RESUMEN
OBJECTIVE: To characterize the environmental factors of children and adolescents with Cerebral Palsy (CP) in the state of Minas Gerais (MG), Brazil. METHODS: This is a cross-sectional study involving 164 caregivers of children/adolescents with CP, aged 1-14 years. The Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were used to classify the participants' functioning, and environmental factors were evaluated by an on-line questionnaire that examined products and technologies, physical environment, services, and systems. A descriptive analysis was performed using percentage and frequency. RESULTS: Most participants had bilateral CP (66.9%) and 45% of them were spastic. Levels II and V of the GMFCS and MACS were the most frequent. About half (49.4%) used anticonvulsants, 27.4% underwent botulinum toxin application, and 29% went through orthopedic surgery in the lower limbs. Among the participants, 71.3% used orthoses in the lower limbs, and 51.8% used the public health care system. Most had access to physiotherapy (91.5%), but found difficulties to access interventions with other professionals, such as psychologists (28%) and nutritionists (37.8%). The school was the most frequently adapted environment (78%), and had the highest level of structural adaptation (42.7%). CONCLUSIONS: The results of this study suggest that the barriers to access health services and barriers to the physical environment may impact participation and social inclusion.
Asunto(s)
Parálisis Cerebral , Niño , Humanos , Adolescente , Parálisis Cerebral/epidemiología , Destreza Motora , Estudios Transversales , Brasil/epidemiología , Evaluación de la DiscapacidadRESUMEN
ABSTRACT Objective: To characterize the environmental factors of children and adolescents with Cerebral Palsy (CP) in the state of Minas Gerais (MG), Brazil. Methods: This is a cross-sectional study involving 164 caregivers of children/adolescents with CP, aged 1-14 years. The Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were used to classify the participants' functioning, and environmental factors were evaluated by an on-line questionnaire that examined products and technologies, physical environment, services, and systems. A descriptive analysis was performed using percentage and frequency. Results: Most participants had bilateral CP (66.9%) and 45% of them were spastic. Levels II and V of the GMFCS and MACS were the most frequent. About half (49.4%) used anticonvulsants, 27.4% underwent botulinum toxin application, and 29% went through orthopedic surgery in the lower limbs. Among the participants, 71.3% used orthoses in the lower limbs, and 51.8% used the public health care system. Most had access to physiotherapy (91.5%), but found difficulties to access interventions with other professionals, such as psychologists (28%) and nutritionists (37.8%). The school was the most frequently adapted environment (78%), and had the highest level of structural adaptation (42.7%). Conclusions: The results of this study suggest that the barriers to access health services and barriers to the physical environment may impact participation and social inclusion.
RESUMO Objetivo: Caracterizar os fatores ambientais de crianças e adolescentes com paralisia cerebral (PC) no estado de Minas Gerais (MG), Brasil. Métodos: Trata-se de um estudo transversal envolvendo 164 cuidadores de crianças/adolescentes com PC, na faixa etária de um a 14 anos. O Sistema de Classificação da Função Motora Grossa (GMFCS) e o Sistema de Classificação da Habilidade Manual (MACS) foram utilizados para classificar a funcionalidade dos participantes e os fatores ambientais foram avaliados por um questionário on-line que abordou produtos e tecnologias, ambiente físico, serviços e sistemas. Análises descritivas foram realizadas por meio de porcentagem e frequência. Resultados: A maioria dos participantes tinha PC bilateral (66,9%) e 45% deles eram espásticos. Os níveis II e V do GMFCS e MACS foram os mais frequentes. Cerca de metade (49,4%) fazia uso de anticonvulsivantes, 27,4% realizaram aplicação de toxina botulínica e 29% cirurgia ortopédica em membros inferiores. Utilizavam órteses em membros inferiores 71,3% e eram usuários do sistema público de saúde 51,8%. A maioria tinha acesso à fisioterapia (91,5%), mas dificuldade de acesso a intervenções com outros profissionais, como psicólogos (28%) e nutricionistas (37,8%). A escola foi o ambiente mais frequentado (78%) e também mais adaptado estruturalmente (42,7%). Conclusões: Os resultados deste estudo sugerem que barreiras de acesso aos serviços de saúde e barreiras no ambiente físico podem impactar a participação e inclusão social.
RESUMEN
Abstract Introduction: The home environment is a fundamental agent for infant development in the first year of life. Objective: To evaluate the opportunities for environmental stimulation and the motor development of infants at 3, 6, 9, and 12 months of age and determine the association between these opportunities and the parents' schooling and economic levels, at each age studied. Methods: This is a longitudinal study using the Alberta Infant Motor Scale (AIMS) to assess motor development, the Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) questionnaire to assess the stimulation opportunities at home, and the Brazilian Association of Research Companies (ABEP) questionnaire to classify the economic level of the families. The association between opportunities for environmental stimulation and schooling and economic levels was determined by the chi-squared test. Results: Thirty-seven infants participated, 54.1% of whom were boys. At 3 months of age, the opportunities for environmental stimulation were unsatisfactory, while at 6, 9, and 12 months satisfactory opportunities predominated. Three infants scored below 10% on the AIMS at 3 months of age, indicating delayed motor development. There was a significant association between economic level and total AHEMD-IS score (p = 0.031), and the toy dimension for gross (p = 0.016) and fine (p = 0.043) motor skills. Conclusion: The infants' home environment did not provide sufficient opportunities for stimulation in the first months, but improved during the first year. Motor development was considered delayed for three infants, but was suitable in subsequent evaluations.
Resumo Introdução: O ambiente domiciliar é um agente fundamental para o desenvolvimento do lactente no primeiro ano de vida. Objetivo: Avaliar as oportunidades do ambiente domiciliar e o desenvolvimento motor de lactentes aos 3, 6, 9 e 12 meses de idade e verificar se há associação entre as oportunidades de estimulação e a escolaridade e nível econômico dos pais, em cada faixa etária estudada. Métodos: Estudo longitudinal, que utilizou o instrumento Alberta Infant Motor Scale para avaliar o desenvolvimento motor, o questionário Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) para avaliar as oportunidades de estimulação oferecidas no domicílio e o questionário da Associação Brasileira de Empresas de Pesquisa para classificar o nível econômico das famílias. A associação entre as oportunidades de estimulação do ambiente e a escolaridade e nível econômico foi verifi-cada pelo teste qui-quadrado. Resultados: Participaram da pesquisa 37 lactentes, sendo 54,1% do sexo masculino. Aos 3 meses de idade, as oportunidades de estimulação do ambiente foram insatisfatórias. Aos 6, 9 e 12 meses, houve predomínio de oportunidades satisfatórias. Três lactentes apresentaram percentil inferior a 10% aos 3 meses de idade, indicando atraso do desenvolvimento motor. Houve associação significativa entre o nível econômico e a pontuação total do AHEMD-IS (p = 0,031), a dimensão brinquedos de motricidade grossa (p = 0,016) e fina (p = 0,043). Conclusão: O ambiente domiciliar dos lactentes estudados apresentou oportunidades insuficientes para estimulação nos primeiros meses, melhorando ao longo do primeiro ano. O desenvolvimento motor foi considerado atrasado para três lactentes, tornando-se adequado nas avaliações subsequentes.