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.

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.

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.

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.

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).

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.

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.

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.

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.

Sit-to-stand movement in childrenwith cerebral palsy and relationships with the International classification of functioning, disability and health: A systematic review.

BACKGROUND: Studying sit-to-stand (STS) in children with Cerebral Palsy addressing the domains of ICF allows determining the factors influencing STS in this population. AIMS: To systematically review the literature on STS in children with CP, identifying which ICF domains have been assessed and how they relate to sit-to-stand. METHODS AND PROCEDURES: A literature search was conducted in electronic databases by combining the keywords (child OR children OR adolescent) AND ("Cerebral Palsy") AND (sit-to-stand). We included cross-sectional articles published in English, that assessed STS movements in children with CP up to 18 years old. OUTCOMES AND RESULTS: 25 articles met the inclusion criteria. All of them assessed Body Functions and Structure. According to them, body alignment, muscle strength and postural sway affect STS movement. Six studies related Activity and Participation with STS, demonstrating that worse scores in scales that evaluate activities and participation are related to the poorer STS execution. Contextual factors were addressed in 15 studies: children's age, bench height, manipulation of sensory information and mechanical restriction impact the way children execute STS. CONCLUSION AND IMPLICATIONS: Contextual factors and Body Functions and Structure impact the STS in children with CP. However, few studies have evaluated the participation of these children. Based on the theoretical framework of the ICF, it is important that future studies evaluate functional tasks in children with CP and the components that can affect them. The adoption of the biopsychosocial model strengthens the understanding of functioning, which can contribute to rehabilitation planning.

Impact of dual task on postural sway during sit-to-stand movement in children with unilateral cerebral palsy.

BACKGROUND: To verify the effect of dual-task on postural oscillation during sit-to-stand movement in children with Cerebral Palsy. METHODS: 17 children with spastic unilateral cerebral palsy and 20 typically-developing children, aged 5 to 12 years, performed the following tasks: Simple task: sit-to-stand with arms crossed against the chest; bimanual dual-task: sit-to-stand while carrying a tray; unimanual dual-task: sit-to-stand while holding a plastic cup with one hand. For data analysis, sit-to-stand was divided in three phases: preparation (phase 1), rising (phase 2), and stabilization (phase 3). Postural control was measured using a force plate, and the variables analyzed were: area, anterior-posterior and medial-lateral velocity, and STS duration. Analysis of variance was applied to test the effects of group; task conditions and interactions. FINDINGS: Children with cerebral palsy presented higher values of postural oscillation when compared to their typical pairs. Bimanual and Unimanual dual tasks presented greater postural oscillation values in sit-to-stand phase 1 compared to simple task. In bimanual dual-task, children with cerebral palsy presented lower values of velocity in phases 3, and greater postural oscillation and duration of the task when compared to single-task and unimanual dual-tasks. I. INTERPRETATION: The insertion of a secondary task seems to interfere differently children with cerebral palsy, depending on the specific demands of each task. Thus, the importance of inserting dual tasks in the interventions is emphasized, considering that they are executed extensively in the day to day, and can act as facilitators or challenge in the execution of functional tasks.

Translation of the "F-Words Tools" into Brazilian Portuguese / Tradução dos "Instrumentos das F-Words" para o português brasileiro

Abstract Introduction: The International Classification of Functionality, Disability and Health (ICF) determines that for any health condition, functionality is the result of the multidirectional relationship between the positive aspects of the components of body structures and functions, activities, participation and contextual factors, encompassing personal and environmental factors. Objective: To translate and culturally adapt the "F-Words Tools" into Brazilian Portuguese. Methods: Permission to translate was granted by the authors. After reading and understanding the instruments, a researcher performed a non-certified translation into Brazilian Portuguese. Next, the back translation into English was done by a specialist in both languages without prior knowledge of the original versions. The result of the back translation was sent to the authors of the instrument for verification of semantics and content. Based on the authors' recommendations and the results of translation analyses, there was no need for cultural adaptation. Results: The back translation was approved by the authors, indicating that the Brazilian Portuguese version of all instruments was adequate. The translated titles are: Termo de Compromisso (Agreement), Colagem (Collage), Perfil (Profile) and Folha de Metas (Goal Sheet). The ICF framework was entitled: "The ICF model and My Favorite Words". The material is available free of charge at the CanChild website. Conclusion: The translation into Brazilian Portuguese allows materials to be used in Brazil to disseminate the concepts of the ICF and the "F-words" in clinical and family settings.

Resumo Introdução: A Classificação Internacional de Funciona-lidade, Incapacidade e Saúde (CIF) determina que para qualquer condição de saúde, a funcionalidade é o resultado da relação multidirecional entre os aspectos positivos dos componentes de estruturas e funções do corpo, atividades, participação e fatores contextuais, que englobam os fatores pessoais e ambientais. Objetivo: Traduzir e adaptar culturalmente as "F-Words Tools" para o português brasileiro. Métodos: A tradução foi autorizada pelos autores. Após leitura e entendimento dos instrumentos, uma tradução livre para o português brasileiro foi realizada por uma pesquisadora. Posteriormente, realizou-se a retro-tradução para o inglês por um especialista em ambos os idiomas e sem conhecimento prévio das versões originais. O resultado da retro-tradução foi enviado aos autores do instrumento para verificação de semântica e de conteúdo. Resultados: A aprovação da retro-tradução foi obtida pelos autores, indicando que a versão em português brasileiro de todos os instrumentos estava adequada. Os títulos traduzidos são: Termo de Compromisso (Agreement), Colagem (Collage), Perfil (Profile) e Folha de Metas (Goal Sheet). O modelo da CIF intitulou-se: "O modelo da CIF e Minhas Palavras Favoritas". O material está disponibilizado gratuitamente no site do CanChild. Não foi necessária adaptação cultural, segundo recomendação dos autores e o conteúdo dos instrumentos traduzidos. Conclusão: A tradução para o português brasileiro possibilita o uso desses materiais no Brasil, de modo a disseminar os conceitos da CIF e das "Minhas Palavras Favoritas" em âmbitos clínicos e familiares.