Sérgio T. Fonseca

Comparação do desempenho de atividades funcionais em crianças com desenvolvimento normal e crianças com paralisia cerebral

OBJECTIVE: To compare the pattern of self-care performance in normal children and children with cerebral palsy (CP). METHOD: 142 normal children and 33 children with CP were evaluated by 22 items from the self-care scale of the PEDI functional test. Rasch methodology transformed scores into interval measures of difficulty from 0 to 100 (logit). Spearman rank correlation coefficient compared the order of logits in the two groups. RESULTS: Eleven items showed significant differences in the logit values received. Out of these, 7 items showed relative difficulty values greater in the group of children with CP and 4 items showed relative difficulty values greater among normal children. A significant correlation was observed in the order of the 22 items displayed in the two interval scales. CONCLUSION: The results suggest that the development of self-care functional activities may be influenced by the presence of CP. These results may support assessment and intervention strategies for children with neuromotor disorders.

The Medium of Haptic Perception: A Tensegrity Hypothesis

ABSTRACT For any given animal, the sources of mechanical disturbances inducing tissue deformation define environment from the perspective of the animals haptic perceptual system. The systems achievements include perceiving the body, attachments to the body, and the surfaces and substances adjacent to the body. Among the perceptual systems, it stands alone in having no defined medium. There is no articulated functional equivalent to air and water, the media that make possible the energy transmissions and diffusions underpinning the other perceptual systems. To identify the haptic systems medium the authors focus on connective tissue and the conjunction of muscular, connective tissue net, and skeletal (MCS) as the bodys proper characterization. The challenge is a biophysical formulation of MCS as a continuum that, similar to air and water, is homogeneous and isotropic. The authors hypothesized a multifractal tensegrity (MFT) with the shape and stability of the constituents of each scale, from individual cell to whole body, derivative of continuous tension and discontinuous compression. Each component tensegrity of MFT is an adjustive-receptive unit, and the array of tensions in MFT is information about MCS. The authors extend the MFT hypothesis to body-brain linkages, and to limb perception phenomena attendant to amputation, vibration, anesthesia, neuropathy, and microgravity.

Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept

Injury prediction is one of the most challenging issues in sports and a key component for injury prevention. Sports injuries aetiology investigations have assumed a reductionist view in which a phenomenon has been simplified into units and analysed as the sum of its basic parts and causality has been seen in a linear and unidirectional way. This reductionist approach relies on correlation and regression analyses and, despite the vast effort to predict sports injuries, it has been limited in its ability to successfully identify predictive factors. The majority of human health conditions are complex. In this sense, the multifactorial complex nature of sports injuries arises not from the linear interaction between isolated and predictive factors, but from the complex interaction among a web of determinants. Thus, the aim of this conceptual paper was to propose a complex system model for sports injuries and to demonstrate how the implementation of complex system thinking may allow us to better address the complex nature of the sports injuries aetiology. According to this model, we should identify features that are hallmarks of complex systems, such as the pattern of relationships (interactions) among determinants, the regularities (profiles) that simultaneously characterise and constrain the phenomenon and the emerging pattern that arises from the complex web of determinants. In sports practice, this emerging pattern may be related to injury occurrence or adaptation. This novel view of preventive intervention relies on the identification of regularities or risk profile, moving from risk factors to risk pattern recognition.

Muscle stiffness and strength and their relation to hand function in children with hemiplegic cerebral palsy

This study compared the passive stiffness of wrist flexors and the strength of wrist flexors and extensors in three different wrist positions (30 degrees of flexion, neutral, and 30 degrees of extension) between children with cerebral palsy (CP) and typically developing (TD) comparison children. It also examined associations between these characteristics and manual function in children with CP. Eleven children with spastic hemiplegic CP (six females, five males; mean age 8y 5mo [SD 1y 8mo], range 6-11y) and 11 TD children, matched for age and sex, took part in this study. Passive stiffness of muscles was measured as the torque/angle relation during passive motion. Isometric strength tests were performed and the time needed to complete three tasks based on the Jebsen-Taylor Hand Function Test was recorded. Flexor stiffness was higher in the group with CP. Strength of flexors and extensors in the group with CP was lower with the wrist extended. No difference among test positions was found in the TD group. Moderate correlations were observed between manual function and variables related to strength and stiffness of wrist muscles in the group with CP. Children with CP showed muscle alterations coherent with the use of the wrist in flexion. Intervention on these characteristics could have a positive impact on manual function.

Nature of Motor Control: Perspectives and Issues

Four perspectives on motor control provide the framework for developing a comprehensive theory of motor control in biological systems. The four perspectives, of decreasing orthodoxy, are distinguished by their sources of inspiration: neuroanatomy, robotics, self-organization, and ecological realities. Twelve major issues that commonly constrain (either explicitly or implicitly) the understanding of the control and coordination of movement are identified and evaluated within the framework of the four perspectives. The issues are as follows: (1) Is control strictly neural? (2) Is there a divide between planning and execution? (3) Does control entail a frequently involved knowledgeable executive? (4) Do analytical internal models mediate control? (5) Is anticipation necessarily model dependent? (6) Are movements preassembled? (7) Are the participating components context independent? (8) Is force transmission strictly myotendinous? (9) Is afference a matter of local linear signaling? (10) Is neural noise an impediment? (11) Do standard variables (of mechanics and physiology) suffice? (12) Is the organization of control hierarchical?

Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles: An in vivo experiment

There are extensive connections between the latissimus dorsi (LD) and gluteus maximus (GMax) muscles and the thoracolumbar fascia (TLF), which suggests a possible pathway for myofascial force transmission. The present study was designed to provide empirical evidence of myofascial force transmission from LD to contralateral GMax through TFL in vivo. To accomplish this goal, we evaluated whether active or passive tensioning of the LD results in increased passive tension of the contralateral GMax, indexed by changes in the hip resting position (RP) or passive stiffness. The hip RP was defined as the angular position in which the passive joint torque equals zero, and passive hip stiffness was calculated as the change in passive torque per change in joint angle. Thirty-seven subjects underwent an assessment of their passive hip torque against medial rotation by means of an isokinetic dynamometer. These measures were carried out under three test conditions: (1) control, (2) passive LD tensioning and (3) active LD tensioning. Electromyography was used to monitor the activity of the hip muscles and the LD under all conditions. Repeated measures analyses of variance demonstrated that passive LD tensioning shifted the hip RP towards lateral rotation (p=0.009) but did not change the passive hip stiffness (p>0.05). Active LD tensioning shifted the hip RP towards lateral rotation (p<0.001) and increased the passive hip stiffness (p≤0.004). The results demonstrated that manipulation of the LD tension modified the passive hip variables, providing evidence of myofascial force transmission in vivo.

Estudo do desenvolvimento da função motora aos 8 e 12 meses de idade em crianças pré-termo e a termo

OBJECTIVE: To compare the development of motor function in children born preterm with those born at term, at 8 and 12 months of age. To investigate the relation of motor function quality at the age of 8 months with motor ability at 12 months. METHOD: Thirty-two children participated in this study: 16 were born preterm (risk group) and 16 were born at term (control group). The spontaneous movements of the children were assessed at 8 months and their mobility skills and independence were assessed at 12 months (corrected ages for the preterm group), using standardized developmental tests (AIMS and PEDI, respectively). Data were analysed using independent t-tests (between-group comparison) and Pearson correlation coefficients (within-group comparison). RESULTS: There was no significant difference in motor function, between those born preterm with those born at term, either at 8 or at 12 months of age. In the control group, there was significant association (r=0.67; p=0.004) between movement at 8 months and mobility skills at 12 months. In the risk group, there was significant relationship between skills and independence in mobility, at 12 months corrected age (r=0.80; p=0.0001). CONCLUSION: Preterm born children, without other disorders and with age correction, might show a similar motor development as those born at term. The path for the acquisition of motor abilities in preterm born children appears to differ among those infants. Language: ptObjective: To compare the development of motor function in children born preterm with those born at term, at 8 and 12 months of age. To investigate the relation of motor function quality at the age of 8 months with motor ability at 12 months. Method: Thirty-two children participated in this study: 16 were born preterm (risk group) and 16 were born at term (control group). The spontaneous movements of the children were assessed at 8 months and their mobility skills and independence were assessed at 12 months (corrected ages for the preterm group), using standardized developmental tests (AIMS and PEDI, respectively). Data were analysed using independent t-tests (between-group comparison) and Pearson correlation coefficients (within-group comparison). Results: There was no significant difference in motor function, between those born preterm with those born at term, either at 8 or at 12 months of age. In the control group, there was significant association (r=0.67; p=0.004) between movement at 8 months and mobility skills at 12 months. In the risk group, there was significant relationship between skills and independence in mobility, at 12 months corrected age (r=0.80; p=0.0001). Conclusion: Preterm born children, without other disorders and with age correction, might show a similar motor development as those born at term. The path for the acquisition of motor abilities in preterm born children appears to differ among those infants.

Adapted version of constraint-induced movement therapy promotes functioning in children with cerebral palsy: a randomized controlled trial

Objective: To evaluate the effects of constraint-induced movement therapy on the use of the affected arm and on daily functioning in children with hemiplegic cerebral palsy. Design: A single-blinded randomized clinical trial. Subjects: Sixteen children with cerebral palsy randomized to intervention (n = 8, 4 males, 4 females, mean age 5 years and 6 months) and control groups (n = 8, 4 males, 4 females, mean age 6 years and 7 months). Interventions: Non-affected arm of intervention group was restricted for 10 hours/ day and the affected arm intensively trained for 3 hours/day for two weeks. The intervention protocol included one week of bimanual functional training following constraint therapy. The control group maintained usual rehabilitation throughout the intervention period. Main measures: Pediatric Evaluation of Disability Inventory (self-care domain) and an adapted version of the Jebsen—Taylor test were administered before and after intervention, and at one month follow-up. General linear models tested differences in gain scores and the number needed to treat estimated relative effectiveness of intervention protocol for functional skills and independence in self-care. Results: Results are reported for 15 children who completed assessments and intervention. Higher gains were observed in the intervention group for functional skills and independence post intervention (dfunctional skills = 1.61, P =0.0134; dindependence=1.37; P =0.0001) and follow-up (dfunctional skills = 2.08, P =0.004; dindependence = 0.85; P =0.0016). No group difference in manual dexterity gains was observed. Low indices of number needed to treat (1.75 and 2.33) illustrate clinical relevance of intervention. Conclusions: The protocol associating constraint-induced movement therapy and bimanual functional training was effective in promoting daily living functioning among children with cerebral palsy.

Stretching versus strength training in lengthened position in subjects with tight hamstring muscles: A randomized controlled trial

Stretching is used to modify muscle length. However, its effects seem to be temporary. There is evidence in animal models that strengthening in a lengthened position may induce long lasting changes in muscle length. The objective of this study was to compare changes in hamstrings flexibility, peak torque angle and stretch tolerance after two training programs: stretching and strengthening in a lengthened position. Forty-five subjects with tight hamstrings were randomly assigned into three groups: control, stretching and strength training in lengthened position. The interventions were performed three times a week for eight weeks. The subjects were assessed before and after the end of the programs. Data provided by an isokinetic dynamometer were used to assess hamstrings flexibility, peak torque angle, and stretch tolerance. The data analysis demonstrated that strengthening in lengthened position changed peak torque angle in the direction of knee extension (p=0.001). No change in flexibility was observed (p=0.449). Both experimental groups showed an increase in stretch tolerance (p=0.001). The results demonstrated that strengthening in a lengthened position produced a shift of the torque-angle curve, which suggests an increase in muscle length. Conversely, stretching did not produce modification of torque-angle curve and flexibility; its effects appear restricted to increases in stretch tolerance.

Efeitos do uso de órtese na mobilidade funcional de crianças com paralisia cerebral

The Effects of the Use of Orthoses on the Functional Mobility of Children with Cerebral Palsy Objective: To compare the motor performance of children with cerebral palsy (CP) under two conditions: with and without orthoses. Method: Twenty children with CP were evaluated using the Gross Motor Function Measure test (GMFM), a modified version of the Physicians Rating Scale (PRS) locomotion assessment, and an interview with their parents to evaluate the use of orthoses in their daily routine. Results: The ANOVA test was used to evaluate the effect of orthosis use on the children’s mobility, and it revealed that, when orthosis was used, the means for gross motor function and gait assessments were significantly higher. The interviews confirmed that the use of orthoses was included in the daily routine, and the parents demonstrated positive perceptions regarding the use of such devices. Conclusion: Orthoses improved the performance of routine daily motor tasks among the children with CP, and this finding may serve to guide the assessment and intervention processes of professionals who work with this clientele.