Escala de desenvolvimento motor: validação para crianças com baixa visão dos 7 10 anos de idade

Abstract

To evaluate the motor performance and gross motor function of children with visual impairment, in the current literature, there are adapted and validated scales, such as the Test of Gross Motor Development - 2 (TGMD-2) and the Movement Assessment Battery for Children (MABC-2), respectively. In Brazil, recently the Motor Development Scale (MDS) was adapted for children with low vision (LV), and at this moment the same research group intends to validate the MDS. Therefore, the proposal of the present study is to elaborate two studies, being the first an integrative review and the second a field research with instrumental validation. The objective of study I is to synthesize, organize and demonstrate the evidence regarding the purpose of the scales/instruments used in the sensory-motor and functional assessment of children and adolescents with visual impairment (VI). In this systematic review, 113 studies indexed in the Cochrane Library, Lilacs/Medline, PEDro, Pubmed, Scielo and Web of Science databases were identified. According to the inclusion criteria, 17 studies were selected, of which 14 were cross-sectional, two were randomized clinical trials, and one was longitudinal. The methodological quality criteria were evaluated according to the study design: cross-sectional and case-control by the Loney Scale; longitudinal by the Newcastle Ottawa Quality Assessment Scale Cohort Studies (NOS) and clinical trials by the Physiotherapy Evidence Database (PEDro). The studies had a total of 552 samples, of which 302 were children with VI from zero months to 12 years of age and 38 were adolescents between 13 and 18 years of age. The remaining 212 samples were from children without VI. No adolescents without VI were identified in the reviewed studies. Regarding the assessment instruments used in the studies, scales with more motor focus than sensory focus were identified, being 13 instruments to assess the physical and functional impairments of this population and three scales to analyze the impairments in orientation and sensory perception. The scales/instruments used in the reviewed studies had a greater analysis on the motor aspect (postural changes, movement analysis, balance, gross motor function, measurement of motor actions, global motricity, gait pattern) compared to fewer investigations on the sensory assessment in children and adolescents with VI. It was also noted on the relevance of investigating in this population the presence of not only motor impairments, but also sensory ones, since the functionalities of these individuals consist of a structuring that integrates the sensory-motor aspects. Therefore, the outcomes identified made possible the importance of the evaluation performed by physical therapists who are members of a multidisciplinary team, whether in the sensory or motor aspect in children and adolescents with VI. The second study is the validation of the EDM-adapted for children with LV from seven to ten years old. For this, its psychometric properties were verified with the MABC-2 adapted for this population, being analyzed the internal consistency by Crobanch‟s Aplha and the convergent and divergent validity with the use of Spearman‟s correlation test. The sample was composed of 62 children with LV, with a mean age of 8.5 (±1.21) years, attending institutions or schools that have the care and inclusion of people with VI in the states of Minas Gerais and São Paulo. After parental consent, the children were assessed by means of two instruments adapted for this population: EDM and MABC-2. As a validation methodological follow-up, the children were evaluated at a single time by only one trained examiner. The data found that the domains assessed by the EDM showed high internal consistency (α = 0.77), in the domains fine motor skills and spatial organization (α = 0.82), in global motor skills (α = 0.81), in temporal organization (α = 0.77). Sperman‟s test revealed strong and significant correlations between the adapted EDM and the adapted MABC-2 in the domains: fine motor skills and manual dexterity (r=0.735; p<0.001), global motor skills and standard MABC-2 score (r=0.714; p<0.001) and balance in both scales (r=0.811; p<0.001). The EDM consolidated positive results that direct the evaluator to a better and reliable assessment of the motor development of children with LV. Considering the results presented in the study, it is evident that the EDM and the MABC-2 are scales that complement each other in the assessment of motor development and performance in this population, with the reliability and validity of the EDM being confirmed in the subtests of fine motor skills, global motor skills, and balance. The EDM adapted for children with LV may be an option of an appropriate tool to assess some items of motor development in LV children.