Dissertations / Theses on the topic 'Infant physical therapy'

This presentation compares the development and implementation of competency checklists for orienting and mentoring practitioner that supports the needs of management, patients and NICU therapist's. Competencies from four NICUs across the US were compared by three neonatal physical therapists via a coding system. After coding, themes arose which described similarities which were then referenced back to the published physical therapy competencies. This varied between hospitals, depending on specific rehabilitation professionals employed, the evolution of NICU status and the complexity of the patient. The neonatal therapist has a unique opportunity to utilize the information from this study to bridge the gap between the operational management and the educational demands of the rehabilitation therapist in the NICU team.

Orientadores: Maria Valeriana Leme de Moura Ribeiro, Marilisa Mantovani Guerreiro
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: Na última década, os avanços no atendimento à gestante, ao concepto, aos procedimentos obstétricos e ao neonato têm proporcionado aumento da sobrevida de recém-nascidos (RN) com idades gestacionais menores. Assim os pré-termos extremos que representam 1,4% de todos os RN tiveram expressivo aumento da sobrevivência, com identificação de morbidades (atraso do neurodesenvolvimento e paralisia cerebral). Objetivo: Comparar o desenvolvimento motor e o crescimento ponderoestatural de lactentes pré-termos classificados como extremos e moderados e compará-los com lactentes a termo. Sujeitos e Métodos: Estudo prospectivo, seccional e longitudinal, de coorte, sendo o Grupo 1 constituído por lactentes nascidos pré-termo extremo PTE (? 30 semanas de idade gestacionais),o Grupo 2 por lactentes nascidos moderadamente pré-termo PTM (entre 31 e 33 semanas e 6 dias), e o Grupo 3 ¿ lactentes a termo de baixo risco classificados como controles (entre 37 e 41 semanas e 6 dias). Foi realizada pesquisa de prontuário e uma entrevista com os pais ou responsáveis legais para identificar os fatores de risco (biológicos e ambientais)pré, peri, neo e pós-natais, dados antropométricos (peso, estatura e perímetro craniano) e desenvolvimento motor nas idades de 1, 2 e 3 meses de idade corrigida. Foi utilizado Test of Infant Motor Performance (TIMP). Foram selecionados os lactentes cujos pais assinaram o Termo de Consentimento Livre e Esclarecido e lactentes que compareceram a pelo menos uma avaliação no Ambulatório de Referência do Desenvolvimento Infantil Fênix do Hospital Municipal "Dr Mário Gatti", durante o ano de 2010 e 2012. Foram excluídos lactentes com diagnóstico de síndromes genéticas, malformações, infecções congênitas ou adquiridas no período neonatal, além de imagem radiológica de hemorragia intracraniana grau III e IV, lesão da substância branca cerebral ou cistos intracranianos. Dos 320 RN que chegaram para acompanhamento, os pais de 269 RN aceitaram participar da pesquisa e somente 110 lactentes preencheram todos os critérios de inclusão. Assim, o grupo PTE foi composto por 36 lactentes, o grupo PTM por 74 e o grupo controle por 57. Resultados: Houve diferença significativa na média do escore bruto e na classificação do Z-escore no TIMP no 1° mês, sendo a média do grupo PTM menor (p=0,030). O grupo PTM apresentou maior proporção de lactentes classificados como pequenos para a idade gestacional segundo a classificação do crescimento intrauterino, sendo 67,5% classificados com assimétrico. O peso, comprimento e perímetro craniano são diferentes entre os grupos nos três meses estudados, porém a média das medidas está dentro da curva de normalidade da Organização Mundial da Saúde na idade corrigida. Constatamos que todas as variáveis de controle estudadas, o PTE apresentou proporções superiores, somente o crescimento intrauterino o grupo PTM. Conclusão: Conclui-se que a prematuridade moderada associada ao nascimento PIG pode prejudicar o desenvolvimento motor avaliado pela escala TIMP
Abstract: Introduction: In the last decade, advances in the care of pregnant women, the fetus, the obstetric procedures, and the neonate have provided increased survival of new born with lower gestational ages. Thus the extremely preterm representing 1.4% of all infants had a significant increase in survival, leading to morbidities (neurodevelopmental delay and cerebral palsy). Objective: To compare motor development and growth of preterm infants classified as extreme or moderate with full-term infants. Subjects and Methods: A prospective, cross-sectional and longitudinal study of the cohort following: Group 1 consisting of extreme preterm infants (PTE ? 30 weeks of gestational age); Group 2 consisting of moderately preterm infants (PTM = between 31-33 weeks and 6 days); and, Group 3 (control group) consisting of low-risk term infants (between 37 - 41 weeks and 6 days). Research records and one interview with the parents or legal guardians were performed to identify risk factors (biological and environmental) pre -, peri- , neo -and post birth , anthropometric data (weight, height and head circumference) and motor development at the first, second and third months of corrected age. The Test of Infant Motor Performance (TIMP) was used. We selected infants whose parents signed the consent form and infants who attended at least one assessment at the Clinic of Child Development Reference ¿Fenix, "Dr Mario Gatti Regional Hospital", during 2010 and 2012. We excluded infants diagnosed with genetic syndromes, malformations, congenital or acquired infections in the neonatal period, radiological imaging of grade III and IV intracranial hemorrhage, and intracranial cysts. Out of 320 infants, 269 parents agreed to participate, only 110 infants met all inclusion criteria. The PTE group consisted of 36 infants, PTM group consisted of 74 infants and control group consisted of 57 term infants. Results: There were significant differences in mean raw score and classification of the Z - score in the TIMP on first month, with a lowest average of the PTM group (p = 0.030). The PTM group had a higher proportion of infants classified as small for gestational age, and 67.5% of those were classified as asymmetric intrauterine growth. The weight, length and head circumference were different between groups in the three months, but the average of the measurements were within the normal values of World Health Organization curves. Conclusion: We conclude that moderate preterm infants who are small for gestational age may present with impaired motor development assessed by TIMP
Doutorado
Ciencias Biomedicas
Doutora em Ciências Médicas

Infants born prior to the term of 36 gestation weeks and 6 days are considered preterm infants. The number of preterm infants in Lithuania amounts to 5 – 6% per year. The most significant health problems of such infants in the neonate period are caused by immaturity of the organs and their systems. Knowledge of a preterm infant’s psychomotoric development contributes to early notification of disorders, more effective composition of problem-orientated corrective programs and monitoring of development progress. According to the reference literature, early application of physical therapy enables recovery of as much as 50 percent of infants and improvement of the condition of the rest. The goal of this thesis is to determine within which group: in the preterm infants (extremely preterm (born within 25-30 gestation week) or very preterm infants (born within 31-36 gestation week)), physical therapy has major effect for the emergence time of motor function. The objectives of the thesis are as follows: 1. Comparison of emergence time of motor functions with regard to extremely preterm and very preterm infants within the same stage of corrected age. 2. Comparison of motor development of the extremely preterm and very preterm infant groups and within each separate group considering the gender aspect. 3. Comparison of motor development alternation of the extremely preterm and very preterm infant groups and within each separate group considering the aspect of applied surgical treatment... [to full text]

Since the introduction of the American Academy of Pediatrics Back to Sleep Campaign infants have not met the recommendation to “incorporate supervised, awake “prone play” in their infant’s daily routine to support motor development and minimize the risk of plagiocephaly”. Interventions are needed to increase infants’ tolerance for prone position and prone playtime to reduce the risk of plagiocephaly and motor delays. Associative learning is the ability to understand causal relationship between events. Operant conditioning is a form of associative learning that occurs by associating a behavior with positive or negative consequences. Operant conditions has been utilized to encourage behaviors such as kicking, reaching and sucking in infants by associating these behaviors with positive reinforcement. This dissertation is a compilation of three papers that each represent a study used to investigate a potential play based interventions to encourage prone motor skills in infants. The first paper describes a series of experiment used to develop the Prone Play Activity Center (PPAC) and experimental protocols used in the other studies. The purpose of the second study was to determine the feasibility of a clinical trial comparing usual care (low tech) to a high-tech intervention based on the principles of operant conditioning to increase tolerance for prone and improve prone motor skills. Ten infants participated in the study where parents of infants in the high tech intervention group (n=5) used the PPAC for 3 weeks to practice prone play. Findings from this study suggested the proposed intervention is feasible with some modifications for a future large-scale clinical trial. The purpose of the third study evaluated the ability of 3-6 months old infants to demonstrate AL in prone and remember the association learned a day later. Findings from this study suggested that a majority of infants demonstrated AL in prone with poor retention of the association, 24 hours later. Taken together these 3 papers provide preliminary evidence that a clinical trial of an intervention is feasible and that associative learning could be used to reinforce specific prone motor behaviors in the majority of infants.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Objetivo: Determinar a frequência e os fatores associados às alterações torácicas musculoesqueléticas em crianças nascidas prematuras e analisar a acurácia e a reprodutibilidade da fotogrametria para detectar tais alterações. Método: Estudo transversal com crianças no primeiro ano de vida, nascidas de fevereiro/2007 a dezembro/2008, idade gestacional <37 semanas, peso ao nascer <2000g e acompanhadas no Ambulatório de Prematuros da Universidade Federal de São Paulo (UNIFESP). Excluíram-se: malformações, doenças neuromusculares e cromossômicas, hemorragia peri-intraventricular grau III/IV e/ou leucomalácia periventricular. Utilizou-se o exame físico para determinar frequência e fatores associados às alterações torácicas e como padrão de referência para análise de acurácia, por curva ROC, do ângulo manúbrio/acrômio/trapézio e da medida da retração costal para detectar, respectivamente, elevação de ombros e retração costal em duas fotografias analisadas em computador. Projeto aprovado pelo Comitê de Ética da UNIFESP, com assinatura do Termo de Consentimento. Resultados: Das 121 crianças com idade gestacional: 31,1+2,8 semanas e peso ao nascer: 1400+338g, 66,9% apresentaram alterações torácicas. À regressão logística, os fatores associados às alterações torácicas foram: idade corrigida (dias): OR: 1,018 (IC95%: 1,004- 1,1019) e dias de oxigenoterapia: OR: 1,096 (IC95%: 1,031-1,164). O ângulo manúbrio/acrômio/trapézio apresentou: acurácia: 0,793, sensibilidade: 71,4%, especificidade: 78,4%, coeficiente de correlação intra e interclasse (CCI): 0,922 e 0,947. A medida de retração costal mostrou: acurácia: 0,895, sensibilidade: 96,6%, especificidade: 75,9%, CCI: 0,841 e 0,838. Conclusões: As alterações torácicas foram freqüentes e se associaram à maior idade corrigida e maior tempo de oxigenoterapia. A fotogrametria apresentou excelente reprodutibilidade e boa acurácia
Objective: To determine the frequency and factors associated with thoracic musculoskeletal alterations in infants born premature and to analyze the accuracy and the reproducibility of photogrammetry to detect these alterations. Methods: Cross sectional study with infants in the first year of life, born from February/2007 to December/2008, with gestational age <37 weeks, birth weight <2000g and followed at the Premature Clinic of the Federal University of São Paulo. Major malformation, intraventricular hemorrhage grade III/IV and/or periventricular leucomalacia were excluded. Physical exam was used as a reference standard to determine the frequency and factors associated with thoracic alterations and for accuracy analysis, by ROC curve. Photographs were analyzed by a computer program to detect shoulder elevation and thoracic retraction by the measurement of manubrium/acromion process/trapezius angle and the greatest thoracic retraction depth. The study was approved by the Ethical Committee of the Institution and parents/guardians signed terms of informed consent. Results: Of 121 studied infants (gestational age: 31.1+2.8 weeks, birth weight: 1400+338g), 81 (66.9%) presented thoracic alterations. By logistic regression, factors associated with thoracic alterations were: days of corrected age (OR=1.018, CI95%: 1.004-1.019) and days on oxygen therapy (OR=1.096, CI 95%: 1.031-1.164). Compared to physical exam, the manubrium/acromion process/trapezius angle presented: accuracy: 0.793, sensitivity: 71.4%, specificity: 78.4%, intraclass and interclass correlation coefficient (ICC): 0.922 and 0.947. The greatest thoracic retraction depth showed: accuracy: 0.895, sensitivity: 96.6%, specificity: 75.9%, (ICC): 0.841 and 0.838. Conclusions: The frequency of thoracic alterations was high and associated with higher corrected age and longer oxygen therapy. The photogrammetry provided an objective, accurate and reliable test to detect thoracic alterations in preterm infants.
TEDE

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Universidade Federal de Minas Gerais
Objectives: Part I) To verify the effect of short-term training on reaching behavior in fullterm infants at the onset of reaching. Part II) To know the behavior of reaching, the reaching training protocols in full-term and preterm infants and to adjust these training for children with cerebral palsy (CP). Methods: In Part I, it was conducted a randomized controlled trial. 30 healthy infants at 3-4 months of age (M =14.0 ±1.6 weeks of age) were randomly assigned to: 1) reaching training group; 2) social training group (control group). The infants were submitted into 3 assessments (kinematics and qualitative) at 45° reclined position (until 5 days after the onset of reaching): 1) Pre-training, before the first session of training; 2) Post-training 1, after the first session of training, at the same day; and 3) Posttraining 2, after three sessions of training, at the following day. To perform the reaching training and social training, the infants were submitted into three short-term sessions of training, one performed on the first day and the two performed on the second day. All infants were seated reclined 45° in the researcher s lap. The infants of training group received three activities of interaction with the object under serial practice (i.e.: ABC, ABC, ABC) in each session. The infants of social group received no reaching training or stimuli for their upper limbs of each session. The variables considered were: characterizing the sample, the total reaching frequency, distal adjustments (hand orientation, hand opening, and surface of the hand contact), and spatio-temporal variables (duration of movement, mean velocity, straightness index, deceleration index, and movement unit). In Part II, we performed a literature review on: the reaching behavior in infants with typical developmental, preterm infants and infants with CP from 0 to 2 years of age; the main techniques of reaching assessment; models of reaching training protocols (immediate and short-term effects) developed for full-term and preterm infants and; on a way of adjusting reaching training for children with CP in clinical practice. Results: In Part I, a training session was effective in increasing the number of reaches and the percentage of reaches with ventral hand, and decreasing the percentage of reaches with closed and dorsal hand. In addition, three training sessions resulted in changes in the spatio-temporal variables (with shorter and more fluent reachs) and increased the percentage of reaches with vertical hand. For Part II, it was highlighted the importance of determining immediate, short, medium and long term goals, planning the therapeutic procedures directed to the goals. In addition, to use and adapt existing training protocols to intervene in infants at risk and / or diagnosis of CP, and others. Conclusions: A few short training sessions under serial varied condiction were effective in improving the reaching performance, such as changes in the number of reaches, in distal adjustments and spatio-temporal reaching variables. These results reflect the flexibility of the perceptual-motor skills development and the important role of experience in the improvement of motor behavior in infants. Furthermore, to direct the interventions to the functional objectives and, to use and adapt existing training protocols, may provide to the professionals one more tool of intervention in infants at risk and / or established diagnosis of CP.
Objetivos: Parte I) Verificar o efeito do treino de curta duração de alcance em lactentes nascidos a termo no período de aquisição da habilidade. Parte II) Conhecer o comportamento de alcance, protocolos de treino de alcance em lactentes a termo e prétermo e; ajustar esses protocolos de treino de alcance para crianças com paralisia cerebral (PC). Métodos: Na Parte I, foi realizado um estudo randomizado controlado, com 30 lactentes a termo, de 3-4 meses de idade (M= 14,0±1.6 semanas de idade), alocados em dois grupos: 1) grupo de treino de alcance, 2) grupo de treino social (grupo controle). Os lactentes foram submetidos à três avaliações (cinemática e qualitativa) na postura reclinada a 45° (até 5 dias após aquisição do alcance): 1) pré-treino, antes da primeira sessão de treino; 2) pós-treino 1, após a primeira sessão de treino, no mesmo dia e; 3) póstreino 2: após a terceira sessão de treino, no dia seguinte ao pré- e pós-treino 1. Para realizar o treino de alcance e o treino social, os lactentes foram submetidos à três sessões, uma realizada no primeiro dia, e duas realizadas no segundo dia. Todos os lactentes foram posicionados no colo do pesquisador em reclinado a aproximadamente 45°. O grupo de treino de alcance recebeu 3 atividades de interação com objeto em condição de prática variada seriada (ex: ABC, ABC, ABC) em cada sessão e o grupo treino social não recebeu estímulos em seus membros superiores em cada sessão. Foram consideradas variáveis de caracterização da amostra, frequência total de alcances, ajustes distais (orientação, abertura e superfície de contato das mãos) e variáveis espaço-temporais (duração do movimento, velocidade média, índice de retidão, índice de desaceleração e unidades de movimento). Na Parte II, realizou-se um revisão da literatura existente sobre: o comportamento do alcance em lactentes com desenvolvimento neurossensoriomotor típico, nascidos prematuros e com PC de 0 a 2 anos de idade; as principais técnicas de avaliação do alcance; os modelos de protocolos de treino de alcance, de efeitos imediatos e de curto prazo, desenvolvidos com lactentes a termo e pré-termos e; formas de como ajustar treinos de alcance para crianças com PC na prática clínica. Resultados: Para Parte I, uma sessão de treino foi eficaz em aumentar o número de alcances e a porcentagem de alcances com mão orientada ventralmente e diminuir a porcentagem de alcances com a mão fechada e dorsal. Além disso, três sessões de treino resultaram em mudanças nas variáveis espaço-temporais (alcances com menor duração e mais fluentes) e maior porcentagem de alcances com a mão orientada verticalmente. Para a Parte II, destaca-se a importância de traçar objetivos imediatos, de curto, médio e longo prazo, planejando as condutas terapêuticas de forma direcionada aos objetivos. Além de utilizar e adaptar os protocolos de treino (efeitos imediatos e de curto prazo) existentes para intervir em bebês com risco e/ou diagnóstico estabelecido de PC, entre outras alterações neurossensoriomotoras. Conclusões: Sessões de curta duração em condição de prática variada seriada foram efetivas em aprimorar o desempenho do alcance, como mudanças no número de alcances, nos ajustes distais e nas variáveis espaço-temporais do alcance. Esses resultados refletem a flexibilidade do desenvolvimento de habilidades percepto-motoras e o importante papel da experiência no aprimoramento do comportamento motor de lactentes. Além disso, direcionar as intervenções aos objetivos funcionais e; utilizar e adaptar os protocolos de treino existentes, podem fornecer à profissionais mais uma ferramenta para intervir em bebês com risco e/ou diagnóstico estabelecido de PC.

A fisioterapia respiratória vem merecendo especial atenção por parte dos pesquisadores, em virtude de seu crescente aumento nos últimos anos. Entretanto, o conceito de que a fisioterapia respiratória além de ser benéfica, não apresenta efeitos deletérios para o recém-nascido (RN) ainda não é consenso. O objetivo deste estudo foi avaliar as repercussões da fisioterapia respiratória sobre a função cárdio-pulmonar em recém-nascidos pré-termo (RNPT) submetidos à ventilação mecânica. Realizou-se, então, um estudo prospectivo, incluindo RNPT com peso de nascimento inferior a 1500 gramas, submetidos à ventilação mecânica durante a primeira semana de vida. Os RN foram divididos em 2 grupos conforme o peso de nascimento: grupo MBP: peso entre 1000 e 1499 gramas e, grupo MMBP: peso inferior a 999 gramas. Foram excluídas as malformações congênitas graves, as síndromes genéticas e as situações clínicas em que a fisioterapia respiratória estava contra-indicada. A fisioterapia foi iniciada após a estabilidade clínica do RN, compreendendo o posicionamento, a vibração manual, os exercícios respiratórios e a aspiração endotraqueal. O estudo consistiu na determinação dos valores da freqüência cardíaca (FC-bpm), da saturação de oxigênio (SatO2 -%), da freqüência respiratória (FR-rpm) e da pressão arterial sistêmica (PA-mmHg), coletados entre o 3o e o 7o dia de vida, em 5 momentos diferentes: antes dos procedimentos de fisioterapia respiratória (T0), imediatamente após (T1), 5 minutos após os procedimentos fisioterapêuticos (T2), imediatamente após a aspiração endotraqueal (T3) e 5 minutos após a aspiração (T4). A análise dos resultados foi realizada através dos testes t- Student e medidas repetidas ANOVA one-way, sendo considerado diferença p<0,05. Foram estudados 21RNPT no grupo MBP e, 21 RNPT no grupo MMBP. Na população estudada as freqüências cardíaca e respiratória, a saturação de oxigênio e a pressão arterial sistêmica (sistólica, diastólica e média) permaneceram dentro dos valores fisiológicos após os procedimentos fisioterapêuticos e de aspiração endotraqueal, embora tenham havido algumas diferenças significativas. O procedimento de aspiração endotraqueal teve maior influência na função cárdiopulmonar do que os procedimentos fisioterapêuticos, sugerindo ser a aspiração um fator determinante das repercussões deletérias da função cárdio-pulmonar em RNPT, devendo ser empregada cautelosamente.
Respiratory physiotherapy has deserved special attention of the researchers due to its increasing practice. However, the concept that besides being effective, the respiratory physiotherapy brings no deleterious effects to the newborn (NB) is not a consensus yet. This study aims to evaluate the repercussions of respiratory physiotherapy on the cardiopulmonary function of preterm newborns (PTNB), subjected to mechanical ventilation. A prospective study was carried out, including PTNB of birth weight lower than 1500g subjected to mechanical ventilation along their first week of life. The NIs were divided into 2 groups, according to their birth weight: VLBW group: weight between 1000 and 1499g and VVLBW group, birth weight lower that 999g. The severe congenital malformations, the genetic syndromes and the clinical situations where the respiratory physiotherapy was not-advisable, were excluded. Physiotherapy was started after the NI?s clinical stability, including positioning, manual vibration, respiratory exercises and endotracheal aspiration.This study consisted of the determination of the heart rate values (HR-bpm), the oxygen saturation (SatO2 -%), of the respiratory frequency (RF-bpm) and of the systemic arterial pressure (SAP-mmHg), collected between the third and the seventh days of the infant?s life in five different moments: before the procedures of respiratory physiotherapy (T0), immediately after (T1), five minutes after the physiotherapeutic procedures (T2), immediately after the endotracheal aspiration (T3) and five minutes after aspiration (T4). The analysis of the results was carried out by means of t-Student?s tests and one-way ANOVA repeated measures, being considered a difference of p<0.05. 21 PTNB in group VLBW and 21 PTNB in group VVLBW have been studied. In the studied population, the heart rate and respiratory frequencies, the oxygen saturation and the systemic arterial pressure (systolic, diastolic and mean) remained within the physiological values after the physiotherapeutic procedures and endotracheal aspiration, though there have been some significant differences. The endotracheal aspiration procedure has shown more influence on the cardiopulmonary function than the physiotherapeutic procedures, suggesting that aspiration is a determining factor of the deleterious repercussions on the cardiopulmonary function of PTNB, therefore, having to be used cautiously

Background: Physiotherapy is the standard primary intervention for infants with torticollis, which is a common reason for consultation in pediatric settings. However, the wide variation of intervention strategies and intensities proposed reflects the lack of clear understanding of these infants' needs. Objective: To identify factors influencing decision making regarding intervention needs for infants with postural and congenital muscular torticollis. Methods: Pediatricians' perspectives were gained through open-ended questionnaires, and physiotherapists' perspectives through focus groups and a national survey. Factors were identified and mapped to the International Classification of Functioning, Disability, and Health-Children and Youth (ICF-CY). Results: All infants presenting with torticollis are thought to require intervention. Factors influencing the determination of intervention needs encompass all ICF-CY domains. Environmental factors represent an important proportion, supporting the importance of family-centered services. Conclusion: Recommendations for assessment are presented and could guide decision making of therapists in providing optimal care for infants with torticollis.
Contexte: La variabilité des paramètres d'intervention en physiothérapie pour les enfants ayant un torticolis proposés dans la littérature reflète le manque de compréhension des besoins de cette population. Objectif: Identifier les facteurs influençant le raisonnement clinique permettant de déterminer les besoins d'intervention des enfants ayant un torticolis postural ou congénital. Méthode: La perspective des pédiatres (questionnaires qualitatifs) et la perspective des physiothérapeutes (groupes de discussion, sondage) ont permis d'identifier les facteurs influençant le raisonnement et les codes correspondants de la Classification Internationale du Fonctionnement, du Handicap et de la Santé –Enfants et Jeunesse(CIF-EJ). Résultats: Les facteurs influençant le raisonnement clinique rassemblent des éléments de tous les domaines de la CIF-EJ, avec une emphase importante sur les facteurs environnementaux, supportant l'importance des services centrés sur la famille. Conclusion: Des recommandations pour l'évaluation de cette clientèle sont présentées afin de guider le raisonnement clinique des thérapeutes dans le choix d'une intervention optimale.

Purpose: To describe behavior of children with periventricular brain injury (PBI) in a tethered-kicking intervention. Methods: Sixteen infants with PBI were randomly assigned to exercise or no-training in a longitudinal pilot study. Frequencies of leg movements and interlimb coordination were described from videos at 2 and 4 months' corrected age (CA). Results: Eight of the 13 children (62%) with longitudinal data increased the frequency of leg movements while tethered to a mobile between 2 and 4 months' CA. Movement frequency was correlated with scores on the Test of Infant Motor Performance, but no differences between experimental groups were found. Children with typical development at 12 months' CA increased the proportion of leg movements that were synchronous between 2 and 4 months, as did a child with cerebral palsy in the experimental group. Conclusions: The tethered-kicking intervention facilitates movement in infants with PBI, but effects on development remain to be demonstrated.

During the first months of age the child is able to better regenerate what has been impaired. Following the phenomenon of integrity of motion and psychics, a method of neurodevelopment therapy (NDT), which helps to treat disordered motion, has been created and successfully applied around the world. In this work a hypothesis was made that if kinesitherapy application is started as early as possible in the infantry, there are better possibilities for the development of disordered motion of infants to reach the level of chronological age development. The aim of the work is to evaluate the effect of kinesitherapy on development of infants’ motion in different periods of infantry. 104 infants, who were brought to Early Rehabilitation Service, were randomly selected. 53 infants constituted the first group (who have started to have kinesitherapy procedures before 4 months of age) and the second group involved 51 infant (who have started to have kinesitherapy procedures being older than 4 months). The following methods were applied in the research: analysis of infants’ anamnesis; evaluation of motion development; mathematical statistics. The research was carried out in Children Clinic of Siauliai Hospital. Each infant was having two kinesitherapy procedures per week for two months. Development of infants was assessed using the method of Munich Functional Development Diagnostics before kinesitherapy procedures and after them (after 2 months). In kinesitherapy procedures the method... [to full text]

In Part 2 of this 2 part sequence, use of abstinence assessment tools to rate NAS scores will be discussed to guide understanding of withdrawal symptoms commonly observed. Abstinence tools will be compared and contrasted against infant assessments commonly used by therapist to guide neurodevelopmental implications of symptoms. Guided by NAS assessments non-pharmological management will be addressed including environmental adaptations, state regulation, rest and sleep (use of swaddling, nonnutritive sucking, rocking, positioning), feeding (formula and breastfeeding). Applied examples of the therapist role in NICU along with treatment interventions for infants and their families will be discussed. Once the caregivers within the NICU are better to understand the scope of the problem, this knowledge will translate into improved developmentally supportive and age appropriate care. A through understanding of infants with NAS and their families will lead to more responsive care for their infants during and after their hospital stay.

Philosophiae Doctor - PhD
The aim of this study was to prospectively, evaluate the effectiveness of an individually designed home-based physical activity programme in combination with massage therapy, on motor and cognitive development in children infected with HIV. This study used a randomized controlled trial design. One hundred and twenty-eight infants and toddlers (children) were recruited between March 2010 and September 2010 and randomly allocated to receive either an individually designed home-based physical activity programme in combination with massage therapy or standard treatment and massage on a 1:1 ratio. Motor and cognitive development was measured using the Bayley Scales of Infant Development third edition (Bayley-III)

El TDAH és un trastorn del neurodesenvolupament amb dèficit d’atenció, hiperactivitat, impulsivitat, autorregulació emocional alterada i problemes motors. Trets somàtics com hipermobilitat-articular, disautonomia, somatologia i deteriorament funcional/psicosocial han evidenciat ser característics no incloent-se en el diagnòstic. Encara que la farmacoteràpia és el tractament d’elecció, s’han observat beneficis de tractaments no farmacològics, representant la Fisioteràpia una oportunitat en l’abordatge multidisciplinari. Els desequilibris autonòmics en patologies mentals proporcionen una oportunitat d’estudiar els efectes neurofisiològics fisioterapèutics, representant la variabilitat-freqüència-cardíaca (VFC) un marcador de l’activitat autonòmica, de l’autorregulació i de la malaltia psiquiàtrica. Objectius: Analitzar els efectes neurofisiològics a curt i mig/llarg termini de dos programes de teràpia-manual (TM) en un grup de nens amb TDAH, a partir de paràmetres domini temps/freqüència VFC. Analitzar la relació entre característiques somàtiques amb la resposta autonòmica. Analitzar i comparar l’eficàcia neuropsicològica de dos programes de TM a mig/llarg termini sobre símptomes nuclears TDAH, desenvolupament psicosocial, qualitat de vida, autopercepció de la salut i efectes secundaris metilfenidat. Analitzar la relació a mig/llarg termini entre la dimensió neurofisiològica-neuropsicològica-psicosocial per estudiar la influència dels canvis neurovegetatius sobre el comportament. Material i mètodes: Assaig clínic a doble cec en 48 nens/es amb TDAH, aleatoritzats en dos grups d’intervenció (GI). Ambdós grups reberen tractament multimodal i 4 sessions de dos programes de TM: massatge (GI1), TM-cranial (GI2). Variables: signes vitals, paràmetres domini temps/freqüència VFC, hipermobilitat-articular, somatotip, coordinació, control-motor, habilitats motores fines, efectes secundaris metilfenidat (dimensió-biològica). Dimensió-neuropsicològica: oposicionisme, inatenció, hiperactivitat, índex-TDAH, atenció selectiva, gravetat-millora. Dimensió-psicosocial: desenvolupament psicosocial, qualitat de vida, autopercepció salut. Resultats i Conclusions: Nivells basals d’hipermobilitat-articular, ectomòrfia, deteriorament psicomotor, afectació desenvolupament psicosocial, qualitat de vida, autopercepció salut i predomini simpàtic basal (afectació control vagal cardíac i pitjor autorregulació). El programa de TM-cranial, podria incloure’s en el maneig del TDAH, pels efectes sobre les habilitats motores i la seva acció autonòmica (desplaçament a predomini parasimpàtic). Va incrementar el control vagal cardíac i l’estat de relaxació, millorant l’autorregulació/autocontrol emocional. Els efectes de la TM-cranial van objectivar una correlació significativa entre la ràtio LF/HF, efectes secundaris metilfenidat i desenvolupament psicosocial. A mesura que VFC es desplaçava cap a un predomini parasimpàtic, van disminuir efectes secundaris metilfenidat i va augmentar la qualitat de vida. Ambdós programes mostraren efectes neuropsicològics sobre símptomes nuclears del TDAH a mig/llarg termini. La TM-cranial va mostrar efectes significatius a mig/llarg termini sobre la satisfacció-autoestima, benestar físic-emocional, participació familiar, resolució problemes i activitat física. Aquestes troballes confirmen que el programa de TM-cranial sembla exercir efectes sobre les funcions vagals, ja que les tècniques aplicades tingueren una influència directa/indirecta sobre el recorregut del nervi vague. L’avaluació dels trets somàtics i neurofisiològics s’hauria d’incloure en el diagnòstic, essent necessari un enfocament que combini psicofarmacologia, psicoteràpia i Fisioteràpia per tractar les manifestacions somàtiques i clíniques. La TM és una tècnica segura que pot reduir els efectes secundaris farmacològics millorant la simptomatologia, qualitat de vida, benestar físic-emocional i relacions interpersonals.
El TDAH es un trastorno del neurodesarrollo con déficit atencional, hiperactividad, impulsividad, autorregulación emocional alterada y problemas motores. Rasgos somáticos como hipermovilidad-articular, disautonomía, somatología y deterioro funcional/psicosocial han evidenciado ser característicos no incluyéndose en su diagnóstico. Aunque la farmacoterapia es el tratamiento de elección, se han observado beneficios de tratamientos no farmacológicos, representando la Fisioterapia una oportunidad en su abordaje multidisciplinar. Los desequilibrios autonómicos en patologías mentales brindan la oportunidad de estudiar los efectos neurofisiológicos fisioterapéuticos, representando la variabilidad-frecuencia-cardíaca (VFC) un marcador de la actividad autonómica, de la autorregulación y de la enfermedad psiquiátrica. Objetivos: Analizar los efectos neurofisiológicos a corto y medio/largo plazo de dos programas de terapia-manual (TM) en un grupo de niños con TDAH, a partir de parámetros dominio tiempo/frecuencia VFC. Analizar la relación entre características somáticas con la respuesta autonómica. Analizar-comparar la eficacia neuropsicológica de dos programas de TM a medio/largo plazo sobre síntomas nucleares del TDAH, desarrollo-psicosocial, calidad vida, autopercepción salud y efectos secundarios metilfenidato. Analizar la relación a medio/largo plazo entre la dimensión neurofisiológica-neuropsicológica-psicosocial para estudiar la influencia de los cambios neurovegetativos sobre el comportamiento. Material-métodos: Ensayo clínico a doble ciego en 48 niños/as con TDAH, aleatorizados en dos grupos intervención (GI). Ambos grupos recibieron tratamiento multimodal y 4 sesiones de dos programas de TM: masaje (GI1), TM-craneal (GI2). Variables: signos vitales, parámetros dominio tiempo/frecuencia VFC, hipermovilidad-articular, somatotipo, coordinación, control-motor, habilidades motoras finas, efectos secundarios metilfenidato (dimensión-biológica). Dimensión-neuropsicológica: oposicionismo, inatención, hiperactividad, índice-TDAH, atención selectiva, gravedad-mejoría. Dimensión-psicosocial: desarrollo-psicosocial, calidad vida, autopercepción salud. Resultados-Conclusiones: Niveles basales de hipermovilidad-articular, ectomorfia, deterioro-psicomotor, afectación desarrollo psicosocial, calidad vida, autopercepción salud, y predominio simpático basal (afectación control vagal cardíaco y peor autorregulación). El programa de TM-craneal, podría incluirse en el manejo del TDAH, por los efectos sobre habilidades motoras y su acción autonómica (desplazamiento a un predominio parasimpático). Incrementó control vagal cardíaco, aumentó el estado relajación, mejorando la autorregulación/autocontrol emocional. Los efectos de la TM-craneal objetivaron una correlación significativa entre la ratio LF/HF, efectos secundarios metilfenidato y desarrollo psicosocial. A medida que VFC se desplazaba a un predominio parasimpático, disminuyeron efectos secundarios metilfenidato y aumentó calidad de vida. Ambos programas mostraron efectos neuropsicológicos sobre síntomas nucleares del TDAH a medio/largo plazo. La TM-craneal mostró efectos significativos a medio/largo plazo sobre la satisfacción-autoestima, bienestar físico-emocional, participación familiar, resolución problemas y actividad física. Estos hallazgos confirman que el programa de TM-craneal parece ejercer efectos sobre las funciones vagales ya que las técnicas aplicadas tuvieron una influencia directa/indirecta sobre el recorrido del nervio vago. La evaluación de rasgos somáticos y neurofisiológicos debería incluirse en su diagnóstico, siendo necesario un enfoque que combine psicofarmacología, psicoterapia y Fisioterapia para tratar las manifestaciones somáticas y clínicas. La TM es una técnica segura que puede reducir los efectos secundarios farmacológicos mejorando la sintomatología, calidad vida, bienestar físico-emocional y relaciones interpersonales.
ADHD is a neurodevelopmental disorder with attention deficit, hyperactivity, impulsivity, poor emotional self-regulation and motor problems. It carries a psychosocial functional impairment that should be considered. Somatic features such as joint-hypermobility, dysautonomia and somatology have been shown to be characteristic, not being included in the diagnostic criteria. Although pharmacotherapy remains the treatment of choice, benefits of non-pharmacological treatments have been observed, representing Physiotherapy (PT) an opportunity in a multidisciplinary approach. Autonomic imbalances involved in mental pathologies provide an opportunity to study the neurophysiological effects of PT, representing heart-rate-variability (HRV) a marker of the autonomic activity, of self-regulation and psychiatric illness. Purpose: To analyze short, medium/long-term neurophysiological effects of two manual-therapy (MT) programs in a group of ADHD children, based on time/frequency domain parameters of HRV, and the relationship between somatic features with the autonomic response. To analyze-compare the neuropsychological efficacy of two MT programs in the medium/long-term, on the core symptoms of ADHD, on psychosocial development, quality of life, health self-perception and on methylphenidate side effects. The medium/long-term relationship between neurophysiological-neuropsychological-psychosocial dimensions was investigated to study the influence of neurovegetative changes on behavior. Material-methods: A double-blind, clinical trial was conducted in 48 children with ADHD randomized into two intervention groups (IG’s). Both groups received multimodal treatment and 4 sessions of two MT programs: a massage (IG1) or a manual cranial-therapy (MCT) program (IG2). Variables: vital signs, time/frequency domain HRV parameters, joint-hypermobility, somatotype, coordination, motor-control, fine motor skills, methylphenidate side effects (biological-dimension). Neuropsychological-dimension: oppositionism, inattention, hyperactivity, ADHD-index, selective attention, severity-improvement. Psychosocial-dimension: psychosocial development, quality of life, health self-perception. Results-Conclusions: Baseline levels of joint-hypermobility, ectomorphism, psychomotor-impairment, impairment of psychosocial development, of quality of life, of health self-perception and basal sympathetic activity (reflecting a worse cardiac vagal control and self-regulation). The MCT program may be included in the management of ADHD, due to the effects in motor skills and its autonomic action (parasympathetic predominance). It also increased cardiac vagal control and the state of relaxation, improving both emotional self-regulation and self-control. The effects of the MCT program revealed a significant interrelation between the LF/HF ratio, methylphenidate side effects and psychosocial development. As HRV moved towards a predominance of parasympathetic activity, methylphenidate side effects decreased and quality of life increased. Both programs showed significant neuropsychological effects on ADHD core symptoms in the medium/long-term. The MCT program showed significant effects in the medium/long-term on satisfaction and self-esteem, physical well-being, emotional, family participation, problem solving and physical activity. These findings support that the MCT program may exert effects on vagal functions since the applied techniques had a direct/indirect influence on the vagus nerve pathways. The evaluation of somatic and neurophysiological features should be included in the diagnosis process, requiring an approach, combining psychopharmacology, psychotherapy and Physiotherapy to treat the somatic and clinical manifestations. Manual-therapy is a safe technique which may reduce pharmacotherapy side effects, improving the symptomatology of this condition, quality of life, physical-emotional well-being and interpersonal relationships.

Although the relationship between increased anteversion and abnormal motor control in children with cerebral palsy is well documented there are no published studies that look at the possible links between motor control and femoral anteversion in children without neurological deficits. Children with intoeing gait are reported to be clumsy; but this clumsiness is usually ascribed to the gait angle. The aim of this study, therefore, is to explore the possible relationship between detorsion of the femur during growth and the development of hip posture and movement. Hip internal and external rotation are commonly used as a clinical measure of anteversion of the femur. In this study the range of hip internal and external rotation (as a clinical measure of anteversion) was related to performance of motor tasks requiring control of the posture and movement of the hip. If the degree of femoral anteversion is linked to the development of motor control, the next step would be to investigate the effectiveness of exercise programmes on the process of detorsion of the femur in children with excessive medial femoral torsion.

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A utilização de jogos e brincadeiras ocorre, com freqüência, nos atendimentos fisioterapêuticos de crianças, inclusive no estágio supervisionado realizado durante a formação acadêmica. O objetivo desse trabalho foi descrever a utilização de jogos e brincadeiras nos atendimentos fisioterapêuticos de crianças, realizados pelos estagiários. Foi realizado estudo descritivo, do tipo observacional, tendo como procedimentos de coleta de informações a observação sistemática e a anotação da evolução do prontuário. A observação sistemática, registrada por meio da filmagem, ocorreu em dois momentos: na primeira e na penúltima semana do estágio supervisionado. Os atendimentos observados foram realizados por seis acadêmicos do 4º ano do curso de graduação em Fisioterapia de uma instituição de ensino superior. As fitas de vídeo foram transcritas em um protocolo de observação, que continha critérios quanto ao recorte das cenas obtidas. Os recortes das cenas que apresentavam jogos e brincadeiras, durante o atendimento, foram submetidos à concordância intra e entre os observadores. As categorias e subcategorias de análise foram estabelecidas após assistir-se, diversas vezes, às cenas gravadas e de acordo com os objetivos do estudo. Posteriormente, foram submetidas à apreciação de juízes por meio de material elaborado. As categorias e subcategorias elaboradas permitiram a análise de cada ocorrência sob os vários aspectos envolvidos na prática da utilização de jogos e brincadeiras. As estagiárias observadas utilizaram os jogos e as brincadeiras na avaliação e no tratamento da criança, com o objetivo de alcançar as metas estabelecidas para o atendimento fisioterapêutico. A manifestação do lúdico no atendimento à criança apresentava caráter terapêutico. Os jogos e as brincadeiras, em sua grande maioria, eram... .
Plays and games are frequently used both at infant physical therapy sessions and at the supervised training period during academic education. The aim of this study was to describe the use of plays and games at infant physical therapy sessions carried out by trainees. A descriptive study, type observational, having systematic observation and the follow up of patient files as data collection procedures, was carried out. Systematic observation, through filming, took place in two occasions: during the first week and the week before the last at the supervised training period. The observed sessions were carried out by six senior students in the fourth year of Physical Therapy at a university. The recorded videotapes were transcribed using an observation protocol containing criteria to guide the cutting of recorded scenes. Cuts of scenes showing plays and games during sessions were submitted to intra- and inter-observers concordance. The categories and sub-categories of analysis were established after repeatedly watching the recorded scenes, and according to the aims of the study. Later, they were submitted to assessors for evaluation. These categories and sub-categories allowed for the analysis of each occurrence under the various aspects involved in using plays and games in physical therapy. The supervised trainees used plays and games for evaluation and treatment of children, aiming at reaching the goals established for the physical therapy sessions. The occurrence of playful activities during the sessions had a therapeutic character. Plays and games were mostly means to achieve the pre-established aims, differing from therapeutic playing. Main identified situations that led to the use of plays and games were: child unwillingness or refusal to receive treatment and the need of active performance from child. Several kinds of plays and games were observed... (Complete abstract, click electronic address below).

Orientador: Eduardo José Manzini
Banca: Sadao Omote
Banca: Lígia Maria Presumido Braccialli
Banca: Maria Amélia Almeida
Banca: Maria Luiza Emmel
Resumo: A utilização de jogos e brincadeiras ocorre, com freqüência, nos atendimentos fisioterapêuticos de crianças, inclusive no estágio supervisionado realizado durante a formação acadêmica. O objetivo desse trabalho foi descrever a utilização de jogos e brincadeiras nos atendimentos fisioterapêuticos de crianças, realizados pelos estagiários. Foi realizado estudo descritivo, do tipo observacional, tendo como procedimentos de coleta de informações a observação sistemática e a anotação da evolução do prontuário. A observação sistemática, registrada por meio da filmagem, ocorreu em dois momentos: na primeira e na penúltima semana do estágio supervisionado. Os atendimentos observados foram realizados por seis acadêmicos do 4º ano do curso de graduação em Fisioterapia de uma instituição de ensino superior. As fitas de vídeo foram transcritas em um protocolo de observação, que continha critérios quanto ao recorte das cenas obtidas. Os recortes das cenas que apresentavam jogos e brincadeiras, durante o atendimento, foram submetidos à concordância intra e entre os observadores. As categorias e subcategorias de análise foram estabelecidas após assistir-se, diversas vezes, às cenas gravadas e de acordo com os objetivos do estudo. Posteriormente, foram submetidas à apreciação de juízes por meio de material elaborado. As categorias e subcategorias elaboradas permitiram a análise de cada ocorrência sob os vários aspectos envolvidos na prática da utilização de jogos e brincadeiras. As estagiárias observadas utilizaram os jogos e as brincadeiras na avaliação e no tratamento da criança, com o objetivo de alcançar as metas estabelecidas para o atendimento fisioterapêutico. A manifestação do lúdico no atendimento à criança apresentava caráter terapêutico. Os jogos e as brincadeiras, em sua grande maioria, eram... (Resumo completo, clicar acesso eletrônico abaixo).
Abstract: Plays and games are frequently used both at infant physical therapy sessions and at the supervised training period during academic education. The aim of this study was to describe the use of plays and games at infant physical therapy sessions carried out by trainees. A descriptive study, type observational, having systematic observation and the follow up of patient files as data collection procedures, was carried out. Systematic observation, through filming, took place in two occasions: during the first week and the week before the last at the supervised training period. The observed sessions were carried out by six senior students in the fourth year of Physical Therapy at a university. The recorded videotapes were transcribed using an observation protocol containing criteria to guide the cutting of recorded scenes. Cuts of scenes showing plays and games during sessions were submitted to intra- and inter-observers concordance. The categories and sub-categories of analysis were established after repeatedly watching the recorded scenes, and according to the aims of the study. Later, they were submitted to assessors for evaluation. These categories and sub-categories allowed for the analysis of each occurrence under the various aspects involved in using plays and games in physical therapy. The supervised trainees used plays and games for evaluation and treatment of children, aiming at reaching the goals established for the physical therapy sessions. The occurrence of playful activities during the sessions had a therapeutic character. Plays and games were mostly means to achieve the pre-established aims, differing from therapeutic playing. Main identified situations that led to the use of plays and games were: child unwillingness or refusal to receive treatment and the need of active performance from child. Several kinds of plays and games were observed... (Complete abstract, click electronic address below).
Doutor

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Financiadora de Estudos e Projetos
Postural variations are common in childhood / adolescence and are corrected spontaneously. When maintained can cause overload. The objective of the first study was to evaluate the prevalence of postural variations in children / adolescents and to identify factors that explain these variations among age, gender, manual preference, body mass index (BMI) and physical activity, through multiple logistic regression analysis. 288 students were evaluated through postural observation. They were 59.4% female, mean age 10.6 (2.4) years, body mass 38.6 (12.7) kg and height 1.5 (0.1) m. Results show high prevalence of postural changes and their association with factors: age (forward head posture, shoulders and iliac crests asymmetry winged scapula), sex (winged scapula), BMI (forward head, iliac crest asymmetry, valgus knees and winged scapula) and not perform physical activity (valgus knees). Among the factors evaluated, obesity is a modifiable factor. Therefore, its association with the changes must be explored to facilitate the planning of preventive measures and more effective treatment. So, the objectives of the second study were to describe the prevalence of overweight in adolescents and identify differences in posture, (evaluated qualitatively and quantitatively) and the reporting of musculoskeletal pain (assessed by an adaptation of the Nordic Questionnaire) among normal weight and overweight in a large sample of students. 420 students were evaluated, 60% female, with mean age 11.1 (2.3) years, height 1.5 (0.1) m. body mass 44.5 (14.1) kg. Findings indicate that the prevalence of overweight was 36.2%. There was a higher prevalence of thoracic kyphosis, lumbar hyperlordosis and valgus knees with overweight students. There was no association between the presence of pain and weight excess. In childhood and adolescence, the posture lies in the development process. Therefore, any functional change to poor posture will reflect negatively in the future. So, the objective of the third study was to evaluate the effects of an exercise program of stretching and strengthening exercises in relation to posture, mobility of the spine and musculoskeletal pain in primary school children. Qualitative and quantitative postural evaluation of the trunk, pain and spine mobility (Whistance method) were collected before and after the intervention. The subjects were randomly assigned to groups. The exercise program was applied in groups, at school, twice weekly for eight weeks, for 50 minutes. The analysis included 78 subjects in the intervention group and 93 in the control, with mean age 11.6 (1.7) years, 1.5 (0.1) meters of height, 46.3 (14.1) kg of mass. It was also comprised of 67.3% female. The control group showed greater worsening percentage than intervention group to the posture of the shoulders. For the pain, the intervention group showed greater improvement percentage. These results show that the exercise program as described is effective in pain and posture of the shoulders. For other variables, adjustments in the duration of the program and individualized care may be recommended.
Variações posturais são frequentes na infância/adolescência e são corrigidas espontaneamente. Quando mantidas podem causar sobrecarga. O objetivo do primeiro estudo foi avaliar a prevalência de variações posturais em crianças/adolescentes e identificar fatores explicativos para estas variações, dentre: idade, sexo, dominância manual, índice de massa corporal (IMC) e atividade física, por meio da análise de regressão logística múltipla. Foram avaliados por meio de observação postural 288 escolares, sendo 59,4% do sexo feminino; idade média de 10,6 (2,4) anos, massa corporal 38,6 (12,7) kg e altura 1,5 (0,1) metros. Os resultados mostram altas prevalências de alterações posturais e sua associação com os fatores avaliados: idade (anteriorização da cabeça, assimetria entre os ombros e cristas ilíacas e escápulas aladas), sexo (escápulas aladas), IMC (anteriorização da cabeça, elevação da crista, joelhos valgos e escápulas aladas) e não realização de atividade física (joelhos valgos). Dentre os fatores avaliados, a obesidade é um fator modificável. Portanto, sua associação com as alterações deve ser explorada para propiciar o planejamento de medidas preventivas e de tratamento mais eficazes. Nesse sentido, os objetivos do segundo estudo foram: descrever a prevalência de excesso de peso em escolares, e identificar diferenças na postura, avaliada de forma qualitativa e quantitativa, e no relato de dor musculoesquelética (avaliada por uma adaptação do Questionário Nórdico) entre sujeitos eutróficos e com excesso de peso em uma ampla amostra de escolares. Foram avaliados 420 escolares, sendo 60% do sexo feminino, com médias de idade 11,1(2,3) anos; altura 1,5(0,1) metros e massa corporal 44,5(14,1) kg. A prevalência de excesso de peso foi 36,2%. Houve maior prevalência de hipercifose torácica, hiperlordose lombar e joelhos valgos entre os estudantes com excesso de peso. Não houve associação entre a presença de dor e o excesso de peso. Como na infância e adolescência a postura encontra-se em processo de desenvolvimento, qualquer alteração funcional conseguinte à má postura irá repercutir negativamente no futuro. Portanto, o objetivo do terceiro estudo foi avaliar os efeitos de um programa de exercícios de alongamento e fortalecimento muscular em relação à postura do tronco, mobilidade da coluna vertebral e dor musculoesquelética em estudantes do ensino fundamental. Avaliação postural qualitativa e quantitativa (SAPo), dor e mobilidade da coluna (método de Whistance) foram coletados antes e após a intervenção. Os sujeitos foram aleatoriamente alocados nos grupos. O programa de exercícios foi aplicado em grupo, no ambiente escolar, duas vezes por semana por oito semanas, durante 50 minutos. A análise contou com 78 sujeitos no grupo intervenção e 93 no controle, com médias de idade 11,6(1,7) anos, 1,5(0,1) metros de altura, 46,3(14,1) quilogramas de massa. Era também constituída de 67,3% do sexo feminino. O grupo controle apresentou porcentagem de piora maior que o grupo intervenção para a postura dos ombros. Para a presença de dor, o grupo intervenção apresentou maior porcentagem de melhora. Esses resultados mostram que o programa de exercícios como descrito tem efeito na a dor e na postura dos ombros. Para as outras variáveis, ajustes na duração do programa e atendimento individualizado podem ser recomendados.

by Ivor Wong (Nga Chung).
Thesis (M.Phil.)--Chinese University of Hong Kong, 1998.
Includes bibliographical references (leaves 114-120).
Abstract also in Chinese.
Chapter PART I --- INTRODUCTION
Chapter 1. --- CHAPTER 1 BACKGROUND --- p.2
Chapter 1.1 --- Objectives --- p.3
Chapter 1.2 --- Effects of chest physiotherapy --- p.3
Chapter 1.2.1 --- Aims of chest physiotherapy --- p.4
Chapter 1.2.1.1 --- Mucus Removal --- p.4
Chapter 1.2.1.2 --- Re-expansion of atelectatic lung --- p.9
Chapter 1.2.2 --- Chest physiotherapy for neonates --- p.10
Chapter 1.2.2.1 --- Pulmonary characteristics in neonates --- p.10
Chapter 1.2.3 --- Chest physiotherapy for infants on mcchanical ventilation --- p.12
Chapter 1.2.3.1 --- Conventional ventilation --- p.12
Chapter 1.2.3.2 --- High frequency ventilation --- p.13
Chapter 2. --- CHAPTER 2 NEONATAL CHEST PHYSIOTHERAPY --- p.15
Chapter 2.1 --- Traditional physiotherapy means --- p.15
Chapter 2.1.1 --- Percussion and Chest vibration --- p.15
Chapter 2.1.2 --- Cup percussion (Cupping) --- p.16
Chapter 2.1.3 --- Postural drainage (PD) --- p.16
Chapter 2.1.4 --- Endotracheal Suctioning --- p.17
Chapter 2.1.4.1 --- Adverse effects of endotracheal suctioning --- p.17
Chapter 2.2 --- Possible Complications of chest physiotherapy --- p.20
Chapter 2.2.1 --- Haemodynamic disturbances --- p.20
Chapter 2.2.2 --- Fluctuation of Cerebral Perfusion --- p.21
Chapter 2.2.3 --- Cystic brain lesions --- p.22
Chapter 2.3 --- Modified manual techniques --- p.23
Chapter 2.3.1 --- Theoretical model of lung squeezing technique --- p.23
Chapter 2.3.2 --- Lung squeezing technique as a volume recruitment manoeuvre --- p.30
Chapter 2.3.2.1 --- Squeezing phase of lung squeezing technique --- p.30
Chapter 2.3.2.2 --- Release phase of lung squeezing technique --- p.31
Chapter 3. --- CHAPTER 3 PHYSIOTHERAPY PRACTICE IN LOCAL NEONATAL ICU --- p.33
Chapter 3.1 --- Current physiotherapy practice in Hong Kong Neonatal ICU settings --- p.33
Chapter 3.1.1 --- Endotracheal suctioning protocol in Prince of Wales Hospital --- p.33
Chapter 3.1.1.1 --- Suctioning Procedures --- p.34
PART II MAIN STUDY
Chapter 4. --- CHAPTER 4 RESEARCH DESIGN --- p.37
Chapter 4.1 --- Ethics --- p.37
Chapter 4.2 --- Methods --- p.37
Chapter 4.2.1 --- Pilot study --- p.37
Chapter 4.2.2 --- Main study --- p.39
Chapter 4.2.2.1 --- Hypothesis --- p.39
Chapter 4.2.2.2 --- Study Design --- p.39
Chapter 4.3 --- Methodology --- p.44
Chapter 4.3.1 --- Treatment protocol --- p.44
Chapter 4.3.1.1 --- Experimental Group protocol --- p.44
Chapter 4.3.1.2 --- Control Group protocol --- p.44
Chapter 4.3.2 --- Outcome Measure --- p.45
Chapter 4.3.2.1 --- Chest X-ray --- p.45
Chapter 4.3.2.2 --- Other Measurements --- p.45
Chapter 4.3.3 --- Statistics --- p.48
Chapter 5. --- CHAPTER 5 RESULTS --- p.50
Chapter 5.2 --- Demographic Data --- p.50
Chapter 5.3 --- Resolution of lung atelectasis --- p.56
Chapter 5.3.1 --- Distribution of lung atelectasis --- p.56
Chapter 5.3.2 --- First re-expansion of lung atelectasis --- p.59
Chapter 5.3.3 --- Complete resolution of lung atelectasis --- p.62
Chapter 5.3.3.1 --- Sites of rccurrencc of lung atelectasis --- p.65
Chapter 5.4 --- Factors correlated with number of treatment sessions required to attain resolution of atelectasis --- p.68
Chapter 5.5 --- Ventilator parameters changes --- p.73
Chapter 5.6 --- Haemodynamic changes --- p.75
Chapter 5.7 --- Arterial blood gas --- p.78
Chapter 5.8 --- Other clinical outcome --- p.80
Chapter 5.8.1 --- Bronchopulmonary dysplasia --- p.80
Chapter 5.8.2 --- Intra-ventricular haemorrhage (IVH) --- p.82
Chapter 5.8.3 --- Mortality rate --- p.86
Chapter PART III --- EFFECTS OF LUNG SQUEEZING TECHNIQUE ON LUNG MECHANICS
Chapter 6. --- CHAPTER 6 LUNG MECHANICS STUDY FOR NEONATES --- p.88
Chapter 6.1 --- Methods --- p.91
Chapter 6.1.1 --- Statistical Analysis --- p.93
Chapter 6.2 --- Results --- p.94
Chapter PART IV --- DISCUSSION AND CONCLUSION
Chapter 7. --- CHAPTER 7 SUMMARY AND CONCLUSION --- p.105
Chapter PART V --- REFERENCE
Chapter 8. --- BIBLIOGRAPHY --- p.114
Chapter PART VI --- GLOSSARY
Chapter PART VII --- APPENDICES

by Emil, Chiu Hong Man.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1993.
Includes bibliographical references (leaves 108-118).
Acknowledgment --- p.6
List of Abbreviations --- p.7
Summary --- p.8
Chapter Chapter 1 --- Childhood Asthma - An Overview --- p.10
Chapter 1.1 --- Definition of childhood asthma --- p.10
Chapter 1.2 --- Basic Pathophysiology of Asthma --- p.11
Chapter 1.2.1 --- Airway obstruction --- p.11
Chapter 1.2.2 --- Airway inflammation --- p.11
Chapter 1.2.3 --- Bronchial hyperresponsiveness --- p.12
Chapter 1.2.4 --- Trigger factors of asthma --- p.12
Chapter 1.3 --- Measurement of the severity of asthma --- p.14
Chapter 1.3.1 --- Obj ective measures of lung function --- p.14
Chapter 1.3.2 --- Measures of bronchial hyperresponsiveness --- p.15
Chapter 1.3.3 --- Clinical measures --- p.16
Chapter 1.4 --- Epidemiology --- p.16
Chapter 1.5 --- Treatment of asthma --- p.19
Chapter 1.5.1 --- Pharmacological treatment --- p.19
Chapter 1.5.2 --- Non-pharmacological treatment --- p.20
Chapter 1.5.3 --- Behavioral Intervention --- p.24
Chapter 1.5.4 --- Summary of treatment of asthma --- p.28
Chapter Chapter 2 --- Change in Lung Mechanic During Asthmatic Attack --- p.29
Chapter 2.1 --- Asthmatic Attack --- p.29
Chapter 2.2 --- Hyperinflation of the lungs during asthmatic attack --- p.30
Chapter 2.3 --- Effect of hyperinflation on respiratory muscle function --- p.32
Chapter Chapter 3 --- Biofeedback Intervention --- p.36
Chapter 3.1 --- Background --- p.36
Chapter 3.2 --- Definition of biofeedback --- p.36
Chapter 3.3 --- Biofeedback as an adjunctive treatment to asthma --- p.37
Chapter 3.3.1 --- Direct airways biofeedback --- p.38
Chapter 3.3.2 --- Muscle EMG biofeedback --- p.41
Chapter 3.4 --- Justification of study --- p.45
Chapter Chapter 4 --- Material and Methods --- p.47
Chapter 4.1 --- Study design and patients recruitment --- p.47
Chapter 4.2 --- Equipment and measurement --- p.49
Chapter 4.2.1 --- Biofeedback unit and the computer system --- p.49
Chapter 4.2.2 --- Mini Wright flow meter --- p.50
Chapter 4.2.3 --- Clinical measures --- p.50
Chapter 4.2.4 --- Bronchial provocation test --- p.51
Chapter 4.3 --- Biofeedback training --- p.53
Chapter 4.3.1 --- Preparation of the patient --- p.53
Chapter 4.3.2 --- Training Procedures --- p.54
Chapter 4.3.3 --- Criteria for successful training --- p.55
Chapter 4.4 --- Statistical methods --- p.56
Chapter Chapter 5 --- Results --- p.58
Chapter 5.1 --- Immediate training effects --- p.58
Chapter 5.1.1 --- Comparison between the successful group and the fail group --- p.59
Chapter 5.1.2 --- Combining successful and fail groups as the training group --- p.63
Chapter 5.2 --- One year follow-up --- p.65
Chapter 5.2.1 --- Social and clinical characteristics of both training and control group --- p.65
Chapter 5.2.2 --- Clinical characteristic --- p.66
Chapter 5.2.3 --- Attack rate --- p.66
Chapter 5.2.4 --- The Fscore --- p.67
Chapter 5.2.5 --- Score --- p.67
Chapter 5.2.6 --- Mscore --- p.68
Chapter 5.2.7 --- Bronchial hyperresponsiveness --- p.68
Chapter 5.2.8 --- Lung functions --- p.69
Chapter Chapter 6 --- Discussion --- p.95
Chapter 6.1 --- Physiological effects --- p.95
Chapter 6.1.1 --- EMG --- p.96
Chapter 6.1.2 --- Pulse rate and skin temperature --- p.97
Chapter 6.1.3 --- Lung functions --- p.97
Chapter 6.2 --- Clinical outcomes --- p.100
Chapter 6.2.1 --- Attack rate and symptom --- p.100
Chapter 6.3 --- Clinical implication of study --- p.101
Chapter 6.4 --- Limitation and difficulties --- p.103
Chapter 6.5 --- Suggestions for further study --- p.104
Chapter Chapter 7 --- Conclusions --- p.105
References --- p.108
Appendix1 --- p.119
Appendix2 --- p.120
List of Figures --- p.122
List of Tables --- p.124

Piaget (1953) believed object permanence emerges through a series of stages at approximately 18-months. Contemporary researchers have suggested infants achieve object permanence by 3.5-months. A series of studies by Baillargeon (1987) utilized a violation-of-expectation paradigm habituating infants to a paddle moving 180$\sp\circ$. During test trials, a block was positioned in the path of the paddle. During "possible" trials, the paddle moved 120$\sp\circ$, stopped at the block and returned. During the "impossible" trials, the paddle moved 180$\sp\circ$, seemingly through the block. Infants looked longer at the impossible events suggesting an understanding that one object cannot occupy the space of another object contiguously. Looking times could not be explained by detecting perceptual novelty because the impossible event was the more familiar of the test events. Hunter and Ames (1988) have demonstrated that infants look longer at familiar stimuli if they have not thoroughly encoded habituation stimuli. These researchers believed that habituation is a function of time, age, and task difficulty. The current research examines the possibility that infants look longer at impossible events because these events are perceptually familiar. To test whether infants had sufficient opportunity to encode habituation events using the moving paddle paradigm, the number of habituation trials and infants' age were manipulated. Four-month-olds who received 7-180$\sp\circ$ habituation trials looked longer at the 180$\sp\circ$ test event (a significant familiarity preference). Four-month-olds receiving 7-112$\sp\circ$ habituation trials looked longer at the 112$\sp\circ$ test event (a significant familiarity preference). Four-month-olds receiving 12-180$\sp\circ$ habituation events looked significantly longer at the 112$\sp\circ$ test event (a significant novelty preference). A group of 6-month-olds habituated to 7-180$\sp\circ$ trials showed no preterential looking during the test trials. For the four-month-olds, looking times during the test trials were a function of the type of familiarity event and whether there were enough trials to fully encode the habituation events. Looking time was not necessarily a function of an inferred violation of physics. Performance on the moving paddle paradigm might be more easily explained by perceptual mechanisms.

Cystic fibrosis is an inherited pathological condition which can be treated but not cured and is ultimately life threatening. Those affected by cystic fibrosis require daily treatment to minimize the symptoms of the illness and retard the progression of pulmonary deterioration. An important component of the prophylactic therapy regime is chest physiotherapy which enhances the clearance of lung secretions. However, chest physiotherapy is time consuming and not always enjoyable, particularly for infants and toddlers. This study utilized an independent and repeated measures design to evaluate the effect of recorded music as an adjunct to daily routine chest physiotherapy on children's enjoyment, caregivers' enjoyment and caregivers' perception of time taken to complete the routine. Participants were caregivers of one or more children with cystic fibrosis who were aged between 4½ months and 24 months at the commencement of the clinical trial and required chest physiotherapy on a daily basis.
The children's cystic fibrosis care was managed by the Department of Thoracic Medicine at the Royal Children's Hospital in Victoria. Participants were randomly allocated into treatment and control groups and were involved in the study for 12 weeks. Participants in the treatment group were given the treatment tape: a specifically compiled music tape consisting of instrumental music and children's songs, newly composed for use as an adjunct to chest physiotherapy. Participants in the control group received no tape for the first 6 weeks, then received their choice from two commercially available, children's audiocassettes) both of which were familiar to the participants. Enjoyment and perception of time were assessed at the commencement of the trial and then twice more at 6-week intervals. After 6 weeks of using the treatment tape, children's and caregivers' enjoyment of chest physiotherapy increased significantly compared to no music. There was no change in perception of time taken to complete the chest physiotherapy after using the treatment tape. Use of the familiar music tape was not associated with significant increases in enjoyment for children or caregivers. Familiar music did not alter the perception of time taken to complete the routine. The results suggest that recorded music is an effective adjunct to daily chest physiotherapy which enhances caregivers' and children's enjoyment, particularly when that music is specifically compiled for use with the physiotherapy.