Ida Lichtig

The concept of disability

Algumas dificuldades da pesquisa e da pratica na area da deficiencia estao relacionadas a imprecisao dos conceitos, que acarreta problemas na aplicacao e na utilizacao do conhecimento produzido em diversos paises. Sao discutidos os conceitos de deficiencia, incapacidade e desvantagem, tomando como ponto de partida o documento do Secretariado Nacional de Reabilitacao da Organizacao Mundial da Saude e fazendo uma analise de publicacoes recentes sobre esse tema. Leituras e discussoes dessas publicacoes possibilitaram seu agrupamento com referencia a: a) conceituacao; b) ampliacao de conceitos; c) questoes relativas a terminologia; d) modelos teoricos e suas implicacoes. Foram tambem analisados as divergencias, convergencias e o alcance dos textos referidos, reafirmando a importância da terminologia utilizada na area da deficiencia para favorecer a proximidade entre as pessoas e a comunicacao entre os especialistas.

The use of non-specialist personnel in providing a service for children disabled by hearing impairment

PURPOSE This paper addresses the issue of how to provide health services for hearing-impaired children in the developed world. Most children live in developing countries, with no access to audiological or therapy services. METHOD The paper reviews the prevalence of hearing impairment in developing countries and stresses the need to examine the details not only of the hearing impairment but also of the disabling consequences of hearing loss, especially in the developing world where the provision of hearing aids (or other amplification) is a financial and/or logistical impossibility for most children. RESULTS Institutional services in developing countries achieve very low coverage rates. CONCLUSIONS Community-based rehabilitation (CBR) reaches disabled children more effectively, and the final part of the paper suggests ways in which CBR workers can assist hearing-impaired children.

Sequelae from meningococcal meningitis in children: a critical analysis of dexamethasone therapy

OBJECTIVE To evaluate the effectiveness of dexamethasone as an adjunctive therapy to antibiotics in children with meningococcal meningitis. METHOD A total of 81 children diagnosed with meningococcal meningitis hospitalized in sequence were studied at the University Hospital of São Paulo University, with the objective of evaluating the presence of sequelae in four different groups of patients, following the administration of dexamethasone: Group I - 25 patients who received the first dose at least 10 minutes before the introduction of the antibiotic therapy; Group II - 19 patients who received the corticosteroid concomitantly; Group III - 14 patients for which the dexamethasone was administered after beginning the antibiotic scheme; Group IV - 23 patients that did not receive dexamethasone. The groups were evaluated for homogeneity through the prognostic indexes and clinical and laboratory characteristics, based on the records obtained at hospitalization. RESULTS Some degree of sequelae occurred in 16 (26.22%) of the survivors and 23 patients (28.39%) coursed with sequelae or died. The mean period of neurological attendance was 36.97 months and neurological alterations were detected in 16.17% of the patients. No significant difference was found between the four groups. There was also no statistical difference in the comparison of the neurological sequelae in the children from group IV with the children of groups I and II or even with groups I, II and III analyzed as a whole. The presence of hearing loss occurred in 11.11% of the patients, again there was no significant difference between the four groups. Psychological evaluation was performed using the WPSSI and WISC tests. A mild mental disability was detected in one patient from group I and another in group III. The overall analysis of the sequelae (neurological, auditory and intellectual level) also did not demonstrate any significant difference between the four groups. Comparing the children from groups I and II together and also groups I, II and III as a whole with the children in group IV also failed to detect a significant difference arising from the use or nonuse of the corticosteroid. CONCLUSION Dexamethasone was not proven to be effective in decreasing the number of sequelae among patients with meningococcal meningitis.

Perfil pragmático de crianças surdas em diferentes fases lingüísticas

PURPOSE: The aim of this study was to ascertain and to assess the interference of deaf childrens linguistic level in their communicative abilities. METHODS:Thirty deaf children participated in this study, 15 in the pre-linguistic phase and 15 in the linguistic phase, independent of the communicative modality used - either oral or sign language. Their age ranged from 41 to 59 months. Thirty videotape recordings of the deaf childrens communicative abilities assessment during their interaction with the examiner were analyzed. The Communicative Abilities Pragmatic Profile was used in order to identify the communicative abilities and their frequency of occurrence. RESULTS: Both groups basically presented the same communicative abilities; however, the linguistic group presented higher frequency of occurrence, especially in the abilities regarding communicative intentions and responses for communication. CONCLUSIONS:There is a direct relationship between linguistic complexity (independent of any kind of modality) and the deaf childs communicative profile, that is, the linguistic level child presents higher frequency of occurrence of more complex and elaborated communicative abilities.

Efeitos da amplificação sonora sobre as modalidades comunicativas utilizadas pelos pais

BACKGROUND auditory rehabilitation in deaf children users of sign language. AIM to verify the effects of sound amplification on parents communicative modalities when interacting with their deaf children. METHOD participants were twelve deaf children, aged 50 to 80 months and their hearing parents. Children had severe or profound hearing loss in their better ear and were fitted with hearing aids in both ears. Children communicated preferably through sign language. The cause-effect relation between the childrens auditory skills profile (insertion gain, functional gain and The Meaningful Auditory Integration Scale--MAIS) and the communicative modalities (auditive-oral, visuo-spacial, bimodal) used by parents was analyzed. Communicative modalities were compared in two different experimental situations during a structured interaction between parents and children, i.e. when children were not fitted with their hearing aids (Situation 1) and when children were fitted with them (Situation 2). Data was analyzed using descriptive statistics. RESULTS the profile of the deaf childrens auditory skills demonstrated to be lower than 53% (unsatisfactory). Parents used predominately the bimodal modality to gain childrens attention, to transmit and to end tasks. A slight positive effect of sound amplification on the communicative modalities was observed, once parents presented more turn-takings during communication when using the auditory-oral modality in Situation 2. CONCLUSION hearing parents tend to use more turn-takings during communication in the auditory-oral modality to gain childrens attention, to transmit and to end tasks, since they observe an improvement in the auditory skills of their children.

Avaliação e acompanhamento audiológico após meningite bacteriana

Hearing loss is the more frequent sequel of bacterial meningitis in children. This study describes the audiological profile (peripheric and central) of 89 children admitted to the hospital wards with the diagnosis of bacterial meningitis. Those children attended audiological follow up, after their hospital descharge, and were submitted to audiological tests. The results showed that 85.4% among them presented normal hearing in both ears 10.1% presented bilateral neurosensorial hearing loss and 4.5% presented unilateral neurosensorial hearing loss. The results from the auditory processing skills assessment showed that 10% of those children presented auditory localization and recognition of sentences with competitive messages (Paediatric Sentences Identification - ipsilateral) disorders.

Assessing deaf and hearing children's communication in Brazil

UNLABELLED In Brazil there are no specific tests for either signed or spoken language for deaf children. A protocol evaluating communicative abilities independent of modality of communication (sign language or spoken language), and comprising assessments of (a) pragmatic profile; (b) modality of communication and linguistic level; (c) complexity of communication; and (d) style and efficacy of communication between parent and child was administered to 127 deaf and hearing children. The children, aged 3-6 years old, were distributed in three groups: 20 with severe hearing loss, 40 with profound hearing loss and 67 normally hearing. Deaf children were found to be delayed, independent of their linguistic level and preferred modality of communication. The protocol in this study proved to be an useful instrument for gathering relevant information about the three groups of preschool childrens communicative abilities, and particularly suitable for use in countries where standardized assessments are not available. LEARNING OUTCOMES The reader will be introduced to the use of an assessment protocol comprising its development, application and data analysis. The reader will be informed about assessment of deaf childrens preferred modality of communication, by the participation of a bilingual (sign language user) professional. Communication abilities can be assessed independently of the linguistic modality. In developing countries in general, where simple and easy to administer assessments tools are scarce, such a protocol is of specific value.

Avaliação das habilidades de metarrepresentação em crianças de sete a oito anos

BACKGROUND Theory of Mind. AIM the purpose of this study was to assess the self-representation abilities in 7-8 year old children and to verify the relationship between the Theory of Mind and language. METHOD subjects of this study were 100 children - 50 boys and 50 girls - with ages between 7:2 and 8:11, divided in four groups: 7-year-old children with no communication deficits (Group 1), with 37 subjects; 7-year-old children with phonological retard (Group 2), with 13 subjects; 8-year-old children with no communication deficits (Group 3), with 46 subjects; and 8- year- old children with phonological retard (Group 4), with 4 subjects. All of the subjects were students of a municipal school in the city of São Paulo and were submitted to speech, language and hearing tests prior to the assessment of the self-representation abilities. The assessment of the self-representation abilities is composed by four tests proposed by Fernandes (2002) and adapted by Mecca (2005). RESULTS 88% of the 7-year-old subjects passed the self-representation abilities test; 92% of the 8-year-old subjects also passed the same test. No statistically significant differences were found between gender, age or group. CONCLUSION generally, children around 7 years have already acquired the Theory of Mind, however this acquisition can take longer and occur at other ages. The type of interaction and the presence of abstract elements during conversation can have an influence on the childrens performance in tasks involving the theory of mind.

Evaluation of the benefit of amplification in children fitted with hearing aids

Summary Introduction: In Brazil, it is rare studies with using deaf children of auditory device above of seven years. Objective: To investigate the benefit supplied for the amplification in deaf children to 7 years old to 11 years old using auditory device, under the perspective of the proper child and the adults with who it more coexists, and to verify if the time of conviviality of the adults with the child intervenes with their answers. Method: One is about a clinical and experimental study. They had participated of the study 48 citizens, divided in 4 distinct groups: G1- 12 deaf children; G2- 12 adults with average companionship of 40 weekly hours with the deaf child; G3- 12 adults with average companionship of 20 weekly hours with the deaf child; G4- 12 adults with average companionship of 10 weekly hours with the deaf child. All the children were using of device bilaterally and presented auditory loss of severe or deep degree. Results: The results indicate damage in the auditory abilities of the children evaluated had to the difficulties faced for them to listen to elements gifts in situations of its daily one. The time of companionship with the child did not have differences in the results between the different groups in agreement. Conclusion: The viability of the evaluation of the proportionate benefit for the auditory device in children was evidenced clinically on the basis of the information of the family. The device of individual sonorous amplification exerted influence in the auditory abilities of the evaluated children, although the proportionate benefit for its use to be lesser of what the waited one.

Evolução do comportamento auditivo após meningite bacteriana: relato de caso

Bacterial meningitis is the main cause for acquired hearing loss. Nevertheless very little has been written about the development of the auditory behaviour either for improvement or for deterioration, after hospital release. The present study describes the case of a five month old boy with Haemophilus influenzae meningitis. Amongst various complications, a decrement in the auditory acuity was detected in the immediate evolution, with significant improvement later on by qualitative and quantitative tests.