Upper limb weight-bearing effect on the body alignment of individuals with cerebral palsy who have spastic hemiparesis: a randomized clinical trial

Edlaine Aparecida Ribeiro De Oliveira,Márcia Harumi Uema Ozu,Lisa Carla Narumia,Maria Harue Misao,Lais Doratiotti Moraes,Juliana Firmo Dos Santos

doi:10.1590/1980-5918.032.ao16

Edlaine Aparecida Ribeiro De Oliveira, Márcia Harumi Uema Ozu + Show 4 more

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https://doi.org/10.1590/1980-5918.032.ao16

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Abstract

Abstract Introduction: Cerebral Palsy (CP) patients who have spastic hemiparesis usually present asymmetrical weight shift between the affected and non-affected side. Objective: To assess the effects of upper limb (UL) weight-bearing exercises on trunk symmetry, weight shift to the affected side and possible secondary effects on gait (speed and quality). Method: eleven participants with CP were randomized into two groups: Intervention Group (IG) and Control Group (CG); IG (n = 6) performed stretching exercises of the major muscle groups of UL and lower limbs (LL) and UL weight-bearing exercises in prone and seated position for 12 weeks. The CG (n = 5) did not undergo any kind of motor therapy during the study period but received the same exercises that IG after the study. The variables analyzed were: Gross Motor Function Measure (GMFM-88); Pediatric Berg Scale; Trunk Impairment Scale (TIS); Six-minute walking test (6MWT); Ten meters walking test (10MWT); Timed Up & Go (TUG); Edinburgh Visual Gait Scale (EVGS); and ground reaction force. Results: The IG showed improvement on 6MWT, TUG, TIS and Pediatric Berg Scale (p < 0.01), and CG showed improvement on GMFM-88 (p < 0.04) only for the intragroup analysis. Conclusion: The exercises were effective to improve static and dynamic balance, increasing gait speed and identifying a trend of improvement on body alignment and weight shift to the affected side.

Highlights

Cerebral Palsy (CP) patients who have spastic hemiparesis usually present asymmetrical weight shift between the affected and non-affected side
Its results can be identified after the second quarter of the first postnatal year, when the child already has some control of the movement against gravity in the prone position
Children and adolescents underwent a phone screening to verify which of them met the inclusion criteria, which were: 1) Individuals of both sexes; 2) Age group between 7 and 15 years; 3) Diagnosis of spastic hemiparesis; 4) Classified as level I in Gross Motor Function Measure (GMFCS), i.e., young people who use gait as a functional way to move around the house, the school and the community without additions [9]; 5) Those not undergoing Physical therapy, Occupational therapy or Aquatic physical therapy and 6) Those able to obey simple commands

Summary

Introduction

Cerebral Palsy (CP) patients who have spastic hemiparesis usually present asymmetrical weight shift between the affected and non-affected side. The upper limb (UL) weight-bearing capacity on normal motor development is an important factor for children to acquire new skills. Its results can be identified after the second quarter of the first postnatal year, when the child already has some control of the movement against gravity in the prone position. In this position, there is a greater involvement of the trunk muscles and UL bearing in an attempt to lift it from the bearing surface [1, 2]. Important movements are acquired for normal motor development from the prone position, such as pivoting, creeping, followed by crawling, and UL bearing helps the baby sit alone. The motor development steps in children with CP are atypical, showing a delay and abnormal progress [5, 6]

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