Efeitos da edição de carga sobre a marcha de crianças com Hemiplegia Espástica e com desenvolvimento motor típico

Abstract

INTRODUCTION: Children with Cerebral Palsy (CP) differently from children with typical motor development have different compensatory motor patterns through the demands during gait. There is also a gap for the differentiation of normal and pathological gait among children through the use of an external disturbance during locomotion, and there is a need for studies that allow a better understanding of such differences. PURPOSE: To compare the immediate effects of loading on the gait of children with CP and children with typical motor development during gait. MATERIALS AND METHODS: This is a quasi-experimental study. The sample consisted of 39 children aged five to 12 years, divided into two groups: PC group (n = 20) composed of children with PC of type spastic hemiplegic; and the DT Group (n = 19) comprised of twenty children with typical motor development. The children in the DT group were matched for age and sex with children in the CP group. Children with CP were classified for their level of functionality (Gross Motor Function Measure System - GMFCS), evaluated in relation to gross motor function (Gross Motor Function Measure - GMFM), the degree of muscle spasticity of the paretic lower limb (Ashworth Modified Scale) and anthropometric data. The gait was evaluated by Qualys kinematic analysis system and all volunteers performed the training protocol on the Gait Trainner System 2® treadmill, divided into three phases: before the addition of the load (PRÉ phase) immediately after the removal of the load (IME phase ) and 8 minutes after the removal of the load (RET phase). The load was 60% of the weight of the lower limb and imposed on both ankles.The gait assessment protocol consisted of a single training session. The measures of outcomes were the angular variables of the hip and knee joints, the maximum height of the foot and the temporal space variables. The data were analyzed by the SPSS 20.0 program, assigning a level of significance of 0.05. For the comparison between the phases, the ANOVA with repeated measurements was performed in both groups. Unpaired ttests were performed to compare the paretic limb of children with CP and the nondominant limb of typical children at each phase of the protocol. RESULTS: In the comparison between the phases of the protocol, the results showed that the PC children had increased maximal flexion (P<0,001) and range of motion (P=0,013) of the paretic knee and paretic foot height (P=0,001) immediately after removal of the load. The effects were not retained after five minutes of rest. The typical children showed increased amplitudes of the hip (P=0,037) and knee (P=0,019) of the nondominant limb and greater height of the foot of the non-dominant limb (P=0,009), between phases PRE and IME. In the inter-limb comparison, greater hip flexion was observed in the paretic limb in the PRE (P=0,001), IME (P<0,001) and RET (P=0,001) phases when compared to the non-dominant limb. Paretic hip extension was also higher in the PRE (P=0,015), IME (P=0,002) and RET (P=0,005) phases. The paretic foot joint showed higher height than the foot of the non-dominant limb of typical children, in the PRE (P<0,001), IME (P<0,001) and RET phases (P<0,001) phases. CONCLUSION: Children with CP and children with typical motor development presented motor adjustments through the load imposed on the paretic limb and the non - dominant limb, respectively. Children with CP showed that despite an altered motor pattern due to injury, new motor behavior emerged from the remaining abilities and demands of the task, while in typical children the responses to the load reflected the repertoire of strategies with intact motor control that these children could adopt to overcome the resistance imposed on the limbs.