Análise do coeficiente de atrito na marcha de crianças com paralisia cerebral

Abstract

Objective: To characterize and to analyze the required coefficient of Friction (RCOF) in the gait of Children with Cerebral Palsy (CP). This Thesis was divided in three studies with different aims: Study 1) Conduct a Systematic Review of Literature on the COF evaluation methodology during the Gait; Study 2) To analyze the behavior of the COF curve of a patient with Cerebral Hemiparetic Paralysis; Study 3) to analyze and to correlate the effects of gait training on a treadmill associated with Transcranial Stimulation Direct Current (tDCS) with the COF and also, to correlate the COF with others gait parameters; and Study 4) to analyze and to compare the COF between children with CP and Typical Development (TD). Materials and Methods: This thesis is going to be present three studies. The Study 1, a systematic review of the literature on the methodology of COF evaluation in gait. The Study 2 was transversal and the participants of this study will perform the 3D gait analysis.The Study 3 was a Case Report of 1 child with hemiparetic spastic CP, submitted to the Transcranial Anodic Chain Stimulation protocol in the primary motor cortex of the injured hemisphere and cathodic stimulation in the contralateral primary motor cortex associated with treadmill walking 5x per week for 2 weeks. The 3D gait analysis was performed in 3 moments (pre-intervention, post-intervention and one month after the intervention). The Study 4 was transversal and the participants of this study will perform the 3D gait analysis. All evaluations were carried out at the Integrated Laboratory in Analysis of Human Movement (LIAMH) at the University Nove de Julho (UNINOVE). Results: Study 1, to be submitted, 728 titles and abstracts have been read so far, excluding 610 articles from the remaining 118, 55 articles are being evaluated, of the 63 that were already read in full, only 10 articles were included in the present review of articles including all cross-sectional studies that evaluated the coefficient of friction required in gait in different populations. Study 2 was published in Gait & Posture, the RCOF curve on the affected side presented with lower peaks and valleys compared to the unaffected side and the control. Study 3 was submitted to the European Journal of Physical Medicine and Rehabilitation, RCOF was a sensitive variable in the evaluation of the patient submitted to treadmill training in treadmill associated to bilateral Transcranial Stimulation corroborated with changes in functional scales and kinematic variables. Study 4 to be submitted, we observed that the First Peak and RCOF Valley are larger on the affected side when compared to the unaffected side and the TD group, while the Second Peak of the RCOF is smaller in the same comparison. Conclusion: RCOF seems to be an important tool for the gait analysis that facilitates the interpretation of the friction data between the foot and the ground during gait and allows quantifying the environmental changes with different types of pavements when using different types of shoes and among normal individuals and with neurological diseases.