Association between environmental factors during the COVID-19 pandemic and functioning of infants with biological risk in the first year of life: Cross-sectional exploratory study.

BACKGROUND: Child development can be influenced by family and environmental factors, which changed during the COVID-19 pandemic. Thus, it is important to explore how these factors are associated with the functioning of infants with biological risk in the first year of life. OBJECTIVE: This study aimed to investigate associations between family factors, home opportunities, caregiver perception of environmental support and barriers at home and environmental factors during the COVID-19 pandemic and gross motor skills and home participation in infants with biological risk in the first year of life. METHODS: Fifty-six infants aged two to 12 months (M = 5.80 months; ±2.44) and their mothers performed remote assessments of gross motor skills using the Alberta Infant Motor Scale (AIMS); participation and environment (phone call) by the Young Children's Participation and Environment Measure (YC-PEM); family factors (income, age and maternal education), home opportunities - The Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) and environmental factors during the COVID-19 pandemic (social distancing, emotional and financial factors and physiotherapy) (online forms). Regression models were constructed, considering gross motor skills and home participation as outcome variables, with a 5 % significance level. RESULTS: We found that older maternal age (p = 0.001), more home opportunities (p = 0.043), and less rigorous social distancing (as opposed to total social distancing [p = 0.045]) were significantly associated with better gross motor skills; and higher maternal education (p = 0.050) was associated with more involvement in home activities. CONCLUSION: Family factors, home opportunities and social distancing were differently associated with the gross motor skills and home participation of infants with biological risk in the first year of life.

The psychometric properties and feasibility of the Alberta infant motor scale used in telehealth: A scoping review.

BACKGROUND: Telehealth can be a viable option for improving equitable access to early motor assessment for financially vulnerable individuals. AIM: This review aimed to identify the psychometric properties of the Alberta Infant Motor Scale (AIMS) when applied via telehealth and assess its feasibility. METHODS: Papers were systematically retrieved from electronic databases until October 4, 2023. We included studies that assessed the motor development of infants using the AIMS through telehealth. RESULTS: Thirteen studies, encompassing 897 infants (449 male and 396 female), were included in this review. Among them, 805 were typical infants and 92 were at risk of motor delay. The age range of participants spanned from 4.9 weeks to 20 months. The studies found good concurrent validity between telehealth and in-person assessments (ICC > 0.98, SEM < 1.6, mean difference = 0.5) and good to excellent reliability (ICC > 0.80) using home videos recorded by parents or video calls with researchers. Telehealth was perceived as feasible by parents, who expressed high satisfaction, and the quality of images and assessments met commendable standards. CONCLUSION: Considering the limited number of studies that have assessed infants with neuromotor disorders, this scale has the potential for telehealth application in evaluating typical infants.

Early Intervention Involving Specific Task-Environment-Participation (STEP) Protocol for Infants at Risk: A Feasibility Study.

Aims: To verify the feasibility and preliminary effects of the STEP protocol, an intervention based on specific motor skills, environmental factors and participation, in infants at biological risk.Methods: Twenty-eight at-risk infants (STEP Protocol = 14; Standard Intervention = 14), aged 3-9 months and at risk for developmental delay. The following outcomes were assessed: motor skills (Alberta Infant Motor Scale-AIMS); frequency and involvement of participation (Young Children's Participation and Environment Measure-YC-PEM), and home environment opportunities (Affordances in the Home Environment for Motor Development-AHEMD-IS). For both groups, interventions were provided by parents. The intervention for group was based on the following principles: (1) standard intervention: stimulation of motor skills; (2) STEP: stimulation of motor skills, participation, mother-infant interaction, environmental enrichment. A mean comparison test was applied to verify difference between groups after the intervention.Results: The protocol showed good retention and recruitment rates. The STEP group had significantly higher outcomes after intervention on the AIMS (p = 0.014); frequency (p = 0.02) and engagement (p = 0.03) in participation, when compared to standard intervention.Conclusions: The results showed that the STEP protocol is feasible, and presents better results compared to the standard intervention, which reinforces the importance of promoting participation, specific motor skills and family involvement.

Telemonitoring of motor skills using the Alberta Infant Motor Scale for at-risk infants in the first year of life.

INTRODUCTION: Remote assessment creates opportunities for monitoring child development at home. Determining the possible barriers to and facilitators of the quality of telemonitoring motor skills allows for safe and effective practices. We aimed to: (1) determine the quality, barriers and facilitators of Alberta Infant Motor Scale (AIMS) home videos made by mothers; (2) verify interrater reliability; (3) determine the association between contextual factors and the quality of assessments. METHODS: Thirty infants at biological risk aged between three and ten months, of both sexes, and their mothers were included. Assessments were based on asynchronous home videos, where motor skills were evaluated by mothers at home according to AIMS guidelines. The following were analyzed: video quality; stimulus quality; camera position; and physical environment. The video characteristics were analyzed descriptively. The intraclass correlation coefficient was used to calculate interrater reliability and the regression model to determine the influence of contextual factors on the outcome variables. Significance was set at 5%. RESULTS: Remote assessment of AIMS exhibited high image and stimulus quality, and a suitable physical environment. Interrater reliability was high for all domains: prone (r = 0.976); supine (r = 0.965); sitting (r = 0.987); standing (r = 0.945) and total score (r = 0.980). The contextual factors had no relation with assessment quality. DISCUSSION: Assessments conducted remotely by the mothers showed high video quality and interrater reliability, and represent a promising assessment tool for telemedicine in at-risk infants in the first year of life.

Tele-care intervention performed by parents involving specific task- environment- participation (STEP protocol) for infants at risk for developmental delay: protocol of randomized controlled clinical trial.

BACKGROUND: With the implementation of social distancing due to the Covid-19 pandemic, many at-risk infants are without therapy. An alternative mode of therapy in this situation is tele-care, a therapy in which assessments and interventions are carried out online, in the home environment. We describe a tele-care protocol involving parent delivered task and context specific movement training, participation and environmental adaptation for infants at risk for developmental delay. METHODS: Randomized controlled trial. Infants at risk, with 3 to 9 months corrected age, will be included, and randomized into two groups: control group (conventional guidelines) and experimental group (task, environment and participation in context-specific home program). Infants will be assessed for motor capacity (Infant Motor Profile and Alberta Infant Motor Scale); participation (Young Children's Participation and Environment Measure) and environment factors (Parent-Child Early Relational Assessment; Affordances in the Home Environment for Motor Development). The intervention period will be 10 weeks, and evaluations will be carried out before and after that period. All the assessment and intervention procedures will be carried out online, with instructions to parents for home therapy. The statistical analysis will be guided according to the distribution of the data, and a significance level of 5% will be adopted. All ethical approvals were obtained by the Ethics Committee of the University of São Carlos (Case number 31256620.5.0000.5504). The protocol will follow the SPIRIT statement. Findings will be disseminated in peer-reviewed publications and presented at national and international conferences. DISCUSSION: The results of this study will describe the effectiveness of a home intervention, focusing on specific activities, participation and environmental changes. These results will support the implementation of a remote protocol, with lower financial costs and focused on the particularities of the family. This type of care model can possibly help public policies to ensure equal access to evidence-based quality healthcare. TRIAL REGISTRATION: Brazilian Clinical Trials Registry: RBR8xrzjs , registered September 1, 2020.

Physical therapy with hippotherapy compared to physical therapy alone in children with cerebral palsy: systematic review and meta-analysis.

AIM: To compare the effects of physical therapy with hippotherapy versus physical therapy alone on the gross motor function of children and adolescents with cerebral palsy (CP). METHOD: Electronic searches were conducted in January 2021. We included controlled trials of the gross motor function of children and adolescents with CP, aged 2 to 18 years. We extracted means, standard deviations, and changes from the baseline to the end of the intervention. We used the Cochrane Collaboration's tool modified by Effective Practice and Organization of Care (EPOC) to assess the methodological quality and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to verify evidence synthesis. We conducted the meta-analysis using Revman 5.3. RESULTS: A total of 315 individuals from six studies were included. Both groups received physical therapy including strength, aerobic, stretch, and mobility exercises, and neurodevelopmental treatment. Studies presented high risk of bias. Both therapies presented similar effects for Gross Motor Function Measure scores, cadence, stride length, and speed during gait. The level of evidence was very low. The change was greater for the physical therapy with hippotherapy group, but inferior to the smallest real difference or the minimal detectable change. INTERPRETATION: Physical therapy with hippotherapy presented similar effects to physical therapy alone on the gross motor function of children and adolescents with CP. Future studies should include larger sample sizes and studies with low risk of bias.

Sex and age influence on postural sway during sit-to-stand movement in children and adolescents: Cross-sectional study.

We investigated the influence of sex and age in postural sway during sit-to-stand (STS) in children and adolescents of 5-15 years. We evaluated sway during STS in 86 typical participants. STS was divided into three phases: preparation, rising, and stabilization. We calculated for each phase: area, anterior-posterior, and medial-lateral velocity of center-of-pressure sway. We applied a stepwise multiple linear regression model to determine if age and sex might be predictors of postural sway during STS. Only age was associated with sway, accounting for between 6.5% and 14.6% of the variability in sway during STS. The age of the subject influences postural sway during STS, but in a small amount. This variable should be taken into account as a variable of control in the assessment of dynamic postural control. Moreover, postural stability during STS was not associated with the sex of the participants.

Asymmetry in children with unilateral cerebral palsy during sit-to-stand movement: Cross-sectional, repeated-measures and comparative study.

BACKGROUND: We aimed to compare motor strategies adopted by children with unilateral Cerebral Palsy and typically developing children during the performance of sit-to-stand. METHODS: Eleven children with unilateral cerebral palsy and 20 typically developing children were evaluated. Kinematic and kinetic analysis of the sit-to-stand movement was performed. Three seat heights were evaluated: neutral (90° of hip-knee-ankle flexion), elevated to 120% of the neutral height, and lowered to 80% of the neutral height. As outcome variables, we considered sit-to-stand duration (temporal); initial, final and maximal sagittal angles and range of motion of trunk, pelvis, hip, knee, and ankle (kinematics); the peak of vertical ground reaction force (kinetics), and asymmetric index. Effect size is represented by η2p. FINDINGS: We found that for the lowered seat, all groups presented increased flexion of lower limbs and trunk to initiate sit-to-stand (p≤0.012; η2p = 0.41-0.84), increased peak flexion of trunk, hip and knee (p≤0.01; η2p = 0.39-0.88), increased range of motion of knee and trunk (p≤0.01; η2p = 0.45-0.85) and the duration of sit-to-stand (p≤0.05 η2p = 0.23-0.56). Children with unilateral cerebral palsy presented increased posterior pelvic tilt (p≤0.01) and decreased hip flexion of both lower limbs (p≤0.01) for all seat heights and moved their non-affected limb backward in the lowered seat (p≤0.01). Asymmetry was observed for the final and the maximal angles of the ankle in neutral and lowered seats in unilateral cerebral palsy (asymmetry index = 3.3-5.8%). INTERPRETATION: The lowered seat height led to adaptive motor strategies in children with unilateral cerebral palsy, which should be considered in clinical practice.

Effects of Kinesio taping in rectus femoris activity and sit-to-stand movement in children with unilateral cerebral palsy: placebo-controlled, repeated-measure design.

Background: Although it has been commonly used in rehabilitation sets, there is a lack of studies verifying the effects of Kinesio taping to improve functionality in children with Cerebral Palsy (CP). This information would promote evidence-based practice. Purpose: To verify the effects of Kinesio taping in the performance of sit-to-stand movement in children with unilateral CP. Methods and materials: A blinded, single placebo-controlled and repeated-measure design. The setting was the rehabilitation clinic of the university and care facilities. A total of 11 children from 6 to 12 years of age (mean: 10.5 years; standard deviation: 2.8 years) and classified as levels I and II by the Gross Motor Function Classification System were included. Kinesio taping was applied over the rectus femoris of the affected limb. Three taping conditions were used: Kinesio taping, without Kinesio taping and placebo. Three seat heights were used: neutral (100%), lowered (80%), and elevated (120%). Muscle activity (electromyography) and trunk and lower limb alignment (kinematics) were evaluated as body structures and function measures. The time required to perform sit-to-stand was used as a functionality measure. Mixed analysis of variation (ANOVA) measured angular variables of the hip, knee, ankle, and rectus femoris activity. Repeated ANOVA measured angular variables of trunk and pelvis and total duration. Significance was accepted for values of p ≤ 0.05. Results: Kinesio taping increased rectus femoris activity, decreased peak flexion of the trunk, knee, hip, and ankle, and increased trunk extension in the end of sit-to-stand when compared with without Kinesio taping and placebo. Total duration was decreased with lower effect sizes. Conclusions: Immediate application of Kinesio taping modified body structures and function measures during sit-to-stand in children with unilateral CP, but it did not alter functionality. Implications for Rehabilitation Evidence-based practice about the use of Kinesio taping in Cerebral Palsy. Knowledge about alternative rehabilitation techniques in Cerebral Palsy. Knowledge about sensory stimulation in Cerebral Palsy. Effectiveness of Kinesio taping in muscle activation.

Immediate effect of kinesio taping on knee extensor torque of children with Cerebral Palsy: Three case reports.

BACKGROUND: Kinesiotaping (KT) has been commonly used in clinical setting. However, beneficial KT effects have not been proved yet. OBJECTIVE: We aimed to verify the effects of KT in knee extensor torque in children with CP. METHODS: We evaluated three children diagnosed as spastic CP, classified as level I, II and III, according with GMFCS. Knee extensor peak torque was analyzed by isokinetic evaluation (Biodex Multi Joint System). The test was performed at 60°/s in the concentric passive mode and the children performed maximal contractions. Children with CP were evaluated with and without KT under rectus femoris. RESULTS: After KT application, knee peak torque of the affected limb increased in children with CP. CONCLUSION: KT may increase muscle strength in children with CP.

Pilates improves lower limbs strength and postural control during quite standing in a child with hemiparetic cerebral palsy: A case report study.

OBJECTIVE: To verify the effect of Pilates exercises in a child with cerebral palsy (CP) with mild functional impairment. METHODS: We evaluated average peak torque of ankle and knee extensors/flexors using a Biodex System, using concentric active-assisted test. We also evaluated amplitude of anterior-posterior and of medial-lateral displacement of the CoP and area of oscillation during quite standing with a BERTEC platform. We applied Pilates exercises for eight weeks. RESULTS: Peak torque/body weight of ankle and knee extensors/flexors of both affected and unaffected limbs increased after Pilates. Also, all kinetic variables decreased after Pilates' intervention. After one-month follow-up, isokinetic variable values were higher while kinetic variable values were lower than baseline values. CONCLUSION: Pilates may be an important rehabilitation technique for children with CP that present mild deficits in motor structures and high functional level, especially when the aims are to improve muscle strength and postural control during quite standing.

Physical and functional evaluation in Marden-Walker syndrome: case report--review of literature.

OBJECTIVE: To review literature concerning Marden-Walker syndrome (MWS) and describe physical-functional characteristics of a child with a suspected diagnosis of MWS. METHODS: Physical examination, laboratory and clinical tests were collected in a two-year-old boy. Bayley Scales of Infant and Toddler Development (BSITD-III) was applied to evaluate motor-cognitive development. RESULTS: Several facial features (blepharophimosis/micrognathia/cleft palate/pectus deformation/kyphoscoliosis), besides delayed physical growth, anemia, hypoplastic muscles, muscle atrophy and arachnodactyly were found; which are typically described in MWS. BSITD-III scaled scores were 1, 2 and 1, respectively, for gross-motor, fine-motor and cognitive skills; representing delays that were slightly more severe for gross-motor and cognitive skills compared with fine motor. We did not find joint contractures, which are strongly associated with MWS. Instead, we observed moderate muscle shortening. CONCLUSIONS: The results found could be attributed to the early intervention applied to the child since eight months old; findings that highlight the importance of early intervention.

Functionality level and its relation to postural control during sitting-to-stand movement in children with cerebral palsy.

In this study we studied functional performance and functional balance in children with cerebral palsy (CP) and typically developing (TD) children. The relationship between these components and postural control during sit-to-stand movement (STS) was also investigated. Ten children with CP (GMFCS I and II) and 27 TD children, ages 5-12 years, were included in the study. The Pediatric Evaluation of Disability Inventory (PEDI) and the Pediatric Balance Scale (PBS) were used to measure functional performance and functional balance, respectively. Postural control during STS was assessed by means of a force plate. Participants were asked to stand from a chair with feet over a force plate. Children with CP exhibited lower scores than TD children in the PBS and in the mobility Functional Skills and Caregiver Assistance domains of the PEDI (p≤0.05). In both groups postural control during STS movement was correlated with mobility Caregiver Assistance scores of the PEDI. The results demonstrate that although the participants had mild to moderate motor impairment, they exhibit deficits in their level of functional performance and functional balance compared to typical children. Moreover, it was observed that impairments in postural control during the STS movement are related to functional performance in both groups. This result demonstrates the importance of the structure and function components to the level of activity in children.

Sit-to-stand movement in children with hemiplegic cerebral palsy: relationship with knee extensor torque and social participation.

This study aimed to investigate the relationship between sit-to-stand (STS) movement, knee extensor torque and social participation in children with cerebral palsy (CP). Seven spastic hemiplegic CP patients (8.0 ± 2.2 years), classified by the Gross Motor Function Classification System as I and II, and 18 typical children (8.4 ± 2.3 years) participated in this study. Trunk, hips, knees, and ankles angles and temporal variables of STS movement were obtained by means of kinematics evaluation. Isokinetic evaluation was performed at 60°/s in the concentric passive mode to measure knee extensors torque. Social participation was assessed by the Assessment of Life Habits for Children (LIFE-H) scale. Results showed that children with spastic hemiplegic CP have lower knee extensor torque in the affected limb and restriction in social participation in dimensions related with fine motor control and language skills when compared to their typical peers. Except for ankle excursion in frontal plane, and ankle excursion and range in transverse plane, patients were similar to typical children regarding the strategies adopted to perform the STS movement, as well as in the participation dimensions related with gross motor function. Moreover, we found a significant non-linear correlation between knee extensors torque and some lower limb and trunk angles for children with CP. Therefore, during evaluation and rehabilitation processes, impairments in body functions and structures should be related with how much they affect a child's ability to perform functional activities, so rehabilitation protocols could be focused on individual needs.

Functional strength training in child with cerebral palsy GMFCS IV: case report.

OBJECTIVE: To evaluate the effectiveness of a functional strength training. CASE REPORT: A nine-year-old child with Cerebral Palsy (CP) classified as level IV according to Gross Motor Function Classification System participated in the study. Assessments were at baseline, five weeks and 10 weeks post-intervention. Lower-extremity muscles strength was evaluated with an isokinetic dynamometer. Also, Gross Motor Function Measure (GMFM-88) and Timed up & Go (TUG) tests were assessed. A functional strength training protocol, four sessions a week, for 10 weeks was applied. RESULTS: Following functional strength training, it improvements were found in hip, knee and ankle muscles strength, as well as increase in GMFM-88 score and decrease in time for TUG test performance. Positives outcomes from functional strength training were obtained beyond improvements in strength, since improvements in functional motor performance were also achieved. CONCLUSION: Therefore, individualized, specific and functional strength training seems to be an alternative to rehabilitation of children with CP with high level of functional disability.

Assessment of postural control in children with cerebral palsy: a review.

This paper aimed to review studies that assessed postural control (PC) in children with cerebral palsy (CP) and describe the methods used to investigate postural control in this population. It also intended to describe the performance of children with CP in postural control. An extensive database search was performed using the keywords: postural control, cerebral palsy, children, balance and functionality. A total of 1065 papers were identified and 25 met the inclusion criteria. The survey showed that PC is widely studied in children with CP, with reliable methods. The link between postural control and functionality was also evident. However, a lack of studies was observed assessing postural control in these children by means of scales and functional tests, as well as exploring postural control during daily functional activities. Thus research addressing these issues can be a promising field for further research on postural control.

International Classification of Functioning, Disability and Health in children with cerebral palsy.

PURPOSE: We intended to describe how concepts from recent models of disability have been studied for evaluation of children with cerebral palsy (CP) and their clinical implications. METHOD: We revised studies that focused on the components of the International Classification of Functioning, Disability and Health (ICF) in children with CP. RESULTS: Researchers have reported that children with CP exhibit impairments in various body functions/structures, limitations in functional activities performance and experience poorer participation outcomes than their typical peers. Moreover, it has been showed that participation of children with CP was affected by environmental factors. CONCLUSION: Therefore, evaluation and rehabilitation processes should be focused on the quality of life improvement by emphasizing what a child can and wants to execute within the environment. Also, environmental factors should be recognized so that barriers could be minimized and adaptations to the environment achieved. However, few studies have verified the interrelationship between contextual factors and the functioning and disability domains in children with CP. This would allow us to know about approaches specifically designed for these children's needs.

Sit-to-stand movement in children with cerebral palsy: a critical review.

Sit-to-stand (STS) movement is widely performed in daily life and an important pre requisite for acquisition of functional abilities. However, STS is a biomechanical demanding task which requires high levels of neuromuscular coordination, muscle strength and postural control. As children with cerebral palsy (CP) exhibit a series of impairments in body structures and functions, STS movement performance could be impaired in this population. Thus, this article aimed to review studies that had described how STS movement is performed by children with CP, the factors that influence it and the methodological procedures adopted in it analyses. A search was performed by one reviewer in relevant databases. In all, 12 articles were identified and 9 were selected for the present review. It was detected a large variation in sample characteristics and methodological issues among studies. In fact, standardization of the method applied to STS movement analysis is not fully established. With regard to STS performance, children with CP exhibited variations among them and also when compared with their typical peers. Moreover extrinsic factors appear to influence STS movement performance in these children and its manipulation could be incorporated into rehabilitation protocols. Moreover, the relationship between STS movement and functionality in reviewed articles was not reported. Therefore the review allowed to observe that STS movement has been under-explored in children with CP, with a lack of standardized methodologies and a not well established relationship between this movement and functionality. Thus, further studies about STS movement in CP are necessary.