Community participation is an important aspect of individuals' functioning. This construct is... more Community participation is an important aspect of individuals' functioning. This construct is defined as an individual's "active involvement in activities that are intrinsically social and either occur outside the home or are part of a nondomestic role" (Chang et al., 2013, p.772). One of the dimensions of community participation is the "attendance" in activities performed outside home. Traditionally, individuals' attendance has been measured by means of self-report questionnaires, through which many parameters can be examined. Such parameters include frequency, intensity and length of attendance, as well as the variety of activities in which an individual takes part. A promising technology that can be used to map an individual's displacement in the community consists of geoprocessing tools and methods (Brusilovskiy et al., 2016). Researchers from several countries, such as Australia, Canada, USA, Israel and Germany, have been using geographic int...
The participation of children with disabilities in daily chores in different environments has bee... more The participation of children with disabilities in daily chores in different environments has been a therapeutic goal shared by both parents and rehabilitation professionals, leading to increased demand for instrument development. The Children Helping Out: Responsibilities, Expectations and Supports (CHORES) questionnaire was created with the objective of measuring child and teenager participation in daily household tasks. To translate the CHORES questionnaire into Brazilian Portuguese, evaluate semantic, idiomatic, experiential, and conceptual equivalences, apply the questionnaire to children and teenagers with and without disabilities, and test its test-retest reliability. Methodological study developed through the following stages: (1) translation of the questionnaire by two different translators; (2) synthesis of translations; (3) back-translation into English; (4) analysis by an expert committee to develop the pre-final version; (5) test-retest reliability; (6) administration t...
O objetivo deste estudo e realizar uma revisao da literatura sobre os mecanismos de acao e efeito... more O objetivo deste estudo e realizar uma revisao da literatura sobre os mecanismos de acao e efeitos da toxina botulinica na diminuicao da espasticidade em membros superiores e inferiores de criancas portadoras de paralisia cerebral e de adultos posacidente vascular cerebral. Os estudos mostram efeitos positivos da aplicacao da toxina botulinica tipo A (TBA) na reducao da espasticidade e, quando associado a intervencoes de fisioterapia e de terapia ocupacional, pode-se observar tambem melhora no desempenho funcional dos pacientes. O efeito da aplicacao da TBA tem duracao limitada, necessitando de repetidas aplicacoes para que o efeito seja mantido.
Brazilian Journal of Animal and Environmental Research, 2021
Purpose: To explore the effects of hippotherapy for children with cerebral palsy (CP) with differ... more Purpose: To explore the effects of hippotherapy for children with cerebral palsy (CP) with different ages, topographies and severities. Method: Before-after study with three longitudinal measurements: (T1) initial, (T2) 3-months, (T3) 6-months after T1. CP children (n=31) stratified by age (4-7; 8-12 years), severity (mild, moderate, severe), topography (hemiplegia, diplegia, quadriplegia), previous hippotherapy time (3-6m, 6 months) undertook their individual weekly 30-minute hippotherapy sessions. Postural control and balance (PCB) was the primary outcome; gross-motor function (GMF) and quality of life (QL) were the secondary outcomes. Results: Changes in PCB associated with changes in GMF. Older children, with mild severity and diplegia had higher PCB and GMF scores between T1 and T3. Age groups’ initial differences in QL disappeared after 6 months. The Rehabilitation Treatment Taxonomy (RTT) guided interpretation of effects. Conclusion: The positive changes in motor and psychoso...
Individuos com lesao do neuronio motor superior (LNMS) apresentam disfuncoes do movimento e postu... more Individuos com lesao do neuronio motor superior (LNMS) apresentam disfuncoes do movimento e postura que prejudicam a mobilidade e o desempenho de tarefas de vida diaria. A espasticidade tem sido considerada tradicionalmente o principal determinante das disfuncoes motoras desses individuos. No entanto, ha evidencias de que alteracoes nas caracteristicas musculares dessa populacao possam contribuir para os defices motores. O objetivo deste estudo foi realizar uma analise critica da literatura referente a caracterizacao da rigidez passiva, curva comprimento-tensao e comprimento dos musculos de individuos com lesao do neuronio motor superior (LNMS). A literatura revisada traz evidencias de que pacientes com LNMS apresentam aumento da rigidez passiva, deslocamento das curvas comprimento-tensao e diminuicao de comprimento muscular. Tais alteracoes parecem decorrer de remodelacao tecidual em resposta a padroes diferenciados de uso, com modificacoes histoquimicas e histologicas do tecido mu...
he Brazilian Journal of Physical Therapy (BJPH) has consolidated its course, continuously reachin... more he Brazilian Journal of Physical Therapy (BJPH) has consolidated its course, continuously reaching for new goals. Its achievements are the result of intense work and commitment on the part of many professionals who, under the guidance of competent chief editors in line with the Journal’s objectives, conquered the status it holds today as the main periodical in its field, not only in Brazil, but also in Latin America. The BJPT editorial team, which is being reformulated in 2010, will continue to encourage the participation of new researchers. It was in this context that we were nominated and elected at an editorial team meeting. As a group, we wish to embrace this honorable and challenging academic task with the best of our efforts, so that we can live up to the standards of excellence set by the editorial teams that preceded us. The renewal of the BJPT editors creates new challenges that include maintaining the important conquests made by the previous editorial teams and continuing ...
Revista de Terapia Ocupacional da Universidade de São Paulo
Estudo de revisão narrativa que apresenta e discute os pressupostos da Prática Centrada na Famíli... more Estudo de revisão narrativa que apresenta e discute os pressupostos da Prática Centrada na Família (PCF) e as influências desta abordagem no contexto da Atenção Domiciliar (AD) no âmbito da reabilitação no Sistema Único de Saúde (SUS). Com base nas informações obtidas, a AD e a PCF foram analisadas, permitindo discutir o potencial impacto dos pressupostos da PCF na AD, do sistema publico de saúde brasileiro. A AD tem importante papel na constituição de redes substitutivas, produzindo novos modos de cuidar. Entretanto, alguns problemas na organização deste serviço geram descontinuidade do cuidado, sobrecarga de todos os níveis de atenção e dificultam o vínculo entre profissionais/usuário/família. A PCF propõe que os programas domiciliares sejam direcionados aos familiares, especialmente aos cuidadores, para que estes desenvolvam as competências necessárias para a prestação do cuidado, possibilitando assim assistência integral, contextualizada e humanizada ao usuário. A utilização da ...
Background People with cerebral palsy experience limitations in performing activities of daily li... more Background People with cerebral palsy experience limitations in performing activities of daily living. Rehabilitation practitioners seek valid instruments to measure changes in the performance of those activities. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) is a new tool to assess functioning in children and youth with various health conditions. Its validity needs to be evaluated in a way that is consistent with the theoretical model on which it was based. We aimed to evaluate the fit of daily activity and mobility items and children with CP to the Rasch model and to compare the performance in daily activities and mobility of older children, adolescents, and young adults with CP based on manual function and gross motor function limitations. Methods Eighty-three parents of children and youth of 8–20 years old (mean age: 11.6) with different severity levels of cerebral palsy participated in this study. Ninety-one items of the PEDI-CAT Daily Activ...
Abstract Aims: Translate the Challenge assessment into Brazilian-Portuguese, determine its face v... more Abstract Aims: Translate the Challenge assessment into Brazilian-Portuguese, determine its face validity, evaluate the reliability of the total score and score per item, investigate whether the child’s gross motor level (classified by the Gross Motor Function Classification System-GMFCS) influences the reliability levels, and estimate responsiveness to change. Methods: The translation followed four stages: translation, synthesis, back-translation, and review. For face validity, ten physical therapists evaluated item relevance. Children and adolescents with cerebral palsy (n = 50, 5-18 years of age) GMFCS I and II were evaluated by two therapists for inter and intra-rater reliability. Thirty of these participants were recruited for the instrument's responsiveness evaluation and reassessed (n = 28) after three months of treatment. Minimal Detectable Change (MDC), and Minimal Clinically Important Difference (MCID) were estimated. Results: The back-translated version was similar to the English version. All test items were considered relevant by the physical therapists. Total score intra and inter-rater reliability were excellent for both GMFCS levels (ICC = 0.94-0.99). Items’ intra- and inter- rater reliability varied from low to almost perfect (kw=-0.14-0.94). MDC90 and MDC95 values were 3.90-6.35 and 4.63-7.54, respectively. MCID values were 3.57-4.56. Conclusion: The translated version of the Challenge showed excellent face validity and reliability and was able to document longitudinal change.
Background: Children with congenital Zika syndrome (CZS) maintain severe motor impairments at the... more Background: Children with congenital Zika syndrome (CZS) maintain severe motor impairments at the end of the first year of life. Presence of certain symptoms and comorbidities increase these children's vulnerability. Aims: To evaluate gross motor function of a group of Brazilian children with CZS at 24 months of age and to investigate the association between the presence of CZS symptoms and comorbidities with gross motor development. Methods and procedures: Fifty children with CZS participated in the study. Information was collected from medical charts, and gross motor development was evaluated by the Gross Motor Function Measure (GMFM)-88. GMFM-88 scores were compared among comorbid groups. Three subgroups of children were identified by cluster analysis, based on information from head circumference at birth, symptoms, comorbidities and gross motor function. Outcomes and results: Significant associations (p < 0.001) were observed between number of comorbidities/ symptoms and dimensions A (r ¼-0.57) and B (r ¼-0.58) of the GMFM-88. Children were grouped into 3 clusters, with different gross motor skills. Children with epilepsy and dysphagia composed the cluster with smaller median scores for dimensions A and B of the GMFM-88. Conclusions and implications: The presence of CZS symptoms and comorbidities compromise the gross motor repertoire of children with CZS at 24 months.
Children with Attention-Deficit Hyperactivity Disorder (ADHD) struggle to perform a host of daily... more Children with Attention-Deficit Hyperactivity Disorder (ADHD) struggle to perform a host of daily activities. Many of these involve forceful interaction with objects and thus implicate dynamic touch. Therefore, deficits in dynamic touch could underlie functional difficulties presented by ADHD children. We investigated whether performance on a dynamic touch task (length perception by wielding) differ between children with ADHD and age-matched controls. We further examined whether this difference could be explained by fractal temporal correlations (wielding dynamics). Forty-two children (ADHD: 21; typically developing: 21) wielded unseen wooden rods and reported their perceived length in the form of magnitude productions. The rods varied in the magnitude of the first principal moment of inertia (I 1). Three-dimensional displacements of hand and rod positions were submitted to Detrended Fluctuation Analysis to estimate trial-by-trial temporal correlations. Children with ADHD reported shorter length for rods with higher I 1 than their typically developing peers, indicative of reduced sensitivity to mechanical information supporting dynamic touch. Importantly, temporal correlations in wielding dynamics moderated children's usage of I 1. This finding points to a role of exploratory movements in perceptual deficits presented by children with ADHD and, thus, should be considered a new potential target for interventions.
Background Hippotherapy is a complementary therapeutic modality that seeks to promote functional ... more Background Hippotherapy is a complementary therapeutic modality that seeks to promote functional changes in children with cerebral palsy (CP). Knowledge of the direct and indirect changes resulting from this therapy will help identify which groups of children with cerebral palsy can benefit from this type of therapy. The present study aimed to analyze the effects of hippotherapy for children with cerebral palsy with regard to age, topography, and severity using the rehabilitation treatment taxonomy. Methods We conducted a before-after clinical trial. Thirty-one children with CP, stratified by age (4-7 years; 8-12 years), severity (mild, moderate, severe), topography (hemiplegia, diplegia, quadriplegia) and previous time in hippotherapy (3-6 months, over 6 months) underwent individual weekly 30-minute hippotherapy sessions for 6 months in addition to regular rehabilitation. Postural control and balance were evaluated by the Early Clinical Assessment of Balance (ECAB). Secondary outco...
O objetivo do estudo foi compreender fatores que influenciam a participação de adolescentes com p... more O objetivo do estudo foi compreender fatores que influenciam a participação de adolescentes com paralisia cerebral (PC) na Educação Física Escolar. Dez adolescentes com PC foram entrevistados utilizando roteiro de entrevista semiestruturado, cujo conteúdo foi gravado, transcrito e submetido à Análise de Conteúdo. Três categorias e sete subcategorias emergiram dessa análise. Verificou-se que fatores ambientais (atitudinais e físicos) e pessoais influenciaram a participação. Especificamente, as atitudes de colegas, professores e monitores, bem como a disponibilidade de dispositivos de auxílio para marcha e a acessibilidade física da escola foram elementos importantes que impactaram, negativamente ou positivamente, a participação na Educação Física. Características pessoais, como medo de realizar as atividades e baixa ou alta percepção de autoeficácia, também influenciaram o engajamento dos adolescentes na Educação Física e devem ser consideradas por profissionais da Educação Física e ...
Clinical trial registration involves placing the protocol for a clinical trial on a free, publicl... more Clinical trial registration involves placing the protocol for a clinical trial on a free, publicly available and electronically searchable register. Registration is considered to be prospective if the protocol is registered before the trial commences (ie, before the first participant is enrolled). Prospective registration has several potential advantages. It could help avoid trials being duplicated unnecessarily and it could allow people with health problems to identify trials in which they might participate. Perhaps more importantly, however, it tackles two big problems in clinical research: selective reporting and publication bias.Selective reporting involves investigators only reporting the most favourable results when they publish a trial, instead of reporting the results for all the outcomes that were measured. Reporting only favourable outcomes can create a misleading appearance of the effect of a therapy in the published literature. For example, imagine that a completely ineffective intervention is tested across several trials and each trial measures multiple outcomes. Most outcomes will show no significant effect of the intervention. However, occasionally an outcome will show significant benefit or harm simply by chance. If the researchers publish the positive outcomes but not all of the non-significant and negative outcomes, readers could interpret falsely that the intervention is beneficial. A similar problem could occur when outcomes are analysed at multiple time points. Researchers may report that an intervention improves walking speed at 6 months, but fail to mention that it does not improve walking speed at 1, 2, 3, 9, 12 and 24 months. Prospective registration of clinical trials combats this problem in several ways. Journal editors and reviewers can compare the range of outcomes reported in a manuscript against those listed in the registered protocol, requesting that any discrepancies be resolved by following the protocol. Readers can also compare the outcomes in the registered protocol against those in the published report, taking greater reassurance when they are consistent.Publication bias arises when trials with positive results are more likely to be published than trials with non-significant or negative results. Like selective reporting, this can also spuriously inflate the apparent effect of an intervention across the published data. For example, a trial in which the intervention appeared to be effective maybe published, while the three other trials in which the intervention appeared ineffective or harmful languish in the filing cabinets of the investigators. If a trial is registered but never published, authors of a systematic review can still find the trial on the register and contact the authors to request the unpublished data for inclusion in the review. Therefore, prospective registration of clinical trials could further limit bias affecting the body of evidence that is available in published physiotherapy trials.Prospective clinical trial registration encourages transparency (Sim et al 2006) and may also make it more difficult for fraudulent authors to fabricate data. For example, some journals now ask for individual patient data to be provided routinely for checking (Herbert 2008) or audit data when fraud is suspected (Smith & Godlee 2005). Data collection should have occurred during the dates of data collection defined on the registry. Because many outcomes are measured and stored electronically with date stamps, this would increase the planning and complexity involved in fabricating data, especially if the fabricated data are to withstand the scrutiny of an audit. Also, researchers who obtain unwelcome data from a particular subgroup of patients may be tempted to eliminate it by retrospectively introducing an additional exclusion criterion. If their protocol has been prospectively registered, however, this would be publicly evident to anyone who compared the registered protocol and the report of the trial. …
A person's participation is acknowledged as an important outcome of the rehabilitation proces... more A person's participation is acknowledged as an important outcome of the rehabilitation process. The Participation Scale (P-Scale) is an instrument that was designed to assess the participation of individuals with a health condition or disability. The scale was developed in an effort to better describe the participation of people living in middle-income and low-income countries. The aim of this study was to use Rasch analysis to examine whether the Participation Scale is suitable to assess the perceived ability to take part in participation situations by patients with diverse levels of function. The sample was comprised by 302 patients from a public rehabilitation services network. Participants had orthopaedic or neurological health conditions, were at least 18 years old, and completed the Participation Scale. Rasch analysis was conducted using the Winsteps software. The mean age of all participants was 45.5 years (standard deviation = 14.4), 52% were male, 86% had orthopaedic co...
Physical & occupational therapy in pediatrics, Aug 14, 2017
We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 ... more We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 hours) and two schedules of the same dose (90 vs. 2 × 45 hours) on hand and daily functioning. Eighteen children with unilateral cerebral palsy were randomized to receive 6 hours of daily training over 3 weeks, totaling 90 hours (Group 90, n = 9) or receive 6 hours of daily training over 1.5 weeks, totaling 45 hours (Group 2 × 45, n = 9). After 6 months, Group 2 × 45 received an additional 45 hours. Hand (Jebsen-Taylor Test of Hand Function, Assisting Hand Assessment) and daily functioning tests (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory) were administered before, immediately after, and 6 months after interventions. Both groups demonstrated significant improvements in hand and daily functioning after 90 hours (Group 90) or the first 45 hours (Group 2 × 45), without differences between groups. However, more children from Group 90 obtained smal...
Brazilian journal of physical therapy, Jan 12, 2017
The Activity Measure for Post-Acute Care was developed to evaluate the limitations of activities ... more The Activity Measure for Post-Acute Care was developed to evaluate the limitations of activities of adult individuals with different health conditions. To translate and cultural adapt the Activity Measure for Post-Acute Care short forms for outpatients into Portuguese-Brazilian, to verify the comprehension of the items and categories of the responses by users of the rehabilitation services and to analyze the reliability indices of the instrument. Translation and back-translation were conducted by two independent teams. Cognitive interviews (n=2) evaluated the comprehension of the translated version among patients. Item reliability and consistency was also investigated. There was conceptual equivalence between the translated and original versions. For some items, the information was modified in order to attend to the measurement units used in Brazil. Comparative analyses of the translated versions chose the most appropriate term to capture the English content. The few discrepancies i...
Brazilian journal of physical therapy, Jan 5, 2017
Therapeutic suits or clothing whether associated with intensive protocols or not, became popular ... more Therapeutic suits or clothing whether associated with intensive protocols or not, became popular in the rehabilitation of children with cerebral palsy. Studies have reported positive effects of these suits on children's posture, balance, motor function and gait. A summary of current literature may help guide therapeutic actions. To evaluate the available evidence on the effects of interventions based on the use of therapeutic suits in the treatment of impairments and functional limitations of children with cerebral palsy. Three independent reviewers searched for experimental studies on MEDLINE, SciELO, BIREME, LILACS, PEDro and CENTRAL databases, between October and December 2015 and updated in May 2016. The reviewers evaluated the methodological quality of selected studies using the Checklist for Measuring Quality. The Grading of Recommendations Assessment, Development and Evaluation was used to synthesize the quality of evidence and strength of recommendation. From the 13 stud...
Brazilian journal of physical therapy, Jan 5, 2017
Gait speed and metabolic cost are indicators of functional capacity in children with cerebral pal... more Gait speed and metabolic cost are indicators of functional capacity in children with cerebral palsy. Uncovering their mechanisms helps guide therapeutic actions. To investigate the contributions of energy-generating and energy-conserving mechanisms to gait speed and metabolic cost of children with unilateral cerebral palsy. Data on eccentric and concentric muscle work, co-contraction, elastic torque and vertical stiffness of the affected-limb, forcing torque of the non-affected limb, gait speed and metabolic cost were collected from 14 children with unilateral cerebral palsy, aged 6-12 years. Analyses included two groups of multiple regression models. The first group of models tested the association between each dependent variable (i.e., speed and metabolic cost) and the independent variables that met the input criteria. The second group verified the contribution of the non-selected biomechanical variables on the predictors of the first model. Gait speed (R(2)=0.80) was predicted by...
Community participation is an important aspect of individuals' functioning. This construct is... more Community participation is an important aspect of individuals' functioning. This construct is defined as an individual's "active involvement in activities that are intrinsically social and either occur outside the home or are part of a nondomestic role" (Chang et al., 2013, p.772). One of the dimensions of community participation is the "attendance" in activities performed outside home. Traditionally, individuals' attendance has been measured by means of self-report questionnaires, through which many parameters can be examined. Such parameters include frequency, intensity and length of attendance, as well as the variety of activities in which an individual takes part. A promising technology that can be used to map an individual's displacement in the community consists of geoprocessing tools and methods (Brusilovskiy et al., 2016). Researchers from several countries, such as Australia, Canada, USA, Israel and Germany, have been using geographic int...
The participation of children with disabilities in daily chores in different environments has bee... more The participation of children with disabilities in daily chores in different environments has been a therapeutic goal shared by both parents and rehabilitation professionals, leading to increased demand for instrument development. The Children Helping Out: Responsibilities, Expectations and Supports (CHORES) questionnaire was created with the objective of measuring child and teenager participation in daily household tasks. To translate the CHORES questionnaire into Brazilian Portuguese, evaluate semantic, idiomatic, experiential, and conceptual equivalences, apply the questionnaire to children and teenagers with and without disabilities, and test its test-retest reliability. Methodological study developed through the following stages: (1) translation of the questionnaire by two different translators; (2) synthesis of translations; (3) back-translation into English; (4) analysis by an expert committee to develop the pre-final version; (5) test-retest reliability; (6) administration t...
O objetivo deste estudo e realizar uma revisao da literatura sobre os mecanismos de acao e efeito... more O objetivo deste estudo e realizar uma revisao da literatura sobre os mecanismos de acao e efeitos da toxina botulinica na diminuicao da espasticidade em membros superiores e inferiores de criancas portadoras de paralisia cerebral e de adultos posacidente vascular cerebral. Os estudos mostram efeitos positivos da aplicacao da toxina botulinica tipo A (TBA) na reducao da espasticidade e, quando associado a intervencoes de fisioterapia e de terapia ocupacional, pode-se observar tambem melhora no desempenho funcional dos pacientes. O efeito da aplicacao da TBA tem duracao limitada, necessitando de repetidas aplicacoes para que o efeito seja mantido.
Brazilian Journal of Animal and Environmental Research, 2021
Purpose: To explore the effects of hippotherapy for children with cerebral palsy (CP) with differ... more Purpose: To explore the effects of hippotherapy for children with cerebral palsy (CP) with different ages, topographies and severities. Method: Before-after study with three longitudinal measurements: (T1) initial, (T2) 3-months, (T3) 6-months after T1. CP children (n=31) stratified by age (4-7; 8-12 years), severity (mild, moderate, severe), topography (hemiplegia, diplegia, quadriplegia), previous hippotherapy time (3-6m, 6 months) undertook their individual weekly 30-minute hippotherapy sessions. Postural control and balance (PCB) was the primary outcome; gross-motor function (GMF) and quality of life (QL) were the secondary outcomes. Results: Changes in PCB associated with changes in GMF. Older children, with mild severity and diplegia had higher PCB and GMF scores between T1 and T3. Age groups’ initial differences in QL disappeared after 6 months. The Rehabilitation Treatment Taxonomy (RTT) guided interpretation of effects. Conclusion: The positive changes in motor and psychoso...
Individuos com lesao do neuronio motor superior (LNMS) apresentam disfuncoes do movimento e postu... more Individuos com lesao do neuronio motor superior (LNMS) apresentam disfuncoes do movimento e postura que prejudicam a mobilidade e o desempenho de tarefas de vida diaria. A espasticidade tem sido considerada tradicionalmente o principal determinante das disfuncoes motoras desses individuos. No entanto, ha evidencias de que alteracoes nas caracteristicas musculares dessa populacao possam contribuir para os defices motores. O objetivo deste estudo foi realizar uma analise critica da literatura referente a caracterizacao da rigidez passiva, curva comprimento-tensao e comprimento dos musculos de individuos com lesao do neuronio motor superior (LNMS). A literatura revisada traz evidencias de que pacientes com LNMS apresentam aumento da rigidez passiva, deslocamento das curvas comprimento-tensao e diminuicao de comprimento muscular. Tais alteracoes parecem decorrer de remodelacao tecidual em resposta a padroes diferenciados de uso, com modificacoes histoquimicas e histologicas do tecido mu...
he Brazilian Journal of Physical Therapy (BJPH) has consolidated its course, continuously reachin... more he Brazilian Journal of Physical Therapy (BJPH) has consolidated its course, continuously reaching for new goals. Its achievements are the result of intense work and commitment on the part of many professionals who, under the guidance of competent chief editors in line with the Journal’s objectives, conquered the status it holds today as the main periodical in its field, not only in Brazil, but also in Latin America. The BJPT editorial team, which is being reformulated in 2010, will continue to encourage the participation of new researchers. It was in this context that we were nominated and elected at an editorial team meeting. As a group, we wish to embrace this honorable and challenging academic task with the best of our efforts, so that we can live up to the standards of excellence set by the editorial teams that preceded us. The renewal of the BJPT editors creates new challenges that include maintaining the important conquests made by the previous editorial teams and continuing ...
Revista de Terapia Ocupacional da Universidade de São Paulo
Estudo de revisão narrativa que apresenta e discute os pressupostos da Prática Centrada na Famíli... more Estudo de revisão narrativa que apresenta e discute os pressupostos da Prática Centrada na Família (PCF) e as influências desta abordagem no contexto da Atenção Domiciliar (AD) no âmbito da reabilitação no Sistema Único de Saúde (SUS). Com base nas informações obtidas, a AD e a PCF foram analisadas, permitindo discutir o potencial impacto dos pressupostos da PCF na AD, do sistema publico de saúde brasileiro. A AD tem importante papel na constituição de redes substitutivas, produzindo novos modos de cuidar. Entretanto, alguns problemas na organização deste serviço geram descontinuidade do cuidado, sobrecarga de todos os níveis de atenção e dificultam o vínculo entre profissionais/usuário/família. A PCF propõe que os programas domiciliares sejam direcionados aos familiares, especialmente aos cuidadores, para que estes desenvolvam as competências necessárias para a prestação do cuidado, possibilitando assim assistência integral, contextualizada e humanizada ao usuário. A utilização da ...
Background People with cerebral palsy experience limitations in performing activities of daily li... more Background People with cerebral palsy experience limitations in performing activities of daily living. Rehabilitation practitioners seek valid instruments to measure changes in the performance of those activities. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) is a new tool to assess functioning in children and youth with various health conditions. Its validity needs to be evaluated in a way that is consistent with the theoretical model on which it was based. We aimed to evaluate the fit of daily activity and mobility items and children with CP to the Rasch model and to compare the performance in daily activities and mobility of older children, adolescents, and young adults with CP based on manual function and gross motor function limitations. Methods Eighty-three parents of children and youth of 8–20 years old (mean age: 11.6) with different severity levels of cerebral palsy participated in this study. Ninety-one items of the PEDI-CAT Daily Activ...
Abstract Aims: Translate the Challenge assessment into Brazilian-Portuguese, determine its face v... more Abstract Aims: Translate the Challenge assessment into Brazilian-Portuguese, determine its face validity, evaluate the reliability of the total score and score per item, investigate whether the child’s gross motor level (classified by the Gross Motor Function Classification System-GMFCS) influences the reliability levels, and estimate responsiveness to change. Methods: The translation followed four stages: translation, synthesis, back-translation, and review. For face validity, ten physical therapists evaluated item relevance. Children and adolescents with cerebral palsy (n = 50, 5-18 years of age) GMFCS I and II were evaluated by two therapists for inter and intra-rater reliability. Thirty of these participants were recruited for the instrument's responsiveness evaluation and reassessed (n = 28) after three months of treatment. Minimal Detectable Change (MDC), and Minimal Clinically Important Difference (MCID) were estimated. Results: The back-translated version was similar to the English version. All test items were considered relevant by the physical therapists. Total score intra and inter-rater reliability were excellent for both GMFCS levels (ICC = 0.94-0.99). Items’ intra- and inter- rater reliability varied from low to almost perfect (kw=-0.14-0.94). MDC90 and MDC95 values were 3.90-6.35 and 4.63-7.54, respectively. MCID values were 3.57-4.56. Conclusion: The translated version of the Challenge showed excellent face validity and reliability and was able to document longitudinal change.
Background: Children with congenital Zika syndrome (CZS) maintain severe motor impairments at the... more Background: Children with congenital Zika syndrome (CZS) maintain severe motor impairments at the end of the first year of life. Presence of certain symptoms and comorbidities increase these children's vulnerability. Aims: To evaluate gross motor function of a group of Brazilian children with CZS at 24 months of age and to investigate the association between the presence of CZS symptoms and comorbidities with gross motor development. Methods and procedures: Fifty children with CZS participated in the study. Information was collected from medical charts, and gross motor development was evaluated by the Gross Motor Function Measure (GMFM)-88. GMFM-88 scores were compared among comorbid groups. Three subgroups of children were identified by cluster analysis, based on information from head circumference at birth, symptoms, comorbidities and gross motor function. Outcomes and results: Significant associations (p < 0.001) were observed between number of comorbidities/ symptoms and dimensions A (r ¼-0.57) and B (r ¼-0.58) of the GMFM-88. Children were grouped into 3 clusters, with different gross motor skills. Children with epilepsy and dysphagia composed the cluster with smaller median scores for dimensions A and B of the GMFM-88. Conclusions and implications: The presence of CZS symptoms and comorbidities compromise the gross motor repertoire of children with CZS at 24 months.
Children with Attention-Deficit Hyperactivity Disorder (ADHD) struggle to perform a host of daily... more Children with Attention-Deficit Hyperactivity Disorder (ADHD) struggle to perform a host of daily activities. Many of these involve forceful interaction with objects and thus implicate dynamic touch. Therefore, deficits in dynamic touch could underlie functional difficulties presented by ADHD children. We investigated whether performance on a dynamic touch task (length perception by wielding) differ between children with ADHD and age-matched controls. We further examined whether this difference could be explained by fractal temporal correlations (wielding dynamics). Forty-two children (ADHD: 21; typically developing: 21) wielded unseen wooden rods and reported their perceived length in the form of magnitude productions. The rods varied in the magnitude of the first principal moment of inertia (I 1). Three-dimensional displacements of hand and rod positions were submitted to Detrended Fluctuation Analysis to estimate trial-by-trial temporal correlations. Children with ADHD reported shorter length for rods with higher I 1 than their typically developing peers, indicative of reduced sensitivity to mechanical information supporting dynamic touch. Importantly, temporal correlations in wielding dynamics moderated children's usage of I 1. This finding points to a role of exploratory movements in perceptual deficits presented by children with ADHD and, thus, should be considered a new potential target for interventions.
Background Hippotherapy is a complementary therapeutic modality that seeks to promote functional ... more Background Hippotherapy is a complementary therapeutic modality that seeks to promote functional changes in children with cerebral palsy (CP). Knowledge of the direct and indirect changes resulting from this therapy will help identify which groups of children with cerebral palsy can benefit from this type of therapy. The present study aimed to analyze the effects of hippotherapy for children with cerebral palsy with regard to age, topography, and severity using the rehabilitation treatment taxonomy. Methods We conducted a before-after clinical trial. Thirty-one children with CP, stratified by age (4-7 years; 8-12 years), severity (mild, moderate, severe), topography (hemiplegia, diplegia, quadriplegia) and previous time in hippotherapy (3-6 months, over 6 months) underwent individual weekly 30-minute hippotherapy sessions for 6 months in addition to regular rehabilitation. Postural control and balance were evaluated by the Early Clinical Assessment of Balance (ECAB). Secondary outco...
O objetivo do estudo foi compreender fatores que influenciam a participação de adolescentes com p... more O objetivo do estudo foi compreender fatores que influenciam a participação de adolescentes com paralisia cerebral (PC) na Educação Física Escolar. Dez adolescentes com PC foram entrevistados utilizando roteiro de entrevista semiestruturado, cujo conteúdo foi gravado, transcrito e submetido à Análise de Conteúdo. Três categorias e sete subcategorias emergiram dessa análise. Verificou-se que fatores ambientais (atitudinais e físicos) e pessoais influenciaram a participação. Especificamente, as atitudes de colegas, professores e monitores, bem como a disponibilidade de dispositivos de auxílio para marcha e a acessibilidade física da escola foram elementos importantes que impactaram, negativamente ou positivamente, a participação na Educação Física. Características pessoais, como medo de realizar as atividades e baixa ou alta percepção de autoeficácia, também influenciaram o engajamento dos adolescentes na Educação Física e devem ser consideradas por profissionais da Educação Física e ...
Clinical trial registration involves placing the protocol for a clinical trial on a free, publicl... more Clinical trial registration involves placing the protocol for a clinical trial on a free, publicly available and electronically searchable register. Registration is considered to be prospective if the protocol is registered before the trial commences (ie, before the first participant is enrolled). Prospective registration has several potential advantages. It could help avoid trials being duplicated unnecessarily and it could allow people with health problems to identify trials in which they might participate. Perhaps more importantly, however, it tackles two big problems in clinical research: selective reporting and publication bias.Selective reporting involves investigators only reporting the most favourable results when they publish a trial, instead of reporting the results for all the outcomes that were measured. Reporting only favourable outcomes can create a misleading appearance of the effect of a therapy in the published literature. For example, imagine that a completely ineffective intervention is tested across several trials and each trial measures multiple outcomes. Most outcomes will show no significant effect of the intervention. However, occasionally an outcome will show significant benefit or harm simply by chance. If the researchers publish the positive outcomes but not all of the non-significant and negative outcomes, readers could interpret falsely that the intervention is beneficial. A similar problem could occur when outcomes are analysed at multiple time points. Researchers may report that an intervention improves walking speed at 6 months, but fail to mention that it does not improve walking speed at 1, 2, 3, 9, 12 and 24 months. Prospective registration of clinical trials combats this problem in several ways. Journal editors and reviewers can compare the range of outcomes reported in a manuscript against those listed in the registered protocol, requesting that any discrepancies be resolved by following the protocol. Readers can also compare the outcomes in the registered protocol against those in the published report, taking greater reassurance when they are consistent.Publication bias arises when trials with positive results are more likely to be published than trials with non-significant or negative results. Like selective reporting, this can also spuriously inflate the apparent effect of an intervention across the published data. For example, a trial in which the intervention appeared to be effective maybe published, while the three other trials in which the intervention appeared ineffective or harmful languish in the filing cabinets of the investigators. If a trial is registered but never published, authors of a systematic review can still find the trial on the register and contact the authors to request the unpublished data for inclusion in the review. Therefore, prospective registration of clinical trials could further limit bias affecting the body of evidence that is available in published physiotherapy trials.Prospective clinical trial registration encourages transparency (Sim et al 2006) and may also make it more difficult for fraudulent authors to fabricate data. For example, some journals now ask for individual patient data to be provided routinely for checking (Herbert 2008) or audit data when fraud is suspected (Smith & Godlee 2005). Data collection should have occurred during the dates of data collection defined on the registry. Because many outcomes are measured and stored electronically with date stamps, this would increase the planning and complexity involved in fabricating data, especially if the fabricated data are to withstand the scrutiny of an audit. Also, researchers who obtain unwelcome data from a particular subgroup of patients may be tempted to eliminate it by retrospectively introducing an additional exclusion criterion. If their protocol has been prospectively registered, however, this would be publicly evident to anyone who compared the registered protocol and the report of the trial. …
A person's participation is acknowledged as an important outcome of the rehabilitation proces... more A person's participation is acknowledged as an important outcome of the rehabilitation process. The Participation Scale (P-Scale) is an instrument that was designed to assess the participation of individuals with a health condition or disability. The scale was developed in an effort to better describe the participation of people living in middle-income and low-income countries. The aim of this study was to use Rasch analysis to examine whether the Participation Scale is suitable to assess the perceived ability to take part in participation situations by patients with diverse levels of function. The sample was comprised by 302 patients from a public rehabilitation services network. Participants had orthopaedic or neurological health conditions, were at least 18 years old, and completed the Participation Scale. Rasch analysis was conducted using the Winsteps software. The mean age of all participants was 45.5 years (standard deviation = 14.4), 52% were male, 86% had orthopaedic co...
Physical & occupational therapy in pediatrics, Aug 14, 2017
We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 ... more We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 hours) and two schedules of the same dose (90 vs. 2 × 45 hours) on hand and daily functioning. Eighteen children with unilateral cerebral palsy were randomized to receive 6 hours of daily training over 3 weeks, totaling 90 hours (Group 90, n = 9) or receive 6 hours of daily training over 1.5 weeks, totaling 45 hours (Group 2 × 45, n = 9). After 6 months, Group 2 × 45 received an additional 45 hours. Hand (Jebsen-Taylor Test of Hand Function, Assisting Hand Assessment) and daily functioning tests (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory) were administered before, immediately after, and 6 months after interventions. Both groups demonstrated significant improvements in hand and daily functioning after 90 hours (Group 90) or the first 45 hours (Group 2 × 45), without differences between groups. However, more children from Group 90 obtained smal...
Brazilian journal of physical therapy, Jan 12, 2017
The Activity Measure for Post-Acute Care was developed to evaluate the limitations of activities ... more The Activity Measure for Post-Acute Care was developed to evaluate the limitations of activities of adult individuals with different health conditions. To translate and cultural adapt the Activity Measure for Post-Acute Care short forms for outpatients into Portuguese-Brazilian, to verify the comprehension of the items and categories of the responses by users of the rehabilitation services and to analyze the reliability indices of the instrument. Translation and back-translation were conducted by two independent teams. Cognitive interviews (n=2) evaluated the comprehension of the translated version among patients. Item reliability and consistency was also investigated. There was conceptual equivalence between the translated and original versions. For some items, the information was modified in order to attend to the measurement units used in Brazil. Comparative analyses of the translated versions chose the most appropriate term to capture the English content. The few discrepancies i...
Brazilian journal of physical therapy, Jan 5, 2017
Therapeutic suits or clothing whether associated with intensive protocols or not, became popular ... more Therapeutic suits or clothing whether associated with intensive protocols or not, became popular in the rehabilitation of children with cerebral palsy. Studies have reported positive effects of these suits on children's posture, balance, motor function and gait. A summary of current literature may help guide therapeutic actions. To evaluate the available evidence on the effects of interventions based on the use of therapeutic suits in the treatment of impairments and functional limitations of children with cerebral palsy. Three independent reviewers searched for experimental studies on MEDLINE, SciELO, BIREME, LILACS, PEDro and CENTRAL databases, between October and December 2015 and updated in May 2016. The reviewers evaluated the methodological quality of selected studies using the Checklist for Measuring Quality. The Grading of Recommendations Assessment, Development and Evaluation was used to synthesize the quality of evidence and strength of recommendation. From the 13 stud...
Brazilian journal of physical therapy, Jan 5, 2017
Gait speed and metabolic cost are indicators of functional capacity in children with cerebral pal... more Gait speed and metabolic cost are indicators of functional capacity in children with cerebral palsy. Uncovering their mechanisms helps guide therapeutic actions. To investigate the contributions of energy-generating and energy-conserving mechanisms to gait speed and metabolic cost of children with unilateral cerebral palsy. Data on eccentric and concentric muscle work, co-contraction, elastic torque and vertical stiffness of the affected-limb, forcing torque of the non-affected limb, gait speed and metabolic cost were collected from 14 children with unilateral cerebral palsy, aged 6-12 years. Analyses included two groups of multiple regression models. The first group of models tested the association between each dependent variable (i.e., speed and metabolic cost) and the independent variables that met the input criteria. The second group verified the contribution of the non-selected biomechanical variables on the predictors of the first model. Gait speed (R(2)=0.80) was predicted by...
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Papers by Marisa Mancini