ABSTRACT
Nowadays there are different alternatives to assess functionality in children with disabilities. The Functional Independence Measure for Children (WeeFIM) and the Pediatric Evaluation of Disability Inventory (PEDI) are two of the most widely used instruments. There is no consensus on which of them is preferable to use, therefore it is necessary to compare both tools, considering the Chilean reality and the characteristics of the Teletón Institute of Santiago. The aim of this descriptive comparison is to address this question and pose a possible answer to it.
Hoy en día existen diferentes escalas de evaluación funcional para niños con discapacidad. The functional Independence Measure for Children (WeeFIM) y The Pediatric Evaluation of Disability Inventory (PEDI) son alternativas utilizadas mas ampliamente. No existe consenso sobre cuál de ellas es preferible usar, por lo que es necesario comparar ambas herramientas en el contexto de la realidad chilena y considerando las características del Instituto de Rehabilitación Infantil Teletón de Santiago. La presente comparación descriptiva pretende abordar esta incógnita y plantear posibles respuestas a ésta.
Subject(s)
Humans , Child , Disability Evaluation , Disabled Children , Surveys and Questionnaires , Activities of Daily Living , Personal Autonomy , Reproducibility of ResultsABSTRACT
Introduction: To evaluate the effect of the Preschoolers Functional Development National Program (FDPN) is of fundamental interest to Teleton Chile (ITCh). Objectives: To estimate the adherence and the effect in functionality of FDPN in preschool children with cerebral palsy (CP) without mayor cognitive impairment according to age, diagnosis, ITCh, and socioeconomic status. Patients and Methods: We studied a cohort of preschool children with PC from 3 to 5.9 years in FDPN, 2007-2009. The adherence to the program, with the dates of assessments as a time scale, was analyzed by Kaplan-Meier statistics. The effect on functionality was measured using WeeFIM at admission, discharge and in a four month follow-up. The goal was achieved when an increase of four points was observed in functionality. Results: Of 498 preschoolers, 37.6 percent completed the follow-up, the overall median of the follow-up time was 148 days (IC95 percent: 146,4-150,6), which differs significantly according to ITCh. In the 187 preschool children who completed the follow-up, on average 74.3 percent achieved progress in the motor area and 58.8 percent in cognition. The behavior of the achievements is similar in motor and cognitive areas according to age, topographic diagnosis and socioeconomic status. Limitations: It was assumed that the study factors of the children who were follow do not differed from those who left the study. Conclusions: The high dropout from the program puts in evidence the lack of compliance of the programs objectives. The median time of adherence to FDPN is relatively higher than expected. In children who completed the PNDF, there are advances in functionality, lower than expected. This program needs to be refocused, seeking to increase the adherence, a greater effectiveness in the cognitive area and a higher impact on the family.
Introducción: Evaluar el efecto del Programa Nacional de Desarrollo Funcional de Preescolares (PNDF), es de fundamental interés para Teletón Chile (ITCh). Objetivos: Estimar adherencia y efecto en funcionalidad del PNDF en preescolares con parálisis cerebral (PC) sin compromiso cognitivo mayor según edad, diagnóstico, ITCh y nivel socioeconómico. Pacientes y Métodos: Se estudia cohorte de preescolares con PC de 3 a 5,9 años en PNDF, años 2007-2009. La adherencia al programa, con las fechas de evaluaciones como escala del tiempo, se analiza mediante estadística Kaplan-Meir. El efecto en funcionalidad, se mide con WeeFIM al ingreso, alta y seguimiento de cuatro meses. Se logra el objetivo, cuando se aumenta cuatro puntos en funcionalidad. Resultados: De 498 preescolares, 37,6 por ciento completa el seguimiento; la mediana global del tiempo de seguimiento es de 148 días (IC95 por ciento:146,4-150,6), que difiere significativamente según ITCh. En 187 preescolares que completan el seguimiento, en promedio 74,3 por ciento logran progresos en área motora y 58,8 por ciento en cognición. El comportamiento de los logros es similar en áreas motora y cognoscitiva según edad, diagnóstico topográfico y estrato socioeconómico. Limitaciones: se asumió que los niños en seguimiento, no diferían según factores en estudio de aquellos que abandonaron. Conclusiones: La alta deserción al programa evidencia falta de cumplimiento de objetivos. La mediana del tiempo de adherencia al PNDF es relativamente mayor a lo esperado. En niños que terminaron el PNDF existen progresos en funcionalidad por debajo de lo estimado. Se necesita reenfocar este programa, buscando aumentar la adherencia, tener mayor efectividad en lo cognitivo e impacto en la familia.
Subject(s)
Humans , Male , Female , Child, Preschool , Patient Compliance , Cerebral Palsy/rehabilitation , Age Factors , Cohort Studies , Motor Skills/physiology , Follow-Up Studies , Knowledge , Patient Dropouts , Program Evaluation , Social Class , Treatment OutcomeABSTRACT
Introduction: It is important to evaluate the effectiveness of the therapeutic endeavour, in order to improve rehabilitation programs in the motor area in patients with neuromusculoskeletal disabilities. Objective: To evaluate changes in the functional independence between admission and discharge from specific treatments in patients with cerebral palsy and spinal cord lesion, and explore whether gender, age or diagnosis, can predict the progress of children in these types of treatments. Patients and Methods: A single cohort study, consisting of 624 subjects of three years or more with cerebral palsy and 155 with spinal cord injury, attending to specific rehabilitation programs in Teletón Chile Institute from 2007-2008. In the analysis, was used the difference between the admission and discharge WeeFIM score and decision trees with p < 0.05. Results: In 264/624 of the cerebral palsy children (42.3 percent)increase discharge score; 321/624 (51.4 percent) remain the same and 39/624 (6.3 percent) decrease; in spinal cord injury 93/155 patients (60 percent) improve, 58/155 (37.4 percent) do not change and 4/155 (2.6 percent) decrease; the improvement occurs mainly in self-care activities; the decision trees show that specific treatments have best result for diplegia and hemiplegia in children under 6 years; in spinal cord injury, for thoracic bifid spine with hydrocephalus and acquired tetraplegia. Conclusion: Specific treatments have a better outcome for children with cerebral palsy hemiplegia and spine lesions, it is associated with the initial diagnosis; the age acquires predictive characteristics for children with hemiplegia and diplegias under 6 years; WeeFIM is poorly sensitive to detect changes in extreme scores and in short duration rehabilitation programs.
Introducción: Es importante evaluar la efectividad del quehacer terapéutico, con el fin de mejorar los programas de rehabilitación en el área motora de los pacientes con discapacidades neuromusculoesqueléticas. Objetivo: Evaluar cambios en la independencia funcional entre ingreso y alta de tratamientos específicos en pacientes con parálisis cerebral y lesión medular, y explorar si el género, edad y diagnóstico, permiten pronosticar el progreso de los niños en este tipo de tratamientos. Pacientes y Método: Estudio de cohorte única, constituida por 624 sujetos de 3 años o más con parálisis cerebral y 155 con lesión medular, asistentes a programas específicos de rehabilitación de Instituto Teletón Chile en 2007-2008. En el análisis, se usó diferencia de puntaje de WeeFIM entre ingreso y alta, y árboles de decisión con p < 0,05. Resultados: En parálisis cerebral 264/624 (42,3 por ciento) de los niños, aumenta puntaje de alta; 321/624 (51,4 por ciento) permanece igual y 39/624 (6,3 por ciento) desmejora; en lesión medular 93/155 pacientes (60 por ciento) mejora, 58/155 (37,4 por ciento) no cambia y 4/155 (2,6 por ciento) desmejora; la mejoría se produce principalmente en actividades de autocuidado; los árboles de decisión indican que los tratamientos específicos tendrían mejor resultado para diplejías y hemiplejias en menores de 6 años; en lesión medular, para espina bífida torácica con hidrocefalia y tetraplejia. Conclusiones: Los tratamientos específicos tienen mejor resultado para niños con hemiplejia por parálisis cerebral y alteraciones raquimedulares altas; el aumento del puntaje, está asociado al diagnóstico inicial; la edad adquiere carácter predictivo para niños con hemiplejias y diplejías menores de 6 años; WeeFIM es poco sensible para detectar cambios en puntajes extremos y en programas de rehabilitación de corta duración.
Subject(s)
Humans , Male , Adolescent , Female , Child , Spinal Dysraphism/rehabilitation , Program Evaluation/methods , Cerebral Palsy/rehabilitation , Age Factors , Cohort Studies , Quadriplegia/rehabilitation , Decision Trees , Hemiplegia/rehabilitation , Personal Autonomy , Prognosis , Sex Factors , Socioeconomic Factors , Treatment OutcomeABSTRACT
@#ObjectiveTo investigate the education rehabilitation on congnitive ability of school-age children with cerebral palsy.Methods50 school-age children with cerebral palsy received education rehabilitation (conventional teaching methods and special teaching methods). The children were assessed by the cognitive part of Rating Scale (WeeFIM) as functional independence before and 1 term after education rehabilitation.ResultsThere was a significant difference in WeeFIM score for the children between and 1 term after education rehabilitation (P<0.01).ConclusionEducation rehabilitation can improve the cognitive abilities of school-age children with cerebral palsy.