Impacto do programa de exercícios sensório-perceptivo-motor para estabilidade do core no controle de tronco para alcançar o sentar independente em crianças com paralisia cerebral – um ensaio clínico randomizado
DOI:
https://doi.org/10.17267/2238-2704rpf.2025.e6004Palavras-chave:
Paralisia Cerebral, Postura Sentada, Postura, Estabilidade Central, Desempenho PsicomotorResumo
RESUMO | OBJETIVO: A capacidade de sentar-se de forma independente, essencial para atividades funcionais cruciais e para o desenvolvimento motor de crianças, é frequentemente prejudicada na Paralisia Cerebral Espástica Bilateral (PCEB) devido a déficits no controle neuromuscular. Este ensaio clínico randomizado e duplo-cego avaliou a eficácia de um Programa de Exercícios de Estabilidade do Core Sensório-Perceptivo-Motor (PEECSM) para melhorar o controle da postura sentada nesta população, abordando a necessidade de novas intervenções além da terapia convencional para melhorar especificamente o controle da postura sentada. MÉTODOS: Setenta e duas crianças com PCEB, com idade entre 3 e 7 anos, foram aleatoriamente designadas para o PEECSM mais terapia convencional (n=36) ou apenas terapia convencional (n=36). Ambos os grupos receberam sessões de 1 hora, 3 vezes por semana, durante 8 semanas. O controle da postura sentada foi avaliado utilizando a Escala de Medida de Controle de Tronco (EMCT) na linha de base, 6 e 8 semanas. RESULTADOS: O grupo PEECSM mostrou melhorias estatisticamente significativas nos escores da EMCT em comparação ao grupo controle em 6 e 8 semanas (p<0,05). A intervenção produziu um tamanho de efeito moderado (0,52) e uma mudança mínima detectável (CMD) substancial, indicando uma melhora clinicamente significativa no controle da postura sentada atribuível à intervenção PEECSM. CONCLUSÃO: A incorporação do PEECSM em programas de reabilitação como um complemento à terapia convencional pode melhorar significativamente o controle da postura sentada em crianças com PCEB, potencialmente apoiando seu desenvolvimento motor contínuo. Estudos futuros são necessários para investigar o impacto a longo prazo do PEECSM nas habilidades funcionais e na participação.
Downloads
Referências
(1) Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14. Cited: PMID: 17370477
(2) Chauhan A, Singh M, Jaiswal N, Agarwal A, Sahu JK, Singh M. Prevalence of cerebral palsy in Indian children: a systematic review and meta-analysis. Indian J Pediatr [Internet]. 2019;86:1124-30. https://doi.org/10.1007/s12098-019-03024-0
(3) Ramanandi VH, Shukla YU. Ramanandi VH, Shukla YU. Socio-demographic and clinical profile of pediatric patients with cerebral palsy in Gujarat, India. Bull Fac Phys Ther [Internet]. 2022;27(1):19. https://doi.org/10.1186/s43161-022-00077-9
(4) Santamaria V, Khan M, Luna T, Kang J, Dutkowsky J, Gordon AM, et al. Promoting Functional and Independent Sitting in Children With Cerebral Palsy Using the Robotic Trunk Support Trainer. IEEE Trans Neural Syst Rehabil Eng [Internet]. 2020;28(12):2995-3004. https://doi.org/10.1109/TNSRE.2020.3031580
(5) Saavedra SL, Goodworth AD. Postural control in children and youth with cerebral palsy. In: Miller F, Bachrach S, Lennon N, O'Neil ME. (editors) Cerebral Palsy. Springer, Cham. 2020. p. 2565–86. https://doi.org/10.1007/978-3-319-74558-9_161
(6) Kausar N, Gul MA, Cheema RUR, Ahmad N, Ammar M, Rehman A. Correlation of Siting and Standing Performance with Gross Motor Functional Classification System in Children with Spastic Cerebral Palsy. JHRR [Internet]. 2024;4(1):89-95. https://doi.org/10.61919/jhrr.v4i1.340
(7) Rosenbaum PL, Palisano RJ, Bartlett DJ, Galuppi BE, & Russell DJ. Development of the Gross Motor Function Classification System for cerebral palsy. Dev Med Child Neurol [Internet]. 2008;50(4):249–253. https://doi.org/10.1111/j.1469-8749.2008.02045.x
(8) Monica S, Nayak A, Joshua AM, Mithra P, Amaravadi SK, Misri Z, et al. Relationship between Trunk Position Sense and Trunk Control in Children with Spastic Cerebral Palsy: A Cross-Sectional Study. Rehabil Res Pract [Internet]. 2021;2021:9758640. https://doi.org/10.1155/2021/9758640
(9) Doctor KN, Karnad SD, Krishnan SK, Jain PD. Understanding Postural and Segmental Trunk Control and their effect on Sitting in Children with Cerebral Palsy: A systematic scoping review. Crit Rev Phys Rehabil Med [Internet]. 2021;33(2):25-45. https://doi.org/10.1615/CritRevPhysRehabilMed.2021039012
(10) Bousquet ER, Hägglund G. Sitting and standing performance in a total population of children with cerebral palsy: a cross-sectional study. BMC Musculoskelet Disord [Internet]. 2010;11:131. https://doi.org/10.1186/1471-2474-11-131
(11) Inamdar K, Molinini RM, Panibatla ST, Chow JC, Dusing SC. Physical therapy interventions to improve sitting ability in children with or at-risk for cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol [Internet]. .2021;63(4),396–406. https://doi.org/10.1111/dmcn.14772
(12) Novak I, Morgan C. High-risk follow-up: early intervention and rehabilitation. Handb Clin Neurol [Internet]. 2019;162:483-510. https://doi.org/10.1016/B978-0-444-64029-1.00023-0
(13) Ryalls BO, Harbourne R, Kelly-Vance L, Wickstrom J, Stergiou N, Kyvelidou A. A perceptual motor intervention improves play behavior in children with moderate to severe cerebral palsy. Front Psychol [Internet]. 2016;7:643. https://doi.org/10.3389/fpsyg.2016.00643
(14) Tiwari S, Rao PT, Karthikbabu S. Correlations between Trunk Control and Balance in Children with Bilateral Spastic Cerebral Palsy. Perceptual and motor skills [Internet]. 2024;131(2):432–445. https://doi.org/10.1177/00315125231226297
(15) Kretch KS, Marcinowski EC, Hsu LY, Koziol NA, Harbourne RT, Lobo MA, et al. Opportunities for learning and social interaction in infant sitting: Effects of sitting support, sitting skill, and gross motor delay. Dev Sci [Internet]. 2023;26(3):e13318. https://doi.org/10.1111/desc.13318
(16) Abd El-Maksoud GM, Abd-Elmonem AM, Rezk-Allah SS. Effect of individual and group Sensory-Perceptual Motor Training on Motor Proficiency and Quality of Life in Children with Down Syndrome. International Journal of Therapies & Rehabilitation Research. 2016;5(4):37-45.
(17) Warutkar VB, Kovela RK. Review of Sensory Integration Therapy for Children With Cerebral Palsy. Cureus [Internet]. 2022;14(10):e30714. https://doi.org/10.7759/cureus.30714
(18) Koziol NA, Kretch KS, Harbourne RT, Lobo MA, McCoy SW, Molinini R, et al. START-Play Physical Therapy Intervention Indirectly Impacts Cognition Through Changes in Early Motor-Based Problem-Solving Skills. Pediatric physical therapy [Internet]. 2023;35(3):293–302. https://doi.org/10.1097/PEP.0000000000001016
(19) Park M, Kim J, Yu C, Lim H. The Effects of Neurodevelopmental Treatment-Based Trunk Control Exercise on Gross Motor Function and Trunk Control in Children with Developmental Disabilities. Healthcare [Internet]. 2023;11(10):1446. https://doi.org/10.3390/healthcare11101446
(20) Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep [Internet]. 2020;20(2):3. https://doi.org/10.1007/s11910-020-1022-z
(21) Elanchezhian C, SwarnaKumari P. Swiss ball training to improve trunk control and balance in spastic hemiplegic cerebral palsy. Sri Lanka Journal of Child Health [Internet]. 2019;48(4):300-4. https://doi.org/10.4038/sljch.v48i4.8821
(22) Heyrman L, Molenaers G, Desloovere K, Verheyden G, De Cat J, Monbaliu E, et al. A clinical tool to measure trunk control in children with cerebral palsy: the Trunk Control Measurement Scale. Res Dev Disabil [Internet]. 2011;32(6):2624-35. https://doi.org/10.1016/j.ridd.2011.06.012
(23) Latash ML, Singh T Neurophysiological basis of motor control. 3rd Ed. Human Kinetics. 2022.
(24) Shumway-Cook A, Woollacott MH. Motor Control: Translating Research into Clinical Practice. 5th Ed. Philadelphia: Wolters Kluwer, 2017. p. 7–19, 195–203.
(25) Hong CS, Rumford H. Sensory motor activities for early development: a practical resource. 2nd Ed. Routledge; 2020.
(26) Johnstone JA, Ramon M. Perceptual-motor activities for children: An evidence-based guide to building physical and cognitive skills. Human Kinetics; 2011.
(27) Szopa A, Domagalska-Szopa M. Postural Stability in Children with Cerebral Palsy. J Clin Med [Internet]. 2024;13(17):5263. https://doi.org/10.3390/jcm13175263
(28) Koutenaei FR, Dehkordi SN, Amini M, ShahAli S. Effect of Swiss Ball Stabilization Training on Trunk Control, Abdominal Muscle Thickness, Balance, and Motor Skills of Children With Spastic Cerebral Palsy: A Randomized, Superiority Trial. Archives of physical medicine and rehabilitation [Internet]. 2023;104(11):1755–1766. https://doi.org/10.1016/j.apmr.2023.05.011
(29) Vasani P, Narayan A, Nayak A, Alsulaimani M, Alzahrani AR. Anticipatory and Compensatory Postural Adjustments in Sitting and Standing Positions During Functional Activities in Children With Cerebral Palsy. Physiother Res Int [Internet]. 2025;30(1):e70028. https://doi.org/10.1002/pri.70028
(30) Talgeri AJ, Nayak A, Karnad SD, Jain P, Tedla JS, Reddy RS, et al. Effect of Trunk Targeted Interventions on Functional Outcomes in Children with Cerebral Palsy- A Systematic Review. Developmental neurorehabilitation [Internet]. 2023;26(3):193–205. https://doi.org/10.1080/17518423.2023.2193265
(31) Özal C, Aksoy S, Kerem Günel M. Postural Control Alterations in Children with Mild Forms of Spastic Cerebral Palsy. Pediatric Health Med Ther [Internet]. 2022;13:367–376. https://doi.org/10.2147/PHMT.S378451
(32) Elshafey MA, Abdrabo MS, Elnaggar RK. Effects of a core stability exercise program on balance and coordination in children with cerebellar ataxic cerebral palsy. J Musculoskelet Neuronal Interact [Internet]. 2022;22(2):172–178. Cited: PMID: 35642697
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2025 Rathish Sivaramachandran, Meena Natarajan
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.
