Reliability and Acceptability to Caregivers of Telehealth Administration of the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) for Brazilian Youth with Down Syndrome.

Purpose: To estimate test-retest reliability of the two versions of the PEDI-CAT administered via telehealth to caregivers of Brazilian young people with DS, to compare scores on the two versions, and to determine caregiver acceptance of telehealth administration of the assessment. Method: A methodological study approved by the research ethics committee. Data collection was performed online, with a mean duration of 45.0 minutes for the content-balanced version of the PEDI-CAT and 17.5 minutes for the speedy version. Results: In total, 28 caregivers of individuals with DS up to age 21 years participated (mean = 5.9 years; SD = 4.9 years). Intra-class correlation coefficients for the four domains of the PEDI-CAT content-balanced version and four domains of the PEDI-CAT speedy version ranged from 0.77 to 0.97. There was a statistical difference between the versions in the scores of the social-cognitive domain (p < 0.05). A mean of 105 items (SD = 21) was administered in the content-balanced version and a mean of 51 items (SD = 8) in the speedy version. All the caregivers found the method of administration of the PEDI-CAT acceptable. Conclusions: This study demonstrated that either version of the Brazilian version of the PEDI-CAT can be used by telehealth in clinical practice to assess children, adolescents, and young adults with DS.

Objectif: évaluer la fiabilité test-retest de deux versions du rapport PEDI-CAT utilisé lors de services de télésanté auprès de proches de jeunes brésiliens ayant le syndrome de Down (SD) afin de comparer les scores des deux versions, et déterminer l'acceptation des proches à procéder à cette évaluation par services de télésanté. Méthodologie: étude méthodologique approuvée par le comité d'éthique de la recherche. La collecte des données a été effectuée en ligne et a duré en moyenne 45,0 minutes pour ce qui est de la version au contenu équilibrée du rapport PEDI-CAT et 17,5 minutes pour ce qui est de la version abrégée. Résultats: Au total, 28 proches de personnes de 21 ans ou moins ayant le SD ont participé (moyenne = 5,9 ans; ÉT = 4,9 ans). Le coefficient de corrélation intraclasse des quatre domaines de la version au contenu équilibré du rapport PEDI-CAT et des quatre domaines de la version abrégée du rapport PEDI-CAT se situait entre 0,77 et 0,97. Le score des deux versions comportait une différence statistique dans le domaine sociocognitif (p < 0,05). En moyenne, 105 points (ÉT = 21) ont été évalués dans la version au contenu équilibré, et 51 (ÉT = 8) dans la version abrégée. Tous les proches ont trouvé la méthode d'utilisation du rapport PEDI-CAT acceptable. Conclusions: la présente étude démontre que les deux versions du rapport PEDI-CAT brésilien peuvent être utilisées lors de services de télésanté en pratique clinique pour évaluer les enfants, les adolescents et les jeunes adultes ayant le SD.

Translation and measurement properties of the Portuguese-Brazil version of the Hammersmith Infant Neurological Examination (HINE-Br).

OBJECTIVE: The current study aimed to translate the Hammersmith Infant Neurological Examination (HINE) into Brazilian Portuguese and analyze the reliability of the translated version for a population of Brazilian infants. METHODS: This was a methodological study, approved by the Ethics Committee, carried out between June 2020 and May 2021. HINE is a standardized clinical neurological examination used for the early detection of cerebral palsy. The quantitative section, "neurological examination", contains 26 items scored from 0 to 3 points, divided into five categories: cranial nerve function, posture, movements, muscle tone and reflexes, and reactions. The HINE translation followed four steps: translation, synthesis, back-translation, and evaluation by an expert committee. To verify the reliability of the HINE-Br (Portuguese-Brazil version) two independent examiners evaluated 43 infants, between 3 and 22 months of age. Internal consistency was verified by Cronbach's Alpha coefficient and interrater reliability by the intraclass correlation coefficient (ICC). RESULTS: The translated version was similar to the original version and a few semantic and idiomatic adjustments were necessary. Appropriate internal consistency (Alpha=0.91) was found for the 26 items of the HINE-Br, as well as strong interrater reliability for the total score (ICC2.1=0.95), and also for the five categories (ICC2.1=0.83-0.95). CONCLUSIONS: The HINE-Br presents adequate rates of internal consistency and interrater reliability, and can be used for the evaluation of children at risk for cerebral palsy, between 3 and 24 months of age, by pediatricians and pediatric physical therapists.

Characterization of environmental factors in children and adolescents with cerebral palsy in Minas Gerais: Participa Minas.

OBJECTIVE: To characterize the environmental factors of children and adolescents with Cerebral Palsy (CP) in the state of Minas Gerais (MG), Brazil. METHODS: This is a cross-sectional study involving 164 caregivers of children/adolescents with CP, aged 1-14 years. The Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were used to classify the participants' functioning, and environmental factors were evaluated by an on-line questionnaire that examined products and technologies, physical environment, services, and systems. A descriptive analysis was performed using percentage and frequency. RESULTS: Most participants had bilateral CP (66.9%) and 45% of them were spastic. Levels II and V of the GMFCS and MACS were the most frequent. About half (49.4%) used anticonvulsants, 27.4% underwent botulinum toxin application, and 29% went through orthopedic surgery in the lower limbs. Among the participants, 71.3% used orthoses in the lower limbs, and 51.8% used the public health care system. Most had access to physiotherapy (91.5%), but found difficulties to access interventions with other professionals, such as psychologists (28%) and nutritionists (37.8%). The school was the most frequently adapted environment (78%), and had the highest level of structural adaptation (42.7%). CONCLUSIONS: The results of this study suggest that the barriers to access health services and barriers to the physical environment may impact participation and social inclusion.

Translation and measurement properties of the Portuguese-Brazil version of the Hammersmith Infant Neurological Examination (HINE-Br) / Tradução e propriedades de medida da versão Português-Brasil do Hammersmith Infant Neurological Examination (HINE-Br)

ABSTRACT Objective: The current study aimed to translate the Hammersmith Infant Neurological Examination (HINE) into Brazilian Portuguese and analyze the reliability of the translated version for a population of Brazilian infants. Methods: This was a methodological study, approved by the Ethics Committee, carried out between June 2020 and May 2021. HINE is a standardized clinical neurological examination used for the early detection of cerebral palsy. The quantitative section, "neurological examination", contains 26 items scored from 0 to 3 points, divided into five categories: cranial nerve function, posture, movements, muscle tone and reflexes, and reactions. The HINE translation followed four steps: translation, synthesis, back-translation, and evaluation by an expert committee. To verify the reliability of the HINE-Br (Portuguese-Brazil version) two independent examiners evaluated 43 infants, between 3 and 22 months of age. Internal consistency was verified by Cronbach's Alpha coefficient and interrater reliability by the intraclass correlation coefficient (ICC). Results: The translated version was similar to the original version and a few semantic and idiomatic adjustments were necessary. Appropriate internal consistency (Alpha=0.91) was found for the 26 items of the HINE-Br, as well as strong interrater reliability for the total score (ICC2.1=0.95), and also for the five categories (ICC2.1=0.83-0.95). Conclusions: The HINE-Br presents adequate rates of internal consistency and interrater reliability, and can be used for the evaluation of children at risk for cerebral palsy, between 3 and 24 months of age, by pediatricians and pediatric physical therapists.

RESUMO Objetivo: Traduzir o Hammersmith Infant Neurological Examination (HINE) para o português brasileiro e analisar a confiabilidade da versão traduzida em lactentes brasileiros. Métodos: Estudo metodológico, aprovado por Comitê de Ética, realizado entre junho de 2020 e maio de 2021. O HINE é um exame clínico neurológico padronizado, utilizado para detecção precoce de paralisia cerebral. A seção quantitativa, "exame neurológico", contém 26 itens pontuados de 0 a 3, divididos em 5 categorias: função dos nervos cranianos; postura; movimentos; tônus muscular e reflexos; e reações. A tradução do HINE seguiu quatro etapas: tradução; síntese; retrotradução; e avaliação por um comitê de especialistas. Dois examinadores independentes avaliaram 43 lactentes, entre 3 e 22 meses, utilizando a versão HINE-Br (versão em português brasileiro), para verificar sua confiabilidade. A consistência interna foi verificada pelo coeficiente Alpha de Cronbach e a confiabilidade interexaminadores pelo coeficiente de correlação intraclasse (CCI). Resultados: A versão traduzida foi semelhante à versão original e poucos ajustes semânticos e idiomáticos foram necessários. Encontrou-se consistência interna adequada (Apha=0,91) para os 26 itens do HINE-Br, bem como forte confiabilidade interexaminadores para o escore total (CCI2,1=0,95) e também para as cinco categorias (CCI2,1=0,83-0,95). Conclusões: O HINE-Br apresenta índices adequados de consistência interna e confiabilidade interexaminadores, podendo ser utilizada para avaliação de crianças com risco de apresentar paralisia cerebral, entre 3 e 24 meses de idade, por pediatras e fisioterapeutas infantis.

Characterization of environmental factors in children and adolescents with cerebral palsy in Minas Gerais: Participa Minas / Caracterização de fatores ambientais de crianças e adolescentes com paralisia cerebral de Minas Gerais: Participa Minas

ABSTRACT Objective: To characterize the environmental factors of children and adolescents with Cerebral Palsy (CP) in the state of Minas Gerais (MG), Brazil. Methods: This is a cross-sectional study involving 164 caregivers of children/adolescents with CP, aged 1-14 years. The Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were used to classify the participants' functioning, and environmental factors were evaluated by an on-line questionnaire that examined products and technologies, physical environment, services, and systems. A descriptive analysis was performed using percentage and frequency. Results: Most participants had bilateral CP (66.9%) and 45% of them were spastic. Levels II and V of the GMFCS and MACS were the most frequent. About half (49.4%) used anticonvulsants, 27.4% underwent botulinum toxin application, and 29% went through orthopedic surgery in the lower limbs. Among the participants, 71.3% used orthoses in the lower limbs, and 51.8% used the public health care system. Most had access to physiotherapy (91.5%), but found difficulties to access interventions with other professionals, such as psychologists (28%) and nutritionists (37.8%). The school was the most frequently adapted environment (78%), and had the highest level of structural adaptation (42.7%). Conclusions: The results of this study suggest that the barriers to access health services and barriers to the physical environment may impact participation and social inclusion.

RESUMO Objetivo: Caracterizar os fatores ambientais de crianças e adolescentes com paralisia cerebral (PC) no estado de Minas Gerais (MG), Brasil. Métodos: Trata-se de um estudo transversal envolvendo 164 cuidadores de crianças/adolescentes com PC, na faixa etária de um a 14 anos. O Sistema de Classificação da Função Motora Grossa (GMFCS) e o Sistema de Classificação da Habilidade Manual (MACS) foram utilizados para classificar a funcionalidade dos participantes e os fatores ambientais foram avaliados por um questionário on-line que abordou produtos e tecnologias, ambiente físico, serviços e sistemas. Análises descritivas foram realizadas por meio de porcentagem e frequência. Resultados: A maioria dos participantes tinha PC bilateral (66,9%) e 45% deles eram espásticos. Os níveis II e V do GMFCS e MACS foram os mais frequentes. Cerca de metade (49,4%) fazia uso de anticonvulsivantes, 27,4% realizaram aplicação de toxina botulínica e 29% cirurgia ortopédica em membros inferiores. Utilizavam órteses em membros inferiores 71,3% e eram usuários do sistema público de saúde 51,8%. A maioria tinha acesso à fisioterapia (91,5%), mas dificuldade de acesso a intervenções com outros profissionais, como psicólogos (28%) e nutricionistas (37,8%). A escola foi o ambiente mais frequentado (78%) e também mais adaptado estruturalmente (42,7%). Conclusões: Os resultados deste estudo sugerem que barreiras de acesso aos serviços de saúde e barreiras no ambiente físico podem impactar a participação e inclusão social.

Rehabilitation Practices Delivered by Physical and Occupational Therapists to Brazilian Children With Congenital Zika Syndrome: A Cross-Sectional Study.

INTRODUCTION: Congenital Zika syndrome (CZS) is a health condition that has affected the development of thousands of children in Brazil. Because it is a new condition, its understanding is an ongoing process. Therefore, it is important to know the rehabilitation interventions being delivered to improve the functioning of these children. We aimed to describe the practices of physical therapists (PTs) and occupational therapists (OTs) who provide follow-up care for children with CZS in Brazil. METHODS: This cross-sectional study included PTs and OTs who assist children with CZS in Brazil. An online questionnaire was used to verify the participants' personal characteristics and professional work environment, as well as the rehabilitation programs they implemented in Brazil for children with CZS. Data were analyzed using descriptive statistics. RESULTS: A total of 116 professionals (79 PT and 37 OT) who work mainly in public health services (81.9%) participated in the study. Of these, 24.1% plan interventions based on reading scientific articles, 66.4% did not report using the biopsychosocial model, 52.6% do not perform any assessments before starting an intervention, 31.9% use neurodevelopmental treatment, and 22.4% use sensorimotor stimulation interventions. The majority of the interventions are delivered 1 to 2 times a week, lasting up to 1 hour. CONCLUSIONS: Professional training and knowledge translation strategies are needed to implement evidence-based practices and improve the quality of rehabilitation programs for Brazilian children with CZS.

Affordances in the home environment of children at risk of developmental delay.

OBJECTIVE: The aim of this study was to verify the adequacy of affordances in the home environment of children at risk of developmental delay and to identify factors associated with their frequency. METHODS: The cross-sectional study included 97 families who responded to the Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) for 3-18 months (n=63), or AHEMD - Self-Report (AHEMD-SR) for 18-42 months (n=34). The Mann-Whitney U test was used to identify the differences between the frequencies of affordances between the groups. Multiple linear regression was used to verify the association between the child's sex, mother's marital status, education, socioeconomic level, child and mother's ages, house residents' number, per capita income, and AHEMD scores (α=0.05). RESULTS: The home affordances' frequency in the AHEMD-IS ranged from less than adequate to excellent, while in the AHEMD-SR, the highest predominance was medium. The offer of stimuli in the AHEMD-IS was significantly higher. Higher socioeconomic level and house residents' number were associated with greater affordances. CONCLUSIONS: The higher the socioeconomic level and house residents' number, the greater the affordances in the homes of children at risk of delay. It is necessary to provide families with some alternatives to make their home environments richer in affordances that favor child development.

Affordances in the home environment of children at risk of developmental delay / Oportunidades de ação no ambiente domiciliar de lactentes e crianças com risco de atraso do desenvolvimento

Abstract Objective: The aim of this study was to verify the adequacy of affordances in the home environment of children at risk of developmental delay and to identify factors associated with their frequency. Methods: The cross-sectional study included 97 families who responded to the Affordances in the Home Environment for Motor Development — Infant Scale (AHEMD-IS) for 3-18 months (n=63), or AHEMD - Self-Report (AHEMD-SR) for 18-42 months (n=34). The Mann-Whitney U test was used to identify the differences between the frequencies of affordances between the groups. Multiple linear regression was used to verify the association between the child's sex, mother's marital status, education, socioeconomic level, child and mother's ages, house residents' number, per capita income, and AHEMD scores (α=0.05). Results: The home affordances' frequency in the AHEMD-IS ranged from less than adequate to excellent, while in the AHEMD-SR, the highest predominance was medium. The offer of stimuli in the AHEMD-IS was significantly higher. Higher socioeconomic level and house residents' number were associated with greater affordances. Conclusions: The higher the socioeconomic level and house residents' number, the greater the affordances in the homes of children at risk of delay. It is necessary to provide families with some alternatives to make their home environments richer in affordances that favor child development.

RESUMO Objetivo Verificar a adequação das oportunidades de ação no ambiente doméstico de crianças em risco de atraso no desenvolvimento e identificar fatores associados à sua frequência. Métodos Este estudo transversal incluiu 97 famílias que responderam ao Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) para 3-18 meses (n=63) ou o Self Report (AHEMD-SR) para 18-42 meses (n=34). O teste de Mann-Whitney foi utilizado para identificar as diferenças entre as frequências de oportunidades de ação entre os grupos. A regressão linear múltipla foi utilizada para verificar a associação entre o sexo da criança, o estado civil, a escolaridade e nível socioeconômico da mãe, as idades da criança e da mãe, o número de residentes da casa, a renda per capita e os escores do AHEMD (α=0,05). Resultados A frequência das oportunidades de ação dos domicílios no AHEMD-IS variou de menos do que adequado a excelente; enquanto, no AHEMD-SR, a maior predominância foi de média frequência. A oferta de estímulos no AHEMD-IS foi significativamente maior. O maior nível socioeconômico e o número de moradores da casa foram associados a maiores oportunidades de ação. Conclusões Quanto maior o nível socioeconômico e o número de moradores, maiores são as oportunidades de ação nos domicílios das crianças em risco de atraso. É necessário oferecer às famílias algumas alternativas para tornar os seus ambientes domésticos mais ricos em oportunidades de ação que favoreçam o desenvolvimento infantil.

[Psychometric properties of the Brazilian version of the Denver II: developmental screening test]. / Propriedades psicométricas da versão brasileira do Denver II: teste de triagem do desenvolvimento.

The scope of the Denver II Developmental Screening Test is to assess the development of children between 0 and 6 years of age. The aim of this study was to verify evidence of intra- and inter-examiner reliability, concurrent validity, sensitivity and specificity of the Brazilian version of Denver II. It involved a cross-sectional methodological study. A total of 254 children, between 0 and 72 months with risk of developmental delay, participated in the study. Two examiners verified the Denver II intra- and inter-examiner reliability. Concurrent validity, sensitivity and specificity were checked against the Brazilian version of the Ages & Stages Questionnaires as a criterion-referenced test. Statistical analysis used the Intraclass Correlation Coefficient, Spearman's Correlation Test and Contingency Table, the level of significance being α=0.05. The results identified that intra and inter examiner reliability was excellent in all age groups. Concurrent validity showed moderate to very strong rates in the 13-to-60-month age group. The sensitivity and specificity indices ranged from 73-99% and 58-92%, respectively. The Brazilian version of Denver II has good rates of psychometric properties and is a reliable and valid instrument to be applied to Brazilian children at risk of developmental delay.

O Denver II tem como objetivo avaliar o desenvolvimento de crianças entre 0 e 6 anos de idade. O objetivo deste estudo foi verificar a confiabilidade intra e interexaminadores, validade concorrente, sensibilidade e especificidade da versão brasileira do Denver II. Estudo metodológico transversal. Participaram 254 crianças, entre 0 e 72 meses, com risco para atraso no desenvolvimento. Dois examinadores verificaram a confiabilidade intra e interexaminadores do Denver II. Validade concorrente, sensibilidade e especificidade foram verificadas com relação à versão brasileira do Ages & Stages Questionnaires como teste de critério. Análise estatística utilizou o Intraclass Correlation Coeficiente, Teste de Correlação de Spearman e Tabela de Contingência, nível de significância α=0.05. Os resultados identificaram que a confiabilidade intra e interexaminadores foi excelente em toda a amostra. A validade concorrente apresentou índices moderados a muito fortes entre 13 e 60 meses. Índices de sensibilidade e especificidade variaram de 73-99% e 58-92%, respectivamente. A versão brasileira do Denver II apresenta bons índices de propriedades psicométricas sendo um instrumento confiável e válido para ser aplicado em crianças brasileiras sob risco de atraso no desenvolvimento.

Propriedades psicométricas da versão brasileira do Denver II: teste de triagem do desenvolvimento / Psychometric properties of the Brazilian version of the Denver II: developmental screening test

Resumo O Denver II tem como objetivo avaliar o desenvolvimento de crianças entre 0 e 6 anos de idade. O objetivo deste estudo foi verificar a confiabilidade intra e interexaminadores, validade concorrente, sensibilidade e especificidade da versão brasileira do Denver II. Estudo metodológico transversal. Participaram 254 crianças, entre 0 e 72 meses, com risco para atraso no desenvolvimento. Dois examinadores verificaram a confiabilidade intra e interexaminadores do Denver II. Validade concorrente, sensibilidade e especificidade foram verificadas com relação à versão brasileira do Ages & Stages Questionnaires como teste de critério. Análise estatística utilizou o Intraclass Correlation Coeficiente, Teste de Correlação de Spearman e Tabela de Contingência, nível de significância α=0.05. Os resultados identificaram que a confiabilidade intra e interexaminadores foi excelente em toda a amostra. A validade concorrente apresentou índices moderados a muito fortes entre 13 e 60 meses. Índices de sensibilidade e especificidade variaram de 73-99% e 58-92%, respectivamente. A versão brasileira do Denver II apresenta bons índices de propriedades psicométricas sendo um instrumento confiável e válido para ser aplicado em crianças brasileiras sob risco de atraso no desenvolvimento.

Abstract The scope of the Denver II Developmental Screening Test is to assess the development of children between 0 and 6 years of age. The aim of this study was to verify evidence of intra- and inter-examiner reliability, concurrent validity, sensitivity and specificity of the Brazilian version of Denver II. It involved a cross-sectional methodological study. A total of 254 children, between 0 and 72 months with risk of developmental delay, participated in the study. Two examiners verified the Denver II intra- and inter-examiner reliability. Concurrent validity, sensitivity and specificity were checked against the Brazilian version of the Ages & Stages Questionnaires as a criterion-referenced test. Statistical analysis used the Intraclass Correlation Coefficient, Spearman's Correlation Test and Contingency Table, the level of significance being α=0.05. The results identified that intra and inter examiner reliability was excellent in all age groups. Concurrent validity showed moderate to very strong rates in the 13-to-60-month age group. The sensitivity and specificity indices ranged from 73-99% and 58-92%, respectively. The Brazilian version of Denver II has good rates of psychometric properties and is a reliable and valid instrument to be applied to Brazilian children at risk of developmental delay.

Development and Validation of an Instrument to Assess Horseback Mobility in Hippotherapy.

Improvement in rider mobility represents an important functional gain for people with disabilities undergoing hippotherapy. However, there is no validated measuring instrument to track and document the rider's progress in riding activities. In this study, we aimed to develop and establish validity evidence for an instrument to assess hippotherapy participants' mobility on horseback. We report on this development through the stages of: (a) content validation, (b) construct validation, (c) inter- and intra-rater reliability and (d) internal consistency analysis. We evaluated its factor structure with exploratory factor analyses, calculated values for inter- and intra-rater reliability using the intra-class correlation coefficient, and calculated its internal consistency using Cronbach's alpha. We followed recommendations by the Guidelines for Reporting Reliability and Agreement Studies. We found good inter-rater reliability (intra-class correlation coefficient - ICC = 0.991-0.999) and good intra-rater reliability (ICC = 0.997-1.0), and there was excellent internal consistency (Cronbach's α = 0.937-0.999). The instrument's factor structure grouped its three domains into one factor. As this instrument is theoretically consistent and has been found to be appropriate and reliable for its intended use, it is now available for the measurement of horseback mobility among hippotherapy riders.