Participação em casa e fatores pessoais e ambientais em crianças e adolescentes com síndrome de Down.

OBJETIVO: Descrever a participação em casa atual (frequência, envolvimento) e o desejo do cuidador por mudança na participação em casa de crianças e adolescentes com síndrome de Down, bem como fatores ambientais da casa, e explorar as associações de fatores pessoais e ambientais com a participação atual e o desejo do cuidador por mudança. MÉTODO: Oitenta e dois cuidadores (média de idade = 45 anos e 10 meses) de crianças e adolescentes com síndrome de Down (média de idade = 10 anos e 7 meses) foram entrevistados sobre a participação em casa da criança e fatores ambientais utilizando a Medida de Participação e do Ambiente ­ Crianças e Jovens. Além disso, foram coletados fatores pessoais e ambientais das crianças. Os resultados são relatados por meio de análise descritiva e correlações (coeficientes de correlação de Spearman ou teste U de Mann­Whitney) para descrever a relação entre a participação atual e o desejo do cuidador por mudança, com fatores pessoais e ambientais, para as variáveis ordinais e nominais, respectivamente (p < 0,05). RESULTADOS: A participação das crianças foi maior em cuidados pessoais e menor em atividades relacionadas à escola. A maioria dos cuidadores desejava mudança nas lições de casa e nas tarefas domésticas. Maior frequência de participação foi associada ao sexo masculino, distanciamento social menos rigoroso do cuidador devido à pandemia de covid­19 e crianças recebendo terapia. O maior envolvimento na participação foi associado a uma idade mais jovem nas crianças e a um maior apoio do ambiente. A idade mais avançada das crianças foi associada ao maior desejo por mudança do cuidador. INTERPRETAÇÃO: Fatores pessoais e ambientais são correlacionados com a participação de formas específicas. Devem ser realizadas estratégias criativas para promover a participação e que considerem os desejos do cuidador.

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.

Home participation and personal and environmental factors in children and adolescents with Down syndrome.

AIM: To describe current home participation (frequency, involvement) and caregiver's desire for change in home participation of children and adolescents with Down syndrome, as well as home environmental factors, and to explore the associations of personal and environmental factors with current participation and caregiver's desire for change. METHOD: Eighty-two caregivers (mean age = 45 years 10 months) of children and adolescents with Down syndrome (mean age = 10 years 7 months) were surveyed about the child's home participation and environmental factors using the Participation and Environment Measure-Children and Youth. Furthermore, children's personal and environmental factors were collected. Results are reported using descriptive analysis and correlations (Spearman's rank correlation coefficients and Mann-Whitney U test) to describe the relationship between current participation and caregiver's desire for change, with personal and environmental factors as ordinal and nominal variables respectively (p < 0.05). RESULTS: Children's participation was highest with regard to personal care management and lowest with regard to school-related activities. Most caregivers desired change in homework and household chores. Greater frequency was associated with male sex, caregiver less rigorous social distancing due to the COVID-19 pandemic, and children receiving therapies. Greater involvement was associated with younger age in children and higher environmental support. Older age in children was associated with caregiver's greater desire for change. INTERPRETATION: Personal and environmental factors correlated with participation in specific ways. Creative strategies to promote participation that consider caregiver's wishes should be undertaken.

Association between participation at home and functional skills in children and adolescents with Down syndrome: A cross-sectional study.

BACKGROUND: According to a biopsychosocial approach to health and disability, participation at home and functional skills are important components of the functioning. Therefore, knowledge about interactions between these components allows for targeting specific interventions. OBJECTIVE: This study investigated whether participation opportunities (frequency and involvement) for children/adolescents with Down syndrome (DS) in a realistic environment at their own home are associated with the functional skills related to the domains of Daily Activities, Mobility, Social/Cognitive and Responsibility. METHODS: This was an observational study. Forty-eight children/adolescents with DS participated (mean age: 10.73 ± 3.43; n = 27 females). Participants were evaluated using the Participation and Environment Measure for Children and Youth (PEM-CY) home environment setting (raw frequency and engagement scores) and Pediatric Evaluation of Disability Inventory speedy version (PEDI-CAT-SV) (continuous score). RESULTS: Significant and positive correlations were found between the frequency of participation at home with Daily Activities (ro = 0.320), Social/Cognitive (ro = 0.423) and Responsibility (ro = 0.455). For involvement, significant and positive correlations were found with Daily Activities (ro = 0.297), Social/Cognitive (ro = 0.380) and Responsibility (ro = 0.380). For the PEDI-CAT-SV Mobility, no significant correlation was found. CONCLUSIONS: Higher frequency and involvement of participation at home are associated with greater functional skills assessed, except for Mobility. This study provided pioneering insights about the relationships between the level of home participation and functional skills in DS, generating evidence that could guide approaches to participation-focused intervention.

Telehealth in paediatric physical therapy education: Strategies and perceptions of interns and caregivers of children with disabilities in Brazil.

AIMS: To describe the implementation of paediatric rehabilitation telehealth at a physical therapy (PT) unit in Brazil during the COVID-19 pandemic and to describe the perception about this modality by two groups: (1) undergraduate PT students using telehealth during their clinical rotations in this unit and (2) the caregivers of children with disabilities receiving the services. METHODS: Twenty-one PT interns (19 females; 25 ± 2 years of age) and seven caregivers (seven females; 40 ± 6 years of age) of seven children with disabilities (five females; 10 ± 4 years of age; five children diagnosed with cerebral palsy) responded to an online questionnaire about their experience with the telehealth programme. Participant attendance and frequency of objective responses were reported descriptively; open-ended responses were analysed qualitatively and grouped according to broad themes. RESULTS: 71.4% of interns rated telehealth as an excellent or good experience, and 28.6% did not appreciate it. In addition, 28.6% of them thought that telehealth should be part of the mandatory internship. Regarding caregivers, 85.8% judged the telehealth programme as excellent or good. Both interns and caregivers cited pros and cons related to technology, professional resources, communication skills and caregiver-related aspects, among others. CONCLUSIONS: Specific teaching strategies had to be utilised for implementation of telehealth. Despite being a novel modality for interns and caregivers, telehealth was well accepted.

Following 4 months of social distancing during COVID-19 Pandemic in Brazil did not change aspects of functioning in children and adolescents with developmental disabilities: A longitudinal study.

The COVID-19 pandemic and its demands of social distancing have created challenges in the lives of children/adolescents with developmental disabilities and their families, which would change aspects of children's functioning. The objetive of this study was to evaluate changes in some components of functioning of children/adolescents with disabilities following 4 months of social distancing during a period of high contamination rate in the year 2020 in Brazil. Participated 81 mothers of children/adolescents with disabilities, 3-17 years, most of them (80%) diagnosed with Down syndrome, cerebral palsy and autism spectrum disorder. Remote assessments of functioning' aspects including IPAQ, YC-PEM/ PEM-C, Social Support Scale and PedsQL V.4.0. Wilcoxon tests compared the measures, with significance level <0.05. No significant changes in participant's functioning were identified. Social adjustments required to facing the pandemic during two points in time in the midst of the pandemic did not change the evaluated aspects of functioning in our sample of Brazilian.

Cognitive-Motor Dual-Task Costs on Postural Sway During Sit-to-Stand Movement in Children With Cerebral Palsy.

OBJECTIVE: The purpose of this study was to investigate the cognitive-motor dual-task costs (DTCs) on postural sway of children with typical development (TD) and children with cerebral palsy (CP) during the sit-to-stand movement. METHODS: Twenty children with TD (mean age = 9.35 years) and 17 children with CP (mean age = 8.29 years) randomly performed 3 test conditions: simple motor task, low-complexity cognitive-motor dual-task, and high-complexity cognitive-motor dual-task. The sit-to-stand movement was divided into 3 phases for data analysis: preparation (P1), rising (P2), and stabilization (P3). For each of these phases, the DTCs were calculated by the percentage change in the center of pressure area of sway, velocity of sway, and duration variables between the simple and dual-task conditions. Analysis of variance was applied to test the group, task conditions, and interaction effects. RESULTS: Children with CP had lower DTC than children with TD in area of sway in P1 and P2 variables; anteroposterior velocity of sway in P1, P2, and P3; and duration in P3. Children with TD had higher DTC in the high-complexity cognitive-motor dual-task than in the low complexity one. Children with CP did not show adaptations between the dual-task conditions, showing no differences in DTCs. CONCLUSION: The simultaneous performance of a motor task and a cognitive task seems to affect children with CP and children with TD differently, but the effects depend on the specific demands of each task. These results demonstrate the importance of rehabilitation actions to place demands involving a variety of postural sway strategies. IMPACT: DTCs are different for children with TD and children with CP. Assessment and rehabilitation strategies must take into account the postural sway behavior of these children.

Perceived Social Support and Quality of Life of Children with and without Developmental Disabilities and Their Caregivers during the COVID-19 Pandemic in Brazil: A Cross-Sectional Study.

BACKGROUND: Social support and Quality of life (QoL) are important aspects of life and should be explored during the specific scenario of the pandemic. AIMS: (i) to compare the perceived social support (PSS) in caregivers and the domains of QoL of the caregiver and the child with developmental disabilities (DD) and typical development (TD); (ii) to verify the existence of the association, in each group, between the PSS, and the domain of QoL of the caregiver and the child. METHODS AND PROCEDURES: 52 caregivers of children with DD and 34 with TD participated remotely. We assessed PSS (Social Support Scale), children's QoL (PedsQL-4.0-parent proxy) and caregivers' QoL (PedsQL-Family Impact Module). The groups were compared for the outcomes using the Mann-Whitney test, and Spearman's test evaluated the correlation between the PSS and the QoL (child and caregiver) in each of the groups. OUTCOMES AND RESULTS: There was no difference between groups for PSS. Children with DD presented lower values in PedsQL total, psychosocial health, physical health, social activities, and school activity. Caregivers of children with TD presented lower values in PedsQL family total, physical capacity, emotional aspect, social aspect, daily activities, and higher value in communication. In the DD group, we found a positive relationship between PSS with child: Psychosocial Health (r = 0.350) and Emotional Aspect (r = 0.380), and with family: Total (r = 0.562), Physical Capacity (r = 0.402), Emotional Aspect (r = 0.492), Social Aspect (r = 0.606), Communication (r = 0.535), Concern (r = 0.303), Daily Activities (r = 0.394) and Family Relationships (r = 0.369). In the TD group, we found that PSS was positively associated with Family: Social Aspect (r = 0.472) and Communication (r = 0.431). CONCLUSIONS AND IMPLICATIONS: During the COVID-19 pandemic, despite both groups presenting similar PSS, there are important differences in QoL between them. For both groups, greater levels of perceived social support are associated with greater caregiver-reported in some domains of the child's and caregiver's QoL. These associations are more numerous, especially for the families of children with DD. This study provides a unique view into the relationships between perceived social support and QoL during the "natural experiment" of living through a pandemic.

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.

Exploration of the Feasibility of Remote Assessment of Functioning in Children and Adolescents with Developmental Disabilities: Parents' Perspectives and Related Contextual Factors.

The COVID-19 pandemic interrupted face-to-face health services, leveraging telehealth strategies. The aim of this cross-sectional study was to investigate, from a parent's perspective, the feasibility of a remote assessment of functioning in children with developmental disabilities during the pandemic and related contextual factors, based on how parents carry out the assessment. Parents of children with developmental disabilities (mean age = 7.56 ± 3.68) responded to a remote assessment via electronic forms and telephone interview. We analyzed parents' perspectives about the feasibility of the assessment. We also tested the association between feasibility score and sociodemographics/pandemic experience. Regression analysis tested if children's functioning characteristics predicted feasibility. A total of 57 mothers completed the remote assessment, and more than 95% did not report difficulties in accessing/responding to electronic forms. They scored remote assessment as easy and feasible, and reported no difficulties with telephone interview. Greater feasibility rates were related to lower maternal age (rho Spearman = -0.290; p = 0.029). The model shows that children's characteristics predicted 20.4% of feasibility (p < 0.005). Remote assessment showed to be feasible. Younger mothers might consider easier-to-use technologies, beyond considering remote assessment more viable. These results can guide the next steps in research and remote clinical practice.

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.

Active Videogame Training Combined with Conventional Therapy Alters Body Oscillation in Children with Cerebral Palsy: A Randomized Controlled Trial.

Objective: Assess the effect of nonimmersive virtual reality (VR) training as complementary rehabilitation on body oscillation in children with cerebral palsy (CP) while standing on different bases of support and surfaces. Materials and Methods: Twenty-three children with unilateral CP randomly allocated to an intervention group (IG, n = 12) or control group (CG, n = 11). The IG underwent two weekly 50-minute sessions of VR training over 8 weeks, associated with conventional therapy, while the CG was submitted to two 45-minute sessions of conventional neurodevelopmental-based physiotherapy a week over the same time period. Participants were evaluated on a force platform under control conditions (CCs) (rigid surface, feet parallel); semitandem stance; flexible surface (FS) with feet parallel; and flexible surface in a semitandem (FSST) stance. The effect of the group and time factors on the center of pressure oscillation variables was analyzed by repeated-measures analysis of variance (ANOVA), with significance set at 0.05. Results: The main effect observed was for time on the FS, with a decline in the amplitude of mediolateral (ML Amp) (P = 0.01) and mediolateral root mean square (P = 0.01) after intervention. In the IG, ML Amp also declined after intervention under CCs (P = 0.02) and total velocity increased for FSST (P = 0.04). The percentage change was significant only in the IG. Conclusion: VR training as complementary rehabilitation can help improve body oscillation in children with CP and mild functional impairment. Nonimmersive VR can be considered a complementary tool for the physical rehabilitation of children with CP. This study was registered with the Brazilian Clinical Trials Registry (RBR-3zty4w).

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.

Postural control in Down syndrome and relationships with the dimensions of the International Classification of Functioning, Disability and Health - a systematic review.

PURPOSE: Postural control assessment in children with Down syndrome (DS) may contribute to understanding the impact of impairments in Body Structures and Functions on Activities and Participation, providing a biopsychosocial approach to support clinical practice. The present study aimed to systematically review the literature addressing postural control in children and adolescents with Down syndrome, with a focus in the interactions among the components of the International Classification of Functioning (ICF). METHODS: We conducted a tailored search in PubMed; Web of Science, SCOPUS and Science Direct databases. RESULTS: We identified 20 full-texts that fulfilled the inclusion and exclusion criteria. Children and adolescents with DS showed lower postural stability across studies. The ICF components most commonly addressed were Body Structure and Function and Activity. Although the studies measured these components, they did not analyze the interrelationships of components when describing the determinants of postural control in this population. CONCLUSIONS: Overall, the studies indicate that children and adolescents with DS show decreased postural stability and greater vulnerability to sensory changes than their typical peers. There is a lack of studies using the biopsychosocial approach. Only few studies have related the activity level of the participants with the variables of postural control. None of them addressed components of Participation and Environmental Factors. The poor methodological quality of the included studies limits the translation of results to clinical practice. Further studies addressing children with disabilities, such as DS, should utilize the ICF framework, thus providing a biopsychosocial approach of health in these individuals.IMPLICATIONS FOR REHABILITATIONChildren with Down syndrome show decreased postural stability and greater vulnerability to sensory changes than their typical peers.In clinical practice, when assessing postural control of individuals with DS, rehabilitation professionals should not only address components of Body Structures and Functions, but also investigate their impact on Activity and Participation.Training of postural control should address strategies that include natural environments and participation situations.The biopsychosocial approach provided by the ICF framework should be implemented in clinical practice.

Functioning of children and adolescents with Down syndrome and the association with environmental barriers and facilitators during the COVID-19 pandemic.

PURPOSE: To compare functioning and environmental aspects before and during physical distancing (DPD) and to determine which social, physical, behavioral and functioning aspects of DPD are correlated. METHODS: Sixteen parents of children/adolescents with Down syndrome (11.38 ± 3.00 years) were surveyed before and DPD. Paired t-tests were used to compare functioning and environmental aspects before and DPD and chi-square tests were used to test associations. RESULTS: There were increases in the frequency (p < 0.001) and involvement (p = 0.01) in home participation and on the impact, noticed by the parents, of the possibility of child to participate in daily activities (p = 0.036), as well as a reduction in social supports perceived by caregivers (p = 0.049). An association was found between the child's socio-emotional difficulties symptoms and practice of physical activity (p = 0.043) and with parents' satisfaction with the level of child's home participation (p = 0.042). CONCLUSION: Functioning can be affected in either positive or negative ways.

Nonimmersive Virtual Reality as Complementary Rehabilitation on Functional Mobility and Gait in Cerebral Palsy: A Randomized Controlled Clinical Trial.

Objective: This study aimed to investigate the effects of nonimmersive virtual reality (VR) as complementary rehabilitation on functional mobility and gait in children with mild unilateral cerebral palsy (CP). Methods: Prospective, randomized, controlled, clinical trial. Twenty-two children with unilateral CP were randomized into two groups: intervention group (IG) (n = 11) and control group (n = 11). After baseline assessments, the participants either started the VR intervention (IG) associated with conventional therapy, or continued conventional physical therapy (control group). Participants in the IG attended 45-minute training sessions twice a week for 8 weeks (total: 16 sessions and 12 hours of training). Participants in the control group underwent standard therapy for 50 minutes, twice a week. Timed Up and Go test (TUG), gait spatiotemporal variables, and pelvic angles were measured at baseline and after treatment sessions. Results: When compared with the control group, the IG performed the following activities in decreased time: TUG, and stride time. Also, the IG increased the velocity of walking and the pelvis retroversion, and decreased the pelvis interval/external rotations and amplitude of pelvis rotation while walking. Conclusions: A rehabilitative approach based on a nonimmersive VR as complementary rehabilitation may improve functional mobility and change joint mobility functions during gait of children with mild unilateral CP. The results of the study demonstrate that the insertion of a therapy based on VR may help in better strategies in the gait of children with CP. Thus, rehabilitation professionals can use this tool combined with conventional therapy.

Effects of motor and cognitive manipulation on the dual-task costs of center of pressure displacement in children, adolescents and young adults: A cross-sectional study.

BACKGROUND: Dual-task paradigms allow to establish a relationship between motor and cognitive performance. The attentional resources needed to accomplish dual-tasks are influenced by age and task complexity. We investigated the dual-task costs for center of pressure displacement following manipulated motor and cognitive tasks in children, adolescents and young-adults. METHODS: Thirty children, 24 adolescents and 32 young-adults performed motor (postural stability) and cognitive (arithmetic) tasks under single and dual-task conditions. Complexity was manipulated by changing the base of support (standard, narrow, standard_on_foam, narrow_on_foam) for motor tasks and the difficulty level of cognitive tasks via serial subtraction (by 5 and by 3). Dual-task costs were calculated based on area and velocity of center of pressure. FINDINGS: Dual-task costs based on area during easy cognitive tasks were lower for children than young-adults. Under all the cognitive conditions, dual-task costs were lower on narrow than on standard bases of support. For all the tested bases of support, dual-task costs based on velocity were lower for more complex cognitive tasks than for easy tasks. INTERPRETATION: In children, more than in adults, dual-task demanded central adaptations which increased area of center of pressure displacement. Mechanical reasons, which might limit the increase in center of pressure displacement when dual-tasking, may explain the lower dual-task costs in narrow bases compared to standard ones. Possibly, high cognitive demands may lead the participants to prioritize the motor task to keep balance, resulting in smaller increases in center of pressure displacement velocity during dual-task when compared to easier cognitive tasks.

Lower Limb Sensorimotor Training (LoSenseT) for Children and Adolescents with Cerebral Palsy: A Brief Report of a Feasibility Randomized Protocol.

Motor disorders in cerebral palsy (CP) are often accompanied by disturbances of sensation and impaired somatosensory functions have been reported in individuals with CP. To test the feasibility of a sensorimotor training protocol for lower limbs in children and adolescents with unilateral and bilateral CP, and to analyze the preliminary effects of this training on sensory and motor variables. This is a single-blind, prospective phase I feasibility randomized protocol. A total of twenty participants with uni or bilateral cerebral palsy, GMFCS level I-III, ages 5 to 20 years will be recruited. The LoSenseT protocol is composed of tactile and proprioceptive activities in a child-friendly format. An original qualitative feedback questionnaire was developed to assess the protocol feasibility. Additionally, proprioception, tactile discrimination, postural stability, and gait parameters will be assessed. The LoSenseT protocol can support the implementation of interventions targeting lower limbs somatosensory impairments in individuals with CP.

Association between the level of attention and dual-task costs on postural sway and cognitive yield in children, adolescents, and young adults.

BACKGROUND: Postural stability requires attentional resources. Dual-task paradigms are used to investigate the attentional demand of the studied tasks. However, no studies have been conducted on the subjects' level of attention, analyzing its association with dual-task costs (DTC). RESEARCH QUESTION: To evaluate the attentional level and DTC on postural sway and cognitive yield in children, adolescents, and young adults, investigating age-related differences, and to analyze if the participants' attention level is associated with DTC. METHODS: Postural sway and cognitive-yield of 30 children, 24 adolescents, and 32 young adults were assessed in a dual-task paradigm. We calculated DTC on postural sway and cognitive yield. Attention level was tested using Psychological Battery for Attention Assessment. We tested the association between DTC and attention level. RESULTS: Young adults showed higher DTC on area and velocity of postural sway than children and adolescents. No differences in DTC on cognitive yield were found between the groups. Children showed lower attention levels than adolescents and young adults. Attention level was negatively associated with DTC on cognitive yield in young adults. Focused Attention is responsible for 24.4% of the variance in DTC on cognitive yield. CONCLUSION: Age impacts DTC on postural stability, but not on cognitive performance. The smaller changes in sway found in children/adolescents when dual-tasking, potentially reflect less developed attentional levels and postural control, which make them performing postural tasks closed to their stability boundaries, and, therefore, make them prioritize stability protection more than adults. Similar DTC on cognition between groups may reflect an equalization of the chosen cognitive task at everyone's difficulty level. The lower attention levels of children may reflect an attentional system in development, with prioritization o postural tasks when dual-tasking to maintain stability. Although attention level increases throughout age, attention only predicted DTC on cognition. Better Focused Attention's levels predicted lower DTC on cognitive yield for young adults.

Association between sensory processing and activity performance in children with cerebral palsy levels I-II on the gross motor function classification system.

BACKGROUND: Investigating the influence of sensory processing disorders on the level of function of children with cerebral palsy (CP) may help therapists identify specific impairments that impact activity and participation in these children. This may provide direction on selection of interventions to improve function and quality of life. OBJECTIVES: To investigate if sensory processing disorders in children with CP levels I and II on the Gross Motor Function Classification System (GMFCS) are associated with activity performance. METHODS: Sensory processing and activity performance of 28 children with CP between 5 and 15 years (mean ±â€¯standard deviation; 9.9 ±â€¯3.2 years) were evaluated using the Sensory Profile (SP) and Pediatric Evaluation of Disability Inventory (PEDI), respectively. Associations between the components of the SP and PEDI were assessed with Spearman correlation coefficients. Multiple linear regression analysis using backward stepwise method was used to determine the variables of sensory processing that are associated with activity performance on the PEDI. RESULTS: The category of Behavioral Outcomes of Sensory Processing was the only variable associated with Functional Abilities in self-care and social function (r2 = 0.30 and r2 = 0.39, respectively) and Caregiver Assistance (r2 = 0.36 and r2 = 0.37, respectively), (p < 0.05). CONCLUSION: Sensory processing in children with CP levels I-II on the GMFCS is associated with their ability to perform daily living activities and in their social interaction with the environment.