Efeitos do treino de marcha em esteira em crianças com paralisia cerebral

Abstract

The objective of this longitudinal study was to verify if the treadmill gait training improves the gross motor function in children with cerebral palsy (PC). This study evaluated 18 children with CP separated in two groups according with Gross Motor Function Classification System (GMFCS). To guarantee more homogeneity in the motor conditions two studies had been carried out: study 1 (levels I/II of the GMFCS) and 2 (levels III and IV of the GMFCS). Study 1 was composed for nine children with average of age of nine years and four months (5,7-13,2 years), level I (3 children) and II (6 children) of the GMFCS and study 2 was composed also for nine children with average of age of nine years (4 - 15 years), level III (3 children) and IV (6 children). Studies 1 and 2 had been lead in three phases: baseline, intervention and retention. The intervention phase consisted of treadmill gait training held twice a week in sessions of 25 minutes for six consecutive weeks. At each stage, the participants were evaluated using the Gross Motor Function Measure (GMFM) and 10m Walk Test (WT). In the retention phase, a Satisfaction Questionnaire for parents / caregivers was applied. Study 2 also used Functional Mobility Scale (FMS) to verify the influence of the protocol in functional mobility. In the statistics analysis, the ANOVA was applied in the two studies, separately. ANOVA with repeated measures was applied (group X evaluation) to analyze the total sample of the participants of the two studies. Study 1 showed positive changes in the scores of the GMFM in six participants and the WT-10m in five participants for normal speed and six for fast speed. The ANOVA indicated that it did not have significant difference between the evaluations. The Questionnaire showed that seven parents/caretakers had observed that the children were walking more rectified and that they were changing the steps easily less tired and needed less help. Study 2 showed positive changes in the scores of the GMFM in seven participants and the WT-10m in seven participants for the normal speed and in six for the fast. The ANOVA showed that it did not have significant difference between the evaluations. The Questionnaire showed that all the parents /caretakers had told that their children had started to walk more rectified, eight had reported that they had become less tired to walk the same distance in its daily routine and five had found that they had walked with more easiness and they had needed less help. The ANOVA with repeated measures showed that group levels I/II presented higher scores of the GMFM (p=0,001) and WT-10m in normal speed (p=0,001) and fast (p=0,001). It had difference between the evaluations for the total scores of the GMFM (p=0,019), being that GMFM 2 superior to GMFM 1 (p=0,06). In relation to the WT-10m, only for the fast speed had difference between the evaluations (p=0,027), being that in the after-intervention the average was greater than in the baseline (p=0,027). The protocol showed to significant changes in the motor function of the children with CP levels I/II and III/IV of GMFCS when the two groups had been analyzed jointly for the two applied quantitative measurements. In the analysis of study 1 and 2 separately, we did not find significant statistical results, however performance improvement was evidenced for the most part of the participants of the two groups, suggesting trend the improvement. The treadmill gait training leads to improvement of the gross motor function in children with CP levels I, II, III and IV.