Protocolo mobility intensive training (Mob-IT) em crianças e adolescentes com paralisia cerebral: viabilidade de implementação e fidelidade do tratamento

Abstract

Although intensive interventions have shown high levels of evidence in children and adolescents with cerebral palsy (CP), intervention protocols focusing on mobility are still limited. Still, the available studies often provide scarce information about the implementation of the intervention, which limits its reproducibility. Thus, two studies were carried out to describe the fidelity and feasibility of implementing an intensive protocol based on the principles of task-oriented therapy with a focus on mobility in children and adolescents with CP. The intervention was delivered using a single-subject experimental design. Four children with CP, median age: 11 years (where the youngest participant is 7 and the oldest is 13) levels I to III in the gross motor function classification system (GMFCS) participated. The mobility intensive training (Mob-IT) protocol proposed 24 hours of activities based on pre-established goals in collaboration with the participants, and was applied 3 times a week, in 2-hour sessions, for four weeks. Study 1 tested the fidelity of Mob-IT, and a manual of procedures was prepared to guarantee the fidelity of the protocol, which was tested in relation to the type of feedback provided, the level of difficulty, progression of tasks and the actual volume of the intervention. The results showed that the sessions ensured the use of extrinsically focused feedback (recommended), that the tasks were at least somewhat difficult, that task progression was performed during the intervention, and an average of 78% of the time was spent with the activities (actual volume), and 22% used as rest time and guidance. Study 2 aimed to verify the feasibility of Mob-IT with the aid of the Qualitative Feedback Questionnaire (QFQ) instrument, through adherence, acceptability, adverse effects, understanding of tasks and intervention time, and evaluating through the Canadian Performance Measure Occupational (COPM) the satisfaction of the participants and their guardians with the protocol. The results showed good acceptability of the protocol, few adverse effects, good understanding, and enough time, as reported by the participants. Regarding satisfaction, both participants and guardians were satisfied with the results of the training. Both studies had favorable results, with the implementation of the protocol being viable and faithful to the training principles and criteria. Thus, the effectiveness of the Mob-IT protocol will be tested in larger scale studies.