Tratamiento de la contractura en flexión de rodilla en parálisis cerebral / Treatment for knee flexion contracture in cerebral palsy

La extensión completa de la rodilla es esencial para la marcha. Los pacientes con parálisis cerebral infantil con frecuencia pueden tener déficit de extensión de distinta magnitud, lo que compromete la marcha e incluso la bipedestación. El tratamiento de la contractura en flexión de rodilla parte por tratar la espasticidad de los músculos comprometidos y con fisioterapia. Cuando el flexo es estructurado, el tratamiento es quirúrgico mediante distintas técnicas, dependiendo de la magnitud de la contractura y de la edad del paciente. Las técnicas sobre partes blandas incluyen alargamientos funcionales de isquiotibiales y transferencias musculares. Cuando la contractura es capsular, es preferible realizar cirugía ósea, la cual extiende el fémur proximal, ya sea en forma progresiva, mediante fisiodesis anterior en pacientes pediátricos, o en forma aguda, mediante osteotomía extensora del fémur distal. Con frecuencia existe una patela alta, la cual hay que corregir en el mismo acto quirúrgico para mantener la eficiencia del aparato extensor

Full knee extension is essential for gait. Patients with cerebral palsy frequently have extension deficits of different magnitudes, which compromise walking and even standing up. The treatment of knee flexion contracture begins by addressing the spasticity of the involved muscles and includes physical therapy. For structured extension deficits, the treatment is surgical, using different techniques depending on the magnitude of the contracture and the patient's age. Soft tissue techniques include functional hamstring lengthening and muscle transfers. For capsular contracture, bone surgery is preferable and extends the proximal femur either progressively, through anterior physiodesis in pediatric patients, or acutely, by extensor distal femoral osteotomy. A high patella is common and requires correction during the same surgical procedure to maintain the efficiency of the extensor apparatus

Eating and Drinking Ability Classification System ­ EDACS: equivalência cultural para o português brasileiro / Eating and Drinking Ability Classification System ­ EDACS: cross-cultural adaptation of the Brazilian Portuguese / Eating and Drinking Ability Classification System ­ EDACS: equivalencia cultural para el portugués brasileño

Objetivo: realizar a tradução e equivalência cultural e linguística para o Português Brasileiro do Eating and Drinking Ability Classification System (EDACS). Método: realizou-se a tradução do EDACS para a língua portuguesa por duas fonoaudiólogas bilíngues e especialistas em disfagia. As duas traduções foram comparadas entre as próprias fonoaudiólogas, sendo as incompatibilidades discutidas entre si e decisões tomadas por consenso. Após o instrumento traduzido, este foi enviado para uma terceira fonoaudióloga, brasileira, bilíngue, residente nos Estados Unidos, para que a retrotradução para o inglês fosse realizada. A versão inicial do instrumento e a retro tradução foram confrontadas entre si, sendo as discrepâncias analisadas, discutidas e definidas por consenso. Resultados: os processos de tradução e adaptação cultural requereram maior esforço na definição da nomenclatura das consistências utilizadas e não trouxeram modificações com relação à estrutura da escala original. Conclusão: realizou-se a equivalência cultural do Sistema de Classificação das Habilidades do Comer e Beber ­ EDACS-PT/BR para o português brasileiro.

Objective: to perform the translation and cultural equivalence to Brazilian Portuguese of the Eating and Drinking Ability Classification System (EDACS). Method: EDACS was translated into Brazilian Portuguese by two bilingual speech language therapists, specialists in dysphagia. The two translations were compared by the speech therapists, the incompatibilities were discussed among themselves and decisions were taken by consensus. After the instrument was translated, it was sent to a third Brazilian speech language therapist, bilingual and resident in the United States, for back-translation into English. The initial version of the instrument and the back-translation were compared and the discrepancies were analyzed, discussed and defined by consensus. Results: the processes of translation and cultural adaptation required more effort in defining the terms of the used consistencies and did not change the structure of the original scale. Conclusion: the cultural equivalence of the Sistema de Classificação das Habilidades do Comer e Beber ­ EDACS-PT/BR was performed for Brazilian Portuguese.

Objetivo: llevar a cabo la traducción y equivalencia cultural y lingüística al portugués brasileño del Eating and Drinking Ability Classification System (EDACS). Método: la EDACS fue traducida al portugués por dos logopedas bilingües y especialistas en disfagia. Las dos traducciones se compararon entre los propios logopedas, discutiéndose las incompatibilidades y tomando decisiones por consenso. Una vez traducido el instrumento, se envió a un tercer logopeda, brasileño, bilingüe, residente en Estados Unidos para la retrotraducción al inglés. La versión inicial del instrumento y la retrotraducción se compararon entre sí, y las discrepancias fueron analizadas, discutidas y definidas por consenso. Resultados: los procesos de traducción y adaptación cultural requirieron un mayor esfuerzo en la definición de la nomenclatura de las consistencias utilizadas y no trajeron cambios en relación a la estructura de la escala original. Conclusión: se realizó la equivalencia cultural del Sistema de Classificação das Habilidades do Comer e Beber ­ EDACS-PT/BR para el portugués brasileño.

Protocol proposal for early dental care in infants with cerebral palsy

Introduction: Children with cerebral palsy (CP) are at high risk of developing oral diseases. Objective: To propose an early dental care protocol for infants with CP. Materials and Methods: A computerized systematic search was performed in the PubMed, Scopus and Embase electronic databases for relevant articles. An early dental care protocol was then proposed for infants with cerebral palsy focused on comprehensive care with a multidisciplinary approach and effective health promotion by caregivers. Results: Fifteen published papers were included in the present literature review and protocol proposal. The protocol comprised the following topics: First dental visit, aspects related to the appointment, oral hygiene recommendations, dietary recommendations and recommendations for the prevention and control of harmful oral habits. The first dental visit should occur prior to the eruption of the teeth. As a special group, it is important to determine the affective bond between the patient and caregiver who will receive the oral health care recommendations. During the clinical examination, the correct positioning and stabilization of the infant is important for the control of involuntary movements and the minimization of swallowing difficulties. Counseling with regards to adequate oral hygiene, a healthy diet and the prevention of harmful oral habits is important to the prevention of dental diseases. Children with oral-motor motility problems and feeding difficulties should be referred to therapeutic follow-up. Due to the neuropsychomotor disorders often found in cerebral palsy, affected children are more vulnerable to oral diseases. Thus, oral health care must be performed as early as possible by the parents/caregivers of these children. Conclusion: Individuals with cerebral palsy are at greater risk of developing oral problems. Thus, oral health programs starting in early childhood and targeting the specificities of these individuals is a strategy for minimizing the occurrence of such problems and the associated burden.

Introdução: Crianças com Paralisia Cerebral (PC) apresentam um alto risco para o desenvolvimento de doenças bucais. Objetivo: Propor um protocolo de atendimento odontológico precoce para lactentes com PC. Materiais e Métodos: Foi realizada uma busca computadorizada sistemática nas bases de dados eletrônicas PubMed, Scopus e Embase. Também foi desenvolvida uma proposta de protocolo de atendimento a bebês com Paralisia Cerebral com foco no cuidado integral, abordagem transdisciplinar e promoção efetiva da saúde pelos cuidadores. Resultados: Foram incluídos 15 artigos publicados na literatura científica. O protocolo desenvolvido é composto pelos seguintes tópicos: Primeira consulta odontológica, tempo ideal da consulta, recomendações de higiene bucal, recomendações sobre dieta e recomendações sobre prevenção e controle dos hábitos bucais. A primeira visita ao dentista deve ser feita antes da erupção do primeiro dente. Como um grupo especial, é importante determinar o vínculo afetivo entre o paciente e o cuidador que receberá as recomendações de cuidados com a saúde bucal. Durante o exame clínico, a correta posição e estabilização do bebê na cadeira odontológica é importante para controlar os movimentos involuntários e reduzir a dificuldade de deglutição. Recomendações quanto à higiene bucal adequada, alimentação saudável e prevenção de hábitos bucais deletérios são importantes para prevenir o desenvolvimento de doenças bucais. Crianças com problemas de motilidade oral-motora e dificuldades de alimentação devem ser encaminhadas para acompanhamento terapêutico. Devido à presença de distúrbios neuropsicomotores normalmente presentes na Paralisia Cerebral, as crianças afetadas são mais vulneráveis às doenças bucais. Assim, os cuidados com a saúde bucal devem ser realizados o quanto antes pelos pais/responsáveis. Conclusão: Indivíduos com PC apresentam maior risco de desenvolver doenças bucais e programas de saúde bucal iniciados na primeira infância e direcionados às suas especificidades podem ser uma estratégia para minimizar as consequências que possam vir a acontecer.

Traumatismo Dentoalveolar en Personas con Parálisis Cerebral: revisión Sistemática y Metaanálisis / Dental Trauma Injuries in Cerebral Palsy: systematic Review and Meta-Analysis

La parálisis cerebral (PC) es un trastorno neurológico que afecta aproximadamente 2 de cada 1000 nacidos vivos. Se describe como un grupo de trastornos del desarrollo del movimiento, equilibrio y postura, que causan limitación de actividad. Algunos estudios han planteado que la PC podría aumentar el riesgo de traumatismos dentoalveolares (TDA). El objetivo de este estudio fue revisar la evidencia científica disponible sobre prevalencia y tendencias de TDA en pacientes con PC, y compararla con la prevalencia de TDA en sujetos sin PC. Se realizó una búsqueda sistemática en Pubmed, Scielo y Lilacs. Se evaluaron títulos y resúmenes, excluyendo casos clínicos, revisiones sistemáticas, artículos duplicados y/o no atingentes al tema. Se incluyeron artículos que reportan prevalencia de TDA en personas con PC y se extrajo la información sobre el tipo estudio, metodología, prevalencia, tipo de diente, de TDA más frecuente en PC y datos de prevalencia de grupo control. Se identificó un total de 32 artículos, de los cuales se seleccionaron e incluyeron 12 estudios para la revisión sistemática y de ellos cuatro se utilizaron en el metaanálisis. La prevalencia de TDA en personas con PC reportada en estos estudios mostró un rango entre 10,6-76,5 %. Los incisivos superiores fueron el tipo de diente más afectado por TDA. Sólo cuatro estudios comparan con un grupo control. La prevalencia de TDA fue mayor en sujetos con PC que en sujetos sanos (odds ratio 1,58 [95 % IC= 0,66 - 3,77]). Sin embargo, esta diferencia no fue estadísticamente significativa y los estudios incluidos presentaron una alta heterogeneidad.

Cerebral palsy (CP) is a neurological disorder that affects approximately 2 out of every 1,000 live births. It is described as a group of developmental disorders of movement, balance, and posture, which cause activity limitation. Some studies have suggested that CP may increase the risk of dental trauma injuries (DTI). The objective of this study was to review the available scientific evidence on the prevalence and trends of DTI in people with CP, and to compare it with the prevalence of people without it. A systematic search was carried out in Pubmed, Scielo and Lilacs. Titles and abstracts were evaluated, excluding clinical case reports, systematic reviews, duplicate articles and/ or not relevant to the topic. Articles reporting the prevalence of DTI in people with CP were included. It was extracted information about the study type, methodology, prevalence of DTI, type of tooth, type of DTI in CP subjects and the prevalence of DTI from the control group, when available. A total of 32 articles were identified, of which 12 studies were selected and included for the systematic review and of these four were used in the meta-analysis. The prevalence of DTI in people with CP reported in these studies showed a range between 10.6-76.5 %. The upper incisors were the type of tooth most affected by DTI. Only four studies compared the DTI prevalence with a control group. The prevalence of DTI was higher in subjects with CP than in people without it (odds ratio 1.58 [95 % CI = 0.66 - 3.77]). However, this difference was not statistically significant and the included studies were highly heterogeneous.

Surgical Treatment for Spasticity: Selective Dorsal Rhizotomy ­ Technique and Literature Review

Spasticity is amotor disorder that leads to a resistance to passive jointmovement. Cerebral palsy is the most important cause of spasticity and can be caused by several factors, including multiple gestations, alcoholism, infections, hemorrhages, drowning, and traumatic brain injuries, among others. There aremany scales that help tomeasure andmonitor the degree of impairment of these patients. The initial treatment should focus on the causal factor, such as tumors, inflammation, degenerative diseases, hydrocephalus, etc. Subsequently, the treatment of spastic musculature includes oral or intrathecal myorelaxants, spinal cord electrostimulation, neurotomies, Lissauer tract lesion, dentatotomy and selective dorsal rhizotomy. The latter is a safetechnique, possibleto beperformed inmost centers with neurosurgical support, and it is effective in the treatment of severe spasticity. In this article, the authors describe the surgical technique and conduct a review the literature.

Análise da mastigação e deglutição na paralisia cerebral com deficiência visual: estudo de caso / Analysis of chewing and swallowing in cerebral palsy with a visual impairment: study of case / Análisis de la masticación y la deglución en la parálisis cerebral con discapacidad visual: un estudio de caso

Introdução: A Paralisia Cerebral pode acarretar alterações em qualquer uma das fases da deglutição, causando uma disfagia neurogênica. No entanto, desordem neurológica e deficiência visual associada é um tema pouco estudado. A criança com a ausência do canal visual, geralmente tem pouca noção na estrutura do espaço e até mesmo em relação à sua estrutura corporal e organizacional. É sabido que a Paralisia Cerebral discorre atrasos no padrão mastigatório e da deglutição, mas questiona-se se a deficiência visual pode interferir ou não neste desempenho. Objetivo: O propósito deste estudo foi analisar as funções de mastigação e o tempo de deglutição em criança com paralisia cerebral e deficiência visual associada. Método: Esta pesquisa é de natureza exploratória e descritiva, desenvolvida por meio de um estudo de caso clínico de uma criança com paralisia cerebral e deficiência visual associada. Três consistências de alimento foram examinadas: líquido (suco), pastosa (iogurte) e sólido (pão), sendo cronometrado o tempo gasto para deglutir cada uma delas, durante o horário normal de alimentação. Resultados: os resultados mostraram que a criança com Paralisia Cerebral e Deficiência Visual apresenta dificuldades na função de mastigação e leva mais tempo para deglutir nas consistências sólida e líquida. Conclusão: A deficiência visual associada à paralisia cerebral pode acentuar na dificuldade das funções de mastigação e deglutição.

Introduction: Cerebral Palsy can cause changes in any of the phases of swallowing, causing neurogenic dysphagia. However, neurological disorder and associated visual impairment is a poorly studied topic. The child with the absence of the visual channel, generally has little idea of the structure of the space and even of its body and organizational structure. It is known that Cerebral Palsy has delays in chewing and swallowing patterns, but it is questioned whether visual impairment can interfere or not in this performance. Objective: The purpose of this study was to analyze chewing functions and swallowing time in children with cerebral palsy and associated visual impairment. Method: This research is exploratory and descriptive in nature, developed through a clinical case study of a child with cerebral palsy and associated visual impairment. Three food consistencies were examined: liquid (juice), pasty (yogurt) and solid (bread), with the time spent swallowing each of them during the normal feeding time being timed. Results: the results showed that the child with Cerebral Palsy and Visually Impaired presents difficulties in chewing function and takes more time to swallow in solid and liquid consistencies. Conclusion: Visual impairment associated with cerebral palsy may accentuate the difficulty in chewing and swallowing functions.

Introducción: La parálisis cerebral puede provocar cambios en cualquiera de las fases de la deglución, provocando disfagia neurogénica. Sin embargo, el trastorno neurológico y la discapacidad visual asociada es un tema poco estudiado. El niño con ausencia del canal visual, generalmente tiene poca idea de la estructura del espacio e incluso de su cuerpo y estructura organizativa. Se sabe que la parálisis cerebral tiene retrasos en los patrones de masticación y deglución, pero se cuestiona si la discapacidad visual puede interferir o no en este desempeño. Objetivo: El propósito de este estudio fue analizar las funciones de masticación y el tiempo de deglución en niños con parálisis cerebral y discapacidad visual asociada. Método: Esta investigación es de naturaleza exploratoria y descriptiva, desarrollada a través de un estudio de caso clínico de un niño con parálisis cerebral y discapacidad visual asociada. Se examinaron tres consistencias de alimentos: líquido (jugo), pastoso (yogur) y sólido (pan), y se pasó el tiempo de deglución de cada uno de ellos durante el tiempo normal de alimentación. Resultados: los resultados mostraron que el niño con parálisis cerebral y deficiencia visual tiene dificultades en la función de masticación y toma más tiempo para tragar en forma sólida y líquida. Conclusión: la discapacidad visual asociada con la parálisis cerebral puede acentuar la dificultad en las funciones de masticación y deglución.

Effectiveness and Determinant Variables of Augmentative and Alternative Communication Interventions in Cerebral Palsy Patients with Communication Deficit: a Systematic Review

ABSTRACT Purpose Assess the effectiveness of augmentative and alternative communication (AAC) interventions in patients with CP and to reveal determinant variables of main intervention outcomes: receptive and expressive language. Research strategies The search was performed in following databases: MEDLINE (Ovid); PubMed (NLM); Embase (Ovid); Cochrane Database of Systematic Reviews; Cumulative Index to Nursing and Allied Health Literature; Database of Abstracts of Reviews of Effects; Cochrane Central Register of Controlled Trials; Health Technology Assessment database and PEDro. Selection criteria Full-text and peer-reviewed studies in English studying the effectiveness of AAC in patients with cerebral palsy were included. Studies with patients (<18 years) diagnosed with CP were included. Data analysis A narrative analysis was conducted to evaluate the efficacy of AAC methods. A random-effects model meta-analysis was used to assess determinants of AAC intervention outcomes. Results The online database and manual reference search revealed 445 records. Nine studies investigating a total of 294 subjects with CP met predefined eligibility criteria: 4 studies with single subject, multiple baseline research designs, 3 longitudinal cohort studies, 1 case control study and 1 case series. Results revealed moderate-quality evidence that AAC interventions improve the receptive and expressive communication skills in patients with CP. The random-effects model meta-analysis revealed the power of identified determinant variables affecting the AAC intervention outcomes. Conclusion Diversity of CP patients requires proper analysis of determinant variables to ensure the efficacy of AAC assessment and intervention. More studies of high methodological and practical quality assessing the efficacy of AAC interventions are needed to clarify the evidence.

Análisis para determinar la edad óptima para el manejo quirúrgico del pie equino en pacientes con parálisis cerebral infantil / Analysis to determine optimal age for surgical management of equinus foot in patients with childhood cerebral palsy

Resumen: Introducción: La parálisis cerebral infantil es una lesión cerebral no progresiva que ocurre antes, durante o después del parto y provoca daño neurológico variable que oscila de leve hasta discapacitante. La deformidad en el pie equino se trata conservadoramente en edades tempranas, pero ¿cuándo está indicado el manejo quirúrgico? Objetivo: Determinar la edad óptima para el manejo quirúrgico del pie equino en pacientes con PCI. Material y métodos: Estudio retrospectivo realizado en pacientes con diagnóstico de PCI (todos los tipos), tratados quirúrgicamente con alargamiento del tendón de Aquiles abierto o percutáneo y valorados con notas de la consulta externa; los pacientes tuvieron de 1-16 años y un seguimiento promedio de seis años, valorándose la marcha con recidiva de deformidad y la marcha plantígrada. Resultados: Se analizaron 55 pacientes, 74 con pie equino (29 niñas y 45 niños); de éstos, presentaron más recidivas los operados antes de los seis años de edad, con un período vulnerable entre los cuatro y seis años. La monoplejía registró 100% de recidivas, mientras que la triplejía 0%. La cirugía abierta se asoció con recurrencia en 50% y la cirugía percutánea sólo en 19%. Conclusiones: En nuestra institución, se sugiere que la edad óptima de la cirugía esté entre los 6-12 años. Es preferible la técnica percutánea sobre la abierta, debiendo poner mayor atención en el seguimiento de la monoplejía.

Abstract: Introduction: Childhood cerebral palsy, a non-progressive brain injury, occurs before, during or after delivery, with variable neurological damage from mild to disabling. The deformity in equine is treated conservatively at an early age, but when is surgical management indicated? Objective: Our goal was to determine the optimal age for surgical management of the equine foot in CCP patients. Material and methods: Retrospective study, in patients diagnosed with CCP (all types), treated surgically with open or percutaneous Achilles tendon elongation, assessed with external consultation notes, in patients aged 1-16 years, and average follow-up of 6 years, evaluating progress with relapse of deformity and gait with plantigrade support. Results: 55 patients, 74 equinus feet (29 in girls, 45 in boys) were analyzed with surgical treatment. Those treated before six years old presented relapses, with vulnerable period in 4-6 years. Monoplegia presented 100% relapses, and triplegia presented 0%. Open surgery presented 50% recurrence and percutaneous technique only 19%. Conclusion: In our institution, the optimal age is suggested in 6-12 years. Percutaneous technique over the open, should be preferred, and greater attention should be paid to monitoring monoplexy.

Assessment of nutritional status and frequency of complications associated to feeding in patients with spastic quadriplegic cerebral palsy / Avaliação do estado nutricional e frequência de complicações associadas à alimentação em pacientes com paralisia cerebral tetraparética espástica

ABSTRACT Objective: To correlate the nutritional status with variables associated to the type of diet and feeding route of children and adolescents with spastic quadriplegic cerebral palsy (CP). Methods: This cross-sectional study included 28 patients aged ≤13 years old who presented a diagnosis of spastic quadriplegic CP and were followed by the nutrition team of the Outpatient Clinic for Special Patients of Hospital de Clínicas de Uberlândia - Universidade Federal de Uberlândia (HC-UFU), between July/2016 and January/2017. Consent forms were signed by the legal guardians. The nutritional status was evaluated and data on dietary complications food route and type of diet were collected. For the description of data, average and median values were used. Correlation was tested with Spearman's index. Significance was set at p<0.05. Results: 75% of patients used alternative feeding routes (nasoenteral, catheter or gastrostomy), 57% were eutrophic. The most frequent complications were oropharyngeal dysphagia, reflux and intestinal constipation. No correlation was found between the occurrence of complications and the nutritional status. There was a positive correlation between the diet received and the patient's nutritional status (0.48; p=0.01), i.e. individuals with adequate caloric and macronutrients intake had a better nutritional status. Conclusions: The results reinforce the need for continued nutritional guidance for the children's parents/caregivers, as well as the choice of an adequate rout of feeding to each child by the multi-professional team, in order to contribute to improved nutritional status and adequate dietary intake.

RESUMO Objetivo: Correlacionar o estado nutricional com variáveis associadas ao tipo de dieta e via de alimentação de crianças e adolescentes com paralisia cerebral (PC) tetraparética espástica. Métodos: Estudo de corte transversal com 28 pacientes com idade ≤13 anos, atendidos pela equipe de nutrição do Ambulatório de Pacientes Especiais do Hospital de Clínicas de Uberlândia da Universidade Federal de Uberlândia (HC-UFU), entre julho de 2016 e janeiro de 2017, que apresentavam diagnóstico de PC tetraparética espástica. Os pacientes incluídos tiveram o termo de consentimento assinado pelo responsável legal. Avaliou-se o estado nutricional e coletaram-se dados sobre complicações alimentares, via de alimentação e tipo de dieta. Para descrição desses dados, foram utilizadas média e mediana; para análises de correlação, correlação de Spearman, sendo significante p<0,05. Resultados: Neste estudo, 75% dos pacientes utilizavam via alternativa para alimentação (sonda nasoenteral ou gastrostomia) e 57% eram eutróficos. As complicações mais frequentes foram disfagia orofaríngea, refluxo e obstipação intestinal. Não houve correlação entre ocorrência de complicações e estado nutricional. Observou-se correlação positiva entre dieta recebida e estado nutricional dos pacientes (0,48; p=0,01), sendo que indivíduos com adequada ingestão calórica e de macronutrientes apresentaram melhor classificação do estado nutricional. Conclusões: Os resultados obtidos reforçam a necessidade de orientações nutricionais contínuas para os pais/cuidadores das crianças do estudo, bem como a escolha de uma via de alimentação adequada a cada uma delas pela equipe multiprofissional, a fim de contribuir para a melhora do estado nutricional e da ingestão alimentar.

Evaluación del seguimiento radiográfico para desplazamiento de cadera en pacientes con parálisis cerebral en el Centro Hospitalario Pereira Rossell / Assessment of X-ray follow-up for hip displacement in patients with cerebral palsy at the Pereira Rossell Hospital / Avaliação do seguimento radiográfico para deslocamento de quadril em pacientescom paralisia cerebral no Hospital Pereira Rossell

Introducción: la luxación de cadera es una complicación severa en pacientes con parálisis cerebral (PC), sobre todo en pacientes incluidos en el sistema de clasificación de la función motora gruesa (GMFCS, por su sigla en inglés) III-V. Para su identificación son necesarias radiografías de pelvis. Objetivos: evaluar el seguimiento radiográfico en estos pacientes y la detección precoz de esta complicación en nuestro hospital. Material y método: se revisaron historias clínicas y radiografías de 17 pacientes GMFCS III-V, entre 2 y 8 años de edad al momento de la radiografía de pelvis índice, midiendo el porcentaje de migración (PM) de cadera de acuerdo al índice de Reimer, el ángulo cérvico-diafisiario y calculando el CPUP Score de cada cadera. Evaluamos el control radiográfico al año o posteriormente a esa fecha, y de no haber sido así, se citaría a los pacientes a control radiológico para detectar las caderas con riesgo migratorio elevado. Resultados: de los 17 pacientes evaluados, 3 (18%) tuvieron una nueva radiografía de pelvis al año; 6 (35%) pacientes la tuvieron posteriormente al año, y antes de la fecha de control designada, 7 (41%) pacientes nunca fueron controlados, citándose para nueva radiografía en 2018. Un paciente (6%) se perdió en el seguimiento. Un paciente presentó una cadera con riesgo alto (CPUP Score 50%-60%), el resto tuvo PM dentro de rangos normales. Conclusiones: pocos pacientes con PC GMFCS III-V tuvieron un seguimiento radiográfico anual. Los monitoreados posteriormente no mostraron progresión de esta condición. El resultado de este estudio y la literatura respaldan la introducción de un programa de vigilancia en nuestro hospital.

Introduction: hip luxation is a severe complication in patients with cerebral palsy (CP), especially in gross motor functional classification system (GMFCS) III-V patients. Pelvic x-rays are necessary to identify this condition. Objectives: to assess the x-ray follow-up in these patients and the early detection of this complication in our hospital. Method: the medical records and x-rays of 17 GMFCS III-V patients who were between 2 and 8 years old at the time of index pelvic x-ray were reviewed, measurement of the hip migration percentage according to Reimer´s index, the cervical-diaphyseal angle and calculation of the CPUP hip score for each hip. We assessed the follow-up x-ray a year later or later than that date, and in the even this had not happened, we would call the patients in for a control x-ray to identify the hips with an increase migration risk. Results: 3 (18%) out of 17 patients assessed underwent a new pelvic x-ray a year later. 6 patients (35%) underwent one later than one year after and prior to the control visit planned, 7 (41%) patients were never controlled and they were called for a new x-ray in 2018. One patient (6%) was lost during follow-up. One patient had an increased risk hip (CPUP Score 50-60%), the rest had normal migration percentages. Conclusions: few patients with PC GMFCS III-V underwent annual follow-up. Those monitored did not evidence progression of this condition. This study and the relevant literature back up the introduction of a surveillance program in our hospital.

Introdução: a luxação de quadril é uma complicação grave nos pacientes com paralisia cerebral (PC), principalmente nos pacientes "Gross motor funcional classificativo system (GMFCS) III-V". Para sua identificação é necessário realizar radiografias de pélvis. Objetivos: avaliar o seguimento radiográfico nesses pacientes e realizar a detecção precoce desta complicação no hospital. Material e método: foram estudados os prontuários e radiografias de 17 pacientes GMFCS III-V, com idades entre 2 e 8 anos no momento da radiografia de pélvis índice, medindo a porcentagem de migração (PM) de quadril de acordo com o índice de Reimer, o ângulo cervico-diafisiario e calculando o CPUP Score de cada quadril. Foi feito o controle radiográfico um ano ou mais depois da data da realização da radiografia; quando não foi possível os pacientes foram convocados para a realização de controle radiológico para detectar os quadris com risco migratório elevado. Resultados: dos 17 pacientes avaliados, 3 (18%) realizaram uma nova radiografia de pélvis um ano depois da primeira, 6 (35%) pacientes depois de um ano mas antes de ser convocados para controle, 7 (41%) pacientes nunca foram controlados, sendo convocados para uma nova radiografia em 2018. Um paciente (6%) foi perdido. Um paciente apresentou um quadril com risco alto (CPUP Score 50-60%), os demais tinham PM dentro de intervalos normais. Conclusões: poucos pacientes com PC GMFCS III-V tiveram um seguimento radiográfico anual. Os que foram monitorados posteriormente não mostraram progressão desta condição. O resultado deste estudo e a literatura respaldam a introdução de um programa de vigilância no nosso hospital.

Hallazgos de videofluoroscopía en niños de 3 a 6 años con parálisis cerebral / Videofluoroscopic findings in children from 3 to 6 years old with cerebral palsy

Introducción: Los trastornos de la alimentación y deglución (TAD) acompañan frecuentemente a la parálisis cerebral (PC). Su diagnóstico oportuno previene numerosas complicaciones. La evaluación clínica es el primer acercamiento a los TAD, pero resulta insuficiente para identificar situaciones de riesgo (penetración laríngea o aspiración). Para ello, es necesaria una evaluación instrumental como la videofluoroscopía (VFC). Objetivo: Describir y cuantificar los hallazgos de VFC en un grupo de niños con PC, entre 3 años y 6 años 11 meses, GMFCS I-V. Pacientes y Métodos: Se practicó una VFC a 50 pacientes con PC, previa determinación del nivel Gross Motor Functional Classification System (GMFCS) e inexistencia de contraindicaciones para dicho examen. Además, se determinaron signos de incompetencia e inseguridad deglutoria, consistencias toleradas y requerimientos de posicionamiento, para facilitar el procedimiento. Resultados: Población predominantemente masculina, edad promedio de 5 años, 78% GMFCS III-V. Hasta el 94% tuvo una o más alteraciones videofluoroscópicas en alguna etapa del examen. El 28% no presentó capacidad de masticación, siendo todos GMFCS V. En eficacia deglutoria la alteración más frecuente fue el residuo vallecular (86%). En seguridad deglutoria fue el derrame posterior en la fase oral (68%). El 26% tuvo aspiración traqueal silente. En la fase esofágica, el 30% presentó tránsito esofágico lento y el 8% reflujo gastroesofágico. Conclusión: La VFC identificó alteraciones potencialmente riesgosas en todos los niveles GMFCS en niños portadores de PC, algunas de ellas silentes, incluso en casos de compromiso motor leve.

Introduction: Cerebral palsy (CP) is frequently accompanied by feeding and swallowing disorders (FSD). An early diagnosis of FSD prevents numerous complications. Clinical assessment stands as the first approach to FSD, although it is insufficient to identify risk factors (laryngeal penetration and aspiration). For this purpose, a videofluoroscopic (VFC) evaluation is required. Objective: To describe and quantify VFC findings in a group of children with CP, aged 3 to 6 years, GMFCS I to V. Patients and Methods: 50 patients underwent a VFC after their Gross Motor Functional Classification System (GMFCS) level was determined and no contraindications for the exam were identified. In addition, the researchers conducted an assessment to establish the presence of signs of unsafe and incompetent swallowing, food consistency tolerance, and mealtime positioning requirements, in order to allow a more comfortable VFC procedure. Results: There was male predominance, average age of 5 years, 78% GMFCS III-V. Up to 94% had one or more VFC alterations at some point of the exam. 28% had no chewing ability, being all the cases GMFCS V. Considering the deglutition efficacy, the commonest alteration was residue in the vallecula (86%), while the most frequent for swallowing safety was posterior spillage in the oral phase (68%). 26% presented silent tracheal aspiration. In the esophageal phase the findings were poor esophageal transit (30%) and gastroesophageal reflux (8%). Conclusions: VFC identified potentially risks in every GMFCS level of children with CP. Some of the VFC alterations are silent, even in mild motor impairment cases.

Nível de comprometimento motor e deglutição em pacientes com paralisia cerebral / Level of gross motor function and swallowing in patients with cerebral palsy

INTRODUÇÃO: as condições motoras orais de pacientes com paralisia cerebral (PC), incluindo a função de deglutição, apresentam influência de diversos aspectos, dentre estes o comprometimento motor global. O Gross Motor Function Classification System (GMFCS) compreende o sistema mais utilizado na classificação das condições motoras globais desses pacientes. Um conhecimento mais amplo da influência das condições motoras globais na deglutição permitirá a identificação e intervenção precoces frente às alterações desta função. OBJETIVO: verificar as condições de deglutição de acordo com o nível de comprometimento motor global em pacientes com PC. MÉTODOS: setenta pacientes com PC, com média de idade de 4 anos e 8 meses e todos os níveis de classificação do GMFCS, atendidos por um centro de reabilitação brasileiro de referência foram avaliados quanto à deglutição. O diagnóstico de deglutição e sua gravidade foram comparados com o nível de comprometimento motor avaliado pelo GMFCS. RESULTADOS: houve diferença significante entre as condições de deglutição e os níveis motores do GMFCS, para as duas consistências oferecidas (pastoso e líquido). A distribuição dos graus de disfagia em relação ao nível motor mostrou piora desta de acordo com a piora na condição motora grossa. CONCLUSÃO: as condições de deglutição de pacientes com PC correlacionaram-se de forma significante com o nível de comprometimento motor estabelecido pelo sistema GMFCS, ou seja, quanto maior este nível de comprometimento, maior a gravidade da disfagia.

INTRODUCTION: the oral sensory-motor conditions of patients with cerebral palsy (CP), including the swallowing function, are influenced by several aspects, among them the global motor impairment. The Gross Motor Function Classification System (GMFCS) comprises the most used system for classifying the motor conditions of these patients. A understanding of the influence of global motor conditions on swallowing will allow for the early identification and intervention of this function. OBJECTIVE: to verify the swallowing conditions according to the level of global motor impairment in patients with CP. METHODS: seventy patients with CP, with mean age of 4 years and 8 months, all GMFCS classification levels, attended by a Brazilian referral rehabilitation center were evaluated for swallowing. The diagnosis of swallowing and its severity were compared with the level of motor impairment assessed by GMFCS. RESULTS: there was a significant difference between the swallowing conditions and the GMFCS motor levels, for the two consistencies offered (pasty and liquid). The distribution of the degrees of dysphagia in relation to the motor level showed worsening of this according to the worsening in the gross motor condition. CONCLUSION: the deglutition conditions of patients with CP correlated significantly with the level of motor impairment established by the GMFCS, that is, the higher level of impairment, the greater severity of dysphagia.

Inflammatory markers in the saliva of cerebral palsy individuals with gingivitis after periodontal treatment

Abstract The aim of this study was to evaluate the effect of periodontal treatment on the salivary cytokine levels and clinical parameters of individuals with cerebral palsy (CP) with gingivitis. A non-randomized, clinical trial was conducted in individuals diagnosed with spastic CP. Thirty-eight individuals were enrolled in the study and were categorized according to gingival index scores between 0-1 or 2-3, assigned to groups G2 or G1, respectively. Periodontal treatment comprised oral hygiene instructions, conventional mechanical treatment and 0.12% chlorhexidine applied as an adjunct. Clinical parameters and saliva samples were collected at baseline and at the 15-day follow-up visit. Bleeding on probing and periodontal screening and recording were determined. Non-stimulated saliva samples were obtained, and the salivary flow rate, the osmolality and the levels of cytokines IL-1β, IL-6, IL-8, IL-10, TNF-α and IL-12p70 were evaluated by a cytometric bead array. The Wilcoxon test, the Mann-Whitney test, Spearman correlation analysis, Poisson regression analysis and an adjusted analysis were performed (α = 0.05). The groups differed significantly in periodontal clinical parameters at baseline and at follow-up. Salivary flow rate and osmolality were similar in both groups at both timepoints. However, TNF-α and IL-1β levels were higher in G1 than in G2 at baseline. Mechanical treatment resulted in improved clinical parameters for both groups. Furthermore, mechanical treatment resulted in a significant reduction in salivary IL-1β and IL-8 levels for both groups after treatment. Periodontal treatment performed in individuals with CP and gingivitis reduces the levels of TNF-α, IL-1β, IL-6 and IL-8.

Ingestão alimentar, estado nutricional e sintomas gastrintestinais em crianças com paralisia cerebral / Food intake, nutritional status and gastrointestinal symptoms in children with cerebral palsy

ABSTRACT BACKGROUND: Cerebral palsy may be associated with comorbidities such as undernutrition, impaired growth and gastrointestinal symptoms. Children with cerebral palsy exhibit eating problems due to the effect on the anatomical and functional structures involved in the eating function resulting in malnutrition. OBJECTIVE: The aim of this study was to investigate the association between food intake, nutritional status and gastrointestinal symptoms in children with cerebral palsy. METHODS: Cross-sectional study that included 40 children with cerebral palsy (35 with spastic tetraparetic form and 5 with non-spastic choreoathetoid form of cerebral palsy, all requiring wheelchairs or bedridden) aged from 4 to 10 years. The dietary assessment with the parents was performed using the usual household food intake inquiry. Anthropometric data were collected. Gastrointestinal symptoms associated with deglutition disorders, gastroesophageal reflux and chronic constipation were also recorded. RESULTS: The median of height-for-age Z-score (-4.05) was lower (P<0.05) than the median of weight-for-age (-3.29) and weight-for-height (-0.94). There was no statistical difference between weight-for-age and weight-for-height Z-scores. Three patients with cerebral palsy (7.5%) exhibited mild anemia, with normal ferritin levels in two. Symptoms of dysphagia, gastroesophageal reflux, and constipation were found in 82.5% (n=33), 40.0% (n=16), and 60.0% (n=24) of the sample, respectively. The patients with symptoms of dysphagia exhibited lower daily energy (1280.2±454.8 Kcal vs 1890.3±847.1 Kcal, P=0.009), carbohydrate (median: 170.9 g vs 234.5 g, P=0.023) and fluid intake (483.1±294.9 mL vs 992.9±292.2 mL, P=0.001). The patients with symptoms of gastrointestinal reflux exhibited greater daily fluid intake (720.0±362.9 mL) than the patients without symptoms of gastroesophageal reflux (483.7±320.0 mL, P=0.042) and a greater height-for-age deficit (Z-score: -4.9±1.7 vs 3.7±1.5, P=0.033). The patients with symptoms of constipation exhibited lower daily dietary fiber (9.2±4.3 g vs 12.3±4.3 g, P=0.031) and fluid (456.5±283.1 mL vs 741.1±379.2 mL, P=0.013) intake. CONCLUSION: Children with cerebral palsy exhibited wide variability in food intake which may partially account for their severe impaired growth and malnutrition. Symptoms of dysphagia, gastroesophageal reflux, and constipation are associated with different food intake patterns. Therefore, nutritional intervention should be tailored considering the gastrointestinal symptoms and nutritional status.

RESUMO CONTEXTO: Paralisia cerebral pode estar associada com comorbidades como desnutrição, déficit de crescimento e sintomas gastrintestinais. Os problemas alimentares na paralisia cerebral podem ser secundários a anormalidades anatômicas e funcionais que interferem no processo de alimentação. OBJETIVO: O objetivo deste estudo foi avaliar a associação entre ingestão alimentar, estado nutricional e sintomas gastrintestinais em crianças com paralisia cerebral. MÉTODOS: Estudo transversal que incluiu 40 crianças com paralisia cerebral (35 com tetraparesia espástica e 5 com coreoatetose não-espástica) com idade entre 4 e 10 anos. Todos os pacientes permaneciam exclusivamente na cama ou dependiam de cadeiras de rodas. Foi utilizado o inquérito dos alimentos consumidos habitualmente em casa que foi respondido pelos pais. Foram mensurados os dados antropométricos. Sintomas gastrintestinais associados com distúrbios da deglutição, refluxo gastroesofágico e constipação intestinal crônica foram obtidos. RESULTADOS: A mediana do escore Z da estatura para idade (-4,05) foi menor (P<0,05) do que a mediana de peso-idade (-3,29) e peso-estatura (-0,94). Não se observou diferença entre os escores Z de peso-idade e peso-estatura. Três pacientes com paralisia cerebral (7,5%) apresentavam anemia leve com valor normal de ferritina. Sintomas de disfagia, refluxo gastroesofágico e constipação intestinal ocorreram, respectivamente, em 82,5% (n=33), 40,0% (n=16) e 60,0% (n=24) dos pacientes estudados. Os pacientes com sintomas de disfagia apresentaram menor ingestão energética diária (1280,2±454,8 Kcal vs 1890,3±847,1 Kcal; P=0,009), de carboidratos (mediana: 170,9 g vs 234,5 g; P=0,023) e de líquidos (483,1±294.9 mL vs 992,9±292,2 mL; P=0,001). Os pacientes com sintomas de refluxo gastroesofágico apresentaram maior ingestão diária de líquidos (720,0±362,9 mL) em relação aos pacientes sem este tipo de manifestação clínica (483,7±320,0 mL; P=0.042) além de maior déficit de estatura-idade (escore Z: -4,9±1,7 vs 3,7±1,5; P=0,033). Os pacientes com sintomas de constipação intestinal apresentaram menor ingestão diária de fibra alimentar (9,2±4,3 g vs 12,3±4,3 g; P=0.031) e líquidos (456,5±283,1 mL vs 741,1± 379,2 mL; P=0,013). CONCLUSÃO: Crianças com paralisia cerebral apresentam uma grande variabilidade na ingestão alimentar que pode, pelo menos em parte, constituir um fator de agravo para o déficit de crescimento. Sintoma de disfagia, refluxo gastroesofágico e constipação intestinal associaram-se com diferentes padrões de ingestão alimentar. Portanto, a intervenção nutricional deve ser individualizada levando em consideração os sintomas gastrintestinais e o estado nutricional.

Terapias para el tratamiento de la disartria en niños con parálisis cerebral: una revisión sistemática / Treatment of dysarthria in children with cerebrall palsy: a systematic review

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.

Dolor crónico en niños y jóvenes con parálisis cerebral / Chronic pain in children and youth with cerebral palsy

Introduction: Pain results in deterioration of the emotional and social status of children and young people with cerebral palsy (CP). Prevalence values are high and vary between 32 and 69%. Despite of these figures, pain is underestimated by parents and health care team. Objective: Quantify the number of patients with chronic pain according to their ability to communicate and establish the association between pain, age and severity of the Gross Motor Function Classification (GMFCS). Method: Cross-sectional descriptive and analytic study in 8 to 20 year-old with CP. A questionnaire was administered to parents and caregivers to establish the presence of and characterize chronic pain. Results: 187 patients were included; 51% (IC95%:43,6-58,0%) experienced chronic pain, corresponding to 54% (IC95%: 45,0-62,0%) of patients that are able to communicate and 43% (IC95%: 29-57%) unable to communicate. Chronic pain was observed mainly in lower extremities, with weekly or daily frequency, of moderate to severe intensity, which limits regular activities in more than 50% of patients. No significant association was observed between the presence of chronic pain, age and GMFCS. Conclusion: Findings provide important information to improve the quality of care for patients with CP and chronic pain. Systematic evaluations must be implemented in order to provide timely and effective treatment for pain. Key words: Cerebral palsy, chronic pain, children, youth.

Introducción: El dolor produce un deterioro del estado emocional y social de niños y jóvenes con parálisis cerebral (PC). Las prevalencias son elevadas y varían entre 32% y 69%. A pesar de estas cifras, el dolor es subvalorado por padres y equipo de salud. Objetivo: Cuantificar el número de pacientes con dolor crónico según su capacidad de comunicar y determinar asociación con edad y severidad del compromiso motor grueso (GMFCS). Método: Estudio descriptivo-analítico y transversal en niños y jóvenes con PC de 8-20 años de edad. Se aplicó cuestionario a los padres/cuidadores para establecer la presencia de dolor crónico y caracterizarlo. Resultados: Se incluyeron 187 pacientes. Un 51% (IC 95%:43,6-58,0%) presentó dolor crónico, correspondiendo 54% (IC 95%: 45,0-62,0%) a pacientes comunicadores y 43% (IC95%: 29-57%) no comunicadores. El dolor crónico se localizó principalmente en extremidades inferiores, con frecuencia semanal o diaria, de intensidad moderada a severa, que limita las actividades habituales en más del 50% de los pacientes. No se encontró asociación significativa entre la presencia de dolor crónico, edad y GMFCS. Conclusión: Los hallazgos otorgan información importante para mejorar la calidad de atención de los pacientes con PC y dolor crónico. Se deben implementar sistemas de evaluación sistemática y tratar de forma oportuna y efectiva el dolor. Palabras claves: Parálisis cerebral, dolor crónico, niños.

Função pulmonar e força muscular respiratória em crianças com paralisia cerebral: estudo de casos / Function and respiratory muscle strength in children with cerebral palsy: case report

Introdução: A paralisia cerebral é um transtorno não progressivo secundário a lesão no cérebro imaturo e que acarreta principalmente em distúrbio motor. Objetivo: Investigar a função pulmonar e força muscular respiratória em crianças na faixa etária entre seis a 12 anos, com paralisia cerebral GMFCS níveis I, II e III. Métodos: Trata-se de um estudo de caso, com amostra de conveniência, na qual foi realizada uma única avaliação que constitui-se em: ficha de identificação e caracterização, avaliação antropométrica, testes de função pulmonar e força muscular respiratória. Resultados: Os três participantes apresentaram função pulmonar preservada quando comparados aos seus valores preditos. Em relação a força muscular respiratória, o participante com menor grau de funcionalidade, GMFCS III foi quem apresentou força muscular respiratória menor que 50% do predito. Conclusão: No presente estudo não houve relação entre função pulmonar e força muscular respiratória em crianças na faixa etária entre seis a 12 anos, com paralisia cerebral do tipo diplegia, GMFCS níveis II e III.

Introduction: Cerebral palsy is a non-progressive disorder secondary to injury to the immature brain and which mainly results in motor disturbance. Objective: To investigate the relationship between lung function and respiratory muscle strength in children aged six to 12 years with cerebral palsy GMFCS levels I, II and III. Methods: This is a case report, with convenience sample, as a single evaluation that was constituted in: identification card and characterization, anthropometric evaluation, pulmonary function and muscle strength tests were performed. Results: The 3 participants had preserved pulmonary function when compared to their predicted values. Regarding respiratory muscle strength, the less functional participant, GMFCS III, presented respiratory muscle strength lower than 50% of predicted. Conclusion: In the present study, there was no relation between pulmonary function and respiratory muscle strength in children between the ages of 6 and 12 years, with Cerebral Paralysis of the diplegia type, GMFCS levels II and III.

Métodos de avaliação do estado nutricional de crianças e adolescentes com Paralisia Cerebral Tetraespástica / Assessment of nutritional status of children and adolescents with spastic quadriplegic cerebral palsy

ABSTRACT BACKGROUND: Due to several factors, such as gastrointestinal's diseases and difficulty in feeding, children with Spastic Quadriplegic Cerebral Palsy tend to present nutritional deficits. OBJECTIVE: To assess the nutritional status of pediatric patients with Spastic Quadriplegic Cerebral Palsy according to reference curves for this population and with the measures of folds and circumferences, obtained by the upper arm circumference and triceps skin fold. METHODS: The data were obtained from: knee-height, estimated height, weight, upper arm circumference, and triceps skin fold. Values of folds and circumferences were compared with Frisancho, and specific curves for these patients were used as reference. The relationship between the values in the growth curve for healthy children, Z-Score, and comparison with the reference curve were verified by Fisher's exact test. We adopted the significance level of 5%. RESULTS: We evaluated 54 patients. The mean age was 10.2 years, and 34 were male, 25 fed by gastrostomy and 29, orally. The frequency of low weight by the reference curve was 22.22%. More than half of the patients presented the parameters indicating lean mass below the 5th percentile. The height of all patients was classified as adequate for the age by the reference curve. CONCLUSION: Low weight was found in 22% of patients, and there is a greater tendency to present reduced muscle mass and increased fat mass, showing the need for evaluation and appropriate interventions for patients with Spastic Quadriplegic Cerebral Palsy.

RESUMO CONTEXTO: Devido a diversos fatores, como doenças do trato gastrointestinal e dificuldade de alimentação, frequentemente crianças com Paralisia Cerebral Tetraespástica apresentam prejuízo no estado nutricional. OBJETIVO: Avaliar o estado nutricional de pacientes pediátricos com Paralisia Cerebral Tetraespástica de acordo com curvas de referência para essa população e comparar com as curvas de referência utilizadas para a população pediátrica em geral. MÉTODOS: Foram obtidos os dados de: altura do joelho, estatura estimada, peso, circunferência braquial e dobra cutânea triciptal. Valores de dobras e circunferências foram comparados com Frisancho e curvas específicas para esses pacientes foram utilizadas como referência. A relação entre os valores plotados na curva de crescimento para crianças saudáveis, Escore-Z e comparação com a curva referencial foram verificados através do teste exato de Fisher. O nível de significância adotado foi de 5%. RESULTADOS: Foram avaliados 54 pacientes. A média de idade foi de 10,2 anos, 34 eram do sexo masculino. Vinte cinco se alimentavam via gastrostomia e 29 via oral. A frequência de baixo peso pela curva referencial foi de 22,22%. Mais da metade dos pacientes apresentaram os parâmetros indicativos de massa magra abaixo do percentil 5. A estatura de todos os pacientes foi classificada como adequada para idade pela curva referencial. CONCLUSÃO: O baixo peso foi encontrado em 22% dos pacientes, e há maior tendência para que esses pacientes apresentem massa muscular reduzida e aumento da massa gorda, mostrando a necessidade de avaliação e intervenções apropriadas para pacientes com Paralisia Cerebral Tetraespástica.