The Impact of COVID-19 Pandemic and Social Distancing on Motor Function and Growth of Children with Congenital Zika Syndrome: A Prospective Cohort Study.

This article describes the impact of social distancing during the COVID-19 pandemic on the motor function and growth of children with congenital Zika syndrome (CZS). Children's motor function, weight, height and joint range of movement (ROM) were evaluated before the onset of the pandemic and soon after their return to face-to-face activities at a rehabilitation center. Fifty-two children (Mean 46.07 months, SD 3.76 months) were assessed. Results showed a reduction in proportion of children with adequate body mass index (p = .04), an increase in proportion with adequate height (p < 0.001), deterioration in gross motor function in children with severe motor impairment (p < .01), and a reduction in the maximum ROM for shoulder (p < .01) and wrist flexion (p = .046), elbow (p = .01), knee (p = .03) and ankle extension (p < .01), and an increase in hip flexion (p = .04). The social distancing period appears to have contributed to important losses in motor function and joint mobility of children with CZS; however, this period of time appeared to have less impact on their growth.

Urological outcomes in children with congenital Zika syndrome: The experience of a cohort in Campina Grande, Brazil.

OBJECTIVE: To describe the urological outcomes in children with congenital Zika syndrome (CZS) and investigate the relationship between clinical and urological findings in this population. METHODS: This cross-sectional study involved children with CZS followed up by a referral centre for children with microcephaly in the state of Paraiba in northeast Brazil. The urological evaluation included clinical history, urine culture results, ultrasonography of the urinary tract, and urodynamic evaluation, following the protocol proposed by Costa Monteiro et al. (2017). Descriptive statistical analysis was performed in addition to association and correlation tests, considering clinical and urodynamic variables. RESULTS: Among the 88 children with CZS (35.5 ± 5.5 months), 97.7% had microcephaly, and 51% presented urinary tract infection (UTI) confirmed with clinical history and lab tests. The number of confirmed UTI episodes varied from one to 14 per child. The urodynamic evaluation confirmed the presence of an overactive bladder in 78 children and incomplete voiding in 50. Urodynamic findings were associated with the number of confirmed UTI episodes, child's sex, and actual weight, in addition to the use of anticonvulsant and myorelaxant drugs. CONCLUSIONS: UTIs were confirmed in most children. Other urological outcomes observed were overactive bladder and low bladder capacity, which were associated with the number of confirmed UTI episodes, use of anticonvulsants and myorelaxants, and the child's sex and weight. These are treatable conditions, and it is paramount that paediatricians, neonatologists, and infectious disease specialists are aware of them to make clinical decisions and help reduce the risk of renal damage and other morbidities.

Efeitos do uso de vestes terapêuticas em programas de reabilitação de crianças com paralisia cerebral: uma revisão integrativa da literatura / Effects of suit therapy rehabilitation programs of children with cerebral palsy: an integrative literature review

A Paralisia Cerebral (PC) engloba um grupo de desordens do movimento e da postura resultantes de uma lesão não progressiva no sistema nervoso. Diversas abordagens fisioterapêuticas vêm sendo propostas para o tratamento de indivíduos com PC, dentre elas o uso de vestes terapêuticas. Sendo assim, a presente revisão teve como objetivo avaliar os efeitos das vestes terapêuticas na reabilitação de crianças com PC, destacando seus benefícios e possíveis limitações. Tratou-se de uma revisão integrativa da literatura realizada nas bases SciELO, Lilacs, Pubmed, Science Direct e PEDro, por meio do descritor "Paralisia Cerebral" e das palavras-chave "AdeliSuit", "PediaSuit", "TheraSuit". Após o levantamento bibliográfico, foram selecionados 11 estudos envolvendo crianças com idade entre um e 15 anos, os quais descreveram o uso das vestes terapêuticas AdeliSuit, TheraSuit e PediaSuit. Todos os estudos apresentaram efeitos favoráveis ao uso das vestes para função motora das crianças avaliadas. Também houveram relatos de melhora na funcionalidade, velocidade e qualidade da marcha e equilíbrio. Apenas quatro estudos compararam programas de reabilitação envolvendo vestes terapêuticas e outras abordagens, os quais apresentaram resultados controversos. Os achados demonstraram resultados favoráveis ao uso das vestes terapêuticas em indivíduos com diagnóstico de PC, apesar de poucas evidências quanto a sua superioridade sobre outras abordagens. (AU)

Cerebral Palsy (CP) is a group of movement and posture disorders resulting from nervous system non-progressive injury. Several physiotherapy approaches have been proposed to individuals with CP treatment, including the use of therapeutic suits. Thus, the present review aimed to assess the effects of therapeutic suits on children with CP rehabilitation, highlighting their benefits and possible limitations. It was an integrative literature review carried out on SciELO, Lilacs, Pubmed, Science Direct and PEDro databases, using tdescriptor "Cerebral Palsy" and keywords "AdeliSuit", "PediaSuit", "TheraSuit". After bibliographic search, 11 studies were selected involving children aged between one and 15 years old, which described the use of therapeutic suits: AdeliSuit, TheraSuit and PediaSuit. All studies showed positive effects therapeutic suits use during rehabilitation for motor function. Improvements in functionality, speed and quality of gait and balance were also reported. Only four studies compared rehabilitation programs involving therapeutic suits and other therapeutic approaches, which showed controversial results. Those findings demonstrated favorable results for the use of therapeutic suits during rehabilitation programs in individuals with CP, despite little evidence regarding their superiority over other approaches. (AU)

Classification of Congenital Zika Syndrome: Muscle Tone, Motor Type, Body Segments Affected, and Gross Motor Function.

Aim: To identify abnormalities in muscle tone and motor function associated with congenital Zika syndrome (CZS).Method: A cross-sectional observational study involving 96 children (55 males) with CZS at a mean (SD) age 35.2 ± 2.9 months. Children's muscle tone was investigated using the pull to sit, scarf sign, shoulder suspension and ventral suspension tests and the modified Ashworth scale (MAS). Motor impairment was determined using the Gross Motor Function Classification System (GMFCS) and body segments most affected with motor impairment.Results: 58 (60,5%) children tested positive for ≥1 maneuver used to evaluate muscle tone, while 38 (39.5%) tested negative in all the tests. MAS score was >0 for at least one of the appendicular muscles in 91 children (94.8%). In 88 children (91.7%), all four limbs were affected.Conclusion: Findings suggestive of axial hypotonia and appendicular hypertonia associated with severe motor impairment were prevalent in children with CZS.

Effect of Intensive Physiotherapy Training for Children With Congenital Zika Syndrome: A Retrospective Cohort Study.

OBJECTIVE: To investigate the effect of intensive physiotherapy training on the motor function of children with congenital Zika syndrome (CZS). DESIGN: A retrospective cohort study. SETTING: A support center for children with microcephaly. PARTICIPANTS: Children (N=7) aged 14 to 18 months old who were diagnosed with CZS and previously monitored more than 1 year. INTERVENTIONS: A 2-stage protocol repeated uninterruptedly for 1 year. In the first stage, the children were submitted to 1 hour of conventional physiotherapy and 1 hour of suit therapy 5 times a week for 4 weeks. The second stage consisted of 1 hour of suit therapy 3 times a week for 2 weeks. MAIN OUTCOME MEASURES: Gross motor function measure (GMFM) and body weight. RESULTS: Six evaluations were conducted approximately 3 months apart. An increase in the overall GMFM score was observed between the first and second (P=.046), first and third (P=.018), first and fourth (P=.018), first and fifth (P=.043), and first and sixth evaluations (P=.018). Differences in the scores of the individual GMFM dimensions were found only for dimension A (lying and rolling) between the first and fourth evaluations (P=.027) and for dimension B (sitting) between the first and third (P=.018), first and fourth (P=.046), and first and sixth evaluations (P=.027). No difference was found in body weight between the first and sixth evaluations (P=.009). During follow-up, only 1 child required hospitalization, and another had increased irritability. CONCLUSIONS: Children with CZS were able to perform 2 hours of motor physiotherapy daily with no serious complications, resulting in an increase or stabilization in GMFM scores.

Mental health and burden in mothers of children with congenital Zika syndrome during COVID-19 pandemic / Saúde mental e sobrecarga das mães de crianças com síndrome congênita do Zika durante a pandemia de COVID-19

Abstract Objectives: to evaluate burden, frequency of anxiety and signs and symptoms of depression in mothers of children with congenital Zika syndrome (CZS) during the COVID-19 pandemic and the social isolation period. Methods: this is a cross-sectional study conducted with mothers who care for their children with CZS. The data were collected by an online form with questions regarding mother's socioeconomic conditions and questions related with Zarit burden scale and Beck's inventories on depression and anxiety. Spearman's correlation tests and multiple regression analyzes were performed to assess factors related to mothers' burden and mental health. Results: 41 mothers were evaluated, 51.2% had mild burden, 39% had minimal anxiety and 73.2% did not have signs and symptoms of depression. Negative correlations were observed between levels of burden and maternal schooling (p=0.01), presence of signs and symptoms of anxiety and receiving financial aid (p<0.04) as well as the presence of signs and symptoms of anxiety and having children with seizures history (p=0.03). Conclusion: despite the risk of their children again being victims of an epidemic virus, mothers who care for their children with CZS did not present serious mental health impairments.

Resumo Objetivos: avaliar a sobre carga e frequência de sinais e sintomas de ansiedade e depressão em mães de crianças com síndrome congênita do Zika (SCZ) durante pandemia de COVID-19. e o período de isolamento social. Métodos: trata-se de um estudo transversal realizado com mães que cuidam de seus filhos com SCZ. Os dados foram coletados por meio de um formulário online contendo questões referentes as condições socioeconômicas da mãe além da escala de sobrecarga de Zarite dos inventários de Beck de depressão e ansiedade. Para avaliação de fatores relacionados a sobrecarga e saúde mental das mães foram realizados testes de correlação de Spearman e análises de regressão múltipla. Resultados: ao todo foram avaliadas 41 mães das quais 51,2% apresentaram sobrecarga leve, 39% apresentaram ansiedade mínima e 73,2% não apresentaram sinais e sintomas de depressão. Correlações negativas foram observadas entre níveis de sobrecarga e a escolaridade materna (p=0,01), presença de sinais e sintomas de ansiedade e recebimento de auxílio financeiro (p<0,04) assim como da presença de sinais e sintomas de ansiedade e ter filhos com histórico de crises convulsivas (p=0,03). Conclusão: apesar do risco iminente de seus filhos serem novamente vítimas de um vírus epidêmico, mães que cuidam de seus filhos com SCZ não apresentaram comprometimento graves na saúde mental.

Comparing the effects of adapting to a weight on one leg during treadmill and overground walking: A pilot study.

BACKGROUND: Locomotor adaptation has been suggested as a way to improve gait symmetry in individuals post-stroke. Most perturbation methods utilize costly, specialized equipment. The use of a unilateral leg weight may provide a low cost, clinically translatable alternative. Furthermore, previous studies have suggested that adaptation context may affect movement outcomes. The purpose of this study was to assess the ability of a unilaterally applied ankle weight to drive locomotor adaptation and determine the effect of context (treadmill versus overground) in young, non-disabled participants. METHODS: Eighteen young non-disabled adults were randomly assigned to receive 10min of walking on a treadmill with a weight (TG), overground with a weight (OG) or as a control on a treadmill/overground without a weight (CG). Outcomes measured before, during and after adaptation were: step length symmetry, single limb support symmetry and gait speed. RESULTS: After adding the weight, single limb support immediately became asymmetrical for all participants without changes in step length symmetry. After walking for 10min, TG step length became asymmetrical. After weight removal, both TG and OG had increased step length asymmetry. TG decreased single limb support asymmetry while OG did not. After walking overground without the weight, walking parameters eventually returned to baseline in both weighted groups. The control group showed no changes. CONCLUSION: A unilaterally applied ankle weight appears able to cause gait adaptation in young, non-disabled participants. However different adaptive changes in the gait pattern are made by the nervous system when the perturbation is applied in different contexts.

Post-stroke hemiparesis: Does chronicity, etiology, and lesion side are associated with gait pattern?

BACKGROUND: Studies that evaluate gait rehabilitation programs for individuals with stroke often consider time since stroke of more than six months. In addition, most of these studies do not use lesion etiology or affected cerebral hemisphere as study factors. However, it is unknown whether these factors are associated with post-stroke motor performance after the spontaneous recovery period. OBJECTIVE: To investigate whether time since stroke onset, etiology, and lesion side is associated with spatiotemporal and angular gait parameters of individuals with chronic stroke. METHODS: Fifty individuals with chronic hemiparesis (20 women) were evaluated. The sample was stratified according to time since stroke (between 6 and 12 months, between 13 and 36 months, and over 36 months), affected cerebral hemisphere (left or right) and lesion etiology (ischemic and hemorrhagic). The participants were evaluated during overground walking at self-selected gait speed, and spatiotemporal and angular gait parameters were calculated. Results Differences between gait speed, stride length, hip flexion, and knee flexion were observed in subgroups stratified based on lesion etiology. Survivors of a hemorrhagic stroke exhibited more severe gait impairment. Subgroups stratified based on time since stroke only showed intergroup differences for stride length, and subgroups stratified based on affected cerebral hemisphere displayed between-group differences for swing time symmetry ratio. CONCLUSION: In order to recruit a more homogeneous sample, more accurate results were obtained and an appropriate rehabilitation program was offered, researchers and clinicians should consider that gait pattern might be associated with time since stroke, affected cerebral hemisphere and lesion etiology.

Influence of treadmill gait training with additional load on motor function, postural instability and history of falls for individuals with Parkinson's disease: A randomized clinical trial.

BACKGROUND: Evaluate the effects of additional load (5% and 10% of body weight) with treadmill gait training on the motor aspects in Parkinson's disease (PD). METHODS: Randomized controlled single-blind trial with 30 individuals with PD. The volunteers were divided into three groups (treadmill with 0%, 5% or 10% load), where Unified Parkinson's Disease Rating Scale was applied. Treadmill gait training was conducted over 4 consecutive weeks, with three weekly sessions of 30 min each. RESULTS: There was a significant reduction in all groups in the time factor for motor function (F = 12.92; P = 0.001) and postural instability (F = 11.23; P = 0.002). No significant difference was observed in group × time interaction (F < 1.76; P > 0.19). CONCLUSION: The treadmill comprises an effective therapy for people with PD, for important motor aspects such as motor function and postural instability. Additional load had no influence on results.

Effects of Treadmill Training with Load on Gait in Parkinson Disease: A Randomized Controlled Clinical Trial.

OBJECTIVE: The aim of this study was to assess the effects of 3% of body weight loads (0%, 5%, and 10%) on treadmill gait training in subjects with Parkinson disease. DESIGN: This study used a randomized controlled single-blind trial. RESULTS: Spatiotemporal variables demonstrated significant intragroup alterations in all three groups at pretraining and posttraining, with an increase in speed (m/sec; F = 4.73, P = 0.04), stride length (m; F = 12.00, P = 0.002), and step length (m; F = 16.16, P = 0.001) and a decrease in the double-stance phase (%; F = 6.59, P = 0.02) and stance phase (%; F = 4.77, P = 0.04). Intergroup pretraining and posttraining did not exhibit significant differences (F < 2.18, P > 0.14). Angular variables showed significant intragroup alterations, with an increase in knee range of motion (F = 5.18, P = 0.03), and intergroup comparison revealed no significant changes (F = 1.87, P = 0.17). CONCLUSIONS: Posttraining improvements in speed, stride length, step length, double-stance, stance phase, and knee range of motion were observed in all groups, where no load (0%, 5%, or 10%) had any significant effect, suggesting that the influence of load did not make one experimental condition better than another. All participants benefitted from treadmill gait training, irrespective of the use of load.

Effects of treadmill inclination on hemiparetic gait: controlled and randomized clinical trial.

OBJECTIVE: The aim of this study was to analyze the effects of inclined treadmill training on the kinematic characteristics of gait in subjects with hemiparesis. DESIGN: A blind, randomized, controlled study was conducted with 28 subjects divided into two groups: the control group, submitted to partial body weight-support treadmill gait training with no inclination, and the experimental group, which underwent partial body weight-support treadmill training at 10% of inclination. All volunteers were assessed for functional independence, motor function, balance, and gait before and after the 12 training sessions. RESULTS: Both groups showed posttraining alterations in balance (P < 0.001), motor function (P < 0.001), and functional independence (P = 0.002). Intergroup differences in spatiotemporal differences were observed, where only the experimental group showed posttraining alterations in velocity (P = 0.02) and paretic step length (P = 0.03). Angular variables showed no significant differences in either group. CONCLUSIONS: In subjects with hemiparesis, the addition of inclination is a stimulus capable of enhancing the effects of partial body weight-support treadmill gait training.

Influence of body weight unloading and support surface during walking of children with cerebral palsy / Influência do alívio de peso corporal e da superfície de suporte durante o andar de crianças com paralisia cerebral espástica

Introduction Partial body weight support (BWS) systems have been employed for gait training of children with cerebral palsy (CP). Therefore, it would be important to analyze if the type of walking surface and the amount of body weight unloading over lower limbs change the way these children walk. Objectives Investigate the influence of walking surface and amount of body weight unloading on the spatial temporal characteristics during walking of children with CP. Materials and methods Seven children with spastic CP between four and eight years old and GMFCS (Gross Motor Function Classification System) between I and IV, were videotaped walking with 0%, 15% and 30% of BWS on both dynamic (treadmill) and static (ground level) surfaces. Walking spatial temporal variables were calculated. Results Children walked with similar velocity in all experimental conditions. While stance duration decreased as the percentage of BWS increased, no differences were found for stance and swing periods and cadence. Children walked with longer steps and strides and with faster strides on static surface compared to dynamic surface. Conclusion Children with CP presenting different levels of motor impairment presented some alterations in the spatial temporal walking parameters as they walked with body unloading. However, such alterations might be due mainly to the type of walking surface than the percentage of body weight unloading on lower limbs.

Introdução Sistemas de suporte parcial de peso corporal (SPPC) têm sido utilizados para treinamento do andar de crianças com paralisia cerebral (PC). Sendo assim, seria importante analisar se o tipo de superfície e a quantidade de alívio de peso corporal sobre os membros inferiores interferem na forma como essas crianças andam. Objetivo Investigar a influência do tipo de superfície e da porcentagem de alívio de peso corporal sobre as características espaço-temporais durante o andar de crianças com PC. Materiais e métodos Sete crianças com PC espástica, entre quatro e oito anos de idade, e GMFCS (Gross Motor Function Classification System) entre I e IV, foram filmadas andando com 0%, 15% e 30% de SPPC em superfícies móvel (esteira motorizada) e fixa (chão). Variáveis espaço-temporais do andar foram calculadas. Resultados As crianças andaram com velocidade semelhante em todas as condições experimentais. Enquanto que a duração do período de apoio diminuiu conforme a porcentagem de SPPC aumentou, nenhuma diferença para as fases de apoio e balanço e cadência foi encontrada. As crianças andaram com passos e passadas mais longos e passadas mais rápidas na superfície fixa do que na superfície móvel. Conclusão Crianças com PC com diferentes níveis de acometimento motor apresentaram algumas alterações nos parâmetros espaço-temporais durante o andar com alívio de peso corporal em superfícies móvel e fixa. Entretanto, tais alterações podem ser atribuídas principalmente ao tipo de superfície em que as crianças andam do que às porcentagens de alívio de peso corporal proporcionadas aos membros inferiores.