Efeitos da inserção da terapia psicomotora no tratamento fonoaudiológico em adultos que gaguejam: ensaio clínico randomizado

Abstract

Introduction: Fluent and effortless speech flow is only possible due to well-established connections between specific brain areas, and these areas are also involved in the development of phonological and temporal processing abilities. People who stutter usually have alterations in these brain areas, which suggest that these abilities may also be impaired. Few previous randomized trials investigated whether other therapies could improve the efficacy of the traditional treatment in adults who stutter (AWS). Objectives: 1) To evaluate in a randomized controlled clinical trial whether the addition of a psychomotor therapy over a standard combined-approach treatment could improve the efficacy of treatment in young AWS and 2) to evaluate phonological and temporal processing skills in adults who stutter, and compare them with a control group matched by age, sex and schooling. Methods: 1) Fortyseven young AWS (mean age 24 years, 79% males) with at least moderate stuttering (evaluated by the Stuttering Severity Instrument-3, SSI-3 ≥21 points) were randomized to either a standard combined-approach treatment (24 AWS, control group, sixteen 40min sessions over 8-weeks) or to standard treatment plus the psychomotor therapy (23 AWS, intervention group, adding 20min of psychomotor training after each session). Treatment efficacy was assessed by reductions in SSI-3 scores, examined by Wilcoxon tests. Primary outcome was the difference in SSI-3 reductions between control and intervention groups, evaluated by Mann-Whitney tests. In the second study, the Rapid Automatized Naming (RAN) and Verbal Fluency (VF) tests evaluated phonological processing in 47 young adults who stutter and compared to a control group matched by age, sex and schooling, by MannWhitney tests. In the group of individuals who stutter, we assessed associations between the tests results and the stuttering severity and duration.Conclusion: The randomized controlled trial did not demonstrate any benefit of adding a psychomotor therapy over a standard combined-approach treatment in young AWS. In the second study, young adults who stutter had alterations in almost all temporal and phonological processing abilities, especially in the phonological working memory and fast and accurate access to the mental lexicon, in relation to an age, gender and schooling-matched control group of fluent individuals. Considering stuttering severity, the RAN test seemed to be a better evaluation tool of these phonological processing impairments than the VF test.