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Previous issue date: 2014-05-28 / The present thesis sought to assess the impact of right- and left-hemisphere damage on communicative and cognitive processes, to investigate the relationship between these functions, as well as to develop and assess the outcomes of communication rehabilitation programs. These goals were achieved through three empirical studies. The first investigation looked into the nature of and relationship between post-stroke impairments in communicative and executive functions in patients with unilateral strokes in the right versus the left hemisphere. Differences in communicative processing between the two clinical groups were investigated based on the performance of 73 patients, of whom 36 had right hemisphere damage (RHD) while 37 had left-hemisphere damage (LHD). Executive function impairments and their association with discourse processing were investigated in 42 participants, of whom 25 had RHD and 17 had LHD, using the Brief Montreal Communication Assessment Battery, the Bells Test, the Oral word span in sentences subtest from the Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN, the Hayling Test and the Modified Wisconsin Card Sorting Test (48 cards). Patient performance was evaluated using Student s T-tests, as well as Chi-square tests of the number of individuals with communicative/cognitive impairment in each group, as indicated by Z scores. The two groups did not differ as to the prevalence of communicative deficits, although patients with LHD displayed slower inhibitory processing. Additionally, two cases had communicative impairments in the absence of executive deficits, while fourteen patients displayed executive function impairments only. The lack of between-group differences may be attributable to the fact that participants were assessed in the chronic stage of recovery. The presence of dissociations between impairments in the two types of processing also reveals that the relationship between these conditions is not causal. The second study involved the development and implementation of a feedback-based discourse rehabilitation program (FDRP) in a patient with TBI. The program was developed using an eight-step process, which culminated in a pilot study. Pre- and post-intervention comparisons revealed improvements in scores on part A of the Hayling test and on the full retelling of the story in the discourse task of the MAC-B Battery. A decrease in inadequate communicative behaviors such as speaking off topic was also observed over the course of the intervention. The use of pictogram-based feedback appeared to contribute significantly to the improvement of inadequate communicative behaviors. However, further studies must be performed to determine the optimal number of sessions required to obtain reliable results, as well as to assess the longterm effects of the intervention through the use of follow-up assessments. The third study involved the development of a context-based lexical-semantic rehabilitation program (CLSR). This process involved eight steps. The expert evaluation of task stimuli and instructions, and of their conformity to the intended goals, was essential for the construction of the CLSR, as was the pilot study in which the judges suggestions for improving the understandability of the tasks were implemented. Studies involving clinical groups should be performed to ensure the efficacy of this rehabilitation approach. To date, most lexical-semantic therapies have focused on the treatment of anomia, so that the present studies provide an important new perspective regarding the rehabilitation of these components. In conclusion, the studies which comprise this thesis make important contributions to our knowledge of the relationship between cognitive-communicative functions and hemispheric lateralization, as well as to the development of rehabilitation programs based on clearly defined methods. / A presente tese buscou investigar o papel do hemisf?rio cerebral lesado e a rela??o entre os processamentos comunicativos e de componentes executivos, al?m de desenvolver e verificar o efeito de programas de reabilita??o neuropsicol?gica da comunica??o. Para tanto, foram realizados tr?s estudos emp?ricos. O primeiro visou a investigar o desempenho comunicativo e executivo de pacientes com les?es cerebrovasculares unilaterais direita versus esquerda, como tamb?m verificar se h? rela??o entre a ocorr?ncia de d?ficits discursivos e executivos. Para responder a quest?o de que se h? diferen?as comunicativas entre os dois grupos cl?nicos, foram avaliados 73 indiv?duos, 36 com les?o de hemisf?rio direito (LHD) e 37 com les?o de hemisf?rio esquerdo (LHE). Para verificar o desempenho executivo e se existe rela??o entre as dificuldades discursivas e executivas, a amostra constituiu-se de 42 indiv?duos, sendo 25 com LHD e 17 com LHE, avaliados pelas ferramentas Bateria MAC B, Teste de Cancelamento dos Sinos, subteste Span auditivo de palavras em senten?as do NEUPSILIN, Teste Hayling e Wisconsin Card Sorting Test modificado (48 cart?es), cujos escores foram comparados pelo Teste t de Student para amostras independentes, al?m da an?lise de ocorr?ncia de d?ficits (escore Z e Qui-quadrado). N?o foram encontradas diferen?as significativas entre os grupos cl?nicos quanto ao desempenho comunicativo. O grupo com LHD apresentou pior desempenho quanto ? velocidade inibit?ria. Dois casos apresentaram apenas dificuldades discursivas sem dificuldades em fun??es executivas e 14 casos, apenas d?ficits executivos. Pode-se concluir que talvez pelo fato dos pacientes serem cr?nicos n?o tenham sido encontradas diferen?as entre os dois grupos cl?nicos e que n?o se pode afirmar que h? uma rela??o causal entre d?ficits executivos e discursivos, havendo dissocia??es. No segundo estudo, foi desenvolvido um Programa de Reabilita??o do Discurso com o uso de feedback (PRDF), cujo efeito terap?utico foi averiguado com uma paciente p?s-traumatismo cr?nio-encef?lico (TCE). Primeiramente, construiu-se o programa de reabilita??o a partir de oito etapas bem definidas, sendo a ?ltima etapa o estudo piloto. Observaram-se melhoras quantitativas no escore de erros da parte A do Teste Hayling e no escore de reconto integral do Discurso narrativo da Bateria MAC, bem como, melhoras qualitativo-quantitativas de diminui??o do comportamento comunicativo desviante fuga do t?pico no decorrer das sess?es. Observou-se que a estrat?gia terap?utica de feedback com o uso de pictogramas pode contribuir para a melhora dos comportamentos desviantes no discurso. No entanto, existe a necessidade de investigar o n?mero de sess?es adequadas para o sucesso terap?utico, bem como, investir em estudos de follow-up. No terceiro estudo, foram desenvolvidos conjuntos de tarefas para um programa de reabilita??o do componente l?xico-sem?ntico com base no contexto (PRLS-C). Esse processo passou por oito etapas bem definidas. A an?lise de ju?zes especialistas para verifica??o do conjunto instru??o-est?mulos de cada tarefa apontou que as estrat?gias estavam adequadas aos objetivos propostos. Todas as etapas foram fundamentais para a constru??o do programa, assim como, o estudo piloto em que modifica??es quanto ? compreensibilidade das tarefas foram realizadas. Sugerem-se estudos com grupos cl?nicos para verificar efic?cia e efetividade dessa abordagem na reabilita??o. At? onde se sabe as terapias l?xico-sem?nticas s?o voltadas para o tratamento da anomia cl?ssica, o que faz com que a partir dessa nova abordagem possa se pensar em outras perspectivas de reabilita??o desse componente na ?rea de interven??o neuropsicol?gica da comunica??o. Em suma, os estudos desenvolvidos contribu?ram para a reflex?o da rela??o entre as fun??es cognitivocomunicativas e especializa??es/coopera??es interhemisf?ricas, bem como, para a elabora??o programas de reabilita??o a partir de etapas bem definidas em seu m?todo.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/892 |
| Date | 28 May 2014 |
| Creators | Casarin, Fab?ola Schwengber |
| Contributors | Fonseca, Rochele Paz |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Psicologia, PUCRS, BR, Faculdade de Psicologia |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 2588426296948062698, 500, 600, 2599381623216554467 |
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