Analysis of muscle activation in children and adolescents with severe cerebral palsy / Análise da ativação muscular em crianças e adolescentes com paralisia cerebral grave

Abstract Introduction: Children and adolescents with spastic quadriparesis have a worse selective motor control, and studies with this population are still very scarce. The same is true with scientific evidence of one of the methods most used as a physiotherapeutic treatment in this population, the Bobath Concept. Objective: To evaluate spine erector muscles activation, gluteus medius and gluteus maximus, through the handling of the Bobath Concept and the sustained kneeling posture in subjects with a diagnosis of severe cerebral palsy; and to compare muscle activation with a reference group, in order to increase the reliability of this study. Methods: A cross-sectional study was carried out with 38 children and adolescents with cerebral palsy, classified by GMFCS at levels IV and V, and 20 healthy participants, aged between 3 and 18 years. They were submitted to the handling of the Bobath Concept and to the sustained kneeling posture, with muscle activation obtained by electromyography. Results: We observed significant muscle activation during handling in side-sitting, with weight transfer and without the help of another therapist, and in the sustained kneeling posture, for the erector of the spine and gluteus medius. Conclusion: The evidence from this study suggests that both the handling in side-sitting and the sustained kneeling posture cause significant muscle activation in the erector of the spine and gluteus medius for severe quadriparesis subjects, GMFCS IV and V, which can contribute to the improvement of postural control and decision-making in physical therapy practice.

Resumo Introdução: Crianças e adolescentes com quadriparesia espástica apresentam pior controle motor seletivo e estudos com essa população ainda são muito escassos. O mesmo ocorre com as evidências científicas de um dos métodos mais utilizados como tratamento fisioterapêutico nessa população, o Conceito Bobath. Objetivo: Avaliar a ativação dos músculos eretores da coluna, glúteo médio e glúteo máximo por meio do manuseio do Conceito Bobath e da postura ajoelhada sustentada, em indivíduos com diagnóstico de paralisia cerebral grave; e comparar a ativação muscular com um grupo de referência, a fim de aumentar a confiabilidade deste estudo. Métodos: Realizou-se um estudo transversal com 38 crianças e adolescentes com paralisia cerebral, classificados pelo GMFCS nos níveis IV e V, e 20 participantes saudáveis com idade entre 3 e 18 anos. Eles foram submetidos ao manuseio do Conceito Bobath e à postura ajoelhada sustentada, com ativação muscular obtida por eletromiografia. Resultados: Observou-se ativação muscular significativa durante o manuseio na posição sentada de lado, com transferência de peso e sem auxílio de outro terapeuta, e na postura ajoelhada sustentada para o eretor da coluna e glúteo médio. Conclusão: As evidências deste estudo sugerem que tanto o manuseio na posição sentada de lado quanto a sustentação da postura ajoelhada causam significativa ativação muscular no eretor da coluna e glúteo médio para indivíduos com quadriparesia grave, GMFCS IV e V, o que pode contribuir para a melhora do controle postural e tomada de decisão na prática fisioterapêutica.

Análise da ativação muscular em indivíduos com paralisia cerebral através de manuseios do conceito bobath: uma revisão crítica / Analysis of muscle activation in individuals with Cerebral Palsy through handling the Bobath Concept: a critical review

O objetivo desse artigo foi analisar criticamente a literatura a respeito da ativação muscular pelo uso do Conceito Bobath em indivíduos com Paralisia Cerebral. As bases de dados consultadas foram Pubmed, Science Direct, Scielo, Lilacs, PEDro e ResearchGate, não limitando o período de publicação, sendo incluídos artigos publicados até maio de 2020. Foram encontrados na literatura 827 estudos, destes apenas cinco foram incluídos nessa revisão. Os artigos inclusos, a partir de critérios pré-estabelecidos, avaliaram através da eletromiografia diferentes musculaturas pelo uso de manuseios do Conceito Bobath. As musculaturas avaliadas estão relacionadas ao controle de cervical e de tronco, além dos músculos oblíquo interno, transverso do abdome e reto abdominal. A ativação muscular foi avaliada nas posturas de decúbito lateral, decúbito ventral e sedestação. Os artigos revisados identificaram através da eletromiografia que ocorre ativação muscular durante alguns manuseios do Conceito Bobath em indivíduos com paralisia cerebral, contudo as pesquisas são escassas, já que os estudos apresentam limitações nos desenhos experimentais e amostras pequenas. Isso reforça a importância de ampliar a investigação acerca da ativação muscular durante os manuseios com esta abordagem, o que poderá contribuir efetivamente na tomada de decisão dos profissionais que atuam nesta área, visando maior eficácia no tratamento e qualidade de vida desta população.AU)

The aim of this article was to critically analyze the literature on muscle activation by the use of the Bobath Concept in individuals with Cerebral Palsy. The databases consulted were Pubmed, Science Direct, Scielo, Lilacs, PEDro and ResearchGate, not limiting the publication period, including articles published until May 2020. A total of 827 studies were found in the literature, and of these only five were included in this review. The included articles, based on pre-established criteria, evaluated through electromyography different muscles using the Bobath Concept handling. The muscles evaluated are related to cervical and trunk control, in addition to the internal oblique, transverse muscles of the abdomen and rectum. Muscle activation was evaluated in lateral decubitus postures, ventral decubitus and sedestation. The reviewed articles identified, through electromyography, that muscle activation occurs during some handling of the Bobath Concept in individuals with cerebral palsy, however research is scarce, since studies have limitations in experimental designs and small samples. This reinforces the importance of expanding the investigation about muscle activation during handling with this approach, which can effectively contribute to the decision making of professionals working in this area, aiming at greater efficiency in the treatment and quality of life of this population.(AU)

Kinesio Taping Associated with Acupuncture in the Treatment of the Paretic Upper Limb After Stroke.

The leading cause of disability in adults, leads to different consequences, such as hemiparesis and loss of function in the upper limb which can impair the performance of activities of daily living. Different techniques, such as like acupuncture and Kinesio Taping (KT), have been used to ameliorate this condition. However, there is no consensus on their concomitant effect on neurological patients. This study aimed to analyze the effects of acupuncture associated with KT on the upper limb of patients with chronic hemiparesis after stroke. In this clinical study, 16 subjects were divided into two intervention groups: acupuncture (ACP)-12 sessions of acupuncture-and acupuncture + Kinesio Taping (ACP-KT)-12 sessions of acupuncture plus KT. The Modified Ashworth Scale (spasticity), active goniometry [range of motion (ROM)], and the Wolf Motor Function Test (speed of movement) were used to assess the function of the affected upper limb. As a main result, both groups reduced spasticity in some studied musculature and increased ROM (p < 0.05), without intergroup difference. Moreover, there was no significant improvement concerning speed of movement in either group. Acupuncture was effective in reducing spasticity and increasing ROM of paretic upper limb after stroke, but did not contribute significantly to speed and quality of movement. KT did not show significant benefits concerning the analyzed variables.

Different horse's paces during hippotherapy on spatio-temporal parameters of gait in children with bilateral spastic cerebral palsy: A feasibility study.

Hippotherapy is often carried out for the rehabilitation of children with Cerebral Palsy (CP), with the horse riding at a walking pace. This study aimed to explore the immediate effects of a hippotherapy protocol using a walk-trot pace on spatio-temporal gait parameters and muscle tone in children with Bilateral Spastic CP (BS-CP). Ten children diagnosed with BS-CP and 10 healthy aged-matched children (reference group) took part in this study. The children with BS-CP underwent two sessions of hippotherapy for one week of washout between them. Two protocols (lasting 30min) were applied on separate days: Protocol 1: the horse's pace was a walking pace; and Protocol 2: the horse's pace was a walk-trot pace. Children from the reference group were not subjected to treatment. A wireless inertial measurement unit measured gait spatio-temporal parameters before and after each session. The Modified Ashworth Scale was applied for muscle tone measurement of hip adductors. The participants underwent the gait assessment on a path with surface irregularities (ecological context). The comparisons between BS-CP and the reference group found differences in all spatio-temporal parameters, except for gait velocity. Within-group analysis of children with BS-CP showed that the swing phase did not change after the walk pace and after the walk-trot pace. The percentage of rolling phase and double support improved after the walk-trot. The spasticity of the hip adductors was significantly reduced as an immediate result of both protocols, but this decrease was more evident after the walk-trot. The walk-trot protocol is feasible and is able to induce an immediate effect that improves the gait spatio-temporal parameters and the hip adductors spasticity.

Terapia Assistida por Animais como recurso fisioterapêutico para idosos institucionalizados / Animal-assisted Therapy as a physical therapy resource for institutionalized elderly

OBJETIVOS: Avaliar os efeitos da Terapia Assistida por Animais em relação à marcha e ao equilíbrio em idosos institucionalizados. MÉTODOS: Este estudo caracteriza-se como um ensaio clínico não controlado, do tipo antes e depois. O estudo foi realizado na instituição Lar da Velhice São Francisco de Assis, localizado na cidade de Caxias do Sul, Rio Grande do Sul. Foram selecionados idosos voluntários, de ambos os sexos, sendo excluídos os que apresentassem alguma alteração osteomuscular, neurológica ou cognitiva que pudesse interferir nos resultados. Foram utilizados três cães, devidamente treinados por um profissional de adestramento e atendendo a critérios específicos para Terapia Assistida por Animais. O grupo realizou 10 sessões da terapia em quatro semanas. Para análise da marcha e equilíbrio dos idosos foram utilizados os seguintes testes: Escala de Equilíbrio de Berg, teste de Equilíbrio de Tinetti, teste de Alcance Funcional e teste de Caminhada de Seis Metros. Os testes foram aplicados antes e depois das sessões de Terapia Assistida por Animais. RESULTADOS: Foram incluídos no estudo nove idosos, com idades entre 68 e 79 anos. Em relação ao equilíbrio e controle postural os indivíduos apresentaram uma melhora significativa nos valores pós-tratamento quando comparados aos do pré-tratamento, pela Escala de Berg (z=2,26 p=0,02) e pelo teste de Alcance Funcional (z=2,2 p=0,02). Na avaliação dos aspectos da marcha, no teste de Tinetti a média do escore pré-terapia foi de 7,9±2,8 e pós-terapia 9,2±1,6 (z=2,02 p=0,04). O teste de Caminhada revelou uma significativa diminuição no tempo gasto para completar o percurso de seis metros após a terapia. A média do tempo antes da terapia foi de 20,2±19 segundos e após a terapia foi de 9,2±7 segundos (z=2,47 p=0,01) (z=2,47 p=0,01). CONCLUSÕES: Encontrou-se uma melhora significativa em ambos os parâmetros avaliados, sugerindo resultados relevantes após aplicação da Terapia Assistida por Animais em relação à marcha e ao equilíbrio de idosos institucionalizados.

AIMS: To evaluate the effects of Animal-assisted Therapy on the gait and balance of institutionalized elderly. METHODS: This is a non-controlled before-after clinical trial. The study was conducted at "Lar da Velhice São Francisco de Assis,", a nursing home located in Caxias do Sul, Rio Grande do Sul, Brazil. Elderly volunteers of both sexes were selected, and those with any musculoskeletal, neurological, or cognitive conditions that could interfere with the results were excluded. Three dogs that were properly trained by a professional trainer and met the specific criteria for animal-assisted therapy were used. The group performed 10 therapy sessions in four weeks. The following tests were used for assessing the gait and balance of the elderly participants: Berg Balance scale, Tinetti Balance test, Functional Reach test, and Six-Meter-Walk test. The tests were applied before and after animal-assisted therapy. RESULTS: The study included nine subjects, aged 68 to 79 years. Regarding balance and postural control, individuals showed a significant improvement in post-treatment outcome when compared to pre-treatment, according to the Berg Balance scale (z=2.26 p=0.02) and Functional Reach test (z=2.2 p=0.02). In the gait assessment, the Tinetti test score averaged 7.9±2.8 before therapy and 9.2±1.6 after therapy (z=2.02 p=0.04). The Six-Meter-Walk test after therapy revealed a significant decrease in the time necessary to complete the six-meter course. The average time was 20.2±19 seconds prior to therapy and 9.2±7 seconds after therapy (z=2.47 p=0.01). CONCLUSIONS: Both assessed parameters showed significant improvement, suggesting important outcomes regarding gait and balance after the use of Animal-assisted Therapy in institutionalized elderly individuals.

Reabilitação aquática como recurso de tratamento da osteoartrose de quadril e joelho / Aquatic rehabilitation as a therapy resource for hip and knee osteoarthritis

Introdução: A osteoartrose caracteriza-se pela degeneração da cartilagem articular gerando hipertrofia e deformação do osso subcondral.A fisioterapia é utilizada para alívio de dor e diminuição de espasmos musculares, proporcionando maior grau de movimento da articulação afetada. Objetivo: Analisar através de estudos bibliográficos a eficácia da hidroterapia em pacientes com osteoartrose de quadril e joelho. Métodos: Estudo observacional do tipo bibliográfico,com levantamento de dados nos sistemas Scielo, Medline, Lilacs ePubmed, elencando artigos na íntegra do período de 2003 a 2011.Resultados: Foram encontrados oito artigos, destes, três abordam a hidroterapia no tratamento para osteoartrose de quadril e joelho, e cinco somente para osteoartrose de joelho. Dos artigos coletados, os testes que serviram de parâmetros para análise foram o WOMAC,Índice de Lequesne, Escala analógica visual da dor, função física e a força muscular. Conclusão: A hidroterapia na osteoartrose manifesta sua eficácia quando utilizada para aliviar desconforto e dor, aumentandoa qualidade de vida dos pacientes portadores desta patologia. A deficiência de estudos relacionados à hidroterapia leva a uma carência de resultados dificultando a abordagem do profissional.

Introduction: Osteoarthritis is characterized by degenerationof articular cartilage causing hypertrophy and deformation in thesubchondral bone. Physical therapy is used to relieve pain and reducemuscle spasms, providing a good degree of movement in theaffected joint. Objective: To analyze through literature review the effectiveness of hydrotherapy in patients with hip and knee osteoarthritis. Methods: Observational study, with data collection in thesystems: Scielo, Medline, Lilacs and Pubmed, for the period 2003to 2011. Results: Were found eight articles, considering that onlythree of them approach hydrotherapy treatment for hip and knee osteoarthritis, while five of them only approach knee osteoarthritis. Considering the articles collected, the tests used as parameters for analysis were the WOMAC, the Lequesne Index, the analog scale of pain, the physical function and the muscle strength. Conclusion: Hydrotherapy in osteoarthritis shows its effectiveness in the discomfort and pain rates, increasing the quality of life of patients with this pathology. A deficiency of studies related to hydrotherapy leadsto a lack of results, making difficult the approach of the professional.