Alongamento como uma intervenção para a Paralisia Cerebral Ir para: navegação, pesquisa

Introduction

The ability to maintain postural control is an important factor to be able to perform daily activities.^[1] Being able to maintain a stable postural control is automatic for healthy people while there is often a challenging task for children with cerebral palsy (CP) or other with balance problems due to pathology or injury. Keeping balance is a complex and difficult task. Postural control requires interaction between the sensory system, muscular system and the nervous system.^[2][3] Through some of our minds as somatosensory, vision and vestibular system, given the continuous information on where the body and body parts are in relation to gravity and in relation to space.^[4] In many situations, the range of motion in the foot can be used to compensate for a disruption of equilibrium. If the ankle mobility is limited, balance problems occur.^[5]

A key issue at the physical rehabilitation of cerebral palsy is how, for example, the risk for contractures due to immobilization of skeletal muscle can be protected or reduced.^[6] Stretching is a common form of treatment used to reduce the rigor and the onset of contractures in the muscles and to some extent increase mobility. Stretching lengthens soft tissue which can result in increased joint mobility.^[7] Increased joint mobility, in turn, can increase flexibility.^[7] In a study by Taylor et. al^[7] demonstrated that greater flexibility improved performance. Despite the widespread use of stretching, there is little research evidence for its effectiveness.^[8][9]

Prolonged stretching of the muscles of children with cerebral palsy is believed to reduce the risk of deformities.^[10][11] Contractures and increased muscle tone is seen today as one of the causes of balance problems in children with CP.^[8][10][12] Is there a relationship between stretching and balance sheet capacity, joint mobility and activity.

Postural stability

The postural control is fundamental to the ability of stable body position.^[13] Postural stability refers to the ability to balance and body control to keep the body in equilibrium, i.e. to maintain the body’s centre of gravity within the support surface. This is done by adapting the muscle force. The body must be kept in equilibrium, both in stationary and in motion. Several sensory information cooperates including the vestibular system, the somatosensory system and the visual system.^[13]

With CP the balance control may be inadequate or ineffective when the compensatory muscular reactions balance disturbed by a lack of supraspinal control and increased glare sensitivity.^[14] A typical compensatory balance reaction patterns means that the muscles that counteract gravity projected outside support surface, ie the equilibrium is disturbed, activated first and straighten up the body.^[15][16] At CP, the pattern may be the opposite, the muscle that further contributes to the shift of the focus is activated in the first place and the equilibrium is disturbed further.^[17][18] One reason for this may be that cortical differentiation of motor control is not optimally developed^[19], which in turn affect the somatosensory feedback and hence the organisation of balance reactions.^[20]

Children with mild to moderate CP has retained directional specificity but lacking in varying degrees the ability to adjust the balance response to ambient varying requirements.^[5] Directional specificity means that when the body is about to fall forward, activate the muscles on the back of the body to prevent the case and straighten up the body. The same occurs in the opposite direction, when the body is falling backwards, activates muscles on the front of the body to prevent the body case and straighten up the body. Children with CP often activates antagonistic muscles when the equilibrium is disturbed, compared with normal motor developing children.^[5]

In many of the neuromuscular disorders contractures are developed due to muscular imbalance and inactivity.^[12] Contracture restricts movement, impairs the conditions for force development, and can cause pain. Contracture is abnormal position of a point as a result of an adaptive shortening of soft tissue or bone changes. Contracture has proven to be difficult to prevent, but they can be delayed in their development and become less pronounced in individuals with CP with treatment such as stretching and flexibility training.^[12][21]

Stretching

Stretching aims to make a muscle longer.^[22] Stretching is an elongation of the connective tissue, muscles and other tissues around a joint. Preventive measures that prolonged stretching of muscles and functional exercise reduces the risk of deformities in children with cerebral palsy when the muscles in passive tension slackens muscle fibres and muscle fibres provide more movement space.^[10][21][23] There are no studies that have shown that passive stretching can increase joint mobility. However, there is evidence to support that passive stretching increases the overall agility of the children with CP.^[8] Pin et. al meant that manual stretching can´t be performed long enough to change the length of a muscle and reduce the development of contractures.^[8] Manual stretching involves passive stretching that occurs without the patient’s own muscular involvement, i.e. using a finisher and finisher body weight force.^[24] Studies have shown that 30-minute daily stretching of a spastic muscle retained its length, but that it took 6 hour stretching to increase of a muscle length.^[6][10][25] Many children with CP treated with periods of stretching felt agile and had a greater ability to perform an activity afterwards.^[12] Evidence for the stretching method that is most effective is not yet coated.^[8] Measures with stretching based on the recommendations of the Daily movement in joints and muscles in healthy individuals.^[10]

Regular functional training is important for motor development.^[26] However, there are no studies on how often children should practice a skill to learn a function. This is due to several factors such as the degree of disability, the task to be learned, the environment in which the function is to be practiced, the learning ability of the child and the method used.^[27][28] One study showed that children with cerebral palsy benefited from functionally targeted training in their gross motor development and its independence in daily activities.^[29]

Insufficient movement has several consequences, including the carrying out of technical and coordination demanding activities of daily life is hampered by poor mobility.^[24] Balance problems can easily be interpreted as coordination conditional, but it may be due to reduced mobility rash in one or more directions. Reduced mobility of a muscle group or in a joint can lead to increased stress on the adjacent muscle and joint structures, which in turn can reduce the function or increase risk of injury. Therefore, stretching can be an important form of treatment.^[24] Impaired joint mobility is often seen in children with CP, which can provide secondary contractures and balance problems.^[30]

References

1. ↑ Ferdjallah M, Harris G, Smith P, Wertsch J. Analysis of postural control synergies during quiet standing in healthy children and children with cerebral palsy. Clinical Biomechanics 2002; 17:203-210
2. ↑ Fedrizzi E, Pagliano E, Mazaroli M, Fazzi E. Developmental sequence of postural control in prone position in children with spastic diplegia. Brain Dev 200; 22:436-444
3. ↑ Behm D, Bambury A, Cahill F, Power K. Effect of acute static stretching on force, balance, reaction time, and movement time. Med Sci Sports Exerc 2004; 36: 1397-1402
4. ↑ Cumberworth VL, Patel NN, Rogers W, Kenyon GS. Maturation of balance in children. J Laryngol Otol 2007; 121:449-454
5. ↑ ^5.05.15.2 Brogren E. Balans och gang: normal och avvikande utveckling, I Bekung E, Brogren E & Rösblad B (red): Sjukgymnastik för barn och ungdomar Lund: Studentlitteratur; 2002: 3:34-45
6. ↑ ^6.06.1 Coutinho E, Gomes A, Franca C, Oishi J, Salvini T. Effect of passive stretching on immobilized soleus muscle fiber morphology. Braz J Med Biol Res 2004; 37:1853-1861
7. ↑ ^7.07.17.2 Taylor D, Brooks D, Ryan J. Viscoelastic charactieristics of muscle: passive stretching versus muscular contractions. Med Sci Sports Exerc 1997; 29:1619-1624
8. ↑ ^{8.08.18.28.38.4} Pin T, Dyke P, Chan M. The effectivness of passive stretching in children with cerebral palsy. Dev Med Child Neurol 2006; 48:855-862
9. ↑ Fregala M, Goodgold S, Dumas H. Effects of lower extremity passive stretching: Pilot study of children and youth with sever limitations in self-mobility. Pediatr Phys Ther 2003; 15:167-175
10. ↑ ^{10.010.110.210.310.4} Hägglund G, Andersson S, Duppe H, Lauge-Pedersen H, Nordmark E, Westbom L. Prevention of severe kontractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity. J Pediatr Orthop 2005; 14:269-273
11. ↑ Harlvey L, Herbert L, Crosbie J. Does stretching induce lasting increases in joint ROM? A systematic rewiew. Phys Rese Inter 2002; 7:1-13
12. ↑ ^{12.012.112.212.3} Levitt S. Treatment of Cerebral Palsy and motor delay. Oxford: Blackwell Publishing; 2004
13. ↑ ^13.013.1 Shumway-Cook A, Hutchinson S, Kartin D, Price R, Wollacoott M. Effect of balance training on recovery of stability in children with cerebral palsy. Dev Med Child Neurol 2003; 45:591-602
14. ↑ Forsberg H. Neutral control of human motor development. Curr Opi Neuro 1999; 9:676-682
15. ↑ Horak FB, Nashner LM. Central programming of postural movements: adaptation to altered support-surface configurations. J Neurophysiol 1986; 55:1369-1381
16. ↑ Keshner EA, Woollacott MH, Debû B. Neck, trunk and limb muscle responses during postural perturbations in human. Exp Brain Res 1988; 71:455-466
17. ↑ Wollacott M, Burther P. Neural and musculoskeletal contributions to the development of stance balance control in typical children and in children with cerebral palsy. Acta Pediatr Suppl 1996; 416:58-62
18. ↑ Brogren E, Hadders-Algra M. Postural control in children with spastic diplegia: muscle activity during perturbations in sitting. Dev Med Child Neurol 1996; 38:379-388
19. ↑ Myklebust B. Areview of myotatic reflexes and the development of motor control and gait in infants and children: a special communication. Phys Ther 1990; 70:188-202
20. ↑ Bader-Johansson C. Grundmotorik. Lund Studentlitteratur; 1991
21. ↑ ^21.021.1 Nordmark E. Cerebral Pares, I Beckung E, Brogren E & Rösblad B (red): Sjukgymnastik för barn och ungdomar, Lund: Studentlitteratur; 2002: 13:143-153
22. ↑ Alther M. Idrottens stretchbok. Farsta: SISU idrottsböcker; 200
23. ↑ Carr J, Shepherd R. Neurological rehabilitation. Bath: The Bath Press; 1998
24. ↑ ^24.024.124.2 Annerstedt C, Gjerset A. Idrottens träningslära. SISU idrottsböcker Farsta: Elanders skogs Grafiska; 2002
25. ↑ Tardieu C, Lespargot A, Tabary C, Bret MD. For how long must the soleus muscle be stretched each day to prevent contracture? Dev Med Child Neurol 1988; 30:310-315
26. ↑ Taub E, Uswatte G, Pidikiti R. Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation- a clinical review. J Rehabil Res Dev 1999; 36:237-251
27. ↑ Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39:214-223
28. ↑ Trahan J, Malouin F. Intermittent intensive physiotherapy in children with Cerebral Palsy: a pilot study. Dev Med Child Neurol 2002; 44:233-239
29. ↑ Keteelaar M, Vermeer A, Hart H, Van Petegem-van Beek E, Helders PJM. Effect of a functional therapy program on motor abilities of children with Cerebral Palsy. Phys Ther 2001; 81:1535-1545
30. ↑ Cambell S, Linden DWV, Palisano RJ. Physical therapy for children Second edition. Philadelphia: Saunders; 2000