Rizotomia dorsal seletiva na paralisia cerebral: critérios de indicação e protocolos de reabilitação fisioterapêutica pós-operatória / Selective dorsal rhizotomy in cerebral palsy: selection criteria and postoperative physical therapy protocols

RESUMO Objetivo: Identificar critérios de seleção para a rizotomia dorsal seletiva (RDS) na paralisia cerebral (PC), analisar os instrumentos de avaliação e descrever as características da fisioterapia nos protocolos pós-operatórios. Fontes de dados: Revisão do tipo integrativa nas bases de dados SciELO, PEDro, Cochrane Library e PubMed. Os termos em português e inglês "paralisia cerebral", "rizotomia dorsal seletiva" e "fisioterapia" foram utilizados na busca. Os critérios de inclusão foram: artigos que arrolaram indivíduos com PC, que realizaram fisioterapia nos protocolos de RDS e que descreviam características desses protocolos. Foram excluídos artigos de revisão da literatura e não houve restrição de período de publicação. Síntese dos dados: Incluíram-se 18 estudos, sendo a maioria coortes prospectivas, com acompanhamento dos pacientes de oito meses a dez anos. Os instrumentos das avaliações contemplam, na maior parte dos trabalhos, os domínios de funções e estruturas corporais e atividade. O percentual de secção das raízes posteriores foi próximo a 50%. A principal indicação para a RDS incluiu deambuladores com diplegia espástica, que preenchiam os seguintes critérios: espasticidade que interfere com a mobilidade, boa força muscular de membros inferiores e tronco, sem deformidades ortopédicas, distonia, ataxia ou atetose e boa função cognitiva. A fisioterapia é parte integrante dos protocolos de tratamento com RDS, devendo ser intensiva, específica e enfatizada principalmente no primeiro ano. Conclusões: Os estudos salientam a importância da seleção adequada dos pacientes para o sucesso dos resultados. A fisioterapia é intensiva e de longa duração, devendo necessariamente ter estratégias para modificar o antigo padrão motor.

ABSTRACT Objective: To identify selection criteria for selective dorsal rhizotomy (SDR) in cerebral palsy, to analyze the instruments used for evaluation, and to describe the characteristics of physical therapy in postoperative protocols. Data sources: Integrative review performed in the following databases: SciELO, PEDro, Cochrane Library, and PubMed. The terms in both Portuguese and English for "cerebral palsy", "selective dorsal rhizotomy", and "physical therapy" were used in the search. Studies whose samples enrolled individuals with cerebral palsy who had attended physical therapy sessions for selective dorsal rhizotomy according to protocols and describing such protocols' characteristics were included. Literature reviews were excluded and there was no restriction as to period of publication. Data synthesis: Eighteen papers were selected, most of them being prospective cohort studies with eight-month to ten-year follow-ups. In most studies, the instruments of assessment encompassed the domains of functions, body structure, and activity. The percentage of posterior root sections was close to 50%. Primary indications for SDR included ambulatory spastic diplegia, presence of spasticity that interfered with mobility, good strength of lower limbs and trunk muscles, no musculoskeletal deformities, dystonia, ataxia or athetosis, and good cognitive function. Postoperative physical therapy is part of SDR treatment protocols and should be intensive and specific, being given special emphasis in the first year. Conclusions: The studies underline the importance of appropriate patient selection to obatin success in the SDR. Postoperative physical therapy should be intensive and long-term, and must necessarily include strategies to modify the patient's former motor pattern.

CORRELATION BETWEEN VISUAL GAIT ANALYSIS AND FUNCTIONAL ASPECTS IN CEREBRAL PALSY

ABSTRACT Objective: To verify the correlation between visual gait analysis (VGA) by the Edinburgh visual gait score (EVGS) and functional aspects using the Timed Up and Go Test (TUG) and Gross Motor Function Classification System (GMFCS) in individuals with cerebral palsy (CP). Methods: Retrospective cross sectional study of 35 patients with CP. The mean age 12.61 years old, 94.3% were spastic; 34.4% hemiplegic, 54.3% diplegic, 11.4% triplegic; 45.7% were level II GMFCS, 42.9% level I, 5.7% level III and 5.7% level IV. VGA was analyzed by the Edinburgh visual gait score (EVGS), functional mobility was assessed by TUG and functionality through GMFCS. The Spearman correlation was used for statistical analysis. Results: The mean EVGS score was 18.97. The mean TUG was 13.71sec. EVGS showed moderate correlation with TUG (r=0.46, p=0.03) and GMFCS (r=0.45, p=0.00). Conclusion: Worse VGA scores correlate to worse functionality and mobility performance. Due to the observed correlation, it is possible to assert that VGA is a useful tool on evaluation of CP patients. Level of Evidence III, Retrospective Comparative Study.