Using multimedia material: effects on the knowledge of dental and speech-language pathology undergraduate students

Uso de material multimídia: efeitos no conhecimento de graduandos de Odontologia e Fonoaudiologia

ABSTRACT

Objective:  To compare the knowledge of Dental and Speech-Language Pathology undergraduate students about prosthesis treatment of velopharyngeal dysfunction in cases of cleft lip and palate before and after using educational multimedia material.

Methods:  The sample comprised 58 students (38 from the Dental program, and 20 from the Speech-Language Pathology program). A questionnaire on prosthesis treatment of velopharyngeal dysfunction in cases of cleft lip and palate was administered to a group of Dental and Speech-Language Pathology undergraduate students before and after they had access to educational multimedia (video) material on the topic approached in this study. Inferential statistics were used to investigate the significance of differences in correct answers before and after the Dental and Speech-Language Pathology undergraduate students had access to the multimedia/video material.

Results:  Before having access to the multimedia/video material, Speech-Language Pathology students had more correct answers (Dental: 4.89±1.31; SLP: 6.30±0.57). After having access to the material, the difference in correct answers between the students of both programs decreased (Dental: 6.00±0.66; SLP: 6.45±0.51), as Dental students’ knowledge of the research topic increased. The comparison of the total sample before and after applying the multimedia/video material also demonstrated an increase in correct answers.

Conclusion:  Speech-Language Pathology students proved to have greater previous knowledge of palatal prostheses used for velopharyngeal dysfunction in cases of cleft lip and palate. Moreover, using the multimedia material possibly increased both Dental and Speech-Language Pathology students’ knowledge of this topic.

Indexing terms
Cleft palate; Health Education; Multimedia

RESUMO

Objetivo:  Comparar conhecimento de graduandos de Odontologia e Fonoaudiologia sobre tratamento protético na disfunção velofaríngea referente a casos de fissura labiopalatina antes e após uso de material multimídia educacional.

Método:  Aplicação de um questionário sobre tratamento protético da disfunção velofaríngea em casos de fissura labiopalatina a um grupo de estudantes de graduação de Odontologia e Fonoaudiologia, antes e após acesso a material multimídia educacional/vídeo desenvolvido sobre o tema abordado neste estudo. Estatística inferencial foi usada para investigar significância das diferenças nas respostas corretas entre as situações antes e após acesso ao material multimídia/vídeo apresentado a graduandos de Odontologia e Fonoaudiologia.

Resultados:  Participaram 58 discentes, 38 do curso de Odontologia e 20 de Fonoaudiologia. Antes do acesso ao material multimídia/vídeo, graduandos de Fonoaudiologia apresentaram mais acertos (Odontologia 4,89±1,31 / Fonoaudiologia 6,30±0,57). Após acesso a esse material, a diferença de acertos entre alunos dos referidos cursos diminuiu (Odontologia 6,00±0,66 / Fonoaudiologia 6,45±0,51), sendo que, neste momento, graduandos de Odontologia mostraram aumento no conhecimento sobre a temática desta pesquisa. Ao comparar a amostra total, antes e após aplicação do material multimídia/vídeo, verificou-se aumento dos acertos.

Conclusão:  Certificou-se maior conhecimento prévio no curso de Fonoaudiologia acerca do tema referente à prótese de palato em quadros de disfunção velofaríngea em casos de fissura labiopalatina. Todavia, o uso de material multimídia, possivelmente, viabilizou ampliação de conhecimentos relacionados a tal tema tanto aos discentes do Curso de Odontologia como de Fonoaudiologia.

Termos de indexação
Fissura palatina; Educação em saúde; Multimídia

INTRODUCTION

Cleft lip and palate (CLP) is a congenital orofacial malformation characterized by an opening in the regions of the lip and/or palate, caused by the non-fusion of these anatomic structures during intrauterine development by the 4th and 8th gestational week [¹].

CLP is classified regarding its anatomical location, taking the incisive foramen as a reference, as follows: pre-incisive foramen cleft, which involves the lip and/or ridge until the incisive foramen and can be bilateral or unilateral; post-incisive foramen cleft, which involves the hard and soft palate and can be complete or incomplete; trans-incisive foramen cleft, which involves the lip, alveolar ridge, and hard and soft palate and can be unilateral or bilateral [¹,²].

This malformation has a multifactorial etiology, encompassing genetic factors that may be related to the individual (mutations and polymorphism) and the environment (poor nutrition, alcohol consumption, and smoking) [³]. About 15,000 children are estimated to be born with CLP per hour worldwide – i.e., every 2 and a half minutes, a child is born with CLP in the world [²]. In Brazil, the number of cases ranges from 0.19 to 1.54 per 1,000 live births [³,⁴] – i.e., one child in every 650 newborns has CLP [⁵].

Given the impairments in orofacial structures, CLP generally causes changes in physical/aesthetic aspects, dental occlusion, articulatory production and voice. Concerning specifically articulatory production, the role of the velopharyngeal mechanism (VPM) stands out due to the concomitant up and down soft palate movement, the mesially displaced lateral pharyngeal walls, and posterior-anterior displacement of the posterior pharyngeal wall. The function of VPM is to delimit the oropharynx from the nasopharynx during speech, particularly when producing oral sounds [⁶]. Hence, in cases of CLP with an impaired palate, the main purpose of primary palatoplasty is to establish an adequate VPM to produce speech/voice. However, the results of this surgical procedure may include velopharyngeal dysfunction (VPD) [⁷], due to structural and/or functional changes [⁸]. In general, VPD, after primary repair of the cleft palate, occurs in 5% to 43% of cases, resulting in the inability to fully separate the oral and nasal cavities during speech [⁹].

Thus, several symptoms result from a VPD condition, such as speech/voice disorders related to oronasal coupling and problems related to middle ear conditions related to Eustachian tube dysfunction [⁹]. With regard to speech/voice symptoms caused by VPD include hypernasality, nasal air emission, and/or compensatory articulation [⁷]. In general, compensatory articulations are considered deviations in the production of sounds, which are established in the early stages of articulatory acquisition as a result of attempts by children with structural alterations, such as VPD, to functionally compensate for the altered velopharyngeal mechanism. These atypical productions are characterized by the use of laryngeal or pharyngeal articulation points, they are already produced in regions of the vocal tract that are below the structural problem, that is, posterior to the velopharynx, replacing oral consonants that require greater intraoral pressure. Therefore, compensatory articulations represent the use of an articulatory mode, which is generally preserved and a posteriorized articulation point, resulting in speech that is often unintelligible and, thus, significantly compromising the quality of life of the affected subjects [¹⁰].

The treatment indicated for these symptoms can be speech therapy, surgery, and/or palatal prosthesis. VPD correction often depends on repairing anatomical structures and their functions, which may be achieved with a physical procedure (surgery or palatal prosthesis) in combination with a speech therapy program [¹¹]. In this regard, Rizatto et al. [¹²] report that the palatal prosthesis alone is insufficient to eliminate hypernasality in patients with hypodynamic VPM, thus requiring the combination of prosthesis and Speech-Language- Pathology (SLP) treatment.

The main function of the palatal prosthesis is to work dynamically and functionally on the VPM musculature, helping control air pressure and flow into the oral cavity during speech sound articulation [⁸]. It is a removable prosthesis with an oral section and a palatal extension to stimulate the impaired VPM in cases of VPD [¹²]. Studies [⁹,¹²-¹⁴] report effective results of using palatal prostheses in VPD patients, with providing sensory-motor stimulation, and increasing muscle movement, which leads to appropriate speech/voice qualities and improved quality of life of individuals with CLP and VPD [¹⁵].

In this perspective, dentists and Speech-Language Pathology (SLP) treatment work together to adapt palatal prostheses to treat VPD. Dentists must know VPM physiology during speech/voice production and the changes caused by VPD, while SLP therapists must know dental materials and their use and limitations to produce this type of prosthesis. Thus, topics on VPM, VPD, speech/voice production in cases of CLP with VPD, and palatal prostheses must be approached in Dental and SLP undergraduate programs, as successful prosthesis treatments of these conditions depend on the synchronous approach of both fields.

Following this line of thought, this study considers the use of multimedia educational material as a means of learning undergraduate academic content, emphasizing the hypothesis that such use can be a productive tool for Dental and SLP students to acquire knowledge. In our present-day society, knowledge is linked to technology, which changes educational practices and directly affects teaching/learning processes in universities [¹⁶].

The fields of education and information technology have been improving educational processes, using digital tools to increase interactivity in the way content is transmitted [¹⁷-¹⁸]. Thus, the purpose of educational multimedia tools is to provide a didactic and interactive resource on a given topic to help the teaching/learning process in an in-person or virtual setting. They can also complement, review, or reinforce content that has already been studied [¹⁷]. Given the above, this study aimed to compare the knowledge of Dental and SLP undergraduate students on prosthesis treatment of VPD in cases of CLP before and after using the educational multimedia material.

METHODS

This experimental nonrandomized study was conducted at a private university in Southern Brazil and approved by the Human Research Ethics Committee under no. 3.403.300. As inclusion criteria for this study: individuals over 18 years old, of both sexes, students of a certain private University located in the South region of Brazil, being Dental students in the 7th and 8th terms who had already taken the courses on prostheses, stomatology, and surgery and SLP students in the 7th and 8th terms who had already taken the courses on oral-motor function and oral language. Researchers orally invited them to participate in the study by visiting their classrooms on dates prescheduled with the professors of both courses included in the research and presenting the educational multimedia material in videos. The sample comprised 58 students – 38 from the Dental program and 20 from the SLP program. They were 52 women and six men, aged 22 to 60 years (26.5 years).

While conventional class models often include an established process regarding the development, analysis and evaluation of the theoretical content addressed, based on the use of multimedia material, a contextualized process is referred to describe an intentional action of planning, developing and applying situations specific didactics, incorporating, both in the design phase and during implementation, mechanisms that favor contextualization and flexibility [¹⁹].

The educational multimedia material presented in videos in this research was produced in a senior project whose objective was to provide information to patients, parents, and/or caregivers about the velopharyngeal sphincter, VPM, speech/voice changes, and palatal prosthesis production and fitting. For its construction, a script of actions was carried out to define the syllabus content, elaboration of an educational script and computational graphic modeling. For the preparation of the educational script, relevant graphic elements were studied and selected that would facilitate the transmission of the content of interest through a visual representation that was incorporated into the multimedia material. The material was built using the Power Point program, later converted into self-demonstrative video and copied in DVD format [²⁰].

Figure 1
Example of the screens contained in the educational multimedia material.

In this way, data were collected in September 2019 in the said programs. Participants individually answered a questionnaire developed by the researchers with 10 yes/no questions (nominal variable) on VPM, VPD, and their consequences to speech sound/voice production, and on palatal prostheses.

The questionnaire was administered in two stages: 1 - before presenting the multimedia material, using 10 questions (three opinion/subjective questions and the other seven on specific knowledge about the topic); 2 - after presenting the multimedia material, 1 week after stage 1, using only seven questions (on specific knowledge about the topic).

Each correct answer scored 1 point. A score was calculated for stage 1 (before the video) and another one for stage 2 (after showing the video, 1 week after stage 1).

Inferential statistical analysis was performed with Fisher’s exact test to compare nominal variables in each question separately regarding Dental and SLP students, and the t-test for numerical variables. Concerning the paired total sample, the McNemar test was used to compare nominal variables before and after exposure to the multimedia material, as well as the t-test, for numerical variables. The level of significance was set at 5%. The program used was Jamovi, version 1.2.25.

RESULTS

Table 1 shows the distribution of the Dental and SLP students’ answers to the three initial questions applied before presenting the study multimedia/video material (stage 1). They characterized the population regarding topics on VPM, VPD, and multimedia material, and indicated that SLP students had greater previous knowledge about VPM and VPD. Both programs provided previous access to multimedia material in the academic process.

Table 1
Questions on VPM, VPD, and exposure to multimedia material in the undergraduate programs, answered before applying the multimedia/video material proposed in this research (stage 1).

				SLP (n = 20)	Dental (n = 38)	p
1.	Do you know what the velopharyngeal mechanism is?	No		0 (0%)	34 (89.5%)	<0.001*
		Yes		20 (100%)	4 (10.5%)
2.	Do you know what velopharyngeal dysfunction is?	No		0 (0%)	36 (94.7%)	0.02*
		Yes		20 (100%)	2 (5.3%)
3.	Do you use or have access to multimedia material in the academic process?	No		2 (10%)	2 (5.3%)	0.600
		Yes		18 (90%)	36 (94.7%)

• Note: Caption: SLP = Speech-Language Pathology; Fisher’s exact test,
• ^*
  at the level of significance of p < 0.05.

Table 2 compares Dental and SLP students’ correct answers before and after showing the multimedia/video material (stages 1 and 2). Differences were found between the programs in three questions before showing the video (stages 1). The summed result showed a difference between the programs both before and after presenting the study multimedia/video material.

Table 2
Comparison of the Dental and SLP students’ answers before and after applying the multimedia/video material proposed in this research (stages 1 and 2).

			BEFORE			AFTER
			SLP (n = 20)	Dental (n = 38)	p	SLP (n = 20)	Dental (n = 38)	p
1.	Velopharyngeal dysfunction can cause speech/voice changes, such as hypernasality.	Correct	20 (100%)	26 (68.4%)	0.005*	20 (100%)	36 (94.7%)	0.54
		Wrong	0 (0%)	12 (31.6%)		0 (0%)	2 (5.3%)
2.	Palatal prostheses are removable appliances whose function is to help separate the oral and nasal cavities, used in the treatment of velopharyngeal dysfunction.	Correct	20 (100%)	31 (81.6%)	0.08	20 (100%)	31 (81.6%)	0.54
		Wrong	0 (0%)	7 (18.4%)		0 (0%)	7 (18.4%)
3.	Palatal prostheses are produced in two stages when they are used in the treatment of velopharyngeal dysfunction: anterior portion and intermediate portion.	Correct	11 (55%)	13 (34.2%)	0.16	12 (60%)	16 (42.1%)	0.27
		Wrong	9 (45%)	25 (65.8%)		8 (40%)	22 (57.9%)
4.	Patients must use their palatal prostheses all day long and remove them after meals to clean them and before sleeping.	Correct	18 (90%)	32 (84.2%)	0.70	19 (95%)	36 (94.7%)	1.00
		Wrong	2 (10%)	6 (15.8%)		1 (5%)	2 (5.3%)
5.	The posterior portion of palatal prostheses (the pharyngeal bulb) is the one in contact with the soft palate and pharyngeal walls to aid the velopharyngeal closure, preventing the flow of nasal air during oral sound production.	Correct	20 (100%)	30 (78.9%)	0.04*	20 (100%)	36 (94.7%)	0.54
		Wrong	0 (0%)	8 (21.1%)		0 (0%)	2 (5.3%)
6.	Palatal prosthesis fitting alone does not correct speech changes but provides the means for the velopharyngeal mechanism to work properly and produce speech sounds.	Correct	18 (90%)	28 (73.5%)	0.18	19 (95%)	36 (94.7%)	1.00
		Wrong	2 (10%)	10 (26.5%)		1 (5%)	2 (5.3%)
7.	As speech therapy aimed at speech sound production progresses, the pharyngeal bulb can be diminished.	Correct	19 (95%)	26 (68.4%)	0.02*	19 (95%)	32 (84.2%)	0.40
		Wrong	1 (5%)	12 (31.6%)		1 (5%)	6 (15.8%)
	Sum of correct answers (mean±SD)		6.30±0.57	4.89±1.31	<0.001*	6.45±0.51	6.00±0.66	0.01*

• Note: Caption: SD: standard deviation; SLP = Speech-Language Pathology; comparison between SLP and Dental students; the questions were analyzed with Fisher’s exact test; the sum was compared with the independent t-test;
• ^*
  level of significance at p < 0.05.

The comparison of the total sample before and after applying the multimedia/video material showed an increase in the number of correct answers to three questions (1, 5, and 6) and in the summed number of correct answers after access to this material (table 3).

Table 3
Paired comparison of the overall students’ answers (not separated per group) before and after applying the multimedia/video material proposed in this research (stages 1 and 2).

		Paired total sample (n = 58)
			BEFORE	AFTER	p
1.	Velopharyngeal dysfunction can cause speech/voice changes, such as hypernasality.	Correct	46 (79.6%)	56 (96.6%)	0.003*
		Wrong	12 (20.4%)	2 (3.4%)
2.	Palatal prostheses are removable appliances whose function is to help separate the oral and nasal cavities, used in the treatment of velopharyngeal dysfunction.	Correct	51 (87.9%)	56 (96.6%)	0.09
		Wrong	7 (12.1%)	2 (3.4%)
3.	Palatal prostheses are produced in two stages when they are used in the treatment of velopharyngeal dysfunction: anterior portion and intermediate portion.	Correct	24 (63.2%)	28 (48.3%)	0.39
		Wrong	34 (36.8%)	30 (51.7%)
4.	Patients must use their palatal prostheses all day long and remove them after meals to clean them and before sleeping.	Correct	50 (86.4%)	55 (94.8%)	0.09
		Wrong	8 (13.6%)	3 (5.2%)
5.	The posterior portion of palatal prostheses (the pharyngeal bulb) is the one in contact with the soft palate and pharyngeal walls to aid the velopharyngeal closure, preventing the flow of nasal air during oral sound production.	Correct	50 (86.4%)	56 (96.6%)	0.03*
		Wrong	8 (13.6%)	2 (3.4%)
6.	Palatal prosthesis fitting alone does not correct speech changes but provides the means for the velopharyngeal mechanism to work properly and produce speech sounds.	Correct	46 (79.6%)	55 (94.8%)	0.01*
		Wrong	12 (20.4%)	3 (5.2%)
7.	As speech therapy aimed at speech sound production progresses, the pharyngeal bulb can be diminished.	Correct	45 (77.6%)	51 (87.9%)	0.08
		Wrong	13 (22.4%)	7 (12.1%)
Sum of correct answers (mean±SD)		5.38±1.30	6.16±0.64		<0.001*

• Note: Caption: SD: standard deviation; paired comparison between results before and after access to the multimedia material; the questions were analyzed with the McNemar test; the sum was compared with the paired t-test;
• ^*
  level of significance at p < 0.05.

DISCUSSION

First, it is worth highlighting the importance and dimension that multimedia materials reached during the period of the COVID-19 pandemic, when the need for the use of resources in the teaching/learning process carried out remotely due to the moment of physical distance was explained, emphasizing the use of information and communication media and technologies in ongoing courses [²¹-²⁴].

This study found that SLP students had more correct answers before watching the multimedia/video material, which indicates they had greater knowledge on those topics than Dental students - even though prostheses are produced by dentists.

Signor [²⁵] highlights the relevance of SLP’ cooperation in teams that treat cases of CLP. These therapists are an integral part of such teams and approach these patients since gestation, based on an intrauterine diagnosis, and accompany them often as far as adulthood [²⁵].

As Dental students had less knowledge of certain topics presented in the collected material, it must be verified whether such issues are properly addressed in their academic training. This attention to the circumstances revealed in the data is due to dentists’ responsibility regarding the issues in this study, particularly in terms of providing palatal prostheses in cases of VPD in patients with CLP. Mendes et al. [²⁶] conducted a study to investigate the perception and experience of dental surgeons who treated individuals with CLP in the municipal health system of Pelotas, RS, Brazil. They concluded that an important part of the professionals in the study had treated patients with an orofacial cleft, whose congenital malformation did not hinder basic clinical procedures. However, the authors verified that these professionals lacked information on CLP and, therefore, pointed out that health services must provide training to dental surgeons who work in the public system, focusing on instructions to parents about the child’s nutrition and oral hygiene in the region of the cleft and the cleft rehabilitation process, which are essential in primary healthcare.

The assessment results of the impact of the multimedia material on the students’ knowledge before and after presenting the video proposed in this study indicate that the number of correct answers sharply increased after having access to this material. These results corroborate the ones presented in research by Costa et al. [⁵], which likewise administered a questionnaire before and after presenting multimedia material. Its results were substantially better after having access to the material, demonstrating that it effectively helped instruct caregivers of patients with CLP.

The study by Polzin [²⁷] also tested the effectiveness of educational material presented to undergraduate SLP students, administering a questionnaire before and after they had access to the didactic material. The author reported an increase in correct answers after presenting the said material, from a mean of correct answers in 73.7% of the questions before having access to the material to 96.8% after it. Hence, these results confirm that the material had a positive impact on the students’ understanding of therapy strategies to correct speech changes due to a hypodynamic velopharynx.

The study by Campoverde [²⁸] aimed to develop multimedia (video) material on the use of pharyngeal bulb prostheses to treat VPD and then assess the knowledge of 4th-year Dental students before and after having access to the material. It found that the number of correct answers increased after having access to the material, with a positive impact on their understanding of VPD treatment with such prostheses in individuals with CLP.

Studies in different areas and various topics approached the use of multimedia material for educational purposes in both professionals and patients. For instance, Galvão and Püschel [²⁹] aimed to develop and assess a multimedia mobile application to teach central venous pressure measurement. Their results point to the possibility of using the tool to aid the pedagogical practice, with significant evidence of new modes of learning in the field of Nursing.

Lopez-Olivo et al. [³⁰] developed and tested a multimedia (video) tool for educational programs for individuals with knee osteoarthritis, osteoporosis, and rheumatoid arthritis. Their objective was to make these programs didactic and interactive, with browsing and interfaces. Most participants reported a clearer understanding of the disease duration, symptoms, and drug use, as well as adherence to the treatment. The authors concluded that the multimedia (video) tool can help patients better understand and manage their diseases.

In 2020, Akca et al. [³¹] conducted a study on the use of a video multimedia device for patients before undergoing hysteroscopy at the office and demonstrated that showing the device reduces pre-procedural anxiety, helped them understand the procedure, and increased their satisfaction in surgical settings.

Hence, these study findings demonstrate assertive subjective, social, physical, and especially educational impacts of using multimedia material. The present research agrees with them, as its results indicate that using multimedia (video) material had a positive effect on both Dental and SLP students. This information is relevant because both areas are involved in VPD treatment, especially regarding speech/voice issues and palatal prosthesis production, fitting, and procedures.

The use of the multimedia resource possibly helped them learn about VPD because it diversified content presentation with images, videos, sounds, animation, and so forth. Thus, it provided simultaneous stimuli, different types of perception, and different forms of acquiring knowledge [⁵], as people learn and acquire content differently. Nevertheless, more incisive statements require further studies with different questionnaires administered before and after exposure to multimedia material or longer follow-ups [³²], given the risk of bias regarding the time between two occasions administering the same questionnaire – which is pointed out as a limitation of this study.

Multimedia resources present information graphically as they reproduce mechanisms or circuits as if they were real. Hence, they can draw more attention and facilitate the acquisition of academic content, in comparison with text-only theoretical media. These resources are essential to convey academic-scientific concepts because they make abstract phenomena visible - which could not be otherwise directly observed or experienced [¹⁸].

Given the successful results of using the multimedia material, verified in this study and similar ones in the literature, as shown in the above pieces of research, some aspects regarding this material should be emphasized, such as the person’s autonomy to access it, independently from other people; interactivity, as the content presentation is dynamic, interactive, and reusable in various contexts; groupable, as other material can be included to further enrich the learning environment [³³].

CONCLUSION

The multimedia material possibly increased both Dental and SLP students’ knowledge of VPD in cases of CLP and its treatment with palatal prostheses. The difference regarding such knowledge was sharper before they had access to the material (stage 1), as SLP undergraduate students had greater previous knowledge. The research findings showed that the multimedia tool can effectively help university students learn these topics.

How to cite this article

• Lima DSG, Tonocchi R, Leão BLC, Cardoso DCR, Corrêa CC, Pegoraro-Krook MI, et al., Using multimedia material: effects on the knowledge of dental and speech-language pathology undergraduate students. RGO, Rev Gaúch Odontol. 2024;72:e20240034. http://dx.doi.org/10.1590/1981-86372024003420230027

REFERENCES

• ¹ Chen CP, Chang TY, Hung FY, Chern SR, Wu PS, Chen SW, Lai ST, Chuang TY, Lee CC, Wang W. Prenatal diagnosis of an 8q22.2-q23.3 deletion associated with bilateral cleft lip and palate and intrauterine growth restriction on fetal ultrasound. Taiwan J Obstet Gynecol. 2017;56(6): 843-846. http://dx.doi.org/10.1016/j.tjog.2017.10.026
  » https://doi.org/10.1016/j.tjog.2017.10.026
• ² Rodrigues R, Fernandes MH, Monteiro AB, Furfuro R, Sequeira T, Silva CC, Manso MC. SPINA classification of cleft lip and palate: A suggestion for a complement. Arch Pediatr. 2018;25(7):439-441. http://dx.doi.org/10.1016/j.arcped.2018.08.001
  » https://doi.org/10.1016/j.arcped.2018.08.001
• ³ Almeida AMFL, Chaves SCL, Santos CML, Santana SF. Atenção à pessoa com fissura labiopalatina: proposta de modelização para avaliação de centros especializados, no Brasil. Rev Saúde Debate. 2017;41(spe): 156-166. http://dx.doi.org/https://doi.org/10.1590/0103-11042017S12
  » https://doi.org/10.1590/0103-11042017S12
• ⁴ Cardoso EF, Martelli DR, Machado RA, Coletta RD, Souza JD, Barbosa FT, et al. Nonsyndromic cleft lip and palate, gastric cancer and tooth agenesis. Med Oral Patol Oral Cir Bucal. 2018; 23(1):e44‐e48. http://dx.doi.org/10.4317/medoral.22132
  » https://doi.org/10.4317/medoral.22132
• ⁵ Matos FGOA, Santos KJJ, Baltazar MMM, Fernandes CAM, Marques AFJ, Luz MS. Perfil epidemiológico das fissuras labiopalatais de crianças atendidas em um centro de referência paranaense. Rev Enferm UFSM. 2020;10:e28. http://dx.doi.org/10.5902/2179769238654
  » https://doi.org/10.5902/2179769238654
• ⁶ Sundström E, Oren L. Sound production mechanisms of audible nasal emission during the sibilant /s/. J Acoust Soc Am. 2019;146(6):4199. http://dx.doi.org/10.1121/1.5135566
  » https://doi.org/10.1121/1.5135566
• ⁷ Vella JB, Tatum SA. Risk factors for velopharyngeal dysfunction following orthognathic surgery in the cleft population. Curr Opin Otolaryngol Head Neck Surg. 2019;27(4):317-323. http://dx.doi.org/10.1097/MOO.0000000000000553
  » https://doi.org/10.1097/MOO.0000000000000553
• ⁸ Cintra H. Disfunção velofaríngea: abordagem multidisciplinar. In: Carreirão S. Cirurgia plástica: para a formação do especialista. Rio de janeiro: Atheneu; 2018. p. 275-290.
• ⁹ Pegoraro-Krook MI, Rosa RR, Aferri HC, Andrade LKF, Dutka JCR. Pharyngeal bulb prosthesis and speech outcome in patients with cleft palate. Braz J Otorhinolaryngol. 2022;88(2):187-193. http://dx.doi.org/10.1016/j.bjorl.2020.05.028.
  » https://doi.org/10.1016/j.bjorl.2020.05.028
• ¹⁰ Marino VCC, Dutka JCR, Pegoraro-Krook MI, Lima-Gregio AM. Articulação compensatória associada à fissure de palate ou disfunção velofaríngea: revisão de literatura. Rev CEFAC. 2012;14(3):528-43.
• ¹¹ Bak SY, Oh WS, Erman A. Treatment of velopharyngeal dysfunction: a clinical report. J Prosthet Dent. 2020;123(6):888-891. http://dx.doi.org/10.1016/j.prosdent.2019.06.022
  » https://doi.org/10.1016/j.prosdent.2019.06.022
• ¹² Rizatto AJP, Lopes MWL, Souza OMV, Aferri HC, Pinto MDB, Whitaker ME, et al. Can a pharyngeal bulb prosthesis eliminate hypernasal speech in individuals with hypodynamic velopharynx? Rev CEFAC. 2022;24(6):e8422. http://dx.doi.org/10.1590/1982-0216/20222468422
  » https://doi.org/10.1590/1982-0216/20222468422
• ¹³ Paul N, Augustine C, Sharma UA, Nishant K, Jyotsna S. Intensive speech therapy programme combined with a speech bulb prosthesis in the prosthodontic rehabilitation of velopharyngeal dysfunction. Cureus. 2020;12(2):e6951. http://dx.doi.org/10.7759/cureus.6951
  » https://doi.org/10.7759/cureus.6951
• ¹⁴ Almeida BK, Ferreira GZ, Aferri HC, Marino VCC, Dutka JCR, Pegoraro-Krook MI. Passavant’s ridge during speech production with and without pharyngeal bulb. J Commun Disord. 2019;82:105939. http://dx.doi.org/10.1016/j.jcomdis.2019.105939
  » https://doi.org/10.1016/j.jcomdis.2019.105939
• ¹⁵ Akshayalingam M, Malar K, Lenapriya A. Palatopharyngeal obturator prosthesis - A substitute for a dynamic separator: A technique. J Indian Prosthodont Soc. 2022;22(2):200-204. http://dx.doi.org/10.4103/jips.jips_403_21
  » https://doi.org/10.4103/jips.jips_403_21
• ¹⁶ Lee LA, Chao YP, Huang CG, Fang JT, Wang SL, Chuang CK, et al. Cognitive style and mobile e-learning in emergent otorhinolaryngology-head and neck surgery disorders for millennial undergraduate medical students: randomized controlled trial. J Med Internet Res. 2018;20(2):e56. http://dx.doi.org/10.2196/jmir.8987
  » https://doi.org/10.2196/jmir.8987
• ¹⁷ Alencar CJF, Sequeira E, Wen CL, Haddad AE. Desenvolvimento de objetos de aprendizagem modernos em teleodontologia. Rev ABENO. 2010;10(2):5-11. http://dx.doi.org/10.30979/rev.abeno.v10i2.14
  » https://doi.org/10.30979/rev.abeno.v10i2.14
• ¹⁸ Anbu D, Robson A, Kurn O, Taylor C, Dean O, Payne D, et al. Evaluating the efficacy and optimisation of the peer-led flipped model using tel resources within neuroanatomy. Adv Exp Med Biol. 2021;1334:1-22. http://dx.doi.org/10.1007/978-3-030-76951-2_1
  » https://doi.org/10.1007/978-3-030-76951-2_1
• ¹⁹ Filantro A, Piconez SCB. Design instrucional contextualizado: planejamento, elaboração e avaliação de materiais didáticos para Educação a Distância. São Paulo: ABED; 2004.
• ²⁰ Rocha DC. Adaptação da prótese de palato: proposta de manual multimídia informativo para pais e pacientes. Trabalho de Conclusão de Curso de Residência Multiprofissional em Saúde: Síndromes e Anomalias Craniofaciais - Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo; 2014.
• ²¹ Brasil, Ministério da Educação. Portaria nº 343, de 17 de março de 2020. Dispõe sobre a substituição das aulas presenciais por aulas em meios digitais enquanto durar a situação de pandemia do Novo Coronavírus - COVID-19. Brasília: MEC; 2020 [citado 2023 Nov 10]. Disponível em: <https://www.in.gov.br/en/web/dou/-/portaria-n-343-de-17-de-marco-de-2020-248564376>
  » https://www.in.gov.br/en/web/dou/-/portaria-n-343-de-17-de-marco-de-2020-248564376
• ²² Feitosa ANA, Nascimento IMG, Alencar Neta RL, Alencar MT, Tavares MML, Assis EV. Tecnologias educacionais em tempos de pandemia: relato de experiência. Braz J Production Engin. 2020;6(6):166-172.
• ²³ Granjeiro EM, Musse JO, Peixoto TM, Nunes IV, Soares IMSC, Silva ICO, Carvalho TB, Dias YO. Estratégias de ensino à distância para a educação interprofissional em saúde frente à pandemia COVID-19. REVISA (online). 2020;9(Esp.1):591-602.
• ²⁴ Queiroz MD’OM, Muniz APS, Mól ACA. Contribuições tecnológicas para a educação durante a pandemia. In: Ações de docência durante a pandemia: Desafios e oportunidades com as novas tecnologias digitais. Rev Carioca Ciência, Tecnol Educ. 2020;5(especial):68-70.
• ²⁵ Signor RCF. Abordagem fonoaudiológica nas fissuras orofaciais não sindrômicas: revisão de literatura. Rev Ciênc Med. 2019;28(1):49-67. http://dx.doi.org/10.24220/2318-0897v28n1a4379
  » https://doi.org/10.24220/2318-0897v28n1a4379
• ²⁶ Mendes M, Silveira MM, Costa FS, Schardosim LR. Avaliação da percepção e da experiência dos cirurgiões-dentistas da rede municipal de Pelotas/RS no atendimento aos portadores de fissuras labiopalatais. RFO. 2012;17(2):196-200. http://dx.doi.org/10.5335/rfo.v17i2.2886
  » https://doi.org/10.5335/rfo.v17i2.2886
• ²⁷ Polzin ACZ. Material didático para capacitação de fonoaudiólogos no tratamento das alterações de fala na disfunção velofaríngea [dissertação]. Bauru: Faculdade de Odontologia de Bauru; 2017.
• ²⁸ Campoverde PXA. Material didático multimídia sobre o tratamento da disfunção velofaríngea por meio de obturador faríngeo [dissertação]. Bauru: Faculdade de Odontologia de Bauru; 2017.
• ²⁹ Galvão ECF, Puschel VAA. Aplicativo multimídia em plataforma móvel para o ensino da mensuração da pressão venosa central. Rev Esc Enferm USP.2012;46(spe):107-115. http://dx.doi.org/10.1590/S0080-62342012000700016
  » https://doi.org/10.1590/S0080-62342012000700016
• ³⁰ Lopez-Olivo MA, Ingleshwar A, Volk RJ, Jibaja-Weiss M, Barbo A, Saag K, et al. Development and pilot testing of multimedia patient education tools for patients with knee osteoarthritis, osteoporosis, and rheumatoid arthritis. Arthritis Care Res (Hoboken). 2018;70(2):213-220. http://dx.doi.org/10.1002/acr.23271
  » https://doi.org/10.1002/acr.23271
• ³¹ Akca A, Yilmaz G, Esmer AC, Yuksel S, Koroglu N, Cetin BA. Use of video-based multimedia information to reduce anxiety before office hysteroscopy. Wideochir Inne Tech Maloinwazyjne. 2020;15(2):329-336. http://dx.doi.org/10.5114/wiitm.2019.89378
  » https://doi.org/10.5114/wiitm.2019.89378
• ³² Chu TL, Wang J, Lin HL, Lee HF, Lin CT, Chieh LY, Sung YS, Lin YE. Multimedia-assisted instruction on pain assessment learning of new nurses: a quasi-experimental study. BMC Med Educ. 2019;19(1):68. http://dx.doi.org/10.1186/s12909-019-1496-z
  » https://doi.org/10.1186/s12909-019-1496-z
• ³³ Barteit S, Jahn A, Bowa A, Lüders S, Malunga G, Marimo C, et al. How self-directed e-learning contributes to training for medical licentiate practitioners in Zambia: evaluation of the pilot phase of a mixed-methods study. JMIR Med Educ. 2018;4(2):e10222. http://dx.doi.org/10.2196/10222
  » https://doi.org/10.2196/10222

Edited by

• Assistant editor: Luciana Butini Oliveira

Publication Dates

• Publication in this collection
  21 Oct 2024
• Date of issue
  2024

History

• Received
  01 June 2023
• Reviewed
  29 Aug 2023
• Accepted
  27 June 2024