Revisão integrativa de avaliações utilizadas em intervenções de terapia ocupacional para crianças com paralisia cerebral

Peters, Carly; Chang, Amy; Morales, Abbiagail; Barnes, Karin; Allegretti, Ana

doi:10.4322/2526-8910.ctoAR1856

Acessibilidade / Reportar erro

Brasil

Cadernos Brasileiros de Terapia Ocupacional

Español English

Brasil

Español English

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Sumário

Review Article • Cad. Bras. Ter. Ocup. 27 (01) • Jan 2019 • https://doi.org/10.4322/2526-8910.ctoAR1856 copiar

Revisão integrativa de avaliações utilizadas em intervenções de terapia ocupacional para crianças com paralisia cerebral

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Introdução:

Crianças com Paralisia Cerebral (PC) apresentam uma ampla gama de déficits e sintomas. Quando submetidos a intervenções de terapia ocupacional (OT), é essencial que as avaliações utilizadas reflitam com precisão as medidas de resultados dos domínios visados.

Objetivo:

Identificar os instrumentos de avaliação mais utilizados como medidas para intervenções no TO no tratamento de crianças com PC.

Método:

Bancos de dados Pubmed e Ovid foram sistematicamente pesquisados usando os termos-chave “paralisia cerebral”, “avaliações” e “terapia ocupacional”. Avaliaçoes foram exploradas e extraídas de artigos contingentes aos seguintes critérios de inclusão: (1) crianças de até 18 anos com diagnóstico de paralisia cerebral; (2) uso da(s) avaliação (ões) como medida de intervenção do TO; (3) publicado em inglês entre 2007 e 2017. Na pesquisa preliminar, foram encontrados 151 artigos em Pubmed e 571 em Ovid. Destes, apenas 76 foram inlcuidos devido aos critérios de inclusão. Dos 76 artigos restantes, um total de 89 avaliaçoes foram encontradas e incluídas nesta revisão da literatura.

Resultados:

Dez avaliações foram consideradas importantes com base na frequência de uso. A “Assisting Hand Assessment” (AHA) e o Inventário de Avaliação Pediátrica de Incapacidade (PEDI) foram os mais utilizados.

Conclusão:

Os achados deste estudo desempenham um papel importante no e do desafio de seleção de avaliação enfrentado pelos terapeutas ocupacionais e fornecem uma base para futuras pesquisas para expandir no que diz respeito ao tratamento de crianças com PC.

Palavras-chave:
Paralisia Cerebral; Terapeutas Ocupacionais; Avaliações

Author, Year	Assessments
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Case-Smith et al. (2012) 10.5014/ajot.2012.002386	AHA, QUEST, PMAL
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Coker-Bolt et al. (2015) 10.5014/ajot.2016.70S1-PO5115	CHUEQ, MA2, PEDI
DeLuca et al. (2012) https://doi.org/10.3233/PRM-2012-0206	AHA, QUEST, PMAL Shriners Hospital
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Yasukawa and Uronis (2014YASUKAWA, A.; URONIS, J. Effectiveness of the dynamic movement orthosis glove for a child with cerebral palsy hemiplegia and obstetric brachial plexus palsy: A case series. JPO Journal of Prosthetics & Orthotics, United States, v. 26, n. 2, p. 107-112, 2014.) http://doi.org/10.1097/JPO.0000000000000022	Melbourne
Ziebell et al. (2009ZIEBELL, M. et al. The relationship between physical performance and self-perception in children with and without cerebral palsy. Australian Occupational Therapy Journal, Cambridgeshire, v. 56, n. 1, p. 24-32, 2009.) https://doi.org/10.1111/j.1440-1630.2008.00775.x	BOT, GMFCS, SPPC

Note: [6MWT = Six-Minute Walk Test; AHA = Assisting Hand Assessment; AIMS = Alberta Infant Motor Scale; AMPS = Assessment of Motor and Process Skills; APCP = Assessment of Preschool Children’s Participation; BBT = Box and Block Test; BFMF = Bimanual Fine Motor Function scale; BOT = Bruininks-Oseretsky Test of Motor Proficiency; CAPE = Children’s Assessment of Participation and Enjoyment; CBC = Child Behavior Checklist; CFUS = Caregiver Functional Use Survey; CHEQ; Children’s Hand-Use Experience Questionnaire; CHQ = Australian Authorised Adaptation of the Child Health Questionnaire; CHUEQ = Children’s Hand-Use Experience Questionaire; COPM = Canadian Occupational Performance Meausure; CPQOL-Child = Cerebral Palsy Quality of Life Questionnaire for Children; ENNAS = Einstein Neonatal Neurobehavioral Assessment Scale; ETCH = Evaluation Tool of Children’s Handwriting; FES Family Empowerment Scale; fTORT = functional Tactile Object Recognition Test; GAS = Goal Attainment Scale; GMA = General Movements Assessment; GMFCS = Gross Motor Function Classification System; GMFM = Gross Motor Function Measure; GMFM- 66 = Gross Motor Function Measure - 66; GMFM-88 = Gross Motor Function Measure - 88; ICFI = International Classification of Functioning Interview; JTTHF = Jebsen-Taylor Hand Function Test; LIFE-H = Assessment of Life Habits; MA2 = Melbourne Assessment 2; MACS = Manual Ability Classification System; MAS = Modified Ashworth Scale; Melbourne = Melbourne Assessment of Unilateral Upper Limb Function; MHA = Minnesota Handwriting Assessment; NHDC = Neurological Hand Deformity Classification; NSMDA = Neurosensory Motor Developmental Assessment; PAC = Preferences for Activity of Children; PAFT = Pediatric Arm Function Test; PDMS-2 = Peabody Developmental Motor Scales II; PEDI = Pediatric Evaluation of Disability Inventory; PedsQL = Pediatric Quality of Life Inventory; PGMS = Peabody Gross Motor Scale; PMAL = Pediatric Motor Activity Log; PQRS = Performance Quality Rating Scale; PRT = Pediatric Reach Test; PSI-Short form = Parenting Stress Index-Short Form; QUEST = Quality of Upper Extremity Skills Test; ROM = Range of Motion; SAS = Sitting Assessment Scale; SIPT = Sensory Integration and Praxis Test; SPPC = Harter Self-Perception Profile; SSC = Sense and Self-Regulation Checklist; SWMs = Semmes Weinstein Monofilaments; TAUT = Toddler Arm Use Test; TCMS = Trunk Control Measurement Scale; THS-R = Test of Handwriting Skills-Revised; TIMP = Test of Infant Motor Performance; TIS = Trunk Impairment Scale; TVPS3 = Test of Visual Perceptual Skill -non-motor; VAS = Visual Analogue Scale; VMI = Beery-Buktenica Developmental Test of Visual-Motor Integration; VOAA = Video Observations Aarts and Aarts].

Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
E-mail: cadto@ufscar.br

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[1] Corresponding author:
Ana Allegretti, Department at UT Health San Antonio, Texas, United States, e-mail: allegrettial@uthscsa.edu

Assessment	Frequency	Type of Assessment	Purpose of Assessment	Age Range	Psychometrics	Administration Time	Price of Assessment
AHA (KRUMLINDE-SUNDHOLM et al., 2007KRUMLINDE-SUNDHOLM, L. et al. The assisting hand assessment: Current evidence of validity, reliability, and responsiveness to change. Developmental Medicine & Child Neurology, London, v. 49, n. 4, p. 259-264, 2007.; WAGNER; DAVIDS, 2012WAGNER, L. V.; DAVIDS, J. R. Assessment tools and classification systems used for the upper extremity in children with cerebral palsy. Clinical Orthopaedics and Related Research, Philadelphia, v. 470, n. 5, p. 1257-1271, 2012.)	22	Skilled observation by clinician	Evaluates assisting hand in bilateral hand use activities using videotaped play session	18 months to 12 years old	Interrater reliability = 0.98 (two rater design) and 0.97 (20-rater design) Intra-rater reliability = 0.99	10-15 minutes play session of child Scoring time dependent on therapist’s experience with AHA	USD $350 for test kit USD $260-$320 for 3-day training/ certification process
PEDI (ASHER, 2007ASHER, I. E. Asher’s occupational therapy assessment tools: An annotated index. Bethesda: American Occupational Therapy Association, 2007.; LIVINGSTONE; PALEG, 2016LIVINGSTONE, R.; PALEG, G. Measuring outcomes for children with cerebral palsy who use gait trainers. Technologies, Switzerland, v. 4, n. 3, p.1-19, 2016.)	17	Behavior checklist/rating scale completed via structured interview or professional observation	Examines functional capabilities and typical performance to detect functional delay, track progress after intervention, and assess intervention outcome	6 months to 7.5 years old; can utilize for older children if functional capabilities do not exceed those of 7.5 year old children with no disabilities	Inter-rater reliability = 0.84-1.00, 0.74-0.94; Internal consistency = 0.95-0.99; Good validity with children with CP	20-60 minutes depending on therapist’s experience with PEDI	USD $115 for manual USD $35 for score forms (x25)
GMFCS (CANCHILD, 2018; WOOD; ROSENBAUM, 2000)	16	Family report questionnaire	5-Level system that classifies according to current gross motor abilities/ limitations, and level of need for assistive technology and wheeled mobility	0 to 18 years old	Inter-rater reliability = 0.93; Test-retest reliability = 0.79; Demonstrated face validity	< 5 minutes if familiar with child; 15-20 minutes if unfamiliar with child and require observation session	Free
COPM (ASHER, 2007ASHER, I. E. Asher’s occupational therapy assessment tools: An annotated index. Bethesda: American Occupational Therapy Association, 2007.; LIVINGSTONE; PALEG, 2016LIVINGSTONE, R.; PALEG, G. Measuring outcomes for children with cerebral palsy who use gait trainers. Technologies, Switzerland, v. 4, n. 3, p.1-19, 2016.)	14	Semi- structured interview- based rating scale	Self-perception of identified occupational performance	7+ years old	Inter-rater reliability: performance = 0.63-0.89, satisfaction = 0.76-0.88; Internal consistency: performance = 0.73, satisfaction = 0.83; Demonstrated content/ construct/criterion validity; Responsive to change (able to detect medium sized effect size in children with hemiplegic CP)	30-40 minutes	COPM Manual and 100 Forms (e-book) = USD $29.51
GAS (ABILITYLAB, 2014; LIVINGSTONE; PALEG, 2016LIVINGSTONE, R.; PALEG, G. Measuring outcomes for children with cerebral palsy who use gait trainers. Technologies, Switzerland, v. 4, n. 3, p.1-19, 2016.; STEENBEEK et al., 2010STEENBEEK, D. et al. Interrater reliability of goal attainment scaling in rehabilitation of children with cerebral palsy. Archives of Physical Medicine and Rehabilitation, Philadelphia, v. 91, n. 3, p. 429-435, 2010.)	14	Patient reported outcome	Self-identified patient goals and measurement criteria	All ages	Inter-rater reliability = 0.82; Intra-rater reliability = 0.64 Criterion validity = 0.44; Content/convergent validity established for children with CP (77-88% of ratings met GAS criterion); Excellent responsiveness to change in goals of children with CP at all GMFCS levels	Variable	Free
MACS (ELIASSON et al., 2006ELIASSON, A. C. et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Developmental Medicine & Child Neurology, London, v. 48, n. 7, p. 549-554, 2006.)	13	Family/patient/ caregiver report questionnaire	System for classifying hand use in daily activities	4 to 18 years old	Interrater reliability between therapists = 0.97 (95% confidence interval 0.96-0.98); Interrater reliability between parents and therapists = 0.96 (95% confidence interval 0.89-0.98); Good validity	Variable	Free MACS chart and identification download Instructional DVD = USD $35.17
MUUL (ASHER, 2007ASHER, I. E. Asher’s occupational therapy assessment tools: An annotated index. Bethesda: American Occupational Therapy Association, 2007.; THE ROYAL…, 2018)	12	Therapist observation scale	Uses video-based measurement to examine unilateral upper limb movements based on activities involving grasp, release, reach and manipulation	2.5 to 15 years old	Interrater reliability: total scores = 0.961, fluency correlation for test components = 0.902; ROM = 0.866, quality of movement = 0.683, Validity: clinically valid for children 2.5 years and older and positively correlated with Quality of Upper Extremity Skills Test scores	Total time = 50-60 minutes including 20-30 minutes to administer and 30 minutes to score	USD $1165.75 per assessment for orders outside Australia
PMAL (USWATTE et al., 2012aUSWATTE, G. et al. Pediatric arm function test: Reliability and validity for assessing more-affected arm motor capacity in children with cerebral palsy. American Journal of Physical Medicine & Rehabilitation, Baltimore, v. 91, n. 12, p. 1060-1069, 2012a.; WALLEN et al., 2009WALLEN, M. et al. Psychometric properties of the Pediatric Motor Activity Log used for children with cerebral palsy. Developmental Medicine & Children Neurology, London, v. 51, n. 3, p. 200-208, 2009.)	10	Parent report/semi- structured interview	Evaluates how often and how well the involved upper extremity is used in the natural environment	7 months to 8 years old	Revised PMAL by Uswatte et al. (2012aUSWATTE, G. et al. Pediatric arm function test: Reliability and validity for assessing more-affected arm motor capacity in children with cerebral palsy. American Journal of Physical Medicine & Rehabilitation, Baltimore, v. 91, n. 12, p. 1060-1069, 2012a.): Internal consistency = 0.93; Test-retest reliability = 0.89; Strong support for convergent validity Revised PMAL by Wallen et al. (2009WALLEN, M. et al. Psychometric properties of the Pediatric Motor Activity Log used for children with cerebral palsy. Developmental Medicine & Children Neurology, London, v. 51, n. 3, p. 200-208, 2009.): How Often Scale test-retest reliability = 0.94 with strong evidence of construct validity; How Well Scale test-retest reliability = 0.93 with strong evidence of construct validity	5-15 minutes to complete 3 minutes to score	Free
QUEST (ABILITYLAB, 2016; ASHER, 2007ASHER, I. E. Asher’s occupational therapy assessment tools: An annotated index. Bethesda: American Occupational Therapy Association, 2007.; LIVINGSTONE; PALEG, 2016LIVINGSTONE, R.; PALEG, G. Measuring outcomes for children with cerebral palsy who use gait trainers. Technologies, Switzerland, v. 4, n. 3, p.1-19, 2016.)	9	Performance based checklist for therapist observation Criterion- referenced	Examines the quality of upper extremity movement associated with grasp, weightbearing, protective extension, and dissociated movement in a play context	18 months to 8 years old	Interrater reliability = 0.93; Test-retest reliability = 0.95; Excellent internal consistency; Validity = strong correlation with PDMS-FM scales	45 minutes	USD $99
JTTHF (ABILITYLAB, 2012; ASHER, 2007ASHER, I. E. Asher’s occupational therapy assessment tools: An annotated index. Bethesda: American Occupational Therapy Association, 2007.)	9	Performance test Norm-referenced	Timed test of effective hand use in daily activities	5 years old and older	Test-retest reliability = 0.98-0.99	15-20 minutes	USD $300+ for commercially sold test kit (instructions, test items, carrying bag, forms) If self-created kit, can cost as low as $0 to $10.