© 2010, International Society for
Augmentative and Alternative
Communication
Ms Miryam Pelosi THE PATH OF AAC IN BRAZIL (RIO DE JANEIRO) AND THE CONTRIBUTIONS PROVIDE BY THE CANADIAN (ONTARIO) EXPERIENCE
Poster Presentation
Type:
Canada has given many important contributions to the field of Augmentative and Alternative Communication (AAC). Blissymbolics was first used in 1971 as a way to enhance communication of children with severe physical disabilities at the Ontario Crippled Children’s Centre (currently called Bloorview Kids Rehab) in Toronto. In 1975, AAC was implemented in clinical setting. In 1983, the International Society of Augmentative and Alternative Communication (ISAAC) was created. These and many more accomplishments promoted the dissemination of AAC in the world. Brazil is no different from many other countries that has been benefiting from the Canadian AAC experience. This research paper presents a summary of the path that AAC took in Brazil (primarily in Rio de Janeiro); reports on current educational and clinical aspects of AAC; and explores option for future direction based on AAC policies in Ontario, Canada.
Canada has often been present in the history of Augmentative and Alternative Communication (AAC) in Brazil. It started in the late 70’s when Blissymbol was introduced at the Educational Association Quero-Quero, in São Paulo, Brazil (Nunes, 2007). It was then enhanced when in 1980, Nadia Browning (originally from Rio de Janeiro) became the first official Blissymbol trainer in Brazil and started training professionals and families all around the country.
The spreading of information takes a long time. For many years the work of the AAC was being done by small group of professionals working in clinics and rehabilitation centers in major cities of the country. It was only in the late 80's, that AAC emerged as a topic of study in a Post-Graduate Education of the State University of Rio de Janeiro.
In 1995, started many researches on augmentative and alternative communication in the Post-Graduate Education of the State University of Rio de Janeiro, associated with the Research Group for Alternative Communication. Since then, there are many studies in AAC: ten projects, 20 master's dissertations and doctoral theses have been oriented, and one postdoctoral on the topic of AAC. (Nunes, 2009).
Recent research on scientific production in Alternative Communication in Brazil identified a total of 45 studies of post-graduate degree in Alternative Communication from 1987 to 2008, eight of PhD and 37 Masters. University of Rio de Janeiro State is now the Brazilian University with the largest number of studies in AAC (Manzini, 2009).
Despite the development of research in Alternative Communication raises Rio de Janeiro to a place of prominence, the services of Alternative Communication in the community are scars. Research carried out by Pelosi (2008) revealed that the municipal health clinics in Rio de Janeiro offers no alternative communication services, and that the occupational therapists, regardless of their experience and specialized training in various areas, have no knowledge of Alternative Communication. The need for more formal AAC course in University and College has also been identified by many researches (Koul & Lloyd, 1994; Ratcliff, Cumley, Mathy, Fox & Romski, 2000). Canadians have been exploring alternative ways of teaching AAC and creating online AAC courses and Virtual Network.
According to AAC in the schools of Rio de Janeiro, Pelosi (2008) indicated that half of the resource teachers (itinerant teachers) surveyed used Alternative Communication as a resource to their work. The itinerant teachers, agents of special education, followed up an average of 16 children with special needs included in mainstream schools on a weekly basis. The tool most often used by teachers was the communication board. However, the study showed that these were mostly thematic boards developed primary for educational purposes and that it did not include vocabulary for communication and social interaction.
AAC is a specialized field that involves health professionals and educators working in a team. This involves working in collaboration and a shared understanding of team roles and problem solving (Health Canada, 2009). AAC centers in Ontario have a transdisciplinary team approach that includes the sharing of information among all the team members.
In Brazil, the partnership between health professionals and educators is just beginning. Pelosi (2008) studied the effectiveness of team and partnership to support the child in inclusion. Her study was designed to have 3 stages. First, she provides an inservice to health professionals (occupational therapists and speech therapists) and teachers participating in the research. Second stage, she did a pilot study to follow up the implementation of AAC service in four Municipal Health Units. Third stage included a joint action of health professionals and educator working in the schools as a team to assist with the inclusion of students with special needs. This intervention occurred in 4 schools. The results were very favorable to implementation of AAC in educational setting and to the inclusion process.
AAC becomes part of the guiding documents of the Brazilian education, in 2002, with the publication of the series Technical Help Portal. This series has three issues on Assistive Technology. (Pelosi, 2008).
Final paper: Theme RESEA
In 2003 and 2004, the Brazilian government included in their guiding educational practice documents the use of augmentative and alternative communication as a resource for students with disabilities. Examples include the publications "Knowledge and practice of inclusion" and "Access of Students with Disabilities to Public Schools and Regular Classroom” (Brasil, 2004).
However, in 2006 Brazil took an important step towards the creation of government policies in the area of Assistive Technology. A Committee on Technical Assistance consisted of Brazilian experts and government agencies representatives was developed.
The Special Secretariat for Human Rights of the Presidency created the Committee for Technical Assistance. The goal of this committee is to: present proposals to modify government policies; promote partnerships between civil society and public organizations; structure the guidelines in the area of knowledge; survey the regional reference centers and professionals working in the AAC; encourage the development of new reference centers; offers courses in the area of Assistive Technology; train qualified human resources in addition to the implementation of proposals for studies and research related to Assistive Technology (Brasil, 2006).
In Ontario (Canada), children with special needs attending the public school system has an IEP (Regulation 181/98 of the Education Act) that outlines the strength and needs of the student, learning expectations, and describes the program, adaptation and/or services required by the student. For the student who needs equipment to meet his/her education goals, the Ministry of Education allocates funding called Special Equipment Amount. These services provide children with an individualized program and adequate resources.
Individuals with AAC needs have access to public funded Centers in Ontario. There are currently 22 AAC centers serving children and adults. Additionally, the Assistive Devices Program of the Ontario Ministry of Health and Long Term Care provides funding assistance to individuals who through assessment is found to benefit from Assistive Technology.
The research presented in this paper and the experience in Ontario (Canada) leads the AAC Brazilian field into the need for increase government support related to distribution of AAC resources; dissemination of AAC courses in University and College or online programs; team approach within all professionals in the field; and adequate resource centers well distributed in the country.
References:
Brasil (2004). Procuradoria federal dos direitos do cidadão. O Acesso de Alunos com Deficiência às Escolas e Classes Comuns da Rede Regular / Ministério Público Federal: Fundação Procurador Pedro Jorge de Melo e Silva (Organizadores) / 2ª ed. rev. e atualização. Brasília, 60p.
Brasil (2006). Portaria 142 Comitê de Ajudas Técnicas – CAT. Disponível em http://www.galvaofilho.net/portaria142.htm, 2006. Acesso em 2 de maio de 2009.
Manzini, E.J. (2009). Um estudo sobre as pesquisas em comunicação alternativa na pós-graduação brasileira. In: Deliberato, D.; Gonçalves, M.J. e Macedo, E.C. (Orgs.). Comunicação Alternativa: Teoria, prática, tecnologias e pesquisa, p.312-321.
Nunes, L.R.O.P. (2007). Um Breve Histórico da Pesquisa da Comunicação Alternativa na UERJ. In: Nunes, L.R.O.P; Pelosi, M.B.; Gomes, M.R. (Orgs.). Um Retrato da Comunicação alternativa no Brasil – Relato de Pesquisas e experiências. Volume II. Rio de Janeiro: 4 Pontos Estúdio Gráfico e Papéis, p.19-32.
Nunes, L.R.O.P. (2009). A pesquisa sobre comunicação alternativa na pós-graduação em Educação da Universidade do Estado do Rio de Janeiro In: Deliberato, D.; Gonçalves, M.J. e Macedo, E.C. (Orgs.). Comunicação Alternativa: Teoria, prática, tecnologias e pesquisa, p.322-334.
Health Canada Website (2009). Interprofessional Education for Collaborative Patient-Centred Practice. http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/interprof/index_e.html#skipall. Retrieved from the Web: December 5, 2009. Koul. R., & Lloyd, L. (1994). Survey of pre-professional preparation in augmentative and alternative communication in speech language pathology and special education programs. American Journal of Speech Language Pathology, 3(3), 13-22.
Ontario Ministry of Education (2005, June 27). Regulation 181/98 of the Education Act. Retrieved November 22, 2009 from http://www.edu.gov.on.ca.
Pelosi, M. B. (2008) Inclusão e Tecnologia Assistiva. Volumes I e II, 303f. Tese (Doutorado em Educação) – Programa de Pós-graduação em Educação da Faculdade de Educação, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2008.
Ratcliff, A., Cumley, G., Mathy, P., Fox, L., & Romski, M. A. (2000). Integrating the WWW into on-campus classes. Workshop presented at the 9th Biennial Conference of the International Society of Augmentative and Alternative Communication, Washington, DC.
Ms Miryam Pelosi THE OCCUPATIONAL THERAPISTS FROM RIO DE JANEIRO HEALTH UNITS AND THEIR ACTIONS IN AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
Poster Presentation
Type:
Introduction
Occupational Therapy care in the public and accredited Units in Brazil was provided for in the Brazilian Health System (Sistema Único de Saúde - SUS), established by the 1988 Brazilian Constitution and regulated by Act # 8080, dated 09/19/1990.
The municipality of Rio de Janeiro has 134 occupational therapists working in its Health Units, among municipality, federal and contracted officers. These therapists work in 33 Units, integrating teams in the emergency hospitals, specific and general hospitals, maternity hospitals, health centers, institutes, psychosocial care centers and technical support teams for “Family Health Program”. The services provision comprises the 10 Planning Areas in which Rio de Janeiro State Health Department is divided into (SOUZA, 2005).
The actions of occupational therapists in the basic system include preventions and management of disabilities in Hansen’s disease and diabetes, elderly care, children with learning disabilities care and mental disease patients in the several Unit Health programs.
In the hospitals, occupational therapy intervention is performed in the orthopedic, neurosurgery, internal medicine, burns care, pediatrics, plastic surgery, vascular surgery and psychiatric wards.
In the rehabilitation centers, therapists act in different stages of the work, in the management of adults, children and adolescents with motor, sensorial and mental disabilities; in the maternity hospitals, the therapists are part of teams working in the neonatal intensive care units and in the “Interdisciplinary Care Centers for Newborns at Risk”.
Regarding mental health services, occupational therapists work in hospital wards, outpatient units, “Psychosocial Care Centers”, therapeutic and income generation workshops and on therapeutic home programs. In the “Interdisciplinary Care Centers for the Infant-Juvenile Development”, occupational therapists follow the neuropsychomotor development stimulating sensorial-motor abilities required to perform daily life and children play activities making the school learning conditions easier.
Brazilian Health System provides some of the Assistive Technology resources with a prefixed equipment table. This mean that “SUS” cannot provide items which are not established in its table, regardless the users’ needs. For instance, wheelchairs, orthosis, prosthesis, hearing aids and insoles are provided (BERSH, 2008). Augmented and Alternative Communication resources are not provided for in the SUS table.
Method
This study aimed to identify the profile of the occupational therapists working in the Health Units in the municipality of Rio de Janeiro and analyze their experience in the area of Augmentative and Alternative Communication. This study was a survey conducted via questionnaire, using Likert Scale, which was sent to 134 occupational therapists working in this Municipality. The instrument had 12 items with socio-demographic data and specific questions regarding the work performed in Health Unit, and 34 questions on AAC, computer access adaptation and school material adaptation. The questionnaire was answered by 78 workers.
The Likert Scale was divided in 10 marked areas every half centimeter to perform the results analysis. A numbering pattern, from 0 to 10, was applied so that numeric values could be assigned to the study participants’ answers. Results
The survey results showed a significantly higher number of women (99%) in comparison with men working as occupational therapists, which represents the profession distribution.
Participants age varied from 27 to 59 years old, with an average of 41 years old and a significantly higher number of women (99%). Occupational therapists had been graduated for 15 years (4 to 28 years), and most of them (85%) had already taken specialization courses.
Only 16% of the participants pointed out having taking part in any AAC course and this fact was reflected by the answers regarding knowledge in the area. The average of the answers obtained in the Likert Scale regarding AAC was 5 points, showing a superficial knowledge of participants.
Final paper: Theme RESEA
Regarding the working area, 66% of the occupational therapists were working in rehabilitation, 31% in mental health and 3% in other areas. Most of them (88%) performed individual follow up and took care of more than one age group of patients (71%). School age children and adolescents, between 6 to 17 years old, were treated by 32% of the occupational therapists. Patients comprised people with physical disabilities (46%), mental disabilities (35%), multiple disabilities (29%), visual disability (24%) and mental disorders (32%).
Most of the patients under treatment could speak without difficulties (69%) and were physically able to write (62%). People speaking few words (60%), those who did not have oral (41%) or written communication (40%) comprised the potential group to develop a work in Alternative Communication.
Only 8% of the occupational therapists stated to be able to evaluate and determine the best alternative communication resource for their patients, and approximately half of the group (47%) stated to know how to evaluate, but not to indicate the most suitable AAC to work.
Most therapists (67%) said they had difficulties in understanding patients’ “Yes” and “No” answers or determining the best way for computer access (69%).
Indication of writing adapters was shown to be familiar to occupational therapists (65%), but most of the workers did not know the Alternative Communication resource selection strategies (83%), using of communication boards (67%), communicators (91%) and adapted computers (80%).
Discussion
Health State Department occupational therapists were women, around 41 years old, who had been working for many years in the same Health Unit. They were experienced workers who had been graduated for 15 years, on average, and who performed outpatient interventions to different patients regarding pathology and age.
As patients treated were not from a specific group, the workers tended to specialize in one of the areas they were working in or in a specific age group, such as mental heath, elderly ageing health, psycopedagogy, neurology and hand rehabilitation. The diversity of patients makes it difficult for these workers to be specialized in the many areas they serve.
The diversity of patients and the reduced number of therapists in the Health Units created difficulties in implementing specific services such as Augmentative and Alternative Communication. Due to the lack of budget to hire more professionals, a new program can only be implement at the expense of decreasing service in another program.
The organization of physical space for therapy was also a problem, as, for many times, the therapist had to deal with different service demands, and some areas showed a lack of materials.
Regarding the Augmented and Alternative Communication, it has been verified that the occupational therapists served children who were part of the potential group to develop a work in the area. Patients who spoke few words (60%), those who did not communicate orally (41%) or in written (40%) formed a significant group, but most of the therapists (83%) was not able to choose the best resource for developing alternative communication, and only half of them (47%) knew how to evaluate the need of the work in the area. Even the affirmative and negative patients’ answers were not always understood by most workers (67%).
Most therapists (69%) did not know how to evaluate the best way for computer access, and only 50% of them thought they were able to perform the evaluation and indication of adaptations for school material.
The study results showed that occupational therapists, despite of their experience and specialized education in several areas, were not sufficiently knowledgeable on Alternative Communication to implement this service. The occupational therapists must take charge of their role in AAC and expand their participation in teams supporting school inclusion. For this to happen, it will be necessary to include AAC in the Occupational Therapy undergraduate program and a continuous education in the field.
References
PELOSI, M. B. Inclusão e Tecnologia Assistiva. 2008. Volumes I e II, 303f. Tese (Doutorado em Educação) – Programa de Pós-graduação em Educação da Faculdade de Educação, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2008.
