A research report submitted to the Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg, April 2017 / The study sought to compare the caregivers’ evaluation of the occupational performance and assistance needed by children with cerebral palsy (CP) to that of treating therapists to ascertain agreement about the children’s strengths/weaknesses so goals for intervention can be set. The Paediatric Evaluation of Disability Inventory (PEDI) parent/caregiver and therapist scores of 50 children with CP in Harare aged four to six and half years were analysed. The association between PEDI scores and the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels as well as the internal consistency of the PEDI for this sample were also determined. Correlations for the caregivers’ and therapists’ scores on the PEDI were strong to excellent. A marked decrease in functional skills on the PEDI was noted in relation to the GMFCS and MACS levels with a negative moderate correlation between the PEDI scores and the GMFCS levels for self care, a negative strong correlation for mobility but a negative weak correlation for social function. The similarity of scores indicates positive correlation that allows for collaborative goal setting and Family Centred Therapy with these children. Internal consistency was excellent for all functional skills domains and caregiver assistance. / MT2017

Made available in DSpace on 2019-03-30T00:02:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-12-18 / Cerebral palsy is a caused lesion in most cases due to lack of oxygenation of brain cells, occurring during the period of gestation, at birth or after birth, still in the child's brain maturation process (up to 3 years) directly affecting their motor skills. Many conventional treatments are considered in rehabilitation of these patients, oftentimes tiresome and onerous, causing disinterest in continuing the same. Order to make the more playful treatment, it is proposed in this paper the development of a game within a virtual environment, based on functions play, based on activities carried out in the Reabilitação Neuropsicomotora do Núcleo de Terapia Ocupacional program of the NAMI/UNIFOR. The integration between the child and the virtual environment occurs through hand motion sensor leap motion, and a sensor brainwave mindwave, optional, responsible for measuring the level of attention during the carrying out of an activity. To validate the proposed environment, eight specialists were subjected to application of a questionnaire considering that the alternative environment is extremely and / or very likely to be a promising tool for cognitive and motor rehabilitation and unlikely to cause risks and / or negatively influence on the development of the patient. Thus, it can be concluded that the model is an alternative tool, promising for the treatment rehabilitation children with cerebral palsy. Keywords: Virtual Reality. Cerebral palsy. Rehab. Motor limitations. Brain stimulation. Cognitive stimulation. Motor stimulation. Functional activities. / Paralisia cerebral é uma lesão provocada, na maioria dos casos, pela falta de oxigenação das células cerebrais, ocorrendo no período da gestação, no momento do parto ou após o nascimento, ainda no processo de amadurecimento do cérebro da criança (até 3 anos), afetando diretamente a sua parte motora. Diversos tratamentos convencionais são considerados na reabilitação destes pacientes, muitas vezes cansativos e onerosos, causando o desinteresse na continuidade do mesmo. Para tornar o tratamento mais lúdico, é proposto neste trabalho o desenvolvimento de um jogo em um ambiente virtual, baseado em brincadeiras funcionas, fundamentadas em atividades realizadas no programa Reabilitação Neuropsicomotora do Núcleo de Terapia Ocupacional do NAMI/UNIFOR. A integração entre a criança e o ambiente virtual ocorre através do sensor de movimento da mão leap motion, e um sensor de ondas cerebrais mindwave, opcional, responsável por mensurar o nível de atenção do durante realização de uma atividade. Para validar o ambiente proposto, oito especialistas foram submetidos a aplicação de um questionário, considerando que o ambiente alternativo é extremamente e/ou muito provável ser um ferramenta promissora para reabilitação cognitiva e motora, sendo pouco provável causar riscos e/ou influenciar negativamente no desenvolvimento do paciente. Desta forma, é possível concluir que o modelo proposto é uma ferramenta alternativa, bastante promissora, para o tratamento de reabilitação de crianças com Paralisia Cerebral. Palavras-chave: Realidade virtual. Paralisia cerebral. Reabilitação. Limitações motoras. Estimulação cerebral. Estimulação cognitiva. Estimulação motora. Atividades funcionais.

Made available in DSpace on 2019-03-30T00:12:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-10-20 / Introduction: Dysphagia is a common issue in patients with cerebrovascular accident (AVC), a leading cause of disability in adults and the third cause of death in the world. The access to speech therapy is limited in the context of health public services, delaying the recovering of these patients. Objective: To assess the impact of the weekly speech therapy on the rehabilitation of patients with dysphagia after AVC served by home care programs of the Hospital Geral de Fortaleza and the Hospital Geral Dr. Waldemar Alcântara. Methods: Open clinical trial, in which 24 patients were paired and randomly distributed in two groups: 14 in the control group (GC) and 10 in the intervention group (GI), including patients with dysphagia after stroke, receiving enteral nutrition and over 40 years old. The evaluation was accomplished through the Modified Rankin Scale (ERM), the Functional Oral Intake Scale (FOIS) and the Dysphagia Risk Evaluation Protocol (PARD). During 6 months follow-up, the GC patients received monthly the speech therapy according to the service routine. Meanwhile, the GI patients were submitted to weekly speech therapy also during the 6 months follow-up. The dysphagia clinical evaluation, the scales results and the possible nutrition tube weaning were evaluated. Results: The major of the subjects in the sample were women, around 60%, with mean age of 73 years old. From the GC 78,57% of patients presented ischemic stroke, while in the GI major of the patients (60%) presented hemorrhagic stroke. Dysphagia was present in 14 patients from the GC and 8 (80%) patients from the GI. In the GC the mean time of enteral nutrition was 18,5 months, and in the GI it was 10,5 months. After 6 months of speech therapy intervention the GI patients displayed significant differences from GC patients regarding the results of the FOIS (p=0,003 vs. 0,32, respectively) as well as in the reduction of the dysphagia degree (p=0,002 vs. 0,42). Conclusion: The results shown that the patients submitted to the weekly speech therapy presented, compared to the monthly therapy, greater chance to migrate from enteral to oral or mixed nutrition, suggesting thus a positive influence of a more frequent speech therapy on the treatment of dysphagia after AVC. Key words: Dysphagia, Cerebrovascular Accident, Home Care, Speech Therapy. / Introdução: Disfagia é uma complicação frequente em pacientes com Acidente Vascular Cerebral (AVC), considerado a principal causa de incapacidade em adultos e terceira causa de morte no mundo. O acesso à fonoterapia é restrito no âmbito do Sistema Único de Saúde, atrasando a recuperação destes pacientes. Objetivo: Avaliar o impacto da fonoterapia semanal na reabilitação de pacientes com disfagia pós-AVC atendidos pelos programas de atenção domiciliar do Hospital Geral de Fortaleza e do Hospital Geral Dr. Waldemar Alcântara. Metodologia: Ensaio clínico aberto, no qual 24 pacientes foram pareados e sorteados em dois grupos: 14 no grupo controle (GC) e 10 no grupo intervenção (GI), sendo incluídos pacientes com disfagia após AVC, com uso de dieta enteral e maiores de 40 anos. Foram utilizados para avaliação a Escala de Rankin Modificada (ERM), Escala Funcional de Ingestão Oral (FOIS) e o Protocolo de Avaliação de Risco para a Disfagia (PARD). Durante seis meses, os pacientes do GC foram avaliados e submetidos à fonoterapia mensal de acordo com a rotina do serviço. Os pacientes do GI realizaram fonoterapia semanal, por seis meses. Foram avaliados a evolução clínica da disfagia, os resultados das escalas e o possível desmame da sonda. Resultados: A amostra foi composta em sua maioria por mulheres, em torno de 60%, com média de idade de 73 anos. Dos pacientes do GC, 78,57% apresentou AVC do tipo Isquêmico, enquanto que no GI a maioria (60%) apresentou AVC hemorrágico. Dos 14 pacientes do GC, 12 (85,71%) apresentaram disfagia grave enquanto no GI foram 8 (80%). O tempo médio de alimentação enteral foi de 18,5 meses para os pacientes do GC e 10,5 meses para os pacientes do GI. Após seis meses de intervenção fonoaudiológica, os pacientes do GI apresentaram diferença significativa em relação aos pacientes do GC nos resultados da FOIS (p= 0,003 e 0,32 respectivamente) como também uma redução do grau de disfagia apresentado (p= 0,002 e 0,42). Conclusão: Através dos resultados deste estudo, verificou-se que os pacientes submetidos à intervenção fonoaudiológica semanal apresentaram maior chance, comparativamente ao grupo acompanhado mensalmente, de migrar da dieta enteral para as dietas mista e oral, sugerindo uma influência positiva da intervenção fonoaudiológica convencional mais frequente junto a estes pacientes. Palavras chave: Disfagia; Acidente Vascular Cerebral; Assistência Domiciliar; Fonoterapia.

Background Cerebral palsy has been identified as the most common, chronic childhood disability that causes appreciable motor deficit. Building the capacity of caregivers and improving children’s functional capacities through rehabilitation programs could reduce the physical and psychological burden imposed by the caregiving process. There is paucity of information about the experiences of caregivers of children with cerebral palsy in Ghana especially those who are not receiving any form of care. The purpose of this study was to explore the experiences and perception of caregivers living in rural communities. Methodology A descriptive phenomenological approach as proposed by Husserl was used to explore the experiences of 12 caregivers of children with cerebral palsy aged between 2 years 9 months to 14 years. The caregivers’ interviews were analysed using Colaizzi’s phenomenological method of data analysis framework. Findings Two main themes emerged from the narratives of the caregivers. The first theme ‘Developing personal beliefs to support the caregiving role’ revealed that caregivers developed religious and spiritual beliefs to interpret their children’s condition, perceive the standard of care and negatively their beliefs caused feeling of despair and sorrow. The second main theme ‘Demands that shaped the experience of caring’ revealed the demands included physical, financial and social demands. The essential structure of the phenomenon demonstrated the complex interaction of personal and environmental factors in harmony with the actual demands to influence the experiences of caregivers positively or negatively. Positively caregivers achieve coping, committed to caring, hope for the future and acceptance of the condition of their children. However negatively caregivers described the triggering factors of feeling of despair and sorrow as frustration, lack of understanding of the condition, felt stigmatised and perceived that the child was going through pain and suffering. Conclusion Caregivers derived strength from their religious and spiritual beliefs to balance the demands of caregiving. The new findings could be used as a basis for developing interventions to support caregivers, inform new strategies for rehabilitation care delivery and sensitisation of community members about inclusion of children with disabilities in the future.

The study explored the experiences of young adults who have a sibling with cerebral palsy living in Nairobi, Kenya in order to establish how they made sense out of the experience of growing up with a sibling with CP. The study used a qualitative approach with an Interpretative Phenomenological Analysis (IPA) whereby six participants all young adults aged between eighteen and twenty four years, were interviewed using semi-structured interviews. Data analysis was undertaken according to IPA guidelines. The findings generated four super ordinate themes namely: increased sense of reward, emotional impact, family relationships and public relations. The findings revealed that there was a direct impact on sense of psychological well-being both negatively and positively. On one hand, the young adults experienced feelings of stigma, fear about the future, anger and a sense of responsibility. While on the other hand they experienced personal growth in terms of a sense of personal development and some concrete rewards. In conclusion, the study demonstrated the potential for personal development in the group studied and made a contribution to understanding the disabling impact of society on the lives of sibling due to disability by association.

O uso de Derivação Ventricular Externa (DVE) é necessário para o tratamento de muitas doenças, como Traumatismo Cranioencefálico (TCE) e Hemorragia Subaracnoide (HSA). As meningites e ventriculites são complicações frequentes desse uso. Neste trabalho buscamos determinar sensibilidade, especificidade e ponto de corte para o Índice de Celularidade (IC) em pacientes com TCE, HSA e acidente vascular cerebral hemorrágico (AVCh). Nossa população de estudo foi composta por pacientes com diferentes doenças de base e poucos resultados de cultura de líquor positiva. Para diagnóstico das infecções foram utilizados os critérios do CDC. A análise global do IC mostrou uma área sob a curva de 0,982. O ponto de corte geral do IC com o valor de 2,9 tem uma sensibilidade de 95% e uma especificidade de 92,9%. Nos pacientes com HSA obtivemos uma área sob a curva de 1,0 com o IC de 2,7. A sensibilidade e especificidade foram de 100%. Também foi analisada a variação relativa do IC. Para esta análise, a área sob a curva foi de 0,882 e um aumento de 4,33 vezes no IC demonstrou ser indicativo de infecção (p=0,002), dados estes semelhantes aos da literatura. Também foi feito Heatmap do IC, mostrando que ele dificilmente volta ao normal em pacientes com meningite, mesmo após o tratamento. Logo, o IC mostrou-se valioso para diagnóstico de infecção e inadequado para o acompanhamento do tratamento. Esperamos utilizar em nossa instituição o novo ponto de corte proposto por este trabalho com o intuito de melhorar desfechos clínicos. / The use of an external ventricular drain (EVD) is required for the treatment of many diseases, such as traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH). Meningitis and ventriculitis are frequent complications arising from the use of EVD therapy. This study aimed to determine the sensitivity, specificity, and cutoff point for cellularity index (CI) in patients with TBI, SAH, and hemorrhagic stroke. Our study population consisted of patients with different underlying diseases and few culture-positive CSF samples. The diagnosis of infections was based on CDC criteria. Overall CI analysis showed an area under the curve (AUC) of 0.982. The cutoff of 2.9 for overall CI provided a sensitivity of 95% and a specificity of 92.9%. In patients with SAH, the AUC was 1.0 for a CI of 2.7; furthermore, sensitivity and specificity were 100%. The relative variation of the CI was also assessed. This analysis revealed an AUC of 0.882, and a 4.33-fold increase was found be indicative of infection (p=0.002), findings similar to those of the literature. Additionally, a heatmap analysis demonstrated that the CI is unlike to return to normal in patients with meningitis, even after treatment. Therefore, this index showed to be valuable for the diagnosis of infection, but was inadequate for monitoring treatment. We hope to use the new cutoff point proposed by this study in our institution to improve patient clinical outcomes.

El presente es un estudio descriptivo retrospectivo en el que se realiza una correlación clínico topográfica entre la localización de la Enfermedad Vascular Cerebral (EVC) Isquémica y la Capacidad funcional. Debido a que la EVC es un problema prioritario de salud y que en la actualidad es considerado como una enfermedad prevenible, una urgencia susceptible de tratamiento y que las discapacidades reflejadas en la Capacidad Funcional que provoca pueden ser reeducables. Se evaluaron 494 pacientes que acudieron al Programa de Hemiplejías del Departamento de Rehabilitación del HNGAI desde 1999 al 2001, incluyéndose a 56 que cumplían con los criterios establecidos , en los que se aplicó una ficha de recolección de datos, se revisaron sus informes de tomografía y se revisaron sus historias clínicas, además los resultados fueron analizados por el programa estadístico SPSS V. 10.0. Encontrándose que La localización más frecuente fue en parietal derecho (21.4%), que el mayor porcentaje de pacientes presentó dependencia parcial (82.1%) ,y que las discapacidades más afectadas fueron: para el uso de transporte público con 42.9% que no lo realiza y para subir escaleras con 17.9% que no lo realiza. Por todo lo cual se evidencia la necesidad de un adecuado esquema terapéutico que incluya rehabilitación temprana (desde las unidades de urgencia) pues no es suficiente salvar la vida de los pacientes , es también muy importante mejorar su calidad de vida. / Tesis de segunda especialidad

Cyberlink:Brainfingers is a human computer user interface that supports hands free computer access. This is especially valuable technology for disabled individuals who lack the motor skills necessary to use a keyboard and mouse easily. Over the course of two months, four students with cerebral palsy, a motor disorder, used Brainfingers to play a variety of spatial software. The primary aims were to see if use of Brainfingers with spatial software could improve the spatial motor abilities of students with cerebral palsy, as well as to assess any apparent behavioral changes. Two of the students showed a large increase in spatial abilities when assessed, and all students displayed improvement or no change in positive behavioral attributes. All students improved their control of Brainfingers over time, and expressed their desire to use Brainfingers in the future over other methods of accessing a computer. The implications of these results are discussed, as well as issues for further study.

Objetivo: Este trabajo tuvo por objetivo determinar las características asociadas a las disfagias neurogénicas en niños con Parálisis Cerebral Infantil del tipo espástica, atetósico y mixto. Método: Fueron evaluados 50 pacientes, siendo 30 espásticos, 10 atetósicos y 10 mixtos, con edades comprendidas entre 1 a 10 años del Hogar Clínica San Juan de Dios. Resultado: Se logró determinar que en los tres tipos de parálisis cerebral tuvieron alteración en la fase oral de la deglución, con perjuicio en el mecanismo de presión de la cavidad oral y en la preparación del bolo. La fase faríngea se mostró poco alterada, observándose mayor alteración en los tipos espástico y mixto, se determinó la presencia de tos antes del inicio de la fase faríngea como característica más frecuente, seguida del reflujo nasal como segunda característica más resaltante. Además en 2 de los pacientes se evidenciaron señales clínicas de aspiraciones. Algunos de los pacientes tuvieron alteración en el tiempo de inicio del reflejo de deglución o permanencia del alimento en la faringe. Conclusión: Fue posible concluir que la mayor dificultad del niño con parálisis cerebral es el control oral del alimento, independiente del tipo de parálisis cerebral. Además que la característica asociada a la disfagia faríngea, más común en los pacientes con parálisis cerebral es la presencia de tos antes del paso de la fase oral a la faríngea.

El presente es un estudio descriptivo retrospectivo en el que se realiza una correlación clínico topográfica entre la localización de la Enfermedad Vascular Cerebral (EVC) Isquémica y la Capacidad funcional. Debido a que la EVC es un problema prioritario de salud y que en la actualidad es considerado como una enfermedad prevenible, una urgencia susceptible de tratamiento y que las discapacidades reflejadas en la Capacidad Funcional que provoca pueden ser reeducables. Se evaluaron 494 pacientes que acudieron al Programa de Hemiplejías del Departamento de Rehabilitación del HNGAI desde 1999 al 2001, incluyéndose a 56 que cumplían con los criterios establecidos , en los que se aplicó una ficha de recolección de datos, se revisaron sus informes de tomografía y se revisaron sus historias clínicas, además los resultados fueron analizados por el programa estadístico SPSS V. 10.0. Encontrándose que La localización más frecuente fue en parietal derecho (21.4%), que el mayor porcentaje de pacientes presentó dependencia parcial (82.1%) ,y que las discapacidades más afectadas fueron: para el uso de transporte público con 42.9% que no lo realiza y para subir escaleras con 17.9% que no lo realiza. Por todo lo cual se evidencia la necesidad de un adecuado esquema terapéutico que incluya rehabilitación temprana (desde las unidades de urgencia) pues no es suficiente salvar la vida de los pacientes , es también muy importante mejorar su calidad de vida.