Influence of functional mobility and manual function on play in preschool children with cerebral palsy.

INTRODUCTION: This study analysed the differences in play performance between preschool children with cerebral palsy and those with typical development and investigated the factors influencing functional mobility and manual dexterity on play in children with cerebral palsy. METHOD: Sixty preschool children (30 with cerebral palsy; 30 with typical development), were assessed by the revised Knox Preschool Play Scale, being that children with cerebral palsy were also classified according to their functional mobility and manual dexterity. RESULTS: On average, all measures were significantly smaller in the cerebral palsy group than the typical development group (p≤ .002). Manual function and functional mobility were negatively correlated with material (r = -.456, p = .011; r = -.487, p = .006) and space (r = -.494, p = .006; r = -.784, p = .000). Also the results pointed out a significant correlation with topography and manual function (r = .404, p = .027) and functional mobility (r = .718, p = .000). Pretend play and participation showed no correlation with topography (r = -.051, p = .788; r = -.312, p = .093), manual function (r = -.019, p = .921; r = -.322, p = .083) and functional mobility (r = -.085, p = .657; r = -.308, p = .097). CONCLUSION: Play performance of children with typical development was superior to those with cerebral palsy. The degree of impairment of functional mobility and manual function negatively was negatively associated with play exploration but did not relate to pretend play or social interaction in play.

Manual Ability Classification System (MACS): reliability between therapists and parents in Brazil.

BACKGROUND: The Manual Ability Classification System (MACS) has been widely used to describe the manual ability of children with cerebral palsy (CP); however its reliability has not been verified in Brazil. OBJECTIVE: To establish the inter- and intra-rater reliability of the Portuguese-Brazil version of the MACS by comparing the classifications given by therapists and parents of children with CP. METHOD: Data were obtained from 90 children with CP between the ages of 4 and 18 years, who were treated at the neurology and rehabilitation clinics of a Brazilian hospital. Therapists (an occupational therapist and a student) classified manual ability (MACS) through direct observation and information provided by parents. Therapists and parents used the Portuguese-Brazil version of the MACS. Intra- and inter-rater reliability was obtained using unweighted Kappa coefficient (k) and intra-class correlation coefficient (ICC). The Chi-square test was used to identify the predominance of disagreements in the classification of parents and therapists. RESULTS: An almost perfect agreement resulted among therapists [K=0.90 (95% CI 0.83-0.97); ICC=0.97 (95%CI 0.96-0.98)], as well as with intra-rater (therapists), with Kappa ranging between 0.83 and 0.95 and ICC between 0.96 and 0.99 for the evaluator with more and less experience in rehabilitation, respectively. The agreement between therapists and parents was fair [K=0.36 (95% CI 0.22-0.50); ICC=0.79 (95% CI 0.70-0.86)]. CONCLUSIONS: The Portuguese version of the MACS is a reliable instrument to be used jointly by parents and therapists.

Manual Ability Classification System (MACS): reliability between therapists and parents in Brazil

BACKGROUND: The Manual Ability Classification System (MACS) has been widely used to describe the manual ability of children with cerebral palsy (CP); however its reliability has not been verified in Brazil. OBJECTIVE: To establish the inter- and intra-rater reliability of the Portuguese-Brazil version of the MACS by comparing the classifications given by therapists and parents of children with CP. METHOD: Data were obtained from 90 children with CP between the ages of 4 and 18 years, who were treated at the neurology and rehabilitation clinics of a Brazilian hospital. Therapists (an occupational therapist and a student) classified manual ability (MACS) through direct observation and information provided by parents. Therapists and parents used the Portuguese-Brazil version of the MACS. Intra- and inter-rater reliability was obtained using unweighted Kappa coefficient (k) and intra-class correlation coefficient (ICC). The Chi-square test was used to identify the predominance of disagreements in the classification of parents and therapists. RESULTS: An almost perfect agreement resulted among therapists [K=0.90 (95% CI 0.83-0.97); ICC=0.97 (95%CI 0.96-0.98)], as well as with intra-rater (therapists), with Kappa ranging between 0.83 and 0.95 and ICC between 0.96 and 0.99 for the evaluator with more and less experience in rehabilitation, respectively. The agreement between therapists and parents was fair [K=0.36 (95% CI 0.22-0.50); ICC=0.79 (95% CI 0.70-0.86)]. CONCLUSIONS: The Portuguese version of the MACS is a reliable instrument to be used jointly by parents and therapists. .

Gross Motor Function Classification System Expanded & Revised (GMFCS E & R): reliability between therapists and parents in Brazil.

BACKGROUND: Several studies have demonstrated the importance of using the Gross Motor Function Classification System (GMFCS) to classify gross motor function in children with cerebral palsy, but the reliability of the expanded and revised version has not been examined in Brazil (GMFCS E & R). OBJECTIVE: To determine the intra- and inter-rater reliability of the Portuguese-Brazil version of the GMFCS E & R applied by therapists and compare to classification provided by parents of children with cerebral palsy. METHOD: Data were obtained from 90 children with cerebral palsy, aged 4 to 18 years old, attending the neurology or rehabilitation service of a Brazilian hospital. Therapists classified the children's motor function using the GMFCS E & R and parents used the Brazilian Portuguese version of the GMFCS Family Report Questionnaire. Intra- and inter-rater reliability was obtained through percentage agreement and Cohen's unweighted Kappa statistics (k). The Chi-square test was used to identify significant differences in the classification of parents and therapists. RESULTS: Almost perfect agreement was reached between the therapists [K=0.90 (95% confidence interval 0.83-0.97)] and intra-raters (therapists) with K=1.00 [95% confidence interval (1.00-1.00)], p<0.001. Agreement between therapists and parents was substantial (k=0.716, confidence interval 0.596-0.836), though parents classify gross motor impairment more severely than therapists (p=0.04). CONCLUSIONS: The Portuguese version of the GMFCS E & R is reliable for use by parents and therapists. Parents tend to classify their children's limitations more severely, because they know their performance in different environments.

Gross Motor Function Classification System Expanded & Revised (GMFCS E & R): reliability between therapists and parents in Brazil

BACKGROUND: Several studies have demonstrated the importance of using the Gross Motor Function Classification System (GMFCS) to classify gross motor function in children with cerebral palsy, but the reliability of the expanded and revised version has not been examined in Brazil (GMFCS E & R). OBJECTIVE:: To determine the intra- and inter-rater reliability of the Portuguese-Brazil version of the GMFCS E & R applied by therapists and compare to classification provided by parents of children with cerebral palsy. METHOD: Data were obtained from 90 children with cerebral palsy, aged 4 to 18 years old, attending the neurology or rehabilitation service of a Brazilian hospital. Therapists classified the children's motor function using the GMFCS E & R and parents used the Brazilian Portuguese version of the GMFCS Family Report Questionnaire. Intra- and inter-rater reliability was obtained through percentage agreement and Cohen's unweighted Kappa statistics (k). The Chi-square test was used to identify significant differences in the classification of parents and therapists. RESULTS: Almost perfect agreement was reached between the therapists [K=0.90 (95% confidence interval 0.83-0.97)] and intra-raters (therapists) with K=1.00 [95% confidence interval (1.00-1.00)], p<0.001. Agreement between therapists and parents was substantial (k=0.716, confidence interval 0.596-0.836), though parents classify gross motor impairment more severely than therapists (p=0.04). CONCLUSIONS: The Portuguese version of the GMFCS E & R is reliable for use by parents and therapists. Parents tend to classify their children's limitations more severely, because they know their performance in different environments. .

Cross-cultural adaptation and reliability of child-initiated pretend play assessment (chlPPA).

BACKGROUND: Play is an indication of a children's development. Purpose. Organize a culturally adapt the Child-Initiated Pretend Play Assessment to Brazilian population. METHOD: Translation and cultural adaptation procedures consisted of translation, synthesis, back translation, author's approval, and pretest of the assessment. For the pretest, 14 typically developing children were assessed. Was evaluated the use of play materials, duration of the assessment, and reliability. FINDINGS: Play materials and duration of the assessment were appropriate for Brazilian children. Analysis of intra-rater reliability showed good agreement ranging from 0.90 to 1.00. Inter-rater reliability showed good to moderate agreement for five items ranging from 0.76 to 0.59. Four items showed chance to poor agreement (rho = -0.13 to 0.50). IMPLICATIONS: Results of the pretest indicate the Brazilian version of the ChlPPA is potentially useful for Brazilian children. ChlPPA training in Portuguese in Brazil with play observation feedback is recommended to improve inter-rater reliability.

Adaptação transcultural para o Brasil do Sistema de Classificação da Função Motora Grossa (GMFCS) / Cross-cultural adaptation of the Gross Motor Function Classification System into Brazilian-Portuguese (GMFCS)

CONTEXTUALIZAÇÃO: Em função da complexidade das manifestações clínicas da paralisia cerebral (PC) e das dificuldades na sua classificação baseada apenas nos tipos motores e topografia de distribuição corporal, estudiosos canadenses propuseram o Gross Motor Function Classification System (GMFCS). Apesar de esse sistema de classificação estar sendo bastante utilizado no Brasil, ele ainda não havia sido adapatado transculturalmente para tal. OBJETIVOS: Realizar a adaptação transcultural para o Brasil do Sistema de Classificação da Função Motora Grossa (GMFCS) para a PC e verificar a confiabilidade entre observadores do instrumento adaptado com crianças brasileiras. MÉTODOS: Este estudo consistiu em duas etapas, sendo a primeira relacionada com o processo de adaptação transcultural, e a segunda referente à testagem do instrumento. A adaptação transcultural do instrumento foi feita por meio da tradução, retrotradução, análise semântica, análise de conteúdo, retrotradução da versão final e aprovação dos autores do instrumento. A testagem do instrumento ocorreu junto a 40 crianças com PC, as quais foram avaliadas por dois examinadores para verificar a confiabilidade entre observadores. RESULTADOS: Os resultados demonstram que as etapas de tradução e retrotradução não apresentaram dificuldades, e a equivalência semântica e a conceitual foram obtidas. A confiabilidade entre examinadores demonstrou que as avaliações quase não diferiam e que havia excelente correlação e consistência interna do constructo, com coeficiente de correlação intraclasse (ICC) de 0,945 (com intervalo de 0,861 a 0,979) e a de Cronbach de 0,972. CONCLUSÕES: A versão final do GMFCS mostrou bom potencial de aplicabilidade por graduandos e profissionais da área de neuropediatria.

BACKGROUND: Due to the complexity of clinical symptoms of cerebral palsy and the difficulties in classifying it based upon the motor types and the topography of the body distribution only, Canadian researchers have proposed the Gross Motor Function Classification System (GMFCS). Although this classification system has been largely used in Brazil, it has not been cross culturally adapted yet. OBJECTIVES: To perform the cross adaptation of the Gross Motor Function Classification System for the Cerebral Palsy (GMFCS) into Brazilian-Portuguese and to verify the reliability among observers of the adapted instrument in Brazilian children. METHODS: This study was performed in two stages; the first stage was related to the process of cross-cultural adaptation and the second stage tested the instrument. Translation, back-translation, semantic and content analysis, back-translation of the final version and the approval of the authors were used for the cross-cultural adaptation. The test of the instrument was performed in 40 children with cerebral palsy, who were evaluated by two raters to verify the reliability among the observers. RESULTS: The results showed that the stages of translation and back-translation did not present any difficulties and the semantic and conceptual equivalence was achieved. The reliability among the observers showed that the evaluations do not differ and that there is an excellent correlation and internal consistency of the construct with an ICC of 0.945 (95 percent CI 0.861 to 0.979) and a Cronbach a of 0.972. CONCLUSIONS: The final version of the GMFCS showed good potential of applicability for undergraduate students and professionals of the neuropediatric area.

Preliminary reliability and repeatability of the Brazilian version of the Revised Knox Preschool Play Scale.

The aim of this study was to create an adaptation of the Revised Knox Preschool Play Scale (RKPPS) for the Brazilian population, as well as to apply the instrument with statistical analysis to verify the preliminary intra-rater and inter-rater reliability and repeatability of the instrument. The instructions presented by Beaton et al. regarding adaptation of instruments were followed to perform a cross-cultural adaptation of the RKPPS. A preliminary test of the Portuguese version was performed on 18 children with no motor, cognitive or sensory impairment. The video recordings of this administration were analysed on two separate occasions by two examiners within a 5-month interval, using the scores suggested by Pfeifer. The Spearman's test was used in the statistical analysis of the obtained data. The author of the RKPPS agreed with the small necessary cultural adaptations. The Spearman test revealed a high correlation coefficient and good significance levels for both intra- and inter-raters values. This study demonstrated the reliability and repeatability of the Brazilian version of the RKPPS. This is a preliminary study and further studies are needed in order to validate the scale to be administered in the Brazilian population.

Cross-cultural adaptation of the Gross Motor Function Classification System into Brazilian-Portuguese (GMFCS).

BACKGROUND: Due to the complexity of clinical symptoms of cerebral palsy and the difficulties in classifying it based upon the motor types and the topography of the body distribution only, Canadian researchers have proposed the Gross Motor Function Classification System (GMFCS). Although this classification system has been largely used in Brazil, it has not been cross culturally adapted yet. OBJECTIVES: To perform the cross adaptation of the Gross Motor Function Classification System for the Cerebral Palsy (GMFCS) into Brazilian-Portuguese and to verify the reliability among observers of the adapted instrument in Brazilian children. METHODS: This study was performed in two stages; the first stage was related to the process of cross-cultural adaptation and the second stage tested the instrument. Translation, back-translation, semantic and content analysis, back-translation of the final version and the approval of the authors were used for the cross-cultural adaptation. The test of the instrument was performed in 40 children with cerebral palsy, who were evaluated by two raters to verify the reliability among the observers. RESULTS: The results showed that the stages of translation and back-translation did not present any difficulties and the semantic and conceptual equivalence was achieved. The reliability among the observers showed that the evaluations do not differ and that there is an excellent correlation and internal consistency of the construct with an ICC of 0.945 (95% CI 0.861 to 0.979) and a Cronbach a of 0.972. CONCLUSIONS: The final version of the GMFCS showed good potential of applicability for undergraduate students and professionals of the neuropediatric area.