Efeitos da fisioterapia aquática na função motora de indivíduos com paralisia cerebral: ensaio clínico randomizado

Objetivo: Avaliar os efeitos de um protocolo terapêutico para controle de tronco em ambiente aquático e sua repercussão na função motora de indivíduos com Paralisia Cerebral (PC) diparética espástica, classificados no nível II ou III do GMFCS. Métodos: Trata-se de um ensaio clínico randomizado, estratificado e cego. Os participantes foram selecionados por meio de triagem dos prontuários do banco de dados da Clínica de PC da instituição. Da triagem de 1.599 prontuários, 20 crianças foram incluídas e 16 finalizaram o estudo. Os pacientes foram alocados por estratificação pelo nível do GMFCS em grupo controle (GC) que realizou fisioterapia convencional e grupo intervenção (GI) que realizou o protocolo de exercícios aquáticos. Ambos os grupos foram submetidos à avaliação pré e pós-intervenção com os seguintes instrumentos: Gross Motor Function Measurement (GMFM), Trunk Control Measurement Scale (TCMS), Eletromiografia de superfície (EMG) dos músculos reto abdominal e latíssimo do dorso, Teste de Caminhada de 6 minutos (TC6), Timed up and Go (TUG), Escala Visual Analógica (EVA) da marcha, Flexômetro de Wells e Child Health Questionnaire (CHQ) PF-50. Resultados: A amostra apresentou-se homogênea para as análises. Na análise intergrupo observa-se melhora no equilíbrio dinâmico sentado (p = 0,001) e reações de equilíbrio (p=0,015) para o GI, houve melhora da flexibilidade da musculatura posterior do tronco e membros inferiores no GC (p = 0,017), para os demais instrumentos não teve diferença significativa nas análises intergrupos. Na análise intragrupo para o GI, constatou melhora no equilíbrio estático e dinâmico do tronco nas três subescalas da TCMS, equilíbrio estático sentado (p= 0,033), equilíbrio dinâmico sentado (p = 0,012) e reações de equilíbrio (p = 0,027), assim como para a pontuação total da escala (p = 0,012); no GMFM, o aumento da pontuação das dimensões D (p = 0,012) e E (p = 0,020), bem como a média das três dimensões (p = 0,012); na EMG observa-se melhora da ativação muscular para o músculo LD; melhora da dor (p = 0,026); ambos os grupos melhoraram significativamente (p = 0,012) a distância percorrida no TC6 e o tempo no TUG, GC (p = 0,017) e GI (p = 0,036). Conclusão: O protocolo de exercícios aquáticos apresentou benefícios para o controle de tronco de indivíduos com PC diparética espástica classificados no nível II ou III do GMFCS sendo efetivo na melhora das reações de equilíbrio e no equilíbrio dinâmico.Palavras-chave: paralisia cerebral, hidroterapia, tronco.

Health-related quality of life and orthosis use in a Swedish population with arthrogryposis

Background: Joint contractures are the main characteristics for children with arthrogryposis multiplex congenita. Orthoses are often used to enable or facilitate walking. Objectives: To describe health-related quality of life in children with arthrogryposis multiplex congenita and satisfaction with orthoses in those using orthoses. Study design: Cross-sectional study. Methods: A total of 33 children with arthrogryposis multiplex congenita participated in the study. Questionnaires were used which measured health-related quality of life (Child Health Questionnaire–Parent Form and EQ-5D youth), mobility and self-care (Paediatric Evaluation of Disability Inventory) and satisfaction with orthoses (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0). Children were divided into groups based on the use of orthoses: Ort-D were dependent on orthoses for walking, Ort-ND used orthoses but were not dependent on them for walking and Non-Ort did not use orthoses. Results: Children with arthrogryposis multiplex congenita had significantly lower Child Health Questionnaire scores in 9 of 12 subscales compared to healthy controls. The children’s reported perceived health with EQ-5D youth did not show any difference between children using orthoses or children using only shoes. Paediatric Evaluation of Disability Inventory showed less mobility in Ort-D than in Non-Ort. In total, both orthosis groups were ‘quite satisfied’ with their orthoses. Conclusion: Child Health Questionnaire–physical functioning was lowest in children who were dependent on orthoses (Ort-D) for walking. Both Ort-D and Ort-ND were similar satisfied with their orthoses. Clinical relevance This study contributes to knowledge about health-related quality of life in a group of ambulatory children with arthrogryposis multiplex congenita. For children using orthoses, it is relevant to capture their opinion about their orthoses but a questionnaire specifically for children should be developed.

Psychometric proprieties of the Child Health Questionnaire in an Arabic-speaking context: A multi-trait and multi-sample study

Ongoing research on the assessment of children’s health has led to the development of a large number of quantitative tools. The Child Health Questionnaire—Parent Form (CHQ-PF) is a set of questionnaires aimed at measuring different facets of children’s health as perceived by their parents. The present multi-trait multi-sample study tested the validity and the reliability of the 50-item version of the CHQ with families ( N = 1095) living in contexts of low-intensity warfare. The validation procedures implemented (exploratory and confirmatory factor analysis, convergent validity, and reliability testing) yielded a new, shorter version of the questionnaire (CHQ-PF-25). We discuss the potential of using the CHQ-PF-25 in Arabic-speaking crisis contexts and the limitations of the present study.

Quality of life of children suffering from motor disabilities as evaluated by their parents

Purpose: We assessed the quality of life of children with motor disabilities in comparison with healthy children, as evaluated by their parents, using the CHQ-PF28 questionnaire (Child Health Questionnaire—Parent Form). Materials and methods: In a prospective study, we evaluated the quality of life of 105 children with motor disabilities. Results: Our research showed lower quality of life in the group of children with motor disabilities compared with controls, both in terms of physical and psychosocial health. Significant correlations between independent walking and physical functioning, general behavior, and mental health of children suffering from motor disabilities were found. According to the average indices of quality of life of children suffering from motor disabilities, depending on sex, the greatest differences occurred in behavior and change of health status, while the smallest differences in self-esteem and parental involvement, compared with controls. In the case of healthy children, the largest differences appeared in the perception of pain, behavior, and self-esteem; whereas, the smallest variations occurred in the change of health status and physical activity. Conclusion: Children suffering from motor disabilities demonstrate lower quality of life compared with healthy children.

Quality of life and exercise performance in unoperated children with anomalous aortic origin of a coronary artery from the opposite sinus of valsalva

BackgroundAnomalous aortic origin of a coronary artery is a congenital cardiac condition that can be associated with increased risk of sudden death. To date, quality of life and exercise performance have not been evaluated in patients with this condition who do not undergo surgical repair.MethodsWe carried out a cross-sectional analysis of patients with unoperated anomalous aortic origin of a coronary artery at our institution from 1 January, 2000 to 31 January, 2016. We prospectively assessed quality of life using standardised questionnaires. Medical records were reviewed for clinical and exercise stress test data. Statistical analyses were performed using Student’s t-tests and Spearman’s correlation coefficients.ResultsIn total, 56 families completed the questionnaires. The average age at enrolment was 14.7±6 years. The majority were male (n=44, 78.6%) and had interarterial anomalous right coronary artery (n=38, 67.9%). Patients had normal quality of life on the PedsQL 4.0 Report, Child Health Questionnaire Child Form 87, and SF-36v2. Their parents had normal quality of life on the PedsQL 4.0 Parent Report, but parents of exercise-restricted patients had decreased Physical Functioning, General Health Perception, Emotional Impact on Parent, and Physical Summary scores (p<0.001–0.048) on the Child Health Questionnaire Parent Form 50.ConclusionsPatients with unoperated anomalous aortic origin of a coronary artery appear to have normal quality of life, but parents of exercise-restricted patients have decreased general health and emotional and physical quality of life scores. Improved counselling of families may be beneficial in this group. Future studies with more patients should evaluate quality of life and exercise performance over time.

Qualidade de vida de crianças com paralisia cerebral: percepção de cuidadores

<p class="resumo"><strong>OBJETIVO:</strong> Avaliar o impacto da idade, do nível de comprometimento motor e do gênero na qualidade de vida (QV) de crianças com paralisia cerebral (PC).</p><p><strong>MÉTODOS:</strong> Participaram 125 cuidadores primários de crianças com PC com idade entre 4 e 12 anos. Os participantes responderam os questionários: <em>Child Health Questionnaire </em>(CHQ-PF50) – versão para cuidadores<em> </em>e<em> </em>o <em>Kidscreen 10 </em>versão para os cuidadores. Foi realizada análise estatística dos dados. Para a comparação entre os grupos de meninos e meninas foi usado o Teste T de Student para grupos independentes. Para a análise da relação entre os domínios de QV e idade e o nível do Sistema de Classificação da Habilidade Motora Grossa (GMFCS) foi usado Teste de Correlação de Pearson.</p><p class="resumo"> </p><p><strong>RESULTADOS:</strong> O domínio atividades familiares apresentou o melhor escore e o domínio percepção de saúde o pior do <em>CHQ-PF50 </em>na percepção dos cuidadores. As crianças mais velhas e os meninos apresentaram a melhor QV, enquanto as crianças com menor comprometimento motor tiveram a pior.</p><p class="resumo"> </p><p class="resumo"><strong>CONCLUSÕES:</strong> O grau de comprometimento motor e a idade têm impacto na QV de crianças com PC e existe diferença na QV de meninas e meninos. </p>