Treino intensivo de demandas funcionais para adolescentes com paralisia cerebral

Abstract

Adolescents with cerebral palsy (CP) present limitations to perform daily living activities. Goal-oriented functional training is considered effective in promoting daily functioning of children with CP. However, rehabilitation services for adolescents with CP are scarce and do not always meet their specific demands. It is possible that an individualized goal-oriented functional training promotes daily functioning of adolescents with CP. The aim of the study was to investigate the feasibility and effects of intensive functional goal training directed at adolescents with PC. A feasibility study was carried out with 12 adolescents with CP, ages 12-17. The adolescents were classified in levels I to IV according to the Gross Motor Function Classification System (GMFCS) and in levels I to III according to the Manual Ability Classification System (MACS). Adolescents identified their main functional goals through the Canadian Occupational Performance Measure (COPM). Individualized training lasted 2 weeks, 5 times a week, 3 hours a day and it was conducted at the rehabilitation center in groups of 4 to 6 adolescents. Adolescents were asked to practice their functional goals at home for 1 hour a day. Outcome measures included the COPM (performance and satisfaction), Pediatric Evaluation of Disability Inventory (PEDI) (functional skills and caregiver assistance in self-care and mobility), Participation and Environment Measure Children and Youth (PEM-CY) (frequency and involvement at home), Children Helping Out-Responsibilities, Expectations and Supports (CHORES) (performance and independence in household tasks) and the Box and Blocks Test (BBT). Data were collected one month prior to intervention (T1), before intervention (T2), post-intervention (T3) and 3 months after intervention (T4) by an examiner blinded to the procedures. Wilcoxon Signed-Rank tests were used to analyze differences in primary and secondary outcomes among the different moments of assessment. At the end of the intervention, adolescents answered a satisfaction questionnaire. Significant changes were observed in COPM performance and satisfaction from the perspective of adolescents and caregivers, as well as functional skills in self-care and caregiver assistance in self-care and mobility (p<0,05). In addition, there was a significant increase in performance and independence scores in household tasks and in the speed to use the dominant upper limb (p <0.05). In the follow-up measure, improvements observed after the intervention were maintained. There was no significant difference in frequency and involvement scores in adolescent’s participation at home and in the speed to use the non-dominant upper limb (p> 0.05). The intensive training of individualized goals was feasible and promoted positive results in the achievement of goals prioritized and in adolesncent’s daily functioning.