Percepção de cuidadores de pré-escolares com TEA sobre seu comportamento e desempenho ocupacional durante a pandemia da COVID-19 / Perception of caregivers of preschool children with ASD on their behavior and occupational performance during the COVID-19 pandemic

Resumo Introdução Crianças com Transtorno do Espectro Autista (TEA) podem apresentar questões comportamentais, no processamento sensorial, na cognição e na linguagem, que afetam seu desempenho ocupacional, necessitando de acesso a serviços escolares, terapêuticos e de saúde. O acesso a esses serviços esteve restrito durante a pandemia de COVID-19, tornando essa população particularmente ainda mais vulnerável às restrições sociais impostas à época. Objetivo Descrever a percepção dos pais cuidadores de pré-escolares com TEA acerca do comportamento e desempenho ocupacional de seus filhos durante a pandemia da COVID-19. Método Estudo transversal, descritivo, quantitativo e qualitativo baseado em entrevistas com 60 cuidadores de pré-escolares com TEA. Os participantes responderam à seguinte pergunta: Você está notando alguma diferença no comportamento e desempenho da criança durante a pandemia? Para caracterização das crianças, foram utilizados o Sistema de Classificação de Funcionalidade no Autismo: Comunicação Social (ACSF:SC), o Inventário de Avaliação Pediátrica de Incapacidade - Teste Adaptativo de Computador (PEDI-CAT) e o Perfil Sensorial 2 (SP-2). Todas as entrevistas foram anotadas e 15 delas foram gravadas e transcritas. O material foi submetido à análise temática de conteúdo. Resultados Foram entrevistadas 43 mães, 15 casais e dois pais de crianças com TEA. Das 60 crianças, 46 (76,7%) eram meninos, com idade de 3 a 5 anos (53,6 ±10,18 meses). Os cuidadores perceberam mudanças no comportamento e desempenho ocupacional, com prevalência de relatos de piora. Houve aumento nas estereotipias, rigidez e hiperfoco, bem como menor engajamento nas atividades cotidianas. A presença dos cuidadores beneficiou algumas crianças, mas há relato de estresse, especialmente por parte das mães. Conclusão Houve variação nos relatos, com maior tendência à piora no comportamento e desempenho ocupacional das crianças com TEA.

Abstract Introduction Children with Autism Spectrum Disorder (ASD) face behavioral, sensory processing, cognitive, and language challenges that affect their ability to perform activities of daily living (ADL) and necessitate access to educational, therapeutic, and health services. The COVID-19 pandemic limited access to these essential services, exacerbating the challenges faced by this vulnerable population due to imposed social distancing measures. Objective To explore the perceptions of parent caregivers of preschoolers with ASD regarding their children's behavior and performance in ADL during the COVID-19 pandemic. Method This cross-sectional, descriptive study utilized both quantitative and qualitative approaches, interviewing 60 caregivers of preschoolers with ASD. Participants were asked about any observed changes in their child's behavior and ability to engage in ADL during the pandemic. Child characterization involved the Autism Classification System of Functioning: Social Communication (ACSF:SC), the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT), and the Sensory Profile 2 (SP-2). Interviews were documented, with 15 recorded and transcribed for thematic content analysis. Results Participants included 43 mothers, 15 couples, and two fathers, totaling 60 children, of whom 46 (76.7%) were boys aged between 3 and 5 years (mean age 53.6 ±10.18 months). Caregivers reported changes in behavior and performance in ADL, predominantly noting deterioration. Increases in stereotypic behaviors, rigidity, and hyperfocus were observed, along with decreased participation in ADL. While the presence of caregivers benefited some children, it also led to reported stress, particularly among mothers. Conclusion The study found a predominant trend of deteriorating behavior and performance in ADL among children with ASD during the pandemic, based on caregiver reports.

Terapia motora cognitiva: descrição e análise clínica de crianças com Transtorno do Desenvolvimento da Coordenação (TDC), / Cognitive motor therapy: description and clinical analysis of children with Developmental Coordination Disorder (DCD)

Resumo Introdução Estima-se que 6% das crianças em idade escolar apresentam Transtorno do Desenvolvimento da Coordenação (TDC), caracterizado por dificuldades motoras que restringem a participação em casa, na comunidade e na escola. A Cognitive Orientation to Daily Occupational Performance Approach (CO-OP) é efetiva para melhorar o desempenho funcional dessas crianças, mas há poucos dados clínicos sobre variações na resposta à intervenção. Objetivo Identificar e descrever as características mais relevantes de crianças com TDC que influenciam sua resposta à CO-OP. Método Estudo de caso conduzido com quatro crianças com TDC submetidas à CO-OP: as duas que obtiveram maior e menor ganho com a intervenção. Os dados obtidos no estudo foram categorizados e sintetizados para compor uma descrição clínica das características dos participantes. Resultados Os pais das crianças com melhor desempenho apresentaram melhor estilo parental. A observação não estruturada das pesquisadoras durante as coletas identificou que as famílias das crianças com maior progresso compareceram mais vezes às coletas e eram mais engajadas. Maior apoio familiar parece proporcionar mais confiança às crianças, além de aumentar a motivação para alcançar os objetivos em terapia. Conclusão O apoio oferecido pelos pais é fator relevante para o bom desempenho de crianças com TDC na intervenção usando a CO-OP. A descrição clínica de crianças com TDC auxilia o raciocínio durante a prática profissional por identificar características que podem influenciar o progresso na intervenção.

Abstract Introduction It is estimated that 6% of school-age children have Developmental Coordination Disorder (DCD), characterized by motor difficulties that restrict participation at home, in the community and at school. The Cognitive Orientation to Daily Occupational Performance Approach (CO-OP) is effective in improving the functional performance of these children, but there is little clinical data on variations in the response to the intervention. Objective To identify and describe the most relevant characteristics of children with DCD that influence their response to CO-OP. Method Case study conducted with four children with DCD who underwent CO-OP: the two who had the highest gain and the two who had the lowest gain with the intervention. The data obtained in this study were categorized and synthesized to compose a clinical description of the participants' characteristics. Results Parents of children with better performance showed better parenting style. Unstructured observation of the researchers during the collections showed that the families of the children with greater progress attended the collections more often and were more engaged. Greater family support seems to provide children with more confidence, as well as increase motivation to achieve goals in therapy. Conclusion The support offered by parents is a relevant factor for the good performance of children with DCD in the intervention using the CO-OP. The clinical description of children with DCD assists in the reasoning during professional practice because it identifies characteristics that can influence progress in the intervention.

Cross-cultural validation of the Brazilian Little Developmental Coordination Disorder Questionnaire (LDCDQ-BR) for preschool children.

INTRODUCTION: Motor difficulties associated with Developmental Coordination Disorder (DCD) are frequently apparent before the accepted diagnostic age of 5. Tools to support identification of DCD markers would allow provision of early intervention to reduce negative sequelae. OBJECTIVE: Establish psychometric properties and define preliminary cut-off scores for the Brazilian Little Developmental Coordination Disorder Questionnaire - Brazil (LDCDQ-BR). METHODS AND PROCEDURES: Parents of 3- and 4-year-old children (n = 312; 154 girls) from Belo Horizonte/MG, Brazil, completed the LDCDQ-BR, the Brazil Economic Classification Criterion and a demographic questionnaire. One sub-set of children (n = 119) was assessed with the Movement Assessment Battery for Children-2nd Edition; another sub-set (n = 77) completed the LDCDQ-BR a second time. RESULTS: Rasch analysis indicated good item functioning with only one erratic item, suggesting unidimensionality. Item calibration reliability was excellent (0.97), children's measures reliability was low (0.72), but implying separation of 2.46 motor ability levels. Significant, low correlations were found between the LDCDQ-BR and MABC-2 (r = 0.30, p < 0.01). Test-retest reliability was 0.77 (total score) and 0.44-0.78 (individual items). ROC curve analysis revealed sensitivity of 68% at a cut-off score of 64. CONCLUSION: The LDCDQ-BR shows promising psychometric properties to support early identification of DCD.

Terapia Ocupacional e telessaúde: relato de experiência de atendimento a criança com transtornos do desenvolvimento / Occupational therapy in telehealth: experience report of care for children with development disorders / Terapia ocupacional y telesalud: informe de experiencia de servicio a niños con transtornos del desarrollo

Contextualização: Relato de experiência do estágio obrigatório do Curso de Graduação em Terapia Ocupacional e da Especialização em Transtorno do Espectro do Autismo (TEA) da Universidade Federal de Minas Gerais. Processo de Intervenção: Participaram 8 estagiários de graduação, 1 terapeuta ocupacional pós-graduanda em TEA e uma docente terapeuta ocupacional, prestando atendimentos remotos a 14 crianças de 1 a 9 anos de idade e suas famílias. As intervenções ocorreram de maneira síncrona, assíncrona ou ambas. Análise crítica da prática: foram observados resultados positivos no desenvolvimento de habilidades das crianças, bem como em seu desempenho e satisfação, avaliados pela Medida Canadense de Desempenho Ocupacional. Síntese de considerações: O estágio no formato telessaúde possibilitou a continuidade das intervenções das crianças previamente atendidas, capacitar pais e cuidadores, além de averiguar possibilidades de atuação em terapia ocupacional pediátrica nesta modalidade, no contexto da COVID-19.(AU) Palavras-chave: telessaúde; terapia ocupacional; transtornos do desenvolvimento

Contextualization: Experience report of the mandatory internship of the Undergraduate Course in Occupational Therapy and of the Specialization in Autism Spectrum Disorder (ASD) of Universidade Federal de Minas Gerais Intervention Process: 8 undergraduate interns participated, 1 occupational therapist specializing in ASD and a teaching occupational therapist, providing remote assistance to 14 children aged 1 and 9 years and their families. The interventions took place in a synchronous, asynchronous or both ways. Critical analysis of the practice: positive results were observed in the development of children's skills, as well as in their performance and satisfaction, assessed by the Canadian Occupational Performance Measure. Summary of considerations: The internship in the telehealth format made it possible to continue the interventions of children previously attended, to train parents and caregivers, in addition to investigating possibilities of work in pediatric occupational therapy in this modality, in the context of COVID-19.(AU) Keywords: telehealth; occupational therapy; developmental disorder

Contextualización: Antecedentes: Informe de experiencia de la pasantía obligatoria del Curso de Grado en Terapia Ocupacional y de la Especialización en Trastorno del Espectro Autista (TEA) da Universidade Federal de Minas Gerais. Proceso de intervención: participaron 8 pasantes de pregrado, 1 terapeuta ocupacional especialista en TEA y un terapeuta ocupacional docente, brindando asistencia remota a 14 niños de 1 y 9 años y sus familias. Las intervenciones se produjeron de forma sincrónica, asincrónica o en ambos sentidos. Análisis crítico de la práctica: se observaron resultados positivos en el desarrollo de las habilidades de los niños, así como en su desempeño y satisfacción, evaluados por la Canadian Occupational Performance Measure. Resumen de consideraciones: La pasantía en el formato de telesalud permitió continuar las intervenciones de los niños previamente atendidos, capacitar a los padres y cuidadores, además de investigar posibilidades de trabajo en terapia ocupacional pediátrica en esta modalidad, en el contexto de COVID- 19.(AU) Palabras clave: telesalud; terapia ocupacional; trastornos del desarrollo

Efficacy of CO-OP Approach With and Without Parental Coaching: RCT Study Protocol: Efficacité de l'approche CO-OP avec et sans coaching parental : protocole d'essai clinique randomisé.

BACKGROUND.: Developmental coordination disorder (DCD) leads to decreased occupational performance and restricted participation. Cognitive Orientation to daily Occupational Performance Approach (CO-OP) is effective, and as parental support is a key element, it seems relevant to investigate. PURPOSE.: To describe a study protocol that will compare CO-OP with and without Occupational Performance Coaching (OPC) on activity and participation of children with DCD. METHOD.: Randomized controlled with seven to 12-year-olds, assigned to either experimental (CO-OP+OPC) or control (CO-OP) group, both receiving traditional CO-OP, with four additional parental group sessions for the experimental group. KEY ISSUES.: Actual and perceived occupational performance and satisfaction of children's chosen goals and participation, motor performance and executive function. Measures will be obtained at baseline, post-intervention, and at 3-month follow-up. IMPLICATIONS.: Detailed description of an intervention protocol may help further replication and may contribute to clarify if a boost on parents' participation promotes better outcomes for children with DCD. TRIAL REGISTRATION.: Clinical Trials, NCT02893852. (https://clinicaltrials.gov/ct2/show/NCT02893852).

Efficacy of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach with and without parental coaching on activity and participation for children with developmental coordination disorder: A randomized clinical trial.

BACKGROUND: Cognitive Orientation to daily Occupational Performance (CO-OP) is recommended for its effectiveness in improving activity performance in children with Developmental Coordination Disorder (DCD). Since parental support is a key element in CO-OP, parental coaching seems relevant to be investigated. AIMS: Compare the efficacy of the CO-OP Approach with and without additional parental coaching to improve activity and participation in children with DCD. METHODS AND PROCEDURES: Randomized clinical trial with 7-12-years-old children with DCD, randomly assigned to experimental (E-group) or active control (AC-group) groups, with 11 children each. Both groups received traditional CO-OP, E-group received four additional parental group-coaching sessions. Occupational performance and satisfaction on intervention goals were measured at baseline, post-intervention, and follow-up. Participation, motor performance and executive function were assessed at baseline and post-intervention. OUTCOMES AND RESULTS: CO-OP with and without additional parental coaching resulted in improved occupational performance according to children, parents, and external evaluators. Children showed statistically significant gains in motor performance and cognitive flexibility. Participation measures did not change. CONCLUSIONS AND IMPLICATIONS: As coaching did not add additional gains, parent's required participation in CO-OP might be enough to support children's occupational performance.

Relação entre integração visomotora e destreza manual em crianças com transtorno do desenvolvimento da coordenação / Relationship between visual-motor integration and manual dexterity in children with developmental coordination disorder

Resumo O objetivo deste estudo foi examinar as habilidades de integração visomotora e destreza manual em crianças com Transtorno do Desenvolvimento da Coordenação (TDC). Estudo descritivo transversal com 22 crianças de 7 a 11 anos com TDC, avaliadas com o Developmental Coordination Disorder Questionnaire (DCDQ-Brasil), Movement Assessment Battery for Children Second Edition (MABC-2) e Beery-Buktenica Developmental Test of Visual-Motor Integration Sixth Edition (VMI). A amostra contou com 4 meninas e 18 meninos. Considerando o percentil 25 no VMI como ponto de corte, 12 crianças apresentaram desempenho abaixo da média no domínio integração visomotora, 13 no domínio visual e 19 no domínio de coordenação motora. Foi observada correlação significativa entre o percentil de destreza motora e o percentil total do MABC-2, mas não entre os escores do MABC-2 e os diferentes domínios avaliados com o VMI. Os resultados sugerem que é necessário e importante o uso combinado de testes para melhor avaliação das crianças com TDC, a fim de detectar suas possíveis dificuldades na integração visomotora e destreza manual e suas implicações no desempenho de tarefas funcionais das crianças no dia a dia.

Abstract This study aimed to examine the visual-motor integration and manual dexterity skills in children with Developmental Coordination Disorder (DCD). A cross-sectional descriptive study of 22 children aged 7 to 11 years old with DCD, assessed with the Brazilian version of the Developmental Coordination Disorder Questionnaire (DCDQ-Brazil), Movement Assessment Battery for Children Second Edition (MABC-2) and Beery-Buktenica Developmental Test of Visual-Motor Integration Sixth Edition (VMI). Four girls and 18 boys participated. Considering the 25th percentile in VMI as the cutoff point, 12 children presented a below-average performance in the visual-motor integration domain, 13 in the visual domain, and 19 in the motor coordination domain. We observed a statistically significant correlation between the motor dexterity and the total MABC-2 percentiles, but not between the MABC-2 percentiles and the different domains evaluated with the VMI. The results suggest that the combined use of tests for better assessment of children with DCD is needed and important to detect their real difficulties in both visuomotor integration and manual dexterity and their implications on the performance of children's daily activities.

Adaptação transcultural do instrumento Autism Classification System of Functioning: Social Communication (ACSF: SC) para uso no Brasil / Cross-cultural adaptation of Autism Classification System of Functioning: Social Communication (ACSF: SC) for use in Brazil

Resumo Objetivo Realizar a adaptação transcultural do instrumento: Autism Classification System of functioning: Social communication (ACSF: SC), que permite classificar o nível da função da comunicação social de crianças com transtorno do espectro autista (TEA), para uso no Brasil. Método Estudo metodológico de adaptação transcultural do instrumento ACSF: SC. Foram seguidas recomendações para adaptação transcultural de protocolos da área da saúde, que incluiu a permissão assegurada, tradução, tradução reversa, revisão e painel de especialistas. Resultados A avaliação dos especialistas evidenciou que a versão traduzida do instrumento ACSF: SC foi bem compreendida conceitualmente e adequada culturalmente, com 48 frases apresentando índice de concordância maior que 90% quanto à equivalência conceitual e cultural. Frases que não obtiveram níveis adequados de concordância foram revisadas, conforme sugestões dos especialistas. Conclusão A equivalência entre o instrumento ACSF: SC original e a tradução está garantida, obtendo índice de concordância acima de 90%. O instrumento estará apto para uso clínico em breve, após validação de suas propriedades de medida.

Abstract Objective To conduct a cross-cultural adaptation of the instrument: Autism Classification System of functioning: Social communication (ACSF: SC), which allows clinicians to classify the level of the social communication function of children with autism spectrum disorder (ASD), for its use in Brazil. Method Methodological study of cross-cultural adaptation of the instrument ACSF: SC. We followed recommendations for transcultural adaptation of health protocols, which included assured permission, translation, reverse translation, review, and panel of experts. Results The evaluation of the experts revealed that the translated version of the ACSF: SC instrument was well understood conceptually and culturally adequate, with 48 sentences presenting a concordance index greater than 90% regarding conceptual and cultural equivalence. Phrases that did not achieve adequate levels of agreement were reviewed, according to experts' suggestions. Conclusion Equivalence between the original ACSF: SC and its translated into Brazilian Portuguese is guaranteed, as it reached a concordance index above 90%. The Brazilian version of the ACSF: SC will be suitable for clinical use once its psychometrics properties are established.

Impacts of Chronic Kidney Disease on occupational performance of children and adolescents on hemodialysis / Impactos da Doença Renal Crônica no desempenho ocupacional de crianças e adolescentes em hemodiálise

Abstract Introduction: Chronic Kidney Disease (CKD) may cause great impacts on areas of occupational performance of children and adolescents on hemodialysis. The identification of these occupations can guide the practice of occupational therapy, enabling specific interventions as well as the creation of policies and guidelines in the field. Objective: To identify the impact of CKD on the occupational performance of children and adolescents on hemodialysis. Method: Twenty-one children and adolescents with CKD undergoing hemodialysis treatment participated in the study. The tools applied were the profile identification questionnaire and the semi-structured interview Canadian Measurement of Occupational Performance (COPM). Numerical variables were described as measures of central tendency and dispersion, and for categorical variables were calculated the frequencies. Results: 13 impacted occupations were identified, in which 9 are related to play/leisure , 1 to productivity/ school, 3 to self-care. In addition, 57% of the sample dropped out of school and 23% repeated one school year or more. Conclusion: Impacts on different areas of occupational performance, mainly related to play and leisure, have been identified. Children and adolescents present specific demands related to their age ranges. Therefore, the occupational therapist, considering this specificity, can enable these clients to improve their performance in occupations and resume significant roles in their lives.

Resumo Introdução: O acometimento pela Doença Renal Crônica (DRC) pode trazer impactos importantes em áreas de desempenho ocupacional de crianças e adolescentes em tratamento hemodialítico. A identificação dessas áreas de desempenho prejudicadas pode direcionar a atuação da terapia ocupacional, possibilitando intervenções específicas e criação de políticas e diretrizes na área. Objetivo: Identificar o impacto da DRC no desempenho ocupacional de crianças e adolescentes em hemodiálise. Método: Participaram do estudo 21 crianças e adolescentes com DRC em tratamento via hemodiálise. Os instrumentos utilizados foram o questionário de identificação do perfil da amostra e a entrevista semiestruturada Medida Canadense de Desempenho Ocupacional (COPM). Os dados da pesquisa foram analisados por meio do programa estatístico SSPS 22.0. As variáveis numéricas foram descritas como medidas de tendência central e dispersão, e para variáveis categóricas foram calculadas as frequências. Resultados: Foram identificadas 13 ocupações impactadas, das quais, 9 são relacionadas à área do brincar/lazer , 1 produtividade/escola e 3 ocupações da área de autocuidado. Além disso, 57% da amostra abandonaram a escola e 23% repetiram um ano escolar ou mais. Conclusão: Foram identificados prejuízos em diferentes áreas do desempenho ocupacional, principalmente relacionadas ao brincar e lazer. As crianças e adolescentes apresentam demandas específicas dessa faixa etária e o terapeuta ocupacional, considerando essa especificidade, pode possibilitar a esses clientes a melhoria de desempenho em ocupações e a retomada de papéis significativos em suas vidas.

Efficacy of the cognitive orientation to daily occupational performance with Brazilian children with developmental coordination disorder.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) have difficulties performing daily activities which reflects negatively on participation, impacting their lives. OBJECTIVES: To examine the effects of the cognitive orientation to daily occupational performance Approach (CO-OP Approach) protocol on occupational performance and satisfaction of Brazilian children who have DCD; to examine whether children could transfer strategies and skills learned during CO-OP to untrained goals. METHODS: A pre-post group comparison design with eight boys aged 6-10 years old. Children participated in 12 CO-OP sessions with their parents twice a week, with an extra session added to the protocol for parents´ orientation. The Canadian Occupational Performance Measure and the Performance Quality Rating Scale were used as outcome measures. The study was registered by the United States Institutes of Health at ClinicalTrials.gov (NCT03112746). RESULTS: Intervention resulted in higher, clinically and statistically significant, occupational performance measures according to parents, children's, and external evaluators' perspectives. All children improved occupational performance on their selected goals and five children could transfer the ability to use cognitive strategies to tasks not addressed in therapy. CONCLUSIONS: This study provides initial directions for future research to investigate the applicability and to implement CO-OP approach on pediatric settings in Brazil.

Clinical application of the Newborn Behavioral Observation (NBO) System to characterize the behavioral pattern of newborns at biological and social risk / Aplicação clínica do Newborn Behavioral Observation (NBO) System para caracterizar o padrão comportamental dos recém-nascidos de risco biológico e social

Abstract Objective To compare the behavior of preterm newborns and full-term newborns using the Newborn Behavioral Observation and to evaluate the mothers' experience when participating in this observation. Method This was a cross-sectional study performed at a referral hospital for high-risk births, involving mothers and neonates before hospital discharge. The mothers answered the sociodemographic questionnaire, participated in the Newborn Behavioral Observation session, and evaluated the experience by answering the parents' questionnaire at the end. The characteristics of the preterm newborn and full-term newborn groups and the autonomic, motor, organization of states, and responsiveness scores were compared. Linear regression was performed to test the association of the characteristics of mothers and neonates with the scores in the autonomic, motor, organization of states, and responsiveness domains. Results The Newborn Behavioral Observation was performed with 170 newborns (eight twins and 77% preterm newborns). Approximately 15% of the mothers were adolescents and had nine years of schooling, on average. The groups differed regarding weight for gestational age, age at observation, APGAR score, feeding, and primiparity. The linear regression adjusted for these variables showed that only prematurity remained associated with differences in the scores of the motor (p = 0.002) and responsiveness (p = 0.02) domains. No statistical difference was observed between the groups in the score attributed to one's own knowledge prior to the session (p = 0.10). After the session, these means increased in both groups. This increase was significantly higher in the preterm newborn group (p = 0.02). Conclusions The Newborn Behavioral Observation increased the mothers' knowledge about the behavior of their children, especially in mothers of preterm newborns, and identified differences in the behavior of preterm newborns and full-term newborns regarding the motor and responsiveness domains.

Resumo Objetivo Comparar o comportamento de recém-nascidos pré-termo e a termo utilizando a Newborn Behavioral Observation e avaliar a experiência das mães em participar dessa observação. Método Estudo transversal realizado em hospital de referência para partos de risco, envolvendo mães e neonatos antes da alta hospitalar. As mães responderam ao questionário sociodemográfico, participaram da sessão de Newborn Behavioral Observation e ao final avaliaram a experiência e responderam ao questionário de pais. As características dos grupos de recém-nascidos pré-termo e recém-nascidos termo e os escores dos domínios autonômico, motor, organização dos estados e responsividade foram comparados. Realizou-se regressão linear para testar a associação de características das mães e neonatos com os escores nos domínios autonômico, motor, organização dos estados e responsividade. Resultados A Newborn Behavioral Observation foi realizada com 170 recém-nascidos (oito gemelares e 77% pré-termo). Cerca de 15% das mães eram adolescentes e estudaram em média por 9 anos. Os grupos diferiram quanto ao peso para idade gestacional, idade na observação, APGAR, alimentação e primiparidade. A regressão linear ajustada para essas variáveis mostrou que apenas a prematuridade manteve-se associada a diferenças nos escores dos domínios motor (p = 0,002) e responsividade (p = 0,02). Não houve diferença estatística entre os grupos na pontuação atribuída ao próprio conhecimento antes da sessão (p = 0,10). Após a sessão estas médias subiram em ambos os grupos. Esse aumento foi significativamente maior no grupo de recém-nascidos pré-termo (p = 0,02). Conclusões A Newborn Behavioral Observation aumentou o conhecimento das mães sobre o comportamento dos filhos, principalmente para as mães de recém-nascidos pré-termo, e identificou diferenças no comportamento de recém-nascidos pré-termo e recém-nascidos termo nos domínios motor e responsividade.

Evasão em ambulatório de seguimento do desenvolvimento de pré-termos: taxas e causas / Drop out in a clinic of preterm development follow-up: rates and causes

[{"text": "Objetivo: Realizar levantamento da taxa de evasão e investigar suas possíveis causas em programa\r\nde acompanhamento do desenvolvimento de recém-nascidos pré-termo. Método: Estudo descritivo, com uso de\r\nmetodologia quanti-qualitativa, desenvolvido em ambulatório multidisciplinar de acompanhamento de crianças\r\nnascidas pré-termo. Foi feito levantamento das evasões ocorridas de janeiro de 2009 a dezembro de 2015. Pais de\r\ncrianças que se evadiram foram entrevistados sobre o motivo da evasão. Para comparar características dos grupos de\r\ncrianças de evasão e em seguimento foram usados teste-t (variáveis contínuas) e qui-quadrado (variáveis categóricas),\r\ne análise de conteúdo foi usada para os dados obtidos nas entrevistas. Resultados: A taxa global de evasão ao\r\nlongo dos sete anos foi de 43,7%, atingindo 60,5% quando se considera apenas as crianças que entraram em 2009.\r\nHouve diferenças significativas entre os grupos de evasão e de seguimento em relação à idade e grau de instrução\r\ndas mães. As entrevistas permitiram identificar motivos para evasão relacionados a aspectos socioeconômicos e à\r\norganização do serviço de saúde. Conclusão: Melhor organização do serviço, estabelecimento de rotinas e objetivos\r\ncompartilhados por toda equipe podem contribuir para manter a adesão ao seguimento. Equipes multidisciplinares\r\nde programas de seguimento, como do ACRIAR, devem reconhecer os desafios sociais e familiares enfrentados\r\npela população atendida, sendo importante manter trabalho constante de sensibilização das famílias acerca da\r\nnecessidade do acompanhamento.", "_i": "pt"}, {"text": "Objective: To make a survey of the dropping out rate and investigate its possible causes in preterm\r\ninfants follow-up program. Method: Descriptive study, using quantitative and qualitative methodology, developed\r\nin a follow-up preterm born children ambulatory. A survey of evasions occurred from January 2009 to December\r\n2015 was done. Parents of children who dropped out were interviewed about the reason of evasion. To compare\r\ncharacteristics of children groups of drop out and follow-up, t-test (continuous variables) and chi-square test (categorical\r\nvariables) were used, and content analysis was used for the data obtained in the interviews. Results: The overall rate\r\nof evasion over the seven years was 43.7%, reaching 60.5% when considering only children who entered in 2009.\r\nThere were significant differences between drop out and follow-up groups in relation to age and education of the\r\nmothers. The interviews enable to identify reasons for evasion related to socioeconomic factors and health service\r\norganization. Conclusion: Better service organization, establishing routines and shared goals for the whole team,\r\ncan contribute to maintain the adhesion to the follow-up program. Multidisciplinary teams of follow-up programs,\r\nsuch as ACRIAR should recognize the social and family challenges faced by population served, being important to\r\nmaintain a constant awareness work to raise awareness of the families about the necessity of the follow-up program.", "_i": "en"}]

Observação do comportamento neonatal: adaptação transcultural do newborn behavioral observations / Observation of neonatal behavior: cross-cultural adaptation of the newborn behavioral observations

RESUMO Objetivo: Realizar a adaptação transcultural para a língua portuguesa brasileira dos protocolos do sistema Newborn Behavioral Observations (NBO), novo recurso para observação do comportamento do bebê e compartilhamento de informações com os pais. Métodos: Estudo metodológico de tradução e adaptação transcultural do sistema NBO, que inclui o Formulário de Registro, com 18 itens, o Guia de Registro, com instruções para pontuação de cada item, o Sumário para os Pais, para registro de sugestões e orientações decorrentes da observação, e o Questionário de Pais, para avaliação da experiência. Foram seguidas as recomendações internacionais para adaptação transcultural de protocolos da área de saúde, o que incluiu solicitação de autorização para tradução aos autores, tradução, retrotradução e pré-teste, seguido de avaliação externa por painel de especialistas, que avaliou a qualidade da adaptação de cada item, com cálculo do índice de concordância entre os avaliadores quanto à equivalência conceitual e cultural. Resultados: A avaliação do painel de especialistas evidenciou que a versão adaptada transculturalmente do sistema NBO foi bem compreendida conceitualmente e adequada culturalmente, com 140 (77,8%) itens apresentando índice de concordância maior que 90% quanto à equivalência conceitual e cultural. Itens que não obtiveram níveis adequados de concordância foram revisados conforme sugestões dos especialistas. Conclusões: A versão brasileira do sistema NBO pode ser utilizada com segurança, já que a metodologia empregada foi rigorosa, garantindo equivalência entre o original e a tradução. O sistema NBO está pronto para ser usado clinicamente, podendo contribuir para a melhora de qualidade da assistência materno-infantil.

ABSTRACT Objective: To conduct the cross-cultural adaptation for Brazilian Portuguese of the Newborn Behavioral Observations (NBO), a new resource for observing neonatal behavior and sharing information with parents. Methods: Methodological study of translation and cultural adaptation of the NBO system, which includes the Recording Form, with 18 items, the Recording Guidelines, with instructions to score each item, the Summary Form, to record suggestions based on the observation, and the Parent Questionnaire, to record the parents' experiences. The adaptation process followed international recommendations for cross-cultural adaptation of health care protocols, which included requesting permission from the authors, translation, back translation and pre-test, followed by external evaluators who scored the quality of the adaptation, which was analyzed quantitatively. The quality of the adaptation of the instruments' items was evaluated by the index of agreement between evaluators for conceptual and cultural equivalence. Results: Expert panel evaluation showed that the cross-cultural adaptation of the NBO protocols was both well understood conceptually and culturally appropriate, with 140 (77.8%) items presenting concordance index higher than 90% for conceptual and cultural equivalence. Items that did not reach adequate level of agreement were revised according to experts' suggestions. Conclusions: The Brazilian version of the NBO system can be safely used, since the methodology was rigorous enough to ensure equivalence between the original and translated versions. The NBO should be tried in clinical practice, as it can contribute to improve the quality of maternal and child care.

Clinical application of the Newborn Behavioral Observation (NBO) System to characterize the behavioral pattern of newborns at biological and social risk.

OBJECTIVE: To compare the behavior of preterm newborns and full-term newborns using the Newborn Behavioral Observation and to evaluate the mothers' experience when participating in this observation. METHOD: This was a cross-sectional study performed at a referral hospital for high-risk births, involving mothers and neonates before hospital discharge. The mothers answered the sociodemographic questionnaire, participated in the Newborn Behavioral Observation session, and evaluated the experience by answering the parents' questionnaire at the end. The characteristics of the preterm newborn and full-term newborn groups and the autonomic, motor, organization of states, and responsiveness scores were compared. Linear regression was performed to test the association of the characteristics of mothers and neonates with the scores in the autonomic, motor, organization of states, and responsiveness domains. RESULTS: The Newborn Behavioral Observation was performed with 170 newborns (eight twins and 77% preterm newborns). Approximately 15% of the mothers were adolescents and had nine years of schooling, on average. The groups differed regarding weight for gestational age, age at observation, APGAR score, feeding, and primiparity. The linear regression adjusted for these variables showed that only prematurity remained associated with differences in the scores of the motor (p=0.002) and responsiveness (p=0.02) domains. No statistical difference was observed between the groups in the score attributed to one's own knowledge prior to the session (p=0.10). After the session, these means increased in both groups. This increase was significantly higher in the preterm newborn group (p=0.02). CONCLUSIONS: The Newborn Behavioral Observation increased the mothers' knowledge about the behavior of their children, especially in mothers of preterm newborns, and identified differences in the behavior of preterm newborns and full-term newborns regarding the motor and responsiveness domains.

OBSERVATION OF NEONATAL BEHAVIOR: CROSS-CULTURAL ADAPTATION OF THE NEWBORN BEHAVIORAL OBSERVATIONS. / OBSERVAÇÃO DO COMPORTAMENTO NEONATAL: ADAPTAÇÃO TRANSCULTURAL DO NEWBORN BEHAVIORAL OBSERVATIONS.

OBJECTIVE: To conduct the cross-cultural adaptation for Brazilian Portuguese of the Newborn Behavioral Observations (NBO), a new resource for observing neonatal behavior and sharing information with parents. METHODS: Methodological study of translation and cultural adaptation of the NBO system, which includes the Recording Form, with 18 items, the Recording Guidelines, with instructions to score each item, the Summary Form, to record suggestions based on the observation, and the Parent Questionnaire, to record the parents' experiences. The adaptation process followed international recommendations for cross-cultural adaptation of health care protocols, which included requesting permission from the authors, translation, back translation and pre-test, followed by external evaluators who scored the quality of the adaptation, which was analyzed quantitatively. The quality of the adaptation of the instruments' items was evaluated by the index of agreement between evaluators for conceptual and cultural equivalence. RESULTS: Expert panel evaluation showed that the cross-cultural adaptation of the NBO protocols was both well understood conceptually and culturally appropriate, with 140 (77.8%) items presenting concordance index higher than 90% for conceptual and cultural equivalence. Items that did not reach adequate level of agreement were revised according to experts' suggestions. CONCLUSIONS: The Brazilian version of the NBO system can be safely used, since the methodology was rigorous enough to ensure equivalence between the original and translated versions. The NBO should be tried in clinical practice, as it can contribute to improve the quality of maternal and child care.

OBJETIVO: Realizar a adaptação transcultural para a língua portuguesa brasileira dos protocolos do sistema Newborn Behavioral Observations (NBO), novo recurso para observação do comportamento do bebê e compartilhamento de informações com os pais. MÉTODOS: Estudo metodológico de tradução e adaptação transcultural do sistema NBO, que inclui o Formulário de Registro, com 18 itens, o Guia de Registro, com instruções para pontuação de cada item, o Sumário para os Pais, para registro de sugestões e orientações decorrentes da observação, e o Questionário de Pais, para avaliação da experiência. Foram seguidas as recomendações internacionais para adaptação transcultural de protocolos da área de saúde, o que incluiu solicitação de autorização para tradução aos autores, tradução, retrotradução e pré-teste, seguido de avaliação externa por painel de especialistas, que avaliou a qualidade da adaptação de cada item, com cálculo do índice de concordância entre os avaliadores quanto à equivalência conceitual e cultural. RESULTADOS: A avaliação do painel de especialistas evidenciou que a versão adaptada transculturalmente do sistema NBO foi bem compreendida conceitualmente e adequada culturalmente, com 140 (77,8%) itens apresentando índice de concordância maior que 90% quanto à equivalência conceitual e cultural. Itens que não obtiveram níveis adequados de concordância foram revisados conforme sugestões dos especialistas. CONCLUSÕES: A versão brasileira do sistema NBO pode ser utilizada com segurança, já que a metodologia empregada foi rigorosa, garantindo equivalência entre o original e a tradução. O sistema NBO está pronto para ser usado clinicamente, podendo contribuir para a melhora de qualidade da assistência materno-infantil.

Motor skills in Brazilian children with developmental coordination disorder versus children with motor typical development.

The aims of the study were to compare the performance of children with probable developmental coordination disorder (DCD) and motor typically developing peers on items from the Assessment of Motor Coordination and Dexterity (AMCD), to determine whether age, gender and type of school had significant impact on the scores of the AMCD items, to estimate the frequency of DCD among Brazilian children ages 7 and 8 years and to investigate whether children with DCD exhibit more symptoms of attention deficit and hyperactivity disorder than children with motor typical development. A total of 793 children were screened by the Developmental Coordination Disorder Questionnaire - Brazilian version (DCDQ-Brazil); 90 were identified as at risk for DCD; 91 matched controls were selected from the remaining participants. Children in both groups were evaluated with the AMCD, the Movement Assessment Battery for Children (MABC-II) and Raven's coloured progressive matrices. Thirty-four children were classified as probable DCD, as defined by a combination of the DCDQ-Brazil and MABC-II scores (fifth percentile). The final frequency of DCD among children ages 7 and 8 years was 4.3%. There were significant differences between children with and without DCD on the majority of AMCD items, indicating its potential for identifying DCD in Brazilian children. The use of a motor test (MABC-II) that is not validated for the Brazilian children is a limitation of the present study. Further studies should investigate whether the AMCD is useful for identifying DCD in other age groups and in children from different regions of Brazil. The application of the AMCD may potentially contribute in improving occupational therapy practice in Brazil and in identifying children that could benefit from occupational therapy services.

Relação entre a Avaliação da Coordenação e Destreza Motora (Acoordem) e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) / Linking the Motor Coordination and Dexterity Assessment (MCDA) to the International Classification of Functioning, Disability and Health (ICF)

INTRODUÇÃO: A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) visa a proporcionar uma base científica para a compreensão e o estudo da saúde e das condições relacionadas, podendo ser utilizada para nortear a criação e utilização de medidas de desfecho em reabilitação. A Avaliação da Coordenação e Destreza Motora (Acoordem) é um teste brasileiro, criado para detectar atraso motor em crianças de 4 a 8 anos. OBJETIVOS: Os objetivos deste estudo foram: a) associar as subcategorias da CIF aos itens da Acoordem; e b) determinar se os itens da Acoordem se encaixam na estrutura da CIF. MATERIAIS E MÉTODOS: Uma terapeuta ocupacional e um fisioterapeuta codificaram independentemente os itens contidos na Acoordem, fazendo o linking com a CIF. Para os itens em que não houve concordância entre os pesquisadores, foi usada a opinião de outras duas pesquisadoras, uma terapeuta ocupacional e uma fisioterapeuta. RESULTADOS: Os itens da Acoordem foram associados aos componentes b (funções do corpo), d (atividades e participação), e (fatores ambientais) e f (fatores pessoais). Não houve itens relacionados com o componente s (estrutura do corpo) e apenas três itens foram codificados como nc (não coberto pela CIF). DISCUSSÃO E CONCLUSÃO: Os itens da Acoordem puderam ser relacionados à estrutura da CIF. Profissionais e pesquisadores da área de reabilitação podem usar a Acoordem para obter dados acerca da atividade e participação em crianças com problemas de coordenação motora, pois sua terminologia e abrangência está de acordo com a perspectiva biopsicossocial da OMS.

INTRODUCTION: The International Classification of Functioning, Disability and Health (ICF) aims to provide a scientific basis for the comprehension and the study of health and its related conditions, and as such it can be used to guide the creation and utilization of outcome measures. The Motor Coordination and Dexterity Assessment (MCDA) is a Brazilian assessment tool that was designed to detect motor delay in 4 to 8 years old children. Objectives: The aims of this study were: a) to link the CIF sub domains with the MCDA items and b) determine if the MCDA items fit with the ICF framework. MATERIALS AND METHODS: One occupational therapist and one physical therapist coded, independently, the MCDA items, conducting the linking with the ICF. Whenever there was no agreement between the researchers, the opinion of other two researchers, one occupational therapist and one physical therapist, was used. RESULTS: The MCDA items were linked to the components b (body functions), d (activities and participation), e (environmental factors), and f (personal factors). DISCUSSION AND CONCLUSION: The MCDA items could be linked with the ICF framework. Professionals and researchers in the rehabilitation field can use the MCDA to get data about activities and participation of children with motor coordination problems, because the MCDA terminology and scope are in accordance with WHO’s biopsychosocial perspective.

Uso da cognitive orientation to daily occupational performance (co-op) com crianças com transtorno do desenvolvimento da coordenação / Cognitive orientation to daily occupational performance (co-op) with children with developmental coordination disorder

Crianças com Transtorno do Desenvolvimento da Coordenação (TDC) têm problemas motores que dificultam a realização de atividades diárias. Muitas abordagens são usadas para tratar estas crianças. O objetivo deste estudo foi explorar o uso da Cognitive Orientation to Daily Occupational Performance ou CO-OP em crianças brasileiras com TDC. Participaram do estudo três crianças de 9 a 10 anos com problemas de coordenação motora que interferiam no desempenho ocupacional em casa e na escola. Para avaliação das crianças foram utilizados o Questionário de Transtorno do Desenvolvimento da Coordenação (DCDQ-Brasil), o Movement Assessment Battery for Children (MABC), o Perceived Efficacy and Goal Setting System (PEGS), e a Medida Canadense de Desempenho Ocupacional (COPM), além da Análise Dinâmica do Desempenho (PQRS). O protocolo do CO-OP foi adaptado e a intervenção consistiu de 13 sessões de 60 minutos, duas vezes por semana, nas quais cada criança aprendeu três tarefas de sua escolha. Os resultados indicaram que o CO-OP pode ser uma abordagem eficaz, pois contribuiu para a melhora no desempenho funcional das crianças em cinco das seis tarefas escolhidas.

Children with Developmental Coordination Disorder (DCD) have motor problems that lead to difficulties to perform every day tasks. Many approaches are used to treat these children. The aim of this study is to explore the use of the Cognitive Orientation to Daily Occupational Performance (CO-OP) with Brazilian children with DCD. Three children ages 9 to 10 years old with motor coordination problems that interfered in occupational performance at home and school participated in the study. They were assessed using the Developmental Coordination Disorder Questionnaire - Brazil (DCDQ-Brazil), the Movement Assessment Battery for Children (MABC), the Perceived Efficacy and Goal Setting System (PEGS) and the Canadian Occupational Performance Measure (COPM); the Performance Quality Rating Scale (PQRS) was also used. The CO-OP's protocol was adapted. The intervention lasted 13 sessions, twice a week, and the children learned three tasks of their choice. The results indicate that CO-OP can be an effective approach, because it contributed to improvement in occupational performance on five of six of the chosen tasks.

Relação entre destreza manual e legibilidade da escrita em crianças: estudo piloto / Relation between manual dexterity and handwriting legibility in children: pilot study

OBJETIVO: Examinar a relação entre legibilidade de escrita, destreza manual, coordenação visomotora e discriminação tátil na mão em crianças de 1ª e 2ª séries do ensino fundamental. MÉTODOS: Foram avaliadas 40 crianças, divididas em quatro grupos, com os instrumentos: Avaliação da Coordenação e Destreza Motora (ACOORDEM) e o Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI). A classificação da legibilidade como boa ou ruim foi realizada por duas pedagogas. RESULTADOS: Ao comparar o desempenho dos grupos da 1ª série, o teste Mann-Whitney identificou diferenças significativas em 5 itens da ACOORDEM e no VMI. Entre os grupos da 2ª série, o teste estatístico apontou diferenças significativas em 7 itens da ACOORDEM. CONCLUSÃO: Resultados refirmam a idéia de que a coordenação visomotora é componente relevante para crianças que 1ª série, que estão na fase inicial de aquisição da escrita, entretanto os dados relativos à destreza manual e discriminação tátil na mão foram inconsistentes.

AIM: To examine the relationship between handwriting legibility, manual dexterity, visuomotor coordination and manual tactile discrimination in 1st and 2nd grade children. METHODS: Forty children divided in four groups were evaluated with the Avaliação da Coordenação e Destreza Motora (ACOORDEM) and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI). Legibility was rated as good or poor by two pedagogues. RESULTS: When comparing the performance of the 1rst grade children, Mann-Whitney test identified significant differences in five ACOORDEM's items and in the VMI. Considering the 2nd graders, statistical differences were found only in seven items of the ACOORDEM. CONCLUSION: The results reaffirm the idea that visuomotor coordination is a relevant component for children in 1rst grade who are in the initial stages of handwriting acquisition; however, data on manual dexterity and manual tactile discrimination were inconsistent.

Desenvolvimento psicomotor em crianças pré-termo e a termo na idade escolar / Psychomotor development of preterm and full term children at school-age

Fatores biológicos, como prematuridade e baixo peso ao nascimento, e fatores ambientais, como nível sócioeconômico, podem influenciar o desenvolvimento infantil. O objetivo deste estudo foi comparar o desenvolvimento psicomotor de três grupos de crianças em idade escolar: (1) pré-termo de famílias de baixa renda, (2) a termo de famílias de baixa renda, e (3) a termo de classe média. Participaram do estudo 120 crianças de 5 a 7 anos de idade, 40 em cada grupo. As crianças foram submetidas a avaliação de equilíbrio estático, tônus postural, habilidades perceptuais e viso-motoras. Foi observada diferença significativa de desempenho entre os grupos na maioria dos testes. Ao analisar o efeito isolado do nível sócioeconômico, observou-se efeito favorável à classe média nos itens de tônus postural e equilíbrio. Os resultados sugerem que o desenvolvimento de crianças prematuras deve ser acompanhado até pelo menos a idade escolar, principalmente daquelas em situação de desvantagem social, sendo importante incentivar a implantação de programas de acompanhamento longitudinal do desenvolvimento dentro do sistema público de saúde.(AU)

Biological risk factors, such as prematurity, low birth weight and environmental factors, such as social class, can influence children development. The aim of this study was to compare the psychomotor development in three groups of school-age children - (1) preterm from low income families, (2) full term from low income families and (3) full term from middle class. The participants were 120 children, aged 5 to 7 years old, 40 in each group. Children were tested on static balance, postural, perceptual and visual motor skills measures. There was significant difference between groups in the majority of the tests. When analyzing the isolated effect of social class, a favorable effect for middle class in the postural and balance measurements was observed. The results suggest that the development of preterm children, especially in those from socially disadvantaged backgrounds, should be followed up to at least school age. Therefore, it is important to incentive the implementation of developmental follow-up programs in the public health system.(AU)