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      The use of orthoses in children with cerebral palsy: perception of caregivers Translated title: O uso de órteses em crianças com paralisia cerebral: percepção dos cuidadores

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          Abstract

          Abstract The orthoses can be used as an adjuvant in the rehabilitation of children with Cerebral Palsy(CP). Studies that investigate caretakers’ opinions over the use of the orthoses are fundamental, especially for propositions that aim to produce a positive impact on the use of orthoses by the children. This study’s objective was to identify the perception of caretakers of children with CP over the functionality, benefits, and satisfaction over the use of the orthoses. Eighteen caretakers of children with CP, who used upper and/or lower limb orthoses, participated in this study. The data was obtained with questionnaires with open and closed questions. Descriptive and quantitative analysis of the data was made. The results suggest that the satisfaction with the orthoses is linked to the consideration of the caretaker’s opinions during the period of prescription and confection of the orthoses; to the guidance provided by professional; to the noticed improvement of the range of movement of fingers and wrists and the increase of the child’s balance and confidence while walking. Disconsidering the caretaker’s opinions over the orthosis and the perception that the orthoses cause pain or discomfort contributed to the dissatisfaction and/or partial satisfaction of the caretakers. The results of this study may be useful for professionals from many areas of knowledge because they provide a basis to contribute for the efficacy of prescription and intervention by healthcare professionals, as well as elements that may help designers to make orthoses that fulfill the user’s expectations and so increase usability, comfort, and satisfaction.

          Translated abstract

          Resumo A órtese pode ser utilizada como adjuvante no tratamento de reabilitação de crianças com paralisia cerebral (PC). Estudos que investigam a opinião dos cuidadores em relação ao uso da órtese são de fundamental importância, especialmente para proposição de melhorias que visem impactar positivamente no seu uso pela criança. Objetivou-se neste estudo identificar a percepção de cuidadores de crianças com PC sobre a função, os benefícios e a satisfação com o uso das órteses. Participaram 18 cuidadores de crianças com PC usuárias de órteses de membros inferiores e/ou superiores. A coleta de dados foi feita por meio de questionário contendo questões abertas e fechadas. Realizou-se análise descritiva e quantitativa dos dados. Os resultados sugerem que a satisfação dos cuidadores se relacionava com o fato de terem sua opinião considerada durante o processo de prescrição e confecção das órteses; com as orientações fornecidas pelos profissionais; com os benefícios percebidos pela melhora na amplitude de movimento de punho e dedos e pela maior confiança e equilíbrio da criança ao andar. Desconsiderar a opinião sobre a órtese, a percepção de que a mesma causa dor e desconforto contribuíram para a insatisfação e/ou satisfação parcial dos cuidadores. Os resultados deste estudo podem ser úteis para profissionais de diferentes áreas do conhecimento, pois trazem subsídios que podem contribuir para a eficácia da prescrição e intervenção por parte dos profissionais da saúde, bem como elementos que podem colaborar para que profissionais do design projetem órteses que atendam aos requisitos do usuário com vistas a favorecer a usabilidade, conforto e satisfação.

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          Most cited references31

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          The epidemiology of cerebral palsy: incidence, impairments and risk factors.

          Describing the epidemiology of cerebral palsy (CP), its impairments and risk factors. Literature review 1965-2004. Search terms: Cerebral palsy, incidence, prevalence, impairments, risk factors. In the last 40 years the prevalence of CP has risen to well above 2.0 per 1000 life births. In this time span the proportion of low-birthweight infants rose, the proportion of diplegia decreased, while the proportion of hemiplegia increased. CP is more prevalent in more deprived socio-economic populations. The majority of people with CP have the spastic syndrome of which the diplegic group is the smallest. Dependent on the subgroup of CP, 25-80% have additional impairments. A large proportion has some kind of cognitive impairment; the prevalence varies with the type of CP and especially increases when epilepsy is present. Epilepsy is present in 20-40%; it is most common among the hemi- and tetraplegics. Sensibility of the hands is impaired in about half. Chronic pain is reported by more than a quarter of the adults. Up to 80% have at least some impairment of speech. Low visual acuity is reported in almost three-quarters of all children. Half of all children have gastrointestinal and feeding problems. Stunted growth occurs in a quarter, while under- or overweight problems are present in half of the children. Almost 70% of people with spastic CP have abnormal brain CT findings; abnormal cranial ultrasounds is most strongly associated with hemiplegia, normal cranial ultrasounds with diplegia. The most important risk factors for CP are low birthweight, intrauterine infections and multiple gestation.
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            Measuring Satisfaction with Amplification in Daily Life: the SADL scale.

            To develop a self-report inventory to quantify satisfaction with hearing aids. The inventory was developed in several stages. To determine the elements that are most important to satisfaction for most people, we conducted structured interviews and then designed a questionnaire. Hearing aid owners responded to the questionnaire, indicating the relative importance of 14 different elements in their hearing aid satisfaction. Analyses indicated that the elements could be placed into four importance content areas. Trial satisfaction items were designed for each content area and submitted to focus groups to identify highly salient items as well as ambiguous items. A 25-item satisfaction questionnaire then was developed and disseminated to hearing aid owners. Results were obtained from 257 individuals. These data were analyzed to generate the final questionnaire. Fifteen items, divided into four subscales, were selected for the final Satisfaction with Amplification in Daily Life (SADL) questionnaire. The questionnaire yields a Global satisfaction score and a profile of subscale scores, which address Positive Effects, Service and Cost, Negative Features, and Personal Image. A preliminary evaluation of retest stability was conducted with 104 subjects. Ninety percent critical differences for the various scores ranged from 0.9 to 2.0 score intervals on a 7 point scale. The SADL scale is both brief enough to be clinically acceptable and comprehensive enough to provide a valid assessment of an inherently multidimensional variable. Additional assessment is necessary to refine understanding of its test-retest properties, explore validity issues, and determine clinical, research, and administrative applications of the data.
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              A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy.

              This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests. Both orthoses increased stride length, reduced abnormal ankle plantar flexion during initial contact, midstance and terminal stance (TST), and increased ankle plantar flexor moments closer to normal during TST. Hinged AFOs increased ankle dorsiflexion at TST and increased ankle power generation during preswing (PSW) as compared to solid AFOs, and increased ankle dorsiflexion at loading compared to no AFOs. No other significant differences were found for the gait variables when comparing these orthoses. Either AFO could be used to reduce the excessive ankle plantar flexion without affecting the knee position during stance. The hinged AFO would be recommended to produce more normal dorsiflexion during TST and increased ankle power generation during PSW in children with spastic diplegic CP.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                cadbto
                Cadernos Brasileiros de Terapia Ocupacional
                Cad. Bras. Ter. Ocup.
                Universidade Federal de São Carlos, Departamento de Terapia Ocupacional (São Carlos, SP, Brazil )
                2526-8910
                January 2019
                : 27
                : 1
                : 35-44
                Affiliations
                [1] Marília orgnameUniversidade Estadual Paulista Brazil
                [2] Marília orgnameUniversidade Estadual Paulista orgdiv1Departamento de Fisioterapia e Terapia Ocupacional Brazil
                Article
                S2526-89102019000100035
                10.4322/2526-8910.ctoao1612
                109545d6-a648-440f-92ac-fc4e965f5636

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 30 December 2017
                : 27 November 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 44, Pages: 10
                Product

                SciELO Brazil

                Categories
                Original Articles

                Orthoses,Cerebral Palsy,Perception,Caretaker,Órteses,Paralisia Cerebral,Percepção,Cuidador

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