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Santana C.A.S.1, Rohr L.A.1, Silva E.S.M.1, Machado L.R.1, Santos G.L.1, Tudella E.1
1Universidade Federal de São Carlos, Departamento de Fisioterapia, São Carlos, Brazil
Background: Children with hemiparetic cerebral palsy have motor impairment in functional performance. These children often have sensory deficits, spasticity and muscle weakness, which impair the activities of daily life and their participation in society. In order to reduce the asymmetry in the use of the upper limbs, the Constraint-Induced Movement Therapy (CIMT) has shown great efficacy. However, there are few studies evaluating its impact on grip strength.
Purpose: To evaluate bilaterally grip strength before and after a modified protocol of CIMT in children with hemiparetic cerebral palsy.
Methods: This longitudinal study consists of a several case studies. The study included four children, three boys between 4 and 11 years (average of 90 months (± 46.36), 1.21 meters (± 0.18), 28.33 kg (± 10.85)) and one girl (84 months, 1.0 meters, 13.2 kg) treated in the Physical Therapy program of Unit Health School of the Federal University of São Carlos, São Paulo - Brazil. All participants were between the levels I and II of GMFCS and level III of Macs. Grip strength was measured with a digital dynamometer (DHD-3 model Digital Hand Dynamometer, SAEHAN) at the following times: a maximum of seven days before the start of therapy (pre-assessment), 24 hours after the end of therapy (post-evaluation), and ten days after the end of therapy (after 10 days). The measurement of force was performed three times in each limb. The average of these measures was calculated. The therapy was performed in the child´s residence for three consecutive weeks with time session of three hours. A synthetic plaster was used in the more-affected limb during 24 hours, which was only removed for cleaning. In the protocol of therapy were performed repetitive training and progressive activities, and behavioral training.
Results: The average of grip strength in the non-affected limb was 9.65 ± 4.29 [GLdS1] in the pre-assessment; in the post-evaluation was 6:43 ± 4.77; and 6.97 ± 3.90 after the 10 days. The affected limb, the average of grip strength was 3.02 ± 1.21 in the pre-assessment; 2.72 ± 1:43 in the post-evaluation; and 1.05 ± 2.91 in the post 10 days. Thus, a reduction of 33.4% in the post-evaluation and 27.8% for after-10 days in the non-affected limb compared to values of pre-assessment were observed. Furthermore, an increase of 8.4% from the post-evaluation and after 10 days also were observed. In the affected limb, a reduction of 10.0% between pre- and post-assessment, and 3.7% after 10 days was observed. In addition, an enhanced of 7.0% between post- and assessment and 10 days.
Conclusion(s): For these children, the effects of CIMT in the non-affected limb were negative because a reduction was observed. Improvements were not observed in the affected limb. These results can be due to the non-specificity of treatment. However, studies with a higher sample size and specific training are necessary.
Implications: This study showed that CIMT following just one functional protocol did not contribute to gain in strength grip. Thus, it is necessary associate strength training with CIMT when the strength gain is the objective of therapy.
Funding acknowledgements: São Paulo Research Foundation-FAPESP.
Topic: Paediatrics
Ethics approval: This research study was approved by Ethical Committe of Federal University of São Carlos (Nº 1.171.889).
All authors, affiliations and abstracts have been published as submitted.
