Introduction: The increase in the number of cases of microcephaly in Brazil and its association with the Zika virus (ZIKV) is a global public health problem. The International Classification of Functioning Disability and Health (ICF) model is a powerful tool and extremely relevant in managing disability. Objective: Describe the functioning profile of children with microcephaly associated with ZIKV in two states of northeastern Brazil. Methods: This is a descriptive cross-sectional study. The sociodemographic characteristics, head circumference, and other clinical data were collected from medical charts, physical examinations, measuring instruments, and interviews with the children and their parents. The Brazilian Portuguese version of the Brief Common ICF Core Set for cerebral palsy (CP) was used. Each ICF category was assigned a qualifier, which ranged from 0 to 4 (no problem, mild problem, moderate problem, severe problem, complete problem). For environmental factors, 0 represents no barrier and 4 represents complete barrier; +0, no facilitator and +4, complete facilitator. Results: A total of 34 children with microcephaly caused by ZIKV were recruited (18 girls and 16 boys) at four rehabilitation facilities in Rio Grande do Norte and Paraíba states, Brazil. The average age of the participants was 21 months, monthly income was ≈USD 300.00, and head circumference z-scores ranged between 0.92 and −5.51. The functioning profile revealed complete disability in most of the body function categories (b). The activity and participation areas (d) were highly impacted, particularly in mobility-related categories. With respect to environmental factors (e), most of the sample reported a complete facilitator for the immediate family, friends, and health services, systems, and policies, as well as a complete barrier to societal attitudes. Conclusion: This is the first study that describes the functioning profile of children with microcephaly associated with ZIKV, using a tool based on the ICF in Brazil. Our findings reinforce the need to maximize health care and access to information, based on the ICF, for multiprofessional teams, administrators, family members, and children.
Background: The International Classification of Functioning, Disability, and Health (ICF) Core Sets for children and youth with cerebral palsy (CP) offer service providers and stakeholders a specific framework to explore functioning and disability for assessment, treatment, evaluation, and policy purposes in a global context. Objective: Describe global initiatives applying the ICF Core Sets for children and youth with CP, with a focus on contributions to clinical practice and challenges in their implementation. Methods: This is a descriptive cross-sectional study. Ongoing initiatives applying the ICF Core Sets for CP in Russia, Poland, Malawi, and Brazil are included. Results: The main contributions of applying the ICF Core Sets for children and youth with CP include: (1) an objective description of abilities and limitations in everyday activities; (2) a consistent identification of facilitators and barriers influencing functioning; (3) a practical communication tool promoting client-centered care and multidisciplinary teamwork; and, (4) a useful guideline for measurement selection. The main challenges of adopting the ICF Core Sets are related to lack of ICF knowledge requiring intense training and translating results from standardized measures into the ICF qualifiers in a consistent way. Conclusions: Global initiatives include research and clinical applications at the program, service and system levels. The ICF Core Sets for CP are useful tools to guide service provision and build profiles of functioning and disability. Global interprofessional collaboration, capacity training, and informatics (e-records) will maximize their applications and accelerate adoption.
Introduction: Cerebral Palsy (CP) is a non-progressive disorder that may compromise functional abilities of the upper limbs due to motor and sensitive loss, that are still poorly evaluated and described by reliable tools. Objective: This study aimed to evaluate motor quality and skills of the upper extremity in children with CP in regions of Trairi and Seridó from Rio Grande do Norte state (Brazil). Methods: It is a cross-sectional exploratory study, with a qualitative approach, with 17 children with CP, aged between four and eight years. The following instruments were used for upper extremity evaluation: Manual Ability Classification System (MACS), Quality of Upper Extremity Skills Test (QUEST) and Gross Motor Function Classification System (GMFCS). Results: Mean and standard deviation (sd) of QUEST total score and the domains dissociated movement, grasp, weight bearing and extensive protection were, respectively, 41.06/37.08; 53.12/34.50; 15.51/62.98; 37.76/37.52; 42.48/47.26. MACS and GMFCS median scores were, respectively, 3 (three) and 5 (five); high positive correlation was observed between MACS and GMFCS (rs=0.83) and high negative correlation between GMFCS and total QUEST (rs=-0.83), as well as between MACS and QUEST (rs=-0.84); and MACS and all QUEST domains (rs=-0.73; rs=-0.82; rs=-0.76; rs=-0.79), p<0.001. Conclusion: Children with CP showed deficit in motor quality and skills of the upper limb, allowing to infer functional limitations regarding manipulation of objects and consequent dependence during life activities.
Cystic fibrosis imposes a heavy treatment burden on the quality of life and psychological well-being of children. Since much of the daily management of cystic fibrosis occurs at home, observing the child's ability to participate in school-based and leisure activities is of paramount importance, as participation in these activities is considered essential for child development, in addition to contributing to health-related quality of life. This study identified the quality of life questionnaires for cystic fibrosis and linked their items to the International Classification of Functioning, Disability and Health (ICF). In the 2 questionnaires presented here, the categories primarily represented body functions and, al though environmental factors play an important role in children's participation in home, school and community activities, and can act as a support or barrier, they were the categories least covered by the 2 questionnaires and no items were related to body structures in any of the instruments. Objective: To identify the most common quality of life instruments for children with cystic fibrosis and link the content with the International Classification of Functioning, Disability and Health (ICF). Methods: The study was conducted in 2 stages. The first stage involved a review of the literature to select quality of life questionnaires. In the second stage 2 independent reviewers identified questionnaire items and categories corresponding to the ICF, according to approved methodology. The degree of agreement was calculated using the kappa coefficient. Results: Two questionnaires were selected: the Cystic Fibrosis Questionnaire and DISABKIDS®. A total of 130 concepts were identified from the 112 items. Forty-seven different ICF categories were linked (k>0.62 for all questionnaires), 21 (44.7%) were related to the "body function" domain, 20 (42.6%) to "activity and participation" and 6 (12.8%) to "environmental factors". Thirteen items (10%) could not be linked because they represent personal factors or are not covered by the ICF. Conclusion: Body functions were the category most linked to the ICF. Environmental factors were poorly described, and no items were related to body structures in any of the instruments.
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