Assento adaptável para pessoas com paralisia cerebral e seqüela de escoliose: aplicando ergonomia por meio do design - num estudo de caso

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Tradução e adaptação transcultural do Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire (CPCHILD©) para a lingua portuguesa do Brasil

Pós-graduação em Bases Gerais da Cirurgia - FMB

O transtorno global do desenvolvimento na educação inclusiva: escola comum ou escola especial?

Este trabalho configura-se numa proposição de estudo de caso, que procurou discutir e orientar a prática pedagógica de alunos da educação especial, com vistas ao seu desenvolvimento acadêmico. Foi realizado no decorrer de um ano letivo, numa unidade escolar de uma rede municipal de ensino do oeste paulista. Contou com a participação de professores do ensino comum, da educação especial, gestores da escola e fez parte de um conjunto de ações desenvolvidas no projeto de extensão universitária, numa proposição conjunta entre universidade e escola. Num primeiro momento foram realizadas observações do cotidiano escolar de um aluno com transtorno global do desenvolvimento, autismo, e de uma aluna com duplo diagnóstico, paralisia cerebral e autismo, associada à coleta de informações sobre as trajetórias educacionais e os diagnósticos clínicos. Com base nessas informações efetivaram-se intervenções psicoeducacionais com os alunos e professoras especialistas e aplicou-se a Escala de Comportamento Adaptativo Vineland. De modo geral, identificou-se um padrão restrito de aprendizagens funcionais e comportamentos interacionas nos casos observados. Ao final da proposta questionou-se qual a contribuição das práticas pedagógicas, ofertadas na sala de aula comum, para o desenvolvimento educacional dos alunos em questão. As análises foram compartilhadas com os profissionais da escola e com os respectivos familiares, e direcionamentos foram apontados a favor da manutenção no ensino comum ou ao encaminhamento à escola especial.

Efeitos de um Protocolo Modificado da Terapia Por Contensão Induzida em Criança com Paralisia Cerebral Hemiparética

Evaluate the effects of a modifi ed ConstraintInduced Therapy intervention protocol regarding movement quality and frequency of use of the affected upper extremity on children with hemiplegic cerebral palsy. Longitudinal study of a single case, performed with a four year old submitted to intervention during three hours daily, for ten days, restricting the non-affected upper extremity for eight hours daily. Data were collected using the Pediatric Upper Extremity Motor Activity Log and analyzed using the arithmetic mean. Signifi cant improvement in quality of movement and frequency of use of the upper limb from pre to post-intervention were noted, maintaining the result in later data collection, besides the acquisition of functional motor skills. The modifi ed constraint-induced movement therapy protocol of this study was effective in treating the child with hemiplegic cerebral palsy, the results may be useful for professionals working with this clientele, assisting them in the intervention process.

Contribuição da amplitude de movimento articular do joelho na marcha de crianças com paralisia cerebral espástica

Individuals with spastic cerebral palsy show muscle weakness, difficulties in the control of agonist and antagonist muscles, decreased range of motion and tonus and sensibility alterations, especially in knee joint. These problems can interfere on the performance of functional activities such gait. The aim of this study was to analyze the contribution of knee range of motion on gait of hemiplegic and diplegic children considering their asymmetries. Twelve children, 6 hemiplegics e 6 diplegics from 7 to 12 years of age (age average= 9,5 ± 1,93) took part. Spasticity was assessed by the Ashworth’s Modified Scale and the passive knee range of motion by an eletrogoniometer. The task was to walk on a walkway of 8m long, in their preferred speed, in 6 attempts, been 3 on right and 3 on left sagital planes. Eigth passive markers were bilaterally fixed for the kinematic record. Orthogonally to the walkway, two digital camcorders were assembled on the sagital plane. The fotogrametric procedures were performed by the Dvideow 6.3 software. The Matlab 7.0.1 software was used to filter and to calculate the dependent variables. The U test of Mann- Whitney found differences to the cerebral palsy type for knee extension/hiperextension (U = - 2.943; p= 0.003), knee relative angle at heel contact (U = - 5.992; p= 0.001) and knee range during stride (U = - 4.099; p= 0.001). The Wilcoxon’s test revealed differences according to the asymmetries for the hemiplegics only for the knee relative angle at heel contact (T= - 2.635; p<0.008). The contributions of passive knee range of motion, revealed by the Spearman correlations, for the more afected limb of the diplegics, showed that the knee extension/hiperextension interfere on the cadence, stride duration and step width; the knee relative angle at heel contact change the stride length and duration and cadence; and the...(Complete abstract click electronic access below)

Paralisia cerebral, extensão universitária e trabalho voluntário: práticas da reflexividade

Report of voluntary work with youngsters suffering from cerebral palsy syndrome. Objective is to highlight information about this syndrome and possibilities of their treatment, especially referred to the method of conductive education. It aims to promote a training experience of a reflexive identity of mother and family of these patients.

Elaboração e validação de um instrumento de avaliação da disfagia orofaríngea na paralisia cerebral

Pós-graduação em Fonoaudiologia - FFC

Factors associated with breastfeeding in disabled and phenotipically normal children

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Saúde bucal e qualidade de vida em indivíduos com paralisia cerebral e Síndrome de Down: percepção dos cuidadores

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

LPS-induced modifications in spontaneous network activity causes neuronal apoptosis in neonatal cerebral cortex

During the perinatal period the developing brain is most vulnerable to inflammation. Prenatal infection or exposure to inflammatory factors can have a profound impact on fetal neurodevelopment with long-term neurological deficits, such as cognitive impairment, learning deficits, perinatal brain damage and cerebral palsy. Inflammation in the brain is characterized by activation of resident immune cells, especially microglia and astrocytes whose activation is associated with a variety of neurodegenerative disorders like Alzheimer´s disease and Multiple sclerosis. These cell types express, release and respond to pro-inflammatory mediators such as cytokines, which are critically involved in the immune response to infection. It has been demonstrated recently that cytokines also directly influence neuronal function. Glial cells are capable of releaseing the pro-inflammatory cytokines MIP-2, which is involved in cell death, and tumor necrosis factor alpha (TNFalpha), which enhances excitatory synaptic function by increasing the surface expression of AMPA receptors. Thus constitutively released TNFalpha homeostatically regulates the balance between neuronal excitation and inhibition in an activity-dependent manner. Since TNFalpha is also involved in neuronal cell death, the interplay between neuronal activity MIP-2 and TNFalpha may control the process of cell death and cell survival in developing neuronal networks. An increasing body of evidence suggests that neuronal activity is important in the regulation of neuronal survival during early development, e.g. programmed cell death (apoptosis) is augmented when neuronal activity is blocked. In our study we were interested on the impact of inflammation on neuronal activity and cell survival during early cortical development. To address this question, we investigated the impact of inflammation on neuronal activity and cell survival during early cortical development in vivo and in vitro. Inflammation was experimentally induced by application of the endotoxin lipopolysaccharide (LPS), which initiates a rapid and well-characterized immune response. I studied the consequences of inflammation on spontaneous neuronal network activity and cell death by combining electrophysiological recordings with multi-electrode arrays and quantitative analyses of apoptosis. In addition, I used a cytokine array and antibodies directed against specific cytokines allowing the identification of the pro-inflammatory factors, which are critically involved in these processes. In this study I demonstrated a direct link between inflammation-induced modifications in neuronal network activity and the control of cell survival in a developing neuronal network for the first time. Our in vivo and in vitro recordings showed a fast LPS-induced reduction in occurrence of spontaneous oscillatory activity. It is indicated that LPS-induced inflammation causes fast release of proinflammatory factors which modify neuronal network activity. My experiments with specific antibodies demonstrate that TNFalpha and to a lesser extent MIP-2 seem to be the key mediators causing activity-dependent neuronal cell death in developing brain. These data may be of important clinical relevance, since spontaneous synchronized activity is also a hallmark of the developing human brain and inflammation-induced alterations in this early network activity may have a critical impact on the survival of immature neurons.

Effect of selective dorsal rhizotomy on gait in children with bilateral spastic paresis: kinematic and EMG-pattern changes

Selective dorsal rhizotomy (SDR) is an effective treatment for reducing spasticity and improving gait in children with spastic cerebral palsy. Data concerning muscle activity changes after SDR treatment are limited.

Effectiveness of selective dorsal rhizotomy in 2 patients with progressive spasticity due to neurodegenerative disease

Selective dorsal rhizotomy at the lumbar level is a neurosurgical procedure, which reduces spasticity in the legs. Its effect has mainly been studied in children with spastic cerebral palsy. Little is known about the outcome of selective dorsal rhizotomy in patients with neurodegenerative disorders. We report the clinical course after selective dorsal rhizotomy in 2 patients with progressive spasticity. Leg spasticity was effectively and persistently reduced in both patients, facilitating care and improving sitting comfort. However, spasticity of the arms and other motor disturbances, such as spontaneous extension spasms and the ataxia, increased gradually in time. Selective dorsal rhizotomy leads to a disappearance of leg spasticity in patients with a neurodegenerative disease. Other motor signs are not influenced and may increase due to the progressive nature of the underlying disease.

Neonatal neurodevelopment outcomes following tocolysis with glycerol trinitrate patches

Objective: The object of this study was to determine the effects of maternal tocolysis with glycerol trinitrate (GTN) patches on the neurodevelopment of infants. Study design: This was a randomized, multicenter, controlled trial comparing the efficacy of GTN patches with standard beta 2 agonist as tocolytic therapy. The previously reported outcomes of this study indicated no difference in neonatal mortality or morbidity to hospital discharge. One hundred fifty-six surviving infants from 2 Australian centers were psychometrically assessed using the Griffiths Mental development Scales (revised) at 18 months of age. Results: There was no difference in psychometric performance between those infants enrolled in either the GTN (81 infants) or beta 2 agonist (75 infants) arm of the study. Conclusion: This randomized trial supports no significant difference between GTN patches in comparison with standard beta 2 agonist for tocolytic therapy. The results underscore the association between premature labor and adverse infant outcomes. (c) 2006 Mosby, Inc. All rights reserved.

A qualitative study of the impact of an educational intervention on older parents of adults with disabilities engaged in the phenomenon of future-care planning

This phenomenological study describes the impact of an educational intervention on the day-to-day experiences of older parent caregivers of adults with developmental disabilities who were engaged in the process of future-care planning. Qualitative strategies of individual and focus group interviewing were used with a purposive sample of older caregivers. Participants were members of an existing parent support group. Twenty-three caregivers representing 18 families were queried before and after the education program. The disabilities represented were mental retardation, cerebral palsy and autism. Parents whose children live at or away from home were included. The intervention was conducted on five Saturdays over a two month period; the duration of the study was five months. Findings used typical words of the respondents from their individual and focus group interviews to describe feelings, attitudes and experiences in making future-care plans. Data from verbatim transcriptions and researcher's field notes were coded, analyzed, sorted into themes, and subjected to interpretive analysis. Respondents showed a positive change in attitudes and actions after participating in the education program, regardless of their initial stage in care planning. Fears were replaced by hope and determination; hesitation and ineptitude by feelings of competence and confidence; and procrastination and delay by purposeful actions. Other key findings: use of a planning document greatly aided caregivers; barriers to planning were often intrinsic and amenable to education; residential plans were the most difficult aspect of planning; listening to the experiences of other parent caregivers was helpful; and making burial plans for their offspring was one aspect of planning parents wished to do themselves. ^

Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy.

Aim: To examine the relationship between electrographic seizures and long-term outcome in neonates with hypoxic-ischemic encephalopathy (HIE). Method: Full-term neonates with HIE born in Cork University Maternity Hospital from 2003 to 2006 (pre-hypothermia era) and 2009 to 2012 (hypothermia era) were included in this observational study. All had early continuous electroencephalography monitoring. All electrographic seizures were annotated. The total seizure burden and hourly seizure burden were calculated. Outcome (normal/abnormal) was assessed at 24 to 48 months in surviving neonates using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales; a diagnosis of cerebral palsy or epilepsy was also considered an abnormal outcome. Results: Continuous electroencephalography was recorded for a median of 57.1 hours (interquartile range 33.5-80.5h) in 47 neonates (31 males, 16 females); 29 out of 47 (62%) had electrographic seizures and 25 out of 47 (53%) had an abnormal outcome. The presence of seizures per se was not associated with abnormal outcome (p=0.126); however, the odds of an abnormal outcome increased over ninefold (odds ratio [OR] 9.56; 95% confidence interval [95% CI] 2.43-37.67) if a neonate had a total seizure burden of more than 40 minutes (p=0.001), and eightfold (OR: 8.00; 95% CI: 2.06-31.07) if a neonate had a maximum hourly seizure burden of more than 13 minutes per hour (p=0.003). Controlling for electrographic HIE grade or treatment with hypothermia did not change the direction of the relationship between seizure burden and outcome. Interpretation: In HIE, a high electrographic seizure burden is significantly associated with abnormal outcome, independent of HIE severity or treatment with hypothermia.