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A fisioterapia utiliza vários recursos e métodos para intervenções no tratamento da Encefalopatia Crônica Não Progressiva da Infância (ECNPI) ou paralisia cerebral (PC), entre eles a Kinesio Taping® (KT) e a Terapia Neuromotora Intensiva (TNMI). Esses métodos podem ser considerados relativamente novos, o que leva à necessidade do desenvolvimento de pesquisas para verificar seus efeitos em crianças com PC. O presente estudo objetivou verificar os efeitos da KT® e da TNMI na postura sentada de crianças com PC do tipo quadriparesia/quadriplegia espástica. Para isso, foram avaliadas 6 crianças, com uma média de idade de 6,25±2,69 anos. As avaliações aconteceram por meio do software SAPO, no qual os dados são obtidos em centímetros e a análise consiste na avaliação da vertical (eixo Y), comparando os lados esquerdo e direito, sendo assim possível a análise das assimetrias de maneira precisa. Com relação aos resultados, não foi identificada diferença significativa (p > 0,05) da aplicação de KT® na comparação entre efeitos imediato, agudo e crônico para os momentos pré e pós aplicação imediata da KT®. No entanto, de forma descritiva, o uso de KT® associado à TNMI favoreceu o alinhamento na postura sentada, principalmente para acrômios e Espinha ilíaca ânterossuperior (EIAS). Nota-se, portanto, que as evidências do uso de KT®, como coadjuvante durante a TNMI, ainda são inconclusivas em crianças com PC do tipo quadriparesia/plegia.

Physical therapy uses various resources and methods for intervention in the Chronic Non-Progressive Childhood Encephalopathy (CNPCE) or cerebral palsy (CP) interventions, including Kinesio Taping® (KT) and Intensive Neuromotor Therapy (INMT). These methods are relatively new, which leads to the need for the development of research to verify effects in children with CP. The present study analyzed the effects of KT® and INMT on the sitting posture of children with spastic quadriplegia. In order to do this, six (6) children (mean age 6.25±2.69 years) were evaluated. The evaluations took place through SAPO software, where data are obtained in centimeters and the analysis consists of the evaluation of the vertical (Y) axis, comparing the left and right side, thus being possible to precisely analyze any asymmetries. Regarding the results, no significant difference (p > 0.05) was observed with the application of KT® in the comparison between immediate, acute and chronic effect for the moments before and immediately after KT® application. However, descriptively, the use of KT® associated with INMT favored alignment in sitting posture, mainly for acromial and anterior superior iliac spine (ASIS). The results show that evidence of the use of KT® as an adjuvant during INMT is still inconclusive in children with CP quadriparesis/plegia.

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RESUMEN Introducción: En las personas tetrapléjicas la carencia de la función del miembro superior constituye la mayor barrera para su autonomía, por lo que muchas de ellas consideran muy importante la reconstrucción y la recuperación de sus miembros superiores. Objetivo: Describir el restablecimiento de la pinza y el agarre de la mano tetrapléjica con el uso de las técnicas de Zancolli y House. Método: Se realizó un estudio longitudinal, prospectivo, con 12 pacientes tetrapléjicos que acudieron a la consulta del equipo de Miembro Superior, del Complejo Científico Ortopédico Internacional "Frank País", de enero de 2013 a diciembre de 2016. Las variables de estudio fueron: edad, sexo, etiología de la lesión, clasificación (según la clasificación internacional de Giens), dependencia en la realización de las actividades cotidianas (índice de Barthel), función de la extremidad (clasificación funcional de Mowery), la satisfacción personal (escala de Allien y Machle) y complicaciones. Se utilizaron las técnicas de Zancolli y House. La información se recogió de las historias clínicas de los pacientes ingresados. Los datos se procesaron en una base de datos creada en microcomputadora con los sistemas Word y Excel. También se utilizó el sistema estadístico SPSS 17. Resultados: Del total de pacientes de la muestra, se atendieron once hombres y una mujer (24 manos en total). La edad promedio fue de 30 años, con un período de latencia de 8,6 años. Se recogió como etiología de la lesión medular la traumática. Según la clasificación internacional de Giens, hubo diez pacientes en el grupo 4, y dos pacientes en el grupo 5. Se presentaron complicaciones en tres casos. Con la cirugía se logró que todos los enfermos cambiaran de la condición de dependientes a independientes. En cuanto a la función de la mano, la gran mayoría de la muestra fue clasificada como excelente y, respecto a la satisfacción personal, nueve pacientes refirieron sentirse excelentes. Conclusiones: La técnica de Zancolli y la de House favorecen el restablecimiento de la pinza y el agarre de la mano tetrapléjica, mejoran la movilidad articular, la fuerza muscular y la funcionabilidad de la mano. Estos procedimientos favorecen la autonomía del paciente y tienen un alto grado de satisfacción(AU)

ABSTRACT Introduction: In tetraplegic persons, the lack of function of the upper limb constitutes the utmost barrier to their autonomy, which is why many of them consider the reconstruction and recovery of their upper limbs to be very important. Objective: To describe the restoration of the caliper and the grip of quadriplegic hand with the use of Zancolli and House techniques. Method: A longitudinal, prospective study was carried out in 12 tetraplegic patients who came to the upper limp consultation at Frank País International Orthopedic Scientific Complex, from January 2013 to December 2016. The study variables were age, sex, injury etiology, classification (according to Giens international classification), dependence on daily activities (Barthel index), function of the limb (Mowery functional classification), personal satisfaction (Allien and Machle scale) and complications. Zancolli and House techniques were used. The information was collected from the medical records of the admitted patients. Data was processed in a microcomputer database with Word and Excel systems. The SPSS 17 statistical system was also used. Results: Eleven men and one woman (24 hands in total) were treated from the total of patients in the sample. The average age was 30 years, with 8.6 years of latency period. Traumatic spinal cord injury was collected as the etiology of the spinal cord injury. According to the international Giens classification, there were ten patients in group 4, and two patients in group 5. Complications occurred in three cases. With surgery, all patients were able to change from dependent to independent status. Regarding hand function, the vast majority of the sample was classified as excellent, and regarding personal satisfaction, nine patients reported feeling excellent. Conclusions: Zancolli and House techniques favor the restoration of the caliper and the grip of the quadriplegic hand, improve joint mobility, muscle strength and the functionality of the hand. These procedures favor the autonomy of the patient and have a high degree of satisfaction(AU)

RÉSUMÉ Introduction: Chez les personnes tétraplégiques, l'absence de fonction des membres supérieurs est la barrière la plus grande qui empêche leur autonomie. C'est pourquoi la plupart d'entre elles considèrent la reconstruction et la récupération de leurs membres supérieurs très importantes. Objectif: Décrire le rétablissement de la pince digitale et la préhension de la main tétraplégique par les techniques de Zancolli et de House. Méthode: Une étude longitudinale et prospective de 12 patients tétraplégiques vus en consultation par l'équipe de Membres supérieurs, au Complexe scientifique international d'orthopédie Frank Pais, a été effectuée de janvier 2013 à décembre 2016. Les variables étudiées ont été l'âge, le sexe, l'étiologie de la lésion, la classification (selon la classification internationale de Giens), la dépendance au moment de réaliser les activités quotidiennes (index de Barthel), la fonction de l'extrémité (classification fonctionnelle de Mowery), la satisfaction personnelle (échelle d'Allien et Machhle), et les complications. Les techniques de Zancolli et de House ont été employées. L'information a été obtenue à partir des dossiers médicaux des patients hospitalisés. Les données ont été traitées dans une base des données créée par ordinateur sur la base des applications telles que Word et Excel. On a aussi utilisé le système statistique SPSS 17. Résultats: Sur la totalité de patients de l'échantillon, onze hommes et une femme (24 mains au total) ont été pris en charge. L'âge moyen a été 30 ans, dans une période de latence de 8.6 ans. Les traumatismes sont à l'origine de la lésion médullaire. D'après la classification internationale de Giens, il y a eu dix patients dans le groupe 4 et deux patients dans le groupe 5. Il y a eu des complications dans trois cas. L'intervention a permis que tous les malades atteignent leur autonomie. La fonction de la main a été considérée excellente dans la majorité des patients de l'échantillon, tandis que neuf ont exprimé leur satisfaction. Conclusions: Les techniques de Zancolli et de House favorisent le rétablissement de la pince digitale et la préhension de la main tétraplégique, et améliorent la mobilité articulaire, la force musculaire et la fonction de la main. Ces procédures facilitent l'autonomie du patient, et obtiennent un haut taux de satisfaction(AU)

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OBJECTIVE: Scapular stabilization exercises (SSE) are well-established for the able-bodies. The aim of the current study is to access the potential benefits of SSE on isometric internal and external rotator strength, endurance and function of the shoulder in persons with tetraplegia, throughout a 12-week exercise program consisting of five resisted movements with elastic bands. DESIGN: Prospective non-controlled intervention study. SETTING/PARTICIPANTS/INTERVENTIONS: A convenience sample of 17 subjects (age, 40.0±10.0 years old) with SCI was recruited from the University Hospital at the State University of Campinas (UNICAMP) from March 2015 to February 2016. They performed 5-resisted-SSE for 12 weeks, using Thera-band® elastic bands. Four evaluations were required: Baseline1, Baseline2, 6W and 12W. OUTCOME MEASURES: The dependent variables were isometric internal and external rotation strength, flexion and abduction endurance and the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: Isometric external rotation strength and flexion endurance increased after SSE and were classified as "clinically relevant" using minimal importance difference (MID). Abduction endurance increased but it was classified as "not clinically relevant". DASH score reported no significant differences but it was classified as "potentially clinically relevant". Correlations were observed among time since injury and endurance improvements. CONCLUSION: This study demonstrated that specific training of the scapula muscles shows a benefit for shoulder strength, endurance and function of the shoulder in subjects with tetraplegia and should be part of the rehabilitation program. Besides, the SSE can be performed by subjects with tetraplegia themselves on a regular basis.

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OBJECTIVE: To evaluate the movement strategies of quadriplegics, assisted by neuromuscular electrical stimulation, on reach and palmar grasp using objects of different weights. METHODS: It was a prospective clinical trial. Four chronic quadriplegics (C5-C6), with injuries of traumatic origin, were recruited and all of them had their reach and palmar grasp movement captured by four infrared cameras and six retro-reflective markers attached to the trunk and right arm, assisted or not by neuromuscular electrical stimulation to the triceps, extensor carpi radialis longus, extensor digitorum communis, flexor digitorum superficialis, opponens pollicis and lumbricals. It was measured by a Neurological and Functional Classification of Spinal Cord Injuries of the American Spinal Injury Association, Functional Independence Measure and kinematic variables. RESULTS: The patients were able to reach and execute palmar grasp in all cylinders using the stimulation sequences assisted by neuromuscular electrical stimulation. The quadriplegics produced lower peak velocity, a shorter time of movement and reduction in movement segmentation, when assisted by neuromuscular electrical stimulation. CONCLUSION: This study showed that reach and palmar grasp movement assisted by neuromuscular electrical stimulation was able to produce motor patterns more similar to healthy subjects. Level of evidence IV; Case series.

OBJETIVO: Avaliar as estratégias de movimento de quadriplégicos com o auxílio de estimulação elétrica neuromuscular sobre o alcance e a preensão palmar com objetos de diferentes pesos. MÉTODOS: Estudo clínico prospectivo. Quatro quadriplégicos crônicos (C5-C6) com lesões de origem traumática foram recrutados e todos tiveram o alcance e movimento de preensão palmar capturado por quatro câmeras infravermelho e seis marcadores retrorreflexivos fixados no tronco e braço direito, assistidos ou não por estimulação neuromuscular do tríceps, extensor radial longo do carpo, extensor dos dedos, flexor superficial dos dedos, oponente do polegar e músculos lumbricais. A medida foi feita com base na Classificação Neurológica e Funcional de Lesões Medulares da American Spinal Injury Association, na Medida de Independência Funcional e em variáveis cinemáticas. RESULTADOS: Os pacientes foram capazes de alcançar e realizar preensão palmar em todos os cilindros utilizando as sequências de estimulação auxiliadas por estimulação elétrica neuromuscular. Os quadriplégicos produziram menor velocidade de pico, menor tempo de movimento e redução na segmentação do movimento, quando foram auxiliados pela estimulação elétrica neuromuscular. CONCLUSÃO: Este estudo mostrou que o alcance e o movimento de preensão palmar assistidos por estimulação elétrica neuromuscular foi capaz de produzir padrões motores mais semelhantes aos dos indivíduos saudáveis. Nível de evidência IV; Série de casos.

OBJETIVO: Evaluar las estrategias de movimiento de cuadripléjicos, con el auxilio de estimulación eléctrica neuromuscular sobre el alcance y la prensión palmar con objetos de diferentes pesos. MÉTODOS: Estudio clínico prospectivo. Fueron reclutados cuatro cuadripléjicos crónicos (C5-C6) con lesiones de origen traumático y todos ellos tuvieron su alcance y movimiento de prensión palmar capturado por cuatro cámaras infrarrojas y seis marcadores retrorreflexivos fijados al tronco y al brazo derecho, asistidos o no por estimulación neuromuscular del tríceps, extensor radial largo del carpo, extensor de los dedos, flexor superficial de los dedos, oponente del pulgar y músculos lumbricales. La medición fue hecha con base en la Clasificación Neurológica y Funcional de Lesiones Medulares de la American Spinal Injury Association, en la Medida de Independencia Funcional y en variables cinemáticas. RESULTADOS: Los pacientes fueron capaces de alcanzar y realizar prensión palmar en todos los cilindros utilizando las secuencias de estimulación auxiliadas por estimulación eléctrica neuromuscular. Los cuadripléjicos produjeron menor velocidad de pico, menor tiempo de movimiento y reducción en la segmentación del movimiento, cuando fueron auxiliados por la estimulación eléctrica neuromuscular. CONCLUSIÓN: El presente estudio mostró que el alcance y el movimiento de prensión palmar asistidos por estimulación eléctrica neuromuscular fue capaz de producir patrones motores más similares a los individuos saludables. Nivel de evidencia IV; Serie de casos.

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Se presenta el caso clínico de un paciente con diagnóstico de cuadriparesia debido a una fractura vertebral cervical y compresión medular graves, producidas por una caída desde una altura de 2 metros. Según el examen físico, los estudios radiológicos y la aplicación de escalas neurológicas, presentaba pérdida total de la función motora, de la discriminación sensorial del dolor y de la temperatura por debajo del nivel de lesión. Debido a las secuelas de las lesiones traumáticas en el sistema nervioso central, se aplicó tratamiento bioenergético rehabilitador: magnetoterapia y craneopuntura, complementado con kinesioterapia y terapia ocupacional, y se obtuvo una mejoría de la fuerza, el tono muscular y la capacidad funcional, con coordinación de la marcha.

The case report of a patient with diagnosis of quadriparesis due to a cervical vertebral fracture and severe medullary compression, taking place due to a fall from a height of 2 meters is presented. According to the physical examination, the radiological studies and the use of neurological scales, he presented total loss of the motor function, of the sensorial discrimination of pain and of temperature under the lesion level. Due to the sequels of the traumatic lesions in the central nervous system, bioenergetic rehabilitative treatment was applied: magnetotherapy and craneopuncture, supplemented with kinesiotherapy and occupational therapy, and an improvement of the force, the muscle tone and the functional capacity, with coordination of walking was obtained.

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OBJECTIVE: To assess whether the addition of an education programme for primary caregivers to rehabilitation improves daily functioning in children with cerebral palsy. DESIGN: A randomized, single-blind, controlled study. SETTING: This study was conducted in a rehabilitation centre in Salvador, Brazil. PARTICIPANTS: A total of 63 boys and girls with cerebral palsy, at 1-12 years of age, with Gross Motor Function Classification Systems I-V, were randomly assigned to two groups: educational programme for primary caregivers and conventional rehabilitation ( n = 29) or conventional rehabilitation alone ( n = 31). INTERVENTION: Each group received 12 sessions of 30 minutes of conventional rehabilitation and 12 sessions of 45 minutes to intervention group. MEASUREMENTS: Gross Motor Function Classification System, Gross Motor Function Measure and daily functioning with the Pediatric Evaluation of Disability Inventory were assessed by a blinded assessor. The clinical outcomes were obtained at the completion of treatment (12 weeks). RESULTS: Of the 63 patients included, 60 (mean ± SD age: 4.6 ± 2.74 years) completed the protocol. The combined education and rehabilitation, as compared with conventional rehabilitation alone, yielded significantly greater benefit in the self-care domain of the Functional Skills Scale (mean change 1.74 versus 5; P = 0.001), self-care (mean change 5.52 versus 13.99; P = 0.017) and the mobility domain of the Caregiver Assistance Scale of Pediatric Evaluation of Disability Inventory (mean change 0.87 versus 17.88; P = 0.002). CONCLUSION: Self-care and mobility improved in children with cerebral palsy with the addition to conventional rehabilitation of an educational programme for primary caregivers.

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STUDY DESIGN: Cross-sectional study. OBJECTIVES: The study aimed (a) to test the cross-validation of current one-repetition maximum (1RM) predictive equations in men with spinal cord injury (SCI); (b) to compare the current 1RM predictive equations to a newly developed equation based on the 4- to 12-repetition maximum test (4-12RM). SETTING: SARAH Rehabilitation Hospital Network, Brasilia, Brazil. METHODS: Forty-five men aged 28.0 years with SCI between C6 and L2 causing complete motor impairment were enrolled in the study. Volunteers were tested, in a random order, in 1RM test or 4-12RM with 2-3 interval days. Multiple regression analysis was used to generate an equation for predicting 1RM. RESULTS: There were no significant differences between 1RM test and the current predictive equations. ICC values were significant and were classified as excellent for all current predictive equations. The predictive equation of Lombardi presented the best Bland-Altman results (0.5 kg and 12.8 kg for mean difference and interval range around the differences, respectively). The two created equation models for 1RM demonstrated the same and a high adjusted R2 (0.971, P<0.01), but different SEE of measured 1RM (2.88 kg or 5.4% and 2.90 kg or 5.5%). CONCLUSION: All 1RM predictive equations are accurate to assess individuals with SCI at the bench press exercise. However, the predictive equation of Lombardi presented the best associated cross-validity results. A specific 1RM prediction equation was also elaborated for individuals with SCI. The created equation should be tested in order to verify whether it presents better accuracy than the current ones.

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Objetivo: realizar uma busca das produções científicas publicadas a respeito da importância dos exercícios físicos na promoção do cuidar multidimensional ao indivíduo paraplégico ou quadriplégico, assim como investigar os conhecimentos da enfermagem sobre o benefício de tais atividades e esclarecer a atuação do enfermeiro na assistência a pessoa paraplégica ou tetraplégica. Métodos: Trata-se de uma revisão integrativa, realizada nas bases de dados LILACS, SciELO, MEDLINE, BDENF e portal da CAPES, correspondendo aos anos de 2004 a 2014. Resultados: Os pacientes acometidos por lesão medular apresentam déficits de cuidado e autocuidado. Dessa maneira, constatou-se que a prática de exercícios oferece diversos benefícios incluindo os biopsicossociais. Conclusão: Percebe-se que a prática dos exercícios físicos ainda não tem sua efetivação, contudo é importante o conhecimento da enfermagem sobre estes exercícios, bem como benefícios, a fim de nortear os familiares e prestar uma assistência de qualidade.

Objective: to conduct a search of published scientific works about the importance of exercise in promoting multidimensional care for the paraplegic or quadriplegic individual, as well as to investigate the knowledge of nursing about the benefit of such activities and to clarify the role of the nurse in assisting the person paraplegic or quadriplegic. Methods: This is an integrative review, conducted in the databases LILACS, SciELO, MEDLINE, BDENF e CAPES portal, corresponding to the years from 2004 to 2014. Results: Patients affected by spinal cord injury have deficits of care and self-care. Thus it was found that exercise offers many benefits including biopsychosocial. Conclusion: It was observed that the practice of physical exercise does not yet have effectiveness, however, it is important that nurses know about these benefits to guide the patients’ family members in the provision of quality care.

Objetivo: realizar una búsqueda de trabajos científicos publicados sobre la importancia del ejercicio en la promoción de la atención multidimensional para el individuo parapléjico o tetrapléjico, así como investigar el conocimiento de enfermería sobre el beneficio de tales actividades y aclarar el papel de la enfermera en la asistencia a la persona parapléjicoo tetrapléjico. Métodos: Se trata de una revisión integradora, llevado acabo en las bases de datos de las LILACS, SciELO, MEDLINE, BDENF y portal CAPES, correspondientes a los años de 2004 a 2014. Resultados: Los pacientes afectados por lesiones de la médula espinal tienen déficit de atención y cuidado de sí mismos. Así, se encontró que el ejercicio ofrece muchos beneficios, incluyendo biopsicosociales. Conclusión: Se observóque la práctica de ejercicio físico aún no ha su eficacia, sin embargo, es importante que las enfermeras saben acerca de estos beneficios para orientar sus familiares y proporcionar una atención de calidad.

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STUDY DESIGN: Cross-sectional study. OBJECTIVES: The present study aims to analyze and correlate the interlimb reflexes (ILRs), through a standard methodology, in tetraplegic and healthy subjects. The study of the connectivity between the injured spinal cord and the ILR transmission empowers new rehabilitation pathways for tetraplegic patients. SETTING: University Hospital-UNICAMP, Campinas, Brazil. METHODS: A total of 15 chronic tetraplegic patients and 10 healthy subjects were analyzed with the same methodology. Two tests were performed: (i) In test 1, the stimulus was applied to the right-arm radial nerve and the electromyography (EMG) signal collected in contralateral left tibial muscle. (ii) In test 2, the stimulus was applied to the left-leg fibular nerve and EMG collected in contralateral limb biceps, exploring the opposite direction of the pathway. In both tests, the subjects were stimulated with intensities from 5 to 30 mA (5 mA step) and 40 × 500 µs current modulated pulses. Reflexes were detected from the averaging of the 40 EMG sweeps. RESULTS: Each group was analyzed with regard to the reflexes' incidence, amplitude and latency. ILRs were found with similar prominence in both groups. A correlation between the ILR amplitude and the subject injury level was verified. Significant differences were found in the correlation of ILR latency with stimulation charge between healthy and tetraplegic subjects. CONCLUSION: The ILR transmission parameters of healthy and tetraplegic subjects were studied. The results obtained strongly suggest a different ILR transmission between healthy and tetraplegic subjects, reinforcing the hypothesis of nerve regeneration after injury.

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This study aimed to investigate the electromyographic (EMG) activation of the main cervical muscles involved in the head control during two postures widely used for the facilitation of head control in children with Cerebral Palsy (CP). A crossover trial involving 31 children with clinical diagnosis of CP and spastic quadriplegia was conducted. Electromyography was used to measure muscular activity in randomized postures. Three positions were at rest: (a) lateral decubitus, (b) ventral decubitus on the floor and (c) ventral decubitus on the wedge. Handlings for facilitating the head control were performed using the hip joint as key point of control in two postures: (a) lateral decubitus and (b) ventral decubitus on wedge. All children underwent standardized handlings, performed by the same researcher with experience in the neurodevelopmental treatment. EMG signal was recorded from muscles involved in the head control (paraspinal and sternocleidomastoid muscles) in sagittal, frontal and transverse planes, at the fourth cervical vertebra (C4), tenth thoracic vertebra (T10) and sternocleidomastoid muscle (SCM) levels. The results showed a significant increase in muscle activation when handling was performed in the lateral decubitus at C4 (P<0.001), T10 (P<0.001) and SCM (P=0.02) levels. A significant higher muscle activation was observed when handling was performed in lateral decubitus when compared to ventral decubitus at C4 level (P<0.001). Handling in ventral decubitus also induced an increase in EMG activation at T10 (P=0.018) and SCM (P=0.004) levels but not at C4 level (P=0.38). In conclusion, handlings performed in both positions may induce the facilitation of head control, as evaluated by the activity of cervical and upper trunk muscles. Handling performed in lateral decubitus may induce a slightly better facilitation of head control. These findings contribute to evidence-based physiotherapy practice for the rehabilitation of severely spastic quadriplegic CP children.

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