File
Israel V.1, Araujo L.2
1Universidade Federal do Paraná, Physical Therapy, Curitiba, Brazil, 2Clinica de Reabilitação, Fisioterapia, Joinville, Brazil
Background: The first years of life are crucial to neuro-psychomotor development (NPMD), a period during which children are susceptible to organic, environmental or activity-related influences that may represent protective or risk factors towards full development, with potential lifelong repercussions.
Purpose: To investigate risk factors associated with NPMD delay in children of zero to three years of age in Early Childhood Education Centers (ECECs) within the Public School system.
Methods: Observational, analytical, cross-sectional study approved by the Federal University of Parana´s Ethics Committee. The International Classification of Functioning, Disability and Health (ICF) concerning body functions and structure (evaluation questionnaire), activity and participation (evaluation of NPMD in school), personal factors (family characteristics), and environmental factors (characteristics of the ECECs) were considered for the evaluation phase. The instruments consisted of a questionnaire containing items to elicit information about the child, including current, neonatal and family traits. For the evaluation DPMD, the Denver II test was used. Inter- and intra-rater reliability was established using Cohen´s kappa, and data subsequently submitted to stepwise (backward) regression analysis using a Logit model, using binary responses. The construction of an ROC (Receiver Operating Characteristic) to define the explanatory profile of the model built also was included, in addition to the calculation of the Odds Ratio (OR), the odds of chance occurrence the association of a given variable with DPMD.
Results: 77 children (6-36 months) enrolled in early childhood public schools in the city of Matinhos (Paraná, Brazil) took part in the study. Among 68.8% of the cohort (n=53), DPMD was found to be within normal parameters, with some 31.2% (n=24) presenting risks of delayed development. The scale utilized showed that the best-performing area was fine motor and adaptive development (3.75%) and the most questionable was that of language (57.5%). The findings obtained via the combination of variables by way of regression analysis reveal that the model reaches an adequate level of adjustment (AIC=82.739). Probability estimates were ordered and plotted along a graph, providing the ROC curve. The ROC curve, in turn, shows that the model of the estimated probabilities successfully predicts 93.5% of the phenomena. The regression analysis further revealed that low birth weight (OR=181), monthly household income (OR=9) and paternal absence (OR=34) are statistically significant risk factors concerning delayed development.
Conclusion(s): This study reemphasizes the systematic and multifactorial nature of early childhood NPMD and provides compelling evidence for the need for close monitoring by a physiotherapist, particularly among children born into or living in unfavorable conditions, especially since the intense neuroplasticity in the first years of life -- an interaction among individual, environment and task, as well as susceptibility to stimulation -- will impact the stimulation of motor behaviors.
Implications: The data presented may serve as a basis for the subsidy and involvement of the physiotherapist, contributing to new public policies and educational practices that are conducive to the full development of children, with concerted actions from both school and family.
Funding acknowledgements: Reuni CNPq Brazil
Topic: Paediatrics
Ethics approval: Research approved by the Committee of Ethics in Research (CEP) of UFPR-BRAZIL CEP / SD: 531.068.08.05 CAAE: 1212.0.000.091-8.
All authors, affiliations and abstracts have been published as submitted.
