Programa de Pós-graduação em Ciências da Reabilitação, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil.
Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil.
Codas. 2022 Jan 7;34(3):e20210069. doi: 10.1590/2317-1782/20212021069. eCollection 2022.
To investigate the effectiveness of a proposal for classification of facial grimace (FG) and its correlation with objective evaluation of velopharyngeal closure (VPC).
Twenty individuals with repaired cleft lip and palate underwent velopharyngeal area measurement by means of rhinomanometry and speech sample recording. The FG was rated in two steps, by three speech-language pathologists. First the evaluators rated the FG using their own criteria as: 1= absent FG; 2=mild; 3=moderate; 4=severe. Subsequently, they were submitted to a training session that established the following FG rating criteria: 1=absent FG; 2=movement only of the nose or upper third of the face; 3=strong movement of the nose or upper third of the face; 4=movement of the nose and upper third of the face. The evaluators rated the FG using the established criteria. Intra- and inter-rater agreement were calculated using weighted Kappa coefficient. Correlation between the two stage ratings with the VPC was calculated by Spearman's correlation coefficient.
In the first stage inter-rater agreement ranged from fair to substantial; in the second stage, from substantial to almost perfect. Intra-rater agreement ranged from moderate to almost perfect in the first stage, and from moderate to substantial in the second stage. The correlation between FG and velopharyngeal area was positive and significant in both stages.
The proposed FG judgement proved to be effective in determining the symptom and reliable in diagnosing the severity of velopharyngeal dysfunction. The significant correlation between perceptual and instrumental methods suggests that FG can be used in predicting VPC.
研究一种用于分类面部表情（FG）的提案的有效性及其与腭咽闭合（VPC）的客观评估的相关性。
20 名唇腭裂修复患者通过鼻压测量法和语音样本记录进行腭咽区测量。FG 通过三位言语语言病理学家进行两步评分。首先，评估者根据自己的标准对 FG 进行评分：1=无 FG；2=轻度；3=中度；4=重度。随后，他们参加了一个培训课程，该课程确立了以下 FG 评分标准：1=无 FG；2=仅鼻子或面部上三分之一运动；3=鼻子或面部上三分之一强烈运动；4=鼻子和面部上三分之一运动。评估者使用既定标准对 FG 进行评分。使用加权 Kappa 系数计算内部和外部评估者之间的一致性。通过 Spearman 相关系数计算两个阶段的评分与 VPC 的相关性。
在第一阶段，评估者之间的一致性从一般到显著；在第二阶段，从显著到几乎完美。在第一阶段，内部评估者之间的一致性从中等到几乎完美，在第二阶段，从中等到显著。FG 与腭咽区之间的相关性在两个阶段均为正且显著。
所提出的 FG 判断在确定症状方面是有效的，在诊断腭咽功能障碍的严重程度方面是可靠的。感知和仪器方法之间的显著相关性表明，FG 可用于预测 VPC。
