Software and equations using segmental measures to estimate height in children and adolescents with cerebral palsy considering the level of gross motor function.

BACKGROUND & AIMS: In children with Cerebral palsy (CP) bone deformities create a difficulty in the collection of height measures by direct methods. Body segments are an alternative to study for anthropometric evaluation in children with CP. Motor compromise affects growth in these children. To our knowledge, no equations have been developed to estimate height that consider the level of involvement of children with CP. The aim was to develop equations to estimate height using segmental measures for children with cerebral palsy (CP). METHODS: This was a cross-sectional study. The sample consisted of children and adolescents with CP of both sexes from 2 to 19 years old from five cities in Argentina. Children whose height and knee-heel height (KH) could be measured were included. Height, KH, and clinical covariables were collected. Linear regression models with height as the dependent variable and KH as predictors adjusted for significant covariates were developed and compared for R2, adjusted R2, and the root mean square of the error. RESULTS: 242 children and adolescents (mean age 9 ± 4 years) with a confirmed diagnosis of CP were included. The interaction between height and other variables such KH, sex, GMFCS, and age was analyzed. Two equations were developed to estimate height according to GMFCS level (GMFCS Level I-III: H = 1.5 × KH(cm) + 2.28 × age(years) + 51; GMFCS Level IV-V: H = 2.13 × KH (cm)+ 0.91 × age(years) + 37). The concordance correlation coefficient between estimated and observed height was 0.95 (95%CI [0.94; 0.96]). CONCLUSION: Height in children and adolescents with CP can be predicted using KH, GMFCS, and age. The equations and software can estimate height when this cannot be obtained directly.

Latin American Cerebral Palsy Register (LATAM-CPR): study protocol to develop a collaborative register with surveillance of children with cerebral palsy in Latin American countries.

INTRODUCTION: Cerebral palsy (CP) is one of the leading causes of childhood disability globally with a high burden in low-income and middle-income countries (LMICs). Preliminary findings from the global LMIC CP Register (GLM CPR) suggest that the majority of CP in LMICs are due to potentially preventable causes. Such data are lacking in the Latin American region. Generating comparable epidemiological data on CP from this region could enable translational research and services towards early diagnosis and early intervention. We aim to establish a Latin American multicountry network and online data repository of CP called Latin American Cerebral Palsy Register (LATAM-CPR). METHODS AND ANALYSIS: The LATAM-CPR will be modelled after the GLM CPR and will support new and emerging Latin American CP registers following a harmonised protocol adapted from the GLM CPR and piloted in Argentina (ie, Argentine Register of Cerebral Palsy). Both population-based and institution-based surveillance mechanisms will be adopted for registration of children with CP aged less than 18 years to the participating CP registers. The data collection form of the LATAM-CPR will include risk factors, clinical profile, rehabilitation, socioeconomical status of children with CP. Descriptive data on the epidemiology of CP from each participating country will be reported, country-specific and regional data will be compared. ETHICS AND DISSEMINATION: Individual CP registers have applied ethics approval from respective national human research ethics committees (HREC) and/or institutional review boards prior to the establishment and inclusion into the LATAM-CPR. Ethical approval for LATAM-CPR has already been obtained from the HREC in the two countries that started (Argentina and Mexico). Findings will be disseminated and will be made publicly available through peer-reviewed publications, conference presentations and social media communications.

Habilidades funcionales de niños, niñas y adolescentes con parálisis cerebral y su relación con el compromiso motor y la discapacidad intelectual en Argentina.

Introduction: Motor compromise characterizes cerebral palsy (CP), and is often associated with intellectual disability (ID). Standardized classification systems have been developed to describe the functions of people with CP. The aim was to functionally characterize children and adolescents aged 0 to 18 years with CP in Argentina and to investigate the association between motor compromise (GMFCS), ID and functional classifications. Methods: Cross-sectional study. Data were collected through family interviews and medical records review. Individuals with CP were included. Data were collected from 19 institutions in different cities of Argentina. Fisher's test and odds ratio [IC95%] were used for data analysis, with significance <0.05. Results: 182 children and adolescents with CP participated. According to GMFCS classification, level V prevailed with 36.3%. Those with more severe motor compromise (GMFCS IV-V) were 72 [25.4;206.0] times and 13 [5.9;28.2] times more likely to present a severe level of MACS and CFCS, respectively. But they were 34 [7.9;146.0] times more likely to have a mild to moderate level of EDACS. Those with DI were 10 [5.1;20.5] times more likely to have severe GMFCS, 6 [3.4;13.2] times more likely to have severe MACS and 4 [2.0;7.8] times more likely to have severe CFCS. On the contrary, they are 4 [1.9;9.5] times more likely to present a mild-moderate EDACS level. Conclusion: the level of GMFCS and the presence of DI influence general functionality and increase severity in engagement, manual and communication skills.

Introducción: El compromiso motor caracteriza la parálisis cerebral (PC), y suele asociarse a la discapacidad intelectual (DI). Se han desarrollado sistemas de clasificación estandarizados para describir las funciones de personas con PC. Objetivo: caracterizar funcionalmente a niños, niñas y adolescentes de 0 a 18 años con PC de Argentina e indagar la asociación entre el compromiso motor (GMFCS), la DI y las clasificaciones funcionales. Métodos: Estudio transversal. Se recolectaron datos a través de entrevistas a las familias y revisión de historias clínicas. Se incluyeron personas con PC. Los datos se recolectaron de 19 instituciones de distintas ciudades de Argentina. Resultados: participaron 182 niños, niñas y adolescentes con PC. Según clasificación GMFCS prevaleció el nivel V con 36,3%. Quienes presentan compromiso motor más severo (GMFCS IV-V), tienen 72 [25,4;206,0] veces y 13 [5,9;28,2] veces más chances de presentar un nivel severo de MACS y CFCS respectivamente. Pero, presentaron 34 [7,9;146,0] veces más chances de un nivel leve a moderado de EDACS. Quienes presentaron DI tuvieron 10 [5,1;20,5] veces más chances de presentar un nivel severo GMFCS, 6 [3,4;13,2] veces más chances un nivel severo MACS y 4 [2,0;7,8] veces más chances de un nivel severo CFCS. Por el contrario, tienen 4 [1,9;9,5] veces más chances de presentar un nivel leve-moderado EDACS. Conclusión: el nivel de GMFCS y la presencia de DI influyen en la funcionalidad general y aumentan la severidad en el compromiso, habilidades manuales y de comunicación.

Nutritional status and dietary intake of children and adolescents with cerebral palsy.

OBJECTIVE: To analyze the association between energy and nutrient intake, nutritional status and motor compromise in children and adolescents aged 2-19 years with cerebral palsy (CP) attending rehabilitation centers in the Province of Cordoba, Argentina. METHODS: Cross sectional study. Data from 105 children and adolescents of both sexes aged 2-19 years with CP (67 boys [63.8% 53.84-72.95]) were collected. Motor compromise was assessed with GMFCS. 24 h records were collected and analyzed. The results were compared with the recommended by FAO/UNU/WHO for age and sex. Normal data were presented with mean and SD, while those of non-normal distribution were described as medians with their ranges. The relationship between variables was analyzed using Fisher, t, or Mann-Whitney tests, with a p value < 0.05. RESULTS: The mean age was 11 years 6 months (SD 4 years 4 months). Fifteen [14.3% 8.23-22.48] children failed to meet at least 80% of the recommended energy. Children with GMFCS IV-V consume fewer daily calories and carbohydrate calories than their peers (I-III). The median protein intake of children GMFCS IV-V group was significantly lower than that of their peers (47.37 g vs. 71.56 g, p = 0.0057). Those who did not reach 80% of the recommended energy intake had lower intakes of macro and micronutrients. CONCLUSION: The greater the motor compromise in children with CP, the greater the compromise in the adequacy of nutrient intake. The intake of macro and micronutrients was different according to whether or not they were able to cover at least 80% of the recommended energy for their age.

[COVID-19 and the reality of people with disabilities in Argentina: possibilities of complying with the considerations of the World Health Organization] / COVID-19 y la realidad de las personas con discapacidad en Argentina: posibilidades del cumplimiento de las consideraciones planteadas por la Organización Mundial de la Salud.

Introduction: In the context of the COVID-19 pandemic, WHO published considerations regarding people with disabilities. The aim of this work was to know if these considerations can be fulfilled and if there are differences in their fulfillment between age groups. Method: Descriptive study aimed at people with disabilities in Argentina. A survey was conducted about the four WHO recommendations for this population in online mode, between the 28th and 39th days of preventive and compulsory social isolation. Statistical analysis was according to the nature of the variables, X2 with Fisher's correction was used to determine the differences between groups. Results: 309 surveys were collected from 18 provinces of Argentina. 230(74.4%[69.1-79.1]) were answered by caregivers and 79(25.5%[20.7-30.7]) by people with disabilities. Persons with disabilities were 138(44.7%[39.0-50.4]) children and adolescents and 171(55.3%[49.5-60.9]) adults and older adults. People with disabilities were able to comply with the WHO recommendations regarding reducing exposure to COVID-19 and to be prepared in case of contracting it. There were difficulties in the number of caregivers needed, since 266(66.6%[61.0-71.8]) have this possibility, and difficulties in 55(32.1%[25.1-39.6]) adults and older adults that do not carry out educational-therapeutic activities. There are feelings of anxiety, distress, or depression in people with disabilities and their caregivers. Conclusion: In Argentina, it is possible to comply with the WHO recommendations to avoid exposure to the virus and to be prepared in case of infection. Challenges remain to be solved in terms of accompanying people with disabilities in their physical and mental health.

Introducción: En el contexto de la pandemia del COVID-19 la OMS publicó consideraciones relativas a las personas con discapacidad. El objetivo del trabajo fue conocer si estas consideraciones pueden cumplirse y si existen diferencias en su cumplimiento entre grupos etarios. Método: Estudio descriptivo dirigido a personas con discapacidad de Argentina. Se realizó una encuesta sobre las cuatro recomendaciones de la OMS para esta población en modalidad online, entre los días 28° y 39° del aislamiento social preventivo y obligatorio.  El análisis estadístico fue según naturaleza de las variables, para determinar las diferencias entre grupos se usó X2 con corrección de Fisher. Resultados: Se recolectaron 309 encuestas de 18 provincias de Argentina. 230(74,4%[69,1-79,1]) fueron respondidas por cuidadores y 79(25,5%[20,7-30,7]) por personas con discapacidad. Las personas con discapacidad fueron 138(44,7%[39,0-50,4]) niños, niñas y adolescentes y 171(55,3%[49,5-60,9]) adultos y adultos mayores.  Las personas con discapacidad pudieron cumplir con las recomendaciones de la OMS en cuanto a disminuir la exposición a COVID-19 y estar preparados en caso de contraerlo. Hubo dificultades en la cantidad de cuidadores necesarios, ya que 266(66,6%[61,0-71,8]) tiene esta posibilidad, y en que 55(32,1%[25,1-39,6]) adultos y adultos mayores no realizan actividades educativas-terapéuticas. Existen sentimientos de ansiedad, angustia o depresión en personas con discapacidad y sus cuidadores. Conclusión: En Argentina se está pudiendo cumplir con las recomendaciones de la OMS para evitar la exposición al virus y estar preparados en caso de contagio. Quedan desafíos por resolver en cuanto al acompañamiento de las personas con discapacidad en su salud física y mental.