Early executive functioning (EF) skills are foundational capabilities that predict school readiness, academic development and psychiatric risk. Early interventions enhancing these capabilities could have critical import in improving outcomes. However, to develop interventions, it is necessary to identify specific EF skills that will vary with child age. Thus, we aimed to examine the characteristics and efficacy of interventions targeting EF in infancy and early childhood up to age 3. A comprehensive search of PubMed, Embase, CINAHL and APA PsycINFO databases was performed for studies published before December 2022. Randomized and non-randomized studies of interventions designed to improve at least one EF skill in children ≤3years were included. EF skills included attentional control, inhibition/self-regulation, activity initiation, working memory, cognitive flexibility, planning ability, problem-solving and performance monitoring. We independently extracted data, used the revised Cochrane Risk-of-Bias tool to assess the quality of the evidence and conducted Synthesis Without Meta-analysis (SWiM). The overall quality of the evidence and the strength of recommendations was determined using elements of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Thirty-five studies met inclusion criteria (original n= 7467). Studies were highly variable in the EF skill targeted, target subject (i.e., child, parent and teacher), nature and dosage of the intervention, and timing of outcome assessment. Most interventions focused on improving impulse control and self-regulation. The overall quality of evidence was low to moderate with a high risk of bias, though six studies had low risk of bias but yielded mixed findings of efficacy. The relatively small number of early EF intervention studies uses such variable methods that there is currently no converging evidence of efficacy to recommend a specific intervention. Thus, findings support the need for a more systematic, targeted approach to the design and implementation of early EF interventions for target populations.

Este trabalho teve como objetivo expor o caso clínico de uma residente, previamente autónoma, que após um Acidente Vascular Cerebral foi referenciada para os Cuidados paliativos, e o impacto que esta referenciação teve na sua qualidade de vida ao longo do tempo, nomeadamente com o surgimento de outras patologias. Recorremos à apresentação de um estudo de caso, com consulta dos registos hospitalares (carta de alta), dos registos internos da residente e consequente revisão integrativa da literatura.A referenciação atempada e posterior intervenção da equipa comunitária de cuidados paliativos, aumenta a qualidade de vida dos residentes com necessidades paliativas e consequentemente num aumento da qualidade do serviço prestado pela Estruturas Residenciais para Pessoas Idosas aos residentes. A resposta às múltiplas necessidades de saúde destas pessoas idosas mais frágeis e em período de fim de deve ser preferencialmente encontrada com respostas de proximidade e não passando necessariamente pelo recurso sistemático à hospitalização.

Adolescents with hemiplegic cerebral palsy undergo conventional physical therapy (CPT) to improve static and dynamic balance, activities of daily living and cardiopulmonary function. To overcome this problem, we developed an innovative deep learning-based rehabilitation application (DRA) to provide a motivational and chaffed platform for such individuals. DRA evaluates the patients' functional abilities and diagnosis an appropriate therapeutic intervention like CPT. We compared the effects of DRA and CPT on 6-minute walking test (6 MWT), Borg rating of perceived exertion scale, Berg balance scale, functional ambulation category, and modified Barthel index in adolescents with hemiplegic cerebral palsy. A convenience sample of 30 adolescents with hemiplegic cerebral palsy was randomized into either the DRA or CPT group. DRA and CPT were administered to the participants, with each session lasting 30 minutes and apportioned thrice a week for a total of 4 weeks. Analysis of variance was performed and the level of significance was set at P < .05. The analysis indicated that DRA showed therapeutic effects on 6 MWT, Berg balance scale, and modified Barthel index compared to CPT. Our results provide evidence that DRA can improve cardiopulmonary function, balance, and activities of daily living more effectively than CPT in adolescents with hemiplegic cerebral palsy.

Introdução: A paralisia cerebral é uma desordem crônica de déficit não progressivo do desenvolvimento motor causada por diferentes fatores etiológicos. Objetivo: Analisar o uso de toxina botulínica como uma abordagem terapêutica para o tratamento de paralisia cerebral em pacientes pediátricos. Metodologia: Trata-se de um estudo epidemiológico transversal que utilizou dados do SIA-PA do DATASUS, analisando crianças até 14 anos com diagnóstico de paralisia cerebral em 2022. Foram considerados variáveis do estudo o mês, região, faixa etária, raça/cor, sexo e tipo de atendimento. Foi utilizado o Software R para a análise dos dados. Resultados: Ao longo do ano, 12.695 crianças foram atendidas, evidenciando uma prevalência na faixa etária de 5 a 9 anos, de raça/cor branca e do sexo masculino. Análises temporais indicaram variações sazonais nos atendimentos, com maior prevalência entre agosto e setembro para crianças de 0 a 4 anos e, em abril e julho para o grupo de 5 a 9 anos, com maior concentração nas categorias quadriplégica espástica, diplégica espástica e hemiplégica espástica. Quanto ao uso da toxina botulínica, este foi mais proeminente na faixa etária de 5 a 9 anos. Conclusão: Os resultados deste estudo oferecem uma compreensão sobre o perfil de atendimento a pacientes pediátricos com paralisia cerebral no Brasil que fazem uso de toxina botulínica. A análise das unidades de toxina botulínica utilizadas em diferentes subcategorias ressaltou a importância de adaptações personalizadas no tratamento, considerando as necessidades específicas de cada perfil de paciente, especialmente na faixa etária de 5 a 9 anos.

Genetic Epistemology defends that the individual goes through several stages of development throughout his life. The development is observed by the overlap of the balance between assimilation and accommodation, resulting in adaptation. Thus, in this formulation, the human being assimilates the data he obtains from the outside, but once he already has a mental structure that is not “empty”, he needs to adapt these data to the existing mental structure. The process of modifying oneself is called accommodation. This scheme reveals that no knowledge arrives from outside without suff ering some alteration by the individual, and that everything one learns is infl uenced by what one has already learned. The assimilation occurs when the information is incorporated into the structures already existing in this dynamic cognitive structure, while the adaptation occurs when the organism is modifi ed in some way in order to dynamically incorporate the new information. Finally, from a modern thought that, seeking the unusual synthesis between the biological and the logical-mathematical, seems to fi nd its limits in the even more unusual deconstruction to which all thought systematically tends nowadays: that of itself building itself in an essentially enlightened way.