Luzia Iara Pfeifer

Adaptação transcultural para o Brasil do Sistema de Classificação da Função Motora Grossa (GMFCS)

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

Classification of cerebral palsy: association between gender, age, motor type, topography and Gross Motor Function

The goal of this study was to assess the relation between gender, age, motor type, topography and gross motor function, based on the Gross Motor Function System of children with cerebral palsy. Trunk control, postural changes and gait of one hundred children between 5 months and 12 years old, were evaluated. There were no significant differences between gender and age groups (p=0.887) or between gender and motor type (p=0.731). In relation to body topography most children (88%) were spastic quadriplegic. Most hemiplegics children were rated in motor level I, children with diplegia were rated in motor level III, and quadriplegic children were rated in motor level V. Functional classification is necessary to understand the differences in cerebral palsy and to have the best therapeutic planning since it is a complex disease which depends on several factors.

Pretend play of children with cerebral palsy.

ABSTRACT Background and Purpose: Evaluate self-initiated pretend play of children with cerebral palsy. Method: Twenty preschool children participated in the study. Pretend play ability was measured by using the child-initiated pretend play assessment culturally adapted to Brazil. Results: There were significant negative correlations between the childrens motor severity level and their elaborateness of play with conventional-imaginative and symbolic play materials and a number of object substitutions in symbolic play. This indicated that children with greater motor limitations had diminished play ability. In this sample, 35% of the children showed typical play styles, identified by good scores in elaborate pretend play actions, number of object substitutions, and ability to self-initiate play, whereas 65% showed delay in their play. Implications: The type of pretend play deficits that might be expected in children with cerebral palsy were described. Furthermore, suggested directions for therapeutic intervention to enhance pretend play performance in cerebral palsy children were proposed.

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

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

Coping Strategies Used by Hospitalized Children with Cancer Undergoing Chemotherapy

PURPOSE To analyze coping strategies used by children with cancer undergoing chemotherapy during hospitalization. DESIGN AND METHODS This was an exploratory study to analyze qualitative data using an inductive thematic analysis. Semistructured interviews using puppets were conducted with 10 children with cancer, between 7 and 12 years old, who were hospitalized and undergoing chemotherapy. FINDINGS The coping strategies to deal with chemotherapy were: understanding the need for chemotherapy; finding relief for the chemotherapys side effects and pain; seeking pleasure in nourishment; engaging in entertaining activities and having fun; keeping the hope of cure alive; and finding support in religion. CONCLUSIONS Children with cancer undergoing chemotherapy need to cope with hospitalizations, pain, medication side effects, idle time, and uncertainty regarding the success of treatment. These challenges motivated children to develop their own coping strategies, which were effective while undergoing chemotherapy. CLINICAL RELEVANCE By gaining knowledge and further understanding about valid coping strategies during chemotherapy treatment, health professionals can mobilize personal and material resources from the children, health teams, and institutions aiming to potentiate the use of these strategies to make treatments the least traumatic.

Cross-Cultural Adaptation and Reliability of Child-Initiated Pretend Play Assessment (ChIPPA)

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

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

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

INCLUSÃO DE CRIANÇAS COM SÍNDROME DE DOWN

This study aimed to explore families’ experiences in the educational inclusion process of children with Down’s syndrome, with a view to promoting the health of these families. A multiple case study was developed with a qualitative approach, involving 11 families of children with Down’s syndrome. Data were collected through semistructured interviews and analyzed through content analysis. The results demonstrated that, from the participants’ perspective, teachers are not prepared for this inclusion but, nevertheless, this process reveals to benefit child education. The need for articulation between education and health sectors and a change in the educational model paradigm were evidenced. The research appoints aspects which the professionals involved should pay attention to, in order to make the inclusion a process to be lived as best as possible.

Validation of the functional and social performance – DSF-84 checklist: preliminary study

Abstract Purpose: To develop, implement and validate an instrument for assessing the functional and social performance of young male adults with lower limb amputees based on the international classification of functionality, incapacity, and health. Methods: Developed the instrument, the items were grouped into domains (organic aspects – OA, daily activities – DA, performance components – PC, social participation – SP and environmental factors – EF) for statistical analysis. The implementation of the instrument was filmed for validation. Four assessors watched the films on two occasions and gave scores. Intra-class correlation was used to evaluate intra- and inter-rater reproducibility and to the internal consistency was calculated by Cronbach’s alpha and the criterion validity was assessed by Student’s t-test and the Mann–Whitney U-test. Results: The results showed good reliability in the scores for OA, DA, PC and SP domains and a reasonable reliability for the EF domain. The differences between assessors performed by the analysis of variance were not significant. The reliability intra-rater, performed through the test–retest method, showed in all domains high levels of intra-rater correspondence. Conclusions: The results show the validity and reliability of DSF-84 to young male adults with amputation of the lower limb, being useful for this population. Implications for Rehabilitation In this study have been developed, implemented, and validated an instrument (DSF-84) for assessing the functional and social performance of young male adults with lower limb amputees based on the ICF. The results show the validity and reliability of DSF-84 to young male adults with amputation of the lower limb, being useful for this population.

Puppets as a strategy for communication with Brazilian children with cancer.

Children are considered competent social actors. Although they are able to express their opinions, they may have some difficulties in answering direct verbal questions, requiring researchers and health professionals to enter their world by using auxiliary resources for communication. This study presents the experience of using finger puppets as a playful strategy for improving interaction and communication with hospitalized children with cancer, aged seven to 12. It describes the strategy of making and using puppets as an auxiliary tool to communicate with children with cancer and presents the results and limitations of using puppets in clinical practice. The use of the puppets, creatively and in accordance with the childrens motor, cognitive, and emotional development, showed benefits, such as allowing the children to freely express themselves; respecting their autonomy; and minimizing the hierarchical adult-child relationship. The use of puppets is an appropriate strategy to communicate with hospitalized children. This tool can also enrich clinical practice, as it encourages children with cancer to report their experience of being ill and also helps the health team during evaluation and intervention.