Estudo de vocábulos para avaliação de crianças com deficiência sem linguagem oral

Researchers in the field of Augmentative and Alternative Communication point out the lack of instruments for assessing children and young people with a complex communication needs. This study's focus is the selection of words for creating an instrument for the vocabulary range in non-speaking children aged two to eleven years and eleven months. Three studies were performed. The first study identified and described tools available for assessing receptive vocabulary and their respective word lists. The second identified and described research that presented word inventories or word lists. The third study identified the vocabulary reported by parents and teachers. The words that were identified in the three studies were analyzed according to: the number of times they occurred; the Picture Communication Symbols system classification; and a semantic and syntactic classification. Based on these studies the following criteria for vocabulary selection were established for word selection: the 45 words which appeared in all three studies, the words that occurred five times or more, considering the three studies, representing 167 (14.14%) words; the words identified in study one or two, but that had been reported by the families - 183 (19.37% out of 945 words) - or by teachers - 108 (11.43% out of 945 words). The word list was composed of 269 items, classified in 18 semantic and syntactic topics; it represents an initial tool for professionals in the field of health and education to set goals for beginning assessment of children and teenagers who are users of Augmentative and Alternative Communication systems.

Orientação para familiares de alunos com paralisia cerebral usuários de sistemas de comunicação suplementar e alternativa

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Opinião de profissionais da educação e da saúde sobre o uso da prancha ortostática para o aluno com paralisia cerebral

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ingestão Oral e Grau de Comprometimento da Disfagia Orofaríngea Neurogênica Pré e Pós-Fonoterapia

Objective. To compare, pre- and post-swallowing therapy, the level of oral intake scale, and the degree of severity of neurogenic oropharyngeal dysphagia. Method. 19 patients with oropharyngeal dysphagia: 10 Post-Stroke adults, aged from 44 years to 76 years (group 1 – G1), and nine children with Cerebral Palsy, aged from two years and five months to 15 years (group 2 – G2). We excluded individuals in the process of spontaneous recovery. We held retrospective analysis of clinical protocols for clinical speech therapy evaluation with classification of the degree of dysphagia severity, applied before and after swallowing therapy. We used the Functional Oral Intake Scale - FOIS to assess the level of oral ingestion, pre and post-swallowing therapy. Results. The degree of commitment of dysphagia was favorable change only in adults, and in FOIS these changes occurred in both groups. Conclusion. There were favorable changes in the degree of impairment of oropharyngeal dysphagia and levels of FOIS, pre and post - speech therapy in stroke, but in ECINP markers used showed no favorable changes should even be reviewed for application in this population. Future studies are needed to investigate the variables in this sample.

Adequação de demandas funcionais de atividades para a participação escolar de crianças com disfu'nções neuromotoras

The school participation is a prerequisite for the construction of knowledge, learning and development. Neurological deficits may affect child's ability to explore the environment and engage in typical activities. Considering the importance of encouraging professionals in the field of education to conduct simple adjustments in school activities of daily life, this study aimed to adapt, with low cost materials, resources of entertainment and educational for children with neuromotor disorders . It was objects of this study eight resources prescribed and designed for three children diagnosed with cerebral palsy: domino, puzzle, memory game, moving magnetized alphabet, crossword, doll body scheme, adaptation of pencils for writing and bracelet sinker.The analysis of these resources occurred in the parameters of conventional design and management skills, followed by identifying the limiting conditions of the motor skills of the cases observed, indicating the materials used in the adaptation and possible uses. This study provides subsidy for implementation of teaching strategies in the care of students with neuromotor disorders.

Avaliação das Habilidades Motoras de Alunos com Paralisia Cerebral: Uso do ASPA-PC

Due to motor limitations of students with cerebral palsy, in many cases, there is the need to adapt pedagogical resources or indicate among available materials which is more accessible according to their Motor Skills to plan teaching strategies. It is known, however, that for these procedures you must perform an assessment not only able to identify their difficulties in relation to the motor act, but their skills related to resource access and what is expected with the handling. However, it is not so easy to evaluate specific characteristics of each student, since the literature has considered that teachers, even those with training in special education, have had difficulty not only in assessing students with disabilities, but also to consider data assessment to plan an effective intervention in teaching these students. Thus, the aim of this study was to evaluate the motor skills of five students with cerebral palsy using the instrument called ASPA-PC. The results indicated that the use of ASPA-PC enabled the identification of motor skills in relation to access to the materials specifically to each student and therefore was possible : 1) adapting teaching resource; 2) contraindicate the use of a particular feature due to difficulties physical and the energy expenditure of the student performing the movement and 3) indicate more accessible materials to the student, taking into account its design. Furthermore, the evaluation result corroborated to develop teaching strategies for each student according to their characteristics.

Sistemas suplementares e alternativos de comunicação nas habilidades expressivas de um aluno com paralisia cerebral

The objective of this research was to describe the use of an augmentative and alternative system for a student with cerebral palsy during intervention. A 10-year-old male student with cerebral palsy participated in this investigation. He attended special classes for people with disability in a public school in a city of the interior of Sao Paulo. The scheduled activities were carried out twice a week for two years at the Laboratory of Special Education of a public University of São Paulo. All of the tapes describing the activities that were filmed during the assessment and implementation of augmentative and alternative communication resource were watched and described using a specific protocol. Based on the information from the protocols, the sessions with intervals greater than 20 days and the ones with activities involving the communication board with the time equal or greater than 20 minutes during the first year of intervention were selected. The chosen sessions were transcribed in full and, after analyzing the text, the following categories were established, according to the stated goal: the graphic system helped the student with utterances of vertical structure (56%) associated with the oral (14%) and non-oral and non-verbal form (30%), while the use of the graphic system along with other forms collaborated to enhance statements, enabling better understanding of the child s intention. The use of augmentative and alternative communication systems provided the expansion of effective dialogical situations for the student during the activities carried out in speech therapy.

Efeitos da comunicação alternativa na interação professor-aluno com paralisia cerebral não-falante

Speech has been regarded as a social communicative modality required for building relationships in different contexts and cultures. Nevertheless, this is not always a readily available resource, especially for those who have developmental disorders. In this sense, Augmentative and Alternative Communication resources and strategies have been used by nonspeaking students with disabilities as useful tools to achieve greater social participation in different environments. Therefore, the present study examined the interaction between teachers and a student with cerebral palsy before and after the use of Alternative Communication strategies in the classroom. The study had a quantitative and qualitative nature and was designed as an intervention study. There were four main stages: 1) filming before the introduction of the resources in the classroom, 2) training the school teachers 3) providing technical assistance regarding the use of alternative communication to the child's teacher 4) filming teacher-student interactions using these technological resources. The interactions were transcribed and grouped into links. In this research, a link means the initiator's behavior directed to the exchange partner and the response in sequence from the interlocutor back to the initiator. It was found that the established interactions presented a maximum of four links, with greater frequency for episodes of 1st and 2nd links. After the intervention, there were different contexts with the presence of interactions up to the 6th link, often greater frequency for episodes of 1st, 2nd and 3rd links. In addition, the teacher showed a tendency to use symbols only as a tool for evaluating and teaching concepts. This perception changed as the teacher became familiarized with the Augmentative and Alternative Communication technology resources.

Paralisia cerebral, extensão universitária e trabalho voluntário: práticas da reflexividade

Report of voluntary work with youngsters suffering from cerebral palsy syndrome. Objective is to highlight information about this syndrome and possibilities of their treatment, especially referred to the method of conductive education. It aims to promote a training experience of a reflexive identity of mother and family of these patients.

Elaboração e validação de um instrumento de avaliação da disfagia orofaríngea na paralisia cerebral

Pós-graduação em Fonoaudiologia - FFC

Saúde bucal e qualidade de vida em indivíduos com paralisia cerebral e Síndrome de Down: percepção dos cuidadores

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Analysis of human body kinematics using a hybrid markerless video acquisition and processing

A main objective of the human movement analysis is the quantitative description of joint kinematics and kinetics. This information may have great possibility to address clinical problems both in orthopaedics and motor rehabilitation. Previous studies have shown that the assessment of kinematics and kinetics from stereophotogrammetric data necessitates a setup phase, special equipment and expertise to operate. Besides, this procedure may cause feeling of uneasiness on the subjects and may hinder with their walking. The general aim of this thesis is the implementation and evaluation of new 2D markerless techniques, in order to contribute to the development of an alternative technique to the traditional stereophotogrammetric techniques. At first, the focus of the study has been the estimation of the ankle-foot complex kinematics during stance phase of the gait. Two particular cases were considered: subjects barefoot and subjects wearing ankle socks. The use of socks was investigated in view of the development of the hybrid method proposed in this work. Different algorithms were analyzed, evaluated and implemented in order to have a 2D markerless solution to estimate the kinematics for both cases. The validation of the proposed technique was done with a traditional stereophotogrammetric system. The implementation of the technique leads towards an easy to configure (and more comfortable for the subject) alternative to the traditional stereophotogrammetric system. Then, the abovementioned technique has been improved so that the measurement of knee flexion/extension could be done with a 2D markerless technique. The main changes on the implementation were on occlusion handling and background segmentation. With the additional constraints, the proposed technique was applied to the estimation of knee flexion/extension and compared with a traditional stereophotogrammetric system. Results showed that the knee flexion/extension estimation from traditional stereophotogrammetric system and the proposed markerless system were highly comparable, making the latter a potential alternative for clinical use. A contribution has also been given in the estimation of lower limb kinematics of the children with cerebral palsy (CP). For this purpose, a hybrid technique, which uses high-cut underwear and ankle socks as “segmental markers” in combination with a markerless methodology, was proposed. The proposed hybrid technique is different than the abovementioned markerless technique in terms of the algorithm chosen. Results showed that the proposed hybrid technique can become a simple and low-cost alternative to the traditional stereophotogrammetric systems.

LPS-induced modifications in spontaneous network activity causes neuronal apoptosis in neonatal cerebral cortex

During the perinatal period the developing brain is most vulnerable to inflammation. Prenatal infection or exposure to inflammatory factors can have a profound impact on fetal neurodevelopment with long-term neurological deficits, such as cognitive impairment, learning deficits, perinatal brain damage and cerebral palsy. Inflammation in the brain is characterized by activation of resident immune cells, especially microglia and astrocytes whose activation is associated with a variety of neurodegenerative disorders like Alzheimer´s disease and Multiple sclerosis. These cell types express, release and respond to pro-inflammatory mediators such as cytokines, which are critically involved in the immune response to infection. It has been demonstrated recently that cytokines also directly influence neuronal function. Glial cells are capable of releaseing the pro-inflammatory cytokines MIP-2, which is involved in cell death, and tumor necrosis factor alpha (TNFalpha), which enhances excitatory synaptic function by increasing the surface expression of AMPA receptors. Thus constitutively released TNFalpha homeostatically regulates the balance between neuronal excitation and inhibition in an activity-dependent manner. Since TNFalpha is also involved in neuronal cell death, the interplay between neuronal activity MIP-2 and TNFalpha may control the process of cell death and cell survival in developing neuronal networks. An increasing body of evidence suggests that neuronal activity is important in the regulation of neuronal survival during early development, e.g. programmed cell death (apoptosis) is augmented when neuronal activity is blocked. In our study we were interested on the impact of inflammation on neuronal activity and cell survival during early cortical development. To address this question, we investigated the impact of inflammation on neuronal activity and cell survival during early cortical development in vivo and in vitro. Inflammation was experimentally induced by application of the endotoxin lipopolysaccharide (LPS), which initiates a rapid and well-characterized immune response. I studied the consequences of inflammation on spontaneous neuronal network activity and cell death by combining electrophysiological recordings with multi-electrode arrays and quantitative analyses of apoptosis. In addition, I used a cytokine array and antibodies directed against specific cytokines allowing the identification of the pro-inflammatory factors, which are critically involved in these processes. In this study I demonstrated a direct link between inflammation-induced modifications in neuronal network activity and the control of cell survival in a developing neuronal network for the first time. Our in vivo and in vitro recordings showed a fast LPS-induced reduction in occurrence of spontaneous oscillatory activity. It is indicated that LPS-induced inflammation causes fast release of proinflammatory factors which modify neuronal network activity. My experiments with specific antibodies demonstrate that TNFalpha and to a lesser extent MIP-2 seem to be the key mediators causing activity-dependent neuronal cell death in developing brain. These data may be of important clinical relevance, since spontaneous synchronized activity is also a hallmark of the developing human brain and inflammation-induced alterations in this early network activity may have a critical impact on the survival of immature neurons.

Infantile spasms: does season influence onset and long-term outcome?

To study whether onset of infantile spasms manifests seasonal variation, as previously reported, and whether any such seasonality is associated with treatment response and long-term outcome, data for 57 patients were retrospectively reviewed. The data were collected from hospital files and through a mail survey of children with infantile spasms born from 1980 to 2002 and monitored at the University Children's Hospital of Berne, Switzerland. The mean age at time of onset of infantile spasms was 7 months (range, 0.75-40), at diagnosis 8 months (range, 1-42) and at follow-up 11.3 years (range, 1-23 years). In 77% of participants, the etiology of infantile spasms was known (symptomatic); in the remaining 23% it was not known (nonsymptomatic). In contrast to previous findings, onset of infantile spasms was not associated with calendar month, photoperiod, or global solar radiation. Long-term prognosis was poor: 4 of the 57 (7%) children died; 49 (86%) had cognitive impairment and 40 (70%) had physical impairment; 31 (54%) had cerebral palsy, 37 had (65%) persistent seizures, and 9 (16%) had Lennox-Gastaut syndrome. Symptomatic infantile spasms were associated with worse cognitive outcome (P < 0.001), but treatment modality and overall duration of infantile spasms were not. There was no association of calendar month or photoperiod at onset with cognitive outcome or treatment response.

Effectiveness of selective dorsal rhizotomy in 2 patients with progressive spasticity due to neurodegenerative disease

Selective dorsal rhizotomy at the lumbar level is a neurosurgical procedure, which reduces spasticity in the legs. Its effect has mainly been studied in children with spastic cerebral palsy. Little is known about the outcome of selective dorsal rhizotomy in patients with neurodegenerative disorders. We report the clinical course after selective dorsal rhizotomy in 2 patients with progressive spasticity. Leg spasticity was effectively and persistently reduced in both patients, facilitating care and improving sitting comfort. However, spasticity of the arms and other motor disturbances, such as spontaneous extension spasms and the ataxia, increased gradually in time. Selective dorsal rhizotomy leads to a disappearance of leg spasticity in patients with a neurodegenerative disease. Other motor signs are not influenced and may increase due to the progressive nature of the underlying disease.