Nutritional risk and functionality of children and adolescents hospitalized with COVID-19.

To evaluate the association between nutritional risk and functionality of children and adolescents hospitalized with COVID-19 at admission and discharge. METHODS: Retrospective cross-sectional study with patients under 19 years old, positive for SARS-COV-2 by RT-PCR test, from February 2020 to May 2022. The STRONGKids screening (Screening Tool Risk On Nutritional Status and Growth) was used to assess nutritional risk on hospital admission and the Functional Status Scale (FSS-Brazil) to determine the functionality of patients on admission and discharge. Data was collected from hospital medical records. Poisson regressions with crude robust variance were used to test the association between nutritional risk and functional status at admission, with adjustments for the age, length of stay, and presence of complex chronic conditions. RESULTS: Of the 217 patients, 55.7% (n = 121) were boys with a median age of 6 years (IQ 0-12), 58.5% (n = 127) had at least one complex chronic condition, 64% (n = 139) had medium/high nutritional risk, and 23.9% (n = 52) had some degree of dysfunctionality upon admission and 14.6% (n = 31) upon discharge. By associating STRONGKids and the FSS-Brasil of hospital admission, it was observed that children with low nutritional risk had a mean global FSS lower (6.4 ± 0.7) than children with medium/high nutritional risk (7. 7 ± 2.8; p < 0.001). Children with low nutritional risk on admission also had a lower mean (6.1 ± 0.59) on the FSS at hospital discharge than children with medium/high nutritional risk (7.1 ± 2.5; p < 0.001). After adjustments, it was identified that the addition of one STRONGKids point increases by 36% (PR 1.36; 95%CI 1.15-1.62) the probability of the patient presenting some degree of functional impairment on admission.    Conclusion: The study found a positive association between nutritional risk and functional impairment in hospitalized children and adolescents with COVID-19 on admission, even after adjusting for age, length of stay, and complex chronic conditions. Furthermore, patients with medium/high nutritional risk at admission also had worse functionality, both on admission and at discharge. WHAT IS KNOWN: • Children and adolescents infected with COVID-19 tend to exhibit milder symptoms and lower hospitalization rates compared to adults, although severe cases and complications can occur. • A paucity of targeted investigations exists regarding the correlation between nutritional risk and functionality in children and adolescents with COVID-19. WHAT IS NEW: • Children and adolescents with COVID-19 who presented with medium to high nutritional risk upon hospital admission demonstrated functional impairments, both at admission and hospital discharge.

Surgical treatment of non-cystic fibrosis bronchiectasis in children and adolescents: A review.

OBJECTIVE: To discuss surgery for non-cystic fibrosis [CF] bronchiectasis in children and adolescents. SOURCES: Non-systematic review including articles in English, mainly from the last 5 years. SUMMARY OF FINDINGS: In this review, we present that in low- and middle-income countries [LMIC] clinical treatment fails in around 20% of cases due to low socioeconomic status and poor adherence. This causes the disease to progress and require surgery. We emphasize that the indications for surgery are not well defined and must be considered on an individual basis. The surgical treatment of bronchiectasis in children may be indicated in selected cases; especially in localized disease with frequent exacerbations despite an optimized clinical approach. Surgery can improve quality of life [QoL] and reduce exacerbations. It has few postoperative complications and low morbidity and mortality. Finally, we propose an algorithm for managing bronchiectasis, which takes into account LMIC settings with limited resources. CONCLUSION: We conclude that in LMICs, surgery is a treatment strategy for selected children/adolescents with bronchiectasis.

Home-based inspiratory muscle training in pediatric patients after kidney transplantation: a randomized clinical trial.

BACKGROUND: Chronic kidney disease (CKD) represents the irreversible stages of renal failure and is a growing worldwide public health issue associated with increases in morbidity, mortality, and decreased quality of life. Kidney transplantation is considered one of the best treatment options in this population. However, even after surgery, respiratory muscle strength is below normal values, and inspiratory muscle training (IMT) improves respiratory muscle function, strength, and endurance. This study aimed to evaluate the effects of IMT regarding respiratory muscle strength, functional capacity, and pulmonary function in pediatric kidney transplant recipients with CKD, and secondarily, to assess the biochemical profile of patients after intervention. METHODS: This is a randomized, double-blind, placebo-controlled trial. Patients were randomized into two groups, intervention (IG) and control (CG) and performed IMT home-based training for 6 weeks. In the IG, the load was adjusted to 40% of the maximal inspiratory pressure and in the CG was adjusted to a minimum placebo load (9 cm H2O). RESULTS: Thirty-one patients were randomly allocated to the intervention (n = 16) or control (n = 15) groups. There were no differences at baseline between groups. Increase of 35% in the maximal inspiratory pressure predicted and 26% in the maximal expiratory pressure predicted in the IG were found, compared with 5 and 4% in the CG. There was an increase in hemoglobin and hematocrit values in the IG. CONCLUSIONS: Home-based IMT provides a significant increase in respiratory muscle strength, without changes in functional capacity and pulmonary function. Benefits regarding biochemical markers (hemoglobin and hematocrit) were also observed.

Functional Status Scale: Cross-Cultural Adaptation and Validation in Brazil.

OBJECTIVE: The goal of the present study was to perform a cross-cultural adaptation and clinical validation of the Functional Status Scale for use in the Brazilian population. DESIGN: Cross-cultural adaptation study followed by a cross-sectional validation study. SETTING: Single-center PICU at a hospital in Porto Alegre, Brazil. PATIENTS: Children and adolescents of both sexes, 1 month and under 18 years old, who had been treated at the PICU. INTERVENTIONS: The cross-cultural adaptation consisted of the following stages: translation, synthesis of the translated versions, back translations, synthesis of the back translations, committee review, and pretesting. For the clinical validation stage, the Brazilian Functional Status Scale was applied within 48 hours after discharge from the PICU. The Brazilian Functional Status Scale's reliability and validity properties were tested. MEASUREMENTS AND MAIN RESULTS: A total of 314 patients were evaluated. Median age was 24 months (7.0-105.0 mo), 54.1% were males, and their overall functional score was 9 ± 2.8. The Brazilian Functional Status Scale demonstrated excellent interobserver reliability, with an intraclass correlation coefficient of 0.98, and κ coefficients between 0.716 and 1.000 for the functional domains, which indicated good to excellent agreement. Using the Bland-Altman method, we confirmed low variability among the evaluator's responses (0.93 to -1.06 points). Regarding the Brazilian Functional Status Scale's content validity, there was a correlation between length of PICU stay (r = 0.378; p < 0.001) and time on invasive mechanical ventilation (r = 0.261; p < 0.05), and the test could discriminate between groups with different comorbidity levels (p < 0.001). CONCLUSIONS: The Functional Status Scale has been culturally adapted and validated for use in Brazil and is now available for use in the assessment of functionality in Brazilian children and adolescents.

Exercise capacity in children and adolescents with corrected congenital heart disease.

Congenital heart disease promotes hemodynamic changes that can contribute to reduce exercise capacity. The aim of the study was to evaluate the exercise capacity of children and adolescents with cyanotic congenital heart disease and to assess respiratory muscle strength, plasma levels of B-type natriuretic peptide and ventricular ejection fraction, as well the associations between these variables. Cross-sectional study that evaluated 48 patients between 6 and 18 years-old that underwent a six-minute walk test (6MWT), respiratory muscle strength, dosage of B-type natriuretic peptide and echocardiography. The mean age was 13.3 ± 4.1 years, and the most prevalent heart disease was tetralogy of Fallot (54.2 %). The average distance walked was 452.7 ± 73.2 m, significantly below the predicted (69 %) (p < 0.001). The maximum inspiratory pressure was above the predicted result (111.4 %), average 58.2 ± 22.3 (p = 0.56), and the maximum expiratory pressure was 63.2 ± 23.3 cm H2O, significantly below the predicted (63 %) (p < 0.001). The level of B-type natriuretic peptide was elevated in all patients, with a median of 2087.17 (502.54-4,768.05). The ventricular ejection fraction showed a median of 65.9 (41-100). There was no correlation between the 6MWT, ventricular ejection fraction (r = -0.05; p = 0.72), inspiratory muscle strength (r = 0.03; p = 0.81), expiratory muscle strength (r = 0.09; p = 0.05) and B-type natriuretic peptide (r = -0.04; p = 0.77). Children and adolescents with cyanotic congenital heart disease present a lower exercise capacity and expiratory muscle strength. No associations were found between exercise capacity, respiratory muscle strength, B-type natriuretic peptide and left ventricular ejection fraction.

Reduced peripheral and respiratory muscle strength in pediatric patients after kidney transplantation.

INTRODUCTION: Reduced muscle strength and low-exercise capacity are well documented in adults, but there are few studies examining those impairments in children and adolescents after kidney transplantation. The objective of this study was to evaluate peripheral and respiratory muscle strength and the association with submaximal exercise capacity in children and adolescents after kidney transplant. METHODS: Forty-seven patients between six and 18 years of age clinically stable after transplantation were included. Peripheral muscle strength (isokinetic and hand-grip dynamometry), respiratory muscle strength (maximal inspiratory and expiratory pressure), and submaximal exercise capacity (six-minute walk test - 6MWT) were assessed. RESULTS: Patients had a mean age of 13.1 ± 2.7 years and an average of 34 months had elapsed since the transplantation. Flexors of the knee showed a significant reduction in muscle strength (77.3% of predicted) and knee extensors had normal values (105.4% of predicted). Hand-grip strength and maximal respiratory pressures (inspiratory and expiratory) also were significantly lower than expected (p < 0.001). Although distance walked in the 6MWT was significantly lower than predicted (p < 0.001), no significant correlation was found with peripheral and respiratory muscle strength. CONCLUSION: Children and adolescents after kidney transplantation have reduced peripheral muscle strength of knee flexors, hand-grip, and maximal respiratory pressures. No associations were found between peripheral and respiratory muscle strength and submaximal exercise capacity.

Reliability of ultrasound in the assessment of muscle thickness in critically ill children.

INTRODUCTION: Ultrasound has been used to quantify and qualify muscle morphology in critically ill children and can detect changes in muscle thickness. The aim of this study was to assess the reliability of ultrasound measurement of muscle thickness in critically ill children and to compare the assessments made by an expert with those made by inexperienced sonographers. MATERIAL AND METHODS: Cross-sectional observational study conducted in the paediatric intensive care unit of a tertiary care university hospital in Brazil. The sample included patients aged 1 month to 12 years who received invasive mechanical ventilation for at least 24 h. Ultrasound images of the biceps brachii/brachialis and quadriceps femoris were obtained by one experienced sonographer and several inexperienced sonographers. We assessed intrarater and inter-rater reliability by means of the intraclass correlation coefficient (ICC) and Bland-Altman plot analysis. RESULTS: Muscle thickness was measured in 10 children with a mean age of 15.5 months. The mean thickness of the assessed muscles as 1.14 cm for the biceps brachii/brachialis (standard deviation [SD], 0.27) and 1.85 cm for the quadriceps femoris (SD, 0.61). The intrarater and inter-rater reliability were good for all sonographers (ICC > 0.81). The differences were small, there was no significant bias in the Bland-Altman plots and all measurements were within the limits of agreement, except for 1 measurement of biceps and quadriceps. CONCLUSION: Sonography can be used in critically ill children to accurately assess changes in muscle thickness, even by different evaluators. More studies are needed to establish a standardised approach to the use of ultrasound for monitoring muscle loss in order to incorporate it in clinical practice.

Evaluation of the functional capacity and quality of life of children and adolescents during and after cancer treatment.

OBJECTIVE: To evaluate the functional capacity and quality of life of children and adolescents during cancer treatment and post-treatment. METHODS: Cross-sectional study of patients during cancer treatment and post-treatment, assessed by the 6-minute walk test (6MWT) and the Pediatric Quality of Life ™ questionnaire (cancer module). RESULTS: Sixty-five patients, aged 11.2±3.5 years, mostly males (50.8%) and white (90.8%), with high incidence of hematological cancers (81.5%) participated in the study. The performance in the 6MWT was 23.1% inferior comparing the mean predicted and achieved (584.3±5 and 447.7±78.6 m, respectively). The percentage difference between the predicted and achieved 6MWT, and the different phases of cancer treatment were significantly different between patients in treatment (73.7±12.8) and post-treatment (84.5±9.1). When grouped by the different diagnoses, it was possible to observe that the distance covered by the patients with leukemia showed results closer to that predicted (80.7±11.7). Regarding the health-related quality of life questionnaire (HRQL), the child's perception (78.0±14.56) was better than that reported by their parents (72.4±17.74). However, when we compared HRQL with the 6MWT, there was no association between them (p=0.597). CONCLUSIONS: Children and adolescents undergoing cancer treatment or post-treatment showed a 23% deficit in functional capacity. In relation to HRQL results, children's perception was higher than that of their parents.

HOSPITAL PHYSICAL THERAPY MANAGEMENT IN PEDIATRIC PATIENTS WITH COVID-19: CASE REPORTS.

OBJECTIVE: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. CASES DESCRIPTION: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. COMMENTS: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.

Functional deficit in children with congenital heart disease undergoing surgical correction after intensive care unit discharge. / Déficit funcional em crianças com cardiopatias congênitas submetidas à correção cirúrgica após alta da unidade de terapia intensiva.

OBJECTIVE: To evaluate the functional status of pediatric patients undergoing congenital heart surgery after discharge from the intensive care unit, and to evaluate the correlations among clinical variables, functional status and surgical risk. METHODS: Cross-sectional study including patients aged 1 month to less than 18 years undergoing congenital heart surgery between October 2017 and May 2018. Functional outcome was assessed by the Functional Status Scale, surgical risk classification was determined using the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and clinical variables were collected from electronic medical records. RESULTS: The sample comprised 57 patients with a median age of 7 months (2 - 17); 54.4% were male, and 75.5% showed dysfunction, which was moderate in 45.6% of the cases. RACHS-1 category > 3 was observed in 47% of the sample, indicating higher surgical risk. There was a correlation between functional deficit and younger age, longer duration of invasive mechanical ventilation and longer intensive care unit stay. Moreover, greater functional deficit was observed among patients classified as RACHS-1 category > 3. CONCLUSION: The prevalence of functional deficit was high among children and adolescents with congenital heart disease after cardiac surgery. Higher surgical risk, longer duration of invasive mechanical ventilation, longer intensive care unit stay and younger age were correlated with worse functional status.

Neuromuscular electrical stimulation to improve gross motor function in children with cerebral palsy: a meta-analysis.

OBJECTIVE: To systematically review the effectiveness of neuromuscular electrical stimulation (NMES) as an adjuvant therapy to improve gross motor function in children with spastic cerebral palsy. METHODS: MEDLINE, EMBASE, Cochrane CENTRAL, PEDro and Scopus were searched. We included randomized controlled trials examining the effects of NMES combined with other therapies on gross motor function as assessed by the Gross Motor Function Measure (GMFM) and its functional dimensions. Two reviewers independently screened, extracted data, assessed the risk of bias (PEDro) and quality of the evidence (GRADE). RESULTS: Six randomized controlled trials (pooled n=174) were included in the meta-analysis. NMES combined with other therapies presented medium effect size to improve gross motor function in children with cerebral palsy in comparison with conventional physical therapy or neurodevelopmental therapy. Our sensitivity analysis showed that NMES combined with other therapies was effective to improve GMFM-sitting and standing dimensions but not GMFM-walking dimension. CONCLUSION: Low-quality evidence suggests that NMES may be used as adjuvant therapy to improve sitting and standing dimensions of GMFM in children with spastic cerebral palsy.

Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis.

OBJECTIVE: To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke. METHODS: This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies. RESULTS: Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD]=-1.89, 95% confidence interval [CI] -2.44 to -1.34; I2 79%, P<0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD=3.50, 95% CI -3.45 to 10.45; I2 54.7%, P=0.32), shoulder flexion (MD=-1.20, 95% CI -8.95 to 6.55; I2 0%, P=0.76) or wrist extension (MD=-0.32, 95% CI -6.98 to 5.75; I2 38.5%, P=0.92). No data were available concerning the mobility of other joints. CONCLUSION: This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD42017078784).

Functional status of children and adolescents with COVID-19 in a reference hospital in southern Brazil / Estado funcional de crianças e adolescentes com COVID-19 em um hospital de referência no sul do Brasil

Abstract Introduction COVID-19 could leave important consequences, including functional decline. Objective Eval-uate functional status in pediatric patients hospitalized with COVID-19 and correlate with clinical variables. Methods Prospective and retrospective longitudinal study with patients with COVID-19. Hospitalization data were collected from medical record review and post discharge data were collected by telephone contact. Functional status was evaluated by Functional Status Scale (FSS-Brazil) in three moments (hospital admission, hospi-tal discharge and after hospital discharge). Spearman test was used to correlate continuous variables and the linear model with generalized estimation equations was used to verify differences in the proportion of functional impairment occurrence (FSS-Brazil ≥ 8) at different mo-ments of the study and previous disease presence. Results It was included 232 patients, 56% male, median age of five years old. Seventy (30.2%) patients had post discharge data. The mean global score of FSS-Brazil was 7.3 at hospital admission, 6.8 at discharge hospital and 6.8 after discharge hospital. Functional status was adequate in the three different moments evaluated in 75% of the sample. The ventilatory support needed was not correlated with functional status and the length of hos-pital stay and oxygen therapy showed weak correlations with functional status. Having no previous disease reduced the risk of functional impairment by 94%. Conclusion The majority of the patients maintained adequate functional status. Absence of previous disease was a protective factor for long term functional impairment.

Resumo Introdução A COVID-19 pode deixar sequelas impor-tantes, como declínio funcional. Objetivo Avaliar a funcionalidade dos pacientes pediátricos internados com COVID-19 e correlacionar com variáveis clínicas. Métodos Estudo longitudinal retrospectivo e prospectivo, com pacientes pediátricos com COVID-19. Os dados de internação hospitalar foram coletados a partir da revisão de prontuários e os dados pós-alta através de contato telefônico. A funcionalidade foi avaliada através da Escala de Estado Funcional Pediátrica (FSS-Brasil) em três momentos (admissão, alta e pós-alta hospitalar). A correlação entre as variáveis contínuas foi avaliada pelo teste de Spearman e utilizou-se o modelo linear com equações de estimação generalizada para verificar as diferenças nas proporções de ocorrência de prejuízo funcional (FSS-Brasil ≥ 8) nos diferentes momentos do estudo e na presença de doenças prévias. Resultados Foram incluídos 232 pacientes, 56% do sexo masculino, mediana de 5 anos de idade. Foram obtidos dados de seguimento pós-alta hospitalar de 70 (30,2%) crianças. O escore global médio da FSS-Brasil foi de 7,3 na admissão, 6,8 na alta e 6,8 após a alta. A funcionalidade apresentou-se adequada nos três momentos de avalia-ção em 75% da amostra. A necessidade de suporte ven-tilatório não foi correlacionado com a funcionalidade, e o tempo de internação e oxigenoterapia apresentaram correlações fracas com a funcionalidade. A inexistência de doenças prévias reduziu em 94% o risco de prejuízo funcional. Conclusão A maioria das crianças manteve funcionalidade adequada. Não ter doenças prévias foi um fator de proteção para o prejuízo funcional em longo prazo.

Noninvasive brain stimulation combined with other therapies improves gait speed after stroke: a systematic review and meta-analysis.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are noninvasive brain stimulation (NIBS) techniques able to modulate cortical excitability. OBJECTIVE: To determine the effects of NIBS combined with other therapies on gait speed after stroke. METHODS: Electronic databases searched were PUBMED, EMBASE, COCHRANE, SCOPUS, SCIELO and PEDro. Eligibility criteria were randomized controlled trials that reported the effects of tDCS and rTMS combined with other therapies for improving gait speed, walking cadence, functional ambulation category (FAC) and motricity index (MI-LE) after stroke. Risk of bias was assessed by Cochrane risk of bias assessment tool. Mean differences (MD) and 95% confidence intervals were calculated. Quality of evidence was assessed by Grades of Researches, Assessment, Development and Evaluation approach. RESULTS: Ten studies (226 subjects) were included in the meta-analysis. NIBS combined with other therapies was effective for improving gait speed (MD 0.09 m/s [95% CI, 0.05 to 0.13; I2 0%, p < 0.0001]). Gait speed improved in both acute/subacute (MD 0.08 m/s [95% CI, 0.02 to 0.14]) and chronic phases (MD 0.08 m/s [95% CI, 0.03 to 0.13]). Furthermore, inhibitory (MD 0.09 m/s [95% CI, 0.04 to 0.14]) and excitatory (MD 0.07 m/s [95% CI, 0.02 to 0.12]) protocols were effective to improve gait speed. NIBS was also effective to improve walking cadence but was unable to modify other outcomes (FAC and MI-LE). CONCLUSIONS: This systematic review with meta-analysis synthesizes moderate-quality evidence that NIBS combined with other therapies are effective to improve gait speed after stroke. Systematic Review registration number: PROSPERO registration number CDR42015024237.

Reduced peripheral and respiratory muscle strength in pediatric patients after kidney transplantation / Redução da força muscular periférica e respiratória em pacientes pediátricos após transplante renal

Abstract Introduction: Reduced muscle strength and low-exercise capacity are well documented in adults, but there are few studies examining those impairments in children and adolescents after kidney transplantation. The objective of this study was to evaluate peripheral and respiratory muscle strength and the association with submaximal exercise capacity in children and adolescents after kidney transplant. Methods: Forty-seven patients between six and 18 years of age clinically stable after transplantation were included. Peripheral muscle strength (isokinetic and hand-grip dynamometry), respiratory muscle strength (maximal inspiratory and expiratory pressure), and submaximal exercise capacity (six-minute walk test - 6MWT) were assessed. Results: Patients had a mean age of 13.1 ± 2.7 years and an average of 34 months had elapsed since the transplantation. Flexors of the knee showed a significant reduction in muscle strength (77.3% of predicted) and knee extensors had normal values (105.4% of predicted). Hand-grip strength and maximal respiratory pressures (inspiratory and expiratory) also were significantly lower than expected (p < 0.001). Although distance walked in the 6MWT was significantly lower than predicted (p < 0.001), no significant correlation was found with peripheral and respiratory muscle strength. Conclusion: Children and adolescents after kidney transplantation have reduced peripheral muscle strength of knee flexors, hand-grip, and maximal respiratory pressures. No associations were found between peripheral and respiratory muscle strength and submaximal exercise capacity.

Resumo Introdução: Força muscular reduzida e baixa capacidade de exercício encontram-se bem documentadas em adultos mas há poucos estudos examinando essas alterações em crianças e adolescentes após transplante renal. O objetivo deste estudo foi avaliar a força muscular periférica e respiratória e a associação com a capacidade submáxima de exercício em crianças e adolescentes após o transplante renal. Métodos: Foram incluídos 47 pacientes entre 6 e 18 anos de idade clinicamente estáveis após o transplante. Avaliou-se a força muscular periférica (dinamometria isocinética e de preensão manual), a força muscular respiratória (pressão inspiratória e expiratória máximas) e a capacidade submáxima de exercício (teste de caminhada de seis minutos - TC6M). Resultados: Os pacientes apresentaram média de idade de 13,1 ± 2,7 anos e uma média de 34 meses desde o transplante. Os flexores de joelho mostraram uma redução significativa na força muscular (77,3% do previsto) e os extensores de joelho apresentaram valores normais (105,4% do previsto). A força de preensão manual e as pressões respiratórias máximas (inspiratória e expiratória) foram significativamente inferiores ao esperado (p < 0,001). Embora a distância percorrida no TC6M tenha sido significativamente menor do que o previsto (p < 0,001), não encontramos nenhuma correlação significativa com a força muscular periférica e respiratória. Conclusão: Crianças e adolescentes submetidos ao transplante renal apresentam força muscular periférica reduzida de flexores de joelho e de preensão manual, bem como das pressões respiratórias máximas. Não foram encontradas associações entre força muscular periférica e respiratória e a capacidade submáxima de exercício.

Hospital physical therapy management in pediatric patients with covid-19: case reports / Manejo da fisioterapia no âmbito hospitalar no paciente pediátrico com covid-19: relato de casos

ABSTRACT Objective: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. Cases description: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. Comments: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.

RESUMO Objetivo: Relatar as condutas fisioterapêuticas dos dois casos de pacientes pediátricos com COVID-19 internados em hospital de referência estadual em Porto Alegre para tratamento da doença. Descrição dos casos: Caso 1, sexo feminino, 10 meses de idade com doença crônica preexistente, internada desde o nascimento, utilizava ventilação mecânica via traqueostomia, evoluiu com hipoxemia, necessidade de oxigenoterapia e aumento dos parâmetros ventilatórios, sendo confirmada COVID-19. Foram realizadas técnicas de desobstrução brônquica e manutenção da expansão pulmonar. Além disso, a criança durante a internação adquiriu controle cefálico, sedestação sem apoio, rolar e alcance de objetos e durante infecção por coronavírus foram passadas orientações ao familiar para manutenção dos marcos motores adquiridos. Caso 2, sexo masculino, 9 anos, com doença psiquiátrica prévia e obesidade, evoluiu com quadro de rebaixamento do sensório e necessidade de tratamento intensivo, sendo o paciente colocado em ventilação mecânica invasiva na chegada à unidade e confirmada a infecção por SARS-CoV-2. Realizou fisioterapia para desobstrução brônquica, reexpansão pulmonar e mobilização precoce, apresentando melhora ventilatória ao longo da internação, e após 17 dias foi extubado com sucesso. Evoluiu de cinesioterapia passiva para assistida e resistida na internação pediátrica, conseguindo deambular sem auxílio, e teve alta hospitalar com condição funcional prévia à internação hospitalar. Comentários: A COVID-19 apresentou-se de forma distinta nos casos, todavia a fisioterapia foi essencial para a manutenção e recuperação do quadro funcional dos pacientes. Estudos futuros são necessários para melhor compreensão do curso da doença e suas repercussões funcionais, a fim de traçar um tratamento eficiente para os pacientes pediátricos acometidos pela COVID-19.

Handgrip strength and its relation to isokinetic dynamometry in COPD / Força de Preensão Palmar e sua relação com dinamometria isocinética na DPOC

Abstract Introduction: Muscle dysfunction is one of the major changes found in chronic obstructive pulmonary disease (COPD) and associated with loss of functionality, morbidity and mortality. Objective: correlate two strength assessment methods: manual dynamometry for handgrip strength and isokinetic dynamometry for quadriceps strength in patients with COPD, and assess the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE), quality of life and muscle strength. Method: twenty-five patients with moderate to very severe COPD were evaluated by pulmonary function parameters, anthropometric variables, functional capacity, via the six-minute walk test, dyspnea, applying the modified Medical Research Council (mMRC) scale, BODE, quality of life, using the Saint George's Respiratory Questionnaire (SGRQ), handgrip strength with manual dynamometer and quadriceps force using an isokinetic dynamometer. Muscle strength was assessed with a manual portable dynamometer and isokinetic dynamometer. For statistical analysis, ANOVA with Bonferroni's post-test, the chi-squared test and Pearson's correlation coefficient were used. Results: There was a strong correlation between the strength measurements and the two instruments (torque and quadriceps extension power with right handgrip strength: r = 0.74; p <0.001). The patients classified as very severe exhibited worse performance in the strength tests when compared to the moderate group, albeit with no statistically significant difference. Conclusion: In muscle strength measurements, a strong correlation was detected between the isokinetic dynamometer for quadriceps and the manual dynamometer for handgrip strength. These findings indicate that, in clinical practice, the manual dynamometer for handgrip strength could be used to assess peripheral muscle strength in patients with COPD.

Resumo Introdução: Disfunção muscular é uma das principais alterações encontradas na Doença Pulmonar Obstrutiva Crônica (DPOC), estando relacionada com perda da funcionalidade, morbidades e mortalidade. Objetivo: Correlacionar dois métodos de avaliação de força: dinamometria manual para força de preensão palmar (FFP) e dinamometria isocinético para força de quadríceps em pacientes com DPOC, e avaliar dispneia, Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE), qualidade de vida e força muscular. Método: Foram avaliados 25 pacientes com DPOC moderada a muito severa quanto a espirometria e antropometria; capacidade funcional através da distância percorrida no teste de caminhada de seis minutos (DTC6); dispneia através da escala modificada Medical Research Council; BODE; e qualidade de vida através do Saint George's Respiratory Questionnaire. A força muscular foi avaliada através de dinamômetro portátil manual e dinamômetro isocinético. Para estatística utilizou-se ANOVA e pós-teste de Bonferroni, teste de Qui-quadrado e Coeficiente de Correlação de Pearson. Resultados: Houve correlação entre medidas de força com os dois instrumentos (torque e potência de extensão do quadríceps com FPP direita: r=0,74; p<0,001). Não houve diferença nos testes de força em relação à gravidade da doença. Além disso, o DTC6 não mostrou diferença significativa entre os grupos e a qualidade de vida mostrou-se pior no grupo muito severo, tendo diferença significativa em relação ao grupo moderado. Conclusão: Foi encontrada forte correlação entre as medidas de força realizadas com dinamômetro isocinético para o quadríceps e dinamômetro manual para FPP. Esses achados indicam que, na prática clínica, o dinamômetro manual pode ser utilizado para avaliação da musculatura periférica em pacientes com DPOC.

Déficit funcional em crianças com cardiopatias congênitas submetidas à correção cirúrgica após alta da unidade de terapia intensiva / Functional deficit in children with congenital heart disease undergoing surgical correction after intensive care unit discharge

RESUMO Objetivo: Avaliar a funcionalidade de pacientes pediátricos submetidos à correção cirúrgica de cardiopatia congênita após a alta da unidade de terapia intensiva e as possíveis correlações com variáveis clínicas e risco cirúrgico. Métodos: Estudo transversal, que incluiu crianças entre 1 mês e 18 anos incompletos, que realizaram cirurgia para correção de cardiopatia congênita, no período de outubro de 2017 até maio de 2018. A avaliação da funcionalidade foi realizada por meio da Functional Status Scale, a avaliação do risco cirúrgico se deu pelo Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), e as variáveis clínicas foram obtidas do prontuário eletrônico. Resultados: A amostra foi composta de 57 crianças, com mediana de idade de 7 (2 - 17) meses, sendo 54,4% do sexo masculino. Dentre as crianças, 75,5% apresentaram alteração na funcionalidade, e 45,6% delas tiveram disfunção moderada. Cerca de 47% da amostra apresentou classificação RACHS-1 > 3, indicando maior risco cirúrgico. Maior déficit funcional foi associado a crianças mais novas, com maior duração da ventilação mecânica invasiva e do tempo de internação na unidade de terapia intensiva. Além disso, maior grau de disfunção foi observado entre aqueles classificados com RACHS-1 > 3. Conclusão: A prevalência de disfunção foi elevada em crianças e adolescentes com cardiopatia após cirurgia cardíaca. Maior risco cirúrgico, duração da ventilação mecânica invasiva, permanência na unidade de terapia intensiva e os mais jovens apresentaram associação com pior desempenho funcional.

Abstract Objective: To evaluate the functional status of pediatric patients undergoing congenital heart surgery after discharge from the intensive care unit, and to evaluate the correlations among clinical variables, functional status and surgical risk. Methods: Cross-sectional study including patients aged 1 month to less than 18 years undergoing congenital heart surgery between October 2017 and May 2018. Functional outcome was assessed by the Functional Status Scale, surgical risk classification was determined using the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and clinical variables were collected from electronic medical records. Results: The sample comprised 57 patients with a median age of 7 months (2 - 17); 54.4% were male, and 75.5% showed dysfunction, which was moderate in 45.6% of the cases. RACHS-1 category > 3 was observed in 47% of the sample, indicating higher surgical risk. There was a correlation between functional deficit and younger age, longer duration of invasive mechanical ventilation and longer intensive care unit stay. Moreover, greater functional deficit was observed among patients classified as RACHS-1 category > 3. Conclusion: The prevalence of functional deficit was high among children and adolescents with congenital heart disease after cardiac surgery. Higher surgical risk, longer duration of invasive mechanical ventilation, longer intensive care unit stay and younger age were correlated with worse functional status.

Fisioterapia respiratória não altera agudamente os parâmetros fisiológicos ou os níveis de dor em prematuros com síndrome do desconforto respiratório internados em unidade de terapia intensiva / Fisioterapia respiratoria no altera de manera aguda los parámetros fisiológicos o los niveles de dolor en recién nacidos prematuros con síndrome de dificultad respiratoria internados en unidad de cuidados intensivos / Chest physical therapy does not alter acute physiological parameters or pain levels in preterm infants with respiratory distress syndrome in intensive care unit

RESUMO Objetivo: avaliar a ocorrência de alterações fisiológicas adversas agudas e a presença de dor em recém-nascidos prematuros com síndrome do desconforto respiratório internados em uma unidade de terapia intensiva neonatal após a fisioterapia respiratória. Métodos: estudo transversal que avaliou 30 neonatos prematuros em três momentos, sendo eles Momento um (M1), antes da fisioterapia, Momento dois (M2), imediatamente após a fisioterapia, e Momento três (M3), 15 minutos após. Consideraram-se alterações fisiológicas as variações da frequência cardíaca (FC), da frequência respiratória (FR), da saturação periférica de oxigênio (SpO2) e da temperatura corporal. A presença de dor foi avaliada pelas escalas neonatal infant pain scale e neonatal facial coding system. Resultados: houve aumento estatisticamente significativo na FC no M2 quando comparados os três momentos, porém com retorno aos valores basais 15 minutos após a fisioterapia. Outras variáveis fisiológicas (FR, SpO2 e temperatura) e a avaliação da dor não apresentaram alterações significativas. Conclusão: parâmetros fisiológicos e comportamentais permaneceram estáveis após a realização da fisioterapia respiratória, com discretas alterações imediatamente após o procedimento, mas com retorno aos valores basais, indicando que a fisioterapia respiratória não alterou agudamente os sinais vitais e os níveis de dor dos neonatos.

RESUMEN Objetivo: evaluar cambios fisiológicos adversos agudos y la presencia de dolor en bebés prematuros con síndrome de dificultad respiratoria internados en una unidad de cuidados intensivos neonatales después de fisioterapia respiratoria. Métodos: este fue un estudio transversal que evaluó a 30 recién nacidos prematuros en tres momentos: Momento Uno (M1), antes de la fisioterapia, Momento Dos (M2), inmediatamente después de la fisioterapia, y Momento Tres (M3), 15 minutos después. Los cambios fisiológicos incluyeron cambios en la frecuencia cardíaca (FC), en la frecuencia respiratoria (FR), en la saturación periférica de oxígeno (SpO2) y en la temperatura corporal. La presencia de dolor se evaluó mediante la escalas neonatal infant pain scale y neonatal facial coding system. Resultados: hubo un aumento estadísticamente significativo en la FC en el M2, pero con retorno al valor inicial 15 minutos después de la fisioterapia. Otras variables fisiológicas (FR, SpO2 y temperatura) y la evaluación del dolor no presentaron cambios significativos. Conclusión: los parámetros fisiológicos y de comportamiento se mantuvieron estables después de la fisioterapia respiratoria, con ligeros cambios inmediatamente después del procedimiento, pero con retorno a los valores basales, lo que indica que la fisioterapia respiratoria no alteró de manera aguda los signos vitales y los niveles de dolor en los recién nacidos.

ABSTRACT Objective: to evaluate the occurrence of acute adverse physiological alterations and the presence of pain in premature newborns with respiratory distress syndrome in a neonatal intensive care unit after chest physical therapy. Methods: a cross-sectional study evaluating 30 preterm neonates in three moments: Moment one (M1), before physical therapy, Moment two (M2), immediately after physical therapy, and Moment three (M3), 15 minutes after. Physiological alterations were considered as variations in heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), and body temperature. The presence of pain was assessed by the scales neonatal infant pain scale and neonatal facial coding system. Results: A statistically significant increase occurred in HR in M2 when comparing the three moments, but with return to baseline values 15 minutes after physical therapy. Other physiological variables (RR, SpO2,and temperature) and pain evaluation did not present significant alterations. Conclusion: physiological and behavioral parameters remained stable after chest physical therapy, with slight alterations immediately after the procedure, but with return to baseline values, indicating that physical therapy has not sharply altered vital signs and pain levels of neonates.