Sheyla Rossana Cavalcanti Furtado

Estudo do desenvolvimento da função motora aos 8 e 12 meses de idade em crianças pré-termo e a termo

OBJECTIVE: To compare the development of motor function in children born preterm with those born at term, at 8 and 12 months of age. To investigate the relation of motor function quality at the age of 8 months with motor ability at 12 months. METHOD: Thirty-two children participated in this study: 16 were born preterm (risk group) and 16 were born at term (control group). The spontaneous movements of the children were assessed at 8 months and their mobility skills and independence were assessed at 12 months (corrected ages for the preterm group), using standardized developmental tests (AIMS and PEDI, respectively). Data were analysed using independent t-tests (between-group comparison) and Pearson correlation coefficients (within-group comparison). RESULTS: There was no significant difference in motor function, between those born preterm with those born at term, either at 8 or at 12 months of age. In the control group, there was significant association (r=0.67; p=0.004) between movement at 8 months and mobility skills at 12 months. In the risk group, there was significant relationship between skills and independence in mobility, at 12 months corrected age (r=0.80; p=0.0001). CONCLUSION: Preterm born children, without other disorders and with age correction, might show a similar motor development as those born at term. The path for the acquisition of motor abilities in preterm born children appears to differ among those infants. Language: ptObjective: To compare the development of motor function in children born preterm with those born at term, at 8 and 12 months of age. To investigate the relation of motor function quality at the age of 8 months with motor ability at 12 months. Method: Thirty-two children participated in this study: 16 were born preterm (risk group) and 16 were born at term (control group). The spontaneous movements of the children were assessed at 8 months and their mobility skills and independence were assessed at 12 months (corrected ages for the preterm group), using standardized developmental tests (AIMS and PEDI, respectively). Data were analysed using independent t-tests (between-group comparison) and Pearson correlation coefficients (within-group comparison). Results: There was no significant difference in motor function, between those born preterm with those born at term, either at 8 or at 12 months of age. In the control group, there was significant association (r=0.67; p=0.004) between movement at 8 months and mobility skills at 12 months. In the risk group, there was significant relationship between skills and independence in mobility, at 12 months corrected age (r=0.80; p=0.0001). Conclusion: Preterm born children, without other disorders and with age correction, might show a similar motor development as those born at term. The path for the acquisition of motor abilities in preterm born children appears to differ among those infants.

Treadmill training for ataxic patients: a single-subject experimental design

Objective: To investigate changes in gait quality, balance and mobility associated with treadmill training for ataxic individuals. Design: Single-subject ABA design. Baseline phases (A) lasted three weeks and intervention (B) lasted four weeks. Setting: University rehabilitation clinic. Subjects: A woman (25 years) and a man (53 years) with chronic ataxia due to head trauma. Intervention: Three 20-minute treadmill training sessions each week with progression in velocity and step length. Main measures: Rivermead Visual Gait Assessment, Timed Up and Go, time to complete a balance task, walking speed, cadence, and stride length assessments three times a week during the 10 weeks. Data were analysed with the celeration line technique and two standard deviation band. Results: Both individuals demonstrated gains in all parameters over initial baseline and subsequent phases, with performance increases ranging from 26% to 233% when first and last assessments were compared. Significantly superior effects of treadmill training over baseline conditions on cadence were detected (P<0.05). Gains in walking speed were not significantly better during intervention, but intervention withdrawal produced deceleration of performance gains. Gains in Timed Up and Go, step length and balance were not consistent and were possibly caused by a learning effect of the association between repeated testing and treadmill training. Rivermead Visual Gait Assessment gains reached significance only for subject 2 (P<0.05), probably because of increased variability of performance of subject 1. Results suggest that the association between repeated testing and treadmill training might have been responsible for the observed gains in the two ataxic patients.

The Relationship Between Diabetes Mellitus, Geriatric Syndromes, Physical Function, and Gait: A Review of the Literature.

Diabetes mellitus is a common and growing problem worldwide, especially in the elderly population imposing a huge economic burden for individuals and healthcare services. The purpose of this narrative review was to summarize the current state of knowledge about the relationship between diabetes and important geriatric syndromes, physical function measures, and gait variables. Studies pertaining to the topics were identified through on-line search of databases. Seniors with diabetes are more likely to experience falls, depression, and frailty. Furthermore, in older patients, diabetes has been associated with disability, including basic and instrumental activities of daily living, and with poorer performance on objective measures of physical function, such as sit-to-stand test, handgrip strength, Timed Up and Go (TUG) test, and Short Physical Performance Battery (SPPB). Diabetic seniors also have an altered gait pattern characterized by lower velocity and stride length, and higher step width, stance time, double support time, and stride length variability compared to non-diabetic seniors. Little is known about fear of falling in older adults with diabetes. The relationship between these outcomes and diabetes in older people is still outstanding and merits further investigation.

Effects of constraint-induced movement therapy in children with hemiplegia: a single case experimental study

Objective: To investigate the profile of changes in the use of the upper extremity in three children with hemiplegia submitted to an adapted protocol of constraint-induced movement therapy (CIMT). Methods: A single-subject design (ABA) was replicated in three children aged 8 to 11 years old. Baseline phases (A1) and (A2) and the intervention phase (B) lasted 2 weeks each. During the intervention period, children wore a splint on the non-affected extremity for 10 hours a day and were submitted to 3 hours of therapy a day during 10 days. Training consisted of activities with the affected upper extremity, with gradually increasing complexity and verbal feedback. Hand function was classified according to the Manual Ability Classification System (MACS). Children were assessed four times every week with the Toddler Arm Use Test (TAUT) and three adapted tasks from the Jebsen-Taylor Hand Function test (JTHF), and once a week with the Pediatric Motor Activity Log (PMAL) and self-care scales of the Pediatric Evaluation of Disability Inventory (PEDI). Celeration Line, Two-Standard Deviation Band and visual analysis methods were used for data analyses. Results: Significant improvements in the amount and quality of upper extremity use (PMAL), TAUT quality of use for children 2 and 3, and participation for child 1, as well as decreased time to complete JTHF tasks for children 2 and 3 were observed. No changes were observed in the PEDI self-care scales. Conclusion: CIMT effects were associated with improvements in manual dexterity, amount and quality of use of the affected upper extremity in children with hemiplegia.

Clinical Functional Tests Help Identify Elderly Women Highly Concerned About Falls

Background/Study Context: Limited research exists on functional tests in the discrimination of elderly individuals with high concern about falls from individuals with low concern about falls. The purpose of this study was to determine which functional test best discriminates between elderly women with low and high concern about falls. Methods: One hundred thirty-five elderly women (72.6 ± 4.8 years) were divided into two groups based on their Falls Efficacy Scale—International score: low concern (n = 56) and high concern (n = 79) about falls. Five functional tests were applied: Timed Up and Go test (TUG), unipodal stance test, five-repetition sit-to-stand test (5-STS), gait velocity, and grip strength. Factorial analysis and discriminant analysis were used. Results: Factorial analysis resulted in three factors that explained 83.8% of the total variance. Factor 1, with 49.5% of total variance explanation, was represented by the TUG, 5-STS, and gait velocity tests and was the only factor to discriminate between the groups, classifying correctly 68.9% of the observations. Among the original variables of Factor 1, the Fisher linear coefficient showed that the TUG was the most discriminant of the tests. Conclusion: The TUG test best discriminates elderly women with low and high concern about falls; therefore, it is an important test that should be performed during the assessment of elderly individuals afraid of falling.

Frontal Plane Motion of the Pelvis and Hip during Gait Stance Discriminates Children with Diplegia Levels I and II of the GMFCS

Objective. To determine if gait waveform could discriminate children with diplegic cerebral palsy of the GMFCS levels I and II. Patients. Twenty-two children with diplegia, 11 classified as level I and 11 as level II of the GMFCS, aged 7 to 12 years. Methods. Gait kinematics included angular displacement of the pelvis and lower limb joints during the stance phase. Principal components (PCs) analyses followed by discriminant analysis were conducted. Results. PC1s of the pelvis and hip in the frontal plane differ significantly between groups and captured 80.5% and 86.1% of the variance, respectively. PC1s captured the magnitude of the pelvic obliquity and hip adduction angle during the stance phase. Children GMFCS level II walked with reduced pelvic obliquity and hip adduction angles, and these variables could discriminate the groups with a cross-validation of 95.5%. Conclusion. Reduced pelvic obliquity and hip adduction were observed between children GMFCS level II compared to level I. These results could help the classification process of mild-to-moderate children with diplegia. In addition, it highlights the importance of rehabilitation programs designed to improve pelvic and hip mobility in the frontal plane of diplegic cerebral palsy children level II of the GMFCS.

Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation, cross-cultural adaptation and reliability

Background: Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities. Objectives : To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF). Method : The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR) was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP). The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC), through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart. Results : During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC≥0.92) for test-retest. Conclusion : The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP.

Terapia de movimento induzido pela restrição na hemiplegia: um estudo de caso único

A terapia de movimento induzido por restricao (TMIR) tem mostrado resultados positivos em individuos hemipareticos apos acidente vascular cerebral; consiste na contencao do membro superior nao-afetado e treinamento intensivo do membro afetado. Este estudo visou documentar longitudinalmente os efeitos da TMIR na funcionalidade do membro superior de um individuo com hemiparesia esquerda cronica. Neste estudo de caso unico tipo ABA, as fases linha de base (A) duraram duas semanas e a intervencao (B) compreendeu a contencao do membro sadio com um splint e cinco sessoes semanais de 3 horas de treino do membro superior afetado, durante duas semanas. As medidas de funcionalidade Action Research Arm (ARA) e de qualidade de movimento e destreza Wolf Motor Function Test (WMFT) foram coletadas cinco vezes por semana, e a medida de qualidade e frequencia de uso do membro superior, Motor Activity Log (MAL), uma vez por semana por seis semanas. Os dados coletados foram tratados estatisticamente. Os resultados mostram ganhos significativos na qualidade de movimento (WMFT) durante a intervencao (p 0,05). Quanto a destreza (WMFT) e funcionalidade (ARA), foram detectadas tendencias significativas de ganho durante as quatro primeiras semanas; apos a intervencao, houve estabilizacao do desempenho (p<0,05). A analise do MAL acusou efeitos sem relevância clinica. Os resultados mostram que a TMIR propiciou ganhos de desempenho motor do paciente com hemiparesia cronica.

Spatiotemporal and variability gait data in community-dwelling elderly women from Brazil

ABSTRACT Background Gait is an extremely complex motor task; therefore, gait data should encompass as many gait parameters as possible. Objective To provide reference values for gait measurements obtained from a Brazilian group of community-dwelling elderly females between the ages of 65 and 89 years and to apply the PCA-biplot to yield insight into different walking strategies that might occur during the aging process. Method 305 elderly community-dwelling females living in Brazil were stratified into four age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80 years (N=30). Age, height, and BMI were assessed to describe the characteristics of the groups. Gait spatiotemporal and variability data were obtained using the GAITRite® system. Principal component analysis, followed by MANOVA and the PCA-biplot approach were used to analyze the data. Results 95% CI showed that only three components – rhythm, variability, and support - together explained 74.2% of the total variance in gait that were different among the groups. The older groups (75-79 and ≥80 years) walked with lower than average velocity, cadence, and step length and were above average for the variables stance, step, swing, and double support time and the ≥80 year old group presented the highest gait variability compared to the other groups. Conclusion Aging is associated with decreased gait velocity and cadence and increased stance, step time, and variability, but not associated with changes in base of support. In addition, the PCA-biplot indicates a decline towards decreased rhythm and increased variability with aging.

Development of a first-contact protocol to guide assessment of adult patients in rehabilitation services networks

Objective: This paper describes the development of the Protocol for Identification of Problems for Rehabilitation (PLPR), a tool to standardize collection of functional information based on the International Classification of Functioning, Disability and Health (ICF). Development of the protocol: The PLPR was developed for use during the initial contact with adult patients within a public network of rehabilitation services. Steps to develop the protocol included: survey of the ICF codes most used by clinical professionals; compilation of data from functional instruments; development and pilot testing of a preliminary version in the service settings; discussion with professionals and development of the final version. The final version includes: user identification; social and health information; brief functional description (BFD); summary of the BFD; and PLPR results. Further testing of the final version will be conducted. Conclusions: The protocol standardizes the first contact between the user and the rehabilitation service. Systematic use of the protocol could also help to create a functional database that would allow comparisons between rehabilitation services and countries over time.