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Belgium
Marc Remacle, Yvoir
Professional state
. independent specialty of its own standing no
. official subspecialty to ENT yes
. official subspecialty to others no
. voice- speech - language - hearing, all included in audio-phoniatrics
. number of university departments related to phoniatrics : 8
. number of doctors working in the field : 15-20 full time
. relevant web sites for links none
Education and training
. program and examination for specialization
ORL training presently 5 years.
Phoniatrics not presently inluded.
Probably, according UEMS, duration will be extended to 6 years.
According to the residents choice, a 1-year training in phoniatics
will be offered. The residents are submitted to 2 controls,
one after 2 years and one after 5 years. If they succeed,
a certificate from the university is delivered.
Professional competence is delivered by a board (commission) in the
framework of the national healthcare ministry. Representatives of the
Universities and of the professional societies are included in this board.
There is a board for the Flemish part and a board for the French-speaking part (as usual in Belgium!).
Presently, any ENT-specialist interested in phoniatrics can consider
himself as a phoniatrician. But a 2-years program included in the 6-years ENT-training will probably be available, as a 2-years training in Head & Neck surgery or oto-neurosurgery... and a certificate with related exclusive competences should be delivered.
This special 2-years training will included all the topics , from the language to the swallowing disorders.
. postgraduate programs
Presently there are no well-structured postgraduate programs.
Details
Société Scientifique et Union Professionnelle belge d’Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale
Commission d’Audio-Phoniatrie
Belgische Wetenschapelijke en Beroepsvereniging voor Oto-Rhino-Laryngologie Gelaats- en Halschirurgie
Commissie voor Audio-Foniatrie
SPEECH and LANGUAGE
A. TRUNCUS COMMUNIS
I. Anatomy
Bucco-pharyngeal pavilion and other cavity.
the mandible;
the pharynx;
the soft palate;
the mouth;
the nasal cavity;
the sinusal cavities.
Muscles of articulation
muscles of the Pharynx
the palatine muscles
muscles of the Mouth
muscles of the Jaw
muscles of the Tongue
fascials muscles .
Neuroanatomy
Cortical area
The reticular formation
The basal ganglia
II. Neurophysiology and physiopathology
Speech
elementary mouvments of the structures making up the
bucco-pharyngeal pavilion phonies and phonetics productions
points of articulation
functionnal modality of the points of articulation;
production of speech
temporal and frequential aspects of the speech the speech segments:
phoneme diphone et polysounds
prosodia
delivery (le débit)
accentuation
melody
articulation and intrinsic quality of the sound
variability of the speech signal
regulation of speech
influence of the hearing on voice and speech
voice and speech regulation
Language
Adults
Functionnal neurocognitives pathways
Brain and Language
Input and output pathways
secondary associative cortex
tertiary associative cortex
role of the mesiales and sub cortical structures in language
gradients of hemispheric dominance
Children
Anatomo-functionnal cerebral development and language
Morphogenesis : cytogenesis and cellular migration
Hodogenesis
Development of the hemispheric dominance for language
Maturation of mecanic constituants of the phono-articulatory
system (speech)
Breathing
Voice
Articulation
Learning and neuro-imprinting
Cerebral Plasticity
functional plasticity
Phenomenon of nervous supplenting when experimental and
pathological neurosensorial deprivation
Consequences of early hemispheric lesions
III. Neuropsychology
IV. Basic science of linguistic and communication
Psycholinguistic models
linguistic model - cognitive model - interaction model
Language emergence
precursors of language
selectif attention and categorical perception of the signs of speech
auditive perception of the signs of speech
prelinguistic stages
Development of linguistic systems
phonological system
lexical system
morphosyntatic system
pragmatic capacities
metalinguistic capacities
V. Diagnostic assesment
Medical examination
Audiological diagnostic
Neurophysiological examination
Radiological examination
Speech therapist examination
Exploration of oral language
Evaluation of scholastic learning
Neuropsychological evaluation
psychophysiological examination of the functional
hmispheric lateralisation for language
Evaluation of behavior
VI. Disorders and dysfunctions
A. Classification
Deficiency of the basic instruments
anatomical deficiency = dysglossia
sensory auditory deficiency = deafness hearinglos
disturbance of the command and the controle of the
bucco-pharyngeal motricity = dysarthria
Neurolinguistic disorders
pathology of oral language
gnostic deficits
praxical deficits
linguistic deficits
sycholinguistic deficits
pathology of written language
Stuttering
Language disorders due to psychopathology and deficiency
deficiency states
communication disorders
B. Specific syndromes
A. Children
Deafness and hearingloss
Early lesions syndroms, I.M.C.
Pseudobulbaires syndromes
Bucco-facial apraxia
Moebius syndrom
developmental dysphasia
Stuttering
Articulation disorders
Rhinolalia
Dyslalia
Dysarthria
Chilhood aphasia
Specific learning disorders
of reading = dyslexia
of writing = dysorthographia
of calculation = dyscalculia
Attention deficit and hyperreactivity
Language and mental impairment
Communication disorders in infantile autism
Affective disorders and language pathology
B. Adults
Deafness and hearingloss
Disorders of oral language
Articulation disorders
Rhinolalia
Aperta
Velum insufciency( postoperative or posttraumatic)
Paresia or isolated paralysis of the velum
Amyotrophic lateral sclerosis
Myopathy Myasthenia
Clausa
Obstructive pathology of the nose
Velo-palatal synechia
Tumor of the rhino -pharynx
Spastic neurological affection of the soft palate
Dyslalia
palatal vault anomalies
pharynx anomalies
tongue anomalies
lips anomalies
facial anomalies
Dysarthria
Cerebral motoric impairment
Progressive primitive myopathy
Amyotrophic lateral sclerosis
Familial hereditary ataxia =Friedreich syndrom
Multiple sclerosis
Parkinson’s disease
Post-encephalitic Parkinson syndrom
Wilson disease
Pseudo-bulbaire paralysis
General paralysis = Bayle disease
Stuttering
Pseudostuttering
Amyotrophic lateral sclerosis
Familial hereditary ataxia =Friedreich syndrom
Multiple sclerosis
Parkinson’s disease
Sydenham’s chorea (between 5-15 of age before disappearing )
Huntington’s chorea
Wilson disease
Pseudo-bulbaire paralysis
Epilepsy
Aphasie sequelae
Cranial trauma
Psychical trauma
Sputtering
Aphasia
Wernicke’s aphasia( sensory predominance)
Broca’s aphasia (motor predominance)
Aphasia dissociate
Pure anarthria
Pure agraphia
Pure verbal deafness
Pure verbal blindness or pure alexia
Dementia
Written language disorders
Dyslexia
Alexia
Dysorthographia
Agraphia
Dysgraphia
Dyscalculation
VII. Professional
VIII. Expertise
IX. Treatment
Medical aspects
Medication
Surgery to improve the speech cavity
adeno-tonsillectomy some time partial incomplete
Cleft palate surgery
Pharyngoplastic surgery
Frenulotomy
Medical or surgical treatment concerning deafness
or hearingloss Prosthesis
Orthodontia
Speechtherapy
articulation training
languagetherapy
Pedagogic-psychological treatment
Behaviortherapy
B. REFERENCES
-Decision making in speech-langage pathology. 1988. D. E. Yoder, R.D. Kent. B.C. Decker Inc.Toronto Philadelphia. 210 pp.
-Introduction to communication sciences and disorders. F.D. Minifie, 1995. Singular Publishing Group San Diego, U.S.A. 708 pp.
-Le Langage de l’enfant C. Chevrier-Muller, J. Narbona 1996. Masson, Paris 427 pp.
-Handbook of speech-language pathology and audiology N.J. Lass, L.V. Macreynolds, J.L. Northern, D.E. Yoder, B.C. Decker Inc. Toronto Philadelphia. 1988 1399pp.
SWALLOWING DISORDERS
A. TRUNCUS COMMUNIS
I. Anatomy
II. Neurophysiology and physiopathology
normal movements of swallowing
anatomy functional development
development of sucking-swallowing mechanism of new-born
and young child anatomical and physiological changes
from suckling to adult
influence of position or food consistency or ... on normal
swallowing physiology
III. Neuropsychology
IV. Diagnostic assessment
Anamnesis
Medical examination
Mirror
Flexible nasal endoscopy
Study of sensomotoric functions palato-pharyngeal
functions laryngeal functions
Radiological examination
Classical
Videofluoroscopy
Ultrasonography
Scintigraphy
Ph-measurement
Manometry
Oesophagoscopy
Electromyography
* Speech therapist examination
* Neuropsychological evaluation
VI. Disorders and dysfunctions
A.Children
Congenital or acquired pathology with consequence
of swallowing disorders deficiency of the basic instruments
cleft palate
cranio-facial malformations
obstructions
Gastro pharyngeal disorders (reflux...)
Neuromotoric disorders
Cardiopulmonary disorders
Sensory disorders
Behavior disorders |