Traumatic brain injury/acquired brain injury (TBI/ABI) is considered a major cause of death and disability in the United States (Blennow et al., 2016). Most often, TBI/ABI affects memory, concentration, judgment, and executive functioning skills. As a result, individuals with moderate–severe TBI/ABI often experience physical and cognitive deficits, long-term disability, and decreased quality of life (Whiteneck et al., 2016). Unaddressed cognitive deficits can result in difficulties with patient performance of meaningful and prioritized occupations and activities (Giles, 2018). Occupational therapy has a role in addressing the cognitive dysfunction that results from moderate–severe TBI/ABI. Occupational therapy practitioners’ (OTPs) role in cognitive rehabilitation based on a neurofunctional approach is to maximize patients’ safety and engagement in meaningful, purposeful activities of daily living and instrumental activities of daily living. Despite the role that OTPs play in addressing cognitive dysfunction, cognition has slowly been marginalized from occupational therapy’s repertoire due to unclear boundaries with other health care disciplines, including speech-language pathology and neuropsychology (Giles et al., 2020). Education is needed to ensure that OTPs understand evaluation and intervention methods based in both functional cognition and the neurofunctional approach. The proposed training program, Hierarchy to Success: A Framework of Functional Cognitive Strategies and Caregiver Education, is provided to OTP participants via an asynchronous, online training format utilizing Blackboard course sites. The training program seeks to address many of these challenges through an evidence-based, theory-driven educational training program. The program aims at increasing OTPs’ knowledge, confidence, and competence in using neurofunctional evaluation and intervention strategies to address cognitive deficits that result from TBI/ABI. / 2023-09-16T00:00:00Z

A presente pesquisa situa-se na interface entre as áreas da psicologia e da fisioterapia e foi construída a partir da proposição de que a prática profissional de fisioterapeutas é influenciada pelos valores pessoais, educação e história particular de cada indivíduo, com alguma contribuição de delineamento durante seus percursos na graduação. O sucesso no tratamento fisioterapêutico de pacientes depende, entre outros fatores, da habilidade do fisioterapeuta em aplicar, na prática, o conhecimento teórico-científico aprendido na graduação. E, mais do que o conhecimento médico-biológico, o acesso ao paciente pelo fisioterapeuta requer também envolvimento no âmbito sociocultural e psicológico. Pressupõe-se que, na graduação de fisioterapia, o aluno depare-se com situações e conteúdos que não são exatamente como antes imaginados e, por consequência, aproprie-se da elaboração de tais situações e conteúdos. As construções de significados a partir do estranhamento somente poderão ser construções particulares, nos seus modos de fazê-las; logo, os novos conteúdos passam a fazer parte de seu repertório particular. Nesse sentido, formar-se em uma profissão exige do indivíduo afastar-se, em parte, de suas expectativas prévias para formar-se em si mesmo como profissional. Para o desenvolvimento da pesquisa, o trabalho foi elaborado a partir das ideias do construtivismo semiótico-cultural a respeito das relações interpessoais e relações indivíduo-mundo, bem como noções da filosofia gadameriana sobre processos formativos. Os objetivos da pesquisa foram: investigar como cada estudante de graduação transforma as próprias tradições (no sentido de Gadamer) e experiências pessoais em conhecimento tácito para atender às demandas do paciente em tratamento fisioterapêutico, em outras palavras, entender processos de Bildung dos graduandos de fisioterapia; como se articulam, na formação profissional, conhecimentos técnico-científicos aprendidos durante a graduação e valores, educação e história particular de cada pessoa que se torna fisioterapeuta. Nos procedimentos metodológicos, foram realizadas entrevistas com oito estudantes do último ano da faculdade de fisioterapia sobre seus percursos na graduação. Os dados obtidos foram analisados qualitativamente e revelaram que a natureza do processo de construção de conhecimento constitui-se nas projeções que o estudante faz sobre seu próprio percurso na faculdade antes mesmo de iniciá-la, e suas concepções vão sendo alteradas conforme o contato com os conteúdos do curso. A partir do confronto entre concepções anteriores com as realidades concretas vividas, os estagiários reconfiguraram suas ações simbólicas (Boesch, 1991). A ressignificação de suas próprias ações simbólicas permitiu a eles lidarem com a realidade percebida de maneira diferente daquela anteriormente imaginada. A ruptura de conceituações prévias oferece ao indivíduo as possibilidades para reflexão sobre seu modo de ser no exercício profissional. Nesse sentido, a variabilidade e a qualidade das experiências com determinados pacientes poderão favorecer os processos de crescimento profissional. Igualmente, cabe ao âmbito acadêmico favorecer subsídios para que cada estudante em formação se reconheça no processo de constante vir a ser para que a prática profissional seja (re)elaborada o tempo todo, com base na interação fisioterapeuta-paciente de cada atendimento. A partir do pressuposto de que áreas acadêmicas da saúde estão pautadas na biologização de conteúdos, o que remonta à abstração de pacientes de suas próprias subjetividades para serem tomados como objetos de estudo, este estudo pode nortear a reflexão a respeito de práticas pedagógicas que considerem o paciente como um corpo dotado de sentidos que estão, o tempo todo, sendo reelaborados em cada interação no meio social em que vivem / This research is based on the interface between areas of psychology and physiotherapy and was constructed based on the proposal that the professional practice of physiotherapists is influenced by personal values, education and personal history of each individual, along with some contribution of design during their University undergraduate studies. The success of physiotherapeutic treatment of patients depends, among other factors, on the physiotherapists ability to apply to their practice the theoretical knowledge learned at college. And, beyond the medical-biological knowledge, the access to the patient by the physiotherapist also requires involvement in the sociocultural and psychological spheres. It is assumed that the student pursuing a physiotherapy undergraduate degree faces situations and contents that are not exactly as previously imagined and, consequently, absorb the elaboration of such situations and contents. Construction of meanings out of strangeness can only be personal constructions, hence the new contents become their own particular repertoire. In this sense, training in a profession requires that the individual partially detaches from previous expectations, towards a self-development as a professional. In order to develop the research, it was drawn from the ideas of semiotic-cultural constructivism regarding interpersonal relations and individual-world relations, as well as the notions of Gadamerian philosophy on formative processes. The objectives of the research were: to investigate how each undergraduate student transforms their own traditions (Gadamers sense) and personal experiences in tacit knowledge to meet the patient\'s demands in physiotherapeutic treatment. In other words, to understand Bildung processes of Physiotherapy undergraduates; The connection in professional training between technical-scientific knowledge learned during undergraduate studies and values, education and particular history of each person who becomes a physiotherapist. In the methodological procedures, an interview was conducted with eight students of last year of physiotherapy college about their pathways while seeking a degree. The data obtained were analyzed qualitatively, thus revealing that the nature of the process of knowledge construction is constituted by the projections that the student makes about their own trajectory in college before its beginning. These conceptions are changed according to students contact with course contents. From the confrontation between previous conceptions with concrete realities experienced, the trainees reconfigured their symbolic actions (Boesch, 1991). The re-signification of their simple actions allowed them to deal with a perceived reality differently from that previously imagined. The rupture of previous conceptualizations offers an individual as possibilities for reflection on their way of being in the professional practice. In this sense, the variable and quality of experiences with patients may favor professional growth processes. Likewise, it is up to the academic field to favor subsidies so that the student in training recognizes themselves in a constant \"becoming\" process so that the professional practice gets constantly (re) elaborated, based on the physiotherapist-patient interaction of each appointment. From the assumption that the academic areas of health are rooted in the \"biologization\" of contents, which goes back to the abstraction of patients from their philosophical subjectivities to be considered subject of study; this research may orientate the thought about pedagogical practices that consider the patient as a body endowed with senses that are, all the time, being reinvented through each interaction in the social environment in which they live

A presente pesquisa situa-se na interface entre as áreas da psicologia e da fisioterapia e foi construída a partir da proposição de que a prática profissional de fisioterapeutas é influenciada pelos valores pessoais, educação e história particular de cada indivíduo, com alguma contribuição de delineamento durante seus percursos na graduação. O sucesso no tratamento fisioterapêutico de pacientes depende, entre outros fatores, da habilidade do fisioterapeuta em aplicar, na prática, o conhecimento teórico-científico aprendido na graduação. E, mais do que o conhecimento médico-biológico, o acesso ao paciente pelo fisioterapeuta requer também envolvimento no âmbito sociocultural e psicológico. Pressupõe-se que, na graduação de fisioterapia, o aluno depare-se com situações e conteúdos que não são exatamente como antes imaginados e, por consequência, aproprie-se da elaboração de tais situações e conteúdos. As construções de significados a partir do estranhamento somente poderão ser construções particulares, nos seus modos de fazê-las; logo, os novos conteúdos passam a fazer parte de seu repertório particular. Nesse sentido, formar-se em uma profissão exige do indivíduo afastar-se, em parte, de suas expectativas prévias para formar-se em si mesmo como profissional. Para o desenvolvimento da pesquisa, o trabalho foi elaborado a partir das ideias do construtivismo semiótico-cultural a respeito das relações interpessoais e relações indivíduo-mundo, bem como noções da filosofia gadameriana sobre processos formativos. Os objetivos da pesquisa foram: investigar como cada estudante de graduação transforma as próprias tradições (no sentido de Gadamer) e experiências pessoais em conhecimento tácito para atender às demandas do paciente em tratamento fisioterapêutico, em outras palavras, entender processos de Bildung dos graduandos de fisioterapia; como se articulam, na formação profissional, conhecimentos técnico-científicos aprendidos durante a graduação e valores, educação e história particular de cada pessoa que se torna fisioterapeuta. Nos procedimentos metodológicos, foram realizadas entrevistas com oito estudantes do último ano da faculdade de fisioterapia sobre seus percursos na graduação. Os dados obtidos foram analisados qualitativamente e revelaram que a natureza do processo de construção de conhecimento constitui-se nas projeções que o estudante faz sobre seu próprio percurso na faculdade antes mesmo de iniciá-la, e suas concepções vão sendo alteradas conforme o contato com os conteúdos do curso. A partir do confronto entre concepções anteriores com as realidades concretas vividas, os estagiários reconfiguraram suas ações simbólicas (Boesch, 1991). A ressignificação de suas próprias ações simbólicas permitiu a eles lidarem com a realidade percebida de maneira diferente daquela anteriormente imaginada. A ruptura de conceituações prévias oferece ao indivíduo as possibilidades para reflexão sobre seu modo de ser no exercício profissional. Nesse sentido, a variabilidade e a qualidade das experiências com determinados pacientes poderão favorecer os processos de crescimento profissional. Igualmente, cabe ao âmbito acadêmico favorecer subsídios para que cada estudante em formação se reconheça no processo de constante vir a ser para que a prática profissional seja (re)elaborada o tempo todo, com base na interação fisioterapeuta-paciente de cada atendimento. A partir do pressuposto de que áreas acadêmicas da saúde estão pautadas na biologização de conteúdos, o que remonta à abstração de pacientes de suas próprias subjetividades para serem tomados como objetos de estudo, este estudo pode nortear a reflexão a respeito de práticas pedagógicas que considerem o paciente como um corpo dotado de sentidos que estão, o tempo todo, sendo reelaborados em cada interação no meio social em que vivem / This research is based on the interface between areas of psychology and physiotherapy and was constructed based on the proposal that the professional practice of physiotherapists is influenced by personal values, education and personal history of each individual, along with some contribution of design during their University undergraduate studies. The success of physiotherapeutic treatment of patients depends, among other factors, on the physiotherapists ability to apply to their practice the theoretical knowledge learned at college. And, beyond the medical-biological knowledge, the access to the patient by the physiotherapist also requires involvement in the sociocultural and psychological spheres. It is assumed that the student pursuing a physiotherapy undergraduate degree faces situations and contents that are not exactly as previously imagined and, consequently, absorb the elaboration of such situations and contents. Construction of meanings out of strangeness can only be personal constructions, hence the new contents become their own particular repertoire. In this sense, training in a profession requires that the individual partially detaches from previous expectations, towards a self-development as a professional. In order to develop the research, it was drawn from the ideas of semiotic-cultural constructivism regarding interpersonal relations and individual-world relations, as well as the notions of Gadamerian philosophy on formative processes. The objectives of the research were: to investigate how each undergraduate student transforms their own traditions (Gadamers sense) and personal experiences in tacit knowledge to meet the patient\'s demands in physiotherapeutic treatment. In other words, to understand Bildung processes of Physiotherapy undergraduates; The connection in professional training between technical-scientific knowledge learned during undergraduate studies and values, education and particular history of each person who becomes a physiotherapist. In the methodological procedures, an interview was conducted with eight students of last year of physiotherapy college about their pathways while seeking a degree. The data obtained were analyzed qualitatively, thus revealing that the nature of the process of knowledge construction is constituted by the projections that the student makes about their own trajectory in college before its beginning. These conceptions are changed according to students contact with course contents. From the confrontation between previous conceptions with concrete realities experienced, the trainees reconfigured their symbolic actions (Boesch, 1991). The re-signification of their simple actions allowed them to deal with a perceived reality differently from that previously imagined. The rupture of previous conceptualizations offers an individual as possibilities for reflection on their way of being in the professional practice. In this sense, the variable and quality of experiences with patients may favor professional growth processes. Likewise, it is up to the academic field to favor subsidies so that the student in training recognizes themselves in a constant \"becoming\" process so that the professional practice gets constantly (re) elaborated, based on the physiotherapist-patient interaction of each appointment. From the assumption that the academic areas of health are rooted in the \"biologization\" of contents, which goes back to the abstraction of patients from their philosophical subjectivities to be considered subject of study; this research may orientate the thought about pedagogical practices that consider the patient as a body endowed with senses that are, all the time, being reinvented through each interaction in the social environment in which they live

A presente pesquisa situa-se na interface entre áreas de psicologia e fisioterapia e foi construída a partir de reflexões sobre aspectos que interferiam a ida ou não ida de pacientes às sessões de fisioterapia. Muito do sucesso na reabilitação de indivíduos com desordens neurológicas requer, além da participação dos familiares e equipe multidisciplinar, a vontade de melhorar do próprio paciente. Portanto, para o continuado replanejamento do tratamento na busca de efetiva melhora da qualidade de vida dos indivíduos é necessário para o fisioterapeuta conhecer sobre as inquietações, desejos e expectativas desses pacientes. Nesse sentido, os objetivos deste trabalham foram: 1) Investigar as razões que levam o paciente a frequentar a fisioterapia; 2) Compreender o que o fisioterapeuta representa para o paciente em tratamento, bem como o processo de empatia, que se constrói na relação fisioterapeuta-paciente; 3) Investigar as tensões geradas pela ruptura de expectativas do paciente e do fisioterapeuta, 4) Analisar a temporalidade dos processos de relação do paciente consigo e com os outros (o fisioterapeuta aí incluído); 5) Identificar os valores positivos e negativos atribuídos pelos pacientes às experiências consigo mesmo e com os outros (o fisioterapeuta aí incluído). A pesquisa seguiu os pressupostos do Construtivismo Semiótico-Cultural em Psicologia, e, nesse sentido, a fisioterapia foi tomada como um espaço para ação simbólica de indivíduos que têm o desejo de superar um problema; as atividades de fisioterapia são parte das ações em direção ao desejo que se quer alcançar e o fisioterapeuta é um dos outros com quem o indivíduo está em constante interação. Nos procedimentos metodológicos foram realizadas entrevistas com quatro pacientes, previamente selecionados, que faziam fisioterapia em uma clínica de reabilitação multidisciplinar. As entrevistas foram gravadas, em dois momentos distintos, durante a realização dos exercícios de uma das sessões de fisioterapia. Os dados obtidos foram analisados pelo método microgenético, o qual busca investigar o processo de construção de conhecimento do indivíduo em face de situações novas que ele experimenta e que o desestabilizam e pode capturar novidades que emergem no processo. Nas sessões, em interação com o fisioterapeuta, cada participante apresentou construções simbólicas particulares sobre suas ações nas sessões de fisioterapia. A temporalidade foi determinante nos processos simbólicos dos participantes porque favoreceu a organização das transformações, integrando-as em suas memórias da condição anterior e em seus desejos, medos e expectativas quanto ao futuro. Os resultados das análises revelaram diversificadas maneiras de cada paciente atribuir significado para o aspecto do tempo no seu percurso na fisioterapia, trazendo implicações para o programa terapêutico. O profissional pode estimular ou inibir a vontade de participação do paciente no tratamento, a depender de suas ações e metas serem coordenadas ou não com as ações e metas do outro. Como consequência, há incentivo para vontade do paciente em participar da fisioterapia porque constata que as ações do profissional e do tratamento estão voltadas para suas metas. Em síntese, buscou-se com este trabalho, em sua interdisciplinaridade, ampliar possibilidades teórico-metodológicas do construtivismo semiótico-cultural em psicologia e da fisioterapia / This present study is based on the interface between psychology and Physical Therapy fields and was built from analyzed aspects which would interfere with the patients´ decision on whether or not to go to Physical Therapy sessions. The rehabilitation success of the patients with neurological disorders comes not only from the family support or from the caretakers and multidisciplinary healthcare team but mostly from the patients´ own desire to get better. Therefore, to continue the treatment process and the search of an effective result for a better quality of life, it is necessary that the physiotherapist look for a deep understanding and also become aware of the patients´ expectations, wishes and conflicts. In this way, the goals of this paper were: 1) to investigate the reasons by which the patients go, or decide to attend the Physical Therapy sessions; 2) to comprehend which role does the physiotherapist play for the patient, regarding the empathy process that is shaped in their relationship; 3) to investigate the tensions which have arisen from the expectations ruptures coming of both sides; 4) to analyze the temporality within the process of the patient with himself/herself and the others (he Physical Therapy is included here); 5) to identify positive and negative values addressed by the patients to the expectations within himself or herself, and with the I other relationship. (the physiotherapist is again included).The study followed the basis of the semiotic - cultural constructivism in Psychology and in this effect, Physical Therapy was taken as a symbolic action field of individuals who have desire or will to overcome a difficult situation. The Physical Therapy activities are part of the actions toward the desires which are aimed and the physiotherapist is part of the others who the patient is constantly interacting with. In the methodological procedures, interviews were made with four patients previously selected, who attended to Physical Therapy sessions in a multidisciplinary rehabilitation clinic. The interviews were recorded in two different moments, while the exercises were being done. The results obtained with the interviews were analyzed using the microgenetic method, which aims to investigate the developing process of knowledge of individuals who are bound to encounter new life situation that are experienced and it might bring some instability and also novelties to them. Through the sessions, while interacting with the physiotherapist, each participant came up with particular symbolic constructions about their actions in the sessions. The temporality was determined in the symbolic process of the participants because has helped to organize the transformations, by way of integrating their former condition memories and in their wishes, fear, and expectation towards the future. The results of the analyzes revealed many ways of addressing meaning regarding to the timing, in the course of the treatment, bringing implications to the therapeutic program. The professional is able to entice or even to make the patient loose his or her desire to continue and keep going on treatment. This desire will depend on how the physiotherapist could lead his or her aims in accordance to the ones of the others. As a consequence, there is an incentive towards the patients´ desire in taking part of the sessions, due to recognition that the attitudes of the physiotherapist are streamlined with their same aims. In summary, this work, in its interdisciplinary, theoretical and methodological possibilities to expand the semiotic-cultural constructivism in psychology and Physical Therapy

A presente pesquisa situa-se na interface entre áreas de psicologia e fisioterapia e foi construída a partir de reflexões sobre aspectos que interferiam a ida ou não ida de pacientes às sessões de fisioterapia. Muito do sucesso na reabilitação de indivíduos com desordens neurológicas requer, além da participação dos familiares e equipe multidisciplinar, a vontade de melhorar do próprio paciente. Portanto, para o continuado replanejamento do tratamento na busca de efetiva melhora da qualidade de vida dos indivíduos é necessário para o fisioterapeuta conhecer sobre as inquietações, desejos e expectativas desses pacientes. Nesse sentido, os objetivos deste trabalham foram: 1) Investigar as razões que levam o paciente a frequentar a fisioterapia; 2) Compreender o que o fisioterapeuta representa para o paciente em tratamento, bem como o processo de empatia, que se constrói na relação fisioterapeuta-paciente; 3) Investigar as tensões geradas pela ruptura de expectativas do paciente e do fisioterapeuta, 4) Analisar a temporalidade dos processos de relação do paciente consigo e com os outros (o fisioterapeuta aí incluído); 5) Identificar os valores positivos e negativos atribuídos pelos pacientes às experiências consigo mesmo e com os outros (o fisioterapeuta aí incluído). A pesquisa seguiu os pressupostos do Construtivismo Semiótico-Cultural em Psicologia, e, nesse sentido, a fisioterapia foi tomada como um espaço para ação simbólica de indivíduos que têm o desejo de superar um problema; as atividades de fisioterapia são parte das ações em direção ao desejo que se quer alcançar e o fisioterapeuta é um dos outros com quem o indivíduo está em constante interação. Nos procedimentos metodológicos foram realizadas entrevistas com quatro pacientes, previamente selecionados, que faziam fisioterapia em uma clínica de reabilitação multidisciplinar. As entrevistas foram gravadas, em dois momentos distintos, durante a realização dos exercícios de uma das sessões de fisioterapia. Os dados obtidos foram analisados pelo método microgenético, o qual busca investigar o processo de construção de conhecimento do indivíduo em face de situações novas que ele experimenta e que o desestabilizam e pode capturar novidades que emergem no processo. Nas sessões, em interação com o fisioterapeuta, cada participante apresentou construções simbólicas particulares sobre suas ações nas sessões de fisioterapia. A temporalidade foi determinante nos processos simbólicos dos participantes porque favoreceu a organização das transformações, integrando-as em suas memórias da condição anterior e em seus desejos, medos e expectativas quanto ao futuro. Os resultados das análises revelaram diversificadas maneiras de cada paciente atribuir significado para o aspecto do tempo no seu percurso na fisioterapia, trazendo implicações para o programa terapêutico. O profissional pode estimular ou inibir a vontade de participação do paciente no tratamento, a depender de suas ações e metas serem coordenadas ou não com as ações e metas do outro. Como consequência, há incentivo para vontade do paciente em participar da fisioterapia porque constata que as ações do profissional e do tratamento estão voltadas para suas metas. Em síntese, buscou-se com este trabalho, em sua interdisciplinaridade, ampliar possibilidades teórico-metodológicas do construtivismo semiótico-cultural em psicologia e da fisioterapia / This present study is based on the interface between psychology and Physical Therapy fields and was built from analyzed aspects which would interfere with the patients´ decision on whether or not to go to Physical Therapy sessions. The rehabilitation success of the patients with neurological disorders comes not only from the family support or from the caretakers and multidisciplinary healthcare team but mostly from the patients´ own desire to get better. Therefore, to continue the treatment process and the search of an effective result for a better quality of life, it is necessary that the physiotherapist look for a deep understanding and also become aware of the patients´ expectations, wishes and conflicts. In this way, the goals of this paper were: 1) to investigate the reasons by which the patients go, or decide to attend the Physical Therapy sessions; 2) to comprehend which role does the physiotherapist play for the patient, regarding the empathy process that is shaped in their relationship; 3) to investigate the tensions which have arisen from the expectations ruptures coming of both sides; 4) to analyze the temporality within the process of the patient with himself/herself and the others (he Physical Therapy is included here); 5) to identify positive and negative values addressed by the patients to the expectations within himself or herself, and with the I other relationship. (the physiotherapist is again included).The study followed the basis of the semiotic - cultural constructivism in Psychology and in this effect, Physical Therapy was taken as a symbolic action field of individuals who have desire or will to overcome a difficult situation. The Physical Therapy activities are part of the actions toward the desires which are aimed and the physiotherapist is part of the others who the patient is constantly interacting with. In the methodological procedures, interviews were made with four patients previously selected, who attended to Physical Therapy sessions in a multidisciplinary rehabilitation clinic. The interviews were recorded in two different moments, while the exercises were being done. The results obtained with the interviews were analyzed using the microgenetic method, which aims to investigate the developing process of knowledge of individuals who are bound to encounter new life situation that are experienced and it might bring some instability and also novelties to them. Through the sessions, while interacting with the physiotherapist, each participant came up with particular symbolic constructions about their actions in the sessions. The temporality was determined in the symbolic process of the participants because has helped to organize the transformations, by way of integrating their former condition memories and in their wishes, fear, and expectation towards the future. The results of the analyzes revealed many ways of addressing meaning regarding to the timing, in the course of the treatment, bringing implications to the therapeutic program. The professional is able to entice or even to make the patient loose his or her desire to continue and keep going on treatment. This desire will depend on how the physiotherapist could lead his or her aims in accordance to the ones of the others. As a consequence, there is an incentive towards the patients´ desire in taking part of the sessions, due to recognition that the attitudes of the physiotherapist are streamlined with their same aims. In summary, this work, in its interdisciplinary, theoretical and methodological possibilities to expand the semiotic-cultural constructivism in psychology and Physical Therapy

La voix est tout sauf un stimulus auditif ordinaire. Pour cause, elle prend son importance de manière très précoce chez l’Homme lorsque, dans l’environnement amniotique, le fœtus entend pour la toute première fois la voix de sa mère. C’est en quelque sorte par l’intermédiaire de cette voix que les premiers contacts avec le monde extérieur, mais également avec l’Autre, s’effectuent. Le statut particulier de la voix humaine perdure au fil du développement, devenant plus tard le principal médium véhiculant le langage oral, si significatif pour l’Homme. En parallèle, et de manière tout aussi adaptative, elle permet la transmission d’informations non langagières renseignant sur l’identité, l’état émotionnel mais également le statut social de chaque individu. C’est ainsi que simplement en entendant la voix d’une personne inconnue, il est généralement possible d’en extrapoler son âge, son genre, mais également d’avoir une idée assez précise de l’état émotionnel dans lequel elle se trouve. Les capacités permettant d’extraire de la voix les divers éléments informationnels qu’elle contient ne seraient toutefois pas stables au fil du temps. Ainsi, le vieillissement normal semble associé à des difficultés de traitement des informations vocales de nature langagière, mais également non langagière. De nombreuses études se sont intéressées au déclin des capacités de traitement du discours avec l’âge. Beaucoup moins de travaux ont cependant considéré les conséquences du vieillissement sur le domaine paralinguistique et, lorsque des travaux s’y sont attardés, c’est essentiellement la sphère affective qui a été investiguée. En raison de ce peu d’études, mais également de leur focus portant spécifiquement sur la sphère émotionnelle, il est extrêmement ardu de généraliser les résultats obtenus au traitement vocal général. La présente thèse s’est donc intéressée aux capacités de traitement de la voix dans le vieillissement normal. La première étude de cette thèse (Article 1) avait pour objectif d’évaluer l’impact du vieillissement normal sur les capacités comportementales de traitement paralinguistique vocal non émotionnel. Pour ce faire, une batterie informatisée composée de quatre tâches a été élaborée : la batterie d’évaluation de la perception vocale (Batterie EPV; tâches de catégorisation de genre, de discrimination de sources sonores, adaptative de discrimination et de mémorisation). Cette batterie permettait de comparer les performances d’adultes jeunes et âgés lors du traitement de stimuli vocaux et non vocaux, mais également lors du traitement de divers stimuli vocaux. Cette première étude met en évidence, pour trois des quatre tâches comportementales, des performances inférieures chez les adultes âgés et ce, malgré le contrôle statistique des contributions du déclin auditif et cognitif. Pour les aînés, le traitement de stimuli vocaux, en comparaison au traitement de stimuli non vocaux, n’était toutefois pas systématiquement inférieur à celui des jeunes adultes. Sans que les performances ne puissent être prédites par la mesure cognitive utilisée comme covariable (performances au MoCA), il appert que les demandes cognitives inhérentes aux tâches participent à ces différences intergroupes. Le second article de ce travail visait quant à lui à explorer à l’aide de l’imagerie par résonnance magnétique fonctionnelle (IRMf), l’influence du vieillissement normal sur les réseaux neuronaux sous-tendant le traitement de l’information vocale, une telle investigation n’ayant jamais été effectuée auparavant. Pour ce faire, une tâche d’écoute passive (permettant le contraste de blocs de sons vocaux et non vocaux) ainsi qu’une tâche adaptative de discrimination ont été utilisées. La tâche adaptative, basée sur une type de protocole psycoacoustique « up-down », assurait l’obtention de niveau de performance équivalent entre les deux groupes, une condition nécessaire pour la comparaison de groupe au niveau neurofonctionnel. La comparaison des adultes jeunes et âgés n’a mis en évidence aucune disparité quant au recrutement des aires répondant préférentiellement à la voix : les aires vocales temporales (AVT). Ce résultat suggère que l’âge n’affecte pas la mobilisation des aires spécialisées dans le traitement de la voix. Néanmoins, à l’extérieur des AVT et chez les aînés, le sous recrutement d’une portion du cortex auditif a été observé, en parallèle au recrutement additionnel de régions pariétale, temporale et frontale (Article 2 – Étude 1). Lors de la réalisation d’une tâche adaptative de discrimination, contrairement à ce qui était attendu, les seuils de discrimination des deux groupes d’âges étaient comparables. Pour effectuer la tâche, les participants âgés ont cependant recruté un réseau neuronal plus étendu que celui des jeunes adultes, et pour les aînés, l’activation additionnelle de régions frontale et temporale sous-tendaient la réalisation de la tâche (Article 2 - Étude 2). Les données comportementales présentées dans cette thèse suggèrent que l’effet délétère que semble avoir le vieillissement normal sur les capacités de traitement paralinguistique vocal affectif est également retrouvé lors du traitement d’informations vocales émotionnellement neutres. En parallèle, la mise en place de phénomènes de plasticité cérébrale est objectivée. Ces derniers ne toucheraient cependant pas les réseaux spécialisés dans le traitement de la voix, qui seraient recrutés de manière comparable par les adultes jeunes et âgés. Néanmoins, la tâche d’écoute passive a mis en évidence la présence, chez les aînés, du recrutement sous-optimal d’une portion du cortex auditif (gyrus temporal transverse). En parallèle, et ce pour les deux tâches, des réseaux neuronaux surnuméraires étaient sollicitées par les adultes âgés, permettant potentiellement d’assurer, chez les ainés, le maintien de performances adéquates. / Amongst all the sounds present in our environment, the human voice is probably the most significant one. Indeed, it takes its importance very early on, when, in the amniotic environment, the foetus hears the voice of its mother. Through this voice, the first contacts with the World but also with others are made. This special status of voice remains during the development, since it later becomes the medium via which speech is carried. Indeed, not only does voice convey oral language, but it also passes on a wide array of paralinguistic information characterising each individual. In fact, simply by hearing a voice, we are generally able to determine the age, identity, social status but also the mood in which the speaker is at the moment. However, during normal aging, the processing of the information contained in voice, may it be linguistic or not, appears to become more difficult. In the paralinguistic domain, the deleterious effects of normal aging were mainly explored via affective prosody. It is thus quite difficult to generalize those results to the processing of vocal information in general. In addition, cerebral reorganization accompanying normal aging was characterized for speech perception, but the effects of age on the cerebral processing of paralinguistic vocal information still remain unclear. The main purpose of this work was to palliate to this shortcoming. The first study presented in this thesis (Article 1) evaluated the impact of normal aging on the behavioral processing of non affective paralinguistic vocal information by comparing the performances of young and older adults. To do so, a computerized battery was created: the Voice Perception Assessment battery, which comprised four behavioral tasks (VPA battery; gender categorization task, auditory source discrimination task, adaptive discrimination task and memory task). The tasks created allowed the comparison of vocal and non vocal processing, as well as the comparison of the processing of different types of vocal stimuli. Our results indicate that, while controlling for cognitive and auditory decline, older adults were less efficient than younger participants for three of the four VPA tasks. However, a systematic age-related decline for vocal processing was not observed. The task performances could not be predicted by the cognitive measure selected as a control variable (MoCA scores). However, the disparities in task demands seem to explain a portion of the paralinguistic vocal processing age-related decline observed. The main purpose of the second article was to empirically assess, using functional magnetic resonance imagery (fMRI), the impact of normal aging on the neural networks underlying the processing of human voice, as it has never been done yet. To do so, a passive listening task (contrasting vocal and non vocal blocks of sounds) and an adaptive discrimination task were used. The adaptive task, based on a transformed up-down protocol, allowed us to insure equivalent performance levels in both age-groups, a necessary condition to neurofunctional group comparison. Our results indicate that young and older adults recruited similarly the cortical areas preferentially responding to voice, the Temporal Voice Areas (TVA). In parallel, outside the TVA, an age-related under recruitment of a portion of the auditory cortex was observed, as well as an over recruitment of parietal, temporal and frontal regions (Article 2 – Study 1). For the adaptive discrimination task, contrary to what was expected, the discrimination thresholds of both age-groups were similar. Nevertheless, to be able to perform the task, older adults needed to engage cortical regions in the temporal and frontal lobes that younger adults did not recruit (Article 2 – Study 2). The behavioral data presented in this work suggest that normal aging can be associated with a decline of the capacity to process non affective paralinguistic vocal information. The observed age-related differences appear to be more salient when the cognitive demands of the task are high. In parallel, mechanisms of cerebral plasticity appear to take place as well. Those phenomena however do not seem to affect the way the cortical areas specialized in the processing of human voice are recruited, which remains the same between young and older adults. However, the passive listening task elicited an age-related under-recruitment for a portion of the auditory cortex (left transverse temporal gyrus). Both for the passive listening task and the adaptive discrimination task, an over-recruitment of additional networks were observed for older adults. This extended network could contribute to the preservation of adequate performance in older adults.

Le maintien de performances cognitives optimales au cours du vieillissement a été associé à des changements adaptatifs au niveau de l’activité cérébrale relative à diverses habiletés qui tendent à décliner avec l’âge. Peu d’études ont toutefois évalué cette réorganisation neurofonctionnelle dans le cadre des habiletés de communication, notamment en ce qui concerne le langage expressif. Or, considérant que plusieurs composantes langagières demeurent généralement intègres chez les aînés, il s’avère nécessaire d’explorer davantage les mécanismes cérébraux sous-jacents afin de mieux cerner les déterminants du vieillissement cognitif réussi. L’objectif de la présente thèse est d’examiner en détail les effets de l’âge sur les patrons d’activations et les interactions fonctionnelles entre les substrats neuraux contribuant aux habiletés de communication expressive. Deux études en neuroimagerie fonctionnelle, ayant recours à des approches méthodologiques distinctes, ont ainsi été menées à l’aide d’un paradigme mixte novateur et d’une tâche auto-rythmée d’évocation lexicale sémantique et orthographique, effectuée par des participants jeunes et âgés présentant plusieurs années de scolarisation. S’intéressant spécifiquement aux patrons d’activations associés à un rendement élevé à cette tâche, la première étude révèle que le maintien des habiletés d’évocation lexicale lors du vieillissement s’accompagne de changements neurofonctionnels superficiels chez les adultes âgés performants. Par contre, la seconde étude indique que les interactions fonctionnelles entre les régions corticales contribuant aux productions lexicales déclinent considérablement avec l’âge, sans qu’il y ait toutefois d’impact au plan comportemental. Cet effet du vieillissement sur l’intégration fonctionnelle du réseau de l’évocation sémantique et orthographique est aussi exacerbé par la difficulté de la tâche, ce qui s’exprime par des perturbations locales de la connectivité fonctionnelle. Somme toute, cette thèse démontre qu’une réorganisation neurofonctionnelle afin de maintenir les habiletés d’évocation lexicale au cours du vieillissement s’avère superflue chez les adultes âgés instruits et performants, et ce, malgré une diminution des interactions fonctionnelles au sein des réseaux corticaux sous-jacents. Ces résultats reflètent possiblement une perte d’efficience neurale avec l’âge, toutefois insuffisante pour avoir un impact comportemental chez des individus bénéficiant de facteurs de protection susceptibles de favoriser le vieillissement réussi, ce qui est discuté à la lumière du concept de réserve cognitive. / The maintenance of optimal cognitive performance in aging has been associated with adaptive changes in cerebral activation patterns for various abilities that tend to decline with age. Yet, few studies have investigated this neurofunctional reorganization based on communication abilities, particularly with regard to the expressive side of language. Considering that a number of language components usually remain well preserved in older adults, it is, however, necessary to further explore the underlying cerebral mechanisms to better understand the determinants of successful cognitive aging. The objective of this thesis is to examine in detail the effects of aging on activation patterns and functional interactions among neural substrates contributing to expressive communication abilities. Two functional neuroimaging studies, using distinct methodological approaches, have been conducted by means of an innovative mixed design and an overt self-paced semantic and orthographic verbal fluency task, performed by well-educated young and older adults. Specifically focusing of cerebral activation patterns associated with high levels of verbal fluency performance, the first study shows that the relative preservation of lexical speech production abilities in aging is characterized by marginal neurofunctional changes in high-performing older adults. Yet, the second study indicates that functional interactions between cortical areas contributing to speech productions significantly decrease with age, without, however, having an impact at the behavioral level. In addition, this effect of aging on the functional integration of the network engaged during semantic and orthographic verbal fluency was found to be exacerbated by task demands, which is expressed by local functional connectivity disruptions. In sum, this thesis demonstrates that a neurofunctional reorganization to maintain lexical speech production abilities in aging is unnecessary in well-educated and high-performing older adults, despite an age-related decrease in functional networks integration. These results may reflect a loss of neural efficiency with age, although insufficient to have behavioral outcomes in individuals who benefited from protective factors known to promote successful aging, which is discussed in light of the concept of cognitive reserve.

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