Assessing the best time interval between doses in a two-dose vaccination regimen to reduce the number of deaths in an ongoing epidemic of SARS-CoV-2.

The SARS-CoV-2 pandemic is a major concern all over the world and, as vaccines became available at the end of 2020, optimal vaccination strategies were subjected to intense investigation. Considering their critical role in reducing disease burden, the increasing demand outpacing production, and that most currently approved vaccines follow a two-dose regimen, the cost-effectiveness of delaying the second dose to increment the coverage of the population receiving the first dose is often debated. Finding the best solution is complex due to the trade-off between vaccinating more people with lower level of protection and guaranteeing higher protection to a fewer number of individuals. Here we present a novel extended age-structured SEIR mathematical model that includes a two-dose vaccination schedule with a between-doses delay modelled through delay differential equations and linear optimization of vaccination rates. By maintaining the minimum stock of vaccines under a given production rate, we evaluate the dose interval that minimizes the number of deaths. We found that the best strategy depends on an interplay between the vaccine production rate and the relative efficacy of the first dose. In the scenario of low first-dose efficacy, it is always better to vaccinate the second dose as soon as possible, while for high first-dose efficacy, the best strategy of time window depends on the production rate and also on second-dose efficacy provided by each type of vaccine. We also found that the rate of spread of the infection does not affect significantly the thresholds of the best window, but is an important factor in the absolute number of total deaths. These conclusions point to the need to carefully take into account both vaccine characteristics and roll-out speed to optimize the outcome of vaccination strategies.

Percolation across households in mechanistic models of non-pharmaceutical interventions in SARS-CoV-2 disease dynamics.

Since the emergence of the novel coronavirus disease 2019 (COVID-19), mathematical modelling has become an important tool for planning strategies to combat the pandemic by supporting decision-making and public policies, as well as allowing an assessment of the effect of different intervention scenarios. A proliferation of compartmental models were developed by the mathematical modelling community in order to understand and make predictions about the spread of COVID-19. While compartmental models are suitable for simulating large populations, the underlying assumption of a well-mixed population might be problematic when considering non-pharmaceutical interventions (NPIs) which have a major impact on the connectivity between individuals in a population. Here we propose a modification to an extended age-structured SEIR (susceptible-exposed-infected-recovered) framework, with dynamic transmission modelled using contact matrices for various settings in Brazil. By assuming that the mitigation strategies for COVID-19 affect the connections among different households, network percolation theory predicts that the connectivity among all households decreases drastically above a certain threshold of removed connections. We incorporated this emergent effect at population level by modulating home contact matrices through a percolation correction function, with the few additional parameters fitted to hospitalisation and mortality data from the city of São Paulo. Our model with percolation effects was better supported by the data than the same model without such effects. By allowing a more reliable assessment of the impact of NPIs, our improved model provides a better description of the epidemiological dynamics and, consequently, better policy recommendations.

Modelling the impact of school reopening and contact tracing strategies on Covid-19 dynamics in different epidemiologic settings in Brazil.

We simulate the impact of school reopening during the COVID-19 pandemic in three major urban centers in Brazil to identify the epidemiological indicators and the best timing for the return of in-school activities and the effect of contact tracing as a mitigation measure. Our goal is to offer guidelines for evidence-based policymaking. We implement an extended SEIR model stratified by age and considering contact networks in different settings - school, home, work, and community, in which the infection transmission rate is affected by various intervention measures. After fitting epidemiological and demographic data, we simulate scenarios with increasing school transmission due to school reopening, and also estimate the number of hospitalization and deaths averted by the implementation of contact tracing. Reopening schools results in a non-linear increase in reported COVID-19 cases and deaths, which is highly dependent on infection and disease incidence at the time of reopening. When contact tracing and quarantining are restricted to school and home settings, a large number of daily tests is required to produce significant effects in reducing the total number of hospitalizations and deaths. Policymakers should carefully consider the epidemiological context and timing regarding the implementation of school closure and return of in-person school activities. While contact tracing strategies prevent new infections within school environments, they alone are not sufficient to avoid significant impacts on community transmission.

Model-based estimation of transmissibility and reinfection of SARS-CoV-2 P.1 variant.

Background: The SARS-CoV-2 variant of concern (VOC) P.1 (Gamma variant) emerged in the Amazonas State, Brazil, in November 2020. The epidemiological consequences of its mutations have not been widely studied, despite detection of P.1 in 36 countries, with local transmission in at least 5 countries. A range of mutations are seen in P.1, ten of them in the spike protein. It shares mutations with VOCs previously detected in the United Kingdom (B.1.1.7, Alpha variant) and South Africa (B.1.351, Beta variant). Methods: We estimated the transmissibility and reinfection of P.1 using a model-based approach, fitting data from the national health surveillance of hospitalized individuals and frequency of the P.1 variant in Manaus from December-2020 to February-2021. Results: Here we estimate that the new variant is about 2.6 times more transmissible (95% Confidence Interval: 2.4-2.8) than previous circulating variant(s). Manaus already had a high prevalence of individuals previously affected by the SARS-CoV-2 virus and our fitted model attributed 28% of Manaus cases in the period to reinfections by P.1, confirming the importance of reinfection by this variant. This value is in line with estimates from blood donors samples in Manaus city. Conclusions: Our estimates rank P.1 as one of the most transmissible among the SARS-CoV-2 VOCs currently identified, and potentially as transmissible as the posteriorly detected VOC B.1.617.2 (Delta variant), posing a serious threat and requiring measures to control its global spread.

Brazil in the face of new SARS-CoV-2 variants: emergencies and challenges in public health.

This article discusses the epidemic situation of Covid-19 in Brazil, in the face of the emergence of a new strain called P.1, which is more transmissible and may be associated with reinfection. Given the collapse of hospital care in Manaus in January 2021 and the results of three recent preprints, each that reports increased transmissibility of the P.1 variant, we propose some urgent measures. Genomic surveillance based on multi-step diagnostics, starting with RT-PCR type tests and up to sequencing, should be established. Efforts to identify reinfections associated with this variant and the update of its definition in protocols should be prioritized, and studies on the efficacy of currently available vaccines in Brazil concerning the new variant should be conducted. We also propose improving the Brazilian health surveillance system such that genomic surveillance is coordinated and thereby better able to respond to future emergencies in a more timely fashion. We call on the public agents involved in health surveillance to share data and information regarding the epidemic in a clear, fast and transparent way. Finally, we propose a greater engagement in inter-institutional cooperation of all those involved in the response and production of knowledge about the pandemic in our country.

A product-service-system proposal for municipalities in developing countries with tight budget to convert the organic waste in energy to eliminate dumps.

In developing countries, organic waste is commonly dumped in untreated landfills. Brazil has around 3,000 landfills distributed in 1,600 cities. The Brazilian government instituted the National Solid Waste Policy (PNRS), which set the goal of ending the dumping grounds in 2014. However, it was not accomplished. Municipal governments do not have the resources to fund the existing treatment technologies. Thus, there is an urgent need to propose low-cost alternatives to solve this problem. This work proposes a low-cost Product-Service System (PSS) solution that enables the proper treatment of organic waste using the current municipal budget, based on the renting of household biodigesters. It was outlined from a model built on various proposals for the PSS design, published between 2011 and 2018. A feasibility simulation of the proposal conducted for the scenario of the Brazilian city of Porto Amazonas has demonstrated that, by adopting the proposal, the administration could comply with the PNRS and save part of its actual budget. It also showed 75% of probability of financial viability for the PSS provider, in a scenario of reduction of up to 20% in the current municipal costs for organic waste collection and transportation, and up to 40% off in cooking gas costs for the equipment-hosting households. The proposal is a potential solution for the Brazilian municipalities with more favorable scenarios to comply with the PNRS, as well as other countries' municipalities with budget constraints to eliminate their dumps.

Modelling the COVID-19 pandemic in context: an international participatory approach.

The SARS-CoV-2 pandemic has had an unprecedented impact on multiple levels of society. Not only has the pandemic completely overwhelmed some health systems but it has also changed how scientific evidence is shared and increased the pace at which such evidence is published and consumed, by scientists, policymakers and the wider public. More significantly, the pandemic has created tremendous challenges for decision-makers, who have had to implement highly disruptive containment measures with very little empirical scientific evidence to support their decision-making process. Given this lack of data, predictive mathematical models have played an increasingly prominent role. In high-income countries, there is a long-standing history of established research groups advising policymakers, whereas a general lack of translational capacity has meant that mathematical models frequently remain inaccessible to policymakers in low-income and middle-income countries. Here, we describe a participatory approach to modelling that aims to circumvent this gap. Our approach involved the creation of an international group of infectious disease modellers and other public health experts, which culminated in the establishment of the COVID-19 Modelling (CoMo) Consortium. Here, we describe how the consortium was formed, the way it functions, the mathematical model used and, crucially, the high degree of engagement fostered between CoMo Consortium members and their respective local policymakers and ministries of health.

Immediate Effect of Grade IV Inferior Hip Joint Mobilization on Hip Abductor Torque: A Pilot Study.

Joint mobilization and manipulation stimulate mechanoreceptors, which may influence the joint and surrounding muscles. The purpose of this pilot study was to determine the effect of grade IV inferior hip joint mobilization on hip abductor torque. Thirty healthy subjects were randomly assigned to a control group (grade I inferior hip joint mobilization) or an experimental group (grade IV inferior hip joint mobilization). Subjects performed a pre- and post-intervention test of five isometric repetitions on the Cybex Normö dynamometer; the average torque was determined for both pre- and post-intervention measurements. These data were analyzed using the independent samples t-test with the significance level set at P<0.05. The results showed a statistically significant difference between the two groups for an increase in hip abductor torque in the experimental group (P=0.03). The experimental group demonstrated a 17.35% increase in average torque whereas the control group demonstrated a 3.68% decrease in average torque. These findings are consistent with other studies demonstrating that the use of grade IV non-thrust mobilization improves strength immediately post-intervention in healthy individuals. The results of this pilot study provide physical therapists with further support for the utilization of manual therapy in conjunction with therapeutic exercise to enhance muscle strength.

The spatial dynamics of ecosystem engineers.

The changes on abiotic features of ecosystems have rarely been taken into account by population dynamics models, which typically focus on trophic and competitive interactions between species. However, understanding the population dynamics of organisms that must modify their habitats in order to survive, the so-called ecosystem engineers, requires the explicit incorporation of abiotic interactions in the models. Here we study a model of ecosystem engineers that is discrete both in space and time, and where the engineers and their habitats are arranged in patches fixed to the sites of regular lattices. The growth of the engineer population is modeled by Ricker equation with a density-dependent carrying capacity that is given by the number of modified habitats. A diffusive dispersal stage ensures that a fraction of the engineers move from their birth patches to neighboring patches. We find that dispersal influences the metapopulation dynamics only in the case that the local or single-patch dynamics exhibit chaotic behavior. In that case, it can suppress the chaotic behavior and avoid extinctions in the regime of large intrinsic growth rate of the population.

Polycyclic aromatic hydrocarbons (PAHs) in street dust of Rio de Janeiro and Niterói, Brazil: Particle size distribution, sources and cancer risk assessment.

Fifteen polycyclic aromatic hydrocarbons (PAHs) were analyzed in two fractions (<63µm and 63-850µm) of street dust samples collected in different urban areas of Rio de Janeiro and Niterói cities, Brazil. Individual PAH concentrations and total PAH concentrations (∑PAH) were evaluated considering geographic and particle size distributions, PAH source and cancer risk. In 53% of the samples, ∑PAH values were higher in the smallest particles than in the largest ones, whereas the inverse was true for 23.5% of the samples. In 23.5% of the samples, both classes of particles showed comparable ∑PAH. The highest ∑PAH concentrations were found in areas of limited air dispersion, resulting in PAH accumulation in street dust. The diagnostic ratios and principal component analysis (PCA) indicated a strong influence of pyrogenic sources on PAH concentration, mainly of vehicular emissions. The cancer risk levels for children and adults, for both particulate size fractions (<63µm and 63µm-850µm), were comparable for dermal contact and by ingestion, and ranged from 10-8 to 10-6, whereas in certain cases the cancer risk level for adults by dermal contact was 2 to 3 times larger than for children. The cancer risk levels via inhalation always ranged from 10-13 to 10-10, so this exposure pathway was almost 104 less severe than through ingestion and dermal contact, and thus negligible.

O uso do plano de parto por gestantes no pré-natal: uma revisão de escopo / El uso del plan de parto por mujeres embarazadas en prenatal: una revisión del alcance / The use of the birth plan by pregnant women in prenatal care: a scoping review

RESUMO Objetivo: identificar a literatura existente sobre a elaboração e utilização do plano de parto. Método: trata-se de revisão de escopo construída com base na estratégia PCC, sendo "P" a população (gestantes), "C" o conceito (plano de parto) e "C" o contexto (pré-natal). A busca foi realizada nas bases de dados PubMed, Scopus e BVS. Foram incluídos estudos na íntegra em inglês, espanhol ou português, que envolvessem a temática do plano de parto e tenham sido publicados até dezembro de 2019. Os dados foram coletados de outubro a dezembro de 2019. Os textos selecionados foram lidos na íntegra e extraídos dados de caracterização da produção, principais resultados e foi destacado o uso do plano de parto. Resultados: a amostra final foi de 27 artigos elegíveis, os quais foram organizados conforme o fluxograma de Itens de Relatórios Preferenciais para Revisões Sistemáticas e Metanálises. Em sua maioria os artigos foram publicados em 2019 (n=6) e com origem nos Estados Unidos (n=9), seguido pela Inglaterra (n=3). O principal tema encontrado foi sobre o uso do plano de parto e sua relação com a satisfação, empoderamento e melhoria da experiência das gestantes. Conclusão: o uso do plano de parto é um incentivo a toda a equipe profissional para o cumprimento dos acordos realizados com a gestante e sua família, modificando as práticas de cuidado no parto nas instituições de saúde e tornando-as mais respeitosas.

RESUMEN Objetivo: identificar la literatura existente sobre el desarrollo y uso del plan de parto. Método: se trata de una revisión de alcance construida a partir de la estrategia del PCC, siendo "P" la población (gestantes), "C" el concepto (plan de parto) y "C" el contexto (prenatal). La búsqueda se realizó en las bases de datos PubMed, Scopus y BVS. Se incluyeron estudios completos en inglés, español o portugués, que involucren la temática del plan de parto y que hayan sido publicados hasta diciembre de 2019. Los datos fueron recolectados de octubre a diciembre de 2019. Los textos seleccionados se leyeron íntegramente y se extrajeron los datos de caracterización de la producción, principales se destacaron los resultados y el uso del plan de parto. Resultados: la muestra final estuvo conformada por 27 artículos elegibles, los cuales fueron organizados de acuerdo con el diagrama de flujo de Ítems Preferidos para Reportes para Revisiones Sistemáticas y Metaanálisis. La mayoría de los artículos se publicaron en 2019 (n = 6) y se originaron en los Estados Unidos (n = 9), seguidos de Inglaterra (n = 3). El tema principal encontrado fue sobre el uso del plan de parto y su relación con la satisfacción, empoderamiento y mejora de la experiencia de la gestante. Conclusión: el uso del plan de parto es un incentivo para que todo el equipo profesional cumpla con los acuerdos realizados con la gestante y su familia, modificando las prácticas de atención durante el parto en las instituciones de salud y haciéndolas más respetuosas.

ABSTRACT Objective: to identify the existing literature on the development and use of the birth plan. Method: this is a scoping review built based on the PCC strategy, with "P" being the population (pregnant women), "C" the concept (birth plan), and "C" the context (prenatal). The search was performed in PubMed, Scopus, and BVS databases. Full studies in English, Spanish or Portuguese were included, involving the theme of the birth plan and having been published until December 2019. Data were collected from October to December 2019. The selected texts were read in full and data extracted of the production characterization, main results, and the use of the birth plan was highlighted. Results: the final sample consisted of 27 eligible articles, which were organized according to the flowchart of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Most articles were published in 2019 (n=6) and from the United States (n=9), followed by England (n=3). The main theme found was about the use of the birth plan and its relationship with the satisfaction, empowerment, and improvement of the experience of pregnant women. Conclusion: the use of the birth plan is an incentive for the entire professional team to comply with the agreements made with the pregnant woman and her family, modifying care practices during childbirth in health institutions and making them more respectful.

Brazil in the face of new SARS-CoV-2 variants: emergencies and challenges in public health / O Brasil perante as novas variantes de SARS-CoV-2: emergências e desafios em saúde pública

ABSTRACT: This article discusses the epidemic situation of Covid-19 in Brazil, in the face of the emergence of a new strain called P.1, which is more transmissible and may be associated with reinfection. Given the collapse of hospital care in Manaus in January 2021 and the results of three recent preprints, each that reports increased transmissibility of the P.1 variant, we propose some urgent measures. Genomic surveillance based on multi-step diagnostics, starting with RT-PCR type tests and up to sequencing, should be established. Efforts to identify reinfections associated with this variant and the update of its definition in protocols should be prioritized, and studies on the efficacy of currently available vaccines in Brazil concerning the new variant should be conducted. We also propose improving the Brazilian health surveillance system such that genomic surveillance is coordinated and thereby better able to respond to future emergencies in a more timely fashion. We call on the public agents involved in health surveillance to share data and information regarding the epidemic in a clear, fast and transparent way. Finally, we propose a greater engagement in inter-institutional cooperation of all those involved in the response and production of knowledge about the pandemic in our country.

RESUMO: Este artigo discute a situação epidêmica da COVID-19 no Brasil diante do aparecimento de uma nova linhagem, chamada P.1, mais transmissível e com possível reinfecção associada. Tendo em vista o colapso do atendimento hospitalar em Manaus em janeiro de 2021 e os resultados de três preprints recentes, dos quais todos encontraram maior transmissibilidade da variante P.1, propomos algumas ações urgentes: o estabelecimento de uma vigilância genômica baseada em diagnóstico em múltiplos passos, iniciando com os testes do tipo transcrição reversa seguida de reação em cadeia da polimerase (RT-PCR) até o sequenciamento; um esforço imediato na identificação de reinfecções associadas à nova variante, com a atualização dos protocolos de definição; e estudos sobre a eficácia das vacinas disponíveis no Brasil na vigência da nova variante. Propomos, ademais, o aprimoramento do sistema de vigilância em saúde brasileiro para que seja articulado com a vigilância genômica, de forma a responder mais oportunamente a emergências futuras. Chamamos os agentes públicos implicados na vigilância em saúde para que compartilhem dados e informações referentes à epidemia de forma clara, rápida e transparente. Finalmente propomos maior engajamento na cooperação interinstitucional de todos os envolvidos na resposta e produção de conhecimento sobre a pandemia em nosso país.

Air stacking: effects of Pilates mat exercises on muscle strength and on pulmonary function in patients with cystic fibrosis.

OBJECTIVE: To analyze the effects of Pilates mat exercises in patients with cystic fibrosis (CF). METHODS: This was a clinical trial involving 19 CF patients recruited from either the CF Outpatient Clinic of the State University at Campinas Hospital de Clínicas or the Children's Institute of the University of São Paulo School of Medicine Hospital das Clínicas. All of the patients performed Pilates mat exercises for four months (one 60-min session per week). The variables studied (before and after the intervention) were respiratory muscle strength, MIP, MEP, FVC, and FEV1. RESULTS: After the intervention, MIP was significantly higher in the male patients (p = 0.017), as were MIP and MEP in the female patients (p = 0.005 and p = 0.007, respectively). There were no significant differences between the pre- and post-intervention values of FVC or FEV1, neither in the sample as a whole nor among the patients of either gender. CONCLUSIONS: Our results show that Pilates mat exercises have beneficial effects on respiratory muscle strength in CF patients.

Seasonal variation of polycyclic aromatic hydrocarbons concentrations in urban streams at Niterói City, RJ, Brazil.

Polycyclic aromatic hydrocarbons (PAHs) were determined in water samples collected in two streams and a lake located at Niteroi City, Rio de Janeiro State, Brazil between October 2008 and September 2009. Samples were extracted using liquid-liquid extraction and analyzed using high performance liquid chromatography with fluorescence detection. The limits of quantification were sufficiently low to accomplish PAH determination below the maximum concentration levels established by the Brazilian (50 ng/L) and USEPA legislations, with recoveries larger than 81.6%. Phenanthrene, fluoranthene, pyrene and benz[a]anthracene predominated among PAHs. Total concentrations of PAHs were well correlated with rainfall indicating a possible role of runoff to local pollution of water by PAHs and showed a seasonal variation in wet and dry seasons. Our results highlight the contribution of the widespread streams located around Guanabara Bay to the PAH burden found in its waters.

Effects of Pilates mat exercises on muscle strength and on pulmonary function in patients with cystic fibrosis / Efeitos do método Pilates na força muscular e na função pulmonar de pacientes com fibrose cística

OBJECTIVE: To analyze the effects of Pilates mat exercises in patients with cystic fibrosis (CF). METHODS: This was a clinical trial involving 19 CF patients recruited from either the CF Outpatient Clinic of the State University at Campinas Hospital de Clínicas or the Children's Institute of the University of São Paulo School of Medicine Hospital das Clínicas. All of the patients performed Pilates mat exercises for four months (one 60-min session per week). The variables studied (before and after the intervention) were respiratory muscle strength, MIP, MEP, FVC, and FEV1. RESULTS: After the intervention, MIP was significantly higher in the male patients (p = 0.017), as were MIP and MEP in the female patients (p = 0.005 and p = 0.007, respectively). There were no significant differences between the pre- and post-intervention values of FVC or FEV1, neither in the sample as a whole nor among the patients of either gender. CONCLUSIONS: Our results show that Pilates mat exercises have beneficial effects on respiratory muscle strength in CF patients. .

OBJETIVO: Analisar os efeitos do método Pilates em pacientes com fibrose cística (FC). MÉTODOS: Foi realizado um ensaio clínico, casuística de 19 pacientes com FC. Os pacientes foram recrutados no Ambulatório de FC do Hospital de Clínicas da Universidade Estadual de Campinas e no Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Todos os pacientes foram submetidos a uma sessão semanal de Pilates de 60 min durante quatro meses. As variáveis estudadas, antes e após a intervenção, foram força muscular respiratória, PImáx, PEmáx, CVF e VEF1. RESULTADOS: Houve um aumento significativo na PImáx nos pacientes do sexo masculino (p = 0,017), enquanto houve aumentos significativos na PImáx e PEmáx nos pacientes do sexo feminino (p = 0,005 e p = 0,007, respectivamente) após a intervenção. Não houve diferenças significativas nos valores de CVF e VEF1 antes e após a intervenção no grupo total de participantes, nem nos subgrupos em relação ao gênero. CONCLUSÕES: Os resultados deste estudo mostraram os efeitos benéficos da aplicação do método Pilates na força muscular respiratória nos pacientes estudados. (Registro Brasileiro de Ensaios Clínicos - ReBEC; número de identificação RBR-86vp8x [http://www.ensaiosclinicos.gov.br]) .

Measurement of depletion region width in poled silica.

The width of the depletion region in fused-silica samples thermally poled during various periods of time is investigated experimentally with four previously reported characterization techniques in an attempt to unify their findings. Although all measurements give a similar width of the depletion region, it is shown that the determination of the profile of chi(2) is also required for a good estimate of the nonlinearity induced by poling.

Avaliação da amplitude articular do tornozelo em crianças com paralisia cerebral após a aplicação de toxina botulínica seguida de fisioterapia / Evaluation of the widthto articulate of the ankle in children with cerebral paralysis after the application of botulinum toxin procceded by physioterapy

Objetivo: avaliar o grau de amplitude de movimento da articulação do tornozelo em crianças com paralisia cerebral, do tipo diparesia e tetraparesia espástica, após a aplicação de toxina botulínica tipo A em músculos gastrocnêmios, seguida por fisioterapia. Método: estudo observacional e transversal, avaliando 10 crianças de ambos os sexos, faixa etária de 2 a 7 anos, sendo 5 diparéticas e 5 tetraparéticas do tipo espástica, com presença de equinismo bilateral. Realizadas 3 avaliações em intervalos pré e pós bloqueio, sendo que o grau de mobilidade do tornozelo, obtido através da goniometria articular. Resultados: constatou-se que a injeção intramuscular de toxina botulínica do tipo A aumentou o grau de movimento da articulação do tornozelo e ainda, aumentou a pontuação na escala de atividades dinâmicas. Conclusão: a toxina botulínica tipo A combinada ao tratamento fisioterapêutico é um método eficaz no processo de reabilitação de pacientes que apresentam espasticidade por seqüela de PC.

Objective: to evaluate the degree of width of movement of the articulation of the ankle in children with cerebral paralysis, of the type diparetic and tetraparetic spastic, after the application of Botulinum Toxyn type A in gastrocnemius muscles proceeded by physiotherapy. Method: were accomplished a study prospective, traverse and observacional, they were appraised 10 children, of both sexes, presenting an age group from 2 to 7 years, being 5 diparetic and 5 tetraparetic of the type spastic, with presence of bilateral bilateral equinus . Were accomplished 3 evaluations in intervals before and powders blockade, and the degree of mobility of the ankle obtained through the goniometry to articulate. Results: it was verified that the injection intramuscular of Botulinum Toxyn type A increased the degree of movement of the articulation of the ankle and still, it increased the punctuation in the scale of activities dynamics. Conclusion: the Botulinum Toxyn type A combined with physiotherapy is an effective method in the process of patient rehabilitation that they present spasticity for sequel of Cerebral Paralysis.