Distinct mental health profiles in children with Developmental Coordination Disorder: A latent class analysis and associations.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) show indications for mental health problems. However, these problems are poorly understood. AIMS: To identify patterns (profiles) of mental health in this population and to analyze the associations between profiles and child characteristics. METHODS AND PROCEDURES: Parents of 119 children with DCD completed the Strengths and Difficulties Questionnaire. OUTCOMES AND RESULTS: Results indicated that a four latent class was the best model. Profile 1 was defined as "no" mental health problems (n = 28; 24 %), Profile 2 was defined as "hyperactivity" problems (n = 53; 43.3 %), for clinical indications for hyperactivity, Profile 3 was defined as "internalizing" problems (n = 8; 7.3 %), for clinical indications for emotional symptoms and peer problems, and Profile 4 was defined as "internalizing and externalizing problems" (n = 30; 25.4 %), for clinical indications for problems in both areas. In addition, having a co-occurring disorder, accommodation plans, and using medications were associated with the profiles. CONCLUSIONS AND IMPLICATIONS: There are distinct and unique profiles that children with DCD exhibit. Clinicians can use these profiles to better understand the presentation of mental health symptoms in this population and provide adequate services or support if mental health difficulties are present.

Executive function in children with and without developmental coordination disorder: A comparative study.

BACKGROUND: Children with motor impairments also show poor performance in some executive functions' components. However, there is no consensus on which specific executive subdomain is more impacted. AIM: The objective of this study was to compare executive functions in children with developmental coordination disorder (DCD), at risk for DCD (r-DCD), and in typically developing (TD) children. METHODS AND PROCEDURES: A sample of 397 children was assessed using the MABC-2. Two groups of children were identified; DCD (n = 63) and at r-DCD (n = 31). A third matched group of children with TD (n = 63) was formed. The MABC-2 checklist and the WASI tests were used as screening tools. Measures of executive function including verbal and nonverbal tasks for working memory, inhibitory control, and cognitive flexibility were tested. Multivariate analysis of variance followed by analyses of variance and Bonferroni tests were used to verify group effects on executive functions. RESULTS: A significant group effects were found for Working Memory, Λ = .78, F(4, 360) = 10.12, p ≤ .001, ηp2 = .12; Inhibitory Control, Λ = .59, F(16, 294) = 5.48, p ≤ .001, ηp2 = .23; and Cognitive Flexibility and Inhibitory Control, Λ = .60, F(22, 288) = 3.74, p ≤ .001, ηp2 = .22, with moderate effect sizes. The DCD group showed lower scores compared with the TD group on the visuospatial and verbal working memory; inhibitory control and in tasks of cognitive flexibility; the r-DCD group showed lower scores compared with the TD group for visuospatial working memory and for cognitive flexibility. CONCLUSIONS AND IMPLICATIONS: Poor performance in several measures of executive functions in children with DCD emphasized the need of motor/executive task-specific interventions. Furthermore, children at r-DCD showed low scores in several executive functions; therefore, preventive services should also be provided for this subclinical group.

Is there a correlation between depressive symptoms and motor skills in post-stroke patients?

Deficits in motor skills and depressive symptoms are common effects observed after stroke, so it is necessary to understand how these variables interact with each other. Therefore, the aim of this study was to investigate the relationship between these two variables in post-ischemic stroke patients. We evaluated 135 patients with a mean age of 60 years (± 15). The Fugl-Meyer assessment of motor function was used to assess motor skills in the upper limbs, lower limbs, balance, and sensitivity and the Beck Depression Inventory was applied to evaluate depressive symptoms. To assess the relationship between both components, Spearman's correlation was performed. Depressive symptoms were negatively correlated with all variables of motor skills. This study suggests that higher motor skills in post-stroke patients may be associated with fewer depressive symptoms. Thus, a better understanding of how post-stroke symptoms are interrelated may improve patient treatment and care, contributing to a better quality of life.

Is there a correlation between depressive symptoms and motor skills in post-stroke patients? / Existe correlação entre sintomas depressivos e habilidades motoras em pacientes pós-AVC?

ABSTRACT Deficits in motor skills and depressive symptoms are common effects observed after stroke, so it is necessary to understand how these variables interact with each other. Therefore, the aim of this study was to investigate the relationship between these two variables in post-ischemic stroke patients. We evaluated 135 patients with a mean age of 60 years (± 15). The Fugl-Meyer assessment of motor function was used to assess motor skills in the upper limbs, lower limbs, balance, and sensitivity and the Beck Depression Inventory was applied to evaluate depressive symptoms. To assess the relationship between both components, Spearman's correlation was performed. Depressive symptoms were negatively correlated with all variables of motor skills. This study suggests that higher motor skills in post-stroke patients may be associated with fewer depressive symptoms. Thus, a better understanding of how post-stroke symptoms are interrelated may improve patient treatment and care, contributing to a better quality of life.

RESUMO Déficits na habilidade motora e presença de sintomas depressivos são comuns em pacientes pós-AVC. Assim, é necessário compreender como estas variáveis interagem entre si. O objetivo deste trabalho foi verificar esta relação em pacientes pós-AVC isquêmico. Participaram 135 sujeitos, com idade média de 60 anos (± 15). Foi utilizado o protocolo de desempenho motor Fugl Meyer para verificar a habilidade motora dos membros superiores, inferiores, equilíbrio e sensibilidade e o Inventário de Depressão de Beck para verificar os sintomas depressivos. Foi realizada a análise de Spearman para verificar a relação entre os dois componentes. Os sintomas depressivos se correlacionaram negativamente com todas as variáveis da habilidade motora. Assim, a maior habilidade motora implicou em menores sintomas depressivos. Portanto, compreender como as sequelas pós-AVC se relacionam auxilia no melhor tratamento e atendimento ao paciente, contribuindo para melhorar sua qualidade de vida.

The "sick dancers": The construction of medical knowledge about the "epidemic of dance" in Itapagipe, Salvador, Bahia (1882-1901).

The goal of this paper is to analyze a little-known set of documents referring to a "Dancing Epidemic" that took place in Itapagipe, a suburb of Salvador, capital of the province of Bahia, Brazil, in 1882. Through the studies of a group of physicians, especially Raimundo Nina Rodrigues (1862-1906), a psychiatrist and anthropologist from the Bahia School of Medicine, the medical knowledge built on this unique phenomenon in Brazilian history is examined. The case in particular involved a crowd that spread through the streets of Itapagipe, attracting the interest of the medical classes, who were intrigued by the symptoms of motor incoordination the patients manifested. Inspired by foreign literature, but developing their own theories, Rodrigues and colleagues created a unique body of knowledge about the infirmity.

As significações acerca da imagem corporal por crianças amputadas / Significations of body image by amputated children / Los significados sobre la imagen corporal de los niños amputados

A imagem corporal é importante na consciência de si, relacionando-se com a experiência existencial de cada um, podendo ser alterada por fatores como a amputação. Assim, as narrativas permitem organizar esta experiência, atribuindo-lhe um significado. O objetivo deste estudo foi investigar as significações construídas por crianças amputadas acerca de sua imagem corporal. Para tanto, foram realizados quatro momentos, gravados e transcritos, com três crianças com amputações adquiridas e uma congênita. As narrativas que remetiam à imagem corporal foram submetidas à análise da enunciação. Nos resultados, o olhar do outro foi a principal forma de preconceito, elegendo-se como uma das dificuldades impostas pela amputação. Porém, crianças com amputação adquirida e congênita diferenciaram-se quanto à significação da prótese e à possível aceitação/negação da amputação. Esses resultados demonstram que a significação sobre a imagem corporal é construída de forma singular e estar sensível a estas particularidades pode auxiliar o profissional em sua prática.

Body image is important in the awareness of the self, relating to the existential experience of each person, and can be altered by factors such as amputation. Discussing and giving a signification to experiences people live can help them organize their body images. The aim of this study was to investigate the significations attributed by amputated children about their body image. In order to achieve this goal, four interviews were organized with three children with congenital or acquired amputations. These interviews were recorded and transcribed, and the narratives that referred to body image were subjected to enunciation analysis. In the results, children mentioned that the discomfort caused by people's reactions when looking at them could be considered as one of the biggest difficulties imposed by amputation. However, children with acquired and congenital amputation differed as to the signification attributed to the prosthesis and the possible acceptance/denial of the amputation. These results demonstrate that the signification of body image is constructed in a unique way and being sensitive to these peculiarities can help professionals in their practice.

La imagen corporal es importante en la conciencia de sí mismo, en relación con la experiencia existencial de cada uno, puede ser alterado por factores tales como la amputación. Por lo tanto, las narrativas permiten organizar esta experiencia, dándole un significado. El objetivo de este estudio fue investigar los significados construidos por los niños amputados por su imagen corporal. Se realizaron cuatro veces, grabadas y transcritas con tres niños con amputaciones adquiridas y congénitas. Se analizaron los relatos que hacían referencia a la imagen corporal de la enunciación. En los resultados, la mirada de la otra era la principal forma de prejuicio, fue elegido como una de las dificultades impuestas por la amputación. Sin embargo, los niños con amputación congénita y adquirida difieren sobre el significado de la prótesis y posible aceptación / denegación de la amputación. Estos resultados demuestran que la importancia de la imagen corporal se construye de una manera única y ser sensible a estas características pueden ayudar a los profesionales en su práctica.

Changes in neural circuitry associated with depression at pre-clinical, pre-motor and early motor phases of Parkinson's disease.

Although Parkinson's Disease (PD) is mostly considered a motor disorder, it can present at early stages as a non-motor pathology. Among the non-motor clinical manifestations, depression shows a high prevalence and can be one of the first clinical signs to appear, even a decade before the onset of motor symptoms. Here, we review the evidence of early dysfunction in neural circuitry associated with depression in the context of PD, focusing on pre-clinical, pre-motor and early motor phases of the disease. In the pre-clinical phase, structural and functional changes in the substantia nigra, basal ganglia and limbic structures are already observed. Some of these changes are linked to motor compensation mechanisms while others correspond to pathological processes common to PD and depression and thus could underlie the appearance of depressive symptoms during the pre-motor phase. Studies of the early motor phase (less than five years post diagnosis) reveal an association between the extent of damage in different monoaminergic systems and the appearance of emotional disorders. We propose that the limbic loop of the basal ganglia and the lateral habenula play key roles in the early genesis of depression in PD. Alterations in the neural circuitry linked with emotional control might be sensitive markers of the ongoing neurodegenerative process and thus may serve to facilitate an early diagnosis of this disease. To take advantage of this, we need to improve the clinical criteria and develop biomarkers to identify depression, which could be used to determine individuals at risk to develop PD.

Efeitos de um protocolo modificado da terapia por contensão induzida em criança com paralisia cerebral hemiparética / Effects of a modified protocol of induced restraint therapy in children with hemiparetic brain paralysis

Avaliar os efeitos de um protocolo de intervenção modificado da Terapia por Contensão Induzida na qualidade do movimento e na frequência do uso da extremidade superior acometida em criança com paralisia cerebral hemiparética. Estudo longitudinal, de caso único, realizado com uma criançade quatro anos de idade submetida à intervenção por três horas diárias, durante dez dias, restrição da extremidade superior não acometida por oito horas diárias. Os dados foram coletados pela Pediatric Upper Extremity Motor Activity Log e analisados por meio de média aritmética. Observou-se melhora na qualidade do movimento e aumento da frequência do uso do membro superiorparético do período de pré para a pós-intervenção, mantendo-se o resultado consistente nas coletas de dados posteriores, além de aquisição de habilidades motoras funcionais. O protocolo de intervenção utilizado neste estudo foi eficaz no tratamento da criança com hemiparesia, os resultados podem ser úteis aos profissionais que trabalham com essa clientela, auxiliando-os no processo de intervenção.

Evaluate the effects of a modified ConstraintInduced Therapy intervention protocol regarding movement quality and frequency of use of the affected upper extremity on children with hemiplegic cerebral palsy. Longitudinal study of a single case, performed with a four year old submitted to intervention during three hours daily, for ten days, restricting thenon-affected upper extremity for eight hours daily. Data were collected using the Pediatric Upper Extremity Motor Activity Log and analyzed using the arithmetic mean. Significant improvement in quality of movement and frequency of use of the upper limbfrom pre to post-intervention were noted, maintaining the result in later data collection, besides the acquisition of functional motor skills. The modifi ed constraint-induced movement therapy protocol of this study was effective in treating the child with hemiplegiccerebral palsy, the results may be useful for professionals working with this clientele, assisting them in the intervention process.

Effects of mirror therapy through functional activites and motor standards in motor function of the upper limb after stroke / Efecto de la terapia del espejo por mediante actividades funcionales y patrones motores em la función del miembro superior después de um accidente cerebrovascular / Efeito da terapia de espelho por meio de atividades funcionais e padrões motores na função do membro superior pós-acidente vascular encefálico

The study aimed to evaluate the effects of mirror therapy through functional activities and motor standards in upper limb function of chronic stroke subjects. Six patients with paresis of the arm within at least six months after stroke were randomly to a group of functional activities (GAF - n=3) and group of motor standards (GPM - n=3). Both groups performed 15 sessions of mirror therapy for 30 minutes, but the first one (GAF) were instructed to do the bilateral and symmetrical movements based on functional activities (i.e. games fitting) and the second one (GAP) made movements based on normal motor patterns (i.e. wrist flexion-extension). There was no statistical significance between pre- and post-treatment for both groups independently. However, analyzing the groups together (n=6), it was observed significance values in the cognitive and total MIF (p=0.002) pre- and post-mirror therapy. This study showed improvement in the functional impairment whatever the type of movement made during the mirror therapy.

El objetivo del estudio fue evaluar los efectos de la aplicación de la terapia de espejo por medio de actividades funcionales y patrones motores del movimiento en la función motora del miembro superior de hemiparéticos crónicos pos-Accidente Vascular Encefálico (AVE). Seis pacientes con hemiparesía del brazo con al menos seis meses pos-AVE fueron asignados de modo aleatorio a un grupo de actividades funcionales (GAF - n=3) y un grupo de patrones motores (GPM - n=3). Ambos grupos realizaron 15 sesiones de terapia del espejo durante 30 minutos, pero el primero (GAF) fue orientado a hacer movimientos bilaterales y simétricos en base a las actividades funcionales (es decir, juegos de encaje) y el segundo (GPM), a hacer movimientos basados ​​en patrones motores normales (es decir, flexión-extensión de la muñeca). No hubo diferencias estadísticamente significativas entre pre y post-tratamiento para ambos grupos de forma independiente. Sin embargo, el análisis de los grupos en conjunto (n=6) demostró valores post-terapia significativos en la Medida de Independencia Funcional (MIF) cognitiva y total (p=0,002) pre y post-terapia de espejo. Este estudio mostró una mejoría en el deterioro funcional en cualquier tipo de movimiento realizado durante la terapia del espejo.

O objetivo do estudo foi avaliar os efeitos da aplicação da terapia de espelho por meio de atividades funcionais e padrões motores do movimento na função motora do membro superior de hemiparéticos crônicos pós-Acidente Vascular Encefálico (AVE). Seis pacientes com hemiparesia do braço com pelo menos seis meses pós-AVE foram randomizados para um grupo de atividades funcionais (GAF - n=3) e um grupo de padrões motores (GPM - n=3). Ambos os grupos realizaram 15 sessões de terapia de espelho por 30 minutos, mas o primeiro (GAF) foi instruído a fazer movimentos bilaterais e simétricos baseados em atividades funcionais (isto é, jogos de encaixe) e o segundo (GPM), a fazer movimentos baseados em padrões motores normais (isto é, flexão-extensão de punho). Não houve significância estatística entre o pré e o pós-tratamento para ambos os grupos de modo independente. No entanto, analisando os grupos em conjunto (n=6), foram observados valores significativos na medida de independência funcional (MIF) cognitiva e total (p=0,002) pré e pós-terapia de espelho. Este estudo mostrou melhora no comprometimento funcional seja qual for o tipo de movimento feito durante a terapia de espelho.

Revisão das propriedades psicométricas de testes de coordenação motora dos membros superiores em hemiparéticos / Review of the psychometric properties of upper limb motor coordination tests for stroke subjects

Objetivo: Sumarisar as propriedades psicométricas e a utilidade clínica de instrumentos de coordenação motora(CM) dos membros superiores, que consideram a velocidade e a qualidade dos movimentos, para hemiparéticos. Procedimentos Metodológicos: Foi realizada uma busca computadorizada nas bases de dados Medline, EMBASE, PsynINFO, CINAHL, Web of Science, LILACS, SciELO, PEDro, Cochrane e OT Seeker e uma busca manual. Dois autores independentes realizaram a extração dos dados. Resultados: A estratégia de busca inicial retornou2.152 estudos, sendo que 2.116 foram excluídos. A busca manual retornou sete estudos e assim, o número total de estudos incluídos foi 43. As propriedades psicométricas dos 16 instrumentos encontrados apresentaram, no geral, valores adequados, no entanto somente seis reportaram valores para todas. A utilidade clínica revelou que nem todos os testes são rápidos, baratos e práticospara serem utilizados. Conclusões: A deficiência na literatura de estudos que investiguem as propriedades psicométricas de teste de CM dos MMSS pode limitar a interpretação e utilização destes instrumentos na prática clínica e pesquisa. Além disso, a utilidade é um importante fator que deve interferir na escolha do instrumento...

Objective: To summarize the psychometric properties and clinical utility of tests, which assess motorcoordination of the upper limbs in stroke subjects. Methods: A computerized search was performed on the Medline, EMBASE, PsynINFO, CINAHL, Web of Science, LILACS, SciELO, PEDro,Cochrane, and OT Seeker databases, followed by a manual search. Two independent researchers extratcted the data. Results: The initial search returned 2,152 studies and 2,116 were excluded. The manual search returned seven studies and thus, the total number of included studies was 43. The psychometric properties of the 16 tests demonstrated, in general, adequate psychometric properties. However, only six studies reported values for all ofthe basic properties. The clinical utility scale revealed that not all tests were quickly administered, cheap, and practical to be applied. Conclusions: The defi ciency in literature of studies that investigate the psychometric properties of the upper limb motor coordinationtest may limit the interpretation and use of these instruments in clinical practice and research. In addition, clinical utility is an important factor to be considered when selecting assesment tests...

Clínica de crianças com transtornos: quando a preocupação está para além do orgânico / Clinic of children with neuromotor disorders: when the concern is beyond organic / Clínica de niños con trastornos neuromotores: cuando la preocupación está más allá de lo orgánico

Apesar de a constituição do sujeito não residir somente no orgânico, não podemos desconsiderar que limitações no real do corpo podem impor obstáculos no processo de constituição subjetiva. A partir de questionamentos da minha experiência clínica como fisioterapeuta neuropediátrica e do meu percurso acadêmico no curso de especialização em atendimento clínico - ênfase psicanálise, alguns interrogantes sobre a prática clínica com crianças com transtornos neuromotores foram surgindo. Testemunhando uma carência na articulação entre esses saberes, busquei encadear conhecimentos das duas especificidades objetivando propor uma clínica que tome a criança como um sujeito em constituição e não apenas preocupada com o real orgânico da lesão.

Even though the subject's constitution doesn't reside only in the organic, we can't disrespect that limitations in the real of body can impose obstacles in the process of the constitution of the subjectivity. Based on questions of my clinic experience as a neuropediatric physiotherapist and on a specialization course in clinical service with emphasis in psychoanalysis, some questions about clinical practice with children with disabilities came up. Attesting a scarcity on the articulation between these fields of knowledge, my attempt is to articulate knowledge of both specialties in order to propose a clinic that takes the child as a subject in constitution and not only concerned with the organic real of the lesion.

A despecho de la constitución sujetiva no residir solo en lo orgánico, no podemos desconsiderar que las limitaciones en lo real del cuerpo pueden imponer obstáculos en el proceso de constitución del sujeto. A partir de cuestionamientos de mi experiencia clínica como fisioterapeuta neuropediátrica y de mi percurso académico en el curso de especialización en atendimiento clínico - énfasis psicoanálisis, fueron surgiendo algunos interrogantes sobre la práctica clínica de niños con trastornos neuromotores. Percibiendo una carencia en la articulación entre esos saberes, busqué articular conocimientos de las dos especificidades a fin de proponer una clínica que tome al niño como un sujeto en constitución y no solamente preocupada con lo real orgánico de la lesión.

Crianças com dificuldades motoras: questões para a conceituação do transtorno do desenvolvimento da coordenação / Niños con dificultad motoras: cuestiones en el concepto del trastorno del desarrollo de la coordinación / Children with motor difficulties: issues on conceptualizing developmental coordination disorder

A investigação da natureza das dificuldades motoras experimentadas por crianças resultou na identificação do Transtorno do Desenvolvimento da Coordenação (TDC). Pouco se sabe sobre sua natureza, embora sejam inúmeras as hipóteses formuladas sobre sua causa. O presente artigo defende a tese de que o problema reside na definição do que se entende por TDC e na seleção de amostras em estudos que não distinguem o uso de critérios clínicos dos critérios de pesquisa. Em conclusão, são apresentadas três etapas para caracterização do TDC.

The investigation of the nature of motor difficulties children experiment resulted in the identification of a Developmental Coordination Disorder (DCD). The lack of consensus on the nature and the mechanisms of DCD might not be due to an apparent resilience of the disorder to the scientific enterprise. On the contrary, the present paper has a goal of presenting a thesis according to which the problem resides on the definition of DCD and on the selection of samples in studies that do not distinguish between clinical and research criteria. In conclusion, three steps for characterizing DCD are presented.

La investigación de la naturaleza de las dificultades motrices experimentadas por los niños ha resultado en la identificación de Trastorno del Desarrollo de la Coordinación (TDC). La falta de un acuerdo acerca de la naturaleza y mecanismos del TDC puede no ser riestrita a una aparente resistencia del trastorno a las investigaciones científicas. El presente artículo postula la tesis de que el problema esta en la definición acerca del entendimiento del TDC y en la selección de las populación en estudios que no distinguen el uso de criterios clínicos de los criterios de investigación científica. La caracterización del TDC se presenta en tres etapas.

Developmental coordination disorder, generalized self-efficacy toward physical activity, and participation in organized and free play activities.

OBJECTIVE: To test a theoretical model linking developmental coordination disorder (DCD) to reduced physical activity (PA) through the mediating influence of generalized self-efficacy regarding PA. STUDY DESIGN: This was a cross-sectional investigation of students in grades 4 through 8 from 5 elementary schools in the Niagara region of Ontario, Canada (n=590). Motor proficiency was evaluated using the short-form Bruininks-Oseretsky Test of Motor Proficiency. Generalized self-efficacy was assessed using the Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity scale, and PA levels were evaluated using a 61-item Participation Questionnaire. Structural equation modeling was used to test the influence of generalized self-efficacy on the relationship between DCD and PA. RESULTS: In this sample, 7.5% (n=44) of the children met the requirements for probable DCD. The effect of DCD on PA was mediated by generalized self-efficacy. In this model, 28% of the variance in children's PA was predicted by generalized self-efficacy and DCD. CONCLUSIONS: Our results suggest that children with DCD are less likely to be physically active and that generalized self-efficacy can account for a considerable proportion of this relationship. The implications for appropriate interventions to increase PA among children with DCD are discussed.