Associação entre desempenho funcional de crianças com paralisia cerebral e tempo de espera pela provisão de órteses em serviço de reabilitação / Association between functional performance of children with cerebral palsy and waiting time for the splint provision in rehabilitation services

Crianças com paralisia cerebral usualmente necessitam de órtese no polegar para função manual. Objetivo: Analisar a associação entre tempo de espera para recebimento de órtese para polegar, habilidade manual e dificuldade de desempenho em atividades cotidianas de crianças com paralisia cerebral. Método: Estudo de métodos mistos, com uma coorte retrospectiva e avaliação transversal de crianças com paralisia cerebral e indicação de confecção de órtese para polegar. Foram coletadas informações socioeconômicas, mensuração das dificuldades para realizar atividades do cotidiano, função manual pelo Sistema de Classificação da Habilidade Manual (MACS) e tempo de espera pela órtese. Análises descritivas, coeficiente de correlação de Spearman e Teste Kruskal Wallis foram realizadas no software IBM SPSS®. Resultados: 17 crianças e seus pais/responsáveis foram avaliados, sendo a maioria menino (76,5%), com paralisia cerebral do tipo hemiparética (52,9%). O tempo médio de espera pela órtese foi 34,12 dias (DP= 39,01). Crianças com comprometimento motor mais severo (p= 0,038) e pior habilidade manual (p= 0,012) receberam órtese em menor tempo de espera. Não houve diferença estatística entre tempo de espera pela órtese e dificuldade para desempenhar atividades cotidianas. Conclusão: A correlação entre habilidade manual e tempo de espera reforça a importância da avaliação funcional para priorizar concessão de um dispositivo de Tecnologia Assistiva em um serviço público de reabilitação, direcionando o cuidado às necessidades mais específicas das crianças.

Children with cerebral palsy usually need orthoses in their thumbs for manual functions. Objective: Analyzing the association between the waiting time for receiving a thumb orthosis, the manual ability, and the difficulty in performing daily tasks of children with cerebral palsy. Method: Mixed-methods study, with a retrospective cohort and cross-sectional evaluation of children with cerebral palsy and the indication and confection of thumb orthoses. Data collection included socioeconomic information, waiting time for the orthoses, and assessments of the difficulty to carry out daily activities and of manual functioning according to the Manual Ability Classification System (MACS). Descriptive analysis, Spearman's coefficient and the Kruskal-Wallis test were calculated in the IBM software SPSS®. Results: 17 children and their parents/guardians were evaluated. Most were male (76.5%) with hemiplegic cerebral palsy (52.9%). Their mean time waiting for the orthosis was 34.12 days (SD= 39.01). Children with a more severe motor impairment (p= 0.038) or worse manual abilities (p= 0.012) waited to receive the orthosis for a shorter period. There was no statistical difference between the waiting time for the orthosis and the difficulty to perform daily tasks. Conclusion: The correlation between manual ability and the waiting time reiterates the importance of functional evaluations to prioritize the concession of Assistive Technology devices in public rehabilitation services, focusing the care on the more specific needs of each child.

Functioning of young patients with cerebral palsy: Rasch analysis of the pediatric evaluation of disability inventory computer adaptive test daily activity and mobility.

BACKGROUND: People with cerebral palsy experience limitations in performing activities of daily living. Rehabilitation practitioners seek valid instruments to measure changes in the performance of those activities. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) is a new tool to assess functioning in children and youth with various health conditions. Its validity needs to be evaluated in a way that is consistent with the theoretical model on which it was based. We aimed to evaluate the fit of daily activity and mobility items and children with CP to the Rasch model and to compare the performance in daily activities and mobility of older children, adolescents, and young adults with CP based on manual function and gross motor function limitations. METHODS: Eighty-three parents of children and youth of 8-20 years old (mean age: 11.6) with different severity levels of cerebral palsy participated in this study. Ninety-one items of the PEDI-CAT Daily Activities and Mobility domains were analyzed through Rasch analysis to evaluate relative item difficulty and participant ability. Participants were described according to the Manual Ability (MACS) (level I: 21.7%; II: 32.5%; III: 24.1%; IV: 7.2% and V: 3.6%) and the Gross Motor Function (GMFCS) (level I: 37.3%; II: 26.5%; III: 6%; IV: 18.1%; and V: 7.2%) classification systems levels. RESULTS: Our data fit the Rasch Model. Parents had difficulty distinguishing some PEDI-CAT response categories. Participants from MACS and GMFCS levels IV and V showed lower ability to perform relatively more difficult items. There was a floor effect in both domains. Only 7.7% of the items presented differential item functioning when individuals with mild MACS and GMFCS levels (I, II) and moderate level (III) and individuals with moderate (III) and severe levels (IV, V) were compared. CONCLUSIONS: PEDI-CAT daily activities and mobility domains are valid to evaluate children, adolescents and youth with CP of different severities, but the addition of items to these domains is recommended in order to address their floor effect.

Characterization of occupational therapy's labor market in Sergipe State / Caracterização do mercado de trabalho da terapia ocupacional no Estado de Sergipe

Abstract Introduction: Occupational Therapy in Brazil is a profession inserted in the areas of health, social and education. In Sergipe, the participation of this professional in the labor market is a challenge, due to the reduced number of occupational therapists in the state. Objective: To characterize the labor market of occupational therapists in Sergipe and to comprehend the perception of professionals in this market. Method: This is a cross-sectional study involving 25 occupational therapists registered in the occupation council, using a semi-structured questionnaire. The descriptive analysis used tabulation in Microsoft Excel worksheet, and the qualitative analysis was performed through the analysis of the speech and identification of the words and key ideas. Results: The labor market of Occupational Therapy in Sergipe is growing despite insertion challenges in the state. Mental health is the main area of work for occupational therapists in Sergipe. Although a significant number of professionals are satisfied with the conditions and infrastructure offered to them, the greatest difficulties cited are related to inadequate physical space and lack of materials. Conclusion: Offering better working conditions, better organizing the occupation council and training new professionals can contribute to greater knowledge and valorization of occupational therapy in the state of Sergipe.

Resumo Introdução: A Terapia Ocupacional, no Brasil, é uma profissão inserida nas áreas da saúde, do campo social e da educação. Em Sergipe, observou-se que a inserção desse profissional no mercado de trabalho é um desafio, em virtude do número reduzido de terapeutas ocupacionais no estado. Objetivo: Caracterizar o mercado de trabalho dos terapeutas ocupacionais em Sergipe e compreender a percepção dos profissionais neste mercado. Método: Trata-se de um estudo transversal do qual participaram 25 terapeutas ocupacionais, registrados no conselho da categoria. Foi aplicado um questionário semiestruturado. Os dados foram analisados de forma descritiva, através de tabulação em planilha do Microsoft Excel, e de forma qualitativa, através da análise do discurso e da identificação das palavras e ideias-chave das respostas. Resultados: O mercado de trabalho da Terapia Ocupacional em Sergipe está em crescimento, embora a profissão encontre desafios de inserção no estado. A saúde mental é a área na qual os terapeutas ocupacionais de Sergipe mais encontram trabalho. Embora uma parcela significativa dos profissionais esteja satisfeita com as condições e a infraestrutura oferecidas a eles, as maiores dificuldades citadas estão relacionadas ao espaço físico inadequado e à falta de materiais. Conclusão: O oferecimento de melhores condições de trabalho, a organização da categoria profissional e a formação de novos profissionais podem contribuir para maior conhecimento e valorização da Terapia Ocupacional no Estado de Sergipe.

Clinical changes during an intervention based on constraint-induced movement therapy principles on use of the affected arm of a child with obstetric brachial plexus injury: a case report.

The objective of this study was to test the feasibility of a treatment programme based on the elements of constraint-induced movement therapy (CIMT) to encourage use of the affected arm of a child with obstetric brachial plexus injury (OBP), as well as to document clinical changes observed with this intervention. A 2-year-old female child with Erb's palsy had 14 weeks of daily home-based treatment with 30-minute sessions planned according to the principles of CIMT. The child was assessed every 2 weeks with the Toddler Arm Use Test. Test scores throughout the intervention period demonstrated improvements in quality of movement, amount of use and willingness to use the affected extremity. The child's mother reported improved ability to perform bimanual activities at home. The results suggest that treatment based on CIMT principles has potential to promote functional gains for children with OBP. Experimental studies should test the effects of this kind of intervention for children with OBP.