A disfagia orofaríngea é um déficit frequentemente relacionado à consequências graves, como a desidratação, desnutrição, aspiração, pneumonia e morte. A avaliação fonoaudiológica a beira do leito é indicada para a detecção precoce deste distúrbio, no ambiente hospitalar. Geralmente inclui a coleta de informações acerca da dificuldade de deglutição; revisão da história médica; observação do estado clínico atual; avaliação da fala, voz e estruturas orofaciais e; observação do paciente durante os testes de deglutição com diferentes consistências de alimentos. Neste estudo, foi proposta a elaboração e validação de conteúdo do Protocolo Fonoaudiológico de Introdução e Transição da Alimentação por Via Oral para pacientes com risco para disfagia orofaríngea (PITA). Este protocolo visa auxiliar o fonoaudiólogo no gerenciamento clínico da disfagia, durante a fase de introdução e transição da alimentação por via oral na internação. O processo de elaboração e validação de conteúdo do PITA foi conduzido em três fases. A primeira fase baseou-se na fundamentação teórica e avaliação do protocolo-piloto. A segunda fase teve como objetivo a elaboração do PITA, sendo determinadas as definições constitutivas e operacionais de cada variável eleita. A terceira fase, a validação de aparência e conteúdo foi conduzida por meio da análise de treze juízes com expertise na área de estudo. Durante a terceira fase, os juízes foram convidados a avaliar o PITA, por meio de um questionário de validação de aparência e conteúdo. Para a análise das respostas dos juízes foram aceitos os índices de 0,78 para validação de conteúdo dos itens individualmente (IVC-I) e 0,90 para o índice de validação total do protocolo (IVC-T). Como resultado, o PITA foi constituído por vinte e um itens, com suas respectivas definições constitutivas e operacionais. Os resultados da terceira fase foram divididos em duas etapas. Na primeira, após a avaliação dos juízes, houve necessidade de modificar, incluir e excluir algumas variáveis. Na segunda, após repetição da avaliação dos juízes, os índices calculados apresentaram-se adequados, conforme a proposta do estudo, sendo definida a aparência e conteúdo do protocolo final. Assim, o PITA apresenta-se como um protocolo teórico, elaborado com base na literatura científica disponível. Por meio da avaliação de juízes experientes na área de estudo foi possível aperfeiçoar o instrumento e validá-lo em sua aparência e conteúdo. Outras pesquisas são essenciais para a aplicação experimental em larga escala, abrangendo diferentes fonoaudiólogos, pacientes, doenças de base e instituições. Apesar de ser um instrumento de baixo custo e fácil utilização, há ressalvas quanto à sua subjetividade e adverte-se a necessidade de treinamento prévio do examinador para a correta aplicação do instrumento. / Dysphagia is a deficit often related to serious consequences such as dehydration, malnutrition, aspiration, pneumonia, and death. Speech evaluation at bedside is indicated for early detection of this disorder in the hospital. It usually includes collecting information about dysphagia; medical review; current clinical status; assessment of speech, voice, and orofacial structures and; clinical tests with intake of different food textures. In this study, the development and validation of content of the \"Oral Feeding Transition Protocol (OFTP) was proposed. This protocol aims to assist speech pathologists in the clinical management of dysphagia, during the introduction and the transition to oral feeding at hospitals. The process of developing and validating the content of OFTP was conducted in three phases. The first phase provided theoretical background and evaluation of the pilot protocol. The OFTP was elaborated in the second phase, when the constitutive and operational definitions of each chosen variable were determined. The third phase was carried out in order to validate the protocol content. This validation was performed through the analysis of thirteen judges with expertise in dysphagia. During the third phase, the judges were asked to assess the OFTP, through a questionnaire of content validation. For this analysis the following validation indexes were accepted: 0.78 for individual items (IVC-I), and 0.90 for the overall scale (CVI-T). As a result, the OFTP was composed of 21 items, with their respective constitutive and operational definitions. The results of third phase were divided in two stages. In the first stage, after the judges evaluations, it was necessary to modify, add and delete some variables. In the second stage, after a new evaluation of the judges, the calculated indexes demonstrated to be adequate, as proposed by the study, and the final version of the protocol was determined. The OFTP is a theoretical protocol based on the available scientific literature. The evaluation of expert judges improved the tool and validated appearance and content of the protocol. Further research is essential for the experimental application with a large scale, different speech therapists, patients, underlying diseases, and institutions. The OFTP is a low cost instrument, with simple procedures for application. Despite this, there are concerns about its subjectivity; specific training is needed prior to the correct application of the instrument.

Introdução: A aringectomia subtotal permite a preservação da função da laringe com um bom controle oncológico local da doença, além de manter uma comunicação satisfatória, traqueostomia temporária e disfagia passível de terapia fonoaudiológica. Objetivos: Descrever resultados da avaliação vocal, estruturas remanescentes, comportamento laríngeo em tarefas específicas e resultados da avaliação de deglutição; e comparar a funcionalidade das estruturas remanescentes com os parâmetros de voz e deglutição após laringectomia com cricohioidoepiglotopexia (CHEP) e traqueohioidoepiglotopexia (THEP). Método: Estudo transversal observacional comparativo em que participaram 15 indivíduos submetidos à laringectomia subtotal reconstruídos com CHEP (12) e THEP (3), após restabelecimento da alimentação via oral. Foram avaliados por meio da captação/registro de amostra de fala para análise perceptivo-auditiva, acústica e de agradabilidade da voz; nasofibrolaringoscopia para análise estrutural e exames de deglutição. Resultados: Foi observado grau acentuado de tensão e de desvio de loudness e as vozes foram consideradas desagradáveis. Quanto às estruturas remanescentes, a maioria apresentou atividade supraglótica vestibular mediana e anteroposterior moderadas durante fonação de vogais. A penetração laríngea silente foi encontrada na maioria dos indivíduos, mas nem sempre seguida de aspiração. Na comparação entre as estruturas remanescentes e os resultados funcionais de voz e deglutição, não houve significância estatística em nenhum dos parâmetros avaliados. Conclusão: Indivíduos submetidos à laringectomia subtotal mantêm disfonia acentuada e comumente episódios de penetração silente sem aspiração laringo-traqueal. Não houve significância estatística na comparação entre a funcionalidade das estruturas remanescentes e os parâmetros vocais e deglutição; o número de aritenóides preservado não se mostrou fator prognóstico para parâmetros positivos na avaliação vocal e eficiência da deglutição. Os diferentes ajustes neolaríngeos inviabilizaram estudo de correlação entre as variáveis / Introduction: Subtotal laryngectomy preserve larynx functions and allows adequate local oncological control and also provide an effective communication to the individual, temporary tracheostomy and dysphagia liable to speech-therapy intervention. Purposes: Describe results of vocal assessment, remaining structures, laryngeal behavior in specific tasks and the evaluation of swallowing; and also compare the functioning of remaining structure to voice and swallowing parameters after laryngectomy with cricohyoidoepiglottopexy (CHEP) traqueohyoidoepiglottopexy (THEP). Methods: Comparative observational cross-sectional study which counted on 15 individuals who underwent subtotal laryngectomy reconstructed with CHEP (12) and THEP (3), after re-establishment of oral feeding route. All individuals were assessed through capture/record of a speech sample for both perceptual-acoustic and voice pleasantness analysis, nasofibrolaryngoscopy for structural analysis, and swallowing examination. Results: We noticed pronounced level of tension and loudness deviation and the voices were considered little pleasant or unpleasant. Concerning remaining structure, the majority of individuals presented median vestibular supraglottic activity and moderated activity anteroposterior during phonation of vowels. Silent larynx penetration was found in the most part of individuals, although not commonly related to aspiration. The comparison between remaining structures and functioning results of voice and swallowing pointed no statistical significance among the assessed parameters. Conclusion: Individuals who underwent subtotal laryngectomy maintain pronounced dysphonia e often episodes of silent penetration without laryngotracheal aspiration. There was found no statistical significance between remaining structure functioning and both vocal and swallowing parameters; quantitatively, the maximum phonation time of arytenoid cartilage may influence on both voice pleasantness and perceptual-acoustic analysis

Acompanhando a crescente utilização de tecnologias de informática nas áreas da educação e saúde, com base nas propostas do EAD, foi desenvolvido, em 2013, o website Voz: fonoaudiologia e medicina, versão em língua inglesa norte-americana, a partir do CD-ROM Voz: fonoaudiologia e medicina, do Projeto Homem Virtual, volume 1, elaborado em 2006, em uma parceria entre a Universidade de São Paulo e a Universidade Federal de São Paulo. Nesse sentido, esta pesquisa teve como objetivo a avaliação de sua eficácia como instrumento educacional, em relação aos aspectos cognitivos e subjetivos, no contexto de ensino de língua inglesa, mais especificamente no ensino de sua pronúncia, constituindo a fase final do projeto multicêntrico de desenvolvimento e avaliação do website. Os participantes desta pesquisa foram 30 alunos, sendo 15 do Curso de Letras e 15 do Curso de Tradutor da Universidade do Sagrado Coração, na cidade de Bauru, SP, que cursavam a disciplina denominada Fonética e Fonologia da Língua Inglesa, ministrada pela própria pesquisadora. O grupo de 30 alunos foi dividido em dois grupos iguais de 15 alunos, denominados Grupo Experimental (GE), aquele que fez uso do website como material complementar à disciplina, e o Grupo Controle (GC), que não fez uso do website. A coleta de dados foi feita por meio da aplicação de dois questionários, que reuniram dados relativos aos aspectos cognitivos - o Questionário anterior ao acesso do website e o Questionário posterior ao acesso do website, bem como do preenchimento da Ficha de Pesquisa Motivacional após o estudo. Foram utilizados, para o acesso ao website, três meios diferentes: tablet, smartphone e computador. Para a comparação entre os grupos, considerando cada questão e o número de acertos de cada aluno, foram aplicados o teste exato de Fisher e o Teste T Pareado, respectivamente. Para a comparação entre os diferentes meios de acesso ao website foi aplicada a Análise de Variância seguida do teste de Tukey. Após o estudo do website, os resultados revelam que o GE apresentou melhor desempenho em todas as questões em relação ao GC, bem como maior número de acertos por participante em relação às questões dos questionários. No que diz respeito aos meios de acesso, não houve diferença estatisticamente significante para a comparação entre os três meios quando considerou-se a diferença entre o número de acertos nos questionários pré e pós. No que se refere à avaliação dos aspectos subjetivos, aferida pela Ficha de Pesquisa Motivacional, a análise dos dados revelou um website Impressionante. Dessa forma, o website mostrou-se eficaz como instrumento educacional considerando-se tanto sua avaliação relativa aos aspectos cognitivos quanto aos subjetivos, independentemente dos meios de acesso utilizados. São sugeridas, todavia, novas pesquisas, a fim de expandir a utilização e avaliar a eficácia do website em outros contextos de ensino de língua inglesa, com vistas a conferir a esse instrumento educacional a distância uma qualidade e eficácia ainda maiores. / Following the increasing use of computer technologies in the areas of education and health, based on Distance Education proposals, the website Voice assessment: speech-language pathology and audiology & medicine was developed, based on the Portuguese version of the CD-ROM Voice assessment: speech-language pathology and audiology & medicine, Virtual Man Project, volume 1, developed in 2006, in a partnership between the University of São Paulo (USP) and the Federal University of São Paulo (UNIFESP). In this sense, this research aimed at evaluating its efficacy as an educational instrument concerning its cognitive and subjective aspects, in the context of English language teaching, more specifically in pronunciation teaching, being the last phase of the multicenter research project responsible for the website development and evaluation. 30 students participated in this research 15 from the Languages Teaching Course and 15 from the Translator Course at University of Sagrado Coração, in the city of Bauru, who were studying the subject English Phonetics and Phonology, whose teacher was the researcher. The group of 30 students was divided into 2 equal groups of 15 students, called Experimental Group which made use of the website as a complementary material for the subject, and the Control Group - which did not use the website. Data collection was carried out by means of two questionnaires, which gathered data related to the cognitive aspects the Pre-website Questionnaire and the Post-website Questionnaire, besides the Motivational Research Form, after the study. Three different means were used to access the website: tablet, smartphone and computer. For the comparison between the groups, considering each question and the number of right answers from each participant, the Fishers Exact Test and the Paired T- Test were used, respectively. For the comparison among the three different website access means, the Analysis of Variance was used followed by the Tukey Test. After the website study, results showed that the Experimental Group had a better performance in all the questions in relation to the Control Group, as well as a greater number of right answers per participant to the questions in the questionnaires. As to the access means, there was no significant statistical difference in the comparison among the three means when the difference between the number of right answers in the pre and post-website questionnaires was considered. In relation to the evaluation concerning the subjective aspects, assessed by the Motivational Research Form, data analysis revealed an Impressive website. Thus, the website showed efficacy as an educational instrument in relation to its evaluation both regarding the cognitive and the subjective aspects, independently of the means used. Nevertheless, further research is suggested aiming at expanding the use and evaluating the efficacy of the website in other contexts of English teaching in order to grant this Distance Education instrument greater quality and efficacy.

No description available.

This study explored the types and uses of informal, on-the-job learning occurring among American Speech-Language-Hearing (ASHA)-certified Speech-Language Pathologists (SLPs) working in medical settings as part of a rehabilitation team. In addressing this purpose, a qualitative, phenomenological approach to research methodology was used. Participants were selected through a process of purposeful sampling, each meeting the criteria of having earned the Certificate of Clinical Competence in Speech-Language Pathology from ASHA and working in a medical setting as part of a rehabilitation team. Twenty-four SLPs from varying demographic profiles took part in one of three online data collection methods. Nine participants completed a computer-mediated interview, 11 participants completed an online journal entry and 4 participants completed a virtual focus group method. All data collection methods were accomplished via internet technologies. Data analysis was performed through a process of thematic analysis and resulted in four significant findings. First, both internal and external forces triggered SLPs to learn informally in the medical workplace. Also, SLPs went through an individually-determined, goal-directed process when learning informally in the medical workplace. SLPs used a combination of collaboration, workplace experience and research to learn informally in the medical workplace. And finally, SLPs employed informal learning activities for the purpose of meeting personal, patient and organizational needs. / It was recommended that (a) the American Speech- Language-Hearing Association review its professional development policy and consider implementation of a process whereby clinicians can document their goal-directed workplace learning and receive professional development credit for these activities; (b) healthcare organizations recognize, support and reward the informal learning in which their SLPs are already engaging; and (c) SLPs enhance their informal learning in the medical workplace through proactivity, critical reflectivity (of their own and others' learning), and creativity. The significance of this research included the use and support of existing theory in both Adult Education and Human Resource Development. Further, this research represents the first of its kind in investigating informal learning in rehabilitative therapies, specifically Speech-Language Pathology. Peer professions such as Physical and Occupational Therapy may also benefit from this study's conclusions and recommendations, as these professionals work in similar medical contexts. / by Patrick Roy Walden. / Thesis (Ph.D.)--Florida Atlantic University, 2008. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2008. Mode of access: World Wide Web.

Hyperacusis and Disorders of Sound Intolerance: Clinical and Research Perspectives is a professional resource for audiology practitioners involved in the clinical management of patients who suffer from sound tolerance concerns. The text covers emerging assessment and intervention strategies associated with hyperacusis, disorders of pitch perception, and other unusual processing deficits of the auditory system. In order to illustrate the patients perspectives and experiences with disorders of auditory processing, cases are included throughout. This collection of diagnostic strategies and tools, evidence-based clinical research, and case reports provides practitioners with avenues for supporting patient management and coping. It combines new developments in the understanding of auditory mechanisms with the clinical tools developed to manage the effects such disorders exert in daily life. Topics addressed include unusual clinical findings and features that influence a patient s auditory processing such as their perceptual accuracy, recognition abilities, and satisfaction with the perception of sound. Hyperacusis is covered with respect to its effects, its relation to psychological disorders, and its management. Hyperacusis is often linked to trauma or closed head injury and the text also considers the management of patients with traumatic brain injury as an opportunity to illustrate the effectiveness of interprofessional care in such cases. Interventions such as cognitive behavioral therapy, self-efficacy training, and hearing aid use are reported in a way that enhances clinicians' ability to weave such strategies into their own work, or into their referral system. Hyperacusis and Disorders of Sound Intolerance illuminates increasingly observed auditory-related disorders that challenge students, clinicians, physicians, and patients. The text elucidates and reinforces audiologists contributions to polytrauma and interprofessional care teams and provides clear definitions, delineation of mechanisms, and intervention options for auditory disorders. / https://dc.etsu.edu/etsu_books/1210/thumbnail.jpg

O nascimento de um recém-nascido prematuro é considerado de risco para o desenvolvimento infantil saudável. Levando-se em consideração o curso do desenvolvimento, no qual sua trajetória pode sofrer interferências pela prematuridade, este estudo foi delineado, com o objetivo de investigar e comparar o desempenho de crianças nascidas com prematuridade extrema, acentuada e moderada e nascidas a termo, quanto ao desenvolvimento nas áreas de linguagem, motora grossa, motora fina-adaptativa, pessoal social e visual, na faixa etária de 0 a 24 meses. Para as crianças nascidas prematuras foram considerados tanto a idade cronológica quanto o cálculo da idade corrigida. Cumpriram-se os aspectos éticos. Foram avaliadas 261 crianças nascidas prematuras e 87 crianças nascidas a termo. Os procedimentos experimentais foram: análise de prontuário, anamnese com familiares, aplicação do Critério de Classificação Econômica Brasil e dos instrumentos: Teste Screening do Desenvolvimento DENVER II e da Escala Early Language Milestone Scale ELM. Os procedimentos de análises foram Teste de Tukey, Teste do Qui-Quadrado e de Proporções, Independent Samples Test, Teste de Correlação de Pearson e o Teste Correlação de Ponto Bisserial (nível de significância p<0,05). Os resultados encontrados e as nossas conclusões foram: o desempenho nas habilidades comunicativas e do desenvolvimento na comparação das crianças nascidas prematuras com as crianças nascidas a termo, verificou-se diferença estaticamente significante para as habilidades Auditiva Expressiva, Pessoal-Social, Motor Fino Adaptativo, Linguagem e Motor Grosso, tanto para idade cronológica quanto para idade corrigida. Na comparação dos grupos de prematuros nas habilidades avaliadas, não foram verificadas diferenças estaticamente significante, considerando o critério idade corrigida. Os escores obtidos no critério passa ou falha, apresentou diferença estatisticamente significante na análise referente às porcentagens obtidas nas habilidades comunicativas da ELM, e nas habilidades do desenvolvimento do TSDD-II, entre os grupos de crianças nascidas prematuras e de crianças nascidas a termo, considerando a idade cronológica e idade corrigida. A influência dos fatores de risco e da idade gestacional correlacionados com o desempenho nas habilidades do desenvolvimento no TSDD-II, com resultados estatisticamente significantes apenas para o GP-I. / The birth of a preterm newborn is considered risky for healthy child development. This study was delineated considering the course of the child development, which may suffer interferences by prematurity. This study aimed at investigating and comparing the development of children who were late, very or extremely preterm, and children born at term, with regard to the development in the language, gross motor, adaptive fine motor, social-personal and visual areas, in subjects from 0 to 24 months old. For preterm children, we considered both chronological and corrected ages. The ethical aspects were met. We evaluated 261 children who were born preterm, and 87 children born at term. The experimental procedures were: analysis of records, anamnesis questionnaire answered by caregivers, and application of the Brazilian Economic Classification Criteria. In addition, the Development Screening Test DENVER II and the Early Language Milestone Scale ELM instruments were used. The analyses procedures were carried out by means of the Tukey test, Chi-Square test and Proportions, Independent Sample Tests, Pearson Correlation Coefficient, and the Point-Biserial Coefficient of Correlation (level of significance - p<0.05).The results approached the performance in communicative abilities and development by comparing preterm and born at term children. There was a statistically significant difference for the expressive auditory, social-personal, adaptive fine motor, language and gross motor abilities for both chronological and corrected ages. There were no statistically significant differences as for the corrected age criterion and the comparison among the preterm groups considering the assessed abilities. The scores obtained through the criterion of passes or fails indicated that there was a statistically significant difference in the analysis of the percentages for the communicative abilities in the ELM and for the development abilities in the TSDD II among the groups of preterm children and the group of children born at term, considering both chronological and corrected ages. The influence of the risk factors and the gestational age correlated with the performance in the abilities of development for the TSDD II, indicating statistically significant results only for the GP-1.

Up to 1.2% of the population is unable to meet daily communication needs using typical speech and may use augmentative and alternative communication (AAC) strategies to communicate, including manual sign language, facial gestures, and aided strategies such as selecting targets on an onscreen keyboard. However, for individuals whose impairments affect both speech and non-speech motor systems (e.g., spinal cord injury, amyotrophic lateral sclerosis, multiple sclerosis), their ability to use manual sign and access computer systems are impacted. AAC access methods in this population remain inherently slow and effortful (e.g., eye-tracking, head-tracking, mechanical switches). Thus, optimizing communication interfaces for alternate access methods may provide significant improvements in communication rates and quality of life. In this series of studies, we developed and evaluated methods for improving communication rates through optimization and prediction in communication interfaces. These interfaces enabled participants to select sounds (phonemes) instead of letters and were computationally optimized offline via a model of human movement in order for targets likely to be selected together to be in close proximity. Online prediction was implemented such that likely targets were dynamically enlarged. Computational simulations suggested that optimized phonemic interfaces could increase communication rates by up to 30.9% compared to random phonemic interfaces. Communication rates were empirically evaluated in 36 participants without motor impairment using an alternate computer access method to produce messages with phonemic interfaces over 12 sessions. Results suggested that optimization increased communication rates by 10.5–23.0% compared to a random phonemic interface. Prediction increased communication rates during training sessions, but was not a significant factor in communication rates during the final session. Empirical evaluations in individuals with motor impairment revealed that all participants strongly agreed that they would improve with practice, and four out of six participants strongly preferred the interface with prediction. Results of these studies suggest that optimized and predictive phonemic interfaces may provide increased communication rates for individuals with motor impairments affecting both oral communication and computer access. Methods for dynamically enlarging targets may also be applicable to other (non-phonemic) interfaces to increase communication rates. Further research is needed to fully translate these results into clinical practice. / 2020-10-24T00:00:00Z

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

Made available in DSpace on 2016-04-27T18:12:01Z (GMT). No. of bitstreams: 1 Cinthia Ferreira Goncalves.pdf: 1340927 bytes, checksum: 75578a8f6de050d66e9e45b15cf4cdc9 (MD5) Previous issue date: 2013-07-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Since the 1990 s, Education has been a relevant theme in Brazil, and the Speech-Language Therapist takes part in the discussions to face the issues related to school failure and inclusion of students with special needs. AIM: With the theory that the position of apprentice in the discourse of teachers generates effects in literacy, this study aims to analyze the position that the apprentice occupies in the speech of teachers and it s unfolding. METHOD: this is a qualitative study. Data collection was conducted with a group of teachers from a state-run school, during the Continued Education activity. The discursive data were collected by recording and then transcribed, and were analyzed using the theory of French Discourse Analysis. DATA ANALYSIS: The analysis enabled the identification of: a) the teachers partaking in the dominant ideology of the educational discourse, characterized by an institutionalized, authoritarian speech, where the teacher does not assume a singular position; b) the teachers ideology about what is language, speech and writing acquisition; c) the position of apprentice occupied by the teacher. RESULTS: We were faced with a teacher who was abandoned and devalued, who considers himself incapable as a consequence of his discursive position of not knowing . This is derived from the entrance of several professional in school who occupy the teacher s space in order to educate him; of the establishment of classes for the teacher to attend (ATPC); of the Continued Education Course that identifies the teacher as someone who must remain in education ; of the binomial social failure/school failure that compares any student to a social failure. CONCLUSION: Leading the teacher to doubt what he says and what is said about him is the starting point for a speech-language therapy action with teachers. The possibility of their speeches gaining other meanings would lead the teacher to occupy other positions in the dialogic structure, making room for abandoning the position of apprentice and fighting school failure / Desde a década de 1990, a Educação tem sido tema de relevância no Brasil e o fonoaudiólogo passa a fazer parte de discussões para enfrentar as questões relacionadas ao fracasso escolar e à inclusão. OBJETIVO: Partindo do pressuposto de que a posição do aprendiz no discurso dos professores gera efeitos na alfabetização, este estudo se propôs a analisar a posição que o aprendiz ocupa no discurso dos professores e seus desdobramentos. MÉTODO: trata-se de uma pesquisa qualitativa. A coleta de dados foi feita com um grupo de professores de uma escola estadual, durante a atividade de Formação Continuada. Os dados discursivos coletados por gravação e transcritos, foram analisados à luz da teoria da Análise de Discurso de linha francesa. ANÁLISE DOS DADOS: A análise permitiu identificar: a) o assujeitamento do professor à ideologia dominante do discurso pedagógico caracterizado por um discurso autoritário, institucionalizado, não havendo um posicionamento singular do professor; b) a ideologia dos professores sobre o que seja a linguagem, a aquisição da fala e da escrita; c) a posição de aprendiz ocupada pelo professor. RESULTADOS: Deparamo-nos com um professor desvalorizado e desamparado, que se considera incapaz como consequência de sua posição discursiva de não saber decorrente: da entrada de diversos profissionais na escola que ocuparam o espaço do professor para instrumentalizá-lo; do estabelecimento de aulas para que o professor assista (ATPC); do Curso de Formação Continuada que identifica o professor como alguém que deve permanecer em formação ; do binômio fracasso social/ fracasso escolar que equipara qualquer aluno a um fracasso social. CONCLUSÃO: Levar o professor a duvidar do que ele diz e do que é dito sobre si é o ponto de partida para uma ação fonoaudiológica com o professor. A possibilidade de seus dizeres ganharem outros sentidos levaria o professor a ocupar outras posições na estrutura dialógica, abrindo espaço para o abandono da posição de aprendiz, ressignificando a posição do professor e combatendo o fracasso escolar