A efetividade da terapia por contensão induzida no membro superior de pacientes com paralisia cerebral
DOI:
https://doi.org/10.33233/fb.v15i4.353Abstract
Introdução: Terapia por Contensão Induzida (TCI) visa o aprendizado motor para reversão do desuso aprendido em pacientes com hemiparesia espástica. Objetivo: Verificar a efetividade do protocolo modificado da TCI pediátrica quanto ao aumento da função do membro superior (MS) afetado em pacientes com Paralisia Cerebral (PC) hemiparéticos espásticos. Métodos: O protocolo modificado foi aplicado em 23 pacientes (crianças e adolescentes) no período de três semanas, duas horas diárias de treino intensivo e uso do gesso 24 horas por dia no MS não afetado. Durante o tratamento foram aplicadas as escalas Pediatric Motor Activity Log (PMAL) ou Tween Motor Activity Log (TMAL), Pediatric Arm Functional Test (PAFT) e Inventory New Motor and Programs (INMAP). Resultados: Pós-tratamento houve melhora da frequência (p < 0,001) e qualidade (p < 0,001) dos movimentos nas escalas PMAL/TMAL. Adolescentes apresentaram melhores resultados na frequência (p = 0,011). A melhora se iniciou no 3° e 4° dia, atingindo platô entre o 11° e 12°. Aumento da pontuação do uso espontâneo nas tarefas unilaterais e bilaterais da escala PAFT. Aquisição de novos programas motores do INMAP (p = 0,027). Houve correlação fraca e não significante entre a escala de habilidade funcional da PAFT e a variável qualidade da PMAL. Conclusão: A TCI mostrou-se efetiva quanto ao aumento da função do MS afetado em pacientes com PC.
Palavras-chave: paralisia cerebral, hemiparesia, reabilitação, extremidade superior.
References
Rosenbaum P, Paneth N, Alan L, Bax MA. A report: definition and classification of cerebral palsy. Dev Med Child Neurol 2006;49:8-14.
Hoare BJ, Imms C, Rawicki HB, Carey L. Modified constraint-induced movement therapy or bimanual occupational therapy following injection of Botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: a randomised controlled trial methods paper. BMC Neurol 2010;10:1-20.
Taub E. Somatosensory deafferentation research with monkeys: implications for rehabilitation medicine. In: Ince LP, ed. Behavioral psychology in rehabilitation medicine: clinical applications. New York: Williams & Wilkins; 1980. p.371-1.
Taub E. The Behavior-analytic origins of constraint-induced movement therapy: an example of behavioral neurorehabilitation. The Behav Analyst 2012;35(2):155-78.
Taub E, Uswatte G, Mark VW, Morris DM. The learned nonuse phenomenon: implications for rehabilitation. Eur J Phys Rehabil Med 2006;42:241-55.
Brady K, Garcia T. Constraint- Induced Movement Therapy (CIMT): pediatric applications. Dev Disabil Res Rev 2009;15:102-11.
Gordon AM, Charles J, Wolf SL. Efficacy of constraint-induced movement therapy on involved upper-extremity in children with hemiplegic cerebral palsy is not age-dependent. Pediatrics 2006;117:363-73.
Sterr A, Elbert T, Berthold I, Kolbel S, Rockstroh B, Taub E. Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis: an exploratory study. Arch Phys Med Rehabil 2002;83:1374-7.
Taub E, Uswatte G, Mark WV, Morris DM, Barman J, Bowman MH, et al. Method for enhancing real-world use of a more affected arm in chronic stroke: transfer package of constraint-induced movement therapy. Stroke 2013;44:1383-8.
Taub E, Uswatte G. Constraint-induced movement therapy: answers and questions after two decades of research. Neuro Rehabilitation 2006;21:93-5.
Wallen M, Ziveanit J, Herbert R, Evans R, Novak I. Modified constraint –induced therapy for children with hemiplegic cerebral palsy: feasibility study. Dev Neurorehabil 2008;11:124-33.
Rostami RH, Arastoo AA, Nejad JS, Mahany KM, Goharped S. Effects of modified constraint-induced movement therapy in virtual enviroment on upper-limb function in children with spastic hemiparetic cerebral palsy: A randomised controlled trial. Neuro Rehabilitation 2012;31:357-65.
Silva LM, Tmashiro V, Assis RD. Terapia por contensão induzida: revisão de ensaios clÃnicos. Fisioter Mov 2010;23:153-9.
Hoare BJ, Wasiak J, Imms C, Carey L. Constraint- induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy. Cochrane Systematic Review 2007;21:675-85.
Taub E, Griffin A, Nick J, Gammons K, Uswatte G, Law CR. Pediatric CI therapy for stroke induced hemiparesis in young children. Developmental Neurorehabilitation 2007;10(1):3-18.
Taub E, Ramey LS, Deluca S, Echols KE. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics 2004;113:305-12.
Uswatte G, Taub E, Griffin A, Vogtle L, Rowe J, Barman J. The pediatric motor activity log-revised: assessing real-world arm use in children with cerebral palsy. Rehabil Psychol 2012;57(2):149-58.
Stedman’s Electronic Medical Dictionary, version 4.0. Baltimore: Williams & Williams; 1998.
Uswatte G, Taub E, Griffin A, Roe J, Vogtle L, Barman J. Pediatric arm function teste. Am J Phys Med Rehabil 2012;91(10).
Taub E, Griffen A, Uswatte G, Gannomns K, Nick J, Law CR. Treatment of congenital hemiparesis with pediatric constraint induced movement therapy. J Child Neurol 2011;26:1163-73.
Colton T. Statistics in Medicine. New York: Little, Brown and Company; 1974. P.209-11.
Huang HH, Fetters L, Hale J, Mcbride A. Bound for Success: A systematic review of constraint-induced movement therapy in children with cerebral palsy supports improved arm and hand use. Phys Ther 2009;89:1126-41.
Deppe W, Thuemmler K, Fleischer J, Berger C, Meyer S, Wiedemann B. Modified constraint-induced movement therapy versus intensive bimanual training for children with hemiplegia - a randomized controlled trial. Clinical Rehabil 2013;27(10):909-20.
Nezu A, Kimura S, Uehara S, Kobayashi T, Tanaka M, Saito K. Magnetic stimulation of motor cortex in children: maturity of corticospinal pathway and problem of clinical application. Brain Dev 1997;19:176-80.
Wolf SL. Revisiting constraint-induced movement therapy: are we too smitten with the mitten? Is all nonuse "learned"? and other quandaries. Phys Ther 2007;87:1212-23.
Martin JH, Chakrabarty S, Friel KM. Harnessing activity dependent plasticity to repair the damaged corticospinal tract in an animal model of cerebral palsy. Dev Med Child Neurol 2011;53(4):9-13.
Gordon AM. To constraint or not to constrain, and others stories of intensive upper extremity training for children with unilateral cerebral palsy. Dev Med Child Neurol 2011;53(4):56-1.
Rickards T, Sterling C, Taub E, Hu-Perkins C, Gauthier L, Graham M, et al. Diffusion tensor imaging study of the response to constraint-induced movement therapy of children with hemiparetic cerebral palsy and adults with chronic stroke. Arch Phys Med Rehabil 2014;95(3):506-41.
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