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Article in Chinese | WPRIM | ID: wpr-927417


OBJECTIVE@#To compare the effect of combination of intradermal needling with oral motor therapy and simple oral motor therapy on salivation in children with cerebral palsy.@*METHODS@#A total of 60 children with salivation in cerebral palsy were randomized into an observation group and a control group, 30 cases in each group. The observation group was treated with intradermal needling (kept for 24 hours each time at Jiache [ST 6], Dicang [ST 4], tongue three needles, etc. ) and oral motor therapy, while the control group was only given oral motor therapy. The intradermal needling was performed 3 times a week, and oral motor therapy was performed 5 times a week, 4 weeks as a course, totally 3 courses of treatment were required. The classification of teacher drooling scale (TDS), drooling severity and Kubota water swallow test, dysphagia disorders survey (DDS) score were compared before treatment and after 4, 8 and 12 weeks of treatment in both groups, and the clinical efficacy was evaluated.@*RESULTS@#After 8 weeks of treatment in the observation group and after 12 weeks of treatment in the two groups, the classification of TDS and drooling severity were improved (P<0.05), and the observation group was better than the control group after 12 weeks of treatment (P<0.05). After 8 and 12 weeks of treatment, the DDS scores of oral period in the observation group were lower than those before treatment (P<0.05). The total effective rate in the observation group was 83.3% (25/30), which was higher than 53.3% (16/30) in the control group (P<0.05).@*CONCLUSION@#The combination of intradermal needling with oral motor therapy can improve salivation symptoms and swallowing function in children with cerebral palsy, the effect is better than oral motor therapy alone, and the effect is earlier.

Acupuncture Points , Acupuncture Therapy , Cerebral Palsy/therapy , Child , Deglutition Disorders/therapy , Humans , Salivation , Sialorrhea/therapy , Treatment Outcome
Rev. méd. Urug ; 37(3): e37303, set. 2021. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1341551


Resumen: Introducción: la parálisis cerebral (PC) es la causa más frecuente de discapacidad motriz en niños y adolescentes. En el 85% de los casos, la manifestación motora predominante es la espasticidad. Las inyecciones de toxina botulínica tipo A (TB-A) se han usado para reducir la espasticidad en niños con PC. No existen investigaciones a nivel nacional que comprueben si los resultados son comparables a los reportados en la literatura. Objetivo: determinar el efecto del tratamiento con TB-A en el tríceps sural en conjunto con la rehabilitación física en niños con PC espástica durante los años 2017-2018 en el Centro de Rehabilitación Infantil Teletón, Uruguay. Métodos: se realizó un estudio descriptivo, retrospectivo, de cohorte histórica única con seguimiento longitudinal, mediante la revisión de historias clínicas de los pacientes con PC con marcha independiente o asistida que recibieron tratamiento con TB-A para el tratamiento de la espasticidad del tríceps sural durante el período 2017-2018. Resultados: se analizaron 40 procedimientos de inyección de TB-A. Se observó una buena respuesta al mes y a los 3 meses del tratamiento con TB-A, con mejoría del ángulo de dorsiflexión del pie con la rodilla en flexión y en extensión, mejoría del puntaje de la escala de espasticidad de Ashworth modificada y, en el 95% de los procedimientos, de la percepción subjetiva de los padres. Se observó una disminución del efecto hacia los 6 meses de la aplicación. Conclusión: la aplicación de TB-A en el Centro Teletón muestra resultados positivos, comparables con los reportados en la bibliografía internacional.

Abstract: Introduction: cerebral palsy (CP) is the most common source of motor disability in children and adolescents. In 85% of cases, the prevailing motor manifestation is spasticity. Botulinum toxin Type A injections (TB-A) have been used to reduce spasticity in children with cerebral palsy (CP). There are no studies at the national level that show whether the results are comparable to those reported in literature. Objective: to determine the effect of TB-A therapy in the triceps surae along with the physical rehabilitation in children with spastic cerebral palsy (CP) during 2017-2018 at the Teleton Children´s Rehabilitation Center, Uruguay. Method: retrospective, descriptive study of a single cohort with a longitudinal follow-up was conducted, through the review of medical records belonging to patients with CP with independent or assisted gait, who received TB-A therapy to treat sural triceps spasticity during 2017-2018. Results: 40 TB-A injection procedures were analysed. A good response was observed one month and three months after being treated with TB-A, evidencing improvement in the dorsiflexion angle between the foot and the knee in flexion and extension, improvement on the modified Ashworth spasticity scale score and, in 95% of procedures, the subjective perception of parents. The effect was observed to decrease towards 6 months after the procedure. Conclusion: application of TB-A at the Teletón Center shows positive results, comparable to those reported by international blibliography.

Resumo: Introdução: a paralisia cerebral (PC) é a causa mais freqüente de deficiência motora em crianças e adolescentes. Em 85% dos casos, a manifestação motora predominante é a espasticidade. As injeções de toxina botulínica tipo A (TB-A) têm sido usadas para reduzir a espasticidade em crianças com PC. Não há pesquisas nacionais que verifiquem se os resultados são comparáveis aos relatados na literatura. Objetivo: determinar o efeito do tratamento da TB-A no tríceps sural em conjunto com a reabilitação física em crianças com PC espástica durante os anos 2017-2018 no Centro de Rehabilitación Infantil Teletón, Uruguai. Métodos: estudo descritivo, retrospectivo, com coorte histórica única com acompanhamento longitudinal, realizado por meio da revisão de prontuários de pacientes com PC com deambulação independente ou assistida que receberam tratamento com TB-A para o tratamento da espasticidade do tríceps sural, no período 2017-2018. Resultados: 40 procedimentos de injeção de TB-A foram analisados. Observou-se boa resposta um mês e três meses após o tratamento com TB-A, com melhora no ângulo de dorsiflexão do pé com o joelho em flexão e extensão, melhora no escore da escala de espasticidade de Ashworth modificada e, em 95% dos procedimentos, a partir da percepção subjetiva dos pais. Uma diminuição no efeito foi observada 6 meses após a aplicação. Conclusão: a aplicação do TB-A no Centro de Rehabilitación Infantil Teletón apresentou resultados positivos, comparáveis aos relatados na literatura internacional.

Humans , Child, Preschool , Child , Adolescent , Cerebral Palsy/therapy , Botulinum Toxins, Type A/therapeutic use , Muscle Spasticity
Chinese Acupuncture & Moxibustion ; (12): 1095-1102, 2021.
Article in Chinese | WPRIM | ID: wpr-921016


OBJECTIVE@#To observe the effect of acupuncture combined with rehabilitation training on cognitive function and amino acid metabolism in children with cerebral palsy.@*METHODS@#Twenty children with cerebral palsy (cerebral palsy group) were randomly divided into an acupuncture and rehabilitation group (11 cases) and a rehabilitation group (9 cases), and 10 healthy children were included as the normal group. The rehabilitation group was treated with rehabilitation training, 30 min each time; on the basis of rehabilitation training, the acupuncture and rehabilitation group was treated with acupuncture at Sishenzhen, Zhisanzhen, Naosanzhen, Niesanzhen, Dazhui (GV 14), Shenzhu (GV 12), Mingmen (GV 4), etc. The Sishenzhen (left and right points) and the ipsilateral Niesanzhen were respectively connected with a group of electrodes, intermittent wave, frequency of 2 Hz for 30 min. Both groups were treated once every other day, three times a week, totaling for 3 months. The Gesell developmental diagnostic scale (GESELL) was used to evaluate the developmental quotient (DQ) scores before and after treatment, and the blood samples of children with cerebral palsy before and after treatment and normal children were collected for amino acid metabolomics.@*RESULTS@#Compared before treatment, the DQ scores of adaptation, fine motor and social in the acupuncture and rehabilitation group was increased after treatment (@*CONCLUSION@#Acupuncture combined with rehabilitation training could improve cognitive function in children with cerebral palsy, and the effect may be related to the down-regulation of L-histidine and L-citrulline metabolism.

Acupuncture Points , Acupuncture Therapy , Amino Acids , Cerebral Palsy/therapy , Child , Cognition , Humans
Article in Chinese | WPRIM | ID: wpr-877620


OBJECTIVE@#To explore the rule of point selection in treatment of cerebral palsy with acupuncture in preschool children.@*METHODS@#Based on the electronic medical records of Xi'an Encephalopathy Hospital of TCM, through structuring medical record text, acupuncture prescriptions were extracted. Using the data mining tools of the ancient and modern medical record cloud platform V2.2.3 and the clinical effective prescription and molecular mechanism analysis system of traditional Chinese medicine V2.0, the cluster analysis and complex network analysis were conducted on acupuncture prescriptions.@*RESULTS@#Of 1584 acupuncture prescriptions for cerebral palsy in children, there were 84 acupoints and stimulating areas of scalp acupuncture, of which, foot-motor-sensory area, balance area and Sanyinjiao (SP 6) were the top 3 acupoints with the highest use rate. With cluster analysis, 5 groups of common supplementary acupoints and stimulating areas were found, named, Weizhong (BL 40) and Waiguan (TE 5), Shousanli (LI 10), Xingjian (LR 2), Xuanzhong (GB 39) and Chengfu (BL 36), foot-motor-sensory area, balance area and Sanyinjiao (SP 6), Xuehai (SP 10) and Fenglong (ST 40), Pishu (BL 20), motor area and Yanglingquan (GB 34). With complex network analysis on core prescriptions, 13 core acupoints and stimulating areas of scalp acupuncture were obtained, including 3 core main points, i.e. Sanyinjiao (SP 6), balance area and foot-motor-sensory area and 10 sub-core points, i.e. Taichong (LR 3), motor area, Xuehai (SP 10), Ganshu (BL 18), Pishu (BL 20), Yanglingquan (GB 34), Sishencong (EX-HN 1), Baihui (GV 20), Fengchi (GB 20) and Shenshu (BL 23).@*CONCLUSION@#In treatment of acupuncture for cerebral palsy in preschool children, the core prescriptions reveal the simultaneous treatment of exterior and interior, the mutual regulation of

Acupuncture Points , Acupuncture Therapy , Cerebral Palsy/therapy , Child, Preschool , Data Mining , Electronic Health Records , Humans
Fisioter. Pesqui. (Online) ; 26(1): 101-109, Jan.-Mar. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1002011


RESUMO A paralisia cerebral é um grupo de desordens neurológicas causadora de inúmeros déficits, principalmente relacionados à função motora, comprometendo os movimentos e o seu controle seletivo. Dentre as diversas terapias disponíveis para tentar amenizar esse processo, o cicloergômetro aparece como um aparato estacionário que tem por finalidade facilitar a movimentação dos membros inferiores. Portanto, o objetivo deste estudo foi analisar os efeitos do cicloergômetro na função motora grossa de crianças com paralisia cerebral através da escala Gross Motor Function Measure (GMFM-66). Trata-se de uma revisão sistemática, com inclusão de ensaios clínicos randomizados publicados até julho de 2017. A busca foi realizada nas bases de dados: MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), SciELO e Embase. Para a avaliação da qualidade metodológica das investigações foi utilizada a escala da Cochrane Handbook. Foram selecionados artigos que aplicaram o cicloergômetro em crianças com paralisia cerebral, comparadas a crianças com paralisia cerebral no grupo-controle ou em outra intervenção, e que avaliaram a função motora grossa com a GMFM. A revisão incluiu três artigos e um total de 127 pacientes. Os resultados mostraram um aumento nos valores da GMFM-66, porém não significativo estatisticamente nem relevantes para uma melhora clínica. Por meio desta revisão sistemática, verificou-se uma grande heterogeneidade nos estudos que abordam esta área e que, apesar do incremento de valores no grupo que realizou o cicloergômetro, não houve diferença estatística quando comparado ao grupo-controle, demonstrando não beneficiar a função motora grossa dessa população quando avaliada pela GMFM66.

RESUMEN La parálisis cerebral es un grupo de desórdenes neurológicos causantes de innumerables déficits, principalmente relacionados con la función motora, y que compromete los movimientos y su control selectivo. Entre las diversas terapias disponibles para intentar amenizar ese proceso, el cicloergómetro aparece como un aparato estacionario que tiene por finalidad facilitar el movimiento de los miembros inferiores. Por lo tanto, este estudio buscó analizar los efectos del cicloergómetro en la función motora gruesa de niños con parálisis cerebral por medio de la escala Gross Motor Function Measure (GMFM-66). Se trata de una revisión sistemática, con la inclusión de ensayos clínicos aleatorizados publicados hasta julio de 2017. La búsqueda se realizó en las bases de datos: MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), SciELO y Embase. En la evaluación de la calidad metodológica de las investigaciones se utilizó la escala de Cochrane Handbook. Se seleccionaron los artículos que aplicaron el cicloergómetro en niños con parálisis cerebral, comparados a niños con parálisis cerebral en el grupo control o el grupo intervención, y que evaluaron la función motora gruesa con la GMFM. La revisión incluyó tres artículos y un total de 127 pacientes. Los resultados mostraron un aumento en los valores de la GMFM-66, pero no fueron significativos estadísticamente ni relevantes para una mejora clínica. Por medio de esta revisión sistemática, se verificó una gran heterogeneidad en los estudios sobre esta área y que, a pesar del incremento de valores en el grupo que realizó el cicloergómetro, no hubo diferencia estadística cuando comparado al grupo control, demostrando que no benefició la función motora gruesa de esa población cuando evaluada por la GMFM-66.

ABSTRACT Cerebral palsy is a group of neurological disorders that causes innumerable deficits, mainly related to motor function, compromising movements and their selective control. Among the various therapies available to try to soften this process, the cycle ergometer appears as a stationary apparatus that aims to facilitate the movement of the lower limbs. Therefore, this study aimed to analyze the effects of the cycle ergometer on the gross motor function of children with cerebral palsy by the Gross Motor Function Measure (GMFM-66) scale. This was a systematic review, with inclusion of randomized clinical trials published until July 2017. The search was performed in MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), SciELO, and Embase. The Cochrane Handbook Scale was used to evaluate the methodological quality of the investigations. We selected articles that applied the cycle ergometer in children with cerebral palsy, compared to children with cerebral palsy in the control group or other intervention, and that assessed gross motor function with GMFM. The review included three articles and a total of 127 patients. The results have shown a not statistically significant increase in GMFM-66 values, not relevant for clinical improvement. This systematic review has found great heterogeneity in the studies addressing this area and, despite the increase in values in the group that used the cycle ergometer, there was no statistical difference compared to the control group, showing that it does not benefit the gross motor function of this population, when evaluated by GMFM-66.

Humans , Child , Adolescent , Cerebral Palsy/therapy , Exercise Therapy/instrumentation , Exercise Therapy/methods , Outcome Assessment, Health Care/methods , Lower Extremity/physiopathology , Monitoring, Physiologic/methods , Motor Skills/physiology
Rev. bras. epidemiol ; 22: e190006, 2019. tab
Article in Portuguese | LILACS | ID: biblio-990727


RESUMO: Introdução: O Método Therasuit possui alto custo e não é disponibilizado pelo Sistema Único de Saúde, o que tem ocasionado a judicialização desse tratamento. O estudo visou traçar o perfil dessa judicialização, bem como estimar os custos diretos decorrentes do cumprimento das decisões judiciais deferidas. Método: Foram analisados processos submetidos ao Tribunal de Justiça do Rio de Janeiro entre janeiro de 2013 e janeiro de 2017, no qual foi solicitado o Método Therasuit. Os dados demográficos, clínicos, advocatícios e jurídicos foram extraídos, assim como o tempo da decisão judicial e os orçamentos da tecnologia requerida. Resultados: O total de 11 processos foi analisado. Os autores tinham uma média de idade de 6,8 anos e mediana de 6, sendo a maioria do sexo masculino e residentes na capital do estado. A quadriparesia foi a condição mais relatada. A gratuidade de justiça foi solicitada por todos, e a Defensoria Pública foi utilizada em 9 dos 11 processos analisados. Foram consideradas as decisões judiciais em primeira instância. O tempo da decisão judicial foi em média de 266,5 dias com uma mediana de 35,5. Em todos houve requerimento da ferramenta jurídica tutela antecipada. O índice de deferimento foi de 90%, totalizando um custo direto anual de R$501.894,09. Discussão: A judicialização desse tratamento pode ocasionar um deslocamento não previsto de verba pública, podendo impactar nos princípios da equidade e na integralidade do Sistema Único de Saúde. Conclusão: Constatou-se elevada taxa de processos deferidos, acarretando um alto custo despendido pelo Poder Público para atender a uma pequena parcela de pacientes.

ABSTRACT: Introduction: The lack of availability of the Therasuit Method by the Unified Health System associated with its high cost has led to the prosecution of this treatment. The study aimed to outline the profile of this judicialization, as well as to estimate the direct costs resulting from compliance with the deferred judicial decisions. Method: Weanalyzed the cases submitted to the Court of Justice of Rio de Janeiro between January 2013 and January 2017, in which the Therasuit Method was applied. Demographic, clinical, advocacy and legal data were extracted, as was the timing of the court's decision and the required technology budgets. Results: Atotal of 11 processes was analyzed. The authors had a mean age of 6.8 years and a median of 6, the majority being male, and resident in thestate capital. Quadriparesis was the most reported condition. The gratuity of justice was requested by all, and the Public Defender's Officewas used by 9 of the 11 processes. The judicial decisions at first instance were considered. In all of processes there was application of the legal tool called guardianship. The time of the judicial decision was on average of 266.5 days with a median of 35.5. The deferral index was 90%, totaling an annual direct cost of R$501,894.09. Discussion: The judicialization of this treatment can cause an unforeseen displacement of public funds, transgressing the principles of equity and the integrality of Unified Health System. Conclusion: It was observed a high rate of deferred processes, resulting in a high cost spent by the Public Power to attend a small portion of patients.

Humans , Male , Female , Child, Preschool , Child , Cerebral Palsy/therapy , Physical Therapy Modalities/instrumentation , Health Care Costs/legislation & jurisprudence , Patient Rights/legislation & jurisprudence , Health Services Accessibility/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Brazil , Cerebral Palsy/economics , Physical Therapy Modalities/economics , Health Services Accessibility/economics , National Health Programs/economics
Rev. cuba. pediatr ; 90(4): e338, set.-dic. 2018. Ilus, Tab
Article in Spanish | LILACS, CUMED | ID: biblio-978466


Introducción: El traje terapéutico o Therasuit es una órtesis blanda que se usa durante el entrenamiento intensivo de patrones de movimiento en personas con afecciones neurológicas como la parálisis cerebral. Objetivo: Describir los cambios en la función motora gruesa en una población pediátrica con distintos tipos de parálisis cerebral, tratada con el traje terapéutico. Métodos: Estudio observacional longitudinal y retrospectivo donde se tomaron mediciones de la función motora gruesa antes y después de la aplicación del traje terapéutico a 56 niños que asistieron a un centro de neurorehabilitación en Cali, Colombia entre Junio de 2008 a Diciembre de 2014. Los niños se encontraban entre 3 -13 años de edad y en niveles I-V según la Clasificación de la Función Motora Gruesa. Se usó el test de Wicolxon para comparar las medianas de los puntajes de las mediciones con la Gross Motor Function Measure de 88 ítems. Resultados: Se observaron cambios positivos después de la aplicación del traje en los puntajes totales de la Gross Motor Function Measure (p= 0). Se hallaron diferencias positivas en todas las edades (dif. = 2 a 2,5 p<0,05), mayor en los niños de 11 a 13 años. Conclusiones: Los cambios observados después de aplicar el traje terapéutico a niños con parálisis cerebral sugieren que el entrenamiento motor con este enfoque terapéutico es efectivo para el logro de habilidades motoras gruesas. El cambio es más visible en niños severamente comprometidos y con espasticidad(AU)

Introduction: The therapeutic suit or Therasuit is a complementary therapy used in rehabilitation for intensive training of motor patterns in people with cerebral palsy. Objective: To describe the changes in the motor function in a pediatric population with different types of cerebral palsys. Methods: Observational, longitudinal and retrospective study in which the gross motor functions were measured before and after trying the therapeutic suit in 56 children admitted in the Center of Neurorehabilitation in Cali, Colombia from June 2008 to December 2014. The 56 participants had ages from 3 to 13 years, and levels from I to V according to the Classification of Gross Motor Function (GMFCS). Wicolxon test was used to compare the median scores of the 88-item Gross Motor Function Measure (GMFM-66) scale scores applied to children before and after the treatment with the suit. Results: After the application of the suit in children with CP, the differences in the measurements of GMFM-88 were effective (p= 0). Stratification of the population studied by age registered positive differences (dif. = 2 a 2,5 p<0,05) in all ages and greater in children aged 11 to 13 years in the total scores. Conclusions: The positive changes observed after applying the therapeutic suit to children with cerebral paralysis suggest that motor training with this therapeutic approach is effective for the achievement of gross motor skills. The change is more evident in children with severe manifestations and spasticity(AU)

Child, Preschool , Child , Adolescent , Splints , Cerebral Palsy/therapy , Cerebral Palsy/epidemiology , Retrospective Studies , Longitudinal Studies , Observational Studies as Topic , Motor Skills , Motor Skills/ethics
Rev. pesqui. cuid. fundam. (Online) ; 10(3, n. esp): 70-73, jun. 2018.
Article in Portuguese | LILACS, BDENF | ID: biblio-905419


A Fisioterapia tem se tornado cada vez mais importante na atuação dos NASF de todo o país; aos poucos foi inserida gradativamente na Atenção Básica, deixando de ser essencialmente voltada para o processo de reabilitação e passando fortemente a ter também enfoque na promoção da saúde e na prevenção de doenças e agravos. A participação intensa do fisioterapeuta na ESF e em programas e ações similares de cuidados primários em saúde tem sido importante para a concretização das diretrizes de uma assistência à saúde realmente integral, ao contrário do tradicional modelo medicalizado, 72 fragmentado, hospitalocêntrico e baseado na dependência e exclusão social. Nesse sentido, o fisioterapeuta tem sido visto como um profissional que não trabalha apenas procurando a cura dos pacientes e sim promovendo a melhora na qualidade da vida deles. Os portadores de deficiência que apresentam sequelas de PC necessitam de tratamento fisioterapêutico contínuo devido principalmente ao fato de apresentarem retardo motor. Assim, uma das principais atribuições do fisioterapeuta é acompanhar o desenvolvimento desses pacientes para que eles possam apresentar o melhor nível de independência possível. Outra contribuição do tratamento é a prevenção de novas incapacidades e deformidades, sendo, portanto, bastante útil na vida das crianças deficientes. Infelizmente, o setor de Fisioterapia do NASF do município de Alagoa Nova apresenta problemas de organização estrutural em relação à elevada quantidade de pacientes atendidos por dia. Como consequência da sobrecarga de trabalho, a qualidade dos serviços prestados diminui e os objetivos almejados pelos pacientes e pelas famílias não são alcançados. Além disso, os fisioterapeutas atuantes ficam "presos" no setor e deixam de priorizar as atividades preconizadas pelo Ministério da Saúde, como o trabalho de educação em saúde, apoio às equipes da ESF e os atendimentos domiciliares dos pacientes que apresentam dificuldades de locomoção, como por exemplo, as crianças sequeladas de PC. Enfim, sabendo que a coordenação do NASF sempre foi bastante atuante e referindo otimismo em relação às mudanças almejadas, espera-se que as falhas apresentadas sejam corrigidas e que os serviços prestados sejam cada vez mais otimizados no intuito de se obter a completa satisfação dos usuários do SUS, em especial das famílias que tanto lutam quando tem algum membro sequelado de Paralisia Cerebral em casa, que requer cuidados intensivos e essenciais. Os resultados deste estudo poderão contribuir para que haja mudanças significativas na organização estrutural do setor, uma vez que serão apresentados aos gestores locais no intuito de melhorar o atendimento à população

Humans , Male , Female , Child, Preschool , Child , Cerebral Palsy/rehabilitation , Cerebral Palsy/therapy , Physical Therapy Modalities/statistics & numerical data , Family Health , Primary Health Care
Rehabil. integral (Impr.) ; 12(2): 66-74, dic. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-882771


Introduction: Dysarthria is a speech disorder most frequently associated with cerebral palsy (CP). The approach from the phono-audiology perspective is typically based on clinical observation criteria for assessment, diagnosis and intervention. Objective: Identify existing speech-language therapies for the treatment of dysarthria in children with cerebral palsy and assess their effectiveness according to the International Classification of Functioning, Disability and Health (ICF). Materials and Methods: Systematic review carried out according to Cochrane recommendations. Randomized and quasi-experimental clinical studies with children with CP and dysarthria were considered. The search was carried out through the on-line platforms CINAHL Plus, Central (Cochrane), Embase, SciELO and LILACS, Medline (Pub Med), Speech Bite and ScienceDirect. Identified studies were reviewed independently by two authors; disagreements were resolved by a third party. Risk of bias was assessed using Cochrane's risk of bias assessment tool. Results: 840 studies were identified in the on-line search. Only three studies met the inclusion criteria. These correspond to quasi-experimental studies and all three indicate that an intervention model focused on basic motor processes related to respiration, phonation, articulation, fluency and prosody, does improve voice and speech functions. Conclusions: There is no evidence to conclude that there is an effective treatment for dysarthria in children with CP.

Introducción: Uno de los trastornos del habla más frecuentemente asociado a la parálisis cerebral es la disartria. El abordaje fonoaudiológico suele basarse en criterios de observación clínica para la evaluación, diagnóstico e intervención. Objetivo: Identificar las terapias fonoaudiológicas existentes para el tratamiento de la disartria en niños con parálisis cerebral y evaluar la efectividad considerando el marco CIF. Materiales y Método: Revisión sistemática realizada de acuerdo a recomendaciones de la Colaboración Cochrane. Se incluyeron ensayos clínicos aleatorizados y cuasiexperimentales que tuvieran como población niños con parálisis cerebral y disartria. Se realizó la búsqueda a través de CINAHL Plus, Central (Cochrane), Embase, SciELO y LILACS, Medline (vía Pub Med), Speech Bite y ScienceDirect. Los estudios identificados fueron revisados en forma independiente por dos autores, los desacuerdos se resolvieron mediante un tercero. La evaluación del riesgo de sesgo se realizó con la herramienta de la Colaboración Cochrane. Resultados: Se identificaron 840 artículos en la búsqueda electrónica. Solo 3 artículos cumplieron los criterios de inclusión y corresponden a trabajos cuasiexperimentales. Coinciden en que el modelo de intervención enfocado en Procesos Motores Básicos (PMB), del habla respiración, fonación, articulación, resonancia y prosodia, como mejoran las funciones del habla y la voz. Conclusiones: No existe evidencia suficiente para declarar que existe una terapia efectiva para el manejo de los niños con disartria en parálisis cerebral.

Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Speech Therapy/methods , Cerebral Palsy/complications , Dysarthria/therapy , Language Therapy/methods , Cerebral Palsy/therapy , Dysarthria/etiology
Rehabil. integral (Impr.) ; 12(1): 13-21, jun. 2017. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-908004


Introduction: Kinesiotape (Kt) is a therapeutic technique producing somatosensory stimulation when placed on the skin, and has shown improvement in dynamic activities in neuropediatric field; however, there are limited studies on its effect during gait. Objective: To assess the effect of KT in children with spastic hemiparetic cerebral palsy (CP) during gait, when applied on tibialis anterior muscle of the affected side. Method: Study carried out with 9 children with spastic hemiparetic cerebral palsy and Gross Motor Function Classification System (GMFCS) I & II, between 4 and 10 years old, male and female, at Instituto teletón Antofagasta. Gait was recorded in video in 3 instances: before Kt, immediately after application of Kt, and 5 days post application. Recordings were assessed using the Edinburgh Visual Gait Score (EVGS) and range of motion (RoM) of the ankle during gait. Results: None of the subjects showed significant improvement in RoM of the ankle during gait or in the EVGS. Conclusion: Kt did not change ROM of the ankle during gait in the studied cases, nor as an immediate effect or 5 days after application. only 2 out of 9 children showed a 1 point improvement during the swing phase during EVGS. It is suggested to consider other exclusion criteria and extend the duration of Kt therapy.

El vendaje neuromuscular (VN) es una herramienta terapéutica que estimula el nivel somatosensitivo al ubicarlo sobre la piel, que ha demostrado mejoras en actividades dinámicas en el ámbito neuroinfantil; sin embargo, existen escasos estudios sobre su efecto durante la marcha. Objetivo: Evaluar el efecto del VN sobre la marcha de niños con parálisis cerebral (PC) hemiparética espástica, aplicado en músculo tibial anterior del lado afectado. Método: Estudio de 9 niños con PC y Gross Motor Function Classification System (GMFCS) I y II tipo hemiparesia espástica entre 4 y 10 años de edad, de ambos sexos en el Instituto Teletón Antofagasta. Se filmó marcha en 3 instancias: antes del VN, inmediato con VN y a los 5 días post aplicación. Las grabaciones fueron valoradas con la Edinburgh Visual Gait Score (EVGS) y rango de movimiento (RoM) de tobillo durante la marcha. Resultados: Ninguno de los 9 niños presentó mejoría significativa en su ROM del tobillo durante la marcha ni en la EVGS. Conclusión: El vendaje neuromuscular no produjo cambios del RoM del tobillo durante la marcha en los casos presentados, ni como efecto inmediato ni a los 5 días post aplicación. Sólo 2 de 9 mejoraron en 1 punto durante la fase de balanceo en la EVGS. Se sugiere considerar otros criterios de exclusión y ampliar el tiempo de aplicación del VN.

Male , Female , Humans , Child, Preschool , Child , Athletic Tape , Cerebral Palsy/physiopathology , Cerebral Palsy/therapy , Gait/physiology , Bandages , Physical Therapy Modalities , Range of Motion, Articular/physiology
Rev. chil. pediatr ; 88(4): 478-486, 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-900006


Introducción: Los niños y adolescentes con Parálisis Cerebral (PC) tienen elevada prevalencia de desnutrición, asociada a peor pronóstico. Para la adecuada evaluación nutricional existen nuevas curvas de crecimiento (Brooks y Col) que han planteado puntos de corte del índice Peso/Edad asociados a mayor morbimortalidad. Objetivo: Evaluar si pacientes con PC, en dicha categoría de riesgo nutricional (RN), presentan mayor riesgo de hospitalización y muerte. Pacientes y Método: Estudio observacional y prospectivo de una cohorte de pacientes con PC, controlados en un centro ambulatorio de referencia. Se registró: datos demográficos, socioeconómicos, evaluación funcional motora y nutricional basal. En seguimiento durante un año se constataron hospitalizaciones y mortalidad. Investigación aprobada por la comisión de ética. Resultados: Se reclutaron 81 niños con PC, edad 131,6 ± 60,4 meses (25-313), 60% de sexo masculino, 77,5% no se movilizaba por sí mismo. Los 23 pacientes con RN (28,4%), presentaban menor masa muscular y masa grasa (p = 0,000). Durante el año de seguimiento, 29 pacientes requirieron hospitalización (35,8%) y 4 fallecieron (4,9%). El grupo con RN no tuvo mayor morbilidad ni mortalidad que los sin RN. Sin embargo, ambos riesgos fueron mayores en los pacientes gastrostomizados versus los alimentados por vía oral (RR: 2,98 IC 95%: 1.32-6.75 al combinar ambas variables). Conclusiones: En esta cohorte de niños y adolescentes con PC seguidos durante un año, aquellos definidos como de riesgo nutricional según nuevas curvas, tuvieron similar morbimortalidad a los que tenían estado nutricional aceptable. La morbimortalidad fue mayor en los gastrostomizados.

Introduction: Children and adolescents with cerebral palsy (CP) have a high prevalence of malnutrition associated to poor prognosis. For an adequate nutritional assessment, new growth curves (Brooks, 2011) are available, in which precise cut-off points in Weight/Age index correlate to increased morbidity and mortality rate. Objective: To evaluate risk of hospitalization and death in patients with CP, according to nutritional risk (NR). Patients and Method: Observational and prospective cohort study of patients with CP in an outpatient referral center. We registered demographic, socioeconomic data and nutritional assessment. During a one-year follow-up, hospitalizations and mortality were recorded. The correspondent committee extended an ethical approval. Results: 81 CP patients were recruit, age 131.6 ± 60.4 months (25-313), 60 % male, 77.5 % without independent mobility. The 23 NR patients (28.4%) had lower muscle and fat mass (p = 0.000). During the follow-up, 29/81 patients required hospitalization (35.8%) and 4/81 died (4.9%). There was not an increased risk of hospitalization and/or mortality in NR group, but both were significantly higher in gastrostomy-fed children (RR: 2,98 CI 95%: 1.32-6.75 combining both variables). Conclusions: In this study, children and adolescents with severe CP and nutritional risk had similar morbidity and mortality during a one-year follow-up, compared to those with acceptable nutritional status. Both risks were higher in gastrostomy-fed than the orally fed children.

Humans , Female , Child, Preschool , Child , Adolescent , Young Adult , Cerebral Palsy/complications , Cerebral Palsy/mortality , Enteral Nutrition/adverse effects , Malnutrition/etiology , Malnutrition/mortality , Hospitalization/statistics & numerical data , Gastrostomy , Nutrition Assessment , Cerebral Palsy/therapy , Chile/epidemiology , Nutritional Status , Prospective Studies , Risk Factors , Follow-Up Studies , Enteral Nutrition/methods , Malnutrition/diagnosis
Rehabil. integral (Impr.) ; 11(2): 99-107, dic. 2016. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-869334


Introduction: Cerebral palsy (CP) is a health condition causing very different levels of function limitation in children. Neurodevelopmental treatment is used with different frequencies and intensities, however there is no consensus regarding optimal dose. Objective: To perform a systematic assessment of the effectiveness of different intensities and/or frequencies of neurodevelopmental intervention in gross motor function, spasticity and range of joint motion, in children diagnosed with cerebral palsy. Materials and Methods: The systematic review was carried out following Cochrane Collaboration recommendations. Randomized and quasi-randomized clinical studies were considered, including > 14 year-old CP diagnosed children as subjects, classified using GMFCS I-V. The search was run in the following databases: PubMed, PEDro, CENTRAL, CINAHL Plus, EMBASE, OpenGrey, LILACS and SciELO. Two independent researchers were responsible for the selection of the studies. Disagreements were resolved by means of a consensus. A descriptive analysis was carried out on the selected studies. The Cochrane Collaboration’s tool for assessing risk of bias was used. Results: Only two of the 484 studies met all eligibility criteria. None of the selected studies showed significant differences between the high intensity or high frequency groups compared to the control groups. Conclusions: There is not enough evidence to conclude if a type of therapeutic frequency or intensity will determine the therapeutic results of neurodevelopmental treatment that are expected in children with CP.

Introducción: La parálisis cerebral es una condición de salud que determina grados muy variables de limitación en la función de niños y niñas. El neurodesarrollo, como intervención terapéutica, se utiliza con variadas frecuencias e intensidades no existiendo consenso respecto de la mejor dosificación. Objetivo: Evaluar sistemáticamente la efectividad de distintas intensidades y/o frecuencias de la intervención de neurodesarrollo en niños diagnosticados con parálisis cerebral en la función motora gruesa, espasticidad y rango articular. Material y Método: La revisión sistemática se realizó siguiendo las recomendaciones de la Colaboración Cochrane. Se incluyeron ensayos clínicos aleatorizados o cuasi aleatorizados, que contuvieran como población niños con PC menores de 14 años, clasificados según GMFCS I-V. La búsqueda se llevó a cabo en las bases de datos PubMed, PEDro, CENTRAL, CINAHL Plus, EMBASE, OpenGrey, LILACS y SciELO. La selección de los estudios la realizaron dos investigadores independientes. Los desacuerdos se resolvieron mediante consenso. Se realizó un análisis descriptivo de los estudios seleccionados. La evaluación del riesgo de sesgo se realizó con la herramienta de Colaboración Cochrane. Resultados: De los 484 trabajos, sólo dos reunían todos los criterios de elegibilidad. Ninguno de los trabajos seleccionados demostró diferencias significativas entre los grupos de alta intensidad o frecuencia en comparación con el control. Conclusiones: No existe evidencia suficiente para concluir si un tipo de frecuencia o intensidad de intervención terapéutica basada en neurodesarrollo determinará los resultados clínicos esperados en niños con parálisis cerebral.

Humans , Male , Adolescent , Female , Child , Physical Therapy Modalities , Cerebral Palsy/therapy , Nervous System/growth & development
Rev. bras. neurol ; 51(2): 37-44, abr.-jun. 2015. tab
Article in Portuguese | LILACS | ID: lil-761194


INTRODUÇÃO: A aprendizagem motora surge de um processo complexo de percepção/cognição/ação. Para a Fisioterapia, o conhecimento sobre aprendizado motor fornece bases neurofisiológicas que sustentam a intervenção terapêutica. Na área de ensino de Ciências, a realidade virtual pode se apresentar como um instrumental pelo qual possam ser alcançadas as adolescentes com paralisia cerebral, com déficit no desempenho motor. OBJETIVOS: O presente estudo propôs a inserção de conhecimentos do ensino de ciências por meio de recursos tecnológicos na prática fisioterapêutica direcionada a adolescentes portadores de paralisia cerebral. Essa abordagem foi mediada pela realidade virtual, visando ao incremento do aprendizado motor. MÉTODOS: O desenho experimental utilizado no presente estudo foi o de abordagem qualitativa participante, utilizando-se como instrumento de coleta de dados as oficinas pedagógicas que tratavam de conceitos da ciência para o aprendizado motor aliado à realidade virtual. A amostra analisada foi constituída de quatro adolescentes, entre 11 e 18 anos, portadores de paralisia cerebral, matriculados no ensino fundamental da rede de ensino do município de Teresópolis (RJ), em tratamento fisioterapêutico na Clínica-Escola de Fisioterapia do Unifeso. Foi utilizada, também, a escala de função motora grossa (GMFM) como escala avaliativa pré e pós-intervenção. RESULTADOS: Os sujeitos/pacientes apresentaram melhora em seu desempenho neuromotor associado com o ensino de ciências, demonstrando ser possível a potencialização do aprendizado motor com a aproximação do aprendizado científico. Em relação à escala GMFM, pode-se perceber aumento de 4% na média geral, confirmando o avanço motor dos participantes, percebido nessa análise qualitativa. CONCLUSÃO: A criação de subsídios para a construção do conhecimento científico por meio dos recursos do ambiente virtual aponta para o incremento do desempenho motor e para a formação de sujeitos histórico-sociais.

INTRODUCTION: Motor learning arises from a complex process of perception/cognition/action. For Physiotherapy, knowledge of motor learning provides neurophysiological bases that support therapeutic intervention. In the area of science education, virtual reality may represent an instrument by which adolescents with cerebral palsy and deficit in motor performance can be reached. OBJETIVES: The present study has as purpose the inclusion of knowledge of science education through technology in physical therapy practice directed at adolescents with cerebral palsy. This approach was mediated by virtual reality, aiming to increase motor learning. METHODS: The experimental design used was a qualitative participant study, using as instrument to collect data pedagogical workshops, which dealt with science concepts for motor learning combined with virtual reality. The sample consisted of four subjects, aged 11 and 18 years, with cerebral palsy, enrolled in primary schools in the municipality of Teresopolis (RJ), and on physiotherapy in the School of Physiotherapy Clinic Unifeso. The scale of motor function (GMFM) as pre- and post-intervention was also used for evaluation. RESULTS: Subjects/patients showed improvement in their neuromotor performance associated with the teaching of science, demonstrating the feasibility of the enhancement of motor learning with the scientific learning approach. Regarding the GMFM scale it could be perceived an increase of 4% in the overall average, confirming the motor progress of the participants, perceived by this qualitative analysis. CONCLUSION: The creation of subsidies for the construction of scientific knowledge, by means of virtual resources environment, point to the enhancement of the motor performance and for the formation of social-historical subjects.

Humans , Male , Female , Child , Adolescent , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/therapy , Cerebral Palsy/rehabilitation , Cerebral Palsy/therapy , Physical Therapy Modalities , Virtual Reality Exposure Therapy , Treatment Outcome , Video Games , Motor Skills
Rev. chil. pediatr ; 86(3): 161-167, jun. 2015. graf, tab
Article in Spanish | LILACS | ID: lil-760109


Los Institutos Teletón atienden al 85% de la población infantil chilena con discapacidad neuro-músculo-esquelética, concentrando el mayor porcentaje de esta población. Sin embargo, no existen registros que permitan caracterizar esta población. Objetivo: Caracterizar la población de pacientes atendidos en el Instituto Teletón de Santiago durante el año 2012. Pacientes y método: Se analizaron las características sociodemográficas de los registros electrónicos del Instituto Teletón de Santiago de los pacientes activos que se atendieron durante el año 2012. Resultados: Durante el año 2012 se atendió un total de 8.959 pacientes en el Instituto Teletón de Santiago. En relación con el nivel socioeconómico, un 33,3% de estos correspondieron a extrema pobreza, y un 28,7% a nivel medio bajo. Con respecto a los diagnósticos clínicos principales se encontró que la parálisis cerebral y otras encefalopatías que también llevan a discapacidad motora concentran el 55,4% de los casos. Conclusiones: Como producto de esta caracterización, sería adecuado fomentar la necesidad de optimizar el registro nacional de la población infantil con discapacidad y sus características particulares, para así poder tomar decisiones de políticas públicas, como destinación de fondos o programas de apoyo.

The Institutos Teletón care for 85% of the Chilean child population with neuromusculoskeletal disability, the large percentage concentrating in this population. However, there are no registers that enable a profile to be determined on this population. Objective: To determine the profile of patients attending the Instituto Teletón de Santiago during the year 2012. Patients and method: The sociodemographic characteristics were analyzed from the computerised records of the Instituto Teletón de Santiago on active patients who were seen during the year 2012. Results: A total of 8,959 patients were seen during the study year in the Instituto Teletón de Santiago. As regards socioeconomic level, 33.3% were in extreme poverty, 28.7% to low-middle level. The main clinical diagnoses were cerebral palsy and other encephalopathies that also lead to motor disability, and accounted for 55.4% of the cases. Conclusions: As a result of determining this profile, it would be appropriate to encourage the need for a national register of the child population with disability, as well as their particular characteristics in order to make decisions on public policy, as a destination for funds or support programs.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Young Adult , Brain Diseases/therapy , Cerebral Palsy/therapy , Disabled Persons/rehabilitation , Neuromuscular Diseases/therapy , Poverty , Socioeconomic Factors , Brain Diseases/physiopathology , Brain Diseases/epidemiology , Cerebral Palsy/epidemiology , Chile , Retrospective Studies , Neuromuscular Diseases/physiopathology , Neuromuscular Diseases/epidemiology
Rev. pediatr. electrón ; 11(4): 2-15, dic. 2014. tab
Article in Spanish | LILACS | ID: lil-774905


Introducción. Es importante determinar una fisioterapia adecuada para las personas que presentan discapacidad de por vida, como es el caso de la parálisis cerebral (PC). El objetivo fue estudiar el efecto de la aplicación de terapia física combinada en las habilidades motoras gruesas. Descripción del caso. Se describe el caso clínico de una niña de 12 años diagnosticada de tetraparesia espástica tras PC y con déficit en las funciones cognitivas. Intervención. Durante 35 semanas se aplicó terapia física combinada que incluyó estiramientos, entrenamiento de la fuerza, equilibrio, trabajo de marcha en suspensión parcial y terapia miofascial. La evaluación se ha llevado a cabo al inicio y al final del tratamiento con el Gross Motor Function Measure (GMFM).Resultados y discusión: Se han observado mejorías clínicas en las dimensiones evaluadas con el GMFM. En el caso de la ‘bipedestación’ (de 17,95 por ciento al inicio a28,21 por ciento al final) y en la dimensión ‘caminar,correr y saltar’ (de 5,56 por ciento al inicio a 19,44 por ciento al final). Si bien las técnicas fisioterápicas utilizadas han demostrado ser útiles aplicadas de forma aislada, hemos observado que su uso combinado mejora la función motora gruesa en el caso presentado.

Background and Purpose. For people suffering from a lifelong disability such as cerebral palsy (CP), establishing an appropriate physiotherapy treatment is of great concern. The aim was to study the effect on gross motor skills of the application of a combined physical therapy. Case description. A case report of a 12-year-old female patient with a diagnosis of spastic tetraparesis after CP, who also showed a cognitive function disorder, is reported. Intervention. A combined physical therapy treatment was applied during 35 weeks. The protocol consisted of stretching, training of muscle resistance, balance, reeducation of gait in partial suspensión and myofascial therapy. Baseline and postintervention assessments were carried out by means of the Gross Motor Function Measure (GMFM). Results and discussion: A clinical improvement was observed in those dimensions of the GMFM which were lower rated at baseline. The dimension ‘standing’ (from 17,95 percent pre-intervention to 28,21 percent post-intervention) and the dimension ‘walking, running and jumping’ (from 5,56 percent pre-intervention to 19,44 percent postintervention). Though the proposed physiotherapy techniques have been shown to be useful separately, when combined, it was observed that the gross motor function clinically improved in our patient.

Humans , Female , Child , Physical Therapy Specialty , Cerebral Palsy/therapy , Combined Modality Therapy
Braz. j. phys. ther. (Impr.) ; 18(5): 419-427, 12/09/2014. tab, graf
Article in English | LILACS | ID: lil-727051


Background: Transcranial direct-current stimulation (tDCS) has been widely studied with the aim of enhancing local synaptic efficacy and modulating the electrical activity of the cortex in patients with neurological disorders. Objective: The purpose of the present study was to determine the effect of a single session of tDCS regarding immediate changes in spatiotemporal gait and oscillations of the center of pressure (30 seconds) in children with cerebral palsy (CP). Method: A randomized controlled trial with a blinded evaluator was conducted involving 20 children with CP between six and ten years of age. Gait and balance were evaluated three times: Evaluation 1 (before the stimulation), Evaluation 2 (immediately after stimulation), and Evaluation 3 (20 minutes after the stimulation). The protocol consisted of a 20-minute session of tDCS applied to the primary motor cortex at an intensity of 1 mA. The participants were randomly allocated to two groups: experimental group - anodal stimulation of the primary motor cortex; and control group - placebo transcranial stimulation. Results: Significant reductions were found in the experimental group regarding oscillations during standing in the anteroposterior and mediolateral directions with eyes open and eyes closed in comparison with the control group (p<0.05). In the intra-group analysis, the experimental group exhibited significant improvements in gait velocity, cadence, and oscillation in the center of pressure during standing (p<0.05). No significant differences were found in the control group among the different evaluations. Conclusion: A single session of tDCS applied to the primary motor cortex promotes positive changes in static balance and gait velocity in children with cerebral palsy. .

Humans , Child , Cerebral Palsy/physiopathology , Cerebral Palsy/therapy , Postural Balance , Transcranial Direct Current Stimulation , Double-Blind Method , Cross-Sectional Studies , Physical Therapy Modalities
Med. reabil ; 33(2): 23-27, maio-ago. 2014. graf, tab
Article in Spanish | LILACS | ID: lil-775909


La parálisis cerebral comprende una serie de síndromes que provocan afectación en el lenguaje. Se realizó un estudio retrospectivo en una muestra de 85 pacientes a quienes se le aplicó la Escala de Praxis Articulatatorias y la Escala Evaluativa para la Expresión Oral y la Pronunciación. Se aprecian más favorecidos los portadores de parálisis cerebral espástica con mejorías significativas en los parámetros evaluados. La incorporación de estos pacientes a la rehabilitación neurológica intensiva aumenta su calidad de vida porque favorece la motricidad orolinguofacial, los procesos de masticación, deglución y control de la sialorrea, lo que permite el desarrollo del lenguaje.

The cerebral paralysis understands a series of syndromes that you/they provoke affectation in the language. He/she was applied the Scale of Articulatory Practice and the Scale Evaluativa for the Oral Expression and the Pronunciation. They are appreciated more favored the payees of cerebral spastic paralysis with significant improvements in the evaluated parameters. The incorporation of these patients to the neurological intensive rehabilitation their quality of life increases, because it favors the motor orolinguofacial, the mastication processes, swallowing and control of the sialorrea, what allows the development of the language.

Humans , Male , Female , Child, Preschool , Child , Adolescent , Cerebral Palsy , Cerebral Palsy/therapy , Rehabilitation
Rev. pediatr. electrón ; 11(2): 54-70, ago.2014. tab, ilus
Article in Spanish | LILACS | ID: lil-774832


Parálisis cerebral es un término que define una serie de trastornos motores de origen cerebral, no progresivos que constituyen la causa más frecuente de discapacidad motora en la infancia. No obstante ser una denominación “antigua”, no ha perdido vigencia ni valor si se le utiliza como término sindromático que supone un estudio etiológico acucioso y una conducta terapéutica que incluye múltiples áreas de intervención y de especialistas coordinados a fin de lograr la máxima funcionalidad posible del niño desde el punto de vista motor, intelectual, de comunicación y la máxima integración social, teniendo en cuenta que el grado de desarrollo de una sociedad se mide por el cuidado que otorga a sus minusválidos.

Cerebral palsy (CP) results from a static brain lesion during pregnancy or early life and remains the most common cause of physical disability in children. Despite being an "old" name, it has not lost its usefulness if used as syndromic term that implies a thorough etiologic study and a therapeutic approach that includes multiple areas of intervention and coordinated work of specialists in order to achieve the maximum possible functionality, optimizing motor, intellectual, communication and social integration, considering that the degree of development of a society is measured by the care given to its disabled people.

Humans , Male , Female , Infant , Child, Preschool , Cerebral Palsy/diagnosis , Cerebral Palsy/therapy , Diagnosis, Differential , Cerebral Palsy/classification , Cerebral Palsy/etiology
Arq. neuropsiquiatr ; 72(5): 360-367, 05/2014. tab
Article in English | LILACS | ID: lil-709366


Objective: Evaluate side-to-side discrepancies in children with hemiplegic cerebral palsy (HCP), and investigate associations of these discrepancies with patients’ age at initiation of physical therapy, motor and cognitive function, and degree of activities and social participation. Method: We obtained eight side-to-side measurements from 24 HCP children with mean age 49.3±5.2 months. Results: Early initiation of physical therapy was associated with lower discrepancy in hand length (p=0.037). Lower foot length discrepancy was associated with lower requirement for caregiver assistance in activities related to mobility. Increased side-to-side discrepancy was associated with reduced wrist extension and increased spasticity. Discrepancy played a larger role in children with hemineglect and in those with right involvement. Conclusion: Increased discrepancy in HCP children was associated with reduced degree of activity/social participation. These results suggest an association between functional use of the extremities and limb growth. .

Objetivo: Avaliar a discrepância entre o crescimento dos lados do corpo em crianças com paralisia cerebral hemiplégica (PCH), e investigar sua associação com a idade de início do tratamento de fisioterapia, função motora e cognitiva, grau de atividades e participação social. Método: Comparamos oito medidas obtidas de 24 crianças com PCH e com média de idade de 49,3±5,2 meses. Resultados: O início precoce da fisioterapia se relacionou à menor discrepância no comprimento da mão (p=0,037). A menor discrepância no comprimento do pé se relacionou à menor necessidade de ajuda do cuidador em atividades de mobilidade. A maior discrepância esteve relacionada à menor extensão de punho e à maior espasticidade. A discrepância foi mais importante em crianças com heminegligência e com envolvimento à direita. Conclusão: Crianças com PCH com maior discrepância apresentaram menor atividade/participação social. Os resultados sugerem associação entre o uso funcional da mão e o crescimento das extremidades. .

Child, Preschool , Female , Humans , Male , Cerebral Palsy , Cognition/physiology , Growth/physiology , Hemiplegia , Motor Activity/physiology , Social Participation , Age Factors , Anthropometry , Cross-Sectional Studies , Cerebral Palsy/pathology , Cerebral Palsy/physiopathology , Cerebral Palsy/therapy , Hemiplegia/pathology , Hemiplegia/physiopathology , Hemiplegia/therapy , Muscle Strength , Physical Therapy Modalities , Reference Values , Time Factors , Wechsler Scales
Rev. ter. ocup ; 24(2): 121-126, maio-ago. 2013. tab
Article in Portuguese | LILACS | ID: lil-746859


A melhora da capacidade de manutenção do equilíbrio é essencial para quem apresenta algum comprometimento motor, como a Paralisia Cerebral (PC). A realidade virtual (RV) já se destaca na reabilitação neurológica, porém com poucos estudos que abordem pacientes adultos com PC. Este estudo teve comoobjetivo investigar a influência da RV por meio de jogos de vídeo Wii no equilíbrio em posição ortostática de um paciente com PC Espástica Hemiparética. Foi utilizado o equipamento Nintendo® Wii, com o jogo Wii Fit Plus, em treinamentos que estimularam o equilíbrio látero-lateral e ântero-posterior do paciente. Osinstrumentos aplicados foram: Escala de Equilíbrio de Berg, Medida de Independência Funcional, além de 3 testes do Neurocom Balance Master: Limits of Stability, Tandem Walk e Step/Quick Turn. O protocolo de tratamento consistiu de 10 sessões, 30 minutos cada, duas vezes por semana por 38 dias. Ao final foi possível observar um aumento expressivo na pontuação de vários itens dos testesrealizados, implicando na melhora da capacidade de equilíbrio do paciente. Esses resultados sugerem a influência benéfica do Wii no que concerne o equilíbrio e capacidade funcional do portador de PC, tornando-o mais confiante para realizar suas atividades diárias.

The improvement of maintaining postural balances its essential i for those who have some motor impairment, such as Cerebral Palsy (CP). Virtual Reality (VR) is a feature that is standing out in neurological rehabilitation, but there are few studies regarding adult patients with CP. This study aimed to investigatethe infl uence of the VR through the Wii on balance in standing position from a patient with Spastic Hemiplegic CP. It was used the equipment Nintendo® Wii, with the game Wii Fit Plus, where the training chosen stimulated the latero-lateral and anterior-posterior patient’s balance. The instruments used were: Berg Balance Scale, Functional Independence Measure, and 3 Neurocom Balance Master Systems tests: Limits of Stability, Tandem Walk and Step/Quick Turn. The treatment protocol consisted of 10 sessions, with30 minutes each, performed twice a week for 38 days. At the end oftreatment, a significant increase in the scores of various test items performed was observed, which resulted in an improvement of patient’s balance. Results suggest a beneficial influence of the video game Wii regarding to postural balance and functional capacity of patients with PC, which become more confident to carry out their activities of daily living.

Humans , Male , Young Adult , Physical Therapy Modalities , Postural Balance , Cerebral Palsy/rehabilitation , Cerebral Palsy/therapy , Video Games , Virtual Reality Exposure Therapy , Motor Skills