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Advisor(s)
Abstract(s)
INTRODUÇÃO: A hemiplegia é um subtipo da Paralisia Cerebral espástica (PCE) em que um
dos lados do corpo está afetado, resultando em posturas e padrões de marcha atípicas. O
objetivo deste estudo de caso consiste numa análise descritiva dos efeitos imediatos de
uma ortótese dinâmica, o TheraSuit® (TS), nas variáveis cinemáticas da marcha. MÉTODOS:
Criança de 5 anos e 10 meses de idade, com PCE unilateral esquerda, nível II (GMFCS), foi
instruída a caminhar a uma velocidade auto-selecionada ao longo de uma passadeira de
10m em duas condições: 1) Baseline (BL); 2) com TS (CTS). Utilizaram-se duas câmaras
vídeo-digitais (Basler piA1000-48gñ GigE) e seis câmaras de infravermelhos (VICON T10),
com uma amostragem de 100 Hz. Foram descritos os parâmetros espaço-temporais e os
deslocamentos angulares dos membros inferiores (MI). RESULTADOS E DISCUSSÃO: Para
os parâmetros espaço-temporais, o TS sugere uma redução da cadência de marcha (BL: 156
+/- 10,1 passos / min; TS: 132 +/- 3,4 passos / min). Os deslocamentos angulares também
sugerem alterações ao longo do ciclo da marcha. No contato inicial, o TS mostrou i) redução
da dorsiflexão no lado não-parético (BL: 10,2 graus +/- 3,4; CTS: 9,2 graus +/- 1,5) e flexão
plantar no lado parético (BL: -5,8 graus + / - 1,1; CTS: 9,3 graus +/- 1,4); Ii) redução do ângulo
de flexão do joelho em ambos os MI, particularmente no MI parético (BL: 19,1 ° ± 1,4; CTS:
10,9 ° ± 1,9); Iii) redução da flexão da anca no MI não parético (BL: 57,5 ± 2,6; CTS: 26 ±
3,1). Durante a fase de apoio, a criança revelou ângulos mais simétricos nas articulações do
tornozelo e diminuição do padrão de flexão, sendo visível uma maior extensão no joelho
no MI parético (BL: 10,9 ° ± 2,5; CTS: 7,22 ° ± 0,9). Na fase de oscilação, diminuição da flexão
do joelho e da anca em ambos os MIs, porém mais favorável no MI não parético (Anca - BL:
62,7 ± 2,5; CTS: 30 ± 2,8); (Joelho - BL: 74,4 ° ± 4,0; TS: 67,7 ° ± 2,5). Embora o TS tenha
revelado poucas alterações em termos dos parâmetros espaço-temporais, a cinemática
angular do MI, parece ter sofrido mais influência na direção de um padrão de marcha mais
funcional. CONCLUSÃO: Este estudo de caso mostra que o TS parece ser capaz de mudar a
cinemática da marcha na direção de um padrão de marcha mais funcional (isto é, reduzir a
flexão da anca e do joelho e os graus de flexão plantar na tibiotársica). No entanto, são
necessários mais estudos que permitam compreender melhor os seus efeitos a curto e
longo prazo e confirmar os presentes resultados.
INTRODUCTION: Hemiplegia is a form of spastic Cerebral Palsy in which one side of the body is affected, resulting in an atypical body posture and abnormal gait patterns. The purpose of this case-report was to provide a descriptive analysis of the immediate effects of a dynamic orthosis, the TheraSuit® (TS), in gait kinematics variables. METHODS: A 5.88 years old child with left spastic hemiplegia, level II (GMFCS), was instructed to walk at a self-selected pace along a 10m walkway in two conditions: 1) BL (Baseline); 2) TS (wearing the TS). Two video-digital cameras (Basler piA1000-48gс GigE) and six infrared cameras (VICON T10), sampled at 100 Hz were used. Spatiotemporal parameters and lower limb (LL) joint angles were determined. RESULTS AND DISCUSSION: For the spatiotemporal parameters, the TS reduced gait cadence (BL: 156 +/- 10.1 steps/min; TS: 132 +/- 3.4 steps/min). Angular displacements also looked to be altered throughout the gait cycle. At the initial contact, the TS showed i) a reduction of dorsiflexion on non-paretic side (BL: 10.2 deg +/- 3.4; TS: 9.2 deg +/- 1.5) and plantarflexion on paretic side (BL: -5.8 deg +/- 1.1; TS: 9.3 deg +/- 1.4); ii) a reduced knee flexion angle in both limbs, particularly in paretic limb (BL: 19,1°±1,4; CTS: 10,9°±1,9); iii) a reduced hip flexion in the non-paretic limb (BL: 57,5°±2,6; TS: 26°±3,1). During the stance phase, the child showed more symmetric angles at ankle joints and decrease the flexion pattern by showing more knee extension in the paretic limb (BL: 10,9°±2,5; CTS: 7,22°±0,9). In the swing phase, a decrease in knee and hip flexion in both limbs, but more favorable in the non-paretic limb (Hip - BL: 62,7°±2,5; TS: 30°±2,8); (Knee - BL: 74,4°±4,0; TS: 67,7°±2,5). While the TS showed few changes in terms of the spatiotemporal parameters, the lower limb joint kinematics looked to be more affected towards a more functional gait pattern. CONCLUSION: This case-report shows that TS seems to be able of changing gait kinematics toward a more functional gait pattern (i.e., reducing hip and knee flexion and the amount of plantarflexion). The TS might be an important dynamic orthosis to include in physical therapy programs. However, further investigation is required to better understand its short and long term effects and to confirm these results.
INTRODUCTION: Hemiplegia is a form of spastic Cerebral Palsy in which one side of the body is affected, resulting in an atypical body posture and abnormal gait patterns. The purpose of this case-report was to provide a descriptive analysis of the immediate effects of a dynamic orthosis, the TheraSuit® (TS), in gait kinematics variables. METHODS: A 5.88 years old child with left spastic hemiplegia, level II (GMFCS), was instructed to walk at a self-selected pace along a 10m walkway in two conditions: 1) BL (Baseline); 2) TS (wearing the TS). Two video-digital cameras (Basler piA1000-48gс GigE) and six infrared cameras (VICON T10), sampled at 100 Hz were used. Spatiotemporal parameters and lower limb (LL) joint angles were determined. RESULTS AND DISCUSSION: For the spatiotemporal parameters, the TS reduced gait cadence (BL: 156 +/- 10.1 steps/min; TS: 132 +/- 3.4 steps/min). Angular displacements also looked to be altered throughout the gait cycle. At the initial contact, the TS showed i) a reduction of dorsiflexion on non-paretic side (BL: 10.2 deg +/- 3.4; TS: 9.2 deg +/- 1.5) and plantarflexion on paretic side (BL: -5.8 deg +/- 1.1; TS: 9.3 deg +/- 1.4); ii) a reduced knee flexion angle in both limbs, particularly in paretic limb (BL: 19,1°±1,4; CTS: 10,9°±1,9); iii) a reduced hip flexion in the non-paretic limb (BL: 57,5°±2,6; TS: 26°±3,1). During the stance phase, the child showed more symmetric angles at ankle joints and decrease the flexion pattern by showing more knee extension in the paretic limb (BL: 10,9°±2,5; CTS: 7,22°±0,9). In the swing phase, a decrease in knee and hip flexion in both limbs, but more favorable in the non-paretic limb (Hip - BL: 62,7°±2,5; TS: 30°±2,8); (Knee - BL: 74,4°±4,0; TS: 67,7°±2,5). While the TS showed few changes in terms of the spatiotemporal parameters, the lower limb joint kinematics looked to be more affected towards a more functional gait pattern. CONCLUSION: This case-report shows that TS seems to be able of changing gait kinematics toward a more functional gait pattern (i.e., reducing hip and knee flexion and the amount of plantarflexion). The TS might be an important dynamic orthosis to include in physical therapy programs. However, further investigation is required to better understand its short and long term effects and to confirm these results.
Description
Documento entregue para a atribuição do Título de Especialista na área de Fisioterapia
Keywords
Paralisia Cerebral Hemiplegia TheraSuit® Cinemática da marcha Ortótese dinâmica parâmetros espaço-temporais Análise de marcha