Paula Silva de Carvalho Chagas

Classificação da função motora e do desempenho funcional de crianças com paralisia cerebral

OBJECTIVE: To classify children with cerebral palsy (CP) using classification systems for mobility and manual function; to compare groups of children with CP regarding gross motor function and functional performance outcomes; and to evaluate associations between the functional classifications and the scores obtained in the outcomes that were investigated. METHODS: Thirty children with CP were classified using the Gross Motor Function Classification System (GMFCS) and the Manual Abilities Classification System (MACS), and were divided into three groups, based on their classification (mild, moderate or severe) in each of these systems. Gross motor function was documented using the Gross Motor Function Measure (GMFM-66) test, while functional abilities and the caregivers assistance regarding self-care and mobility were documented using the Pediatric Evaluation of Disability Inventory (PEDI). RESULTS: One-way ANOVA showed that the groups were significantly different regarding the GMFM-66 and PEDI results. Post-hoc comparison tests (Scheffe) revealed that the children with moderate impairment (GMFCS) had functional abilities and caregiver support that were similar to those of the mildly impaired children. However, the moderate children (MACS) were not different from the severe children. Spearman rank correlations showed strong and significant inverse associations between the functional classifications and the results from the PEDI and GMFM-66 tests. CONCLUSIONS: The results suggest that the MACS and GMFCS functional classifications are good indicators of the manual function and mobility of children with CP. These classifications may be useful in the processes of evaluation and intervention planning.OBJECTIVE: To classify children with cerebral palsy (CP) using classification systems for mobility and manual function; to compare groups of children with CP regarding gross motor function and functional performance outcomes; and to evaluate associations between the functional classifications and the scores obtained in the outcomes that were investigated. METHODS: Thirty children with CP were classified using the Gross Motor Function Classification System (GMFCS) and the Manual Abilities Classification System (MACS), and were divided into three groups, based on their classification (mild, moderate or severe) in each of these systems. Gross motor function was documented using the Gross Motor Function Measure (GMFM-66) test, while functional abilities and the caregivers assistance regarding self-care and mobility were documented using the Pediatric Evaluation of Disability Inventory (PEDI). RESULTS: One-way ANOVA showed that the groups were significantly different regarding the GMFM-66 and PEDI results. Post-hoc comparison tests (Scheffe) revealed that the children with moderate impairment (GMFCS) had functional abilities and caregiver support that were similar to those of the mildly impaired children. However, the moderate children (MACS) were not different from the severe children. Spearman rank correlations showed strong and significant inverse associations between the functional classifications and the results from the PEDI and GMFM-66 tests. CONCLUSIONS: The results suggest that the MACS and GMFCS functional classifications are good indicators of the manual function and mobility of children with CP. These classifications may be useful in the processes of evaluation and intervention planning.Objective: To classify children with cerebral palsy (CP) using classifi cation systems for mobility and manual function; to compare groups of children with CP regarding gross motor function and functional performance outcomes; and to evaluate associations between the functional classifi cations and the scores obtained in the outcomes that were investigated. Methods: Thirty children with CP were classifi ed using the Gross Motor Function Classifi cation System (GMFCS) and the Manual Abilities Classifi cation System (MACS), and were divided into three groups, based on their classifi cation (mild, moderate or severe) in each of these systems. Gross motor function was documented using the Gross Motor Function Measure (GMFM-66) test, while functional abilities and the caregivers assistance regarding self-care and mobility were documented using the Pediatric Evaluation of Disability Inventory (PEDI). Results: One-way ANOVA showed that the groups were signifi cantly different regarding the GMFM-66 and PEDI results. Post-hoc comparison tests (Scheffe) revealed that the children with moderate impairment (GMFCS) had functional abilities and caregiver support that were similar to those of the mildly impaired children. However, the moderate children (MACS) were not different from the severe children. Spearman rank correlations showed strong and signifi cant inverse associations between the functional classifi cations and the results from the PEDI and GMFM-66 tests. Conclusions: The results suggest that the MACS and GMFCS functional classifi cations are good indicators of the manual function and mobility of children with CP. These classifi cations may be useful in the processes of evaluation and intervention planning.

Influência da porção extensora do músculo glúteo máximo sobre a inclinação da pelve antes e depois da realização de um protocolo de fadiga

INTRODUCTION: There is a lack of data in the literature for determining the influences of the extensor portion of the gluteus maximus muscle on pelvic tilting and, thus, on lumbar stability. OBJECTIVES: To assess the influences of the extensor portion of the gluteus maximus muscle on pelvic tilt. METHODS: Ten healthy young subjects were recruited, with a body mass index (BMI) below 24.9 kg/m2 and leg length discrepancy below 1 cm. The BMI, pelvic perimeter and lower-limb lengths were assessed and, subsequently, the degrees of hemi-pelvic tilt and asymmetry between them were analyzed using lateral view photographs of the subjects in a standing position, using SAPO (Software for Postural Assessment). Next, fatigue was induced in the extensor portion of the gluteus maximus muscle on the dominant side, and after that the hemi-pelvic tilt and the asymmetry between the hemi-pelvises were reassessed. The Pearson r and Student t tests were conducted at the significance level of α=0.05. RESULTS: There were no significant correlations between the confounding variables and asymmetry of the hemi-pelvic angles. There were significant changes in the hemi-pelvic angle of the dominant side (t=3.760; p=0.004). CONCLUSIONS: Fatigue in the extensor portion of the gluteus maximus muscle can generate increases in the tilt angle of the ipsilateral pelvis.

Impact of leg length and body mass on the stride length and gait speed of infants with normal motor development: A longitudinal study

BACKGROUND Gait acquisition is supported by changes in the neuromusculoskeletal system of the child. Changes in the dimensions of the body structures resulting from the growth of the child partly explain gait improvement in the first year of life. OBJECTIVES To evaluate whether changes in body mass and leg length modulate the effect of independent gait practice (experience) on gait speed and stride length. METHOD Thirty-two infants with normal development were monitored monthly from the acquisition of independent gait until six months post-acquisition. Longitudinal evaluations included measurements of the body mass and leg length of each child. Temporospatial variables of gait (speed and stride length) were documented using the Qualisys Pro-reflex(r) system. The data were analyzed using multilevel regression models, with a significance level of α=0.05. RESULTS An effect of the practice time on speed (p<0.0001) and stride length (p<0.0001) was observed. The change in leg length had a marginal effect on the rate of gait speed change: children whose leg growth was faster showed a higher rate of speed change (p=0.07). No other effects of anthropometric parameters were observed. CONCLUSIONS The results suggest that the practice time promotes the improvement of the gait pattern of infants in the first year of life. However, the effects of the leg length and body weight of infants on the benefit of practice time remain undefined.

Assessment of gait in toddlers with normal motor development and in hemiplegic children with mild motor impairment: a validity study

BACKGROUND: The optimization of gait performance is an important goal in the rehabilitation of children with cerebral palsy (CP) who present a prognosis associated with locomotion. Gait analysis using videos captured by digital cameras requires validation. OBJECTIVE: To evaluate the validity of a method that involves the analysis of videos captured using a digital camera for quantifying the temporal parameters of gait in toddlers with normal motor development and children with CP. METHOD: Eleven toddlers with normal motor development and eight children with spastic hemiplegia who were able to walk without assistive devices were asked to walk through a space contained in the visual field of two instruments: a digital camera and a three-dimensional motion analysis system, Qualisys Pro-Reflex. The duration of the stance and swing phases of gait and of the entire gait cycle were calculated by analyzing videos captured by a digital camera and compared to those obtained by Qualisys Pro-Reflex, which is considered a highly accurate system. RESULTS: The Intraclass Correlation Coefficient (ICC) demonstrated excellent agreement (ICC>0.90) between the two procedures for all measurements, except for the swing phase of the normal toddlers (ICC=0.35). The standard error of measurement was less than 0.02 seconds for all measures. CONCLUSIONS: The results reveal similarities between the two instruments, suggesting that digital cameras can be valid instruments for quantifying two temporal parameters of gait. This congruence is of clinical and scientific relevance and validates the use of digital cameras as a resource for helping the assessment and documentation of the therapeutic effects of interventions targeted at the gait of children with CP.

Análise de confiabilidade de medidas das pressões plantares estática e dinâmica de crianças e adolescentes com desenvolvimento normal

A pressao plantar e utilizada na avaliacao clinica do pe e informa caracteristicas da distribuicao de carga plantar em atividades funcionais. Diversos instrumentos de avaliacao podem ser utilizados e devem ter as propriedades psicometricas analisadas. A confiabilidade teste-reteste e uma medida de reprodutibilidade. O objetivo deste estudo foi analisar a confiabilidade teste-reteste das medidas de pressao maxima na estatica e dinâmica de criancas e adolescentes com desenvolvimento normal (DN). Onze criancas e adolescentes com DN, de ambos os sexos, com idade entre 6 e 17 anos foram avaliados duas vezes, em uma plataforma sensivel a pressao plantar em ortostatismo, com e sem calcado usual, com os pes posicionados de forma livre (passo interrompido) e com os pes alinhados. Dados dinâmicos foram obtidos pela caminhada sobre a plataforma com e sem calcado. Coeficientes de correlacao intraclasse (CCI) foram analisados (α=0,05). Os CCI foram consistentes para: descarga de peso (DP) anterior calcado (CCI=0,83) e DP posterior descalco (CCI=0,95) e calcado (CCI=0,83) durante a analise estatica com o passo interrompido. Tambem foram consistentes para a variavel DP estatica do membro inferior (MI) direito (CCI=0,86) e esquerdo (CCI=0,82) com passo interrompido descalco e, com os pes alinhados, utilizando calcados (CCI=0,82). Na analise do MI esquerdo, com o uso de calcado, a variavel pressao maxima tambem gerou resultado satisfatorio (CCI=0,85). As demais variaveis apresentaram variacao de CCI entre 0,25 e 0,74, consideradas insatisfatorias. Conclui-se que os valores de CCI foram considerados excelentes para algumas condicoes estaticas e inconsistentes na avaliacao dinâmica.

El análisis de la exactitud de las medidas de las presiones plantares estática y dinámica de niños y adolescentes con desarrollo normal

A pressao plantar e utilizada na avaliacao clinica do pe e informa caracteristicas da distribuicao de carga plantar em atividades funcionais. Diversos instrumentos de avaliacao podem ser utilizados e devem ter as propriedades psicometricas analisadas. A confiabilidade teste-reteste e uma medida de reprodutibilidade. O objetivo deste estudo foi analisar a confiabilidade teste-reteste das medidas de pressao maxima na estatica e dinâmica de criancas e adolescentes com desenvolvimento normal (DN). Onze criancas e adolescentes com DN, de ambos os sexos, com idade entre 6 e 17 anos foram avaliados duas vezes, em uma plataforma sensivel a pressao plantar em ortostatismo, com e sem calcado usual, com os pes posicionados de forma livre (passo interrompido) e com os pes alinhados. Dados dinâmicos foram obtidos pela caminhada sobre a plataforma com e sem calcado. Coeficientes de correlacao intraclasse (CCI) foram analisados (α=0,05). Os CCI foram consistentes para: descarga de peso (DP) anterior calcado (CCI=0,83) e DP posterior descalco (CCI=0,95) e calcado (CCI=0,83) durante a analise estatica com o passo interrompido. Tambem foram consistentes para a variavel DP estatica do membro inferior (MI) direito (CCI=0,86) e esquerdo (CCI=0,82) com passo interrompido descalco e, com os pes alinhados, utilizando calcados (CCI=0,82). Na analise do MI esquerdo, com o uso de calcado, a variavel pressao maxima tambem gerou resultado satisfatorio (CCI=0,85). As demais variaveis apresentaram variacao de CCI entre 0,25 e 0,74, consideradas insatisfatorias. Conclui-se que os valores de CCI foram considerados excelentes para algumas condicoes estaticas e inconsistentes na avaliacao dinâmica.

Reliability analysis of static and dynamic plantar pressure measurements of children and youths with normal development

A pressao plantar e utilizada na avaliacao clinica do pe e informa caracteristicas da distribuicao de carga plantar em atividades funcionais. Diversos instrumentos de avaliacao podem ser utilizados e devem ter as propriedades psicometricas analisadas. A confiabilidade teste-reteste e uma medida de reprodutibilidade. O objetivo deste estudo foi analisar a confiabilidade teste-reteste das medidas de pressao maxima na estatica e dinâmica de criancas e adolescentes com desenvolvimento normal (DN). Onze criancas e adolescentes com DN, de ambos os sexos, com idade entre 6 e 17 anos foram avaliados duas vezes, em uma plataforma sensivel a pressao plantar em ortostatismo, com e sem calcado usual, com os pes posicionados de forma livre (passo interrompido) e com os pes alinhados. Dados dinâmicos foram obtidos pela caminhada sobre a plataforma com e sem calcado. Coeficientes de correlacao intraclasse (CCI) foram analisados (α=0,05). Os CCI foram consistentes para: descarga de peso (DP) anterior calcado (CCI=0,83) e DP posterior descalco (CCI=0,95) e calcado (CCI=0,83) durante a analise estatica com o passo interrompido. Tambem foram consistentes para a variavel DP estatica do membro inferior (MI) direito (CCI=0,86) e esquerdo (CCI=0,82) com passo interrompido descalco e, com os pes alinhados, utilizando calcados (CCI=0,82). Na analise do MI esquerdo, com o uso de calcado, a variavel pressao maxima tambem gerou resultado satisfatorio (CCI=0,85). As demais variaveis apresentaram variacao de CCI entre 0,25 e 0,74, consideradas insatisfatorias. Conclui-se que os valores de CCI foram considerados excelentes para algumas condicoes estaticas e inconsistentes na avaliacao dinâmica.

Prevalência de instabilidade atlantoaxial e sua associação com sinais clínicos em crianças com síndrome de down

A change in the atlanto-axial alignment in children with Down syndrome may be associated with pain, neurological disorders, high spinal cord compression and sudden death OBJECTIVE: To determine the prevalence of atlanto-axial instability in children with Down syndrome and its association with the presence of signs and symptoms of atlanto-axial instability METHODS: A cross-sectional study evaluated 21 children with Down syndrome aged between 3 and 5 years. Children who had undergone cervical spine surgery or who had diseases not associated with this syndrome were excluded. Sex, age, ethnicity of the child and the presence of signs suggestive of atlanto-axial instability, as reported by caregivers, such as neck pain, difficulty walking, weakness in the lower limbs, fatigue, difficulty with balance, urinary and fecal incontinence and projectile vomiting were studied. Children underwent a cervical spine X-ray in the lateral view in three positions: neutral, flexion and extension. When the atlas-odontoid distance was equal to or greater than 4.5 mm, atlanto-axial instability was diagnosed RESULTS: The prevalence of atlanto-axial instability in the studied population was 9.5%. There was no significant association revealed in the chi-square test between the signs suggestive of atlanto-axial instability and the presence of atlanto-axial instability (p >0.05) CONCLUSIONS: Atlanto-axial instability is possibly not associated with its suggestive signs. A alteracao no alinhamento atlantoaxial em criancas com sindrome de Down pode estar associada a dor, transtornos neurologicos, compressao medular alta e ate a morte subita OBJETIVO: Determinar a prevalencia de instabilidade atlantoaxial em criancas com sindrome de Down e verificar a associacao entre a instabilidade atlantoaxial e a presenca de sinais e sintomas desta alteracao METODO: Estudo transversal que avaliou 21 criancas com sindrome de Down com idade entre 3 e 5 anos. Nao foram incluidas criancas que realizaram cirurgia cervical e com patologias nao associadas a sindrome. Foram investigados sexo, idade e raca da crianca e a presenca de sinais sugestivos de instabilidade atlantoaxial segundo relato dos cuidadores, como dor no pescoco, dificuldade de andar, fraqueza em membros inferiores, cansaco, dificuldade de equilibrio, incontinencia fecal e urinaria e vomito em jato. As criancas foram submetidas a radiografia da coluna cervical em perfil em tres posicoes: neutro, flexao e extensao, sendo considerada instabilidade atlantoaxial quando a distância atlas-odontoide era igual ou maior que 4,5 milimetros RESULTADOS: A prevalencia de instabilidade atlantoaxial na populacao estudada foi de 9,5%. Nao foi verificada, pelo teste Qui-quadrado, associacao estatisticamente significativa entre os sinais sugestivos e a presenca de instabilidade atlantoaxial (p-valor>0,05) CONCLUSAO: A instabilidade atlantoaxial possivelmente nao tem associacao com os seus sinais sugestivos.

Brazilian Journal of Physical Therapy

BACKGROUND The optimization of gait performance is an important goal in the rehabilitation of children with cerebral palsy (CP) who present a prognosis associated with locomotion. Gait analysis using videos captured by digital cameras requires validation. OBJECTIVE To evaluate the validity of a method that involves the analysis of videos captured using a digital camera for quantifying the temporal parameters of gait in toddlers with normal motor development and children with CP. METHOD Eleven toddlers with normal motor development and eight children with spastic hemiplegia who were able to walk without assistive devices were asked to walk through a space contained in the visual field of two instruments: a digital camera and a three-dimensional motion analysis system, Qualisys Pro-Reflex. The duration of the stance and swing phases of gait and of the entire gait cycle were calculated by analyzing videos captured by a digital camera and compared to those obtained by Qualisys Pro-Reflex, which is considered a highly accurate system. RESULTS The Intraclass Correlation Coefficient (ICC) demonstrated excellent agreement (ICC>0.90) between the two procedures for all measurements, except for the swing phase of the normal toddlers (ICC=0.35). The standard error of measurement was less than 0.02 seconds for all measures. CONCLUSIONS The results reveal similarities between the two instruments, suggesting that digital cameras can be valid instruments for quantifying two temporal parameters of gait. This congruence is of clinical and scientific relevance and validates the use of digital cameras as a resource for helping the assessment and documentation of the therapeutic effects of interventions targeted at the gait of children with CP.ING AND INDEXING

Estimulação ambiental e uso do andador infantil por lactentes com desenvolvimento normal

OBJECTIVES: to evaluate the quantity and quality of environmental stimuli available to infants with normal development who use a baby walkers prior to learning to walk by themselves. METHODS: a cross-sectional study was carried out with 24 infants distributed into two groups of twelve: one group of children who had used a baby walkers (BW) and 12 who had not (C), with the children in both groups being of equivalent ages, sex, and socio-economic background. The Home Observation for Measurement of the Environment (HOME) test provided a documentary Record of the stimuli provided by the environment. Students t-test for independent samples was used to compare the mean scores on the HOME test of both groups, considering the level of significance to be α=0.05. RESULTS: differences in the HOME scores, with the BW group obtaining higher scores than the control group (p=0.014), with a low magnitude effect (d=0.24). CONCLUSIONS: the use of a childrens baby walkers in the period before learning to walk by infants with normal development may be associated with more stimulating home environments.