Paralisia Cerebral: Fundamentos para Pais e Cuidadores

One aspect that cannot be ignored is the impact of cerebral palsy in the internal dynamics of the family, due to the fact that its members are confronted with a different reality which requires adaptations and changes daily. The way parents, caregivers and family members adjust is crucial for the future of the child and of the people involved. Due to the difficulties of parents and caregivers of children with cerebral palsy in acquiring knowledge about the definitions, classifications and differences caused by disability, this work aims to present theoretical and practical explanations about cerebral palsy. Therefore, an explanatory text was organized with the main reasons that cause changes in posture and movement of children with disabilities, because it is known that the knowledge of parents can interfere in the care and education, whereas parents play an essential role as educators of their children, especially during the early formative years, and that this will provide all opportunities for participation, learning and growth.Um aspecto que não pode ser ignorado é o impacto da paralisia cerebral na dinâmica interna da família, devido ao fato de que seus membros são confrontados com uma realidade diferente que exige adaptações e modificações diárias. A forma como os pais, cuidadores e membros da família se ajustam é crucial para o futuro da criança e das pessoas envolvidas. Devido às dificuldades dos pais e cuidadores de crianças com paralisia cerebral em adquirir conhecimentos sobre as definições, classificações e diferenças causadas pela deficiência, este trabalho tem como objetivo apresentar esclarecimentos teóricos e práticos sobre paralisia cerebral. Para tanto, organizou-se um texto explicativo dos principais motivos que causam as alterações na postura e movimento das crianças com deficiência, pois é sabido que o conhecimento dos pais pode interferir no cuidado e na educação, considerando que os pais desempenham um papel essencial como educadores de seus filhos, especialmente durante os primeiros anos de formação, e que isso proporcionará a todos oportunidades de participação, aprendizado e crescimento

Autonomic Modulation in Duchenne Muscular Dystrophy during a Computer Task: A Prospective Control Trial

Introduction Duchenne Muscular Dystrophy (DMD) is characterized by progressive muscle weakness that can lead to disability. Owing to functional difficulties faced by individuals with DMD, the use of assistive technology is essential to provide or facilitate functional abilities. In DMD, cardiac autonomic dysfunction has been reported in addition to musculoskeletal impairment. Consequently, the objective was to investigate acute cardiac autonomic responses, by Heart Rate Variability (HRV), during computer tasks in subjects with DMD. Method HRV was assessed by linear and nonlinear methods, using the heart rate monitor Polar RS800CX chest strap Electrocardiographic measuring device. Then, 45 subjects were included in the group with DMD and 45 in the healthy Typical Development (TD) control group. They were assessed for twenty minutes at rest sitting, and five minutes after undergoing a task on the computer. Results Individuals with DMD had a statistically significant lower parasympathetic cardiac modulation at rest when compared to the control group, which further declined when undergoing the tasks on the computer. Conclusion DMD patients presented decreased HRV and exhibited greater intensity of cardiac autonomic responses during computer tasks characterized by vagal withdrawal when compared to the healthy TD control subjects.FAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo)Univ Sao Paulo, Sch Med, Phys Therapy Speech & Occupat Therapy Dept, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Dept Neurol Neurosurg, Sao Paulo, SP, BrazilUniv Estadual Paulista, Speech Therapy Dept, Auton Nervous Syst Ctr Study, Fac Sci,UNESP, Marolia, SP, BrazilABC Med Sch, Dept Community Hlth, Lab Design & Sci Writing, Santo Andre, SP, BrazilUniv Estadual Paulista, Dept Physiotherapy, UNESP, Sao Paulo, SP, BrazilOxford Brookes Univ, Fac Hlth & Life Sci, Dept Biol & Med Sci, Cardioresp Res Grp, Gipsy Lane, Oxford OX3 0BP, EnglandUniv Sao Paulo, Sch Arts Sci & Humanities, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Dept Neurol Neurosurg, Sao Paulo, SP, BrazilFAPESP: 2012/16970-6Web of Scienc

Analysis of Different Device Interactions in a Virtual Reality Task in Individuals With Duchenne Muscular Dystrophy—A Randomized Controlled Trial

There is a need to support individuals with Duchenne Muscular Dystrophy (DMD) to achieve optimal functionality in everyday life and with meaningful tasks and activities, throughout stages of the disease progression. Thus, technological developments have created an exciting opportunity for the use of affordable virtual reality (VR) systems with different kinds of interaction devices, providing an efficient and fun tool for enabling improvement in motor performance.Objective: To compare performance on a virtual task using interfaces with and without physical contact in order to identify functionality by using different devices in individuals with DMD.Methods: One hundred and twenty male individuals took part on this study: 60 with DMD with a mean age of 16 ± 5 (range 9–34 years old) and 60 without DMD in the control group (CG) matched by age. Participants were divided into three groups of 20 individuals each which performed a virtual task in three different interfaces: Kinect®, computer Touch Screen and Leap Motion®, in a cross over design in which all participants used all devices. Motor impairment in the DMD group was measured by using the Motor Function Measurement and Vignos scales.Results: All participants improved performance through practice, regardless of the interface used, although the DMD group had a continuous lower performance compared to the CG. In addition, the DMD group obtained a significant better performance with Leap Motion interface compared to the other interfaces, while the CG presented better performance on Touch Screen interface.Conclusion: Leap Motion provided better performance for individuals with DMD due to enablement of distal muscle function and ease of instrument adjustment using the virtual interface. Therefore, this type of interface should be encouraged for promoting functionality on general tasks using computer systems. Clinical Trial register number: NCT02891434

Analysis of psychomotor development and level of physical activity of children with extracurricular physical activities

Objetivo: Avaliar o desenvolvimento psicomotor nas áreas de habilidades motoras globais, equilíbrio e estrutura corporal e nível de atividade extracurricular escolar. Método: A amostra foi constituída por 30 indivíduos de ambos os sexos de 6 a 10 anos de idade, divididos em dois grupos: Grupo Extracurricular Ativo e Grupo Extracurricular Sedentário. A coleta de dados incluiu a caracterização dos sujeitos, os dados antropométricos e os testes Development Scale Motor e a versão curta do IPAQ. As variáveis ​​foram expressas em frequências e proporções, sendo o teste de Shapiro-Wilk utilizado e o teste t de Student para determinar a significância estatística. Quanto aos dados não normais, utilizou-se o teste de Mann Whitney, que foi considerado estatisticamente significativo p <0,05. Resultados: Mostraram que a classificação de IMC / idade de ambos os grupos foi eutrófica (53,3%) e o restante (46,6%) apresentou sobrepeso. O grupo sedentário apresentou melhores resultados no desenvolvimento motor global, e o grupo ativo no esquema do equilíbrio e do corpo. Conclusão: As crianças que realizam atividade extracurricular apresentaram melhor desenvolvimento de equilíbrio e estrutura corporal, quando comparadas com aquelas que não o fizeram.         Objective: The objective was to evaluate the psychomotor development in the areas of global motor skills, balance and body structure and level of school extracurricular physical activity. Method: The sample consisted of 30 individuals of both sexes from 6 to 10 years old, divided into two groups: Active Extracurricular Group and Sedentary Extracurricular Group. Data collection included the characterization of the subjects, anthropometric data, and the tests Development Scale Motor and the IPAQ short version. The variables were expressed as frequencies and proportions, the normality was tested with the Shapiro-Wilk test. Student t test was used to determine the statistical significance of normal data and Mann Whitney test for the non-normal data. Statistical significance was set at p0.05. Results: The classification of BMI / age of both groups was eutrophic (53.3%) and the remainder (46.6%) were overweight. The sedentary group had better results in overall motor development, and the active group in balance and body scheme. Conclusion: The children who engage in extracurricular physical activity showed better development in balance and body structure, when compared to those that do no

Famílias e o tratamento diretamente observado da tuberculose: sentidos e perspectivas para produção do cuidado

O objetivo foi identificar a participação das famílias na gestão do cuidado do doente de tuberculose, o aporte oferecido pelos profissionais de saúde às famílias de doentes em tratamento e a importância atribuída pelas famílias ao Tratamento Diretamente Observado. Trata-se de um estudo descritivo de corte transversal, realizado no município de Ribeirão Preto, SP, junto às famílias dos pacientes diagnosticados de tuberculose. Para coleta de dados, foi elaborado um instrumento que passou pela validação de conteúdo e pré-teste. Foram entrevistados 94 sujeitos. Nos resultados, 64 (68,0%) dos familiares participaram da gestão do cuidado, 81 (86,2%) relataram boa relação com a equipe, 63 (67%) não receberam orientação dos medicamentos e 75 (80,0%) consideraram a estratégia como relevante. Os achados do estudo apontam que o Tratamento Diretamente Observado apresenta ainda limitações quanto às orientações do manejo clínico da doença, a inclusão da família na gestão do cuidado e na compreensão dos seus objetivos.Descritores: Relações familiares. Terapia diretamente observada. Tuberculose

Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

O traumatismo cranioencefálico (TCE) é um problema de saúde pública com muitos casos de mortalidade e repercussões socioeconômicas. Este estudo visa investigar a influência da gravidade do TCE no tempo de ventilação mecânica (VM) e hospitalização, e na prevalência de casos de traqueostomia, pneumonia, neurocirurgia e morte. É um estudo retrospectivo e observacional, que avaliou prontuários de 67 pacientes com TCE na Irmandade Santa Casa de Misericórdia de São Paulo. A gravidade foi avaliada pela escala de Glasgow (ECG): leve (13-15 pontos; 36 pacientes; 53.7%); moderado (9-12 pontos; 14 pacientes; 20.9%); ou grave (3-8 pontos; 17 pacientes; 25.4%). Pacientes com TCE grave apresentaram maior prevalência de traqueostomia, pneumonia e neurocirurgia. Não houve diferença significativa entre gravidade do TCE, óbito e tempo em VM, apesar de a gravidade do TCE ter influenciado o tempo de hospitalização. A gravidade do TCE na admissão, avaliada pela ECG, influenciou a prevalência de traqueostomia, pneumonia, neurocirurgia e de maiores tempos de internação.El traumatismo craneoencefálico (TCE) es un problema de salud pública con alta mortalidad y repercusiones socioeconómicas. Este estudio ha tenido el objetivo de investigar la influencia de la gravedad del TCE en el tiempo de ventilación mecánica (VM) y de hospitalización y en la prevalencia de traqueotomía, neumonía, neurocirugía y mortalidad. Este estudio retrospectivo, observacional ha evaluado historias clínicas de 67 pacientes con TCE admitidos en Irmandade Santa Casa de Misericórdia de São Paulo. La gravedad ha sido evaluada por la escala de Glasgow (ECG): leve (13-15 puntos; 36 pacientes; el 53,7%), moderado (9-12 puntos; 14 pacientes; el 20,9%) o grave (3-8 puntos; 17 pacientes; el 25,4%). Pacientes con TCE grave han presentado prevalencia más grande de traqueotomía, neumonía y neurocirugía. No ha habido diferencia significativa entre la gravedad del TCE, la mortalidad y el tiempo en VM; mientras tanto, la gravedad del TCE ha influenciado el tiempo de hospitalización. La gravedad del TCE en la admisión, que ha sido evaluada por la ECG, ha influenciado la prevalencia de traqueotomía, neumonía, neurocirugía y ha sido asociada la internación prolongada.Traumatic brain injury (TBI) is a public health problem with high mortality and socioeconomic repercussions. We aimed to investigate the influence of TBI severity on the length of mechanical ventilation (MV) stay and length of hospital stay and on the prevalence of tracheostomy, pneumonia, neurosurgery and death. This retrospective, observational study evaluated medical records of 67 patients with TBI admitted to Irmandade da Santa Casa de Misericórdia de São Paulo. Severity was determined according to the Glasgow Coma Scale (GCS): mild (13-15 points; 36 patients; 53.7%), moderate (9-12 points; 14 patients; 20.9%) or severe (3-8 points; 17 patients; 25.4%). Severe TBI patients had higher prevalence of tracheostomy, pneumonia and neurosurgery. No significant differences were observed between TBI severity, mortality and length of MV stay. However, TBI severity influenced the length of hospital stay. TBI severity at admission, evaluated according to the GCS, influenced the prevalence of tracheostomy, pneumonia, neurosurgery and was associated to prolonged hospital stay

Maze computer performance in Down syndrome

Introduction: These changes are the main causes of defi cits in perceptual-motor skills responsible for motor skill acquisition and performance of functional activities. AIMS: The current study aimed at verifying the quantitative performance of people with DS in undertaking a computer task to compare the performances of typical development (TD). Method: 60 subjects participated in the study, 30 with Down’s syndrome and 30 with typical development, matched by sex. Individuals were aged from 10–36. The groups were divided into three subgroups by age: Group 1 (G1) 10–18; Group 2 (G2) 18–25; Group 3 (G3) 25–36. They performed a computer maze task. During the acquisition phase all groups attempted the maze 30 times, and then after 5 minutes they performed 5 repetitions of Maze 1 for the retention phase. Finally, for the transfer phase, they performed fi ve repetitions in Maze 2. The dependent variables were submitted to a group, age group, gender and block ANOVA with repeated measures on the last factor. Results: In acquisition phase there was a significant decrease in movement time (MT) between the fi rst and last acquisition block, but only for the DS-group. In retention, there was a significant effect of Group, and an interaction between Block and Group, indicating that MTs increased from retention to transfer, but only for the DS-group. Conclusion: It was found that participants with DS improved performance during acquisition and retention, but they had diffi culty in performing the transfer of the computational task for a similar situation. The age and gender were not signifi cant in any of the stages of the study.Introduction: These changes are the main causes of defi cits in perceptual-motor skills responsible for motor skill acquisition and performance of functional activities. AIMS: The current study aimed at verifying the quantitative performance of people with DS in undertaking a computer task to compare the performances of typical development (TD). Method: 60 subjects participated in the study, 30 with Down’s syndrome and 30 with typical development, matched by sex. Individuals were aged from 10–36. The groups were divided into three subgroups by age: Group 1 (G1) 10–18; Group 2 (G2) 18–25; Group 3 (G3) 25–36. They performed a computer maze task. During the acquisition phase all groups attempted the maze 30 times, and then after 5 minutes they performed 5 repetitions of Maze 1 for the retention phase. Finally, for the transfer phase, they performed fi ve repetitions in Maze 2. The dependent variables were submitted to a group, age group, gender and block ANOVA with repeated measures on the last factor. Results: In acquisition phase there was a significant decrease in movement time (MT) between the fi rst and last acquisition block, but only for the DS-group. In retention, there was a significant effect of Group, and an interaction between Block and Group, indicating that MTs increased from retention to transfer, but only for the DS-group. Conclusion: It was found that participants with DS improved performance during acquisition and retention, but they had diffi culty in performing the transfer of the computational task for a similar situation. The age and gender were not signifi cant in any of the stages of the study

Análise da prevalência de sobrepeso e obesidade e do nível de atividade física em crianças e adolescentes de uma cidade do sudoeste de São Paulo

This study aimed to verify the prevalence of overweight, obesity and physical activity level according to the sex of children and adolescents from public schools city of Nantes, São Paulo, Brazil. The sample consisted of 170 children and 232 adolescents with a mean age of 8.04±1.31 and 13.2±1.83 years, respectively, of both sexand frequenters oftwoschools. Anthropometric measurements were collected: body mass index by age (BMI/age) and abdominal circumference. The BMI/age was classified according to the Sistema de Vigilância Alimentar e Nutricional (SISVAN) (2007) and a modified, adapted and suggested questionnaire by Silva (2009) was used to analyze the physical activity level. An unpaired t test was used and p-values < 0.05 were considered significant. The prevalence of 30.59% of the overweight or obese individuals, most of them adolescents, was verified. A higher media was also found with a significant value difference of the abdominal circumference in the females sex in the children group. It was observed that 62.68% of the sample was inactive or inadequately active and that most were female. Those facts demonstrate the sizable risk that these individuals may present for cardiovascular and musculoskeletal complications throughout life. The importance of the early educational and nutritional programs in schools should be emphasized with the prevention and treatment of overweight and low physical activity level individuals.Este estudo teve como objetivo verificar a prevalência de sobrepeso, obesidade e o nível de atividade física segundo o sexo de crianças e adolescentes de escolas públicas da cidade de Nantes, São Paulo, Brasil. A amostra foi composta de 170 crianças e 232 adolescentes com a idade média de 8,04±1,31 e 13,2±1,83 anos, respectivamente, de ambos os sexos e frequentadores de duas escolas. Foram coletadas as medidas antropométricas: Índice de massa corpórea pela idade (IMC/idade) e circunferência abdominal. O IMC/idade foi classificado de acordo com o Sistema de Vigilância Alimentar e Nutricional (SISVAN) (2007) e um questionário modificado e adaptado sugerido por Silva (2009) foi utilizado para analisar o nível de atividade física. O teste t não pareado foi realizado e os valores de p<0,05 foram considerados significativos.A prevalência de 30,59% dos indivíduos com sobrepeso ou obesidade, foi verificada sendo a maioria desta adolescente. Também foi encontrada maior média e com diferença significativa do valor da circunferência abdominal no sexo feminino no grupo das crianças. Foi observado que 62,68% da amostra são inativos ou inadequadamente ativos e que a maioria desses era do sexo feminino. Estes fatos demonstram considerável risco que estes indivíduos podem apresentar de complicações cardiovasculares e musculoesqueléticas no decorrer da vida. A importância da realização precoce de programas educacionais e nutricionais na escola deve ser enfatizada para prevenção e tratamento destes indivíduos com excesso de peso e baixo nível de atividade física

Evaluation of speed-accuracy trade-off in a computer task to identify motor difficulties in individuals with Duchenne Muscular Dystrophy: A cross-sectional study

Introduction: Individuals with Duchenne Muscular Dystrophy (DMD) present with progressive loss of motor function which can impair both control of speed and accuracy of movement. Aim: to evaluate movement time during a task at various levels of difficulty and to verify whether the level of difficulty affects the speed and/ or accuracy during the task. Methods: the DMD group comprised of 17 individuals age matched with 17 individuals with typical development (TD group). The task evaluates the relationship between speed and accuracy, consisting of the execution of manual movements (using the mouse of the computer) aimed at a target at three different levels of difficulty (ID). Results: A MANOVA demonstrated statistically significant differences in dispersion data and intercept values between the groups with greater movement time in the DMD group. An ANOVA indicated differences between groups for ID, except for when there was a higher accuracy demand (higher ID). In the other IDs that required lower accuracy demand, individuals in the DMD group had significantly longer movement time when compared to the TD group. Conclusion: These results show that the TD and DMD did not differ in the higher ID, therefore it can be concluded that for those with DMD, motor performance is more affected by speed than accuracy of movement. What this paper adds? It is known that individuals with DMD have considerable motor deficits, however this paper shows that when the task involves higher accuracy compared with speed, people with DMD have performance similar to typically developed peers. This insight is a novel finding and can inform the rehabilitation team, to focus on training of speed, whilst maintaining accuracy for better execution of daily life tasks