Guia ilustrado de orientações a cuidadores de crianças com deficiências neuromotoras / Illustrated guide for caregivers of children with neuromotor disabilities

Introdução: Limitações funcionais de crianças com deficiência neuromotora (CDN) as tornam dependentes de cuidados. Objetivo: Elaborar e avaliar um guia ilustrado de orientações para familiares de CDN a partir das necessidades dos cuidadores. Método: Estudo descritivo transversal prospectivo feito em famílias de CDN de sete a quarenta e dois meses de idade. Etapas: (1) entrevista com 15 famílias para investigar suas principais habilidades, dificuldades e dúvidas; (2) Elaboração de guia ilustrado; (3) 5 famílias usaram e avaliaram o guia; (4) Adequação do material. Os resultados foram ponderados por análise de conteúdo. Resultados: As principais dúvidas das famílias foram contempladas no guia que aborda: principais posicionamentos, e como posicionar as crianças, órteses, quarto, alimentação, banho, carregando seu filho, vestir, cuidados com quem cuida e, lazer, brinquedos e brincadeiras. Conclusão: O guia foi considerado útil para facilitar o cotidiano das famílias, para reforçar orientações recebidas pelos profissionais de saúde e para levar novas informações sobre cuidados com essas crianças em casa.

Introduction: Functional limitations of children with neuromotor deficiency (CDN) make them dependent on care. Objective: To elaborate and evaluate an illustrated guide of guidelines for relatives of CDN from the needs of caregivers. Method: A prospective, cross-sectional descriptive study of CDN families from seven to forty-two months of age. Steps: (1) interview with 15 families to investigate their main skills, difficulties and doubts; (2) Preparation of illustrated guide; (3) 5 families used and evaluated the guide; (4) Material suitability. The results were weighted by content analysis. Results: The main doubts of the families were contemplated in the guide that addresses: main positions, and how to position children, orthoses, room, feeding, bathing, carrying their child, dressing, caring for the caregiver and, leisure, toys and games. Conclusion: The guide was considered useful to facilitate the daily lives of families, to reinforce guidelines received by health professionals and to take new information about care with these children at home.

Influences of age, gender, and parents' educational level in knowledge, behavior and preferences regarding noise, from childhood to adolescence.

Exposure to loud sound during leisure activities for long periods of time is an important area to implement preventive health education, especially among young people. The aim was to identify the relations among awareness about the damaging effects of loud levels of sounds, previous exposures do loud sounds, preferences-related to sound levels and knowledge about hearing protection with age, gender, and their parent's educational level among children. Prospective cross-sectional. Seven hundred and forty students (5-16 years old) and 610 parents participated in the study. Chi-square test, Fisher exact test and linear regression. About 86.5% of the children consider that loud sounds damage the ears and 53.7% dislike noisy places. Children were previously exposed to parties and concerts with loud music, Mardi Gras, firecrackers and loud music at home or in the car and loud music with earphones. About 18.4% of the younger children could select the volume of the music, versus 65.3% of the older ones. Children have poor information about hearing protection and do not have hearing protection device. Knowledge about the risks related to exposures to loud sounds and about strategies to protect their hearing increases with age, but preference for loud sounds and exposures to it increases too. Gender and parents' instructional level have little influence on the studied variables. Many of the children's recreational activities are noisy. It is possible that the tendency of increasing preference for loud sounds with age might be a result of a learned behavior.

Are parents aware of their children's hearing complaints?

UNLABELLED: The accuracy of parents' impressions about their child's hearing status is variable and may not correspond to the child's complaints. AIM: To investigate children's self-reported hearing symptoms and parents' impressions about it. METHODS: 477 children (2nd to 5th grades of elementary schools) were interviewed and parents answered a survey at home. There were 393 matches between the children's interview and the parent's survey. RESULTS: 29% of the children reported trouble in understanding what people said, 36.1% had history of 1-3 ear infections, 12.7% had four or more ear infections, 21.7% had continuous tinnitus (positive association with history of exposure to loud sounds, p = 0.0007), 3.8% had pulsatile tinnitus and 2.9% had auditory hallucinations. 28.5% of the children were annoyed by loud sounds (associated with tinnitus, p = 0.0142, and gender, p = 0.0029) 10.4% had had audiological tests, and the determinant factors were history of ear infections (p < 0.001) and parents' concern about their child's hearing (p = 0.043). Parents and their own child's responses were significantly different. CONCLUSIONS: Children's auditory complaints were prevalent and relevant, but most of them had never had an audiological evaluation and most parents were not aware of their child's complaints. Sound intolerances and auditory hallucinations should be considered in clinical and audiological examinations.

Os pais conhecem as queixas auditivas de seus filhos? / Are parents aware of their children's hearing complaints?

A acurácia dos pais sobre a audição dos filhos é variável e pode diferir das queixas das crianças. OBJETIVO: Investigar as queixas auditivas de crianças e as impressões dos pais a respeito da audição das crianças. MÉTODOS: 477 crianças (2º ao 5º ano do ensino fundamental) foram entrevistadas e seus pais responderam a pesquisa em casa. RESULTADOS: Vinte e nove porcento das crianças referiram dificuldade para entender fala no silêncio, 36,1% tinham história de um a três otites e 12,7% de quatro ou mais otites, 21,7% tinham zumbido contínuo (associação com exposição a sons intensos, p = 0.0007), 3,8% tinham zumbido pulsátil e 2,9% tinham alucinações auditivas. Vinte e oito e meio porcento referiram incômodo com sons intensos (associação com a queixa de zumbido, p = 0,0142, e com gênero, p = 0,0029) 10,4% haviam feito avaliação audiológica, e os fatores determinantes foram história de otites (p < 0,001) e preocupação dos pais com a audição dos filhos (p = 0,043). As respostas dos pais e de seus filhos foram significativamente diferentes. CONCLUSÕES: As queixas auditivas das crianças são prevalentes e relevantes, mas a maioria delas nunca teve a audição avaliada e a maioria dos pais não sabe das queixas de seus filhos. Intolerância a sons e alucinações auditivas deveriam ser consideradas em avaliações clínicas e audiológicas.

The accuracy of parents' impressions about their child's hearing status is variable and may not correspond to the child's complaints. AIM: To investigate children's self-reported hearing symptoms and parents' impressions about it. METHODS: 477 children (2nd to 5th grades of elementary schools) were interviewed and parents answered a survey at home. There were 393 matches between the children's interview and the parent's survey. RESULTS: 29% of the children reported trouble in understanding what people said, 36.1% had history of 1-3 ear infections, 12.7% had four or more ear infections, 21.7% had continuous tinnitus (positive association with history of exposure to loud sounds, p = 0.0007), 3.8% had pulsatile tinnitus and 2.9% had auditory hallucinations. 28.5% of the children were annoyed by loud sounds (associated with tinnitus, p = 0.0142, and gender, p = 0.0029) 10.4% had had audiological tests, and the determinant factors were history of ear infections (p < 0.001) and parents' concern about their child's hearing (p = 0.043). Parents and their own child's responses were significantly different. CONCLUSIONS: Children's auditory complaints were prevalent and relevant, but most of them had never had an audiological evaluation and most parents were not aware of their child's complaints. Sound intolerances and auditory hallucinations should be considered in clinical and audiological examinations.

Knowledge, habits, preferences, and protective behavior in relation to loud sound exposures among Brazilian children.

OBJECTIVE: Identification of the beliefs and attitudes towards noise exposure and the risk of noise-induced hearing loss in Brazilian children. DESIGN: Prospective cross-sectional study through interviews with children and their parents. STUDY SAMPLE: 753 children were selected and invited to participate. The final sample was 475 children and 404 parents. RESULTS: In general, children disliked noisy places (67%). Although 87.4% of the children and 93.9% of the parents considered loud sounds damaging to the ears, children were poorly informed about hearing protection and did not have hearing protection devices. Children were mostly exposed to parties and concerts with loud music (51.9%), carnaval (Mardi Gras) parties (38.2%), firecrackers (36.8%), and loud music at home or in the car (33.1%), or from listening to loud music with earphones (17.3%). Compared to children from private schools, children from public schools had a greater preference for loud sounds and were less informed about hearing protection. CONCLUSIONS: Knowledge of hearing risk from loud sounds was not enough to prompt preventive behaviors, and adults exposed children to loud sounds.

Musical hallucination associated with hearing loss.

In spite of the fact that musical hallucination have a significant impact on patients' lives, they have received very little attention of experts. Some researchers agree on a combination of peripheral and central dysfunctions as the mechanism that causes hallucination. The most accepted physiopathology of musical hallucination associated to hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information) is the disinhibition of auditory memory circuits due to sensory deprivation. Concerning the cortical area involved in musical hallucination, there is evidence that the excitatory mechanism of the superior temporal gyrus, as in epilepsies, is responsible for musical hallucination. In musical release hallucination there is also activation of the auditory association cortex. Finally, considering the laterality, functional studies with musical perception and imagery in normal individuals showed that songs with words cause bilateral temporal activation and melodies activate only the right lobe. The effect of hearing aids on the improvement of musical hallucination as a result of the hearing loss improvement is well documented. It happens because auditory hallucination may be influenced by the external acoustical environment. Neuroleptics, antidepressants and anticonvulsants have been used in the treatment of musical hallucination. Cases of improvement with the administration of carbamazepine, meclobemide and donepezil were reported, but the results obtained were not consistent.

Selective auditory attention and silence elicit auditory hallucination in a nonclinical sample.

INTRODUCTION: Several investigations have shown that the occurrence of auditory hallucinations (AH) is not restricted to neuropsychiatric patients. The aim of this study is to analyse the effect of attention and sustained silence on the emergence of AH in a nonclinical sample. METHODS: Sitting in a silent sound booth, 66 adults were studied under different attention demands and then where asked about their auditory perception. RESULTS: While performing a Hanoi Tower in silence, 10.6% of the individuals had hallucination-like perceptions (music, voices, and others). This rate decreased to 6.0% during a visual attention task, but highly increased to 36.4% during auditory attention. CONCLUSIONS: Auditory hallucinations may occur in a nonclinical population in a silent environment. Concomitant auditory attention increases both the quantity and the quality of those perceptions.

Vestibular rehabilitation in a university hospital.

UNLABELLED: The aim of vestibular rehabilitation is to improve total balance, quality of life and spatial orientation of patients with dizziness. AIMS: To determine the characteristics of the patients who underwent the Vestibular Rehabilitation program of the Neurotology Ward of a University Hospital, and to verify the results obtained between November/2000 and December/2004. MATERIALS AND METHODS: analysis of 93 files from patients under Vestibular Rehabilitation during the studied period. STUDY DESIGN: Retrospective clinical. RESULTS: the mean age of patients was 52.82 years, 56 females and 37 males. The average number of therapy sessions was 4.3, higher for patients with central neurotological disorders (average of 5.9). Among the patients who concluded the treatment, 37 (60.7%) had significant improvement, 14 (22.9%) presented partial improvement and 10 (16.4%) did not report significant benefits. Patients with peripheral neurotological disorders were the ones who most benefited from Vestibular Rehabilitation. CONCLUSION: Most of the patients were female, with a mean age of 52.8 years. Fifty one patients (83.6%) benefited from the therapy, confirming treatment efficacy.

Reabilitação vestibular em um hospital universitário / Vestibular rehabilitation in a university hospital

A Reabilitação Vestibular visa melhorar o equilíbrio global, a qualidade de vida e orientação espacial dos pacientes com tontura. OBJETIVOS: Traçar o perfil dos pacientes atendidos no Ambulatório de Reabilitação Vestibular do Setor de Otoneurologia de um hospital universitário e verificar os resultados obtidos no período de novembro/2000 a dezembro/2004. MATERIAL E MÉTODO: Levantamento de dados contidos nas fichas dos 93 pacientes submetidos à Reabilitação Vestibular no período. FORMA DE ESTUDO: Clínico retrospectivo. RESULTADOS: A média etária dos pacientes foi de 52,82 anos, 56 do sexo feminino e 37 do sexo masculino. O número médio de atendimentos foi 4,3, sendo maior para os pacientes com distúrbios otoneurológicos centrais (média de 5,9). Dentre os pacientes que concluíram o tratamento proposto, 37 (60,7 por cento) obtiveram melhora significativa, 14 (22,9 por cento) tiveram melhora parcial e 10 (16,4 por cento) não referiram benefícios significativos. Os pacientes que mais se beneficiaram com a Reabilitação Vestibular tinham distúrbios otoneurológicos periféricos. CONCLUSÃO: A maior parte dos pacientes era do sexo feminino, com idade média de 52,8 anos. Cinqüenta e um pacientes (83,6 por cento) tiveram benefício com a terapia confirmando a eficácia do tratamento.

The aim of vestibular rehabilitation is to improve total balance, quality of life and spatial orientation of patients with dizziness. AIMS: To determine the characteristics of the patients who underwent the Vestibular Rehabilitation program of the Neurotology Ward of a University Hospital, and to verify the results obtained between November/2000 and December/2004. MATERIALS AND METHODS: analysis of 93 files from patients under Vestibular Rehabilitation during the studied period. STUDY DESIGN: Retrospective clinical. RESULTS: the mean age of patients was 52.82 years, 56 females and 37 males. The average number of therapy sessions was 4.3, higher for patients with central neurotological disorders (average of 5.9). Among the patients who concluded the treatment, 37 (60.7 percent) had significant improvement, 14 (22.9 percent) presented partial improvement and 10 (16.4 percent) did not report significant benefits. Patients with peripheral neurotological disorders were the ones who most benefited from Vestibular Rehabilitation. CONCLUSION: Most of the patients were female, with a mean age of 52.8 years. Fifty one patients (83.6 percent) benefited from the therapy, confirming treatment efficacy.

Influence of silence and attention on tinnitus perception.

OBJECTIVE: The purpose of this study was to study the effect of attention and sustained silence on the emergence of auditory phantom perception in normal-hearing adults. STUDY DESIGN: Cross-sectional survey. SUBJECTS AND METHODS: While sitting in a sound booth, 66 volunteers (age range, 18-65; mean age, 37.3) performed 3 experiments of 5 minutes each, consecutively and randomly presented. Two deviated attention from auditory system (Hanoi and visual attention experiments), and 1 drove attention to the auditory system (auditory attention). After each experiment, participants were asked about their auditory and visual perception. No sound or light change was given at any moment. RESULTS: Of the participants, 19.7% experienced tinnitus during Hanoi, 45.5% during visual attention, and 68.2% during auditory attention experiment, with no significant differences for studied variables. CONCLUSION: Tinnitus-like perceptions may occur in a nonclinical population in a silent environment. Concomitant auditory attention plays an important role on the emergence of tinnitus.

Influência do silêncio e da atenção na percepção auditiva: implicações na compreensão do zumbido / Influence of silence and auditory attention on auditory perceptions: implications to tinnitus comprehension

OBJETIVOS: Estudar o efeito da atenção e do silêncio sustentado no aparecimento de percepções auditivas fantasma em adultos normo-ouvintes e a relação com características sócio-demográficas. MÉTODOS: Dentro de uma cabina acústica, 66 voluntários (18 a 65 anos, média etária 37,3 anos) realizaram três experimentos de cinco minutos cada, apresentados consecutivamente e em ordem aleatória. Dois desviavam a atenção do sistema auditivo (Hanói - H e Atenção Visual - AV) e outro a direcionava para ele (Atenção Auditiva - AA). Os sujeitos foram questionados sobre suas percepções auditivas e visuais. Em nenhum momento foram apresentados quaisquer sons ou mudanças na iluminação. RESULTADOS: 19,7% dos sujeitos experimentaram alguma percepção auditiva durante o experimento H, 68,2% durante o experimento AV e 68,2% durante o experimento AA, enquanto percepções visuais foram relatadas por 6,1%, 15,2% e 4,5% dos sujeitos para os mesmos três experimentos. A diferença na freqüência de percepções auditivas e visuais foi estatisticamente significativa, assim com a diferença na freqüência de percepções auditivas nos três experimentos. Não houve diferença estatisticamente significativa para o aparecimento de percepções auditivas ou visuais em relação às variáveis estudadas (idade, gênero, nível de instrução, hipertensão arterial, diabetes, história de tontura, história prévia de zumbido ou de exposição a níveis de pressão sonora elevados). Um maior número de percepções auditivas foi referido no experimento AA. Enquanto nos experimentos H e AV a maioria das percepções auditivas foi descrita como sons típicos de zumbido (apito, chiado, "hum", som de insetos ou de água corrente), no experimento AA 39,9% dos sujeitos (n=26) relataram a percepção de sons atípicos, mais compatíveis com vivências alucinatórias que com zumbido...

OBJECTIVE: To study the effect of attention and sustained silence on the emergence of auditory phantom perception in normal hearing adults and social-demographics relations. METHODS: sitting in a sound booth, 66 volunteers (age range 18-65, mean age 37.3) performed three experiments of five minutes each, consecutively and randomly presented. Two deviated attention from auditory system, called Hanoi (H) and Visual Attention (VA) experiments and one drove attention to the auditory system, called Auditory Attention (AA). After each experiment, subjects were asked about their auditory and visual perception. No sound or light change was given at any moment. RESULTS: 19.7% of the subjects experienced auditory perceptions during H, 45.5% during VA and 68.2% during AA, while visual perceptions were experienced by 6.1%, 15.2% and 4.5% of the subjects for the same three experiments. The frequency of auditory and visual perception was statistically different, as well as the frequency of auditory perception among experiments. No significant differences for auditory perceptions emergence for studied variables were found (age, gender, instructional level, hypertension, diabetes, history of dizziness, history of tinnitus, previous exposure to high sound pressure levels). A higher prevalence of auditory perceptions was found on AA experiment. While on H and VA experiments most of the auditory perceptions were described as typical tinnitus sounds (whistle, buzzing, hum, insects and running water), on AA experiment 39,9% of the subjects (n=26) experienced non-typical tinnitus sounds, closer to hallucinatory experiences than to tinnitus...

[Loudness discomfort level in normal hearing individuals]. / Nível de desconforto para sensação de intensidade em indivíduos com audição normal.

BACKGROUND: Loudness Discomfort Level (LDL), a test used in the hearing aid fitting process, has also been recommended to evaluate patients with tinnitus and/or suspect of hyperacusis. AIM: To determine LDL reference values for normal hearing individuals and to correlate the LDL to the Acoustic Reflex Threshold (ART). METHOD: LDL was investigated in 64 normal hearing subjects, with ages between 18 and 25 years (53.1% female), in the frequency threshold of 0.5 to 8KHz and for speech (non-recorded, non-standardized connected discourse). Pulsate pure tones were presented for two seconds, with a one-second interval between each presentation. The initial stimulus intensity was at 50dB and was followed by ascending presentations, of 5dB each, until the subject referred initial discomfort with loudness. The testing procedure was performed separately in each ear, and was immediately repeated at the end of the test (test and retest situation). The choice of the ear that would start the testing procedure was alternated for each subject. After that contralateral acoustic reflexes ART were measured. The presence of the ART was indicated by a minimal needle deflection (larger than 0.05ml) on the emittance equipment. RESULTS: Median varied from 86 to 98dBHL, with no statistically significant differences between gender (p > 0.11), between ears (p > 0.36) and between the test-retest situation (p > 0.34). The determination coefficients (r2) of the linear regression model revealed absence of correlation between log(LDL) and log(ART). CONCLUSION: Normal hearing individuals have LDL between 86 and 98dBHL for all of the tested stimuli. Inter-subject differences and the good reproductivity suggest that the interpretation of the test should be cautious and analyzed considering the patient's history. The test can be an useful instrument go follow-up patients. No correlation was found between LDL and ART.

Nível de desconforto para sensação de intensidade em indivíduos com audição normal / Loudness discomfort level in normal hearing individuals

TEMA: o Loudness Discomfort Level (LDL), teste muito utilizado na adaptação de próteses auditivas, teve sua indicação ampliada e passou a ser recomendado para complementar a avaliação de pacientes com zumbido e/ou com suspeita de hiperacusia. OBJETIVO: determinar valores de referência do LDL para normo-ouvintes e sua correlação com o Limiar do Reflexo Acústico (LRA). MÉTODO: o LDL foi aplicado em 64 sujeitos normo-ouvintes de 18 a 25 anos (53,1 por cento do sexo feminino) nas freqüências de 0,5 a 8KHz e para sons da fala encadeada espontânea a viva-voz. Os tons puros pulsáteis foram apresentados por dois segundos, com intervalo de um segundo entre cada apresentação, a partir de 50dB de modo ascendente em passos de 5dB até que o sujeito referisse desconforto inicial com a sensação de intensidade. O procedimento foi realizado nas duas orelhas separadamente e repetido imediatamente (situações de teste e reteste), com alternância da orelha inicial a cada sujeito. O reflexo contralateral foi obtido em seguida. Foi considerado LRA a menor intensidade sonora capaz de provocar uma deflexão visível na agulha do imitanciômetro (maior que 0,05ml). RESULTADOS: a mediana do LDL variou de 86 a 98dBNA, sem diferenças estatisticamente significativas entre homens e mulheres (p > 0,11), entre orelhas (p > 0,36) ou entre as situações de teste e reteste (p > 0,34). Os coeficientes de determinação (r²) do modelo de regressão linear mostraram ausência de correlação entre log(LDL) e log(LRA). CONCLUSAO: normo-ouvintes apresentam LDL de 86 a 98dBNA para todos os estímulos apresentados. Diferenças inter-sujeitos e boa reprodutibilidade sugerem que a interpretação do teste deve ser cuidadosa e aliada à anamnese e que o teste pode ser útil no acompanhamento de pacientes. Não houve correlação entre LDL e LRA.

Atuaçao dos fonoaudiólogos do Estado de Sao Paulo (Brasil) na avaliaçao de pacientes com queixa de zumbido e/ou hipersensibilidade a sons / The practice of audiologists of the State of Sao Paulo (Brazil) on evaluating patients with tinnitus and/or hypersensitivity to sounds

Tema: avaliaçao audiológica de pacientes com zumbido e/ou hiperacusia. Objetivo: conhecer o modod como os fonoaudiólogos do Estado de Sao Paulo os avaliam. Mótodo: análise de 47 questionários enviados. Resultados: a presença do zumbido é questionada na anamnese por 87 por cento dos profissionais, sendo que 53 por cento alteram pelo menos um procedimento de avaliaçao e 47 por cento dao alguma orientaçao aos pacientes. A hiperacusia é questionada por 52 por cento dos entrevistados, 53 por cento deles alteram algum procedimentode avaliaçao e 23 por cento orientam os pacientes. Conclusao: a amostra de fonoaudiólogos entrevistados neste estudo necessita de maior conhecimento e aplicaçao prática dos métodos de avaliaçao audiológica propostos para pacientes com zumbido e/ou hiperacusia.