Static balance and function in children with cerebral palsy submitted to neuromuscular block and neuromuscular electrical stimulation: study protocol for prospective, randomized, controlled trial.

BACKGROUND: The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT- A. METHODS/DESIGN: Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale. DISCUSSION: The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and functional balance in children with CP submitted to BT-A in the lower limbs. This study describes the background, hypotheses, methodology of the procedures and measurement of the results. TRIAL REGISTRATION: RBR5qzs8h.

Análise do equilíbrio estático em crianças com paralisia cerebral do tipo diparesia espástica com e sem o uso de órteses / Analysis of static balance in children with cerebral palsy spastic diparetic type with and without the use of orthoses

Introdução: Crianças com paralisia cerebral (PC) do tipo diparesia espástica são frequentes usuárias de órtesespara membros inferiores, com a finalidade de proporcionar melhora funcional da postura ortostática e durante a marcha. Objetivo: analisar o equilíbrio estático de crianças diparéticas espasticas com PC, com e sem uso de órteses, por meio de parâmetros estabilométricos. Materiais e métodos: A amostra foi composta por 15 indivíduos com idades entre 4 e 14 anos (médias de 8,33 ± 2,74), sete do sexo masculino e oito do sexo feminino, divididos em dois grupos: o grupo controle (GC) com seis participantes e o grupo estudado(GE) com nove crianças com PC diparesia espástica. Para a análise do equilíbrio estático utilizou-se uma plataforma de pressão (Medicapteurs Fusyo) e a coleta foi realizada com a criança em pé, em duas condições:com órteses e sem órteses. Resultados: O GE sem órtese apresentou maiores oscilações, estatisticamente significantes, no sentido médio-lateral e na área total de oscilação quando comparado ao desempenho do GC. Conclusão: Os resultados apresentados sugerem que a utilização de órteses para membros inferiores possa influenciar no equilíbrio estático, diminuindo a oscilação durante a postura ortostática estática

INTRODUCTION: Children with spastic diparetic cerebral palsy (CP) are frequent users of orthoses for lower limbs, in order to provide functional improvement of posture during walking and standing. OBJECTIVES: To analyze the static balance of spastic diparetic children with CP, with and without the use of orthoses, through stabilometric parameters. MATERIALS AND METHODS: The sample comprised 15 individuals aged between 4 and 14 years old (8.33 ± 2.74), seven males and eight females, divided into two groups: the control group (CG), with six participants, and the study group (SG), with nine spastic diparetic children with CP. For static balance analysis it was used a pressure platform (Medicapteurs Fusyo) and the collection was performed with the child standing on two conditions: with orthoses and without orthosis. RESULTS: The EG with orthesis showed higher oscilation, statistically significant, mediolateral and the total area of oscillation compared to the GC. CONCLUSION: The results suggest that the use of orthoses for lower limbs can influence the static balance, reducing the oscillation during static standing position.