Habilidades de comprensión y producción narrativa en niños montevideanos de 5 años. Una comparación por nivel socioeconómico / Narrative abilities in a group of Uruguayan preschoolers from different socioeconomic backgrounds

Resumen Este estudio caracteriza y compara las habilidades narrativas y el vocabulario receptivo de 54 preescolares montevideanos de nivel socioeconómico medio (NSM) y bajo (NSB). Los niños realizaron tareas de vocabulario receptivo, producción narrativa (en dos condiciones: manipulando títeres al contar la historia y sin manipularlos), y comprensión narrativa (recuento oral y preguntas posteriores a la reconstrucción). Las narrativas fueron transcritas, codificadas y analizadas en términos de super y macroestructura siguiendo la gramática de historias de Stein y Glenn (1979) (coherencia) y de microestructura (productividad y complejidad). Los niños de ambos grupos tuvieron un desempeño acorde a su edad en comprensión y producción narrativa, a pesar de que el grupo de NSM tuvo un mejor desempeño en vocabulario receptivo. Hubo diferencias en comprensión (cantidad de episodios recuperados y en la respuesta a preguntas) que favorecieron al NSM, pero no en la cantidad de categorías recuperadas ni en la extensión y complejidad del recuento. Para producción narrativa no hubo diferencias en secuencia narrativa, ni en la cantidad de episodios completos en ninguna de las condiciones, pero sí en cuanto a la complejidad sintáctica en la condición sin títeres. Los resultados muestran una relación compleja entre vocabulario y habilidades narrativas, dado que diferencias importantes en vocabulario no se reflejaron de manera homogénea en el desempeño narrativo. Estos resultados aportan a los debates actuales sobre el papel del vocabulario en el desarrollo de habilidades narrativas, así como a pensar la validez ecológica de las evaluaciones en el desarrollo cognitivo y lingüístico.

Abstract Narrative abilities are an important part of communication, academic success, and healthy relationships. These abilities involve complex language and cognitive skills, such as precise vocabulary, control of the coherence markers, relations of cause-effect, and planning. They are also relevant during the elementary school years and interact with the socio-emotional skills necessary to understand different points of view. Oral narrative production develops dramatically from 3 to 5 years of age and is a key factor in a child's ability to communicate about the world. During this period narratives are a product of increasing linguistic sophistication over the preschool period and there is a complex relationship between early narratives and language proficiency. So far, most research about this topic has been pursued in populations other than Latin American preschoolers. At the same time, a considerably lesser number of studies about narrative abilities development have been carried out comparing typically developing children from different socioeconomic backgrounds. To our knowledge, there are no studies in Uruguay that assess the narrative abilities development in typically developing preschool children who grow up in vulnerable contexts. It is therefore of the utmost relevance to produce empirical evidence for this population. For these reasons, this study aimed at characterizing and comparing narrative abilities and receptive vocabulary in a group of a total of 54 Uruguayan preschoolers from different socioeconomic backgrounds (middle and low socioeconomic status, SES). Children were assessed in receptive vocabulary and narrative abilities across two task conditions: (1) narrative comprehension through a story retelling task which included some final questions about the story; (2) narrative production elicited from a set of thematically related puppets. The examiner gives a child a puppet set and asks him/her to elaborate a narrative using them. After that, puppets are removed and the child is asked to retell the story without puppets. Children's oral productions were video-taped and then transcribed and categorized using the ELAN software (Max Planck Institute for Psycholinguistics, 2019). The verbal information was categorized according to Stein and Glenn's (1979) story grammar and considering the microstructural aspects (productivity and complexity). Analyses showed that both groups performed according to their stage of development in both narrative task conditions. With regards to the narrative comprehension task, no differences in the number of recovered categories, extension, or narrative complexity were observed. Concerning the narrative production task, there were no differences between the groups in narrative sequences, nor in the number of completed episodes in conditions neither with puppets nor without puppets. Results showed that children who grow up in poverty perform more poorly than their peers from middle-income families in receptive vocabulary, in the number of recovered episodes, ask-answer items of narrative comprehension tasks. Moreover, concerning the microstructural parameters analyses showed that children from middle socioeconomic backgrounds scored better in syntactic complexity in the without puppets condition. No differences between the groups were observed in syntactic complexity in the puppets condition. Taken together these results indicate a complex link between vocabulary and narrative abilities. It is worth noting that important differences in vocabulary did not reflect in the children's narrative performance. These findings are also relevant as a contribution to an ongoing debate about the role of vocabulary in the development of narrative abilities. Furthermore, these results could inform the discussion about the ecological validity of the test of cognitive and linguistic development. Finally, to provide some additional evidence to Uruguayan Spanish language about the relationships between oral language and cognitive development allows to carry out early interventions before formal schooling sets children for success in school and life.

Habilidades prelectoras en niños uruguayos de diferente nivel socioeconómico / Differential pre-literacy skills development in Uruguayan children from different socioeconomic backgrounds

Resumen El objetivo del presente estudio fue comparar las habilidades prelectoras en 50 preescolares uruguayos de 5 años de edad de diferente nivel socioeconómico (NSE) y analizar el impacto de estas habilidades en el aprendizaje de la lectura. Para ello, se evaluó a los niños mediante pruebas de vocabulario receptivo, conciencia fonológica, conocimiento sobre el nombre y el sonido de las letras, y denominación rápida de objetos a fin del nivel preescolar Tiempo 1 (T1). Un año más tarde, se evaluó a un subgrupo de la muestra inicial mediante una prueba de lectura de palabras Tiempo 2 (T2). Los resultados señalaron la existencia de correlaciones significativas entre los predictores (T1) y la lectura de palabras (T2) y entre todas las variables evaluadas y el nivel socioeconómico de los niños. La comparación del desempeño intergrupal señaló la existencia de diferencias significativas en todas las habilidades evaluadas a favor del nivel socioeconómico medio. Sin embargo, el desempeño en la lectura de palabras de ambos grupos fue bajo. Por otra parte, un análisis de regresión mostró que, para los niños de nivel socioeconómico bajo, el nivel de conciencia fonológica fue el que explicó la mayor parte de la varianza en la eficiencia lectora. El nivel de lectura de los niños de nivel socioeconómico medio fue mayormente explicado por el conocimiento del nombre de las letras. Los resultados ponen en evidencia la importancia de atender a las diferencias que se generan temprano en el desarrollo de habilidades lingüísticas fundamentales para aprender a leer.

Abstract Learning to read transforms lives. Reading contributes to knowledge acquisition, cultural engagement, and success in the school. The unequal distribution of literacy skills in a society is associated with economic and social inequalities as a result, children with a poor foundation in literacy before entering formal schooling are more likely to struggle academically and to drop out of school. For these reasons, there has been an intense scientific interest for decades in understanding how children learn to read. It is well established that in the early stages of reading development, phonological awareness, letter name-sounds knowledge, and the naming speed are three independent longitudinal predictors of children's later word-reading skills in alphabetic-writing systems. Phonological awareness constitutes the ability to recognize and manipulate the sounds of their own language, meanwhile letter knowledge promotes the discovery of systematic relationships between writing and oral language. As early readers develop some level of phonological awareness and some level of letter knowledge, they can recognize written words through phonological recoding processes, in which graphemes are recoded as phonemes and assembled to pronounce words. In addition, rapid naming expresses the speed at which phonological information is accessed from a graphic label. Phonological processing and letter knowledge are powerfully affected by the experience, stimulation, and support that children receive before beginning formal education. Most children acquire these abilities relatively effortlessly during early childhood. However, there is a significant number of children in Latin America who experience difficulties in their pre-literacy skills development. This study examined the cognitive profiles of a total of 50 Uruguayan preschoolers from different socioeconomic backgrounds from two public schools in Montevideo, Uruguay. Twenty-six children from low-income households were compared to peers from middle-income. At the end of the pre-schooling period (time 1) receptive vocabulary, phonological awareness, letter name-sounds knowledge, and object naming speed tests were administered to children. One year later (time 2), word -reading of a subgroup of children was measured. Significant correlations were observed between all predictors at time 1; between predictors at time 1 and word reading at time 2; and between all measured abilities and socioeconomic status. Comparative analysis between children of different socioeconomic status showed that children growing up in poverty contexts performed more poorly than their peers from middle-income families in all the tests. Nonetheless, both groups performed poorly in word reading. Descriptive statistics indicated that, out of a total of 26 words, low SES children correctly read a total of 7 words per minute, and medium SES children a total of 14 words. Finally, regression analyses indicated that phonological awareness contributed 30 % variance in predicting the total score achieved in a reading-word test in children of low-income families, meanwhile letter name knowledge contributed 74 % variance in predicting the total score achieved in a reading-word test in their peers from middle-income families. In general terms, results of pre-reading skills and reading performance seem to indicate that children of different socioeconomic status use different word recognition strategies according to their level of letter-knowledge of and phonological processing. Discussion considers international literature pointing out that children who enter elementary school with limited reading-related skills are unlikely to be able to keep pace with their peers. These findings warn about the importance to elaborate systematic and high-quality educational proposals to try to reduce the gap in reading development for children from low-income families. Developing literacy and language skills before formal schooling sets a child up for success in school and life. Results also suggest the importance of analyzing the variables that affect reading development in populations that are not the majority described.

Perfil sociodemográfico e percepção do trabalho de trabalhadores com deficiência física de uma instituiçao de ensino superior / Sociodemographic profile and work perception according to workers with physical disabilities in a higher education institution

Objetivo: O estudo analisou o perfil sociodemográfico e a percepção do trabalho de trabalhadores com e sem deficiência física do campus I da Universidade Federal da Paraíba- João Pessoa/ Paraíba/ Brasil. Material e Métodos:O estudo caracteriza-se como descritivo transversal, com26 trabalhadores, em dois grupos, 50% de Trabalhadores Com Deficiência Física (TCDF) e 50% de Trabalhadores SemDeficiência Física (TSDF). Utilizou-se o Questionário Sociodemográfico e percepção do trabalho (elaborado e adaptado pelo Método ANACT). Os dados foram analisados através da estatística descritiva, no programa estatístico SPSS versão 19.0. Resultados: Os dois grupos eram constituídos em sua maioria por mulheres, nos TCDF (53,8%)e TSDF (69,2%). Os TCDF apresentaram predomínio na faixa etária 50-59 anos (38,5%), diferente dos TSDF em que a faixa etária predominante foi 20-29 anos (53,8%). Na maioria casados, sendo nos TCDF (46,2%) e nos TSDF (53,8%); o nível de escolaridade como especialista nos TCDF foi de38,5% e nos TSDF 30,8%. Em relação à percepção no trabalho os TCDF (69,2%) e TSDF (53,8%) referiram em sua maioria o trabalho como importante; quanto ao final do dia de trabalho, os TCDF relataram predomínio na sensação de cansados (46,2%) enquanto que os TSDF disseram não possuir queixas (69,2%) ao final do dia de trabalho.Conclusão: Os resultados apontam que os TCDF valorizam mais o trabalho, apesar de referirem à sensação de desconforto (cansados), sugerindo a realização de estudos que promovam medidas de prevenção e a promoção de saúde destes trabalhadores.

Objective: This study examined the sociodemographic profile and work perception according to workers with and withoutphysical disabilities in the Federal University of Paraíba(Campus I), João Pessoa, Paraíba, Brazil. Material andMethods: This was a cross-sectional study with 26employees categorized into two groups, 50% of Workerswith Disabilities (WD) and 50% of Workers without Disabilities(WWD). We used the Sociodemographic and work perceptionquestionnaire (compiled by and adapted through the ANACTmethod). Data were analyzed using descriptive statistics onSPSS version 19.0. Results: Both groups were comprisedmostly of women: 53.8% (WD) and 69.2% (WWD). The WD predominated in the age group 50-59 years (38.5%), unlikethe WWD that were found predominantly in the group 20-29years (53.8%). The majority was married: 46.2% (WD) and53.8% (WWD); the education level as a specialist was 38.5%and 30.8% for the WD and WWD groups, respectively. As tothe work perception, most WD (69.2%) and WWD (53.8%)referred to work as being important; with regard to the endof the workday, WD reported tiredness (46,2%), while WWDhad no complaints (69.2%). Conclusion: The results suggestthat WD give more value to their work, although they refer toan uncomfortable feeling (tiredness), suggesting theconduction of further studies in order to provide these workers with preventive and health promotion measures.

Independência funcional e qualidade de vida em pacientes com sequelas neurológicas: a contribuição de um grupo terapêutico interdisciplinar / Functional independence and quality of life in patients with neurological disorders: interdisciplinary therapeutic group’s contribution

O objetivo do estudo foi descrever e analisar o impacto de um programa de tratamento interdisciplinar na independência funcional e qualidade de vida de pacientes com sequelas neurológicas. Os quinze participantes do estudo apresentavam limitações relacionadas a atividades da vida diária, como autocuidados e comunicação, além de encontrarem-se minorados parâmetros como habilidades físicas, energia e relações emocionais, antes da submissão ao programa. Os resultados evidenciaram evolução positiva, após o tratamento, tanto para aspectos funcionais, como para qualidade de vida, sugerindo a eficiência e importância de ações de saúde interdisciplinares.

Assistência à mulher climatérica: novos paradigmas / Atención a la mujer climatérica: nuevos paradigmas / Assistance to the climacteric woman: new paradigms

O envelhecimento populacional é uma realidade demográfica brasileira. Como conseqüência, espera-se, nos próximos anos, um aumento progressivo na procura dos serviços de saúde por mulheres com queixas relacionadas ao climatério. Paralelamente, a assistência ao climatério tem passado por uma modificação de paradigmas, impondo aos profissionais de saúde uma mudança de atitude. Reconhece-se que o climatério é influenciado tanto por fatores biológicos, como por fatores psicossociais e culturais, cujo conhecimento é fundamental para uma assistência mais qualificada e humanizada. Este artigo propõe refletir sobre as mudanças de paradigmas na assistência ao climatério, destacando a multidisciplinaridade e interdisciplinaridade, no sentido acolher melhor essa parcela da população e proporcionar-lhe um cuidado integral e individualizado, aproximando o saber da sensibilidade, voltado a uma melhor qualidade vida.

Population aging is a demographic reality for Brazil. Consequently, in the next years it is expected a progressive increase in seeking health care services in the country by women with complaints related to climacterium. Parallel to it, assistance at this part of woman's life has been going through a paradigm shift which has imposed to health professionals a change of attitude in relation to this stage of woman's life. Today it is acknowledged that the climacterium is influenced by biological, psychosocial and cultural factors, whose knowledge is fundamental for planning a more qualified and humanized care. This article proposes a reflection on the paradigm shifts in assistance at climacterium, highlighting important aspects as multidisciplinarity and interdisciplinarity, so as to serve better this portion of population, and provide it with more integrated and individualized care, bringing together knowledge and sensitivity, and always aiming at a better quality of life.

Envejecimiento poblacional es una realidad demográfica brazilian. Consecuentementese espera un aumento progresivo de la búsqueda en los servicios de salud del país por mujeres con quejas relacionadas al climaterio. La asistencia al climaterio ha pasado por un cambio de paradigmas que han impuesto a los profesionales de la salud. El climaterio es influenciado por factores biológicos, factores psicosociales y culturales, cuyo conocimiento es fundamental para la planificación de una asistencia. Artículo se propone reflexionar sobre los cambios de paradigmas, el abordaje multidisciplinario e interdisciplinario, en el sentido de recibir mejor esta parcela de la población y proporcionarle un cuidado integral e individualizado, aproximando el saber de la sensibilidad, y el tener como objetivo a una mejor calidad de vida.

Intervenção fisioterapêutica na fase inicial da esclerose lateral amiotrófica / Physical therapy intervention in early stage of amyotrophic lateral sclerosis

Esclerose lateral amiotrófica (ELA) é uma doença neurodegenerativa progressiva de causa idiopática que leva a paresia e hipotrofias musculares por acometimento de neurônios motores. Uma vez que permanece incógnita uma terapia eficaz que possa evitar a evolução da doença, este trabalho objetiva demonstrar a importância da fisioterapia no retardo dos sintomas da ELA através do relato de caso de um paciente no estágio inicial da doença. O atendimento foi realizado na Clínica Escola de Fisioterapia da Universidade Federal da Paraíba, sendo aplicado um tratamento fisioterapêutico específico com freqüência de três vezes semanais e duração média de 50 minutos. O paciente apresentava incoordenação do membro superior esquerdo, paresia, diminuição da função e da amplitude de movimento, e apatia. O tratamento concentrou-se em trabalho de alongamento, coordenação motora, exercícios ativos-livres nas diagonais do método Kabat, associados ao trabalho respiratório e atenção ao surgimento e prevenção da fadiga. Durante o tratamento, observou-se considerável melhora da coordenação motora, bem como da auto-estima, e manutenção da força muscular, apontando para os efeitos positivos da intervenção no retardo dos sintomas mais graves da ELA, prevenindo maiores complicações funcionais e melhorando o aspecto emocional do paciente.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of undetermined cause, which leads to muscle hypertrophy and paresis by progressive damage of motor neurones. Since it remains obscure an efficacious therapy which can stop the disease’s evolution, this study aims at demonstrating the importance of physical therapy in retarding the progression of ALS’s symptoms, through a case report of a patient in the early stage of the disease. The intervention was carried out at the School of Physical Therapy of Federal University of Paraíba, where a specific physical therapy procedure was carried out 3 days a week for 50 minutes. The patient showed incoordination of the left upper limb, paresis, reduction of muscle function and movement range and apathy. The treatment focused on stretching, motor coordination training, exercises using the Kabat method with diagonals movements, associated to respiratory work and attention to onset and prevention of fatigue. During treatment it was observed significant improvement on motor coordination and self-esteem, as well as maintenance of muscle strength, which points out to the positive effects of the adopted intervention in retarding the severe symptoms of ALS, preventing increase of functional complications and improving on patient’s emotional aspect.

Toxina botulínica A e intervenção fisioterapêutica no tratamento do ombro doloroso pós acidente vascular cerebral: relato de caso / Botulinum toxin A and physiotherapy intervention in the treatment of the painful shoulder after stroke: case report

A síndrome do ombro doloroso é considerada um achado comum em pacientes que sofreram acidente vascular cerebral. Várias modalidades terapêuticas são apontadas para melhoria do quadro clínico dos pacientes. Neste relato, será apresentado um caso de síndrome do ombro doloroso, cujo tratamento consistiu no emprego de toxina botulínica A associada à fisioterapia. Após quatro meses de tratamento, houve melhorias significativas quanto à dor, espasticidade, amplitude de movimento e qualidade de vida, e isso sugere ser essa associação terapêutica uma ferramenta eficaz contra os efeitos incapacitantes relacionados a esta síndrome.

The syndrome of the painful shoulder is considered a common finding in patients who suffered stroke. Several therapeutic modalities are suggested for the improvement of the patients’ clinical condition. In this report, a case of syndrome of the painful shoulder will be discussed, whose treatment consisted of the use of botulinum toxin A associated to physiotherapy. After a four-month treatment, significant improvements occurred concerning pain, spasticity, range of motion and quality of life, suggesting that this therapeutic association is an efficient tool against the incapacitating effects related to this syndrome.

Intervenção fisioterapêutica e síndrome da imunodeficiência adquirida associada à leucoencefalopatia e neurotoxoplasmose: relato de caso / Physical therapy intervention and acquired immunodeficiency syndrome associated to leukoencephalopathy and neurotoxoplasmisis: case's relate

No presente trabalho, relata-se um caso de paciente com Síndrome da Imunodeficiência Adquirida (SIDA) associada à Leucoencefalopatia Multifocal Progressiva (LMP) e Neurotoxoplasmose (NT), descrevendo sua evolução clínica e intervenção fisioterapêutica durante o período de um ano. A SIDA consiste na infecção pelo Vírus da Imuinodeficiência Humana e nas contagens de células CD4 abaixo de 200/mm3, possui considerável incidência em vários países e apresenta-se geralmente associada a outras afecções oportunistas; as duas mais comuns são a LMP, doença desmielinizante do sistema nervooso central, e a NT, que nestes pacientes é causada pela reativação de uma infecção latente provocada pelo parasita intracelular Toxoplasma gondii. Para avaliação do paciente, foram utilizados a escala de Ashworth, a Medida de Independ~encia Funcional, a escala de Equilíbrio de Berg e o Teste de Função Muscular. Foi aplicada uma estratégia de tratamento fisioterapêutico envolvendo alongamentos, exercícios ativos e resistidos, exercícios de Frenkel, facilitação neuromuscular proprioceptiva e método neuroevolutivo. A intervenção fisioterapêutica mostrou-se eficaz para boa evolução do paciente, comprovada pela diminuição dos déficits apresentados no início da terapia e significativa melhora no prognóstico. O estudo vem colaborar para obtençaõ de maior massa crítica nessa temática, demonstrando bons resultados da atuação fisioterapêutica e incentivando o desenvolvimento de novos estudos

The present work reports the case of a patient with acquired immunodeficiency syndrome (AIDS) associated to Progressive Multifocal Leukoencephalopathy (PML) and Neurotoxoplasmosis (NT), describing his clinical evolution and physiotherapical intervention during the period of one year. AIDS consists of the infection for Human Immunodeficiency Virus and in the countings of cells CD4 below of 200/mm³; it possesss considerable incidence in some countries and is presented generally associated to other opportunist diseases; two more common they are the LMP, desmielinizante disease of the central nervous system, and the NT, that in these patients is caused by the reactivation of a latent infection provoked by the intracellular parasite Toxoplasma gondii. For the patient’s evaluation, the Scale of Ashworth, the Scale of Measure of Functional Independence, the Scale of Balance of Berg and the Test of Muscular Function were used. The strategy of treatment focused on stretching, active and resisted exercises, Frenkel’s exercises, Proprioceptive Neuromuscular Facilitation and Neuro-Developmental Treatment. The conducted physiotherapical intervention was shown to be effective for a good evolution of the patient, what was proven by the decrease of the deficits presented in the beginning of the therapy and the significant improvement on prognosis. The study comes out to collaborate in the promotion of a larger critical mass about the theme, demonstrating good results of a physiotherapical performance and motivating the development of new studies.