Previsão fenotípica de melhorias funcionais após intervenção com exercícios estruturados em crianças com transtorno do espectro da hipermobilidade
DOI:
https://doi.org/10.17267/2238-2704rpf.2026.e6668Palavras-chave:
Hipermobilidade Articular, Criança, Propriocepção, Atividade MotoraResumo
CONTEXTO: A terapia com exercícios é amplamente prescrita para crianças com transtorno do espectro da hipermobilidade (TEH), porém estudos de intervenção relatam consistentemente uma variabilidade interindividual substancial nos resultados funcionais. Análises de eficácia baseadas em médias dominam a literatura e podem mascarar diferenças nos mecanismos de controle sensório-motor que podem limitar a resposta à reabilitação. OBJETIVO: Avaliar se o controle sensório-motor basal e a variabilidade do movimento predizem a resposta funcional ao exercício estruturado em crianças com TEH. MÉTODOS: Neste estudo prospectivo, intervencionista e de grupo único, 48 crianças de 9 a 12 anos com TEH participaram de um programa de exercícios estruturado de 18 semanas com ênfase em treinamento proprioceptivo, controle neuromuscular e prática de tarefas funcionais. O desempenho funcional foi avaliado utilizando o domínio Esportes e Função Física do Instrumento de Coleta de Dados de Resultados Pediátricos (PODCI). O erro de propriocepção articular basal, a variabilidade do tempo de passo da marcha e a variabilidade da coordenação interarticular foram avaliados como preditores de melhora funcional utilizando regressão multivariável, classificação de respondedores e análises estratificadas por fenótipo. RESULTADOS: O desempenho funcional melhorou significativamente após a intervenção (Δ PODCI médio = 10,2 ± 5,4 pontos; p < 0,001). O erro de propriocepção basal, a variabilidade do tempo de passo da marcha e a variabilidade da coordenação interarticular previram independentemente os ganhos funcionais e, em conjunto, explicaram uma proporção substancial da variância interindividual (R² ajustado = 0,43; modelo p < 0,001). Um erro proprioceptivo basal mais elevado e uma maior variabilidade do movimento foram associados a menores ganhos (p < 0,05). A estratificação do fenótipo demonstrou um padrão de resposta gradual. CONCLUSÃO: A responsividade ao exercício em crianças com transtorno do espectro da hipermobilidade é limitada pelo controle sensório-motor basal e pela variabilidade do movimento, em vez de uma exposição uniforme ao exercício, o que reforça a importância de estratégias de reabilitação informadas pelo fenótipo.
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Copyright (c) 2026 Kshama Susheel Shetty, Hariharasudhan Ravichandran, Kumaragurubaran Ravikumar, Madhusudhan Shivanna, Sutamali Subramanian, Balamurugan Janakiraman
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Esta obra está licenciada com uma Licença Creative Commons Atribuição 4.0 Internacional.
