Kely Maria Pereira de Paula

Avaliação assistida e comunicação alternativa: procedimentos para a educação inclusiva

Research on dynamic assessment points to a promising field where its innovative features differ from traditional assessment by favoring the population that presents challenges in the learning processes or who present socially disadvantaged conditions. Children who need alternative resources for expressive language constitute a significant group that can be benefited from assessment tailored to their needs. In this study, seven children with special needs (communication problems) took part in a dynamic assessment situation using Tzuriel and Kleins Childrens Analogical Thinking Modifiability Test (CATM), in order to complete the psychometric assessment carried out by Raven, Columbia and TVIP tests. The latter was a computerized version, applied before and after intervention with an Augmentative and Alternative Communication (AAC) system. Besides the thought processes, other not specifically cognitive aspects of great importance were considered: the childs reaction to the assessment situation and the kind of task put before, personal and situational variables such as motivation and fatigue, as well as accessibility to the mediation strategies. Such variables were systematized in cognitive, behavioral and affective-motivational categories in the teaching and intervention contexts compounding a mosaic of indicators about the characteristics of children with communicative deficits at different stages of the study. Even though the assessment conditions - traditional and dynamic - were tiring for the children, we were able to identify the operations and cognitive dysfunctions both in the traditional tests and in the dynamic testing, as well as in the intervention. Furthermore, affective-motivational and behavioral factors were shown to affect performance, composing an intra-group learning profile for problem solving. Thus, the study demonstrated that dynamic assessment can be an important tool for psychological diagnosis, complementing traditional psychometric approach, for children with communication problems.

Voice-related quality of life in the pediatric population: validation of the Brazilian version of the Pediatric Voice-Related Quality-of Life survey

OBJETIVO: A utilizacao de um protocolo que analise os mesmos aspectos que o Perfil Funcional da Comunicacao (PFC) pode colaborar para a determinacao de perfis individuais de habilidades e dificuldades de forma mais rapida e economica. O objetivo deste estudo foi verificar a utilizacao de um checklist, em substituicao ao protocolo completo, como elemento de facilitacao do processo de acompanhamento clinico-terapeutico. METODOS: Participaram do estudo 50 criancas entre 3 e 12 anos, que tem diagnostico incluido no espectro do autismo e recebem atendimento fonoaudiologico especializado ha pelo menos seis meses. Os participantes foram filmados em situacao de interacao com o fonoaudiologo e os dados, transcritos para o protocolo do PFC. Antes da analise, foi solicitado que as terapeutas respondessem ao checklist da Funcionalidade Comunicativa. RESULTADOS: Todas as respostas do checklist e do PFC foram comparadas. Os resultados indicaram que, quando se compara a ocorrencia de cada uma das funcoes, tem-se resultados diferentes em nove das 20 funcoes comunicativas e em nove das 50 criancas. Esses resultados indicam que o checklist mostra-se eficiente na descricao do grupo de criancas, mas nao na caracterizacao individual. Assim, e possivel identificar diferencas nos perfis pragmaticos, mas nao especificar a frequencia de ocorrencia das funcoes. CONCLUSAO: O checklist pode ser usado como instrumento de acompanhamento de processos terapeuticos de criancas com Disturbios do Espectro do Autismo, mas nao substitui o instrumento completo.PURPOSE To measure the voice-related quality of life in children/adolescents with vocal complaints through the validation of the Brazilian Pediatric Voice-Related Quality-of-Life survey - VR-QOL-P (Qualidade de Vida em Voz Pediátrico - QVV-P), to verify whether the presence of vocal complaints interfere with the quality of life of children/adolescents, and to determine the relationship between the vocal assessment carried out by parents and the VR-QOL-P scores. METHODS The participants included 246 parents of children/adolescents of both sexes, aged between 2 years and 18 years (divided into preschoolers, schoolers and adolescents), with and without vocal complaints. All participants signed the informed consent form. Translation, linguistic and cultural adaptation, assessment of cultural equivalence, implementation of the protocol in its final version, voice assessment by parents, demographic and clinical descriptive statistical analysis of the population, individual analysis of the items, verification of psychometric measures of validation, reliability, reproducibility and responsiveness of the instrument to treatment, were carried out. RESULTS Low scores, especially in the physical domain, were found in subjects with vocal complaints. Among those, adolescents suffered the greatest impact. The social-emotional domain was not sensitive in preschoolers. There was a correlation among the overall, social-emotional and physical scores, and the vocal assessment performed by parents. The VR-QOL-P was reliable, reproducible and responsive to voice problems. CONCLUSION Voice change interferes with the quality of life of children/adolescents, and there is a relationship between the assessment of voice quality and VR-QOL-P scores - the older the individual, the worse the quality of life in aspects related to voice, especially in the physical domain, and the better the vocal quality, as perceived by the parents.PURPOSE The use of a different protocol to assess the same aspects of the Functional Communication Profile (FCP) may contribute to a faster and less expensive determination of individual profiles of abilities and inabilities. The purpose of this study was to verify the applicability of a checklist to replace the aforementioned complete protocol as a way to facilitate clinical and therapeutic follow-up processes. METHODS The participants in this study were 50 children aged from 3 to 12 years, with diagnoses within the autism spectrum who were receiving specialized speech-language therapy for at least six months. The participants were filmed while interacting with the speech-language pathologist, and the data were transcribed to the FCP protocol. After the recording and prior to the transcription, the speech-language pathologists were asked to answer the checklist of Communicative Functions. RESULTS All answers on the checklist and on the FCP were compared. The results indicated that there were statistical differences in nine of the 20 communicative functions, and in nine of the 50 children. These results suggest that the checklist is efficient to describe a group of children but not to characterize them individually. Therefore, it is possible to identify differences in the communicative profile but not to specify the frequency with which each function occurs. CONCLUSION The checklist can be used as a tool in the therapeutic follow-up processes of children with autism spectrum disorders, but it does not replace the complete FCP protocol.

Teoria motivacional do coping: uma proposta desenvolvimentista de análise do enfrentamento do estresse

Coping Motivational Theory is a recent developmental research designed to analyze the coping with stress related to the coping approach as a regulatory action. Any event may be perceived as stressful as it challenges or threatens the basic psychological needs of relationships, competence and autonomy. This theory proposes an analysis system based on the organization of coping strategies into 12 categories according to their probable adaptation outcome: (a) positive: self-confidence, search for support, problem resolution, search for information, accommodation and negotiation; and (b) negative: delegation, isolation, hopelessness, escape, submission and opposition. The use of this system in the analysis of childrens coping allows us to identify patterns of coping related to age, as well as to evaluate the role of developmental changes in the use of specific strategies, thus contributing to the analysis of the evolution of coping throughout childhood.

Avaliação e controle da dor por enfermeiras de uma unidade de terapia intensiva neonatal

BACKGROUND AND OBJECTIVES: Pain is frequent during hospitalization of premature neonates (PNN) in neonatal intensive care units (NICU) and is caused by routine invasive procedures. This study aimed at identifying and analyzing pain conceptions and management by nurses during nine routine invasive procedures in a NICU of a teaching hospital. METHOD: This was a descriptive study with nine nurses working from one to nine years in NICUs, who answered an adapted questionnaire with 13 open and closed questions about pain conceptions. Answers went through descriptive and content statistical analysis. RESULTS: Nurses acknowledged PNNs ability to feel pain and the importance of pain control to minimize childrens development risks. Pain was primarily evaluated by behavioral indicators, such as weeping, facial mimics and motor activity. Routine procedures were considered from moderate to extremely painful, such as venous/arterial puncture and chest drainage; however they used to be carried out without adequate relief measures. CONCLUSION: Although acknowledging that PNNs feel pain and that invasive procedures are painful, nurses considered that pain relief measures were still inadequate. Qualification in pain control is critical for professionals to act as a source of resources to protect future childrens development.

A dor no cotidiano de cuidadores e crianças com anemia falciforme

Las crisis de dolor agudo o cronico de diferente intensidad y recurrencia impredecible son uno de los sintomas mas comunes de la enfermedad de celulas falciformes y tienden a afectar a la calidad de vida de quienes la padecen. Este estudio trata de describir y comparar la percepcion del doloroso episodio de anemia falciforme entre los ninos y sus cuidadores. Entre los participantes habia 27 pares de cuidador-nino, estando formados por 11 hijos parejas tratadas en la Clinica Pediatrica del Hospital Universitario Cassiano Antonio de Moraes Vitoria/ES y 16 pares integrados por ninos que asisten al Hemocentro de Cuiaba/MT. Los resultados revelaron diferencias en la percepcion del nino y cuidador de la caracterizacion del dolor en cuanto al tipo e intensidad. Las crisis de dolor interfieren especialmente en las actividades cotidianas. La estrategia de afrontamiento mas utilizada por ambos grupos se centro en pensamientos que incumban a los aspectos negativos de la experiencia no deseada, lo que indica la necesidad de intervencion psicologica con esta poblacion.

Qualidade de Vida em Voz na População Pediátrica: validação da versão brasileira do Protocolo Qualidade de Vida em Voz Pediátrico

OBJETIVO: A utilizacao de um protocolo que analise os mesmos aspectos que o Perfil Funcional da Comunicacao (PFC) pode colaborar para a determinacao de perfis individuais de habilidades e dificuldades de forma mais rapida e economica. O objetivo deste estudo foi verificar a utilizacao de um checklist, em substituicao ao protocolo completo, como elemento de facilitacao do processo de acompanhamento clinico-terapeutico. METODOS: Participaram do estudo 50 criancas entre 3 e 12 anos, que tem diagnostico incluido no espectro do autismo e recebem atendimento fonoaudiologico especializado ha pelo menos seis meses. Os participantes foram filmados em situacao de interacao com o fonoaudiologo e os dados, transcritos para o protocolo do PFC. Antes da analise, foi solicitado que as terapeutas respondessem ao checklist da Funcionalidade Comunicativa. RESULTADOS: Todas as respostas do checklist e do PFC foram comparadas. Os resultados indicaram que, quando se compara a ocorrencia de cada uma das funcoes, tem-se resultados diferentes em nove das 20 funcoes comunicativas e em nove das 50 criancas. Esses resultados indicam que o checklist mostra-se eficiente na descricao do grupo de criancas, mas nao na caracterizacao individual. Assim, e possivel identificar diferencas nos perfis pragmaticos, mas nao especificar a frequencia de ocorrencia das funcoes. CONCLUSAO: O checklist pode ser usado como instrumento de acompanhamento de processos terapeuticos de criancas com Disturbios do Espectro do Autismo, mas nao substitui o instrumento completo.PURPOSE To measure the voice-related quality of life in children/adolescents with vocal complaints through the validation of the Brazilian Pediatric Voice-Related Quality-of-Life survey - VR-QOL-P (Qualidade de Vida em Voz Pediátrico - QVV-P), to verify whether the presence of vocal complaints interfere with the quality of life of children/adolescents, and to determine the relationship between the vocal assessment carried out by parents and the VR-QOL-P scores. METHODS The participants included 246 parents of children/adolescents of both sexes, aged between 2 years and 18 years (divided into preschoolers, schoolers and adolescents), with and without vocal complaints. All participants signed the informed consent form. Translation, linguistic and cultural adaptation, assessment of cultural equivalence, implementation of the protocol in its final version, voice assessment by parents, demographic and clinical descriptive statistical analysis of the population, individual analysis of the items, verification of psychometric measures of validation, reliability, reproducibility and responsiveness of the instrument to treatment, were carried out. RESULTS Low scores, especially in the physical domain, were found in subjects with vocal complaints. Among those, adolescents suffered the greatest impact. The social-emotional domain was not sensitive in preschoolers. There was a correlation among the overall, social-emotional and physical scores, and the vocal assessment performed by parents. The VR-QOL-P was reliable, reproducible and responsive to voice problems. CONCLUSION Voice change interferes with the quality of life of children/adolescents, and there is a relationship between the assessment of voice quality and VR-QOL-P scores - the older the individual, the worse the quality of life in aspects related to voice, especially in the physical domain, and the better the vocal quality, as perceived by the parents.PURPOSE The use of a different protocol to assess the same aspects of the Functional Communication Profile (FCP) may contribute to a faster and less expensive determination of individual profiles of abilities and inabilities. The purpose of this study was to verify the applicability of a checklist to replace the aforementioned complete protocol as a way to facilitate clinical and therapeutic follow-up processes. METHODS The participants in this study were 50 children aged from 3 to 12 years, with diagnoses within the autism spectrum who were receiving specialized speech-language therapy for at least six months. The participants were filmed while interacting with the speech-language pathologist, and the data were transcribed to the FCP protocol. After the recording and prior to the transcription, the speech-language pathologists were asked to answer the checklist of Communicative Functions. RESULTS All answers on the checklist and on the FCP were compared. The results indicated that there were statistical differences in nine of the 20 communicative functions, and in nine of the 50 children. These results suggest that the checklist is efficient to describe a group of children but not to characterize them individually. Therefore, it is possible to identify differences in the communicative profile but not to specify the frequency with which each function occurs. CONCLUSION The checklist can be used as a tool in the therapeutic follow-up processes of children with autism spectrum disorders, but it does not replace the complete FCP protocol.

Concepções de humanização de profissionais em Unidades de Terapia Intensiva Neonatal

Considerando-se a importância das estrategias de humanizacao e intervencao hospitalar no atendimento ao recem-nascido enfermo, esta pesquisa investigou a concepcao de humanizacao da equipe de profissionais de tres Unidades de Terapia Intensiva Neonatal da Regiao Metropolitana da Grande Vitoria, Espirito Santo. Participaram do estudo 29 profissionais de saude, entre medicos, enfermeiros, fonoaudiologos, fisioterapeutas e tecnicos de enfermagem, os quais responderam a roteiros de entrevistas semiestruturadas. Os dados das entrevistas foram processados pelo software Alceste e submetidos a Analise de Conteudo. Concluiu-se que os profissionais compreendem o cuidado humanizado a partir do resgate da perspectiva afetiva, em oposicao ao modelo medico-tecnicista de atencao a saude, ou seja, com enfase nos aspectos emocionais que envolvem sua relacao com o bebe e com o trabalho em Neonatologia. A participacao da familia foi o aspecto mais relevante para os profissionais, que expressaram a importância da permanencia dos pais na unidade de terapia e sua participacao nos cuidados ao recem-nascido.

ESTRESSE E ENFRENTAMENTO EM PROFESSORES: UMA ANÁLISE DA LITERATURA

Stress has been linked to health problems to teachers. Conversely, it is important to understand teachers coping strategies. Thus, this study reviewed the literature on stress and coping to teachers, by analyzing most important researches results in addition to its methodological characteristics. The keywords considered were stress, coping and teacher on articles published by CAPES international portal of journals, between 2006 and 2011. It was possible to examine 19 empirical studies that were fully available. As far as this material is concerned, analyses related to stress, coping strategies and their implications for teaching were conveyed. It showed the need for evaluative and interventionism practices in attention to cope and symptoms of stress, in order to extend the understanding processes that lead to the well-being on teaching and, consequently, the education quality.

Curva ROC do Protocolo Qualidade de Vida em Voz Pediátrico (QVV-P)

To verify the efficiency and to determine the cutoff values that discriminate children/adolescents with and without vocal complaints, as well as the measures of sensibility, specificity and efficiency of the Brazilian Pediatric Voice-Related Quality-of-Life Survey (P-VRQOL). The participants included 230 parents of children/adolescents of both genders, aged between 2 years and 18 years, with and without vocal complaints that responded the validated Brazilian version of P-VRQOL. The three scores (total, physical and social-emotional) were analyzed by the Receiver Operating Characteristic Curve (ROC curve). The cutoff values, ROC curve and the measures of specificity, sensibility and efficiency varied as the score investigated - total, physical or social-emotional. The total score demonstrated excellent discrimination (efficiency=0.936; specificity=0.991; and sensibility=0.881); the social-emotional score was a reasonable indicator (efficiency=0.794; specificity=0.604; and sensibility=0.983) and the physical score was an excellent sorter (efficiency=0.918; specificity=0.946; and sensibility=0.890). The cutoff values and area under curve were: total score- cutoff=96.25 and AUC=0.98; physical score- cutoff=91.68 and AUC=0.97; social-emotional score cutoff=96.87 and AUC=0.79. The P-VRQOL is an excellent sorter to discriminate children/adolescents with and without vocal complaints. The perception of parents about the presence of vocal problem allows the judge of lower quality of life in 98% of the cases, especially, in P-VRQOL physical domain.To verify the efficiency and to determine the cutoff values that discriminate children/adolescents with and without vocal complaints, as well as the measures of sensibility, specificity and efficiency of the Brazilian Pediatric Voice-Related Quality-of-Life Survey (P-VRQOL). The participants included 230 parents of children/adolescents of both genders, aged between 2 years and 18 years, with and without vocal complaints that responded the validated Brazilian version of P-VRQOL. The three scores (total, physical and social-emotional) were analyzed by the Receiver Operating Characteristic Curve (ROC curve). The cutoff values, ROC curve and the measures of specificity, sensibility and efficiency varied as the score investigated - total, physical or social-emotional. The total score demonstrated excellent discrimination (efficiency=0.936; specificity=0.991; and sensibility=0.881); the social-emotional score was a reasonable indicator (efficiency=0.794; specificity=0.604; and sensibility=0.983) and the physical score was an excellent sorter (efficiency=0.918; specificity=0.946; and sensibility=0.890). The cutoff values and area under curve were: total score- cutoff=96.25 and AUC=0.98; physical score- cutoff=91.68 and AUC=0.97; social-emotional score cutoff=96.87 and AUC=0.79. The P-VRQOL is an excellent sorter to discriminate children/adolescents with and without vocal complaints. The perception of parents about the presence of vocal problem allows the judge of lower quality of life in 98% of the cases, especially, in P-VRQOL physical domain.

Perfil comportamental de crianças com anemia falciforme

Sickle Cell Anemia is a genetic disease that, by presenting varied symptomatology, produces a series of damages throughout child’s development. Considering the severity of the disease, and the pain being