I Want to Play: Children With Cerebral Palsy Talk About Their Experiences on Barriers and Facilitators to Participation in Leisure Activities.

PURPOSE: To explore how children with cerebral palsy (CP) experience participation in leisure activities and to describe the environmental barriers and facilitators. METHODS: Sixteen children with cerebral palsy aged 7 to 17 years participated in 3 focus groups. Data were analyzed thematically by 3 researchers on the basis of the International Classification of Functioning, Disability and Health. RESULTS: A total of 38 International Classification of Functioning, Disability and Health categories were identified (4 linked to Body functions; 2 linked to Body structures; 8 linked to Activities & Participation, and 24 to Environmental factors: 10 facilitators and 14 barriers). The most mentioned categories were Voluntary movement control functions, Functions related to gait pattern, Structure of upper arm, Recreation and leisure, Nuclear family and finally, and Individual attitudes of acquaintances. CONCLUSIONS: The main barriers identified by children with cerebral palsy highlight aspects of the physical, social, and attitudinal environment that could be modified to enhance participation in leisure activities.

Participation in leisure activities from the perception of children with disabilities and their families in Brazil.

OBJECTIVE: To understand the perception of children with disabilities and their families regarding factors that interfere with participation in leisure activities in Brazil. METHODS: This qualitative study included 14 focus groups, involving a total of 80 participants (40 children with disabilities and 40 family members). Discus-sions were recorded and transcribed. Coding was based on the International Classification of Functioning Disability and Health, following linking rules. RESULTS: A total of 80 individuals participated in the study. For parents and children the most-cited barriers to participation in leisure activities were relat-ed to environmental factors. For children, the main barriers were the attitudes of their nuclear family, acquaintances, and friends. Access to products and technology for personal mobility were also important obstacles. For them, support from immediate family was both a facilitator and barrier. Other barriers identified by family members were open-space planning services and assets. As facilitators, the atti-tudes and support of people in positions of authority also were reported by this group. CONCLUSION: For parents and children, most disabling barriers were related to environmental factors, such as access to products and technology, support, and attitudes. Some differences in perception were observed between comments from children and parents; for example, regarding barriers due to immediate family. Parents showed greater awareness of barriers and facilitators to participation in leisure activities.

Linking quality of life questionnaires for asthma to the International Classification of Functioning.

OBJECTIVE: To link the content of the most common quality of life instruments for children with asthma to the International Classification of Functioning, Disability and Health (ICF). METHODS: The study was conducted in two stages. The first involved a review of the literature to select quality of life questionnaires and in the second, two independent reviewers identified questionnaire items, and categories corresponding to the ICF, according to approved methodology. The degree of agreement was calculated using the kappa coefficient. RESULTS: Two questionnaires were selected: the Pediatric Asthma Quality of Life (PAQLQ) and Pediatric Quality of Life Asthma Module (PedsQL-Asthma), self and proxy versions. The degree of agreement was strong for all the instruments: PAQLQ (k = 0.624), PedsQL- Asthma self (k = 0.610), and PedsQL-Asthma proxy (k = 0.673). A total of 114 concepts were identified in the 77 items. Thirty-five different ICF categories were linked, 16 (45.7%) related "body function," 13 (37.1%) "activity and participation," and 6 (17.1%) "environmental factors." Two items (1.7%) could not be linked because they represent personal factors or are not covered by the ICF. CONCLUSION: The categories linked to the PAQLQ contained primarily "body function" and "activity and participation," but not "environmental factors." Those linked to the PedsQL-Asthma versions encompass three of the four ICF components, where the highest content frequency was associated with "body function," followed by "environmental factors" and "activities and participation."

Effects of Load Addition During Gait Training on Weight-Bearing and Temporal Asymmetry After Stroke: A Randomized Clinical Trial.

OBJECTIVE: The aim of the study was to evaluate the effects of adding load to restrain the nonparetic lower limb during gait training on weight-bearing and temporal asymmetry after stroke. DESIGN: Thirty-eight subjects were randomized into treadmill training with load (5% of body weight) on the nonparetic limb (experimental group) and treadmill training without load (control group). Interventions lasted 30 mins/d for 2 wks (9 sessions). Both groups performed home-based exercises and were instructed to increase the use of paretic limb in daily life situations. Ground reaction force was obtained by a force plate during standing position (static) and gait (dynamic). Temporal gait parameters were assessed by a motion system analysis. Outcome measures were evaluated at baseline, posttraining, and after a 40-day follow-up. RESULTS: The experimental group increased static ground reaction force of the paretic limb at posttraining (P = 0.037) and the control group increased dynamic ground reaction force of the paretic limb at posttraining (P = 0.021), both with maintenance at follow-up. Neither group showed a change in the swing time symmetry ratio after training (P = 0.190). CONCLUSIONS: Treadmill training associated with behavioral strategies/home-based exercises seemed to be useful to minimize weight-bearing asymmetry, but not to improve temporal gait asymmetry. Load addition did not show additional benefits.

Immediate effects of a single treadmill session with additional ankle loading on gait in children with hemiparetic cerebral palsy.

BACKGROUND: Children with hemiparetic cerebral palsy are often characterized by reduced speed progression, shorter step length, and increased support base. These kinematic alterations result in inefficient gait. OBJECTIVE: To assess the immediate effects of treadmill training with additional lower limb loading on kinematic gait parameters in children with Cerebral Palsy (CP). METHODS: This cross-sectional, observational study, involved 20 children with hemiparetic CP that underwent single treadmill session with ankle loading. Kinematic gait data were collected by the Qualisys Motion Capture System during baseline (PRE), immediately after training (POST) and 5 minutes after post session (FOLLOW UP). RESULTS: The results demonstrated increase in knee (p = 0.001) and hip (p = 0.005) range of motion, maximum knee (p <.0.001) and hip (p =.001) flexion in swing and paretic foot height during swing (p <0.001) when PRE x POST were compared. CONCLUSION: Treadmill gait training with additional lower limb loading was a disturbance capable of modifying the locomotor strategy of these population. The increase in hip flexion during swing phase allowed higher paretic foot clearance which may favor the improvement of gait function.

Common content between quality of life questionnaires for children with cystic fibrosis and the International Classification of Functionality, Disability and Health.

OBJECTIVE: To identify the most common quality of life instruments for children with cystic fibrosis and link the content with the International Classification of Functioning, Disability and Health (ICF). METHODS: The study was conducted in 2 stages. The first stage involved a review of the literature to select quality of life questionnaires. In the second stage 2 independent reviewers identified questionnaire items and categories corresponding to the ICF, according to approved methodology. The degree of agreement was calculated using the kappa coefficient. RESULTS: Two questionnaires were selected: the Cystic Fibrosis Questionnaire and DISABKIDS®. A total of 130 concepts were identified from the 112 items. Forty-seven different ICF categories were linked (k>0.62 for all questionnaires), 21 (44.7%) were related to the "body function" domain, 20 (42.6%) to "activity and participation" and 6 (12.8%) to "environmental factors". Thirteen items (10%) could not be linked because they represent personal factors or are not covered by the ICF. CONCLUSION: Body functions were the category most linked to the ICF. Environmental factors were poorly described, and no items were related to body structures in any of the instruments.

Functioning and Disability Profile of Children with Microcephaly Associated with Congenital Zika Virus Infection.

INTRODUCTION: The increase in the number of cases of microcephaly in Brazil and its association with the Zika virus (ZIKV) is a global public health problem. The International Classification of Functioning Disability and Health (ICF) model is a powerful tool and extremely relevant in managing disability. OBJECTIVE: Describe the functioning profile of children with microcephaly associated with ZIKV in two states of northeastern Brazil. METHODS: This is a descriptive cross-sectional study. The sociodemographic characteristics, head circumference, and other clinical data were collected from medical charts, physical examinations, measuring instruments, and interviews with the children and their parents. The Brazilian Portuguese version of the Brief Common ICF Core Set for cerebral palsy (CP) was used. Each ICF category was assigned a qualifier, which ranged from 0 to 4 (no problem, mild problem, moderate problem, severe problem, complete problem). For environmental factors, 0 represents no barrier and 4 represents complete barrier; +0, no facilitator and +4, complete facilitator. RESULTS: A total of 34 children with microcephaly caused by ZIKV were recruited (18 girls and 16 boys) at four rehabilitation facilities in Rio Grande do Norte and Paraíba states, Brazil. The average age of the participants was 21 months, monthly income was ≈USD 300.00, and head circumference z-scores ranged between 0.92 and -5.51. The functioning profile revealed complete disability in most of the body function categories (b). The activity and participation areas (d) were highly impacted, particularly in mobility-related categories. With respect to environmental factors (e), most of the sample reported a complete facilitator for the immediate family, friends, and health services, systems, and policies, as well as a complete barrier to societal attitudes. CONCLUSION: This is the first study that describes the functioning profile of children with microcephaly associated with ZIKV, using a tool based on the ICF in Brazil. Our findings reinforce the need to maximize health care and access to information, based on the ICF, for multiprofessional teams, administrators, family members, and children.