Desempenho sensorial e motor em crianças e jovens com paralisia cerebral: inter-relações e perspectivas para a intervenção fisioterapêutica

Abstract

Cerebral palsy (CP) is mainly characterized by disorders of movement and posture. However, somatosensory deficits are often reported and known to be involved in limitations related to motor performance. The somatosensory system includes peripheral receptors and neural pathways related to touch and body position, being central to motor control. However, the relations between sensory and motor components are not well known, as it is not clear if these relations may mediate the effects of interventions in individuals with CP. Thus, we conducted the study 1, which is a literature review that aims to verify the state of the evidence concerning the interrelationships between somatosensory and motor components in individuals with cerebral palsy. The results have shown the direct relationships between sensory and motor aspects in this population, however, there are literature gaps and variability in results reported. Moreover, the low methodological rigor of the included studies limits the understanding of interactions between these components and clinical implications. being necessary that further studies be conducted. Based on the findings regarding the influence of the sensory system on the motor performance, and since most studies addressing this topic are focused on the upper limbs, study 2 was conducted. Study 2 is about the development and evaluation of the viability and effects of a short-term sensorimotor training with predominantly sensory focus directed at the lower limbs of children and adolescents with cerebral palsy. This exploratory study had a randomized controlled design, where 8 participants were allocated to receive the sensorimotor training developed for this study, and 8 received a conventional, predominantly motor training; both protocols were applied for 3 consecutive days, with total duration of 180 minutes. The results of this study show that the developed training protocol was feasible and well-accepted in practice, but was not superior to the control protocol. However, we found significant relationships between tactile discrimination and proprioception of the lower limbs with motor components (postural stability and gait) and tendencies were observed showing that sensory and motor aspects might be influenced by a sensorimotor training protocol. The results of this study can serve as the basis for the expansion and development of sensorimotor protocols directed to the lower limbs in individuals with cerebral palsy.