Protocols for assessing the nature and pattern of oromotor movements and
speech: PAOF and FDA-2
Guimarães, I.1;4; Cardoso, R.2;4; Pinto3,S. & Ferreira, J.J.2;4
1
School of Health Sciences at Alcoitão - Santa Casa da Misericórdia de Lisboa; 2Campus
Neurológico Sénior (CNS), Torres Vedras; 3Laboratoire Parole et Langage, Aix-en-Provence,
França; 4Clinical Pharmacologic Unit, Instituto de Medicina Molecular, Lisbon
Abstract
Introduction: One of the speech therapists’ challenges is to distinguish and/or
determine the association level of speech and oromotor disorders. It is common for
both levels to coexist in some disorders due to the great interdependence of the
speech production system (e.g, respiration, phonation, articulation, and prosody
resonance). Despite speech therapists have expertise to identify the nature and pattern
of oral mechanism, a central element in clinical evaluation is the use of a well-defined
and validated protocol. Nowadays, in Portugal, there are a limited number of protocols
available that provide specific application instructions, validity, reliability and published
normative data for the Portuguese population. In 1995 was published the protocol of
orofacial evaluation (PAOF)1 and more recently, in 2014, the cross-cultural adaptation
and validation for the European Portuguese Frenchay dysarthria Assessment, version
two (FDA-2)2 was performed. Purpose: PAOF and the Portuguese version of the FDA2 will be presented. Results: PAOF was developed for screening structure and
orofacial function and oral diadochokinesis. PAOF has an examiner’s manual with
theoretical information, application, registration and quotation rules. The person is
observed at rest (morphology) or function or "speech" (oral diadochokinesis) or a set of
tasks is given by the examiner. Its development went through different stages: (a)
construction, through focus group methodology involving 16 speech therapists
specialized in different clinical fields; (b) Validation - Application protocol for validation
of their construct system quote and applicability. Its validity and reliability were
analysed in several studies3-7, was presented at national and international scientific
congresses8,9 and continues to be cited10. The original FDA-2, has an examiner’s
manual with detailed instructions for administration, quotation and the validity and
reliability were obtained in studies in different countries and contexts, with different
groups of patients, healthy subjects and types and degrees of severity of disartria 2. The
evaluation consists of seven sections. In each section the patient is observed (at rest or
in function or "speech") or given a set of tasks or questions by the examiner. The rating
scale has nine points with the 'e' (no function) that corresponds to "zero "and the" a
"(normal) corresponding to nine. The European Portuguese adaptation was authorized
by the authors and publishers only for scientific purposes. The study involved different
phases: cross-cultural adaptation, translation methodology, application and validation
were carried out in 80 subjects with Parkinson's disease using a multidisciplinary
protocol involving the use of various tools (eg. MDS-UPDRS11, VHI12, DIP13) and is
being used within the project FraLusoPark 14. FDA-2 validity and reliability was tested.
Conclusion: Both, PAOF (screening) and FDA-2 (dysarthria specific) are protocols for
assessing the nature and pattern of oromotor movements and speech. Despite the
existence of protocols for clinical use, in Portugal, it is recommended in the near future
to update and improve the psychometric qualities of PAOF and in the case of the
Portuguese version of the FDA-2 improved their versatility, sensitivity and specificity.
References
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14
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2