Efeito em curto prazo de dois protocolos de hidrocinesioterapia em crianças com síndrome congênita associada à infecção do vírus Zika

Abstract

Objetivo: Avaliar o efeito em curto prazo de dois protocolos de hidrocinesioterapia sobre o tônus muscular e o nível de estresse de crianças com SCZ. Métodos: Estudo cruzado, randomizado e cego, com crianças com microcefalia/SCZ entre 3-36 meses de idade. O tônus foi avaliado pela Escala Modificada de Tardieu(EMT), analisando-se o grau de tônus muscular e a amplitude de movimento articular(ADM); o nível de estresse, através de Escala visual analógica de faces variando desde um estado sem estresse (1) até estresse intenso (4). Dois protocolos de hidrocinesioterapia(Protocolo PI e PII) foram aplicados em ambiente aquático restrito, por 15 minutos com temperatura da água a 37ºC. Resultados: Doze crianças participaram do estudo(média de idade em meses: 23,9+3,97), 58,7% do sexo feminino. Após PI, observamos redução do grau de tônus dos músculos extensores de cotovelo(p=0,03) e joelho(p=0,04); em PII, não houve mudanças significativas no grau de tônus. Não houve mudanças significativas no nível de estresse em PI e PII, porém 83,3% se encontravam sem estresse ou estresse leve antes das intervenções. Conclusões: O protocolo I acarretou redução do grau de tônus muscular em curto prazo quando comparado com PII. Enfatiza-se que os protocolos aplicados são de baixo custo, e podem ser uma opção de técnica não farmacológica viável no acompanhamento terapêutico destas crianças. Ressalta-se que a experiência do fisioterapeuta deve guiar a escolha do protocolo adequado para o objetivo terapêutico de cada criança e a vantagem de ser uma técnica facilmente replicável em ambiente terapêutico e domiciliar.

Early stimulation for neuropsychomotor development in children with microcephaly: a systematic review

“…In addition, Silva et al 16 showed gains in muscle tone and socialization with the environment by involving the family of children with microcephaly in a carnival activity that included colors and textures, different tastes and temperatures, a decorated environment, and different positions as forms of stimulation. This finding corroborates the study by Monteiro et al, 20 who used the aquatic environment as a means of stimulation for children diagnosed with CZVS and showed a reduction in muscle tone and improvement in range of motion. It is important to note that the study by Monteiro et al 20 was the only randomized clinical trial that met the eligibility criteria established in this systematic review.…”

“…This finding corroborates the study by Monteiro et al, 20 who used the aquatic environment as a means of stimulation for children diagnosed with CZVS and showed a reduction in muscle tone and improvement in range of motion. It is important to note that the study by Monteiro et al 20 was the only randomized clinical trial that met the eligibility criteria established in this systematic review.…”

“…In addition, some of the studies carried out in Brazil point to the logistical difficulties of including these children in scheduled sessions, which may affect the progress and continuity of therapy. 20,22 This finding reinforces the importance of involving parents and caregivers in the process of adherence and continuity of therapy. 20 In general, the benefits of early stimulation therapy for human neurodevelopment have been demonstrated.…”

“…15 In addition to therapies, the involvement and commitment of the entire family is an unconditional part of the treatment, as well as the performance of a multidisciplinary team for proper monitoring and guidance. [16][17][18][19] Among the studies analyzed, the main interventions performed were playful activities involving the use of body positions that stimulate specific muscle groups, 14,16,18,20,21 either through stretching, physiotherapy equipment or aquatic activities. It has been found that the environment in which the child with microcephaly is inserted and the participation of the family in stimulation activities have advantages in the continuity of treatment and in understanding its importance.…”

“…20 In general, the benefits of early stimulation therapy for human neurodevelopment have been demonstrated. 14,[16][17][18][20][21][22][23][24] However, there is a paucity of studies analyzing the appropriateness of available therapies applied to healthy children to the needs of children born with microcephaly.…”