Navegando por Palavras-chave "paralisia cerebral"
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- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)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; HCORCerebral 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.
- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)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 DeficienteAIM: 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.
- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)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 EinsteinObjective: 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.
- ItemSomente MetadadadosTerapia de estimulação elétrica muscular em crianças com paralisia cerebral: revisão sistemática(Universidade Federal de São Paulo (UNIFESP), 2014-04-30) Battibugli, Simone [UNIFESP]; Belloti, Joao Carlos Belloti [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Over the past two decades, the Electrical Stimulation (ES) has been established as an adjuvant therapy for spasticity management in children with CP. Objectives: To evaluate ES effectiveness to reduce spasticity in children with CP. Methods: Systematic review of randomized and quasi-randomized controlled trials following the Cochrane Collaboration methods. Five electronic databases were searched: MEDLINE, EMBASE , CINAHL, LILACS and PEDRO. No restrictions regarding language or date were imposed. The primary outcomes considered were: spasticity, range of motion (ROM) and muscle strengthening. Results: Fifteen studies involving 477 participants were analysed. Four comparison groups were created: 1. NMES (Neuromuscular Electrical Stimulation) applied to the lower limbs. 2. NMES to the trunk and lower back muscles. 3. TES (Threshold Electrical Stimulation) to the lower limbs and trunk. 4. FES (Functional Electrical Stimulation) to the lower limbs. In the first comparison group a significant reduction of spasticity (two studies) and increased gait velocity (four studies) were seen in the combined analysis. In the second group the meta-analysis of the two studies showed a significant improvement in GMFM (Gross Motor Function Measure) scores and kyphotic’s angle correction. In comparison groups 3 and 4, just one meta-analysis was possible with no significant difference between groups. Only three of the fifteen studies described isolated adverse events. Conclusions: There is evidence that NMES (lower limbs) can contribute to a reduce spasticity and increasing walking speed. NMES (trunk and lower back) was related to improvement in motor function (sitting) and kyphotic’s angle correction. The ES is a safe therapy for children with CP.