Análise da qualidade de vida de famílias de crianças surdas atendidas em um centro de referência do Sistema Único de Saúde / Quality of life analysis of families having deaf children assisted in a reference center of the Unified Health System

A família desempenha um papel fundamental na promoção da saúde de seus filhos. Em relação à deficiência auditiva, ainteração entre a díade família-criança surda possibilita o adequado desenvolvimento linguístico, social e emocional dacriança. Para isso uma boa qualidade de vida da família é essencial. O presente estudo teve como objetivo investigara percepção da qualidade de vida de familiares que possuem um integrante com deficiência auditiva e relacionar coma comunicação cotidiana. Participaram do estudo 20 familiares de crianças com deficiência auditiva que frequentamum centro de média complexidade de referência no Sistema Único de Saúde-SUS. Foram utilizados na pesquisa oquestionário de qualidade de vida (WHOQOL-BREF) e “Aspectos Cotidianos que Interferem na Comunicação entreFamiliares e Sujeitos com Deficiência Auditiva”, elaborado pelas pesquisadoras. Houve correlação entre qualidade devida e interferência na comunicação na díade família-criança surda, em todos os domínios do WHOQOL-BREF. Quantomaior a percepção no domínio físico, menores as dificuldades comunicativas na presença de ruído eletroeletrônico.Quanto maior o domínio psicológico, menor a interferência de eletroeletrônicos e de fala competitiva na comunicação.Quanto menor o domínio social, menor a interferência do ruído eletroeletrônico, fala competitiva e ausência de leituraorofacial na comunicação. Por fim, quanto maior o domínio ambiental, menor a interferência do eletroeletrônicona comunicação. Concluiu-se que investigar a qualidade de vida dos familiares pode auxiliar no planejamento eelaboração de estratégias terapêuticas, maximizando o bem-estar do familiar e da criança por meio de intervençõesmais contextualizadas a realidade do paciente.(AU)

The family plays a fundamental role in promoting the health of their children. Regarding hearing impairment, theinteraction between deaf family-child dyad enables the appropriate language development, social and emotional of thechild. For this a good quality of family life is essential. This study aimed to investigate the perception of quality of life forfamilies who have a member with a hearing impairment and relate with everyday communication. The study included20 families of hearing impaired children who attend a middle complexity center of reference in the Health-SUS System.In the research were used the questionnaire of quality of life (WHOQOL-BREF) and “Everyday Things that Interfere withCommunication between Families and Individuals with Hearing Impairment”, developed by the researchers. There wasa correlation between quality of life and interference with communication in deaf-child dyad family in all domains ofWHOQOL-BREF. The greater the perception in the physical domain, the less communicative difficulties in the presenceof electronics noise. The higher the psychological domain, the less interference from electronic and competitive speechcommunication. The less the social field, the less interference from noise electronics, competitive speech and absenceof orofacial reading communication. Finally, the higher the environmental sphere, the less interference from electronicscommunication. It is concluded that investigate the quality of life of the family can help in the planning and developmentof therapeutic strategies, maximizing the family and child well-being through more contextualized interventions thereality of the patient.(AU)

Hybrid simulated annealing and its application to optimization of hidden Markov models for visual speech recognition.

We propose a novel stochastic optimization algorithm, hybrid simulated annealing (SA), to train hidden Markov models (HMMs) for visual speech recognition. In our algorithm, SA is combined with a local optimization operator that substitutes a better solution for the current one to improve the convergence speed and the quality of solutions. We mathematically prove that the sequence of the objective values converges in probability to the global optimum in the algorithm. The algorithm is applied to train HMMs that are used as visual speech recognizers. While the popular training method of HMMs, the expectation-maximization algorithm, achieves only local optima in the parameter space, the proposed method can perform global optimization of the parameters of HMMs and thereby obtain solutions yielding improved recognition performance. The superiority of the proposed algorithm to the conventional ones is demonstrated via isolated word recognition experiments.

A educação especial na perspectiva da inclusão escolar: abordagem bilíngue na escolarização de pessoas com surdez

Propõe considerar a pessoa com surdez, o conhecimento e o objeto de estudo a partir da base conceitual do pensamento pós-moderno, que envolve epistemologicamente a complexidade do fenômeno inter e intra-humano e estabelece uma simbiose entre a educação da consciência e da instrução da inteligência

Barriers to health care for people with hearing loss: a review of the literature.

Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.

Communication strategies for nurses interacting with deaf patients.

Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.

Nonlinear color space and spatiotemporal MRF for hierarchical segmentation of face features in video.

This paper deals with the low-level joint processing of color and motion for robust face analysis within a feature-based approach. To gain robustness and contrast under unsupervised viewing conditions, a nonlinear color transform relevant for hue segmentation is derived from a logarithmic model. A hierarchical segmentation scheme is based on Markov random field modeling, that combines hue and motion detection within a spatiotemporal neighborhood. Relevant face regions are segmented without parameter tuning. The accuracy of the label fields enables not only face detection and tracking but also geometrical measurements on facial feature edges, such as lips or eyes. Results are shown both on typical test sequences and on various sequences acquired from micro- or mobile cameras. The efficiency of the method makes it suitable for real-time applications aiming at audiovisual communication in unsupervised environments.

Criteria of candidacy for unilateral cochlear implantation in postlingually deafened adults I: theory and measures of effectiveness.

OBJECTIVES: The objectives of this study were to distinguish the equivalent-effectiveness, health-economic, and actuarial approaches to specifying criteria of candidacy for medical interventions; to apply the equivalent-effectiveness approach to unilateral cochlear implantation for postlingually deafened adults; and to determine whether the criterion should take age at implantation and duration of profound deafness into account. DESIGN: The study was designed as a prospective cohort study in 13 hospitals with four groups of severely-profoundly hearing-impaired subjects distinguished by their preoperative ability to identify words in sentences when aided acoustically. The groups represent a progressive relaxation of criteria of candidacy: Group I (N=134) scored 0% correct without lipreading and did not improve their lipreading score significantly when aided; group II (N=93) scored 0% without lipreading but did improve their lipreading score significantly when aided; group III (N=53) scored 0% without lipreading when the to-be-implanted ear was aided but between 1% and approximately 50% when the other ear was aided. Group IV (N=31) scored between 1% and approximately 50% without lipreading when the to-be-implanted ear was aided. Measures of speech intelligibility, health utility, and otologically relevant quality of life were obtained before surgery and 9 mo after surgery from each subject. Measures of effectiveness were calculated as the difference between 9-mo and preoperative scores. RESULTS: Effectiveness differed only slightly between groups. Effectiveness was not strongly associated with age at the time of implantation. Greater effectiveness was associated with implantation in the ear with the shorter duration of profound deafness. Cochlear implantation was least effective when the preoperative audiological status of the better-hearing ear was good and the duration of profound deafness of the implanted ear was long. As a result, effectiveness was not significant for the subsets of groups III and IV, who were given implants in ears that had been profoundly deaf for more than 30 yr. CONCLUSIONS: The effectiveness of cochlear implantation differs little between groups of candidates who score zero with acoustic hearing aids before surgery and groups who score up to approximately 50% correct, thereby justifying a relaxation of the criterion of candidacy to embrace some members of the latter groups. The criterion should be based not only on preoperative speech intelligibility but also on duration of profound deafness in the to-be-implanted ear.

A vez da voz: interagindo com as diferenças

Apresenta um vídeo elaborado pela fonoaudióloga e escritora Cláudia Cotes sobre a surdez. Mostra a história de fictícia, porém inspirada em fatos reais de Amanda, uma menina que foi abençoada com o dom de ouvir o som do silêncio e por isso se diferenciava das outras crianças. Através da história dessa criança se passa uma mensagem sutil da interação de uma pessoa com deficiência no meio escolar e que todas as diferenças podem ser neutralizadas. É possível para um criança com deficiência interagir normalmente com uma turma de alunos não deficientes, basta um acompanhamento adequado e o apoio dos professores e colegas

Auditory brainstem implant part II: subjective assessment of functional outcome.

UNLABELLED: OBJECTIVE The purpose of this study was to present the patients' recommendations and judgments about their hearing and communication abilities with the help of the auditory brainstem implant. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS AND METHODS: This evaluation was based on the data obtained by the self-administered questionnaires designed for the European Auditory Brainstem Implant Multicenter Clinical Trial. Eleven patients who had used their auditory brainstem implant for a minimum of 6 months to a maximum of 41 months were evaluated with the help of these questionnaires. RESULTS: All the patients had used their implant on a regular daily basis for an average of 13 hours per day. None of them experienced any side effects during the daily use of the device. Nine patients (82%) used their auditory brainstem implant in both quiet and noisy surroundings. The most common cause of disturbance was a noisy surrounding. All the patients were able to distinguish speech from environmental sounds. The role of the auditory brainstem implant in differentiating various environmental sounds was considered to be very useful by 9 patients (82%). As an adjuvant to lip-reading, the auditory brainstem implant was considered most useful for understanding speech in quiet surroundings. DISCUSSION AND CONCLUSION: It was concluded that the auditory brainstem implant is an effective support for receiving and, to some degree, differentiating environmental sounds, and that as an adjuvant to lip-reading, it enhances speech perception, especially in quiet surroundings. A comparison between the results of this study and the results of the audiologic tests presented in Part I of this study (published earlier) revealed that patient satisfaction was not directly correlated with the results of the objective auditory tests. In general, patients' judgments of their individual hearing and communication abilities usually rated higher than could have been predicted by the objective audiometric data.

A Monte Carlo EM approach for partially observable diffusion processes: theory and applications to neural networks.

We present a Monte Carlo approach for training partially observable diffusion processes. We apply the approach to diffusion networks, a stochastic version of continuous recurrent neural networks. The approach is aimed at learning probability distributions of continuous paths, not just expected values. Interestingly, the relevant activation statistics used by the learning rule presented here are inner products in the Hilbert space of square integrable functions. These inner products can be computed using Hebbian operations and do not require backpropagation of error signals. Moreover, standard kernel methods could potentially be applied to compute such inner products. We propose that the main reason that recurrent neural networks have not worked well in engineering applications (e.g., speech recognition) is that they implicitly rely on a very simplistic likelihood model. The diffusion network approach proposed here is much richer and may open new avenues for applications of recurrent neural networks. We present some analysis and simulations to support this view. Very encouraging results were obtained on a visual speech recognition task in which neural networks outperformed hidden Markov models.

Development of speechreading supplements based on automatic speech recognition.

In manual-cued speech (MCS) a speaker produces hand gestures to resolve ambiguities among speech elements that are often confused by speechreaders. The shape of the hand distinguishes among consonants; the position of the hand relative to the face distinguishes among vowels. Experienced receivers of MCS achieve nearly perfect reception of everyday connected speech. MCS has been taught to very young deaf children and greatly facilitates language learning, communication, and general education. This manuscript describes a system that can produce a form of cued speech automatically in real time and reports on its evaluation by trained receivers of MCS. Cues are derived by a hidden markov models (HMM)-based speaker-dependent phonetic speech recognizer that uses context-dependent phone models and are presented visually by superimposing animated handshapes on the face of the talker. The benefit provided by these cues strongly depends on articulation of hand movements and on precise synchronization of the actions of the hands and the face. Using the system reported here, experienced cue receivers can recognize roughly two-thirds of the keywords in cued low-context sentences correctly, compared to roughly one-third by speechreading alone (SA). The practical significance of these improvements is to support fairly normal rates of reception of conversational speech, a task that is often difficult via SA.

Social work practice with deaf clients: issues in culturally competent assessment.

Persons with severe hearing loss live in a unique cultural context with which social workers may not be familiar. This paper reviews the skills needed for the culturally competent social work assessment with deaf clients, including communication skills, interviewing methods, taking case and family histories and behavioral observation.

Reported use of communication strategies by SHHH members: client, talker, and situational variables.

Two hundred and twelve members of the Self Help for Hard of Hearing People (SHHH) organization completed a survey that evaluated their use of communication strategies. Reported use of strategies was correlated with attitudinal variables and social-interaction indices. On average, subjects agreed most strongly with questionnaire items stating they would ask a talker to repeat a misperceived utterance. They agreed less strongly with items stating they would ask the talker to restructure or elaborate an utterance. Subjects agreed strongly that they would use the communication strategies with familiar talkers, and less strongly that they would use them with unfamiliar talkers. Subjects who appeared less likely to say nothing after misperceiving an utterance were more likely to disagree that they were frustrated with their speechreading skills, and they appeared less likely to avoid social interactions. Subjects who indicated a greater likelihood of using anticipatory strategies, such as reviewing potential vocabulary before an appointment, were on average more likely to avoid social interactions. They also agreed more strongly that poor speechreaders appear less intelligent.

Evaluation of five different cochlear implant designs: audiologic assessment and predictors of performance.

The audiologic performance of 54 postlingually deafened adults wearing cochlear implants was uniformly evaluated. The participants had 9 months' or more experience with one of five different cochlear prostheses (Los Angeles Single Channel (N = 11), Vienna Single Channel (N = 4), Melbourne Multichannel (N = 18), Utah Multichannel (N = 19), San Francisco Multichannel (N = 2). The multichannel designs enabled participants to recognize more environmental sounds, provided more speech reading enhancement, and enabled most users to understand limited speech in the sound-only condition, compared to the single-channel implant group.

The assessment of lipreading ability: some practical considerations in the use of the tracking procedure.

Continuous discourse tracking is potentially a very useful clinical technique and the practical difficulties it may present to the inexperienced user can readily be overcome. Some modifications to the traditional scoring procedure are described to provide a measure of fluency in addition to the basic word per minute score. Suggestions are offered regarding the practical management of the timing and the choice and preparation of the text. The procedure is discussed in the context of evaluating different augmentative approaches to lipreading for individual patients.

Hearing disability and communication handicap for compensation purposes based on self-assessment and audiometric testing.

It is reasoned that for compensation or epidemiological studies an evaluation of hearing disability and the concomitant handicap must include the ability to perceive visual cues. A scaling procedure for hearing- and audiovisual communication handicap is presented. The procedure deviates in two ways from previous handicap assessments: (1) It is based on individual self-assessment of semantic speech perception but can be implemented by means of professional audiological test procedures. (2) The system does not make use of pure-tone auditory thresholds as a predominant audiological principle, but is based on speech perception. The interrelationship between auditory and audiovisual handicap is evaluated. A total score including audio- and audiovisual perception handicap is proposed and a suggestion for disability percentages is presented.