Correlation between Pediatric Balance Scale and Functional Test in Children with Cerebral Palsy.

[Purpose] To investigate the correlation of functional balance with the functional performance of children with cerebral palsy. [Subjects and Methods] This was a cross-sectional study of children with cerebral palsy with mild to moderate impairment. The children were divided into 3 groups based on motor impairment. The evaluation consisted of the administration of the Pediatric Balance Scale (PBS) and the Pediatric Evaluation Disability Inventory. Correlations between the instruments were determined by calculating Pearson's correlation coefficients. [Results] In Group 1, a strong positive correlation was found between the PBS and the mobility dimension of the Pediatric Evaluation Disability Inventory (r=0.82), and a moderate correlation was found between the PBS and self-care dimension of the Pediatric Evaluation Disability Inventory (r=0.51). In Group 2, moderate correlations were found between the PBS and both the self-care dimension (r=0.57) and mobility dimension (r=0.41) of the Pediatric Evaluation Disability Inventory. In Group 3, the PBS was weakly correlated with the self-care dimension (r=0.11) and moderately correlated with the mobility dimension (r=0.55). [Conclusion] The PBS proved to be a good auxiliary tool for the evaluation of functional performance with regard to mobility, but cannot be considered a predictor of function in children with cerebral palsy.

Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial.

BACKGROUND: The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. METHODS/DESIGN: A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. DISCUSSION: This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. TRIAL REGISTRATION: ReBEC RBR-9B5DH7.

Effects of Transcranial Direct Current Stimulation Combined with Treadmill Training on Kinematics and Spatiotemporal Gait Variables in Stroke Survivors: A Randomized, Triple-Blind, Sham-Controlled Study.

The present study assessed the effects of anodal transcranial direct current stimulation (tDCS) combined with treadmill training on spatiotemporal and kinematic variables in stroke survivors using gait speed as the primary outcome. A randomized, sham-controlled, triple-blind, study was conducted involving 28 patients with hemiparesis allocated to two groups. The experimental group was submitted to treadmill training combined with anodal tDCS over the primary motor cortex (M1) of the damaged hemisphere. The control group was submitted to treadmill training combined with sham tDCS. Stimulation was administered (2 mA, 20 min) five times a week for two weeks during treadmill training. No significant differences (p > 0.05) in spatiotemporal variables were found in the intra-group and inter-group analyses. However, the experimental group demonstrated improvements in kinematic variables of the knee and ankle (p < 0.05) and these results were maintained one month after the end of the intervention. The inter-group analysis revealed significant differences (p < 0.05) with regard to the pelvis, hip and knee. Anodal tDCS over M1 of the damaged hemisphere combined with treadmill training did not affect spatiotemporal variables, but promoted improvements in kinematic variables of the pelvis, hip, knee and ankle and results were maintained one month after treatment.

Desempenho funcional de crianças com mielomeningocele / Functional performance of children with myelomeningocele

Este trabalho visou analisar o impacto dos níveis de lesão, deambulação e alterações neurológicas associadas ao quadro clínico da mielomeningocele sobre o desempenho funcional de seus portadores. Neste estudo transversal prospectivo foram examinadas 40 crianças com mielomeningocele, avaliando-se...

This study aimed at analysing the impact of level of lesion, locomotion, and neurological changes associated to meningomyelocele clinical framework concerning functional performance. For this prospective cross-sectional study 40 children with meningomyelocele were assessed...

Qualidade de vida em indivíduos portadores da Síndrome pós-pólio / Quality of life in subjects with post-polio syndrome

Objetivo: traçar um perfil sobre qualidade de vida em pacientes com Síndrome Pós-Polio, e verificar o impacto da doença sobre a qualidade de vida destes indivíduos, por meio do questionário de qualidade de vida SF-36.7. Material e Método: Foram entrevistados quinze indivíduos com diagnóstico clínico de Síndrome Pós-Pólio através da aplicabilidade do SF-36 (Medical Outcomes Study 36- Item Short-Form Health Survey), um instrumento validado, traduzido e adaptado para a nossa população. Sendo que 9 indivíduos eram do sexo feminino e 6 do sexo masculino, com idades entre 38 e 52 anos (média de idade de 45 anos). Resultados: Através do estudo e análise estatística das 8 variáveis propostas pelo SF-36, foi possível verificar que os componentes aspecto físico e dor apresentaram maior variabilidade. Conclusão: O presente estudo mostrou que o impacto das alterações na qualidade de vida dos indivíduos com Síndrome Pós-Pólio é muito importante, pois a partir destes dados obtidos, poderemos realizar um tratamento específico individual, visando à independência funcional, com conseqüente e melhora da qualidade de vida.

Objective: To verify the impact of the post-polio syndrome in the quality of life through the questionnaire SF-36 forquality of life. Materials and method: Fifteen subjects were interviewed with clinical diagnosis of Post-Polio syndromethrough the applicability of the SF-36 (Medical Outcomes Study 36 – Item Short-Form Health Survey), a validatedinstrument, translated and adapted to our population, constituted by 9 females and 6 males, from 38 to 52 yearsold (mean 45 years old). Results: Through the study and statistical analysis of the 8 proposed variables by the SF-36, it was possible to verify that the components of the physical aspect and pain are variables with a higher variability. Conclusion: The present study showed that it is extremely important to know the impact of the changes in the quality of life of subjects with Post-Polio syndrome, so an specific treatment aiming the functional independence and improve the quality of life can be proposed.

Alterações no comportamento da marcha após o uso da estimulação elétrica neuromuscular em pacientes com seqüela de paralisia cerebral do tipo hemiparesia espástica / Gait alterations after the use of neuromuscular electrical stimulation in patients with sequels of spastic hemiparetic cerebral palsy

Uma das alterações mais importantes da marcha de pacientes com seqüela de paralisia cerebral do tipo hemiparesia espástica é o pé eqüino, que, em geral, é causado por fraqueza dos músculos dorsiflexores. Diversas abordagens não invasivas vem sendo utilizadas no tratamento destas crianças, contudo a estimulação elétrica neuromuscular (EENM) não tem sido freqüentemente reportada como um recurso utilizado na terapia destes pacientes, a qual teria por objetivo o recondicionamento muscular, a redução de espasticidade e o auxílio na aprendizagem motora. Este trabalho foi idealizado, portanto, no intuito de verificar as possíveis alterações no comportamento das forças reação do solo durante a marcha de crianças portadoras de paralisia cerebral do tipo hemiparética espástica, imediatamente após o uso de EENM aplicadas sobre o músculo tibial anterior. Neste estudo foram selecionadas 6 crianças, com idade média de 7,83 ± 3,60 anos, em que foram aplicadas a freqüência de 50 Hz no músculo tibial anterior com avaliação do padrão de marcha na plataforma de pressão pré e imediatamente pós EENM. Através dos resultados observou-se que uma única aplicação de EENM não demonstra melhora do comportamento da marcha, quando comparado pré e imediatamente pós EENM, entretanto, faz-se necessário a continuação desse estudo com ênfase em aprendizado motor, intensidade da corrente e freqüência terapêutica.

One of the most important alterations in gait of patients with sequel of spastic hemiparetic cerebral palsy is the equine foot, which, in general, is caused by muscles weakness. Several non-invasive procedures are used to treat these children, however the neuromuscular electrical stimulation (NMES) has not been frequently reported as a resource used in the therapy of these patients, which would have as objective the muscular reconditioned, the reduction of spasticity and aid motor learning. This work aimed at verifying possible alterations in the ground reactions forces during gait of children with spastic hemiparetic cerebral palsy, immediately after the use of NMES on the tibialis anterior muscle. Six children, average age 7.83 ± 3.60 years old, were selected and stimulation frequency at 50 Hz was applied on the tibialis anterior muscle with evaluation of the standard gait in the pressure platform before and after NMES. Through the results it was observed that there is no gait improvement with only one application of NMES, when compared before and after NMES, however, more investigations are necessary to continue this study with emphasis in motor learning, intensity, and therapeutic frequency.

Estimulação e aquisição do controle cervical e do rolar por meio do método Halliwick associado ao conceito Bobath, em crianças com atraso motor / Estimulation of cervical control through Halliwick method associated with Bobath method in children with motor delay

O desenvolvimento motor é um processo contínuo que depende de fatores biológicos, comportamentais e ambientais. Qualquer alteração de um desses fatores provocará um atraso motor. A incidência suspeita de atraso no desenvolvimento neuropsicomotor na faixa etária de zero a dois anos nas creches municipais de Florianópolis, durante o segundo semestre de 2001, foi alta, perfazendo 86,1% da amostra. A fisioterapia oferecerá à criança uma vida com melhor funcionalidade, servindo-se de recursos como o conceito Bobath, que visa a uma adequação de tônus, inibição de padrões patológicos e a uma facilitação de movimentos funcionais, associado ao método Halliwick, que utiliza atividades lúdicas visando a melhora dos movimentos. O objetivo deste estudo foi demonstrar os benefícios do método Halliwick como complemento ao conceito Bobath na aquisição e melhora do controle cervical e do rolar em crianças com atraso motor. Foram estudadas 5 crianças com atraso motor, com idade inferior a 2 anos. Elas foram submetidas a uma terapia em piscina aquecida com duração de 45 minutos, e uma no solo, por 1 hora, totalizando 44 sessões. Foi aplicado um protocolo de hidroterapia (método Halliwick) associado a um de solo utilizando o conceito Bobath. Houve melhora das atividades realizadas na água (rotações: sagital, transversal e longitudinal). No solo as crianças adquiriram controle cervical completo e o rolar, passar para postura sentada e o sentar foram realizados com auxílio do terapeuta. A fisioterapia motora, em conjunto com a hidroterapia, proporcionou à criança novas aquisições, em relação à melhora do controle cervical, rolar e sentar. A hidroterapia, por meio do método Halliwick, proporcionou às crianças maior liberdade de amplitude de movimento, aumentando a funcionalidade e contribuindo para a realização das atividades propostas no solo, além da melhora das atividades realizadas na piscina, englobando as diferentes rotações.

The motor development is a continuous process that depends on biological, behavior and ambient factors. Any alteration of one of these factors will provoke a motor delay. The incidence suspicion of delay in the neuropsicomotor development in the age of zero to two years in the municipal day-care centers of Florianópolis, during the second semester of 2001, was high, with 86,1% of the sample. The physical therapy gives to the child a life with better functionality, using resources like the Bobath concept, which aims at the adequacy of tonus, the inhibition of pathological standards and the facilitation of functional movements, associate to the Halliwick method, which utilizes playful activities aiming at the improvement of the movements. The objective was to demonstrate the benefits of the Halliwick method as complement to the Bobath concept in the acquisition and improvement of the cervical control and rolling in children with motor delay. Were studied 5 children with motor delay, age ƒ¬ƒn2 years. They had been submitted to a therapy in warm swimming pool with duration of 45 minutes, and one in the ground, for 1 hour, totalizing 44 sessions. Was applied a hydrotherapy protocol (Halliwick method) associate to one in the ground using the Bobath concept. It had improvement of the activities carried through in the water (rotations: sagital, transversal and longitudinal). On the ground the children acquired complete cervical control and rolling, passing to position seated with aid of the therapist and also seating with aid. The motor physical therapy, in set with hydrotherapy, provided to the children new acquisitions, in relation to the improvement of the cervical control, to roll and to seat. Th e hydrotherapy, by means of the Halliwick method provided to the children biggest freedom of movement, increasing the functionality and contributing for the accomplishment of the activities carried through in the swimming pool, using the different rotations.