A Organização Mundial de Saúde tem hoje duas classificações de referência para a descrição dos estados de saúde: a CID-10 (Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde) e a CIF (Classificação Internacional de Funcionalidade, Incapacidade e Saúde). A utilização da CIF vem sendo aguardada com grande expectativa pelas organizações de pessoas com deficiências e instituições relacionadas. A falta de definição clara de “deficiência" ou “incapacidade" tem sido apontada como um impedimento para a promoção de saúde de pessoas com deficiência. Este trabalho tem como objetivo apresentar definições de deficiência, discutindo a utilização da CID-10 e da CIF e a contribuição da CIF para melhorar a compreensão sobre definições de deficiência a partir do conceito de funcionalidade e dos fatores contextuais. Foram revisados alguns diferentes conceitos/definições de deficiência, bem como publicações envolvendo a aplicação da CIF. São apresentadas algumas categorias de diagnósticos de estados de saúde da CID-10 hoje utilizadas em alguns sistemas, além de elementos da recém-apresentada CIF, que podem contribuir para diferentes campos de aplicabilidade no que diz respeito ao entendimento das definições de deficiência ou incapacidade. / The World Health Organization has nowadays two reference classifications for description of health conditions: ICD-10 (International Statistical Classification of Diseases and Health Related Problems) and ICF (International Classification of Functioning, Disability and Health). Organizations of people with disabilities and related institutions are waiting with high expectation for the ICF utilization. Lack of clear definition of “disability" is being pointed out as a deterrent for promoting the health of people with disabilities. The objective of this work is to evaluate definitions of disability, and discuss the use of ICD-10 and ICF and the contribution of ICF to improve understanding of definitions of disability through functioning and contextual factors. Some different definitions of disability have been reviewed, as well as publications involving ICF application. Diagnostic categories of health conditions of ICD-10 used in some systems are presented, as well as ICF components that could contribute for different fields of applicability regarding the understanding of definitions of disability.

A família é sempre um fator de grande importância no processo de habilitação da criança com implante coclear. O desenvolvimento da linguagem depende do envolvimento dos pais no processo de habilitação e exige um compromisso contínuo, para que a criança com deficiência auditiva tenha benefícios com o seu implante coclear. A família tem assumido uma sobrecarga significativa ao longo do processo, trazendo repercussões na vida familiar e nas próprias necessidades e interesses. Nesse contexto, o objetivo deste estudo é compreender a vivência de mães, na trajetória da infância à adolescência de seus filhos com implante coclear, buscando apreender os significados e sentidos atribuídos por elas nessa experiência. O estudo foi de natureza qualitativa e o método utilizado foi a investigação fenomenológica, que consiste na apreensão do fenômeno tal como ele se manifesta para a pessoa que o vivencia. Foram entrevistadas 12 mães das primeiras crianças que realizaram a cirurgia, no programa de implante coclear do Centro de Pesquisas Audiológicas do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo. Os depoimentos, mediados por uma questão norteadora e submetidos ao processo de análise fenomenológica, revelaram as seguintes categorias temáticas: A ressonância subjetiva do diagnóstico; Conhecendo o implante coclear e tomando decisões; A vivência da angústia na cirurgia; O nascimento da audição; Vivenciando o cotidiano no processo de habilitação; A experiência de momentos críticos no percurso da habilitação; Relações familiares; A fase escolar: uma nova etapa de enfrentamento; O processo do adolescer vivenciado com superproteção e com novos desafios; O apoio do psicólogo, da equipe e outros; Temporalidade e projetos de vida. Foi utilizado o referencial teórico de Romero, que nos levou à compreensão da vivência dessas mães, a partir da afetividade, que é o modo como elas são afetadas subjetivamente na sua relação com o mundo e, nessa relação, mostraram como se vinculam e o significado que elas dão ao que vem ao seu encontro, revelando o sentido de sua existência com um filho com implante coclear. / The family is always a major important factor in the habilitation process of the child with cochlear implant. The development of language depends on the parental involvement in the habilitation process and requires a continuous commitment, so that the child with hearing impairment may be benefited by the cochlear implant. The family has been assuming a significant overload during the process, causing repercussions in the family life and the needs and interests. Within this context, this study aimed to understand the experience of mothers in the trajectory of infancy to adolescence of their children with cochlear implants, aiming to identify the meanings and feelings assigned by them in this experience. The study was qualitative and the method comprised phenomenological investigation, which consists of apprehension of the phenomenon as it is manifested to the person experiencing it. The interviews were applied to 12 mothers of the first children submitted to surgery in the cochlear implant program of the Center for Audiological Research of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo. The reports, mediated by a guiding question and submitted to the phenomenological analysis process, revealed the following thematic categories: the subjective resonance of diagnosis; knowing the cochlear implants and making decisions; the experience of anxiety in the surgery; the birth of hearing; experience the daily life in the habilitation process; the experience of critical moments in the habilitation process; family relationships; the school age: a new stage of coping; the process of adolescing experienced with overprotection and new challenges; the support of the psychologist, staff and others; temporality and life projects. The theoretical reference of Romero was used, which led us to understand the experience of these mothers, based on the affectivity, which is the way through which they are subjectively affected in their relationship with the world and, in that relationship, they showed how they link themselves and the meaning they assign to what comes to them, revealing the meaning of their existence with a child with cochlear implant.

Obstructive sleep apnea (OSA) is a common breathing and sleeping disorder, characterized by repeated episodes of airway obstruction during sleep resulting in intermittent hypoxia (IH). From clinical reports, patients with OSA are associated with behavioral and neuropsychological deficits, including impaired spatial learning memory and cognitive deficiencies. Previous studies proposed that reactive oxygen species (ROS) and apoptosis caused by intermittent hypoxia (IH) contributed to this cognitive deficits. However, the exact mechanism is still poorly understood and not settled. / The endoplasmic reticulum (ER) is a cellular organelle in which all secretory and integral membrane proteins are folded and is also the site where proteins are post-translationally modified in ATP-dependent chaperone-mediated processes. In this study, we hypothesized that ER stress in the hippocampus is initiated in the OSA via elevated levels of ROS. Four groups of adult male mice were used, with two of them exposed to normoxia as control, and the other two exposed to IH treatment, each receiving either vehicle or tauroursodeoxycholic acid (TUDCA), an ER stress inhibitor. Eight-armed radial maze was used to investigate the performance of reference memory during the whole IH/normoxia treatment. After behavior test, long-term potentiation (LTP) was measured to investigate synaptic plasticity in hippocampus. Furthermore, ER stress-associated pro-apoptotic effectors were detected by Western blotting, and ultra-structure of rough ER and the morphology of hippocampal dendritic spines and synapses in the hippocampal CA1 area were observed. / LTP was impaired in the hippocampus after IH treatment, which was rescued by TUDCA. Furthermore, ER stress-associated pro-apoptotic effectors, CHOP and caspase-12, were up-regulated after chronic IH treatment and was abolished by co-infusion of TUDCA. Meanwhile, increased cleaved-caspase-3 after chronic IH treatment was reduced by TUDCA via increased expression of Bcl-2. On the other hand, ultrastructural analysis of rough ER in the hippocampal CA1 revealed IH-induced ER luminal swelling, and was attenuated by TUDCA. In addition, the length of synaptic active zone was significantly reduced after chronic IH treatment and was partially rescued by the application of TUDCA. Golgi staining also showed a decrease in mature dendritic spines in IH group, and reversed by TUDCA. In behavioral analysis, the number of reference memory errors significantly increased after IH treatment and rescued by TUDCA injection. Overall, the data suggest a critical role of ER stress underlying the impairment of long-term synaptic plasticity and neurocognitive deficits in chronic IH. Targeting ER stress could be a potential therapeutic strategy for neural dysfunction in OSA. / On the other hand, neuronal firing, especially robust persistent activity of neuron in hippocampus, is critical role in memory formation. Increased ROS induced by IH has been implicated in long-term potentiation of neural activity. IH could be involved in a variety of K⁺ channels which eventually leads to excitotoxicity by increased Ca2⁺-dependent glutamate release. Although the results were just shown in acute IH treatment, the chronic effect of IH on the firing frequency of hippocampus is still unknown. / Therefore, to investigate the effect of chronic IH treatment on firing activities and local field potentials of hippocampal neurons, implantation of multi-channel micro-wires electrode array into hippocampus of OSA model rat was performed to monitor spontaneous discharge. The results were shown the firing frequency of pyramidal neurons (PNs) was significantly elevated after 8 hours IH in second and third days, on the other hand, interneurons (INs) seem to be more sensitive to intermittent hypoxia since the higher firing frequency was sustained from third day to seventh day after 8 hours IH, however, at the end of 14 days IH treatment, the firing frequencies of PNs and INs are all both dramatically reduced. Meanwhile, the results in this part will enable us to understand the exact change of firing pattern and local field potential during intermittent hypoxia. The percentage of complex burst spikes was decreased after 14 days IH in PNs and the power of theta rhythms was also impaired. It suggests that the disorder of neuronal pattern and the change of local field potential are associated with cognitive impairment in OSA model. After 1 week recovery, the firing frequency of PNs was rescued again, but not for that of INs. We also found that the power of theta rhythms which had an important role in memory formation was weaker after 2 weeks IH treatment, however, the precise mechanism was still unknown. From the effect of intermittent hypoxia on spontaneous discharges and LFP of hippocampal neurons in free moving rat, it may reveal some roles of IH in cognitive impairment via disorder neuronal function in CA1 region. / 阻塞性睡眠呼吸暫停(OSA) 是一種常見的睡眠障礙疾病，這種疾病的主要特徵是在睡眠過程中反復發作的氣道阻塞，從而導致间歇性缺氧(IH)。從臨床報導中發現，OSA患者表現出行為和神經心理缺陷，包括空間學習記憶的受損和認知缺陷。通過之前的研究表明，活性氧(ROS)的增多和細胞凋亡是間歇性缺氧所引起認知功能障礙的主要機制之一，然而，其具體的機制仍不清楚。 / 作為細胞重要的細胞器，內質網是分泌蛋白和膜蛋白折疊組裝的主要場所，同時，由ATP依賴的分子伴侶所介導的蛋白質翻譯後修飾這一過程也主要在內置網中完成。在本課題中，我們假設在OSA模型的海馬組織中，內質網應激的啟動是由於缺氧引起的與活性氧(ROS)的升高。在本課題中，我們使用了四組成年雄性小鼠，其中兩組作為正常對照組，分別接受生理鹽水和牛磺去氧膽酸（一種常用的內質網抑制劑）的腹腔注射，另外兩組接受缺氧處理，同時也分別接受照生理鹽水和牛磺去氧膽酸注射。八臂放射迷宮被用來研究參考記憶的表現。行為學結束之後，長時程增強(LTP)用來測定海馬的突觸可塑性。用免疫印跡的方法檢測內質網應激的相關凋亡蛋白的表達情況，並且觀察海馬CA1區域中，內質網超微結構和海馬樹突棘數目及突觸形態的變化。 / 從實驗結果中，LTP在缺氧後減弱，而TUDCA能夠部分恢復由於缺氧所導致的LTP的降低。除此之外，內質網應激相關的促凋亡蛋白(CHOP和caspase-12)在缺氧組中表達升高，但是在TUDCA組中有所減低，同時，我們還發現，TUDCA也能夠減低缺氧組中cleaved-caspase-3的表達，而這一作用，可能與提高Bcl-2蛋白的表達（一個可標記的抗凋亡蛋白）有關。在間歇性缺氧組的海馬CA1區域中，粗面內質網出現管腔的腫脹，這一超微結構的變化表明在內質網出現官腔中有的許多未折疊蛋白聚集，並通過TUDCA的注射能夠降解未折疊蛋白來緩解這一現象的發生。同時，在IH處理後，突觸超微結構也發生了形態上的變化。突觸活性區的長度在IH處理組中顯著減少，但是在TUDCA組中有一定程度的恢復。高爾基染色顯示，成熟樹突棘（海馬突觸可塑性的結構基礎）的數目在間歇性缺氧組中有所下降，而在TUDCA治療後，成熟樹突棘的數目有所上升。我們發現參考記憶錯誤次數在缺氧後都有明顯的升高，而在注射TUDCA後，參考記憶錯誤次數都有所降低。總之，這些結果證明，內質網應激在間歇性缺氧的所引起的長時程突觸可塑性減弱和神經認知功能的損傷起到關鍵的作用，而抑制內質網應激對OSA中的出現神經功能紊亂起到一定的預防和治療效果。 / 而另一方面，神經元的放電，特別是海馬中神經元穩定持久的放電形式，對記憶的形成起到關鍵的作用。間歇性缺氧所引起的ROS的升高對於長時程增強的神經活動存在一定的關係，因為，通過以往的研究發現，間歇性缺氧可以通過多種鉀離子通道的啟動，最終由於鈣離子依賴的谷氨酸釋放的增多从而導致興奮性毒性的神經遞質的釋放。而這些結果只在急性缺氧模型中發現，慢性的間歇性缺氧對海馬的放電頻率的影響仍是未知之數。 / 因此，為了探討長時程的間歇性缺氧對海馬神經元的放電頻率和局部場電位的影響，多管道微絲電極陣列植入OSA大鼠的海馬中來監控自發放電的影響。結果表明，錐體細胞的放電頻率在第二天和第三天的8小時的間歇性低氧後明顯的升高了。另一方面，我們觀察到中間神經元似乎對間歇性缺氧更敏感，因為，從第三天到第七天缺氧8小時後，神經元的放電頻率都明顯的增高。但是在間歇性缺氧14天后，錐體細胞和中間神經元的放電頻率都所有顯著性的減少。同時，這一部分結果準確表明了海馬神經元的放電模式和局部場電位在間歇性缺氧的模型的是如何變化的。我們發現錐體細胞所具有的複合簇狀放電的比例減少，同時，theta波(與記憶的形成有關)的能量也有所減低。而這種神經元活動和局部的場電位的異常變化可能與OSA模型中出現的總認知功能障礙有關。在恢復一周後，錐體細胞的放電頻率有所增加，基本上可以恢復到缺氧前的狀態，但是中間神經元的頻率卻沒有多大的改變, 但是，其具體機制仍不清楚。從間歇性缺氧對大鼠海馬神經元自發放電和場電位影響的結果，它揭示了間歇性缺氧通過擾亂海馬CA1區域神經元的功能從而導致認知功能損傷。 / Xu, Linhao. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 167-199). / Abstracts also in Chinese. / Title from PDF title page (viewed on 03, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

The thesis deals with general public's awareness of the issue of hearing impairment. The theoretical part introduces the classification of hearing handicaps; it describes groups of people with hearing disabilities, their means of communication as well as attitudes and prejudice of the public towards such people. It offers an account of how the relationship of the public to the people with hearing impairments changed over time and discusses causes of the prejudice and stereotypes. The thesis similarly presents a number of options for obtaining information on the issue and focuses on the possibilities regarding teaching of sign language. The empirical part investigates the level of public awareness regarding the issue of hearing handicap, whether they are satisfied with the level of understanding, and whether they are interested in receiving information via an educational event in their surrounding or a short informative video providing basic information. KEYWORDS: public's awareness, hearing impairment, prejudice, enlightenment.

Having a sight impairment should not limit one’s opportunity to be socially included and obtain the many benefits of being in a green space. It is a challenge for landscape architects to ensure that every green space is sensibly planned and designed to provide benefits to all users, including the visually impaired. However, to date, little research has explored the extent to which this group of people use their local green space and how the attributes of green space help to maintain or increase their sense of emotional well-being, especially when their vision loss occurs later in life. This study has drawn on a sample of visually impaired people with central vision loss caused by late onset Age-related Macular Degeneration (AMD) from across Scotland to address this research gap. Subjects ranged from being partially sighted to severely sight impaired or blind. It employed a mixed method research strategy with a quantitative method as the main approach, supplemented by qualitative methods and triangulation. The study began with focus group discussions aimed at identifying those green space attributes that this group of people deemed important, as a basis for developing a choice-based conjoint (CBC) questionnaire survey. The survey data were analysed using conjoint analysis software (Sawtooth Software version 8.3) with a Hierarchical Bayesian (HB) method to evaluate the relative importance of green space attributes to the study participants. The purpose of this method was to demonstrate the different priorities placed by people with visual impairment on the physical, social, sensory and accessibility attributes of the green space. This work was followed by a series of walk-along and home interviews to gain an in-depth understanding of how the attributes that emerged as most important from the conjoint survey helped the participants to obtain a restoration of their emotional well-being through being in green spaces. The conjoint analysis results demonstrated that the relative importance of green space attributes differs by gender, visual condition and the emotional state caused by sight loss. The qualitative findings suggest that green space can act as a medium to promote emotional restoration by offering a compatible environment that motivates individuals to undertake the kind of outdoor physical and social activities that reduce social isolation. Taken together, the two most influential factors in relative importance and emotional restoration were individual affordance and social company. The value of this research lies in identifying the landscape design attributes that are of the greatest importance to people with AMD. Such findings could help policymakers and landscape architects to provide better design solutions to include this group of people. They may also prove valuable as part of a new approach to enable people to deal with the emotional issues surrounding their late-onset visual impairment.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-08-05T12:13:18Z No. of bitstreams: 1 Nayara Thais de Oliveira Costa.pdf: 1071808 bytes, checksum: f97bb08403576a1534a911329fa2a041 (MD5) / Made available in DSpace on 2016-08-05T12:13:18Z (GMT). No. of bitstreams: 1 Nayara Thais de Oliveira Costa.pdf: 1071808 bytes, checksum: f97bb08403576a1534a911329fa2a041 (MD5) Previous issue date: 2016-03-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Purpose: The main purpose of this study was to establish he relation between audibility for speech sounds and speech recognition in children with neurosensory hearing loss using hearing aid. Method: The subjects of this study were 40 children with moderate to severe hearing loss, of both sexes, with chronological age between tive and 12 years. Initially, the factors that may influence the analyzed subjects' performances in speech recognition tests were assessed. The investigated factors were: audibility for speech, according to Speech intelligibility index (SII); chronological age; audiometric characteristics; information regarding audiologic rehabilitation; means of communication and test material. Finally, groups composed by children with similar SII values were compared in order to identify the individual characteristics of each group and the aspects able to distinguish on group from the other. The studied variables were: audiologic and hearing aid use characteristics (time of sensory deprivation and mean hours of daily use) and performance in recognition of words and consonants. Results: The analysis showed that the SII values had a weak to moderate relation with speech recognition results. Regarding the other variables concerning the child, only the audiometric thresholds were also related to the child's behavior on the test, though this relation ,was always weak. There were statistical differences identified in the performances on the speech material, better for words with greater linguistic content. Finally, children in the group with better audibility - GrSII-1 had better performances in the speech recognition test, however, with more heterogeneous results among its members n compared to the group with lower audibility - GrSII-2. GrSII-1's recognition performance was more susceptible to the influence of other factors, such as time of sensory deprivation. The results of the group with lower audibility was more influenced by ifs audiometric limitations since children in this group had more errors than those in the first group, and these errors were mainly for speech segments with low acoustic energy. Conclusion: Audibility for speech, measured based on SII values is related to the performances of neurosensory hearing impaired children using individual hearing aid in speech recognition tests. However, it must be considered that, although this relation exists, SII represents only the speech signal that is accessible and useful through the hearing aid, and is incapable of expressing adverse factors that may influence the performance of children, such as adequate auditory stimulation deprivation or the test's material characteristic / Objetivo: O objetivo geral desta pesquisa foi estabelecer a relação entre audibilidade para sons de fala e reconhecimento de fala em crianças com deficiência auditiva neurossensorial usuárias de Aparelho de Amplificação Sonora Individual (AASI). Método: Participaram deste estudo 40 crianças com perda auditiva de grau moderado a severo, de ambos os sexos e idade cronológica entre cinco e 12 anos. Inicialmente, foram pesquisados os fatores que poderiam influenciar o desempenho dos sujeitos analisados em teste de reconhecimento de fala, sendo investigados: audibilidade para fala, a partir de valores de Índice de Inteligibilidade de Fala - mais comumente denominado de SII; idade cronológica; características audiométricas; informações relacionadas à reabilitação auditiva; meio de comunicação e material de teste. Por último, grupos formados por crianças que possuíam valores de SII similares foram comparados buscando-se identificar as características individuais de cada grupo e os aspectos capazes de distinguir um grupo do outro, sendo pesquisadas como variáveis: as características audiológicas, de uso de AASI (tempo de privação sensorial e média de horas de uso por dia) e desempenho de reconhecimento de palavra e consoantes. Resultados: A análise mostrou que valores de SII tiveram relação fraca a moderada com resultados de reconhecimento de fala. Em relação às demais variáveis relacionadas à criança, foram identificadas que somente os limiares audiométricos também tiveram relação com o comportamento das crianças no teste, porém essa relação foi sempre fraca. Quanto ao material de fala, foram identificadas diferenças estatísticas entre os desempenhos, sendo melhores para palavras com maior conteúdo linguístico. Por último, foi observado que crianças pertencentes ao grupo com melhor audibilidade - GrSII-1, possuíam melhor desempenho em teste de reconhecimento de fala, porém, com resultados mais heterogêneos entre seus membros, se comparado ao grupo com menor audibilidade - GrSII-2. O desempenho de reconhecimento do GrSII-1 se mostrou mais suscetível à influencia de outros fatores, como o tempo de privação sensorial, já os resultados do grupo com menor audibilidade se mostrou mais influenciado por suas limitações audiométricas, sendo que crianças desse grupo tiveram mais erros do que do primeiro grupo, e esses erros foram principalmente para segmentos de fala com baixa energia acústica. Conclusão: A audibilidade para fala, mensurada a partir de valores de SII, tem relação com desempenhos de crianças com deficiência auditiva neurossensorial usuárias de AASI em teste de reconhecimento de fala. No entanto, deve-se levar em consideração que, apesar dessa relação existir, o SII representa apenas que o sinal de fala está acessível e útil por meio do AASI, sendo incapaz de expressar fatores adversos que podem ter influencia sobre o desempenho das crianças, como a privação de estimulação auditiva adequada ou característica do material de teste

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-08-08T12:08:58Z No. of bitstreams: 1 Claudia Aparecida Morgado Soares.pdf: 4329914 bytes, checksum: f9ea8576e4437d726ef6727ec7c5b76e (MD5) / Made available in DSpace on 2016-08-08T12:08:58Z (GMT). No. of bitstreams: 1 Claudia Aparecida Morgado Soares.pdf: 4329914 bytes, checksum: f9ea8576e4437d726ef6727ec7c5b76e (MD5) Previous issue date: 2016-03-16 / This study aims to discuss the participation of students with visual impairment in the administrative and pedagogical decisions taken by school managers. In addition, we discuss the attitude of directors towards the visually impaired, that is, as the shares are currently practiced and how they can be expanded to provide the effective inclusion of these students. To develop this work was held initially extensive literature on proposals for educational management and the process of inclusion of blind students and low vision. Applied also, a survey of the visually impaired students, to meet their needs and expectations regarding the posture of managers. Another important factor to consolidate the research was designed and implemented to interview the coordinator and the director of the college, in order to identify inclusive work them before the current educational setting. At the end of this thesis it was found that, although there is the conviviality of the visually impaired with the other students in mainstream schools is not observed their participation in the meetings with school administrators so that they can express their needs and propose measures to facilitate inclusive process / O presente estudo tem por finalidade discutir a participação dos alunos com deficiência visual nas decisões administrativas e pedagógicas da escola tomadas pelos gestores. Além disso, discutiremos a postura dos diretores perante a deficiência visual, ou seja, como as ações são praticadas atualmente e como elas poderão ser ampliadas para proporcionar a efetiva inclusão desses educandos. Para o desenvolvimento deste trabalho realizou-se inicialmente, extensa pesquisa bibliográfica sobre as propostas de gestão educacional e o processo de inclusão dos estudantes cegos e com baixa visão. Aplicou-se, também, uma pesquisa com os alunos deficientes visuais para conhecer as suas necessidades e expectativas com relação à postura dos gestores. Outro fator importante para consolidar a pesquisa foi à entrevista elaborada e aplicada a coordenadora e a diretora do colégio, com o intuito de identificar o trabalho inclusivo delas diante do cenário educativo atual. Ao finalizar esta dissertação verificou-se que, ainda que exista o convívio dos deficientes visuais com os demais alunos nas escolas regulares, não se observa a participação deles nas reuniões com os gestores escolares, para que possam expor suas necessidades e propor providências para facilitar o processo inclusivo

Submitted by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-12-03T17:33:36Z No. of bitstreams: 1 PauloSergioJoseVieiraDissertacao2018.pdf: 1703351 bytes, checksum: 5be676e8cbdc3d6eb43b15a65a064956 (MD5) / Approved for entry into archive by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-12-03T17:35:35Z (GMT) No. of bitstreams: 1 PauloSergioJoseVieiraDissertacao2018.pdf: 1703351 bytes, checksum: 5be676e8cbdc3d6eb43b15a65a064956 (MD5) / Made available in DSpace on 2018-12-03T17:35:35Z (GMT). No. of bitstreams: 1 PauloSergioJoseVieiraDissertacao2018.pdf: 1703351 bytes, checksum: 5be676e8cbdc3d6eb43b15a65a064956 (MD5) Previous issue date: 2018-09-06 / This main goal of this study is to analyze the public policies and practices of inclusive education for students with visual impairment at Escola de Música de Brasília, Brazil. For this purpose, a qualitative and exploratory survey was conducted using document analysis; semi-structured interviews and direct observation in regular classes and in the Resource Room, constituting a case-study. Five students with visual impairment, five teachers of regular classes and one teacher of the Resource Room took part in this study. For the theoretical frame the ideas of Glat (1995), Mantoan (2003, 2006), Prieto (2006, 2009), Bonilha (2006), Mattos and Pinheiro (2007), Garcia and Michels (2011), Bardin (2011), Baptista (2011), Glat and Pletsch (2012), Salomão (2013), and also Vasconcelos and Síveres (2018) were used. Several international documents were consulted, such as The Universal Declaration of Human Rights (1948), The Salamanca Statement (1994) and The Inter-American Convention on the Elimination of All Forms of Discrimination against Persons with Disabilities (1999). National legislation, including the Brazilian Constitution of 1988, was also consulted, in addition to local legislation. The data generated was submitted to content analysis. On the theme of public policies, the main characteristic is that according to the documents, all the spaces of educational services are inclusive. As far as the success of the practice of inclusion is concerned, the results expose, as a positive aspect of SES (Special Education Services) the support the students receive in the Resource Rooms, which promote aspects of development that are essential to enable educational inclusion. On the other hand, the drawbacks this study has identified include the lack of continuing educational courses, the lack of teaching resources, as well as the lack of appropriate assets and assistive technology to promote the educational inclusion process in the school that was surveyed. The demands of the entrance examination force the visually impaired students to compete in the same terms with all the other students. The main strategies observed in the teaching practices were the partnership between the Resource Class teacher and the teachers of regular classes to promote the learning process and the creation of a pleasant and motivating environment for the visually impaired students in the Specific Resource Room. The study arrives at the conclusion that there are weaknesses and difficulties in the process of including visually impaired students. Thus, the need to strengthen the entire structures of SES should be considered throughout the school context involved in the educational inclusion process. / Este trabalho teve por objetivo analisar políticas e práticas de educação inclusiva para pessoas com deficiência visual na Escola de Música de Brasília. Para esse propósito, foi realizada uma pesquisa qualitativa de caráter exploratório, configurando um estudo de caso. Utilizou-se a análise documental, entrevistas semiestruturadas e observação direta em sala comum e na Sala de Recursos. Participaram dessa pesquisa cinco alunos com deficiência visual, cinco professores de classe comum e uma professora da Sala de Recursos. O referencial teórico se ampara nas ideias dos seguintes autores: Glat (1995), Mantoan (2003, 2006), Prieto (2006, 2009), Bonilha (2006), Mattos e Pinheiro (2007), Garcia e Michels (2011), Bardin (2011), Baptista (2011), Glat e Pletsch (2012), Salomão (2013), além de Vasconcelos e Síveres (2018). Foram realizadas consultas aos textos da legislação de nível internacional, como por exemplo, a Declaração Universal dos Direitos Humanos da ONU ([1948], 1998), a Declaração de Salamanca (1994) e a Convenção de Guatemala (1999). Para o nível nacional, consultou-se a Constituição da República Federativa do Brasil (1988), a Lei n. 9.394/96 de Diretrizes e Bases da Educação Nacional, a Política Nacional Especial na Perspectiva da Educação Inclusiva (2008), o Decreto n. 7.611/11 e a Lei Brasileira de Inclusão n. 13.146/15. Em nível local, foram analisados: a Orientação Pedagógica Educação Especial (2010) e o Currículo em Movimento da Educação Básica Educação Especial (2014), entre outros. Os dados gerados foram submetidos à análise de conteúdo. Em relação às políticas, a legislação mantém uma característica em comum: todos os espaços de atendimento são inclusivos. Em relação às práticas de inclusão, foi verificado como aspecto positivo o acolhimento e o atendimento educacional especializado na Sala de Recursos com vistas à efetiva aprendizagem do aluno com deficiência visual. Como aspecto negativo verificou-se a insuficiência de formação continuada para os docentes, bem como, a carência de materiais pedagógicos, equipamentos e tecnologia assistiva para promover a inclusão educacional na escola pesquisada. O edital de ingresso não promove a entrada do aluno cego na Escola de Música de Brasília, impulsionando o candidato à disputa da vaga na ampla concorrência. As principais estratégias adotadas na prática docente consistiram na articulação dos professores de classe comum e a professora da Sala de Recursos com a finalidade de promover o aprendizado do estudante e a promoção de um ambiente acolhedor e amigável na Sala de Recursos do tipo Específica. A pesquisa conclui que existem falhas no processo de inclusão educacional direcionado ao estudante cego. Considera-se que para o fortalecimento do Atendimento Educacional Especializado devem ser promovidas ações com todos os atores envolvidos no processo de inclusão educacional no contexto escolar.

O acidente vascular encefálico (AVE) é uma doença comum e de grande impacto para a saúde da população, uma vez que é considerado a principal causa de incapacidades neurológicas, principalmente motora e cognitiva. Considerando que os exossomos e o seu conteúdo podem ser marcadores prognóstico de demência em pacientes com Doença de Alzheimer, avaliamos o perfil exossomal circulante em pacientes pós AVE isquêmico com e sem comprometimento cognitivo. Ainda, é de conhecimento que os pacientes tratados com trombolíticos apresentam redução na dependência funcional a longo prazo, assim é de interesse avaliar os exossomos periféricos destes pacientes. Este trabalho visou investigar o perfil de exossomos circulantes em pacientes após diagnóstico de AVE isquêmico (AVEI) nas fases aguda e crônica. Foram determinados o conteúdo de proteína total e a atividade da acetilcolinesterase (AChE), marcadores de exossomos, além de correlacionar escores de comprometimento neurológico com os parâmetros bioquímicos. Ainda, considerando que o estresse oxidativo tem um papel central na fisiopatologia da isquemia cerebral, determinamos o conteúdo de espécies reativas e a atividade da enzima superóxido dismutase (SOD) em exossomos circulantes. Os fatores comprometimento cognitivo e o uso do trombolítico na fase aguda da doença não mostraram ter influência sobre os parâmetros estudados. Os resultados sugerem que uma diminuição de exossomos circulantes, já que houve uma redução na quantificação de proteínas totais na fase crônica, pode sugerir um prejuízo no sistema de remoção de materiais tóxicos levando ao acúmulo de materiais indesejados disso, o estado oxidativo exossomal, representado pelos níveis de espécies reativas e a atividade da SOD, foi alterado na fase crônica quando comparado com a fase aguda. Estes resultados sugerem que há uma alteração do perfil dos exossomos ao longo do tempo nos pacientes com AVE isquêmico. Nossos dados indicam que os níveis de espécies reativas na fase aguda podem predizer alterações no perfil dos exossomos na fase crônica de pacientes com comprometimento cognitivo, especificamente nas atividades das enzimas SOD e AChE e na concentração de proteínas totais. Estas associações não foram observadas em pacientes sem comprometimento cognitivo. Correlacionamos os parâmetros bioquímicos com as escalas de déficit neurológico, os escores do Mini-Exame do Estado Mental (MEEM) foram inversamente proporcionais aos níveis de AChE naqueles pacientes que não receberam o tratamento trombolítico na fase aguda. Assim, nossos dados demonstram que o prejuízo cognitivo (menores escores de MEEM) está associado a maiores níveis de atividade da AChE em exossomos circulantes. O papel dosexossomos na fisiopatologia da isquemia cerebral, assim como na predição de diagnóstico de comprometimento cognitivo precisa ser melhor investigado. / Stroke is a common disease and has a major impact on the public health, since it is considered the main cause of neurological disabilities, mainly motor and cognitive impairment. Considering that exosomes’ content may be prognostic markers of dementia in patients with Alzheimer's disease we evaluated the circulating exosomal profile in patients with ischemic stroke with and without cognitive impairment. Furthermore, it is known that thrombolytic therapy reduces long-term disability, so it is interesting to evaluate the peripheral exosomes of these patients. This work aimed to investigate the profile of circulating exosomes in patients after diagnosis of ischemic stroke in the acute and chronic phases. Total protein content and acetylcholinesterase activity (AChE), markers of exosomes were determined, also it was correlated the scores of cognitive function tests with biochemical parameters. Considering that oxidative stress plays a central role in the pathophysiology of cerebral ischemia, we determined the content of reactive species and the activity of the superoxide dismutase enzyme (SOD) in circulating exosomes. The factors cognitive impairment and the use of thrombolytic in the acute phase of the disease did not show influence on the studied parameters. The results suggest that a decrease in circulating exosomes, since there was a reduction in the quantification of total proteins in the chronic phase, may suggest a damage in the system of removal of toxic materials leading to the accumulation of unwanted materials. The exosomal oxidative state, represented by the reactive species levels and the SOD activity, was altered in the chronic phase when compared to the acute phase These results suggest that the profile of the exosomes is altered over time in patients with ischemic stroke. Our data indicate that reactive species levels in the acute phase may predict changes in the exosome profile in the chronic phase of patients with cognitive impairment, specifically in the activities of SOD and AChE enzymes and in the concentration of total proteins. These associations were not observed in patients without cognitive impairment. We correlated the biochemical parameters with the the scores of the assessment of cognitive function tests, the Mini-Mental State Examination (MMSE) scores were inversely proportional to the AChE levels in those patients who did not receive the thrombolytic treatment in the acute phase. Thus, our data demonstrate that cognitive impairment (lower MMSE scores) is associated with higher levels of AChE activity in circulating exosomes. The role of exosomes in the pathophysiology of cerebral ischemia, as well as in the prediction of diagnosis of cognitive impairment, needs to be better investigated.

Crianças com Distúrbio Específico de Linguagem (DEL) podem apresentar dificuldades de recepção e emissão da linguagem que podem trazer prejuízos na sua interação com outras crianças, familiares e sociedade uma vez que estudos relatam a importância social da comunicação como um veículo de extensas redes de trocas sociais, pelas quais se forma e se transforma a cultura e, em consequência a própria realidade social. O objetivo deste estudo foi investigar as habilidades comunicativas de seis crianças com DEL, na faixa etária entre sete e oito anos e onze meses e comparar com crianças com desenvolvimento típico pertencentes ao grupo controle (GC), pareado por idade e gênero. A investigação compreendeu: (i) a avaliação do período da narrativa oral com quatro figuras de sequência lógico temporal e (ii) avaliação do desempenho em habilidades sociais comunicativas (HSC) por meio da analise de filmagens de situações estruturadas entre cada criança com DEL e seu respectivo par do GC e entre cada criança com DEL e um adulto do gênero feminino. Como resultado, todas as crianças com DEL apresentaram déficits nas HSC tanto nas interações com seus pares quanto com o adulto e cinco delas mostraram desempenho narrativo abaixo do esperado em relação ao GC, o que evidencia prejuízo nas interações sociais desses indivíduos. O estudo permitiu caracterizar e identificar necessidades especiais relacionadas ao repertório social e comportamental, mas são necessários novos estudos sobre protocolos de avaliação e intervenção que tenham como meta tanto a melhoria nos aspectos de fala e linguagem quanto nas relações interpessoais das crianças com DEL. / Children with Specific Language Impairment ( SLI ) may present difficulties in receiving and issuing of language that can bring harm in their interaction with other children , family and society as social studies report the importance of communication as a vehicle for extensive exchange networks social and shape by which the culture is transformed and therefore social reality . The aim of this study was to investigate the communicative abilities of six children with SLI , aged between seven and eight years and eleven months and compared with typically developing children in the control group ( CG) , matched for age and gender . The investigation included: ( i ) assessing the period of oral narrative with four figures logical temporal sequence and ( ii ) assessing performance in communicative social skills ( HSC ) through the analysis of shooting situations structured between each child with SLI and its respective pair of the GC and between each child with SLI and an adult female . As a result , all children with SLI showed deficits in HSC both in interactions with their peers and with adult and five of them showed narrative performance below expectations compared to GC , which show impaired social interactions of these individuals . The study allowed us to characterize and identify special needs related to social and behavioral repertoire , but further studies are needed on protocols for assessment and intervention that have as a goal the improvement in both aspects of speech and language and interpersonal relationships of children with SLI .