Diss. Linköping : Univ., 2001.

Complex orthopaedic surgery is often indicated in the management of deformity in children with spastic diplegic cerebral palsy (CP) and a long rehabilitation programme is important for a successful outcome. However, the frequency and content of physiotherapy treatment following surgery varies between centres. This thesis aimed at providing a scientific basis for post-operative rehabilitation following multi-level surgery in children with CP. The effect of muscle weakness on function in patients with CP is recognised. However, the short and long-term impact of multi-level orthopaedic surgery on muscle strength is unclear. Strength changes would have implications for both surgical and conservative treatment planning. The objectives of this study were to establish a better understanding of the impact of surgery on muscle strength, gait and function, as well as the natural history of weakness in CP. Furthermore, the study aimed to clarify whether physiotherapy, focused on resistance strengthening techniques, was more effective than routine physiotherapy. The reliability of a protocol for measuring muscle strength in lower limb muscle groups in this population was firstly established. A pilot study of 10 children with a diagnosis of spastic diplegic CP and healthy counterparts demonstrated a reliable strength testing protocol. The main study of 20 diplegic children who underwent multi-level surgery showed that despite improvements in gait parameters, significant loss of strength in lower limb muscle groups and gross motor function persisted at six months. The value of intensive physiotherapy was assessed in a randomised controlled trial six months after surgery. Advantages of resistance training over active exercise were demonstrated. Assessment at one year showed that surgical patients preserved the post-physiotherapy strength and function gains but these did not reach the pre-operative values. Another group of 10 diplegic children who received routine physiotherapy but no surgical treatment for 12 months showed significant deterioration of their gait. The rate of deterioration demonstrated in conservatively treated diplegic patients and the degree of weakness caused by surgery, should inform parents and clinicians during decisions regarding surgery. Future research in multi-level surgery should include specific strength assessment protocols. The results from the randomised clinical trial showed that overall intensive strengthening regimes after multi-level surgery are beneficial. This finding would have significant implications on managing resources and designing appropriate rehabilitation programmes after multi-level orthopaedic surgery.

Orientador: Edison Duarte / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Física / Made available in DSpace on 2018-08-22T12:52:05Z (GMT). No. of bitstreams: 1 Costa_PolianaChiemiYamagute_M.pdf: 15146484 bytes, checksum: ca36299d74b388fb3f24ed7129e0b522 (MD5) Previous issue date: 2013 / Resumo: As crianças e adolescentes com Paralisia Cerebral (PC) Espástica diparética apresentam comprometimentos músculo-esqueléticos e neuromusculares que restringem o controle normal da postura e as estratégias de equilíbrio estático e dinâmico, interferindo no desempenho de atividades funcionais. As inovações tecnológicas dos últimos anos têm agregado intervenções sensório-motoras através de sistemas de realidade virtual para melhora da estabilidade postural e do controle motor seletivo. Com estes objetivos, o vídeo game Nintendo Wii® que utiliza um sistema de realidade virtual é amplamente utilizado no Brasil, sendo conhecido como Wiireabilitação. Poucos estudos comprovam seus benefícios em crianças com desordens neuromotoras, portanto, este estudo teve como objetivo analisar as mudanças que o uso do sistema de realidade virtual Nintendo Wii® como terapia complementar pode provocar na função motora grossa, alinhamento postural, equilíbrio estático e dinâmico de crianças e adolescentes com PC espástica diparética com marcha independente. Métodos: 12 sujeitos com PC diparética foram alocados aleatoriamente em: grupo controle submetido à fisioterapia convencional (GC, n=6) e grupo experimental submetido à fisioterapia associada à Wiireabilitação (GE, n=6), ambos para treino de alinhamento postural, equilíbrio e função motora grossa. Equilíbrio estático e dinâmico foram avaliados através do sistema de Baropodometria Eletrônica, o alinhamento postural pelo Software para Avaliação Postural (SAPO), e a função motora grossa através das dimensões D e E da escala Gross Motor Function Measure (GMFM-88). Estas variáveis foram mensuradas nos dois grupos antes e após 20 sessões de intervenção, sendo comparadas entre grupo e entre grupo e momento com o testes estatístico ANOVA one-way para medidas repetidas. Para as comparações pairwise foi utilizada análise gráfica (boxplot e gráfico de interação). Resultados: No teste de estabilometria da baropodometria eletrônica, houve diferença estatisticamente significativa na comparação entre grupo para oscilação médio-lateral e ânteroposterior com olhos fechados (cm) e oscilação do centro de pressão na superfície (cm2) com olhos fechados (p=0.050; p=0.005; p=0.009 respectivamente), e diferença na comparação entre grupo e momento para as mesmas variáveis anteriores (p=0.042; p=0.012 e p=0.006 respectivamente). Neste teste observa-se melhora de todas as variáveis no grupo experimental, e piora de todas no grupo controle. Não foram encontradas diferenças significativas que indicassem melhora para as variáveis da função motora grossa, do alinhamento postural, da baropodometria estática e dinâmica. Conclusão: Os resultados deste estudo sugerem que 20 sessões de fisioterapia convencional associadas à Wiireabilitação produzem melhora no controle do equilíbrio estático, porém não foram suficientes para produzir mudanças significativas na função motora grossa, no alinhamento postural e na distribuição da carga corporal nos pés / Abstract: Children and adolescents with Spastic Diplegia Cerebral Palsy (CP) present musculo-skeletal impairments that restrict normal postural control and static and dynamic balance strategies, interfering in functional performance activities. Recent technological innovations have added sensory-motor interventions through the use of virtual reality systems to improve postural stability and selective motor control. The video game Nintendo Wii® uses a virtual reality system, approaching the objectives before it is widely used in Brazil and is known as Wiihabilitation. Few researches have proved its benefits in children with motor disorders, thus this research aimed to analyze the changes that using the Nintendo Wii® virtual game system, as a complementary therapy, can cause in gross motor function, postural alignment, static and dynamic balance of children and adolescents with spastic diplegia and independent gait. 12 spastic diplegia subjects were randomly allocated into: control group submitted to conventional physiotherapy (CG, n=6) and experimental group submitted to physiotherapy associated with Wiihabilitation (EG, n=6), both for postural alignment, balance and gross motor function training. Static and dynamic balance were assessed through Electronic Baropodometry, postural alignment was assessed by the Software for Posture Assessment (SAPO), and gross motor function through D and E dimensions of the Gross Motor Function Measure (GMFM-88). These variables were measured in both groups before and after 20 sessions of intervention, and were compared between groups and between group and moment with ANOVA one-way for repeated measures. For pairwise comparisons, a graphic analysis was used (boxplot and interaction graph). Results: In the stabilometry test of the electronic baropodometry, there were statistically significant differences between groups for medio-lateral and antero-posterior oscillations with eyes closed (cm) and center of pressure surface oscillation (cm2) with eyes closed (p=0.050; p=0.005; p=0.009 respectively), and in the comparison between group and moment for the same variables (p=0.042; p=0.012 e p=0.006 respectively). In this test, there was improvement in all variables of experimental group, and decline in all variables of control group There were no significant differences that would indicate improvement on gross motor function, postural alignment, static and dynamic baropodometry variables. The results of the present research suggest that 20 sessions of conventional physiotherapy associated with Wiihabilitation improves control of static balance, however were not sufficient to produce significant changes on gross motor function, postural alignment and foot loading distribution / Mestrado / Atividade Fisica Adaptada / Mestra em Educação Física

Made available in DSpace on 2014-07-29T15:25:22Z (GMT). No. of bitstreams: 1 tese doutorado - Prudente COM.pdf: 1326905 bytes, checksum: 6e4291c24908e39406b7e44110628295 (MD5) Previous issue date: 2009-06-17 / This thesis follows the scientific article model. The first article, Quality of life of primary caregivers of children with Cerebral Palsy: integrative review of the literature was submitted to the Revista Eletrônica de Enfermagem . In this article, which used the descriptors Quality of Life , Mothers , Parents , Caregivers and Cerebral Palsy , a integrative review of the literature was undertaken which included scientific articles published between 1997 and 2008. Of the 28 articles found, 5 formed part of this sample, which despite their considerable methodological limitations, made it clear that certain aspects of the quality of life of caregivers of children with Cerebral Palsy are lower than those of caregivers of healthy children. In some of these studies, the possibility of a correlation between the level of the children s motor disability and the quality of life of the caregivers was investigated. However, the authors did not agree on this correlation, which showed the need for further investigation. So to answer this need, a second article, entitled The quality of life of mothers of children with Cerebral Palsy: the impact of motor disability , was forwarded to the periodical Disability & Rehabilitation . This was a crosssectional study, which set out to correlate the quality of life of 146 mothers of children with Cerebral Palsy with that of 30 mothers of children with normal development, all evaluated by the Medical Outcome Study 36-item Short-Form Health Survey (SF-36). In addition, the Gross Motor Function Classification System (GMFCS) was used to characterize the motor disability of the children with Cerebral Palsy. This study proved that the quality of life of mothers of children with Cerebral Palsy is lower than that of mothers with children with normal development in terms of Functioning Capacity and Vitality domains, but the children s motor disability did not influence it. A third article, entitled Relationship between the quality of life of mothers of children with Cerebral Palsy and the children s motor functioning, after ten months of rehabilitation was submitted to the periodical Revista Latino-Americana de Enfermagem . In this article, 100 mothers of children with Cerebral Palsy were studied, in an effort to assess the quality of life of these mothers after their children s rehabilitation, over a period of ten months. The abovementioned tools were also used and the Gross Motor Function Measure (GMFM). However, this was a longitudinal study which sought to correlate the quality of life of the mothers with the development of their children s gross motor function. The results show that after ten months of rehabilitation, the gross motor function of the children with Cerebral Palsy had improved significantly, while the mothers of these children showed an improvement in life quality in the pain domain; in addition, the improvement in the children s motor function did not influence the changes which occurred in the mothers quality of life, including the pain domain. On considering the complexity of quality of life and the clinical condition which Cerebral Palsy represents, one is led to believe that other factors could have a greater influence than motor functioning disability, since this factor alone does not interfere with the quality of life of the mothers. / Tese construída no modelo de artigos científicos. No primeiro, submetido à Revista Eletrônica de Enfermagem , intitulado Qualidade de vida de cuidadores primários de crianças com Paralisia Cerebral: revisão integrativa da literatura , utilizando os descritores Qualidade de Vida , Mães , Pais , Cuidadores e Paralisia Cerebral , foi realizada uma revisão integrativa da literatura, incluindo artigos científicos publicados no período de 1997 a 2008. Dos 28 artigos encontrados, 5 fizeram parte da amostra, sendo que muitos deles tiveram fortes limitações metodológicas, ficando evidente, contudo, que alguns aspectos da qualidade de vida dos cuidadores de crianças com Paralisia Cerebral são menores do que o dos cuidadores de crianças saudáveis. Em alguns destes trabalhos foi investigada uma possível correlação entre o nível de comprometimento motor das crianças e a qualidade de vida dos cuidadores, porém, não houve concordância entre os autores, evidenciando a necessidade de novas investigações. Neste sentido, em um segundo artigo, encaminhado ao periódico Disability & Rehabilitation , com o título Quality of life of mothers of children with Cerebral Palsy: impact of motor disability , um estudo do tipo transversal, procurou-se correlacionar a qualidade de vida de 146 mães de crianças com Paralisia Cerebral, comparando-as com 30 mães de crianças com desenvolvimento normal, ambas avaliadas pelo Medical Outcome Study 36-item Short-Form Health Survey (SF-36); além disso, para caracterizar o comprometimento motor das crianças com Paralisia Cerebral utilizou-se o Sistema de Classificação da Função Motora Grossa (GMFCS). Neste estudo ficou comprovado que a qualidade de vida das mães de crianças com Paralisia Cerebral é menor do que a das mães de crianças com desenvolvimento normal quanto aos domínios Capacidade Funcional e Vitalidade, mas o comprometimento motor das crianças não teve influência. No terceiro artigo, submetido ao periódico Revista Latino-Americana de Enfermagem , com o título Relação entre a qualidade de vida de mães de crianças com Paralisia Cerebral e a função motora dos filhos após dez meses de reabilitação , foram estudadas 100 mães de crianças com Paralisia Cerebral, procurando-se avaliar a qualidade de vida destas mães após dez meses de reabilitação de seus filhos, utilizando-se os mesmos instrumentos já referidos e a Medição da Função Motora Grossa (GMFM). Trata-se, portanto, de um estudo longitudinal, no qual se procurou correlacionar a qualidade de vida das mães com a evolução da função motora grossa das crianças. Os resultados demostraram que ao final de dez meses de reabilitação, as crianças com Paralisia Cerebral tiveram significativa melhora da função motora grossa, enquanto as mães destas crianças tiveram uma melhora na qualidade de vida no domínio dor; ademais, a melhora da função motora das crianças não influenciou nas mudanças ocorridas na qualidade de vida das mães, inclusive no domínio dor. Considerando a complexidade de qualidade de vida e da condição clínica representada pela Paralisia Cerebral, tudo leva a crer que outros fatores poderão ter maior influência do que o comprometimento da função motora, pois este fator, por si só, não interfere na qualidade de vida das mães.