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.
RESUMO: 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 nível de lesão, deambulação, malformação de Arnold-Chiari, hidrocefalia, hidromielia, medula ancorada e incontinência esfincteriana. O desempenho funcional foi avaliado pelo Pediatric Evaluation of Disability Inventory (PEDI), para um registro quantitativo da capacidade funcional e autonomia nas atividades cotidianas, nas áreas de autocuidado, mobilidade e função social. Os dados coletados foram analisados estatisticamente, estabelecendo-se o nível de significância em p<0,05. Os níveis de lesão e a deambulação influenciaram significativamente (p<0,01) os escores das três áreas do PEDI. Os graus de limitação foram diretamente proporcionais ao nível de lesão. O maior acometimento foi verificado no autocuidado e na mobilidade, tendo as crianças obtido melhor pontuação na área de função social. Nos pacientes com nível de lesão torácico, a hidromielia sintomática mostrou-se fator significativo na área de autocuidado (p<0,01). Conclui-se que os níveis de lesão e a deambulação influenciam, com impactos diferenciados, cada área do desempenho funcional. Em pacientes com lesão torácica, a hidromielia sintomática pode ser apontada como fator limitante do autocuidado. DESCRITORES:Autocuidado; Criança; Desempenho psicomotor; Locomoção; Meningomielocele ABSTRACT: 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 as to level of lesion, ambulatory ability, Arnold-Chiari malformation, hydrocephalus, hydromyelia, tethered cord, and sphincter incontinence. Functional performance was evaluated by the Pediatric Evaluation of Disability Inventory (PEDI) which quantitatively assesses functional performance and independence in daily activities in the areas of selfcare, mobility, and social functioning. Collected data were statistically analysed and the significance level set at p<0.05. Lesion levels and ambulatory ability had a significant (p<0.01) impact on scores of all three PEDI areas. Limitation degree was found to be directly proportional to level of lesion. Functional performance was more severely affected in self-care and mobility activities, and the best functional scores being obtained in social functioning. In patients with thoracic lesion level, symptomatic hydromyelia proved to be a significant factor for self-care (p<0.01). Lesion level and ambulatory ability thus may be said to influence, at different levels of impact, each area of functional performance. For patients with thoracic lesion level, symptomatic hydromyelia may be pointed out as a self-care limiting factor.
[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.
RESUMO PALAVRAS-CHAVE Mielomeningocele. Distúrbios neurológicos da marcha. ABSTRACT Prognostic factors influencing ambulation in children with KEY WORDSMeningomyelocele. Gait disorders, neurologic.
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.Palavras-chave: estimulação elétrica, marcha, paralisia cerebral, paresia.
Introdução. A Paralisia Cerebral (PC) é uma encefalopatia crônica não evolutiva, estacionária, com distúrbio de motricidade e sensorial, resultante de uma lesão cerebral no início do desenvolvimento neuromaturacional, que, de acordo com a severidade, pode evoluir com deformidades ortopédicas. Objetivo. O objetivo deste estudo foi avaliar as deformidades existentes em crianças portadoras de tetraplegia e associá-las ao uso precoce de cadeira de rodas adaptada. Método. Foram avaliadas 10 crianças portadoras de PC tetraplégica entre 5 e 13 anos, com tônus espástico, atetóide ou misto, que faziam uso deste mobiliário. O estudo foi realizado na clínica de fisioterapia da Uninove, através de um questionário oferecido aos pais sobre adaptações existentes na cadeira de rodas, tempo de uso, órteses utilizadas, deformidades associadas e recursos adotados para sentar as crianças antes de adaptar a cadeira. Resultados. Os resultadosobtidos demonstraram que a grande maioria das crianças que iniciaram o uso tardio de cadeira de rodas, mesmo com as principais adaptações e acessórios necessários, apresentou deformidades. Foi verificado também que essas deformidades estão diretamente relacionadas ao tônus predominante espástico e ao mau posicionamento precoce. Conclusão. Pode-se concluir que o uso da cadeira de rodas adaptada é muito importante na prevenção de deformidades, principalmente quando associada ao seu uso precoce.
Background: Interventions that imitate the intrauterine environment can have beneficial effects on the development of premature infants. Purpose: The aim of the present literature review was to determine what sensory-motor stimulation techniques are administered to premature newborns in neonatal intensive care units and analyze the impact of these interventions on neuropsychomotor development. Methods: The SciELO, LILACS, PubMed, PEDro and Cochrane databases were searched for pertinent articles published between 2007 and 2018. Results: Seventy-five articles were identified and 10 were included in the review. Different sensory-motor interventions are employed, the most widely used of which are tactile and acoustic stimuli. Such interventions generate both immediate and long-term benefits to neuropsychomotor development in this population. Implications: Premature newborns have the ability to interact with different environment and sensory-motor stimulation methods. These interventions generate both immediate and long-term benefits to neuropsychomotor development in this population, leading to weight gain and other improvements, such as a reduction in pain in this population. PROSPERO register number: CRD42018098693.
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.
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