Análise do equilíbrio estático em indivíduos com paralisia cerebral submetidos ao bloqueio neuromuscular e à estimulação elétrica funcional

Abstract

Spasticity is one of the main complications of cerebral palsy (CP) and directly affects the physical therapy process. Botulinum toxin A (TBA) and functional electrical stimulation (FES) are the most often employed forms of treatment and are aimed at reducing the spasticity of specific muscle groups, thereby improving static balance and ambulation among individuals with CP. The aim of the present study was to analyze static balance in individuals with spastic CP after being submitted to TBA associated to FES. The sample was made up of 18 male and female individuals between five and 17 years of age (9.11±3.28) years divided into three groups of six individuals: Group 1 (individuals with CP treated with TBA and FES), Group 2 (individuals with CP treated with conventional therapy) and Group 3 (healthy controls). The modified Ashworth scale was used to assess the degree of spasticity. A pressure plate was used to analyze static balance. Data collection was carried out with eyes open and eyes closed, each for 30 seconds. All groups were submitted to an initial evaluation. Group 1 (TFG) was treated with 30-minute sessions of TBA + FES twice a week and was evaluated on four separate occasions. Group 2 (CG) was treated with conventional physical therapy twice a week for three months and was evaluated a second time at the end of treatment. Group 3 (HG) did not undergo any type of intervention and was only submitted to the initial evaluation. There was a significant reduction in spasticity in Group 1 (TFG), whereas no statistically significant reduction was observed in Group 2 (CG). Analyzing the total area of oscillation in Group 1 (TFG) with eyes open, there was a significant reduction between the 1st and 2nd evaluations (p<0.05), between the 2nd and 3rd evaluations (p<0.05) and between the 2nd and 4th evaluations (p<0.01). The same occurred regarding the oscillation of the center of pressure (COP) on the anterior-posterior (A/P) and medial-lateral (M/L) axes over the four evaluations. In Group 2 (CG), the COP oscillation values on the A/P and M/L axes underwent a non-significant reduction between the 1st and 2nd evaluations. There was a significant difference between Groups 1 (TFG) and 3 (CG) on the 1st evaluation, whereas no significant difference between these groups was found on the 4th evaluation, thereby indicating an approximation of Group 1 to Group 3 after treatment. In the intra-group comparison with eyes open versus closed, oscillation values always increased with eyes closed. The results of the present study suggest a reduction in spasticity and COP oscillation following treatment with TBA associated to FES. Further studies with a larger sample and a division of groups according to type of treatment are needed in order to confirm the data presented here.