Vania L C Carvalho Lima1, Camila Cosmo2, Kleber B Lima3, Mariana A Martins4, Suellen G Rossi4, Luanda A Collange Grecco5, Mauro Muzskat6, Clara R Brandão de Ávila4. 1. Department of Hearing and Speech Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; Teaching Center, Assistance and Research in Reading and Writing (NEAPEL) - Department of Hearing and Speech Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; Laboratory of Neuromodulation & Center of Clinical Research Learning, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: fono.vania@gmail.com. 2. Laboratory of Neuromodulation & Center of Clinical Research Learning, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Brazil; Center for Technological Innovation in Rehabilitation, Federal University of Bahia, Brazil; Specialized Support Network Coordination, State of Bahia Health Department, Brazil. 3. Department of Hearing and Speech Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil. 4. Department of Hearing and Speech Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; Teaching Center, Assistance and Research in Reading and Writing (NEAPEL) - Department of Hearing and Speech Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil. 5. Center for Pediatric Neurosurgery - Rehabilitation (CENEPE), São Paulo, SP, Brazil. 6. Department of Education and Health in Childhood and Adolescence, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
Abstract
INTRODUCTION: Transcranial direct current stimulation (tDCS) modulates cortical activity and potentiates functional gains achieved during therapeutic protocols. The aim of Integrative Speech Therapy Protocol is to rehabilitate speech in patients with impairments regarding neuropyschomotor development by combining oral motor stimuli, specific articulatory production, and the stimulation of phonological aspects of language. OBJECTIVE: Investigate the effect of transcranial direct current stimulation combined to integrative speech therapy in a child with cerebral palsy. METHODS: We performed a case study with tDCS and speech therapy in a patient with cerebral palsy and apraxia of speech. To assess the patient's speech, we used a parameterized test for the Brazilian Portuguese speech - ABFW. The CFCS and Vicking Speech Scales presented level IV and III, respectively. The patient underwent two periods with ten stimulation sessions each: first with anodal stimulation over Broca's area; and second over the left dorsolateral prefrontal cortex. Two indices were calculated: the percentage of consonants correct; and percentage of consonants correct-revised. Descriptive statistics were employed for the clinical data. For the outcomes, changes in each score were calculated as the difference in pre-intervention and post-intervention using Wilcoxon-Mann-Whitney test. RESULTS: Increases were found in percentage of correct consonants indices as well as to produce two-syllable and three-syllable words after both types of stimulation, characterized mainly by correct vowels that marked the presence of the syllable. Number of phonemes increased 0 to 4 at first the stimulation and 4 to 10 at the second. CONCLUSION: The combined-therapy program contributed to improve the speech rehabilitation results in a patient with cerebral palsy.
INTRODUCTION: Transcranial direct current stimulation (tDCS) modulates cortical activity and potentiates functional gains achieved during therapeutic protocols. The aim of Integrative Speech Therapy Protocol is to rehabilitate speech in patients with impairments regarding neuropyschomotor development by combining oral motor stimuli, specific articulatory production, and the stimulation of phonological aspects of language. OBJECTIVE: Investigate the effect of transcranial direct current stimulation combined to integrative speech therapy in a child with cerebral palsy. METHODS: We performed a case study with tDCS and speech therapy in a patient with cerebral palsy and apraxia of speech. To assess the patient's speech, we used a parameterized test for the Brazilian Portuguese speech - ABFW. The CFCS and Vicking Speech Scales presented level IV and III, respectively. The patient underwent two periods with ten stimulation sessions each: first with anodal stimulation over Broca's area; and second over the left dorsolateral prefrontal cortex. Two indices were calculated: the percentage of consonants correct; and percentage of consonants correct-revised. Descriptive statistics were employed for the clinical data. For the outcomes, changes in each score were calculated as the difference in pre-intervention and post-intervention using Wilcoxon-Mann-Whitney test. RESULTS: Increases were found in percentage of correct consonants indices as well as to produce two-syllable and three-syllable words after both types of stimulation, characterized mainly by correct vowels that marked the presence of the syllable. Number of phonemes increased 0 to 4 at first the stimulation and 4 to 10 at the second. CONCLUSION: The combined-therapy program contributed to improve the speech rehabilitation results in a patient with cerebral palsy.