Funcionalidade de pessoas hospitalizados em vulnerabilidade comunicativa pela CIF / Functioning of hospitalized people in vulnerable communication by the ICF / Funcionalidad de las personas hospitalizadas con vulnerabilidad comunicativa por el CIF

Introdução: Pacientes hospitalizados, por causas diversas, podem apresentar comprometimentos de fala e linguagem que os coloquem em situação de vulnerabilidade comunicativa, influenciando sua funcionalidade. Adota-se a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para análise, sob esta perspectiva. Objetivo: Analisar a linguagem e funcionalidade de pessoas em vulnerabilidade comunicativa, em cuidados intensivo e semi-intensivo no hospital, pela CIF, como base conceitual. Método: Estudodescritivo e transversal, constituído por 18 participantes. Para a coleta de dados realizou-se: (i) levantamento dos prontuários, para caracterização do perfil sociodemográfico e das condições clínicas dos participantes; (ii) aplicação do protocolo ICUCS (Intensive Care Unit Communication Screening Protocol);(iii) introdução da Comunicação Suplementar e/ou Alternativa (CSA) e (iv) diário de campo (registro dos relatos). Os resultados foram analisados pela CIF e realizada análise estatística descritiva. Resultados: A maioria dos participantes estava alerta e compreendia comandos simples, sendo que 39% apresentaram problema grave de expressão de linguagem. Quanto à atividade e participação, 50% apresentaram dificuldade grave no falar, 33%, em iniciar e em manter conversas. Quanto aos fatores ambientais, familiares e profissionais de Saúde foram apontados tanto como facilitadores quanto como barreiras para a comunicação. A CSA foi vista como facilitadora da comunicação. Conclusão: Os participantes apresentaram alteração de expressão da linguagem oral, com compreensão preservada e dificuldades de atividade e participação, com impacto nos fatores ambientais, sendo a CSA uma facilitadora da comunicação. Reafirma-se a aplicabilidade da CIF no contexto hospitalar, para pessoas em vulnerabilidade comunicativa, para cuidado ampliado e humanizado.

Introduction: Hospitalized patients, due to various causes, may present impairment of speech and language which may lead them to a situation of communicative vulnerability, influencing its functioning. The ICF - International Classification of functioning, Disability and Health is adopted to perform this analysis, under this perspective. Purpose: To analyze the language and functioning of people in communicative vulnerability, under intensive or semi-intensive care at the hospital, according to ICF, as a concept basis. Methods: Descriptive and cross-sectional study, composed by 18 participants. Data collected through: (i) hospital chart survey analysis, in order to characterize sociodemographic profile and clinical conditions of the participants; (ii) application of ICUCS - Intensive Care Unit Communication Screening Protocol; (iii) introduction of AAC - Augmentative and Alternative Communication and (iv) field journal (entries of reports). The results were analyzed by ICF and then performed descriptive statistic analyses. Results: Most participants were alert and could comprehend simple commands, from which 39% presented severe problems regarding language expression. Regarding activity and participation, 50% presented severe difficulty of speaking and 33% of starting and keeping conversations. Regarding environmental, family and health professionals factors, they have all been appointed both as facilitators and barriers to communication. AAC was seen as a communication facilitator. Conclusion: Participants presented alteration of oral language expression, preserved comprehension and difficulties in activity and participation with impact in environmental factors, being AAC a communication facilitator. Reassurance of applicability of ICF in hospital context, directed to people in communicative vulnerability, regarding ample and humanized treatment.

Los pacientes hospitalizados, por las causas diversas, pueden presentar deterioro de la funcionalidad del habla y del lenguaje que se sitúa en el discurso comunicativo, lo que influye en su funcionalidad. Se utiliza la Clasificación Internacional del Funcionamiento de la Discapacidad y de la Salud (CIF) para análisis desde esta perspectiva. Objetivo: Analizar el lenguaje y la funcionalidad de personas en vulnerabilidad comunicativa, en cuidados intensivos y semiintensivos hospitalarios, utilizando la CIF, como fundamento conceptual. Método: Estudiodescriptivo y transversal, con 18 participantes. La recogida de datos incluyó: (i) estudios de las historias clínicas, para caracterizar el perfil sociodemográfico y las condiciones clínicas de los participantes; (ii) la aplicación del protocolo ICUCS (Intensive Care Unit Communication Screening Protocol);(iii) la introducción de la Comunicación Aumentativa y Alternativa (CAA) y (iv) un diario de campo (registro de informes). Los resultados se analizaron por la CIF y se realizó un análisis estadístico descriptivo. Resultados: La mayoría de los participantes estaban alerta y entendían órdenes sencillas, el 39% presentaron graves problemas para expresarse en el lenguaje. Em cuanto, a la actividad y la participación, el 50% tenía graves dificultades para hablar, y el 33%, para iniciar y mantener conversaciones. Los factores ambientales, los miembros de la familia y los profesionales sanitarios fueron identificados tanto como facilitadores como obstáculo para la comunicación. Se consideró que el CAA facilitaba la comunicación. Conclusión: Los participantes presentaban alteración en la expresión del lenguaje oral, con entendimiento resguardado y dificultades en la actividad y la participación, con impacto en los factores ambientales, siendo la CAA facilitadora de la comunicación. Se reafirma la aplicabilidad de la CIF en el contexto hospitalario, para personas en vulnerabilidad comunicativa, para la atención ampliada y humanizada.

Use of alternative communication with pictures for outpatient periodontal treatment in fragile X syndrome patients.

The purpose of this article is to discuss the clinical management and behavior during periodontal treatment in two patients with fragile X syndrome (FXS) using alternative communication with pictures (ACP). Both patients had a history of previous dental care only possible under general anesthesia. The ACP was used to anticipate the activities to be carried out, promoting ambiance, improving the professional-patient communication, and decreasing the stress of the patient. It was possible to carry out outpatient care without oral sedation and containment/physical restraint in both patients, being surpassed the communicative and behavioral difficulties. These case reports allow us to re-think dental care under general anesthesia or other invasive methods for patients with FXS. Therefore, the ACP is an important mediator tool that can facilitate the insertion and the management of patients with FXS, allowing the dental care outpatient clinic to promote oral health and quality of life for these patients, improving adherence to periodontal treatment and the periodontal maintenance for oral hygiene.

Comunicação Alternativa para Alunos com Autismo na Escola: uma Revisão da Literatura / Alternative Communication for Students with Autism at School: a Literature Review

RESUMO: Estudos meta-analíticos e descritivos conduzidos nas últimas décadas têm demonstrado a efetividade da Comunicação Alternativa e Ampliada (CAA) para pessoas com Transtorno do Espectro Autista (TEA). A maior parte dessas investigações tem focado, contudo, na efetividade clínica da CAA sem atentar para os aspectos pragmáticos da comunicação assistida em contextos não estruturados, como a escola. O objetivo desta investigação foi ampliar, por meio de uma revisão integrativa da literatura, o acervo de pesquisas tratadas em revisões anteriores e, assim, analisar os contextos em que a CAA foi utilizada com educandos com TEA na escola regular. Para isso, foi realizada uma busca no portal de periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) e no catálogo eletrônico de teses e dissertações dessa mesma agência com termos previamente definidos. As oito pesquisas encontradas, publicadas entre 2015 e 2018, incluíram participantes entre 3 e 12 anos de idade que utilizavam sistemas assistidos de comunicação, sendo predominantes as pranchas/álbuns de CAA ou pictogramas avulsos. Todos os estudos foram conduzidos na sala de aula regular e/ou nas Salas de Recursos Multifuncionais, mas dois deles incluíram o ambiente domiciliar. A despeito do uso da CAA em contextos naturais envolver interlocutores conhecidos, foram identificadas lacunas em aspectos pragmáticos da comunicação dos educandos. Observou-se a predominância da comunicação imperativa, a qual focava primordialmente nos comportamentos pragmáticos de solicitação. Embora limitações tenham sido identificadas, os estudos revelaram resultados positivos sobre o uso da CAA para alunos com TEA.

ABSTRACT: Meta-analytical and descriptive studies conducted in recent decades have demonstrated the effectiveness of Augmentative and Alternative Communication (AAC) for people with Autism Spectrum Disorders (ASD). Most of these investigations have focused, however, on the clinical effectiveness of AAC without considering pragmatic aspects of assisted communication in unstructured contexts, such as schools. Te aim of this investigation was to expand, through an integrative literature review, the current body of research, analyzing the contexts where AAC was used with students with ASD in regular schools. In this sense, a search was carried out on the Coordination for the Improvement of Higher Education Personnel (CAPES) journals portal and on the electronic catalog of theses and dissertations of this same agency with previously defined terms Te eight studies found, published between 2015 and 2018, included participants between 3 and 12 years of age who used assisted communication systems, primarily AAC boards and picture cards. All studies were conducted in the regular classroom and / or Multifunctional Resource Rooms, but two included the home environment. Despite the use of AAC in natural contexts, involving known interlocutors, gaps were identified in pragmatic aspects of student communication. Tere was a predominance of imperative communication, focusing primarily on pragmatic solicitation behaviors. Despite the limitations identified, the studies revealed positive results on the use of AAC for students with ASD.

Comunicación en el aula: estudio de casos de valoración docente sobre implementación de sistemas de comunicación aumentativa y alternativa en educación especial en Uruguay / Classroom communication: case studies of teacher's evaluations of implementation of augmentative and alternative communication systems in special education in Uruguay / Comunicação na sala de aula: estudo de casos de avaliações do professores sobre implementação de sistemas de comunicação auxiliares e alternativos na educação especial do Uruguai

Resumen: Este artículo muestra los resultados de una investigación cualitativa sobre las valoraciones de docentes sobre la implementación de Sistemas de Comunicación Aumentativa y Alternativa (SAAC) con niños con parálisis cerebral en la Educación Especial Pública de Uruguay. Acceder a la posibilidad de comunicación representa un derecho fundamental de todo niño. En Uruguay la intervención en la reeducación del lenguaje depende de los fonoaudiólogos, sin embargo, la implementación de estos apoyos son parte de las prácticas educativas de los docentes que trabajan con esta población. Este estudio se enmarca en una perspectiva sociocultural del lenguaje y la comunicación. En este artículo se describen los usos y las funciones de los SAAC desde la perspectiva de los docentes. En tal sentido, al igual que ocurre con otras tecnologías del lenguaje, se parte del supuesto que las funciones cognitivas de los SAAC dependen de los contextos en los que se utilizan y del sentido que las personas le atribuyen. Con base en los resultados de entrevistas semiestructuradas, el trabajo actual se desarrolló en el único centro público de Educación Especial que atiende a esta población en Uruguay. Las entrevistas revelaron que los docentes valoraron positivamente los diversos usos de los SAAC. Señalaron las ventajas asociadas a los aspectos emocionales y motivacionales en el uso ya que reduce el aislamiento social y la ansiedad. No obstante, también se observaron limitaciones en la accesibilidad de los dispositivos digitales dada la variabilidad y severidad de la discapacidad motriz experimentada por esta población.

Abstract: This paper shows the results of a qualitative research on the evaluations of teachers on the implementation of Augmentative and Alternative Communication Systems (SAAC) with children with cerebral palsy in the Public Special Education of Uruguay. The access to communication constitutes a fundamental right of any child. In Uruguay, intervention in language re-education depends on the practice of speech therapists, however, are part of the educational practices of teachers working with this population. This study is framed within a sociocultural perspective of language and communication. This article describes the uses and functions of AACS from the teachers' perspective. In this sense, as with other language technologies, it is assumed that the cognitive functions of AACS depend on the contexts in which they are used and the meaning that people attribute to them. Based on the results of semi-structured interviews, the current work was developed in the only public center for Special Education that serves this population in Uruguay. The interviews revealed that teachers valued in a positive way the various uses of AACS. Along these lines, they pointed out the advantages associated with emotional and motivational aspects in children's use as it reduces social isolation and anxiety. Despite the obvious advantages identified by the teachers, several disadvantages were also associated with the limitations of children's accessibility of the devices, given the variability and severity of the motor disability experienced by this population.

Resumo: Este artigo apresenta os resultados de uma pesquisa qualitativa sobre as avaliações de professores sobre a implantação de Sistemas de Comunicação Alternativa e Aumentativa (SCAA) com crianças com paralisia cerebral na Educação Especial Pública do Uruguai. O acesso à possibilidade de comunicação representa um direito fundamental de cada criança. No Uruguai, a intervenção na reeducação linguística depende do fonoaudiólogo, porém a implantação desses apoios faz parte das práticas educacionais dos professores que atuam com essa população. Este estudo se enquadra em uma perspectiva sociocultural da linguagem e da comunicação. Este artigo descreve os usos e funções do AACS na perspectiva dos professores. Nesse sentido, como acontece com outras tecnologias de linguagem, pressupõe-se que as funções cognitivas do AACS dependem dos contextos em que são utilizadas e do significado que as pessoas lhes atribuem. Com base nos resultados de entrevistas semiestruturadas, o presente trabalho foi desenvolvido no único centro público de Educação Especial que atende essa população no Uruguai. As entrevistas revelaram que os professores avaliaram positivamente os vários usos dos SCAA. Apontaram as vantagens associadas aos aspectos emocionais e motivacionais no uso infantil, pois diminui o isolamento social e a ansiedade. Apesar das óbvias vantagens apontadas pelos professores, várias desvantagens também estiveram associadas, como limitações na acessibilidade dos dispositivos, dada a variabilidade e gravidade da deficiência motora vivenciada por esta população.

Effectiveness and Determinant Variables of Augmentative and Alternative Communication Interventions in Cerebral Palsy Patients with Communication Deficit: a Systematic Review

ABSTRACT Purpose Assess the effectiveness of augmentative and alternative communication (AAC) interventions in patients with CP and to reveal determinant variables of main intervention outcomes: receptive and expressive language. Research strategies The search was performed in following databases: MEDLINE (Ovid); PubMed (NLM); Embase (Ovid); Cochrane Database of Systematic Reviews; Cumulative Index to Nursing and Allied Health Literature; Database of Abstracts of Reviews of Effects; Cochrane Central Register of Controlled Trials; Health Technology Assessment database and PEDro. Selection criteria Full-text and peer-reviewed studies in English studying the effectiveness of AAC in patients with cerebral palsy were included. Studies with patients (<18 years) diagnosed with CP were included. Data analysis A narrative analysis was conducted to evaluate the efficacy of AAC methods. A random-effects model meta-analysis was used to assess determinants of AAC intervention outcomes. Results The online database and manual reference search revealed 445 records. Nine studies investigating a total of 294 subjects with CP met predefined eligibility criteria: 4 studies with single subject, multiple baseline research designs, 3 longitudinal cohort studies, 1 case control study and 1 case series. Results revealed moderate-quality evidence that AAC interventions improve the receptive and expressive communication skills in patients with CP. The random-effects model meta-analysis revealed the power of identified determinant variables affecting the AAC intervention outcomes. Conclusion Diversity of CP patients requires proper analysis of determinant variables to ensure the efficacy of AAC assessment and intervention. More studies of high methodological and practical quality assessing the efficacy of AAC interventions are needed to clarify the evidence.

Brincar e Contar Histórias com Crianças com Transtorno do Espectro Autista: Mediação do Adulto / Playing and Telling Stories with Children with Autism Spectrum Disorder: Mediation of Adults

RESUMO: O objetivo deste estudo foi descrever a mediação do adulto e as habilidades comunicativas de duas crianças com Transtorno do Espectro Autista, em situações lúdicas, por meio da narração de histórias. As atividades foram realizadas em um Centro Especializado em Reabilitação de uma cidade do interior do estado de São Paulo. Foram selecionadas duas crianças do gênero masculino com 2 anos e 9 meses e 3 anos e 3 meses de idade. Os dados foram coletados durante seis meses, por meio de atividades semanais com as famílias e profissionais da saúde, seguindo um programa de intervenção com histórias. As atividades foram filmadas e registradas por meio do diário de campo. As categorias e as subcategorias foram identificadas após a transcrição dos vídeos e incorporação dos registros do diário de campo em um texto único organizado em sequência temporal das atividades. As categorias e as subcategorias identificadas em relação aos objetivos deste estudo foram: a) mediação do adulto: modelação, questionamento e entonação da voz do adulto interlocutor, uso de sistemas suplementares e alternativos de comunicação: sistema tangível, sistema pictográfico e mediação combinada; b) habilidades de expressão: expressão verbal e vocal, expressão não verbal e vocal, expressão não verbal e não vocal, expressões combinadas. Os resultados ilustraram a importância da mediação do adulto na atividade da narração de histórias como um instrumento para o acesso à linguagem e às habilidades comunicativas das crianças envolvidas durante o processo de mediação.

ABSTRACT: The aim of this study was to describe the mediation of adults and the communication skills of two children with Autism Spectrum Disorder, in playful situations, through storytelling. The activities were carried out in a Specialized Rehabilitation Center in a city in the hinterlands of the state of São Paulo, Brazil. Two male children aged 2 years and 9 months and 3 years and 3 months old were selected. Data were collected during six months, through weekly activities with families and health professionals, following an intervention program with stories. The activities were filmed and recorded through the field diary. The categories and subcategories were identified after the videos were transcribed and the field diary records were incorporated into a single text organized in time sequence of the activities. The categories and subcategories identified in relation to the objectives of this study were: a) adult mediation: modeling, questioning and intonation of the adult interlocutor's voice, use of supplementary and alternative communication systems: tangible system, pictographic system and combined mediation; b) skills of expression: verbal and vocal expression, non-verbal and vocal expression, non-verbal and non-vocal expression, combined expressions. The results illustrated the importance of adult mediation in the activity of storytelling as an instrument for accessing language and communicative skills of the children involved during the mediation process.

Implementação do Pecs Associado ao Point-Of-View Video Modeling na Educação Infantil para Crianças com Autismo / Implementation of PECS Associated with Point-Of-View Video Modeling in Early Childhood Education for Children with Autism

RESUMO Este estudo teve por objetivo analisar os efeitos do Picture Exchange Communication System (PECS) associado ao Point-of-view Video Modeling (POVM) nas habilidades comunicativas de três crianças diagnosticadas com Transtorno do Espectro Autista (TEA) e Necessidades Complexas de Comunicação. Empregou-se o delineamento experimental de múltiplas sondagens combinado ao delineamento de tratamentos alternados, sendo o PECS associado ao POVM a variável independente e as habilidades de comunicação a variável dependente. Os dados foram analisados considerando aspectos como: a porcentagem de non-overlapping, a porcentagem de respostas corretas quanto ao desempenho dos participantes e os dados da escala Likert quanto à validade social. Os resultados mostraram que a partir do início da intervenção, os níveis e as tendências de seus dados mudaram, todos os participantes obtiveram o critério, atingindo o non-overlapping de 100%. Em todas as fases do PECS associado ao POVM, os participantes obtiveram porcentagem média acima de 90%. O estudo foi considerado pelos responsáveis, pelas estagiárias e pelas professoras como socialmente válido. Conclui-se que os participantes com TEA indicaram uma mudança após a intervenção, ao comparar a condição de linha de base com a intervenção e follow-up, demonstrando uma possibilidade em Comunicação Suplementar e/ou Alternativa para as crianças com TEA.

ABSTRACT This study aimed to analyze the effects of the Picture Exchange Communication System (PECS) associated to Point-of-view Video Modeling (POVM) in communicative skills of three children diagnosed with Autistic Spectrum Disorder (ASD) and Complex Communication Needs. The experimental design of multiple probe combined with the design the alternate treatments was used, being PECS associated to POVM the independent variable and the communication skills were the dependent variables. Data were analyzed considering aspects such as: the percentage of non-overlapping, participants' performance percentage of correct responses and Likert scale data on social validity. The results showed that from the beginning of the intervention, the data levels and trends changed, all the participants obtained the criterion, reaching 100% non-overlapping. In all phases of PECS associated to POVM the participants had an average percentage above 90%. The study was considered by those responsible for the child, the trainees and the teachers. It was concluded that the participants with ASD indicated a change after the intervention, when comparing baseline condition with intervention and follow-up, demonstrating a possibility in Augmentative and Alternative Communication for children with ASD.

Augmentative and Alternative Communication in Ventilated Patients: A Scoping Review / Comunicación Aumentativa y Alternativa en Pacientes Ventilados: Scoping Review / Comunicação Alternativa e Aumentativa em Doentes Ventilados: Scoping Review

ABSTRACT Objectives: to map the benefits of Augmentative and Alternative Communication in ventilated adults in Intensive Care Unit and identify strategies used. Methods: a Scoping Review was carried out according to the Joanna Brigs Institute Protocol. The research question was: "In adult patients ventilated in Intensive Care Units, what are the benefits of Augmentative and Alternative Communication?". An article research was carried out at PubMed, EBSCOhost and B-On databases. It was held between October and November 2018, from 2013 to 2018, in Portuguese and in English. Results: 61 references were obtained. After selection according to the inclusion criteria, 7 articles were analyzed. Conclusions: studies enunciate Augmentative and Alternative Communication as a strategy to enhance communication, describing methods and tools. There is no agreement on the most effective tool.

RESUMEN Objetivos: mapear los beneficios de la Comunicación Aumentativa y Alternativa en adultos ventilados en Unidades de Terapia Intensiva e identificar las estrategias utilizadas. Métodos: fue realizada una Scoping Review según el Protocolo Joanna Brigs Institute. La cuestión de investigación fue: "En enfermos adultos ventilados en Unidades de Terapia Intensiva: ¿cuáles los beneficios de la Comunicación Aumentativa y Alternativa?". Una investigación de artículos fue realizada en las bases de datos PubMed, EBSCOhost y B-On, entre octubre y noviembre de 2018, referente al periodo de 2013-2018, en los idiomas portugués e inglés. Resultados: tras la selección según los criterios de inclusión, se obtuvieron 7 referencias. Conclusiones: los diferentes estudios enuncian a Comunicación Aumentativa y Alternativa como estrategia que potencia la comunicación, describiendo los métodos e instrumentos. No existe consenso relativamente al instrumento más eficaz.

RESUMO Objetivos: mapear os benefícios da Comunicação Alternativa e Aumentativa em adultos ventilados em Unidade de Terapia Intensiva e identificar estratégias utilizadas. Métodos: realizada uma Scoping Review segundo o Protocolo Joanna Brigs Institute. A questão de pesquisa foi: "Em doentes adultos ventilados em Unidades de Cuidados Intensivos, quais os benefícios da Comunicação Alternativa e Aumentativa?". Realizada pesquisa de artigos nas bases de dados PubMed, EBSCOhost e B-On, entre outubro e novembro de 2018, referente ao período de 2013 e 2018, nos idiomas português e inglês. Resultados: foram obtidas 61 referências. Após seleção de acordo com os critérios de inclusão, foram analisados 7 artigos. Conclusões: os diversos estudos enunciam a Comunicação Alternativa e Aumentativa enquanto estratégia potenciadora da comunicação, descrevendo métodos e instrumentos. Não existe consenso relativamente ao instrumento mais eficaz.

Programa de Comunicação Alternativa para uma Criança com Paralisia Cerebral e seus Parceiros de Comunicação: um Estudo de Delineamento de Múltiplas Sondagens / Alternative Communication Program for a Child with Cerebral Palsy and His Communication Partners: a Multiple-Probe Design Study

RESUMO A Comunicação Suplementar e/ou Alternativa para crianças (CSA) com paralisia cerebral é essencial para o seu envolvimento em diferentes contextos. Assim sendo, o objetivo deste artigo foi verificar os efeitos de um programa individualizado de CSA para uma criança com paralisia cerebral não verbal em três contextos da vida cotidiana: escola, casa e ambientes clínicos. Este estudo utilizou o delineamento experimental de múltiplas sondagens. Os participantes foram uma criança com paralisia cerebral e três parceiros de comunicação em seus respectivos contextos: professor, mãe e terapeuta ocupacional. A intervenção consistiu no processo individualizado de formação teórica e prática dirigida aos parceiros de comunicação e implementação da CSA. Após a implementação do programa de intervenção, os resultados demonstraram que a criança e os parceiros de comunicação usaram com sucesso os recursos da CSA. Os resultados apontam que as estratégias adotadas nos três contextos foram eficazes e proporcionaram aprendizado sobre o uso de CSA para a criança e seus parceiros de comunicação.

ABSTRACT Augmentative and Alternative Communication (AAC) for children with cerebral palsy is essential for their engagement in different contexts. Therefore, the purpose of this paper was to verify the effects of a program of AAC for a non-verbal child with cerebral palsy in three different contexts of daily life: school, home and rehabilitation settings. This study used a Multiple-probe Experimental Design. The participants were a child with cerebral palsy and three communication partners in their respective settings: teacher, mother and occupational therapist. The intervention consisted of the individualized process of theoretical and practical training directed at the communication partners and implementation of the AAC. After implementation of the intervention program, the results showed that the child and the communication partners successfully used AAC resources. The results indicate that the strategies adopted in the three contexts were effective and provided to the child and his communication partners an understanding of how to use the AAC effectively.

AAC Technologies with Visual Scene Displays and "Just in Time" Programming and Symbolic Communication Turns Expressed by Students with Severe Disability.

BACKGROUND: The current study investigated the impact of an intervention that included aided augmentative and alternative communication (AAC) technologies on the frequency of symbolic communication turns of school-age children, adolescents, and young adults with severe disability. METHOD: Nine students ages 8-20 were engaged in interactive activities using an aided AAC system with visual scene displays (VSDs; concepts embedded within a photograph of a naturally occurring event), and "just-in-time" (JIT) programming (the capability to add new contexts "on the fly"). Effectiveness was evaluated using a single subject multiple probe across participants design. RESULTS: All participants demonstrated increases in symbolic communication turns upon introduction of the AAC technologies with VSDs using JIT technology. CONCLUSIONS: AAC with VSDs and JIT programming may be effective in increasing symbolic communication for students with severe developmental disability. The fast and easy creation of VSDs and hotspots to provide communication may be a valuable tool for interventionists.

Use of alternative communication technology on quality of life evaluation of head and neck neoplasms patients / Uso de tecnologia de comunicação alternativa na avaliação da qualidade de vida de pacientes com câncer de cabeça e pescoço

Abstract: Introduction: Communication, social interactions and health-related quality of life (HRQoL) of the person affected by head and neck cancer (HNC) are affected by both diagnosis and treatment. Objective: The aim of this study was to evaluate the use of alternative communication software as a resource for the application of HRQoL assessment tools for people with HNC who underwent laryngectomy. Method: An exploratory, cross-sectional study with 100 adult individuals of both genders. A Sociodemographic identification form was used and the Brazilian Criteria for Economic Classification was applied the Functional Assessment of Cancer Therapy-Head and Neck-FACT-H&N scale. These instruments were inserted, in their original format, into the alternative communication software Livox®, which is an auxiliary communication resource that favors the communication of people with speech difficulties providing a conversion of text into sounds. Results: The dimensions of functional well-being and emotional well-being were the most affected in the evaluation of HRQoL. Most interviewees did not have difficulty in using Livox® to respond to the questionnaires. However, there was an association between the age and professional activity in relation to the use of the software, since 100% of the over-58s and non-active retirees reported some difficulties in their use. Conclusion: The use of technological resources may facilitate access to services and treatments by laryngectomized individuals, however, the elderly present greater difficulties in the use of modern communication technologies due to sociocultural contexts, cognitive and emotional difficulties. Occupational therapy can facilitate this adaptation through the use of resources, strategies, and techniques for the use of technology instruments as facilitators for communication in intra- and extra-hospital contexts, providing autonomy and independence for the subjects.

Resumo Introdução: A comunicação, as interações sociais e a qualidade de vida relacionada à saúde (QVRS) da pessoa acometida pelo câncer de cabeça e pescoço (CCP), são afetadas tanto pelo diagnóstico como pelos tratamentos. Objetivo: Avaliar o uso de um software de comunicação alternativa como recurso para aplicação de instrumentos de avaliação da QVRS de pessoas com CCP, submetidas à laringectomia. Método: Estudo exploratório, transversal, realizado com 100 pessoas adultas, de ambos os sexos. Foi utilizada uma ficha de identificação Sociodemográfica e foram aplicados o Critério de Classificação Econômica Brasil e a escala Functional Assessment of Cancer Therapy - Head and Neck - FACT - H & N. Esses instrumentos foram inseridos, em seu formato original, no software de comunicação alternativa Livox®, que é um recurso auxiliar de comunicação que favorece a comunicação de pessoas com dificuldades na fala, fornecendo uma conversão de texto em sons. Resultados: As dimensões do Bem-Estar Funcional e Bem-Estar Emocional foram as mais comprometidas na avaliação da QVRS. Os entrevistados, em sua maioria, não demonstraram dificuldade em utilizar o Livox® para responder aos questionários. Porém, observou-se associação entre a idade e atividade profissional exercida em relação à utilização do software, pois 100% das pessoas com mais de 58 anos e os aposentados não ativos referiram alguma dificuldade em sua utilização. Conclusão: O uso de recursos tecnológicos pode facilitar acessos à serviços e tratamentos por parte das pessoas laringectomizadas, mas os idosos apresentam maiores dificuldades no uso de tecnologias modernas de comunicação, devido à contextos socioculturais, dificuldades cognitivas e emocionais. A terapia ocupacional pode facilitar essa adaptação através do uso de recursos, estratégias e técnicas de uso de instrumentos de tecnologia como facilitadores para comunicação em contextos intra e extra-hospitalares, proporcionando autonomia e independência aos sujeitos.

AACVOX: mobile application for augmentative alternative communication to help people with speech disorder and motor impairment

AbstractIntroduction: Communication is a fundamental element for the development of human beings, promoting their coexistence in society. However, changes in muscle tone, associated with cerebral palsy (CP), among other conditions, cause phono-articulatory dysfunctions hindering speech capabilities. Although there are resources for augmentative and alternative communication (AAC), most of them do not completely satisfy the needs of individuals with motor impairment. Therefore, this study proposes a tool based on mobile technology for AAC, which can be adapted to the characteristics of the motor limitations of CP users. Methods Mobile system development was conducted employing user-centered design and development methods. Functions were developed allowing the communication of phrases through pictographic resources and a mechanism of speech synthesis, that can be customized according to specific communication needs. To validate this system, 20 CP volunteers with speech difficulties and motor impairment were recruited from two institutions in the State of São Paulo, Brazil. They operated the system following a pre-defined test protocol, and they answered a system usability scale (SUS) questionnaire, to rate the ease of learning, memorization, efficiency, occurrence of runtime errors, and the level of user satisfaction. Results The results showed a score of 85.85 ± 2.28 above the average SUS scale, for each one of the quality components assessed by the volunteers. Conclusion The developed software is user-friendly, representing a new option for AAC, and is customized according to the communication needs of people with speech disorder and motor impairment.

Augmentative and alternative communication in children with Down's syndrome: a systematic review.

BACKGROUND: The use of technology to assist in the communication, socialization, language, and motor skills of children with Down's syndrome (DS) is required. The aim of this study was to analyse research findings regarding the different instruments of 'augmentative and alternative communication' used in children with Down's syndrome. METHODS: This is a systematic review of published articles available on PubMed, Web of Science, PsycInfo, and BVS using the following descriptors: assistive technology AND syndrome, assistive technology AND down syndrome, down syndrome AND augmentative and alternative communication. Studies published in English were selected if they met the following inclusion criteria: (1) study of children with a diagnosis of DS, and (2) assistive technology and/or augmentative and alternative communication analysis in this population. RESULTS: A total of 1087 articles were identified. Thirteen articles met the inclusion criteria. The instruments most used by the studies were speech-generating devices (SGDs) and the Picture Exchange Communication System (PECS). CONCLUSION: Twelve instruments that provided significant aid to the process of communication and socialization of children with DS were identified. These instruments increase the interaction between individuals among this population and their peers, contributing to their quality of life and self-esteem.

Low cost assistive technology to support educational activities for adolescents with cerebral palsy.

INTRODUCTION: The concept of assistive technology covers several areas of action; one of them is communication with the elaboration of accessible solutions to overcome daily difficulties. It contributes to the resumption of functional abilities, expanding and facilitating inclusion and independent living. OBJECTIVE: To analyze the usability of a low cost prototype device to support educational activities of adolescents with cerebral palsy. METHODS: A descriptive observational study. The evaluation of a prototype device was made through a validated questionnaire, Quest Version 2.0, on the level of the user's satisfaction with an assistive technology, composed of 12 evaluation items. The questionnaire was filled out by the educator based on the observation of four wheelchair-bound participants diagnosed with cerebral palsy according to the international classification of diseases and health-related problems, ICD-10, who attend a coexistence and teaching institution in the state of São Paulo, Brazil. RESULTS: The device developed was considered an assistive technology, which provided an experience with a positive level of satisfaction for the participants. CONCLUSION: The tested prototype contributes to communication and interaction allowing adolescents with cerebral palsy to participate in educational activities. Implications for Rehabilitation The device assists the individual in the educational activities and can positively influence their development, observe the individual number 5, who has an important limitation in coordination and fine movements, placing the role of the task in the vertical position offers a new perspective to perform the task, this stimulates him to try to perform the work, so the challenge was adjusted to the demands of each individual which can contribute to its neuromotor development, the amplitude of the distal movements and the manual ability, since it must look for alternatives to complete the task requested.

Manejo de la salud bucal en discapacitados. Artículo de revisión / Oral health management in people with disabilities

Resumen En el mundo existen más de 1 000 millones de personas con alguna discapacidad y aunque estas condiciones no son sinónimos de alteraciones bucales severas, si se ha logrado detectar en los pacientes que las padecen, señales de mala higiene bucal y enfermedades bucales producto de la poca o nula atención odontológica, relacionadas en gran medida al temor que los profesionales del área enfrentan al momento de la atención. La comunicación con pacientes en condición de discapacidad como autismo, síndrome de Down, parálisis cerebral, deficiencia auditiva, presenta un componente adicional de difultad, por lo cual es necesario apoyarse en un sistema de estrategias comunicativas, protocolos de atención y otros medios que pueden variar entre las distintas discapacidades. Estos permiten que personas con dificultades de comunicación puedan relacionarse e interactuar con su entorno. La capacitación para el odontólogo en este campo no es fácil, dado que no se cuenta con suficientes programas que cubran de manera completa la formación del profesional en este ámbito. El propósito de este artículo fue realizar una revisión de tema sobre algunos tipos de discapacidades, las manifestaciones bucales más comunes, el manejo odontológico y estrategias de comunicación alternativa apropiada, para brindar una atención de calidad.

Abstract In the world there are more than one billion people with disabilities and although these terms are not synonymous with severe oral changes, it has been detected that people with disabilities have more risk to suffer oral pathologies due to poor dental service related to the reluctance dentist have to take care of these patients. Communication with patients with conditions such as autism, Down syndrome, cerebral palsy, hearing impairment; presents an additional component of difficulty, so it is necessary to rely on a system of communicative strategies, care protocols and means of support that may vary among different disabilities. These enable people with communication difficulties to interact with their environment. Training for dentists on this field is not easy, since there are not sufficient programs covering completely professional training in dentistry in this area. The purpose of this article was to review some types of disabilities, their most common oral manifestations, dental management and appropriate alternative communication strategies to provide good dental services.

Nuevas tecnologías: puentes de comunicación en el trastorno del espectro autista (TEA) / New technologies: communication bridges in autism spectrum disorders (ASD)

Los trastornos del espectro autista (TEA) son alteraciones del neurodesarrollo caracterizados por dificultades en interacción social, con principal hincapié en la comunicación, sea esta verbal y no verbal. La investigación y desarrollo aplicada en TEA se centra en hallar estrategias terapéuticas adecuadas y que sean focalizadas en el individuo, valiéndose de todos los recursos que estén al alcance (interfaces virtuales, realidad virtual, entornos 3D, robótica, etc). Así, el uso de tecnologías para mejorar y estimular particularmente la comunicación de los niños con TEA ha aumentado en los últimos tiempos de manera exponencial. Estas herramientas en contextos terapéuticos posibilitan una generalización del comportamiento hacia contextos naturales del niño. Por lo tanto, el uso de un software personalizado en dispositivos móviles permitirá que se avance con su tratamiento fuera del ámbito clínico pudiendo utilizarlo en su casa/escuela para comunicarse con sus vínculos sociales cercanos.

Autism Spectrum Disorder (ASD) refers to neurodevelopmental problems characterized by difficulties in social interaction, especially verbal or nonverbal communication. Research on ASD focuses in finding appropriate solutions for a patient, using all available resources (virtual interfaces, virtual reality, 3D environments, robotics, etc.) in order to develop therapeutic strategies. Therefore, the use of technologies to improve and stimulate communication, particularly in children with ASD, has increased exponentially in recent years. When used in therapeutic contexts, these tools allow a generalization of a child's behavior towards a natural context. Hence, the use of customized softwares for mobile devices will allow progress in treating ASD beyond a clinical setting and may be used at home/school to communicate with their close social peers.

High-technology augmentative communication for adults with post-stroke aphasia: a systematic review.

INTRODUCTION: Augmentative and alternative communication (AAC) systems were introduced into clinical practice by therapists to help compensate for persistent language deficits in people with aphasia. Although, there is currently a push towards an increased focus on compensatory approaches in an attempt to maximize communication function for social interaction, available studies including AAC systems, especially technologically advanced communication tools and systems, known as 'high-technology AAC', show key issues and obstacles for these tools to become utilized in mainstream clinical practice. Areas covered: The current review synthesizes communication intervention studies that involved the use of high-technology communication devices to enhance linguistic communication skills for adults with post-stroke aphasia. The review focuses on compensatory approaches that emphasized functional communication. It also summarizes recommendations for the report of studies evaluating high-technology devices that may be potentially relevant for other researchers working with adults with post-stroke aphasia. Expert commentary: Taken together with positive results in heterogeneous studies, high-technology devices represent a compensatory strategy to enhance communicative skills in individuals with post-stroke aphasia. Improvements in the design of studies and reporting of results may lead to better interpretation of the already existing scientific results from aphasia management.

Benefícios do Programa PECS-Adaptado para um Aluno com Paralisia Cerebral / Benefits of PECS-Adapted Program for a Student with Cerebral Palsy

RESUMO: a comunicação humana constitui uma troca de sentimentos e necessidades entre duas ou mais pessoas, seja realizada pela linguagem oral, gestual, gráfica e/ou escrita. Com isso, este estudo teve como objetivo verificar os efeitos da implementação do Sistema de Comunicação por intercâmbio de figuras associada a metodologia do Currículo Funcional (PECS-Adaptado) em um aluno com paralisia cerebral. A pesquisa foi realizada nas dependências de uma escola de educação especial, em uma cidade de pequeno porte localizada no interior do estado de São Paulo. Participaram do estudo um aluno com paralisia cerebral e sem a fala oral, sua professora e seus pais. Os pais do aluno e a professora foram orientados para a utilização do sistema em casa e na escola, respectivamente, instrumentalizando assim interlocutores mais imediatos. A coleta dos dados durou aproximadamente sete meses. Durante a pesquisa, observou-se que o participante com paralisia cerebral aumentou suas habilidades comunicativas, de acordo com as suas necessidades e a professora e os pais compreenderam a importância do uso do sistema de comunicação alternativa para o processo de ensino e aprendizagem.

ABSTRACT: Human communication is an exchange of feelings and needs between two or more people, either carried out by oral, sign, graphic and/or written languages. Therefore, this study aimed to verify the effects of the implementation of the Picture Exchange Communication System. (PECS-adapted) for a student with cerebral palsy. The research was carried out in a special education school, in a small town in the state of São Paulo, Brazil. One non-speaking student with cerebral palsy participated in the research, his teacher and his parents. The parents and the teacher were guided in using the system at home and at school, and this instrumentalizing the most immediate partners. Data collection lasted about seven months. During the research, it was observed that the participant increased his communication skills, according to his needs, and the teacher and the parents understood the importance of using the alternative communication system for teaching and learning.

Estratégias de Comunicadores Auxiliados para Instruir Parceiros de Comunicação na Construção de Modelos Físicos / AIDED Communicators Strategies to Instruct Communication Partners when Constructing Physical Models

RESUMO: este estudo teve como objetivo analisar as estratégias utilizadas pelos comunicadores auxiliados e comunicadores naturalmente falantes ao instruir um parceiro de comunicação para a construção de modelos físicos. Os participantes foram 18 comunicadores auxiliados e 18 comunicadores naturalmente falantes de um grupo de comparação, com idade entre 5-15 anos, do Brasil e da Noruega. Além disso, três diferentes grupos de parceiros de comunicação naturalmente falantes participaram da pesquisa: pais, colegas e profissional. Em um primeiro momento, as crianças comunicadores auxiliados foram avaliadas. Em seguida, as tarefas de construção foram administradas. Nessa tarefa, os comunicadores auxiliados e as crianças do grupo de comparação tiveram que instruir o parceiro de comunicação para construir modelos físicos. Os participantes foram filmados ao fazer a construção e as gravações foram transcritas. Foi realizada a análise de conteúdo, de que resultou no delineamento de categorias, e os resultados foram analisados qualitativa e quantitativamente. Este estudo sugere que existem diferenças entre as estratégias utilizadas nas construções. Comunicadores auxiliados e seu parceiro de comunicação usam mais tempo para concluir as construções. No entanto, ambos os grupos usaram a linguagem para instruir o parceiro de comunicação e finalizar as construções.

ABSTRACT: This study aimed to analyze the strategies used by aided communicators and of naturally speaking communicators to instruct a communication partner for the construction of physical models. Participants were 18 aided communicators and 18 naturally speaking communicators of a comparison group, aged 5-15 years, from Brazil and Norway. In addition, three different groups of naturally speaking communication partners participated in the research: parents, peers and one professional. At first, the aided communicator children were evaluated. Next, the construction tasks were administered. In this task, aided communicators and comparison group had to instruct the communication partner to build physical models. Participants were filmed during the building and the recordings were transcribed. Content analysis was performed, which resulted in the delineation of categories, and the results were qualitatively and quantitatively analyzed. This study suggests that there are differences between the strategies used in the constructions. Aided communicators and their communication partners spent more time to complete the construction. However, both groups used the language to instruct the communication partners and finish the constructions.

As Contribuições do Uso da Comunicação Alternativa no Processo de Inclusão Escolar de um Aluno com Transtorno do Espectro do Autismo / Contributions of Alternative Communication in the Process of School Inclusion of a Student with Autism Spectrum Disorder

RESUMO: o presente estudo é a continuidade de uma pesquisa maior, cujo objetivo foi implementar um programa de capacitação oferecido a professores da rede municipal do RJ, atuando no Atendimento Educacional Especializado (AEE) para introduzir o uso do sistema PECS-Adaptado junto aos alunos com Transtorno do Espectro do Autismo (TEA). Ao término da pesquisa, surgiram questionamentos, dando origem a esta investigação, que foi dividida em dois estudos: primeiro foi o follow-up da pesquisa maior e teve como objetivo verificar a eficácia e continuidade do uso do PECS-Adaptado pela professora do AEE com seu aluno com TEA. Foi realizado em uma sala de recursos no município do RJ e participaram da pesquisa a professora e o aluno com TEA. Ocorreram sete sessões, que foram analisadas a partir de um protocolo de registro dos níveis de apoio oferecido nas fases do PECS-Adaptado. Os resultados sinalizaram continuidade no uso do sistema pela professora. O Estudo II objetivou analisar as interações comunicativas do mesmo aluno do estudo I com uma professora e uma estagiária em ambiente de sala de aula regular. Foram realizadas 10 sessões de observação e intervenção quanto aos atos comunicativos e estes foram categorizados e dispostos em quadros para melhor visualização. Os resultados mostraram maior interação comunicativa do aluno com a estagiária na fase de intervenção, além de generalizar o uso do PECS-Adaptado na sala de aula regular. Concluiu-se que a comunicação é um dos fatores fundamentais para que a inclusão escolar de um aluno com TEA ocorra de forma mais efetiva.

ABSTRACT: This study is the continuation of a larger research aimed to implement a training program offered to the teachers of Rio de Janeiro, working in the Specialized Education Service to introduce the use of Adapted-PECS system to the students with Autism Spectrum Disorder (ASD). At the end of the study, questions were raised, which originated this research, and were divided into two studies: the first one was the follow-up of the major research and aimed to verify the effectiveness and continued use of Adapted-PECS by the teacher with the student with ASD. It was conducted in a Multifuncional Resources classroom in RJ with the participation of the teacher and the student with ASD as study subjects. Data was collected in seven sections, which were analyzed from a record protocol of support levels offered in the phases of Adapted-PECS. The results showed continuity in the use of the system by the teacher. Study II aimed to analyze communicative interactions of the same student in Study I with a teacher and a trainee in the regular classroom environment. A series of 10 observation sessions and intervention were conducted to verify the communicative acts, which were categorized and arranged in tables. The results showed higher communicative interaction with the student and the trainee in the intervention phase, in addition to generalize the use of adapted-PECS in the regular classroom. It was concluded that communication is one of the key factors for effective school inclusion of a student with ASD.