O envelhecimento é um fenômeno mundial, resultado da diminuição progressiva das taxas de fecundidade e mortalidade e do aumento da expectativa de vida. O grupo de idosos, no Brasil e em países em desenvolvimento, segundo a OMS, é constituído por pessoas a partir dos 60 anos. Dentre desse grupo, a população que mais rapidamente cresce são os denominados idosos em velhice avançada (80 anos e mais) cujas demandas específicas ainda são desconhecidas em nosso meio. O envelhecimento pode ser acompanhado por um declínio funcional progressivo que pode estar associado a quadros de dependência responsáveis por demandas assistenciais específicas. A dependência em si constitui o maior temor dos idosos. Assim, conhecer os fatores preditores do alcance das idades mais longevas com independência funcional torna-se primordial e constitui o objetivo desse estudo que é parte do Estudo SABE - Saúde Bem-estar e Envelhecimento na América Latina e Caribe. Esse estudo, realizado no ano 2000, foi coordenado pela Organização Pan-Americana de Saúde (OPAS) e desenvolvido simultaneamente em sete países da dessa região com o objetivo de traçar as condições de vida e saúde dos idosos aí residentes. No Brasil, foi desenvolvido na zona urbana do Município de São Paulo com uma amostra de 2.143 idosos representativa da população residente na região no período. Para o desenvolvimento desse estudo, foi utilizada a parcela dos idosos com 80 anos e mais que foi subdividida segundo seu estado funcional. Trata-se de uma pesquisa descritiva e exploratória. Do total dos idosos em velhice avançada, 9,9% eram funcionalmente independentes nas atividades de vida diária, básicas e instrumentais. Desses 66,4% eram mulheres, 33,6% eram homens, 75% eram nascidos no Brasil, 25,6% eram analfabetos e 63,1% estudaram entre 1e 6 anos, 10,1% ainda trabalhavam. Quanto ao estado marital, 71,1% eram viúvos e 26,5 % eram casados; 53,6% viviam sozinhos e a maioria (68,6%) tiveram pais que faleceram com 80 anos ou mais. Com relação a renda 38% se enquadravam no primeiro quintil, no entanto, 44,1% referiram que a renda era suficiente. Quanto aos hábitos de vida, 43,2% praticavam atividade física, 41,6% praticavam atividades de lazer, 70,4% nunca beberam e 68,9% nunca fumaram. Em relação às condições de vida e saúde na infância, 47,7% referiram que saúde e 35,2% boas condições econômicas. Quanto ao estado de saúde atual, 63,5% referiram ter saúde excelente, 43,5% referiram a presença de HAS, 34,7% de DPOC e de 7,3% DM e 95,1% apresentavam capacidade cognitiva preservada. Quanto a assistência à saúde, 81,2% referiam ter procurado por assistência médica nos doze meses anteriores à entrevista sendo que 83,8% referiram uma ou duas consultas. Quanto a história laboral 50,2% trabalharam como empregados e 37,3% como autônomos. Entre as mulheres 50% referiram ter trabalhado porque gostavam e 85% dos homens porque necessitavam. 97,5% deles sentiram-se capacitados para realizar os testes de flexibilidade e mobilidade. Essa variáveis foram submetidas à analise multivariada através da Regressão Logística, utilizando-se um nível de significância (µ = 0,05). As variáveis foram agrupadas em blocos temáticos de interesse, sendo submetidas à analise univariada, mostrando-se significantes diabetes referida, companhia e atividade física. Essas variáveis foram agrupadas e submetidas à análise múltipla de forma a constituir o modelo do estudo. Os testes estatísticos mostraram que a presença da diabetes diminui por um fator de 0.14 vezes o odds para não ter dificuldades nas ABVDs e/ou AIVDS. Viver acompanhado diminui esse risco por um fator de 0.15. Não praticar atividade física diminui os odds para não ter dificuldade de 0.13 vezes. Apesar dos idosos conseguirem chegar na velhice avançada sem incapacidades, o estudo mostrou que poucos são fatores que possam influenciar neste processo. Pode ser porque estes fatores já tenham feito diferença entre os idosos mais “jovens”, mas com a idade avançada, os “muito velhos” tendem a igualar estas diferenças / Aging is a world phenomenon and it is a result of the progressive decrease of the fecundity and mortality rates and of the increase of life expectation. The elderly group, in Brazil, is composed by people since 60 years. Inside this group, the population which grows very fast is called very old people (80 years and more) whose specific demand are yet unknown. Aging is normally associated with progressive functional decrease which creates attendance demands and a lot of dependent scene, the great fear of this population. So, to know the factors associated with functional independence become primordial and compose the aim of this study. In this context, predict factors are considered important for the elaboration of preventive acts that alter disability events, responsible for dependence. Aiming to clarify the health load that may come up from a population that has grown old too fast, the Pan-American Health Organization developed a multi central study called SABE, involving seven countries of Latin America and the Caribbean. In Brazil, it was developed at an urban area of Sao Paulo city in 2000 with a total final sample of 2.143 elderly people representing the population who live in this region in this period. The elderly with 80 years and more, were used to develop this study. This is a descriptive and exploratory research. Of the total of the elderly in advanced old age, 9,9% were functionally independents in the activities of daily living. Of these 66.4% were women, 33.6% were men, 75% were born in Brazil, 25.6% never went to school, 10.1% have already worked. Concerning the marital condition 71.1% were widow and 26.5 % were marriage; 53.6% were living alone and the most of them (68.6%) have had parents who died with 80 years or more. Concerning the income 38% were in the first quintile, meanwhile, 44.1% had reported that the income was sufficient. Concerning the life habits, 43.2% had practiced physical activity, 41.6% had practice leisure activities, 70.4% had never drunken and 68,9% had never smoked. In relation to life conditions in childhood 47.7% had reported that they had good health and 35.2% good economical conditions. Concerning the health condition current, 63.5% had reported to have excellent health, 43.5% had reported the presence of hypertension, 34.7% chronicle pulmonary disease and 7.3% diabetes. 95.1% had shown preserved cognitive ability. These variables were submitted to the multivariety analysis through Logistical Regression, using a significance level (µ = 0,05). The variables were gather in thematic blocks of interested, being submitted to the univariety analysis, showing itself meaning diabetes reported, fellowship and physical activity. Regarding to the predict factors for aging without disability, data was submitted to multivaried analysis through Logistic Regression, using a significance level of 5% (a=0.05). These variables were grouped and submitted to multiple analyses in order to constitute the model of the study. The statistical analysis have shown that the presence of diabetes decreases by a factor of 0.14 times the odds for do not have the difficulties in the ADL. To live with company decreases this risk by a factor of 0.15. The odds decrease if there is not the practice of physical activity. The study shows that factors are few and these can influence in this process. This can happen because these factors have already been difference among the “younger” elderly, but among the very old people, the “older” tends to equalize these differences

Introdução: A Doença Renal Crônica (DRC) está associada à alta morbidade e mortalidade, com aumento progressivo nas populações mundiais. A DRC e o tratamento hemodialítico podem desencadear mudanças no estilo de vida dos pacientes como alterações em seu cotidiano, na capacidade para desempenhar atividades do seu dia a dia e no autocuidado. Objetivos: Caracterizar os pacientes atendidos nos serviços de hemodiálise de uma cidade do interior paulista quanto aos aspectos sociodemográficos, econômicos e clínicos; descrever a independência funcional utilizando o instrumento de Medida de Independência Funcional (MIF); descrever a capacidade de autocuidado utilizando a escala para avaliar as capacidades de autocuidado (ASA-A); verificar a associação da independência funcional e da capacidade do autocuidado com as variáveis sociodemográficas e clínicas e verificar correlação entre a independência funcional e a capacidade de autocuidado. Material e Método: Foi realizado um estudo transversal, populacional e descritivo com abordagem quantitativa nos três serviços de diálise do município de São José do Rio Preto-SP, nos quais foram entrevistados 214 pacientes com 18 anos ou mais de idade, residentes nesse município, em tratamento por hemodiálise e que aceitaram participar do estudo. Os instrumentos utilizados para a coleta de dados foram: Miniexame do Estado Mental (MEEM) para a avaliação do estado cognitivo; instrumento para caracterização dos dados sociodemográficos, econômicos e clínicos; a MIF e a ASA-A. Os dados foram analisados por meio do programa estatístico SAS®9.0, no qual foram gerados as análises descritivas, os testes de associação e a correlação entre as variáveis do estudo. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de São José do Rio Preto - FAMERP. Resultados: Dos 214 pacientes, 108 eram adultos e 106 idosos, dos quais 136 eram homens e 78 mulheres. O número médio de comorbidades para cada paciente foi de 2,3, e o número médio de complicações físicas foi de 4,7 por paciente. Foram evidenciados um nível de independência completa ou modificada nessa população (média MIF total 118,38; dp12,4) e um relativo conhecimento dos pacientes referente a sua capacidade de autocuidado (média 94,53; dp12,86). A MIF se correlacionou positivamente com a ASA-A e as duas negativamente com as variáveis idade, complicações relacionadas ao tratamento hemodialítico e comorbidades. Conclusão: Os pacientes em tratamento hemodialítico apresentaram resultados satisfatórios de independência funcional e a capacidade de autocuidado. À medida que aumentam os escores de independência funcional, aumentam também os de capacidade de autocuidado. As variáveis sexo, idade, comorbidades, complicações relacionadas ao tratamento hemodialítico constituíram fatores importantes que prejudicaram a independência funcional e a capacidade de autocuidado dessa população. Os resultados deste estudo permitiram compreender aspectos referentes a essas variáveis que poderão subsidiar intervenções para a melhoria da assistência de enfermagem prestada a essa população. / Introduction: Chronic Kidney Disease (CKD) is associated with high and progressively increasing morbidity and mortality levels around the world. CKD and hemodialysis treatment can trigger changes in patients\' lifestyles, such as changes in their daily lives, in their ability to perform daily activities and in self-care. Aims: To characterize the patients attended at hemodialysis services in an interior city in São Paulo State, Brazil regarding sociodemographic, economic and clinical aspects; to describe their functional independence using the Functional Independence Measure (FIM) scale; to describe their self-care ability using the Appraisal of Self-Care Agency Scale (ASA-A); to check the association between functional independence and self-care ability and sociodemographic and clinical variables and to check for the correlation between functional independence and self-care ability. Material and Method: A cross-sectional and descriptive population study with a quantitative approach was developed at the three dialysis services in the city of São José do Rio Preto- SP, where 214 patients were interviewed, aged 18 years or older, living in this city, under hemodialysis treatment and who accepted to participate in the study. The instruments used for data collection were: Mini-Mental State Examination (MMSE) for cognitive state assessment; instrument to characterize sociodemographic, economic and clinical data; FIM and ASA-A. Data were analyzed in SAS®9.0, used to generate descriptive analyses, association tests and correlations among the study variables. Approval for the project was obtained from the Research Ethics Committee at São José do Rio Preto Medical School - FAMERP. Results: Out of 214 patients, 108 were adults and 106 elderly, with 136 men and 78 women. The average number of comorbidities for each patient was 2.3, and the mean number of physical complications was 4.7 per patients. Complete or modified independence levels were evidenced in this population (mean total FIM 118.38; sd12.4) and patients\' relative knowledge about their self-care skills (mean 94.53; sd12.86). The FIM was positively correlated with the ASA-A and both instruments were negatively correlated with age, hemodialysis treatment-related complications and comorbidities. Conclusion: Patients under hemodialysis treatment presented satisfactory functional independence and self-care ability results. Gender, age, comorbidities, hemodialysis treatment-related complications represented important factors that impaired this population\'s functional independence and self-care ability. These study results permitted understanding aspects related to these variables that can support interventions to improve nursing care delivery to this population.

Objective: The transition to long-term care (LTC) of older adults receiving home care services is preceded by declining functional independence with basic and instrumental activities of daily living (ADL and IADL, respectively). These individual, and group, level time-dependent changes occur within unique provincial and regional policy contexts across Canada, which determine the amount and types of services received by home care recipients during this transition period. It is currently unknown whether activities of daily living (ADL) or IADL (instrumental activities of daily living) exhibit accelerated decline preceding transition to LTC, and if so, whether the onset and rate of decline differs for ADL versus IADL. This dissertation sets out to determine whether such change points exist within longitudinal data gathered from home care recipients in Ontario during the years of 2008 to 2015. Methods: A profile likelihood method was employed to identify the best fitting change points at which the slopes of functional decline in ADL and IADL for those who transition to LTC from home care services depart from the normative age slope of those who remain in community. Data analyzed was collected at approximately 6-month intervals using the International Residential Assessment Instrument – Home Care (RAI-HC) in Ontario, Canada, and was obtained from the Canadian Institutes for Health Information (CIHI) for the period of 2006-2015. A policy review was conducted to determine whether changes had occurred to the amount or type of home care services provided during the data collection period, and subsequently data from 2008 to 2015 were retained. IADL was measured using the 21-point IADL Involvement Scale and ADL was measured using the 28-point ADL Long Form. Best fitting change point models were first identified for ADL and IADL scores in the full sample of participants who remained in community and those who transitioned to LTC and within subgroups stratified by sex. Two additional subgroups were also examined: 1) participants without a primary or secondary caregiver living in the home, and 2) participants with a primary caregiver living in the home. Each caregiver group was also stratified by sex, resulting in a total of 9 groups in which IADL and ADL change points were estimated and compared. Results: In all groups who remained in community with home care services, age-related decline in IADL and ADL were observed. Further, IADL impairment was higher at the time of first assessment and had a greater age-related slope than ADL for those who remained in community. Both measures had discernable change points preceding discharge to LTC and the change point for IADL preceded that of ADL in all groups. Across groups, the change point for ADL had a range of 0.5 years before LTC discharge for men without a primary or secondary caregiver living in the home to 2 years for women with a primary caregiver in the home. IADL change points ranged from 2.5 years before LTC discharge for men with a primary caregiver in the home to 3.6 years for women without a primary or secondary caregiver in the home. Within the full sample, including both men and women, the onset of accelerated IADL decline for those discharged to LTC preceded the onset of home care service by 1.49 years and the time of first assessment by 1.84 years. Women in the full sample, and in both caregiver groups, experienced an earlier IADL change point relative to the availability of home care services and assessment when compared to men. Conclusions: Both IADL and ADL have discernible change points for in the years preceding discharge from home care to LTC. The change point for IADL consistently precedes that of ADL for the entire sample, for those with or without a caregiver in the home and for both men and women. The onset of accelerated IADL decline in the presence of age normative ADL decline may be an early indicator of pending transition from home care to LTC for home care recipients identified in this study. The province of Ontario has committed to providing the right care, at the right time in the right place. This study demonstrates that home care policy in Ontario during this study period, which does not provide for IADL services until after patients first qualify for ADL services, may not be achieving the provinces commitment of ensuring IADL care is provided at the right time for recipients of home care services. Opportunities for early identification and intervention may be available through early monitoring of, and intervention with, IADL function. A stepped care model holds promise for early identification and intervention of IADL impairment in community living older adults. Future research will help to confirm if accelerating decline in IADL function in the absence of appropriate rehabilitation and support services may hasten the onset of accelerated ADL impairment and subsequent admission to LTC. / Graduate / 2022-12-16

<p>This thesis focuses on routine outcome measurement in occupational therapy; specifically the use of the Canadian Occupational Performance Measure (COPM) in inpatient geriatric rehabilitation.</p> <p>The purpose of the first study (Chapters two and three) was to: 1) determine if routine COPM use was associated with improved functional outcome; 2) gather therapist perceptions on routine COPM use; and, 3) propose a template for summarizing COPM data. A cohort study with a therapist participant survey measured the difference in Functional Independence Measure (FIM^™) change scores between an experimental group (n = 45) that implemented the routine use of the COPM for evaluation/planning and a historical “usual care” comparison group (n = 58). Using generalized linear modeling, it was found that both groups had significant changes in FIM^™scores over time (p <. 05). Differences between groups were not significant. Therapists perceived that the COPM facilitated treatment but experienced challenges in routine use. Therapists placed more importance on individual than group data.</p> <p>The second study (Chapter four) determined if routine use of the COPM was associated with changes in five domains of practice: focus of care on occupation, knowledge of client perspective, clinical decision-making, clinician ability to articulate outcomes, and documentation. Twenty-four occupational therapists on eight geriatric rehabilitation units completed a before-and-after study with a repeated baseline. Domains of practice during three months of standard care (no COPM) were compared using Chart Stimulated Recall and chart audit as outcome measures to three months of intervention (COPM). Mean practice scores indicated a significant effect for time (p < .0001) but no effect based on the frequency of COPM use. Chart audit indicated that COPM use resulted in more occupation-focused issue identification.</p> <p>This thesis challenges assumptions regarding the value of measurement and contains the first study to demonstrate that routine outcome measure use affects occupational therapy practice.</p> / Doctor of Philosophy (PhD)

OF MASTER THESIS Author: Bc. Anna Stiborová Supervisor: Mgr. Kateřina Svěcená, Ph.D. Title of master thesis: Utilization of Functional Independence Measure and Functional Assessment Measure on acute inpatient rehabilitation unit with brain damage patients Abstract: This master thesis focuses on the utilization of Functional Independence Measure and Functional Assessment Measure (FIM+FAMUK ). The subject of interest is the use of FIM+FAMUK in an acute phase of rehabilitation in brain damaged patients. The aim of the thesis is to demonstrate the usefulness of FIM+FAMUK as an assessment of functional status on an acute inpatient rehabilitation unit. Theoretical part provides basic information on the system of cerebrovascular care in Czech republic, on the importance of assessing functional status in neurorehabilitation and on some other assessments of disability in neurorehabilitation besides FIM+FAMUK . It also brings insight into FIM+FAMUK , its items, evaluation process and its utilization. Practical part presents the results of a clinical application of FIM+FAMUK on a stroke unit. Fifteen people were assessed with FIM+FAMUK as input and output assessment. Statistical data analysis has confirmed the utilization of FIM+FAMUK as an assessment of functional status on acute inpatient rehabilitation...

Com o aumento da expectativa de vida do ser humano, a condição social e de saúde tem delineado um novo panorama na sociedade. Estudos sobre qualidade de vida do idoso é de interesse internacional diante desse quadro. Os aspectos como a manutenção da independência física e mental para o idoso desenvolver as atividades de vida diária e autonomia pode ser comprometida decorrente de questões sociais e de saúde. O objetivo deste estudo foi avaliar a qualidade de vida, independência funcional e sintomas depressivos de idosos que vivem no domicílio. Trata-se de um delineamento transversal e descritivo realizado na cidade de Ribeirão Preto, estado de São Paulo. A amostra foi por conglomerado de duplo estágio de 240 sujeitos com idade de 60 anos ou mais e de ambos os sexos. Os dados foram coletados por meio de visitas domiciliares no período de novembro de 2010 a fevereiro de 2011. O instrumento para a coleta de dados foi composto de questões sóciodemográficas para a caracterização do idoso, presença de morbidades, Mini-Exame do Estado Mental (MEEM), Medida da Independência Funcional (MIF), Whoqol Old, Whoqol Bref e Escala de Depressão Geriátrica (EDG). A média de idade dos idosos foi 73,2 anos com predomínio da faixa etária de 80 anos ou mais (23,8%). A maioria foi do sexo feminino (62,1%); com escolaridade de um a quatro anos de estudo (48,5%); casados (58,3%); possuem renda mensal superior a um salário mínimo (54,0%); moravam com o cônjuge (29,4%); relataram ter cinco ou mais morbidades (61,7%), sendo mais prevalente a hipertensão arterial (67,5%) seguido de problemas de coluna (54,5%); Foi observado que os idosos do sexo masculino e feminino apresentaram desempenho similiares na MIF e os idosos mais jovens tiveram melhor desempenho na MIF total em relação ao mais velhos(?<0,001). Os sintomas depressivos foram mais prevalentes no sexo masculino (38,2%), idosos mais velhos (44,6%) e entre aqueles que não possuíam companheiro (37,1%). O maior escore médio de QV foi encontrado na faceta intimidade (68,93) e o menor escore médio no domínio físico (60,62). Para todos os domínios apresentaram correlação significativa, sendo para o físico e para as facetas habilidades sensoriais e autonomia apresentaram correlação de moderada intensidade. Os idosos que apresentaram sintomas depressivos tiveram maior escore médio no domínio social (61,07) e menor escore médio no domínio físico (50,21). As mulheres apresentaram maiores escores médios de QV para a maioria das facetas, sendo significativamente maior apenas na faceta morte e morrer (?=0,003). Em relação a faixa etária, os idosos mais jovens apresentaram escores médios de QV superiores aos idosos mais velhos na maioria dos domínios e facetas, sendo significativamente maior no domínio físico (?<0,001) e nas facetas autonomia (?< 0,048) e participação social (?<0,041). Os idosos com presença de companheiro apresentaram escores médios similares de QV para os domínios e facetas, sendo significativamente maior na faceta intimidade (? <0,019) em relação aqueles que não possuíam companheiro. Esse estudo tem como finalidade promover o conhecimento sobre a qualidade de vida dos idosos para instituir políticas públicas que visam melhor benefícios a saúde do idoso, por meio da ação multidisciplinar das equipes de saúde. / The increased life expectancy, social and health conditions of human beings have designed a new panorama in society. In this context, research on the quality of life of elderly people is of international interest. Aspects like the maintenance of physical and mental independence for the elderly to develop their activities of daily living and autonomy can be compromised due to social and health issues. The aim in this study was to evaluate the quality of life, functional independence and depressive symptoms of elderly people living at home. A cross-sectional and descriptive research was developed in Ribeirão Preto, São Paulo State, Brazil. A two-stage cluster sample of 240 male and female subjects aged 60 years or older was used. The data were collected through home visits between November 2010 and February 2011. The data collection instrument consisted of sociodemographic questions to characterize the elderly, presence of morbidities, Mini-Mental State Examination (MMSE), Functional Independence Measure (FIM), Whoqol Old, Whoqol Bref and Geriatric Depression Scale (GDS). The elderly\'s mean age was 73.2 years, with a predominance of the age range of 80 years or older (23.8%). The majority was female (62.1%); with one to four years of education (48.5%); married (58.3%); monthly income of more than one minimum wage (54.0%); lived with their partner (29.4%); reported five or more morbidities (61.7%), the most prevalent of which was arterial hypertension (67.5%), followed by back problems (54.5%). The performance of male and female elderly on the FIM was similar, and younger elderly performed better on the total FIM than older ones (?<0.001). Depressive symptoms were more prevalent among men (38.2%), elder elderly (44.6%) and participants without a partner (37.1%). The highest mean QoL score was found for intimacy (68.93) and the lowest mean score for the physical domain (60.62). Significant correlations were found for all domains, which were of moderate intensity for the physical domain and the sensory skills and autonomy facets. Elderly with depressive symptoms showed a higher mean score in the social domain (61.07) and a lower mean score in the physical domain (50.21). Women obtained higher mean QoL scores for most facets, which were significantly higher only for death and dying (?=0.003). As regards the age range, younger elderly showed higher mean QoL scores than older elderly in most domains and facets, which were significantly higher in the physical domain (?<0.001) and for the facets autonomy (?< 0.048) and social participation (?<0.041). Elderly participants with a partner revealed similar mean QoL scores for the domains and facets, which were significantly higher for the intimacy facet (? <0.019), when compared to participants without a partner. The intent of this study is to promote knowledge on elderly quality of life with a view to the establishment of public policies aimed at improving the benefits for elderly health through health teams\' multidisciplinary actions.

The Polytrauma/TBI Rehabilitation Center (PRC) of the Veterans Affairs Hospital (VAH) treats patients with Traumatic Brain Injury (TBI). These patients have major motor and cognitive disabilities. Most of the patients stay in the hospital for many months without major improvements. This suggests that patients, family and the VAH could benefit if healthcare provider had a way to better assess or "predict" patients' progression. The individual progress of patients over time is assessed using a pre-defined multi-component performance measure Functional Independence Measures (FIM) at admission and discharge, and a semi-quantitative documentation parameter Clinical Pathway (CP) at weekly intervals. This work uses already de-identified and transformed data to explore developing a clinical outcome predictive model for patients with TBI, as early as possible. The clinical outcome is measured as percentage of recovery using CP scores. The results of this research will allow healthcare providers to improve the current resource management (e.g. staff, equipment, space) through setting goals for each patient, as well as to provide the family more accurate and timely information about the status and needs of the patient.

Made available in DSpace on 2016-06-02T20:30:56Z (GMT). No. of bitstreams: 1 5408.pdf: 1181775 bytes, checksum: 5f7558320a6c72689a7a2d18a904a1a5 (MD5) Previous issue date: 2013-07-19 / Financiadora de Estudos e Projetos / Children with atypical development and with verbal behavior deficits, specifically children with autism, can benefit from a systematic teaching of verbal operants and programs that promote its generalization. Verbal behavior is an operant behavior maintained by consequences mediated by a listener that was previously trained by the verbal community to respond to such verbal stimuli. Among the verbal operants, three were of particular interest to this research: echoic, tact and mand. The aim of this research was to examine the effects of tact training for high and low preferred leisure items in the emergence of mand for these same items. Five students with autism (aged from 5 to 14 years old) attending a special education school participated in this research. Participants were exposed one at a time to the experimental conditions and the behavior was observed in the test condition of mand, teaching tact and, then, the effects of the tact teaching was observed in the emergence of mand. The experimental stimuli (leisure items and edibles) were selected from the indication of the parents and teacher, followed by a Forced Choice preference assessment. At the end of the teaching procedure, participants presented tact for high (AP) and low preferred (BP) items. In the mand post-test, participants demonstrated the emergence of this operant with a higher frequency of responses for AP items. The results suggest that the emergence of mands with a higher frequency of responses for AP items may be related to the motivating operation, since the AP items could exert a more reinforcing function than the BP items, which has practical implications for the teaching of verbal behavior. / Crianças com desenvolvimento atípico e que apresentam déficits no comportamento verbal, mais especificamente crianças com autismo, podem se beneficiar de um ensino sistematizado dos operantes verbais e de programas que promovam sua generalização. O comportamento verbal é um comportamento operante mantido por consequências mediadas por um ouvinte que foi previamente treinado pela comunidade verbal a responder a tais estímulos verbais. Dentre os operantes verbais, três foram de particular interesse para esta pesquisa: ecoico, tato e mando. O objetivo da presente pesquisa foi examinar os efeitos do treino de tato para itens de lazer de alta e de baixa preferência na emergência do mando para esses mesmos itens. Participaram desta pesquisa cinco alunos com autismo (P1com 14 anos, P2 com 12 anos, P3 com 10 anos, P4 com 6 anos e P5 com 5 anos) que frequentam uma escola de educação especial. Os participantes foram expostos um de cada vez às condições experimentais e o comportamento foi observado na condição de teste de mando, ensino de tato e na sequência observado os efeitos deste ensino na emergência de mando. Os estímulos experimentais (itens de lazer e comestíveis) foram selecionados a partir de indicação dos pais e professor, seguido da avaliação de preferência por Escolha Forçada. Ao final do procedimento de ensino, os participantes adquiriram tato para itens de alta (AP) e de baixa preferência (BP). No pós-teste de mando os participantes demonstraram emergência deste operante com uma frequência maior de respostas para itens de AP. Os resultados sugerem que a emergência de mando com uma frequência maior de respostas para itens de AP possa estar relacionada às operações motivacionais, uma vez que os itens de AP poderiam exercer função mais reforçadora do que os itens de BP, o que traz implicações práticas para o ensino do comportamento verbal.

Made available in DSpace on 2014-12-17T15:36:39Z (GMT). No. of bitstreams: 1 AnaATS_TESE.pdf: 4274123 bytes, checksum: 50f286f423e0b4c4e687ba8d81bb4d69 (MD5) Previous issue date: 2012-07-20 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / ABSTRACT Introduction: The cerebrovascular accident (CVA) is an important cause of neurological impairment. Few data about the factors associated with morbidity of cerebrovascular accident are found in Brazil. Objectives: Evaluate sociodemographic characteristics, sleep habits, cognitive and functional status of patients with cerebrovascular accident. Methods: The patients evaluated through questionnaire Step 1 to survey the sociodemographic characteristics and Modified Rankin Scale for functional assessment. The neurological degree was evaluated by the National Institutes of Health Stroke Scale (NIHSS), the sleep Habits questionnaire for sleep and cognitive status by the Mini-Examination of the Mental State (MEMS). The data were analyzed using the chi-square test to determine differences in proportions of variables and linear regression analysis. Results: 305 patients were evaluated and the larger number of subjects was between 50 and 69 years (40%), most patients had no formal education (40.3%) and had ischemic type of cerebrovascular accident (72.5%). In the analysis of the functionality it was found that most patients had moderate impairment (55.1%). The results of the sleep habits showed that 63,6% of patients had one more person in the bedroom,12,3% complained about too much noise in the 11 room and 35% of too much light. From these patients 5,8% were smokers, 7,8% and 70,1% drank coffee drinkers, 28,6% had difficulty in initiate to sleep and woke up 37,6% in the middle of the night. Were showed complaints about nightmares (11%), feeling of suffocation (37,7%) and 35% felt very sleepy during the day. In addition, 95% were unemployed, 80,5% did not perform physical activities and 95,4% did not perform mental activities. The cognitive screening conducted a determined association of cognitive status with age and education level and neurological status. Conclusion: The study showed a high frequency of cases of cerebrovascular accident with functional dependence in a moderate degree, identified that many patients do not follow hygienic measures of sleep and found that the assessment of cognitive deficits must take into consideration the age, educational level and degree of neurological patients. We suggest the need for programs of assistance to victims of cerebrovascular accident patients, with a multidimensional approach including the rehabilitation team, the role of sleep medicine and Neuropsychology, so that patients have access to a more appropriate functional rehabilitation, develop a lifestyle that ensures a good sleep quality and are evaluated and rehabilitated with regard to cognitive impairment / Introdu??o: O Acidente Vascular Cerebral (AVC) ? uma importante causa de comprometimento neurol?gico. Poucos dados ? respeito dos fatores associados ? morbidade do AVC s?o encontrados no Brasil. Objetivos: Avaliar as caracter?sticas sociodemogr?ficas, h?bitos de sono, estado cognitivo e funcional de pacientes com AVC. M?todos: Os pacientes foram avaliados atrav?s do question?rio Step 1 para levantamento das caracter?sticas sociodemogr?ficas e Escala Modificada de Rankin para avalia??o funcional. O grau neurol?gico foi avaliado pela National Institute of Health Stroke Scale (NIHSS), o sono pelo Question?rio de H?bitos de sono e o estado cognitivo pelo Mini-Exame do Estado Mental (MEEM). Os dados foram analisados atrav?s do teste Qui-quadrado para verificar diferen?as nas propor??es das vari?veis estudadas e an?lise de regress?o linear. Resultados: Foram avaliados 305 pacientes e o maior n?mero de indiv?duos estava entre 50 e 69 anos (40%), grande parte dos pacientes n?o possu?a estudo formal (40,3%) e tinham AVC do tipo isqu?mico (72,5%). Na an?lise da funcionalidade constatou-se que a maioria dos pacientes tinha incapacidade moderada (55,1%). Os resultados dos h?bitos de sono apontaram que 63,6% dos pacientes apresentavam mais uma pessoa no quarto de dormir, 12,3% se queixavam de muito barulho no quarto e 35% de muita ilumina??o. Dos pacientes avaliados 5,8% fumavam, 7,8% bebiam e 70,1% tomavam caf?, 28,6% apresentavam dificuldade de iniciar o sono e 37,6% acordavam no meio da noite. Foram apresentadas queixas de pesadelos (11%), sensa??o de sufoco (37,7%) e 35% sentiam muito sono durante o dia. Al?m disso, 95% n?o trabalhavam, 80,5% n?o realizavam atividades f?sicas e 95,4% n?o realizavam atividades mentais. O rastreamento cognitivo realizado determinou uma associa??o do estado cognitivo com a idade e escolaridade e o grau neurol?gico. Conclus?o: O estudo conseguiu evidenciar uma frequ?ncia elevada de casos de AVC com depend?ncia funcional de grau moderado, identificou que muitos pacientes n?o seguem medidas de higiene do sono e verificou que a avalia??o de 10 d?ficits cognitivos deve levar em considera??o a idade, escolaridade e o grau neurol?gico dos pacientes. Sugerimos a necessidade de programas de aten??o aos pacientes v?timas do AVC, com uma abordagem multidimensional incluindo a equipe de reabilita??o, a atua??o da Medicina do sono e da Neuropsicologia, a fim de que os pacientes tenham acesso a uma reabilita?ao funcional mais adequada, desenvolvam um estilo de vida que garanta uma boa qualidade de sono e sejam bem avaliados e reabilitados quanto aos comprometimentos cognitivos

Com o aumento da expectativa de vida do ser humano, a condição social e de saúde tem delineado um novo panorama na sociedade. Estudos sobre qualidade de vida do idoso é de interesse internacional diante desse quadro. Os aspectos como a manutenção da independência física e mental para o idoso desenvolver as atividades de vida diária e autonomia pode ser comprometida decorrente de questões sociais e de saúde. O objetivo deste estudo foi avaliar a qualidade de vida, independência funcional e sintomas depressivos de idosos que vivem no domicílio. Trata-se de um delineamento transversal e descritivo realizado na cidade de Ribeirão Preto, estado de São Paulo. A amostra foi por conglomerado de duplo estágio de 240 sujeitos com idade de 60 anos ou mais e de ambos os sexos. Os dados foram coletados por meio de visitas domiciliares no período de novembro de 2010 a fevereiro de 2011. O instrumento para a coleta de dados foi composto de questões sóciodemográficas para a caracterização do idoso, presença de morbidades, Mini-Exame do Estado Mental (MEEM), Medida da Independência Funcional (MIF), Whoqol Old, Whoqol Bref e Escala de Depressão Geriátrica (EDG). A média de idade dos idosos foi 73,2 anos com predomínio da faixa etária de 80 anos ou mais (23,8%). A maioria foi do sexo feminino (62,1%); com escolaridade de um a quatro anos de estudo (48,5%); casados (58,3%); possuem renda mensal superior a um salário mínimo (54,0%); moravam com o cônjuge (29,4%); relataram ter cinco ou mais morbidades (61,7%), sendo mais prevalente a hipertensão arterial (67,5%) seguido de problemas de coluna (54,5%); Foi observado que os idosos do sexo masculino e feminino apresentaram desempenho similiares na MIF e os idosos mais jovens tiveram melhor desempenho na MIF total em relação ao mais velhos(?<0,001). Os sintomas depressivos foram mais prevalentes no sexo masculino (38,2%), idosos mais velhos (44,6%) e entre aqueles que não possuíam companheiro (37,1%). O maior escore médio de QV foi encontrado na faceta intimidade (68,93) e o menor escore médio no domínio físico (60,62). Para todos os domínios apresentaram correlação significativa, sendo para o físico e para as facetas habilidades sensoriais e autonomia apresentaram correlação de moderada intensidade. Os idosos que apresentaram sintomas depressivos tiveram maior escore médio no domínio social (61,07) e menor escore médio no domínio físico (50,21). As mulheres apresentaram maiores escores médios de QV para a maioria das facetas, sendo significativamente maior apenas na faceta morte e morrer (?=0,003). Em relação a faixa etária, os idosos mais jovens apresentaram escores médios de QV superiores aos idosos mais velhos na maioria dos domínios e facetas, sendo significativamente maior no domínio físico (?<0,001) e nas facetas autonomia (?< 0,048) e participação social (?<0,041). Os idosos com presença de companheiro apresentaram escores médios similares de QV para os domínios e facetas, sendo significativamente maior na faceta intimidade (? <0,019) em relação aqueles que não possuíam companheiro. Esse estudo tem como finalidade promover o conhecimento sobre a qualidade de vida dos idosos para instituir políticas públicas que visam melhor benefícios a saúde do idoso, por meio da ação multidisciplinar das equipes de saúde. / The increased life expectancy, social and health conditions of human beings have designed a new panorama in society. In this context, research on the quality of life of elderly people is of international interest. Aspects like the maintenance of physical and mental independence for the elderly to develop their activities of daily living and autonomy can be compromised due to social and health issues. The aim in this study was to evaluate the quality of life, functional independence and depressive symptoms of elderly people living at home. A cross-sectional and descriptive research was developed in Ribeirão Preto, São Paulo State, Brazil. A two-stage cluster sample of 240 male and female subjects aged 60 years or older was used. The data were collected through home visits between November 2010 and February 2011. The data collection instrument consisted of sociodemographic questions to characterize the elderly, presence of morbidities, Mini-Mental State Examination (MMSE), Functional Independence Measure (FIM), Whoqol Old, Whoqol Bref and Geriatric Depression Scale (GDS). The elderly\'s mean age was 73.2 years, with a predominance of the age range of 80 years or older (23.8%). The majority was female (62.1%); with one to four years of education (48.5%); married (58.3%); monthly income of more than one minimum wage (54.0%); lived with their partner (29.4%); reported five or more morbidities (61.7%), the most prevalent of which was arterial hypertension (67.5%), followed by back problems (54.5%). The performance of male and female elderly on the FIM was similar, and younger elderly performed better on the total FIM than older ones (?<0.001). Depressive symptoms were more prevalent among men (38.2%), elder elderly (44.6%) and participants without a partner (37.1%). The highest mean QoL score was found for intimacy (68.93) and the lowest mean score for the physical domain (60.62). Significant correlations were found for all domains, which were of moderate intensity for the physical domain and the sensory skills and autonomy facets. Elderly with depressive symptoms showed a higher mean score in the social domain (61.07) and a lower mean score in the physical domain (50.21). Women obtained higher mean QoL scores for most facets, which were significantly higher only for death and dying (?=0.003). As regards the age range, younger elderly showed higher mean QoL scores than older elderly in most domains and facets, which were significantly higher in the physical domain (?<0.001) and for the facets autonomy (?< 0.048) and social participation (?<0.041). Elderly participants with a partner revealed similar mean QoL scores for the domains and facets, which were significantly higher for the intimacy facet (? <0.019), when compared to participants without a partner. The intent of this study is to promote knowledge on elderly quality of life with a view to the establishment of public policies aimed at improving the benefits for elderly health through health teams\' multidisciplinary actions.