ABSTRACT
RESUMO: A Perturbação do Espectro do Autismo (PEA) caracteriza-se por défices na comunicação e na interação social e por padrões repetitivos e restritos do comportamento, eventualmente explicados por alterações nas funções executivas (FE) e empatia. O objetivo desta investigação foi, assim, estudar as relações entre os comportamentos típicos da PEA, FE e empatia, de forma a estabelecer orientações de intervenção. O Questionário dos Comportamentos Típicos da PEA, o Inventário Comportamental de Avaliação das Funções Executivas - Pais e a Escala de Avaliação da Empatia foram aplicados a 75 crianças com PEA (9.67±1.29). Os resultados apontaram correlações positivas entre a sintomatologia da PEA e as FE, nomeadamente na regulação comportamental e na metacognição. A correlação positiva mais forte (p<.01) ocorreu entre a alternância e os comportamentos totais (r=.660), e padrões restritos e repetitivos (r=.665) e comunicação e interação social (r=.536). Todos os domínios e os subdomínios apresentaram associações com a iniciação e a planificação. Não se verificaram correlações entre os domínios e os subdomínios da PEA e empatia, apenas com alguns comportamentos específicos. Verificou-se que a empatia cognitiva estava associada à regulação comportamental. Esses resultados sugerem que as FE e a empatia têm um papel preponderante na melhoria dos défices sociais e não-sociais da PEA e a importância da intervenção individualizada centrada nas características da PEA, na empatia e nas FE, nomeadamente na regulação comportamental e na metacognição. A intervenção deve abranger não apenas os sintomas da PEA, mas também processos cognitivos subjacentes que possibilitam a melhoria dos comportamentos e uma maior adaptação a diferentes contextos e situações.
ABSTRACT: Autism Spectrum Disorder (ASD) is characterized by deficits in social communication and interaction and by restricted and repetitive behaviors and interests, eventually explained by difficulties in executive functions (EF) and empathy. Tus, the aim of this investigation was to study the relationships between typical behaviors of ASD, EF and empathy, in order to establish intervention guidelines. Te ASD Typical Behavior Questionnaire, the Behavior Rating Inventory of Executive Function for parents (BRIEF) and the Empathy Assessment Scale (EAS) were applied to 75 children with ASD (9.67±1.29). Te results showed positive correlations between the symptomatology of ASD and E F, namely in behavioral regulation and metacognition. Te strongest positive correlation (p<.01) occurred between shifting and total behaviors (r=.660), and restricted and repetitive patterns (r=.665) and communication and social interaction (r=.536). All domains and subdomains had correlations with initiation and planning. There were no correlations between the domains and subdomains of ASD and empathy, only with some specific behaviors. It was verified that cognitive empathy was associated with behavioral regulation. Tese results suggest that EF and empathy are essential to improve the social and non-social deficits of the ASD and the importance of individualized intervention centered on the characteristics of the ASD, empathy and E F, namely on the behavioral regulation and metacognition. Te intervention must cover not only the symptoms of the ASD, but also cognitive processes that enable the improvement of behaviors and better adaptation to different contexts and situations.
ABSTRACT
Resumen En el curso de la demencia, la etapa avanzada se caracteriza por un deterioro cognitivo y físico severo, definiéndola como una etapa que incluye profundos déficits de memoria, habilidades verbales mínimas, incapacidad para deambular de forma independiente, incontinencia urinaria y fecal, y necesidad de asistencia para realizar cualquier actividad de la vida diaria básica. El presente reporte tiene por objeto comunicar un caso de una usuaria con 89 años con demencia avanzada que acude a control neurológico en compañía de su familia, quienes solicitan información de cómo mejorar la calidad de vida en esa etapa. Describimos una propuesta desde el enfoque de cuidados paliativos, específicamente la concepción terapéutica activa, como una guía que permita observar a la persona no sólo desde el buen morir, sino también desde la incorporación de una actitud proactiva en función del bienestar. Este enfoque permite facilitar experiencias placenteras, definidas dentro del marco de intervenciones no farmacológicas, las cuales han demostrado en la última década importantes beneficios en personas con demencia avanzada, permitiendo individualizar las estrategias de intervención en esta etapa de la enfermedad.
In the course of dementia, the advanced stage is characterized by severe cognitive and physical impairment, defining it as a stage that includes deep memory deficits, minimal verbal skills, inability to walk independently, need of assistance to perform any basic daily life activity and urinary and fecal incontinence. The aim of this report is to describe a case of a 89-year-old woman with Advanced Dementia who goes to neurological control in the company of her family, who request information on how to improve the quality of life at this stage. We describe a proposal of palliative care approach, specifically the active therapeutic conception, as a guide that allows to observe the person not only from the good dying, but also from the incorporation of a proactive attitude in function of well-being. This approach allows to facilitate pleasurable experiences, defined within the framework of Nonpharmacological intervention, which have shown important benefits in people with advanced dementia in the last decade, allowing the identification of intervention strategies in this stage of the disease.
Subject(s)
Humans , Female , Aged, 80 and over , Dementia/therapy , Palliative Care , Quality of LifeABSTRACT
[Background] Over the last thirty years, majority of researches on clinical effectiveness of acupuncture have been explanatory (or experimental) randomized controlled trial. The benefits of acupuncture in clinical trials are stillcontroversial and most studies concluded that further control studies were required. Standardized combinations of acupuncture points for all the experimental subjects in various past studies have been criticized because such treatments do not reflect current routine clinical treatment.<BR>[Objective] This paper aims to review pragmatic clinical trials on the effect of acupuncture treatment and to develop the ideal clinical research methodology of acupuncture study.<BR>[Method] Clinical studies of acupuncture relevant with pragmatic or individualized trials were searched mainly in Pubmed and Science direct databases. All articles were fully reviewed by researchers, and data were evaluated by usage of a standardized form.<BR>[Results & Suggestion] Pragmatic acupuncture researches were tried for various symptoms (eg. low back pain, hypertension, depression during pregnancy, sleep quality in HIV disease, chronic poststroke leg spasticity, headache, etc). Individualized acupuncture treatments based on oriental disease pattern diagnosis reflexes practical treatments which is more effective than unified and fixed acupuncture treatments without any theoretical basis of oriental medical philosophy.<BR>[Conclusion] To overcome the controversies and limitations of past explanatory acupuncture trials, more individualized and tailored acupuncture trials with the theoretical basis of oriental medical diagnosis is highly recommended. Also clear definition and categorization of pattern identification should be established for further active clinical researches and applications of acupuncture.