Oportunidades de estimulação no domicílio e habilidade funcional de lactentes e pré-escolares com fatores de risco para alteração no desenvolvimento

Abstract

Infant motor development is influenced by biological, social and environmental risk factors and their association. The aims of this study were to investigate the relationship between functional mobility skills (HFM-PEDI) of children aged 18-42 months and motor stimulus opportunities in their home environment, and to investigate if this relationship is affected by biological and socioeconomic factors. A transversal study was conducted with a random sample of 112 patients from two follow-up services. Instruments used were the Pediatric Evaluation Disability Inventory (PEDI) and the Affordance in the Home Enviroment for Motor Development (AHEMD-SR). Descriptive statistical analysis were carried out and Student t test was used to assess the association between HFM-PEDI and environmental stimulus (AHEMD-SR), and between HFM-PEDI and socioeconomic status (SES), mother's educational level, pathology and day-care attendance. Multiple linear regression analysis was carried out in order to investigate possible moderating effects of variables on the association between environmental stimulus opportunities and the scores of the HFM-PEDI. A predominance of good performance of functional mobility skills (82.1%) was observed among participants. More than two thirds of participants (74.1%) presented “average level” of environmental stimulus opportunities for Total AHEMD-SR classification, and the lowest percentage (1.8%) was observed to "high level” of stimulus. There was no significant association between HFM-PEDI and AHEMD-SR. Variability of the mean of HFM-PEDI was greater among participants who had insufficient opportunities to motor development on the variety of stimulation and gross motor dimensions. Findings revealed a significant association only between HFM-PEDI and presence of pathology (p = 0,004). Children with pathology had lower mean PEDI normative score. Multiple linear regression analysis revealed significant result for pathology in the interaction among environment, moderating variables and HFM-PEDI (p = 0.003). Presence of pathology decreased PEDI normative score in almost 8 points. It was concluded that there was no association between functional mobility skills of children with risk factors and motor stimulus opportunities in their home environment. Presence of pathology resulted in functional mobility skills significantly lower, and it strongly affected the HFM-PEDI resultant from the individual-environment interaction.