Neurological, cognitive and learning evaluation of students who were born preterm / Avaliação neurológica, cognitiva e de aprendizagem de escolares nascidos prematuros

ABSTRACT Objective: To evaluate the cognitive and academic profile of preterm newborns at school age and to determine the factors related to prematurity and sociodemographic profile that influence these results. Methods: Patients aged 6-14 years old that were assisted in the preterm follow-up clinic were recruited. The cognitive, academic, and neurological capacities were accessed through a detailed evaluation with a child neurologist, a neuropsychologist and a psychopedagogue. Neonatal data were collected from patient records. Results: 97 children were included and 14 were excluded from the study, resulting in 83 children. Gestational age (GA) was 30±3 weeks and weight at birth was 1138g (605 to 4185g). Poor performance was shown in 38.4% for writing, 57.5% for reading and 42.5% for mathematics. The mean total intelligence quotient (IQ) was 96±14.9 points, and 10.9% were considered altered. Children with unstructured families presented 78.3% of failure in reading tests (p=0.029). The multivariate analysis showed association between GA at birth and classic mini-mental score (p=0.043), total IQ (p=0.047), perceptual organization IQ (p=0.035), and processing speed IQ (p=0.036). There was also association between weight at birth and the classic (p=0.004) and adapted (p=0.007) mini-mental scores; invasive mechanic ventilation duration and classic mini-mental (p=0.049); and lower maternal age and processing speed IQ (p=0.033). Conclusions: Preterm infants at school age had high frequency of failure in cognitive and academic evaluation tests. Learning difficulties are high among them. Multiple neonatal variables are related with altered cognitive and students development.

RESUMO Objetivo: Avaliar o perfil de desenvolvimento cognitivo e acadêmico de recém-nascidos pré-termo em idade escolar e indicar os fatores relacionados à prematuridade e ao perfil sociodemográfico que influenciam esse resultado. Métodos: Recrutaram-se pacientes com idades entre 6 e 14 anos que fizeram seguimento no ambulatório de acompanhamento de prematuros. As capacidades cognitiva, acadêmica e neurológica foram acessadas por avaliação pormenorizada com neuropediatra, neuropsicóloga e psicopedagoga. Buscaram-se os dados neonatais nos prontuários. Resultados: Foram incluídos 97 recém-nascidos pré-termo e excluídos 14, resultando em 83 crianças. A idade gestacional foi 30±3 semanas e o peso de nascimento 1138g (605; 4185g). Tiveram mau desempenho em escrita 38,4%, leitura 57,5% e matemática 42,5%. A média de quociente de inteligência total foi de 96,0±14,9 pontos, sendo 10,9% considerados alterados. Crianças com famílias desestruturadas apresentaram 78,3% de falha de leitura (p=0,029). Pela regressão multivariada, houve relação entre idade gestacional ao nascimento e pontuação no miniexame do estado mental (minimental) clássico (p=0,043), quociente de inteligência total (p=0,047), quociente de inteligência organização perceptual (p=0,035) e quociente de inteligência velocidade de processamento (p=0,036); entre peso ao nascer e minimental clássico (p=0,004) e adaptado (p=0,007); entre tempo de ventilação mecânica invasiva e minimental clássico (p=0,049); e entre idade materna mais baixa e quociente de inteligência velocidade de processamento (p=0,033). Conclusões: Os recém-nascidos pré-termo apresentaram alta frequência de falha nos testes de avaliação cognitiva e acadêmica. Uma série de intercorrências neonatais apresenta associação com alterações no desenvolvimento cognitivo e escolar.

Neurological, cognitive and learning evaluation of students who were born preterm.

OBJECTIVE: To evaluate the cognitive and academic profile of preterm newborns at school age and to determine the factors related to prematurity and sociodemographic profile that influence these results. METHODS: Patients aged 6-14 years old that were assisted in the preterm follow-up clinic were recruited. The cognitive, academic, and neurological capacities were accessed through a detailed evaluation with a child neurologist, a neuropsychologist and a psychopedagogue. Neonatal data were collected from patient records. RESULTS: 97 children were included and 14 were excluded from the study, resulting in 83 children. Gestational age (GA) was 30±3 weeks and weight at birth was 1138g (605 to 4185g). Poor performance was shown in 38.4% for writing, 57.5% for reading and 42.5% for mathematics. The mean total intelligence quotient (IQ) was 96±14.9 points, and 10.9% were considered altered. Children with unstructured families presented 78.3% of failure in reading tests (p=0.029). The multivariate analysis showed association between GA at birth and classic mini-mental score (p=0.043), total IQ (p=0.047), perceptual organization IQ (p=0.035), and processing speed IQ (p=0.036). There was also association between weight at birth and the classic (p=0.004) and adapted (p=0.007) mini-mental scores; invasive mechanic ventilation duration and classic mini-mental (p=0.049); and lower maternal age and processing speed IQ (p=0.033). CONCLUSIONS: Preterm infants at school age had high frequency of failure in cognitive and academic evaluation tests. Learning difficulties are high among them. Multiple neonatal variables are related with altered cognitive and students development.

The First Unprovoked Seizure in Typically Developing Children: A Real-Life Setting in Southern Brazil.

AIM: To describe the first unprovoked seizure in typically developing children, its clinical characteristics, recurrence rate, and possible risk factors in a real-life setting in Southern Brazil. METHOD: In this retrospective cohort study, medical records of typically developing children aged 28 days to 14 years who had a first unprovoked seizure in a single tertiary care center were reviewed, in a 10-year period (2006-2016). RESULTS: Seventy-four children were included, 41 males and 33 females. The most frequent age group of the first seizure was 5 to 10 years and seizure main type was focal (50%). Most seizures occurred while children were awake (70%). All patients underwent an electroencephalogram (EEG), which was normal in 44.6%. Neuroimaging was performed in 81%, in 2 cases the etiology was considered structural, the remaining was classified as unknown. Median follow-up period was 32.5 months. Seizure recurrence rate was 56.7% and age younger than 5 years was a possible risk factor. INTERPRETATION: In the subpopulation of Brazilian typically developing children with a first unprovoked epileptic seizure there is a high recurrence rate. An abnormal EEG was a common finding, although it was not associated with a higher risk of seizure recurrence. A possible risk factor was age younger than 5 years, which may suggest a more rigorous follow-up of these patients.

Internet addiction and its correlation with behavioral problems and functional impairments - A cross-sectional study / Dependência de internet e sua correlação com sintomas comportamentais e prejuízos funcionais - Um estudo transversal

ABSTRACT Objective Evaluate the prevalence of internet addiction (IA) among adolescents, as well as characterize behaviors that are considered to be a risk in this population regarding the use and addiction of the Internet. Methods In this cross-sectional study conducted in one public and one private school 91 adolescents, aged 12 to 16 years old, responded the Internet Addiction Test - Brazilian version (IAT) and Child Behavior Checklist (CBCL). Results The prevalence of internet addiction found was 21%, with no difference between private and public schools. On the group dependent on the Internet, there was a statistically significant correlation with Anxiety/Depression, Withdrawn/Depression, Rule Breaking Behavior and Aggressive Behavior, as well as the syndrome scales Social Problems, Thought Problems and Attention Problems. Conclusion Our study provides evidence of a relationship between internet addiction and behavioral problems among adolescents. As this is a cross-sectional study, we consider that future research is necessary to corroborate our results.

RESUMO Objetivo Avaliar a prevalência da dependência de internet entre adolescentes, assim como caracterizar comportamentos de risco nessa população em relação ao uso e à dependência de internet. Métodos Estudo transversal analítico realizado em dois colégios, um público e um particular, com 91 adolescentes de idade entre 12 e 16 anos, que responderam aos questionários Internet Addiction Test - versão brasileira (IAT) e Child Behavior Checklist (CBCL). Resultados Entre a população estudada, a prevalência de dependência de internet encontrada foi de 21%, não havendo diferença entre as escolas pública e particular. No grupo dependente de internet, houve relação estatisticamente significativa com os sintomas Ansiedade/Depressão, Isolamento/Depressão e Comportamento Agressivo e de Quebrar Regras. As escalas Problemas Sociais, Problemas de Pensamento e Problemas de Atenção também se correlacionam à dependência de internet. Conclusão O presente estudo demonstra evidência de correlação entre a dependência de internet e sintomas comportamentais entre adolescentes. Por se tratar de um estudo transversal, contudo, esses dados devem ser vistos com cautela e pesquisas futuras são necessárias para corroborar nossos resultados.

Relação entre vínculo de apego e desenvolvimento cognitivo, linguístico e motor / Relationship between attachment bond and cognitive, language and motor development / Relación entre el vinculo de apego y el desarrollo cognitivo, lingüístico y motor

O estabelecimento de uma relação de apego segura é importante, pois fornece à criança segurança para que ela possa explorar o ambiente, atividade essencial para o desenvolvimento infantil. Este estudo tem como objetivo investigar se crianças com padrão de apego seguro e inseguro diferem quanto ao desempenho cognitivo, linguístico e motor. Participaram do estudo 50 crianças, com idades entre 12 e 25 meses. Foram utilizados um questionário de anamnese, a Situação Estranha de Ainsworth, as Escalas Bayley de Desenvolvimento Infantil ­ 3ª ed. e o questionário Estilo Materno como instrumentos de avaliação. Os resultados apontam diferença entre os grupos no desempenho cognitivo e de linguagem. Crianças com padrões inseguros de apego obtiveram menores escores nos testes que avaliam o desenvolvimento dos dois domínios. Estes resultados demonstram a importância da relação entre mãe e filho como um fator de proteção do desenvolvimento.

Establishing a secure attachment relationship is important because it provides security for the child to explore the environment, an essential activity for child development. This study aims to investigate whether children with a secure and insecure attachment pattern differ in cognitive, linguistic and motor performance. Fifty children, aged between 12 and 25 months, participated in the study. An anamnesis questionnaire, the Ainsworth Strange Situation, the Bayley Child Development Scales ­ 3rd ed. and the Maternal Style questionnaire were used as assessment tools. The results show a difference between groups in cognitive and language performance. Children with insecure attachment patterns had lower scores on tests that assessed the development of both domains. These results demonstrate the importance of the relationship between mother and child as a protective factor of development.

El establecimiento de una relación de apego seguro es importante porque proporciona seguridad al niño para que pueda explorar el ambiente, actividad esencial para el desarrollo infantil. En este estudio, se tiene como objetivo investigar si los niños con patrón de apego seguro e inseguro difieren en cuanto al desempeño cognitivo, lingüístico y motor. El estudio incluyó a 50 niños con edades comprendidas entre 12 y 25 meses. Se utilizó una ficha de anamnesis, la situación extraña de Ainsworth, las Escalas Bayley de Desarrollo Infantil ­ 3ª ed. y el cuestionario Estilo Materno como instrumentos de evaluación. Los resultados apuntam a una diferencia entre los grupos en el desempeño cognitivo y del lenguaje. Los niños con tipos de apego inseguro tenían puntuaciones más bajas en las pruebas que evalúan el desarrollo de los dos campos. Estos resultados demuestran la importancia de la relación entre la madre y el niño como un factor de protección del desarrollo.

Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation.

OBJECTIVE: Evaluate side-to-side discrepancies in children with hemiplegic cerebral palsy (HCP), and investigate associations of these discrepancies with patients' age at initiation of physical therapy, motor and cognitive function, and degree of activities and social participation. METHOD: We obtained eight side-to-side measurements from 24 HCP children with mean age 49.3±5.2 months. RESULTS: Early initiation of physical therapy was associated with lower discrepancy in hand length (p=0.037). Lower foot length discrepancy was associated with lower requirement for caregiver assistance in activities related to mobility. Increased side-to-side discrepancy was associated with reduced wrist extension and increased spasticity. Discrepancy played a larger role in children with hemineglect and in those with right involvement. CONCLUSION: Increased discrepancy in HCP children was associated with reduced degree of activity/social participation. These results suggest an association between functional use of the extremities and limb growth.

Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation / Discrepâncias no crescimento dos dimídios em crianças com paralisia cerebral hemiplégica: associação com a função, atividades e participação social

Objective: Evaluate side-to-side discrepancies in children with hemiplegic cerebral palsy (HCP), and investigate associations of these discrepancies with patients’ age at initiation of physical therapy, motor and cognitive function, and degree of activities and social participation. Method: We obtained eight side-to-side measurements from 24 HCP children with mean age 49.3±5.2 months. Results: Early initiation of physical therapy was associated with lower discrepancy in hand length (p=0.037). Lower foot length discrepancy was associated with lower requirement for caregiver assistance in activities related to mobility. Increased side-to-side discrepancy was associated with reduced wrist extension and increased spasticity. Discrepancy played a larger role in children with hemineglect and in those with right involvement. Conclusion: Increased discrepancy in HCP children was associated with reduced degree of activity/social participation. These results suggest an association between functional use of the extremities and limb growth. .

Objetivo: Avaliar a discrepância entre o crescimento dos lados do corpo em crianças com paralisia cerebral hemiplégica (PCH), e investigar sua associação com a idade de início do tratamento de fisioterapia, função motora e cognitiva, grau de atividades e participação social. Método: Comparamos oito medidas obtidas de 24 crianças com PCH e com média de idade de 49,3±5,2 meses. Resultados: O início precoce da fisioterapia se relacionou à menor discrepância no comprimento da mão (p=0,037). A menor discrepância no comprimento do pé se relacionou à menor necessidade de ajuda do cuidador em atividades de mobilidade. A maior discrepância esteve relacionada à menor extensão de punho e à maior espasticidade. A discrepância foi mais importante em crianças com heminegligência e com envolvimento à direita. Conclusão: Crianças com PCH com maior discrepância apresentaram menor atividade/participação social. Os resultados sugerem associação entre o uso funcional da mão e o crescimento das extremidades. .

Niemann-Pick disease type C: a case series of Brazilian patients.

UNLABELLED: The aim of the study was to analyze a series of Brazilian patients with Niemann-Pick disease type C (NP-C). METHOD: Correlations between clinical findings, laboratory data, molecular findings and treatment response are presented. RESULT: The sample consisted of 5 patients aged 8 to 26 years. Vertical supranuclear gaze palsy, cerebellar ataxia, dementia, dystonia and dysarthria were present in all cases. Filipin staining showed the "classical" pattern in two patients and a "variant" pattern in three patients. Molecular analysis found mutations in the NPC1 gene in all alleles. Miglustat treatment was administered to 4 patients. CONCLUSION: Although filipin staining should be used to confirm the diagnosis, bone marrow sea-blue histiocytes often help to diagnosis of NP-C. The p.P1007A mutation seems to be correlated with the "variant" pattern in filipin staining. Miglustat treatment response seems to be correlated with the age at disease onset and disability scale score at diagnosis.

Niemann-Pick disease type C: a case series of Brazilian patients / Doenca de Niemann-Pick tipo C: serie de casos de pacientes brasileiros

The aim of the study was to analyze a series of Brazilian patients with Niemann-Pick disease type C (NP-C). Method Correlations between clinical findings, laboratory data, molecular findings and treatment response are presented. Result The sample consisted of 5 patients aged 8 to 26 years. Vertical supranuclear gaze palsy, cerebellar ataxia, dementia, dystonia and dysarthria were present in all cases. Filipin staining showed the “classical” pattern in two patients and a “variant” pattern in three patients. Molecular analysis found mutations in the NPC1 gene in all alleles. Miglustat treatment was administered to 4 patients. Conclusion Although filipin staining should be used to confirm the diagnosis, bone marrow sea-blue histiocytes often help to diagnosis of NP-C. The p.P1007A mutation seems to be correlated with the “variant” pattern in filipin staining. Miglustat treatment response seems to be correlated with the age at disease onset and disability scale score at diagnosis. .

O objetivo desse estudo foi analisar uma série de casos de pacientes brasileiros com doença de Niemann-Pick tipo C (NP-C). Método Correlação entre manifestações clínicas, alterações laboratoriais, estudo molecular e resposta ao tratamento foram realizadas. Resultado A amostra consiste de 5 pacientes com idade entre 8 e 26 anos. Paralisia do olhar vertical supranuclear, ataxia cerebelar, demência, distonia e disartria estavam presentes em todos os casos. Coloração de filipina na cultura de fibroblastos mostrou padrão “clássico” em dois pacientes e padrão “variante” em três casos. O estudo molecular encontrou mutações no gene NPC1 em todos os alelos. O tratamento com miglustate foi realizado em 4 pacientes. Conclusão Embora coloração de filipina seja utilizada para confirmar o diagnóstico, o histiócito azul-marinho no aspirado de medula óssea frequentemente auxilia a confirmar o diagnóstico de NP-C. A mutação p.P1007A está correlacionada com o padrão “ variante” na coloração de filipina. A resposta ao tratamento com miglustate parece estar correlacionada com a idade e escore de desabilidade no momento do diagnóstico. .

Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study.

OBJECTIVE: To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP). Only the study group (SG) received early treatment of spasticity with botulinum neurotoxin type A (BXT-A). METHODS: Gross Motor Function Measure (GMFM), functional performance (Pediatric Evaluation of Disability Inventory - PEDI), range of movement, gait pattern (Physician Rating Scale - PRS) and the speed of hand movements were considered. RESULTS: The SG, composed of 11 HCP (45.64±6.3 months), was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months). SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. CONCLUSION: Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance.

Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study / Efeitos do tratamento precoce da espasticidade em criancas com paralisia cerebral hemiplegica: um estudo preliminar

Objective To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP). Only the study group (SG) received early treatment of spasticity with botulinum neurotoxin type A (BXT-A). Methods Gross Motor Function Measure (GMFM), functional performance (Pediatric Evaluation of Disability Inventory - PEDI), range of movement, gait pattern (Physician Rating Scale - PRS) and the speed of hand movements were considered. Results The SG, composed of 11 HCP (45.64±6.3 months), was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months). SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. Conclusion Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance. .

Objetivo Comparar a performance motora e funcional de dois grupos de crianças com paralisia cerebral hemiplégica (PCH). Apenas o grupo de estudo (GE) recebeu tratamento precoce da espasticidade com toxina botulínica do tipo A (BXT-A). Métodos Foram considerados a Função Motora Grossa (Gross Motor Function Measure - GMFM), performance funcional (Pediatric Evaluation of Disability Inventory - PEDI), amplitude de movimento, padrão da marcha (Physician Rating Scale - PRS) e a velocidade de movimento das mãos. Resultados O GE, composto de 11 PCH (45,64±6,3 meses), foi analisado em relação ao grupo de comparação, composto por 13 PCH (45,92±6,4 meses). O GE mostrou maiores escores em quatro das cinco dimensões da GMFM, sendo a diferença estatisticamente significativa na dimensão B, e melhores escores em cinco das seis áreas avaliadas na PEDI. A extensão ativa do punho, a velocidade de movimento das mãos e o escore na PRS foram maiores no GE. Conclusão As crianças que receberam tratamento precoce da espasticidade com BXT-A mostraram melhores escores motores e funcionais. .

Identification and functional characterization of a novel mutation in the NKX2-1 gene: comparison with the data in the literature.

BACKGROUND: NKX2-1 mutations have been described in several patients with primary congenital hypothyroidism, respiratory distress, and benign hereditary chorea, which are classical manifestations of the brain-thyroid-lung syndrome (BTLS). METHODS: The NKX2-1 gene was sequenced in the members of a Brazilian family with clinical features of BTLS, and a novel monoallelic mutation was identified in the affected patients. We introduced the mutation in an expression vector for the functional characterization by transfection experiments using both thyroidal and lung-specific promoters. RESULTS: The mutation is a deletion of a cytosine at position 834 (ref. sequence NM_003317) (c.493delC) that causes a frameshift with formation of an abnormal protein from amino acid 165 and a premature stop at position 196. The last amino acid of the nuclear localization signal, the whole homeodomain, and the carboxy-terminus of NKX2-1 are all missing in the mutant protein, which has a premature stop codon at position 196 (p.Arg165Glyfs*32). The p.Arg165Glyfs*32 mutant does not bind DNA, and it is unable to transactivate the thyroglobulin (Tg) and the surfactant protein-C (SP-C) promoters. Interestingly, a dose-dependent dominant negative effect of the p.Arg165Glyfs*32 was demonstrated only on the Tg promoter, but not on the SP-C promoter. This effect was also noticed when the mutation was tested in presence of PAX8 or cofactors that synergize with NKX2-1 (P300 and TAZ). The functional effect was also compared with the data present in the literature and demonstrated that, so far, it is very difficult to establish a specific correlation among NKX2-1 mutations, their functional consequence, and the clinical phenotype of affected patients, thus suggesting that the detailed mechanisms of transcriptional regulation still remain unclear. CONCLUSIONS: We describe a novel NKX2-1 mutation and demonstrate that haploinsufficiency may not be the only explanation for BTLS. Our results indicate that NKX2-1 activity is also finely regulated in a tissue-specific manner, and additional studies are required to better understand the complexities of genotype-phenotype correlations in the NKX2-1 deficiency syndrome.

Triagem cognitiva e comportamental de crianças com dificuldades de aprendizagem escolar: um estudo preliminar / Cognitive and behavioral screening of children with learning disabilities: a preliminary study / Selección cognitiva y conductual de niños con dificultades de aprendizaje escolar: un estudio preliminar

Avaliar a aplicabilidade do Mini-Mental State Examination (MMSE) e da lista de sintomas pediátricos (LSP) como teste de triagem cognitiva e de problemas psicossociais em crianças com dificuldades de aprendizagem. MÉTODOS: Estudo descritivo e transversal envolvendo 103 crianças entre seis e nove anos de uma escola pública de Curitiba (PR) com prováveis dificuldades de aprendizagem, realizado de 1º de março de 2002 a 30 de junho de 2009. Os dados foram obtidos simultaneamente por uma equipe multidisciplinar na avaliação inicial, com a aplicação do MMSE, da LSP e do Wechsler Intelligence Scale for Children (WISC III). Após 2007 o Child Behavior Checklist (CBCL) e o Teacher's Report Form (TRF) foram utilizados, sendo também comparados à LSP. Os coeficientes de correlação entre os testes foram calculados, sendo significante p<0,05. RESULTADOS: Das crianças analisadas, 10 por cento apresentavam algum tipo de dificuldade de aprendizagem, sendo 76 por cento do sexo masculino e 24 por cento do feminino. A faixa etária mais prevalente foi entre seis e sete anos de idade. História familiar positiva ocorreu em 45 por cento dos casos e antecedentes obstétricos em 18 por cento, sendo o baixo peso o mais frequente. O escore do MMSE mostrou correlação com o do WISC III (r=0,73) e o CBCL mostrou moderada correlação com o LSP (r=0,53). CONCLUSÕES: O MMSE e a LSP podem ser utilizados pelo pediatra como triagem cognitiva e de problemas psicossociais em crianças com dificuldade de aprendizagem.

To evaluate the applicability of the Mini-Mental State Examination (MMSE) and the Pediatric Symptom Checklist (PSC) as a screening test for cognitive and psychosocial problems in children with learning disabilities. METHODS: Descriptive and cross-sectional study involving 103 children aged 6 to 9 years, with possible learning disabilities, referred from a public school in Curitiba, Brazil, from March 1, 2002 to June 30, 2009. Data were simultaneously collected by a multidisciplinary team using the PSC, MMSE, and Wechsler Intelligence Scale for Children (WISC-III). From 2007 on the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) were used and compared with the PSC. Correlation coefficients between the tests were calculated, with the significance level set at p<0.05. RESULTS: Among the studied children, 10 percent had some type of learning disability, 76 percent were male, and 24 percent were female. The most prevalent age group was 6 to 7 years. A positive family history was found in 45 percent of cases, and an adverse obstetric history in 18 percent, with low birth weight the most common issue. Correlations were detected between the MMSE and WISC-III (r=0.73) and between the CBCL and PSC (r=0.53). CONCLUSION: The MMSE and PSC can be used by pediatricians as screening tools for detection of cognitive and psychosocial problems in children with learning disabilities.

Evaluar la aplicabilidad del mini-mental state examination (MMSE) y de la lista de síntomas pediátricos (LSP) como prueba de selección cognitiva y de problemas psicosociales en niños con dificultades de aprendizaje. MÉTODOS: Estudio descriptivo y transversal implicando a 103 niños entre seis y nueve años de una escuela pública de Curitiba (Paraná, Brasil) con probables dificultades de aprendizaje, realizado desde el 1 de marzo de 2002 hasta el 30 de junio de 2009. Los datos se obtuvieron simultáneamente por un equipo multidisciplinario en la evaluación inicial, con la aplicación del MMSE, de la LSP y del Wechsler intelligence scale for children (WISC III). Después de 2007 el child behavior checklist (CBCL) y el teacher's report form (TRF) fueron utilizados, siendo también comparados a la LSP. Los coeficientes de correlación entre las pruebas fueron calculados, siendo significante p<0,05. RESULTADOS: De los niños analizados, el 10 por ciento presentaba algún tipo de dificultad de aprendizaje, siendo el 76 por ciento del sexo masculino y el 24 por ciento del femenino. La franja de edad más prevalente fue entre seis y siete años. Historia familiar positiva ocurrió en el 45 por ciento de los casos y antecedentes obstétricos en 18 por ciento, siendo el bajo peso el más frecuente. El escore del MMSE mostró correlación con el del WISC III (r=0,73) y el CBCL mostró moderada correlación con el LSP (r=0,53). CONCLUSIONES: El pediatra puede utilizar el MMSE y la LSP como selección cognitiva y de problemas psicosociales en niños con dificultad de aprendizaje.

Inclusão escolar de crianças e adolescentes com paralisia cerebral: esta é uma realidade possível para todas elas em nossos dias? / School inclusion of children and adolescents with cerebral palsy: is this possible for all of them in our days?

OBJETIVO: Descrever a distribuição escolar de um grupo de crianças e adolescentes com paralisia cerebral (PC) e analisar o impacto da função motora grossa e outros déficits no processo de inclusão. MÉTODOS: Estudo prospectivo de pacientes do Ambulatório de Paralisia Cerebral da Universidade Federal do Paraná, avaliados em 2005. Pais ou cuidador completaram um questionário com dados relativos a: tipo de escola frequentada, dificuldades do aprendizado e necessidade de suporte psicopedagógico e fonoaudiológico. Os dados obtidos incluíram quem era o cuidador primário, seu nível de escolaridade e renda. As variáveis coletadas dos prontuários foram antecedentes perinatais e pós-natais, classificação topográfica da PC e função motora (Sistema de Classificação Motora Grossa - SCFMG), classificação da fala e presença de epilepsia. RESULTADOS: 105 crianças e adolescentes foram incluídos. A média de idade foi 10,8 anos, 61 (58 por cento) masculinos. Dentre as 105 crianças, 97 (92 por cento) frequentavam a escola, 36 (34 por cento) em classe regular, 7 (6,5 por cento) em classe especial e 54 (51 por cento) em escola especial. Crianças que frequentavam a escolar regular apresentavam predominantemente SCFMG nível I ou II, hemiplegia, epilepsia ausente ou com bom controle e fala normal ou disartria. Aqueles em escola especial eram crianças com SCFMG níveis III, IV e V, diplegia ou tetraplegia, epilepsia refratária e atraso na fala ou sua ausência. CONCLUSÕES: Até o momento, a inclusão de crianças com PC em escolas regulares parece trazer benefícios para aquelas com hemiplegia, nível I ou II do SCMFG, sem epilepsia e com fala normal.

OBJECTIVE: To describe the school distribution of a group of children and adolescents with cerebral palsy (CP) and to analyze the impact of gross motor function and other deficits in the inclusion process. METHODS: Prospective study of patients from de Outpatient Clinic for Cerebral Palsy of the Federal University of Paraná, Brazil, in 2005. Parents or caregivers completed a questionnaire about type of school attended at the moment, learning disabilities, and need for psychopedagogic and speech-language support. Data collected included who was primary caregiver, his/her school level and per capita income. Data obtained from medical records were: perinatal and post natal antecedents, topographic classification of CP and motor function (Gross Motor Function Classification System - GMFCS), speech classification and presence of epilepsy. RESULTS: 105 children and adolescents were included. Mean age was 10.8 years old and 61 (58 percent) were male; 97 (92 percent) attended school, with 36 (34 percent) in regular classes, 7 (6.5 percent) in special classes and 54 (51 percent) in special schools. Most of the children attending regular school had GMFCS level I or II, hemiplegia, absence of epilepsy or good control of seizures and either normal speech or dysarthria. Those in special schools had GMFCS levels III, IV or V, diplegia or tetraplegia, refractory epilepsy and a delayed speech or muteness. CONCLUSIONS: Up to now, inclusion of children with CP in regular schools proved to be indicated for those hemiplegic, with GMFCS level I or II, without epilepsy and with normal speech.

Valor preditivo de avaliação neurológica no desenvolvimento cognitivo de crianças nascidas pré-termo / Predictive value of neurological assessment in cognitive development of children born preterm

O objetivo deste estudo foi analisar o valor preditivo da Avaliação Neurológica Amiel-Tison no desenvolvimento cognitivo de crianças nascidas pré-termo. Foi estudada uma amostra de 23 crianças pré-termo, com idade cronológica entre 10 e 36 meses, que haviam sido submetidas à avaliação neurológica durante internação na UTINeo. A avaliação cognitiva foi realizada através do Screening Test das Escalas Bayley-III. Pouco mais de 78 por cento das crianças obtiveram resultados normais no exame neurológico e na avaliação cognitiva. Mas houve dois casos de falsos positivos e dois de falsos negativos. Segundo a análise estatística realizada através do teste Qui-quadrado (p=0,05), o instrumento Amiel-Tison não teve valor preditivo significativo para o desenvolvimento cognitivo (p=0,083). Apesar das limitações, este estudo vem no sentido de ressaltar a importância de pesquisas que indiquem um método sistemático de avaliação neurológica e neuropsicológica para esta população de risco, para que ocorram investimentos em ações preventivas e interventivas adequadas.(AU)

The purpose of this study was to analyze the predictive value of Amiel-Tison Neurological Assessment in the cognitive development of preterm children. The sample consisted of 23 children born preterm, between 10 and 36 months of chronological age, who had undergone neurological assessment during hospitalization in the NICU. The cognitive assessment was performed by the Screening Test of Bayley-III. Approximately 78 percent of children had normal results on neurological examination and cognitive assessment. But there were two cases of false positives and two cases of false negatives. According to statistical analysis using Chi-square (p=0.05), the instrument Amiel-Tison had no significant predictive value for cognitive development (p=0.083). Despite the limitations, this study contributed to emphasize the relevance of more research that indicate a systematic method of neurological and neuropsychological assessment of this population, that can be invested in preventive and interventional measures.(AU)

Valor preditivo de avaliação neurológica no desenvolvimento cognitivo de crianças nascidas pré-termo / Predictive value of neurological assessment in cognitive development of children born preterm

O objetivo deste estudo foi analisar o valor preditivo da Avaliação Neurológica Amiel-Tison no desenvolvimento cognitivo de crianças nascidas pré-termo. Foi estudada uma amostra de 23 crianças pré-termo, com idade cronológica entre 10 e 36 meses, que haviam sido submetidas à avaliação neurológica durante internação na UTINeo. A avaliação cognitiva foi realizada através do Screening Test das Escalas Bayley-III. Pouco mais de 78 por cento das crianças obtiveram resultados normais no exame neurológico e na avaliação cognitiva. Mas houve dois casos de falsos positivos e dois de falsos negativos. Segundo a análise estatística realizada através do teste Qui-quadrado (p=0,05), o instrumento Amiel-Tison não teve valor preditivo significativo para o desenvolvimento cognitivo (p=0,083). Apesar das limitações, este estudo vem no sentido de ressaltar a importância de pesquisas que indiquem um método sistemático de avaliação neurológica e neuropsicológica para esta população de risco, para que ocorram investimentos em ações preventivas e interventivas adequadas.

The purpose of this study was to analyze the predictive value of Amiel-Tison Neurological Assessment in the cognitive development of preterm children. The sample consisted of 23 children born preterm, between 10 and 36 months of chronological age, who had undergone neurological assessment during hospitalization in the NICU. The cognitive assessment was performed by the Screening Test of Bayley-III. Approximately 78 percent of children had normal results on neurological examination and cognitive assessment. But there were two cases of false positives and two cases of false negatives. According to statistical analysis using Chi-square (p=0.05), the instrument Amiel-Tison had no significant predictive value for cognitive development (p=0.083). Despite the limitations, this study contributed to emphasize the relevance of more research that indicate a systematic method of neurological and neuropsychological assessment of this population, that can be invested in preventive and interventional measures.

Effective results with botulinum toxin in cerebral palsy.

This study evaluated the improvement in clinical measures and quality of life (QOL) among patients with cerebral palsy treated with botulinum toxin type A. Fifty-seven parents of cerebral palsy patients who used botulinum toxin during the time of the study were enrolled. The QOL questionnaires included the following: Child Caregiver Questionnaire, Pediatrics Outcomes Data Collection Instrument, and clinical evaluations. The questionnaires were administered before the first use of botulinum toxin and approximately 1 year later, a mean interval of 13.8 months. Treatment resulted in clinical improvement in tone, upper limb function, and Gross Motor Function Classification System score. Better outcomes were observed in patients younger than 6.5 years. QOL questionnaires revealed a tendency toward improvement in the comfort dimension of the Child Caregiver Questionnaire as well as in the upper extremities and physical functions, transfers and basic mobility, and global function and symptom of the Pediatrics Outcomes Data Collection Instrument. The QOL measures correlated with clinical evaluations. Patients with low cognitive ability and refractory epilepsy had the worst results. Children and adolescents have reduced spasticity and experience good results in the clinical measurements and in QOL after treatment with botulinum toxin.

Crescimento e antropometria em pacientes com paralisia cerebral hemiplégica / Growth and anthropometry in hemiplegic cerebral palsy patients

OBJETIVO: Analisar o crescimento linear, o perímetro cefálico e as diferenças antropométricas entre o lado envolvido e o não-envolvido de 24 crianças com paralisia cerebral (PC) hemiplégica, comparados à média para a idade. MÉTODOS: Estudo transversal com amostragem consecutiva de crianças com PC, classificadas clinicamente como hemiplegia espástica. As medidas antropométricas incluíram: peso, estatura, perímetro cefálico, comprimento total de membro superior, comprimento da mão, largura da palma da mão, comprimento total do membro inferior, comprimento do pé e a circunferência dos membros (braço, coxa e panturrilha). As diferenças antropométricas entre os dimídios foram calculadas em centímetros e como porcentagem de encurtamento, comparando o lado envolvido com o não-envolvido. Dois referenciais populacionais, tabelas de crescimento e o software ABase®, desenvolvido para sistema PalmOS, foram comparados na classificação das medidas do comprimento da mão e do pé. A análise estatística utilizou o coeficiente de correlação de Spearman para avaliar a associação entre variáveis quantitativas e o teste não-paramétrico de Wilcoxon para comparar as medidas do lado envolvido e não-envolvido. RESULTADOS: As médias de peso, estatura e perímetro cefálico se mostraram dentro dos limites normais para a idade e 21 por cento dos pacientes apresentaram microcefalia. A discrepância entre os dimídios foi evidente em todos os casos, sendo maior na largura e comprimento da mão. Houve correlação da dis observada entre os membros superiores e inferiores no lado envolvido (r=0,48) e a discrepância aumenta com a idade (r=0,44). CONCLUSÕES: O maior comprometimento no crescimento das crianças com paralisia cerebral estudadas ocorreu nos membros envolvidos pela hemiplegia e, em menor proporção, no perímetro cefálico.

OBJECTIVE: To analyze the linear growth, the head circumference and the anthropometric differences between involved and non-involved sides of 24 children with hemiplegic cerebral palsy, comparing them to standard values for age. METHODS: This cross-sectional study enrolled 24 consecutive children with cerebral palsy clinically classified as spastic hemiplegia. The anthropometric measures included: weight, lenght, head circumference, total upper limb length, hand length, palm width, total lower limb length, foot length, and limb circumference of upper-arm, thigh and calf. The anthropometric differences between both sides were calculated in centimeters and a comparison of the involved and non-involved sides was made. Two different reference values were used to compare the measures of hand and foot length: growth charts and the software ABase® (a PalmOS-based software). The Spearman's correlation coefficient was estimated for the association between quantitative variables and the Wilcoxon non-parametric test was used for age comparisons between involved and noninvolved sides. RESULTS: The mean values of weight, length and head circumference were within the normal range for age and 21 percent of the children presented microcephaly. Discrepancy was noted between both sides in all cases, being the largest discrepancy in hand length and width. There was a positive correlation between the discrepancy observed in superior and inferior affected limbs (r=0.48), and discrepancy increases with age (r=0.44). CONCLUSION: Growth impairment in children with hemiplegic cerebral palsy was observed on the affected limbs and in smaller proportion in head circumference.