Objetivo: Caracterizar os aspectos funcionais de deglutição na população com trauma cranioencefálico (TCE) de um hospital de grande porte, considerando as características clínicas e a gravidade dos indivíduos no momento da admissão hospitalar, utilizando sistemas prognósticos usualmente aplicados no ambiente das unidades de terapia intensiva. Métodos: Participaram do estudo 113 adultos, admitidos em um hospital terciário, com diagnóstico de TCE, submetidos à avaliação fonoaudiológica à beira-leito. As etapas de coleta de dados envolveram: a avaliação fonoaudiológica clínica do risco de broncoaspiração, determinação do nível funcional da deglutição (American Speech-Language-Hearing Association National Outcome Measurement System), determinação da gravidade do indivíduo de acordo com a Escala de Coma de Glasgow no momento da avaliação fonoaudiológica, Sequential Organ Failure Assessment (SOFA) no momento da admissão na Unidade de Terapia Intensiva e no dia da avaliação fonoaudiológica. Foram realizadas duas análises com a mesma população: análise 1- de acordo com a gravidade do TCE, análise 2- de acordo com a funcionalidade da deglutição. Resultados: Indicaram que as pontuações baixas na Escala de Coma de Glasgow têm relação com o aumento do tempo de intubação orotraqueal e na piora da funcionalidade da deglutição na avaliação fonoaudiológica. Houve associação entre o maior tempo de intubação, maior tempo de hospitalização, maior número de atendimentos fonoaudiológicos até a reintrodução da dieta via oral e pior funcionalidade da deglutição. A tosse e o escape extraoral foram os sinais clínicos preditores de broncoaspiração no TCE. Após a intervenção fonoaudiológica, o grupo com pior Glasgow apresentou piores resultados na evolução da funcionalidade da deglutição. Em relação ao escore SOFA, os sistemas orgânicos respiratório, cardiovascular e neurológico foram as principais alterações encontradas na população com TCE. É importante entender os mecanismos do TCE nos aspectos neurológico, cognitivo e comportamental para poder utilizar as melhores estratégias na identificação dos indivíduos com pior funcionalidade da deglutição e com necessidade de terapia fonoaudiológica precoce. Conclusão: Ao estabelecer os parâmetros clínicos que podem prever os aspectos relacionados à funcionalidade da deglutição durante a internação hospitalar, é possível auxiliar no gerenciamento e planejamento da reabilitação / Objective: to characterize the swallowing functional aspects in the severe traumatic brain injury (TBI) population in a large hospital considering the clinical features and the subjects\' severity at the moment of hospital admission adopting prediction models usually applied in the intensive care unit environment. Methods: 113 adults participated in the study; they were admitted at a tertiary referral hospital with a TBI diagnosis and were submitted to a bedside speech-language assessment. The data collection steps included: a clinical speech-language assessment for risk of bronchoaspiration, determination of swallowing functional level (American Speech-Language-Hearing Association National Outcome Measurement System), determination of individual\'s severity according to the Glasgow Coma Scale at the moment of the speech-language assessment, Sequential Organ Failure Assessment (SOFA) at the moment of admission at the intensive care unit and on the day of the speech-language assessment. Two analyses were carried out with the same population: analysis 1 - according to the trauma severity, analysis 2 - according to the swallowing functionality. Results: The results indicated that low scores in the Glasgow Coma Scale are related to higher orotracheal intubation time and worsening of swallowing functionality in the speech-language assessment. There was a link between higher intubation and hospitalization periods, higher number of speech-language therapies until the reintroduction of oral diet and worse swallowing functionality. Cough and extraoral escape were found as clinical risk factors for bronchoaspiration in the TBI. After the speech-language intervention, the group with worst Glasgow presented worst results in the swallowing functionality progress. With regard to the SOFA score, the respiratory, cardiovascular and neurological organic systems were the main alterations found in the TBI population. It is important to understand the TBI mechanisms in the neurological, cognitive and behavioral aspects to adopt the best strategies in the identification of the subjects with worst swallowing functionality and in need of early speech-language therapy. Conclusion: By establishing the clinical parameters that may foresee aspects related to the swallowing functionality during hospitalization, it is possible to help in the management and planning of rehabilitation

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At the Ottawa Hospital in Ontario, Canada, clinicians use full body immersion virtual reality to treat a variety of health conditions, including: traumatic brain injuries, post- traumatic stress disorder, acquired brain injuries, complex regional pain syndrome, spinal cord injuries, Guillain-Barré syndrome, and lower limb amputations. The system is shared between military and civilian patient populations. Viewed by clinicians and the system’s designers as a value neutral medical technology, clinical virtual reality’s sights, sounds, movements, and smells reveal cultural assumptions about universal patient experiences. In this dissertation I draw from reflexive feminist research methodologies, visual anthropology and sensory ethnography in a hospital to centre the body in current debates about digital accessibility in the 21st Century. 40 in-depth interviews with practitioners and patients, 210 clinical observations, and film and photography ground research participant experiences in day-to-day understandings of virtual reality at the hospital. In this dissertation I address an ongoing absence of the body as a site of analytical attention in anthropological studies of virtual reality. While much literature in the social sciences situates virtual reality as a ‘post-human’ technology, I argue that virtual reality treatments are always experienced, resisted and interpreted through diverse body schemata. Furthermore, virtual reality cannot be decoupled from the sensitivities, socialities and politics of particular bodies in particular places and times. The Ottawa Hospital’s Computer Assisted Rehabilitation Environment (CAREN) system features a digitally enhanced walk-in chamber, treadmills on hydraulic pistons, surround sound audio, advanced graphics and user feedback utilizing force plates and a dynamic infrared motion capture system. The CAREN system utilizes hardware and software reliant on specific assumptions about human bodies. For example, these assumptions are echoed in depictions of race, gender, class, and indigeneity. Patients using virtual reality technologies can experience more than one disability or health condition at a time, further disrupting the idea of universal user experiences. As clinicians and patients confront the limitations of body normativity in the CAREN system’s interface design, they improvise, resist, and experience virtual reality in ways that defy design agendas, ultimately shaping patient treatments and unique paths to healing and health. / Graduate