The Midfoot Joint Complex (Foot Arch) Contributes to the Upper Body Position in Bipedal Walking and Coordinates With the Lower Limb Joints.

This study estimated the contribution of the midfoot joint complex (MJC) kinematics to the pelvis anterior-posterior positions during the stance phase of walking and investigated whether the MJC is functionally coordinated with the lower limb joints to maintain similar pelvic positions across steps. Hip, knee, ankle, and MJC sagittal angles were measured in 11 nondisabled participants during walking. The joints' contributions to pelvic positions were computed through equations derived from a link-segment model. Functional coordination across steps was identified when the MJC contribution to pelvic position varied and the summed contributions of other joints varied in the opposite direction (strong negative covariations [r ≤ -.7] in stance phase instants). We observed that the MJC plantarflexion (arch raising) during the midstance and late stance leads the pelvis backward, avoiding excessive forward displacement. The MJC was the second joint that contributed most to the pelvis positions (around 18% of all joints' contributions), after the ankle joint. The MJC and ankle were the joints that were most frequently coordinated with the other joints (≅70% of the stance phase duration). The findings suggest that the MJC is part of the kinematic chain that determines pelvis positions during walking and is functionally coordinated with the lower limb joints.

Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management.

BACKGROUND: The biomedical understanding of chronic musculoskeletal pain endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. Although the biopsychosocial approach is an important advancement, it has a limited theoretical foundation. As such, it tends to be misinterpreted in manners that lead to artificial boundaries between the biological, psychological, and social, with fragmented and polarized clinical applications. OBJECTIVE: We present an ecological-enactive approach to complement the biopsychosocial model. In this approach, the disabling aspect of chronic pain is characterized as an embodied, embedded, and enactive process of experiencing a closed-off field of affordances (i.e., shutting down of action possibilities). Pain is considered as a multi-dimensional, multicausal, and dynamic process, not locatable in any of the biopsychosocial component domains. Based on a person-centered reasoning approach and a dispositional view of causation, we present tools to reason about complex clinical problems in face of uncertainty and the absence of 'root causes' for pain. Interventions to open up the field of affordances include building ability and confidence, encouraging movement variability, carefully controlling contextual factors, and changing perceptions through action according to each patient's self-identified goals. A clinical case illustrates how reasoning based on an ecological-enactive approach leads to an expanded, multi-pronged, affordance-based intervention. CONCLUSIONS: The ecological-enactive perspective can provide an overarching conceptual and practical framework for clinical practice, guiding and constraining clinicians to choose, combine, and integrate tools that are consistent with each other and with a true biopsychosocial approach.

Conceptions of disability among physiotherapists: an exploratory qualitative study.

INTRODUCTION: Physiotherapists' (PTs) assumptions about disability, for the most part unrecognized and unquestioned, may or may not be aligned with the vision of the International Classification of Functioning, Disability, and Health (ICF). They can influence a wide range of PT practices and impact the lives of patients. OBJECTIVE: To investigate whether PTs at different stages of their training rely on medical, social, or biopsychosocial conceptions of disability in line with the International Classification of Functioning, Disability and Health (ICF). METHODS: A qualitative study with three focus groups: 1) PT students at the beginning; and 2) at the end of their training; and 3) PTs active in several different clinical fields. Content analysis was used identify definitions, causes, judgments, and solutions to disability. RESULTS: Some clinicians and senior students expressed views of functioning and disability as interactive, situational, continuous, and ubiquitous features of the human condition. However, in all groups there was a strong predominance of medical definitions and causal attributions for disability, some fitting the tripartite linear causal logic from impairment to subnormal performance to social disadvantage. Most of moral judgments were negative and associated disability with a 'diminished state,' personal loss, and suffering. Surprisingly, most solutions to disability-related problems were of a social or interactionist character, including vigilance against ableism. CONCLUSIONS: Results revealed paradoxical conceptions and point to challenges of ensuring a deeper understanding of non-medical framings, to avoid an uncritical adoption of the ICF that may neutralize its potential to challenge culturally entrenched medical conceptions of disability.

Measuring subjective aspects of participation in adults with disabilities: A systematic review of the coverage, content validity and internal structure of standardised instruments.

OBJECTIVE: To systematically review evidence on the coverage, content validity and internal structure of self-report measures capturing subjective aspects of participation for adults with disabilities. DATA SOURCES: EMBASE, MEDLINE and reference lists were searched until July 10th, 2022 for articles on measurement properties of instruments measuring participation as defined in the International Classification of Functioning, Disability and Health, from a subjective perspective. METHOD: Each instrument was assessed for its coverage of subjective aspects of participation. The Consensus-based Standards for the Selection of Health Measurement Instruments were used to assess the quality of each study. Content validity and internal structure (structural validity, internal consistency and cross-cultural validity) were rated against published standards and qualified by the adapted Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Thirty-eight studies regarding 10 instruments were analysed. Most instruments mix activity and participation items. Only the Measure of Experiential Aspects of Participation (with high-quality evidence of sufficient structural validity and generally sufficient internal consistency), the Participation Enfranchisement and the Community Integration Measure showed adequate coverage. For all instruments, evidence of content validity is of low- to very low quality. There is high-quality evidence that the Participation Scale is not unidimensional. CONCLUSION: In general, the coverage and the evidence for content validity and internal structure of measures capturing experiential aspects of participation are limited. The Measure of Experiential Aspects of Participation has the best level of evidence in support of its use. The score of the Participation Scale cannot be considered an adequate reflection of participation.

Por que as ocupações "femininas pagam menos? Um estudo longitudinal / Why do "female" occupations pay less? A longitudinal study / ¿Por qué las ocupaciones «femeninas¼ tienen salarios más bajos? Un estudio longitudinal

Resumo Nas últimas décadas, a taxa de participação feminina na força de trabalho cresceu de maneira expressiva no Brasil, passando de 18,5% em 1970 para 48,9% em 2010. Apesar disso, a segregação ocupacional por sexo persiste e pode ser um fator determinante para explicar a diferença salarial em desfavor das mulheres no país. Nesse sentido, o objetivo do presente trabalho é compreender porque as ocupações femininas pagam menos. A fim de testar a teoria sociológica da desvalorização do trabalho feminino, avalia-se o impacto da transição entre ocupações distintas quanto à composição por sexo no rendimento dos trabalhadores. Para isso, são utilizados os microdados longitudinais de divulgação trimestral das edições de 2012 a 2019 da PNAD Contínua (IBGE) em um modelo de painel de efeitos fixos. A tipologia de integração ocupacional proposta por Oliveira (2001) é adotada para classificar as ocupações em predominantemente femininas, predominantemente masculinas ou integradas. Os resultados mostram que o trabalhador experimenta queda no rendimento quando transita para uma ocupação feminina, de modo que a hipótese da desvalorização é suportada. Observa-se, ainda, que os maiores rendimentos são recebidos nas ocupações integradas, indicando que a relação entre a composição ocupacional por sexo e os rendimentos é não linear.

Abstract During the last decades, female participation in the labor force has increased significantly in Brazil, going from 18.5% in 1970 to 48.9% in 2010. Despite this, occupational gender segregation persists and may be determinant to explain the gender pay gap. This study aims to understand why female occupations have lower pay. In order to test the sociological theory of female work devaluation we evaluate the impact of the transition between different occupations regarding the sex composition on the salary of workers in the Brazilian labor market. To that end, we use a model with fixed effects with microdata from the 2012-2019 editions of the PNAD Contínua (IBGE). The typology of occupational integration proposed by Oliveira (2001) is adopted to classify occupations as predominantly female, predominantly male, or integrated. Results show that workers experience a decrease in wages when moving to a female occupation, hence supporting the devaluation theory. Also, the highest salaries are observed in integrated occupations, indicating that the relationship between occupational sex composition and pay is a non-linear one.

Resumen En las últimas décadas, la tasa de participación femenina en la fuerza de trabajo creció significativamente en Brasil, del 18,5 % en 1970 al 48,9 % en 2010. A pesar de esto, la segregación ocupacional por sexo persiste y puede ser un factor determinante para explicar la brecha salarial que desfavorece a las mujeres en el país. En este sentido, el objetivo de este trabajo es comprender por qué las ocupaciones femeninas tienen salarios más bajos. Con el fin de probar la teoría sociológica de la desvalorización del trabajo femenino, se evalúa el impacto de la transición entre distintas ocupaciones en cuanto a la composición por sexo sobre los salarios de los trabajadores. Para eso, se utilizan microdatos longitudinales de divulgación trimestral de las ediciones entre 2012 y 2019 de la PNAD continua (IBGE) en un modelo de panel de efectos fijos. Se adopta la tipología de integración ocupacional propuesta por Oliveira (2001) para clasificar las ocupaciones en predominantemente femeninas, predominantemente masculinas o integradas. Los resultados muestran que el trabajador sufre la caída de su salario cuando pasa a una ocupación femenina, lo que sustenta la hipótesis de la devaluación. También se observa que los salarios más altos se reciben en ocupaciones integradas, lo que indica que la relación entre la composición ocupacional por sexo y los salarios no es lineal.

Family-Centered practice in a Brazilian rehabilitation network service.

BACKGROUND: Family-centered practice (FCP) is widely accepted as a best practice in pediatric rehabilitation. However, its implementation in Brazil is incipient, and systematic documentation of the extent to which it has been achieved is not available. OBJECTIVES: To determine parents' and service providers' perceptions of family-centeredness and specific areas in need of improvement in four rehabilitation hospitals. METHODS: A total of 107 caregivers and 89 service providers responded to the Measure of Processes of Care-20 (MPOC-20) and the Measure of Processes of Care for Service providers (MPOC-SP), respectively. The MPOC questionnaires evaluate FCP from the point of view of parents and rehabilitation professionals. Domain scores within each questionnaire were compared with Kruskal-Wallis and Mann-Whitney tests. MPOC items with low scores (from 1-4 out of 7 by 33% or more of respondents) were considered to indicate weaknesses in service delivery. RESULTS: Median MPOC-20 scores varied from 5.2 (4.7, 5.8) (Providing General Information) to 7.0 (6.0, 7.0) (Enabling and Partnership). The Providing General Information scores were significantly lower than those of other domains (p <  0.003). The MPOC-SP scores varied from 4.8 (4.0, 5.8) (Providing General Information) to 6.1 (5.8, 6.6) (Treating People Respectfully). Scores for Treating People Respectfully were significantly higher (p <  0.0001) and Providing General Information scores significantly lower (p <  0.0001) than those of the other domains. Most items with high percentages of low scores were from the domain Providing General Information. CONCLUSION: Except for Providing General Information, the results indicated that services implement FCP "to a fairly great extent," comparing favorably to international data. Provision of information can be improved.

Testing a new active learning approach to advance motor learning knowledge and self-efficacy in physical therapy undergraduate education.

BACKGROUND: Motor learning (ML) science is foundational for physical therapy. However, multiple sources of evidence have indicated a science-practice gap. Clinicians report low self-efficacy with ML concepts and indicate that the lack of access to systematic training is a barrier for practical implementation. The general goal of this preliminary study was to describe the effects of a new educational intervention on physical therapy student's ML self-efficacy and knowledge. METHODS: Self-efficacy was assessed with the Physical Therapists' Perceptions of Motor Learning questionnaire. Data was acquired from third-semester students before their participation in the ML educational intervention. Reference self-efficacy data was also acquired from physical therapy professionals and first and last-semester students. The educational intervention for third-semester students was designed around an established framework to apply ML principles to rehabilitation. A direct experience, the "Learning by Doing" approach, in which students had to choose a motor skill to acquire over 10 weeks, provided the opportunity to apply ML theory to practice in a personally meaningful way. After the intervention self-efficacy was re-tested. ML knowledge was tested with an objective final exam. Content analysis of coursework material was used to determine how students comprehended ML theory and related it to their practical experience. The Kruskal-Wallis and Mann-Whitney U tests were used to compare self-efficacy scores between the four groups. Changes in self-efficacy after the educational intervention were analyzed with the Wilcoxon test. Spearman rank correlation analysis was used to test the association between self-efficacy and final exam grades. RESULTS: By the end of the intervention, students' self-efficacy had significantly increased (p < 0.03), was higher than that of senior students (p < 0.00) and experienced professionals (p < 0.00) and correlated with performance on an objective knowledge test (p < 0.03). Content analysis revealed that students learned to apply the elements of ML-based interventions present in the scientific literature to a real-life, structured ML program tailored to personal objectives. CONCLUSIONS: Positive improvements were observed after the intervention. These results need confirmation with a controlled study. Because self-efficacy mediates the clinical application of knowledge and skills, systematic, active training in ML may help reduce the science-practice gap.

Attention Focus Does Not Influence Performance of Sit-to-Stand in Young and Older Adults.

An external focus of attention can improve performance, but there is little research on effects for the elderly in every day, well-learned mobility tasks. 57 older and 59 young adults performed the sit-to-stand and stand-to-sit while holding a cup, at three difficulty levels (cup empty or full, at normal or fast speed). Half were instructed to focus internally (on their movements) and half externally (on the cup). The effects of focus, age, and difficulty level were tested for movement time, mean inclination of the cup, inclination variability, and smoothness with 2 × 2 × 3 ANOVAs. Significant effects of difficulty were consistent across variables (p < 0.05). An effect of focus was present only for the inclination variability of the stand-to-sit (p < 0.03), favoring an internal focus (less variability). The age × focus interaction was significant for mean cup inclination, but post hoc tests failed to reveal any significant differences. The results of this study, together with the literature, suggest that an external focus may not benefit the performance of young or older adults in general mobility activities of daily living. The prevalent assumption that an external focus is always beneficial for performance needs further empirical testing.

Stress, anxiety, self-efficacy, and the meanings that physical therapy students attribute to their experience with an objective structured clinical examination.

BACKGROUND: Excessive stress and anxiety can impair learning. The objective structured clinical examination (OSCE) is a valuable tool to assess and promote the acquisition of clinical skills. However, significant OSCE-related stress and anxiety are frequently reported. The aim of this study was to investigate the relationships between physiological stress, self-reported levels of anxiety due to an OSCE, self-efficacy, and the meanings that physical therapy students attribute to their experience with the exam. DESIGN: Concurrent mixed methods study. METHODS: A total of 32 students took part in this study. All were enrolled in the third semester of a 10-semester Physical Therapy Bachelor Program. Salivary cortisol levels, self-reported anxiety (State-Trait Anxiety Inventory, STAI) were measured before the OSCE. Exam scores and self-efficacy ratings were also recorded. Correlations between variables were tested with the Pearson correlation, with ɑ at 0.05. Semi-structured interviews were used to explore the personal perspectives of students. Thematic analysis was used to investigate emergent themes. RESULTS: Trait anxiety scores were significantly higher than normative values (p < 0.001). A high proportion of students showed high (STAI> 49) state anxiety (37.5%) and trait anxiety (65.6%). Salivary cortisol was not associated anxiety (p > 0.05). Neither stress nor anxiety correlated with OSCE scores. A moderate and significant direct correlation was found for self-efficacy scores and OSCE scores (r = 0.475, p = 0.007). Students reported that confidence had a calming effect and led to better self-perceived performance. They also reported that the OSCE can provide meaningful learning experiences despite being stressful. CONCLUSIONS: A high proportion of our students reported a stable/lingering negative affect. However, neither stress nor anxiety related to OSCE scores. Students' confidence in their capabilities was correlated with their performance. Their subjective reports suggest that self-confidence may have protected them from the negative effects of stress and anxiety on academic performance.

Background familiar, retornos da educação e desigualdade racial no brasil / Background familiar, retornos de la educación y desigualdad racial en brasil / Contexte familial, taux de rendement de léducation et inégalité raciale au brésil / Family background, returns to education and racial inequality in brazil

Resumo Este trabalho analisa o efeito do background familiar sobre os rendimentos do trabalho e sobre os retornos da escolaridade no Brasil, comparando os resultados obtidos por brancos e negros. São estimadas equações de rendimento com dados de 1996 e 2014 da Pesquisa Nacional por Amostra de Domicílios (Pnad/IBGE), adotando- -se a escolaridade dos pais do trabalhador como proxy de seu background familiar. Os resultados mostram que ter um diploma universitário tem efeito pronunciado sobre os rendimentos, porém em menor magnitude para os negros. Entre 1996 e 2014, apesar de ter ocorrido uma diminuição do efeito diploma, bem como do diferencial salarial entre brancos e negros, não houve redução da importância do background familiar para o desempenho dos indivíduos no mercado de trabalho.

Resumen Este artículo analiza el efecto del background familiar sobre los ingresos laborales y las tasas de rendimiento de la escolaridad en Brasil, comparando los resultados obtenidos por blancos y negros. Se calculan ecuaciones de salarios con datos de 1996 y 2014 de la Pesquisa Nacional por Amostra de Domicílios (Pnad/IBGE), adoptándose la escolaridad de los padres del trabajador como proxy de su contexto familiar. Se verificó que el hecho de poseer un diploma universitario ocasiona efectos pronunciados sobre la remuneración, pero con menor magnitud en el caso de los negros. Entre 1996 y 2014, a pesar de observarse la disminución del efecto diploma, así como la diferencia salarial entre blancos y negros, no hubo reducción de la importancia del background familiar para el desempeño de los individuos en el mercado laboral.

Résumé Cet article examine l'effet du contexte familial sur les revenus de travail et sur le aux rendement de l'éducation au Brésil, dans la comparaison des résultats des travailleurs noirs et blancs. À cette fin, des équations de revenus sont estimées a partir des données de la Pesquisa Nacional por Amostra de Domicílios (Pnad/IBGE). La scolarisation des parents est utilisée comme proxy du contexte familial. Les résultats montrent que le diplôme universitaire augmente substantiellement les rémunérations, bien que de façon moins prononcée chez les travailleurs noirs. Entre 1996 et 2014, malgré la chute dans l'effet diplôme ainsi que dans l'écart de salaires entre blancs et noirs, l'importance du contexte familial sur la performance des individus au marché du travail n'a pas décliné.

Abstract This paper analyzes the effect of family background on earnings from labor and on returns to education in Brazil, comparing results from white and black workers. We estimate earnings equations using cross-sectional data from the 1996 and 2014 National Household Sample Survey (Pnad/IBGE); parents' education is used as a proxy for family background. Our findings show that having a university degree significantly increases labor earnings, but less so for the blacks. Although the diploma effect and the racial wage gap decreased over the 1996-2014 period, there was no decrease in the influence of family background on individuals' performance in the job market.

Brazilian versions of the Measure of Processes of Care-20 and Measure of Processes of Care-Service Providers: translation, cross-cultural adaptation and reliability.

BACKGROUND: The Measure of Processes of Care (MPOC) questionnaires evaluate Family-Centered Practice (FCP) in services for children with developmental disorders. The MPOC-20 and MPOC-SP are completed by parents and by rehabilitation professionals, respectively, and are widely used in several countries. OBJECTIVES: To translate and cross-culturally adapt the MPOC-20 and MPOC-SP to Brazilian Portuguese and evaluate their reliability and internal consistency. METHODS: this study included translation, back-translation, cognitive interviews, testing of the pre-final versions, analysis of reliability and of internal consistency of the final versions. Respondents included parents and rehabilitation professionals from rehabilitation centers in four capital cities in Brazil. RESULTS: Translation and cultural-adaptation procedures ensured the Brazilian versions were understandable and semantically equivalent to the original MPOC-20 and MPOC-SP. Pre-final and final versions were analyzed and vetted by the original authors. The MPOC-20 internal consistency Cronbach's alpha varied between 0.61 and 0.91 (n=107), the test-retest reliability ICC varied between 0.44 and 0.83 and the standard error of measurement varied between 0.66 and 0.85 (n=50). The MPOC-SP internal consistency Cronbach's alpha varied between 0.52 and 0.83 (n=92), the test-retest reliability ICC between 0.83 and 0.90, and the standard error of measure between 0.34 and 0.46 (n=62). CONCLUSION: The Brazilian versions of the MPOC-20 and the MPOC-SP are in general stable and sufficiently reliable. They are relevant to the evaluation of FCP and provide information that can improve health services and ensure better care.

Segregação ocupacional por sexo no mercado de trabalho brasileiro: uma análise de decomposição para o período 2004-2015 / Occupational gender segregation in the Brazilian labor market: a decomposition analysis for the period 2004-2015 / Segregación ocupacional por sexo en el mercado laboral brasileño: un análisis de descomposición para el período 2004-2015

Este artigo analisa a evolução da segregação ocupacional por sexo no mercado de trabalho brasileiro de 2004 a 2015. Além da mensuração da segregação por meio de indicadores tradicionais, como o índice de dissimilaridade e o de Gini, utiliza-se a classe de medidas aditivamente decomponíveis proposta por Hutchens (2004), que permite decompor a segregação em duas parcelas: uma relacionada à segregação entre grandes grupos ocupacionais; e outra que corresponde a uma soma ponderada dos níveis de segregação dentro desses grupamentos. Os resultados mostram que a segregação aumentou entre 2004 e 2015, revertendo a tendência de queda que vinha sendo relatada na literatura referente a anos anteriores a esse período. A análise de decomposição indica que tal crescimento foi impulsionado pela segregação entre os grandes grupos ocupacionais, portanto, entre grupos com ocupações mais heterogêneas entre si. Conclui-se que, à medida que o nível da participação feminina no mercado de trabalho se estabiliza, o processo de integração das ocupações segundo o sexo também apresenta seus primeiros sinais de esgotamento.

This article analyzes the evolution of occupational gender segregation in the Brazilian labor market from 2004 to 2015. Segregation is measured with traditional indicators, such as the dissimilarity and Gini indices, and also using the set of additively decomposable measures proposed by Hutchens (2004), which allows to separate segregation into two parts: one referring to segregation between large occupational groups (1-digit occupational classification), and the other one corresponding to a weighted sum of segregation levels within these groups. Our findings indicate that segregation increased between 2004 and 2015, reversing the downward trend reported in the literature for the period before 2004. The decomposition analysis indicates that this increase has been mainly driven by segregation among broadly defined occupational groups, i.e., across groups entailing very different tasks. We conclude that, as the female labor force participation rate stabilizes, the integration of occupations according to sex may have reached its limit.

Este artículo analiza la evolución de la segregación ocupacional por sexo en el mercado laboral brasileño entre 2004 y 2015. La segregación se mide con indicadores tradicionales como los índices de disimilitud y de Gini, y también utilizando la clase de medidas aditivamente descomponibles propuestas por Hutchens (2004), que permiten separar la segregación en dos partes: una que refiere a la segregación entre grandes grupos ocupacionales (clasificación ocupacional de un dígito) y otra que corresponde a una suma ponderada de los niveles de segregación dentro de estos grupos. Los resultados indican que la segregación aumentó entre 2004 y 2015, revirtiendo la tendencia a la baja reportada en la literatura para el período anterior a 2004. El análisis de descomposición indica que este aumento ha sido impulsado principalmente por la segregación medida entre los grandes grupos ocupacionales, es decir, entre grupos que agregan tareas muy distintas. Concluimos que, a medida que la tasa de participación femenina en la fuerza laboral se estabiliza, la integración de ocupaciones según sexo puede haber alcanzado su límite.

Physical Therapist Education and the Labor Market in Brazil: Advances and Challenges.

BACKGROUND: In Brazil, the number of physical therapy education programs and, consequently, of professionals has been growing for the past 20 years. OBJECTIVES: The objective of the study was to describe the evolution and distribution of physical therapist education programs in Brazil and to analyze the impact of workforce growth on the labor market for these professionals. DESIGN: This was a descriptive, exploratory, quantitative study. METHODS: Secondary data collected from official sources in Brazil were used. RESULTS: The first physical therapist education program was created in 1958, and, after significant growth, 536 programs were active in 2014. The historical series (1996-2014) shows a corresponding increase in the number of admissions by higher educational institutions. This expansion resulted in an increase in the number of professionals, with an impact on the labor market. The workforce in physical therapy is predominantly female, and women increased their participation in this labor market from 59% in 1996 to 81% in 2014. An increase in nominal monthly salaries was observed over the years from US $797.00 in 1996 to US $1056.00 in 2014. Nevertheless, the real average salaries, that is, salaries adjusted to inflation, have followed a trend of devaluation. LIMITATIONS: Results of this study must be interpreted in terms of overall trends rather than as precise absolute numbers due to the inherent nature of the varied secondary data sources. CONCLUSIONS: These data can support further discussion on training and the labor market in the field of physical therapy.

Mechanisms contributing to gait speed and metabolic cost in children with unilateral cerebral palsy.

BACKGROUND: Gait speed and metabolic cost are indicators of functional capacity in children with cerebral palsy. Uncovering their mechanisms helps guide therapeutic actions. OBJECTIVES: To investigate the contributions of energy-generating and energy-conserving mechanisms to gait speed and metabolic cost of children with unilateral cerebral palsy. METHODS: Data on eccentric and concentric muscle work, co-contraction, elastic torque and vertical stiffness of the affected-limb, forcing torque of the non-affected limb, gait speed and metabolic cost were collected from 14 children with unilateral cerebral palsy, aged 6-12 years. Analyses included two groups of multiple regression models. The first group of models tested the association between each dependent variable (i.e., speed and metabolic cost) and the independent variables that met the input criteria. The second group verified the contribution of the non-selected biomechanical variables on the predictors of the first model. RESULTS: Gait speed (R2=0.80) was predicted by elastic torque (ß=0.62; 95%CI: 0.60, 0.63), vertical stiffness (ß=-0.477; 95%CI: -0.479, -0.474) and knee co-contraction (ß=0.27; 95%CI: -1.96, 2.49). The production of eccentric work by the affected limb proved relevant in adjusting the vertical stiffness (R2=0.42; ß=-0.64; 95%CI: 0.86, -0.42); elastic torque of the affected-leg was associated with impulsive torque of the non-affected leg (R2=0.31; ß=0.55; 95%CI: 0.46, 0.64). Metabolic cost of gait (R2=0.48) was partially predicted by knee co-contraction (ß=0.69; 95%CI: 0.685, 0.694). CONCLUSIONS: The chain of associations revealed by the two steps models helped uncover the mechanisms involved in the locomotion of children with unilateral cerebral palsy. Intervention that changes specific energy conserving and generating mechanisms may improve gait of these children.

Motor synergies research in physical therapy: advantages of the uncontrolled manifold approach / Pesquisa de sinergias motoras em fisioterapia: vantagens da abordagem da variedade não controlada / Estudio de sinergias motoras en fisioterapia: ventajas del enfoque múltiple no controlado

ABSTRACT Movement is central to physical therapy identity and practice. Advances in the science of movement control, motor learning and development are thus inextricably tied to professional development and clinical activity. This paper aims to describe a prominent approach to motor control with potential to greatly advance the understanding of movement dysfunction: the uncontrolled manifold (UCM). An argument is formulated for incorporating this method of data analysis in rehabilitation research. It is a narrative review of the relevant literature. Research in physical therapy could greatly benefit from investigating synergies with the theory and methods of UCM. Research should seek connections between functioning in daily life tasks and the assembling of synergies to stabilize different performance variables, the UCM variability measures, the synergy strength indexes, and the anticipatory synergy adjustments. Changes in these synergy variables should also be quantified after rehabilitation interventions. UCM can offer one solid science-based approach to inform clinical decisions on whether synergies have to be broken, rebalanced, created, or reinforced in patients with movement dysfunction.

RESUMO O movimento humano é fundamental para a identidade e prática profissional da Fisioterapia. Avanços nas ciências do controle, aprendizagem e desenvolvimento motor são portanto inseparáveis do desenvolvimento da profissão e da atividade clínica. Este trabalho descreve uma abordagem importante de controle motor com grande potencial de contribuição para a investigação de disfunções de movimento: a abordagem da variedade não controlada (UCM). Argumentos para a incorporação dos métodos de investigação da UCM na pesquisa em reabilitação é apresentado. Trata-se de uma revisão narrativa da literatura relacionada. A pesquisa na Fisioterapia pode se beneficiar bastante da investigação de sinergias com a teoria e os métodos de análise de dados da UCM. A pesquisa deve investigar conexões entre atividades de vida diária e a formação de sinergias motoras para estabilizar diferentes variáveis de desempenho, assim como a distribuição de variabilidade das sinergias, sua força e seus ajustes antecipatórios. Mudanças nesses quantificadores de sinergias também devem ser investigadas após intervenções de reabilitação. A UCM é uma abordagem científica sólida para informar decisões clínicas sobre a necessidade de desfazer, reequilibrar, criar ou reforçar sinergias motoras dos pacientes com disfunção de movimento.

RESUMEN El movimiento del ser humano es esencial a la identidad y práctica profesional en Fisioterapia. Los avances en las ciencias de control, del aprendizaje y del desarrollo motor son inseparables del desarrollo profesional y práctica clínica. En este estudio se intenta describir un importante abordaje de control motor que puede contribuir a los estudios sobre los trastornos del movimiento: el enfoque múltiple no controlado (UCM). Se presentan argumentos para incorporar a los métodos de estudios de la UCM en rehabilitación. Se trata de una revisión sistemática de literatura. Las investigaciones en Fisioterapia se pueden favorecer del estudio de sinergias con la teoría y los métodos de análisis de datos del UCM. Se estudian las conexiones entre las actividades de la vida diaria y la formación de sinergias motoras para estabilizar los distintos niveles de rendimiento, así como la distribución de la variabilidad de las sinergias, su fuerza y sus ajustes de anticipación. Tras las intervenciones en la rehabilitación también se deben estudiar cambios en los valores de las sinergias. El UCM es un sólido abordaje científico para informar sobre decisiones clínicas a cerca de la necesidad de deshacer, reequilibrarse, crear o fortalecer las sinergias motoras de los pacientes con trastornos de movimiento.

Effects of kinesiology taping in children with cerebral palsy: a systematic review / Os efeitos do Kinesiotaping em crianças com Paralisia Cerebral: Uma revisão sistemática

Abstract Introduction: Cerebral Palsy is a group of non-progressive movement and posture disorders. There are many rehabilitation methods for children and adolescents with these disorders. Kinesiology Taping(KT) is becoming a popular as an option of rehabilitation method for these children. Objective: The aim of this systematic review is to summarize evidence regarding the methods of Kinesiology Taping use in children and adolescents with Cerebral Palsy and its effects. Materials: A search of scientific papers in the databases Medline, Scielo and PEDro was conducted with no data or language restriction. For this search the keywords "Kinesio taping", "Kinesiology Taping", "Taping", and "Bandages" combined with "Cerebral Palsy" were used. The search was conducted between May of 2015 and November of 2016. Results: Eleven studies were included in the review, six were randomized controlled clinical trials, four were quasi-experimental studies, and one was a case study. In general, the studies followed the guidelines proposed by the Kinesiology Taping creator; they used corrective techniques and muscle contraction facilitation/inhibition techniques. Results varied according to techniques used and outcomes chosen. Conclusion: There is strong to insufficient evidence of KT effects in motor function related outcomes. Stronger quality level studies are necessary to support use of KT in clinical practice.

Resumo Introdução: A Paralisia Cerebral é definida como um grupo de distúrbios não progressivos de movimento e de postura. Existem diferentes métodos de reabilitação para crianças e adolescentes com Paralisia Cerebral. Dentre eles, o uso do Kinesio Taping vem se tornando comum. Objetivo: O objetivo da presente revisão sistemática é sumarizar evidências relativas a métodos de aplicação do Kinesio Taping e seus efeitos em crianças e adolescentes com Paralisia Cerebral. Métodos: Foi realizada uma busca da literatura científica nas bases de dados Medline, Scielo e PEDro sem restrição de idioma. Para esta pesquisa foram utilizadas as palavras-chave "Kinesio taping", "Kinesiology Taping", "Taping" e "Bandages" combinadas à "Cerebral Palsy". A busca aconteceu entre Maio de 2015 a Novembro de 2016. Resultados: Foram selecionados onze estudos, sendo seis ensaios clínicos controlados e aleatorizados, quatro ensaios clínicos não controlados e um estudo de caso. Os estudos no geral seguem os modelos de aplicação do taping propostos pelo criador da técnica, utilizando técnicas corretivas e técnicas de facilitação/inibição da contração muscular. Há pobre evidência de efeitos e estes variam com os métodos de aplicação utilizados e os desfechos escolhidos. Conclusão: Há evidência forte a insuficiente quanto aos efeitos do KT desfechos relacionados às funções motoras. São necessários estudos com maior qualidade metodológica para justificar o uso do KT na prática clínica.

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy.

BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis. OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP). METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact. CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy

BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis.OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP).METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively.RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact.CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

Fortalecimento muscular em adolescentes com paralisia cerebral: avaliação de dois protocolos em desenho experimental de caso único / Muscle strengthening in adolescents with cerebral palsy: an evaluation of two singlecase experimental design protocols

Descrever mudanças na função motora de dois adolescentes com diplegia espástica, sendo um deles participante de um protocolo de fortalecimento muscular isolado (FMI) e o outro de protocolo de fortalecimento com tarefas funcionais (FTF). Métodos: desenho experimental de caso único, metodologia que revela a temporalidade do perfil de mudanças ao longo e após a terapia. Este desenho incluiu fases de baseline, de intervenção e de followup com quatro, seis e três semanas, respectivamente. Participantes foram duas adolescentes com displegia espástica submetidas, cada uma, a um protocolo de intervenção: fortalecimento muscular isolado (FMI) ou fortalecimento com tarefas funcionais (FTF). Os protocolos de intervenção incluíram exercícios de fortalecimento muscular isolado de extensores de quadril, extensores de joelho e flexores plantares (para a participante do FMI), ou de exercícios funcionais para as mesmas musculaturas (para a participante do FTF). Mensurações três vezes por semana avaliaram força muscular, velocidade de marcha, tempo para subir e descer escadas, tempo para se levantar do chão e tempo no teste Timed Get Up and Go. Os dados foram analisados com Celeration Line, Amplitude de Dois Desvios Padrão e Análise Visual. Resultados: ganhos de força muscular de membros inferiores foram observados nas adolescentes submetidas a ambos os protocolos. Mudanças nas atividades motoras foram observadas em 2 das 4 tarefas testadas em somente uma das adolescentes (p<0,05). Conclusões: a especificidade funcional do protocolo de fortalecimento FTF produziu modestos efeitos no desempenho de atividades motoras de uma das adolescentes com PC, em acréscimo aos ganhos de força muscular produzidos por ambos os protocolos...

To describe changes in the motor function of two adolescents with spastic diplegia, one of them participating in a muscle strengthening in isolation (MSI) protocol, the other in a functional tasks strengthening (FTS) protocol. Methods: a single case experimental design is a method that reveals the pattern of changes over time during and after therapy. The design included baseline, intervention and four- six- and three-week follow-up phases. The participants were two adolescents with spastic diplegia, each undergoing an intervention protocol: muscle strengthening in isolation (MSI) or functional tasks strengthening (FTS). The intervention protocols included isolated muscle strengthening of the hip and knee extensors and plantar flexors (for the MSI participant), or functional exercises for the same musculatures (for the FTS participant). Weekly measurements were taken of muscle strength, walking speed, time taken to walk up and down stairs, time taken to get up off the floor and time on the Timed Get Up and Go test. The data were analyzed using Celeration Line, Two Standard Deviation Amplitude and Visual Analysis. Results: gains in muscle strength in the lower limbs were observed in both adolescents. Changes in motor activity were observed in two of the four tasks tested in only one of the adolescents (p<0.05). Conclusions: The functional specificity of the FTS protocol produced modest effects on performance of motor activities in one of the adolescents with CP, in addition to the gains in muscle strength produced by both protocols...

Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation, cross-cultural adaptation and reliability.

BACKGROUND: Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities. OBJECTIVES: To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF). METHOD: The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR) was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP). The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC), through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart. Results : During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC ≥ 0.92) for test-retest. CONCLUSION: The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP.