specific learning difficulties in school period
Using fairy tales with the Maslow's hierarchy of needs to improve the positive capacities of children with hearing and speech impairment
No full textBajke i dječji crtani filmovi te njihovi šaroliki likovi utjelovljuju gotovo sve potrebe koje se nalaze u Maslowljevoj piramidi potreba. Ovakav koncept primijenio se u radu radionica s djecom s oštećenjem sluha i govorno-jezičnim teškoćama u okviru Poliklinike SUVAG, s ciljem njihova osnaživanja i socijalnog razvoja, omogućujući time jačanje zaštitnih čimbenika. Radionice su provedene u okviru preventivnih programa sprječavanja neprihvatljivih oblika ponašanja. Korištenjem bajki i crtanih filmova napustio se svijet zbilje i realnosti te „ušuljalo“ u neku drugu dimenziju u kojoj su najdublja značenja različita za svaku osobu. Nastojalo se potaknuti dječju maštu i osvijestiti osnovna pitanja i probleme s kojim se djeca susreću u užoj i široj društvenoj zajednici. Na taj su način usvojene jednostavne, ali snažne poruke koje će ih pratiti u budućem životu. Kroz bajke i dječje crtane filmove, koristeći se Maslowljevom hijerarhijom ljudskih potreba te verbotonalnim načelima, obrascima, postupcima, pojmovima i sintagmama, dobio se referentni okvir razumijevanja bajkovitog materijala te uvid u dječje želje i težnje. Ujedno, sama su djeca osvijestila i razumjela vlastite osjećaje i potrebe, kao i osjećaje i potrebe drugih. Počelo se s D potrebama kroz određene bajke i crtane filmove (primjerice, Ivica i Marica - potreba za hranom, Princeza i žabac - potreba za vodom, Mala sirena - potreba za zrakom, Vuk i tri praščića - potreba za sigurnošću životnog prostora, itd.), a nastavilo s B potrebama (primjerice, Zvonar crkve Notre Dame - potreba za ljubavlju, Carevo novo ruho - potreba za samopoštovanjem, Pinokio ili Aladin - potreba za samoostvarenjem, itd.
The role of grammatical gender and number in the comprehension of relative clauses among children with specific language impairment
No full textOvim se istraživanjem nastojalo utvrditi olakšavaju li razlike u rodu i broju imenica razumijevanje subjektnih i objektnih odnosnih rečenica u ciljnoj skupini djece s posebnim jezičnim teškoćama (PJT), u dobi od 6 do 11 godina. Razumijevanje tih složenih sintaktičkih struktura ispitano je zadatcima u kojima su djeca trebala odgovarati na pitanja kojima se provjeravalo razumijevanje tematskih uloga unutar odnosne rečenice. Rezultati pokazuju da su ispitanici bili uspješniji u razumijevanju odnosnih rečenica koje se odnose na subjekt, u odnosu na one koje se odnose na objekt. Djeca u dobi od 8 do 11 godina, u odnosu na mlađu skupinu (od 6 do 7 godina), postigla su bolje rezultate u razumijevanju rečenica s različitim morfološkim oznakama (jednina-množina; muško-žensko). Ti nam rezultati omogućuju bolje razumijevanje prirode PJT-a, a istodobno pružaju i smjernice terapijskog pristupa.This study sought to determine whether a difference in gender and number of the head noun facilitates the comprehension of subject and object relative clauses within a group of children with Specific Language Impairment (SLI) aged between 6 and 11 years. The comprehension of these complex syntactic structures was assessed using a task in which children had to answer questions designed to check their understanding of thematic roles in a relative clause. The results demonstrated that object relative clauses were more difficult to comprehend than subject relative clauses. On the other hand, children aged 8 to 11 years were more successful than those in the younger group (6-7 years) at understanding object relative clauses that varied in morphological characteristics (singular-plural, feminine-masculine). These results provide further insight into the linguistic nature of SLI and have implications for therapy
Applying a Verbotonal Method to Rehabilitation of the Hearing Impaired Children
No full textThe rehabilitation of listening in the principles of verbotonal method (VT) implies expansion of optimal hearing field of impaired ear. That means achieved hearing transfer i.e., transpose of listening from impaired frequency range to undemaged part. For example, ear which is strong impaired in the high frequency range obtain a capability for listening of words and sentences which belong to high frequency range. In the first case there is patient whose hearing impaired progressively because of many ear abscess (the main disease is Mucopolisaharidose tip II), this patient listens with hearing aids. While in the second case patient with the same history of the hearing impairment (progressively) at the age of nine received cochlear implant because of the strong hearing impairment. A scale was used as a test for the purpose of assessing listening of speech (EHS), (Jurjević, 2002), which is the result of many years of work with hearing impaired children, using the VT method and its basic principles about listening. The EHS scale is the easy and simple way of examining the listening of speech in the conditions of everyday spontaneous communication, in order to gain insight into the real possibility of listening of speech in all its components. The EHS scale examines listening of speech through ten levels from basic auditory recognition to precise listening and discernment of pairs of similar words. When choosing words, the frequency of speech material in the speech of children of certain chronological age was taken into account, as well as representation of congruent pitch words according to their appearance in the Croatian language. Tasks could be repeated up to three times, making sure that the repetition of a task does not undermine values of spoken language. The system of errors was analyzed as well as the number of repetitions in which the correct answer was reached. The results of this test give us the valuable data in further procedures of speech and hearing rehabilitation
Croatian guidelines for diagnosis and management of benign paroxysmal positional vertigo (BPPV)
No full textBPPV je općenito najčešći uzrok vrtoglavice, prouzročen otkidanjem sitnih kristalića kalcijeva karbonata, zvanih otokonije ili otoliti, iz otolitičke mrlje utrikulusa, najčešće zbog degenerativnih procesa ili traume. Djelovanjem sile teže, pri određenom položaju glave koji se podudara sa smjerom sile teže, otoliti dospijevaju u jedan od polukružnih kanalića labirinta, najčešće stražnji zbog postojećih anatomskih odnosa. Plutajući endolimfom, podražuju kupularno osjetilo, izazivajući simptome kratkotrajne, ali snažne vrtoglavice. Razlikuju se dva glavna klinička oblika BPPV-a: kanalolitijaza – nakupljanje otolita u kanalićima i kupulolitijaza – nakupljanje otolita neposredno uz sámo kupularno osjetilo. Dijagnoza bolesti postavlja se pozitivnom položavajućom probom, Dix-Hallpikeovom za stražnji polukružni kanalić, a supine roll za bočni kanalić. Premda se može očekivati spontani oporavak nakon nekoliko tjedana ili mjeseci, različiti postupci repozicije otolita dovode do trenutačnog poboljšanja, smanjenjem ili potpunim povlačenjem simptoma bolesti. Ove smjernice namijenjene su svima koji se u svojem radu mogu susresti s BPPV-om, a cilj im je pomoć u postavljanju dijagnoze i primjeni odgovarajućeg načina liječenja oboljelih.BPPV is generally the most common cause of vertigo, caused by a pinch-off of tiny calcium carbonate crystals (called the otoconia or the otoliths) from the macula utriculi, most frequently due to the degenerative processes or a trauma, whereby the crystals, under the action of gravity in certain head positions coinciding with its direction, arrive to some of the semicircular canals, usually the posterior one, due to the existent anatomical circumstances and relationships, thus creating an inadequate stimulus of the cupular senses while floating through the endolymph and provoking symptoms of a strong and short-term dizziness. Two main clinical forms can be distinguished: canalolythiasis, with an accommodation of otolithic debris in the semicircular canal, and cupulolythiasis, with their location immediately next to the cupular sense. The diagnosis is established by a positive positioning test, Dix-Hallpike for the posterior and the supine roll for the lateral canal. Although one can expect a spontaneous recovery subsequent to few weeks or months, various methods of otolith repositioning to a less sensitive place lead to a prompt improvement while reducing or withdrawing the symptoms completely. These guidelines are intended for all who treat the BPPV in their work, with an intention to assist in the diagnosis and application of an appropriate therapeutic method