The technological advance of the systems of amplification, in specific the device of individual sonorous amplification (AASI), has brought the necessity to evaluate the resultant impact of these resources in the auditory abilities of its users as well as in the services given for the programs of audiologic rehabilitation (1, 2). Questionnaires and scales of evaluation of the auditory abilities have been widely used with this objective, for being of easy application and the same allowing the accomplishment of longitudinal studies with the use of instrument in different stages of the therapeutically process (3).
Amongst the methods that consider the perspective of the user in the evaluation of the benefits of the amplification, auto-evaluation instruments exist, which in its majority, directed the adult and aged population. The related to the available auditory difficulties for children and adapted questionnaires of evaluation for the Portuguese concentrate in the age group of zero the seven years of age and are directed its parents: The Meaningful Auditory Integration Scale - MORE (4,1); The Infant-Toddler Meaningful Auditory Integration Scale - IT-MAOR (5, 6). Related studies the children above of this age group and that they still consider the perspective of the proper child are scarce (7).
The linguistic development of the deaf child follows the same periods of training that of a child listener, either in the verbal or visual modality (language of signals). However, due to interference of the auditory sensorial privation in the acquisition of the verbal language, the deaf children, children of parents listeners - that they are not displayed to the language of signals since the birth, as occurs with the deaf children, children of deaf parents - generally reach the pertaining to school phase without possessing a systemize language. From there the difficulty in having access such population by means of questionnaires appears (8, 9, 10, 11).
It is important to stand out that the beneficiaries of the auditory device are not only the users, but also all those that suffer to limitations in activities and restrictions from participation in reason of the existence of a involved deaf person in the action or task. That is, familiar and the too much people who also coexist an user of auditory device are beneficiary of this product and, as such, they search evidences of that it will promote an improvement in the auditory abilities as a whole (12, 13).
In reply to this, the Institute of Audiologic Research developed the LSQ - Listening Situations Questionnaire (14). Later, APPLETON and BAMFORD (15) had used this questionnaire in a research with 16 deaf children with auditory loss daily pre-linguistic in the age group of 7 to the 11 years, and the respective parents. The study compared the degree of auditory difficulty told by the children and observed by the parents. In the majority of the cases, the children had told to minor difficulty with regard to the auditory abilities of what she was observed by the adults. The authors had argued if the differences in the answers between parents and children must to the fact of the parents overestimate the difficulty of the children or the children not to confer as much importance to the difficulty who feel a time that does not possess an experience that serves of parameter for the comparison of the degree of the difficulty. The situations proposals in the LSQ evaluate the auditory abilities of the child to detect, to discriminate, to recognize and to understand says and some sonorous signals to it of alert or social conviviality, considering in the distance of the sonorous source (localization) and the presence or not of noise (figure-deep).
Considering that the auditory difficulty generates restrictions of participation to the child in diverse activities of the daily one and the LSQ is an instrument that measures the auditory abilities, is inferred that the use of the auditory device will be able to promote changes in the auditory abilities of the deaf child (2, 16).
The objectives of the present study had been: to investigate the benefit supplied for the amplification in deaf children of 7 to the 11 years that uses the auditory device, under the perspective of the proper child and the adults with who it more coexists; e to verify if the time of conviviality of the adults with the child intervene with its answers.METHOD
It is about a clinical, observational and transversal study, approved in August 24th of 2007 for the Commission of Ethics for Analysis of Projects of Research - CAPPesq of the Clinical Direction of the Hospital of the Clinics and the College of Medicine of the University of São Paulo (protocol #0601/07).
The research was carried through with 12 families of deaf children in the age group of 7 to the 11 years. All the children were using auditory device bilaterally and presented auditory loss of severe degree the deep one. All the citizens were using of auditory device have three years more than and the average of the time of use of the device was five years (Table 1).
The citizens whose preferential communicative modality was the language of signals totalized seven children, all with auditory losses of deep degree. Between the citizens whose preferential communicative modality was the verbal language, of a total of five children, four (80%) presented auditory losses of severe degree, and only one child (20%) presented loss of deep degree.
48 citizens had participated of the study, which had been divided in four distinct groups: C1- 12 deaf children; A1- 12 adults with average coexistence of 40 weekly hours in relation to the deaf child; A2- 12 adults with average coexistence of 20 weekly hours in relation to the deaf child; A3- 12 adults with average coexistence of 10 weekly hours in relation to the deaf child.
The age group of the adults varied of 19 the 73 years (average of 40 years), of which 24 (66.7%) were of feminine sex and 12 (33.3%) of the masculine sex (Table 2).
How much to the proximity or degree of kindred, 11 adults of the A1 group were mothers (91.7%), and only one citizen (8.3%) was father of the deaf child. In the A2 group, 10 adults were parents (83.4%), one was friend of the family (8.3%) and an age godmother of the child (8.3%). In the A3 group, it had four grandmothers (33.4%), two friends of the family (16.8%), a sister (8.3%), a neighbor (8.3%), an aunt (8.3%), a cousin (8.3%), a phonoaudiologic (8.3%) and a teacher (8.3%).
Already how much to the schooling degree, 60% of the adults were of basic level (less than nine years of study), 20% of average level (the nine to twelve years of study) and 20% of superior level (above of twelve years of study).
The used criteria of inclusion in this study had been:
-Pertaining to school children with age group between 7 years to the 11 years and 11 months; inserted in intervention bilingual program; with sensorineural auditory loss of severe or deep degree; AASI users have one year at least, in order to guarantee its experience of use; pertaining the families of listeners, therefore in the questionnaire had been observed situations that used to be part of the routine of families listeners, as to hear music and to speak to the telephone; minimum time of daily use of the devices of eight hours.
-Adults with age group above of 18 years of age; listeners; time of coexistence with the equal or superior child the ten weekly hours. In the absence of familiar that they satisfied the criteria demanded for participation in the research, other adults had been invited who coexisted in agreement child the established criteria.
Had been considered as exclusion criteria:
-Children with commitments associates - neurological (syndromes, deficiencies or any another condition that generated a cognitive delay, a time that this would harm the understanding of the questions), appearance (blindness, low vision or vision subnormal, what AASI would hinder the correct manipulation it and would make it difficult the identification of the figures of the questionnaire), emotional (depression/ hyperactivity, to guarantee the contribution of the child);
-Children who did not attend school (a time that one of the factors analyzed in the research was the proportionate benefit for the AASI in the pertaining to school environment).
The Questionnaire of Situations of Hear was used (LSQ) - version for children (14) and version for parents (17). This questionnaire was translated and adapted for the Brazilian Portuguese as the norms of the Scientific Advisory Committee of Medical Outcomes Trust (18,19) and currently meets in validation phase. It understands ten situations related to the common auditory difficulties to the majority of the deaf children, namely: to hear what is said by the professor in a noise classroom; to hear the instructions of an adult in external environments; to hear the bell or the touch of the telephone when he is in another one room of the house; to hear the sound of vehicles if approaching; to talk with some children in a classroom; to hear television with other people; to hear alone television; to hear music; to hear what it is said in the telephone; to hear the sound of the buzzer of an ambulance. For each situation, three questions are made: a) how much this situation is important for the child; b) which the frequency where it occurs; c) how much difficulty the child presents in this situation (scores of difficulty).
For each one of the three items of the LSQ had four possibilities of reply, which varied of 1 to 4 points, in accordance with the importance/frequency/degree of difficulty of the ten presented situations. The maximum total score for this questionnaire was of 120 points, and the minimum, 30 points. How much bigger is the score, greater the difficulty faced for the child and, consequently, less its auditory abilities (15).
The score of difficulty was determined by the addition of the punctuations gotten in item C of each question. The maximum score was of 40 points, and minimum ten. In the cases where the child did not use the auditory device in definitive situation, she asked herself if the child did not use it for presenting much difficulty in this situation (4 points), or for it not to have difficulty (1 point).
By the APPLETON and BAMFORD (15), superior total scores to 100 points indicate the necessity of revision of the device and score of difficulty above of 22 demands the analysis of the situations where the child presents more difficulty, associated with a detailed revision of the functioning of the device. Scores of difficulty is closely on to the benefit offered for the auditory device, being that high scores disclose the existence of obstacles in the execution of activities considered excellent in the daily one of a child.
It is considered, therefore, that the benefit supplied for the amplification is adjusted when there is total score below of 100 points and props up of inferior difficulty the 22 in the LSQ (Table 3).
After the signature of the assent term (Annex1), the questionnaire was managed with deaf child and, in the sequence, with three adults whom the child coexisted. In the cases of the deaf children whose preferential communicative modality was the language of signals, the application of the questionnaire was made in Brazilian Language of Signals (LIBRAS). For in such a way, the researcher received the training from a deaf professor. For the children who found in the initial periods of training of the verbal language, one used the figures of the questionnaire to facilitate to its understanding, requesting itself it the child who pointed the chosen option.
It was opted to managing the protocol in the residences of the citizens in order to offer to greater comfort to the families and to uninhibited the child, a time that being outside of the therapeutically environment this would hold in more natural way, propitiating the comment of same in situations daily it and the familiar dynamics (20).RESULTS
Auditory abilities in the perception of the children
There was great variability of answers for the item (how much the situation is important for the child). Perhaps this explains due to the character most personal of this question, generating bigger divergence between the answers given for the citizens. In item B (which the frequency where the situation occurs), had some divergences between the answers due the differences in the routine and familiar dynamics of the analyzed citizens. Already item C (difficulty presented for the child in the situation) had little divergence between the answers, what it is justified for the raised degree of auditory difficulty related by all the citizens (Table 4).
Two citizens (16.7%) had presented total scores above of the waited one in the LSQ. Already how much to score of difficulty, 11 citizens (91.7%) had gotten inadequate performance (Table 5).
Citizens 3, 10 and 11 had presented scores difficulty higher. But citizen 1 had score of adequate difficulty.
Considering that total scores raised in the LSQ they disclose a reduction of the auditory abilities, it can be said that it had improvement of the auditory abilities in the majority of the analyzed deaf children, however still persists one high degree of difficulty in the different presented situations of listening.
Auditory abilities in the perception of the adults
In the comparative degrees between the members how much to the answers for question, test ANOVA with repeated measures was used, and it did not have statistical significant differences in none of the comparative degrees (Table 6).
Also it did not have statistical significant differences between the answers of the children and the adults and enters the three groups of adults (Table 7).DISCUSSION
The majority of the citizens presented inside total scores of the waited one in the LSQ, however a deaf child only got score of adequate difficulty. This perhaps if must to the fact of it props up total to encompass other aspects (importance and frequency of the situations), which can have masked the difficulties faced for the children.
Situations related for the children as of big difficulty had been understood in item 8 (to hear music) and 9 (to hear what it is said in the telephone), both situations that involves more advanced abilities auditory (understanding of speaks without visual track). The situations of lesser difficulty had been to hear the buzzer of an ambulance and to hear the touch of the telephone in another room of the house (item 10 and 3, respectively), due to raised intensity of these sonorous signals.
The majority of the citizens presented damage in auditory abilities due to auditory loss, exactly making device use. A possible explanation for such fact is the delayed identification of the deafness of the pertaining children to the study (11). But a citizen (subject 4) received the diagnosis before the six months from life, being diagnosised to the rising (mother had rubella in the gestation). The average age of the diagnosis for the too much citizens was of 25,3 months, age very above of the recommended one for the Brazilian Committee On Auditory Losses of childhood (CBPAI). According to committee, all the children must be tested to the birth or in the maximum until the three months of age, and, in case of confirmed auditory deficiency, to receive educational intervention until the six months from life (8).
The three citizens with the worse scores of difficulty had auditory losses of deep degree, in such a way, can be said that the degree of the auditory loss intervened with the auditory abilities of the evaluated deaf children.
All the children with auditory loss of severe degree had preferred to use the verbal language to the one of signals. Already it enters the children with deep loss; only one (12.5%) preferred to use the verbal language. Such data suggest that the degree of audibility with the use of the auditory device can also intervene with the choice of the linguistic modality.
It is interesting to notice despite the only citizen with score of difficulty adjusted in the LSQ was also the only one in such a way to present satisfactory linguistic performance in the verbal language how much of signals, presenting auditory loss of severe degree and making device use in a long period.
The children of the study had been capable to answer to the LSQ in satisfactory way, a time that none of the citizens presented difficulty to answer to the questions of the questionnaire. It is treated, therefore, of an instrument adjusted for use with Brazilian deaf children above of seven years, therefore the simple language and proportionate the visual support for the figures allows the understanding of the same content for children in initial periods of training of the linguistic, independent development of its modality (verbal or language of signals). It is standed out that the phonoaudiology must have basic slight knowledge of POUNDS to manage the questionnaire with using children of language of signals (9,10).
The results demonstrated the viability of the evaluation of the auditory abilities in using deaf children of auditory device the information of the family, a time that the difference differently between the data offered for the groups that had participated of this research were not statistical significant, of the found results in the study of APPLETON and BAMFORD (15).
Independent of the time of weekly conviviality with the child, the adults of the different groups had had similar visions on the exploitation, the difficulties and the frequency of each situation presented in the questionnaire. However, it is interesting to observe that, amongst adults who had made suggestions or commentaries in the LSQ, five they belonged to the A1 group, three were of the A2 group and only one belonged to the A3 group. This leads to the conclusion of that the adults whose copes with the child is bigger, tend to have ampler visions of their behavior, being more intent to their reactions and preferences, although the results not to have statistical been significant in this aspect. It is interesting to observe also that it had a trend of the groups C1 and A1 to present more similar answers in the LSQ, pointing out that how much bigger the conviviality with the child, greater can be equivalence between the answers.
Thinking about forms to reduce the difficulties faced for the using deaf children of auditory device, in order to improve the quality of life of these children and their families, an available resource is the use of systems of frequency modulated (FM) in environments where it has sonorous competition (classrooms, for example), use that, unhappily, still little is spread in Brazil due to the raised financial cost (2).
Future studies become necessary to also validate the use of the LSQ in children listeners, a time that the questionnaire is capable to supply important information concerning the auditory behavior of this population by means of situations of sonorous competition, being able to be an instrument of great utility for the evaluation of children with problems of auditory processing. Using children of implantation to also cochlear can benefit themselves of such use.CONCLUSION
The results supplied for the studied groups indicate damage in the auditory abilities of the children evaluated had to the difficulties faced for them to listen to elements gifts in situations of the daily one. Such damage, however, suffers sensible reduction with the use from the auditory device, a time that the majority of the children benefited of the amplification supplied for the device, getting props up totals adjusted in the LSQ.
The device of individual sonorous amplification exerted influence in the auditory abilities of the evaluated children and the adults which they coexist, although the proportionate benefit for their use to be lesser of what the waited one.
The viability of the administration of the LSQ with deaf children above of seven years using of auditory device and with the adults was evidenced clinically whose coexistence with these children is superior the ten weekly hours, indicating the effectiveness of this instrument for evaluation of such population. It is standed out, however, that the LSQ does not have to be the only instrument of evaluation of the auditory abilities of this population, but a complement to the structuralized procedures.
More studies are necessary to corroborate the data found in this research and to clarify the differences between the available data in international literature and the results gotten in the present study.BIBLIOGRAPHIC REFERENCES
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1) Master in Human Being Communication. Phonoaudiologist.
2) Doctor in Sciences of the Communication. Professor Doctor of the Course of Phonoaudiology of the University of São Paulo.
3) Doctor in Sciences of the Communication. Technique of the Course of Phonoaudiology of the University of São Paulo.
Institution: University of São Paulo. São Paulo / SP - Brazil. Mailing address: Luciana Regina de Lima Carvalho - Augusto César do Nascimento Neto Street, 35 - Vila Gomes - São Paulo/SP - Brazil - Zip-code: 05589-060 - E-mail: firstname.lastname@example.org
Article received in June 19, 2011. Article approved in October 12, 2011.