Imagética motora: desenvolvimento, neuropsicologia e uso na reabilitação de crianças com paralisia cerebral hemiplégica

Abstract

The Motor Imagery (MI) is a neurocognitive process during which the representation of an action is reproduced internally without any external manifestation of the motor act. The MI is important in a number of cognitive processes and action, including motor control, mental rehearsal, motion planning, feedforward control and orientation in space. Theorists suggest that active IM the same processes involved in planning and execution of movements. In adult literature, MI is an experimental paradigm widely used to study cognitive aspects of planning and motor control. Although MI today is a cognitive phenomenon widely studied in adults, few studies have investigated its development in children of preschool and school age. Investigate the development of MI is crucial to our understanding of motor development and enables better understand the IM atypical performance in clinical populations, such as in children with hemiplegic cerebral palsy (HCP). The HCP, the motor deficits observed in the affected upper limb are assigned to mechanisms involved in both running as motor planning. Recent evidence has suggested that the motor planning deficits in subjects with HCP may be associated with a reduced ability to use IM. In this regard, recent studies show convergent results, not allowing definitive conclusions about the IM capacity in individuals with HCP. Considering the fact that the neural structures of both the motor planning and IM are overlapping, rehabilitation using the MI could ease motor problems in the HCP. There is increasing evidence for this approach in the post-cerebrovascular accident adult hemiplegia, yet Im still awaits empirical tests in children with HCP. Given the above, the present work aims to clarify the existing gap in the literature on MI in children with typical development and HCP. To this end, this paper consists of three studies. In the study I was examined the development of MI in healthy children and adolescents in pre-school and school age. To investigate at what age children are able to perform MI, apply the judgment task laterality of hands (JLH) in 72 neurologically healthy children, divided into four age groups: 6-7 years old, 8-9 years old, 10-11 years and 12-13 years. In this task, participants must judge the handedness of digital drawings of hands in different spatial orientations. To verify that the volunteers have used MI to solve the task, it measured the reaction time (RT), accuracy and biomechanical effect, ie, less reaction time to recognize the stimulus rotated medially. The results showed a lower RT and better accuracy as increasing the age range of participants, however, all age groups presented the biomechanical effect of the task, showing that younger children, 6-7 years old, are able to engage in MI. Additionally, the study II evaluated the ability of MI in children and adolescents with HCP, as operationalized by JLH task. This task was applied in 24 children and adolescents with HCP divided into two groups: HCP on the right - RHCP (N: 19, age 10 ± 2.8 years) and HCP on the left - LHCP (N: 5, age 12.8 ± 1.09 years). A group of 68 children without neurological injury was included in the study to make up the control group - CG (average age 10.62 ± 1.95 years). The results demonstrated that children with HCP were less accurate and slower than the task CG, suggesting impairment in MI. But the differences did not reach statistical significance, moreover, as the CG, children with HCP had the biomechanical effect of job showing that MI was used by all participants. Finally, the study III was designed to provide preliminary evidence on the effectiveness of MI in the rehabilitation of the upper limb on HCP. To this end, 24 children with HCP were divided into two groups: intervention group (IG) underwent an MI training program twice a week for 8 consecutive weeks, lasting 50 minutes the session. The CG was subjected only to conventional therapy. To check the effects of the intervention on the functional performance of the upper limb, volunteers were evaluated in the pre-intervention period, post-intervention and follow-up by the Assisting Hand Assessment (AHA) and Habilhand Kids. The repeated measures ANOVA showed significant improvement in pre and post-intervention IG in both the AHA (p <0.001) and the Habilhand Kids (p = 0.003). The CG showed significant improvement only between pre-intervention measures and follow-up on Habilhand Kids (p = 0.027). The results of this study provide preliminary evidence for the effectiveness of MI task training in upper limb rehabilitation of children and adolescents with HCP.