Análise dos resultados do protocolo de gesso seriado, órtese tornozelo-pé e exercícios domiciliares no tratamento do equino de crianças com paralisia cerebral

Abstract

Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture causing activity limitation. These are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Although static and nonprogressive, orthopedic deformities and changes in the pattern of movements may occur. Toe walking is a common presentation in young children with spastic CP. It is secondary to an upper motor neuron lesion and muscular weakness of dorsiflexors and plantiflexors. As the child grows, the toe walking can bring problems such as pain, callosity, ankle instability (valgus or varus) and impaired gait may develop. Serial casting is an effective action to gain joint amplitude; however, the effect on triceps spasticity and gait speed are controversial. The aim of this study was to evaluate the effects of a serial casting protocol, followed by the use of orthosis and home exercises in joint amplitude of the ankle, spasticity and gait speed in children with CP.

A retrospective study was carried out by using medical records of children with CP between June 2015 and July 2017, at Sarah Network of Hospital of Rehabilitation - Belo Horizonte. Outcome measures included dorsiflexion, spasticity of triceps sural and gait speed and were followed for 12 months after the immobilization. For the statistical analysis we used the Generalized Estimation Equation (GEE) Method.

It was observed that the serial casting increased joint amplitude of dorsiflexion with flexed and extended knees and reduced spasticity of the triceps sural, evidenced in the rapid stretch test. The regular use of orthosis and the irregular use of orthosis increased the odds of gain of dorsiflexion with flexed knee in 10.2% and 9.2%, and the odds of gain of dorsiflexion with extended knee in 11.9% and 9.6%, compared to children who did not use the orthosis. Similarly, it increased the odds of gain in R1 by 15.9% for regular use and 12.0% for irregular use of the orthosis, respectively. Regarding gait speed, the study showed that children with GMFCS IV, III and II had 60.1%, 41.0% and 10.9% less chances of increased walking speed during the protocol in relation to children with GMFCS level I. Doing the exercises regularly, irregularly or not doing any at all had no effect on outcome measures. The serial casting is a minimally invasive, low-cost and effective intervention, with increased joint amplitude of dorsiflexion with flexed and extended knees and reduced spasticity of the triceps sural. Similarly, regular or irregular use of ankle-foot orthosis after serial casting increases the chance of ankle dorsiflexion gain and of spasticity reduction. The orthosis time can be reduced and we suggest that a new protocol of physical exercises, that includes functional activities, might be introduced to the program.