Carolina Souza Neves da Costa

Measuring changes in functional mobility in children with mild cerebral palsy

Objective: To support the use of TUG and TUDS to detect changes in functional mobility in children with mild cerebral palsy. Methods: Six children with spastic cerebral palsy and classified by GMFCS as level I or II were enrolled in the study. The gross motor function was measured by the GMFM and functional mobility by the TUG and TUDS. The participants were assessed before and after an 8-week follow-up. Results: After this period, increased GMFM scores were found at dimensions D (standing) and E (walking, running and jumping). The time to complete TUG and TUDS was shorter after the follow-up period. Negative correlations were found between GMFM dimension E and the TUG and TUDS tests. Conclusion: Changes in the gross motor skills measured by the GMFM may be accompanied by changes in the movement speed measured by TUG and TUDS. These tests may complement information provided by GMFM.

Pilot study: Investigating the effects of Kinesio Taping® on functional activities in children with cerebral palsy

Objective: To investigate the immediate effects of Kinesio Taping® (KT) on sit-to-stand (STS) movement, balance and dynamic postural control in children with cerebral palsy (CP). Methods: Four children diagnosed with left hemiplegic CP level I by the Gross Motor Function Classification System were evaluated under conditions without taping as control condition (CC); and with KT as kinesio condition. A motion analysis system was used to measure total duration of STS movement and angular movements of each joint. Clinical instruments such as Pediatric Balance Scale (PBS) and Timed up and Go (TUG) were also applied. Results: Compared to CC, decreased total duration of STS, lower peak ankle flexion, higher knee extension at the end of STS, and decreased total time in TUG; but no differences were obtained on PBS score in KT. Conclusion: Neuromuscular taping seems to be beneficial on dynamic activities, but not have the same performance in predominantly static activities studied.

Infants with Down Syndrome and Their Interactions with Objects: Development of Exploratory Actions after Reaching Onset.

During infant development, objects and their functions are learned by means of active exploration. Factors that may influence exploration include reaching and grasping ability, object properties and the presence of developmental disorders. We assessed the development of exploratory actions in 16 typically-developing (TD) infants and 9 infants with Down syndrome (DS) after reaching onset. Infants with DS reached for and explored objects less frequently than TD infants, especially small objects. Over time, the amount of reaches increased in both groups, with no changes in the amount of exploration in the DS group. Pre-grasping actions were different across objects, but less efficient in generating action-relevant information in the DS group. These infants also performed fewer behaviors requiring complex motor skills. The results suggest that perceptual-motor abilities determine different exploratory behaviors in TD and DS infants. The reduced amount and complexity of exploratory actions may impact developmental outcome in DS.

Capacidade para o trabalho e qualidade de vida de trabalhadores industriais

The scope of this study was to evaluate the quality of life and work ability of industrial workers by means of self-perception questionnaires. 100 industrial production line workers on the night shift participated in this study. Authorized Brazilian translations of the Work Ability Index (WAI) and the Abbreviated World Health Organization Quality of Life (WHOQOL-Bref) Assessment Instrument were applied. The results show an association between work ability and the whole set of domains of quality of life, presenting a closer association with the physical domain (r =0.61). Furthermore, young men obtained higher ability to work results, while women aged between 30 and 39 had the lowest quality of life indices (p =0.027), especially in the Social Relationships and Environment domains. This shows that preventive guidelines for the improvement of aspects linked to the Physical domain are necessary both in the workplace and outside the workplace, since this interaction exacerbates the effects on the physical aspect in both spheres.

The effect of additional weight load on infant reaching

The objective of this study was to investigate the effect of additional weight load on reaching movement characteristics in 4-6-month-old infants over age. The task-load provided adaptedness on infant reaching movements, especially influencing to optimal interlimb coupling in bimanual reaches.

Quality and structure of variability in children during motor development: A systematic review

Variability has been perceived to be beneficial to movement organization and execution, being essential to selection of movement patterns during motor development, to obtain flexible patterns and adaptability to different task demands. Human movement variability can be measured by linear and nonlinear tools. Recently, nonlinear techniques have been used successfully to give insight into motor skills control in children, and be able to discriminate pathologic and non-pathologic children. For that, this paper is the first to review systematically studies that used nonlinear measures in children. We intend to describe which mathematical tools are utilized to analyze quality and structure of variability, the factors that influence this variability and methodological procedures which are considered for its analysis, and how they are interpreted in child motor development field. A search was performed by one reviewer in relevant databases and the quality appraisal was conducted independently by two reviewers. In all, 27 articles were identified and 20 were selected for the present review. It was detected a large variation in sample characteristics and methodological issues among studies. In fact, the main importance of this review was due to the attempt to define some parameters and standardize some values for typical children and children with disabilities. It is noted that the results from nonlinear techniques depend on the task being analyzed, the age and the type of mathematical technique chosen. The presence of disability is associated to decreases in complexity and nonlinear tools were considered sensible to investigate the effectiveness of practice and intervention in typical children and children with cerebral palsy. Furthermore, future studies should be more careful in standardizing selection, recruitment and explaining missing data. Future reports also should present details of their results and limitations to favor comparisons and helping in formulating new research questions.

Evaluation and characterization of manual reaching in children with cerebral palsy: A systematic review

Manual reaching is used daily to perform manipulative tasks and activities of daily routine. Children with cerebral palsy (CP) have limitations in this activity, with functional loss as a possible consequence. This review aimed to gather studies that evaluated and characterized manual reaching in children with CP, with the purpose of identifying the aspects analyzed, as well as review and discuss the results in the studies and its relationship to the childrens level of functionality. 17 studies were selected for this systematic review from the search in electronic databases. The studies showed that children with CP show deficits in several spatio-temporal variables of reaching compared to typical children, such as longer time to perform the activity, higher peak velocity, lower index of curvature, and greater number of units of motion, which indicates lower smoothness and linearity of the movements of upper limbs. The performance is influenced by the level of motor impairment and various manipulations of the task. However, more studies are needed that help translating these results into treatment strategies that facilitate the performance of manual activities in children with CP.

Functional strength training in child with cerebral palsy GMFCS IV: case report.

Objective: To evaluate the effectiveness of a functional strength training. Case report: A nine-year-old child with Cerebral Palsy (CP) classified as level IV according to Gross Motor Function Classification System participated in the study. Assessments were at baseline, five weeks and 10 weeks post-intervention. Lower-extremity muscles strength was evaluated with an isokinetic dynamometer. Also, Gross Motor Function Measure (GMFM-88) and Timed up & Go (TUG) tests were assessed. A functional strength training protocol, four sessions a week, for 10 weeks was applied. Results: Following functional strength training, it improvements were found in hip, knee and ankle muscles strength, as well as increase in GMFM-88 score and decrease in time for TUG test performance. Positives outcomes from functional strength training were obtained beyond improvements in strength, since improvements in functional motor performance were also achieved. Conclusion: Therefore, individualized, specific and functional strength training seems to be an alternative to rehabilitation of children with CP with high level of functional disability.

Effect of Biomechanical Constraints on Neural Control of Head Stability in Children With Moderate to Severe Cerebral Palsy

Background External support has been viewed as an important biomechanical constraint for children with deficits in postural control. Nonlinear analysis of head stability is necessary to confirm benefits of interaction between external trunk support and level of trunk control. Objective To compare the effect of biomechanical constraints (trunk support) on neural control of head stability during development of trunk control. Design Quasi-experimental repeated measure study. Methods Fifteen children (4-16 years) with moderate (Gross Motor Function Classification System (GMFCS) IV; n=8; 4 males) or severe (GMFCS V; n=7; 4 males) CP were compared to previous longitudinal data from TD infants (3-9 months of age). Kinematic data were used to document head sway with external support at four levels (axillae, mid-rib, waist, and hip). Complexity, predictability and active degrees of freedom (DOF) for both AP and ML directions were assessed. Results Irrespective of level of support, CP groups had lower complexity, increased predictability and greater DOF (p<0.001). The effect of support differed based on the childs segmental level of control. GMFCS V and youngest TD groups demonstrated better head control with increased complexity and decreased predictability with higher levels of support. GMFCS IV group had the opposite effect, showing decreased predictability, increased complexity and DOF with lower levels of support. Conclusions The effect of external support varies depending on the childs level of control and diagnostic status. Children with GMFCS V and young TD infants had better outcomes with external support, but external support was not enough to completely correct for influence of CP. Children with GMFCS IV performed worse with support at axillae or midribs suggesting that too much support can interfere with postural sway quality.

Effect of the severity of manual impairment and hand dominance on anticipatory and compensatory postural adjustments during manual reaching in children with cerebral palsy

AIM To investigate the role of the severity of manual impairment and of hand dominance on postural sway during anticipatory [APA] and compensatory [CPA] postural adjustments in a seated manual reaching task performed by children with cerebral palsy (CP) and typical children (TC). METHODS We tested 26 TC (mean age 9.5 ± 2.1 years) and 29 children with CP (age 9.6 ± 3 years) classified based on manual impairment levels as mild (Manual Ability Classification System [MACS] I; n = 18) or moderate-to-severe (MACS II-III, n = 11). Participants were instructed to reach towards a target using their dominant vs. non-dominant arm while sitting on a force-plate. Center of pressure (CoP) sway was analyzed during APA and CPA. RESULTS For all groups, using the non-dominant arm determined greater amplitude and velocity of CoP sway in CPA. Children with moderate-to-severe manual impairment showed greater sway during APA and CPA compared to mild impairment and TC groups. CONCLUSION More severe manual impairment resulted in higher sway during the anticipatory and compensatory phases of the reaching task. Using the non-dominant arm resulted in greater compensatory adjustments during reaching.