Manual Ability Classification System (MACS): reliability between therapists and parents in Brazil

BACKGROUND: The Manual Ability Classification System (MACS) has been widely used to describe the manual ability of children with cerebral palsy (CP); however its reliability has not been verified in Brazil. OBJECTIVE: To establish the inter- and intra-rater reliability of the Portuguese-Brazil version of the MACS by comparing the classifications given by therapists and parents of children with CP. METHOD: Data were obtained from 90 children with CP between the ages of 4 and 18 years, who were treated at the neurology and rehabilitation clinics of a Brazilian hospital. Therapists (an occupational therapist and a student) classified manual ability (MACS) through direct observation and information provided by parents. Therapists and parents used the Portuguese-Brazil version of the MACS. Intra- and inter-rater reliability was obtained using unweighted Kappa coefficient (k) and intra-class correlation coefficient (ICC). The Chi-square test was used to identify the predominance of disagreements in the classification of parents and therapists. RESULTS: An almost perfect agreement resulted among therapists [K=0.90 (95% CI 0.83-0.97); ICC=0.97 (95%CI 0.96-0.98)], as well as with intra-rater (therapists), with Kappa ranging between 0.83 and 0.95 and ICC between 0.96 and 0.99 for the evaluator with more and less experience in rehabilitation, respectively. The agreement between therapists and parents was fair [K=0.36 (95% CI 0.22-0.50); ICC=0.79 (95% CI 0.70-0.86)]. CONCLUSIONS: The Portuguese version of the MACS is a reliable instrument to be used jointly by parents and therapists. .

Parálisis cerebral / Cerebral palsy

Parálisis cerebral es un término que define una serie de trastornos motores de origen cerebral, no progresivos que constituyen la causa más frecuente de discapacidad motora en la infancia. No obstante ser una denominación “antigua”, no ha perdido vigencia ni valor si se le utiliza como término sindromático que supone un estudio etiológico acucioso y una conducta terapéutica que incluye múltiples áreas de intervención y de especialistas coordinados a fin de lograr la máxima funcionalidad posible del niño desde el punto de vista motor, intelectual, de comunicación y la máxima integración social, teniendo en cuenta que el grado de desarrollo de una sociedad se mide por el cuidado que otorga a sus minusválidos.

Cerebral palsy (CP) results from a static brain lesion during pregnancy or early life and remains the most common cause of physical disability in children. Despite being an "old" name, it has not lost its usefulness if used as syndromic term that implies a thorough etiologic study and a therapeutic approach that includes multiple areas of intervention and coordinated work of specialists in order to achieve the maximum possible functionality, optimizing motor, intellectual, communication and social integration, considering that the degree of development of a society is measured by the care given to its disabled people.

Environmental settings and families' socioeconomic status influence mobility and the use of mobility devices by children with cerebral palsy / Contextos ambientais e nível socioeconômico das famílias influenciam a mobilidade e a utilização de dispositivos de suporte por crianças com paralisia cerebral

Functional mobility of children with cerebral palsy (CP) is influenced by personal and environmental factors, serving as barriers and/or facilitators and impacting on children's strategies and functional outcome. OBJECTIVES: To describe typical mobility methods used by children with CP at home, school and community and to compare them across family's socioeconomic levels (SES). METHODS: The Functional Mobility Scale was used to assess mobility of 113 children with CP of high and low SES at home, school, and community. RESULTS: Differences in mobility methods of participants classified as Gross Motor Function Classification System levels II, III and IV were found between home and community. For levels III and IV, differences were also found between home and school. At home, participants from higher SES used wheelchairs more frequently while those from lower SES used floor mobility (crawling). CONCLUSIONS: Environmental settings and families' socioeconomic status influence mobility and use of mobility devices by children with CP.

A mobilidade funcional de crianças com paralisia cerebral (PC) é influenciada por fatores pessoais e ambientais, que servem como barreiras e/ou facilitadores e têm impacto nas estratégias e nos desfechos funcionais dessas crianças. OBJETIVOS: Descrever os métodos usuais de mobilidade usados por crianças com PC em ambiente domiciliar, escolar e comunitário, e compará-los entre famílias de diferentes níveis socioeconômicos (NSE). MÉTODOS: Foi usada a Escala de Mobilidade Funcional para avaliar a mobilidade de 113 crianças com PC de NSE alto e baixo, em casa, escola e comunidade. RESULTADOS: Foram encontradas diferenças nos métodos de mobilidade nos participantes classificados nos níveis II, III e IV do Gross Motor Function Classification System entre casa e comunidade; nos níveis III e IV, adicionalmente, foram encontradas diferenças entre casa e escola. Participantes de NSE alto relataram uso frequente da cadeira de rodas no ambiente domiciliar, enquanto os de NSE baixo usavam o engatinhar. CONCLUSÕES: Contexto ambiental e NSE das famílias podem influenciar a mobilidade e a utilização de dispositivos de suporte por crianças com PC.

Relation among the Gross Motor Function, Manual Performance and Upper Limb Functional Measures in Children with Spastic Cerebral Palsy

PURPOSE: The objective of this study was to describe hand function in relation with gross motor function and subtype of spastic cerebral palsy and to investigate the relationships among gross motor function, bimanual performance, unimanual capacity and upper limb functional measures in children with spastic cerebral palsy (CP). MATERIALS AND METHODS: We collected upper extremity data of 140 children with spastic CP. The Gross Motor Functional Classification System (GMFCS) was used to assess gross motor function, Manual Ability Classification System (MACS) for bimanual performance, and Modified House Functional Classification (MHC) for the best capacity of each hand. Upper limb functions were evaluated by using the Upper Limb Physician's Rating Scale and Upper Extremity Rating Scale. RESULTS: There was a good correlation between GMFCS and MACS in children with bilateral CP, but the correlation was not strong in children with unilateral CP. No significant difference between GMFCS and MACS was found in children with bilateral CP, but children with unilateral CP scored higher on GMFCS than on MACS. A strong correlation was observed between MACS and MHC in children with bilateral CP, but not in children with unilateral CP. The upper limb functional measures in each hand were highly related with MACS and MHC in bilateral CP, but not in unilateral CP. CONCLUSION: Gross motor function, bimanual performance and the best capacity of each hand are closely related with each other in children with bilateral CP, but not in children with unilateral CP.

Classificação do nível da mobilidade fucional dos pacientes com paralisia cerebral da Reabilitação Pediátrica da Irmandade da Santa Casa de Misericórdia de São Paulo através do Sistema de Classificação da Função Motora Grossa (GMFCS) / Rating the level of functional mobility of patients with cerebral palsy in Pediatric Rehabilitation of the Irmandade da Santa Casa de Misericórdia de São Paulo through the Classification System of gross motor function (GMFCS)

A Paralisia Cerebral é uma desordem de movimento e postura devido a uma lesão do encéfalo em desenvolvimento. O Sistema de Classificação Motora grossa é baseado no movimento auto-iniciado, com ênfase no sentar e andar, contendo cinco níveis diferenciados pela limitação funcional e necessidade de assistência externa. O objetivo deste estudo foi avaliar o nível de mobilidade fucional das crianças com paralisia cerebral do Ambulatório de Reabilitação da Irmandade da Santa Casa da Misericórdia de São Paulo através da escala GMFCS. O resultado do estudo foi que a maioria das crianças avaliadas apresentou nível 1, observando resultados semelhantes na literatura.

Análisis comparativo de puntajes GMFM-66 según sistema de clasificación de la función motora gruesa GMFFCS en Instituto Teletón Santiago 2006-2010 / Comparative analysis of GMFM-66 scores and GMFCS in Teletón Santiago Institute, 2006-2010

Introduction: The gross Motor Measure (GMFM), and two validated scales that measure gross motor developmental changes in children with cerebral palsy (CP), and are utilized to quantify therapeutic intervention results. Objetive: To analyze gross motor function scores (GMFM-66), across condiction severity levels (GMFCS), considering age, type, and CP topographical distribution, at Santiago's Teletón Institute, from 2006 to 2010. Comparison of results with that obtained in the literature, and evaluate the eventual prognostic value of both scales. Methodology: A descriptive retrospective review study of a GMFM database was conducted. A total of 397 children with CP met the inclusion criteria. GMFM-66 scores and GMFCS levels were associated according to the selected variables, and were compared to the literature. Results: 63.2 percent of the children are under 6 years of age. Hemiplegic and diplegic patients concentrate 76.6 percent of cases. According to type, 84.9 percent of patients with spastic CP. Independently from the analyzed variable, the mediam values of GMFM-66 decrease two to four time as the severity of the pathology increases from level I to level IV. Quadriplegic children are distributed among levels III and IV. No hemiplegic patients were found at level V. Compared to other studies, no significant differences were found in GMFM-66 scores across GMFCS levels. Visually, the score diagram by GMFCS levels and age is similar to Rosenbaum's. Conclusion: GMFM-66 score distribution across GMFCS levels turns out as described in the literature, however caution is suggested if used as a predictive value for individual cases.

Introducción: Gross Motor Function Measure (GMFM) Y Gross Motor Function Classification System (GMFCS) son escalas validadas que miden cambios en el desarrollo motor grueso del niño con parálisis cerebral (PC); se utilizan para cuantificar resultados de las intervenciones terapéuticas. Objetivo: Analizar puntajes de función motora gruesa (GMFM-66) por nivel de severidad de la patología (GMFCS), según edad, tipo y distribución topográfica de PC del Instituto Teletón Santiago 2006-2010, comparar con resultados obtenidos en literatura y evaluar el eventual pronóstico de ambas escalas. Metodología: Estudio descriptivo, retrospectivo de revisión a base de datos del GMFM. Un total de 397 niños con PC cumplen con requisitos de inclusión. Se relacionan puntajes de GMFM-66 por niveles de GMFCS según variables consideradas y se compara con bibliografía. Resultados: 63,2 por ciento de los niños son menores de 6 años. Pacientes con diplejía y hemiplejía concentran 76,6 por ciento. Según tipo, el 84,9 por ciento son espásticos. Independientemente de la variable analizada, los valores de las medianas de GMFM-66 disminuye entre 2 y 4 veces a medida que aumenta la severidad de la patología de nivel I a V. Los niños con cuadriplejía se distribuyen de nivel III a V; no se observan diferencias significativas de puntajes GMFM-66 por niveles de GMFCS; visualmente, el diagrama de puntajes por nivel de GMFCS y edad sería similar a Rosenbaum. Conclusión: La distribución de puntajes obtenidos en GMFM-66 por nivel de GMFCS guarda relación con estudios descritos en la literatura, pero se sugiere cautela al usarlos como valor predictivo para los casos individuales.

Risk factors and clinical patterns of cerebral palsy in children welfare teaching hospital in Baghdad

Cerebral palsy [CP] is a disorder of posture, movement and tone due to a static encephalopathy acquired during brain growth in fetal life, infancy or early childhood. To identify the risk factors of CP and its clinical patterns. This case control study was done from the 1st of January 2009 to the end of September 2009, on 100 patients with CP who attended the neurology clinic or have been admitted to the neurology ward in Children Welfare Teaching Hospital in Medical City complex, Baghdad. For comparative purposes,100 control individuals matched for sex and age were selected. Some of those patients were referred to pediatric clinic and registered with a diagnosis of CP and some of them were brought by the parents or caregivers without referral for various complaints, then we reviewed their full history and examination [mainly neurological] to confirm the diagnosis of CP. A specially designed questionnaire form was used. Out of 100 patients with cerebral palsy, male:female ratio was [1.3:1], 89% of the patients were born at term whereas 11% were preterm. Those patients were found to have history of normal vaginal delivery in 70%, with one patient only delivered by assisted delivery, while 29% of them delivered by caesarean section mode of delivery. History of intrauterine growth retardation found in 21% patients, 4% were twin. The mothers of those patients had history of pre-eclampsia in 8% of the cases, regular antenatal care in 65%, history of antipartum haemorrhage in 4%, premature rupture of membrane in 13%. Abnormal presentation was found in 8%, cord prolapse in 4%, neonatal jaundice in 62%, neonatal seizure in 8%, history of head trauma in 4% and history of central nervous system infection in 20%. Spastic CP was the commonest type [67%], while mixed and atonic CP were the least type [1% for each]. Quadriplegic CP was the commonest topographical subtype [56%]. Delayed social milestone was found in 46%, speech difficulty in 94%, deafness in 2%, ocular problem in 29%, seizure in 58% and all of them had delayed milestone and weakness. Neonatal convulsion, neonatal jaundice, neonatal infection, antepartum hemorrhage and head trauma are significant risk factors for cerebral palsy while precipitate labour, caesarean section, twins, toxemia, breech delivery, low birth weight and cord prolapse were not found to be significantly associated with cerebral palsy. The most common clinical pattern of CP was spastic quadriplegic CP

[Accompanying problems in children with cerebral palsy and their relationship to type and level of motor disability]

There are some accompanying problems in children with cerebral palsy. These problems may affect the children and their family even more than cerebral palsy. The aim of this study was to investigate the rate of six common accompanying problems and their relationship to type and level of motor function. In this study, 120 children aged 2 to 14 years old were selected from 4 rehabilitation centers in Tehran. At first consent of the child's mothers were obtained, and then child's medical history was gathered and accompanying problems were extinguished. The gross motor function level and the type of cerebral palsy were determined. The data was analyzed by SPSS-16 using kolmogrov smironov test and spearman's rho correlation coefficient. The speech disorder was the most and hearing problem was the least common among children. The type of cerebral palsy was associated significantly with intellectual disabilities, speech, feeding problems and number of problems [p<0.05].There was significant correlation between Gross motor function classification system and intellectual disabilities, speech, feeding problems, seizure and number of problems [p<0.05]. According to high occurrence of accompanying problems in children with cerebral palsy especially more severe ones, early detection and treatment of these problems could enhance the quality of life of the children and their family

Adaptação transcultural para o Brasil do Sistema de Classificação da Função Motora Grossa (GMFCS) / Cross-cultural adaptation of the Gross Motor Function Classification System into Brazilian-Portuguese (GMFCS)

CONTEXTUALIZAÇÃO: Em função da complexidade das manifestações clínicas da paralisia cerebral (PC) e das dificuldades na sua classificação baseada apenas nos tipos motores e topografia de distribuição corporal, estudiosos canadenses propuseram o Gross Motor Function Classification System (GMFCS). Apesar de esse sistema de classificação estar sendo bastante utilizado no Brasil, ele ainda não havia sido adapatado transculturalmente para tal. OBJETIVOS: Realizar a adaptação transcultural para o Brasil do Sistema de Classificação da Função Motora Grossa (GMFCS) para a PC e verificar a confiabilidade entre observadores do instrumento adaptado com crianças brasileiras. MÉTODOS: Este estudo consistiu em duas etapas, sendo a primeira relacionada com o processo de adaptação transcultural, e a segunda referente à testagem do instrumento. A adaptação transcultural do instrumento foi feita por meio da tradução, retrotradução, análise semântica, análise de conteúdo, retrotradução da versão final e aprovação dos autores do instrumento. A testagem do instrumento ocorreu junto a 40 crianças com PC, as quais foram avaliadas por dois examinadores para verificar a confiabilidade entre observadores. RESULTADOS: Os resultados demonstram que as etapas de tradução e retrotradução não apresentaram dificuldades, e a equivalência semântica e a conceitual foram obtidas. A confiabilidade entre examinadores demonstrou que as avaliações quase não diferiam e que havia excelente correlação e consistência interna do constructo, com coeficiente de correlação intraclasse (ICC) de 0,945 (com intervalo de 0,861 a 0,979) e a de Cronbach de 0,972. CONCLUSÕES: A versão final do GMFCS mostrou bom potencial de aplicabilidade por graduandos e profissionais da área de neuropediatria.

BACKGROUND: Due to the complexity of clinical symptoms of cerebral palsy and the difficulties in classifying it based upon the motor types and the topography of the body distribution only, Canadian researchers have proposed the Gross Motor Function Classification System (GMFCS). Although this classification system has been largely used in Brazil, it has not been cross culturally adapted yet. OBJECTIVES: To perform the cross adaptation of the Gross Motor Function Classification System for the Cerebral Palsy (GMFCS) into Brazilian-Portuguese and to verify the reliability among observers of the adapted instrument in Brazilian children. METHODS: This study was performed in two stages; the first stage was related to the process of cross-cultural adaptation and the second stage tested the instrument. Translation, back-translation, semantic and content analysis, back-translation of the final version and the approval of the authors were used for the cross-cultural adaptation. The test of the instrument was performed in 40 children with cerebral palsy, who were evaluated by two raters to verify the reliability among the observers. RESULTS: The results showed that the stages of translation and back-translation did not present any difficulties and the semantic and conceptual equivalence was achieved. The reliability among the observers showed that the evaluations do not differ and that there is an excellent correlation and internal consistency of the construct with an ICC of 0.945 (95 percent CI 0.861 to 0.979) and a Cronbach a of 0.972. CONCLUSIONS: The final version of the GMFCS showed good potential of applicability for undergraduate students and professionals of the neuropediatric area.

Desempeño funcional y asociación entre función motora gruesa y habilidad manual en niños con parálisis cerebral del Hogar Clínica San Juan de Dios, Lima-Perú / Functional performance and association between gross motor function and manual skills in children with cerebral palsy from the Hogar Clínica San Juan de Dios, Lima-Perú

Introduction: Children with cerebral palsy (CP) are a heterogeneous and difficult group to classify, therefore, we recommend using a functional approach based on the gross motor function and manual dexterity. We propose a transversal and descriptive study to 1) classify a population of children with CP and to determine the degree of association between Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) and 2) establish the relationship of GMFCS with age, gender, topographic distribution, predominant motor disorder and gross motor function. Patients and Methods: We evaluated 122 children (1-12 years) according to GMFCS, in the subgroup (81/122) of children over 4 years, MACS was applied. The relationship between variables was evaluated using the association test x2, and the association between GMFCS-MACS using Kappa statics with p < 0.05. Results: According to GMFCS, the level V predominates in the different groups: 44.4 percent in < 2 years, 34.8 percent in 2-4 years, and 40 percent in 6-12 years. 88.5 percent of the hemiplegic had level I or II and 75 percent of the quadriplegics had level IV or V (p < 0.01). In regards of manual dexterity, 38.3 percent had MACS I or II. In only 6.1 percent (5/81) we observed GMFCS and MACS level I. There is a relationship between the two systems, but the degree of agreement was low (weighted Kappa = 0.40). Conclusion: The use of both systems helps to functionally characterize our patients and therefore to establish impact measures in the clinical practice, reinforcing the interventions to improve the activities and participation.

Introducción: Los niños con parálisis cerebral (PC) constituyen un grupo heterogéneo de difícil clasificación, por tanto, se recomienda emplear un enfoque funcional basado en la función motora gruesa y la habilidad manual. Se plantea un estudio descriptivo de corte transversal para 1) clasificar una población de niños con PC y determinar el grado de asociación entre los sistemas Gross Motor Function Clasification System (GMFCS) y Manual Ability Classification System (MACS) y, 2) establecer la relación de GMFCS con edad, género, distribución topográfica, trastorno motor predominante y función motora gruesa. Pacientes y Métodos: Se evaluaron 122 niños (1-12 años) según GMFCS; en subgrupo (81/122) de niños mayores de 4 años, se aplicó MACS. La relación entre las variables fue evaluada con prueba de asociación basada en x2 y, la asociación GMFCS-MACS mediante estadística Kappa con p < 0,05. Resultados: Según GMFCS, el nivel V predomina en los distintos grupos: 44,4 por ciento en < 2 años; 34,8 por ciento de 2-4 años y 40 por ciento en 6-12 años. 88,5 por ciento de los hemipléjicos tenían nivel I o II y el 75 por ciento de los cuadripléjicos nivel IV o V (p <0,01). Según habilidad manual 38,3 por ciento tuvieron MACS I o II. En sólo el 6,1 por ciento (5/81) se observó un GMFCS y MACS nivel I. Existe una relación entre ambos sistemas, pero el grado de concordancia fue bajo (Kappa ponderado =0,40). Conclusión: El uso de ambos sistemas permite caracterizar funcionalmente a nuestros pacientes para establecer medidas de impacto en la práctica clínica, reforzando las intervenciones que mejoren las actividades y la participación.

Caracterização de adultos com paralisia cerebral / Caracterization of adults with cerebral palsy

CONTEXTUALIZAÇÃO: Paralisia Cerebral (PC) é um grupo de perturbações permanentes no desenvolvimento de movimentos e posturas que causam limitação nas atividades funcionais e que são atribuídas a distúrbios não-progressivos que ocorrem no cérebro fetal ou infantil. Nos últimos anos, com o aumento na expectativa de vida dos indivíduos com PC, vários estudos têm descrito a instalação de deficiências musculoesqueléticas e limitações funcionais ao longo do ciclo vital. OBJETIVO: Caracterizar adultos com PC por meio de informações sociodemográficas, classificações, saúde geral e condições associadas, complicações físicas e locomoção. MÉTODOS: Participaram deste estudo 22 adultos com PC residentes em uma cidade no interior do Brasil, recrutados nos centros de reabilitação locais. Aplicou-se um questionário para caracterização sociodemográfica, de comorbidades e complicações físicas. Além disso, realizou-se breve avaliação fisioterapêutica e aplicaram-se as classificações padronizadas, Sistema de Classificação da Função Motora Grossa (GMFCS) e Sistema de Classificação das Habilidades Manuais (MACS). Os dados foram analisados de forma descritiva. RESULTADOS: A média de idade foi de 28,7 anos, 86,4 por cento participantes moravam com os pais, 4,5 por cento possuíam emprego. A maior parte da amostra era composta por quadriplégicos espásticos, níveis IV e V do GMFCS e do MACS. Houve presença de diferentes comorbidades e importantes complicações físicas, como escoliose e contraturas musculares. Mais da metade dos participantes não deambula. Conclusões: A maioria dos participantes demonstrou ter importante restrição na participação social, além de escolaridade baixa. Adultos com PC estão sujeitos ainda a instalação de várias complicações físicas e limitações progressivas na marcha.

BACKGROUND: Cerebral Palsy (CP) is a group of permanent disorders of the development of movement and posture that cause functional limitation and are attributed to non-progressive disorders which occur in the fetal or infant brain. In recent years, with the increase in life expectancy of individuals with CP, several studies have described the impact of musculoskeletal disabilities and functional limitations over the life cycle. OBJECTIVE: To characterize adults with CP through sociodemographic information, classifications, general health, associated conditions, physical complications and locomotion. METHODS: Twenty-two adults with CP recruited from local rehabilitation centers in an inner town of Brazil participated in this study. A questionnaire was used to collect data on sociodemographic characteristics, comorbities, and physical complications. A brief physical therapy evaluation was carried out, and the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were applied. Data were analyzed through descriptive statistics. RESULTS: The mean age was 28.7 (SD 10.6) years, 86.4 percent of participants lived with parents, and 4.5 percent were employed. Most of the sample consisted of spastic quadriplegic subjects, corresponding to levels IV and V of the GMFCS and MACS. Different comorbidities and important physical complications such as scoliosis and muscle contractures were present. More than half of the participants were unable to walk. CONCLUSIONS: Most participants demonstrated important restrictions in social participation and lower educational level. Adults with CP can be affected by several physical complications and progressive limitations in gait.

Classification of cerebral palsy: association between gender, age, motor type, topography and Gross Motor Function / Classificação da paralisia cerebral: associação entre gênero, idade, tipo motor, topografia e Função Motora Grossa

The goal of this study was to assess the relation between gender, age, motor type, topography and gross motor function, based on the Gross Motor Function System of children with cerebral palsy. Trunk control, postural changes and gait of one hundred children between 5 months and 12 years old, were evaluated. There were no significant differences between gender and age groups (p=0.887) or between gender and motor type (p=0.731). In relation to body topography most children (88 percent) were spastic quadriplegic. Most hemiplegics children were rated in motor level I, children with diplegia were rated in motor level III, and quadriplegic children were rated in motor level V. Functional classification is necessary to understand the differences in cerebral palsy and to have the best therapeutic planning since it is a complex disease which depends on several factors.

Este estudo teve como objetivo avaliar a relação entre gênero, idade, tipo motor, topografia e Função Motora Grossa, baseado no Sistema de Função Motora Grossa em crianças com paralisia cerebral. Participaram desta pesquisa 100 crianças com idade entre 5 meses a 12 anos que foram observadas em relação ao controle de tronco, trocas posturais e marcha. Não houve diferenças significativas entre gêneros e grupos etários (p=0,887) e entre gênero e tipo motor (p=0,731). Em relação à topografia corporal, houve predomínio de crianças com quadriplegia, sendo que a maioria (88 por cento) era do tipo espástico. Quanto ao nível motor, as crianças hemiplégicas pertenciam em sua maioria ao nível I, as diplégicas ao nível III e as quadriplégicas ao nível V. Sendo a paralisia cerebral uma condição complexa que depende de diversos fatores, beneficia-se de classificações funcionais para compreensão da diversidade e melhor planejamento terapêutico.

Avaliação do volume inspiratório de crianças com paralisia cerebral através de diferentes técnicas / Assessment of inspiratory volume in children with cerebral palsy through different techniques

As crianças com paralisia cerebral (PC) evoluem com um conjunto de alterações neurológicas que são responsáveis pelo comprometimento motor e respiratório freqüentemente observado nesta população. Objetivo: Avaliar o volume inspiratório de crianças portadoras de PC através de diferentes técnicas incentivadoras. Materiais e métodos: Foram selecionadas crianças com PC classificadas no nível V (Gross Motor Function Classification System) que estivessem estáveis hemodinamicamente. Foram excluídas crianças que apresentassem hipersecreção pulmonar que pudesse interferir na realização das medidas. Para a avaliação do volume inspiratório foram utilizados dois recursos fisioterapêuticos distintos: Inspirômetro de incentivo a volume (IIV) e Breath Stacking (BS). Resultados: Foram avaliadas 13 crianças, com idade média de 5,61 ± 2,46 anos, sendo que 69 por cento delas tinham o diagnóstico topográfico de quadriplegia espástica e 31 por cento apresentam componente atetóide na sua classificação. Em relação ao volume inspiratório ocorreu diferença significativa (p = 0,000) entre o IIV (204,60 ± 37,10) e o BS (1134,00 ± 702). Entretanto, no IIV as crianças mobilizaram um volume correspondente a duas vezes o volume corrente mínimo pré-estabelecido para elas de acordo com o peso corporal. Conclusão: Na população estudada, o IIV se mostrou mais eficaz para avaliação do volume inspirado.

Children with cerebral palsy (CP) have a set of neurological alterations responsible for the motor disability and respiratory dysfunctions frequently observed in this population. Aim: Assessment of inspiratory volume in children with CP through different techniques. Materials and methods: Were selected children with CP classified in level V (Gross Motor Function Classification) and that were stable. Children with pulmonary excessive production of sputum that could interfere in the measures were excluded. For the assessment of the inspiratory volume two different resources were used: incentive volumetric spirometer (IVS) and breath stacking (BS). Results: 13 children with mean age of 5.61 ± 2.46 years old were studied. 69 percent had topographical diagnosis of spastic quadriplegia and 31 percent had athetoid component in their classification. About the inspiratory volume was observed differences among IVS (204.60 ± 37.10) and BS (1134.00 ± 702.00) p = 0,000. However, in the IVS the children were able to achieve a volume of two times the minimum tidal volume established according to their body weight. Conclusion: In the population studied the IVS showed efficient for assessment of the inhale volumes.

A study on patients with cerebral palsy.

A prospective study was carried-out in the department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medicine & Research (IPGMR) now Bangabandhu Sheikh Mujib Medical University (BSMMU) during a period of 9 months starting from 1st April to 31st December 1996 to find out the probable causes of Cerebral Palsy (CP), the types of CP and associated disabilities among these patients attending the department. A total of 5412 patient were treated, of them 93 (1.72%) were diagnosed as CP. Boys and girls were 62 (66.7%) and 30 (33.3%) respetively. Majority 44 (47.3%) were quadriplegic type followed by diplegic type 29 (31.1%), hemiplegic type 15 (16.1%) and athetoid type 1 (1%). Associated disabilities were mental retardation (45.1%), convulsive disorders (38.7%), speech disorders (49.4%), hearing impairment (13.9%), visual problem (8.6%) and squint (26.8%). Spastic quadriplegia was the mostsevere form with multiple disabilities found in our study.

Cerebral palsy-definition, classification, etiology and early diagnosis.

Cerebral palsy is a common neurodevelopmental condition encountered by pediatricians. The condition may present itself in many different clinical spectra. The etiological and risk factors are many and an awareness of the interplay of multiple factors in the causation of CP is crucial. In many cases, the cause of Cerebral palsy may not be apparent. Cerebral palsy is invariably associated with many deficits such as mental retardation, speech and language and oromotor problems. A thorough neurodevelopmental assessment of the child with Cerebral Palsy should include evaluation of associated deficits so that a comprehensive early intervention program an be planned and executed.

Terapias de rehabilitación en niños con o en riesgo de parálisis cerebral / Rehabilitation therapies in childrens whit or in risk of cerebral paralysis

La Parálisis Cerebral Infantil (PC) es un problema de salud importante que genera gran discapacidad en la infancia. Existen múltiples alternativas terapéuticas, sin embargo hay escasa literatura disponible que respalde la indicación de las distintas terapias de neurorehabilitación y que ayude a los médicos clínicos en la recomendación de éstas a los padres. En este artículo se revisa literatura relacionada con las indicaciones y efectos de distintas terapias. Se concluye que la calidad de la metodología de investigación es deficiente, sin embargo ha mejorado en la última década. Hasta ahora no existe evidencia que respalde la indicación de un tipo de terapia de rehabilitación motora por sobre otra, lo que no significa que se deba dejar a los niños con parálisis cerebral sin tratamiento, sino que la indicación de una terapia debe ser basada en objetivos funcionales y adaptativos, y se deben reevaluar periódicamente los resultados en forma crítica. Es fundamental participar activamente en trabajos de investigación que busquen determinar las mejores intervenciones disponibles, considerando las dificultades de la investigación clínica en rehabilitación motora. Se debe estar atento a la aparición de nuevas técnicas validadas científicamente, a fin de ofrecer a los pacientes alternativas terapéuticas racionales y fundamentadas.

Diagnóstico fonoaudiológico: reconhecimento semântico e reconhecimento de frases acusticamente distorcidas (PSI) em paralíticos cerebrais / Fonoaudiologico diagnosis: semantic recognition assesment and pediatric syntetic intelligibility test (PSI) in cerebral palsy

O objetivo deste estudo foi avaliar o processo receptivo de paralíticos cerebrais por meio de Provas de Reconhecimento Semântico e Inventário de Habilidades Semânticas e do Teste Pedíatric Syntetic íntellibility (PSI). Foram avaliados 80 indivíduos classificados de acordo com o tipo e grau da paralisia cerebral: 62 espásticos, sendo 26 quadriplégicos, 18 diplégicos e 18 hemiplégicos e 18 atetóides e o grupo-controle formado de 61 indivíduos. A avaliação da linguagem receptiva apontou para a grande variabilidade das habilidades lingüísticas, nestes indivíduos, sendo que apresentaram pior desempenho respectivamente os quadriplégicos; atetóides, diplégicos e hemiplégicos. Na avaliação da audição periférica por meio da Audiometria tonal Limiar, quando consideradas todas as freqüências testadas (O.25 a 8kHz), observou - se perda auditiva em mais de 50 por cento, nos quadriplégícos, diplégicos e atetóides e em 12 por cento nos hemiplégicos. A configuração da curva audiométrica descendente foi encontrada em 79 por cento dos indivíduos avaliados. No testes do PSI MCC os resultados indicaram normalidade para a orelha direita e esquerda em 8 por cento e 17 por cento nos quadriplégicos; 38 por cento e 44 por cento nos diplégicos; 53 por cento e 65 por cento nos hemíplégicos e 27 por cento em ambas as orelhas nos atetóides. No teste PSI - MCI apresentaram normalidade para a orelha direita e esquerda 29 por cento e 12 por cento nos diplégicos; 6 por cento e 12 por cento nos hemiplégicos e 27 por cento e 27 por cento nos atetóides. Nenhum quadriplégico conseguiu índices de normalidade nesta condição