Oscilação postural na condição de dupla tarefa durante atividade sentado para de pé em crianças com paralisia cerebral
Lima, Camila Resende Gâmbaro
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The International Classification of Functioning, Disability and Health (ICF) is a guideline proposed by the World Health Organization that has as its premise the functionality of the individual, through a biopsychosocial model. According to this model, the health condition of the individual results from the interaction between the integrity of body structures and functions, ability to perform activities of daily living, social participation and contextual factors. In this sense, populations that present some type of disability benefit from a broader assessment. Among these populations, we highlight Cerebral Palsy (CP). CP is a health condition that causes permanent changes in posture and movement development, as well as secondary disorders such as sensory, cognitive, communicative and behavioral disturbances. The motor and sensory impairments present in these children also lead to a compromise in their functionality, evidenced by the deficits presented when performing daily tasks, such as reaching, maintenance of orthostatic posture and postural transfers, such as sitting upright (STS). Performed several times a day, the STS activity is an activity with high biomechanical demand, and it is limited in children with CP. The importance of this task for functionality, and the possible interrelationships of the ICF domains for the task to be carried out effectively, arose the motivation for Study I, entitled " Sit-to-stand movement in children with cerebral palsy and relationships with the International Classification of Functionality, Disability and Health: a systematic review”. This study sought to verify which dimensions of the ICF are taken into account when evaluating the STS activity, thus being able to elucidate which are the gaps in this field of knowledge. It was found that the domain of body structure and function is the most evaluated by the studies found, and the domain of activity and participation is the least studied. Although contextual factors were evaluated in most of the studies, few changes on the STS task were found. Since this activity is performed in various ways throughout the day, a gap in the literature has been found. In this sense, no studies that associate the STS activity with a secondary task were found. The accomplishment of two tasks simultaneously is present in several activities of daily life, and is denominated dual-task. Due to the necessity for integer organic systems in order to perform them effectively, the execution of dual-tasks may be impaired in populations with any neuromotor impairment, such as CP. Thus, the STS activity is performed often associated with a second task, but no study was found in literature evaluating this activity associated with a secondary task in children with CP. Thus, the motivation for study II, entitled "Influence of the dual task on postural sway during sit-to-stand movement in children with cerebral palsy". Children with CP and typical developmental, aged 5 to 12 years, were evaluated, and STS activity was assessed in association with the unimanual and bimanual motor dual-task and cognitive dual-task. To verify the effect of the insertion of dual-task, the postural control was evaluated through a force plate. The study showed that children with CP have higher postural oscillation to perform the STS activity than their typical pairs. However, the insertion of a dual-task required different motor strategies in children with CP, so that the activity could be performed effectively. Thus, the insertion of activities involving dual tasks must be inserted in the therapeutic plans and in the day-to-day of these children, allowing new strategies of postural control to be acquired for the accomplishment of functional activities.