Kids Intervention Therapy - Aquatic Environment (KITE) for babies 4 to 18 months old, by following the International Classification of Functioning (ICF): clinical trial protocol

Abstract Introduction: the biopsychosocial (BPS) model from the perspective of the International Classification of Functioning (ICF) agrees with the current theories regarding child development. They state the interdependence between the individual's relations, environment and received stimuli. The early interventions, particularly in the aquatic environment (AE), present gaps concerning their systematization, above all in their being in accordance with the ICF. Objectives: to describe an ICF-based aquatic early intervention program, named KITE, for the neuropsychomotor development (NPMD) of typical, at-risk and/or delayed babies 4 to 18 months old. Methods: the KITE is a program systematized on the AE, centered on the family and the daycare environment; it takes place twice a week, lasting for 4 weeks, in 45- to 60-minute sessions. The assessments and interventions are systematized by following the ICF. For the main outcome on the NPMD, the Alberta Infant Motor Scale (AIMS) and the Denver Developmental Screening Test II (DDST-II) are used, and as the secondary outcome on the stimulation received, quality of life and aquatic skills, the Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS), the Pediatric Quality of Life Inventory (PedsQL™) and the Aquatic Functional Assessment Scale - Baby (AFAS Baby) are used, respectively. Conclusion: This study has presented tools for the application of a clinical trial through the KITE for the NPMD of babies, systematized and based on the BPS perspective of the ICF, and discussed according to the neuroplastic evidence of the child development.

Efeitos da fisioterapia aquática na função motora de indiví­duos com paralisia cerebral: ensaio clí­nico randomizado / Effects of aquatic physical therapy in motor functional in subjects with cerebral palsy: randomized clinical trial

Objetivo: Avaliar os efeitos de um protocolo terapêutico para controle de tronco em ambiente aquático e sua repercussão na função motora de indiví­duos com Paralisia Cerebral (PC) diparética espástica, classificados no ní­vel II ou III do GMFCS. Métodos: Trata-se de um ensaio clí­nico randomizado, estratificado e cego. Os participantes foram selecionados por meio de triagem dos prontuários do banco de dados da Clí­nica de PC da instituição. Da triagem de 1.599 prontuários, 20 crianças foram incluí­das e 16 finalizaram o estudo. Os pacientes foram alocados por estratificação pelo ní­vel do GMFCS em grupo controle (GC) que realizou fisioterapia convencional e grupo intervenção (GI) que realizou o protocolo de exercí­cios aquáticos. Ambos os grupos foram submetidos í avaliação pré e pós-intervenção com os seguintes instrumentos: Gross Motor Function Measurement (GMFM), Trunk Control Measurement Scale (TCMS), Eletromiografia de superfí­cie (EMG) dos músculos reto abdominal e latí­ssimo do dorso, Teste de Caminhada de 6 minutos (TC6), Timed up and Go (TUG), Escala Visual Analógica (EVA) da marcha, Flexômetro de Wells e Child Health Questionnaire (CHQ) PF-50. Resultados: A amostra apresentou-se homogênea para as análises. Na análise intergrupo observa-se melhora no equilí­brio dinâmico sentado (p = 0,001) e reações de equilí­brio (p=0,015) para o GI, houve melhora da flexibilidade da musculatura posterior do tronco e membros inferiores no GC (p = 0,017), para os demais instrumentos não teve diferença significativa nas análises intergrupos. Na análise intragrupo para o GI, constatou melhora no equilí­brio estático e dinâmico do tronco nas três subescalas da TCMS, equilí­brio estático sentado (p= 0,033), equilí­brio dinâmico sentado (p = 0,012) e reações de equilí­brio (p = 0,027), assim como para a pontuação total da escala (p = 0,012); no GMFM, o aumento da pontuação das dimensões D (p = 0,012) e E (p = 0,020), bem como a média das três dimensões (p = 0,012); na EMG observa-se melhora da ativação muscular para o músculo LD; melhora da dor (p = 0,026); ambos os grupos melhoraram significativamente (p = 0,012) a distância percorrida no TC6 e o tempo no TUG, GC (p = 0,017) e GI (p = 0,036). Conclusão: O protocolo de exercí­cios aquáticos apresentou benefí­cios para o controle de tronco de indiví­duos com PC diparética espástica classificados no ní­vel II ou III do GMFCS sendo efetivo na melhora das reações de equilí­brio e no equilí­brio dinâmico. (AU)

Objective: To evaluate the aquatic trunk control effects and its impact on functionality in individuals with diparetic spastic type of CP, classified at level II or III on the GMFCS. Methods: This is a randomized, controlled, stratified and blind clinical trial. Participants were selected through the sorting of medical records of the institution's PC Clinic database. 1599 records were screened, 20 children were included and 16 completed the study. Patients were allocated by GMFCS in control group (CG) which underwent conventional therapy, and intervention group (IG) which performed an aquatic exercises protocol. Both groups underwent pre and post intervention evaluation with Gross Motor Function Measurement (GMFM), Trunk Control Measurement Scale (TCMS), rectus femuris and latissimus dorsi EMG, 6 Minute Walk Test (6MWT), Average Speed, Energy Expenditure Index, TUG, Gait EVA, Wells Flexometer and CHQ PF-50. Results: The sample was homogeneous for the analysis. In the intergroup analysis, there was an improvement in the sitting dynamic balance (p = 0.001) and balance reactions (p = 0.015) for the GI. We oberved an improvement in the flexibility of the posterior trunk and lower limbs muscles in the CG (p = 0.017). The other instruments did not have significant difference in the intergroup analyzes. In the intragroup analysis for the GI, we observed improvement in the static and dynamic trunk balance in the three subscales of the TCMS, sitting static balance (p = 0.033), sitting dynamic balance (p = 0.012) and equilibrium reactions (p = 0.027), as for the total score of the scale (p = 0.012); at GMFM score increased D (p = 0.012) and E (p = 0.020), as well as the mean of the three dimensions (p = 0.012); in the EMG we observed an improvement of the muscular activation for the DL muscle; improvement of pain (p = 0.026); both groups significantly improved the distance walked on the 6MWT and the time on the TUG, CG (p = 0.017) and IG (p = 0.036). Conclusion: There was an improvement of balance reactions and dynamic balance in individuals with CP. (AU)