Reference Equations for the ADL-Glittre Test in Pediatric Subjects.

BACKGROUND: The ADL-Glittre test (TGlittre) was initially proposed to evaluate the activities of daily life (ADL) of adults with COPD that involve activities with the upper limbs in addition to walking. Recently, the test has been adapted for children (TGlittre-P), but no reference values have been proposed for its use in this population. The main objective of this study was to develop reference equations for the pediatric adaptation of the TGlittre. METHODS: A cross-sectional study carried out over a period of 19 months. Children 6-14 y old participated in the study. The study was rigorously controlled based on the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and on normal spirometry. Study subjects were evaluated for their biometric data (ie, weight, height, body mass index, body surface area, and length of the lower limbs) and spirometric data. Subjects then performed 2 TGlittre-P tests with an interval of 30 min between them. Statistical analysis included a Pearson correlation test to verify a correlation between time spent on the TGlittre-P and biometric variables such as gender and age. Subsequently, a multiple regression analysis was conducted for those variables. The level of signficance was set at a P of 0.05. RESULTS: Eighty-seven children (44 girls) participated in the study. Age was the predictive variable with the greatest influence on the time spent on the TGlittre-P (male: adjusted R2 = 39.6%; female: adjusted R2 = 25.2%). The following equations were established: time spent on the TGlittre-P = 3.781 - 0.083 × age (female), and time spent on the TGlittre-P = 4.025 - 0.123 × age (male). CONCLUSIONS: TGlittre-P reference equations were developed for females and males, with age being the most influential predictive variable in the test performed by children.

The validity and reliability of the ADL-Glittre test for children.

Objective: The ADL-Glittre was created to assess more comprehensively the essential activities of daily living in adults with chronic obstructive pulmonary disease. The aim of this study was to validate the ADL-Glittre test adapted for children (TGlittre-P) and verify its reliability. Methods: This is a cross-sectional study with 87 healthy children aged 6 to 14 years (mean 10.36 ± 2.32 years). Biometric and spirometry data were collected from all participants. On the same day, part of the sample (36 children included in the validation process) performed two 6MWT and two TGlittre-P (30-minute interval between them). The other part of the sample just performed two TGlittre-P for the reliability process. Pearson and Spearman correlation tests were used to verify the correlation between the time spent on the TGlittre-P and the distance walked in the 6MWT. The intraclass correlation coefficient (ICC) was also used to assess the reproducibility of the TGlittre-P. Results: The TGlittre-P showed a moderate negative correlation with the 6MWT (r = -0.490; p = 0.002; 95%CI -0.712 to -0.233). However, the behavior of the physiological variables that were monitored during the tests was similar and showed to be reproducible (ICC = 0.843; p = 0.000; 95%CI 0.695 to 0.911). Conclusion: The TGlittre-P proved to be a valid and reliable assessment of the functional capacity of healthy children aged 6 to 14 years.

Reference Equations for Impulse Oscillometry System Parameters in Healthy Brazilian Children and Adolescents.

BACKGROUND: The impulse oscillometry system is a noninvasive method of evaluating respiratory mechanics that is being increasingly used in the pediatric population. To date, no reference equations have been developed for healthy Brazilian children and adolescents. The purpose of the study was to determine the reference equations for impulse oscillometry system parameters in healthy children and adolescents. METHODS: We undertook an observational cross-sectional analytical study with healthy students age 6-14 y from educational institutions in the Greater Florianópolis area. Biometric data were evaluated (weight, height, body mass index, and body surface area) as predictors and for sample characterization. All participants were submitted to evaluation of respiratory mechanics using an oscillometry system following American Thoracic Society standards. Three tests were recorded, with data acquisition for ≥20 s. For data normality verification, the Kolmogorov-Smirnov test was applied, and Pearson's correlation test identified the relationship between the predicted values of height, age, and weight and the oscillometric variables of resistance at 5 and 20 Hz reactance; respiratory impedance at 5 Hz resonant frequency; and reactance area. Models were developed using simple linear regression and multiple analyses. RESULTS: After the recruitment of 864 children, 123 subjects with an average age of 10.0 ± 2.4 y for boys and 9.9 ± 2.4 y for girls (P = .94) were considered for final analysis. Correlations were identified between the dependent and predictor oscillometric variables, with height identified as having the greatest predictive power in the equations developed for boys in all oscillometric parameters, with a mean adjusted R(2) of 46.51%. Age had greater influence on resonant frequency (adjusted R(2) = 40.1%) and reactance area (adjusted R(2) = 48.8%) for girls. CONCLUSIONS: Reference equations were developed for males and females, and height was the most influential predictor variable for most impulse oscillometry system parameters in the population studied.

Static and dynamic postural control in low-vision and normal-vision adults.

OBJECTIVE: This study aimed to evaluate the influence of reduced visual information on postural control by comparing low-vision and normal-vision adults in static and dynamic conditions. METHODS: Twenty-five low-vision subjects and twenty-five normal sighted adults were evaluated for static and dynamic balance using four protocols: 1) the Modified Clinical Test of Sensory Interaction on Balance on firm and foam surfaces with eyes opened and closed; 2) Unilateral Stance with eyes opened and closed; 3) Tandem Walk; and 4) Step Up/Over. RESULTS: The results showed that the low-vision group presented greater body sway compared with the normal vision during balance on a foam surface (p≤0.001), the Unilateral Stance test for both limbs (p≤0.001), and the Tandem Walk test. The low-vision group showed greater step width (p≤0.001) and slower gait speed (p≤0.004). In the Step Up/Over task, low-vision participants were more cautious in stepping up (right p≤0.005 and left p≤0.009) and in executing the movement (p≤0.001). CONCLUSION: These findings suggest that visual feedback is crucial for determining balance, especially for dynamic tasks and on foam surfaces. Low-vision individuals had worse postural stability than normal-vision adults in terms of dynamic tests and balance on foam surfaces.

Static and dynamic postural control in low-vision and normal-vision adults

OBJECTIVE: This study aimed to evaluate the influence of reduced visual information on postural control by comparing low-vision and normal-vision adults in static and dynamic conditions. METHODS: Twenty-five low-vision subjects and twenty-five normal sighted adults were evaluated for static and dynamic balance using four protocols: 1) the Modified Clinical Test of Sensory Interaction on Balance on firm and foam surfaces with eyes opened and closed; 2) Unilateral Stance with eyes opened and closed; 3) Tandem Walk; and 4) Step Up/Over. RESULTS: The results showed that the low-vision group presented greater body sway compared with the normal vision during balance on a foam surface (p≤0.001), the Unilateral Stance test for both limbs (p≤0.001), and the Tandem Walk test. The low-vision group showed greater step width (p≤0.001) and slower gait speed (p≤0.004). In the Step Up/Over task, low-vision participants were more cautious in stepping up (right p≤0.005 and left p≤0.009) and in executing the movement (p≤0.001). CONCLUSION: These findings suggest that visual feedback is crucial for determining balance, especially for dynamic tasks and on foam surfaces. Low-vision individuals had worse postural stability than normal-vision adults in terms of dynamic tests and balance on foam surfaces. .

Limitations of the Neurological Evolutional Exam (ENE) as a motor assessment for first graders.

BACKGROUND: many clinicians and researchers in Brazil consider the Neurological Developmental Exam (NDE), a valid and reliable assessment for Brazilian school-aged children. However, since its inception, several tests have emerged that, according to some researchers, provide more in-depth evaluation of motor ability and go beyond the detection of general motor status (soft neurological signs). OBJECTIVES: to highlight the limitations of the NDE as a motor skill assessment for first graders. METHODS: thirty-five children were compared on seven selected items of the NDE, seven of the Bruininks-Oseretsky Test (BOT), and seven of the Visual-Motor Integration test (VMI). Participants received a "pass" or "fail" score for each item, as prescribed by the respective test manual. RESULTS: chi-square and ANOVA results indicated that the vast majority of children (74%) passed the NDE items, whereas values for the other tests were 29% (BOT) and 20% (VMI). Analysis of specific categories (e.g. visual, fine, and gross motor coordination) revealed a similar outcome. CONCLUSIONS: our data suggest that while the NDE may be a valid and reliable test for the detection of general motor status, its use as a diagnostic/remedial tool for identifying motor ability is questionable. One of our recommendations is the consideration of a revised NDE in light of the current needs of clinicians and researchers.

Limitations of the Neurological Evolutional Exam (ENE) as a motor assessment for first graders / Limitações do Exame Neurológico Evolutivo (ENE) como um instrumento de avaliação motora para crianças da primeira série

BACKGROUND: Many clinicians and researchers in Brazil consider the Neurological Developmental Exam (NDE), a valid and reliable assessment for Brazilian school-aged children. However, since its inception, several tests have emerged that, according to some researchers, provide more in-depth evaluation of motor ability and go beyond the detection of general motor status (soft neurological signs). OBJECTIVES: To highlight the limitations of the NDE as a motor skill assessment for first graders. METHODS: Thirty-five children were compared on seven selected items of the NDE, seven of the Bruininks-Oseretsky Test (BOT), and seven of the Visual-Motor Integration test (VMI). Participants received a "pass" or "fail" score for each item, as prescribed by the respective test manual. RESULTS: Chi-square and ANOVA results indicated that the vast majority of children (74 percent) passed the NDE items, whereas values for the other tests were 29 percent (BOT) and 20 percent (VMI). Analysis of specific categories (e.g. visual, fine, and gross motor coordination) revealed a similar outcome. CONCLUSIONS: Our data suggest that while the NDE may be a valid and reliable test for the detection of general motor status, its use as a diagnostic/remedial tool for identifying motor ability is questionable. One of our recommendations is the consideration of a revised NDE in light of the current needs of clinicians and researchers.

CONTEXTUALIZAÇÃO: Muitos clínicos e pesquisadores brasileiros consideram o Exame Neurológico Evolutivo (ENE), um instrumento válido e confiável para crianças brasileiras em idade escolar. Entretanto, desde a sua criação, surgiram outros testes para uma avaliação mais profunda de habilidade motora, os quais vão além de detectar status motor geral em forma de sinais neurológicos leves. OBJETIVOS: Demonstrar os pontos fracos do ENE como teste de avaliação de habilidade motora para crianças de primeira série. MÉTODOS: Trinta e cinco crianças realizaram 7 itens selecionados do ENE, 7 do teste Bruininks-Oseretsky (BOT) e 7 do Visual-Motor Integration Test (VMI), numa sessão única de 30 minutos. Para cada item, os participantes receberam a classificação "êxito" ou "fracasso", como prescrito por cada manual. RESULTADOS: Os testes chi-quadrado e ANOVA indicaram que a vasta maioria das crianças (74 por cento) passaram nos itens do ENE, enquanto os valores para os outros testes foram 29 por cento (BOT) e 20 por cento (VMI). Análises das categorias específicas (fino, visual e motor grosso) revelaram um resultado similar. CONCLUSÕES: Estes dados sugerem que, enquanto o ENE pode ser um teste válido e confiável para detecção de status motor geral, a sua atuação como instrumento diagnóstico e de encaminhamento para identificação de habilidade motora é questionável. Uma das nossas recomendações é a consideração de uma versão do ENE revisada, baseada nas necessidades atuais de profissionais clínicos e pesquisadores.

Interlimb coordination differentiates Brazilian children from two socioeconomic settings.

BACKGROUND: The aim of the present study was to test the notion that Brazilian children entering private school have a motor function advantage over those entering their first year in public school. METHODS: Four hundred and two children from the two cultural settings were examined for motor function in the first and 10th month of school (first grade). Participants were assessed based on age-level standards and by total score for all items for children 3 to 7 years of age. RESULTS: The private school group outperformed their public setting peers on the first and second assessment; both groups improved over the school year. The most interesting outcome was the type of motor task that most clearly differentiated the groups: activities requiring gross motor (interlimb) coordination. CONCLUSION: Among the recommendations given, it is suggested that motor skill activities, especially those involving interlimb coordination, be included with any type of motor programming for young children.