Carla Ciceri Cesa

Novas perspectivas em comunicação suplementar e/ou alternativa a partir da análise de periódicos internacionais

TEMA: A Comunicacao Suplementar e/ou Alternativa (CSA) e uma area do conhecimento da pratica clinica, educacional e de pesquisa que favorece a qualidade de vida de seus usuarios e familiares. OBJETIVO: propor diretrizes de intervencao e pesquisa na area de CSA a partir da identificacao e sintese descritiva de artigos publicados em periodicos indexados em bases de dados eletronicas internacionais, quanto a tematica comunicacao suplementar e/ou alternativa, abrangendo pesquisas experimentais, relatos de atendimento individual e/ou em grupo, estudos de casos que incluissem sujeitos com paralisia cerebral ou com problemas neurologicos nao definidos e/ou com retardo mental. CONCLUSAO: A individualizacao das praticas quanto ao design, relevância e velocidade do processamento da informacao e o processo de inclusao da familia e demais parceiros conversacionais sao fundamentais ao sucesso na intervencao, generalizacao e manutencao de uso da prancha de comunicacao suplementar e/ou alternativa em contextos formais e informais. A prescricao individualizada dos recursos da area de CSA conforme caracteristicas fisicas, mentais, psiquicas, cognitivas e linguisticas do usuario tem impacto positivo na sua qualidade de vida e na de seus familiares. Portanto, recomenda-se a introducao o mais breve possivel dos recursos terapeuticos da area da comunicacao suplementar e/ou alternativa para sujeitos com oralidade restrita e/ou ausente.

Dialogismo e comunicação aumentativa alternativa em um caso

TEMA: a evolucao linguistica de um sujeito com sindrome nao esclarecida, caracterizada por prejuizos motores e ausencia de fala, a partir da introducao do recurso da prancha de Comunicacao Aumentativa Alternativa (CAA). PROCEDIMENTOS: realizou-se um estudo de caso de um sujeito, que no inicio da pesquisa tinha 6 anos e 8 meses. O periodo estudado compreendeu agosto de 2007 a dezembro de 2008. Este sujeito ja se encontrava em atendimento fonoaudiologico desde 2002, com queixa de escape de saliva e ausencia de fala, apresentando poucas evolucoes fonoaudiologicas, no que se refere a oralidade. Durante o periodo estudado, a intervencao fonoaudiologica preconizou a introducao da prancha de CAA em um funcionamento dialogico que incluiu a familia e a escola. Foram realizadas avaliacoes observacionais por meio do PROC antes e apos o periodo estudado. RESULTADOS: a evolucao do menino foi positiva tanto em relacao a compreensao, quanto expressao linguistica. O uso da CAA favoreceu o surgimento da fala. Tanto na familia quanto na escola, foi possivel perceber boa incorporacao do uso desse recurso considerando a perspectiva teorica em que foi introduzido. CONCLUSAO: a CAA, em uma perspectiva dialogica, apresentou-se com boa generalizacao de uso, o que permitiu avancos linguisticos no caso estudado.

Comunicação aumentativa e alternativa: panorama dos periódicos brasileiros

Clinical practices and education in Augmentative and Alternative Communication have expanded in Brazil. The purpose of this study is to identify the areas of Brazilian knowledge that search the Augmentative and Alternative Communication and their contributions. Among Speech, Language and Hearing Sciences, Physical Therapy Specialty, Occupational Therapy, Psychology and Education areas that investigate the CAA, Speech, Language and Hearing Sciences is the most expressive in publishing. Despite being an area under consolidation in Brazil, there is an increase in the inclusion of studies focusing on adults and elderly, as well as the family as an object of analysis. The early implementation in different contexts contributes to the maintenance of the use of CAA. This is a support for speaking, understanding, assisted assessment, reading and writing. Investigative practices that address the effects produced by the intervention on quality of life of people with disabilities are suggested as well as larger samples of that.

Intersubjetividade mãe-filho na experiência com comunicação ampliada e alternativa

PURPOSE: to analyze the maternal perception on the introduction and use of alternative and augmentative communication boards in cerebral palsy language clinic. METHODS: semi-structured interviews were conducted and used to created analysis categories based on three guiding aspects: a) the constitution of maternal function and its execution with individuals with cerebral palsy; b) dialogic interaction under Bakhtinian perspective; and c) the effects of language clinic on the maternal role and on the dialogue between mothers and their children. RESULTS: the results indicate different types of resource usage in the mother-child dyad, which are related to the quality of the maternal role and to the form of presenting the resource to users and their family. When the conception of language with which the resource is implemented does not include the family or consider the exercise of maternal role, the results in its generalization and maintenance are precarious. In cases where there was a debate on family use of the communication board, favoring the process of intersubjectivity between subjects without orality and their family, use and generalization were increased. CONCLUSIONS: it may be concluded that Bakhtin conception on dialogic language crossed by psychoanalysis allows for a more efficacious approach as for the probed communicative device.

Avaliação da capacidade funcional de crianças com paralisia cerebral

Purpose to describe the functional capacity of children with cerebral palsy who performed the care of Physical Therapy Specialty and Speech, Language and Hearing Sciences. Methods a cross sectional observational study, comprising 14 children with spastic quadriplegic (6 performed Physiotherapy and 8 performed Physiotherapy and Speech therapy). The Pediatric Evaluation of Disability Inventory (PEDI) and the Manual Abilities Classification System (GMFCS) were used to evaluate them. The associations between categorical variables were analyzed using Fisher exact test. Comparisons between means were performed using the Student t test. Results we didn’t obtain statistically significant improvement in the areas of self-care, mobility and social function between the two groups in the fields of functional skills and caregiver assistance. Conclusion the Physiotherapy group of children had higher functional scores than those in the Physiotherapy group associated with Speech Therapy, but there was no statistically significant difference between the groups. This was probably due to the small number of participants, the diversity of clinical presentation and possible differences of Physical Therapy intervention conducted in two states with very different socioeconomic situations.

Proposta de um protocolo de análise conversacional de comunicação suplementar e alternativa

Purpose: to propose an assessment of communication that includes the conversational analysis of children who have cerebral palsy, with complex communication needs and their interlocutors. Methods: a propositional study type of a speech language and hearing science assessment tool whose methodological flowchart was divided into five phases. Results: the final version of the protocol consisted of fifty-four items divided into three parts: (a) communicative means, acts of speech, topic maintenance and dialogue turn-taking, common to the dyads; (b) acts of child speech, use of resource, thematic maintenance and dialogue turn-taking and (c) speaker speech acts, encouragement of the use of the communication resource, theme maintenance and dialogue turn-taking. All assessment items receive a score by the assessment record according to presented linguistic behavior. Conclusion: this study showed the development and creation of a conversation evaluation protocol for children with cerebral palsy and their interlocutors. It can be used to evaluate the means, the communicative acts and adjacent-pairs observed in conversational contexts, leading the initial clinical speech language and hearing assessment process to the introduction, maintenance and general use of the Augmentative and Alternative Communication with different interlocutors and environments.

Augmentative and alternative communication: from qualification to speech, language and hearing science clinical practice

Mailing adress: Carla Ciceri Cesa Avenida Dom Cláudio José Gonçalves Ponce de Leon, 140 ap. 203, torre 2 Coimbra Vila Ipiranga, Porto Alegre, Rio Grande do Sul, Brasil CEP: 91370-170 E-mail: carlacesafga@yahoo.com.br ABSTRACT Purpose: to investigate the qualification of the speech language and hearing therapists and their clinical performance with Augmentative and Alternative Communication. Methods: a descriptive, transversal, individual and contemporary study. Data were collected through a questionnaire, filled by twenty-four speech therapists, selected by a convenience sample. Content analysis was chosen for data study. Results: regarding access to the information media, all speech therapists in the sample presented the initiative to supply the absence of language training with Augmentative and Alternative Communication by different means. Regarding the dual focus on intervention, all speech therapists were favorable to this practice. However, according to experience, they reported resistance from the family, school and other therapists. The results showed two different types of introduction implementation and use of Augmentative and Alternative Communication, predominantly formed by strategies contemplating the pragmatic use of language through the contextualization of significant activities for the user. The other way used the Picture Exchange Communication System. Conclusion: the speech-language and hearing therapists in the present study inserted different interlocutors in the intervention, guided by implicit or explicit linguistic principles, by theoretical frameworks specific to the area of Augmentative and Alternative Communication knowledge, by global neuromotor elements and, finally, by principles of functionality and general wellness.

Conhecimento dos profissionais da área da saúde acerca da comunicação suplementar e alternativa em instituições de longa permanência para idosos

Purpose: to analyze the knowledge of professionals that work in the long-term care institutions for the elderly about Augmentative and Alternative Communication. Methods: across-sectional and contemporary study was conducted. The sample was composed by active healthcare professionals of long-term care institutions for the elderly, accredited by the Conselho Municipal do Idoso in the city of Caxias do Sul - Rio Grande do Sul. A 14 objective and multiple choice questions questionnaire, including personal, academic, practice and knowledge with Augmentative and Alternative Communication was administered. The variables were described by absolute and relative frequencies and to cross variables with the professionals knowledge on the Augmentative and Alternative Communication acting in the long term care institutions for the elderly, the qui-square Pearson method or the Fisher method were used (when at least one of the categories had less than 5 participants). In the case of polytomous variables, the residual adjustment test was used to complement these analyses and identify the association between the categories. The significance level adopted was 5% (p≤0,05). Results: from the 60 professionals recruited, 40 had knowledge of Augmentative and Alternative Communication and 20 did not. There was a statistical significant association for the formation variables (p=0,02), the presence of individuals with difficulties of comprehension in the acting institution (p=0,01) and the presence of individuals users of Augmentative and Alternative Communication in their acting institution (p=0,04). Conclusion: the majority of professionals that work in long term care institutions for the elderly have knowledge of Augmentative and Alternative Communication.