O biofeedback (BFD) é uma estratégia terapêutica em que ocorre aprendizagem por associação de sensações com o propósito de controlá-las levando a melhor enfrentamento fornecendo novas respostas e permitindo novos padrões, mesmo que se mantenha a ativação dos estímulos originais disfuncionais. Em migranosos ocorreria inibição da expressão da angústia relacionada ao nível fisiológico, devido a persistência de estados induzidos de estresse. Pesquisas de enfrentamento da migrânea incluem tratamento por condicionamento operante, biofeeback e outras técnicas como tratamento psicodinâmico. Tais tratamentos apontam para a redução do reforçamento do comportamento doloroso e melhora de comportamentos adaptativos para o enfrentamento das dificuldades. Objetivo geral: verificar a efetividade da técnica do biofeeback térmico como tratamento auxiliar em migranosos, através do Multidimensional Pain Inventory (MPI), antes e depois da intervenção. População: 60 doentes (masculino e feminino); idade variando entre 20 e 60 anos, com duração dos sintomas superior à 6 meses; em condições de locomoção e retorno às consultas e aceite do termo de Consentimento Pós-Informado CAPPesq. Instrumentos e Procedimento: Entrevista psicológica semi-dirigida para doentes com dor, através de protocolo próprio (Perissinotti, 2001); PRIME-MD + Qp; ABIPEME; Multidimensional Pain Inventory - MPI; ProComp + BioGraph 2.1. Duas amostras randomizadas foram separadas: grupo experimental (30 doentes) e grupo comparativo (30 doentes). O procedimento foi composto por triagem e direcionamento para grupo experimental, treinamento por BFD, 10 sessões que objetivaram o treino de dimensão de sensibilização discriminativa; e para o grupo comparativo adotado tratamento médico preventivo com medicação profilática padrão, para crise de migrânea. Resultados: O BFD alterou o comportamento da amostra experimental estudada, ocorrendo melhora geral da adaptabilidade, quando dos cálculos pela análise paramétrica. Quando da análise pelo teste qui-quadrado para variáveis qualitativas, houve resultados significantes para a amostra experimental, quanto aos sinais e sintomas psicopatológicos, qualidade das queixas e qualidade da saúde auto-referida. Houve diminuição da escala de intensidade de dor com BFD de 5,0 (83,3%) no pré-tratamento, e para 3,15 (52,5%) no pós-tratamento. Mostraram-se sem anormalidades mentais 20 doentes (60%) da amostra experimental. Transtornos de ansiedade foram encontrados em 11 doentes (36,6%) e transtorno depressivo em 9 doentes (33,3%). Para 18 (60%) doentes da amostra experimental o BFD melhorou as condições psicológicas, e para 14 (46,6%) doentes a melhora estaria relacionada exclusivamente ao relacionamento interpessoal, conjugal, afetivo e psicocomportamental. Para 4 (13,3%) deles primariamente reconheceram melhora no enfrentamento das condições psicofisiológicas, além dos aspectos psicológicos associados. Conclusões: O BFD alterou o comportamento da amostra experimental, fornecendo maior adaptabilidade geral, quando da análise paramétrica. Foi possível a ruptura do círculo vicioso entre percepção, tensão, estresse e dor, também pelo relacionamento estabelecido entre psicólogo e paciente. O psicólogo, portanto operador do método que calculou aspectos psicopatógicos, psicodinâmicos, além de servir como aquele que certifica as percepções do paciente consigo mesmo e suas expressões psicofisiológicas, é o operador funcional como um todo. Futuras pesquisas devem se desenvolver para esclarecer a compreensão entre os mecanismos psicofisiológicos que induzem a diferentes interpretações em distintos sintomas e as subseqüentes respostas psicofisiológicas quanto aos aspectos psicológicos dos migranosos. / Biofeedback (BFD) is a therapeutic strategy in which occurs the learning by the sensations association, with the purpose of controlling them leading to a behavior of better copping because provides new responses permitting new patterns, even with a new activation of dysfunctional original stimuli. In migrainers there would be the inhibition of anger expression related to the physiological level due to persistence of stressor-induced activation states. The migraine management research includes operant behavior treatment, biofeeback and other techniques as psychodynamic treatments. These treatments point out to reduce the reinforcement for pain behaviors and to improve adaptative behaviors to copping difficulties. General Objective: Verify the thermal biofeeback technique effectiveness as an auxiliary treatment in migraine patients by Multidimensional Pain Inventory (MPI), before and after intervention. Population: 60 patients (female and male): variance age between 20 and 60 years old, symptoms duration superior to 6 months, in condition to locomotion, to return to consultation and acceptance of the Post-Informed Consenting Term CAPPesq. Instruments and Procedure: Semi-directed structured psychological interviews for pain patients by Owner Protocol (Perissinotti, 2001); PRIME MD + PQ; ABIPEME; Multidimensional Pain Inventory - MPI; ProComp + BioGraph 2.1. Two random samples were separated: experimental group (30 patients) and comparative group (30 patients). The procedure was composed by triage and directionless: for experimental group, the BFD training, 10 sessions for sensitive-discriminative dimension training; for comparative group, the preventive medical treatment with standard prophylactic medication for migraine crisis. Results: The BFD has interfered in the behavior of the experimental sample studied, occurring a general better in adaptability, when calculated the parametric analysis. When the analysis by qui-square test for qualitative variables, there were significant results to the experimental sample, as to psychopathological signs and symptoms, quality of complains and quality of auto-referred health. The pain severity scale has decreased with BFD into 5.0 (83.3%) in the pre-treatment and into 3.15 (52.5%) in the post-treatment. No mental abnormalities were seen in 20 patients (60%) of the experimental sample. Anxiety disorders were found in 11 patients (36.6%) and depressions disorders in 9 patients (33.3%). For 18 (60%) patients of the experimental sample, the BFD improved the psychological conditions, and for 14 (46.6%) patients we could relate improving exclusively in interpersonal, conjugal, affective and behavior relationship. For 4 (13.3%) of them, primarily was recognized improvement in the psychophysiological conditions, further to the psychological aspects associated. Conclusions: The BFD has interfered in the behavior of the experimental sample, providing bigger general adaptability on the occasion of the parametric analysis. It was possible the break of the vicious circle among perception, tension, stress and pain, also by the relationship established between psychologist and patient. The psychologist, the method operator which has calculated the psychopathologic, psychodynamic aspects, besides of being the one who certifies the patient perceptions with himself and his psychophysiological expressions, is the functional operator of the whole. Future researches must be developed to clarify the comprehension between the psychophysiological mechanisms inducing different kinds of interpretation in distinct symptoms, and the subsequent psychophysiological responses as to psychological aspects in migrainers.

Base teórica A incontinência urinária (IU) é um sintoma comum, afetando mulheres em todas as idades, com prevalência estimada em 30%. A incontinência urinária aos esforços (IUE) pode representar cerca de metade dos casos. O treinamento da musculatura do assoalho pélvico (TMAP), associado a medidas comportamentais e reeducação vesical constitui a primeira linha de tratamento. Apesar dos bons resultados em curto e médio prazo, pode haver perda de motivação e adesão ao tratamento em longo prazo. Técnicas complementares como o biofeedback (BIO) podem auxiliar no treinamento inicial e contribuir para melhores resultados, mas permanece indefinido o perfil de casos que pode realmente se beneficiar desta abordagem. Novos estudos e a implementação de dispositivos facilitadores do tratamento são necessários, pois a adesão é etapa fundamental para manutenção dos resultados. Objetivo Determinar o efeito do TMAP associado ao BIO comparados ao treinamento vesical (TV), considerando resultados com questionários de sintomas, qualidade de vida (QV) e função sexual (FS). Investigação adicional a partir de dados do diário miccional (DM), avaliação da funcionalidade dos músculos do assoalho pélvico por meio de palpação manual e perineométrica do assoalho, gerando informações adicionais sobre o efeito de ambos os tratamentos. Métodos Ensaio clínico randomizado, paralelo, aberto, incluindo mulheres acima de 18 anos com IUE na ausência de prolapso genital. Recrutamento de casos de forma consecutiva em ambulatório de uroginecologia, com alocação aleatória para TV ou BIO, sendo comparadas a resposta aos sintomas, força muscular, escores de QV e FS ao final de 3 meses de tratamento supervisionado com fisioterapeuta. Para o cálculo amostral foi considerada a detecção de uma diferença de 42 pontos percentuais entre os grupos e estimadas 26 pacientes em cada grupo para um α=0,05 e β-80%. Resultados Ao final do estudo, das 53 pacientes inicialmente recrutadas, 28 pacientes foram analisadas, 14 em cada grupo. Ambos os grupos apresentaram melhores resultados em número de perdas diárias (P<0.001), micções noturnas (P<0.002) e no questionário de sintomas (p<0.001). Na FS, não houve diferença individual e entre os grupos. Alguns domínios do questionário de qualidade de vida foram significativamente melhores nas pacientes que fizeram o treinamento vesical (TV), mas a percepção geral de saúde não se modificou de forma significativa ao longo do tempo e entre os grupos TV (P=0.157) e BIO (P=0.795). Apesar de ter havido melhora subjetiva da contração perineal, esse achado não se correlacionou com aumento de força muscular (rs=0.428 P=0.144). Conclusão No presente estudo, os resultados em ambos os grupos foram equivalentes em termos de melhora clínica, nas ferramentas de medida utilizadas, não sendo possível demonstrar um efeito significativo do biofeedback. O desenvolvimento de tecnologias para melhorar a adesão e motivação dos pacientes para o tratamento conservador segue sendo um desafio atual. / Objective: To compare the effect of pelvic exercises combined with biofeedback, against bladder training, using questionnaires on symptoms, quality of life, and sexual function. Methods: Randomized clinical trial. Women over the age of 18 with stress urinary incontinence, but without genital prolapse, were recruited at a urogynecology clinic and assigned to bladder training or pelvic floor restoration at home with biofeedback. Results for muscle strength and symptoms, quality of life, and sexual function questionnaires were compared after 3 months of physiotherapist-supervised treatment. Results: Fourteen patients in each group were analyzed at the end of the study. Both groups exhibited improved results for number of daily leakages (P<0.001), nighttime micturitions (P<0.002) and symptoms (P<0.001). For sexual function, there were no individual or intragroup differences. Some quality of life domains were significantly better in the bladder training patients, but perceived general health did not change significantly and did not differ between the BT (P=0.157) and BIO (P=0.795) groups. Improvements in perineal contraction were not correlated with increased muscle strength (rs=0.428 P=0.144). Conclusion: The two methods had equivalent results, but larger patient samples could change certain findings. It remains a challenge to develop technologies to improve patients’ motivation and adherence to conservative treatment. Registration: Plataforma ReBec (Brazilian Clinical Trials Register - http://www.ensaiosclinicos.gov.br/). Reference code REQ:7854.

This diploma thesis deals with monitoring the movement of the upper limbs in patients after acquired brain injury using an accelerometer. The diploma thesis is processed from the perspective of occupational therapy. The thesis is divided into the theoretical and practical part. The main objective of the theoretical part is to collect specialist literature about monitoring the movement of the upper limbs by accelerometer in rehabilitation, especially in the occupational therapy. The practical part of the thesis has three objectives. The first objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to an objective improvement of the activity of daily living (ADL) in the areas of eating, washing and dressing. The second objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to subjective improvement in the same ADLs, and the third objective is to compare whether objective and subjective improvement is related. The practical part was prepared in the form of pilot studies. Quantitative research was used, specifically the type of pre-experiment - One Group Pretest Posttest Design. The study included 14 patients after acquired brain injury. The...

This diploma thesis deals with monitoring the movement of the upper limbs in patients after acquired brain injury using an accelerometer. The diploma thesis is processed from the perspective of occupational therapy. The thesis is divided into the theoretical and practical part. The main objective of the theoretical part is to collect specialist literature about monitoring the movement of the upper limbs by accelerometer in rehabilitation, especially in the occupational therapy. The practical part of the thesis has three objectives. The first objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to an objective improvement of the activity of daily living (ADL) in the areas of eating, washing and dressing. The second objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to subjective improvement in the same ADLs, and the third objective is to compare whether objective and subjective improvement is related. The practical part was prepared in the form of pilot studies. Quantitative research was used, specifically the type of pre-experiment - One Group Pretest Posttest Design. The study included 14 patients after acquired brain injury. The...

Syfte och frågeställningar Syftet var att undersöka i vilken utsträckning mödrahälsovården i Stockholms läns landsting följer de riktlinjer som finns gällande bäckenbottenbedömning och information om knipträning vid eftervårdsbesöket och om det skiljer sig mot övriga landet. Syftet följs av ett flertal frågeställningar men den primära lyder; i vilken utsträckning har nyförlösta kvinnor fått information gällande knipövningsinstruktioner samt blivit erbjudna en vaginal undersökning hos mödrahälsovården? Metod Kvinnor i Sverige som fött barn 2018 deltog. Tillsammans med ett brev skickades en enkät ut till 6155 personer i 3 olika facebookgrupper och fanns tillgänglig i två veckor. Resultaten sammanställdes via överföring från Google formulär till tabeller i Excel. De data som samlades in analyserades i programmet SPSS. Av 155 svar inkluderades totalt 108 svar i analysen, 32 från Stockholm och 76 från övriga landet. 48 svar togs bort på grund av att de inte nådde upp till inklusionskriterierna. Resultat Sett till hela landet blev 73% (n=79) av kvinnorna erbjudna en vaginal undersökning vid eftervårdsbesöket hos mödrahälsovården medan 23% (n=25) inte blev det (vet ej, n=1, bortfall, n=3). I Stockholm blev 75% (n=24) erbjudna en undersökning. 51% (n=55) av alla kvinnor fick instruktioner om knipövningar, 44% (n=48) fick inte det (vet ej, n=3, bortfall n=2). Resultaten i Stockholm säger att 50% (n=16) fick knipinstruktioner. Av de kvinnor som förlösts vaginalt blev 79% (n=71) erbjudna en vaginal undersökning vid eftervårdsbesöket samtidigt som endast 44% (n=8) av de som förlösts med kejsarsnitt blev erbjudna samma undersökning (p=0,001). 10% (n=11) av kvinnorna uppgav att de hade urininkontinens och 73% (n=8) av de här kvinnorna ville ha fler träffar med utbildad personal för stöd och hjälp med knipträning. Slutsats Resultaten bekräftade hypotesen om att riktlinjerna ej efterföljdes i den utsträckning de borde, både gällande bäckenbottenbedömning och information om träning. Inga direkta skillnader kan ses vid jämförelser mellan Stockholm och övriga landet, med undantag för förekomst av urininkontinens, vilken var större i Stockholm. En viktig skillnad kan dock ses vid jämförelsen av att de som förlösts vaginalt i större utsträckning blev erbjudna en vaginal undersökning vid eftervårdsbesöket än de som förlösts med kejsarsnitt. Från de kommentarer kvinnorna lämnat går även att utläsa att flertalet vill ha mer och personligare information.

At any given time, 3-9% of the general population experiences a voice problem. The incidence of voice disorders in children can vary anywhere between 6 and 23%, yet, only 2-4% of the population are seen by speech-language pathologists for further assessment and treatment. Voice disorders have negative effects on the social, emotional, and physical functioning of the child. Unfortunately, there is little known about the appropriate management of children with voice disorders. Depending on the nature of the voice disorder, different approaches, including behavioral voice therapy, vocal hygiene management, or medical intervention, are available. However, a concern with behavioral voice therapy is the ability of the child to transfer skills learned in clinic to an outside setting - limiting generalization and adaptation of the new behavioral approach. Biofeedback has been successfully used in adults with voice disorders to help generalize new vocal behaviors. Such data is lacking in the treatment of voice problems in the pediatric population. The current case study aimed to understand the use of biofeedback in an eight-year-old male who was diagnosed with a unilateral vocal fold lesion, who exhibited difficulty maintaining and generalizing his new vocal behaviors. It was hypothesized that the child would benefit from biofeedback and would maintain new vocal behaviors including the use of a safe and efficient voice pattern outside the clinic setting. Longitudinal data on vocal parameters including the pitch, loudness, and vocal fold vibration were obtained over a period of five weeks using an ambulation phonation monitor (APM). The APM uses an accelerometer attached to the sternal notch and measures pitch, loudness, and vocal fold vibration, which helps determine an individual’s daily voice use pattern and thereby determines the appropriate biofeedback setting. The five week period included (a) a week of pretesting, (b) two weeks of biofeedback, (c) a week of post-testing immediately following the week of biofeedback, and (d) a generalization testing two months post-study. During the five-week period, vocal parameters were monitored for an average of 7- 10 hours for 2-3 days each week. On weeks two and three, the child was provided with biofeedback on loudness levels based on his data from the pretesting week. Results indicated change in vocal parameters including loudness and vocal fold vibration patterns during the weeks of biofeedback. However, such generalization was not observed neither during immediate post feedback monitoring nor two months following the study protocol. Such data provide immediate effects from biofeedback on vocal behavior, however, motor learning principles, dose, and frequency of biofeedback will be discussed to further understand the long-term effects of biofeedback in children with voice problems.

Musicians are a high-risk occupational group for musculoskeletal disorders. Often manifesting in muscle tension, pain and paresthesia, musculoskeletal disorders can drastically affect comfort, mentality and endurance while performing. This study sought to examine the effects of electromyography (EMG) biofeedback training in reducing musculoskeletal symptoms in music performance. The subjects were university-level violinists and cellists. Over a period of 2-4 weeks, all participants underwent EMG biofeedback training while performing their instrument using audio feedback. No significant results were found, but patterns of decreased muscle tension and increased performance comfort and endurance were observed.

Increasingly, virtual reality therapy (VRT) technologies are being used to augment pediatric rehabilitation. The mechanisms underlying success/failure of VRTs are not well understood. This thesis proposed an innovative 3-phase framework for evaluating VRT technologies with respect to neuroplasticity based on results of a scoping review of 21 studies. A case study was undertaken to demonstrate use of the framework to design and evaluate ‘Musical Steps’, a VRT technology aimed at promoting heel contact in toe-walking children. 5 therapists and 4 children were engaged in this study. The system accurately detected 88%(SD=7%) of heel contacts and was rated positively in usability testing (phase 1). Feasibility studies indicated that, while enjoyable, children did not understand the feedback provided and hence, heel contact was not increased (phase 2). These findings will direct future reiterations prior to evaluating clinical impact (phase 3). The proposed framework may enhance design and translation of therapeutically relevant VRTs.

Increasingly, virtual reality therapy (VRT) technologies are being used to augment pediatric rehabilitation. The mechanisms underlying success/failure of VRTs are not well understood. This thesis proposed an innovative 3-phase framework for evaluating VRT technologies with respect to neuroplasticity based on results of a scoping review of 21 studies. A case study was undertaken to demonstrate use of the framework to design and evaluate ‘Musical Steps’, a VRT technology aimed at promoting heel contact in toe-walking children. 5 therapists and 4 children were engaged in this study. The system accurately detected 88%(SD=7%) of heel contacts and was rated positively in usability testing (phase 1). Feasibility studies indicated that, while enjoyable, children did not understand the feedback provided and hence, heel contact was not increased (phase 2). These findings will direct future reiterations prior to evaluating clinical impact (phase 3). The proposed framework may enhance design and translation of therapeutically relevant VRTs.

This thesis introduces a novel situated interactive composition system called the SMuSe (for Situated Music Server) that is grounded on principles of modern cognitive science, provides perceptual control of sound synthesis and includes emotional feedback. It illustrates both a new music composition paradigm and a synthetic psychology approach to the study of music perception, emotion and cognition. The SMuSe is composed of cognitively plausible modules implemented as a hierarchy of musical agents and relies on distributed control, parallelism, emergence and embodiment. By interacting with its environment, which provides feedback via multiple sensors, the system generates complex adaptive affective musical structures. Focusing on the micro-level of sound generation, we present two complementary techniques that give high-level perceptual control over low-level sound synthesis parameters. In a first implicit approach, a support vector machine algorithm learns to automatically map perceptual features such as loudness, pitch and brightness onto additive synthesis parameters. In a second approach, a physically-inspired synthesis model provides explicit access to perceptual and physical parameters such as pitch, loudness, brightness, attack time, inharmonicity and damping. Moving from the study of music generation and control towards the study of the musical experience itself, we then evaluate how the music generated by the SMuSe influences the listeners' emotional responses. A first psychoacoustics experiment shows the significant influence of structural (scale, register, harmony), expressive (velocity, tempo, articulation) and timbre (brightness, attack time, spectral flux) parameters on the emotional scales of valence, arousal and dominance. An additional large scale experiment involving dementia patients (an illness known to induce cognitive and affective deficits) shows that specific sound features (e.g. low loudness, low brightness) provoke specific emotional responses within the patients (e.g. low stress). Moreover, the patients' emotional responses differ from the age-matched control group, and the analysis shows an increased emotional sensitivity to sounds as the severity of the disease increases. These results suggest that sound-based therapy and diagnosis for dementia are possible. Finally, the maturity and flexibility of the SMuSe music system are demonstrated by a series of real-world applications including the sonification of a mixed-reality space, a study on physiologically-based musical interaction, a neurofeedback musical interface, a closed loop system based on reinforcement learning of emotional feedback, and a large scale multimedia performance using brain-computer interfaces. A situated, perceptive, emotive and cognitive approach to the design of musical systems paves the way for new applications for therapy but also for interactive gaming and novel physiologically-based instruments. Our approach provides a well-grounded paradigm to develop advanced synthetic aesthetics system that can inform our understanding of the psychological processes on which they rely. / Esta tesis introduce un nuevo sistema de composición situada e interactiva llamado SMuSe (por Situated Music Server). Dicho sistema está basado en principios extraídos de la ciencia cognitiva moderna, proporciona control perceptual sobre la síntesis sonora e incluye feedback emocional. Por lo tanto, ilustra tanto un paradigma nuevo para la composición musical, como un sintético enfoque psicológico al estudio de la percepción musical, las emociones y la cognición. SMuSe consta de diversos modulos, plausibles desde un punto de vista cognitivo, implementados como una jerarquía de agentes. El funcionamiento de SMuSe explota los principios de control distribuido, paralelismo, emergencia y embodiment. En función del feedback obtenido por la interacción con el entorno, el sistema genera complejas estructuras musicales afectivas. En concreto, a nivel de generación de sonido, presentamos dos técnicas complementarias que proporcionan un control perceptivo de alto nivel sobre parámetros concretos de síntesis sonora. En un primer método implícito, un algoritmo de support vector machine aprende a traducir automáticamente características perceptuales, como volumen, tono y brillo en parámetros de síntesis aditiva. En el segundo método, un modelo físico de síntesis proporciona explícitamente acceso a parámetros perceptivos y físicos, tales como tono, volumen, brillo, tiempo de ataque, inarmonía y factor de amortiguamiento. En lo que respecta al estudio de la experiencia musical en sí misma, evaluamos la influencia de la música generada por SMuSe en las respuestas emocionales del sujeto. Un primer experimento psicoacústico muestra la influencia significativa que tienen parámetros estructurales (escala,registro, armonía), expresivos (velocidad, tempo, articulación) y de timbre (brillo, ataque, flujo espectral) en la escalas emocionales de valencia, activacíon y dominancia. Adicionalmente, un experimento de gran escala realizado con pacientes de demencia, una patología que asociada a déficits afectivos y cognitivos, demuestra que los pacientes responden emocionalmente a rasgos específicos del sonido (e.g. bajo volumen y brillo inducen poca tensión). Además, la respuesta emocional de los pacientes difiere si se compara con la mostrada por un grupo de control con la misma edad media. De tal manera, una mayor respuesta emocional aparece asociada a un mayor grado de demencia. Estos resultados sugieren que sería posible desarrollar técnicas basadas en el uso de música tanto para el tratamiento de la demencia como para su diagnóstico. Para concluir, la madurez y flexibilidad de SMuSe se demuestra con una serie de aplicaciones que incluyen la sonificación de un espacio de realidad mixta, un estudio acerca de la interacción musical mediante datos fisiológicos, un interfaz musical basado en feedback neurológico, un sistema basado en aprendizaje por refuerzo del feedback emocional, y una performance multimedia de gran escala controlada mediante interfaces cerebro-máquina. Este enfoque situado, perceptivo, emocional y cognitivo al diseño de sistemas musicales abre la posibilidad de desarrollar aplicaciones no sólo terapéuticas sino también para los juegos interactivos y nuevos interfaces que empleen fisiología. Nuestra propuesta proporciona un sólido paradigma para el desarrollo de sistemas de síntesis de estéticas avanzadas, que puedan servir para entender los procesos psicológicos subyacentes