à expressão facial, compreensão e velocidade de fala, uso de pausas e qualidade de voz. S2 descreveu as mudanças de maneira positiva para os aspect...

à expressão facial, compreensão e velocidade de fala, uso de pausas e qualidade de voz. S2 descreveu as mudanças de maneira positiva para os aspectos: postura corporal, movimentos de cabeça, expressão facial, compreensão e velocidade de fala, uso de pausas e ênfases, intensidade e qualidade de voz. Para os parentes dos sujeitos, os aspectos mais apontados foram: expressão facial, compreensão de fala e qualidade de voz. Os fonoaudiólogos fizeram uma avaliação mais técnica da comunicação verbal, pois perceberam a marcação de ênfases por pausas e variação da loudness, bem como associaram maior melodia de fala com melhora na qualidade de voz, embora tenham feito pouca menção à comunicação não verbal. Os juízes leigos observaram mais o corpo dos sujeitos ao perceberem diferenças principalmente nos gestos e expressão facial, além da melhora na compreensão de fala e qualidade de voz. Conclusão: a comunicação verbal, tão valorizada na clínica fonoaudiológica, em laringectomizados totais com FT, recebeu maior destaque do que a não-verbal na percepção de todos juízes. As fonoaudiólogas mostraram-se mais detalhistas em identificar mudanças na comunicação verbal e os juízes leigos observaram a comunicação de forma mais global. Isso evidencia que a clínica fonoaudiológica pode transcender a voz e valorizar o trabalho com expressividade na reabilitação desses indivíduos. Palavras-Chave: laringectomia, comunicação, inteligibilidade de fala viii ABSTRACT

Introduction: Tracheoesophageal speech obtained by means of a tracheoesophageal prosthesis has limitations, represented by its restricted melodic variation and intensity. Thus, there is interference in the communicative efficiency of these individuals. The speech therapist in the context of total laryngectomy has focused his/her work more in the direction of phonation. Frequently, by giving more attention to the voice, the therapist forgets the other aspects of verbal (speed of speech, emphasis, pause and inflection, among others) and non-verbal (posture, gestures and facial expression) communication. Aim: to analyze expressiveness before and after completing a phonoaudiological intervention program, in two individuals with tracheoesophageal speech. Method: two subjects (S1 and S2) with tracheoesophageal speech participated in a phonoaudiological program with focus on expressiveness, conducted in four meetings of two hours each. Two video recordings were made (one pre- and one post-intervention). Ten judges participated in the judgment of each subject’s communication (the subject him/herself, three relatives, three phonoaudiologists experienced in attending oncologic patients, and three individuals from the population not familiar with tracheoesophageal speech. The judges were asked whether the communicative performance (in the two video recordings) was equal or different. If they perceived differences, they should justify their reply, identifying which aspect had changed, according to a pre-established evaluation script, with aspects of verbal and non-verbal communication. Results: In the opinion of S1, there were changes as regards facial expression, understanding and speed of speech, use of pauses and voice quality. S2 described the changes in a positive manner for the other aspects: bodily posture; head movements; facial expression, understanding and speed of speech, use of pauses and emphasis; voice intensity and quality. For the subjects’ relatives, the aspects most pointed out were: facial expression, understanding the speech and voice quality. The speech therapist made a more technical assessment of the verbal communication such as marking emphasis by pauses and variation in loudness, and they also associated more melodious speech with improvement in voice quality, although they made little mention of the non-verbal communication. The lay judges took more notice of the body when they perceived differences particularly in the gestures and facial expression, in addition to