Brazilian children's quality of life during the COVID-19 pandemic: analysis of contextual factors and dimensions.

OBJECTIVE: The aim of this study was to investigate the contextual factors associated with the quality of life (QOL) of Brazilian children aged 0-12 years during the strict period of social isolation. METHODS: This observational cross-sectional study was conducted between July and September 2020 using an online questionnaire on QOL-related family factors and the Pediatric Quality of Life Inventory (PedsQL™). Results were analyzed by multinomial logistic regression analysis. RESULTS: The sample had 849 children, mostly from the South Region of Brazil (75%), white (83%), with typical development (79%), sedentary (68%), using screen (85%) for >3 h/day (44%). Their mothers were their main caregivers (90%). The following variables were significantly associated with high scores of QOL: typical health status (OR 2.38; 95%CI 1.60-3.55; screen time ≤2 h/day (OR 1.62; 95%CI 1.17-2.24); social distancing considered as "easy" (OR 1.67; 95%CI 1.20-2.32), and stimulation of the child by the family (OR 1.93; 95%CI 1.08-3.45). CONCLUSIONS: This study indicates that the family context can influence children's QOL, especially during the COVID-19 pandemic and home environment reorganization.

Mom Didn't Go to School, Dad Is Out of Work: Associations between Maternal Educational Attainment, Family Socioeconomic Status, and Infant Development.

The purpose of this research is to assess the neuropsychomotor development (NPMD) of 6- to 18-month-old infants and identify factors that may pose a risk to their development. They underwent NPMD assessments, while the parents/guardians were interviewed through the other instruments. Altogether, 64 infants participated in this research. The results revealed infants with questionable NPMD: 29.7% verified with AIMS and 32.8%, with Denver II. There were significant associations between NPMD and maternal low educational attainment (P = .032); family low socioeconomic status and NPMD (P = .026), verified with AIMS and Denver II (P = .037); stimulation opportunities at home and maternal low educational attainment (P = .00026), socioeconomic status (P = .035), and NPMD, verified with AIMS (P = .02) and Denver II (P = .009). The following were identified as risk factors for NPMD: maternal low educational attainment (the lower her attainment, the more likely for the NPMD to be questionable) and family socioeconomic status (infants from disadvantaged homes tend to have questionable NPMD). Stimulation opportunities at home were also significantly associated with NPMD-that is, insufficient stimulations at home may lead to questionable NPMD.

Intimate Partner Violence Against Brazilian Mothers is Associated With Their Children's Lower Quality-of-Life Scores: A Cross-Sectional Study During the COVID-19 Pandemic.

The COVID-19 pandemic led to family and routine reorganization, triggering social problems. Women were further exposed to domestic violence, especially intimate partner violence (IPV), with consequences to their and their children's health. However, few Brazilian studies address the issue, especially considering the pandemic and its restrictive measures. The objective was to verify the relationship between mothers'/caregivers' IPV and their children's neuropsychomotor development (NPMD) and quality of life (QOL) during the pandemic. Seven hundred one female mothers/caregivers of children (0-12 years old) responded to the online epidemiological inquiry. NPMD was investigated with the Caregiver Reported Early Development Instruments (CREDI-short version); QOL, with the Pediatric Quality of Life Inventory (PedsQL™); and IPV, with the Composite Abuse Scale (CAS). The independence chi-square test was used, with Fisher's exact statistics, in SPSS Statistics 27®. Children whose mothers were exposed to IPV were 2.68 times as likely to have a "low" QOL score (χ2(1) = 13.144, P < .001; φ = 0.137). This indicates a possible environmental influence on the children's QOL, which may have been aggravated by strict social distancing during the COVID-19 pandemic.

Improvement of Balance, Motor Aspects, and Activities of Daily Living in Parkinson's Disease after a Sequential Multimodal Aquatic- and Land-Based Intervention Program.

Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (r). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.

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

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

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

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

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