Nest positioning on motor development, sleep patterns, weight gain in preterm infants: systematic review.

The aim was to evaluate the effects of Nest Positioning (NP) on motor development, sleep patterns, and weight gain in preterm newborns (PTNB) hospitalized in a neonatal intensive care unit (NICU). This study was constructed based on PRISMA guideline criteria. Systematic research was carried out in electronic databases: MEDLINE via PubMed, Web of Science, Scopus, and VHL-BIREME following the PICOS strategy. Studies with PTNB populations who were hospitalized in the NICU and received therapeutic NP as an intervention strategy in this population were included in this study. We sought outcomes related to sleep patterns, weight gain, and motor development. After selection, 12 studies were included in this systematic review, of which 5 (41.7%) evaluated motor development as their primary outcome, 6 (50%) sleep-wake cycle patterns, and 1 (8.3%), weight gain and, subsequently, hospital discharge. Qualitative results indicate that prolonged exposure to decubitus variations may favor PTNB hospitalized in NICUs acquiring flexor postures, stimulate their midline, and increase their total sleep time. Studies reported no adverse effects regarding the use of NP. Evidence suggests that NP benefits motor development and sleep pattern in PTNB hospitalized in NICUs. IMPACT: Nest positioning improves sleep quality in preterm newborns hospitalized in neonatal intensive care unit. Nest positioning improves motor development in preterm newborns hospitalized in neonatal intensive care unit. No evidence of nest positioning on weight gain was observed. Half of the included clinical studies showed good methodological quality. Nesting positioning is a secure and cost-effective method.

Gross motor trajectories of pre-term and full-term infants under different parental educational approaches.

This study aimed to explore motor trajectories of Brazilian pre-term and full-term infants from 3 to 12 months old whose parents participated in an educational program and had received guidance on gross motor development. Forty-eight Brazilian infants aged 3 months old were divided into Group 1 (full-term infants and their parents who received only verbal guidance, n = 14), Group 2 (full-term infants with parents who received an educative folder in addition to the same verbal guidance, n = 23), and Group 3 (preterm infants with parents who received the same verbal guidance and educative folder, n = 11). The folder had similar information to the verbal guidance; nonetheless, it helped to teach parents and allowed later consultation at home. We applied Alberta Infant Motor Scale, Affordances in Home Environment for Motor Development-Infant Scale, and a questionnaire about infants' information at 3-, 6-, 9-, and 12-months old. In longitudinal comparison, all groups showed a significant difference for AIMS variables on total score and subscales; all subitems of AHEMD-IS; and time spent in prone, supine, sitting, and standing positions. In general, no differences were found between groups. Motor trajectory, home opportunities, and parental positioning practices were similar between full-term and preterm infants with different guidance approaches.

Questionário de autopercepção corporal de professores durante atividades escolares (P&Hscreen): desenvolvimento, validação e confiabilidade / Questionnaire on teachers' physical self-perception during school activities (P&Hscreen): development, validation, and reliability

Construir e validar um questionário para avaliar a autopercepção de professores sobre sua postura e a percepção dos hábitos posturais dos alunos em diferentes situações no ambiente escolar. Foram realizadas 7 etapas para a construção do questionário. A estratégia de validação de conteúdo foi julgada por um painel de especialistas e pelo Índice de Validade (VI). A confiabilidade teste-reteste foi realizada com professores e medida pelo Coeficiente de Correlação Intraclasse (ICC) e Coeficiente Kappa (KC). 11 especialistas com doutorado, experiência em educação e na área de postura participaram da validação de conteúdo e 40 professores participaram da confiabilidade teste-reteste. As medidas de VI foram todas acima de 0,81, e a média geral de ICC e KC foi de 0,94 e 0,91, respectivamente. Este questionário foi considerado válido, confiável e viável com linguagem compreensível para os professores. Pode ser recomendado para pesquisas em escolas e programas de educação postural, contribuindo para a prevenção de hábitos posturais inadequados e suas consequências.

To construct and validate a questionnaire for assessing teachers' self-perception of their posture, and their perception of students' posture habits in different situations in the school environment. 7-step were performed for the construction of the questionnaire. The content validation strategy was judged by a panel of experts and the Validity Index (VI). Test-retest reliability was performed with teachers and measured by the Intraclass Correlation Coefficient (ICC) and Kappa Coefficient (KC). Eleven experts with a doctorate, experience in education, and the field of posture participated in content validation and 40 teachers participated in test-retest reliability. VI measurements were all above 0.81, and the overall mean of ICC and KC were 0.94 and 0.91, respectively. This questionnaire was considered valid, reliable, and feasible with language understandable to teachers. It can be recommended for research in schools, and posture education programs, contributing to the prevention of inadequate posture habits and their consequences.

Does premature birth affect Brazilian parents' practices related to infant positioning?

OBJECTIVE: To verify whether the time spent in prone, supine, or seated positions differed between term and preterm infants; and to determine whether a single verbal guidance session for parents changed the time spent in different positions, and, consequently, the motor development scores, after one month in preterm infants. METHODS: Sixty-one infants from a full-term and preterm group from Brazil were included. Motor development was assessed by the Alberta Infant Motor Scale (AIMS) and the parents registered the time spent in each position on a 24-hour schedule. A month after verbal guidance, a second assessment was performed only on the preterm infants. RESULTS: The positioning times awake determined for the full-term and preterm parents were similar. Preterm infants spent more time in the prone sleeping position (2.1 vs. 0.8 h; p=0.037) than full-term infants. The AIMS percentile scores did not differ significantly between the groups. For preterm infants, the time spent in all positions did not change during the second assessment (n=18). CONCLUSIONS: The fact that some parents position their infants in the prone posture during sleeping periods reinforce the importance of parental education approaches for sudden infant death syndrome (SIDS) prevention during the first months of life. The verbal guidance provided to parents of preterm infants did not influence the AIMS percentile and time spent in various positions but increased preterm parents' confidence in placing their infants in a prone position to play.

Postural education program for socially vulnerable adolescents protected by institutional care: case series / Programa de educação postural para adolescentes socialmente vulneráveis protegidos por cuidados institucionais

Introduction: Institutionalized young people may exhibit impaired development due to lack of support, correct guidance regarding their physiological changes, and knowledge about postural changes. Methods: This is a longitudinal observational case series study. Adolescents residing in shelters who could understand the entire protocol were invited to participate in the study. Ten meetings were held, once a week, with 8 theoretical-practical interventions and 2 pre and post-PEP evaluations. The evaluations were: static posture, dynamic balance, handgrip strength, self-esteem, quality of life, and a theoretical questionnaire on general knowledge. Results: From 18 adolescents, 11 (7 boys and 4 girls), with an average age of 14.8 (±1.3) years concluded the study. After the PEP intervention, a significant improvement was found in the knee angles (3.56º vs. 2.28º) and hip (-12.03º vs. -4.18º) in its plane lateral. The scores of the theoretical questionnaire were 4.75 vs. 11.63 and the handgrip strength was 22.91 vs. 28.54 kgf and 21.55 vs. 26.82 kgf for the right and left limbs. In the quality of life and self-esteem questionnaires, no statistically significant differences were obtained. Conclusion: PEP imparts benefits to socially vulnerable adolescents for postural angles, handgrip strength and theoretical knowledge. Self-esteem and quality of life did not change, probably due to their high vulnerability.

Introdução: Jovens institucionalizados podem apresentar comprometimento do desenvolvimento por falta de apoio, orientação correta quanto às suas alterações fisiológicas e conhecimento sobre alterações posturais. Métodos: Trata-se de um estudo observacional longitudinal de série de casos. Foram convidados a participar do estudo adolescentes residentes em abrigos que conseguissem compreender todo o protocolo. Foram realizados dez encontros, uma vez por semana, com 8 intervenções teórico-práticas e 2 avaliações pré e pós-PEP. (programa de educação postural). As avaliações foram: postura estática, equilíbrio dinâmico, força de preensão manual, autoestima, qualidade de vida e questionário teórico de conhecimentos gerais. Resultados: Dos 18 adolescentes, 11 (7 meninos e 4 meninas), com idade média de 14,8 (±1,3) anos, concluíram o estudo. Após a intervenção PEP, foi encontrada melhora significativa nos ângulos do joelho (3,56º vs. 2,28º) e quadril (-12,03º vs. -4,18º) no seu plano lateral. As pontuações do questionário teórico foram 4,75 vs. 11,63 e a força de preensão manual foi 22,91 vs. 28,54 kgf e 21,55 vs. 26,82 kgf para os membros direito e esquerdo. Nos questionários de qualidade de vida e autoestima não foram obtidas diferenças estatisticamente significativas. Conclusão: A PEP traz benefícios aos adolescentes em situação de vulnerabilidade social quanto aos ângulos posturais, força de preensão manual e conhecimento teórico. A autoestima e a qualidade de vida não se alteraram, provavelmente devido à sua elevada vulnerabilidade.

Conservative management following patellar dislocation: a level I systematic review.

BACKGROUND: Patellar instability is a common and disabling clinical condition. Treatment of acute primary patellar dislocation aims to reduce the risk of recurrence or painful subluxation and improve function. However, the actual clinical efficacy of any management modality following an acute dislocation has never been demonstrated in prospective or retrospective studies, and the optimal way in which the various management modalities should be used is at best unclear. METHODS: A search was conducted in PubMed, Bireme and Embase databases. Inclusion criteria followed the acronym PICOS, (P) subjects with patellar instability, (I) therapeutic interventions, (C) placebo or control or surgical treatments, (O) rate of dislocations and function, and (S) clinical trials. The Medical Subject Headings (MeSH) terms used were: (("patellar instability") OR ("patellar dislocation")) AND ((physiotherapy) OR (rehabilitation) OR ("conservative treatment") OR (therapy) OR (therapeutic)). The risk of bias was analysed using the PeDRO scale. RESULTS: Seven randomized controlled trials including 282 patients were considered. The quality of studies detailing the results of conservative treatment was higher than that of surgical procedures, but all studies have relatively low methodological quality. Four studies compared physiotherapeutic interventions with surgical procedures, and three studies compared conservative intervention techniques. CONCLUSION: An unstructured lower limb physical therapy programme evidences similar outcomes to specific exercises. Surgical management is associated with a lower rate of re-dislocation; however, whether surgery produces greater functional outcomes than conservative management is still unclear. The use of a knee brace with a limited range of motion, stretching and neuromuscular exercises are the most commonly recommended physiotherapy methodologies.

Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis.

Achilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented "some concerns", and 37.5% (five and three articles, respectively) presenting "high risk" of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was - 1.21 (- 2.72 to - 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT.Level of evidence: Level 1.Registration: CRD42018118016.

Does premature birth affect Brazilian parents' practices related to infant positioning? / A prematuridade afeta as práticas maternas brasileiras relacionadas ao posicionamento de lactentes?

Abstract Objective: To verify whether the time spent in prone, supine, or seated positions differed between term and preterm infants; and to determine whether a single verbal guidance session for parents changed the time spent in different positions, and, consequently, the motor development scores, after one month in preterm infants. Methods: Sixty-one infants from a full-term and preterm group from Brazil were included. Motor development was assessed by the Alberta Infant Motor Scale (AIMS) and the parents registered the time spent in each position on a 24-hour schedule. A month after verbal guidance, a second assessment was performed only on the preterm infants. Results: The positioning times awake determined for the full-term and preterm parents were similar. Preterm infants spent more time in the prone sleeping position (2.1 vs. 0.8 h; p=0.037) than full-term infants. The AIMS percentile scores did not differ significantly between the groups. For preterm infants, the time spent in all positions did not change during the second assessment (n=18). Conclusions: The fact that some parents position their infants in the prone posture during sleeping periods reinforce the importance of parental education approaches for sudden infant death syndrome (SIDS) prevention during the first months of life. The verbal guidance provided to parents of preterm infants did not influence the AIMS percentile and time spent in various positions but increased preterm parents' confidence in placing their infants in a prone position to play.

RESUMO Objetivo: Verificar se o tempo nas posições prono, supino ou sentado difere entre lactentes a termo e pré-termo; bem como determinar se uma única sessão de orientação verbal aos pais alterou o tempo despendido nas diferentes posições e, consequentemente, o escore de desenvolvimento motor, após um mês em lactentes pré-termo. Métodos: Foram incluídos 61 lactentes brasileiros nos grupos a termo e pré-termo. O desenvolvimento motor foi avaliado pela Alberta Infant Motor Scale (AIMS), e os pais registraram o tempo despendido em cada posição em uma linha do tempo de 24 horas. Um mês após a orientação verbal, uma segunda avaliação foi realizada apenas nos lactentes pré-termo. Resultados: O tempo de posicionamento acordado determinado pelos pais de lactentes a termo e pré-termo foi semelhante. Os lactentes pré-termo passaram mais tempo dormindo na posição prona (2,2 vs. 0,8 h; p=0,037) do que os lactentes a termo. Os escores de percentil AIMS não diferiram significativamente entre os grupos. Para lactentes pré-termo, o tempo despendido em todas as posições não se modificou durante a segunda avaliação (n=18). Conclusões: O fato de alguns pais posicionarem os lactentes em decúbito ventral durante os períodos de sono reforça a importância das abordagens educativas parentais para a prevenção da síndrome da morte súbita do lactente (SMSL) durante os primeiros meses de vida. A orientação verbal fornecida aos pais de prematuros não influenciou o percentil da AIMS e o tempo de permanência em várias posições, mas aumentou a confiança dos pais de lactentes prematuros em utilizar a posição prona para brincar.

Acompanhamento das funções respiratória e motora de crianças com atrofia muscular espinhal e distrofia muscular de Duchenne: um estudo longitudinal / Monitoring of respiratory and motor functions on children with spinal muscular atrophy and Duchenne muscular dystrophy: a longitudinal study

Objetivo: Realizar o acompanhamento de crianças e adolescentes com Atrofia Muscular Espinhal (AME) e Distrofia Muscular de Duchenne (DMD) em um centro de referência, por meio de avaliações de parâmetros respiratórios e motores. Métodos: Conduziu-se 3 avaliações em um período de 24 meses, em pacientes até 15 anos, com DMD e AME. Avaliações respiratórias incluíram: parâmetros cardiorrespiratórios, força muscular respiratória, pico de fluxo de tosse e espirometria. Analisou-se a função motora por meio de escalas especificas: 1) Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) para crianças até 2 anos; 2) Medida da Função Motora (MFM-32) acima de 6 anos; 3) versão reduzida (MFM-20) para 2 a 6 anos. A análise estatística incluiu o teste de Shapiro-Wilk e utilizou-se ANOVA com Post Hoc de Bonferroni ou Friedman, e aplicou-se os coeficientes de Spearman ou Pearson. Resultados: Participaram 16 pacientes com mediana de idade de 6,5 anos, 12 com AME e 4 DMD. Houve diferença entre dados antropométricos, a frequência de crianças que não realizava fisioterapia reduziu (12,5%X6,3%) e houve aumento na adesão para técnica de empilhamento de ar (37,5%X43,8%). Uso de ventilação não invasiva se manteve igual, assim como parâmetros respiratórios e escalas motoras. Verificou-se forte correlação entre valor predito da capacidade vital forçada e escores MFM-20 e MFM-32. Conclusão: O acompanhamento ambulatorial de crianças com AME e DMD evidenciou relativa manutenção em parâmetros respiratórios e de função motora, o que pode ser atribuído a melhora na adesão de rotinas terapêuticas e aos cuidados em um centro de referência.

Objective: The aim of this study was to monitor children and adolescents with Spinal Muscular Atrophy(SMA) and Duchenne Muscular Dystrophy (DMD) at a referral center, through assessments of respiratory and motor parameters. Methods: 3 evaluations were conducted over a period of 24 months, in patients up to 15 years old, with DMD and SMA. Respiratory assessments included: cardiorespiratory parameters, respiratory muscle strength, peak cough flow and spirometry. Motor function was analyzed using specific scales: 1) Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) for children up to 2 years old; 2) Measurement of Motor Function (MFM-32) over 6 years; 3) reduced version (MFM-20) for 2 to 6 years. The statistical analysis included the Shapiro-Wilk test and ANOVA with Bonferroni or Friedman's Post Hoc was used, and the Spearman or Pearson coefficients were applied. Results: 16 patients with a median age of 6.5 years, 12 with SMA and 4 DMD participated. There was a difference between anthropometric data, the frequency of children who did not undergo physical therapy decreased (12.5%X6.3%) and there was an increase in adherence to the air stacking technique (37.5%X43.8%). Use of non-invasive ventilation remained the same, as did respiratory parameters and motor scales. There was a strong correlation between the predicted value of forced vital capacity and scores MFM-20 and MFM-32. Conclusion: Outpatient follow-up of children with SMA and DMD showed a relative maintenance of respiratory and motor function parameters, which can be attributed to the improvement in adherence to therapeutic routines and care in a reference center.

Utilização clínica de testes e escalas funcionais: uma entrevista com Fisioterapeutas / Clinical use of tests and functional scale: an interview with Physiotherapists

Objetivo: Investigar a utilização das escalas e testes funcionais por fisioterapeutas brasileiros que atuam clinicamente na área ortopédica, traumatológica e/ou esportiva. Métodos: Para coleta de dados foi utilizado um questionário eletrônico, autoaplicável, elaborado pelos autores, divulgado por meio de redes sociais. Os participantes foram divididos em quatro grupos conforme suas respostas: grupo que utiliza testes e escalas funcionais (GTE); grupo que utiliza somente testes funcionais (GST); grupo que utiliza somente escalas funcionais (GSE); grupo que não utiliza nenhum (GN). Para análise de dados, foi realizada uma análise descritiva dos dados sociodemográficos e profissionais dos participantes. A associação entre variáveis qualitativas nominais foi avaliada por meio do teste Qui quadrado. Resultados: Do total de 100 voluntários participantes da pesquisa, 75 compuseram o GTE, 19 o GST, 1 o GSE e 5 o GN, demonstrando alto índice de utilização tanto de escalas quanto de testes funcionais na prática clínica. Não foram encontradas associações (p>0,05) entre o uso das ferramentas com características do profissional. As principais barreiras encontradas para não utilização das ferramentas foram a falta de tempo na sessão e o pouco conhecimento sobre os instrumentos. A maior parte dos participantes julga muito relevante o uso de avaliações funcionais na prática clínica. Conclusão: Os fisioterapeutas da amostra, em sua maioria, utilizam os testes e escalas funcionais na prática clínica. O principal uso dessas ferramentas é identificar as disfunções presentes nos pacientes durante as avaliações e as barreiras encontradas para não utilização são a falta de tempo e pouco conhecimento dos instrumentos.

Objective: to investigate the use of these tools by Brazilian physical therapists who work clinically in the orthopaedic, traumatological and sports areas, characterizing the professional and his possible relationship with the use of these instruments. Methods: For data collection, through social midias, a self-administered questionnaire online was applied. The participants were divided into four groups according to their answers: group that applied tests and functional scales (GTE); group that applied only functional tests (GST); group that applied only functional scales (GSE); group that did not use any (GN). For data analysis, a descriptive analysis of the sociodemographic and professional data of the participants was performed. The association between nominal qualitative variables was assessed by Chi-square test. Results: Of 100 volunteers participating in the research, 75 composed the GTE, 19 the GST, 1 the GSE and 5 the GN. Tests and scales are used by most professionals interviewed to follow the evolution of treatment and identify dysfunctions. As for the GSE, the main barriers found for not using it were the lack of time in the session and the little knowledge of the instruments. Most participants consider the use of functional assessments to be very relevant in clinical practice. Conclusion: Most orthopaedic, traumatological and sports physical therapists in the sample use tests and functional scales in clinical practice. Their main objective with these tools is to identify the dysfunctions present in patients during physical therapy assessments and the main barriers to not using them are time and little knowledge.

A Cross-Cultural Adaptation and Content Validity of COMFORTneo Scale into Brazilian Portuguese.

CONTEXT: The instrument used to assess neonatal pain must be adequate regarding the type of pain, population, country, and language to provide the best evidence-based clinical strategies; however, few neonatal pain instruments have been translated and validated for the Brazilian population. OBJECTIVE: The aim was to perform a cross-cultural adaptation of the COMFORTneo scale into Brazilian Portuguese and to evaluate the content validity of the adapted scale. METHODS: The cross-cultural adaptation process followed six main steps: translation, synthesis of the translations, back-translation, submission to the expert committee, final version pretest, being that 65 individuals participated in this stage, including both healthcare professionals and students, and submission to the committee for process appraisal. Additionally, an equivalence form composed of a four-point Likert scale was sent to each committee participant to calculate the content validity index (CVI). The CVI was obtained as the sum of the items ranked as three or four by the experts divided by the total number of experts. RESULTS: No difficulties were reported in the production of translated versions. The CVI for the final version of the translated instrument was 0.99. The final version was reviewed to correct any possible grammatical errors. The layout was modified as necessary, and instructions on scale scoring were added to facilitate the application, resulting in the COMFORTneo Brazil scale. CONCLUSION: The COMFORTneo scale was properly and cross-culturally adapted into Brazilian Portuguese, reaching semantic, idiomatic, experimental, and conceptual equivalence with the original instrument, and a good CVI.

Canadian and Brazilian Percentile Ranks for the Alberta Infant Motor Scale.

Aim: To verify if there is a difference between the percentile ranks for Brazilian infants compared with norms for Canadian infants on the Alberta Infant Motor Scale (AIMS). Method: A cross-sectional study in which 322 Brazilian infants, 2 to 15 months old, were administered the AIMS. Percentile ranks were calculated using norms for Canadian infants and norms from two studies of Brazilian infants. The Friedman test compared the AIMS percentile ranks for the entire sample. For reliability analysis, the interclass correlation coefficient (ICC) was used. Bland Altman's analysis was applied to compare percentile ranks. Results: Of the 322 evaluations analyzed, there were significant differences (p<.001) between the three percentile ranks compared. The Canadian norms presented the lowest average rating. There was good reliability between the percentile ranks (ICC > 0.75) but low agreement (Bland Altman; p<.001). Conclusion: There are differences between the Brazilian and Canadian percentile ranks and between the Brazilian percentile ranks of 2014 and 2016, and these differences may influence identification of motor development.

Quality Assessment of Neonatal Pain Scales Translated and Validated to Brazilian Portuguese: A Systematic Review of Psychometric Properties.

OBJECTIVES: The objective of this systematic review was to identify and describe the psychometric properties of neonatal pain scales that were translated into Brazilian Portuguese and to verify the methodological quality of these translation, transcultural adaptations and validation. DESIGN: The present study is a systematic review. A systematic search in the literature included studies of development, validation, and transcultural adaptation of neonatal pain scales to Brazilian Portuguese. The instruments must have been developed for health care professionals to evaluate neonatal pain and stress in full-term and preterm newborns. DATA SOURCES: The search strategy was conducted in PubMed, Web of Science, Scopus, and Scielo databases following The PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). REVIEW /ANALYSIS METHODS: A total of 1,479 publications were identified and 5 fulfilled the inclusion criteria, with 4 instruments evaluated. For the methodological quality analysis of the measurement properties of the instruments the Consensus-based Standards for Health Measurement Instruments (COSMIN) Risk of Bias checklist was used. The psychometric properties verified were internal consistency, content validity, reliability, and construct validity. RESULTS: Three instruments reviewed were inadequate and one was doubtful. CONCLUSIONS: The neonatal pain scales wich were cross culturally adapted to Brazilian Portuguese were shown to be of low methodological quality based on COSMIM checklist. Caution should be considered for clinical decisions about pain management judgment coming from these instruments.

Neuroimaging and motor development of twins with congenital microcephaly associated with Zika virus: a case report / Neuroimagem e desenvolvimento motor de gêmeas com microcefalia congênita por Zika virus: estudo de caso

Objective: We aimed to describe a case of congenital microcephaly caused by Zika virus infection in a monozygotic twin pregnancy. Methods: Transfontanelle ultrasonography and cranial computed tomography revealed different lesion patterns for both twins with congenital microcephaly caused by Zika virus infection. Motor development assessments were performed using the Alberta Infant Motor Scale and the Gross and Motor Function Measure before, during, and after physiotherapy. Results: The evaluations showed differences in motor acquisition between the twins. The values in the first case were much lower than those in the second case, which showed more motor delay. Conclussion: The present study showed that despite the twins being monozygotic, the effects of neurological lesions as revealed by neuroimaging were worse in the first case, and even with two weekly rehabilitation sessions, motor development over time was considerably worse in the twin in case 1 than in the other twin.

Objetivo: Descrever um caso de microcefalia congênita causada pela infecção do Zika vírus em uma gestação gemelar monozigótica. Métodos: A ultrassonografia transfontanelar e a tomografia computadorizada de crânio revelaram diferentes padrões de lesão para ambos gêmeos com microcefalia congênita causada pela infecção do Zika vírus. As avaliações do desenvolvimento motor foram realizadas por meio da Escala Motora Infantil de Alberta (EMIA) e da Medida de Função Motora Grossa antes, durante e após o tratamento fisioterapêutico. Resultados: As avaliações mostraram diferenças na aquisição motora entre os gêmeos. Os valores nas avaliações do primeiro caso foram bem menores do que os do segundo caso, que apresentou maior atraso motor. Conclusão: O presente estudo mostrou que apesar dos gêmeos serem monozigóticos, os efeitos das lesões neurológicas reveladas por exames de neuroimagem foram piores no primeiro caso, e mesmo com duas sessões semanais de reabilitação, o desenvolvimento motor ao longo do tempo foi consideravelmente pior no gêmeo do caso 1 quando comparado ao caso 2.

Confiabilidade intra e interexaminadores da aplicação da Escala Motora Infantil de Alberta (EMIA) em ambulatório de seguimento de recém-nascidos de risco / Fiabilidad intraevaluadores e interevaluadores de la aplicación de la Escala Motora Infantil de Alberta (EMIA) en un seguimiento ambulatorio de recién nacidos de riesgo / Intra-and inter-examiner reliability of Alberta Infant Motor Scale application in follow-up ambulatory of at-risk newborns

RESUMO A prematuridade é fator de risco para atraso do desenvolvimento motor, e recomenda-se o acompanhamento desses lactentes nos primeiros dois anos de vida. Verificar a confiabilidade intra e interexaminadores da Escala Motora Infantil de Alberta (EMIA) em ambulatório de seguimento de recém-nascidos de risco de uma maternidade pública. Estudo prospectivo realizado em ambulatório de seguimento de recém-nascidos de risco. As avaliações do desenvolvimento motor foram realizadas por meio da EMIA, por dois avaliadores previamente treinados. O Coeficiente de Correlação Intraclasse (CCI) foi utilizado para análise das confiabilidades. Para a comparação entre as avaliações intraexaminadores foi realizado o Teste T pareado ou Teste de Wilcoxon. O Teste T independente foi utilizado para comparar as avaliações interexaminadores. A correlação entre as variáveis foi analisada a partir do Teste de Pearson ou Spearman. Para avaliar a concordância entre os escores foi realizada análise de Bland Altman. Foram avaliados 31 recém-nascidos pré-termo (RNPT) com idade corrigida média de 8,47 ± 4,49. Não houve diferença significativa entre as avaliações intraexaminadores e interexaminadores. Os valores de CCI se mantiveram acima de 0,88 para a confiabilidade intraexaminadores e interexaminadores. Os escores apresentaram alta concordância, analisada por meio do teste de Bland Altman. EMIA apresentou adequada confiabilidade intra e interexaminadores para avaliação e acompanhamento de RNPT até 18 meses em ambulatório de seguimento de lactentes de risco.

RESUMEN La prematuridad es un factor de riesgo de retraso en el desarrollo motor de los lactantes y se recomienda la monitorización de ellos durante los dos primeros años de vida. Verificar la fiabilidad intraevaluadores e interevaluadores de la Escala Motora Infantil de Alberta (EMIA) en un seguimiento ambulatorio de recién nacidos de riesgo en una maternidad pública brasileña. Estudio prospectivo realizado en un seguimiento ambulatorio de recién nacidos de riesgo. Para evaluar el desarrollo motor, la EMIA fue empleada por dos evaluadores previamente capacitados. Se utilizó el coeficiente de correlación intraclase (CCI) para analizar la fiabilidad. Para comparar las evaluaciones intraevaluadores, se utilizó la prueba T pareada o la prueba de Wilcoxon. La prueba T independiente se utilizó para comparar las evaluaciones interevaluadores. La correlación entre las variables se analizó mediante la prueba de Pearson o Spearman. Para evaluar la concordancia entre los puntajes, se aplicó el análisis de Bland Altman. Se evaluaron a 31 recién nacidos pretérmino (RNPT) con un promedio de edad media corregida de 8,47 ± 4,49. No hubo diferencias significativas entre las evaluaciones intraevaluadores e interevaluadores. Los valores de CCI se mantuvieron por encima de 0,88 para la fiabilidad intraevaluadores e interevaluadores. Los puntajes mostraron un alto nivel de concordancia, que se analizó mediante el Bland Altman. La EMIA apuntó una adecuada fiabilidad intra e interevaluadores para evaluar y monitorear los RNPT hasta 18 meses en seguimiento ambulatorio de lactantes de riesgo.

ABSTRACT Prematurity is a risk factor for delayed motor development, and it is recommended to monitor these infants in the first two years of life. To verify the properties of intra and inter-examiner measurements of AIMS in an outpatient follow-up clinic for newborns at risk in a public maternity hospital. Prospective study conducted in an outpatient follow-up of high-risk newborns. The Intraclass Correlation Coefficient (ICC) was used to analyze reliability. To compare the intra-examiner evaluations, the paired T-test or Wilcoxon test was performed. The independent T-test was used to compare inter-examiner assessments. The correlation between variables was analyzed using the Pearson or Spearman test. The Bland Altman test was performed to assess the concordance between the scores. 31 preterm infants with 8,47 ± 4,49 of corrected age were evaluated. There was no significant difference between the evaluations intra and inter-examiner. The ICC values remained above 0.88 for both intra and inter-examiner evaluation. The scores showed high agreement. AIMS has intra- and inter-examiner reliability for assessing and monitoring preterm newborns for up to 18 months in a follow-up clinic.

Effects of Myofascial Self-Release on Range of Motion, Pressure Pain Threshold, and Hamstring Strength in Asymptomatic Individuals: A Randomized, Controlled, Blind Clinical Trial.

CONTEXT: Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time. OBJECTIVE: To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention. DESIGN: Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups. SETTING: Institutional physiotherapy clinic. PARTICIPANTS: A total of 40 university students (18-30 y), who had no symptoms, participated. INTERVENTION: Foam roller for 30 seconds and 2 minutes for group 2. MAIN OUTCOME MEASURES: Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention. RESULTS: Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT. CONCLUSIONS: Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.

Whole-body vibration mediates mechanical hypersensitivity through Aß-fiber and C-fiber thermal sensation in a chronic pain model.

Whole-body vibration (WBV), which is widely used as a type of exercise, involves the use of vibratory stimuli and it is used for rehabilitation and sports performance programmes. This study aimed to investigate the effect of WBV treatment in a chronic pain model after 10 WBV sessions. An animal model (chronic pain) was applied in 60 male Wistar rats (±180 g, 12 weeks old) and the animals were treated with low intensity exercise (treadmill), WBV (vibrating platform), and a combined treatment involving both. The controls on the platform were set to a frequency of 42 Hz with 2 mm peak-to-peak displacement, g ≈ 7, in a spiral mode. Before and after the vibration exposure, sensitivity was determined. Aß-fibers-mediated mechanical sensitivity thresholds (touch-pressure) were measured using a pressure meter. C-fibers-mediated thermal perception thresholds (hot pain) were measured with a hot plate. After each session, WBV influenced the discharge of skin touch-pressure receptors, reducing mechanical sensitivity in the WBV groups (P < 0.05). Comparing the conditions "before vs. after", thermal perception thresholds (hot pain) started to decrease significantly after the third WBV session (P < 0.05). WBV decreases mechanical hyperalgesia after all sessions and thermal sensitivity after the third session with the use of WBV.

Positioning Effects for Procedural Pain Relief in NICU: Systematic Review.

OBJECTIVES: To systematically review the literature regarding the effectiveness of different positioning methods for procedural pain relief in neonates admitted to the Neonatal Intensive Care Unit (NICU). DESIGN: A systemized search of the literature was carried out by means of two independent evaluators through the systematic search of electronic index databases. DATA SOURCES: A search for relevant studies was performed in four databases (Medline, Web of Science, Scopus, and BVS-BIREME). REVIEW/ANALYSIS METHODS: Manual searches were conducted on suitable references from the included articles, and 1,941 publications were eligible for the analysis. The flowchart for the articles' selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and in relation to bias risks according to the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Based on the inclusion criteria, only 20 publications remained. According to the PEDro scale, 75% of the studies presented good methodological quality, with scores between 6 and 8, and 5% scored ≤4 points. None of them were blinded in relation to the therapies, but all of them performed intergroup statistical comparisons. According to the results of this review, we recommend facilitated tucking by parents (FTP) in NICU of at least 30 minutes duration, starting 15 minutes before, during the painful procedure, and 15 minutes after to relieve pain and to stabilize the physiological, hormonal, and behavioral responses of the newborns. CONCLUSIONS: Positioning should be used as a nonpharmacological strategy for procedural pain relief in newborns. This review showed that facilitated tucking by parents for 30 minutes was the best position for pain relief in premature newborns during procedures in the NICU. Positioning is recommended as a nonpharmacological method for pain relief; FTP of at least 30 minutes duration should be the first positioning choice during procedures in the NICU.

Transcutaneous electrical nerve stimulation, acupuncture, and spinal cord stimulation on neuropathic, inflammatory and, non-inflammatory pain in rat models.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS), manual acupuncture (MA), and spinal cord stimulation (SCS) are used to treat a variety of pain conditions. These non-pharmacological treatments are often thought to work through similar mechanisms, and thus should have similar effects for different types of pain. However, it is unclear if each of these treatments work equally well on each type of pain condition. The purpose of this study was to compared the effects of TENS, MA, and SCS on neuropathic, inflammatory, and non-inflammatory pain models. METHODS: TENS 60 Hz, 200 µs, 90% motor threshold (MT), SCS was applied at 60 Hz, an intensity of 90% MT, and a 0.25 ms pulse width. MA was performed by inserting a stainless-steel needle to a depth of about 4-5 mm at the Sanyinjiao (SP6) and Zusanli (ST36) acupoints on a spared nerve injury (SNI), knee joint inflammation (3% carrageenan), and non-inflammatory muscle pain (intramuscular pH 4.0 injections) in rats. Mechanical withdrawal thresholds of the paw, muscle, and/or joint were assessed before and after induction of the pain model, and daily before and after treatment. RESULTS: The reduced withdrawal thresholds were significantly reversed by application of either TENS or SCS (P < 0.05). MA, on the other hand, increased the withdrawal threshold in animals with SNI and joint inflammation, but not chronic muscle pain. CONCLUSIONS: TENS and SCS produce similar effects in neuropathic, inflammatory and non-inflammatory muscle pain models while MA is only effective in inflammatory and neuropathic pain models.

Persistent pain induces mood problems and memory loss by the involvement of cytokines, growth factors, and supraspinal glial cells.

Lesions of peripheral nerves lead to pain, hyperalgesia, and psychological comorbidities. However, the relationship between mood disorders and neuropathic pain is unclear, as well as the underlying mechanisms related to these disorders. Therefore, we investigated if nerve injury induces depression, anxiety, and cognitive impairment and if there were changes in cytokines, growth factors, and glial cell activation in cortical sites involved in processing pain and mood in animals with nerve injury. Nerve injury was induced by partial sciatic nerve ligation (PSNL) in male Swiss mice and compared to sham-operated animals. Nociceptive behavioral tests to mechanical and thermal (heat and cold) stimuli confirmed the development of hyperalgesia. We further examined mood disorders and memory behaviors. We show nerve injury induces a decrease in mechanical withdrawal thresholds and thermal latency to heat and cold. We also show that nerve injury causes depressive-like and anxiety-like behaviors as well as impairment in short-term memory in mice. There were increases in proinflammatory cytokines as well as Brain-Derived Neurotrophic Factor (BDNF) in the injured nerve. In the spinal cord, there were increases in both pro and anti-inflammatory cytokines, as well as of BDNF and Nerve Growth Factor (NGF). Further, in our data was a decrease in the density of microglia and astrocytes in the hippocampus and increased microglial density in the prefrontal cortex, areas associated with neuropathic pain conditions.