Thesis (MPhil (Centre for Health Sciences Education)--University of Stellenbosch, 2010. / AFRIKAANSE OPSOMMING: Doel: Te min spraak-taalterapeute (STT’e) wêreldwyd spreek vlotheidsversteurings aan. Dit mag aan hul gevoelens van onbevoegdheid in die hantering van persone wat hakkel toegeskryf word. Nuut-gegradueerde STT’e, in die Suid-Afrikaanse konteks, het dikwels nie toegang tot ondersteuning en leiding van ervare klinici om hul vaardighede en bevoegdheid in die hantering van persone wat hakkel, te ontwikkel nie. Die doel van hierdie studie was om voorgraadse STTstudente se persepsies van hul eie bevoegdheid om persone wat hakkel te hanteer, te ondersoek en beskryf 1) direk na die voltooiing van hul teoretiese module en voor kliniese plasing, en 2) na blootstelling aan ‘n bykomende opleidingskomponent waar hulle waargeneem het hoe intervensieprosedures op ‘n gesimuleerde pasiënt toegepas word. Metodes: ‘n Beskrywende opnameontwerp, met pre- en post-intervensie-vraelyste is gebruik om die andragogiese benadering se impak op studente, voor en nadat hulle die bykomende opleidingsgeleentheid ontvang het, te evalueer. Resultate: Voor die intervensie het die meeste studente hulself nie as bevoegd geag om persone wat hakkel te evalueer of behandel nie. Na die intervensie is statisties beduidende veranderinge in die studente se self-ervare bevoegdheid vir die meeste aspekte verwant aan die evaluering en behandeling van mense wat hakkel, gerapporteer. Opsomming: Daar is tot die gevolgtrekking gekom dat die studente hierdie tipe innoverende opleidingsmetodologie hoog op prys stel en dat dit ‘n nodige aanvulling tot studente se bestaande kliniese plasings is.

Thesis (M Speech Path)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Narrative skills have found to be a predictor of academic success with clear correlations to later reading and writing abilities in children. The quality of narratives and the language disorders displayed in specific clinical populations has also been correlated, making narratives a useful diagnostic tool. To be able to know what is atypical, one has to know what is normal. Normative based assessment materials are very limited in South Africa. Commercially available assessments are often inappropriate because of the complex nature of narratives and the influence of socio-economic, linguistic and cultural factors. There is therefore a need not only to develop appropriate assessment materials but also to obtain normative data for use in the South African context. The main research question this study attempted to answer is: What are the patterns of narrative development in normally developing children? A total of 62 typically developing children from schools in a middle class residential area was selected. Three different age groups were identified: Grade R (5 to 6 years), Grade 1 (6 to 7 years) and Grade 3 (8 years 6 months to 9 years 6 months) based on their different exposure to literate language. It was assumed that they would display distinct patterns of narrative development, with an increase in the complexity of narrative features with age. A wordless picture book, regarded as appropriate for the South African context, was developed and used to elicit a narrative from each participant. Narratives were analysed using a comprehensive narrative assessment protocol. Assessment areas included macrostructure, microstructure, use of literate language and the use of abstraction. Results were compared in terms of group differences and developmental trajectories. The assessment protocol showed similar story lengths in all age groups, suggesting that when the developed wordless picture book was used as elicitation stimulus, any significant differences between groups could be of diagnostic value. Results showed clear developmental trajectories in terms of macrostructural measures. The group differences between Grade R and Grade 1 in terms of microstructural measures were not significant. There was, however, a significant increase in terms of syntactic complexity and lexical diversity from Grade R to Grade 3. No significant development was observed in terms of the use of literate language features across the year groups and a group effect was offered as a possible explanation. In contrast to concrete statements, children as young as 5 years old used mainly abstractions in their generated narratives. / AFRIKAANSE OPSOMMING: Narratiefvaardighede is nie net ‘n voorvereiste vir akademiese sukses nie, maar korreleer ook met lees- en skryfvaardighede in kinders. Weens die korrelasie tussen die kwaliteit van narratiewe en die taal van kinders met spesifieke taalgestremdhede, het narratiewe ook diagnostiese waarde. Om te weet wat atipies is, moet ‘n mens weet wat normaal is. Normatiewe evaluasiemateriaal is baie beperk in Suid-Afrika. Die evaluasies wat kommersieël beskikbaar is, is dikwels ontoepaslik weens die kompleksiteit van narratiewe en die invloed van sosioekonomiese, linguistiese en kulturele faktore. Dit is daarom belangrik om geskikte evaluasie materiaal te ontwikkel en normatiewe data te bepaal vir gebruik in die Suid-Afrikaanse konteks. Met hierdie studie is daar gepoog om die volgende navorsingsvraag te beantwoord: Hoe ontwikkel narratiewe in normaal ontwikkelende kinders? ‘n Totaal van 62 tipies-ontwikkelende kinders is geselekteer uit hoofstroomskole in ‘n middelklas residensiële omgewing. Drie verskillende ouderdomsgroepe is geteiken op grond van hulle blootstelling aan geletterdheidstaal: Graad R (5 – 6 jaar), Graad 1 (6 – 7 jaar) en Graad 3 (8 jaar 6 maande – 9 jaar 6 maande). Daar is aangeneem dat die groepe baie spesifieke patrone in narratiefontwikkeling sou toon, met ‘n toename in die kompleksiteit van narratiewe met toename in ouderdom. ‘n Woordlose prenteboek, wat beskou is as toepaslik binne die Suid-Afrikaanse konteks, is ontwikkel en gebruik om ‘n narratief van elke deelnemer te ontlok. Narratiewe is ontleed met behulp van ‘n omvattende evaluasieprotokol. Areas vir ontleding het makrostruktuur, mikrostruktuur, gebruik van geletterdheidstaal en die gebruik van abstraksie ingesluit. Resultate is vergelyk ten opsigte van groepsverskille en ontwikkelingspatrone. Die storielengte van die verkillende ouderdomsgroepe het ooreengestem en suggereer dat wanneer die woordlose prenteboek as ontlokkingstimulus gebruik word, enige beduidende verskille tussen groepe van diagnostiese waarde is. Die resultate het duidelike ontwikkelingspatrone getoon ten opsigte van makrostrukturele meetings. Groepsverskille tussen Graad R en Graad 1 was onbeduidend ten opsigte van mikrostrukturele metings. Daar was egter ‘n beduidende toename ten opsigte van sintaktiese kompleksiteit en leksikale diversiteit van Graad R tot Graad 3. Geen beduidende ontwikkeling is waargeneem ten opsigte van die gebruik van geletterdheidstaal oor die jaargroepe nie en ‘n groepseffek is as moontlike verduideliking gegee. Kinders so jonk as 5 jaar oud het hoofsaaklik abstrakte taal teenoor konkrete taal in hul narratiewe gebruik. Kliniese implikasies vir spraak- en taalterapeute is bespreek.

Intensive Language Action Therapy (ILAT) is a short-term aphasia therapy that emphasises massed-practise of language, where communication is framed through language action games that approximate everyday interactions. Despite increasing interest in ILAT, a comprehensive description of its methods has thus far been missing. Furthermore due to inconsistent results, further exploration of cortical reorganisation of language functions following ILAT is warranted. The underlying principles and practical features of ILAT methods and of language-action games are fully described, including the structure and materials for two specific games. 14 English speaking patients with chronic aphasia underwent two weeks of ILAT utilising the methods outlined. Pre and post measures of language performance were collected through standardised clinical assessments, along with functional Magnetic Resonance Imaging scans from a subset of 8 patients. Accuracy and response times for speech output and comprehension during language-action games were also recorded to measure success during the therapy interval. Data analysis showed significant improvements in clinical assessments of naming and comprehension, but not in auditory or syntactic processing tasks. Significant increases were also seen in patients’ self-ratings of quality of communication following therapy. Video and voice recordings during therapy sessions demonstrated significantly faster response times in production and comprehension of language, alongside an increase in the complexity of patients’ spoken output. Cortical activation was recorded whilst patients heard low-level noise, sentences containing ambiguous words and low-ambiguity sentences. Although the results showed no changes in cortical activation in the group of patients whilst processing low-level noise or low ambiguity sentences, increases in language-induced activation were seen in single-subject analyses in both the left and right hemispheres. Furthermore the group of patients recruited the right hemisphere significantly more than the left hemisphere following ILAT when processing complex sentences containing ambiguous words. iii Clinical assessments and measures of everyday communication showed undergoing two weeks of ILAT significantly improved speech output and comprehension in patients with chronic aphasia. Gains made in communicative performance during therapy highlight the importance of recording therapy sessions for additional assessment of therapy efficacy. Although conclusions regarding cortical reorganisation are not entirely clear, they indicate the important role of the right hemisphere in reorganisation of language after stroke.

This thesis is concerned with the experience of aphasia in Khayelitsha, a township on the outskirts of Cape Town characterised by poverty, violence, limited resources and a culture and language that differs from the setting of most speech and language services in South Africa. It is based on three years of intermittent fieldwork that entailed participant observation of the everyday life of five adults living with aphasia and interviews with participants, kin and healthcare workers in various settings. Grounded in sociocultural theory, this thesis has aimed to provide an ethnographic account of cultural frameworks of interpretation of communication impairment following stroke and of the daily reality of life for adults living with aphasia in this setting. An exploration of causal notions in this setting provided interesting commentary on social and cultural processes and how people, caught up in these processes, search for meaning and for cure. Participants entertained plural notions of causation of aphasia and explored numerous therapeutic avenues. The wide variation in causal notions included biomedical causes, social and behavioural determinants, and the influences of supernatural powers, such as witches and ancestors. Similarly participants experienced aphasia through multiple healing systems, including traditional, biomedical and religious therapy options. All however seemed to be ambiguous sources of help. Whilst encounters with the health system presented serious challenges to participants, traditional and religious avenues for help were obscured by a burgeoning and not always ethical open market offering miracle cures. An articulation of the circumstances of this group of adults provided further commentary on the influence of the social context on aphasia. In a context where sociopolitical processes have had a disintegrating effect on social cohesion, questions of support, care and security were of primary concern. Prejudices towards the elderly and women were more acutely felt and vulnerability, isolation, insecurity and fluidity of circumstance emerged as overarching themes. The central argument in this thesis is that the genesis of these experiences can be found in contextual factors in Khayelitsha, such as poverty, inequality, urbanisation and changing cultural paradigms. These emerging themes highlight the disjunctions between the medical alignment of the discipline of speech language therapy in South Africa and the capacity for socially-engaged practice. They also highlight the socio-cultural complexity of the experience of aphasia, specifically the influences of culture and poverty. There is thus theoretical and clinical relevance in using anthropological objectives to explore the world of the adult living with aphasia and the interface between context and service provision. Interventions and healthcare communications that will make a meaningful difference to adults with aphasia in a setting such as Khayelitsha are proposed.

Este estudo buscou compreender o contexto cultural que envolve as práticas das mães residentes na comunidade pesqueira de Zimbros em Bombinhas, Santa Catarina e foi construído a partir do diálogo entre Fonoaudiologia, Saúde Pública e as Ciências Sociais. O caminho metodológico contou com contribuições da Etnografia, utilizando-se na pesquisa a observação participante realizada na sala de espera da Unidade de Saúde do bairro. A partir da análise dos textos dos diários de campo, observei a importância de construir-se uma escuta em relação à população e explorar mais o espaço da Unidade de Saúde como um espaço comunicativo para que a população possa ressignificar as suas práticas. As práticas das mães refletem a maneira como a comunidade entende as questões de linguagem. Neste local há um silêncio em relação às questões de linguagem que estão atreladas ao desejo da criança de falar, a espera do tempo certo para falar, sendo mais evidentes para as mães as questões atreladas ao uso de chupeta, à amamentação e/ou alimentação. A função das mães circula entre atender os desejos do filho ou repassar normas de conduta. Portanto, a Fonoaudiologia deve aprofundar as questões relacionadas à linguagem e cultura; construir formas alternativas de abordar a população, buscando situações dialógicas e que possam auxiliar outros profissionais a valorizarem as falas das mães. / This study has sought to understand the cultural context which involves the practice of the mothers living in the fishing community of Zimbros in Bombinhas, Santa Catarina State, and was developed from the dialog among Speech Therapy, Public Health, and Social Sciences. The methodological path featured the contributions from Etnography, by using, in the research, the participant observation carried out in the waiting room of the neighborhood’s Health Department. From the analyses of the field diary texts, I have noticed the importance of developing a hearing related to the population and futher exploring the Health Department space as a communicative space so that the population may give a new meaning to their practices. The mothers’ practices reflect the way in which the community understands the language issues. In this place, there is a silence with reference to the language issues which are linked to the child’s desire to speak, the right waiting period to speak, where the issues which are more evident to the mothers included the use of pacifiers, breastfeeding and/our feeding. The mothers’ roles range from meeting the child’s wishes to passing on behavior rules. Therefore, Speech Therapy must further study the issues related to language and culture, develop alternative ways of approaching the population, seeking dialogical situations that may help other professionals to value the mothers' speeches.

INTRODUÇÃO: A Dislexia do Desenvolvimento é um transtorno específico da aprendizagem, caracterizado como um comprometimento apresentado pelo indivíduo ao realizar a leitura, mesmo com inteligência, motivação e instrução escolar adequadas. Possui base neurobiológica de origem genética. Embora a literatura disponibilize muitos estudos sobre a dislexia que enfocam a elaboração e o uso de instrumentos de avaliação da compreensão leitora, consciência fonológica, entre outros, ainda são pouco divulgados os programas de intervenção em compreensão de leitura para essa população. A Técnica de Cloze, que consiste na organização de um texto curto com lacunas, tem sido caracterizada como um método eficaz na mensuração e na remediação da compreensão leitora. OBJETIVOS: Elaborar um Programa Fonoaudiológico em Compreensão Leitora e Ortografia e verificar seus efeitos na compreensão de leitura de escolares com dislexia. MÉTODOS: Fizeram parte dessa pesquisa onze indivíduos diagnosticados com dislexia do desenvolvimento, entre 09 e 11 anos, desses, 8 eram meninos. O programa foi composto por 16 sessões divididas em quatro níveis de complexidade. Todas as sessões contaram com um texto adaptado com a Técnica de Cloze, atividades de compreensão leitora e ortografia. Os sujeitos foram submetidos ao pré e pós-teste, com a avaliação da compreensão leitora e da ortografia. RESULTADOS: Os achados demonstraram que os sujeitos apresentaram melhor desempenho de compreensão leitora no pós em comparação ao pré-teste, tanto na porcentagem de acertos no Cloze e nas perguntas de compreensão textual, quanto no nível de compreensão de leitura atingido. Além disso, foram observadas generalizações dos ganhos de compreensão leitora para outros contextos. CONCLUSÕES: O Programa Fonoaudiológico de Compreensão Leitora e Ortografia foi um instrumento relevante na remediação da compreensão de leitura dos participantes dessa pesquisa, por desenvolver melhora na compreensão leitora tanto de textos com Cloze quanto em perguntas de compreensão e por produzir leitores mais motivados. Além disso, concluiu-se que tanto a Técnica de Cloze quanto as perguntas de compreensão textual são instrumentos precisos para avaliar a compreensão de leitura dos indivíduos com dislexia. Esse estudo foi inovador por elaborar e verificar os efeitos de um programa específico de remediação para crianças com dislexia com uma proposta de atuação conjunta em compreensão de leitura de textos com a Técnica de Cloze, tarefas de perguntas e respostas e ortografia / INTRODUCTION: Developmental dyslexia is a specific learning disorder, typified as an impairment showed by the individual while reading, even with intelligence, motivation and proper school instruction. It has neurobiological basis with genetic inheritance. Although the literature provides several studies about dyslexia which focus on the elaboration and use of evaluation instruments of the reading comprehension, phonological awareness, and others, there is almost no published studies of reading comprehension intervention programs for this population. Cloze\"s Technique, which consists on the organization of a short text with blanks, is been characterized as an effective method on the measurement and remediation of reading comprehension. OBJECTIVES: Elaborate a Speech Therapy Program of Reading Comprehension and Orthography and verify its effects on reading comprehension of dyslexic students. METHODS: There were part of this research eleven individuals diagnosed with developmental dyslexia, in ages between 09 and 11 years old, which, 8 of them where boys. The program was comprised of 16 sessions split into four levels of complexity. All of the sessions relied on an adapted text with Cloze\"s Technique, activities of reading comprehension and orthography. The subjects underwent pre-tests and post-tests, with the evaluation of reading comprehension and orthography. RESULTS: Findings showed that the subjects had better performance on reading comprehension at the post-test in comparison to the pre-test, in the percentage of right answers on Cloze\"s and in the comprehension questions as well as in the level of reading comprehension. Apart from that, generalizations of the gains in reading comprehension could be observed in another contexts. CONCLUSIONS: The Speech Therapy Program of Reading Comprehension and Orthography was a relevant instrument in remediation of reading comprehension on the subjects of this study, by increasing reading comprehension in texts with Cloze´s Technique as well in the comprehension questions, and by producing more motivated readers. Besides, this study concluded that Cloze´s Technique and comprehension questions were precise instruments for evaluating reading comprehension of dyslexic children. This study was innovative because of the elaboration of a specific remediation program for children with dyslexia and the verification of its effects allied with a purpose of joint work among reading comprehension of texts using Cloze\"s Technique, questions and answers tasks and orthography

Made available in DSpace on 2016-04-27T18:12:00Z (GMT). No. of bitstreams: 1 Marta Cecilia Rabinovitsch Gertel.pdf: 373314 bytes, checksum: cf2047b869df618d4c40f072b05b703b (MD5) Previous issue date: 2013-03-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / INTRODUCTION: The clinical experience has shown the importance of understanding Family and School in its mutual influence and interdependence in the development of children sent for speech-language therapy. Thinking the relationships between family and school implies to be attentive to the modes by which said instances are related and interfere in the subjective structure and development of a child´s (oral and graphic) language. It also implies to understand that the language disorder, even in the cases it arises from organic events and marks (either congenital or acquired), has the crossed influence of the family and school dynamics, in whose interactions tendencies for the sequence of child´s development is designed. The educational inclusion policy, which has been consolidating in the regular teaching network along the last years, points to the need of integrated actions between school, family and professionals dealing with children presenting language and/or apprenticeships difficulties, said professionals including the speech-language therapist. OBJECT: to present and discuss the pertinence of a speech therapy attention to children with language disorder, by means of an approach that includes the family and the school in the therapeutically process in a simultaneous form and by means of a triangle between speechlanguage therapy events of the child, his/her living experiences, routines and family and school routines. METHOD: This paper bears a clinical-qualitative nature and was designed by means of a reflection based on vignettes selected from clinical case records served by the researcher speech-language therapist, from 2010 to 2011. The utilized material was elaborated along the therapeutically process, from the records appearing in reports obtained from services to children, family and the school. The analysis of clinical material making up the vignettes in the selected cases was supported by the bibliographic review of the thesis, both by speechlanguage literature that considers the family and school dimension in the infantile development, or the conceptual operators inspired in a theoretical reference of Winnicott. For such, two complementary criteria have been followed: the way along the family history axis and the patient´s social-educational axis, and sections of significant moments favoring unfolding in the development of the speech-language therapeutic process. Results: The strategy of simultaneous service to family and school had a direct influence on the therapeutic process of the patients involved in this study. A significant development of each child´s behavior was noticed, mainly concerning the oral and/or graphic communication and the social circulation within the family and school environment. Final considerations: To think the relationships between the child, family and school, as made in this paper, implies to build and enhancing an attention able to apprehend the modes through which said instances go against each other, act in a triangle and interfere in the subjective structuring and development of the child´s (oral and graphic) language. It also assumes that the speech-language therapist is willing to deal with the tensions inherent to said constitutive environments, with the eventual overlapping of roles and functions and with the unavoidable divergences present and expressed about the infantile development. As we understand it, it is for the speech-language therapist to perform the important function of providing the family and the school with a middle way that promotes the acceptance, comprehension and the collaboration with the other, from the foreign perspective. Such mediation, as a willingness to live in the middle of instances and persons in a relationship, is what is liable to benefit and potentialize the child´s development. As the clinical experience has shown, this is possible and very productive in a large part of cases. / INTRODUÇÃO: A experiência clínica tem mostrado a importância de compreender Família e Escola em sua mútua influência e interdependência no desenvolvimento das crianças encaminhadas para atendimento fonoaudiológico. Pensar as relações entre família e escola pressupõe estar atento aos modos pelos quais essas instâncias triangulam e interferem na estruturação subjetiva e no desenvolvimento da linguagem (oral e gráfica) da criança. Implica também compreender que o transtorno de linguagem, mesmo nos casos em que é decorrente de questões e marcas orgânicas (congênitas ou adquiridas), está simultaneamente atravessado pela dinâmica familiar e escolar, em cujas interações se desenham tendências para sequência do desenvolvimento da criança. A política de inclusão educacional, que vem se consolidando na rede regular de ensino nos últimos anos, sinaliza para a necessidade de ações integradas entre a escola, a família e os profissionais que lidam com crianças que apresentam dificuldades de linguagem e/ou aprendizagem, entre eles o fonoaudiólogo. OBJETIVO: apresentar e discutir a pertinência de uma proposta de atendimento fonoaudiológico às crianças com transtorno de linguagem, por meio de uma abordagem que inclui a família e a escola no processo terapêutico, de modo simultâneo e por meio da triangulação entre acontecimentos da terapia fonoaudiológica da criança, de suas vivências, rotinas e dinâmicas familiares e escolares. MÉTODO: Esta pesquisa é de natureza clínico-qualitativa e foi desenvolvida por meio de reflexão baseada em vinhetas selecionadas a partir de registros de casos da clínica atendidos pela fonoaudióloga-pesquisadora no período de 2010 e 2011. O material utilizado foi elaborado ao longo do processo terapêutico, a partir de registros em forma de relatórios obtidos nos atendimentos à criança, à família e à escola. A análise do material clínico, que compõe as vinhetas dos casos selecionados, foi subsidiada pela revisão bibliográfica da tese, tanto pela literatura fonoaudiológica que considera a dimensão familiar e escolar no desenvolvimento infantil, quanto pelos operadores conceituais inspirados em referencial teórico de Winnicott. Para tanto, seguimos dois critérios complementares: o percurso ao longo do eixo da história familiar e do eixo sócio-educacional do paciente; e o recorte de momentos significativos que favoreceram desdobramentos no desenvolvimento do processo terapêutico fonoaudiológico. Resultados: A estratégia de atendimento simultâneo à família e à escola influiu diretamente no processo terapêutico dos pacientes envolvidos neste estudo. Observou-se desenvolvimento significativo no comportamento de cada criança, sobretudo no que se refere à comunicação oral e/ou gráfica e à circulação social no ambiente familiar e escolar. Considerações finais: Pensar as relações entre criança, família e escola, tal como foi feito nessa pesquisa, pressupõe construir e aguçar uma escuta capaz de apreender os modos pelos quais essas instâncias incidem umas nas outras, triangulam e interferem na estruturação subjetiva e no desenvolvimento de linguagem (oral e gráfica) da criança. Também pressupõe que o fonoaudiólogo se disponha e se prepare para lidar com as tensões inerentes a esses ambientes constitutivos, com as eventuais sobreposições de papeis e funções, e com as inevitáveis divergências que se apresentam e se manifestam acerca do desenvolvimento infantil. Em nosso entender, ao fonoaudiólogo cabe exercer a importante função de propiciar à família e à escola um caminho pelo meio, que promova o acolhimento, a compreensão e a colaboração com o outro, com a perspectiva alheia. Essa mediação, como disposição de habitar o entre das instâncias e pessoas em relação, é o que pode beneficiar e potencializar o desenvolvimento da criança. A experiência clínica tem mostrado que isso é possível e muito produtivo em boa parte dos casos

Made available in DSpace on 2016-04-27T18:12:38Z (GMT). No. of bitstreams: 1 Patricia Trinta e Farias.pdf: 1110472 bytes, checksum: 1739798374fb2dd30939aeadadc88368 (MD5) Previous issue date: 2008-11-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present paper had the objective of describing the transformation in the clinical-therapeutical perspective occurred during the ambulatory speechlanguage treatment of a young child with feeding problems that used an exclusive alternative feeding via gastrotomy. The difficulty concerning the feeding dynamic was understood beyond the organical and functional aspects, considering the patient s familial context. Being applied a clinical exploratory methodology, to collect the data there were used registrations (handbooks) of the attendances, including the parents interviews. In order to reflect about the transformation in the attendance process contemplating the child s life history, there were applied concepts of the Winnicottian theory, namely: holding, object management and presentation. Finally, it was possible to conclude that the speech-language therapist that deals with feeding problems, based on a favorable setting, may offer the patient conditions to a safe pleasant feeding / O presente estudo teve como objetivo descrever a transformação na perspectiva clínico-terapêutica ocorrida durante o tratamento fonoaudiológico ambulatorial de uma criança pequena com problema alimentar que utilizava uma via de alimentação alternativa exclusiva gastrostomia. A dificuldade em torno da dinâmica da alimentação foi compreendida para além dos aspectos orgânicos e funcionais, considerando-se o contexto familiar da paciente. Sendo a metodologia clínica exploratória, para a coleta dos dados foram utilizados registros (prontuário) dos atendimentos, incluindo as entrevistas com os pais. Para refletir sobre a transformação no processo de atendimento, contemplando a história de vida da criança, foram abordados conceitos da teoria winnicottiana, a saber: holding, manejo e apresentação de objeto. Por fim, foi possível concluir que o fonoaudiólogo que atua com problemas alimentares, a partir de um setting favorável, pode oferecer ao paciente condições para uma alimentação segura e prazerosa

A Telefonoaudiologia ou Teleprática em Fonoaudiologia, entendida como a utilização de tecnologias de informação e comunicação (TIC) em ações fonoaudiológicas, apresenta-se como alternativa para promover a integração e valorização das práticas profissionais. Este estudo teve por objetivo apresentar um material hipermídia sobre o tratamento do Transtorno Fonológico, desenvolvido para ser utilizado como recurso didático no ensino e aprimoramento/aperfeiçoamento da Fonoaudiologia, e avaliar sua qualidade. O desenvolvimento do CDROM Procedimentos Terapêuticos no Transtorno Fonológico foi realizado em 4 etapas: análise/planejamento, modelagem conceitual, de navegação/interface, implementação e avaliação. A fase de avaliação foi desenvolvida para atingir 3 objetivos: avaliar o aspecto técnico no material, verificando sua execução e possíveis incompatibilidades; a qualidade do conteúdo e das estratégias utilizadas; e a adequação instrucional e estética. Para atender as exigências de cada aspecto, os avaliadores foram respectivamente: analistas de sistema e membro da equipe de desenvolvimento do material; especialistas no conteúdo em questão (fonoaudiólogos e profissionais que atuam na área de Educação a Distância); e usuários - alunos de graduação e profissionais fonoaudiólogos. Na navegação utilizou-se a estratégia de hipertexto para que pudesse ser respeitado o estilo de aprendizagem de cada usuário, uma das premissas da EAD. Elementos como: perfil do público alvo, apresentação do conteúdo de forma clara e objetiva, disponibilização de informações atuais e abrangentes sobre o tema, além da integração de diversas mídias (som, vídeo, imagem, animação) foram considerados no desenvolvimento do material. De maneira geral, o CDROM Procedimentos Terapêuticos no Transtorno Fonológico foi bem aceito pelos avaliadores, emergindo respostas positivas na maioria dos itens avaliados. Todos os avaliadores consideraram o material adequado ao público a que se destina. A partir dos resultados e das observações realizadas durante o desenvolvimento do CDROM concluiu-se que as fases de análise e planejamento despenderam mais tempo, por exigir extensa pesquisa para seleção e elaboração do conteúdo; durante as fases de modelagem de navegação e interface o trabalho integrado entre fonoaudiólogo e o profissional da área de design gráfico foi determinante para o desenvolvimento do material. O processo de avaliação por fonoaudiólogos, profissionais da área de informática e educação foi efetivo para conferir qualidade ao material e atingir o objetivo estabelecido. / The use of information and communication technologies in Speech and Language Pathology, called Telehealth or Telepractice in Speech and Language Pathology, is an alternative to promote the integration and enhancement of professional practices. This study aimed to present a hypermedia material on the Phonological Disorders therapy, developed to be used as a didactic resource in teaching and continuing education of Speech and Language Pathology, and assess its quality. The development of \"Therapeutic Procedures in Phonological Disorder\" CDROM was accomplished in 4 stages: analysis/planning, conceptual and navigation/interface modeling, implementation and evaluation. The evaluation stage was developed to reach 3 goals: to assess the technical aspect of the material, verifying its execution and possible incompatibilities; the content and used strategies quality; and instructional adequacy and aesthetics. To assist the demands of each aspect, the judges were respectively: system analysts and member of the material development team; experts in the content in subject (Speech and Language Pathologist and professionals working in Distance Education); and users - graduation students and Speech and Language Pathologists. In the navigation the strategy of hypertext was used so the style of learning of each user could be respected, one of the DL assumptions. It was considered in the developing of the material elements as: audience profile, presentation of content in a clear and objective way, providing current and comprehensive information on the subject, beyond the integration of various media (sound, video, image, animation). In general, the \"Therapeutic Procedures in Phonological Disorder\" CDROM was well accepted by the judges, emerging positive answers in most of the appraised items. All judges considered the material appropriate to the audience destined. Starting from the results and of the observations accomplished during the CDROM development it was concluded that the analysis and planning stages spent more time because it demanded extensive research for content selection and elaboration; the work integrated between Speech and Language Pathologist and graphic design area professional during the stages of navigation and interface modeling was decisive for the development of the material. The evaluation process by Speech and Language Pathologists and informatics and distance learning professionals was effective to check quality to the material and to reach the established objective.

A aquisição lexical é uma das primeiras manifestações observáveis no desenvolvimento normal da linguagem, e, portanto, alterações nesse processo constituem um marco inicial das Alterações no Desenvolvimento da Linguagem (AEDL). O objetivo principal deste trabalho foi investigar a aquisição lexical de crianças normais e aquelas com AEDL em três situações de apresentação de novas palavras, que reproduziam contextos freqüentemente usados na intervenção fonoaudiológica. Vinte e uma crianças com AEDL (GP) e 30 em desenvolvimento normal (GC), todas na faixa etária de três anos, foram randomicamente designadas a um dos subgrupos de exposição: G1 - brincadeira simbólica, G2 - jogo, G3 - interação baseada em livro de história. As mesmas cinco não-palavras foram apresentadas em quantidade controlada aos sujeitos de cada subgrupo, em três sessões de interação, na presença dos respectivos referentes, também desconhecidos. O desempenho dos sujeitos foi analisado considerando a situação natural de interação (Etapa I) e tarefas de nomeação, compreensão e reconhecimento das novas palavras em um pós-teste realizado a cada sessão (Etapa II). Para melhor discussão dos dados, a pesquisa foi dividida em três estudos. O Estudo 1 analisou o desempenho do GC no procedimento experimental, e mostrou algumas diferenças do GC3 em relação aos outros subgrupos de exposição nas medidas referentes à Etapa I, refletindo que a presença física dos referentes, a demanda atencional e o nível de maturidade simbólica necessários para a aquisição podem ter influenciado as respostas dos sujeitos desse subgrupo. Os sujeitos do GC, de maneira geral, apresentaram melhores habilidades de compreensão que de nomeação, e evoluíram ao longo das sessões em relação às variáveis que indicaram aquisição (produção espontânea na Etapa I; compreensão e nomeação na Etapa II). O Estudo 2 analisou o desempenho do GP no procedimento experimental, contrastando os resultados com os apresentados pelo GC, e mostrou que os processos envolvidos e a influência das variáveis analisadas foram os mesmos para os dois grupos. As diferenças entre eles foram quantitativas e qualitativas, sugerindo que as crianças com AEDL necessitam de maior quantidade de experiências e demoram mais tempo do que seus pares em desenvolvimento normal para adquirirem uma nova palavra. Tanto no GC quanto no GP, a imitação não-solicitada foi utilizada por alguns sujeitos como estratégia para a aquisição das palavras, mostrando correlação positiva com a ocorrência de produções espontâneas. O Estudo 3 correlacionou as habilidades demonstradas pelos sujeitos dos dois grupos em adquirir palavras e o domínio lexical medido em prova específica de vocabulário expressivo. A correlação positiva entre essas habilidades, nos dois grupos, e ainda com a quantidade de intervenção fonoaudiológica anterior recebida pelos sujeitos do GP sugeriram que a prática em adquirir palavras influenciou positivamente o desempenho na tarefa de aquisição dos novos itens lexicais. Considerados em conjunto, os resultados mostraram grande variabilidade de desempenho em ambos os grupos, indicando que a aquisição lexical é um processo individual e heterogêneo, e que as habilidades de cada criança com AEDL devem ser consideradas individualmente no processo terapêutico para que este seja o mais efetivo possível. / Lexical acquisition is one of the first observable manifestations of normal language development and, therefore, deficits in this process constitute an early indication of Language Impairment (LI). The aim of the present study was to investigate the lexical acquisition of children within normal language development and children with LI in three different word-learning situations, which reproduced contexts frequently used in language therapy. The subjects were 21 three-year-old children with LI (Research Group - RG) and 30 normally developing controls with the same chronological age (Control Group - CG), randomly designated to one of the exposure subgroups: G1 - symbolic play; G2 - game; G3 - interaction based on a storybook. The same five nonwords were presented to subjects of each subgroup (Phase I), along with their respective unknown referents, over three interaction sessions. The number of presentations was controlled. Subjects\' performances under natural interaction (Phase I) and during tasks of naming, comprehension and recognition of the novel words (Phase II) were analyzed. The research was divided into three studies. Study 1 analyzed the CG performance on the experimental procedure, and showed that CG3 had differed from the other subgroups regarding the measures used to access performance on Phase I. These differences suggested that the physical presence of the referents, the attentional demand and the symbolic abilities necessary to word learning may have influenced the performance of this subgroup. Study 2 analyzed the RG performance on the experimental procedure, comparing the results to those presented by CG children. The processes involved and the influences played by the analyzed variables were the same for both groups. Differences between groups, however, were both quantitative and qualitative, suggesting that children with LI require more experiences and take a longer time than their normally developing peers to learn a novel word. The CG presented better comprehension and naming abilities, and improved throughout the sessions, regarding the variables that indicated acquisition (spontaneous production in Phase I; comprehension and naming of the novel words in Phase II). In both CG and RG, unsolicited imitation was used by some subjects as a word-learning strategy, showing positive correlation with the occurrence of spontaneous production. Study 3 analyzed the correlations between subjects\' abilities in acquiring novel words and lexical knowledge, measured by an expressive vocabulary test. The correlation was positive within each group. In addition, there were also positive correlations among novel word acquisition, expressive vocabulary and the amount of prior language intervention received by RG subjects, which suggested that the practice in learning words positively influenced novel lexical items acquisition. Taken together, the results showed great variability among subjects regardless of their group, indicating that lexical acquisition is an individual and heterogeneous process, and that the abilities of children with LI must be considered individually during therapeutic process, making intervention as effective as possible.