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Como avaliar a percepção de competência e aceitação social de crianças com paralisia cerebral?Estudo inicial para a determinação das propriedades psicométricas da versão portuguesa da Dutch Pictorial Scale of Perceived Competence and Social Acceptance in Children with Cerebral Palsy How to measure children with cerebral palsy's perception of competence and social acceptance?Preliminary study to determinate the psychometric properties of the portuguese version of the Dutch Pictorial Scale of Perceived Competence and Social Acceptance in Children with Cerebral PalsyO principal objectivo deste estudo consistiu na determinação das propriedades psicométricas da versão portuguesa da Dutch Pictorial Scale of Perceived Competence and Social Acceptance in Children with Cerebral Palsy. Participaram neste estudo 108 crianças (60 rapazes e 48 raparigas) com paralisia cerebral, com idades entre os 4 e os 9 anos, distribuídas em hemiplegicas, diplégicas e tetraplégicas e com um QI igual ou superior a 70. A maioria (n=98) frequentava o ensino regular, enquanto apenas 10 frequentavam escolas especiais. O instrumento foi aplicado num segundo momento a 41 das crianças, com um intervalo máximo de duas semanas. Os resultados da correlação de Pearson relativamente aos dois momentos (entre 0.80 e 0.98) bem como o valor do alfa de Cronbach (entre 0.69 e 0.93) evidenciam uma boa fiabilidade da versão portuguesa. Também os valores das inter-correlações entre as quatro subescalas (r=0.60 ou superior) bem como os valores médios das respostas das crianças em função de diferentes características (idade, sexo, condição médica) para as diferentes subescalas apoiam a validade interna do instrumento. Em suma, os resultados do nosso estudo, na sua globalidade, parecem confirmar as propriedades psicométricas da versão portuguesa da Dutch Pictorial Scale, pelo que esta parece constituir-se como um instrumento fiável e válido para a avaliação do modo como as crianças portuguesas com Paralisia Cerebral se percebem no domínio cognitivo, físico e social.<br>The main purpose of this study was to examine the psychometric properties of the Portuguese version of the Dutch Pictorial Scale of Perceived Competence and Social Acceptance in Children with Cerebral Palsy. The sample was made up of 108 children (60 boys and 48 girls) with cerebral palsy, aged between 4 and 9 years, who suffered hemiplegia, diplegia or quadriplegia and had an IQ of 70 or higher. Most of the children (n=98) attended regular schools (integrated in kindergarten or primary school); indeed, only 10 children attended special schools for children with special needs. A sub-sample of 41 children filled out the scale in two different moments, separated one to two weeks maximum. The results of Pearson correlations between the two administrations (ranging 0.80 to 0.98) and the Cronbach's alpha (ranging 0.69 to 0.93) showed good reliability of the Portuguese version of the Dutch Pictorial Scale. Moreover, the inter-correlations between the four subscales (r=0.60 or higher) as well the mean scores associated by children with different characteristics (age, sex, medical condition) to the different subscales supported the internal validity of the instrument. Therefore, this study provides initial evidence about the psychometric properties of the Portuguese version of the Dutch Pictorial Scale, which is why its use is recommended to assess the perceived competence and social acceptance of Portuguese children with cerebral palsy.
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Post Traumatic Cerebral Oedema in Severe Head Injury is Related to Intracranial Pressure and Cerebral Perfusion Pressure but not to Cerebral ComplianceThis was a prospective cohort study, carried out in the Neuro Intensive Care Unit, Department of Neurosciences, Hospital Universiti Sains Malaysia, Kubang Kerian Kelantan. The study was approved by the local ethics committee and was conducted between November 2005 and September 2007 with a total of 30 patients included in the study. In our study, univariate analysis showed a statistically significant relationship between mean intracranial pressure (ICP) as well as cerebral perfusion pressure (CPP) with both states of basal cistern and the degree of diffuse injury and oedema based on the Marshall classification system. The ICP was higher while CPP and compliance were lower whenever the basal cisterns were effaced in cases of cerebral oedema with Marshall III and IV. In comparison, the study revealed lower ICP, higher mean CPP and better mean cerebral compliance if the basal cisterns were opened or the post operative CT brain scan showed Marshall I and II. These findings suggested the surgical evacuation of clots to reduce the mass volume and restoration of brain anatomy may reduce vascular engorgement and cerebral oedema, therefore preventing intracranial hypertension, and improving cerebral perfusion pressure and cerebral compliance. Nevertheless the study did not find any significant relationship between midline shifts and mean ICP, CPP or cerebral compliance even though lower ICP, higher CPP and compliance were frequently observed when the midline shift was less than 0.5 cm. As the majority of our patients had multiple and diffuse brain injuries, the absence of midline shift did not necessarily mean lower ICP as the pathology was bilateral and even when after excluding the multiple lesions, the result remained insignificant. We assumed that the CT brain scan obtained after evacuation of the mass lesion to assess the state basal cistern and classify the diffuse oedema may prognosticate the intracranial pressure and cerebral perfusion pressure thus assisting in the acute post operative management of severely head injured patients. Hence post operative CT brain scans may be done to verify the ICP and CPP readings postoperatively. Subsequently, withdrawal of sedation for neurological assessment after surgery could be done if the CT brain scan showed an opened basal cistern and Marshall I and II coupled with ICP of less than 20 mmHg.
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Análise clínico-qualitativa do discurso de uma criança com paralisia cerebral Análisis clinico-cualitativo del discurso de un niño con parálisis cerebral Cinical-qualitative analysis of the discourse of a child with cerebral palsyEsse artigo propõe uma reflexão sobre a constituição processual de produções linguístico-discursivas de uma criança com paralisia cerebral, à luz de situações interativas. Apresenta o método clínico-qualitativo como forma de investigação e intervenção linguístico-discursiva, privilegiando a interação socioverbal e a relação intersubjetiva. Os dados foram coletados longitudinalmente ao longo de um ano e quatro meses e as produções linguísticas de uma criança com paralisia cerebral de quatro anos e dois meses de idade foram analisadas de uma perspectiva discursiva. Assim, distantes de avaliações e tratamentos mensuráveis, os quais se pautam em tarefas mecânicas de codificação e decodificação de palavras isoladas, nossa pesquisa pautou-se na análise processual da construção conjunta da significação. Tal análise nos permite afirmar que, mediante o processo interlocutivo, essa criança ampliou seu papel no diálogo. Observamos como ela, de um momento inicial em que apresentava apenas fragmentos de enunciados, passou a estruturar narrativas mais completas.<br>Ese artículo propone una reflección sobre la constitución procesual de producciones linguístico-discursivas de un niño con parálisis cerebral, a la luz de situaciones interactivas. Presenta el método clínico-cualitativo y la investigación como una forma de expresión y de lenguaje, discursivas, con el énfasis en la interacción socio-verbal y en la relación intersubjetiva. Los datos fueron recogidos longitudinalmente más de un año y cuatro meses y la producción linguística de un niño con parálisis cerebral con cuatro años y dos meses de edad fueron analizados bajo una perspectiva discursiva. Por lo tanto, lejos de las evaluaciones y tratamientos que son guiados por medios mecánicos, tareas de codificación y decodificación de palabras aisladas, nuestra investigación se orienta en el análisis del procedimiento de la construcción conjunta de significado.<br>This article proposes a reflection on the establishment of procedural linguistic-discursive production of a child with cerebral palsy in the light of interactive situations. It presents clinic qualitative method as a way of linguistic-discursive investigation and intervention, emphasizing a social verbal interaction and a subjective relationship. The data was longitudinal collected during one year and four months and the linguistic productions of a four-year-old child were analysed in a discursive perspective. Therefore, faraway from measurable evaluations and treatments, which are based in mechanic tasks of words codification and de-codification, our research was based in a group process significant construction analysis. Such analysis allow us to affirm that this child amplify her role in the dialogue. Thus, we observe that in the beginning of the process the child presented a fragmented discourse, and after all she presented complete structured narratives.