Brazilian children's quality of life during the COVID-19 pandemic: analysis of contextual factors and dimensions / Qualidade de vida de crianças brasileiras durante a pandemia de COVID-19: análise de fatores e dimensões contextuais

ABSTRACT Objective: The aim of this study was to investigate the contextual factors associated with the quality of life (QOL) of Brazilian children aged 0-12 years during the strict period of social isolation. Methods: This observational cross-sectional study was conducted between July and September 2020 using an online questionnaire on QOL-related family factors and the Pediatric Quality of Life Inventory (PedsQL™). Results were analyzed by multinomial logistic regression analysis. Results: The sample had 849 children, mostly from the South Region of Brazil (75%), white (83%), with typical development (79%), sedentary (68%), using screen (85%) for >3 h/day (44%). Their mothers were their main caregivers (90%). The following variables were significantly associated with high scores of QOL: typical health status (OR 2.38; 95%CI 1.60-3.55; screen time ≤2 h/day (OR 1.62; 95%CI 1.17-2.24); social distancing considered as "easy" (OR 1.67; 95%CI 1.20-2.32), and stimulation of the child by the family (OR 1.93; 95%CI 1.08-3.45). Conclusions: This study indicates that the family context can influence children's QOL, especially during the COVID-19 pandemic and home environment reorganization.

RESUMO Objetivo: Investigar os fatores contextuais associados à qualidade de vida (QV) de crianças brasileiras de zero a 12 anos, em momento de ápice de distanciamento social. Métodos: Estudo observacional, transversal, online, de julho a setembro de 2020, com questionário sobre fatores do contexto familiar associados à QV e Inventário Pediátrico sobre QV — PedsQL™. A análise dos dados foi feita por de regressão logística multinomial. Resultados: A amostra foi de 849 crianças, na maioria da Região Sul (75%), brancas (83%), com desenvolvimento típico (79%), sedentárias (68%), com uso de telas (85%) em tempo >3h/dia (44%). As mães eram as cuidadoras principais (90%). Foram significativamente associadas a escores mais elevados de QV: a condição de saúde típica (odds ratio — OR 2,38; intervalo de confiança de 95% — IC95% 1,60-3,55), o tempo de tela ≤2h/dia (OR 1,62; IC95% 1,17-2,24), o distanciamento social considerado "fácil" (OR 1,67; IC95% 1,20-2,32) e a família afirmar estimular a criança (OR 1,93; IC95% 1,08-3,45). Conclusões: Este estudo mostra que o contexto familiar pode influenciar a QV de crianças, especialmente no período de pandemia e de reorganização do ambiente domiciliar.

Brazilian children's quality of life during the COVID-19 pandemic: analysis of contextual factors and dimensions.

OBJECTIVE: The aim of this study was to investigate the contextual factors associated with the quality of life (QOL) of Brazilian children aged 0-12 years during the strict period of social isolation. METHODS: This observational cross-sectional study was conducted between July and September 2020 using an online questionnaire on QOL-related family factors and the Pediatric Quality of Life Inventory (PedsQL™). Results were analyzed by multinomial logistic regression analysis. RESULTS: The sample had 849 children, mostly from the South Region of Brazil (75%), white (83%), with typical development (79%), sedentary (68%), using screen (85%) for >3 h/day (44%). Their mothers were their main caregivers (90%). The following variables were significantly associated with high scores of QOL: typical health status (OR 2.38; 95%CI 1.60-3.55; screen time ≤2 h/day (OR 1.62; 95%CI 1.17-2.24); social distancing considered as "easy" (OR 1.67; 95%CI 1.20-2.32), and stimulation of the child by the family (OR 1.93; 95%CI 1.08-3.45). CONCLUSIONS: This study indicates that the family context can influence children's QOL, especially during the COVID-19 pandemic and home environment reorganization.

Impacto da fisioterapia aquática em UTIN sobre a mobilidade diafragmática avaliada por ultrassonografia cinesiológica: ensaio clínico / Impact of Aquatic Therapy in the NICU on diaphragmatic mobility assessed by ultrasound: clinical trial

INTRODUÇÃO: A fisioterapia aquática é uma modalidade de hidroterapia realizada em recém-nascidos (RN) nas Unidades de Terapia Intensiva Neonatal (UTIN). Os efeitos sobre nível de dor, estado comportamental e função respiratória já são conhecidos, porém pouco se refere aos efeitos sobre a função diafragmática na população recém-nascida a termo prematura. OBJETIVO: Avaliar o efeito da fisioterapia aquática sobre a amplitude diafragmática por meio da ultrassonografia cinesiológica diafragmática (USCD) em RNs internados em UTIN, bem como a segurança de sua realização quanto a estabilidade clínica dos RNs, estado comportamental, dor e desconforto respiratório. MÉTODOS: Ensaio clínico tipo antes e depois, de caráter transversal. Os RNs participantes do estudo receberam uma única intervenção com fisioterapia aquática durante 10 minutos. Foi realizada a avaliação utilizando a USCD antes e depois da sessão, e anotado as frequências cardíaca e respiratória, estado comportamental, dor e desconforto respiratório. RESULTADOS: Participaram 26 RNs. Observou-se aumento significativo da amplitude diafragmática (p= 0,02) e da saturação periférica de oxigênio (p= 0,05); os parâmetros fisiológicos permaneceram nos limites da normalidade e a intervenção não provocou desorganização comportamental, dor ou desconforto respiratório aos RNs. CONCLUSÃO: A fisioterapia aquática promoveu aumento da amplitude diafragmática, sugerindo que esta técnica pode ser utilizada como forma de estimular a contração da musculatura respiratória em RN, além de se mostrar uma técnica segura, pois não gerou instabilidade clínica, desorganização comportamental, dor ou desconforto respiratório aos participantes.

INTRODUCTION: Aquatic physiotherapy is a modality of hydrotherapy performed on newborn babies (NB) in the Neonatal Intensive Care Unit (NICU). The effects on pain levels, behavior, and respiratory function are already known; however, little has been said about the effects on diaphragmatic function in the preterm newborn population. OBJECTIVE: To evaluate the effect of aquatic physiotherapy on diaphragmatic amplitude using diaphragmatic kinesiologic ultrasound (DKUS) in NBs admitted to a NICU, as well as the safety regarding the clinical stability of the NBs, behavioral state, pain, and respiratory distress. METHODS: Crosssectional before-and-after clinical trial. The NBs participating in the study received a single intervention with aquatic physiotherapy for 10 minutes. An assessment was performed using the USCD before and after the session, and heart and respiratory rates, behavioral state, pain, and respiratory discomfort were recorded. RESULTS: Twenty-six NBs participated. There was a significant increase in diaphragmatic amplitude (p= 0.02) and peripheral oxygen saturation (p= 0.05); physiological parameters remained within normal limits, and the intervention did not cause behavioral disorganization, pain, or respiratory discomfort in NBs. CONCLUSION: Aquatic physiotherapy promoted an increase in diaphragmatic amplitude, suggesting that this technique can be used as a way to stimulate the contraction of the respiratory muscles in NB, in addition to being a safe technique, as it did not generate clinical instability, behavioral disorganization, pain, or respiratory discomfort to the participants.

Aquatic Dual-Task Training and Its Relation to Motor Functions, Activities of Daily Living, and Quality of Life of Individuals With Parkinson's Disease: A Randomized Clinical Trial.

Objectives: Parkinson's disease (PD) is a neurodegenerative disorder that impacts the dopaminergic neurons of the substantia nigra, leading to motor and non-motor symptoms, as well as changes in activities of daily living (ADL) and quality of life (QoL). Aquatic physical exercises and dual-task physical exercises have been used to manage PD symptoms. The aim of this study was to investigate the effects of a dual-task aquatic exercise program on the ADL, motor symptoms, and QoL of individuals with PD. Methods: A randomized controlled trial with a parallel group design was employed, and participants were randomized into 2 groups: a control group and an experimental group. The intervention was a 10-week program consisting of twice-weekly 40-minute aquatic dual-task exercises. Pre-intervention evaluations of ADL, motor function, and QoL were conducted at baseline (AS1), immediately after the intervention (AS2), and 3 months post-intervention (follow-up-AS3). The Unified Parkinson's Disease Rating Scale (UPDRS) II and III sections and the Parkinson's Disease Questionnaire 39 (PDQ-39) were utilized for outcome measures. Results: A total of 25 individuals completed the study. The experimental group showed significant improvements in both the UPDRS II (ADL) and III (motor function) sections (P's < .05), but there was no significant difference in PDQ-39 scores. Additionally, significant differences were observed in the experimental group between the AS2 and AS3 time periods (P < .05) for both UPDRS II and III scores (P < .05). Conclusions: Aquatic dual-task training may be effective in improving both ADL and motor functions in individuals with PD. Furthermore, the combination of aquatic environment and dual-task exercises may represent a promising approach to maintaining and improving the functionality of individuals with PD.

Mom Didn't Go to School, Dad Is Out of Work: Associations between Maternal Educational Attainment, Family Socioeconomic Status, and Infant Development.

The purpose of this research is to assess the neuropsychomotor development (NPMD) of 6- to 18-month-old infants and identify factors that may pose a risk to their development. They underwent NPMD assessments, while the parents/guardians were interviewed through the other instruments. Altogether, 64 infants participated in this research. The results revealed infants with questionable NPMD: 29.7% verified with AIMS and 32.8%, with Denver II. There were significant associations between NPMD and maternal low educational attainment (P = .032); family low socioeconomic status and NPMD (P = .026), verified with AIMS and Denver II (P = .037); stimulation opportunities at home and maternal low educational attainment (P = .00026), socioeconomic status (P = .035), and NPMD, verified with AIMS (P = .02) and Denver II (P = .009). The following were identified as risk factors for NPMD: maternal low educational attainment (the lower her attainment, the more likely for the NPMD to be questionable) and family socioeconomic status (infants from disadvantaged homes tend to have questionable NPMD). Stimulation opportunities at home were also significantly associated with NPMD-that is, insufficient stimulations at home may lead to questionable NPMD.

Intimate Partner Violence Against Brazilian Mothers is Associated With Their Children's Lower Quality-of-Life Scores: A Cross-Sectional Study During the COVID-19 Pandemic.

The COVID-19 pandemic led to family and routine reorganization, triggering social problems. Women were further exposed to domestic violence, especially intimate partner violence (IPV), with consequences to their and their children's health. However, few Brazilian studies address the issue, especially considering the pandemic and its restrictive measures. The objective was to verify the relationship between mothers'/caregivers' IPV and their children's neuropsychomotor development (NPMD) and quality of life (QOL) during the pandemic. Seven hundred one female mothers/caregivers of children (0-12 years old) responded to the online epidemiological inquiry. NPMD was investigated with the Caregiver Reported Early Development Instruments (CREDI-short version); QOL, with the Pediatric Quality of Life Inventory (PedsQL™); and IPV, with the Composite Abuse Scale (CAS). The independence chi-square test was used, with Fisher's exact statistics, in SPSS Statistics 27®. Children whose mothers were exposed to IPV were 2.68 times as likely to have a "low" QOL score (χ2(1) = 13.144, P < .001; φ = 0.137). This indicates a possible environmental influence on the children's QOL, which may have been aggravated by strict social distancing during the COVID-19 pandemic.

Improvement of Balance, Motor Aspects, and Activities of Daily Living in Parkinson's Disease after a Sequential Multimodal Aquatic- and Land-Based Intervention Program.

Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (r). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.

Construction and validation of an instrument for physical therapy assessment and functional classification in the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF) for hospitalized HIV patients / Construcción y validación de un instrumento de evaluación fisioterapéutica y de clasificación funcional en el modelo biopsicosocial de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) para pacientes VIH hospitalizados / Construção e validação de instrumento de avaliação fisioterapêutica e de classificação funcional no modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para pacientes HIV hospitalizados

ABSTRACT The human immunodeficiency virus (HIV) is responsible for the compromise of the immune system and a high number of hospitalizations. Considering the biopsychosocial (BPS) context of the individual, the International Classification of Functioning, Disability and Health (ICF) provides the maximum description of a health condition and the impact of interventions and service delivery for the physiotherapeutic process. The aim of this study was to build and validate a physical therapy assessment and functional classification instrument based on the ICF for hospitalized members of the HIV community. This is an observational, cross-sectional, and descriptive study based on the analysis of demand, elaboration, and improvement of the instrument and its validation with the consensus of a experts committee of physical therapists; they evaluated 58 items and the classification codes resulted in 0.858 overall Kappa value=strong agreement between assessments, all statistically significant (p-value<0.05). The final version of the instrument included 36 items, all with Kappa coefficient >0.80. The constructed instrument is valid for the evaluation and functional classification in the ICF model for hospitalized members of the HIV community, contributing to the physical therapy clinical practice in the hospital environment.

RESUMEN El virus de la inmunodeficiencia humana (VIH) es responsable del deterioro del sistema inmunitario y de un elevado número de hospitalizaciones. Considerando el contexto biopsicosocial (BPS) del individuo, el proceso fisioterapéutico cuenta con la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), que brinda la máxima descripción de una condición de salud y el impacto de las intervenciones y prestación de servicios. El objetivo de este estudio es construir y validar un instrumento de evaluación fisioterapéutica y clasificación funcional basado en el CIF para pacientes VIH hospitalizados. Se trata de un estudio observacional, transversal y descriptivo, realizado desde el análisis de la demanda, desarrollo y perfeccionamiento del instrumento y su validación con el consenso de un comité de fisioterapeutas especialistas que evaluaron 58 ítems y los códigos de clasificación, lo que resultó un valor kappa global 0,858=fuerte concordancia entre las evaluaciones, todas estadísticamente significativas (p<0,05). La versión final del instrumento incluyó 36 ítems, todos con índice kappa >0,80. El instrumento construido presenta validez para la evaluación y clasificación funcional en el modelo CIF para pacientes con VIH hospitalizados, lo que contribuye a la práctica clínica fisioterapéutica en el ámbito hospitalario.

RESUMO O vírus da imunodeficiência humana (HIV - human immunodeficiency virus) é responsável pelo comprometimento do sistema imune e por um elevado número de hospitalizações. Considerando o contexto biopsicossocial (BPS) do indivíduo, o processo fisioterapêutico dispõe da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), que fornece a máxima descrição de uma condição de saúde e o impacto das intervenções e prestação de serviços. O objetivo deste estudo é construir e validar um instrumento de avaliação fisioterapêutica e classificação funcional baseada na CIF para os pacientes HIV hospitalizados. Trata-se de um estudo observacional, transversal e descritivo realizado a partir da análise de demanda, elaboração e aprimoramento do instrumento e sua validação com o consenso de um comitê de fisioterapeutas especialistas que avaliaram 58 itens e os códigos de classificação, resultando no valor kappa geral de 0,858=concordância forte entre as avaliações, todas estatisticamente significativas (p<0,05). A versão final do instrumento incluiu 36 itens, todos com índice kappa >0,80. O instrumento construído apresenta validade para a avaliação e classificação funcional no modelo da CIF para os pacientes HIV hospitalizados, contribuindo para a prática clínica fisioterapêutica no ambiente hospitalar.

Aquatic physical therapy effects on cardiorespiratory variables in Parkinson's disease / Efeitos da fisioterapia aquática sobre variáveis cardiorrespiratórias na doença de Parkinson

Abstract Introduction Parkinson's (PD) is a neurodegenerative disease characterized by the loss of dopaminergic neurons in the substantia nigra. It has motor and non-motor symptoms which is directly related to these people's decreased autonomy and quality of life. Aquatic physical therapy (APT) is a non-drug treatment option that is a resource to complement functional rehabilitation and/or prevention. Objective To analyze the effects of an APT program on cardiovascular and fatigue conditions in individuals with PD. Methods The cardiorespiratory conditions were assessed with vital signs - heart rate (HR) and blood pressure (BP), measured before and after each intervention. The double product (DP) and the Fatigue Severity Scale (FSS), measured pre- and post-intervention, were also used as variables. The intervention had eight 40- minute biweekly sessions over 4 weeks, with immersion in a heated swimming pool at 33 ºC on average. The statistical analysis was made with the paired t-test (to analyze the FSS) and the repeated measures ANOVA test (for DP, BP and HR); significance was set at p < 0.05. Results Fatigue perception with FSS improved significantly (p = 0.037), from 4.7 ± 1.6 (pre-intervention) to 4.3 ± 1.6 (post-intervention). There were no statistically significant differences in DP, BP and HR (p = 1). Conclusion HR and BP remained at appropriate values for older people, and DP remained within a safe submaximal training range. Furthermore, the proposed APT program statistically decreased fatigue in this specific group of people with PD.

Resumo Introdução A Doença de Parkinson (DP) é uma doença neurodegenerativa caracterizada pela perda de neurônios dopaminérgicos na substância negra. Apresenta sintomas motores e não motores ligados à diminuição da autonomia e qualidade de vida. Entre os tratamentos prescritos está a fisioterapia aquática (FA), sendo um recurso na reabilitação e/ou prevenção de alterações funcionais. Objetivo Analisar os efeitos de um programa de FA nas condições cardiovasculares e fadiga em indivíduos com DP. Métodos Foram utilizados os sinais vitais frequência cardíaca (FC) e pressão arterial (PA), mensurados antes e depois de cada intervenção, e o duplo-produto (DPr) e Escala de Severidade da Fadiga (ESF) pré e pós-intervenção. A intervenção consistiu em oito encontros, durante quatro semanas, duas vezes por semana, com 40 minutos de imersão em piscina aquecida com média de 33 ºC. A análise estatística deu-se pelo test T pareado para a ESF e teste Anova para medidas repetidas do DPr, PA e FC, adotando p < 0,05. Resultados Houve melhora significativa na percepção de fadiga pela ESF (p = 0,037) de 4,7 ± 1,6 (pré-intervenção) para 4,3 ± 1,6 (pós-intervenção). DPr, PA e FC não apresentaram diferença significativa (p = 1). Conclusão Os sinais vitais de FC e PA se mantiveram em valores apropriados para idosos, bem como o DPr se manteve dentro de uma faixa segura de treinamento submáximo. Assim, o programa de FA proposto foi capaz de diminuir de forma significativa a fadiga nesta amostra de pessoas com DP.

Effects of an Aquatic Physical Exercise Program on Ventilatory Parameters in People with Parkinson's Disease.

Problems in the respiratory system are the main cause of death in Parkinson's disease (PD). Ventilatory limitations can also be part of a vicious cycle involving physical-functional limitations (e.g., walking difficulties) and the patients' perception of fatigue. The objective of this study was to analyze the effects of an aquatic physical exercise intervention program on ventilatory parameters, perception of fatigue, and gait capacity in participants with PD. This quasi-experimental study had a single group with repeated measures in four assessments, proposing an aquatic physical exercise intervention program. The inclusion criteria encompassed being in levels 1 to 4 on the Hoehn and Yahr scale and having a medical certificate for the activities. Assessments took place at 3-month intervals between them-the first period was the control, the second following the intervention, and the third period was the follow-up. The intervention had 25 biweekly sessions over 3 months. A total of 13 people (71.3 ± 5.61 years old) participated in the intervention, without significant differences in the control period. Between the intervention assessments, they had statistically significant differences in MIP, MEP, FVC, Tiffeneau index, MVV, and fatigue. The study demonstrated that the aquatic physical exercise intervention was effective for ventilatory outcomes and fatigue in people with PD.

Multicomponent Aquatic Training (MAT) Program for People with Parkinson's Disease: A Protocol for a Controlled Study.

INTRODUCTION: The complications from Parkinson's disease (PD) are directly related to decreased muscle function, balance deficits, and independence loss. Practicing aquatic exercises can minimize these symptoms and slow disease progress. OBJECTIVE: To develop a Multicomponent Aquatic Training (MAT) protocol for people with PD between stages 1 and 4 of the Hoehn and Yahr scale. METHODS: The protocol is for a single blind controlled clinical trial. The sample will comprise of people with PD between stages 1 and 4 in Hoehn and Yahr scale, divided into a control group and MAT group (who will participate in the MAT). Musculoskeletal function, functional mobility, and balance will be the primary outcomes of interest, assessed with an isokinetic dynamometer, the Five-Times-Sit-to-Stand test (FTSST), the Timed "Up and Go" test (TUG), the 6-m gait speed test, the Berg Balance Scale (BBS), and a force platform. Quality of life (QOL), activities of daily living (ADL), and motor aspects will be the secondary outcome measures, assessed with the Parkinson's Disease Questionnaire (PDQ-39) and Unified Parkinson's Disease Rating Scale (UPDRS), sections II and III. The MAT will be 12 weeks long, with two 50-min sessions per week. The outcome measures will be assessed before and after the interventions. DISCUSSION: This study is expected to establish parameters to prescribe and monitor a MAT program for people with PD in stages 1 to 4 in the Hoehn and Yahr scale, respecting individual progress and assisting the professionals in their procedure with these people.

Multidimensional Factors Can Explain the Clinical Worsening in People With Parkinson's Disease During the COVID-19 Pandemic: A Multicenter Cross-Sectional Trial.

Background: Self-reported clinical worsening by people with Parkinson's disease (PD) during social distancing may be aggravated in Brazil, where the e/tele-health system is precarious. Objectives: This study aims to investigate self-reported changes in motor and non-motor aspects during social distancing in people with PD living in Brazil and to investigate the factors that might explain these changes. Methods: In this multicenter cross-sectional trial, 478 people with a diagnosis of idiopathic PD (mean age = 67, SD = 9.5; 167 female) were recruited from 14 centers distributed throughout the five geographical regions of Brazil. The evaluators from each center applied a questionnaire by telephone, which included questions (previous and current period of social distancing) about the motor and non-motor experiences of daily living, quality of life, daily routine, and physical activity volume. Results: Self-reported clinical worsening in non-motor and motor aspects of daily life experiences (Movement Disorder Society-Unified PD Rating Scale-parts IB and II-emotional and mental health, and fear of falling) and in the quality of life was observed. Only 31% of the participants reported a guided home-based physical activity with distance supervision. Perceived changes in the quality of life, freezing of gait, decreased physical activity volume, daily routine, and fear of falling explained the self-reported clinical worsening (P < 0.05). Conclusions: Self-reported clinical worsening in people with PD living in Brazil during social distancing can also be aggravated by the precarious e/tele-health system, as perception of decreased physical activity volume and impoverishment in daily routine were some of the explanatory factors. Considering the multifaceted worsening, the implementation of a remote multi-professional support for these people is urgent.

Hand Function as Predictor of Motor Symptom Severity in Individuals with Parkinson's Disease.

INTRODUCTION: Parkinson's disease (PD) leads to deficits in upper limb strength and manual dexterity and consequently resulting in functional impairment. Handgrip strength is correlated with the motor symptom severity of the disease, but there is a gap in the literature about the influence of freezing in PD patients. OBJECTIVE: The objective is to study the correlation between handgrip strength and motor symptom severity considering the freezing phenomenon and to verify variables that can predict Unified Parkinson's Disease Rating Scale (UPDRS) III. METHODS: This is a multicenter cross-sectional study in PD. 101 patients were divided into 2 groups: freezing of gait (FOG) (n = 51) and nonfreezing (nFOG) (n = 52). Freezing of Gait Questionnaire (FOGQ); UPDRS II and III sections; Hoehn and Yahr (HY) scale; handgrip dynamometry (HD); 9 Hole Peg Test (9-HPT) were assessed. RESULTS: In both groups, HD was correlated to UPDRS III (nFOG: -0.308; FOG: -0.301), UPDRS total (nFOG: -0.379; FOG: -0.368), UPDRS item 23 (nFOG: -0.404; FOG: -0.605), and UPDRS item 24 (nFOG: -0.405; FOG: -0.515). For the correlation to UPDRS II (0.320) and 9-HPT (-0.323), only nFOG group presented significance. For the UPDRS 25 (-0.437), only FOG group presented statistical significance. The UPDRS III can be predicted by 9-HPT, age, and HY in nFOG patients (Adjusted R2 = 0.416). In FOG group, UPDRS III can be predicted by HD, 9-HPT, age, and HY (Adjusted R2 = 0.491). CONCLUSION: Handgrip strength showed to be predictive of motor impairment only in the FOG group. Our results showed clinical profile differences of motor symptoms considering freezers and nonfreezers with PD.

Quality of life and neuropsychomotor development of infants between 4-18 months in daycare center.

Quality of Life (QoL) is a predictor of development depending on multiple factors, being the QoL of infants still little studied, especially in permanent settings such as infants educational center or daycare centers. Correlate quality of life with age, family income and the neuropsychomotor development of infants between 4 and 18 months of age in daycare centers. Descriptive transverse study research, with clinical trials registration : RBR 2hd6sm on November 2, 2016. Quality of life was evaluated with interviews with the family through Pediatric Quality of Life Inventory-PedsQL™ (Brazilian version). The infants were evaluated in a playful way, through the use of Alberta Infant Motor Scale (AIMS) and Denver II test . 88 infants participated in the study. The infants evaluated had a good quality of life, with scores above 64%. AIMS presented the correlation with for physical functioning and total score of QoL. QoL of infants from 4 to 18 months of age is correlated with their neuropsychomotor development, which suggests the need for investigations between this theme and daycare centers.

Quality of life and neuropsychomotor development of infants between 4-18 months in daycare center / Qualidade de vida e desenvolvimento neuropsicomotor de bebês de 4-18 meses em centros de educação infantil

Abstract Quality of Life (QoL) is a predictor of development depending on multiple factors, being the QoL of infants still little studied, especially in permanent settings such as infants educational center or daycare centers. Correlate quality of life with age, family income and the neuropsychomotor development of infants between 4 and 18 months of age in daycare centers. Descriptive transverse study research, with clinical trials registration : RBR 2hd6sm on November 2, 2016. Quality of life was evaluated with interviews with the family through Pediatric Quality of Life Inventory-PedsQL™ (Brazilian version). The infants were evaluated in a playful way, through the use of Alberta Infant Motor Scale (AIMS) and Denver II test . 88 infants participated in the study. The infants evaluated had a good quality of life, with scores above 64%. AIMS presented the correlation with for physical functioning and total score of QoL. QoL of infants from 4 to 18 months of age is correlated with their neuropsychomotor development, which suggests the need for investigations between this theme and daycare centers.

Resumo Qualidade de vida (QV) é um preditor de desenvolvimento e depende de múltiplos fatores, sendo a QV de bebês ainda pouco estudada, especialmente em ambientes de permanência como os centros de educação infantil ou creches. Correlacionar a qualidade de vida com idade, renda familiar e desenvolvimento neuropsicomotor de bebês entre 4 a 18 meses de idade que frequentam centros de educação infantil. Pesquisa descritiva transversal, com registro clínico RBR 2hd6sm em novembro de 2016. A Qualidade de Vida foi avaliada por meio de entrevistas com as famílias com o questionário Pediátrico de Qualidade de Vida-PedsQL™ (versão brasileira). Os bebês foram avaliados de maneira lúdica pela escala motora infantil de Alberta (AIMS) e pela Denver II. 88 bebês participaram do estudo. Os bebês avaliados tiveram uma boa qualidade de vida com escores acima de 64%. AIMS apresentou correlação com os escores de capacidade física e escore total de qualidade de vida. Qualidade de vida de bebês de 4 a 18 meses de idade correlacionam-se com seu desenvolvimento neuropsicomotor, sugerindo a necessidade de investigações sobre esse tema em centros de educação infantil.

Kids Intervention Therapy - Aquatic Environment (KITE) for babies 4 to 18 months old, by following the International Classification of Functioning (ICF): clinical trial protocol

Abstract Introduction: the biopsychosocial (BPS) model from the perspective of the International Classification of Functioning (ICF) agrees with the current theories regarding child development. They state the interdependence between the individual's relations, environment and received stimuli. The early interventions, particularly in the aquatic environment (AE), present gaps concerning their systematization, above all in their being in accordance with the ICF. Objectives: to describe an ICF-based aquatic early intervention program, named KITE, for the neuropsychomotor development (NPMD) of typical, at-risk and/or delayed babies 4 to 18 months old. Methods: the KITE is a program systematized on the AE, centered on the family and the daycare environment; it takes place twice a week, lasting for 4 weeks, in 45- to 60-minute sessions. The assessments and interventions are systematized by following the ICF. For the main outcome on the NPMD, the Alberta Infant Motor Scale (AIMS) and the Denver Developmental Screening Test II (DDST-II) are used, and as the secondary outcome on the stimulation received, quality of life and aquatic skills, the Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS), the Pediatric Quality of Life Inventory (PedsQL™) and the Aquatic Functional Assessment Scale - Baby (AFAS Baby) are used, respectively. Conclusion: This study has presented tools for the application of a clinical trial through the KITE for the NPMD of babies, systematized and based on the BPS perspective of the ICF, and discussed according to the neuroplastic evidence of the child development.

Efeitos de exercícios físicos aquáticos na flexibilidade e alcance funcional de indivíduos com Doença de Parkinson / Effects of aquatic physical exercises on the flexibility and functional reach in individuals with Parkinson's Disease

O objetivo deste estudo foi analisar os efeitos de um programa de exercícios físicos aquáticos na flexibilidade e no alcance funcional de pacientes com Doença de Parkinson (DP). Para avaliar a flexibilidade foi utilizado o Teste de Flexibilidade da bateria AAHPERD (adaptado), enquanto que para verificar o alcance funcional, utilizou-se o Functional Reach Test (FRT). As variáveis foram analisadas pré e pós-intervenção. O programa de intervenção consistiu em 20 atendimentos, duas vezes por semana, 40 minutos de imersão em piscina aquecida a 33ºC, com exercícios aquáticos envolvendo Dupla Tarefa (DT) com uma progressão gradual de complexidade. A análise estatística consistiu no Teste T pareado para o comparativo pré e pós-intervenção. Os resultados encontrados mostraram melhora significativa nas variáveis analisadas no Teste de Flexibilidade da bateria AAHPERD (p<0,0001) e FRT (p<0,001) após a FA. Assim, conclui-se que o programa de exercícios aquáticos proposto foi capaz de promover melhora no alcance funcional e flexibilidade dos indivíduos com DP participantes da pesquisa...(AU)

The aim of this study is to analyze the effects of an aquatic physical exercise program on the flexibility and functional range of patients with Parkinson's disease (PD). To evaluate flexibility, the Flexibility Test of the AAHPERD (adapted) battery was used, while the Functional Reach Test (FRT) was used to verify the functional range. The variables were analyzed before and after intervention. The intervention program consisted of 20 visits, twice a week, 40 minutes of immersion in a heated pool at 33ºC, with aquatic exercises involving dual task (DT) conditions with a gradual progression of complexity. tatistical analysis consisted of paired T-test for the pre and post-intervention comparative. The results showed a significant improvement in the variables analyzed in the Flexibility Test of AAHPERD (p<0.0001) and FRT (p <0.001) after aquatic physical exercise program. Thus, it is concluded that the proposed aquatic exercise program was able to promote improvement in the functional scope and flexibility of individuals with PD participating in the research...(AU)

Sistematização de instrumentos de avaliação para os dois primeiros anos de vida de bebês típicos ou em risco conforme o modelo da CIF / Sistematización de herramientas de evaluación para los primeros dos años de vida de bebés típicos o en riesgo según el modelo CIF / Systematization of evaluation instruments for the two first years of life of typical or risk infants according to the ICF model

RESUMO O objetivo deste trabalho foi identificar instrumentos de avaliação do desenvolvimento neuropsicomotor (DNPM) de crianças de 0 a 2 anos, de baixo custo, que possam ser usados no contexto de creche e/ou ambiente clínico em programas de intervenção precoce, sistematizando esses instrumentos conforme o modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Foram selecionados instrumentos de avaliação do DNPM com tradução ou adaptação para o Brasil. Para isso os domínios da CIF foram escolhidos triangulando o checklist da própria CIF-CJ, core set de estimulação precoce e a última versão da CIF, para busca na literatura de instrumentos de avaliação. A sistematização das categorias selecionadas da CIF foi realizada por dois fisioterapeutas, e um terceiro para itens discordantes. As escalas que responderam aos critérios foram: Alberta Infant Motor Scale (AIMS), Teste de Triagem de Denver II, Inventário Pediátrico sobre Qualidade de Vida (PedSQl®), Affordance in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) e vínculo mãe-bebê. Mesmo com essas escalas, verificou-se a necessidade de um questionário de anamnese complementar para o responsável, dados da Caderneta de Saúde da Criança e de um questionário socioeconômico da Associação Brasileira de Empresas de Pesquisa para o Brasil (ABEP). Essa sistematização está disponível no apêndice, e procura facilitar o olhar ampliado do fisioterapeuta ou profissional da educação com abrangência biopsicossocial dos bebês, além de possibilitar a identificação de riscos de forma precoce e subsidiar ações de promoção e intervenção em diferentes contextos.

RESUMEN El objetivo de este estudio fue identificar herramientas de evaluación de desarrollo neuropsicomotor (DNPM) de bajo costo para niños de 0 a 2 años las cuales se pueden utilizar en el contexto de jardines infantiles y/o el entorno clínico en programas de intervención temprana, y sistematizar estos instrumentos como el modelo biopsicosocial de la Clasificación Internacional de Funcionamiento, Discapacidad y Salud (CIF). Se seleccionaron las herramientas de evaluación del DNPM con traducción o adaptación a Brasil. Para esto, los dominios de CIF se eligieron triangulando el checklist de la CIF-IA, core set de estimulación temprana y la última versión de CIF, para buscar en la literatura herramientas de evaluación. La sistematización de las categorías de CIF seleccionadas fue realizada por dos fisioterapeutas, y un tercero para artículos discordantes. Las escalas que cumplieron con los criterios fueron: Alberta Infant Motor Scale (AIMS), Prueba de tamizaje del desarrollo Denver II, Pediatric Quality of Life Inventory (PedSQl®), Affordance in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) y el enlace madre e hijo. Incluso con estas escalas, era necesario un cuestionario de anamnesis complementario para el tutor, datos del Manual de Salud Infantil y un cuestionario socioeconómico de la Asociación Brasileña de Empresas de Investigación para Brasil (Abep). Esta sistematización está disponible en el apéndice y busca facilitar la apariencia ampliada del fisioterapeuta o profesional de la educación con cobertura biopsicosocial de los bebés, así como permitir la identificación temprana de riesgos y subsidiar la promoción e intervención en diferentes contextos.

ABSTRACT The objective of this study was to identify low-cost instruments of evaluation of neuropsychomotor development (NPMD) of children aged zero to two years, that can be used in the context of daycare and/or clinical environment in early intervention programs, and to systematize these instruments as the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF). NPMD evaluation instruments with translation or adaptation for Brazil were selected. For this purpose, the ICF domains were chosen triangulating the ICF-CY's own checklist, the early stimulation core set, and the latest version of the ICF for searching the evaluation instruments in literature. Two physical therapists and a third for discordant items performed the systematization of the selected categories of ICF. The scales that met the criteria were: Alberta Infant Motor Scale (AIMS), Denver II Screening Test, PedIatric Quality of Life Inventory (PedSQl ™), Affordance in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) and Mother-child bond. Even with these scales, there was a need for a complementary anamnesis questionnaire for the infant's caregiver, data from the Child Health Handbook and a socioeconomic questionnaire from the Brazilian Association of Research Companies for Brazil (ABEP). This systematization is available in the appendix and seeks to facilitate the broader view of the physical therapist or education professional with a biopsychosocial comprehension of the infants, in addition to allowing the early identification of risks and subsidizing actions of promotion and intervention in different contexts.

Tecnologias no desenvolvimento neuropsicomotor em escolares de quatro a seis anos / Technologies in neuropsicomotor development in schools four to six years

Resumo Introdução Estudos apontam que as crianças estão passando cada vez mais tempo com a tecnologia. Objetivo Verificar a influência da tecnologia no desenvolvimento neuropsicomotor (DNPM) de crianças de quatro a seis anos de idade em uma escola particular. Método Aplicou-se um questionário a pais e mães referente ao tempo de exposição e formas de utilização de tecnologias e atividades lúdicas cotidianas e o teste Denver II, comparando o desempenho de crianças mais expostas às menos expostas à tecnologia. Resultados A tecnologia não influenciou o DNPM das crianças, possivelmente porque, além do uso de tecnologias, os pais relatam estímulos diversos, incluindo brincadeiras não tecnológicas. Observou-se uma influência da idade na existência de atrasos, de modo que quanto menor a idade maior o atraso neuropsicomotor. Conclusão Para esta amostra, a tecnologia não teve influência, porém sugere-se mais estudos com um número maior de participantes e de outras idades.

Abstract Introduction Studies indicate that children are spending more time with technology. Objective To verify the influence of technology in the neuro psychomotor development of children from four to six years of age in a private school. Method a questionnaire was applied to parents regarding the time of exposure and ways of using technologies and daily activities and was applied Denver II Test, comparing the performance of the most with those least exposed to the technology. Results technology does not influenced the neuropsychomotor development, possibly because besides the use of technologies, they report diverse stimuli, including jokes. An age influence was observed in the existence of delays, and the lower the age the greater the neuro psychomotor delay. Conclusion For this sample the technology had no influence, but more studies are suggested with a larger number of participants and other ages.

Relatos de Séries de Casos de Adultos Institucionalizados com Deficiência Múltipla: Como Avaliar a Funcionalidade? / Reports of Case Series of Institutionalized Adults with Multiple Disabilities: how to Assess Functionality?

RESUMO: O objetivo deste artigo é propor e aplicar uma forma de classificação neurofuncional, baseada em posicionamentos e transferências em adultos institucionalizados com deficiência múltipla grave. O método utilizado foi o estudo transversal, descritivo, em uma instituição de longa permanência de Curitiba, estado do Paraná. Foi realizada filmagem dos participantes nas posições da escala Gross Motor Function Measure (GMFM), transferências de posturas e deslocamento. A pontuação de 1 a 5 pontos foi dada a partir da escala Aquatic Functional Assessment Scale (AFAS), como uma adaptação em solo. Utilizou-se a Classificação Internacional da Funcionalidade (CIF) como ferramenta para detalhar as posições quanto aos qualificadores de facilitadores e restritores para cada participante. Foram avaliados cinco participantes com deficiência múltipla, com idades entre 21 e 29 anos, com predomínio do sexo feminino (80%). Apenas um participante tinha a marcha assistida e 3 (60%) apresentaram estereotipia de mãos ou tronco. As transferências entre as posições não foram realizadas de forma independente por nenhum participante. A maior pontuação encontrada pela AFAS foi de 14 pontos e a pior foi de 5 pontos. Os resultados indicam que a CIF foi sensível para perceber os movimentos ou posicionamentos restritores e facilitadores para cada um dos participantes, e ela pode ser capaz de auxiliar na escolha das melhores formas de avaliação.

ABSTRACT: The objective of this paper is to propose and apply a form of functional neurological classification, based on positioning and transference in institutionalized adults with severe multiple disabilities. The method used was the cross-sectional, descriptive study in a long-stay institution in Curitiba, state of Paraná, Brazil. Participants were filmed at the Gross Motor Function Measure (GMFM), posture transfer and displacement positions. The score from 1 to 5 points was given from the Aquatic Functional Assessment Scale (AFAS), as an adaptation to the floor. The International Classification of Functionality (ICF) was used as a toll to detail the positions regarding qualifiers of facilitators and restrictors for each participant. Five participants with multiple disabilities were evaluated, aged between 21 and 29 years, with a predominance of females (80%). Only one participant had assisted gait and 3 (60%) had stereotyped hands or upper body. Transfers between positions were not performed independently by any participant. The highest score found by AFAS was 14 points and the worst score was 5 points. The results indicate that the ICF was sensitive to perceive the movements or restrictive positions and facilitators for each of the participants and it may be able to help in choosing the best forms of evaluation.