PACING OPPORTUNITIES AT HOME AND SKILL OF CHILDREN WITH POTENTIAL CHANGES IN FUNCTIONAL DEVELOPMENT

Introduction: the multifactorial nature of motor development is reinforced by the combination of biological and environmental risk factors, which intensify the chances of impaired motor development. Objectives: to verify the relationship between functional mobility skills of children with risk factors and motor stimulus opportunities in their home environment. Methods: transversal study conducted with 112 patients aged 18-42 months from follow-up services. Motor stimulus opportunities were evaluated by the Affordance in the Home Environment for Motor Development (AHEMD-SR) and Functional mobility skills by the Pediatric Evaluation Disability Inventory (PEDI). Student t test and multiple linear regression analysis were carried out. Results: predominance of good performance of functional mobility skills and “average level” of environmental stimulus opportunities were observed. There was no significant association between HFM-PEDI and AHEMD-SR. The results showed significant association only between HFM-PEDI and presence of health problems (p = 0.004). Children with health problems had lower mean PEDI normative score. Multiple linear regression analysis showed significant result for health problems in the interaction among environment, control variables and HFM-PEDI (p = 0.003). Conclusion: there was no association between functional mobility skills of children with risk factors and motor stimulus opportunities in their home environment. On the other hand, children with some health problem showed lower performance in functional mobility skills

Functional performance according to gestational age and birth weight of preschool children born premature or with low weight

OBJETIVO: Avaliar o desempenho funcional de crianças em idade pré-escolar nascidas com diferentes graus de prematuridade e baixo peso, acompanhados em serviço de follow-up. MATERIAL E MÉTODOS: Estudo transversal, que utilizou o instrumento Inventário de Avaliação Pediátrica de Incapacidade - PEDI, uma entrevista estruturada para cuidadores de crianças que avalia as habilidades funcionais e o nível de independência nas áreas de autocuidado, mobilidade e função social. O teste foi realizado com 98 participantes divididos em três grupos, em um momento de acordo com o grau de prematuridade e em outro de acordo com o peso ao nascer. Utilizou-se o teste qui-quadrado e a análise de variância para verificar a associação e diferença entre os grupos com diferentes graus de prematuridade e baixo peso ao nascer e o PEDI. Em todas as análises considerou-se o nível de significância de α = 0,05. RESULTADOS: Houve atraso nas habilidades funcionais de autocuidado (HFAC), de mobilidade (HFM), e de função social (HFFS) de 10,2%, 12,2% e 14,3%, respectivamente, e no nível de assistência recebida do cuidador de 11,2% em autocuidado (ACAC), 19,4% em mobilidade (ACM) e 15,3% em função social (ACFS). Não foram encontradas diferenças estatisticamente significativas entre os grupos de diferentes graus de prematuridade e baixo peso ao nascer em relação a nenhum dos domínios do PEDI. CONSIDERAÇÕES FINAIS: Crianças prematuras e com baixo peso ao nascer apresentaram alterações na idade pré-escolar do desempenho funcional nas áreas autocuidado, mobilidade e função social que não variaram em magnitude entre os diferentes graus de prematuridade e peso ao nascimento.OBJECTIVE: Evaluate the functional performance of preschool children born with different degrees of prematurity and low birth weight who are follow in a care specialized service. METHODS: A cross-sectional study, which used the Pediatric Evaluation Disability Inventory- PEDI, an interview structured for caregivers that assesses children's functional abilities and independence level, in the areas of self-care, mobility and social function. The test was achieved with 98 participants divided into three groups according to the degree of prematurity and according to birth weight. It was used the chi-square test and the variance analys is to verify the association and the difference between groups according the degrees of prematurity (three) or birth weight (three) and the PEDI. In all analysis it was considered the significant level of α = 0,05. RESULTS: There was found a delay of 10,2%, 12,2% and 14,3% in the functional abilities in the areas of self-care, mobility and social function, respectively, and of 11,2%, 19,4% and 15,3% in the assistance level received from the caregivers (independence), in the same areas. It was not found statistically significant differences or associations between groups of different degrees of prematurity or birth weight and the PEDI performance. CONCLUSION: Premature and low birth weight children demonstrated high rates of delay in functional performance at preschool age that did not vary in magnitude among different degrees of prematurity and low birth weight, suggesting that exist others factors contributing to the development outcome at this age

Motor development in children at risk and maternal home care

Com o objetivo de verificar a contribuição das orientações (verbal e folder) fornecidas às mães na estimulação do desenvolvimento motor de crianças de risco, realizou-se estudo experimental prospectivo com crianças cadastradas no serviço de follow up do Hospital Universitário do Oeste do Paraná, com fatores de risco e idade corrigida entre quatro e 12 meses. Houve aprovação pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto-USP. Entre março e abril de 2017, elaborou-se e validou-se, com juízes e mães, um folder com orientações para o desenvolvimento motor no domicílio. O folder foi validado por cinco fisioterapeutas, cujas considerações para estilo da escrita, organização e aparência foram aceitas e implementadas; e por dez mães que responderam a um questionário, cujas questões apresentaram concordância de adequação acima de 70%. As sugestões sobre layout e conteúdo foram incorporadas, respeitando-se a versão e o sentido original do folder. Juízes e mães concordaram, unanimemente, com a aplicabilidade do folder. Em seguida, entre março e novembro de 2017, na etapa de orientações verbais e folder, participaram 60 crianças e suas mães, inseridas em dois grupos de 30, que foram avaliados em dois momentos, com intervalo de dois meses. No primeiro, as mães responderam um questionário e receberam orientações sobre estímulos a serem realizados (verbal e folder); as crianças foram avaliadas com a Escala de Avaliação Motora de Alberta (AIMS). No segundo encontro, as mães responderam ao questionário sobre a realização dos estímulos e as que receberam folder indicaram sua contribuição; as crianças tiveram o desenvolvimento reavaliado. A avaliação da variável \"Entendeu as orientações? \" apresentou associação significativa entre os grupos, e a frequência de mães que entenderam todas orientações foi maior no grupo que recebeu o folder (p=0,01). Na avaliação do desempenho motor não houve diferença entre os grupos. Identificou-se aumento da média do escore total da AIMS e das posturas prono, supino, sentado e de pé, em ambos os grupos, indicando melhora do controle postural e repertório motor. Ao se considerar fatores que poderiam interferir no desenvolvimento, conclui-se que houve relação significativa com nível socioeconômico (p=0,46) e realização de fisioterapia motora (p=0,003). Conclui-se que a realização de fisioterapia motora pode atuar como fator de proteção e contribuir no desempenho motor. Ambos os grupos, na pré-intervenção, apresentaram maior número de crianças com desenvolvimento suspeito ou atrasado. O fato de a maioria das famílias pertencer às classes C1 e C2 pode ter contribuído para o baixo desempenho, de ambos os grupos, préintervenção. O estudo espera contribuir para a sensibilização dos atores envolvidos e para a otimização do suporte oferecido a populações vulneráveis. Recomenda-se, para fisioterapeutas, a reflexão sobre a importância da atenção não somente para as necessidades das crianças, mas também para o suporte familiar. Por fim, indica-se a instituição desse folder para compor o trabalho voltado ao desenvolvimento motor da criança de riscoIn order to verify the contribution of the guidelines provided to mothers, verbal and leaflet, in the stimulation of motor development of at-risk children, a prospective experimental study was enrolled in the Follow up service of the Western Parana University Hospital, with children with risk factors and corrected age between four and twelve months. The Research Ethics Committee of the Nursing School of the University of São Paulo, Ribeirão Preto-USP approved this study. Between March and April 2017, a leaflet with guidelines for motor development was elaborated and validated with judges and mothers. Five physiotherapists participated in the validation, whose considerations related to the style of writing, organization, and appearance were accepted and implemented; 10 mothers answered a questionnaire, whose questions presented an agreement of adequacy of 70%. Mothers\' suggestions on layout and content were incorporated, respecting the version and the original meaning of the leaflet. Judges and mothers unanimously agreed with its applicability. Between March and November 2017, in the stage of verbal orientations or leaflet, 60 children and their mothers were enrolled in two groups of 30, which were evaluated in two moments, with a two-month interval. First, mothers answered questionnaire and received guidance on stimuli to be performed at home (verbal and leaflet), the children were evaluated through the Alberta Infant Motor Scale (AIMS). Afterwards, mothers answered questionnaires about the realization of the stimuli and those who had received the leaflet indicated whether it contributed or not; children had their motor development evaluated over again. Variable \'Did you understand the guidelines?\' presented association between groups, and the frequency of mothers who understood all guidelines was higher in the group that received the leaflet (p = 0.01). In motor performance evaluation using AIMS, there was no difference between groups. A significant increase in the mean AIMS total score and the prone, supine, sitting and standing postures were identified in both groups, indicating an improvement of postural control and motor repertoire. Considering factors that could interfere in the development, there was a significant relationship with socioeconomic status (p = 0.46) and motor physical therapy (p = 0.003). The conclusion is that motor physical therapy can act as a protection factor, and contribute to the motor development. Both groups at the pre-intervention stage had a higher number of children with suspected or delayed development. The fact that most families belong to the lower class may have contributed to the low motor performance of both groups at the pre-intervention time. Thus, this study hopes to contribute to raising the awareness of the actors involved, and to optimize the support offered to vulnerable populations. For the Physiotherapy area, professionals are recommended to reflect on the importance of directing their attention not only to the needs of at-risk children but also to family support and maternal care. Furthermore the institution of the leaflet is indicated to compose the work aimed at stimulating the motor development of children at ris

Oportunidades de estimulação no domicílio e habilidade funcional de lactentes e pré-escolares com fatores de risco para alteração no desenvolvimento

Infant motor development is influenced by biological, social and environmental risk factors and their association. The aims of this study were to investigate the relationship between functional mobility skills (HFM-PEDI) of children aged 18-42 months and motor stimulus opportunities in their home environment, and to investigate if this relationship is affected by biological and socioeconomic factors. A transversal study was conducted with a random sample of 112 patients from two follow-up services. Instruments used were the Pediatric Evaluation Disability Inventory (PEDI) and the Affordance in the Home Enviroment for Motor Development (AHEMD-SR). Descriptive statistical analysis were carried out and Student t test was used to assess the association between HFM-PEDI and environmental stimulus (AHEMD-SR), and between HFM-PEDI and socioeconomic status (SES), mother's educational level, pathology and day-care attendance. Multiple linear regression analysis was carried out in order to investigate possible moderating effects of variables on the association between environmental stimulus opportunities and the scores of the HFM-PEDI. A predominance of good performance of functional mobility skills (82.1%) was observed among participants. More than two thirds of participants (74.1%) presented “average level” of environmental stimulus opportunities for Total AHEMD-SR classification, and the lowest percentage (1.8%) was observed to "high level” of stimulus. There was no significant association between HFM-PEDI and AHEMD-SR. Variability of the mean of HFM-PEDI was greater among participants who had insufficient opportunities to motor development on the variety of stimulation and gross motor dimensions. Findings revealed a significant association only between HFM-PEDI and presence of pathology (p = 0,004). Children with pathology had lower mean PEDI normative score. Multiple linear regression analysis revealed significant result for pathology in the interaction among environment, moderating variables and HFM-PEDI (p = 0.003). Presence of pathology decreased PEDI normative score in almost 8 points. It was concluded that there was no association between functional mobility skills of children with risk factors and motor stimulus opportunities in their home environment. Presence of pathology resulted in functional mobility skills significantly lower, and it strongly affected the HFM-PEDI resultant from the individual-environment interaction.Os fatores de risco biológicos, sociais e ambientais, e sua associação, aumentam a probabilidade do desenvolvimento motor ser comprometido. Os objetivos do presente estudo foram verificar a associação entre a habilidade funcional de mobilidade (HFM-PEDI) e as oportunidades de estímulos do ambiente domiciliar de lactentes e pré-escolares, com idade entre 18 e 42 meses, com fatores de risco, e averiguar se esta interação é afetada por fatores biológicos e socioeconômicos. Foi realizado um estudo transversal, com uma amostra aleatória de 112 participantes acompanhados em dois serviços de follow-up. Os instrumentos utilizados foram o Inventario de Avaliação Pediátrica de Incapacidade (PEDI) e o questionário Affordance in the Home Enviroment for Motor Development (AHEMD-SR). Foram realizadas estatísticas descritivas das variáveis estudadas e aplicado o Teste t de Student para verificar a significância da associação entre HFM-PEDI e as oportunidades de estímulos ambientais (AHEMD-SR), e com as variáveis moderadoras, nível socioeconômico (NSE), escolaridade materna, patologia e freqüência à creche. A análise de regressão linear múltipla foi utilizada a fim de investigar os possíveis efeitos das variáveis moderadoras na associação entre as oportunidades de estímulos no domicilio e os escores do HFM-PEDI. Entre os participantes, deste estudo, houve o predomínio de bom desempenho na HFM-PEDI (82,1%). Na classificação Total do AHEMD-SR, encontrou-se “nível médio” de presença de oportunidades de estimulação domiciliar em mais de dois terços dos participantes (74,1%), e um baixíssimo percentual (1,8%) apresentou “alto” nível de estímulos. Não foi observada associação significativa entre as variáveis HMF-PEDI e AHEMD-SR, mas a variabilidade da média para HFM-PEDI foi maior entre aqueles que tinham oportunidades insuficientes para o desenvolvimento motor nas dimensões variedade e motricidade grossa. Foi encontrada associação significativa (p = 0,004) apenas entre o desfecho (HFM-PEDI) e a presença de patologia. Participantes que apresentavam patologia tiveram menor média no escore normativo do PEDI. Na análise de regressão linear múltipla a variável patologia foi a única que apresentou associação significativa (p = 0,003), quando considerada a interação entre o ambiente, as variáveis moderadoras e o desfecho nas HFM-PEDI, uma vez que diminuiu em quase 8 pontos a média do escore normativo do PEDI. Conclui-se que não houve associação entre as oportunidades do ambiente domiciliar e a habilidade funcional de mobilidade de lactentes e pré-escolares com fatores de risco. A presença de patologia levou a desempenhos significativamente inferiores nas habilidades funcionais de mobilidade, sendo que esta variável impactou fortemente no desfecho resultante da interação do ambiente com o indivíduo.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Motor development in children at risk and maternal home care

Com o objetivo de verificar a contribuição das orientações (verbal e folder) fornecidas às mães na estimulação do desenvolvimento motor de crianças de risco, realizou-se estudo experimental prospectivo com crianças cadastradas no serviço de follow up do Hospital Universitário do Oeste do Paraná, com fatores de risco e idade corrigida entre quatro e 12 meses. Houve aprovação pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto-USP. Entre março e abril de 2017, elaborou-se e validou-se, com juízes e mães, um folder com orientações para o desenvolvimento motor no domicílio. O folder foi validado por cinco fisioterapeutas, cujas considerações para estilo da escrita, organização e aparência foram aceitas e implementadas; e por dez mães que responderam a um questionário, cujas questões apresentaram concordância de adequação acima de 70%. As sugestões sobre layout e conteúdo foram incorporadas, respeitando-se a versão e o sentido original do folder. Juízes e mães concordaram, unanimemente, com a aplicabilidade do folder. Em seguida, entre março e novembro de 2017, na etapa de orientações verbais e folder, participaram 60 crianças e suas mães, inseridas em dois grupos de 30, que foram avaliados em dois momentos, com intervalo de dois meses. No primeiro, as mães responderam um questionário e receberam orientações sobre estímulos a serem realizados (verbal e folder); as crianças foram avaliadas com a Escala de Avaliação Motora de Alberta (AIMS). No segundo encontro, as mães responderam ao questionário sobre a realização dos estímulos e as que receberam folder indicaram sua contribuição; as crianças tiveram o desenvolvimento reavaliado. A avaliação da variável \"Entendeu as orientações? \" apresentou associação significativa entre os grupos, e a frequência de mães que entenderam todas orientações foi maior no grupo que recebeu o folder (p=0,01). Na avaliação do desempenho motor não houve diferença entre os grupos. Identificou-se aumento da média do escore total da AIMS e das posturas prono, supino, sentado e de pé, em ambos os grupos, indicando melhora do controle postural e repertório motor. Ao se considerar fatores que poderiam interferir no desenvolvimento, conclui-se que houve relação significativa com nível socioeconômico (p=0,46) e realização de fisioterapia motora (p=0,003). Conclui-se que a realização de fisioterapia motora pode atuar como fator de proteção e contribuir no desempenho motor. Ambos os grupos, na pré-intervenção, apresentaram maior número de crianças com desenvolvimento suspeito ou atrasado. O fato de a maioria das famílias pertencer às classes C1 e C2 pode ter contribuído para o baixo desempenho, de ambos os grupos, préintervenção. O estudo espera contribuir para a sensibilização dos atores envolvidos e para a otimização do suporte oferecido a populações vulneráveis. Recomenda-se, para fisioterapeutas, a reflexão sobre a importância da atenção não somente para as necessidades das crianças, mas também para o suporte familiar. Por fim, indica-se a instituição desse folder para compor o trabalho voltado ao desenvolvimento motor da criança de riscoIn order to verify the contribution of the guidelines provided to mothers, verbal and leaflet, in the stimulation of motor development of at-risk children, a prospective experimental study was enrolled in the Follow up service of the Western Parana University Hospital, with children with risk factors and corrected age between four and twelve months. The Research Ethics Committee of the Nursing School of the University of São Paulo, Ribeirão Preto-USP approved this study. Between March and April 2017, a leaflet with guidelines for motor development was elaborated and validated with judges and mothers. Five physiotherapists participated in the validation, whose considerations related to the style of writing, organization, and appearance were accepted and implemented; 10 mothers answered a questionnaire, whose questions presented an agreement of adequacy of 70%. Mothers\' suggestions on layout and content were incorporated, respecting the version and the original meaning of the leaflet. Judges and mothers unanimously agreed with its applicability. Between March and November 2017, in the stage of verbal orientations or leaflet, 60 children and their mothers were enrolled in two groups of 30, which were evaluated in two moments, with a two-month interval. First, mothers answered questionnaire and received guidance on stimuli to be performed at home (verbal and leaflet), the children were evaluated through the Alberta Infant Motor Scale (AIMS). Afterwards, mothers answered questionnaires about the realization of the stimuli and those who had received the leaflet indicated whether it contributed or not; children had their motor development evaluated over again. Variable \'Did you understand the guidelines?\' presented association between groups, and the frequency of mothers who understood all guidelines was higher in the group that received the leaflet (p = 0.01). In motor performance evaluation using AIMS, there was no difference between groups. A significant increase in the mean AIMS total score and the prone, supine, sitting and standing postures were identified in both groups, indicating an improvement of postural control and motor repertoire. Considering factors that could interfere in the development, there was a significant relationship with socioeconomic status (p = 0.46) and motor physical therapy (p = 0.003). The conclusion is that motor physical therapy can act as a protection factor, and contribute to the motor development. Both groups at the pre-intervention stage had a higher number of children with suspected or delayed development. The fact that most families belong to the lower class may have contributed to the low motor performance of both groups at the pre-intervention time. Thus, this study hopes to contribute to raising the awareness of the actors involved, and to optimize the support offered to vulnerable populations. For the Physiotherapy area, professionals are recommended to reflect on the importance of directing their attention not only to the needs of at-risk children but also to family support and maternal care. Furthermore the institution of the leaflet is indicated to compose the work aimed at stimulating the motor development of children at ris

Functional capacity, independence and home affordances of premature children attending daycare centers

Abstract Introduction: Child development is the result of the interaction between biological and environmental factors. Objective: The aim of this study is to evaluate and compare the Functional Capacity, Independence and Home Affordances Level of Stimulation of premature children between 18 and 42 months, attending or not daycare centers. Methods: Cross-sectional study with a convenience sample of 26 premature children between 18 and 42 months, paired and divided into two groups: attending (study group) and not attending daycare centers (control group). Data was collected from the questionnaires AHEMD-SR, PEDI and an identification questionnaire. Data analysis was performed by descriptive statistics, and Chi-square, Fisher, Mann-Whitney and Univariate Analysis tests, considering the level of significance of α = 0.05 and tendency of differentiation when α < 010. Results: There was a significant difference in the AHEMD-SR`s Variety of Stimulation (p = 0.036), higher in the control group, and tendency in the Gross Motor Toys (p = 0.086), more available in the study group. In PEDI, there was significant difference in Self-care (p = 0.045) and tendency of differentiation in Mobility (0.068), both of the Caregiver Assistance part (greater to the study). The sample showed low stimulation opportunities regarding Fine and Gross Motor Toys and high percentages of delay in Functional Skills (Mobility) and Independence (Self Care and Mobility), especially in the control group. Conclusion: Daycare centers seem to positively affect the Functional Capacity and Independence in premature children between 18 and 42 months

PACING OPPORTUNITIES AT HOME AND SKILL OF CHILDREN WITH POTENTIAL CHANGES IN FUNCTIONAL DEVELOPMENT

Introduction: the multifactorial nature of motor development is reinforced by the combination of biological and environmental risk factors, which intensify the chances of impaired motor development. Objectives: to verify the relationship between functional mobility skills of children with risk factors and motor stimulus opportunities in their home environment. Methods: transversal study conducted with 112 patients aged 18-42 months from follow-up services. Motor stimulus opportunities were evaluated by the Affordance in the Home Environment for Motor Development (AHEMD-SR) and Functional mobility skills by the Pediatric Evaluation Disability Inventory (PEDI). Student t test and multiple linear regression analysis were carried out. Results: predominance of good performance of functional mobility skills and “average level” of environmental stimulus opportunities were observed. There was no significant association between HFM-PEDI and AHEMD-SR. The results showed significant association only between HFM-PEDI and presence of health problems (p = 0.004). Children with health problems had lower mean PEDI normative score. Multiple linear regression analysis showed significant result for health problems in the interaction among environment, control variables and HFM-PEDI (p = 0.003). Conclusion: there was no association between functional mobility skills of children with risk factors and motor stimulus opportunities in their home environment. On the other hand, children with some health problem showed lower performance in functional mobility skills