La présente recherche a pour objet la pratique orthophonique en suppléance à la communication (SC) auprès de personnes qui ont une déficience intellectuelle (DI). Des recherches ont montré que les aides à la communication à sortie vocale (ACSV) pouvaient améliorer la communication des personnes ayant une DI. Cependant, la plupart de ces recherches ont été menées dans des conditions idéales qui ne reflètent pas nécessairement celles que l’on retrouve dans les milieux cliniques typiques. On connaît peu de choses sur les pratiques professionnelles en SC auprès des personnes ayant une DI. Le but de cette recherche est de décrire la pratique orthophonique, de documenter les perspectives des utilisateurs sur les résultats des interventions et de décrire l’implication des parents et leurs habiletés à soutenir leur enfant dans l’utilisation d’une ACSV afin de proposer un modèle d’intervention en SC auprès de cette clientèle qui tienne compte de ces différentes perspectives. Une méthode qualitative a été choisie pour réaliser la recherche. Des entrevues individuelles semi-structurées ont été réalisées avec onze orthophonistes francophones et avec des parents ou familles d’accueil de dix utilisateurs d’ACSV et des entrevues structurées ont été menées avec huit utilisateurs d’ACSV. Un outil d’entrevue a été conçu à l’aide de pictogrammes pour permettre aux utilisateurs d’ACSV de répondre à des questions portant sur leur appréciation et utilisation de leur ACSV, leur satisfaction et priorités de communication. Un cadre conceptuel a été conçu à partir des guides de pratique clinique et un codage semi-ouvert a été utilisé pour réaliser les analyses thématiques des données provenant des orthophonistes. Un codage ouvert a servi à analyser les données provenant des parents. Des analyses descriptives ont servi à examiner les réponses des utilisateurs. Diverses procédures ont assuré la crédibilité des analyses. Entre autres, les analyses des entrevues des orthophonistes ont été validées lors d’un groupe de discussion avec sept participantes orthophonistes. Les résultats montrent que les ACSV sont utilisées surtout dans le milieu scolaire. Elles sont parfois utilisées lors des loisirs et dans la communauté, mais ces contextes sont ceux où les utilisateurs ont exprimé le plus d’insatisfaction et où se situe la majeure partie des priorités qu’ils ont identifiées. Les analyses ont permis d’identifier les facteurs qui rendent compte de ces résultats. Les orthophonistes manquent d’outils pour réaliser des évaluations exhaustives des capacités des clients et elles manquent de procédures pour impliquer les parents et obtenir d’eux une description complète des besoins de communication de leur enfant. Conséquemment, l’ACSV attribuée et le vocabulaire programmé ne répondent pas à l’ensemble des besoins de communication. Certaines orthophonistes manquent de connaissances sur les ACSV ou n’ont pas le matériel pour faire des essais avec les clients. Il en résulte un appariement entre la personne et l’ACSV qui n’est pas toujours parfait. À cause d’un manque de ressources en orthophonie, les parents sont parfois laissés sans soutien pour apporter les changements à la programmation lors des transitions dans la vie de leur enfant et certains ne reçoivent pas d’entraînement visant à soutenir l’utilisation de l’ACSV. Un modèle d’intervention en SC est proposé afin d’améliorer la pratique orthophonique auprès de cette population. / This research targets the practices in Augmentative and Alternative Communication (AAC) of speech-language pathologists (SLPs) who work with individuals who have an intellectual disability (ID). Prior research has shown that speech generating devices (SGDs) can help individuals with ID to improve their communication. However, these studies were conducted under ideal conditions, which do not necessarily reflect those that prevail in typical clinical settings. We have little information about AAC practices with individuals with ID or about the efficacy of SGD attribution and AAC intervention under typical conditions. The goals of this research are therefore to describe AAC practices of SLPs with individuals who have an ID, to document the users’ perspectives on the outcome of AAC interventions and to describe the parents’ implication and their abilities to support their child’s use of an SGD in order to propose an intervention model that takes into account these different perspectives. Qualitative methods were chosen to address these questions. Individual semi-structured interviews were conducted with eleven French-speaking SLPs and with the parents or foster families of ten SGD users, and structured interviews with eight SGD users. These interviews were analyzed in order to gather information about research questions. An evaluation tool, made of graphic symbols, was developed to gather information from SGD users about their use of their SGD, their satisfaction, and communication priorities, and about their appreciation of their SGDs. A conceptual framework was developed based on clinical practice guidelines to analyze SLP’s interviews, and a thematic analysis was conducted with semi-open coding. Open coding was used for the data from parents’ interviews, and descriptive analysis of the SGD users’ responses was performed. Steps were taken to ensure credibility of the findings; in particular a focus group was conducted with seven of the participating SLPs to validate the interview results. The results showed that the SGDs are used most frequently in school settings. They are used only occasionally in leisure activities and in the community, but these are the contexts in which the users were most dissatisfied with their communication and in which they most frequently indicated priorities for communication. Factors that explain these results were identified through thematic analysis. SLPs lack the tools they need to perform a comprehensive evaluation of the users’ capacities. They lack procedures for involving parents in the evaluation and for obtaining a thorough description of their child’s communication needs. This might result in attribution of SGSs and identification of vocabulary that do not meet the user’s needs. Some of the SLPs lack sufficient knowledge and do not have SGDs available for trials with their clients, resulting in a less-than-perfect matches between the users and the SGDs. Lack of professional resources leaves parents without support to make changes needed in times of transition in their child’s life. Parents may be unable to support their child’s use of SGD in a variety of contexts. An attribution and AAC intervention model is proposed in order to improve AAC intervention and SLP’s practices.

Made available in DSpace on 2016-04-28T18:24:14Z (GMT). No. of bitstreams: 1 Roseli Vasconcellos.pdf: 1453622 bytes, checksum: e7c7e34df88afe178f5c1080bbbafb3a (MD5) Previous issue date: 2010-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study discusses issues related to the distinction between the body conceived as an organism and the body approached as parlêtre (Lacan s expression). This subject-matter emerged from my clinical practice carried on with persons with Cerebral Palsy (CP). It is assumed that a theoretical dialogue with the fields of Medicine (Neurology) and with the Speech Pathology and Therapy is necessary and extremely relevant. Therefore, two chapters were dedicated to the literature of those areas. Recent papers and manuals, concerning CP, were selected. It is pointed out that the most recent research conclusions suggest, in fact, a strong convergence between what is taken as new and what is said to be old knowledge in the field of CP. Freud s statement, written in 1897, should, no doubt, be viewed as up-to-date. Some critical comments related to the Alternative Communication Systems (CA) were also included and a brief presentation of the Blissymbols and the Picture Communication Symbols (PCS) were followed by considerations about their importance for the Language Clinic theoretical development. I tried to point to the fact that such a Clinic takes clear distance from all others, since the CA introduction is guided by the specific language and subject conceptions assumed in this study. The theoretical orientation, here assumed, allowed me to address the problematic distinction between organic body and language body. This doctoral dissertation, which departs from the clinical practice with persons with Cerebral Palsy, is committed to the theorization undertaken in the CNPq Research Group, headed by Maria Francisca Lier-DeVitto, at LAEL PUCSP. It must be said that the Language Clinic is affiliated to the Interacionism in Language Acquisition, proposed by Cláudia de Lemos. Such a theoretical framework has strong links with the so called european structuralism as interpreted by Jacques Lacan. Such a theoretical trend triggered the inclusion of the psychoanalytical reflection on the subject speaker and about the relationship between child-language-speech. The difference this study introduces is illuminated by the clinical effects of the implementation of Alternative Communication Systems. It is worth saying that it is the therapist s body and speech that provide and support the materialization of the significant. The heterogeneous clinical effects analyzed led to considerations about the nature of listening, about transference and about the tension between conflict and pleasure that accompany some subtle and fragile vocalized speech. Data were discussed here and the interpretation conveyed sustains, I believe, the clinical and theoretical supposition proposed and advanced in this doctoral dissertation, i. e., that the body as organism and the body as parlêtre do not coincide / Esta tese discute a questão da diferença entre organismo e corpo, a partir do atendimento de sujeitos com Paralisia Cerebral (PC) na Clínica de Linguagem. Para falar em corpo, não o corpo-orgânico da Medicina, um diálogo inicial com a Neurologia é desenvolvido. Enfoco, para tanto, investigações recentes em torno da PC e assinalo que os mais novos achados sugerem uma forte convergência entre o novo e o mais antigo, nesse caso. Refiro-me a afirmações feitas há muito por Freud acerca da PC a partir de sua clínica com essas pessoas. Do mesmo modo, assumo a importância da interlocução com o campo da Comunicação Alternativa (CA). Uma breve apresentação do Bliss e do Picture Communication Symbols (PCS) é seguida por pontuações sobre sua importância modo de introdução na Clínica de Linguagem. Dou ênfase, nesta parte, ao distanciamento desta Clínica em relação a todas as outras que operam com a CA. A particularidade da Clínica e Linguagem decorre das concepções de linguagem e sujeito assumidas nesta tese. Com o intuito de delinear a natureza da literatura produzida sobre a CA, em nosso país e em âmbito internacional, ofereço um panorama de trabalhos representativos e de interesse para a Clínica de Linguagem com pacientes com PC. A direção teórica assumida, que tornou possível abordar a distinção entre corpo-orgânico e corpo-linguagem ou corpo pulsional, parte dos estudos desenvolvidos no interior da Clínica de Linguagem, pelo grupo de pesquisa liderado por Maria Francisca Lier-DeVitto, no LAEL PUCSP. A Clínica de Linguagem tem laço de filiação com o Interacionismo em Aquisição de Linguagem, proposto por Cláudia De Lemos, vertente teórica que, ao aproximar-se do Estruturalismo Europeu através da leitura de Lacan, dispara implicações entre Lingüística e Psicanálise, pondo em questão a relação criança-língua-fala do outro. A diferença tanto teórica, quanto clínica, que introduzo nesta tese, relativamente ao tratamento de pacientes com PC que não oralizam, é iluminada pelos efeitos dessa clínica que inclui a CA e a materialização do significante, que se faz pela via do empréstimo do corpo e da voz do outro-terapeuta. Abordo a heterogeneidade dos efeitos desta Clínica que suscitaram considerações sobre a escuta, sobre a transferência e sobre o prazer ou o conflito que acompanham a produção de certas falas vocalizadas de alguns pacientes. Os dados analisados nesta tese falam a favor da presença de um corpo-linguagem: um corpo que irrompe em manifestações significantes e que fala (como pode) - o que corrobora a afirmação que remete ao título desta tese: a de que sujeito e organismo não coincidem

A linguagem e a comunicação são processos fundamentais para o desenvolvimento humano. Mas longe de serem processos inatos ou maturacionais são processos sócio-históricos que se desenvolvem ao longo da vida. Dessa forma, quando as crianças chegam à idade escolar trazem com elas uma linguagem e comunicação oral não como produtos acabados, mas como processos sociais e em desenvolvimento Professores de séries iniciais muitas vezes são surpreendidos quando uma criança não fala, ficando sem ação, pois a expectativa deles é trabalhar apenas com a escrita. Eles pressupõem que oralidade já deveria estar desenvolvida em seus alunos. A escola tem papel fundamental nesse processo de alfabetização, mas também no desenvolvimento da linguagem como um todo incluindo as diversas formas de comunicação possíveis, pois, é de suma importância que a escola acolha todas as pessoas sem discriminações ou preconceitos. Esta pesquisa teve como foco principal propor ações mediadoras com uso de recursos e estratégias de CAA para promover o desenvolvimento da comunicação em sujeitos com TGD. As ações mediadoras foram embasadas nos pressupostos da Teoria Sócio-Histórica, focando em estratégias nas quais a interação vise à comunicação com recursos de CAA de baixa e alta tecnologia como foco principal. O presente trabalho estruturou-se como um estudo de caso (multicaso) de dois sujeitos incluídos nas séries iniciais do ensino fundamental na rede publica municipal da grande Porto Alegre. Ambos os sujeitos tem TGD, sendo que um tem diagnóstico de autismo e o outro de Síndrome de Cornélia de Lange (CdLS). Os resultados a serem apresentados mostram que é possível a utilização da CAA no processo do desenvolvimento de sujeitos não oralizados com TGD, pois, de forma geral, percebe-se que no final da pesquisa os sujeitos ampliaram suas formas de comunicação graças ao uso da CAA. Os indícios de intencionalidade de comunicação que emergiram nos sujeitos com TGD, quando utilizadas ações mediadoras com CAA, se ampliaram de forma significativa chegando os sujeitos a tornarem-se agentes intencionais em diversos momentos das interações. / Language and communication are key processes in human development. But far from being innate or maturational processes, they are socio-historical processes that develop throughout life. Thus, when children reach school age they bring with them the language and oral communication not as a finished product, but as a social process in development. Schoolteachers are often surprised when a child does not speak, and do not know what to do, because their expectation is to work only with writing. They assume that orality should have been already developed in their students. The school has a fundamental role in the process of literacy, but also in language development as a whole, including the various forms of possible communication. Therefore, it is essential that the school accepts all persons without discrimination or prejudice. This research aims to propose mediation actions through the use of resources and strategies of AAC to promote the communication development in subjects with PDD. The mediating actions were based on the principles of the Social-Historical Theory, focusing on strategies in which the interaction aimed at communicating with AAC features of low and high technology. This study was structured as a case study (multicase) of two individuals inserted in the initial grades of elementary public school at Porto Alegre. Both subjects have PDD; one was diagnosed with autism and the other with Cornelia de Lange Syndrome (CdLS). The results presented show that it is possible to use the AAC in the development process of individuals with PDD and with oral language issues because, in general, at the end of the study subjects increased their forms of communication through the use of AAC. The evidence of intentional communication that emerged in subjects with PDD when using mediation actions with AAC have expanded significantly, reaching the subjects and turning them into intentional agents at different times of the interactions.

<p>Syftet med föreliggande studie var att undersöka vilka ordtyper som är lätta respektive svåraatt nå fram till med bliss standardkarta och vilka strategier som är mer respektive mindreeffektiva. Deltagarna, 24 kvinnliga studenter utan funktionshinder, delades upp i par. Den enai paret fick i uppgift att förklara 12 målord, som inte finns med på bliss standardkarta, enbartgenom att använda bliss standardkarta. Den andra i paret fick i uppgift att gissa vilkamålorden var. Eftersom tidigare studier indikerat att ordklass, frekvensnivå ochabstraktionsnivå kan påverka ords svårighetsgrad, valdes målorden i föreliggande studieutifrån dessa variabler. Resultatet visade att målordens ordklass inte påverkade derassvårighetsgrad. Målordens frekvensnivå påverkade svårighetsgraden i viss utsträckning.Abstraktionsnivå var den variabel som påverkade svårighetsgraden mest. Eftersom deabstrakta och ovanliga målorden var svårast, kan det vara klokt att inkludera de ordtyperna påblisskartan. Några strategier som gynnade kommunikationen var när blissaren använde syntaxoch syntaktiskt prompting samt när gissaren gav blissaren tid att avsluta sina fraser. Dessastrategier kan vara lämpliga att rekommendera till blissanvändare och deras samtalspartners.</p> / <p>The aim of this study was to investigate which types of words that are easy and difficult toreach with Bliss Swedish standard chart and also which strategies that is more and lessefficient. The participants, 24 female students with no functional limitations, were grouped inpairs. One in each pair was given the task to explain 12 target words that is not present onBliss standard chart, by using only Bliss standard chart. The other person in each pair wasgiven the task to guess which words that were asked for. Since former studies have indicatedthat word class, level of frequency and level of abstraction can affect words' degree ofdifficulty, the target words in this study were chosen based upon those factors. The resultsdemonstrated that the word class of the target words did not affect their degree of difficulty.The frequency of the target words affected their degree of difficulty in some ways. The levelof abstraction of the target words was the factor that affected the degree of difficulty the most.Since the abstract and infrequent target words were most difficult, it may be a good idea toinclude those types of words on the Bliss chart. Some of the strategies that were beneficial forcommunication were the blisser’s use of syntax and syntactic prompting. Another strategy thatwas beneficial for the communication was giving the blisser enough time to finish herphrases. It may be appropriate to recommend those strategies to Bliss users and theircommunication partners.</p>

<p>Huvudsyftet med denna studie är att beskriva hur ett barn, som använder ett datorbase­rat grafiskt kommunikationshjälpmedel (Tellus), med hjälp av reparationer löser lokala kommunikativa problem i samarbete med människor i sin omgivning. Barnet har video­filmats i vardagliga naturligt förekommande aktiviteter – skola och hem. Som analys­metod har Conversation Analysis (CA) använts. Resultaten visar att reparationer är en typ av resurser för deltagarna att, bland annat, skapa samförstånd genom att förtydliga oklarheter och missförstånd i samtalet. Reparationssekvenserna är ofta långa, och leder till inskottssekvenser i samtalet, men har en viktig interaktionell betydelse för att uppnå samförstånd. Analysen visar även att kommunikation med datorbaserad AKK är mul­timodal, trots att datorn är barnets primära kommunikationshjälpmedel. Exempelvis används tecken, gester och ljud för att markera fel och för att visa upp känslor. Aktivi­teten och datorns placering påverkar också interaktionen. I skolan används datorn oftare som en traditionell kommunikationskarta. Detta beror till stor del på att samtalspartnern sitter på ett sådant sätt att det barnet gör med datorn blir synligt för båda. Forskning som belyser reparationer i denna typ av AKK-samtal saknas. Denna studie kommer förhopp­ningsvis att skapa intresse för fortsatt forskning som, med ett interaktionellt synsätt, identifierar och beskriver fungerande kommunikativa praktiker i AKK-samtal.</p> / <p>The main purpose of this study is to describe how a child, who uses a computer based graphical communication aid (Tellus), with the help of repairs resolves local communi­cative problems in cooperation with people in the immediate surroundings. The child has been videotaped in natural occurring activities – school and home. Conversation Analysis (CA) has been used as a method. The results show that repairs are a set of re­sources for the participants to, among other things, create mutual understanding by clarifying ambiguities and misunderstandings in the talk. The sequences of repair are often long, and lead to inserted sequences in the talk, but have an important interac­tional meaning in achieving mutual understanding. The analysis also shows that the computer based AAC is multimodal, despite the fact that the computer is the user’s pri­mary technical communication aid. For example, signs, gestures and sounds are used to indicate errors and to display emotion. The activity and the placement of the computer also affect the interaction. In school the computer is more often used as a traditional communication map. This is largely due to the fact that the communication partner is positioned in such a way that what the child is doing with the computer becomes visible to both of them. Presently, research that illustrates repair in these kinds or AAC conver­sations is sparse. This study will hopefully create interest for continuing research that, with an interactional approach, identifies and describes functional communicative prac­tices in AAC conversations.</p>

Syftet med föreliggande studie var att undersöka vilka ordtyper som är lätta respektive svåraatt nå fram till med bliss standardkarta och vilka strategier som är mer respektive mindreeffektiva. Deltagarna, 24 kvinnliga studenter utan funktionshinder, delades upp i par. Den enai paret fick i uppgift att förklara 12 målord, som inte finns med på bliss standardkarta, enbartgenom att använda bliss standardkarta. Den andra i paret fick i uppgift att gissa vilkamålorden var. Eftersom tidigare studier indikerat att ordklass, frekvensnivå ochabstraktionsnivå kan påverka ords svårighetsgrad, valdes målorden i föreliggande studieutifrån dessa variabler. Resultatet visade att målordens ordklass inte påverkade derassvårighetsgrad. Målordens frekvensnivå påverkade svårighetsgraden i viss utsträckning.Abstraktionsnivå var den variabel som påverkade svårighetsgraden mest. Eftersom deabstrakta och ovanliga målorden var svårast, kan det vara klokt att inkludera de ordtyperna påblisskartan. Några strategier som gynnade kommunikationen var när blissaren använde syntaxoch syntaktiskt prompting samt när gissaren gav blissaren tid att avsluta sina fraser. Dessastrategier kan vara lämpliga att rekommendera till blissanvändare och deras samtalspartners. / The aim of this study was to investigate which types of words that are easy and difficult toreach with Bliss Swedish standard chart and also which strategies that is more and lessefficient. The participants, 24 female students with no functional limitations, were grouped inpairs. One in each pair was given the task to explain 12 target words that is not present onBliss standard chart, by using only Bliss standard chart. The other person in each pair wasgiven the task to guess which words that were asked for. Since former studies have indicatedthat word class, level of frequency and level of abstraction can affect words' degree ofdifficulty, the target words in this study were chosen based upon those factors. The resultsdemonstrated that the word class of the target words did not affect their degree of difficulty.The frequency of the target words affected their degree of difficulty in some ways. The levelof abstraction of the target words was the factor that affected the degree of difficulty the most.Since the abstract and infrequent target words were most difficult, it may be a good idea toinclude those types of words on the Bliss chart. Some of the strategies that were beneficial forcommunication were the blisser’s use of syntax and syntactic prompting. Another strategy thatwas beneficial for the communication was giving the blisser enough time to finish herphrases. It may be appropriate to recommend those strategies to Bliss users and theircommunication partners.

Huvudsyftet med denna studie är att beskriva hur ett barn, som använder ett datorbase­rat grafiskt kommunikationshjälpmedel (Tellus), med hjälp av reparationer löser lokala kommunikativa problem i samarbete med människor i sin omgivning. Barnet har video­filmats i vardagliga naturligt förekommande aktiviteter – skola och hem. Som analys­metod har Conversation Analysis (CA) använts. Resultaten visar att reparationer är en typ av resurser för deltagarna att, bland annat, skapa samförstånd genom att förtydliga oklarheter och missförstånd i samtalet. Reparationssekvenserna är ofta långa, och leder till inskottssekvenser i samtalet, men har en viktig interaktionell betydelse för att uppnå samförstånd. Analysen visar även att kommunikation med datorbaserad AKK är mul­timodal, trots att datorn är barnets primära kommunikationshjälpmedel. Exempelvis används tecken, gester och ljud för att markera fel och för att visa upp känslor. Aktivi­teten och datorns placering påverkar också interaktionen. I skolan används datorn oftare som en traditionell kommunikationskarta. Detta beror till stor del på att samtalspartnern sitter på ett sådant sätt att det barnet gör med datorn blir synligt för båda. Forskning som belyser reparationer i denna typ av AKK-samtal saknas. Denna studie kommer förhopp­ningsvis att skapa intresse för fortsatt forskning som, med ett interaktionellt synsätt, identifierar och beskriver fungerande kommunikativa praktiker i AKK-samtal. / The main purpose of this study is to describe how a child, who uses a computer based graphical communication aid (Tellus), with the help of repairs resolves local communi­cative problems in cooperation with people in the immediate surroundings. The child has been videotaped in natural occurring activities – school and home. Conversation Analysis (CA) has been used as a method. The results show that repairs are a set of re­sources for the participants to, among other things, create mutual understanding by clarifying ambiguities and misunderstandings in the talk. The sequences of repair are often long, and lead to inserted sequences in the talk, but have an important interac­tional meaning in achieving mutual understanding. The analysis also shows that the computer based AAC is multimodal, despite the fact that the computer is the user’s pri­mary technical communication aid. For example, signs, gestures and sounds are used to indicate errors and to display emotion. The activity and the placement of the computer also affect the interaction. In school the computer is more often used as a traditional communication map. This is largely due to the fact that the communication partner is positioned in such a way that what the child is doing with the computer becomes visible to both of them. Presently, research that illustrates repair in these kinds or AAC conver­sations is sparse. This study will hopefully create interest for continuing research that, with an interactional approach, identifies and describes functional communicative prac­tices in AAC conversations.

Kommunikation och interaktion är viktigt för att utveckla både språklig och social kompetens. Barn som använder alternativ och kompletterande kommunikation (AKK) får dock inte alltid samma möjligheter som talande barn att kommunicera. Speciellt svårt kan det vara att interagera och därigenom skapa relationer med jämnåriga. Det övergripande syftet med denna studie var att studera samtal mellan jämnåriga, speciellt hur de bygger upp och upprätthåller gemensam förståelse i samtal. Studien innefattade två unga pojkar som på grund av cerebral pares (CP) saknade talförmåga och därför använde bliss som AKK. De filmades under ett samtal med varsin klasskamrat. En samtalsanalytisk metod (conversation analysis, CA) användes för att identifiera mönster i interaktionen och analysera deltagarnas strategier för att etablera gemensam förståelse. De strategier som användes visade sig vara tolkningsförslag, följdfrågor, formuleringar och reparationer. Strategierna användes främst vid responspunkter efter blissyttranden, men reparationer förekom även under konstruktionen av yttranden. Analysen visade också att förståelsestrategier ibland saknades i det ena samtalet vilket då ledde till att samtalet stannade av. De talande tog större delen av ansvaret för förståelsearbetet i båda samtalen, men även de blissande pojkarna var delaktiga. Sammantaget visade analysen att samtal med AKK kan se mycket olika ut. Vilka strategier deltagarna använde sig av för att etablera gemensam förståelse var av stor betydelse i båda samtalen. Det krävdes att alla samtalsdeltagare var engagerade i förståelsearbetet för att samtalet inte skulle avstanna. / Communication and interaction are important parts in developing both linguistic and social skills. Children who uses augmentative and alternative communication (AAC) may not always have the same opportunities as talking children to communicate. It can be especially difficult to interact and thereby create relationships with peers. The aim of this study was to explore conversations between peers, more specifically in which ways they establish and maintain common understanding in the conversation. Participants in the study were two young boys with cerebral palsy (CP) causing non-intelligible speech, and therefore using blissymbolics as their AAC. The boys were videotaped during a conversation with a classmate. A Conversation Analysis method (CA) were used to identify patterns in the interaction, and to analyze the participants' strategies to establish common understanding. Strategies used were suggestions of interpretation, following up-questions, formulations and reparations. The strategies were most used in transition-relevance places, but reparations could also be found during the creation of blissymbolic utterances. The analysis also found that understanding-oriented strategies sometimes were missing in one of the conversations, which led to breakdown in the conversation. The talking individuals were responsible for establishing common understanding in the major part of both conversations, but the boys using blissymbolics did not leave the responsibility entirely to them. In total the analysis showed that conversations with AAC can differ in many ways. Which strategies the participants used to establish common understanding were of great importance in both conversations. Every participant in the conversation were obliged to engage in creating common understanding in order to not lead the conversation to a breakdown.

La présente recherche a pour objet la pratique orthophonique en suppléance à la communication (SC) auprès de personnes qui ont une déficience intellectuelle (DI). Des recherches ont montré que les aides à la communication à sortie vocale (ACSV) pouvaient améliorer la communication des personnes ayant une DI. Cependant, la plupart de ces recherches ont été menées dans des conditions idéales qui ne reflètent pas nécessairement celles que l’on retrouve dans les milieux cliniques typiques. On connaît peu de choses sur les pratiques professionnelles en SC auprès des personnes ayant une DI. Le but de cette recherche est de décrire la pratique orthophonique, de documenter les perspectives des utilisateurs sur les résultats des interventions et de décrire l’implication des parents et leurs habiletés à soutenir leur enfant dans l’utilisation d’une ACSV afin de proposer un modèle d’intervention en SC auprès de cette clientèle qui tienne compte de ces différentes perspectives. Une méthode qualitative a été choisie pour réaliser la recherche. Des entrevues individuelles semi-structurées ont été réalisées avec onze orthophonistes francophones et avec des parents ou familles d’accueil de dix utilisateurs d’ACSV et des entrevues structurées ont été menées avec huit utilisateurs d’ACSV. Un outil d’entrevue a été conçu à l’aide de pictogrammes pour permettre aux utilisateurs d’ACSV de répondre à des questions portant sur leur appréciation et utilisation de leur ACSV, leur satisfaction et priorités de communication. Un cadre conceptuel a été conçu à partir des guides de pratique clinique et un codage semi-ouvert a été utilisé pour réaliser les analyses thématiques des données provenant des orthophonistes. Un codage ouvert a servi à analyser les données provenant des parents. Des analyses descriptives ont servi à examiner les réponses des utilisateurs. Diverses procédures ont assuré la crédibilité des analyses. Entre autres, les analyses des entrevues des orthophonistes ont été validées lors d’un groupe de discussion avec sept participantes orthophonistes. Les résultats montrent que les ACSV sont utilisées surtout dans le milieu scolaire. Elles sont parfois utilisées lors des loisirs et dans la communauté, mais ces contextes sont ceux où les utilisateurs ont exprimé le plus d’insatisfaction et où se situe la majeure partie des priorités qu’ils ont identifiées. Les analyses ont permis d’identifier les facteurs qui rendent compte de ces résultats. Les orthophonistes manquent d’outils pour réaliser des évaluations exhaustives des capacités des clients et elles manquent de procédures pour impliquer les parents et obtenir d’eux une description complète des besoins de communication de leur enfant. Conséquemment, l’ACSV attribuée et le vocabulaire programmé ne répondent pas à l’ensemble des besoins de communication. Certaines orthophonistes manquent de connaissances sur les ACSV ou n’ont pas le matériel pour faire des essais avec les clients. Il en résulte un appariement entre la personne et l’ACSV qui n’est pas toujours parfait. À cause d’un manque de ressources en orthophonie, les parents sont parfois laissés sans soutien pour apporter les changements à la programmation lors des transitions dans la vie de leur enfant et certains ne reçoivent pas d’entraînement visant à soutenir l’utilisation de l’ACSV. Un modèle d’intervention en SC est proposé afin d’améliorer la pratique orthophonique auprès de cette population. / This research targets the practices in Augmentative and Alternative Communication (AAC) of speech-language pathologists (SLPs) who work with individuals who have an intellectual disability (ID). Prior research has shown that speech generating devices (SGDs) can help individuals with ID to improve their communication. However, these studies were conducted under ideal conditions, which do not necessarily reflect those that prevail in typical clinical settings. We have little information about AAC practices with individuals with ID or about the efficacy of SGD attribution and AAC intervention under typical conditions. The goals of this research are therefore to describe AAC practices of SLPs with individuals who have an ID, to document the users’ perspectives on the outcome of AAC interventions and to describe the parents’ implication and their abilities to support their child’s use of an SGD in order to propose an intervention model that takes into account these different perspectives. Qualitative methods were chosen to address these questions. Individual semi-structured interviews were conducted with eleven French-speaking SLPs and with the parents or foster families of ten SGD users, and structured interviews with eight SGD users. These interviews were analyzed in order to gather information about research questions. An evaluation tool, made of graphic symbols, was developed to gather information from SGD users about their use of their SGD, their satisfaction, and communication priorities, and about their appreciation of their SGDs. A conceptual framework was developed based on clinical practice guidelines to analyze SLP’s interviews, and a thematic analysis was conducted with semi-open coding. Open coding was used for the data from parents’ interviews, and descriptive analysis of the SGD users’ responses was performed. Steps were taken to ensure credibility of the findings; in particular a focus group was conducted with seven of the participating SLPs to validate the interview results. The results showed that the SGDs are used most frequently in school settings. They are used only occasionally in leisure activities and in the community, but these are the contexts in which the users were most dissatisfied with their communication and in which they most frequently indicated priorities for communication. Factors that explain these results were identified through thematic analysis. SLPs lack the tools they need to perform a comprehensive evaluation of the users’ capacities. They lack procedures for involving parents in the evaluation and for obtaining a thorough description of their child’s communication needs. This might result in attribution of SGSs and identification of vocabulary that do not meet the user’s needs. Some of the SLPs lack sufficient knowledge and do not have SGDs available for trials with their clients, resulting in a less-than-perfect matches between the users and the SGDs. Lack of professional resources leaves parents without support to make changes needed in times of transition in their child’s life. Parents may be unable to support their child’s use of SGD in a variety of contexts. An attribution and AAC intervention model is proposed in order to improve AAC intervention and SLP’s practices.

A linguagem e a comunicação são processos fundamentais para o desenvolvimento humano. Mas longe de serem processos inatos ou maturacionais são processos sócio-históricos que se desenvolvem ao longo da vida. Dessa forma, quando as crianças chegam à idade escolar trazem com elas uma linguagem e comunicação oral não como produtos acabados, mas como processos sociais e em desenvolvimento Professores de séries iniciais muitas vezes são surpreendidos quando uma criança não fala, ficando sem ação, pois a expectativa deles é trabalhar apenas com a escrita. Eles pressupõem que oralidade já deveria estar desenvolvida em seus alunos. A escola tem papel fundamental nesse processo de alfabetização, mas também no desenvolvimento da linguagem como um todo incluindo as diversas formas de comunicação possíveis, pois, é de suma importância que a escola acolha todas as pessoas sem discriminações ou preconceitos. Esta pesquisa teve como foco principal propor ações mediadoras com uso de recursos e estratégias de CAA para promover o desenvolvimento da comunicação em sujeitos com TGD. As ações mediadoras foram embasadas nos pressupostos da Teoria Sócio-Histórica, focando em estratégias nas quais a interação vise à comunicação com recursos de CAA de baixa e alta tecnologia como foco principal. O presente trabalho estruturou-se como um estudo de caso (multicaso) de dois sujeitos incluídos nas séries iniciais do ensino fundamental na rede publica municipal da grande Porto Alegre. Ambos os sujeitos tem TGD, sendo que um tem diagnóstico de autismo e o outro de Síndrome de Cornélia de Lange (CdLS). Os resultados a serem apresentados mostram que é possível a utilização da CAA no processo do desenvolvimento de sujeitos não oralizados com TGD, pois, de forma geral, percebe-se que no final da pesquisa os sujeitos ampliaram suas formas de comunicação graças ao uso da CAA. Os indícios de intencionalidade de comunicação que emergiram nos sujeitos com TGD, quando utilizadas ações mediadoras com CAA, se ampliaram de forma significativa chegando os sujeitos a tornarem-se agentes intencionais em diversos momentos das interações. / Language and communication are key processes in human development. But far from being innate or maturational processes, they are socio-historical processes that develop throughout life. Thus, when children reach school age they bring with them the language and oral communication not as a finished product, but as a social process in development. Schoolteachers are often surprised when a child does not speak, and do not know what to do, because their expectation is to work only with writing. They assume that orality should have been already developed in their students. The school has a fundamental role in the process of literacy, but also in language development as a whole, including the various forms of possible communication. Therefore, it is essential that the school accepts all persons without discrimination or prejudice. This research aims to propose mediation actions through the use of resources and strategies of AAC to promote the communication development in subjects with PDD. The mediating actions were based on the principles of the Social-Historical Theory, focusing on strategies in which the interaction aimed at communicating with AAC features of low and high technology. This study was structured as a case study (multicase) of two individuals inserted in the initial grades of elementary public school at Porto Alegre. Both subjects have PDD; one was diagnosed with autism and the other with Cornelia de Lange Syndrome (CdLS). The results presented show that it is possible to use the AAC in the development process of individuals with PDD and with oral language issues because, in general, at the end of the study subjects increased their forms of communication through the use of AAC. The evidence of intentional communication that emerged in subjects with PDD when using mediation actions with AAC have expanded significantly, reaching the subjects and turning them into intentional agents at different times of the interactions.