Environmental and personal factors that explain functional abilities and caregiver assistance on children aged 6 to 18 months: a cross-sectional study

Abstract Aims: This study investigated environmental and personal factors that explain functional skills and caregiver assistance in young infants/toddlers. Methods: A cross-sectional study was conducted involving seventy-four children with typical development between 6 and 18 months of age. Functioning skills were evaluated using the Pediatric Evaluation of Disability Inventory, and the home environment was evaluated using the Affordances in the Home Environment for Motor Development-Infant Scale. Statistical analyses were performed by regression models. Results: Child's age explained 45% of self-care (β = 0.68); child's age (β = 0.72), attending daycare (β = 0.33) explained 71% of mobility, and child's age (β = 0.80) and breastfeeding duration (β = 0.17) explained 69% of social function. With regards to caregiver assistance, child's age (β = 0.46), attending daycare (β = 0.20) and number of siblings (β = -0.22) explained 31% of self-care; child's age (β = 0.62) and attending daycare (β = 0.34) explained 56% of mobility; and child's age (β = 1.91) and total AHEMD-IS score (environment) (β = 2.63) explained 30% of social function. Conclusion: Daycare, breastfeeding duration, number of siblings, stimulation at home, and age explained functional skills and caregiver assistance to toddlers/infants.

The Sarah evaluation scale for children and adolescents with cerebral palsy: description and results

ABSTRACT Background Assessments of motor-functional aspects in cerebral palsy are crucial to rehabilitation programs. Objective To introduce the Sarah motor-functional evaluation scale and to report the initial results of its measurement properties. This scale was created based on the experience of the Sarah Network of Rehabilitation Hospitals in the care of children and adolescents with cerebral palsy. Method Preliminary results concerning the measurement properties of the scale were obtained via assessment of 76 children and adolescents with cerebral palsy. Experts' opinions were used to determine an expected empirical score by age group and to differentiate severity levels. Results The scale exhibited a high Cronbach’s alpha coefficient (0.95). Strong correlation was observed with experts’ classification for severity levels (0.81 to 0.97) and with the scales Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory (0.80 to 0.98). Regression analysis detected a significant relationship between the scale score and the severity of the child’s motor impairment. The inter-rater reliability was also strong (intraclass correlation coefficient ranging from 0.98 to 0.99). The internal responsiveness of the scale score was confirmed by significant differences between longitudinal evaluations (paired Student’s t test with p<0.01; standardized response mean of 0.60). Conclusion The Sarah scale provides a valid measure for assessing the motor skills and functional performance of children and adolescents with cerebral palsy. The preliminary results showed that the Sarah scale has potential for use in routine clinical practice and rehabilitation units.

Avaliação do desempenho funcional de crianças com paralisia cerebral de acordo com níveis de comprometimento motor / Functional performance assessment of children with cerebral palsy according to motor impairment levels

Contextualização: Diversos estudos têm avaliado a função motora de crianças com Paralisia Cerebral (PC), entretanto pouco se sabe sobre as inter-relações entre comprometimentos da mobilidade, autocuidado e função social relacionadas às habilidades funcionais da criança e à assistência do cuidador. OBJETIVOS: Identificar diferenças funcionais de crianças com PC em diferentes níveis de disfunção motora e correlacioná-las com os domínios mobilidade, autocuidado e função social na habilidade funcional e na assistência do cuidador. MÉTODOS: Realizou-se uma pesquisa analítica de corte transversal com 70 crianças/famílias, com idades de 4 a 7,5 anos, atendidas no Centro de Reabilitação Infantil, por meio do Pediatric Evaluation Disability Inventory (PEDI) e do Gross Motor Function Classification System (GMFCS). A análise dos dados foi realizada por meio da ANOVA e teste de correlação de Pearson. RESULTADOS: Os resultados indicaram importante variabilidade funcional das crianças com PC em diferentes níveis de severidade da disfunção motora. Essa variação foi observada nos domínios mobilidade, autocuidado e função social. Os resultados apresentaram, também, forte correlação entre os domínios mobilidade e autocuidado e mobilidade e função social. CONCLUSÕES: Diante da variabilidade apresentada pelas crianças, percebe-se a necessidade de aplicação do PEDI e GMFCS, o que parece aumentar o entendimento sobre a relação entre funções motoras grossas e atividades da vida diária. Essa correlação demonstra o quanto a mobilidade é determinante para avaliar o desempenho funcional e orientar a prática terapêutica no sentido de desenvolver as potencialidades das crianças, bem como orientar o cuidador na estimulação.

Background: Several studies have evaluated motor function among children with cerebral palsy (CP), but little is known about how mobility impairment, self-care and social function interrelate with their functional skills and caregiver assistance. OBJECTIVES: To identify functional differences among children with CP at different levels of motor dysfunction, and to investigate the relationship between these differences and the domains of mobility, self-care and social function in functional skills and caregiver assistance. METHODS: An analytical cross-sectional study was conducted among 70 children and their families. The children were aged 4 to 7.5 years and received care at the Children's Rehabilitation Center. The instruments used were the Pediatric Evaluation Disability Inventory (PEDI) and the Gross Motor Function Classification System (GMFCS). Data analysis was performed by means of ANOVA and Pearson's correlation. RESULTS: The results showed significant functional variability among the children with CP at different levels of motor dysfunction severity. This variation was observed in the domains of mobility, self-care and social function. The results also showed a strong correlation between mobility and self-care and between mobility and social function. CONCLUSIONS: In view of the variability shown by the children, it was necessary to apply PEDI and GMFCS, which appears to increase the understanding of how gross motor function relates to activities of daily living. This correlation demonstrates the extent to which mobility is a determinant for evaluating functional performance and guiding therapeutic practice to develop children's potentials and instruct caregivers in stimulation.