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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Seg&#250;n su definici&#243;n cl&#225;sica&#44; la par&#225;lisis cerebral &#40;PC&#41; es un trastorno de los movimientos y la postura debido a un defecto de inmadurez cerebral<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; A ra&#237;z del taller internacional de Bethesda en 2004 se propone la definici&#243;n de PC como un grupo de trastornos del desarrollo del movimiento y la postura que causa limitaci&#243;n de la actividad y que se atribuye a alteraciones no progresivas producidas en el desarrollo del cerebro fetal o infantil&#46; Estos d&#233;ficits motores se acompa&#241;an frecuentemente de&#44; entre otros problemas&#44; alteraciones en la sensibilidad&#44; la cognici&#243;n&#44; la comunicaci&#243;n&#44; la percepci&#243;n o el comportamiento&#44; as&#237; como de crisis epil&#233;pticas<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; La lesi&#243;n cerebral se produce en el periodo prenatal en el 25&#37; de los casos&#44; en el perinatal en el 20&#37;&#44; en el posnatal en el 21&#37; y en los primeros a&#241;os de vida en el 6&#37;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los ni&#241;os con PC&#44; aparte de trastornos motores&#44; presentan otras condiciones que pueden tener un gran impacto en su desarrollo<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; entre las que destacan la epilepsia&#44; con una incidencia entre el 28 y el 42&#37;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#59; los trastornos del habla y de lenguaje entre el 56<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> y el 80&#37;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44; y las alteraciones visuales&#44; que afectan a un 40&#37;&#44; y auditivas que sufren entre el 10 y el 16&#37;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; La presencia de estas complicaciones se ha relacionado con la disminuci&#243;n de las capacidades cognitivas<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8-10</span></a>&#44; hall&#225;ndose d&#233;ficits en estas &#225;reas entre un 40&#37; y un 65&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; constituyendo las principales la lentitud en el procesamiento de la informaci&#243;n&#44; la dificultad en la descodificaci&#243;n de est&#237;mulos complejos&#44; el aumento en el tiempo de reacci&#243;n y las dificultades de asociaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La incidencia del retraso mental definido como puntuaciones de cociente intelectual &#40;CI&#41; de 69 o menos se sit&#250;a entre el 30 y el 70&#37;&#44; siendo grave entre el 14 y el 59&#37;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;10</span></a>&#46; La frecuencia del retraso mental var&#237;a de manera significativa entre los subtipos de PC y los niveles de deterioro var&#237;an dentro de cada subtipo&#46; La mayor&#237;a de los ni&#241;os con tetraplej&#237;a esp&#225;stica sufren deficiencia mental grave&#44; mientras que entre el 40 y el 50&#37; de los ni&#241;os con hemiplej&#237;a tiene un CI medio y un 18&#37; presenta un CI superior a 100<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; En los ni&#241;os con diplej&#237;a esp&#225;stica&#44; suelen estar relacionados la gravedad del d&#233;ficit motor y el nivel de retraso<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por otra parte&#44; los problemas de conducta&#44; el d&#233;ficit de atenci&#243;n con hiperactividad o el negativismo son m&#225;s comunes en ni&#241;os con PC que en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Los ni&#241;os con PC y deterioro cognitivo reducen sus niveles de participaci&#243;n en numerosos &#225;mbitos de la vida&#44; tales como el autocuidado&#44; las actividades recreativas&#44; las relaciones personales&#44; sociales&#44; la vida familiar y escolar<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Esto incrementa el riesgo de sufrir aislamiento social y rechazo de los iguales&#44; lo cual&#44; junto a la falta de capacidades funcionales y de independencia personal&#44; puede causar problemas adicionales de salud mental<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para evaluar el desarrollo en ni&#241;os peque&#241;os suelen utilizarse escalas de desarrollo&#44; que eval&#250;an las distintas &#225;reas&#44; incluidas las capacidades cognitivas&#46; Han sido elaboradas con el fin de estudiar a los ni&#241;os desde el nacimiento y por ello son &#250;tiles para obtener respuestas de sujetos con poca movilidad y lenguaje&#59; adem&#225;s&#44; algunas de ellas est&#225;n dise&#241;adas para la realizaci&#243;n y la valoraci&#243;n de programas de intervenci&#243;n&#44; de manera que se adecuan m&#225;s que los test de inteligencia para el estudio de los ni&#241;os con PC&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En algunos ni&#241;os&#44; como los que presentan bajo peso al nacer pero que no presentan complicaciones neurol&#243;gicas&#44; las bajas puntuaciones en las escalas de desarrollo en los primeros meses de vida no predicen un bajo CI&#44; posiblemente porque sus capacidades se van acercando progresivamente a la normalidad&#59; sin embargo&#44; en los ni&#241;os con lesi&#243;n cerebral el deterioro permanece a lo largo de la infancia<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Por ese motivo&#44; estas escalas pueden resultar &#250;tiles en el pron&#243;stico del desarrollo de estos &#250;ltimos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Shevell et al&#44; en un estudio con ni&#241;os que sufr&#237;an retraso global del desarrollo que inclu&#237;a sujetos con PC y que utilizaba el inventario de desarrollo de Battelle &#40;BDI&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; encontraron baja ejecuci&#243;n en todas las &#225;reas&#44; con unas puntuaciones medias que oscilaron entre un cociente de desarrollo de 66 para la escala total y 71 para la personal-social&#46; El 93&#37; de los sujetos obtuvo puntuaciones inferiores a 1&#44;5 desviaciones t&#237;picas &#40;Dt&#41; de la media en la escala total&#44; el 80&#37; en la cognitiva y el 78&#37; en la personal-social&#46; En otro estudio&#44; con las escalas de desarrollo de Bayley<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#44; 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de 0 a 5 a&#241;os con diferentes trastornos motores y observar sus diferencias&#44; as&#237; como compararlo con un grupo control sin trastornos en el desarrollo para conocer el alcance de sus d&#233;ficits y su evoluci&#243;n a lo largo de la primera infancia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Participantes</span><p id="par0045" class="elsevierStylePara elsevierViewall">La muestra estuvo compuesta por 100 ni&#241;os de entre 4 y 70 meses &#40;subgrupos de 0&#44; 1&#44; 2&#44; 3&#44; 4 y 5 a&#241;os&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Tanto el grupo cl&#237;nico como el control estaban formados por 50 sujetos &#40;25 ni&#241;os y 25 ni&#241;as&#41;&#46; Para el grupo cl&#237;nico se seleccion&#243; a ni&#241;os con diagn&#243;stico de PC y alteraciones cerebrales detectadas en resonancia magn&#233;tica&#46; Todos eran atendidos en el Servicio de Rehabilitaci&#243;n del Hospital Juan Ram&#243;n Jim&#233;nez de Huelva&#44; en tratamiento o seguimiento fisioter&#225;pico&#44; de atenci&#243;n temprana y&#47;o logop&#233;dico&#46; El 32&#37; naci&#243; con prematuridad y bajo peso&#44; el 6&#37; padeci&#243; sufrimiento fetal&#44; el 19&#37; hipoxia cerebral y un 24&#37; sufr&#237;a epilepsia&#46; Todos padec&#237;an trastornos motores en alg&#250;n grado &#40;hemiplej&#237;a 26&#37;&#44; tetraplej&#237;a 24&#37;&#44; diplej&#237;a 32&#37; y otros d&#233;ficits motores 18&#37;&#41;&#46; Las complicaciones neurol&#243;gicas observadas en t&#233;cnicas de neuroimagen fueron las siguientes&#58; leucomalacia 28&#37;&#44; hemorragia intraventricular perinatal 28&#37;&#44; malformaciones cerebrales 12&#37;&#44; infartos focales 10&#37;&#44; atrofia cerebral generalizada 6&#37;&#44; secuelas de traumatismo craneoencef&#225;lico 2&#37;&#44; neoplasia 2&#37; y otras encefalopat&#237;as no especificadas 12&#37;&#46; El grupo control fue seleccionado de diversas guarder&#237;as y colegios de la ciudad mediante emparejamiento&#44; de modo que tuviese los mismos valores de edad y sexo que el grupo cl&#237;nico&#46; Ning&#250;n ni&#241;o de este grupo sufr&#237;a trastornos neurol&#243;gicos o psiqui&#225;tricos ni d&#233;ficits sensoriales o motores&#46; Se siguieron los protocolos establecidos por el hospital para acceder a los datos de las historias cl&#237;nicas&#46; El proyecto pas&#243; por el comit&#233; &#233;tico del hospital y los padres o tutores firmaron un consentimiento informado para la participaci&#243;n en esta investigaci&#243;n&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Procedimiento</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los sujetos fueron evaluados en un una sola sesi&#243;n consistente en la recogida de datos de la historia cl&#237;nica&#44; entrevista con los padres y aplicaci&#243;n de la prueba de cribado del BDI&#44; seg&#250;n las instrucciones detalladas en el procedimiento de la prueba mediante la administraci&#243;n directa al ni&#241;o y la entrevista estructurada con los padres para aquellos &#237;tems no observables en la sala de evaluaci&#243;n &#40;alimentaci&#243;n&#44; higiene&#44; relaci&#243;n con los iguales&#44; etc&#46;&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Instrumentos</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se utiliz&#243; la adaptaci&#243;n espa&#241;ola de la prueba de cribado del BDI<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> debido a su r&#225;pida administraci&#243;n&#44; a que est&#225; dise&#241;ada para facilitar informaci&#243;n &#250;til para el tratamiento de los problemas detectados y a su amplio rango de edad&#44; lo cual son tres ventajas dentro del ambiente cl&#237;nico&#46; La aplicaci&#243;n de la prueba de cribado presenta en todas las subescalas correlaciones con la prueba total por encima de 0&#44;96&#44; excepto para el &#225;rea cognitiva que es de 0&#44;92<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; Por consiguiente&#44; los resultados de la prueba predicen perfectamente los resultados de todo el inventario y sus componentes&#46; Se divide en cinco &#225;reas&#58; personal&#47;social&#44; adaptativa&#44; motora &#40;fina y gruesa&#41;&#44; comunicaci&#243;n &#40;receptiva y expresiva&#41; y cognitiva&#44; ofreciendo tambi&#233;n una puntuaci&#243;n total&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="par0060" class="elsevierStylePara elsevierViewall">Es una investigaci&#243;n ex post facto de dise&#241;o prospectivo simple<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; La variable independiente es la presencia de PC &#40;con dos grupos&#58; uno cl&#237;nico&#44; compuesto por sujetos con PC y lesiones cerebrales objetivadas en las pruebas de neuroimagen&#44; y otro control&#44; formado por ni&#241;os sin ning&#250;n trastorno&#41; y la variable dependiente es la puntuaci&#243;n total y de las diferentes subescalas del cribado del BDI&#46; Las puntuaciones directas fueron transformadas en edades equivalentes utilizando los baremos normativos proporcionados por la prueba&#46; Tambi&#233;n se transformaron en cocientes de desarrollo dividiendo las edades equivalentes entre las edades reales y multiplicando el resultado por 100&#46; En los ni&#241;os nacidos con prematuridad se realiz&#243; la correcci&#243;n por edad al pasar la escala&#46; Las variables sexo y edad fueron controladas mediante emparejamiento&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Al tratarse de un dise&#241;o ex post facto prospectivo simple&#44; se utiliz&#243; el test de la t de Student para la comparaci&#243;n de dos variables&#44; el ANOVA de un factor y comparaciones para pares de niveles a posteriori mediante el procedimiento de Bonferroni &#40;que mantiene constante el riesgo &#945; en el total de comparaciones&#41;&#44; y la prueba de la chi al cuadrado para las variables cualitativas<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; Se consider&#243; estad&#237;sticamente significativa una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se estimaron los intervalos de confianza del 95&#37;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">No se encontraron diferencias significativas en la prueba de la t de Student en funci&#243;n del sexo en las puntuaciones de la prueba en ninguno de los dos grupos &#40;todas las p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;1124&#41; por ese motivo ambos sexos se analizaron como un &#250;nico grupo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se estudiaron las puntuaciones de los sujetos en las diferentes subescalas de la prueba para los grupos cl&#237;nico y control&#46; Las puntuaciones medias &#40;M&#41; y Dt de los distintos grupos de edad y los resultados de la prueba de la t de Student en la comparaci&#243;n del grupo cl&#237;nico y el grupo control se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Al comparar los resultados del conjunto de todos los sujetos del grupo control y el grupo cl&#237;nico&#44; observamos que los del grupo control obtienen unas puntuaciones con una significaci&#243;n estad&#237;sticamente superior a los del grupo cl&#237;nico en todas las subescalas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; En los ni&#241;os menores de un a&#241;o&#44; los sujetos del grupo control obtienen puntuaciones superiores y estad&#237;sticamente significativas en todas las escalas&#44; excepto en las sub&#225;reas personal&#47;social&#44; adaptativa y motora fina&#44; donde no se encontraron diferencias estad&#237;sticamente significativas&#46; En los dem&#225;s grupos de edad&#44; los ni&#241;os del grupo control obtienen resultados estad&#237;sticamente significativos y mejores que los del grupo cl&#237;nico en todas las subpruebas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Al comparar mediante el ANOVA de un factor &#40;con correcci&#243;n de Bonferroni&#41; los cocientes de desarrollo obtenidos por los ni&#241;os con distintos trastornos motores que compon&#237;an el grupo cl&#237;nico&#44; se obtuvieron diferencias estad&#237;sticamente significativas entre los ni&#241;os con tetraplej&#237;a y todos los dem&#225;s en las &#225;reas adaptativa&#44; motora fina&#44; motora gruesa y motora total&#44; pero no en el resto de las subescalas&#44; donde no se encontraron diferencias estad&#237;sticamente significativas&#46; No se encontraron diferencias al comparar entre s&#237; los sujetos con las dem&#225;s patolog&#237;as motoras en ninguna subprueba &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3 y 4</a>&#41;&#46; No se analizaron estas diferencias entre los distintos grupos de edad debido al tama&#241;o de la muestra&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">El 62&#37; de los sujetos del grupo cl&#237;nico obtuvieron resultados patol&#243;gicos en la subescala cognitiva &#40;definido como una puntuaci&#243;n de 2 Dt por debajo de la M&#41;&#46; Al dividir este grupo seg&#250;n patolog&#237;as motoras&#44; obtuvimos una puntuaci&#243;n patol&#243;gica en un 50&#37; de los ni&#241;os con hemiplej&#237;a&#44; un 77&#37; de los ni&#241;os con tetraplej&#237;a&#44; un 75&#37; de los que padec&#237;an diplej&#237;a y un 55&#37; de ni&#241;os con otros trastornos motores&#46; Estos porcentajes no presentaron diferencias significativas entre s&#237; &#40;chi al cuadrado&#44; &#967;<span class="elsevierStyleSup">2</span>&#40;3&#44; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>250&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;000&#44; p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;572&#41;&#46; Ning&#250;n ni&#241;o del grupo control obtuvo en esta escala puntuaciones 2 Dt inferiores a la M&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0090" class="elsevierStylePara elsevierViewall">Las bajas puntuaciones de los ni&#241;os con PC en las escalas de desarrollo han sido informadas por la literatura<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21-23&#44;27&#44;28</span></a> mostrando que estas son una buena herramienta para detectar los trastornos del desarrollo en los primeros a&#241;os de la infancia&#46; Este estudio muestra la detecci&#243;n de d&#233;ficits en m&#250;ltiples &#225;reas del desarrollo en ni&#241;os menores de 5 a&#241;os con PC mediante la prueba de cribado del BDI&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los resultados muestran que la prueba detecta las diferencias entre el grupo control y el cl&#237;nico en todos los niveles de edad&#46; Esto se&#241;ala la utilidad de este instrumento incluso en ni&#241;os menores de 12 meses&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Como se esperaba de acuerdo con lo se&#241;alado por otros estudios<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; la mayor&#237;a de los ni&#241;os con PC presentan d&#233;ficits marcados en el desarrollo de todas las &#225;reas evaluadas&#46; Esto supone que la lesi&#243;n cerebral produce una disminuci&#243;n generalizada del funcionamiento en todos los &#225;mbitos de la vida&#44; que se traduce en dificultades de adaptaci&#243;n escolar y familiar&#44; alto grado de dependencia&#44; as&#237; como la presencia de trastornos del aprendizaje y de la comunicaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;17&#44;18</span></a>&#46; Estas diferencias se mantienen e incluso tienden a acentuarse con la edad a lo largo de los primeros 5 a&#241;os de vida&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">No se encontraron diferencias en funci&#243;n del sexo en ninguno de los grupos de edad o patolog&#237;a motora&#46; Esta homogeneidad concuerda con la aportada por los distintos autores&#44; aunque en otro estudio s&#237; se dan diferencias en sujetos con hemiplej&#237;a<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; La modalidad del trastorno motor tiene evidentes influencias en aquellas subescalas que dependen m&#225;s de la capacidad de deambulaci&#243;n y de la necesidad de los miembros superiores funcionales para realizar la mayor&#237;a de las actividades de la vida diaria&#46; As&#237;&#44; los sujetos con tetraplej&#237;a muestran unos resultados significativamente inferiores a los que sufren diplej&#237;a&#44; hemiplej&#237;a u otros trastornos motores&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nuestros resultados &#40;62&#37; de la muestra cl&#237;nica con d&#233;ficits en la funci&#243;n cognitiva&#41; concuerdan con los datos aportados por la literatura&#44; que sit&#250;an entre un 30 y un 70&#37; el porcentaje de sujetos con PC que presentan d&#233;ficits intelectuales<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;14&#44;29-31</span></a>&#46; Los porcentajes de sujetos con puntuaciones cognitivas patol&#243;gicas seg&#250;n el trastorno motor tambi&#233;n se asemejan a los datos aportados por la mayor&#237;a de los autores&#44; observ&#225;ndose una alta proporci&#243;n&#44; superior al 70&#37; en los pacientes con tetraplej&#237;a y diplej&#237;a&#44; y una cantidad inferior &#40;50&#37;&#41; en los que sufr&#237;an hemiplej&#237;a&#46; Ning&#250;n ni&#241;o del grupo control obtuvo puntuaciones patol&#243;gicas en el &#225;rea cognitiva &#40;definidas por 2 Dt por debajo de la M&#41;&#44; mientras que se observan en un 62&#37; de los ni&#241;os con PC&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Resulta evidente que el reducido tama&#241;o de la muestra por cada grupo de edad es una limitaci&#243;n del presente estudio&#46; El n&#250;mero reducido de participantes de cada grupo de edad en las categor&#237;as de d&#233;ficit motor puede ser la causa de que no se encontraran diferencias significativas entre las capacidades cognitivas de los ni&#241;os con afectaci&#243;n unilateral y bilateral&#46; Por otra parte&#44; al comparar a ni&#241;os de los grupos cl&#237;nico y control de diferentes edades&#44; los &#250;nicos datos no significativos que se obtienen en algunas &#225;reas aparecen en los sujetos de menos de un a&#241;o&#44; que constituyen el grupo menos numeroso&#44; por lo que cabe la posibilidad de que las diferencias aumentaran con una muestra m&#225;s amplia&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Del presente estudio concluimos que&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los ni&#241;os con PC sufren desde el nacimiento d&#233;ficits en todas las &#225;reas del desarrollo&#44; que afectan a todos los &#225;mbitos medidos por la prueba de cribado del BDI &#40;personal y social&#44; adaptativo&#44; motor&#44; comunicativo y cognitivo&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">Se dan diferencias significativas en todas las &#225;reas respecto a un grupo control que se mantienen al menos durante los primeros 5 a&#241;os de edad del ni&#241;o&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">No se encontraron diferencias en funci&#243;n del sexo en ninguno de los dos grupos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">Un alto porcentaje de sujetos de grupo cl&#237;nico &#40;62&#37;&#41; presentan d&#233;ficits cognitivos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los d&#233;ficits presentados por los ni&#241;os con PC se pueden objetivar a edades muy tempranas de modo amplio mediante el uso de una escala breve de desarrollo como el cribado de la BDI&#46;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">La principal aportaci&#243;n de este estudio tiene car&#225;cter cl&#237;nico y se refiere a la posibilidad de realizar una detecci&#243;n temprana de los trastornos en el desarrollo de los ni&#241;os con PC&#44; incluso durante el primer a&#241;o de vida&#44; empleando una prueba de administraci&#243;n sencilla y breve&#46; La implantaci&#243;n sistem&#225;tica de este m&#233;todo de detecci&#243;n ser&#237;a de gran ayuda en el tratamiento e intervenci&#243;n temprana de los d&#233;ficits asociados a esta condici&#243;n m&#233;dica&#46; Esto supone prever y anticipar los medios necesarios para la intervenci&#243;n multidisciplinar&#44; as&#237; como facilitar la orientaci&#243;n a otros profesionales de la salud y proporcionar el apoyo escolar&#44; social y familiar que necesitar&#225;n en un futuro inmediato&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La par&#225;lisis cerebral &#40;PC&#41; est&#225; frecuentemente asociada a trastornos en diversas funciones &#40;movilidad&#44; lenguaje y capacidades cognitivas entre otras&#41;&#44; que provocan deficiencias en las habilidades de la vida diaria&#44; sociales&#44; acad&#233;micas y de independencia personal&#46; La detecci&#243;n precoz de estos d&#233;ficits en el &#225;mbito cl&#237;nico es esencial para prever y dotar al sujeto de los apoyos necesarios para la adaptaci&#243;n a su entorno en todos los &#225;mbitos&#46; El objetivo principal de este estudio demostrar que estos d&#233;ficits se pueden objetivar a edades muy tempranas y de modo amplio mediante el uso de una escala breve de desarrollo&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; a 100 ni&#241;os de entre 4 y 70 meses de edad&#44; la mitad de los cuales presentan PC y la otra mitad no padece ning&#250;n tipo de trastorno&#46; Todos los sujetos fueron evaluados mediante la prueba de cribado del inventario de desarrollo de Battelle &#40;BDI&#41;&#44; de lo cual se obtuvieron cocientes de desarrollo que fueron comparados entre ambos grupos y entre los sujetos con diferentes alteraciones motoras mediante un dise&#241;o ex post facto prospectivo simple&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prueba detecta las diferencias entre ambos grupos de estudio en todos los niveles de edad y entre los sujetos con tetraplej&#237;a y el resto de trastornos motores&#44; no encontr&#225;ndose diferencias en funci&#243;n del sexo&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los d&#233;ficits en el desarrollo asociados a la PC se pueden objetivar a edades muy tempranas mediante el uso de una escala breve de desarrollo&#44; por lo que la implantaci&#243;n sistem&#225;tica de este m&#233;todo de detecci&#243;n ser&#237;a de gran ayuda para su tratamiento e intervenci&#243;n temprana&#46; Esto permitir&#237;a prever y anticipar los medios necesarios para la intervenci&#243;n multidisciplinar&#44; proporcionar orientaci&#243;n a otros profesionales de la salud y adecuar el apoyo escolar&#44; social y familiar&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cerebral palsy is usually associated with motor&#44; cognitive&#44; and language deficits&#44; and with other disorders that cause disability in daily living skills&#44; personal independence&#44; social interaction and academic activities&#46; Early detection of these deficits in the clinical setting is essential to anticipate and provide the child with the necessary support for adapting to the environment in all possible areas&#46; The main objective of this study is to demonstrate that these deficits can be detected at an early age and comprehensively through the use of a brief development scale&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We studied 100 children between 4 and 70 months old&#44; half of them with cerebral palsy and the other half without any disorder&#46; All subjects were evaluated using the Battelle Developmental Inventory screening test&#46; We compared the developmental quotients in both groups and between the subjects with different motor impairments&#44; using a simple prospective ex post facto design&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The test detected statistically significant differences between the clinical group and the control group at all age levels&#46; Statistically significant differences were also found between tetraplegia and other motor disorders&#46; There were no differences by gender&#46;</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The deficit in development associated with cerebral palsy can be quantified at early ages through the use of a brief development scale&#44; thus we propose that the systematic implementation of protocols with this screening tool would be helpful for treatment and early intervention&#46; This would also help in anticipating and establishing the means for the multidisciplinary actions required&#44; and could provide guidance to other health professionals&#44; to provide adequate school&#44; social&#44; and family support&#44;&#46;</p>"
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    "multimedia" => array:6 [
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        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Puntuaciones en cociente de desarrollo de los grupos cl&#237;nico y control en las distintas subescalas &#40;gris&#58; grupo control&#59; blanco&#58; grupo cl&#237;nico&#41;&#46; A&#58; adaptativa&#59; Cog&#58; cognitiva&#59; Com&#58; comunicativa&#59; E&#58; expresiva&#59; Mf&#58; motora fina&#59; Mg&#58; motora gruesa&#59; Mot&#58; motora&#59; P&#47;S&#58; personal-social&#59; R&#58; receptiva&#59; Tot&#58; total&#46;</p>"
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      1 => array:7 [
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        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Puntuaciones de edades equivalentes totales en los grupos cl&#237;nico y control en los distintos grupos de edad &#40;cuadrados&#58; grupo control&#59; tri&#225;ngulos&#58; grupo cl&#237;nico&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " colspan="14" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Medias y desviaciones t&#237;picas en los grupos cl&#237;nico y control</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Todos</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">0 a&#241;os</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1 a&#241;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">3 a&#241;os</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">5 a&#241;os</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Com&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab192031.png"
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            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t" style="border-bottom: 2px solid black">Valor de la t y significaci&#243;n estad&#237;stica en la comparaci&#243;n entre los grupos cl&#237;nico y control</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">gl 14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">gl 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">TP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">TP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Significaci&#243;n estad&#237;stica de los resultados de la correcci&#243;n de Bonferroni en las subpruebas que hab&#237;an mostrado diferencias significativas en la ANOVA de un factor al comparar los sujetos con distintas patolog&#237;as motoras</p>"
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La prueba de cribado del inventario de desarrollo de Battelle para la detección precoz de alteraciones del desarrollo en parálisis cerebral
The Battelle developmental inventory screening test for early detection of developmental disorders in cerebral palsy
E. Moraleda-Barrenoa,b,
Autor para correspondencia
enrique.moraleda@dpsi.uhu.es

Autor para correspondencia.
, M. Romero-Lópeza,b, M.J. Cayetano-Menéndeza,b
a Servicio de Neuropsicología y Rehabilitación SEREN, Huelva, España
b Departamento de Psicología Clínica, Experimental y Social, Facultad de Ciencias de la Educación, Universidad de Huelva, Huelva, España
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y las alteraciones visuales&#44; que afectan a un 40&#37;&#44; y auditivas que sufren entre el 10 y el 16&#37;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; La presencia de estas complicaciones se ha relacionado con la disminuci&#243;n de las capacidades cognitivas<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8-10</span></a>&#44; hall&#225;ndose d&#233;ficits en estas &#225;reas entre un 40&#37; y un 65&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; constituyendo las principales la lentitud en el procesamiento de la informaci&#243;n&#44; la dificultad en la descodificaci&#243;n de est&#237;mulos complejos&#44; el aumento en el tiempo de reacci&#243;n y las dificultades de asociaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La incidencia del retraso mental definido como puntuaciones de cociente intelectual &#40;CI&#41; de 69 o menos se sit&#250;a entre el 30 y el 70&#37;&#44; siendo grave entre el 14 y el 59&#37;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;10</span></a>&#46; La frecuencia del retraso mental var&#237;a de manera significativa entre los subtipos de PC y los niveles de deterioro var&#237;an dentro de cada subtipo&#46; La mayor&#237;a de los ni&#241;os con tetraplej&#237;a esp&#225;stica sufren deficiencia mental grave&#44; mientras que entre el 40 y el 50&#37; de los ni&#241;os con hemiplej&#237;a tiene un CI medio y un 18&#37; presenta un CI superior a 100<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; En los ni&#241;os con diplej&#237;a esp&#225;stica&#44; suelen estar relacionados la gravedad del d&#233;ficit motor y el nivel de retraso<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por otra parte&#44; los problemas de conducta&#44; el d&#233;ficit de atenci&#243;n con hiperactividad o el negativismo son m&#225;s comunes en ni&#241;os con PC que en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Los ni&#241;os con PC y deterioro cognitivo reducen sus niveles de participaci&#243;n en numerosos &#225;mbitos de la vida&#44; tales como el autocuidado&#44; las actividades recreativas&#44; las relaciones personales&#44; sociales&#44; la vida familiar y escolar<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Esto incrementa el riesgo de sufrir aislamiento social y rechazo de los iguales&#44; lo cual&#44; junto a la falta de capacidades funcionales y de independencia personal&#44; puede causar problemas adicionales de salud mental<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para evaluar el desarrollo en ni&#241;os peque&#241;os suelen utilizarse escalas de desarrollo&#44; que eval&#250;an las distintas &#225;reas&#44; incluidas las capacidades cognitivas&#46; Han sido elaboradas con el fin de estudiar a los ni&#241;os desde el nacimiento y por ello son &#250;tiles para obtener respuestas de sujetos con poca movilidad y lenguaje&#59; adem&#225;s&#44; algunas de ellas est&#225;n dise&#241;adas para la realizaci&#243;n y la valoraci&#243;n de programas de intervenci&#243;n&#44; de manera que se adecuan m&#225;s que los test de inteligencia para el estudio de los ni&#241;os con PC&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En algunos ni&#241;os&#44; como los que presentan bajo peso al nacer pero que no presentan complicaciones neurol&#243;gicas&#44; las bajas puntuaciones en las escalas de desarrollo en los primeros meses de vida no predicen un bajo CI&#44; posiblemente porque sus capacidades se van acercando progresivamente a la normalidad&#59; sin embargo&#44; en los ni&#241;os con lesi&#243;n cerebral el deterioro permanece a lo largo de la infancia<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Por ese motivo&#44; estas escalas pueden resultar &#250;tiles en el pron&#243;stico del desarrollo de estos &#250;ltimos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Shevell et al&#44; en un estudio con ni&#241;os que sufr&#237;an retraso global del desarrollo que inclu&#237;a sujetos con PC y que utilizaba el inventario de desarrollo de Battelle &#40;BDI&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; encontraron baja ejecuci&#243;n en todas las &#225;reas&#44; con unas puntuaciones medias que oscilaron entre un cociente de desarrollo de 66 para la escala total y 71 para la personal-social&#46; El 93&#37; de los sujetos obtuvo puntuaciones inferiores a 1&#44;5 desviaciones t&#237;picas &#40;Dt&#41; de la media en la escala total&#44; el 80&#37; en la cognitiva y el 78&#37; en la personal-social&#46; En otro estudio&#44; con las escalas de desarrollo de Bayley<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#44; se encontr&#243; que los ni&#241;os con PC obtuvieron puntuaciones inferiores en el &#237;ndice de desarrollo psicomotor respecto al &#237;ndice de desarrollo mental &#40;IDM&#41;&#46; En un estudio reciente&#44; con ni&#241;os de entre 2 y 8 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> se encontr&#243; que todos los ni&#241;os con tetraplej&#237;a menores de 4 a&#241;os presentaban un IDM en la escala Bayley III de 3 Dt por debajo de la media&#44; mientras que los que sufr&#237;an hemiplej&#237;a obten&#237;an una media de 77 para los ni&#241;os y 92 para las ni&#241;as&#46; Los sujetos con hemiplej&#237;a mayores de 4 a&#241;os obtuvieron en la Wechsler Pre-school and Primary Scale of Intelligence unos CI medios de 82 &#40;ni&#241;os&#41; y 81 &#40;ni&#241;as&#41;&#44; siendo el verbal de 92 &#40;ni&#241;os&#41; y 90 &#40;ni&#241;as&#41;&#44; y el manipulativo de 74 en ambos sexos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El objetivo del presente trabajo fue estudiar el perfil de desarrollo de los ni&#241;os con PC&#44; de 0 a 5 a&#241;os con diferentes trastornos motores y observar sus diferencias&#44; as&#237; como compararlo con un grupo control sin trastornos en el desarrollo para conocer el alcance de sus d&#233;ficits y su evoluci&#243;n a lo largo de la primera infancia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Participantes</span><p id="par0045" class="elsevierStylePara elsevierViewall">La muestra estuvo compuesta por 100 ni&#241;os de entre 4 y 70 meses &#40;subgrupos de 0&#44; 1&#44; 2&#44; 3&#44; 4 y 5 a&#241;os&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Tanto el grupo cl&#237;nico como el control estaban formados por 50 sujetos &#40;25 ni&#241;os y 25 ni&#241;as&#41;&#46; Para el grupo cl&#237;nico se seleccion&#243; a ni&#241;os con diagn&#243;stico de PC y alteraciones cerebrales detectadas en resonancia magn&#233;tica&#46; Todos eran atendidos en el Servicio de Rehabilitaci&#243;n del Hospital Juan Ram&#243;n Jim&#233;nez de Huelva&#44; en tratamiento o seguimiento fisioter&#225;pico&#44; de atenci&#243;n temprana y&#47;o logop&#233;dico&#46; El 32&#37; naci&#243; con prematuridad y bajo peso&#44; el 6&#37; padeci&#243; sufrimiento fetal&#44; el 19&#37; hipoxia cerebral y un 24&#37; sufr&#237;a epilepsia&#46; Todos padec&#237;an trastornos motores en alg&#250;n grado &#40;hemiplej&#237;a 26&#37;&#44; tetraplej&#237;a 24&#37;&#44; diplej&#237;a 32&#37; y otros d&#233;ficits motores 18&#37;&#41;&#46; Las complicaciones neurol&#243;gicas observadas en t&#233;cnicas de neuroimagen fueron las siguientes&#58; leucomalacia 28&#37;&#44; hemorragia intraventricular perinatal 28&#37;&#44; malformaciones cerebrales 12&#37;&#44; infartos focales 10&#37;&#44; atrofia cerebral generalizada 6&#37;&#44; secuelas de traumatismo craneoencef&#225;lico 2&#37;&#44; neoplasia 2&#37; y otras encefalopat&#237;as no especificadas 12&#37;&#46; El grupo control fue seleccionado de diversas guarder&#237;as y colegios de la ciudad mediante emparejamiento&#44; de modo que tuviese los mismos valores de edad y sexo que el grupo cl&#237;nico&#46; Ning&#250;n ni&#241;o de este grupo sufr&#237;a trastornos neurol&#243;gicos o psiqui&#225;tricos ni d&#233;ficits sensoriales o motores&#46; Se siguieron los protocolos establecidos por el hospital para acceder a los datos de las historias cl&#237;nicas&#46; El proyecto pas&#243; por el comit&#233; &#233;tico del hospital y los padres o tutores firmaron un consentimiento informado para la participaci&#243;n en esta investigaci&#243;n&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Procedimiento</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los sujetos fueron evaluados en un una sola sesi&#243;n consistente en la recogida de datos de la historia cl&#237;nica&#44; entrevista con los padres y aplicaci&#243;n de la prueba de cribado del BDI&#44; seg&#250;n las instrucciones detalladas en el procedimiento de la prueba mediante la administraci&#243;n directa al ni&#241;o y la entrevista estructurada con los padres para aquellos &#237;tems no observables en la sala de evaluaci&#243;n &#40;alimentaci&#243;n&#44; higiene&#44; relaci&#243;n con los iguales&#44; etc&#46;&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Instrumentos</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se utiliz&#243; la adaptaci&#243;n espa&#241;ola de la prueba de cribado del BDI<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> debido a su r&#225;pida administraci&#243;n&#44; a que est&#225; dise&#241;ada para facilitar informaci&#243;n &#250;til para el tratamiento de los problemas detectados y a su amplio rango de edad&#44; lo cual son tres ventajas dentro del ambiente cl&#237;nico&#46; La aplicaci&#243;n de la prueba de cribado presenta en todas las subescalas correlaciones con la prueba total por encima de 0&#44;96&#44; excepto para el &#225;rea cognitiva que es de 0&#44;92<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; Por consiguiente&#44; los resultados de la prueba predicen perfectamente los resultados de todo el inventario y sus componentes&#46; Se divide en cinco &#225;reas&#58; personal&#47;social&#44; adaptativa&#44; motora &#40;fina y gruesa&#41;&#44; comunicaci&#243;n &#40;receptiva y expresiva&#41; y cognitiva&#44; ofreciendo tambi&#233;n una puntuaci&#243;n total&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="par0060" class="elsevierStylePara elsevierViewall">Es una investigaci&#243;n ex post facto de dise&#241;o prospectivo simple<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; La variable independiente es la presencia de PC &#40;con dos grupos&#58; uno cl&#237;nico&#44; compuesto por sujetos con PC y lesiones cerebrales objetivadas en las pruebas de neuroimagen&#44; y otro control&#44; formado por ni&#241;os sin ning&#250;n trastorno&#41; y la variable dependiente es la puntuaci&#243;n total y de las diferentes subescalas del cribado del BDI&#46; Las puntuaciones directas fueron transformadas en edades equivalentes utilizando los baremos normativos proporcionados por la prueba&#46; Tambi&#233;n se transformaron en cocientes de desarrollo dividiendo las edades equivalentes entre las edades reales y multiplicando el resultado por 100&#46; En los ni&#241;os nacidos con prematuridad se realiz&#243; la correcci&#243;n por edad al pasar la escala&#46; Las variables sexo y edad fueron controladas mediante emparejamiento&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Al tratarse de un dise&#241;o ex post facto prospectivo simple&#44; se utiliz&#243; el test de la t de Student para la comparaci&#243;n de dos variables&#44; el ANOVA de un factor y comparaciones para pares de niveles a posteriori mediante el procedimiento de Bonferroni &#40;que mantiene constante el riesgo &#945; en el total de comparaciones&#41;&#44; y la prueba de la chi al cuadrado para las variables cualitativas<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; Se consider&#243; estad&#237;sticamente significativa una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se estimaron los intervalos de confianza del 95&#37;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">No se encontraron diferencias significativas en la prueba de la t de Student en funci&#243;n del sexo en las puntuaciones de la prueba en ninguno de los dos grupos &#40;todas las p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;1124&#41; por ese motivo ambos sexos se analizaron como un &#250;nico grupo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se estudiaron las puntuaciones de los sujetos en las diferentes subescalas de la prueba para los grupos cl&#237;nico y control&#46; Las puntuaciones medias &#40;M&#41; y Dt de los distintos grupos de edad y los resultados de la prueba de la t de Student en la comparaci&#243;n del grupo cl&#237;nico y el grupo control se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Al comparar los resultados del conjunto de todos los sujetos del grupo control y el grupo cl&#237;nico&#44; observamos que los del grupo control obtienen unas puntuaciones con una significaci&#243;n estad&#237;sticamente superior a los del grupo cl&#237;nico en todas las subescalas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; En los ni&#241;os menores de un a&#241;o&#44; los sujetos del grupo control obtienen puntuaciones superiores y estad&#237;sticamente significativas en todas las escalas&#44; excepto en las sub&#225;reas personal&#47;social&#44; adaptativa y motora fina&#44; donde no se encontraron diferencias estad&#237;sticamente significativas&#46; En los dem&#225;s grupos de edad&#44; los ni&#241;os del grupo control obtienen resultados estad&#237;sticamente significativos y mejores que los del grupo cl&#237;nico en todas las subpruebas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Al comparar mediante el ANOVA de un factor &#40;con correcci&#243;n de Bonferroni&#41; los cocientes de desarrollo obtenidos por los ni&#241;os con distintos trastornos motores que compon&#237;an el grupo cl&#237;nico&#44; se obtuvieron diferencias estad&#237;sticamente significativas entre los ni&#241;os con tetraplej&#237;a y todos los dem&#225;s en las &#225;reas adaptativa&#44; motora fina&#44; motora gruesa y motora total&#44; pero no en el resto de las subescalas&#44; donde no se encontraron diferencias estad&#237;sticamente significativas&#46; No se encontraron diferencias al comparar entre s&#237; los sujetos con las dem&#225;s patolog&#237;as motoras en ninguna subprueba &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3 y 4</a>&#41;&#46; No se analizaron estas diferencias entre los distintos grupos de edad debido al tama&#241;o de la muestra&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">El 62&#37; de los sujetos del grupo cl&#237;nico obtuvieron resultados patol&#243;gicos en la subescala cognitiva &#40;definido como una puntuaci&#243;n de 2 Dt por debajo de la M&#41;&#46; Al dividir este grupo seg&#250;n patolog&#237;as motoras&#44; obtuvimos una puntuaci&#243;n patol&#243;gica en un 50&#37; de los ni&#241;os con hemiplej&#237;a&#44; un 77&#37; de los ni&#241;os con tetraplej&#237;a&#44; un 75&#37; de los que padec&#237;an diplej&#237;a y un 55&#37; de ni&#241;os con otros trastornos motores&#46; Estos porcentajes no presentaron diferencias significativas entre s&#237; &#40;chi al cuadrado&#44; &#967;<span class="elsevierStyleSup">2</span>&#40;3&#44; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>250&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;000&#44; p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;572&#41;&#46; Ning&#250;n ni&#241;o del grupo control obtuvo en esta escala puntuaciones 2 Dt inferiores a la M&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0090" class="elsevierStylePara elsevierViewall">Las bajas puntuaciones de los ni&#241;os con PC en las escalas de desarrollo han sido informadas por la literatura<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21-23&#44;27&#44;28</span></a> mostrando que estas son una buena herramienta para detectar los trastornos del desarrollo en los primeros a&#241;os de la infancia&#46; Este estudio muestra la detecci&#243;n de d&#233;ficits en m&#250;ltiples &#225;reas del desarrollo en ni&#241;os menores de 5 a&#241;os con PC mediante la prueba de cribado del BDI&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los resultados muestran que la prueba detecta las diferencias entre el grupo control y el cl&#237;nico en todos los niveles de edad&#46; Esto se&#241;ala la utilidad de este instrumento incluso en ni&#241;os menores de 12 meses&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Como se esperaba de acuerdo con lo se&#241;alado por otros estudios<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; la mayor&#237;a de los ni&#241;os con PC presentan d&#233;ficits marcados en el desarrollo de todas las &#225;reas evaluadas&#46; Esto supone que la lesi&#243;n cerebral produce una disminuci&#243;n generalizada del funcionamiento en todos los &#225;mbitos de la vida&#44; que se traduce en dificultades de adaptaci&#243;n escolar y familiar&#44; alto grado de dependencia&#44; as&#237; como la presencia de trastornos del aprendizaje y de la comunicaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;17&#44;18</span></a>&#46; Estas diferencias se mantienen e incluso tienden a acentuarse con la edad a lo largo de los primeros 5 a&#241;os de vida&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">No se encontraron diferencias en funci&#243;n del sexo en ninguno de los grupos de edad o patolog&#237;a motora&#46; Esta homogeneidad concuerda con la aportada por los distintos autores&#44; aunque en otro estudio s&#237; se dan diferencias en sujetos con hemiplej&#237;a<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; La modalidad del trastorno motor tiene evidentes influencias en aquellas subescalas que dependen m&#225;s de la capacidad de deambulaci&#243;n y de la necesidad de los miembros superiores funcionales para realizar la mayor&#237;a de las actividades de la vida diaria&#46; As&#237;&#44; los sujetos con tetraplej&#237;a muestran unos resultados significativamente inferiores a los que sufren diplej&#237;a&#44; hemiplej&#237;a u otros trastornos motores&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nuestros resultados &#40;62&#37; de la muestra cl&#237;nica con d&#233;ficits en la funci&#243;n cognitiva&#41; concuerdan con los datos aportados por la literatura&#44; que sit&#250;an entre un 30 y un 70&#37; el porcentaje de sujetos con PC que presentan d&#233;ficits intelectuales<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;14&#44;29-31</span></a>&#46; Los porcentajes de sujetos con puntuaciones cognitivas patol&#243;gicas seg&#250;n el trastorno motor tambi&#233;n se asemejan a los datos aportados por la mayor&#237;a de los autores&#44; observ&#225;ndose una alta proporci&#243;n&#44; superior al 70&#37; en los pacientes con tetraplej&#237;a y diplej&#237;a&#44; y una cantidad inferior &#40;50&#37;&#41; en los que sufr&#237;an hemiplej&#237;a&#46; Ning&#250;n ni&#241;o del grupo control obtuvo puntuaciones patol&#243;gicas en el &#225;rea cognitiva &#40;definidas por 2 Dt por debajo de la M&#41;&#44; mientras que se observan en un 62&#37; de los ni&#241;os con PC&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Resulta evidente que el reducido tama&#241;o de la muestra por cada grupo de edad es una limitaci&#243;n del presente estudio&#46; El n&#250;mero reducido de participantes de cada grupo de edad en las categor&#237;as de d&#233;ficit motor puede ser la causa de que no se encontraran diferencias significativas entre las capacidades cognitivas de los ni&#241;os con afectaci&#243;n unilateral y bilateral&#46; Por otra parte&#44; al comparar a ni&#241;os de los grupos cl&#237;nico y control de diferentes edades&#44; los &#250;nicos datos no significativos que se obtienen en algunas &#225;reas aparecen en los sujetos de menos de un a&#241;o&#44; que constituyen el grupo menos numeroso&#44; por lo que cabe la posibilidad de que las diferencias aumentaran con una muestra m&#225;s amplia&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Del presente estudio concluimos que&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los ni&#241;os con PC sufren desde el nacimiento d&#233;ficits en todas las &#225;reas del desarrollo&#44; que afectan a todos los &#225;mbitos medidos por la prueba de cribado del BDI &#40;personal y social&#44; adaptativo&#44; motor&#44; comunicativo y cognitivo&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">Se dan diferencias significativas en todas las &#225;reas respecto a un grupo control que se mantienen al menos durante los primeros 5 a&#241;os de edad del ni&#241;o&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">No se encontraron diferencias en funci&#243;n del sexo en ninguno de los dos grupos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">Un alto porcentaje de sujetos de grupo cl&#237;nico &#40;62&#37;&#41; presentan d&#233;ficits cognitivos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los d&#233;ficits presentados por los ni&#241;os con PC se pueden objetivar a edades muy tempranas de modo amplio mediante el uso de una escala breve de desarrollo como el cribado de la BDI&#46;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">La principal aportaci&#243;n de este estudio tiene car&#225;cter cl&#237;nico y se refiere a la posibilidad de realizar una detecci&#243;n temprana de los trastornos en el desarrollo de los ni&#241;os con PC&#44; incluso durante el primer a&#241;o de vida&#44; empleando una prueba de administraci&#243;n sencilla y breve&#46; La implantaci&#243;n sistem&#225;tica de este m&#233;todo de detecci&#243;n ser&#237;a de gran ayuda en el tratamiento e intervenci&#243;n temprana de los d&#233;ficits asociados a esta condici&#243;n m&#233;dica&#46; Esto supone prever y anticipar los medios necesarios para la intervenci&#243;n multidisciplinar&#44; as&#237; como facilitar la orientaci&#243;n a otros profesionales de la salud y proporcionar el apoyo escolar&#44; social y familiar que necesitar&#225;n en un futuro inmediato&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La par&#225;lisis cerebral &#40;PC&#41; est&#225; frecuentemente asociada a trastornos en diversas funciones &#40;movilidad&#44; lenguaje y capacidades cognitivas entre otras&#41;&#44; que provocan deficiencias en las habilidades de la vida diaria&#44; sociales&#44; acad&#233;micas y de independencia personal&#46; La detecci&#243;n precoz de estos d&#233;ficits en el &#225;mbito cl&#237;nico es esencial para prever y dotar al sujeto de los apoyos necesarios para la adaptaci&#243;n a su entorno en todos los &#225;mbitos&#46; El objetivo principal de este estudio demostrar que estos d&#233;ficits se pueden objetivar a edades muy tempranas y de modo amplio mediante el uso de una escala breve de desarrollo&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; a 100 ni&#241;os de entre 4 y 70 meses de edad&#44; la mitad de los cuales presentan PC y la otra mitad no padece ning&#250;n tipo de trastorno&#46; Todos los sujetos fueron evaluados mediante la prueba de cribado del inventario de desarrollo de Battelle &#40;BDI&#41;&#44; de lo cual se obtuvieron cocientes de desarrollo que fueron comparados entre ambos grupos y entre los sujetos con diferentes alteraciones motoras mediante un dise&#241;o ex post facto prospectivo simple&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prueba detecta las diferencias entre ambos grupos de estudio en todos los niveles de edad y entre los sujetos con tetraplej&#237;a y el resto de trastornos motores&#44; no encontr&#225;ndose diferencias en funci&#243;n del sexo&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los d&#233;ficits en el desarrollo asociados a la PC se pueden objetivar a edades muy tempranas mediante el uso de una escala breve de desarrollo&#44; por lo que la implantaci&#243;n sistem&#225;tica de este m&#233;todo de detecci&#243;n ser&#237;a de gran ayuda para su tratamiento e intervenci&#243;n temprana&#46; Esto permitir&#237;a prever y anticipar los medios necesarios para la intervenci&#243;n multidisciplinar&#44; proporcionar orientaci&#243;n a otros profesionales de la salud y adecuar el apoyo escolar&#44; social y familiar&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cerebral palsy is usually associated with motor&#44; cognitive&#44; and language deficits&#44; and with other disorders that cause disability in daily living skills&#44; personal independence&#44; social interaction and academic activities&#46; Early detection of these deficits in the clinical setting is essential to anticipate and provide the child with the necessary support for adapting to the environment in all possible areas&#46; The main objective of this study is to demonstrate that these deficits can be detected at an early age and comprehensively through the use of a brief development scale&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We studied 100 children between 4 and 70 months old&#44; half of them with cerebral palsy and the other half without any disorder&#46; All subjects were evaluated using the Battelle Developmental Inventory screening test&#46; We compared the developmental quotients in both groups and between the subjects with different motor impairments&#44; using a simple prospective ex post facto design&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The test detected statistically significant differences between the clinical group and the control group at all age levels&#46; Statistically significant differences were also found between tetraplegia and other motor disorders&#46; There were no differences by gender&#46;</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The deficit in development associated with cerebral palsy can be quantified at early ages through the use of a brief development scale&#44; thus we propose that the systematic implementation of protocols with this screening tool would be helpful for treatment and early intervention&#46; This would also help in anticipating and establishing the means for the multidisciplinary actions required&#44; and could provide guidance to other health professionals&#44; to provide adequate school&#44; social&#44; and family support&#44;&#46;</p>"
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    "multimedia" => array:6 [
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        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Puntuaciones en cociente de desarrollo de los grupos cl&#237;nico y control en las distintas subescalas &#40;gris&#58; grupo control&#59; blanco&#58; grupo cl&#237;nico&#41;&#46; A&#58; adaptativa&#59; Cog&#58; cognitiva&#59; Com&#58; comunicativa&#59; E&#58; expresiva&#59; Mf&#58; motora fina&#59; Mg&#58; motora gruesa&#59; Mot&#58; motora&#59; P&#47;S&#58; personal-social&#59; R&#58; receptiva&#59; Tot&#58; total&#46;</p>"
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      1 => array:7 [
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        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Puntuaciones de edades equivalentes totales en los grupos cl&#237;nico y control en los distintos grupos de edad &#40;cuadrados&#58; grupo control&#59; tri&#225;ngulos&#58; grupo cl&#237;nico&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " colspan="14" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Medias y desviaciones t&#237;picas en los grupos cl&#237;nico y control</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Todos</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">0 a&#241;os</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1 a&#241;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">3 a&#241;os</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">5 a&#241;os</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Dt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Com&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab192031.png"
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            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t" style="border-bottom: 2px solid black">Valor de la t y significaci&#243;n estad&#237;stica en la comparaci&#243;n entre los grupos cl&#237;nico y control</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">gl 14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">gl 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">TP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">TP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Significaci&#243;n estad&#237;stica de los resultados de la correcci&#243;n de Bonferroni en las subpruebas que hab&#237;an mostrado diferencias significativas en la ANOVA de un factor al comparar los sujetos con distintas patolog&#237;as motoras</p>"
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  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331100347X?idApp=UINPBA00005H"
]
Información del artículo
ISSN: 16954033
Idioma original: Español
DOI:10.1016/j.anpedi.2011.06.004
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