Cibelle Albuquerque de la Higuera Amato

Fonoaudiologia e Núcleos de Apoio à Saúde da Família: conceitos e referências

ABSTRACT In order to provide subsidies to the analysis of the speech-language and hearing pathologist work in Primary Care, specifically in the Nucleus of Support for Family Health (NASF), this study conducted a literature review on the subject using the search tools of Medline, SciELO and LILACS, through the simultaneous advanced database search of the Virtual Health Library – Bireme. The study briefly recovered the history of Speech-Language and Hearing Pathology on the Brazilian’s national health system (Unified Health System – SUS), and emphasized the importance of the Family Health Strategy related to Speech-Language and Hearing Pathology services in the NASFs. The literature review indicates that the performance of Speech-Language and Hearing Pathology within the health system is quite extensive, spanning different levels of assistance, which requires the development of different technologies of health work. Actions developed by NASFs necessarily require the performance of interdisciplinary teams, involved in interdisciplinary work processes and in the creation/invention of therapeutic strategies. The analysis of Speech-Language and Hearing Pathology’s experiences in Primary Health Care, in Family Health Care and, more recently, in NASFs, deserves to be closely monitored and evaluated, so the production and systematization of health care practices can advance to attend the population needs, and can be able to face the serious effects of language, voice, oral motor and hearing disorders. Thus, it is necessary to monitor and to systematize the limits and potentials of this model, aiming its improvement and ownership as a strategy for the integration of Speech-Language and Hearing Pathology in the SUS.

A systematic review of the use of telehealth in speech, language and hearing sciences

Introduction We conducted a systematic literature review to investigate the domain of speech-language and hearing sciences (SLHS) in telehealth. Methods The databases used for the literature search were Web of Knowledge, Pubmed, Scopus, Embase and Scielo. The inclusion criteria consisted of papers published up to August 2014. Papers without peer-review evaluation, and those without abstracts or available full texts were excluded. Results A total of 103 papers were selected. The selected studies have focused primarily on hearing (32.1%), followed by speech (19.4%), language (16.5%), voice (8.7%), swallowing (5.8%), multiple areas (13.6%) and others (3.9%). The majority of the studies focused on assessment (36.9%) or intervention (36.9%). The use of telehealth in SLHS has been increasing in many countries, especially in the last 5 years. The country with the largest number of published studies was the United States of America (32.03%), followed by Australia (29.12%). The remaining studies were distributed in lower numbers among other countries. Discussion The advancement of information and communication technologies provides more favourable conditions for providing distance care in several areas. Most of studies concluded that the telehealth procedure had advantages over the non-telehealth alternative approach (85.5%); however, 13.6% reported that it was unclear whether the telehealth procedure had advantages. Some barriers still need to be overcome, such as technology, training, regulation, acceptance and recognition of the benefits of this practice by the public and professionals. The need for speech-language pathologists and audiologists to adapt to this new health care modality is evident.

Orientação a mães de crianças do espectro autístico a respeito da comunicação e linguagem

Purpose: To verify the results obtained by ten sessions of specific instruction about language and communi cation to mothers of children of the autistic spectrum. Methods: Subjects were 26 mother-child dyads. The children attended language therapy in a specialized service. Five pre-planned instruction sessions and five accompanying sessions to small groups of mothers parallel to the children’s language therapy were conducted. Results: The focus directed to the child’s communication allowed the identification of essential elements to the determination of successful interactive situation as joint attention, latency to answers and child’s individual interests. The individualized analysis has shown that all subjects presented progress at least in one of the assessed areas. Conclusion: There was a positive impact of the systematic orientations to mothers about language and communication, conducted at the same time as language therapy (and not alternatively). The formal planning and recording were flexible enough to allow adjustments to group specific needs and demands.

O uso interativo da comunicação em crianças autistas verbais e não verbais

Background: communication of autistic children. Aim: to assess the communication functionality of verbal and non-verbal children of the autistic spectrum and to identify possible associations amongst the groups. Method: subjects were 20 children of the autistic spectrum divided into two groups: V with 10 verbal children and NV with 10 non-verbal children with ages varying between 2y10m and 10y6m. All subjects were video recorded during 30 minutes of spontaneous interaction with their mothers. The samples were analyzed according to the functional communicative profile and comparisons within and between groups were conducted. Results: data referring to the occupation of communicative space suggest that there is an even balance between each child and his mother. The number of communicative acts per minute shows a clear difference between verbal and non-verbal children. Both verbal and non-verbal children use mostly the gestual communicative mean in their interactions. Data about the use of interpersonal communicative functions point out to the autistic childrens great interactive impairment. Conclusion: the characterization of the functional communicative profile proposed in this study confirmed the autistic childrens difficulties with interpersonal communication and that these difficulties do not depend on the preferred communicative mean.

Comparação dos instrumentos Childhood Autism Rating Scale e Autism Behavior Checklist na identificação e caracterização de indivíduos com distúrbios do espectro autístico

PURPOSE: To compare the results obtained in the Autism Behavior Checklist with those obtained in the Childhood Autism Rating Scale to identify and characterize children with Autism Spectrum Disorders. METHODS: Participants were 28 children with psychiatric diagnosis within the autism spectrum that were enrolled in language therapy in a specialized service. These children were assessed according to the Autism Behavior Checklist and Childhood Autism Rating Scale criteria, based on information obtained with parents and therapists, respectively. Data were statistically analyzed regarding the agreement between responses. Results indicating high or moderate probability of autism in the Autism Behavior Checklist were considered concordant with the results indicating mild-to-moderate or severe autism in the Childhood Autism Rating Scale. Results indicating low probability of autism in the Autism Behavior Checklist and without autism in the Childhood Autism Rating Scale were also considered concordant. RESULTS: There was agreement on most of the responses. Cases in which there was disagreement between results obtained on both protocols corroborate literature data, showing that the instruments may not be sufficient, if applied alone, to define the diagnosis. CONCLUSION: The Childhood Autism Rating Scale may not effectively diagnose autistic children, while the Autism Behavior Checklist may result in over- diagnose, including within the autism spectrum children with other disorders. Therefore, the associated use of both protocols is recommended.

Aspectos funcionais da comunicação: estudo longitudinal dos primeiros três anos de vida

The aim of this multiple case-study is to present issues to the analysis and discussion of communicative development since the pre-verbal period. The case presentation starts with the description of the analyzed sample followed by the synthesis of data regarding the pragmatic aspects of six subjects, from the 1st to the 36th month of life. Data regarding the number of communicative acts expressed per minute, occupation of the communicative space, proportion of use of the communicative means and the communications interaction proportion are included. The individualized analysis of the number of communicative acts produced per minute in each sample shows an increasing tendency that is almost constant, but also frequent individual variations. The occupation of the communicative space has shown larger and more constant variations that, nevertheless, continue to evidence evolution. The longitudinal follow-up allowed the observation of the proportion of the use of the verbal communicative mean and its essential role in the childs communication from the 21st month on. Since the 30th month the verbal mean is the more frequent but the gestural mean is still responsible for an important part of the communication initiated by the child. In what refer to the communications interactivity, data show that the infant seek the interactivity since birth and that with age improve the quality and quantity of his/her communications abilities.

Fatores intervenientes na terapia fonoaudiológica de crianças autistas

Recent studies state that the incidence of autism spectrum disorders is 1% of the infantile population. It implies the need of urgent identification of efficient intervention proposals as well as of the factors that may intervene in these processes. The aim of this study is to describe three years of language therapy processes of three children diagnosed within the autism spectrum with different developmental characteristics and different responses to the therapeutic process. All the children were attending a specialized ambulatory program once a week. The language therapists were post-graduate students in the field and the therapeutic intervention started approximately six months prior to the beginning of the study. The children presented evidence of the diversity of the autism phenotype. Although it was not the purpose of this study, the reference to the three different features of the autism spectrum is clear. This way, the intervention processes received subtle adjustments to each childs specific needs and possibilities. All children had significant progress in their manifestations. The longitudinal individual analysis of therapeutic intervention processes allows the identification of associate process that might be determinant to the results and that demand consistent approaches.

Speech-Language Intervention for Children with Autism Spectrum Disorder in Brazil.

Brazil has more than 200 million inhabitants living in an area of more than 8.5 million km2 (Ministério da Saúde, Brasil, 2013a,b). Granting access to health and educational services for populations in such different environments clearly demands different actions and resources. Official policies regarding rehabilitation services and education to children and adolescents with autism spectrum disorders (ASDs) are being gradually defined and implemented. This article aims to present an overview of the Brazilian health system that considers health as a universal right and a states duty. Some of the strategies created to provide services to persons with different needs living in different environments are outlined. Specifically in what refers to persons with ASD, there are laws, bills of rights, and guidelines, but their implementation is gradual and uneven. More developed regions provide more comprehensive support to these persons and their families, but some initiatives of outreach are being implemented. Speech–language pathology services are integrated to the health system and present their own challenges. Undergraduate programs for speech–language pathology include ASD as part of the mandatory training, and there are postgraduate studies in the field. Some challenges are being met by several initiatives by different groups as parents, scientific associations, and universities. Issues such as tests and protocols that can be used to Portuguese-speaking children and the identification of efficient methods that can be applied in different situations and orientation to parents and families have been object of research for some decades. There are still many challenges that must be addressed to provide adequate health and educational services to children with ASD and their families in Brazil.

Análise de Comportamento Aplicada e Distúrbios do Espectro do Autismo: revisão de literatura

OBJETIVO: Realizar uma revisao sistematica da literatura envolvendo as propostas de terapia baseada na analise de comportamento aplicada (ABA) dirigida a pessoas portadoras de disturbios do espectro do autismo (DEA), contribuindo, dessa forma, para uma pratica efetivamente baseada em evidencias. ESTRATEGIA DE PESQUISA: As bases de dados Web of Science, Medline, SciELO e Lilacs foram consultadas para o levantamento das referencias bibliograficas publicadas nos ultimos cinco anos. CRITERIOS DE SELECAO: Foram selecionados os artigos publicados em periodicos com revisao por pares. Foram utilizados como criterios de exclusao o idioma, o tipo de artigo, o tema e os artigos repetidos. Essa selecao resultou em 52 artigos, que foram analisados na integra. ANALISE DOS DADOS: Foram consideradas as informacoes referentes a autor, periodico e data; titulo; tema e abordagem; casuistica; criterios de inclusao e exclusao e conclusoes. RESULTADOS: Os artigos abordam processos de intervencao, revisoes de literatura, formacao profissional e a contribuicao dos pais no processo de intervencao. Apenas quatro artigos relatam a contribuicao dos pais na aplicacao dos principios da ABA no ambiente domestico. Os estudos sobre formacao profissional enfatizam a valorizacao da formacao especializada. A maioria das revisoes de literatura conclui que os processos de intervencao sao controversos, caros e dependentes de fatores externos. Embora artigos que relatam processos de intervencao envolvam 663 participantes, nao e possivel a realizacao de meta-analise devido a ausencia de criterios de inclusao e caracterizacao comparaveis. CONCLUSAO: Nao ha evidencia suficiente para corroborar a preponderância da ABA sobre outras alternativas.

Serving the Underserved: Language Intervention to Children with Disorders of the Autism Spectrum in Brazil

Language disorders are considered part of the symptoms of the autism spectrum disorders (ASD) since the first descriptions by Kanner. Providing language therapy services to children with ASD is a challenge in countries such as Brazil, where besides geographic and social-cultural diversity there is a lack of enough professionals with adequate training. Therefore university-related services have a fundamental role in filling this gap. This presentation will describe the various initiatives by such a service is Sao Paulo, one of the worlds largest metropolitan areas. This specialized service provides language assessment, diagnosis and weekly therapy to children with ASD since 1986. During this period ASDs complexity became clear and demanded the inclusion of other activities such as: multiprofessional colaboration; interdisciplinary research; out-reaching and mentoring of teachers with children and adolescents with ASD in their classes; systematic meetings with parents; use of tele-health resources to increase the number of services provided to this population; editing and distribution of brochures to improve the awareness about ASD and development of assessment tools adapted to the Brazilian reality. These initiatives were conducted whithin the context of scientific research, therefore providing elements to evidence-based-practice. Many of the researches were associated to 37 Master and Doctorate projetcs and were published in scientific journals (115 papers). Also, during this period many professionals had their specialized training and are now teaching in other universities. Today 80 children and adolescents attend to weekly language therapy sessions and 12 undergraduate, 8 graduate students, 3 post-doctorate and 2 researches comprise the team.