Desempenho funcional de crianças com mielomeningocele

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 self-care, mobility, and social functioning. Collected data were statistically analysed and the significance level set at pEste 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

Estratégias de intervenção sensório-motora para crianças prematuras no cuidado intensivo neonatal: uma revisão sistemática / Sensory-motor intervention strategies for premature infants in neonatal intensive care: a systematic review

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

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-9B5DH

Protocol study for a randomised, controlled, double-blind, clinical trial involving virtual reality and anodal transcranial direct current stimulation for the improvement of upper limb motor function in children with Down syndrome

Introduction Down syndrome results in neuromotor impairment that affects selective motor control, compromising the acquisition of motor skills and functional independence. The aim of the proposed study is to evaluate and compare the effects of multiple-monopolar anodal transcranial direct current stimulation and sham stimulation over the primary motor cortex during upper limb motor training involving virtual reality on motor control, muscle activity, cerebral activity and functional independence. Methods and analysis A randomised, controlled, double-blind, clinical trial is proposed. The calculation of the sample size will be defined based on the results of a pilot study involving the same methods. The participants will be randomly allocated to two groups. Evaluations will be conducted before and after the intervention as well as 1 month after the end of the intervention process. At each evaluation, three-dimensional analysis of upper limb movement muscle activity will be measured using electromyography, cerebral activity will be measured using an electroencephalogram system and intellectual capacity will be assessed using the Wechsler Intelligence Scale for Children. Virtual reality training will be performed three times a week (one 20 min session per day) for a total of 10 sessions. During the protocol, transcranial stimulation will be administered concomitantly to upper limb motor training. The results will be analysed statistically, with a p valueâ\u89¤0.05 considered indicative of statistical significance. Ethical aspects and publicity The present study received approval from the Institutional Review Board of Universidade Nove de Julho (Sao Paulo,Brazil) under process number 1.540.113 and is registered with the Brazilian Registry of Clinical Trials (N° RBR3PHPXB). The participating institutions have presented a declaration of participation. The volunteers will be permitted to drop out of the study at any time with no negative repercussions. The results will be published and will contribute evidence regarding the use of this type of intervention on children

Transcranial direct current stimulation combined with upper limb functional training in children with spastic, hemiparetic cerebral palsy: study protocol for a randomized controlled trial

The aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy

Transcranial direct current stimulation combined with upper limb functional training in children with spastic, hemiparetic cerebral palsy: study protocol for a randomized controlled trial

The aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy

Effect of physiotherapeutic intervention on the gait after the application of botulinum toxin in children with cerebral palsy: Systematic review

Introduction: Cerebral palsy is a group of movement and posture development disorders. 90% of this population has gait impairment, often due to the presence of spasticity. Anumber of studies emphasize the importance of combined physical therapy with botulinum toxin Atreatment. However, no consensus can be reached concerning the content of the physiotherapy program after treatment with botulinum toxin A. The purpose of the present study was to investigate, through a systematic review of the literature, the effects of physiotherapeutic intervention on gait after botulinum toxin application in children with cerebral palsy. Evidence Acquisition: PubMed, Scielo, Cochrane Library, OTseeker, and PEDro databases were searched for randomized trial published between January 2000 and January 2017. Evidence Synthesis: Sixty-eight articles were identified, four of which met the eligibility criteria and were selected for the present systematic review. Atable was created showing the main characteristics of the studies (groups, inclusion criteria, dosage, injection site, physiotherapeutic intervention, evaluation and outcomes). Conclusions: This study offers a view on the increase in the therapeutic effectiveness of botulinum toxin Aon the lower limbs when used in conjunction with a physiotherapeutic intervention, with improvements in mobility, gait pattern, range of motion and spasticity, which are maintained after the end of the physical therapy protocol. The use of botulinum toxin Aon the lower limbs when used in conjunction with a physiotherapeutic intervention, can improve muscle tone, allowing a combined treatment and intended to provide improvement of motor ability and functional skills, and potentially, delay the need for surgery

Alteração espirométrica em crianças com mielomeningocele é dependente do nível de lesão funcional

OBJETIVO: Avaliar a função pulmonar de crianças com mielomeningocele (MMC) de diferentes níveis de lesão funcional comparados a controles saudáveis pareados por idade e sexo. MATERIAL E MÉTODO: Este foi um estudo caso-controle, no qual foi selecionada apenas uma criança por nível funcional de lesão e com função cognitiva preservada, e controles de crianças saudáveis pareados por idade e gênero ao grupo de MMC. Medidas antropométricas e espirométricas de função pulmonar foram obtidas de ambos os casos e controles de MMC. RESULTADOS: Todas as crianças com MMC apresentaram reduzido estado nutricional segundo os índices recomendados pela OMS. Foi observada presença de distúrbio ventilatório restritivo leve nas crianças com nível de lesão torácica (CVF = 0,65 %prev) e lombar-alta (CVF = 0,69 %prev), e apesar de dentro dos limites da normalidade, as crianças com MMC com níveis inferiores de lesão apresentaram valores espirométricos menores do que seus respectivos controles. Houve correlação negativa perfeita entre a capacidade vital forçada e o nível de lesão funcional das crianças com MMC. CONCLUSÃO: Crianças com MMC apresentam reduzidos valores de função pulmonar quando comparados aos controles saudáveis, sobretudo os com níveis de lesão funcional elevada, os quais demonstraram distúrbio ventilatório restritivo. A fisioterapia respiratória deve ser incorporada na avaliação e segmento das crianças com MMC, coadjuvante à fisioterapia motora, especialmente naquelas acometidas com níveis de lesões mais elevadas

Alteração espirométrica em crianças com mielomeningocele é dependente do nível de lesão funcional

Objetivo: Avaliar a função pulmonar de crianças com mielomeningocele (MMC) de diferentes níveis de lesão funcional comparados a controles saudáveis pareados por idade e sexo. Material e método: Este foi um estudo caso-controle, no qual foi selecionada apenas uma criança por nível funcional de lesão e com função cognitiva preservada, e controles de crianças saudáveis pareado por idade e gênero ao grupo de MMC. Medidas antrompométricas e espirométricas de função pulmonar foram obtidas de ambos os casos e controles de MMC. Resultados: Todas as crianças com MMC apresentaram reduzido estado nutricional segundo os índices recomendados pela OMS. Foi observada presença de distúrbio ventilatório restritivo leve nas crianças com nível de lesão torácica (CVF = 0,65 %prev) e lombar-alta (CVF = 0,69 %prev), e apesar de dentro dos limites da normalidade, as crianças com MMC com níveis inferiores de lesão apresentaram valores espirométricos menores do que seus respectivos controles. Houve uma correlação negativa perfeita entre a capacidade vital forçada e o nível de lesão funcional das crianças com MMC. Conclusão: Crianças com MMC apresentam reduzidos valores de função pulmonar quando comparados aos controles saudáveis, sobretudo os com níveis de lesão funcional elevada, os quais demonstraram distúrbio ventilatório restritivo. A fisioterapia respiratória deva ser incorporada na avaliação e segmento das crianças com MMC, coadjuvante à fisioterapia motora, especialmente, naquelas acometidas com níveis de lesões mais elevadas