Nelci Adriana Cicuto Ferreira Rocha

Development of reaching and grasping skills in infants with Down syndrome

Reaching and grasping skills have been described to emerge from a dynamic interaction between intrinsic and extrinsic factors. The aims of the study were to investigate the effect of such intrinsic factors as age and Down syndrome on the development of reaching and grasping skills and on overall gross motor skill, and to test the influence of the overall level of gross motor skill on the development of reaching and grasping. Seven infants with Down syndrome (DS) and seven infants with typical development were assessed at the ages of 4, 5 and 6 months. The following variables were analyzed: straightness index, mean velocity, movement units and deceleration time (for reaching movements), grasping frequency and AIMS scores. Intrinsic factors such as age and DS were found to influence the development of reaching, grasping, and of the overall level of gross motor skill. The overall level of gross motor skill was observed to influence grasping.

Assessment of postural control in children with cerebral palsy: A review

This paper aimed to review studies that assessed postural control (PC) in children with cerebral palsy (CP) and describe the methods used to investigate postural control in this population. It also intended to describe the performance of children with CP in postural control. An extensive database search was performed using the keywords: postural control, cerebral palsy, children, balance and functionality. A total of 1065 papers were identified and 25 met the inclusion criteria. The survey showed that PC is widely studied in children with CP, with reliable methods. The link between postural control and functionality was also evident. However, a lack of studies was observed assessing postural control in these children by means of scales and functional tests, as well as exploring postural control during daily functional activities. Thus research addressing these issues can be a promising field for further research on postural control.

International Classification of Functioning, Disability and Health in children with cerebral palsy.

Purpose: We intended to describe how concepts from recent models of disability have been studied for evaluation of children with cerebral palsy (CP) and their clinical implications. Method: We revised studies that focused on the components of the International Classification of Functioning, Disability and Health (ICF) in children with CP. Results: Researchers have reported that children with CP exhibit impairments in various body functions/structures, limitations in functional activities performance and experience poorer participation outcomes than their typical peers. Moreover, it has been showed that participation of children with CP was affected by environmental factors. Conclusion: Therefore, evaluation and rehabilitation processes should be focused on the quality of life improvement by emphasizing what a child can and wants to execute within the environment. Also, environmental factors should be recognized so that barriers could be minimized and adaptations to the environment achieved. However, few studies have verified the interrelationship between contextual factors and the functioning and disability domains in children with CP. This would allow us to know about approaches specifically designed for these children’s needs. Implications for Rehabilitation Cerebral palsy is a disabling disease which impacts in body structures and functions, functional activities performance and social participation. ICF is a model of disability that focuses on the integration of these three dimensions. The knowledge about the concepts of ICF applied in children with CP allows an evidence-based practice.

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.

Functionality level and its relation to postural control during sitting-to-stand movement in children with cerebral palsy

In this study we studied functional performance and functional balance in children with cerebral palsy (CP) and typically developing (TD) children. The relationship between these components and postural control during sit-to-stand movement (STS) was also investigated. Ten children with CP (GMFCS I and II) and 27 TD children, ages 5-12 years, were included in the study. The Pediatric Evaluation of Disability Inventory (PEDI) and the Pediatric Balance Scale (PBS) were used to measure functional performance and functional balance, respectively. Postural control during STS was assessed by means of a force plate. Participants were asked to stand from a chair with feet over a force plate. Children with CP exhibited lower scores than TD children in the PBS and in the mobility Functional Skills and Caregiver Assistance domains of the PEDI (p≤0.05). In both groups postural control during STS movement was correlated with mobility Caregiver Assistance scores of the PEDI. The results demonstrate that although the participants had mild to moderate motor impairment, they exhibit deficits in their level of functional performance and functional balance compared to typical children. Moreover, it was observed that impairments in postural control during the STS movement are related to functional performance in both groups. This result demonstrates the importance of the structure and function components to the level of activity in children.

Sit-to-stand movement in children with cerebral palsy: A critical review

Sit-to-stand (STS) movement is widely performed in daily life and an important pre requisite for acquisition of functional abilities. However, STS is a biomechanical demanding task which requires high levels of neuromuscular coordination, muscle strength and postural control. As children with cerebral palsy (CP) exhibit a series of impairments in body structures and functions, STS movement performance could be impaired in this population. Thus, this article aimed to review studies that had described how STS movement is performed by children with CP, the factors that influence it and the methodological procedures adopted in it analyses. A search was performed by one reviewer in relevant databases. In all, 12 articles were identified and 9 were selected for the present review. It was detected a large variation in sample characteristics and methodological issues among studies. In fact, standardization of the method applied to STS movement analysis is not fully established. With regard to STS performance, children with CP exhibited variations among them and also when compared with their typical peers. Moreover extrinsic factors appear to influence STS movement performance in these children and its manipulation could be incorporated into rehabilitation protocols. Moreover, the relationship between STS movement and functionality in reviewed articles was not reported. Therefore the review allowed to observe that STS movement has been under-explored in children with CP, with a lack of standardized methodologies and a not well established relationship between this movement and functionality. Thus, further studies about STS movement in CP are necessary.

Influência do tamanho e da rigidez dos objetos nos ajustes proximais e distais do alcance de lactentes

BACKGROUND: Studies have identified that object properties lead to adjustments to reaching. However, few have investigated the specific influence of object size and rigidity among young infants. OBJECTIVE: To verify whether four to six-month-old infants make proximal and distal adjustments when reaching for objects of different sizes and rigidity. METHOD: Nine healthy infants were seated on a chair inclined at 50°. Four objects were presented to them: one large rigid (LR), one small rigid (SR), one large malleable (LM) and one small malleable object (SM), each for a one-minute period. A total of 384 reaches were analyzed to verify proximal adjustments (single-hand and two-hand reaching) and distal adjustments (horizontal, vertical and oblique hand orientation; opened, closed and half-open hand), and the success in reaching the objects. RESULTS: The infants exhibited two-hand adjustments for the LR object and single-hand adjustments for the other objects. Oblique orientation was predominant for touching the objects, while vertical orientation was predominant for grasping them, particularly the LR object. Horizontal orientation was not observed for grasping the LR object. At the start of reaching for all objects, the hands were most frequently half-open, while the hands were predominantly open when touching the LR object. Success was greater when reaching for malleable objects (LM, SM) than for rigid objects (LR and SR). CONCLUSION: The young infants studied were capable of planning and adjusting their movements on the basis of their perceptions of the physical properties of the objects, which suggests that perception-action interaction was occurring.

Sit-to-Stand Movement in Children: A Review

ABSTRACT The influence of determining factors on sit-to-stand (STS) movement in adults has been extensively described in the literature; however, there is a lack of information about such factors on children. Therefore, the purposes of the present study are to analyze the scientific publications about intrinsic and extrinsic factors influencing STS movement in children and to describe methodological procedures used in the studies under review. A bibliographical review was obtained from relevant database (1988–2009) using keywords, such as rising, chair, sit-to-stand, and children. In all, 109 articles were identified and 11 were selected. The literature indicates there is a lack of articles investigating disabilities other than cerebral palsy as well as extrinsic factors such as chair-type characteristics in typical and atypical children.

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.