Navegando por Palavras-chave "cerebral palsy"

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    Adaptação cultural e análise da confiabilidade da versão brasileira da Escala de Equilíbrio Pediátrica (EEP)
    (Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia, 2012-06-01) Ries, Lílian Gerdi Kittel; Michaelsen, Stella Maris; Soares, Patrícia S. A. [UNIFESP]; Monteiro, Vanessa Costa [UNIFESP]; Allegretti, Kátia Maria Gonçalves [UNIFESP]; Universidade do Estado de Santa Catarina Postgraduate Program in Physical Therapy; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: The Pediatric Balance Scale (PBS) was developed from a modified version of the Berg Balance Scale aiming to obtain a balance scale more appropriate for the child population. OBJECTIVES: To adapt the PBS into Brazilian-Portuguese and to evaluate the intra and inter-rater reliability of the Brazilian-Portuguese version of PBS. METHODS: To perform the cross-cultural adaptation of the American version of PBS four translators were involved, who have performed two translations and their respective back-translations. Then, a review by a multidisciplinary committee and a subsequent an assessment of the equivalence of meaning between the back-translations and the original English scale were performed by 3 and 30 healthcare professionals respectively. The intra-rater reliability of the final version of the Brazilian-Portuguese PBS was evaluated using a test-retest design with one-week interval. The Brazilian-Portuguese version of the PBS was tested twice on the same day by two different raters to test the inter-rater reliability. The inter-rater reliability, which was measured from a video of the volunteers performance, was evaluated by comparing the score given by five raters independently. Reliability was evaluated by Intraclass Correlation Coefficient (ICC). Fifteen volunteers (11±2.7 years) diagnosed with Cerebral Palsy (CP) classified at level I and II on the Gross Motor Function Classification System (GMFCS) were assessed. RESULTS: The reliability of the PBS total score for both intra-rater (ICC=0.85) and inter-rater (ICC=0.91) was excellent. The inter-rater reliability (measured from the video) for the total score was also classified as excellent (ICC=0.98). CONCLUSION: The results showed adequate reliability for the PBS for pediatric population with CP diagnostic classified at level I and II on the GMFCS.
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    Assistive stabilization based on the neurodevelopmental treatment approach for dental care in individuals with cerebral palsy
    (Quintessence Publishing Co Inc, 2007-09-01) Santos, Maria Teresa Botti Rodrigues [UNIFESP]; Manzano, Felipe Scalco [UNIFESP]; Univ Cruzeiro Sul; Universidade Federal de São Paulo (UNIFESP)
    Objective: To study the effects of positioning individuals with cerebral palsy (GP) on a dental chair according to the neurodevelopmental treatment (NDT) approach, to establish the best position to perform dental care in the safest and most efficient manner in such individuals. Method and Materials: A group of 158 noninstitutionalized patients (78 males and 80 females) with CP (mean age 10.5 [SD +/- 4.6]) were enrolled in the study. The behavior management techniques used were tell-show-do, voice control, assistive stabilization, oral premedication, a combination of techniques, and general anesthesia. Results: The tell-show-do and voice control techniques were effective for only 36 (22.8%) of the patients who were collaborators: 3 presenting spastic diplegic, 23 presenting spastic hemiplegic, 4 presenting spastic double hemiplegic, and 6 presenting ataxic CP. The totality of patients with spastic quadriplegic CP, dystonic CP with athetosis, and mixed CP required all the combined forms of assistive stabilization and postural maintenance. The majority of the individuals with spastic diplegic CID required head and upper member stabilization and a mouth prop. Among the dental care treatments performed, preventive care (dental prophylaxis, sealants, and fluoride application) was performed on 78 (50.0%) patients, restorative dentistry on 40 (25.6%), and oral surgery on 38 (24.4%). Conclusion: Present data suggest that the use of assistive stabilization was effective and permitted the dental care of individuals with CP at the outpatient clinic level, while reducing the number of patients referred for general anesthesia and ensuring better quality of life for this patient population regarding oral health.
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    Autonomic nervous system in individuals with cerebral palsy: a controlled study
    (Wiley-Blackwell, 2011-08-01) Ferreira, Maria C.; Pastore, Carlos; Imada, Rodrigo; Guare, Renata; Leite, Mariana; Poyares, Dalva [UNIFESP]; Santos, Maria T.; Univ Cruzeiro Sul; Univ Paulista; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: Disturbances in homeostatic functions have been observed in individuals with cerebral palsy (CP), possibly resulting from autonomic dysfunction. Salivary flow rate and saliva composition are controlled by the autonomic nervous system, and CP individuals exhibit alterations in salivary parameters that suggest autonomic impairment. This study aimed to investigate cardiac parameters as indicative of autonomic disturbances, possibly associated with salivary changes observed in CP individuals.METHODS: Ninety individuals with CP were compared with 35 sibling volunteers with no neurological damage (CG). Twenty-four-hour ECG/Holter monitoring (SEER (R) Light; GE Medical Systems, Milwaukee, WI, USA) and 12-lead electrocardiographic recordings were performed on the CP and control groups. Total saliva was collected, and the salivary flow rate and total protein concentration were determined.RESULTS: Cerebral palsy (CP) individuals presented a significant reduction in salivary flow rate (P < 0.01) and increased protein concentrations (P < 0.01) compared to CG. Twenty-four-hour Holter ECG analysis showed differences for high frequency (HF), low frequency (LF) and LF/HF ratio between the groups, with the CP group presenting higher HF and LF values and lower LF/HF. Electrocardiographic parameters showed a statistically significant difference for heart rate, and its correlates, and mean corrected QT interval between the groups studied (P < 0.05). Snoring was frequent among CP patients. ECG and autonomic changes were independently associated with CP.CONCLUSION: Individuals with cerebral palsy present cardiovascular changes principally manifested as disturbed sympathovagal balance. These autonomic dysfunctions could contribute to the salivary changes observed. J Oral Pathol Med (2011) 40: 576-581
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    Avaliação clínica e videofluoroscópica da deglutição em crianças com paralisia cerebral tetraparética espástica
    (Academia Brasileira de Neurologia - ABNEURO, 2003-09-01) Furkim, Ana Maria [UNIFESP]; Behlau, Mara [UNIFESP]; Weckx, Luc Louis Maurice [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); CEFAC; HCOR
    Cerebral palsy is a condition that may be associated with swallowing disorders, that is, oropharingeal dysphagia. The aim of this study was to characterize and compare the swallowing processes of 32 children with this condition, by clinical and videofluoroscopic evaluation, with special focus on tracheal aspiration detectability. Results show an important compromise of oral phase. The most important findings during the pharyngeal phase were velopharingeal incompetence and residuals on the pharyngeal recesses. Aspiration was more common with liquids, before and after deglutition. On clinical and videofluoroscopic evaluation, cervical hyperextension was the commonest postural abnormality. Videofluoroscopy confirmed the occurrence of aspiration on most of the cases that presented suggestive signs of aspiration during clinical evaluation. We conclude that clinical and videofluoroscopic evaluations are complementary on deglutition evaluation and together may point to the most specific rehabilitation procedure.
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    Cerebellar transcranial direct current stimulation in children with ataxic cerebral palsy: A sham-controlled, crossover, pilot study
    (Taylor & Francis Inc, 2017) Collange Grecco, Luanda Andre; Oliveira, Claudia Santos; Carvalho Duarte, Natalia de Almeida; Lima, Vania Lucia Costa de Carvalho [UNIFESP]; Zanon, Nelci; Fregni, Felipe
    Objective: The aim of the present study was to analyze the use of anodal tDCS of the cerebellar region combined with treadmill training to improve balance and functional performance in children with ataxic cerebral palsy. Design: Single-blind, sham-controlled, crossover, pilot study. Setting: Rehabilitation center and research motion analysis laboratory. Participants: Children (N = 6) with ataxic cerebral palsy and balance deficit. Main Outcome Measures: Static balance (oscillations of the center of pressure), functional balance (Pediatric Balance Scale) and functional performance (Pediatric Evaluation of Disability Inventory) were evaluated. Results: Significant reductions occurred in oscillations of the center of pressure with eyes closed after active anodal tDCS only. The effects of treadmill training on functional balance and functional performance in mobility were maintained in the active tDCS group only. Conclusion: These preliminary data support the notion that anodal tDCS of the cerebellar region combined with treadmill training improves balance in children with ataxic cerebral palsy.
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    Depressão, ansiedade e sonolência diurna em cuidadores primários de crianças com paralisia cerebral
    (Sociedade de Pediatria de São Paulo, 2011-12-01) Marx, Catherine [UNIFESP]; Rodrigues, Erica Masruha [UNIFESP]; Masruha, Marcelo Rodrigues [UNIFESP]; Vilanova, Luiz Celso Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate depression, anxiety and excessive daytime sleepiness (EDS) levels in primary caregivers of children with cerebral palsy (CCP) and to trace the relationships with their socioeconomic conditions and child neurological characteristics, as compared with caregivers of typical children (CTC). METHODS: 45 CCP and 50 CTC were randomly chosen and answered a semi-structured questionnaire. We evaluated EDS on the Epworth scale. Beck depression inventory (BDI) and the state-trait anxiety inventory (STAI) identified depressive and anxious symptoms, respectively. RESULTS: The majority of subjects were mothers with low socioeconomic level. Self-perception of anxiety and depressive symptoms of CCP were confirmed through BDI and STAI. EDS was statistically related to high levels of depression. Children's disabilities did not influence the results. CONCLUSIONS: Depression, anxiety symptoms and sleep disruption were common in CCP. Child functional level did not influence the results.
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    Effect of a single session of transcranial direct-current stimulation on balance and spatiotemporal gait variables in children with cerebral palsy: A randomized sham-controlled study
    (Associacao Brasileira Pesquisa Pos-graduacao Fisioterapia-abrapg-ft, 2014-09-01) Grecco, Luanda A. C.; Duarte, Natalia A. C.; Zanon, Nelci [UNIFESP]; Galli, Manuela; Fregni, Felipe; Oliveira, Claudia S.; Univ Nove de Julho UNINOVE; Harvard Univ; Ctr Neurocirurgia Pediat CENEPE; Universidade Federal de São Paulo (UNIFESP); Politecn Milan
    Background: Transcranial direct-current stimulation (tDCS) has been widely studied with the aim of enhancing local synaptic efficacy and modulating the electrical activity of the cortex in patients with neurological disorders. Objective: the purpose of the present study was to determine the effect of a single session of tDCS regarding immediate changes in spatiotemporal gait and oscillations of the center of pressure (30 seconds) in children with cerebral palsy (CP). Method: A randomized controlled trial with a blinded evaluator was conducted involving 20 children with CP between six and ten years of age. Gait and balance were evaluated three times: Evaluation 1 (before the stimulation), Evaluation 2 (immediately after stimulation), and Evaluation 3 (20 minutes after the stimulation). the protocol consisted of a 20-minute session of tDCS applied to the primary motor cortex at an intensity of 1 mA. the participants were randomly allocated to two groups: experimental group - anodal stimulation of the primary motor cortex; and control group - placebo transcranial stimulation. Results: Significant reductions were found in the experimental group regarding oscillations during standing in the anteroposterior and mediolateral directions with eyes open and eyes closed in comparison with the control group (p<0.05). in the intra-group analysis, the experimental group exhibited significant improvements in gait velocity, cadence, and oscillation in the center of pressure during standing (p<0.05). No significant differences were found in the control group among the different evaluations. Conclusion: A single session of tDCS applied to the primary motor cortex promotes positive changes in static balance and gait velocity in children with cerebral palsy.
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    Evolução de 31 crianças submetidas à ressecção bilateral das glândulas submandibulares e ligadura dos ductos parotídeos para controlar a sialorréia
    (ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-02-01) Manrique, Dayse [UNIFESP]; Brasil, Osiris de Oliveira Campones do [UNIFESP]; Ramos, Hugo Valter Lisboa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Associação de Assistência à Criança Deficiente
    AIM: To evaluate the safety of bilateral submandibular gland excision and parotid duct ligation in order to control drooling in children; to assess its long-term efficacy and complications. STUDY DESIGN: longitudinal cohort. MATERIALS AND METHODS: Thirty-one children aged 6 to 13 years (7.6 years old in average), with multiple neurological disabilities were submitted to a bilateral submandibular gland excision with parotid duct ligation in order to control ptyalism between December 1999 and December 2005, mean follow up of 36 months. RESULTS: According to Wilkie s success criteria, 87% of children had excellent or good results and insignificant morbidity was insignificant; with temporary parotid edema as the major complication. CONCLUSION: Bilateral submandibular gland excision with parotid duct ligation were safe to be performed in children, with 87% of success in drooling control.
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    Food pattern and nutritional status of children with cerebral palsy
    (Sociedade de Pediatria de São Paulo, 2013-09-01) Lopes, Patricia Ayrosa C.; Amancio, Olga Maria Silverio [UNIFESP]; Camilo-Araújo, Roberta Faria [UNIFESP]; Vitalle, Maria Sylvia de Souza [UNIFESP]; Braga, Josefina Aparecida Pellegrini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVESTo assess the food intake pattern and the nutritional status of children with cerebral palsy.METHODSCross-sectional study with 90 children from two to 12.8 years with cerebral palsy in the following forms: hemiplegia, diplegia, and tetraplegia. Nutritional status was assessed by weight, height, and age data. Food intake was verified by the 24-hour recall and food frequency questionnaire. The ability to chew and/or swallowing, intestinal habits, and physical activity were also evaluated.RESULTSFor 2-3 year-old age group, the mean energy intake followed the recommended range; in 4-6 year-old age group with hemiplegia and tetraplegia, energy intake was below the recommended limits. All children presented low intake of carbohydrates, adequate intake of proteins and high intake of lipids. The tetraplegia group had a higher prevalence of chewing (41%) and swallowing (12.8%) difficulties compared to 14.5 and 6.6% of children with hemiplegia, respectively. Most children of all groups had a daily intestinal habit. All children presented mild physical activity, while moderate activity was not practiced by any child of the tetraplegia group, which had a significantly lower height/age Z score than those with hemiplegia (-2.14 versus -1.05; p=0.003).CONCLUSIONSThe children with cerebral palsy presented inadequate dietary pattern and impaired nutritional status, with special compromise of height. Tetraplegia imposes difficulties regarding chewing/swallowing and moderate physical activity practice.
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    Frequency of parafunctional oral habits in patients with cerebral palsy
    (Blackwell Publishing, 2007-05-01) Ortega, A. O. L.; Guimaraes, A. S.; Ciamponi, A. L.; Marie, S. K. N.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    Cerebral palsy (CP) is one of the most frequent conditions encountered in the daily practice of dentists who treat special-needs patients and it seems that parafunctional oral habits are often present in such individuals. the aim of this study was to investigate the frequency of occurrence of parafunctional habits in individuals with CP. Sixty-five patients with CP were evaluated through a questionnaire and clinical observation, regarding the following habits: pacifier-sucking, finger-sucking, biting objects, tongue interposition, and bruxism. the results showed that nine (13.8%) patients presented with pacifier-sucking, four (6.1%) showed finger-sucking, 12 (18.4%) had the habit of biting objects, 27 (41.5%) presented with tongue interposition, and 24 (36.9%) had eccentric bruxism. the significance of the presence of oral parafunctional habits in individuals with CP, revealed in this study, justifies the need to establish protocols for adequate prevention and clinical intervention in order to minimize the deleterious consequences that may result from such habits.
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    Frequency of temporomandibular disorder signs in individuals with cerebral palsy
    (Blackwell Publishing, 2008-03-01) Ortega, A. O. L. [UNIFESP]; Guimaraes, A. S. [UNIFESP]; Ciamponi, A. L.; Marie, S. K. N.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    This study aimed to determine the frequency of temporomandibular disorder (TMD) signs in 68 individuals with cerebral palsy, aged between 3 and 23 years. TMD signs were evaluated according to the Research Diagnostic Criteria to assess temporomandibular joint sounds, lateral jaw deviation during opening and closing movements and limitation of maximum mouth opening (> 40 mm). the frequency of TMD signs observed in the cerebral palsy group (46/68-67.6%) was higher than in the control group (17/68-25%). the clinical scenario of CP seems to make these individuals more prone to the development of TMD signs.
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    Fusos extremos na era da ressonância magnética: características clínicas, eletrográficas e de neuroimagem
    (Liga Brasileira de Epilepsia (LBE), 2005-12-01) Maia, Maria Goretti Lima [UNIFESP]; Caboclo, Luís Otávio Sales Ferreira [UNIFESP]; Carrete Junior, Henrique [UNIFESP]; Garzon, Eliana [UNIFESP]; Sakamoto, Américo Ceiki [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVES: Extreme spindles were described by Gibbs and Gibbs in 1962. They are typically observed in children younger than five years, occurring in 0.05% of normal children and in up to 5 to 18% of children with mental retardation or cerebral palsy. In this study we describe the clinical and neurophysiological characteristics of five children with extreme spindles, correlating these findings to neuroimaging data, obtained in magnetic resonance imaging of the brain. PATIENTS AND METHODS: Eight patients from the children epilepsy outpatient clinic at UNIFESP were initially included, who had extreme spindles in at least one electroencephalogram (EEG) examination. Five out of these eight were selected, since they had MRI of the brain available for analysis. RESULTS: The age of the children varied from two to 15 years. The five children had mental retardation, and three presented associated motor deficits. All had epilepsy; in three children seizures were controlled with antiepileptic drugs, but in two they were considered refractory to medical treatment. In one patient only the MRI of the brain was considered normal. In the other cases, the findings were: bilateral pachygiria, diffuse brain atrophy, right occipital lesion, and bilateral frontal atrophy. The frequency of extreme spindles varied form 8.9 to 16 Hz, and amplitude from 67 to 256 µV. In three patients, frontal fast activity was observed along with extreme spindles. CONCLUSIONS: Extreme spindles are seldom observed in normal children, but may be quite frequent among those with mental retardation or cerebral palsy. They are probably not related to epilepsy, though in our series all children had epilepsy as well as mental retardation. Diagnostic investigation of these children with MRI of the brain showed that extreme spindles may occur either in children with defined structural abnormalities or in those with normal neuroimaging examination, suggesting that this specific electroencephalographic pattern is associated to mental retardation but not to specific etiologies.
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    Oral hydration in children with cerebral palsy
    (Faculdade de Odontologia de Piracicaba - UNICAMP, 2014-04-01) Santos, Maria Teresa Botti Rodrigues; Ferreira, Maria Cristina Duarte; Guaré, Renata Oliveira; Nascimento, Oliver Augusto [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Cruzeiro do Sul School of Dentistry; Serviço Nacional de Aprendizagem Comercial; Universidade Federal de São Paulo (UNIFESP)
    AIM:To investigate whether oral motor performance is determinant for the hydration status and the effect of a supplemental oral fluid supply on salivary osmolality.METHODS:The sample consisted of 99 children with cerebral palsy aged 6 to 13 years old. In this study, children participated in 2-day evaluations: 1st day - baseline: saliva collection, caries experience and oral motor performance evaluations; and 2nd day: saliva collection after supplemental fluid supply. Prior to each evaluation, the participants were trained for saliva collection. Unstimulated whole saliva was collected using cotton roll at baseline, with the amount of fluid usually offered by caregivers, and 48 h after baseline, with as much as twice the normal daily fluid intake previously offered. Salivary osmolality was measured using a freezing point depression osmometer. Caries experience index for decayed, missed and filled teeth (DMFT) was evaluated. According to the Oral Motor Assessment Scale, the children were classified into subfunctional or functional groups. Chi-square, Student's t test and Pearson's correlation coefficient were used.RESULTS:The subfunctional group presented a higher percentage of quadriplegic children (p<0.001), with significantly higher values for caries experience (p<0.001) and salivary osmolality (p<0.001), which did not diminish when supplemental fluid supply was offered, compared with the functional group (p=0.001).CONCLUSIONS:The effectiveness of oral motor performance plays an important role in the hydration status of children with cerebral palsy and those with worse oral motor performance may be at higher risk of oral diseases.
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    Oral motor performance in spastic cerebral palsy individuals: are hydration and nutritional status associated?
    (Wiley-Blackwell, 2012-02-01) Santos, Maria Teresa; Batista, Renato; Previtali, Elisangela; Ortega, Adriana; Nascimento, Oliver [UNIFESP]; Jardim, Jose [UNIFESP]; Univ Cruzeiro Sul; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: Previous studies reported alterations in salivary parameters in cerebral palsy (CP) individuals; however, none of these considered oral motor performance as possibly responsible for these conditions. the aim of this study was to investigate the influence of oral motor performance on the nutritional status and salivary parameters in individuals with CP.METHODS: Forty-three individuals aged 11-19 yearsold, with spastic CP were included in this study. Oral motor performance was evaluated using the Oral Motor Assessment Scale, which classified the individuals into two groups: subfunctional or functional. Unstimulated saliva was collected and the flow rate was calculated (ml / min). Salivary osmolality was measured using a freezing point depression osmometer. Blood samples were collected to evaluate complete blood count, total protein, albumin / globulin ratio and transferrin levels.RESULTS: the subfunctional (n = 21) and the functional group (n = 22) did not differ regarding sex (P = 0.193), however the functional group was older (P = 0.023) and had a higher mean BMI (P < 0.001). the subfunctional CP group presented a reduction in salivary flow rate (36.4%) (P < 0.01) and an increase in salivary osmolality (35.5%) (P < 0.001) compared to the functional group. Slightly lower values for red blood cells (millions / mm 3) (P < 0.001), hemoglobin (g / dl) (P < 0.009), hematocrit (%) (P = 0.001), number of platelets (N / mm 3), total protein (g / dl) and albumin / globulin ratio (P = 0.003 and P = 0.036, respectively) were determined for the subfunctional group, but within the normal range of normality.CONCLUSION: Cerebral palsy individuals appear to present impaired adequate hydration due to compromised oral motor performance. J Oral Pathol Med (2012) 41: 153-157
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    Perda auditiva em indivíduos paralíticos cerebrais: discussão etiológica
    (ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2002-05-13) Lamônica, Dionísia A. C.; Chiari, Brasilia Maria [UNIFESP]; Pereira, Liliane Desgualdo [UNIFESP]; Universidade do Sagrado Coração Curso de Fonoaudiologia; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    Aim: the present study aimed at verifying the ability to detect pure tones of different frequencies by means of liminal tonal audiometries. Study design: clinical prospective randomized. Material and method: we studied 67 individuals with cerebral palsy who presented no complaints of hearing problems in order to discuss the etiologic factors likely to be responsible for the motorial sequelae. Results: Since the results have pointed to a high variability of hearing losses, the relationship of the factors pointed by the parents as responsible for the motorial deficits was reviewed, correlating them to the probable etiology of hearing loss.
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    Qualidade de vida e grau de ansiedade e depressão em cuidadores de crianças com paralisia cerebral
    (Sociedade de Pediatria de São Paulo, 2012-09-01) Zanon, Márcia Andreya; Batista, Nildo Alves [UNIFESP]; Uncisal; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate the level of anxiety and depression and the quality of life of caregivers of children with cerebral palsy. METHODS: A cross-sectional and descriptive study with caregivers of children followed by two institutions: the Association of Parents and Friends of Exceptional Children (Apae) and the Association of Physically Disabled of Children of Alagoas (Adefal), in Maceió, Alagoas (Northeast Brazil). A total of 82 caregivers were enrolled and answered the following questionnaires: Hospital Scale of Anxiety and Depression and the SF-36 (Medical Outcomes Study 36 - Item Short-Form Health Survey). Data were analyzed using mean, standard deviation, median, and 95% confidence intervals (95%CI). RESULTS: The mean age of the caregivers was 32.4±10.3 years-old, ranging from 18 to 77. Anxiety was detected in 49% of the caregivers (95%CI 38 - 60), and depression in 31% (95%CI 22 - 42). In the SF-36, the most affected areas were: limitation by emotional aspects (score=56; 95%CI 46 - 65) and vitality (score=57; 95%CI 52 - 62). CONCLUSIONS: Caregivers presented high anxiety and depression values; they did not have a good quality of life, with special limitations in the emotional aspects and the vitality domains.
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    Relationship between vision and motor impairment in children with spastic cerebral palsy: new evidence from electrophysiology
    (Elsevier B.V., 2004-03-02) Costa, M. F. da; Salomão, Solange Rios [UNIFESP]; Berezovsky, Adriana [UNIFESP]; Haro, F. M. de; Ventura, D. F.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    The aim of the present study was to measure visual acuity (VA) by the sweep visual evoked potential method (sVEP) and relate it to the degree of motor impairment in children with spastic cerebral palsy (SCP). Monocular VA was estimated in 37 SCP children aged from 6 to 48 months, classified as tetraplegic (n = 14), diplegic (n = 13), and hemiplegic (n = 10), without ophthalmological complaints with ages ranging from 6 to 48 months. Motor impairment was rated according to the Gross Motor Function Classification System (GMFCS), in five levels of severity. VA was below age norms in 13/14 (92%) tetraplegics, 10/13 (77%) diplegics and 4/10 (40%) hemiplegics. in addition, a two-way ANOVA within each subgroup showed significant differences in VA between the five GMFCS levels, with high positive correlation between VA loss and the GMFCS rating. Differences between the three types of SCP impairment in each level of GMFCS were not statistically significant, possibly due to the small number of patients. in conclusion, the use of an electrophysiological method (sweep-VEP) for the measurement of visual acuity in these patients allows a more precise and reliable estimate than behavioral measurements, since their motor impairment might interfere with the behaviorally assessed visual acuity. in addition, the finding of a high correlation between quantified motor impairment and VA loss in SCP patients is a new observation that might help to understand the causes of VA loss in these patients. (C) 2003 Elsevier B.V. All rights reserved.
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    Salivary osmolality and hydration status in children with cerebral palsy
    (Wiley-Blackwell, 2011-08-01) Santos, Maria Teresa B.; Batista, Renato; Guare, Renata O.; Leite, Mariana F.; Ferreira, Maria Cristina D.; Durao, Marcelino S. [UNIFESP]; Nascimento, Oliver A.; Jardim, Jose R.; Univ Cruzeirio Sul; Lar Escola Sao Francisco; Univ Paulista; Universidade Federal de São Paulo (UNIFESP); Univ Fed Sao
    BACKGROUND: Unstimulated whole salivary parameters have been identified as potential markers of hydration status. Reduced salivary flow rate and increased salivary osmolality have been shown to be useful to identify dehydration, even when minimal loss of body water occurs. This study aimed to evaluate whether unstimulated salivary flow rate and salivary osmolality from individuals with cerebral palsy correlate with plasma and urine osmolality.METHODS: Thirty-five male and female children, aged 9-13 years old, diagnosed with cerebral palsy were compared to 27 nondisabled children (10-12 years old). Unstimulated whole saliva was collected under slight suction and salivary flow rate (ml/min) was calculated. Plasma without venostasis and urine were also collected. Salivary, plasma and urine osmolality were measured using a freezing point depression osmometer.RESULTS: Cerebral palsy children presented a reduction in salivary flow rate (50%) compared to the control group (P < 0.01). Moreover, an increase in salivary (50%), plasma (3%), and urine osmolality (20%) was also observed in the cerebral palsy children compared to the control group (P < 0.01). Salivary flow rate was negatively correlated with the salivary, plasma and urine osmolality (P < 0.01). Salivary osmolality correlated positively with plasma and urine osmolality (P < 0.01).CONCLUSION: Cerebral palsy children seem to present impaired adequate hydration status. Since the possible hypohydration condition may be reflected in saliva fluid, which could compromise the protective function exerted by saliva, the earlier this condition is identified the greater the chances of administering preventive measures. Moreover, salivary osmolality is a reliable parameter that reflects changes in plasma and urine. J Oral Pathol Med (2011) 40: 582-586
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    O Senso Numérico Na Criança Com Paralisia Cerebral
    (Universidade Federal de São Paulo (UNIFESP), 2017-09-28) Feldberg, Silvia Cristina De Freitas [UNIFESP]; Bueno, Orlando Francisco Amodeo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Investigar o senso numérico em crianças/adolescentes com paralisia cerebral, visando analisar as causas de frequentes queixas de aprendizagem da matemática nestes casos, bem como discutir as bases neuropsicológicas da cognição numérica. Métodos: O desenho experimental foi exploratório de caráter quantitativo. Participaram 50 crianças/adolescentes com idade entre 7 e 15 anos de idade, de ambos os sexos, sendo 31 controles e 19 com paralisia cerebral. Dentre estes, nove eram do tipo hemiplégico e dez do tipo diplégico. Os procedimentos de avaliação incluíram o ZAREKI-R (bateria de testes específicos para avaliação das habilidades matemáticas, apropriada para o diagnóstico de discalculia do desenvolvimento), teste de comparação de magnitudes não simbólicas (investiga senso numérico) e testes neuropsicológicos complementares, avaliando funções executivas e abrangendo memória operacional. Análises inferenciais (Análise de Variância) foram utilizadas na comparação entre os grupos. Resultados: As crianças e adolescentes com paralisia cerebral apresentaram um desempenho inferior em diversas medidas do ZAREKI-R, nas provas de senso numérico e de memória operacional visuoespacial em comparação às controles. Conclusões: A paralisia cerebral, independentemente da distribuição topográfica, está associada a risco para discalculia, justificando problemas na aprendizagem da matemática. Os resultados indicam ainda que as bases neuropsicológicas da cognição numérica, no que concerne o funcionamento executivo, sejam mais associadas à memória operacional do que ao controle inibitório ou à flexibilidade cognitiva.
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    Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation
    (Academia Brasileira de Neurologia - ABNEURO, 2014-05-01) Zonta, Marise Bueno; Ramalho-júnior, Amâncio; Puppi, Marilene; Bruck, Isac; Magdalena, Neiva; Muzzolon, Sandra Regina B.; Carvalho-neto, Arnolfo De; Santos, Lúcia H Coutinho Dos; Curitiba; PR; Universidade Federal do Paraná Hospital de Clínicas Centro de Neuropediatria; São Paulo; SP; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Paraná Departamento de Pediatria; Universidade Federal do Paraná Departamento de Clínica Médica; Hospital Albert Einstein
    Objective: Evaluate side-to-side discrepancies in children with hemiplegic cerebral palsy (HCP), and investigate associations of these discrepancies with patients’ age at initiation of physical therapy, motor and cognitive function, and degree of activities and social participation. Method: We obtained eight side-to-side measurements from 24 HCP children with mean age 49.3±5.2 months. Results: Early initiation of physical therapy was associated with lower discrepancy in hand length (p=0.037). Lower foot length discrepancy was associated with lower requirement for caregiver assistance in activities related to mobility. Increased side-to-side discrepancy was associated with reduced wrist extension and increased spasticity. Discrepancy played a larger role in children with hemineglect and in those with right involvement. Conclusion: Increased discrepancy in HCP children was associated with reduced degree of activity/social participation. These results suggest an association between functional use of the extremities and limb growth.