Desenvolvimento infantil e práticas parentais de crianças brasileiras no segundo ano da pandemia de COVID-19 / Child development and parenting practices of Brazilian children in the second year of the COVID-19 pandemic

Usando o modelo biopsicossocial da CIF, este estudo teve o objetivo de examinar a associação entre o desenvolvimento infantil e as práticas parentais de famílias brasileiras no segundo ano da pandemia de COVID-19. Trata-se de uma pesquisa descritiva transversal que envolveu 30 crianças e suas respectivas famílias. O teste Denver-II foi aplicado presencialmente, e, de forma virtual, as famílias responderam perguntas sobre fatores biológicos e ambientais relacionados à interferência da pandemia no cotidiano da criança. Verificou-se que 83,3% das crianças foram classificadas com desenvolvimento típico, e 16,7%, com desenvolvimento questionável. Quanto às práticas parentais durante a COVID-19, identificou-se que as crianças tiveram tempo excessivo de tela (60%) e diferentes impactos comportamentais e emocionais (43,3%). Apesar do potencial da pandemia de afetar o desenvolvimento das crianças, não houve efeito negativo do segundo ano da pandemia no desenvolvimento global, o que pode dever-se às características dos participantes e suas famílias.

Using the ICF biopsychosocial model, this study aimed to examine the association between child development and parenting practices of Brazilian families during the second year of the COVID-19 pandemic. This was a descriptive cross-sectional study. Thirty children and their respective families participated. Denver-II test was applied in person. In a virtual form, families answered questions about biological and environmental factors related to the interference of the COVID-19 pandemic in the child's daily life. It was verified that 83,3% of children were classified with typical development and 16,7% of children with questionable development. Regarding parenting practices during the pandemic, it was identified that children had excessive screen time (60%) and different behavioural, and emotional impacts (43.3%). Despite the potential of the pandemic to affect children's development, there was no negative effect of the second year of the COVID-19 pandemic on their global development which could be due to the characteristics of the participants and their families.

Mom Didn't Go to School, Dad Is Out of Work: Associations between Maternal Educational Attainment, Family Socioeconomic Status, and Infant Development.

The purpose of this research is to assess the neuropsychomotor development (NPMD) of 6- to 18-month-old infants and identify factors that may pose a risk to their development. They underwent NPMD assessments, while the parents/guardians were interviewed through the other instruments. Altogether, 64 infants participated in this research. The results revealed infants with questionable NPMD: 29.7% verified with AIMS and 32.8%, with Denver II. There were significant associations between NPMD and maternal low educational attainment (P = .032); family low socioeconomic status and NPMD (P = .026), verified with AIMS and Denver II (P = .037); stimulation opportunities at home and maternal low educational attainment (P = .00026), socioeconomic status (P = .035), and NPMD, verified with AIMS (P = .02) and Denver II (P = .009). The following were identified as risk factors for NPMD: maternal low educational attainment (the lower her attainment, the more likely for the NPMD to be questionable) and family socioeconomic status (infants from disadvantaged homes tend to have questionable NPMD). Stimulation opportunities at home were also significantly associated with NPMD-that is, insufficient stimulations at home may lead to questionable NPMD.

Intimate Partner Violence Against Brazilian Mothers is Associated With Their Children's Lower Quality-of-Life Scores: A Cross-Sectional Study During the COVID-19 Pandemic.

The COVID-19 pandemic led to family and routine reorganization, triggering social problems. Women were further exposed to domestic violence, especially intimate partner violence (IPV), with consequences to their and their children's health. However, few Brazilian studies address the issue, especially considering the pandemic and its restrictive measures. The objective was to verify the relationship between mothers'/caregivers' IPV and their children's neuropsychomotor development (NPMD) and quality of life (QOL) during the pandemic. Seven hundred one female mothers/caregivers of children (0-12 years old) responded to the online epidemiological inquiry. NPMD was investigated with the Caregiver Reported Early Development Instruments (CREDI-short version); QOL, with the Pediatric Quality of Life Inventory (PedsQL™); and IPV, with the Composite Abuse Scale (CAS). The independence chi-square test was used, with Fisher's exact statistics, in SPSS Statistics 27®. Children whose mothers were exposed to IPV were 2.68 times as likely to have a "low" QOL score (χ2(1) = 13.144, P < .001; φ = 0.137). This indicates a possible environmental influence on the children's QOL, which may have been aggravated by strict social distancing during the COVID-19 pandemic.

Impacts of COVID-19 on Neuropsychomotor Development From the Perspective of the International Classification of Functioning, Disability and Health in a Case Series of Children Aged 4 to 24 Months Assessed in Land and Aquatic Settings.

Mitigation measures the pandemic caused by the coronavirus disease 2019 (COVID-19) can change neuropsychomotor development (NPMD), diminishing adaptation, learning, and physical and cognitive development skills. Biopsychosocial screening in this scenario requires specific physical therapy assessment for each intervention setting, with validated scales. Hence, the objective of this study was to analyze the consequences of the COVID-19 pandemic on NPMD based on a case series in 4-to-24-month-old children assessed on land and in water. Case series descriptive study, based on physical therapy assessments with the Alberta Infant Motor Scale (AIMS), Developmental Screening Test (Denver II), and Adaptation of the Aquatic Functional Assessment Scale for Babies (AFAS-BABY©). AIMS classified 8 children as typical NPMD and 5 as suspect NPMD, while Denver II classified 10 children as typical NPMD, 3 as questionable NPMD, and 2 as delayed NPMD. AFAS-BABY© created a qualitative profile, relating it to the land assessments. Thus, the consequences of the COVID-19 pandemic on NPMD were analyzed based on a case series in 4-to-24-month-old children assessed on land and in water.

Improvement of Balance, Motor Aspects, and Activities of Daily Living in Parkinson's Disease after a Sequential Multimodal Aquatic- and Land-Based Intervention Program.

Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (r). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.

Quality of life and neuropsychomotor development of infants between 4-18 months in daycare center.

Quality of Life (QoL) is a predictor of development depending on multiple factors, being the QoL of infants still little studied, especially in permanent settings such as infants educational center or daycare centers. Correlate quality of life with age, family income and the neuropsychomotor development of infants between 4 and 18 months of age in daycare centers. Descriptive transverse study research, with clinical trials registration : RBR 2hd6sm on November 2, 2016. Quality of life was evaluated with interviews with the family through Pediatric Quality of Life Inventory-PedsQL™ (Brazilian version). The infants were evaluated in a playful way, through the use of Alberta Infant Motor Scale (AIMS) and Denver II test . 88 infants participated in the study. The infants evaluated had a good quality of life, with scores above 64%. AIMS presented the correlation with for physical functioning and total score of QoL. QoL of infants from 4 to 18 months of age is correlated with their neuropsychomotor development, which suggests the need for investigations between this theme and daycare centers.

Quality of life and neuropsychomotor development of infants between 4-18 months in daycare center / Qualidade de vida e desenvolvimento neuropsicomotor de bebês de 4-18 meses em centros de educação infantil

Abstract Quality of Life (QoL) is a predictor of development depending on multiple factors, being the QoL of infants still little studied, especially in permanent settings such as infants educational center or daycare centers. Correlate quality of life with age, family income and the neuropsychomotor development of infants between 4 and 18 months of age in daycare centers. Descriptive transverse study research, with clinical trials registration : RBR 2hd6sm on November 2, 2016. Quality of life was evaluated with interviews with the family through Pediatric Quality of Life Inventory-PedsQL™ (Brazilian version). The infants were evaluated in a playful way, through the use of Alberta Infant Motor Scale (AIMS) and Denver II test . 88 infants participated in the study. The infants evaluated had a good quality of life, with scores above 64%. AIMS presented the correlation with for physical functioning and total score of QoL. QoL of infants from 4 to 18 months of age is correlated with their neuropsychomotor development, which suggests the need for investigations between this theme and daycare centers.

Resumo Qualidade de vida (QV) é um preditor de desenvolvimento e depende de múltiplos fatores, sendo a QV de bebês ainda pouco estudada, especialmente em ambientes de permanência como os centros de educação infantil ou creches. Correlacionar a qualidade de vida com idade, renda familiar e desenvolvimento neuropsicomotor de bebês entre 4 a 18 meses de idade que frequentam centros de educação infantil. Pesquisa descritiva transversal, com registro clínico RBR 2hd6sm em novembro de 2016. A Qualidade de Vida foi avaliada por meio de entrevistas com as famílias com o questionário Pediátrico de Qualidade de Vida-PedsQL™ (versão brasileira). Os bebês foram avaliados de maneira lúdica pela escala motora infantil de Alberta (AIMS) e pela Denver II. 88 bebês participaram do estudo. Os bebês avaliados tiveram uma boa qualidade de vida com escores acima de 64%. AIMS apresentou correlação com os escores de capacidade física e escore total de qualidade de vida. Qualidade de vida de bebês de 4 a 18 meses de idade correlacionam-se com seu desenvolvimento neuropsicomotor, sugerindo a necessidade de investigações sobre esse tema em centros de educação infantil.

Efeito imediato, agudo e crônico da Kinesio taping® associada à Terapia Neuromotora Intensiva na postura sentada de crianças com paralisia cerebral / Immediate, acute and chronic effects of Kinesio taping® associated with Intensive Neuromotor Therapy on the sitting position of children with cerebral paralysis

A fisioterapia utiliza vários recursos e métodos para intervenções no tratamento da Encefalopatia Crônica Não Progressiva da Infância (ECNPI) ou paralisia cerebral (PC), entre eles a Kinesio Taping® (KT) e a Terapia Neuromotora Intensiva (TNMI). Esses métodos podem ser considerados relativamente novos, o que leva à necessidade do desenvolvimento de pesquisas para verificar seus efeitos em crianças com PC. O presente estudo objetivou verificar os efeitos da KT® e da TNMI na postura sentada de crianças com PC do tipo quadriparesia/quadriplegia espástica. Para isso, foram avaliadas 6 crianças, com uma média de idade de 6,25±2,69 anos. As avaliações aconteceram por meio do software SAPO, no qual os dados são obtidos em centímetros e a análise consiste na avaliação da vertical (eixo Y), comparando os lados esquerdo e direito, sendo assim possível a análise das assimetrias de maneira precisa. Com relação aos resultados, não foi identificada diferença significativa (p > 0,05) da aplicação de KT® na comparação entre efeitos imediato, agudo e crônico para os momentos pré e pós aplicação imediata da KT®. No entanto, de forma descritiva, o uso de KT® associado à TNMI favoreceu o alinhamento na postura sentada, principalmente para acrômios e Espinha ilíaca ânterossuperior (EIAS). Nota-se, portanto, que as evidências do uso de KT®, como coadjuvante durante a TNMI, ainda são inconclusivas em crianças com PC do tipo quadriparesia/plegia.

Physical therapy uses various resources and methods for intervention in the Chronic Non-Progressive Childhood Encephalopathy (CNPCE) or cerebral palsy (CP) interventions, including Kinesio Taping® (KT) and Intensive Neuromotor Therapy (INMT). These methods are relatively new, which leads to the need for the development of research to verify effects in children with CP. The present study analyzed the effects of KT® and INMT on the sitting posture of children with spastic quadriplegia. In order to do this, six (6) children (mean age 6.25±2.69 years) were evaluated. The evaluations took place through SAPO software, where data are obtained in centimeters and the analysis consists of the evaluation of the vertical (Y) axis, comparing the left and right side, thus being possible to precisely analyze any asymmetries. Regarding the results, no significant difference (p > 0.05) was observed with the application of KT® in the comparison between immediate, acute and chronic effect for the moments before and immediately after KT® application. However, descriptively, the use of KT® associated with INMT favored alignment in sitting posture, mainly for acromial and anterior superior iliac spine (ASIS). The results show that evidence of the use of KT® as an adjuvant during INMT is still inconclusive in children with CP quadriparesis/plegia.

Kids Intervention Therapy - Aquatic Environment (KITE) for babies 4 to 18 months old, by following the International Classification of Functioning (ICF): clinical trial protocol

Abstract Introduction: the biopsychosocial (BPS) model from the perspective of the International Classification of Functioning (ICF) agrees with the current theories regarding child development. They state the interdependence between the individual's relations, environment and received stimuli. The early interventions, particularly in the aquatic environment (AE), present gaps concerning their systematization, above all in their being in accordance with the ICF. Objectives: to describe an ICF-based aquatic early intervention program, named KITE, for the neuropsychomotor development (NPMD) of typical, at-risk and/or delayed babies 4 to 18 months old. Methods: the KITE is a program systematized on the AE, centered on the family and the daycare environment; it takes place twice a week, lasting for 4 weeks, in 45- to 60-minute sessions. The assessments and interventions are systematized by following the ICF. For the main outcome on the NPMD, the Alberta Infant Motor Scale (AIMS) and the Denver Developmental Screening Test II (DDST-II) are used, and as the secondary outcome on the stimulation received, quality of life and aquatic skills, the Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS), the Pediatric Quality of Life Inventory (PedsQL™) and the Aquatic Functional Assessment Scale - Baby (AFAS Baby) are used, respectively. Conclusion: This study has presented tools for the application of a clinical trial through the KITE for the NPMD of babies, systematized and based on the BPS perspective of the ICF, and discussed according to the neuroplastic evidence of the child development.

Characterization of neuropsychomotor and language development of children receiving care from groups at an extended Family Health Care Center: an interprofessional approach / Caracterização do desenvolvimento neuropsicomotor e de linguagem de crianças atendidas por grupos no Núcleo Ampliado de Saúde da Família: uma abordagem interprofissional

ABSTRACT Purpose: to characterize the language and neuropsychomotor development of children referred for speech-language-hearing and physical therapy at an Extended Family Health Care Center (NASF) in Paranaguá, Paraná, Brazil. Methods: 36 children aged 3 to 13 (7.9 ± 2.3) years were assessed through anamnesis, speech-language-hearing assessment with a flipchart, and motor development scale (MDS). The analysis was made with the two-tailed Pearson correlation test. Results: 69% had no initial clinical diagnosis; 83% were referred by their school, due to suspected language difficulties (92%), which were confirmed. Children both at risk and with psychomotor delays represented 69% of the sample; 78% of the children had learning difficulties and overall motor age 16 months below their chronological age, on average. The psychomotor areas with the worst scores for motor age and motor quotient were temporal organization, body scheme, and spatial organization. School difficulties were related to delays in motor age (p = 0.03), MDS psychomotor profile classification (p = 0.01), overall motor quotient (p = 0.04), and psychomotor diagnosis (p = 0.001). Conclusion: it is concluded that children both at risk and with psychomotor delays pose a great demand. Most of them present language delays, and have difficulties in other areas as well, confirming the need for health professionals' multi- and interdisciplinary actions. NASF is an option for promoting follow-up and intervention.

RESUMO Objetivo: caracterizar o desenvolvimento neuropsicomotor e de linguagem de crianças encaminhadas para fonoaudiologia e fisioterapia do Núcleo Ampliado de Saúde da Família (NASF) de Paranaguá-PR, Brasil. Métodos: 36 crianças de 3-13 (7,9±2,3) anos foram avaliadas por meio de anamnese, avaliação fonológica por meio do álbum seriado e escala de desenvolvimento motor (EDM), e analisados pelo teste de correlação de Pearson bi-caudal. Resultados: 69% não apresentavam diagnóstico clínico inicial, com encaminhamentos (83%) feitos pela escola, por suspeitas de dificuldades na linguagem (92%), as quais foram confirmadas, sendo evidenciados risco e atrasos psicomotores em 69% da amostra, com 78% das crianças com dificuldade de aprendizado e com idade motora geral média 16 meses inferior à idade cronológica. As áreas psicomotoras com piores escores para idade motora e quociente motor foram: organização temporal, esquema corporal e organização espacial. As dificuldades escolares foram relacionadas a atrasos na idade motora (p=0,03), com a classificação do perfil psicomotor pela EDM (p=0,01), com quociente motor geral (p=0,04) e com diagnóstico psicomotor (p=0,001). Conclusão: Conclui-se que existe uma demanda de crianças em risco e atrasos psicomotores, na maioria identificadas com atraso de linguagem, que apresentam, também, dificuldades em outras áreas, ratificando a necessidade de ações multi e interdisciplinares de profissionais de saúde, sendo, o NASF, uma opção para promoção de acompanhamento e intervenção.

Sistematização de instrumentos de avaliação para os dois primeiros anos de vida de bebês típicos ou em risco conforme o modelo da CIF / Sistematización de herramientas de evaluación para los primeros dos años de vida de bebés típicos o en riesgo según el modelo CIF / Systematization of evaluation instruments for the two first years of life of typical or risk infants according to the ICF model

RESUMO O objetivo deste trabalho foi identificar instrumentos de avaliação do desenvolvimento neuropsicomotor (DNPM) de crianças de 0 a 2 anos, de baixo custo, que possam ser usados no contexto de creche e/ou ambiente clínico em programas de intervenção precoce, sistematizando esses instrumentos conforme o modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Foram selecionados instrumentos de avaliação do DNPM com tradução ou adaptação para o Brasil. Para isso os domínios da CIF foram escolhidos triangulando o checklist da própria CIF-CJ, core set de estimulação precoce e a última versão da CIF, para busca na literatura de instrumentos de avaliação. A sistematização das categorias selecionadas da CIF foi realizada por dois fisioterapeutas, e um terceiro para itens discordantes. As escalas que responderam aos critérios foram: Alberta Infant Motor Scale (AIMS), Teste de Triagem de Denver II, Inventário Pediátrico sobre Qualidade de Vida (PedSQl®), Affordance in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) e vínculo mãe-bebê. Mesmo com essas escalas, verificou-se a necessidade de um questionário de anamnese complementar para o responsável, dados da Caderneta de Saúde da Criança e de um questionário socioeconômico da Associação Brasileira de Empresas de Pesquisa para o Brasil (ABEP). Essa sistematização está disponível no apêndice, e procura facilitar o olhar ampliado do fisioterapeuta ou profissional da educação com abrangência biopsicossocial dos bebês, além de possibilitar a identificação de riscos de forma precoce e subsidiar ações de promoção e intervenção em diferentes contextos.

RESUMEN El objetivo de este estudio fue identificar herramientas de evaluación de desarrollo neuropsicomotor (DNPM) de bajo costo para niños de 0 a 2 años las cuales se pueden utilizar en el contexto de jardines infantiles y/o el entorno clínico en programas de intervención temprana, y sistematizar estos instrumentos como el modelo biopsicosocial de la Clasificación Internacional de Funcionamiento, Discapacidad y Salud (CIF). Se seleccionaron las herramientas de evaluación del DNPM con traducción o adaptación a Brasil. Para esto, los dominios de CIF se eligieron triangulando el checklist de la CIF-IA, core set de estimulación temprana y la última versión de CIF, para buscar en la literatura herramientas de evaluación. La sistematización de las categorías de CIF seleccionadas fue realizada por dos fisioterapeutas, y un tercero para artículos discordantes. Las escalas que cumplieron con los criterios fueron: Alberta Infant Motor Scale (AIMS), Prueba de tamizaje del desarrollo Denver II, Pediatric Quality of Life Inventory (PedSQl®), Affordance in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) y el enlace madre e hijo. Incluso con estas escalas, era necesario un cuestionario de anamnesis complementario para el tutor, datos del Manual de Salud Infantil y un cuestionario socioeconómico de la Asociación Brasileña de Empresas de Investigación para Brasil (Abep). Esta sistematización está disponible en el apéndice y busca facilitar la apariencia ampliada del fisioterapeuta o profesional de la educación con cobertura biopsicosocial de los bebés, así como permitir la identificación temprana de riesgos y subsidiar la promoción e intervención en diferentes contextos.

ABSTRACT The objective of this study was to identify low-cost instruments of evaluation of neuropsychomotor development (NPMD) of children aged zero to two years, that can be used in the context of daycare and/or clinical environment in early intervention programs, and to systematize these instruments as the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF). NPMD evaluation instruments with translation or adaptation for Brazil were selected. For this purpose, the ICF domains were chosen triangulating the ICF-CY's own checklist, the early stimulation core set, and the latest version of the ICF for searching the evaluation instruments in literature. Two physical therapists and a third for discordant items performed the systematization of the selected categories of ICF. The scales that met the criteria were: Alberta Infant Motor Scale (AIMS), Denver II Screening Test, PedIatric Quality of Life Inventory (PedSQl ™), Affordance in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) and Mother-child bond. Even with these scales, there was a need for a complementary anamnesis questionnaire for the infant's caregiver, data from the Child Health Handbook and a socioeconomic questionnaire from the Brazilian Association of Research Companies for Brazil (ABEP). This systematization is available in the appendix and seeks to facilitate the broader view of the physical therapist or education professional with a biopsychosocial comprehension of the infants, in addition to allowing the early identification of risks and subsidizing actions of promotion and intervention in different contexts.

Tecnologias no desenvolvimento neuropsicomotor em escolares de quatro a seis anos / Technologies in neuropsicomotor development in schools four to six years

Resumo Introdução Estudos apontam que as crianças estão passando cada vez mais tempo com a tecnologia. Objetivo Verificar a influência da tecnologia no desenvolvimento neuropsicomotor (DNPM) de crianças de quatro a seis anos de idade em uma escola particular. Método Aplicou-se um questionário a pais e mães referente ao tempo de exposição e formas de utilização de tecnologias e atividades lúdicas cotidianas e o teste Denver II, comparando o desempenho de crianças mais expostas às menos expostas à tecnologia. Resultados A tecnologia não influenciou o DNPM das crianças, possivelmente porque, além do uso de tecnologias, os pais relatam estímulos diversos, incluindo brincadeiras não tecnológicas. Observou-se uma influência da idade na existência de atrasos, de modo que quanto menor a idade maior o atraso neuropsicomotor. Conclusão Para esta amostra, a tecnologia não teve influência, porém sugere-se mais estudos com um número maior de participantes e de outras idades.

Abstract Introduction Studies indicate that children are spending more time with technology. Objective To verify the influence of technology in the neuro psychomotor development of children from four to six years of age in a private school. Method a questionnaire was applied to parents regarding the time of exposure and ways of using technologies and daily activities and was applied Denver II Test, comparing the performance of the most with those least exposed to the technology. Results technology does not influenced the neuropsychomotor development, possibly because besides the use of technologies, they report diverse stimuli, including jokes. An age influence was observed in the existence of delays, and the lower the age the greater the neuro psychomotor delay. Conclusion For this sample the technology had no influence, but more studies are suggested with a larger number of participants and other ages.

Relatos de Séries de Casos de Adultos Institucionalizados com Deficiência Múltipla: Como Avaliar a Funcionalidade? / Reports of Case Series of Institutionalized Adults with Multiple Disabilities: how to Assess Functionality?

RESUMO: O objetivo deste artigo é propor e aplicar uma forma de classificação neurofuncional, baseada em posicionamentos e transferências em adultos institucionalizados com deficiência múltipla grave. O método utilizado foi o estudo transversal, descritivo, em uma instituição de longa permanência de Curitiba, estado do Paraná. Foi realizada filmagem dos participantes nas posições da escala Gross Motor Function Measure (GMFM), transferências de posturas e deslocamento. A pontuação de 1 a 5 pontos foi dada a partir da escala Aquatic Functional Assessment Scale (AFAS), como uma adaptação em solo. Utilizou-se a Classificação Internacional da Funcionalidade (CIF) como ferramenta para detalhar as posições quanto aos qualificadores de facilitadores e restritores para cada participante. Foram avaliados cinco participantes com deficiência múltipla, com idades entre 21 e 29 anos, com predomínio do sexo feminino (80%). Apenas um participante tinha a marcha assistida e 3 (60%) apresentaram estereotipia de mãos ou tronco. As transferências entre as posições não foram realizadas de forma independente por nenhum participante. A maior pontuação encontrada pela AFAS foi de 14 pontos e a pior foi de 5 pontos. Os resultados indicam que a CIF foi sensível para perceber os movimentos ou posicionamentos restritores e facilitadores para cada um dos participantes, e ela pode ser capaz de auxiliar na escolha das melhores formas de avaliação.

ABSTRACT: The objective of this paper is to propose and apply a form of functional neurological classification, based on positioning and transference in institutionalized adults with severe multiple disabilities. The method used was the cross-sectional, descriptive study in a long-stay institution in Curitiba, state of Paraná, Brazil. Participants were filmed at the Gross Motor Function Measure (GMFM), posture transfer and displacement positions. The score from 1 to 5 points was given from the Aquatic Functional Assessment Scale (AFAS), as an adaptation to the floor. The International Classification of Functionality (ICF) was used as a toll to detail the positions regarding qualifiers of facilitators and restrictors for each participant. Five participants with multiple disabilities were evaluated, aged between 21 and 29 years, with a predominance of females (80%). Only one participant had assisted gait and 3 (60%) had stereotyped hands or upper body. Transfers between positions were not performed independently by any participant. The highest score found by AFAS was 14 points and the worst score was 5 points. The results indicate that the ICF was sensitive to perceive the movements or restrictive positions and facilitators for each of the participants and it may be able to help in choosing the best forms of evaluation.

Early intervention program by ICF model for babies of 4-18 months frequenting daycare center: protocol for clinical trial

A daycare center is a long-term place for infants, which means that early intervention programs should be thought of in this environment. There are still many gaps regarding the best way of stimulation/intervention, duration and description of effects and controlled outcomes. Aim: The objective of this clinical trial is to propose an early physical activity intervention program performed in infants of 4-18 months with risk/delay and with typical development at infant's daycare. Method: The protocol of this study is indicated for a controlled trial, in a crossover format, to be applied in 4 groups composed by in 4-18 month-old infants who attend daycare: Intervention group 1 Typical, Intervention group 1 Risk/delay, group Intervention 2 Typical, group Intervention 2 Risk/delay, in 4-18 month old infants who attend daycare. The ICF criteria about functions and structure (through evaluation questionnaire) are considered, as well as activities and participation (AIMS, Denver II, and PedsQl™ evaluation), personal characteristics (questionnaire, ABEP and AHEMD-IS) and environmental factors (AHEMD-IS). Conclusion: This original proposal can highlight a low-cost intervention program performed in a daycare environment verifying the infant's NMD in a systematized way using theoretical basis.(AU)

Avaliação psicomotora de crianças com paralisia cerebral deambuladoras: caracterização e aplicabilidade / Psycomotor evaluation of ambulatory children with cerebral palsy: characterization and applicability

Introdução: A paralisia cerebral (PC) promove desordens no desenvolvimento neuorpsicomotor (DNPM). Objetivo: verificar a aplicabilidade e caracterização do perfil psicomotor de seis crianças de 4 a 12 anos de idade com PC do tipo diplegia e hemiplegia, GMFCS I a III, deambuladoras. Métodos: estudo transversal que verificou o DNPM de crianças com PC hemiplégicas e diplégicas por meio da Bateria Psicomotora de Fonseca (BPM) de forma a adaptar às suas necessidades. Resultados: Verificou-se que foi possível adaptar a BPM para avaliar crianças com hemiplegia e diplegia deambuladoras em um tempo maior de avaliação, e que, com relação aos seus desempenhos, apenas uma criança apresentou perfil geral dispráxico e os demais com perfil típico eupráxico, demonstrando maiores dificuldades nos fatores praxia global e fina e estruturação espaço-temporal, itens esses que precisaram ser adaptados. Conclusão: É possível usar a BPM para avaliar crianças hemiplégicas e diplégicas com PC, permitindo identificar as áreas mais acometidas, numa perspectiva mais ampliada de avaliação que considere suas capacidades e funcionalidade.

Introduction: Cerebral palsy (CP) promotes neuropsychomotor disorders. Aim: verify the applicability and characterization of the psychomotor profile of six children from 4 to 12 years of age with ambulatory cerebral palsy (CP) diplegia and hemiplegia, GMFCS I to III. Methods: cross-sectional study that verified the psychomotor development of children with hemiplegic and diplegic CP through BPM in order to adapt to their needs. Results: It was verified that it was possible to adapt the Fonseca's Psycomotor Battery (BPM) to evaluate children with hemiplegia and ambulatory diplegia in a longer time of evaluation, and that, in relation to their performance, only one child presented a general dyspraxic profile and the others with typical eupráxico profile, showing larger difficulties in the global and fine praxia factors and spatio-temporal structuring, items that needed to be adapted. Conclusion: It is possible to use the BPM to evaluate hemiplegic and diplegic children with CP, allowing them to identify the most affected areas, in a broader perspective of evaluation that considers their capabilities and functionality.

Characterization of the neuropsychomotor development of children up to three years old: the ICF model in the context of the Family Health Support Center / Caracterização do desenvolvimento neuropsicomotor de crianças até três anos: o modelo da CIF no contexto do NASF

Abstract: Introduction: The neuropsychomotor development (NPMD) is dynamic and complex, explained by the contextual model, which can be discussed with an expanded view of health through the International Classification of Functioning, Disability, and Health (ICF). Objective: To characterize the NPMD of children up to 3 years old participating in the "Children's Milk Program" (CMP) from the ICF model in the context of the Family Health Support Center (FHSC) and to relate to individual, family, socioeconomic aspects and stimulation of the child in different environments. Method: In this study, 19 volunteer children, 10 (52.63%) boys and 9 girls (47.37%), aged 7-35 months old (19.42 ± 9.11), duly authorized by the person responsible participated in the study, evaluated through a semi-structured interview, and ABEP socioeconomic questionnaire, Denver Developmental Screening Test and Affordances in the Home Environment for Motor Development test. The instruments were related to ICF components for Children and Young People. The study was performed at the FHCS of a metropolitan city of Curitiba/PR, Brazil. Statistical analysis was performed using the Spearman's rô (rs) for non-parametric correlation, Mann-Whitney in quantitative comparison and Fisher's Exact Test in categorical data for occurrence probability. Results: Regarding the Denver II test, 9 (47.37%) children had questionable NPDM, and the language area was the most compromised (88.88%), 7 families (36.84% were classified in C1 by ABEP and 6 children (54.5%) up to 18 months old received adequate stimulation in the home environment and all the kids (n=8) over 19 months old, presented reasonable stimulation. The model proposed in this study responded to contextual approach of the ICF. Conclusion: It is necessary to use appropriate instruments to plan actions in basic care so children at risk to NPMD can be included in programs of early intervention, to enable the FHCS as a space for monitoring and promoting the NPMD. The ICF has proved to be an adequate and valid classification instrument for this context.

Resumo Introdução: O desenvolvimento neuropsicomotor (DNPM) é dinâmico e complexo, explicado pelo modelo contextual, que pode ser discutido com visão ampliada de saúde por meio da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Objetivo: Caracterizar o DNPM de crianças com até três anos participantes do Programa Leite das Crianças (PLC) a partir da abordagem contextual por meio da CIF, no contexto do Núcleo de Apoio à Saúde da Família (NASF), e relacionar com aspectos individuais, familiares, socioeconômicos e estimulação da criança nos diferentes ambientes. Método: Participaram deste estudo 19 crianças, 10 (52,63%) meninos e 9 meninas (47,37%), com idade entre 7 e 35 meses (19,42 ± 9,11), devidamente autorizadas pelo responsável, avaliadas por meio de entrevista semiestruturada, questionário socioeconômico da ABEP, teste de triagem de Denver II e questionário de oportunidades no ambiente domiciliar para o desenvolvimento motor. Os instrumentos foram relacionados com os componentes da CIF para crianças e jovens (CIF-CJ). O estudo foi realizado no NASF de uma cidade da região metropolitana de Curitiba/PR, Brasil. Para análise estatística utilizou-se rô de Spearman (rs) para correlação não-paramétrica, Mann-Whitney na comparação quantitativa e o Exato de Fisher em dados categóricos para probabilidade de ocorrência. Resultados: Com relação à triagem, 9 (47,37%) crianças apresentaram o DNPM questionável, sendo a área da linguagem a mais comprometida (88,88%), 7 famílias (36,84%) foram classificadas em C1 pela ABEP. Para a estimulação recebida no ambiente domiciliar, 6 crianças (54,5%) com até 18 meses tiveram estimulação adequada e todas (n=8) as crianças maiores de 19 meses apresentaram estimulação razoável. O modelo proposto neste estudo respondeu à abordagem contextual da CIF. Conclusão: É necessária a utilização de instrumentos adequados para planejar ações na atenção básica, para que crianças que apresentem risco ao DNPM possam ser incluídas em programas de intervenções precoces, para viabilizar o NASF enquanto espaço de acompanhamento e promoção do DNPM. A CIF mostrou-se um instrumento de classificação adequado e válido para este contexto.

O efeito da terapia neuromotora intensiva na motricidade de pacientes com alterações genéticas raras / The effect of intensive neuromotor therapy on the motricity of patients with rare genetic syndromes

Introdução: muitas doenças são causadas por distúrbios genéticos, sejam eles cromossômicos, que afetam seu número ou estrutura, monogênicos ou multifatoriais, muitos deles com repercussões no desenvolvimento motor, sendo necessários intervenções de estimulação do mesmo. A Terapia Neuromotora Intensiva (TNMI) combina quatro horas de terapia por dia, por cinco dias por semana, durante três ou quatro semanas para o tratamento de indivíduos com distúrbios neurológicos. Objetivo: o presente estudo teve como objetivo verificar os efeitos da TNMI na função motora grossa dos pacientes que possuem síndromes genéticas raras. Relato de casos: a amostra foi constituída por duas crianças com distúrbios genéticos, com idade de 4 e 6 anos que realizaram TNMI. Para avaliar o efeito da TNMI na função motora grossa desses pacientes, foi empregado a escala GMFM no primeiro e no último dia de terapia com o intuito de quantificar as mudanças motoras. Resultados: analisando os resultados do GMFM foi possível constatar uma pequena melhora na dimensão B para a criança 1 e resultados relevantes nas dimensões A, B e C para a criança 2. Conclusão: concluiu-se que a TNMI em doenças genéticas raras apresentou resultados positivos para a criança 2 com ECNPI associado à hidrocefalia sem derivação e deleção intersticial no braço curto do cromossomo 2 (2p24.2-p23.2) e resultados pouco relevantes para a criança com ECNPI associada à microduplicação da região do braço longo do Cromossomo 1 (1q21.1).

Introduction: many diseases caused by genetic disorders, whether they are chromosomal, affecting their number or structure, monogenic or multifactorial, many of them with repercussions on motor development, requiring stimulation interventions. Intensive Neuromotor Therapy (INMT) combines four hours of therapy per day, five days a week, for three or four hours by weeks for the treatment of individuals with neurological disorders. Objective: this study aimed to verify the effects of INMT on gross motor function of patients with rare genetic syndromes. Case report: the sample consisted of two children with genetic disorders, aged 4 and 6 years, who underwent INMT. To evaluate the effect of INMT on the gross motor function of these patients, the GMFM scale was used on the first and last day of therapy in order to quantify the motor changes. Results: there was a small improvement in size B for children 1 and relevant results in size A, B and C for child. Conclusion: it was concluded that INMT in rare genetic diseases showed positive results for child 2 with cerebral palsy (CP) associated with hydrocephalus without derivation and interstitial deletion in the short arm of chromosome 2 (2p24.2-p23.2) and results not relevant for the child with CP associated with the microduplication of the long arm region of Chromosome 1 ( 1q21.1).

Spastic diparetic does not directly affect the capacity to ascend and descend access ramps: three-dimensional analysis / Diparesia espástica não afeta a capacidade de subir e descer rampas de acesso: análise tridimensional

Abstract Introduction: Diplegic children have difficulties in gait and therefore ramps are used as strategies of accessibility. Objective: The present study investigated the influence of an inclined surface (ascending and descending) on the kinematic characteristics during gait of the diplegic group (DG) when compared to typically developing children of the control group (CG). Methods: Study participants included 20 children (10 with DG and 10 CG) matched by age, which were evaluated in three experimental conditions (horizontal and inclined ascending and inclined descending surfaces of 7º) through an optoelectronic imaging system. Results: Among the linear kinematic variables, only step width differed among groups, however, without influence of the surface. The foot height differed among the groups only in the descending phase, where DG had greater difficulty in raising the foot. The 3-dimensional gait analyses could not provide more evidences of differences in kinematics variables, especially in transverse plane, between DG and CG, but provide some evidence to support that hip range of motion (ROM) during the gait cycle, hip flexion-extension in initial contact, knee ROM and the 2nd anterior-posterior trunk peak amplitude of the DG were influenced on descent by their flexor pattern. Conclusion: The DG was most affected by the inclination plane than CG especially on descent. Although a hip and knee flexor pattern is evident for DG on inclination of 7º, this angle is accessible since it allows independent gait functional activity.

Resumo Introdução: Crianças com diplegia apresentam dificuldades na marcha e rampas são utilizadas como estratégia de acessibilidade. Objetivo: O presente estudo investigou a influência da superfície inclinada (subida e descida) sobre as variáveis cinemáticas durante a marcha no grupo com diplegia (GD) comparado ao grupo de crianças com desenvolvimento típico no grupo controle (GC). Métodos: Participaram do estudo 20 crianças (10 GD e 10 GC) pareadas por idade, as quais foram avaliadas em 3 condições experimentais (horizontal, subida e descida de 7º) por meio de um sistema de imagem optoeletrônico. Resultados: Nas variáveis cinemáticas lineares apenas o comprimento do passo diferiu entre os grupos sem influência da inclinação do plano. A altura do pé diferiu entre os grupos na descida, com maior dificuldade do GD em elevar o pé. A análise tridimensional da marcha não permitiu identificar diferenças cinemáticas no plano transverso entre GD e GC, mas identificou que a ADM de quadril durante o ciclo de marcha, flexo-extensão de joelho no contato inicial, ADM de joelho e o 2º pico de amplitude de movimento (ADM) ântero-posterior de tronco do GD foram influenciadas na descida devido ao padrão flexor desse grupo. Conclusão: O GD foi mais afetado que o GC, especialmente na descida. Embora sejam evidenciados padrões de flexão de quadril e joelhos do GD na inclinação de 7º, essa angulação é acessível ao permitir marcha funcional independente.

Baixo peso ao nascer, renda familiar e ausência do pai como fatores de risco ao desenvolvimento neuropsicomotor / Low birth weight, family income and paternal absence as risk factors in neuropsychomotor development

INTRODUCTION: The first years of life are crucial to neuropsychomotor development (NPMD), during this period children are susceptible to organic, environmental or activity-related influences that may represent protective or risk factors towards full development, with potential lifelong repercussions. OBJECTIVE: This study aimed to investigate and verify the risk factors in the NPMD of children aged from zero to three years, attending public early childhood education centers. METHODS: Cross-sectional study, contextual approach - based on ICF (International Classification of Functioning, Disability and Health) -, Denver II developmental screening test and additional assessments about nutritional status. For the analysis, a logistic regression was performed. The ICF concerning body functions and structure (evaluation questionnaire), activity and participation (evaluation of NPMD in school), personal factors (family characteristics), and environmental factors (characteristics of the ECECs) were considered for the evaluation phase. The instruments consisted of a questionnaire containing items to elicit information about the child, including current, neonatal and family traits. For the evaluation DPMD, the Denver II test was used. Inter- and intra-rater reliability was established using Cohen's kappa, and data subsequently submitted to stepwise (backward) regression analysis using a Logit model, using binary responses. The construction of an ROC (Receiver Operating Characteristic) to define the explanatory profile of the model built also was included, in addition to the calculation of the Odds Ratio (OR), the odds of chance occurrence the association of a given variable with DPMD. RESULTS: NPMD was within the normal parameters, in 68.8% (n = 53) and risk of delays was in 31.2% (n = 24). The area with the best performance was the fine motor-adaptive (3.75%) and the most questionable one was the language (57.5%). It was verified that 48% (n=37) of the children had normal weight while 52% (n = 40) presented some nutritional risk. Low birth weight (OR = 181), monthly family income (OR = 9) and paternal absence (OR = 34) were statistically significant factors on the risk of NPMD delays. CONCLUSION: Low birth weight, family income and paternal absence are factors associated with risks of NPMD delays. These findings reinforce the systemic and multifactorial nature of NPMD and emphasize the need for monitoring and formulating public policies -- especially the ones dedicated to children with low income conditions --, which could contribute to the full development of children, since public early childhood education centers should be transforming agents in the quality of child development.

INTRODUÇÃO: Os primeiros anos de vida são fundamentais para o desenvolvimento neuropsicomotor (DNPM), neste período as crianças estão propensas a sofrer influências de fatores orgânicos, ambientais ou de atividades que podem ser protetores ou de risco para um desenvolvimento pleno com repercussões até a vida adulta. OBJETIVO: O presente estudo teve como objetivo analisar o DNPM de crianças de zero a três anos de idade e os fatores de risco associados ao desenvolvimento. MÉTODO: Estudo transversal, abordagem contextual, baseada na Classificação Internacional de Funcionalidade Incapacidade e Saúde (CIF), por meio do Teste de Triagem de Denver II e avaliações complementares do estado nutricional. Na avaliação foram considerados os domínios da CIF de funções e estrutura (questionário de avaliação), atividades e participação (avaliação do DNPM na escola), fatores pessoais (características familiares) e fatores ambientais (características dos CEIs). Os instrumentos de avaliação consistiram em um questionário com informações sobre a criança, características atuais, neonatais e familiares. Para avaliação do DNPM, utilizou-se o teste de Denver II. Na análise estatística realizou-se a calibração pelo índice Kappa de concordância intra e inter-avaliadores e posteriormente a regressão logística utilizando como seleção de modelo Logit com resposta binária e método Stepwise (Backward); a construção de uma curva ROC (Receiver Operating Characteristic) para definir o perfil de explicabilidade do modelo construído; o cálculo do Odds Ratio (OR), a razão de chances de ocorrência de uma variável estar associada com o DNPM. RESULTADOS: O DNPM encontrou-se dentro dos parâmetros de normalidade em 68,8% (n=53) e com riscos de atrasos em 31,2% (n=24). A área de melhor desempenho foi a motora fina-adaptativa (3,75%) e a mais questionável foi da linguagem (57,5%). Foi acurado que 52% (n=40) das crianças apresentaram algum risco nutricional. Verificou-se que o baixo peso ao nascer (OR= 181), a renda familiar mensal (OR=9) e a ausência do pai (OR=34) são fatores estatisticamente significantes sobre o risco de atrasos no DNPM. CONCLUSÃO: O baixo peso ao nascer, a renda familiar e a ausência do pai estão associados com riscos de atraso do DNPM. Estes achados reforçam a natureza sistêmica e multifatorial do DNPM e comprova a necessidade de acompanhamento, monitoramento e criação de políticas públicas, especialmente em crianças com condições desfavoráveis, que contribuam para o desenvolvimento pleno das crianças, uma vez que instituições de educação infantil do ensino público devem ser agentes transformadoras na qualidade do desenvolvimento infantil.

Motor abilities, activities, and participation of institutionalized Brazilian children and adolescents with cerebral palsy

Abstract Aim: To assess motor abilities and functioning of institutionalized children and adolescents with cerebral palsy (CP) within a contextual model of development. Methods: Eleven institutionalized Brazilian children and adolescents aged 2-19 (14 ± 5) years, 5 males and 6 females, were evaluated through the Gross Motor Function Measure (GMFM-88 and 66) and the Functional Independence Measure (FIM), and classified according to the ICF core set. Results: The evaluated individuals have severe impairments as indicated by their GMFM scores and confirmed by their need for full assistance in basic activities of daily living according to the FIM assessment. The difficulties manifested reflected on the ICF body functions and activities and participation domains. Conclusion: Most institutionalized children and adolescents with CP had GMFM-66 scores comparable to those indicated in literature. The ICF-based assessment identified environmental barriers that might be considered for improvement in order to facilitate activities and participation.