Parental priorities in the home care of preterm and full term newborns.

BACKGROUND: The initial weeks after hospital discharge is a period of adaptation when parents assume great responsibility for the care of their child. Preterm birth may impact their demands of care. AIMS: To compare parental priorities in the care of preterm and full-term newborns in the first two months after hospital discharge and to identify changes in priorities over time. METHODS: Parents of 22 full-term and 19 preterm infants were followed for two months after hospital discharge, with three timepoint evaluations of the parental priorities. They reported on infant care demands in a semi-structured interview. RESULTS: Despite prematurity, demands were similar between groups. Within-group changes occurred over time. Priorities related to bathing and caring for the navel showed significant reduction (p < 0.01); demands related to children's health care increased in the groups (p < 0.01). Feeding and sleep priorities were reduced in the full-term group (p < 0.02). Children's adaptation to routine increased significantly in the preterm group (p = 0.04). CONCLUSION: Knowledge of parents' priorities in caring for preterm or full-term newborns at home helps health care teams develop appropriate support strategies and improve specialized assistance to the families.

Cross-country validity of the Alberta Infant Motor Scale using a Brazilian sample.

BACKGROUND: Previous validity studies of the Alberta Infant Motor Scale (AIMS), using raw scores and percentile curves for group comparisons, showed that infants in Brazil achieved gross motor milestones at later ages. Validity of the AIMS norms were later reassessed using a logistic regression model that placed the AIMS items on an age scale. OBJECTIVES: Our study examined the validity of the AIMS norms for Brazilian infants using the recommended method for calculating and comparing item locations. METHODS: Data from 732 Brazilian infants (2009-11), 3 days to 18 months old, were compared to the AIMS normative sample (n=2202). Logistic regression placed the AIMS items of both samples on age scales representing the age at which 50% of infants passed an item and compared the two datasets. Pearson correlation coefficient tested the association across samples. RESULTS: 47 of the 58 AIMS items met the criterion for stable regression to calculate item locations of the Brazilian dataset. Based on the age when 50% of the infants passed a criterion, most of the items from the Brazilian sample (n=28) differed by two weeks or less compared to the Canadian normative sample. CONCLUSION: The sequence and age for the emergence of AIMS items were similar between the Brazilian and Canadian samples. Canadian norms are appropriate for clinical decisions and research with Brazilian infants.

Measurement Properties and Translation to Brazilian-Portuguese of the Challenge for Children and Adolescents with Cerebral Palsy.

Aims: Translate the Challenge assessment into Brazilian-Portuguese, determine its face validity, evaluate the reliability of the total score and score per item, investigate whether the child's gross motor level (classified by the Gross Motor Function Classification System-GMFCS) influences the reliability levels, and estimate responsiveness to change.Methods: The translation followed four stages: translation, synthesis, back-translation, and review. For face validity, ten physical therapists evaluated item relevance. Children and adolescents with cerebral palsy (n = 50, 5-18 years of age) GMFCS I and II were evaluated by two therapists for inter and intra-rater reliability. Thirty of these participants were recruited for the instrument's responsiveness evaluation and reassessed (n = 28) after three months of treatment. Minimal Detectable Change (MDC), and Minimal Clinically Important Difference (MCID) were estimated.Results: The back-translated version was similar to the English version. All test items were considered relevant by the physical therapists. Total score intra and inter-rater reliability were excellent for both GMFCS levels (ICC = 0.94-0.99). Items' intra- and inter- rater reliability varied from low to almost perfect (kw=-0.14-0.94). MDC90 and MDC95 values were 3.90-6.35 and 4.63-7.54, respectively. MCID values were 3.57-4.56.Conclusion: The translated version of the Challenge showed excellent face validity and reliability and was able to document longitudinal change.

Children with congenital Zika syndrome: symptoms, comorbidities and gross motor development at 24 months of age.

BACKGROUND: Children with congenital Zika syndrome (CZS) maintain severe motor impairments at the end of the first year of life. Presence of certain symptoms and comorbidities increase these children's vulnerability. AIMS: To evaluate gross motor function of a group of Brazilian children with CZS at 24 months of age and to investigate the association between the presence of CZS symptoms and comorbidities with gross motor development. METHODS AND PROCEDURES: Fifty children with CZS participated in the study. Information was collected from medical charts, and gross motor development was evaluated by the Gross Motor Function Measure (GMFM)-88. GMFM-88 scores were compared among comorbid groups. Three subgroups of children were identified by cluster analysis, based on information from head circumference at birth, symptoms, comorbidities and gross motor function. OUTCOMES AND RESULTS: Significant associations (p < 0.001) were observed between number of comorbidities/symptoms and dimensions A (r = -0.57) and B (r = -0.58) of the GMFM-88. Children were grouped into 3 clusters, with different gross motor skills. Children with epilepsy and dysphagia composed the cluster with smaller median scores for dimensions A and B of the GMFM-88. CONCLUSIONS AND IMPLICATIONS: The presence of CZS symptoms and comorbidities compromise the gross motor repertoire of children with CZS at 24 months.

Combining balance-training interventions with other active interventions may enhance effects on postural control in children and adolescents with cerebral palsy: a systematic review and meta-analysis.

BACKGROUND: Improvement of postural control in children and adolescents with cerebral palsy is a primary goal in child rehabilitation. OBJECTIVE: A systematic review investigated whether combining balance-training interventions with other active interventions enhances the effects of the active intervention alone on postural control of children and adolescents with cerebral palsy. METHODS: Searches were performed in MEDLINE, PEDro, CINAHL, Cochrane and EMBASE databases without date or language restrictions. Randomized controlled trials investigating the combination of balance-training interventions with other active interventions on the postural control of children and adolescents with cerebral palsy were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. Meta-analysis was conducted, and quality of the evidence followed the GRADE methodology. Pooled data were presented using standardized mean difference and 95% confidence interval. RESULTS: Seven studies involving 194 participants were included in this review. A large additional effect on postural control was found when balance-training interventions were combined with Neurodevelopmental Treatment at short-term (standardized mean difference of 1.3; 95% confidence interval 0.5, 2.0, p=0.001). The quality of the evidence was very low due to publication bias, imprecision and inconsistency. CONCLUSION: Combining balance-training interventions with other active interventions may enhance effects on postural control of this population at short-term. As the estimated effect had only very low quality of evidence to support it, larger studies with low risk of bias are needed.

Cultural adaptation and reliability analysis of the early clinical assessment of balance / Adaptação cultural e análise da confiabilidade da early clinical assessment of balance

ABSTRACT Objective: To translate the Early Clinical Assessment of Balance (ECAB), an assessment scale developed specifically for children and adolescents with cerebral palsy into Brazilian Portuguese, evaluate semantic, idiomatic, experiential and conceptual equivalences, and to examine the face validity and the reliability within and between examiners of the Brazilian version. Methods: The following steps were done: translation by two independent translators; synthesis of translations; back translation into English; analysis of back-translations by a multidisciplinary committee and the author of the test to develop the final version of the test; test application training; administration of the translated version of ECAB (videotaped) in 60 children and adolescents with cerebral palsy; intra and inter-examiner reliability assessment. Reability was assessed by intraclass correlation coefficient (CCI). Results: The discrepancies found were related mainly to semantic equivalence and, therefore, there was no need to make cultural adaptations in any of the 13 items on the scale. The rate of agreement was greater than 90% and the reliability of the ECAB-Portuguese total score was excellent both for the intra-rater test (CCI=1.00) and for the inter-rater test (CCI=0.998). Likewise, the reliability evaluation of each of the scale items was also excellent. Conclusions: The translated version of the ECAB into Portuguese provides a tool for the evaluation of the specific balance for children and adolescents with cerebral palsy with different levels of functioning.

RESUMO Objetivo: Traduzir a Early Clinical Assessment of Balance (ECAB), escala de avaliação do equilíbrio desenvolvida especificamente para crianças e adolescentes com paralisia cerebral (PC) para a língua portuguesa do Brasil; avaliar as equivalências semânticas, idiomáticas, experiencial e conceituais; e examinar a validade de face e a confiabilidade intra e interavaliadores da versão brasileira. Métodos: Estudo envolveu tradução do instrumento por dois tradutores independentes; síntese das traduções; retrotradução para o inglês; análise das retrotraduções por um comitê multidisciplinar; treinamento; administração da versão traduzida da ECAB (gravadas em vídeo) em 60 crianças e adolescentes com PC; e avaliação da confiabilidade intra e interexaminadores. A confiabilidade foi avaliada por meio do coeficiente de correlação intraclasse (CCI). Resultados: As discrepâncias encontradas foram referentes principalmente à equivalência semântica e, portanto, não houve necessidade da realização de adaptações culturais em nenhum dos 13 itens da escala. A taxa de concordância foi maior que 90%, e a confiabilidade do escore total da ECAB-português foi excelente tanto para o teste intra-avaliador (CCI=1,00) quanto para interavaliadores (CCI=0,998). Da mesma forma, a avaliação da confiabilidade de cada um dos itens da escala também foi excelente. Conclusões: A versão traduzida da ECAB para o português disponibiliza, para os profissionais da reabilitação infantil, um instrumento confiável de avaliação do equilíbrio específico para crianças e adolescentes com PC com diferentes níveis de funcionalidade.

CULTURAL ADAPTATION AND RELIABILITY ANALYSIS OF THE EARLY CLINICAL ASSESSMENT OF BALANCE.

OBJECTIVE: To translate the Early Clinical Assessment of Balance (ECAB), an assessment scale developed specifically for children and adolescents with cerebral palsy into Brazilian Portuguese, evaluate semantic, idiomatic, experiential and conceptual equivalences, and to examine the face validity and the reliability within and between examiners of the Brazilian version. METHODS: The following steps were done: translation by two independent translators; synthesis of translations; back translation into English; analysis of back-translations by a multidisciplinary committee and the author of the test to develop the final version of the test; test application training; administration of the translated version of ECAB (videotaped) in 60 children and adolescents with cerebral palsy; intra and inter-examiner reliability assessment. Reability was assessed by intraclass correlation coefficient (CCI). RESULTS: The discrepancies found were related mainly to semantic equivalence and, therefore, there was no need to make cultural adaptations in any of the 13 items on the scale. The rate of agreement was greater than 90% and the reliability of the ECAB-Portuguese total score was excellent both for the intra-rater test (CCI=1.00) and for the inter-rater test (CCI=0.998). Likewise, the reliability evaluation of each of the scale items was also excellent. CONCLUSIONS: The translated version of the ECAB into Portuguese provides a tool for the evaluation of the specific balance for children and adolescents with cerebral palsy with different levels of functioning.

Assessing gross motor development of Brazilian infants.

PURPOSE: To determine whether the Alberta Infant Motor Scale (AIMS) requires reference values specific for Brazilian infants. METHODS: A total of 660 (330 girls) healthy full-term infants from Belo Horizonte were assessed using the AIMS. Scores and percentile curves were compared with the Canadian reference values. RESULTS AND DISCUSSION: Differences were found in the 5th percentile (9-<10 and 10-<11 months) and the 10th percentile (4-<5, 9-<10, and 10-<11 months) curves. No significant differences were found between sexes on the basis of the economic classification or the criteria of the Human Development Index. CONCLUSION: Primarily because of the corrections made to the 5th and 10th percentile curves, we recommend the use of the Brazilian infant data curves reported here for further studies conducted in Brazil. Because the Human Development Index of Belo Horizonte is similar to that for Brazil as a whole, the results of this study should be relevant for clinicians throughout Brazil.

Análise das intervenções de terapia ocupacional no desempenho das atividades de vida diária em crianças com paralisia cerebral: uma revisão sistemática da literatura: [revisão] / Analysis of occupational therapy interventions in the performance of everyday activities in children with cerebral palsy: a systematic review of the literature: [review]

OBJETIVOS: avaliar, através da seleção e análise criteriosa de artigos, os efeitos das intervenções voltadas para a promoção do desempenho de atividades de vida diária, utilizadas por terapeutas ocupacionais, em crianças com paralisia cerebral. MÉTODOS: a busca na literatura foi realizada nas bases eletrônicas: Ovid, Medline, CINAHL e Lilacs, incluindo artigos publicados entre janeiro de 2001 e maio de 2006, nos idiomas inglês e português, utilizando os seguintes descritores: terapia ocupacional, paralisia cerebral e criança. Foram selecionados quatro estudos, seguindo critérios de inclusão pré-definidos, avaliados quanto à qualidade metodológica com a escala OTSeeker. RESULTADOS: a análise da qualidade metodológica dos estudos selecionados revelaram pontuações de magnitudes baixa à moderada na escala OTSeeker. Foram encontradas diferenças quanto ao tipo de intervenção utilizada para a promoção das atividades de vida diária, bem como dos desfechos investigados. CONCLUSÕES: a análise crítica dos artigos sugere que o contexto no qual a criança com paralisia cerebral está inserida parece ser um fator importante no seu desempenho funcional. A avaliação sistemática da literatura sobre os efeitos de intervenções de Terapia Ocupacional na promoção de atividades de vida diária em crianças com paralisia cerebral poderá contribuir para uma prática baseada em evidências, entre esses profissionais.

OBJECTIVES: to evaluate, by means of a careful search for and analysis of articles, the effects of interventions used by occupational therapists to improve the performance of everyday activities in children with cerebral palsy. METHODS: the search for literature on the subject was conducted using the electronic databases Ovid, Medline, CINAHL and LILACS, and covered articles published between January 2001 and May 2006, in English or Portuguese, using the following keywords: occupational therapy, cerebral palsy, and child. Four studies were selected, according to previously determined inclusion criteria, and these were evaluated for their methodological quality using the OTSeeker scale. RESULTS: the analysis of the methodological quality of the selected studies revealed scores from low to moderate on the OTSeeker scale. There were differences in relation to the type of intervention used to promote everyday activities, and regarding the outcomes that were investigated. CONCLUSIONS: the context in which the child with cerebral palsy is living seems to be an important factor in his/her functional performance. The systematic evaluation of the literature on the effects of Occupational Therapy interventions in promoting everyday activities in children with cerebral palsy may contribute to evidence-based practices among these health professionals.

Therapeutic effects of electrical stimulation on manual function of children with cerebral palsy: evaluation of two cases.

PURPOSE: To investigate changes in hand function associated with electrical stimulation for children with hemiplegic cerebral palsy. METHOD: An ABCA single-subject design, replicated in two children, was used in this study. Each baseline (phase A) lasted 4 weeks. Intervention consisted of electrical stimulation of wrist extensors (phase B) and of wrist extensors and flexors (phase C) for 15 minutes three times a week. Intervention phases also lasted 4 weeks. Active wrist extension range of movement and three timed manual tasks were tested two times a week every week. Data analysis included the Celeration Line and Two Standard Deviation Band methods in addition to visual analysis. RESULTS: Significant performance gains were observed for both children, especially in phase C, when both extensors and flexors were stimulated. After intervention withdrawal, significant performance decreases were observed on most analysed variables. CONCLUSIONS: The observed performance changes seem to be associated with the presence of intervention and suggest that electrical stimulation can be a useful adjunct to improve hand function of children with cerebral palsy.

Mudanças antropométricas e habilidade motora em crianças no início da marcha independente / Anthropometrical changes and motor skill in infants at the onset of independent walking

As mudanças nas proporções corporais durante o desenvolvimento infantil podem impor uma demanda motora diferenciada às crianças durante o início da marcha independente, ou seja, as características antropométricas podem exercer influência em seu desempenho motor grosso. Este estudo visou massa corporal (IMC) com o desempenho motor de crianças com desenvolvimento típico, comparando o desempenho motor entre dois grupos de crianças.

Changes in infant's body dimensions occuring during development may impose specific motor demands at the onset of independent walking. That is, anthropometric features may influence infant's gross motor performance. This study aimed at assessing the association between weight, height, and body mass index (BMI) with motor perfomance of typically developing infants, comparing two groups of infants with different...

O impacto da asma infantil no perfil funcional de crianças entre um e quatro anos de idade / The impact of the asthma in children from one to four years of age

Objetivo: O objetivo deste estudo foi descrever as conseqüências funcionais da asma no desenvolvimento de crianças entre 1 e 4 anos de idade. Métodos: 90 crianças, divididas em 3 grupos, participaram do estudo: 1) crianças com asma agudizada (n=30); 2) crianças com asma controlada (n=30); 3) crianças sem o distúrbio respiratório (n=30). A seleção foi baseada em critérios de inclusão e exclusão definidos para cada grupo. Todos os participantes foram avaliados pelo teste funcional infantil PEDI. Este teste avalia quantitativamente o desempenho infantil nas áreas de autocuidado, mobilidade e função social. O desempenho funcional dos 3 grupos foi comparado utilizando o teste Análise de Covariância, que controlou estatisticamente por diferenças em idade entre grupos. Resultados: Foram observadas diferenças significativas entre os grupos (p < 0,05) nas habilidades de mobilidade e autocuidado e na independência em mobilidade. O sentido dessas diferenças indica que crianças com asma agudizada apresentaram desempenho funcional inferior ao dos outros dois grupos. Conclusão: Os resultados sugerem que as conseqüências da asma infantil parecem ultrapassar as funções respiratórias e interferir negativamente no desempenho de atividades diárias de autocuidado e de mobilidade da criança nos primeiros 4 anos de vida. Estes resultados revelam que o cuidador da criança com asma agudizada limita suas experiências de mobilidade, não permitindo a participação independente em atividades de locomoção, transferência e subir/descer escadas. Os resultados indicam a necessidade de minimizar as conseqüências da asma agudizada no desenvolvimento das funções de mobilidade e de autocuidado da criança.

Aids pediátrica: características do neurodesenvolvimento / HIV+ children: neuromotor development

O objetivo deste estudo foi comparar características do desenvolvimento neuromotor de crianças HIV+ com crianças soronegativas. Uma amostra de 28 crianças de faixa etária entre 0 e 3 anos, sendo 14 HIV+ e 14 HIV-, foi avaliada por dois testes de desenvolvimento infantil: Bayley Infant Neurodevelopment Screener (BINS) e o Teste de Desenvolvimento de Denver (TDD). A comparação dos dois grupos de crianças foi feita por meio dos teste Qui-quadrado e Mann-Whitney-U. Crianças dos dois grupos apresentaram condições semelhantes nos fatores socioeconômico e demográfico. Foram observadas diferenças significativas entre os dois grupos, principalmente nas habilidades motoras grossas e de linguagem. O sentido dessas diferenças indica um desempenho inferior do grupo de crianças HIV+ quando comparado com o grupo HIV-. O atraso nas funções motora e de linguagem encontrado em crianças HIV+ reforça a importância dessas crianças serem encaminhadas para programas de acompanhamento e de intervenção precoce, visando à promoção de seu desenvolvimento.

Teoria neuromaturacional versus abordagem dos sistemas dinâmicos / Neuromaturacional theory and the dynamical system approach

Em fisioterapia e terapia ocupacional pediátrica, as estratégias de intervençäo devem ser fundamentadas num modelo teórico de desenvolvimento motor que justifiquem as técnicas empregadas na prática clínica. O tratamento deve ser baseado em teorias e o terapeuta deve ser capaz de justificar teoricamente suas decisöes clínicas e intervençöes terapêuticas. Seräo apresentadas e analisadas duas teorias: a teoria neuromaturacional e a abordagem dos sistemas dinâmicos