Spatiotemporal and variability gait data in community-dwelling elderly women from Brazil.

BACKGROUND: Gait is an extremely complex motor task; therefore, gait data should encompass as many gait parameters as possible. OBJECTIVE: To provide reference values for gait measurements obtained from a Brazilian group of community-dwelling elderly females between the ages of 65 and 89 years and to apply the PCA-biplot to yield insight into different walking strategies that might occur during the aging process. METHOD: 305 elderly community-dwelling females living in Brazil were stratified into four age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80 years (N=30). Age, height, and BMI were assessed to describe the characteristics of the groups. Gait spatiotemporal and variability data were obtained using the GAITRite® system. Principal component analysis, followed by MANOVA and the PCA-biplot approach were used to analyze the data. RESULTS: 95% CI showed that only three components - rhythm, variability, and support - together explained 74.2% of the total variance in gait that were different among the groups. The older groups (75-79 and ≥80 years) walked with lower than average velocity, cadence, and step length and were above average for the variables stance, step, swing, and double support time and the ≥80 year old group presented the highest gait variability compared to the other groups. CONCLUSION: Aging is associated with decreased gait velocity and cadence and increased stance, step time, and variability, but not associated with changes in base of support. In addition, the PCA-biplot indicates a decline towards decreased rhythm and increased variability with aging.

Development of a first-contact protocol to guide assessment of adult patients in rehabilitation services networks.

OBJECTIVE: This paper describes the development of the Protocol for Identification of Problems for Rehabilitation (PLPR), a tool to standardize collection of functional information based on the International Classification of Functioning, Disability and Health (ICF). DEVELOPMENT OF THE PROTOCOL: The PLPR was developed for use during the initial contact with adult patients within a public network of rehabilitation services. Steps to develop the protocol included: survey of the ICF codes most used by clinical professionals; compilation of data from functional instruments; development and pilot testing of a preliminary version in the service settings; discussion with professionals and development of the final version. The final version includes: user identification; social and health information; brief functional description (BFD); summary of the BFD; and PLPR results. Further testing of the final version will be conducted. CONCLUSIONS: The protocol standardizes the first contact between the user and the rehabilitation service. Systematic use of the protocol could also help to create a functional database that would allow comparisons between rehabilitation services and countries over time.

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy.

BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis. OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP). METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact. CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation, cross-cultural adaptation and reliability.

BACKGROUND: Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities. OBJECTIVES: To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF). METHOD: The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR) was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP). The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC), through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart. Results : During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC ≥ 0.92) for test-retest. CONCLUSION: The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP.

Spatiotemporal and variability gait data in community-dwelling elderly women from Brazil

ABSTRACT Background Gait is an extremely complex motor task; therefore, gait data should encompass as many gait parameters as possible. Objective To provide reference values for gait measurements obtained from a Brazilian group of community-dwelling elderly females between the ages of 65 and 89 years and to apply the PCA-biplot to yield insight into different walking strategies that might occur during the aging process. Method 305 elderly community-dwelling females living in Brazil were stratified into four age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80 years (N=30). Age, height, and BMI were assessed to describe the characteristics of the groups. Gait spatiotemporal and variability data were obtained using the GAITRite® system. Principal component analysis, followed by MANOVA and the PCA-biplot approach were used to analyze the data. Results 95% CI showed that only three components – rhythm, variability, and support - together explained 74.2% of the total variance in gait that were different among the groups. The older groups (75-79 and ≥80 years) walked with lower than average velocity, cadence, and step length and were above average for the variables stance, step, swing, and double support time and the ≥80 year old group presented the highest gait variability compared to the other groups. Conclusion Aging is associated with decreased gait velocity and cadence and increased stance, step time, and variability, but not associated with changes in base of support. In addition, the PCA-biplot indicates a decline towards decreased rhythm and increased variability with aging.

Development of a first-contact protocol to guide assessment of adult patients in rehabilitation services networks

Objective: This paper describes the development of the Protocol for Identification of Problems for Rehabilitation (PLPR), a tool to standardize collection of functional information based on the International Classification of Functioning, Disability and Health (ICF). Development of the protocol: The PLPR was developed for use during the initial contact with adult patients within a public network of rehabilitation services. Steps to develop the protocol included: survey of the ICF codes most used by clinical professionals; compilation of data from functional instruments; development and pilot testing of a preliminary version in the service settings; discussion with professionals and development of the final version. The final version includes: user identification; social and health information; brief functional description (BFD); summary of the BFD; and PLPR results. Further testing of the final version will be conducted. Conclusions: The protocol standardizes the first contact between the user and the rehabilitation service. Systematic use of the protocol could also help to create a functional database that would allow comparisons between rehabilitation services and countries over time.

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy

BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis.OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP).METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively.RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact.CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation, cross-cultural adaptation and reliability / Versão brasileira do instrumento de avaliação ambiental Craig Hospital Inventory of Environmental Factors (CHIEF): tradução, adaptação cultural e confiabilidade

Background: Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities. Objectives : To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF). Method : The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR) was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP). The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC), through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart. Results : During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC≥0.92) for test-retest. Conclusion : The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP. .

Contextualização: Fatores ambientais são essenciais para a caracterização dos processos de funcionalidade e incapacidade, no entanto a escassez de instrumentação padronizada sobre tais elementos restringe a investigação científica de barreiras e facilitadores associados à participação social de pessoas com deficiência. Objetivos : Traduzir para o Português do Brasil, adaptar culturalmente e verificar a confiabilidade do questionário de avaliação ambiental denominado Craig Hospital Inventory of Environmental Factors (CHIEF). Método : O questionário foi traduzido para o Português, analisado, retrotraduzido para o Inglês e comparado com a versão original. A versão final (CHIEF-BR) foi administrada em 47 cuidadores de crianças e adolescentes com paralisa cerebral (PC), e a confiabilidade teste-reteste foi analisada pelo Kappa quadrático e índice de consistência (CCI) a partir de entrevista com 23 cuidadores dessa amostra, em dois momentos, com intervalo de dez dias. Resultados : Durante a administração, foi necessário o fornecimento de exemplos para facilitar a compreensão das questões relacionadas à subescala política. Kappa quadrático evidenciou que a confiabilidade teste-reteste de cada questão variou de 0,28 a 1,0 no escore de frequência e de 0,38 a 0,98 no escore de magnitude. Os coeficientes de correlação intraclasse dos escores totais apresentaram um alto índice de consistência (CCI≥0,92). Conclusão: O CHIEF-BR mostrou-se reprodutível e aplicável à amostra do estudo, podendo ser utilizado para documentar os efeitos de intervenções que visem a minimizar o impacto das barreiras ambientais na participação de crianças e jovens com PC. .

Effects of constraint-induced movement therapy in children with hemiplegia: a single case experimental study / Efeitos da terapia de restrição por movimento induzido em crianças com hemiplegia: desenho experimental de caso único

OBJECTIVE: To investigate the profile of changes in the use of the upper extremity in three children with hemiplegia submitted to an adapted protocol of constraint-induced movement therapy (CIMT). METHODS: A single-subject design (ABA) was replicated in three children aged 8 to 11 years old. Baseline phases (A1) and (A2) and the intervention phase (B) lasted 2 weeks each. During the intervention period, children wore a splint on the non-affected extremity for 10 hours a day and were submitted to 3 hours of therapy a day during 10 days. Training consisted of activities with the affected upper extremity, with gradually increasing complexity and verbal feedback. Hand function was classified according to the Manual Ability Classification System (MACS). Children were assessed four times every week with the Toddler Arm Use Test (TAUT) and three adapted tasks from the Jebsen-Taylor Hand Function test (JTHF), and once a week with the Pediatric Motor Activity Log (PMAL) and self-care scales of the Pediatric Evaluation of Disability Inventory (PEDI). Celeration Line, Two-Standard Deviation Band and visual analysis methods were used for data analyses. RESULTS: Significant improvements in the amount and quality of upper extremity use (PMAL), TAUT quality of use for children 2 and 3, and participation for child 1, as well as decreased time to complete JTHF tasks for children 2 and 3 were observed. No changes were observed in the PEDI self-care scales. CONCLUSION: CIMT effects were associated with improvements in manual dexterity, amount and quality of use of the affected upper extremity in children with hemiplegia.

OBJETIVO: Investigar mudanças longitudinais no uso da extremidade superior em três crianças com hemiplegia submetidas a um protocolo adaptado de terapia de movimento induzido por restrição (CIMT). MÉTODOS: Um desenho experimental de caso único (ABA) foi replicado em três crianças entre 8 e 11 anos de idade. Fases de baseline (A1) e (A2) e fase de intervenção (B) duraram duas semanas cada. Durante a fase de intervenção, as crianças usaram um splint na extremidade não afetada por dez horas por dia e foram submetidas a três horas de terapia diária por dez dias. O treinamento consistiu em atividades para a extremidade superior acometida, com aumento gradual da complexidade da tarefa e reforço verbal. A função manual foi classificada de acordo com o Manual Ability Classification System (MACS). As crianças foram avaliadas quatro vezes por semana com o Toddler Arm Use Test (TAUT) e três provas adaptadas do Teste Jebsen-Taylor de Função Manual (JTHF) e uma vez por semana com o Pediatric Motor Activity Log (PMAL) e escalas de autocuidado do Inventário de Avaliação Pediátrica de Incapacidade (PEDI). Os métodos Celeration Line, Banda de Dois Desvios-Padrão e análise visual foram usados para análise de dados. RESULTADOS: Resultados significativos demonstraram melhora na qualidade e frequência de uso da extremidade superior (PMAL), qualidade de uso do TAUT nas crianças 2 e 3, participação na criança 1, bem como diminuição do tempo gasto para completar as tarefas do JTHF para as crianças 2 e 3. Nenhuma mudança foi observada nas escalas de autocuidado do teste PEDI. CONCLUSÃO: Efeitos da CIMT associaram-se à melhora na destreza manual, frequência e qualidade de uso da extremidade acometida em crianças com hemiplegia.