Avaliação do desempenho funcional de crianças com paralisia cerebral de acordo com níveis de comprometimento motor

Contextualization: Several studies have examined the mobility of this group of children, however little is known about the impact of motor function in activities of daily living, considering the seriousness of their neuromotor damage. Objective: Identify the functional differences of children with Cerebral Palsy with different levels of motor dysfunction and correlate these differences with the areas of mobility, self-care and social function in functional ability and caregiver´s assistance of these children. Methods: An l analytical cross-section search was developed, which were part 70 children / families aged from 4 to 7.5 years, in the Rehabilitation Center for Children. As tools were used the Pediatric Evaluation Disability Inventory (PEDI) and the Gross Motor Function Classification System (GMFCS). Data analysis was performed by ANOVA and Pearson's correlation tests. Results: The results show the functional variability of children CP in different severity levels of motor disfunction This variation was observed in the areas of mobility, self-care and social function. The results also showed a strong correlation between the domains mobility and self-care, mobility and social function. Conclusions: The variability shown by the children with CP, suggests the use of PEDI and GMFCS as this association appears to increase the understanding of how the gross motor functions are related to activities of daily living, describing the best commitments and their degree of impact on functional activities. This correlation demonstrates how mobility is crucial to evaluate the performance and guide the therapeutic practice, to develop the children´s potencial, and guide the caregiver in stimulation

Do olhar inquieto ao olhar comprometido: uma experiência de intervenção voltada para a atuação com alunos que apresentam paralisia cerebral

Compte tenu de l importance de la formation des enseignants pour répondre, de nos jours, aux besoins des élèves dont les caractéristiques marquantes sont la diversité et la différentiation, desquels nécessairement font partie , à un échelon croissant, des personnes atteintes d une déficience quelconque ; devant le constat que les actuelles politiques d éducation, en fonction de leurs limitations, peuvent être considérées comme un des principaux facteurs qui entravent la concrétisation d un vrai processus d inclusion de ces personnes ; compte tenu, encore, que le confront des situations éducatives concernant le processus d inclusion de ceux ayant des déficiences physiques, notamment lorsqu il s agit d élèves atteints de paralysie cérébrale, engendre chez les enseignants un état de troublante inquiétude du fait de ne se sentir convenablement préparés pour se confronter avec des situations pareilles, cette recherche, centrée sur cette problématique, a chosi comme objectif planifier, mettre en marche et analyser un programme d intervention pédagogique dans une école régulière de la ville de Natal/RN, auprès de quatre enseignants de l école fondamentale (7e Série) qui avaient reçu, dans leur classe, deux élèves atteints de paralysie cérébrale. S utilisant comme recours méthodologique de la recherche-action, le programme d intervention s est structuré autour de troix axes thématiques : l attitudinal, le pédagogique et le vécu en milieu scolaire, sous la forme de discussions théoriques et la mise en oeuvre de ces thématiques. Les données qui devraient être soumises à l analyse ont été collectées à partir des procédés d observation, d entretiens avant et après l intervention, du régistre de photos et d un questionnaire. Les interprétations faites, basées dans la comparaison du discours des sujets ont signalé que les enseignants ont progressé dans la maîtrise des savoirs scienfiques concernant la paralysie cérébrale et dans la connaissance des personnes atteintes par cette déficience. Par rapport aux valeurs et significations attribuées par les enseignants à ce programme d intervention à partir de leur choix des photos dans l ensemble du déroulement de ce processus formatif, elles s expriment par une prise de conscience très marquée, de la part des enseignants, par rapport :aux besoins éducatifs des élèves atteints de paralysie cérébrale ; à l importance et au vrai rôle que l école doit jouer face aux politiques d éducation inclusive ; aux difficultés vécues par ces personnes, qui réclament le plus profond respect de leurs ingularités ; la reconstruction d une nouvelle image concernant ces personnes ; la constatation qu il est possible aux enseignants d adapter et même de créer à l école des ressources et matériaux pédagogiques envisageant la qualité du processus d enseignement et apprentissage de l élève atteint de paralysie cérébrale ; finalement, la perception de l importance du travail en équipe, d un milieu scolaire accessible à ces personnes et de l appuis de la famille dans le contexte de l éducation inclusive. Les résultats obtenus, issus de ce programme d intervention, d après l évaluation finale des sujets, de part de témoigner de son efficacité, montrent que l intervention a été une excellente opportunité d habiliter ces enseignants et d améliorer le processus d enseignement à l école choisie comme le locus de cette recherche

Trilhas da inclusão escolar percorridas por uma aluna com paralisia cerebral na EJA: concepções e práticas

On this qualitative study, it has been discussed the school inclusion paths done by a student with cerebral palsy, who we call Liz, and who was also the reference and indirect subject for this study. For the representation of landscapes found, it follows throughout historical, political and pedagogical paths, getting through the case study method references on the current Brazilian educational context, analyzing, which concepts are attributed to the inclusion and which practices are developed by educational managers and teachers in a regular school of the City of Natal/RN. The theory which based this research is supported on Vygotsky's central ideas (1991, 1997, 2004) and his followers. Furthermore, it was essential to bring to this investigative journey a literature which could dialogue with the most relevant aspects of the cultural-historical approach, emphasizing the assumptions of a progressive education tendency, which promotes the subject involvement of his/her work in the world and for the world. This way, it was necessary to seek for theoretical support on assistive technology and on alternative communication, in order to show the importance of establishing other communications, which is, to break away from the conventional pattern established by the school. On this journey it was used procedures for the data construction, such as: observation, conducting semistructured interviews and questionnaires; and document analysis that supported and legitimized the inclusion, besides the permanent field diaries record. On the access paths to this landscape it entered in the Youth and Adults Education (Educação de Jovens e Adultos - EJA), seeking to establish a dialogue among Youth and Adult Education and Special Education. It was verified that, still, there are large gaps in these policies articulation. Among the results obtained it was raised discussions on new scenery, in which Youth and Adults Education (EJA) emerges as prominent mode of the established relationships throughout the school inclusion process. There were target reflections on: the planning and evaluation systematic, the pedagogical articulation among the Youth and Adults Education (EJA) teachers and the multifunctional resource room teacher's actions and the continuous training importance of the educators involved. It was considered, therefore, that the necessary mediations for school inclusion may be sustained if the walkers are involved in a permanent contact with the nature of a proposal from the Special Education inclusive perspective

Uma contribuição crítica para o redesenho de cadeiras de rodas adaptadas para crianças e adolescentes com paralisia cerebral

This work was aimed at making a critical analysis of the product wheelchair, both for using four different models, which were objects of study of the dissertation of Cláudia Regina Cabral Galvão, entitled Critical Analysis of the Mobility Products Seated a wheelchair - Used by Children and Adolescents with Cerebral Palsy in Natal / RN and other municipalities of Rio Grande do Norte . This product is considered an instrument in the social rehabilitation of great importance for people with physical disabilities. This study aims to position the issue and develop comments on technical up grading of certain models according to the needs of the user. Describes features of four models in search searched through catalogs in order to know its advantages and disadvantages of use. Were presented the definitions of ergonomics and ergonomic aspects to be considered on a design, the study of anthropometry and its recommendations. Discussions the methodology of project design in two parts: the first, on the structuring of design problem (formulation, analysis, synthesis and evaluation.) And the second on the project (design and development, implementation and evaluation and solution). With that review will include the possibilities for a new redesign of the wheelchair, based on forms of adaptation in order to achieve the target that was compressed by the average population studied. Seeks to that this project makes an improvement in quality of life of people in wheelchairs by including these people in society but also the improvement of rehabilitation

Desenvolvimento de protótipo de cadeira de banho para indivíduos com paralisia cerebral tetraparética espástica

This study proposes to develop an equipment that attends the demands of tetraplegic people due to cerebral palsy and that promotes an adequate caregivers postural biomechanics during the shower activity of daily living. First, a bibliographic review was performed to define the terms refering to cerebral palsy, activity of daily living (specifically shower), and assistive technology, besides listing the wheelchairs made on the mainly national assistive technology companies. Therefore, this is a descriptive-exploratory study based on a literature review and on a based-field exploration research. On the field research a survey was adopted as a methodological procedure as it is related to a direct investigation related to a phenomenon, on the case, represented by the current shower situation of the people investigated in this study. Data were collected with the application of a form to the caregivers and consumers of the medical-therapeutic treatment and place used by the participants. Such form, which was made up of open and close questions, tried to identify, besides the personal data of evaluated users and consumers, the characteristics of the current shower activity, such as the place where it takes place in the house, the used equipmentS, in the case there is any, and how often it occurs. The form also was used to identify the caregivers and consumers desires and perceptions in relation to the present characteristics of the new dispositive besides the users and consumers anthropometric data. The evaluation of the results obtained through the form, together with the practice and clinical experience of the researchers and engineers involved in this study, made it possible to develop and make up a real shower chair prototype with the specific adjusts destined to adequate the equipment to be used according to the needs of each user and consumer

Análise crítica dos produtos de mobilidade sentada - cadeiras de rodas - utilizados por crianças e adolescentes com paralisia cerebral em Natal/RN e outros municípios do Rio Grande do Norte

The objective of this work is to critically analyze the seated mobility adaptive equipment, wheelchair, used by non-ambulatory children/adolescents diagnosed with cerebral palsy of the quadriplegy type with ages in between 0-18 years old in the municipal city of Natal/RN and of other ones in the state of Rio Grande do Norte. This study is characterized as descriptive as it took into consideration the individualized conditions of each child/adolescent and of their home environment, and also evaluates the condition of the used seated mobility devices such as wheelchairs or strollers. Thirty three (33) subjects which had a wheelchair prescribed by a healthcare professional specialist in adaptive equipment within the past 3 years were selected. A questionnaire was applied through a phone with the patient s primary care giver or parents. The results obtained showed that all the equipment being used had an anatomical seat and back and the tilt system mechanism and even though most of the patients required small individual adjustments upon receiving the wheelchair in order to accommodate to the patients characteristics. From the point of view of the caregiver/parents interviewed, 97% described satisfied with the equipment and report assistance with mobility (97%), comfort (82%) and good posture (82%) as the main positive aspects from the equipment. The results also describe the aspects related to the maintenance, time used and activities developed that were reported by the patients. The conclusion therefore is that in order to select the equipment to meet the needs of the consumer it is necessary that: an appropriate wheelchair prescription takes place, the up-to-date knowledge of equipment available in the market, the appropriate use of the resources from the concession programs of the government that purchase equipment and the establishment of link in between the manufacturers, patients and the caregivers

Influência da adição de carga na marcha em esteira de crianças com paralisia cerebral hemiparética espástica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

A criança com paralisia cerebral na educação infantil: um olhar sobre a prática docente

La inclusión de los niños con discapacidad en la educación infantil, además de ser un tema poco planteado en la comunidad científica, es un reto actual en lo que se refiere a la práctica docente. Basándose en este aspecto, nuestro objetivo en esta investigación realizada, que resultó en la elaboración de este trabajo, fue analizar cómo se procesa la práctica docente con vistas a la inclusión escolar de un niño con parálisis cerebral, en un Centro Municipal de Educación Infantil (CMEI), en la ciudad de Natal / RN. Más específicamente, buscamos: reflexionar sobre la práctica de la profesora responsable por la clase, en lo que se refiere al desarrollo del niño con parálisis cerebral; analizar las interacciones entre educador y niño con parálisis cerebral; observar la práctica docente en la perspectiva de favorecer la interacción entre el niño con parálisis cerebral y otros niños. Para ello, realizamos una pesquisa exploratoria, cualitativa, y así que optamos por el método del Estudio de Caso. Utilizamos como procedimientos metodológicos el análisis documental, la investigación bibliográfica, la entrevista semiestructurada, la observación y la filmación de escenas relacionadas a la práctica docente. Los sujetos de la investigación fueron la profesora y el niño con parálisis cerebral. Los datos construidos durante la investigación señalaron el hecho de que la práctica de la profesora no estaba encaminada a las necesidades específicas de la alumna con parálisis cerebral, todavía, se desarrollaba de una manera similar para todos los niños en la clase. La presencia de limitaciones significativas para la inclusión de la niña con parálisis cerebral en la educación infantil puede ser considerado como el resultado de la ausencia de una adecuada preparación docente, tanto en el nivel de la formación inicial, cuanto de una formación continua y también la escasez de directrices para el maestro, en proceso; directrices estas acerca de la educación de los niños con parálisis cerebral, lo que hacía imposible a la profesora contribuir de manera efectiva a su mayor desarrollo cognitivo y social.

Efeitos de florações de cianobactérias sobre os cladóceros ceriodaphnia dubia e daphnia gessneri

Cyanobacterial blooms are common in eutrophic reservoirs in Brazilian northeastern semi-arid. Given this reality, the present study aimed to analyze the effect of potentially toxic cyanobacterial blooms in Gargalheiras reservoir (semi-arid) on the cladocerans Ceriodaphnia dubia and Daphnia gessneri. In vitro chronic bioassays were performed with reservoir water dilutions from August/2011 to May/2012 and the following effects were evaluated on: intrinsic rate of population growth (r), reproductive parameters (age of first reproduction and fecundity per capita) and cladocerans movements. Phytoplankton was dominated by Cylindrospermopsis raciborskii and Planktothrix agardhii and saxitoxin and microcystin were detected in reservoir water. In most months C. dubia showed differences in r between control (absence of cyanobacteria) and treatments, and has shown negative effects on reproductive parameters. In all months paralysis of swimming movements was observed in C. dubia when both C. raciborskii and saxitoxin (cyanotoxin neurotoxic) were present in water. While C. dubia was sensitive to the reservoir water containing cyanobacteria, D. gessneri showed less intense negative effects in r and reproductive parameters. Furthermore, D. gessneri showed no paralysis of swimming movements. These results support the hypothesis in the literature that D. gessneri is resistant to the Cylindrospermopsis effects. The clone‟s life history may be a key to understand the results. The C. dubia clone, isolated from eutrophicated environment, is in the lab for ten years and it is an exotic species in Brazil. D. gessneri is a common species in the country and this clone was isolated from the Gargalheiras reservoir (where there are constant blooms of potentially toxic cyanobacteria) a year ago. Perhaps the recent contact with cyanobacteria explain the higher resistance presented by this D. gessneri clone. In conclusion, the cladocerans studied have different levels of sensitivity to cyanobacteria, characterizing species-specific responses

Uma nova tecnologia no pensamento de Herbert Marcuse: arte e técnica na sociedade unidimensional

This dissertation addresses the issue of technology in the work of Herbert Marcuse, explaning the merger between technology and domination that result in a totalitarian technological apparatus. Thus, technological civilization is supported and justified by a rational technological apparatus in the society, we have come not only the philosophy of Marcuse, but other great thinkers too, like Heidegger, Hegel, Marx. We also present a debate involving the philosophy of science, logic and linguage. Marcuse points to the need for a new technological rationality that emerge from a new sensibility, where the technique would allow a new relationship between man and nature. From then on, would emerge the need for a new subject. This transition would be possible by means of sensitivity, where art would become the art of live. With the link between art and technique made possible by new sensitivity, the author leaves one of its main contribution: he leaves open the possibility for the subject to choose new targests for technological development

Uma nova tecnologia no pensamento de Herbert Marcuse: arte e técnica na sociedade unidimensional

This dissertation addresses the issue of technology in the work of Herbert Marcuse, explaning the merger between technology and domination that result in a totalitarian technological apparatus. Thus, technological civilization is supported and justified by a rational technological apparatus in the society, we have come not only the philosophy of Marcuse, but other great thinkers too, like Heidegger, Hegel, Marx. We also present a debate involving the philosophy of science, logic and linguage. Marcuse points to the need for a new technological rationality that emerge from a new sensibility, where the technique would allow a new relationship between man and nature. From then on, would emerge the need for a new subject. This transition would be possible by means of sensitivity, where art would become the art of live. With the link between art and technique made possible by new sensitivity, the author leaves one of its main contribution: he leaves open the possibility for the subject to choose new targests for technological development

Características bioativas, funcionais e efeito protetor do resíduo desidratado de camu-camu (Myrciaria dubia H.B.K. (McVaugh)) sobre doenças degenerativas utilizando modelos in vivo C. elegans

Camu-camu (Myrciaria dubia H.B.K. (McVaugh)) is a native Amazon fruit, recognized worldwide as one of the main natural sources of ascorbic acid. Due to its great acidity, this fruit is generally consumed after processing into juice or as ingredient in food preparations. As a co-product of the camu-camu processing, a significant amount of agroindustrial residue is generated. Despite the studies showing the bioactive value and biological potential of the fruit, few studies have approached the possible processing techniques, transformation and preservation of camu-camu fruits and its agroindustrial pomace. Therefore, the present work has the objective of evaluating two different drying processes applied to camu-camu pomace (peel and seeds with residual pulp), freeze drying and hot air drying, in order to obtain a functional fruit product. This thesis was divided into three stages: the first one shows the studies related to the freeze drying and hot air drying, where we demonstrated the impact of the selected drying techniques on the bioactive components of camu-camu, taking the fresh pomace as the control group. Among the investigated conditions, the groups obtained at 50ºC and 4 m/s (SC50) and 80ºC and 6 m/s (SC80) were selected as for further studies, based on their ascorbic acid final content and Folin-Ciocalteau reducing capacity. In addition to SC50 and SC80, the fresh pomace (RF) and freeze dried (RL) samples were also evaluated in these further stages of the research. Overall, the results show higher bioactive concentration in the RF samples, followed by RL, SC50 and SC80. On the second step of the research, the antioxidant, antimicrobial and antienzymatic activities were evaluated and the same tendency was observed. It was also reported, for the first time in the literature, the presence of syringic acid in dried camu-camu pomace. In the third and final stage of the research, it was investigated the effect of dried camu-camu on aging and neuroprotective disorders, using the in vivo model C.elegans. It was observed that camu-camu extracts were able to modulate important signaling genes relevant to thermal and oxidative stresses (p < 0.05). The polar acid, polar basic and polar neutral fractions obtained from the low molecular extracts of SC50 were able to extend the lifespan of wild type N2 C. elegans in 20% and 13% (p < 0.001). Results also showed that the paralysis induced by the β1-42 amyloid was significantly (p < 0.0001) retarded in CL4176 worms. Similarly, the camu-camu extracts attenuated the dopaminergic induction associated to Parkinson’s disease. Finally, a global analysis of the data presented here reveal that the camu-camu pomace, a co-product obtained from the industrial processing of a native Brazilian fruit, is a relevant natural source of health relevant compounds. This thesis, shows for the first time, the multifunctionality of camu-camu pomace, a natural resource still underexploited for scientific, commercial and technological purposes.

Polpa de jambolão (Eugenia jambolana Lam.) fresca e desidratada: características físico-químicas, bioativas e funcionais, efeitos biológicos em Caenorhabditis elegans e uso para produção de frozen yogurt caprino probiótico

This work evaluated the fresh, spray dried (with 10 % of Arabic Gum) and freeze dried jambolan pulp (Eugenia jambolana Lam.) in regard to physicochemical (pH, moisture, water activity, average particle diameter, solubility and color), bioactive [total phenolic content (TPC), monomeric anthocyanin, pronathocyanidin (PA), total elagic acid (TEA), myricetin and cyanidin] and in vitro functionality (antioxidant, antienzymatic and antimicrobial activities]. In addition, the in vivo functionality of jambolan pulp was investigated using the Caenorhabditis elegans model for insulin signaling, longevity and induced neurodegeneration (Alzheimer’s disease and Parkinson’s disease related symptoms). The dried jambolan pulp presented TPC retention (50% to 75%), PA (90% to 98%), TEA (31% to 83%), myricetin (40% to 84%), cyanidin (72% to 84%) and antioxidant activity (15%). The fresh jambolan pulp, the freeze dried pulp and the spray dried jambolan pulp presented high enzymatic inhibitory activity against pancreatic lipase (4,4 to 5,8 mg/mL), alpha-glycosidase (10,3 to 13,8 mg/mL) and alpha-amylase (8,9 to 11,2 mg/mL). They also were active inhibitors against the pathogen S. aureus. The dried jambolan experimental samples were able to increase the expression of several genes linked to the insulin signaling pathways (SIR-2.1, PPTR-1, DAF-16, SOD-3, e CTL) and increased the lifespan in C. elegans (18,07 % - 24,34 %), besides decreasing the amyloid AB1-42 aggregation induced paralysis and MPP+ (1-methyl-4-phenylpyridinium) induced neurodegeneration. Based on that, the jambolan pulp and the spray dried jambolan pulp were further selected for the production of caprine frozen yogurt with the addition of Bifidobacterium animalis subsp. lactis BI-07. The final product were evaluated in regard to their physicochemical (pH, acidity, total solids, protein, total reducing sugars, fat, ashes, overrun, melting test), bioactive (TPC and monomeric anthocyanin, antioxidant activity, probiotic viability and sensory analysis (sensory acceptance). The results showed that samples with probiotic had lowest pH and higher acidity, TPC, anthocyanin and antioxidant activity. It was also observed low overrun (14.2% to 22.6%). vi Samples with probiotic had lower flavor scores. Overall, this research presents the jambolan as a highly functional bioactive-rich fruit with the potential to modulate important biological pathways, extend lifespan and retard the development of neurodegenerative diseases. Jambolan is an underexploited exotic fruit with a high colorant potential and this thesis shows for the first time in the literature important technological, biological and scientific data about this fruit that could be used towards the development of health-oriented food products.

Síndrome de Guillain-Barré: epidemiologia, prognóstico e fatores de risco

Introduction. Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy and the principal cause of acute neuromuscular paralysis. The most prominent GBS subtypes are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Fisher syndrome (FS). Differences in geographical distribution of variants have been reported. In Brazil, there are few studies describing the characteristics of GBS, but none on the frequency of GBS variants and their clinical manifestations. Infection-induced aberrant immune response resulting from molecular mimicry and formation of cross-reacting antibodies, contribute to complement activation. Functional biallelic polymorphism in immunoglobulin receptors that influence the affinity of IgG subclasses and the type of immune response have been described, suggesting genetic susceptibility to developing disease. It remains unclear whether individuals carrying different FCGR alleles have differential risk for GBS and⁄or disease severity. The goals of this study were: (1) To characterize GBS and describe the clinical findings in a cohort of patients with GBS from the state of Rio Grande do Norte, Brazil; (2) to determine whether polymorphism in FCGR were associated with development of GBS, and (3) to tease out whether the global gene expression studies could be a tool to identify pathways and transcriptional networks which could be regulated and decrease the time of disease. Methods. Clinical and laboratory data for 149 cases of GBS diagnosed from 1994 to 2013 were analyzed. Genomic DNA and total RNA were extracted from whole blood. Antigangliosides antibodies were determined in the sera. In addition, we also assessed whether FCGR polymorphism are present in GBS (n=141) and blood donors (n=364), and global gene expressions were determined for 12 participants with GBS. Blood samples were collected at the diagnosis and post-recovery. Results. AIDP was the most frequent variant (81.8%) of GBS, followed by AMAN (14.7%) and AMSAN (3.3%). The incidence of GBS was 0.3 ⁄ 100,000 people for the state of Rio Grande do Norte and cases occurred at a younger age. GBS was preceded by infections, with the axonal variant associated with episodes of diarrhea (P = 0.025). Proximal weakness was more frequent in AIDP, and distal weakness predominant in the axonal variant. Compared to 42.4% of cases with AIDP (P<0.0001), 84.6% of cases with the axonal variant had nadir in <10 days. Individuals with the axonal variant took longer to recover deambulation (P<0.0001). The mortality of GBS was 5.3%. A worse outcome was related to an axonal variant (OR17.063; P=0.03) and time required to improve one point in the Hughes functional scale (OR 1.028; P=0.03). The FCGR genotypes and allele frequencies did not differ significantly between the patients with GBS and the controls (FCGR2A p=0.367 and FCGR3A p=0.2430). Global gene expression using RNAseq showed variation in transcript coding for protein isoforms during acute phase of disease. Conclusions. The annual incidence of GBS was 0.3 per 100,00 and there was no seasonal pattern. A predominance of the AIDP variant was seen, and the incidence of the disease decreased with age. The distribution of weakness is a function of the clinical variants, and individuals with the axonal variant had a poorer prognosis. Early diagnosis and variant identification leads to proper intervention decreasing in long-term morbidity. FCGR polymorphisms do not seem to influence susceptibility to GBS in this population. This study found deregulated genes and signs of transcriptional network alterations during the acute and recovery phases in GBS. Identification of pathways altered during disease might be target for immune regulation and with potential to ameliorate symptoms.